Evidence reviews
Bell's palsy or idiopathic facial palsy is the most common disorder affecting the facial nerves and results in weakness or paralysis on one side of the face. The paralysis causes distortion of the face and interferes with normal functions, such as closing the eye and eating. It is thought to be caused by inflammation of the facial nerve.
Bell’s palsy is a paralysis of the muscles of the face, usually on one side, that has no known underlying cause. The symptoms probably occur when a nerve in the face is trapped and swollen. People with Bell's palsy generally recover but there is a small group who do not. Some surgeons have thought that an operation to free the nerve could improve recovery. We did this review to assess the effects of surgery for Bell's palsy compared with no treatment, other types of surgery, sham (fake) treatment or treatment with medicines.
Bell's palsy is a weakness of one side of the face that is diagnosed after other causes of facial weakness have been ruled out. It is a 'diagnosis of exclusion'. Bell's palsy may be caused by a virus affecting the facial nerve. Standard treatment includes steroids to help settle swelling of the facial nerve, whereas antiviral treatment does not appear to help. In hyperbaric oxygen therapy, the person undergoing treatment breathes 100% oxygen in a pressurised chamber for about one hour (called a 'dive'). This may produce more dissolved oxygen in the facial nerve and might reduce nerve damage in Bell's palsy. We searched for evidence from randomised controlled trials on hyperbaric oxygen therapy in adults with moderate to severe Bell's palsy. Our searches revealed no trials that met the inclusion criteria for the review. We found very low quality evidence from one trial to suggest that hyperbaric oxygen therapy might be beneficial for moderate to severe Bell's palsy. The trial involved 79 participants and compared hyperbaric oxygen therapy to prednisone, a corticosteroid, which is a proven active treatment. The participants did not know which treatment they were being given. Those treated with hyperbaric oxygen recovered more quickly and recovered normal facial movement more often (95% versus 76%). All participants tolerated the treatment well, and there were no major complications. The quality of evidence from this trial was very low because the assessors of facial function were aware of which treatment each participant had been given, which introduces a high risk of bias. There is therefore no high quality evidence on which to base conclusions about the efficacy of hyperbaric oxygen therapy in Bell's palsy.
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Summaries for consumers
Bell's palsy or idiopathic facial palsy is the most common disorder affecting the facial nerves and results in weakness or paralysis on one side of the face. The paralysis causes distortion of the face and interferes with normal functions, such as closing the eye and eating. It is thought to be caused by inflammation of the facial nerve.
Bell’s palsy is a paralysis of the muscles of the face, usually on one side, that has no known underlying cause. The symptoms probably occur when a nerve in the face is trapped and swollen. People with Bell's palsy generally recover but there is a small group who do not. Some surgeons have thought that an operation to free the nerve could improve recovery. We did this review to assess the effects of surgery for Bell's palsy compared with no treatment, other types of surgery, sham (fake) treatment or treatment with medicines.
Bell's palsy is a weakness of one side of the face that is diagnosed after other causes of facial weakness have been ruled out. It is a 'diagnosis of exclusion'. Bell's palsy may be caused by a virus affecting the facial nerve. Standard treatment includes steroids to help settle swelling of the facial nerve, whereas antiviral treatment does not appear to help. In hyperbaric oxygen therapy, the person undergoing treatment breathes 100% oxygen in a pressurised chamber for about one hour (called a 'dive'). This may produce more dissolved oxygen in the facial nerve and might reduce nerve damage in Bell's palsy. We searched for evidence from randomised controlled trials on hyperbaric oxygen therapy in adults with moderate to severe Bell's palsy. Our searches revealed no trials that met the inclusion criteria for the review. We found very low quality evidence from one trial to suggest that hyperbaric oxygen therapy might be beneficial for moderate to severe Bell's palsy. The trial involved 79 participants and compared hyperbaric oxygen therapy to prednisone, a corticosteroid, which is a proven active treatment. The participants did not know which treatment they were being given. Those treated with hyperbaric oxygen recovered more quickly and recovered normal facial movement more often (95% versus 76%). All participants tolerated the treatment well, and there were no major complications. The quality of evidence from this trial was very low because the assessors of facial function were aware of which treatment each participant had been given, which introduces a high risk of bias. There is therefore no high quality evidence on which to base conclusions about the efficacy of hyperbaric oxygen therapy in Bell's palsy.
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