The aim of this study was to describe clinical features of Bell’s palsy (BP) in children and outcomes of physical therapy interventions. Medical records of 186 patients with diagnosis of BP were reviewed. The severity of facial nerve dysfunction was graded according to House Brackmann Facial Nerve Grading Scale (HB FGS). After one month, patients who had HB FGS grade three or more were included in a physical therapy programme consisting of superficial heat, massage, exercises, and electrical stimulation. Among 186 children with BP, 167 children had a severity of HB FGS grade three or more and 19 had the incomplete type at the time of the diagnosis. After one month follow-up, 144 patients fully recovered, 35 patients recovered partially, while 7 patients had no recovery. Patients who had not fully recovered one month after onset of paralysis were included in the physical therapy programme. There was statistically significant difference between pretreatment and posttreatment HB FGS scores in patients who had not fully recovered one month after onset of paralysis. We concluded that the prognosis of BP in children seems to be good with higher recovery rate and physical therapy programme might be an effective method to facilitate recovery in patients with poor prognosis. 1. Introduction The most common type of facial paralysis in children is Bell’s palsy (BP), which is defined as an acute, idiopathic, unilateral paralysis of the facial nerve without any associated disorders. Known congenital, genetic, and acquired causes of facial nerve paralysis need to be ruled out before the diagnosis of BP is made [1]. It has an incidence rate of 18.8 cases per 100.000 in children younger than 18 years old [2]. BP is an important cause of disability in some pediatric patients with major facial dysfunction and reduced quality of life [3]. Facial functions are multidimensional, serving emotional, social, and physical aspects of a person’s health. Incomplete recovery from facial nerve damage has significant social and psychological consequences. The prognosis of BP in pediatric population is generally good with a high rate of recovery. In spite of high complete recovery rate, some patients with BP do not achieve even satisfactory recovery. Moreover children with complete facial palsy and absence of recovery within 3 weeks may suffer poor outcomes as frequently as adults [4, 5]. In contrast with adults, the natural course of BP in children is not well documented and there are still many unresolved issues regarding the treatment and prognosis. Even though the treatment and
References
[1]
M. Lorch and S. J. Teach, “Facial nerve palsy: etiology and approach to diagnosis and treatment,” Pediatric Emergency Care, vol. 26, no. 10, pp. 763–769, 2010.
[2]
A. Rowhani-Rahbar, R. Baxter, B. Rasgon et al., “Epidemiologic and clinical features of Bell's palsy among children in Northern California,” Neuroepidemiology, vol. 38, no. 4, pp. 252–258, 2012.
[3]
J. Shargorodsky, H. W. Lin, and Q. Gopen, “Facial nerve palsy in the pediatric population,” Clinical Pediatrics, vol. 49, no. 5, pp. 411–417, 2010.
[4]
N. J. Holland and G. M. Weiner, “Recent developments in Bell's palsy,” The British Medical Journal, vol. 329, no. 465, pp. 553–557, 2004.
F. Drack and M. Weissert, “Outcome of peripheral facial palsy in children—a catamnestic study,” European Journal of Paediatric Neurology, vol. 17, no. 2, pp. 185–191, 2013.
[7]
W. X. Chen and V. Wong, “Prognosis of Bell's palsy in children—analysis of 29 cases,” Brain and Development, vol. 27, no. 7, pp. 504–508, 2005.
[8]
A. C. Jenke, L. M. Stoek, M. Zilbauer, S. Wirth, and P. Borusiak, “Facial palsy: etiology, outcome and management in children,” European Journal of Paediatric Neurology, vol. 15, no. 3, pp. 209–213, 2011.
[9]
K. Dhiravibulya, “Outcome of Bell's palsy in children,” Journal of the Medical Association of Thailand, vol. 85, pp. 334–339, 2002.
[10]
C. H. Wang, Y. C. Chang, H. M. Shih, C. Y. Chen, and J. C. Chen, “Facial palsy in children: emergency department management and outcome,” Pediatric Emergency Care, vol. 26, no. 2, pp. 121–125, 2010.
[11]
J. W. House and D. E. Brackmann, “Facial nerve grading system,” Otolaryngology—Head and Neck Surgery, vol. 93, no. 2, pp. 146–147, 1985.
[12]
H. J. Christen, F. Hanefeld, H. Eiffert, and R. Thomssen, “Epidemiology and clinical manifestations of Lyme borreliosis in childhood. A prospective multicentre study with special regard to neuroborreliosis,” Acta Paediatrica, vol. 386, pp. 1–75, 1993.
[13]
M. Peltomaa, H. Saxen, I. Sepp？l？, M. Viljanen, and I. Pyykk？, “Paediatric facial paralysis caused by Lyme borreliosis: a prospective and retrospective analysis,” Scandinavian Journal of Infectious Diseases, vol. 30, no. 3, pp. 269–275, 1998.
[14]
K. E. Campbell and J. F. Brundage, “Effects of climate, latitude, and season on the incidence of Bell's palsy in the US Armed Forces, October 1997 to September 1999,” The American Journal of Epidemiology, vol. 156, no. 1, pp. 32–39, 2002.
[15]
E. Peitersen, “Bell's palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies,” Acta Oto-Laryngologica, no. 549, pp. 4–30, 2002.
[16]
A. Biebl, E. Lechner, K. Hroncek et al., “Facial nerve paralysis in children: is it as benign as supposed?” Pediatric Neurology, vol. 49, no. 3, pp. 178–181, 2013.
[17]
K. K. Adour, F. M. Byl, R. L. Hilsinger Jr., Z. M. Kahn, and M. I. Sheldon, “The true nature of Bell's palsy: analysis of 1,000 consecutive patients,” Laryngoscope, vol. 88, no. 5, pp. 787–801, 1978.
[18]
T. S. Shafshak, “The treatment of facial palsy from the point of view of physical and rehabilitation medicine,” Europa Medicophysica, vol. 42, no. 1, pp. 41–47, 2006.
[19]
G. M. Thaera, K. E. Wellik, D. M. Barrs, E. D. D. Dunckley, D. M. Wingerchuk, and B. M. Demaerschalk, “Are corticosteroid and antiviral treatments effective for bell palsy? A critically appraised topic,” Neurologist, vol. 16, no. 2, pp. 138–140, 2010.
[20]
E. Unüvar, F. O？uz, M. Sidal, and A. Kili？, “Corticosteroid treatment of childhood Bell's palsy,” Pediatric Neurology, vol. 21, no. 5, pp. 814–816, 1999.
[21]
L. J. Teixeira, B. G. Soares, V. P. Vieira, and G. F. Prado, “Physical therapy for Bell's palsy (idiopathic facial paralysis),” Cochrane Database of Systematic Reviews, no. 16, Article ID CD006283, 2008.
