EC Paediatrics

Facial nerve palsies are a prevalent and significant concern, particularly for ear, nose, and throat (ENT) surgeons, as well as in general medical practice. The facial nerve plays a critical role in communication and emotional expression, making any functional impairment potentially detrimental to an individual's quality of life. An essential aspect of the initial assessment for a patient presenting with facial weakness is the differentiation between lower motor neuron (LMN) and upper motor neuron (UMN) palsies. The underlying causes and subsequent treatment approaches for these conditions differ considerably. By integrating anatomical knowledge with the patient's clinical history and examination findings, clinicians can accurately identify the likely cause of facial nerve palsy and tailor management strategies accordingly. The most common cause of facial nerve palsy is classified as Bell palsy, the etiology of which remains largely unknown. The incidence of Bell palsy ranges from 10 to 40 cases per 100,000 individuals. This condition is often diagnosed through exclusion. Clinically, it typically presents as a lower motor neuron lesion resulting in total unilateral paralysis. Patients may experience a viral prodromal period prior to the onset of symptoms, and recurrence can occur in up to 10% of cases. The full presentation of facial nerve palsy generally arises within the first 24 to 48 hours. Compression of the nerve within the bony canal may lead to oedema and secondary pressure, resulting in ischemia and diminished function. Recovery can extend up to one year, with approximately 13% of patients experiencing incomplete recovery. In our case, facial tics will be prioritized at the top of our differential diagnosis list. Tics are characterized as "sudden, rapid, recurrent, nonrhythmic motor movements or vocalizations." They may be classified as simple tics, involving a singular movement or sound, or complex tics, which encompass a combination of various actions or vocalizations.

 Keywords: Facial; Tics; Differential; Diagnosis; Facial Nerve; Palsy

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