Bell's palsy: Surgery based upon prognostic indicators and results

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Abstract
We studied 164 patients with Bell's palsy prospectively over the six-year period between August 1974 and June 1980. We found that the results of measuring tear production, sub-mandibular salivary flow, the response to maximal stimulation, and evoked electromyography gave us sufficient information to group these patients according to prognosis —either unfavorable or favorable — for spontaneous return of facial function. When the test results were 26% or more of normal, 90% of the patients had complete recovery of function; these patients were given a favorable prognosis on the basis of the results of tests described above. The natural history of Bell's palsy in patients with an unfavorable prognosis could be improved if a transmastoid facial nerve decompression to the labyrinthine segment were performed. The results were better with this approach than with supportive or steroid therapy or transmastoid vertical-horizontal surgical decompression of the facial nerve.