Highlights & Basics
- Bell's palsy is an acute, sudden-onset, unilateral facial palsy of probable viral etiology.
- Clinical diagnosis of exclusion.
- High-dose corticosteroids should be administered in all patients in the absence of significant contraindications.
- Other treatment options include concomitant antiviral agents, physical therapy, and, in severe or recurrent cases, surgical decompression.
- Eye protection should always be considered.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
Baugh RF, Basura GJ, Ishii LE, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-27.[Abstract][Full Text]
Gronseth GS, Paduga R; American Academy of Neurology. Evidence-based guideline update: steroids and antivirals for Bell palsy. Neurology. 2012 (reaffirmed 2023) Nov 27;79(22):2209-13.[Abstract][Full Text]
Madhok VB, Gagyor I, Daly F, et al. Corticosteroids for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2016;(7):CD001942.[Abstract][Full Text]
Gagyor I, Madhok VB, Daly F, et al. Antiviral treatment for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2019 Sep 5;9:CD001869.[Abstract][Full Text]
Gantz BJ, Rubinstein JT, Gidley P, et al. Surgical management of Bell palsy. Laryngoscope. 1999 Aug;109(8):1177-88.[Abstract]
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36. Abraham-Inpijn L, Devriese PP, Hart AA. Predisposing factors in Bell palsy: a clinical study with reference to diabetes mellitus, hypertension, clotting mechanism and lipid disturbance. Clin Otolaryngol Allied Sci. 1982 Apr;7(2):99-105.[Abstract]
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38. Gilden D, Cohrs RJ, Mahalingam R, et al. Neurological disease produced by varicella zoster virus reactivation without rash. Curr Top Microbiol Immunol. 2010;342:243-53.[Abstract][Full Text]
39. Chweya CM, Anzalone CL, Driscoll CLW, et al. For whom the Bell's toll: recurrent facial nerve paralysis, a retrospective study and systematic review of the literature. Otol Neurotol. 2019 Apr;40(4):517-28.[Abstract]
40. Baugh RF, Basura GJ, Ishii LE, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-27.[Abstract][Full Text]
41. Pacheco A, Rutler O, Valenzuela I, et al. Positive tests for Lyme disease and emergency department visits for Bell's palsy patients. J Emerg Med. 2020 Dec;59(6):820-7.[Abstract]
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44. American College of Radiology. ACR appropriateness criteria: cranial neuropathy. 2022 [internet publication].[Full Text]
45. Guntinas-Lichius O, Volk GF, Olsen KD, et al. Facial nerve electrodiagnostics for patients with facial palsy: a clinical practice guideline. Eur Arch Otorhinolaryngol. 2020 Jul;277(7):1855-74.[Abstract][Full Text]
46. Butler DP, De la Torre A, Borschel GH, et al. An international collaborative standardizing patient-centered outcome measures in mediatric facial palsy. JAMA Facial Plast Surg. 2019 Sep 1;21(5):351-8.[Abstract][Full Text]
47. Fieux M, Franco-Vidal V, Devic P, et al. French society of ENT (SFORL) guidelines. Management of acute Bell's palsy. Eur Ann Otorhinolaryngol Head Neck Dis. 2020 Dec;137(6):483-8.[Abstract][Full Text]
48. Gronseth GS, Paduga R; American Academy of Neurology. Evidence-based guideline update: steroids and antivirals for Bell palsy. Neurology. 2012 (reaffirmed 2023) Nov 27;79(22):2209-13.[Abstract][Full Text]
49. Sullivan FM, Swan IR, Donnan PT, et al. A randomised controlled trial of the use of aciclovir and/or prednisolone for the early treatment of Bell's palsy: the BELLS study. Health Technol Assess. 2009 Oct;13(47):iii-iv, ix-xi 1-130.[Abstract][Full Text]
50. Hato N, Yamada H, Kohno H, et al. Valacyclovir and prednisolone treatment for Bell's palsy: a multicenter, randomized, placebo-controlled study. Otol Neurotol. 2007 Apr;28(3):408-13.[Abstract]
51. Engström 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 Nov;7(11):993-1000.[Abstract]
52. Madhok VB, Gagyor I, Daly F, et al. Corticosteroids for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2016;(7):CD001942.[Abstract][Full Text]
53. Gagyor I, Madhok VB, Daly F, et al. Antiviral treatment for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2019 Sep 5;9:CD001869.[Abstract][Full Text]
54. Sullivan FM, Swan IR, Donnan PT, et al. Early treatment with prednisolone or acyclovir in Bell's palsy. N Engl J Med. 2007 Oct 18;357(16):1598-607.[Abstract]
55. Axelsson S, Berg T, Jonsson L, et al. Prednisolone in Bell's palsy related to treatment start and age. Otol Neurotol. 2011 Jan;32(1):141-6.[Abstract]
56. Axelsson S, Berg T, Jonsson L, et al. Bell's palsy - the effect of prednisolone and/or valaciclovir versus placebo in relation to baseline severity in a randomised controlled trial. Clin Otolaryngol. 2012 Aug;37(4):283-90.[Abstract]
57. Berg T, Bylund N, Marsk E, et al. The effect of prednisolone on sequelae in Bell's palsy. Arch Otolaryngol Head Neck Surg. 2012 May;138(5):445-9.[Abstract][Full Text]
58. Fujiwara T, Namekawa M, Kuriyama A, et al. High-dose corticosteroids for adult Bell's palsy: systematic review and meta-analysis. Otol Neurotol. 2019 Sep;40(8):1101-8.[Abstract]
59. Jowett N, Gaudin RA, Banks CA, et al. Steroid use in Lyme disease-associated facial palsy is associated with worse long-term outcomes. Laryngoscope. 2017 Jun;127(6):1451-8.[Abstract]
60. Jalali MM, Soleimani R, Soltanipour S, et al. Pharmacological treatments of Bell's palsy in adults: a systematic review and network meta-Analysis. Laryngoscope. 2021 Jul;131(7):1615-25.[Abstract]
61. de Almeida JR, Al Khabori M, Guyatt GH, et al. Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta-analysis. JAMA. 2009 Sep 2;302(9):985-93.[Abstract][Full Text]
62. 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 Jun;135(6):558-64.[Abstract][Full Text]
63. 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 Sep 7;339:b3354.[Abstract][Full Text]
64. de Ru JA, van Benthem PP. Combination therapy is preferable for patients with Ramsay Hunt syndrome. Otol Neurotol. 2011 Jul;32(5):852-5.[Abstract]
65. Monsanto RD, Bittencourt AG, Bobato Neto NJ, et al. Treatment and prognosis of facial palsy on Ramsay Hunt syndrome: results based on a review of the literature. Int Arch Otorhinolaryngol. 2016 Oct;20(4):394-400.[Abstract][Full Text]
66. Gantz BJ, Rubinstein JT, Gidley P, et al. Surgical management of Bell palsy. Laryngoscope. 1999 Aug;109(8):1177-88.[Abstract]
67. Menchetti I, McAllister K, Walker D, et al. Surgical interventions for the early management of Bell's palsy. Cochrane Database Syst Rev. 2021 Jan 26;1:CD007468.[Abstract][Full Text]
68. May M, Klein SR, Taylor FH. Idiopathic (Bell's) facial palsy: natural history defies steroid or surgical treatment. Laryngoscope. 1985 Apr;95(4):406-9.[Abstract]
69. Lee SY, Seong J, Kim YH. Clinical implication of facial nerve decompression in complete Bell's palsy: a systematic review and meta-analysis. Clin Exp Otorhinolaryngol. 2019 Nov;12(4):348-59.[Abstract][Full Text]
70. Casazza GC, Schwartz SR, Gurgel RK. Systematic review of facial nerve outcomes after middle fossa decompression and transmastoid decompression for Bell's palsy with complete facial paralysis. Otol Neurotol. 2018 Dec;39(10):1311-8.[Abstract]
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74. Borodic G, Bartley M, Slattery W, et al. Botulinum toxin for aberrant facial nerve regeneration: double-blind, placebo-controlled trial using subjective endpoints. Plast Reconstr Surg. 2005 Jul;116(1):36-43.[Abstract]
75. Fuzi J, Taylor A, Sideris A, et al. Does botulinum toxin therapy improve quality of life in patients with facial palsy? Aesthetic Plast Surg. 2020 Oct;44(5):1811-9.[Abstract]
76. de Sanctis Pecora C, Shitara D. Botulinum toxin type A to improve facial symmetry in facial palsy: a practical guideline and clinical experience. Toxins (Basel). 2021 Feb 18;13(2).[Abstract][Full Text]
77. Teixeira LJ, Valbuza JS, Prado GF, et al. Physical therapy for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2011;(12):CD006283.[Abstract][Full Text]
78. Khan AJ, Szczepura A, Palmer S, et al. Physical therapy for facial nerve paralysis (Bell's palsy): an updated and extended systematic review of the evidence for facial exercise therapy. Clin Rehabil. 2022 Nov;36(11):1424-49.[Abstract][Full Text]
79. Beurskens CH, Heymans PG, Oostendorp RA. Stability of benefits of mime therapy in sequelae of facial nerve paresis during a 1-year period. Otol Neurotol. 2006 Oct;27(7):1037-42.[Abstract]
80. Pourmomeny AA, Zadmehre H, Mirshamsi M, et al. Prevention of synkinesis by biofeedback therapy: a randomized clinical trial. Otol Neurotol. 2014 Apr;35(4):739-42.[Abstract]
81. Nicastri M, Mancini P, De Seta D, et al. Efficacy of early physical therapy in severe Bell's palsy: a randomized controlled trial. Neurorehabil Neural Repair. 2013 Jul-Aug;27(6):542-51.[Abstract]
82. Chen N, Zhou M, He L, et al. Acupuncture for Bell's palsy. Cochrane Database Syst Rev. 2010;(8):CD002914.[Abstract]
83. Yu Z, Shen M, Shang W, et al. Timing of acupuncture treatment in peripheral facial paralysis: a systematic review and meta-analysis. Comput Math Methods Med. 2021;2021:4221955.[Abstract][Full Text]
84. Wen J, Chen X, Yang Y, et al. Acupuncture medical therapy and its underlying mechanisms: a systematic review. Am J Chin Med. 2021;49(1):1-23.[Abstract]
85. Zou Z. Comparison of efficacy and safety of acupuncture and moxibustion in acute phase and non-acute phase of Bell's palsy: a meta-analysis. Neuro Endocrinol Lett. 2021 Nov 30;42(7):438-45.[Abstract]
86. Yang LS, Zhou DF, Zheng SZ, et al. Early intervention with acupuncture improves the outcome of patients with Bell's palsy: a propensity score-matching analysis. Front Neurol. 2022;13:943453.[Abstract][Full Text]
87. Holland NJ, Bernstein JM, Hamilton JW, et al. Hyperbaric oxygen therapy for Bell's palsy. Cochrane Database Syst Rev. 2012;(2):CD007288.[Abstract][Full Text]
88. Racic G, Denoble PJ, Sprem N, et al. Hyperbaric oxygen as a therapy of Bell's palsy. Undersea Hyperb Med. 1997;24(1):35-8.[Abstract]
89. Gillman GS, Schaitkin BM, May M, et al. Bell palsy in pregnancy: a study of recovery outcomes. Otolaryngol Head Neck Surg. 2002 Jan;126(1):26-30.[Abstract]
90. Shmorgun D, Chan WS, Ray JG. Association between Bell's palsy in pregnancy and pre-eclampsia. QJM. 2002 Jun;95(6):359-62.[Abstract][Full Text]
91. Cuenca-Martínez F, Zapardiel-Sánchez E, Carrasco-González E, et al. Assessing anxiety, depression and quality of life in patients with peripheral facial palsy: a systematic review. PeerJ. 2020;8:e10449.[Abstract][Full Text]
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