Familial congenital facial palsy.

Congenital unilateral facial palsy has been described as a distinct entity, but there have been few reports of an isolated unilateral familial form, and no reports with supportive neuroimaging. We studied three males from three generations in the same family. Each had a left facial palsy, which was more pronounced with every successive generation. On the House grading scale, the proband, a 9-year-old male, manifested moderately severe facial nerve dysfunction. His 40-year-old father had mild to moderate dysfunction, and his 61-year-old paternal grandfather manifested mild dysfunction. The proband and his father both had abnormal magnetic resonance imaging studies, with the proband's revealing enlargement and enhancement of the tympanic portion of the left facial nerve, and the father's demonstrating enhancement. Temporal bone computed tomography on the 9-year-old confirmed the enlarged left facial nerve. By electromyography/nerve conduction studies there was evidence of a chronic, incomplete, left facial palsy affecting both the father and his son, with substantially lowered compound muscle action potential amplitudes on the left. Congenital unilateral facial palsy spanning three generations with supportive neuroimaging and electromyography/nerve conduction studies has not been previously reported in the literature.

Headache and facial pain in children and adolescents.

Headaches commonly affect children and adolescents. Proper diagnosis and management is dependent on thorough history taking and a comprehensive physical and neurological examination. Additional diagnostic testing is indicated in some cases. The second edition of the headache classification system by the International Headache Society has recently become available. The classification system is primarily based on adults, but we discussed the subtle distinctions made regarding children. In addition to the primary headache types of migraine, tension-type, and cluster headaches, we discussed selected symptomatic headaches. Emphasis was placed on migraine and tension-type headaches because these are the most common pediatric headache types. We briefly discussed genetic aspects of headaches. Genetic factors have been hypothesized for chronic tension headache and other forms of migraine, but genetic linkage has only been established for familial hemiplegic migraine. We reviewed the nonpharmacologic and pharmacologic therapies, including abortive and prophylactic medications for various age groups. Unlike headaches, facial neuralgias are rare in otherwise healthy children. Facial pain may be neurological, vascular, or dental in origin. We focused on trigeminal neuralgia, glossopharyngeal neuralgia, occipital neuralgia, and Bell's palsy as neurological causes of facial pain in children.