Paralisis facial o parálisis de bell

Clinical Evidence Handbook
A Publication of BMJ Publishing Group

Bell Palsy
JULIAN HOLLAND, University Hospitals Bristol (NHS) Trust, Bristol, United Kingdom JONATHAN BERNSTEIN, Manchester Royal Infirmary, Manchester, United Kingdom
This is one in a series of chapters excerpted from the Clinical Evidence Handbook, published by the BMJ Publishing Group, London, U.K. The medicalinformation contained herein is the most accurate available at the date of publication. More updated and comprehensive information on this topic may be available in future print editions of the Clinical Evidence Handbook, as well as online at http:// www.clinicalevidence. bmj.com (subscription required). Those who receive a complimentary print copy of the Clinical Evidence Handbook from United HealthFoundation can gain complimentary online access by registering on the Web site using the ISBN number of their book.

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Bell palsy is an idiopathic, unilateral,acute paresis or paralysis of facial movement caused by dysfunction of the lower motor neuron. Up to 30 percent of persons with acute peripheral facial palsy have an alternative cause diagnosed at presentation or during the course of their facial palsy. Alternative causes are higher in children (more than 50 percent), warranting specialist evaluation at presentation. Severe pain, vesicles (earor oral), and hearing loss or imbalance suggest Ramsay Hunt syndrome caused by herpes zoster virus infection, which requires specialist management. • Most persons with paresis (partial weakness) make a spontaneous recovery within three weeks. Up to 30 percent of persons, typically those with paralysis (complete palsy), have a delayed or incomplete recovery. Corticosteroids alone improve therate of recovery, increase the proportion of persons who make a full recovery, and reduce cosmetically disabling sequelae, motor synkinesis, and autonomic dysfunction compared with placebo or no treatment. Antiviral treatment alone is no more effective than placebo and is less effective than corticosteroid treatment at improving recovery of facial motor function and at reducing the risk ofdisabling sequelae. For persons with paresis at presentation (approximately 70 percent), there is no evidence of a clinically important effect of adding antivirals to corticosteroid therapy. • For persons who develop paralysis (approximately 30 percent), and who may demonstrate a trend toward complete degeneration on electrophysiologic testing, it is unknown whether adding antiviral treatment tocorticosteroid therapy has a significant additive or synergistic effect.

Hyperbaric oxygen therapy may improve time to recovery and the proportion of persons who make a full recovery, compared with corticosteroids; however, the evidence for this is weak. We do not know whether facial nerve decompression surgery is beneficial in the treatment of Bell palsy. Facial retraining may improve recoveryof facial motor function scores, including stiffness and lip mobility, and may reduce the risk of motor synkinesis in Bell palsy, but the evidence is too weak to draw conclusions. Definition Bell palsy is an idiopathic, acute, unilateral paresis or paralysis of the face in a pattern consistent with peripheral facial nerve dysfunction. The paralysis may be partial or
Clinical QuestionsWhat are the effects of drug treatments  for Bell palsy in adults and children? Likely to be beneficial Corticosteroids Corticosteroids plus antiviral treatment Unknown Hyperbaric oxygen effectiveness therapy Unlikely to be Antiviral agents alone beneficial What are the effects of surgical  treatments for Bell palsy in adults and  children? Unknown Facial nerve effectiveness decompression surgery...