Acute Facial Palsy

Author: Jon Whittaker / Editors: Taj Hassan, Chris Wearmouth / Reviewer: Liz Florey, Eugene Henry / Code: A5 / Published: 25/10/2021


This session looks at the assessment and management of acute facial palsy.

By the end of this session you will be able to:

  • Differentiate clinically between a upper motor neuron (central) and a lower motor neuron (peripheral) facial palsy.
  • Recognise the link between the clinical features of facial nerve palsy and the corresponding anatomy of the facial nerve
  • Identify and describe causes of peripheral facial muscle weakness
  • Formulate an appropriate treatment regime for a patient with Bells palsy
  • Identify the clinical features of Ramsay Hunt syndrome and formulate an appropriate treatment regime


  1. Adour KK, Byl FM, Hilsinger RL Jr et al. The true nature of Bell’s palsy: analysis of 1,000 consecutive patients. Laryngoscope 1978;88:787-801. View abstract
  2. Rowlands S, Hooper R, Hughes R. et al. The epidemiology and treatment of Bells palsy in the UK. Eur J Neurol 2002;9:63-67. View abstract
  3. Bird TD. Nicolaus A. Friedreichs description of peripheral facial nerve paralysis in 1798. J Neurol Neurosurg Psychiatry 1979;42:56-58. View abstract
  4. Peitersen E. Bells palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl 2002;549:4-30. View abstract
  5. Murakami S, Mizobuchi M, Nakashiro Y et al. Bell palsy and herpes simplex virus: identification of viral DNA in endoneural fluid and muscle. Ann Intern Med 1996;124:27-30. View abstract
  6. Kanerva M, Mannonen L, Piiparinen H et al. Search for herpesviruses in cerebrospinal fluid of facial palsy patients by PCR. Acta Otolaryngol 2007;127:775-779. View abstract
  7. Lazarini PR, Vianna MF, Alcantara MP et al. Herpes simplex virus in the saliva of peripheral Bells palsy patients. Braz J Otolaryngolog 2006;72:7-11. View abstract
  8. Saito O, Aoyagi M, Tojima H et al. Diagnosis and treatment for Bells palsy associated with diabets mellitus. Acta Otolaryngol Suppl 1994 511:153-155. View abstract
  9. Benatar M, Edlow J. The spectrum of cranial neuropathy in patients with Bells palsy. Arch Int Med 2004;164:2383-2385. View abstract
  10. Baumann BM, Jarecki, J. Posttraumatic delayed facial nerve palsy. Am J Emerg Med 2008;26:115.e1-2.
  11. Holland NJ, Weiner GM. Recent developments in Bells palsy. BMJ 2004:329;553-755. View abstract
  12. Engstrm M, Stjernquist-Desatnik A, Axelsson S et al. Prednisolone and valciclovir in Bells palsy: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet Neurol 2008;7:993-1000.
  13. Sullivan FM, Swan IRC, Donnan PT et al. Early treatment with prednisolone or acyclovir in Bells palsy. N Eng J Med 2007;357:1598-1607. View abstract
  14. de Almeida JR, Al Khabori M, Guyatt GH et al. Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta-analysis. JAMA 2009;302:985-993. View abstract
  15. Goudakos JK, Markou KD. Corticosteroids vs corticosteroids plus antiviral agents in the treatment of Bell palsy: a systematic review and meta-analysis. Arch Otolaryngol Head Neck Surg 2009;135:558-564. View abstract
  16. Quant EC, Jeste SS, Muni RH et al. The benefit of steroids plus antivirals for treatment of Bells palsy: a meta-analysis. BMJ 2009;339:b3354. View abstract
  17. Beurskens CH, Heymans PG. Positive effects of mime therapy on sequelae of facial paralysis: stiffness, lip mobility, and social and physical aspects of facial disability. Otol Neurotol 2003;24:677-681. View abstract
  18. He L, Zhou MK, Zhou D, Wu B, Li N, et al. Acupuncture for Bell’s palsy. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD002914.
  19. Best Evidence Topics (Buttress SJ, Herren K) [Internet]. Electrical stimulation and Bells palsy. BestBets; Manchester Royal Infirmary; c2002 View link
  20. Gilden DH. Bells palsy. N Eng J Med 2004;351:1323-1331. View abstract
  21. Sweeney CJ, Gilden DH. Ramsay Hunt syndrome. J Neurol Neurosurg Psychiatry 2001;71:149-154. View abstract
  22. Robillard RB, Hilsinger RL Jr, Adour KK. Ramsay Hunt facial paralysis: clinical analyses of 185 patients. Otolaryngol Head Neck Surg 1986;95:292-297. View abstract
  23. Murakami S, Hato N, Horiuchi J et al. Treatment of Ramsay Hunt syndrome with acyclovir-predisone: significance of early diagnosis and treatment. Ann Neurol 1997;41:353-357. View abstract
  24. Kinishi M, Amatsu M, Mohri M et al. Acyclovir improves recovery rate of facial nerve palsy in Ramsay Hunt syndrome. Auris Nasus Larynx 2001;28:223-226. View abstract
  25. NICE CKS – Bell’s Palsy – Management Scenarios. 2019.

Leave a Reply