Update on Medical Management of Acute Peripheral Facial Palsy

Acute facial nerve palsy, particularly Bell’s palsy, is a common neurological disorder with an annual incidence of 20–30 cases per 100,000 individuals. It is characterized by sudden or gradual facial muscle palsy and is caused by viral reactivation, inflammation, or ischemia of the facial nerve. Prognosis varies widely, depending on the severity of nerve damage and timeliness of the intervention. Steroid therapy remains the cornerstone of Bell’s palsy treatment because it reduces inflammation and facilitates recovery. Early administration, preferably within 72 hours of symptom onset, considerably improves outcomes. However, the efficacy of combination therapy remains controversial. Current guidelines recommend oral steroids as the primary treatment for Bell’s palsy and suggest the selective use of antiviral agents in severe cases or when viral involvement is strongly suspected. For severe facial palsy, such as Ramsay Hunt syndrome or varicella-zoster virus-induced cases, combination therapy may improve outcomes and reduce sequelae; however, high-quality evidence is limited. Steroid therapy is the main treatment of Bell’s palsy and antiviral therapy can be added in severe cases to improve prognosis. Additional research is required to develop standardized guidelines, concerning the use of antiviral therapies in conjunction with steroids.