Acute Peripheral Facial Palsy: Recent Guidelines and a Systematic Review of the Literature

Abstract

Background This study reviews recent literature on facial palsy guidelines and provides systematic reviews on related topics of interest. Methods An electronic database search was performed to identify recent guidelines dealing with facial nerve palsy, systematic reviews and recent meta-analysis published between 2011 and 2019 (inclusive). The literature search used the search terms “Bell's palsy,” “Ramsay-Hunt syndrome,” “Facial palsy,” “Facial paralysis,” “Facial paresis,” “Guideline,” “Meta-analysis,” “Systematic review,” and “Randomized controlled trial.” Only studies written in English were used. Results The characteristics of treatment trends for facial palsy have been reviewed over the past decade. The most prominent change noted may be the shift from the conventional House-Brackmann facial nerve grading system to the Sunnybrook and eFACE systems. In addition, the results of serial meta-analyses indicate increasing agreement with the use of surgical decompression of the facial nerve. Beyond steroids or combined steroid-antiviral treatment, various novel drugs and treatments have been tried. For long-standing facial paralysis and postparetic synkinesis sequelae after facial palsy, facial reanimation has been highlighted and the necessity of new paradigms have been raised. Conclusion For peripheral facial paralysis, various changes have been made, not only in the facial nerve grading systems, but also in medical treatments, from surgical procedures to rehabilitation, during the last decade.

Acute Facial Nerve Palsy in Children: Gold Standard Management

“…In the children population, the most common causes of FNP are Bell’s palsy (60 to 80% of the cases) [ 9 , 11 , 12 ], infectious diseases, malignancies, trauma and congenital abnormalities [ 13 , 14 , 15 ]. Therefore, these are the causes to investigate in the history and physical examination.…”

“…Drack et al reported an idiopathic cause in 60.7% of children diagnosed with peripheral facial palsy (84 patients aged 10 months to 16 years) retrospectively between 1998 and 2007 in Switzerland [ 9 ]. The reactivation of herpes simplex virus-1 is presumed to support the pathogenesis of Bell’s palsy [ 5 , 13 ]. Symptoms are likely caused by facial nerve oedema, with the autoimmune system proposed to be involved in causing local myelin damage and an inflammatory process of the facial nerve, leading to its compression [ 11 , 16 , 17 ].…”

Kabat Rehabilitation in Facial Nerve Palsy after Parotid Gland Tumor Surgery: A Case-Control Study

“…Updated guidelines have confirmed steroids to be effective at increasing the possibility of complete facial functional recovery in acute FNP, while novel treatments such as nimodip-ine and mycophenolate mofetile are under study. Nonetheless, postoperative corticosteroid treatment for iatrogenic FNP is unadvised, although clear evidence is lacking [8][9][10][11].…”

Role of Biomarkers as Prognostic Factors in Acute Peripheral Facial Palsy

“…The pathogenesis of APFP is unclear; however, it is widely recognized as a result of reactivation of herpes simplex virus type 1 and varicella-zoster virus [ 3 ]. In addition to viruses, there are other potential causes, such as tumors, trauma, anatomical abnormalities, inflammation, ischemia, and acute cold exposure [ 4 , 5 ]. For APFP treatment, there is consensus that early use of prednisolone is effective; however, the use of antiviral drugs remains controversial.…”