Designed and created by Guideline Central in participation with the American Academy of Otolaryngology - Head and Neck Surgery Foundation
Bell’s Palsy
Objective
Objective
The purpose of this patient summary is to provide guidance to patients of all ages with Bell’s Palsy.
Background and Definitions
Background and Definitions
- Bell’s Palsy is a rapid one-sided facial nerve paresis or paralysis of unknown cause.
- Paresis: weakness
- Paralysis: complete loss of movement
- It is the most common disorder affecting a single nerve.
- Approximately 70% of facial nerve palsies are Bell’s palsy.
- Bell’s palsy can lead to partial or complete inability to voluntarily move facial muscles on the affected side of the face.
- It can cause temporary loss of the ability to keep the lips closed while speaking or swallowing and an inability to close the eyelid which could lead to eye injury.
- Treatments aim to improve facial function and recovery.
- Not all patients with facial paresis/paralysis have Bell’s Palsy. Other possible causes should be considered.
Evaluation and Diagnostics
Evaluation and Diagnostics
- A history and physical examination should be performed to evaluate for identifiable causes of facial paresis/paralysis.
- Diagnostic imaging (CT/MRI) and laboratory testing are NOT recommended for individuals with new-onset Bell’s palsy.
- For partial facial weakness or paralysis, electrodiagnostic testing is NOT recommended but may be offered to patients with complete facial paresis/paralysis.
- Electrodiagnostic testing: refers to electromyography (EMG) and electroneuronography (ENoG) testing
- Electromyography: records the muscles response to voluntary muscle contraction
- Electroneuronography: tests the facial nerve by evaluating the facial muscle response to an electrical stimulation of the facial nerve.
- Electrodiagnostic testing: refers to electromyography (EMG) and electroneuronography (ENoG) testing
Treatment
Treatment
- It is recommended that oral steroids be prescribed within 72 hours of the start of Bell’s palsy symptoms for individuals that are at least 16 years old.
- Oral steroids: medications taken by mouth that have anti-inflammatory effects
- Oral antiviral therapy may be offered in addition to oral steroids within 72 hours of the start of Bell’s Palsy symptoms, but it is NOT recommended that antiviral therapy be given alone (without steroids).
- Antiviral therapy: medications taken by mouth to treat viral infections
- Eye protection is recommended for people with impaired eye closure.
- No recommendations can be made regarding the effects of surgical decompression, acupuncture, or physical therapy on Bell’s Palsy.
- Reassessment or referral to a facial nerve specialist is recommended for individuals with any of the following:
- New or worsening neurologic findings
- The development of eye symptoms at any time
- Incomplete facial recovery 3 months after symptoms began.
Additional Information:
Causes of Facial Paralysis
Additional Information:
Causes of Facial Paralysis
Type: Autoimmune
Condition-Cause: Guillain-Barre-autoimmune/infectious, Melkersson-Rosenthal syndrome-unknown, Multiple sclerosis-unknown Sarcoidosis-unknown
Type: Congenital
Condition-Cause: Mobius syndrome-possibly viral
Type: Endocrine
Condition-Cause: Diabetes-microvascular
Type: Idiopathic
Condition-Cause: Acute facial nerve paresis/paralysis-unknown
Type: Infectious
Condition-Cause: Encephalitis/meningitis-fungal, viral or bacterial; Herpes simplex-Herpes virus, HIV-human immunodeficiency virus, Lyme disease-Spirochete Borrelia burgdorferi, Mononucleosis-Epstein-Barr virus, Otitis media- bacterial, Ramsay Hunt Syndrome-Herpes Zoster virus, Syphilis-Treponema pallidum
Type: Inherited
Condition-Cause: Heritable disorder-autosomal dominant inheritance
Type: Neoplastic
Condition-Cause: facial nerve tumor, skin cancer, parotid tumors-multiple carcinomas of the head and neck
Type: Neurovascular
Condition-Cause: Stroke-Ischemia, hemorrhage
Type: Traumatic
Condition-Cause: Injury to facial nerve-trauma, including forceps delivery
Abbreviations
- EMG: Electromyography
- ENoG: Electroneuronography
Source Citation
Disclaimer
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.