Case of the month: Facial deviation in a child

Contributed by

Dr.Ghulam Nabi, MD.

Pediatric Consultant and Neonatologist.

Bugshan Hospital Jeddah, 21432.K.S.A.

P.O. Box 5860, Kingdom of Saudi Arabia.

E-mail: drgnabi2@gmail.com

Clinical scenario :

A7 years old girl came to our hospital outpatient department with 

history of weakness left side face for the last two days.

On examination vital signs and growth parameters were normal. 

Two weeks prior to current presentation  she had upper respiratory

tract infection and recovered fully after treatment.

Due to the weakness of left facial muscles no wrinkles on forehead,

left eye not closing fully, she could not show her teeth fully due to the weakness 

of the face muscles (Figure 1).

We could not test anterior part of tongue for the taste.

In the nervous system only left facial nerve 

was affected. All other systems were normal.

She was diagnosed to have Bell s palsy

Bell’s palsy is acute onset peripheral facial nerve palsy that is 

not associated with any other cranial nerve neuropathies or brain 

stem dysfunction.

No significant difference between genders , 

Described in 1830 by Sir Charles Bell.

The incidence of FNP varies in children younger than 10 years of age is 2.7 per 

100,000 annually, while in children 10 to 20 years of age, it is 

estimated to be 10.1 per 100,000  

It is an acquired, idiopathic facial palsy characterized

by a palsy or weakness of facial 

muscles, usually on one side, with no obvious cause.

It is a common disorder in pediatric population.

Usually developing suddenly two weeks after viral infection.

Weakness of affected side of the face, unable to close eye on affected side.

Inability to wrinkle the forehead, loss of taste anterior two third tongue. 

Missed or delayed diagnosis can have a serious impact on a 

patient’s quality of life.  

Outcome is very good, some people 

give steroids for one to two weeks.

Improvement begins within 1 to 2 weeks, total recovery is observed within two 

months.

In all cases, treated or not, children have a very good 

recovery rate.