Facial Palsy: A Retrospective Study of 416 Cases Based on Electrodiagnostic Consultation

Vanessa F.M Ferreira,João A Kouyoumdjian,Carla R Graça

doi:10.2174/1874205x02014010015

Abstract

Background: Facial nerve palsy (FP) is a frequent neurological condition caused mostly by Bell´s Palsy (BP). Objectives: The main objective of this study is to describe electrophysiological parameters in a retrospective 28-year review of 416 cases of FP based on electrodiagnostic consultation. Methods: In total, 520 exams from 416 patients over a 28-year period were reviewed. Sex, age, etiology, comorbidities, and variables from electroneurography and needle electromyography were analyzed. Cases were grouped as BP (70.7%), injury (16.4%), iatrogenic (10.3%) and Ramsay Hunt syndrome (RHS) (2.6%). Results: The mean age was 41 years (3-82), 53.4% female. Diabetes was the most frequent comorbidity. Estimated Axon Loss (EAL), >90%, was found in 50% of the cases, mainly in the iatrogenic group. The amplitude drop of the Compound Muscle Action Potentials (CMAPs) was proportional in the Orbicularis Oculi, Orbicularis Oris and Nasalis muscles. The absence of CMAPs was more frequent in the iatrogenic group and less frequent in the BP one. Bell´s palsy associated with diabetes was more severe. The R1 latency (blink reflex) was significantly longer in the BP group (P>0.001). Synkinesis due to the misdirection of regenerating axons was much more frequent in the BP and RHS groups. Conclusion: Bell´s palsy was the most common cause. The EAL was equal in all facial branches. Facial nerve inexcitability was more frequent in the iatrogenic/injury groups. The R1 latency was found to be prolonged in the BP group and the only good prognosis indicator in a few cases. Misdirection reinnervation was more frequent in BP and RHS groups. There was no sex or side predominance.

Highlights

Acute peripheral facial nerve Palsy (FP) is most frequently idiopathic (Bell's Palsy or Bells Palsy (BP)) and represents 46.4% to 69.2% of all Facial nerve palsy (FP) [1 - 4]
The Estimated Axon Loss (EAL) was equal in all facial branches
The R1 latency was found to be prolonged in the BP group and the only good prognosis indicator in a few cases

Summary

Introduction

Acute peripheral facial nerve Palsy (FP) is most frequently idiopathic (Bell's Palsy or BP) and represents 46.4% to 69.2% of all FPs [1 - 4]. Digastric branch, which leaves the main trunk below but close to the stylomastoid foramen, immediately below the posterior auricular nerve which supplies the muscles of the auricle [6, 7]. Sensory loss in the external auditory canal, auditory fluttering due to weakness of the stapedius muscle, ageusia, and involvement of the salivary and lacrimal glands associated with facial weakness, suggest intracranial injury [2]. This differential diagnosis is relatively easy, and most patients receive correct diagnoses in emergency services [8]. Facial nerve palsy (FP) is a frequent neurological condition caused mostly by Bells Palsy (BP)

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Conclusion