facial nerve

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Dr Pankaj Maheria

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INTRODUCTION VII cranial nerve Nerve of II pharyngeal arch Mixed cranial nerve with sensory & motor components Motor root & sensory root( nervus intermedius/ nerve of Wrisberg)

Smile:

Cry Smile Salivate Taste

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FUNCTIONAL COMPONENTS Branchial efferent (BM): Muscles from II pharyngeal arch Visceral efferent :(Preganglionic parasympathetic fibres)(GVE): Submandibular, sublingual, lacrimal glands and glands of nose, palate and pharynx.`

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FUNCTIONAL COMPONENTS Special visceral Afferent (Taste)(SVA): Anterior 2/3rds of tongue General somatic afferent (General sensations)(GSA): Concha of auricle

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DEEP ORIGIN (NUCLEI) Motor Nucleus (Pons): BM Superior Salivatory Nucleus (Pons): GVE Lacrimatory Nucleus (Pons) : GVE Nucleus of Tractus Solitarius (Medulla Oblongata): SVA Upper part of spinal nucleus of of V Nerve (Pons): GSA

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PONS MEDULLA OBLONGATA FACIAL COLLICULUS Winding of Facial nerve around VI nucleus

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CENTRAL CONNECTIONS The part of motor nucleus supplying upper part of face---controlled by corticonuclear fibres of both sides The part of motor nucleus supplying lower part of face---controlled by corticonuclear fibres of opposite side (only)

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SUPERFICIAL ORIGIN (Attachment to base of Brain) Lower border of Pons Between Olive & Inferior cerebellar peduncle Motor root large, medial to Sensory root Sensory root between Motor root & VIII nerve

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1. Intracranial(Pontine) segment - 23-24mm length - from brain stem to the internal auditory canal 2. Meatal segment - 8-10mm length - from the fundus of the meatus to the meatal foramen - anterior superior part of meatus 3. Labyrinthine segment - 3-5mm length - from the meatal foramen to the geniculate ganglion - branch: GPSC

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4. Tympanic segment 8-12mm length from first genu to second genu 5. Mastoid segment 10-15mm length from second genu to stylomastoid foramen chorda tympani 6. Extratemporal segment - from the stylomastoid foramen to the the muscles of innervations

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COURSE AND RELATIONS Passes through Internal Acoustic Meatus Comes out of Skull through Stylomastoid Foramen Stylomastoid Foramen divides its course into [ Intracranial-Intrapetrous part Extracranial part

INTERNAL ACOUSTIC MEATUS:

INTERNAL ACOUSTIC MEATUS

STYLOMASTOID FORAMEN:

STYLOMASTOID FORAMEN

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Intracranial-Intrapetrous Course: Internal acoustic meatus Accompanied by VIII nerve & Labyrinthine vessels Sensory & motor roots separate At bottom of meatus the two roots fuse

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Intracranial-Intrapetrous Course: Passes above vestibule of internal ear Reaches medial wall of middle ear Bends backwards forming Genu Geniculate ganglion present here Passes above promontory Passes vertically downwards along posterior wall of middle ear Comes out through stylomastoid foramen

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Extracranial course: Passes superficial to styloid process of temporal bone Enters postero-medial surface of Parotid gland Superficial to Retromandibular vein & ECA Divides into Temporofacial & Cervicofacial branches and form terminal branches Come out through anterior border of Parotid gland

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BRANCHES Branches of Communication Branches of Distribution

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BRANCHES OF COMMUNICATION In Internal acoustic meatus With VIII nerve At Geniculate ganglion With Pterygopalatine ganglion through Greater petrosal nerve With Otic ganglion by a branch joining lesser petrosal nerve With Sympathetic plexus around Middle meningeal artery through External petrosal nerve

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BRANCHES OF COMMUNICATION In Facial canal With auricular branch of Vagus Below Stylomastoid canal With IX, X, auriculotemporal, greater auricular nerves In the Face With branches of V nerve 6. In the Neck With Transverse nerve of neck

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BRANCHES OF DISTRIBUTION In Facial canal Greater petrosal nerve:-joins deep petrosal nerve– Nerve of pterygoid canal– Pterygopalatine ganglion– Postganglionic fibres– Zygomatic nerve– Lacrimal nerve– Lacrimal gland

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BRANCHES OF DISTRIBUTION In Facial canal Nerve to Stapedius Chorda tympani Preganglionic parasympathetic fibres—submandibular ganglion—postganglionic fibres—submandibular gland & through lingual nerve to sublingual gland Taste fibres from anterior 2/3 of Tongue

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Below Stylomastoid foramen Posterior auricular nerve:Scalp Nerve to Posterior belly of digastric Nerve to Stylohyoid

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In the Face (Terminal branches-Pes Anserinus) Temporal Zygomatic Upper & lower Buccal Marginal Mandibular Cervical Muscles Of Face

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APPLIED ANATOMY Clinical Testing of Facial nerve: Ask patient to Raise eyebrows To smile Close eyes

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APPLIED ANATOMY Supranuclear Palsy Nuclear & Infranuclear Palsy Bell’s Palsy

SUPRANUCLEAR PALSY:

SUPRANUCLEAR PALSY Upper part of face escapes paralysis coz of bilateral representation of upper part of face in cerebral hemisphere Lower part of Opposite side of face paralysed

Lower Motor Neuron Palsy:

Nuclear: Involves VI nerve & Hemiplegia Infranuclear: IAM: Involves VIII nerve Facial canal: Dry eyes Hyperacusis Loss of Taste & salivation Muscles of face paralysed Lower Motor Neuron Palsy

BELL’S PALSY:

BELL’S PALSY Muscles of entire half of face paralysed on the side of lesion: Eyelids cannot be closed-Keratitis, Corneal ulcer Absence of wrinkles on forehead Food accumulates in the vestibule of mouth Nasolabial fold flattened Angle of mouth cannot be raised Lesion after nerve comes out of stylomastoid foramen

PALSY:

PALSY

THANK YOU:

THANK YOU