Bell Palsy — ORE Part 1 MCQ

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ModerateOral MedicineBell PalsyORE Part 1

A patient presents to the dental surgery complaining of sudden onset of facial weakness on the left side. They cannot close their left eye or smile on the left. There is no forehead sparing. What is the most likely diagnosis?

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Correct answer: A — Bell palsy (lower motor neuron facial nerve palsy)

The key diagnostic feature is absence of forehead sparing. In Bell palsy (lower motor neuron [LMN] facial nerve palsy), weakness affects the entire face including the forehead muscles (inability to raise eyebrow). In contrast, upper motor neuron (UMN) palsy from stroke spares the forehead because upper facial muscles receive bilateral cortical innervation. The sudden onset, inability to close the eye, and inability to smile are typical LMN presentations. Bell palsy is idiopathic and the most common cause of acute facial paralysis. Ramsay Hunt syndrome would present with vesicular rash in the ear; trigeminal neuralgia causes pain not paralysis; parotid tumour typically presents insidiously, not suddenly.

Reference: NHS Scotland Right Decisions: Bells Palsy and Facial Nerve Palsy (Adult) guidance. https://www.rightdecisions.scot.nhs.uk/borders-ref-help-toolkit/ear-nose-and-throat/bells-palsy/