Bell's Palsy

Treatment Overview

Bell's palsy usually goes away without treatment, especially if you can still partly move the muscles on the affected side of your face. Almost all people who can still move their facial muscles to some degree recover completely without needing any medicine or other treatment.¹

Your chances for a full recovery are better if your symptoms start to improve on their own within 3 weeks.³ About 2 out of 3 people who get Bell's palsy recover completely.⁴ The rest have ongoing weakness that ranges from partial to complete paralysis, which may never completely disappear. Some people develop involuntary facial movements (movements they cannot control), such as twitching lips, tearing eyes, or spasms of the face or eyelids.

If your doctor thinks that your Bell's palsy is caused by a virus, you may be given antiviral drugs, such as acyclovir. But there is no clear evidence that antiviral drugs are an effective treatment for Bell's palsy.⁵

If your doctor thinks that your Bell's palsy is caused by inflammation from another disease, you may be given corticosteroids, such as prednisone, to reduce the inflammation.

If Bell's palsy affects your ability to close the affected eye, proper eye care, including keeping the eye moist, is essential to prevent eye damage. Try the following to help protect your eye:

• Use your finger to close and open your eyelid. Doing this often will help keep your eye moist.
• Use "artificial tears," which are eyedrops that contain methylcellulose, to keep your eye moist during the day. Talk to your doctor about how often to use the eyedrops.
• Apply special ointment or wear an eye patch at night to protect your eye and keep it moist. You may need to apply ointment and then tape your eyelid shut at night.
• Wear glasses or goggles to keep dust and other foreign matter out of the eye.

If your eye starts to hurt or is damaged, you may need to see an eye doctor (ophthalmologist).

If your condition does not improve as expected, your doctor may order some tests, such as an MRI or a blood culture, to rule out other possible causes for your facial paralysis.

Some people develop involuntary facial movements months after being diagnosed with Bell's palsy. This condition may be treated with injections of botulinum toxin to temporarily paralyze the facial muscles.

Treating permanent facial paralysis

If you develop permanent facial paralysis, you may benefit from surgery or physical therapy.

Your doctor may recommend surgery if you have had Bell's palsy for 6 to 12 months without improvement. Surgeries that may improve your appearance and partially restore muscle function include:

• Grafting another nerve to the facial nerve. In many cases, the nerve that controls tongue sensitivity is attached to the facial nerve. Damage to this nerve causes a loss of sensation on half of the tongue. But some people who have had Bell's palsy for a long time may find this preferable to having the muscles on one side of their face completely paralyzed.
• Transferring normal muscle tissue to the affected area, usually the lips.

Who to see for Bell's palsy

Health professionals who can diagnose and treat Bell's palsy include:

• Family medicine physicians.
• Internists.
• Neurologists.
• Physician assistants.
• Nurse practitioners.

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Author:	Shannon Erstad, MBA/MPH	Last Updated: August 8, 2007
Medical Review:	Anne C. Poinier, MD - Internal Medicine Colin Chalk, MD, CM, FRCPC - Neurology
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