The facial nerve is the 7th cranial nerve. It leaves the brain at the brainstem (between the pons and medulla) and travels to innervated the muscles of the face, the taste of the anterior two-thirds of the tongue and the lacrimal/salivary glands. In addition there is a small cutaneous branch that provides sensation around the earlobe. These nerves are paired so that one nerve takes care of the function on that side of the body.
Although facial paralysis can be a presenting/progressing neurologic sign, most cases of 7th nerve dysfunction with brain tumors occur from surgical trauma with posterior fossa tumor removal.
While studies on pediatric facial nerve paralysis are limited, parents may want to look at a 2005 study conducted by Harvard Medical School regarding the management and outcomes of children dealing with this issue.
Symptoms of Facial Nerve Paralysis
When the facial nerve is injured, children will have limited motion or paralysis on one side of the face. There will be facial asymmetry with flattening of the forehead and nasolabial fold, droopy eyebrow and corner of the mouth, inability to close the eyes and lips tightly and abnormal tearing. In most cases this is unilateral but rare cases of bilateral injury has been reported.
The House-Brackmann Scale is typically used to grade the amount of facial nerve dysfunction.
- no abnormality
- slight weakness
- obvious weakness but not disfiguring
- barely perceptible motion
- no movement
Treatment issues involve both the upper and lower part of the face. If the eye is unable to close there is risk of injury particularly from a dry eye or inadvertent trauma. Children may need artificial tears and patching/taping the eyelid closed at night to prevent damage. Children may benefit in seeing an ophthalmologist, perhaps one specializing in ocular plastics.
A similar dysfunction of the 7th cranial nerve happens with Bell’s Palsy. Parents may be able to find useful translatable information in websites dealing with this condition.
If the facial nerve function does not improve there are a variety of reconstructive options that are available. One should consider seeing a specialist in plastic and reconstructive surgery specializing in facial reanimation. They may recommend Static Reconstruction or Dynamic Reconstruction
Although not life-threatening, the loss of a child’s smile is heart-breaking for parents. You can connect with others dealing with this problems through the Pediatric Brain Tumor Facial Paralysis List Serve.