Paralysie faciale idiopathique de l’enfant

RésuméLa paralysie faciale idiopathique est la première cause de paralysie faciale périphérique de l’enfant. Sa prise en charge est controversée. Les objectifs de notre travail étaient d’étudier ses caractéristiques cliniques et évolutives afin d’en proposer un traitement adapté. Pour ce faire, nous avons étudié rétrospectivement les dossiers de 37 enfants (24 filles) atteints de paralysie faciale idiopathique entre 2007 et 2012. Leur âge moyen était de 13,9 ans. Soixante-dix-huit pour cent avaient une atteinte modérément sévère (grade IV) ou sévère (grade V de House et Brackmann). La prise en charge avait été uniquement ambulatoire chez 27 enfants et en hospitalisation chez 3 enfants. Sept avaient eu un suivi d’abord ambulatoire puis en hospitalisation. Tous avaient reçu une corticothérapie et un traitement antiviral avait été administré chez 8 enfants. La récupération avait été complète chez 94,6 % des enfants après un délai moyen de 7,4 semaines. En conclusion, la paralysie faciale idiopathique de l’enfant est de bon pronostic et la prescription précoce de stéroïdes et d’antiviraux nous paraît justifiée. Cependant, des essais pédiatriques contrôlés randomisés seraient nécessaires pour préciser la stratégie de prise en charge.

SummaryBackgroundIdiopathic facial palsy is the most common cause of facial nerve palsy in children. Controversy exists regarding treatment options. The objectives of this study were to review the epidemiological and clinical characteristics as well as the outcome of idiopathic facial palsy in children to suggest appropriate treatment.Patients and methodsA retrospective study was conducted on children with a diagnosis of idiopathic facial palsy from 2007 to 2012.ResultsA total of 37 cases (13 males, 24 females) with a mean age of 13.9 years were included in this analysis. The mean duration between onset of Bell's palsy and consultation was 3 days. Of these patients, 78.3% had moderately severe (grade IV) or severe paralysis (grade V on the House and Brackmann grading). Twenty-seven patients were treated in an outpatient context, three patients were hospitalized, and seven patients were treated as outpatients and subsequently hospitalized. All patients received corticosteroids. Eight of them also received antiviral treatment. The complete recovery rate was 94.6% (35/37). The duration of complete recovery was 7.4 weeks.DiscussionChildren with idiopathic facial palsy have a very good prognosis. The complete recovery rate exceeds 90%. However, controversy exists regarding treatment options. High-quality studies have been conducted on adult populations. Medical treatment based on corticosteroids alone or combined with antiviral treatment is certainly effective in improving facial function outcomes in adults. In children, the recommendation for prescription of steroids and antiviral drugs based on adult treatment appears to be justified.ConclusionRandomized controlled trials in the pediatric population are recommended to define a strategy for management of idiopathic facial paralysis.