Dear Editor,

I read with interest the case report by Khair and Ibrahim on idiopathic non-traumatic Bell’s palsy (BP) in a two-week-old neonate published in the January 2018 issue of the Oman Medical Journal.1 The authors discussed the different etiologies contributing to the development of BP, namely congenital, inflammatory, traumatic, infectious, syndromic, and ischemic factors. However, none of them was conclusive in explaining the rare occurrence of BP in the studied neonate. I presume that the following factor might be explanatory. It is worthy to mention that the association of human leukocyte antigens (HLA) with BP were studied more than three decades ago.2–4 Smith et al,2 found no association between HLA and idiopathic BP and stated that a lack of association does not exclude a correlation since the possibility exists that the disease is comprised of various etiologically different subgroups, some or all, being associated with different antigens. However, Schwartz et al,3 found a possible association of BP with HLA-DR2, HLA-DR4, HLA-DRW6, and HLA-DRW7. Shibahara et al,4 also reported a significant association between HLA and BP. I presume that it could be possible that certain HLA types might trigger the increased susceptibility to BP and early clinical presentation in the reported case. In-depth studies are needed to firm the actual contribution of HLA types to BP.

references

1. 1. Khair AM, Ibrahim K. Idiopathic non-traumatic facial nerve palsy (Bell’s palsy) in neonates; an atypical age and management dilemma. Oman Med J 2018 Jan;33(1):65-68.
2. 2. Smith CI, Hammarström L, Sidén A. No significant association between HLA and Bell’s palsy. Tissue Antigens 1978 Nov;12(5):404-406.
3. 3. Schwartz MS, Tiwari JL, Rice DH. Bell’s palsy and HLA-DR. A possible association. Arch Otolaryngol Head Neck Surg 1986 Jul;112(7):753-754.
4. 4. Shibahara T, Okamura H, Yanagihara N. Human leukocyte antigens in Bell’s palsy. Ann Otol Rhinol Laryngol Suppl 1988 Nov-Dec;137:11-13.