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What is Bell's palsy?
Bell's palsy is a form of facial paralysis resulting from damage to the VIIth (facial) cranial nerve. The condition is named for Sir Charles Bell, a Scottish surgeon who studied the nerve and its innervations of the facial muscles 200 years ago. Since the function of the facial nerve is so complex, many symptoms may occur when the fibers of the facial nerve are disrupted. A disorder of the facial nerve may result in twitching, weakness or paralysis of the face, dryness of the eye or the mouth, in disturbance of taste etc.
      Bell's Palsy temporarily prevents the nerve from transmitting signals to the muscles, causing weakness or paralysis. When half or one side of these individual nerve fibers are interrupted, hemi-facial weakness occurs. If these nerve fibers are irritated, then movements of the facial muscles appear as spasms or twitching.
     The muscles that close the eyelid are controlled by VII nerve, but the muscles that control other eye movements and the ability to focus are not. There will be difficulty in closing the eyelids, but other functions and movement of the eye is not affected. The sense of taste is affected, but tongue motion is not. Skin sensation may be affected near the ear, but sensation over the rest of the face usually remains normal. Chewing and swallowing are usually not affected.

What are the causes for Bell’s palsy?
The specific cause of Bell's Palsy is unknown. It can strike almost anyone at any age. A number of things can damage the facial cranial nerve and lead to Bell's palsy. Several systemic diseases can cause facial paralysis and are sometimes misdiagnosed as Bell's palsy.
      Most Bells Palsy are designated as idiopathic (unknown), but it is said to be caused by an inflammation within a small bony tube called the fallopian canal, through which the nerve passes before exiting from the stylomastoid foramen. The canal is an extremely narrow area, and an inflammation within it is likely to exert pressure on the nerve. The nerve has not yet divided into its several branches thus resulting in impairment of all functions controlled by the VIIth nerve.

• Most Bells Palsy are designated as idiopathic, but the herpes simplex virus (HSV-1) has been identified as the most frequent cause of Bells palsy, accounting for at least 60 - 70% of cases. Exposure to HSV-1 is common. A vast majority of the population has been exposed to it during childhood. The active virus is commonly associated with cold sores, but the virus often runs its course without causing any blisters (blisters actually appear only 15% of the time). HSV-1 is only infectious for a short period of time. It then enters a dormant state, residing on nerve tissue. For most people, the virus remains dormant forever. However, there are triggers that can cause the dormant virus to reactivate. When this occurs the immune system begins to produce antibodies, causing an inflammation. This is a normal body function, and is part of the process that eliminates harmful foreign bodies such as viruses and bacteria so that we can recover from illness and injury. The inflammation can be in an area when the nerve is in the canal with no room for swelling. The inflammation puts pressure on the nerve, compressing it. Compression on the nerve is the injury that stops transmission of signals to muscles, and causes the symptoms of weakened or paralyzed facial muscles.
        The triggers for reactivation of the virus have not been proven conclusively. However, decreased immunity, whether temporary (stress, lack of sleep, minor illness, upper respiratory infection, etc.) or long-term (autoimmune syndromes, chronic disease, etc.) is being strongly targeted as the most likely trigger.
• The process that leads to Ramsey Hunt Syndrome (RHS) is similar. The culprit is varicella zoster virus (VSV), the virus that causes chicken pox. Like HSV-1, it remains in the body, residing on nerve tissue in a dormant state on nerve ganglia after the initial infectious stage has passed. The symptom that generally leads to a diagnosis of Ramsey Hunt Syndrome is the appearance of blisters (shingles) in the ear, which can be expected to last 2 - 5 weeks. Pain can continue after the blisters have disappeared. The blisters may appear prior to, concurrent to, or after the onset of facial paralysis. RHS can also affect the auditory nerve (VIII Cranial nerve). Unlike reactivated HSV-1, shingles is contagious. Contact with an open blister by someone who has never had chickenpox can result in transmission of the virus. Herpes zoster has been confirmed to be associated with suppressed immune systems.
• HIV can cause facial paralysis and increases the chance of developing Ramsey Hunt Syndrome. In the early stage of HIV, paralysis can be directly due to the viral infection. In later stages paralysis is more likely to be associated with the opportunistic infections or tumors associated with severe immune deficiency. 
• Lyme disease can cause facial paralysis and the same symptoms as Bells palsy. Bacteria enter the body through the skin at the site of the tick bite. Typical early symptoms of Lyme disease are a red ring around the site of the bite and flu-like symptoms. Unfortunately these symptoms do not always appear. The symptoms will pass, but administration of an antibiotic as early as possible is important to avoid serious problems later. Without an antibiotic the bacteria can spread throughout the body, causing arthritis, heart disease, and nervous system disorders such as facial paralysis.
• Otitis Media. Bacteria from some acute or chronic middle ear infections can invade the canal around the nerve through small portals. As with viruses, the invasion can evoke an inflammatory response, and compress the nerve.
• Cytomegalovirus, Epstein Barr virus, Kawasaki disease, multiple sclerosis, sarcoidosis, parotitis and venereal diseases. The common threads are viral and bacterial infections, as well as autoimmune disorders.
• Facial and surgical wounds, trauma due to a blunt force, temporal bone fractures, brain stem injuries can result in facial palsy.
• Cysts and tumors of the maxillofacial region.
• Diabetes, high blood pressure, thyroid malfunctions.
• Lupus, Sjogrens syndrome and congenital defects can, infrequently, cause facial paralysis.
• It disproportionately attacks pregnant women.
• People who have influenza, cold, or some other upper respiratory ailment.
• In addition to these, there are many other factors that are currently thought to trigger facial paralysis, or increase the risk. Among them are cold breeze blowing on to the face.

What are the symptoms?
The 7th cranial nerve has both motor and sensory functions. Its motor functions include shutting the eye, lifting the eyebrow, and supply the muscles that move the mouth and lips. Its sensory functions include tasting on the front of the tongue and dampening the level of the sound we hear. So the symptoms of Bell's palsy include any abnormalities involving these various muscles. Many people describe feeling a pain behind their ear or near the jaw a few days before the other symptoms develop. The most common symptom of Bell's palsy is weakness on one entire side of the face. A person may not be able to close one eye, or they may have difficulty shutting their eye completely. The forehead doesn't wrinkle when a person tries to lift their eyebrow. The lower part of the face may droop down. Patients aren't able to lift their mouths to smile or fill their cheeks with air. They may drool from the mouth. Some people may feel a tingling or numbness in the face. In addition to one-sided facial paralysis with possible inability to close the eye, symptoms of Bell's palsy may include pain, tearing, drooling, hypersensitivity to sound in the affected ear, and impairment of taste.
      One of the functions of the eyelid is to protect the eye from injury, and our eyes usually shut very quickly when something is likely to hit or fly into them. Sometimes people with Bell's palsy get eye injuries as a result of the eye not shutting completely in defense.
      Sensory Functions may be affected. Some people may not have any taste on the front of their tongue. People may have an increased sensitivity to sound in the ear on the affected side, and so things sound louder than normal.