Bell’s palsy: clinical and neurophysiologic predictors of recovery

Abstract

Background: The annual incidence of Bell's palsy (BP) is 15 to 20 per 100,000 with 40,000 new cases each year, and the lifetime risk is 1 in 60. For decades, clinicians have searched the prognostic tests of sufficient accuracy for acute facial paralysis. Objective: The present study was designed to verify in BP which clinical or electrophysiological parameters could be considered as predictive of the degree of recovery of normal facial muscle function. Methods: Sixty-three patients with BP were initially assessed according to the House and Brackmann facial function scoring system "HB system". All patients were followed for 3 months, the functional recovery then reassessed according to HB system. Nerve conduction studies were measured on the affected side via a bipolar surface stimulator placed over the stylomastoid foramen. Results: We could not find statistically significant differences between BP with good and poor prognosis as regard age, sex, onset, diabetes, hypertension, dyslipidemia, or the initial HB Score. Compound motor action potential amplitude (CMAP) detected during the initial electroneurography (ENoG) was statistically significant between BP with good and poor prognosis. Conclusions: The initial ENoG is more predictive of recovery of Bell's palsy than the initial clinical grading using the HB system. Age, sex, hypertension, diabetes, and dyslipidemia do not seem to correlate with the degree of recovery in Bell's palsy.

Factors contributing to favorable outcome in adults with Bell’s palsy: experience from a tertiary care hospital of Bangladesh

“…On multivariable logistic regression analysis, favorable outcome was observed with female gender, younger age group, lower initial H-B Grade, absence of hypertension and treatment with steroid and antiviral drugs (Table III). 11 showed that age, sex, hypertension, diabetes and dyslipidemia did not correlate with the degree of recovery in BP. In our study, female sex was associated with good prognosis initially but later on in univariate and multivariate regression analysis it was not appear to be significant factor for favorable outcome.…”

“…Generally, the prognosis of BP is good, with 71% patients regain normal function with or without medical therapy, often within 3 weeks and within next 3 to 5 months improves further 10,11 but up to 30% cases are left with potentially disfiguring facial weakness, involuntary movements and/or persistent lacrimation requiring further interventions. [12][13][14] Therefore, the resolution of BP and risk of paralysis are of great concern to patients.…”

Morphological and Morphometric Analysis of Stylomastoid Foramen in Dry Human Skulls and its Clinical Implications

“…The face becomes asymmetrical and is drawn up to the normal side [14]. The affected side is motionless [15]. Result is asymmetry of corner of mouth, inability to close the eye and disappearance of nasolabial fold [16].…”

New onset of Bell’s palsy in a patient with West Nile Encephalitis

“…However, there are no known reports of development of Bell's palsy with WNV encephalitis. The annual incidence of Bell's palsy is 40 000 new cases each year with 8% to 12% recurrence rate 13 . Up to 70% of patients will have complete resolution without treatment 14 .…”

“…The annual incidence of Bell's palsy is 40 000 new cases each year with 8% to 12% recurrence rate. 13 Up to 70% of patients will have complete resolution without treatment. 14 Even though the underlying pathophysiology remains elusive, Bell's palsy is thought to result due to virus-mediated inflammation resulting in swelling of the CN VII and its compression at the geniculate ganglion.…”