The onset of Bell’s palsy is sudden and symptoms typically peak fast, within a few days. The main symptom is acute peripheral facial weakness. The hallmark of Bell’s palsy is unilateral, acute paresis or paralysis of facial movement. A positive history of viral infections, Ischemic mononeuropathy,Diabetes mellitus and Thyroid disorders is suggestive of Bell’s palsy. Patients with Bell’s palsy may also have a positive history of: Herpes simplex virus reactivation, Herpes Zoster, Cytomegalovirus, Epstein Barr virus, rubella virus, Mumps, influenza B, coxsackie virus, rickettsial infection, Borrelia burgdorferi, acute HIV infection, ischemic mononeuropathy, Diabetes mellitus and Thyroid disorders. Complications of Bell’s palsy include: incomplete eyelid closure with resultant dry eye, permanent facial weakness with muscle contractures, motor synkinesis , crocodile tears (tears when eating due to misdirection of regenerating gustatory fibres destined for the salivary glands, so that they become secretory fibres to the lacrimal gland and cause ipsilateral tearing while the patient is eating), contracture of facial muscles, reduction or loss of taste sensation and problems with dysarthria due to facial muscle weakness. Prognosis of Bell’s palsy is generally good. If left untreated approximately 71% of patients with Bell’s palsy recover normal function and around 13% are left with slight weakness and around 4% with severe weakness resulting in major facial dysfunction. The presence of complete palsy, advanced age and Herpes zoster infection is associated with a particularly poor prognosis among patients with Bell’s palsy. The Bell’s palsy recurs in 7% of patients. The House-Brackmann grading system was devised both as a clinical indicator of severity and also an objective record of progress.

• The onset of Bell’s palsy is sudden and symptoms typically peak fast, within a few days.^[1][2]
• the main symptom is acute peripheral facial weakness.
• The hallmark of Bell’s palsy is unilateral, acute paresis or paralysis of facial movement. A positive history of viral infections, Ischemic mononeuropathy,Diabetes mellitus and Thyroid disorders is suggestive of Bell’s palsy.

Patients with Bell’s palsy may have a positive history of:

• Viral infections:
  • Herpes simplex virus reactivation^[3]
  • Herpes Zoster^[4]
  • Cytomegalovirus^[5]
  • Epstein Barr virus^[6]
  • Rubella virus^[7]
  • Mumps^[8]
  • Influenza B^[9]
  • Coxsackievirus^[10]
  • Rickettsial infection ^[11]
  • Borrelia burgdorferi^[12]
  • Acute HIV infection^[13]
• Ischemic mononeuropathy^[14]
• Diabetes mellitus^[15]
• Thyroid disorders^[16]

• Complications of Bell’s palsy include:^[17][18]
  • Incomplete eyelid closure with resultant dry eye
  • Permanent facial weakness with muscle contractures
  • Motor synkinesis (involuntary movement of muscles occurring at the same time as deliberate movement, e.g. involuntary mouth movement during voluntary eye closure)
  • Crocodile tears (tears when eating due to misdirection of regenerating gustatory fibres destined for the salivary glands, so that they become secretory fibres to the lacrimal gland and cause ipsilateral tearing while the patient is eating)
  • Incomplete recovery
  • Contracture of facial muscles
  • Reduction or loss of taste sensation
  • Problems with dysarthria due to facial muscle weakness

• Prognosis of Bell’s palsy is generally good.^[19]
• If left untreated approximately 71% of patients with Bell’s palsy recover normal function and around 13% are left with slight weakness and around 4% with severe weakness resulting in major facial dysfunction.^[18]
• The presence of complete palsy, advanced age and Herpes zoster infection is associated with a particularly poor prognosis among patients with Bell’s palsy.^[19]
• The Bell’s palsy recurs in 7% of patients.^[19]
• The House-Brackmann grading system was devised both as a clinical indicator of severity and also an objective record of progress.^[20]