FACIAL NERVE G IT 'S DISORDERS

FACIAL NERVE

→ mixed Nerve

Motor

SensorySecreto motor

3. N. Saliva torius

MILLARD GUBLERSuperiors is

SYNDROME ,l I

-I Nerve intermedius [ N . Of WISBERG ]

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FallopianBe

canal C 27mm ]⇐¥E¥¥e¥oa÷I. MOTOR NUCLEUS 2. N . Tracks

[ PONS ] Solitaries 1St genu[ Geniculateand

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.Htc RWET

cand Tympani¥1of N .

Sty to HugieeerBwp mastoid

IV foramen

Segments

I . Intracranial segmentI Intrameatal segment

II Intra temporal Segment

IIIa- Labyrinthine segment C shortest C 3mm ] , Narrowest Co . 68mm ] Segment ]

HIB-

Tympanic I Horizontal segment

IIc- Mastoid I vertical segment

HI Extra temporal segment

→ fallopian canal ⇒ longest bony canal for any cranial Nerve

→ 8th Nerve accompanies the facial N . in Intra auditory meatus→ MILLARD GUBLER G SYNDROME → Lesion around 615 Nerve nucleus along I

715 N. Nucleus a facial Nerve

→ 1st Ee 2nd genu present in intra temporal segment

Ist genu has Geniculate ganglion

BRANCHES OF FACIAL NERVE

→ No branches in Segment I,

I,

# a

→ from 1st Genu → 3 branches

i. GSPN [ Greater Superficial Petrosal N

.]

• carries pre ganglionic parasympathetic Fibres

2.

Lesser Petrosal Nerve

3.

External Petrosal Nerve

Petro tympanic Middle cranial Deep petrosal1st GSPN y y[ sympathetic

fissure Fossa Nervefibres ]

pre ganglionicparasympathetic

v

VIDI AN NERVE

[ N . Of pterygoid canal ]

v

I in pterygo palatine fossa ]

PTERYGO PALATINE I→ Post Ganglionic fibres

SPHENO PALATINE GANGLION

C largest peripheral parasympathetic Ganglion ]

Supplies

.

Lacrimal Gland 8 Nasal Glands Minor Salivary glandsq

Taste in Palate

→No Branches for IIb

→ Just after and genu , facial N . gives a branch → N.

to Stapedius[ 1St motor branch of facial Nerve ]

→ Before facial N. goes out of style mastoid foramen , gives a branch →

chord a tympani Nerve C first Embryological branch ]

-

comes in from the posterior wall a Comes out from anterior wall throughcanal of AUGIER

CHORD A TYMPANI N.

canal OFLINGUAL N .

HU Gier I

43 IX x

- -Vii Submandibular Ee Sublingual

chord a salivary glands q43 .

tympanyTaste in

Anterior 213 rd of the Tongue

→ submandibular g sublingual Salivary glands supplied by → chord a tympani GHB

Parotid gland Supplied by → Glossopharyngeal Ctx ]

→ After coming out of style mastoid foramen , facial N. goes into the Parotid

gland Ee divides Parotid gland into 2 lobes

I . Superficial lobe

2 . Deep lobe.

→ In parotid gland , facial N.

divides,

into 5 terminal branches

1. TEMPORAL

2. ZYGOMATIC

3. BUCCAL µGOOSE FEET ARRANGEMENT

( Or )

4. MARGINAL MANDIBULARPES ANSE RINUS

5. CERVICAL✓

Bills Bat

Facial N .

superior •

vestibular N .

Region Region

Transverse

crest

cochlear onferror

Nerve vestibular N.

Region Region

BBSTASBB.tnIAM I Int . Auditory canal

BILL 's BAR - vertical ledge of bone

• Named after Dr. William House

[ father Of Neuro otology ]

° Imp . Sx land mark of facial

Nerve

PTERYGO PALATINE FOSSA

Sx Landmarks of facial N . for Parotid Sx

→ facial N .lies I. 5cm deep Ee internal to the CARTILAGE NOUS

TRAGAL POINTER

→ Facial N . is anterior a Superior to the Digastric muscle

→ facial N . is superficial a anterior to the styloid process

TOPO DIAGNOSTIC TESTS

→ used to identify the locator of injury to the facial Nerve

I. SCHIRM ERS I TEAR I LACRIMATION TEST

→ - ive → Bolts sides laerimatn is equal → Normal

→ GSPN is Normal → facial N.

is normal till

1st Genu .

→ t ve →one side lacrimator is decreased

→ Gsp N is affected → injury to facial N . is at Cor ) above Istgenu

2. Stapedial Reflex Test I Acoustic Reflex test

→ protective Reflex

→ positive in N ears → FN is N till and genu→ of it is - ive → Injury may be at or above and genu

3. Taste lest

→ Ant 21 3rd of tongue → by chord a tympani nerve

→ Taste present → + ive → FN is N till style mastoid foramen

→ Taste absent → - ive → Injury is above the style mastoid foramen

4 .

Submandibular Salivary flow Rate

→ supplied by chord a tympani→ salivatn on both sides N

- ive → a , → rap . ④ till £7183,101'd→ salivatn on both Sides Different → + ve → Ab → Injury is above style -

mastoid foramen

Q Patient of RTA , Clo Rt sided UH patsy .

Schriner , Stapedial Reflex , taste test → - ive

Site OF Injury ?

A. Seg IIIa C

. Seg IIc

B . Seg IIb D. Seg Ill

ELECTRO PHYSIOLOGICAL NERVE TESTING

→ Electrical stimulus is given proximal to injury } Normally

Response is recorded distal to stimulus

→ for facial N.

19%

→j÷÷÷÷i÷÷

me

I ] .

( ) ↳ WALLER IAN ,DnEGENERATION

7 2 hrs

4¥.

-

Test is done after 72 hrs

-

Prognostic test

→ Some times,

stimulus can be given proximal to injury a response is recorded

distal to stimulus even in facial Palsy

Q Not a topo diagnostic test of 1111 Nerve Q Not a topo diagnostic test of Vil Nerve

A.

Schirmer s test A.

Schirmer test

B.

Taste Test B.

Taste Test

C.

Impedance Auddometry C . TympanometryD.. Electrophysiological Testing

D . Electrophysiological Testing

DISEASES OF FACIAL NERVE

BELL 'S PALSY

→ Mcc of Facial Nerve Palsy→ Ipsilateral

LMN CUMIN palsy → CIL lower half facial palsy )

Idiopathic

Theories ,

I.

viral Infect 's [ Herpes ]

2. Hypersensitivity I Allergic Theory § EDEMA

OF

3- Autoimmune theory Facial N.

-

But fallopian canal don't → compresses FN → BELL 's PALSY

RAMSAY HUNT SYNDROME I HERPES ZOSTER OTICUS

→ LIVIN facial palsy t Vesicular rash in External Ear

→ 70% of Bell 'S palsy → complete Recovery

15T . of Bell 's palsy → on complete RecoveryL

→I

85% Recovery tout Re

→ 50T . Of H2 Olives → 50J . partial Recovery [ poor Recovery ]

→ Involve other Nerves also.

14 OF Bell 's PalsyI

.Steroids

Prednisone 1mg 1kg I Day

2.

Antiviral

Acyclovir 800mg , 5 times ) Day X 5 Days

Only tin 72 hrs

3. Eye protect 's

Artificial eye drops

Wear goggles , avoid sunny areas , avoid windy areas

Pad the eye in night times ee tape it

4 .Facial Physiotherapy

→ I 2 3 4 X 7 Days → NO improvement-

I.

steroids

3. Eye Protector & TO be continued for 7 days more

4 . Physiotherapy,

2.

Antivirals → stopped

→ After 2 wK$ → No improvement

I.

Steroids → Taper the dose Ee stop

t ,

Not much

Electrophysiological N . testing → Electro physiotherapyDamage

13¥ Sx C labyrinthine compression of

prognosis facial Nerve )