Prognosis of patients with recurrent facial palsy

Abstract

No studies to date have classified recurrent facial palsy according to the House-Brackmann grade, thus limiting any comparisons between patients with recurrent and primary facial palsy. The aims of the study were to analyze the degree of recovery from recurrent facial palsy and factors affecting the degree of recovery and to compare with patients recovering from primary facial palsy. Seventy-two patients with recurrent facial palsy were treated by the same treatment approach as 1,185 patients with general facial palsy. Underlying disease, palsy side, and extent of recovery were measured. Temporal bone magnetic resonance image (MRI), Electroneurography (ENoG), electromyography (EMG), and initial House-Brackmann grade were assessed and compared by statistical analyses. Recovery rate of facial palsy were compared and related risk factors were analyzed. We found that recovery to better than House-Brackmann grade II was more common in patients with primary (88.4%, 1,047/1,185) than with recurrent (72.2%, 52/72) facial palsy. Recovery was observed in 80.6% (25/31) of patients with recurrence on the ipsilateral side and in 72% (18/25) with recurrence on the contralateral side. The accuracies of ENoG and EMG were 76.4 and 84.7%, respectively. In MRI, 26.4% patients showed enhancement findings. Multivariate logistic regression analysis showed that initiation of treatment within 7 days and unfavorable EMG results were significant risk factors in patients with recurrent facial palsy. The recovery rate was lower in patients with recurrent than with primary facial palsy, but there were no significant differences in recovery rates between recurrences on the ipsilateral and contralateral sides. The prognosis of patients with recurrent facial palsy was associated with initiation of treatment within 7 days, with EMG shown to be the most reliable test.

Recurrent Bell's palsy

“…Studies have yielded contradictory results on the relationship between the side affected by recurrence and patient prognosis. Four studies showed that rates of complete recovery were lower in patients with ipsilateral than contralateral recurrent facial palsy, whereas a fifth study found that patients with ipsilateral recurrent facial palsy had a better prognosis . The current meta‐analysis showed no significant difference in complete recovery rate between patients with ipsilateral and contralateral recurrence.…”

“…Patient outcomes were assessed most frequently by House‐Brackmann (H‐B) grade, with other measures including acoustic stapedius reflexes, and FPRP(facial paralysis recovery profile)/FPRI(facial paralysis recovery index) ratios . After a follow‐up period of 6 months to 2 years, 58 patients had H‐B grade ≤ 4 and 14 had H‐B grade ≥ 5.…”

“…H‐B grade, the standard selected by the Facial Nerve Disorders (FND) Committee, is a gross grading system that includes items evaluating the sequelae of facial palsy, including contracture, synkinesis and spasm . Of the 27 included studies, only six evaluated H‐B grade as an outcome . Most of the included studies were performed prior to 1985, when H‐B grade was first introduced.…”

“…Because only one of the 27 included studies utilised ENOG and EMG for neuropsychological tests, it could not be determined whether the results of these tests would be useful in assessing recovery from recurrent facial palsy. In that study, however, the accuracies of ENoG and EMG were 76.4% and 84.7%, respectively, suggesting that the results of both tests, especially EMG, would be prognostic.…”

La paralysie faciale périphérique bilatérale et l’infiltration mastoïdienne comme symptômes d’une récidive de leucémie aiguë myéloblastique

“…Son incidence est faible (20-30/100 000 cas dans la population) et son taux de séquelles le plus faible, avec une régression complète de la symptomatologie dans 83 % des cas [1]. D'autres étiologies sont rarement suspectées ou investiguées, il est donc possible que le rôle de la PFF dans les PFP soit surestimé.…”