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French Society of ENT (SFORL) guidelines. Management of acute Bell's palsy.
Eur Ann Otorhinolaryngol Head Neck Dis. 2020 Dec; 137(6):483-488.EA

Abstract

AQFThe authors present the guidelines of the French Society of ENT and Head and Neck Surgery (SFORL) regarding the management of Bell's palsy in adults. After a literature review by a multidisciplinary workgroup, guidelines were drawn up based on retrieved articles and group-members' experience, then read over by an independent group to edit the final version. Guidelines were graded A, B, C or "expert opinion" according to decreasing level of evidence. Thorough ENT and neurological clinical examination is recommended in all patients presenting with peripheral facial palsy to confirm diagnosis of Bell's palsy. MRI with gadolinium enhancement should explore the entire course of the facial nerve, if possible within the first month. ENMG should be performed to assess prognosis for recovery. In confirmed Bell's palsy, corticosteroid therapy should be implemented as early as possible (ideally within 72h) at a dose of 1mg/kg/day for 7-10 days. Antiviral therapy should be associated to steroids in patients with severe and early-onset disease and in Ramsay-Hunt syndrome. Isolated antiviral therapy is not recommended. To date, there is no evidence that surgical facial nerve decompression provides benefit.

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Authors+Show Affiliations

Fieux M
Service d'Otologie et d'Otoneurologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Chemin du Grand Revoyet, 69495 Pierre-Bénite, France.
Franco-Vidal V
Service ORL et Chirurgie Cervico-Faciale, Hôpital Pellegrin, Place Amélie Raba-Léon, 33076 Bordeaux, France.
Devic P
Service de Neurologie Clinique et Fonctionnelle, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Chemin du Grand Revoyet, 69495 Pierre-Bénite, France.
Bricaire F
Service des Maladies Infectieuses, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, Boulevard de l'Hôpital, 75013 Paris, France.
Charpiot A
Service ORL et Chirurgie Cervico-Faciale, Hôpital de Hautepierre, 1, Avenue de Molière, 67200 Strasbourg, France.
Darrouzet V
Service ORL et Chirurgie Cervico-Faciale, Hôpital Pellegrin, Place Amélie Raba-Léon, 33076 Bordeaux, France.
Denoix L
Service d'Otologie et d'Otoneurologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Chemin du Grand Revoyet, 69495 Pierre-Bénite, France.
Gatignol P
Service ORL et Chirurgie Cervico-Faciale, Hôpital Pitié-Salpêtrière, AP-HP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.
Guevara N
Service ORL et Chirurgie Cervico-Faciale, Centre Hospitalier de Nice, IUFC, 31, Avenue de Valombrose, 01600 Nice, France.
Montava M
Service ORL et Chirurgie Cervico-Faciale, Hôpital de la Conception, AP-HM, 147, Boulevard Baille, 13005 Marseille, France.
Roch JA
Service de Radiologie, Hôpital Privé Jean Mermoz, 55, Avenue Jean Mermoz, 69008 Lyon, France.
Tankéré F
Service ORL et Chirurgie Cervico-Faciale, Hôpital Pitié-Salpêtrière, AP-HP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.
Tronche S
SFORL, 26, Rue Lalo, 75016 Paris, France.
Veillon F
Service de Radiologie, Hôpital de Hautepierre, 1, Avenue de Molière, 67200 Strasbourg, France.
Vergez S
Service ORL et Chirurgie Cervico-Faciale, Hôpital Larrey, 24, Chemin de Pouvourville, 31059 Toulouse, France.
Vincent C
Service ORL et Chirurgie Cervico-Faciale, Hôpital Salengro, Rue Michel Polonowski, 59037 Lille, France.
Lamas G
Service ORL et Chirurgie Cervico-Faciale, Hôpital Pitié-Salpêtrière, AP-HP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.
Tringali S
Service d'Otologie et d'Otoneurologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Chemin du Grand Revoyet, 69495 Pierre-Bénite, France. Electronic address: stephane.tringali@chu-lyon.fr.

MeSH

Acute DiseaseAdrenal Cortex HormonesAntiviral AgentsBell PalsyContrast MediaDecompression, SurgicalDrug Administration ScheduleDrug Therapy, CombinationFacial NerveFacial ParalysisFranceGadoliniumHerpes Zoster OticusHumansHyperbaric OxygenationMagnetic Resonance ImagingNeurologic ExaminationOtolaryngologyPhysical Therapy ModalitiesPrognosisRecovery of FunctionSocieties, Medical

Pub Type(s)

Journal Article
Practice Guideline
Systematic Review

Language

eng

PubMed ID

32636146

Citation

Fieux, M, et al. "French Society of ENT (SFORL) Guidelines. Management of Acute Bell's Palsy." European Annals of Otorhinolaryngology, Head and Neck Diseases, vol. 137, no. 6, 2020, pp. 483-488.
Fieux M, Franco-Vidal V, Devic P, et al. French Society of ENT (SFORL) guidelines. Management of acute Bell's palsy. Eur Ann Otorhinolaryngol Head Neck Dis. 2020;137(6):483-488.
Fieux, M., Franco-Vidal, V., Devic, P., Bricaire, F., Charpiot, A., Darrouzet, V., Denoix, L., Gatignol, P., Guevara, N., Montava, M., Roch, J. A., Tankéré, F., Tronche, S., Veillon, F., Vergez, S., Vincent, C., Lamas, G., & Tringali, S. (2020). French Society of ENT (SFORL) guidelines. Management of acute Bell's palsy. European Annals of Otorhinolaryngology, Head and Neck Diseases, 137(6), 483-488. https://doi.org/10.1016/j.anorl.2020.06.004
Fieux M, et al. French Society of ENT (SFORL) Guidelines. Management of Acute Bell's Palsy. Eur Ann Otorhinolaryngol Head Neck Dis. 2020;137(6):483-488. PubMed PMID: 32636146.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - French Society of ENT (SFORL) guidelines. Management of acute Bell's palsy. AU - Fieux,M, AU - Franco-Vidal,V, AU - Devic,P, AU - Bricaire,F, AU - Charpiot,A, AU - Darrouzet,V, AU - Denoix,L, AU - Gatignol,P, AU - Guevara,N, AU - Montava,M, AU - Roch,J A, AU - Tankéré,F, AU - Tronche,S, AU - Veillon,F, AU - Vergez,S, AU - Vincent,C, AU - Lamas,G, AU - Tringali,S, Y1 - 2020/07/04/ PY - 2020/7/9/pubmed PY - 2021/9/24/medline PY - 2020/7/9/entrez KW - Bell's palsy KW - Drug therapy KW - ENMG KW - Imaging KW - Physical therapy SP - 483 EP - 488 JF - European annals of otorhinolaryngology, head and neck diseases JO - Eur Ann Otorhinolaryngol Head Neck Dis VL - 137 IS - 6 N2 - AQFThe authors present the guidelines of the French Society of ENT and Head and Neck Surgery (SFORL) regarding the management of Bell's palsy in adults. After a literature review by a multidisciplinary workgroup, guidelines were drawn up based on retrieved articles and group-members' experience, then read over by an independent group to edit the final version. Guidelines were graded A, B, C or "expert opinion" according to decreasing level of evidence. Thorough ENT and neurological clinical examination is recommended in all patients presenting with peripheral facial palsy to confirm diagnosis of Bell's palsy. MRI with gadolinium enhancement should explore the entire course of the facial nerve, if possible within the first month. ENMG should be performed to assess prognosis for recovery. In confirmed Bell's palsy, corticosteroid therapy should be implemented as early as possible (ideally within 72h) at a dose of 1mg/kg/day for 7-10 days. Antiviral therapy should be associated to steroids in patients with severe and early-onset disease and in Ramsay-Hunt syndrome. Isolated antiviral therapy is not recommended. To date, there is no evidence that surgical facial nerve decompression provides benefit. SN - 1879-730X UR - https://www.unboundmedicine.com/medline/citation/32636146/French_Society_of_ENT__SFORL__guidelines__Management_of_acute_Bell's_palsy_ DB - PRIME DP - Unbound Medicine ER -