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Facial weakness rarely seen as sole finding. Spasticity and hyperreflexia are found

The lesion is below the facial decussation and above the corticospinal decussation. If congenital, may see anomalies of the ear or jaw

CN VlII is usually involved, and its symptoms are usually the chief complaint, especially unilateral hearing loss. As lesions enlarge, other structures are involved

Signs and symptoms from CN Vll and CN Vlll only

When the facial canal is involved, the cochlea and/or the vestibular organs may be involved. Hearing loss can be conductive or sensorineural

If there was trauma, check for CSF otorrhea, blood in ear canal, Battle s sign, impaired consciousness

Lesions before the chorda tympani have impaired salivation and taste

Sparing of peripheral branches may be seen

CSF, cerebrospinal fluid.

nucleus. When the fibers reach the area below the medial part of the abducens nucleus, they turn laterally to cross the front of the abducens nucleus and continue to curve around its lateral border. After looping around the abducens nucleus, the fibers travel caudally between the medial border of the trigeminal nucleus and the lateral edge of the facial motor nucleus. The motor fibers exit the caudolateral border of the pons in the cerebellopontine angle medial to CN VIII. The medial-to-lateral loop around the abducens nucleus is called the internal genu of the facial nerve (.Fig 11-1 ). This anatomical relationship explains how certain disorders of facial nerve motor function can be associated with abducens palsy. y , '10!

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