Bilateral Facial Paralysis: A 13-Year Experience.
BACKGROUND
Bilateral facial palsy is a rare clinical entity caused by myriad disparate conditions requiring different treatment paradigms. Lyme disease, Guillain-Barré syndrome, and leukemia are several examples. In this article, the authors describe the cause, the initial diagnostic approach, and the management of long-term sequelae of bilateral paralysis that has evolved in the authors' center over the past 13 years.


METHODS
A chart review was performed to identify all patients diagnosed with bilateral paralysis at the authors' center between January of 2002 and January of 2015. Demographics, signs and symptoms, diagnosis, initial medical treatment, interventions for facial reanimation, and outcomes were reviewed.


RESULTS
Of the 2471 patients seen at the authors' center, 68 patients (3 percent) with bilateral facial paralysis were identified. Ten patients (15 percent) presented with bilateral facial paralysis caused by Lyme disease, nine (13 percent) with Möbius syndrome, nine (13 percent) with neurofibromatosis type 2, five (7 percent) with bilateral facial palsy caused by brain tumor, four (6 percent) with Melkersson-Rosenthal syndrome, three (4 percent) with bilateral temporal bone fractures, two (3 percent) with Guillain-Barré syndrome, one (2 percent) with central nervous system lymphoma, one (2 percent) with human immunodeficiency virus infection, and 24 (35 percent) with presumed Bell palsy. Treatment included pharmacologic therapy, physical therapy, chemodenervation, and surgical interventions.


CONCLUSIONS
Bilateral facial palsy is a rare medical condition, and treatment often requires a multidisciplinary approach. The authors outline diagnostic and therapeutic algorithms of a tertiary care center to provide clinicians with a systematic approach to managing these complicated patients.
Boston, Mass.|From the Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School.
Robert A
RA
Gaudin
Boston, Mass.|From the Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School.
Nathan
N
Jowett
Boston, Mass.|From the Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School.
Caroline A
CA
Banks
Boston, Mass.|From the Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School.
Christopher J
CJ
Knox
Boston, Mass.|From the Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School.
Tessa A
TA
Hadlock
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D000066491:Clinical Decision-Making; D003131:Combined Modality Therapy; D005158:Facial Paralysis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D055815:Young Adult