Prognosis of Peripheral Facial Palsy
An Electroneuronographic Study
1978 Volume 71 Issue 2 Pages 153-161
Details
1978 Volume 71 Issue 2 Pages 153-161
Using electroneuronography (NG), the prognosis of 60 patients with peripheral facial palsy including Bell's palsy (42 cases), Hunt's syndrome (15 cases) and traumatic facial palsy (3 cases) were investigated.
In most cases in this series, the first measurement of NG% (amplitude of neuronograph on paralysed side/amplitude of neuronograph in unimpaired side) was done within four weeks after onset of the palsy. NG% deteriorating below 19% within four weeks after onset was observed in 19.4% with Bell's palsy and in 44.5% with Hunt's syndrome.
During the observation period there was no improvement of NG% in Bell's palsy in which NG% deteriorated below 19% in early stage of the palsy. But in contrast to Bell's palsy, there was some improvement of NG% parallel to the clinical recovery of the palsy those with Hunt's syndrome in which NG% deteriorated below 19% in early stage of the palsy.
In two with Hunt's syndrome decompression surgery was done and there was some improvement in NG% in the fifth or sixth month, post-operatively.
In the early stage of the facial palsy, we use routinely the Nerve Excitability Test (NET) and NG for estimating the prognosis. In cases in which both NET and NG showed good responses in the early stage, the palsy recovered within three months. In cases in which both NET and NG showed poor responses, a longer period (more than three months) was required for recovery. The prognosis of patients in which responses between NET and NG showed a discrepancy in early stages of the palsy was almost the same as that indicated with NG. Therefore, NG is more accurate than NET for estimating the prognosis. But at present, the combination of NET and NG is apparently the best way for estimating the prognosis. After the clinical recovery appeared to come to the end in the patients with incomplete recovery, NET showed findings parallel to the clinical recovery compared with the other electrical tests.
Through the combination with NET, NG is at present a most useful test for estimating the prognosis, but with these two tests, the indication for decompression surgery cannot be determined in most patients with peripheral facial palsy.
