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
Bells 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.