Facial nerve

By
Dona mariam sam
Third Year BDS
Reg no 170021349
CONTENTS

 Introduction
 Functional component
 Nucleus
 Origin and course
 Branches
 Function
 Surface marker
 Facial nerve palsy
Introduction

 Facial nerve is the seventh cranial nerve.

 The facial nerve is associated with the derivatives
of second pharyngeal arch.
 It has got motor, sensory and parasympathetic
fibres and therefore is a mixed nerve.
Functional component

 General somatic afferent-provide sensory input from

part of external acoustic meatus and deeper parts of
auricle
 Special visceral afferent-are for taste of anterior two-
third of the tongue
 General visceral efferent-parasympathetic, stimulate
secretomotor activity of lacrimal gland, submandibular
and sublingual salivary gland, glands in mucous
membrane of oral cavity, hard and soft palate
 Special visceral efferent-muscles of face, stapedius,
posterior belly of digastric and the stylohyoid muscle.
Nuclei
Origin, Course and
Relation
 The facial nerve attaches
to the lateral surface of
the brainstem.
 Between the pons and
medulla oblongata
 It consist of a large motor
root and a small sensory
root(the intermediate
nerve)
 The intermediate nerve
(sensory) consist of
parasympathetic fibres,
SA fibres, GVA fibres.
 The larger motor root contains the SVE fibres.

Course
 Can be divided into:- a. Intracranial
b. Extracranial
 Facial nerve nucleus,
superior salivatory nucleus, Emerges at lower Through the
border of pons Through the
nucleus tractus solitarius in internal
with nervus facial canal
pons and spinal nucleus of acoustic meatus
trigeminal in pons, intermedius
medulla and spinal cord

Facial nerve turns Geniculate ganglion

Through the inferiorly into where the facial
facial canal in nerve turns Medial wall of
stylomastoid
posterior wall of posteriorly middle ear
foramen
middle ear cavity

Temperofacial

Divides into
Enter the branches
parotid gland
Cervicofacial
Course of the Facial nerve
Branches
Geniculate ganglion Greater petrosal nerve

Nerve to stapedius

In the bony canal

Chorda tympani

Posterior auricular nerve

Near stylomastoid
foramen Nerve to posterior belly
of digastric

Nerve to stylohyoid
 Temporal

Temperofacia
l
Zygomatic
Within the
parotid gland,
terminates into

Buccal

Marginal
Cervicofacial
mandibular

Cervical
FUNCTION
MOTOR FUNCTION
Facial nerve innervates the muscles which are derivatives
of second pharyngeal arch.
 Nerve to stapedius- supply stapedius muscle in the
middle ear
 Posterior auricular nerve- supply the intrinsic and
extrinsic muscle of outer ear.
 Nerve to posterior belly of digastric-supply posterior
belly of digastric. Responsible for raising the hyoid bone.
 Nerve to stylohyoid- Innervates te stylohyoid muscle.
SPECIAL SENSORY FUNCTION

 Chorda tympani- nerve arises in facial canal, passes

through the middle ear and exits through the petro
tympanic fissure.
Along with the lingual nerve it innervates the anterior
two-third of the tongue.
PARASYMPATHETIC FUNCTION

 Greater petrosal nerve- moves distal to the geniculate

ganglion, leaves the temporal bone, enters the middle
cranial fossa.
 Travels across the foramen lacerum(not through), joins
with the deep petrosal nerve to form nerve to pterygoid
canal.
 Nerve to the pterygoid canal enters the pterygopalatine
fossa and synapses with the pterygopalatine ganglion
 Branches from this ganglion provide parasympathetic
innervation to the mucous membrane of oral cavity, nose,
palate and lacrimal gland.
Surface marker

Marked by a horizontal line which joins the following two

points
 A point at the middle of the anterior border of mastoid
process. The stylomastoid foramen lies 2cm deep to this
point.
 A second point behind the neck of the mandible. Here the
nerve divides into five terminal branches.
 Facial nerve palsy
 The seventh nerve carries motor impulses
to the muscles of facial expression, scalp
and external ears.
 Paralysis of the terminal branches
whenever a infraorbital nerve block is
administered or when maxillary canine
infiltrated.
 Muscle droop is observed when inadvertent
deposition of local anesthetic- while
anesthetic is introduced into the deep lobe
of parotid gland.
Symptoms
 Facial paralysis on one side.
 Loss of blinking control on
affected side
 Decreased tearing
 Altered sense of taste
 Drooping of mouth on the
affected side
 Slurred speech
 Drooling
 Pain in or behind the ear
 Sound hypersensitivity
 Difficulty in eating
Cause
 Introduction of local anesthetic by inferior alveolar nerve
block into the capsule of parotid gland (Posterior border of
mandibular ramus which is clothed by medial pterygoid and
masseter muscle).
 Stroke
 Tumor compressing facial nerve anywhere along its complex
pathway.
 Trauma-Blunt trauma especially the fractures of temporal
bone.
 Diabetes mellitus
 Infection-Reactivation of herpes zoster virus(Ramsay-Hunt
syndrome).
Problem

 Loss of motor function to the muscles of facial expression produced by local

anaesthetic deposition is normally transitory .
 It lasts no longer than several hours ,depending on the local anaesthetic
formulation used, the volume injected ,and proximity to the facial
nerve.Usualy,minimal or no sensory loss occurs.
 Patient has unilateral paralysis and the persons face appears lopsided.
 No treatment than waiting until the drug action resolves .
 A secondary problem is that patient is unable to voluntarily close one eye.
The protective lid of the eye is abolished. Winking and blinking is impossible.
Prevention
 Prevantable by adhering to the protocol with the inferior alveolar nerve and
Vazirani-Akinosi nerve blocks
 A needle tip that comes in contact with bone(medial aspect of the ramus)
before depositing local anesthetic solution essentially precludes the
possibility that anaesthetic will be deposited into the parotid gland during an
IANB
 If the needle deflects posteriorly during this block and bone is not contacted,
the needle should be withdrawn almost entirely from soft tissues, the barrel
of the syringe brought posteriorly and the needle readvanced until it contacts
the bone.
 Over insertion of the needle either absolute(>25mm) or relative(25mm in the
smaller patients) should be avoided.
Management
 Reassure the patient. Explain the situation is transient, will resolve
without residual effect. Mention that it is produced by the normal
action of local anesthetic drugs on the facial nerve.
 Contact lenses should be removed until muscular movement returns.
 An eye patch should be applied to the affected eye until muscle tone
returns. If resistance is offered by patient, advice the patient too
manually close the affected eyelid periodically to keep the cornea
lubricated.
 Record the incidence on the patients chart.
 Although no contra indication is known to re anesthetising the patient
to achieve mandibular anesthesia, it maybe prudent to forego further
dental care at disappointment.
Treatment
 Application of soothening agent such as calamine cream or
lotion, antiseptic powder containing povidone iodine.
 Immunocompromised or elderly individuals with severe
disease- idoxuridine 20-40% .
 Acyclovir- an antiviral agent, 800 mg orally five times
daily for 7 days.
 Steroids- Prednisolone in doses of 40-60 mg four times
daily for 5 days.
 Carbamazepine (200 to 400 mg 8 hourly) to reduce facial
neuralgic pain.
Source

 Gray’s Anatomy
 B.D Chaurasia’s Human Anatomy Volume 3 and Volume 4
 Medical Emergencies-Stanley F Malamed
 Medical Problems in Dentistry-Crispian Scully,Cawson
 Textbook of Clinical Medicine-Dr S N Chugh