Professional Documents
Culture Documents
INTRODUCTION
COURSE OF FACIAL NERVE
BRANCHES
Surg imp :
1) Iatrogenic trauma in CP angle
tumour surgery
2) Difficult to identify in schwannoma
(no connective tissue)
From fundus to
Stylomastoid foramen
Length – 28 to 30 mm
“Fallopian canal”
Longest bony canal
Enters in ant sup
segment of IAC
Length 5 – 12 mm
Crista falciformis
Bills bar
No separate sheath
Shares with NI & 8th CN
Narrowest(0.68) &
Shortest(3-5mm)
No anastomosing
arteries
Periostium is thicker
Postero-Superior to
cochlea
Antero-Medial to SSCC
Distal end – Geniculate
ganglion;1st genu
Surgical importance:
1) Anatomical bottle neck – ischemia in oedema
2) Part most vulnerable for ischemia (no arterial
anastomosis)
3) Temporal bone # - MC injured
Geniculate ganglion:
Bipolar gang cells
Afferent input – somatic & special visceral afferents
Secretomotor Fibers to lacrimal gland (without
synapse)
Horizontal segment
From GG to 2nd genu
Length – 8 to 11mm
Lies beneath LSCC &
above OW
above & medial to
“Processus cochleariformis”
Nerve lies lateral &
posterior to Pyramidal
process
Creats 2 recesses
1. Facial recess (lat)
2. Sinus tympani(med)
2nd genu
Surgical importance:
Processus
cochleariformis(consistant
landmark)
Imp landmark for 2nd genu –
-LSCC
-Pyramidal eminence
-B/w short process of
incus(L) & LSCC(M)
Vertical Segment
From 2nd Genu To SMF
Longest (13mm)
segment
Landmark – “Digastric
Ridge”
From SMF to terminal
branches
Runs in substance of
parotid
Main trunk divides
- upper temperofacial
- lower cervicofacial
“Pes anserinus”
Superficial to
Retromandibular Vein
Intra temporal region :
1) GSPN
2) Nerve to stapedius
3) Chorda tympani
4) Sensory auricular
branch
From GG
2 types of fibers
Pregang para symp –
Pterygopalatine gang.
Post gang – lacrimal G
Sensory fibers to
nasal & palatine glands
Joins deep petrosal N
– N to pterygoid canal
NERVE TO STAPEDIUS
Arises 6mm above SMF
Supply stapedius muscle
2 types of fibers
1. Pre Ganglionic Parasympathetic – submandibular
gland
Post Ganglionic – submandibular & subligual Glands
2. Special sensory – anterior 2/3rd of tongue
Extra temporal region
A. TOPODIAGNOSTIC TESTING
B. ELECTROPHYSIOLOGY
TEST NERVE BRANCH
ASSESSED
1. SCHIRMER TEST Greater superficial petrosal
nerve
2. TRAUMA
Basal skull fracture
Facial injuries
Barotruma {scuba diving , altitude paralysis}
3. NEUROLOGICAL
Opercular syndrome (cortical lesion in facial motor
area)
Millard – Gublar syndrome (abducens palsy with
contralateral hemiplegia d/t lesion in base of pons )
4. INFECTION
Otitis externa
Otitis media , cholesteatoma
Mastoiditis
Herpes zoster cephalicus (Ramsay Hunt Syndrome)
Encephalitis
Others
5. METABOLIC
Diabetes mellitus
Hyperthyroidism
Pregnancy
Hypertension
Acute porphyria
5. NEOPLASTIC
VII th nerve tumour
Glomus jugulare
Meningioma
Schwannoma
Others (nf2 , hemangioma, glioma)
7. TOXIC
Thalidomide
Carbon monoxide
Tetanus
Diphtheria
8. IATROGENIC
Mandibular block anesthesia
Dental procedures
Parotid surgery
Mastoid surgery
9. IDIOPATHIC
Bell’s palsy
Melkersson – Rosenthal syndrome (recurrent
alternating facial palsy, furrowed tongue, faciolabial
oedema)
Hereditary hypertrophic neuropathy (charcot marie
tooth disease)
Temporal arteritis
Thrombotic thrombocytopenic purpura
Myasthenia gravis
Sarcoidosis (Heerfordt Syndrome- uveoparotid
fever)
Diagnostic criteria-
Paralysis or paresis of all muscle groups on one side of
the face;
Sudden onset;
Absence of signs of central nervous system disease;
Absence of signs of ear or CPA disease.
Aetiology –
Microcirculatory failure of vassa nervosum
Ischaemic neuropathy
Infectious (HSV-1,HSV-2,VZV,EBV,Influenza B)
Genetic
Immunologic
TREATMENT
STEROIDS
Prednisolone -1mg/kg for 5 days f/b a ten day taper.
ANTIVIRAL DRUGS
Oral Acyclovir – (200-400 mg five times a day) for ten
days.
Definition –
peripheral facial nerve palsy accompanied by
an erythematous vesicular rash on the ear (zoster oticus)
or in the mouth.
Mechanism -
reactivation of the latent VZV in the geniculate
ganglion
Persistent excruciating Pain and SNHL
TREATMENT-
If started within three days of onset = significant
improvement
Prednisolone - 1mg/kg for 5 days f/b a ten
day taper
Late Exploration-
• End to end anastomosis
• Interposition grafting (cable grafts- ipsilateral great
auricular nv, sural nv, medial antebrachial cutaneous
nvs)
• Rerouteing
• Reinnervation – hypoglossal facial anastomosis, cross
facial nerve grafting (using a sural nv graft)
“JOHN GROVES”