From the Guidelines
The treatment for facial nerve palsy (Bell's palsy) should begin with oral corticosteroids like prednisone, started within 72 hours of symptom onset, to reduce inflammation and improve recovery chances, as supported by high-quality randomized controlled trials 1. The goal of treatment is to reduce inflammation, promote recovery, and prevent complications.
- Oral corticosteroids, such as prednisone, are the primary treatment for Bell's palsy, with a strong recommendation based on high-quality evidence 1.
- The dosage and duration of prednisone treatment may vary, but a common regimen is 60-80mg daily for 7 days, followed by a taper 1.
- Antiviral medications, such as valacyclovir, may be added to the treatment regimen, especially if a herpes virus infection is suspected, although the evidence for this is not as strong 1.
- Eye protection is crucial to prevent corneal damage, and measures such as artificial tears, lubricating ointment, and taping the eyelid closed may be necessary.
- Physical therapy, including facial exercises and massage, can help maintain muscle tone and prevent contractures, although the evidence for this is limited 1.
- In severe cases that do not improve within 3-6 months, surgical options like nerve decompression or facial reanimation procedures may be considered, although the evidence for these interventions is not well established 1. The effectiveness of treatment is highest when started early, as the steroids reduce inflammation around the facial nerve, allowing faster healing and preventing permanent nerve damage 1.
From the Research
Treatment Options for Facial Nerve Paresis
The treatment for facial nerve paresis, also known as facial nerve paralysis, can vary depending on the severity and cause of the condition.
- Corticosteroids, such as prednisolone, are generally agreed to be beneficial in the treatment of Bell's palsy, a common cause of facial nerve paresis 2, 3.
- The recommended dosage of prednisolone is 25 mg twice a day for 10 days, or 60 mg once a day for 5 days followed by a taper to off in decrements of 10 mg per day 3.
- Antiviral medications, such as acyclovir, may be used in combination with corticosteroids, especially in cases of severe Bell's palsy or varicella-zoster virus infection 2, 3, 4.
- However, the effectiveness of antiviral treatment alone or in combination with corticosteroids is still uncertain, and some studies have found no significant benefit from adding antivirals to corticosteroids 4.
Surgical Intervention
- In cases of severe Bell's palsy with incomplete recovery, surgical decompression of the facial nerve may be considered 2, 5.
- The optimal timing for surgical intervention is still unclear, but studies suggest that surgery performed within 30 to 90 days after the onset of paralysis may have therapeutic benefits 5.
- Decompression surgery was found to be effective in 64.4% of patients with severe Bell's palsy, with similar rates for patients who underwent surgery after 30-60 days and 61-90 days 5.
Other Treatments
- Corneal protection with dexpanthenol ophthalmic ointment, artificial tears, and a nocturnal moisture-retaining eye shield may be useful in practice 3.
- In cases of incomplete recovery with residual facial weakness, both static and microsurgical dynamic methods can be used to restore facial nerve function 3.