Facial palsy in children: long-term outcome assessed face-to-face and follow-up revealing high recurrence rate

Abstract

Purpose To evaluate the long-term (minimum of 2 years from the palsy onset) outcome of pediatric facial palsy by patient questionnaire and face-to-face assessment by the Sunnybrook facial grading system, House–Brackmann grading system, and Facial Nerve Grading System 2.0. To compare the outcome results of self-assessment with the face-to-face assessment. To assess the applicability of the grading scales. To assess the palsy recurrence rate (minimum of a 10-year follow-up). Methods 46 consecutive pediatric facial palsy patients: 38 (83%) answered the questionnaire and 25 (54%) attended a follow-up visit. Chart review of 43 (93%) after a minimum of 10 years for the facial palsy recurrence rate assessment. Results Of the 25 patients assessed face-to-face, 68% had totally recovered but 35% of them additionally stated subjective sequelae in a self-assessment questionnaire. Good recovery was experienced by 80% of the patients. In a 10-year follow-up, 14% had experienced palsy recurrence, only one with a known cause. Sunnybrook was easy and logical to use, whereas House–Brackmann and the Facial Nerve Grading System 2.0 were incoherent. Conclusions Facial palsy in children does not heal as well as traditionally claimed if meticulously assessed face-to-face. Patients widely suffer from subjective sequelae affecting their quality of life. Palsy recurrence was high, much higher than previously reported even considering the whole lifetime. Of these three grading systems, Sunnybrook was the most applicable.

Ramsay Hunt syndrome: long-term facial palsy outcome assessed face-to-face by three different grading scales and compared to patient self-assessment

“…The patient number in this study was too small to draw statistically reliable conclusions whether the type or dosing of the used medication played any role in the outcome of FP. In our previous study [ 11 ], the outcome stayed the same as long as the medication was started within 72 h of the RHS onset. The outcome was worse with those receiving no medication or starting the medication over 72 h from RHS onset.…”

“…We have previously published the results of the retrospective chart study (120 patients) and the patient questionnaire study (81 patients): medical treatment, blister location and time to FP, hearing loss and its outcome, other adjoining symptoms, and outcome of FP on grounds of patient charts, and patient self-assessment [ 11 ]. In the current study, we concentrated on the face-to-face assessed long-term FP outcome of those 57 patients coming to the follow-up visit.…”

“…Patients were sent a questionnaire about their RHS [ 11 ]. They were asked to self-assess their RHS FP outcome and were invited to come to one follow-up visit, where their facial function was graded by the corresponding author with HB, FNGS, and SB concomitantly.…”

“…Even in one-third of RHS cases, blisters follow FP [ 10 , 11 ] making the diagnosis of RHS impossible at the time of FP onset. Clinicians must be alert to remember the syndrome and inform patients of this possibility.…”

Incomplete Enrollment in Clinical Trials

“…Bell palsy (idiopathic facial nerve paralysis) in children typically resolves, but there can be prolonged periods of functional and cosmetic impairment. 1 Facial paralysis can reappear after initial resolution. Steroid treatment is typically prescribed in adults, but in children, the risk: benefit ratio might not be as favorable.…”