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The facial nerve also supplies preganglionic [[parasympathetic]] fibers to several head and neck [[ganglia]]. The facial and [[intermediate nerve]]s can be collectively referred to as the '''nervus intermediofacialis.'''{{citation needed|date=August 2024}} ==<span lang="ar" dir="rtl">Structure</span>== The path of the facial nerve can be divided into six segments: # intracranial (cisternal) segment (from brainstem pons to internal auditory canal) # meatal (canalicular) segment (within the internal auditory canal) # labyrinthine segment (internal auditory canal to geniculate ganglion) # tympanic (or horizontal) segment (from [[geniculate ganglion]] to [[pyramidal eminence]]) # mastoid (or vertical) segment (from pyramidal eminence to stylomastoid foramen) # extratemporal segment (from stylomastoid foramen to post parotid branches) The motor part of the facial nerve arises from the [[facial nerve nucleus]] in the [[pons]], while the sensory and parasympathetic parts of the facial nerve arise from the [[intermediate nerve]]. From the brain stem, the motor and sensory parts of the facial nerve join and traverse the [[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. The labyrinthine segment is the shortest and narrowest segment of the facial nerve 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 first branch of the facial nerve, the [[greater petrosal nerve]], arises here from the geniculate ganglion. The greater petrosal nerve runs through the [[pterygoid canal]] and synapses at the [[pterygopalatine ganglion]]. Postsynaptic fibers of the greater petrosal nerve innervate the [[lacrimal gland]]. In the tympanic segment, the facial nerve runs through the [[tympanic cavity]], medial to the [[incus]]. The [[pyramidal eminence]] is the second bend in the facial nerve, where the nerve runs downward as the mastoid segment, the longest segment of the facial nerve. In the temporal part of the facial canal, the nerve gives branch to the [[stapedius muscle]] and [[chorda tympani]]. The chorda tympani supplies taste fibers to the anterior two thirds of the tongue, and also synapses with the [[submandibular ganglion]]. Postsynaptic fibers from the submandibular ganglion supply the [[Sublingual gland|sublingual]] and [[submandibular gland]]s. Upon emerging from the [[stylomastoid foramen]], the facial nerve gives rise to the [[Posterior auricular branch of facial|posterior auricular branch]]. It then gives rise to the branch to the posterior belly of the digastric, and then the branch to the stylohyoid. The facial nerve then passes through the [[parotid gland]], which it does not innervate, to form the [[parotid plexus]]. The nerve then bifurcates at the [[Pes anserinus (facial nerve)|pes anserinus]] to become the upper and lower divisions of the facial nerve.<ref>{{Cite web |title=Parotidectomy with Facial Nerve Dissections {{!}} Iowa Head and Neck Protocols |url=https://medicine.uiowa.edu/iowaprotocols/parotidectomy-facial-nerve-dissections#:~:text=The%20pes%20anserinus%20is%20the,buccal,%20marginal%20mandibular%20and%20cervical. |access-date=2023-11-05 |website=medicine.uiowa.edu}}</ref> It then splits into five branches (temporal, zygomatic, buccal, marginal mandibular and cervical), innervating the [[muscles of facial expression]].<ref>{{cite journal | vauthors = Gupta S, Mends F, Hagiwara M, Fatterpekar G, Roehm PC | title = Imaging the facial nerve: a contemporary review | journal = Radiology Research and Practice | volume = 2013 | pages = 248039 | date = 2013 | pmid = 23766904 | pmc = 3676972 | doi = 10.1155/2013/248039 | doi-access = free }}</ref><ref>{{Cite book | edition = Ninth | publisher = LWW | isbn = 9781451110326 | vauthors = Snell RS | title = Clinical Anatomy by Regions | location = Philadelphia, Pa.; London | date = 2011}}</ref> ===Intracranial branches=== The [[greater petrosal nerve]] arises at the [[superior salivatory nucleus]] of the pons and provides parasympathetic innervation to several glands, including the [[nasal glands]], the [[palatine glands]], the [[lacrimal gland]], and the [[pharyngeal gland]]. It also provides parasympathetic innervation to the [[sphenoid sinus]], [[frontal sinus]], [[maxillary sinus]], [[ethmoid sinus]], and [[nasal cavity]]. This nerve also includes taste fibers for the [[palate]] via the [[lesser palatine nerve]] and [[greater palatine nerve]]. The communicating branch to the [[otic ganglion]] arises at the [[geniculate ganglion]] and joins the [[lesser petrosal nerve]] to reach the otic ganglion.<ref>{{cite book |title=Textbook of Clinical Neuroanatomy |edition=2nd | vauthors = Singh V |page=104}}</ref> The [[nerve to stapedius]] provides motor innervation for the [[stapedius muscle]] in middle ear The [[chorda tympani]] provides parasympathetic innervation to the sublingual and submandibular glands, as well as special sensory taste fibers for the anterior two thirds of the tongue.<ref name=":0" /> ===Extracranial branches=== Distal to [[stylomastoid foramen]], the following nerves branch off the facial nerve: * [[Posterior auricular nerve]] which controls movements of some of the scalp muscles around the ear * Branch to posterior belly of [[digastric muscle]] * Branch of the [[stylohyoid muscle]] * Five major facial branches (at [[parotid plexus]]) – from superior to inferior: ** [[Temporal branch of the facial nerve|Temporal branch]] ** [[Zygomatic branch of the facial nerve|Zygomatic branch]] ** [[Buccal branch of the facial nerve|Buccal branch]] ** [[Marginal mandibular branch of the facial nerve|Marginal mandibular branch]] ** [[Cervical branch of the facial nerve|Cervical branch]] {{Citation needed span|text=Intra operatively the facial nerve is recognized at 3 constant landmarks:|date=January 2011}} # At the tip of [[Tragus (ear)|tragus]] where the nerve is 1&nbsp;cm deep and inferior<ref>{{cite journal | vauthors = Saha S, Pal S, Sengupta M, Chowdhury K, Saha VP, Mondal L | title = Identification of facial nerve during parotidectomy: a combined anatomical & surgical study | journal = Indian Journal of Otolaryngology and Head and Neck Surgery | volume = 66 | issue = 1 | pages = 63–8 | date = January 2014 | pmid = 24605304 | pmc = 3938689 | doi = 10.1007/s12070-013-0669-z }}</ref> # At the posterior belly of digastric by tracing this backwards to the tympanic plate, the nerve can be found between these two structures # By locating the [[posterior facial vein]] at the inferior aspect of the gland where the marginal branch would be seen crossing it. #[[Lateral semicircular canal]] # Foot of incus ===Nucleus=== The [[cell bodies]] for the facial nerve are grouped in anatomical areas called [[nucleus (neuroanatomy)|nuclei]] or [[ganglion|ganglia]]. The cell bodies for the afferent nerves are found in the [[geniculate ganglion]] for taste sensation. The cell bodies for muscular efferent nerves are found in the [[facial motor nucleus]] whereas the cell bodies for the parasympathetic efferent nerves are found in the [[superior salivatory nucleus]]. ===Development=== The facial nerve is developmentally derived from the second [[pharyngeal arch]], or branchial arch. The second arch is called the hyoid arch because it contributes to the formation of the lesser horn and upper body of the [[hyoid bone]] (the rest of the hyoid is formed by the third arch). 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 plate (neural tube)|basal plate]] of the embryonic pons, while the sensory division originates from the [[cranial neural crest]].<ref>{{Cite book | edition = Sixth | publisher = LWW | isbn = 9781451190380 | vauthors = Dudek RW | title = BRS Embryology | date = 2014 }}</ref> Although the anterior two thirds of the tongue are derived from the first pharyngeal arch, which gives rise to the trigeminal nerve, not all innervation of the tongue is supplied by it. The lingual branch of the [[mandibular division]] (V3) of the [[trigeminal nerve]] supplies non-taste sensation (pressure, heat, texture) to the anterior part of the tongue via [[general somatic afferent fibers]]. Nerve fibers for taste are supplied by the chorda tympani branch of the facial nerve via [[special visceral afferent]] fibers.<ref>{{Cite book | edition = 9th | publisher = Saunders | isbn = 9781437720020 | vauthors = Moore KL, Persaud TV, Torchia MG | title = The Developing Human: Clinically Oriented Embryology with Student Consult Online Access, 9th Edition | location = Philadelphia, PA | date = 2011}}</ref> == Function == ===Facial expression=== The main function of the facial nerve is motor control of all the [[facial muscles|muscles of facial expression]]. It also innervates the posterior belly of the [[digastric muscle]], the [[stylohyoid muscle]], and the [[stapedius muscle]] of the [[middle ear]]. These [[skeletal muscle]]s are developed from the [[Pharyngeal arch#Second arch |second pharyngeal arch]]. ===Facial sensation=== 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 (superior part) of the [[solitary nucleus]]. General sensation from the anterior two-thirds of tongue are supplied by afferent fibers of the third division of the fifth cranial nerve ([[CN V]]-3). These sensory ([[CN V3]]) and taste (VII) fibers travel together as the lingual nerve briefly before the chorda tympani leaves the lingual nerve to enter the tympanic cavity (middle ear) via the petrotympanic fissure. It joins the rest of the facial nerve via the canaliculus for chorda tympani. The facial nerve then forms the [[geniculate ganglion]], which contains the cell bodies of the taste fibers of chorda tympani and other taste and sensory pathways. From the geniculate ganglion, the taste fibers continue as the intermediate nerve which goes to the upper anterior quadrant of the fundus of the [[internal acoustic meatus]] along with the motor root of the facial nerve. The intermediate nerve reaches the posterior cranial fossa via the internal acoustic meatus before synapsing in the [[solitary nucleus]]. The facial nerve also supplies a small amount of afferent 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 [[Pinna (anatomy)|auricle]] (outer ear). ===Other=== The facial nerve also supplies [[parasympathetic nervous system|parasympathetic]] fibers to the [[submandibular gland]] and [[sublingual gland]]s via [[chorda tympani]]. Parasympathetic innervation serves to increase the flow of saliva from these glands. It also supplies parasympathetic innervation to the nasal mucosa and the [[lacrimal gland]] via the [[pterygopalatine ganglion]]. The parasympathetic fibers that travel in the facial nerve originate in the [[superior salivatory nucleus]]. The facial nerve also functions as the efferent limb of the [[corneal reflex]]. ===Functional components=== The facial nerve carries axons of type GSA, [[general somatic afferent]], to skin of the posterior ear. The facial nerve also carries axons of type GVE, [[general visceral efferent]], which innervate the sublingual, submandibular, and lacrimal glands, also mucosa of nasal cavity. Axons of type SVE, [[special visceral efferent]], innervate muscles of facial expression, stapedius, the posterior belly of digastric, and the stylohyoid. The axons of type SVA, [[special visceral afferent]], provide taste to the anterior two-thirds of tongue via [[chorda tympani]]. ==Clinical significance== ===Palsy=== {{See also|Bell's palsy|acute facial nerve paralysis}} People may suffer from [[acute facial nerve paralysis]], which is usually manifested by facial paralysis.<ref>{{cite journal | vauthors = Masterson L, Vallis M, Quinlivan R, Prinsley P | title = Assessment and management of facial nerve palsy | journal = BMJ | volume = 351 | pages = h3725 | date = September 2015 | pmid = 26378061 | doi = 10.1136/bmj.h3725 | s2cid = 206906594 }}</ref> [[Bell's 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 Bell's palsy may also be as a result of an incorrectly placed dental local-anesthetic ([[Inferior alveolar nerve anaesthesia|inferior alveolar nerve block]]). Although giving the appearance of a hemiplegic stroke, effects 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.{{citation needed|date=August 2013}} [[Facial nerve decompression]] surgery is also sometimes carried out in certain cases of facial nerve compression. ===Examination=== Voluntary facial movements, such as wrinkling the brow, showing teeth, frowning, closing the eyes tightly (inability to do so is called [[lagophthalmos]]),<ref name=Lindgren>Kliniska Färdigheter: Informationsutbytet Mellan Patient Och Läkare, LINDGREN, STEFAN, {{ISBN|91-44-37271-X}}</ref> pursing the lips and puffing out the cheeks, all test the facial nerve. There should be no noticeable asymmetry. In an [[upper motor neuron]] lesion, called [[central seven]], only the lower part of the face on the contralateral side will be affected, due to the bilateral control to the upper facial muscles ([[Frontalis muscle|frontalis]] and [[Orbicularis oculi muscle|orbicularis oculi]]). [[Lower motor neuron]] lesions can result in a CN VII palsy (Bell's palsy is the idiopathic form of facial nerve palsy), manifested as both upper and lower facial weakness on the same side of the lesion. Taste can be tested on the anterior two-thirds of the tongue. This can be tested with a swab dipped in a flavored solution, or with electronic stimulation (similar to putting your tongue on a battery). [[Corneal reflex]]. The afferent arc is mediated by the general sensory afferents of the trigeminal nerve. The efferent arc occurs via the facial nerve. The reflex involves consensual blinking of both eyes in response to stimulation of one eye. This is due to the facial nerves' innervation of the muscles of facial expression, namely orbicularis oculi, responsible for blinking. Thus, the corneal reflex effectively tests the proper functioning of both cranial nerves V and VII. ==Additional images== <gallery> File:Brain human normal inferior view with labels en.svg|Inferior view of the human brain, with the cranial nerves labelled. File:Gray781.png|Mandibular division of the trifacial nerve. File:Gray788.png|Plan of the facial and intermediate nerves and their communication with other nerves. File:Gray789.png|The course and connections of the facial nerve in the [[temporal bone]]. File:Gray792.png|Upper part of medulla spinalis and hind- and mid-brains; posterior aspect, exposed in situ. File:Gray1209.png|Left temporal bone showing surface markings for the tympanic antrum (red), transverse sinus (blue), and facial nerve (yellow). File:Head facial nerve branches.jpg|Head facial nerve branches File:Slide2umr.JPG|Facial nerve. Deep dissection. </gallery> == See also == {{Anatomy-terms}} * [[List of medical mnemonics#Anatomy]] * [[List of anatomy mnemonics#Cranial nerves]] == References == {{Gray's}} {{Reflist}} == External links == {{Commons category|Nervus facialis}} {{Cranial nerves}} {{Authority control}} {{Portal bar|Anatomy}} [[Category:Facial nerve| ]] [[Category:Cranial nerves]] [[Category:Motor system]] [[Category:Innervation of the face]] [[Category:Autonomic nervous system]] [[Category:Gustatory system]] [[Category:Human mouth anatomy]] [[Category:Otorhinolaryngology]] [[Category:Nerves of the head and neck]] [[Category:Neurology]] [[Category:Nervous system]] [[Category:Parasympathetic nervous system]] </textarea><div class="templatesUsed"><div class="mw-templatesUsedExplanation"><p><span id="templatesused">Pages transcluded onto the current version of this page<span class="posteditwindowhelplinks"> (<a href="/wiki/Help:Transclusion" title="Help:Transclusion">help</a>)</span>:</span> </p></div><ul> 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