Bell's palsy natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
The onset of Bell's palsy is sudden and symptoms typically peak fast, within a few days. the main symptom is acute peripheral facial weakness. Additional symptoms may include: pain in or behind the ear, numbness or tingling in the affected side of the face usually without any objective deficit on neurological examination
Hyperacusis and disturbed taste on the ipsilateral anterior part of the tongue
Complications of Bell’s palsy include:
Incomplete eyelid closure with resultant dry eye
Permanent facial weakness with muscle contractures
Motor synkinesis (involuntary movement of muscles occurring at the same time as deliberate movement, e.g. involuntary mouth movement during voluntary eye closure)
Crocodile tears (tears when eating due to misdirection of regenerating gustatory fibres destined for the salivary glands, so that they become secretory fibres to the lacrimal gland and cause ipsilateral tearing while the patient is eating)
Incomplete recovery
Contracture of facial muscles
Reduction or loss of taste sensation
Problems with dysarthria due to facial muscle weakness
Prognosis of Bell's palsy is generally good.
If left untreated approximately 71% of patients with Bell's palsy recover normal function and around 13% are left with slight weakness and around 4% with severe weakness resulting in major facial dysfunction.
The presence of complete palsy, advanced age and Herpes zoster infection is associated with a particularly poor prognosis among patients with Bell's palsy.
The Bell's palsy recurs in 7% of patients.
The House-Brackmann grading system was devised both as a clinical indicator of severity and also an objective record of progress.
Natural History, Complications, and Prognosis
Natural History
- The onset of Bell's palsy is sudden and symptoms typically peak fast, within a few days[1][2]
- the main symptom is acute peripheral facial weakness.
- Additional symptoms may include:
- Pain in or behind the ear
- Numbness or tingling in the affected side of the face usually without any objective deficit on neurological examination
- Hyperacusis and disturbed taste on the ipsilateral anterior part of the tongue
Complications
- Complications of Bell’s palsy include:[3][4]
- Incomplete eyelid closure with resultant dry eye
- Permanent facial weakness with muscle contractures
- Motor synkinesis (involuntary movement of muscles occurring at the same time as deliberate movement, e.g. involuntary mouth movement during voluntary eye closure)
- Crocodile tears (tears when eating due to misdirection of regenerating gustatory fibres destined for the salivary glands, so that they become secretory fibres to the lacrimal gland and cause ipsilateral tearing while the patient is eating)
- Incomplete recovery
- Contracture of facial muscles
- Reduction or loss of taste sensation
- Problems with dysarthria due to facial muscle weakness
Prognosis
- Prognosis of Bell's palsy is generally good.[5]
- If left untreated approximately 71% of patients with Bell's palsy recover normal function and around 13% are left with slight weakness and around 4% with severe weakness resulting in major facial dysfunction.[4]
- The presence of complete palsy, advanced age and Herpes zoster infection is associated with a particularly poor prognosis among patients with Bell's palsy.[5]
- The Bell's palsy recurs in 7% of patients.[5]
- The House-Brackmann grading system was devised both as a clinical indicator of severity and also an objective record of progress.[6]
References
- ↑ Murthy JM, Saxena AB (2011). "Bell's palsy: Treatment guidelines". Ann Indian Acad Neurol. 14 (Suppl 1): S70–2. doi:10.4103/0972-2327.83092. PMC 3152161. PMID 21847333.
- ↑ Hauser WA, Karnes WE, Annis J, Kurland LT (1971). "Incidence and prognosis of Bell's palsy in the population of Rochester, Minnesota". Mayo Clin Proc. 46 (4): 258–64. PMID 5573820.
- ↑ Tiemstra JD, Khatkhate N (2007). "Bell's palsy: diagnosis and management". Am Fam Physician. 76 (7): 997–1002. PMID 17956069.
- ↑ 4.0 4.1 Somasundara D, Sullivan F (2017). "Management of Bell's palsy". Aust Prescr. 40 (3): 94–97. doi:10.18773/austprescr.2017.030. PMC 5478391. PMID 28798513.
- ↑ 5.0 5.1 5.2 MATTHEWS WB (1961). "Prognosis in Bell's palsy". Br Med J. 2 (5246): 215–7. PMC 1969111. PMID 13768298.
- ↑ Reitzen SD, Babb JS, Lalwani AK (2009). "Significance and reliability of the House-Brackmann grading system for regional facial nerve function". Otolaryngol Head Neck Surg. 140 (2): 154–8. doi:10.1016/j.otohns.2008.11.021. PMID 19201280.