HSC Section 3 - Trauma, Critical Care and Sleep Medicine

Medical Management of Acute Facial Paralysis

show that after crush injury, stimulation of a motor nerve proximal to the injury im- proves recovery. 94 At this time, there is no evidence to suggest that E-stim is beneficial in acute FP. 87 Some studies show a decreased time to recovery with no difference af- ter 6 months. Overall, there was a trend toward more motor synkinesis (not statistically significant) 85 and thus E-stim is not currently recommended. Psychological counseling Many patients with FP suffer some element of distress and depression. 95 Our faces and facial expressions are intimately tied to how we perceive ourselves and how others perceive us. Alongside the functional and aesthetic changes, there is also un- certainty and grief in the acute setting. Patients may benefit from individual counseling or a FP support group. 1. Peitersen E. Bell’s palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl 2002;(549):4–30 . 2. Hohman MH, Hadlock TA. Etiology, diagnosis, and management of facial palsy: 2000 patients at a facial nerve center. Laryngoscope 2014;124(7):E283–93 . 3. Adour KK, Byl FM, Hilsinger RL Jr, et al. The true nature of Bell’s palsy: analysis of 1,000 consecutive patients. Laryngoscope 1978;88(5):787–801 . 4. Devriese PP, Schumacher T, Scheide A, et al. Incidence, prognosis and recovery of Bell’s palsy. A survey of about 1000 patients (1974-1983). Clin Otolaryngol Al- lied Sci 1990;15(1):15–27 . 5. Bell C. On the nerves; giving an account of some experiments on their structure and functions, which lead to a new arrangement of the system. Philos Trans R Soc Lond 1821;111:398–424 . 6. Bird TD, Nicolaus A. Friedreich’s description of peripheral facial nerve paralysis in 1798. J Neurol Neurosurg Psychiatry 1979;42(1):56–8 . 7. Vrabec JT. The facial nerve. In: Slattery WH, Azizzadeh B, editors. Medical treat- ment of bell palsy. New York: Thieme; 2014 . 8. De Diego JI, Prim MP, Madero R, et al. Seasonal patterns of idiopathic facial pa- ralysis: a 16-year study. Otolaryngol Head Neck Surg 1999;120(2):269–71 . 9. Yanagihara N. Incidence of Bell’s palsy. Ann Otol Rhinol Laryngol Suppl 1988; 137:3–4 . 10. Campbell KE, Brundage JF. Effects of climate, latitude, and season on the inci- dence of Bell’s palsy in the US Armed Forces, October 1997 to September 1999. Am J Epidemiol 2002;156(1):32–9 . 11. Adour KK, Bell DN, Hilsinger RL Jr. Herpes simplex virus in idiopathic facial pa- ralysis (Bell palsy). JAMA 1975;233(6):527–30 . 12. Murakami S, Hato N, Mizobuchi M, et al. Role of herpes simplex virus infection in the pathogenesis of facial paralysis in mice. Ann Otol Rhinol Laryngol 1996; 105(1):49–53 . 13. Murakami S, Mizobuchi M, Nakashiro Y, et al. Bell palsy and herpes simplex virus: identification of viral DNA in endoneurial fluid and muscle. Ann Intern Med 1996; 124(1 Pt 1):27–30 . 14. Furuta Y, Fukuda S, Suzuki S, et al. Detection of varicella-zoster virus DNA in pa- tients with acute peripheral facial palsy by the polymerase chain reaction, and its use for early diagnosis of zoster sine herpete. J Med Virol 1997;52(3):316–9 . 15. McCormick DP. Herpes-simplex virus as a cause of Bell’s palsy. Lancet 1972; 1(7757):937–9 . REFERENCES

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