Peripheral facial paralysis
EBM Guidelines
Nov 21, 2024 • Latest change Oct 30, 2023
Table of contents
Extract
- Peripheral facial paralysis is often idiopathic (known as Bell’s palsy) but it may also be caused by the herpes virus, borreliosis, otitis, trauma or, in rare cases, by a tumour.
- The diagnosis of Bell's palsy is made by excluding other causes.
- An adult with a characteristic Bell's palsy can be examined and treated in primary care. If recovery starts quickly within a few weeks and the patient makes a full recovery, no further investigations are needed.
- If peripheral facial paralysis is prolonged or the clinical picture is atypical, the patient should be referred to an ear, nose and throat (ENT) specialist for investigations and treatment. Paediatric patients should always be referred for emergency consultation of an ENT specialist and/or a paediatrician.
Linked evidence summaries
- Early treatment with prednisolone improves the recovery of facial function in patients with Bell apos;s palsy as compared to antiviral treatments or placebo, but seems not to make any significant longer-term difference in cosmetically disabling sequelae.A
- There is no direct evidence that aciclovir has a beneficial effect on outcomes in Ramsay Hunt syndrome (herpes zoster oticus, HZO, associated with acute facial paralysis), although the use of aciclovir in patients with HZ in other parts of the body suggest that they have a role also in HZO.D
Search terms
Bell Palsy, Blepharoptosis, Cheek, Eyelids, Facial Nerve, Facial Paralysis, Forehead, G51.0, H02.2, Microsurgery, Neurology, Otorhinolaryngology, Paralysis, Paresis, Plastic surgery, Surgery, Surgery, Plastic, angle of the mouth, facial paralysis, central, lagophthalmos, peripheral facial paralysis