Title : The approach of non-traumatic congenital unilateral facial paralysis through two cases reports and literature review
Abstract:
Introduction: The incidence of facial paralysis in children is 0,2%, trauma and infection includes the majority, and it can be diagnosed as a part of a syndrome or sole. However, non-traumatic congenital facial paralysis (NCFP) is quite rare. Developmental abnormality due to interruption of blood supply occurring during nerve embriogenesis results in peripheral facial paralysis. First presentation of this comprises Moebius Syndrome (MS) which includes other malformations. Two conditions that might enter in discussion are hereditary congenital facial paresis (HCFP) and unilateral facial nerve agenesis (UFNA).
Method: The objective is to give a peer review about congenital facial paralysis and report 2 cases, approaching the possible differential diagnosis.
Results: Case1: A female 4-month-old infant referred to the neuropediatrician after the mother’s perception that the child has asynchrony in blinking the eyes, with deficiency of this movement in the right eye. The child, without previous hospitalizations, nor previous complaints of health, was born of caesarean delivery, term and normal follow-up in the developmental milestone without intercurrences. There isn’t family history of consanguinity or neurological diseases. She has adequate tone and strength. In MRI, the seventh right cranial nerve was not found in the intra-meatal tract, but branches of the right and left vestibular and cochlear nerves (thickness and preserved signs) were found. On the left side we also observed the seventh cranial nerve with caliber and present and normal signs. The initial approach adopted included follow-up with ophthalmologist and physiotherapist. Case 2: A female, 3 years, natural term delivery, with left facial paralysis and jaundice. She was transferred to neonatal ICU. She was diagnosed with MS with an adequate neuropsychomotor development. In February 2017, she underwent surgery to correct strabismus. She is being followed up by an otolaryngologist for a nasal obstruction. Nowadays, she has dysphagia, choking with water sometimes. On physical exam, she has right peripheral facial paralysis, bilateral patellofemoral hyperreflexia nor other alterations. She has a normal echocardiogram, CT with paranasal sinus veins; on MRI, there’s hypodensity area in sickle and tent. The ophthalmologic evaluation suggests Moebius Syndrome, even being unilateral facial paralysis, due to having fixed bilateral convergent strabismus and laryngomalacia with indication of supraglottoplasty and bilateral tympanotomy. The actual MRI and otologic evaluation are normal. Discussion: Both cases are unilateral congenital facial palsy, the first has an isolated NCFP, which moves away from incomplete MS or other causes of complex NCFP, and clinical suspicions go further between HCFP and UFNA. However, her MRI confirms facial nerve agenesis, tapering to congenital right facial nerve agenesis. The second case has unilateral facial palsy, otolaryngological abnormalities, strabismus and dysphagia, which takes us to the diagnosis of incomplete MS.
Conclusion: The neuropathology of the three conditions most approached on our research are quite different between themselves, and clinically the diagnosis of incomplete MS is confused given to cases of HCNP or UFNA. Therefore, all of the causes above (isolated or complex) might have be considered in the painel of differential diagnosis.
Audience Take Away:
• The initial optimal assessment of the neonate born with unilateral facial paralysis should be performed as soon after birth as possible by a multidisciplinary team with the goal being to distinguish between a traumatic or developmental etiology.
• Our research with those two cases exemplify really rare conditions and non-widespread in neuropediatrics science, which leads to a huge learning on science community. The cases in question report a non-routine condition of the pediatricians and neurologists practice and a very rare and contraditional situation. Therefore, it is really relevant for the identification of children. Whom enter in the difficult differential diagnosis of congenital facial paralysis.
