Prognostication of recovery time after acute peripheral facial palsy: a prospective cohort study

Abstract

ObjectiveOwing to a lack of prospective studies, our aim was to evaluate diagnostic factors, in particular, motor and non-motor function tests, for prognostication of recovery time in patients with acute facial palsy (AFP).DesignProspective cohort study.SettingUniversity hospital.Participants259 patients with AFP.MeasurementsClinical data, facial grading, electrophysiological motor function tests and other non-motor function tests were assessed for their contribution to recovery time.ResultsThe predominant origin of AFP was idiopathic (59%) and traumatic (21%). At baseline, the House-Brackmann scale (HB) was >III in 46% of patients. Follow-up time was 5.6±9.8 months with a complete recovery rate of 49%. The median recovery time was 3.5 months (95% CI 2.2 to 4.7 months). The following variables were associated with faster recovery: Interval between onset of AFP and treatment <6 days versus ≥6 days (median recovery time in months 2.1 vs 6.5; p<0.0001); HB ≤III vs >III (2.2 vs 4.6; p=0.001); no versus presence of pathological spontaneous activity in first electromyography (EMG; 2.8 vs probability of recovery <50%; p<0.0001); no versus voluntary activity in EMG (probability of recovery <50% vs 3.1; p<0.0001); normal versus pathological ipsilateral electroneurography (1.9 vs 6.5; p=0.008), normal versus pathological stapedius reflexes (1.6 vs 3.3; p=0.003).ConclusionsStart of treatment and grading, but most importantly EMG evaluated for pathological spontaneous activity and the stapedius reflex test are powerful prognosticators for estimating the recovery time from AFP. These results need confirmation in larger datasets.

Paralisia facial periférica: atividade muscular em diferentes momentos da doença

“…Studies carried out with an invasive EMG, which is a more accurate procedure for muscle evaluation, indicated that the healthy human face may present up to 6% of symmetry during the production of facial expressions (21) . The acute unilateral facial palsy is the most common disease of the facial nerve (19) . Most of those cases end up being diagnosed as idiopathic facial paralysis (Bell's palsy), once the cause of the disease is not identified, with an early use of oral steroids as a traditional medical treatment (12,24) .…”

“…Most of those cases end up being diagnosed as idiopathic facial paralysis (Bell's palsy), once the cause of the disease is not identified, with an early use of oral steroids as a traditional medical treatment (12,24) . The great challenge of the studies is in determining prognosis indicators for the probability and time of recovery for patients, as the existing studies have low casuistry and are mostly retrospective (19) . It is known that much more than the underlying cause for paralysis, the severity of the damage to the facial nerve is crucial in the recovery of movements (19) .…”

“…The great challenge of the studies is in determining prognosis indicators for the probability and time of recovery for patients, as the existing studies have low casuistry and are mostly retrospective (19) . It is known that much more than the underlying cause for paralysis, the severity of the damage to the facial nerve is crucial in the recovery of movements (19) . In this study, it was not possible to characterize, by means of peripheral muscle function, significant differences between individuals with shortterm facial paralysis (0-3 months) and the long-term one (3-6 months).…”

“…Thus, the clinical scales present higher reliability for the evaluation of voluntary movements, possibly because of the difficulty in measuring the spontaneous function or the involuntary movements (18) . Objective tests for the evaluation of PFP include the use of electromyography (EMG), which allows evaluating the degree of degeneration of the nerve to define a prognosis (19) . However, this test is highly invasive, painful, and of limited use in clinical practice, considering that the equipment is found only in a few institutions.…”

Facial Nerve Paralysis in Children

“…Although with less evidences, other rehabilitative approaches, such as physical therapy, biofeedback therapy, relaxation exercises with massages therapy, coordination and facial expression exercises, can reduce muscle stiffness, facilitating facial movements. Relatively to acupuncture and electrical nerve stimulation (in order to accelerate healing by stimulating muscle), there are still not enough data in the literature in order to [32] Ramsay Hunt syndrome Intravenous steroids as soon as possible 75% recovery at 6 mo if treated within 3 d from onset; 30% recovery at 6 mo if treated after 7 d from onset [36,44] Temporalis elongation mioplasty 80% recovery within 1 mo [38] Gracilis muscle microvascular free flap 89% recovery within 4-6 mo [45] Sural nerve grafting N/A Cross-facial nerve grafting 83% recovery within 1 yr [46] Rehabilitation approaches Botulinum toxin 100% recovery (temporary) [24] Physiotherapy Ciorba A et al . Facial palsy in children certify the real efficacy [15,[24][25][26][27] .…”