High Profile Call Girls Coimbatore Saanvi☎️ 8250192130 Independent Escort Se...
facial-nerve-paralysis.ppt
1.
2. ANATOMY
INTRODUCTION
COURSE OF FACIAL NERVE
BRANCHES
CAUSES OF FACIAL NERVE PARALYSIS
AND THEIR MANAGEMENT
3. VII Cr Nv ; Mixed Nerve
10,000 fibers- Motor , Sensory , Parasympathetic fibers
Motor root – 7000, Special Visceral Efferent Fibers
Sensory & Parasympathetic – 3000 carried by “NERVUS
INTERMEDIUS” (Nv of Wrisberg)
NI consists of – General Visceral Efferent
– Special Visceral Afferent
– Somatic Afferent
4. 3 nuclei
1) Motor nucleus –
lower Pons below 4th
ventricle
2) Superior salivatory
nucleus – dorsal to
motor Nucleus
3) Nucleus of tractus
solitarius– medulla
oblongata
5.
6. From brainstem to fundus of IAM
Length 24mm
FN crosses CP angle with 8th CN &
NI
Devoid of epineurium
Thin layer of pia mater
Surg imp :
1) Iatrogenic trauma in CP angle
tumour surgery
2) Difficult to identify in schwannoma
(no connective tissue)
7. From fundus to
Stylomastoid foramen
Length – 28 to 30 mm
“Fallopian canal”
Longest bony canal
8. Enters in ant sup
segment of IAC
Length 5 – 12 mm
Crista falciformis
Bills bar
No separate sheath
Shares with NI & 8th CN
9. Narrowest(0.68) &
Shortest(3-5mm)
No anastomosing
arteries
Periostium is thicker
Postero-Superior to
cochlea
Antero-Medial to SSCC
Distal end – Geniculate
ganglion;1st genu
10. Surgical importance:
1) Anatomical bottle neck – ischemia in oedema
2) Part most vulnerable for ischemia (no arterial
anastomosis)
3) Temporal bone # - MC injured
Geniculate ganglion:
Bipolar gang cells
Afferent input – somatic & special visceral afferents
Secretomotor Fibers to lacrimal gland (without
synapse)
11. Horizontal segment
From GG to 2nd genu
Length – 8 to 11mm
Lies beneath LSCC &
above OW
above & medial to
“Processus cochleariformis”
13. Surgical importance:
Processus
cochleariformis(consistant
landmark)
Imp landmark for 2nd genu –
-LSCC
-Pyramidal eminence
-B/w short process of
incus(L) & LSCC(M)
14. Vertical Segment
From 2nd Genu To SMF
Longest (13mm)
segment
Landmark – “Digastric
Ridge”
15. From SMF to terminal
branches
Runs in substance of
parotid
Main trunk divides
- upper temperofacial
- lower cervicofacial
“Pes anserinus”
Superficial to
Retromandibular Vein
16. Intra temporal region :
1) GSPN
2) Nerve to stapedius
3) Chorda tympani
4) Sensory auricular
branch
17. From GG
2 types of fibers
Pregang para symp –
Pterygopalatine gang.
Post gang – lacrimal G
Sensory fibers to
nasal & palatine glands
Joins deep petrosal N
– N to pterygoid canal
19. 4mm above SMF
Lateral & anterior to Facial Nerve
Lateral to Long Process of incus & medial to malleus
2 types of fibers
1. Pre Ganglionic Parasympathetic – submandibular
gland
Post Ganglionic – submandibular & subligual Glands
2. Special sensory – anterior 2/3rd of tongue
20. Extra temporal region
1) Posterior auricular Nerve (occipito
frontalis & muscles of pinna)
2) Muscular Branches (posterior belly of
digastric & stylohyoid)
21.
22. There are three imp. issues when confronted with
facial nerve paralysis:
The cause
The site of lesion
The prognosis
A. TOPODIAGNOSTIC TESTING
B. ELECTROPHYSIOLOGY
23. TEST NERVE BRANCH
ASSESSED
1. SCHIRMER TEST Greater superficial petrosal
nerve
2. STAPEDIAL REFLEX Nerve to stapedius muscle
3. ELECTROGUSTROMETRY Chorda tympani
4. SALIVARY FLOW
TESTING
Chorda tympani
24. 1. MINIMAL NERVE EXCITABILITY TEST
2. MAXIMAL STIMULATION TEST (MST)
3. ELECTRONEURONOGRAPHY (ENoG)
4. ELECTROMYOGRAPHY (EMG)
30. Diagnostic criteria-
Paralysis or paresis of all muscle groups on one side of
the face;
Sudden onset;
Absence of signs of central nervous system disease;
Absence of signs of ear or CPA disease.
Aetiology –
Microcirculatory failure of vassa nervosum
Ischaemic neuropathy
Infectious (HSV-1,HSV-2,VZV,EBV,Influenza B)
Genetic
Immunologic
31. TREATMENT
STEROIDS
Prednisolone -1mg/kg for 5 days f/b a ten day taper.
ANTIVIRAL DRUGS
Oral Acyclovir – (200-400 mg five times a day) for ten
days.
32. Definition –
peripheral facial nerve palsy accompanied by
an erythematous vesicular rash on the ear (zoster oticus)
or in the mouth.
Mechanism -
reactivation of the latent VZV in the geniculate
ganglion
Persistent excruciating Pain and SNHL
33. TREATMENT-
If started within three days of onset = significant
improvement
Prednisolone - 1mg/kg for 5 days f/b a ten
day taper
Intravenous acyclovir (250 mg three times
daily) or oral acyclovir (800 mg five times
daily)
34. LONGITUDINAL FRACTURE
More common (80%)
Parietal blow
Conductive hearing loss
CSF otorrhoea
Facial paralysis less (20%). Delayed onset
TRANSVERSE FRACTURE
Less common (20%)
Occipital blow
SNHL
Facial paralysis more common (50%). Immediate
onset
MIXED
35. TREATMENT
Surgical exploration- goals:
a. To decompress the nerve
b. To remove bony fragments that impinge on nerve.
c. To re establish continuity in case of transaction
1. Early post injury stage–
Acute onset incomplete palsy without progression –
Medical Treatment
Acute complete paralysis /incomplete paralysis that
progresses to complete paralysis – Surgical
Exploration (ENoG shows>90%denervation within 6
days of onset)
36. 2. Late post injury stage –
Late Exploration-
• End to end anastomosis
• Interposition grafting (cable grafts- ipsilateral great
auricular nv, sural nv, medial antebrachial cutaneous
nvs)
• Rerouteing
• Reinnervation – hypoglossal facial anastomosis, cross
facial nerve grafting (using a sural nv graft)
Static or Dynamic Facial Reanimation
Procedures (if EMG findings suggest long term
denervation)
Temporalis muscle transfer
Masseter muscle transfer
37. Otology could be a dull way of life without the 7th
cranial N arrogantly swerving through the temporal
bone to the muscles of facial expression
“JOHN GROVES”