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Review
. 2019 Oct 11;116(41):692-702.
doi: 10.3238/arztebl.2019.0692.

The Diagnosis and Treatment of Idiopathic Facial Paresis (Bell's Palsy)

Josef Georg Heckmann  1 , Peter Paul Urban, Susanne Pitz, Orlando Guntinas-Lichius, Ildikό Gágyor
Affiliations
Review

The Diagnosis and Treatment of Idiopathic Facial Paresis (Bell's Palsy)

Josef Georg Heckmann et al. Dtsch Arztebl Int. .

Abstract

Background: Peripheral facial nerve palsy is the most com- mon functional disturbance of a cranial nerve. 60-75% of cases are idiopathic.

Methods: This review is based on a selective literature search proceeding from the current, updated German-language guideline on the diagnosis and treatment of idiopathic facial nerve palsy.

Results: The recommended drug treatment consists of prednisolone 25 mg bid for 10 days, or 60 mg qd for 5 days followed by a taper to off in decrements of 10 mg per day. This promotes full recovery (number needed to treat [NNT] = 10; 95% confidence interval [6; 20]) and lessens the risk of late sequelae such as synkinesia, autonomic disturbances, and contractures. Virostatic drugs are optional in severe cases (intense pain or suspicion of herpes zoster sine herpete) and mandatory in cases of varicella-zoster virus (VZV) infection. Corneal protection with dexpanthenol ophthalmic ointment, artificial tears, and a nocturnal moisture- retaining eye shield has been found useful in practice. In cases of incomplete recovery with residual facial weakness, both static and microsurgical dynamic methods can be used to restore facial nerve function.

Conclusion: Because 25-40% of cases of facial nerve palsy are not idiopathic, differential diagnosis is very important; key diagnostic methods include a clinical neurological examin- ation, otoscopy, and a lumbar puncture for cerebrospinal fluid examination. High-level evidence supports corticosteroid treatment for the idiopathic form of the disorder.

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Figures

Figure 1
Figure 1
Clinical features of right-sided peripheral facial nerve palsy: a) lessened innervation of the forehead; b) flattened nasolabial fold; c) drooping corner of mouth; d) impaired lid closure with Bell phenomenon when the patient is asked to close the eyes.
Figure 2
Figure 2
Course and branches of the facial nerve. The intracranial course is shown as transparent (modified from [e6]; with the kind permission of Thieme).
Figure 3
Figure 3
Forest plot of the meta-analysis of randomized and quasi-randomized clinical trials on the question of corticosteroids vs. placebo (modified from [30]; with the kind permission of Wiley). The clinical endpoint is incomplete resolution of weakness 6 months or more after randomization. CI, confidence interval; RR, relative risk; heterogeneity 18%; a fixed-effects model was used in the analysis.
Figure 4
Figure 4
Forest plot of the meta-analysis of randomized and quasi-randomized clinical trials on the question of corticosteroids plus virostatic agent vs. corticosteroids alone (modified from [31]; with the kind permission of Wiley). CI, confidence interval; RR, relative risk; a random-effects model was used in the analysis.
Figure 5
Figure 5
Decision tree for acute facial nerve palsy depending on the clinical presentation. *suspect history (pain, gradual development, additional symptoms)
See this image and copyright information in PMC

Comment in

References

    1. Gilden DH. Bell’s palsy. N Engl J Med. 2004;351:1323–1331. - PubMed
    1. Rowlands S, Hooper R, Hughes R, Burney P. The epidemiology and treatment of Bell‘s palsy in the UK. Eur J Neurol. 2002;9:63–67. - PubMed
    1. Morales DR, Donnan P, Daly F, van Sta T, Sullivan FM. Impact of clinical trial findings on Bell’s palsy management in general practice in the UK 2001-2012: interrupted time series regression analysis. BMJ Open. 2013;3 e003121. - PMC - PubMed
    1. Sullivan FM, Swan IR, Donnan PT, et al. Early treatment with prednisolone or acyclovir in Bell‘s palsy. N Engl J Med. 2007;357:1598–1607. - PubMed
    1. Glass GE, Tzafetta K. Optimising treatment of Bell’s palsy. Br J Gen Pract. 2014 e:807–809. - PMC - PubMed