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Bell's palsy: aetiology, clinical features and multidisciplinary care
  1. Timothy J Eviston1,
  2. Glen R Croxson2,
  3. Peter G E Kennedy3,
  4. Tessa Hadlock4,
  5. Arun V Krishnan1
  1. 1Prince of Wales Clinical School, University of NSW, Sydney, New South Wales, Australia
  2. 2Department of Otolaryngology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
  3. 3Department of Neurology, Glasgow University, Southern General Hospital, Glasgow, UK
  4. 4Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Arun Krishnan, Prince of Wales Clinical School, University of New South Wales, Randwick, NSW 2031, Australia; Arun.Krishnan{at}


Bell's palsy is a common cranial neuropathy causing acute unilateral lower motor neuron facial paralysis. Immune, infective and ischaemic mechanisms are all potential contributors to the development of Bell's palsy, but the precise cause remains unclear. Advancements in the understanding of intra-axonal signal molecules and the molecular mechanisms underpinning Wallerian degeneration may further delineate its pathogenesis along with in vitro studies of virus–axon interactions. Recently published guidelines for the acute treatment of Bell's palsy advocate for steroid monotherapy, although controversy exists over whether combined corticosteroids and antivirals may possibly have a beneficial role in select cases of severe Bell's palsy. For those with longstanding sequaelae from incomplete recovery, aesthetic, functional (nasal patency, eye closure, speech and swallowing) and psychological considerations need to be addressed by the treating team. Increasingly, multidisciplinary collaboration between interested clinicians from a wide variety of subspecialties has proven effective. A patient centred approach utilising physiotherapy, targeted botulinum toxin injection and selective surgical intervention has reduced the burden of long-term disability in facial palsy.

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