Recurrent and Bilateral Facial Palsy in Bell's Palsy and Ramsay-Hunt Syndrome: Risk Factors and Clinical Outcomes

Area of Science:

• Neurology
• Ophthalmology
• Otolaryngology

Background:

• Bell's Palsy and Ramsay Hunt Syndrome typically cause nonrecurrent unilateral facial palsy.
• Risk factors for recurrent or bilateral facial palsy remain poorly understood.
• This study investigates risk factors and severity in recurrent and bilateral facial palsy cases.

Purpose of the Study:

• Identify risk factors for recurrent and bilateral facial palsy.
• Assess facial palsy severity in recurrent and bilateral cases.
• Compare risk factors and severity between Bell's Palsy and Ramsay Hunt Syndrome.

Main Methods:

• Retrospective analysis of 440 patients with facial palsy from 2009-2025.
• Comparison of risk factors for recurrence and bilaterality against a nonrecurrent unilateral group.
• Facial Nerve Clinician-Graded Scale (eFACE) used for severity assessment.

Main Results:

• Age under 40 at onset was a risk factor for recurrence (p=0.017).
• Autoimmune disease was associated with bilaterality (p=0.030).
• No significant difference in severity was found between recurrent, bilateral, and unilateral groups, nor between Bell's Palsy and Ramsay Hunt Syndrome.

Conclusions:

• Younger age and autoimmune disease are key factors in facial palsy recurrence and bilaterality, respectively.
• Facial palsy severity is comparable across different forms (recurrent, bilateral, unilateral) and etiologies (Bell's Palsy vs. Ramsay Hunt Syndrome).
• Recurrence and bilaterality rates were similar between Bell's Palsy and Ramsay Hunt Syndrome, with events occurring approximately a decade apart.