Facial Nerve Paralysis: report of two cases of Bell’s Palsy 5/7/10

Department of Pediatric Dentistry
Resident’s Name: Murphy Program: Lutheran Medical Center - Providence
Article title: Facial Nerve Paralysis: report of two cases of Bell’s Palsy
Author(s): Keels DDS, Martha. Linwood Long, Jr. DDS. Willie Vann, Jr. DMD
Journal: Pediatric Dentistry
Year. Volume (number). Page #’s: 1987. 9(1) 58-62
Major topic: Facial nerve paralysis in children
Overview of method of research: Discussion of 2 cases of Bell’s Palsy(BP)

Findings: Facial nerve paralysis(FNP) is a important and serious cause of morbidity in children, with it’s presentation being quite nerve-racking(no pun intended). FNP can be a sign of an underlying disease. The most common cause of FNP is BP, a unilateral paralysis. Causes of BP are debated, however it is suggested that it may have something to do with Herpes simplex or zoster, nerve compression, venous ischemia, an IAN block gone awry, and narrowing of the bony canal. There is a familial tendency. BP is rare in kid’s younger than2, and is slightly more common on females than males. Signs of BP include widening of the affected palpebral fissure, flattening of nasolabial fold, inability to the eye completely, inability to purse the lips, and drooping of one corner of the mouth. Pain and numbness are reported as well.

Treatment
The most important thing to do is to care for the eye. Artificial tears during the daytime, and a nighttime patch are necessary to prevent corneal abrasion. For chronic BP, steroid therapy and surgical nerve decompression may be necessary. 75% of cases regress spontaneously with full recovery, 15% have satisfactory recovery w/ some neurological deficit, and 10% have permanent paralysis.

Case one was an 11yo male who complained of not being able to smile. It was the first time this had happened to the child. There was no history of trauma. The child’s PCP referred him to an ophthalmologist, who made the diagnosis of BP. Drops were prescribed for the eyes with nighttime patch wear. One month after onset, the BP was hardly noticeable, and after 3 months, there was a full recovery.

Case two was an 8 year old male who presented with what his mom described as ‘a crooked jaw’. The pediatric dentists who saw the child referred him to their PCP for possible BP. The PCP confirmed, and no treatment was recommended. The child’s symptoms did not improve. Approx 2 weeks after the initial diagnosis, the child began choking on a piece of food. The child was brought to the hospital and treated for the incident. At the hospital, numerous tests were conducted. Eventually a diagnosis of pontine glioma was made. The child was treated with radiation. The child eventually died of complications 12 months after the initial diagnosis. Wild.

Key points/Summary: We as pediatric dentists may be the first healthcare providers to see children who present with symptoms of BP. While an extremely small percentage of children who present with FNP have brainstem tumors, it’s our job to make a prompt, proper referral to the PCP.

Assessment of Article: Scary stuff. I’m not even going to say the ‘S’ word

Appliance for chronic drooling in cerebral palsy patients

Resident: Roberts
Date: 5/7/10
Article title: Appliance for chronic drooling in cerebral palsy patients
Author: Inga, Charlie et al.
Journal: Pediatric Dentistry
Volume 23:3
Year: 2001
Discussion
The drooling appliance is very similar to an orthodontic retainer in its design and fabrication. It is an intraoral appliance with full palatal coverage that is constructed of dental acrylic with wire clasp arms and a labial bow. A movable rolling bead is placed in the posterior aspect of the appliance. The location of the place of the bead is dependent on the swallowing pattern of the child Normal tongue position during swallowing is in the midline; however patients with CP may have a deviation to one side or the other. It is critically important to place the bead so that the tongue will be able to come in contact with it and yet be positioned far back in the throat. Instructions on how to use the appliance are controversial. Some clinicians believe that the appliance should only be used when in public places where drooling is a social stigma. They believe that the patient will become resistant to the effect of the appliance. Others believe that it should be used all the time and that the bead should be manipulated as the tongue position changes. Both have been proven to be effective. One recommendation in the article was that the patient be of age and have the cognitive ability to understand the appliance and be involved with the fabrication of it by responding to verbal commands to swallow and helping to determine proper bead placement.
Assessment: Short article and did not get much into explaining why this physiologically worked.