Bell’s facial nerve palsy in pregnancy: a clinical review

Abstract Bell’s facial nerve palsy (FNP) during pregnancy and the puerperium can present significant challenges for the patient and clinician. Presentation and prognosis can be worse in this group of patients. This article reviews the background, manifestation and management options of FNP. In particular, it focuses on the controversies that exist regarding corticosteroid use during pregnancy and outlines approaches to diagnosis and treatment. Based on this review, we recommend an early evidence-based approach using guidelines derived from non-pregnant populations. This includes assessment for atypical causes, a multidisciplinary input and early introduction of corticosteroids to limit progression and improve prognosis.

[1]  M. Engström,et al.  The effect of study design and analysis methods on recovery rates in Bell's palsy , 2009, The Laryngoscope.

[2]  C. Quesenberry,et al.  Bell's Palsy Treatment with Acyclovir and Prednisone Compared with Prednisone Alone: A Double-Blind, Randomized, Controlled Trial , 1996, The Annals of otology, rhinology, and laryngology.

[3]  J. Chan,et al.  Management of facial paralysis in the 21st century. , 2011, Facial plastic surgery : FPS.

[4]  P. Middleton,et al.  Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes. , 2011, The Cochrane database of systematic reviews.

[5]  Brian McKinstry,et al.  Early Treatment with Prednisolone or Acyclovir in Bell’s Palsy , 2007, New England Journal of Medicine.

[6]  G. Rennick.  Use of systemic glucocorticosteroids in pregnancy: Be alert but not alarmed , 2006, The Australasian journal of dermatology.

[7]  W. E. Josey,et al.  Relation of cytohistopathology of genital herpesvirus infection to cervical anaplasia. , 1973, Cancer research.

[8]  J I De Diego-Sastre,et al.  [The epidemiology of Bell's palsy]. , 2005, Revista de neurologia.

[9]  M. Álvarez,et al.  Corticosteroids for Bell's palsy (idiopathic facial paralysis). , 2002, The Cochrane database of systematic reviews.

[10]  A. Franx,et al.  Corticosteroids, Pregnancy, and HELLP Syndrome: A Review , 2005, Obstetrical & gynecological survey.

[11]  A. Guberman,et al.  Idiopathic facial nerve paralysis (Bell's palsy) in late pregnancy and the early puerperium. , 1987, Obstetrics and gynecology.

[12]  C. E. Edwards.  BELL'S PALSY IN THE LAST TRIMESTER OF PREGNANCY AND THE PUERPERIUM. , 1964, American journal of obstetrics and gynecology.

[13]  F. Daly,et al.  Corticosteroids for Bell's palsy (idiopathic facial paralysis). , 2016, The Cochrane database of systematic reviews.

[14]  E. Reece,et al.  Gestational diabetes: the need for a common ground , 2009, The Lancet.

[15]  M. Vallejo,et al.  Oral Herpes Simplex Reactivation After Intrathecal Morphine: A Prospective Randomized Trial in an Obstetric Population , 2005, Anesthesia and analgesia.

[16]  J. Atkins,et al.  Otolaryngologic manifestations of pregnancy , 1990, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[17]  A. Korczyn.  BELL'S PALSY AND PREGNANCY , 1971, Acta neurologica Scandinavica.

[18]  M. Kanerva,et al.  Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial , 2008, The Lancet Neurology.

[19]  E. Peitersen,et al.  Bell's Palsy: The Spontaneous Course of 2,500 Peripheral Facial Nerve Palsies of Different Etiologies , 2002, Acta oto-laryngologica. Supplementum.

[20]  J. Paschoal,et al.  [Facial palsy and pregnancy: management and treatment]. , 2013, Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia.

[21]  R. Dersimonian,et al.  Corticosteroid Treatment for Idiopathic Facial Nerve Paralysis: A Meta‐analysis , 2000, The Laryngoscope.

[22]  L. Weinstein.  Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. , 1982, American journal of obstetrics and gynecology.

[23]  S. Moore,et al.  Recrudescent herpes labialis during and prior to early pregnancy , 2003, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[24]  R. Birkenhäger,et al.  Periphere Fazialisparese in der Schwangerschaft , 2012, HNO.

[25]  Y. Furuta,et al.  Valacyclovir and Prednisolone Treatment for Bell's Palsy: A Multicenter, Randomized, Placebo-Controlled Study , 2007, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[26]  J. Ray,et al.  Bell's palsy and tinnitus during pregnancy: predictors of pre-eclampsia? Three cases and a detailed review of the literature. , 1999, Acta oto-laryngologica.

[27]  B. Marciniak,et al.  Glucocorticoids in pregnancy. , 2011, Current pharmaceutical biotechnology.

[28]  M. Nørgaard,et al.  Use of inhaled and oral corticosteroids in pregnancy and the risk of malformations or miscarriage. , 2015, Basic & clinical pharmacology & toxicology.

[29]  Jonas L. Matzon,et al.  Carpal tunnel syndrome in pregnancy. , 2012, The Orthopedic clinics of North America.

[30]  I. Rahman,et al.  Ophthalmic management of facial nerve palsy: a review. , 2007, Survey of ophthalmology.

[31]  L. Smeeth,et al.  Effect of maternal asthma, exacerbations and asthma medication use on congenital malformations in offspring: a UK population-based study , 2008, Thorax.

[32]  De Diego-Sastre Ji,et al.  Epidemiología de la parálisis facial de Bell , 2005 .

[33]  G. Liggins,et al.  A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. , 1972, Pediatrics.

[34]  S. C. Bell.  THE NERVOUS SYSTEM OF THE HUMAN BODY , 1969 .

[35]  R. Hilsinger,et al.  Idiopathic Facial Paralysis, Pregnancy, and the Menstrual Cycle , 1975, The Annals of otology, rhinology, and laryngology.

[36]  B. Schaitkin,et al.  Bell's Palsy in Pregnancy: A Study of Recovery Outcomes , 2002, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[37]  T. Einarson,et al.  Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies. , 2000, Teratology.

[38]  S. Schwartz,et al.  Clinical Practice Guideline: Bell’s Palsy , 2013 .

[39]  R. Hilsinger,et al.  Idiopathic Facial Paralysis, Pregnancy, and the Menstrual Cycle , 1975, The Annals of otology, rhinology, and laryngology.

[40]  C. Ulrik,et al.  Safety of bronchodilators and corticosteroids for asthma during pregnancy: what we know and what we need to do better , 2013, Journal of asthma and allergy.

[41]  J. Terzis,et al.  Blink Restoration in Adult Facial Paralysis , 2010, Plastic and reconstructive surgery.

[42]  K. Ragupathy,et al.  Bell’s palsy in pregnancy , 2012, Archives of Gynecology and Obstetrics.

[43]  E. Sheiner,et al.  Bell's palsy during pregnancy: Is it associated with adverse perinatal outcome? , 2011, The Laryngoscope.

[44]  N. Hato,et al.  Steroid and antiviral treatment for Bell's palsy , 2008, The Lancet.

[45]  A. Deshpande.  Recurrent Bell's palsy in pregnancy , 1990, The Journal of Laryngology & Otology.

[46]  P. D. Kenan,et al.  Bell's palsy in pregnancy. , 1969, Archives of otolaryngology.

[47]  E. Eriksson,et al.  Idiopathic facial palsy in pregnancy and the puerperium. , 1989, Surgery, gynecology & obstetrics.