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Anatomy of Facial NerveAnatomy of Facial Nerve
Presented by Dr. Ketaki Pawar.
1
Table of contents
• Introduction
• Surface marking
• Functional components
• Nuclei
• Course and relations
• Branches and distribution
• Ganglia
• Clinical anatomy
2
Introduction
• Seventh cranial nerve
• 2nd
only to vagus as the “busiest” cranial nerve of
the human body
• Nerve of the second branchial arch
• The facial nerve consists of the facial nerve
proper and the intermedius nerve.
• Both the facial nerve proper and the intermedius
nerve emerge from the CNS in the
cerebellopontine angle at the caudal border of
the pons, between the abducens nerve and the
vestibulocochlear nerve .
3
Surface markings
• Marked by a short
horizontal line which
joins following two
points:
1)A point at the middle
of the anterior border
of the mastoid process.
2)Behind the neck of the
mandible.
4
Functional components
1. Special visceral or branchial efferent, to
muscles responsible for facial expression,
posterior belly of digastric muscle , stylohyoid
and stapedius
2. General visceral efferent or
parasympathetic:
These fibers are secretomotor to the
submandibular and sublingual salivary glands,
the lacrimal gland, and glands of the nose,
the palate and the pharynx.
3. General visceral afferent : carries afferent
impulses from the above mentioned glands.
5
4. Special visceral afferent fibres carry taste sensations
from the anterior two thirds of the tongue except
from vallate papillae and from the palate.
5. General somatic afferent fibres innervate a part of
skin of the ear .
Brachial motor- largest portion
6
7
Functional components of facial nerve
Nuclei
• The fibres of the nerve arise from four nuclei
situated in the lower pons.
1.Motor nucleus or brachiomotor : lies deep in
the reticular formation of the lower pons.
2.Superior salivatory nucleus or
parasympathetic.
3.Lacrimatory nucleus – parasympathetic.
4.Nucleus of tractus solitarius – gustatory and
also receives afferent fibres from the glands.
8
Supranuclear
anatomy
• Cortex and internal capsule:
Voluntary responses of the facial
muscles arises from efferent
discharge from motor face area
of the cerebral cortex.
• The motor face area is situated
on the pre central and post central
gyrus.
9
10
•Discharges from the facial motor
area are carried through fascicles
of the corticobulbar tract to the
internal capsule, then through the
upper midbrain to the lower
brainstem, where they synapse in
the facial nerve nucleus located in
pons.
•Corticobulbar tracts arising from
the cortical representation
of the upper face area cross and
recross in reaching the pontine
facial motor nucleus
The tracts to lower face are
crossed only once.
Posterior view of the brainstem
11
Contents of right internal auditory canal
•Facial nerve emerges from
the brainstem with nervus
intermedius
•The average distance
between
the point where the nerves
exit the brainstem and the
place where they enter the
internal auditory canal is
approximately
15.8 mm
Intracranial course and relations
• Facial nerve is attached to the brainstem by two roots
: motor and sensory ( nervus intermedius) which are
attached to the lateral part of the lower border of
pons just medial to eight cranial nerve.
• The motor and sensory root runs laterally and
forwards, with the 8th
nerve to reach the internal
acoustic meatus. In the meatus the motor root lies in
a groove on the 8th
nerve with the sensory root
intervening.
• At the bottom of the meatus , the two roots fuse to
form a single trunk which lies in the petrous temporal
bone.
12
13Intracranial course of facial nerve
14
Within the canal, the course of the nerve can be
divided into three parts by two bends:
1.First part is directed laterally above the vestibule.
2.Second part runs backwards in relation to the
medial wall of the middle ear, above the promontory.
3.Third part is directed vertically downwards behind
the promontory.
15
Intracranial course: facial nerve exits the
Cranium at the stylomastoid foramen
16
• The first bend at the junction of first and second
part is sharp and it is called as genu.
• The second bend is gradual and lies between the
promontory and the aditus to the mastoid
antrum.
• Facial nerve leaves the skull by passing through
the stylomastoid foramen.
Extracranial course
• The facial nerve crosses the lateral side of the
base of the styloid process.
• It enters the posteromedial surface of the
parotid gland, runs forwards through the
gland crossing the retromandibular vein and
the external carotid artery.
• Behind the neck of the mandible it divides into
its five terminal branches which emerge along
the anterior border of parotid gland
17
Branches and distribution
A. Within the facial canal:
1. Greater petrosal nerve
2. The nerve to the stapedius
3. Chorda tympani
B. At its exit from the stylomastoid foramen:
1. The posterior auricular
2. Digastric
3. Stylohyoid
18
19
C. Terminal branches
within the parotid gland:
1.Temporal
2.Zygomatic
3.Buccal
4.Marginal mandibular
5.Cervical
D. Communicating
branches
with adjacent cranial and
Spinal nerves.
20
Greater Petrosal nerve
• Leaves at the genu
• pre ganglionic parasympathetic fibers
pterygopalatine ganglion lacrimal gland
• Leaves the facial canal through the hiatus, runs forwards,
downward and inward in a furrow on the anterior
surface of the pyramid of the temporal bone.
• Leaves the cranial cavity through foramen lacerum after
joining the deeo petrosal nerve from the sympathetic
plexus of the internal carotid artery
• Sup and deep petrosal nerves form the pterygoid or the
vidian nerve pterygopalatine ganglion
21
Nerve to stapedius muscle
• Arises opp. to the pyramid of the middle ear
• Supplies the stapedius muscle
• Stapedius muscle – dampening of excessive
vibrations of the stapes
• In paralysis- hyperacusis
22
Chorda tympani
• Arises 6 mm above stylomastoid foramen
• Contains taste fibers and preganglionic
parasympathetic secretory fibers
• Enters tympanic cavity posterior wall in close
relation to tympanic membrane Leaves the middle
ear by passing though petrotympanic fissure Enters
infratemporal fossa joins lingual nerve
23
Posterior auricular
• Turns backwards and upwards between the
mastoid process and the auricle
• Supplies posterior auricular and occipital
muscles
Nerve to stylohyoid
• Supplies stylohyoid muscle
Digastric
• Supplies posterior belly of digastric
24
Terminal branches
• At the stylomastoid foramen, the main trunk
enters the substance of the parotid gland.
• First separation into upper and lower division
usually occurs behind the mandible.
• The upper division- temporal, zygomatic and
upper buccal
• The lower division- lower buccal, mandibular
and cervical
25
26
Temporal
• Emerge from the parotid gland at its upper pole
slightly in front of the superficial temporal artery
• Anterior temporal : frontalis, superior part of
orbicularis oculi, corrugator supercilii, procerus
• Posterior temporal : anterior and superior auricular
muscles
Zygomatic
• Leave the parotid gland on its anterosuperior
border
• Crosses the body of zygomatic bone
• Supply inferior part of orbicularis oculi
27
Buccal
• Emerge at the anterior border of parotid
• Upper buccal: muscles of upper lip and the
muscles of the nose
• Lower buccal : buccinator and risorius
• Orbicularis oris
28
Marginal mandibular
• Runs parallel to lower border of the mandible
• Cross facial vein and facial artery
• Supplies muscles of lower lip (depressor anguli
oris and depressor labii inferioris) and mental
muscles
29
Cervical
• Leaves parotid gland at or slightly above its
inferior pole
• Runs downward and anteriorly
• Supplies platysma
30
Communicating branches
• Facial nerve branches exchange fibers with
sensory cutaneous branches of the trigeminal
nerve.
• Connections between facial and trigeminal
branches results in formation of small mixed
terminal nerves, which carry motor and
sensory fibers to a limited area of the face
31
32
Terminal motor branches of facial nerve
33
Most important of these connections are:
• a branch of the auriculotemporal nerve joins the
upper branch of the facial nerve
•The upper buccal branches of the facial nerve join
branches of the infratemporal nerve in the canine fossa
•The cervical branch exchanges fibers with the
transverse colli nerve of the cervical plexus.
Ganglia
1. The geniculate ganglion is located on the first bend of
the facial nerve in relation to the medial wall of the
middle ear. It is a sensory ganglion. The taste fibres
present in the nerve are peripheral processes of
pseudounipolar neurons present in the geniculate
ganglion.
2. The submandibular ganglion is a parasympathetic
ganglion for relay of secretomotor fibre to the
submandibular and sublingual glands.
3. The pterygopalatine ganglion is also a
parasympathetic ganglion. Secretomotor fibres
present for the lacrimal gland relay in this ganglion.
34
Vascular Supply
• Proximal and middle portions of the nerve via
the anterior inferior cerebellar artery and the
internal auditory artery respectively
• Further supply of middle portion of the nerve
comes from the petrosal artery via the middle
meningeal artery of the external carotid.
• Distal segment – by stylomastoid artery, also a
branch of external carotid artery
35
References
• B.D. Chaurasia’s Human Anatomy- Vol 3
• Sicher And Dubrul’s Oral Anatomy
• RODRIGUES, Antonio de Castro et al. Anatomy of the
Facial Nerve and its Implication in the Surgical
Procedures. Int. J. Morphol. [online]. 2009, vol.27, n.1
• Gulam Hasan, Ashfaqul Hasan,Kulbeer Kaur, Muzaffar
Ahmad, Mohd. Shafi, The Facial Nerve : The
Anatomical and Surgical important,JK-
Practitioner2005;12(1):53-57
• Mark May , Barry M. Schaitkin The facial nerve 2nd
edition
36

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Anatomy of facial nerve

  • 1. Anatomy of Facial NerveAnatomy of Facial Nerve Presented by Dr. Ketaki Pawar. 1
  • 2. Table of contents • Introduction • Surface marking • Functional components • Nuclei • Course and relations • Branches and distribution • Ganglia • Clinical anatomy 2
  • 3. Introduction • Seventh cranial nerve • 2nd only to vagus as the “busiest” cranial nerve of the human body • Nerve of the second branchial arch • The facial nerve consists of the facial nerve proper and the intermedius nerve. • Both the facial nerve proper and the intermedius nerve emerge from the CNS in the cerebellopontine angle at the caudal border of the pons, between the abducens nerve and the vestibulocochlear nerve . 3
  • 4. Surface markings • Marked by a short horizontal line which joins following two points: 1)A point at the middle of the anterior border of the mastoid process. 2)Behind the neck of the mandible. 4
  • 5. Functional components 1. Special visceral or branchial efferent, to muscles responsible for facial expression, posterior belly of digastric muscle , stylohyoid and stapedius 2. General visceral efferent or parasympathetic: These fibers are secretomotor to the submandibular and sublingual salivary glands, the lacrimal gland, and glands of the nose, the palate and the pharynx. 3. General visceral afferent : carries afferent impulses from the above mentioned glands. 5
  • 6. 4. Special visceral afferent fibres carry taste sensations from the anterior two thirds of the tongue except from vallate papillae and from the palate. 5. General somatic afferent fibres innervate a part of skin of the ear . Brachial motor- largest portion 6
  • 8. Nuclei • The fibres of the nerve arise from four nuclei situated in the lower pons. 1.Motor nucleus or brachiomotor : lies deep in the reticular formation of the lower pons. 2.Superior salivatory nucleus or parasympathetic. 3.Lacrimatory nucleus – parasympathetic. 4.Nucleus of tractus solitarius – gustatory and also receives afferent fibres from the glands. 8
  • 9. Supranuclear anatomy • Cortex and internal capsule: Voluntary responses of the facial muscles arises from efferent discharge from motor face area of the cerebral cortex. • The motor face area is situated on the pre central and post central gyrus. 9
  • 10. 10 •Discharges from the facial motor area are carried through fascicles of the corticobulbar tract to the internal capsule, then through the upper midbrain to the lower brainstem, where they synapse in the facial nerve nucleus located in pons. •Corticobulbar tracts arising from the cortical representation of the upper face area cross and recross in reaching the pontine facial motor nucleus The tracts to lower face are crossed only once. Posterior view of the brainstem
  • 11. 11 Contents of right internal auditory canal •Facial nerve emerges from the brainstem with nervus intermedius •The average distance between the point where the nerves exit the brainstem and the place where they enter the internal auditory canal is approximately 15.8 mm
  • 12. Intracranial course and relations • Facial nerve is attached to the brainstem by two roots : motor and sensory ( nervus intermedius) which are attached to the lateral part of the lower border of pons just medial to eight cranial nerve. • The motor and sensory root runs laterally and forwards, with the 8th nerve to reach the internal acoustic meatus. In the meatus the motor root lies in a groove on the 8th nerve with the sensory root intervening. • At the bottom of the meatus , the two roots fuse to form a single trunk which lies in the petrous temporal bone. 12
  • 13. 13Intracranial course of facial nerve
  • 14. 14 Within the canal, the course of the nerve can be divided into three parts by two bends: 1.First part is directed laterally above the vestibule. 2.Second part runs backwards in relation to the medial wall of the middle ear, above the promontory. 3.Third part is directed vertically downwards behind the promontory.
  • 15. 15 Intracranial course: facial nerve exits the Cranium at the stylomastoid foramen
  • 16. 16 • The first bend at the junction of first and second part is sharp and it is called as genu. • The second bend is gradual and lies between the promontory and the aditus to the mastoid antrum. • Facial nerve leaves the skull by passing through the stylomastoid foramen.
  • 17. Extracranial course • The facial nerve crosses the lateral side of the base of the styloid process. • It enters the posteromedial surface of the parotid gland, runs forwards through the gland crossing the retromandibular vein and the external carotid artery. • Behind the neck of the mandible it divides into its five terminal branches which emerge along the anterior border of parotid gland 17
  • 18. Branches and distribution A. Within the facial canal: 1. Greater petrosal nerve 2. The nerve to the stapedius 3. Chorda tympani B. At its exit from the stylomastoid foramen: 1. The posterior auricular 2. Digastric 3. Stylohyoid 18
  • 19. 19 C. Terminal branches within the parotid gland: 1.Temporal 2.Zygomatic 3.Buccal 4.Marginal mandibular 5.Cervical D. Communicating branches with adjacent cranial and Spinal nerves.
  • 20. 20
  • 21. Greater Petrosal nerve • Leaves at the genu • pre ganglionic parasympathetic fibers pterygopalatine ganglion lacrimal gland • Leaves the facial canal through the hiatus, runs forwards, downward and inward in a furrow on the anterior surface of the pyramid of the temporal bone. • Leaves the cranial cavity through foramen lacerum after joining the deeo petrosal nerve from the sympathetic plexus of the internal carotid artery • Sup and deep petrosal nerves form the pterygoid or the vidian nerve pterygopalatine ganglion 21
  • 22. Nerve to stapedius muscle • Arises opp. to the pyramid of the middle ear • Supplies the stapedius muscle • Stapedius muscle – dampening of excessive vibrations of the stapes • In paralysis- hyperacusis 22
  • 23. Chorda tympani • Arises 6 mm above stylomastoid foramen • Contains taste fibers and preganglionic parasympathetic secretory fibers • Enters tympanic cavity posterior wall in close relation to tympanic membrane Leaves the middle ear by passing though petrotympanic fissure Enters infratemporal fossa joins lingual nerve 23
  • 24. Posterior auricular • Turns backwards and upwards between the mastoid process and the auricle • Supplies posterior auricular and occipital muscles Nerve to stylohyoid • Supplies stylohyoid muscle Digastric • Supplies posterior belly of digastric 24
  • 25. Terminal branches • At the stylomastoid foramen, the main trunk enters the substance of the parotid gland. • First separation into upper and lower division usually occurs behind the mandible. • The upper division- temporal, zygomatic and upper buccal • The lower division- lower buccal, mandibular and cervical 25
  • 26. 26 Temporal • Emerge from the parotid gland at its upper pole slightly in front of the superficial temporal artery • Anterior temporal : frontalis, superior part of orbicularis oculi, corrugator supercilii, procerus • Posterior temporal : anterior and superior auricular muscles
  • 27. Zygomatic • Leave the parotid gland on its anterosuperior border • Crosses the body of zygomatic bone • Supply inferior part of orbicularis oculi 27
  • 28. Buccal • Emerge at the anterior border of parotid • Upper buccal: muscles of upper lip and the muscles of the nose • Lower buccal : buccinator and risorius • Orbicularis oris 28
  • 29. Marginal mandibular • Runs parallel to lower border of the mandible • Cross facial vein and facial artery • Supplies muscles of lower lip (depressor anguli oris and depressor labii inferioris) and mental muscles 29
  • 30. Cervical • Leaves parotid gland at or slightly above its inferior pole • Runs downward and anteriorly • Supplies platysma 30
  • 31. Communicating branches • Facial nerve branches exchange fibers with sensory cutaneous branches of the trigeminal nerve. • Connections between facial and trigeminal branches results in formation of small mixed terminal nerves, which carry motor and sensory fibers to a limited area of the face 31
  • 32. 32 Terminal motor branches of facial nerve
  • 33. 33 Most important of these connections are: • a branch of the auriculotemporal nerve joins the upper branch of the facial nerve •The upper buccal branches of the facial nerve join branches of the infratemporal nerve in the canine fossa •The cervical branch exchanges fibers with the transverse colli nerve of the cervical plexus.
  • 34. Ganglia 1. The geniculate ganglion is located on the first bend of the facial nerve in relation to the medial wall of the middle ear. It is a sensory ganglion. The taste fibres present in the nerve are peripheral processes of pseudounipolar neurons present in the geniculate ganglion. 2. The submandibular ganglion is a parasympathetic ganglion for relay of secretomotor fibre to the submandibular and sublingual glands. 3. The pterygopalatine ganglion is also a parasympathetic ganglion. Secretomotor fibres present for the lacrimal gland relay in this ganglion. 34
  • 35. Vascular Supply • Proximal and middle portions of the nerve via the anterior inferior cerebellar artery and the internal auditory artery respectively • Further supply of middle portion of the nerve comes from the petrosal artery via the middle meningeal artery of the external carotid. • Distal segment – by stylomastoid artery, also a branch of external carotid artery 35
  • 36. References • B.D. Chaurasia’s Human Anatomy- Vol 3 • Sicher And Dubrul’s Oral Anatomy • RODRIGUES, Antonio de Castro et al. Anatomy of the Facial Nerve and its Implication in the Surgical Procedures. Int. J. Morphol. [online]. 2009, vol.27, n.1 • Gulam Hasan, Ashfaqul Hasan,Kulbeer Kaur, Muzaffar Ahmad, Mohd. Shafi, The Facial Nerve : The Anatomical and Surgical important,JK- Practitioner2005;12(1):53-57 • Mark May , Barry M. Schaitkin The facial nerve 2nd edition 36