• The Facial nerve is the 7th of twelve paired cranial nerves. • It is a mixed nerve with motor and sensory roots. • It also supplies pre-ganglionic parasympathetic fibres to several head and neck ganglia Branches 1. Greater superficial petrosal – arises from the geniculate ganglion. 2. Branches within the facial canal: • i) nerve to stapedius • ii) Chorda tympani 3. After exit from stylomastoid foramen: • i) Posterior auricular • ii) Nerve to posterior belly of digastric • iii) Nerve to stylohyoid. 4. On the face - Five major branches: • i) Temporal • ii) Zygomatic • iii) Buccal • iv) Marginal mandibular • v) Cervical

1. Neurology
department
TSMU
DONE BY :
MUSTAFA KHALIL IBRAHIm
4th
year, 2nd
sem, 1st
group

2. CONTENTS
1.Introduction
2. Nuclei of origin
3. Course & Relations
4. Branches of facial nerve
5. Ganglia associated with facial nerve
6. Testing of facial nerve
7. Identification of facial nerve
8. Nerve injury

3. • The Facial nerve is the 7th of twelve paired cranial nerves.
• It is a mixed nerve with motor and sensory roots.
• It also supplies pre-ganglionic parasympathetic fibres to several
head and neck ganglia
Introduction
Nuclei of Origin
1.Motor nucleus
2. Superior salivatory nucleus
3.Nucleus of tractus solitaries
This facial nuclei in pons is divided into :
1- Lower parts which innervate the upper half of
The face & it has double cortical innervation.
2- upper parts which innervate the lower half of
The face & it has single cortical innervation.

4. The facial nerve is formed mainly of two parts:
• 1- Facial nerve proper (motor): arising from facial motor nucleus in
pons.
• 2- Nervus intermedius: it is the sensory root of facial lies position between
the facial proper and vestibulcochlear nerve in the pontocerebellar angle.
Carrying para-sympathetic fibers (from superior salivary nucleus) and taste fibers
( to the solitary nucleus).
Course & Relations
• I- Intracranial (intrapetrosal) course
• II- Extracranial course

7. Branches
1. Greater superficial petrosal – arises from the geniculate ganglion.
2. Branches within the facial canal:
• i) nerve to stapedius
• ii) Chorda tympani
3. After exit from stylomastoid foramen:
• i) Posterior auricular
• ii) Nerve to posterior belly of digastric
• iii) Nerve to stylohyoid.
4. On the face - Five major branches:
• i) Temporal
• ii) Zygomatic
• iii) Buccal
• iv) Marginal mandibular
• v) Cervical

8. Ganglia associated with facial nerve
• Geniculate ganglion
• Submandibular ganglion
• Pterygopalatine ganglion
Geniculate ganglion
• The geniculate ganglion (from Latin genu, for "knee") is an L-shaped collectionof
fibers and sensoryneurons of the facial nerve located in the facial canal of the head.
• It receives fibers from the motor, sensory, and parasympathetic components of the
facial nerve
Submandibular ganglion
• The submandibular ganglion is small and fusiform in shape. It is situated above
the deep portion of the submandibular gland, on the hyoglossus muscle, near the
posterior border of the mylohyoid muscle
Pterygopalatine ganglion
• The pterygopalatine ganglion (meckel's ganglion, nasal ganglion or
sphenopalatine ganglion) is a parasympathetic ganglion found in the
pterygopalatine fossa.
• It's largely innervated by the greater petrosal nerve (a branch of the facial
nerve); and its axons project to the lacrimal glands and nasal mucosa
Facial Nerve blood supply
• The facial nerve gets it’s blood supply from 5 vessels:
 Anterior inferior cerebellar artery – at the cerebellopontine angle
 Labyrinthine artery (branch of anterior inferior cerebellar artery) – within
internal acoustic meatus
 Superficial petrosal artery (branch of middle meningeal artery) – geniculate
ganglion and nearby parts
 Stylomastoid artery
(branch of posterior auricular artery) – mastoid segment
 Posterior auricular artery supplies the facial nerve at & distal to stylomastoid
foramen
• Venous drainage parallels the arterial blood supply

9. Testing of Facial Nerve Branches
• Temporal branches -patient is asked to frown and wrinkle his or her forehead.
• Zygomatic branches -the patient is asked to close their eyes tightly
• Buccal branches -puff up cheeks (buccinator) smile and show teeth
(orbicularis oris) tap with finger over each cheek to detect ease of air expulsion
on the affected side
Temporal branch
• It exits the parotid gland anterior to superficial temporal artery
During an open approach to the TMJ, violation of this branch is possible
Zygomatic Branch
• Its course is antero superior crossing the zygomatic bone
Inadvertent damage may occur to this nerve during open reduction of
zygomatic arch or with the use of zygomatic hook during closed approaches
Buccal Branch:
• It runs almost horizontally and will often divide into separate branch above
and below parotid duct as it runs anteriorly
Injury is possible in association with soft tissue trauma to the cheek region
Marginal mandibular branch
• It extends anteriorly and inferiorly within the substance of parotid gland, there
may be two or three branches of this nerve.
These branches run anteriorly parallel to inferior border of mandible and in
some cases the course of the nerve is above the inferior border.
In essentially all cases the nerve is located above the inferior border of
mandible beyond the facial artery. The marginal mandibular branch is an
important structure encountered at the inferior border of the mandible just
beneath the platysma muscle fibres during an open approach to the mandibular
angle and body area.
• For this reason, an initial incision made approximately 1 to 1.5cm below the
inferior border which prevents direct exposure or trauma to the nerve

10. Cervical Branch:
• The cervical branch exits the parotid gland above its inferior pole and runs
downwards underneath the platysma muscle
3 surgicalmaneuvers used to identify
nerve trunk
A. Bloodfree plane in front
of external acoustic
meatus
B. Exposure of anterior
border of SCM below
insertion into mastoid
process
C. Peripheral identification
of terminal branch of
facialnerve (marginal
mandibular branch)
Identification of Facial Nerve

12.  Duus'_Topical_Diagnosis_in_Neurology
 Neuroanatomy atlas
 ginsberg_l_lecture_notes_neurology
 Dan Kirshenbaum BUSM Class of 2011 - Gross Anatomy 2007
 Dr.Hassan Elwan Neurology
 Also Some internet photos
References