Idiopathic Facial Paralysis (Bell Palsy)

Presentation

The patient with Bell palsy can present with any of the following signs or symptoms: sudden onset of facial numbness; a feeling of fullness or swelling; periauricular pain; muscular facial asymmetry; an irritated, dry, or tearing eye; drooling; or changes in hearing or taste. Symptoms can develop over several hours or days. Often there will have been a viral illness 1 to 3 weeks earlier, or there may have been another trigger such as stress, fever, dental extraction, or cold exposure. Initial presentation typically includes an isolated partial or complete unilateral facial paralysis in an otherwise alert patient ( Fig. 5.1 ). It is notable that if the forehead paralysis is bilateral, the diagnosis of central cause (stroke) must be considered.