[Consider the diagnosis 'Bell's palsy' carefully]

Ned Tijdschr Geneeskd. 2019 Jan 24;163:D2594.
[Article in Dutch]


Patients with facial palsy present with both cosmetic and functional symptoms. When a facial palsy develops quickly (within 72 hours) with no other symptoms, and no cause can be identified, it is probably an idiopathic facial palsy or 'Bell's palsy'. The diagnosis Bell's palsy is, thus, to a certain extent a diagnosis 'per exclusionem'. We present three cases with an incorrectly diagnosed Bell's palsy or inadequate diagnostics or treatment: a 5-year-old male with recurrent facial palsy caused by acute otitis media; a 46-year-old male with facial palsy caused by a malignant parotid tumour; and a 75-year-old female with facial palsy caused by a facial nerve schwannoma in the mastoid segment of the facial nerve. We, therefore, emphasize the importance of thorough history-taking and adequate diagnostics and imaging when patients present with facial palsy.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Bell Palsy / diagnosis*
  • Child, Preschool
  • Diagnosis, Differential
  • Diagnostic Errors*
  • Facial Nerve
  • Facial Paralysis / etiology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neurilemmoma / complications*
  • Neurilemmoma / diagnosis
  • Otitis Media / complications*
  • Otitis Media / diagnosis
  • Parotid Neoplasms / complications*
  • Parotid Neoplasms / diagnosis
  • Peripheral Nervous System Neoplasms / complications*
  • Peripheral Nervous System Neoplasms / diagnosis