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Related Experiment Video

Updated: May 24, 2026

Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer
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Upper-Lower Discordance and Recovery Patterns in Bell's Palsy: A Region-Specific Analysis Using House-Brackmann

Tankut Uzun, Eray Uzunoğlu, Hayder Al Farjawee

    ORL; Journal for Oto-Rhino-Laryngology and Its Related Specialties
    |May 22, 2026
    PubMed
    Summary
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    Bell's palsy recovery varies by facial region. Separate grading of upper and lower face reveals differences, with steroids aiding early recovery and comorbidities like diabetes and hypertension hindering it.

    Area of Science:

    • Neurology
    • Otolaryngology
    • Facial Nerve Disorders

    Background:

    • Bell's palsy is the most common cause of acute unilateral facial paralysis.
    • The standard House-Brackmann (HB) grading system may obscure region-specific facial nerve involvement.
    • Evaluating upper and lower facial regions separately offers a more nuanced understanding of Bell's palsy.

    Purpose of the Study:

    • To assess upper and lower facial regions independently in Bell's palsy.
    • To identify factors influencing recovery in different facial regions.
    • To determine the prognostic value of region-specific House-Brackmann grading.

    Main Methods:

    • Adult patients with Bell's palsy were evaluated within 3 days of symptom onset.
    • Standardized photographs were graded using separate upper and lower facial House-Brackmann grades by blinded otolaryngologists.

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  • Treatment (steroids, physiotherapy) and comorbidities (diabetes mellitus, hypertension) were recorded and analyzed over 6 months.

    • Main Results:

    • Region-specific House-Brackmann grades were discordant in 41.8% of patients at presentation.
    • Lower facial regions showed greater initial severity (higher HB grades) compared to upper regions.
    • Corticosteroid treatment correlated with accelerated early recovery (days 1-30), while diabetes and hypertension were linked to poorer outcomes.

    Conclusions:

    • Separate grading of upper and lower facial regions in Bell's palsy reveals significant heterogeneity.
    • Region-specific assessment can enhance prognostic accuracy at the time of presentation.
    • Corticosteroids appear to expedite early recovery, whereas comorbidities negatively impact outcomes, suggesting a need for individualized patient management.