Last edited: 9/6/2021

54. FACIAL NERVE | CRANIAL NERVE VII

Neurology | Facial Nerve | Cranial Nerve VII Medical Editor: Dr. Ana Guerra

OUTLINE II) BRANCHES: COURSE AND STRUCTURES

SUPPLIED
I) ORIGIN OF NERVE
II) BRANCHES: COURSE AND STRUCTURES
Table 1. The Letter Symbols Commonly Used to Indicate the
SUPPLIED
Functional Components of Each Cranial Nerve [Clinical
III) CLINICAL CORRELATION
Neuroanatomy, RS Snell]
IV) APPENDIX
V) REVIEW QUESTIONS Component Function Letter symbol
VI) REFERENCES Afferent Fibers Sensory
General somatic General GSA
afferent Sensations.
I) ORIGIN OF NERVE Special somatic Hearing, SSA
afferent balance, vision.
General GVA
General visceral
sensations from
afferent
viscera.
Special visceral SVA
Smell, taste.
afferent
Efferent Fibers
General somatic Somatic striated GSE
efferent muscles.
Glands and GVE
General visceral smooth muscles
efferent (parasympathetic
innervation).
Figure 1. Nucleus of CN VII. Special visceral Branchial arch SVE
(A) FACIAL NERVE NUCLEUS efferent striated muscles.

SVE fibers (special visceral efferent).

o Supplies the 2nd pharyngeal arch.
 Muscles of facial expression, digastric posterior (A) AURICULAR BRANCHES
belly and stylohyoid muscle.
Its fibers move around CN VI nucleus and then anteriorly Supply innervation to:
to it, leaving the brainstem lateral to the abducens nerve a. Tympanic cavity and tympanic membrane.
exit. b. A portion of the external acoustic meatus.
Leaves the skull through the internal acoustic meatus. c. Some of the skin around the ear.
GSA fibers coming from the the auricular branches
(B) SUPERIOR SALIVATORY NUCLEUS synapse with the Geniculate ganglion.
GVE fibers (general visceral efferent). Fibers then travel until reaching the Spinal nucleus of
o Supplies to nasal and lacrimal glands. the trigeminal nerve.
Runs alongside the facial nerve motor fibers through the
internal acoustic meatus.

(C) SPINAL NUCLEUS OF CN V

GSA fibers (general somatic afferent).
o Touch, pain and temperature.

(D) NUCLEUS OF TRACTUS SOLITARIUS

SVA fibers (special visceral afferent)
o Taste of anterior 2/3 of tongue.
GVA fibers (general visceral afferent)
o Sensation of soft palate.
Nice to know
There are two types of special afferent fibers:
o SSA (special sensory afferent): Figure 1-2. Structures supplied by GSA fibers of the auricular
 Optic nerve and vestibulocochlear nerve. branches of CN VII.
o SVA (special visceral afferent):
 Gustation and smell. Nice to know
A ganglion is a group of cell bodies located within the
peripheral nervous system.
The geniculate ganglion picks up information from
(E) DORSAL NUCLEUS OF VAGUS SVA fibers, GSA fibers and GVA fibers.
Receives GVA fibers from the soft palate as well.

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 (B) GVA FIBERS (D) SVE FIBERS
Pick up visceral sensation from the soft palate. Fibers coming from the facial nerve nucleus move
Fibers synapse with the geniculate ganglion. through the internal acoustic meatus.
Postganglionic fibers take the information to the nucleus They enter to the tympanic cavity through the facial
of tractus solitarius and the dorsal nucleus of vagus. canal and gives off its first branch, the nerve to
stapedius.

(i) Nerve to stapedius:

(C) CHORDA TYMPANI
Passes through the pyramidal
eminence to supply the
(1) SVA fibers: stapedius muscle in the middle
ear.
o Responsible of innervating the anterior 2/3 of tongue
o Its function is to prevent
with the special sense of taste.
excess movement of the
 All different types of taste get picked up by SVA
stapes to the oval window,
fibers on the taste buds located all over the
controlling the amplitude of Figure 1-4. Nerve to
tongue. stapedius.
sound waves to the inner
 Information runs alongside the lingual nerve, a
ear.
branch of the V3 division of CN V,
• It supplies touch, pain and temperature to
Fibers keep moving down and come out through the
anterior 2/3 of tongue.
stylomastoid foramen, but before crossing the parotid
 Then, SVA fibers enter the skull through the
gland, three branches are giving off:
petrotympanic fissure, moving from the anterior
canaliculus to the posterior canaliculus. (ii) Posterior auricular nerve
 Finally, they cross through the internal acoustic
meatus and move to the nucleus of tractus Innervates the intrinsic and extrinsic muscles of the outer
solitarius. ear, and the occipital part of the occipital frontalis muscle.

(2) GVE fibers: (iii) Nerve to the posterior belly of the digastric
o Parasympathetic GVE fibers run through the facial muscle
canal within the middle ear. Responsible for raising the hyoid bone.
o Then, they emerge from the skull moving from the
posterior canaliculus to the anterior canaliculus, and (iv) Nerve to stylohyoid muscle
then through the petrotympanic fissure.
Raises the hyoid bone.
o These combine with the lingual nerve in the
infratemporal fossa and form the submandibular
Within the parotid gland, VII CN gives off five motor
ganglion.
branches that innervates muscles of facial expression:
 Branches from this ganglion innervate the
submandibular and sublingual salivary glands. (v) Temporal
Innervates the occipital frontalis, orbicularis oculi and
corrugator supercilii.

(vi) Zygomatic
Innervates the zygomaticus major, zygomaticus minor,
orbicularis oculi, and levator labii superioris.

(vii) Buccal
Innervates the buccinator, risorius and orbicularis oris.

Figure 1-3. Tongue and salivary glands innervation by the (viii) Marginal mandibular
chorda tympani. Innervates the depressor labii inferioris, depressor anguli
oris and mentalis.

(ix) Cervical
Summary of the chorda tympani course:
Innervates the platysma.
V3, one of the main divisions of CN V runs through the
foramen ovale and gives off the lingual nerve branch.
a. This supplies touch, pain and temperature fibers to
the anterior 2/3 of tongue.
SVA fibers from CN VII pick up taste from anterior 2/3 of
tongue and run alongside the lingual nerve.
Parasympathetic GVE fibers coming from the superior
salivatory nucleus join the SVA fibers and the lingual
nerve branch.
a. They travel together until GVE fibers reach the
submandibular ganglion, where they separate from
SVA fibers and lingual nerve to supply innervation to
the mandibular and sublingual salivary glands.

Figure 1-5. Muscles of facial expression innervated by the VII

CN.

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 (E) GREATER PETROSAL NERVE III) CLINICAL CORRELATION

It arises immediately distal to the geniculate ganglion (A) BELL’S PALSY

within the facial canal, and moves in anteromedial
(1) Causes
direction to the middle cranial fossa through the hiatus
of the greater petrosal nerve. Herpes Simplex 1 virus.
It moves in the middle cranial fossa and comes out o If it gets reactivated in the latent stage
through the foramen lacerum (next to the internal
carotid artery).
Here it combines with the deep petrosal nerve (which
is a branch of the sympathetic plexus that moves
around the internal carotid artery).
(2) Manifestations
If SVA fibers are affected:
From here, it moves through the pterygoid canal
(vidian canal), enters the pterygopalatine fossa and If GSA fibers are affected:
synapses with the pterygopalatine ganglion.
Postganglionic fibers will run up through the inferior
orbital fissure alongside the zygomatic and infraorbital
nerve (branches of V2 from the CN V)
Inside the orbital cavity two branches will be given off:
If GVA fibers are affected:

If SVE fibers are affected:

 Closing eyes or smiling.

If GVE fibers are affected:

 Halitosis, dental caries, cavities or gingivitis.

(B) OTHER CONDITIONS THAT CAN AFFECT CN VII

(1) Lyme’s disease
Caused by the bacterium Borrelia burgdorferi.
Facial paralysis, bull’s-eye pattern rash, dysarthria,
fatigue, joint pain and fever.
Figure 1-6. The Greater Petrosal Nerve: Course and structures
supplied.
(2) Sarcoidosis:
Inflammatory reaction with production of granulomas within
different tissues in the body, included the nervous system.

(3) Herpes Zoster:

Can produce facial paralysis with vesicular rashes in the
ear.

(4) Otitis media

Infections in middle ear.

(5) Guillain-Barré Syndrome

Demyelinating condition on the peripheral axons that can
affect CN VII.

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 IV) APPENDIX

Figure 1-7. Summary of VII CN: Origin, course, structures supplied and clinical correlation.

V) REVIEW QUESTIONS
4) Which of the following nerves is responsible of
1) Which of the following fibers are responsible of supplying taste to the anterior 2/3 of tongue?
supplying innervation to the 2nd pharyngeal arch a) Lingual nerve
derivates? b) The chorda tympani
a) GVE fibers c) Buccal nerve
b) GSA fibers d) Marginal mandibular nerve
c) SVE fibers 5) One of Bell’s palsy symptoms can be change in the
d) SVA fibers amount of production of saliva. Which of the
following fibers would be the ones affected?
2) Name of the nucleus that receives both SVA fibers a) Sympathetic GVE fibers
and GVA fibers: b) Parasympathetic GVE fibers
a) Facial nerve nucleus c) Motor SVE fibers
b) Superior salivatory nucleus d) Motor GSE fibers
c) Spinal nucleus of the trigeminal nerve
d) Nucleus of tractus solitarius VI) REFRENCES
● Snell, R. S. (2010). Clinical neuroanatomy (7th ed.).
Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
3) Select the correct statement: ● The Facial Nerve (CN VII) - Course - Functions. (2021, 20
a) The geniculate ganglion picks up information from agosto). TeachMeAnatomy.
SVA fibers, GSA fibers and GVA fibers https://teachmeanatomy.info/head/cranial-nerves/facial-nerve/
b) The geniculate ganglion picks up information from
SVA fibers, GVE fibers and GVA fibers
c) The geniculate ganglion picks up information from
SVA fibers, GSA fibers and SVE fibers
d) The geniculate ganglion picks up information from
SSA fibers, GSA fibers and GVA fibers

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