Bell's palsy

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

Last reviewed: 19 Aug 2025

Last updated: 01 Oct 2024

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

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, physiotherapy, 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.

Definition

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 aetiology (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.

病史和体格检查

关键诊断因素

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

完整详情

其他诊断因素

presence of risk factors
any age
hyperacusis
dysgeusia

完整详情

危险因素

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

完整详情

诊断性检查

首要检查

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

完整详情

需考虑的检查

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

完整详情

治疗流程

急症处理

all patients

撰稿人

作者

Matthew Q. Miller, MD

Assistant Professor Otolaryngology-Head and Neck Surgery

Director UNC Facial Nerve Center

University of North Carolina-Chapel Hill

Chapel Hill

利益声明

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

利益声明

LE declares that she has no competing interests.

鸣谢

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.

利益声明

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 paralysed face (WO2017124019A1).

同行评议者

Giles Elrington, MBBS (Hons), MD, FRCP

Consultant Neurologist

Barts Health NHS Trust

London

利益声明

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

利益声明

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

利益声明

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.

参考文献

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.

关键文献

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.全文摘要

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

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.全文摘要

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

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.全文摘要

参考文献

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

鉴别诊断
- Herpes zoster oticus (Ramsay Hunt syndrome)
- Lyme disease
- Benign facial nerve tumour (e.g., facial nerve schwannoma)
更多鉴别诊断
指南
- ACR appropriateness criteria: cranial neuropathy
- Management of acute Bell's palsy
更多指南
患者教育信息
Bell's palsy
更多患者教育信息
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Bell's palsy

Summary

Definition

病史和体格检查

关键诊断因素

其他诊断因素

危险因素

诊断性检查

首要检查

需考虑的检查

治疗流程

all patients

撰稿人

作者

Matthew Q. Miller, MD

利益声明

Liliana Ein, MD

利益声明

鸣谢

利益声明

同行评议者

Giles Elrington, MBBS (Hons), MD, FRCP

利益声明

Patrick Grogan, MD

利益声明

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

利益声明

Peer reviewer acknowledgements

Disclosures

参考文献

关键文献

参考文献

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

鉴别诊断

指南

患者教育信息

登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容

登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容

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