Key points:
All patients with irreversible facial nerve palsy require further
diagnostics to exclude organic, infectious, metabolic and
autoimmunological cause of such a process.
Clinicians should pay special attention to patients with new or
worsening neurologic findings at any point, ocular symptoms developing
at any point, or incomplete facial recovery 3 months after initial
symptom onset.
The differential diagnosis should put emphasis on expansive processes,
including cancers.
Depending on the suspected localization of the lesion, high-resolution
CT of the temporal bone and MRI with contrast enhancement are
recommended for the evaluation of the facial nerve.
In selected undiagnosed cases, repeated imagings or even explorative
surgery with biopsy of tissues adjacent to the facial nerve should be
considered.