Trigeminal and facial nerve

Trigeminal nerve
1. Sensory component
  1. 3 nuclei
    1. Main sensory nucleus (touch and position)
    2. Spinal nucleus of V (pain and temperature)
    3. Mesencephalic nucleus (proprioception and mechanoception from jaw and teeth)
2. Motor component
  1. Masticatory muscles
3. Reflexes
  1. Corneal reflex (blink reflex)
  2. Jaw jerk reflex
    1. If exaggerated, it can be due to pseudobulbar palsy
4. 3 exits
  1. Superior orbital fissure
  2. Foramen rotundum
  3. Foramen ovale
5. Trigeminal neuralgia
  1. Therapy
    1. Gasserian ganglion ablative technique
    2. Microvascular decompression
    3. Gamma-knife radiosurgery
  2. excruciating lancinating paroxysms in the face
  3. Pathogenesis
    1. compression near the entry zone due to an ectatic vascular loop
Facial nerve
1. Intracranial branches
  1. Greater petrosal nerve
  2. Nerve to stapedius
  3. Chorda tympani
2. Extracranial branch
  1. Posterior auricular nerve
  2. Branch to posterior belly of digastric muscle and the stylohyoid muscle
  3. 5 major facial branches (in parotid gland)
3. Bell's palsy
  1. Etiology
    1. Inflammation of the nerve at the geniculate ganglion
      1. -> Compression, ischemia and demyelination of the nerve
      2. viral infections (HSV in young) and vascular damage in elderly, especially diabetic patients
  2. Diagnosis
    1. EMG
    2. MRI
    3. CSF
  3. Therapy
    1. Protect the eye by patching and lubrication
    2. Corticosteroids
    3. Antiviral agents
  4. Consequences
    1. Aberrant reinnervation of muscles and glands
      1. Synkinesis
    2. Aberrant parasympathetic reinnervation
    3. Hemifacial spasms
      1. Causes
      2. Treatment
        Botulinum Toxin
        Microvascular decompression of VII
        Anticonvulsants
  5. sudden onset (1-5 days)
4. Nuclei
  1. Facial nucleus
    1. Motor
    2. Lower pons
  2. Nucleus solitarius
  3. Superior salivatory nucleus
    1. Parasympathetic efferents to salivary glands
5. Peripheral VII nerve palsy
  1. Signs
  2. Peripheral vs Central CN VII palsy
    1. Central palsy
      1. Lesion of the corticopontine fibers
  3. Causes
    1. Compressive
    2. Herpes Zoster
    3. Meningitis
    4. Autoimmune diseases
    5. Gullain-Barré
    6. Lyme disease

Nächster

Trigeminal and facial nerve

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