FACIAL NERVE

ANATOMY &
COURSE IN MIDDLE
EAR
DONE BY;
THASNI T U;ROLL NO 102
VIGNESH SUNIL;ROLL NO 105
7TH SEM
INTRODUCTION
There are 12 pairs of cranial nerves.
Facial nerve is the 7th cranial nerve.
It is the nerve of second branchial arch.
Hence it supplies all the muscles that is developed from the
mesoderm of this arch.
It is a mixed nerve with a large motor and a small sensory
root.
It emerges from the brainstem between pons and medulla,
controls muscles of facial expression.
The sensory root is also known as the NERVE OF
WRISBERG and carries secretomotor fibres to the
lacrimal gland and salivary glands and brings fibres of
taste and general sensation.
It also supplies preganglionic parasympathetic fibres to
several head and neck ganglion.
 FUNCTIONAL
COMPONENTS
1.SPECIAL VISCERAL OR BRANCHIAL EFFERENT (SVE):-
Forms the motor root and supplies all the muscles derived
from the second branchial arch, i. e.,all the muscles of facial
expression, auricular muscles (now vestigial), stylohyoid,
posterior belly of digastric and the stapedius.
2.GENERAL VISCERAL EFFERENT (GVE) OR
PARASYMPATHETIC FIBRES:-
Supplies secretomotor fibres to lacrimal,
submandibular and sublingual glands and the smaller
secretory glands in the nasal mucosa and the palate and
pharynx.
3.SPECIAL VISCERAL AFFERENT (SVA):-
Brings taste from the anterior two-third of tongue
via chorda tympani and soft and hard palate via greater
superficial petrosal nerve. Taste is carried to nucleus of
tractus Solitarius.
4. GENERAL VISCERAL AFFERENT (GVA):-
Components carries afferent impulses from lacrimal
gland, submandibular and sublingual salivary gland,
glands of nose, palate and pharynx.
5. GENERAL SOMATIC AFFERENT (GSA):-
Fibres probably innervate a part of skin of the ear. The
nerve does not give any direct branches to the ear, but some
fibres may reach it through communication with the vagus nerve.
Brings general sensation from the concha, posterosuperior
part of external canal and the tympanic membrane. These fibres
accounts for vesicular eruption in herpes zoster infection of the
geniculate ganglion.
It also brings proprioceptive sensation from the facial muscles
which travel through branches of the trigeminal nerve to reach
the mesencephalic nucleus of the nerve.
NUCLEI
1. MOTOR NUCLEUS OF FACIAL NERVE :-
It lies in the lower part of the pons.

Origin and course:

The axons arising from this nucleus take an unusual
course. The fibres first pass in a dorsomedial direction and then
loop over the abducent nerve nucleus. These fibres then come
out on the surface as the motor root at the lower border of pons
in the cerebellopontine angle.
Termination :-

Motor branches terminate in skeletal muscles

derived from the second pharyngeal arch.
Function :-

This nucleus supplies muscles of face, posterior

belly of digastric, stylohyoid and stapedius muscle.
 CORTICAL
CONNECTIONS OF
MOTOR NUCLEUS
The motor nucleus of the facial nerve is innervated by the corticonuclear
fibres(supranuclear fibres or UMN fibres )arising from the cerebral cortex.
The fibres arising from the facial nucleus (infranuclear fibres or LMN fibres)
innervate facial muscles.
The neurons of facial nerve supplying the muscles of the upper part of the face
have double innervation, i. e, they are supplied by corticonuclear fibres from the
same and opposite cerebral hemispheres. However, the neurons of facial nerve
Supplying muscles of lower face are supplied by corticonuclear fibres of the
opposite cerebral hemisphere only.
The function of forehead is preserved in
supranuclear lesions because of the bilateral
innervation.
Facial nucleus also receives fibres from the
thalamus by alternate routes and provide
involuntary control to the facial muscles.
The emotional movements such as smiling and
crying are thus preserved in supranuclear palsies
because of these fibres from the thalamus.
2. SUPERIOR SALIVATORY NUCLEUS (GVE):-

It lies in the pons lateral to the main motor

nucleus of VII and gives rise to
Secretomotor parasympathetic fibres that pass in
greater superficial Petrosal nerve and chorda
tympani.
Origin and course :-

The preganglionic parasympathetic axons arising

from the superior salivatory nucleus leave the
facial nerve and enters its chorda tympani branch.
These fibres then travel through the lingual nerve
to reach the submandibular ganglion located in
the floor of oral cavity. The postganglionic fibers
from the submandibular ganglion are distributed
to submandibular and sublingual glands.
Termination :-
postganglionic fibres (secretomotor) supplies the
submandibular and sublingual glands.
Function :-
Secretion of saliva from submandibular and
sublingual salivary glands.
3. LACRIMATORY NUCLEUS :-
Origin and course :-
The preganglionic parasympathetic fibres from the
lacrimatory nucleus pass through the greater
petrosal nerve. These fibres synapse with the
postganglionic parasympathetic neurons located in
the pterygopalatine ganglion in the pterygopalatine
fossa. The postganglionic fibres pass through the
zygomatic branch of maxillary nerve to innervate
the lacrimal gland.
Termination :-
Postganglionic fibres (secretomotor ) supplies the
lacrimal gland.
Function :-
Secretion of tears from lacrimal gland.
4. NUCLEUS OF TRACTUS SOLITARIUS
(SVA):-

It lies in medulla, receives the taste sensation

from the anterior 2/3 of the tongue via the central
processes of the cells of the geniculate ganglion of
the facial nerve.
Origin and course :-

This nucleus is situated in the medulla and is

concerned with the taste sensation. The sensation of
taste from the anterior 2/3rd of the tongue is carried
by the Peripheral process of ganglion cells located
in the genicular ganglion of the facial nerve.
Termination :-
The central process of these sensory neurons
terminates on the nucleus of tractus solitarius.
Function :-
Sensation of taste from the anterior 2/3 rd of the
tongue and soft palate.
5. SPINAL TRIGEMINAL NUCLEUS :-

Through these fibres to acoustic meatus and

back of auricle through communication from
auricular branch of vagus. These fibres terminate in
main sensory nucleus and spinal nucleus of 5 th
nerve.
Origin and course :-

This sensory nucleus extends from the lower

pons to upper cervical spinal cord. The sensation of
touch, temperature and pain, from the area of skin
of ear supplied by the facial nerve, is carried by the
peripheral process of ganglion cells located in
genicular ganglion.
Termination :-
The central processes of these neurons in the
genicular ganglion travel in the spinal tract of the
trigeminal nerve to terminate in the spinal nucleus.
Function :-
The sensation of touch, temperature and pain,
from the area of skin of ear supplied by the facial
nerve.
 COURSE AND RELATIONS
OF FACIAL NERVE
Motor fibres take origin from the nucleus of VIIth nerve, hook
round the nucleus of VI th nerve and are joined by the sensory
root (nerve of wrisberg ).
Facial nerve leaves the brainstem at pondomedullary junction,
travels through posterior cranial fossa and enters the internal
acoustic meatus.
At the fundus of the meatus (lateral most part of
the meatus ), the nerve enters the bony facial canal,
traverses the temporal bone and comes out through
the stylomastoid foramen.
Here it crosses the styloid process and divides into
terminal branches.
The course of nerve can thus be divided into 3
parts :
INTRACRANIAL PART :-
From pons to internal acoustic meatus
(15-17mm).
INTRATEMPORAL PART :-
From internal acoustic meatus to
stylomastoid foramen.
It is further divided into :-
1. Meatal segment:- Within internal acoustic
meatus (8-10mm).
2.Labyrinthine segment (4 mm):-
From fundus of meatus to the geniculate ganglion
where the nerve takes a turn posteriorly forming a
“genu”.
The nerve in the labyrinthine segment has the narrowest
diameter (0.61-0.68 mm) and the bony canal in this
segment is also the narrowest.
Thus edema and inflammation can easily compress the
nerve and cause paralysis.
This is also the shortest segment of the nerve.
3.Tympanic or horizontal
segment (11 mm):-
From geniculate ganglion to
just above the pyramidal
eminence.
It lies above the oval window
and below the lateral
semicircular canal.
4. Mastoid or vertical segment
(13mm):-
From the pyramid to
stylomastoid foramen. Between
the tympanic and mastoid
segments is the second genu of
the nerve.
EXTRACRANIAL PART :-
Facial nerve crosses the lateral side of the base of the
styloid process.
It enters the posteromedial surface of the parotid
gland, runs forward through the gland crossing the
retromandibular vein and external carotid artery.
Behind the neck of the mandible, it divides into five
terminal branches which emerges along the anterior
border of the parotid gland.
BRANCHES AND
DISTRIBUTION
1. WITHIN THE FACIAL CANAL :-
Greater petrosal nerve
The nerve to stapedius
The chorda tympani
2. AT IT’S EXIT FROM THE
STYLOMASTOID FORAMEN :-
Posterior auricular
Digastric
Stylohyoid
3. TERMINAL BRANCHES WITHIN THE PAROTID
GLAND :-

Temporal
Zygomatic
Buccal
Marginal mandibular
Cervical

4. COMMUNICATING BRANCHES WITH ADJACENT

CRANIAL AND SPINAL NERVES
• GREATER Nerve supply of lacrimal gland
SUPERFICIAL
PETROSAL
NERVE
It arises from geniculate
ganglion and carries
secretomotor fibres to
lacrimal gland and the
glands of nasal mucosa
and palate.
 NERVE TO STAPEDIUS
MUSCLE
It arises opposite the pyramid of middle ear, at the
level of second genu and supplies the stapedius
muscle.
The muscle dampens excessive vibrations of the
stapes caused by the high pitched sounds.
In paralysis of the muscle, even normal sound
appears too loud and is known as hyperacusis.
 CHORDA TYMPANI
It arises from the vertical part of facial canal about 6mm
above the stylomastoid foramen.
It runs upwards and forwards in a bony canal.
It enters the middle ear and runs forward between incus
and neck of malleus in close relation to the tympanic
membrane.
It leaves the middle ear by passing through the
petrotympanic fissure.
It then passes medial to the spine of sphenoid and
enters the infratemporal fossa.
Here it joins the lingual nerve through which the chorda
tympani nerve is distributed.
It carries :-
1.Preganglionic secretomotor fibres to the
submandibular ganglion for the supply of
submandibular and sublingual salivary glands.
2.Taste fibres from the anterior 2/3 rd of the tongue
except circumvallate pappillae.
POSTERIOR AURICULAR NERVE

It arises just below the stylomastoid foramen.

It ascends between mastoid process and external
acoustic meatus, and supplies
1.Auricularis posterior
2.Occipitalis
3.Intrinsic muscles on the back of auricle
MUSCULAR BRANCHES
The Digastric branch,arises close to the posterior
auricular nerve.
It is short and supplies posterior belly digastric muscle.

The Stylohyoid branches arises with the digastric branch,

is long and supplies the Stylohyoid muscle.
 PERIPHERAL BRANCHES
1.Temporal branches :-
cross the zygomatic arch and supplies,
Auricularis anterior
Auricularis superior
Intrinsic muscles on the lateral side of the ear
Frontalis
Orbicularis oculi
Corrugator supercilii
The zygomatic branches run across the zygomatic bone and
supply the orbicularis oculi.
The buccal branches are two in number.
The upper buccal branch runs above the parotid duct and
the lower buccal branch below the duct-they supply
muscles in that vicinity especially buccinator.
The marginal mandibular branch runs below the angle of
mandible deep to the platysma. It crosses the body of
mandible and supplies muscles of lower lip and chin.
The cervical branch emerges from the apex of the parotid gland,
and runs downwards and forwards in neck to supply platysma.
COMMUNICATING BRANCHES :-
For the effective coordination between the movements of muscles
of first, second and third branchial arches, the motor nerves of the
three arches communicate with each other. The facial nerve also
communicates with the sensory nerve distributed all over its motor
territory.
It joins with auricular branch of vagus and supplies the concha,
retroauricular groove, posterior meatus and outer surface of
tympanic membrane.
GANGLIA
The ganglia associated with the facial nerve is as follows :

1.GENICULATE GANGLION
2.SUBMANDIBULAR GANGLION
3.PTERYGOPALATINE GANGLION
 GENICULATE GANGLION
Geniculate ganglion is located on the first bend of the
facial nerve, in relation to the medial wall of the
middle ear.
It is a sensory ganglion The taste fibres present in the
nerve are the peripheral processes of pseudounipolar
neurons present in the geniculate ganglion.
It receives fibres from the motor, sensory, and
parasympathetic components of the facial nerve
and sends fibres that Will innervate the lacrimal
glands, submandibular glands, sublingual glands,
tongue, palate, pharynx, external auditory meatus,
stapedius, posterior belly of digastric muscles,
Stylohyoid muscles and muscles of facial
expression.
 SUBMANDIBULAR
GANGLION
It is a parasympathetic ganglion for relay of secretomotor fibres
to the submandibular and sublingual glands.
The preganglionic fibres come from the chorda tympani nerve.
It is small and fusiform in shape, situated above the deep portion
of the submandibular gland, on the hyoglossus muscle, near the
posterior border of the myloid muscle.
The ganglion hangs by two nerve filaments (anterior and
posterior )from the lower border of the lingual nerve.
Through the posterior of these it receives a branch from
the chorda tympani nerve which runs in the sheath of the
lingual nerve.
PTERYGOPALATINE
GANGLION
Also called as Meckel’s ganglion, nasal ganglion or
sphenopalatine ganglion is found in the
pterygopalatine fossa.
It is also a parasympathetic ganglion.
Secretomotor fibres for lacrimal gland relay in this
ganglion.
The fibres reach the ganglion from the nerve to the
pterygoid canal.
 BLOOD SUPPLY OF
FACIAL NERVE
It is derived from four blood vessels :
1.ANTERIOR-INFERIOR CEREBELLAR ARTERY
:-
Supplies the nerve in cerebellopontine angle.
2.LABYRINTHINE ARTERY :-
Branch of anterior –inferior cerebellar artery,
which supplies the nerve in internal auditory canal.
3.SUPERFICIAL PETROSAL ARTERY :-
Branch of middle meningeal artery, which
supplies geniculate ganglion and adjacent region.
4.STYLOMASTOID ARTERY :-
Branch of posterior auricular artery, which
supplies the mastoid and tympanic segment.
All the arteries forms an external plexus which lies
in the epineurium and feeds a deeper intraneural
internal plexus.
SURGICAL LANDMARKS
For middle ear and mastoid surgery :-
1.Processus cochleariformis:-
It demarcates the geniculate ganglion which lies
just anterior to it.Tympanic segment of the nerve
starts at this level.
2. Oval window and horizontal canal :-
The facial nerve runs above the oval window
(stapes) and below the horizontal canal.
3. Short process of incus :-
Facial nerve lies medial to the short process of incus at the level of
aditus.
4. Pyramid :-
Nerve runs behind the pyramid and the posterior tympanic sulcus.
5. Tympanomastoid suture :-
In vertical or mastoid segment, nerve runs behind this suture.
6. Digastric ridge :-
The nerve leaves the mastoid at the anterior end of digastric ridge.
For parotid surgery :-
1.Cartilaginous pointer :-
The nerve lies 1 cm deep and slightly anterior and inferior to
the pointer.
Cartilaginous pointer is a sharp triangular piece of cartilage of
the pinna and points to the nerve.
2. Tympanomastoid suture :-
Nerve lies 6-8mm deep to this suture.
3. Styloid process
The nerve crosses lateral to styloid process.
4. Posterior belly of digastric :-
If posterior belly of digastric muscle is traced
backwards along its upper border to its attachment
to the digastric groove, nerve is found to lie
between it and the styloid process.