Facial nerve

The facial nerve is the seventh cranial nerve, or simply

cranial nerve VII. It emerges from the brainstem between
the pons and the medulla, controls the muscles of facial
expression, and functions in the conveyance of taste sensations from the anterior two-thirds of the tongue and oral
cavity. It also supplies preganglionic parasympathetic
bers to several head and neck ganglia.

petrosal nerve runs through the pterygoid canal

and synapses at the pterygopalatine ganglion. Post
synaptic bers of the greater petrosal nerve innervate the lacrimal gland.
4. In the tympanic segment, the facial nerve runs
through the tympanic cavity, medial to the incus.
5. The pyramidal eminence is the second bend in the
facial nerve, where the nerve runs downward as the
mastoid segment. In the temporal part of the facial
canal, the nerve gives to the stapedius and chorda
tympani. The chorda tympani supplies taste bers
to the anterior two thirds of the tongue, and also
synapses with the submandibular ganglion. Postsynaptic bers from the submandibular ganglion supply the sublingual and submandibular glands.

Structure

The path of the facial nerve can be divided into six segments.
1. intracranial (cisternal) segment
2. meatal segment (brainstem to internal auditory
canal)

6. Upon emerging from the stylomastoid foramen, the

facial nerve gives rise to the posterior auricular
branch. The facial nerve then passes through the
parotid gland, which it does not innervate, to form
the parotid plexus, which splits into ve branches
innervating the muscles of facial expression (temporal, zygomatic, buccal, marginal mandibular,
cervical).[1][2]

3. labyrinthine segment (internal auditory canal to

geniculate ganglion)
4. tympanic segment (from geniculate ganglion to
pyramidal eminence)
5. mastoid segment (from pyramidal eminence to stylomastoid foramen)

6. extratemporal segment (from stylomastoid foramen 1.1 Intracranial branches

to post parotid branches)
Greater petrosal nerve - It arises at the geniculate ganglion and provides parasympathetic inner1. The motor part of the facial nerve arises from the
vation to several glands, including the nasal gland,
facial nerve nucleus in the pons while the sensory
palatine gland, lacrimal gland, and pharyngeal
and parasympathetic parts of the facial nerve arise
gland. It also provides parasympathetic innervation
from the intermediate nerve.
to the sphenoid sinus, frontal sinus, maxillary sinus,
ethmoid
sinus and nasal cavity. This nerve also in2. From the brain stem, the motor and sensory parts
cludes
taste
bers for palate via lesser palatine nerve
of the facial nerve join together and traverse the
and
greater
palatine
nerve.
posterior cranial fossa before entering the petrous
temporal bone via the internal auditory meatus.
Upon exiting the internal auditory meatus, the nerve
then runs a tortuous course through the facial canal,
which is divided into the labyrinthine, tympanic, and
mastoid segments.

Communicating branch to the otic ganglion - It

arises at the geniculate ganglion and joins the lesser
petrosal nerve to reach the otic ganglion.[3]
Nerve to stapedius - provides motor innervation for
stapedius muscle in middle ear

3. The labyrinthine segment is very short, and ends

where the facial nerve forms a bend known as
the geniculum of the facial nerve (genu meaning
knee), which contains the geniculate ganglion for
sensory nerve bodies. The rst branch of the facial
nerve, the greater supercial petrosal nerve, arises
here from the geniculate ganglion. The greater

Chorda tympani
Submandibular gland
Sublingual gland
Special sensory taste bers for the anterior 2/3
of the tongue.
1

1.2

Extracranial branches

FUNCTION

plate of the embryonic pons, while the sensory division

originates from the cranial neural crest.[4]

Distal to stylomastoid foramen, the following nerves

Although the anterior two thirds of the tongue are derived
branch o the facial nerve:
from the rst pharyngeal arch, which gives rise to cranial nerve V, not all innervation of the tongue is supplied
Posterior auricular nerve - controls movements of by CN V. The lingual branch of the mandibular divisome of the scalp muscles around the ear
sion (V3) of CN V supplies non-taste sensation (pressure,
heat, texture) from the anterior part of the tongue via
Branch to Posterior belly of Digastric muscle as well
general visceral aerent bers. Nerve bers for taste are
as the Stylohyoid muscle
supplied by the chorda tympani branch of cranial nerve
[5]
Five major facial branches (in parotid gland) - from VII via special visceral aerent bers.
top to bottom:
Temporal branch
Zygomatic branch
Buccal branch
Marginal mandibular branch
Cervical branch

2 Function
2.1 Facial expression

Intra operatively the facial nerve is recognized at 3 con- The main function of the facial nerve is motor control of
all of the muscles of facial expression. It also innervates
stant landmarks:
the posterior belly of the digastric muscle, the stylohyoid
muscle, and the stapedius muscle of the middle ear. All
1. At the tip of tragal cartilage where the nerve is 1cm
of these muscles are striated muscles of branchiomeric
deep and inferior
origin developing from the 2nd pharyngeal arch.
2. At the posterior belly of digastric by tracing this
backwards to the tympanic plate the nerve can be
found between these two structures
3. By locating the posterior facial vein at the inferior 2.2 Facial sensation
aspect of the gland where the marginal branch would
be seen crossing it.
In addition, the facial nerve receives taste sensations from
the anterior two-thirds of the tongue via the chorda tympani; taste sensation is sent to the gustatory portion (supe1.3 Nucleus
rior part) of the solitary nucleus. General sensation from
the anterior two-thirds of tongue are supplied by aerent
The cell bodies for the facial nerve are grouped in anatombers of the third division of the fth cranial nerve (Vical areas called nuclei or ganglia. The cell bodies for
3). These sensory (V-3) and taste (VII) bers travel tothe aerent nerves are found in the geniculate ganglion
gether as the lingual nerve briey before the chorda tymfor taste sensation. The cell bodies for muscular eerpani leaves the lingual nerve to enter the tympanic cavity
ent nerves are found in the facial motor nucleus whereas
(middle ear) via the petrotympanic ssure. It joins the
the cell bodies for the parasympathetic eerent nerves are
rest of the facial nerve via the canaliculus for chorda tymfound in the superior salivatory nucleus.
pani. The facial nerve then forms the geniculate ganglion,
which contains the cell bodies of the taste bers of chorda
tympani and other taste and sensory pathways. From the
1.4 Embryology
geniculate ganglion the taste bers continue as the interThe facial nerve is developmentally derived from the sec- mediate nerve which goes to the upper anterior quadrant
ond pharyngeal arch, or branchial arch. The second arch of the fundus of the internal acoustic meatus along with
is called the hyoid arch because it contributes to the for- the motor root of the facial nerve. The intermediate nerve
mation of the lesser horn and upper body of the hyoid reaches the posterior cranial fossa via the internal acousbone (the rest of the hyoid is formed by the third arch). tic meatus before synapsing in the solitary nucleus.
The facial nerve supplies motor and sensory innervation
to the muscles formed by the second pharyngeal arch,
including the muscles of facial expression, the posterior
belly of the digastric, stylohyoid and stapedius. The motor division of the facial nerve is derived from the basal

The facial nerve also supplies a small amount of aerent innervation to the oropharynx below the palatine tonsil. There is also a small amount of cutaneous sensation
carried by the nervus intermedius from the skin in and
around the auricle (outer ear).

3.2

2.3

Examination

Other

The facial nerve also supplies parasympathetic bers to

the submandibular gland and sublingual glands via chorda
tympani. Parasympathetic innervation serves to increase
the ow of saliva from these glands. It also supplies
parasympathetic innervation to the nasal mucosa and the
lacrimal gland via the pterygopalatine ganglion. The
parasympathetic bers that travel in the facial nerve originate in the superior salivary nucleus.

3
nerve compression.

3.2 Examination
Voluntary facial movements, such as wrinkling the brow,
showing teeth, frowning, closing the eyes tightly (inability
to do so is called lagophthalmos)[6] , pursing the lips and
pung out the cheeks, all test the facial nerve. There
should be no noticeable asymmetry.

The facial nerve also functions as the eerent limb of the In an UMN lesion, called central seven, only the lower
corneal reex.
part of the face on the contralateral side will be aected,
due to the bilateral control to the upper facial muscles
(frontalis and orbicularis oculi).

2.4

Functional components

The facial nerve carries axons of type GSA, general somatic aerent, to skin of the posterior ear.

Lower motor neuron lesions can result in a CNVII palsy

(Bells palsy is the idiopathic form of facial nerve palsy),
manifested as both upper and lower facial weakness on
the same side of the lesion.

The facial nerve also carries axons of type GVE, general

Taste can be tested on the anterior 2/3 of the tongue.
visceral eerent, which innervate the sublingual, subThis can be tested with a swab dipped in a avoured somandibular, and lacrimal glands, also mucosa of nasal
lution, or with electronic stimulation (similar to putting
cavity.
your tongue on a battery).
Axons of type SVE, special visceral eerent, innervate
Corneal reex. The aerent arc is mediated by the Genmuscles of facial expression, stapedius, the posterior belly
eral Sensory aerents of the Trigeminal Nerve. The efof digastric, and the stylohyoid.
ferent arc occurs via the Facial Nerve. The reex inThe axons of type SVA, special visceral aerent, provide volves consensual blinking of both eyes in response to
taste to the anterior two-thirds of tongue via chorda tym- stimulation of one eye. This is due to the Facial Nerves
pani.
innervation of the muscles of facial expression, namely
Finally, the facial nerve also carries axons of type GVA, Orbicularis oculi, responsible for blinking. Thus, the
general visceral aerent, which provide sensation to the corneal reex eectively tests the proper functioning of
both Cranial Nerves V and VII.
soft palate and parts of the nasal cavity.

3
3.1

Clinical signicance
Palsy

See also: Bells palsy and acute facial nerve paralysis

People may suer from acute facial nerve paralysis,
which is usually manifested by facial paralysis. Bells
palsy is one type of idiopathic acute facial nerve paralysis,
which is more accurately described as a multiple cranial
nerve ganglionitis that involves the facial nerve, and most
likely results from viral infection and also sometimes as
a result of Lyme disease. Iatrogenic Bells Palsy may
also be as a result of an incorrectly placed dental localanesthetic (Inferior alveolar nerve block). Although giving the appearance of a hemi-plegic stroke, eects dissipate with the drug. When the facial nerve is permanently
damaged due to a birth defect, trauma, or other disorder, surgery including a cross facial nerve graft or masseteric facial nerve transfer may be performed to help regain
facial movement. Facial nerve decompression surgery
is also sometimes carried out in certains cases of facial

4 Additional images
Inferior view of the human brain, with the cranial
nerves labelled.
Mandibular division of the trifacial nerve.
Plan of the facial and intermediate nerves and their
communication with other nerves.
The course and connections of the facial nerve in the
temporal bone.
Upper part of medulla spinalis and hind- and midbrains; posterior aspect, exposed in situ.
Left temporal bone showing surface markings for
the tympanic antrum (red), transverse sinus (blue),
and facial nerve (yellow).
Head facial nerve branches
Facial nerve. Deep dissection.

See also

This article uses anatomical terminology;

overview, see Anatomical terminology.

for an

List of medical mnemonics

References

This article incorporates text in the public domain from the

20th edition of Grays Anatomy (1918)
[1] Gupta, Sachin; Francine Mends; Mari Hagiwara;
Girish Fatterpekar; Pamela C. Roehm (2013).
Imaging the Facial Nerve: A Contemporary Review. Radiology Research and Practice 2013: 248039.
doi:10.1155/2013/248039. ISSN 2090-1941. Retrieved
2015-02-07.
[2] PhD, Richard S. Snell MD (2011). Clinical Anatomy by
Regions (Ninth ed.). Philadelphia, Pa.; London: LWW.
ISBN 9781451110326.
[3] Singh, Vishram. Textbook of Clinical Neuroanatomy (2nd
ed.). p. 104.
[4] Dudek, Ronald W. (2014). BRS Embryology (Sixth ed.).
LWW. ISBN 9781451190380.
[5] Moore, Keith L.; T. V. N. Persaud; Mark G. Torchia
(2011). The Developing Human: Clinically Oriented Embryology with Student Consult Online Access, 9th Edition (9th ed.). Philadelphia, PA: Saunders. ISBN
9781437720020.
[6] Kliniska Frdigheter: Informationsutbytet Mellan Patient Och Lkare, LINDGREN, STEFAN, ISBN 91-4437271-X

External links
ent/8 at eMedicine
position of facial nerve on MRI
WUSTL - map
Notes on Facial Nerve

EXTERNAL LINKS

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Facial nerve Source: https://en.wikipedia.org/wiki/Facial_nerve?oldid=707518312 Contributors: Alex.tan, Fnielsen, William Avery,

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