Recurrent facial palsy: Characteristics of ipsilateral and alternative palsies of 104 cases

Yusuke Kikuoka; Shin-Ichi Haginomori; Yusuke Ayani; Tsuyoshi Jin-Nin; Takahiro Ichihara; Yuko Inaka; Akiko Ozaki; Takaki Inui; Ryo Kawata

doi:10.1016/j.anl.2022.11.005

Recurrent facial palsy: Characteristics of ipsilateral and alternative palsies of 104 cases

Auris Nasus Larynx. 2023 Aug;50(4):507-512. doi: 10.1016/j.anl.2022.11.005. Epub 2022 Dec 8.

Authors

Yusuke Kikuoka¹, Shin-Ichi Haginomori², Yusuke Ayani¹, Tsuyoshi Jin-Nin¹, Takahiro Ichihara¹, Yuko Inaka¹, Akiko Ozaki¹, Takaki Inui¹, Ryo Kawata¹

Affiliations

¹ Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Osaka Medical and Pharmaceutical University, Osaka 569-8686, Japan.
² Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Osaka Medical and Pharmaceutical University, Osaka 569-8686, Japan. Electronic address: hagi@ompu.ac.jp.

PMID: 36503866
DOI: 10.1016/j.anl.2022.11.005

Abstract

Objective: Recurrent facial palsy is relatively rare and its clinical details of recurrent facial palsy are not well known. We analyzed recurrent facial palsy cases and clarified its characteristics, especially the difference between ipsilateral and alternative palsies. The analysis aimed to obtain information about recurrent facial palsy that would be useful for delivering explanations to patients and help improve recurrent facial palsy treatments based on the etiology.

Methods: We picked up data from the chart and analyzed the clinical characteristics of patients with recurrent facial palsy from 1243 facial palsy patients (Bell's palsy, VZV-related palsy (Ramsay Hunt syndrome and zoster sine herpete [ZSH])) between 2006 and 2020.

Results: Recurrent facial palsy was observed in 104 of 1243 patients (8.4%). There were 35 cases (34%) of ipsilateral palsy and 69 cases (66%) of alternative palsy. The mean age at the onset of the first palsy was 38.9 years old in the ipsilateral group and 48.4 years old in the alternative group, and a significant difference was observed between them. The number of recurrences ranged from 1 to 4. Among the ipsilateral group, 6 patients experienced more than second recurrence. In two cases, the condition failed to resolve after the second recurrence. A serological examination confirmed that 4 cases had recurrent VZV-related palsy (both the first and second palsies were VZV-related) and all of them initially had ZSH: no cases had Hunt syndrome as the first palsy.

Conclusions: The VZV-specific immunity obtained with ZSH might be insufficient to suppress VZV reactivation, and VZV vaccination should be recommended for ZSH patients to prevent further recurrence of VZV-related facial palsy. More than 2 ipsilateral recurrent episodes may be a risk factor for incomplete recovery.

Keywords: Alternative palsy; Ipsilateral palsy; Mean age; Ramsay Hunt syndrome; Recurrent facial nerve paralysis; Zoster sine herpete.

MeSH terms

Adult
Bell Palsy* / complications
Facial Paralysis* / etiology
Herpes Zoster Oticus* / complications
Herpesvirus 3, Human / physiology
Humans
Risk Factors