Bell's Palsy

Bell's palsy is sudden weakness or paralysis of the muscles on one side of the face, thought to come from a viral inflammation of the facial nerve. Most cases recover fully in weeks to months, especially with early treatment. It can look alarming — many patients fear stroke — but Bell's palsy is usually distinguishable and is not life-threatening.

Classic features

• Sudden drooping on one side of the face — usually over hours.
• Inability to close one eye fully.
• Difficulty smiling, raising an eyebrow, whistling on the affected side.
• Numbness or heaviness in the face.
• Drooling; taste changes; sensitivity to sound in one ear.
• The forehead on the affected side cannot wrinkle — distinguishes from stroke (in stroke, forehead muscles are spared).

Red flags — go to hospital / dial 112

• Facial weakness with arm/leg weakness, slurred speech, confusion — suspect stroke.
• Facial weakness with severe headache, ear pain with vesicles, hearing loss (Ramsay Hunt — herpes zoster of ear — needs urgent antiviral treatment).
• Both-sided facial weakness (think Guillain-Barré, Lyme, sarcoidosis, brainstem).
• Progressive over days, or with fever.

Treatment

• Oral steroid course within 72 hours — significantly improves full recovery.
• Antivirals — added when herpes infection suspected (Ramsay Hunt).
• Eye protection — cannot close eye fully → exposure keratitis. Artificial tears by day, lubricant and eye patch at night. Prevents corneal damage.
• Facial exercises once movement starts returning.
• Physiotherapy if recovery is slow.
• Surgery is rarely needed.
• Most people recover substantially; a minority have residual weakness or synkinesis (involuntary co-movement).