Modern management of facial palsy: a review of current literature

IntroduCtIonFacial nerve dysfunction can severely affect a patient's quality of life.The human face is a focal point for communication and expression.The facial nerve carries motor, sensory, and parasympathetic fibres, so facial palsy results in both a functional and cosmetic impairment.Facial weakness secondary to upper motor neurone lesions will not be discussed in this article.Facial nerve palsy is diagnosed upon clinical presentation with weakness of the facial muscles.There may be immobility of the brow, incomplete lid closure, drooping of the corner of the mouth, impaired closure of the lips, dry eye, hyperacusis, impaired taste, or pain around the ear.There are many causes of unilateral facial palsy that should be considered, including idiopathic, traumatic, infective, neoplastic, congenital, and autoimmune (Box 1).Seventy per cent of facial nerve palsies are diagnosed as Bell's palsy 1 with 11-40 new cases per 100 000 each year. 2 Bell's palsy disproportionately attacks pregnant women and patients with respiratory tract illness.Bilateral facial palsy is far less common (2% of facial palsies) and typically represents a systemic disorder with multiple manifestations.Bell's palsy is also the most common diagnosis in childhood and accounts for 90% of facial paralysis.Up to 10% of patients with Bell's palsy will experience recurrence after a mean latency of 10 years. 2 ManageMentThe management of facial palsy is dictated by clinical assessment and working diagnosis.Facial motor neurone disturbance should only be considered as Bell's palsy after all other aetiologies have been excluded.Careful evaluation of the patient, particularly with respect to the history, otoscopy, and neurologic assessment, will differentiate a true Bell's palsy from other causes.A patient with Bell's palsy will typically present with acute onset, painless facial weakness (lower motor neurone distribution) with a normal ear, nose, and throat (ENT) examination (Box 2).If the examiner is confident that there are no signs of an alternative diagnosis, then this patient may be managed in primary care.Any patient whose presentation is atypical, be that an insidious and painful onset or clinical signs, such as otorrhoea and focal neurology, then a prompt and thorough work-