HSC Section 3 - Trauma, Critical Care and Sleep Medicine

Reprinted by permission of Otolaryngol Clin North Am. 2018; 51(6):1051-1075.

Medi cal Management of Acute Fac ial Paralys i s

Teresa M. O, MD, MArch

KEYWORDS Acute facial paralysis Bell palsy Facial paresis Medical therapy Corticosteroids Antiviral therapy Physical therapy

KEY POINTS

Acute facial paralysis occurs within hours to days, and the most common cause is viral- associated Bell palsy, which is a diagnosis of exclusion. A complete history and physical examination are essential to making a diagnosis. Therapy is multimodal and multidisciplinary; medical therapy, meticulous eye care, and physical therapy are important. Depending on the etiology, surgery also plays a role. High-dose corticosteroids are the cornerstone of medical therapy. Absence of recovery after 4 months should prompt further diagnostic workup.

Acute facial paralysis (FP) describes acute onset of partial or complete weakness of the facial muscles innervated by the facial nerve. Acute FP occurs within a few hours to days. Bilateral acute FP is possible, but rare. The differential diagnosis ( Table 1 ) of acute FP is broad; however, the most common cause is viral-associated Bell palsy (BP). 1 A comprehensive history (age, time course, associated symptoms, and medical history) and physical examination are essential in arriving at a diagnosis.

HISTORY

The importance of a thorough history cannot be overstated. Acute FP is a devastating event that causes aesthetic, functional, and psychological issues. Patients are very precise in the time/date or date range during which paralysis occurred. They will also be able to relay any events leading up to or after the paralysis. Viral-associated acute FP (BP) is the most common cause and may be associated with a prodrome and fully evolve over 1 to 3 days. Any history of recent travel, infec- tion, or tick exposures may suggest other infectious causes. Recent head trauma and

Disclosure Statement: The author has nothing to disclose. Facial Nerve Center, Vascular Birthmark Institute of New York, Department of Otolaryngology- Head and Neck Surgery, Manhattan Eye, Ear, and Throat Hospital, Lenox Hill Hospital, 210 East 64th Street, 7th Floor, New York, New York, 10065, USA E-mail address: to@vbiny.org

Otolaryngol Clin N Am 51 (2018) 1051–1075 https://doi.org/10.1016/j.otc.2018.07.004 0030-6665/18/ ª 2018 Elsevier Inc. All rights reserved.

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