From the Guidelines
Outpatient treatment options for facial weakness and swelling, aside from a CT maxillofacial scan, typically include medications, physical therapy, and supportive care, with the goal of addressing the underlying cause and improving morbidity, mortality, and quality of life. For infectious causes like cellulitis, oral antibiotics such as amoxicillin-clavulanate (875/125 mg twice daily for 7-10 days) or clindamycin (300-450 mg four times daily for 7-10 days) are recommended, as they have been shown to be effective in reducing morbidity and mortality associated with these conditions 1. If Bell's palsy is suspected, oral corticosteroids like prednisone (60 mg daily for 5 days, then tapered over 5 days) should be started within 72 hours of symptom onset, often with antiviral medication such as valacyclovir (1000 mg three times daily for 7 days), as this has been demonstrated to improve outcomes and reduce the risk of long-term facial weakness 1. Some key considerations for outpatient treatment include:
- Medications: oral antibiotics, oral corticosteroids, antiviral medication, and antihistamines
- Physical therapy: focusing on facial exercises to help with muscle weakness rehabilitation
- Supportive care: protecting the affected eye with lubricating drops and ointment, warm compresses to reduce swelling, and adequate hydration and rest These treatments address the inflammation, infection, or nerve dysfunction that commonly underlie facial weakness and swelling, and are supported by recent guidelines and studies, such as the American College of Radiology's appropriateness criteria for cranial neuropathy 1. It is essential to note that the choice of treatment should be guided by the underlying cause of the facial weakness and swelling, and that a thorough evaluation and diagnosis are crucial in determining the most effective treatment plan. In terms of diagnostic imaging, MRI orbits, face, and neck without and with IV contrast is usually appropriate for the initial imaging of patients with unilateral isolated weakness of the facial expression, paralysis of the facial expression, hemifacial spasm, or Bell palsy (facial nerve, CN VII), as recommended by the American College of Radiology 1.
From the Research
Outpatient Treatment Options for Facial Weakness and Swelling
Outpatient treatment options for patients with facial weakness and swelling, aside from a CT maxillofacial scan, include:
- Corticosteroids, which are the mainstay of treatment for Bell's palsy and should be initiated within 72 hours of symptom onset 2
- Antiviral therapy in combination with corticosteroid therapy, which may confer a small benefit and may be offered on the basis of shared decision making 2, 3
- Valacyclovir and prednisolone treatment, which has been shown to be effective in treating Bell's palsy, with a recovery rate of 96.5% compared to 89.7% with prednisolone alone 3
- Steroid monotherapy, which remains effective and may be initiated within 72 hours for optimal results 4
- Combined steroid and antiviral therapy, which may have potential advantages, especially in patients with more severe disease 4, 5
Considerations for Treatment
When considering treatment options, factors such as:
- Age, with patients aged 20 to 39 years having a higher recovery rate 4
- Electroneurography (ENoG) and electromyography (EMG) results, with fairly predictive EMG results associated with significantly higher recovery rates 4
- Comorbid conditions, which may affect treatment outcomes 4
- Timing of treatment initiation, with treatment within 72 hours associated with better outcomes 2, 4
Other Conditions to Consider
Other conditions that may cause facial weakness and swelling, such as blepharoptosis, may require different treatment approaches, including surgical intervention 6