Familial Facial Palsy: A Case Series of Six Families from the Northern State, Sudan


Familial facial palsy is uncommon, accounting only for 4–14% of Bell's palsy cases. We report six families with single or recurrent episodes of familial facial palsy from Northern State, Sudan. The first family had two brothers with single episodes of Bell's palsy. The index case of the second family was a 19-year-old female who and nine other members of her family had a single or recurrent episodes of Bell's palsy. The third, fourth, fifth, and sixth families had eight, five, four, and five members, respectively, who developed either single or recurrent episodes of Bell’s palsy. None of the index cases or other members of the six families who were examined showed evidence of facial swelling or fissured tongue suggestive of Melkersson-Rosenthal syndrome. Literature review revealed two studies on Bell's palsy from Sudan but no studies on familial facial palsy. The mode of inheritance was either autosomal dominant with variable penetrance or autosomal recessive. In the second family, there could be a possibility of autosomal recessive inheritance due to increased number of cases after consanguineous marriage. Steroids remain the mainstay of treatment together with protective eye regimens. The role of physiotherapy, although widely used, is controversial. Genetic analysis is recommended and family history should be considered in patients with Bell's palsy.


Bell's palsy, familial facial palsy, Northern State, Sudan

[1] Gilden, D. H. (2004). Clinical practice. Bell's palsy. New England Journal of Medicine, vol. 351, no. 13, pp. 1323–1331.

[2] Kubik, M., Robles, L., and Kung, D. (2012). Familial Bell's Palsy: a case report and literature review. Case Reports in Neurological Medicine, vol. 2012, article 674981.

[3] Mehrjardi, M. Y. V., Maroofian, R., Kalantar, S., et al. (2017). A novel loss-of-function mutation in HOXB1 associated with autosomal recessive hereditary congenital facial palsy in a large Iranian family. Journal of Molecular Syndromology, vol. 8, no. 5, pp. 261–265.

[4] National Organization for Rare Diseases. (n.d.). Melkersson–Rosenthal syndrome. Retrieved from https://rarediseases.org/rare-diseases/melkersson-rosenthal-syndrome/#:~:text=Melkersson%2DRosenthal%20syndrome%20(MRS),the%20tongue%20(fissured%20tongue)

[5] Cancian, M., Giovannini, S., Angelini, A., et al. (2019). Melkersson–Rosenthal syndrome: a case report of a rare disease with overlapping features. Allergy, Asthma & Clinical Immunology, vol. 15, p. 1.

[6] Abbas, K. E. and Prabhu, S. R. (1981) Bell's palsy among Sudanese children report of 7 cases and review of literature. Journal of Oral Medicine, vol. 36, no. 4, pp. 111–113.

[7] Mustafa, A. H. K. and Sulaiman, A. M. (2018). The epidemiology and management of Bell's Palsy in Sudan. Open Dentistry Journal, vol. 12, pp. 827–836.

[8] Gronhoj Larsen, C., Gyldenlove, M., Jonch, A. E., et al. (2015). A three-generation family with idiopathic facial palsy suggesting an autosomal dominant inheritance with high penetrance. Case Reports in Otolaryngology, vol. 2015, article 683938.

[9] Parastatidou, S., Karakaidos, D., Kafalidis, G., et al. (2017). P124 Familial bell’s palsy with recurrency. Archives of Disease in Childhood, vol. 102, no. 2, p. A82.

[10] Quin, D., Ouyang, Z., and Luo, W. (2009). Familial recurrent Bell's Palsy. Neurology India, vol. 57, no. 6, pp. 783–784.

[11] Baugh, R. F., Basura, G. J., Ishii, L. E., et al. (2013). Clinical practice guideline: Bell's Palsy. Otolaryngology–Head and Neck Surgery, vol. 149, no. 3, pp. S1–S27.

[12] Peitersen, E. (2002). Bell’s Palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Oto-laryngologica. Supplementum, vol. 549, pp. 4–30.

[13] Samsudin, W. S. W. and Sundaral, K. (2013). Evaluation and grading systems of facial paralysis for facial rehabilitation. Journal of Physical Therapy Science, vol. 25, pp. 515–519.