Facial Paralysis in Children - Pediatric Facial Nerve

A child's smile is the most natural way to express their emotions. However, damage to the facial nerve can cause them to lose this expression temporarily or permanently. In this context, pediatric facial paralysis is a condition that occurs when the facial muscles in children weaken or become completely immobile. You can browse our content for more detailed information about this condition, which can develop due to congenital causes, trauma, infections, or after surgical procedures. This will provide you with detailed and accurate information about the causes, symptoms, and treatment methods of facial paralysis in children.

What Causes Facial Paralysis in Children?

Facial paralysis in children is usually caused by damage to the seventh cranial nerve (n. facialis), which controls the facial muscles, and can occur for many different reasons. The most common of these causes is idiopathic facial paralysis, also known as Bell's palsy. This type of facial paralysis occurs due to temporary inflammation of the nerve and is usually unilateral. In addition, infections, especially middle ear infections (otitis media) or herpes simplex virus infections, can also cause inflammation in the tissues surrounding the nerve. Consequently, birth or head trauma can cause paralysis due to physical damage or pressure on the nerve. The risk of peripheral facial paralysis increases, especially in difficult births. In addition, although rare, congenital anomalies or congenital nerve structure abnormalities can also cause weakness in the facial muscles. Furthermore, certain neurological diseases (e.g., Guillain-Barré syndrome) or central nervous system problems such as brain tumors can also cause central facial paralysis in children. Consequently, facial paralysis in children can occur in varying durations and severities depending on the underlying cause. Therefore, careful evaluation is necessary for accurate diagnosis and treatment.

Types of Facial Paralysis in Children

There are two types of pediatric facial paralysis that occur in children. These types can be congenital or acquired. The types of childhood facial paralysis mentioned above are as follows:

• Peripheral facial paralysis: Peripheral facial paralysis in children is a condition that occurs as a result of damage to the facial nerve after it exits the brain and usually affects all the muscles on the affected side of the face. For this reason, the child may not be able to raise their eyebrow, may have difficulty closing their eye, and asymmetry may occur in mouth movements. Peripheral facial paralysis is also the most common type of facial paralysis in the pediatric age group and is mostly unilateral. In this context, undiagnosed idiopathic (Bell's palsy) conditions, middle ear infections or virus-induced infections such as herpes simplex, birth or head trauma, and rarely congenital nerve anomalies can cause peripheral facial paralysis. Consequently, early diagnosis and appropriate treatment—corticosteroids, eye protection measures, and physical therapy exercises—allow most children to recover completely. However, mild facial asymmetry may remain in severe or delayed-treatment cases.
• Central facial paralysis: Central facial paralysis in children occurs due to damage to the central pathways of the nerve that controls the facial muscles and usually affects the lower part of the face, while the upper facial muscles remain largely intact. This characteristic of central facial paralysis is the most distinctive feature that distinguishes it from peripheral facial paralysis. This type of facial paralysis is rare, and the underlying causes usually indicate serious neurological problems. The most common causes are stroke or cerebrovascular events, brain tumors, and certain neurological diseases (e.g., Guillain-Barré syndrome or multiple sclerosis, rarely in pediatric age). Therefore, these types of paralysis usually begin suddenly and can affect the child's ability to speak, eat, or use facial expressions.

Symptoms of Facial Paralysis in Children

There are certain main symptoms of facial paralysis in children. These symptoms vary from child to child and do not appear with the same severity in every child. In this context, the symptoms of facial paralysis in children are as follows:

• Sudden weakness or drooping on one side of the face
• Difficulty raising the eyebrow or drooping on one side
• Difficulty closing the eyes or incomplete closure of the eyelid
• Asymmetry in mouth movements when smiling, speaking, or eating
• Impaired speech or difficulty moving the lips
• In some cases, ear pain or a feeling of fullness in the ear
• Change in taste or difference in tasting certain foods (rare)
• Dry eyes or increased tearing
• Noticeable difference in facial expressions and loss of facial expressions
• Difference in taste perception

Pediatric Facial Paralysis Diagnosis 

The diagnosis of pediatric facial paralysis in children begins with a detailed physical examination. During this examination, facial symmetry, eyebrow elevation, eyelid closure, and mouth movements are carefully assessed. This allows for the determination of whether the paralysis is peripheral or central. Electroneurophysiological tests (EMG) may then be used, depending on the child's age and the severity of the symptoms; these tests show the nerve's conduction capacity and the condition of the muscles. If necessary, especially if a central type is suspected, imaging methods such as CT or MRI are used to examine the brain and nerve pathways. This allows for the exclusion or identification of stroke, tumors, or other neurological causes. Finally, laboratory tests may be performed to identify possible infections or inflammatory causes; for example, viral agents such as herpes simplex or chickenpox are investigated. The patient's history is also very important in the diagnostic process; birth trauma, head injuries, previous infections, or a history of neurological disease are inquired about. All these assessments are combined to determine the type and cause of the child's facial paralysis and the appropriate treatment plan.

Treatment for Pediatric Facial Paralysis

When treating pediatric facial paralysis, the stage of the child's facial paralysis is accurately determined. Therefore, a detailed examination is conducted. In this context, pediatric facial paralysis treatments include the following:

• Free Muscle Transfer: Free muscle transfer is a procedure in which muscle taken from another part of the body is transplanted to the face in cases where the facial muscles do not work or are atrophied. This procedure is generally preferred in cases of long-standing or congenital facial paralysis. Therefore, the transplanted muscle is connected to the facial vessels and nerves using microsurgical techniques to restore function. This method helps the child regain facial expressions when smiling and speaking.

• Temporalis Tendon Transfer (MIT-3): Temporalis tendon transfer is the process of redirecting the temporalis muscle, one of the chewing muscles, to the mouth and facial muscles. This procedure restores facial symmetry and dynamic movements with minimal surgery. It is also used in pediatric patients, particularly for eyelid closure and mouth corner movements. This method contributes to the formation of natural facial expressions during smiling and speaking.

• Masseter Muscle Transfer: Masseter muscle transfer involves redirecting the masseter muscle, one of the chewing muscles, to enable movement of the corners of the mouth. This redirection improves drooping of the corners of the mouth or loss of smile. Thanks to the muscle's strong structure, the transferred muscle quickly begins to function and supports the dynamic movements of the face.

• Crossed Facial Nerve Graft: A crossed facial nerve graft is a procedure in which nerve segments taken from the healthy side of the face are connected to the paralyzed side. It is preferred especially in cases of unilateral paralysis and when nerves have been damaged for a long time. Since nerve regeneration occurs more rapidly in children than in adults, the results are generally favorable. The goal is to restore movement to the paralyzed side and help maintain facial symmetry.

• Botulinum Toxin for Facial Paralysis: Botulinum toxin is administered to prevent excessive compensation of facial muscles and to ensure symmetry. In pediatric patients, it is generally used to balance the overactivity of muscles on the healthy side. Although its effect is temporary, it helps preserve facial aesthetics and mimic functions in children, especially as a supportive method after surgery.

If you are looking for a professional team specializing in pediatric facial paralysis, you can contact Dr. Berke Özücer and his team immediately.