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Surgical interventions for the early management of Bell's palsy

  • Review
  • Intervention




Bell's palsy is an acute paralysis of one side of the face of unknown aetiology. Bell's palsy should only be used as a diagnosis in the absence of all other pathology. As the proposed pathophysiology is swelling and entrapment of the nerve, some surgeons suggest surgical decompression of the nerve as a possible management option.


The objective of this review was to assess the effectiveness of surgery in the management of Bell's palsy and to compare this to outcomes of medical management.

Search methods

We searched the Cochrane Neuromuscular Disease Group Specialized Register (23 November 2010). We also searched the Cochrane Central Register of Controlled Trials (CENTRAL) (23 November in The Cochrane Library, Issue 4 2010). We adapted this strategy to search MEDLINE (January 1966 to November 2010) and EMBASE (January 1980 to November 2010).

Selection criteria

We included all randomised or quasi-randomised controlled trials involving any surgical intervention for Bell's palsy.

Data collection and analysis

Two review authors independently assessed whether trials identified from the search strategy were eligible for inclusion. Two review authors assessed trial quality and extracted data independently.

Main results

Two trials with a total of 69 participants met the inclusion criteria. The first study considered the treatment of 403 patients but only included 44 in their surgical study. These were randomised into a surgical and non surgical group. The second study had 25 participants which they randomly allocated into surgical or control groups.

The nerves of all the surgical group participants in both studies were decompressed using a retroauricular approach. The primary outcome was recovery of facial palsy at 12 months. The first study showed that both the operated and non operated groups had comparable facial nerve recovery at nine months. This study did not statistically compare the groups but the scores and size of the groups suggested that statistically significant differences are unlikely. The second study reported no statistically significant differences between their operated and control groups. One operated patient in the first study had 20 dB sensorineural hearing loss and persistent vertigo.

Authors' conclusions

There is only very low quality evidence from randomised controlled trials and this is insufficient to decide whether surgical intervention is beneficial or harmful in the management of Bell's palsy.

Further research into the role of surgical intervention is unlikely to be performed because spontaneous recovery occurs in most cases.



Intervenciones quirúrgicas para el tratamiento temprano de la parálisis de Bell

La parálisis de Bell es una parálisis aguda de etiología desconocida que afecta uno de los lados de la cara. La parálisis de Bell sólo debe usarse como diagnóstico cuando se han descartado todas las otras causas posibles. Debido que la fisiopatología propuesta es la tumefacción y la compresión del nervio, algunos cirujanos sugieren la descompresión quirúrgica del nervio como posible opción de tratamiento.


El objetivo de esta revisión fue evaluar la efectividad de la cirugía en el tratamiento de la parálisis de Bell y compararla con los resultados del tratamiento médico.

Estrategia de búsqueda

Se hicieron búsquedas en el Registro Especializado del Grupo Cochrane de Enfermedades Neuromusculares (Cochrane Neuromuscular Disease Group) (23 noviembre de 2010). También se realizaron búsquedas en el Registro Cochrane Central de Ensayos Controlados (CENTRAL) (23 noviembre en The Cochrane Library, número 4 2010). Se adaptó esta estrategia para buscar en MEDLINE (enero de 1966 hasta noviembre de 2010) y EMBASE (enero de 1980 hasta noviembre de 2010).

Criterios de selección

Se incluyeron todos los ensayos controlados aleatorios y cuasialeatorios que realizaban alguna intervención quirúrgica para el tratamiento de la parálisis de Bell.

Obtención y análisis de los datos

Dos revisores evaluaron de forma independiente si los ensayos identificados a partir de la estrategia de búsqueda eran elegibles para la inclusión. Dos revisores evaluaron la calidad de los ensayos y extrajeron los datos de forma independiente.

Resultados principales

Dos ensayos con un total de 69 participantes cumplieron los criterios de inclusión. El primer estudio consideró el tratamiento de 403 pacientes, pero sólo incluyó a 44 en su estudio quirúrgico. Estos pacientes fueron asignados al azar a un grupo quirúrgico y a uno no quirúrgico. El segundo estudio contó con 25 participantes que fueron asignados al azar en grupos quirúrgicos o de control.

Se descomprimieron los nervios de todos los participantes en el grupo quirúrgico en ambos estudios mediante un abordaje retroauricular. El resultado primario fue la recuperación de la parálisis facial a los 12 meses. El primer estudio reveló que tanto el grupo quirúrgico como el no quirúrgico tuvieron una recuperación del nervio facial equivalente a los nueve meses. Este estudio no comparó estadísticamente los grupos sino las puntuaciones, y el tamaño de los grupos sugirió que es improbable que haya diferencias estadísticamente significativas. El segundo estudio no informó diferencias estadísticamente significativas entre el grupo quirúrgico y el de control. Un paciente operado en el primer estudio presentó pérdida de la audición neurosensorial de 20 dB y vértigo persistente.

Conclusiones de los autores

Sólo hay pruebas de calidad muy baja de los ensayos controlados aleatorios, lo que es insuficiente para decidir si la cirugía es beneficiosa o perjudicial en el tratamiento de la parálisis de Bell.

Es poco probable que se realicen más estudios de investigación sobre la función de la cirugía, porque en la mayoría de los casos hay recuperación espontánea.


Traducción realizada por el Centro Cochrane Iberoamericano

Plain language summary

Surgical operation for idiopathic facial paralysis

There is insufficient evidence to support surgical operation for the management of Bell’s palsy.

Bell’s palsy is a paralysis of the muscles of the face, usually on one side, that has no known cause. People generally recover but there is a small group who do not recover. It is thought to be caused by swelling and entrapment of the nerve. Some surgeons thought that an operation to release the nerve may improve recovery.

Two studies were included in our review. They compared surgery with non-surgical management of 69 participants with Bell's palsy in total. The first study did not state how the participants were randomly allocated into surgical and non-surgical groups. The second study allocated their participants randomly using statistical charts into surgical and control groups (no treatment). There was no attempt in either study to hide which groups patients were being allocated into and both patients and assessors were aware of the management plan proposed. The first study lost seven participants to follow-up and there were no losses to follow-up in the second study.

The most important outcome was recovery of facial palsy at 12 months. The first study showed that the operated and non operated groups both had comparable facial nerve recovery at nine months. The second study reported no differences in recovery of the facial palsy between their operated and control groups at one year. One patient operated on in the first study had mild hearing loss and vertigo after the surgery.

The review found that there was only very low quality evidence and that this was insufficient to decide whether an operation would be beneficial or harmful in the management of Bell's palsy.

Further research into the role of an operation is unlikely to be performed because spontaneous recovery occurs in most cases.

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