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). Study Design: Retrospective case review with current follow-up wherever possible. Setting: Tertiary referral centers. Patients: 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. Intervention: Therapy with systemic corticosteroids and antiviral agents and outpatient follow-up for I month to 4 years after discharge. Main Outcome Measure: Assessment of recovery from FNP using the Rouse-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 I to 6 days of the involvement of I side (mean period, 3.4 d). Bell's palsy was the most common cause (5 of 7; 71.4%), the other 2 being infectious rnononucleosis and Ramsay Hunt syndrome zoster sine herpete (I of 7; 14.3% each). Although most patients recovered completely within I to 6 months, I 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. Conclusion: 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.