Bell’s palsy is caused when inflammation of the seventh cranial nerve (known as the facial nerve), causes partial or complete facial paralysis, usually on one side of the face. In around 1% of cases, both sides of the face are affected. The condition takes its name from Sir Charles Bell, a 19-century Scottish doctor, who discovered that severing the facial nerve causes facial paralysis.
Bell’s palsy is the most common form of acute facial paralysis, accounting for up to 80% of cases. It affects between 20 to 30 per 100,000 people every year. Most people will recover fully within the first three weeks following the onset of their symptoms. Approximately three out of 10 people will experience a delayed recovery and their symptoms may persist for several months. People who have a delayed recovery may experience long-term effects, such as problems with blinking and closing the eye for sleep, loss of expressiveness and involuntary movement or muscle twitching on the affected side (synkinesis).
If you are affected by Bell’s palsy, you may feel self-conscious about your appearance. There is support available from us here at Changing Faces and other organisations to help you manage these challenges. On this page, we look at causes and symptoms of Bell’s palsy as well as possible treatments. We’ll also take you through the ways we can help you manage the impacts it may have on your life. You may also find this page useful if you are affected by another form of facial palsy.
Important: If you suspect a stroke, call 999 immediately. With Bell’s palsy, seek medical advice within 72 hours of onset, as this way it is more likely to respond to treatment.
On this page we focus on Bell’s palsy, the most common cause of facial palsy. It is not the only cause of facial palsy and typically a diagnosis is reached if no other reason for facial weakness or paralysis is identified. Other, more common causes of facial paralysis are:
- Ramsay Hunt Syndrome: A complication of a shingles infection whereby the shingles infection occurs on the facial nerve near to the ear. It is the varicella zoster virus which causes chicken pox in children and shingles in adults. Commonly the facial palsy is accompanied by a rash usually in or around the ear, hairline and/or mouth. It can occasionally occur without a rash and is more common in people over the age of 60.
- Lyme Disease: A bacterial infection caused by a tick bite. A blood test can identify the presence of infection.
The presentations are very similar which may occasionally result in a misdiagnosis. However, a clinician who takes a good history and does a full examination will be able to distinguish between the different diagnoses and order further investigations.
You can contact the charity Facial Palsy UK for information about these and other causes of facial palsy/paralysis.
You may find this guide useful if you are affected by another form of facial palsy and you are struggling with the impacts of a change in your appearance.
What is the difference between Bell’s palsy and a stroke?
It is important to differentiate between facial paralysis caused by Bell’s palsy (a lower motor neurone condition affecting the nerve only), and one caused by a stroke (damage to the brain itself). A thorough clinical examination can help differentiate between the two conditions. A facial paralysis, as the result of a stroke, tends to affect the lower part of the face only and usually involves weakness or paralysis of the arm and/or leg on the affected side. This mean that the person is still able to close their eyes, blink and raise their eyebrows but the lower part of the face is weak. In contrast, Bell’s palsy affects the whole side of the face resulting in an inability to blink, close the eye, and raise the eyebrow as well as loss of movement lower part of the face. There is no limb weakness associated with Bell’s palsy as it is a condition that affects the facial nerve only and not the brain itself.
If you suspect you may have Bell’s palsy, seek medical advice immediately either from your GP or your local Accident and Emergency Department. It is important to be seen as soon as possible so that a diagnosis can be made, and the appropriate medication prescribed. Treatment for Bell’s palsy is a course of steroid tablets which should be commenced within 72 hours of the onset of your symptoms to maximise their effectiveness. If you are in any doubt, call 999.
Bell’s palsy is a paralysis or weakness commonly on one side of the face. Paralysis of the facial muscles typically causes a facial droop on the affected side. The following symptoms are a result of muscle weakness or paralysis of the facial muscles.
Bell’s palsy causes an inability or difficulty:
- Closing the affected eye, blinking, or squinting against the sun
- Raising the brow or looking surprised
- Some sounds may be hard to make because the lip is weak, for example, p and b
- Eating and drinking may be harder due to weakness in the lip and cheek
At the onset of paralysis, you may notice a sharp pain in the inner ear or around the ear itself. You may also be recovering from a cold- or flu-like illness.
Other Bell’s palsy symptoms include:
- Altered taste or change in sense of taste
- Sensitivity to loud noises
- Dry mouth
- Dry/sore eye due to lack of blink or inability to close the eye for sleep