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The Facial Nerve - Anatomy and Clinical Implications

Conference Paper · February 2015

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Raluca Pascalau
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THE FACIAL AND
INTERMEDIUS
NERVES
Anatomy and Clinical
Implications

Raluca Pașcalău
Iuliu Hațieganu University of Medicine
and Pharmacy Cluj-Napoca
 2

Agenda
1. Overview
2. Deep origin
3. Intra-nevraxial course
4. Apparent origin
5. Extra-nevraxial course
6. Branches
7. Supplied structures
8. Lesions
 3

Overview

Before the geniculate ganglion

-2 separate nerves:
 Facial nerve= motor + parasympathetic
 Wrisberg’s intermediary nerve= somatic
seosory + special sensory +parasympathetic
 4

Deep origin

Middle pons
 Motor nucleus
 Superior salivary nucleus (intermedius)
 Pontine solitary tract –Nageotte
(termination-intermedius)
 Spinal trigeminal nucleus (termination-
Ramsay-Hunt zone sensory fibres)
 5

Intra-nevraxial
course
 Facial colliculus

(1)

(2)
 6

Apparent origin
 Supraolivary fossa

2-3 mm

(2)
 7

Extra-nevraxial course
 Cisternal segment
–cerebellopontine angle
 Intratemporal segment
–Fallopio canal
 Extracranial segment
–parotid gland

(1)
 8
Cisternal segment

(2)
 9
Neurovascular conflict
Hemifacial spasm

Geniculate neuralgia

(2)
 10
Meatal segment
Sup

Ant

(2)

(3)
 11
Labyrinthine segment
Sup Med

Ant
Ant
(2)

Ant

Med (4)
 12
Tympanic segment

(2)

(4)
 13
Mastoid segment

(2)

Ant Ant

Sup Sup

(4)
 14
Mandibulo-vertebro-pharyngeal
space
Sup
Ant
Ant

(4)

Digastric muscle Stylohyoid muscle

Med Mb.
(posterior belly)
PRESTYLIAN
SPACE
T.
V3
M.A.
FACIAL TRIANGLE
Ph,
St. D. d.P. G. s.P. G.
IX R. B.
E.C.A.
Pv. Mm. I.C.A. VII
I.J.V.
XI X
Scm. M.

C. V. Sy. C. XII

RETROSTYLIAN SPACE
 15

Branches
Intrapetrous:
 Superficial greater petrosal nerve
 Nerve to stapedius muscle
 Chorda tympani nerve
 Communicating branch to vagus
Extrapetrous:
 Haller loop
 Sensory branch for Ramsay-Hunt
zone
 Posterior auricular branch
 Suprahyoid motor branches
(stylohyoid muscle, posterior belly
of digastric muscle)
Terminal:
 Temporofacial trunk
 Cervicofacial trunk
 16
Superficial greater petrosal nerve

Sup

Lat
Ant

Lat

(2)
 17
Chorda tympani nerve
Sup

Ant

(4)
(2)

Sup

Ant

(5)
 18

Supplied structures
 Motor:  Special sensory:
 Muscles of expression  Taste anterior 2/3 of the
 Stapedius muscle tongue, hard and soft
 Stylohyoid muscle palate
 Posterior belly of  Parasympathetic:
digastric muscle  Lacrimal gland
 Platisma  Oral and nasal mucosa
 Sensory:  Submandibular and
 Ramsay-Hunt zone sublingual salivary
glands
Lesions
19

 Supranuclear
 Nuclear/Infranuclear

 House-Brackmann
scale

(8) (7)
 20

Hyperacusis ?

(2)

(7)
 21

“The labor of many months

discloses to the anatomist a
part of these nervous cords;
[…] proof of the excellence
of design, but a design made
manifest by the results, rather
than comprehensible in its
means.” (6)
Sir Charles Bell
 22

References
1) Szabo Bianca, B. M. H. The Bones and the Muscles of the Head
and Neck. The Cranial Nerves. Editura Medicală Universitară “Iuliu
Hatieganu” Cluj Napoca, 2011
2) Rhoton A., The Posterior Cranial Fossa: Microsurgical Anatomy
and Surgical Approaches, Neurosurgery, Vol. 47, No. 3,
September 2000 Supplement
3) Koos W. T., Spetzler R. F. Color atlas of microneurosurgery:
microanatomy, approaches, techniques, Thieme, 1985
4) Wanibuchi M., Fukushima ‎T., Photo Atlas of Skull Base Dissection:
Techniques and Operative Approaches, Thieme, 2011
5) Abrahams P. H., Spratt J. D., Loukas M., McMinn and Abrahams'
Clinical Atlas of Human Anatomy, Elsevier, 2013
6) Sir Charles Bell – THE ANATOMY AND PHILOSOPHY OF
EXPRESSION, London, 1865
7) Lindsay K. W., Bone I., Neurology and neurosurgery illustrated,
Churchill Livingstone, 1997
8) Binder D. K., ‎Sonne D. C., Cranial Nerves: Anatomy, Pathology,
Imaging: Anatomy, Pathology, Imaging, Thieme, 2011
9) Osborn A. G.,Osborn’s Brain: Imaging, Pathology, and Anatomy.
10) Albu, I. : Inima si nervi cranieni, Editura UMF Cluj Napoca, 1994

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