Facial nerve palsy

FACIAL NERVE
 VII cranial nerve  Supplies muscles of facial expression  Some treated as intermediofacial nerve  Willis-portiodura(facial), portiomollis(auditory)  Soummering seperated 2 and numbered seperately

EMBROYOLOGY

 Nerve of 2nd branchial arch  Facial nuclei are derived from neural crest  Migrates ventrally  Ventrolateral aspect of hindbrain  Motor fibres are axons of cells in ventrolateral lamina of midbrain & grows outwards to muscle fibres of their distribution

NUCLEUS

 Facial nucleusspecial visceral/branchial efferent  Superior salivatory nucleus-general visceral efferent  Lacrimatory n- GVE & GSA fibres

Nucleus of Tractus Solitarius

 SVA nuclei  GVA nuclei  Site-medulla oblongata  supply

 Facial nerve is a mixed nerve, having a motor root and a sensory root.  Sensory root nervus intermedius of Wrisberg carries taste fibers from the anterior 2/3 of the tongue, lacrimal, palatine mucosa and general sensation from the concha and retroauricular skin,submandibular & sublingual salivary gland  Motor root supplies the muscles of the face, auricle, stapedius,stylohyoid,digastric(post.belly)

Braches of facial nerve :

Branchial motor (special visceral efferent) Visceral motor (general visceral efferent) Supplies the muscles of facial expression; posterior belly of digastric muscle; stylohyoid, and stapedius.

Parasympathetic innervation of the lacrimal, submandibular, and sublingual glands, as well as mucous membranes of nasopharynx, hard and soft palate.

Special sensory (special afferent) General sensory (general somatic afferent)

Taste sensation from the anterior 2/3 of tongue; hard and soft palates

General sensation from the skin of the concha of the auricle and from a small area behind the ear.

Neurons:

 1- Upper motor neuron: Primary motor cortex (Precentral gyrus)  The axons of these neurons enter the Corticonuclear fiber bundle to reach the second lower motor neuron in the Pons.  2- Lower motor neuron: Facial motor nucleus.  The facial nucleus is divided into two parts:  The upper part receives bilateral innervations, and supplies the muscles of the forehead and eyebrows (temporal branches).  The lower part receives innervations mainly from the contra lateral hemisphere, and supplies the muscles of the lower part of the face through the facial nerve.

Site of lesion and manifestations

 Etiology  Over 40 causes; broadly classified into three major groups 1. Central or intracranial region  Vascular abnormalities  Central nervous system degenerative diseases  Myasthenia gravis  multiple sclerosis  Guillain Barre syndrome
2. Tumors of the intracranial cavity  scwanomma  neurofibroma  neurogenic sarcoma  Glomus tumour  3. Intratemporal  Bacterial (e.g., otitis media; malignant otitis externa) and viral (e.g., herpes zoster) infections, diptheria, TB, mumps, infectious mononucleosis.  Cholesteatoma  Trauma  Longitudinal and horizontal fractures of the temporal bone  Gunshot wounds  Tumors invading the middle ear, mastoid, and FN  Iatrogenic causes (surgical injury)  Congenitial osteopetrosis (hereditary)

Extracranial  Parotid gland region  Malignant tumors of the parotid gland  Trauma (lacerations and gunshot wounds)  Iatrogenic factors  Surgical injury  Parotid main trunk, branches  Facelift marginal  TMJ frontal  Tumor excision cystic hygroma; hemangioma  At birth use of suction or forceps

Types of facial palsy:

Facial palsy central/ supranuclear

peripheral

nuclear