Facial nerve: Anatomical revision

G. Milanes Rodriguez; LdeF Iba?ez Valdés; H. Foyaca Sibat

摘要

This article describes the observations collected from the dissection of nonformalinized cadavers analyzed in respect to the anatomical relation variations of facial nerves. Other findings reported on the medical literature are analyzed. Introduction We manage patients with facial nerve (FN) problems secondary to upper motor neuron or lower motor neuron lesions on every single day and those problems do not have the same characteristic in spite of to be secondary to the same etiology or under similar pathophysiological process therefore we have hypothesized about some anatomical variations of the FN from one patient to another to explain our clinical findings.There are many reports about malformation of the FN and its anatomical variations, since racial differences in mastoid morphology exist, there may be racial differences in the surgical anatomy of the FN in the mastoid. Low 1 dissected thirty Chinese adult temporal bones and he found that the facial nerve in the mastoid coursed vertically (60.0%), anteriorly (33.3%) and posteriorly (6.7%) in the sagittal plane. In the coronal plane, it coursed vertically (46.7%) and laterally (53.3%). The chorda tympani was found to have extra temporal origin in 53.3% and for the rest, the distance of its origin from the stylomastoid foramen averaged 3.17 mm (range 0.5-6.0 mm). The mean dimension of the extended facial recess was 4.40 mm (range 3.0-6.0 mm). The FN was at a mean of 3.15 mm (range 2.0-5.0 mm) posterior to the most posterior point of the tympanic annulus and partially crossed the tympanic annulus from medial to lateral at this point. In conclusion, the typical surgical anatomy of the mastoid FN as described in the Western literature may not apply to the Chinese.The FN is a mixed peripheral nerve being the cranial nerves most commonly affected in neurology. Its main function is motor (Facial expression muscle, buccinators, posterior digastrics, Stylohyoid, Stapeius), also has sensory function (Taste – Ant. 2/3 tongue) and autonomic (Parasymp. –Lachrymal, Sub Maxillary and Sub Lingual glands) we test FN functions on bedside activities very easy (Smile, screw eyes, whistle, show teeth, taste ant 2/3 rd ). Main branches of FN are: A. Posterior auricular branch to occipital belly of occipitofrontalis and auricular muscles, B. Branch to posterior belly digastrics and stylohyoid muscle. C. Temporal branch. D. Zygomatic branch. E. Stylomastoid foramen. F. Bucal branch (buccinators). G. Marginal mandible branch. H. Cervical branch (Platysma)In order to get a better idea about variations of FN we reviewed the investigation done by H?usler and his collaborators 2 He performed 595 stapedotomies between 1992 and 1999 and found 40 cases (6.7%) where the facial nerve had an abnormal course. In 32, a partial nerve prolapsed over the oval window was noted with (6 cases, 1 being a duplicated nerve around the oval window) or without (26 cases) dehiscence in the long bony canal. In 8 cases, there was a total prolapsed of the nerve over the oval window, with 2 special cases: facial nerve having an inferior course over the oval window and the promontory; facial nerve being widely spread over the oval window and the promontory. Concomitant anomalies of the stapes were seen and several patients had dimorphic syndromes with conductive hearing loss since early childhood. Stapedotomy was performed in 39 patients. In the 32 cases of partial nerve prolapsed, a small piston (0.4 mm) was placed in the lower part of the oval window which was sometimes enlarged towards the promontory, except when the nerve was duplicated: the prosthesis was placed into the footplate between the nerve branches. In the 8 patients with total facial nerve prolapsed, the prosthesis was either placed directly in a burr hole into the promontory just below the oval window (6 cases), or, when the nerve ran over the promontory and over the oval window, the prosthesis was placed above the oval window at the site where the facial nerve i

机译：本文介绍了从非正规化尸体解剖中收集的有关面神经解剖关系变化的观察结果。分析医学文献中报道的其他发现。简介我们每天都会处理上运动神经元或下运动神经元病变继发的面神经（FN）问题的患者，尽管这些病因具有相同的病因或在类似的病理生理过程中存在，但仍不具有相同的特征。我们假设从一名患者到另一名患者的FN的一些解剖学变化可以解释我们的临床发现。关于FN畸形及其解剖学变化的报道很多，因为存在乳突形态的种族差异，因此可能存在种族差异。乳突中FN的外科手术解剖。低位1解剖了中国成年的30块颞骨，他发现乳突中的面神经在矢状面内垂直行进（60.0％），向前行（33.3％）和向后行（6.7％）。在冠状平面中，它垂直（46.7％）和横向（53.3％）行进。发现鼓室鼓膜有额外的颞叶起源，占53.3％，其余部分，其起源与胸锁乳突孔的平均距离为3.17 mm（范围为0.5-6.0 mm）。延长的面部凹陷的平均尺寸为4.40毫米（范围为3.0-6.0毫米）。 FN位于鼓膜瓣环最后点的后方平均3.15 mm（范围2.0-5.0 mm），在此点上，鼓膜瓣膜从内侧到外侧部分穿过鼓膜瓣环。总之，西方文献中描述的乳突FN的典型外科手术解剖学可能不适用于中国人。FN是混合的周围神经，是神经学中最常受影响的颅神经。它的主要功能是运动功能（面部表情肌肉，腹直肌，后胃，Stylohyoid，Stapeius），还具有感觉功能（味觉–蚂蚁2/3舌头）和自主神经功能（副瘫痪–唇ach肌，上颌下腺和舌下腺）在床边活动中测试FN功能非常容易（微笑，拧紧眼睛，吹口哨，露出牙齿，品尝蚂蚁2/3号）。 FN的主要分支是：A.耳后支到枕额肌和耳后肌的枕腹部，B。支后腹到腹肌和茎舌肌。 C.临时分支。 D. Z骨科。 E.茎突肌孔。 F.颊支（鼓泡器）。 G.下颌骨边缘分支。 H.宫颈分支（腹膜炎）为了更好地了解FN的变化，我们回顾了H？usler及其合作者所做的调查2他在1992年至1999年间进行了595例手术，发现40例（6.7％）面部神经病程异常。在32例中，发现长椭圆形窗口上部分神经脱垂（6例，其中1例是椭圆形窗口周围的重复神经），或长骨桥中无裂开（26例）。在8例中，卵圆形窗上的神经全部脱出，其中2种特殊情况：面神经在卵圆形窗和海角上的进程较差;面神经广泛散布在椭圆形的窗户和海角上。自儿童早期以来，就发现the骨伴有异常，几例患者患有双态性综合征，伴有传导性听力丧失。造足术共39例。在32例部分神经脱垂的病例中，将一个小的活塞（0.4毫米）放置在椭圆形窗口的下部，有时向海角方向扩大，除非复制了神经：将假体放置在足底之间的足板中神经分支。在8例全部面部神经脱垂的患者中，将假体直接放置在椭圆形窗口正下方的海角上的毛刺孔中（6例），或者当神经越过海角和椭圆形窗口上方时，假体被放置在椭圆形窗口上方的面部神经

Facial nerve: Anatomical revision

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