Bell's palsy

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Última revisão: 14 Jul 2025

Última atualização: 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.

Definição

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.

História e exame físico

Principais fatores diagnósticos

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

Detalhes completos

Outros fatores diagnósticos

any age
hyperacusis
dysgeusia

Detalhes completos

Fatores de risco

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

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

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

Detalhes completos

Investigações a serem consideradas

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

Detalhes completos

Algoritmo de tratamento

AGUDA

all patients

Colaboradores

Autores

Matthew Q. Miller, MD

Assistant Professor Otolaryngology-Head and Neck Surgery

Director UNC Facial Nerve Center

University of North Carolina-Chapel Hill

Chapel Hill

Declarações

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

Declarações

LE declares that she has no competing interests.

Agradecimentos

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.

Declarações

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).

Revisores

Giles Elrington, MBBS (Hons), MD, FRCP

Consultant Neurologist

Barts Health NHS Trust

London

Declarações

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

Declarações

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

Declarações

VS declares that he has no competing interests.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

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.Texto completo Resumo

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.Texto completo Resumo

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

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.Texto completo Resumo

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

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Herpes zoster oticus (Ramsay Hunt syndrome)
- Lyme disease
- Benign facial nerve tumor (e.g., facial nerve schwannoma)
Mais Diagnósticos diferenciais
გაიდლაინები
- ACR appropriateness criteria: cranial neuropathy
- Management of acute Bell's palsy
Mais გაიდლაინები
პაციენტის ბროშურები
Bell palsy
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Bell's palsy

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

all patients

Colaboradores

Autores

Matthew Q. Miller, MD

Declarações

Liliana Ein, MD

Declarações

Agradecimentos

Declarações

Revisores

Giles Elrington, MBBS (Hons), MD, FRCP

Declarações

Patrick Grogan, MD

Declarações

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

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

გაიდლაინები

პაციენტის ბროშურები

შედით სისტემაში ან გამოიწერეთ BMJ Best Practice

შედით სისტემაში ან გამოიწერეთ BMJ Best Practice

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