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What Is Bell's Facial Palsy? Its Causes, Symptoms and Treatment.

Updated on July 9, 2012
Bell's facial paralysis of left side...
Bell's facial paralysis of left side... | Source

Bell’s palsy is the most common form of acute facial paralysis or weakness (inability to control facial movements) on one side of the face, that results from the inflammation (swelling) of or a lesion in the facial nerve (Cranial Nerve VII palsy) after it exits the skull.

The facial nerve supplies the muscles of the face and control many functions such as smiling, frowning, closing the eye, raising eyebrows, lacrimation (production of tears) and salivation.

Facial nerve also supplies stapedius (muscle attached to stapes) in the ear and carries taste sensation from the anterior two-thirds of the tongue.

The forehead muscles receive nerve supply from both sides of the brain (both hemispheres), thus it is important to see for forehead wrinkling and whether or not the forehead muscles spared.

If facial weakness were caused by a problem in one of the sides of the brain, the person would still be able to wrinkle his forehead. However, if the weakness is due to a problem in the facial nerve itself, the forehead muscles are not spared and all the movements are compromised on the same side of the face, whereas facial movements on the other side of the face are intact, including wrinkling of the forehead.

Can you guess which side is affected?
Can you guess which side is affected?
Now? Yeah, right!
Now? Yeah, right!

How does Bell's Palsy occur?

It is possible that one morning you wake up only to find that one side of your face is not working properly, you cannot close your eye, and you are having difficulty with smiling or even frowning. If there is no other cause you can think of, and it has appeared all of a sudden, most probably it is Bell's Facial Palsy.

Bell’s palsy develops abruptly, mostly overnight, and maximum facial weakness is attained by 48 hrs as a rule.

Pain behind the ear or discharge from the ear may precede the paralysis for a day or two. Unilateral (on one side) taste sensation may be lost and hyperacusis (sensitivity to loud sounds) may be present.

MRI may reveal swelling of the facial nerve and, in some cases, entrapment of the swollen nerve in the temporal bone.

Prognosis in Bell's Facial Paralysis

Bell’s palsy is usually temporary and approximately 80% of patients recover spontaneously and achieve near-normal to normal facial movements within a few weeks or months, even without treatment.

Electromyography is considered to be of some prognostic value; if there are evidences of degeneration of nerve fibers, it indicates that there will be a delay of about 3-4 months before regeneration occurs, and that normal functions may still not be achieved.

Bell’s palsy affects about 60 in every 10,000 individuals. So it isn’t rare, is it?

Bell's facial paralysis of the right side.
Bell's facial paralysis of the right side. | Source

What Causes Bell's Palsy?

It is believed to be caused by reactivation of a pre-existing latent or dormant infection by some viruses (Herpes zoster virus, and Epstein Barr virus), though a causal role is yet to be proved.

However, certain conditions like accidents or surgery (facial nerve damage), extremely cold climate, metabolic conditions and emotional stress may also trigger development of acute facial paralysis or weakness.

Congenital facial paralysis is also not uncommon, especially when delivery is conducted with the use of forceps.

It is only when a definite cause for facial paralysis cannot be defined that it is termed Bell’s palsy.

Symptoms of Bell's Palsy

The cranial nerve seven (or Facial nerve) paralysis interferes with facial expressions and other movements on the side of the nerve damage.

Thus, the symptoms of Bell's palsy are:

  • The corner of the mouth droops and cannot be lifted, thereby causing difficulty in smiling, and even talking.
  • The facial creases and skin folds are effaced.
  • The forehead is smooth and unfurrowed, even on attempted frowning.
  • Eyelids will not close or close with difficulty.
  • Upon attempted closure of eyelids, the eyes on the paralyzed side roll upward (Bell’s phenomenon).
  • Excessive tearing or a dry eye.
  • The lower lid sags and falls away from the conjunctiva, permitting tears to spill over the cheek.
  • Food collects between the teeth and lips.
  • Saliva drools from the corner of the mouth.
  • Loss of taste sensation on the affected side.
  • Affected side may feel numb.
  • Pain may be present in or behind the ear.
  • There may be an increased sensitivity to loud sounds (hyperacusis).

How is Bell's Palsy Diagnosed?

Diagnosis of Bell’s palsy is essentially through elimination of other causative conditions of facial weakness or paralysis. There are many other causes of acute facial palsy that must be considered in the differential diagnosis of Bell’s palsy.

Lyme’s disease (due to infection with Borrelia burgdorferi) can cause unilateral or bilateral facial palsies, mainly in the endemic areas.

The Ramsay-Hunt syndrome also causes severe facial palsy associated with vesicular eruptions in the ear canal. Sarcoidosis and Guillain Barre Syndrome often result in bilateral facial palsy.

Apart from these, facial paralysis may also be observed in meningitis, leprosy, stroke, diabetes and acute HIV infection.

Bell's Palsy Treatment

Each individual presents with Bell’s (facial) palsy differently. Some may have only incomplete loss of facial movements, which has greater chances of complete recovery and there is no need for treatment per se, while some may present with complete paralysis where prompt treatment (within 2 days after the onset) is mandated.

Analgesics may be given to relieve pain if it there. Steroids are used mainly to reduce the swelling of and around the nerve and thus have proved efficacious in the treatment of Bell’s palsy, whereas anti-viral drugs have not shown much promise, unless the causal role of Zoster or Epstein Barr virus could be demonstrable.

Symptomatic treatment measures include:

  • Use of eye-cover or paper tape to shut the upper eyelid during sleep and prevent corneal drying (xerosis), as corneal drying and infection is one of the major complications of Bell’s palsy.
  • Massage and exercise of affected muscles
  • Use of lubricants or artificial teardrops during working hours and ointment for application during sleep, again to prevent corneal drying and infection.
  • A course of glucocorticoids, given as prednisolone 60-80 mg daily for the first five days and then tapered over the next five days, appears to shorten the recovery period and modestly improve the functional outcome.

Smile Surgery for Persistent Bell's Palsy
Smile Surgery for Persistent Bell's Palsy | Source

Do you know of someone with Bell's palsy?

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Other Treatment Modalities

Once paralysis has set in, irrespective of whether or not it needs treatment, it is important to maintain the tone of affected muscles of the face as well as to stimulate the facial nerve. Physiotherapy is thus recommended on a regular basis these days, which also involves education about some facial muscle exercises to aid in early recovery.

Acupuncture has been reported to be beneficial in some cases.

TCES (Transcutaneous Electrical Stimulation) may be tried in cases of unresolved facial paralysis.

Botox injection is also emerging to be one of the recent advancements in the treatment of Bell’s palsy.

In long-standing cases of facial palsy where significant recovery has not occurred even after 6 months to a year, Smile surgery is one procedure that can bring back the smile for people with Bell’s palsy. It involves re-innervation of the degenerated nerve fibers. It is also done in cases of paralysis due to facial nerve damage because of trauma or surgery.


Complications with Bell's Palsy

The major complication in patients of Bell's palsy is corneal dryness (irritation) and infection.

Another common complication of Bell’s palsy is faulty or anomalous regeneration of fibers during recovery, which may result in other bothersome phenomena, for instance, closure of eye may cause retraction of the mouth, or anomalous tears (crocodile tears) may occur with any activity of the facial muscles, such as eating.

These complications are observed in about 8% of people after recovery from Bell’s facial palsy.

You're Not Alone!

Lastly, I hope you remember Sylvester ‘Rocky’ Stallone. Yes, he has had Bell’s palsy since birth and that is how he could pull off that amazing yet peculiar look he was well known for.

There’ve been some other eminent personalities too who have been affected by facial paralysis once, like Salman Khan, Pierce Brosnan, George Clooney, Allen Ginsberg, Katie Holmes (yes, she too!) and many more. Therefore, have heart and just know that you are not alone.


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    • ashish04joshi profile imageAUTHOR

      Ashish Joshi 

      7 years ago from India

      Thank you so much Ma'm, for reading and appreciating.

    • ashish04joshi profile imageAUTHOR

      Ashish Joshi 

      7 years ago from India

      Oh, that's really sad...but there are many treatment options to help her with that. I hope she gets alright some day.

      Thanks, trinity for dropping by and commenting.

    • tillsontitan profile image

      Mary Craig 

      7 years ago from New York

      This was a very interesting read. You did a lot of research and presented it well. Lots of facts, great diagrams, and video. I always wondered about Sylvester Stallone and now, thanks to you, I know.

      I voted this up, useful and interesting. Great job!

    • Trinity M profile image

      Trinity M 

      7 years ago

      Great hub. My best friend suffers from Bells Palsy. She is sadly one of the few who has not fully recovered from it and has had partial facial paralysis since we were children. Up and useful.

    • ashish04joshi profile imageAUTHOR

      Ashish Joshi 

      7 years ago from India

      Thanks for reading Ma' what you tell, I suspect it might not be Bell's...there are hundreds of other causes for recurrent facial palsy.

      I hope she's getting the necessary medical advice and treatment.

    • shiningirisheyes profile image

      Shining Irish Eyes 

      7 years ago from Upstate, New York

      I am all too familiar with this type of palsy and my sister suffers from episodes. Not frequent, but still there none the less.

    • ashish04joshi profile imageAUTHOR

      Ashish Joshi 

      7 years ago from India

      Yup...then that is it. And it is curable, in fact it has to be treated, doesn't go by itself, unlike Bell's...

      Thanks for the return visit.

    • Made profile image

      Madeleine Salin 

      7 years ago from Finland

      I'm not sure. Maybe it could have been Ramsay-Hunt syndrome? I heard it had something to do with the ear.

    • ashish04joshi profile imageAUTHOR

      Ashish Joshi 

      7 years ago from India

      For months? Are you sure? It might not be Bell's palsy too...unless every other possibility is excluded, it is not said to be Bell's palsy. It is truly idiopathic.

      Thanks for reading, I'm glad you find it useful.

    • Made profile image

      Madeleine Salin 

      7 years ago from Finland

      I know about a person who has Bell's palsy. I haven't seen her for a while, but I think she has had it for months. Very informative hub. Voted up!

    • ashish04joshi profile imageAUTHOR

      Ashish Joshi 

      7 years ago from India

      Ha's okay...but you must have at least known there's something wrong with him! And look, he still went on to become a phenomenon.

      I'm glad you liked it.

      Thanks for reading and appreciating.

    • ashish04joshi profile imageAUTHOR

      Ashish Joshi 

      7 years ago from India

      @radhapriestess: Thank you so much for visiting the hub. I just checked it out, yes, Gordon too was one of them...there are many!

      And yeah...mercury toxicity can also a variety of problems, Bell's palsy being one of them.

    • ashish04joshi profile imageAUTHOR

      Ashish Joshi 

      7 years ago from India

      @RealHousewife: Thanks for the visit...Yeah, it's not that uncommon a condition. And no one knows its cause really...some theories are postulated but yet to be proved.

      Stroke may be one of the reasons for facial paralysis, but that is known as an upper motor neuron that case the forehead muscles of the other side of the face are spared.

      Thanks for reading.

    • profile image


      7 years ago

      I didn't know Sylvester Stallone had bell's palsy. The work you put into this hub is obvious. It's a fantastic resource for anyone facing this condition. Thanks for sharing it! Voted up and shared! Kelley

    • profile image


      7 years ago

      Gordon Lightfoot, the Canadian singer/songwriter, was another well-known individual who had this condition. I also know of people who have reacted to mercury fillings in their mouth having this problem. They get their fillings removed and replaced by a wholistic dentist and it's entirely cured.

    • RealHousewife profile image

      Kelly Umphenour 

      7 years ago from St. Louis, MO

      Very good article about Bell's Palsy! I have seen it - and the patiend did develop this side of her face drooped as if she had a stroke. This particular patient was textbook and it did resolve itself in a couple of days.

      I suspect my MIL just had a bout of this...her PCP did not guess Bell's which makes me wonder a little but when it resolved itself I was completely sure this is what happened! The patient I saw in the lab had the exact same stuff and it was diagnosed as Bells.

      Interesting! I did not know the cause of it - just that it seems to come out of nowhere and it paralyzes cranial nerves. Great job!


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