Bell’s palsy is the most common peripheral facial paralysis, characterized by sudden, unilateral facial muscle weakness of unknown etiology. Although more than 50% of peripheral facial paralysis cases are idiopathic, infectious, traumatic, neoplastic, congenital, and iatrogenic causes are also recognized. The primary pathophysiology involves inflammation and compression of the facial nerve, frequently associated with herpes simplex virus type 1. While idiopathic in nature, upper respiratory tract infections, including chronic sinusitis, have been implicated as potential triggers. To report a pediatric case of Bell’s palsy potentially related to chronic sinusitis. J.L.F.M., a 6-year-old boy, initially presented with frontal headache and, 24 hours later, developed left hemifacial paralysis. He had no systemic symptoms. Neurological examination was normal except for facial expression asymmetry. Laboratory tests were negative for acute infection and herpesvirus. Cranial CT revealed mucosal thickening of the paranasal sinuses and reduced aeration of mastoid cells and tympanic cavities, suggestive of chronic sinusitis. Bell’s palsy secondary to sinus disease was hypothesized. The patient received oral prednisolone (1 mg/kg/day for 10 days), sulfamethoxazole-trimethoprim (30 mg/kg/day + 6 mg/kg/day every 12 hours for 10 days), and underwent 20 sessions of facial physiotherapy. Full recovery was observed after three months. Although Bell’s palsy is typically idiopathic, associations with upper respiratory tract infections, particularly otitis media and sinusitis, have been reported. In this case, radiologic findings and absence of acute infection suggest a possible correlation between chronic sinusitis and peripheral facial paralysis. Early recognition and treatment may contribute to favorable outcomes.
Magnus et al. (Sun,) studied this question.