This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines to explore diagnostic errors in peripheral facial palsy in adults and their impact on medical and paramedical care. Four databases were used to collect 303 articles, 23 of which, published between 2015 and 2024, were analyzed using the CARE grid for case studies and the JBI grid for case series. Fifty cases of diagnostic error were identified. A tumor was found to be the cause in 56% of cases that were initially identified as Bell's palsy. The results of this meta-analysis show that symptoms that come on gradually are linked to longer time to diagnosis (P=0.04). Furthermore, time to diagnosis was significantly longer (P=0.04) when the final diagnosis was a tumor. The results also highlight the importance of detailed clinical and medical assessment, particularly for women, who are consistently diagnosed later than men despite presenting the same symptoms. The challenge of diagnosis by exclusion is highlighted by the diversity of etiologies, but is essential before a diagnosis of Bell's palsy can be established. Healthcare professionals must be vigilant in case of atypical developments in peripheral facial palsy, as such cases can be complex and require careful monitoring. Paramedical professionals also play a key role in alerting the medical profession when the progression of the disorder does not correspond to the typical clinical picture.

Patients with post-paralytic facial synkinesis (PPFS) experience a diverse array of neuronal changes from aberrant peripheral neurogenesis to cortical changes. The aim of this review is to utilize a comprehensive search strategy to (1) identify studies using functional magnetic resonance imaging (fMRI) to evaluate PPFS, and (2) synthesize the available evidence for any unifying structural and functional cortical changes which hold promise for future investigation. A search of Pubmed and Embase databases was conducted with a research librarian. Articles were then screened and reviewed independently by two authors. Inclusion criteria specified studies reporting quantitative imaging evaluation of post-paralytic facial synkinesis. Cerebral cortical changes were evaluated using diffuse tensor imaging, task-based, and resting-state fMRI. Specific assessments of sameness (Dice coefficients), transmission patterns (functional anisotropy), synchronization (Voxel-Mirrored Homotopic Connectivity: VMHC), intrinsic activity (Amplitude of Low Frequency Fluctuations: ALFF), and network efficiency (rich-club nodes) were all examined. Of the 359 studies identified, 13 studies met inclusion criteria. The cortical changes observed included diffuse/overlapping activation patterns, impaired interhemispheric communication, structural brain changes, and structural/functional connectivity mismatch. Evidence of cortical reorganization is apparent in post-paralytic facial synkinesis. Maladaptive neuroplasticity is a hallmark of multiple neuropathologic disorders and should be investigated as a future therapeutic target.

We present a rare case of recurrent glomus jugulare tumour, manifesting as an isolated facial nerve palsy. Glomus jugulare tumours are slow-growing paragangliomas of the jugular bulb adventitia. We report the case of a 73-year-old female referred for oculoplastic management of a facial nerve palsy, with a history of a right-sided glomus jugulare tumour treated surgically 40 years prior. Her 6-month history of facial palsy had initially been attributed towards Bell's palsy, particularly in the context of communication challenges related to residual dysphonia and hearing loss following her prior skull-base surgery. This case underscores the importance of maintaining a high index of suspicion in patients with atypical or high-risk clinical features and highlights the necessity of timely neuroimaging to exclude underlying structural pathology.

Bell's palsy, an idiopathic facial nerve paralysis (FNP), causes one-sided facial muscle weakness. Although this is a common clinical diagnosis in the pediatric population, further workup is warranted if FNP is accompanied by atypical symptoms or recurrence as this could be indicative of an alternative diagnosis. We report a 12-year-old female patient who experienced two right-sided episodes of lower motor neuron FNP occurring 10 months apart with atypical sensory nerve involvement. Both episodes resolved with oral corticosteroid therapy, and the patient did not follow up with pediatric neurology for further workup. This case is notable for its recurrent ipsilateral presentation in a child with otherwise normal systemic workup, contributing to the limited literature on pediatric recurrence patterns. It underscores the diagnostic challenge of distinguishing idiopathic from secondary causes, reinforces the role of corticosteroids in management, and highlights the importance of clinical follow-up despite spontaneous recovery.