Immediately | Facial palsy associated with other neurological findings, slow-onset facial palsy (over >3 days), palpable pre-auricular mass, systemic constitutional symptoms, bilateral facial palsy | Alternative aetiology to Bell’s palsy likely. Needs early additional investigations | ENT/neurology depending on distribution of symptoms and signs |
Immediately | Persistent dry eye, corneal irritation, corneal ulceration | Requires urgent ophthalmology input to restore corneal protection | Ophthalmology within comprehensive facial palsy service |
3 weeks after onset | No improvement in facial movements | Need to exclude alternative aetiology | Comprehensive facial palsy service (ENT surgery) |
3 months after onset | Incomplete resolution of facial palsy | Need to exclude alternative aetiology. May benefit from early surgical and non-surgical interventions to improve short-and long-term outcome | Comprehensive facial palsy service (plastic surgery) |