Signs and symptoms
Signs and symptoms of Bell palsy include the following:
- Acute onset of unilateral upper and lower facial paralysis (over a 48-hr period)
- Posterior auricular pain
- Decreased tearing
- Hyperacusis
- Taste disturbances
- Otalgia
- Weakness of the facial muscles
- Poor eyelid closure
- Aching of the ear or mastoid
- Tingling or numbness of the cheek/mouth
- Epiphora
- Ocular pain
- Blurred vision
- Flattening of forehead and nasolabial fold on the side affected by palsy
- When patient raises eyebrows, palsy-affected side of forehead remains flat
- When patient smiles, face becomes distorted and lateralizes to side opposite the palsy
See or more specific information on the signs and symptoms of Bell palsy.
Diagnosis
Examination for Bell palsy includes the following:
- Otologic examination: Pneumatic otoscopy and tuning fork examination, particularly if evidence of acute or chronic otitis media
- Ocular examination: Patient often unable to completely close eye on affected side
- Oral examination: Taste and salivation often affected
- Neurologic examination: All cranial nerves, sensory and motor testing, cerebellar testing
Grading
The grading system developed by House and Brackmann categorizes Bell palsy on a scale of I to VI as follows:
Grade I: normal facial function
Grade II: mild dysfunction
Grade III: moderate dysfunction
Grade IV: moderately severe dysfunction
Grade V: severe dysfunction
Grade VI: total paralysis
See for more specific information on patient history and physical examination for Bell palsy.
Testing
Although there are no specific diagnostic tests for Bell palsy, the following may be useful for identifying or excluding other disorders:
- Rapid plasma reagin and/or venereal disease research laboratory test or fluorescent treponemal antibody absorption test
- HIV screening by enzyme-linked immunosorbent assay and/or Western blot
- Complete blood count
- Erythrocyte sedimentation rate
- Thyroid function
- Serum glucose
- CSF analysis
- Blood glucose
- Hemoglobin A1c
- Antineutrophil cytoplasmic antibody levels
- Salivary flow
- Schirmer blotting test
- Nerve excitability test
- Computed tomography
- Magnetic resonance imaging
Management
Goals of treatment: (1) improve facial nerve (seventh cranial nerve) function; (2) reduce neuronal damage; (3) prevent complications from corneal exposure
Treatment includes the following:
- Corticosteroid therapy (prednisone)
- Antiviral agents
- Eye care: Topical ocular lubrication is usually sufficient in most cases to prevent corneal drying, abrasion, and ulcers
Surgical options
Surgical treatment options include the following:
- Facial nerve decompression
- Subocularis oculi fat lift
- Implantable devices (eg, gold weights) placed into the eyelid
- Tarsorrhaphy
- Transposition of the temporalis muscle
- Facial nerve grafting
- Direct brow lift
