Forehead sparing (i.e. UMN lesion) or other abnormal neurology |
Neurological examination should be otherwise entirely normal in Bell’s palsy. Look for signs of intracranial lesion. Loss of corneal reflex may indicate a very proximal lesion. |
Middle ear infection, effusion, hearing loss, vertigo, ear discharge |
Look for vesicles – Ramsey-Hunt syndrome Children with acute otitis media and facial palsy – refer to ENT Consider more serious ENT pathology such as cholesteatoma - discuss with ENT |
Parotid mass |
Consider referral to ENT |
Bilateral Palsy |
Consider Guillain Barre or multiple sclerosis. Discuss with paediatric neurology |
Severe Pain |
Consider Ramsay Hunt syndrome and herpes zoster infection. Vesicles not always present but pain is a feature. |
Bruising or organomegaly |
Consider oncological diagnoses |
Hypertension |
Can cause facial palsy and has been a presenting feature of coarctation of the aorta in case reports |
Document Version:
2.0 Lead Author: Kate Pryde, Paediatric Consultant Additional Author: Neeraj Bhangu, Paediatric Registrar Saul Faust, Paediatric Infectious Disease Consultant |
Approving Network:
Wessex Neurosciences Clinical Network Date of Approval: 07/2020 Review Date: 07/2023 |
PIER Contact |
|