Bell Palsy: Idiopathic Facial Paralysis
Bell palsy is a sudden, usually unilateral facial nerve paralysis that often develops rapidly over a few hours. It commonly presents with drooping of the mouth, inability to close the eye, decreased tear production, and changes in taste. Because it can resemble other more serious conditions, prompt medical evaluation is essential to confirm the diagnosis and begin appropriate therapy.
Early treatment with corticosteroids significantly improves outcomes and is the standard of care. Current guidance from the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) recommends initiating oral steroids as soon as possible after symptom onset—ideally within 72 hours—because early therapy increases the likelihood of full recovery. Antiviral medication may be considered in select cases, but steroids remain the primary effective treatment. For the AAO-HNS guideline, see: https://www.entnet.org/resource/bell-palsy-guideline/
During the acute phase, protecting the affected eye is critical because incomplete eyelid closure increases the risk of corneal drying and injury. Measures include lubricating eye drops, ointments at night, and taping or using a moisture chamber for sleep.
Prognosis for Bell palsy is generally favorable: about 70% of patients experience substantial recovery within one month, and nearly all patients have some degree of recovery by three months. Lack of recovery should prompt further radiographic evaluation, often an MRI. However, a minority who do not show early improvement are at greater risk for long-term sequelae, including synkinesis (involuntary facial movements due to aberrant nerve regeneration). Synkinesis can often be managed effectively with targeted treatments such as botulinum toxin (Botox) injections to reduce unwanted muscle activity and improve facial symmetry. In some cases, surgical disruption of overactive nerves (selective neurolysis) can help create more permanent change. Other adjunctive plastic surgery such as brow lifting can be done to provide better symmetry.
If you or someone you know develops sudden facial weakness, seek prompt evaluation so treatment can be started early to maximize the chance of full recovery. If you still have lingering signs of Bell palsy, there are treatment options!