Bells palsy treatment

This long-awaited Bells palsy treatment trial chosen as our neurology article of the month last December concluded that in patients with Bell's palsy, early treatment with prednisolone significantly improves the chances of complete recovery at 3 and 9 months. There is no evidence of a benefit of acyclovir given alone or an additional benefit of acyclovir in combination with prednisolone. For full abstract click here.

EarlyTreatmentwith Prednisolone or Acyclovir in Bell's Palsy

FrankM. Sullivan,Ph.D., Iain R.C. Swan, M.D., Peter T. Donnan, Ph.D.,JillianM. Morrison, Ph.D., Blair H. Smith, M.D., Brian McKinstry,M.D., RichardJ. Davenport, D.M., Luke D. Vale, Ph.D., Janet E.Clarkson, Ph.D.,Victoria Hammersley, B.Sc., Sima Hayavi, Ph.D., AnneMcAteer, M.Sc., KenStewart, M.D., and Fergus Daly, Ph.D.

Latest Bell's palsy treatment research publications (daily updates)

Bell's palsy treatment article access

Prednisolone or acyclovir in Bell's palsy.

Prednisolone or acyclovir in Bell's palsy.

N Engl J Med. 2008 Jan 17;358(3):306; author reply 307

Authors: Leiner S

PMID:- Bells palsy treatment 18203331 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Prednisolone or acyclovir in Bell's palsy.

Prednisolone or acyclovir in Bell's palsy.

N Engl J Med. 2008 Jan 17;358(3):306-7; author reply 307

Authors: Korf ES, Killestein J

PMID:- Bells palsy treatment 18203330 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Prednisolone or acyclovir in Bell's palsy.

Prednisolone or acyclovir in Bell's palsy.

N Engl J Med. 2008 Jan 17;358(3):306; author reply 307

Authors: Beutner D

PMID:- Bells palsy treatment 18199872 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Visual diagnosis: a 5-year-old child who has facial palsy and rash.

Visual diagnosis: a 5-year-old child who has facial palsy and rash.

Pediatr Rev. 2007 Dec;28(12):465-9

Authors: Arnold DH, Spiro DM

PMID:- Bells palsy treatment 18055646 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Bell's palsy and pregnancy.

Bell's palsy and pregnancy.

Otolaryngol Head Neck Surg. 2007 Dec;137(6):858-61

Authors: Vrabec JT, Isaacson B, Van Hook JW

OBJECTIVE: To describe the epidemiology, pathophysiology, presentation, treatment, and prognosis of Bell's palsy (BP) in pregnancy. RESULTS: The incidence of BP in pregnant women is not significantly greater than expected compared to all women of childbearing age. There is a high incidence of cases in the third trimester and corresponding low incidence during early pregnancy. CONCLUSION: There is no conclusive evidence that the etiology of BP in pregnancy is different than in nonpregnant patients. Altered susceptibility to herpes simplex viral reactivation during pregnancy is the most likely explanation for concentration of cases in the third trimester. Outcome may be poorer in pregnant patients, though historically, treatment is often withheld from these patients. SIGNIFICANCE: Management of BP in pregnancy can mirror that of nonpregnant individuals with the exception of first-trimester cases.

PMID:- Bells palsy treatment 18036410 [PubMed - indexed for MEDLINE Bells palsy treatment ]

[Effects of administration of high dose steroids for complete idiopathic facial nerve palsy: propriety of a second course of steroid therapy]

[Effects of administration of high dose steroids for complete idiopathic facial nerve palsy: propriety of a second course of steroid therapy]

Nippon Jibiinkoka Gakkai Kaiho. 2007 Oct;110(10):665-71

Authors: Ohno T, Takegoshi H, Kikuchi S

OBJECTIVE: The purpose of this study was to investigate the existence of any relationship between the initial or total prednisolone dose and the degree of facial nerve recovery in patients with complete idiopathic facial nerve palsy (Bell's palsy). MATERIALS AND METHODS: This study was carried out on 102 patients with unilateral complete Bell's palsy of no more than 14 days duration. The patients were divided into four study groups: one receiving a single tapering course of steroids after an initial hydrocortisone (HC) dose of 600 mg, one receiving a second tapering course of steroids after an initial HC dose of 600 mg, one receiving a single tapering course of steroids after an initial HC dose of 1200 mg, and one receiving a second tapering course of steroids after an initial HC dose of 1200 mg. The following variables were analyzed among the groups: the cure rate, the average time needed to achieve maximum recovery, and the rate of side effects. RESULTS: The total cure rate of the patients was 77%. No significant differences were detected among the groups in terms of the cure rate, average time to achieve maximum recovery, or the side effects rate (P > 0.05). CONCLUSION: High-dose steroid therapy was considered to be somewhat effective in curing complete Bell's palsy. However, there were no correlations between the initial or total steroid dose and the prognosis if a prednisolone equivalent dose of more than 150 mg initially, or a total dose of more than 880 mg was used. These findings show no significant benefits of treating complete Bell's palsy with a second course of steroids.

PMID:- Bells palsy treatment 18018594 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Inflammatory pseudotumor of the middle ear masquerading as Bell's palsy.

Inflammatory pseudotumor of the middle ear masquerading as Bell's palsy.

Am J Otolaryngol. 2007 Nov-Dec;28(6):423-6

Authors: Lee RG, Weber DE, Ness AB, Wasman JK, Megerian CA

We describe the case of a 28-year-old woman who presented with an acute dense left facial paralysis. Magnetic resonance imaging demonstrated enhancement of the labyrinthine portion of the facial nerve, and Bell's palsy was the presumed initial diagnosis. After 2 months without recovery despite receiving steroid and antiviral therapy, the patient underwent further workup. Computed tomographic scan demonstrated a mass lesion adjacent to the tympanic portion of the facial nerve, and electromyography showed active denervation and prominent fibrillation potentials. Surgical excision of the tumor was performed with decompression and sparing of the facial nerve. Histologically, the tumor proved to be an inflammatory pseudotumor (IPT). At the 3-year follow-up, the patient had an improvement in her facial nerve function, progressing to a House-Brackman grade III. An IPT can masquerade as Bell's palsy with sudden complete facial paralysis. Failure to obtain even slight recovery in Bell's palsy should prompt further workup, including appropriate imaging, to assess for a mass lesion. Confusion of an IPT with a nerve-based tumor on frozen section and imaging could lead to inappropriate resection and cable grafting of the facial nerve. Therefore, the relationship between an IPT and facial nerve paralysis is vital and must be recognized for treatment and to maximize postoperative facial nerve function.

PMID:- Bells palsy treatment 17980777 [PubMed - indexed for MEDLINE Bells palsy treatment ]

A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction.

A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction.

Mayo Clin Proc. 2007 Nov;82(11):1341-9

Authors: Yawn BP, Saddier P, Wollan PC, St Sauver JL, Kurland MJ, Sy LS

OBJECTIVE: To establish accurate, up-to-date, baseline epidemiological data for herpes zoster (HZ) before the introduction of the recently licensed HZ vaccine. METHODS: Using data from January 1, 1996, to October 15, 2005, we conducted a population-based study of adult residents (Greater than or equal to 22 years) of Olmsted County, MN, to determine (by medical record review) the incidence of HZ and the rate of HZ-related complications. Incidence rates were determined by age and sex and adjusted to the US population. RESULTS: A total of 1669 adult residents with a confirmed diagnosis of HZ were identified between January 1, 1996, and December 31, 2001. Most (92%) of these patients were immunocompetent and 60% were women. When adjusted to the US adult population, the incidence of HZ was 3.6 per 1000 person-years (95% confidence interval, 3.4-3.7), with a temporal increase from 3.2 to 4.1 per 1000 person-years from 1996 to 2001. The incidence of HZ and the rate of HZ-associated complications increased with age, with 68% of cases occurring in those aged 50 years and older. Postherpetic neuralgia occurred in 18% of adult patients with HZ and in 33% of those aged 79 years and older. Overall, 10% of all patients with HZ experienced 1 or more nonpain complications. CONCLUSIONS: Our population-based data suggest that HZ primarily affects immunocompetent adults older than 50 years; 1 in 4 experiences some type of HZ-related complication.

PMID:- Bells palsy treatment 17976353 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Information from your family doctor. Bell's palsy.

Information from your family doctor. Bell's palsy.

Am Fam Physician. 2007 Oct 1;76(7):1004

Authors:

PMID:- Bells palsy treatment 17956070 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Bell's palsy: diagnosis and management.

Bell's palsy: diagnosis and management.

Am Fam Physician. 2007 Oct 1;76(7):997-1002

Authors: Tiemstra JD, Khatkhate N

Bell's palsy is a peripheral palsy of the facial nerve that results in muscle weakness on one side of the face. Affected patients develop unilateral facial paralysis over one to three days with forehead involvement and no other neurologic abnormalities. Symptoms typically peak in the first week and then gradually resolve over three weeks to three months. Bell's palsy is more common in patients with diabetes, and although it can affect persons of any age, incidence peaks in the 40s. Bell's palsy has been traditionally defined as idiopathic; however, one possible etiology is infection with herpes simplex virus type 1. Laboratory evaluation, when indicated by history or risk factors, may include testing for diabetes mellitus and Lyme disease. A common short-term complication of Bell's palsy is incomplete eyelid closure with resultant dry eye. A less common long-term complication is permanent facial weakness with muscle contractures. 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.

PMID:- Bells palsy treatment 17956069 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Acupuncture for Bell's palsy.

Acupuncture for Bell's palsy.

Cochrane Database Syst Rev. 2007;(4):CD002914

Authors: He L, Zhou MK, Zhou D, Wu B, Li N, Kong SY, Zhang DP, Li QF, Yang J, Zhang X

BACKGROUND: Bell's palsy or idiopathic facial palsy is an acute facial paralysis due to inflammation of the facial nerve. A number of studies published in China have suggested acupuncture is beneficial for facial palsy. OBJECTIVES: The objective of this review was to examine the efficacy of acupuncture in hastening recovery and reducing long-term morbidity from Bell's palsy. SEARCH STRATEGY: We searched the Cochrane Neuromuscular Disease Group Trials Register, MEDLINE (January 1966 to April 2006), EMBASE (January 1980 to April 2006), LILACS (from January 1982 to April 2006) and the Chinese Biomedical Retrieval System (January 1978 to April 2006) for randomised controlled trials using 'Bell's palsy' and its synonyms, 'idiopathic facial paralysis' or 'facial palsy' as well as search terms including 'acupuncture'. Chinese journals in which we thought we might find randomised controlled trials or controlled clinical trials relevant to our study were handsearched. We reviewed the bibliographies of the randomised trials and contacted the authors and known experts in the field to identify additional published or unpublished data. SELECTION CRITERIA: We included all randomised or quasi-randomised controlled trials involving acupuncture in the treatment of Bell's palsy irrespective of any language restrictions. DATA COLLECTION AND ANALYSIS: Two review authors identified potential articles from the literature search and extracted data independently using a data extraction form. The assessment of methodological quality included allocation concealment, patient blinding, differences at baseline of the experimental groups and completeness of follow-up. Two review authors assessed quality independently. All disagreements were resolved by discussion between the review authors. MAIN RESULTS: Six studies including a total of 537 participants met the inclusion criteria. Five of them used acupuncture while another one used acupuncture combined with drugs. No trials reported on the outcomes specified for this review.Harmful side effects were not reported in any of the trials. Flaws in study design or reporting (particularly uncertain allocation concealment and substantial loss to follow-up) and clinical differences between trials prevented conclusions about the efficacy of acupuncture. AUTHORS' CONCLUSIONS: The quality of the included trials was inadequate to allow any conclusion about the efficacy of acupuncture. More research with high quality trials is needed.

PMID:- Bells palsy treatment 17943775 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Bell's palsy--is glucocorticoid treatment enough?

Bell's palsy--is glucocorticoid treatment enough?

N Engl J Med. 2007 Oct 18;357(16):1653-5

Authors: Gilden DH, Tyler KL

PMID:- Bells palsy treatment 17942879 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Early treatment with prednisolone or acyclovir in Bell's palsy.

Early treatment with prednisolone or acyclovir in Bell's palsy.

N Engl J Med. 2007 Oct 18;357(16):1598-607

Authors: Sullivan FM, Swan IR, Donnan PT, Morrison JM, Smith BH, McKinstry B, Davenport RJ, Vale LD, Clarkson JE, Hammersley V, Hayavi S, McAteer A, Stewart K, Daly F

BACKGROUND: Corticosteroids and antiviral agents are widely used to treat the early stages of idiopathic facial paralysis (i.e., Bell's palsy), but their effectiveness is uncertain. METHODS: We conducted a double-blind, placebo-controlled, randomized, factorial trial involving patients with Bell's palsy who were recruited within 72 hours after the onset of symptoms. Patients were randomly assigned to receive 10 days of treatment with prednisolone, acyclovir, both agents, or placebo. The primary outcome was recovery of facial function, as rated on the House-Brackmann scale. Secondary outcomes included quality of life, appearance, and pain. RESULTS: Final outcomes were assessed for 496 of 551 patients who underwent randomization. At 3 months, the proportions of patients who had recovered facial function were 83.0% in the prednisolone group as compared with 63.6% among patients who did not receive prednisolone (P<0.001) and 71.2% in the acyclovir group as compared with 75.7% among patients who did not receive acyclovir (adjusted P=0.50). After 9 months, these proportions were 94.4% for prednisolone and 81.6% for no prednisolone (P<0.001) and 85.4% for acyclovir and 90.8% for no acyclovir (adjusted P=0.10). For patients treated with both drugs, the proportions were 79.7% at 3 months (P<0.001) and 92.7% at 9 months (P<0.001). There were no clinically significant differences between the treatment groups in secondary outcomes. There were no serious adverse events in any group. CONCLUSIONS: In patients with Bell's palsy, early treatment with prednisolone significantly improves the chances of complete recovery at 3 and 9 months. There is no evidence of a benefit of acyclovir given alone or an additional benefit of acyclovir in combination with prednisolone. (Current Controlled Trials number, ISRCTN71548196 [controlled-trials.com].).

PMID:- Bells palsy treatment 17942873 [PubMed - indexed for MEDLINE Bells palsy treatment ]

[A clinical study of Bell's palsy and factors influencing its prognosis]

[A clinical study of Bell's palsy and factors influencing its prognosis]

Nippon Jibiinkoka Gakkai Kaiho. 2007 Aug;110(8):592-8

Authors: Oishi N, Shinden S, Yamashita T, Minami S, Ogura M

We encountered 185 patients with Bell's palsy at our hospital between January 2003 and December 2005. Of these patients, 60% visited our department within 3 days of the onset, and 90% within 7 days of the onset; the interval from onset to hospital visit showed no relation with the severity of the paralysis. Complete recovery was obtained in 85.0% of the patients with steroid or steroid + antiviral treatment. Preservation of the stapedius reflex was a statistically significant predictor of good prognosis, with a high positive predictive value (95.5%). Several factors influencing the prognosis were examined with a Cox's proportional hazards model. The factors considered were the sex of the patients, left / right localization, age, postauricular pain, eye symptoms, taste disorder, underlying diabetes, the Yanagihara facial grading system score, and use of antiviral drugs. The analysis revealed only the Yanagihara score and antiviral drug use as statistically important, with hazard ratios of 1.101 and 1.586, respectively. Although this study had several limitations, steroid + antiviral treatment could yield a better prognosis as compared to steroid treatment alone.

PMID:- Bells palsy treatment 17874541 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Lip-support prosthesis--a unique approach in management of bilateral facial palsy.

Lip-support prosthesis--a unique approach in management of bilateral facial palsy.

Quintessence Int. 2007 Sep;38(8):e517-20

Authors: Sajjan MC, Krishna RG

Facial palsy is a relatively uncommon condition with a variety of proposed etiologic factors. Commonly it affects the nerve unilaterally; bilateral involvement is very rare, accounting for less than 1% of cases. This article presents a case of bilateral idiopathic Bell palsy in a patient who had a hanging lower lip. A prosthetic appliance anchored to the teeth was fabricated to maintain the lip in its normal position, thereby helping the patient to perform normal functions.

PMID:- Bells palsy treatment 17823677 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Prognosis for Bell's palsy: a comparison of diabetic and nondiabetic patients.

Prognosis for Bell's palsy: a comparison of diabetic and nondiabetic patients.

Acta Otolaryngol. 2007 Aug;127(8):888-91

Authors: Kanazawa A, Haginomori S, Takamaki A, Nonaka R, Araki M, Takenaka H

CONCLUSION: The present study indicates that recovery from Bell's palsy in a diabetic group (DG) is delayed, and the facial movement score remains low in comparison with a nondiabetic group (NDG). More aggressive treatments, such as higher-dose corticosteroid administration and/or facial nerve decompression surgery, might be considered in diabetic patients with severe Bell's palsy. OBJECTIVES: The purpose of this study was to reveal prognostic differences for Bell's palsy in the DG and NDG. PATIENTS AND METHODS: The grades of facial palsy in 19 diabetic and 57 nondiabetic patients with Bell's palsy were assessed using the House-Brackmann grading system (HB system). Recovery was defined as grade I. The average of HB system grades and recovery rates were compared in the DG and NDG at the start of the treatment, and 1 month, 3 months, and 6 months after onset. RESULTS: There were no differences in the HB system between the DG and NDG at the start of treatment and at 1 month after onset. However, facial movement in the DG was poorer than that in the NDG at 3 months and 6 months after onset. In terms of the recovery rate, the rate in the DG (52.6%) was much lower than that in the NDG (82.5%) at 6 months after onset.

PMID:- Bells palsy treatment 17763003 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Infectious causes of bilateral facial nerve palsy.

Infectious causes of bilateral facial nerve palsy.

J Otolaryngol. 2007 Jun;36(3):E42-4

Authors: Balatsouras DG, Kaberos A, Korres S, Leontiadis A, Kandiloros D

PMID:- Bells palsy treatment 17711763 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Bilateral cerebellopontine angle metastatic melanoma: a case report.

Bilateral cerebellopontine angle metastatic melanoma: a case report.

Ear Nose Throat J. 2007 Jul;86(7):388-90

Authors: Jacob A, Brightman RP, Welling DB

Although melanoma accounts for approximately 1% of all malignancies, melanoma metastases to the cerebellopontine angles (CPAs) are exceedingly rare. Here we describe a patient with melanoma metastases to the internal auditory canals and CPAs who presented with a remote history of cutaneous melanoma. This patient had a rapidly progressive hearing loss, vestibulopathy, and facial nerve dysfunction. Magnetic resonance imaging demonstrated bilateral, enhancing CPA lesions but was otherwise nonspecific. The diagnosis required a careful history, unilateral surgical resection for tissue acquisition, and histopathologic confirmation. A search for primary cutaneous melanoma at the time of presentation was negative. However, the history of cutaneous melanoma 8 years earlier distinguishes this patient's metastatic disease from solitary primary intracranial melanoma, an equally rare disease. Treatment consists of surgical excision, radiation, chemotherapy, and immunotherapy. The prognosis for patients with melanoma metastases is generally poor, but isolated reports of long-term survival have been described. Metastatic disease to the CPAs must be included in the differential diagnosis for any patient presenting with rapid-onset VIIth or VIIIth cranial nerve symptoms.

PMID:- Bells palsy treatment 17702316 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Bell's Palsy following acupuncture treatment--a case report.

Bell's Palsy following acupuncture treatment--a case report.

Acupunct Med. 2007 Jun;25(1-2):47-8

Authors: Rosted P, Woolley DR

A case of Bell's palsy after acupuncture is presented. It concerns a healthy 47 year old man who developed Bell's palsy less than 24 hours after local acupuncture treatment for temporomandibular dysfunction. The Bell's palsy recovered within two weeks, and may have been caused by a haematoma around the facial nerve.

PMID:- Bells palsy treatment 17641568 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Effect of facial neuromuscular re-education on facial symmetry in patients with Bell's palsy: a randomized controlled trial.

Effect of facial neuromuscular re-education on facial symmetry in patients with Bell's palsy: a randomized controlled trial.

Clin Rehabil. 2007 Apr;21(4):338-43

Authors: Manikandan N

OBJECTIVE: To determine the effect of facial neuromuscular re-education over conventional therapeutic measures in improving facial symmetry in patients with Bell's palsy. DESIGN: Randomized controlled trial. SETTING: Neurorehabilitation unit. SUBJECTS: Fifty-nine patients diagnosed with Bell's palsy were included in the study after they met the inclusion criteria. Patients were randomly divided into two groups: control (n = 30) and experimental (n = 29). INTERVENTIONS: Control group patients received conventional therapeutic measures while the facial neuromuscular re-education group patients received techniques that were tailored to each patient in three sessions per day for six days per week for a period of two weeks. MAIN MEASURES: All the patients were evaluated using a Facial Grading Scale before treatment and after three months. RESULTS: The Facial Grading Scale scores showed significant improvement in both control (mean 32 (range 9.7-54) to 54.5 (42.2-71.7)) and the experimental (33 (18-43.5) to 66 (54-76.7)) group. Facial Grading Scale change scores showed that experimental group (27.5 (20-43.77)) improved significantly more than the control group (16.5 (12.2-24.7)). Analysis of Facial Grading Scale subcomponents did not show statistical significance, except in the movement score (12 (8-16) to 24 (12-18)). CONCLUSION: Individualized facial neuromuscular re-education is more effective in improving facial symmetry in patients with Bell's palsy than conventional therapeutic measures.

PMID:- Bells palsy treatment 17613574 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Case 14: a woman with bilateral Bell's palsy.

Case 14: a woman with bilateral Bell's palsy.

MedGenMed. 2006;8(4):23

Authors: Rafii MS

PMID:- Bells palsy treatment 17415306 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Valacyclovir and prednisolone treatment for Bell's palsy: a multicenter, randomized, placebo-controlled study.

Valacyclovir and prednisolone treatment for Bell's palsy: a multicenter, randomized, placebo-controlled study.

Otol Neurotol. 2007 Apr;28(3):408-13

Authors: Hato N, Yamada H, Kohno H, Matsumoto S, Honda N, Gyo K, Fukuda S, Furuta Y, Ohtani F, Aizawa H, Aoyagi M, Inamura H, Nakashima T, Nakata S, Murakami S, Kiguchi J, Yamano K, Takeda T, Hamada M, Yamakawa K

OBJECTIVE: To investigate the effects of valacyclovir and prednisolone in comparison with those of placebo and prednisolone for the treatment of Bell's palsy, excluding zoster sine herpete. STUDY DESIGN: Prospective, multicenter, randomized placebo-controlled study. SETTING: Six academic tertiary referral centers. PATIENTS: Ultimately, 221 patients with Bell's palsy who were treated within 7 days of the onset. Serological and polymerase chain reaction examinations were performed to distinguish Bell's palsy from zoster sine herpete. INTERVENTION: The patients were treated with either valacyclovir (dosage, 1,000 mg/d for 5 days) plus prednisolone (VP [n = 114]) or placebo plus prednisolone (PP [n = 107]) administered orally. MAIN OUTCOME MEASURE: Recovery from the palsy was defined as a score higher than 36 using Yanagihara 40-point scoring system without facial contracture or synkinesis. The patients were followed up until complete recovery occurred or for more than 6 months in cases with a poor prognosis. RESULTS: The overall rate of patient recovery among those treated with VP (96.5%) was significantly better (p < 0.05) than the rate among those treated with PP (89.7%). The rate of patient recovery was also analyzed by classifying the initial severity of facial palsy. In cases of complete or severe palsy, the rates of patients treated with VP and PP who recovered were 95.7% (n = 92) and 86.6% (n = 82), respectively; the recovery rate for treatment with VP was significantly better than that with PP (p < 0.05). CONCLUSION: The valacyclovir and prednisolone therapy was more effective in treating Bell's palsy, excluding zoster sine herpete, than the conventional prednisolone therapy. To our knowledge, this is the first controlled study of an antiviral agent in the treatment of a sufficient number of Bell's palsy cases based on an etiologic background.

PMID:- Bells palsy treatment 17414047 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Recruitment and retention in a multicentre randomised controlled trial in Bell's palsy: a case study.

Recruitment and retention in a multicentre randomised controlled trial in Bell's palsy: a case study.

BMC Med Res Methodol. 2007;7:15

Authors: McKinstry B, Hammersley V, Daly F, Sullivan F

BACKGROUND: It is notoriously difficult to recruit patients to randomised controlled trials in primary care. This is particularly true when the disease process under investigation occurs relatively infrequently and must be investigated during a brief time window. Bell's palsy, an acute unilateral paralysis of the facial nerve is just such a relatively rare condition. In this case study we describe the organisational issues presented in setting up a large randomised controlled trial of the management of Bell's palsy across primary and secondary care in Scotland and how we managed to successfully recruit and retain patients presenting in the community. METHODS: Where possible we used existing evidence on recruitment strategies to maximise recruitment and retention. We consider that the key issues in the success of this study were; the fact that the research was seen as clinically important by the clinicians who had initial responsibility for recruitment; employing an experienced trial co-ordinator and dedicated researchers willing to recruit participants seven days per week and to visit them at home at a time convenient to them, hence reducing missed patients and ensuring they were retained in the study; national visibility and repeated publicity at a local level delivered by locally based principal investigators well known to their primary care community; encouraging recruitment by payment to practices and reducing the workload of the referring doctors by providing immediate access to specialist care; good collaboration between primary and secondary care and basing local investigators in the otolarnygology trial centres RESULTS: Although the recruitment rate did not meet our initial expectations, enhanced retention meant that we exceeded our planned target of recruiting 550 patients within the planned time-scale. CONCLUSION: While difficult, recruitment to and retention within multi-centre trials from primary care can be successfully achieved through the application of the best available evidence, establishing good relationships with practices, minimising the workload of those involved in recruitment and offering enhanced care to all participants. Primary care trialists should describe their experiences of the methods used to persuade patients to participate in their trials when publishing their results.

PMID:- Bells palsy treatment 17391510 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Management of recurrent oral herpes simplex infections.

Management of recurrent oral herpes simplex infections.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Mar;103 Suppl:S12.e1-18

Authors: Woo SB, Challacombe SJ

The literature has been reviewed for evidence of the efficacy of antiviral agents in both the prophylaxis and treatment of recurrent oral herpes simplex virus (HSV) infections and discussed by a panel of experts. Emphasis was given to randomized controlled trials. Management of herpes-associated erythema multiforme and Bell palsy were also considered. The evidence suggests that 5% acyclovir (ACV) in the cream base may reduce the duration of lesions if applied early. Recurrent herpes labialis (RHL) and recurrent intraoral HSV infections can be effectively treated with systemic ACV 400 mg 3 times a day or systemic valacyclovir 500 to 1000 mg twice a day for 3 to 5 days (longer in the immunocompromised). RHL in the immunocompetent can be effectively prevented with (1) sunscreen alone (SPF 15 or above), (2) systemic ACV 400 mg 2 to 3 times a day, or (3) systemic valacyclovir 500 to 2000 mg twice a day. Valacyclovir 500 mg twice a day is also effective in suppressing erythema multiforme triggered by HSV. Further studies are needed to compare treatment efficacy between topical penciclovir, docosanol, and ACV cream for RHL.

PMID:- Bells palsy treatment 17379150 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Ramsay Hunt syndrome.

Ramsay Hunt syndrome.

Ethiop Med J. 2006 Oct;44(4):401-4

Authors: T/Selasic H, Zenebe G

Ramsay Hunt Syndrome was described in a 58 years old woman from Addis Ababa. The woman presented with vesicular eruptions in the right ear which was followed by weakness of the same side of face & otalgia. The objective of this case report is to address herpes zoster & its complications with the treatment modalities & an uncommon clinical entity, Ramsay hunt syndrome.

PMID:- Bells palsy treatment 17370442 [PubMed - indexed for MEDLINE Bells palsy treatment ]

[Peripheral paralysis of facial nerve in children]

[Peripheral paralysis of facial nerve in children]

Przegl Lek. 2006;63(11):1237-40

Authors: Steczkowska-Klucznik M, Kaciński M

Peripheral facial paresis is one of the most common diagnosed neuropathies in adults and also in children. Many factors can trigger facial paresis and most frequent are infectious, carcinoma and demyelinisation diseases. Very important and interesting problem is an idiopathic facial paresis (Bell's palsy). Actually the main target of scientific research is to assess the etiology (infectious, genetic, immunologic) and to find the most appropriate treatment.

PMID:- Bells palsy treatment 17348424 [PubMed - indexed for MEDLINE Bells palsy treatment ]

[Observation on non-invasive electrode pulse electric stimulation for treatment of Bell's palsy]

[Observation on non-invasive electrode pulse electric stimulation for treatment of Bell's palsy]

Zhongguo Zhen Jiu. 2006 Dec;26(12):857-8

Authors: Guo QH, Yan JZ, Yan WS, Xiao MZ

OBJECTIVE: To explore non-invasive therapy for treatment of Bell palsy. METHODS: Two hundred and seventy-six were randomly divided into two groups, a treatment group and a control group, 138 cases in each group. The treatment group were treated with non-invasive electrode pulse electric stimulation at Taiyang (EX-HN 5), Sibai (ST 2), Qianzheng (Extra), Dicang (ST 4), and the control group with routine medicine (prednisone, dibazol, vitamine B complex and Qianzheng Powder), once each day, 10 days constituting one course. After two courses, their therapeutic effects were compared. RESULTS: The cured rate and the effective rate were 83.3% and 99.3% in the treatment group, and 48.5% and 88.4% in the control group respectively with a significant difference between the two groups (P < 0.05). CONCLUSION: Non-invasive electrode pulse electric stimulation at facial points has obvious therapeutic effect on Bell palsy.

PMID:- Bells palsy treatment 17313006 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Bilateral Bell palsy and acute HIV type 1 infection: report of 2 cases and review.

Bilateral Bell palsy and acute HIV type 1 infection: report of 2 cases and review.

Clin Infect Dis. 2007 Mar 15;44(6):e57-61

Authors: Serrano P, Hernández N, Arroyo JA, de Llobet JM, Domingo P

Two adult patients who presented to a hospital with bilateral facial Bell palsy who were also experiencing human immunodeficiency virus type 1 seroconversion are described. Ten additional cases retrieved from the literature are also reviewed. Bell palsy appeared a median of 15 days after the beginning of the clinical disease, and aseptic meningitis was an invariable concomitant of facial neuropathy. All but 1 patient (8.3%) recovered without sequelae.

PMID:- Bells palsy treatment 17304442 [PubMed - indexed for MEDLINE Bells palsy treatment ]

On call. Last month I developed severe weakness on the whole left side of my face. My doctor diagnosed Bell's palsy and referred me to a neurologist. I recovered before I got to see her, so I didn't keep the appointment. Although my face is now back to normal, I'd like to know more about the condition. What can you tell me?

Harv Mens Health Watch. 2006 Nov;11(4):8

Authors: Simon HB

PMID:- Bells palsy treatment 17278299 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Management and outcome of antenatally diagnosed congenital cystic adenomatoid malformation of the lung.

Management and outcome of antenatally diagnosed congenital cystic adenomatoid malformation of the lung.

Hong Kong Med J. 2007 Feb;13(1):31-9

Authors: Chow PC, Lee SL, Tang MH, Chan KL, Lee CP, Lam BC, Tsoi NS

OBJECTIVE: To review the management and outcome of babies with antenatally diagnosed congenital cystic adenomatoid malformation. DESIGN: Retrospective cohort review. SETTING: Tertiary neonatal care unit at Queen Mary Hospital and antenatal diagnostic centre at Tsan Yuk Hospital. PATIENTS: Consecutive patients with antenatally suspected congenital cystic adenomatoid malformation in their concepti among antenatal patients attending Tsan Yuk Hospital from 1994 to 2002. Twenty-four of 33 cases were referred to Queen Mary Hospital for postnatal management and for whom comprehensive records were available for analysis in 23. INTERVENTIONS: Postnatal interventions in their babies included investigational imaging for congenital cystic adenomatoid malformation and surgery. MAIN OUTCOME MEASURES: Antenatal and postnatal outcome, as well as pathology of the excised lesions. RESULTS: Antenatal outcome: termination of pregnancy in two cases and spontaneous abortion in one; in-utero regression was documented in nine cases and in one hydropic change was apparent. Postnatal outcome: only eight of 20 babies born alive had symptoms in neonatal period. Two developed serious infective complications in infancy, one with documented in-utero regression. Pulmonary parenchymal abnormalities were detected on computed tomography of the thorax in six of seven cases with normal or non-specific chest radiograph findings. Among nine cases with in-utero regression, congenital cystic adenomatoid malformation was confirmed by operative histology in five and abnormal computed tomography findings in three. Fifteen babies underwent surgical excision, one of whom died because of severe pre-existing pulmonary hypoplasia and nine endured minor postoperative complications. A favourable outcome was documented at a mean follow-up of 22 months (range, 2 months-7 years). CONCLUSIONS: In-utero regression of congenital cystic adenomatoid malformation on antenatal ultrasound may not represent genuine resolution. Computed tomographic thorax should be considered in all newborns with antenatally diagnosed congenital cystic adenomatoid malformation, and if confirmed early operation before first hospital discharge is recommended.

PMID:- Bells palsy treatment 17277390 [PubMed - indexed for MEDLINE Bells palsy treatment ]

[Clinical analysis of patients with peripheral facial palsy]

[Clinical analysis of patients with peripheral facial palsy]

Ideggyogy Sz. 2006 Nov 20;59(11-12):400-5

Authors: Ilniczky S

Peripheral facial palsy is one of the most frequent neurological symptoms. In two thirds of the cases the cause is unknown, this is called "idiopathic peripheral facial palsy or Bell's palsy", but several different diseases have to be considered in the differential diagnosis. In this paper we reviewed the case histories of 110 patients treated for "peripheral facial palsy" in the Department of Neurology, Semmelweis University, Budapest in a five year period, 2000-2004. We studied the age, gender distribution, seasonal occurrence, comorbidities, sidedness, symptoms, circumstances of referral to the hospital, the initial diagnoses and therapeutic options. We also discuss the probable causes and consequences of diagnostic failures. RESULTS: the proportion of males and females was equal. There was no considerable difference between sexes regarding age-distribution. Of the 110 patients 106 was diagnosed with idiopathic Bell's palsy, three cases with otic herpes zoster and one patient with Lyme disease. In our material, peripheral facial palsy was significantly more frequent in the cold period of late autumn, winter, and early spring. Diabetes mellitus and hypertension were more frequent than in the general population. 74% of the patients were admitted within two days from the onset of the symptoms. In 37% preliminary diagnosis was unavailable. In 15% cerebrovascular insult was the first, incorrect diagnosis, the correct diagnosis of "Bell's palsy" was provided only in 16%. The probable causes of diagnostic failures may be the misleading symptoms and accompanying conditions. We examined the different therapies applied and reviewed the literature in this topic. We conclude that intravenous corticosteroid treatment in the early stage of the disease is the therapy of choice.

PMID:- Bells palsy treatment 17203875 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Reactivation of herpes simplex virus type 1 and varicella-zoster virus and therapeutic effects of combination therapy with prednisolone and valacyclovir in patients with Bell's palsy.

Reactivation of herpes simplex virus type 1 and varicella-zoster virus and therapeutic effects of combination therapy with prednisolone and valacyclovir in patients with Bell's palsy.

Laryngoscope. 2007 Jan;117(1):147-56

Authors: Kawaguchi K, Inamura H, Abe Y, Koshu H, Takashita E, Muraki Y, Matsuzaki Y, Nishimura H, Ishikawa H, Fukao A, Hongo S, Aoyagi M

OBJECTIVES: To determine whether reactivation of herpes simplex virus (HSV) type 1 or varicella-zoster virus (VZV) is the main cause of Bell's palsy and whether antiviral drugs bring about recovery from Bell's palsy. STUDY DESIGN: Randomized, multicenter, controlled study. METHODS: One hundred fifty patients with Bell's palsy were enrolled in this study. The patients were randomly assigned to a prednisolone group or a prednisolone-valacyclovir group, in whom virologic examinations for HSV-1 and VZV were performed by simple randomization scheme in sealed envelopes. The recovery rates among various groups were analyzed using the Kaplan-Meier method and the Cox proportional hazards model. RESULTS: Reactivation of HSV-1, VZV, and both viruses was detected in 15.3%, 14.7%, and 4.0% of patients, respectively. There was no significant difference in recovery rates between the prednisolone group and the prednisolone-valacyclovir group, although recovery in the patients with HSV-1 reactivation tended to be higher in the prednisolone-valacyclovir group than in the prednisolone group. There was a significant difference in recovery among age groups and between individuals with complete and incomplete paralysis. CONCLUSIONS: Reactivation of HSV-1 or VZV was observed in 34% of the patients with Bell's palsy. The effect of combination therapy with prednisolone and valacyclovir on recovery was not significantly higher than that with prednisolone alone.

PMID:- Bells palsy treatment 17202945 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Bell's palsy associated with influenza vaccination: two case reports.

Bell's palsy associated with influenza vaccination: two case reports.

Vaccine. 2007 Apr 12;25(15):2839-41

Authors: Chou CH, Liou WP, Hu KI, Loh CH, Chou CC, Chen YH

The etiology of Bell's palsy is often unknown. We present herein two cases of adults who developed a Bell's palsy following the administration of an influenza vaccine. While the incidence is low, with the widespread recommendation for annual influenza vaccines, patients should be apprised of the possibility of this complication and the benefit of early treatment.

PMID:- Bells palsy treatment 17084492 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Does electrical stimulation improve motor recovery in patients with idiopathic facial (Bell) palsy?

Does electrical stimulation improve motor recovery in patients with idiopathic facial (Bell) palsy?

Phys Ther. 2006 Nov;86(11):1558-64

Authors: Ohtake PJ, Zafron ML, Poranki LG, Fish DR

PMID:- Bells palsy treatment 17079755 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Analysis of prognostic factors in Bell's palsy and Ramsay Hunt syndrome.

Analysis of prognostic factors in Bell's palsy and Ramsay Hunt syndrome.

Auris Nasus Larynx. 2007 Jun;34(2):159-64

Authors: Yeo SW, Lee DH, Jun BC, Chang KH, Park YS

OBJECTIVE: This study evaluated the prognostic factors in Bell's palsy and Ramsay Hunt syndrome (HZO). METHODS: A retrospective, institutional review board-approved study at a university-based hospital. A total of 81 patients consisting of 55 Bell's palsy patients and 26 HZO patients were enrolled in this study. The treatment consisted uniformly in all cases, and acyclovir was administered in the case of Ramsay Hunt syndrome. All patients were followed up until they recovered or for least up 6 months. RESULTS: The recovery rates to House-Brackmann grade II or better were 96.3% in those with Bell's palsy and 84.6% in those with HZO. In the HZO cases, older patients had a poorer initial and final status, and less chance of making a complete recovery than the younger patients. The HZO patients without diabetes mellitus had a higher chance of recovery, a higher chance of complete recovery, and a better final status. In addition, HZO patients without essential hypertension had a higher degree of recovery. HZO patients not suffering from vertigo had a higher chance of recovery. CONCLUSION: There was no prognostic factor found in the Bell's palsy patients in this study. The prognostic factors of HZO were age, diabetus mellitus, essential hypertension and vertigo.

PMID:- Bells palsy treatment 17055202 [PubMed - indexed for MEDLINE Bells palsy treatment ]

[Facial nerve decompression]

[Facial nerve decompression]

Harefuah. 2006 Aug;145(8):557-60, 632

Authors: Shapira Y, Migirov L, Kronenberg J

Facial nerve palsy is usually managed conservatively, but in some cases may require surgical intervention. In cases in which the continuity of the nerve is not disrupted, decompression is the procedure of choice. No reports were found in the literature addressing this group separately. We report the results of 33 facial nerve decompressions conducted in the Sheba Medical Center through the years 1985-2002. Fifteen of our patients were operated on using the middle cranial fossa approach, 12 underwent mastoidectomy and 6 were treated using the combined middle cranial fossa mastoidectomy approach. Twenty-four (72.7%) underwent surgery for temporal bone fracture and the rest (27.3%) due to other reasons (iatrogenic injury, infection). The postoperative results were determined using the House-Brackmann (HB) scale. Patients who were operated on more than 30 days after complete palsy achieved better results than those operated on earlier than 30 days. The total average HB score was 3.2. The followup results are significantly worse in patients after less than 3 months, as compared to those with 3 to 12 months followup. On the basis of our experience, facial nerve decompression achieves good functional results. We found no advantage in early vs. late intervention with regard to results. The final results can be determined only a year after surgery.

PMID:- Bells palsy treatment 16983835 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Bell's palsy.

Bell's palsy.

Clin Evid. 2006 Jun;(15):1745-50

Authors: Holland J

PMID:- Bells palsy treatment 16973065 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Bell's palsy: a review of treatment using antiviral agents.

Bell's palsy: a review of treatment using antiviral agents.

Ann Pharmacother. 2006 Oct;40(10):1838-42

Authors: Alberton DL, Zed PJ

OBJECTIVE: To review the evidence evaluating the efficacy and safety of antiviral agents to reduce morbidity associated with Bell's palsy. DATA SOURCES: MEDLINE, EMBASE, and PubMed were searched (all up to April 2006) for English-language, prospective, randomized, controlled clinical trials that evaluated the use of antiviral agents in Bell's palsy. Search terms included Bell's palsy, acyclovir, valacyclovir, famciclovir, and randomized controlled trials. STUDY SELECTION AND DATA EXTRACTION: Prospective, randomized, controlled trials that evaluated efficacy and safety endpoints of antiviral agents in the treatment of Bell's palsy were included. Primary efficacy outcomes included facial paralysis recovery profile, facial paralysis recovery index, and the House-Brackmann facial nerve grading scale. Safety outcomes were also identified by each trial. DATA SYNTHESIS: Two prospective, randomized clinical trials were included in this review, both involving the use of acyclovir for treatment of Bell's palsy. Acyclovir monotherapy was shown to be inferior to prednisone monotherapy; however, the combination of acyclovir and prednisone was found to be superior to prednisone alone. There are limited data describing the safety of acyclovir in Bell's palsy. CONCLUSIONS: The use of acyclovir in the treatment of Bell's palsy remains controversial. Additional, adequately powered, randomized, placebo-controlled trials are needed to definitively support its use. For the time being, the evidence reviewed in this article would favor the combination of acyclovir and prednisone if commenced within the first 72 hours of symptom onset.

PMID:- Bells palsy treatment 16968821 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Establishing a case for cause and effect.

Establishing a case for cause and effect.

J Am Osteopath Assoc. 2006 Aug;106(8):443-4

Authors: Carbon JR

PMID:- Bells palsy treatment 16943512 [PubMed - indexed for MEDLINE Bells palsy treatment ]

[Mona Lisa syndrome: idiopathic facial paralysis during pregnancy]

[Mona Lisa syndrome: idiopathic facial paralysis during pregnancy]

Z Geburtshilfe Neonatol. 2006 Aug;210(4):126-34

Authors: Hellebrand MC, Friebe-Hoffmann U, Bender HG, Kojda G, Hoffmann TK

Mona Lisa has been pregnant shortly before the famous painting of Leonardo da Vinci was created (1503-1506). Recently, it has been speculated that Mona Lisa's famous smile is caused by facial muscle contracture and/or synkinesis after Bell's palsy with incomplete nerval regeneration. During pregnancy the incidence of Bell's palsy is increased up to 3.3 times compared to nonpregnant women. The etiology, associated factors as well as various treatment options aiming at the prevention of associated complications and improving recovery of facial nerve function have intensively been evaluated over the past three decades. However, the preferred mode of therapy management, particularly in pregnant women, remains undecided. Corticosteroids may be beneficial if they are applied after the first trimester.

PMID:- Bells palsy treatment 16941305 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Bell's palsy associated with linezolid therapy: case report and review of neuropathic adverse events.

Bell's palsy associated with linezolid therapy: case report and review of neuropathic adverse events.

Pharmacotherapy. 2006 Aug;26(8):1183-9

Authors: Thai XC, Bruno-Murtha LA

Bell's palsy is one of the most common neurologic disorders affecting the seventh cranial nerve. Several disease states have been associated with facial paralysis. Drugs, however, have been rarely implicated as an etiology. We describe a 49-year-old man who developed peripheral facial paralysis after 3 weeks of linezolid therapy, along with recurrence of symptoms on rechallenge. He had insulin-dependent diabetes mellitus and a longstanding history of bilateral diabetes-related foot problems. After hospitalization, debridement, and vancomycin therapy for methicillin-resistant Staphylococcus aureus osteomyelitis, the patient was discharged to home with oral linezolid therapy. On day 23 of linezolid therapy, he developed signs and symptoms that were consistent with Bell's palsy. Linezolid was discontinued; the Bell's palsy gradually improved, with complete resolution occurring at month 3. On rechallenge with linezolid for recurrent osteomyelitis, the patient developed a second episode of Bell's palsy within a similar time frame as in the first episode. Assessment of causality using the Naranjo adverse drug reaction probability scale revealed a probable relationship between this adverse drug event and linezolid therapy. Clinicians should be aware that Bell's palsy may be another neuropathic adverse effect associated with linezolid.

PMID:- Bells palsy treatment 16863496 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Managing Bell's palsy.

Managing Bell's palsy.

Drug Ther Bull. 2006 Jul;44(7):49-53

Authors:

Each year in the UK, around 1 in 5,000 people develop Bell's palsy--a unilateral lower motor neurone facial weakness of rapid onset that can be physically and psychologically disabling. While around 71% of patients recover normal function of the facial muscles without treatment, 13% are left with slight weakness and 16% with moderate to severe weakness resulting in major facial dysfunction. People who recover usually do so quickly, with 85% of them reporting some improvement in the first 3 weeks. There is longstanding controversy about what, if any, treatment should be initiated for Bell's palsy. Here we discuss the management of patients with this condition.

PMID:- Bells palsy treatment 16846138 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Transitory, spontaneously recovering, peripheral facial nerve palsy after vinorelbine administration.

Transitory, spontaneously recovering, peripheral facial nerve palsy after vinorelbine administration.

Neurol Sci. 2006 Jun;27(2):110-3

Authors: Massimino M, Simonetti F, Balestrini MR, Spreafico F, La Spina M, Terenziani M, Gandola L

Childhood intrinsic brain-stem gliomas have a dismal prognosis. Different treatment strategies have been adopted over the years without changing the final outcome of this ominous disease. Due to this grim prognosis, experimental therapeutic designs are worthwhile. Vinorelbine is a semi-synthetic vinca alkaloid that has demonstrated a broad spectrum of activity both in in vitro and in vivo experimental systems. By adopting vinorelbine during and after focal radiotherapy in the last two years, we have tried to evocate its known synergistic effect in brain-stem tumour control. Vinorelbine was administered intravenously before, during and after radiotherapy on tumour bed for a total duration of 10 months. All the consecutive patients whose clinical and radiological features corresponded to the diagnosis of an intrinsic brain-stem tumour, i.e., diffuse pontine glioma, have been accrued to this treatment protocol since July 2002. A histological assessment was not required. All patients were treated during hospital stay or in the outpatient clinic at the Istituto Nazionale Tumori of Milan (n=12) and at the Pediatric Clinic of Policlinico in Catania (n=1). Two of the thirteen patients so far treated have developed multiple subsequent, and transitory, episodes of monolateral peripheral facial nerve palsy during vinorelbine administration. The palsy always completely and spontaneously resolved at a short interval-around 30 min-after the end of the drug infusion. Obvious tumour progression was excluded by means of MRI; therefore the drug was administered as scheduled until the end of the treatment. We describe possible neurological and oncological implications of this unusual side effect, until now not reported in any other series dealing with vinorelbine as adjuvant treatment.

PMID:- Bells palsy treatment 16816907 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Bilateral facial paralysis: case presentation and discussion of differential diagnosis.

Bilateral facial paralysis: case presentation and discussion of differential diagnosis.

J Gen Intern Med. 2006 Jul;21(7):C7-10

Authors: Jain V, Deshmukh A, Gollomp S

Bilateral facial paralysis is a rare condition and therefore represents a diagnostic challenge. We report the case of a 34-year-old healthy woman with sequential bilateral facial paralysis as a sole manifestation of sarcoidosis. She initially presented with an isolated left sided Bell's palsy without any symptoms to suggest alternative diagnoses. Within a month there was progression to peripheral facial paresis on the contra lateral side, prompting a diagnosis of Lyme disease. Her physical examination and chest x-ray did not reveal any clinical evidence of sarcoidosis. After failing to respond to an empiric trial of intravenous ceftriaxone for a presumptive diagnosis of Lyme disease, computed tomography scan of the chest was ordered which demonstrated bilateral hilar lymphadenopathy. Bronchoscopic biopsy confirmed a diagnosis of sarcoidosis. The patient then made a complete recovery on steroid therapy. We discuss the differential diagnosis of facial diplegia and focus on the clinical presentation, diagnosis and treatment of neurosarcoidosis.

PMID:- Bells palsy treatment 16808763 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Osteopathic manipulative treatment of a 26-year-old woman with Bell's palsy.

Osteopathic manipulative treatment of a 26-year-old woman with Bell's palsy.

J Am Osteopath Assoc. 2006 May;106(5):285-9

Authors: Lancaster DG, Crow WT

Bell's palsy is caused by a lesion of the facial nerve and results in unilateral paralysis or paresis of the face. The condition affects approximately 23 in 100,000 persons, with onset typically occurring between the ages of 10 and 40 years. The authors report the case of a 26-year-old woman with Bell's palsy, whom they treated with osteopathic manipulative treatment that was focused on the enhancement of lymphatic circulation. The osteopathic manipulative procedures used involved reducing restrictions around four key diaphragms (thoracic outlet, respiratory diaphragm, suboccipital diaphragm, cerebellar tentorium), as well as applying the thoracic pump, muscle energy, primary respiratory mechanism, and osteopathy in the cranial field. The authors, who were guided by the four principles of osteopathic philosophy, report that the patient's symptoms resolved within 2 weeks, during which two sessions of osteopathic manipulative treatment, each lasting approximately 20 minutes, were held. Patient recovery occurred without the use of pharmaceuticals.

PMID:- Bells palsy treatment 16717371 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Acute facial asymmetry.

Acute facial asymmetry.

Clin Pediatr (Phila). 2006 Apr;45(3):289-92

Authors: Kannikeswaran N, Mahajan PV, Kamat D

PMID:- Bells palsy treatment 16708146 [PubMed - indexed for MEDLINE Bells palsy treatment ]

A multicentral randomized control study on clinical acupuncture treatment of Bell's palsy.

A multicentral randomized control study on clinical acupuncture treatment of Bell's palsy.

J Tradit Chin Med. 2006 Mar;26(1):3-7

Authors: Liang F, Li Y, Yu S, Li C, Hu L, Zhou D, Yuan X, Li Y

OBJECTIVE: To confirm the clinical therapeutic effects of acupuncture and moxibustion on Bell's palsy. METHODS: 480 cases from 4 hospitals were enrolled for this study, among whom 439 cases completed the whole course of the study. The patients were randomly divided into the following 3 groups, a control group(treated with prednisone, vitamin B1, vitamin B12 and dibazol), an acu-moxibustion group (treated with filiform needle plus moxibustion), and a basic treatment plus acu-moxibustion group (treated with oral medicine like those in the control group plus acupuncture, and with moxibustion like in the acu-moxibustion group). The whole treatment course lasted 4 weeks. The therapeutic effects were evaluated according to the symptoms and signs, House-Brackmann grading scale and facial disability indexes(FDI). RESULTS: All the 4 centers (hospitals) completed this study well, with no statistically significant difference found among the 4 centers in therapeutic effects. The patients with different conditions were well distributed in the 3 groups, thus the basic general data were comparable (P > 0.05). The therapeutic effects of the two treatment groups were better than the control group (respectively P < 0.05 and P < 0.01), and it was the best in the acu-moxibustion group (P < 0.01). CONCLUSION: Acupuncture and moxibustion may exert definite therapeutic effects on Bell's palsy, better than that of the basic treatment group or the basic treatment plus acu-moxibustion group.

PMID:- Bells palsy treatment 16705841 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Bilateral vidian nerve schwannomas associated with facial palsy. Case report and review of the literature.

Bilateral vidian nerve schwannomas associated with facial palsy. Case report and review of the literature.

J Neurosurg. 2006 May;104(5):835-9

Authors: Cheong JH, Kim JM, Bak KH, Kim CH, Oh YH, Park DW

Intracranial schwannomas are relatively common benign tumors arising from Schwann cells. Among the cranial nerves, the vestibular division of the vestibulocochlear nerve is the site most commonly affected by these lesions, followed by the trigeminal nerve. The authors report a case of bilateral schwannomas arising from both of the pterygoid canals. A 13-year-old girl presented with intermittent headaches and left-sided facial palsy. Preoperative computerized tomography scans and magnetic resonance images revealed nonenhancing round masses within the bilateral vidian canals, bone erosion, and sclerosis. The transnasal transseptal transsphenoidal approach was used to remove the masses. Postoperatively, the patient recovered uneventfully. On histopathological examination, the masses were confirmed as schwannomas. The clinical presentation and probable histogenesis of schwannomas arising in this location are discussed together with a review of the literature.

PMID:- Bells palsy treatment 16703893 [PubMed - indexed for MEDLINE Bells palsy treatment ]

[Idiopathic facial nerve paralysis (Bell's palsy)]

[Idiopathic facial nerve paralysis (Bell's palsy)]

Nippon Rinsho. 2006 Mar;64 Suppl 3:276-80

Authors: Murakami S, Hamajima Y, Ezaki S

PMID:- Bells palsy treatment 16615483 [PubMed - indexed for MEDLINE Bells palsy treatment ]

[What is your diagnosis? The examination shows peripheral facial paresis]

[What is your diagnosis? The examination shows peripheral facial paresis]

Schweiz Rundsch Med Prax. 2006 Mar 29;95(13):481-2

Authors: Binder RK, Stanga Z, Cottagnoud P, Stucki A

PMID:- Bells palsy treatment 16602667 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Traumas of the middle skull base with TMJ involvement. Case report.

Traumas of the middle skull base with TMJ involvement. Case report.

Minerva Stomatol. 2006 Mar;55(3):151-7

Authors: Bottini DJ, Gnoni G, De Angelis B, Savo P, Trimarco A, Cervelli G, Cervelli V

The authors report their experience with temporomandibular joint (TMJ) traumas involving breakage of the roof of the glenoid cavity, an infrequent event that occurs in those cases in which, as a result of the condylar neck not fracturing, the traumatic energy is transmitted to the middle skull base. As the literature contains no valid series for establishing standardized protocols for the treatment of these fractures, we propose our own orthopedic-functional approach. The patient observed by us had suffered a cranio-facial trauma and presented the classical symptoms and signs of TMJ traumas and complete bilateral Bell paralysis. He was subjected to a CAT scan and then to 2-stage treatment consisting of functional rest with liquid diet followed by physiotherapy. An almost total recovery in TMJ function was observed after 1 month. At 1-year follow-up the facial paralysis had resolved completely. On the basis of our experience, breakages of the glenoid cavity can be compared, in terms of treatment procedure, to intracapsular fractures of the TMJ with surgery confined to cases of ankylosis sequelae. To avoid the onset of ankylosis careful control of clinical, functional and radiological follow-up is required.

PMID:- Bells palsy treatment 16575386 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Evaluation of a physiotherapeutic treatment intervention in "Bell's" facial palsy.

Evaluation of a physiotherapeutic treatment intervention in "Bell's" facial palsy.

Physiother Theory Pract. 2006 Jan;22(1):43-52

Authors: Cederwall E, Olsén MF, Hanner P, Fogdestam I

The aim of this study was to evaluate a physiotherapeutic treatment intervention in Bell's palsy. A consecutive series of nine patients with Bell's palsy participated in the study. The subjects were enrolled 4-21 weeks after the onset of facial paralysis. The study had a single subject experimental design with a baseline period of 2-6 weeks and a treatment period of 26-42 weeks. The patients were evaluated using a facial grading score, a paresis index and a written questionnaire created for this study. Every patient was taught to perform an exercise program twice daily, including movements of the muscles surrounding the mouth, nose, eyes and forehead. All the patients improved in terms of symmetry at rest, movement and function. In conclusion, patients with remaining symptoms of Bell's palsy appear to experience positive effects from a specific training program. A larger study, however, is needed to fully evaluate the treatment.

PMID:- Bells palsy treatment 16573245 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Should we use steroids to treat children with Bell's palsy?

Should we use steroids to treat children with Bell's palsy?

Can Fam Physician. 2006 Mar;52:313-4

Authors: Atzema C, Goldman RD

QUESTION: A healthy 6-year-old boy came to my office with severe Bell's palsy that had lasted for 24 hours following an upper respiratory tract infection he had had a little over a week ago. Should I treat him with steroids? ANSWER: While there is currently no definitive answer, the risk that Bell's palsy will become permanent seems exceptionally small in children (even smaller than in adults), and the best evidence demonstrates no benefit from steroids. Until a large randomized controlled trial can prove benefit, these patients should not be treated with steroids. The vast majority will recover fully without treatment.

PMID:- Bells palsy treatment 16572574 [PubMed - indexed for MEDLINE Bells palsy treatment ]

The treatment of facial palsy from the point of view of physical and rehabilitation medicine.

The treatment of facial palsy from the point of view of physical and rehabilitation medicine.

Eura Medicophys. 2006 Mar;42(1):41-7

Authors: Shafshak TF

There are evidences to support recommending the early intake of prednisone (in its appropriate dose of 1 mg/kg body weight for up to 70 or 80 mg/day) or the combined use of prednisone and acyclovir (or valacyclovir) within 72 h following the onset of paralysis in order to improve the outcome of Bell's palsy (BP). Although there may be a controversy about the role of physiotherapy in BP or facial palsy, it seemed that local superficial heat therapy, massage, exercises, electrical stimulation and biofeedback training have a place in the treatment of lower motor facial palsy. However, each modality has its indications. Moreover, some rehabilitative surgical methods might be of benefit for some patients with traumatic facial injuries or long standing paralysis without recovery, but early surgery in BP is usually not recommended. However, few may recommend early surgery in BP when there is 90-100% facial nerve degeneration. The efficacy of acupuncture, magnetic pellets and other modalities of physiotherapy needs further investigation. The general principles and the different opinions in treating and rehabilitating facial palsy are discussed and the need for further research in this field is suggested.

PMID:- Bells palsy treatment 16565685 [PubMed - indexed for MEDLINE Bells palsy treatment ]

[Prednisolone dosage in Bell palsy]

[Prednisolone dosage in Bell palsy]

Lakartidningen. 2006 Feb 1-7;103(5):303

Authors: Lindh J, Böttiger Y

PMID:- Bells palsy treatment 16512571 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Bell's palsy treated with cortisone. 1955.

Bell's palsy treated with cortisone. 1955.

Conn Med. 2005 Aug;69(7):423-4

Authors: Dwyer GK

PMID:- Bells palsy treatment 16350487 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Oral medicine -- update for the dental practitioner. Disorders of orofacial sensation and movement.

Oral medicine -- update for the dental practitioner. Disorders of orofacial sensation and movement.

Br Dent J. 2005 Dec 10;199(11):703-9

Authors: Scully C, Felix DH

This series provides an overview of current thinking in the more relevant areas of oral medicine for primary care practitioners, written by the authors while they were holding the Presidencies of the European Association for Oral Medicine and the British Society for Oral Medicine, respectively. A book containing additional material will be published. The series gives the detail necessary to assist the primary dental clinical team caring for patients with oral complaints that may be seen in general dental practice. Space precludes inclusion of illustrations of uncommon or rare disorders, or discussion of disorders affecting the hard tissues. Approaching the subject mainly by the symptomatic approach -- as it largely relates to the presenting complaint -- was considered to be a more helpful approach for GDPs rather than taking a diagnostic category approach. The clinical aspects of the relevant disorders are discussed, including a brief overview of the aetiology, detail on the clinical features and how the diagnosis is made. Guidance on management and when to refer is also provided, along with relevant websites which offer further detail.

PMID:- Bells palsy treatment 16341177 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Linear scleroderma en coup de sabre with associated neurologic abnormalities.

Linear scleroderma en coup de sabre with associated neurologic abnormalities.

Pediatrics. 2006 Jan;117(1):e132-6

Authors: Holland KE, Steffes B, Nocton JJ, Schwabe MJ, Jacobson RD, Drolet BA

Linear scleroderma represents a unique form of localized scleroderma that primarily affects the pediatric population, with 67% of patients diagnosed before 18 years of age. When linear scleroderma occurs on the head, it is referred to as linear scleroderma en coup de sabre, given the resemblance of the skin lesions to the stroke of a sabre. Here we describe 3 pediatric patients with linear scleroderma en coup de sabre who presented with neurologic abnormalities before or concurrent with the diagnosis of their skin disease. Our patients' cases highlight the underrecognized relationship between neurologic complications and linear scleroderma en coup de sabre and illustrate the importance of a thorough skin examination in patients with unexplained neurologic disease.

PMID:- Bells palsy treatment 16326691 [PubMed - indexed for MEDLINE Bells palsy treatment ]

[Clinical observation on acupuncture by stages combined with exercise therapy for treatment of Bell palsy at acute stage]

[Clinical observation on acupuncture by stages combined with exercise therapy for treatment of Bell palsy at acute stage]

Zhongguo Zhen Jiu. 2005 Aug;25(8):545-7

Authors: Qu Y

OBJECTIVE: To find out a method for increasing clinical therapeutic effect on Bell palsy at acute stage. METHODS: Ninety cases of Bell palsy were randomly divided into an observation group, a control group I and a control group II, 30 cases in each group. They were treated respectively with acupuncture plus exercise therapy, simple acupuncture therapy, and simple exercise therapy, and their therapeutic effects were observed. RESULTS: The cured rate was 66.7% in the observation group, 53.3% in the control group I and 46.70% in the control group II, the observation group being better than the two control groups (P<0.05). CONCLUSION: Acupuncture by stage combined with exercise therapy can increase the therapeutic effect on Bell palsy at acute stage, and it is a better therapy for Bell palsy.

PMID:- Bells palsy treatment 16309052 [PubMed - in process]

The efficacy of steroids in idiopathic facial nerve paralysis: an open, randomized, prospective controlled study.

The efficacy of steroids in idiopathic facial nerve paralysis: an open, randomized, prospective controlled study.

Kulak Burun Bogaz Ihtis Derg. 2005;14(3-4):62-6

Authors: Türk-Börü U, Koçer A, Bilge C

OBJECTIVES: Although corticosteroid therapy is widely used in idiopathic facial nerve paralysis, its efficacy has not been clearly demonstrated. This study was designed to evaluate the role of steroids in idiopathic facial nerve paralysis. PATIENTS AND METHODS: The study included 56 patients (29 males, 27 females; mean age, in men 44.1, in women 40.3 years) with a diagnosis of idiopathic facial nerve paralysis. Within the first three days after the onset of symptoms, the patients were randomly assigned to two groups to receive either steroids or other medications for the prevention of ocular complications or to provide pain relief. The severity of facial paralysis was evaluated using the House-Brackmann classification before and after three and six weeks of the treatment. Regression to stage 1 or 2 disease was regarded as a successful response. RESULTS: Although the initial response to steroid therapy seemed to be better, the results at the end of three and six weeks of the treatment were not statistically different from those of patients receiving other supportive treatments (p>0.05). CONCLUSION: Further studies with large patient series are needed to clarify the use of steroids in the treatment of idiopathic facial nerve paralysis.

PMID:- Bells palsy treatment 16227727 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Prognosis of Bell's palsy in children--analysis of 29 cases.

Prognosis of Bell's palsy in children--analysis of 29 cases.

Brain Dev. 2005 Oct;27(7):504-8

Authors: Chen WX, Wong V

We report 29 children with 32 episodes of Bell's palsy admitted to a university affiliated hospital during an 8-year period (1995-2003). The peak age of onset was under 3 years. Three (10.3%) had recurrent attacks. Complete recovery occurred in all 32 episodes except 1 (3.1%) with partial recovery, having MRI evidence of parotitis shown in the contralateral side. The recovery rate within 3 weeks was 68.8%. There was statistically significant increase in the duration of complete recovery for those with positive virological confirmation or mycoplasma infection. There was no significant difference between the rate of recovery in those treated with a short course of steroid (N = 23 attacks) than those without steroid treatment (N = 9 attacks). As there were few studies in the natural course of children with Bell's palsy, evidence based trials should be done to assess the natural course rather than giving steroid empirically as those with more protracted recovery might be viral in origin.

PMID:- Bells palsy treatment 16198208 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Familial Bell's palsy in females: a phenotype with a predilection for eyelids and lacrimal gland.

Familial Bell's palsy in females: a phenotype with a predilection for eyelids and lacrimal gland.

Orbit. 2005 Jun;24(2):121-4

Authors: Zaidi FH, Gregory-Evans K, Acheson JF, Ferguson V

The authors report a family with familial Bell's palsy affecting seven individuals, six of whom are females. This is a distinct subtype of Bell's palsy with a predilection for juvenile females, previously reported only very rarely. In conjunction with a review of the literature, this case suggests that this phenotype carries with it a greater risk of serious complications affecting the eyelids and lacrimal gland. These carry significant functional and cosmetic implications owing to aberrant regeneration of the seventh, sixth and possibly third cranial nerves, chronicity and relapses. Clinical features include synkinesis of the eyelids with the orbicularis oris causing synkinetic ptosis, recurrent paralytic ectropion, paralysis of facial muscles of expression with dry eye, hyperlacrimation (crocodile tears), and transient strabismus. Clinically, the decision to offer surgery in place of conservative treatment should consider the natural history of chronicity and relapses often seen with this subtype of familial Bell's palsy. Botulinum toxin injections are especially versatile in managing the complications associated with this phenotype.

PMID:- Bells palsy treatment 16191801 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Inverse Bell's phenomenon observed following levator resection for blepharoptosis.

Inverse Bell's phenomenon observed following levator resection for blepharoptosis.

Graefes Arch Clin Exp Ophthalmol. 2006 Jul;244(7):868-70

Authors: Betharia SM, Sharma V

BACKGROUND: Ptosis surgery is one of the more widely performed surgeries in ophthalmology. Preoperative lagophthalmos, Bell's phenomenon, corneal sensation and dry eye are important factors to be assessed in these cases, which influence the functional and cosmetic results. We herein describe the interesting complication of transient inversion of Bell's phenomenon observed following extensive levator resection performed for congenital ptosis. METHODS: Three patients are described who underwent levator resection and showed an inversion of the Bell's phenomenon in the postoperative period, with the eye going down instead of up, during eyelid closure. RESULTS: The Bell's phenomenon reverted to normal in all three cases within 2 weeks and there were no corneal complications. The patients were given frequent lubricating eye drops during this period. CONCLUSIONS: It is important to look for variations in Bell's phenomenon in all cases of congenital ptosis, especially following levator resection. In cases with a poor or ineffective Bell's phenomenon, it is imperative to keep a close watch on the cornea along with copious lubrication during the early postoperative period.

PMID:- Bells palsy treatment 16175375 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Treatment of peripheral nerve disorders.

Treatment of peripheral nerve disorders.

Curr Opin Neurol. 2005 Oct;18(5):554-6

Authors: Hughes R

PMID:- Bells palsy treatment 16155439 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Facial paralysis caused by malignant skull base neoplasms.

Facial paralysis caused by malignant skull base neoplasms.

Neurosurg Focus. 2002 May 15;12(5):e2

Authors: Marzo SJ, Leonetti JP, Petruzzelli G

OBJECT: Bell palsy remains the most common cause of facial paralysis. Unfortunately, this term is often erroneously applied to all cases of facial paralysis. METHODS: The authors performed a retrospective review of data obtained in 11 patients who were treated at a university-based referral practice between July 1988 and September 2001 and who presented with acute facial nerve paralysis mimicking Bell palsy. All patients were subsequently found to harbor an occult skull base neoplasm. A delay in diagnosis was demonstrated in all cases. Seven patients died of their disease, and four patients are currently free of disease. CONCLUSIONS: Although Bell palsy remains the most common cause of peripheral facial nerve paralysis, patients in whom neoplasms invade of the facial nerve may present with acute paralysis mimicking Bell palsy that fails to resolve. Delays in diagnosis and treatment in such cases may result in increased rates of mortality and morbidity.

PMID:- Bells palsy treatment 16119900 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Bell's palsy-induced blepharospasm relieved by passive eyelid closure and responsive to apomorphine.

Bell's palsy-induced blepharospasm relieved by passive eyelid closure and responsive to apomorphine.

Clin Neurophysiol. 2005 Oct;116(10):2348-53

Authors: Cattaneo L, Chierici E, Pavesi G

OBJECTIVE: We describe the case of a woman with Bell's Palsy-induced blepharospasm (BPIB) of the right eye that appeared simultaneously with a complete left facial nerve palsy. The involuntary spasm was relieved by passive lowering of the upper eyelid on the paretic side. METHODS: The recovery curve of the blink reflex was evaluated on the non-paretic side in baseline conditions, after subcutaneous apomorphine and placebo administration and 8 months later, at recovery from the palsy. RESULTS: We found increased recovery of the test-R2 responses at short interstimulus intervals at baseline, which was normalised by apomorphine but not by placebo. At recovery the blink reflex R2 recovery curve returned to normal. CONCLUSIONS: This report demonstrates for the first time a response of BPIB to a dopamine agonist. SIGNIFICANCE: Our findings are in agreement with an animal model of blepharospasm that suggests a combined role of weakness of the orbicularis oculi muscle and a dysfunction of the dopaminergic system in the pathogenesis of this disorder.

PMID:- Bells palsy treatment 16098807 [PubMed - indexed for MEDLINE Bells palsy treatment ]

The management of Bell's palsy.

The management of Bell's palsy.

Ir Med J. 2005 Jun;98(6):165

Authors: Hutchinson M

PMID:- Bells palsy treatment 16097504 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Usefulness of BFB/EMG in facial palsy rehabilitation.

Usefulness of BFB/EMG in facial palsy rehabilitation.

Disabil Rehabil. 2005 Jul 22;27(14):809-15

Authors: Dalla Toffola E, Bossi D, Buonocore M, Montomoli C, Petrucci L, Alfonsi E

OBJECTIVE: To analyze and to compare the recovery and the development of synkinesis in patients with idiopathic facial palsy (Bell's palsy) following treatment with two methods of rehabilitation, kinesitherapy (KT) and biofeedback/EMG (BFB/EMG). STUDY DESIGN: Retrospective cases--series review. METHODS: Seventy-four patients with Bell' palsy were clinically evaluated within 1 month from onset of palsy and at 12 months after palsy (House scale and synkinesis evaluation). Electromyography (EMG) and Electroneurography (ENG) were performed about 4 weeks after palsy to better evaluate functional abnormalities due to facial nerve lesion. The patients followed two different protocols for rehabilitation: the first 32 patients were treated with therapeutic exercises performed by therapists (KT group), the latter 42 patients were treated using BFB/EMG methods (BFB group) with inhibition of synkinetic movement as the primary goal. RESULTS: KT and BFB patients were evaluated for clinical and neurophysiological characteristics before rehabilitative treatment. BFB patients showed better clinical recovery and minor synkinesis than KT patients. CONCLUSIONS: BFB/EMG seems to be more useful than KT in Bells palsy treatment. This could be due to the fact that BFB/EMG gives more accurate information than KT on muscle activation with better modulation in voluntary recruitment of motor unit.

PMID:- Bells palsy treatment 16096233 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Revisional operations improve results of neurovascular free muscle transfer for treatment of facial paralysis.

Revisional operations improve results of neurovascular free muscle transfer for treatment of facial paralysis.

Plast Reconstr Surg. 2005 Aug;116(2):371-80

Authors: Takushima A, Harii K, Asato H, Momosawa A

BACKGROUND: Neurovascular free muscle transfer is currently the mainstay for smile reconstruction. However, problems such as excessive muscle bulk and dislocation of the transferred muscle attachment have been described. Furthermore, dynamic movements of the transferred muscle are sometimes too strong or too weak, resulting in facial asymmetry. In these cases, secondary revisional operations for the transferred muscle are required after neurovascular free muscle transfer. This report describes revisional operative procedures in detail and examines the extent of improvement of the smile by comparing preoperative and postoperative results. METHODS: Of 468 patients in whom neurovascular free muscle transfer was performed between 1977 and 2000, a total of 183 received revisional operations for the transferred muscle. Operations included revision of muscle attachment in 129 patients, debulking of the cheek in 114 patients, and fascia graft in 21 patients. RESULTS: Evaluation with the grading scale was performed in 117 of the 183 patients. Grading improved in 59 patients and worsened in seven patients. The remaining 51 patients displayed no change in grading. Differences between preoperative and post-operative grading were compared statistically, and revisional operations improved the grading score. CONCLUSIONS: Revisional operations are effective and important as secondary operations after neurovascular free muscle transfer. However, care must be taken not to damage the neurovascular pedicles.

PMID:- Bells palsy treatment 16079658 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Bilateral seventh nerve palsy--a manifestation of polyneuritic leprosy.

Bilateral seventh nerve palsy--a manifestation of polyneuritic leprosy.

Indian J Lepr. 2005 Apr-Jun;77(2):140-7

Authors: Khan A, Sardana K, Koranne RV, Bhushan P

PMID:- Bells palsy treatment 16044812 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Diagnostic relevance of transcranial magnetic and electric stimulation of the facial nerve in the management of facial palsy.

Diagnostic relevance of transcranial magnetic and electric stimulation of the facial nerve in the management of facial palsy.

Clin Neurophysiol. 2005 Sep;116(9):2051-7

Authors: Nowak DA, Linder S, Topka H

OBJECTIVE: Earlier investigations have suggested that isolated conduction block of the facial nerve to transcranial magnetic stimulation early in the disorder represents a very sensitive and potentially specific finding in Bell's palsy differentiating the disease from other etiologies. METHODS: Stimulation of the facial nerve was performed electrically at the stylomastoid foramen and magnetically at the labyrinthine segment of the Fallopian channel within 3 days from symptom onset in 65 patients with Bell's palsy, five patients with Zoster oticus, one patient with neuroborreliosis and one patient with nuclear facial nerve palsy due to multiple sclerosis. RESULTS: Absence or decreased amplitudes of muscle responses to early transcranial magnetic stimulation was not specific for Bell's palsy, but also evident in all cases of Zoster oticus and in the case of neuroborreliosis. Amplitudes of electrically evoked muscle responses were more markedly reduced in Zoster oticus as compared to Bell's palsy, most likely due to a more severe degree of axonal degeneration. The degree of amplitude reduction of the muscle response to electrical stimulation reliably correlated with the severity of facial palsy. CONCLUSIONS: Transcranial magnetic stimulation in the early diagnosis of Bell's palsy is less specific than previously thought. While not specific with respect to the etiology of facial palsy, transcranial magnetic stimulation seems capable of localizing the site of lesion within the Fallopian channel. SIGNIFICANCE: Combined with transcranial magnetic stimulation, early electrical stimulation of the facial nerve at the stylomastoid foramen may help to establish correct diagnosis and prognosis.

PMID:- Bells palsy treatment 16024292 [PubMed - indexed for MEDLINE Bells palsy treatment ]

[Arguments against the pharmacotherapy of Bells' palsy]

[Arguments against the pharmacotherapy of Bells' palsy]

Ned Tijdschr Geneeskd. 2005 Jun 25;149(26):1455

Authors: Portegies P

Bell's palsy is the most frequent type of peripheral facial paresis. Its cause is unknown. The prognosis is good in 85% of patients. Based on theories about its pathogenesis, antivirals and corticosteroids have been tried. In 6 studies with antivirals and 9 with corticosteroids (most ofthe studies were methodologically flawed), the efficacy of these treatments was not demonstrated.

PMID:- Bells palsy treatment 16010957 [PubMed - indexed for MEDLINE Bells palsy treatment ]

[Arguments favouring the pharmacotherapy of Bells' palsy]

[Arguments favouring the pharmacotherapy of Bells' palsy]

Ned Tijdschr Geneeskd. 2005 Jun 25;149(26):1454

Authors: de Ru JA, van Benthem PP, Hordijk GJ

Some clinicians claim a spontaneous complete recovery of facial nerve function after Bell's palsy in more than 80% of patients. However, for elderly patients and patients with a severe paresis/paralysis this is not the case. The main cause of Bell's palsy is probably reactivation of latent herpes viruses. Recent literature supports treatment with corticosteroids and antiviral medication, inhibiting viral replication and reducing oedema in the bony canal of the facial nerve. Using this medication in the first days of the disease provides a further 15% of patients with a good outcome in addition to the ones that improve spontaneously. Therefore, prednisone and valacyclovir are recommended for all patients with Bell's palsy and severe dysfunction, i.e. House-Brackmann facial grading scale IV, V and VI.

PMID:- Bells palsy treatment 16010956 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Best evidence topic report. Do we need to give steroids in children with Bell's palsy?

Best evidence topic report. Do we need to give steroids in children with Bell's palsy?

Emerg Med J. 2005 Jul;22(7):505-7

Authors: Ashtekar CS, Joishy M, Joshi R

A short cut review was carried out to establish whether steroids are indicated in children presenting with Bell's palsy. A total of 60 papers were found using the reported search, of which three represented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

PMID:- Bells palsy treatment 15983089 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Role of T-lymphocyte subsets in facial nerve paralysis owing to the reactivation of herpes simplex virus type 1.

Role of T-lymphocyte subsets in facial nerve paralysis owing to the reactivation of herpes simplex virus type 1.

Acta Otolaryngol. 2005 Mar;125(3):316-21

Authors: Kisaki H, Hato N, Mizobuchi M, Honda N, Takahashi H, Wakisaka H, Hitsumoto Y, Yanagihara N, Gyo K

CONCLUSION: Although both T-cell subsets are essential for inhibiting HSV-1 reactivation in the GG, CD4 + T cells play a more important role in host defense against virus replication. OBJECTIVE: To elucidate the host immunological factors that participate in herpes simplex virus type 1 (HSV-1) reactivation in the geniculate ganglia (GG) and lead to facial paralysis, we developed a mouse model of facial paralysis that involved the reactivation of HSV-1 following general immune suppression. MATERIAL AND METHODS: Eight weeks after recovery from primary facial paralysis caused by inoculating the auricle with HSV-1 the auricle was scratched and mice (n = 69) were given an i.p. injection of either anti-CD4 (n = 46) or anti-CD8 (n = 23) monoclonal antibody to deplete specific T-lymphocyte subsets. Following this reactivation procedure, the rate of recurrent facial paralysis was compared between the two models. The GG were examined histopathologically and using polymerase chain reaction to detect HSV-1 DNA. RESULTS: Facial paralysis developed in 42% of mice in the anti-CD4 model and in 13% in the anti-CD8 model. HSV-1 DNA was detected in 50% of the mice in both models. Histopathologically, neurons were destroyed in parts of the GG and numerous virus particles were seen in the surviving neurons.

PMID:- Bells palsy treatment 15966705 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Bell's palsy.

Bell's palsy.

BMJ. 2005 Jun 11;330(7504):1374

Authors: Piercy J

PMID:- Bells palsy treatment 15947400 [PubMed - indexed for MEDLINE Bells palsy treatment ]

[Pediatric facial paralysis:is it a "bell" or "alarming bell"?]

[Pediatric facial paralysis:is it a "bell" or "alarming bell"?]

Duodecim. 2005;121(8):847-9

Authors: Lohi O, Kuusela AL

PMID:- Bells palsy treatment 15931828 [PubMed - indexed for MEDLINE Bells palsy treatment ]

When is facial paralysis Bell palsy? Current diagnosis and treatment.

When is facial paralysis Bell palsy? Current diagnosis and treatment.

Cleve Clin J Med. 2005 May;72(5):398-401, 405

Authors: Ahmed A

Bell palsy is largely a diagnosis of exclusion, but certain features in the history and physical examination help distinguish it from facial paralysis due to other conditions: eg, abrupt onset with complete, unilateral facial weakness at 24 to 72 hours, and, on the affected side, numbness or pain around the ear, a reduction in taste, and hypersensitivity to sounds. Corticosteroids and antivirals given within 10 days of onset have been shown to help. But Bell palsy resolves spontaneously without treatment in most patients within 6 months.

PMID:- Bells palsy treatment 15929453 [PubMed - indexed for MEDLINE Bells palsy treatment ]

[Bell palsy--evidence-based treatment?]

[Bell palsy--evidence-based treatment?]

Lakartidningen. 2005 Apr 25-May 1;102(17):1361, 1363; author reply 1363

Authors: Flodström A

PMID:- Bells palsy treatment 15921118 [PubMed - indexed for MEDLINE Bells palsy treatment ]

[Is neuroborreliosis as a cause of facial paralysis missed?]

[Is neuroborreliosis as a cause of facial paralysis missed?]

Lakartidningen. 2005 Apr 25-May 1;102(17):1361

Authors: Hagberg L, Strömberg A

PMID:- Bells palsy treatment 15921117 [PubMed - indexed for MEDLINE Bells palsy treatment ]

[Evidence-based treatment guidelines are not available, new studies are required]

[Evidence-based treatment guidelines are not available, new studies are required]

Lakartidningen. 2005 Apr 25-May 1;102(17):1358, 1361

Authors: Bertholds E

PMID:- Bells palsy treatment 15921116 [PubMed - indexed for MEDLINE Bells palsy treatment ]

[A case of brainstem encephalitis caused by herpes simplex virus type 1 with possible infection via trigeminal nerve]

[A case of brainstem encephalitis caused by herpes simplex virus type 1 with possible infection via trigeminal nerve]

Rinsho Shinkeigaku. 2005 Apr;45(4):293-7

Authors: Yoshidome Y, Hayashi S, Maruyama Y

A 24-year-old man was admitted to our hospital because of consciousness disturbance, a stiff neck and various brainstem symptoms including a right one-and-a-half syndrome and right peripheral facial palsy a week after an episode of pharyngitis and right facial herpes simplex. Magnetic resonance imaging of the brain on admission showed high-signal intensities in the right pontine tegmentum, right cerebellar peduncle and vermis on fluid-attenuated inversion recovery imaging. Examination of cerebrospinal fluid yielded mononuclear pleocytosis, elevated protein and increased IgM antibodies to herpes simplex virus (HSV) by enzyme immunoassay. HSV-1 specific antibodies also were detected in serum by neutralization test. We gave a diagnosis of brainstem encephalitis caused by HSV-1. The patient was successfully treated with high dose of acyclovir, steroid and intravenous immunoglobulin. He was discharged without any neurologic sequelae. We herein presented a case of atypical encephalitis due to HSV-1 involving mainly the brainstem with possible infection via right trigeminal nerve and summarized recent 35 cases with herpetic brainstem encephalitis since 1990.

PMID:- Bells palsy treatment 15912797 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Comparisons of steroid, acyclovir, lipoprostoglandin E1 and steroid + acyclovir treatments in facial paralysis: a rat study.

Comparisons of steroid, acyclovir, lipoprostoglandin E1 and steroid + acyclovir treatments in facial paralysis: a rat study.

Int J Pediatr Otorhinolaryngol. 2005 Sep;69(9):1199-204

Authors: Gök U, Alpay HC, Akpolat N, Yoldaş T, Kilic A, Yilmaz B, Kabakuş N

OBJECTIVE: To induce experimental peripheral facial paralysis by inoculation of HSV1 and to compare the effects of steroid, acyclovir, lipoprostoglandin E2 and steroid + acyclovir treatments in terms of clinical recovery, electrophysiologically and histopathologically. MATERIALS AND METHODS: A total of 132 adult female rats were used in this study. HSV type 1 strain was inoculated at the back of the left ear by using 27 gauge needle. Of all animals, 70 (53%) rats which developed facial paralysis were divided into five groups (n = 14 for each group) as control, steroid + acyclovir, lipoprostaglandin E1, steroid only and acyclovir only. At the end of the 21 days period, the rats were clinically examined and electrophysiological tests were performed, then decapitated and the nerve specimens were obtained. RESULTS: A modified electroneurography (ENoG) test was performed and the latencies and the amplitudes were compared. The findings of the intact side were better, but with no significant difference. Histopathologicaly edema was significantly smaller in all groups compared to the controls (p < 0.05). Similarly, no difference was seen in terms of vacuolar degeneration and Schwann cell hyperchromatisation among the groups and no significant difference in recovery period and rate of facial paralysis when all groups were compared. CONCLUSION: Facial paralysis induced by HSV1 recovered spontaneously within a week. In the treatment of facial paralysis, steroid alone, acyclovir alone, steroid + acyclovir, or lipoprostaglandin E1 all reduced edema in the infected facial nerve but there was no statistical difference in of the rate or degree of recovery.

PMID:- Bells palsy treatment 15869809 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Idiopathic facial paralysis (Bell's palsy) in the immediate puerperium in a patient with mild preeclampsia: a case report.

Idiopathic facial paralysis (Bell's palsy) in the immediate puerperium in a patient with mild preeclampsia: a case report.

Arch Gynecol Obstet. 2005 Sep;272(3):241-3

Authors: Mylonas I, Kästner R, Sattler C, Kainer F, Friese K

INTRODUCTION: Idiopathic peripheral facial palsy is the most common and frequent unilateral cranial neurological disorder characterized by an isolated facial nerve paralysis. CASE REPORT: We report a case of an idiopathic facial paralysis (Bell's palsy) in the immediate puerperium in a patient with mild preeclampsia and diagnosed fetal IUGR. Additionally, the presence of Bell's palsy in the puerperium of the mother of our patient suggests a familiar tendency. DISCUSSION: Every gynaecologist and obstetrician should be aware of this quite uncommon complication during pregnancy and the puerperium. This case report illustrates that Bell's palsy can occur in the immediate post-partum after mild preeclamptic symptoms. For these women, a maternal surveillance can be recommended. A fast and accurate diagnosis with a subsequent immediate treatment might be very important in avoiding worsening of the symptoms and therefore improve the recovery prognosis.

PMID:- Bells palsy treatment 15868184 [PubMed - indexed for MEDLINE Bells palsy treatment ]

The phenomenon of the late recovered Bell's palsy: treatment options to improve facial symmetry.

The phenomenon of the late recovered Bell's palsy: treatment options to improve facial symmetry.

Plast Reconstr Surg. 2005 May;115(6):1466-71

Authors: Bulstrode NW, Harrison DH

BACKGROUND: Bell's palsy is an idiopathic neuropathy of cranial nerve VII, and the incidence ranges from 15 to 40 per 100,000. The majority of patients recover, but up to 16 percent of patients have significant sequelae. The phenomenon of the "late recovered" Bell's palsy has the following specific features and has not formerly been described: (1) tightening of the facial muscles, with a deepening nasolabial fold and reduced palpebral fissure; (2) blepharospasm; and (3) incomplete recovery of peripheral VIIth nerve branches, with ipsilateral forehead paralysis, reduced depressor anguli oris function, and poor excursion of the angle of the mouth on smiling. METHODS: Nonsurgical treatment involved four monthly botulinum toxin injections. Patients had injections to paralyze the ipsilateral orbicularis oculi, contralateral forehead rhytides, and depressor anguli oris and to treat blepharospasm and muscle tightness. The effectiveness of the botulinum toxin injections on facial symmetry and patient appreciation of this were assessed by measuring brow height and teeth exposure before and 3 weeks after injection. RESULTS: Twenty-three patients were followed up for a mean period of 37 months. The difference in brow height and teeth exposure after injection was less than preinjection measurements, but this did not reach statistical significance. Patient self-assessments showed improvements in their appreciation of the facial symmetry, ability to go out in public, and feelings of self-worth (visual analogue scale). Surgical treatment options include ipsilateral brow lift, division of the contralateral frontal branch, contralateral tarsorrhaphy to equalize the palpebral fissures, and bilateral upper blepharoplasty. CONCLUSIONS: The true benefit of botulinum toxin injections was more apparent during facial animation and not when the face was static. The patients greatly appreciated the improvement in facial symmetry. Various treatment options are available to improve the quality of life for patients with late recovered Bell's palsy.

PMID:- Bells palsy treatment 15861048 [PubMed - indexed for MEDLINE Bells palsy treatment ]

[Treatment of facial paresis--evidence-based recommendations]

[Treatment of facial paresis--evidence-based recommendations]

Lakartidningen. 2005 Mar 7-13;102(10):744-5

Authors: Hultcrantz M

PMID:- Bells palsy treatment 15839165 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Postauricular pain with Bell's palsy.

Postauricular pain with Bell's palsy.

Nurse Pract. 2005 Apr;30(4):58-61

Authors: Frock TL, McCaffrey R

PMID:- Bells palsy treatment 15818281 [PubMed - indexed for MEDLINE Bells palsy treatment ]

When your patient has acute facial paralysis.

When your patient has acute facial paralysis.

Nursing. 2005 Apr;35(4):54-5

Authors: Carlson DS, Pfadt E

Learn to distinguish between Bell's palsy and Ramsay Hunt syndrome.

PMID:- Bells palsy treatment 15818257 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Bell's palsy associated with IFN-alpha and ribavirin therapy for hepatitis C virus infection.

Bell's palsy associated with IFN-alpha and ribavirin therapy for hepatitis C virus infection.

J Interferon Cytokine Res. 2005 Mar;25(3):174-6

Authors: Hoare M, Woodall T, Alexander GJ

First-line therapy for hepatitis C virus (HCV) infection comprises interferon-alpha (IFN-alpha) and ribavirin for 6 or 12 months. Mild complications of therapy are common, but more serious complications are rare. Three patients with chronic HCV infection, acquired through injecting drug use, developed idiopathic facial paralysis (Bell's palsy) during therapy, with spontaneous resolution after withdrawal of treatment. Large-scale cohort studies reveal that IFNs are associated rarely with neurologic complications, and only one previous report has linked IFN-alpha therapy and Bell's palsy. We postulate that IFN-alpha therapy led to a breakdown of peripheral tolerance to myelin sheath antigens, leading to neuropathy, just as IFN-alpha therapy can cause autoimmune thyroiditis through breakdown of tolerance to native thyroid antigens.

PMID:- Bells palsy treatment 15767792 [PubMed - indexed for MEDLINE Bells palsy treatment ]

[Accuracy of the prognostic diagnosis in acute peripheral facial palsy]

[Accuracy of the prognostic diagnosis in acute peripheral facial palsy]

Nippon Jibiinkoka Gakkai Kaiho. 2005 Jan;108(1):1-7

Authors: Aoyagi M

The important factors in the prognostic diagnosis of acute peripheral facial palsy are (1) the causal disease, (2) the site of injury and (3) the degree of injury, although the age of the patient, complication, treatment method and initial day of treatment are also important. Among these 3 factors, the degree of injury is most strongly related to the prognosis. However, the diagnosis of etiology is the most important for the selection of the treatment method. Above all, the differential diagnosis between Bell's palsy and zoster sine herpete (Ramsay Hunt syndrome), is the most significant. However, it is impossible to diagnose all patients with complete accuracy within 3 days after the onset of palsy, even using molecular biological examination including polymerase chain reaction analysis. The diagnosis of the site of injury does not contribute to the prediction of prognosis or the selection of treatment method, except for the determination of the approaching route of the facial nerve decompression for traumatic facial palsy. The scoring system of facial movement (40-point method), nerve excitability test (NET), electroneurography (ENoG), transcranial magnetic stimulation (TMS) and stapedial reflex (SR) are commonly used to estimate the degree of injury. To estimate the accuracy of these examinations, sensitivity and specificity of the tests were calculated according to the findings within 3 days after the onset of palsy and the outcome of 116 patients with Bell's palsy and 31 with Ramsay Hunt syndrome. According to the results, none of these tests seem to be a perfect diagnostic examination for the completely precise prediction of prognosis. However, a patient is predicted to have a good prognosis, if the following 3 findings are observed: (1) more than 10 points in the 40-point scoring system of facial movement, (2) a positive response to TMS and (3) a positive response to SR. An antidromic facial nerve response probably contributes to a precise prediction of prognosis within 3 days after the onset of facial palsy.

PMID:- Bells palsy treatment 15712490 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Neurovascularized free short head of the biceps femoris muscle transfer for one-stage reanimation of facial paralysis.

Neurovascularized free short head of the biceps femoris muscle transfer for one-stage reanimation of facial paralysis.

Plast Reconstr Surg. 2005 Feb;115(2):394-405

Authors: Hayashi A, Maruyama Y

The single-stage technique for cross-face reanimation of the paralyzed face without nerve graft is an improvement over the two-stage procedure because it results in early reinnervation of the transferred muscle and shortens the period of rehabilitation. On the basis of an anatomic investigation, the short head of the biceps femoris muscle with attached lateral intermuscular septum of the thigh was identified as a new candidate for microneurovascular free muscle transfer. The authors performed one-stage transfer of the short head of the biceps femoris muscle with a long motor nerve for reanimation of established facial paralysis in seven patients. The dominant nutrient vessels of the short head were the profunda perforators (second or third) in six patients and the direct branches from the popliteal vessels in one patient. The recipient vessels were the facial vessels in all cases. The length of the motor nerve of the short head ranged from 10 to 16 cm, and it was sutured directly to several zygomatic and buccal branches of the contralateral facial nerve in six patients. One patient required an interpositional nerve graft of 3 cm to reach the suitable facial nerve branches on the intact side. The period required for initial voluntary movement of the transferred muscles ranged from 4 to 10 months after the procedures. The period of postoperative follow-up ranged from 5 to 42 months. Transfer of the vascularized innervated short head of the biceps femoris muscle is thought to be an alternative for one-stage reconstruction of the paralyzed face because of the reliable vascular anatomy of the muscle and because it allows two teams to operate together without the need to reposition the patient. The nerve to the short head of the biceps femoris enters the side opposite the vascular pedicle of the muscle belly, and this unique relationship between the vascular pedicle and the motor nerve is anatomically suitable for one-stage reconstruction of the paralyzed face. As much as to 16 cm of the nerve can be harvested, and the nerve is long enough to reach the contralateral intact facial nerve in almost all cases. The lateral intermuscular septum, which is attached to the short head, provides "anchor/suture-bearing" tissue, allowing reliable fixations to the zygoma and the upper and lower lips to be achieved. In addition, the scar and deformity of the donor site are acceptable, and loss of this muscle does not result in donor-site dysfunction.

PMID:- Bells palsy treatment 15692342 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Bell's palsy.

Bell's palsy.

N Engl J Med. 2005 Jan 27;352(4):416-8; author reply 416-8

Authors: Djalilian HR

PMID:- Bells palsy treatment 15675101 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Bell's palsy.

Bell's palsy.

N Engl J Med. 2005 Jan 27;352(4):416-8; author reply 416-8

Authors: Magaldi JA

PMID:- Bells palsy treatment 15675099 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Bell's palsy.

Bell's palsy.

N Engl J Med. 2005 Jan 27;352(4):416-8; author reply 416-8

Authors: Stuart ME, Strite SA

PMID:- Bells palsy treatment 15673811 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Bell's palsy: a study of the treatment advice given by Neurologists.

Bell's palsy: a study of the treatment advice given by Neurologists.

J Neurol Neurosurg Psychiatry. 2005 Feb;76(2):293-4

Authors: Shaw M, Nazir F, Bone I

PMID:- Bells palsy treatment 15654059 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Bell's palsy.

Bell's palsy.

Nurs Times. 2004 Dec 7-13;100(49):32

Authors:

PMID:- Bells palsy treatment 15630969 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Use of a suture anchor for correction of ectropion in facial paralysis.

Use of a suture anchor for correction of ectropion in facial paralysis.

Plast Reconstr Surg. 2005 Jan;115(1):234-9

Authors: Hayashi A, Maruyama Y, Okada E, Ogino A

PMID:- Bells palsy treatment 15622256 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Temporary management of upper lid ptosis, lid malposition, and eyelid fissure asymmetry with botulinum toxin type A.

Temporary management of upper lid ptosis, lid malposition, and eyelid fissure asymmetry with botulinum toxin type A.

Plast Reconstr Surg. 2004 Dec;114(7):1892-902

Authors: Fagien S

During the past 10 years the primary focus for the aesthetic use of botulinum toxin has been directed to the treatment of dynamic facial lines. This agent has been shown to be very effective for the improvement of facial shape. The use of botulinum toxin type A for the correction of a variety of presentations of facial asymmetry has also been well established. The general principles regarding the counter-effects of facial muscle protagonists and antagonists and their potential effects on the position of facial soft-tissue regions apply here as well. Twenty-two patients received botulinum toxin type A for the temporary treatment of mild to moderate unilateral upper eyelid ptosis and aesthetic improvement of lower eyelid position, with favorable results. Although commonly related to a rare yet feared adverse consequence from the inappropriate application of botulinum toxin, its application for the treatment of upper eyelid ptosis, eyelid position, and other lid fissure asymmetries for aesthetic improvement is presented.

PMID:- Bells palsy treatment 15577365 [PubMed - indexed for MEDLINE Bells palsy treatment ]

[Bell's palsy in children: analysis of clinical findings and course]

[Bell's palsy in children: analysis of clinical findings and course]

No To Hattatsu. 2004 Nov;36(6):461-5

Authors: Tanaka M, Mochizuki M, Sugiyama N, Hamano S

To evaluate treatment of Bell's palsy (acute idiopathic peripheral facial nerve paralysis) of children, the authors analyzed 38 cases (18 females, 20 males) of Bell's palsy in children aged below 16 years old. The mean age of all cases was 6.8 +/- 6.2 years old. All cases resulted in complete recovery within 6 months. Clinical score of facial motor functions were adapted to 17 patients who were more than 5 years old. They were divided into two groups: early recovery group (clinical symptoms recovered within 3 months; 10 cases) and later recover group (over 3 months; 7 cases). Clinical scores evaluated in the first week from the onset were not significantly different. Steroid therapy was used for 9 patients of early group and 6 patient of later group. All patients of this study were recovered, thus we could not evaluate effect of steroid therapy for Bell's palsy in children. Use of steroid therapy for Bell's palsy needs more concretely administration. We consider how the region locates near to the center is an important prognostic factor.

PMID:- Bells palsy treatment 15560388 [PubMed - indexed for MEDLINE Bells palsy treatment ]

Bell's palsy.

Bell's palsy.

Clin Evid. 2003 Dec;(10):1504-7

Authors: Salinas R

PMID:- Bells palsy treatment 15555157 [PubMed - indexed for MEDLINE Bells palsy treatment ]