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Sarah Alshami, David Hodge, Elizabeth Bradley; The Epidemiology and Surgical Outcomes of Facial Nerve Palsy in a Population-Based Cohort. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3848.
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Herpes zoster likely plays a causal role in many cases of Bell’s palsy. The incidence of herpes zoster has increased substantially over the last 4 decades. We sought to evaluate whether the incidence of facial nerve palsy is also changing over time. We also describe the surgical management and outcomes of facial nerve palsy rehabilitation surgery in an incidence cohort.
We used the Rochester Epidemiology Project (REP) database to search cases of facial nerve palsy in Olmsted County from 2000 through 2010. Of the 1,316 patients identified, 619 patients met our inclusion criteria. Data were gathered regarding age, gender, cause of facial nerve palsy, laterality and degree of paralysis, and medical and surgical treatment outcomes. The overall incidence of facial nerve palsy in Bell's palsy patients and stroke patients was estimated using the age- and sex-specific population figures. Yearly incidence rates for age and sex groups were determined by dividing the number of cases within that group by the estimated total Olmsted County resident population of the group for that given year. The 95% confidence intervals (CIs) for the rates were calculated assuming Poisson error distribution. Institutional review board approval was obtained for this study.
Bell’s palsy and stroke were the two most common causes of facial nerve palsy. The annual incidence of Bell’s palsy in Olmsted County per 100,000 population was 39.9 (95% CI 36.1-43.7) for the total population. The annual incidence per 100,000 for stroke resulting in facial nerve palsy was 17.4 (95% CI 14.1-20.6). The incidence of facial nerve palsy due to Bell’s palsy and stroke did not differ between males and females. Compared to an earlier study performed at our institution from 1968 to 1982, the incidence of Bell’s palsy increased from 25.0 per 100,000 (95% CI 21.7-28.7), a 14.9 per 100,000 absolute increase and a 60% relative increase in the incidence of Bell’s palsy. 11 of 619 patients (1.7%) required surgical intervention for facial nerve palsy. The most common procedures were gold weight placement, performed in 3 patients, and tarsorrhaphy, performed in 5 of 11 patients.
The incidence of Bell’s Palsy has increased significantly over 35 years. This increase has occurred in the context of increasing rates of herpes zoster infection. Only a minority of patients underwent surgical management for facial nerve palsy.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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