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Observational Study
. 2025 Jun;135(6):1964-1969.
doi: 10.1002/lary.32022. Epub 2025 Jan 27.

Early Prognostic Markers for Idiopathic Facial Palsy

Miguel Vaca  1   2 , Belén Alonso  3 , Rubén Polo  1 , María Del Mar Medina  1   2 , Adela Cordero  1   4 , Cecilia Pérez  1   4 , Gonzalo de Los Santos  1
Affiliations
Observational Study

Early Prognostic Markers for Idiopathic Facial Palsy

Miguel Vaca et al. Laryngoscope. 2025 Jun.

Abstract

Objectives: To analyze the prognostic value of markers available at the onset of idiopathic facial palsy. To define the evolution of the episode by tracing changes in facial function over time.

Methods: This is an observational prospective study on patients with facial palsy consulting in the first 24 hs. The evolution was recorded with photographs and monthly visits. Multivariate analysis was conducted between clinical and analytical parameters determined in the first visit and prognostic outcomes: progression, resolution, and "facial palsy evolution index," which integrates severity of the palsy and duration.

Results: Sixty-five patients were included. The mean initial HB grade was III, but 31% of the cases progressed in the following days. Complete recovery was observed in 89.5% of the cases (mean duration of the episode of 48 days), and exposure keratitis in 21.5%, with a mean of 42 days after the onset. Multivariate analysis showed that retroauricular pain and white blood cell count were significantly related to progression (odds ratio [OR] 19.08; 1.49, p < 0.05), incomplete resolution (OR 1/0.04; 1/0.59, p < 0.05), and higher evolution index (12.8; 2.9, p < 0.05). Age was also significantly associated with evolution index (0.27, p < 0.05), and platelet-to-lymphocyte ratio with progression (OR 1.02, p < 0.05). The rest of the parameters did not show an association with prognosis.

Conclusions: Retroauricular pain and white blood cell count are early indicators of prognosis in idiopathic facial palsy. Initial examinations may not reflect the maximum grade of weakness reached by the patient. Ocular complications can occur several weeks after the onset, even with mild grades of paralysis.

Level of evidence: 3 Laryngoscope, 135:1964-1969, 2025.

Keywords: Bell's palsy; exposure keratitis; facial nerve; facial palsy; prognosis.

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References

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