Bell's palsy: Difference between revisions

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Revision as of 14:14, 22 March 2016


  • Dysfunction of peripheral cranial nerve VII of unknown cause due to Inflammation at geniculate ganglion [1]
  • Maximal clinical weakness around 3wks; at least partial recovery by 6 months
  • Always test CN VI function (should be normal) to rule-out CVA

Clinical Features

Right-sided peripheral facial nerve palsy with inability to wrinkle the forehead and nose, unequal lid fissures, and inability to lift the corner of the mouth.
  • Acute onset (over hours) of unilateral facial paralysis
    • No forehead sparing
  • Inability to raise eyebrows
    • Drooping of angle of the mouth
  • Incomplete closure of the eyelids on the affected side
    • Can lead to corneal exposure keratitis

Associated Symptoms

  1. Alterations in taste
  2. Hyperacusis
  3. Inability to produce tears
  4. Subjective feeling of facial numbness although no demonstrable numbness

Differential Diagnosis


  • Clinicians should NOT obtain routine laboratory testing or diagnostic imaging in patients with new-onset Bell's palsy (Level C)[2]


  • Cornea eye protection (Level X)[2]
    • Artificial tears qhr while pt is awake AND
    • Ophthalmic ointment at night
    • Protective glasses or goggles

Eye Protection

  • Cornea eye protection (Level X)[2]
    • Artificial tears qhr while patient is awake
    • Ophthalmic ointment at night
    • Eye should be taped shut at night
    • Protective glasses or goggles


Should be started within 72hrs of symptom onset[3]


Most likely no added benefit when combined with steroids.[6] However also little harm associated with antivirals especially in patients with normal renal function[5]


  • Consider empiric doxycycline if high index of suspicion for Lyme based on clinical presentation or lab data


  • Discharge with ophtho f/u for monitoring of the affected cornea
  • Refer to a facial nerve specialist for:[2]
    • New or worsening neurologic findings at any point
    • Ocular symptoms developing at any point
    • Incomplete facial recovery 3 months after initial symptom onset.

See Also


  1. Greco A. et al. Bell's palsy and autoimmunity. Autoimmun Rev. 2012;12 622-627
  2. 2.0 2.1 2.2 2.3 Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.
  3. Vargish L. For Bell’s palsy, start steroids early; no need for an antiviral. J Fam Pract. Jan 2008; 57(1): 22–25
  4. 4.0 4.1 UpToDate. Bell's Palsy Prognosis and Treatment. March, 2014
  5. 5.0 5.1 Gronseth GS, Paduga R. Evidence-based guideline update: Steroids and antivirals for Bell palsy: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2012Full Text
  6. Lockhart et al. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD001869.