What are the treatment options for residual Bell's (Bell's) palsy?

From the Guidelines

Residual Bell's palsy treatment should focus on managing persistent facial weakness, with a priority on protecting the eye and addressing functional and psychological impairment, as there is no strong evidence supporting a specific treatment modality, including physical therapy, as stated in the clinical practice guideline: Bell's palsy 1.

Treatment Options

• Physical therapy, although commonly used, has limited evidence to support its effectiveness in treating residual Bell's palsy, with no significant difference found in clinical outcomes between different rehabilitation techniques 1.
• Botulinum toxin (Botox) injections can be used to reduce asymmetry by temporarily weakening the stronger side of the face, with doses of 2.5-5 units per site, lasting 3-4 months and potentially requiring repetition.
• Surgical options, such as facial nerve decompression, nerve grafting, hypoglossal-facial nerve anastomosis, or facial slings/static procedures, may be considered for patients with severe, long-term deficits persisting beyond 12-18 months.
• Adjunctive treatments, including electrical stimulation therapy, acupuncture (though evidence is limited), and psychological support, can help address the cosmetic and functional impacts of residual Bell's palsy.

Eye Protection

• Eye protection is essential if incomplete eye closure persists, using artificial tears during the day and lubricating ointment with eye taping at night to prevent corneal damage, as recommended in the clinical practice guideline: Bell's palsy 1.

Follow-up and Referral

• Patients should be reassessed every 3-6 months to monitor progress and adjust treatment strategies accordingly, with referrals to specialists, such as ophthalmologists, facial plastic and reconstructive surgeons, or psychologists, as needed to address functional and psychological impairment 1.

Antiviral Therapy

• There is limited evidence to support the use of antiviral therapy in treating residual Bell's palsy, with some studies suggesting potential benefits, but results are suspect due to methodological limitations 1.

Steroid Therapy

• Oral steroids should be prescribed within 72 hours of symptom onset for Bell's palsy patients 16 years and older, as recommended in the clinical practice guideline: Bell's palsy executive summary 1.

From the Research

Treatment Options for Residual Bell's Palsy

The treatment options for residual Bell's palsy include:

• Electromyographic rehabilitation (EMGR) 2
• Botulinum toxin injection 2, 3
• Surgical reanimation 2
• Physical therapy, including exercises and electrostimulation 4, 5, 6
• Neuromuscular retraining therapy 6
• Antiviral medication 3
• Corticosteroid therapy 3
• Eye care 3
• Acupuncture 4, 5, 3

Efficacy of Treatment Options

The efficacy of these treatment options varies:

• EMGR, botulinum toxin injection, and surgical reanimation have shown improvement in patients with residual Bell's palsy 2
• Physical therapy, including exercises and electrostimulation, has shown limited evidence of significant benefit or harm 4, 5
• Neuromuscular retraining therapy has been shown to minimize facial synkinesis if commenced early 6
• Antiviral medication, corticosteroid therapy, and acupuncture may be used in the management of Bell's palsy, but their efficacy is not well established 3

Important Considerations

It is essential to note that:

• Early intervention, including physical therapy and neuromuscular retraining therapy, may be crucial in minimizing facial synkinesis 6
• Psychological and emotional care is important for patients with Bell's palsy, as facial disability can result in anxiety and stress 3