Facial Paralysis in Guillain-Barré Syndrome: Clinical Considerations and Outcomes

Introduction: Guillan-Barré syndrome (GBS) is an autoimmune disease that commonly manifests as an ascending paralysis of the extremities and trunk. Facial paralysis is a rare and often unreported complication of GBS that can be refractory to typical treatment modalities. In this study, we will illustrate outcomes of those with facial paralysis due to GBS while highlighting the course of recovery, surgical interventions, and treatment paradigms for flaccid and non-flaccid clinical presentations.

Methods: In this case series, patients were identified who presented to an academic facial nerve center from August 2023 to December 2025 with the diagnosis of GBS-induced facial paralysis. Clinical details regarding their disease course and interventions were extracted from the medical record. Patient-reported outcome measures were collated.

Results: Of the 7 patients included, 5/7 were female and 2/7 male. The average age of participants was 46 years (SD = 20). 3/7 (43%) had bilateral facial paralysis. 7/7 (100%) experienced facial paralysis that presented after initial lower extremity symptoms. 6/7 recovered with remaining non-flaccid facial paralysis, and 1/7 recovered with a mixed flaccid/non-flaccid facial paralysis. 3/7 were treated with IVIG prior to presentation. Interventions include selective denervation (n=3, including 1 bilateral), DAO resection (n=1), and chemodenervation (n=4). One patient experienced unexpected severe facial paresis after denervation which spontaneously recovered. Those who underwent selective denervation had an average improvement in FACE scores by 58.6% and DAO improved by 48.9%.

Conclusions: This case series is the first to illustrate an in-depth clinical and surgical approach to GBS-induced facial reanimation. While it is a distinct etiology from Bell’s Palsy or Ramsay Hunt Syndrome, GBS-induced facial paralysis may be approached via similar algorithms.