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Bell palsy

The facial nerveBell palsy (previously called Bell's palsy) is a condition where the facial nerve is damaged, affecting the face muscles. It affects around one in 5,000 people.

Often doctors don’t know why the nerve becomes damaged, but sometimes it's caused by a virus like a herpes virus (which cause cold sores or chickenpox).

Once a person has picked up this virus (usually in childhood) it doesn't go away completely. It sits quietly in the spinal cord and can come back as Bell palsy later in life. The virus causes inflammation and compression of the nerve that controls muscles in your face. The virus may also cause a blistering rash on the same side of your face. The nerve inflammation leads to weakness, or total paralysis of your face muscles on the affected side.

Because it usually only affects one of the two facial nerves, this leads to a lopsided appearance to the person’s face, which is less apparent at rest, but becomes obvious when a person shows emotion or tries to close their eyes.

Symptoms include drooping of one side of the face, being unable to smile or close your eye properly, problems holding food and drink in the mouth while eating and slurred speech. People sometimes feel their sense of taste is affected. Occasionally, there can be ear pain. The level of facial weakness can vary from mild to total paralysis.

Bell palsy isn't a serious problem, but it can have a big effect on a person’s social interactions and feelings about themselves because it affects how their face looks. This can make people feel very self-conscious, or embarrassed. It usually gets better with time though. The most important thing to think about is protecting your eye if the lid can't close properly. This might lead to the eye drying out, and an ulcer or scratch appearing on the eye surface. Sometimes a patch may need to be worn to protect the eye, and artificial tears are often needed to help with the dryness.

If you get Bell palsy, there is a good chance that you'll recover without any treatment. Oral steroid tablets can improve recovery, but only if you start them in the first three days. If there's good reason to suspect that a herpes virus has caused the palsy and it's within 3 days of the rash appearing, then your GP may also try antiviral medications. After this, they may not help much. Bell palsy is temporary in most people, but the symptoms can take up to nine months to go away completely. Occasionally, the symptoms won't go away completely.


Facial paralysis can also be a sign of a stroke. If you or someone with you suddenly develops facial droop or slurred speech, call an ambulance for urgent medial help.

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Written by HealthInfo clinical advisers. Last reviewed September 2019.

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Page reference: 52919

Review key: HIBPA-19334