The neurologist’s dilemma: A comprehensive clinical review of Bell’s palsy, with emphasis on current management trends

Abstract

BackgroundRecent advances in Bell’s palsy (BP) were reviewed to assess the current trends in its management and prognosis.Material/MethodsWe retrieved the literature on BP using the Cochrane Database of Systematic Reviews, PubMed, and Google Scholar. Key words and phrases used during the search included ‘Bell’s palsy’, ‘Bell’s phenomenon’, ‘facial palsy’, and ‘idiopathic facial paralysis’. Emphasis was placed on articles and randomized controlled trails (RCTs) published within the last 5 years.ResultsBP is currently considered the leading disorder affecting the facial nerve. The literature is replete with theories of its etiology, but the reactivation of herpes simplex virus isoform 1 (HSV-1) and/or herpes zoster virus (HZV) from the geniculate ganglia is now the most strongly suspected cause. Despite the advancements in neuroimaging techniques, the diagnosis of BP remains one of exclusion. In addition, most patients with BP recover spontaneously within 3 weeks.ConclusionsCorticosteroids are currently the drug of choice when medical therapy is needed. Antivirals, in contrast, are not superior to placebo according to most reliable studies. At the time of publication, there is no consensus as to the benefit of acupuncture or surgical decompression of the facial nerve. Long-term therapeutic agents and adjuvant medications for BP are necessary due to recurrence and intractable cases. In the future, large RCTs will be required to determine whether BP is associated with an increased risk of stroke.

Microcystic adnexal carcinoma (MAC)-like squamous cell carcinoma as a differential diagnosis to Bell's palsy: Review of guidelines for refractory facial nerve palsy

“…Some authors do, however, suggest considering a biopsy of the surrounding tissue of the facial nerve, e.g. parotid gland tissue in the case of negative imaging at 7 months [1, 5]. In patients with non-resolving FNP, an exploration, or even a biopsy of the facial nerve itself, can be discussed.…”

“…Medical therapy with corticosteroids should be started within the first 72 h after the onset of symptoms in patients over the age of 16 with all degrees of severity [3, 4]. This increases the rate of facial nerve recovery [1] and significantly reduces the risk of synkinesis [5]. In patients with severe to complete paresis, the combination of corticosteroids and antivirals can be used [3, 4].…”

Varicella Zoster Aseptic Meningitis: Report of an Atypical Case and Literature Review

“…However, the dramatic response to antiviral medication suggests that aseptic meningitis was the direct cause of her symptoms. Moreover, a recently published review concluded that reactivation of herpes simplex virus isoform 1 (HSV-1) and/or herpes zoster virus (HZV) from the geniculate ganglia is the most strongly suspected cause of isolated Bell’s palsy [ 17 ].…”

Increased risk of peripheral arterial occlusive disease in patients with Bell's palsy using population data

“…Bell’s palsy features with a sudden onset of unilateral facial paresis or paralysis. The symptom is caused by the inflammatory facial nerve, resulting from compression of the narrowest portion of the fallopian canal [ 6 , 7 ]. The etiology is still unclear but viral and immunological hypothesis have been postulated to explain the potential pathophysiological mechanism.…”