Idiopathische Fazialisparese (Bell-Parese): Aktueller Stand in Diagnostik und Therapie

Bei idiopathischer Fazialisparese stellt Prednisolon als Monotherapie innerhalb von 72 Stunden nach Auftreten immer noch den Behandlungsstandard dar, und die Rolle von Virostatika ist unklar. Ziel dieses Beitrags ist es, das aktuelle Facharztwissen zur Diagnostik und Therapie der idiopathischen Fazialisparese, inklusive neuester Erkenntnisse und Kontroversen, zusammenzutragen. Der Schwerpunkt liegt dabei auf der akuten Phase der Krankheit.

Abstract

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 Bellʼs 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 Bellʼs 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.

Schlüsselwörter

Nervus facialis - Elektromyografie - Leitlinie - Glukokortikoide - Synkinesie

Keywords

facial nerve - electromyography - guideline - glucocorticoids - synkinesis

Publication History

Article published online:
26 November 2021

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