Cochleariform process: small bony protuberance (from which tensor tympani muscle turns 90 0 to insert into malleus) lies 1 mm inferior to geniculate ganglion at anterior end of tympanic segment.
Facial nerve leave brainstem in close association with vestibulocochlear nerve at Cerebello-pontine angle (CP angle).
Location: At the  fundus or lateral end of the internal auditory canal (IAC), the transverse or falciform crest divides the IAC into superior and inferior portions. Greater petrosal nerve carries parasympathetic fibers and Deep petrosal nerve carries sympathetic fibers (sympathetic plexus of Internal Carotid Artery). Note: Facial recess is a triangular space bounded by fossa incudis, facial nerve and chorda tympani (which branches from facial nerve making approximately 30°). Cog: bony ridge hanging from tegmen tympani lies 1 mm above & posterior to cochleariform process. Intracanalicular segment Labyrinthine segment Tympanic segment (horizontal) Mastoid segment (vertical) Then its emerges from the stylomasotid foramen and gives the extra-cranial segment 2: The extra-cranial part 1. Emotional component: Input to the facial nucleus from the basal ganglia and limbic system control involuntary facial expression associated with emotion.
Wrinkling of forehead is a function of frontalis muscle and this is preserved in Upper motor neuron lesions (UMNL) of facial nerve. Emotional (Involuntary) smile may be preserved in supranuclear palsy, while volitional (forced) smile is lost as the pathway for both are different.


Upper motor neuron lesion results in contralateral weakness while the lower motor neurol lesion results in ipsilateral weakness. Vestibular schwannoma and other tumors arising in the region of the cerebellopontine angle, may compress the facial nerve. The Vidian nerve forms at the junction of these nerves on the base of the skull and enters the vidian (pterygoid) canal in the anterior wall of foramen lacerum.
This is an important surgical route for entry into middle ear, especially in combined approach tympanoplasty. Exits: the skull base through the stylomastoid foramen, between the mastoid tip laterally and the styloid process medially. Motor function of facial nerve is tasted for these peripheral branches by asking the patient to wrinkle forehead, open closed eyelids against resistance, whistle and clench the teeth. Injury to the parotid or any parotid mass or swelling can lead to the injury of facial nerve. Sensory innervation to the skin of face is through the trigeminal nerve (CN V), hence general sensation from face remains intact in facial nerve palsy. Facial nerve supplies the muscles of facial expression which are derived from the 2nd branchial arch. Donor nerve: The most common donor nerve for facial nerve grafting is Greater auricular nerve.


This is because, the frontal branch components of facial nucleus receives innervation from the cortex of both the sides. Bell’s palsy and Ramsay hunt sydrome (Herpes zoster oticus) are the examples of lower motor neuron type of facial nerve palsy. The nerve enters the pterygopalatine ganglion from its posterior surface and the sympathetic and parasympathetic information is distributed to all locations communicating with the ganglion. The surgical landmarks necessary to identify facial nerve during parotid surgery has already been discussed earlier. Pes anserinus is also named for the common insertion of sartorius, gracilis and semitendinosus into the proximal tibia, medial to tibial tuberosity. Ross B, Nedzelski JM, McLean JA: Efficacy of feedback training in long-standing facial nerve paresis. Maiman DJ, Cusick JF, Anderson AJ et al: Nonoperative management of traumatic facial nerve palsy.



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