The surgical management of Bell's palsy: a review

Facial nerve paralysis is a devastating problem for those affected. Few areas in otolaryngology have been as controversial as the management of Bell's palsy. The past several decades have witnessed many theories about the etiology and pathogenesis of Bell's palsy. In concert with each of these theories has been an appropriate management scheme. Because of the nature of the literature, it has been difficult for clinicians to unequivocally outline management algorithms. In the forefront of this debate is the issue of surgical therapy for a subset of these patients. Recent technology has provided some concrete insights into the mechanisms underlying Bell's palsy. Further, new clinical studies, albeit retrospective, support the need to re-evaluate surgery in the treatment of selected patients. The literature regarding the pathophysiology of Bell's palsy and the history of facial nerve surgery for this disease are reviewed.