Home > Adults > Neurology >

Bell's Palsy

Checked: 06-04-2021 by Vicky Ryan Next Review: 05-04-2023

Overview

Please see Clinical Knowledge Summaries for advice on diagnosis and management of Bell's Palsy in adults.

Bell's palsy will usually resolve with time and can be managed in primary care in many cases. Most people with Bell's palsy make a full recovery within 3–4 months.

Please be aware of atypical features and red flags and refer appropriately if indicated (see CKS guidelines and sections below).

Bell's Palsy in Children

Please go to the separate Bell's Palsy in Children page.

Who to Refer

CKS guidelines list the following indications for secondary care referral.

Refer urgently to an appropriate specialist people with facial nerve palsy and:

Worsening of existing neurologic findings, or new neurologic findings.
Features suggestive of an upper motor neurone cause (for example limb paresis, facial paraesthesia, other cranial nerve involvement, postural imbalance).
Features suggestive of cancer (for example, gradual onset of symptoms, persistent facial paralysis for more than 6 months, pain in the distribution of the facial nerve, head or neck lesion suggestive of cancer, history of head and neck cancer, hearing loss on the affected side).
Systemic or severe local infection.
Trauma.

Refer to a facial nerve specialist if there is doubt about the diagnosis or a person with Bell's palsy has:

No improvement after 3 weeks of treatment.
Consider referring adults with Bell's palsy who have developed symptoms of aberrant reinnervation (including gustatory sweating or jaw-winking) 5 months or more after the onset of Bell's palsy for neurological assessment and possible treatment.
Any atypical features.

Refer to an ophthalmologist if the person has eye symptoms (for example, pain, irritation, or itch).

Referral options are listed below under Services.

Red Flags

Consider the list of differential diagnoses. In particular:

If stroke is suspected then admit immediately to hospital.

If TIA is suspected then use the TIA pathway.

If brain or head and neck tumour is suspected please use the relevant 2WW pathway:

Be wary of infectious differentials such as:

Ramsay Hunt Syndrome (Herpes Zoster Oticus)

Meningitis / Encepalitis

Services

Acute Presentation

Ophthalmology - if there are eye symptoms as a result of eye lid paralysis then refer to the emergency department at the eye hospital.
Neurology - if there are concerns about progressive symptoms or diagnostic uncertainty consider advice and guidance or HOT clinic referral.

Persistent Problems

For more persistent problems following the acute phase then consider the following depending on symptoms:

Neurology referral - via eRS
Neurology advice and guidance via eRS
Maxillo-facial surgery referral via eRS
Ophthalmology referral (adnexal and occuloplastics) via eRS.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.