(1) Background: The effectiveness of decompression surgery for Bell's palsy is controversial. This study investigated the effects of facial nerve decompression in patients with severe Bell's palsy who were expected to have a poor prognosis. (2) Methods: We retrospectively reviewed 1721 patients with Bell's palsy who visited the Kyung Hee University Hospital between January 2005 and December 2021. Of these, 45 patients with severe Bell's palsy were divided into two groups; 30 patients were treated conservatively with steroids and antiviral agents alone, while 15 patients underwent additional decompressive surgery after the conservative treatment. Outcomes were measured using House-Brackmann (H-B) grade for least 6 months after treatment was finished and conducted until full recovery was achieved. (3) Results: There was no significant difference in the rate of favorable recovery (H-B grade 1 or 2) between the surgery group and the conservative treatment group (75% vs. 70.0%, p > 0.05). Although H-B grade improvement occurred in both groups, the degree of improvement was not significantly different between groups. (4) Conclusions: Facial nerve decompression surgery in severe Bell's palsy patients did not significantly improve prognosis beyond that offered by conservative treatment alone. Additional surgical decompression may not be necessary in patients with severe Bell's palsy if they receive sufficient conservative treatment.
Keywords: Bell’s palsy; facial nerve; surgical decompression.