What it is
A short, honest summary.
- —Sudden, unexplained weakness of the facial nerve (cranial nerve VII), causing drooping of one side of the face.
- —Often linked to viral inflammation. Onset is rapid, often noticed on waking.
- —Roughly 70% recover completely; physiotherapy supports the remainder.
What families notice
The signals worth taking seriously.
- 01Inability to fully close one eye
- 02Drooping at the corner of the mouth
- 03Loss of forehead wrinkling on one side
- 04Altered taste, drooling, or dribbling fluids
- 05Discomfort or pain behind the ear at onset
My approach
How the work is structured.
- —Gentle facial neuromuscular re-education — not random exercises, but specific patterning.
- —Eye protection counselling: lubrication, taping at night.
- —Avoiding the well-meaning but harmful 'work it hard' approach that drives synkinesis.
- —Mirror feedback work, EMG biofeedback where available.
What recovery looks like
A plain-language picture.
“Most see substantial recovery in 3 to 6 months. Targeted physiotherapy reduces the risk of long-term asymmetry and synkinesis (involuntary co-movement).”
FAQ
Common questions, answered briefly.
- Should I do facial exercises immediately?
- Gentle, specific work yes — vigorous facial workouts no. Over-driving the nerve too early can cause permanent miswiring.
- Will I have lasting asymmetry?
- Most don't. For those who do, targeted neuromuscular work over months meaningfully improves it.
For clinicians
Clinical detail, assessment and evidence.
Clinical summary
The picture in clinician register.
Bell's palsy is an acute idiopathic lower-motor-neuron facial (CN VII) palsy, attributed to viral-mediated nerve oedema. Around two-thirds recover fully; outcome is shaped by early eye protection and graded neuromuscular re-education. Premature high-effort exercise drives synkinesis and is avoided.
Terminology
Terms worth being precise about.
- Lower-motor-neuron facial weakness
- Forehead is involved — distinguishing it from a central (upper-motor-neuron) lesion.
- Synkinesis
- Involuntary co-movement (e.g. eye closes when smiling) from aberrant reinnervation.
- House-Brackmann grade
- Standard 6-point grading of facial-nerve function.
- Lagophthalmos
- Incomplete eye closure — the key corneal-protection concern.
Assessment & measures
What the first sessions measure.
- —House-Brackmann or Sunnybrook facial grading.
- —Documentation of eye closure and corneal-protection status.
- —Synkinesis assessment; a photo or video baseline.
Red flags
Signs that need urgent escalation.
- Bilateral facial weakness, slowly progressive onset, other cranial-nerve involvement, or a palpable mass — these are not Bell's palsy; refer.
- No recovery by 3-4 months.
Referral & MDT
When and to whom to refer.
Ophthalmology if corneal exposure is a concern. ENT or neurology where the picture is atypical or non-recovering.
Evidence
References and guideline anchors.
- Timing of facial neuromuscular re-education — PLACEHOLDER — verify against current guidelines before launch.