Peripheral facial nerve palsy

Czech version

Authors: Jakub Malý ¹; Miroslav Mamiňák ²; Ivana Monková ³
Authors‘ workplace: Klinika dětí a dorostu, 3. lékařská fakulta, Univerzita Karlova a Fakultní nemocnice Královské Vinohrady, Praha ¹; Klinika dětské neurologie, 2. lékařská fakulta, Univerzita Karlova a Fakultní nemocnice Motol a Homolka, Praha ²; Klinika rehabilitace a tělovýchovného lékařství, 2. lékařská fakulta, Univerzita Karlova a Fakultní nemocnice Motol a Homolka, Praha ³
Published in: Čes-slov Pediat 2026; 81 (5): 253-258.
Category: Pediatric Protocols in Praxis
doi: https://doi.org/10.55095/CSPediatrie2026/040

Overview

The facial nerve is the seventh cranial nerve, although primarily known for the innervation of the muscles of facial expression of the head and neck, it has mixed functions. Lesions of this nerve are classified as central, involving the cortical region and the corticonuclear tract, or peripheral, affecting the facial nuclei, the facial nerve and the nervus intermedius. Peripheral facial nerve palsy is not uncommon in the paediatric population and represents one of the most frequent mononeuropathies in childhood. Detailed knowledge of the anatomical course and functions of the seventh cranial nerve is essential for proper clinical examination and accurate diagnosis. The differential diagnosis is broad and determines the appropriate therapeutic approach. Facial nerve palsy may have congenital, infectious, autoimmune or traumatic etiology. As facial nerve palsy may represent a manifestation of neuroinfection, lumbar puncture with cerebrospinal fluid analysis is considered a standard diagnostic procedure. In diagnostically unclear cases, contrast-enhanced magnetic resonance imaging of the brain is used to detect facial nerve edema or possible tumor involvement. Regardless of etiology, rehabilitation plays a key role in management. Therapeutic approaches include physiotherapy (soft-tissue techniques, massage, subcutaneous tissue mobilization, and neurophysiologically based methods), electrostimulation, kinesiotaping, and less commonly, balneotherapy. Parental education is essential. Delayed initiation of rehabilitation may lead to irreversible complications such as keratopathy, synkinesis, contractures or hearing impairment.

Keywords:

Physiotherapy – Facial nerve – rehabilitation – Lyme borreliosis – Bell's palsy – synkinesis

Sources

1. Ambler Z. Periferní paréza nervus facialis. Interní Med 2010; 12(9): 445–447.

2. Seidl Z. Neurologie –⁠ pro studium i praxi. 2. vyd. Praha: Grada 2015.

3. Kraus J, Sebroňová V, Brožová M. Léze mozkových nervů u dětí. Neurol praxi 2012; 13(5): 261–264.

4. Zaidman C. Facial nerve palsy in children. Dostupné na: https://www.uptodate.com/contents/facial-nerve-palsy-in-children

5. Karatoprak E, Yilmaz S. Prognostic factors associated with recovery in children with Bell’s palsy. J Child Neurol 2019; 34(14): 891–896.

6. Fancello V, Ciorba A, Monzani D, et al. Acute onset of peripheral facial nerve palsy in children: an overview. Pediatr Rep 2024; 16(4): 844–853.

7. Karalok ZS, Taskin BD, Ozturk Z, et al. Childhood peripheral facial palsy. Childs Nerv Syst 2018; 34(5): 911–917.

8. Goswami Y, Gaurkar SS. Ramsay Hunt syndrome: an introduction, signs and symptoms, and treatment. Cureus 2023; 15(1).

9. Společnost infekčního lékařství ČLS JEP. Doporučený postup diagnostiky a léčby lymeské borreliózy. Dostupné na: https://infektologie.cz/DPLB18.htm

10. Gronseth GS, Paduga R. Evidence-based guideline update: steroids and antivirals for Bell palsy: report of the guideline development subcommittee of the American Academy of Neurology. Neurology 2012; 79(22): 2209–2213.

11. Babl FE, Herd D, Borland ML, et al. Efficacy of prednisolone for Bell palsy in children: a randomized, double-blind, placebo-controlled, multicenter trial. Neurology 2022; 99(20): e2241–e2252.

12. Klímová A, Bydžovský J, Skalická P. Oční komplikace periferní parézy nervus facialis a možnosti jejich terapeutického řešení. Neurol praxi 2023; 24(2): 94–97.

13. Růžička E, et al. Neurologie. 2. vyd. Praha: Triton 2021.

14. Khan AJ, Szczepura A, Palmer S, et al. Physical therapy for facial nerve paralysis (Bell’s palsy): an updated and extended systematic review of the evidence for facial exercise therapy. Clin Rehabil 2022; 36(11): 1424–1435.

15. Teixeira LJ, Valbuza JS, Prado GF. Physical therapy for Bell’s palsy (idiopathic facial paralysis). Cochrane Database Syst Rev 2011; (12): CD006283.

16. Janda V. Svalové funkční testy. Praha: Grada 2004.

17. House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985; 93(2): 146–147.

18. Beurskens CHG, Heymans PG. Physiotherapy in patients with facial nerve paresis: description of outcomes. Am J Otolaryngol 2004; 25(6): 394–400.

19. Hromádková J. Fyzioterapie. Praha: H & H Vyšehradská 1999.

20. Kolář P, et al. Rehabilitace v klinické praxi. 2. vyd. Praha: Galén 2020.

21. Klinika rehabilitace a tělovýchovného lékařství 2. LF UK a FNMH. Pokyny pro pacienty s obrnou lícního nervu. 2019. Dostupné na: https://fnmotol.cz/wp-content/uploads/doporuceni-pro-pacienty-s-obrnou-licniho-nervu.pdf

22. Loyo Li M, Cameron MH, Volk GF. Does electrical stimulation still have a place in the treatment armamentarium for Bell’s palsy? Expert Rev Neurother 2024; 24(1): 1–3.

23. Ministerstvo zdravotnictví ČR. Materiál k aplikaci zákonné úpravy v oblasti poskytování lázeňské léčebně rehabilitační péče. 2025. Dostupné na: https://mzd.gov.cz/wp-content/uploads/2020/07/Material-k-aplikaci-zak.-upr.-v-oblasti-poskytovani-LLRP.pdf

24. Bilge S, Mert GG, Hergüner MÖ, et al. Peripheral facial nerve palsy in children: clinical manifestations, treatment and prognosis. Egypt J Neurol Psychiatr Neurosurg 2022; 58(1): 152.