1 Bell’s Palsy is named after Sir Charles Bell, a Scottish surgeon.

2 There is a lifetime prevalence of 6-20 per 1000 cases. Increased incidence is seen with age, diabetes and pregnancy. Right side is affected in 63 percent of cases.

3 The facial nerve is almost entirely a motor nerve and supplies all the muscles of the face and scalp. It also supplies salivary and lacrimal gland, taste receptors of the tongue and the stapedius muscle.

4 The diagnosis is made on clinical features – facial asymmetry, loss of forehead and nasolabial folds and when the patient smiles, the mouth is drawn towards the normal side. Fluid may escape from the affected side and food may collect between teeth and gums.

5 The common causes are Herpes Virus type I, Herpes Zoster – Ramsay Hunt Syndrome, otitis media, cholesteatoma and lyme disease.

6 The prognosis is worse if there are no signs of recovery in three weeks.

7 Patients should be started on both antivirals and oral steroids (BMJ article Piercy J ,10 minute consultation: Bell’s Palsy, BMJ 2005;330:1,374). There is no universal agreement on this.

8 However there is agreement that there is more benefit if corticosteroid is started within 48 hrs of onset or at least within one week. Dose – 60 mg Prednisolone for 4 days and tapered for 6 days. Review in 7-10 days and check eye care. Review in 8-12 weeks from the onset.

9 Aciclovir is more effective in Ramsay Hunt’s syndrome dose of 800mg. Five times a day for five days.

10 If no recovery - refer to facial palsy physiotherapist with a view to trial of eutrophic stimulation.

Patient information www.bellspalsy.org.uk