Peripheral Facial Palsy in Emergency Department

Document Type: Original


Department of Otorhinolaryngology, Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal.


Peripheral facial palsy (PFP) is commonly diagnosed in every emergency department. Despite being a benign condition in most cases, PFP causes loss in quality of life mostly due to facial dysmorphia. The etiology of PFP remains unknown in most cases, while medical opinion on epidemiology, risk factors and optimal treatment is not consensual. The aim of this study was to review the demographic characteristics of our patients and the medical care administered in our emergency department.
Materials and Methods:
Emergency episodes occurring in a 4-year period and codified as facial nerve pathology were analyzed. IBM SPSS software was used for statistical analysis.
In total, 582 emergency episodes were obtained. Due to inexpressive representation of other causes of PFP in our study, we focused our analyses on the 495 patients who were considered to have idiopathic PFP. There was equal distribution among genders, and all age ranges were affected. There were no clear epidemic phenomena. Hypertension was not a statistically significant risk factor for Bell's palsy. Most patients sought medical care in the early stages of the disease and complained of isolated facial weakness. Most patients had mild-to-moderate symptoms. Previous upper way infections (PUAI) were more frequent among children. There was a statistically significant difference regarding computed tomography (CT) scan requests among specialties.
Epidemiologic findings were consistent with most literature on Bell's palsy. Drug therapy is widely used and follows current guidelines. The role of PUAI in the pediatric population must be investigated. Despite evidence of good medical practice, there was an excess of CT scans requested by physicians other than otorhinolaryngologists.


Main Subjects

1. Spencer C, Irving R. Causes and management of facial nerve palsy. Br J Hosp Med. 2016;77:        686–91.

2. Eviston T, Croxson G, Kennedy P, Hadlock T, Krishnan A. Bell’s palsy: aetiology, clinical features and multidisciplinary care. J Neurol Neurosurg Psychiatry. 2015;86:1356–61.

3. Ferreira M, Firmino-Machado J, Marques E, Santos P, Simões A, Duarte J. Prognostic factors for recovery in Portuguese patients with Bell’s palsy. Neurol Res. 2016;38:851–6.

4. Finsterer J. Management of peripheral facial nerve palsy. Eur Arch Oto-Rhino-Laryngology. 2008;265:743–52.

5. Monini S, Lazzarino A, Iacolucci C, Buffoni A, Barbara M. Epidemiology of Bell’s palsy in an Italian Health District: incidence and case-control study. Acta Otorhinolaryngol Ital. 2010;30:198–204.

6. Newadkar U, Chaudhari L, Khalekar Y. Facial palsy, a disorder belonging to influential neurological dynasty: Review of literature. N Am J Med Sci. 2016;8:263–7.

7. Baugh R, Basura G, Ishii L, Schwartz SR, Drumheller CM, Burkholder R, et al. Clinical Practice Guideline. Otolaryngol Neck Surg. 2013; 149:S1–S27.

8. Savadi-Oskouei D, Abedi A, Sadeghi-Bazargani H. Independent role of hypertension in Bell’s palsy: A case-control study. Eur Neurol. 2008; 60: 253–7.

9. Rowlands S, Hooper R, Hughes R, Burney P. The epidemiology and treatment of Bell’s palsy in the UK. Eur J Neurol. 2002;9:63–67.

10. Konrad-Martin D, Reavis KM, McMillan G, Helt WJ, Dille M. Proposed comprehensive ototoxicity monitoring program for VA healthcare (COMP-VA). J Rehabil Res Dev. 2014;51:81–100.

11. Murakami S, Mirzobuchi M, Nakashiro Y, Doi T, Hato N, Yanagihara N. Bell’s palsy and herpes simplex virus: identification of viral DNA in endoneural fluid and muscle. Ann Int Med. 1996; 124:27–30.

12. Glass G, Tzafetta K. Bell’s palsy: A summary of current evidence and referral algorithm. Fam Pract. 2014;31:631–42.

13. Galluzzi L, Blomgren K, Kroemer G. Mitochondrial membrane permeabilization in neuronal injury. Nat Rev Neurosci. 2009;10:       481–94.

14. Nichols M, Townsend N, Scarborough P, Rayner M, Leal, J, Luengo-Fernandez R, et al. European Cardiovascular Disease Statistics 2012, available online at in 08/ 06/2017.

15. Instituto Nacional de Estatística IP. Censos 2011 Resultados Definitivos - Portugal 2011, available on line at http://censos. xportal/ xmain?xpid=CENSOS&xpgid=ine_censos_publicacoes in 08/06/2017.

16. Sociedade Portuguesa de Diabetologia. Diabetes: Factos E Números – O Ano de 2014 − Relatório Anual Do Observatório Nacional Da Diabetes, available on line at http:// www. in 08/ 06/ 2017.

17. Ciorba A, Corazzi V, Conz V, Bianchini C, Aimoni C, Facial nerve paralysis in children. World J Clin Cases. 2015;3:973–9.

18. Wang C, Chang Y, Shih H, Chen C, Chen J. Facial Palsy in Children. Pediatr Emerg Care. 2010; 26:121–5.

19. Reddy S, Redett R. Facial paralysis in children. Facial Plast Surg. 2015;31:117–22.

20. Evans A, Licameli G, Brietzke S, Whittemore K, Kenna M. Pediatric facial nerve paralysis: Patients, management and outcomes. Int J Pediatr Otorhinolaryngol. 2005;69:1521–8.

21. House J, Brackmann D. Facial nerve grading system. Otolaryngol Head Neck Surg. 1985; 93: 146–7.

22. Kattah J, Talkad A, Wang D, Hsieh Y, Newman-Toker D. HINTS to diagnose stroke in the acute vestibular syndrome: Three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009; 40: 3504–10.

23. Chalela J, Kidwell C, Nentwich L, Luby M, Butman JA, Demchuk AM, et al. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet. 2007; 369:293–8.

24. Kim C, Lelli G. Current considerations in the management of facial nerve palsy. Curr Opin Ophthalmol. 2013;24:478–83.