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The Cochrane Database of Systematic... Oct 2007Bell's palsy or idiopathic facial palsy is an acute facial paralysis due to inflammation of the facial nerve. A number of studies published in China have suggested... (Review)
Review
BACKGROUND
Bell's palsy or idiopathic facial palsy is an acute facial paralysis due to inflammation of the facial nerve. A number of studies published in China have suggested acupuncture is beneficial for facial palsy.
OBJECTIVES
The objective of this review was to examine the efficacy of acupuncture in hastening recovery and reducing long-term morbidity from Bell's palsy.
SEARCH STRATEGY
We searched the Cochrane Neuromuscular Disease Group Trials Register, MEDLINE (January 1966 to April 2006), EMBASE (January 1980 to April 2006), LILACS (from January 1982 to April 2006) and the Chinese Biomedical Retrieval System (January 1978 to April 2006) for randomised controlled trials using 'Bell's palsy' and its synonyms, 'idiopathic facial paralysis' or 'facial palsy' as well as search terms including 'acupuncture'. Chinese journals in which we thought we might find randomised controlled trials or controlled clinical trials relevant to our study were handsearched. We reviewed the bibliographies of the randomised trials and contacted the authors and known experts in the field to identify additional published or unpublished data.
SELECTION CRITERIA
We included all randomised or quasi-randomised controlled trials involving acupuncture in the treatment of Bell's palsy irrespective of any language restrictions.
DATA COLLECTION AND ANALYSIS
Two review authors identified potential articles from the literature search and extracted data independently using a data extraction form. The assessment of methodological quality included allocation concealment, patient blinding, differences at baseline of the experimental groups and completeness of follow-up. Two review authors assessed quality independently. All disagreements were resolved by discussion between the review authors.
MAIN RESULTS
Six studies including a total of 537 participants met the inclusion criteria. Five of them used acupuncture while another one used acupuncture combined with drugs. No trials reported on the outcomes specified for this review. Harmful side effects were not reported in any of the trials. Flaws in study design or reporting (particularly uncertain allocation concealment and substantial loss to follow-up) and clinical differences between trials prevented conclusions about the efficacy of acupuncture.
AUTHORS' CONCLUSIONS
The quality of the included trials was inadequate to allow any conclusion about the efficacy of acupuncture. More research with high quality trials is needed.
Topics: Acupuncture Therapy; Bell Palsy; Combined Modality Therapy; Humans; Randomized Controlled Trials as Topic
PubMed: 17943775
DOI: 10.1002/14651858.CD002914.pub3 -
The Cochrane Database of Systematic... 2004Bell's palsy or idiopathic facial palsy is an acute facial paralysis due to inflammation of the facial nerve. A number of studies published in China have suggested... (Review)
Review
BACKGROUND
Bell's palsy or idiopathic facial palsy is an acute facial paralysis due to inflammation of the facial nerve. A number of studies published in China have suggested acupuncture is beneficial for facial palsy.
OBJECTIVES
The objective of this review was to examine the efficacy of acupuncture in hastening recovery and reducing long-term morbidity from Bell's palsy.
SEARCH STRATEGY
We searched the Cochrane Neuromuscular Disease Group Register, MEDLINE (January 1966 to December 2002), EMBASE (January 1980 to December 2002), LILACS (from January 1982 to December 2002) and the Chinese Biomedical Retrieval System (January 1978 to December 2002) for randomised controlled trials using 'Bell's palsy' and its synonyms, 'idiopathic facial paralysis' or 'facial palsy' as well as search terms including 'acupuncture'. Chinese journals in which we thought we might find randomised controlled trials or controlled clinical trials relevant to our study were handsearched. We reviewed the bibliographies of the randomised trials and contacted the authors and known experts in the field to identify additional published or unpublished data.
SELECTION CRITERIA
We included all randomised or quasi-randomised controlled trials involving acupuncture in the treatment of Bell's palsy irrespective of any language restrictions.
DATA COLLECTION AND ANALYSIS
Two reviewers identified potential articles from the literature search and extracted data independently using a data extraction form. The assessment of methodological quality included allocation concealment, patient blinding, differences at baseline of the experimental groups and completeness of follow-up. Two reviewers assessed quality independently. All disagreements were resolved by discussion between the reviewers.
MAIN RESULTS
Three studies including a total of 238 patients met the inclusion criteria. Two of them used acupuncture while the third used acupuncture combined with drugs. No trials reported on the outcomes specified for this review. Three included studies showed that the therapeutic effect of acupuncture alone was superior to that of medication or that acupuncture combined with medication was better than medication alone. Harmful side-effects were not reported in any of the trials. Flaws in study design or reporting (particularly uncertain allocation concealment and substantial loss to follow-up) and clinical differences between trials prevented a meta-analysis.
REVIEWER'S CONCLUSIONS
The quality of the included trials was inadequate to allow any conclusion about the efficacy of acupuncture. More research with high quality trials is needed.
Topics: Acupuncture Therapy; Bell Palsy; Combined Modality Therapy; Humans; Randomized Controlled Trials as Topic
PubMed: 14973996
DOI: 10.1002/14651858.CD002914.pub2 -
Clinical Evidence Dec 2002
Review
Topics: Acyclovir; Adrenal Cortex Hormones; Adult; Bell Palsy; Child; Decompression, Surgical; Facial Nerve; Humans; Prednisone
PubMed: 12603941
DOI: No ID Found -
The American Journal of Case Reports Sep 2022BACKGROUND Bell's palsy, also called facial nerve palsy, occasionally co-occurs with trigeminal neuropathy, which presents as additional facial sensory symptoms and/or... (Review)
Review
BACKGROUND Bell's palsy, also called facial nerve palsy, occasionally co-occurs with trigeminal neuropathy, which presents as additional facial sensory symptoms and/or neck pain. Bell's palsy has a proposed viral etiology, in particular when occurring after dental manipulation. CASE REPORT A 52-year-old Asian woman presented to a chiropractor with a 3-year history of constant neck pain and left-sided maxillary, eyebrow, and temporomandibular facial pain, paresis, and paresthesia, which began after using a toothpick, causing possible gum trauma. She had previously been treated with antiviral medication and prednisone, Chinese herbal medicine, and acupuncture, but her recovery plateaued at 60% after 1 year. The chiropractor ordered cervical spine magnetic resonance imaging, which demonstrated cervical spondylosis, with no evidence of myelopathy or major pathology. Treatment involved cervical and thoracic spinal manipulation, cervical traction, soft-tissue therapy, and neck exercises. The patient responded positively. At 1-month follow-up, face and neck pain and facial paresis were resolved aside from residual eyelid synkinesis. A literature review identified 12 additional cases in which chiropractic spinal manipulation with multimodal therapies was reported to improve Bell's palsy. Including the current case, 85% of these patients also had pain in the face or neck. CONCLUSIONS This case illustrates improvement of Bell's palsy and concurrent trigeminal neuropathy with multimodal chiropractic care including spinal manipulation. Limited evidence from other similar cases suggests a role of the trigeminal pathway in these positive treatment responses of Bell's palsy with concurrent face/neck pain. These findings should be explored with research designs accounting for the natural history of Bell's palsy.
Topics: Antiviral Agents; Bell Palsy; Chiropractic; Drugs, Chinese Herbal; Facial Pain; Facial Paralysis; Female; Humans; Middle Aged; Neck Pain; Prednisone; Trigeminal Nerve Diseases
PubMed: 36117309
DOI: 10.12659/AJCR.937511 -
Obstetrical & Gynecological Survey Mar 2000The aim of the present work was to review the published evidence on the association of Bell palsy (BP), an acute idiopathic peripheral facial paralysis of unknown... (Review)
Review
UNLABELLED
The aim of the present work was to review the published evidence on the association of Bell palsy (BP), an acute idiopathic peripheral facial paralysis of unknown etiology, with pregnancy. Reports have shown that women of reproductive age are affected two to four times more often than men of the same age, and pregnant women 3.3 times more often than nonpregnant women. The apparent predisposition of pregnant women to Bell palsy has been attributed to the high extracellular fluid content, viral inflammation, and immunosuppression characteristic of pregnancy, but findings are controversial. Most cases of Bell palsy occur in the third trimester or the puerperium. Onset is acute and painful. Some authors suggest that Bell palsy increases the risk of hypertension and toxemia of pregnancy, whereas the pregnant state, in turn, may affect the course and severity of disease. Recovery is usually good; poor prognostic markers are recurrence in subsequent pregnancy and bilateral disease, both of which are rare. Neonatal outcome is apparently unaffected, although this has been studied rarely. The preferred mode of management remains undecided; it is usually confined to supportive care. Corticosteroids in pregnancy are controversial. We think clinicians should be aware of these findings to avoid unnecessary testing and treatment and to help the patient cope with this acute, painful disease.
TARGET AUDIENCE
Obstetricians & Gynecologists, Family Physicians
LEARNING OBJECTIVES
After completion of this article, the reader will be able to identify the potential etiologies of Bell palsy associated with pregnancy and to describe the clinical presentation of this condition in pregnancy and its likelihood for recovery.
Topics: Adrenal Cortex Hormones; Bell Palsy; Diagnosis, Differential; Female; Humans; Male; Pregnancy; Pregnancy Complications; Prognosis; Recurrence; Risk Factors; Sex Factors
PubMed: 10713984
DOI: 10.1097/00006254-200003000-00027 -
Family Practice Dec 2014Spontaneous idiopathic facial nerve (Bell's) palsy leaves residual hemifacial weakness in 29% which is severe and disfiguring in over half of these cases. Acute medical... (Review)
Review
Spontaneous idiopathic facial nerve (Bell's) palsy leaves residual hemifacial weakness in 29% which is severe and disfiguring in over half of these cases. Acute medical management remains the best way to improve outcomes. Reconstructive surgery can improve long term disfigurement. However, acute and surgical options are time-dependent. As family practitioners see, on average, one case every 2 years, a summary of this condition based on common clinical questions may improve acute management and guide referral for those who need specialist input. We formulated a series of clinical questions likely to be of use to family practitioners on encountering this condition and sought evidence from the literature to answer them. The lifetime risk is 1 in 60, and is more common in pregnancy and diabetes mellitus. Patients often present with facial pain or paraesthesia, altered taste and intolerance to loud noise in addition to facial droop. It is probably caused by ischaemic compression of the facial nerve within the meatal segment of the facial canal probably as a result of viral inflammation. When given early, high dose corticosteroids can improve outcomes. Neither antiviral therapy nor other adjuvant therapies are supported by evidence. As the facial muscles remain viable re-innervation targets for up to 2 years, late referrals require more complex reconstructions. Early recognition, steroid therapy and early referral for facial reanimation (when the diagnosis is secure) are important features of good management when encountering these complex cases.
Topics: Acute Disease; Adrenal Cortex Hormones; Algorithms; Bell Palsy; Chronic Disease; Comorbidity; Databases, Bibliographic; Diabetes Mellitus; Diagnosis, Differential; Disease Progression; Evidence-Based Practice; Facial Nerve; Female; Humans; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications, Infectious; Prevalence; Referral and Consultation; Time-to-Treatment
PubMed: 25208543
DOI: 10.1093/fampra/cmu058 -
BMJ Case Reports Jun 2022A man in his 70s presented with a 4-day history of bilateral frontal headache and heaviness of the face. He was unable to close either of his eyes, to wrinkle his...
A man in his 70s presented with a 4-day history of bilateral frontal headache and heaviness of the face. He was unable to close either of his eyes, to wrinkle his forehead bilaterally and to raise either corner of his mouth. The patient was admitted with a diagnosis of bilateral facial palsy. From history, epidemiology, physical and laboratory findings, Bell's palsy was considered more probable than viral infection, Guillain-Barré syndrome and sarcoidosis. Oral administration of prednisolone, valacyclovir and mecobalamin were initiated promptly, which improved his symptoms. In areas in which Lyme disease is not endemic, we believe that Bell's palsy is the most probable cause of isolated bilateral facial palsy. Patients with bilateral facial paralysis under the suspicion of Bell's palsy should be immediately started on steroid therapy.
Topics: Bell Palsy; Facial Paralysis; Guillain-Barre Syndrome; Humans; Male; Prednisolone; Valacyclovir
PubMed: 35688576
DOI: 10.1136/bcr-2022-250364 -
Nederlands Tijdschrift Voor Geneeskunde Aug 2023Peripheral facial palsy is a common clinical symptom and is most often caused by Bell's palsy. The pathogenesis is largely unknown, but inflammation of the facial nerve,...
Peripheral facial palsy is a common clinical symptom and is most often caused by Bell's palsy. The pathogenesis is largely unknown, but inflammation of the facial nerve, possibly after a viral infection, may play a role. Bell's palsy has a monophasic course with usually - but not always - a good recovery. Even though Bell's palsy exhibits clear clinical features, in clinical practice diagnosis and choice of treatment remain difficult and other causes of an isolated facial palsy may easily be overlooked.
Topics: Humans; Bell Palsy; Facial Paralysis; Diagnosis, Differential; Facial Nerve; Inflammation
PubMed: 38205976
DOI: No ID Found -
The Turkish Journal of Pediatrics 2020Idiopathic facial paralysis or Bell`s palsy is the most common type of peripheral facial paralysis. Children with Bell`s palsy is an uneasy situation for the family and...
BACKGROUND
Idiopathic facial paralysis or Bell`s palsy is the most common type of peripheral facial paralysis. Children with Bell`s palsy is an uneasy situation for the family and physician with questions about the etiology, treatment options and the healing process. Here, we aimed to compare the epidemiologic features and prognostic factors of patients with Bell`s palsy aged < 18 years.
METHODS
Records of patients with Bell`s palsy who were admitted to our clinic between January 2008 and December 2017 were evaluated.
RESULTS
Forty-seven patients with Bell`s palsy were included to this study. The patients` ages varied between 7 and 17 (14.7±2.5) years. At the end of at least 6 months of follow-up, 32 (68.1%) of the patients presented with House Brackmann (HB) grade 1 facial paralysis, while 12 (25.5%) of them had grade 2 and 3 (6.4%) of them had grade 3 facial paralysis. Mean neutrophil-to-lymphocyte ratio (NLR) in patients with advanced grades (grade 4, 5, 6) was higher, compared to that of patients with grade 2 and 3 (4.10 ± 1.06 vs 1.34 ± 1.02 (p < 0.001).
CONCLUSIONS
In our study, the response rate to treatment was high. In differential diagnosis, congenital anomalies, malignancy, trauma, middle ear infection and surgery should be considered. In addition, NLR at admission can be considered as a prognostic factor.
Topics: Adolescent; Bell Palsy; Child; Facial Paralysis; Humans; Lymphocytes; Prognosis; Treatment Outcome
PubMed: 33372441
DOI: 10.24953/turkjped.2020.06.014 -
Laryngo- Rhino- Otologie Dec 2021The purpose of this review is to report the knowledge for otolaryngologists on standard of care, latest advances, interesting new findings and controversies about the... (Review)
Review
The purpose of this review is to report the knowledge for otolaryngologists on standard of care, latest advances, interesting new findings and controversies about the treatment of Bell's palsy. This review is focusing on the acute phase of the disease. The chronic phase, with incomplete, incorrect or no recovery of the palsy, is described briefly. Treatment with prednisolone alone within 72 hours after onset still is the cornerstone of the treatment. The role of antivirals still is unclear. Since 2009 no new and breakthrough clinical trials with influence on the treatment standards have been performed. A study to clarify the role of prednisolone treatment in children is ongoing. Patient-related outcome measures like the Facial Clinimetric Evaluation Scale and the Facial Disability Index are important tools to assess the subjective severity of the disease and psychosocial impact of Bell's palsy next to the motor deficits. Simplified subjective electronic grading systems like the eFACE and first automated image analysis systems have been introduced. Studies clarifying the role of antivirals for severe cases are urgently needed as well as studies on the role of salvage second line therapy after insufficient response to initial corticosteroid treatment. An international consensus on the outcome measures in diagnostics and follow-up is also needed.
Topics: Antiviral Agents; Bell Palsy; Child; Drug Therapy, Combination; Facial Paralysis; Humans; Prednisolone
PubMed: 34826861
DOI: 10.1055/a-1529-3582