History

Fact Explanation
Acute weakness of one side of the face is the commonest presenting complaint[1] muscles of facial expression are supplied by the facial nerve.unilateral, acute paresis or paralysis of the lower motor neuron facial nerve causes the sudden onset weakness. [3]
Eye problems[[1] Acute paresis or paralysis of orbicularis oculi caused by dysfunction of the lower motor neuron. [5]
Loss of ability to taste.[1] Taste fibers to anterior two thirds of the tongue originate in the nucleus of the tractus solitarius (NTS), these fibers travel with the facial nerve and are given off as the chorda tympani,So facial nerve paralysis results in impaired /loss of taste over anterior part of the tongue.[3],[4]
Increased sensitivity to sound.[1] The nerve to stapedius arises from the facial nerve to supply the stapedius muscle. Stapedius muscle contract in response to loud sound which impairs the conduction/ reduces the intensity of Sound paralysis of stapedius causes hypersensitivity to common everyday sounds, perceived as unbearable, strong or painful [hyperacusis]. [5]
Numbness in the affected side of your face.[4][1] Unilateral, acute paresis or paralysis of facial movement caused by dysfunction of the lower motor neuron. [3]
Drooling[4] Acute paresis or paralysis of facial movement caused by dysfunction of the lower motor neuron. [3]
References
  1. BAUGH RF, BASURA GJ et al.Clinical practice guideline: Bell's palsy.Otolaryngology- Head and Neck Surgery[online] . pubmed .2013 Nov;149(3 Suppl):S1-27.[Viewed on 10 May 2014] Available from: doi: 10.1177/0194599813505967.
  2. JEFFREY D. TIEMSTRA, NANDINI KHATKHATE . Bell's Palsy: Diagnosis and Management[online] Am Fam Physician. 2007 Oct 1;76(7):997-1002 [Viewed on 05 th May 2014] Available From:http://www.aafp.org/afp/2007/1001/p997.html
  3. JULIAN HOLLAND. JONATHAN BERNSTEIN.Bell Palsy:Clinical Evidence Handbook [online]Am Fam Physician. 2011 Oct 15;84(8):947-948.[Viewed on 05 th May 2014] Available From:http://www.aafp.org/afp/2011/1015/p947.html
  4. Murthy J .M K ,AMRIT B SUXENA ,Bell's palsy: Treatment guidelines .Annals of indian Academy of neurology[online] Medknow . July 2011.14(suppl1) S70-S72[Viewed on 10 th May 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3152161/
  5. Raquel Ysabel Guzmán LirianoI ,Sandra Lira Bastos de MagalhãesI , et al .Relation of hyperacusis and peripheral facial paralysis - Bell's palsy.Revista Brasileira de Otorrinolaringologia[online] Nov./Dec. 2004: vol.70 no.6 :.[Viewed on 10 May 2014] Available from:http://www.scielo.br/scielo.php?pid=S0034-72992004000600012&script=sci_arttext&tlng=en

Examination

Fact Explanation
Muscle function examination Extra temporal segment of facial nerve temporal, zygomatic, buccal, mandibular marginal and cervical supply the muscles of facial expressions. In bell s palsy patient will present with inability to furrow the forehead, drooping of the mouth, loss of nasolabial fold of the affected side[1]
Ocular examination: Inability of tight closure of the eye and on attempted closure, the eye rolls upward (Bell's phenomenon)[1] The eyelids will not close and the lower lid sags[1] Orbicularis oculli is supplyes by zygomatic branch of facial nerve[2] [3]
Otoscopy examination: Thick fluid in the middle ear, perforation of tymphanic membrane[4] chronic otitis media causes secondary facial nerve palsy[1]Otoscopy is mandatory in all patients presenting with facial paralysis[4]
Oral examination: taste fibres of anterior part of the tongue is carried via facial nerve.In bell' s palsy ,oral examination will reveal impaired taste over anterior part of the tounge9 usulayy complaints of metallic taste[5]
Neurological examination: Mainly cranial nerves The first step in the diagnosis is to determine whether facial weakness is upper motor neurone type or lower motor neurone type .LMN type involves all the facial muscles ipsilateral to the side of facial nerve involvement where as in UMN lesion involves lower facial muscles contralateral side.[4]In bell s palsy there should be an isolated facial nerve palsy. there for complete neurological examination is necesary. Stroke is a secondary cause for facial nerve palsy[1]
Systemic examination: Elevated blood pressure[4] Hypertension is a rare but well recognised cause of facial paralysis[6][3][7]
References
  1. JEFFREY D. TIEMSTRA, NANDINI KHATKHATE . Bell's Palsy: Diagnosis and Management[online] Am Fam Physician. 2007 Oct 1;76(7):997-1002 [Viewed on 05 th May 2014] Available From:http://www.aafp.org/afp/2007/1001/p997.html
  2. MITSUKAWA N, MORIYAMA H et al .Study on distribution of terminal branches of the facial nerve in mimetic muscles (orbicularis oculi muscle and orbicularis oris muscle).Annals of plastic sugery[online]. PubMed .2014 Jan.72(1).71-4.[Viewed 09 May 2014]Availble from: doi: 10.1097/SAP.0b013e318284eca0.
  3. M RIORDEN. Investigation and treatment of facial paralysis. Archives of disease in childhood [online] . PubMed .April 84(4). 286–288. [ viewed on 08 May 2014] Available from: doi: 10.1136/adc.84.4.2862001. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1718736/pdf/v084p00286.pdf
  4. Murthy J .M K ,AMRIT B SUXENA ,Bell's palsy: Treatment guidelines .Annals of indian Academy of neurology[online] Medknow . July 2011.14(suppl1) S70-S72[Viewed on 10 th May 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3152161/
  5. MCFARLIN A, PECKLER B. An unusual presentation of Bell's palsy: A case report and review of literature J Emerg Trauma Shock [online] 2008, 1(1):50-52 [viewed 12 May 2014] Available from: doi:10.4103/0974-2700.40574
  6. Facial paralysis in hypertension. Br Med J [online] 1966 Dec 24, 2(5529):1547 [viewed 12 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1944951
  7. LLOYD AV, JEWITT DE, STILL JD. Facial paralysis in children with hypertension. Arch Dis Child [online] 1966 Jun, 41(217):292-294 [viewed 12 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2019561

Differential Diagnoses

Fact Explanation
Upper motor neurone type facial nerve palsy-stroke or tumour in motor cortex or internal capsule. in UMN type facial nerve palsy, lower part of the face in the contra-lateral side is affected whereas in LMN type bells palsy ipsilateral full half of the face is affected[7][8]
Lower motor neurone type facial nerve palsy: Stroke or tumor in pons both 6 th and 7th cranial nerves arises from the brain stem (pons). In pontine lesion there is associated ipsilateral abducent nerve palsy with contralateral hemiplegia. however isolated facial nerve palsy is also but rare presentation of pontine lesions[8][9][10]
Lower motor neurone type facial nerve palsy: CP angle tumour both 7th and 8th cranial nerves emerge at cerebro-pontine angle. where as nucleas of 5th nere has long course through pontine region.So in CP angle tumours there will be associated 5th and 8th nerve palsy.[8][11][12]
Lower motor neurone type facial nerve palsy: internal Acoustic meatus: carcinoma after emerging from brain stem, 7th nerve enters through the internal auditory canal accompanied with 8th nerve[8] So there will be associalted 8th nerve palsy[13]
Inner ear: Otitis media[1] Facial nerve paralysis is an uncommon but significant complication of chronic otitis media (COM).COM ]cholesteatoma also causses facial paralysis [3] Gradual onset; ear pain, fever, and conductive hearing loss are distinguishing features[1]
Inner ear:Ramsay Hunt syndrome[1] Ramsay Hunt syndrome is a cause for LMN type facial palsy accompanied by an erythematous vesicular rash on the ear (zoster oticus) or in the mouth.[4]Pronounced prodrome of pain; vesicular eruption in ear canal or pharynx are distinguishing features from bells palsy[1]
Lower motor neurone type facial nerve palsy: Parotid tumours , Parotid surgrey when the facial nerve emerge from stylomastoid foramen, it runs through the parotid gland .from here onward it has complete motor supply . Isolated facial nerve palsy will present without hyperacusis ,impaired taste .[8][14][15]
Lyme disease[1] late disseminated Lyme disease causes encephalitis ,peripheral neuropathology causing facial nerve palsy.[2]History of tick exposure, rash, or arthralgias; exposure to areas where Lyme disease is endemic are distinguishing features [1]
Sarcoidosis[1] Facial nerve palsy is the most frequent neurological presentation of sarcoidosis. It occurs with equal frequency on the right or left side, and equally unilateral or bilateral.[5]
Guillain Barre Syndrome[1] Guillain-Barré syndrome is a post infectious, immune-mediated disease with cranial nerve involvement observed in 45-75% of patients. Bilateral facial nerve palsy is rather uncommon and occurs in 0.3% to 2% of all facial palsies.[6]being bilateral is the distinguishing feature[1]
References
  1. JEFFREY D. TIEMSTRA, NANDINI KHATKHATE. Bell's Palsy: Diagnosis and Management [online]American Family Physician. 2007 Oct 1;76(7):997-1002.[Viewed 06 May 2014]Available from:http://www.aafp.org/afp/2007/1001/p997.html
  2. WILLIAM F. WRIGHT, DAVID J. RIEDEL, ROHIT TALWANI, BRUCE L. GILLIAM. Diagnosis and Management of Lyme Disease[online] Americal Family Physician. 2012 Jun 1. 85(11). 1086-1093.[Viewed 06 May 2014]Available from: http://www.aafp.org/afp/2012/0601/p1086.html
  3. Kim J, Jung GH, Park SY, Lee WS. Facial nerve paralysis due to chronic otitis media: prognosis in restoration of facial function after surgical intervention.Yonsei Med Journal[online].Pubmed 2012 May;53(3). 642-8. doi: 10.3349/ymj.2012.53.3.642.[Viewed 06 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/22477011
  4. Sweeney CJ, Gilden DH. Ramsay Hunt syndrome. Journal of neurology, neurosurgery and psychiatry[online] Pubmed. 2001 Aug;71(2). 149-54.[Viewed 06 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/11459884
  5. James DG. Differential diagnosis of facial nerve palsy. journal of World Association Of Sarcoidosis and Other Granulomatous Diseases[online]. Pubmed. 1997 Sep; 14(2).115-20.[Viewed 06 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/9306501
  6. D'Amore A, Viglianesi A, Cavallaro T, et al. Guillain-barré syndrome associated with acute onset bilateral facial nerve palsies. A case report and literature review. The neuroradiology journal[online]. PubMed . 2012 Dec 20. 25(6). 665-70. [Viewed 06 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/24029178
  7. BHATTI MT, SCHIFFMAN JS, PASS AF, TANG RA. Neuro-ophthalmologic complications and manifestations of upper and lower motor neuron facial paresis. Curr Neurol Neurosci Rep [online] 2010 Nov, 10(6):448-58 [viewed 13 May 2014] Available from: doi:10.1007/s11910-010-0143
  8. KOSINS AM, HURVITZ KA, EVANS GR, WIRTH GA. Facial paralysis for the plastic surgeon Can J Plast Surg [online] 2007, 15(2):77-82 [viewed 13 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2698806
  9. OGAWA K, TOUGOU M, OISHI M, KAMEI S, MIZUTANI T. [Case of pontine infarction causing alternating hemiplegia with ipsilateral abducens nerve palsy and contralateral supranuclear facial nerve palsy]. Rinsho Shinkeigaku [online] 2008 Feb, 48(2):135-8 [viewed 13 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/18326308
  10. ROH JK, KIM BK, CHUNG JM. Combined peripheral facial and abducens nerve palsy caused by caudal tegmental pontine infarction. Eur Neurol [online] 1999, 41(2):99-102 [viewed 13 May 2014] Available from: doi:8011
  11. SON DW, CHOI CH, CHA SH. Epidermoid Tumors in the Cerebellopontine Angle Presenting with Trigeminal Neuralgia J Korean Neurosurg Soc [online] 2010 Apr, 47(4):271-277 [viewed 13 May 2014] Available from: doi:10.3340/jkns.2010.47.4.271
  12. ROLAND JT JR, FISHMAN AJ, GOLFINOS JG, COHEN N, ALEXIADES G, JACKMAN AH. Cranial Nerve Preservation in Surgery for Large Acoustic Neuromas Skull Base [online] 2004 May, 14(2):85-90 [viewed 13 May 2014] Available from: doi:10.1055/s-2004-828699
  13. YILDIZ O, BUYUKTAS D, EKIZ E, SELCUKBIRICIK F, PAPILA I, PAPILA C. Facial Nerve Palsy: An Unusual Presenting Feature of Small Cell Lung Cancer Case Rep Oncol [online] , 4(1):35-38 [viewed 13 May 2014] Available from: doi:10.1159/000324182
  14. WIERZBICKA M, KOPEć T, SZYFTER W, KEREIAKES T, BEM G. The presence of facial nerve weakness on diagnosis of a parotid gland malignant process Eur Arch Otorhinolaryngol [online] 2012 Apr, 269(4):1177-1182 [viewed 13 May 2014] Available from: doi:10.1007/s00405-011-1882-6
  15. WATANABE Y, ISHIKAWA M, SHOJAKU H, MIZUKOSHI K. Facial nerve palsy as a complication of parotid gland surgery and its prevention. Acta Otolaryngol Suppl [online] 1993:137-9 [viewed 13 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/8385873

Investigations - for Diagnosis

Fact Explanation
Full Blood Count[2] Facial paralysis is a recognised feature of leukaemic recurrence in both adults and children. A small number of cases of facial paralysis in children occur as a presentation of leukaemia.[2]
Thyroid function test bells palsy has been reported in association with hypothyroidism[5]
Lyme antibody titers [1] if the patient's history suggests possible exposure. [1]
Serum titers of herpes simplex virus[1] Herpes simplex and varicella zoster viruses have been implicated in the pathogenesis of idiopathic facial palsy.[2]
VDRL, HIV screening Syphilis and HIV are infective causes for idiopathic facial palsy[6] [7]
Shimmer test due to denervation of lacrimal glands, patients are suffering from dry eyes [6][8] Shimmer test is used for qualitative assessment of tear production.this test is cheap and easy to perform[9]
Salivary flow metry parasympathetic innervation of salivary glands is carried via facial nerve. in bell s palsy there is reduced salivation. bells palsy can be detected by salivary flowmetry early as within 48 hours of onset. Also it has a prognostic value[10][11]
Neurophysiological tests: EMG fibrillation potentials in muscle indicates axonal degeneration which can be detected by EMG. Approximately after 3 months from onsetof bell s palsy, this can be detected. it also has a prognostic value[10][12]
CSF analysis[2] CSF investigations may show pleocytosis, increased or decreased glucose, increased protein, antibodies against viruses or against Borrelia burgdorferi, or virus DNA or RNA. [4][7]
Radiological imaging such as CT, MRI [2][3] If history and examination suggest the possibility of underlying neurological abnormality, radiological imaging is recommended. MRI is really helpful in identifying brain stem pathology, HRCT is better in the evaluation of the intratemporal portion of the nerve.Contrast enhanced MRI can identify sections of affected nerve in idiopathic facial palsy.[2]
References
  1. JEFFREY D. TIEMSTRA, NANDINI KHATKHATE. Bell's Palsy: Diagnosis and Management[online] American Family Physician. 2007 Oct 1. 76(7). 997-1002.[ viewed on 08 May 2014] Available from:http://www.aafp.org/afp/2007/1001/p997.html
  2. M RIORDEN. Investigation and treatment of facial paralysis. Archives of disease in childhood [online] . PubMed .April 84(4). 286–288. [ viewed on 08 May 2014] Available from: doi: 10.1136/adc.84.4.2862001. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1718736/pdf/v084p00286.pdf
  3. MURAI A, KARIA S,et al.The facial nerve canal in patients with Bell's palsy: an investigation by high-resolution computed tomography with multiplanar reconstruction.European Archive for Otorhinolaryngology{online] PubMed.2013 July .270(7).2035-8 [ viewed on 08 May 2014] Available from. doi: 10.1007/s00405-012-2253-7.
  4. JOSEF F. Management of peripheral facial nerve palsy. European Archive of Otorhinolaryngology [online]. PubMed. July 2008.265(7).743-752. [Viewed 08 May 2014] Available from:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440925/
  5. EARLL JM, KOLB FO. Facial paralysis occurring with hypothyoidism. A report of two cases. Calif Med [online] 1967 Jan, 106(1):56-58 [viewed 12 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1502625
  6. ALSUHAIBANI AH. Facial Nerve Palsy: Providing Eye Comfort and Cosmesis Middle East Afr J Ophthalmol [online] 2010, 17(2):142-147 [viewed 12 May 2014] Available from: doi:10.4103/0974-9233.63078
  7. JAIN V, DESHMUKH A, GOLLOMP S. Bilateral Facial Paralysis Case Presentation and Discussion of Differential Diagnosis J Gen Intern Med [online] 2006 Jul, 21(7):C7-C10 [viewed 12 May 2014] Available from: doi:10.1111/j.1525-1497.2006.00466.x
  8. MCFARLIN A, PECKLER B. An unusual presentation of Bell's palsy: A case report and review of literature J Emerg Trauma Shock [online] 2008, 1(1):50-52 [viewed 12 May 2014] Available from: doi:10.4103/0974-2700.40574
  9. SENCHYNA M, WAX MB. Quantitative assessment of tear production: A review of methods and utility in dry eye drug discovery J Ocul Biol Dis Infor [online] 2008 Mar, 1(1):1-6 [viewed 12 May 2014] Available from: doi:10.1007/s12177-008-9006-2
  10. BLOM S, EKSTRAND T. Electromyography (EMG) and sialometry in the prognosis of Bell's palsy. A methodological study of early investigated, untreated patients. Acta Otolaryngol [online] 1981 Mar-Apr, 91(3-4):289-95 [viewed 12 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/7257761
  11. MAY M. Peripheral facial paralysis: diagnosis, prognosis, and treatment. J Natl Med Assoc [online] 1972 Sep, 64(5):424-426 [viewed 12 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2608734
  12. M RIORDEN. Investigation and treatment of facial paralysis. Archives of disease in childhood [online] . PubMed .April 84(4). 286–288. [ viewed on 08 May 2014] Available from: doi 10.1136/adc.84.4.286

Investigations - Fitness for Management

Fact Explanation
fasting blood sugar or HbA1c Diabetes mellitus causes secondary facial nerve palsy, It has been seen in more than 10 percent of patients with Bell's palsy, When the patient present with additional risk factors (e.g., family history, obesity, older than 30 years).fasting glucose or A1C testing should be performed .[1]
References
  1. JEFFREY D. TIEMSTRA, NANDINI KHATKHATE. Bell's Palsy: Diagnosis and Management[online] American Family Physician. 2007 Oct 1. 76(7). 997-1002.[ viewed on 08 May 2014] Available from:http://www.aafp.org/afp/2007/1001/p997.html

Investigations - Followup

Fact Explanation
Neurophysiological studies: electromyography Neurophysiological studies help in evaluation as well predicting the prognosis While several tests exist, the presence of fibrillation potentials in muscles indicates significant axonal degeneration .this test can provide an objective assessment on patient prognosis in long term[1]
References
  1. M RIORDEN. Investigation and treatment of facial paralysis. Archives of disease in childhood [online] . PubMed .April 84(4). 286–288. [ viewed on 08 May 2014] Available from: doi 10.1136/adc.84.4.286

Management - General Measures

Fact Explanation
Patient education education of the patient regarding the condition, cause , treatment and prognosis is essential part in management. Psychological support is mandatory.[4]
Facial physiotherapy physiotherapy including automassage, relaxation exercises, coordination exercises, or emotional expression exercises, are proven to be beneficial in improvement of facial expression. [1][7][8]
Eye care Denervation of lacrimal glands causes lack of lubrication and irritation of eye[1] artificial tear drops during the day and lubricating ophthalmic solution in night is recommended to prevent dry eyes and corneal damage[5][6]
Hyperboric oxygen therapy[3] Hyperboric oxygen treatment may improve the duration of recovery and the proportion of persons who make a full recovery,in comparison with corticosteroids; however, the evidence for this is weak.[3]
Accupunture[2] beneficence of acupuncture in relation to bell s palsy is controversial , But some studies has revealed that increasing evidence for a beneficial effect of acupuncture as an adjunctive treatment of Bell’s palsy[1].[9]
References
  1. JOSEF F. Management of peripheral facial nerve palsy. European Archive of Otorhinolaryngology [online]. PubMed. July 2008.265(7).743-752. [Viewed 08 May 2014] Available from:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440925/
  2. JEFFREY D. TIEMSTRA, NANDINI KHATKHATE. Bell's Palsy: Diagnosis and Management [online]American Family Physician. 2007 Oct 1;76(7):997-1002.[Viewed 06 May 2014]Available from:http://www.aafp.org/afp/2007/1001/p997.html
  3. JULIAN HOLLAND. JONATHAN BERNSTEIN.Bell Palsy:Clinical Evidence Handbook [online]Am Fam Physician. 2011 Oct 15;84(8):947-948.[Viewed on 05 th May 2014] Available From:http://www.aafp.org/afp/2011/1015/p947.html
  4. J. M. K. MURTHI , AMRIT B. SAXENA.Bell's palsy: Treatment guidelines. Annals of Indian academy of neurology[online] . Medknow. July 2011.14(suppl 1). S70-S72.[Viewed on 05 th May 2014] Available From:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3152161/#!po=25.0000
  5. STEW B, WILLIAMS H. Modern management of facial palsy: a review of current literature Br J Gen Pract [online] 2013 Feb, 63(607):109-110 [viewed 12 May 2014] Available from: doi:10.3399/bjgp13X663262
  6. ALSUHAIBANI AH. Facial Nerve Palsy: Providing Eye Comfort and Cosmesis Middle East Afr J Ophthalmol [online] 2010, 17(2):142-147 [viewed 12 May 2014] Available from: doi:10.4103/0974-9233.63078
  7. TEIXEIRA LJ, VALBUZA JS, PRADO GF. Physical therapy for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev [online] 2011 Dec 7:CD006283 [viewed 12 May 2014] Available from: doi:10.1002/14651858.CD006283.pub3
  8. AMINOFF MJ. Bell's palsy and its treatment. Postgrad Med J [online] 1973 Jan, 49(567):46-51 [viewed 12 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2495368
  9. KWON HJ, KIM JI, LEE MS, CHOI JY, KANG S, CHUNG JY, KIM YJ, LEE SH, LEE S, NAM D, KIM YS, LEE JD, CHOI DY. Acupuncture for sequelae of Bell's palsy: a randomized controlled trial protocol Trials [online] :71 [viewed 12 May 2014] Available from: doi:10.1186/1745-6215-12-71

Management - Specific Treatments

Fact Explanation
Oral corticosteroids [1] widely used in the management. Prednisone -starring dose 60mg per day then tapering it over 10 days.[1]but the efficacy on bell s palsy has not been clearly demonstrated despite of wide usage.[2]
Antivirals[1] 7 day course of acyclovir 400 mg , five times per day or7 day course of valacyclovir 1 g ,three times per day[1] the antiviral drugs acy-clovir (Zovirax) and valacyclovir (Valtrex) have been studied to determine if they have any benefit in treatment because of the possible role of HSV-1 in the etiology of Bell's palsy.[1]
Pentoxifyllin [2] There were studies showing that pentoxifylline in combination therapy(particularly with steroids and low molecular dextran) has a beneficial effort on the recovery of bell s palsy[2]
surgical decompression[1] Pathophysiology of bell s palsy explained as acute inflammation and oedema of facial nerve.[1] surgical decompression is proven to have beneficial effect if it is performed within 2 weeks from the onset[3]
Tarsorraphy[4] Denervation of orbicularis oculi causes inability of closure of eyelid which leads to several ocular problems. temporary closure of eyelids(tarsoraphy) is used acute management of bell s palsy [4]
Surgical nerve grafting.[5] Surgical nerve grafting is a treatment option which used rarely in treatment of bell s palsy. Hypoglossalfacial anastomosis is commonly used in nerve grafting[5]
References
  1. JEFFREY D. TIEMSTRA, NANDINI KHATKHATE. Bell's Palsy: Diagnosis and Management [online]American Family Physician. 2007 Oct 1;76(7):997-1002.[Viewed 06 May 2014]Available from:http://www.aafp.org/afp/2007/1001/p997.html
  2. JOSEF F. Management of peripheral facial nerve palsy. European Archive of Otorhinolaryngology [online]. PubMed. July 2008.265(7).743-752. [Viewed 08 May 2014] Available from:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440925/
  3. GANTZ BJ, RUBINSTEIN JT, GIDLEY P, WOODWORTH GG. Surgical management of Bell's palsy. Laryngoscope [online] 1999 Aug, 109(8):1177-88 [viewed 11 May 2014] Available from: doi:10.1097/00005537-199908000-00001
  4. RAPOZA PA, HARRISON DA, BUSSA JJ, PRESTOWITZ WF, DORTZBACH RK. Temporary sutured tube-tarsorrhaphy: reversible eyelid closure technique. Ophthalmic Surg [online] 1993 May, 24(5):328-30 [viewed 11 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/8515949
  5. SOCOLOVSKY M, PáEZ MD, MASI GD, MOLINA G, FERNáNDEZ E. Bell's palsy and partial hypoglossal to facial nerve transfer: Case presentation and literature review Surg Neurol Int [online] :46 [viewed 11 May 2014] Available from: doi:10.4103/2152-7806.95391