SURGICAL

ANATOMY OF
FACIAL NERVE

Naina

Introduction

VII Cr N ; Mixed N
Motor , Sensory , parasympathetic fibers

Motor root special visc. eff. Fibers

Sensory & Parasymp. carried by NERVUS

INTERMEDIUS(N of wrisberg)

NI consists of General visc. Eff.

Special visc. Aff.
Somatic Aff.

Facial Nerve Nuclei

1)

2)

3)

3 nuclei
Motor nucleus lower
pons below 4th
ventricle
Superior salivatory
nucleus dorsal to
motor N
N of tractus solitarius
medulla oblongata

Central Connections of
FN

Dorsal part of N B/L

supra nuclear inn.

Lower part of N C/L inn.

Imp Clinical varieties of

VII N lesions

Cont

Fibers course towards

floor of IV ventricle
Wrap around VI N nucl.
Facial colliculus
Retrace along pons
Exits ponto medullary jn.

Course

Intra cranial portion

1)

From brainstem to IAM

length 15-17mm
FN crosses CP angle wit 8th CN
& NI
Devoid of epineurium
Thin layer of pia mater
Surg imp :
Iatrogenic trauma in CP angle
tumour surgery

Intra Temporal
From IAM to SMF
Length 28 to 30
mm
Fallopian canal
Longest bony canal
3 segments by 2
genus

Region

Meatal Segment

Enters in ant sup segment

of IAC
Length 5 12 mm
No separate sheath
Shares wit NI & 8th CN
FN merges wit NI at fundus

Labyrinthine Segment

Narrowest(0.68) &
Shortest(3-5mm)
No anastomosing arteries
Periostium is thicker
Post. Sup. to cochlea
Ant. Med. to SSCC
Post. to vestibule
Distal end Geniculate
ganglion;1st genu


1)

2)
3)

)
)
)
)

Surgical importance:
Oedema or inflammation can easily compress the
nerve
Part most vulnerable for ischemia(no art anast)
Temporal bone # - Most commonly injured
Geniculate ganglion:
Bipolar ganglion cells
Aff. input somatic & special visceral aff
Secretomotor F to lacrimal gland

Tympanic Segment

Horizontal segment
From GG to 2nd genu
Length 8 to 11mm
Lies beneath LSCC &
above OW
above & medial to
Processus cochleariformis

Cont
Nerve lies lateral &
posterior to Pyramidal
process
Creats 2 recesses
1.
Facial recess (lat)
2.
Sinus tympani(med)
) 2nd genu

Cont

Surgical importance:
Processus
cochleariformis(consistant
landmark)
Imp landmark for 2nd genu

-LSCC
-Pyramidal eminence
-B/w short process of
incus(L) & LSCC(M)

Mastoid Segment

Vertical segment
From 2nd genu(PM) to
SMF(AL)
Longest (13mm)
Landmark Digastric
Ridge
FN leaves FC via
SMF(b/w mastoid tip &
styloid process)

Extra Temporal Region

From SMF to terminal
branches
Runs in substance of
parotid
Main trunk divides
- upper temperofacial
- lower cervicofacial
Pes anserinus
Superficial to
Retromandibular V

Cont
FN
RMV

DM
SCM

EJV

Branches

1)
2)
3)
4)

Intra temporal
region :
GSPN
N to stapedius
Chorda tympani
Sensory auricular
branch

GSPN

From GG
2 types of fibers
Pregang para symp
Pterygopalatine gang.
Post gang lacrimal G
Sensory fibers to nasal
& palatine glds
Joins deep petrosal N
N to pterygoid canal

N to stapedius
6mm above SMF
Supply stapedius
Sensory auricular Br
Joins auricular br of
vagus
Supply retro auricular
groove & concha

Chorda tympani

4mm above SMF

Lat & ant to FN
Post canaliculus
Lat to LP of incus & med to
malleus
Ant canaliculus(Canal of huguier)
2 types of fibers
Parasympathetic submandibular
& subligual G fibres
Special sensory ant 2/3rd of
tongue

1)

2)
3)
4)

Surgical importance:
GSPN - landmark in middle cranial fossa
approach
CT landmark in post tympanotomy
CT lat margin of facial recess
CT medial limit for facial ridge reduction

1)

2)

Extra temporal region

Post.auricular N(occ
frontalis &muscles of
pinna)
Muscular Brs(post belly of
digastric &stylohyoid)

Terminal branches

TEMPORAL
ZYGOMATIC

Temporal :
BUCCAL
Cross zygomatic
arch
Auricularis ant &
sup;frontalis;orb
oculi &
MANDIBULAR
corrugator supercilii
CERVICAL

Zygomatic :
Cross zygomatic bone
Orbiculatis oculi

Marginal mandibular :
1-2cm below inf ramus of
mandible
Muscles of lower lip&chin
Cervical :
Platysma &depressor
anguli oris
Buccal :
1 cm below zyg arch
Along parotid duct

BUCCAL

MANDIBULAR

CERVICAL

1)
2)
3)
4)
5)
6)
7)

Buccal br supplies :
Risorius (smirk)
Buccinator (aids chewing)
Levator Labii Superioris
Levator Labii Alaque Nasi
(snarl)
Levator Anguli Oris(soft smile)
Nasalis (Flare Nostrils)
Orbicularis Oris (Purse Lips)

Blood Supply

Surgical Landmarks

1)
2)
3)
4)
5)
6)
7)

Ear surgery:
GG lies superior to Processus cochleariformis
2nd genu hugs inf aspect of LSCC
FN lies above OW niche
Incus lies lat to FN
FN runs behind Pyramid
FN lies 6-8mm deep to Tympano Mastoid suture
Digastric ridge mastoid seg

Cont

1)
2)
3)
4)
5)

Parotid surgery
Tragal pointer 1cm deep&inf
Tympanomastoid suture
N lies lat to Styloid process
Superficial to Retromandibular
N bisects angle b/w Post
belly of digastric & styloid
process

vein

Otology could be a dull way of life without the

7th cranial N arrogantly swerving through the
temporal bone to the muscles of facial
expression
JOHN GROVES

THANK YOU