Task force of the Brazilian Society of Otology — evaluation and management of peripheral facial palsy

Abstract

Objective

To review key evidence-based recommendations for the diagnosis and treatment of peripheral facial palsy in children and adults.

Methods

Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on peripheral facial palsy were eligible for inclusion. The American College of Physicians’ guideline grading system and the American Thyroid Association’s guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions.

Results

The topics were divided into 2 main parts: (1) Evaluation and diagnosis of facial palsy: electrophysiologic tests, idiopathic facial palsy, Ramsay Hunt syndrome, traumatic peripheral facial palsy, recurrent peripheral facial palsy, facial nerve tumors, and peripheral facial palsy in children; and (2) Rehabilitation procedures: surgical decompression of the facial nerve, facial nerve grafting, surgical treatment of long-term peripheral facial palsy, and non-surgical rehabilitation of the facial nerve.

Conclusions

Peripheral facial palsy is a condition of diverse etiology. Treatment should be individualized according to the cause of facial nerve dysfunction, but the literature presents better evidence-based recommendations for systemic corticosteroid therapy.

Keywords
Facial palsy; Facial paralysis; Bell palsy; Facial nerve disease; Herpes Zoster Oticus; Facial nerve trauma; Microvascular decompression surgery; Guidelines

Highlights

This is an evidence-based review on the recommendations for the diagnosis and treatment of Peripheral Facial Palsy (PFP).

The diagnosis of PFP is based on epidemiological data, medical history, and physical examination.

As the nerve regenerate, neural desynchronization and muscle depolarization occurs at different intervals.

Surgical decompression of the facial nerve is suggested when electrophysiologic testing shows degeneration greater than 90%.