eMedicine Specialties > Neurology > Inflammatory and Demyelinating Diseases

Bell Palsy: Follow-up

Author: Kim Monnell, DO,, Neurology Consulting Staff, Department of Medicine, Bay Pines VA Medical Center
Coauthor(s): Sally B Zachariah, MD, Associate Professor, Department of Neurology, University of South Florida; Director, Department of Neurology, Division of Strokes, Veteran Affairs Medical Center of Bay Pines; Suzan Khoromi, MD, Fellow, Pain and Neurosensory Mechanisms Branch, National Institute of Dental and Cranial Research, National Institutes of Health
Contributor Information and Disclosures

Updated: Oct 26, 2009

Follow-up

Further Outpatient Care

  • If the paralysis is not resolved or is progressing to complete paralysis, a thorough neurologic and HEENT examination should be performed to rule out neoplastic causes of seventh nerve palsy.
  • The patient should be monitored if the initial EMG shows the involved facial muscles to have less than 25% of the function of the normal side.
  • If the residual paralysis is severe, the patient should be referred for counseling.

Complications

  • Approximately 30% of patients with Bell palsy experience sequelae of the paralysis, which include incomplete motor recovery, incomplete sensory regeneration, and parasympathetic impairment.
    • Incomplete motor recovery may manifest as oral incompetence or epiphora.
    • Incomplete sensory recovery may result in dysgeusia (impairment of taste) or ageusia (loss of taste).
    • Parasympathetic impairment causes aberrant function of lacrimal glands, which manifests as crocodile tears; patients report shedding tears while eating.

Prognosis

  • The natural course of Bell palsy varies from early complete recovery to substantial nerve injury resulting in persistent paralysis and synkinesis.
  • One third of patients regain complete recovery of facial motor function without sequelae.
  • One third of patients have incomplete recovery of facial motor function. These patients do not have any noticeable abnormalities.
  • The remainder of patients have permanent neurological and cosmetic abnormalities.

Patient Education

  • To prevent corneal abrasions, the patient should be educated concerning eye care.
  • They also should be encouraged to do facial muscle exercises using passive range of motion as well as actively closing their eyes and smiling.
  • For excellent patient education resources, visit eMedicine's Brain and Nervous System Center. Also, see eMedicine's patient education article Bell Palsy.

Miscellaneous

Medicolegal Pitfalls

In most cases, the diagnosis of Bell palsy is straightforward as long as the patient underwent a thorough history and physical examination. Failure to recognize structural, infectious, or vascular lesions leading to seventh nerve damage may result in further deterioration of the patient's condition. For example, if other cranial nerve, motor, or sensory symptoms were present at the time, then treatable or preventable nervous system diseases should be sought. These may include stroke, GBS, basilar meningitis, or cerebellar pontine angle tumor.

 


More on Bell Palsy

Overview: Bell Palsy
Differential Diagnoses & Workup: Bell Palsy
Treatment & Medication: Bell Palsy
Follow-up: Bell Palsy
Multimedia: Bell Palsy
References
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Further Reading

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Keywords

Bell's palsy, idiopathic facial paralysis, facial nerve compression, acute unilateral facial paralysis, bilateral facial palsy, Guillain-Barré syndrome, GBS, sarcoidosis, Lyme disease, meningitis, neoplastic meningitis, infectious meningitis, bilateral neurofibromas, neurofibromatosis type 2, ipsilateral facial palsy

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Contributor Information and Disclosures

Author

Kim Monnell, DO,, Neurology Consulting Staff, Department of Medicine, Bay Pines VA Medical Center
Kim Monnell, DO, is a member of the following medical societies: American Academy of Neurology and American Osteopathic Association
Disclosure: Nothing to disclose.

Coauthor(s)

Sally B Zachariah, MD, Associate Professor, Department of Neurology, University of South Florida; Director, Department of Neurology, Division of Strokes, Veteran Affairs Medical Center of Bay Pines
Sally B Zachariah, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, and American Society of Neuroimaging
Disclosure: none None None

Suzan Khoromi, MD, Fellow, Pain and Neurosensory Mechanisms Branch, National Institute of Dental and Cranial Research, National Institutes of Health
Suzan Khoromi, MD is a member of the following medical societies: American Academy of Neurology, American Pain Society, and International Association for the Study of Pain
Disclosure: Nothing to disclose.

Medical Editor

Milind J Kothari, DO, Professor and Vice-Chair, Department of Neurology, Pennsylvania State University College of Medicine; Consulting Staff, Department of Neurology, Hershey Medical Center
Milind J Kothari, DO is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and American Neurological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Florian P Thomas, MD, MA, PhD, Drmed, Director, Spinal Cord Injury Unit, St Louis Veterans Affairs Medical Center; Director, National MS Society Multiple Sclerosis Center; Professor, Department of Neurology and Psychiatry, Associate Professor, Institute for Molecular Virology, and Department of Molecular Microbiology and Immunology, St Louis University
Florian P Thomas, MD, MA, PhD, Drmed is a member of the following medical societies: American Academy of Neurology, American Paraplegia Society, and National Multiple Sclerosis Society
Disclosure: Nothing to disclose.

Chief Editor

B Mark Keegan, MD, FRCPC, Assistant Professor of Neurology, College of Medicine, Mayo Clinic; Master's Faculty, Mayo Graduate School; Consultant, Department of Neurology, Mayo Clinic, Rochester
B Mark Keegan, MD, FRCPC is a member of the following medical societies: American Academy of Neurology, American Medical Association, and Minnesota Medical Association
Disclosure: Nothing to disclose.

 
 
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