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. 2022 Dec;122(6):1419-1432.
doi: 10.1007/s13760-022-02026-8. Epub 2022 Aug 2.

Epidemiology, clinical features, and treatment modalities of facial nerve palsy in COVID-19 patients: a systematic review

Aya Turki #  1   2 , Kirellos Said Abbas #  2   3 , Abdelrahman M Makram #  2   4   5 , Mostafa Elfert  2   6 , Mahmoud Elmarabea  2   6 , Nahla Ahmed El-Shahat  2   7 , Hassan Abdalshafy  1   2 , Akua Sampong  2   8 , Sirisha Chintalapati  2   8 , Nguyen Tien Huy  9   10
Affiliations

Epidemiology, clinical features, and treatment modalities of facial nerve palsy in COVID-19 patients: a systematic review

Aya Turki et al. Acta Neurol Belg. 2022 Dec.

Abstract

Background: Coronavirus disease 2019 (COVID-19) is responsible for a wide variety of multi-system clinical features. Facial nerve palsy (FNP) is identified as one of the neurological complications of the virus. This work aims to systematically review the clinical picture, laboratory/imaging findings, treatment options, and prognostic factors of FNP in COVID-19 patients.

Methods: Using six online databases, a search was conducted to include all articles with patients infected with COVID-19 and presenting with unilateral or bilateral FNP. Screening for eligibility and data extraction were done by three and four independent reviewers, respectively. Descriptive analyses and data visualizations were done using Google Sheets. Survival analysis and Kaplan-Meier plotting were done by R software.

Results: The data from 22 studies included 32 patients who were infected with COVID-19 and presented with clinical features of FNP. Fourteen patients were male while 18 were female. FNP affected 29 patients unilaterally and 3 patients bilaterally. The imaging findings confirmed that complications of FNP were COVID-19 related. Additionally, antivirals combined with steroids had the lowest median time (21, IQR = 8) to clinical improvement compared to steroid-only (30, IQR = 15) and antiviral-only (33, IQR = 3.5) treatments.

Conclusion: This study has shown a potential correlation between the increased incidence of FNP and COVID-19. We have also found that combining antivirals with steroids may have better outcomes in patients with FNP and COVID-19 although the evidence to support this claim is not strong enough. Further studies are required to assess the extent of linkage between the two conditions and how to properly manage FNP when encountered in COVID-19 patients.

Keywords: COVID-19; Cranial nerve VII palsy; Facial nerve palsy; SARS-CoV-2.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of the literature search and screening for eligibility steps
Fig. 2
Fig. 2
The reported frequency of COVID-19 symptoms in the included studies
Fig. 3
Fig. 3
The reported frequency of FNP symptoms in the included studies
Fig. 4
Fig. 4
Survival analysis with Kaplan–Meier plot showing the performance of steroid-only, antiviral-only, and combined therapy in improvement of FNP symptoms
See this image and copyright information in PMC

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