The initial current treatment of choice for acute Bell’s palsy and paralysis from the herpes zoster virus (herpes zoster oticus) is the concomitant use of oral steroids (such as prednisone) and oral antiviral medications (such as acyclovir or similar agents).
Bacterial external ear infections may result in facial paralysis, and often is due to a compromised immune system or as a complication of diabetes. In those cases, appropriate therapy may involve intravenous antibiotics, followed by surgical debridement.
The current treatment for acute bacterial middle ear infections resulting in facial paralysis is appropriate oral and/or intravenous antibiotics, dependent upon the initial presentation and severity, and surgical incision of the ear drum (myringotomy). Treatment for traumatic head injuries with partial facial paralysis or delayed complete facial paralysis is similar to that for Bell’s palsy.
The current treatment for a severe Bell’s palsy injury that does not respond to treatment with steroids and antivirals is complete nerve surgical decompression within the first two weeks of onset. Surgery debridement and drainage of the middle ear and mastoid for refractory acute, subacute, or chronic bacterial middle ear and/or mastoid infections resulting in facial paralysis may include appropriate intravenous antibiotics.
Surgical treatment for traumatic head injuries with immediate, complete facial paralysis is surgical decompression of the nerve along with steroids and possibly antiviral medication. Electrodiagnostic evidence of an intact and viable nerve may alter this course.
A severed nerve may be repaired surgically by suturing the cut ends together or by inserting a nerve graft between the two severed ends. The details of how this is done are important. Treatment for an acute lack of the facial nerve from the brainstem is surgical connection (anastomosis) of another nerve to the remaining facial nerve stump to the face. For the chronically denervated face, dynamic muscle transfers and non-dynamic slings and weights may be used.