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Previous reports from this department based on controlled clinical trials (Peiris and Miles, 1965 ; Taverner et al., 1966) have described methods for the early establishment of an accurate prognosis in idiopathic facial palsy and for the reduction in the incidence of denervation, with permanent sequelae, in this common condition. The present communication describes our experience of the use of these two methods in the routine management of facial palsy in the two years following the controlled trials. The results support the claims previously made, and we are now confident that these methods should be introduced into routine medical practice. Material and MethodsAll patients attending the department of electromyography in the 23 months following the conclusion of the previous study (Taverner et al., 1966) who were suffering from their first attack of idiopathic facial paralysis of not more than five days' duration are included. It was laid down that patients known to be in early pregnancy or to be suffering from diabetes mellitus, severe hypertension, or active peptic ulceration were to be excluded. Four patients were affected. The criteria for diagnosis were the same as those previously used (Taverner, 1955). The patients were allocated to treatment or observation groups on the basis of the threshold to anodal galvanic stimulation of the tongue by the method of electrogustometry (Krarup, 1958; Peiris and Miles, 1965). Treated patients were given five daily intramuscular injections of 80 units of adrenocorticotrophic hormone (A.C.T.H. gel), then 60, 40, 20, and 10 units on successive days. In 26% of the cases the injections were given in the outpatient department of the General Infirmary at Leeds. The remainder were given by the patients' general practitioners or by the district nurse. Some patients were examined electromyographically as described by Langworth and Taverner (1963).At least three months after the onset of paralysis the final evaluation was made on clinical grounds, and patients with evidence of denervation were followed until no further improvement could be detected. In all except a few very mild cases each patient was seen by more than one observer. Two patients failed to reattend and have been excluded. Three others defaulted from the final assessment, but a reasonable conclusion seemed possible by combining the last clinic record with a report from the family doctor.Clinical assessment of function in the facial muscles was estimated in terms of a percentage of the normal function of the orbicularis oris, orbicularis oculi, and frontalis muscles on the unaffected side. The results were classified as complete recovery or denervation. Denervation was recorded in the presence of any permanent defect of voluntary movement or any degree of associated movement, however slight. ResultsA study was made of 383 consecutive patients with idiopathic facial palsy of not more than five days' duration. Two de-

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