Page 105 - FINAL COMPENDIUM 2020-2021 27.2.2022

BELL PALSY IN A 10-YEAR-OLD BOY: A CASE REPORT

Syed Abd Halim SN, Hassan S, Adnan K, Mohd Ariffin S
Introduction: Bell’s palsy, also known as idiopathic facial nerve paralysis, is the most
common diagnosis for peripheral facial nerve palsy. It is defined as acute unilateral
facial nerve paresis or paralysis with onset in less than 72 hours without an identifiable
cause. Clinical presentation typically includes unilateral facial drooping with absence
of facial creases and lagophthalmos. Although idiopathic facial palsy accounts for 60 -
75% of cases, literature reported that facial nerve palsy could be associated with
infections, trauma, inflammatory or neoplastic conditions. Therefore, it is essential for
early clinical detection and recognition in order to facilitate appropriate management.
We present a case of a 10-year-old boy with Bell’s palsy. Case report: A healthy ten-
year-old boy was referred to the Department of Paediatric Dentistry for management
of acute right facial weakness that started 2 days ago. He initially complained of sharp,
intermittent pain over left side of his face which resolved spontaneously. The pain
subsequently recurred over the right side of his face and was associated with obvious
right facial weakness. He claimed he fell from his bicycle whilst playing 3 days prior to
developing his initial symptoms. Otherwise, he denied sustaining any other injuries,
ear pain or any recent history of fever and cold. Generally, he ambulated well,
understands commands and was cooperative upon examination. Peripheral nerve
functions in his extremities were intact and no dermatological lesions were observed.
Extra-oral assessment revealed evident facial asymmetry with right-sided facial
weakness, loss of right nasolabial fold and drooping right corner of mouth. He was also
unable to close his right eye completely. There were no significant intra-oral findings
other than tenderness at the upper right vestibule upon palpation. Radiographic
investigations showed no significant abnormalities. Ear infection was ruled out by the
Otolaryngologist. Based on his history and clinical investigations, the patient was
diagnosed with Bell’s palsy of idiopathic origin. He was prescribed with tapering dose
of Prednisolone for 20 days, home eye care management and referred for facial
physiotherapy. Subsequent reviews showed progressive clinical improvement of his
right facial weakness which completely resolved within 1 month of initial presentation.
Conclusion: The overall prognosis of Bell’s palsy in children is good with uneventful
complete recovery. However, thorough investigation of facial nerve palsy in children
is crucial as it could be associated with other medical conditions. Therefore, proper
history taking and clinical assessment are essential in order to appropriately diagnose
this condition early.

Key words: Bell’s palsy, Facial nerve palsy, Management, Paediatric

th
Virtual poster presentation at the 10 Pahang Research Day 2021 on 22 October 2021
Dr Syarifah Nuratiqah Syed Abd Halim Dr Khairulzaman binti Adnan
Dr Shina binti Mohd Ariffin Dr Syahir Hassan
Department of Paediatric Dentistry Department of Oral and Maxillofacial Surgery
Hospital Sultan Haji Ahmad Shah Hospital Sultan Haji Ahmad Shah
Temerloh, Pahang Temerloh, Pahang

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