Study Highlights Early Warning Signs for Worse Outcomes in Idiopathic Facial Palsy

"We found that 31% of patients experienced deterioration in their condition, although 89.5% fully recovered. However, 21.5% of patients developed exposure keratitis, with symptoms appearing approximately 42 days after the initial onset. Additionally, age and platelet-to-lymphocyte ratio was also found to influence the prognosis," the researchers reported in The Laryngoscope.

Idiopathic facial palsy, commonly known as Bell’s palsy, is a condition characterized by sudden, temporary weakness or paralysis of the muscles on one side of the face. While many patients recover with little intervention, the severity of the condition can vary, and in some cases, complications can arise even weeks after the initial symptoms appear. Miguel Vaca, Otolaryngology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain, and colleagues aimed to assess the prognostic value of early markers in idiopathic facial palsy and track the progression of the condition by observing changes in facial function over time.

For this purpose, the researchers conducted an observational prospective study involving patients with facial palsy who sought consultation within the first 24 hours of symptom onset. The evolution of the condition was monitored through photographs and monthly follow-up visits. Multivariate analysis was performed to examine the relationship between clinical and analytical parameters assessed during the first visit and various prognostic outcomes, including progression, resolution, and the "facial palsy evolution index," which combines the severity of the palsy and its duration.

Key Findings:

• The study included a total of 65 patients.
• The mean initial HB grade was III, with 31% of cases showing progression in the following days.
• There was complete recovery in 89.5% of cases, with an average episode duration of 48 days.
• Exposure keratitis developed in 21.5% of cases, with an average onset of 42 days after symptom onset.
• Multivariate analysis revealed that retroauricular pain and white blood cell count were significantly linked to progression (OR 19.08), incomplete resolution (OR 1/0.04), and a higher evolution index (OR 12.8).
• Age was significantly associated with the evolution index, while the platelet-to-lymphocyte ratio correlated with progression (OR 1.02).
• Other parameters did not show a significant association with prognosis.

The study found that retroauricular pain and white blood cell count are early indicators of prognosis in idiopathic facial palsy. It's important to note that initial examinations may not fully capture the extent of facial weakness the patient may experience later. Additionally, ocular complications can develop weeks after the onset of symptoms, even in cases with mild paralysis," the researchers concluded.

Reference:

Vaca, M., Alonso, B., Polo, R., Medina, M., Cordero, A., & Pérez, C. Early Prognostic Markers for Idiopathic Facial Palsy. The Laryngoscope. https://doi.org/10.1002/lary.32022