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Bell's palsy: a summary of current evidence and referral algorithm.
Fam Pract. 2014 Dec; 31(6):631-42.FP

Abstract

Spontaneous idiopathic facial nerve (Bell's) palsy leaves residual hemifacial weakness in 29% which is severe and disfiguring in over half of these cases. Acute medical management remains the best way to improve outcomes. Reconstructive surgery can improve long term disfigurement. However, acute and surgical options are time-dependent. As family practitioners see, on average, one case every 2 years, a summary of this condition based on common clinical questions may improve acute management and guide referral for those who need specialist input. We formulated a series of clinical questions likely to be of use to family practitioners on encountering this condition and sought evidence from the literature to answer them. The lifetime risk is 1 in 60, and is more common in pregnancy and diabetes mellitus. Patients often present with facial pain or paraesthesia, altered taste and intolerance to loud noise in addition to facial droop. It is probably caused by ischaemic compression of the facial nerve within the meatal segment of the facial canal probably as a result of viral inflammation. When given early, high dose corticosteroids can improve outcomes. Neither antiviral therapy nor other adjuvant therapies are supported by evidence. As the facial muscles remain viable re-innervation targets for up to 2 years, late referrals require more complex reconstructions. Early recognition, steroid therapy and early referral for facial reanimation (when the diagnosis is secure) are important features of good management when encountering these complex cases.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Glass GE
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK and graeme.glass@ndorms.ox.ac.uk.
Tzafetta K
St. Andrews Centre for Plastic Surgery Broomfield Hospital, Chelmsford, UK.

MeSH

Acute DiseaseAdrenal Cortex HormonesAlgorithmsBell PalsyChronic DiseaseComorbidityDatabases, BibliographicDiabetes MellitusDiagnosis, DifferentialDisease ProgressionEvidence-Based PracticeFacial NerveFemaleHumansPractice Guidelines as TopicPregnancyPregnancy Complications, InfectiousPrevalenceReferral and ConsultationTime-to-Treatment

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

25208543

Citation

Glass, Graeme E., and Kallirroi Tzafetta. "Bell's Palsy: a Summary of Current Evidence and Referral Algorithm." Family Practice, vol. 31, no. 6, 2014, pp. 631-42.
Glass GE, Tzafetta K. Bell's palsy: a summary of current evidence and referral algorithm. Fam Pract. 2014;31(6):631-42.
Glass, G. E., & Tzafetta, K. (2014). Bell's palsy: a summary of current evidence and referral algorithm. Family Practice, 31(6), 631-42. https://doi.org/10.1093/fampra/cmu058
Glass GE, Tzafetta K. Bell's Palsy: a Summary of Current Evidence and Referral Algorithm. Fam Pract. 2014;31(6):631-42. PubMed PMID: 25208543.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bell's palsy: a summary of current evidence and referral algorithm. AU - Glass,Graeme E, AU - Tzafetta,Kallirroi, Y1 - 2014/09/10/ PY - 2014/9/12/entrez PY - 2014/9/12/pubmed PY - 2015/7/16/medline KW - Bell’s palsy KW - Herpes simplex KW - corticosteroids KW - cross facial nerve graft KW - facial nerve palsy KW - facial nerve paralysis KW - idiopathic KW - meatal segment. SP - 631 EP - 42 JF - Family practice JO - Fam Pract VL - 31 IS - 6 N2 - Spontaneous idiopathic facial nerve (Bell's) palsy leaves residual hemifacial weakness in 29% which is severe and disfiguring in over half of these cases. Acute medical management remains the best way to improve outcomes. Reconstructive surgery can improve long term disfigurement. However, acute and surgical options are time-dependent. As family practitioners see, on average, one case every 2 years, a summary of this condition based on common clinical questions may improve acute management and guide referral for those who need specialist input. We formulated a series of clinical questions likely to be of use to family practitioners on encountering this condition and sought evidence from the literature to answer them. The lifetime risk is 1 in 60, and is more common in pregnancy and diabetes mellitus. Patients often present with facial pain or paraesthesia, altered taste and intolerance to loud noise in addition to facial droop. It is probably caused by ischaemic compression of the facial nerve within the meatal segment of the facial canal probably as a result of viral inflammation. When given early, high dose corticosteroids can improve outcomes. Neither antiviral therapy nor other adjuvant therapies are supported by evidence. As the facial muscles remain viable re-innervation targets for up to 2 years, late referrals require more complex reconstructions. Early recognition, steroid therapy and early referral for facial reanimation (when the diagnosis is secure) are important features of good management when encountering these complex cases. SN - 1460-2229 UR - https://www.unboundmedicine.com/medline/citation/25208543/Bell's_palsy:_a_summary_of_current_evidence_and_referral_algorithm_ DB - PRIME DP - Unbound Medicine ER -