This document provides information on facial palsy (facial paralysis), including:
1. It discusses the anatomy of the facial nerve and different classifications of nerve injuries.
2. Common causes of facial palsy are also outlined, such as Bell's palsy which is an idiopathic sudden onset paralysis of the facial nerve.
3. Evaluation and assessment of facial nerve function is described, including tests of tear production, taste, saliva flow, and electrical nerve testing to determine the severity and likely prognosis of the palsy.
The term facial palsy generally refers to weakness of the facial muscles, mainly resulting from temporary or permanent damage to the facial nerve
Facial palsy not only cause a paresis of the target muscles, but as the nerve is responsible for a range of facial expressions, it causes serious disturbances in social life, facial expression being so important in transferring emotion.
The document summarizes the anatomy and clinical applications of the facial nerve. It begins with the nuclear origin and functional components of the facial nerve. It then describes the intra cranial and extra cranial course of the nerve, its branches including the greater petrosal, chorda tympani, and terminal branches. Applications including facial nerve palsy, Bell's palsy, and preventing injury during dental procedures are discussed. Clinical testing and special tests of facial nerve function are also outlined.
This document provides an overview of the anatomy and embryology of the facial nerve (cranial nerve VII). It discusses the nuclei of origin, functional components, course through the skull and branches/distribution. Key points include that the facial nerve has motor, secretomotor and sensory fibers and exits the skull via the stylomastoid foramen. It describes associated ganglia like the geniculate ganglion and presents variations, disorders like Bell's palsy, and evaluation methods involving tests of motor/sensory function.
The document provides information on facial palsy/paralysis, including its causes, symptoms, diagnosis, and treatment options. It discusses how facial palsy can result from various congenital, traumatic, infectious, neoplastic, and metabolic disorders. Diagnostic tests are described that evaluate different branches of the facial nerve, such as the Schirmer test for the lacrimal branch. Management includes medical approaches like corticosteroids as well as surgical options when needed like nerve decompression or microsurgery. Prognosis depends on factors like results from electrophysiological tests measured within the first weeks.
This document provides information on the facial nerve (cranial nerve VII) including its embryology, anatomy, functions, and various disorders. It discusses the facial nerve's motor and sensory roles. Disorders covered include Bell's palsy, Ramsay Hunt syndrome, Moebius syndrome, and Guillain-Barré syndrome. Classification systems for facial nerve paralysis and nerve injuries are also summarized. The document provides detailed information on evaluating facial nerve disorders.
This document provides information on physiotherapy treatment for Bell's palsy. It begins with an overview of Bell's palsy, including its causes, symptoms, and grading scales. It then discusses specific assessments, including cranial nerve and facial muscle testing. Treatment approaches covered include corticosteroids, antiviral medications, eye care, facial exercises, electrical stimulation, massage, and rarely, surgery. Outcome measures used to evaluate recovery are also outlined.
Facial palsy, or facial paralysis, can be caused by lesions of the facial nerve that disrupt motor function on one side of the face. It is commonly unilateral and can result from various etiologies like Bell's palsy, tumors, trauma, or infections. Clinical features include weakness or paralysis of facial muscles on the affected side leading to issues like eyelid drooping, inability to fully close the eye, and drooping of the mouth corner. Treatment involves facial exercises and in severe cases, surgery or implants may help restore more natural movement. Prognosis is generally good with many cases recovering normal function, but some are left with minor to severe long-term weakness or contractures.
The term facial palsy generally refers to weakness of the facial muscles, mainly resulting from temporary or permanent damage to the facial nerve
Facial palsy not only cause a paresis of the target muscles, but as the nerve is responsible for a range of facial expressions, it causes serious disturbances in social life, facial expression being so important in transferring emotion.
The document summarizes the anatomy and clinical applications of the facial nerve. It begins with the nuclear origin and functional components of the facial nerve. It then describes the intra cranial and extra cranial course of the nerve, its branches including the greater petrosal, chorda tympani, and terminal branches. Applications including facial nerve palsy, Bell's palsy, and preventing injury during dental procedures are discussed. Clinical testing and special tests of facial nerve function are also outlined.
This document provides an overview of the anatomy and embryology of the facial nerve (cranial nerve VII). It discusses the nuclei of origin, functional components, course through the skull and branches/distribution. Key points include that the facial nerve has motor, secretomotor and sensory fibers and exits the skull via the stylomastoid foramen. It describes associated ganglia like the geniculate ganglion and presents variations, disorders like Bell's palsy, and evaluation methods involving tests of motor/sensory function.
The document provides information on facial palsy/paralysis, including its causes, symptoms, diagnosis, and treatment options. It discusses how facial palsy can result from various congenital, traumatic, infectious, neoplastic, and metabolic disorders. Diagnostic tests are described that evaluate different branches of the facial nerve, such as the Schirmer test for the lacrimal branch. Management includes medical approaches like corticosteroids as well as surgical options when needed like nerve decompression or microsurgery. Prognosis depends on factors like results from electrophysiological tests measured within the first weeks.
This document provides information on the facial nerve (cranial nerve VII) including its embryology, anatomy, functions, and various disorders. It discusses the facial nerve's motor and sensory roles. Disorders covered include Bell's palsy, Ramsay Hunt syndrome, Moebius syndrome, and Guillain-Barré syndrome. Classification systems for facial nerve paralysis and nerve injuries are also summarized. The document provides detailed information on evaluating facial nerve disorders.
This document provides information on physiotherapy treatment for Bell's palsy. It begins with an overview of Bell's palsy, including its causes, symptoms, and grading scales. It then discusses specific assessments, including cranial nerve and facial muscle testing. Treatment approaches covered include corticosteroids, antiviral medications, eye care, facial exercises, electrical stimulation, massage, and rarely, surgery. Outcome measures used to evaluate recovery are also outlined.
Facial palsy, or facial paralysis, can be caused by lesions of the facial nerve that disrupt motor function on one side of the face. It is commonly unilateral and can result from various etiologies like Bell's palsy, tumors, trauma, or infections. Clinical features include weakness or paralysis of facial muscles on the affected side leading to issues like eyelid drooping, inability to fully close the eye, and drooping of the mouth corner. Treatment involves facial exercises and in severe cases, surgery or implants may help restore more natural movement. Prognosis is generally good with many cases recovering normal function, but some are left with minor to severe long-term weakness or contractures.
This document discusses techniques for reanimating facial paralysis. It begins by outlining general principles, including reinnervating muscles early, separately reanimating the upper and lower face, and tailoring the procedure to the patient's needs and assessment. Surgical techniques are then described, including neural methods like nerve grafting and transfers, musculofacial transpositions, and static procedures. The timing of different techniques depends on whether the paralysis is acute (<3 weeks), intermediate (3 weeks to 2 years), or chronic (>2 years). Assessment involves evaluating the cause and extent of paralysis along with patient factors. The goal is to restore facial symmetry, competence, protection, and dynamic smile.
This document provides information on the surgical anatomy of the facial nerve. It begins with an introduction to the facial nerve and its functional components and nuclei. It then describes the different parts of the facial nerve from its intracranial portion to its extra-temporal portion in the neck. Several clinical considerations are discussed, including Bell's palsy, Ramsay Hunt syndrome, and Guillain-Barre syndrome. Surgical techniques for facial nerve repair are outlined, including nerve grafting and substitution techniques like hypoglossal-facial nerve crossover. In summary, this document details the anatomy and clinical implications of the facial nerve as well as surgical strategies for repairing injuries to this nerve.
Anatomy of facial nerve/certified fixed orthodontic courses by Indian dental ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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The document discusses the muscles of facial expression (mimetic muscles) that are innervated by the facial nerve (cranial nerve VII). It describes the various muscle groups - orbicular, nasal, oral and others. It details each individual muscle, their origin, insertion and function. The document also discusses applied anatomy concepts like Bell's palsy, Parkinson's disease, Ramsay Hunt syndrome and others where these facial muscles are involved. It provides clinical features and diagnostic evaluation for certain conditions. Overall, the document is a detailed overview of the facial expression muscles, their function and involvement in various clinical scenarios.
The document discusses the anatomy and clinical examination of the facial nerve. It describes the facial nerve's anatomy from its supranuclear pathways in the brain to its peripheral branches in the face. Regarding clinical examination, it outlines how to assess the motor functions of the facial nerve by inspecting facial symmetry and movements. It also describes how to test the nerve's branches and examine reflexes, sensory functions, and secretory functions. The document distinguishes between peripheral and central facial palsies and provides localization of lesions that can affect the facial nerve.
This document provides an overview of the anatomy and clinical management of Bell's palsy. It describes the course of the facial nerve from its central pathways through the various segments in the skull and temporal bone. Key points include use of steroids and possibly antivirals within 72 hours, eye protection for impaired closure, and selective use of electrodiagnostic testing or decompression surgery for patients with complete paralysis. Management aims to reduce inflammation and promote recovery of facial nerve function.
The document discusses the muscles of facial expression and mastication. It provides details on the origin, insertion, function and nerve supply of the main facial muscles including the orbicularis oculi, corrugator supercili, and zygomaticus major. It also discusses the muscles of mastication - masseter, temporalis, lateral pterygoid, and medial pterygoid - and their roles in elevating and moving the mandible for chewing. The document emphasizes the importance of understanding facial muscle anatomy for areas like prosthodontics and in treating patients with facial paralysis.
FACIAL NERVE DYSFUNCTION AFTER SUPERFICIAL PAROTIDECTOMY WITH OR.pptxabishekanish
This study aimed to compare rates of facial nerve dysfunction after superficial parotidectomy with and without continuous intraoperative electromyographic monitoring. The prospective randomized pilot study assigned patients undergoing superficial parotidectomy for parotid tumors to either standard surgery alone or surgery with continuous electromyographic monitoring of the facial nerve. The main outcome measured was rates of transient facial nerve dysfunction within the first postoperative week. The study aimed to provide insight into whether continuous electromyographic monitoring during surgery could help reduce rates of facial nerve injury and dysfunction.
The facial nerve is the seventh cranial nerve, or simply CN VII. It emerges from the pons of the brainstem, controls the muscles of facial expression, and functions in the conveyance of taste sensations from the anterior two-thirds of the tongue.
A 40-year-old man presented with a unilateral facial weakness for 2 days. The history and examination are important to determine the cause, which could be Bell's palsy, Ramsay Hunt syndrome, infection, trauma, tumors or other central nervous system issues. Specific questions focus on ear symptoms, trauma history, medications, and family history. Examination includes grading the facial weakness, ear/mastoid exam, and cranial nerve assessment. Initial workup may include blood tests, imaging, and biopsy depending on findings. Treatment focuses on eye protection and managing any identifiable causes like herpes zoster or tumors.
This document discusses the anatomy and functional components of the facial nerve (cranial nerve VII). It describes the course and branches of the facial nerve from its nuclei in the brainstem through the temporal bone. Key points include that the facial nerve has both motor and sensory fibers, and innervates the muscles of facial expression as well as the lacrimal and salivary glands. Tests to localize lesions of the facial nerve include the Schirmer test for lacrimation, stapedius reflex test, and taste/electrogustometry testing.
This document discusses the anatomy and function of the facial nerve (cranial nerve VII). It begins by describing the supranuclear and infranuclear pathways of the facial nerve from the brain to the muscles of facial expression. It then discusses the facial nucleus and branches of the facial nerve. The document outlines the muscles innervated by branches of the facial nerve and clinical examination of the facial nerve's motor, sensory and secretory functions. Finally, it describes various disorders of facial nerve function including Bell's palsy, central facial palsy, and other causes of peripheral facial paralysis.
The cranial nerves VII-XII control facial expression and innervate muscles of the face and neck. The facial nerve is commonly damaged and can cause Bell's palsy with paralysis of facial muscles on one side. Damage to different branches causes specific symptoms like taste loss or ear problems. Most Bell's palsy cases recover on their own but steroids may speed recovery. The facial nerve exits the skull and splits into branches innervating individual facial muscles. Central facial palsy spares forehead muscles while peripheral lesions weaken all facial muscles on one side.
(Neurology) trigeminal neuralgia and facial paralysis in pashto language by d...Kalimullah Wardak
The document discusses various neurological conditions involving the trigeminal nerve and facial nerve including trigeminal neuralgia, facial weakness, and Bell's palsy. It covers the anatomy, etiology, clinical manifestations, differential diagnosis and management of these conditions. Key points include that trigeminal neuralgia causes excruciating facial pain, facial weakness can result from lesions in the pons or facial nerve, and Bell's palsy is an acute, isolated, idiopathic paralysis of the facial nerve that typically has good recovery.
This document provides an overview and update on facial palsy. It discusses the functions of the face, including displaying emotions, communication, sensory functions, and physical roles. Facial nerve lesions can be central or peripheral. Bell's palsy is described as an idiopathic peripheral facial paralysis. Treatment options discussed include steroids, antivirals, physical therapy techniques like exercises and mime therapy, and a functional training program. Chronic facial palsy can cause issues like synkinesis, asymmetry, and psychological impacts that rehabilitation aims to address.
This document discusses techniques for reanimating facial paralysis. It begins by outlining general principles, including reinnervating muscles early, separately reanimating the upper and lower face, and tailoring the procedure to the patient's needs and assessment. Surgical techniques are then described, including neural methods like nerve grafting and transfers, musculofacial transpositions, and static procedures. The timing of different techniques depends on whether the paralysis is acute (<3 weeks), intermediate (3 weeks to 2 years), or chronic (>2 years). Assessment involves evaluating the cause and extent of paralysis along with patient factors. The goal is to restore facial symmetry, competence, protection, and dynamic smile.
This document provides information on the surgical anatomy of the facial nerve. It begins with an introduction to the facial nerve and its functional components and nuclei. It then describes the different parts of the facial nerve from its intracranial portion to its extra-temporal portion in the neck. Several clinical considerations are discussed, including Bell's palsy, Ramsay Hunt syndrome, and Guillain-Barre syndrome. Surgical techniques for facial nerve repair are outlined, including nerve grafting and substitution techniques like hypoglossal-facial nerve crossover. In summary, this document details the anatomy and clinical implications of the facial nerve as well as surgical strategies for repairing injuries to this nerve.
Anatomy of facial nerve/certified fixed orthodontic courses by Indian dental ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The document discusses the muscles of facial expression (mimetic muscles) that are innervated by the facial nerve (cranial nerve VII). It describes the various muscle groups - orbicular, nasal, oral and others. It details each individual muscle, their origin, insertion and function. The document also discusses applied anatomy concepts like Bell's palsy, Parkinson's disease, Ramsay Hunt syndrome and others where these facial muscles are involved. It provides clinical features and diagnostic evaluation for certain conditions. Overall, the document is a detailed overview of the facial expression muscles, their function and involvement in various clinical scenarios.
The document discusses the anatomy and clinical examination of the facial nerve. It describes the facial nerve's anatomy from its supranuclear pathways in the brain to its peripheral branches in the face. Regarding clinical examination, it outlines how to assess the motor functions of the facial nerve by inspecting facial symmetry and movements. It also describes how to test the nerve's branches and examine reflexes, sensory functions, and secretory functions. The document distinguishes between peripheral and central facial palsies and provides localization of lesions that can affect the facial nerve.
This document provides an overview of the anatomy and clinical management of Bell's palsy. It describes the course of the facial nerve from its central pathways through the various segments in the skull and temporal bone. Key points include use of steroids and possibly antivirals within 72 hours, eye protection for impaired closure, and selective use of electrodiagnostic testing or decompression surgery for patients with complete paralysis. Management aims to reduce inflammation and promote recovery of facial nerve function.
The document discusses the muscles of facial expression and mastication. It provides details on the origin, insertion, function and nerve supply of the main facial muscles including the orbicularis oculi, corrugator supercili, and zygomaticus major. It also discusses the muscles of mastication - masseter, temporalis, lateral pterygoid, and medial pterygoid - and their roles in elevating and moving the mandible for chewing. The document emphasizes the importance of understanding facial muscle anatomy for areas like prosthodontics and in treating patients with facial paralysis.
FACIAL NERVE DYSFUNCTION AFTER SUPERFICIAL PAROTIDECTOMY WITH OR.pptxabishekanish
This study aimed to compare rates of facial nerve dysfunction after superficial parotidectomy with and without continuous intraoperative electromyographic monitoring. The prospective randomized pilot study assigned patients undergoing superficial parotidectomy for parotid tumors to either standard surgery alone or surgery with continuous electromyographic monitoring of the facial nerve. The main outcome measured was rates of transient facial nerve dysfunction within the first postoperative week. The study aimed to provide insight into whether continuous electromyographic monitoring during surgery could help reduce rates of facial nerve injury and dysfunction.
The facial nerve is the seventh cranial nerve, or simply CN VII. It emerges from the pons of the brainstem, controls the muscles of facial expression, and functions in the conveyance of taste sensations from the anterior two-thirds of the tongue.
A 40-year-old man presented with a unilateral facial weakness for 2 days. The history and examination are important to determine the cause, which could be Bell's palsy, Ramsay Hunt syndrome, infection, trauma, tumors or other central nervous system issues. Specific questions focus on ear symptoms, trauma history, medications, and family history. Examination includes grading the facial weakness, ear/mastoid exam, and cranial nerve assessment. Initial workup may include blood tests, imaging, and biopsy depending on findings. Treatment focuses on eye protection and managing any identifiable causes like herpes zoster or tumors.
This document discusses the anatomy and functional components of the facial nerve (cranial nerve VII). It describes the course and branches of the facial nerve from its nuclei in the brainstem through the temporal bone. Key points include that the facial nerve has both motor and sensory fibers, and innervates the muscles of facial expression as well as the lacrimal and salivary glands. Tests to localize lesions of the facial nerve include the Schirmer test for lacrimation, stapedius reflex test, and taste/electrogustometry testing.
This document discusses the anatomy and function of the facial nerve (cranial nerve VII). It begins by describing the supranuclear and infranuclear pathways of the facial nerve from the brain to the muscles of facial expression. It then discusses the facial nucleus and branches of the facial nerve. The document outlines the muscles innervated by branches of the facial nerve and clinical examination of the facial nerve's motor, sensory and secretory functions. Finally, it describes various disorders of facial nerve function including Bell's palsy, central facial palsy, and other causes of peripheral facial paralysis.
The cranial nerves VII-XII control facial expression and innervate muscles of the face and neck. The facial nerve is commonly damaged and can cause Bell's palsy with paralysis of facial muscles on one side. Damage to different branches causes specific symptoms like taste loss or ear problems. Most Bell's palsy cases recover on their own but steroids may speed recovery. The facial nerve exits the skull and splits into branches innervating individual facial muscles. Central facial palsy spares forehead muscles while peripheral lesions weaken all facial muscles on one side.
(Neurology) trigeminal neuralgia and facial paralysis in pashto language by d...Kalimullah Wardak
The document discusses various neurological conditions involving the trigeminal nerve and facial nerve including trigeminal neuralgia, facial weakness, and Bell's palsy. It covers the anatomy, etiology, clinical manifestations, differential diagnosis and management of these conditions. Key points include that trigeminal neuralgia causes excruciating facial pain, facial weakness can result from lesions in the pons or facial nerve, and Bell's palsy is an acute, isolated, idiopathic paralysis of the facial nerve that typically has good recovery.
This document provides an overview and update on facial palsy. It discusses the functions of the face, including displaying emotions, communication, sensory functions, and physical roles. Facial nerve lesions can be central or peripheral. Bell's palsy is described as an idiopathic peripheral facial paralysis. Treatment options discussed include steroids, antivirals, physical therapy techniques like exercises and mime therapy, and a functional training program. Chronic facial palsy can cause issues like synkinesis, asymmetry, and psychological impacts that rehabilitation aims to address.
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Basics of Electrocardiogram
CONTENTS
●Conduction System of the Heart
●What is ECG or EKG?
●ECG Leads
●Normal waves of ECG.
●Dimensions of ECG.
● Abnormalities of ECG
CONDUCTION SYSTEM OF THE HEART
ECG:
●ECG is a graphic record of the electrical activity of the heart.
●Electrical activity precedes the mechanical activity of the heart.
●Electrical activity has two phases:
Depolarization- contraction of muscle
Repolarization- relaxation of muscle
ECG Leads:
●6 Chest leads
●6 Limb leads
1. Bipolar Limb Leads:
Lead 1- Between right arm(-ve) and left arm(+ve)
Lead 2- Between right arm(-ve) and left leg(+ve)
Lead 3- Between left arm(-ve)
and left leg(+ve)
2. Augmented unipolar Limb Leads:
AvR- Right arm
AvL- Left arm
AvF- Left leg
3.Chest Leads:
V1 : Over 4th intercostal
space near right sternal margin
V2: Over 4th intercostal space near left sternal margin
V3:In between V2 and V4
V4:Over left 5th intercostal space on the mid
clavicular line
V5:Over left 5th intercostal space on the anterior
axillary line
V6:Over left 5th intercostal space on the mid
axillary line.
Normal ECG:
Waves of ECG:
P Wave
•P Wave is a positive wave and the first wave in ECG.
•It is also called as atrial complex.
Cause: Atrial depolarisation
Duration: 0.1 sec
QRS Complex:
•QRS’ complex is also called the initial ventricular complex.
•‘Q’ wave is a small negative wave. It is continued as the tall ‘R’ wave, which is a positive wave.
‘R’ wave is followed by a small negative wave, the ‘S’ wave.
Cause:Ventricular depolarization and atrial repolarization
Duration: 0.08- 0.10 sec
T Wave:
•‘T’ wave is the final ventricular complex and is a positive wave.
Cause:Ventricular repolarization Duration: 0.2 sec
Intervals and Segments of ECG:
P-R Interval:
•‘P-R’ interval is the interval
between the onset of ‘P’wave and onset of ‘Q’ wave.
•‘P-R’ interval cause atrial depolarization and conduction of impulses through AV node.
Duration:0.18 (0.12 to 0.2) sec
Q-T Interval:
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and ventricular repolarization,
i.e. it signifies the
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Duration:0.4-0.42sec
S-T Segment:
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Duration: 0.08 sec
R-R Interval:
•‘R-R’ interval is the time interval between two consecutive ‘R’ waves.
•It signifies the duration of one cardiac cycle.
Duration: 0.8 sec
Dimension of ECG:
How to find heart rhytm of the heart?
Regular rhytm:
Irregular rhytm:
More than or less than 4
How to find heart rate using ECG?
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300/No.of large b/w 2 QRS complex
= 300/4
=75 beats/mins
How to find heart rate using ECG?
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3. • "The human face is the organic seat of
beauty. It is the register of value in
development, a record of Experience,
whose legitimate office is to perfect the
life, a legible language to those who will
study it, of the majestic mistress, the
soul."
• Farnham, Eliza
QUOTE
5. INTRODUCTION
• Facial function plays an integral part in our
everyday lives
– Smile; nonverbal communication, etc.
• Facial paralysis is devastating on many levels
– Functional
– Cosmetic
• Fortunately, a plethora of techniques are
available to treat the paralyzed face.
6. NERVE FIBER COMPONENTS
• Endoneurium
– Surrounds each axon
– Adherent to Schwann cell
layer
– Vital for regeneration
• Perineurium
– Encases endoneural tubules
– Tensile strength
– Barrier to infection
• Epineurium (nerve sheath)
– Outermost layer
– Houses vasa nervosum for
nutrition
7. NERVE INJURY
• Two acceptable classification schemes used
to describe the histologic changes that occur
following nerve injury.
8. SEDDON CLASSIFICATION (1943)
• Neurapraxia-a conduction block from
transient anoxia owing to acute
epineurial/endoneurial vascular interruption
resulting from mild nerve manipulation with
rapid and complete recovery of sensation.
• Axonotmesis- This damage extends through
and includes the endoneurium with no
significant axonal disorganization.
Recovery is slow and may take weeks to
months, and it may not be complete.
• Neurotmesis- injuries result from complete
or near complete transection of the nerve
with epineurial discontinuity and likely
neuroma formation. Spontaneous
neurosensory recovery is unlikely.
12. 7th Cranial nerve
Nerve of the 2nd branchial
arch
Has two roots. A large
motor and a smaller mixed
sensory and
parasympathetic (nervus
intermedius)
FACIAL NERVE
13.
14. FUNCTIONAL COMPONENTS
• Brancial motor(special visceral efferent)-
Supplies; Stapedius , Stylohyoid,
posterior belly of digastric muscle and the
muscles of facial expression.
• Visceral motor(general visceral efferent)
Parasympathetic innervations of the
lacrimal, submandibular, and sublingual
glands, as well as mucous membranes of
nasopharynx, hard and soft palate.
•Special sensory(special afferent)-Taste sensation from the anterior 2/3 of tongue;
hard and soft palates.
•General sensory(general somatic afferent)-General sensation from the skin of the
concha of the auricle and from a small area behind the ear.
15. The facial nerve is
responsible for:
I. Contraction of the
muscles of the face
II. Production of tears from a
gland (Lacrimal gland)
III. Conveying the sense of
taste from the front part
of the tongue (via the
Chorda tympani nerve)
IV. The sense of touch at
auricular conchae
17. FACIAL PARALYSIS
Commonly Unilateral
Nuclear- from
destruction of the
nucleus
Central or cerebral or
Supranuclear
Peripheral- from a lesion
of the nerve
18. NUCLEAR LESIONS
Supranuclear lesions-
usually a part of hemiplegia,
only the lower part of the
face is paralysed. The upper
part (frontalis and part of
orbicularis oculi)escapes due
to bilateral representation in
the cerebral cortex.
Infranuclear lesions- entire
face is paralysed, as seen in
bell’s palsy
19.
20. ETIOLOGIC CLASSIFICATON OF FACIAL
PALSY
Various classification have been suggested in this
respect.
Based on:
Course of the nerve
Various etiologic causes
Degree of dysfunction observed
21. Vascular abnormalities
CNS degenerative diseases
Tumours of the intracranial cavity
Trauma to the brain
Congenital abnormalities and agenesis
INTRACRANIAL (CENTRAL) CAUSES
22. Bacterial and Viral infection
Cholesteatoma
Trauma- blunt temporal bone trauma,
longitudinal and horizontal fractures of the
temporal bone and gunshot wounds.
Tumours invading the middle ear, mastoid and
facial nerve
Iatrogenic causes
INTRATEMPORAL CAUSES
23. Malignant tumours of the parotid gland
Trauma
Iatrogenic causes
Primary tumours of the facial nerve
Malignant tumours of the ascending ramus of the
mandible, pterygoid region and skin.
EXTRACRANIAL CAUSES
25. HOUSE-BRACKMAN(1985) CLASSIFICATION
• Grade I-normal function without weakness.
• Grade II-mild dysfunction with sligth facial asymmetry
with a minor degree of synkinesis.
• Grade III-moderate dysfunctions-obvious, but not
disfiguring, asymmetry with contracture and/or
hemifacial spasm, but residual forehead motion and
incomplete eye closure.
• Grade IV-moderately severe dysfunction- obvious,
disfiguring asymmetry with lack of forehead motion and
incomplete eye closure.
• Grade V-severe dysfunction-asymmetry at rest and only
slight facial movement.
• Grade VI-total paralysis-complete absence of tone or
motion.
27. BELL’S PALSY
• It is defined as an idiopathic
paresis or paralysis of the facial
nerve of sudden onset.
• The name was ascribed to SIR
CHARLES BELL, who in 1821
demonstrated the separation of
motor and sensory innervation of
face.
28. • INCIDENCE-15-40 cases per 1 lakh cases
• SEX PREDILECTION- women more affected
than men.3.3 more times common in
pregnancy and in the third trimester.
• AGE- can occur at any age, common in middle
aged people.
• SIDE INVOLVMENT- can be equally seen,
usually unilateral.
29. CLINICAL FEATURES
• There is sudden onset, usually pt gives h/o
occurrence after awakening early morning.
• Unilateral involvement of entire side of the
face.
• Abrupt loss of muscular on one side of face.
• Inability to smile, close the eye or raise the
eyebrow on affected side.
• Whistling is not possible.
30. • In an attempt to close eyelid, the eyeball
rolls upward.
• Inability to wrinkle forehead or elevate
upper or lower lip.
• Obliteration of nasolabial fold.
Face appears distorted and mask like
appearance to the facial features.
Speech becomes slurred.
Occasionally there is loss or alternative of
taste.
31. Partial paralysis always resolves completely within a few
weeks.
Recovery from complete paralysis takes longer (months)
and is complete in only about 60-70% of cases.
Approximately 15% of patients are left with troublesome
residual palsy and or synkinesis.
32. COMPLICATIONS OF FACIAL PARALYSIS
Facial paralysis severely hinders:
• Normal facial expressions
• Mastication
• Speech production
• Eye protection.
33. Psychological Trauma
• The most significant complication is the social
isolation these patients often succumb to.
34. The most serious complication is corneal damage.
One of the greatest problems with Bell's palsy is the involvement of
the eye if the lid fissure remains open.
In this case, eye care focuses on protecting the cornea from
dehydration, drying, or abrasions due to insufficient lid closure or
tearing
35. ASSESSMENT AND PLANNING
Cause of facial paralysis
Functional deficit/extent of paralysis
Time course/duration of paralysis
Likelihood of recovery
Other cranial nerve deficits
Patient’s life expectancy
Patient’s needs/expectations
36. EVALUATIONS OF NERVE FUNCTION
• HISTORY is of vital importance to establish the
onset characteristics,duration and degree of
recovery.
• Previous trauma, surgery or infection may help in
arriving at a diagnosis
• Examination of the face at rest and movement.
• Radiolologic evaluations
• Nerve excitability tests.
37. • TEAR TEST: (Schirmer’s test)
• Semiquantitative method for comparing lacrimal
secretion on normal & affected side.
• 0.5×5cm strip of filter paper.
• If moistened length in affected side <25% of
normal: significant hyposecretion is present.
38. TASTE
CHORDA TYMPANI:
• Subjective loss of sensation: unreliable symptom.
• Swab sides of tongue by a cotton applicator dipped in lemon juice.
• Threshold measured with electrogustometer (measured electric
current). N:30gk microamp
• Patient percieves this as sour or metallic.
SALIVARY FLOW
• Cannulate wharton duct on each side with no.50 polyethylene tube
• Stimulate saliva with lemon juice
• Output of saliva measured in each tube
• 25% reduction is significant
• Indicates interruption of chorda tympani or facial nerve to this branch.
• LIMITATIONS- Unequal penetration of cannula, assymetry of glands.
39. ELECTRICAL TESTING OF FACIAL NERVE
MAXIMUM STIMULATION TEST
• Pulsed electric current is delivered through a cutaneous
electrode
• Short pulse will stimulate an intact nerve & elicit a
muscular twitch.
• In paralysed facial nerve, this indicates that lesion is
neuropraxia & distal neurons have not undergone
degeneration
• Hence differentiates between neuropraxia & axonotmesis:
prognostic value.
40. NERVE EXCITABILITY TEST:
• Current required for stimulation on normal side is compared with
paralysed side.
• Disadv: even few intact fibres can elicit a response when rest in
undergoing degeneration.
Muscle twitch response is subjective
Uncomfortable procedure
Requires patient co-operation
ELECTRONEUROGRAPHY
• Measures compound action potential in facial muscles in response to
facial nerve stimulation.
• Similar to MST, except instead of visually ration the muscle
contraction, the muscle action potential is measured on EEG- more
accurate.
• Best test to predict & follow facial nerve recovery.
• Compare & represent it as percentage of normal side.
41. Treatment
• Oral antivirals - Acyclovir
• Corticosteroids
• Eye protection
• Follow progression with serial exams
• Physiotherapy
42. MEDICATION
• If the patient is seen within 2 to 3 weeks of onset
of symptoms-tab. Prednisolone in doses of
1mg/kg/d for 10 to 14 days has been
recommended with a gradual tapering.
• Vitamins B1, B6, B12 may be administered.
• If pt is seen after 3-4 weeks, then steroid therapy
is of no use.
44. A. Acute (< 3 wks)
1. Nerve exploration/decompression
2. Nerve repair
a. Primary anastomosis
b. Cable grafting
i. Great auricular nerve
ii. Sural nerve
B. Intermediate (3 wks- 2 yrs)
1. Nerve transfer
a. Hypoglossal-facial
b. Spinal accessory-facial
c. Masseteric-facial
2. Cross face nerve grafting using sural nerve
C. Chronic (>2 yrs)
1. Muscle transfers
a. Temporalis
b. Masseter
c. Digastrics
2. Free muscle flaps/
microneurovascular transfer
a. Gracilis
b. Latissimus dorsi
c. Serratus anterior
d. Pectoralis minor
D. Static procedures/ancillary procedures
(can be performed at any time period
listed above)
1. Gold weight/spring implants
2. Slings
3. Lid procedures
Ryan Ridley. Facial Reanimation .Grand Rounds Presentation, UTMB, Dept. of Otolaryngology
SURGICAL TREATMENT MODALITIES
45. Micro-neurological Surgery
• Facial nerve repair is the most effective
procedure to restore facial function in patients
who have suffered nerve damage from an
accident or during surgery.
• It involves microscopic repair of a nerve that
has been cut.
46. PRIMARY NERVE REPAIR
End-to-end
anastomosis preferred
No tension
Extratemporal repair
performed < 72 hrs of
injury
Most common methods
Group fascicular repair
Epineural repair Group fascicular repair
47. Primary Nerve Repair
Severed ends of nerve
exposed
Devitalized tissue/debris
removed with fine scalpel
Small bites of epineurium
Epineural sheath
approximated with 9-0
nonabsorbable suture
Epineural repair recommended
for injury proximal to pes
anserinus and intratemporal
EPINEURAL REPAIR TECHNIQUE
48. INTERPOSITION GRAFTING
Cable grafts
Used when defect > 17mm; nerve cannot be
reapproximated without tension
Most common
Greater Auricular Nerve
Sensory nerves from superficial cervical plexus
Sural nerve
49. INTERPOSITION GRAFTING GREATER AURICULAR
NERVE
Harvesting
Located on lateral surface of
SCM at the midpoint of a
line drawn between mastoid
tip and mandibular angle
May extend postauricular
incision or use separate neck
incision
Advantages:
Proximity to facial nerve
Cross-sectional area
Limited morbidity
Limitations:
Reconstruction of long defects
Ideal for defects < 6cm in length
50. SURAL NERVE
• Anatomy
– Formed by union of medial
sural cutaneous nerve and
lateral sural cutaneous branch
of peroneal nerve.
Advantages :
Length : >12cm
Accessibility
Low morbidity associated with
sacrifice
Disadv:
Variable caliber
Often too large
Difficult to make graft approximation
Unsightly scar
51. NERVE TRANSPOSITION/ CROSSOVER
• Nerve transposition is also known as facial-
hypoglossal transfer.
• Restores movement to the side of the face that
has been paralyzed.
• With the stump of the 12th nerve hooked up to
the end of the 7th nerve, the face will move
when the tongue is moved.
51
52. CROSSOVER TECHNIQUES
INDICATIONS:
Irreversible facial nerve injury
Intact facial musculature/distal facial nerve
Intact proximal donor nerve
Prior to distal muscle/facial nerve atrophy
Ideal if performed within a year of facial paralysis
Adv:
Time interval until movement
4-6 months
Avoid multiple sites of anastomosis
Mimetic-like function achievable with practice
Disadv:
Donor site morbidity
Some degree of synkinesis
53. Hypoglossal-Facial Technique
1. Parotidectomy incision extended
into cervical crease ~ 2-3 cm below
inferior border of mandible
2. Facial nerve identified and
dissected distal to pes anserinus
3. Identify hypoglossal nerve
a. SCM retracted posteriorly
b. Dissect superiorly until
posterior belly of digastic is
identified
c. Retract digastric superiorly
and CN XII is found
inferiorly.
d. Hypoglossal is within
2-3 c m of main trunk of the
facial nerve
4. Hypoglossal nerve is dissected
anteriorly and medially into the
tongue.
1. Transect distal to ansa
hypoglossis
5. Facial nerve transected at the
stylomastoid foramen
6. Anastomose nerves using 9-0
54. Hypoglossal Facial Nerve Transfer
Entire hypoglossal nerve
transected
40% segment of nerve secured to
lower division.
54
Hypoglossal nerve
reflected superiorly
55. Hypoglossal Facial Nerve Transfer
Jump graft modification
Reflection of the facial nerve
out of the mastoid bone.
55
56. CROSS-FACIAL NERVE GRAFTING
• Contralateral Facial nerve used to reinnervate
paralyzed side using a nerve graft
– Sural nerve often employed
– ~25-30cm of graft needed
• Restitution of smile and eye blinking obtained.
• Disadvantage
– 2nd surgical site
– Violation of the normal facial nerve
57. CROSS-FACIAL NERVE GRAFTING
FOUR techniques
Sural nerve graft routed from buccal
branch of normal VII to stump of
paralyzed VII
Zygomaticus and buccal branch of
normal VII used to reinnervate
zygomatic and marginal mandibular
portions respectively
4 separate grafts from temporal,
zygomatic, buccal and marginal
mandibular divisions of normal CN
VII to corresponding divisions on
paralyzed side.
Entire lower division of normal side
grafted to main trunk on paralyzed
side.
58. MUSCLE TRANSPOSITION
(“DYNAMIC SLING”)
INDICATION:
– Congenital facial paralysis
– Facial nerve interruption of at least 3 years
• Loss of motor endplates
– Crossover techniques not possible due to donor
nerve sacrifice
59. TEMPORALIS
Often used for reanimation of
the oral commisure.
Middle 1/3 of muscle is best for
transfer (Sherris, 2004)
60. Temporalis Transfer
1. Incision in preauricular crease
extending to superior temporal
line
2. Obtain wide exposure of
temporalis muscle by dissecting
above the SMAS
3. Incise down on periosteum to
elevate muscle fibers
-Harvest middle 1/3
4. Large tunnel created over
zygomatic arch
5. Orbicularis oris muscle exposed
via vermilion border incision at
oral commissure
6. Large tunnel over zygomatic arch
used to connect oral commisure to
zygomatic arch/superior incision.
7. Temporalis flap detached and
elevated from its origin and
tunneled to the oral commissure.
8. 3-0 prolene used to suture
orbicularis to temporalis at oral
commissure
9. Overcorrection of nasolabial fold
and oral commissure
61. MASSETER
• Used when temporalis muscle is not opted.
• May be preferred due to avoidance of large facial
incision
• Disadvantage:
– Less available muscle compared to temporalis
– Vector of pull on oral commisure is more horizontal
than superior/oblique like temporalis
62. Masseter Transfer
1. Expose muscle with gingival
incision along mandibular sulcus
2. Dissection carried out in a plane
between mucosa and muscle.
3. Muscle freed off of mandible
medially and from the
inferiolateral edge of mandible.
4. Vertical incision made in inferior
portion of muscle
5. Anterior half of muscle is split
into 2 divisions.
6. The 2 anterior slips of muscle are
tunneled anteriorly to reach the
oral commisure via external
vermillion border incisions
7. Muscle slips are attached to lips
and oral commisure in the deep
dermal layer using suture
63. MICRONEUROVASCULAR TRANSFER
FREE MUSCLE FLAPS
• They have potential of achieving individual
segmental contractions
– Reduction of synkinesis
• Muscle flaps used are:
– Gracilis
– Latissimus dorsi
– Inferior rectus abdominus
64. MICRONEUROVASCULAR TRANSFER
FREE MUSCLE FLAPS
Requires viable muscle and nerve innervation
Traditionally done in 2 stages
1st: Cross-face nerve graft ~ 1 yr prior to muscle transfer
2nd: Muscle transfer performed after neural ingrowth of graft
65. GRACILIS
1. “Workhorse” for free muscle
transfer
2. Long, thin muscle in medial
thigh
-Good neurovasular pedicle
1. Adductor artery and
vein
2. Anterior obturator
nerve
3. 2 stages involved:
1. Sural nerve employed for
cross-face graft
2. Gracilis muscle transferred
after 6-12 months
4. Vascular anastomosis to the
facial artery and vein or to
superficial temporal vessels.
5. Obturator nerve of gracilis
connected to distal end of sural
nerve graft.
Anterior Obturator nerve
Adductor a. & v.
66. ADDRESSING PARALYTIC EYELIDS
Complications of orbicularis oculi paresis
Delayed blinking
Impairment of nasolacrimal system
Dry eye
Risk of exposure keratitis, corneal ulceration and
blindness
Goal of treatment is to maintain cornea
Treatment Options
Tarsorrhaphy
Gold weight/spring implants
Open / endoscopic brow lifts for significant brow ptosis
67. GOLD WEIGHT
IMPLANTATION
1. Small incision
made several
millimeters above
the upper eyelid
margin.
2. Tarsal plate
exposed with sharp
dissection
3. Gold weight
secured to tarsus
using 8-0 nylon.
4. Wound closed in 2
layers
68. Horizontal mattress 5-0 nylon
Begin 3mm medial to lateral canthus,
6mm from lid margin
Stitch travels through gray line to
5mm below lower lid margin
Bolster with 3mm, 4-french rubber
catheter.
Cosmetically unappealing, visual field
affected.
TARSORRHAPHY
69. Surgical management of LAGOPHTHALMOS
• F. Stagno d’Alcontres, G. Cuccia*, F. Lupo, G. Delia, M. RomeoThe
orbicularis oculi muscle flap: Its use for treatment of lagophthalmos. Journal
of Plastic, Reconstructive & Aesthetic Surgery (2010) 63, 416e422
70.
71. STATIC PROCEDURES
Indications:
Debilitated individuals; poor prognosis
Nerve or muscle not available for dynamic procedures
Adjuct procedure with dynamic techniques to
provide immediate benefit
Advantages:
Immediate restoration of facial symmetry at rest
No oral commisure ptosis
Drooling, disarticulation, mastication difficulties
Relief of nasal obstruction caused by alar collapse
• Static Facial Suspension is used to lift the corner
of the mouth so that balance is restored to the face
and drooling out of the mouth is helped.
72. STATIC SLINGS
Variety of materials
used
• PTFE (Gor-Tex)
• Alloderm
• Fascia lata
Gor-Tex and alloderm
have advantage of no
donor site morbidity
but higher risk of
infection.
73. STATIC FACIAL SLING TECHNIQUE
1. Preauricular, temporal or nasolabial
fold incision may be used
2. Additional incisions made adjacent
to oral commisure at vermillion
border of upper and lower lip
3. Subcutaneous tunnel dissected to
connect temporal to oral
commisure incisions
4. Dissection may be carried out in
midface adjacent to nasal ala, if
needed (for alar collapse)
5. Implant strip is split distally to
connect to the upper/lower lips
6. Implant secured to orbicularis
oris/commisure using permanent
suture
7. Implant is suspended and anchored
superiorly to superficial layer of
deep temporal fascia, or zygomatic
arch periosteum, using permanent
suture.
8. May also secure to malar eminence
using small miniplate or bone
anchoring screw
74. REFERENCES
• Cranial nerves-Functional Anatomy – Stanley Monkhouse
• Anatomy for Surgeons: Hollinshead
• Maxillofacial surgery: Peter Ward Booth Vol 1 & 2
• Peterson’s Principles of Oral & Maxillofacial Surgery, 2nd edition.
• Oral pathology- Regezi.
• Textbook of oral surgery – Neelima Malik
• Gray’s anatomy.
• Text of Anatomy by Roylce.