Abstract
(1) Background: The effectiveness of decompression surgery for Bell’s palsy is controversial. This study investigated the effects of facial nerve decompression in patients with severe Bell’s palsy who were expected to have a poor prognosis. (2) Methods: We retrospectively reviewed 1721 patients with Bell’s palsy who visited the Kyung Hee University Hospital between January 2005 and December 2021. Of these, 45 patients with severe Bell’s palsy were divided into two groups; 30 patients were treated conservatively with steroids and antiviral agents alone, while 15 patients underwent additional decompressive surgery after the conservative treatment. Outcomes were measured using House–Brackmann (H–B) grade for least 6 months after treatment was finished and conducted until full recovery was achieved. (3) Results: There was no significant difference in the rate of favorable recovery (H–B grade 1 or 2) between the surgery group and the conservative treatment group (75% vs. 70.0%, p > 0.05). Although H–B grade improvement occurred in both groups, the degree of improvement was not significantly different between groups. (4) Conclusions: Facial nerve decompression surgery in severe Bell’s palsy patients did not significantly improve prognosis beyond that offered by conservative treatment alone. Additional surgical decompression may not be necessary in patients with severe Bell’s palsy if they receive sufficient conservative treatment.
Highlights
Bell’s palsy is an acute, unilateral, peripheral facial nerve paresis or paralysis of unknown cause
(4) Conclusions: Facial nerve decompression surgery in severe Bell’s palsy patients did not significantly improve prognosis beyond that offered by conservative treatment alone
These 775 patients were classified by the severity of their initial facial paralysis, as follows: 578 (74.9%) had mild to moderate palsy (H–B grade 2, 3, 4), and 197 (25.1%) had severe palsy (H–B grade 5, 6)
Summary
Bell’s palsy is an acute, unilateral, peripheral facial nerve paresis or paralysis of unknown cause. It has an annual incidence of 20–30 per 100,000 population [1,2]. The pathophysiology of Bell’s palsy includes edematous swelling of the facial nerve within the Fallopian canal, which causes a conduction block and subsequent dysfunction. Most patients with Bell’s palsy have a good prognosis, approximately 10–29% of affected patients develop persistent facial nerve dysfunction [3,4]. It is important to identify and treat patients at high risk of poor long-term outcomes in order to reduce the risk of persistent facial nerve dysfunction and psychological distress [5]
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