Beyond Bell's Palsy: Skull Base Pathology Presenting with Facial Paralysis

Area of Science:

• Neurology
• Oncology
• Skull Base Surgery

Background:

• Bell's palsy is the most common cause of acute facial paralysis.
• Occult skull base pathology can mimic idiopathic facial paralysis.
• Identifying predictors of occult pathology is crucial for accurate diagnosis.

Purpose of the Study:

• To evaluate the incidence of occult skull base pathology in patients initially diagnosed with Bell's palsy.
• To identify clinical predictors associated with occult skull base pathology.

Main Methods:

• Retrospective review of 345 patients with presumed Bell's palsy (2002-2024).
• Exclusion of patients with known malignancy, trauma, or infectious causes.
• Analysis of demographic data, medical therapy, imaging, neurological exams, and final diagnoses.

Main Results:

• Occult skull base pathology found in 6.1% of patients.
• 90.5% of these patients had additional cranial neuropathies (facial numbness, vocal fold paralysis, hypoglossal nerve palsy).
• Squamous cell carcinoma was the most common diagnosis; no benign pathology seen with additional deficits.

Conclusions:

• Additional cranial neuropathies are strong indicators of occult skull base malignancy.
• Prompt skull base imaging and evaluation are recommended for facial paralysis with neurological deficits.
• Distinguishing idiopathic from secondary causes is critical for patient management.