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Bell's PalsyDefinitionBell's palsy is a sudden weakness and paralysis on one side of the face due to injury to the facial nerve. It occurs in approximately 40,000 Americans each year. It affects men and women equally. Bell's Palsy: Facial Droop ![]() 2009 Nucleus Medical Media, Inc. CausesThe exact cause of Bell's palsy is unknown. It is suspected that an irritated facial nerve becomes swollen. As the facial nerve passes through narrow openings in the skull, it is compressed and symptoms result. Doctors believe a herpes virus may cause the nerve to become inflamed, and, in turn, cause Bell’s palsy. Lyme disease or other infections may also be a cause of facial weakness. Paralysis of the facial nerve may also be caused by:
Risk FactorsThese factors increase your chance of developing Bell's palsy. Tell your doctor if you have any of these risk factors:
SymptomsBell's palsy symptoms may come on suddenly or develop over a few days. Initial symptoms may include:
Symptoms of full-blown Bell's palsy may include:
Late complications (occurring 3-4 months after onset) can include:
DiagnosisThe doctor will ask about your symptoms and medical history, and do a physical exam. Other tests may include:
TreatmentIn most cases, symptoms go away within a few weeks without treatment. Many cases of Bell's palsy completely resolve after a few months. Protecting the eye is important. This is because you may not be able to blink. If an underlying cause of the symptoms is known, it is treated. In some cases, however, symptoms may never go away. Below are several ways to treat Bell's palsy: MedicationYour doctor may prescribe corticosteroids. These reduce swelling and pain. For example, studies have shown that prednisolone can improve the chance of complete recovery from Bell's palsy. In addition to corticosteroids, antiviral medications (eg, valacyclovir [Valtrex], acyclovir [Zovirax]) may also be prescribed for this condition. But, the evidence is mixed as to how effective antivirals are in treating Bell's palsy. SurgerySome doctors try to surgically relieve pressure on the nerve by removing part of the bone. This is an unproven procedure. It is considered controversial and is no longer commonly done. If the eyelid will not close, other surgeries around the eye may be considered. Self-careYou may need to apply lubricant or put drops in the eye. The eye can be covered and taped closed at night. Do not place tape directly on the eyelid. An eye patch may be worn to keep the eye closed. This helps moisten and keep particles out of the eye. Massage of the weakened facial muscles may be beneficial. TherapySymptoms can be very distressing. You may need help dealing with emotional issues associated with the condition. Physical therapy and speech therapy may be helpful in improving symptoms. If you are diagnosed with Bell's palsy, follow your doctor's instructions . RESOURCES: Bell's Palsy Information Site National Institute of Neurological Disorders and Stroke CANADIAN RESOURCES: Alberta Health and Wellness Health Canada References: American Academy of Otolaryngology—Head and Neck Surgery website. Available at: http://www.entnet.org/ . Accessed June 30, 2009. Bell’s palsy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated June 18, 2009. Accessed June 30, 2009. Bell’s palsy fact sheet. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/disorder_index.htm . Updated July 2, 2008. Accessed June 30, 2009. Bell’s palsy information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/disorder_index.htm . Updated July 2, 2008. Accessed June 30, 2009. Dambro MR. Griffith's 5-Minute Clinical Consult . Philadelphia, PA: Lippincott Williams & Wilkins; 1999. Finsterer J. Management of peripheral facial nerve palsy. Eur Arch Otorhinolaryngology. 2008;265:743-752. Kasper DL, Braunwald E, Fauci AS, et al. Harrison's Principles of Internal Medicine . 16th ed. New York, NY: The McGraw-Hill Companies; 2005. National Institute of Dental and Craniofacial Research website. Available at: http://www.nidcr.nih.gov/ . Accessed June 30, 2009. New concepts in Bell's palsy improve treatment options. American Family Physician website. Available at: http://www.aafp.org/afp/20050701/tips/6.html . Published July 1, 2005. Accessed June 30, 2009. Primary Care Medicine . 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000. Quant EC, Jeste SS, Muni RH, et al. The benefits of steroids versus steroids plus antivirals for treatment of Bell's palsy: a meta-analysis. BMJ. 2009;339:b3354. Rakel RE, Bope ET. Conn's Current Therapy . 53rd ed. Philadelphia, PA: WB Saunders Company; 2001. Russell J. Bells palsy. In: Gilman S, ed. MedLink Neurology. San Diego, CA: MedLink Corporation. Samuels MA, Feske SK. Office Practice of Neurology . Philadelphia, PA: Churchill Livingstone; 2003. ¹11/6/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Sullivan FM, Swan IR, Donnan PT, Morrison JM, et al. Early treatment with prednisolone or acyclovir in Bell's palsy. N Engl J Med . 2007;357:1598-1607. ²1/6/2009 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Engstrom M, Berg T, Stjernquist-Desatnik A, et al. Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet Neurol. 2008;7:993-1000.
³9/15/2009 DynaMed's Systematic Literature Surveillance
DynaMed's Systematic Literature Surveillance
: Goudakos JK, Markou KD. Corticosteroids vs corticosteroids plus antiviral agents in the treatment of Bell palsy: a systematic review and meta-analysis.
Arch Otolaryngol Head Neck Surg.
2009;135:558-564.
Last reviewed October 2009 by Rimas Lukas, MD Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition. Copyright © 2009 EBSCO Publishing All rights reserved.
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