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Facial Nerve
DR ADITI GUPTA
PG 1ST YEAR
DEPARTMENT OF PROSTHODONTICS
Contents:
 Course
 Branches & Distribution
 Ganglia
 Blood Supply
 Surgical Anatomy of Facial Nerve
 Clinical Aspects
 References
INTRODUCTION
 Nerves are clusters of cells called neurons.
 A bundle of fibers that receives and sends
messages between the body and the brain.
Nerve and it’s Conduction
 Neurons (also called nerve cells) are the fundamental units of the brain and nervous system.
 There are about 130 billion neurons in an adult brain.
 The length of a nerve cell can vary from nanometers to meters.
 Functionally, each neuron is a specialized for sensitivity and conductivity.
 The impulses can flow in them with great rapidity, in some cases about 125 meters per second.
 The impulses flows towards the cell body in the dendrites and away from the cell body in axon.
 Mature neurons do not divide after birth except in olfactory region and hippocampus.
Dendrite → cell → body → axon → nerve ending → synapse →
dendrite.
FACIAL NERVE
Classification of Nervous System
1. Central Nervous System (CNS): Comprises of brain and spinal cord. It is responsible for
integrating, coordinating the sensory information and ordering appropriate motor actions. CNS
is the seat of learning, memory, intelligence and emotions.
2. Peripheral Nervous System (PNS): Includes 12 pairs of cranial nerves and 31 pairs of spinal
nerves.
a) Afferent components provide sensory information to CNS.
b) Efferent component carries motor information to muscles, glands, blood vessels and heart via:
i. Somatic nervous system for the control of skeletal muscles.
ii. Autonomic nervous system for the control of heart, smooth muscles of the organs, glands and
blood vessels.
FACIAL NERVE
TWELVE CRANIAL NERVES
Introduction to Facial Nerve
 The facial nerve or the 7th cranial nerve is a mixed nerve
and consists of a motor and a sensory root (nervous
intermedius).
 It arises from the brain stem and extends posteriorly to
the abducens nerve and anteriorly to the
vestibulocochlear nerve.
 Both the roots are attached to the lower border of the
pons between the olive and inferior cerebellar
peduncle.
 The motor root is large and lies medial to the sensory
root.
Embryology
 Facial nerve is developmentally derived from the 2nd
brachial arch.
 The facial nerve with its complex course, branches, and
its relationship with the surrounding structures develop
during the first 3 months of prenatal life, although the
nerve is not fully developed before 4 years of life.
 Structures derived from any arch carry with them
the nerve supply of that arch.
 Thus the muscles of mastication are innervated by
trigeminal nerve and that of facial expressions by
facial nerve.
NUCLEI
The fibres of the nerve are connected to four
nuclei situated in the lower pons.
1. Motor nucleus or branchiomotor
2. Superior salivatory nucleus or
parasympathetic.
3. Lacrimatory nucleus is also
parasympathetic.
4. Nucleus of the tractus solitaries which is
gustatory.
Functional Components
 The facial nerve has the following functional components:
1. Special visceral efferent (branchial motor) innervates the muscles of facial expression, stylohyoid,
posterior belly of digastric, and the stapedius muscle, which are derived from the second branchial arch.
2. General visceral efferent (visceral motor) gives autonomic (parasympathetic) innervation to the
lacrimal, salivary, and mucosal glands.
3. General visceral afferent component carries efferent impulses from the above mentioned glands.
4. Special visceral afferent (special sensory) carries taste sensation from the anterior two-thirds of the
tongue.
5. General somatic afferent (general sensory) carries sensation from the skin of the concha of the
external ear.
Course
 The two roots of the facial nerve are attached to the lateral
part of the lower border of the pons just medial to the
eighth cranial nerve.
 The two roots run laterally and forwards, with the eighth
nerve to reach the internal acoustic meatus.
Course
 The first part is directed laterally above the vestibule.
 The second part runs backwards in relation to the medial wall of
the middle ear, above the promontory.
 The third part is directed vertically downwards behind the
promontory.
 The facial nerve leaves the skull by passing through the
stylomastoid foramen.
Branches and Distribution
 The Branches of facial nerve:-
1. The temporal branch – innervating the frontalis and orbicularis
oculi muscles and the muscles in the upper part of the face.
2. The zygomatic branch – innervating the middle part of the
face.
3. The buccal branch – innervating the cheek muscles, including
the buccinator muscle.
4. The mandibular branch – innervating muscles of the lower part
of the face.
5. The cervical branch – innervating the muscles below the chin
and, among others, the platysma muscle.
The facial nerve innervates:
 The muscles of facial expression – responsible for the expression of emotions by changing facial
expression.
 The stylohyoid muscle – draws the hyoid bone backward, which initiates a swallowing action and
elevates the tongue.
 The posterior belly of the digastric muscle – together with the anterior belly of the digastric
muscle, elevates the hyoid bone and is involved in any complex movements involving the jaw.
 The stapedius muscle of the middle ear – stabilizes the stapes, preventing excessive movement in
response to loud sounds.
Branches Within the Facial Canal:
1. Greater (superficial) petrosal nerve arises from the
geniculate ganglion. It carries parasympathetic preganglionic
fibers.
2. The nerve to the stapedius supplies the stapedius muscle.
3. Chorda tympani carries taste from the anterior two-thirds of
the tongue to the brain via the middle ear.
Ganglia
 The ganglia associated with the facial nerve are as follows:
1. The geniculate ganglion: It is a sensory ganglion. The taste
fibres present in the nerve are peripheral processes of
pseudo unipolar neurons.
2. The submandibular ganglion is a parasympathetic
ganglion for relay of secreto-motor fibres to the
submandibular and sublingual glands. The pre ganglionic
fibres come from the chorda tympani nerve.
3. The pterygopalatine ganglion is also a parasympathetic
ganglion. Secretomotor fibres meant for the lacrimal gland
relay in this ganglion. The fibres reach the ganglion from the
nerve to the pterygoid canal.
FACIAL NERVE
Blood Supply
 At the vertical part of the facial
nerve, the stylomastoid
artery lies on its anteromedial
side as far as the upper third
of the nerve. The artery then
loops around the lateral or
medial side of the nerve, and
divides into several branches.
Surgical anatomy of Facial Nerve
 Facial nerve is marked by a short horizontal line joining
the following two points:
1. A point at the middle of the anterior border of the
mastoid process. The stylomastoid foramen lies 2 cm
deep to this point.
2. A second point behind the neck of mandible.
 The pes anserinus is the main
bifurcation of the facial nerve
into the upper and lower
branches.
 The facial nerve further divides
into it’s 5 branches.
 The facial nerve is examined by testing the following facial muscles:
1. Frontalis: Ask the patient to look upwards, without moving his head, and look for the normal
horizontal wrinkles on the forehead.
2. Dilators of mouth: Showing the teeth.
3. Orbicularis oculi: Tight closure of the eyes.
4. Buccinator: Puffing the mouth and then blowing forcibly as in whistling.
Clinical Aspects
 Syndromes associated with facial nerve are:
1. Moebius syndrome
2. Goldenhar syndrome
3. Ramsay Hunt syndrome
Facial nerve paresis
 It is at the time of birth can either be congenital or acquired and must be evaluated before we plan
the management.
1. Acquired: One in 2,000 live births suffer from unilateral facial palsy out of which almost 90%
recover spontaneously. Approximately 75 to 80% of palsies in newborns are related to birth trauma.
2. Congenital: The presence of bilateral facial paralysis, other cranial nerve deficits, or other anomalies
suggests a developmental etiology and facial palsy in such cases is part of different syndromes
involving other parts of the body. Most of the syndromes involving facial nerve are manifested at
the time of birth only. Very few may present later in life.
Bell’s palsy
 Facial paralysis is a condition that involves loss of control of
facial muscles on the affected side and is generally sudden in
onset.
 The commonly factors are immune or viral diseases (herpes
zoster), trauma (iatrogenic, accidental), ischemia of the nerve
(neoplasms), or idiopathic (Bell’s palsy).
 Based on the site of the neurons affected they are classified as
upper motor neuron (UMN) and lower motor neuron (LMN)
paralysis.
Clinical Features
 The affected side is motionless.
 Wrinkles disappear from the forehead.
 The eye cannot be closed.
 Any attempt to smile draws the mouth to the
normal side.
 During mastication, food accumulates
between the teeth and the cheek.
 Articulation of labials is impaired.
Crocodile Tears Syndrome
 The term “crocodile tears” is
derived from the ancient belief
that crocodiles weep after killing
their victims. “crocodile tears
syndrome,” also known as
Bogorad syndrome, is the
shedding of tears while eating or
drinking in patients recovering
from Bell palsy. It is also referred
to as gustatory lacrimation.
Prosthodontic Management of a Patient
with Bell’s Palsy
 PI were made for the upper and lower edentulous arches using irreversible hydrocolloid. Diagnostic cast obtained.
Custom trays constructed using auto polymerizing polymethyl methacrylate resin.
 Border molding was done, and FI obtained. Borders of the affected side made thick to add adequate buccal sulcus
support. To replicate the symmetry of his face and preserve esthetics, the anterior teeth were set according to the
shifted midline. Monoplane posterior teeth were selected.
Case of liquid-supported denture
 Patients with diabetes, xerostomia, and atrophied ridges present problems in stability, retention, and soreness
that can result in hyperemia of the palatal mucosa.
 Liquid-supported denture can be a permanent solution in these patients.6 Liquid-supported dentures will have
optimal stress distribution during masticatory function.
 A preliminary impression of the maxillary and mandibular arches was made with impression compound and
impressions were poured with dental plaster and the primary casts were retrieved.
 It was followed by border molding with low-fusing compound and final impression with light body impression
material.
 The obtained impressions were poured with dental stone. The record bases were fabricated, assessed, and
modified for stability, extension, and comfort.
 The impression material was softened in a 65°C water bath. The
softened compound was kneaded and a roll was formed according to
the crest and was attached to the base.
 The attached roll of compound was reheated in the water bath and was
carried into the patient’s mouth. With the record base firmly seated, the
patient was asked to perform a series of actions like swallowing,
speaking, sucking, pursing lips, pronouncing vowels, sipping water, and
slightly protruding the tongue several times which simulated
physiological functioning.
 During function of the lips, cheeks, and the tongue, the forces exerted
on the soft compound mold it into the shape of the neutral zone.
 Maxillary rim oriented in patient’s mouth, height of the lower compound rim was adjusted with a knife, and
tentative jaw registration was carried out and face bow transfer done on a semi-adjustable articulator (Hanau
Wide Vue).
 Neutral zone impression so obtained was placed on master model, and locating grooves (3 facially: 1 anterior &
2 posterior, while 2 grooves lingually: 1 anterior & 1 posterior) were cut on the master cast and covered with a
silicone putty index around the impression on both the labial and lingual sides.
 Compound of mandibular occlusal rim then removed from the base plate & replaced by the index preserving the
space of neutral zone.
 Teeth arrangement was done exactly following the index.
LAB PROCEDURE - I:
 At time of packing, a 1 mm thick, soft, flexible polyethylene sheet was incorporated in the maxillary denture which
was 2 mm short of the borders. This sheet was adapted over the master cast with the help of a vacuum heat-pressed
machine.
 The sheet along with the heat-cure denture base resin was packed to facilitate proper sealing. The denture was then
finished, polished, and inserted into the patient’s mouth to check for retention, stability, support, and border
extension.
LAB PROCEDURE – II:
 A putty impression of tissue surface of maxillary denture was obtained to get junction of temporary sheet &
denture base resin.
 A new polyethylene sheet of 0.5 mm thickness was adapted on this stone replica.
 Temporary 1 mm thick sheet/spacer embedded in the denture was replaced with the new 0.55 mm thick permanent sheet in
the final denture.
 Two holes were made in the denture buccally in the molar region.
 Permanent polyethylene sheet then incorporated in denture base with cyanoacrylate adhesive.
 A viscous liquid, i.e., glycerin, was filled through the holes & the vertical dimension was checked simultaneously.
 A corrective surgical procedure of the affected nerve would be the ultimate cure for
any unrecovered facial paralysis. However, in complicated cases where surgery is not
a choice, oral prosthesis plays a vital role in the patient’s well-being.
 Objectives of prosthetic rehabilitation in facial paralysis cases:
1. Support weakened musculature.
2. Decrease the amount of surgical procedures.
3. Comfort and aesthetics.
4. Increase confidence and improve social interactions.
References
 Gosain AK. Surgical anatomy of the facial nerve. Clin Plast Surg. 1995 Apr;22(2):241-51. PMID: 7634735.
 Muthuvignesh J, Kumar NS, Reddy DN, Rathinavelu P, Egammai S, Adarsh A. Rehabilitation of Bell's palsy patient
with complete dentures. J Pharm Bioallied Sci. 2015 Aug;7(Suppl 2):S776-8. doi: 10.4103/0975-7406.163558.
PMID: 26538967; PMCID: PMC4606709.
 Pandey S, Datta K. Prosthodontic management of a completely edentulous patient with unilateral facial
paralysis. J Indian Prosthodont Soc 2007;7(4)211–213. DOI: 10.4103/0972-4052.41076. 2. Chaurasia BD. In:
Chaurasia BD, editor. Human anatomy. 2nd ed. p. 41–113.
 Robert G, Anderson MD. Facial nerve disorders and surgery. Sel Read Plast Surg. 2006;10:1–41.
 Neuroanatomy, Cranial Nerve 7 (Facial) - StatPearls - NCBI Bookshelf (nih.gov)
 Rajapur A, Mitra N, Prakash VJ, Rah SA, Thumar S. Prosthodontic Rehabilitation of Patients with Bell's Palsy: Our
Experience. J Int Oral Health. 2015;7(Suppl 2):77-81. PMID: 26668488; PMCID: PMC4672843.
 Ahn H, Jung WJ, Lee SY, Lee KH. Recovery from Bell's palsy after treatment using uncultured umbilical cord-
derived mesenchymal stem cells: A case report. World J Clin Cases. 2023 Apr 26;11(12):2817-2824. doi:
10.12998/wjcc.v11.i12.2817. PMID: 37214571; PMCID: PMC10198102.
Thankyou!

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FACIAL NERVE

  • 1. Facial Nerve DR ADITI GUPTA PG 1ST YEAR DEPARTMENT OF PROSTHODONTICS
  • 2. Contents:  Course  Branches & Distribution  Ganglia  Blood Supply  Surgical Anatomy of Facial Nerve  Clinical Aspects  References
  • 3. INTRODUCTION  Nerves are clusters of cells called neurons.  A bundle of fibers that receives and sends messages between the body and the brain.
  • 4. Nerve and it’s Conduction  Neurons (also called nerve cells) are the fundamental units of the brain and nervous system.  There are about 130 billion neurons in an adult brain.  The length of a nerve cell can vary from nanometers to meters.  Functionally, each neuron is a specialized for sensitivity and conductivity.  The impulses can flow in them with great rapidity, in some cases about 125 meters per second.  The impulses flows towards the cell body in the dendrites and away from the cell body in axon.  Mature neurons do not divide after birth except in olfactory region and hippocampus. Dendrite → cell → body → axon → nerve ending → synapse → dendrite.
  • 6. Classification of Nervous System 1. Central Nervous System (CNS): Comprises of brain and spinal cord. It is responsible for integrating, coordinating the sensory information and ordering appropriate motor actions. CNS is the seat of learning, memory, intelligence and emotions. 2. Peripheral Nervous System (PNS): Includes 12 pairs of cranial nerves and 31 pairs of spinal nerves. a) Afferent components provide sensory information to CNS. b) Efferent component carries motor information to muscles, glands, blood vessels and heart via: i. Somatic nervous system for the control of skeletal muscles. ii. Autonomic nervous system for the control of heart, smooth muscles of the organs, glands and blood vessels.
  • 9. Introduction to Facial Nerve  The facial nerve or the 7th cranial nerve is a mixed nerve and consists of a motor and a sensory root (nervous intermedius).  It arises from the brain stem and extends posteriorly to the abducens nerve and anteriorly to the vestibulocochlear nerve.  Both the roots are attached to the lower border of the pons between the olive and inferior cerebellar peduncle.  The motor root is large and lies medial to the sensory root.
  • 10. Embryology  Facial nerve is developmentally derived from the 2nd brachial arch.  The facial nerve with its complex course, branches, and its relationship with the surrounding structures develop during the first 3 months of prenatal life, although the nerve is not fully developed before 4 years of life.
  • 11.  Structures derived from any arch carry with them the nerve supply of that arch.  Thus the muscles of mastication are innervated by trigeminal nerve and that of facial expressions by facial nerve.
  • 12. NUCLEI The fibres of the nerve are connected to four nuclei situated in the lower pons. 1. Motor nucleus or branchiomotor 2. Superior salivatory nucleus or parasympathetic. 3. Lacrimatory nucleus is also parasympathetic. 4. Nucleus of the tractus solitaries which is gustatory.
  • 13. Functional Components  The facial nerve has the following functional components: 1. Special visceral efferent (branchial motor) innervates the muscles of facial expression, stylohyoid, posterior belly of digastric, and the stapedius muscle, which are derived from the second branchial arch. 2. General visceral efferent (visceral motor) gives autonomic (parasympathetic) innervation to the lacrimal, salivary, and mucosal glands. 3. General visceral afferent component carries efferent impulses from the above mentioned glands. 4. Special visceral afferent (special sensory) carries taste sensation from the anterior two-thirds of the tongue. 5. General somatic afferent (general sensory) carries sensation from the skin of the concha of the external ear.
  • 14. Course  The two roots of the facial nerve are attached to the lateral part of the lower border of the pons just medial to the eighth cranial nerve.  The two roots run laterally and forwards, with the eighth nerve to reach the internal acoustic meatus.
  • 15. Course  The first part is directed laterally above the vestibule.  The second part runs backwards in relation to the medial wall of the middle ear, above the promontory.  The third part is directed vertically downwards behind the promontory.  The facial nerve leaves the skull by passing through the stylomastoid foramen.
  • 16. Branches and Distribution  The Branches of facial nerve:- 1. The temporal branch – innervating the frontalis and orbicularis oculi muscles and the muscles in the upper part of the face. 2. The zygomatic branch – innervating the middle part of the face. 3. The buccal branch – innervating the cheek muscles, including the buccinator muscle. 4. The mandibular branch – innervating muscles of the lower part of the face. 5. The cervical branch – innervating the muscles below the chin and, among others, the platysma muscle.
  • 17. The facial nerve innervates:  The muscles of facial expression – responsible for the expression of emotions by changing facial expression.  The stylohyoid muscle – draws the hyoid bone backward, which initiates a swallowing action and elevates the tongue.  The posterior belly of the digastric muscle – together with the anterior belly of the digastric muscle, elevates the hyoid bone and is involved in any complex movements involving the jaw.  The stapedius muscle of the middle ear – stabilizes the stapes, preventing excessive movement in response to loud sounds.
  • 18. Branches Within the Facial Canal: 1. Greater (superficial) petrosal nerve arises from the geniculate ganglion. It carries parasympathetic preganglionic fibers. 2. The nerve to the stapedius supplies the stapedius muscle. 3. Chorda tympani carries taste from the anterior two-thirds of the tongue to the brain via the middle ear.
  • 19. Ganglia  The ganglia associated with the facial nerve are as follows: 1. The geniculate ganglion: It is a sensory ganglion. The taste fibres present in the nerve are peripheral processes of pseudo unipolar neurons. 2. The submandibular ganglion is a parasympathetic ganglion for relay of secreto-motor fibres to the submandibular and sublingual glands. The pre ganglionic fibres come from the chorda tympani nerve. 3. The pterygopalatine ganglion is also a parasympathetic ganglion. Secretomotor fibres meant for the lacrimal gland relay in this ganglion. The fibres reach the ganglion from the nerve to the pterygoid canal.
  • 21. Blood Supply  At the vertical part of the facial nerve, the stylomastoid artery lies on its anteromedial side as far as the upper third of the nerve. The artery then loops around the lateral or medial side of the nerve, and divides into several branches.
  • 22. Surgical anatomy of Facial Nerve  Facial nerve is marked by a short horizontal line joining the following two points: 1. A point at the middle of the anterior border of the mastoid process. The stylomastoid foramen lies 2 cm deep to this point. 2. A second point behind the neck of mandible.
  • 23.  The pes anserinus is the main bifurcation of the facial nerve into the upper and lower branches.  The facial nerve further divides into it’s 5 branches.
  • 24.  The facial nerve is examined by testing the following facial muscles: 1. Frontalis: Ask the patient to look upwards, without moving his head, and look for the normal horizontal wrinkles on the forehead. 2. Dilators of mouth: Showing the teeth. 3. Orbicularis oculi: Tight closure of the eyes. 4. Buccinator: Puffing the mouth and then blowing forcibly as in whistling.
  • 25. Clinical Aspects  Syndromes associated with facial nerve are: 1. Moebius syndrome 2. Goldenhar syndrome 3. Ramsay Hunt syndrome
  • 26. Facial nerve paresis  It is at the time of birth can either be congenital or acquired and must be evaluated before we plan the management. 1. Acquired: One in 2,000 live births suffer from unilateral facial palsy out of which almost 90% recover spontaneously. Approximately 75 to 80% of palsies in newborns are related to birth trauma. 2. Congenital: The presence of bilateral facial paralysis, other cranial nerve deficits, or other anomalies suggests a developmental etiology and facial palsy in such cases is part of different syndromes involving other parts of the body. Most of the syndromes involving facial nerve are manifested at the time of birth only. Very few may present later in life.
  • 27. Bell’s palsy  Facial paralysis is a condition that involves loss of control of facial muscles on the affected side and is generally sudden in onset.  The commonly factors are immune or viral diseases (herpes zoster), trauma (iatrogenic, accidental), ischemia of the nerve (neoplasms), or idiopathic (Bell’s palsy).  Based on the site of the neurons affected they are classified as upper motor neuron (UMN) and lower motor neuron (LMN) paralysis.
  • 28. Clinical Features  The affected side is motionless.  Wrinkles disappear from the forehead.  The eye cannot be closed.  Any attempt to smile draws the mouth to the normal side.  During mastication, food accumulates between the teeth and the cheek.  Articulation of labials is impaired.
  • 29. Crocodile Tears Syndrome  The term “crocodile tears” is derived from the ancient belief that crocodiles weep after killing their victims. “crocodile tears syndrome,” also known as Bogorad syndrome, is the shedding of tears while eating or drinking in patients recovering from Bell palsy. It is also referred to as gustatory lacrimation.
  • 30. Prosthodontic Management of a Patient with Bell’s Palsy  PI were made for the upper and lower edentulous arches using irreversible hydrocolloid. Diagnostic cast obtained. Custom trays constructed using auto polymerizing polymethyl methacrylate resin.  Border molding was done, and FI obtained. Borders of the affected side made thick to add adequate buccal sulcus support. To replicate the symmetry of his face and preserve esthetics, the anterior teeth were set according to the shifted midline. Monoplane posterior teeth were selected.
  • 31. Case of liquid-supported denture  Patients with diabetes, xerostomia, and atrophied ridges present problems in stability, retention, and soreness that can result in hyperemia of the palatal mucosa.  Liquid-supported denture can be a permanent solution in these patients.6 Liquid-supported dentures will have optimal stress distribution during masticatory function.
  • 32.  A preliminary impression of the maxillary and mandibular arches was made with impression compound and impressions were poured with dental plaster and the primary casts were retrieved.  It was followed by border molding with low-fusing compound and final impression with light body impression material.  The obtained impressions were poured with dental stone. The record bases were fabricated, assessed, and modified for stability, extension, and comfort.
  • 33.  The impression material was softened in a 65°C water bath. The softened compound was kneaded and a roll was formed according to the crest and was attached to the base.  The attached roll of compound was reheated in the water bath and was carried into the patient’s mouth. With the record base firmly seated, the patient was asked to perform a series of actions like swallowing, speaking, sucking, pursing lips, pronouncing vowels, sipping water, and slightly protruding the tongue several times which simulated physiological functioning.  During function of the lips, cheeks, and the tongue, the forces exerted on the soft compound mold it into the shape of the neutral zone.
  • 34.  Maxillary rim oriented in patient’s mouth, height of the lower compound rim was adjusted with a knife, and tentative jaw registration was carried out and face bow transfer done on a semi-adjustable articulator (Hanau Wide Vue).  Neutral zone impression so obtained was placed on master model, and locating grooves (3 facially: 1 anterior & 2 posterior, while 2 grooves lingually: 1 anterior & 1 posterior) were cut on the master cast and covered with a silicone putty index around the impression on both the labial and lingual sides.
  • 35.  Compound of mandibular occlusal rim then removed from the base plate & replaced by the index preserving the space of neutral zone.  Teeth arrangement was done exactly following the index. LAB PROCEDURE - I:  At time of packing, a 1 mm thick, soft, flexible polyethylene sheet was incorporated in the maxillary denture which was 2 mm short of the borders. This sheet was adapted over the master cast with the help of a vacuum heat-pressed machine.
  • 36.  The sheet along with the heat-cure denture base resin was packed to facilitate proper sealing. The denture was then finished, polished, and inserted into the patient’s mouth to check for retention, stability, support, and border extension. LAB PROCEDURE – II:  A putty impression of tissue surface of maxillary denture was obtained to get junction of temporary sheet & denture base resin.
  • 37.  A new polyethylene sheet of 0.5 mm thickness was adapted on this stone replica.  Temporary 1 mm thick sheet/spacer embedded in the denture was replaced with the new 0.55 mm thick permanent sheet in the final denture.  Two holes were made in the denture buccally in the molar region.  Permanent polyethylene sheet then incorporated in denture base with cyanoacrylate adhesive.  A viscous liquid, i.e., glycerin, was filled through the holes & the vertical dimension was checked simultaneously.
  • 38.  A corrective surgical procedure of the affected nerve would be the ultimate cure for any unrecovered facial paralysis. However, in complicated cases where surgery is not a choice, oral prosthesis plays a vital role in the patient’s well-being.  Objectives of prosthetic rehabilitation in facial paralysis cases: 1. Support weakened musculature. 2. Decrease the amount of surgical procedures. 3. Comfort and aesthetics. 4. Increase confidence and improve social interactions.
  • 39. References  Gosain AK. Surgical anatomy of the facial nerve. Clin Plast Surg. 1995 Apr;22(2):241-51. PMID: 7634735.  Muthuvignesh J, Kumar NS, Reddy DN, Rathinavelu P, Egammai S, Adarsh A. Rehabilitation of Bell's palsy patient with complete dentures. J Pharm Bioallied Sci. 2015 Aug;7(Suppl 2):S776-8. doi: 10.4103/0975-7406.163558. PMID: 26538967; PMCID: PMC4606709.  Pandey S, Datta K. Prosthodontic management of a completely edentulous patient with unilateral facial paralysis. J Indian Prosthodont Soc 2007;7(4)211–213. DOI: 10.4103/0972-4052.41076. 2. Chaurasia BD. In: Chaurasia BD, editor. Human anatomy. 2nd ed. p. 41–113.  Robert G, Anderson MD. Facial nerve disorders and surgery. Sel Read Plast Surg. 2006;10:1–41.  Neuroanatomy, Cranial Nerve 7 (Facial) - StatPearls - NCBI Bookshelf (nih.gov)  Rajapur A, Mitra N, Prakash VJ, Rah SA, Thumar S. Prosthodontic Rehabilitation of Patients with Bell's Palsy: Our Experience. J Int Oral Health. 2015;7(Suppl 2):77-81. PMID: 26668488; PMCID: PMC4672843.  Ahn H, Jung WJ, Lee SY, Lee KH. Recovery from Bell's palsy after treatment using uncultured umbilical cord- derived mesenchymal stem cells: A case report. World J Clin Cases. 2023 Apr 26;11(12):2817-2824. doi: 10.12998/wjcc.v11.i12.2817. PMID: 37214571; PMCID: PMC10198102.

Editor's Notes

  1. Gm everyone the topic for my seminar is fn
  2. Here is the process of conduction of nerve impulse which is mainly divided into 3 parts: Polarization The polarized state of nerves is also described as resting potential, which means that nerve fibres are not propagating any form of a nerve impulse at this stage. The axoplasm comprises negatively charged proteins and a low sodium ion concentration with a high potassium ion concentration at this stage. There is a concentration differential between inside and outside the membrane because there is a high concentration of sodium ions and a low concentration of potassium ions outside the axoplasm. Along the Axon’s membrane is a sodium-potassium pump that allows ions to traverse the membrane. When three sodium ions are transported outside the membrane, three potassium ions are transported inside the membrane, resulting in a charge difference between the membranes and the generation of positive charges outside the membrane and negative charges inside the membrane with negatively charged protein. Depolarization When nerve fibres start to conduct a nerve impulse, this depolarization begins. If the strength of the stimulus is close to the predetermined threshold level of a polarized membrane, a stimulus from the cell arrives at this step. The Sodium-Ion then enters the Axon membrane, resulting in the polarized state’s reversibility. Positive charges form inside the membrane and negative charges form outside the membrane. The action potential for a nerve impulse is this type of potential difference across the membrane, however, it is only a transient signal because the depolarized condition of a nerve is relatively short. Repolarization Within a fraction of a second after depolarization, the creation of negative charges within the axon membrane and positive charges outside the axon membrane commences, resulting in the restoration of the polarized state. The nerve cell for fiber is then prepared for another stimulus and transfers the next nerve impulse. The refractory period is the time it takes for a nerve fiber to return to its polarized condition, and it is very short.
  3. Nervous system is anatomically divided into two main systems. Peripheral ns functionally has two components.
  4. Here is a flowchart chart of the same.
  5. There are 12 pairs of cranial nerves found in the human body and facial nerve is the 7th cranial nerve which is highlighted here
  6. Sensory and parasympathetic division of the facial nerve
  7. This is because The exit of facial nerve through the stylomastoid foramen (SMF) is still superficially located. The deeper location of exit of facial nerve at SMF occurs along with the parallel development of mastoid tip which goes on till about 4 years of age.
  8. Here is a diagram showing the development of nerve throught the Bpharnyngeal ARCH Like the trigeminal nerve derives from 1st pharyngeal arcg
  9. The motor nucleus lies deep in the reticular formation of the lower pons. The part of the nucleus that supplies muscles of the upper part of the face receives corticonuclear fibres from the motor cortex of both the right and left sides. In contrast, the part of the nucleus that supplies muscles of the lower part of the face receive corticonuclear fibres only from the opposite cerebral hemisphere.
  10. The facial nerve is attached to the brainstem by 2 roots, motor and sensory. In the meatus, the motor root lies in a groove on the eighth nerve, with the sensory root intervening. Here the seventh and eighth nerves are accompanied by the labyrinthine vessels. At the bottom or fundus of the meatus, the two roots, sensory and motor, fuse to form a single trunk, which lies in the Petrous part of temporal bone.
  11. Within the canal, the course of the nerve can be divided into three parts by two bends. The first bend at the junction of the first and second parts is sharp. It lies over the anterosuperior part of the promontory, and is also called the genu. The geni-culate ganglion of the nerve is so called because it lies on the genu. The second bend is gradual, and lies between the promontory and the aditus to the mastoid antrum. FUTHER In its extracranial course, the facial nerve crosses the lateral side of the base of styloid process. It enters the posteromedial surface the parotid gland, runs forwards through the gland crossing the retromandibular vein and the ECA. Behind the neck of the mandible, it divides into its five terminal branches which emerge along the anterior border of the parotid gland.
  12. 1 The postganglionic fibers from the pterygopalatine ganglion synapse with mucosal glands of the nose, palate, pharynx, and also lacrimal gland.
  13.  it is collection of neuronal bodies found in the voluntary and autonomic branches of the peripheral nervous system (PNS).
  14. (Here is a diagram showing pterygopalatine ganglion and geniculate ganglion ) AS YOU CAN SEE HERE the geniculate ganglion IS located on the first bend of the facial nerve AND in relation to the medial wall of the middle ear.
  15. Which is a branch of the posterior auricular artery, which is a part of the external carotid artery.
  16. If the pt is unable to do these features then we can conclude that theres somtheing wrong with the facial muscle
  17. Anomalies of the facial nerve can be associated with either normal facial nerve or facial palsy. It can occur with or without malformations of the ear, or in conjunction with various syndromes which include abnormalities involving other organs in the body. : mobius syn : which is a congenital disorder characterized by uni- or bilateral palsy of the abducens (VI) and the facial (VII) nerves, causing facial paralysis. Goldenhar syndrome : is also a congenital disorder and is a triad of 1) mandibular hypoplasia , 2) ocular and auricular malformations and 3) vertebral anomalies  or aka herpes zoster oticus - occurs when a shingles outbreak affects the facial nerve near one of your ears. Which is also a triad of 1 ipsilateral facial paralysis 2 , otalgia, and 3 vesicles near the ear and auditory canal In 2022 justin Bieber a pop singer had this syndrome Genrally theres not much damage to your facial nerve in this and you get better completely within a few weeks.  By taking antivirals. (70 percent) pts recover
  18. Although an etiology is identified only in about 20% of cases, it is important to carefully evaluate each patient so that appropriate therapy may be instituted.
  19. Clinical features of bells palsy
  20. Monoplane posterior teeth were selected as they help in easier closure for uncoordinated movements, prevent lateral stresses, and reduce the damage to the tissues that support the denture. After try-in, wax up and carving were carried out. Heat-cured PMMA resin was used to make the upper complete denture and the lower partial denture. The dentures were finished and polished and insertion was carried out
  21. . The problems encountered during prosthodontic rehabilitation in facial palsy pt include uncontrolled flow of saliva, dryness of mouth, and poor muscle coordination. Alll these features may interfere with steps in impression making, jaw relation, and denture retention and stability, which may necessitate modification of cd procedures So liquid-supported denture was planned for maxillary arch and neutral zone concept for fabrication of contour of the polished surfaces of mandibular denture to enhance denture stability.
  22. Before making the neutral zone impression, the patient was made comfortable in an upright position with the head supported.
  23. When the compound has cooled,
  24. The position of the teeth was checked by placing the index together around the wax try-in. The wax trial dentures were tried intraorally to check the appearance and occlusion.
  25. Patient is asked to use the denture for 2 weeks till he got adjusted. 2- Maxillary denture is now ready to be converted into a liquid-supported denture. . Impression poured with dental stone, and the positive replica of the denture was obtained with the junction marked over it.
  26. again vacuum-pressed and cut into the desired shape as on the stone replica to form the ultimate denture base. This sheet was a permanent one of 0.5 mm thickness as compared with the temporary one which was 1 mm thick. This difference in space was occupied by liquid in the final prosthesis In areas of leakage, it resealed till a perfect seal was obtained at the junction. Seal was checked properly. A viscous liquid, i.e., glycerin, was filled through the holes & the vertical dimension was checked simultaneously. And holes were then sealed with self-cure acrylic resin. Denture insertion was done and again it was evaluated for stability, esthetics, and occlusion
  27. Denture care instructions were given to the patient. Patient was told to clean the tissue surface using soft cloth. Recall appointments were scheduled at 1 day, 1 week, 1 month, and 3 months. At 1 week’s appointment, patient may complain of floating feeling But at around 3 months or recall appointment, the patient will be comfortably use the denture. Also theres an article of last year for the treatment of bells palsy in which they had taken an Uncultured umbilical cord-derived mesenchymal stem cell and done the transplantation which may be a potential treatment for patients who do not spontaneously recover.