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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright 1957 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.
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PARALYSIS
M.D.
School,
Center,
Department
of Pediatrics,
Medicine
Medical
and
the
Boston
Department of
P
Sir course its
ARALYSIS
of to
is
often
re-fibers
ganglion as
join
is
of
the
found
facial
at an
nerve.
acute
The
turn at
geniculate
the distal
the
meatus; leave petrosal the downward, off then turns the anserinus mandibular, the fibers
in the
the
nerve at this nerve through branch through and gland its terncernerve.
concerned
He
also
or
presented
some infection, and of can causes. facial and of is be a
several
them and due
cases
of
facial
facial
the
and muscle.
disease
divide
zygornatic,
the published
( Park
and
these of children of experience will be facial the are Experience subject may
vical
of
innervate efferent
musculature concerned
superior sali-
Sullivan
but adults. view and causes and
cortisone
Smith,4
concerned has as be paralysis with presented.
James
indicated it of applies interest
and
principally
Russell)
with with vatory that a renervus to infants tympani and value. within
nucleus, intermedius, nerve, the surface bone, mandibular activity glands ganglion. nerve their central the at lie single ends
into
join which
facial nerve pass into the the passes the lingual drum, to finally sublingual in geniculate divide passing via near the the facial the tractus
Sensations
in the chorda nerve over the the branch the subof ganglion, the
facial of and
Differential
diagnosis
10
among
will cases be
the
treated
various
discussed,
inner
ANATOMY
The cated tract From
ward,
OF THE
(See Figure
of of the
beneath
FACIAL
I)
the the axones
the floor
NERVE
nerve near the slightly
of the
submaxil-
a T, nervus of and
taste,
tegmentum,
spinal the
motor the
taste
solitarius,
of
ventricle
of the
iIitO
and
abducens brainstem
form
nerve. at the
genu
They lower
the
emerge the
the
by
of
these
the
from nerves
the and
anterior
in the
conveyed
the
nerve
cerebebbopontine
runs
space. and
in meatus,
From forward
close
there to
association
lingual
and
chorda
the
upward nerve
internal
auditor
geniculate ganglion the the salivatorv impulses but taste tvmpani sensation chorda
with
intermedius,
the
acoustic
through April 9,
and
with
visceral July 3, Boston
the
nervus Some
efferent
which accepted
Avenue,
(Submitted
ADDRESS:
300 Longwood
303
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304 return
to
FACIAL
petrosal according impulses
PARALYSIS
IN
CHILDREN
and taste. The occurrence
the
geniculate
to may
should
branching muscle,
place
of but is
the
the
lesion
nerve not children to
various at
above
to generally give evaluate findings the
authorities.
conthe point ceivablv follow a similar path in reverse, while stapedius others probably pass originally in the gbossoclinically pharyngeal nerve, from the petrosal ganglion a history via an extracraniab anastomotic branch, to the objectively. facial, upward through the stybomastoid foramen, and thence into the chorda tympani. Thein facial facial nerve also transmits superficial sensation anatomical
from part of
few difficult
Table it in
I.
the
ear
palate and,
near
posterior
from part
nasal In is auditory is
in
past
the
possible
age
to
of
test
4 5 or years,
taste
mucous
of
frequently
the
the
meatus;
usual him
fact solutions
by
having dropping
and
close
exists.
if not to
it deep be
in from
sour,
the
sation
muscles, the
con-
on the anterior portion of side. Since young children to as the can after to say
and
the a more
veved
on
A study
that tion
of
of
some the lesion
Figure
extent lesion
1 will
the causing
make
a
it apparent
to of facial
anatomical peripheral
what sweet,
ask the
salty,
child to
bitter,
paralysis in
( bearing
the brain
in of
mind
stem
nuclear
head
one
reaches the correct to say, the test must the child mouth taste are withdrawand spreadareas. not Even able to
the
possible
peripheral from
accompanying
type
weakness) according
in
classification
defects
his
bacrima-
other who
from
submaxillary
and
-TASTE
SALIVATION
LACRIMATION
Anatomical arrangement of the facial nerve. The course of the niotor fibers isshown in gray. Relative length and size have been somewhat distorted for clarity and to permit labelling. There is an anastoniotic connection from the facial nerve to the auricular branch of the vagus; this leaves the nerve in the facial canal, but has been omitted from the drawing. Possible secondary pathways for taste and salivation are described in the text, but have b2en omitted from the drawing for simplification.
FIG.
1.
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REVIEW
TABLE
(iixii FINnINGS IN F.cJ.&L IAUALYSES 1)uE
ARTICLE
I
TO LESIONS OF VARIOUS ANATOMI( LOCATIONS
305
Voluntary
Morements Lower Fare
Lost
Bmolwnai
and lingual
Sub-
Taste
perOPUSlX
Retained
lost
Retained
Retained Usually lost Lost
Al,sent
Present
Present
hit racranial
jut.
illl(l.
(between
meatus)
or above
pons
and
Lost
lii (311011 at
gil oglion
geniculate
Lost
ganglion
and and
tynipani
nerve
to
Retained
Retained
Retained
Lost
Lost
Retained
stapedius
chorda
aiicl
charlia
aiiseriiius
Al,sent
Al)seflt
Iii
J,tS
lartlv
lost
Retained
Retained
Retaine(l
identify
the facial something will indicate
flavor,
expression
it
may
that unpleasant) of
be
the
obvious
patient and Taste this
from maxillary
tastes is sensa- loss
or
sublingual difficult
inasmuch parallels
salivation. to perform
as that of
The and
retention taste.
test not
or A
technically
useful, of salivation
( usually
retention
especially
taste.
tion palsy
that ential
an
was
as an
lost
in
52 by
of Park
test,
the and
it It is is
cases
not
of
of
to can after It be
that used
to measure by of result
also,
described
isolated diagnostic unfavorable
Watkins2
supposed
of of
lacrimation
value.
importance,
a
with
lesion
late
Eventual
sign, indicating since in the facial canal. tion reaction degeneration of some
partial recovery was cases,
50% of It
tively have against
more is
by l)een the
common poSSil)le
the use
among to
of
patients salivation
cotton
boss petrosal
as in
superficial ganglion, and of of retained. by the noted because mother the cases, idioReens-
by Tremble
majority all is the of
test
small
Penfield.l7 pathic
the assurance
the or
great practically
which including of
weighed.
previously
One sublingual
weighed salivation
of
dried
a pair duct
is placed on
in been its
submaxillary
side
ing
or
then after
either tomary
weigh- that stimu- at
and bottle
again has
( overflow
of
facial
lated stance
that gland
by on
the
placing the
flow of
mustard tongue.
saliva
or
from
a similar in
the
subthe mind on
eye
this
remained
point of
open.
is obtained,
If a clear
gravimetric is unnecessary.
statement
meas-
Bearing the
parotid urement
lacrimation
is
through
auricubo-
temporal of the
ton
Only
must cover the orifice on each side with cotneed difference the in cases not he weighed. thesuit subof of between
CLASSIFICATION
FACIAL
It is obvious from the facial lesions nerve, that
AND
facial anywhere and
ETIOLOGY
paralysis in that the
OF
can re-
PARALYSIS
course
which,
sides
however,
is significant
a several-fold
two
there must
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306
FACIAL
causes.
PARALYSIS
The extensor as well of
are carpi
IN
CHILDREN
of and as fingers well of syndrome the as the wrist, and webbing right is bilateral butin of long the of hand. generally sixth
a
be more
as
variety causes
acquired II.
of
possible of congenital
facial
the
thumbs
paralysis
given
Facial
seldom
paralysis
occurs as
an
isolated
but in and
in described bilateral
broad
normabities, congenital
chiefly
includes only
number tabulated
of
cranial
paralysis
facial of other
is the but deficiency,
TABLE
ETI0LOGI( CLAssIFIcATIoN OF
II
FACIAL PARALYSIS
may
occur.
however,
is
infrequent.
I. Congenital
50011
Four facial of
We have to be
of the
seen
cases one of
with
had inface
what
(i.e.,
present
at birth
or
at least
ncted
unilateral volvement
only. is
paralysis, lower
two
had the
A.
B.
afterward) Congenital
anomaly
(Moebius
syndrome6)
Trauma 1. Skull
l. S. 4. Intracranial
fracture
hemorrhage
believed
paralysis in one of the face situation the a lower that may from half. In
paralyses and The should prin-
Pressure
Pressure
from
against
forceps
maternal sacrum7
is upper
I!.
Postnalally A. Trauma
1.
.
Acquired fractures
Skull
Surgical
representation whereas
3.
B.
is it the is
concerned
bower with
face discrete
facial
C.
anatomically
I . Neoplasms,
ing
2. 3.
lesians
Hypertension9
Intracranial eluding
pressure hemorrhage
mass le8ions
or
of
whatever
cause,
in-
as
congenital
always
(in neck)
suspicion.
cipal
mastoiditis
media
with
without
Poliomyelitis
Meningitis
usually
Encephalitis
Guillain-Barr#{233} syndrome
5.
6.
lions
with other insis
It is the
drome port them
most
of
common
the
cranial
pterygium
nerve
colli
paralysyn-
accompanying
Bonnevie-Ullrich in
and
in
one
Herpes
of
zoster familial
(Ramsay relapsing
Hunt
11 of 177 cases, It may be familial, with from question pontine others, whether contrabateral in has
syiidron:e)4
facial paralysis
F.
Syndrome
it
may
associated signs
I.
i.
Occurring
as isolated
finding5
oflip or face (Mel-
pyramidal cases
important.
( Trautman9);
Associated
kerssons
with
edema
syndrome)6
Ford,2#{176} among
G. Idiopathic
cently
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REVIEW
genital
aplasia the facial
ARTICLE
the sociated of
gener- Some
307
facial
of nerve
paralysis
muscle nucleus
is in fact
rather as than has
a congenital
absence been
of media
are are of
asterm Some
Facial
ably
the ports frontalis
assumed to by
three muscle external
to
rectus
be Duanes
the
muscles
case, syndrome
of
and in
the
may
eye of
Bells be
are paralysis
idiopathic
due results or
group.
trauma. from hyperostosis comosteo-
comparable replaced
however, occasionally of
fibrous
cases in showed
cords.
which total
Richards2
biopsy absence
facial as type
cranial in
muscle
a
tissue.
at seventh necropsy
Rainy child
nucleus
and with
showed and
Fowler22 facial
degeneration facial
reported diplegia
of nerve
Albers-Schonbergs
10-week-old
hypercalparother
in facial isolated
intracranial abscesses
lesions, only can rarely
processes, and
result cause
not
of
total
the
aplasia.
scanty
On
necropsy
the
other
material
neoplasms,
to
as as
indicate
of for
of nervous case
this The
nuclear system of
situation entity
cells b23
can needs will
other
example
elements,
not to
paralysis because
in nucleus.
without of
the The
other proximity
to most the frequent
neurologic of
facial
the
pons
other
nerve tumors
primary stated
well
one, narily genital
known
although suggest or
as
a
it
whether
is
relatively
history the situation
frequent in
is
the
posterior
the cause
well) signs.
patients
ordimedulboblastoma, conlast-mentioned iar combination abducens pyramidal tumors through at times can
The familcon(usually
postnataliy
acquired.
paralysis
Congenital present
generally sure and from pes
facial birth
been anserinus.
paralysis subsequently
to forceps The if pressure not study be on of most, of the due
which clears,
to the Hepner,7
at
but
assumed
also
facial
obstetrical
obscure simulate
the
however,
dicates probably that
is
due
extremely
many, to
challenging
and
cases
peripheral, type of
infants cranial
the
paralysis course while been and case of period course. lacerations, necessary,
great that
Hypertension
facial
so or
by
a variety of a
of vessel
pressure pressure.
newborn
swelling
hemorrhage,
the Except
facial for
recovery It
its
Of
paralysis without
identifiable
in children, mastoiditis
infectious
otitis is by
causes
media far the
of facial
with commonor
cases
neurosurgical
and jority.
place borne
in in
the mind
est. ma-
The
to
be but effective in
less the
favorable in
treatment
the
newborn may
period, be most
as a symptom
in
later of
paralysis abnormality, in
quired
newborn
otitis well
accompanied known
poliomyelitis,
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308
PAINE
facial other
is nuclear,
FACIAL
involved
PARALYSIS
together geniculate The paraby- 1944
IN
CHILDREN
herpes by Denny-Brown32 in
the with
sis
nerve lower
and
is
often
of the
cranial
nerves.
peripheral
a case ganglion
found
cervical
in
outbreaks as an
due to
ganglion
the
nerve.
the
the
connections several other fluid.directly with the Chiland herpes zoster and
paralysis ment of has the been fifth,
may motic
between the facial nerve cranial nerves and inhigher cervical nerves, of the ear and facial
reported eighth, and with tenth involvecranial
third
virus the
nerves in
cervical.a3h5 More
paralysis may( not
as
well
as
the
second and
causes
case with
obscure
such
reported
as a
of
facial
bulbar if persistence
poliomyelitis
the
almost
survives, appreciable paralysis
invariably
impacted
necessarily
inevitably representing palsy.
infected)
viewed with coincidental
wisdom
some idiopathic
teeth,#{176}
suspicion
are
10of
cases
was
reported syndrome
flaccid
in
one
paralysis
series.29 be-
Bells
Guillain-Barr#{233} the
ings,
It
is
in
of
for
the
evaluation
facial most
found
andifferential d
paralysis that of his
in
symmetrical
in diagnosis
idiopathic faces
the cases
extremities,
and in many
with
cases
variable
symmetrical
find-the
cranial Except
pediatrician
otitis
prol)lems.
association
nerve
any with
palsy, other.
facial
more Other
paralysis
facial
media, be idiopathic.
will to
polyneuritis findings of
pathologically but
been
with elevated
typical should typical
or
without protein
of be borne
spinal the
mind
fluid absence
syndrome, that
answer is of of
cells3#{176} or type
it is supranuclear
Guillain-Barr#{233}
Itit is neuron
entire
usually type
half
stated of facial
of the face,
lower involves
the
motor the
upper
with Most
facial
may finding.31
II are
occur
face in of
labo-of readily tionab or
is spared supranuclear
or volitional)
at
least and
the
other
listed their in other
infectious
Table symptoms
causes
( as
opposed are
identifiable ratorv
the
face
Facial zoster of
associated ear
with auditory
( the
Hunt,
the in be children. based
deserves
relative on
with
of
Ramsay in spite
peripheral
of paralysis
herpes
ganglion sensory
the in
has
pes part
It has
of the
it
facial
is at
nerve As
beast
about nus
debat- stated
previously
in
leprosy,
the
the
upper
lower face.1
is
has if
certainly Doubt
with validity
the cranial
promise of
also bear in mind that extralesions in the neck can cornfacial nerve at or near its exit
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REVIEW
froni voive
ARTICLE
inX, CASES
OF ISOLATED MEDICAL
309
TABLE
FACIAL CENTER,
tlw other
StylOmaStOi(l cranial
foramen, nerves as
and well
may (IX,
HI
PARALYSIS 1943-5() AT CIiIInRExs
XII).
fore Neoplasms, phoma
of
Such
not
a combination
always due to an including
of those
the most cervical be of on
palsies of the
is therelesion.
intracranial
Season
of Onset WinierSpring
bymcause (ause
sumher of Cases
SummerFall
this In
Congenital
case based
with
facial obvious
Congenital
anomaly
Birth
Postnatal
trauma
18
consideration
anatomic
Surgical
trauma
trauma 3
factors
the
previously
conclusion that
discussed
the
will
is
lead
probably
to Other
Intracranial
Extracranial
tumor
tumor
in
fails and
the
to the
facial
yield is
as
canal.
frn-ther
Examination
diagnostic of iodiopathic
usually
information
hypertension
Poliomyelitis
diagnosis made by Of and to but of adults. this In more cases still Table
of
facial
other causes reported each small 87% composed infectious media, but the the a the face were riumwere a over was the
media
upper resp.
16 19
6 10
10 9
paralysis
insofar
inoti(9) (6)
(4) (6)
Park to were
feet.
(hut
upper
not
trauma due
tis)
without infect.
(3)
resp. (10) HO
tumor
i(1i01)athic, chiefly
group,
is
18
19
particularly
those
otitis
proportionately group.
part
of
the
Melkersson paralysis of of
syndrome
of
re-
idiopathic single
experience
with
facial treatment
edema
paralysis
of
the
and
summarizes
the 8-year
Childrens period
is time-honored due were ought the by summer unrecognized equal and an rarely other etiobogic obtains to based true, to of
Medical ending
some is of on occur cases poliomyeseasonal studies agent, the the great during exposure theory edema
Cenin
that its 1950. interest, an
ter
The
over
seasonal
a
as
depends
on
assessment The
to make
of percentage
evaluation
the
prognosis of
of
in
various
untreated is so high
means of
inasmuch Bells
nerve
cases.
facialas
palsy
in
treatment to of mapatients
controlled the
difficult, which
study are
since would
not
number for
in most
cold jority winter accounted litis. cidence against the history sional cepted. paralysis
neuritis
air. of
available
could inas
in
the
is adults which of
the
approximately this as one exposure, it seems usually facial edematous. idiopathic the or is too more
itself past,
argues a statistically
a convincing
although
striking probable due nerve It facial is to
in
not some whether
an
to that
occabe form
the Childrens unsuccessful, from accept of contact. majority those was group. due rate
Medical and many Of of to those all among Park and congenital groups
otitis idio-
worthy paralysis
( 7%,
Park
and
palsy
Watkins2),
is not
facial
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310
PAINE poor to
90%
FACIAL Other
PARALYSIS reports of Govern,46 ofof facial age covery, rebeen ing at is inter- in
question
IN
CHILDREN
with
recovery
75
or
rates
no
recovery.
include those
who palsy of
that
of complete
80%. in
of
Collier3
and Taverner40
better
of 80 to
in reported
the of but
raise
group,
Moor38
90% and
the facial
skull
of
covery sons
92%.
in of
in
follow-
45
of
100ases, c
always
of
how In
strictly general,
recovery tissue
to
be
always
separate
Russell5
emphasized.
Wablerian
difficult and
to
As
days
reported
complete
ally within
or
a
almost
months
recovery, slightly slow in a distal complete, invariably regrowth those more. reaction a total
degenera-
A second degeneration covery tion. quires eludes of fibers they which phenomenon
probably 1906 by monkey
in A of
partial obtained
fair those
Such
those with total if ever followed the reaction of to respond current. The current is galvanic closing cathodal reverse quick the to manner Testing nerve
to
months, or
recovery.
than
nerve ceases or galvanic respond current), to anodal than the fewer is the slow normal the
its
connected. regrowth
Lipschitz4
not
to the
faradic but
more
ircurcon-
and
Ford
has
and
been
discussed
and by Howe,
in
some
confirmed Tower
Woodhabl42
experiments
Duel.
regrowth paralysis
The
in are
manifestations
incomplete of several recovery types:
of
misdirected
from
for
facial normal
its
1.
results
Mass
in
action activity
activity
or
of
overflow of
several
Before complete,
only
reaction
response
attempted groups.
one
muscle
different
stimulation which
effect, syndrome of crocodile tears
and in for
2. Tics,
mass 3. action The
may
actually
be
a form
uncomfortable A is l)e-
which food be in
after the
of and difficult of stimuli because willsimpler, than whether this fore is 1. The Such andthan if the time apparent 18 days followed
to carry out in young children their lack of co-operation. more is superficial, observed to criterion begin for degeneration. beginning sooner experience always or at least
( including
followed salivation. plausible
entity has was been
recovery
of
by
basis of Figure
Bogorod44 and Ford45
first
described
reviewed
Mcbeen
complete
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REVIEW
nearly would will rather growth. follow than complete seem the to course secondary eventual indicate of thathe t primary by recovery recovery.
ARTICLE
It nerve
cause
311 in its canal, whatever may edema reports edema. evidence of recovery tendency cases logic benefit
it should
the
underlying recases, to of bein have and be are produced before inescapable most for debeen not
patient
recovery re-
be. KetteI48 in 28 of 50 both It on the rate to which select is the canal microscopic difficult
TREATMENT
In physical
local splinting
ill front of
value
the
heat,
acute therapy
stage, are
face
several available
stimulation, and
modalities including
massage, active
the those
electrical of the
exercises followed
several The
weeks seems is to be
difficult if one
a mirror.
recovery
According
rate was
to but
Bierman,19
not much
the
final
if substantial
decompression,
by
with to recover
done
to
reported weeks,
a
degeneration in within
that tinely and one to to
has 18 days),
ought decompression
taken and it
to is subject
place
( namely
argue rouan patients expects
and 90%
and 72%, given
respectively,
as compared if treatment
week. of Park
only
Watkins2 difference
on
in
the
the
other
percentage
hand, with
trying
reported
no
80
rate justification
with can
on recovery
no be
those
treatment. made
patients and a begin-
recovery
Considerable in
for
treated The
paralysis and (loes the thing. plain
as process
compared of waiting
is always and the the comfort
of
the
degeneration
but as
if
at
the question whether would
perhaps
would the be value ma-
14
parents offer
use
physiotherapy satisfaction
onset,
to
doctor
We the
is
have situation
at
least
preferred, quite
trying
frankly
to
however,
do
to
some- of
to terially exparents course
any,
if
of
the
so of
late treatment
in
the for
and
support cipal sary olive prevent used young
to
try
in
to
a
provide
more measure open
the
usually
necessary
manner. The found of eye chamber keep in mineral at
moral prin-
drop moist to
by theory, by
Skinnerll but has cortisone years but its recovery and resuccess of of 300
studied
replaced
affected
treatment. to he Cortisone
for on
treatment
for several paralysis, the is high Rothendlerll with doses all They duration
onset have been
children. is less
The its
In severe,
corneal
the except
reflex arc
daytime in
is
bern
mates. cause
difficult
efferent
nerve,
The the
but patient
iso n aware
six,
to
least
his
mother. treatment
decompression
quite 12 the
10 the
whom senot
for less
years basis
days results
were of
and been obtained
approach facial
by
from
the
favored rationale
canal,
the depends
which
majority on the
is
of
still
The to
of 2
paralysis be
total
was in
assumption
necessarily
The recovery
required
rate
complete
recoveries
the
paralysis
is
due
to
edema
of
Downloaded from www.pediatrics.org. Provided by Washtenaw Comm Coll on March 10, 2011
312
IN the began
in
cases of strikseries
cortithe pa-
is
not
significantly
recovery
of the
duration same
group. approximately
The
paralysis
the
Our
second
seen and results of
day
again
and of
the cortisone.
on
the
consistent
Nevertheless
especially
practice
tients and review of others in the literature, safe that in cases of facial palsy treated with invirtually full recovery in 14 days if usedcortisone,
idiopathic
unless
cases
are
as
already
promptly
showing
as
isall the rule, compared treat those untreated possible, in urged prompt evidence Thomas 10 days of onset; results form if it is started a in owing of 300 mg daily
for earliest
or more recover. (within less unitime our favorably pawith for plan of in cortian seemed in1 week, to dosage
adults. detectable
the
available,
improvein treated comparable are available our mg for has been 150 age, week,
for for
untreated
serieswith
1943 were
to
1950 adequately
Unfortunately, time
children. treat- untreated treat children with are sone that daily, depending for dosage a if
with statistical
CASES
OF IDIOPATHIC
FACIAL
PARALYSIS
TREATED
CORTISONE
AT ChILDRENS
Days of lie. lie.
MEI)I(AL
(ENTER
of
;ex
Paraly-
(yr)
,,
1 1
Jisit
gin niFty
Rrcorery
Fi,ial
Reeniery
8 9 F
no
otitis
S 10 4
SO mg 75 75 75mg mg mg
7 5 8 6
4 1 5
2
a
4
11)
l(i(l(
Ill
7
7
F F F M
1 R R L R R
M
air
()l3SCt
5
6
May Oct
May
total
98r;..
1
I00
50mg mg 75mg
1 S
K unknown
5
it
day
before
7
15 total
7
8 9
F F
3
July Dec
Jan
g,z
16
Ireious with
treatnient
tliian,,i,e
[100mg
8
S 4
total
almost total
.1 so
mg mg
S
6
(75mg
100
R I.
cases showed
4 10
100mg
75 mg
total
total
2
4
40
41
10
a None
S
of the
Feb none
any beginning from additional except this with recovery chart. days of extreme
at
the
time
first
seen.
Patients
already
improving
at
initial
examination
were
not
treated
with
cortisone
andare
excluded
withdrawal.
Downloaded from www.pediatrics.org. Provided by Washtenaw Comm Coll on March 10, 2011
REVIEW
ARTICLE
313
Fie.
SeCOn(l
2.
Case
day of
4,
a girl f o
paralysis.
(left) (a)
cortisone
Appearance therapy.
when Recovery
first
seen, is not
on yet
so.
to tion
such balance,
dosage, added
special not
the
plan
polio
may
season.
be
In to
epidemic
other-
years, if far of
seen
potassium necessary,
contraindicated;
wise
it
is
safe been
have,
use
cortisone so
antibiotics
table
urging have perfectly if
food
of been
with
4 to
poliomyelitis feasible,
spinal 16 fluid.
excluded examination
however,
as the the
We
three
OUI1CCS
with Massachusetts
facial
identified
paralysis epidemic
as
(luring which
)oliomyelitis
1955 after
were cortisone
treatment
carefully
use to corti-
super- subsequently
reluctant
they
other any
had
been
complication
treated
None or
with
of worsening
the dolle
of two
otitis
instances
l)ut l)y
suffered
physicians.
these
three of
e
ho
ha\C
recoveiy first
seemed
administering
to he to and
place,
for
the
and due of
been
none
had
permanent to and
to
after
antibiotics
paralysis.
(lays of facial to
prior the
treatment. of undoubt-
consideration otitis
our
the poliotreat
possible
myelitis, is cortisone
media
practice
of end
facial to the of
paralysis plan 14 of to
and
with mentioned 18
a
oral there
or
general hesitant
contraindicated
one
above.
is no
days
partial
apparent
recovery,
facial
total
electrical
reaction
degeneration
is
Downloaded from www.pediatrics.org. Provided by Washtenaw Comm Coll on March 10, 2011
FACIAL
IN
CHILDREN
otologic surgical
the
SUMMARY
anatomy etiobogic
acquired
of
facial
the
facial in
paralysis
nerve both
in of
and congenital
children
the
present
factors
the so
use
of
recovery cases
has that of
been
the
reviewed.
more
Differential
important
diagnosis
these has
treatment
are available
facial
paralysis
their scope
of
discussion paper.
approaches
is A
to
beyond graft
problem.
nerve
the
per-been discussed but possible methods the This evaluation is one high recovery which mocareful andindicates be treatment in that of high the cortisone recovery average at children. may study its with While of
and
the the If
Apparently tor
also used,
type whether
of
nerve, reversed
whether or
serves
or
not, can
degenerated graft
( Tickle55)
probably
to
a
provide
distal
a better
Duel56
channel
The and in 932, 1
for
classical also and in about was
regrowth described
anastomotic
it is difficult greatly improved rate, it seems more time in Cortisone adults is seems and
Ballance both
recovery least
in-
treatment
procedures
hypogbossal ported anastomosis, plete and excellent
using
nerves. but amounted
the
Love results recovery to
spinal
accessory
Cannon57
fluenced, or also in
rement
using 50%
never than 75%
ing
com- 10
of choice at the present time an(l diirthe past 2 years at one hospital, all of patients so treated recovered. This has the decompression need for of consideration the facial canal. true with larger to be seen. of
no
more
of
normal
In recovery
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FACIAL PARALYSIS IN CHILDREN: Review of the Differential Diagnosis and Report of Ten Cases Treated with Cortisone Richmond S. Paine Pediatrics 1957;19;303-316
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