Anatomy Nuclei Course Branches and distribution Ganglia Blood supply Functional Components Functions of the Facial Nerve

l Nerve Clinical Examination of the Facial Nerve Pathology of the Facial Nerve Importance of facial nerve in operative dentistry Endodontic implications of facial nerve Conclusion
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 Nerve Sympathetic Parasympathetic Neuron Nuclei

Motor/Efferent (Brachial, visceral)

Sensory/Afferent (General, special) Upper motor neuron Lower Motor neuron Paresis Plegia
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ANATOMY
7th Cranial nerve

Mixed nerve

Nerve of the hyoid arch

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NUCLEI
Four nuclei -

Motor nucleus (branchiomotor)

Superior salivatory nucleus (parasympathetic) Lacrimatory nucleus (parasympathetic) Nucleus of tractus solitarius (gustatory)
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Nerve innervation by the Motor Nucleus in the upper and lower part of the face

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Origin

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Labrynthine vessels

Relationship of the cranial nerves in the internal acoustic meatus

Nervus intermedius

VII (m)

Arachnoid Dura
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INTRACRANIAL COURSE

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EXTRACRANIAL COURSE

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Within the facial canal

At its exit from the stylomastoid foramen

Terminal branches within the parotid gland

Communicating branches with adjacent cranial and spinal nerves

BRANCHES AND DISTRIBUTION

Within the facial canal 1. Greater Petrosal Nerve

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3. Chorda Tympani Nerve

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COURSE OF CHORDA TYMPANI NERVE

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Chorda tympani taste fibre Tongue Chorda tympani Secretomotor fibre (preganglionic) Lingual nerve carrying general sensation

Submandibular Ganglion

Submandibular Gland

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At its exit from the stylomastoid foramen

1. Posterior auricular 2. Digastric 3. Stylohyoid

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Terminal branches within the parotid gland

Temporal

Zygomatic

Buccal

Cervical Mandibular
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Anatomic Variations

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In the internal acoustic meatus - With the acoustic nerve at the geniculate ganglion nerve.

With the sphenopalatine ganglion by the greater superficial petrosal

With the otic ganglion by a branch which joins the lesser superficial

petrosal nerve.

In the facial canal - With the auricular branch of the vagus. At its exit from the stylomastoid foramen - With the glossopharyngeal. On the face - With the trigeminal. In the neck - With the cutaneous cervical.

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Ganglia Of The Facial Nerve

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 The facial nerve

derives both an intrinsic and an extrinsic blood supply. cerebral artery

Intrinsic middle

Extrinsic the stylomastoid

artery the middle meningeal artery the anterior cerebellar artery

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Functional Components
1. Branchial Motor

2. Visceral Motor

3. Special Sensory

4. General Sensory

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Clinical Examination of the Facial Nerve Motor Examination

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Testing Taste

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Corneal Reflex

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Sucking Reflex

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EFFERENT FUNCTION

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AFFERENT FUNCTION

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Review Article The receptors and cells for mammalian taste 34 Nature 444, 288-294 (16 November 2006)

 Physiology of Nerve injury Sunderland's classification five degrees

Neuropraxia 1st degree Axonotmesis 2nd degree Endoneurotmesis 3rd degree Perineurotmesis 4th degree Neurotmesis 5th degree

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 Facial paralysis is a dysfunction of the facial nerve

that results in inability to control facial muscles on the affected side.

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 Congenital/Acquired Brain or parotid gland tumours Trauma

Stroke
Lyme disease

Latent virus reactivation of zoster and Epstein Barr

Idiopathic Bells Palsy
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I - Normal facial movements; No synkinesis II - Slight Mild deformity, mild synkinesis, good forehead function, slight asymmetry III - Moderate Obvious facial weakness, forehead motion present, good eye closure, asymmetry, Bell's phenomenon present IV - Moderately Obvious weakness, increasing synkinesis; no forehead motion V - Severe Very obvious facial paralysis, some tone present, cannot close eye
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 Paralysis involving all divisions of the facial nerve is

peripheral and that sparing the forehead is central.

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 Central Seven It usually results from

damage to upper motor neurons of the facial nerve.

Most commonly

occurs due to stroke.

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 Named after Scottish anatomist

Charles Bell

Idiopathic, unilateral, self-

limiting facial palsy

Infranuclear/lower motor type Persistent latent viral infection

activation, exposure to cold side

Facial drooping on the affected

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 As a result of inflammation of the facial nerve,

pressure is produced on the nerve where it exits the skull within its bony canal, blocking the transmission of neural signals or damaging the nerve.

Classic presentation weakness on one side of face Awareness drooling after brushing teeth or drinking,

asymmetry
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 INFRANUCLEAR (LMN):

a. Lesion at or below stylomastoid foramen loss of facial expression on the same side as the lesion b. Lesion in the facial canal (lower level) a + loss of taste sensation in anterior 2/3 rds of tongue and salivation c. Lesion in the facial canal (higher level) a + b + loss of hearing d. Lesion at genu/proximal to genuculate ganglion a + b + c + loss of lacrimation
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 NUCLEAR LESION (LMN):

Lesion in pons unilateral facial palsy (6th nerve involvement also seen) + Contralateral pyramidal signs (Millard Gubler syndrome)

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 SUPRANUCLEAR LESION (UMN) :

Contralateral lower side of face involved (voluntary movement) facial expressions + Unilateral pyramidal signs (UMN type) (Hemiplegia)

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 Bell's palsy is a diagnosis of exclusion. Lyme disease Tumours (e.g., Acoustic neuroma , parotid gland tumours) Ramsay Hunt syndrome Demyelinating lesions

Sarcoidosis

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 Heerfordt's

syndrome
Melkersson-

Rosenthal syndrome
Gustatory tearing or

crocodile tears
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 Eye care

Oral steroid Prednisone

1 mg/kg/day for 10-14 days

Surgery to relieve pressure on the nerve Local superficial heat therapy (i.e. hot
(Europa Medicophys 2006;42:41-7)

pack or infrared rays) for 15min/session

Physiotherapy (Physiotherapy treatment of Bell's

palsy: a case report New Zealand Journal of Physiotherapy, Nov, 2006 by James M. Elliott )

Facial muscle protection

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 Described by Gowers in

1884
A neurological disorder

wherein blood vessels constrict the facial nerve causing facial spasm.
First symptom -

intermittent twitching of the eyelid muscle leading to forced closure of the eye.
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 Medications -

carbamazepine, phenytoin and gabapentin

Injection of botulinum

toxin type A

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 Trauma Petrous bone fracture

Surgery of middle ear, mastoidectomy, parotid gland Tumours Neuroma/schwanoma Meningioma Hemangioma Metastasis Osteopetrosis

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 The transient loss of motor function of the orofacial

muscles can hamper the smile line evaluation, an important parameter for restorative and prosthetic dentistry approaches. Chiche G, Pinault A. Esthetics of anterior fixed prosthodontics. Chicago: Quintessence, 1994.

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 Released and ionized mercury can be taken up by tissues

and nerves beneath fillings and in root canals.

Current animal experiments show that mercury is taken up

by nerve endings and is transported towards the central nervous system in the same way as lead (Baruah, 1981).
When the amalgam fillings in the right part of the lower

jaw were removed, the painful strain after the facial paralysis, present four years, disappeared. It seems close at hand to suspect a combination of the general poisoning and the mercury source in the two teeth in the lower jaw as primary causes of the nerve inflammation, resulting in the face paralysis on the same side.
Mercury Poisoning From Dental Amalgam Jaro Pleva, Ph.D.1 Orthomolecular Psychiatry, volume 12, Number 3, 1983 Pp. 184-193
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Neurological complications following extrusion of sodium hypochlorite solution into the facial soft tissues during root canal treatment International Endodontic
Journal, 38, 843848, 2005

Neurological sequelae can follow inadvertent hypochlorite extrusion. Early recognition may avert a potentially more serious outcome. Active hospital treatment including intravenous steroids and

antibiotics is recommended.

Permanent mimic musculature and nerve damage caused by sodium hypochlorite: a case report.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Sep;106(3):e80-3. Epub 2008 Jul 7
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 Transient facial nerve paralysis introduction of LA into the

capsule of the parotid gland during IANB or Vazirani Akinosi nerve block
Problem

Prevention
Management

Facial nerve palsy following intra-oral surgery performed with local anaesthesia J.R.Coll.Surg.Edinb., 45,October 2000, 330-333
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 7th cranial nerve

Branches

Within facial

At the stylomastoid

On the face 1. Temporal 2. Zygomatic 3. Buccal

Communicating

canal
1.

foramen
1. Posterior auricular 2. Digastric

Branches

Greater petrosal

2. Nerve to

Stapedius
3.

3. Stylohyoid

4. Mandibular
5. Cervical

Chorda tympani

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 The most important thing you wear is the expression

on your face.
Certain cases of facial nerve palsy following dental or

maxillofacial procedures occur.

Prevention is better than cure.

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B.D. Chaurasias Human Anatomy vol 3

The Facial Nerve, Mark May Barry M. Schaitkin - 2000

Chiche G, Pinault A. Esthetics of anterior fixed prosthodontics. Chicago: Quintessence, 1994.

Handbook of Local Anesthesia 5th edition Mercury Poisoning From Dental Amalgam Jaro Pleva, Ph.D.1

Orthomolecular Psychiatry, volume 12, The facial nerve: anatomy and common Number 3, 1983 Pp. 184-193 pathology Semin Ultrasound CT MR. 2002 Color Atlas of neuroscience: Jun;23(3):202-17 Neuroanatomy and Neurophysiology by Ben Greenstein, Adam Greenstein International Endodontic Journal, 38, 843 Neurological Classics 848, 2005 By Robert H. Wilkins, Robert Wilkins, Irwin Brody Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Sep;106(3):e80-3. Epub 2008 Jul 7

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