Facial Nerve is one of the major nerves associated with the head and neck region. This presentation explains about its development, anatomy, and introduction on its clinical correlation.

1. Dr. Divya Banu
PG Pedodontics and
Preventive Dentistry

2. CONTENTS
 Introduction
 Functional Components
 Nuclei
 Ganglia
 Course And Relations
 Branches And Distribution
 Clinical Co-relation
 References

3. INTRODUCTION
 7th cranial nerve
 Mixed nerve, predominantly motor.
 Most frequently paralyzed peripheral nerve.
 Supplies muscles of facial expression.

4. Embryology/Development
 Developmentally derived from
hyoid arch (second branchial arch).
 Motor division: Derived from basal
plate of embryonic pons.
 Sensory division: Originates from
cranial neural crest.

5.  The nerve course, branching
pattern, and anatomical
relationships: First
trimester
 Nerve is not fully developed
until about 4 years of age.
 Third week of gestation:
Facioacoustic primordium or
crest : First identifiable
facial nerve tissue

6. Motor Nucleus
(Branchiomotor)
Superior Salivatory
Nucleus
(Parasympathetic)
Lacrimatory Nucleus
(Parasympathetic)
Nucleus of Tractus
Solitarius
(Gustatory)
NUCLEI
(In lower pons)

7. FUNCTIONAL
COMPONENTS
EFFERENT
Special visceral
or branchial
efferent
General visceral
efferent or
parasympathetic
AFFERENT
Special
visceral
afferent
General
somatic
afferent

8. • Taste sensations from palate and
anterior two-thirds of tongue
except vallate papillae.
• Terminates in nucleus of tractus
solitarius.
SVA
• General sensations from
skin of auricle.
• Terminates in spinal nucleus
of trigeminal nerve.
GSA

9. • Arise from motor nucleus.
• Supplies muscles of facial
expression.
• Elevation of hyoid bone.
SVE
• Arise from lacrimatory and
superior salivatory nuclei
• Pre-ganglionic
parasympathetic fibers.
• Supply secretomotor fibers
to lacrimal, submandibular
and sublingual glands.
GVE

11. GANGLIA
Geniculate
ganglion
Submandibular
ganglion
Pterygopalatine
ganglion

12. Geniculate Ganglion
 Located on first
bend of facial
nerve.
 Sensory ganglion.
 The taste fibres
present in nerve
are peripheral
processes of
pseudounipolar
neurons present in
geniculate ganglion.

13. Submandibular ganglion
 Parasympathetic
ganglion for relay
of secretomotor
fibres to
submandibular and
sublingual glands.
 Preganglionic fibres
come from chorda
tympani nerve.

14. Pterygopalatine ganglion
 Parasympathetic
ganglion.
 Secretomotor fibres
for lacrimal gland
relay in this ganglion.
 The fibres reach
ganglion from nerve to
pterygoid canal.

15. COURSE AND RELATIONS
Attachment of
facial nerve to
brain stem
Motor Root
Sensory Root
(Nervus
Intermedius)
Lateral part of lower
border
of pons just medial to 8th
cranial nerve

16. Motor and sensory root
Internal Acoustic Meatus
Motor Root lies in a groove on
8th cranial nerve
Sensory Root intervening
Single trunk in FACIAL CANAL of petrous part
of temporal bone
Laterally and
Forwards
Fundus of
meatus

18. Facial Canal
Two Bends
Laterally above the
vestibule
Backwards irt
medial wall of
middle ear above
promontary
Vertically
downwards behind
promontary
Facial Nerve leaves skull through
STYLOMASTOID FORAMEN

19. EXTRACRANIAL COURSE
Facial nerve crosses lateral side of base of styloid
process
Posteromedial surface of parotid gland
Crosses retromandibular vein and ECA
Terminal branches along anterior border of parotid gland
Behind neck of mandible

21. Within Facial Canal:
1. Greater petrosal nerve.
2. Nerve to stapedius.
3. Chorda tympani.
At its exit from
Stylomastoid Foramen:
1. Posterior auricular.
2. Digastric.
3. Stylohyoid.
Terminal Branches within
Parotid Gland:
1. Temporal.
2. Zygomatic.
3. Buccal.
4. Marginal mandibular.
5. Cervical.
Communicating Branches
with adjacent cranial and
spinal nerves
Branches And
Distribution

23. Greater Petrosal Nerve
Greater petrosal nerve and deep
petrosal nerve
Nerve of pterygoid canal
Postganglionic for lacrimal gland join
zygomatic nerve
Pass through communicating
branch
Lacrimal nerve
Lacrimal gland
RELAY

24. Nerve to Stapedius
 Arises opposite the pyramid of middle ear.
 Supplies stapedius muscle
 The muscle dampens excessive vibrations of
stapes caused by high-pitched sounds.

25.  Chorda Tympani
 Arises in vertical part of facial canal about 6 mm above
stylomastoid foramen.
Runs upwards and forwards
Middle ear
Runs forwards in close relation to tympanic membrane
Passes through petrotympanic fissure
Medial to spine of sphenoid Infratemporal fossa
Joins lingual nerve through which it is distributed

27. Chorda tympani carries:
Preganglionic
Secretomotor Fibres
• To submandibular
ganglion.
• Supplies
submandibular and
sublingual salivary
glands.
Taste Fibres
• From anterior two-
thirds of tongue
except
circumvallate
papillae.

28. Posterior Auricular Nerve
Arises just below stylomastoid foramen
Ascends between mastoid process and external
acoustic meatus
Auricularis Occipitalis Intrinsic
posterior muscles on
the back of
auricle

29. • Arises close to posterior
auricular nerve.
• Short.
• Supplies posterior belly
of digastric.
Digastric
Branch
• Arises with the
digastric branch.
• Long.
• Supplies stylohyoid
muscle.
Stylohyoid
Branch

31. Terminal Branches of Parotid
Gland

33. Temporal Branches
Crosses zygomatic arch
Supplies:
1. Auricularis anterior
2. Auricularis superior
3. Intrinsic muscles on the lateral side of the ear
4. Frontalis
5. Orbicularis oculi
6. Corrugator supercilii

34. Zygomatic
Branches
• Run across
zygomatic bone.
• Supplies
orbicularis oculi.
Buccal Branches
• Two in number.
• Upper: Runs above
the parotid duct.
• Lower: Below the
duct.
• Supply muscles in
that vicinity,
especially the
buccinator.

36. Marginal
Mandibular Branch
• Runs below angle
of mandible deep
to platysma.
• Crosses body of
mandible and
supplies muscle
of lower lip and
chin.
Cervical Branch
• Emerges from
apex of parotid
gland.
• Runs downwards
and forwards in
the neck to
supply the
platysma.

37. Communicating Branches
 Motor nerves of first, second and third
branchial arches communicate with each other
for effective coordination between
movements of muscles of these arches.
 The facial nerve also communicates with the
sensory nerves distributed over its motor
territory.

38. Nervus Intermedius
 Formed of
central processes
of unipolar cells
of geniculate
ganglion.
 Also contains
efferent
preganglionic
parasympathetic
fibers from
parasympathetic
nuclei.

39. CLINICAL CORRELATION
Lesions of
facial nerve
Supranuclear Infranuclear

41. Conclusion
 Functional and esthetic outcomes in children.
 Bell’s palsy (idiopathic) is most common in children
too.
 Careful diagnostic workout and differential diagnosis
is required.
 Hopefully, regenerative medicine could offer new
options for the treatment of this condition.

42. Take Home Message

43. References
 Grey’s Anatomy
 Carpenter’s Neurophysiology
 Burkit’s Oral Medicine
 B.D. Chaurasia’s Human Anatomy
 Vishram Singh Anatomy of Head, Neck and Brain.
 Transient Delayed Facial Nerve Palsy After
Inferior Alveolar Nerve Block Anesthesia
Fotios H. Tzermpos, DMD, MD, PhD,* Alina Cocos, Matthaios
Kleftogiannis.
 Facial nerve paralysis in children
Andrea Ciorba, Virginia Corazzi, Veronica Conz, Chiara Bianchini,
Claudia Aimoni
 Hadlock TA, Malo JS, Cheney ML, Henstrom DK. Free gracilis
Transfer for smile in children: the Massachusetts Eye and Ear
Infirmary Experience in excursion and quality-of-life changes.
 Arch Facial Plast Surg 2011; Malik S, Bhandekar HS, Korday
CS. Traumatic peripheral neuropraxias
in neonates: a case series. J Clin Diagn Res 2014;

44.  Shahidullah M, Haque A, Islam MR, Rizvi AN, Sultana N, Mia
BA, Hussain MA. Comparative study between combination of
famciclovir and prednisolone with prednisolone alone in acute Bell’s
palsy. Mymensingh Med J 2011
 Goudakos JK, Markou KD. Corticosteroids vs corticosteroids plus
antiviral agents in the treatment of Bell palsy: a systematic review
and meta-analysis. Arch Otolaryngol Head Neck Surg 2009; 135:
558-564
 Numthavaj P, Thakkinstian A, Dejthevaporn C, Attia J. Corticosteroid
and antiviral therapy for Bell’s palsy: a network meta-analysis. BMC
Neurol 112011
 Pitaro J, Waissbluth S, Daniel SJ. Do children with Bell’s palsy
benefit from steroid treatment? A systematic review. Int J Pediatr
Otorhinolaryngol 2012
 Chen WX, Wong V. Prognosis of Bell’s palsy in children--analysis
of 29 cases.

45. Thank You