Bell's palsy

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

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Последний просмотренный: 23 Jul 2026

Last updated: 28 Oct 2024

Bell’s palsy is an acute, sudden-onset, unilateral facial palsy of probable viral etiology.

Clinical diagnosis of exclusion.

High-dose corticosteroids should be administered in all patients in the absence of significant contraindications.

Other treatment options include concomitant antiviral agents, physical therapy, and, in severe or recurrent cases, surgical decompression.

Eye protection should always be considered.

Failure to demonstrate any return of hemi-facial tone or movement within 4-6 months suggests an alternative diagnosis.

Определение

Bell's palsy is an acute unilateral peripheral facial nerve palsy in patients for whom physical examination and history are otherwise unremarkable. It consists of deficits affecting all facial zones equally that fully evolve within 72 hours. To date, it remains a clinical diagnosis of exclusion. Complete recovery to normal facial function occurs in approximately 70% of cases, with permanently impaired facial function occurring to a minor degree in 13% of cases and to a major degree in 16% of cases.[1][2][3][4] However, recovery rate is lower in patients with recurrent Bell's palsy.[2] Onset of clinical recovery is nearly always demonstrated within 4-6 months of symptom onset; absence of any return of hemi-facial tone or movement by this time is highly suggestive of an alternative diagnosis.[1] Facial palsy of an otherwise known etiology (e.g., Lyme disease-associated facial palsy) or facial palsy that is progressive, is waxing and waning, or affects facial zones in an uneven fashion, is not Bell's palsy.

Анамнез и осмотр

Ключевые диагностические факторы

single episode
unilateral
absence of constitutional symptoms
involvement of all nerve branches
keratoconjunctivitis sicca
pain
synkinesis

Полная информация

Другие диагностические факторы

any age
hyperacusis
dysgeusia

Полная информация

Факторы риска

intranasal influenza vaccination
pregnancy
upper respiratory tract infection
arid/cold climate
hypertension
family history of Bell's palsy
diabetes
dental procedures

Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

clinical diagnosis
electroneuronography (ENoG) (evoked electromyography)
needle electromyography
serology for Borrelia burgdorferi

Полная информация

Исследования, проведение которых нужно рассмотреть

pure-tone audiometry
tympanometry and stapedius reflex
MRI (gadolinium-enhanced fine-cut of facial nerve course)
CT (fine-cut, non-enhanced)

Полная информация

Алгоритм лечения

Острый

all patients

Составители

Авторы

Matthew Q. Miller, MD

Assistant Professor Otolaryngology-Head and Neck Surgery

Director UNC Facial Nerve Center

University of North Carolina-Chapel Hill

Chapel Hill

Раскрытие информации

MQM is a paid consultant for Checkpoint Surgical, Inc.

Liliana Ein, MD

Assistant Professor Otolaryngology-Head and Neck Surgery

Division of Facial Plastic and Reconstructive Surgery

University of Miami

Miami

Раскрытие информации

LE declares that she has no competing interests.

Выражение благодарностей

Dr Matthew Q. Miller and Dr Liliana Ein would like to gratefully acknowledge Dr Tessa Hadlock, Dr Nathan Jowett, Dr Vishnu Madhok, Dr Iain Swan, Dr Pauline Lockhart, Dr Michael Norbury, and Dr John Gail Neely, previous contributors to this topic.

Раскрытие информации

TH, VM, IS, PL, MN, and JGN declare that they have no competing interests. NJ holds a patent on the methods and systems for functional electrical stimulation of the paralyzed face (WO2017124019A1).

Рецензенты

Giles Elrington, MBBS (Hons), MD, FRCP

Consultant Neurologist

Barts Health NHS Trust

London

Раскрытие информации

GE is involved in a number of clinical trials on multiple sclerosis sponsored by Genzyme, Roche, Teva, Novartis, Biogen, as well as one funded by the MRC. He is also involved in clinical trials sponsored by Allergan, NMT Medical, GlaxoSmithKline (GSK), Bristol-Myers, the UK's Parkinson's Disease Research Group, and Pharmacia. In addition, he has attended lectures, conferences and symposia with the following companies - GSK, AstraZeneca, MSD, Almirall, Pfizer, Menarini, Allergan, Biogen, Teva, Conference Plus, Infomed, and BMJ.

Patrick Grogan, MD

Major

US Air Force

MC Program Director

Department of Neurology

MMCN

Wilford Hall Medical Center

Lackland Air Force Base

Раскрытие информации

PG declares that he has no competing interests.

Venkat Srinivasan, MBBS, DLO, FRCS (Ed), FRCS (ORL)

Consultant in ENT/Thyroid Surgery

Arrowe Park Hospital

Upton

Wirral

Раскрытие информации

VS declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Список литературы

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Основные статьи

Baugh RF, Basura GJ, Ishii LE, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-27.Полный текст Аннотация

Gronseth GS, Paduga R; American Academy of Neurology. Evidence-based guideline update: steroids and antivirals for Bell palsy. Neurology. 2012 (reaffirmed 2023) Nov 27;79(22):2209-13.Полный текст Аннотация

Madhok VB, Gagyor I, Daly F, et al. Corticosteroids for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2016;(7):CD001942.Полный текст Аннотация

Gagyor I, Madhok VB, Daly F, et al. Antiviral treatment for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2019 Sep 5;9:CD001869.Полный текст Аннотация

Gantz BJ, Rubinstein JT, Gidley P, et al. Surgical management of Bell palsy. Laryngoscope. 1999 Aug;109(8):1177-88. Аннотация

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Отличия
- Herpes zoster oticus (Ramsay Hunt syndrome)
- Lyme disease
- Benign facial nerve tumor (e.g., facial nerve schwannoma)
Больше Отличия
Рекомендации
- ACR appropriateness criteria: cranial neuropathy
- Management of acute Bell's palsy
Больше Рекомендации
Лифлеты для пациента
Bell palsy
Больше Лифлеты для пациента
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Использование этого контента попадает под действие нашего заявления об отказе от ответственности

Bell's palsy

Резюме

Определение

Анамнез и осмотр

Ключевые диагностические факторы

Другие диагностические факторы

Факторы риска

Диагностические исследования

Исследования, которые показаны в первую очередь

Исследования, проведение которых нужно рассмотреть

Алгоритм лечения

all patients

Составители

Авторы

Matthew Q. Miller, MD

Раскрытие информации

Liliana Ein, MD

Раскрытие информации

Выражение благодарностей

Раскрытие информации

Рецензенты

Giles Elrington, MBBS (Hons), MD, FRCP

Раскрытие информации

Patrick Grogan, MD

Раскрытие информации

Venkat Srinivasan, MBBS, DLO, FRCS (Ed), FRCS (ORL)

Раскрытие информации

Peer reviewer acknowledgements

Disclosures

Список литературы

Основные статьи

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Отличия

Рекомендации

Лифлеты для пациента

Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice

Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice

Войдите в учетную запись, чтобы получить полноценный доступ к BMJ Best Practice