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The facial nerve is made of 10,000 fibers (7000 mylinated motor, 3000 unmylinated sensory & parasympathetic)
General Visceral motor ( presynaptic secretory parasympathetic): input from Superior salivatory
nucleus
a) Greater superficial petrosal :pterygopalatine ganglion:
1. Lacrimal gland
2. Nasal glands
3. Palatine glands
b)
Nervus Intermedius:
Exists the Brain stem adjacent to the motor branch of the facial nerve
It clings to the adjacent VIII nerve complex rather than the facial nerve
Joins the VII nerve as it approaches the Internal auditory canal to form the common Facial nerve
Segment
Intracranial part
1-CP <
From
To
Pon
Fundus of
IAC
Fundus of
IAC
Meatal
foramen
Intratemporal/intrepetrous part
( within the fallopian canal)
Meatal
Periganglionic 3-labyrinthine
segment
foramen
Size
Branches
30mm
24mm(3/4)
8 mm (1/4)
30mm
Genigulate
ganglion
4mm
4-tympanic
segment
5-mastoid /vertical segment
Genigulate
ganglion
Pyramidal
eminence
Pyramidal
eminence
Styloid
foramen
6-Extra-cranial part(parotid)
8-11 mm
8-14 mm
15-20 mm
meatal segment:
internal auditory canal extends from the meatal fundus to meatal foramen
the facial nerve lies ant to the vestibular nerve & sup to the cochlear nerve
Fallopian canal:
contains the intratrmporal segment of the facial nerve
extends from the meatal foramen at the fundus of IAC into styloid foramen
labrynthin segment: fallobian canal is narrowest in this segment esp at the meatal foramen
at this stage the nerve lies on the post belly of digastrics muscle
Efferent fibers:
a. Motor fibers
b. Presynaptic parasympathetic fibers supply:
the lacrimal gland,nasal,palate,sublingual,submandibular
2.
Afferent fibers:
a. General sensation
b. Taste sensation
Fiber type
Facial part
Cranial nucleus
Segment
branches
Motor
Vertical segment
Stapedius
Extracranial
Vertical
-Tympanozygomatic
division
-Lower cervicofacial
division
Greater petrosal
Lesser petrosal
Chordi tympani
Vertical
Chordi tympani
Extracranial
Post auricular
Presynaptic
parasympathetic
Superior salivatory
nucleus
Labrynthin
Nervus intermedius
Taste
Solitary nucleus
General sensation
Posterior auricular
Stylohyoid muscle
Tempofacial
Temporal division
occipitofrontalis
ant & sup auricular branch
Orbicularis oculi
Zygomatic division
Orbicularis oculi
Zygomatic muscles
Common between 2
trunk
Buccal
Buccinators
Around the nose & mouth
Lower cervicofacial
Marginal Mandibular
Orbicularis oris
Depressor labii inferioris
Depressor anguli oris
Platyzma
Cervical
Supranuclear Pathways:
a- Branchial motor:
Cell bodies of Preganglionic parasympathetic fibers arise in the Superior salivary nucleus
Cerebellopontine angle
VII emerges between the abducens N (VI) and the vestibuloacoustic N (VIII) in the cerebellopontine angle
This intimate relationship between the facial nerve & vestibulocochlear nerve takes on critical importance when
In this location the facial nerve is placed in jeopardy both during the growth of tumor & during attempted surgical
resection
During its lateral course through the cerebellopontine angle & the internal auditory canal, the relative positions of
the VII& VIII changes by rotating 90 degree
The average distance between the point where the nerves exit the brain stem and the place where they enter into
the internal auditory canal (IAC) is approximately 15.8 mm.
In the CPA the VII is covered with pia & bathed in cerebrospinal fluid,& devoid of epineurium,leaving it susceptible
to manipulation trauma during intracranial surgery
1-Meatal segment:
2.
Both the facial nerve and the nervus intermedius remain distinct entities at this
level.
After traversing the labyrinthine segment, the facial nerve changes direction to
form the first genu (ie, bend or knee), marking the location of the genigulate
ganglion.
So the genigulate ganglion is considered the end of the labyrinthine segment &
lie just sup to the nerve
2.
3.
the petrous bone to the foramen lacerum, through which it travels to the pterygoid canal.
In the pterygoid canal, the greater petrosal nerve joins the deep petrosal nerve to become the nerve of the pterygoid canal
(Vidian nerve).
Axons from this nerve synapse in the pterygopalatine ganglion (sphenopalatine ganglion); postganglionic
parasympathetic fibers, which are carried via branches of the maxillary (V2) divisions of the trigeminal nerve (CN V),
innervate the lacrimal gland and mucus glands of the nasal and oral cavities.
2-The external petrosal nerve:
An inconstant branch that carries sympathetic fibers to the middle meningeal artery;
3-The lesser petrosal nerve carries:
See temporal bone:middle cranial surface: superior tympanic canaliculus
So called because it runs in the middle ear cavity against the medial wall of the epitympanic
The nerve passes behind the cochleariform process and the tensor tympani.
Land mark of the proximal end of the tympanic segment of the Facial Nerve is The cochleariform process
The distal portion of the facial nerve emerges from the middle ear between the posterior wall of the middle ear
cavity and the horizontal semicircular canal.
This is just distal to the pyramidal eminence, where the facial nerve makes a second turn marking the 2nd genu.
The Ant end of the facial nerve canal is marked by processus cochleariformis.
It is: curved projection of bone over the medial wall
concave ant
it houses the tendon of the tensor tympani muscle as it turns laterally to the
handle of the malleus.
a) The nerve then curves inferiorly at its 2nd Genu post to:
1.
oval window
2.
pyramidal process
3.
Stapedius tendon
b) Ant to;
c) Inf to:
2.
Always anticipate finding a dehiscent or prolapsed facial nerve in its tympanic segment, especially in patients with
congenital ear deformities.
When the bone is thin or nerve is exposed by disease, there r 2-3 straight B.V clearly visible along this line of
nerve, these r the only straight B.V in the middle ear & indicate that the facial nerve is very close by
Note:
Superior petrosal artery travels in the fallopian canal
2.
Ossicular abnormalities
3.
Caraniofacial anomalies
4.
2.
3.
The auricular branch of the vagus nerve arises from the jugular foramen and joins the facial nerve just distal to the point at
which the nerve to the stapedius muscle arises. Pain fibers to the posterior auditory canal may be carried with this nerve.
The chorda tympani:
See middle ear :lateral wall:3 chordi tympani
The facial nerve exits the fallopian canal via the stylomastoid foramen.
The nerve travels between the digastric and stylohyoid muscles and enters the parotid gland.
A sensory branch exits the nerve just below the stylomastoid foramen and innervates the posterior wall of the external
auditory canal and a portion of the tympanic membrane.
Bells Palsy is caused by an inflammation within a small bony tube called the fallopian canal. The canal is an extremely
narrow area. An inflammation within it is likely to exert pressure on the nerve, compressing it. Likewise, if the nerve itself
becomes inflamed within this small canal, it can encounter pressure, with the same result of compression.
The nerve has not yet exited the skull ( INTRATEMPORAL portion) and divided into its several branches, resulting in
impairment of all functions controlled by the 7th nerve. If only part of the face is affected, the condition is not Bell's palsy.
The most important landmarks for identifying the facial nerve in the mastoid are:
1.
2.
3.
The second genu of the facial nerve runs inferolateral to the lateral semicircular canal. This is a relatively constant
relationship.
The digastric ridge points to the lateral and inferior aspect of the vertical course of the facial nerve in the temporal bone. In
poorly pneumatized temporal bones, the digastric ridge may be difficult to identify. The distal aspect of the tympanic
segment can be surgically located via a facial recess approach. The chorda tympani nerve and the fossa incudis can be
used to identify the nerve when performing a facial recess approach.
The long process of the incus points toward the facial recess. The chorda tympani nerve serves at the lateral margin of the
triangular facial recess. The chorda tympani nerve can be exposed along its length and can be followed inferiorly and
medially to its takeoff from the main trunk of the facial nerve.
Exposure of the facial nerve after a cortical mastoidectomy. The facial recess has been opened by
thinning of the posterior canal wall. The recess is identified using the incus, chorda tympani, and
horizontal semicircular canal as landmarks.
a) Labryinthin segment
Occurs superior to the basal turn of the cochlea (promontory), anterior to the ampullated ends of the
superior & lateral semicircular canal
located:
superior-posteriomedial to the cochleariformis process (landmark of genigulate ganglion)
c) Horizantal/tympanic segment:
The nerve directs posteriorly with inferiolateral inclination which makes the facial canal prominence
located:
inferior to the lateral semicircular canal
Superior to the oval window
Deep to the short process of the incus
Located:
Post to:
oval window
Stapedius tendon
pyramidal process
Ant to;
Inf to:
One of the most important landmarks for identifying the second genu in the mastoid is the lateral semicircular
canaL The second genu hugs the inferior aspect of the lateral semicircular canal and this relationship is
extremely constant. The pyramidal eminence is another useful landmark for the second genu where the facial
nerve makes a sharp turn downwards, marking the beginning of the mastoid segment. This can be located
surgically by the interval between the short process of the incus laterally and the lower border of the horizontal
canal medially. The nerve is lateral and posterior to the pyramidal process which creates two recesses in the
mesotympanum, the facial recess laterally and the sinus tympani medially (Figure 241c.2). The posterior semicircular
canal is located just posterior to the second genuand also marks the superior end of the retrofacial air cells,
which are helpful in delineating the medial aspect of the facial canaL
source scott brown
Note that the stylomastoid foramen is the only constant land mark of the facial nerve
extracranial Land Mark: see netter p223
Identification of the nerve depends on marking the position of the posterior belly
of the digastric muscle, the external meatal cartilage, the tympanomastoid suture
line, and the styloid process.
1.
2.
Tympanomastoid suture
3.
4.
branch to stylohyoid
The 1st major subdivision of the extracranial facial nerve is usually situated within the parotid gland.
Within the substance of the parotid gland, each divides, some rejoining and then dividing again to emerge finally from
the parotid gland in 5 main groups of branch (see netter p201)
1.
Temporofacial:
a) temporal branch:
b) zygomatic branch
2.
cervicofacial division:
a) marginal mandibular branch:
b) cervical branch:
note that cervical branch & mandibular branch are in close association with the parotid gland and lies
directly under the platysma in the plane of deep cervical fascia
3.
pes anserinus:
plexiform arrangement of branching (the site of division between the upper & lower part)
truly plexiform can sustain surgical injury better than those that are not.
Sacrifice of one small branch in a plexiform nerve is rarely accompanied by a significant or noticeable facial
weakness.
2.
3.
Therefore, the facial nerve is vulnerable to injury because it will be closer & more superficial to the mastoid cortex
as it exits the stylomastoid foramen.
With maturation the facial nerve is placed more medially & inferiorly
Note: any developmental abnormality of the ear is an alert 4 the possibility of facial nerve anomalies
The facial nerve differs from peripheral nerves in that it traverses a long bony canal.
The canal limits the normal supply of regional nutrient vessels, increasing the reliance on a
longitudinal blood supply.
only two nutrient vessels provide the arterial supply of the facial nerve within the Fallopian
canal:
The stylomastoid artery:
branch of the post-auricular artery
enter the stylomastoid foramen
divides into two or more branches
run superficially within the epineurium to the second genu.
These overlap with the larger descending branch of superior petrosal artery
Superior petrosal artery:
branch of the middle meningeal artery
divides into two or more longitudinal vessels
reaching as far as the stylomastoid foramen.
Its smaller ascending branch passes proximally to the entrance of the bony Fallopian
canal
The labyrinthine branch of the anterior inferior cerebellar artery anastomoses with the
ascending branch of the petrosal artery at the entrance to the Fallopian canaL
There is no overlap within the labyrinthine portion of the Fallopian canal and therefore
the labyrinthine portion of the facial nerve receives its vascular supply from only one
nutrient vessel, the petrosal artery.