(423) Understanding Modern Facial Paralysis: Insights from the Largest USA Database

Introduction: Facial paralysis represents a heterogeneous clinical entity with diverse etiologies, demographics, and care patterns, yet contemporary characterizations of affected patients remain limited. Using the largest national healthcare database, this study examines trends that define the modern facial paralysis population across the last decade.

Methods: A retrospective study was conducted using Epic Cosmos, a national, multi-institutional EHR database. Facial paralysis of any etiology was identified using a comprehensive set of ICD-10 codes. Data were collected from January 1, 2015 - January 1, 2025. All encounter settings were included. Outcomes included overall patient volume, etiologic categories, demographic characteristics, and social determinants of health, including Social Vulnerability Index (SDI) and Area Deprivation Index (ADI). Proportions were used to characterize distributions and temporal trends.

Results: A total of 1,118,889 patients with facial paralysis were identified in Epic Cosmos. SVI was available for 621,582 patients (55.6%) and was broadly distributed across quartiles: < 25%: 147,958 (23.8% of those with SVI), 25–50%: 160,206 (25.8%), 50–75%: 160,390 (25.8%), and >75%: 153,028 (24.6%). ADI was available for 625,121 patients (55.9%) and spanned the full range of deprivation deciles: < 10: 20,573, 10–20: 39,353 (6.3%), 20–30: 52,680 (8.4%), 30–40: 65,379 (10.5%), 40–50: 73,208 (11.7%), 50–60: 78,169 (12.5%), 60–70: 76,733 (12.3%), 70–80: 74,662 (11.9%), 80–90: 72,186 (11.5%), and >90: 72,178 (11.5%). ADI ≥50 accounted for 373,928 patients.

Conclusions: Facial paralysis has affected over one million patients in the USA over the last 10 years and represents a clinically diverse, demographically broad, and etiologically complex population. Findings from this analysis highlight that the modern patient with facial paralysis cannot be defined by a single cause, age group, or demographic profile which emphasizes the need for multidisciplinary expertise, individualized management strategies, and continued research into disparities across this heterogeneous population.