Bell’s Palsy: Prognosis and Follow-up

In 70% of cases of Bell’s palsy facial paralysis is complete and, if untreated, almost 75% of patients will recover fully with 84% recovering full or near normal function [4]. It usually develops in 72 hours and does not progress after 72 hours.

Common sequelae found in those that fail to recover are:

• Residual partial facial weakness
• Facial contracture
• Ageusia – loss of taste function (of the tongue)
• Motor synkinesis – involuntary muscle movement accompanying a voluntary movement, e.g. eye closure when smiling
• Autonomic synkinesis – e.g. crocodile tears syndrome when lacrimation occurs with salivation

Learning bite

84% of patients with Bell’s Palsy will recover full or near normal function without any treatment. Most people with Bell’s palsy make a full recovery within 9 months.

Although the vast majority of patients will regain normal or near normal facial function, there are certain prognostic indicators that predict a poorer outcome [20]:

• Increased age
• Hypertension
• Impairment of taste
• Pain other than in the ear
• Complete facial weakness

Follow-up of a patient with Bell’s palsy who attends the ED should be arranged either through the GP or ENT clinic, according to local policy.

Recurrence of Bell’s palsy is very rare but, if a second episode does occur, then an alternative diagnosis should be considered, e.g. myasthenia gravis or brain stem lesion [20].