Table 3.

Flow chart—Aetiology of Bell’s palsy

1- Anatomical variations of fallopian canal

2- Cold/viral prodrome

3- Primary ischemia

Vasospasm—oedema and congestion of facial nerve

Reversible with Medical treament

4- Secondary ischemia

Transudate formation and leads to zonal Ischemia

Reversible with medical treatment otherwise in addition may require facial nerve decompression by trans mastoid approach

5- Tertiary ischemia

Thickening of facial nerve sheath with formation of fibrous band/bands

Can lead to Residual facial palsy

Facial nerve decompression with transmastoid approach and slitting of it’s sheath and cutting of fibrous band/bands is required along the medical treatment