almost 75% of patients recovering normal mimetical function and just over a tenth having minor sequelae
about one sixth of patients are left with either moderate to severe weakness, hemifacial spasm, contracture or synkinesis
patients with a partial palsy fair better
94% making a full recovery
in partial palsy, outcome is worse when herpes zoster virus infection is involved
in patients who recover without treatment
in the majority, major improvement occurs within three weeks
if recovery does not occur within this time
recovery is then unlikely to be seen until four to six months - this is when nerve regrowth and reinnervation have occurred
it is clear by six months who will have moderate to severe sequelae
indicators of poor prognosis in Bell's palsy include:
a complete facial palsy
no recovery by three weeks
if there are associated conditions
hypertension, diabetes, pregnancy
if the patient is aged over 60 years
if there is severe pain associated with the facial palsy
Ramsay Hunt syndrome (herpes zoster virus)
if electrophysiological testing shows severe degeneration of the facial nerve
in facial palsies caused by herpes simplex virus or herpes zoster virus there remains a strong correlation between the peak severity of the palsy and the outcome
there is currently no reliable investigation or test at presentation that can indicate who will make a full recovery
80% of patients with Bell's palsy have a conduction block in the facial canal which is probably caused by segmental demyelination
in this group, recovery occurs within about 4 weeks
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