The document discusses facial nerve paralysis, including: - The facial nerve controls facial muscles and taste, emerging from the brainstem. - It describes the anatomy and course of the facial nerve from the brainstem to its branches. - Causes of facial nerve paralysis include Bell's palsy, infections, trauma, tumors, and other systemic diseases. Symptoms include facial drooping and difficulties with facial expressions. Exams and tests help diagnose the cause and location of damage. Management includes medical and sometimes surgical approaches, with varying prognosis and potential complications.

1. Arshad Ali
Final Year, MBBS
Saidu Medical College, Swat
Facial NerveDepartment of Otorhinolaryngology,
Saidu Group of Teaching Hospitals,
Saidu Sharif, Swat - KP

3. Anatomy
 Course, branches & blood supply
Facial Nerve Paralysis
Causes
Symptoms
Investigations
 Exams & tests
Management
 Counselling
 Medical
 Surgical
 Prevention
Prognosis
Possible complications
Contents

4. The facial nerve is the seventh cranial
nerve, or simply cranial nerve VII. It emerges
from the brainstem between the pons and
the medulla, and controls the muscles of
facial expression, and functions in the
conveyance of taste sensations from the
anterior two-thirds of the tongue and oral
cavity. It also supplies
preganglionic parasympathetic fibers to
several head and neck ganglia.
Facial Nerve

5. Intracranial
 From pons to internal acoustic meatus (15 -17 mm)
Intratemporal
 Meatal segment (8-10 mm)
 Labyrinthine segment (4 mm)
 Tympanic/horizontal segment (11 mm)
 Mastoid/vertical segment (13 mm)
Extracranial
 Stylomastoid foramen to the termination of its
peripheral branches
Course

10. Greater Petrosal Nerve to Lacrimal Gland
Nerve to Stapedius
Chorda tympani
Communicating branch
Posterior auricular branch
Muscular branches
Peripheral branches
Branches

11. •Peripheral
branches
(pes anserinus or
Goose foot)
Temporal
Zygomatic
Buccal
Mandibular
Cervical

12. Anterior-inferior cerebellar artery
Labyrinthine artery
Superficial petrosal artery
Stylomastoid artery
Arterial Supply

13. For middle ear & mastoid surgery
•Processus cochleariformis
•Oval window & horizontal canal
•Short process of incus
•Pyramid
•Tympanomastoid suture
•Digastric ridge
Surgical Land Marks of CN VII

14. For parotid surgery
•Cartilaginous pointer
•Tympanomastoid suture
•Styloid process
•Posterior belly of digastric
Surgical Land Marks of CN VII

15. Facial nerve paralysis is a nervous system disorder in which a
damaged nerve in the skull affects the movement of the muscles of
the face.
Facial Nerve Paralysis

16. Neuropathy – facial
Cranial mononeuropathy VII
Seventh cranial nerve palsy
Alternative Names

17. Idiopathic
 Bell’s palsy: viral, ischemia, heredatary, autoimmune
 Melkersson syndrome
 Recurrent facial nerve palsy
 Bilateral facial paralysis
Infections
 Herpes zoster oticus (Ramsy-Hunt syndrome)
Trauma
 Fractures of temporal bone (immediat or delayed
onset)
 Ear or mastoid surgery
 Parotid surgery & trauma to face
Causes

18. Neoplasms
 Intratemporal neoplasms
 Tumors of the parotid
Systemic disease & facial paralysis
 Mostly idiopathic
 Diabetes
 Hypothyroidism
 Leukemia
 Sacroidosis
 Wegener’s granulomatosis
 Leprosy
 Demyelinating disease
Causes cont’d

19. Change in the appearance of the face
 Difficulty closing one eye
 Difficulty making expressions,
grimacing
 Difficulty with fine movements
of the face
 Facial droop
 Paralysis of one side of the
face
Difficulty eating (items fall out of the weak corner of the
mouth)
Face feels pulled to one side
Face feels stiff
Headache
Impairment of taste
Increased loudness of sound in one ear
Pain behind the ear (for Bell's palsy)
Symptoms

22. Bell phenomena

23. An examination will show facial drooping on one
side of the face or just on the forehead, eyelid, or
mouth. Examination of the eardrum may show fluid-
filled sacs (vesicles).
A blood test may be done to check for Lyme disease
Other tests may include:
 Lumbar puncture
 MRI of the head
 Tests to rule out a stroke
or other nervous system
problems
Exams and Tests

24. (to didegenerafferentiate b/w neuropraxia & degeneration)
Minimal nerve excitability test
Maximal stimulation test (MST)
Electroneuronography (ENoG)
Electromyography
Electrodiagnostic Tests

25. 1.Central facial paralysis
2.Peripheral facial paralysis
At the level of nucleus: associated with the
paralysis of CN VI
At cerbellopontine angle: associated with
the involvement of CN VIII, V, IX, X, XI
In the bony canal: identified by the
topodiagnostic tests
In the parotid area: effects only the motor
functions of nerve
Localization of facial lesion

26. Schirmer test
Stapedial reflex
Taste test
Submandibular salivary flow test
Topodiagnostic tests

27. Medical
 Reassurance
 Analgesics
 Protection for the cornea
 Corticosteroids for idiopathic facial nerve palsy
 Physiotherapy
Surgical
 Decompression
 End-to-end anastomosis
 Nerve graft (cable graft)
 Hypoglossal facial anastomosis
 Plastic procedures
Management

28. The outlook varies. Some patients recover
completely, while others permanently lose movement
of the face.
Outlook (Prognosis)

29. Changes to the appearance of the face
(disfigurement) from loss of movement
Changes to taste
Damage to the eye (corneal ulcers and infections)
Nerves that grow back to the wrong structures
(aberrant regeneration) - for example, smiling causes
the eye to close
Spasm of face muscles or eyelids
Frey’s syndrome
Possible Complications

30. Call your health care provider if your face droops or
you have other symptoms of facial nerve palsy.
When to Contact a Medical
Professional?

31. Quickly treating tumors or other growths that
press down on the facial nerve may reduce the risk of
facial nerve palsy in some cases.
Prevention