Abstract
To determine treatment and outcome in a tertiary multidisciplinary facial nerve center, a retrospective observational study was performed of all patients referred between 2007 and 2018. Facial grading with the Stennert index, the Facial Clinimetric Evaluation (FaCE) scale, and the Facial Disability Index (FDI) were used for outcome evaluation; 1220 patients (58.4% female, median age: 50 years; chronic palsy: 42.8%) were included. Patients with acute and chronic facial palsy were treated in the center for a median of 3.6 months and 10.8 months, respectively. Dominant treatment in the acute phase was glucocorticoids ± acyclovir (47.2%), followed by a significant improvement of all outcome measures (p < 0.001). Facial EMG biofeedback training (21.3%) and botulinum toxin injections (11%) dominated the treatment in the chronic phase, all leading to highly significant improvements according to facial grading, FDI, and FaCE (p < 0.001). Upper eyelid weight (3.8%) and hypoglossal–facial-nerve jump suture (2.5%) were the leading surgical methods, followed by improvement of facial motor function (p < 0.001) and facial-specific quality of life (FDI, FaCE; p < 0.05). A standardized multidisciplinary team approach in a facial nerve center leads to improved facial and emotional function in patients with acute or chronic facial palsy.
Highlights
Peripheral facial palsy is the most frequent cranial nerve palsy causing significant functional and psychological morbidity
The patients with acute palsy were referred at a median time of 1 day; 76.2% of the patients with acute palsy were referred within 72 h after onset
The patients with chronic palsy were referred at a median time of 1.5 years
Summary
Peripheral facial palsy is the most frequent cranial nerve palsy causing significant functional and psychological morbidity. The management of patients with facial palsy can be challenging because there are over 50 etiologies [1]. The annual incidence of idiopathic Bell’s palsy as the most frequent type of acute facial palsy is reported to be 20 to 40 of 100,000 persons [2]. As about 70% of the cases of acute facial palsy are Bell’s palsy, the overall incidence of acute facial palsy is 29 to 57 of 100,000 persons per year [3]. Depending on the severity of the lesion, at least 30% of the cases will not recover completely. These cases will remain flaccid (chronic flaccid facial palsy) if not treated otherwise or develop post-paralytic synkinesis due to pathological facial nerve regeneration. The management of patients with facial palsy often requires complex clinical decision-making [5]. Patients with a low probability of recovery are not referred or referred very late to specialized facial palsy services [2,6]
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