eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Reconstructive Surgery

Bell Palsy: Follow-up

Author: Craig H Zalvan, MD, Director of Laryngology, Assistant Professor of Otolaryngology, Head and Neck Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, ENT Faculty Practice
Contributor Information and Disclosures

Updated: Oct 26, 2009

Follow-up

Further Outpatient Care

  • Eye care
    • Treatment options are limited when recovery is incomplete. However, in general, any facial nerve weakness that limits the ability of the patient to blink requires vigilant eye care, including hourly saline eye drops and nightly ophthalmic ointment and eye protection.
    • Further long-term management of ocular complications includes gold weight placement and lid-shortening procedures.
  • Management strategy: The management strategy described by Gantz in 1999 is as follows:9
    • Acute paresis, day 0-14: The patient is started on prednisone and followed up in 5 days. If the paresis remains or is improved, then the patient is followed up in 1 month. If the paresis progresses, then electroneuronography is performed and the paralysis protocol provided below is followed. If the acute paresis persists for longer than 14 days, then the patient is observed and followed up in 6 months.
    • Acute paralysis
      • Day 0-3: The patient is started on prednisone and followed up in 3 days.
      • Day 3-14: Electroneuronography is performed. If less than 90% degeneration is noted, then the patient is started on prednisone and followed up in 14 days depending on the findings of electroneuronography. If greater than 90% degeneration is noted, then middle cranial fossa decompression should be considered.
      • Day 14 and after: The patient is followed up in 6 months.

Prognosis

  • Most patients have an excellent prognosis, both functionally and aesthetically. Even if a patient presents with a complete paralysis, over 70% have a full recovery.
  • The most important prognostic factor is whether the paralysis is complete or incomplete on presentation.
  • An abrupt onset, early return of function, partial paralysis, and no signs of other diseases indicate a good prognosis.
  • Signs of spontaneous remission are observed in 85% of patients within 3 weeks of the initial paresis.
  • Patients who do not progress to complete facial paralysis have an excellent prognosis for the recovery of facial motor function, with over 94% recovering completely.
  • In about 15% of the patients, recovery does not begin until 3-6 months after the onset of paralysis.
  • The sooner the recovery, the less likely are the chances that sequelae will develop. If some restoration of function is noted within 3 weeks, then the recovery is most likely to be complete. If the recovery begins between 3 weeks and 2 months, then the ultimate outcome is usually satisfactory. If the recovery does not begin until 2-4 months from the onset, likelihood of permanent sequelae, including residual paresis and synkinesis, is higher.
  • The sequelae include dysgeusia, ageusia, dysesthesias, synkinesis, residual weakness, facial spasms, and tics.
  • Multiple coincident factors associated with a bad prognosis are as follows: (1) hyperacusis, (2) diabetes mellitus, (3) hypertension, (4) decreased tears, (5) age more than 60 years, and (6) severe aural, anterior facial, or radicular pain.

Patient Education

For excellent patient education resources, visit eMedicine's Brain and Nervous System Center. Also, see eMedicine's patient education article Bell Palsy.

 


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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References

  1. Murakami S, Mizobuchi M, Nakashiro Y, et al. Bell palsy and herpes simplex virus: identification of viral DNA in endoneurial fluid and muscle. Ann Intern Med. Jan 1 1996;124(1 Pt 1):27-30. [Medline].

  2. Kawaguchi K, Inamura H, Abe Y. Reactivation of herpes simplex virus type 1 and varicella-zoster virus and therapeutic effects of combination therapy with prednisolone and valacyclovir in patients with Bell's palsy. Laryngoscope. 2007;Jan;117(1):147-56.

  3. Stowe J, Andrews N, Wise L. Bell's palsy and parenteral inactivated influenza vaccine. Hum Vaccin. 2006;2(3):110-2.

  4. Mutsch M, Zhou W, Rhodes P, Bopp M, Chen RT, Linder T, et al. Use of the inactivated intranasal influenza vaccine and the risk of Bell's palsy in Switzerland. N Engl J Med. Feb 26 2004;350(9):896-903. [Medline].

  5. Völter C, Helms J, Weissbrich B, Rieckmann P, Abele-Horn M. Frequent detection of Mycoplasma pneumoniae in Bell's palsy. Eur Arch Otorhinolaryngol. Aug 2004;261(7):400-4. [Medline].

  6. Papaevangelou V, Falaina V, Syriopoulou V, Theodordou M. Bell's palsy associated with Mycoplasma pneumoniae infection. Pediatr Infect Dis J. Nov 1999;18(11):1024-6. [Medline].

  7. [Best Evidence] Quant EC, Jeste SS, Muni RH, Cape AV, Bhussar MK, Peleg AY. The benefits of steroids versus steroids plus antivirals for treatment of Bell's palsy: a meta-analysis. BMJ. Sep 7 2009;339:b3354. [Medline].

  8. Pulec JL. Early decompression of the facial nerve in Bell's palsy. Ann Otol Rhinol Laryngol. Nov-Dec 1981;90(6 Pt 1):570-7. [Medline].

  9. Gantz BJ, Rubinstein JT, Gidley P, Woodworth GG. Surgical management of Bell's palsy. Laryngoscope. Aug 1999;109(8):1177-88. [Medline].

  10. Adour KK, Byl FM, Hilsinger RL Jr, Kahn ZM, Sheldon MI. The true nature of Bell's palsy: analysis of 1,000 consecutive patients. Laryngoscope. May 1978;88(5):787-801. [Medline].

  11. Adour KK, Ruboyianes JM, Von Doersten PG, Byl FM, Trent CS, Quesenberry CP Jr. Bell's palsy treatment with acyclovir and prednisone compared with prednisone alone: a double-blind, randomized, controlled trial. Ann Otol Rhinol Laryngol. May 1996;105(5):371-8. [Medline].

  12. Adour KK, Sheldon MI, Kahn ZM. Maximal nerve excitability testing versus neuromyography: prognostic value in patients with facial paralysis. Laryngoscope. Sep 1980;90(9):1540-7. [Medline].

  13. Adour KK, Wingerd J. Idiopathic facial paralysis (Bell's palsy): factors affecting severity and outcome in 446 patients. Neurology. Dec 1974;24(12):1112-6. [Medline].

  14. Allen D, Dunn L. Aciclovir or valaciclovir for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2004;(3):CD001869. [Medline].

  15. Choi SH, Yoon TH, Lee KS. Blepharokymographic analysis of eyelid motion in Bell's palsy. Laryngoscope. 2007;117(2):308-12.

  16. De Diego JI, Prim MP, Madero R, Gavilan J. Seasonal patterns of idiopathic facial paralysis: a 16-year study. Otolaryngol Head Neck Surg. Feb 1999;120(2):269-71. [Medline].

  17. Fisch U. Surgery for Bell's palsy. Arch Otolaryngol. Jan 1981;107(1):1-11. [Medline].

  18. Hato N, Yamada H, Kohno H, Matsumoto S, Honda N, Gyo K. Valacyclovir and Prednisolone Treatment for Bell's Palsy: A Multicenter, Randomized, Placebo-Controlled Study. Otol Neurotol. Feb 5 2007;[Medline].

  19. House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg. Apr 1985;93(2):146-7. [Medline].

  20. Hughes GB, Pensak ML. Facial nerve disorders. In: Clinical Otology. 2nd ed. New York, NY: Thieme Medical Publishers;1997:367-80.

  21. Jackler RK, Brackmann DE. The acute facial palsies. In: Neurotology: Principles and Practice. St. Louis, Mo: Mosby-Year Book;1994:1291-5.

  22. Kanoh N, Nomura J, Satomi F. Nocturnal onset and development of Bell's palsy. Laryngoscope. Jan 2005;115(1):99-100. [Medline].

  23. Kress B, Griesbeck F, Stippich C, Bähren W, Sartor K. Bell palsy: quantitative analysis of MR imaging data as a method of predicting outcome. Radiology. Feb 2004;230(2):504-9. [Medline].

  24. Peitersen E. The natural history of Bell's palsy. Am J Otol. Oct 1982;4(2):107-11. [Medline].

  25. Salinas RA, Alvarez G, Ferreira J. Corticosteroids for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2004;(4):CD001942. [Medline].

  26. Yanagihara N, Hato N, Murakami S, Honda N. Transmastoid decompression as a treatment of Bell palsy. Otolaryngol Head Neck Surg. Mar 2001;124(3):282-6. [Medline].

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Further Reading

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Keywords

Bell palsy, Bell's palsy, BP, acute facial paralysis, idiopathic facial paralysis, IFP, facial palsy, lower motor neuron facial paresis, lower motor neuron facial paralysis, cranial nerve VII, CN VII

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Contributor Information and Disclosures

Author

Craig H Zalvan, MD, Director of Laryngology, Assistant Professor of Otolaryngology, Head and Neck Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, ENT Faculty Practice
Craig H Zalvan, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Bronchoesophagological Association, American College of Surgeons, American Laryngological Association, American Laryngological Rhinological and Otological Society, American Medical Association, Medical Society of the State of New York, New York County Medical Society, Triological Society, and Voice Foundation
Disclosure: Nothing to disclose.

Medical Editor

B Viswanatha, MBBS, MS, DLO, Professor of ENT, Sri Venkateshwara ENT Institute, Victoria Hospital, Bangalore Medical College and Research Institute, India
B Viswanatha, MBBS, MS, DLO is a member of the following medical societies: Association of Otolaryngologists of India, Indian Medical Association, and Indian Society of Otology
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Dominique Dorion, MD, MSc, FRCSC, Program Director and Division Chair, Professor of Surgery, Division of Otolaryngology, University of Sherbrooke, Canada
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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