Bell's Palsy

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What is Bell's Palsy?

Bell's palsy is often mistakenly used as a generic, catch-all term to describe facial paralysis. Facial weakness, however, can result from a large number of disorders including tumors, trauma, infections and central nervous system diseases. Bell's palsy is thought to result from a Herpes Simplex Virus (HSV) infection involving the facial nerve and remains the most common cause of facial paralysis in America. It will affect about 1 in 60 people during their lifetime. Men and women are equally affected as are the right and left sides of the face. Pregnant women, especially during the third trimester are more prone to develop Bell's palsy. The facial nerve, on its path from the brain stem to the face passes through a narrow bony canal in the base of the skull. The viral infection of the nerve is thought to produce inflammation and swelling. The tight bony canal cannot expand to accommodate the enlarged nerve that becomes subjected to increasing amounts of pressure producing the rapid onset of facial weakness and varying degrees of long term damage.

Bell's Palsy Symptoms

Clinically, individuals who develop Bells palsy typically experience the rapid onset of unilateral facial weakness affecting all the branches of the facial nerve. This limits the individual’s ability to generate brow elevation, eye closure and a smile. The facial weakness is often associated with significant impairment of speech and eating. Bell's palsy symptoms include flu-like symptoms, ear pain and changes in taste. Individuals with these symptoms should seek immediate medical attention in an emergency room so that alternate causes of one-sided facial weakness such as stroke can be ruled out.

Bell's Palsy Treatment

If the diagnosis of Bell's palsy is confirmed then a course of steroids and antiviral medications are often provided in an effort to maximize spontaneous recovery. It is important that these medications be started as soon as possible to obtain their full advantage. Additional evaluation and treatment is often sought from a neurologist, ophthalmologist and an ear specialist. A neurologist can help confirm the diagnosis of Bell's palsy and may recommend a series of blood tests, imaging studies (MRI) and nerve conduction tests such as ENoG and or EMG. Specialized physical therapy called neuromuscular retraining may also be recommended. An ophthalmologist can teach the affected individual how to lubricate and protect their eye while awaiting the recovery of active eye closure and protective blinking. This is crucial if corneal injury and visual impairment is to be avoided.

Bell's Palsy Recovery

The good news is that the great majority of individuals who develop true Bell's palsy will make a good spontaneous recovery. Approximately 85% make a complete recovery with little or no residual signs or symptoms. An additional 10% will experience an incomplete recovery with residual facial weakness and some uncoordinated facial movements (synkinesis). Unfortunately, 5% will demonstrate little or no recovery. If an unsatisfactory recovery occurs then surgical treatment can be considered to enhance facial symmetry and motion. This is usually deferred for one year after the onset of the facial weakness to allow time for spontaneous nerve regeneration. Additional delay in surgical evaluation however, can lead to the loss of certain treatment options that are time dependant.

Recurrent Bell's palsy develops in 7-13% of patients and is more common on the opposite side of the original weakness.

Treatment of Patients with Incomplete Bell's Palsy Recovery

Houston Methodist Institute for Reconstructive Surgery's Center for Facial Paralysis Surgery and Functional Restoration specializes in the treatment of patients who have made an incomplete recovery after Bell's palsy. We are not involved in the initial diagnosis and management of new cases. Surgical evaluation for potential correction of residual facial asymmetry and weakness is usually performed 10-12 months after the initial episode of Bell's palsy. If you are experiencing residual facial weakness, asymmetry, spasm and or uncoordinated motion (synkinesis) due to Bell's palsy, please feel free to contact our Texas Medical Center office at 713.441.6100 to explore your potential treatment options.


Patient exhibited an incomplete resolution of Bells palsy with persistent left facial weakness. After Surgical Smile Restoration (cross face nerve graft and free gracilis muscle flap), the patient is able to smile again.