Key points

Introduction

Our face is our window to the world, serving not only as the primary method of identification, but also as our portal for expression of emotion. Disorders of the face, and specifically those impacting facial movement such as facial nerve disorders, can have substantial negative psychosocial impact. In addition to the psychosocial impact, the functional deficits resulting from facial nerve disorders may also be significant, manifesting with incomplete eye closure, drooling, and difficulty eating, to name a few. Consideration for facial nerve rehabilitation specifically in children is of utmost importance as a growing body of literature documents the specific negative impact of facial nerve paralysis on perception by others. This is of particular importance for children actively developing their self-esteem, self-confidence, and perceptions of self. Although facial nerve rehabilitation in adults has been extensively described, a considerable body of literature exists to guide in the management of children with facial nerve disorders as well.

Facial nerve disorders are fortunately rare in infants and children, with a calculated incidence of 21.1 in 100,000 described in children younger than age 15 in one prospective study of 106 patients. Another study in a pediatric population estimated the incidence to be 2.7 per 100,000 under age 10 years, and 10.1 per 100,000 between ages 10 and 20 years. Similar to adults, even in the pediatric population, the most common cause of unilateral facial paralysis remains idiopathic or Bell palsy, accounting for ranges of 40% to 75% of cases.

Introduction

Our face is our window to the world, serving not only as the primary method of identification, but also as our portal for expression of emotion. Disorders of the face, and specifically those impacting facial movement such as facial nerve disorders, can have substantial negative psychosocial impact. In addition to the psychosocial impact, the functional deficits resulting from facial nerve disorders may also be significant, manifesting with incomplete eye closure, drooling, and difficulty eating, to name a few. Consideration for facial nerve rehabilitation specifically in children is of utmost importance as a growing body of literature documents the specific negative impact of facial nerve paralysis on perception by others. This is of particular importance for children actively developing their self-esteem, self-confidence, and perceptions of self. Although facial nerve rehabilitation in adults has been extensively described, a considerable body of literature exists to guide in the management of children with facial nerve disorders as well.

Facial nerve disorders are fortunately rare in infants and children, with a calculated incidence of 21.1 in 100,000 described in children younger than age 15 in one prospective study of 106 patients. Another study in a pediatric population estimated the incidence to be 2.7 per 100,000 under age 10 years, and 10.1 per 100,000 between ages 10 and 20 years. Similar to adults, even in the pediatric population, the most common cause of unilateral facial paralysis remains idiopathic or Bell palsy, accounting for ranges of 40% to 75% of cases.

Causes (not exhaustive)

• 
  

  Congenital

  
  
• 1.
  

  Syringobulbia—fluid-filled cavities, or syrinxes, that affect the brainstem. Typically congenital but may be caused by tumor

  
  
• 2.
  

  Mobius syndrome—bilateral or unilateral facial paralysis, prevalence reported at 1 in 150,000 live births, affecting cranial nerves (CN) VI and CN VII with other CN variably involved, leads to “blank” faces of affected children

  
  
• 3.
  

  Goldenhar-Gorlin syndrome (several craniofacial abnormalities, including hemifacial microsomia, epibulbar dermoid, and microtia)

  
  
• 4.
  

  Hemifacial microsomia

• 
  

  Acquired

  
  
• 1.
  

  Trauma—surgical or nonsurgical (temporal bone trauma)

  
  
• 2.
  

  Infection—Ramsey Hunt syndrome, Epstein-Barr virus, Lyme disease, human immunodeficiency virus, cytomegalovirus, adenovirus idiopathic, Bell palsy

  
  
• 3.
  

  Neoplasm—schwannomas of CN VII, hemangiomas, parotid tumors

Rehabilitation

Facial nerve rehabilitation is conceptually more challenging in children for unique concerns, including growing anatomy, and requirement for parental consent on behalf of the children. Although facial reanimation procedures are generally deferred until children are at least 5 or 6 years of age, with methods of eye protection incorporated earlier as appropriate, the literature does not support any untoward effects of the procedures on facial growth. Facial rehabilitation aims to restore both resting facial symmetry and symmetry with motion for aesthetic and functional purposes, including emotion, articulation, and eating, to name a few.