From the Guidelines
Treatment for patients after Bell's palsy should focus on addressing residual symptoms and promoting recovery, with a strong emphasis on oral corticosteroids within 72 hours of symptom onset for patients 16 years and older, as recommended by 1 and 1. The primary goal of treatment is to decrease recovery time and improve facial nerve functional recovery.
- For patients with incomplete recovery, physical therapy, including facial exercises and neuromuscular retraining, can help improve muscle control and prevent contractures, as suggested by the general principles of rehabilitation.
- Botulinum toxin (Botox) injections may be beneficial for patients with synkinesis (unwanted facial movements), typically administered every 3-4 months by a specialist, as mentioned in 1.
- Surgical options, such as nerve grafts, muscle transfers, or static procedures like gold weight eyelid implants, can be considered for those with long-term facial weakness, as discussed in 1.
- Psychological support is also crucial, as persistent facial weakness can cause significant emotional distress, and patients may benefit from counseling or support groups, as noted in 1.
- For ongoing eye symptoms, artificial tears (4-6 times daily) and eye ointments at night are recommended, with eye patches or moisture chambers for severe cases, as suggested by 1 and 1. It is essential to individualize treatment based on the specific deficits and needs of each patient, taking into account the potential risks and benefits of each intervention, as emphasized in 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Post Bell's Palsy
- The treatment options for patients after Bell's palsy include nonsurgical and surgical methods 2.
- Nonsurgical treatment involves the use of botulinum toxin injections to paralyze the ipsilateral orbicularis oculi, contralateral forehead rhytides, and depressor anguli oris, and to treat blepharospasm and muscle tightness 2.
- Surgical treatment options include ipsilateral brow lift, division of the contralateral frontal branch, contralateral tarsorrhaphy to equalize the palpebral fissures, and bilateral upper blepharoplasty 2.
Medications and Therapy
- Oral corticosteroids, such as prednisone, are the first-line treatment for Bell's palsy, and combination therapy with an oral corticosteroid and antiviral may reduce rates of synkinesis 3.
- Antivirals, such as valacyclovir or acyclovir, may be used in combination with corticosteroids, but treatment with antivirals alone is ineffective and not recommended 3.
- Physical therapy, including facial neuromuscular re-education, may be beneficial in patients with more severe paralysis, and can improve facial symmetry and minimize synkinesis 4, 5, 6.
Timing of Treatment
- Early physical interventions, including neuromuscular retraining therapy, can minimize excessive movement or unwanted co-contraction after a severe Bell's palsy, and should be commenced before synkinesis develops 6.
- The timing of neuromuscular retraining therapy is essential, and patients with sudden severe Bell's palsy should receive oral steroids as soon as possible, along with physical therapy within 3 months, to minimize synkinesis 6.
Effectiveness of Treatment
- The effectiveness of botulinum toxin injections on facial symmetry and patient appreciation of this were assessed by measuring brow height and teeth exposure before and 3 weeks after injection, and patient self-assessments showed improvements in their appreciation of facial symmetry, ability to go out in public, and feelings of self-worth 2.
- Facial neuromuscular re-education was found to be more effective in improving facial symmetry in patients with Bell's palsy than conventional therapeutic measures 5.