Bell's palsy
Bell's palsy, the most common cause of acute spontaneous peripheral facial paralysis, is believed to involve inflammation and edema of the facial nerve, possibly related to herpes simplex virus reactivation. While most patients recover within several months to a year, up to a third experience chronic facial weakness, impacting function and appearance. Treatment primarily involves early short-term oral glucocorticoids, like prednisolone, and in severe cases, antiviral therapy with agents such as valacyclovir or acyclovir
2024-01-05 14:59:27 - Editor
Bell's palsy, also known as idiopathic facial nerve palsy, is the most common cause of acute spontaneous peripheral facial paralysis. The pathogenesis likely involves inflammation and edema of the facial nerve, with reactivation of the herpes simplex virus (HSV) thought to play an etiological role.
Recovery and Outcomes
Most patients recover completely within months to a year, but up to one-third may experience chronic facial weakness, impacting functional and cosmetic outcomes.
Pharmacological Therapy
The primary treatment for Bell's palsy is early, short-term oral glucocorticoid therapy. Severe acute cases may benefit from combining antivirals with glucocorticoids. Prednisolone is typically prescribed at 60-80 mg/day for a week. Antiviral options include valacyclovir (1000 mg thrice daily for a week) or acyclovir (400 mg five times daily for 10 days).
Eye Care
Patients with incomplete eyelid closure need meticulous eye care to prevent corneal injury. This includes artificial tears eye drops, protective glasses or goggles, and potential ophthalmology referral for additional measures like scleral lenses or eyelid weighting.
Follow-Up and Additional Interventions
Patients should be monitored for facial weakness improvement, with those showing incomplete recovery considered for multidisciplinary clinic referrals. Interventions for persistent deficits may include botulinum toxin injections and surgical procedures like eyelid weights and tarsorrhaphy.
Physical Therapy
Physical therapy options, such as facial exercises, acupuncture, massage, thermotherapy, and electrical stimulation, are used to aid recovery, though their effectiveness lacks significant supporting evidence.
References
1-Linder T, Bossart W, Bodmer D. Bell’s palsy and Herpes simplex virus:
fact or mystery? Otol Neurotol 2005;26:109-13.
2-Peitersen E. Bell’s palsy: the spontaneous course of 2,500 peripheral
facial nerve palsies of different etiologies. Acta Otolaryngol Suppl 2002;549:4-30
3-Baugh RF, Basura GJ, Ishii LE, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg 2013; 149:S1.
4-de Almeida JR, Guyatt GH, Sud S, et al. Management of Bell palsy: clinical practice guideline. CMAJ 2014; 186:917.
5-Sullivan FM, Swan IR, Donnan PT, Morrison JM, Smith BH, McKinstry B, et al. Early treatment with prednisolone or acyclovir in Bell’s palsy. N Engl J Med 2007;357:1598-607.
6-. de Almeida JR, Al Khabori M, Guyatt GH, Witterick IJ, Lin VY, Nedzelski JM, et al. Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and metaanalysis. JAMA 2009;302:985-93.
7-Gronseth GS, Paduga R, American Academy of Neurology. Evidence-based guideline update: steroids and antivirals for Bell palsy: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2012; 79:2209.
8-Grogan PM, Gronseth GS. Practice parameter: Steroids, acyclovir, and
surgery for Bell’s palsy (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001;56:830-6.
9-McAllister K, Walker D, Donnan PT, Swan I. Surgical interventions for the early management of Bell’s palsy. Cochrane Database Syst Rev 2013;10:CD007468
10-Nava-Castañeda A, Tovilla-Canales JL, Boullosa V, et al. Duration of botulinum toxin effect in the treatment of crocodile tears. Ophthal Plast Reconstr Surg 2006; 22:453.
11-Douglas RS, Gausas RE. A systematic comprehensive approach to management of irreversible facial paralysis. Facial Plast Surg 2003; 19:107.
12-Teixeira LJ, Valbuza JS, Prado GF. Physical therapy for Bell’s palsy
(idiopathic facial paralysis). Cochrane Database Syst Rev 2011;12:CD006283.