DISORDERS OF FACIAL

NERVE
 Facial nerve
Nerve of second branchial arch

 Mixed nerve- Both sensory and motor

 Motor- muscles of facial expression*
-muscles of 2nd pharyngeal arch

 Sensory- Taste from anterior 2/3 of tongue &

palate
-general somatic sensations
- secretomotor fibres
 Facial nerve-components
 Special visceral efferent

 General visceral efferent

 Special visceral afferent

 General somatic afferent

 Facial nerve-Nuclei
Motor nucleus

Superior salivatory nucleus

Lacrimatory nucleus

Nucleus tractus solitarius

 Facial nerve-Course
 Intracranial part

 Intratemporal part

 Extracranial part
 Intratemporal part
Meatal segement

Labrynthine segment

Tympanic segment

Mastoid segment
 Labrynthine segment
Shortest segmnet of nerve

Narrowest diameter

Bony canal in this segment – narrowest

Odema or inflammation
 Surgical landmarks
Processus cochleariformis
Oval window and horizontal canal
Short process of incus
Pyramid
Tympanomastoid suture
Digastric ridge
 Surgical landmarks
Cartilagenous pointer

Tympanomastoid suture

Styloid process

Posterior belly of digastric

 Variation and anomalies
Bony dehiscence
Prolapse of nerve
Hump
Bifurcation and trifurcation
Bifurcation enclosing stapes
Between oval and round window
Structure of nerve
 Sunderland classification-
nerve injuries
1°-Neurapraxia
2°-Axonotmesis
3°-Neurotmesis
4°-partial transection
5°-complete transection
 Electrodiagnostic tests
Minimal nerve exitability test

Maximal stimulation test

Electroneuronography

Electromyography
 Facial paralysis-causes
Central
Intracranial part(cerebellopontine angle)
Intratemporal part
Extracranial part
Systemic diseases
 Intratemporal part
Idiopathic

Infections IIT-N
Trauma

Neoplasm
 Bell’s palsy
60-70% of facial paralysis

Both sexes-equal frequency

Any age group- incidence increase with age

Family history-6-8%

Angiopathy and fluid retention

 Bell’s palsy- Aetiology
Viral infection

Vascular ischemia

Hereditary

Autoimmune disorder
 Bells’s palsy-clinical features
• Onset-sudden

• ‘Bell phenomenon’-attempt to close eye, eyeball

turn up & out

• Asymmetry of face,Dribbling of
saliva,epiphoria,noise intolerance,
Loss of taste

• Recurrent-3-10%
 Bell’s palsy-Diagnosis
Diagnosis by exclusion

History ,complete otological , head & neck

examination

Imaging studies,blood test –cbc, ps,ESR,Blood

sugar,serology
 Bell’s palsy-Diagnosis
• Nerve excitability test

• Topodiagnosis
Bell’s palsy-treatment

general

medical surgical
• General-reassure
analgesics, care of eye, physiotherapy
• Medical-steroids

PREDNISOLONE 1mg/kg/day x 5 days

review after 5 days
• If Recovering – taper dose during next 5 days

• If Complete paralysis – continue 10 days

thereafter taper the dose

 Combined with acyclovir

 Other drugs- vitamins , vasodilators,

antihistamines, mast cell inhibitors
• Surgical- Nerve decompression
PROGNOSIS
 85-90% -Recover fully

 10-15%- incomplete

Good prognosis- incomplete & recovery

within 3 weeks
 Facial
Swelling paralysis
lips

Fissured
tongue

Melkersson
syndrome
Infections- Ramsay-Hunt syndrome

Herpis zoster oticus

Facial paralysis along with vescicular rash

Anasthesia of face,giddiness,hearing
impairment
 Trauma
Fractures of temporal bone***

Ear or mastoid surgery

Parotid surgery or trauma to face

 Neoplasm
• Intratemporal

• Tumours of parotid
 Localisation of facial lesion
• Central facial paralysis
CVA, tumor, abcess

-paralysis only lower half of face on c/l side

-involuntary movements and muscle tone

retained
• Peripheral facial paralysis
Level of nucleus-6th nerve involement

Cerebellopontine angle- other cranial nerve

Bony canal???

Lesion outside temporal bone- only motor

functions affected
 Topodiagnostic test-
intratemporal part
1. Schirmer test

2.Stapedial reflex

3.Taste test

4.Submandibular salivary flow test

 Complications following facial
paralysis
Incomplete recovery

Exposure keratitis

Synkinesis

Tics and spasms

Contractures

Crocodile tears

Frey’s syndrome

Psychological & social problems

 Hyperkinetic disorders
Hemifacial spasm
i)Essential
ii)secondary

 Blepharospasm
 surgery
1. Decompession
2.end-end anastomoses
3.Nerve graft
4.Hypoglossal facial anstomoses
5.Plastic procedures