FACIAL NERVE

&
ITS APPLIED ASPECTS
BY-DR. ABDUL RAZAK
POST GRADUATE ORAL SURGERY
B.I.D.S., BANGALORE
• INTRODUCTION
• MOTOR ROOT
• SENSORY ROOT
• COURSE
• ARTERIAL SUPPLY
• VENOUS DRAINAGE
•COMMUNICATING BRANCHES
• BRANCHES
• APPLIED ASPECTS
INTRODUCTION
•7TH CRANIAL NERVE

•FACIAL NERVE IS A MIXED NERVE

•BOTH MOTOR AND SENSORY ROOTS EMERGE FROM THE

CAUDAL PART OF THE PONS

•MOTOR ROOT LIES MEDIAL TO THE SENSORY WHICH LIES

MEDIAL TO VESTIBULOCOCHLEAR NERVE
MOTOR ROOT
•MOTOR ROOT ARISES FROM 2 NUCLEI
MOTOR NUCLEUS
SUPERIOR SALIVARY NUCLEUS

•MOTOR NUCLEUS : MOST OF THE MOTOR FIBRES ARISE

FROM THIS NUCLEUS

•IT IS LOCATED DEEP IN THE RETICULAR FORMATION AT

THE CAUDAL PART OF THE PONS

•FIBRES FROM THIS NUCLEUS ARE OF BRANCHIAL EFFERENT

COLUMN
•SUPERIOR SALIVARY NUCLEUS: FEW MOTOR FIBRES ARISE FROM
THIS NUCLEUS

•IT IS LOCATED IN THE RETICULAR FORMATION POSTERIOLATERAL

TO THE CAUDAL PART OF THE MOTOR NUCLEUS

•THESE FIBRES ARE OF GENERAL VISCERAL EFFERENT COLUMN

•THIS NUCLEUS SENDS FIBRES TO THE SENSORY ROOT WHICH

REACH SUBMANDIBULAR & SUBLINGUAL GLANDS VIA CHORDA
TYMPANI, MAY BE TO PAROTID GLAND ALSO
•AFTER EMERGING FROM BOTH THE NUCLEI MOTOR ROOT PASSES
POSTERIOMEDIALLY TO THE CAUDAL END OF THE ABDUCENT
NUCLEUS & ASCENDS SUPERFICIAL TO IT & DEEP TO THE FACIAL
COLICULUS

•AT THE UPPER LIMIT OF THE ABDUCENT NUCLEUS THE NERVE

DEVIATES INFERIOANTERIOR TO THE ORIGIN

•FACIAL MOTOR NUCLEUS IS COMPLEX COMPRISING OF

LATERAL,INTERMEDIATE & MEDIAL SUBNUCLEI

•MEDIAL SUBNUCLEUS IS FURTHER DIVIDED INTO VENTRAL,DORSAL

& INTERMEDIATE GROUPS
•LATERAL SUBNUCLEUS INNERVATES THE BUCCAL
MUSCULATURE

•INTERMEDIATE SUBNUCLEUS SEND AXONS INTO

TEMPORAL,ORBITAL & ZYGOMATIC FACIAL BRANCHES

•MEDIAL SUBNUCLEUS INTO POSTERIOR AURICULAR &

CERVICAL RAMI & PROBABLY TO STAPEDIAL NERVE
SENSORY ROOT
•SENSORY ROOT IS KNOWN AS NERVUS INTERMEDIUS

•SENSORY NUCLEUS IS THE ROSTRAL END OF THE NUCLEUS

SOLITARIUS IN THE MEDULLA OBLANGATA

•NUCLEUS RECIEVES TASTE & OTHER AFFERENT FROM THE SENSORY

ROOT & SEND FIBRES TO CONTRALATERAL ANTERIOR
LATERALTHALAMIC NUCLEI

•THALAMIC NUCLEI SENDS FIBRES TO THE INFERIOR PART OF THE

POST CENTRAL GYRI

•SENSORY ROOT CONTAINS CENTRIPETAL PROCESS OF UNIPOLAR

NEURONS IN GENICULAR GANGLION
•IT LEAVES THE MAIN TRUNK IN THE INTERNAL AUCOUSTIC
MEATUS IN THE ONE OR MORE SLENDER BRANCHES

•SENSORY ROOT RUNS BETWEEN MOTOR ROOT &

VESTIBULOCOCHLEAR NERVE OR SOMETIMES ADHERENT TO
IT & ENTERS BRAIN STEM AT THE CAUDAL PART OF THE PONS

•THE SENSORY ROOT ALSO CONTAINS EFFERENT

PREGANGLIONIC PARASYMPATHETIC FIBRES TO THE
SUBMANDIBULAR & SUBLINGUAL SALIVARY GLANDS &
LACRIMAL GLAND & PHARYNGEAL, NASAL & PALATINE
GLANDS
COURSE
•BOTH ROOTS PASS ANTEROLATERAL WITH
VESTIBULOCOCHLEAR NERVE UPTO INTERNAL ACOUSTIC
MEATUS

•MOTOR ROOT IS IN THE ANTEROSUPERIOR GROOVE ON

THE VESTIBULOCOCHLEAR NERVE & SENSORY ROOT IN
BETWEEN THE TWO

•AT THE LATERAL SIDE OF THE MEATUS IT ENTERS THE

FACIAL CANAL PROCEEDING AT FIRST LATERALLY ABOVE
THE VESTIBULE & NEAR MEDIAL WALL OF EPITYMPANIC
RECESS
•IT THEN BENDS SHARPLY OVER THE PROMONTORY &
ARCH DOWN IN THE MEDIAL WALL OF THE
STYLOMASTOID ANTRUM

•IT THEN DESCENDS IN THE STYLOMASTOID FORAMEN

•IT THEN BENDS SHARPLY BACKWARDS IN THE

GENICULUM,IT PRESENT A REDDISH SWELLING CALLED
GENICULAR GANGLION
•AFTER EMERGING FROM THE STYLOMASTOID FORAMEN
NERVE RUNS FORWARD IN THE PAROTID GLAND, CROSSES
OVER THE STYLOID PROCESS, RETROMANDIBULAR VEIN &
EXTERNAL CAROTID ARTERY & DIVIDES BEHIND THE NECK
OF THE MANDIBLE INTO BRANCHES WHICH PIERCES THE
ANTEROMEDIAL SURFACE OF THE PAROTID GLAND &
DIVERGE UNDER COVER OF IT

•THEY FORM A NETWORK PAROTID PLEXUS,

DISTRIBUTING TO THE FACIAL MUSCULATURE

•AT THE STYLOMASTOID FORAMEN THE NERVE IS ABOUT

2 CM DEEP TO THE MIDDLE OF THE ANTERIOR BORDER OF
THE MASTOID PROCESS
ARTERIAL SUPPLY
•INTRACRANIALLY SUPPLIED BY ANFERIOR INFERIOR
CEREBELLAR ARTERY

•WITHIN CANAL BY SUPERFICIAL PETROSAL BRANCH OF

MIDDLE MENINGEAL ARTERY & STYLOMASTOID BRANCH
OF POSTERIOR AURICULAR ARTERY OR OCCIPITAL ARTERY

•EXTRACRANIALLY BY BRANCHES FROM STYLOMASTOID,

POSTERIOR AURIULAR,OCCIPITAL, SUPERFICIAL TEMPORAL
& TRANVERSE FACIAL ARTERIES
VENOUS DRAINAGE

•VENOUS DRAINAGE BY VENAE COMITANS OF

SUPERFICIAL PETROSAL & STYLOID ARTERIES
COMMUNICATING BRANCHES

INTRACRANIAL
VESTIBULOCOHLEAR

GENICULAR GANGLION
PTERYGOPALATINE GANGLION VIA GREATER PETROSAL
NERVE
OTIC GANGLION VIA LESSE PETROSAL NERVE
MIDDLE MENINGEAL SYMPATHETIC PLEXUS

FACIAL CANAL
AURICULAR BRANCH OF VAGUS
EXIT FROM STYLOMASTOID FORAMEN
TO GLOSSOPHARYNGEAL,VAGUS,GREAT AURICULAR &
AURICULOTEMPORAL NERVES

POST AURICULAR
TO THE LESSER OCIPITAL NERVE

FACIAL
TRIGEMINAL NERVE

CERVICAL
TRANSVERSE CERVICAL NERVES
•THE GREATER PETROSAL NERVE STARTS FROM GENICULAR GANGLION &
CONTAINS MAINLY TASTE FIBRES FROM THE PALATINE MUCOSA & ALSO
PREGANGLIONIC SYMPATHETIC FIBRES TO PTERYGOPALATINE GANLION

•THEY ARE RELAYED TO THE LACRIMAL GLAND VIA ZYGOMATIC & LACRIMAL
NERVES

• RELAYED TO THE NASAL & PALATINE MUCOSAL GLANDS VIA NASAL & PALATINE
NERVES

•IT RECEIVES COMMUNICATION FROM TYMPANIC PLEXUS, TRAVERSES THE

HAITUS ON THE ANTERIOR SURFACE OF PETROUS TEMPORAL BONE & ENTERS THE
GROOVE, PASSES UNDER TRIGEMINAL GANGLION TO THE FORAMEN
LACERUM,HERE JOINED BY DEEP PETROSAL NERVE FROM INTERNAL CAROTID
SYMPATHETIC PLEXUS & FORMS NERVE OF THE PTERYGOID CANAL

•THIS NERVE OF THE PTERYGOID CANAL PASSES THROUGH THE PTERYGOID

CANAL TO END IN PTERYGOPALATINE GANGLION
•FROM THE FACIAL NERVE NEAR GENICULAR GANGLION
THE GLAND ITSELF OR ROOT OF GREATER PETROSAL
NERVE, A BRANCH OF LESSER PETROSAL NERVE ARISE

•IT REACHES THE OTIC GANGLION

•THE MIDDLE MENINGEAL SYMPATHETIC PLEXUS IS

JOINED BY AN INCONSTANT EXTERNAL PETROSAL NERVE
BRANCHES

IN THE FACIAL CANAL

NERVE TO STAPEDIUS
CHORDA TYMPANI

AT THE EXIT FROM STYLOMASTOID FORAMEN

POSTERIOR AURICULAR
POSTERIOR BELLY OF DIAGSTRIC
STYLOHYOID
ON THE FACE
TEMPORAL
ZYGOMATIC
BUCCAL
MARGINAL MANDIBULAR
CERVICAL
•NERVE TO STAPEDIUS ARISES BEHIND THE PYRAMIDAL EMINENCE
OF THE POSTERIOR WALL OF THE TYMPANIC CAVITY, PASSING
THROUGH A CANAL TO REACH THE MUSCLE

•THE CHORDA TYMPANI LEAVES THE FACIAL NERVE ABOUT 6 MM

ABOVE THE STYLOMASTOID FORAMEN,RUNS FORWARD IN THE
CANAL, PERFORATES THE POSTERIOR WALL OF THE TYMPANIC
CAVITY, VIA ITS POSTERIOR CANALICULUS NEAR POSTERIOR
BORDER OF THE TYMPANIC MEMBRANE’S MEDIAL ASPECT, AT THE
LEVEL OF THE HANDLE OF THE MALLEUS

•PASSES BETWEEN THE MEMBRANE’S MUCOUSAL AND FIBROUS

LAYER ON THE MEDIAL ASPECT OF THE HANDLE OF THE MALLEUS
TO RE-ENTER THE BONE VIA ITS ANTERIOR CANALICULUS AT THE
MEDIAL END OF THE PETROTYMPANIC FISSURE
•IT DESCEND ANTERIORLY ON THE MEDIAL ASPECT OF THE SPINE OF THE
SPHENOID & PASSES DEEP TO THE LATERAL PTERYGOID MUSCLE

•HERE NERVE IS POSTERIOLATERAL TO THE TENSOR VELI PALATINI & CROSSED

MEDIALLY BY TH MIDDLE MENINGEAL ARTERY,AURICULOTEMPORAL & INFERIOR
ALVEOLAR NERVE

•IT JOINS THE POSTERIOR ASPECT OF THE LINGUAL NERVE

•IT CONTAINS EFFERENT PREGANGLIONIC PARASYMPATHETIC FIBRES ENTERING

SUBMANDIBULAR GANGLION

•FROM THE GANGLION POSTGANGLIONIC FIBRES ARE RELAYED TO

SUBMANDIBULAR & SUBLINGUAL GLANDS

•MOST OF THE FIBRES OF CHORDA TYMPANI ARE AFFERENT CARRYING

SENATION OF TASTE FROM ANTERIOR 2/3RD OF THE TONGUE
•POSTERIOR AURICULAR NERVE ARISES NEAR THE STYLOMASTOID
FORAMEN ASECENDS IN FRONT OF THE MASTOID PROCESS,JOINED
BY FILAMENT FROM AURICULAR BRANCH OF THE VAGUS &
POSTERIOR BRACNH OF GREAT AURICULAR & LESSER OCCIPITAL
NERVES

•IT ASCENDS BETWEEN EXTERNAL ACOUSTIC MEATUS & MASTOID

PROCESS DIVIDES INTO AURICULAR & OCCIPITAL BRANCHES

•AURICULAR BRANCH SUPPLIES AURICULARIS POSTERIOR &

INTRINSIC MUSCLES ON THE AURICLE’S CRANIAL ASPECT

•LARGER OCCIPITAL BRANCH PASSES ALONG THE SUPERIOR

NUCHAL LINE SUPPLIES OCCIPITAL BELLY OF OCCIPITOFRONTALIS
•DIGASTRIC BRANCH STARTS NEAR THE STYLOMASTOID FORAMEN DIVIDES
INTO SEVERAL FILAMENTS SUPPLYING THE POSTERIOR BELLY OF DIAGSTRIC
MUSCLE,

• ONE OF THE FILAMENTS JOINS THE GLOSSOPHARYNGEAL NERVE

•STYLOHYOID BRANCH LONG & SLENDER FREQUESNTLY ARISES WITH THE

DIGASTRIC BRANCH & ENTERS THE MIDDLE PART OF THE STYLOHYOID MUSCLE

•TEMPORAL BRANCH CROSS THE ZYGOMATIC ARCH TO THE TEMPLE, SUPPLYING

INTRINSIC MUSCLES OF THE LATERAL SURFACE OF THE AURICLE, ANTERIOR &
SUPERIOR AURICULAR MUSCLES & JOIN WITH ZYGOMATICOTEMPORAL BRANCH
OF MAXILLARY NERVE & AURICULOTEMPORAL BRANCH OF MANDIBULAR NERVE

•THE MORE ANTERIOR BRANCHES SUPPLY THE FRONTAL BELLY OF THE

OCCIPITOFRONTALIS , ORBICULARIS OCULI & CORRUGATOR & JOIN THE
SUPRAORBITAL & LACRIMAL BRANCHES OF OPTHALMIC NERVE
•ZYGOMATIC BRANCH CROSS ZYGOMATIC BONE TO THE LATERAL CANTHUS
SUPPLYING THE ORBICULARIS OCULI & JOINING FILAMENTS OF THE LACRIMAL
NERVE & ZYGOMATICOFACIAL BRANCH OF MAXILLARY NERVE

•BUCCAL BRANCH PASS HORIZONTAL TO A DISTRIBUTION BELOW THE ORBIT

& AROUND TH MOUTH.

•SUPERFICIAL BRANCHES RUN BETWEEN TH SKIN & SUPERFICIAL MUSCLES,

SUPPLYING THE SUPERFICIAL MUSCLES, SOME PASS TO PROCERUS JOIN WITH
INFRATROCHLEAR & EXTERNAL NASAL NERVES

•UPPER DEEP BRANCHES PASS UNDER THE ZYGOMATICUS MAJOR & LEVATOR
LABII SUPERIORIS, SUPPLYING THEM & FORM INFRAORBITAL PLEXUS WITH
SUPERIOR LABIAL BRANCH OF INFRAORBITAL NERVE
•THEY ALSO SUPPLY ZYGOMATICO MINOR, LEVATOR LABII
SUPERIORIS ALAEQUE NASI & SMALL NASAL MUSCLES

•LOWER DEEP BRANCHES SUPPLY BUCCINATOR & ORBICULARIS

ORIS & JOIN WITH BUCCAL BRANCH OF MANDIBULAR NERVE

•MARGINAL MANDIBULAR BRANCH RUNS FORWARDS BELOW THE

ANGLE OF MANDIBLE UNDER PLATYSMA, AT FIRST SUPERFICIAL TO
THE UPPER PART OF THE DIGASTRIC TRIANGLE THEN TURNS
UPWARD & FORWARD ACROSS BODYO F THE MANDIBLE TO PASS
UNDER DEPRESSOR ANGULI ORIS

•IT SUPPLIES RISORIUS & MUSCLES OF LOWER LIP & CHIN &
JOINING MENTAL NERVE
•CERVICAL BRANCH ISSUES FROM THE LOWER PART OF
PAROTID GLAND, RUNS ANTEROINFERIORLY UNDER
PLATYSMA TO THE FRONT OF THE NECK.

•IT SUPPLIES PLATYSMA & COMMUNICATES WITH

TRANVERSE CUTANEOUS CERVICAL NERVE

•CUTANEOUS FIBRES ACCOMPANY AURICULAR BRANCH

OF VAGUS & INNERVATE SKIN ON BOTH AURICULAR
ASPECTS, CONCHAL DEPRESSION & OVER ITS EMINENCE
SUBMANDIBULAR GANGLION

•IT IS A SMALL FUSIFORM GANGLON LOCATED ON UPPER

ASPECT OF HYOGLOSSUS

•IT IS PHERIPHERAL PARASYMPATHETIC GANGLION

•IT IS SUPERIOR TO DEEP PART OF SUBMANDIBULAR

GANGLION & INFERIOR TO LINGUAL NERVE

•THOUGH RELATED TO LINGUAL NERVE,FUNCTIONALLY

CONNECTED WITH FACIAL & CHORDA TYMPANI
•ITS MOTOR PARASYMPATHETIC ROOT IS DERIVED FROM
POSTERIOR FILAMENT OF LINGUAL NERVE

•IT CONVEYS PREGANGLIONIC FIBRES FROM SUPERIOR

SALIVARY NUCLEUS,PASSING THROUGH FACIAL, CHORDA
TYMPANI & LINGUAL NERVE TO THE GANGLION

•POSTGANGLIONIC FIBRES ARE SECROMOTOR & REACH

SUBMANDIBULAR & SUBLINGUAL GLAND

•SOME FIBRES ALSO REACH PAROTID GLAND

•THE SYMPATHETIC ROOT IS DERIVED FROM THE PLEXUS
AROUND THE FACIAL NERVE

•IT CONSISTS OF POSTGANGLIONIC FIBRES FROM

SUPERIOR CERVICAL GANGLION,PASS THROUGH
SUBMANDIBULAR GANGLION WITHOUT SYNAPSING

•THEY ARE VASOMOTOR TO THE BLOOD VESSELS OF

SUBMANDIBULAR & SUBLINGUAL GLAND

•5-6 FIBRES SUPPLY THE SUBMANDIBULAR GLAND & ITS

DUCT, OTHERS PASS THROUGH ANTERIOR FILAMENT OF
LINGUAL NERVE CARRIED TO SUBLINGUAL GLAND &
APPLIED ASPECTS
•SUPRANUCLEAR LESIONS AFFECT THE UPPER MOTOR
NEURONS AFFECTING THE LOWER PART OF THE FACE
•VOLUNTARY ACTIONS BEING WEAK OR ABSENT BUT
EMOTIONAL EXPRESSION BEING LITTLE AFFECTED

•NUCLEAR OR INFRANUCLEAR LESIONS INVOLVE THE

LOWER MOTOR NEURONS CAUSING PARALYSIS OF ONE
SIDE OF THE FACE
•IT IS KNOWN AS BELLS PALSY
•THERE IS FACIAL ASSYMMETRY WITH AFFECTED SIDE
BEING IMMOBILE
•EYEBROW DROOPS,WRINKLES ARE SMOOTHED OUT,
PALPEBRAL FISSURE WIDENED UNOPPOSEDACTION OF
LEVATOR SUPERIORIS PALPEBRAE
•CONJUNCTIVAL REFLEX ABSENT & EFFORTS TO CLOSE THE
EYE ROLLS THE CORNEA UNDER THE UPPER LID
•ALA NASI DOESN’T MOVE WITH RESPIRATION
•LIPS REMAIN IN CONTACT BUT DO NOT PURSE
•AFFECT TO SMILE THE ANGLE OF THE MOUTH NOT
DRAWN AFFECTED SIDE
•LIPS REMAIN CLOSED & MOUTH TYPICALLY TRIANGULAR
•PROTRUDED TONGUE APPEARS TO BE TURNED TO
AFFECTED SIDE BUT ITS REALTIVE POSITION TO INCISAL
TEETH IS NORMAL
•PLATYSMA & AURICULAR MUSCLES ARE AFFECTED

•DURING INFERIOR ALVEOLAR NERVE BLOCK IF THE

PENETRATION OF NEEDLE IS POSTERIOR, NEEDLE MAY BE
IN THE PAROTID GLAND
•DEPOSITING THE SOLUTION IN THIS POSITION CAN
CAUSE ANESTHESIA OF FACIAL NERVE, PRODUCING
SYMTOMS SIMILAR TO BELLS PALSY
 RISDON INCISION

•WHILE MAKING SUBMANDIBULAR INCISION(RISDON

INCISION),INCISION IS TAKEN 1CM BELOW THE ANGLE OF THE
MANDIBLE TO PREVENT INJURY TO THE MRGINAL MANDIBULAR
NERVE
•CROCODILE TEARS LACRIMATION WHEN FOOD IS
EATEN PARICULARLY HOT & SPICY FOODS
•IT GENERALLY FOLLOW FACIAL PALSY, HERPES ZOSTER
INFECTION, HEAD INJURY OR INTRACRANIAL OPERATIVE
TRAUMA
•IT OCCURS DUE TO SALIVARY-LACRIMAL REFLEX
ESTABLISHMENT
 PREAURICULAR INCISION

•TEMPORAL BRANCH OF FACIAL NERVE CROSS THE LATERAL

SURFACE OF THE ZYGOMATIC ARCH WITH VARYING IN DISTANCE
FROM EXTERNAL ACOUSTIC MEATUS BETWEEN 8-35MM AVERAGE
20MM.
•TO PRESERVE TEMPORAL BRANCH INCISION MADE 0.8MM
ANTERIOR TO EXTERNAL ACOUSTIC MEATUS
AL-KAYAT BRAMLEY PREAURICULAR MODIFIED INCISION
•IT IS SIMILAR TO PREAURICULAR INCISION
BUT IT IS EXTENDED SUPERIORLY UPTO
HAIR-BEARING TEMPORAL SKIN (HOCKEY-
STICK) & INFERIORLY BRINGING BEHIND
THE TRAGUS HIDING THE INCISION
•IT IS ESPECIALLY USEFUL IN YOUNG
PATIENT WITH LESS PREAURICULAR SKIN
FOLD
•THIS RETROAURICULAR INCISION HIDES
THE INCISION & ALSO PRESERVES THE
AURICULOTEMPEROL NERVE
PAROTIDECTOMY
•DURING REMOVAL OF THE PAROTID GLAND,THE PRECAUTION
SHOULD BE TAKEN TO PREVENT DAMAGE TO FACIAL NERVE
•ESPECIALLY LOWER ZYGOMATIC BRANCH WHICH LIES ON THE
SURFACE OF THE DUCT JUST BELOW THE GLAND
GILLE’S TEMPORAL APPROACH
•INCISION IS PLACED AT THE HAIR LINE IN THE TEMPORAL REGION
OF BETWEEN 2 DIVISION OF SUPERFICIAL TEMPORAL VESSELS
•ELEVATOR IS PLACED BETWEEN THE TEMPORAL FASCIA &
TEMPORALIS MUSCLE & THE ARCH IS ELEVATED
•IF THE ELEVATION IS DONE ABOVE THE TEMPORAL FASCIA CAN
RESULT IN INJURY OF TEMPORAL BRANCH
 THANK YOU

HAVE A GOOD DAY