Introduction: Half of facial paralysis in children is idiopathic at origin. However, dismissing facial
paralysis as being idiopathic without a thorough history and meticulous examination could be
disastrous as illustrated by this case.
Case report: We report a case of sphenoid wing meningioma in a 4-year-old girl. She first
presented with only facial asymmetry that was noticed by her mother. Examination suggested a
left upper motor neuron facial nerve palsy. A sphenoid wing meningioma was found on magnetic
resonance imaging (MRI) of her brain. She underwent craniotomy and total tumour excision.
Histopathological examination of the tumour showed a grade 1 transitional type meningioma.
Meningiomas in children are rare compared to the adult population. Presentations in children
may be delayed due to their inability to recognise or communicate abnormalities. Distinguishing
between upper and lower motor neuron facial palsy is crucial in decision making for facial paralysis
in children.