Bell’s Palsy

Bell’s palsy is a sudden, temporary weakness or paralysis of the muscles on one side of the face, resulting from dysfunction of the facial nerve. Most people recover fully, especially with prompt treatment.

• Sudden onset (over hours to a day) of weakness or paralysis affecting one side of the face, including the forehead
• Drooping of the mouth or eyelid on the affected side
• Difficulty closing the eye on the affected side, which can lead to dryness or irritation
• Changes in taste, or increased sensitivity to sound on the affected side, in some cases
• Drooling or difficulty with facial expressions such as smiling

• The exact cause is often not identified, though it is believed to involve inflammation and swelling of the facial nerve, in some cases linked to a viral infection.
• Risk may be increased by pregnancy, diabetes, and recent upper respiratory infection.

• Diagnosed clinically based on the sudden onset of one-sided facial weakness affecting the whole side of the face, including the forehead — this distinguishes it from weakness caused by a stroke, which typically spares the forehead.
• It is important to assess for other neurological signs, since weakness affecting only the lower face, or accompanied by arm or leg weakness or speech difficulty, suggests a stroke rather than Bell's palsy and needs urgent, different management.

A short course of oral corticosteroids (such as prednisolone), started as early as possible — ideally within 72 hours of symptom onset — improves the chances of full recovery.

Eye care is essential for the affected side, including lubricating eye drops or ointment during the day and taping the eye closed at night if it cannot close fully, to prevent injury to the surface of the eye.

Most people begin to improve within a few weeks, with full recovery over one to several months in the majority of cases.

Anyone with facial weakness should be assessed to exclude stroke, especially if there is arm or leg weakness, speech difficulty, or if the forehead is spared, as this needs urgent stroke-pathway management instead.

• Protect the affected eye with lubricating drops and, at night, taping it closed if it does not close on its own, to prevent dryness and injury.
• Seek prompt medical assessment for facial weakness so that treatment can be started early and stroke can be excluded.
• Attend follow-up to monitor recovery, as most cases improve steadily over weeks to months.