Treatment of acute and chronic facial palsy in children and adolescents: Prognostic factors for the outcomes

Abstract

Introduction

Pediatric facial palsy is a rare disease. There is a lack of data on the outcome of peripheral acute facial palsy (AFP) or chronic facial palsy (CFP) in children and adolescents after treatment and on the prognostic factors.

Methods

A retrospective study was conducted in a university facial nerve center. Clinical data was analyzed for their impact on probability of recovery or functional improvement using univariable and multivariable statistics.

Results

84 F P patients (range: 0–18 years, 35 % AFP, 17.9 % flaccid CFP; 29.8 % synkinetic CFP) treated 2003–2021 were included. All AFP received intravenous prednisolone therapy (PT). 56 % of patients with synkinetic CFP were treated with electromyography biofeedback facial training (EBFT). Facial nerve reconstruction (FNR) was the most common treatment (40 %) for flaccid CFP. 82.8 % of AFP fully recovered. Synkinetic CFP showed improvement in 60 %. 26.7 % of flaccid CFP patients showed improved facial mobility. AFP patients with a Stennert Index (SI) > 6 (p = 0.024), House Brackmann scale (HB) > III (p = 0.034), or PT started more than 96 h after onset had worse outcomes. CFP patients with SI motor function >4 (p = 0.002), total SI > 6 (p = 0.015), HB > III (p = 0.002), or ipsilateral loss of the stapedius reflex (p = 0.021) had a lower probability of improvement.

Conclusions

PT should ideally begin within 96 h after the onset of AFP in children to maximize recovery chances. The severity of FP is a key prognostic factor for recovery. Like adults, children with synkinetic CFP benefit from EBFT. Guideline-based therapies for adults seem to be also effective for children and adolescents.