Nasal obstruction and cheek biting as overlooked sequelae of facial nerve palsy: Findings from an exploratory cohort study

Conventional grading systems for facial nerve palsy, such as the House-Brackmann, Sunnybrook, and Yanagihara scales, assess symmetry and motor recovery but fail to capture patient-reported outcomes. Patient-reported outcome measures (PROMs), such as the Facial Clinimetric Evaluation (FaCE) scale, address this gap, yet sequelae, including nasal obstruction and cheek biting, remain undocumented. We conducted a repeated-measures analysis within a prospective cohort study at Kanazawa Medical University. Twenty-two patients with unilateral facial nerve palsy were evaluated using paired assessments of Sunnybrook and FaCE scores obtained at multiple time points up to 1 year after onset. Objective facial function was evaluated using the Sunnybrook system, and subjective function was assessed using the FaCE questionnaire supplemented with two additional items addressing nasal obstruction and cheek biting. Symptoms were defined as scores ≤50 on a 0-100 scale. At 1 year, nasal obstruction was reported in 9/15 cases and cheek biting in 11/15. The Sunnybrook score correlated moderately with the total FaCE score (<i>ρ</i> = 0.449, <i>p</i> = 0.003). Nasal obstruction correlated significantly with Sunnybrook (<i>ρ</i> = 0.406, <i>p</i> = 0.009) and FaCE (<i>ρ</i> = 0.597, <i>p</i> < 0.001) scores, whereas cheek biting correlated only with FaCE (<i>ρ</i> = 0.437, <i>p</i> = 0.004). Nasal obstruction was associated with all FaCE subdomains except Eye Comfort, whereas cheek biting correlated with all but Eye Comfort, Lacrimal Control, and Social Function. This exploratory study identified nasal obstruction and cheek biting as frequent, clinically meaningful, yet overlooked, sequelae of facial palsy. Their persistence despite motor recovery underscores the limitations of physician-based grading and value of PROMs. Routine inquiry into these symptoms and their inclusion in facial palsy assessment and rehabilitation planning may enhance the comprehensiveness of evaluation and planning.