Predictability of recovery from Bell's palsy using evoked electromyography

The role of surgery in the treatment of idiopathic facial paralysis (Bell's Palsy) has been the subject of much controversy. Some have advocated aggressive surgical therapy to prevent nerve injury based on evoked electromyography (EEMG) results. The present study analyzes the outcome of 23 patients who presented with Bell's palsy and were evaluated with EEMG. Of the 15 patients who showed greater than 90 percent compound action potential reduction in the affected side, a widely used criterion for surgical decompression of the facial nerve, almost half (47%) had normal to near-normal recovery, and only three (20%) had residual severe dysfunction. Results infer that patients who meet surgical criteria based on EEMG results but who do not undergo surgery do not show a greater morbidity. The authors conclude that conservative criteria should be used when recommending facial nerve decompression.