The facial nerve, CN VII, is the seventh paired cranial nerve.

In this article, we shall

look at the anatomical course of the nerve, and the motor, sensory and
parasympathetic functions of its terminal branches.

The facial nerve is associated with the derivatives of the second pharyngeal arch.

Motor: Innervates the muscles of facial expression, the posterior belly of the
digastric, the stylohyoid and the stapedius muscles.

Sensory: None.

Special Sensory: Provides special taste sensation to the anterior 2/3 of the tongue.

Parasympathetic: Supplies many of the glands of the head and neck, including the
submandibular, sublingual, nasal, palatine, lacrimal and pharyngeal gland.

Anatomical Course
The course of the facial nerve is very complex. There are many branches, which
transmit a combination of sensory, motor and parasympathetic fibres.

Anatomically, the course of the facial nerve can be divided into two parts:

Intracranial the course of the nerve through the cranial cavity, and the cranium
itself.
Extracranial the course of the nerve outside the cranium, through the face and
neck.
Intracranial

The nerve arises in the pons, an area of the brainstem. It begins as two roots; a
large motor root, and a small sensory root (the part of the facial nerve that arises
from the sensory root is sometimes known as the intermediate nerve).

The two roots travel through the internal acoustic meatus, a 1cm long opening in
the petrous part of the temporal bone. Here, they are in very close proximity to the
inner ear.

Still within the temporal bone, the roots leave the internal acoustic meatus, and
enter into the facial canal. The canal is a Z shaped structure. Within the facial
canal, three important events occur:

Firstly the two roots fuse to form the facial nerve.

Next, the nerve forms the geniculate ganglion (a ganglion is a collection of nerve
cell bodies)
Lastly, the nerve gives rise to the greater petrosal nerve (parasympathetic fibres to
glands), the nerve to stapedius (motor fibres to stapedius muscle), and the chorda
tympani (special sensory fibres to the anterior 2/3 tongue).
The facial nerve then exits the facial canal (and the cranium) via the stylomastoid
foramen. This is an exit located just posterior to the styloid process of the temporal
bone.

Extracranial

After exiting the skull, the facial nerve turns superiorly to run just anterior to the
outer ear.

Fig 1.1 - Schematic of the course and branches of the facial nerve. Fig 1.1
Schematic of the course and branches of the facial nerve.
The first extracranial branch to arise is the posterior auricular nerve. It provides
motor innervation to the some of the muscles around the ear. Immediately distal to
this, motor branches are sent to the posterior belly of the digastric muscle and to
the stylohyoid muscle.

The main trunk of the nerve, now termed the motor root of the facial nerve,
continues anteriorly and inferiorly into the parotid gland (Note that the facial nerve
does not contribute towards the innervation of the parotid gland).

Within the parotid gland, the nerve terminates by splitting into five branches:

Temporal branch
Zygomatic branch
Buccal branch
Marginal mandibular branch
Cervical branch
These branches are responsible for innervating the muscles of facial expression.

Motor Functions
Branches of the facial nerve are responsible for innervating many of the muscles of
the head and neck. All these muscles are derivatives of the second pharyngeal arch.

The first motor branch arises within the facial canal; the nerve to stapedius. The
nerve passes through the pyramidal eminence to supply the stapedius muscle in the
middle ear.

Between the stylomastoid foramen, and the parotid gland, three more motor
branches are given off:

Posterior auricular nerve Ascends in front of the mastoid process, and innervates
the intrinsic and extrinsic muscles of the outer ear. It also supplies the occipital part
of the occipitofrontalis muscle.
Nerve to the posterior belly of the digastric muscle Innervates a suprahyoid
muscle of the neck. It is responsible for raising the hyoid bone.

Nerve to the stylohyoid muscle Innervates a suprahyoid muscle of the neck. It is

responsible for raising the hyoid bone.
Within the parotid gland, the facial nerve terminates by bifurcating into five motor
branches. These innervate the muscles of facial expression:

Temporal branch Innervates the frontalis, orbicularis oculi and corrugator

supercilii
Zygomatic branch Innervates the orbicularis oculi.
Buccal branch Innervates the orbicularis oris, buccinator and zygomaticus
muscles.
Marginal Mandibular branch Innervates the mentalis muscle.
Cervical branch Innervates the platysma.
Fig 1.? - The terminal motor branches of the facial nerve. Fig 1.2 The terminal
motor branches of the facial nerve.
Special Sensory Functions
The chorda tympani branch of the facial nerve is responsible for the taste
innervation of the anterior 2/3 of the tongue.

The nerve arises in the facial canal, and travels across the bones of the middle ear,
exiting via the petrotympanic fissure, and entering the infratemporal fossa. Here,
the chorda tympani hitchhikes with the lingual nerve. The parasympathetic fibres
of the chorda tympani stay with the lingual nerve, but the main body of the nerve
leaves to innervate the anterior 2/3 of the tongue.

Parasympathetic Functions
The parasympathetic fibres of the facial nerve are carried by the greater petrosal
and chorda tympani branches.

The greater petrosal nerve arises just distal to the geniculate ganglion, within the
facial canal. Making an antero-medial turn from the geniculate ganglion, the nerve
exits the temporal bone into the middle cranial fossa.

From here it travels through the foramen lacerum to the pterygopalatine fossa.
Within this fossa, the greater petrosal nerve forms the pterygopalatine ganglion.
Branches from this ganglion then go on to provide parasympathetic innervation to
the mucous glands of the oral cavity, nose and pharynx, and the lacrimal gland.

The chorda tympani also carries some parasympathetic fibres. These combine with
the lingual nerve (a branch of the trigeminal nerve) in the infratemporal fossa. The
two nerves form the submandibular ganglion. Branches from this ganglion travel to
the submandibular and sublingual salivary glands.

Clinical Relevance: Damage to the Facial Nerve

The facial nerve has a wide range of functions. Thus, damage to the nerve can
produce a varied set of symptoms, depending on the site of the lesion.

Intracranial Lesions

Intracranial lesions occur during the intracranial course of the facial nerve (proximal
to the stylomastoid foramen).

By James Heilman, MD [CC-BY-SA-3.0] via Wikimedia CommonsFig 1.4 - Right sided

weakness of the muscles of facial expression, due to facial nerve paralysis. Fig 1.3
Right sided weakness of the muscles of facial expression, due to facial nerve
paralysis.
The muscles of facial expression will be paralysed or severely weakened. The other
symptoms produced depend on the location of the lesion, and the branches that are
affected:

Chorda tympani reduced salivation and loss of taste on the ipsilateral 2/3 of the
tongue.
Nerve to stapedius ipsilateral hyperacusis (hypersensitive to sound).
Greater petrosal nerve ipsilateral reduced lacrimal fluid production.

The most common cause of an intracranial lesion of the facial nerve is middle ear
pathology such as a tumour or infection. If no definitive cause can be found, the
disease is termed Bells palsy.

Extracranial Lesions

Extracranial lesions occur during the extracranial course of the facial nerve (distal to
the stylomastoid foramen). Only the motor function of the facial nerve is affected,
resulting in paralysis or severe weakness of the muscles of facial expression.

There are various causes of extracranial lesions of the facial nerve:

Parotid gland pathology e.g a tumour, parotitis, surgery.

Infection of the nerve particularly by the herpes virus.
Compression during forceps delivery the neonatal mastoid process is not fully
developed, and does not provide complete protection of the nerve.
Idiopathic If no definitive cause can be found, the disease is termed Bells palsy.