Analytical review of facial nerve palsy following SARS-CoV-2 vaccination: comprehensive assessment

doi:10.1007/s00405-024-09173-z

Review

. 2025 Jun;282(6):2787-2797.

doi: 10.1007/s00405-024-09173-z. Epub 2025 Jan 10.

Analytical review of facial nerve palsy following SARS-CoV-2 vaccination: comprehensive assessment

Ahmad A Mirza^{1

2}, Abdulaziz H Almalki³, Zaid AlMubarak^{4

5}, Jennifer L Spiegel^{6

7}, Valerie Dahm^{6

8}, Vincent Y Lin^{9

6

10}

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. aamirza1@kau.edu.sa.
² Department of Otolaryngology-Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, 6 Queen's Park Crescent West, Suite 120, Toronto, ON, M5S 3H2, Canada. aamirza1@kau.edu.sa.
³ Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
⁴ Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, N6A 5C1, Canada.
⁵ Department of Otolaryngology Head and Neck Surgery, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
⁶ Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
⁷ Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany.
⁸ Department of Otolaryngology-Head & Neck Surgery, Medical University of Vienna, Vienna, Austria.
⁹ Department of Otolaryngology-Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, 6 Queen's Park Crescent West, Suite 120, Toronto, ON, M5S 3H2, Canada.
¹⁰ Biological Sciences Platform, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.

PMID: 39792199
DOI: 10.1007/s00405-024-09173-z

Review

Analytical review of facial nerve palsy following SARS-CoV-2 vaccination: comprehensive assessment

Ahmad A Mirza et al. Eur Arch Otorhinolaryngol. 2025 Jun.

. 2025 Jun;282(6):2787-2797.

doi: 10.1007/s00405-024-09173-z. Epub 2025 Jan 10.

Authors

Ahmad A Mirza^{1

2}, Abdulaziz H Almalki³, Zaid AlMubarak^{4

5}, Jennifer L Spiegel^{6

7}, Valerie Dahm^{6

8}, Vincent Y Lin^{9

6

10}

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. aamirza1@kau.edu.sa.
² Department of Otolaryngology-Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, 6 Queen's Park Crescent West, Suite 120, Toronto, ON, M5S 3H2, Canada. aamirza1@kau.edu.sa.
³ Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
⁴ Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, N6A 5C1, Canada.
⁵ Department of Otolaryngology Head and Neck Surgery, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
⁶ Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
⁷ Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany.
⁸ Department of Otolaryngology-Head & Neck Surgery, Medical University of Vienna, Vienna, Austria.
⁹ Department of Otolaryngology-Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, 6 Queen's Park Crescent West, Suite 120, Toronto, ON, M5S 3H2, Canada.
¹⁰ Biological Sciences Platform, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.

PMID: 39792199
DOI: 10.1007/s00405-024-09173-z

Abstract

Purpose: The SARS-CoV-2 vaccination has reduced COVID-19 infection, though facial nerve palsy (FNP) has emerged as a notable side effect of the vaccine. We evaluated the current literature on the clinical presentation and outcomes of FNP related to COVID-19 vaccination.

Methods: A comprehensive search of seven databases was conducted for studies up to January 2023. We included individually reported patients on FNP following COVID-19 vaccination, while cases with co-existing neurological disorders or secondary causes of FNP were excluded. Pooled descriptive and inferential analyses were conducted, with prognostic factors evaluated through regression and Kaplan-Meier survival analysis.

Results: A total of 33 studies were included, with data from 52 patients who developed post-COVID-19 vaccination FNP (PV-FNP). Most cases (71%) followed mRNA vaccines, primarily occurring after the first dose and within the first week post-vaccination. Nearly all cases (98%) were unilateral, with Grade III palsy being most common. Complete recovery was achieved in 55% of patients, significantly lower than pre-pandemic rate (83%). A longer latency period was associated with a reduced likelihood of full recovery, and females experienced faster recovery compared to males.

Conclusion: FNP following SARS-CoV-2 vaccination tends to present as mild and unilateral, with a lower full recovery rate compared to pre-pandemic cases. Symptoms often develop within the first week after vaccination, and earlier symptom onset is associated with a higher likelihood of full recovery. Recognizing these patterns provides valuable guidance for clinicians in counseling patients about prognosis and managing follow-up care effectively.

Keywords: Bell Palsy; COVID-19; Facial nerve diseases; SARS-CoV-2; Vaccination.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that they have no competing interests. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable.

Cited by

Unilateral Facial Paralysis in an Infant Post-vaccination: Insights Into Bell's Palsy.
Kumar S, Islam AA, Ward P, Collignon TE, Castro A. Kumar S, et al. Cureus. 2025 Mar 3;17(3):e79971. doi: 10.7759/cureus.79971. eCollection 2025 Mar. Cureus. 2025. PMID: 40182388 Free PMC article.

References

1. Mustafa AHK, Suleiman AM (2020) Bell’s Palsy: a prospective study. Int J Dent 2020:2160256. https://doi.org/10.1155/2020/2160256 - DOI - PubMed - PMC
1. Cellina M, D’Arrigo A, Floridi C, Oliva G, Carrafiello G (2022) Left Bell’s palsy following the first dose of mRNA-1273 SARS-CoV-2 vaccine: a case report. Clin Imaging 82:1–4. https://doi.org/10.1016/j.clinimag.2021.10.010 - DOI - PubMed
1. Ozonoff A, Nanishi E, Levy O (2021) Bell’s palsy and SARS-CoV-2 vaccines. Lancet Infect Dis 21(4):450–452. https://doi.org/10.1016/s1473-3099(21)00076-1 - DOI - PubMed - PMC
1. Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A et al (2020) Neurological associations of COVID-19. Lancet Neurol 19(9):767–783. https://doi.org/10.1016/s1474-4422(20)30221-0 - DOI - PubMed - PMC
1. Chatterjee A, Chakravarty A (2023) Neurological complications following COVID-19 vaccination. Curr Neurol Neurosci Rep 23(1):1–14. https://doi.org/10.1007/s11910-022-01247-x - DOI - PubMed

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[1] Mustafa AHK, Suleiman AM (2020) Bell’s Palsy: a prospective study. Int J Dent 2020:2160256. https://doi.org/10.1155/2020/2160256 - DOI - PubMed - PMC

[2] Mustafa AHK, Suleiman AM (2020) Bell’s Palsy: a prospective study. Int J Dent 2020:2160256. https://doi.org/10.1155/2020/2160256 - DOI - PubMed - PMC

[3] Cellina M, D’Arrigo A, Floridi C, Oliva G, Carrafiello G (2022) Left Bell’s palsy following the first dose of mRNA-1273 SARS-CoV-2 vaccine: a case report. Clin Imaging 82:1–4. https://doi.org/10.1016/j.clinimag.2021.10.010 - DOI - PubMed

[4] Cellina M, D’Arrigo A, Floridi C, Oliva G, Carrafiello G (2022) Left Bell’s palsy following the first dose of mRNA-1273 SARS-CoV-2 vaccine: a case report. Clin Imaging 82:1–4. https://doi.org/10.1016/j.clinimag.2021.10.010 - DOI - PubMed

[5] Ozonoff A, Nanishi E, Levy O (2021) Bell’s palsy and SARS-CoV-2 vaccines. Lancet Infect Dis 21(4):450–452. https://doi.org/10.1016/s1473-3099(21)00076-1 - DOI - PubMed - PMC

[6] Ozonoff A, Nanishi E, Levy O (2021) Bell’s palsy and SARS-CoV-2 vaccines. Lancet Infect Dis 21(4):450–452. https://doi.org/10.1016/s1473-3099(21)00076-1 - DOI - PubMed - PMC

[7] Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A et al (2020) Neurological associations of COVID-19. Lancet Neurol 19(9):767–783. https://doi.org/10.1016/s1474-4422(20)30221-0 - DOI - PubMed - PMC

[8] Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A et al (2020) Neurological associations of COVID-19. Lancet Neurol 19(9):767–783. https://doi.org/10.1016/s1474-4422(20)30221-0 - DOI - PubMed - PMC

[9] Chatterjee A, Chakravarty A (2023) Neurological complications following COVID-19 vaccination. Curr Neurol Neurosci Rep 23(1):1–14. https://doi.org/10.1007/s11910-022-01247-x - DOI - PubMed

[10] Chatterjee A, Chakravarty A (2023) Neurological complications following COVID-19 vaccination. Curr Neurol Neurosci Rep 23(1):1–14. https://doi.org/10.1007/s11910-022-01247-x - DOI - PubMed

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Analytical review of facial nerve palsy following SARS-CoV-2 vaccination: comprehensive assessment

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Analytical review of facial nerve palsy following SARS-CoV-2 vaccination: comprehensive assessment

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