Figure 2. Bell's Palsy Management Algorithm
Patient presenting with acute-onset,
unilateral facial paresis/paralysis
Assess patient with history & physical
exam to exclude identifiable causes of
facial paresis/paralysis
YES
Cause of facial
paresis/paralysis
identified?
NO
Offer oral antiviral
therapy in addition
to oral steroids
Manage
accordingly
NO
NO
Prescribe oral steroids
Does the
patient have
incomplete eye
closure?
Implement eye
protection
Does
the patient
have complete
facial paresis/
paralysis?
Does the patient have:
1. New or worsening neurologic
findings at any point, or
2. Ocular symptoms developing at
any point, or
3. Incomplete facial recovery 3
months after initial onset?
YES
Reassess or refer to a
facial nerve specialist or
ocular specialist for ocular
symptoms
Acute management of
patient complete
Optional
Optional
NO
Diagnostic
Treatment
YES
YES
Offer electrodiagnostic
testing