The diagnosis and treatment of Bell’s palsy

Abstract

Bell’s palsy is an idiopathic peripheral nerve disorder involving the facial nerve. It is of rapid onset, and almost always unilateral. It is the most common diagnosis associated with facial nerve palsy. It has been described in patients of all ages, but the incidence is slightly higher after age 40. Methods: Using internet search, a comprehensive literature review was done and words such as facial nerve palsy, Bell’s palsy were searched. Results: In confirmed Bell’s palsy, unless contraindicated, corticosteroids should be given to all patients with Bell’s palsy as early as possible, (ideally within 72 hours). Combination therapy with steroids and antiviral agents are recommended for patients with severe to complete paresis. Patients with incomplete eye closure should be given eye protection, with lubricating drops and ointments, to prevent corneal damage. Conclusion: Establishing the correct diagnosis is imperative to avoid missing another treatable condition. Determining whether the facial nerve paralysis is central or peripheral is important. The history of a Bell’s palsy case should include discomfort or sensory symptoms in the distribution of the facial nerve in the hours or days preceding facial palsy, and it is very important to reveal whether the symptoms were progressive in nature. Although many patients with Bell palsy will experience improvement in their facial nerve function without treatment, persistent facial weakness can have implications for quality of life. Choosing the correct treatment options for suitable patients can optimize the likelihood of recovery. Oral steroids should be prescribed within 72 hours of symptoms onset for Bell’s palsy patients. Combined steroid and antiviral treatment are recommended for patients with severe to complete paresis. Physiotherapy may be suggested in severe Bell’s palsy. Surgical decompression is not recommended and may be considered in severe facial nerve degeneration on electroneuronography if the patient is willing to accept the surgical risks. Eye protection remains crucial in preventing long-term eye complications. Clinical and ophthalmological follow-up, and referral to a specialist for patients with no improvement or progressive weakness are recommended. Key words: Facial nerve palsy, Bell’s palsy, Glucocorticoids, Antiviral.