CRANIAL

NERVES
WITH
EMPHASIS
ON
FACIAL
NERVE
 CONTENT
1- INTRODUCTION
2- ATTACHEMENT
3- FORAMINA
4- TYPE AND FUNCTIONS
5- FACIAL NERVE
•Introduction
•Nuclei
• Functional components
• Course and relations
• Branches
• Ganglions associated
•Clinical anatomy
6- CONCLUSSION
 INTRODUCTION
“
○ There are 12 pairs of cranial nerves supply
muscle of eyeball, face, palate, pharynx,
larynx, tongue and two large muscle of neck.

Garg K. BD Chaurasia's human anatomy volume 3. 5th ed. New Delhi: CBS Publishers
& Distributors; 2010.
ATTACHEMENT OF
CRANIAL NERVES
FACIAL NERVE
 Introduction
• Facial nerve is the seventh cranial nerve.
• It is the nerve of second branchial arch,
the Hyoid arch.
• It has two roots : Sensory root or Nervus
Intermedius
Motor root

Garg K. BD Chaurasia's human anatomy volume 3. 5th ed. New Delhi: CBS Publishers
& Distributors; 2010.
 NUCLEI
Four Nuclei are associated which are situated
in lower pons:

1.Motor Nucleus or branchiomotor.

2.Superior Salivatory nucleus or parasympathetic.

3.Lacrimatory nucleus also parasympathetic

4.Nucleus of tractus solitarius which is gustatory

and also receives afferent fibres from the glands.
Garg K. BD Chaurasia's human anatomy volume 3. 5th ed. New Delhi: CBS Publishers
& Distributors; 2010.
 FUNCTIONAL COMPONENTS
1-SPECIAL VISCERAL EFFERENT (SVE)

2-GENERAL VISCERAL EFFERENT(GVE)

3. SPECIAL VISCERAL AFFERENT(SVA)

4. GENERAL SOMATIC AFFERENT (GSA)

Garg K. BD Chaurasia's human anatomy volume 3. 5th ed. New Delhi: CBS Publishers
& Distributors; 2010.
 Course And Relations
• The facial nerve is attached to brainstem by
two roots, motor and sensory.
• The two roots are attached to lateral part of
lower border of pons.
• The two roots run laterally and forwards with
the eighth cranial nerve to reach internal
acoustic meatus.
• Within the canal the course of nerve can be
divided into 3 parts by two bends.

Garg K. BD Chaurasia's human anatomy volume 3. 5th ed. New Delhi: CBS Publishers
& Distributors; 2010.
 • The first part is directed laterally above the
vestibule; the second part runs backwards in
relation to medial wall of the ear above the
promontory.
• Third part is directed vertically downwards
behind promontory.
• The facial nerve leaves the skull by passing
through the stylomastoid foramen.

Garg K. BD Chaurasia's human anatomy volume 3. 5th ed. New Delhi: CBS Publishers
& Distributors; 2010.
INTRA-CRANIAL COURSE
Location of the stylomastoid foramen
 Branches And Distribution
A.Within the Facial Canal:

1. Greater petrosal nerve

2. The nerve to the stapedius.
3. The chorda tympani.

B.At its exit from the stylomastoid foramen:

4. Posterior auricular.
5. Digastric.
6. Stylohyoid.
Garg K. BD Chaurasia's human anatomy volume 3. 5th ed. New Delhi: CBS Publishers
& Distributors; 2010.
 C.Terminal branches within parotid
gland:
1. Temporal
2. Zygomatic
3. Buccal
4. Marginal mandibular
5. Cervical

D. Communicating branches with

adjacent cranial and spinal nerves

Garg K. BD Chaurasia's human anatomy volume 3. 5th ed. New Delhi: CBS Publishers
& Distributors; 2010.
 GANGLIA
Ganglia associated with facial nerve are:-
1. Geniculate ganglion
2. Submandibular ganglion
3. Pterygopalatine ganglion

Garg K. BD Chaurasia's human anatomy volume 3. 5th ed. New Delhi: CBS Publishers
& Distributors; 2010.
CLINICAL ANATOMY
 SUPRANUCLEAR AND INFRANUCLEAR
LESIONS:
SUPRANUCLEAR LESIONS:

• It is a part of hemiplegia.
• The upper part of face remains unaffected while the lower part
of opposite side of face is paralyzed.
• Frontalis and orbicularis oculi escapes.

Garg K. BD Chaurasia's human anatomy volume 3. 5th ed. New Delhi: CBS Publishers
& Distributors; 2010.
 INFRANUCLEAR LESIONS:
BELL’S PALSY:

• It is due to injury at or after the facial nerve exit from the

stylomastoid foramen.
• The face becomes asymmetrical and affected side is
immobile.
• The affected side of face and forehead is motionless.
• Wrinkles disappear from the forehead and the eye cannot be
closed.
• Any attempt to smile draws the mouth to the normal side.
• Food accumulation between cheek and teeth occurs during
mastication.
• The lips remain in contact in paralyzed side but cannot be
pursued for whistling.
Malik N. Textbook of oral and maxillofacial surgery. 4th ed. Jaypee Brothers Medical
 Facial nerve palsy in
newborn:
 Mastoid process- is absent in newborn.

 Stylomastoid foramen- superficial

Manipulation of baby head during delivery

may lead to damage to nerve.

This leads to paralysis of facial muscle

especially: buccinator- required for sucking of
milk.
Garg K. BD Chaurasia's human anatomy volume 3. 5th ed. New Delhi: CBS Publishers
& Distributors; 2010.
 FREY’S SYNDROME
Stimulus to secretion of saliva causes
sweating and flushing of the skin in the area of
distribution of auriculotemporal nerve.
 The symptoms of Frey's syndrome are
redness and sweating on the cheek area
adjacent to the ear .

Malik N. Textbook of oral and maxillofacial surgery. 4th ed. Jaypee Brothers Medical
 CROCODILE TEAR
SYNDROME
Due to the lesion proximal to genticulate
ganglion resulting in defective secretomotor
supply.
As a result, the patient lacrimates while eating.

Malik N. Textbook of oral and maxillofacial surgery. 4th ed. Jaypee Brothers Medical
RAMSAY HUNT SYNDROME :
• Due to herpes zoster infection in the geniculate
ganglion.
• It leads to facial nerve paralysis.
MOEBIUS SYNDROME:

• A complex congenital anomaly involving

multiple cranial nerves, affecting mainly the
abducens(VI) and facial (VII) nerves, and often
associated with limb anomalies.
 Facial paralysis & Local
anaesthesia
Transcient facial nerve paresis on accidental
injury to parotid capsule during inferior alveolar
nerve block.
Directing the needle posteriorly or
inadvertently deflecting it in a posterior direction
during an IANB may place the tip of the needle
within the body of the parotid gland.

MALAMED S. HANDBOOK OF LOCAL ANESTHESIA, 6th ed.: ELSEVIER INDIA;

2014.
 PROBLEM

•The primary problem assosciated with transient

facial nerve paralysis is cosmetic.
•A secondary problem is unable to voluntarily close
one eye.

PREVENTION
• Always contact bone before injecting
• Avoid deep injections
MALAMED S. HANDBOOK OF LOCAL ANESTHESIA, 6th ed.: ELSEVIER INDIA;
2014.
 Conclusion
2nd most important nerve for dental practitioner
Thorough knowledge of anatomy and physiology of
the nerve essential
Any pathology/trauma can cause debilitating
disfigurement
Care of facial nerve important in local anaesthesia.