Describe the symptomatic therapy.
Provide symptom-based treatment for all patients (regardless of the cause).
Incomplete eye closure: Initiate eye care (e.g., artificial tears, eye ointment, and/or taping or patching of the eye). [9]
Incomplete mouth closure: Advise the patient on proper lip and mouth care.
Describe the targeted treatment for bell palsy.
Idiopathic peripheral facial nerve palsy is self-limited, but early treatment is recommended to improve recovery time and prevent incomplete recovery.
Oral glucocorticoids: Consider for all patients (regardless of severity).
Start early (i.e., within 48–72 hours of symptom onset)
Available agents: prednisone OR prednisolone
Antivirals
Consider adding an antiviral to steroid therapy (do not use as monotherapy). [8][9]
Available agents: acyclovir OR valacyclovir
Initiate therapy (i.e., oral glucocorticoids with or without antivirals) within 48–72 hours of symptom onset.
Describe the treatment of secondary facial nerve palsy.
Consider the following depending on the suspected etiology.
Peripheral causes
Antiviral therapy for herpes zoster (see “Treatment” in “Shingles”) [13]
Antibiotic therapy for Lyme disease or otitis media (see “Treatment” in “Lyme disease” and “Otitis media”) [14]
Central causes: See “Treatment” sections in “Ischemic stroke,” “Intracerebral hemorrhage,” “Multiple sclerosis,” and “Brain tumors.”
What is the prognosis?
Idiopathic facial palsy: complete recovery in ∼ 85% of cases (within 3 weeks)
Misdirected regrowth of nerve fibers can lead to persistent disorders (e.g., synkinesias)
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