In these individuals, the best procedure is lateral tarsorrhaphy. This procedure eliminates the necessity of constant drops and ointments, and it improves cosmesis by eliminating lid sag or preserving vision on the affected side. Lateral tarsorrhaphy can be taken down completely or in part, whenever recovery occurs. Recently, use of upper lid gold weights and lower lid shortening have become common and are effective surgical options. By definition, Bell palsy is idiopathic.
Incidence is roughly equal among males and females.
Peak ages are 20-40 years. Bell palsy rarely occurs with other cranial nerve palsies or brainstem signs. Facial palsy in children may be caused by pontine glioma, whereas in young and middle-aged adults, facial palsy can be the early sign of a cerebellar pontine tumor. A short course of high-dose corticosteroids may relieve pain and may decrease the incidence of late complications, such as aberrant regeneration of the facial nerve in patients with severe paralysis. Because steroids have not been shown to be beneficial in a controlled study, consider withholding this form of therapy, especially in diabetic patients who are predisposed to having Bell palsy.