Facial palsy as a manifestation of COVID‐19: A systematic review of cases

Abstract

Background and Aims Facial palsy is a rare complication of the COVID‐19 infection. Herein, we conducted a systematic review of all published cases of facial palsy post‐COVID‐19 infection in an attempt to educate the general population and medical practitioners regarding the likely occurrence of facial palsy in COVID‐19 patients, its detection, effective treatment plan, and prognosis of the condition. Methods We searched PubMed, Google Scholar, and Directory of Open Access Journals (DOAJ) from December 1, 2019 to September 21, 2021. Results We included 49 studies bearing accounts of 75 cases who had facial palsy. The mean age of patients was 42.9 ± 19.59 years, with a male‐to‐female ratio of 8:7. The majority of the cases were reported from Brazil ( n = 14), USA ( n = 9), Turkey ( n = 9), and Spain ( n = 9). Noticeably, 30.14% of COVID‐19 patients were diagnosed with Guillain‐Barré syndrome. In total, 22.97% of patients complained of bilateral facial paralysis ( n = 17), whereas ipsilateral paralysis was observed in 77.03% ( n = 57). These were common complaints of Lagophthalmos, otalgia, facial drooping, dysarthria, and compromised forehead wrinkling. The treatment regimen mainly included the use of corticosteroids ( n = 51) (69.86%), antivirals ( n = 23) (31.51%), IVIG ( n = 18) (24.66%), antibiotics ( n = 13) (17.81%), antiretroviral ( n = 9) (12.33%), and antimalarial ( n = 8) (10.96%) medications. In all, 35.62% of patients ( n = 26) adhered to a combination of antiviral and corticosteroid‐based therapy. Positive treatment outcomes were observed in 83.58% ( n = 56) of cases. In contrast, 10 patients (14.93%) showed nonsignificant recovery, out of which 3 (4.48%) died from the disease. Conclusion The association of facial palsy with COVID‐19 is controversial and therefore requires further investigation and published work to confirm a causal relationship. However, physicians should not overlook the likelihood of facial palsy post‐COVID‐19 infection and treat it accordingly.

Efficacy and Adverse Effects of Remdesivir in Patients with COVID-19 Pneumonia: A Retrospective Study

“…In line with previous research (24), our ndings show that preexisting comorbidity and an increase in baseline in ammatory markers substantially impact the progression of COVID-19. This data suggests that careful observation of patients at admission and periodic re-evaluation throughout hospitalization are essential for selecting the appropriate treatment based on individual characteristics and COVID-19 severity and progression.…”

“…It is important to emphasize that in most cases; baseline tachycardia was associated with high body temperatures (fever) and tachypnea at admission. QTc interval prolongation of more than 440 ms in women and more than 460 ms in men was reported in 123 patients (21%) in group B vs. 12% (24) in group B.Except for isolated ventricular ectopic beats, no new-onset heart rhythm abnormalities were observed in any patient group. There was no signi cant bradycardia or ectopic-related clinical symptoms in any of the patients, and remdesivir could continue the full course.…”

“…Furthermore, despite a signi cant decrease in heart rate following remdesivir administration, no severe cardiovascular toxicity was observed in COVID-19 patients, even those with severe disease and cardiovascular comorbidity. (13,(23)(24) We consider the clinician's job to evaluate the cause of the impairment.…”

Comparing the Clinical Manifestations of Bell’s Palsy between Pre-COVID-19 Pandemic and COVID-19 Pandemic Periods

“…The present study found no significant difference in the sex distribution of patients with Bell’s palsy between before and during the COVID-19 pandemic. Two previous systematic reviews of recently reported cases found a slightly higher tendency for facial paralysis among males, but this difference was not significant [ 17 , 18 ]. However, in both the pre- and pandemic periods, there was no significant difference in the incidence of Bell’s palsy between males and females.…”

“…In a systematic review of facial paralysis in patients with COVID-19 from 1 December 2019 to 21 September 2021, in 49 studies involving 74 facial paralysis patients, complete paralysis was observed in one case, and most cases had moderate-to-severe facial dysfunction. Positive treatment outcomes were seen in 83.5% of patients, whereas 14.9% showed nonsignificant recovery [ 17 ]. However, studies on SARS-CoV-2-associated cranial nerve mononeuropathies or polyneuropathies yielded different results.…”