Aetiological Profile of Patients with Acquired Lower Motor Neuron Facial Paralysis

Background: Facial nerve paralysis is a disorder that severely affects a patient’s quality of life causing severe emotional, social and vocational handicaps. The diverse aetiological factors make it a huge diagnostic challenge for doctors. It is important to understand the cause and nature of the disease to treat and rehabilitate patients with facial nerve paralysis. Aim: To analyse the aetiological profile of acquired lower motor neuron facial paralysis and to study the socio-demographic characteristics of the patients, grade the disease severity and assess the outcome in disease progression following various treatment modalities. Methods: A prospective, longitudinal and descriptive study of 18 months duration conducted in 86 patients who presented with LMN facial nerve paralysis. After history taking and clinical examination, including severity grading using House-Brackmann grading system, patients were investigated and treated with appropriate medical and surgical modalities. The recovery status of patients was assessed after 1,3- and 6-month follow-up by grading the improvement with House Brackmann grading system. Results: Of the 86 patients with acquired lower motor neuron facial paralysis, Bell’s palsy was the commonest followed by temporal bone trauma. Most cases presented with House-Brackmann Grade III stage. Majority of the cases were managed conservatively with steroids and physiotherapy. Surgical management included facial nerve decompression, nerve grafting, tumour excision and modified radical mastoidectomy for disease clearance. Most of the cases showed a complete recovery of facial function by six months with Bell’s palsy having the best prognosis. Conclusion: Among the causes of peripheral facial nerve paralysis, Bell’s palsy and post-traumatic facial paralysis were the commonest. While most cases can be managed conservatively, some need careful evaluation and early surgical intervention for a complete or partial recovery.