Right sided facial nerve palsy
It also supplies the occipital part of the occipitofrontalis muscle. Nerve to the posterior belly of the digastric muscle innervates the posterior belly of the digastric muscle (a suprahyoid muscle of the neck). It is responsible for raising the hyoid bone. Nerve to the stylohyoid muscle innervates the stylohyoid muscle (a suprahyoid muscle of the neck). Within the parotid gland, the facial nerve terminates by bifurcating into five motor branches. These innervate the muscles of facial expression : Temporal branch Innervates the frontalis, orbicularis oculi and corrugator supercilii zygomatic branch Innervates the orbicularis oculi. Buccal branch Innervates the orbicularis oris, buccinator and zygomaticus muscles. Marginal Mandibular branch Innervates the mentalis muscle.
By teachmeseries Ltd (2018) Fig.1 Schematic of the course and branches of the facial nerve. The first extracranial branch to arise is the posterior auricular nerve. It provides motor innervation to the some of the muscles around the ear. Immediately distal to this, motor branches are sent to the posterior belly of the digastric muscle and to the stylohyoid muscle. The main trunk of the nerve, now termed the motor root of the facial nerve, continues anteriorly and inferiorly into the parotid gland (note the facial nerve does not contribute towards the innervation of the parotid gland, which is innervated by the glossopharyngeal nerve ). Within the parotid gland, the nerve terminates by splitting into five branches: Temporal branch Zygomatic branch Buccal branch Marginal mandibular branch Cervical branch These branches are responsible for innervating the muscles of facial expression. Motor Functions Branches of the facial nerve are responsible for innervating many of the muscles of the head and neck. All these muscles are derivatives of the second nagellack pharyngeal arch. The first motor branch arises within the facial canal; the nerve to stapedius. The nerve passes through the pyramidal eminence to supply the stapedius muscle in the middle ear. Between the stylomastoid foramen, and the parotid gland, three ultrasun more motor branches are given off: Posterior auricular nerve ascends in front of the mastoid process, and innervates the intrinsic and extrinsic muscles of the outer ear.
the facial nerve. Next, the nerve forms the geniculate ganglion (a ganglion is a collection of nerve cell bodies). Lastly, the nerve gives rise to: Greater petrosal nerve parasympathetic fibres to mucous glands and lacrimal gland. Nerve to stapedius motor fibres to stapedius muscle of the middle ear. Chorda tympani special sensory fibres to the anterior 2/3 tongue and parasympathetic fibres to the submandibular and sublingual glands. The facial nerve then exits the facial canal (and the cranium) via the stylomastoid foramen. . This is an exit located just posterior to the styloid process of the temporal bone. Extracranial After exiting the skull, the facial nerve turns superiorly to run just anterior to the outer ear.
Bell's palsy - wikipedia
Fig.0 overview of the anatomical course of the facial nerve. Anatomical course, the course of the facial nerve is very complex. There are many branches, which transmit a venusheuvel combination of sensory, motor and parasympathetic fibres. Anatomically, the course of the facial nerve can be divided into two parts: Intracranial the course of the nerve through the cranial cavity, and the cranium itself. Extracranial the course of the nerve outside the cranium, through the face and neck. Intracranial, the nerve arises in the pons, an area of the brainstem. It begins as two roots; a large motor root, and a small sensory root (the part of the facial nerve that arises from the sensory root is sometimes known as the intermediate nerve). The two roots travel through the internal acoustic meatus, a 1cm long opening in the petrous part of the temporal kromme bone. Here, they are in very close proximity to the inner ear.
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Increasingly, various viral causes are being identified, particularly herpes simplex type 1 or varicella (herpes) zoster. Approximately 7 of patients have a recurrence. There may be a familial component in recurrent cases, possibly due to anatomical abnormality of the facial canal. 11 The incidence is higher in people with diabetes than in those without diabetes. Ramsay hunt syndrome lmn facial nerve palsy due specifically to varicella (herpes) zoster is Ramsay hunt syndrome. Pain is often a prominent feature and vesicles are seen in the ipsilateral ear, on the hard palate and/or on the anterior two thirds of the tongue. It can include deafness and vertigo and other cranial nerves can be affected. When the rash is absent it is known as zoster sine herpete; 2-23 of people with Bell's palsy actually have ramsay hunt syndrome.
Acute lmn palsy Acute lmn palsy can present at any age but is most frequently seen at age 15-60 years, affecting both sexes equally. There is a rapid onset of unilateral facial paralysis: Ask the patient to give a big grin showing their teeth. Ask them to blow out their cheeks. Ask them to screw up their eyes. Ask them to raise their eyebrows (preserved in umn lesion).
Aching pain below the ear or in the mastoid area is also common and may suggest middle ear or herpetic cause. There may be hyperacusis. Patients with lesions proximal to the geniculate ganglion may be unable to produce tears and have loss of taste. Bell's palsy 3 This, the most common cause huid of acute lmn facial palsy, was originally described by sir Charles Bell in 1821. Incidence is 11-40 per 100,000 with a lifetime risk of 1. 9 Probably caused by ischaemic bevallen compression of the facial nerve within the facial canal, as a result of inflammation, most likely due to a viral infection. In the past no cause was found in the majority of cases of lmn facial nerve palsy and these were labelled as idiopathic (ie bell's palsy).
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5, otitis media or cholesteatoma. Trauma: Fractures of the skull base. 6, haematoma after acupuncture. 7, neurological: guillain-Barré syndrome. Mononeuropathy - eg, due to diabetes mellitus, sarcoidosis or amyloidosis.
Neoplastic: Posterior fossa tumours, primary and secondary. Hypertension in pregnancy and eclampsia. Sjögren's syndrome and rheumatoid arthritis. 8 melkersson-Rosenthal syndrome (recurrent facial palsy, chronic facial oedema of the face and lips, and hypertrophy/fissuring of the tongue). 9 umn cerebrovascular disease. Intracranial tumours, primary and secondary. If bilateral, particularly consider immunosuppression (hiv guillain-Barré syndrome or Lyme disease. If recurrent, particularly consider lymphoma, sarcoidosis and Lyme disease. In children, particularly consider Lyme disease and middle ear disease.
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There appear to be different pathways for voluntary and emotional movement. Cerebrovascular accidents usually weaken voluntary movement, often sparing involuntary movements (eg, spontaneous smiling). The much rarer selective loss of emotional movement is called mimic paralysis and is usually due homme to a frontal or thalamic lesion. Lmn, idiopathic (Bell's palsy pregnancy - 3x more common. Cerebrovascular disease (eg, brainstem stroke). Iatrogenic: Local anaesthetic for dental treatment. 4, infective: Herpesvirus (type 1). Herpes zoster (Ramsay hunt syndrome) - see below. Lyme disease (more likely if bilateral when responsible for 36 of cases).
Facial nerve - teachMeAnatomy
Voluntary eye closure may not be possible and can produce damage to the conjunctiva and cornea. In partial paralysis, the lower face is generally more affected. In severe cases, there is often perricone demonstrable loss of taste over the anterior two thirds of the tongue and intolerance to high-pitched or loud noises. It may cause mild dysarthria and difficulty with eating. The most common system used for describing the degree of paralysis is the house-Brackmann scale, where 1 is normal power and 6 is total paralysis. 2, it is important to identify whether the patient has an umn or lmn lesion, to assist in identifying the cause. In an lmn lesion, the patient can't wrinkle their forehead - the final common pathway to the muscles is destroyed. The lesion must be either in the pons, or outside the brainstem (posterior fossa, bony canal, middle ear or outside skull). In a umn lesion, the upper facial muscles are partially spared because of alternative pathways in the brainstem, ie the patient can wrinkle their forehead (unless there is bilateral lesion) and the sagging of the face seen with lmn palsies is not as prominent.
Synonym: Bell's palsy (lower motor neurone facial palsy idiopathic facial paralysis (IFP). Damage to the facial nerve - either upper motor neurone (UMN) or lower motor neurone (LMN) - produces weak muscles of bicarbonaat facial expression. The viith cranial (facial) nerve is largely motor in function (some sensory fibres from external acoustic meatus, fibres controlling salivation and taste fibres from the anterior tongue in the chorda tympani branch). It also supplies the stapedius (so a complete nerve lesion will alter auditory acuity on the affected side). From the facial nerve nucleus in the brainstem, fibres loop around the vi nucleus before leaving the pons medial to viii and passing through the internal acoustic meatus. It passes through the petrous temporal bone in the facial canal, widens to form the geniculate ganglion (taste and salivation) on the medial side of the middle ear, whence it turns sharply (and the chorda tympani leaves to emerge through the stylomastoid foramen to supply. Weakness of the muscles of facial expression and eye closure. The face sags and is drawn across to the opposite side on smiling.
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Contents, the facial nerve, cn vii, is the seventh paired cranial nerve. In this article, we shall look at the anatomical course of the nerve, and the motor, sensory and parasympathetic functions of its terminal branches. The facial nerve is associated with the derivatives of the second pharyngeal arch. Motor: Innervates the muscles of facial expression, the posterior belly of the digastric, the stylohyoid and the stapedius muscles. Sensory : A small area around the concha of the auricle. Special Sensory : Provides special taste sensation to the anterior 2/3 of the tongue. Parasympathetic : Supplies many of the glands of the head and neck, including: Submandibular and sublingual salivary glands. Nasal, palatine and pharyngeal mucous glands. Lynch decolte cc-by-2.5, via wikimedia commons.