Facial paralysis in children: differential diagnosis

Otolaryngol Head Neck Surg. Sep-Oct 1981;89(5):841-8. doi: 10.1177/019459988108900528.


The differential diagnosis in 170 patients between birth and 18 years of age is reviewed. There are a number of obvious physical findings and historical features that allow one to make a diagnosis rather quickly. Pain, vesicles, a red pinna, vertigo, and sensorineural hearing loss suggest herpes zoster oticus. Slow progression beyond three weeks, recurrent facial paralysis involving the same side, facial twitching, weakness, or no return of function after six months indicate a neoplasm. Bilateral simultaneous facial paralysis indicates a cause other than Bell's palsy, such as Guillain-Barré syndrome, pseudobulbar palsy, sarcoidosis, and leukemia. Recurrent facial paralysis associated with a fissured tongue, facial edema, and a positive family history should suggest Melkersson-Rosenthal syndrome.

MeSH terms

  • Abnormalities, Multiple*
  • Adolescent
  • Birth Injuries / complications
  • Child
  • Child, Preschool
  • Cranial Nerve Neoplasms / complications
  • Craniocerebral Trauma / complications
  • Diagnosis, Differential
  • Facial Nerve / anatomy & histology*
  • Facial Paralysis / congenital
  • Facial Paralysis / etiology*
  • Humans
  • Infant
  • Infant, Newborn
  • Mouth Abnormalities / complications*
  • Otitis Media, Suppurative / complications