Bell palsy

Acute 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 cases, surgical decompression.

Eye protection should always be considered.

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

Bell palsy is an acute unilateral peripheral facial nerve palsy in patients for whom physical examination and history are otherwise unremarkable, consisting 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 untreated cases, with permanently impaired facial function occurring to a minor degree in 13% and to a major degree in 16% of cases.[1]Peitersen E. The natural history of Bell palsy. Am J Otol. 1982 Oct;4(2):107-11. http://www.ncbi.nlm.nih.gov/pubmed/7148998?tool=bestpractice.com Onset of clinical recovery is nearly always demonstrated within 4 to 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. Facial palsy of an otherwise known etiology (e.g., Lyme disease-associated facial palsy), or facial palsy that is progressive, waxing and waning, or affects facial zones in an uneven fashion, is not Bell palsy.