Introduction
Bell’s palsy accounts for approximately 65% of acute facial
palsies.1 Diagnosis of Bell’s palsy is still one of
exclusion. Its etiology has been the subject of debates for years
.2-4 Nowadays, most authors refer to the theory of
inflammatory demyelinating neuritis caused by reactivated latent viral
infection (herpex simplex virus 1, herpes zoster virus) or other
pathogens like Coxsackie virus, adenovirus or Epstein-Barr virus. Among
non-infectious causes atherosclerosis and autoimmunological disorders
(like Hashimoto or Sjogren disease) leading to facial nerve edema are
listed.3 Facial nerve palsy (FNP) has occasionally
been reported as a complication following the administration of some
vaccinations, including mRNA vaccines (BNT162b2 and mRNA-1273) against
coronavirus disease 2019 (COVID-19).5-6 Most
researchers show that over 70% of patients with Bell’s palsy make a
full recovery in one week to six months.2,4 In some
groups, involving people over 60, patients with severe pain or pregnant
at onset, with complete paralysis, suffering from diabetes and high
blood pressure, the course of the disease may be more severe, even with
cases of permanent FNP.2,4All patients with irreversible
palsy need further diagnostics to exclude organic, infectious, metabolic
and autoimmunological cause of such a process. The detailed evaluation
should be based on in-depth history, clinical neurological and
otolaryngological examination, laboratory tests and imagings to check
for any viral (HIV, human herpesvirus 6, mumps virus, cytomegalovirus,
and rubella virus), bacterial (Borrelia burgdorferi, Rickettsia,
otogenic process), autoimmunological / metabolic (sarcoidosis, Sjogren’s
syndrome, sclerosis multiplex, GPA), and organic (tumors in the region
of cerebellopontine angle, parotid gland, petrous bone, brainstem)
pathologies.2-4
The goal of the study was to assess the frequency of malignancies hidden
under the diagnosis of “Bell’s palsy”. We aimed to create diagnostic
algorithm to avoid failures concerning patients whose only symptom of
parotid gland cancer was irreversible FNP. One can use the algorithm for
daily clinical practice and initiation of further studies.