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Isolated unilateral Palatal Palsy- a postinfectious inflammatory mononeuritis of the pharyngeal branch of the vagal nerve

Objectives: To describe our experience of managing 3 children with isolated unilateral palatal palsy .

Methods: This is a retrospective case series analysis. Results: All the patients had a history of preceding infection and on examination was found to have isolated unilateral palatal palsy with no other systemic or neurological abnormalities . Investigations (table1) were unremarkable except for vitamin D deficiency. All were treated with steroids and made full recovery without any residual deficit. Preceding infection and full recovery with steroids point to a probable postinfectious inflammatory mononeuritis as the cause for the disease.

Conclusion: We suggest that the approach to management of isolated unilateral palatal palsy can be similar to managing Bell’s Palsy. Patients would likely respond to oral steroids. The red flags to consider would include history of trauma, weight loss , sub-acute onset , fever, involvement of other cranial nerves or presence of other neurological signs apart from isolated palatal palsy. In the absence of above mentioned red flags invasive and expensive investigations may not be necessary. Excellent prognosis supported by previous studies can help us in reassuring the parents(1,2). References: 1. Sondhi V, Patnaik SK. Isolated idiopathic unilateral paralysis of soft palate and pharynx. Indian Pediatr. 2011 Mar;48(3):237–9 2. Walter V, Nisa L, Leuchter I. Acute isolated velopharyngeal insufficiency in children: case report and systematic review of the literature. Eur Arch Otorhinolaryngol. 2013 Jul 1;270(7):1975–80
Keywords: Palatal Palsy inflammatory mononeuritis