contents: introduction functional components nuclei course branches relations ganglias associated applied anatomy conclusion references

1. G
O
O
D
M
O
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N
I
N
G

3. Introduction
Functional components
Nuclei
Course
Branches & Distribution
Ganglia Associated
Blood supply
Age changes
Variation in branching patterns
Nerve lesions : supranuclear
 infranuclear
Causes of facial paralysis
Bells palsy
Management of facial palsy
Nerve disorders in children
Testing of facial nerve
 Applied Anatomy
CONTENTS :FACIAL NERVE

4.  7th cranial nerve
 Mixed nerve
 motor components
 sensory components
2nd arch
INTRODUCTION

5. SPECIAL VISCERAL EFFERENT (BRANCHIAL)
muscle response for
1, facial expression
2. Elevation of hyoid bone
Functional components

6. Special visceral afferent
These fibers carry taste
sensation
from anterior 2/3 rd of
tongue
& palate

7. GENERAL VISCERAL EFFERENT (parasympathetic)
Secretomotor to the
•Submandibular gland
•sublingual gland ,
• lacrimal gland ,
• glands of the nose,the
palate,and the pharynx

8. GENERAL SOMATIC EFFERENT
General sensation
from the skin of the
concha of the auricle
&
from a small area
behind the ear.

9. Nuclei
 Motor Nucleus
 Superior Salivatory nucleus
 Upper part of nucleus
of tractus solitarius
 Upper part of spinal
nu of trigeminal nerve

10. Cranial nerve
nuclei

12. Course of a facial nerve
INTRA
CRANIAL
INTRA
TEMPORAL
EXTRA
CRANIAL

13. Intra cranial course:
 Two roots…..lower border of pons..
 motor root medial to sensory root
 stylomasoid divide…
 Sensory root & motor root passes
forwards and laterally leave the …….

15. Intra Temporal
(within Facial Canal )

17. Extracranial part

18. Submandibular
gland

20. BRANCHES
Within facial canal
1.Greater petrosal
nerve
2.Nerve to
stapedius
3.Chorda tympani
At its exits from
the stylomastoid
foramen
1.Posterior
auricular
2.Digastric
3.stylohyoid
Terminal branches
1.Temporal
2.Zygomatic
3.Buccal
4.Mandibular
5.cervical

22. Greater
Petrosal
Nerve

24. Nerve to Stapedius

25. 
CHORDA TYMPANI

26. At its exits from the stylomastoid foramen

27. TERMINAL BRANCHES

29. GANGLIA ASSOCIATED WITH THE FACIAL NERVE

30.  location…..
Sensory and
parasympathetic -nervus
intermedius.
 Motor fibers are carried
via the facial nerve proper.
greater petrosal nerve,
which carries sensory fibers
as well as preganglionic
parasympathetic fibers
Geniculate ganglion

31. Pterygopalatine Ganglion

32. BRANCHES OF PTERYGOPALATINE GANGLION
orbital
palatine
Nasal
1.Lateral post.sup
nasal nerve
2.Medial post.sup
nasal nerve
3.nasopalatine
pharyngeal

33. SUBMANDIBULAR GANGLION
 it lies on ….
topograpically…
functionally…

34. Motor
Superior salivatory nucleus
Nervus intermedius
chorda tympani
Lingual nerve
Ganglion
GLAND
Sympathetic root
Plexus around the
facial artery
supply vasomotor
fibers to
submandibular &
sublingual gland
Sensory root
Lingual nerve

35. Facial nerve – Blood Supply
Intracranial/Meatal: labyrinthine branches from ant .
inf cerebellar artery
Perigeniculate: superficial petrosal branch of middle
meningeal artery
Tympanic/Mastoid: stylomastoid branch of posterior
auricular artery

36. Branching Patterns
13%
20%
28%
6%
9%
24%

37. AGE CHANGES

39. CLINICO ANATOMICAL CONSIDERATION
by using knowledge of the anatomy of the facial nerve the location of a lesion
can be determined by presence or absence of certain deficits

42. Testing of facial nerve
Topographic testing
1.schirmer’s test
2.Stapedial reflex
3.Taste testing
4.Salivary flow rate &
salivary ph
Electro-physiological testing
 Nerve excitability testing( NET)
 Maximum stimulation test(MST)
 Electroneuronography| (ENOG)
 Electromyography (EMG)

43. Topographic testing
schirmer’s test

44. Stapedial reflex
 Evaluates…
 Impedance audiometry

45. Taste testing
Electrogustometer

46. Salivary Flow rate & salivary pH
Normal values:
Saliva ph - 6.7-7.4
Volume – 600-1000 ml/day
Resting flow rate – 0.2-0.4 ml/m
Stimulated flow rate - 2-5 ml/m

47. Facial paralysis
Upper motor neuron palsy
Lesion above the
level of pons
Lower motor neuron palsy
Lesion is in the pons or
in the pathway from pons to its exit

48. UMN LMN
 Paralysis of lower ½ of face on
C/L side
 Total facial paralysis on same
side
 Emotional movements (e.g.
Laughing) are intact.
 Emotional movements are lost
 Associated hemiplegia  No hemiplegia
 Hypertonia (spastic).  Hypotonia (flaccid).
 No fasiculation.  Fasiculations are present.
 No muscle atrophy.  Muscle atrophy occurs later.

50. TRAUMA: birth trauma,
temporal bone fractures,
skull base fractures,
facial injuries
middle ear injuries,
surgical trauma.
Nervous system disease: Opercular syndrome,
Millard-Gubler syndrome.
Infection: of the ear or face,
Herpes zoster of the facial nerve (Ramsey-Hunt
syndrome).
Factors causing Facial Nerve Disorders

51. Metabolic: diabetes mellitus
Tumors: acoustic neuroma
schwannoma,
cholesteatoma,
malignant parotid tumors,
glomus tumors.
Toxins: alcoholism
carbon monoxide poisoning.
Bell's palsy: Also called idiopathic facial
nerve paralysis

52. Facial nerve disorders in
children

53. Bell’s palsy
Sudden occurrence of a flaccid facial
paralysis in a apparently healthy
individual
(1774-1882)

54. Bell’s phenomenon:

55. DRUG DOSE
PREDNISOLONE Adults: 60 mg daily for five
days, then 40 mg daily for
five days
Children: 2 mg per kg daily
for seven to 10 days
ACYCLOVIR (ZOVIRAX) Adults: 400 mg five times
daily for seven days
Children older than two
years: 80 mg per kg daily
divided every six hours for
five days
Treatment plan
recent research shown that no added benefit of acylovir
compared to prednisolone alone for treatment of bell’s palsy

56. Eye protection
Lubricating eye drops, such as artificial
tears
eye ointments or gels
eye patches
Facial massage and exercises
Moist heat
Surgical decompression & cosmetic reconstructive
surgery
To prevent
Exposure
keratitis
About 80% of patients recover
spontaneously within 12 weeks

57. Syndromes associated with Bell’s Palsy
 JamesRamsayHuntSyndrome
 MelkerssonRosenthalSyndrome
 Moebius Syndrome
 Gullian barre syndrome

58. James Ramsay Hunt Syndrome

59. Melkersson Rosenthal Syndrome
Facial palsy
cheilitis
Fissured tongue

60. Moebius Syndrome
Facial diplegia
Bilateral
paralysis of
ocular muscles.

61. Glossopharyngeal nerve
Contents:
Introduction
Nuclei
Functional components
Course
Branches & Distribution
Ganglia Associated
Applied Anatomy

62. INTRODUCTIONNinth cranial nerve
3rd arch
Mixed nerve
o Branchio Motor…
o Preganglionic
secretomotor…
o general somatic
Sensation….
oSpecial visceral (taste)
sensation ….
o general visceral
sensory…baro n chemo

63. nuclei

64. COURSE & RELATIONS
Intra cranial
Attached to lateral side of upper
part of the medulla between
olivary body & the inferior
cerebellar peduncle
It leaves the cranial cavity ….

65. Extra Cranial
Course

67. Branches
communication
distribution
Tympanic
Carotid
Pharyngeal
Muscular
Tonsillar
lingual

68. OTIC GANGLION
Located in…
Topographically…..
Functionally ……

69. Glossopharyngeal Nerve Testing
1.Taste sensation
2, gag reflex
Afferent – 9th
Efferent – 10th
On tickling the posterior wall of the pharynx ,there is reflex contraction of the
throat muscles.
No such contraction occurs when ninth nerve is paralysed

70. Transient or sustained hypertension : may follow surgical section of
nerve reflecting involvement of carotid branch.
Isolated lesions of the nerve are ………
Glossopharyngeal neuralgia:
• bohm & strang
•Middle age
•M = F
• etiology : ……..
Applied anatomy

71. • Sharp & shooting Pain in the ear, the pharynx, nasopharynx,
tonsil
• Almost invariably unilateral
• Trigger zone - posterior oropharnx, tonsillar fossa
Treatment
Carbamazepine,
gabapentin
Surgical : Microvascular decompression
Rhizotomy

72. Cervical plexus
Contents:
1.Formation
2.Branches & relations
3.Ansa cervicalis
4.Applied anatomy

73. Formation of Cervical plexus
Formed by union of……
Each of cervical nerve divides into…….
Ascending branch of the second nerve
joins the first nerve
Descending branch of second nerve
joins the ascending branch of the third
nerve

74. branches
Cutaneous
branch
1, lesser occipital
nerve
2, greater auricular
nerve
3, transverse
cutaneous nerve
4, supraclavicular
nerve
Muscular
branch
1, branches to
prevertebral nerve
2. Branches to muscle
forming boundaries
of the posterior
triangle
3, pherenic nerve
4, branches to infra
hyoid muscle

76. Course and distribution

77. muscular branches

78. Pherenic nerve
•Arises from the…..
•Descends vertically through the lower part of
neck and then through the thorax to reach the
diaphragm & it enters abdomen also

79. Formation of Ansa cervicalis
It formed by…….
Superior root is derived from….
Inferior root derived from …..
Two roots join in front of CCA

81. Applied anatomy
An effective cervical plexus block
produces anesthesia over the
• neck,
• occipital region,
• shoulder region
• upper pectoral region.
Analgesic solution is infiltrated
subcutaneously around the midpoint
of the posterior border of
sternocleidomastoid

82. Occasional inadvertent injections into the phrenic and vagus
nerves
 Miosis (constriction of pupils)
 Ptosis (drooping of eyelid)
 Anhydrosis (affected side)
 enopthalmos
Horner’s syndrome

83. 1. Gray’s anatomy– The anatomical basis of clinical practice, 39th
edition
2.Textbook of anatomy- Inderbir singh, 4th edition
3.B.D. Chaurasias human anatomy, vol 3, 4th edition
4.Cunningham’s Manual Of Practical Anatomy. Vol 3: Head & Neck
& Brain. 15th ed.
5.Clinically oriented anatomy – Moore 6th edition
6.Clinical anatomy by regions – Snells 9th edition
7.The facial nerve – Mays 2nd edition
8. Textbook of human neuroanatomy – Inderbeer Singh 8th edition
9. Head and neck anatomy for dental medicine – Baker
References