Sudden, spontaneous interruption of the function of the seventh cranial nerve is no longer treated expectantly. It must be dealt with as a medical emergency to relieve the ischemia of the nerve in the facial canal. The ischemia results from vasospasm and is aggravated by reactive edema. The pathological process is that of ischemic neuritis. Treatment should be started as soon after the onset of paralysis as possible, preferably within the first 48 hours. It consists of blocking the stellate ganglion and administering nicotinic acid parenterally to achieve vasodilation and administering corticosteroids to reduce edema. Although in most cases recovery is spontaneous, the possibility of permanent distressing sequelae, such as residual paralysis, contracture, associated movements, and hemifacial spasm makes prompt treatment essential.
Cohen DD. BELL'S PALSY-A MEDICAL EMERGENCY. JAMA. 1960;173(14):1563-1565. doi:10.1001/jama.1960.03020320043012