Novel and Emerging Treatments
Infusion therapy is an approach for treating Bell’s palsy using corticosteroids mixed in an infusion solution containing dextran and pentoxifylline. The corticosteroids help reduce inflammation of the facial nerve and the combination of dextran and pentoxifylline increase blood flow to the nerve, helping it recover from the deleterious effects of the inflammation (Kinishi 1989). Although this approach has not been heavily researched in recent years, multiple studies in Europe and Asia have found it to be an effective method of treating Bell’s palsy and suggested it may be more effective than steroids alone (Sittel, Stennert 2000; Sittel, Sittel 2000; Kinishi 1989; Kinishi 1991). One study compared the effectiveness of 7 days of infusion therapy with 500 mL of dextran solution plus 500 mg of hydrocortisone (starting at 500 mg and tapering down to 100 mg) to oral hydrocortisone. Patients with complete paralysis who received infusion therapy had a significantly better recovery rate compared to the oral hydrocortisone group (Kinishi 1989). Another study by the same investigators modified the infusion therapy by adding pentoxifylline. It was found that 87% of the patients with complete palsy had total recovery when treated with modified infusion therapy compared to 68% of those receiving oral steroids (Kinishi 1991). Finally, a study of 239 people with Bell’s palsy found that a dextran and pentoxifylline infusion combined with prednisone (starting dose 250 mg and tapering over 18 days) provided total recovery (based on the House-Brackmann scale) in 92% of people with complete facial paralysis and 97% of people with partial facial paralysis; results were superior when therapy started within 3 days of developing palsy (Sittel, Stennert 2000; Sittel, Sittel 2000).
Photobiomodulation/laser therapy utilizes different wavelengths of light to help repair cells. One study examined the effects of laser treatments using laser light with wavelengths of 660 and 780 nm on Bell’s palsy in a 3-year old child. The treatments, which began shortly after the onset of the facial paralysis, lasted for 15-30 minutes at a time. After 11 sessions over the course of three weeks, the child’s facial muscle function had returned to normal (Fontana 2013). Another study found that 12 sessions with either a laser at 760 nm or a LED light of 850 nm also cured or resulted in significant improvement in 11 of 14 patients with Bell’s palsy (Colombo 2012). In 2014 the efficacy of low-intensity and high-intensity laser therapy was investigated in a double-blind, randomized, controlled trial on 48 subjects with Bell’s palsy. The participants were divided into three groups: 1) high-intensity laser therapy plus facial massage and exercise, 2) low-intensity laser therapy plus facial massage and exercise, and 3) facial massage and exercise only. The laser therapy was administered to 8 points on the affected side of the face 3 times weekly for 6 consecutive weeks. Recovery of facial function was measured at 3 and 6 weeks following treatment using the House-Brackmann scale and the facial disability scale. The researchers concluded “…both [high-intensity laser therapy] and [low-intensity laser therapy] are effective physical therapy modalities for the recovery of patients with Bell's palsy, with [high-intensity laser therapy] showing a slightly greater improvement than [low-intensity laser therapy]” (Alayat 2014).
Hyperbaric Oxygen Therapy
Hyperbaric oxygen therapy involves sitting in a pressurized (hyperbaric) chamber breathing 100% oxygen for approximately an hour. These treatments increase the amount of oxygen in the blood and may help increase oxygen delivery to the facial nerve, thus helping speed recovery after Bell’s palsy (Holland 2012). Although there is a scarcity of well-designed randomized controlled trials examining the effects of hyperbaric oxygen on Bell’s palsy, one study did compare the effects of hyperbaric oxygen treatments to corticosteroids for people with Bell’s palsy (Holland 2012; Racic 1997). This study used one-hour sessions in the hyperbaric oxygen chamber, twice daily, five days per week for up to 3 weeks or until recovery along with oral placebo, compared to normal atmospheric oxygen (21%) with 450 mg of prednisone delivered over eight days. After 9 months, greater than 95% of the people receiving hyperbaric oxygen therapy had fully recovered compared to less than 76% of those receiving prednisone. Furthermore, the hyperbaric oxygen-treated group showed significant improvement in nerve excitability measures compared to the prednisone-treated group (Racic 1997). Hyperbaric oxygen therapy represents a possible integrative therapy for the treatment of Bell’s palsy, especially as it has minimal side effects (Holland 2012).
Facial Fillers and Botulinum Injections
Two potential long-term effects of Bell’s palsy are facial asymmetry and a condition called synkinesis, in which a voluntary facial movement results in the involuntary movement of a different facial muscle group (Husseman 2008; Mayo Clinic 2012b). A case study examined the effects of injections of facial fillers (eg, hyaluronic acid gel fillers) and botulinum toxin (Botox®) injections for the treatment of a 50-year-old woman with these complications from Bell’s palsy. Multiple rounds of these treatments improved the facial asymmetry and muscle spasms, reducing pain and improving her quality of life (Wiener 2011). Botulinum injections can also be administered to the non-affected side of the face to improve facial symmetry and cosmetic appearance in people with Bell’s palsy (Kim 2013).