Bell's palsy

Overview

Bell's palsy causes sudden, temporary weakness in your facial muscles. This makes half of your face appear to droop. Your smile is one-sided, and your eye on that side resists closing.

Bell's palsy, also known as facial palsy, can occur at any age. The exact cause is unknown. It's believed to be the result of swelling and inflammation of the nerve that controls the muscles on one side of your face. Or it might be a reaction that occurs after a viral infection.

For most people, Bell's palsy is temporary. Symptoms usually start to improve within a few weeks, with complete recovery in about six months. A small number of people continue to have some Bell's palsy symptoms for life. Rarely, Bell's palsy can recur.

Symptoms

Signs and symptoms of Bell's palsy come on suddenly and may include:

Rapid onset of mild weakness to total paralysis on one side of your face — occurring within hours to days
Facial droop and difficulty making facial expressions, such as closing your eye or smiling
Drooling
Pain around the jaw or in or behind your ear on the affected side
Increased sensitivity to sound on the affected side
Headache
A decrease in your ability to taste
Changes in the amount of tears and saliva you produce
In rare cases, Bell's palsy can affect the nerves on both sides of your face.

When to see a doctor

Seek immediate medical help if you experience any type of paralysis because you may be having a stroke. Bell's palsy is not caused by a stroke, but it can cause similar symptoms.

See your doctor if you experience facial weakness or drooping to determine the underlying cause and severity of the illness.

Causes

Although the exact reason Bell's palsy occurs isn't clear, it's often related to exposure to a viral infection. Viruses that have been linked to Bell's palsy include the virus that causes:

Cold sores and genital herpes (herpes simplex)
Chickenpox and shingles (herpes zoster)
Infectious mononucleosis (Epstein-Barr)
Cytomegalovirus infections
Respiratory illnesses (adenovirus)
German measles (rubella)
Mumps (mumps virus)
Flu (influenza B)
Hand-foot-and-mouth disease (coxsackievirus)
The nerve that controls your facial muscles passes through a narrow corridor of bone on its way to your face. In Bell's palsy, that nerve becomes inflamed and swollen — usually related to a viral infection. Besides facial muscles, the nerve affects tears, saliva, taste and a small bone in the middle of your ear.

Risk factors

Bell's palsy occurs more often in people who:

Are pregnant, especially during the third trimester, or who are in the first week after giving birth
Have an upper respiratory infection, such as the flu or a cold
Have diabetes
Recurrent attacks of Bell's palsy are rare. But in some of these cases, there's a family history of recurrent attacks — suggesting a possible genetic predisposition to Bell's palsy.

Complications

A mild case of Bell's palsy normally disappears within a month. Recovery from a more severe case involving total paralysis varies. Complications may include:

Irreversible damage to your facial nerve
Abnormal regrowth of nerve fibers, resulting in involuntary contraction of certain muscles when you're trying to move others (synkinesis) — for example, when you smile, the eye on the affected side may close
Partial or complete blindness of the eye that won't close due to excessive dryness and scratching of the clear protective covering of the eye (cornea)