Compressive Neuropathy of the Facial Nerve Presenting as Bell's Palsy in a Pediatric Patient on High-Frequency Oscillatory Ventilation

A three-year eight-month-old female with Werdnig Hoffman disease presented with an acute onset of respiratory failure secondary to influenza infection. The patient required conventional mechanical ventilation (CMV). Due to worsening hypoxemia on maximal support, high-frequency oscillatory ventilation (HFOV) was initiated. On recovery from her respiratory failure, she was noted to have developed a left-sided Bell's palsy. A pressure ulcer in the left mastoid area through which the facial nerve transverses was noted, with no evidence of mastoiditis. The patient fully recovered after a course of oral steroid therapy. We postulate that compression pressure might have contributed to the palsy. However, it is unclear what role the acute viral illness played in this case.