From the Guidelines
Patients with partial Bell's palsy should be treated with oral steroids within 72 hours of symptom onset to improve recovery chances and reduce inflammation, as evidenced by high-quality randomized controlled trials showing significant improvement in facial nerve function with prednisolone treatment 1.
Treatment Overview
The treatment for partial Bell's palsy typically includes:
- Oral corticosteroids like prednisone (60-80mg daily for 5-7 days, then tapered) to reduce inflammation and improve recovery chances
- Eye protection if eye closure is affected, using artificial tears during the day (every 2-4 hours) and lubricating ointment at night, along with taping the eye closed or using an eye patch if needed to prevent corneal damage
- Physical therapy with facial exercises and massage to maintain muscle tone and prevent contractures
Prognosis and Follow-up
Most patients with partial Bell's palsy have a good prognosis, with approximately 85-90% experiencing significant improvement within 3-6 months 1. However, if symptoms worsen or don't improve within a few weeks, follow-up with a neurologist is recommended to rule out other causes of facial weakness. Patients with incomplete facial nerve recovery may be at risk for functional and psychological impairment, and may benefit from referral to a facial plastic and reconstructive surgeon or other specialists for further evaluation and treatment 1.
Key Considerations
- The condition results from inflammation of the facial nerve (cranial nerve VII) as it passes through the narrow facial canal, often triggered by viral infection, particularly herpes simplex virus
- Patients with facial paralysis may experience psychosocial dysfunction and diminished quality of life, and may benefit from support or counseling to deal with the emotional and physical consequences of persistent facial paresis/paralysis 1
From the Research
Definition and Diagnosis of Bell's Palsy
- Bell's palsy is characterized by an acute onset of unilateral, lower motor neuron weakness of the facial nerve in the absence of an identifiable cause 2.
- The diagnosis of Bell's palsy is based on exclusion, and a thorough history and physical examination are essential for establishing the correct diagnosis 2, 3.
- Bell's palsy is a diagnosis of exclusion, meaning that no features from the history, neurologic examination, or head and neck examination suggest a specific or alternative cause 3, 4.
Treatment Options for Bell's Palsy
- Corticosteroids are the mainstay of treatment for Bell's palsy and should be initiated within 72 hours of symptom onset 2, 5.
- Antiviral therapy in combination with corticosteroid therapy may confer a small benefit and may be offered on the basis of shared decision making 2, 6.
- The available moderate- to high-quality evidence from randomized controlled trials showed significant benefit from treating Bell's palsy with corticosteroids 5.
- Current evidence suggests that prednisolone is effective for Bell's palsy, but there was no statistically significant difference observed with acyclovir 6.
Prognosis and Recovery
- Even without treatment, the outcome of Bell's palsy is favorable, but treatment with corticosteroids significantly increases the likelihood of improvement 3.
- Most patients will recover fully within six months regardless of the treatment 4.
- The number of people who need to be treated with corticosteroids to avoid one incomplete recovery was 10 (95% CI 6 to 20) 5.