Bell's Palsy: Some Problems of Prognosis and Treatment

Abstract

This study is based on a survey of the patients suffering from facial paralysis examined by me in the E.N.T. department of the United Birmingham Hospitals during a two-year period 1954 to 1956. The aims of the investigation were to seek criteria which will give guidance on the probability of spontaneous recovery in idiopathic facial paralysis and to assess the value of present methods of treatment. Material and Methods Of the 107 patients (54 male, 53 female) examined, 56 were affected on the right, 49 on the left, and 2 bilaterally. Their ages ranged from 5 to 75 years, the highest incidence being in the 30-40 age-group. All the palsies were of lower-motor-neurone type, and so in a sense could be described as cases of Bell's palsy; for in 1821 Bell distinguished between " paralysis which proceeds from the brain, and that affection of the muscles of the face when from a less alarming cause they have lost the controlling influence of the respiratory (i.e., facial) nerve." However, the term Bell's palsy is nowadays reserved for those cases of peripheral facial palsy in which there is no obvious cause such as injury, infection, or new growth (Cawthorne, 1951). Preliminary investigations established pathological causes in 10 patients. They were: (a) chronic mastoid infection (three patients); (b) intratemporal epidermoid of the type described by Jefferson and Smalley (1938) (two patients); (c) fracture involving the temporal bone (two patients); (d) sarcoidosis (one patient with bilateral paralysis); (e) acute middle-ear infection (one patient); (f) brain-stem glioma, which presented originally as a nuclear lesion (one patient). These are listed for completeness and are not discussed further.

Bell's palsy: prognostic accuracy of case history, sialometry and taste impairment

“…Recurrent paresis Twenty-one patients (8.8%)' I I women and 10 men, had had a previous attack of Bell's palsy. Others have reported similar frequencies.22' 28- 30 Ten of the recurrencies were on the same side and 1 1 on the other side.…”

Bell's palsy and infection with rubella virus.

“…Other authors, investigating large numbers of Bell's palsy patients, failed to demonstrate any evidence of viral infection.6 [28][29][30][31] To date there has been no report on unequivocal serological evidence of rubella virus infection coincident with Bell's palsy. This report of four patients is believed to be the first.…”

Bell's palsy and its treatment

“…On clinical assessment, a poor prognosis is indicated by the presence of initial pain (Tumarkin, 1936;Cawthorne, 1952;Kettel, 1959;Taverner, 1959). Thus, Dalton (1960) found that of forty-four patients with Bell's palsy and accompanying pain only 595/O made a complete recovery while of fortytwo patients without pain, 747/ recovered completely. Advancing age (Matthews, 1961) and a complete paresis (Matthews, 1961;Taverner, 1959) are also of poor prognostic significance.…”