Dr.

Giovanni Henry (MBBS)

Senior House Officer
CRH-Otorhinolaryngology Service

Otolaryngology service 2016 7/28/16

The Anatomy of the

Facial Nerve

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FACIAL EXPRESSION!!

A summary of the history of Facial Nerve Surgery

The Embryology of the facial Nerve
Anatomy & function of the Facial Nerve
Nucleus of the facial nerve
Course of The facial Nerve
Branches Of the Facial Nerve
Blood Supply of the Facial Nerve
Surgical Landmarks
Structure of the Nerve
Severity Of Nerve Injury

Otolaryngology service 2016 7/28/16

Outline

Electro-diagnostic test
Causes of Facial Nerve paralysis
Physical Examination of cranial nerve VII
Localization of facial nerve lesions
Complications following facial paralysis
Hyperkinetic disorders of the Facial Nerve
Surgery Of the Facial Nerve
Common Mistakes To Avoid

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Part II: Outline

(Continued)

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Introduction

 The facial nerve is a mixed nerve having a motor and a

sensory root. It emerges from the brain stem between the
pons and the medulla
The sensory root (nerve of Wrisberg) carries secreto-motor
fibres to lacrimal, submandibular and sublingual salivary
glands and to those in the nose and palate
Supplies- preganglionic parasympathetic fibres to
several head and neck ganglia
It also carries taste from the anterior 2/3rds of the tongue via
the chorda tympani and soft and hard palate via the greater
superficial petrosal nerve distributed through palatine
branches of the sphenopalatine ganglion and general
sensation from the concha and retro-auricular skin

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Introduction

 SOME OF THE PHOTOGRAGHS YOU ARE

ABOUT TO SEE WERE OBTAINED FROM
PATIENTS WITH THEIR PERMISSION TO
BE USED FOR EDUCATIONAL PURPOSES,
OTHERS WERE TAKEN FROM VARIOUS
WEBSITES EASILY ACCESSIBLE TO THE
GENERAL PUBLIC

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DISCLAIMER:

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Clinical Case # 1

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Clinical Case # 2

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Clinical Case # 2

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 The history of facial nerve surgery

can be viewed as five overlapping
periods, each characterized by a
new understanding or approach to
the management of facial nerve
conditions.
The first period, the period of
discovery of the nerve of facial
expression, began with Sir Charles
Bell's description in 1829 of 3 cases
of facial paralysis due to facial
nerve trauma.
he described in the trajectory of
thefacial nerveand a disease,
Bell's Palsywhich led to the
unilateral paralysis of facial muscles

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Summary of the History of

Facial Nerve Surgery

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 The second period, from 1873 to 1960, was the

era of facial nerve repair.
Decompression of the facial nerve was the
primary focus of facial nerve surgery in the third
period, from 1908 to 1969.
The fourth period, from 1970 to 2000, can be
characterized as the "bottleneck" period in honor
of the contributions to facial nerve surgery that
resulted as Ugo Fisch and other surgeons sought
ways to operate on this portion of the proximal
nerve.

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History Of Facial Nerve Surgery

(contd)

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 In the current or fifth,

period in the history of
facial nerve surgery, we
anticipate the advent of
vaccines and antiviral
medications to minimize
the sequelae of Bell's palsy,
further improvements in
endoscopic equipment and
techniques, and better
surgical outcomes through
the use of new technologies
such as robotics.

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Advances in Facial Nerve Surgery

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 The facial nerve is developmentally derived from

the 2nd branchial arch (hyoid arch)
It arises as 2 main divisions- motor and sensory
The motor division of the facial nerve is derived
from the basal plate of the embryonic pons
The sensory division originates from the cranial
neural crest

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Embryology Of the Facial Nerve

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 The facial nerve course, branching pattern and

anatomical relationships are established during
the 1st three months of gestation
The nerve is not fully developed until approx. 4
years of age
The first identifiable facial nerve tissue is seen at
the 3rd week of gestation the facio-acoustic
primordium

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Embryology of the Facial nerve

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The Nerve Of the 2nd Branchial Arch

PHARYNG
EAL
ARCH

NERVE

ARTERY

MUSCLE

SKELETON

2ND
pharyngeal
arch

Cranial
Nerve VII

STAPEDIAL

Muscles of
facial
expression

Manubriu
m of
Malleus

=Hyoid

=Facial
Nerve

Buccinator

Long
process of
Incus

Posterior
belly of the
digastric

Stapes
(except for
footplate)

Stylohyoid

Facial
Canal

Stapedius

Stylohyoid

Reicherts
cartilage

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DERIVATIVES OF THE SECOND PHARYNGEAL

ARCH

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Nucleus Of the facial

Nerve

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NUCLEI

DISTRIBUTION

FUNCTION

GVE

Superior salivatory
nucleus
(lies in the pons
lateral to the main
motor nucleus of VII )

Submandibular
and sublingual
salivary glands.

Preganglionic
Secretomotor

SVE

Motor nucleus of
facial nerve
(lies in lower part of
pons)

Muscles of facial
expression,
stylohyoid,
posterior belly of
digastric,
platysma and
stapedius.

Facial expression

SVA

Nucleus of tractus
solitarius (lies in
medullla)

Taste buds in the

anterior 2/3rd of
tongue except
vallate papillae.

Taste sensations

GSA

Spinal nucleus of Vth

nerve

Part of skin of
external ear.

Exteroceptive
sensation

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FUNCTIONA
L
COMPONEN
T

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REVIEW QUESTIONS
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 Which statement regarding the facial Nerve

is correct?
a) The corda Tympani conveys parasympathetic
fibres for the parotid gland
b) The main trunk of the facial nerve emerges from
the stylomastoid foramen
c) It has five branches after exiting the skull
d) It lies deep to the retromandibular vein
e) In the supra-nuclear palsy, weakness of the
ipsilateral facial muscles would be noted

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MCQs #1

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 Which of the following statements is true?

a) Common sensation to the anterior 2/3rds of the
tongue is derived from the facial nerve
b) The intrinsic muscles of the tongue are all
innervated by the facial nerve
c) Mylohyoid is supplied by the facial nerve
d) Stylohyoid is supplied by the facial nerve

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MCQs # 2

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 All of the following muscles are supplied by

branches of the facial nerve except?
a) Stapedius
b) Anterior belly of the digastric
c) Stylohyoid
d) Posterior belly of the digastric
e) Buccinator muscle

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MCQs # 3

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