Objective: To develop an overview of facial paralysis associated with COVID-19 to identify the clinical pattern, other symptoms, disease severity, besides discussing epidemiologic characteristics.

Background: The coronavirus is comprehended as a respiratory disease. However, in many cases of Covid-19, there are manifestations of some neurological conditions, and the inflammation of the seventh cranial nerve causing Bell’s palsy may be related^1,2,3,4.

Method: A systematic review was performed according to PRISMA-P⁵ protocol in 2 databases: PubMed and Science Direct. The screening was conducted utilizing the following search strategy: (“Facial Paralysis” OR “Facial Palsy”) AND (“COVID-19” OR “Corona Virus” OR “Coronavirus Infections” OR “SARS-COV-2”). We selected articles published after 2019, written in English, that approached COVID-19 patients affected by facial palsy. The exclusion criteria were articles not related to the subject, evidence of coinfection, studies that did not confirm the diagnosis of COVID-19, plus cases associated with Guillain-Barré and Merkelsson-Rosenthal syndromes.

Results: [figure1] We identified 110 studies through database searching, 34 were selected, however, only 8 were included for the qualitative synthesis. The studies covered 55 subjects, diagnosed with COVID-19, of whom 29 were males and 26 were females [figure2]. The median age of the patients involved was 31,8 ± 12,7 years (min. 6 – max. 50), and they manifested facial paralysis isolated as the only symptom or correlated to others. Of the subjects, 28 presented paralysis of the left facial nerve, and 27 exhibited palsy of the right facial nerve [figure3]. It was evidenced that most of the patients evaluated in this research had COVID-19 infection with conditions that ranged from mild to moderate, the majority correlated with few other symptoms since no patient showed severe manifestations of the disease. Among the findings, the most frequent were mild and systemic respiratory symptoms (8/55; 14.55%), followed by coughing (3/55; 5.64%), in addition to fever, headache, and anosmia, all with 2 cases mentioned (2/55; 3.64%).^6,7,8,9 [figure4]

Conclusion: Therefore, there might be a correlation between infection by SARS-COV-2 and the presence of acute facial paralysis (Bell’s palsy), nonetheless, further investigations with ampler evidence and methodology quality are necessary to establish this association.

References: [1] THEOPHANOUS, Christos; SANTORO, Jonathan D.; ITANI, Reem. Bell’s palsy in a pediatric patient with hyper IgM syndrome and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Brain & Development, The Japanese Society of Child Neurology, v. 43, n. 2, p. 357-359, set./2020. [2] Bastola, A, Sah, R, Nepal, G, et al. Bell’s palsy as a possible neurological complication of COVID‐19: A case report. Clin Case Rep. 2021; 9: 747– 750. https://doi.org/10.1002/ccr3.3631 [3] Lima, M.A., Silva, M.T.T., Soares, C.N. et al. Peripheral facial nerve palsy associated with COVID-19. J. Neurovirol. 26, 941–944 (2020). https://doi.org/10.1007/s13365-020-00912-6 [4] Figueiredo R, Falcão V, Pinto MJ, Ramalho C. Peripheral facial paralysis as presenting symptom of COVID-19 in a pregnant woman. BMJ Case Rep. 2020 Aug 11;13(8):e237146. doi: 10.1136/bcr-2020-237146. PMID: 32784234; PMCID: PMC7418655. [5] Moher, D., Shamseer, L., Clarke, M. et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4, 1 (2015). https://doi.org/10.1186/2046-4053-4-1 [6] ISLAMOGLU, Yuce; CELIK, Burak; KIRIS, Muzaffer. Facial paralysis as the only symptom of COVID-19: A prospective study. American Journal of Otolaryngology, v. 42, n. 4, fev./2021. [7] Homma Y, Watanabe M, Inoue K, Moritaka T. Coronavirus Disease-19 Pneumonia with Facial Nerve Palsy and Olfactory Disturbance. Intern Med. 2020;59(14):1773-1775. doi: 10.2169/internalmedicine.5014-20. Epub 2020 Jul 15. PMID: 32669517; PMCID: PMC7434541. [8] Ribeiro BNF, Marchiori E. Facial palsy as a neurological complication of SARS-CoV-2. Arq Neuropsiquiatr. 2020 Oct;78(10):667. doi: 10.1590/0004-282X20200127. PMID: 33111851. [9] Goh Y, Beh DLL, Makmur A, Somani J, Chan ACY. Pearls & Oy-sters: Facial nerve palsy in COVID-19 infection. Neurology. 2020 Aug 25;95(8):364-367. doi: 10.1212/WNL.0000000000009863. Epub 2020 May 21. PMID: 32439822.

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