Bell's Palsy is a condition characterized by acute facial weakness. The patient began experiencing symptoms all of a sudden and the peak of severity reaches within a few days. Patients who have the history of Bell's Palsy are at risk for recurrence of the condition. Various treatment options are available for the management of Bell's Palsy.
Various treatment options are available for Bell's Palsy. The majority of the patients recover from Bell's Palsy. Some of them require treatment while others recover without any treatment. The condition has an excellent prognosis and the disease has spontaneous recovery in many patients. It has been found that within 6 months, almost 71% of the patients recover fully without any treatment.
The risk of damage increases in patients with old age, diabetes mellitus, and high blood pressure. The prognosis is poor if the patient has suffered complete facial weakness and impairment of taste. The treatment of Bell’s Palsy is to reduce the damage to neuronal function and to improve the recovery of the cranial nerve. Surgical management is required in some cases when the disease is prolonged and severe and is not managed with non-invasive therapies.
Following are some of the treatment options for Bell’s Palsy:
Steroids are highly effective and have the potential to provide recovery of facial nerve function. Both the American Academy of Neurology and the American Academy of Otolaryngology-Head and Neck Surgery Foundation supports the use of corticosteroids in Bell's Palsy. The steroidal therapy should be initiated within 72 hours of the onset of symptoms. It has also been shown that there is complete recovery in patients within 3 to 9 months if the treatment with prednisolone is started within 72 hours of experiencing symptoms. However, the physician should be cautious in administering steroids to patients with the compromised immune system, active infection, tuberculosis, sarcoidosis, peptic ulcer, and pregnancy.
Studies have indicated that antiviral medications provide no recovery to patients with Bell's Palsy. However, in some cases, Bell's Palsy is caused due to viral infections. In such cases, patients may benefit from antiviral therapy. American Academy of Neurology in 2012 guidelines states that there may be, at best, the modest benefit of antivirals in Bell's Palsy. Antivirals generally used in Bell's Palsy include acyclovir and valacyclovir.
Combination of corticosteroid and antivirals
In comparison to acyclovir, prednisolone has a better recovery in Bell's Palsy. However, a clinical trial concluded that the combination of prednisone and acyclovir is more effective as compared to prednisolone monotherapy in preventing nerve damage. It is also concluded in a clinical trial that the combination of valacyclovir and prednisone is effective in patients s with complete facial palsy. However, the researchers caution against the routine administration of antiviral drugs. The antiviral drugs should be used when the possible cause of Bell's Palsy is a viral infection. Newer antiviral agents are found to be more effective than older agents.
During Bell’s Palsy, eye care is important. The eye is at risk of dryness, corneal ulcer, and corneal abrasion. The ocular dryness can be managed through administering ocular lubricants in the form of drops and ointments. To reduce the risk or preventing corneal abrasion, the eyelids may be occluded. The cornea can be protected by injecting botulinum toxin injection as it has the property of relaxing facial muscles.
Better control over facial muscles: The patients may have better control over the facial muscles through biofeedback training.
Acupuncture: Acupuncture may also provide relief by activating nerves and muscles.
Exercises: Perform routine physical exercise as directed by your healthcare professional.
Caring eyes: Take good care of eyes. Administer the ocular drugs as advised by the doctor.
Pain killers: In case of pain in the muscles, you may take over-the-counter analgesics such as aspirin or paracetamol.
Shrinking and shortening of muscles due to Bell’s Palsy results in permanent contracture. Various physical therapies are used to speed up recovery. These physical therapies include massage, electrotherapy, biofeedback training, exercises, and thermotherapy. Physical therapy specialist should advise physical therapy plan to the patients.
Various surgical interventions are recommended either to provide relief to the patients or to improve the look of patients. Facial nerve decompression surgery was used in the past to relieve pressure from the facial nerves. However, owing to the risk of nerve injury and hearing loss, the use of this surgical intervention is controversial. Other surgical interventions used include tarsorrhaphy, sub-ocularis oculi fat (SOOF) lift, facial nerve grafting, and Transposition of the temporalis muscle.