Management of Bell palsy: clinical practice guideline.

paralysis of the face of peripheral nerve origin, with acute onset. It affects 20–30 persons per 100 000 annually, and 1 in 60 individuals will be affected over the course of their lifetime. The major cause of Bell palsy is believed to be an infection of the facial nerve by the herpes simplex virus. As a result of this viral infection, the facial nerve swells and is compressed in its canal as it courses through the temporal bone. Recovery of facial nerve function is an important outcome that guides treatment recommendations. The initial severity of facial weakness provides valuable prognostic information for facial recovery. Commonly used facial grading instruments (e,g., House–Brackmann and Sunnybrook scales) quantify the severity of facial weakness. Patients with mild to moderate paresis have higher rates of recovery than those with severe or complete paresis. In a large, single-institution cohort study, recovery rates of 61% and 94% were documented in patients with complete and incomplete paralysis, respectively. Other important clinical outcomes exist in Bell palsy. Up to 16% of those affected will have residual involuntary movements known as syn kinesis, whereas others may have abnormal lacrimation with eating, known as Bogorad syndrome (crocodile tears). Failure to protect the cornea among patients who are unable to blink adequately may result in corneal ulceration and permanent visual impairment. Those with residual deficits may have long-term reduction in quality of life and psychological distress. In this guideline, we review the evidence for treatment of Bell palsy with corticosteroids and antivirals, facial exercise, electrostimulation, physiotherapy and decompression surgery, as well as the need for eye-protective measures, specialist referral and further investigation in patients with persistent and progressive weakness. This guideline is aimed at all health care providers, primarily front-line or primary care physicians who treat patients with Bell palsy. Methods