Chapter 12. Diseases and Injuries of Facial Nerves (E.I. Deryabin)
5 topics with brief reviews: definitions, key facts, and class questions.
In this chapter, edited by E.I. Deryabin, we examine the cranial nerve pathology that dentists and maxillofacial surgeons encounter on a regular basis. We will focus on the two main nerves of the maxillofacial region: the trigeminal nerve, responsible for sensation, and the facial nerve, which controls facial expression.
The section covers four key nosologies. You will study the clinical presentation, diagnosis, and treatment of trigeminal neuralgia and neuropathy, and examine facial nerve lesions—both inflammatory (neuritis) and traumatic (injuries). Special attention is paid to the differential diagnostic algorithms for acute pain syndromes and facial muscle paralysis.
In practical classes and exams, instructors most frequently ask about the differences between true neuralgia and secondary neuropathy, the identification of trigger zones, and pain management techniques. For the facial nerve, it is critically important to know the topical diagnosis of lesions—at what level the injury occurred. Without a solid understanding of topographic anatomy, passing this section will not be possible.
Why does percussion pain of the causal tooth subside during periostitis?
The reduction in pain is associated with the breakout of exudate from the confined periodontal space into the subperiosteum. Intraperiodontal pressure drops, thereby decreasing the tension in the ligament, and the symptoms shift to the soft tissues and periosteum.
Why are the conjunctival and corneal reflexes evaluated during the examination?
These reflexes help to verify the integrity of the reflex arc involving the sensory fibers of the V nerve.
Are there periods of complete pain freedom in neuropathy?
No, unlike neuralgia, the pain in neuropathy is constant in nature. The intensity may vary, but pain-free intervals are absent.
How to test the function of the motor portion of the nerve during an appointment?
Facial expression tests must be performed: ask the patient to wrinkle their forehead, close their eyes tightly, puff out their cheeks, bare their teeth, or whistle.
In peripheral facial nerve palsy, asymmetry is always observed on the affected side.
In peripheral facial nerve palsy, asymmetry is always observed on the affected side.
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