Clinical Scenario

This protocol applies to patients diagnosed with Bell's palsy who present with severe peripheral facial palsy — specifically those classified as House-Brackmann (HB) grade V or VI. These grades represent near-complete to complete loss of voluntary facial motor function on the affected side, and they carry a distinct management pathway given the severity of motor deficit.

Treatment Approach (Partial Overview)

In this severe presentation, management centres on early high-dose corticosteroid therapy, alongside systematic ophthalmologic care as an integral part of the approach. The complete structured protocol — including all components, sequencing, timing criteria, and associated interventions — is available below.

References

DOI: 10.1016/j.anorl.2020.06.004

In severe forms (HB grade V or VI), 10 days' high-dose corticotherapy (2 mg/kg/day) seem justified unless contraindicated.
In Bell's palsy, corticotherapy with prednisolone or methylprednisolone should be implemented as early as possible (ideally, within 72 h).
Ophthalmologic treatment comprising local care, nocturnal occlusion and patient education should be systematic and as early as possible.
They can be prevented by systematic administration of eye-drops, protective gel or artificial tears several times daily and especially at night.

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Treatment of Bell's Palsy with Severe Peripheral Facial Palsy (House-Brackmann Grade V or VI)

References