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lower third of contralateral
Genu of internal capsule.
Medial portion cerbralpeduncles
Then decussate to converge on
the facial nucleus.
Lower half of the face has
Upper half has bilateral
Some of the corticobulbar
fibres descend in to the
aberrent pyramidal tract to
the medullary levels,decussate
there and ascend
contralaterally in to the dorsal
medulla to converge in to the
Special visceral efferent nerve.
Branchiomotar nerve .
Lies deep in the tegmentum of caudal pons.
Is formed by nervus intermedius (NI) of wrisberg.
It forms 30% of the facial nerve.
Sensory and parasympathetic division of facial nerve.
Parasympathetic fibres arise from
superior salivatory and lacrimal nucleus
The gustatory efferents end primarily in the nucleus of the
Facial nerve exits the pons in to the internal auditory
canal at ponto medullary junction.
The nerve pierces the meninges and enter in to the
facial canal at the bottom of internal auditory meatus.
tympanic or horizantal
Course and branches of facial nerve
1st branch is greater superficial petrosal nerve.
2nd branch is nerve to stapedius, arises from distal
tympanic or upper mastoid part.
3rd branch is nerve to chordotympani arises slightly above
After the exit,posterior auricular,digastric and stylohoid
In the parotid gland,it divides in to temporofacial and
Inspection of the face.
Tone,atrophy and fasciculations.
Pattern of blinking
Is limited to taste
Peripheral receptors are present in the tongue
epithelium,also in the soft palate and epiglottis.
5 major tastes:
umami(delicious or savory)
Ageusia is complete inability to taste.
Hypogeusia is taste perception delayed or blunted.
History and observation.
Schirmer test filter strips are placed in the inferior
conjuctival sacs and left for 5min
Lacrimal reflex is elicited by stimulation of nasal
mucosa (mechanical or chemical substances)
DISORDERS OF FUNCTION
changes in these functions helps to localise the lesion
2 types of facial weakness.
peripheral facial palsy(facial nucleus to t.branches)
cental facial palsy(supranuclear pathway)
PERIPHERAL FACIAL PALSY
Affected side of the face is smooth.
No wrinkles on the forehead.
Eye is open.
Inferior lid sags
Nasolabial fold is flattened
Angle of mouth droops
Bell’phenomenon(attempting to close the involved eye
causes upturning of the eyeball.
Platysma sign of babinski.
The involved eye does not blink no matter which
side is stimulated
Named after sir charless bell,
scottish surgeon,anatomist,and artist.
Idiopathic facial paralysis.
Frequently after viral infections
Nerve damage is more common
in the labyrinthine part.
Most common symptoms are increased tearing,pain in
and around the ear,and taste abnormalities
CRITERIA FOR BELL’S PALSY
There should be diffuse peripheral facial palsy.
Onset should with in a day or two.
Paralysis reaching maximum with in 3 weeks.
Full or partial recovery with in 6 months.
It is due to aberrant regeneration.
Common after bell’s palsy and traumatic injury.
Axons destined for one muscle regrow to innervate the other.
Crocodiletears(gustatory lacrimal reflex).
Aurico temporofacial syndrome
On blinking,corner of the mouth deviates(marin amit sign)
Other causes of peripheral facial paralysis
Motor neuron disease
Mobius syndrome(congenital occulofacial paralysis)
Abscess,syringobulbia,demyelinating disease and trauma
in the pons
Acoustic neuroma,meningioma in cerbello pontine angle.
Ramsay hunt syndrome.
Fracture of petrous bones
Melkerson syndrome is charecterised by recurrent attacks of
CENTRAL FACIAL PALSY
Weakness of lowerface with relative sparing of upper face.
Lower facial weakness is not as severe as in peripheral facial
volitional or voluntary facial asymmetry more
apparent with spontaneous expression.
emotional or mimetic facial asymmetry more
apparent with voluntary contraction.
ABNORMAL FACIAL MOVEMENTS
Hemifacial spasm due to intermittent compression by an
ectatic arterial loop in the post circulation,most often a
redundant loop of the AICA.
Spastic paretic facial contracture instead of spasm there
may be fixed contracture.
Facial myokymia is acontinous,involuntary muscle
quivering that has ripping worm like appearance.
multiple sclerosis,Gbsyndrome,CPA tumors,SAH.