Facial Nerve Anatomy

http://emedicine.medscape.com/article/835286-overview

Facial Nerve Anatomy
Author: Alpen A Patel, MD; Chief Editor: Arlen D Meyers, MD, MBA more... Updated: Aug 15, 2011

Overview
The facial nerve, or cranial nerve (CN) VII, is the nerve of facial expression. The pathways of the facial nerve are variable, and knowledge of the key intratemporal and extratemporal landmarks is essential for accurate physical diagnosis and safe and effective surgical intervention in the head and neck. (See the image below.)

The surgical anatomy and landmarks of the facial nerve.

The facial nerve is composed of approximately 10,000 neurons, 7,000 of which are myelinated and innervate the nerves of facial expression. Three thousand of the nerve fibers are somatosensory and secretomotor and make up the nervus intermedius. The course of the facial nerve and its central connections can be roughly divided into 6 segments, as shown in Table 1, below. Table 1. Segmental Description of the Facial Nerve and Central Connections (Open Table in a new window) Length, Segment Location mm NA 13-15 3-4 8-11 10-14 15-20

Supranuclear Brainstem Meatal segment Labyrinthine segment Tympanic segment Mastoid segment

Cerebral cortex Brainstem to internal auditory canal (IAC) Fundus of IAC to facial hiatus Geniculate ganglion to pyramidal eminence Pyramidal process to stylomastoid foramen

Motor nucleus of facial nerve, superior salivatory nucleus of tractus solitarius NA

Extratemporal segment Stylomastoid foramen to pes anserinus

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com/article/835286-overview The objective of this article is to briefly review the anatomy of the facial nerve in each of these segments and to follow the nerve from its most proximal origin to its end organ. midface. Jenny and Saper performed an extensive study of the proximal facial nerve organizations in a primate model and found evidence that in monkeys. To innervate these muscles. Embryology of the Facial Nerve By the third week of gestation. bilaterally. the facial nerve courses across the region that eventually becomes the middle ear. the muscles of facial expression. upper facial movement is relatively preserved in upper motor neuron injury. the tracts to the lower face cross only once. In 1987. smiling when taking a photograph) arise from efferent discharge from the motor face area of the cerebral cortex. [1. nervus intermedius. have provided 2 of the most complete descriptions of the facial nerve's central connections. except for its location in the mastoid.medscape. because their motor neurons depend on significant cortical innervation. The authors believe 2 of 12 Wednesday. The pontine facial nerve nucleus is divided into an upper and a lower half. 2] Cortex and internal capsule The voluntary responses of the facial muscles (eg. and greater superficial petrosal nerve are visible by the fifth week. Discharges from the facial motor area are carried through fascicles of the corticobulbar tract to the internal capsule. In the newborn. the lower facial muscles are more severely affected. where they synapse in the pontine facial nerve nucleus. 12 October. the facial nerve has arborized extensively. This homunculus illustrates the location on the motor strip of facial areas relative to the hand and upper extremities. then through the upper midbrain to the lower brainstem. The former courses ventrally into the first branchial arch and terminates near a branch of the trigeminal nerve that eventually becomes the lingual nerve. During the fourth week. ie. The lower half of the figure depicts the anatomy of the pyramidal system. By the eleventh week. because these motor neurons receive relatively little direct cortical input. The reader is referred to these references for a more detailed description of the supranuclear and nuclear organization of the facial nerve. the facial nerve anatomy approximates that of an adult. and lips sequentially located more inferiorly (see the image below and Table 2). 2011 01:40 PM . nose. The second branchial arch gives rise to the muscles of facial expression in the seventh and eighth week. The facial motor nerves are represented on the homunculus with the forehead uppermost and the eyelids. along with Nelson. In contrast. Central Connections Crosby and DeJonge. The main trunk courses into the mesenchyme. the fascioacoustic primordium gives rise to CN VII and VIII. The geniculate ganglion. which is more superficial. the chorda tympani can be discerned from the main branch.Facial Nerve Anatomy http://emedicine. The motor face area is situated on the precentral and postcentral gyri. approaching the epibranchial placode. The corticobulbar tracts from the upper face cross and recross en route to the pons.

The upper facial motor nuclear regions received scant direct cortical innervation on either side of the brain.Facial Nerve Anatomy [3] http://emedicine. or with an injury to the nerve in its distribution in the face. with selective lesions in the temporal bone. An accurate neurologic diagnosis is best made by examining deficits in conjunction with "the company they keep. 2011 01:40 PM . These findings may explain why a focal lesion in the facial area on one side of the motor cortex in humans spares eyelid closure and forehead movement but results in paralysis of the lower face.medscape." A cortical lesion that produces a lower facial deficit is usually 3 of 12 Wednesday. In their study. occipital belly Anterior auricular Superior auricular Occipitofrontalis. 12 October. Jenny and Saper found that the descending corticofacial fibers in monkeys innervated the lower facial motor nuclear region bilaterally but with contralateral predominance. Table 2.com/article/835286-overview these observations also explain similar findings in humans. Patients may have sparing of forehead function with lesions in the pontine facial nerve nucleus. occipital belly Corrugator supercilii Procerus Temporal and zygomatic Zygomatic and buccal Buccal Orbicularis oculi Zygomaticus major Zygomaticus minor Levator labii superioris Levator labii superioris alaeque nasi Risorius Buccinator Levator anguli oris Orbicularis Nasalis. dilator naris Nasalis. The deficits observed with unilateral ablation of the corticobulbar fibers reflect the fact that upper facial motor neurons do not receive significant cortical innervations and that lower facial motor neurons contralateral to the lesion have functional loss because of their dependence on direct contralateral cortical innervation and because the remaining ipsilateral cortical projections are not sufficient to drive them. Summary of Innervation and Actions of Facial Mimetic Muscles (Open Table in a new window) Branch of CN VII Posterior auricular Temporal Location of Lesion Posterior auricular Occipitofrontalis. compressor naris Buccal and marginal mandibular Marginal mandibular Cervical Depressor anguli oris Depressor labii inferioris Mentalis Platysma Pulls ear backward Moves scalp backward Pulls ear forward Raises ear Moves scalp forward Pulls eyebrow medially and downward Pulls medial eyebrow downward Closes eyelids and contracts skin around eye Elevates corners of mouth Elevates upper lip Elevates upper lip and midportion nasolabial fold Elevates medial nasolabial fold and nasal ala Aids smile with lateral pull Pulls corner of mouth backward and compresses cheek Pulls angles of mouth upward and toward midline Closes and compresses lips Flares nostrils Compresses nostrils Pulls corner of mouth downward Pulls lower lip downward Pulls skin of chin upward Pulls down corners of mouth Actions Caution is advised in using preservation of forehead function to diagnose a central lesion.

This system is associated with spontaneous. Supranuclear pyramidal lesions spare movements of the face initiated as emotional responses and reflexes. Table 3. the corneal reflex.com/article/835286-overview associated with a motor deficit of the tongue and weakness of the thumb. The interplay between the pyramidal and extrapyramidal systems accounts for resting tone and stabilizes the motor responses. ipsilateral facial analgesia. a peripheral type of ipsilateral facial paralysis might be apparent. ipsilateral seventh nerve palsy. Lower midbrain A lesion in the lower midbrain above the level of the facial nucleus may cause contralateral paresis of the face and muscles of the extremities. ipsilateral abducens muscle paresis (due to effects on the abducens nerve). ipsilateral abducens (CN VI) palsy Masked facies Bilateral facial paresis with other CN defects. Input from the acoustic nuclei to the facial nerve nucleus forms part of the stapedial reflex response to loud noises. The facial dystonia seen in Meige syndrome is thought to be due to basal ganglion disease. beneath the fourth ventricle. Pons The facial motor nucleus is located in the lower third of the pons. ipsilateral Homer syndrome. and ipsilateral internal strabismus. loss of involuntary and voluntary facial movement occurs. some of which are summarized in Table 3. A lesion near the ventricle at the level of the superior salivatory nucleus may result in a dry eye in addition to a peripheral facial paralysis and abducens paresis. Nerve fibers influencing emotional facial expression are thought to arise in the thalamus and globus pallidus. Input from the trigeminal nerve and nucleus form the basis of the trigeminofacial reflexes. Syndromes Associated with Central Lesions (Open Table in a new window) Syndrome Foville syndrome Millard-Gubler syndrome Moebius syndrome Parkinson disease Pseudobulbar palsy Fundus of IAC to facial hiatus Extrapyramidal pathways Pontine Location of Lesion Lateral pons Characteristic Feature Ipsilateral facial paresis. eg. The masked facies associated with Parkinsonism are known to be the result of destruction of the extrapyramidal pathways. With nuclear and infranuclear lesions. Extrapyramidal system The extrapyramidal system consists of the basal ganglia and the descending motor projections other than the fibers of the pyramidal or corticospinal tracts. hyperreflexia associated with hypertension. fingers. emotional lability 4 of 12 Wednesday.Facial Nerve Anatomy http://emedicine. The neurons leaving the nucleus pass around the abducens nucleus as they emerge from the brainstem. The facial nerve nuclei also receive afferent input from other brainstem nuclei. or hand on the ipsilateral side (see the image above).medscape. If the lesion extends far enough laterally to include the emerging facial nerve fibers. contralateral hemiparesis [4] Meige syndrome Basal ganglion Pontine nucleus Ipsilateral facial paresis. mimetic facial motions. ipsilateral deafness Facial dystonia Unilateral sixth nerve palsy. Many syndromes are known to result from pontine lesions. 2011 01:40 PM . emotional. Involvement of the facial nerve nucleus and VI nerve nucleus are suggestive of a lesion near the fourth ventricle. 12 October. hyperactive gag reflex.

Note the interconnections of cranial nerve (CN) VII with CN V. Note the relationship between the nervus intermedius (ie. unilateral hearing loss. and submandibular glands originate in the superior salivatory nucleus. Large acoustic schwannomas may progress to involve the facial nerve and even CN V. Also note the superior location of the facial nerve relative to the vestibulocochlear nerve.medscape. 12 October. Common examples are the symptoms of tinnitus. The nervus intermedius gained its name from its position as it courses across the cerebellopontine angle (CPA) between the facial nerve and the vestibulocochlear nerves (ie. sublingual.8 mm. which come from the anterior two thirds of the tongue. ie. The facial nerve and the nervus intermedius lie above and slightly anterior to CN VIII. and balance disturbances often associated with acoustic schwannomas. the nervus intermedius (see the image below).com/article/835286-overview Weber syndrome Upper midbrain Ipsilateral loss of direct and consensual pupillary light reflexes. ipsilateral external strabismus. CN IX. where they branch off as the Vidian nerve. Fibers to the lacrimal gland are carried with the greater superficial petrosal nerve until it exits the skull. oculomotor paresis Cerebellopontine Angle and the Internal Auditory Canal The facial nerve emerges from the brainstem with the nerve of Wrisberg. and (3) preganglionic parasympathetic innervation to the submandibular. CN VII. 2011 01:40 PM . This drawing shows the contents of the right internal auditory canal. and lacrimal glands. The average distance between the point where the nerves exit the brainstem and the place where they enter into the internal auditory canal (IAC) is approximately 15. and the vestibulocochlear nerve at the level of the CPA and in the IAC may result in disturbances in tearing. as shown in the image below. palatal mucus. nerve of Wrisberg) and the facial nerve. and CN XI.Facial Nerve Anatomy http://emedicine. balance. and the fibers to the lacrimal. nasal. The nervus intermedius also has a small cutaneous sensory component from afferent fibers originating from the skin of the auricle and postauricular area. The nervus intermedius conveys (1) afferent taste fibers from the chorda tympani nerve. The close anatomic association between the facial nerve. the nervus intermedius. 5 of 12 Wednesday. salivary gland flow. (2) taste fibers from the soft palate via the palatine and greater petrosal nerves. CN VIII). and facial function as a result of lesions at this level. Schematic illustration shows the facial nerve and its peripheral connections. CN X. hearing. The fibers for taste originate in the nucleus of the tractus solitarius (NTS). taste. CN IX. and CN X.

separated from the superior vestibular nerve by a vertical bony ridge named the Bill bar (after the esteemed Dr William House). Spatial anatomic relationship between the nerves traveling through the internal auditory canal is shown. perpendicular to the axis of the temporal bone. This is the only segment of the facial nerve that lacks anastomosing arterial cascades. 2011 01:40 PM . in a bony canal called the fallopian canal (after Gabriel Fallopius). the facial nerve changes direction to form the first genu (ie. A useful mnemonic for remembering this relationship is "Seven-up over Coke. as shown in the image below. No other nerve in the body travels such a long distance through a bony canal. The term labyrinthine segment is derived from the location of this segment of the nerve immediately posterior to the cochlea." At the fundus of the IAC. The labyrinthine segment is the narrowest part of the facial nerve and is susceptible to compression by means of edema. inflammatory processes involving the central nervous system (CNS). as shown above. Additional afferent fibers from the anterior two thirds of the 6 of 12 Wednesday. Intratemporal Course of the Facial Nerve The facial nerve travels through the petrous temporal bone. the nerve is directed obliquely forward. Note the changing spatial relationship between the facial nerve (cranial nerve [CN] VII) and the vestibulocochlear nerve (CN VIII). making the area vulnerable to embolic phenomena. In this segment. marking the location of the geniculate ganglion. the falciform crest (crista falciformis) divides the IAC into superior and inferior compartments. Note the vascular arcades feeding the facial nerve throughout its course in the bony fallopian canal. facial nerve. Both the facial nerve and the nervus intermedius remain distinct entities at this level. After traversing the labyrinthine segment. The facial nerve runs superiorly (cephalad) along the roof of the IAC. and vascular compression. Labyrinthine (proximal) segment The labyrinthine segment of the facial nerve lies beneath the middle cranial fossa and is the shortest segment in the fallopian canal (approximately 3. The vestibulocochlear nerve enters the IAC inferiorly (caudad). The nerve is posterolateral to the ampullated ends of the horizontal and superior semicircular canals and rests on the anterior part of the vestibule in this segment. low-flow states. 12 October. and the nervus intermedius.com/article/835286-overview The facial nerve and the nervus intermedius enter the IAC with the vestibulocochlear nerve. The facial nerve passes along the superior part of the ledge. shown in the image below. CN VIII.Facial Nerve Anatomy http://emedicine. The geniculate ganglion is formed by the juncture of the nervus intermedius and the facial nerve into a common trunk. The gross and microscopic anatomic relationships among the locations of CN VII.5-4 mm in length). bend or knee). are of surgical importance. and traumatic injuries to the temporal bone can produce unique complications.medscape. The transtemporal course of the facial nerve is shown. Because of this bony shell around the nerve.

which are carried via branches of the maxillary (V2) divisions of the trigeminal nerve (CN V).Facial Nerve Anatomy http://emedicine. trigeminal ganglion) to the foramen lacerum. This is a relatively constant relationship. especially in patients with congenital ear deformities.com/article/835286-overview tongue are added to the geniculate ganglion from the chorda tympani. through which it travels to the pterygoid canal. surgeons most likely employ cues from all these landmarks in respecting the integrity of the facial nerve. The fallopian canal has been reported to be dehiscent in the area of the oval window in 25-55% of postmortem specimens. [5] Tympanic (horizontal) segment The tympanic segment extends from the geniculate ganglion to the horizontal semicircular canal and is 8-11 mm in length. The digastric ridge points to the lateral and inferior aspect of the vertical course of the facial nerve in the temporal bone. The external petrosal nerve is an inconstant branch that carries sympathetic fibers to the middle meningeal artery. The chorda tympani nerve serves at the lateral margin of the triangular facial recess. along with cautious exploration. This nerve carries parasympathetic contributions from the tympanic plexus (from CN IX) and the nervus intermedius. 7 of 12 Wednesday. and the middle ear mucosa may lay in direct contact with the facial nerve sheath. The cochleariform process is a useful landmark for finding the facial nerve. the use of other landmarks. and the digastric ridge. and the external petrosal nerve. tumor). however. In the pterygoid canal. 12 October. The chorda tympani nerve and the fossa incudis can be used to identify the nerve when performing a facial recess approach. The greater petrosal nerve emerges from the upper portion of the ganglion and carries secretomotor fibers to the lacrimal gland. chorda tympani. Three nerves branch from the geniculate ganglion: the greater superficial petrosal nerve. The wall can be very thin or dehiscent in this area. The chorda tympani nerve can be exposed along its length and can be followed inferiorly and medially to its takeoff from the main trunk of the facial nerve. The recess is identified using the incus. and horizontal semicircular canal as landmarks. Axons from this nerve synapse in the pterygopalatine ganglion. The lesser petrosal nerve carries secretory fibers to the parotid gland. The nerve passes deep to the Gasserian ganglion (ie. In practice. above and posterior to the oval window. the digastric ridge may be difficult to identify.medscape. The most important landmarks for identifying the facial nerve in the mastoid are the horizontal semicircular canal. the lesser petrosal nerve. shown in the image below. The distal portion of the facial nerve emerges from the middle ear between the posterior wall of the external auditory canal and the horizontal semicircular canal. The long process of the incus points toward the facial recess. This is just distal to the pyramidal eminence. The greater petrosal nerve exits the petrous temporal bone via the greater petrosal foramen to enter the middle cranial fossa. Always anticipate finding a dehiscent or prolapsed facial nerve in its tympanic segment. 2011 01:40 PM . is advised. where the facial nerve makes a second turn marking the second genu. it is not as well known. The distal aspect of the tympanic segment can be surgically located via a facial recess approach. The facial recess has been opened by thinning of the posterior canal wall. innervate the lacrimal gland and mucus glands of the nasal and oral cavities. The nerve passes behind the cochleariform process and the tensor tympani. In poorly pneumatized temporal bones. The nerve lies against the medial wall of the cavum tympani. cholesteatoma. the greater petrosal nerve joins the deep petrosal nerve to become the nerve of the pterygoid canal. postganglionic parasympathetic fibers. The second genu of the facial nerve runs inferolateral to the lateral semicircular canal. Exposure of the facial nerve after a cortical mastoidectomy. the fossa incudis. In cases in which the lateral canal is difficult to identify (eg.

 2011 01:40 PM . The chorda runs laterally in the middle ear. shown in the image below. The main trunk of the nerve can also be found midway between (10 mm posteroinferior to) the cartilaginous tragal pointer of the external auditory canal and the posterior belly of the digastric muscle. 8 of 12 Wednesday. The nerve travels between the digastric and stylohyoid muscles and enters the parotid gland. The nerve is usually located inferior and medial to the pointer.com/article/835286-overview Mastoid segment The second genu marks the beginning of the mastoid segment. The topographic trajectory of the frontal and/or marginal branches should be identified during a rhytidoplasty. anterior and superiorly to a point 1. Extratemporal Facial Nerve A number of useful landmarks are used to locate the facial nerve. and/or neck dissection. The chorda also carries special sensory afferent fibers (ie. Removal of parotid tissue inferior to this line can be performed relatively safely. During middle ear surgery. (2) the chorda tympani nerve. 7] Surgical landmarks to the facial nerve include the tympanomastoid suture line. taste fibers) from the anterior two thirds of the tongue and fibers from the posterior wall of the external auditory canal responsible for pain. approximately 10-14 mm long. The 3 branches that exit from the mastoid segment of the facial nerve are (1) the nerve to the stapedius muscle. and (3) the nerve from the auricular branch of the vagus. The nerve continues vertically down the anterior wall of the mastoid process to the stylomastoid foramen. Pain fibers to the posterior auditory canal may be carried with this nerve. The nerve crosses the middle ear cavity and exits through the petrotympanic fissure (ie. and the posterior belly of the digastric muscle. [6. can serve as guides for locating the course of the facial nerve and its branches. submandibular gland excision. a line drawn between the mastoid tip and the angle of the mandible can serve as a useful landmark for the superior limits of a neck dissection. The chorda tympani is the terminal branch of the nervus intermedius. canal of Huguier) to join the lingual nerve. between the incus and the handle of the malleus. A sensory branch exits the nerve just below the stylomastoid foramen and innervates the posterior wall of the external auditory canal and a portion of the tympanic membrane. Topographic landmarks. The mastoid segment is the longest part of the intratemporal course of the facial nerve.5 cm above the lateral aspect of the ipsilateral eyebrow. The surgical anatomy and landmarks of the facial nerve. temperature. the facial nerve is most commonly injured at the pyramidal turn. The chorda tympani nerve carries preganglionic secretomotor fibers to the submaxillary and sublingual glands. The facial nerve exits the fallopian canal via the stylomastoid foramen. The second genu is lateral and posterior to the pyramidal process. The frontal branch can be roughly located along a line extending from the attachment of the lobule (approximately 5 mm below the tragus).Facial Nerve Anatomy http://emedicine. The tympanomastoid suture line lies between the mastoid and tympanic segments of the temporal bone and is approximately 6-8 mm lateral to the stylomastoid foramen. For example. the tragal pointer. The auricular branch of the vagus nerve arises from the jugular foramen and joins the facial nerve just distal to the point at which the nerve to the stapedius muscle arises.medscape. and touch sensations. 12 October.

but the two are most likely embryologic equivalents. 5 major branches of the facial nerve exist. In the upper face. A conceptual understanding of the anatomy of the SMAS is important to the surgeon. the SMAS invests the facial muscles and is continuous with the platysma muscle. Two small branches innervate the stylohyoid muscle and posterior belly of the digastric muscle. these landmarks are not applicable because of differences in the rate of anatomic development of the parotid gland and mastoid. Superficial musculoaponeurotic system The superficial musculoaponeurotic system (SMAS) is a superficial fascial layer that extends throughout the cervical facial region. the superiorly directed temporal-facial and the inferiorly directed cervicofacial branches. In the parotid gland. and mentalis muscles). The nerve lies in a fibrous plane that separates the deep and superficial lobes of the parotid gland.medscape. the facial nerve always runs deep to the platysma and SMAS and innervates the muscles on their undersurfaces (except for the buccinator. frontal) Zygomatic Buccal Marginal mandibular Cervical The facial nerve innervates 14 of the 17 paired muscle groups of the face on their deep side. the facial nerve gives off several rami before it divides into its main branches. Frequent connections between the buccal and zygomatic branches exist. In the lower face. and some of the postauricular muscles. thus transmitting contractions of the facial muscles to the overlying skin. and further dissection should proceed cautiously. levator anguli oris. and the risk of injury is increased with elevation of the skin flaps. Once it has exited the fallopian canal at the stylomastoid foramen. In the temporal region. occipitalis. The SMAS encloses all of the facial muscles and is their only attachment to the overlying dermis. The temporal and marginal mandibular branches are at highest risk during surgical procedures and are usually terminal connections without anastomotic connections. the neurovascular structures exit their bony foramina and penetrate the SMAS to run within its superficial aspects or on its surface. 2011 01:40 PM . Superiorly. Brisk bleeding at this time may be a sign that the nerve is in close proximity. where the nerve can be found running on top of the masseter muscle just below the SMAS. procerus. In the infant and young child. The temporoparietal fascia extends from the zygomatic arch as an extension of the deep temporal fascia. In the scalp. hemostasis should be obtained using bipolar electrocautery. and mentalis muscles. 9 of 12 Wednesday. After the main point of division. which splits to ensheathe the frontalis. The modified Blair incision most commonly used in adults is often avoided in children because the facial nerve is located more superficially. Below the stylomastoid foramen. the SMAS ends at the level of the zygoma because of attachments of the fascial layers to the zygomatic arch. Many textbooks on pediatric otolaryngology provide detailed descriptions of the safe placement of surgical incisions for exposing the facial nerve and its branches in children. the equivalent of the SMAS is the galea aponeurotica. the nerve divides at the pes anserinus into 2 major divisions.com/article/835286-overview During surgical dissection. The 3 muscles innervated from other sources are the buccinator. the posterior auricular nerve leaves the facial nerve and innervates the postauricular muscles.Facial Nerve Anatomy http://emedicine. The facial nerve crosses lateral to the styloid process and penetrates the parotid gland. the surgeon may encounter a branch from the occipital artery that lies lateral to the facial nerve. The SMAS also helps the surgeon to identify the location of the facial nerve during dissection toward the midline of the face. 12 October. The styloid process is deep to the main trunk of the nerve. In the lower face. The temporoparietal fascia is not continuous with the SMAS. as follows: Temporal (ie. levator anguli oris. the frontal branch of the facial nerve crosses the zygomatic arch and courses within the superficial layer of the deep temporal fascia (temporoparietal fascia).

These are summarized in Table 4. [7] Marginal branches The mandibular (or marginal) division lies along the body of the mandible (80%) or within 1-2 cm below (20%). synkinesis. Venous drainage parallels the arterial blood supply. but not severe. Refer to Larrabee and Makielski for a more complete anatomic description. the facial nucleus receives its blood supply primarily from the anterior inferior cerebellar artery (AICA). incomplete eye closure Only barely perceptible motion. Within the pons. The marginal branch lies deep to the platysma throughout much of its course. Injury to the marginal branch results in paralysis of the muscles that depress the corner of the mouth. This is a critical landmark in head and neck surgery. It becomes more superficial approximately 2 cm lateral to the corner of the mouth and ends on the undersurface of the muscles. Intermediate grades vary according to function at rest and with effort. The AICA. The posterior auricular artery supplies the facial nerve at and distal to the stylomastoid foramen. a branch of the basilar artery. normal symmetry and tone at rest.medscape. and characterizing the degree of paralysis can be difficult. asymmetry at rest No movement Characteristics Vascular Supply of the Facial Nerve The cortical motor area of the face is supplied by the Rolandic branch of the middle cerebral artery. Contributor Information and Disclosures Author Alpen A Patel. The AICA branches into the labyrinthine and cochlear arteries. In this scale. MD. Towson Medical Center Alpen A Patel. Facial Nerve Paralysis The spectrum of facial motor dysfunction is wide. 12 October. House-Brackmann Facial Nerve Grading System (Open Table in a new window) Grade I II III IV V VI Description Normal Mild dysfunction Moderate dysfunction Moderately severe dysfunction Severe dysfunction Total paralysis Normal facial function in all areas Slight weakness noticeable on close inspection. the House-Brackmann system has been widely used. American Association of Physicians of Indian 10 of 12 Wednesday. contracture. grade I is assigned to normal function. may have very slight synkinesis Obvious. noticeable. enters the IAC with the facial nerve. and grade VI is complete paralysis. Table 4. but since the mid 1980s. complete eye closure with effort Obvious weakness or disfiguring asymmetry. MD Otolaryngologist.Facial Nerve Anatomy http://emedicine. intrapetrosal) facial nerve. difference between 2 sides.com/article/835286-overview Temporal branches The relationships of the temporal branch are complex and only briefly described in this article. is a member of the following medical societies: American Academy of Otolaryngic Allergy. To avoid injury to the frontal branch during elevation of facial flaps. The frontal branch enters the undersurface of the frontalis muscle and lies superficial to the deep temporalis fascia. the surgeon should elevate either in a subcutaneous plane or deep to the SMAS. American Academy of Otolaryngology-Head and Neck Surgery. but not disfiguring. Several systems have been proposed. The superficial petrosal branch of the middle meningeal artery is the second of 3 sources of arterial blood supply to the extramedullary (ie. 2011 01:40 PM . or hemifacial spasm. The temporal branch of the facial nerve exits the parotid gland and runs within the SMAS over the zygomatic arch into the temple region.

American Otological Society. and American Medical Association Disclosure: Nothing to disclose. Specialty Editor Board Michael E Hoffer. Los Angeles. Vice President. and Society of University Otolaryngologists-Head and Neck Surgeons Disclosure: Nothing to disclose. Spatial Orientation Center. American Neurotology Society. Coauthor(s) Neil Tanna. Department of Otolaryngology-Head and Neck Surgery. Ponchartrain Surgery Center Gerard J Gianoli. GYRUS ACMI Honoraria Consulting References 1. and Triological Society Disclosure: Vesticon. Syndicom Ownership interest Consulting. American Academy of Facial Plastic and Reconstructive Surgery. American College of Surgeons. MD. American Academy of Otolaryngology-Head and Neck Surgery. University of California. American Academy of Otolaryngology-Head and Neck Surgery. 12 October. Naval Medical Center of San Diego Michael E Hoffer. Jun 11 of 12 Wednesday. Associated Coastal ENT. MD. American Academy of Facial Plastic and Reconstructive Surgery. Axis Three Corporation Ownership interest Consulting. Chief Editor Arlen D Meyers. American College of Surgeons. Sentegra Ownership interest Board membership. US Tobacco Corporation Unrestricted gift Unknown.755. 1963. PhD Adjunct Assistant Professor. MD is a member of the following medical societies: Alpha Omega Alpha. and Medical Society of the District of Columbia Disclosure: Nothing to disclose. American College of Surgeons. None Board membership Christopher L Slack. and American Head and Neck Society Disclosure: Covidien Corp Consulting fee Consulting. American Medical Association. Department of Otolaryngology. Inc. Division of Plastic and Reconstructive Surgery. MD. Medical Director. Tulane University School of Medicine. DeJonge BR. MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery. MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery. University of Colorado School of Medicine Arlen D Meyers. 2011 01:40 PM . Medvoy Ownership interest Management position. MD Private Practice in Otolaryngology and Facial Plastic Surgery. Treasure Coast Sleep Disorders Christopher L Slack. 2. MD. Crosby ED.Facial Nerve Anatomy http://emedicine. Nelson JR. MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery Disclosure: American biloogical group Royalty Other Francisco Talavera. MBA is a member of the following medical societies: Alpha Omega Alpha. Facial paralysis of central nervous system origin. David Geffen School of Medicine Neil Tanna. MD Clinical Associate Professor.com/article/835286-overview Origin. Chief Executive Officer. MBA Professor. Omni Biosciences Ownership interest Consulting. Department of Otolaryngology-Head and Neck Surgery. Phi Beta Kappa. MBA Resident Physician. University of Nebraska Medical Center College of Pharmacy. Medscape Drug Reference Disclosure: Medscape Salary Employment Gerard J Gianoli. MD Director. Cerescan Imaging Honoraria Consulting. Experimental and clinical studies of the central connections and central relation of the facial nerve. Oxlo Consulting. American Academy of Otolaryngology-Head and Neck Surgery. Editor-in-Chief. Society of University Otolaryngologists-Head and Neck Surgeons. The Ear and Balance Institute. PharmD.72:735 . Otolaryngol Clin North Am.medscape.

7(2):411-24. Plast Reconstr Surg. Larrabee WF Jr. 12 October. The frontal branch of the facial nerve: the importance of its variations in face lifting. Saper CB.27(6):466-74. 2000. 2nd Edition. eds. 2011 01:40 PM .38(4):352-6. 6. May M. [Medline]. [Medline]. May M. Jun 1987. New York. Schaitkin B. Jenny AB. Organization of the facial nucleus and corticofacial projection in the monkey: a reconsideration of the upper motor neuron facial palsy. Neurology. Medscape Reference © 2011 WebMD. Makielski KH. 5. etiology. evaluation. Schaitkin B.37(6):930-9.com/article/835286-overview 3. LLC 12 of 12 Wednesday. Ramos AS. Mavrikakis I. 2008. [Medline]. 7. The Facial Nerve.medscape. [Medline]. New York: Raven Press. Pitanguy I. Oct 1966. NY: Thieme. and management. Facial nerve palsy: anatomy. Orbit. Surgical Anatomy of the Face. 1993. http://emedicine.Facial Nerve Anatomy 1974. 4.

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