Practice Manager:  Tel. 020 7183 1559

Bell’s Palsy and Treatment

Bell's palsy is the commonest cause of facial paralysis and affects people of all age groups. Men and women are equally affected. It is usually temporary. Symptoms generally start suddenly and have no obvious cause, often over a few hours or overnight. The main symptom is weakness or paralysis of one side of the face. The eyebrow may sag and eye closure is difficult. The eye can be dry or watery. Mild earache or pain behind the ear may be the first sign of Bell’s palsy in some patients. The mouth may droop and saliva and drinks can dribble from the mouth. Speech may be difficult and taste can be altered. Hearing is sometimes unusually sharp on the affected side of the face.

Bell’s palsy is caused by herpes simplex virus infection of the facial nerve. The virus causes cold sores and is thought to lie dormant in the nerve root, causing swelling if it reactivates. Approximately 75% of patients with Bell's palsy recover completely spontaneously. Most patients have significant improvement within three to eight weeks of the start of the condition, but in others it can take three to six months before symptoms improve.

Treatment includes using artificial tears to keep the eye moist and an eye pad or tape at night to keep the eye closed during sleep. Oral steroids may reduce the swelling of the nerve and prevent damage, particularly if they are commenced within three days of symptoms first starting. They are usually taken for 10 days. Antivirals (eg valaciclovir) can be prescribed to treat the herpes virus, although there is little evidence that they help Bell's palsy. Facial exercises and physiotherapy may also be useful to aid recovery

Around 15% of patients are left with residual facial weakness, muscle tightness or facial spasms. Spasm or facial tightness can be treated by botulinum injection to balance facial movement. The residual facial weakness and problems with eye closure can be treated with a range of surgical procedures described subsequently.

Facial Palsy: Introduction
Facial Palsy: Dynamic Muscle Transfer
Static Correction
Facial Palsy: Eyelid Surgery
Adjunctive Procedures – Brow and Facelift