 There are many nodes and connections are in and around the temporal bone and we have to comment on that. In fact, you should have a small paragraph saying facial now. And facial now is the most important now. But we look at facial now, greater superficial, phytosal now, caudate tympani, Jacobson now, and vestibular cochlea now. And vestibular cochlea now, again I put it at last because I am going to, it will be better than when he is doing the internal layer as well. So the seventh cranial now is an important now. It is an important now because it goes through the temporal bone. So if you are going to report a temporal bone, you have to comment on your facial now. And there are more and more papers coming, the Bell's palsy is a very common problem and there are more and more people are getting imaging for temporal bone, which is good for pride practice. So you will be able to comment on something positive on Bell, because it is going to be normal. But at least your report should not say it is normal. You say in this patient with Bell's palsy, there is no secondary cause for facial now palsy scene. That is your report. Because they are sending it to exclude facial now palsy due to some other causes. It can be at CP angle, it can be within the temporal bone, it can be within the parotid gland, it can be within the stylo-mantibular canal. So sometimes you have to combine CT and MR to comment on the normality of the facial now. So the facial muscles movement is by the facial now and it is a motor now. So that is the thing. So that is the main action for the facial now. But the problem is it carries something else. It is a carrier for taste sensation. It is a carrier for lacrimation. It is a carrier for salivary secretion. So it does all these things through because it acts as a carrier for carrying those fibers, you know, in addition to the, so it is a very important must know. So first we have to look at the labyrinthine segment, labyrinthine segment. So we all know this is the internal artery canal. The southern ethno centers through this and here you see a small bony projection called Krista falsiformis or falsiform crust. And then this actually divides the facial now which is going anteriorly. That is the labyrinthine segment or the first part of the facial now canal. And as soon as you enter, it makes almost 170 degrees, 160 degrees turned back here. And that particular area a little widened. And that area is called the geniculate ganglion location of the facial now. And from this, there is actually another linear line going anteriorly and that is the greater superficial pitrosal now. So within this particular area, there are too many things to remember. First part of the facial now, geniculate ganglion. Second part of the facial now and greater superficial pitrosal now. So now come back to the anteriorly. So here you are able to see the turning here. This is the sort of geniculate ganglion. The cut is done at this level. So it's going, coming anteriorly and then turning back. You can see that there. And then while it's turned back, you'll see two eyes there like a cobra. Okay. So this, this one is the horizontal part beginning. And this is the end of the labyrinthine part on the coronal plane. And then when you go back a little posteriorly, you can see the horizontal part here. And it is coming a little bit into the middle ear cavity. So it is one of the nerves which courses through the middle ear cavity. So whenever there is a middle ear disease, we have to come and turn it. And we have to come and turn not only the patient may not have a facial now policy, but if the patient has got an ocular chain erosion, or if the patient has got a soft tissue, you have to mention a sentence saying this, this soft tissue is seen close to the canal for the horizontal facial now canal. That means when they're going to explore that area, they have to be a little bit careful not to injure the nerve. So you give that caution to the ENT surgeon. They really appreciate that. And again, you can see that here. So this is the first part of the facial now canal, which turns quite a bit. And then the sturning is called the geniculate ganglion, because the ganglion is located there and from there, the relay happens for the origin for the greater superficial pitracellum. The horizontal part, the second part comes back like this. It comes back like this, below the lateral semicircular canals. It comes back like this, comes back posteriorly. And you can see it here. It's located below the semicircular canal. You'll see a little bit of dot there. And this particular dot is actually covered by a small bony covering. There may not be a bony covering, which you can see, but there is a little bony covering there. And beneath that, you see that incidusteptial joint and stapes. So when they do a steppidectomy, an ENT surgeon, well-informed ENT surgeon, wants to know two things. One, whether this facial now is actually dehesant, is there a bony canal or not? And the second thing, is it lying there as it's sort of hanging around? Sometimes it can hang around and touch the stapes. So think about they're going in. They're going to cut the stapes foot plate, putting it up to stand. And they just see the no going there. They got really irritated with the radiologist, not telling this beforehand. So it has happened to me. That's why I don't remember. Okay, so, and in private practice, you have to say, okay, boss, I'll definitely do it next time. And they're always right. So there you go. So here is the horizontal facial canal, which is located below the horizontal semicircular canal. And you can see this little bony depression at the top. And sometimes you can have a bony covering. Sometimes you don't have the bony covering. And you have to tell about its relationship with stapes. So that's a key point in horizontal canal. And then the mastoid or the vertical segment or the third part, again, you can see that here, the sinus tympani, pyramidal eminence, facial resist, posterior to that is your facial canal. That's the landmark. And you can see that here, it's descending down on the coronal plane. You can actually appreciate that going through that towards the stylo-mastoid foramen. This is the sagittal reconstruction. You can actually appreciate the gap, the mastoid temporal, mastoid part of the facial, now going down like this, okay? So this part, again, you have to appreciate in all three planes. And you have to say that what is happening with the mastoid aerosols and then make sure that this is actually not eroded or involved. Okay, and the sagittal oblique or sometimes the coronal plane, you have to appreciate the mastoid much better. This is the sort of sagittal oblique. This is the coronal plane. And you can see the descending or the mastoid segment of the facial now. And why this is important? So this is a patient with Bell's palsy. You give contrast on MRI, and you see sometimes a dominant enhancement within the geniculate ganglion. Enhancement without expansion within the geniculate ganglion can be associated with facial now palsy or Bell's palsy or inflammatory palsy or the adiapathic Bell's palsy, okay? So the reason assumed to be used is due to facial neuritis. Normally there are areas like the interior part of the fundal end of the internal artery canal. Sometimes you can have vascular plexus. Even here they say there is some vascular plexus surrounding this area. But the vascular plexus is within the geniculate ganglion and doesn't come into the horizontal canal. So if you have an enhancement coming into the horizontal canal, you got an enhancement going into the labyrinthine canal without canal expansion. You think it could be facial neuritis. And that's sometimes we are able to appreciate it in patients who has given a MRI with contrast to the thin sections. You'll be able to appreciate them. And this is another patient who has got a facial canal. Here is an enhancing lesion, but the canal is expanded. So the canal is expanded. So along the now, the canal is expanded. There is an enhancing lesion. Then the diagnosis is it's a shawarma, okay? And another one which is more common here is that you got a patient who has got a longitudinal fracture of the temporal bone, longitudinal fracture because it goes through the long axis of the temporal bone. The short axis of the temporal bone is here. That is the transverse fracture. So this longitudinal fracture, if you look at here, it comes here and then it actually goes through the air pockets. So it's through this area and you can see it's going through the geniculate ganglion region and you can see the fracture going there. And this patient presented with facial palsy following. So you have to mention that there is a horizontal phase. So there is a longitudinal fracture which is going through the geniculate ganglion and they might want to see if there is any bony spicule protruding into the canal or not. You can say that there, if there is a bony spicule, then they will have to go and remove that. If there is no bony spicule, they will put him on steroids, reduce the edema, reduce the inflammation, try and get the facial nerve function. So this is a long term. So other one which we need to appreciate is the gator superficial vitrosal nerve. It's a parasympathetic secretive fiber to lacrimal gland. Okay, this is the complexity of it. This is also called intermediate, nervous intermediates or seventh nerve B starts from the superior salivary nucleus coming to the geniculate ganglion, go as a GSPN. It goes along the forearm and lacerum and joins the deep pitrosal nerve. The so-called nerve of the Vidian canal or the Terrigoid canal is this nerve. And then it finally joins the spinopanatein ganglion. Why this is important? Unilateral loss of lacrimation is a very rare symptom. And there is anilateral loss of lacrimation. The problem can be with the GSPN. So gator superficial pitrosal nerve. So you have to know where it is. At least you can exclude an abnormality here. There are some skull-based pathologies where you can have inlet loss of lacrimation. So you suspect a GSPN or Vidian nerve, neuropathy. So here is the Vidian nerve or the gator superficial pitrosal nerve. I just flipped it for the right side. And you can see it here. It's coming along the pitrosapex margin, going along it and comes to the area of forearm and lacerum where the ICA is coming. And this is the area where it joins with the deep pitrosal nerve and goes as the pterigoid canal. So it goes through the pterigoid canal. And you can see that in your temporal bone CT. And here you can see this is the gator superficial pitrosal nerve. You can see that there, gator superficial pitrosal nerve. And then you can see that there's a little linear gap which is going along this area. And this layer is here. You can see this running parallel to the carotid canal. And then this is the region of forearm and lacerum where it is coming and turning anteriorly. And this is the region where it turns anteriorly, going there into the pterigoid canal. So you can see that there. You wanted to see if this patient has got any symptoms related to lacrimation. I just looked at that area, make sure it is not eroded. So that's the main thing. The cauda tympani is another nerve which is the connection between seventh nerve to the mandibular nerve. The cauda tympani carries the special sensor state. It actually arises from the mastrite segment. So from the mastrite segment, you will see there is something going on like this. That's the nerve. And then it goes through the tympanic membrane, go into the middle ear side of the tympanic membrane, goes around the neck of malleus and see how dangerous this is. People are putting, opening the tympanostom is right, left and center, but luckily it goes at the top and comes anteriorly between the pterotympanic fissure. And there it joins the mandibular division of the trigonal nerve, goes into the lingual nerve. So cauda tympani, will you see it? You will see it often, but you will see on the axial plane, you see a little dot here, just at the posterior margin of the tympanic membrane, that's your cauda tympani canal. Not a problem, often it is there. Patient has got a taste sensation, you just wanted to show off, you can show this cauda tympani, right? And see this cauda tympani anteriorly, okay? Right. And then the jackups on which bottom was alluding to, the nerve, you cannot see it, but the nerve goes through an important area called inferior tympanic canaliculus. And that's an important thing, because inferior tympanic canaliculus is important in two areas. It contributes to the tympanic fluxes overlying cochlear promontory, this particular nerve, and it contains neuroendocrine cells, therefore you can get chemo-dectomus, so-called glomus tympanicum. And there are strong cells, you can get neuroma as well. So here is a little dot between the carotid canal and the pars nervosa. In this area, there is a dot there, that is your inferior tympanic canaliculus. On the coronal plane, you can see this gap going there, going towards the middle ear, and this is the cochlear promontory. This is the area where the nerve comes, and this is the area where we should look for, glomus tympanicum. Okay, so inferior tympanic canaliculus, harbors the inferior tympanic artery, and jackups and snow, which comes from ninth cranial nerve, so you can get an associated paraganglioma, neuroma, and it is widened, this inferior tympanic artery is enlarged in aberrant internal carotid artery, running through the middle ear. So the last nerve, which we need to understand is the posterior amplary nerve, or the singular nerve, which comes from the eighth cranial nerve, and there is, you can see this J-shaped structure, which is coming from internal artery canal, going to the vestibule. And this particular structure, as you can see here, this is the nerve, so sometimes you can, this posterior amplary nerve goes, you know, creates its own pathway before reaching the vestibule and posterior semicircular canal, you can see that there. So this is just normal variant, don't think this is a fracture, okay? In a setting of temporal bone fracture, they mimic a transfer fracture, and fracture through the singular nerve canal may cause a posterior semicircular canal dysfunction. And you can see that here, this is the J-shaped structure of the singular nerve.