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Bell's palsy is a rapid unilateral facial nerve paresis (weakness) or paralysis (complete loss of movement) of unknown cause. The condition leads to the partial or complete inability to voluntarily move facial muscles on the affected side of the face. Although typically self\u2010limited, the facial paresis\/paralysis that occurs in Bell's palsy may cause significant temporary oral incompetence and an inability to close the eyelid, leading to potential eye injury. Additional long\u2010term poor outcomes do occur and can be devastating to the patient. Treatments are generally designed to improve facial function and facilitate recovery. There are myriad treatment options for Bell's palsy, and some controversy exists regarding the effectiveness of several of these options, and there are consequent variations in care. In addition, numerous diagnostic tests available are used in the evaluation of patients with Bell's palsy. Many of these tests are of questionable benefit in Bell's palsy. Furthermore, while patients with Bell's palsy enter the health care system with facial paresis\/paralysis as a primary complaint, not all patients with facial paresis\/paralysis have Bell's palsy. It is a concern that patients with alternative underlying etiologies may be misdiagnosed or have unnecessary delay in diagnosis. All of these quality concerns provide an important opportunity for improvement in the diagnosis and management of patients with Bell's palsy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The primary purpose of this guideline is to improve the accuracy of diagnosis for Bell's palsy, to improve the quality of care and outcomes for patients with Bell's palsy, and to decrease harmful variations in the evaluation and management of Bell's palsy. This guideline addresses these needs by encouraging accurate and efficient diagnosis and treatment and, when applicable, facilitating patient follow\u2010up to address the management of long\u2010term sequelae or evaluation of new or worsening symptoms not indicative of Bell's palsy. The guideline is intended for all clinicians in any setting who are likely to diagnose and manage patients with Bell's palsy. The target population is inclusive of both adults and children presenting with Bell's palsy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Action Statements<\/jats:title>\n                    <jats:p>\n                      The development group made a\n                      <jats:italic>strong recommendation<\/jats:italic>\n                      that (a) clinicians should assess the patient using history and physical examination to exclude identifiable causes of facial paresis or paralysis in patients presenting with acute\u2010onset unilateral facial paresis or paralysis, (b) clinicians should prescribe oral steroids within 72 hours of symptom onset for Bell's palsy patients 16 years and older, (c) clinicians should not prescribe oral antiviral therapy alone for patients with new\u2010onset Bell's palsy, and (d) clinicians should implement eye protection for Bell's palsy patients with impaired eye closure. The panel made\n                      <jats:italic>recommendations<\/jats:italic>\n                      that (a) clinicians should not obtain routine laboratory testing in patients with new\u2010onset Bell's palsy, (b) clinicians should not routinely perform diagnostic imaging for patients with new\u2010onset Bell's palsy, (c) clinicians should not perform electrodiagnostic testing in Bell's palsy patients with incomplete facial paralysis, and (d) clinicians should reassess or refer to a facial nerve specialist those Bell's palsy patients with (1) new or worsening neurologic findings at any point, (2) ocular symptoms developing at any point, or (3) incomplete facial recovery 3\u00a0months after initial symptom onset. The development group provided the following\n                      <jats:italic>options<\/jats:italic>\n                      : (a) clinicians may offer oral antiviral therapy in addition to oral steroids within 72 hours of symptom onset for patients with Bell's palsy, and (b) clinicians may offer electrodiagnostic testing to Bell's palsy patients with complete facial paralysis. The development group offered the following\n                      <jats:italic>no recommendations<\/jats:italic>\n                      : (a) no recommendation can be made regarding surgical decompression for patients with Bell's palsy, (b) no recommendation can be made regarding the effect of acupuncture in patients with Bell's palsy, and (c) no recommendation can be made regarding the effect of physical therapy in patients with Bell's palsy.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0194599813505967","type":"journal-article","created":{"date-parts":[[2013,11,4]],"date-time":"2013-11-04T13:54:55Z","timestamp":1383573295000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":310,"title":["Clinical Practice Guideline: Bell's Palsy"],"prefix":"10.1002","volume":"149","author":[{"given":"Reginald F.","family":"Baugh","sequence":"first","affiliation":[{"name":"University of Toledo Medical Center Toledo Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory J.","family":"Basura","sequence":"additional","affiliation":[{"name":"University of Michigan Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa E.","family":"Ishii","sequence":"additional","affiliation":[{"name":"Johns Hopkins University Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seth R.","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Virginia Mason Medical Center Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin Murray","family":"Drumheller","sequence":"additional","affiliation":[{"name":"Department of Research and Quality Improvement American Academy of Otolaryngology\u2014Head and Neck Surgery Foundation Alexandria Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Burkholder","sequence":"additional","affiliation":[{"name":"National Consumers League Washington, DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan A.","family":"Deckard","sequence":"additional","affiliation":[{"name":"Cooper University Camden New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cindy","family":"Dawson","sequence":"additional","affiliation":[{"name":"University of Iowa Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin","family":"Driscoll","sequence":"additional","affiliation":[{"name":"Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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