All patients presenting within 72 hours onset of Bell’s Palsy should be enrolled in the PMH Emergency Department Bell’s Palsy Study (BellPic). Please contact the PMH Emergency Department Consultant for information.
Bell’s Palsy is the unilateral lower motor neurone facial nerve palsy without detectable underlying cause.
General health / concurrent illness
Acute or chronic otitis media
Mastoiditis / osteomyelitis
Herpes Zoster (Ramsay Hunt Syndrome)
Bell’s Palsy is diagnosed by physically examining the child and excluding other causes of facial weakness and paralysis
Unilateral lower motor neurone facial nerve palsy
Upper respiratory tract infection in previous month
Posterior auricular pain in previous days
Poor tear clearance due to weakness
Rapid onset – most patients present within 48 hours
House Brackmann Facial Grading Scale
Normal symmetrical function in all areas
Slight weakness noticeable only on close inspection. Complete eye closure with minimal effort. Slight asymmetry of smile with maximal effort.
Obvious weakness, but not disfiguring. May not be able to lift eyebrow. Complete eye closure; strong but asymmetrical mouth movement with maximal effort.
Obvious disfiguring weakness. Inability to lift brow. Incomplete eye closure and asymmetry of mouth with maximal effort.
Motion barely perceptible. Incomplete eye closure, slight movement of corner of mouth.
No movement; loss of tone.
Synkinesis (abnormal re-wiring of the nerves when healing) : will usually not be a clinical issue in ED. This will develop later in Bell’s Palsy
Swab for PCR and blood for titres if vesicles are noted
Management of idiopathic facial palsy
Consider eligibility for enrolment in BellPic study
If less than two years of age and/or the diagnosis of Bell’s palsy is uncertain consider a neurology and/or ENT consult
If not enrolled in BellPic study (not eligible or consent refused), consult with the on call Neurologist regarding use of steroids.
Photographs of the face of the child at initial presentation and on follow up are useful to monitor progress. Instructions as per the Health Facts – Bell’s Palsy
Option 2: Genteal Gel (carbomer 980 0.2%, hypromellose 0.3%) or Refresh Liguigel (carmellose 1%) initially QID then reduce to TDS when back at school – for ease of use.
Ointment for night time until lid closure is complete
Lacrilube, Polyvisc or Ircal (all paraffin and wool fat)
Severe lid laxity/redness
Lacrilube, Polyvisc or Ircal (all paraffin and wool fat) can be used QID
Note If the eye becomes red (and fails to settle over a few days with increased lubricant) or the Bell’s is not resolving as expected over 4-6 weeks then ophthalmology should be involved to consider whether a tarsorrhaphy is required.