Bell′s palsy: Treatment guidelines

Murthy, J. M. K.; Saxena, Amrit B.

doi:10.4103/0972-2327.83092

Cited by 57 publications

(62 citation statements)

References 17 publications

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“…36 Of two other treatment guidelines, one concluded that there was insufficient evidence to give corticosteroids to children 37 and the other suggested use of corticosteroids on the basis of a narrative review of the available evidence. 38 The present guideline used the GRADE methodology and offers recommendations addressing nonmedical therapeutic options that have been omitted from other guidelines.…”

Section: Other Guidelinesmentioning

confidence: 99%

Management of Bell palsy: clinical practice guideline

Almeida

Guyatt

Sud

et al. 2014

CMAJ

141

108

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Section: Other Guidelinesmentioning

confidence: 99%

Management of Bell palsy: clinical practice guideline

Almeida

Guyatt

Sud

et al. 2014

CMAJ

141

108

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“…27,36,[84][85][86][87][88][89][90][91][92] Studies in patients with eye problems similar to those found in patients with Bell's palsy-such as intensive care unit (ICU) patients in a coma where eyelid muscle function is absent-yielded a number of articles recommending treatment. 82 None of the studies found statistical benefit or harm from any of the following treatment modalities for the prevention of corneal damage:…”

Section: Supporting Textmentioning

confidence: 99%

Clinical Practice Guideline: Bell's Palsy

Baugh

Basura

Ishii

et al. 2013

Otolaryngol.--head neck surg.

386

114

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Objective Bell’s palsy, named after the Scottish anatomist, Sir Charles Bell, is the most common acute mono-neuropathy, or disorder affecting a single nerve, and is the most common diagnosis associated with facial nerve weakness/paralysis. Bell’s palsy is a rapid unilateral facial nerve paresis (weakness) or paralysis (complete loss of movement) of unknown cause. The condition leads to the partial or complete inability to voluntarily move facial muscles on the affected side of the face. Although typically self-limited, the facial paresis/paralysis that occurs in Bell’s palsy may cause significant temporary oral incompetence and an inability to close the eyelid, leading to potential eye injury. Additional long-term poor outcomes do occur and can be devastating to the patient. Treatments are generally designed to improve facial function and facilitate recovery. There are myriad treatment options for Bell’s palsy, and some controversy exists regarding the effectiveness of several of these options, and there are consequent variations in care. In addition, numerous diagnostic tests available are used in the evaluation of patients with Bell’s palsy. Many of these tests are of questionable benefit in Bell’s palsy. Furthermore, while patients with Bell’s palsy enter the health care system with facial paresis/paralysis as a primary complaint, not all patients with facial paresis/paralysis have Bell’s palsy. It is a concern that patients with alternative underlying etiologies may be misdiagnosed or have unnecessary delay in diagnosis. All of these quality concerns provide an important opportunity for improvement in the diagnosis and management of patients with Bell’s palsy. Purpose The primary purpose of this guideline is to improve the accuracy of diagnosis for Bell’s palsy, to improve the quality of care and outcomes for patients with Bell’s palsy, and to decrease harmful variations in the evaluation and management of Bell’s palsy. This guideline addresses these needs by encouraging accurate and efficient diagnosis and treatment and, when applicable, facilitating patient follow-up to address the management of long-term sequelae or evaluation of new or worsening symptoms not indicative of Bell’s palsy. The guideline is intended for all clinicians in any setting who are likely to diagnose and manage patients with Bell’s palsy. The target population is inclusive of both adults and children presenting with Bell’s palsy. Action Statements The development group made a strong recommendation that (a) clinicians should assess the patient using history and physical examination to exclude identifiable causes of facial paresis or paralysis in patients presenting with acute-onset unilateral facial paresis or paralysis, (b) clinicians should prescribe oral steroids within 72 hours of symptom onset for Bell’s palsy patients 16 years and older, (c) clinicians should not prescribe oral antiviral therapy alone for patients with new-onset Bell’s palsy, and (d) clinicians should implement eye protection for Bell’s palsy patients with impaired eye closure. The panel made recommendations that (a) clinicians should not obtain routine laboratory testing in patients with new-onset Bell’s palsy, (b) clinicians should not routinely perform diagnostic imaging for patients with new-onset Bell’s palsy, (c) clinicians should not perform electrodiagnostic testing in Bell’s palsy patients with incomplete facial paralysis, and (d) clinicians should reassess or refer to a facial nerve specialist those Bell’s palsy patients with (1) new or worsening neurologic findings at any point, (2) ocular symptoms developing at any point, or (3) incomplete facial recovery 3 months after initial symptom onset. The development group provided the following options: (a) clinicians may offer oral antiviral therapy in addition to oral steroids within 72 hours of symptom onset for patients with Bell’s palsy, and (b) clinicians may offer electrodiagnostic testing to Bell’s palsy patients with complete facial paralysis. The development group offered the following no recommendations: (a) no recommendation can be made regarding surgical decompression for patients with Bell’s palsy, (b) no recommendation can be made regarding the effect of acupuncture in patients with Bell’s palsy, and (c) no recommendation can be made regarding the effect of physical therapy in patients with Bell’s palsy.

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“…HSV et VZV ont été incriminés, l'origine herpétique pure se différenciant par l'absence de douleur et d'érythème dans la zone de Ramsay-Hunt qui caractérisent l'origine zostérienne. Les cas de paralysie faciale périphérique après une anesthésie pour des soins dentaires sont très peu nombreux : 20 à 30 cas pour 100 000 [5,6]. Il n'y a aucune hypothèse satisfaisante pour expliquer cette complication rare.…”

Section: Discussionunclassified

“…Pour le traitement, les données sont contradictoires et il existe différentes approches [5,[7][8][9][10]. Pour certains auteurs, la prise de corticoïdes augmente significativement la probabilité de guérison complète, l'efficacité des antiviraux serait plus aléatoire ; pour d'autres, c'est l'inverse.…”

Section: Discussionunclassified

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Paralysie faciale périphérique et soins dentaires : lien ou coïncidence, pour quelle prise en charge ?

Makhoul

Even

Sudrat

et al. 2014

Med Buccale Chir Buccale

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Résumé -Introduction : L'atteinte du nerf facial est angoissante pour le patient du fait de la déformation faciale qu'elle entraîne et pour le praticien qui se sent impuissant. La survenue d'une paralysie faciale périphérique, suite à des soins dentaires, est rare. Lorsqu'elle survient, aucune notion de traumatisme ou d'étiologie iatrogène ne peut être mise en cause de manière formelle. Observation : Le cas d'une patiente atteinte d'une paralysie faciale périphérique de grade IV selon la classification de House-Brackmann apparue suite à une anesthésie loco-régionale au foramen mandibulaire est décrit. Discussion : La notion de réactivation du virus varicelle-zona suite à un stress quel qu'il soit serait l'origine la plus probable. L'American Association of Neurology recommande la mise en place d'un traitement combiné de prednisolone (1 mg/kg/j) et d'aciclovir (400 mg 5 ×/j) pendant 10 jours ; il est également admis que toute paralysie faciale doit être prise en charge le plus précocement possible, idéalement dans les 72 heures, le succès du traitement dépendant en grande partie de sa rapidité d'instauration. Abstract -Introduction:Any facial nerve injury is a distressing condition for both the patient because of the facial deformity it leads and the practitioner who feels powerless. The occurrence of facial palsy following dental care is rare. When it occurs, any notion of trauma or iatrogenic etiology cannot be questioned formally. Observation: This article focuses on the case of a patient with a grade IV peripheral facial palsy according to House-Brackmann's classification, appeared after regional anesthesia at the mandibular foramen. Discussion: The concept of reactivation of varicella-zoster virus following stress would be the most likely origin. The American Association of Neurology recommends the establishment of a combined treatment of prednisolone (1 mg/kg/day) and aciclovir (400 mg 5 times/day) during 10 days, it is also recognized that any facial paralysis should be supported as early as possible, ideally within 72 hours, the success largely depends on the rapidity of introduction of treatment.

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Bell′s palsy: Treatment guidelines

Cited by 57 publications

References 17 publications

Management of Bell palsy: clinical practice guideline

Management of Bell palsy: clinical practice guideline

Clinical Practice Guideline: Bell's Palsy

Paralysie faciale périphérique et soins dentaires : lien ou coïncidence, pour quelle prise en charge ?

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