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Bell's palsy is a
paralysis or weakness of the muscles on one side of
your face. Damage to the facial nerve that controls muscles on one side of the
face causes that side of your
face to droop. The nerve damage may also affect your sense of taste and how you
make tears and saliva. This condition comes on suddenly, often overnight, and
usually gets better on its own within a few weeks.
is not the result of a
stroke or a
transient ischemic attack (TIA). While stroke and TIA
can cause facial paralysis, there is no link between Bell's palsy and either of
these conditions. But sudden weakness that occurs on one side of your face should be checked by a doctor right away to rule out these more serious causes.
The cause of Bell's
palsy is not clear. Most cases are thought to be caused by the
herpes virus that causes cold sores.
In most cases of Bell's palsy, the nerve that
controls muscles on one side of the face is damaged by
Many health problems can
cause weakness or paralysis of the face. If a specific reason cannot be found
for the weakness, the condition is called Bell's palsy.
Symptoms of Bell's palsy include:
Your doctor may
diagnose Bell's palsy by asking you questions, such as about how your symptoms
developed. He or she will also give you a physical and neurological exam to
facial nerve function.
If the cause of your symptoms is not clear, you may need other tests, such as blood tests, an MRI, or a CT scan.
Most people who have Bell's
palsy recover completely, without treatment, in 1 to 2 months.1
This is especially true for people who can still partly move their facial muscles. But a small number of people may have permanent muscle weakness or other problems on the
affected side of the face.
Treatment with corticosteroid medicines (such as prednisone) can make it more likely that you will regain all facial movement. They work best if they are taken soon after symptoms start (within 3 days).
Sometimes antiviral medicines (such as acyclovir) may be added to corticosteroid medicines to treat Bell's palsy. But evidence for using antiviral medicines is weak. They may help in some cases, but in general they do not affect recovery.2
Some people may not be able to take corticosteroid medicines because of other health problems. It's important to remember that most people with Bell's palsy recover completely without any treatment.
Facial exercises. As the nerve in your face begins to work again,
doing simple exercises—such as tightening and relaxing your facial muscles—may
make those muscles stronger and help you recover more quickly. Massaging your
forehead, cheeks, and lips with oil or cream may also help.
Eye care. If you can't blink or close your eye fully, your eye may become dry. A dry eye can lead to sores and serious vision problems. To help protect the eye and keep it moist:
Mouth care. If you have no feeling and little
saliva on one side of your tongue, food may get stuck there, leading to
gum disease or
tooth decay. Brush and floss your teeth often
and well to help prevent these problems. To prevent
swallowing problems, eat slowly and chew your food well. Eating
soft, smooth foods, such as yogurt, may also help.
Learning about Bell's palsy:
Ropper AH, Samuels MA (2009). Diseases of the cranial nerves. In Adams and Victor's Principles of Neurology, 9th ed., pp. 1326–1340. New York: McGraw-Hill.
Gronseth GS, Paduga R (2012). Evidence-based guideline update: Steroids and antivirals for Bell palsy. Neurology, 79(22): 2209–2213.
Other Works Consulted
Brannagan TH, Weimer LH (2010). Cranial and peripheral nerve lesions. In LP Rowland, TA Pedley, eds., Merritt’s Neurology, 12th ed., pp. 503–519. Philadelphia: Lippincott Williams and Wilkins.
de Almeida JR, et al. (2009). Combined corticosteroid and antiviral treatment for Bell palsy: A systematic review and meta-analysis. JAMA, 302(9): 985–993.
Lockhart P, et al. (2009). Antiviral treatment for Bell’s palsy (idiopathic facial paralysis). Cochrane Database of Systematic Reviews (4).
Sullivan FM, et al. (2007). Early treatment
with prednisolone or acyclovir in Bell's palsy. New England Journal of Medicine, 357(16): 1598–1607.
July 23, 2013
Anne C. Poinier, MD - Internal Medicine & Colin Chalk, MD, CM, FRCPC - Neurology
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