Bell's palsy natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Natural History, Complications and Prognosis
- The House-Brackmann grading system was devised both as a clinical indicator of severity and also an objective record of progress.
- Clinically incomplete lesions tend to recover.
- The natural history without treatment was described in a study of 1011 patients in 1982:
- 67% had incomplete paralysis, with 94% rate of return to normal function
- 33% had complete paralysis, with 60% rate of return to normal function
- By 3 weeks, 71% had complete recovery, 13% had slight sequelae , and 16% had residual weakness
- Herpes zoster is associated with more severe paresis and worse prognosis compared with "idiopathic" Bell's palsy.
- There is a favorable prognosis if some recovery is seen within the first 21 days of onset.
- In severe lesions that recover, the outgrowth of new axons from the injury site may be disorganized and misdirected.
- On blinking there is twitching of the angle of the mouth, and on smiling the eye may close or wink.
- With misdirected autonomic fibers, a salivary stimulus may result in excess lacrimation, the syndrome of "crocodile tears."
- Recurrent attacks of on either the ipsilateral or contralateral side have been observed in 7 to 15% of patients.