Emerging Medications in Facial Nerve Recovery: A Systematic Review and Meta-Analysis.

Abstract

Objective: To systematically review the literature for medical therapies that promote facial nerve regeneration and recovery.

Data sources: PubMed/Medline, Embase, and SCOPUS databases were searched for English-language studies published from inception through May 2025.

Review methods: Human studies evaluating the efficacy of medical therapy on facial nerve regeneration using validated facial nerve grading scales were included.

Results: Nine studies were included in qualitative analysis, and 6 were included in a meta-analysis. Treatments included nimodipine (n = 6), pentoxifylline (n = 1), co-enzyme Q10 (n = 1), and extracellular vesicles (n = 1). All studies used HB score, and recovery was defined as HB score ≤3. Recovery was observed in 94% (95% CI:[90%, 97%]) of patients treated with nimodipine and 84% (95% CI: [70%, 97%]) of control patients; this was not statistically significant (OR 2.26, 95% CI: [0.97, 5.26]). Nimodipine significantly decreased HB score by 1.66 (95% CI: [0.81, 2.52]) before and after treatment. Pentoxifylline and extracellular vesicles demonstrated some efficacy, while co-enzyme Q10 was not efficacious.

Conclusion: Nimodipine improved HB score but was not significantly associated with recovery to HB score ≤3 compared to controls. Pentoxifylline and extracellular vesicles may have some efficacy, but co-enzyme Q10 is not effective. Further research is required to uncover additional treatments.