Abstract
ObjectivesThere is a lack of data on patients’ and diagnostic factors for prognostication of complete recovery in patients with non-idiopathic peripheral facial palsy (FP).MethodsCohort register-based study of 264 patients with non-idiopathic peripheral FP and uniform diagnostics and standardized treatment in a university hospital from 2007 to 2017 (47% female, median age: 57 years). Clinical data, facial grading, electrodiagnostics, motor function tests, non-motor function tests, and onset of prednisolone therapy were assessed for their impact on the probability of complete recovery using univariable and multivariable statistics.ResultsThe most frequent reason for a non-idiopathic peripheral FP was a reactivation of Varicella Zoster Virus (VZV; 36.4%). Traumatic origin had a higher proportion of complete FP (52.9%). Furthermore, in traumatic FP, the mean interval between onset and start of prednisolone therapy was longer than in other cases (5.6 ± 6.2 days). Patients with reactivation of VZV, Lyme disease or otogenic FP had a significant higher recovery rate (p = 0.002, p < 0.0001, p = 0.018, respectively), whereas patients with post-surgery FP and other reasons had a significant lower recovery rate (p < 0.0001). After multivariate analyses voluntary activity in first EMG, Lyme disease and post-surgery cause were identified as independent diagnostic and prognostic factors on the probability of complete recovery (all p < 0.05).ConclusionInfectious causes for non-idiopathic FP like VZV reactivation and Lyme disease had best probability for complete recovery. Post-surgery FP had a worse prognosis.Level of evidence2
Highlights
Peripheral facial palsy (FP) is a most common cranial nerve damage presented to otolaryngologists, neurologists, general practitioners, pediatricians
The present study focused on patients with non-idiopathic peripheral FP in the acute phase
The median Stennert indexes at rest and during voluntary activity at baseline were 2 and 4, respectively. 17% of the patients had a diabetes mellitus
Summary
Peripheral facial palsy (FP) is a most common cranial nerve damage presented to otolaryngologists, neurologists, general practitioners, pediatricians. Facial Nerve Center, Jena University Hospital, Jena, Germany. Less is known on the outcome of non-idiopathic FP. Temporal bone fractures and facial wounds are a common cause for traumatic FP (10–23%, [1]). Iatrogenic lesions during otologic, parotid and vestibular schwannoma surgery are reasons for postoperative FP [1]
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