What is the treatment for facial droop in a patient diagnosed with mumps?

Treatment for Facial Droop in Mumps

For patients with facial droop (facial nerve palsy) associated with mumps infection, corticosteroid therapy is recommended as the primary treatment to reduce inflammation and improve nerve function, with early initiation being crucial for optimal outcomes.

Pathophysiology of Facial Nerve Involvement in Mumps

• Mumps virus demonstrates tropism for salivary glands but can also affect neural tissues, including the facial nerve, leading to inflammation and subsequent facial weakness or paralysis 1
• The facial nerve palsy in mumps represents a neurological complication similar to other cranial neuropathies that can occur with this viral infection 1
• The mechanism involves direct viral invasion of the nerve and/or inflammatory response affecting the nerve as it passes through the narrow facial canal 1

Diagnostic Approach

• Confirm mumps diagnosis through clinical presentation (parotid swelling) plus laboratory confirmation via:
  • Isolation of mumps virus from clinical specimens
  • Significant rise in serum mumps IgG antibody between acute and convalescent phases
  • Positive serologic test for mumps IgM antibody 2
• Optimal specimens for laboratory confirmation include:
  • Oral/buccal swab from around the affected parotid gland and Stensen duct (preferred for culture/NAAT)
  • Serum for antibody testing 2
• Rule out other causes of facial paralysis through careful neurological examination 1

Treatment Recommendations

Primary Treatment

• Initiate corticosteroid therapy promptly to reduce inflammation and improve nerve function:
  • Prednisone 1-2 mg/kg/day (maximum 60-80 mg daily) for 5-7 days followed by a taper over 5-7 days 2
  • Begin treatment as soon as possible after onset of facial weakness for optimal outcomes 2

Important Considerations for Corticosteroid Use

• Corticosteroid therapy is not contraindicated in mumps when:
  • Treatment is short-term (less than 14 days)
  • Low-to-moderate doses are used
  • It's administered for physiologic replacement 2
• Patients receiving corticosteroid doses equivalent to prednisone ≥2 mg/kg/day or ≥20 mg/day for ≥14 days should avoid live virus vaccines for at least 1 month after stopping steroids 2

Supportive Care

• Provide adequate hydration and pain control with acetaminophen or NSAIDs 2
• Eye protection if facial weakness prevents complete eye closure:
  • Artificial tears during the day
  • Lubricating eye ointment at night
  • Eye patch or tape eyelid closed at night if needed 1
• Physical therapy with facial exercises may help maintain muscle tone during recovery 1

Monitoring and Follow-up

• Monitor for improvement in facial nerve function, which typically begins within 2-3 weeks in most cases 1
• Complete recovery occurs in approximately 70-80% of cases within 3-6 months 1
• Follow up for potential development of other neurological complications of mumps:
  • Aseptic meningitis (occurs in 4-6% of clinical cases)
  • Encephalitis (less common but more serious) 1, 3
• Assess for hearing loss, which can be a rare but serious complication of mumps 1, 4

Prevention of Mumps and Its Complications

• Vaccination remains the most effective prevention strategy:
  • Two doses of MMR vaccine provide approximately 88% protection 1
  • Vaccination has reduced mumps incidence by 99% in the United States 1
• During outbreaks, implement droplet precautions and isolation for 5 days after onset of parotitis 2
• Identify and vaccinate susceptible contacts to limit spread 2

Special Considerations

• Facial droop associated with mumps typically has a better prognosis than idiopathic Bell's palsy 1
• In immunocompromised patients, consider consultation with infectious disease specialists for management 2
• If symptoms worsen despite treatment or fail to improve after 3-4 weeks, consider alternative diagnoses or complications 1