Periocular management of paediatric facial nerve palsy
Author: Christina Lim
Base Hospital / Institution: Queen Victoria Hospital, East Grinstead, UK
ePoster presentation
Abstract ID: 24-189
Purpose
Facial nerve palsy (FNP) in children is challenging to treat and is associated with neurotrophic cornea and vision loss. There is limited knowledge in the literature regarding its ophthalmic features and surgical management other than tarsorrhaphy. This study reports characteristics of FNP unique to children and alternative surgical techniques.
Methods
A retrospective, case-series in a specialist unit was performed over 9-year period. Inclusion criteria were those with FNP under the age of 18 years at the time of referral. Outcome measures include visual acuity (VA) and CADS grading scale (Cornea, Asymmetry, Dynamic function, Synkinesis).
Results
A total of 26 patients were identified with 29 affected eyes. The mean age of the children in this cohort was 8 (range 1-17) years. Corneal sensation was reduced in 8 children (28%). It was absent in 3 (10%) children with pre-existing corneal scarring. The mean follow-up duration was 60.4 months (range 8-104 months). Periocular surgery was performed in 16 children (62%) which included platinum segment insertion, full-thickness skin graft (FTSG), anterior lamellar repositioning, lower eyelid elevation and punctal cautery. No children underwent tarsorrhaphy. Baseline average CADS scores were Cornea 1.4, Asymmetry 1.0, Dynamic function 2.4 and Synkinesis 0. Following treatment, the average scores were Cornea 0.2, Asymmetry 0.5, Dynamic function 1.4 and Synkinesis 0. The improvements were statistically significant (p<0.05) in all aspects except Synkinesis. Corneal sensation improved in all children who underwent periocular surgery. VA was available in 19 children- it improved in 11 children (58%), stable in 4 (21%), and reduced in 4 children (21%).
Conclusion
Corneal involvement is common in children with FNP. Upper eyelid skin contracture and lower eyelid retraction were notable findings. Lagophthalmos was improved by platinum segment insertion +/- FTSG and lower eyelid elevation which resulted in corneal sensation improvement with VA preservation. Tarsorrhaphy may be contributing to amblyopia. Synkinesis is a rare feature in children with FNP.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Raman | Malhotra | Queen Victoria Hospital, East Grinstead, UK |
| Ruben | Kannan | Queen Victoria Hospital, East Grinstead, UK |
| Charles | Nduka | Queen Victoria Hospital, East Grinstead, UK |
| Catriona | Neville | Queen Victoria Hospital, East Grinstead, UK |
