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Bell's palsy

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Screening and diagnosis

Bell’s palsy is a neurological condition that presents as an acute onset of weakness on one side of the face. It sometimes progresses to total paralysis of the afflicted side of the face. Bell's palsy is a weakness or paralysis of the muscles that control expression on one side of your face. The disorder results from damage to a facial nerve, one of which runs beneath each ear to the muscles on the same side of your face.

The condition may result in a droopy appearance of your face, which can be a blow to your self-esteem. Most often, Bell's palsy isn't serious. The disorder clears up on its own within weeks or months for most people. In some cases, doctors prescribe a corticosteroid medication within the first few days, hoping to increase the likelihood of a good recovery. Bell's palsy, also called facial palsy, is named for Dr. Charles Bell, of Edinburgh, Scotland, who first described the condition in 1882.

The problem can occur at any age. Bell's palsy occurs more often in pregnant women, in people with diabetes or upper respiratory ailments, such as the flu or a cold, and in people with conditions that compromise their immune systems, such as  AIDS or Sarcoidosis.

Your doctor may be able to make a preliminary diagnosis of Bell's palsy by looking at your face and asking you to try to move your facial muscles. Other conditions, such as a stroke, infections and tumors, also may cause facial muscle weakness, mimicking Bell's palsy.

If after a few days there's still doubt about the diagnosis, a test called electromyography (EMG) can confirm the presence of nerve damage and determine its severity. An EMG, an outpatient procedure, can measure:

  • The electrical activity of a muscle in response to stimulation

  • The nature and speed of the conduction of electrical impulses along a nerve

To measure electrical currents in your facial muscles, fine needles are inserted into one of the muscles to be tested. A wire connects the needles to an electronic recording device. The patterns of electrical activity are recorded when the muscle is at rest and as you voluntarily tighten it. These patterns appear on a screen and may be recorded on film for further analysis.

To study your nerves, two small, disk-like recording electrodes are taped to your skin directly above the nerve to be tested. Then, a small instrument applies a mild shock over the nerve. This electrical signal moves down the nerve, passing under the electrodes. By comparing the recording of the signal at each electrode site and calculating the time it takes to travel between them, the speed of conduction along the nerve is determined. In some nerve disorders, the conduction time is dramatically slowed.


Although a mild case of Bell's palsy normally disappears within a month, recovery from a case involving total paralysis varies. If the damage to your facial nerve is unusually severe, the fibers may be irreversibly damaged. Another complication can arise from misdirected regrowth of nerve fibers, which can result in involuntary contraction of certain muscles when you're trying to move others (synkinesis). For example, when you smile, the eye on the affected side may close shut.


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