Facial nerve lesions

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Information about Facial nerve lesions
Health & Medicine

Published on March 18, 2014

Author: samankaru

Source: slideshare.net


For first year medical/dental students

Lesion Clinical Features Discription Upper motor neuron lesion spastic paralysis of the contralateral lower face. For example, a left corticobulbar lesion results in paralysis of the muscles that control the lower right quadrant of the face(stylohyoid; posterior belly of digastric, buccinator, and platysma) with near normal eye closure. Spontaneous emotional expression may be un affected with sub cortical lesions. Any lesion occurring within or affecting the corticobulbar tract is known as an upper motor neuron lesion. Corticobulbar fibers from the precentral gyrus (frontal lobe) project to the facial nucleus, with most crossing to the contralateral side. As a result, crossed and uncrossed fibers are found in the nucleus. Moreover, the facial nucleus can be divided into two parts: (1) the upper part, which receives corticobulbar projections bilaterally and later courses to the upper parts of the face, including the forehead, and (2) the lower part, the predominantly crossed projections of which supply innervation to lower facial muscles (stylohyoid; posterior belly of digastric, buccinator, and platysma) Lower motor neuron lesion Pons ( facial nerve nucleus) paralysis of ipsilateral facial muscles (both upper and lower parts of the face) Associated ipsilateral VI nerve palsy and contralateral hemiplegia. Causes: Vascular Tumour Demyelination LMN lesion of the branchial motor component of CN VII. lower motor neuron lesion eliminate innervation altogether because the nerves no longer have a means to receive compensatory contralateral input at a downstream decussation. Close proximity of VI nerve and VII nerve nucleus. Facial Nerve Lesions

Cerebello pontine angle/ internal auditory meatus Facial canal MND Associated V, VIII (IX, X, XI) nerve palsies. Loss of taste of ipsilateral anterior 2/3 of the tongue, Loss of secretion from ipsilateral lacrimal gland and mucous membranes of nasal and oral pharynx, Loss of secretion from ipsilateral submandibular and sublingual glands. Loss of general sensation from concha of external ear and small area of skin behind the ear Hyperacusis Causes: Acoustic tumors Meningioma Epidermoid Loss of taste of ipsilateral anterior 2/3 of the tongue, Loss of secretion from ipsilateral submandibular and sublingual glands. Hyperacusis ( If proximal to nerve to stapedius) Lacrimation is intact. special sensory component of CN VII ( via corda tympanic nerve) secreto motor parasympathetic component of CN VII(via greater petrosal nerve) secreto motor parasympathetic component component of CN VII (via corda tympanic nerve) general sensory component of CN VII visceral motor component of CN VII( via nerve to stapedius)

Extra cranial branches Causes: Base of the skull fractures( specially temporal bone) Otitis media Ramsey Hunt Syndrome Bell’s palsy Weakness localize to specific muscle groups Lacrimation, salivation and taste retained. Causes: Parotid gland lesions Parotid surgeries Facial trauma posterior auricular nerve (innervating postauricular and occipital muscles) Two smaller branches to the stylohyoid and posterior belly of the digastric muscle The temporal trunk innervates the following muscles: Frontalis Orbicularis oculi Corrugator supercilii Pyramidalis The zygomatic division innervates the following muscles: Zygomaticus major Zygomaticus minor Elevator ala nasi Levator labii superioris Caninus Depressor septi Compressor nasi Dilatator naris muscles The buccal division gives off fibers to innervate the buccinator and superior part of the orbicularis oris muscle. Mandibular division innervations are found in the following muscles:

Risorius Quadratus labii inferioris Triangularis Mentalis Lower parts of the orbicularis oris The cervical division provides platysma innervation.

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