Introduction Facial nerve paralysis in paediatric population, although relatively uncommon, represents a serious clinical problem due to its aesthetic and functional repercussions. Causes of facial nerve paralysis in children can be classified as congenital or acquired with acute, idiopathic, unilateral facial paralysis (Bell’s palsy) accounting for approximately 40%–75% of all cases. Familial clustering of Bell’s palsy noted in the literature strongly indicates a hereditary basis. There have been only sporadic reports of recurrent facial paralysis in children.
Case report A 12-year-old girl presented with face asymmetry, left-sided facial paralysis and slightly slurred speech. She reported acute onset of symptoms 24 hours ago. A similar, less severe episode of ipsilateral facial weakness had occurred 2 years ago, which spontaneously resolved within a few days without sequelae. Her past medical history was otherwise unremarkable. Physical examination was normal, except from the peripheral left facial paresis. There was no indication of infection, trauma or other underlying condition. Family history revealed that the patient’s father and a father’s sister both suffered from permanent unilateral facial weakness following relapsing episodes of facial nerve paralysis. The patient was admitted to the hospital for further workup. She was initiated on corticosteroids and supportive eye care. Basic laboratory blood tests were within normal limits. ENT examination did not reveal any signs of herpetic infection. Serological markers for various viruses including HSV and EBV were also negative. Brain contrast MRI detected abnormal enhancement of the meatal, labyrinthine, tympanic, and mastoid segment of the facial nerve. After hospital discharge, the patient was followed up and presented significant clinical improvement in the first few weeks. We also report another case of Bell’s palsy in an 8-year-old boy. The patient presented with right upper and lower face weakness of sudden onset. His medical history was uneventful. His father reported an episode of facial paralysis 10 years ago. The patient received corticosteroids and clinically improved over the next few days.
Conclusion Recurrent idiopathic facial paralysis is rare in children; however, it is more common in cases with a positive family history. Further studies are needed to elucidate the possible anatomic (facial canal abnormalities), vascular, or immunogenetic predisposition of familial Bell’s palsy.
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