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Facial n. Evaluation :new_moon_with_face: (:sunny:Anatomy (Blood supply…
Facial n. Evaluation
:new_moon_with_face:
:sunny:
Anatomy
Structural anatomy
Intracranial
Since motor cortex ⇨ Cerebellopontine angle
ก่อนเข้า Internal Auditory canal
(IAC)
Portion
Supranuclear pathway
Facial nucleus
Infranuclear pathway
Lesion & its involvement
:grapes:
Intratemporal
portion
Meatal
segment
Within
IAC
—
Contents
within IAC includes
Facial n.
Cochlear n.
Superior vestibular n.
Inferior vestibular n.
Labyrinthine artery
วิธีจำ “7up Cokedown”
Labyrinthine
segment
Fr Fundus ⇨ Geniculate gg. between Labyrinth & Cochlear
Gives
1st branch — Greater superficial petrosal nerve (GSPN)
No vascular anastomosis
Narrowest segment of Fallopian canal (0.68 mm diameter)
So if n. บวม ⇨ Facial n. ฉีกขาดได้
Tympanic
or
Horizontal
segment
Fr Geniculate gg. ⇨ Oval window (1st genu to 2nd genu)
No branch
Most dehiscence (50%)
Mastoid
or
Vertical
segment
Fr 2nd genu ⇨ Stylomastoid foramen
Gives branches
Branch to Stapedial ms
Chorda tympani nerve
Extratemporal :star:
main
:star:
Fr Stylomastoid foramen ⇨ Parotid gland (superficial & deep lobe)
แตกแขนงแบบ Peis ancerinus (Goose’s foot)
Blood supply
No significance*
Internal Auditory a. (AICA)
Petoral branch of Middle meningeal a,
Stylomastoid branch of Post. Auricular a. (Occipital a.)
No vascular anastomosis at Geniculate gg
Functional anatomy
Recall that nerve fibers have
6 jobs
Afferent nerve fiber (Sensory neuron) ⇨ GSA, GVA, SSA, SVA
Efferent nerve fiber (Motor neuron) ⇨ GSE, GVE, SVE
Func of Facial n
(4)
Special Visceral Afferent (SVA)
Taste fiber (Taste bud Ant. 2/3 of tongue, Hard palate & Soft palate)
Chorda tympani (lingual nerve)⇨Geniculate gg
Nervus intermedius⇨Nucleus of Tractus solitareus
General Visceral Afferent (GVA)
Sensory fibers (Tympanic cavity, Tympanic mb, EAC)
⇨ Nucleus of Tractus solitareus
Special Visceral Efferent (SVE)
Motor fibers ⇨ Muscles of facial expression, Platysma ms, Posterior belly of Digastric m, Stylohyoid m.
General Visceral Efferent (GVE)
Parasympathetic fibers fr Supeiror salivary nucleus
⇨ lacrimal, palatine, minor salivary gland (GSPN)
⇨ submandibular, sublingual gland (Chorda tympani n.)
:gear:
PathoPSO of nerve injury
:crescent_moon:
Nerve fiber component
:fire:
Nerve injury
Classification
Seddon classification
Sunderland classification
The goddamn House-Brackmann
Def of Nerve injury
Seddon
Neuropraxia
Axonotmesis
Neurontmesis
Sunderland
compared as
Degree
1st deg (Neurapraxia)
2nd deg (Axonotemesis)
3rd deg
endoneurium โดน
(Neurotemesis)
4th deg
perineurium โดน
(Neurotemesis)
5th deg
epineurium โดน
(Neurotemesis)