HSC Section 3 - Trauma, Critical Care and Sleep Medicine

Medical Management of Acute Facial Paralysis

except for those in Lyme-endemic areas where serology should always be sent. In cases of bilateral FP, or if there is suspicion for other autoimmune or infectious causes, targeted laboratory testing (eg, HIV, ANA, ESR), or CSF testing should be done. Imaging Acute FP with a history and physical consistent with BP does not require imaging. If the paralysis does not resolve or improve within 4 months, CT or MRI with contrast should be ordered to rule out a facial nerve tumor. Electrodiagnostic Testing Electrodiagnostic testing may be considered in patients with acute and complete flaccid FP secondary to BP or nondisplaced temporal bone fractures. Testing con- sists of electroneuronography (ENoG) and electromyography (EMG). Acute surgical decompression is indicated for patients with ENoG showing more than 90% decrease in the maximum amplitude of a suprathreshold evoked compound muscle action potential in comparison with the healthy side and absent voluntary motor unit action potentials on EMG within 4 to 14 days of FP onset (see Dr. Daniel Q. Sun and colleagues’ article, “ Surgical Management of Acute Facial Palsy ,” in this issue, for further details.)

MEDICAL THERAPY FOR BELL PALSY

The medical treatment plan for patients with acute FP should be multimodal and multi- disciplinary ( Fig. 4 , Table 2 ).

Fig. 4. Algorithm for evaluation of patient with acute FP. CT, computed tomography; FP, facial paralysis; f/u, follow-up; MCF, middle cranial fossa; MRI, magnetic resonance imaging; PT, physical therapy; Q, every.

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