Despite this, there is no consensus for when imaging is actually indicated. Moreover, imaging is not without risk (e.g., contrast-induced side effects) and may carry significant healthcare costs, although to date there have been no studies examining the cost effectiveness of imaging in the diagnosis of facial paralysis. This review aims to determine when it is appropriate to use imaging in the workup of unilateral facial paralysis, and which modality would be most useful for further management.
Best Practice
Imaging is indicated in the initial evaluation of unilateral facial paralysis in the presence of symptoms inconsistent with Bell’s palsy, such as slow, progressive onset of paralysis or multiple cranial nerve involvement, and also at three to six months after onset if there are no signs of recovery. Choice of CT or MRI should depend on symptoms, clinical concern, and availability of resources. Although MRI can identify a wider range of pathologies and should likely be first-line, CT often is faster and more readily available. Intratemporal causes of facial paralysis can be evaluated with either modality, with CT more often utilized for surgical planning. Imaging is best done with contrast enhancement for either modality, should include all portions of the facial nerve, and ideally should be interpreted by a radiologist with specialization in head and neck imaging. However, current imaging techniques are unable to provide prognostic information for management of facial paralysis, and further work is needed to better understand the cost–benefit ratio of imaging as a diagnostic tool (Laryngoscope. 2018;128:297–298). | ← Previous | | | Next → | Single Page