Materiały źródłowe

• #1 Bell’s Palsy: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/1001/p997.html

  Bell’s palsy is a peripheral palsy of the facial nerve that results in muscle weakness on one side of the face. […] Approximately 70 to 80 percent of patients will recover spontaneously; however, treatment with a seven-day course of acyclovir or valacyclovir and a tapering course of prednisone, initiated within three days of the onset of symptoms, is recommended to reduce the time to full recovery and increase the likelihood of complete recuperation. […] Patients with Bell’s palsy should be treated within three days of the onset of symptoms with a seven-day course of oral acyclovir (Zovirax) or valacyclovir (Valtrex), plus a tapering course of oral prednisone. […] Given the safety profile of acyclovir, valacyclovir, and short-course oral corticosteroids, patients who present within three days of the onset of symptoms and who do not have specific contraindications to these medications should be offered combination therapy.

• #2 Bell Palsy Treatment & Management: Approach Considerations, Pharmacologic Therapy, Local Treatment

  https://emedicine.medscape.com/article/1146903-treatment

  Because persons with true Bell palsy generally have an excellent prognosis, and because spontaneous recovery is fairly common, treatment of Bell palsy is still controversial. The goals of treatment are to improve facial nerve (seventh cranial nerve) function and reduce neuronal damage. Treatment of Bell palsy should be conservative and guided by the severity and probable prognosis in each particular case. Studies have shown the benefit of high-dose corticosteroids for acute cases. […] Although antiviral treatment has also come into use, evidence is now available indicating that it may not be beneficial. […] Topical ocular therapy is useful in most cases, with the exception of those in which the condition is severe or prolonged. In these cases, surgical management is best. Several procedures are aimed at protecting the cornea from exposure and achieving facial symmetry. These procedures reduce the need for constant use of lubrication drops or ointments, may improve cosmesis, and may be needed to preserve vision on the affected side.

• #3 Bell’s palsy: Treatment and prognosis in adults – UpToDate

  http://www.uptodate.com/contents/bells-palsy-prognosis-and-treatment-in-adults

  Bell’s palsy: Treatment and prognosis in adults […] INITIAL TREATMENT […] The mainstay of pharmacologic therapy for Bell’s palsy or facial nerve palsy is early short-term oral glucocorticoid treatment. In severe acute cases, combining antiviral therapy with glucocorticoids may improve outcomes. Eye care is essential for patients with incomplete eye closure (algorithm 1). […] Glucocorticoids for all patients — A short-term course of oral glucocorticoids is recommended for all patients with new-onset Bell’s palsy. Treatment should ideally begin within three days of symptom onset, as this is the setting in which glucocorticoids have been studied and shown to be beneficial. We typically treat patients who are within seven days of symptom onset.

• #4 Bell’s palsy: Treatment guidelines

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3152161/

  The aims of treatment in the acute phase of Bell’s palsy include strategies to speed recovery and to prevent corneal complications. Eye care includes eye patching and lubrication, lubricating drops should be applied frequently during the day and a eye ointment should be used at night. […] Strategies to speed recovery include physical therapy, corticosteroids and antiviral agents. […] The rationale for the use of corticosteroids in acute phase of Bell’s palsy is that inflammation and edema of the facial nerve are implicated in causing Bell’s palsy and corticosteroids have a potent anti-inflammatory action which should minimise nerve damage and thereby improve the outcome. […] Randomized, double-blind, placebo-controlled trials have provided compelling evidence that treatment with prednisolone improves outcome in patients with Bell’s palsy and shortens the time to complete recovery. Prednisolone should be used in all patients with facial palsy of less than 72 h duration who do not have contraindications to steroid therapy.

• #5 Bell’s palsy: Treatment guidelines

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3152161/

  The aims of treatment in the acute phase of Bell’s palsy include strategies to speed recovery and to prevent corneal complications. Eye care includes eye patching and lubrication, lubricating drops should be applied frequently during the day and a eye ointment should be used at night. […] Strategies to speed recovery include physical therapy, corticosteroids and antiviral agents. […] The rationale for the use of corticosteroids in acute phase of Bell’s palsy is that inflammation and edema of the facial nerve are implicated in causing Bell’s palsy and corticosteroids have a potent anti-inflammatory action which should minimise nerve damage and thereby improve the outcome. […] Randomized, double-blind, placebo-controlled trials have provided compelling evidence that treatment with prednisolone improves outcome in patients with Bell’s palsy and shortens the time to complete recovery. Prednisolone should be used in all patients with facial palsy of less than 72 h duration who do not have contraindications to steroid therapy.

• #6 Bell’s palsy – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bells-palsy/diagnosis-treatment/drc-20370034

  Most people with Bell’s palsy recover fully with or without treatment. There’s no one-size-fits-all treatment for Bell’s palsy. But your healthcare professional may suggest medicines or physical therapy to help speed your recovery. Surgery is rarely an option for Bell’s palsy. […] Commonly used medicines to treat Bell’s palsy include: […] Corticosteroids, such as prednisone (Rayos, Prednisone Intensol). These are powerful anti-inflammatory agents. If they can reduce the swelling of the facial nerve, the nerve can fit more comfortably within the bony corridor that surrounds it. Corticosteroids may work best if they’re started within several days of when symptoms start. Steroids started early improve the likelihood of complete recovery. […] Antiviral drugs. The role of antivirals is not certain. Antivirals alone have shown no benefit compared with placebo. Antivirals added to steroids may benefit some people with Bell’s palsy, but this is still not proved.

• #7 A general practice approach to Bell’s palsy

  https://www.racgp.org.au/afp/2016/november/a-general-practice-approach-to-bell-s-palsy

  On the basis of a recent review, the American Academy of Otolaryngology has recommended a 10-day course of oral steroids, with at least five days at a high dose (either prednisolone 50 mg daily for 10 days or prednisone 60 mg daily for five days, then tapered over five days). […] To date, there is no evidence to suggest that oral antiviral therapy alone is effective for the management of Bells palsy. […] Well-designed clinical trials have shown that antiviral therapy in combination with corticosteroid therapy is of no additional benefit, compared with corticosteroid therapy alone; however, a small benefit cannot be completely excluded. […] Currently, the most extensively studied antiviral agents are acyclovir (400 mg five times daily) and valacyclovir (1000 mg three times daily). […] Given that there is a small potential for benefit and the adverse effects are of low risk, the American Academy of Otolaryngology has recommended that patients are offered combination corticosteroid and antiviral therapy within 72 hours of symptom onset, based on shared decision making.

• #8 Bell Palsy Treatment & Management: Approach Considerations, Pharmacologic Therapy, Local Treatment

  https://emedicine.medscape.com/article/1146903-treatment

  A larger double-blind, controlled trial showed that prednisolone significantly shortened the time to complete recovery, while valacyclovir did not affect facial recovery compared with placebo. […] The recommended dose of prednisone for the treatment of Bell palsy is 1 mg/kg or 60 mg/day for 6 days, followed by a taper, for a total of 10 days. […] High-dose steroids (120 mg/day of prednisone) have been safely used to treat Bell palsy in patients with diabetes; however, optimal dosing has not been established. […] Evaluation of the use of antiviral medicines in Bell palsy has shown limited benefit from these drugs, with 3 randomized, controlled trials having demonstrated no benefit from them. […] The 2001 AAN practice parameter suggested that the use of acyclovir for the treatment of Bell palsy is only possibly effective and that therapy with this agent alone is not effective in facial recovery.

• #9 Management of Bell’s palsy – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/management-of-bells-palsy.html

  The treatments considered for Bells palsy include oral corticosteroids (prednisolone) and antiviral drugs. Although the aetiology of Bells palsy is uncertain, it is known that inflammation and oedema of the facial nerve are responsible for the symptoms. Corticosteroids have therefore been used for their anti-inflammatory effect. […] The maximum benefit is seen when steroids are commenced within 72 hours of the onset of symptoms. There is no optimum regimen, but in adults 50-60 mg prednisolone daily for 10 days has been commonly used. […] In a randomised controlled trial the recovery rate at nine months with prednisolone was 94%. It was 81.6% in patients who did not receive prednisolone. […] A systematic review of trials that used prednisolone showed that at six months 17% of patients had incomplete recovery compared with 28% of patients who received no treatment.

• #10 Bell Palsy Treatment & Management: Approach Considerations, Pharmacologic Therapy, Local Treatment

  https://emedicine.medscape.com/article/1146903-treatment

  The most widely accepted treatment for Bell palsy is corticosteroid therapy. However, the use of steroids is still controversial because most patients recover without treatment. Antiviral agents have also been studied in this setting, as have combinations of the 2 types of drugs. […] Guidelines from the American Academy of OtolaryngologyHead and Neck Surgery Foundation (AAO-HNSF) were issued in November 2013 that also support the AAN guidelines. The guidelines recommend use of corticosteroids within 72 hours from the onset of symptoms. […] Many trials have been carried out to study the efficacy of prednisone in Bell palsy. […] However, 3 subsequent randomized, controlled trials showed significant improvement in outcomes when prednisolone was started within 72 hours of symptom onset. […] Based on these 3 studies, steroids should be strongly considered to optimize outcomes. Once the decision to use steroids is made, the consensus is that this treatment should be started immediately.

• #11 Management of Bell’s palsy – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/management-of-bells-palsy.html

  The treatments considered for Bells palsy include oral corticosteroids (prednisolone) and antiviral drugs. Although the aetiology of Bells palsy is uncertain, it is known that inflammation and oedema of the facial nerve are responsible for the symptoms. Corticosteroids have therefore been used for their anti-inflammatory effect. […] The maximum benefit is seen when steroids are commenced within 72 hours of the onset of symptoms. There is no optimum regimen, but in adults 50-60 mg prednisolone daily for 10 days has been commonly used. […] In a randomised controlled trial the recovery rate at nine months with prednisolone was 94%. It was 81.6% in patients who did not receive prednisolone. […] A systematic review of trials that used prednisolone showed that at six months 17% of patients had incomplete recovery compared with 28% of patients who received no treatment.

• #12 Management of Bell’s palsy – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/management-of-bells-palsy.html

  The antiviral drugs used in trials were aciclovir (400 mg five times daily for five days) or valaciclovir (1000 mg/day for five days). […] A randomised controlled trial found that at nine months of diagnosis, facial function had recovered in 94.4% of patients who took prednisolone alone, 85.4% of those who took aciclovir alone and 92.7% of those who received both. […] A guideline development group found that there was low-quality evidence of benefit from adding antivirals. Patients who are offered them in addition to corticosteroids should be counselled that the increase in recovery is less than 7%. […] A Cochrane review in 2015 found that antivirals combined with corticosteroids improved rates of incomplete recovery compared with corticosteroids alone, but this was not significant and the evidence was low quality.

• #13 Bell’s palsy: Treatment guidelines

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3152161/

  The rationale for the use of antiviral agents is the evidence that the inflammation of the facial nerve in Bell’s palsy might be related to the herpes simplex virus (HSV). However, the benefit of acyclovir or valacyclovir, either as single agents or in combination with prednisolone in Bell’s palsy has not been definitively established. […] In Bell’s palsy various physical therapies, such as exercise, biofeedback, laser, electrotherapy, massage and thermotherapy are used to hasten recovery. However, the evidence for the efficacy any of these therapies, is lacking. Cochrane systemic review of the efficacy of physical therapies, electrostimulation and exercises, on outcome of Bell’s palsy concluded that there was no significant benefit or harm from any of these physical therapies for Bell’s palsy.

• #14 Bell’s palsy – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bells-palsy/diagnosis-treatment/drc-20370034

  Most people with Bell’s palsy recover fully with or without treatment. There’s no one-size-fits-all treatment for Bell’s palsy. But your healthcare professional may suggest medicines or physical therapy to help speed your recovery. Surgery is rarely an option for Bell’s palsy. […] Commonly used medicines to treat Bell’s palsy include: […] Corticosteroids, such as prednisone (Rayos, Prednisone Intensol). These are powerful anti-inflammatory agents. If they can reduce the swelling of the facial nerve, the nerve can fit more comfortably within the bony corridor that surrounds it. Corticosteroids may work best if they’re started within several days of when symptoms start. Steroids started early improve the likelihood of complete recovery. […] Antiviral drugs. The role of antivirals is not certain. Antivirals alone have shown no benefit compared with placebo. Antivirals added to steroids may benefit some people with Bell’s palsy, but this is still not proved.

• #15 Bell Palsy Treatment & Management: Approach Considerations, Pharmacologic Therapy, Local Treatment

  https://emedicine.medscape.com/article/1146903-treatment

  A Cochrane review found no significant benefit to the use of antivirals over placebo in reducing the rate of incomplete recovery from Bell palsy. […] Acyclovir (Zovirax) is administered at a dosage of 400 mg orally 5 times daily for 10 days. […] Valacyclovir (Valtrex), taken orally in doses of 500 mg twice daily for 5 days, may be used instead of acyclovir. […] It is universally accepted that eye care is imperative in Bell palsy. The patients eye is at risk for drying, corneal abrasion, and corneal ulcers. […] In most cases, topical ocular lubrication (with artificial tears during the day and lubricating ophthalmic ointment at night, or occasionally ointment day and night) is sufficient to prevent the complications of corneal exposure. […] Surgery to decompress the facial nerve is controversial. Patients with a poor prognosis, identified by facial nerve testing or persistent paralysis, appear to benefit the most from surgical intervention.

• #16 A general practice approach to Bell’s palsy

  https://www.racgp.org.au/afp/2016/november/a-general-practice-approach-to-bell-s-palsy

  On the basis of a recent review, the American Academy of Otolaryngology has recommended a 10-day course of oral steroids, with at least five days at a high dose (either prednisolone 50 mg daily for 10 days or prednisone 60 mg daily for five days, then tapered over five days). […] To date, there is no evidence to suggest that oral antiviral therapy alone is effective for the management of Bells palsy. […] Well-designed clinical trials have shown that antiviral therapy in combination with corticosteroid therapy is of no additional benefit, compared with corticosteroid therapy alone; however, a small benefit cannot be completely excluded. […] Currently, the most extensively studied antiviral agents are acyclovir (400 mg five times daily) and valacyclovir (1000 mg three times daily). […] Given that there is a small potential for benefit and the adverse effects are of low risk, the American Academy of Otolaryngology has recommended that patients are offered combination corticosteroid and antiviral therapy within 72 hours of symptom onset, based on shared decision making.

• #17 Bell Palsy Treatment & Management: Approach Considerations, Pharmacologic Therapy, Local Treatment

  https://emedicine.medscape.com/article/1146903-treatment

  A Cochrane review found no significant benefit to the use of antivirals over placebo in reducing the rate of incomplete recovery from Bell palsy. […] Acyclovir (Zovirax) is administered at a dosage of 400 mg orally 5 times daily for 10 days. […] Valacyclovir (Valtrex), taken orally in doses of 500 mg twice daily for 5 days, may be used instead of acyclovir. […] It is universally accepted that eye care is imperative in Bell palsy. The patients eye is at risk for drying, corneal abrasion, and corneal ulcers. […] In most cases, topical ocular lubrication (with artificial tears during the day and lubricating ophthalmic ointment at night, or occasionally ointment day and night) is sufficient to prevent the complications of corneal exposure. […] Surgery to decompress the facial nerve is controversial. Patients with a poor prognosis, identified by facial nerve testing or persistent paralysis, appear to benefit the most from surgical intervention.

• #18 A general practice approach to Bell’s palsy

  https://www.racgp.org.au/afp/2016/november/a-general-practice-approach-to-bell-s-palsy

  On the basis of a recent review, the American Academy of Otolaryngology has recommended a 10-day course of oral steroids, with at least five days at a high dose (either prednisolone 50 mg daily for 10 days or prednisone 60 mg daily for five days, then tapered over five days). […] To date, there is no evidence to suggest that oral antiviral therapy alone is effective for the management of Bells palsy. […] Well-designed clinical trials have shown that antiviral therapy in combination with corticosteroid therapy is of no additional benefit, compared with corticosteroid therapy alone; however, a small benefit cannot be completely excluded. […] Currently, the most extensively studied antiviral agents are acyclovir (400 mg five times daily) and valacyclovir (1000 mg three times daily). […] Given that there is a small potential for benefit and the adverse effects are of low risk, the American Academy of Otolaryngology has recommended that patients are offered combination corticosteroid and antiviral therapy within 72 hours of symptom onset, based on shared decision making.

• #19 Bell Palsy: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2023/0400/bell-palsy.html

  Bell palsy should be suspected in patients with acute onset of unilateral facial weakness or paralysis involving the forehead in the absence of other neurologic abnormalities. […] An oral corticosteroid regimen (prednisone, 50 to 60 mg per day for five days followed by a five-day taper) is the first-line treatment for Bell palsy. […] Combination therapy with an oral corticosteroid and antiviral may reduce rates of synkinesis (misdirected regrowth of facial nerve fibers manifesting as involuntary co-contraction of certain facial muscles). […] Recommended antivirals include valacyclovir (1 g three times per day for seven days) or acyclovir (400 mg five times per day for 10 days). […] Treatment with antivirals alone is ineffective and not recommended. […] Physical therapy may be beneficial in patients with more severe paralysis.

• #20 Management of Bell’s palsy – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/management-of-bells-palsy.html

  The antiviral drugs used in trials were aciclovir (400 mg five times daily for five days) or valaciclovir (1000 mg/day for five days). […] A randomised controlled trial found that at nine months of diagnosis, facial function had recovered in 94.4% of patients who took prednisolone alone, 85.4% of those who took aciclovir alone and 92.7% of those who received both. […] A guideline development group found that there was low-quality evidence of benefit from adding antivirals. Patients who are offered them in addition to corticosteroids should be counselled that the increase in recovery is less than 7%. […] A Cochrane review in 2015 found that antivirals combined with corticosteroids improved rates of incomplete recovery compared with corticosteroids alone, but this was not significant and the evidence was low quality.

• #21 Bell Palsy Treatments | Northwestern Medicine

  https://www.nm.org/conditions-and-care-areas/ent-ear-nose-throat/bells-palsy/treatments

  Most patients with Bell palsy begin to improve within two weeks and return to normal function within six months. If your symptoms are severe or last longer, your physician may consider treatments including: […] Steroids to reduce inflammation […] Over-the-counter analgesics to lessen pain […] Anti-viral medications to treat underlying viral infection […] Physical therapy to enhance movement and strengthen muscles […] Electrical stimulation […] Acupuncture to treat pain […] Vitamin therapy […] Eye protection and drops to treat dry eye and avoid scratching of the cornea. […] Surgery is rarely used to lessen compression of the nerve. […] Medications.

• #22 Bell’s palsy

  https://www.nhs.uk/conditions/bells-palsy/

  Bell’s palsy is temporary weakness or lack of movement that usually affects 1 side of the face. Treatment with steroids can help and most people get better within 6 months. […] Treatments for Bell’s palsy include: a 10-day course of steroid medicine, sometimes with antiviral medicine, eye drops and ointment to stop the affected eye drying out, surgical tape to keep the eye closed at bedtime. […] If you cannot close your eye, you may need treatment to prevent damage to your vision.

• #23 Bell Palsy Treatment & Management: Approach Considerations, Pharmacologic Therapy, Local Treatment

  https://emedicine.medscape.com/article/1146903-treatment

  A Cochrane review found no significant benefit to the use of antivirals over placebo in reducing the rate of incomplete recovery from Bell palsy. […] Acyclovir (Zovirax) is administered at a dosage of 400 mg orally 5 times daily for 10 days. […] Valacyclovir (Valtrex), taken orally in doses of 500 mg twice daily for 5 days, may be used instead of acyclovir. […] It is universally accepted that eye care is imperative in Bell palsy. The patients eye is at risk for drying, corneal abrasion, and corneal ulcers. […] In most cases, topical ocular lubrication (with artificial tears during the day and lubricating ophthalmic ointment at night, or occasionally ointment day and night) is sufficient to prevent the complications of corneal exposure. […] Surgery to decompress the facial nerve is controversial. Patients with a poor prognosis, identified by facial nerve testing or persistent paralysis, appear to benefit the most from surgical intervention.

• #24 Bell’s palsy fact sheet | Emergency Care Institute

  https://aci.health.nsw.gov.au/networks/eci/clinical/ed-factsheets/bells-palsy

  As mentioned, there is a good chance of full recovery without any treatment. But treatment with medication is usually advised to improve the chance of full recovery. Also, you need to protect your eye if your eyelids cannot close (see Eye protection). […] A course of steroid tablets is usually prescribed for about 10 days. The steroid tablet most used is prednisolone. Steroids help to reduce inflammation, which is why they help. Taking a course of steroids does not guarantee full recovery of the nerve function. But it can increase the chance of full recovery compared to no treatment. […] If you cannot close your eyelids, the front of your eye is at risk of becoming damaged. Also, your tear glands may not work properly for a while and your eye may become dry. Dryness can cause damage, so seek treatment to keep your eye moist. Your doctor may advise one or more of the following until your eyelid and tear production recover: an eye pad or goggles to protect your eye, eye drops to lubricate your eye during the day, eye ointment to lubricate your eye overnight, an option of taping your upper and lower lid together when you are asleep. Other procedures are sometimes done to keep your eye shut until the eyelids recover.

• #25 Bell Palsy

  https://www.massgeneral.org/condition/bells-palsy

  Steroids to reduce inflammation […] Antiviral medicine, such as acyclovir […] Analgesics or moist heat to relieve pain […] Physical therapy to stimulate the facial nerve. […] Some people may choose to use alternative therapies in the treatment of Bell palsy, but there is no proof they make a difference in recovery. Such treatment may include: […] Relaxation […] Acupuncture […] Electrical stimulation […] Biofeedback training […] Vitamin therapy, including B-12, B-6, and the mineral zinc. […] Bell palsy usually resolves in time and causes no long-term complications. But it’s important to take medicines as directed. It’s also crucial that you protect the affected eye from drying. Use of eye drops during the day and ointment at bedtime can protect the cornea from scratching. […] Medicine and eye care are important in treating Bell palsy.

• #26 Bell’s palsy – causes, symptoms and treatments | healthdirect

  https://www.healthdirect.gov.au/bells-palsy

  Most people recover from Bell’s palsy within about 6 months without treatment. […] Treatment can help relieve your symptoms and let you recover more quickly. […] To treat Bell’s palsy, your doctor may prescribe you medicines. Oral steroids, or an antiviral medicine can be taken in the first few days from the onset of Bell’s palsy. This can improve your chance of a full recovery. […] They may also prescribe you lubricating eye drops or an eye ointment to protect your affected eye. Your doctor may also recommend physiotherapy or face massage. […] You can help your recovery by: […] using prescription eye drops and ointment regularly […] wearing glasses or goggles during the day […] using artificial tears to keep your eye moist […] using a lubricant ointment on the affected eye and tape it closed while you sleep.

• #27 Bell’s palsy – causes, symptoms and treatments | healthdirect

  https://www.healthdirect.gov.au/bells-palsy

  Most people recover from Bell’s palsy within about 6 months without treatment. […] Treatment can help relieve your symptoms and let you recover more quickly. […] To treat Bell’s palsy, your doctor may prescribe you medicines. Oral steroids, or an antiviral medicine can be taken in the first few days from the onset of Bell’s palsy. This can improve your chance of a full recovery. […] They may also prescribe you lubricating eye drops or an eye ointment to protect your affected eye. Your doctor may also recommend physiotherapy or face massage. […] You can help your recovery by: […] using prescription eye drops and ointment regularly […] wearing glasses or goggles during the day […] using artificial tears to keep your eye moist […] using a lubricant ointment on the affected eye and tape it closed while you sleep.

• #28 Bell Palsy

  https://www.massgeneral.org/condition/bells-palsy

  Bell palsy is not considered permanent. But in rare cases, it doesn’t disappear. Currently, there’s no known cure for Bell palsy. But recovery usually begins 2 weeks to 6 months from the start of the symptoms. Most people with Bell palsy recover full facial strength and expression. […] If a specific cause for Bell palsy is identified, such as infection, that cause will be treated. Otherwise, the symptoms are treated as needed. […] One treatment usually advised is protecting the eye from drying at night or while working at a computer. Eye care may include eye drops during the day, ointment at bedtime, or a moisture chamber at night. This helps protect the cornea from being scratched. This is very important to manage Bell palsy. […] Your healthcare provider will prescribe other treatment for your condition based on the severity of your symptoms and your health history. Other treatment choices include:

• #29 Bell Palsy

  https://www.massgeneral.org/condition/bells-palsy

  Steroids to reduce inflammation […] Antiviral medicine, such as acyclovir […] Analgesics or moist heat to relieve pain […] Physical therapy to stimulate the facial nerve. […] Some people may choose to use alternative therapies in the treatment of Bell palsy, but there is no proof they make a difference in recovery. Such treatment may include: […] Relaxation […] Acupuncture […] Electrical stimulation […] Biofeedback training […] Vitamin therapy, including B-12, B-6, and the mineral zinc. […] Bell palsy usually resolves in time and causes no long-term complications. But it’s important to take medicines as directed. It’s also crucial that you protect the affected eye from drying. Use of eye drops during the day and ointment at bedtime can protect the cornea from scratching. […] Medicine and eye care are important in treating Bell palsy.

• #30 Guide | Physical Therapy Guide to Bell’s Palsy | Choose PT

  https://www.choosept.com/guide/physical-therapy-guide-bells-palsy

  The first priority is to protect your eye. […] If you have partial facial movement, your therapist will teach you a few general facial exercises to do at home. […] Your physical therapist will help you regain the healthy pattern of movements that you need for facial expressions and function. […] Your therapist will design exercises to: Improve the coordination of your facial muscles. […] Your therapist will coach you to use your face as naturally as possible, without trying to restrict facial expressions because they look „different.” […] You may want to consider: A physical therapist who is experienced in treating people with neurological problems. […] When you contact a physical therapist for an appointment, be sure to ask about his or her experience in helping people with Bell palsy or facial paralysis.

• #31 Effective Physical Therapy Exercises For Bell’s Palsy

  https://facialparalysisinstitute.com/physical-therapy/exercises-for-bells-palsy/

  Exercises for Bells PalsyExercises for Bells Palsy […] This condition is known as a diagnosis of exclusion, meaning that it has no proven, single cause and is diagnosed after medical professionals exclude more serious conditions such as a stroke or brain tumor. […] those affected should seek medical care and Bells Palsy Physical Therapy right away to rule out stroke or other serious conditions. […] Some evidence suggests that customized Facial Muscle therapy like Bells Palsy exercises can help patients improve their facial function, as well. […] During Bells Palsy Exercises therapy, facial muscles that are holding other muscles captive have to be retrained to allow the primary muscles to move properly. […] At the Facial Paralysis Institute, we stress the importance of being evaluated by an expert neuromuscular therapist.

• #32 Guide | Physical Therapy Guide to Bell’s Palsy | Choose PT

  https://www.choosept.com/guide/physical-therapy-guide-bells-palsy

  The first priority is to protect your eye. […] If you have partial facial movement, your therapist will teach you a few general facial exercises to do at home. […] Your physical therapist will help you regain the healthy pattern of movements that you need for facial expressions and function. […] Your therapist will design exercises to: Improve the coordination of your facial muscles. […] Your therapist will coach you to use your face as naturally as possible, without trying to restrict facial expressions because they look „different.” […] You may want to consider: A physical therapist who is experienced in treating people with neurological problems. […] When you contact a physical therapist for an appointment, be sure to ask about his or her experience in helping people with Bell palsy or facial paralysis.

• #33 Guide | Physical Therapy Guide to Bell’s Palsy | Choose PT

  https://www.choosept.com/guide/physical-therapy-guide-bells-palsy

  The first priority is to protect your eye. […] If you have partial facial movement, your therapist will teach you a few general facial exercises to do at home. […] Your physical therapist will help you regain the healthy pattern of movements that you need for facial expressions and function. […] Your therapist will design exercises to: Improve the coordination of your facial muscles. […] Your therapist will coach you to use your face as naturally as possible, without trying to restrict facial expressions because they look „different.” […] You may want to consider: A physical therapist who is experienced in treating people with neurological problems. […] When you contact a physical therapist for an appointment, be sure to ask about his or her experience in helping people with Bell palsy or facial paralysis.

• #34 Bell’s Palsy: Causes, Symptoms, Diagnosis, Treatment, Outlook

  https://www.healthline.com/health/bells-palsy

  In most cases, Bells palsy symptoms improve without treatment. However, it can take several weeks or months for the muscles in your face to regain their normal strength. […] The following treatments may help in your recovery. […] Your doctor may recommend medications such as: corticosteroid drugs, which reduce inflammation; antiviral or antibacterial medication, which may be prescribed if a virus or bacteria causes your Bells palsy; over-the-counter pain medications, such as ibuprofen or acetaminophen, which can help relieve mild pain; eye drops to keep your affected eye well lubricated. […] Home treatment: an eye patch (for your dry eye); a warm, moist towel over your face to relieve pain; facial massage; physical therapy exercises to stimulate your facial muscles. […] Call your doctor immediately if you have symptoms of Bells palsy. Prompt treatment can help speed up your recovery time and prevent any complications.

• #35 Facial Paralysis & Bell’s Palsy | Jeevam Therapy | Edison NJ | Paramus NJ

  https://jeevamtherapy.com/orthopedic-conditions/facial-paralysis-bells-palsy/

  Bells Palsy: Physical Therapy for Facial Paralysis […] Understanding this condition and the benefits of physical therapy can help patients adjust and recover from facial paralysis. […] Recovery from this condition can occur naturally. However, physical therapy can help patients regain control over their facial muscles. […] Physical therapy treatment for Bells Palsy utilizes initiation and facilitation exercises. Initiation exercises will teach you to cause facial movement, as your therapist teaches you how to position your face. […] Your Edison, NJ Paramus, NJ therapist will design exercises to strengthen and control your facial muscles. Paired with movement exercises, these activities will help you regain the movement and coordination previously lost due to Bells Palsy. […] Working with our physical therapists is a proactive solution for patients with Bells Palsy.

• #36 Exercises for Bell’s Palsy: What You Should Know to Get Started

  https://www.webmd.com/brain/best-exercises-bells-palsy

  Bells palsy is the unexpected weakening of the facial nerve or temporary facial paralysis. There is no cure, but most people regain their facial strength and expression between 2 weeks and 6 months after symptoms begin. […] To help speed up the recovery process, many people choose to do physical therapy for Bells palsy. […] Facial exercises and physical therapy for Bells palsy help to increase muscle strength and to regain facial coordination from this temporary facial paralysis. Most exercises should be done three or four times a day in short sessions, with up to 30 repetitions per exercise. […] Exercises for Bells palsy are considered to be quite safe to do at home, unsupervised. However, you shouldnt overexert yourself or your muscles. […] If during your exercises for Bells palsy you see that muscles are moving or pulling, you should stop. Relax your muscles and take a rest.

• #37 Effective Physical Therapy Exercises For Bell’s Palsy

  https://facialparalysisinstitute.com/physical-therapy/exercises-for-bells-palsy/

  Thus, we tailor each Bells palsy recovery facial exercise regimen for his patient. […] Our physical therapists will put together a customized plan based on the impact Bells palsy is having on your face. […] By working closely with a Bells palsy physical therapy therapist, affected individuals can learn the right exercises to streamline recovery and strengthen muscles in the face. […] If the paralysis does not resolve within eight months, the team at the Facial Paralysis Institute may determine that additional treatment is needed. […] Bells palsy massage is sometimes recommended as part of a facial paralysis treatment program. […] Typical Bells palsy massage techniques focus on several areas of the face, including: […] A therapist may request that a patient apply moist heat to the face after performing Bells palsy exercise and massage therapy for Bells palsy.

• #38 Physical Therapy for Bell’s Palsy: Techniques and Exercises | Miracle Rehab Clinic

  https://www.miraclerehabclinic.com/blog/physical-therapy-for-bells-palsy

  Physical therapy for Bell’s Palsy may help manage all these symptoms. […] Physical therapy for Bell’s Palsy can play a supportive role in treating the condition by helping to manage and improve muscle weakness and facial asymmetry. […] Physical therapists can design physical therapy exercises for Bell’s Palsy to strengthen the affected muscles. […] Specific exercises are designed to improve the coordination of facial muscles, helping the affected side of the face move more naturally. […] Physical therapy can help improve the range of motion of the facial muscles, allowing for better control and symmetry of facial movements. […] Some physical therapy techniques use biofeedback to help patients visualize and monitor their muscle movements. […] Physical therapists can guide proper eye protection, particularly if the ability to close the eye on the affected side is compromised.

• #39 Physical Therapy for Bell’s Palsy: Techniques and Exercises | Miracle Rehab Clinic

  https://www.miraclerehabclinic.com/blog/physical-therapy-for-bells-palsy

  Physical therapy for Bell’s Palsy may help manage all these symptoms. […] Physical therapy for Bell’s Palsy can play a supportive role in treating the condition by helping to manage and improve muscle weakness and facial asymmetry. […] Physical therapists can design physical therapy exercises for Bell’s Palsy to strengthen the affected muscles. […] Specific exercises are designed to improve the coordination of facial muscles, helping the affected side of the face move more naturally. […] Physical therapy can help improve the range of motion of the facial muscles, allowing for better control and symmetry of facial movements. […] Some physical therapy techniques use biofeedback to help patients visualize and monitor their muscle movements. […] Physical therapists can guide proper eye protection, particularly if the ability to close the eye on the affected side is compromised.

• #40 Exercises for Bell’s Palsy: What You Should Know to Get Started

  https://www.webmd.com/brain/best-exercises-bells-palsy

  Bells palsy is the unexpected weakening of the facial nerve or temporary facial paralysis. There is no cure, but most people regain their facial strength and expression between 2 weeks and 6 months after symptoms begin. […] To help speed up the recovery process, many people choose to do physical therapy for Bells palsy. […] Facial exercises and physical therapy for Bells palsy help to increase muscle strength and to regain facial coordination from this temporary facial paralysis. Most exercises should be done three or four times a day in short sessions, with up to 30 repetitions per exercise. […] Exercises for Bells palsy are considered to be quite safe to do at home, unsupervised. However, you shouldnt overexert yourself or your muscles. […] If during your exercises for Bells palsy you see that muscles are moving or pulling, you should stop. Relax your muscles and take a rest.

• #41 Bell’s palsy: Treatment guidelines

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3152161/

  The rationale for the use of antiviral agents is the evidence that the inflammation of the facial nerve in Bell’s palsy might be related to the herpes simplex virus (HSV). However, the benefit of acyclovir or valacyclovir, either as single agents or in combination with prednisolone in Bell’s palsy has not been definitively established. […] In Bell’s palsy various physical therapies, such as exercise, biofeedback, laser, electrotherapy, massage and thermotherapy are used to hasten recovery. However, the evidence for the efficacy any of these therapies, is lacking. Cochrane systemic review of the efficacy of physical therapies, electrostimulation and exercises, on outcome of Bell’s palsy concluded that there was no significant benefit or harm from any of these physical therapies for Bell’s palsy.

• #42 Bell’s Palsy Treated with Facial Nerve Decompression

  http://eyerounds.org/cases/256-Bells-Palsy.htm

  Several smaller trials have demonstrated a trend towards benefit with antiviral therapy, and one trial showed a benefit to receiving both antiviral (valacyclovir) and steroid therapy compared to steroids alone. Furthermore, a 2015 Cochrane review that pooled results from 10 trials, including all of the studies mentioned above, found antiviral and steroid therapy to be superior to steroid therapy alone. Importantly, no serious adverse effects have been documented in any study using antivirals for Bell’s palsy to date. Patients who present to our institution within 7 days of symptom onset are treated with valacyclovir 500 mg orally 3 times per day for 10 days in addition to steroid therapy. […] Physical therapy is another potential treatment for facial paresis that includes exercises, massage, electrical stimulation, acupuncture, and biofeedback. A recent Cochrane review found only twelve low to moderate quality studies that evaluated the efficacy of physical therapy for facial paresis due to Bell’s palsy. One of these studies showed that facial exercises reduce the rate of synkinesis (involuntary facial movement that occurs with voluntary movement of a different facial muscle group) at three months. Another trial showed some benefit for facial exercises for patients that have had persistent nerve palsy for nine months or longer. While physical therapy may provide some benefit for patients, the evidence supporting its use remains relatively weak, and it should only be considered as an adjuvant therapy. At our institution, practice patterns vary in term of the use of physical therapy. Electrical physical therapy is not used, as it may cause an increased rate of complications.

• #43 Bell Palsy: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2023/0400/bell-palsy.html

  Patients with Bell palsy should be treated with oral corticosteroids, which have been shown to improve rates of full recovery (number needed to treat = 10) and reduce rates of synkinesis in adults. […] Patients with Bell palsy should be offered combination therapy with oral corticosteroids and antivirals. […] Patients with Bell palsy should not be treated with antivirals alone. […] Facial physical therapy should be offered to patients with severe or complete paralysis (House-Brackmann grade V or VI) or prolonged paralysis (more than three months), based on a Cochrane review of lower-quality studies and on one high-quality randomized trial. […] There is no high-quality evidence showing that treatment with low-level or high-level laser therapy, hyperbaric oxygen, intratympanic steroid injections, or stellate ganglion blocks is more effective than standard medical therapy.

• #44 The Best Treatment For Bell’s Palsy | Facial ParaIysis Institute

  https://facialparalysisinstitute.com/blog/best-treatments-for-bells-palsy/

  In 85% of cases, Bells palsy symptoms will disappear on their own. But if an individual experiences Bells palsy symptoms for eight months or longer, he or she may require treatment from an expert facial plastic and reconstructive surgeon like Dr. Babak Azizzadeh. […] Although Bells palsy is a serious disorder, there are many safe, effective treatments. In fact, some of the top treatments for Bells palsy include: […] Botox has played a key role in Bells palsy treatments for the past two decades. It has been shown to help Bells palsy patients relax unwanted muscle movements on the normal side of the face and reduce tension areas of the face that are hyperactive. […] Some evidence suggests customized facial exercises, or neuromuscular retraining therapy, may help Bells palsy patients improve facial function.

• #45 Bell Palsy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482290/

  While every patient with true Bell palsy recovers facial motor function to some extent, many will develop synkinesis, particularly if presenting with severe or total hemifacial paralysis. […] Physiotherapy remains a critical element of the treatment of severe Bell palsy, whether as an aspect of nonoperative management in conjunction with botulinum toxin injection or as part of the postoperative recovery regimen. […] The use of botulinum toxin injection to alleviate spasms and dyscoordinated or asymmetric movement due to facial palsy has been well-documented and found to be effective in both pediatric and adult populations. […] Patients who have undergone botulinum toxin injections with good results but who desire a longer-term solution or who are losing the effectiveness of the injections due to antibody development may be candidates for myomectomy procedures, in which a segment of muscle is removed to reduce synkinetic contraction.

• #46 The Best Treatment For Bell’s Palsy | Facial ParaIysis Institute

  https://facialparalysisinstitute.com/blog/best-treatments-for-bells-palsy/

  In 85% of cases, Bells palsy symptoms will disappear on their own. But if an individual experiences Bells palsy symptoms for eight months or longer, he or she may require treatment from an expert facial plastic and reconstructive surgeon like Dr. Babak Azizzadeh. […] Although Bells palsy is a serious disorder, there are many safe, effective treatments. In fact, some of the top treatments for Bells palsy include: […] Botox has played a key role in Bells palsy treatments for the past two decades. It has been shown to help Bells palsy patients relax unwanted muscle movements on the normal side of the face and reduce tension areas of the face that are hyperactive. […] Some evidence suggests customized facial exercises, or neuromuscular retraining therapy, may help Bells palsy patients improve facial function.

• #47 Bell’s palsy – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bells-palsy/diagnosis-treatment/drc-20370034

  Home treatment may include: […] Doing physical therapy exercises. Massaging and exercising your face according to your physical therapist’s advice may help relax your facial muscles. […] Although there’s little scientific evidence to support the use of alternative medicine to treat Bell’s palsy, some people with the condition may benefit from the following: […] OnabotulinumtoxinA (Botox). This medicine may help manage symptoms such as facial spasms and tearing. Injections of onabotulinumtoxinA also may help improve the balance of the face.

• #48 Bell’s Palsy Treatment MN | Midwest Facial Plastic Surgery

  https://www.mw-fp.com/facial-plastic-surgery-st-paul/surgical/bells-palsy/

  The 2 main treatments for synkinesis are physical therapy and botulinum toxin injections. The purpose of physical therapy is to teach the patient techniques to help relax the face and gain better control over facial movement. […] You can use Botox injections to partially weaken the muscle that closes the eye so that it doesn’t close so tight during smiling. Botox can also be used to weaken the muscles that pull down on the lip, which can release a “frozen smile” and allow a patient to create a more symmetric and pleasing smile. For patients who develop significant facial asymmetry at rest, temporary injectable fillers like Juvederm®, Voluma®, and Vollure® can be used to create better facial symmetry.

• #49 Bell’s Palsy Treatment MN | Midwest Facial Plastic Surgery

  https://www.mw-fp.com/facial-plastic-surgery-st-paul/surgical/bells-palsy/

  The 2 main treatments for synkinesis are physical therapy and botulinum toxin injections. The purpose of physical therapy is to teach the patient techniques to help relax the face and gain better control over facial movement. […] You can use Botox injections to partially weaken the muscle that closes the eye so that it doesn’t close so tight during smiling. Botox can also be used to weaken the muscles that pull down on the lip, which can release a “frozen smile” and allow a patient to create a more symmetric and pleasing smile. For patients who develop significant facial asymmetry at rest, temporary injectable fillers like Juvederm®, Voluma®, and Vollure® can be used to create better facial symmetry.

• #50 Seeking a referral for specialist help for facial palsy – Facial Palsy UK

  https://www.facialpalsy.org.uk/support/useful-info/seeking-a-referral-for-specialist-help-for-facial-palsy/

  BT should be seen as an adjunct to therapy by providing a window of opportunity for effective exercising. […] If a patient only receives BT but does not work on building length back into the muscles and inhibiting synkinesis, once the Botox wears off the patient will lose all the benefit they gained. […] It is also important to see what can be achieved by specialist facial therapy before considering invasive surgeries. […] If the tightness is due to surgery please speak to a specialist facial therapist before undertaking facial exercise. […] There are many ways that symptoms can be improved resulting in a better quality of life.

• #51 Bell’s palsy – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bells-palsy/diagnosis-treatment/drc-20370034

  Despite this, an antiviral medicine, such as valacyclovir (Valtrex) or acyclovir, is sometimes given in combination with prednisone in people with severe facial palsy. […] A physical therapist can teach you how to massage and exercise your facial muscles to help prevent this from occurring. […] In the past, decompression surgery was used to relieve the pressure on the facial nerve by opening the bony passage that the nerve passes through. Today, decompression surgery isn’t recommended. Facial nerve injury and permanent hearing loss are possible risks associated with this surgery. […] Rarely, plastic surgery may be needed to correct lasting facial nerve problems. Facial reanimation surgery helps make the face look more even and may restore facial movement. Examples of this type of surgery include an eyebrow lift, an eyelid lift, facial implants and nerve grafts. Some procedures, such as an eyebrow lift, may need to be repeated after several years.

• #52 Bell’s Palsy: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/1001/p997.html

  The most widely cited study supporting this approach only reported results for a total of 34 treated patients at three different sites, included a nonrandomized control group, and lacked a blinded evaluation of outcome. […] Based on the significant potential for harms and the paucity of data supporting benefit, the American Academy of Neurology does not currently recommend surgical decompression for Bell’s palsy. […] Some published studies have reported benefit with acupuncture versus steroids and placebo, but all had serious flaws in study design and reporting.

• #53 Bell’s Palsy Treated with Facial Nerve Decompression

  http://eyerounds.org/cases/256-Bells-Palsy.htm

  Facial nerve decompression has been described via either a transmastoid or middle cranial fossa (MCF) approach. The MCF approach has demonstrated the greatest promise, as it provides access for decompression of the labyrinthine segment of the facial nerve. One multi-center, case-control study demonstrated near complete recovery of facial nerve function (House-Brackmann I-II) for 31 of 34 (91%) patients treated with facial nerve decompression via an MCF approach as compared to 15 of 36 (42%) patients treated with steroids alone. All patients who underwent surgery had 90% reduction in amplitude on ENoG, absent voluntary facial nerve activity, and were able to undergo surgery within 3-14 days of symptom onset. The efficacy of a MCF approach has also been validated by an additional report. […] Awareness of the window of opportunity for facial nerve decompression is critical. Providers in primary care clinics, emergency departments, and eye clinics must recognize that patients with complete or near-complete facial nerve paralysis need urgent referral so that appropriate diagnostic testing (ENoG and EMG) may be attained and surgical intervention completed within 14 days of symptom onset. All patients with complete facial nerve paralysis should be referred to a center with expertise in MCF surgery. Identifying and maintaining appropriate referral pathways is important as the number of neuro-otologists who regularly perform procedures via the MCF approach remains limited. Additionally, the MCF approach is a technically demanding procedure that can be associated with severe complications (e.g. cerebrospinal fluid leak, hearing loss, facial nerve injury). These factors should be considered and discussed when choosing to proceed with facial nerve decompression.

• #54 Bell’s Palsy, Current Treatment – Michigan Ear Institute

  https://michiganear.com/posts/bells-palsy-current-treatment/

  A recent study by Bruce Gantz, M.D. and others outlines the role of surgical decompression in Bell’s Palsy. Those patients with complete clinical facial paralysis, greater than 90% degeneration on ENOG and no evidence of voluntary action muscle potentials on EMG testing were candidates for surgical decompression. Those patients under going decompression within the first two weeks of the onset of paralysis showed a 91% chance of a good outcome vs a 42% chance of obtaining a House-Brackmann scale grade I or II if treated with steroids only. Facial nerve decompression should be performed by the middle cranial fossa technique in order to achieve decompression of the meatal foramen area. […] Our data on facial nerve decompression at the Michigan Ear Institute confirms Dr. Gantz study. We have found that early decompression, generally within the first three weeks leads to an overall better result compared to medically treated patients with complete facial paralysis and ENOG features of severe degeneration. It does appear that the middle cranial fossa approach, decompressing the area of the meatal foramen, offers these patients the most benefit.

• #55 Bell’s palsy – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bells-palsy/diagnosis-treatment/drc-20370034

  Despite this, an antiviral medicine, such as valacyclovir (Valtrex) or acyclovir, is sometimes given in combination with prednisone in people with severe facial palsy. […] A physical therapist can teach you how to massage and exercise your facial muscles to help prevent this from occurring. […] In the past, decompression surgery was used to relieve the pressure on the facial nerve by opening the bony passage that the nerve passes through. Today, decompression surgery isn’t recommended. Facial nerve injury and permanent hearing loss are possible risks associated with this surgery. […] Rarely, plastic surgery may be needed to correct lasting facial nerve problems. Facial reanimation surgery helps make the face look more even and may restore facial movement. Examples of this type of surgery include an eyebrow lift, an eyelid lift, facial implants and nerve grafts. Some procedures, such as an eyebrow lift, may need to be repeated after several years.

• #56 Bell’s palsy – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bells-palsy/diagnosis-treatment/drc-20370034

  Despite this, an antiviral medicine, such as valacyclovir (Valtrex) or acyclovir, is sometimes given in combination with prednisone in people with severe facial palsy. […] A physical therapist can teach you how to massage and exercise your facial muscles to help prevent this from occurring. […] In the past, decompression surgery was used to relieve the pressure on the facial nerve by opening the bony passage that the nerve passes through. Today, decompression surgery isn’t recommended. Facial nerve injury and permanent hearing loss are possible risks associated with this surgery. […] Rarely, plastic surgery may be needed to correct lasting facial nerve problems. Facial reanimation surgery helps make the face look more even and may restore facial movement. Examples of this type of surgery include an eyebrow lift, an eyelid lift, facial implants and nerve grafts. Some procedures, such as an eyebrow lift, may need to be repeated after several years.

• #57 Bell’s palsy – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bells-palsy/diagnosis-treatment/drc-20370034

  Despite this, an antiviral medicine, such as valacyclovir (Valtrex) or acyclovir, is sometimes given in combination with prednisone in people with severe facial palsy. […] A physical therapist can teach you how to massage and exercise your facial muscles to help prevent this from occurring. […] In the past, decompression surgery was used to relieve the pressure on the facial nerve by opening the bony passage that the nerve passes through. Today, decompression surgery isn’t recommended. Facial nerve injury and permanent hearing loss are possible risks associated with this surgery. […] Rarely, plastic surgery may be needed to correct lasting facial nerve problems. Facial reanimation surgery helps make the face look more even and may restore facial movement. Examples of this type of surgery include an eyebrow lift, an eyelid lift, facial implants and nerve grafts. Some procedures, such as an eyebrow lift, may need to be repeated after several years.

• #58 Bell Palsy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482290/

  Ideally, patients with acute Bell palsy should be seen as soon as possible and given corticosteroids within 72 hours of paralysis onset. A common regimen is 1 mg/kg daily up to 60 mg of prednisone or an equivalent dose of prednisolone for 5 to 7 days with or without a taper. […] In addition to steroids and antivirals, corneal protection during recovery is a critical intervention for patients without complete eye closure. […] Surgical options for improving eye closure include placement of a weight or a spring into the upper eyelid, tightening of the lower eyelid with medial or lateral canthopexy and tarsal strip, and tarsorrhaphy or tarsoconjunctival flap transfer. […] Surgery on the facial nerve itself, such as grafting or transfer, is not commonly performed in cases of acute Bell palsy; decompression of the facial nerve may be offered to patients who meet the electrodiagnostic criteria enumerated above and who are both willing and able to undergo the operation.

• #59 Bell Palsy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482290/

  Ideally, patients with acute Bell palsy should be seen as soon as possible and given corticosteroids within 72 hours of paralysis onset. A common regimen is 1 mg/kg daily up to 60 mg of prednisone or an equivalent dose of prednisolone for 5 to 7 days with or without a taper. […] In addition to steroids and antivirals, corneal protection during recovery is a critical intervention for patients without complete eye closure. […] Surgical options for improving eye closure include placement of a weight or a spring into the upper eyelid, tightening of the lower eyelid with medial or lateral canthopexy and tarsal strip, and tarsorrhaphy or tarsoconjunctival flap transfer. […] Surgery on the facial nerve itself, such as grafting or transfer, is not commonly performed in cases of acute Bell palsy; decompression of the facial nerve may be offered to patients who meet the electrodiagnostic criteria enumerated above and who are both willing and able to undergo the operation.

• #60 Bell Palsy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482290/

  Ideally, patients with acute Bell palsy should be seen as soon as possible and given corticosteroids within 72 hours of paralysis onset. A common regimen is 1 mg/kg daily up to 60 mg of prednisone or an equivalent dose of prednisolone for 5 to 7 days with or without a taper. […] In addition to steroids and antivirals, corneal protection during recovery is a critical intervention for patients without complete eye closure. […] Surgical options for improving eye closure include placement of a weight or a spring into the upper eyelid, tightening of the lower eyelid with medial or lateral canthopexy and tarsal strip, and tarsorrhaphy or tarsoconjunctival flap transfer. […] Surgery on the facial nerve itself, such as grafting or transfer, is not commonly performed in cases of acute Bell palsy; decompression of the facial nerve may be offered to patients who meet the electrodiagnostic criteria enumerated above and who are both willing and able to undergo the operation.

• #61 Facial Paralysis Treatment | Facial Nerve Conditions | Duke Health

  https://www.dukehealth.org/treatments/plastic-and-reconstructive-surgery/facial-paralysis-treatment

  Facial reanimation microsurgery — sometimes referred to as „smile surgery” — can restore your ability to smile spontaneously after a damaged facial nerve has caused facial paralysis. […] This procedure may be recommended when synkinesis is present and chemodenervation and physical therapy are not effective. Selective neurolysis involves selecting and cutting the nerves that are misfiring so that they no longer cause abnormal facial movements. […] A variety of procedures may be performed to restore balance and create symmetry in the face when at rest.

• #62 Bell Palsy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482290/

  While every patient with true Bell palsy recovers facial motor function to some extent, many will develop synkinesis, particularly if presenting with severe or total hemifacial paralysis. […] Physiotherapy remains a critical element of the treatment of severe Bell palsy, whether as an aspect of nonoperative management in conjunction with botulinum toxin injection or as part of the postoperative recovery regimen. […] The use of botulinum toxin injection to alleviate spasms and dyscoordinated or asymmetric movement due to facial palsy has been well-documented and found to be effective in both pediatric and adult populations. […] Patients who have undergone botulinum toxin injections with good results but who desire a longer-term solution or who are losing the effectiveness of the injections due to antibody development may be candidates for myomectomy procedures, in which a segment of muscle is removed to reduce synkinetic contraction.

• #63 Bell Palsy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482290/

  Like removing portions of abnormally-contracting muscles, resection of segments of nerve branches that innervate these muscles can supplement or replace long-term botulinum toxin injections, or be performed as an adjunct to myomectomy. […] Nerve transfer for smile rehabilitation most often involves rerouting the nerve to the masseter into the facial nerve’s buccal branch that controls the zygomaticus major muscle.

• #64 Bell’s Palsy: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/1001/p997.html

  The most widely cited study supporting this approach only reported results for a total of 34 treated patients at three different sites, included a nonrandomized control group, and lacked a blinded evaluation of outcome. […] Based on the significant potential for harms and the paucity of data supporting benefit, the American Academy of Neurology does not currently recommend surgical decompression for Bell’s palsy. […] Some published studies have reported benefit with acupuncture versus steroids and placebo, but all had serious flaws in study design and reporting.

• #65 NCD – Electrotherapy for Treatment of Facial Nerve Paralysis (Bell’s Palsy) (160.15)

  https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?NCDId=94&NCDver=1

  Electrotherapy for the treatment of facial nerve paralysis is the application of electrical stimulation to affected facial muscles to provide muscle innervation with the intention of preventing muscle degeneration. […] Electrotherapy for the treatment of facial nerve paralysis, commonly known as Bell’s Palsy, is not covered under Medicare because its clinical effectiveness has not been established.

• #66 Bell’s Palsy: Causes, Treatment & Nutrients – Life Extension

  https://www.lifeextension.com/protocols/neurological/bells-palsy?srsltid=AfmBOork0KVkhLTMNkInc3Gi9tQnodDF6IpqbSiReziS7Iav2d8QW5oz

  Antiviral medications, such as acyclovir and valacyclovir, are sometimes added to the corticosteroid regimen in severe cases, but studies have been inconclusive as to whether antivirals offer any significant benefit. […] The impaired tearing that accompanies Bells palsy can put the eye at risk for damage. The cornea can become dry and scratched, which can lead to permanent vision problems. It is recommended that, while awake, patients use artificial tears four times daily or every hour if needed and apply ophthalmic ointments at night. […] Low-level laser therapy, sometimes known as cold laser or photobiomodulation therapy, utilizes wavelengths of light between 660 nm and 905 nm. […] In Bells palsy, low-level laser therapy is believed to enhance healing and regeneration of nerves by increasing blood flow to affected tissues and decreasing inflammation.

• #67 Bell’s Palsy: Causes, Treatment & Nutrients – Life Extension

  https://www.lifeextension.com/protocols/neurological/bells-palsy?srsltid=AfmBOork0KVkhLTMNkInc3Gi9tQnodDF6IpqbSiReziS7Iav2d8QW5oz

  Hyperbaric oxygen therapy involves sitting in a pressurized (hyperbaric) chamber breathing 100% oxygen for approximately an hour. […] These treatments increase the amount of oxygen in the blood and may help increase oxygen delivery to the facial nerve, and thus have been suggested to help speed recovery after Bells palsy. […] Infusion therapy is an approach for treating Bells palsy using corticosteroids mixed in an infusion solution containing dextran and pentoxifylline. […] Although this approach has not been heavily researched in recent years, multiple older studies in Europe and Asia have found it to be an effective method of treating Bells palsy and suggest it may be more effective than steroids alone. […] Nerve growth factor is a protein with neurotrophic effects. […] A meta-analysis of eight clinical trials performed in China found the inclusion of nerve growth factor in Bells palsy treatment was likely to improve outcomes.

• #68 Bell Palsy

  https://www.massgeneral.org/condition/bells-palsy

  Steroids to reduce inflammation […] Antiviral medicine, such as acyclovir […] Analgesics or moist heat to relieve pain […] Physical therapy to stimulate the facial nerve. […] Some people may choose to use alternative therapies in the treatment of Bell palsy, but there is no proof they make a difference in recovery. Such treatment may include: […] Relaxation […] Acupuncture […] Electrical stimulation […] Biofeedback training […] Vitamin therapy, including B-12, B-6, and the mineral zinc. […] Bell palsy usually resolves in time and causes no long-term complications. But it’s important to take medicines as directed. It’s also crucial that you protect the affected eye from drying. Use of eye drops during the day and ointment at bedtime can protect the cornea from scratching. […] Medicine and eye care are important in treating Bell palsy.

• #69 Optimal Bell’s Palsy Treatment: Steroids, Antivirals, and a Timely and Personalized Approach

  https://www.mdpi.com/2077-0383/13/1/51

  The best treatment results were achieved when steroid treatment was administered within 72 h. […] These findings underscore the importance of individualized treatment approaches in Bell’s palsy management. […] Treatment guidelines have evolved over time. The 2013 guidelines recommended steroid monotherapy, with antiviral treatment alone not recommended. […] However, subsequent studies have presented mixed results. Some indicated that combining steroids and antiviral agents yielded better recovery rates, while others found limited benefit in adding antivirals. […] The results of this study may inform clinical decision-making in the management of this condition. […] The choice between steroid monotherapy and combined steroid and antiviral therapy may depend on the initial severity of Bell’s palsy. […] These findings suggest that treatment strategies should be tailored based on the initial severity of Bell’s palsy, with more aggressive combination therapy warranted in patients with more severe disease.

• #70 Optimal Bell’s Palsy Treatment: Steroids, Antivirals, and a Timely and Personalized Approach

  https://www.mdpi.com/2077-0383/13/1/51

  The best treatment results were achieved when steroid treatment was administered within 72 h. […] These findings underscore the importance of individualized treatment approaches in Bell’s palsy management. […] Treatment guidelines have evolved over time. The 2013 guidelines recommended steroid monotherapy, with antiviral treatment alone not recommended. […] However, subsequent studies have presented mixed results. Some indicated that combining steroids and antiviral agents yielded better recovery rates, while others found limited benefit in adding antivirals. […] The results of this study may inform clinical decision-making in the management of this condition. […] The choice between steroid monotherapy and combined steroid and antiviral therapy may depend on the initial severity of Bell’s palsy. […] These findings suggest that treatment strategies should be tailored based on the initial severity of Bell’s palsy, with more aggressive combination therapy warranted in patients with more severe disease.

• #71 Bell Palsy Treatment & Management: Approach Considerations, Pharmacologic Therapy, Local Treatment

  https://emedicine.medscape.com/article/1146903-treatment

  A larger double-blind, controlled trial showed that prednisolone significantly shortened the time to complete recovery, while valacyclovir did not affect facial recovery compared with placebo. […] The recommended dose of prednisone for the treatment of Bell palsy is 1 mg/kg or 60 mg/day for 6 days, followed by a taper, for a total of 10 days. […] High-dose steroids (120 mg/day of prednisone) have been safely used to treat Bell palsy in patients with diabetes; however, optimal dosing has not been established. […] Evaluation of the use of antiviral medicines in Bell palsy has shown limited benefit from these drugs, with 3 randomized, controlled trials having demonstrated no benefit from them. […] The 2001 AAN practice parameter suggested that the use of acyclovir for the treatment of Bell palsy is only possibly effective and that therapy with this agent alone is not effective in facial recovery.

• #72 Bell’s palsy: Treatment and prognosis in adults – UpToDate

  http://www.uptodate.com/contents/bells-palsy-prognosis-and-treatment-in-adults

  Bell’s palsy: Treatment and prognosis in adults […] INITIAL TREATMENT […] The mainstay of pharmacologic therapy for Bell’s palsy or facial nerve palsy is early short-term oral glucocorticoid treatment. In severe acute cases, combining antiviral therapy with glucocorticoids may improve outcomes. Eye care is essential for patients with incomplete eye closure (algorithm 1). […] Glucocorticoids for all patients — A short-term course of oral glucocorticoids is recommended for all patients with new-onset Bell’s palsy. Treatment should ideally begin within three days of symptom onset, as this is the setting in which glucocorticoids have been studied and shown to be beneficial. We typically treat patients who are within seven days of symptom onset.

• #73 Bell’s palsy: Treatment guidelines

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3152161/

  The aims of treatment in the acute phase of Bell’s palsy include strategies to speed recovery and to prevent corneal complications. Eye care includes eye patching and lubrication, lubricating drops should be applied frequently during the day and a eye ointment should be used at night. […] Strategies to speed recovery include physical therapy, corticosteroids and antiviral agents. […] The rationale for the use of corticosteroids in acute phase of Bell’s palsy is that inflammation and edema of the facial nerve are implicated in causing Bell’s palsy and corticosteroids have a potent anti-inflammatory action which should minimise nerve damage and thereby improve the outcome. […] Randomized, double-blind, placebo-controlled trials have provided compelling evidence that treatment with prednisolone improves outcome in patients with Bell’s palsy and shortens the time to complete recovery. Prednisolone should be used in all patients with facial palsy of less than 72 h duration who do not have contraindications to steroid therapy.

• #74 Bell Palsy: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2023/0400/bell-palsy.html

  Bell palsy should be suspected in patients with acute onset of unilateral facial weakness or paralysis involving the forehead in the absence of other neurologic abnormalities. […] An oral corticosteroid regimen (prednisone, 50 to 60 mg per day for five days followed by a five-day taper) is the first-line treatment for Bell palsy. […] Combination therapy with an oral corticosteroid and antiviral may reduce rates of synkinesis (misdirected regrowth of facial nerve fibers manifesting as involuntary co-contraction of certain facial muscles). […] Recommended antivirals include valacyclovir (1 g three times per day for seven days) or acyclovir (400 mg five times per day for 10 days). […] Treatment with antivirals alone is ineffective and not recommended. […] Physical therapy may be beneficial in patients with more severe paralysis.

• #75 Bell Palsy Treatment & Management: Approach Considerations, Pharmacologic Therapy, Local Treatment

  https://emedicine.medscape.com/article/1146903-treatment

  A Cochrane review found no significant benefit to the use of antivirals over placebo in reducing the rate of incomplete recovery from Bell palsy. […] Acyclovir (Zovirax) is administered at a dosage of 400 mg orally 5 times daily for 10 days. […] Valacyclovir (Valtrex), taken orally in doses of 500 mg twice daily for 5 days, may be used instead of acyclovir. […] It is universally accepted that eye care is imperative in Bell palsy. The patients eye is at risk for drying, corneal abrasion, and corneal ulcers. […] In most cases, topical ocular lubrication (with artificial tears during the day and lubricating ophthalmic ointment at night, or occasionally ointment day and night) is sufficient to prevent the complications of corneal exposure. […] Surgery to decompress the facial nerve is controversial. Patients with a poor prognosis, identified by facial nerve testing or persistent paralysis, appear to benefit the most from surgical intervention.

• #76 Bell Palsy: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2023/0400/bell-palsy.html

  Patients with Bell palsy should be treated with oral corticosteroids, which have been shown to improve rates of full recovery (number needed to treat = 10) and reduce rates of synkinesis in adults. […] Patients with Bell palsy should be offered combination therapy with oral corticosteroids and antivirals. […] Patients with Bell palsy should not be treated with antivirals alone. […] Facial physical therapy should be offered to patients with severe or complete paralysis (House-Brackmann grade V or VI) or prolonged paralysis (more than three months), based on a Cochrane review of lower-quality studies and on one high-quality randomized trial. […] There is no high-quality evidence showing that treatment with low-level or high-level laser therapy, hyperbaric oxygen, intratympanic steroid injections, or stellate ganglion blocks is more effective than standard medical therapy.

• #77 The Best Treatment For Bell’s Palsy | Facial ParaIysis Institute

  https://facialparalysisinstitute.com/blog/best-treatments-for-bells-palsy/

  In 85% of cases, Bells palsy symptoms will disappear on their own. But if an individual experiences Bells palsy symptoms for eight months or longer, he or she may require treatment from an expert facial plastic and reconstructive surgeon like Dr. Babak Azizzadeh. […] Although Bells palsy is a serious disorder, there are many safe, effective treatments. In fact, some of the top treatments for Bells palsy include: […] Botox has played a key role in Bells palsy treatments for the past two decades. It has been shown to help Bells palsy patients relax unwanted muscle movements on the normal side of the face and reduce tension areas of the face that are hyperactive. […] Some evidence suggests customized facial exercises, or neuromuscular retraining therapy, may help Bells palsy patients improve facial function.

• #78 Bell’s Palsy, Current Treatment – Michigan Ear Institute

  https://michiganear.com/posts/bells-palsy-current-treatment/

  Bell’s Palsy, the acute onset of facial paralysis, is a devastating disorder to both the patient and their family. Most often however this paralysis is short lived and recovery occurs back to normal in the majority of patients. A study by Peitersen looked at 1,011 patients studying the natural history of Bell’s Palsy. Without any treatment 84% of patients had facial function recover to either normal or near normal function. It is the remaining 16% of patients who demonstrate a poor outcome that treatment has been directed towards. […] The treatment of Bell’s Palsy thus centers around the reduction of swelling of the facial nerve as well as an attack on the herpes simplex one virus. Currently medical treatment consists of high dose steroids and Acyclovir. Our current approach includes Prednisone 60 mg per day (20 mg t.i.d.) for at least one week followed by a rapid taper. Famvir in a dose of 500 mg b.i.d. is used for Bell’s Palsy and 500 mg t.i.d. of Famvir is utilized for herpes zoster oticus. All patients with Bell’s Palsy are treated in the above manner. Those patients with a partial facial paralysis are treated in order to prevent them from going to complete facial paralysis. Patients with a complete facial paralysis are also treated in this manner.

• #79 Bell’s Palsy Clinic: Expert Care at Lone Star Neurology

  https://lonestarneurology.net/bells-palsy/

  Neurology provides ongoing care and support to manage patients symptoms and achieve outcomes. The team works with patients to check their condition and adjust treatment plans. […] We collaborate with ophthalmologists, ENT specialists, and physical therapists. This does provide comprehensive care for patients with Bells palsy. […] Yes, a doctor can do many things to help manage and treat Bells Palsy. Bells palsy is a condition that causes facial paralysis. It can also cause weakness on one side of the face due to inflammation or damage to the facial nerve. […] The symptoms of Bells palsy can be uncomfortable. But most people recover without treatment within a few weeks or months. But, in some cases, treatment may be necessary to reduce the severity of symptoms or speed up recovery. […] There are a few things you can do to speed up your recovery and increase your chances of a full recovery. Here are some tips: Take prescribed medication. Do facial exercises. Apply heat or cold packs. Get enough rest. Maintain good nutrition. Stay hydrated.

• #80 Treatment of idiopathic facial paralysis (Bell’s Palsy) and secondary facial paralysis with extracellular vesicles: a pilot safety study | BMC Neurology | Full Text

  https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-023-03400-6

  Paralysis of the facial nerve (CN VII) is one of the most debilitating issues that any patient can encounter. Bells palsy is the most commonly seen mononeuropathy. Although usually self-limited, symptomatology can persist for decades in persistent cases. The non-surgical alternative therapies discussed in this study are successful without reconstruction and are regenerative. […] We performed a pilot safety study of 7 patients with idiopathic and secondary facial paralysis to determine if any functional restoration was possible. Each patient had symptomology for varying periods of time, with diverse House-Brackmann scores. They were all treated with the same protocol of extracellular vesicles (EVs) over a 4-week period of time and were evaluated both before and after treatment. […] All seven patients enrolled in the study improved with this treatment protocol. After the second week of treatment, we saw a progression of independent motion of the affected eyelid, brow motion, and commissure.

• #81 Bell’s Palsy: Causes, Treatment & Nutrients – Life Extension

  https://www.lifeextension.com/protocols/neurological/bells-palsy?srsltid=AfmBOork0KVkhLTMNkInc3Gi9tQnodDF6IpqbSiReziS7Iav2d8QW5oz

  Hyperbaric oxygen therapy involves sitting in a pressurized (hyperbaric) chamber breathing 100% oxygen for approximately an hour. […] These treatments increase the amount of oxygen in the blood and may help increase oxygen delivery to the facial nerve, and thus have been suggested to help speed recovery after Bells palsy. […] Infusion therapy is an approach for treating Bells palsy using corticosteroids mixed in an infusion solution containing dextran and pentoxifylline. […] Although this approach has not been heavily researched in recent years, multiple older studies in Europe and Asia have found it to be an effective method of treating Bells palsy and suggest it may be more effective than steroids alone. […] Nerve growth factor is a protein with neurotrophic effects. […] A meta-analysis of eight clinical trials performed in China found the inclusion of nerve growth factor in Bells palsy treatment was likely to improve outcomes.

• #82 Bell’s Palsy: Causes, Treatment & Nutrients – Life Extension

  https://www.lifeextension.com/protocols/neurological/bells-palsy?srsltid=AfmBOork0KVkhLTMNkInc3Gi9tQnodDF6IpqbSiReziS7Iav2d8QW5oz

  Hyperbaric oxygen therapy involves sitting in a pressurized (hyperbaric) chamber breathing 100% oxygen for approximately an hour. […] These treatments increase the amount of oxygen in the blood and may help increase oxygen delivery to the facial nerve, and thus have been suggested to help speed recovery after Bells palsy. […] Infusion therapy is an approach for treating Bells palsy using corticosteroids mixed in an infusion solution containing dextran and pentoxifylline. […] Although this approach has not been heavily researched in recent years, multiple older studies in Europe and Asia have found it to be an effective method of treating Bells palsy and suggest it may be more effective than steroids alone. […] Nerve growth factor is a protein with neurotrophic effects. […] A meta-analysis of eight clinical trials performed in China found the inclusion of nerve growth factor in Bells palsy treatment was likely to improve outcomes.

• #83 Refractory Bell’s palsy responding to late treatment with high-dose intravenous steroids

  https://www.e-acn.org/journal/view.php?doi=10.14253/acn.2021.23.2.121

  Bells palsy is an acute peripheral facial paralysis with no detectable cause. […] Here we present two cases of refractory Bells palsy with facial nerve enhancement in magnetic resonance imaging who showed symptomatic improvement after the late administration of high-dose intravenous methylprednisolone. […] Treatment of Bells palsy is based on the empirical administration of oral steroids, with the addition of an antiviral drug such as acyclovir, famciclovir, or valacyclovir if symptoms are severe. […] In our patients, the conventional antiviral and oral corticosteroid treatment did not result in any clinical improvement, whereas the administration of high-dose IV methylprednisolone on day 72 after the onset in one patient and on day 60 in the other patient accelerated their recovery of facial weakness.

• #84 Can SoftWave Therapy Help Treat Bell’s Palsy? – SoftWave

  https://softwaveclinics.com/blog/can-softwave-help-treat-bells-palsy/

  Bell’s Palsy is a sudden and usually temporary weakness or paralysis of the muscles on one side of the face. […] With the rise of innovative treatments, SoftWave Therapy has been making strides as a potential remedy. This therapy employs broad-focused shockwaves to promote healing, showing promise in treating conditions like Bell’s Palsy. […] SoftWave Therapy has recently come into focus as a possible treatment avenue for Bell’s Palsy. The rationale is straightforward: if SoftWave can stimulate tissue healing and reduce inflammation, it can be beneficial in treating conditions resulting from nerve inflammation or damage. […] SoftWave Therapy, in contrast, provides a unique approach. It directly targets the affected area, promoting faster healing without the systemic side effects of medications. […] If you or a loved one is grappling with Bell’s Palsy, consider exploring SoftWave Therapy. Its potential to reduce recovery time, combined with its non-invasive nature, makes it a compelling option.

• #85 Treatment of idiopathic facial paralysis (Bell’s Palsy) and secondary facial paralysis with extracellular vesicles: a pilot safety study | BMC Neurology | Full Text

  https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-023-03400-6

  Clearly, the duration of the treatment protocol needs to be longer than one month. […] The primary objective was to demonstrate a safety profile utilizing EVs for a successful improvement without surgery. Additionally, we wanted to see if any improvement could be achieved toward the ultimate goal of total facial nerve functional restoration. […] Each patient, before treatment and upon completion of the study was scored with the House-Brackmann scale, as well as a Facial Disability Index score. EVs were administered as follows on the schedule outlined above in the Timeline section. ExoFlo in 100 ccs normal saline intravenously with a synchronous injection of 2 ccs ExoFlo directly into tissue around the facial nerve with ultrasound guidance. […] Overall, extracellular vesicles have been found to be safe and effective in the treatment of facial paralysis.

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