FACIAL NERVE

4 FUNCTIONAL COMPONENTS Facial N. is the nerve of the 2n !har"n#eal arch. $. %ranchial Motor &S!. 'isceral Efferent( &Lar#est !ortion( 'ol)ntar" control 'II N)cle)s 2. 'isceral Motor &*eneral visceral efferent( S)!erior salivar" n)cle)s an lacri+ator" n)cle)s ,. S!ecial sensor"- &S!ecial afferent( *enic)lar *an#lion 4. *eneral sensor" &*eneral afferent( *enic)lar *an#lion 0 0 Taste sensation fro+ anterior 21, of ton#)e. 2ar an soft !alate *eneral sensation fro+ the s3in of concha of the a)ricle an a s+all area /ehin ear. 0 M)co)s +e+/rane of naso!har"n.- har an soft !alate. 0 Paras"+!athetic innervation of lacri+al- s)/+an i/)lar an s)/lin#)al #lan s M)scles of facial e.!ression Posterior /ell" of ia#astric St"loh"oi Sta!e i)s

BRANCHIAL MOTOR COMPONENT Origin and central course: The /ranchial +otor co+!onent ori#inates fro+ the +otor n)cle)s of CN 'II in the ca) al !ons. Fi/res leavin# the +otor n)cle)s of CN 'II initiall" travel +e iall" an orsall" to loo! aro)n the i!silateral a/ )cens n)cle)s &CN 'I( !ro )cin# a /)l#e in the floor of 4th ventricle FACIAL COLLICULUS. Fi/res e.it the ventrolateral as!ect of the /rain ste+ at the ca) al /ro er of !ins in con4)ction 5ith nerves inter+i i)s co+!onents of CN 'II. INTRACRANIAL COUR E

U!on e+er#in# fro+ the ventrolateral as!ect of the ca) al /or er of the !ons- all the co+!onents of facial nerve enter the internal a) itor" +eat)s alon# 5ith the fi/res of vesti/)locochlear nerve. Facial nerve !asses thro)#h the facial canal in the !etro)s !ortion of te+!oral /one. The ca)se of the fi/res is alon# the roof of the vesti/)le of inner ear- !osterior to cochlea. At the #enic)late #an#lion the co+!onents of the facial nerve ta3e ifferent !ath5a"s. %ranchial +otor co+!onent !asses thro)#h the #enic)late #an#lion 5itho)t s"na!sin#- t)rn 677 !osteriorl" an laterall" /efore c)rvin# inferiorl" 4)st +e ial to the +i FO:AMEN. The nerve to the sta!e i)s +)scle is #iven off fro+ the facial nerve in its ca)se thro)#h the !etro)s !ortion of the te+!oral /one. E!TRACRANIAL COUR E AN" FINAL INNERVATION The !osterior a)ric)lar nerve- nerve to !osterior /ell" of ia#astric an the nerve to st"loh"oi +)scle are #iven )!on the facial nerves e.it fro+ st"lo+astoi fora+en. The re+ainin# fi/res enter the s)/stance of the !aroti #lan an 0 0 0 0 0 Te+!oral ;"#o+atic %)ccal Man i/)lar An cervical /ranches that innervate the +)scles of facial e.!ression. ION$ ivi e to for+ the le ear to e.it the s3)ll thro)#h the ST8LOMASTOI9

VOLUNTAR# CONTROL OF MU CLE OF FACIAL E!PRE

It ori#inates in the +otor corte. is in association 5ith other cortical areas( an !ass via the cortico/)l/ar tract in the !osterior li+/ of the internal ca!s)le to the +otor n)clei of facial nerve. Fi/res !ass to /oth- the i!silateral an contralateral +otor n)clei of facial nerve in the ca) al !ons. 0 The !ortion of the n)cle)s that innervates the +)scles of forehea receives cortico/)l/ar fi/res fro+ /oth- the contralateral an i!silateral +otor corte..

The !ortion of the n)cle)s that innervates the lo5er +)scles of facial e.!ression receives cortico/)l/ar fi/res fro+ onl" the contralateral +otor corte.. This is ver" i+!ortant clinicall" as central &)!!er +otor ne)ron( an !eri!heral

&lo5er +otor ne)ron( lesions 5ill !resent ifferentl". LO%ER MOTOR NEURON &LMN' LE ION: It res)lts fro+ a+a#e to +otor n)cle)s of facial nerve or its a.ons. A LMN lesion res)lts in the !aral"sis of all +)scles of facial e.!ression &incl) in# those of the forehea i!silateral to the lesion. Clinical correlation %ell<s Pals"0 A LMN lesion occ)rs at or /e"on co++onl" calle %ells Pals". 0 A LMN lesion is con4)nction 5ith eficits associate 5ith a/ )cens nerve in icate a lesion in the /rainste+ 5hich affects /oth- the +otor n)cle)s of facial nerve an a/ )cens n)cle)s. 0 A LMN lesion in con4)nction 5ith eficits associate 5ith vesti/)locochlear nerve are characteristic of a lesion in the re#ion of the internal aco)stic +eat)s. E#. Aco)stic Ne)ro+a. 0 U!!er +otor ne)ron &UMN( lesion= :es)lts in a+a#e to ne)ronal cell /o ies in the corte. or their a.ons that !ro4ect via the cortico/)l/ar tract thro)#h the !osterior li+/ of the internal ca!s)le to the facial nerve +otor n)cle)s. 'ol)ntar" control of onl" lo5er n)cle)s of facial e.!ression on the si e control lateral to the lesion 5ill /e lost. 'ol)ntar" control of the +)scles of the forehea 5ill /e s!are )e to /ilateral innervation of the !ortion of the +otor n)cle)s &C' 'II(. That innervates the )!!er +)scles of facial e.!ression. UMN lesions are )s)all" )e to stro3e. C(aracteristics o) an UMN lesion o) )acial ner*e 0 0 0 Facial as"++etr" Atro!h" of +)scles of lo5er !ortion of face on affecte si e No e"e/ro5 roo! the st"lo+astoi fora+en is

0 0 0 0 0 0

Intact fol s on forehea Intact con4)nctival refle. S+oothin# of nasola/ial fol s on affecte si e. Li!s can<t /e hel ti#htl" to#ether or !)rse . 9iffic)lt to 3ee! foo in +o)th 5hile che5in# on affecte si e. 9istin#)ishes UMN fro+ LMN lesion.

VI CERAL MOTOR COMPONENT 0 Paras"+!athetic co+!onent of facial nerve. Consists of efferent fi/res 5hich sti+)late secretion fro+ s)/+an i/)lar- s)/lin#)al- an lacri+al #lan s as 5ell as +)co)s +e+/ranes of naso!har"n. an har an soft !alates. ORI+IN AN" CENTRAL COUR E The visceral +otor co+!onent ori#inates fro+ a iff)se collection of cell /o ies in the ca) al !ons 4)st /elo5 the facial n)cle)s SUPE:IO: SALI'ATO:8 NUCLEUS. Fi/res e.it the ventrolateral as!ect of the /rainste+ at the ca) al /or er of the !ons as !art of the nerv)s inter+e i)s !ortion. These on<t< loo! aro)n the a/ )cens n)cle)s. The nerves inter+e i)s e.ists the /rainste+ 4)st lateral to /rachial +otor co+!onent.

INTERNCRANIAL COUR E U!on e+er#in# fro+ the !ons- all the co+!onents of facial nerve enter the internal a) itor" +eat)s alon# 5ith the fi/res of the vesti/)locochlear nerve. >ithin the facial canal the visceral +otor fi/res ivi e into 2 #ro)!s $( *reater !etrosal nerve 2( Chor a T"+!ani *reater !etrosal nerve0 lacri+al- nasal an S)/+an i/)lar an s)/lin#)al #lan s. COUR E OF +REATER PETRO AL !alatine #lan s chor a t"+!ani0

At the #enic)late #an#lion it t)rns anteriorl" an +e iall" e.itin# the te+!oral /one via the !etrosal fora+en an enters the +i le cranial fossa. It !asses ee! to the tri#e+inal #an#lion to enter the fora+en lacer)+. The nerve traverses the fora+en an enters a canal at the /ase of the +e ial !ter"#oi !late in con4)nction 5ith s"+!athetic fi/res & ee! !etrosal nerve( /ranchin# fro+ the !le.)s follo5in# the internal caroti arter". The !aras"+!athetic an the s"+!athetic fi/res to#ether +a3e )! the nerve of the !ter"#oi canal. On e.istin# the canal- !re#an#lionic !aras"+!athetic fi/res of facial nerve s"na!se in the !ter"#o!alatine #an#lion 5hich is s)s!en e fro+ the fi/res of the +a.illar" ivision of the tri#e+inal nerve &'2( in the !ter"#o!alatine fossa. COUR E OF CHOR"A T#MPANI The !re#an#lionic fi/res of the chor a t"+!ani /ranch fro+ the other fi/ers of facial nerve as the" !ass the facial canal 4)st !osterior to the +i thro)#h the +i le ear. The fi/res !ass le ear in close relationshi!s 5ith the t"+!anic +e+/rane an e.it the

/ase of the s3)ll to enter the infrate+!oral fossa. 2ere in the fossa the chor a t"+!ani 4oins the fi/res of the lin#)al /ranch of +an i/)lar ivision of &' ,( tri#e+inal N. the &CN 'III( !re#an#lionic fi/res s"na!se in the s)/+an i/)lar #an#lion s)s!en e fro+ the lin#)al nerve &',(. Post #an#lionic fi/res then either enter the s)/+an i/)lar #lan irectl" or follo5 the lin#)al nerve /efore /ranchin# to innervate the s)/lin#)al #lan . PECIAL EN OR# COMPONENT: Afferent fi/res that conve" taste infor+ation fro+ anterior 21, of the ton#)e an har an soft !alates PERIPHERAL COUR E: Che+orece!tors of taste /) s locate on anterior 21, of the ton#)e an har an soft !alates- initiate rece!tor !otentials in res!onse to che+ical sti+)li. The taste /) s s"na!se 5ith the !eri!heral !rocesses of s!ecial sensor" ne)rons fro+ facial nerve. These ne)rons #enerate action !otentials in res!onse to the taste /) <s rece!tor !otentials. The !eri!heral !rocesses of these ne)rons follo5 the lin#)al N. an then chor a t"+!ani to

the !etro)s !ortion of the te+!oral /one &as the !ath follo5e /" efferent visceral +otor fi/res( CENTRAL COUR E: The central !rocesses of the s!ecial sensor" ne)rons !ass fro+ the #enic)late #an#lion thro)#h the facial canal an enter the /rainste+ as !art of the nervo)s inter+e i)+ !ortion. The fi/res then 4oin the ca) al !ortion of tract)s solitari)s an ascen to s"na!se in nostral !ortion of the n)cle)s solitari)s &#)stator" n)cle)s&. N)cle)s solitari)s !ro4ect /oth- i!silaterall" an &'PM( n)cle)s of the thala+)s. Tertiar" ne)rons fro+ the thala+)s !ro4ect via the !osterior li+/ of the internal corte. to the area of the corte. res!onsi/le for taste. contralaterall" to the ventral !ostero+e ial

+ENERAL EN OR# COMPONENT 0 0 Minor co+!onent Afferent fi/res 5hich conve" the #eneral sensor" infor+ation fro+ the s3in of the concha of the e.ternal ear fro+ a s+all area of the s3in /ehin the ear. It +a" also s)!!le+ent the +an i/)lar +e+/rane. CENTRAL COUR E: Cell /o ies of these !ri+ar" sensor" ne)rons resi e in the #enic)late #an#lion. The !eri!heral !rocesses of these ne)rons !ans fro+ the s3in of the e.ternal ear an s+all re#ion of s3in /ehin the ear thro)#h the st"lo+astol fora+en- in con4)nction 5ith the fi/res of /ranchial +otor. The" then co)rse thro)#h the !etro)s !ortion of te+!oral /one to the #enic)late #an#lion. Fro+ here- the central !rocesses of the #eneral sensor" fi/res travel thro)#h the facial canal of the !etro)s !ortion of te+!oral /one an e.it in the internal aco)stic +eat)s. ivision of tri#e+inal N in !rovi in# the o)ter s)rface of t"+!anic sensation fro+ the 5all of the aco)stic +eat)s an

The central !rocesses then enter the /rain ste+ as !art of nerv)s inter+e i)s. These fi/res then escen in the s!inal tract of tri#e+inal N. To s"na!se in the s!inal tract of tri#eni+al nerve to s"na!se in the s!inal n)cle)s of tri#e+inal nerve. Ascen in# secon ar" ne)rons ori#inatin# fro+ the s!inal n)cle)s of tri#e+inal nerve !ro4ect to the contralateral 'PN &ventral !ostero+e ial( n)cle)s of the thala+)s via the anterolateral s"ste+. Tertiar" ne)rons fro+ the thala+)s !ro4ect via the !osterior li+/ of the internal ca!s)le to the sensor" corte. of the !ost central #"r)s. PERIPHERAL LE ION %" )sin# the 3no5le #e of the anato+" of the facial nerve- the location of a lesion can /e eter+ine /" the !resence or a/sence of certain eficits. A lesion of the facial !ro.i+al to the /ranchin# of the #reater !etrosal nerve an chor a t"+!ani is characteri?e /" the follo5in#= 0 0 Paral"sis of all the +)scles of facial e.!ression i!silateral to the lesion &LMN lesion of /rachial +otor co+!onent(. Loss of secretion fro+ lacri+al #lan an +)co)s +e+/rane of nasal an oral !har"n. i!silateral to the lesion &lesion of #reater !etrosal N- visceral +otor co+!onent(. 0 0 0 0 0 0 Loss of secretion fro+ s)/+an i/)lar an s)/lin#)al #lan s i!silateral to the lesion &lesion of chor a t"+!ani- 0 visceral +otor co+!onent. Loss of taste fro+ anterior 21, of ton#)e i!silateral to the lesion &lesion of chor a t"+!ani- s!ecial sensor" co+!onent(. Loss of #eneral sensation fro+ concha of e.ternal ear an s+all area of s3in /ehin the ear &#eneral sensor" co+!onent(. 9eficits in heavin# an 1 or vesti/)lar f)nctions i!silateral to the lesion &associate 5ith vesti/)locochlear N(. Intact #eneral sensation of the ton#)e &s)!!lie /" tri#e+inal N(. If the lesion 5as istal to the #reater !etrosal nerve /)t !ro.i+al to the chor a t"+!ani the !atient 5o)l !resent as a/ove- e.ce!t that the secretor" f)nctions of lacri+al- nasal an !alatine #lan s 5o)l /e intact.

0 0 0 0

A lesion 5hich affecte the lin#)al N 4)st istal to its 4)nction 5ith chor a t"+!ani 5o)l !resent as follo5s= Loss of secretion fro+ s)/+an i/)lar an s)/lin#)al #lan s i!silateral to the lesion &visceral +otor co+!onent(. Loss of taste fro+ anterior 21, of ton#)e i!silateral to the lesion &s!. Sensor" co+!onent(. Loss of #eneral sensation fro+ the ton#)e &#eneral sensor" co+!onent of tri#e+inal N.(

FACIAL NERVE PARAL# I 0 T5itchin#- 5ea3ness a !aral"sis of the face is a s"+!to+ of sa+e involvin# the facial N. It is not a isease itself. It +a" /e ca)se i+!air+ent. "IA+NO I OF FACIAL NERVE "I OR"ER An e.tensive eval)ation is often necessar" to eter+ine the ca)se of the isor er an locali?e the area of nerve involve+ent. $. Sta!e i)s nerve test &2earin# test( 0 9eter+ines isor ers in the elicate heavin# +echanis+. I+!e ance a) io+etr" recor s the !resence or a/sence of sta!e i)s +)scle contraction. A/sence of refle. Lesion !ro.i+al to sta!e i)s N. 2. Petrosal nerve test &Tear test( Schir+er test0 @)antitative tear !ro )ction eval)ation. 0 I+!lies a lesion at a !ro.i+al to #enic)late #an#lion A ra". 0 CT scan- 5ith an 5itho)t contrast is !referre for lesions of internal aco)stic +eat)s- !osterior fossa an /rain ste+. 2i#her resol)tions for /ase of s3)ll lesions 0 M:I scan is /est for soft tiss)e assess+ent of t)+o)rs an infection. ,. Electrical tests a( Nerve e.cita/ilit" tests ist)r/ances- in4)r"- infection or t)+o)r. The" are acco+!anie isor ers )e to circ)lator" /" heavin#

9eter+ines the e.tent of nerve fi/er a+a#e in total !aral"sis. Test +a" /e nor+al ins!ite of !aral"sis of fare in icatin# /etter o)tloo3 for ret)rn of f)nction. /( c( Electrone)ro#ra!h" Meas)res +)scle res!onse to electrical sti+)lation Electro+"o#ra!h" For lon# stan in# cases. 9eter+ines if +)scles1 Nerves BELL, PAL # 0 The +ost co++on con ition res)ltin# in facial nerve 5ea3ness or !aral"sis is %ell<s !als"- na+e after Sir Charles %ell 5ho Ist escri/e the con ition. The )n erl"in# ca)se of this con ition is not 3no5n /)t it +a" /e )e to a vir)s infection of the nerve. This s5ellin# res)lts in !resence on the nerve fi/res an their /loo vessels- ca)sin# facial !aral"sis. 0 0 0 7.2B !o!)lation is affecte Mi le a#e !eo!le are +ore affecte an a hi#her ten enc" in 5o+en 9ia/etics have 4 ti+es #reater chance to evelo! %ell<s Pals"- Last tri+ester of !re#nanc" is also a ti+e of increase ris3 of %ell<s Pals". %ells Pals" is ca)se /" infla++ation 5ithin a s+all /on" t)/e calle fallo!ian canal. This canal is e.tre+el" narro5. An infla++ation 5ithin it is li3el" to e.ert !resence on the nerve- co+!ressin# it. Li3e5ise- if the nerve itself /eco+es infla+e 5ithin the canal it enco)nters !ress)re 5ith the res)lt of co+!ression. The nerve has "et not e.ite the s3)ll an ivi e into its several /ranches- res)ltin# in i+!air+ent of all f)nctions controlle /" the Cth crania- nerve. If onl" a !art of the face is affecte the con ition is not D%ell<s Pals".E E.#. If the +o)th area is 5ea3 /)t the forehea +oves%ells Pals" is r)le o)t. Facial +)scles iffer fro+ s3eletal +)scles is that the" o not i++e iatel" /e#in to atro!h" fro+ lac3 of )se. Facial N is one of the $2 cranial nerves. Th)s all the facial +)scles are not affecte . The +)scles that close the e"eli are controlle /" facial N. /)t not the +)scles that control e"e +ove+ents. Che5in# an e.a+!les 5hich are not affecte . s5allo5in# are other

I+N AN" #MPTOM OF BELL, PAL # 0 %ell<s Pals" /e#ins 5ith sli#ht !ain aro)n one ear follo5e /" a/r)!t !aral"sis of the +)scles of that si e of the face. The follo5in# are the characteristics in ication on the affecte si e= 0 0 0 0 0 0 0 0 Mar3e facial as"++etr" E"e/ro5 roo! S+oothin# o)t of forehea an nasola/ial fol s 9ro!!in# of the corner of the +o)th Uncontrolle tearin# Una/le to close e"e 9iffic)lt" in 3ee!in# foo in +o)th 5hile che5in# on affecte si e Li!s can<t /e ti#htl" hel to#ether or !)rse . The e#ree of !aral"sis sho)l !ea3 5ithin several a"s of onset0 never lon#er than 2 5ee3s. 0 'iral an /acterial infections an a)toi++)ne isor ers are the co++on ca)ses of %ell<s Pals". HERPE 0 IMPLE! -$

2S'I 5as s)##este as a ca)se of %ell<s Pals". E.!os)re to 2S'I is co++on )rin# chil hoo . The active vir)s r)ns thro)#ho)t its co)rse 5itho)t /listers &onl" $FB cases evelo! /listers(. After the active sta#e- in the or+ant sta#e it resi es on the nerve tiss)e. >hen the latent vir)s reactivates at the facial N. The i++)ne s"ste+ !ro )ces anti/o ies 5hich ca)se infla++ation. If the location of infla++ation is in the fallo!ian canal it ca)ses !ress)re on the nerve lea in# to te+!orar" !aral"sis.

RAM E# HUNT #N"ROME 0 Ca)sative vir)s is varicella ?oster vir)s &';'( 5hich is the vir)s that ca)ses chic3en !o.. The vir)s resi es on the nerve tiss)e in or+ant state on the nerve #an#lia after the initial infectio)s sta#e. >hen the vir)s is reactivate the res)ltin# /listers are calle DShin#lesE.

In a ition to the classic s"+!to+s of %ells Pals" there are a itional s"+!to+s. a( /( c( ( e( Pain Ac)te !ain /ehin the ear an insi e the ear 5hich is ver" severe. 'erti#o 2earin# loss %listers Shin#les in the ear. The" last for 20F 5ee3s an are ver" !ainf)l. S5ollen an ten er l"+!h no es near affecte area.

HIV . AI" 2I' can ca)se facial !aral"sis an increase chance of evelo!in# :a+se" 2)nt S"n ro+e an %ells Pals". Earl" sta#es of 2I' !aral"sis is )e to viral infection. Later sta#es !aral"sis is )e to o!!ort)nistic infections. BACTERIAL TRI++ER $( L"+e isease Ca)ses facial !aral"sis an sa+e si#ns an s"+!to+s as %ell<s Pals". %acteria enter the /o " thro)#h the s3in at the site of thic3 /ite. Earl" s"+!to+ is a re rin# aro)n the site of the /ite an fl) li3e s"+!to+s. 2( Otitis Me ia %acteria fro+ ac)te or chronic +i le ear infections can inva e the canal aro)n the nerve thro)#h s+all !ortals. Bilateral: %ell<s Pals" an :a+se" 2int S"n ro+e can /e /ilateral altho)#h e.tre+el" rare. Monon)cleosis- fl)- *)illain0%asre s"n ro+e- L"+e isease are !otential tri##ers for /ilateral !als". MEL/ER 0 ON 0 RO ENTHAL #N"ROME1

Can /e )nilateral1 /ilateral !als". It is rec)rrent. More ever there is a fiss)re ton#)e an non0!ittin# oe e+a of the face.

ME"ICAL TREATMENT Altho)#h sa+e !atients recover s!ontaneo)sl"- the after effects in the re+ainin# $7B 0 27B can /e severe an recover". istressin#. Corticosteroi s res)lt in G7B067B co+!lete

0 0 0

Pre nisolone 27 +# fo)r ti+es a a" for F a"s an then taile off is reco++en e . Co+/ination of oral ac"clovir 477 +# F ti+es a a" 5ith oral !re nisolone $+#1 H# ail" for $7 a"s is +ore effective. Use of vaso ilators e.#. 2ista+ine are hel!f)l in so+e cases. UR+ICAL TREATMENT S)r#ical eco+!ression ai+s at relievin# the !ress)re on the facial N. an eco+!ression of facial nerve

restorin# its circ)lation a#ain. $. Mastoi 0 It is !erfor+e 5hen the nerve f)nction is eterioratin#. 0 Incision is +a e /ehin the ri i# +astoi /one aro)n the s5ollen nerve 5hich is re+ove - relievin# the !ress)re. The e#ree an ra!i it" of facial nerve f)nction e!en s )!on the a+o)nt of a+a#e !resent in the nerve at the ti+e of the s)r#er". :ecover" ta3es , $2 +onths an +a" not /e co+!lete. 2. Mi le fossa facial nerve eco+!ression 0 At ti+es ee!er !ortions of the facial N are affecte . 0 The incision is +a e a/ove the ear 5ith re+oval of s+all !ortion of the s3)ll. 0 Mastoi an +i le fossa facial nerve eco+!ression 0 It s a co+/ination of the a/ove 2 !roce )res. RI / AN" COMPLICATION OF FACIAL NERVE UR+ER# $. 2earin# loss so+e hearin# i+!air+ent in o!erate ear i++e iatel" follo5in# s)r#er". This is )e to fl)i an s5ellin# in +astoi an +i 204 5ee3s an hearin# ret)rns to !reo!erative level. 2. ,. 9i??iness 9)e to s5ellin# of the inner ear str)ct)res. So+e )nstea iness !ersists for a fe5 a"s !ost o!erativel". :elate to +i le fossa a!!roach= a( /( c( ( 2e+ato+a &collection of /loo )n er s3in incision( Cercloros!inal fl)i lea3 Infection 5hich +a" lea to +enin#itis Te+!orar" !aral"sis of half the /o " )e to s5ellin# in the /rain. le ear. It s)/si es in

E#E CARE The +ost co+!lication that +a" evelo! as a res)lt of total facial N. !aral"sis is a )lcer of the cornea of the e"e. Te e"e or the affecte si e sho)l /e !rotecte /" 3ee!in# it +oist. 0 0 0 0 0 Usin# the e"e 5ith the /ac3 of the fin#er is an effective 5a" to 3ee! the e"e +oist. *lasses +)st /e 5orn o)tsi e to !revent )st fro+ enterin# the e"e. Artificial tears are )se in cases of r" e"e. At ti+es it is necessar" to ta!e the e"eli In lon# stan in# facial !aral"sis cases- it +a" /e necessar" to insert a #ol 5ei#ht or a s!rin# into the e"eli to hel! close it. IN2URIE OF THE FACIAL NERVE 0 0 0 The +ost co++on ca)se of an in4)r" is a s3)ll fract)re Ma" occ)r i++e iatel" or evelo! so+e a"s later )e to nerve s5ellin# Facial nerve in4)ries +a" occ)r )e to o!erations on the ear. This #enerall" occ)rs 5hen the nerve is not in its nor+al anato+ical !osition or 5hen the nerve is istorte /" +i le ear isease. Treat3ent: 9e!en s on the e.tent of nerve a+a#e Me ical treat+ent Sa+e as %ell<s Pals" S)r#ical treat+ent= a( /( c( 9eco+!ression Mi le fossa eco+!ression Facial nerve #raft0 Necessar" if the a+a#e to the nerve is e.tensive. A s3in sensation nerve is re+ove fro+ the nec3 an trans!lante into ear /one- to re!lace isease !ortion of facial nerve. TUMOR Aco)stic T)+ors=

The +ost co++on t)+or to involve the facial nerve is a non+ali#nant fi/roi t)+or of the vesti/)locochlear nerve- the aco)stic t)+or. Altho)#h there is no5 5ea3ness of the face /efore s)r#er"- t)+or re+oval res)lts in 5ea3ness or !aral"sis of the face. This s)/si es in several +onths. It +a" /e necessar" to re+ove a !ortion of the facial N to re+ove the aco)stic t)+or. :arel" it +a" /e !ossi/le to se5 the nerve en s to#ether a insert a nerve #raft at the ti+e of s)r#er". Later a nerve anasto+osis s)r#er" is carrie o)t connectin# the h"!o#lossal N to the facial N. the face is totall" !aral"?e )ntil the nerve re#ro5s. FACIAL NERVE NEUROMA A non+ali#nant fi/roi #ro5th 5hich +a" #ro5 in the facial nerve itself. 0 It +a" or +a" not !ro )ce a #ra )al facial N !aral"sis. :e+oval of the ne)ro+a involves re+oval of affecte facial nerve !ortion. Us)all" a #raft is !ossi/le at the ti+e of s)r#er". &*raft ta3en fro+ s3in sensation nerve(. >hen !ortion of facial N nearest to the /rain is estro"e - then a facial reani+ation !roce )re is necessar". FACIAL REANIMATION: $. 2. E"eli s)r#er"= i+!lantation of #ol or a s!rin# into the )!!er e"eli can /e hel!f)l in co)nter /alancin# the liftin# e"eli +)scle. 2"!o#lossal0 Facial nerve anasto+osis0 Connection of a !ortion or all of the ton#)e N to the facial N +a" !rovi e a #oo tone to the face. Facial +ove+ents are o/taine /" atte+!tin# to +ove the ton#)e to the involve si e 5hen a s+ile is esire . ,. Te+!oralis +)scle trans!osition= Transferrin# one of the 4a5 +)scles to the corner of the +o)th i+!roves facial s"++etr". S+ilin# is relearne /" atte+!tin# to /ite at the sa+e si e. 4. Miscellaneo)s A face life or re+oval of e.cess s3in at the /ro5n or chee3 can /e carrie o)t. 0 So+e !atients 5ho have fa)lt" ret)rn of facial f)nction- selective c)ttin# of facial N /ranches facial +)scles +a" /e of /enefit.

OTHER FACIAL NERVE "I OR"ER $. Facial s!as+0 s)r#er" to correct this !ro/le+ +a" involve &a( Intentional 5ea3enin# of nerve thro)#h an incision on the face or &/( relievin# !ress)re on the nerve a 4acent to the /rain. 2. Mastoi infection= It is )e to ac)te or chronic +i s)/si es. In chronicall" infecte ears there is !ress)re fro+ a cholesteato+a &s3in line c"st(. ,. Post o!erative facial nerve 5ea3ness 9ela"e 4. F. 5ea3ness or !aral"sis follo5in# reconstr)ctive +i le ear s)r#er" is )nco++on- /)t occ)rs at ti+es )e to s5ellin# of the nerve )rin# healin# !erio . 2e+ifacial s!as+ )nco++on isease of )n3no5n ca)se 5hich res)lts in s!as+o ic contractions of one si e of the face. %rain isease0 T)+ors an circ)lator" ist)r/ances of the nervo)s s"ste+ +a" ca)se facial N !aral"sis e#. Stro3e. NEUROMU CULAR RETRAININ+ FOR FACIAL PARAL# I Ne)ro+)sc)lar retrainin# &NM:( for facial !aral"sis is a +arria#e of ne)ro!h"siolo#"- !s"cholo#"- thera!e)tic sciences- earnin# theor" an +otor activit" &s"n3inesis(. The !atients are instr)cte +ove+ents on the contralateral si e. FACIAL E!ERCI E F:O0 :aise "o)r e"e/ro5 CO:- P:O %rin# "o)r e"e/ro5s o5n an to#ether OCS- OCI *entl" close e"es OCS- OCI SI)int "o)r lo5er e"eli s )! OCS- OCI Close "o)r e"es ti#htl" 9IN Flare nostrils art- it )ses selective +otor trainin# to facilitate s"++etrical +ove+ent an control )n esire #ross to !erfor+ s+all- s!ecific le ear infections. In ac)te infections the 5ea3ness )s)all" s)/si es as the infection is controlle an the s5ellin# aro)n the nerve

:IS- ;8J- ;8N- LAO- LLS S+ile evenl" 5ith li!s to#ether :IS- ;8J- ;8N- LAO- LLS A /i# 5i e s+ile 5ith li!s a!art. LLS- LAO :aise )!!er li! 5hile 5rin3lin# "o)r nose :IS Move the corner of the +o)th /ac3 to5ar s the ear OOS- OOI P)c3er the li!s OOS- OOI Press li!s to#ether OOS- OOI P)ll li!s /ac3 an over the teeth OOS- OOI P)sh the li!s o)t as far as "o) can OOI- 9AO- 9LI :oll lo5er li! o)t an o5n 9AO- 9LI T)rn corner of +o)th o5n5ar s 9AO- 9LI P)ll lo5er li! o5n to e.!ose lo5er teeth MEN Ti#hten the chin PLA Ti#hten the nec3 "ENTAL A PECT OF FACIAL PARAL# I 0 0 0 0 0 :es)lts in !oor soft tiss)e cleansin# an vesti/)les. E.cessive !laI)e or the teeth an affecte si e >here there is resi )al !als"- saliva +a" lea3 fro+ the affecte si e an ca)se an#)lar sto+atitis- lea in# to a cos+etic efect. Constr)ction of a s!lint to s)!!ort the an#le of the +o)th +a" then i+!rove aesthetics. A facial #raft or facial l"!o#lossal nerve anasto+osis +a" re )ce the cos+etic efor+it". CRO $. REFERENCE Orofacial !ro/le+s associate 5ith /ilateral 'II cranial N. Pals" Francis ST an PM %anasi3 JA9A $6CC 'ol 6F P# ,$F0 ,$G. Per+anent /ilateral facial !als" is rate an can ca)se +)lti!le !ro/le+s for the entist. Case re!ort= A ,F "ears +an evelo!e left facial N !aral"sis follo5e /" the ri#ht si e after K +onths. 9i??iness- na)sea an vo+itin# an ata.ia slo5l" a!!eare acc)+)lation of foo e/ris in the

The e.traoral e.a+ination reveale Aerosto+ia 5as evi ent.

classical facies of /ilateral %ell<s Pals". isease.

Oral h"#iene 5as !oor- severe caries an #en. !erio ontal Treat+ent= 0 0 0 0 0

All re+ainin# +a.illar"1 +an i/)lar teeth 5ere e.tracte . Meth"lcell)lose $B aI)eo)s sol)tion 5as !rescri/e to re )ce .erosto+ia. The !als" an .erosto+ia 5o)l affect ent)re entition. Conventional ent)res 5ere fa/ricate . Mar3e re )ction in .erosto+ia 5as seen as the oral cavit" 5as seale fro+ the a+/ient air. Man i/)lar ent)re ha an attache li! s)!!ort. 'ertical #rooves 5ere !lace istal to the c)s!i . A $6 #a)#e 5ire 5as /ent to fit the #roove an e.ten e hori?ontall" over the li! at the ri#ht co++iss)re. This en 5as affi.e /" col c)re resin. The ent)re 5as then inserte an the 5ire 5as +a e to follo5 the conto)r of the lo5er li!. It 5as then /ent over the li! at the left co++iss)re an attache to the left si e in the sa+e +anner. Treat+ent res)lte in /etter esthetic- !h"siolo#ic an !s"cholo#ical i+!rove+ent.

2. 0

Prostho ontic Mana#e+ent Of A Patient >ith Ne)rolo#ical 9isor er After :esection Of Aco)stic Ne)ro+a 2. C. Har3a?is JP9 2772L 'ol GC P# 4$60422. The aco)stic ne)ro+a ori#inates 4)st insi e the internal antitor" +eat)s- event)all" ca)ses is!lace+ent of a 4acent /rain tiss)e as 5ell as tri#e+inal- #losso!har"n#eal facial an va#)s nerves. This ca)ses )nilateral facial !aral"sis- ata.ia- "s!horia"sarthria an "s!ha#ia. Prostho ontic +ana#e+ent for an e ent)lo)s !atient 5ith severe ne)rolo#ical isor ers after the ne)ro+a 5as resecte is escri/e . Esta/lish+ent of a ne)tral ?one in s)ch !atients is a challen#e. Clinical re!ort= A GF "ear +an ha a histor" of a lar#e aco)stic ne)ro+a re+ove fro+ the ri#ht si e. 9)e to re )ce !har"n#eal sensation an !oor #a# refle.)rin# i+!ression +a3in# the e.cess +aterial 5as i++e iatel" re+ove fro+ the

PPS area. A +e i)+ /o " !ol"ether 5as )se for the final i+!ression )e to hi#h viscosit". A !ro!erl" fittin# +a.illar" ri+ 5as !lace in the +a.illa. 9)rin# the !roce )re- the !aral"?e li! 5as retracte to create s"++etr" on tooth si es. A thic3 +i. of tiss)e con itionin# +aterial &TCM( 5as a a!te to the to! of the +an i/)lar ri+. It 5as !lace in the +o)th 5ith +a.illar" ri+ an !atient 5as as3e to !erfor+ the nor+al +ove+ents. After initial set- it 5as re+ove an tri++e - then re!lace in the +o)th. The re!eate s5allo5in# actions #)i e the +an i/le to close in centric relation. The secon /ase 5as then !lace on the cast/)ccal an lin#)al in ices 5ere fa/ricate 5ith silicone !)tt". The te+ 5as re+ove an +olten 5as 5a. fille in its !lace. The final '9O an centric 5as eter+ine in the !atients +o)th. 0 Teeth settin# 5as one. Man i/)lar !osterior teeth 5ere !ositione in the recor e ne)tral ?one area. 9ent)res 5ere !rocesse in the )s)al +anner. 9)rin# finishin# no ent)re /ase acr"lic 5as re+ove fro+ the !olishe s)rface. The ne)tral ?one +an i/)lar co+!lete ent)re a resse the nee to +a.i+i?e +)scle control. REFERENCE $. 2. ,. 4. F. K. C. *ra"<s Anato+". h)+an Anato+" %. 9. Cha)rasia. Oral Me icine- ia#nosis an treat+ent %)r3et<s. Te.t %oo3 on Oral Patholo#" Shafer- 2ine- Lev". Man)al of Practical Anato+" C)nnin#ha+s. JA9A 'ol 6F A)# $6CC P# ,$F. JP9 2772 'ol GC P# 4$60422.