VII N.

facialis (mixed)
Nucleus
1. Main motor nucleus (in reticular formation of lower part of pons) (innervate mimetic facial muscles)
- Part of nucleus innervate upper part of face has bilateral corticonuclear innervations
- Part of nucleus innervate lower part of face has contralateral corticonuclear innervation
2. Parasympathetic nucleus
- Consist of
a. Superior salivatory (receive afferentation from hypothalamus and nucleus tractus solitarius)
b. Lacrimal nuclei (afferentation from hypothalamus for emotional response and sensory nuclei of trigeminal nerve for reflex
lacrimation for secondary irritation of cornea or conjunctiva)

3. Sensory nucleus (upper part of nucleus tractus solitarius)

- Efferent fiber cross median plane and ascend to ventral posterior medial nucleus of contralateral thalamus then thru internal
capsule to corona radiate and end in postcentral gyrus

General pathway

General signs of lesions of n. facialis

1. Peripheral paralysis of muscles of facial expression (prosoplegia), asymmetry face (affected side becomes like mask-like, as in
Parkinsonism)
2. Forehead and nasolabial crease smoothened
3. Wider palpebral fissure, lowered mouth angle
4. Expressionless (cannot form facial wrinkle, cannot close eye @ lagopthalmus due to weakness of m. orbicularis oculi)
5. Difficulty eating (foods particle fall out to the weak corner)
6. Hyperacusis
7. Bells palsy/phenomenon
8. Other features of peripheral paralysis: muscular atrophy, absent of reflexes (e.g. superciliary)
Different level of lesions of n. facialis
1. Lesions of nucleus or fibers inside brainstem
- Peripheral paralysis of facial muscles (muscles of expression)
- Maybe accompanied with contralateral central paralysis of body (Alternating Miere-Gubler syndrome) or n. abducens palsy
(Fovilles syndrome)
2. Lesions of root n. facialis (from its exit from brainstem)
- Peripheral paralysis of facial muscles (muscles of expression)
- Usually combined with n. vestibulocohclearis palsy (deafness) with other sign of ponto-medulla oblongata lesions)
- Not accompanied by either excessive lacrimation or dryness of eye (xeropthalmia)
- Marked disturbances of taste in anterior 2/3 of tongue together with dryness of mouth
- Hyperakusis absent due to n. vestibulocohclearis palsy
[hyperakusis: Unpleasant or enhanced perception of sound especially low tone]
3. Lesions in canalis facialis
a. Lesions up to origin of n. petrosus major
- Peripheral paralysis of facial muscles (muscles of expression)
- Xeropthalmia
- Depression of reflexes (superciliary and corneal reflex)
- Taste disturbances and decrease salivation leads to dryness of mouth
- Hyperacusia
b. Lesions up to origin of n. stapedius
- Same as above, but instead of xeropthalmia there is excessive lacrimation
- If lesions occur more distally from origin of n. stapedius, hyperacusia absent
4. Lesions at place of its exit from foramen stylomastoideum
- Only peripheral paralysis of facial muscles with excessive lacrimation
5. Central lesions (rare): usually in combination with hemiplegia. Isolated central paralysis of facial muscles occur very rare (e.g.
lesion of frontal lobe, inferior part of precentral gyrus, tractus corticospinalis at cortex, corona radiate, internal capsule, cerebral
peduncle, pons, etc). Upper facial muscles are almost always not affected because of bilateral control of cortex. Atrophy absent with
pathological reflexes present.
- Isolated mononeuropathy occur frequently (usually unilateral)