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edema of the facial nerve as it passes through the facial canal within the temporal bone There is often a history or preceding upper respiratory tract infection, and in at least a subset of patients, there is evidence of reactivation of infection with Epstein–Barr virus or HSV Seventh nerve palsy may occur in association with otitis media, in which case it may indicate the presence of mastoid involvement Facial palsy may also be a manifestation of early-disseminated Lyme disease In general most cases of facial nerve palsy in children are of the idiopathic (or viral reactivation) type; however, in endemic areas, Lyme disease may be the most common cause Facial weakness may be partial or complete On the affected side, there is flattening of the nasolabial fold at rest, and the child has difficulty closing the eye or raising the corner of the mouth to smile With upper motor neuron involvement, there will be some residual capacity to furrow the brow because of crossed innervation, whereas the entire face is involved with peripheral disease The diagnosis of idiopathic facial nerve palsy is clinical and based on diffuse involvement of all distal branches of cranial nerve VII, an acute onset with progressive course, and an associated prodrome typically consisting of ear pain or dysacusis In endemic areas, testing for Lyme disease is recommended Further evaluation with imaging and CSF is not necessary in patients with a typical presentation Other associated neurologic abnormality, specifically involvement of other cranial nerves, or concomitant otitis media, necessitates further evaluation, including CT or MRI Peripheral nerve palsy in association with acute otitis media may require myringotomy Symptomatic treatment for facial nerve palsy consists of protection of the cornea by the instillation of bland ointments (e.g., Lacri-Lube) The most recent Cochrane Review (2010) demonstrated that treatment with systemic corticosteroids significantly improves the likelihood of complete resolution for patients with idiopathic facial paralysis A separate Cochrane Review (2009) did not demonstrate any improvement in the rate of recovery for those treated with antivirals against herpes virus alone compared to placebo or to antivirals plus corticosteroids Patients treated with antiviral and corticosteroids did have improved rates of recovery As such, antiretroviral therapy is not recommended without evidence of recent or active herpes infection Regardless of treatment, complete recovery is seen in 60% to 80% of children, beginning during the second to third week of illness Those with partial paralysis generally have a better prognosis Patients should be referred for reexamination to ensure recovery during the expected time period
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