From the Guidelines
Bell's palsy patients with forehead involvement should be treated with oral steroids within 72 hours of symptom onset to improve facial nerve function and reduce morbidity. The use of oral steroids, such as prednisolone, has been shown to significantly improve recovery rates in patients with Bell's palsy, with one study reporting 83% of patients recovering facial nerve function 3 months after treatment compared to 63.6% of those receiving placebo 1. This treatment is particularly effective when started within 72 hours of symptom onset, as demonstrated by the study by Sullivan et al, which reported significant improvement in facial nerve function in patients treated with prednisolone within this timeframe 1.
Some key points to consider in the treatment of Bell's palsy with forehead involvement include:
- Oral steroids, such as prednisolone, should be prescribed within 72 hours of symptom onset to maximize recovery rates
- The dosage and duration of oral steroid treatment may vary, but a common regimen is 60-80mg daily for 5-7 days, then tapered over the next 5-7 days
- Adding an antiviral like valacyclovir may be beneficial, especially if started within 72 hours of symptom onset
- Eye protection is crucial if the patient cannot fully close the affected eye, with artificial tears and lubricating ointment used to prevent corneal damage
- Physical therapy with facial exercises and massage may help maintain muscle tone during recovery, although the evidence for this is not as strong as for oral steroid treatment 1.
It is essential to note that the treatment of Bell's palsy should prioritize reducing morbidity and improving quality of life, and oral steroid treatment has been shown to be effective in achieving these goals 1.
From the Research
Bells Palsy Forehead Symptoms
- Reduced forehead wrinkling is a common symptom of Bell's palsy, as it affects the facial nerve, which controls the muscles of the face, including those in the forehead 2.
- The presentation of Bell's palsy is unmistakable, with unilateral facial weakness, including the forehead, being a key characteristic 2.
Diagnosis and Treatment
- The diagnosis of Bell's palsy is based on exclusion, and a thorough history and physical examination are essential to confirm the diagnosis 3, 4.
- Corticosteroids are the mainstay of treatment for Bell's palsy and should be initiated within 72 hours of symptom onset 3, 5, 4.
- Antiviral therapy may be offered in combination with corticosteroids, especially in severe cases, but its effectiveness is still debated 3, 5, 4.