Not all acute peripheral facial palsy in children recovers completely: A telediagnostic follow-up study.
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OBJECTIVES: Up to 30% of adults with peripheral facial palsy (FP) develop synkinesis, but it's incidence in children remains unclear due to limited long-term data. METHODS: Children (<18 years) treated for acute peripheral FP at Jena University Hospital between 2009 and 2021 were screened in this cross-sectional study. Bell's palsy and infection-associated FP (e.g., Lyme disease, Zoster) were included, while secondary causes such as tumors, trauma, CNS disorders, and conditions like Guillain-Barré syndrome or Chiari malformation were excluded. Video follow-ups collected clinicodemographic information and PROMs including Facial Clinimetric Evaluation Scale (FaCE), Facial Disability Index (FDI), and Synkinesis Assessment Questionnaire (SAQ). Facial movements were video-recorded and assessed using Sunnybrook and eFACE. RESULTS: Of 85 eligible patients, 26 participated (46% female; response rate 30.6%). Mean age at onset was 8.5 years (range: 0.2-16); 54% had idiopathic FP (IFP) and 46% Lyme-associated FP (LFP). Median follow-up was 7.56 years (range: 2.5-13). All LFP participants and 11 out of 14 IFP participants achieved complete or near-complete recovery (eFACE and Sunnybrook scores 90-100). Four participants (28.6%), exclusively from the IFP group, developed synkinesis, three with functional impairments in PROMs and video-based assessment. Seven participants (five (35.7%) from the IFP group and two (16.7%) from the LFP group) reported that they still experience mental health-related effects of FP today. CONCLUSION: The data indicate that a relevant proportion (around 21.4%) of children with Bell's palsy develop moderate to severe synkinesis. Long-term follow-up and further research on corticosteroids use in pediatric FP are warranted.