Upload
others
View
5
Download
0
Embed Size (px)
Citation preview
FACIAL NERVE G IT 'S DISORDERS
FACIAL NERVE
→ mixed Nerve
Motor
SensorySecreto motor
3. N. Saliva torius
MILLARD GUBLERSuperiors is
SYNDROME ,l I
-I Nerve intermedius [ N . Of WISBERG ]
in-Game•
DARES-EasoaEoooams
aaaaamwmrfiFE.a.am
.
*EEoi¥⇒⇒.
iieii: ramen
FallopianBe
canal C 27mm ]⇐¥E¥¥e¥oa÷I. MOTOR NUCLEUS 2. N . Tracks
[ PONS ] Solitaries 1St genu[ Geniculateand
.em÷⇐÷oE⇒⇒::÷
.Htc RWET
cand Tympani¥1of N .
Sty to HugieeerBwp mastoid
IV foramen
Segments
I . Intracranial segmentI Intrameatal segment
II Intra temporal Segment
IIIa- Labyrinthine segment C shortest C 3mm ] , Narrowest Co . 68mm ] Segment ]
HIB-
Tympanic I Horizontal segment
IIc- Mastoid I vertical segment
HI Extra temporal segment
→ fallopian canal ⇒ longest bony canal for any cranial Nerve
→ 8th Nerve accompanies the facial N . in Intra auditory meatus→ MILLARD GUBLER G SYNDROME → Lesion around 615 Nerve nucleus along I
715 N. Nucleus a facial Nerve
→ 1st Ee 2nd genu present in intra temporal segment
Ist genu has Geniculate ganglion
BRANCHES OF FACIAL NERVE
→ No branches in Segment I,
I,
# a
→ from 1st Genu → 3 branches
i. GSPN [ Greater Superficial Petrosal N
.]
• carries pre ganglionic parasympathetic Fibres
2.
Lesser Petrosal Nerve
3.
External Petrosal Nerve
Petro tympanic Middle cranial Deep petrosal1st GSPN y y[ sympathetic
fissure Fossa Nervefibres ]
pre ganglionicparasympathetic
v
VIDI AN NERVE
[ N . Of pterygoid canal ]
v
I in pterygo palatine fossa ]
PTERYGO PALATINE I→ Post Ganglionic fibres
SPHENO PALATINE GANGLION
C largest peripheral parasympathetic Ganglion ]
Supplies
.
Lacrimal Gland 8 Nasal Glands Minor Salivary glandsq
Taste in Palate
→No Branches for IIb
→ Just after and genu , facial N . gives a branch → N.
to Stapedius[ 1St motor branch of facial Nerve ]
→ Before facial N. goes out of style mastoid foramen , gives a branch →
chord a tympani Nerve C first Embryological branch ]
-
comes in from the posterior wall a Comes out from anterior wall throughcanal of AUGIER
CHORD A TYMPANI N.
canal OFLINGUAL N .
HU Gier I
43 IX x
- -Vii Submandibular Ee Sublingual
chord a salivary glands q43 .
tympanyTaste in
Anterior 213 rd of the Tongue
→ submandibular g sublingual Salivary glands supplied by → chord a tympani GHB
Parotid gland Supplied by → Glossopharyngeal Ctx ]
→ After coming out of style mastoid foramen , facial N. goes into the Parotid
gland Ee divides Parotid gland into 2 lobes
I . Superficial lobe
2 . Deep lobe.
→ In parotid gland , facial N.
divides,
into 5 terminal branches
1. TEMPORAL
2. ZYGOMATIC
3. BUCCAL µGOOSE FEET ARRANGEMENT
( Or )
4. MARGINAL MANDIBULARPES ANSE RINUS
5. CERVICAL✓
Bills Bat
Facial N .
superior •
vestibular N .
Region Region
Transverse
crest
cochlear onferror
Nerve vestibular N.
Region Region
BBSTASBB.tnIAM I Int . Auditory canal
BILL 's BAR - vertical ledge of bone
• Named after Dr. William House
[ father Of Neuro otology ]
° Imp . Sx land mark of facial
Nerve
PTERYGO PALATINE FOSSA
Sx Landmarks of facial N . for Parotid Sx
→ facial N .lies I. 5cm deep Ee internal to the CARTILAGE NOUS
TRAGAL POINTER
→ Facial N . is anterior a Superior to the Digastric muscle
→ facial N . is superficial a anterior to the styloid process
TOPO DIAGNOSTIC TESTS
→ used to identify the locator of injury to the facial Nerve
I. SCHIRM ERS I TEAR I LACRIMATION TEST
→ - ive → Bolts sides laerimatn is equal → Normal
→ GSPN is Normal → facial N.
is normal till
1st Genu .
→ t ve →one side lacrimator is decreased
→ Gsp N is affected → injury to facial N . is at Cor ) above Istgenu
2. Stapedial Reflex Test I Acoustic Reflex test
→ protective Reflex
→ positive in N ears → FN is N till and genu→ of it is - ive → Injury may be at or above and genu
3. Taste lest
→ Ant 21 3rd of tongue → by chord a tympani nerve
→ Taste present → + ive → FN is N till style mastoid foramen
→ Taste absent → - ive → Injury is above the style mastoid foramen
4 .
Submandibular Salivary flow Rate
→ supplied by chord a tympani→ salivatn on both sides N
- ive → a , → rap . ④ till £7183,101'd→ salivatn on both Sides Different → + ve → Ab → Injury is above style -
mastoid foramen
Q Patient of RTA , Clo Rt sided UH patsy .
Schriner , Stapedial Reflex , taste test → - ive
Site OF Injury ?
A. Seg IIIa C
. Seg IIc
B . Seg IIb D. Seg Ill
ELECTRO PHYSIOLOGICAL NERVE TESTING
→ Electrical stimulus is given proximal to injury } Normally
Response is recorded distal to stimulus
→ for facial N.
19%
→j÷÷÷÷i÷÷
me
I ] .
( ) ↳ WALLER IAN ,DnEGENERATION
7 2 hrs
4¥.
-
Test is done after 72 hrs
-
Prognostic test
→ Some times,
stimulus can be given proximal to injury a response is recorded
distal to stimulus even in facial Palsy
Q Not a topo diagnostic test of 1111 Nerve Q Not a topo diagnostic test of Vil Nerve
A.
Schirmer s test A.
Schirmer test
B.
Taste Test B.
Taste Test
C.
Impedance Auddometry C . TympanometryD.. Electrophysiological Testing
D . Electrophysiological Testing
DISEASES OF FACIAL NERVE
BELL 'S PALSY
→ Mcc of Facial Nerve Palsy→ Ipsilateral
LMN CUMIN palsy → CIL lower half facial palsy )
Idiopathic
Theories ,
I.
viral Infect 's [ Herpes ]
2. Hypersensitivity I Allergic Theory § EDEMA
OF
3- Autoimmune theory Facial N.
-
But fallopian canal don't → compresses FN → BELL 's PALSY
RAMSAY HUNT SYNDROME I HERPES ZOSTER OTICUS
→ LIVIN facial palsy t Vesicular rash in External Ear
→ 70% of Bell 'S palsy → complete Recovery
15T . of Bell 's palsy → on complete RecoveryL
→I
85% Recovery tout Re
→ 50T . Of H2 Olives → 50J . partial Recovery [ poor Recovery ]
→ Involve other Nerves also.
14 OF Bell 's PalsyI
.Steroids
Prednisone 1mg 1kg I Day
2.
Antiviral
Acyclovir 800mg , 5 times ) Day X 5 Days
Only tin 72 hrs
3. Eye protect 's
Artificial eye drops
Wear goggles , avoid sunny areas , avoid windy areas
Pad the eye in night times ee tape it
4 .Facial Physiotherapy
→ I 2 3 4 X 7 Days → NO improvement-
I.
steroids
3. Eye Protector & TO be continued for 7 days more
4 . Physiotherapy,
2.
Antivirals → stopped
→ After 2 wK$ → No improvement
I.
Steroids → Taper the dose Ee stop
t ,
Not much
Electrophysiological N . testing → Electro physiotherapyDamage
13¥ Sx C labyrinthine compression of
prognosis facial Nerve )