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      Facial Nerve Paralysis and COVID‐19: A Systematic Review

      review-article
      Author(s): , MD 1 , , BMSc 2 , , MD 1 , , , BSc 3 , , MD, MSc, FRCSC 1 , 4
      Publication date (Electronic):
      Journal: The Laryngoscope
      Publisher: John Wiley & Sons, Inc.
      Keywords: Bell's palsy, COVID‐19, facial nerve, paralysis

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          Abstract

          Objective

          Several cases of facial nerve paralysis (FNP) post‐COVID‐19 infection have been reported with varying presentations and management. This study aims to identify FNP clinical characteristics and recovery outcomes among patients acutely infected with COVID‐19. We hypothesize that FNP is a potentially unique sequalae associated with COVID‐19 infections.

          Methods

          A systematic review of PubMed‐Medline, OVID Embase, and Web of Science databases from inception to November 2021 was conducted following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines.

          Results

          This search identified 630 studies with 53 meeting inclusion criteria. This resulted in 72 patients, of which 30 (42%) were diagnosed with Guillain‐Barré Syndrome (GBS). Non‐GBS patients were on average younger (36 vs. 53 years) and more likely to present with unilateral FNP (88%) compared to GBS patients who presented predominantly with bilateral FNP (74%). Among non‐GBS patients, majority (70%) of FNP presented a median of 8 [IQR 10] days after the onset of initial COVID‐19 symptom(s). Treatment for non‐GBS patients consisted of steroids (60%), antivirals (29%), antibiotics (21%), and no treatment (21%). Complete FNP recovery in non‐GBS patients was achieved in 67% patients within a median of 11 [IQR 24] days.

          Conclusion

          FNP is a possible presentation post COVID‐19 infections, associated with both GBS and non‐GBS patients. Although no causation can be assumed, the clinical course of isolated FNP associated with COVID‐19 raises the possibility of a unique presentation differing from Bell's palsy, seen with higher proportion of patients developing bilateral FNP and a shorter duration to complete recovery. Laryngoscope, 2022

          Abstract

          Several cases of facial nerve paralysis (FNP) post‐COVID‐19 infection have been reported. This study aims to identify FNP clinical characteristics and recovery outcomes among patients acutely infected with COVID‐19. A systematic review of databases was performed resulting in 53 included studies and a total of 72 patients, of which 30 (42%) were diagnosed with Guillain‐Barré Syndrome (GBS). Among non‐GBS patients, 70% of FNP presented a median of 8 days after the onset of initial COVID‐19 symptom(s). Complete FNP recovery in non‐GBS patients was achieved in 67% patients within a median of 11 days. Although no causation can be assumed, the clinical course of isolated FNP associated with COVID‐19 raises the possibility of a unique presentation differing from Bell's palsy, seen with higher proportion of patients developing bilateral FNP and a shorter duration to complete recovery.

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          Most cited references79

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          Guillain–Barré Syndrome Associated with SARS-CoV-2

          Gianpaolo Toscano, Francesco Palmerini, Sabrina Ravaglia … (2020)
          To the Editor: From February 28 through March 21, 2020, in three hospitals in northern Italy, we examined five patients who had Guillain–Barré syndrome after the onset of coronavirus disease 2019 (Covid-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). During that period, an estimated 1000 to 1200 patients with Covid-19 were admitted to these hospitals. Four of the patients in this series had a positive nasopharyngeal swab for SARS-CoV-2 at the onset of the neurologic syndrome, and one had a negative nasopharyngeal swab and negative bronchoalveolar lavage but subsequently had a positive serologic test for the virus. Detailed case reports are provided in the Supplementary Appendix, available with the full text of this letter at NEJM.org. The first symptoms of Guillain–Barré syndrome were lower-limb weakness and paresthesia in four patients and facial diplegia followed by ataxia and paresthesia in one patient (Table 1). Generalized, flaccid tetraparesis or tetraplegia evolved over a period of 36 hours to 4 days in four patients; three received mechanical ventilation. The interval between the onset of symptoms of Covid-19 and the first symptoms of Guillain–Barré syndrome ranged from 5 to 10 days (Table 1 and Fig. S1 in the Supplementary Appendix). None of the patients had dysautonomic features. On analysis of the cerebrospinal fluid (CSF), two patients had a normal protein level and all the patients had a white-cell count of less than 5 per cubic millimeter. Antiganglioside antibodies were absent in the three patients who were tested. In all the patients, a real-time polymerase-chain-reaction assay of the CSF was negative for SARS-CoV-2. Results of electrophysiological studies are shown in Table S1. Compound muscle action potential amplitudes were low but could be obtained; two patients had prolonged motor distal latencies. On electromyography, fibrillation potentials were present in three patients initially; in another patient, they were absent initially but were present at 12 days. The findings were generally consistent with an axonal variant of Guillain–Barré syndrome in three patients and with a demyelinating process in two patients. 1 Magnetic resonance imaging, performed with the administration of gadolinium, showed enhancement of the caudal nerve roots in two patients, enhancement of the facial nerve in one patient, and no signal changes in nerves in two patients. Additional laboratory findings are shown in Table S2. All the patients were treated with intravenous immune globulin (IVIG); two received a second course of IVIG and one started plasma exchange. At 4 weeks after treatment, two patients remained in the intensive care unit and were receiving mechanical ventilation, two were undergoing physical therapy because of flaccid paraplegia and had minimal upper-limb movement, and one had been discharged and was able to walk independently. The interval of 5 to 10 days between the onset of viral illness and the first symptoms of Guillain–Barré syndrome is similar to the interval seen with Guillain–Barré syndrome that occurs during or after other infections. 2 Although many infectious agents have been associated with Guillain–Barré syndrome, there may be a propensity for preceding infection with Campylobacter jejuni, Epstein–Barr virus, cytomegalovirus, and Zika virus. There have been reports of an association between Guillain–Barré syndrome and coronavirus infections. 3,4 On the basis of this observational series involving five patients, it is not possible to determine whether severe deficits and axonal involvement are typical features of Covid-19–associated Guillain–Barré syndrome. We could not determine the effect of reduced vital capacity due to neuromuscular failure from Guillain–Barré syndrome in these patients, but such an effect might be considered if findings on chest imaging are not commensurate with the severity of respiratory insufficiency. Guillain–Barré syndrome with Covid-19 should be distinguished from critical illness neuropathy and myopathy, which tend to appear later in the course of critical illness than Guillain–Barré syndrome.
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            Guillain Barre syndrome associated with COVID-19 infection: a case report

            Zahra Sedaghat, Narges Karimi (2020)
            Highlight • A novel coronavirus (COVID-19) was detected in Wuhan City, Hubei Province of China. • The most symptoms of disease have reported fever, cough, dyspnea, myalgia, headache, and diarrhea. • We described GBS symptoms in one infected patient with COVID-19, for the first time. • The patient revealed quadriplegia and facial paresis bilaterally, two weeks after COVID-19 infection. • The electrodiagnostic findings of patient demonstrated acute motor sensory axonal polyneuropathy.
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              Facial nerve grading system.

              J W House, D Brackmann (1985)
              Article 0 comments Cited 264 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Hedyeh Ziai:
                ORCID: https://orcid.org/0000-0002-4617-3586
                Hedyeh.ziai@mail.uToronto.ca
                Journal
                Journal ID (nlm-ta): Laryngoscope
                Journal ID (iso-abbrev): Laryngoscope
                Journal ID (doi): 10.1002/(ISSN)1531-4995
                Journal ID (publisher-id): LARY
                Title: The Laryngoscope
                Publisher: John Wiley & Sons, Inc. (Hoboken, USA )
                ISSN (Print): 0023-852X
                ISSN (Electronic): 1531-4995
                Publication date (Electronic): 08 August 2022
                Publication date PMC-release: 08 August 2022
                Electronic Location Identifier: 10.1002/lary.30333
                Affiliations
                [ 1 ] Department of Otolaryngology Head and Neck Surgery University of Toronto Toronto Ontario Canada
                [ 2 ] Schulich School of Medicine and Dentistry Western University London Ontario Canada
                [ 3 ] Temerty Faculty of Medicine University of Toronto Toronto Ontario Canada
                [ 4 ] Department of Otolaryngology – Head and Neck Surgery Sunnybrook Health Sciences Centre Toronto Ontario Canada
                Author notes
                [*] [* ] Send correspondence to Hedyeh Ziai, 6 Queen's Park Crescent West, Suite 120, Toronto, ON M5S 3H2, Canada. E‐mail: Hedyeh.ziai@ 123456mail.uToronto.ca

                Author information
                https://orcid.org/0000-0002-6719-4589
                https://orcid.org/0000-0002-3828-4307
                https://orcid.org/0000-0002-4617-3586
                https://orcid.org/0000-0001-5533-5586
                Article
                Publisher ID: LARY30333
                DOI: 10.1002/lary.30333
                PMC ID: 9538897
                PubMed ID: 35938708
                SO-VID: e3ad5ab4-f166-4c5f-9761-4a917f68d4ac
                Copyright © © 2022 The American Laryngological, Rhinological and Otological Society, Inc.
                License:

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                Date revision received : 23 June 2022
                Date received : 04 March 2022
                Date accepted : 22 July 2022
                Page count
                Figures: 2, Tables: 3, Pages: 7, Words: 6830
                Categories
                Subject: Systematic Review
                Subject: Systematic Reviews
                Custom metadata
                source-schema-version-number 2.0
                edited-state corrected-proof
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.2.0 mode:remove_FC converted:07.10.2022

                ScienceOpen disciplines: Otolaryngology
                Keywords: bell's palsy,covid‐19,facial nerve,paralysis
                Data availability:
                ScienceOpen disciplines: Otolaryngology
                Keywords: bell's palsy, covid‐19, facial nerve, paralysis

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