Clinical Practice Guideline for the Evaluation and Management of Facial Nerve Palsy

Objective: To develop evidence-based clinical practice guidelines for evaluating and managing peripheral facial nerve palsy within the Korean healthcare system. Methods: A multidisciplinary guideline committee-comprising otolaryngologists, a neurologist, a neurosurgeon, a rehabilitation medicine specialist, an ophthalmologist, a plastic surgeon, and a methodology expert-conducted de novo systematic reviews. Literature searches were performed in MEDLINE, Embase, the Cochrane Library, and KoreaMed through November 30, 2024. Evidence was appraised using the GRADE methodology, and nine key clinical questions (KQs) were formulated using the PICO framework. Recommendations were finalized through structured consensus requiring at least 70% agreement. A patient preference survey (n = 51) informed value considerations. The draft guideline underwent external review by seven independent experts. Results: Ten recommendations addressing nine KQs were developed. The House-Brackmann grading system is recommended as the standard assessment tool (Grade A). Routine testing is unnecessary for typical Bell's palsy; selective testing is advised for atypical features (Grade B). Electrodiagnostic studies may be used for prognostic evaluation in severe cases (Grade B). Oral corticosteroids are strongly recommended within 72 hours of symptom onset (Grade A). Antivirals may be added based on clinical judgment and patient preference (Grade B). Facial nerve decompression may be considered in selected patients with severe degeneration (Grade B). Rehabilitation therapy, surgery for chronic palsy, botulinum toxin injection for synkinesis, and multidisciplinary management are conditionally recommended (Grade B). Conclusion: This guideline provides an evidence-based framework for managing facial nerve palsy in Korea. It integrates systematic evidence, patient preferences, and healthcare system factors, including National Health Insurance coverage and regional accessibility.