Bell's palsy

Also called Facial palsy

Sudden weakness of one side of the face. Usually temporary, and treatment works best within 72 hours.

What it is

Bell's palsy is sudden weakness or paralysis of the muscles on one side of the face, caused by inflammation of the facial nerve. It affects around 1 in 5,000 people a year.

Most people recover substantially, and the great majority recover fully or nearly so. But there is a time-critical element that is often missed: oral steroids started within 72 hours of onset significantly improve the chance of complete recovery.

The first thing to rule out is a stroke. In Bell's palsy the forehead is affected, so the person cannot raise the eyebrow on that side. In a stroke the forehead is usually spared. That distinction matters, and if there is any doubt, treat it as a stroke and call 999.

Signs you might notice

Rapid onset, over hours, of weakness on one side of the face.

Inability to close the eye or raise the eyebrow on that side.

Drooping mouth, drooling, difficulty eating and drinking.

Loss of taste on the front of the tongue, and sound seeming louder in one ear.

Pain around the jaw or behind the ear, often preceding the weakness.

How it can affect day-to-day life

The eye is the urgent practical problem. An eye that will not close dries out, and corneal damage from an unprotected eye is the commonest lasting harm and is entirely preventable.

The psychological effect is underestimated. A changed face affects identity and social confidence profoundly, and people report feeling stared at and misread emotionally.

Eating, drinking and speech are all affected, and a straw and softer food help considerably.

Supporting someone well

Protect the eye, relentlessly. Lubricating drops through the day, ointment at night, and tape the lid closed at night if advised. This is the single most important care task.

Get steroids started within 72 hours. Do not wait for a routine appointment.

Do not attempt aggressive facial exercises early. Ask for a facial therapist rather than improvising, because incorrect retraining causes synkinesis, where muscles move together involuntarily.

Support eating: soft food, small mouthfuls, and check for pocketing on the weak side.

Ask for referral if recovery has not begun within about three weeks.

Where to get help

Seek same-day medical assessment for new facial weakness. If there is any weakness elsewhere, or the forehead is spared, call 999.

Facial Palsy UK provide excellent guidance on eye care and on facial therapy.

Ask for referral to a facial therapy service if recovery is incomplete after three months.