Editing Bell's palsy (section)

==Treatment==
Steroids are effective at improving recovery in Bell's palsy while antivirals have not.<ref name=CPG2013/> In those who are unable to close their eyes, eye-protective measures are required.<ref name=CPG2013>{{cite journal | vauthors = Baugh RF, Basura GJ, Ishii LE, Schwartz SR, Drumheller CM, Burkholder R, Deckard NA, Dawson C, Driscoll C, Gillespie MB, Gurgel RK, Halperin J, Khalid AN, Kumar KA, Micco A, Munsell D, Rosenbaum S, Vaughan W | display-authors = 6 | title = Clinical practice guideline: Bell's Palsy executive summary | journal = Otolaryngology–Head and Neck Surgery | volume = 149 | issue = 5 | pages = 656–63 | date = November 2013 | pmid = 24190889 | doi = 10.1177/0194599813506835 | s2cid = 25468987 }}</ref> Management during pregnancy is similar to management in the non-pregnant.<ref name=Preg2017/>

===Steroids===
[[Corticosteroid]]s such as [[prednisone]] improve recovery at 6 months and are thus recommended.<ref name="ReferenceA">{{cite journal | vauthors = Madhok VB, Gagyor I, Daly F, Somasundara D, Sullivan M, Gammie F, Sullivan F | title = Corticosteroids for Bell's palsy (idiopathic facial paralysis) | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | pages = CD001942 | date = July 2016 | issue = 7 | pmid = 27428352 | pmc = 6457861 | doi = 10.1002/14651858.CD001942.pub5 }}</ref> Early treatment (within 3 days after the onset) is necessary for benefit<ref name="Surgery09"/> with a 14% greater probability of recovery.<ref name="Evidence-based guideline update: st">{{cite journal | vauthors = Gronseth GS, Paduga R | title = Evidence-based guideline update: steroids and antivirals for Bell palsy: report of the Guideline Development Subcommittee of the American Academy of Neurology | journal = Neurology | volume = 79 | issue = 22 | pages = 2209–13 | date = November 2012 | pmid = 23136264 | doi = 10.1212/WNL.0b013e318275978c | doi-access = free }}</ref> There is some debate regarding the optimal dosing strategy which is generally physician dependent.<ref>{{Cite journal |last1=Gupta |first1=Keshav Kumar |last2=Balai |first2=Edward |last3=Tang |first3=Ho Tsun |last4=Ahmed |first4=Abiya Amna |last5=Doshi |first5=Jayesh R. |date=2023-04-01 |title=Comparing the Use of High-Dose to Standard-Dose Corticosteroids for the Treatment of Bell's Palsy in Adults-A Systematic Review and Meta-analysis |url=https://pubmed.ncbi.nlm.nih.gov/36706448 |journal=Otology & Neurotology|volume=44 |issue=4 |pages=310–316 |doi=10.1097/MAO.0000000000003823 |issn=1537-4505 |pmid=36706448|s2cid=256326046 }}</ref>

===Antivirals===
One review found that [[antivirals]] (such as [[aciclovir]]) are ineffective in improving recovery from Bell's palsy beyond steroids alone in mild to moderate disease.<ref name="Antiviral treatment of Bell's palsy">{{cite journal | vauthors = Turgeon RD, Wilby KJ, Ensom MH | title = Antiviral treatment of Bell's palsy based on baseline severity: a systematic review and meta-analysis | journal = The American Journal of Medicine | volume = 128 | issue = 6 | pages = 617–28 | date = June 2015 | pmid = 25554380 | doi = 10.1016/j.amjmed.2014.11.033 }}</ref> Another review found a benefit when combined with corticosteroids but stated the evidence was not very good to support this conclusion.<ref name=Gag2015 />

In severe disease, it is also unclear. One 2015 review found no effect regardless of severity.<ref name="Antiviral treatment of Bell's palsy"/> Another review found a small benefit when added to steroids.<ref name=Gag2015/>

They are commonly prescribed due to a theoretical link between Bell's palsy and the [[herpes simplex]] and [[varicella zoster virus]].<ref name="Sullivan-NEJM">{{cite journal | vauthors = 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 | display-authors = 6 | title = Early treatment with prednisolone or acyclovir in Bell's palsy | journal = The New England Journal of Medicine | volume = 357 | issue = 16 | pages = 1598–607 | date = October 2007 | pmid = 17942873 | doi = 10.1056/NEJMoa072006 | s2cid = 3916563 | doi-access = free }}</ref> There is still the possibility that they might result in a benefit less than 7% as this has not been ruled out.<ref name="Evidence-based guideline update: st"/>

===Eye protection===
When Bell's palsy affects the blink reflex and stops the eye from closing completely, frequent use of tear-like eye drops or eye ointments is recommended during the day, and protecting the eyes with patches or taping them shut is recommended for sleep and rest periods.<ref name=garro_2018/><ref name=OTC-Drops>{{cite web| vauthors = Stephenson M |title=OTC Drops: Telling the Tears Apart |url=https://www.reviewofophthalmology.com/article/otc-drops-telling-the-tears-apart |website=Review of Ophthalmology |publisher=Jobson Medical Information LLC |date=October 4, 2012 | access-date=April 16, 2019}}</ref>

===Physiotherapy===
[[Physiotherapy]] can be beneficial to some individuals with Bell's palsy as it helps to maintain [[muscle tone]] of the affected [[facial muscles]] and stimulate the [[facial nerve]].<ref name="ninds">{{cite web | url = http://www.ninds.nih.gov/disorders/bells/detail_bells.htm| title = Bell's Palsy Fact Sheet | access-date = 2011-05-12 | date = April 2003 | author = National Institute of Neurological Disorders and Stroke (NINDS)| archive-url=https://web.archive.org/web/20110408004237/http://www.ninds.nih.gov/disorders/bells/detail_bells.htm | archive-date= 8 April 2011 | url-status= live}}</ref> It is important that muscle re-education exercises and [[soft tissue technique]]s be implemented before recovery to help prevent permanent [[contractures]] of the [[Paralysis|paralyzed]] facial muscles.<ref name="ninds"/> To reduce [[pain]], heat can be applied to the affected side of the face.<ref>{{cite journal | vauthors = Shafshak TS | title = The treatment of facial palsy from the point of view of physical and rehabilitation medicine | journal = Europa Medicophysica | volume = 42 | issue = 1 | pages = 41–47 | date = March 2006 | pmid = 16565685 }}</ref> There is no high-quality evidence to support the role of electrical stimulation for Bell's palsy.<ref>{{cite journal | vauthors = Teixeira LJ, Valbuza JS, Prado GF | title = Physical therapy for Bell's palsy (idiopathic facial paralysis) | journal = The Cochrane Database of Systematic Reviews | issue = 12 | pages = CD006283 | date = December 2011 | pmid = 22161401 | doi = 10.1002/14651858.CD006283.pub3 }}</ref>

===Surgery===
Surgery may be able to improve outcomes in facial nerve palsy that has not recovered.<ref name=Surgery09>{{cite journal | vauthors = Hazin R, Azizzadeh B, Bhatti MT | title = Medical and surgical management of facial nerve palsy | journal = Current Opinion in Ophthalmology | volume = 20 | issue = 6 | pages = 440–50 | date = November 2009 | pmid = 19696671 | doi = 10.1097/ICU.0b013e3283313cbf | s2cid = 45094564 }}</ref> A number of different techniques exist.<ref name=Surgery09/> [[Smile surgery]] or smile reconstruction is a surgical procedure that may restore the smile for people with facial nerve paralysis. Adverse effects include hearing loss which occurs in 3–15% of people.<ref name="AFP2007">{{cite journal|vauthors=Tiemstra JD, Khatkhate N|date=October 2007|title=Bell's palsy: diagnosis and management|journal=American Family Physician|volume=76|issue=7|pages=997–1002|pmid=17956069}}</ref> A Cochrane review (updated in 2021), after reviewing applicable [[Randomized controlled trial|randomized and quasi-randomized controlled trials]] was unable to determine if early surgery is beneficial or harmful.<ref>{{Cite journal|last1=Menchetti|first1=Isabella|last2=McAllister|first2=Kerrie|last3=Walker|first3=David|last4=Donnan|first4=Peter T.|date=January 26, 2021|title=Surgical interventions for the early management of Bell's palsy|journal=The Cochrane Database of Systematic Reviews|volume=1|issue=1 |pages=CD007468|doi=10.1002/14651858.CD007468.pub4|issn=1469-493X|pmid=33496980|pmc=8094225}}</ref> As of 2007 the [[American Academy of Neurology]] did not recommend surgical decompression.<ref name=AFP2007/>

===Alternative medicine===
The efficacy of [[acupuncture]] remains unknown because the available studies are of low quality (poor primary study design or inadequate reporting practices).<ref name="acupuncture">{{cite journal | vauthors = Chen N, Zhou M, He L, Zhou D, Li N | title = Acupuncture for Bell's palsy | journal = The Cochrane Database of Systematic Reviews | issue = 8 | pages = CD002914 | date = August 2010 | volume = 2010 | pmid = 20687071 | pmc = 7133542 | doi = 10.1002/14651858.CD002914.pub5 | veditors = He L }}</ref> There is very tentative evidence for [[hyperbaric oxygen therapy]] in severe disease.<ref>{{cite journal | vauthors = Holland NJ, Bernstein JM, Hamilton JW | title = Hyperbaric oxygen therapy for Bell's palsy | journal = The Cochrane Database of Systematic Reviews | volume = 2 | issue = 2 | pages = CD007288 | date = February 2012 | pmid = 22336830 | doi = 10.1002/14651858.CD007288.pub2 | pmc = 8406519 }}</ref>