Summary
Definition
History and exam
Key diagnostic factors
- single episode
- unilateral
- absence of constitutional symptoms
- involvement of all nerve branches
- keratoconjunctivitis sicca
- pain
- synkinesis
Other diagnostic factors
- any age
- hyperacusis
- dysgeusia
Risk factors
- intranasal influenza vaccination
- pregnancy
- upper respiratory tract infection
- arid/cold climate
- hypertension
- family history of Bell's palsy
- diabetes
- dental procedures
Diagnostic tests
1st tests to order
- clinical diagnosis
- electroneuronography (ENoG) (evoked electromyography)
- needle electromyography
- serology for Borrelia burgdorferi
Tests to consider
- pure-tone audiometry
- tympanometry and stapedius reflex
- MRI (gadolinium-enhanced fine-cut of facial nerve course)
- CT (fine-cut, non-enhanced)
Treatment algorithm
all patients
Contributors
Authors
Matthew Q. Miller, MD
Assistant Professor Otolaryngology-Head and Neck Surgery
Director UNC Facial Nerve Center
University of North Carolina-Chapel Hill
Chapel Hill
NC
Disclosures
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
FL
Disclosures
LE declares that she has no competing interests.
Acknowledgements
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.
Disclosures
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).
Peer reviewers
Giles Elrington, MBBS (Hons), MD, FRCP
Consultant Neurologist
Barts Health NHS Trust
London
UK
Disclosures
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
TX
Disclosures
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
UK
Disclosures
VS declares that he has no competing interests.
Differentials
- Herpes zoster oticus (Ramsay Hunt syndrome)
- Lyme disease
- Benign facial nerve tumor (e.g., facial nerve schwannoma)
More DifferentialsGuidelines
- ACR appropriateness criteria: cranial neuropathy
- Facial palsy (Bell's palsy)
More GuidelinesPatient information
Bell palsy
More Patient informationLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer