it give a detail and easy understandig about facial nerve and its significance and use in health care and living .

1. GOOD MORNING

4.  INTRODUCTION
 EMBRYOLOGY
 FUNCTIONAL COMPONENTS
 NUCLEAR ORGIN
 FUNCTIONAL COMPONENTS
 COURSE AND RELATION
 BRANCHES AND DISTRIBUTION
 GANGLIA ASSOCIATED WITH FACIAL NERVE
 BLOOD SUPPLY
 PROSTHODONTIC IMPLICATIONS
 APPLIED ASPECTS

5.  The Facial nerve is the seventh of twelve paired
cranial nerves, it is a mixed nerve with motor and
sensory roots that controls the muscles of facial
expression.
 It functions in the conveyance of taste sensations
from the anterior 2/3rd of the tongue and oral cavity.
 Facial nerve course, branching pattern, and
anatomical relationships are established during the
first 3 months of prenatal life.
 The facial nerve innervates 14 of the 17 paired
muscle groups of the face on their deep side.

7. Facial nerve derived from the hyoid arch (second
branchial arch)
Motor division derived from the basal plate of the
embryonic pons
Sensory division originates from the cranial neural
crest
Nerve is not fully developed until about 4 years of
age
First identifiable Facial Nerve tissue seen at the 3rd
wk of gestation facioacoustic primordium or crest

9. FUNCTIONAL
COMPONENTS
Special visceral
efferent(SVE)
General visceral
efferent(GVE)
Special visceral
afferent(SVA)
General somatic
afferent(GSA)
NUCLEAR ORGIN
Motor nucleus of
facial nerve (SVE)
Superior salivatory
nucleus (GVE)
Nucleus of tractus
solitarus (SVA)
Lacrimal nucleus

12.  Intra cranial
 Intra temporal
Intrameatal
Labyrinthine
Tympanic
Mastoid
 Extra cranial

15.  Intratemporal
Travel through internal acoustic meatus, 1 cm long
opening in petrous part of temporal bone
In temporal bone the roots leave the internal acoustic
meatus and enter facial canal
Facial canal is a z shaped canal

16. MEATAL SEGMENT
– Lies in Internal acoustic meatus(IAC)
– Enters in ant. sup. segment of IAC with VIII CN – Length 5 –12 mm

17. LABYRINTHINE SEGMENT
 From fundus to
the geniculate
ganglion –Runs in
the narrowest
portion –Greater
superficial
petrosal nerve
 Posterolateral
to the ampullated
ends of the
horizontal and
superior
semicircular
canals and rests on
the anterior part of
the vestibule .

18.  Extends from the
geniculateganglion to
the horizontal
semicircular canal
 At geniculate
ganglion the nerve
turns posteriorly
across tympanic cavity
to pyramidal
eminence making
second genu.
 Then it emerges
from middle ear
between the posterior
wall of external
auditory canal and
horizontal
semicircular canal

19.  Second genu marks the
beginning of the mastoid
segment.
 Located lateral and
posterior to the pyramidal
process.
 Continues vertically
down the anterior wall of
the mastoid process to the
stylomastoid foramen.
 Gives branch to
stapedius muscle and
chordatympani.

21.  At the exit from the stylomastoid foramen:
- Posterior auricular
-Digastric
-Stylohyoid

22. Post. Auricular nerve
Arises just below stylomastoid foramen
Divides into two branches
a)Auricular Branch Muscles of auricle
b) Occipital branch : Occipital belly of
occipitofrontalis Runs forward through a short canal.
Diagastric Nerve
Arises near the origin of posterior auricular nerve
Supplies the posterior belly of digastric muscle.
Stylohyoid Nerve
stylohyoid muscle

24.  Terminal branches within the parotid gland
a. Temporal
b. Zygomatic
c. Buccal
d. Marginal mandibular
e. Cervical

26.  It communicates with the following neighboring nerves
at various sites:
 Vestibulo-cochlear nerve, at the internal acoustic meatus
 Sympathetic plexus around the middle meningeal
artery, at geniculate ganglion
 Auricular branch of vagus nerve, in the facial canal
 9th and 10th cranial nerves, below the stylomastoid
foramen
 Lesser occipital nerve, behind the ear
 Branches of trigeminal nerve, in the face

27. GENICULATE
GANGLION
SUBMANDIB-
ULAR
GANGLION
PTERYGO-
PALATINE
GANGLION

29. Facial Nerve blood supply
The facial nerve gets it’s blood supply from 4
vessels:
 Anterior inferior cerebellar artery – at the
cerebellopontine angle
 Labyrinthine artery (branch of anterior inferior
cerebellar artery) – within internal acoustic meatus
 Superficial petrosal artery (branch of middle
meningeal artery) –geniculate ganglion and nearby
parts

30.  Stylomastoid artery (branch of posterior auricular
artery) –mastoid segment
 Posterior auricular artery supplies the facial nerve
at & distal to stylomastoid foramen
Venous drainage parallels the arterial blood
supply

31. Causes of facial nerve paralysis
The cause may be central or peripheral.
Central:
 Brain abscess
 Pontine gliomas
 Poliomyelitis
 Multiple sclerosis
 Cerebrovascular strokes
 If symptoms or signs of other cranial nerve deficits are
present, central and systemic cause should be suspected

32. Peripheral lesions are more common , 70% of them are of the
idiopathic variety may involve the nerve in its intracranial,
intratemporal or extratemporal parts.
Intracranial part :-
 Cerebellopontine Angle Tumors:
Acoustic neuroma (Vestibular Schwannoma )
Intratemporal Part
 Idiopathic: Bell’s palsy, recurrent facial palsy and
Melkersson’s syndrome
 Infection: Acute and chronic suppurative otitis media, Herpes
zoster oticus, tuberculosis and malignant otitis externa .
 Surgical trauma: mastoid and middle ear surgery and parotid
surgery.
 Accidental trauma: Fractures of temporal bone
 Neoplasms: Malignancy of external and middle ear,
rhabdomyosarcoma, histiocytosis, leukemia, glomus tumors,
facial nerve neuroma, metastasis to temporal bone (from
cancer of breast, bronchus)

33.  Parotid: Malignancy, surgery, accidental injury and birth
trauma.
 Congenital: Compression injury, Mobius syndrome,
lower lip paralysis
 Systemic Diseases:
Diabetes mellitus
Sarcoidosis (Heerfordt’s syndrome)
Leprosy
Guillain-Barre syndrome
Lyme’s disease
Infectious mononucleosis

34. THE FACIAL NUCLEUS IS DIVIDED INTO TWO PARTS:
 The upper part receives bilateral innervations, and supplies the muscles of
the forehead and eyebrows (temporal branches)
 The lower part receives innervations mainly from the contra lateral
hemisphere, and supplies the muscles of the lower part of the face through
the facial nerve.
 This arrangement allows the examiner to differentiate central
(supranuclear) paralysis from the peripheral (infranuclear) paralysis.
 In the central paralysis (loss of the upper motor neuron) the patient will
present clinically with paralysis of the contra lateral muscle of the facial
expression in the lower half of the face, the contra lateral forehead and
extra-ocular muscles remain functional.
 Peripheral paralysis (loss of lower motor neurons) is characterized by
complete paralysis of the ipsilateral muscles. The patient cannot wrinkle
the forehead.

38. 1. Support weakened musculature
2. Decrease the amount of surgical procedures
3. Comfort and esthetics
4. Increase confidence and improve social interactions
(Meisan A Bukhari and Samar M Jambi.Prosthodontic rehabilitation of completely and
partially edentulous patients with bell’s palsy.EC Dental Science 17.6(2018):810819

39. 1.Poor muscle coordination
2.Mask like expressionless appearance
3.Uncontrolled flow of saliva
4.Unpredictable and erratic mandibular movements
5.Difficulty with labial plosive sounds(p, b) and labio
dental fricative sounds(f, v)
6.Dryness of mouth
7.Cheek biting

40.  Impression making
 Jaw relation recording
 Teeth arrangement
 Denture retention
 Denture stability

41. • Bells palsy
• Sarcoidosis
• Leprosy
• Lymes Disease
• HIV infection related facial nerve palsy
• Herpes Zoster (Ramsay Hunt Syndrome )

42. • Melkersson Rosenthal syndrome
• Möbius syndrome
• Guillain Barré syndrome
• HIV infection related facial nerve : may precede
seroconversion

43. I. Unilateral involvement
II. Inability to smile, close eye or raise eyebrow
III. Whistling impossible
IV. Drooping of corner of the mouth
V. Inability to close eyelid (Bell’s sign)
VI. Inability to wrinkle forehead
VII. Loss of blinking reflex
VIII. Slurred speech
IX. Mask like appearance of face

44. Iatrogenic Causes:
 Anti tetanus serum
 Vaccine treatment for Rabies
 Mandibular block anesthesia
 Head and neck surgery

45. “ THE UPWARD DIVERSION
OF THE EYE BALL ON
ATTEMPTED CLOSURE OF
THE LID IS SEEN WHEN EYE
CLOSURE IS INCOMPLETE ”
Whenever patient
attempts to close the
eyelid, the eyeball
rolls upward so that
the pupil is covered
and only the white
sclera is visible.
Bell’s sign

47. Diagnosis of Bells palsy by exclusion
Criteria
 Paralysis or paresis of all muscle groups of one side
of the face
 Sudden onset
 Absence of signs of CNS disease
 Absence of signs of Ear disease

48. MEDICAL TREATMENT
 Corticosteroids : Prednisolone1 mg/kg/day 7-10
days
 Corticosteroids combine with antiviral drug is better
Acyclovir 400 mg 5 times/day
 Famciclovir and valacyclovir500 mg bid

49. • Intra oral-extra oral approach
• Intra oral approach with no
vestibular tension
• Intra oral approach with disto
superior tension
• Intra oral approach with medio
superior tension

53. Stabilizing jaw movement in Bell’s palsy

54. Prosthodontic Rehabilitation of Patients with Bell’s Palsy: Our Experience Anand Rajapur etal
journal of International Oral Health 2015; 7(Suppl 2):77-81
 We modified the conventional method of complete denture fabrication
and planned a systematic approach to improving the mandibular
movements and then go ahead with complete denture fabrication
We used flat occlusal tables to analyze the occlusion; ideally the flat
tables should have been elastic and soft though we used auto-
polymerizing self-cure acrylic resin as it is simple and easy to
manipulate.

55. Prosthodontic Management of a Completely Edentulous Patient with
Bell’s Palsy to alter existing denture design and dimensions
 A hollow denture was fabricated with
monoplane occlusal scheme for improved
retention and stability.
Low fusing
compound
was added in
the
distosuperior
margin of the
vestibular
fornix of the
affected site.
A 3D spacer using silicone putty was
used to fabricate the planned hollow
cavity of the prosthesis.
(Prosthodontic Management of a Completely Edentulous Patient with Bell’s Palsy
Sharmila Hussain ,etal Indian Journal of Multidisciplinary Dentistry, Vol. 2, Issue 1, November 2011 to January 2012)

57. Symptoms:
 Facial paralysis
 Ear pain
 Vesicles
 Sensorineural hearing loss
 Vertigo
The combination of facial paralysis and herpes
infection is called Ramsay Hunt syndrome.

58. Rare neurological disorder
 Characterized by recurring facial paralysis,
 Swelling of the face and lips (usually the upper lip), and
 development of folds and furrows in the tongue.
 Onset is in childhood or early adolescence.
 Recurrent attacks (ranging from days to years in between), swelling may
persist and increase, eventually becoming permanent
 Rare congenital condition characterized by the absence or
underdevelopment of the abducens nerve (CN VI) and facial nerve (CN
VII) nuclei.
Clinical presentation
 The earliest sign is the inability of the newborn to suckle, with an
expressionless face, floppy limbs and drooling.

59. Prosthodontic Management of a Patient with Moebius Syndrome: A Clinical
Report
 This report will describe prosthodontic
rehabilitation of a patient with Moebius
Syndrome using an implant retained maxillary
complete overdenture and mandibular partial
removable denture prosthesis (PRDP).
The patient had a short upper lip with minimal vestibular
depth

60.  Three dimensional radiographic data was evaluated using S implant software
(Dentsply), and the decision was made to place only two implants at sites #3
and 14 due to insufficient restorative space anteriorly, limited availability of
alveolar bone at other sites.

62.  The facial paralysis in these patients involves only
those muscles concerned with pulling the lower lip
downwards and outwards
 These are the mentalis, depressor labii inferioris
and depressor angulioris muscles

63. INTRAORAL SPLINT FOR SUPPORT OF THE LIP IN BELL’S PALSY
INTRAORAL SPLINT FOR SUPPORT OF THE LIP IN BELL’S PALSY JOHN B. LAZZARI, D.D.S.* Bay Pines, Fla. J.
Pros. Den. July, 1955 Volume 5 Number 4

65. Dentures with detachable buccal/cheek plumper

66.  Extension of the buccal flange beyond the occlusal plane towards the mandible was
adjusted to come in contact with the mandibular denture while the teeth are in firm occlusion.
 This further prevented the food being escaped into the buccal vestibule and also provided
stability to the mandibular denture during mastication
(Godavarthi S.S., M.C. S.S., A.V. R.R., Kumar R.:EExtended buccal flange technique to
manage bell’s palsy patient with complete denture.Int. J. Dent.Clinics. 2012;4(3): 58-60.)

67.  Facial nerve is an important cranial nerve of the
head and neck region.
 Study of the nerve supply of orofacial region helps
to get knowledge of different structures which are
directly or indirectly related to oral cavity.
 Nerves specially trigeminal and facial , without a
thorough knowledge of it, its anatomy &
physiology, diagnostic and therapeutic procedures
will be not be useful.

68.  • GRAY’S ANATOMY FOR STUDENT- 3RD
EDITION
 • BD CHAURASIA’S HUMAN ANATOMY- VOL
3FOURTH EDITION
 • ANAND’S HUMAN ANATOMY- 3RD
EDITION
 • ILLUSTRATED ANATOMY OF THE HEAD
AND NECK4TH EDITION