**6. Treatment**

To achieve a good cosmetic, and functional recovery, reduction of neuronal damage and prevention of sequel, medical management for Bell's palsy can be categorized into two, i.e., pharmacotherapy and physiotherapy [8]. Surgery is rarely an option for the management of Bell's palsy.

Till recently, corticosteroid was the only drug in our armamentarium to tackle Bell's palsy. Because of their anti-inflammatory mode of action, they can reduce edema and inflammation of the facial nerve. American Academy of Neurology guidelines stated that steroids are highly effective in recovery of facial nerve function in new-onset Bell palsy [10]. Now we have antiviral therapy, which has improved the outcome. Commonly used antiviral agents are acyclovir, famciclovir, and valaciclovir [1]. They can be given concurrently with steroids. The Cochrane review concluded that a small but just significant benefit of combination therapy compared with corticosteroids alone in severe Bell's palsy [11]. To achieve better results, treatment with steroids and antiviral drugs should be initiated at the earliest, preferably within the first week of symptom onset.

Physical therapy, such as exercise, massage, biofeedback, laser treatment, electrostimulation, and thermotherapy, is the backbone of the management of Bell's palsy

*Introductory Chapter: Bell's Palsy DOI: http://dx.doi.org/10.5772/intechopen.108156*

[8, 12, 13]. Facial exercises not only hasten recovery during the acute stage but prevent contractures in paralyzed muscles in long term. However, the Cochrane review and other meta-analyses have failed to substantiate tall claims made in many studies. It was concluded that combined physical therapies and steroids plus antiviral drugs may be associated with a better facial function recovery outcome than any single therapy [8, 12].

Kabat rehabilitation, also known as proprioceptive neuromuscular facilitation (PNF), involves the facilitation of the voluntary response of an impaired muscle through the global pattern of an entire muscular section that undergoes resistance [14]. It has shown to be useful to prevent or treat synkinesis. Steroid plus antiviral plus Kabat treatment has shown good facial function recovery [8, 14]. Lately, acupuncture has also been studied as a supplement to other physical therapies. However, these trials are mostly inadequate to draw any conclusions [8, 12, 15]. Hyperbaric oxygen has also been tried to reduce edema over the facial nerve inside the fallopian canal in the temporal bone without any significant clinical recovery [1]. Botulinum toxin can be tried in patients with complications of hemifacial spasm, ipsilateral synkinesis, contralateral hyperkinesis, and facial asymmetry [16].

Most patients with Bell's palsy have reduced blinking ability and protection of eyes from drying, irritation, and injury merit close consideration. Artificial tears or eye ointments or gels, lubricating eye drops, and eye patches are to be used as per the requirement. In severe cases, tarsorrhaphy can also be considered.
