Learn more about Bell's palsy, which causes temporary facial paralysis. Find out why Bell's palsy happens and what to do about it.
Bell's palsy is a condition that causes sudden weakness in the muscles on one side of the face. In most cases, the weakness is temporary and significantly improves over weeks. The weakness makes half of the face appear to droop. Smiles are one-sided, and the eye on the affected side resists closing.
Bell's palsy is also known as acute peripheral facial palsy of unknown cause. It can occur at any age. The exact cause is unknown. Experts think it's caused by swelling and inflammation of the nerve that controls the muscles on one side of the face. It could be caused by a reaction that occurs after a viral infection.
Symptoms usually start to improve within a few weeks, with complete recovery in about six months. A small number of people continue to have some Bell's palsy symptoms for life. Rarely, Bell's palsy occurs more than once.
Signs and symptoms of Bell's palsy come on suddenly and may include:
In rare cases, Bell's palsy can affect the nerves on both sides of your face.
Seek medical help right away if you experience any type of paralysis because you may be having a stroke. Bell's palsy is not caused by a stroke, but it can cause similar symptoms.
If you have facial weakness or drooping, see your health care provider if you have facial weakness or drooping to find out the underlying cause and severity of the illness.
The nerve that controls your facial muscles passes through a narrow corridor of bone on its way to your face. Facial weakness or paralysis may cause one corner of your mouth to droop, and you may have trouble retaining saliva on that side of your mouth. The condition may also make it difficult to close the eye on the affected side of your face.
Although the exact reason Bell's palsy occurs isn't clear, it's often related to having a viral infection. Viruses that have been linked to Bell's palsy include viruses that cause:
The nerve that controls facial muscles passes through a narrow corridor of bone on its way to the face. In Bell's palsy, that nerve becomes inflamed and swollen — usually related to a viral infection. Besides facial muscles, the nerve affects tears, saliva, taste and a small bone in the middle of the ear.
Bell's palsy occurs more often in people who:
Recurrent attacks of Bell's palsy are rare. But when they do recur, there's often a family history of recurrent attacks. This suggests that Bell's palsy might have something to do with your genes.
A mild case of Bell's palsy typically disappears within a month. Recovery from a more severe case where the face was completely paralyzed can vary. Complications may include:
There's no specific test for Bell's palsy. Your health care provider will look at your face and ask you to move your facial muscles by closing your eyes, lifting your brow, showing your teeth and frowning, among other movements.
Other conditions — such as a stroke, infections, Lyme disease, inflammatory conditions and tumors — can cause facial muscle weakness that mimics Bell's palsy. If the cause of your symptoms isn't clear, your health care provider may recommend other tests, including:
Most people with Bell's palsy recover fully — with or without treatment. There's no one-size-fits-all treatment for Bell's palsy. But your health care provider may suggest medications or physical therapy to help speed your recovery. Surgery is rarely an option for Bell's palsy.
Because the eye on the affected side doesn't close, it's important to take steps to protect and care for that eye. Using lubricating eye drops during the day and an eye ointment at night will help keep your eye moist. Wearing glasses or goggles during the day and an eye patch at night can protect your eye from getting poked or scratched. In severe cases of Bell's palsy, an eye doctor may need to monitor the eye.
Commonly used medications to treat Bell's palsy include:
Antiviral drugs. The role of antivirals remains unsettled. Antivirals alone have shown no benefit compared with placebo. Antivirals added to steroids may benefit some people with Bell's palsy, but this is still unproved.
Despite this, an antiviral drug, such as valacyclovir (Valtrex) or acyclovir (Zovirax), is sometimes given in combination with prednisone in people with severe facial palsy.
Paralyzed muscles can shrink and shorten, which may be permanent. A physical therapist can teach you how to massage and exercise your facial muscles to help prevent this from occurring.
In the past, decompression surgery was used to relieve the pressure on the facial nerve by opening the bony passage that the nerve passes through. Today, decompression surgery isn't recommended. Facial nerve injury and permanent hearing loss are possible risks associated with this surgery.
Rarely, plastic surgery may be needed to correct lasting facial nerve problems. Facial reanimation surgery helps make the face look more even and may restore facial movement. Examples of this type of surgery include an eyebrow lift, an eyelid lift, facial implants and nerve grafts. Some procedures, such as an eyebrow lift, may need to be repeated after several years.
Home treatment may include:
Although there's little scientific evidence to support the use of alternative medicine for people with Bell's palsy, some people with the condition may benefit from the following:
You'll likely start by seeing your family doctor or other health care provider. However, in some cases when you call to set up an appointment, you may be referred immediately to a doctor who specializes in the nervous system (neurologist).
It's good to prepare for your appointment. Here's some information to help you get ready.
Preparing a list of questions will help you make the most of your time with your provider. For Bell's palsy, some basic questions to ask include:
Don't hesitate to ask any additional questions that occur to you during your appointment.
Be prepared to answer questions such as:
If you have facial pain:
If your eye won't close completely, try these tips: