What are the treatment options for Facial Palsy (Bell's Palsy)?

From the Guidelines

Facial palsy treatment should always begin with oral steroids within 72 hours of symptom onset for patients 16 years and older, as this has been shown to significantly improve recovery rates and reduce inflammation, as demonstrated by high-quality randomized controlled trials such as those by Sullivan et al and Engstrom et al 1. The primary goal of treatment is to reduce inflammation, improve nerve function, and prevent long-term damage.

• Oral corticosteroids, such as prednisolone, are the first line of treatment for Bell's palsy, with a strong recommendation based on high-quality evidence 1.
• The dosage and duration of prednisolone treatment can vary, but a common regimen is 60-80mg daily for 7-10 days, followed by a tapering dose.
• Antiviral medications, such as valacyclovir, may be added if a herpes virus infection is suspected, but their effectiveness is still a topic of debate.
• Eye protection is crucial for patients who cannot close their affected eye completely, and can include artificial tears, lubricating ointment, and an eye patch or tape to prevent corneal damage.
• Physical therapy, including facial exercises, massage, and electrical stimulation, can help maintain muscle tone and prevent contractures.
• Moist heat application to the affected side can improve comfort and circulation.
• For severe cases not responding to medication, or for other types of facial palsy like those caused by trauma or tumors, surgical interventions might be necessary. It is essential to note that early treatment significantly improves outcomes by reducing nerve inflammation and preventing permanent damage to facial muscles and structures, as highlighted by the studies 1.

From the Research

Treatment Options for Facial Palsy

• Corticosteroids are the mainstay of treatment for Bell's palsy and should be initiated within 72 hours of symptom onset 2, 3, 4, 5, 6
• High-dose corticosteroids can improve outcomes when given early 2, 4, 5
• Antiviral therapy may confer a small benefit when used in combination with corticosteroids, but the evidence is not conclusive 3, 4, 5, 6
• Reconstructive surgery can improve long-term disfigurement, but acute and surgical options are time-dependent 2
• Other treatments such as acupuncture, physical therapy, electrotherapy, or surgical decompression are not recommended due to lack of evidence 3

Importance of Early Recognition and Treatment

• Early recognition and treatment of Bell's palsy are crucial to improve outcomes 2, 3, 4, 5, 6
• Delayed treatment can result in residual hemifacial weakness, which can be severe and disfiguring in some cases 2
• The facial muscles remain viable re-innervation targets for up to 2 years, making early referral for facial reanimation important 2

Diagnosis and Assessment

• The diagnosis of Bell's palsy is based on exclusion, and a thorough history and physical examination are essential 3, 6
• The condition is characterized by an acute onset of unilateral, lower motor neuron weakness of the facial nerve in the absence of an identifiable cause 3, 6
• Red flags or features atypical for Bell's palsy should be recognized to avoid diagnostic pitfalls and suggest an alternative cause of peripheral facial palsy 6