Good

afternoon

TRIGEMINAL NERVE
AND
FACIAL NERVE

PRESENTED BY
DR.ESTHER

O INTRODUCTION
O CRANIOCAUDAL SEQUENCE
O ORIGIN OF TRIGEMINAL NERVE
O DIVISIONS-OPTHALMIC

MAXILLARY
O
MANDIBULAR
O TRIGEMINAL NEURALGIA
O FACIAL NERVE
O
INTRACRANIAL COURSE
O
EXTRACRANIAL COURSE
O BRANCHES AND DISTRIBUTION
O FACIAL NERVE DISORDERS
O CONCLUSION
O

INTRODUCTION
O Nervous system is predominantly made up of the tissue,

which has special property to conduct impulses rapidly

from one part to other part of the body

O Neurons --- specialized cells that forms the functional

unit of nervous system

O Neuroglia --- supporting CT of neuron in brain & spinal

cord
4

O Large cell body / soma

O Large central nucleus

surrounded by cytoplasm --perikaryon

O Cytoplasm --- numerous
mitochondria, lysosomes,
Golgi complex
O Granular material --- Nissel
substance

O Neurites --- processes

arising from cell body

O Short branching process ---

dendrites
O Longer process --- axon

CRANIOCAUDAL SEQUENCE
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

Olfactory
Optic
Occulomotor
Trochlear
Trigeminal
Abducent
Facial
Vestibulocochlear
Glossopharyngeal
Vagus
Accessory
Hypoglossal

TRIGEMINAL NERVE
O Is the largest cranial

nerve
O It is the fifth cranial
nerve.
O It is a mixed cranial nerve
{both sensory & motor}
O General somatic afferent
fibres convey both
exteroceptive and
proprioceptive impulses
8

O Exteroceptive

impulses of
touch, pain, and thermal
senses are transmitted from
skin of face, forehead, mucous
membrane of nasal cavity, oral
cavity, floor of mouth and
anterior 2/3 rd of tongue.

O Proprioceptive

impulses
(deep pressure and kinesthesis)
are conveyed from teeth
periodontium, hard palate and
TMJ receptors
9

O Special visceral efferent fibers innervate muscles of

mastication, tensor tympani, tensor veli palatine muscles.

O Afferent fibres constitute the sensory root (portio major)

and efferent, the motor root (portio minor)

10

O ORIGIN emerges from side of pons, near its

upper border, at the junction of middle

cerebellar peduncle.

11

O Trigeminal nerve is attached to the lateral part

of pons by its two roots

O Motor
O Sensory
O The two roots enter the middle cranial fossa

12

SENSORY ROOT OF TRIGEMINAL NERVE

O ORIGIN fibres of sensory

root arise from the semilunar /

gasserian ganglion
O The peripheral branches form
O Opthalmic
O Maxillary
O Mandibular divisions of the

nerve
13

O The central branches leave

the semilunar ganglion and

pass back and enter the
pons
O Sensory fibres runs towards

Principal sensory nucleus

O Forms ascending and

descending fibres

14

O The ascending fibers terminate in

the upper sensory (main) nucleus

in the PONS lateral to the motor
nucleus.
O The ascending fibers convey light,

touch, tactile discrimination, sense

of position and passive movement
O Some ascending fibres enters

mesencephalic nucleus conveys

proprioceptive impulses from
masticatory muscles, teeth and
facial and ocular muscles
15

DEVELOPMENTAL ASPECTS OF SENSORY

ROOT

O Medullation of fibres of sensory root begins about 5th

month of foetal life and completes until the 3rd month

after birth

16

MOTOR ROOT OF TRIGEMINAL NERVE

O It arises from the motor nucleus

located in the upper PONS

O These fibers pass from the pons,

along the medial side of the

semilunar ganglia and then
passes below to the foramen
ovale and joins with the
mandibular division immediately
below the base of the skull.
O It also called masticator nerve
17

SEMI LUNAR /GASSERIAN

GANGLION

O Developed from the neural

crest
O Sensory ganglion of fifth
cranial nerve
O Contains unipolar neurons
O Located in meckels cavity
in duramater near the apex
of petrous part of temporal
bone.
18

RELATIONS OF TRIGEMINAL GANGLION

O Medially: Internal carotid

artery, posterior part of

cavernous sinus.
O Laterally: middle

meningeal artery
O Inferiorly: Motor root of

the nerve itself, greater

petrosal nerve, apex of
petrous temporal bone,
foramen lacerum, carotid
artery in its bony canal

19

DIVISIONS OF TRIGEMINAL NERVE

O 1.OPHTHALMIC NERVE.
O 2.MAXILLARY NERVE.
O 3.MANDIBULAR NERVE

20

OPHTHALMIC NERVE
O First division of

trigeminal nerve
O It is a sensory nerve
O Smallest of the three

divisions
O Passes forwards and

enters the orbit through

superior orbital fissure
21

O It passes forwards from the anterio-medial part of the

semilunar ganglion and enters the lateral wall of the

CAVERNOUS SINUS
Supplies : Eyeball
Lacrimal Gland
Conjunctiva
Part Of Nasal Mucosa
Skin Of Nose
Eyelids
Forehead
Part Of Scalp
Sclera Of Eyeball , Lining Of Ethmoidalcells

22

O In the middle cranial fossa, it gives nervus tentori

branches to supply to the dura.

O It also gives communicating branches to

OCCULOMOTOR, TROCHLEAR AND ABDUCENT

cranial nerves

O As the ophthalmic division passes forward from the

cavernous sinus, it divides into three branches:

O LACRIMAL
O FRONTAL
O NASOCILIARY

23

LACRIMAL NERVE
O It is the smallest branch
O passes into the orbit at the lateral

angle of the superior orbital fissure.

O It then courses in an anterolateral
direction to reach the lacrimal
gland.
O It supplies to the gland and adjacent
conjunctiva.
O Postganglionic secretory fibers
from the sphenopalatine ganglion
meet & travel with the lacrimal
nerve and these fibers are from the
Zygomatic Nerve.
24

FRONTAL NERVE

O It is the largest and appears

to be the direct continuation

of the ophthalmic division.
O It enters the orbit from the
superior orbital fissure.
O Frontal nerve divides into two
branches in the middle of the
orbit:
O A. SUPRAORBITAL &
O B. SUPRATROCHLEAR
NERVES.

SUPRAORBITAL NERVE
O It is the largest branch of the

frontal nerve.
O It passes forwards and leaves
the orbit through the
supraorbital foramen or notch
to supply
O the skin of the upper eyelid,
the forehead and the anterior
scalp region to the vertex of
the skull.
26

SUPRATROCHLEAR NERVE
O It is the smallest of the

frontal nerve.
O It passes towards the upper
medial angle of the orbit.
O Here it pierces the fascia of
the upper eyelid to supply
the skin of the upper eyelid
and lower medial portion of
the forehead.

27

NASOCILIARY NERVE
O Third main branch of ophthalmic division
O It enters the orbit through the superior orbital fissure.

Branches of the Nasociliary nerve are:

O A. Branches in the orbit
O B. Branches in the nasal cavity
O C. Branches on the face

28

BRANCHES IN THE ORBIT

Long root of the ciliary
ganglion:
O It contains sensory fibers which
pass through the nasociliary
ganglion without synapsing and
continue on to the eyeball by
means of the Short Ciliary Nerves.
Long ciliary nerves:
O Usually two or three branches
present and are distributed to Iris
and Cornea.

Posterior Ethmoid nerve:

O It enters the posterior ethmoid canal and supplies to the
mucous membrane lining the posterior ethmoid cells and the
sphenoid sinus
Anterior Ethmoid Nerve:
Nasociliary nerve continues anteriorly along the medial wall
of the orbit.
The anterior ethmoid nerve gives off the filaments to supply
the mucous membrane of the anterior ethmoid cells and
frontal sinus.
In the upper part NASAL CAVITY it divides into two sets of
anterior nasal branches:
a. Internal Nasal branches,
b. External Nasal branches
30

O Internal Nasal Branches: It in turn divides into two

divisions:
i. Medial or Septal Branches:
O It travels downwards and supply to the mucous
membrane of the nasal septum.
ii. Lateral Branches:
O It supplies to the mucous membrane of the anterior
ends of the Superior and Middle nasal conchae and to
the Anterior Lateral Nasal wall.
O External Nasal Branches:
O It supplies to the skin of the tip of the nose and over
the ala of the nose.

BRANCHES IN THE NASAL CAVITY

O Branches that arising from the nasal cavity supply to the

mucous membrane lining the nasal cavity.

BRANCHES ON THE FACE

O These terminal branches course below the trochlear
nerve to supply the skin of the medial parts of both the
eyelids, the Lacrimal sac and the Lacrimal caruncle.
O It also supply to the skin of the side of the Bridge of the
Nose.

CILIARY GANGLION
O It is autonomic ganglion

lying in the posterior part

of orbital cavity to the
lateral side of optic nerve
medial to the lateral rectus
muscle
O Topographically the
ganglion is related to
nasociliary nerve, but
functionally it is related to
oculomotor nerve
33

O It has three roots

O Sensory root- from the long

ciliary nerve
O Sympathetic root- long
ciliary nerve from plexus
around ophthalmic artery
O Motor root- Arises from the
cells of Edinger Westphal
nucleus in the grey substance
of the mesencephalon and the
axons of this root course with
the fibers of occulomotor
nerve to the ciliary ganglion
34

MAXILLARY DIVISION
O Maxillary division of

trigeminal nerve is entirely

sensory in function
It originates at the middle of

the semilunar ganglion and

continues in the lower part of
the cavernous sinus and leaves
the cranial fossa through
FORAMEN ROTUNDUM
and enters the PTERYGOPALATINE FOSSA.
35

O It enters the Inferior

Orbital Fissure to pass

into the Orbital Cavity,
then it turns laterally into
the Infraorbital Groove
O Continuing forward
emerges on the anterior
surface of the maxilla
through the
INFRAORBITAL
FORAMEN and gives
its terminal branches.

36

O In its course the MAXILLARY NERVE gives

of the branches in four regions:

O 1. Branches in the Middle Cranial Fossa
O 2. Branches in the Pterygpalatine Fossa
O 3.Branches in the Infraorbital groove and
Canal
O 4. Branches on the face (terminal branches)

37

BRANCHES IN THE MIDDLE CRANIAL FOSSA

O A small branch Middle Meningeal Nerve

passes with the Middle Meningeal Artery and

supply to the DURA
O Also know as nervus meningeus
medius

38

BRANCHES IN THE PTERGOPALATINE FOSSA

O It gives of three main branches in the Pterygopalatine

fossa:
O A. Zygomatic nerve
O B. Pterygopalatine (Sphenopalatine) nerve
O C. Posterior Superior Alveolar Branches

39

ZYGOMATIC NERVE

Starts in pterygopalatine fossa

Enters the orbit through inferior orbital fissure
Divides into 2 branches
1) Zygomatico -temporal branch
2) Zygomatico -facial branch

40

ZYGOMATICOFACIAL NERVE:
O It passes forward on the lateral orbital foramen.
O This nerve pierces the Orbicularis Oculi and supply to
the skin over the prominence of the Zygomatic Bone.
ZYGOMATICOTEMPORAL NERVE:
O It leaves the orbit between the greater wing of sphenoid
and the zygomatic bone to enter the temporal fossa.
O It supplies to the skin over the Anterior Temporal Fossa
region.

41

PTERYGOPALATINE NERVES
O Two short pterygopalatine nerves unite at the

pterygopalatine ganglion and then redistributed

into several branches.
O The branches of pterygopalatine nerves are
divided into three groups
O Orbital
O Nasal
O Palatine

42

ORBITAL
O 2 or 3 fine filaments, enters the orbit and

supply the periosteum of the orbit

O Mucous membrane of the posterior ethmoidal
sinus
O sphenoid sinus

43

NASAL BRANCHES
In the nasal cavity the nerve divides into two branches
Posterior Superior Lateral Nasal branches
It supplies to the mucous membrane of the nasal septum
and posterior ethmoid cells.
Medial or Septal branch
It supplies to the mucous membrane over the vomer and
then descends into incisal canal and ramifies in the premaxillary region of the hard palate.
44

PALATINE BRANCHES

It descends in the pterygopalatine canal and they

divide into 3 strands
1)Greater or anterior palatine
2)Middle palatine
3)Posterior palatine

45

GREATER OR ANTERIOR PALATINE NERVE

O It emerges on to the hard

palate through greater palatine

foramen
O Courses in an anterior
direction between the osseous
hard palate and the
mucoperiosteum to supply the
major part of the hard palate
and the palatine gingiva
46

MIDDLE PALATINE NERVE

O It emerges from lesser palatine foramen and supplies to

the mucous membrane of the soft palate.

POSTERIOR PALATINE FIBERS

O These also emerge from lesser palatine foramen and go

to the mucous membrane of the tonsillar area as a part

of the sensory supply to the tonsil itself.

47

POSTERIOR SUPERIOR ALVEOLAR BRANCHES

O Two or three branches leave the maxillary nerve just before it

enters the inferior orbital fissure and pass downward and

continue on the posterior surface of maxilla.
O An internal branch of posterior superior alveolar nerve goes

along with the branch of internal maxillary artery through

the posterior superior alveolar canal
O In the bone it passes down the posterior lateral wall of the

maxillary sinus and supplies to the mucous membrane of the

sinus and then supplies to the maxillary molars and their
gingiva.
48

BRANCHES IN THE INFRA-ORBITAL GROOVE

& CANAL
O It is also known as the

infra-orbital nerve.
O Middle Superior Alveolar
nerve
O Anterior Superior Alveolar
nerve

49

MIDDLE SUPERIOR ALVEOLAR NERVE

O It branches within the mucous membrane of the maxillary
sinus to join with other alveolar nerves forming the
superior dental plexus of nerves
O ANTERIOR SUPERIOR ALVEOLAR NERVE

It descends from the infra-orbital nerve just inside infraorbital foramen.

It supplies to the maxillary centrals and lateral incisors and
cuspids
It also supplies to the mucous membrane of the anterior part
of the maxillary sinus as well as labial gingivae of the
incisors and cuspids.

TERMINAL BRANCHES ON THE FACE

O The infra-orbital nerve emerges from the infra-orbital

foramen on the anterior surface of maxilla an divides

into three terminal branches
O Inferior Palpebral branches
O Two or three in number supplies to skin of the lower

eyelid and its conjunctiva

51

EXTERNAL OR LATERAL
BRANCHES:
It supplies to the skin of the

side of the nose.

SUPERIOR LABIAL BRANCHES:
Three or more in number and

supply to the skin and mucous

membrane of the upper lip.

52

GANGLION ASSOCIATED WITH THE MAXILLARY DIVISION

OF THE TRIGEMINAL NERVE SPHENOPALATINE
GANGLION (PTERYGOPALATINE GANGLION)

O Largest peripheral parasympathetic ganglion

O Placed deep in pterygo -palatine fossa near

Sphenopalatine foramen

O Connected functionally with the facial nerve

O Majority of the branches of ganglion are maxillary

division sensory fibers from the palatal nasal mucosa ,

pharynx and orbit , they pass through ganglion and enters
the maxillary nerve through its ganglionic branches
53

54

O Parasympathetic /motor root

O Has pre -ganglionic fibers which arise from a special lacrimatory

nucleus
O The ganglionic fibers join the maxillary nerve which passes into

zygomatic branch , then into the zygomatico -temporal nerve to

reach the lacrimal nerve (secreto motor)
O Secreto -motor fibers -For palatine , pharyngeal and nasal glands

Sympathetic root
O Its postganglionic fibers arise in the superior cervical ganglion
and travel via the internal carotid plexus and deep petrosal nerve
55

BRANCHES FROM THE SPHENOPALATINE GANGLION

O Orbital branches
O Nasal branches-

Posterior superior lateral nerves

Nasopalatine (long Sphenopalatine) nerve
O Palatine branches- anterior ,posterior and middle
O Pharyngeal branches

56

MANDIBULAR DIVISION

O It is the largest branch of

the trigeminal nerve.

O It is formed by the union of

large sensory and small

motor bundle of fibers

57

O The motor root located in

the middle cranial fossa

joins the sensory nerve as
it leaves the semilunar
ganglion.

O The two roots pass side

by side in the dura and

come out of Foramen
Ovale, then both the roots
join to form single trunk.
58

BRANCHES OF THE UNDIVIDED NERVE

Nervus Spinosus
O It arises outside the skull and then passes into the middle
cranial fossa through the Foramen spinosum and supplies
to the Dura of the Posterior cranial fossa and the Mastoid
cells.
Nerve to medial Pterygoid muscle
O A branch of the motor root passes and supplies to the
Medial Pterygoid muscle.
O It also supplies to the Tensor Palatini and Tensor
Tympani muscles
59

BRANCHES FROM THE DIVIDED NERVE

Anterior division
O It is smaller than the posterior division.
O It passes downwards and forwards and divides into:
i. Branch to External Pterygoid muscle:
O It provides the motor supply to the Lateral Pterygoid
muscle.
ii. Branch to Masseter muscle:
O It passes above the external pterygoid nerve and traverse
the Mandibular Notch and supply to the Masseter
muscle.
60

iii. Nerve to Temporalis muscle:

a. Anterior deep Temporal nerve:
It passes upward and crosses the
Infratemporal crest of the Sphenoid
bone and supplies to the Anterior
portion of the Temporalis muscle.
b. Posterior deep Temporal nerve:
It passes upwards and supplies to
the deeper portion the Temporalis
muscle.
61

Buccal nerve
It passes downward, anteriorly and
laterally between the two heads of the
external pterygoid muscle.
O At the level of the occlusal plane of

the mandibular second and third

molar it divides into several branches
and ramifies on the Buccinator
muscle
O It is purely sensory and supplies to

the buccal gingiva of the mandibular

molars and the mucous membrane of
the Buccal Vestibule.

62

POSTERIOR DIVISION
O It is mainly sensory and partly motor.
O It extends downwards and medially and then divides into

the following branches.

Branches :
a) Auriculotemporal nerve
b) lingual nerve
c) inferior alveolar nerve

63

AURICULOTEMPORAL NERVE
O It arises from the medial and

lateral root and embrace the

middle meningeal artery and
unite just below the Foramen
Spinosum.
O The united nerve passes
posteriorly, deep to the external
pterygoid muscle, and then
between the sphenomandibular
ligament and the neck of the
condyle of the mandible.

64

O It then traverses the upper deep

part of the Parotid Gland and

crosses the posterior root of the
Zygomatic Arch
O It passes upwards with the

Superficial Temporal Artery and

divides into numerous branches,
to the Tragus, Scalp about the
ear and Vertex of skull.
65

COMMUNICATIONS OF AURICULOTEMPORAL
NERVE
Communicating branches to the otic ganglion
These are from Glossopharyngeal nerve and control the
secretion of the Parotid Gland.
Communicating branches of postganglionic sympathetic
fibers
They pass to the Parotid Gland.
Communicating branches to the Facial nerve
These fibres are purely sensory
66

BRANCHES OF AURICULOTEMPORAL NERVE

Parotid branches: It gives off sensory, secretory and

vasomotor fibers to the Parotid Gland.
Articular branches: Two sensory fibers supply to
posterior part of the Temporomandibular Joint.
Auricular branches: Two sensory fibers supply to the
skin of the Helix and the Tragus.

67

Meatal Branches: Two branches supply to the skin

lining the meatus and Tympanic membrane
Terminal branches: These filaments supply to the
scalp over the Temporal region.

68

LINGUAL NERVE

O Smaller of the two terminal

branches of the posterior

division of the mandibular
nerve
O It passes medially to the

External Pterygoid muscle

and descends to lie between
the Internal Pterygoid muscle
and the Ramus of the
Mandible in the
Pterygomandibular space

69

O In the Pterygomandibular space

the Lingual nerve lies parallel

to the Inferior Alveolar nerve
but medial and anterior to it.
O The Lingual nerve enters the
side of the base of the Tongue
and lies below the Lateral
Lingual Sulcus.
O In the Lateral Lingual Sulcus
the Lingual nerve is separated
from the tongue by
Alveololingual sulcus.
70

 It passes forwards and loops

downward and medially

beneath the Submandibular
Duct

Lingual nerve supplies the

sensory fibers to the mucous

membrane of the Floor of the
mouth and Gingiva on the
lingual surface of the Mandible.
71

O The Lingual nerve passes

medially to the External

Pterygoid muscle and then
communicates with the
Chorda Tympanic branch of
the Facial nerve.
O The Chorda Tympanic nerve

conveys the secretory fibers

of the Facial nerve to control
the Submandibular and
Sublingual Salivary gland.

CHORDA TYMPANI
NERVE

72

INFERIOR ALVEOLAR NERVE

O It is the largest branch of

the Posterior division of the

Mandibular part of the
Trigeminal Nerve.
O It passes downwards to the
medial side of the External
Pterygoid muscle and the
medial surface of the Ramus
of the Mandible in the
Pterygomandibular space
and enters the Mandibular
Foramen.

73

O After entering the foramen

it descends in the Inferior

Alveolar canal and is
distributed throughout the
Body of the Mandible
O In the Inferior Alveolar

canal it gives off branches

to the mandibular teeth as
apical fibers through the
apical foramina to the
dental pulps of each tooth.
74

O As it reaches the Mental

Foramen it divides into two

terminal branches
O The Mental nerve leaves the

mandible through the

Mental Foramen and
supplies to the skin of the
chin and mucous membrane
of the Lower Lip.

75

O The Incisive branch continues in the Body of the

Mandible and forms the Incisive plexus to the

Anterior teeth

76

O Before the Inferior Alveolar nerve

enters the Mandibular Foramen it

gives off a branch
Mylohyoid nerve
O The Mylohyoid nerve continues in the
Mylohyoid groove and passes below
the Mylohyoid muscle and supplies
motor fibers to Mylohyoid muscle and
to the Anterior belly of the Digastric
muscle.
O It is a mixed nerve( both sensory and
motor).
O Its sensory fibers supply to the
mandible in the area of chin.
77

Autonomic Ganglia Associated With The

Mandibular Nerve
O Submandibular /Sub maxillary ganglion
O Its a small ovoid body that suspends from lingual nerve

above the Submandibular gland .

O Pre ganglionic fibers come from sup.Salivatory.nucleus
and pass via chorda tympani and lingual nerve to the
ganglion .
O Post ganglionic fibers are secreto-motor to the
Submandibular and sublingual gland.
O The ganglion also receives post ganglionic sympathetic
fibers from the plexus around the external maxillary
artery.
78

79

OTIC GANGLION
O Its a flattened ovoid body located on the medial side

of undivided mandibular division of trigeminal nerve

O Its below the foramen ovale and in front of middle

meningeal artery.

80

O Has two roots

O Parasympathetic root
O Originating in inf.salivatory nucleus,passing via glosso

pharyngeal nerve to tympanic nerve, plexus then via

lesser petrosal nerve to the otic ganglion.
O Post ganglionic fibers (secretomotor)pass via auriculo

temporal nerve to the parotid gland .

81

Sympathetic root
Its made up of postganglionic fibers that originates in

the sup. cervical sympathetic ganglion and the plexus

on the middle meningeal artery

These fibers pass uninterruptedly through the

ganglion joining the Auriculotemporal nerve and

with its glandular branches continuing to the parotid
gland.

82

APPLIED ASPECTS OF
TRIGEMINAL NERVE

83

TRIGEMINAL NERVE INJURY

Trigeminal nerve May Be Injured By
Tumours,trauma,aneurysms or Meningeal Infections (Lange et al

1995)
Injury To Cn5 Causes :
Paralysis Of Muscles Of Mastication
Loss Of Ability To appreciate soft Tactile ,Thermal Or Painful

Sensations In Face
Loss Of Corneal Reflex And Sneezing Reflex
84

TRIGEMINAL NEURALGIA
Tic Doulourex, Trifacial Neuralgia, Fothergills
Disease
O It is defined as severe paroxysmal

bursts of pain in one or more

branches of trigeminal nerve
often induced by touching trigger
zones in and around the mouth.
O John Locke first described the

disease.(1677)
O John Fothergill first described

clinical symptoms(1773)
85

ETIOLOGY
O Uncertain
O Idiopathic
O Aberrant loop of artery pressing on trigeminal rootlets
O Multiple Sclerosis,Osteopetrosis
O Gasserian ganglion tumor,Corotid Siphon
O Arterio-Ventricular malformation
O Tertiary syphilis
O Oro-dental lesions

86

87

CLINICAL FEATURES
O More in elders(>35yrs)
O Right side more affected than left(1.7:1)
O Pain is searing,stabbing or lacinating type.
O Pain initiated when trigger zones are touched

especially on lips,nose,cheeks and around eyes.

O Mandibular and maxillary divisions are more
commonly involved
O Pain lasts for few minutes to seconds and disease is
unilateral
88

Sphenopalatine Neuralgia
(Lower half headache,Atypical facial
neuralgia,Histamine cephalgia,Hortons
syndrome,Cluster headache)

O Variant of migraine

ETIOLOGY
O Vasodilatation of Internal Maxillary Artery
where it supplies the shenopalatine region

89

Auriculo-Temporal Syndrome
(Freys syndrome,Gustatory sweating)
O It is an unusual phenomenon which arises as a result

of damage to the auriculotemporal nerve and

subsequent re-innervation of sweat glands to
parasympathetic nerve fibers.
ETIOLOGY
O Surgery on parotid damaging the auriculotemporal
nerve

90

FACIAL NERVE
Seventh Cranial Nerve

Nerve Of The Second Branchial

Arch

Hence The Name "The Nerve

Of Facial Expression

Sensory and Motor root

91

92

FUNCTIONAL COMPONENTS
O Special visceral or branchial efferent- muscles

responsible for facial expression and for elevation of

hyoid bone
O General visceral efferent or parasympatheticO These fibres are secretomotor to submandibular and
sublingual salivary glands, lacrimal gland,glands of
nose, palate and the pharynx
O General visceral afferent component- carries afferent
impulses from the above glands

93

O Special visceral afferent fibres- carry taste

sensation from the anterior two thirds of the

tongue except from vallate papillae and from the
palate
O General somatic afferent fibres- innervate a part
of the skin of the ear

94

NUCLEI
O The fibres of the nerves arise from four nuclei situated in

the lower pons:

O MOTOR OR BRANCIOMOTOR NUCLEUS
O SUPERIOR SALIVATORY OR PARASYMPATHETIC
O LACRIMATORY NUCLEUS

which is gustatory
and also receives afferent fibres from glands

O NUCLEUS OF TRACTUS SOLITARIUS

95

O Motor nucleus lies deep in the reticular formation

of the lower pons

O The part of the nucleus that supplies muscles of
the upper part of the face receives
corticonuclear fibres from the motor cortex of
both right and left sides
O In contrast ,the part of the nucleus that supplies
muscles of the lower part of the face receive
corticonuclear fibres only from the opposite
cerebral hemisphere

96

COURSE AND RELATIONS

O Facial nerve is attached to the brain stem by two roots,

motor and sensory

O Sensory root is also called nervus intermedius
O Two parts of the facial nerve are attached to the lateral
part of lower border of pons just medial to eighth
cranial nerve
O The two roots run laterally and forward, with eighth
nerve to reach internal acoustic meatus

97

O In the meatus , the motor root lies in a groove on the

eighth nerve, intervening with the sensory root

O At the bottom of the meatus ,sensory and motor roots

fuse to form a single trunk , which lies in the petrous

temporal bone

98

O Within the canal , the course

of the nerve can be divided

into three parts by two bends
O First part directed laterally

above the vestibule

O Second part runs backwards

in relation to the medial wall

of the middle ear above the
promontory
99

O Third part directed

vertically downward
behind the promontory
O The first bend junction
of first and second parts
is sharp
O It lies over the
anterosuperior part of
the promontory- is called
as genu

100

O Second bend is

gradual, and lies

between the
promontory and the
auditus to the
mastoid antrum
O Facial nerve leaves
the skull by passing
through the
stylomastoid
foramen
101

EXTRACRANIAL COURSE
O In its exracranial course, facial nerve

crosses the lateral side of the base of the

styloid process
O It enters the posteromedial surface of the
parotid gland, runs forward through the
gland crossing the retromandibular vein &
external carotid artery
O Behind the neck of the mandible it divides
into its five terminal branches which emerge
along the anterior border of the parotid
gland
102

O BRANCHES AND DISTRIBUTION

O

Within The Facial Canal

O Greater Petrosal Nerve
O Nerve To Stapedius
O Chorda Tympani
O Exit from stylomastoid foramen
O Posterior auricular
O Digastric
O Stylohyoid Branch
103

Terminal Branches Within Parotid Gland

O Temporal
O Zygomatic
O Buccal - Upper And Lower
O Marginal Mandibular
O Cervical

104

GREATER PETROSAL NERVE

O Greater petrosal

nerve passes beneath

trigeminal ganglion &
reaches foramen
lacerum
O Joined by deep

petrosal nerve from

sympathetic plexus
on the internal carotid
artery
105

O Two join and pass forward

through the pterygoid canal

O Emerges into the

pterygopalatine fossa and

enters the pterygopalatine
ganglion

106

NERVE TO STAPEDIUS
O Given off in the facial canal
O Arises opposite to the pyramid of the

middle ear and supplies the stapedius

muscle

107

CHORDA TYMPANI NERVE

O Arises in the vertical

part of facial canal

6mm above the
stylomatoid foramen
O Enters the middle ear
in close relation to
tympanic membrane
O Leaves the middle ear
through
petrotympanic fissure
108

O Passes medial to spine of

sphenoid and enters the

infratemporal fossa
O It joins the lingual nerve
O Carries preganglionic
secretomotor fibres to the
submandibular ganglion
O For supply of
submandibular & sublingual
salivary glands
O Taste fibres anterior 2/3rds
of tongue
109

POSTERIOR AURICULAR BRANCH

O Auricularis Posterior
O Occipitalis
O Intrinsic Muscles On Back Of Auricle

THE DIGASTRIC BRANCH

O Starts Near The Stylomastoid Foramen supplies
Posterior Belly Of Digastric
THE STYLOHYOID BRANCH
O Long And Slender Arises With The Digastric
Branch And Supplies The Stylohyoid Muscle.

110

TERMINAL BRANCHES
Temporal
Zygomatic
Buccal
Marginal Mandibular
Cervical

111

O Temporal branch
O Crosses the

zygomatic arch and

supply
O i) auricularis anterior
O ii)auricularis superior
O iii) intrinsic muscles
on lateral side of the
ear
O Iv) frontalis
O V)Orbicularis oculi
112

O Zygomatic branch
O Runs across zygomatic bone

and supply orbicularis oculi

O Buccal branches
O Upper and lower buccal

branches
O Supplies muscles of cheek
and upper lip
113

O Marginal mandibular
O Supplies muscles of lower

lip and chin

O Cervical branch
O Emerges from apex of

parotid gland
O Supply the platysma
114

 GENICULATE GANGLION

Located On First Bend

Sensory Ganglion
SUBMANDIBULAR GANGLION
Parasympathetic Ganglion
Topographically Related To Lingual Nerve
Functionally Related To Chorda Tympani
PTERYGOPATINE GANGLION
Topographically Related To Maxillary Nerve
Functionally Related To Facial Nerve By
Greater Petrosal Nerve

115

APPLIED ASPECTS

116

SYMPTOMS ACCORDING TO LEVEL OF INJURY TO FACIAL

NERVE

FACIAL NERVE PARALYSIS

Commonly Seen.
Can be ----- Nuclear Paralysis : Injury Or Disease Of
Facial Nucleus
Supranuclear Paralysis :Facial Muscles Paralysed by
Interruption Of Corticonuclear Fibres Running from Motor
Cortex to Facial Nucleus
UMN Involved--Movts In Lower Part Of Face affected
Infranuclear Paralysis : Injury Of The Nerve Any Where
Along Its Course
Most Common Type : Bells Palsy

118

BELLS PALSY
O Most common neurologic disorder
O Abrupt ,isolated, unilateral, facial nerve

paralysis without detectable cause

O Etiology: considered an idiopathic facial
nerve paralysis
O HSV isolated in many patients with bells
palsy
O Inflammation of facial nerve with resultant
edema causes nerve compression while
passing through temporal bone
119

Inability To Close Eye ,to Smile

Wrinkles Disappear from
forehead
Slurred Speech
Taste Sensation Disappear
Hyperacusis
120

ANOMALIES OF FACIAL NERVE

1.
2.
3.

Duplication Of Facial Nerve

Congenital {Hypoplastic Or Aplastic}
Dehiscence Of Facial Nerve

121

DUPLICATION OF FACIAL NERVE

Also Called As Bifid Nerve
Nerve Commonly Bifurcates Along Proximal Aspect

Of Tympanic Segment Inferior To Semicircular Canal

Larger Lateral Branch

Smaller Medial Branch

Reunite At Stylomastoid Foramen

Rarely Bifurcates Proximal To Geniculate Ganglion
122

CONGENITALLY HYPOPLASTIC OR APLASTIC

NERVE
May Occur In Isolation Or As Part Of Moebius Syndrome
Patients Have ---

Facial Diplegia
Bilateral Lateral Rectus Paralysis

DEHISCENCE OF FACIAL NERVE

Associated With Ossicular Chain Anamolies
Patients With Congenital Middle Ear Malformation Usually Have

Displacement And Wide Bony Dehiscence Of Tympanic Segment

123

SPECIAL STAINS
O Neurons --- H & E
O Nissel substances basic dyes like neutral red, methylene

blue, azur, pyronin, thionin, toluidineblue & crystal fast

violet
O Axons & Neuronal processes ( brown black) ammonical

silver bielschowskys method & its modifications

O Vital staining of nerve fibers and endings with methylene

blue
124

O Holmes silver technique --- neurons---red-black

& myeline---blue
O Eagers method --- degenerating axons --- brown

black & normal fibers--- pale yellow

125

O Bundles of nerve fibres

are held together by

connective tissue
O Outer layer- epineurium
surrounding the whole
nerve
O Perineurium
surrounding bundles of
nerve fibres
O Endoneurium
individual neurons
126

H&E staining
O Cross section- each nerve fibre shows

centrally placed axon

O Axon is surrounded by a myelin space
O Externel to myelin space thin cytoplasmic
rim neurilemma
O Longitudinal section- nerve fibres show
charecteristic wavy pattern
O Among the wavy nerve fibres nuclei
belonging to schwann cells are present
O high power-Myelinated nerves- nodes of
ranvir
127
O Appears as constiction of neurilemma

IMMUNOHISTOCHEMISTRY
O S-100
O Collagen IV
O Vimentin
O Neural filaments- Glial Fibril

Associated Protein

128

O Conclusion
O Trigeminal nerve through its three divisions is the

chief nerve sensory nerve of the face

O Facial nerve is the motor nerve of the face

129

O REFERENCES
O Grays anatomy-13th edition -CHURCHILL

LIVIVGSTONE
O Cunninghams manual of practical anatomy-15th edition
E L B S oxford
O Human anatomy- vol- head , neck and brain 3 rd edition B D Chaurasia
O Lasts anatomy- tenth edition- chummy S.Sinnatamby
O Monheims Local Anesthesia And Pain Control In Dental
Practice 7th Edition
130

Thank you
131