Use of the inactivated SARS-CoV-2 vaccine and the risk of Bell's palsy in China: A case-control study.

Nationwide Adherence to Bell's Palsy Clinical Practice Guidelines: Retrospective Analysis Using a Large-Scale EHR Database.

Background: Dentofacial anomalies, including malocclusion, emerge from the interplay of genetic, clinical, and environmental determinants. Understanding the factors associated with these anomalies is crucial at the primary care level. Our study aimed to determine the possible associated factors with dentofacial anomalies in patients attended at the primary care level. Methods: A multivariate logistic regression model was applied to a primary care population, with the presence of dentofacial anomalies as the dependent variable. Independent variables included age and selected clinical conditions of dental and neurological origin. Results: Age was inversely associated with dentofacial anomalies (OR = 0.991; 95% CI 0.985-0.998; p = 0.013). Significant clinical factors included vertigo (OR = 2.59; 95% CI 1.42-4.71; p = 0.002), hearing loss (OR = 4.34; 95% CI 2.44-7.72; p < 0.001), trigeminal neuralgia (OR = 8.54; 95% CI 3.22-22.67; p < 0.001), Bell's palsy (OR = 9.19; 95% CI 4.01-21.04; p < 0.001), caries limited to enamel (OR = 17.92; 95% CI 12.99-24.71; p < 0.001), and acute gingivitis (OR = 10.64; 95% CI 5.61-20.20; p < 0.001). Conclusions: Both oral and neurological conditions showed strong associations with dentofacial anomalies. The model identified key factors that may facilitate early detection and guide the development of targeted preventive strategies in oral health practice and policy, supporting the integration of multidisciplinary approaches to patient care.

Introduction: facial paralysis is an acute condition at the peripheral level that sets in abruptly. It produces a decrease or absence of mobility of the muscles that innervate the affected hemiface. It can be of central or peripheral origin. Depending on this, the rehabilitation treatment should be adjusted, taking into account the particularities of the affected persons and paying special attention to the emotional aspect.Objective: to identify the degree of satisfaction with the rehabilitation treatment of people with Bell's Palsy at the Dr. Carlos Juan Finlay Teaching Hospital. Methods: a cross-sectional descriptive study was carried out with a sample of 50 clinical histories. The variables used were sex, age, personal pathologic antecedents, symptoms and signs observed and the patient's evolution. Results: a clinical evolution with a very satisfactory result was observed in 64 % of the totality. The symptoms of facial asymmetry and deviation of the labial commissure after treatment were those that most frequently had a positive response. Conclusions: it was possible to identify that the clinical evolution achieved in more than half of the studied sample was very satisfactory. As secondary findings it was found that the most frequent pathological antecedents were arterial hypertension, diabetes mellitus and ischemic heart disease.

Bell's palsy appears to be more common in pregnancy, but incidence numbers differ. Risk factors for pregnancy-associated Bell's palsy have been discussed, but larger studies are needed to receive significant results. This study aimed to investigate the incidence and maternal risk factors of pregnancy-associated Bell's palsy. It is a nationwide register-based cohort study. Women with Bell's palsy in Sweden from 2005 to 2015 were identified in the National Patient Register. Women giving birth at ≥22 gestational weeks during the same period were identified in the Medical Birth Register. Pregnancy-associated Bell's palsy was defined as the first diagnosis of Bell's palsy during pregnancy or within the first 2 months postpartum, identified by linking the data sets. Childbirths in women without a history of Bell's palsy were used as a comparison group. Risk factors were identified using backward conditional multivariable logistic regression and presented with adjusted odds ratios (aOR) with 95% confidence intervals (CIs). A total of 2051 childbirths in women with pregnancy-associated Bell's palsy were identified. For a comparison 1 188 489 childbirths in women without a history of Bell's palsy were used. The incidence of pregnancy-associated Bell's palsy was 171.6 per 100 000 childbirths. Pregnancy-associated Bell's palsy was associated with high BMI (e.g., BMI 30-34.9, aOR 1.30, 95% CI 1.12-1.50), being born in Asia (aOR 1.19, 95% CI 1.04-1.37), Africa (aOR 1.76, 95% CI 1.47-2.11), or South America (aOR 1.85, 95% CI 1.35-2.55), multiple pregnancy (aOR 1.83, 95% CI 1.48-2.26), and a diagnosis of herpes zoster (aOR 6.55, 95% CI 2.93-14.67), borreliosis (aOR 3.70, 95% CI 1.38-9.89), gestational diabetes (aOR 1.68, 95% CI 1.31-2.15), or preeclampsia (aOR 2.02, 95% CI 1.74-2.35). The incidence of pregnancy-associated Bell's palsy was 171.6 per 100 000 childbirths. Risk factors related to metabolic stress were associated with pregnancy-associated Bell's palsy, although the causal pathway remains unclear.

Importance: Corticosteroids are recommended as first-line treatment for adults with acute Bell's palsy, but their role in children remains uncertain. Objective: To assess the effect of corticosteroid therapy on recovery rates in children with acute Bell's palsy. Evidence Review: PubMed, Scopus, and Cochrane Library were systematically searched from inception to April 2, 2025, for studies on corticosteroids for children with Bell's palsy. Odds ratios and risk ratios with 95% confidence intervals were pooled using R software (version 4.2.3). Risk of bias was assessed with RoB2 and ROBINS-I. Findings: Eleven studies were included, comprising 750 children, of whom 495 (66%) received corticosteroids. The analysis across final follow-ups showed no significant difference. Because follow-ups ranged from 1 to 24 months, 1, 3, and 6 months were used as key points to create comparable intervals. The following subgroups were analyzed for each interval: corticosteroid monotherapy and corticosteroids plus adjunctive therapy. Corticosteroid monotherapy was associated with higher complete recovery rates beyond 1 month and a lower risk of incomplete recovery after 6 months. Conclusions and Relevance: Corticosteroid monotherapy in children with acute Bell's palsy may improve recovery rates beyond the first month, supporting its implementation in treatment protocols.

Glucagon-like peptide-1 (GLP-1) receptor agonists have emerged as key agents in managing type 2 diabetes mellitus (T2DM), with proven benefits in glycemic control, weight loss, and cardiovascular risk reduction. However, their neurologic safety profile remains underexplored. To evaluate the association between GLP-1 receptor agonist use and the incidence of cranial nerve (CN) palsies in patients with T2DM. This retrospective cohort study utilized the TriNetX Global Collaborative Network, comprising de-identified records from 160 healthcare organizations. Patients with T2DM treated with GLP-1 receptor agonists were compared to propensity-score-matched T2DM controls who never received GLP-1 therapy. Exclusion criteria included prior CN palsy diagnoses, CNS malignancy, type 1 diabetes, and neurological comorbidities. Outcomes assessed over a 10-year period included third nerve palsy (H49.0), sixth nerve palsy (H49.2), and Bell's palsy (G51.0). Propensity score matching was applied for age, sex, hypertension, dyslipidemia, insulin exposure, metformin use, and SGL2 inhibitor use. After matching (n = 841,219 per group), GLP-1 users had a significantly reduced incidence of CN III palsy (RR: 0.86, 95% CI: 0.76-0.98) and Bell's palsy (RR: 0.92, 95% CI: 0.87-0.96), with p < 0.05 for both. CN VI palsy demonstrated a moderately elevated risk ratio (RR: 1.15, 95% CI: 1.03-1.28), but long-term hazard favored GLP-1 therapy (HR: 0.76, 95% CI: 0.68-0.84). Hazard ratios showed consistent protective ratios across all three outcomes, supported by Kaplan-Meier survival analysis (log-rank p < 0.001). While absolute risks remain low, GLP-1 receptor agonist use was associated with a statistically significant decrease in cranial nerve palsies, demonstrating a potential protective pattern across multiple cranial nerve palsies. These findings suggest possible neuroprotective or microvascular benefits of GLP-1 signaling and warrant further investigation, particularly in ophthalmological and neurological domains.

Background: Bell's palsy affects approximately 20-30 per 100,000 individuals annually. While conventional facial exercises show benefits (Khan et al., 2022; Teixeira et al., 2011), systematic application of eccentric muscle training principles to facial rehabilitation remains unexplored. Objective: To propose an evidence-informed protocol integrating eccentric facial muscle exercises during early and recovery phases of Bell's palsy, emphasizing accessibility and costeffectiveness. Methods: This protocol synthesizes current facial rehabilitation evidence with established eccentric exercise principles to create a progressive home-based intervention requiring minimal equipment. Results: A 12-week protocol is presented incorporating acute protection (weeks 1-3), active eccentric training (weeks 4-8), and functional integration (weeks 9-12) phases. Total material cost: $3-23 per patient versus $1,600-3,600 for conventional therapy. Conclusion: Eccentric facial muscle exercises represent a promising, cost-effective approach addressing gaps in Bell's palsy rehabilitation. Clinical trials are warranted to establish efficacy.

Professional society guidelines recommend against routine diagnostic imaging for suspected Bell's palsy at initial presentation. This study examines national trends in imaging use, adherence to guidelines, and the utility of CT and MRI in treatment practices. A retrospective cohort study of 35,942 adult Bell's palsy patients using ICD-9-CM and ICD-10-CM diagnosis codes from 2016 to 2021 was conducted. These patients were continuously enrolled for ≥ 1 year in the employer-sponsored MarketScan commercial or Medicare outpatient and prescription drugs claims data. The main outcomes of interest were CT and MRI scan usage at or after the diagnosis date. CT scans were performed in 27% of patients (median time: 3 days), while MRI was performed in 25% (median time: 36 days). Within 30 days of their index claim, 16% underwent CT scanning and 12% underwent MRI. Patients on combination therapy (steroids and antivirals) had significantly higher rates of early imaging (CT: 38% vs. 25%, p < 0.001; MRI: 19% vs. 17%, p < 0.001) compared to monotherapy. CT imaging within 30 days of index diagnosis was strongly associated with combination therapy (OR = 3.49, 95% CI = 3.28-3.73, p < 0.001), as was early MRI to a lesser extent (OR = 1.26, 95% CI = 1.17-1.35, p < 0.001). Imaging was most frequent in acute care settings, and median costs rose significantly with dual-modality imaging (p < 0.001). CT and MRI are frequently used in Bell's palsy despite guideline recommendations, especially in patients receiving combination therapy. This study finds an association between diagnostic imaging for Bell's palsy and combination therapy, highlighting opportunities to reduce unnecessary testing and promote guideline-based care.

Background: Bell's Palsy (BP) is the most common cause of unilateral facial paralysis worldwide. It is an acute peripheral facial nerve paralysis of unknown etiology. All cases of peripheral facial nerve paralysis without a known cause are referred to as Bell's Palsy, a term coined by Sir Charles Bell in 1821 after studying several patients with asymmetric faces. Bell's Palsy is very common globally. Objective: To determine the effects of physiotherapy management using Electrical Stimulation (ES), Laser, Massage, and Mirror Exercise modalities on left-sided Bell's Palsy. Results: Physiotherapy treatment with electrical stimulation (ES), laser, massage, and mirror exercises for Bell's palsy sinistra was carried out in accordance with physiotherapy SOPs, resulting in a reduction in pain, increased muscle strength on the sinistra side of the face, and improved functional ability on the sinistra side of the face Conclusion: Physiotherapy modalities including Electrical Stimulation (ES), Laser, Massage, and Mirror Exercise have been applied to a patient with left-sided Bell's Palsy. After four therapy sessions, there was a significant improvement in facial functional ability, including the presence of muscle contractions during forehead frowning, eyebrow raising, eye closure, and whistling, indicating enhanced facial muscle strength

Diagnostic value of electrodiagnostic parameters for assessing initial severity in Bell's Palsy: A retrospective study of 3219 patients.

Introduction: Bell's palsy, an idiopathic peripheral facial palsy, often resolves naturally but can benefit from electric stimulation therapy. However, efficacy and safety during the acute stage remain controversial and understudied. Objective: To measure the effectiveness of electrical stimulation therapy as an add-on treatment for patients in the acute stage of Bell's palsy, as measured by incomplete recovery rates. Methods: We searched nine databases for randomized controlled trials comparing add-on electric stimulation therapy with usual care or placebo in patients within 7 days of Bell's palsy onset. The primary outcome was incomplete recovery. Risk of bias was assessed using Cochrane RoB 2 tool, with results synthesized via random-effects meta-analysis and evidence certainty evaluated using GRADE. Results: Fourteen studies encompassing 1,311 participants were included. Electric stimulation therapy plus usual care reduced incomplete recovery rates compared with usual care alone (risk ratio 0.65, 95% CI: 0.48-0.88; 13 trials, n = 1,191; moderate certainty). The effect persisted after excluding six studies with a high risk of bias. Conclusion: Add-on electric stimulation therapy during acute Bell's palsy may reduce incomplete recovery risk. However, results had moderate certainty with limitations including risk of bias and short follow-up durations.

The underlying mechanism of how natural musk treats Bell's palsy is not clear. This study aims to reveal the potential mechanism of musk in treating peripheral nerve injury in vitro. To achieve this, an oxidative stress injury model was established in Schwann cells (SCs) using cobalt chloride (CoCl2). To assess the protective effects of Muscone (Mus) on this injury and explore its mechanism, cell viability assays, siRNA transfection, enzyme-linked immunosorbent assays (ELISA), quantitative reverse transcription polymerase chain reaction (qRT-PCR), western blotting, immunofluorescence staining, and ultrastructural analysis of cells were employed. As a result, it is indicated that Mus intervention enhanced SC proliferation and S-100b mRNA under hypoxia, while also reducing reactive oxygen species (ROS) and elevating superoxide dismutase (SOD) levels. Mus ameliorated oxidative stress and inflammation in hypoxic SCs by reducing IL-1β and TNF-α. Furthermore, Mus modulated key indicators involved in oxygen metabolism, cell repair, and neurometabolism, including C-JUN and GDNF. IL-1R1, localized to the SC membrane, was upregulated by hypoxia but significantly downregulated following Mus intervention. Mus also inhibited the expression of NF-κB pathway components (IRAK1, IKK, p65, p50) and increased IκB-α. Critically, abolishing IL-1R1 expression via siRNA knockdown showed a consistent effect with Mus. It is concluded that by suppressing IL-1R1, Mus attenuated inflammation in hypoxic SCs through inhibition of the NF-κB pathway. This study indicated IL-1R1's role in hypoxia-induced SC dysfunction. Furthermore, Mus might be a potentially effective medicinal for treating Bell's palsy.

Bell's palsy significantly impacts patients' quality of life, with approximately 30% not fully recovering. In South Korea, Korean Medicine (KM) is widely used as a complementary approach for facial palsy, with 50.86% of patients utilizing KM in 2021. Although quantitative studies have shown KM's effectiveness, there is a lack of research on lived experiences of the participants on KM treatment. We aim to identify the meaning of using KM among the patients with Bell's palsy. This study will be conducted in compliance with the consolidated criteria for reporting qualitative research. Patients with Bell's palsy who had or have received KM treatment and whose onset was less than two years prior to the interview date will be recruited by purposive and snowball sampling. One-on-one interviews will be conducted in person using a semi-structured interview guide. Interviews and recruitment will continue until meaning saturation is reached. The interviews will be conducted in South Korea in a private area near the patient's residence to make them feel comfortable. The data will be analyzed using Colaizzi's seven-step method. This study will explore the lived experiences of patients using KM for Bell's palsy and seek to understand the essence of their experiences. Utilizing Colaizzi's phenomenological approach, common themes in patients' experiences of receiving KM treatment will be uncovered. The findings are expected to provide valuable insights into healthcare professionals, potentially enhancing clinical practice and patient-centered care in the treatment of Bell's palsy.

Background: Acne fulminans (AF) is rare and is the most severe form of acne vulgaris, especially in men who have a previous history of acne. The disease is characterized by painful ulcerative pustules that are covered by hemorrhagic crusts and are localized in the torso, face, and neck, and can cause systemic symptoms. The cause of fulminant acne is still unknown. Case Description: We reported a 29-year-old man who developed AF after getting high doses of methylprednisolone due to previous Bell's palsy. Patients complained of the appearance of painful and swollen pus lumps on the face, accompanied by fever. Successful management is achieved through systemic and topical therapies provided so that patients experience significant clinical improvement. Early diagnosis and proper management are essential to avoid scarring and minimize the risk of recurrence. Conclusion: Acne fulminans is a severe manifestation of acne vulgaris that more often affects adult men with a previous history of acne. Symptoms shown eruptive lesions, nodules, and painful plaques, and are usually found on the torso, face, and neck with or without systemic symptoms. The pathogenicity of AF is still unknown. Proper and prompt diagnosis and effective management can prevent complications and avoid recurrence.

The rapid rollout of mRNA-based COVID-19 vaccines, including Pfizer-BioNTech's BNT162b2 and Moderna's mRNA-1273, has been instrumental in curbing the pandemic, demonstrating high efficacy and safety in the general population. However, concerns regarding neurological adverse effects, particularly in individuals with epilepsy (PWE), warrant scrutiny. Clinical data from case reports, multicenter studies, and meta-analyses (encompassing over 3000 PWE) indicate that most tolerate vaccination well, with seizure worsening in approximately 5% of cases, often transient and lower than post-COVID-19 infection rates. Rare severe events, such as status epilepticus, highlight vulnerabilities, though background seizure incidence remains comparable or lower than natural rates. This review examines potential neuroimmune mechanisms linking mRNA vaccination to seizure exacerbation, emphasising immune activation, neuroinflammation, and epileptogenesis. mRNA vaccines utilise lipid nanoparticles (LNPs) to deliver spike protein-encoding mRNA, eliciting robust immune responses. Potential triggers for seizures include cytokine storms (e.g., IL-1β, TNF-α, IL-6), blood-brain barrier (BBB) disruption, molecular mimicry with neuronal antigens, and autoantibody production, which may heighten neuronal hyperexcitability in susceptible individuals. Neurological side effects, including Bell's palsy, transverse myelitis, and herpes zoster reactivation, are more prevalent in mRNA platforms, potentially tied to LNP-induced inflammation or cross-reactive immunity. While evidence supports vaccination benefits outweighing risks for PWE, gaps persist in understanding individual predispositions. Future research should prioritise longitudinal studies, EEG monitoring, and AI-driven approaches for personalised risk assessment, mRNA optimisation, and pharmacovigilance. Integrating multi-omics and computational modelling could enhance vaccine safety, ensuring equitable protection for vulnerable populations.

This case report details the presentation, diagnostic workup, and management of 57-year-old paramilitary personnel who developed acute onset, left-sided lower motor neuron facial paralysis, diagnosed as Bell's palsy. The patient presented with sudden facial weakness, inability to close the left eye, deviation of mouth, and loss of taste, following a prodromal episode of sore throat and dry cough. Neurological examination confirmed idiopathic lower motor neuron facial nerve palsy, with no abnormalities detected on non-contrast CT head or relevant serologies. A comprehensive treatment approach was adopted incorporating acyclovir, prednisolone with tapering, vitamin B complex, intensive eye care, and physical therapy exercises. Notably, the patient exhibited prompt clinical improvement within 10 days, regaining facial strength, eye closure ability, and taste sensation. The discussion highlights prevailing theories in Bell’s palsy pathogenesis, particularly viral reactivation and nerve compression, and supports combination corticosteroid and antiviral therapy for severe cases. The importance of vigilant eye protection and rehabilitative therapy is emphasized to minimize corneal complications and synkinesis. Psychosocial impact is also acknowledged, advocating holistic, multidisciplinary follow-up to support patient recovery and emotional health. This report underscores that early diagnosis, integrated medical management, and tailored rehabilitative strategies are critical for optimal outcomes in Bell’s palsy, while ongoing psychosocial support addresses concerns over facial changes and functional impairments during recovery.

Short courses of systemic corticosteroids are used in the management of a number of acute clinical conditions, including Bell palsy, croup, and pneumonia, but research on associations of corticosteroid use with adverse events (AEs) in children is limited. To document AEs associated with short-term (≤14 days) use of systemic corticosteroids in children and adolescents (1 to younger than 18 years) across different clinical conditions. MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from inception to February 2025. Reference lists of eligible articles and related systematic reviews were also searched. Randomized clinical trials evaluating AEs (any unfavorable and unintended signs, symptoms, or syndromes that occurred during the period of using an investigational product) after use of short-course systemic corticosteroids in children and adolescents were included. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline, pairs of reviewers independently reviewed abstracts, extracted data, and assessed risk of bias of eligible trials. Pairwise, fixed-effects meta-analyses were performed using Mantel-Haenszel methods with risk difference (RD). The primary outcomes were serious AEs (events resulting in death, life-threatening conditions, hospitalization, or substantial disability), AEs leading to discontinuation, hyperglycemia, sleep disturbances, change in behavior, and gastrointestinal bleeding. RDs were reported as AEs per 1000 patients with 95% CIs. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the certainty of evidence (high, moderate, low, or very low certainty). A total of 45 eligible trials that included 6470 children (mean [SD] age, 5.57 [3.62] years; 3753 male [58%]) were identified. In pooled analysis, there was moderate certainty evidence that compared with usual care, corticosteroids were not associated with serious AEs (RD, 1 fewer AE per 1000 patients [95% CI], 9 fewer to 7 more AEs per 1000 patients]), AEs leading to discontinuation (RD, 4 more AEs per 1000 patients [95% CI, 3 fewer to 11 more AEs per 1000 patients]), or change in behavior (RD, 8 more AEs per 1000 patients [95% CI, 5 fewer to 21 more AEs per 1000 patients]). With moderate certainty evidence, corticosteroids were associated with an increased risk of hyperglycemia (RD, 38 more AEs per 1000 patients [95% CI, 11 to 64 more AEs per 1000 patients]) and sleep problems (RD, 15 more AEs per 1000 patients [95% CI, 1 to 28 more AEs per 1000 patients]). Corticosteroid use was also associated with an increased risk of gastrointestinal bleeding (RD, 13 more per AEs per 1000 patients [95% CI, 3 to 23 more AEs per 1000 patients]), but the certainty of evidence was low. In this systematic review and meta-analysis of randomized trials, there was moderate certainty evidence that corticosteroids were associated with an increased risk of hyperglycemia and sleep problems and low certainty evidence that corticosteroids were associated with increased risk of gastrointestinal bleeding, but these AEs were very seldom serious. These findings suggest that an individualized approach to short-term corticosteroid use may be warranted and that further research is needed to obtain better quality of evidence.

ObjectiveThis study utilized resting-state functional magnetic resonance imaging (fMRI) to examine changes in brain functional activity following acupuncture treatment for acute Bell’s palsy (BP) and to investigate the potential central regulatory mechanisms involved.MethodsA total of 55 patients with acute Bell’s facial paralysis (within 1–7 days of onset) were enrolled in the patient group, while 48 individuals without the condition were included as the healthy control group. The patient group received acupuncture therapy at EX-HN16 (Qianzheng), SJ17 (Yifeng), ST2 (Sibai), GB14 (Yangbai), EX-HN4 (Yuyao), SI18 (Quanliao), ST6 (Jiache), ST4 (Dicang), ST8 (Touwei), and bilateral LI4 (Hegu) points on the affected side. Each session lasted 30 min and was administered three times a week (Wednesday, Friday, and Sunday) until day 28 of the disease course. The patient group underwent fMRI scans, House–Brackmann (H-B) grading, Sunnybrook scale evaluation, and facial disability index (FDI) assessment both prior to the initial treatment and on the 28th day. The healthy group received a single fMRI scan after enrollment. MATLAB R2017 software was used to calculate the fractional amplitude of low-frequency fluctuation (fALFF) and regional homogeneity (ReHo) in patients before and after treatment, as well as in healthy controls.ResultsFollowing treatment, the patient group showed significant improvements in H-B, Sunnybrook, and FDI scores compared to pretreatment levels (P < 0.05), with an overall effective rate of 96.4% (53/55). Prior to treatment, compared to healthy controls, patients exhibited decreased fALFF in the right posterior cingulate gyrus, increased fALFF in the right postcentral gyrus, left and right middle frontal gyri, and increased ReHo in the left precentral gyrus, right postcentral gyrus, and left middle occipital gyrus. After treatment, when compared to healthy controls, patients showed decreased fALFF in the left and right medial superior frontal gyri, and increased fALFF in the right postcentral gyrus, left precentral gyrus, and bilateral lingual gyri, and increased ReHo in the right precentral gyrus, bilateral transverse temporal gyri, right lingual gyrus, and right thalamus, and decreased ReHo in the right middle frontal gyrus. Relative to pretreatment values, patients displayed decreased fALFF in the left medial superior frontal gyrus and increased fALFF in the left precentral gyrus. Additionally, ReHo decreased the right and left medial superior frontal gyri, while it increased in the right inferior parietal angular gyrus, right precentral gyrus, and left superior parietal gyrus.ConclusionAcupuncture demonstrates a clear therapeutic effect on acute BP and contribute to clinical symptom improvement. Marked differences in brain functional activity were observed between patients and healthy individuals. The therapeutic effect of acupuncture may be linked to its ability to facilitate functional reorganization in brain regions associated with sensation, movement, and emotion.Clinical trial registrationhttps://www.chictr.org.cn/searchproj.html? title=&officialname=&subjectid=®status=®no=ChiCTR2200065223& secondaryid=&applier=&studyleader=&createyear=&sponsor=&secsponsor= &sourceofspends=&studyailment=&studyailmentcode=&studytype=&study stage=&studydesign=&recruitmentstatus=&gender=&agreetosign=&measure= &country=&province=&city=&institution=&institutionlevel=&intercode=& ethicalcommitteesanction=&whetherpublic=&minstudyexecutetime=&maxstudy executetime=&btngo=btn, identifier ChiCTR2200065223.

To evaluate the prognostic significance of inflammatory markers, computed tomography (CT)-based facial nerve measurements, and clinical parameters in pediatric patients with Bell's palsy. In this retrospective study, 136 patients aged 4-18 years diagnosed with Bell's palsy were evaluated. Clinical data included age, sex, affected side, initial House-Brackmann (HB) grade, recovery grades at one month and final follow-up, presence of pain, and treatment timing. Inflammatory markers-mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein-to-albumin ratio (CAR)- were calculated from laboratory data obtained at admission. Facial nerve-to-facial canal (FN/FC) ratios were measured via CT in five regions. The control group included 70 age-matched children with normal CT scans obtained for non-specific complaints such as headache. Recovery was categorized as full (HB 1), partial (improved but not grade 1), or poor. Initial HB grade was significantly correlated with both one-month (r = 0.67, p < 0.001) and final recovery (r = 0.33, p < 0.001). CAR was weakly correlated with one-month recovery (r = 0.224, p = 0.0089) but not long-term outcome. MPV, NLR, and PLR showed no significant prognostic value. FN/FC ratios were significantly higher in the labyrinthine, geniculate, and tympanic regions on the paralyzed side compared to both the control group and non-paralyzed side. However, no correlations were found between FN/FC ratios and recovery. A moderate correlation was observed between initial HB grade and tympanic FN/FC ratio (r = 0.321, p = 0.001). Initial clinical severity best predicts recovery in pediatric Bell's palsy. Inflammatory and radiologic parameters offer limited prognostic value and warrant cautious interpretation.