title: Delayed surgical management is not effective for severe Bell's palsy after two months of onset.
abstract: OBJECTIVE
  To assess the effectiveness of delayed surgery and follow-up observation in managing severe Bell's palsy after two months of onset.
  
  
  METHODS
  Forty-one Bell's palsy patients with severe facial paralysis were treated after two months of onset. Eighteen patients in group I underwent decompression operations between two and three months after onset, and eight patients in group II underwent surgery after three months of onset; 15 patients in group III were managed with follow-up observation. All patients were followed up at the end of 3rd, 6th and 12th months, and surgical outcomes were compared with follow-up observations using House-Brackmann score and Facial Clinimetric Evaluation (FaCE) scale.
  
  
  RESULTS
  Between groups I and III, the difference in the proportion of the patients with fair or poor recoveries was statistically significant (p < 0.05) at the three-month follow-up visit. There was no significant difference in the distribution of complete, fair or poor recoveries at the 12-month follow-up visits among the three groups (p < 0.05). The total FaCE score and five individual domains were significantly improved at the end of the follow-up period in groups I and III (p < 0.05). However, in group I, the lacrimal control scores were significantly decreased at the end of the follow-up period compared to scores before surgery (p < 0.05). After surgery, four patients had sensorineural hearing loss, three patients had tinnitus and no patients had vertigo.
  
  
  CONCLUSIONS
  Patients with severe Bell's palsy after two months of onset would not benefit from delayed decompression surgery.
authors.affiliation: a Department of Otolaryngology-Head and Neck Surgery, The Second Hospital , Xi'an Jiao Tong University , Xi'an , China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Li
authors.affiliation: a Department of Otolaryngology-Head and Neck Surgery, The Second Hospital , Xi'an Jiao Tong University , Xi'an , China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Sheng
authors.affiliation: b Department of Otolaryngology, Peking Union Medical College Hospital , Chinese Academy of Medical Sciences & Peking Union Medical College , Beijing , China.
authors.forename: Guo-Dong
authors.initials: GD
authors.lastname: Feng
authors.affiliation: b Department of Otolaryngology, Peking Union Medical College Hospital , Chinese Academy of Medical Sciences & Peking Union Medical College , Beijing , China.
authors.forename: Hai-Yan
authors.initials: HY
authors.lastname: Wu
authors.affiliation: b Department of Otolaryngology, Peking Union Medical College Hospital , Chinese Academy of Medical Sciences & Peking Union Medical College , Beijing , China.
authors.forename: Zhi-Qiang
authors.initials: ZQ
authors.lastname: Gao
mesh_terms: D000328:Adult; D020330:Bell Palsy / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods* / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D013997:Time Factors; D055815:Young Adult
keywords: Bell's palsy; facial nerve; facial nerve surgery; surgical decompression