Facial nerve
By
Dona mariam sam
Third Year BDS
Reg no 170021349
CONTENTS
Introduction
Functional component
Nucleus
Origin and course
Branches
Function
Surface marker
Facial nerve palsy
Introduction
Facial nerve is the seventh cranial nerve.
The facial nerve is associated with the derivatives
of second pharyngeal arch.
It has got motor, sensory and parasympathetic
fibres and therefore is a mixed nerve.
Functional component
General somatic afferent-provide sensory input from
part of external acoustic meatus and deeper parts of
auricle
Special visceral afferent-are for taste of anterior two-
third of the tongue
General visceral efferent-parasympathetic, stimulate
secretomotor activity of lacrimal gland, submandibular
and sublingual salivary gland, glands in mucous
membrane of oral cavity, hard and soft palate
Special visceral efferent-muscles of face, stapedius,
posterior belly of digastric and the stylohyoid muscle.
Nuclei
Origin, Course and
Relation
The facial nerve attaches
to the lateral surface of
the brainstem.
Between the pons and
medulla oblongata
It consist of a large motor
root and a small sensory
root(the intermediate
nerve)
The intermediate nerve
(sensory) consist of
parasympathetic fibres,
SA fibres, GVA fibres.
The larger motor root contains the SVE fibres.
Course
Can be divided into:- a. Intracranial
b. Extracranial
Facial nerve nucleus,
superior salivatory nucleus, Emerges at lower Through the
border of pons Through the
nucleus tractus solitarius in internal
with nervus facial canal
pons and spinal nucleus of acoustic meatus
trigeminal in pons, intermedius
medulla and spinal cord
Facial nerve turns Geniculate ganglion
Through the inferiorly into where the facial
facial canal in nerve turns Medial wall of
stylomastoid
posterior wall of posteriorly middle ear
foramen
middle ear cavity
Temperofacial
Divides into
Enter the branches
parotid gland
Cervicofacial
Course of the Facial nerve
Branches
Geniculate ganglion Greater petrosal nerve
Nerve to stapedius
In the bony canal
Chorda tympani
Posterior auricular nerve
Near stylomastoid
foramen Nerve to posterior belly
of digastric
Nerve to stylohyoid
Temporal
Temperofacia
l
Zygomatic
Within the
parotid gland,
terminates into
Buccal
Marginal
Cervicofacial
mandibular
Cervical
FUNCTION
MOTOR FUNCTION
Facial nerve innervates the muscles which are derivatives
of second pharyngeal arch.
Nerve to stapedius- supply stapedius muscle in the
middle ear
Posterior auricular nerve- supply the intrinsic and
extrinsic muscle of outer ear.
Nerve to posterior belly of digastric-supply posterior
belly of digastric. Responsible for raising the hyoid bone.
Nerve to stylohyoid- Innervates te stylohyoid muscle.
SPECIAL SENSORY FUNCTION
Chorda tympani- nerve arises in facial canal, passes
through the middle ear and exits through the petro
tympanic fissure.
Along with the lingual nerve it innervates the anterior
two-third of the tongue.
PARASYMPATHETIC FUNCTION
Greater petrosal nerve- moves distal to the geniculate
ganglion, leaves the temporal bone, enters the middle
cranial fossa.
Travels across the foramen lacerum(not through), joins
with the deep petrosal nerve to form nerve to pterygoid
canal.
Nerve to the pterygoid canal enters the pterygopalatine
fossa and synapses with the pterygopalatine ganglion
Branches from this ganglion provide parasympathetic
innervation to the mucous membrane of oral cavity, nose,
palate and lacrimal gland.
Surface marker
Marked by a horizontal line which joins the following two
points
A point at the middle of the anterior border of mastoid
process. The stylomastoid foramen lies 2cm deep to this
point.
A second point behind the neck of the mandible. Here the
nerve divides into five terminal branches.
Facial nerve palsy
The seventh nerve carries motor impulses
to the muscles of facial expression, scalp
and external ears.
Paralysis of the terminal branches
whenever a infraorbital nerve block is
administered or when maxillary canine
infiltrated.
Muscle droop is observed when inadvertent
deposition of local anesthetic- while
anesthetic is introduced into the deep lobe
of parotid gland.
Symptoms
Facial paralysis on one side.
Loss of blinking control on
affected side
Decreased tearing
Altered sense of taste
Drooping of mouth on the
affected side
Slurred speech
Drooling
Pain in or behind the ear
Sound hypersensitivity
Difficulty in eating
Cause
Introduction of local anesthetic by inferior alveolar nerve
block into the capsule of parotid gland (Posterior border of
mandibular ramus which is clothed by medial pterygoid and
masseter muscle).
Stroke
Tumor compressing facial nerve anywhere along its complex
pathway.
Trauma-Blunt trauma especially the fractures of temporal
bone.
Diabetes mellitus
Infection-Reactivation of herpes zoster virus(Ramsay-Hunt
syndrome).
Problem
Loss of motor function to the muscles of facial expression produced by local
anaesthetic deposition is normally transitory .
It lasts no longer than several hours ,depending on the local anaesthetic
formulation used, the volume injected ,and proximity to the facial
nerve.Usualy,minimal or no sensory loss occurs.
Patient has unilateral paralysis and the persons face appears lopsided.
No treatment than waiting until the drug action resolves .
A secondary problem is that patient is unable to voluntarily close one eye.
The protective lid of the eye is abolished. Winking and blinking is impossible.
Prevention
Prevantable by adhering to the protocol with the inferior alveolar nerve and
Vazirani-Akinosi nerve blocks
A needle tip that comes in contact with bone(medial aspect of the ramus)
before depositing local anesthetic solution essentially precludes the
possibility that anaesthetic will be deposited into the parotid gland during an
IANB
If the needle deflects posteriorly during this block and bone is not contacted,
the needle should be withdrawn almost entirely from soft tissues, the barrel
of the syringe brought posteriorly and the needle readvanced until it contacts
the bone.
Over insertion of the needle either absolute(>25mm) or relative(25mm in the
smaller patients) should be avoided.
Management
Reassure the patient. Explain the situation is transient, will resolve
without residual effect. Mention that it is produced by the normal
action of local anesthetic drugs on the facial nerve.
Contact lenses should be removed until muscular movement returns.
An eye patch should be applied to the affected eye until muscle tone
returns. If resistance is offered by patient, advice the patient too
manually close the affected eyelid periodically to keep the cornea
lubricated.
Record the incidence on the patients chart.
Although no contra indication is known to re anesthetising the patient
to achieve mandibular anesthesia, it maybe prudent to forego further
dental care at disappointment.
Treatment
Application of soothening agent such as calamine cream or
lotion, antiseptic powder containing povidone iodine.
Immunocompromised or elderly individuals with severe
disease- idoxuridine 20-40% .
Acyclovir- an antiviral agent, 800 mg orally five times
daily for 7 days.
Steroids- Prednisolone in doses of 40-60 mg four times
daily for 5 days.
Carbamazepine (200 to 400 mg 8 hourly) to reduce facial
neuralgic pain.
Source
Gray’s Anatomy
B.D Chaurasia’s Human Anatomy Volume 3 and Volume 4
Medical Emergencies-Stanley F Malamed
Medical Problems in Dentistry-Crispian Scully,Cawson
Textbook of Clinical Medicine-Dr S N Chugh
