Intended for healthcare professionals

Clinical Review

Recent developments in Bell's palsy

BMJ 2004; 329 doi: (Published 02 September 2004) Cite this as: BMJ 2004;329:553
  1. N Julian Holland, specialist registrar (,
  2. Graeme M Weiner, consultant1
  1. 1 Department of Otolaryngology, Royal Devon and Exeter NHS Foundation Trust, Exeter EX2 5DW
  1. Correspondence to: N J Holland
  • Accepted 8 June 2004


General practitioners in the United Kingdom will see about one patient with Bell's palsy every two years. Increasing evidence shows that the way the patient is managed has an important effect on outcome. Untreated Bell's palsy leaves some patients with major facial dysfunction and a reduced quality of life. Of patients with Bell's palsy registered by general practitioners between 1992 and 1996 a fifth were referred for specialist opinion, just over a third received oral steroids, and 0.6% received aciclovir.1 Improving outcomes requires coordination between specialists and general practitioners so that patients are treated during the critical first 72 hours. We outline recent developments in Bell's palsy and current best evidence in its management.

Sources and selection criteria

We canvassed specialists with an interest in acute facial palsy and incorporated the latest consensus from key publications and systematic reviews. We performed a hierarchical literature search through Medline, CINAHL, SUMSearch,, Lancet Neurology Network, Bandolier, Health Technology Assessment, Clinical Evidence, and the Cochrane Library. Both authors are otolaryngologists with an interest in neurotology and facial palsy.

Incidence and pathophysiology

Bell's palsy accounts for almost three quarters of all acute facial palsies, with the highest incidence in the 15 to 45 year old age group (table 1).2 The annual incidence in the UK population is around 20 per 100 000, with one in 60 people being affected during their lifetime. Men and women are equally affected, although the incidence is higher in pregnant women (45 cases per 100 000).

View this table:
Table 1

Causes and incidence of acute facial palsy2

Recent developments

Bell's palsy is probably caused by herpes viruses, mainly herpes simplex virus type 1 and herpes zoster virus

Facial palsy improves after treatment with combined oral aciclovir and prednisone

Treatment of partial Bell's palsy is controversial; a few patients don't recover if left untreated

Treatment is probably more effective …

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