The document provides information on the facial nerve (cranial nerve VII), including its embryology, nuclei, course, branches, landmarks, neurophysiology, causes of damage, and grading systems for facial palsy. It describes the facial nerve's development during gestation, its motor, sensory and parasympathetic functions. Key points along its intra- and extracranial course are identified. Variations, injuries, and resulting functional deficits are also discussed.

1. FACIAL
NERVE
DR. JEFF K. ZACHARIA
1ST YEAR POST GRADUATE
DEPARTMENT OF ORAL &
MAXILLOFACIAL SURGERY
A.J. INSTITUTE OF DENTAL
SCIENCES

2. CONTENTS
• INTRODUCTION
• EMBRYOLOGY
• NUCLEI
• COURSE AND RELATIONS
• LANDMARKS
• NEUROPHYSIOLOGY
• CAUSES OF FACIAL PALSY
• TESTING OF FACIAL NERVE
• BELL’S PALSY
• CONCLUSION
• REFERENCES

3. INTRODUCTION
• THE FACIAL NERVE IS THE VII
CRANIAL NERVE.
• IT IS THE NERVE OF THE SECOND
BRANCHIAL ARCH.

4. EMBRYOLOGY
MAIN PATTERN OF THE NERVE’S COMPLEX COURSE, BRANCHING PATTERN
AND RELATIONSHIPS ARE ESTABLISHED DURING THE FIRST THREE MONTHS
OF PRENATAL LIFE.
DURING THIS PERIOD, THE MUSCLES OF EXPRESSION DIFFERENTIATE,
BECOME FUNCTIONAL AND ACTIVELY CONTRACT.
IMPORTANT STEPS IN FACIAL NERVE DEVELOPMENT OCCUR THROUGH OUT
GESTATION AND THE NERVE IS NOT FULLY DEVELOPED UNTIL 4 YEARS

5. TIME DURING GESTATION THAT ANATOMICAL
STRUCTURES APPEAR
• 3RD WEEK: FACIOACOUSTIC MEATUS DEVELOPS
• 4TH WEEK: FACIAL NERVE DIVIDES INTO TWO PARTS
• 5TH WEEK: GENICULATE GANGLION, NERVUS INTERMEDIUS, GREATER
PETROSAL NERVE VISIBLE
• 7TH & 8TH WEEK: MUSCLES OF FACIAL EXPRESSION DEVELOP
• 11TH WEEK: FACIAL NERVE ARBORIZED.

6. NUCLEI
• THE FIBRES OF THE NERVE ARISE FROM 4 NUCLEI SITUATED AT LOWER PONS:
1. BRACHIAL NUCLEUS (MOTOR NUCLEUS)
2. SUPERIOR SALIVATORY NUCLEUS (PARASYMPATHETIC NUCLEUS)
3. NUCLEUS OF TRACTUS SOLITARIUS (TASTE)
4. SPINAL TRIGEMINAL NUCLEUS (GENERAL SENSATION)

7. IT IS A MIXED NERVE
MOTOR: MUSCLES OF EXPRESSION, STYLOHYOID MUSCLE, POSTERIOR
BELLY OF DIGASTRIC AND STAPEDIUS MUSCLE.
PARASYMPATHETIC: SUBMANDIBULAR GLAND, SUBLINGUAL GLAND,
NASAL GLANDS, PALATINE GLANDS AND LACRIMAL GLANDS.
SPECIAL SENSORY: TASTE FROM ANTERIOR 2/3RD OF THE TONGUE.
SENSORY: SKIN AROUND THE EAR

8. BRACHIMOTOR NUCLEUS
IT IS DIVIDED INTO AN UPPER PART AND A LOWER PART
THE UPPER PART IS CONTROLLED BY THE LEFT AND THE RIGHT SIDE OF
THE BRAIN.
THE UPPER PART OF THE NUCLEUS IS RESPONSIBLE FOR SUPPLYING THE
MUSCLES OF THE UPPER PART OF THE FACE (ORBICULARIS OCULI,
FRONTALIS MUSCLE, CORRUGATOR SUPERCILI, NASALIS, LEVATOR LABII
SUPERIORIS)
THE LOWER PART OF THE NUCLEUS IS CONTROLLED BY THE OPPOSITE OF

9. COURSE AND RELATIONS OF FACIAL NERVE

10. COURSE AND RELATIONS
THE COURSE OF THE FACIAL NERVE IS VERY COMPLEX SINCE THERE ARE
MANY BRANCHES.
THE COURSE CAN BE DIVIDED INTO THREE PARTS:
INTRACRANIAL
INTRATEMPORAL
EXTRACRANIAL

11. INTRACRANIAL COURSE
THE NERVE ARISES IN THE PONS, AN AREA
OF THE BRAINSTEM. IT BEGINS AS TWO
ROOTS: A LARGE MOTOR ROOT AND A
SMALL SENSORY ROOT
THE TWO ROOTS TRAVEL THROUGH THE
INTERNAL ACOUSTIC MEATUS, A 1CM
LONG OPENING IN THE PETROUS PART OF
THE TEMPORAL BONE WHERE THEY ARE IN
VERY CLOSE PROXIMITY TO THE INNER
EAR.
IT TRAVELS SLIGHTLY ABOVE AND
TH

12. INTRATEMPORAL COURSE
THE TOTAL LENGTH OF THE NERVE HERE IS 22-33 MM

13. INTRATEMPORAL
BRANCHES
NERVE TO STAPEDIUS: ARISES FROM THE MASTOID SEGMENT
AND SUPPLIES THE STAPEDIUS MUSCLE.
CHORDA TYMPANI: ARISES FROM THE MASTOID SEGMENT,
MOVES ANTERIORLY BETWEEN INCUS & MALLEUS AND JOINS
THE LINGUAL NERVE TO SUPPLY THE ANTERIOR 2/3RD OF
THE TONGUE.
IT ALSO SUPPLIES PARASYMPATHETIC FIBRES TO
SUBMANDIBULAR AND SUBLINGUAL GLANDS.
SENSORY FIBRES: JOINS THE AURICULAR BRANCH OF VAGUS

14. MORPHOLOGIC PECULIARITIES (GERRIER
1977)
a) INDIVIDUAL SHEATH OF PIA MATER CURVES UP AND CONTINUES
WITH ARACHINOID.
b) SLIGHT CONSTRICTION OF THE NERVE JUST PRIOR TO THE
LABYRINTH SEGMENT WHICH IS A NORMAL CONSTRICTION.
c) CHANGE IN THE DIRECTION OF THE NERVE THAT PRODUCES AN
ANGLE OF 132°

15. THE NERVE THEN EMERGES OUT OF THE STYLOMASTOID FORAMEN
IN A NEWBORN, THE STYLOMASTOID FORAMEN IS AT A HIGHER LEVEL
WITH THE FACIAL NERVE EMERGING AT THE LEVEL OF THE MASTOID
ANTRUM

16. EXTRACRANIAL COURSE
AFTER EXITING THE FORAMEN, IT GIVES RISE TO THE:
POSTERIOR AURICULAR NERVE: WHICH ASCENDS IN FRONT OF THE MASTOID PROCESS AND
PROVIDES MOTOR INNERVATION TO THE INTRINSIC AND EXTRINSIC MUSCLES OF THE OUTER
EAR. IT ALSO SUPPLIES THE OCCIPITAL PART OF THE OCCIPITOFRONTALIS MUSCLE.
NERVE TO THE POSTERIOR BELLY OF THE DIGASTRIC MUSCLE: INNERVATES THE POSTERIOR
BELLY OF THE DIGASTRIC MUSCLE WHICH IS RESPONSIBLE FOR RAISING THE HYOID BONE.
NERVE TO THE STYLOHYOID MUSCLE: INNERVATES THE STYLOHYOID MUSCLE WHICH IS
RESPONSIBLE FOR RAISING THE HYOID BONE.

17. THE MAIN TRUNK OF THE NERVE CONTINUES ANTERIORLY AND INFERIORLY INTO THE PAROTID
GLAND AND TERMINATES BY SPLITTING INTO FIVE BRANCHES:
TEMPORAL BRANCH: INNERVATES THE FRONTALIS, ORBICULARIS OCULI AND CORRUGATOR
SUPERCILII
ZYGOMATIC BRANCH: INNERVATES THE ORBICULARIS OCULI.
BUCCAL BRANCH: INNERVATES THE ORBICULARIS ORIS, BUCCINATOR
AND ZYGOMATICUS MUSCLES.
MARGINAL MANDIBULAR BRANCH: INNERVATES THE MENTALIS MUSCLE.
CERVICAL BRANCH: INNERVATES THE PLATYSMA

18. SUMMARY OF BRANCHES OF FACIAL NERVE
A: WITHIN THE FACIAL CANAL:
1. GREATER PETROSAL NERVE
2. NERVE TO STAPEDIUS
3. THE CHORDA TYMPANI

19. B: AT ITS EXIT FROM STYLOMASTOID FORAMEN
1. POSTERIOR AURICULAR NERVE
2. DIGASTRIC
3. STYLOHYOID

20. C: TERMINAL BRANCHES WITHIN THE PAROTID GLAND
1. TEMPORAL
2. ZYGOMATIC
3. BUCCAL
4. MARGINAL MANDIBULAR
5. CERVICAL

21. VASCULAR SUPPLY
THE FACIAL NERVE GETS IT’S BLOOD SUPPLY FROM:
1. ANTERIOR INFERIOR CEREBELLAR ARTERY – AT THE
CEREBELLOPONTINE ANGLE
2. LABYRINTHINE ARTERY (BRANCH OF ANTERIOR INFERIOR CEREBELLAR
ARTERY) – WITHIN INTERNAL ACOUSTIC MEATUS
3. SUPERFICIAL PETROSAL ARTERY (BRANCH OF MIDDLE MENINGEAL
ARTERY) – GENICULATE GANGLION AND NEARBY PARTS

22. 4. STYLOMASTOID ARTERY (BRANCH OF POSTERIOR AURICULAR
ARTERY) – MASTOID SEGMENT
5. POSTERIOR AURICULAR ARTERY SUPPLIES THE FACIAL NERVE
DISTAL TO STYLOMASTOID FORAMEN.
6. VENOUS DRAINAGE PARALLELS THE ARTERIAL BLOOD SUPPLY

23. LANDMARKS OF FACIAL NERVE

24. LANDMARKS FOR EXTRATEMPORAL PART
TRAGAL POINTER OF CONLEY: THE NERVE IS
LOCATED MEDIAL AND ABOUT 1 CM
INFERIOR TO THE TRAGAL CARTILAGE
TYMPANOMASTOID SUTURE: THIS IS LOCATED
AT THE APEX OF THE VAGINO-MASTOID ANGLE
OR VALLEY OF THE NERVE .
THE FACIAL NERVE RUNS DEEP TO THIS SUTURE.

25. STYLOID PROCESS: THE NERVE PASSES LATERAL
TO THE STYLOID.
TENDON OF POSTERIOR BELLY OF DIGASTRIC
MUSCLE: THE MAIN TRUNK OF THE NERVE CAN BE
FOUND MIDWAY BETWEEN THE CARTILAGINOUS POINTER
OF THE EXTERNAL ACCOUSTIC MEATUS AND THE POSTERIOR
BELLY OF DIGASTRIC MUSCLE.
POSTERIOR AURICULAR VEIN OR THE RETROMANDIBULAR VEIN

26. LANDMARKS IN THE MASTOID AND MIDDLE EAR
THE COG: IT IS A BONY RIDGE WHICH HANGS FROM THE TEGMEN,
ANTERIOR TO THE HEAD OF THE MALLEUS AND IS USEFUL FOR
IDENTIFYING THE
FIRST GENU
COCHLEARIFORM PROCESS: IT IS INFERIOR TO THE ANTERIOR
PORTION OF THE TYMPANIC SEGMENT OF THE FACIAL NERVE.

27. OVAL WINDOW: IT IS A USEFUL GUIDE TO THE POSTERIOR PORTION OF THE HORIZONTAL
SEGMENT OF THE NERVE. THE NERVE LIES ABOVE THE OVAL WINDOW
LATERAL SEMICIRCULAR CANAL: IT LIES POSTERIOR-
SUPERIOR TO THE SECOND GENU AND IS A
CONSTANT LANDMARK.
RETROFACIAL AIR CELLS: IT HELPS IN DELINEATING
THE MEDIAL ASPECT OF THE VERTICAL SEGMENT
OF THE FACIAL NERVE.

28. LANDMARKS IN THE MIDDLE CRANIAL FOSSA
THE GREATER PETROSAL NERVE IS IDENTIFIED AND FOLLOWED BACKWARDS
TO THE GENICUALATE GANGLION AND FACIAL NERVE IS IDENTIFIED.
IDENTIFICATION OF THE INTERNAL AUDITORY CANAL SINCE IT LIES IN THE
SAME CORONAL PLANE WITH THE EXTERNAL AUDITORY CANAL.
THE BULGE OF THE SEMICIRCULAR CANAL CAN BE IDENTIFIED AND
SUBSEQUENTLY THE INTERNAL AUDITORY CANAL IS IDENTIFIED.

29. VARIATIONS IN FACIAL NERVE

30. • VARIATION 1: FACIAL NERVE GOES
ABOVE THE LATERAL
SEMICIRCULAR CANAL
• VARIATION 2: FACIAL NERVE GOES
ABOVE THE FOOT PLATE OF STAPES
• VARIATION 3: GOES IN BETWEEN
THE COURA OF THE STAPES.
VARIATIONS IN TYMPANIC
SEGMENT

31. • VARIATION 4: GOES INFERIOR TO
THE FOOT PLATE OF STAPES
• VARIATION 5: GOES IN BETWEEN THE
OVAL WINDOW & ROUND WINDOW
• VARIATION 6: GOES BELOW ROUND
WINDOW
• VARIATION 7: NERVE SPLITS

32. VARIATIONS IN MASTOID
SEGMENT
• VARIATION 1: (DORSAL HUMP): HUMPS BELOW
LATERAL
SEMICIRCULAR CANAL
• VARIATION 2: CURVES ANTERIORLY AND
CONTINUES
ABOVE THE FOOT PLATE
• VARIATION 3: VERTICAL PART OF THE NERVE

33. • VARIATION 4: VERTICAL PART OF THE FACIAL
NERVE GOES VERY POSTERIORLY AND STAYS
ABOVE THE SIGMOID SINUS
• VARIATION 5: BIFURCATION OR TRIFURCATION
• VARIATION 6: HYPOPLASIA OF VERTICAL PART
OF FACIAL NERVE

34. NEUROPHYSIOLOGY OF FACIAL NERVE

35. NEUROPHYSIOLOGY OF FACIAL NERVE
FACIAL EXPRESSION DEPENDS ON 7000 MOTOR FIBRES OF THE FACIAL
NERVE FIRING IN UNISON TO BRING ABOUT MUSCULAR CONTRACTION

36. DEGREES OF NERVE INJURY
SEDDON (1943) DESCRIBED THREE TYPES OF NERVE INJURY:
NEUROPRAXIA: PRESSURE ON A PERIPHERAL NERVE CAN BLOCK THE
TRANSMISSION OF THE IMPULSES WITHOUT DEATH AND DEGENERATION OF
THE AXON BEYOND THE SITE OF PRESSURE.
ASSOCIATED WITH LOSS OF MYELIN. THIS IS A REVERSIBLE CONDUCTION
BLOCK.
AXONTEMESIS: SECTIONING OF AN AXON AND RESULTS IN DEATH OF THE
BLOCKED DISTAL SEGMENT.
NEURONTEMESIS: SECTIONING OF THE ENTIRE NERVE TRUNK

37. SUNDERLAND (1978) CLASSIFIED NERVE INJURIES INTO 5 DEGREES.
FIRST DEGREE: INDICATES COMPRESSION OF THE NERVE. IT IS REVERSIBLE.
SECOND DEGREE: THERE IS INTERRUPTION OF THE AXON AND MYELIN.
OCCURS WHEN THE COMPRESSION PERSISTS. HERE, THERE IS LOSS OF AXON
BUT ENDONEURIUM IS INTACT. RECOVERY MAY TAKE MORE THAN 1 – 2
MONTHS.
THIRD DEGREE: THERE IS LOSS OF MYELIN TUBES DUE TO INCREASED
INTRANEURAL PRESSURE. RECOVERY TAKES ABOUT 2 – 4 MONTHS. THERE
MAY NOT BE COMPLETE RECOVERY
FOURTH DEGREE: PARTIAL TRANSECTION OF THE NERVE. RECOVERY IS
POOR.

38. HOUSE AND BRACKMAN FACIAL NERVE GRADING
SYSTEM
APPROVED BY AMERICAN ACADEMY OF OTOLARYNGOLOGY
GRADE I: NORMAL
GRADE II: MILD DYSFUNCTION
FOREHEAD MOTION IS MODERATE TO GOOD.
SLIGHT ASYMMETRY OF THE MOUTH.
EYE CLOSURE COMPLETE
GRADE III: MODERATE DYSFUNCTION
FOREHEAD MOTION IS SLIGHT TO MODERATE.
WEAKNESS OF ANGLE OF THE MOUTH ON MAXIMAL EFFORT
EYE CLOSURE IS INCOMPLETE WITH MAXIMAL EFFORT

39. GRADE IV: MODERATELY SEVERE DYSFUNCTION
NO FOREHEAD MOTION
MOUTH MOVEMENT IS COMPLETE ON MAXIMAL EFFORT
EYE CLOSURE IS INCOMPLETE WITH MAXIMAL EFFORT
GRADE V: SEVERE DYSFUNCTION
NO FOREHEAD MOTION
VERY SLIGHT MOUTH MOVEMENT
EYE CLOSURE IS INCOMPLETE
GRADE VI: TOTAL PARALYSIS

40. DAMAGE TO THE FACIAL NERVE

41. DAMAGE TO THE FACIAL NERVE
THE FACIAL NERVE HAS A WIDE RANGE OF FUNCTIONS. THUS,
DAMAGE TO THE NERVE CAN PRODUCE A VARIED SET OF
SYMPTOMS, DEPENDING ON THE SITE OF THE LESION.

42. INTRACRANIAL LESIONS
• THE MUSCLES OF FACIAL EXPRESSION WILL BE PARALYZED OR SEVERELY
WEAKENED.
• CHORDA TYMPANI – REDUCED SALIVATION AND LOSS OF TASTE ON THE
IPSILATERAL 2/3 OF THE TONGUE.
• NERVE TO STAPEDIUS – IPSILATERAL HYPERACUSIS (HYPERSENSITIVE TO
SOUND).
• GREATER PETROSAL NERVE – IPSILATERAL REDUCED LACRIMAL FLUID
PRODUCTION.

43. EXTRACRANIAL LESIONS
• PAROTID GLAND PATHOLOGY – E.G. A TUMOR, PAROTITIS,
SURGERY.
• INFECTION OF THE NERVE – PARTICULARLY BY THE HERPES VIRUS.
• COMPRESSION DURING FORCEPS DELIVERY – THE NEONATAL
MASTOID PROCESS IS NOT FULLY DEVELOPED, AND DOES NOT
PROVIDE COMPLETE PROTECTION OF THE NERVE.

44. CAUSES OF FACIAL PALSY

45. CAUSES OF FACIAL PALSY
AT BIRTH
• FORCEPS DELIVERY
• MOEBIUS SYNDROME
• DYSTROPHIA MYOTONICA
TRAUMA
A) ACCIDENTAL
• SKULL BASE FRACTURES
• PENETRATING INJURY TO
MIDDLE EAR
• BAROTRAUMA
• SCUBA DIVING
B) IATROGENIC
• MASTOID SURGERY
• PAROTID SURGERY
• POSTAURAL LOCAL
Infections
A) Bacterial
• Otitis media
• Tuberculosis
• Botulism
• Lyme disease
B) Viral
• Ramsay Hunt Syndrome
• Poliomyelitis
C) Fungal
• Mucormycosis
Neoplastic
• Vestibular schwannoma
• Von Recklinghausen’s disease
• Teratoma
• Leukemia
Neurological
• Multiple sclerosis
• Myasthemis gravis
• Encephalitis
Miscellaneous
A) Toxic
• Tetanus
• Diphteria
B)Metabolic
• Diabetes

46. TESTING THE FACIAL NERVE

47. SCHIRMER’S TEST
• A STRIP OF PAPER OF 5 CM X 0.5 CM IS PLACED ON THE LOWER
CONJUNCTIVAL FORNIX OF EACH EYE AND THE PATIENT IS
INTRODUCED TO INHALATION AMMONIA TO ENHANCE LACRIMATION.
• A REDUCED LACRIMATION BY 30% COMPARED TO THE NORMAL SIDE
IS SIGNIFICANT.
SALIVARY FLOW TEST
• A NO. 50/60 POLYETHYLENE CATHETER IS INTRODUCED TO BOTH WHARTON’S
PAPILLAE FOR ABOUT 3 MM.
• THE PATIENT IS GIVEN A FEW DROPS OF LEMON, AND THE NUMBER OF DROPS OF
SALIVA OVER ONE TO FIVE MINUTES IS MONITORED.
• A 25% REDUCTION BETWEEN THE SIDES IS SIGNIFICANT

48. TASTE SENSATION OF THE ANTERIOR 2/3RD OF THE TONGUE
• IT IS BEST ASSESSED USING A ELECTROGUSTOMETRY, HOWEVER, IT IS NOT
PROVED TO BE A USEFUL DIAGNOSTIC TOOL.
STAPEDIAL REFLEX
• THIS TEST ASSESSES THE STAPEDIAL MOVEMENTS BY TYMPANOMETRY.
NERVE CONDUCTION TIME
• IT IS USED TO TEST THE LATENCY RESPONSE OF A MUSCLE (INNERVATED BY
FACIAL NERVE) ON ELECTRICAL STIMULATION.
NERVE EXCITABILITY TEST
• PERFORMED BY STIMULATING THE NERVE AT THE STYLOMASTOID FORAMEN
AND IS DETERMINED BY A TWITCH RESPONSE IN THE FACIAL MUSCULATURE.
BLINK TEST
• THIS TEST IS DONE BY ELECTRICALLY STIMULATING THE NERVE AT THE
SUPRAORBITAL FORAMEN.

49. OTHER TESTS INCLUDE:
ELECTROMYOGRAPHY
MAXIMAL STIMULATION TEST
ELECTRONEUROGRAPHY
MAGNETIC STIMULATION

50. BELL’S PALSY

51. BELL’S PALSY
DESCRIBED BY SIR CHARLES BELL (1829)
IT IS AN ACUTE IDIOPATHIC LOWER MOTOR NEURON PALSY OF
THE FACIAL NERVE THAT IS UNILATERAL, SELF LIMITING, NON-
PROGRESSIVE, NON LIFE THREATENING AND SPONTANEOUSLY
REMITS BY 4-6 MONTHS AND ALWAYS BY 1 YEAR.

52. THEORIES
VASCULAR ISCHEMIC THEORY
IN THIS THEORY, THERE IS DECREASE IN CIRCULATION TO THE FACIAL
NERVE WHICH IS BELIEVED TO BE DUE TO THE INTERRUPTION OF A NUTRIENT
VESSEL.
VIRAL THEORY
IT IS CONCLUDED THAT BELL’S PALSY IS AN ACUTE BENIGN CRANIAL
POLYNEURITIS CAUSED BY THE REACTIVATION OF HERPES SIMPLEX VIRUS.
THE VIRUS REPLICATES IN THE GANGLION CELLS CAUSING LOCAL DAMAGE
AND HYPOFUNCTION OF THE NERVES THEREFORE PREVENTING

53. HEREDITARY THEORY
A FAMILIAL ANATOMIC VARIATION IN THE FACIAL CANAL (BONY
CONSTRICTION) MAY ACCOUNT FOR A GREATER TENDENCY TOWARDS
THE DEVELOPMENT OF FACIAL PALSY.
IT IS BELIEVED TO BE A RECESSIVE TRAIT.

54. EXAMINATION
DIFFERENTIATE BETWEEN UPPER MOTOR LESION (UML) OR LOWER MOTOR MOTOR
NEURON LESION (LML)
IN UML, THE FRONTALIS MUSCLE IS SPARED ALLOWING NORMAL FURROWING OF
EYE BROW AND EYE BLINKING.
IN LML, ALL THE MUSCLES OF FACIAL EXPRESSION ARE
AFFECTED ON ONE SIDE.
EYE CLOSURE (ORBICULARIS OCULI)
WIDE SMILE
BLOWING (BUCCINATOR, ORBICULARIS ORIS)

55. CLINICAL FEATURES
• RAPID ONSET OF MILD WEAKNESS TO TOTAL PARALYSIS ON ONE SIDE OF THE FACE.
• FACIAL DROOP AND DIFFICULTY IN MAKING EXPRESSIONS.
• INCREASED SENSITIVITY TO SOUND.
• DECREASED ABILITY TO TASTE.
• DRIPPING OF SALIVA (WEIR, PENTLAND & MURRAY, 1993)
• ACCUMULATION OF FOOD INSIDE THE CHEEK.
• PAIN AROUND THE JAW AND/OR BEHIND EAR OF THE AFFECTED SIDE.
• FLATTENING OF THE NASOLABIAL FOLD.

56. MANAGEMENT
MEDICAL MANAGEMENT
PREDNISOLONE 1MG/KG/DAY OR 60 MG GIVEN ORALLY
ACYCLOVIR 200 TO 400 MG GIVEN ORALLY
VASODILATORS LIKE XANITOL
ASCORBIC ACID
MULTIVITAMINS LIKE B1, B6 AND B12
SURGICAL TREATMENT
FACIAL NERVE DECOMPRESSION IN CASE OF NO IMPROVEMENT AFTER 3 WEEKS OF
MEDICAL TREATMENT.

57. CONCLUSION
SURGEONS HAVE TO PAY ATTENTION TO MINIMIZE THE RISK OF COMPLICATION
DURING PAROTIDECTOMY.
THE BEST WAY TO REDUCE IATROGENIC FACIAL NERVE INJURY IS TO HAVE A CLEAR
UNDERSTANDING OF THE ANATOMY, GOOD SURGICAL TECHNIQUE AND USE OF
MULTIPLE LANDMARKS.
THE PATIENT HAS TO BE INFORMED ABOUT THE COSMETIC SEQUELAE OF THE
INCISION AND ALL PATIENTS HAVE TO BE TOLD THAT FACIAL NERVE PARALYSIS IS
POSSIBLE AND CAN BE PARTIAL OR TOTAL, TEMPORARY OR PERMANENT.

58. REFERENCES
B.D. CHAURASIA’S HUMAN ANATOMY VOLUME III
ATLAS OF FACIAL NERVE SURGERY EDITION II

59. THANK
YOU