Bell's palsy (BP) is characterized by idiopathic acute weakness of the facial muscles associated with compression of the facial nerve. The present prospective study sought to evaluate the clinical efficacy of ultrasound-guided combined perineural and intramuscular dextrose injection for management of refractory Bell's palsy. The study included 30 patients with Bell's palsy with House-Brackmann scale ≥ 3 who were refractory to standard medical treatment after 3 months of disease onset. They received ultrasound-guided combined perineural and intramuscular dextrose injection. Clinical outcome was assessed using the House-Brackmann scale.