Science News: Analysis of Predictive Factors for the Poor Prognosis of Peripheral Facial Paralysis

Submitted by: Nandita Keole, MD
Edited by: Milvia Pleitez, MD

Citation: Frutos-Reoyo EJ, López-Izquierdo R, Luque-Linero P, et al. Analysis of Predictive Factors for the Poor Prognosis of Peripheral Facial Paralysis. Am J Phys Med Rehabil. 2024;103(3):245-250. doi:10.1097/PHM.0000000000002328

Summary: The aim of the study is to evaluate predictive factors for a poor prognosis in patients with facial paralysis evaluated in the rehabilitation department of a tertiary hospital.

This prospective cohort study analyzed patients aged 18 years or older with a diagnosis of facial paralysis or facial paresis (lower motor neuron) who were seen in the emergency department of Río Hortega University Hospital in Valladolid, Spain, and referred for a Physical Medicine and Rehabilitation (PM&R) consultation during 2019. The severity of the condition was assessed using the House-Brackmann and Sunnybrook Facial Grading System (SFGS) scales at the first appointment (SFGS1) and at a follow-up appointment 1 month after symptom onset (SFGS2) in the PM&R service. The neurophysiological profile, determined through electrodiagnostic (EDX) testing (neurapraxia, axonotmesis, neurotmesis), was also analyzed as an independent variable. Patients were followed monthly for 6 months. Those who required elective botulinum toxin injections, surgical intervention, or follow-up beyond 6 months due to incomplete recovery were considered to have a poor prognosis. Descriptive and analytical analyses of clinical and epidemiological variables were conducted over the 6-month follow-up period.

A total of 47 adult patients were analyzed, 54.2% of whom were women. The mean age was 53.2 yrs. (SD, 15.5 yrs.). Twenty-five percent had an unfavorable prognosis. A statistically significant association with prognosis was observed for neurophysiological results and the scores of the House-Brackmann scale and the SFGS.

Neurophysiological tests are especially useful when evaluating prognosis. Likewise, SFGS is a useful and accessible tool with prognostic value, especially within a month of initial diagnosis, when a score lower than 65 indicates a poor prognosis with high sensitivity and specificity. These tools can be especially useful to reduce the clinical and psychological impact and to provide patients with early therapeutic management. A delay in performing aggressive techniques can lead to atrophy and irreversible fibrosis of the native musculature that makes many of the nerve resuscitation techniques useless.

Comments: In this study they did not specify whether they only reviewed idiopathic facial nerve palsy. This is useful to consider in places where EDX studies are not easily available. This study shows the prognostic value of the House-Brackmann and SFGS scales which could be used as an adjunct tool in clinic. Early intervention could help improve outcomes in patients who score lower (between 65 and 70 on the SFGS and those who stay at level II or higher on the House-Brackman scales).