Bell’s palsy

A diagnosis of Bell's palsy is made based on clinical presentation—acute facial nerve weakness or paralysis on one side of the face with onset in less than 72 hours—and by ruling out other possible causes of facial paralysis. There is no specific laboratory test to confirm diagnosis of the disorder.

Your healthcare provider can make a diagnosis based on symptoms. Other conditions, including stroke, sarcoidosis and Lyme disease, can also cause facial paralysis. To rule out those causes, you may have one or more of these tests:

Blood tests to check for conditions like Lyme disease or sarcoidosis.

Electromyography (EMG) to measure nerve activity and damage. This test may help your provider predict how quickly you’ll recover.

Magnetic resonance imaging (MRI) or computed tomography (CT) scans to rule out stroke or other causes of nerve damage.

Most people with Bell's palsy recover fully — with or without treatment. There's no one-size-fits-all treatment for Bell's palsy. But your health care provider may suggest medications or physical therapy to help speed your recovery. Surgery is rarely an option for Bell's palsy.

Because the eye on the affected side doesn't close, it's important to take steps to protect and care for that eye. Using lubricating eye drops during the day and an eye ointment at night will help keep your eye moist. Wearing glasses or goggles during the day and an eye patch at night can protect your eye from getting poked or scratched. In severe cases of Bell's palsy, an eye doctor may need to monitor the eye.

Medications

Commonly used medications to treat Bell's palsy include:

Corticosteroids, such as prednisone. These are powerful anti-inflammatory agents. If they can reduce the swelling of the facial nerve, the nerve will fit more comfortably within the bony corridor that surrounds it. Corticosteroids may work best if they're started within several days of when your symptoms started. Steroids started early improve the likelihood of complete recovery.

Antiviral drugs. The role of antivirals remains unsettled. Antivirals alone have shown no benefit compared with placebo. Antivirals added to steroids may benefit some people with Bell's palsy, but this is still unproved.

Despite this, an antiviral drug, such as valacyclovir (Valtrex) or acyclovir (Zovirax), is sometimes given in combination with prednisone in people with severe facial palsy.

Physical therapy

Paralyzed muscles can shrink and shorten, which may be permanent. A physical therapist can teach you how to massage and exercise your facial muscles to help prevent this from occurring.

Surgery

In the past, decompression surgery was used to relieve the pressure on the facial nerve by opening the bony passage that the nerve passes through. Today, decompression surgery isn't recommended. Facial nerve injury and permanent hearing loss are possible risks associated with this surgery.

Rarely, plastic surgery may be needed to correct lasting facial nerve problems. Facial reanimation surgery helps make the face look more even and may restore facial movement. Examples of this type of surgery include an eyebrow lift, an eyelid lift, facial implants and nerve grafts. Some procedures, such as an eyebrow lift, may need to be repeated after several years.

Antivirals added to steroids may benefit some people with Bell's palsy, but this is still unproved. Despite this, an antiviral drug, such as valacyclovir (Valtrex) or acyclovir (Zovirax), is sometimes given in combination with prednisone in people with severe facial palsy.