Exceptions and Special Situations

There are exceptions to the comments of the preceding discussion. In a small number of patients with acute facial palsy (less than 5%), it is known that the cause is a demyelinating disease similar to Guillain-Barre syndrome. Patients with palsy of this type will have complete loss of nerve excitability, suggesting an unsatisfactory result. Complete recovery without treatment within 1 month indicates the true nature of the problem. In addition, surgery performed on patients with this problem reveals no edema and has no effect on the outcome, one way or the other.

Most patients will sustain progressive deterioration of the nerve over a period during which no recovery occurs. However, a small number of patients will maintain normal nerve excitability for months or even years after the onset of palsy. Surgical decompression in such cases usually results in prompt, complete recovery within 3 or 4 weeks. Surgical decompression of the facial nerve for long-term idiopathic hemifacial spasm with facial nerve edema and partial weakness can also provide complete recovery after the myelin sheath of the nerve regrows.

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