This study investigated a new objective method of analyzing facial movements and examined the physiological range of asymmetry and differences between children and adults. Facial expression data input to an Apple Computer using Quick Time was analyzed with digital image editing techniques. Seven children (3∼7-year-old) and forty-six adults (20∼29-year-old) were analyzed utilizing this method. Four voluntary facial movements (wrinkling forehead, closing eye, grinning and wliistiing) were examined. The differences in the ratio between the left and right sides were less than 6% in any area and with any movement. There were no significant differences between children and adults. Some areas obtained by subdivision showed larger changes with facial movements than other areas.
Idiopathic facial nerve palsy is sometimes due to infection by several viruses, and has been associated with members of the herpesvirus and influenza virus groups. We report an 8-month-old boy's case with peripheral facial nerve palsy preceding the febrile period of exanthem subitum, a mild disease of infants recently shown to be caused by human herpesvirus 6.
A case of congenial unilateral lower lip palsy (CULLP) followed for 13 years is described. At age 3 months, this male case revealed an “asymmetric crying face, ” due to left-side lower lip palsy. After a 13-year follow-up period, the weakness has persisted, but the abnormal facial appearance has disappeared with growth and development. Nevertheless CULLP is a minor congenital anomaly with a good prognosis, but possible association with other serious anomalies must be considered.
We reviewed 57 patients less than sixteen years old with peripheral facial paraplysis who visited our out-patient office in the period between 1984 and April 1994. Table 1 shows the details of facial palsy. According to measurement of varicella zoster virus and herpes simplex virus (HSV) antibody titre (EIA or ELISA) in 37 subjects symptomatically diagnosed as Bell's palsy, the following results were obtained: these contained 6 patients with zoster sine herpete (ZSH) and 2 cases of HSV involvement, and one of two was likely to be the primary infection of HSV. Furthermore, in the incidence of Bell's palsy, Hunt's syndrome and ZSH, there was no significant difference between children of this study and adults with facial palsy which we reported in 1992.
132 cascs (17.2%) of facial palsy in children under 15 years of age among a total of 768 cases of facial palsy seen during an 11-year period (1982-1992) were divided into two groups: an infant group (under 5 years,59 cascs) and a schoolchild group (over 6 years,73 cases). The infant group included Bell's palsy (29 cases,49%), congenital palsy (10 cases,17%), otogenic palsy (5 cases,8%), Hunt's syndrome (3 cases,5%) and others. The schoolchild group, ineluding Bell's palsy (37 cases,51%), Hunt's syndrome (15 cases,21%), traumatic palsy (7 cases,10%) and others was similar to the adult palsy population. 96% of 50 Bell's palsy cases and 82% of 11 Hunt's syndrome cases in children who were treated with medication resulted in recovery. These rates were better than in adults, although a statistical significant difference was not found.
Successful management of facial palsy requires a confident and accurate diagnosis, a reliable estimate of prognosis and effective treatment. For children, however, it is difficult to evaluate the degree of facial palsy and select an adequate therapeutic protocol. A total of 119 patients were subjected to clinical observation of their facial movements, nerve excitability test (NET), treatment and prognosis. Of 119 patients,112 were divided into 47 cases of incomplete palsy and 65 cases of complete palsy by the evaluation of facial movements, while 7 patients could not be classified into either of these groups. The results obtained with NET could be estimated in 60 of the 72 patients who required NET. Of 94 patients with Bell's palsy and 25 patients with Hunt syndrome,84 (89%) and 22 (88%) recoverd completely, respectively.
Thirty-seven children with facial palsy were examined in Chiba Children's Hospital between April 1989 and March 1994. We report the patients' characteristics, classification of the palsy and the clinical course. 1. Thirty-seven children (including 12 girls) were diagnosed, as facial palsy and accounted for 1.0% of all the ENT patients seen during the same period. Twenty-two children were under three years of age.2. In all of these patients, the palsy was unilateral peripheral facial palsy. 3. In 13 (35%) of the 37 children, the palsy was congenital unilateral facial palsy. In the 13 congenital children,5 had congenital unilateral lower lip palsy (CULLP). Of the 37 cases, Bell's palsy was found in 17 cases (46%), and 7 cases (19%) were found to have aquired facial palsy, excluding Bell's palsy. 4. All cases with congenital facial palsy had other complications. Seventy-five per cent had anomalies in their head and neck region. 5. None of the cases with congenital palsy, showed an improved clinical course. However, all of the cases with Bell's palsy were completely improved, irrespective of the degree of severity. In other cases with acquired facial palsy, the patient's condition was improved completely or to some degree.
One-hundred and ninety facial palsy patients aged less than 15 years were examined. After excluding patients with congenital and traumatic palsy,163 cases were distributed through the ages, but a predominant tendency to symptomatic palsy for cases aged less than 2 years was observed, ENoG was useful in all age groups for prognostic diagnosis. Of 66 cases of acute peripherel facial palsy in intants,37 were observed clinically but given no treatment,10 were given steroids, and 19were given vitamins and other non-steroid drugs. Of 79 cases of patients in school children,12 were observed clinically but given no treatment,54 were given steroids, and 13 were given vitamin and other drugs. Sixty-five fants (98.5%) and 75 school children (94.9%) with facial palsy showed cornrecovery. Facial palsy in children is considered to have a good prognosis regardless of the type of treatment used. Steroid administration does not appear to be necessary, especially in infants.