A 31-year-old woman with a new right facial droop and an inability to lift the eyebrow or close the eye. What is the most likely treatment?

• A. Acetaminophen
• B. Acyclovir
• C. Ibuprofen
• D. Prednisone

Answer: (D)

Unilateral peripheral facial nerve palsy presenting with inability to raise the eyebrow and close the eye points to Bell palsy, a lower motor neuron pattern of facial nerve injury. The key treatment goal is to reduce inflammation and edema of the facial nerve as it travels through the narrow facial canal, which helps recovery.

Corticosteroids, such as prednisone, started early, reliably improve recovery and shorten the course when given within a few days of onset. That anti-inflammatory effect on the inflamed facial nerve is why it’s the best choice here. Antivirals like acyclovir are not routinely first-line for typical Bell palsy, unless there’s suspicion of herpes virus involvement (e.g., vesicles or Ramsay Hunt syndrome). Pain relievers address symptoms but don’t change the nerve inflammation, so they’re not disease-modifying.