03 JUN 2011
History
Friedreich- Paralysis may occur when local causes act on the facial nerve 1821- Sir Charles Bell-
Embryology
Nerve of 2nd branchial arch 3rd wk Fibro Acoustic
Crest (Dorso Lateral aspect of hindbrain , cranial to otic placode) 4th wk Distinct Facial Nerve
Cont
5th wk Geniculate Ganglion formed
Facial Nerve divides(main trunk & Chorda Tympani) 7th wk 5 branches appear in parotid bud 8th wk Sulcus in posterior Otic capsule(primitive Facial Canal) 16th wk Neural communications with Facial Muscles is complete
Cont
Facial nucleus Neuroblasts in PONS with 6th Nerve nucleus in close
Congenital Anomalies
Moebius Syndrome(Congenital Facial diplegia)
Abnormal VI ,VII,XII Nerve nuclei Facial Nerve absent / smaller Congenital Extra ocular muscle & facial palsy
Treacher Collins Syndrome (Mandibulo Facial Dysostosis) Goldenhars Syndrome (Oculoauriculo Vertebral Dysplasia)
Introduction
VII Cranial Nerve ; Mixed Nerve
Pons below 4th Ventricle 2) Superior salivatory Nucleus dorsal to Motor Nucleus 3) Nucleus of Tractus Solitarius Medulla Oblongata
Central Connections of FN
Dorsal part of Nucleus B/L
Nerve Lesions
Cont
Facial Nerve course unusual Fibers course towards floor of IV Ventricle Wrap around VI Nerve nucleus
Facial Colliculus
Retrace along pons Exits Ponto medullary jn.
Course
angle with 8th CN & NI Devoid of epineurium Thin layer of pia mater
Surg imp : 1) Iatrogenic trauma in CP angle
Meatal Segment
Enters in anterosuperior
segment of IAC Length 5 12 mm Crista Falciformis Bills bar No separate sheath Shares with NI & 8th CN Facial Nerve merges with NI at Fundus
Surgical importance: 1) Anatomical bottle neck Ischemia in oedema 2) Part most vulnerable for Ischemia(no arterial anastamosis) 3) Temporal bone # - Most Commonly injured
Geniculate ganglion: Bipolar ganglion cells Aff. input somatic & special visceral afferent Secretomotor Fibres to lacrimal gland(without synapse)
Tympanic Segment
Horizontal segment
From Geniculate Ganglion to 2nd genu Length 8 to 11mm Lies beneath LSCC & above Oval Window above & medial to Processus cochleariformis
Cont
Nerve lies lateral & posterior to Pyramidal process Creates 2 Recesses
1. Facial recess (lateral) 2. Sinus tympani(medial)
2nd Genu
Surgical importance:
Cont
Mastoid Segment
Vertical Segment From 2nd genu(PM) to Stylomastoid Foramen (AL) Longest (13mm) Landmark Digastric Ridge FN leaves FC via Stylomastoid Foramen(b/w mastoid tip & styloid process)
Branches
Intra temporal region : 1) Greater Superficial Petrosal Nerve 2) Nerve to Stapedius 3) Chorda Tympani 4) Sensory Auricular
branch
N to pterygoid canal
GSPN
MIDDLE CRANIAL
FOSSA
FORAMEN LACERUM DEEP PETROSAL PTERYGOPALATINE
GANGLION
NERVE OF PTERYGOID
NERVE
CANAL
Chorda Tympani
4mm above Stylomastoid Foramen Lateral & Anterior to Facial Nerve Posterior Canaliculus Lateral to Long Process of Incus &
Medial to Malleus Ant canaliculus(Canal of huguier) 2 types of fibers Pre G parasym sub mand Gang Post G submand & subligual G Special sensory ant 2/3rd of tongue
INFRATEMPORAL FOSSA
LINGUAL NERVE SUBMANDIBULAR GANGLION
Surgical importance:
1) Greater Superficial Petrosal Nerve
1) Chorda Tympani
- Landmark in Posterior Tympanotomy -Lateral margin of Facial Recess -Medial limit for Facial Ridge reduction
Terminal Branches
Temporal :
BUCCAL
ZygomaticCERVICAL :
Marginal mandibular : 1-2cm below inferior ramus of mandible Muscles of lower lip&chin Cervical : Platysma &depressor anguli oris Buccal : 1 cm below zygomatic
BUCCAL
MANDIBULAR
CERVICAL
Buccal branch supplies : 1) Risorius (smirk) 2) Buccinator (aids chewing) 3) Levator Labii Superioris 4) Levator Labii Alaque Nasi
(snarl) 5) Levator Anguli Oris(soft smile) 6) Nasalis (Flare Nostrils) 7) Orbicularis Oris (Purse Lips)
Anatomical Relationship
Child Adult
2nd genu is more acute & 2nd genu less acute &
lateral more medial N trunk on exit from SMF N trunk is less anterior & is more ant & lat deeper N very superficial over N superficial over angle angle of mandible of mandible
Blood Supply
Surgical Landmarks
Ear surgery: 1) Geniculate Ganglion lies superior to Processus cochleariformis 2) 2nd genu hugs inferior aspect of LSCC 3) Lies above Oval Window Niche 4) Incus lies lateral to Facial Nerve 5) Runs behind Pyramid 6) Lies 6-8mm inferior to Tympano Mastoid suture 7) Digastric ridge mastoid segment 8) Blood vessels
Cont
Parotid surgery
Tragal pointer 1cm deep & inferior Tympanomastoid suture Lies lateral to Styloid process Superficial to Retromandibular vein Bisects angle b/w Posterior belly of digastric & ear canal Retrograde dissection
Variations
Most Common variations
Cont
Nerve to stapedius & Chorda Tympani variation Large Chorda Tympani can be real Facial Nerve (shouldnt sacrifice)
Nerve partially obliterating stapes footplate Bifurcation of Nerve Nerve rests on foot plate Nerve rests on promontory
Katz & Catalano classification: 1. Type I (25%) 2. Type II (14%) 3. Type III(44%) 4. Type IV(14%) 5. Type V(3%)
Cont
References
Scott-Browns Otorhinolaryngology, Head and Neck Surgery.7th ed. Ballengers Otorhinolaryngology ,Head and Neck Surgery. 17th ed. Internet References
Otology could be a dull way of life without the 7th cranial N arrogantly swerving through the temporal bone to the muscles of facial expression JOHN GROVES
THANK YOU