The etiology of Bell's palsy (BP) is still not defined. Familial inheritance has been found in 4–14% of cases. We describe a case of one such family affected by BP and review the current literature concerning hereditary influences.

The patient case history, clinical examination and detailed family history provided by the patient.

We report the case of a ten-month-old female presented with acute onset of right-sided facial muscle weakness. BP is rare in children under the age of two years. Further questioning revealed she was one of seven members with a history of BP. One of those was another children (seven-months-old) affected by BP (Fig. 1).

The manifestation is slightly greater in females at a 1.5 to 1 ratio. There are some described causes of facial nerve palsy in children, as it can be congenital or acquired.

The literature showed the association between HLA and BP. It was postulated that familial facial palsy is an autoimmune disease with genetic predisposition, suggesting autosomal dominant inheritance with low penetrance or variable penetrance. One study of 92 patients with BP found a significant decrease in the HLA class 2 DR antigen and severely decreased levels of CD3/CD4T cells, suggesting that it may exist resistance HLA-DR gene. Furthermore, it is described in literature that a structural abnormality of the dimension of facial canal is the most common cause of the familial facial palsy.

There are few cases described about familial facial palsy in the literature. It's uncommon BP in children under two years. The familial clustering of BP is not an incidental happening, the number of related cases suggests the familial influence component. Familial facial palsy is an autoimmune disease with an HLA genetic association or anatomical abnormality of the facial canal.