Bilateral simultaneous facial nerve palsy: clinical analysis in seven cases.
OBJECTIVE
To analyze clinical manifestations and prognosis of bilateral simultaneous facial nerve palsy (BS-FNP).


METHODS
: Retrospective case review with current follow-up wherever possible.


METHODS
: Tertiary referral centers.


METHODS
Patients (n = 7; 4 women and 3 men; mean age, 37 yr; range, 18-58 yr) diagnosed with BS-FNP at the time of their first visit.


METHODS
Therapy with systemic corticosteroids and antiviral agents and outpatient follow-up for 1 month to 4 years after discharge.


METHODS
Assessment of recovery from FNP using the House-Brackmann grading system.


RESULTS
: The occurrence rate of BS-FNP of total FNP cases for the past 10 years was 0.4%. All patients showed palsy more severe than House-Brackmann Grade IV and similar grades of FNP bilaterally. Patients complained of the involvement of the other side within 1 to 6 days of the involvement of 1 side (mean period, 3.4 d). Bell's palsy was the most common cause (5 of 7; 71.4%), the other 2 being infectious mononucleosis and Ramsay Hunt syndrome zoster sine herpete (1 of 7; 14.3% each). Although most patients recovered completely within 1 to 6 months, 1 with a positive Varicella zoster virus immunoglobulin M titer showed bilateral House-Brackmann Grade II FNP after recovery. No recurrence was noted during the follow-up period.


CONCLUSIONS
Bell's palsy is the most common cause of BS-FNP in authors' centers. Although BS-FNP may show more severe paralysis, the overall prognosis in most cases is as good as that in unilateral FNP, excluding life-threatening or traumatic cases. Differential diagnosis is very important because the treatment outcome of BS-FNP depends on the cause.
Kim
Young Ho
YH
Department of Otolaryngology, Head and Neck Surgery, Seoul Municipal Boramae Hospital, Seoul National University College of Medicine, Seoul, South Korea. yhkiment@yahoo.co.br
Choi
Ik Joon
IJ
Kim
Hyoung Mi
HM
Ban
Jae Ho
JH
Cho
Chang Hyun
CH
Ahn
Joong Ho
JH
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D020330:Bell Palsy / Q000188:drug therapy* / Q000503:physiopathology; D005158:Facial Paralysis / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index
D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents