Facial nerve , anatomy , pathology , diagnosis , management .

1. Facial Nerve By Dr. Ibrahim Habib ENT Consultant (MD)

2. ( وجعل لكم السمع والأبصار والأفئدة قليلا ما تشكرون ) ( السجدة : 9 ) (هذا خلق الله فأروني ماذا خلق الذين من دونه ) ( لقمان : 10 ) ( فأقم وجهك للدين القيم من قبل أن يأتي يوم لا مرد له من الله ) ( الروم : 43 )

3. Facial Nerve Anatomy Mixed nerve Sensory: from Nucleus Solitarius Motor : Facial nucleus (at the level of Pons) Parasympathetic: superior salivary nucleus

4. Segments of Facial Nerve

5. Course of Facial Nerve

9. Branches of Facial Nerve

10. Facial N. Branches

11. Facial N. Branches( cont. )

12. Pathophysiology of nerve injury Neuropraxia : Blocks flow of axoplasm from stoma to distal axon. Axonotemesis : Wallerian degeneration with intactendoneural tubules. Neurotemesis : Wallerian degeneration with loss of endoneural tubules . Transection : Complete division of the nerve .

13. Facial nerve paralysis: Signs Facial asymmetry Eyebrow droop Loss of forehead & nasolabial folds Drooping of corner of mouth Uncontrolled tearing Inability to close eye Lips cannot be held tightly together: difficulty keeping food in mouth Facial muscle atrophy ( late (

14. Facial nerve palsy

15. Clinical Testing of Facial Nerve Functions Observe patient Face during rest & movement for : Asymmetry Hemi facial spasm Facial tics blinking

16. Clinical Testing of Facial Nerve Functions Blink test: Delay in blinking on one side Testing facial movement Temporal branch: To wrinkle forehead, To elevate eye brow Zygomatic branch: to screw up the eye Buccal branch: to wrinkle the nose Mandibular branch: to show the teeth, to blow out the cheeks Crvical branch: by grimacing

17. House-Brackmann grading system of facial function

18. House-Brackmann grading system of facial function (cont.)

19. Features associated with facial palsy Synkinesis: movement of group of muscles that don’t usually contract together. Hemifacial spasm: an intermittent spasm of some or all of the facial muscles Facial myokymia: multiple facial movement. Blepharospasm: involuntary spasmodic eye closure Crocodile tears: lacrimation with eating due to regenerating motor nerve fibers connect the greater petrosal nerve.

20. Topognostic testing Help to determine the site of facial n. injury

21. Supranuclear lesion : Lower face palsy associated with neurological deficit Nuclear lesion: Motor function affected only

22. C P A , labyrinthine segment , geniculate ganglion lesions : Lacrimation , stapedeal reflex , taste , salivation impaired Lesion between geniculate g. and n. to stapedius : Stapedeal reflex , taste , salivation lost .

23. Lesion between stapedius and chorda tympani n. : Taste impaired . Lesion bellow chorda tympani n. : Pure motor deficit .

24. Topognostic testing of Facial palsy

25. Topognostic testing of Facial palsy (cont.)

26. Topognostic testing of Facial palsy (cont.)

27. Causes of facial nerve palsy Congenital Birth trauma. Inherited disorder . Mytonic dystrophy Albers –Schoenberg disease Osteoporosis of bony canals for cranial n. III, VIII & VII cranial n. affected. Developmental abnormalities . Moebius syndrome Occulo-auriculo-vertebral syndrome

28. Causes of facial nerve palsy(cont.) Inflammatory : Bell’s palsy ( an acute peripheral self- limiting (55% ) non progressive facial paralysis due to viral inflammatory process Ramzy Hunt syndrome (7%) (herpes zoster virus causes facial palsy and vesicles often visible in ext. ear canal & on tympanic membrane. Lyme disease ( tick - born spirochaete causes facial paralysis in children)

29. Causes of facial nerve palsy(cont.) AIDS ( HIV causes facial paralysis as a result of : -herpes zoster Atticus -progressive multifocal leucoencephalopath - Neoplasm Suppurative otitis media( 4%) - facial paralysis may complicate acute or chronic suppurative otitis media or malignant otitis externa.

31. In chronic SOM: compression of facial n. by cholesteatoma or granulation tissue

33. Causes of facial nerve palsy(cont.) Traumatic facial nerve paralysis ( 19 %) Iatrogenic injury : Chronic ear surgery . Parotid tumor resection . Facial nerve tumor resection . Resection of acoustic tumor . Temporal bone fracture . Facial wounds .

34. cholesteatoma

35. Acinic cell tumour

36. parotidecomy

38. C T temporal bone fracture

39. Temporal bone fracture

40. Acoustic neuroma

41. Causes of facial nerve palsy(cont.) Other causes : Multiple sclerosis . Cerebrovascular accident . Myasthenia gravis . Sarcoidosis .

42. Treatment of facial palsy Eye protection Specific treatment : Bell’s palsy ; steroids and decompression . Ramsay Huntsyndrom ; acyclovir . Trauma ; exploration and repair . Tumour ; may need facial nerve sacrifice . Infection ; in chronic otitis media need mastiod exploration.

43. ventilation tube insertion

44. mastoidectomy

45. Thank you Dr. Ibrahim HabibBarakat ENT consultant (MD) E-mail: salamatuall@yahoo.com www.facebook.com/Dr.Ibrahim.Barakat