FACIAL NERVE

CONTENTS
Anatomy
Nuclei
Course
Branches and distribution
Ganglia
Blood supply
Functional Components
Functions of the Facial Nerve
Clinical Examination of the Facial Nerve
Pathology of the Facial Nerve
Importance of facial nerve in operative dentistry
Endodontic implications of facial nerve
Conclusion

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Key terms:
Nerve
Sympathetic
Parasympathetic
Neuron
Nuclei
Motor/Efferent (Brachial, visceral)
Sensory/Afferent (General, special)
Upper motor neuron
Lower Motor neuron
Paresis
Plegia

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 ANATOMY
• 7th Cranial
nerve

• Mixed nerve

• Nerve of the
hyoid arch

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 NUCLEI
• Four nuclei -

 Motor nucleus
(branchiomotor)

 Superior salivatory
nucleus
(parasympathetic)

 Lacrimatory nucleus
(parasympathetic)

 Nucleus of tractus
solitarius (gustatory)
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 Nerve innervation by the Motor Nucleus in the upper
and lower part of the face

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 Origin

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 Relationship of the cranial nerves in the
Labrynthine
internal acoustic meatus
vessels
Nervus
intermedius

VII
(m)

II
VI

Arachnoid

Dura
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 INTRACRANIAL COURSE

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DISTRIBUTION OF FACIAL NERVE
WITHIN THE TEMPORAL BONE

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Stylomastoid
Foramen

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 EXTRACRANIAL COURSE

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 Branches and Distribution

Within the facial canal

At its exit from the stylomastoid foramen

Terminal branches within the parotid gland

Communicating branches with adjacent cranial and

spinal nerves

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 BRANCHES AND DISTRIBUTION
Within the facial canal
1. Greater Petrosal Nerve

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2. Nerve to the stapedius muscle

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 3. Chorda Tympani Nerve

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 COURSE OF CHORDA TYMPANI NERVE

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 Chorda
tympani
taste fibre

Tongue
Chorda tympani
Secretomotor
fibre
(preganglionic)
Su
bl Lingual
gl ing
an ua nerve
d l carrying
general
sensation

Submandibular
Ganglion Submandibular
Gland

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 At its exit from the stylomastoid foramen
1. Posterior auricular 2. Digastric 3. Stylohyoid

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 Terminal branches within the parotid gland

Temporal

Zygomatic

Buccal

Cervical
Mandibular

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Anatomic
Variations

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 Branches of Communication
  
 In the internal acoustic meatus - With the acoustic nerve at the geniculate
ganglion

With the sphenopalatine ganglion by the greater superficial petrosal nerve.

With the otic ganglion by a branch which joins the lesser superficial petrosal
nerve.

In the facial canal - With the auricular branch of the vagus.

At its exit from the stylomastoid foramen - With the glossopharyngeal.

On the face - With the trigeminal.

In the neck - With the cutaneous cervical.   

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 Ganglia Of The Facial Nerve

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 Blood supply of the Facial Nerve
The facial nerve
derives both an
intrinsic and an
extrinsic blood supply.

Intrinsic – middle
cerebral artery

Extrinsic -
 the stylomastoid
artery
 the middle meningeal
artery
 the anterior cerebellar
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artery
 Functional Components
1. Branchial
Motor

2. Visceral
Motor

3. Special
Sensory

4. General
Sensory

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 Clinical Examination of the Facial Nerve
Motor Examination

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 Testing Taste

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 Corneal Reflex

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 Sucking Reflex

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 EFFERENT
FUNCTION

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 AFFERENT FUNCTION

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 Review Article The receptors and cells for mammalian taste
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Nature 444, 288-294 (16 November 2006)
 Pathology
Physiology of Nerve injury

Sunderland's classification – five degrees

 Neuropraxia – 1st degree
 Axonotmesis – 2nd degree
 Endoneurotmesis – 3rd degree
 Perineurotmesis – 4th degree
 Neurotmesis – 5th degree

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 Facial Palsy
Facial paralysis is a dysfunction of the facial nerve
that results in inability to control facial muscles on the
affected side.

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 Causes
Congenital/Acquired

Brain or parotid gland tumours

Trauma

Stroke

Lyme disease

Latent virus reactivation of zoster and Epstein Barr

Idiopathic – Bell’s Palsy

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Grade Of Facial Paralysis House
- Brackmann score
I - Normal facial movements; No synkinesis

II - Slight Mild deformity, mild synkinesis, good forehead function,

slight asymmetry

III - Moderate Obvious facial weakness, forehead motion present, good

eye closure, asymmetry, Bell's phenomenon present

IV - Moderately Obvious weakness, increasing synkinesis; no forehead

motion

V - Severe Very obvious facial paralysis, some tone present, cannot

close eye

VI - Total Complete facial paralysis, absent tone

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 Central versus Peripheral Paralysis
Paralysis involving all divisions of the facial nerve is
peripheral and that sparing the forehead is central.

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 Central Facial Palsy
Central Seven

It usually results from

damage to upper
motor neurons of the
facial nerve.

Most commonly
occurs due to stroke.

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 Bell’s Palsy
Named after Scottish anatomist
Charles Bell

Idiopathic, unilateral, self-

limiting facial palsy

Infranuclear/lower motor type

Persistent latent viral infection

activation, exposure to cold

Facial drooping on the affected

side
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 Pathology
As a result of inflammation of the facial nerve,
pressure is produced on the nerve where it exits the
skull within its bony canal, blocking the transmission
of neural signals or damaging the nerve.

Symptoms
Classic presentation – weakness on one side of face
Awareness – drooling after brushing teeth or drinking,
asymmetry

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Signs

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BELL’S PHENOMENON

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Level of the lesion and the corresponding symptoms
INFRANUCLEAR (LMN):
a. Lesion at or below stylomastoid foramen – loss
of facial expression on the same side as the lesion
b. Lesion in the facial canal (lower level)– a + loss
of taste sensation in anterior 2/3 rds of tongue and
salivation
c. Lesion in the facial canal (higher level) – a + b +
loss of hearing
d. Lesion at genu/proximal to genuculate ganglion
– a + b + c + loss of lacrimation

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NUCLEAR LESION (LMN):
Lesion in pons – unilateral facial palsy (6th nerve
involvement also seen)
+
Contralateral pyramidal signs
(Millard Gubler syndrome)

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SUPRANUCLEAR LESION (UMN) :
Contralateral lower side of face involved
(voluntary movement) facial expressions
+
Unilateral pyramidal signs (UMN type)
(Hemiplegia)

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 Differential Diagnosis
 Bell's palsy is a diagnosis of exclusion.

 Lyme disease

 Tumours (e.g., Acoustic neuroma , parotid gland tumours)

 Ramsay Hunt syndrome

 Demyelinating lesions

 Sarcoidosis

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Syndromes associated with
Bell’s Palsy

Heerfordt's syndrome

Melkersson-
Rosenthal syndrome

Gustatory tearing or
crocodile tears

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Guillain-Barrésyndrome

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Moebius Syndrome

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Ramsay Hunt Syndrome

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Treatment
Eye care

Oral steroid – Prednisone

1 mg/kg/day for 10-14 days

Surgery to relieve pressure on the nerve

Local superficial heat therapy (i.e. hot pack or

infrared rays) for 15min/session (Europa Medicophys
2006;42:41-7)

Physiotherapy (Physiotherapy treatment of Bell's palsy: a

case report New Zealand Journal of Physiotherapy, Nov, 2006 by
James M. Elliott )

Facial muscle protection

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 Hemifacial Spasm
Described by Gowers in
1884

A neurological disorder
wherein blood vessels
constrict the facial nerve
causing facial spasm.

First symptom -
intermittent twitching of
the eyelid muscle leading
to forced closure of the
eye. 12/07/2021 54
HemiFacialSpasm before amp after.flv

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 Treatment
Medications -
carbamazepine,
phenytoin and
gabapentin

Injection of botulinum
toxin type A

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Microvascular Decompression

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FACIAL NERVE TRAUMA AND TUMOURS
Trauma – Petrous bone fracture
Surgery of middle ear, mastoidectomy,
parotid gland
Tumours – Neuroma/schwanoma
Meningioma
Hemangioma
Metastasis
Osteopetrosis

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 IMPORTANCE OF FACIAL NERVE IN
OPERATIVE DENTISTRY
The transient loss of motor function of the orofacial
muscles can hamper the smile line evaluation, an
important parameter for restorative and prosthetic
dentistry approaches.
Chiche G, Pinault A. Esthetics of anterior fixed
prosthodontics. Chicago: Quintessence, 1994.

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Released and ionized mercury can be taken up by tissues and
nerves beneath fillings and in root canals.

Current animal experiments show that mercury is taken up by

nerve endings and is transported towards the central nervous
system in the same way as lead (Baruah, 1981).

When the amalgam fillings in the right part of the lower jaw were
removed, the painful strain after the facial paralysis, present four
years, disappeared. It seems close at hand to suspect a
combination of the general poisoning and the mercury source in
the two teeth in the lower jaw as primary causes of the nerve
inflammation, resulting in the face paralysis on the same side.

Mercury Poisoning From Dental Amalgam Jaro Pleva, Ph.D.1

Orthomolecular Psychiatry, volume 12, Number 3, 1983 Pp. 184-193
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 ENDODONTIC IMPLICATIONS OF
FACIAL NERVE
Neurological complications following extrusion of
sodium hypochlorite solution into the facial soft
tissues during root canal treatment International Endodontic
Journal, 38, 843–848, 2005


Neurological sequelae can follow inadvertent hypochlorite extrusion.


Early recognition may avert a potentially more serious outcome.


Active hospital treatment including intravenous steroids and antibiotics
is recommended.

Permanent mimic musculature and nerve damage

caused by sodium hypochlorite: a case report.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Sep;106(3):e80-3. Epub 2008 Jul 7
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CASE REPORT - 1

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CASE REPORT - 2

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Transient facial nerve paralysis –
introduction of LA into the
capsule of the parotid gland
during IANB or Vazirani – Akinosi
nerve block

Problem

Prevention

Management

Facial nerve palsy following intra-oral surgery performed with local anaesthesia
J.R.Coll.Surg.Edinb., 45,October 2000, 330-333
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 Summary
7th cranial nerve
Branches

Within facial At the stylomastoid On the face Communicating

canal foramen Branches
1. Greater 1. Posterior 1. Temporal
petrosal auricular 2. Zygomatic
2. Nerve to 2. Digastric 3. Buccal
Stapedius 3. Stylohyoid 4. Mandibular
3. Chorda 5. Cervical
tympani

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 CONCLUSION
“The most important thing you wear is the expression
on your face.”

Certain cases of facial nerve palsy following dental or

maxillofacial procedures occur.

Prevention is better than cure.

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 REFERENCES
 B.D. Chaurasia’s Human Anatomy vol 3
 The Facial Nerve, Mark May Barry M.
Schaitkin - 2000
 Handbook of Local Anesthesia 5 th edition
 The facial nerve: anatomy and common
pathology Semin Ultrasound CT MR.
2002 Jun;23(3):202-17
 International Endodontic Journal, 38,
843–848, 2005
 Oral Surg Oral Med Oral Pathol Oral
Radiol Endod. 2008 Sep;106(3):e80-3.
Epub 2008 Jul 7
 Chiche G, Pinault A. Esthetics of anterior
fixed prosthodontics. Chicago:
Quintessence, 1994.
 Mercury Poisoning From Dental
Amalgam Jaro Pleva, Ph.D.1
Orthomolecular Psychiatry, volume 12,
Number 3, 1983 Pp. 184-193
 Color Atlas of neuroscience:
Neuroanatomy and Neurophysiology by
Ben Greenstein, Adam Greenstein
 Neurological Classics
 By Robert H. Wilkins, Robert Wilkins,
Irwin Brody
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Thank you

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