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Prognostic value of inflammatory and radiologic markers in pediatric bell's palsy: a retrospective study
Cem Çelik1, Belgin Tutar2, Güler Berkiten3
1Department of Otorhinolaryngology, Gaziantep City Hospital, İbn-i Sina Mahallesi, 298R+GC, Şahinbey/Gaziantep, 27470, Turkey. ceemcelik1@gmail.com.
Insights
Initial clinical severity is the strongest predictor of recovery in pediatric Bell's palsy. Inflammatory markers and CT-based facial nerve measurements showed limited prognostic value for outcomes in children.
Area of Science:
- Neurology
- Pediatrics
- Radiology
Background:
- Bell's palsy is a common cause of acute unilateral facial nerve paralysis in children.
- Accurate prognostic indicators are crucial for managing pediatric Bell's palsy and guiding treatment decisions.
Purpose of the Study:
- To assess the prognostic significance of inflammatory markers, CT-derived facial nerve measurements, and clinical factors in pediatric Bell's palsy.
- To identify reliable predictors of recovery in children diagnosed with Bell's palsy.
Main Methods:
- Retrospective analysis of 136 pediatric Bell's palsy patients (age 4-18).
- Evaluation of clinical data (age, sex, HB grade, recovery), inflammatory markers (MPV, NLR, PLR, CAR), and CT-based facial nerve-to-facial canal (FN/FC) ratios.
- Comparison with 70 age-matched controls.
Main Results:
- Initial House-Brackmann (HB) grade strongly correlated with one-month and final recovery.
- C-reactive protein-to-albumin ratio (CAR) showed a weak correlation with one-month recovery only.
- Facial nerve-to-facial canal (FN/FC) ratios were elevated in affected regions but did not correlate with recovery outcomes.
Conclusions:
- Initial clinical severity (HB grade) is the primary predictor of recovery in pediatric Bell's palsy.
- Inflammatory markers and CT-based radiologic parameters have limited prognostic utility in this population.
- Further research may be needed to clarify the role of these markers in specific Bell's palsy cases.
Purpose:
To evaluate the prognostic significance of inflammatory markers, computed tomography (CT)-based facial nerve measurements, and clinical parameters in pediatric patients with Bell's palsy.
Methods:
In this retrospective study, 136 patients aged 4-18 years diagnosed with Bell's palsy were evaluated. Clinical data included age, sex, affected side, initial House-Brackmann (HB) grade, recovery grades at one month and final follow-up, presence of pain, and treatment timing. Inflammatory markers-mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein-to-albumin ratio (CAR)- were calculated from laboratory data obtained at admission. Facial nerve-to-facial canal (FN/FC) ratios were measured via CT in five regions. The control group included 70 age-matched children with normal CT scans obtained for non-specific complaints such as headache. Recovery was categorized as full (HB 1), partial (improved but not grade 1), or poor.
Results:
Initial HB grade was significantly correlated with both one-month (r = 0.67, p < 0.001) and final recovery (r = 0.33, p < 0.001). CAR was weakly correlated with one-month recovery (r = 0.224, p = 0.0089) but not long-term outcome. MPV, NLR, and PLR showed no significant prognostic value. FN/FC ratios were significantly higher in the labyrinthine, geniculate, and tympanic regions on the paralyzed side compared to both the control group and non-paralyzed side. However, no correlations were found between FN/FC ratios and recovery. A moderate correlation was observed between initial HB grade and tympanic FN/FC ratio (r = 0.321, p = 0.001).
Conclusion:
Initial clinical severity best predicts recovery in pediatric Bell's palsy. Inflammatory and radiologic parameters offer limited prognostic value and warrant cautious interpretation.
