Professional Documents
Culture Documents
Introduction
Functional components
Deep/nuclear origin
Central connections
Superficial origin
Course
Relations
Branches of communication
Branches of distribution
Applied aspects
Peripheral course
Central course
Central course, cont'd
Overview of general sensory component
Central course
Central course, cont'd
Central course, cont'd
Peripheral lesions of the facial nerve
Peripheral lesions of the facial nerve, cont'd
Cranial Nerve VII - Facial Nerve
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Component Overview
The facial nerve has four components with distinct functions:
Branchial motor
(special visceral efferent)
Visceral motor
(general visceral efferent)
Special sensory
(special visceral afferent)
General sensory
(general somatic afferent)
Branchial motor fibers constitute the largest portion of the facial nerve.
The remaining three components are bound in a distinct fascial sheath from the
branchial motor fibers. Collectively these three components are referred to as the
nervus intermedius.
Component Overview
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Intracranial course
Upon emerging from the ventrolateral aspect of the caudal border of the pons, all
of the components of CN VII enter the internal auditory meatus along with the
fibers of CN VIII (vestibulocochlear nerve).
The fibers of CN VII pass through the facial canal in the petrous portion of the
temporal bone. The course of the fibers is along the roof of the vestibule of the
inner ear, just posterior to the cochlea.
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Eyebrow droop
Uncontrolled tearing
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Intracranial Course
Upon emerging from the ventrolateral aspect of the caudal border of the pons, all
of the components of CN VII enter the internal auditory meatus along with the
fibers of CN VIII (vestibulocochlear nerve).
Within the facial canal the visceral motor fibers divide into two groups to become
the greater petrosal nerve and the chorda tympani:
The greater petrosal nerve supplies the lacrimal, nasal, and palatine glands.
The chorda tympani supplies the submandibular and sublingual glands.
Figure 7-15a. Course of the greater petrosal nerve through the temporal bone.
The greater petrosal nerve passes deep to the trigeminal ganglion to enter the
foramen lacerum. The nerve traverses the foramen and enters a canal at the base of
the medial pterygoid plate in conjunction with sympathetic fibers (deep petrosal
nerve) branching from the plexus following the internal carotid artery. The
parasympathetic and sympathetic fibers together make up the nerve of the
pterygoid canal.
Upon exiting the pterygoid canal, pre-ganglionic parasympathetic fibers of CN VII
synapse in the pterygopalatine ganglion which is suspended from the fibers of the
maxillary division of the trigeminal nerve (V2) in the pterygopalatine fossa.
In the inferotemporal fossa the chorda tympani joins the fibers of the lingual
branch of the mandibular division of CN V (V3).
CN VII pre-ganglionic fibers synapse in the submandibular ganglion suspended
from the lingual nerve (V3). Post-ganglionic fibers then either enter the
submandibular gland directly or again follow the lingual nerve before branching to
Peripheral Course
Chemoreceptors of the taste buds located on the anterior 2/3 of the tongue and hard
and soft palates initiate receptor (generator) potentials in response to chemical
stimuli.
The taste buds synapse with the peripheral processes of special sensory neurons
from CN VII. These neurons generate action potentials in response to the taste
bud's receptor potentials. The peripheral processes of these neurons follow the
lingual nerve and then chorda tympani to the petrous portion of the temporal bone
(similar to the path followed by the efferent visceral motor fibers).
Central Course
The central processes of the special sensory neurons pass from the geniculate
ganglion through the facial canal and enter the brainstem as part of the nervus
intermedius portion of CN VII.
The fibers then join the caudal portion of tractus solitarius and ascend to synapse in
the rostral portion of the nucleus solitarius - also referred to as the gustatory
nucleus:
Central Course
Ascending secondary neurons originating from nucleus
solitarius project both ipsilaterally and contralaterally to the
ventral posteromedial (VPM) nucleus of the thalamus.
Tertiary neurons from the thalamus project via the posterior
limb of the internal capsule to the area of the cortex
responsible for taste.
Cranial Nerve VII - Facial Nerve
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The cell bodies of these primary sensory neurons reside in the geniculate
ganglion. The peripheral processes of these neurons pass from the skin of
the external ear and small region of skin behind the ear through the
stylomastoid foramen in conjunction with the fibers of the branchial motor
component of CN VII.
They then course through the petrous portion of the temporal bone to the
geniculate ganglion.
From the geniculate ganglion, the central processes of these general sensory
fibers travel through the facial canal of the petrous portion of the temporal
bone and exit the internal acoustic meatus.
Central Course
The central processes of the general sensory neurons enter
the brainstem as part of the nervus intermedius portion of
CN VII. The fibers then descend in the spinal tract of the
trigeminal nerve to synapse in the spinal nucleus CN V.
Central Course
Ascending secondary neurons originating from the spinal nucleus of CN V project
to the contralateral ventral posteromedial (VPM) nucleus of the thalamus via the
anterolateral system.
Tertiary neurons from the thalamus project via the posterior limb of the internal
capsule to the sensory cortex of the post-central gyrus.
Peripheral Lesions
By using your knowledge of the anatomy of the facial nerve, the location of a lesion can be
determined by the presence or absence of certain deficits.
A lesion in the facial canal proximal to the branching of the greater petrosal nerve and chorda
tympani is characterized by the following:
Paralysis of all the muscles of facial expressionipsilateral to the lesion (LMN lesion
of the branchial motor component of CN VII).
Loss of secretion from lacrimal gland and mucous membranes of nasal and oral
pharynx ipsilateralto the lesion (lesion of the greater petrosal nerve, visceral motor
component of CN VII).
Loss of secretion from submandibular and sublingual glands ipsilateral to the lesion
(lesion of the chorda tympani, visceral motor component of CN VII).
Loss of taste from anterior 2/3 of tongueipsilateral to the lesion (lesion of the chorda
tympani, special sensory component of CN VII).
Loss of general sensation from concha of external ear and small area of skin behind
the ear (general sensory component of CN VII).
If the lesion was distal to the greater petrosal nerve but proximal to the chorda tympani the
patient would present as above, except that secretory functions of the lacrimal, nasal, and
palatine glands would be intact.
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Peripheral Lesions
A lesion which affected the lingual nerve just distal to its junction with the chorda
tympani would present as follows:
Loss of secretion from submandibular and sublingual glands ipsilateral to the lesion
(visceral motor component of CN VII) Loss of taste from anterior 2/3 of tongue
ipsilateral to the lesion (special sensory component of CN VII) Loss of general
sensation from the tongue (general sensory component of CN V3).
Cranial Nerves
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Introduction
OLFACTORY NERVE
OPTIC NERVE
OCCULOMOTOR NERVE
TRIGEMINAL NERVE
FACIAL NERVE:
VESTIBULOCOCHLEAR NERVE
VAGUS NERVE
ACESSORY NERVE
HYPOGLOSSAL NERVE
About Me
AMBER MUNIR
FACIAL NERVE:
It is the 7th Cranial Nerve.
It has a medial motor root and a lateral sensory root, the nervous intermedius.
FUNCTIONAL COMPONENTS
Special Visceral (brachial) Efferent
Nucleus of the facial nerve lies in the lower part of Pons supplies various muscles
innervated by facial nerve. The part of nucleus that supplies muscles of the upper part of the
face receives corticonuclear fibers from the motor cortex of both the right and left sides. In
contrast the part of nucleus that supplies muscles of the lower part of the face receive
corticonuclear fibers only from the opposite side of cerebral hemisphere.
MOTOR ROOT
Supplies Muscles of face, scalp, auricle, buccinator, platysma, Stapedius, stylohyoid &
posterior belly of diagastric
SENSORY ROOT
It carries the taste fibers from anterior two thirds of tongue, floor of mouth and palate.
It also conveys parasympathetic secretromotor fibers to Submandibular and sublingual
salivary glands, lacrimal gland and glands of nose and palate.
ORIGIN
The two roots of facial nerve emerge from the anterior surface of brain between the pons and
medulla oblongata. They pass laterally forward in the posterior cranial fossa with the
Vestibulocochlear nerve to the opening of internal acoustic meatus. At the bottom of the
meatus the nerve enters the facial canal runs laterally above the vestibule of labyrinth until it
reaches the medial wall of tympanic cavity. (Middle ear)Here the nerve expands to form
sensory Geniculate ganglion. The nerve then bends sharply backwards above the
promontory, on arriving at the posterior wall of the middle ear, it curves downward. On the
medial side of the aditus of the mastoid antrum. It descends in the posterior wall of middle
ear, behind the pyramid and finally emerges through the stylomastoid foramen.
EXAMINATION
Routinely only the motor function of the 7th nerve is tested.
MOTOR FUNCTION
When 7th nerve is paralyzed, the patient may complain of inability to close the eyelid,
collection of food in the mouth and dribbling of saliva on the affected side of the mouth and
deviation of the angle of the mouth towards the opposite side.
On inspection, palpebral fissure may be wide and nasolabial fold may be flattened on
theparalyzed side.
Ask the patient to frown or wrinkle the forehead.
cted side.
Ask the patient to close the eyes; the affected side will remain open and there will be
brisk upward rolling of the eye ball (Bells phenomenon). To test the power of orbicularis
occuli ask the patient to close the eyes as strongly as possible while you try to open the upper
eyelids. The affected side will be weak.
Ask the patient to inflate the cheek and tap on both sides with finger. The weak
side will be deflated easily.
Ask the patient to show the teeth. The angle of mouth will be deviated towards the
healthy side.
The patient cannot whistle as air escapes from the paralyzed side.
The patient will complain of unusually loud sounds on paralyzed if nerve to Stapedius is
involved.
TASTE
Test taste of the anterior two third of the tongue by following technique.
Get solutions of four common tastes- sweet, salt, sour and bitter.
Instruct the patient to identify the taste, either by writing or raising fingers, e.g. one finger
if taste is sweet, two fingers if salty and so on.
Ask the patient to protrude the tongue. Hold it with a gauze, dry it and test each side
separately.
Put a drop of each solution one by one and ask for response.
Test bitter at the end.
SECRETOMOTOR FUNCTION
Lacrimation and salivation can be tested by various tests but it is not done routinely.
INTERPRETATION
The facial nerve is the most commonly affected cranial nerve by lesion of both upper motor
neuron and lower motor neuron.
UPPER MOTOR NEURON LESION
Manifestations are on the opposite side. Upper half of the face (wrinkling of the forehead,
closure of the eyelid) is less severely affected because the part of the facial nerve nucleus
which supplies muscles of the upper half of the face is connected with both cerebral
hemispheres; the part of the facial nerve nucleus which supplies muscles of lower half of the
face is connected only with the contra lateral cerebral hemispheres. Smiling and other
emotional movements are usually preserved in UMN lesion because there is a separate path
for these movements.
LOWER MOTOR NEURON LESION
Whole of the ipsilateral half of the face is affected. Bells palsy is the most common cause of
isolated lower motor neuron facial palsy. Etiology is unknown. The lesion is in the facial
canal.
As facial nerve has a long route and gives off branches at various sites, the site of lesion can
be localized with considerable precision.
If the lesion is after the nerve exits from the skull, there is only weakness of the
facial muscles.
If the lesion is in the facial canal, between the chorda tympani and branch to
Stapedius, in addition to motor weakness, there is loss of taste as well.
If the lesion is between the branch to Stapedius and internal auditory meatus,
there is hyperacusis on the affected side, in addition to motor weakness and loss of taste.
Geniculate ganglion can be affected by herpes zoster(Ramsay Hunt syndrome). In
addition to other features of facial palsy, there are vesicles in that part of external auditory
meatus which gets sensory supply from the facial nerve.
If the lesion is in the internal auditory meatus, in addition to the features of facial
nerve palsy, 8th nerve is also paralyzed.
3 comments:
1.
Dr.ShireenOctober 25, 2011 at 6:16 AM
1.
Amber MunirJune 26, 2012 at 8:04 AM
ur welcum :)
Reply
2.