Background: Background: Facial paralysis is the most common cranial nerve injury. Bell’s palsy
is the name commonly used to describe an acute peripheral facial paralysis of unknown origin.
The annual incidence of Bell’s palsy is 20-30 cases per 100,000 persons, regardless of age and
gender.
Objective: Our objective was to appraise the efficacy of steroid and antiviral treatments for
facial paralysis.
Study Design: We conducted a network meta-analysis of studies of steroid and antiviral
treatments for facial paralysis.
Setting: Second Hospital of Jilin University.
Methods: We performed a systematic search of PubMed and Embase databases to retrieve
relevant studies. The efficacy outcome was overall recovery, measured in terms of the odds ratio
(OR) and a corresponding 95% confidence interval (CI). The comprehensive ranking for each
treatment with respect to overall recovery is presented as the value of the surface under the
cumulative ranking curve (SUCRA).
Results: A total of 23 articles representing 4,623 patients were eligible for our study. In terms
of overall recovery, no significant differences were found in the pairwise meta-analysis. From the
results of the network meta-analysis, antiviral combined with steroid treatment was superior
to placebo treatment (OR = 3.25; 95% CI, 1.23-8.61), but neither steroid nor antiviral therapy
alone resulted in significant benefit compared with placebo. According to the SUCRA, antiviral
combined with steroid treatment was the most effective, with a SUCRA value of 0.96, and
the probability of ranking first was 90%. Only a small difference was observed between the
efficacies of steroid and antiviral treatments (SUCRA values of 0.55 and 0.36, respectively), and
they were both better than the placebo (SUCRA value of 0.134).
Limitations: The major limitation of our study is that, due to the limited number of related
studies in the last several years, we were not able to evaluate the safety of these therapies.
Conclusions: Antiviral combined with steroid therapy is significantly better than antiviral
or steroid therapy alone with respect to overall recovery, and the efficacies of single antiviral
medications or single steroid treatments are nearly equal. In addition, all 3 therapies are more
effective than placebo, according to the SUCRA values.
Key words: Facial paralysis, Bell´s palsy, steroids, antiviral drugs, efficacy, overall recovery,
network meta-analysis, SUCRA