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. 2023 Nov;270(11):5303-5312.
doi: 10.1007/s00415-023-11897-7. Epub 2023 Jul 31.

Acquired bilateral facial palsy: a systematic review on aetiologies and management

Giulia Molinari  1   2 , Daniela Lucidi  3 , Ignacio Javier Fernandez  1   2 , Alice Barbazza  4   5 , Elena Vanelli  1   2 , Federico Lami  3 , Gaia Federici  3 , Cecilia Botti  1   6 , Livio Presutti  1   2 , Roberto D'Angelo  7 , Rita Rinaldi  7 , Matteo Alicandri-Ciufelli  3
Affiliations

Acquired bilateral facial palsy: a systematic review on aetiologies and management

Giulia Molinari et al. J Neurol. 2023 Nov.

Abstract

Objective: To systematically review the published cases of bilateral facial palsy (BFP) to gather evidence on the clinical assessment and management of this pathology.

Methods: Following PRISMA statement recommendations, 338 abstracts were screened independently by two authors. Inclusion criteria were research articles of human patients affected by BFP, either central or peripheral; English, Italian, French or Spanish language; availability of the abstract, while exclusion criteria were topics unrelated to FP, and mention of unilateral or congenital FP. Only full-text articles reporting the diagnostic work-up, the management, and the prognosis of the BFP considered for further specific data analysis.

Results: A total of 143 articles were included, resulting a total of 326 patients with a mean age of 36 years. The most common type of the paralysis was peripheral (91.7%), and the autoimmune disease was the most frequent aetiology (31.3%). The mean time of onset after first symptoms was 12 days and most patients presented with a grade higher than III. Associated symptoms in idiopathic BFP were mostly non-specific. The most frequently positive laboratory exams were cerebrospinal fluid analysis, autoimmune screening and peripheral blood smear, and the most performed imaging was MRI. Most patients (74%) underwent exclusive medical treatment, while a minority were selected for a surgical or combined approach. Finally, in more than half of cases a complete bilateral recovery (60.3%) was achieved.

Conclusions: BFP is a disabling condition. If a correct diagnosis is formulated, possibilities to recover are elevated and directly correlated to the administration of an adequate treatment.

Keywords: Acquired facial palsy; Bilateral facial palsy; Facial function; Facial nerve; Facial paralysis.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow chart for study selection according to PRISMA guidelines
Fig. 2
Fig. 2
Diagnostic flow-chart for patients presenting with bilateral facial palsy (BFP). CT computed tomography, ENT ear nose thorat specialist, CSF cerebrospinal fluid, MRI magnetic resonance imaging
See this image and copyright information in PMC

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