Idiopathic recurrent facial palsy: a detailed investigation

Authors

  • Sasirekah Kandasamy Department of Medicine, Thanthai Periyar Government Headquarters Hospital, Erode, Tamil Nadu, India
  • Priya Jayakumar Department of Medicine, Thanthai Periyar Government Headquarters Hospital, Erode, Tamil Nadu, India
  • Ganesan Balasubramanian Department of Medicine, Thanthai Periyar Government Headquarters Hospital, Erode, Tamil Nadu, India
  • Thameem Ansari Saburdeen Department of Medicine, Thanthai Periyar Government Headquarters Hospital, Erode, Tamil Nadu, India
  • Arun Balasubramaniam Department of Physiotherapy, Thanthai Periyar Government Headquarters Hospital, Erode, Tamil Nadu, India
  • Poovarasan Murugaiyan Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, Tamil Nadu, India
  • Yamini Umasankar Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, Tamil Nadu, India
  • Vignesh Srinivasan Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, Tamil Nadu, India
  • Prathap Suganthirababu Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20260271

Keywords:

Recurrent facial palsy, Idiopathic facial palsy, Exercises, Electrical stimulation

Abstract

The seventh cranial nerve may be partially or completely damaged, resulting in central or peripheral facial palsy. This leads to weakness of facial muscles, distorted facial expressions and drooling on the affected side. Common causes include cold exposure, pregnancy-related fluid retention, middle ear infections and herpes zoster infection. This case report discusses a 33-year-old male, Mr. RSY, who presented with right-sided facial palsy for the fifth time. Previous episodes occurred annually from 2020 to 2023. He is a chef from Erode who presented to the Medicine OPD with mouth deviation, incomplete right eye closure with positive Bell’s phenomenon, and mild headache and neck pain. He had no relevant medical history or recent cold exposure. Blood tests were normal and chest X-ray revealed mild hilar lymphadenopathy. ENT examination and HRCT of the temporal bone were normal. The only notable finding was the involvement of the seventh cranial nerve. Management included a seven-day course of corticosteroids, antiviral drugs and physiotherapy. The physiotherapy regimen comprised facial massage, facial exercises and stimulation. A home exercise program was also advised. The patient improved significantly with this combined treatment and recovered within four weeks. This case underscores the importance of early and comprehensive management of facial palsy with corticosteroids and physiotherapy for full recovery. It also highlights some patients' potential seasonal recurrence patterns, warranting further research to elucidate the exact pathogenesis and risk factors associated with facial palsy.

Metrics

Metrics Loading ...

References

Zhang W, Xu L, Luo T, Wu F, Zhao B, Li X. The etiology of Bell's palsy: a review. J Neurol. 2020;267(7):1896-905. DOI: https://doi.org/10.1007/s00415-019-09282-4

Eviston TJ, Croxson GR, Kennedy PG, Hadlock T, Krishnan AV. Bell's palsy: aetiology, clinical features and multidisciplinary care. J Neurol Neurosurg Psychiatry. 2015;86(12):1356-61. DOI: https://doi.org/10.1136/jnnp-2014-309563

Rajangam J, Lakshmanan AP, Rao KU, Jayashree D, Radhakrishnan R, Roshitha B, Sivanandy P, Sravani MJ, Pravalika KH. Bell Palsy: Facts and Current Research Perspectives. CNS Neurol Dis Drug Targets. 2024;23(2):203-14. DOI: https://doi.org/10.2174/1871527322666230321120618

Kennedy PG. Herpes simplex virus type 1 and Bell's palsy—a current assessment of the controversy. J Neurovirol. 2010;16(1):1-5. DOI: https://doi.org/10.3109/13550280903552446

Greco A, Gallo A, Fusconi M, Marinelli C, Macri GF, de Vincentiis M. Bell's palsy and autoimmunity. Autoimmunity Rev. 2012;12(2):323-8.

Sajadi MM, Sajadi MR, Tabatabaie SM. The history of facial palsy and spasm: Hippocrates to Razi. Neurology. 2011;77(2):174-8. DOI: https://doi.org/10.1212/WNL.0b013e3182242d23

Campbell KE, Brundage JF. Effects of climate, latitude, and season on the incidence of Bell’s palsy in the US Armed Forces, October 1997 to September 1999. Am J Epidemiol. 2002;156(1):32-9. DOI: https://doi.org/10.1093/aje/kwf009

Hsieh RL, Wang LY, Lee WC. Correlation between the incidence and severity of Bell's palsy and seasonal variations in Taiwan. Int J Neurosci. 2013;123(7):459-64. DOI: https://doi.org/10.3109/00207454.2013.763804

Spengos K, Sameli S, Stouraitis G, Kolias A, Koulouri O, Kokkinos Z, et al. Seasonal variation of Bell’s palsy in Athens, Greece–a hospital-based retrospective evaluation over fifteen years. Eur Neurol. 2006;55(2):84-8. DOI: https://doi.org/10.1159/000092779

Bosco D, Plastino M, Bosco F, Consoli A, Labate A, Pirritano D, Consoli D, Fava A. Bell’s palsy: a manifestation of prediabetes? Acta Aeurol Scandinavica. 2011;123(1):68-72. DOI: https://doi.org/10.1111/j.1600-0404.2010.01365.x

Peng KP, Chen YT, Fuh JL, Tang CH, Wang SJ. Increased risk of Bell palsy in patients with migraine: a nationwide cohort study. Neurology. 2015;84(2):116-24. DOI: https://doi.org/10.1212/WNL.0000000000001124

Aditya V. LMN facial palsy in pregnancy: an opportunity to predict preeclampsia—report and review. Case Rep Obstet Gynaecol. 2014;2014(1):626871. DOI: https://doi.org/10.1155/2014/626871

Khateri M, Cheraghi S, Ghadimi A, Abdollahi H. Radiation exposure and Bell’s palsy: a hypothetical association. J Biomed Phy Eng. 2018;8(3):337. DOI: https://doi.org/10.31661/jbpe.v0i0.627

Zhao H, Zhang X, Tang YD, Zhu J, Wang XH, Li ST. Bell's palsy: clinical analysis of 372 cases and review of related literature. Eur Neurol. 2017;77(3-4):168-72.

Diamond M, Wartmann CT, Tubbs RS, Shoja MM, Cohen‐Gadol AA, Loukas M. Peripheral facial nerve communications and their clinical implications. Clin Anatomy. 2011;24(1):10-8. DOI: https://doi.org/10.1002/ca.21072

Singh A, Deshmukh P. Bell's palsy: a review. Cureus. 2022;14:10. DOI: https://doi.org/10.7759/cureus.30186

Peitersen E. Bell's palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Oto-laryngol. 2002;122(7):4-30. DOI: https://doi.org/10.1080/000164802760370736

Madhok VB, Gagyor I, Daly F, Somasundara D, Sullivan M, Gammie F, et al. Corticosteroids for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2016;7(7):CD001942. DOI: https://doi.org/10.1002/14651858.CD001942.pub5

Teixeira LJ, Valbuza JS, Prado GF. Physical therapy for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2011;12:CD006283. DOI: https://doi.org/10.1002/14651858.CD006283.pub3

Cirpaciu D, Goanta CM, Cirpaciu MD. Recurrences of Bell's palsy. J Med Life. 2014;7(3):68.

Ronthal M, Greenstein P. Bell's palsy: Pathogenesis, clinical features and diagnosis in adults. 2022. Available at: http://112.2.34.14:9095/contents/bells-palsy-pathogenesis-clinical-features-and-diagnosis-in-adults/print. Accessed on 02 November 2025.

Mutsch M, Zhou W, Rhodes P, Bopp M, Chen RT, Linder T, et al. Use of the inactivated intranasal influenza vaccine and the risk of Bell's palsy in Switzerland. New Eng J Med. 2004;350(9):896-903. DOI: https://doi.org/10.1056/NEJMoa030595

Heckmann JG, Urban PP, Pitz S, Guntinas-Lichius O, Gágyor I. The Diagnosis and Treatment of Idiopathic Facial Paresis (Bell's Palsy). Dtsch Arztebl Int. 2019;116(41):692-702. DOI: https://doi.org/10.3238/arztebl.2019.0692

Franzke P, Bitsch A, Walther M, Schiffner R, Rupprecht S, Rasche M, et al. Weather, weather changes and the risk of Bell’s palsy: a multicentre case-crossover study. Neuroepidemiology. 2018;51(3-4):207-15. DOI: https://doi.org/10.1159/000492671

Wolf SR. Die idiopathische Fazialisparese. HNO. 1998;46:786-98. DOI: https://doi.org/10.1007/s001060050314

Garg P, Jotdar A, Kapoor D. Ramsay Hunt syndrome. Pan-Am J Ophthalmol. 2024;6(3):96. DOI: https://doi.org/10.4103/pajo.pajo_63_24

Sweeney CJ, Gilden DH. Ramsay Hunt syndrome. J Neurol Neurosurg Psychiatry. 2001;71(2):149-54. DOI: https://doi.org/10.1136/jnnp.71.2.149

Gaitan-Quintero G, Camargo-Camargo L, López-Velásquez N, González M. Presentation of Bilateral Facial Paralysis in Melkersson-Rosenthal Syndrome. Case Rep Neurol Med. 2021;2021:6646115. DOI: https://doi.org/10.1155/2021/6646115

Greco A, Gallo A, Fusconi M, Marinelli C, Macri GF, de Vincentiis M. Bell's palsy and autoimmunity. Autoimmun Rev. 2012;12(2):323-8. DOI: https://doi.org/10.1016/j.autrev.2012.05.008

Alfaya TA, Tannure PN, Dip EC, Uemoto L, Barcelos R, Gouvêa CV. Bell's palsy and temporomandibular disorder association: clinical treatment. RFO UPF. 2012;17(2):222-7.

Priya BS, Srinivasan KR, Lakshmanan P, Selvi P. Facial nerve injury following TMJ surgery and its management by electrical stimulation–a case study. Biomed Pharmacol J. 2017;10(4):1855-61. DOI: https://doi.org/10.13005/bpj/1304

Finkensieper M, Volk GF, Guntinas-Lichius O. Facial nerve disorders. Laryngorhinootol. 2012;91(2):121-41. DOI: https://doi.org/10.1055/s-0031-1300965

Finsterer J. Management of peripheral facial nerve palsy. Eur Arch Oto-Rhino-Laryngol. 2008;265:743-52. DOI: https://doi.org/10.1007/s00405-008-0646-4

Zhao H, Zhang X, Tang YD, Zhu J, Wang XH, Li ST. Bell's palsy: clinical analysis of 372 cases and review of related literature. Eur Neurol. 2017;77(3-4):168-72. DOI: https://doi.org/10.1159/000455073

Pecket P, Schattner A. Concurrent Bell's palsy and diabetes mellitus: a diabetic mononeuropathy? J Neurol Neurosurg Psychiatry. 1982;45(7):652-5. DOI: https://doi.org/10.1136/jnnp.45.7.652

Saito O, Aoyagi M, Tojima H, Koike Y. Diagnosis and treatment for Bell's palsy associated with diabetes mellitus. Acta Oto-Laryngol. 1994;114:153-5. DOI: https://doi.org/10.3109/00016489409128322

Riga M, Kefalidis G, Danielides V. The role of diabetes mellitus in the clinical presentation and prognosis of Bell palsy. J Am Board Family Med. 2012;25(6):819-26. DOI: https://doi.org/10.3122/jabfm.2012.06.120084

Nguyen CN, Mallepally N, Tabilona JR, Lu LB. Not So Benign Bell's Palsy: Malignant Peripheral Nerve Sheath Tumor of the Facial Nerve Involving the Temporal Bone. J Gen Intern Med. 2021;36(4):1102-5. DOI: https://doi.org/10.1007/s11606-020-06463-0

Baugh RF, Basura GJ, Ishii LE, Schwartz SR, Drumheller CM, Burkholder R, Deckard NA, Dawson C, Driscoll C, Gillespie MB, Gurgel RK. Clinical practice guideline: Bell’s palsy. Otolaryngol Head Neck Surg. 2013;149(3):S1-27. DOI: https://doi.org/10.1177/0194599813505967

Caplan LR. Basic pathology, anatomy, and pathophysiology of stroke. In LR Caplan, Caplan’s stroke: A clinical approach, 4th edition. Saunders Elsevier: Philadelphia. 2009. Available at: https://www.researchgate.net/publication/316589029_Caplan's_Stroke_A_Clinical_Approach_Fourth_Edition/citation/download. Accessed on 02 November 2025.

Induruwa I, Holland N, Gregory R, Khadjooi K. The impact of misdiagnosing Bell’s palsy as acute stroke. Clin Med. 2019;19(6):494-8. DOI: https://doi.org/10.7861/clinmed.2019-0123

Downloads

Published

2026-01-30

How to Cite

Kandasamy, S., Jayakumar, P., Balasubramanian, G., Saburdeen, T. A., Balasubramaniam, A., Murugaiyan, P., Umasankar, Y., Srinivasan, V., & Suganthirababu, P. (2026). Idiopathic recurrent facial palsy: a detailed investigation. International Journal of Research in Medical Sciences, 14(2), 748–752. https://doi.org/10.18203/2320-6012.ijrms20260271

Issue

Section

Case Reports