2. facial,glossopharyngeal,cervical plexus
- 3. Introduction Functional components Nuclei Course Branches & Distribution Ganglia Associated Blood supply Age changes Variation in branching patterns Nerve lesions : supranuclear infranuclear Causes of facial paralysis Bells palsy Management of facial palsy Nerve disorders in children Testing of facial nerve Applied Anatomy CONTENTS :FACIAL NERVE
- 4. 7th cranial nerve Mixed nerve motor components sensory components 2nd arch INTRODUCTION
- 5. SPECIAL VISCERAL EFFERENT (BRANCHIAL) muscle response for 1, facial expression 2. Elevation of hyoid bone Functional components
- 6. Special visceral afferent These fibers carry taste sensation from anterior 2/3 rd of tongue & palate
- 7. GENERAL VISCERAL EFFERENT (parasympathetic) Secretomotor to the Submandibular gland sublingual gland , lacrimal gland , glands of the nose,the palate,and the pharynx
- 8. GENERAL SOMATIC EFFERENT General sensation from the skin of the concha of the auricle & from a small area behind the ear.
- 9. Nuclei Motor Nucleus Superior Salivatory nucleus Upper part of nucleus of tractus solitarius Upper part of spinal nu of trigeminal nerve
- 12. Course of a facial nerve INTRA CRANIAL INTRA TEMPORAL EXTRA CRANIAL
- 13. Intra cranial course: Two roots..lower border of pons.. motor root medial to sensory root stylomasoid divide Sensory root & motor root passes forwards and laterally leave the 盒彫.
- 15. Intra Temporal (within Facial Canal )
- 20. BRANCHES Within facial canal 1.Greater petrosal nerve 2.Nerve to stapedius 3.Chorda tympani At its exits from the stylomastoid foramen 1.Posterior auricular 2.Digastric 3.stylohyoid Terminal branches 1.Temporal 2.Zygomatic 3.Buccal 4.Mandibular 5.cervical
- 25. CHORDA TYMPANI
- 26. At its exits from the stylomastoid foramen
- 29. GANGLIA ASSOCIATED WITH THE FACIAL NERVE
- 30. location.. Sensory and parasympathetic -nervus intermedius. Motor fibers are carried via the facial nerve proper. greater petrosal nerve, which carries sensory fibers as well as preganglionic parasympathetic fibers Geniculate ganglion
- 32. BRANCHES OF PTERYGOPALATINE GANGLION orbital palatine Nasal 1.Lateral post.sup nasal nerve 2.Medial post.sup nasal nerve 3.nasopalatine pharyngeal
- 33. SUBMANDIBULAR GANGLION it lies on . topograpically functionally
- 34. Motor Superior salivatory nucleus Nervus intermedius chorda tympani Lingual nerve Ganglion GLAND Sympathetic root Plexus around the facial artery supply vasomotor fibers to submandibular & sublingual gland Sensory root Lingual nerve
- 35. Facial nerve Blood Supply Intracranial/Meatal: labyrinthine branches from ant . inf cerebellar artery Perigeniculate: superficial petrosal branch of middle meningeal artery Tympanic/Mastoid: stylomastoid branch of posterior auricular artery
- 37. AGE CHANGES
- 39. CLINICO ANATOMICAL CONSIDERATION by using knowledge of the anatomy of the facial nerve the location of a lesion can be determined by presence or absence of certain deficits
- 42. Testing of facial nerve Topographic testing 1.schirmers test 2.Stapedial reflex 3.Taste testing 4.Salivary flow rate & salivary ph Electro-physiological testing Nerve excitability testing( NET) Maximum stimulation test(MST) Electroneuronography| (ENOG) Electromyography (EMG)
- 44. Stapedial reflex Evaluates Impedance audiometry
- 46. Salivary Flow rate & salivary pH Normal values: Saliva ph - 6.7-7.4 Volume 600-1000 ml/day Resting flow rate 0.2-0.4 ml/m Stimulated flow rate - 2-5 ml/m
- 47. Facial paralysis Upper motor neuron palsy Lesion above the level of pons Lower motor neuron palsy Lesion is in the pons or in the pathway from pons to its exit
- 48. UMN LMN Paralysis of lower 遜 of face on C/L side Total facial paralysis on same side Emotional movements (e.g. Laughing) are intact. Emotional movements are lost Associated hemiplegia No hemiplegia Hypertonia (spastic). Hypotonia (flaccid). No fasiculation. Fasiculations are present. No muscle atrophy. Muscle atrophy occurs later.
- 50. TRAUMA: birth trauma, temporal bone fractures, skull base fractures, facial injuries middle ear injuries, surgical trauma. Nervous system disease: Opercular syndrome, Millard-Gubler syndrome. Infection: of the ear or face, Herpes zoster of the facial nerve (Ramsey-Hunt syndrome). Factors causing Facial Nerve Disorders
- 51. Metabolic: diabetes mellitus Tumors: acoustic neuroma schwannoma, cholesteatoma, malignant parotid tumors, glomus tumors. Toxins: alcoholism carbon monoxide poisoning. Bell's palsy: Also called idiopathic facial nerve paralysis
- 52. Facial nerve disorders in children
- 53. Bells palsy Sudden occurrence of a flaccid facial paralysis in a apparently healthy individual (1774-1882)
- 55. DRUG DOSE PREDNISOLONE Adults: 60 mg daily for five days, then 40 mg daily for five days Children: 2 mg per kg daily for seven to 10 days ACYCLOVIR (ZOVIRAX) Adults: 400 mg five times daily for seven days Children older than two years: 80 mg per kg daily divided every six hours for five days Treatment plan recent research shown that no added benefit of acylovir compared to prednisolone alone for treatment of bells palsy
- 56. Eye protection Lubricating eye drops, such as artificial tears eye ointments or gels eye patches Facial massage and exercises Moist heat Surgical decompression & cosmetic reconstructive surgery To prevent Exposure keratitis About 80% of patients recover spontaneously within 12 weeks
- 57. Syndromes associated with Bells Palsy JamesRamsayHuntSyndrome MelkerssonRosenthalSyndrome Moebius Syndrome Gullian barre syndrome
- 58. James Ramsay Hunt Syndrome
- 59. Melkersson Rosenthal Syndrome Facial palsy cheilitis Fissured tongue
- 60. Moebius Syndrome Facial diplegia Bilateral paralysis of ocular muscles.
- 61. Glossopharyngeal nerve Contents: Introduction Nuclei Functional components Course Branches & Distribution Ganglia Associated Applied Anatomy
- 62. INTRODUCTIONNinth cranial nerve 3rd arch Mixed nerve o Branchio Motor o Preganglionic secretomotor o general somatic Sensation. oSpecial visceral (taste) sensation . o general visceral sensorybaro n chemo
- 63. nuclei
- 64. COURSE & RELATIONS Intra cranial Attached to lateral side of upper part of the medulla between olivary body & the inferior cerebellar peduncle It leaves the cranial cavity .
- 69. Glossopharyngeal Nerve Testing 1.Taste sensation 2, gag reflex Afferent 9th Efferent 10th On tickling the posterior wall of the pharynx ,there is reflex contraction of the throat muscles. No such contraction occurs when ninth nerve is paralysed
- 70. Transient or sustained hypertension : may follow surgical section of nerve reflecting involvement of carotid branch. Isolated lesions of the nerve are 盒彫 Glossopharyngeal neuralgia: bohm & strang Middle age M = F etiology : 盒彫.. Applied anatomy
- 71. Sharp & shooting Pain in the ear, the pharynx, nasopharynx, tonsil Almost invariably unilateral Trigger zone - posterior oropharnx, tonsillar fossa Treatment Carbamazepine, gabapentin Surgical : Microvascular decompression Rhizotomy
- 72. Cervical plexus Contents: 1.Formation 2.Branches & relations 3.Ansa cervicalis 4.Applied anatomy
- 73. Formation of Cervical plexus Formed by union of盒彫 Each of cervical nerve divides into盒彫. Ascending branch of the second nerve joins the first nerve Descending branch of second nerve joins the ascending branch of the third nerve
- 74. branches Cutaneous branch 1, lesser occipital nerve 2, greater auricular nerve 3, transverse cutaneous nerve 4, supraclavicular nerve Muscular branch 1, branches to prevertebral nerve 2. Branches to muscle forming boundaries of the posterior triangle 3, pherenic nerve 4, branches to infra hyoid muscle
- 78. Pherenic nerve Arises from the.. Descends vertically through the lower part of neck and then through the thorax to reach the diaphragm & it enters abdomen also
- 79. Formation of Ansa cervicalis It formed by盒彫. Superior root is derived from. Inferior root derived from .. Two roots join in front of CCA
- 81. Applied anatomy An effective cervical plexus block produces anesthesia over the neck, occipital region, shoulder region upper pectoral region. Analgesic solution is infiltrated subcutaneously around the midpoint of the posterior border of sternocleidomastoid
- 82. Occasional inadvertent injections into the phrenic and vagus nerves Miosis (constriction of pupils) Ptosis (drooping of eyelid) Anhydrosis (affected side) enopthalmos Horners syndrome
- 83. 1. Grays anatomy The anatomical basis of clinical practice, 39th edition 2.Textbook of anatomy- Inderbir singh, 4th edition 3.B.D. Chaurasias human anatomy, vol 3, 4th edition 4.Cunninghams Manual Of Practical Anatomy. Vol 3: Head & Neck & Brain. 15th ed. 5.Clinically oriented anatomy Moore 6th edition 6.Clinical anatomy by regions Snells 9th edition 7.The facial nerve Mays 2nd edition 8. Textbook of human neuroanatomy Inderbeer Singh 8th edition 9. Head and neck anatomy for dental medicine Baker References
Editor's Notes
- #15: Course of facial nerev in pterous temporal. Transerve sectn through pons at level of genu of 7th nerv. 3 d course of facal nerve in pons.
- #16: Facial nerve relation with int acoustic meatus and int ear
- #20: Facial nerve : facial canal and tympanic cavity have been opened viewed fronm right .
- #24: Peripheral communications of facial nerve
- #26: It carries, 1. taste from the anterior 2/3rd of tongue 2.Secretomotor to submandibular & sublingual gland
- #67: Relations of glossonervwe
- #77: Course n distri of lesse occi, grt auri,, trnsverse