Surgical interventions for the early management of Bell's palsy.

Abstract:

BACKGROUND:Bell's palsy is an acute unilateral facial paralysis of unknown aetiology and should only be used as a diagnosis in the absence of any other pathology. As the proposed pathophysiology is swelling and entrapment of the nerve, some surgeons suggest surgical decompression of the nerve as a possible management option; this is ideally performed as soon as possible after onset. This is an update of a review first published in 2011, and last updated in 2013. This update includes evidence from one newly identified study. OBJECTIVES:To assess the effects of surgery in the early management of Bell's palsy. SEARCH METHODS:On 20 March 2020, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, ClinicalTrials.gov and WHO ICTRP. We handsearched selected conference abstracts for the original version of the review. SELECTION CRITERIA:We included all randomised controlled trials (RCTs) or quasi-RCTs involving any surgical intervention for Bell's palsy. Trials compared surgical interventions to no treatment, later treatment (beyond three months), sham treatment, other surgical treatments or medical treatment. DATA COLLECTION AND ANALYSIS:Three review authors independently assessed trials for inclusion, assessed risk of bias and extracted data. We used standard methodological procedures expected by Cochrane. The primary outcome was complete recovery of facial palsy at 12 months. Secondary outcomes were complete recovery at three and six months, synkinesis and contracture at 12 months, psychosocial outcomes at 12 months, and side effects and complications of treatment. MAIN RESULTS:Two trials with 65 participants met the inclusion criteria; one was newly identified at this update. The first study randomised 25 participants into surgical or non-surgical (no treatment) groups using statistical charts. One participant declined surgery, leaving 24 evaluable participants. The second study quasi-randomised 53 participants; however, only 41 were evaluable as 12 declined the intervention they were allocated. These 41 participants were then divided into early surgery, late surgery or non-surgical (no treatment) groups using alternation. There was no mention on how alternation was decided. Neither study mentioned if there was any attempt to conceal allocation. Neither participants nor outcome assessors were blinded to the interventions in either study. There were no losses to follow-up in the first study. The second study lost three participants to follow-up, and 17 did not contribute to the assessment of secondary outcomes. Both studies were at high risk of bias. Surgeons in both studies used a retro-auricular/transmastoid approach to decompress the facial nerve. For the outcome recovery of facial palsy at 12 months, the evidence was uncertain. The first study reported no differences between the surgical and no treatment groups. The second study fully reported numerical data, but included no statistical comparisons between groups for complete recovery. There was no evidence of a difference for the early surgery versus no treatment comparison (risk ratio (RR) 0.76, 95% confidence interval (CI) 0.05 to 11.11; P = 0.84; 33 participants; very low-certainty evidence) and for the early surgery versus late surgery comparison (RR 0.47, 95% CI 0.03 to 6.60; P = 0.58; 26 participants; very low-certainty evidence). We considered the effects of surgery on facial nerve function at 12 months very uncertain (2 RCTs, 65 participants; very low-certainty evidence). Furthermore, the second study reported adverse effects with a statistically significant decrease in lacrimal control in the surgical group within two to three months of denervation. Four participants in the second study had 35 dB to 50 dB of sensorineural hearing loss at 4000 Hz, and three had tinnitus. Because of the small numbers and trial design we also considered the adverse effects evidence very uncertain (2 RCTs, 65 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS:There is very low-certainty evidence from RCTs or quasi-RCTs on surgery for the early management of Bell's palsy, and this is insufficient to decide whether surgical intervention is beneficial or harmful. Further research into the role of surgical intervention is unlikely to be performed because spontaneous or medically supported recovery occurs in most cases.

authors

Menchetti I,McAllister K,Walker D,Donnan PT

doi

10.1002/14651858.CD007468.pub4

subject

Has Abstract

pub_date

2021-01-26 00:00:00

pages

CD007468

issn

1469-493X

journal_volume

1

pub_type

杂志文章,评审
  • Donepezil for dementia due to Alzheimer's disease.

    abstract:BACKGROUND:Alzheimer's disease is the most common cause of dementia in older people. One of the aims of therapy is to inhibit the breakdown of a chemical neurotransmitter, acetylcholine, by blocking the relevant enzyme. This can be done by a group of chemicals known as cholinesterase inhibitors. OBJECTIVES:The objecti...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD001190.pub2

    authors: Birks J,Harvey RJ

    更新日期:2006-01-25 00:00:00

  • Steroidal contraceptives: effect on bone fractures in women.

    abstract:BACKGROUND:Steroidal contraceptive use has been associated with changes in bone mineral density in women. Whether such changes increase the risk of fractures later in life is not clear. However, osteoporosis is a major public health concern. Age-related decline in bone mass increases the risk of fracture, especially of...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD006033.pub2

    authors: Lopez LM,Grimes DA,Schulz KF,Curtis KM

    更新日期:2006-10-18 00:00:00

  • Clonazepam add-on therapy for drug-resistant epilepsy.

    abstract:BACKGROUND:This is an updated version of the original Cochrane Review published in 2018, Issue 5. Epilepsy affects over 70 million people worldwide, and nearly a quarter of patients with seizures have drug-resistant epilepsy. People with drug-resistant epilepsy have increased risks of premature death, injuries, psychos...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章

    doi:10.1002/14651858.CD012253.pub3

    authors: Song L,Liu F,Liu Y,Zhang R,Ji H,Jia Y

    更新日期:2020-04-20 00:00:00

  • Voxel-based morphometry for separation of schizophrenia from other types of psychosis in first episode psychosis.

    abstract:BACKGROUND:Schizophrenia is a psychiatric disorder which involves distortions in thought and perception, blunted affect, and behavioural disturbances. The longer psychosis goes unnoticed and untreated, the more severe the repercussions for relapse and recovery. There is some evidence that early intervention services ca...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD011021.pub2

    authors: Palaniyappan L,Maayan N,Bergman H,Davenport C,Adams CE,Soares-Weiser K

    更新日期:2015-08-07 00:00:00

  • Tea tree oil for Demodex blepharitis.

    abstract:BACKGROUND:Demodex blepharitis is a chronic condition commonly associated with recalcitrant dry eye symptoms though many people with Demodex mites are asymptomatic. The primary cause of this condition in humans is two types of Demodex mites: Demodex folliculorum and Demodex brevis. There are varying reports of the prev...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD013333.pub2

    authors: Savla K,Le JT,Pucker AD

    更新日期:2020-06-20 00:00:00

  • Whole brain radiation therapy (WBRT) alone versus WBRT and radiosurgery for the treatment of brain metastases.

    abstract:BACKGROUND:Historically, whole brain radiation therapy (WBRT) has been the main treatment for brain metastases. Stereotactic radiosurgery (SRS) delivers high-dose focused radiation and is being increasingly utilized to treat brain metastases. The benefit of adding SRS to WBRT is unclear. This is an updated version of t...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD006121.pub3

    authors: Patil CG,Pricola K,Sarmiento JM,Garg SK,Bryant A,Black KL

    更新日期:2012-09-12 00:00:00

  • Physiotherapy for pain and disability in adults with complex regional pain syndrome (CRPS) types I and II.

    abstract:BACKGROUND:Complex regional pain syndrome (CRPS) is a painful and disabling condition that usually manifests in response to trauma or surgery. When it occurs, it is associated with significant pain and disability. It is thought to arise and persist as a consequence of a maladaptive pro-inflammatory response and disturb...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD010853.pub2

    authors: Smart KM,Wand BM,O'Connell NE

    更新日期:2016-02-24 00:00:00

  • Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections.

    abstract:BACKGROUND:Acute respiratory infections (ARIs) comprise a large and heterogeneous group of infections including bacterial, viral and other aetiologies. In recent years, procalcitonin - the prohormone of calcitonin - has emerged as a promising marker for the diagnosis of bacterial infections and for improving decisions ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD007498.pub2

    authors: Schuetz P,Müller B,Christ-Crain M,Stolz D,Tamm M,Bouadma L,Luyt CE,Wolff M,Chastre J,Tubach F,Kristoffersen KB,Burkhardt O,Welte T,Schroeder S,Nobre V,Wei L,Bhatnagar N,Bucher HC,Briel M

    更新日期:2012-09-12 00:00:00

  • Surgery for lateral elbow pain.

    abstract:BACKGROUND:This review is one in a series of reviews of interventions for lateral elbow pain. Lateral elbow pain, or tennis elbow, is a common condition causing pain in the lateral elbow and forearm and lack of strength and function of the elbow and wrist. Surgery is sometimes recommended in treating chronic cases of l...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD003525

    authors: Buchbinder R,Green S,Bell S,Barnsley L,Smidt N,Assendelft WJ

    更新日期:2002-01-01 00:00:00

  • Gabapentin for chronic neuropathic pain and fibromyalgia in adults.

    abstract:BACKGROUND:This review is an update of a review published in 2011, itself a major update of previous reviews published in 2005 and 2000, investigating the effects of gabapentin in chronic neuropathic pain (pain due to nerve damage). Antiepileptic drugs are used to manage chronic neuropathic pain and fibromyalgia. OBJE...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD007938.pub3

    authors: Moore RA,Wiffen PJ,Derry S,Toelle T,Rice AS

    更新日期:2014-04-27 00:00:00

  • Vaccines for preventing invasive salmonella infections in people with sickle cell disease.

    abstract:BACKGROUND:Salmonella infections are a common bacterial cause of invasive disease in people with sickle cell disease especially children, and are associated with high morbidity and mortality rates. Although available in some centres, people with sickle cell anaemia are not routinely immunized with salmonella vaccines. ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD006975.pub3

    authors: Odey F,Okomo U,Oyo-Ita A

    更新日期:2015-06-05 00:00:00

  • Alemtuzumab for multiple sclerosis.

    abstract:BACKGROUND:Multiple sclerosis (MS) is an autoimmune, T-cell-dependent, inflammatory, demyelinating disease of the central nervous system, with an unpredictable course. Current MS therapies focus on treating exacerbations, preventing new exacerbations and avoiding the progression of disability. However, at present there...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD011203.pub2

    authors: Riera R,Porfírio GJ,Torloni MR

    更新日期:2016-04-15 00:00:00

  • Prophylactic intravenous antifungal agents to prevent mortality and morbidity in very low birth weight infants.

    abstract:BACKGROUND:Invasive fungal infection is an increasingly common cause of mortality and morbidity in very low birth weight infants. As the diagnosis is often difficult, and treatment is often delayed, there is a need to assess whether antifungal prophylaxis is beneficial. OBJECTIVES:To assess whether prophylactic intrav...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD003850.pub2

    authors: McGuire W,Clerihew L,Austin N

    更新日期:2004-01-01 00:00:00

  • Gamma-aminobutyric acid agonists for neuroleptic-induced tardive dyskinesia.

    abstract:BACKGROUND:Chronic antipsychotic drug treatment may cause tardive dyskinesia (TD), a long-term movement disorder. The gamma-aminobutyric acid (GABA) agonist drugs have been trialed as a treatment for TD, but these drugs have intense sedative properties and can possibly exacerbate psychotic symptoms. OBJECTIVES:To dete...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD000203

    authors: Soares KV,McGrath JJ,Deeks JJ

    更新日期:2000-01-01 00:00:00

  • Combination inhaled steroid and long-acting beta(2)-agonist in addition to tiotropium versus tiotropium or combination alone for chronic obstructive pulmonary disease.

    abstract:BACKGROUND:The long-acting bronchodilator tiotropium and single inhaler combination therapy of inhaled corticosteroids and long-acting beta(2)-agonists are both commonly used for maintenance treatment of chronic obstructive pulmonary disease. Combining these treatments, which have different mechanisms of action, may be...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD008532.pub2

    authors: Karner C,Cates CJ

    更新日期:2011-03-16 00:00:00

  • Trastuzumab-containing regimens for metastatic breast cancer.

    abstract:BACKGROUND:Patients with breast cancer are classified as having cells that over-express the human epidermal growth factor receptor 2 (known as HER2-positive) or not (HER2-negative). Typically, patients with HER2-positive disease have a worse prognosis. Trastuzumab is a selective treatment that targets the HER2 pathway....

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD006242.pub2

    authors: Balduzzi S,Mantarro S,Guarneri V,Tagliabue L,Pistotti V,Moja L,D'Amico R

    更新日期:2014-06-12 00:00:00

  • Exercise for haemophilia.

    abstract:BACKGROUND:Haemophilia is a bleeding disorder associated with haemorrhaging into joints and muscles. Exercise is often used to aid recovery after bleeds, and to improve joint function in the presence of arthropathy. OBJECTIVES:Our objective was to systematically review the available evidence on the safety and effectiv...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD011180.pub2

    authors: Strike K,Mulder K,Michael R

    更新日期:2016-12-19 00:00:00

  • Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation.

    abstract:BACKGROUND:Good neurologic outcome after cardiac arrest is hard to achieve. Interventions during the resuscitation phase and treatment within the first hours after the event are critical. Experimental evidence suggests that therapeutic hypothermia is beneficial, and a number of clinical studies on this subject have bee...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD004128.pub2

    authors: Arrich J,Holzer M,Herkner H,Müllner M

    更新日期:2009-10-07 00:00:00

  • Coenzyme Q10 for Parkinson's disease.

    abstract:BACKGROUND:A number of preclinical studies in both in vitro and in vivo models of Parkinson's disease have demonstrated that coenzyme Q10 can protect the nigrostriatal dopaminergic system. Some clinical trials have looked at the neuroprotective effects of coenzyme Q10 in patients with early and midstage Parkinson's dis...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD008150.pub2

    authors: Liu J,Wang L,Zhan SY,Xia Y

    更新日期:2011-12-07 00:00:00

  • EMG biofeedback for the recovery of motor function after stroke.

    abstract:BACKGROUND:Electromyographic biofeedback (EMG-BFB) is a technique that is believed to have additional benefit when used with standard physiotherapy for the recovery of motor function in stroke patients. However, evidence from individual trials and previous systematic reviews has been inconclusive. OBJECTIVES:To assess...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD004585.pub2

    authors: Woodford H,Price C

    更新日期:2007-04-18 00:00:00

  • Telemedicine for the support of parents of high-risk newborn infants.

    abstract:BACKGROUND:Telemedicine is the use of electronic communications technology to provide care for patients when distance separates the practitioner and the patient. As the parents and families of infants admitted to the NICU require major support from health professionals in terms of information and time, telemedicine has...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD006818.pub2

    authors: Tan K,Lai NM

    更新日期:2012-06-13 00:00:00

  • Interventions to increase attendance for diabetic retinopathy screening.

    abstract:BACKGROUND:Despite evidence supporting the effectiveness of diabetic retinopathy screening (DRS) in reducing the risk of sight loss, attendance for screening is consistently below recommended levels. OBJECTIVES:The primary objective of the review was to assess the effectiveness of quality improvement (QI) intervention...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD012054.pub2

    authors: Lawrenson JG,Graham-Rowe E,Lorencatto F,Burr J,Bunce C,Francis JJ,Aluko P,Rice S,Vale L,Peto T,Presseau J,Ivers N,Grimshaw JM

    更新日期:2018-01-15 00:00:00

  • Hepatitis B immunisation in persons not previously exposed to hepatitis B or with unknown exposure status.

    abstract:BACKGROUND:The benefits and harms of hepatitis B vaccination in persons not previously exposed to hepatitis B infection or with unknown exposure status have not been established. OBJECTIVES:To assess the benefits and harms of hepatitis B vaccination in people not previously exposed to hepatitis B infection or with unk...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD006481.pub2

    authors: Mathew JL,El Dib R,Mathew PJ,Boxall EH,Brok J

    更新日期:2008-07-16 00:00:00

  • Treatment for methaqualone dependence in adults.

    abstract:BACKGROUND:Methaqualone is a potent quinazoline, a class of sedative-hypnotics, that has a high potential for abuse. While the oral use of methaqualone (Quaalude, Mandrax) has waned in western countries since the mid-late 1980's, the practice of smoking methaqualone is a serious public health problem in South Africa, o...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD004146.pub2

    authors: McCarthy G,Myers B,Siegfried N

    更新日期:2005-04-18 00:00:00

  • Glutamatergic drugs for schizophrenia.

    abstract:BACKGROUND:It has been shown that central nervous system dopamine can play a major role in the pathophysiology of schizophrenia. Brain glutamate is thought to mediate symptoms in schizophrenia due to the influence of glutamate neurons on the dopaminergic transmission in the brain. It might be possible to decrease negat...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD003730.pub2

    authors: Tuominen HJ,Tiihonen J,Wahlbeck K

    更新日期:2006-04-19 00:00:00

  • Medical day hospital care for the elderly versus alternative forms of care.

    abstract:BACKGROUND:Geriatric day hospitals provide multi-disciplinary rehabilitation in an outpatient setting. Concern has been expressed that evidence for effectiveness is equivocal and that day hospital care is expensive. OBJECTIVES:To assess the effects of medical day hospitals for elderly people. SEARCH STRATEGY:We searc...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD001730

    authors: Forster A,Young J,Langhorne P

    更新日期:2000-01-01 00:00:00

  • Inhaled steroids and risk of pneumonia for chronic obstructive pulmonary disease.

    abstract:BACKGROUND:Inhaled corticosteroids (ICS) are anti-inflammatory drugs that have proven benefits for people with worsening symptoms of chronic obstructive pulmonary disease (COPD) and repeated exacerbations. They are commonly used as combination inhalers with long-acting beta2-agonists (LABA) to reduce exacerbation rates...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD010115.pub2

    authors: Kew KM,Seniukovich A

    更新日期:2014-03-10 00:00:00

  • Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users.

    abstract:BACKGROUND:Problem alcohol use is common among illicit drug users and is associated with adverse health outcomes. It is also an important factor in poor prognosis among drug users with hepatitis C virus (HCV) as it impacts on progression to hepatic cirrhosis or opiate overdose in opioid users. OBJECTIVES:To assess the...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD009269.pub2

    authors: Klimas J,Field CA,Cullen W,O'Gorman CS,Glynn LG,Keenan E,Saunders J,Bury G,Dunne C

    更新日期:2012-11-14 00:00:00

  • Early erythropoiesis-stimulating agents in preterm or low birth weight infants.

    abstract:BACKGROUND:Preterm infants have low plasma levels of erythropoietin (EPO), providing a rationale for the use of erythropoiesis-stimulating agents (ESAs) to prevent or treat anaemia and to provide neuro protection and protection against necrotising enterocolitis (NEC). Darbepoetin (Darbe) and EPO are currently available...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD004863.pub6

    authors: Ohlsson A,Aher SM

    更新日期:2020-02-11 00:00:00

  • Household interventions for preventing domestic lead exposure in children.

    abstract:BACKGROUND:Lead poisoning is associated with physical, cognitive and neurobehavioural impairment in children, and trials have tested many household interventions to prevent lead exposure. This is an update of the original review, first published in 2008. OBJECTIVES:To assess the effects of household interventions for ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD006047.pub5

    authors: Nussbaumer-Streit B,Yeoh B,Griebler U,Pfadenhauer LM,Busert LK,Lhachimi SK,Lohner S,Gartlehner G

    更新日期:2016-10-16 00:00:00