Trends in the Treatment of Bell's Palsy

Tom Shokri; Robert Saadi; Eric W. Schaefer; Jessyka G. Lighthall

doi:10.1055/s-0040-1713808

Facial Plastic Surgery, Inhaltsverzeichnis

Facial Plast Surg 2020; 36(05): 628-634
DOI: 10.1055/s-0040-1713808

Original Research

Trends in the Treatment of Bell's Palsy

Authors

Tom Shokri

¹Department of Otolaryngology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania
Robert Saadi

¹Department of Otolaryngology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania
Eric W. Schaefer

²Department of Public Health Sciences, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania
Jessyka G. Lighthall

³Section of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania

Abstract

The aim of the study is to: (1) evaluate national trends in care of facial paralysis, namely Bell's palsy, patients to identify the types of treatments patients are receiving and treatment gaps and (2) identify if newer, more complex surgical therapies published in the literature are being employed. Data were collected from the MarketScan Commercial Claims and Encounters Database by Truven Health. From the database, all inpatient and outpatient claims with International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes for facial paralysis/dysfunction between 2005 and 2013 were extracted. Trends in medical and surgical management were evaluated specifically cataloging the use of steroids, antivirals, botulinum toxin, surgical and rehabilitation service current procedural terminology codes. A total of 42,866 of patients with a formal diagnosis of Bell's palsy were identified with 39,292 (92%) adults and 3,754 (8%) children (< 18 years old), respectively. Steroids were provided to 50.1% of children and 59.8% of adults and antivirals were prescribed to 26.2 and 39.4% of the children and adults, respectively. Within the first 2 years after diagnosis, 0.5% of children and 0.9% of adults received surgery, 0.1% of children and 0.8% of adults received botulinum toxin treatments, and 10.9% of children and 21.5% of adults received rehabilitation services. Despite the limitations of a claims database study, results showing trends in care of facial paralysis are still nonsurgical with many patients receiving no treatment at all. Although limited literature has shown an increase in the use of pharmacotherapy as well as techniques including physiotherapy, chemodenervation, and various surgical therapies, these interventions may be underutilized.

Keywords

facial paralysis - bell palsy - facial nerve - synkinesis

Volltext

Referenzen

References
1 Jowett N, Hadlock TA. An evidence-based approach to facial reanimation. Facial Plast Surg Clin North Am 2015; 23 (03) 313-334
2 Jowett N, Hadlock TA. A contemporary approach to facial reanimation. JAMA Facial Plast Surg 2015; 17 (04) 293-300
3 Beurskens CH, Heymans PG. Positive effects of mime therapy on sequelae of facial paralysis: stiffness, lip mobility, and social and physical aspects of facial disability. Otol Neurotol 2003; 24 (04) 677-681
4 Baugh RF, Basura GJ, Ishii LE. et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg 2013; 149 (Suppl. 03) S1-S27
5 Gantz BJ, Rubinstein JT, Gidley P, Woodworth GG. Surgical management of Bell's palsy. Laryngoscope 1999; 109 (08) 1177-1188
6 Diels HJ, Beurskens C. Neuromuscular retraining: non-surgical therapy for facial palsy. In: Slattery W, Azizzadeh B. , eds. The Facial Nerve. New York, NY: Thieme; 2014: 205-212
7 Wesley R. Management of facial palsy. In: Yen M. , ed. Surgery of the Eyelid, Lacrimal System, and Orbit. New York, NY: Oxford University Press; 2012: 145-168
8 Balliet R, Shinn JB, Bach-y-Rita P. Facial paralysis rehabilitation: retraining selective muscle control. Int Rehabil Med 1982; 4 (02) 67-74
9 Salles AG, Toledo PN, Ferreira MC. Botulinum toxin injection in long-standing facial paralysis patients: improvement of facial symmetry observed up to 6 months. Aesthetic Plast Surg 2009; 33 (04) 582-590
10 Sadiq SA, Khwaja S, Saeed SR. Botulinum toxin to improve lower facial symmetry in facial nerve palsy. Eye (Lond) 2012; 26 (11) 1431-1436
11 Choi KH, Rho SH, Lee JM, Jeon JH, Park SY, Kim J. Botulinum toxin injection of both sides of the face to treat post-paralytic facial synkinesis. J Plast Reconstr Aesthet Surg 2013; 66 (08) 1058-1063
12 Beurskens CH, Heymans PG. Physiotherapy in patients with facial nerve paresis: description of outcomes. Am J Otolaryngol 2004; 25 (06) 394-400
13 Beurskens CH, Heymans PG. Mime therapy improves facial symmetry in people with long-term facial nerve paresis: a randomised controlled trial. Aust J Physiother 2006; 52 (03) 177-183
14 Sullivan FM, Swan IR, Donnan PT. et al. Early treatment with prednisolone or acyclovir in Bell's palsy. N Engl J Med 2007; 357 (16) 1598-1607
15 Engström M, Berg T, Stjernquist-Desatnik A. et al. Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet Neurol 2008; 7 (11) 993-1000
16 Pitaro J, Waissbluth S, Daniel SJ. Do children with Bell's palsy benefit from steroid treatment? A systematic review. Int J Pediatr Otorhinolaryngol 2012; 76 (07) 921-926
17 Atzema C, Goldman RD. Should we use steroids to treat children with Bell's palsy?. Can Fam Physician 2006; 52: 313-314
18 Takayanagui OM, Madhok VB, Daly F. et al. Antiviral treatment for Bell's palsy (idiopathic facial paralysis). Sao Paulo Med J 2015; 133 (04) 383
19 Salman MS, MacGregor DL. Should children with Bell's palsy be treated with corticosteroids? A systematic review. J Child Neurol 2001; 16 (08) 565-568
20 Granat MH, Ferguson AC, Andrews BJ, Delargy M. The role of functional electrical stimulation in the rehabilitation of patients with incomplete spinal cord injury--observed benefits during gait studies. Paraplegia 1993; 31 (04) 207-215
21 Lal D, Hetzler LT, Sharma N. et al. Electrical stimulation facilitates rat facial nerve recovery from a crush injury. Otolaryngol Head Neck Surg 2008; 139 (01) 68-73
22 Ross BG, Fradet G, Nedzelski JM. Development of a sensitive clinical facial grading system. Otolaryngol Head Neck Surg 1996; 114 (03) 380-386
23 Teixeira LJ, Valbuza JS, Prado GF. Physical therapy for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev 2011; (12) CD006283
24 Manikandan N. Effect of facial neuromuscular re-education on facial symmetry in patients with Bell's palsy: a randomized controlled trial. Clin Rehabil 2007; 21 (04) 338-343
25 Hadlock TA, Greenfield LJ, Wernick-Robinson M, Cheney ML. Multimodality approach to management of the paralyzed face. Laryngoscope 2006; 116 (08) 1385-1389
26 Lindsay RW, Robinson M, Hadlock TA. Comprehensive facial rehabilitation improves function in people with facial paralysis: a 5-year experience at the Massachusetts Eye and Ear Infirmary. Phys Ther 2010; 90 (03) 391-397
27 Monini S, De Carlo A, Biagini M. et al. Combined protocol for treatment of secondary effects from facial nerve palsy. Acta Otolaryngol 2011; 131 (08) 882-886
28 Azuma T, Nakamura K, Takahashi M. et al. Mirror biofeedback rehabilitation after administration of single-dose botulinum toxin for treatment of facial synkinesis. Otolaryngol Head Neck Surg 2012; 146 (01) 40-45
29 Mehta RP, Hadlock TA. Botulinum toxin and quality of life in patients with facial paralysis. Arch Facial Plast Surg 2008; 10 (02) 84-87
30 May M, Klein SR, Taylor FH. Idiopathic (Bell's) facial palsy: natural history defies steroid or surgical treatment. Laryngoscope 1985; 95 (04) 406-409
31 Peitersen E. The natural history of Bell's palsy. Am J Otol 1982; 4 (02) 107-111