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NECK

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Fascia of Neck
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\ 1. Cervical Subcutaneous Tissue & Platysma • / wlfcutaneous tissue of the neck (superficial cervial fasica) - thin layer of\t:t'-that lies b/w dermis &deep cervical - contains: 1. cutaneous nerves 2. blood & lymphatic vessels 3. s~Eerfi~ffilly~hnodes it contains: p~ C Superior view of trensverse platysma section (at level C7 verlebra} - a muscle of facial expression - arises in fascia covering the superior parts of the ddtoid__&_p.ectoralis...1Il.aj_Q_t_MM - goes superomedially over the clavicle to .the inferior border of the mandible 2. Deep Cervical Fascia • consists of 3 layers 1. investing 2. pretracheal 3. prevertebral • these fascial layers provide slipperiness that allows structures in the neck to move & pass over one-another without difficulty (e.g., when swallowing & turning the head & neck) • layers form natural cleavage planes, allowing separation of tissues during surgery investing I®-,ero-[-deep cervical fascia • most superficial deep fascial layer surrounds _1-=:'1..-- neck deep to the subcutaneous tissue entire '.:. . at "four corners" of neck it splits into superficial & deep layer to surround SeN[ & trapezius (shown in green above) • ~ferjo~'?__ mandible, it splits to enclose the mandibular gland • /p:ci'"sterior-to mandible, it splits to form the fil:>rous ca]2sule of the parotid gland • is continuous with the periosteum coveting C7 spinous process & the '~!__!igame~t • attaches to anterior and posterior sides of manubrium to form a suprasternal space that ,encloses: 1. the inferior ends of the a:gJ~~jorjugular yeins ~ 2. jugular venous arch • • • .::-

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f~w_de_~p~lyroph_Qodes prelracheallqyer of deep cervical fascia • limited to anterior part of necV" • extends from hyoid into thorax, where it blends with the fibrous pericardium of the-heart • includes a thin muscular part. encloses infrahyoid -'., • includes a visceralpart. encloses the thyroid gland, trachea, esophagus o continuous posteriorly & superiorly with the buccopharyllgealfascia • blends laterally with carotid sheaths • carotid sheath 0 extends from cranial base to the root of the neck 0 blends anteriorly with pretracheal cervical fascia & posteriorly w_'ith__prev~rtd>Jal cervical fascia ' .
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carotid sheath contents ~omtn0r:- & intern.al carotid arteries ~tn;:_:nal Jupul~!em (IJV) c..:3. vagus nerve (eN X) .

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prevertebrallqyer _ ... forms o o o

some deep cervical lymph nodes 5. carotid s~-;;·erve 6. sy!fi~edr nervefibers (carotid periarterial plexuses) NOTE: carotid sheath communicates with the mediastinum of the thorax inferiorly & the cranial cavity superiorly - these communications represent potential pathways for the spread of infection & extravasated blood of deep cervical fascia a "hIbular sheath for vertebral column & mm associated with it anteriorly: longus colli & longus capitis laterally: scalene posteriorly: deep cervical muscles

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retropharyngeal

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-. , largest & most important interfascial space in neck - major pathway for the spread of infection - potential space that consists of :J;,..c.T. between yj_s_c_er_§.Lpart0f~the prevertebrallayer of deep cervical fascia & the buccopharyngeal jaJcia surrounding pharynx - alar jdfiitiTorms a further subdivision of the retropharyngeal space - closed superiorly by the base of the cranium - closed on each side by the carotid sheath - permits movement of pharynx, esophagus, larynx & trachea relative to the vertebral column during swallowing Cl,...u:.uJ. Cl1 ~~Q. P re-v u+e-br-~

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Wuperficial Structures of the Neck; Cervical Regions
• consists 1. 2. 3. of 4 major regions sternocliedomastoid region posterior cervical regioh lateral cervical region t> anterior cervical region>

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1. Sternocliedomastoid Region • divides each side of the neck into anterior & lateral cervical 1'1's • region between these triangular regions is the sternocliedomastoid region of the neck • SCM has 2 heads: 1. rounded tendon of the sternal head attaches to the manubrium 2. thick, fleshy clavicular head attaches to the superior surface of the media13'd of clavicle - 2 heads are separated inferiorly by the lesser supraclavicular fossa - heads join superiorly as they attach to the mastoid pl:Ocess of the temporal bone & superior nuchal line of the occipital bone

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INN
~ m~tor: eN ~I (Ac~essory Nerve) ~pa1n & propnoception: -(;2 &C3 Actions: • unilateral contraction: tilts head to same side (laterally flexes neck) & rotates it so face is turned superiorly toward opposite side • bilateral contraazon: 1. extends neck 2. flexes cervical vertebrae so that chin approaches manubrium 3. extends superior cervical vertebrae while flexing inferior vertebrae so chin is thrust forward with head kept level 4. may elevate manubrium & medial side of clavicles, assisting pump-handle action of .. deep respiration
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A~t~llot tONka I(eglon 1000tltllo('ttiangle)

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CLINICAL CORRELATION - T ortieollis •.------, ~ contraction of the cervical muscles that produces twisting of the neck & slanting of the head . ~

2.

most common type results from a fibrous tissue tumor that develops in Sq:M before or after birth ~ ifbaby's head is pulled excessively the SCM may be injured, tearing its fibers a hematoma occurs that may develop into a fibrous mass that entraps a branch of CN XI treatment: surgical release of a partially fibrotic SCM from its distal attachments to the manubrium & clavicle Posterior Cervical Region • region posterior to the anterior border of the trapezius Trapezius ~~-

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yuapezius
large, flat triangular muscle that covers the posterolateral aspect of the neck & thorax attaches the pectoral girdle to the cranium & vertebral column

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INN

motor: Accessory Nerve (CN XI) Ypain & proprioception: C2 & C3 spinal nerves Acfons~ elevates, retracts, & rotates scapula

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Lateral Cervical Region (Posterior A of N eck) yboundaries C PQ$t~riorview - anteriorly: posterior border of SCM - posteriorly: anterior border of trapezius - inferiorly: middle 3rd of clavicle between the trapezius & SCM - by an apex, where the SCM & trapezius meet on the superior nuchal line of the occipital bone - by a roof, formed by the investing layer of deep cervical fascia - by a jloor, formed by mm covered by prevertebrallayer of deep cervical fascia \._!/ covered by skin & subcutaneous tissue containing the platysma V'" MM in the posterior t:. of the neck floor is usually formed by the prevertebral fascia overlying 4 muscles I~' ""'iu, 1.~plenius capitis 2. ~evator scapulae 3. urUddle scalene 4. \...pe;sterior scalene for more precise localization of structures, the lateral cervical region is divided inio a rger V ocapita! D.. & a small omoclavicttlar (JubcialJian) D.. inferiorly by the il!folior bellY of the omllh)'oid • occipital A ,~'''OCIT'US'''. (po>\e,;o< belly) 0 boundaries: • medially: posterior border of SCM ~rDig,,.ttlcl'"b<""l'jibula<Jt'la"g(o • laterally: trapezius I belly) • inferiorly: omohyoid contents: • part of external jugular vein • accessory nerve (eN XI) • brachial plexus trunks & cervical plexus • transverse cervical artery & cervical lymph nodes -

omoclavicular (subclavian) d
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boundaries: • superiorly: omohyoid • inferiorly: clavicle • medially: posterior border of SCM @ contents: • deep in 8 : yd part of subclavian artery • inferior part of the external jugular vein • part of subclavian vein • suprascapular artery & suprascapular lymph nodes AA in the posterior b, of the neck

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cervicalt:![tery.\.
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originates fro~ tlryrocenticaltrunk (branch of the subclavian) runs superficially & laterally across the phrenic nerve& anterior scalene muscle (2-3cm above clavicle) passes through the tm1lks of the brachialplexus & passes deep to the trapezius supeJjicial branch of transverse cervical artery accompanies CN XI to trapezius deep branch runs anterior to the rhomboid mm as the dorsal scapular

mtery
o note: dorsal scapular artery may arise iod-ependently. directly from the subclaV1illl artery

f1fP"~pular
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artery branch of tbyrocersical tmnk passes inferolaterally across the phrenic nerve & anterior sclane muscle then crosses the 3,d part of the subclavian artery & the cords of the brachialplexus passes posterior to the clavicle to supply rom on posterior aspect of scapula onate: s_uprascaP0ar artery may arise directly from the subclavian artery

~~ctifital
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artery
branch of the external carotid artery _- _ enters lateral cervical region at 'its superior apex & ascends over the head to supply the posterior half of scalp
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3m part of subclavian artery
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blood to upperlimb lies posterosuperior to subclavian vein artery is in contact with the 1" rib as it passes posterior to the anterior scalene muscle o .', compression of the artery against the 1" rib can control bleeding in the upper limb VV in the posterior b, of the neck

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• • • • begins near the L of the mandible by union of the posterior division of the retromandlbuiar vein with the postelioT alldculaT vein crosses SCM obliquely~ deep to platysma pierces the investing layer of deep cervical fascia at the posterior border of SCM descends into the inferior part of the posterior I!:" & terminates in subclavian vein

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- 0ubdavtan
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vetn
major venous channel draining the upperlimb courses through the inferior part of the posterior b, passes anterior to the anterior scalene and the phrenic-nerve

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joins IJV to form the brachiocephalic vein posterior to the medial end of the clavicle just superior to clavicle, the EJV receives o transverse cervical vein o suprascapular vein o anterior jugular vein NN in the posterior !1 of the neck

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-/ spinal aceessory,nerve
• • passes deep to SCM (supplies it) passes posteroinferiorly, within or deep to the investing layer of the deep cervical fascia, running on the levator scapulae from which it is separated by the prevertebral layer of the deep cervical fascia then disappears deep to the anterior border of trapezius anterior rami of CS-C8, & T1 all ::2_l)_Di~. __to_fu_!1nhe 3 trunks t • •
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18 roots of brachial plexus
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of the brachial plexus fll/2IaJ'cgJ2!tlaT J~~rve --arises from ~uperior trunk of the brachial plexus runs laterally as.!9ss __ the.posterior !1to supply the supraspinatus infraspinatus mm on posterior aspect of scapula also sends articular branches to the glenohumeral joint
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ce17_Jicai plexus
• • • • Cl-C4 plexus lies anterornedial to the levator scapulae & middle scalene muscle & deep to SCM superficial branches are cutaneous deep branches are motor branches, including roots of phrenic nerve & an,[a cetyicalis
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cutaneous branches
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emerge around the middle of the posterior border of SCM (nerve point of the neck) skin of neck o superolateral thoracic wall o scalp between auricle & external occipital protuberance cutanecua.branches.are: '--?Ie~er occipital nerve (C2) • skgl of neck & scalJ:2-P.osterosuperior to auricle greater auricular nerVe (C2, C3) • skin over parotid gland, posterior aspect of auricle, area of skin from mandible to mastoid process transverse cervical nerve (C2, C3) • skill covering' the anterior cervical region ~..Right. "",",om ~9"' . -_. \ supraclavicular nn (C3 , C4) Jo.'1"'S<·"""·"'I·I~ .A.rI~JiQlj"~Lel')e

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• skin of neck • cross clavicle to skin over shoulder Heme (C3, C4,. CS - ke.eps the diaphgram alive). descend obliquely WIth IJVs across the anterior scalene, deep to the prevertebrallayer of the deep cervical fascia crossed overby transverse cervical artery & suprascapular artery 011 left: crosses anterior to the first part of the subclavian artery on right: lies anterior on the anterior scalene muscle & crosses anterior to the 2nd part of the subclavian artery both sides: runs posterior to subclavian vein & anterior to internal thoracic artery is it enters thorax

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posteriorly: anterior border of SCM superiorly: inferior border of mandible apex: located at jugular notch in the manubrium of stern . larynx. aiming at the apex of the f::. b/w the sternal & the clavicular heads of SCM t""""-.anteriorly: median line of neck .floor: formed by the pharynx..IIt\~:~w&jja::::• digastric muscle superoanteriorly: lower-border of the mandible contents: o submandibular gland o submandibular lymph nodes o hypoglossal nerve o mylohyoid nerve o parts of facial artery + vein boundaries o superoanteriorly: o superoanteriorly: 2. however.roof formed by subcutaneous tissue containing platysma . & thyroid gland • subdivided into 4 smaller L1s: 1. (1 Anterior Cervical Region (Anterior A of the Neck) • boundaries . the clinician palpates the common carotid artery & inserts the needle into the I]V just lateral to it at a 30° L.• CLINICAL CORRELATIONS "':'Vdiaphragmatic pain referred to the shoulder / • • .'-~-~~--""li'"'- • -Jnternal Jugular Vein Puncture • • • 4. submental • anterior belly of digastric muscle anterior belly of digastric muscle . 0 ~~~~~ ==:--'~:"\iK"I. surgical procedures. weakness can occur in turning the head to one side agrunst resistance lesions of CN XI produce weakness & atrophy of the trapezius drooping of the shoulder is an obvious sign unilateral paraiysis of the trapeifus is evident by the patient's inability to elevate & retract the shoulder & by difficulty in elevating the arm superior to the horizontal level a needle & catheter may be inserted into the I]V for diagnostic or therapeutic purposes right I]V is preferable because it is usually larger & straighter during this procedure. superornedially: anterior belly of digastric muscle superolaterally: posterior belly of . tumors & fractures of jugular foramen unilateral lesion: usually does not produce an abnormal position of the head.superoposteriorly: hyoid • o contents o submental lymph nodes o veins that unite to form anterior jugular vein . submandibular • boundaries __ 9. supraclavicular nerve & phrenic nerve both arise from C3 & C4 irritation of the diaphragmatic pleura or peritoneum produces pain that is carried by the phrenic nerve & referred to the area supplied by the supraclavicular nerves (shoulder & clavicular region) n -0ksions • • • • of the Spinal Accessory Nerve (eN XI) may be damaged by penetrating trauma.

suprahyoid muscles • connected to cranium . carotid • boundaries o laterally: SCM o superiorly: posterior belly of digastric muscle o inferiorly: anterior belly of omohyoid muscle contents o carotid artery + branches o '-I1'V + tributaries o vagus nerve o external carotid artery + branches o pypoglossal nerve +vsuperior root of ansa cervicalis d spinal accessory nerve o thyroid gland + larynx + pharynx o deep cervical lymph nodes o branches of cervical plexus • 4.' thyrohyoid: inn. by ansa cervicalis .byoid provides attachment to suprahyoid muscle superior to it & the infrahyoid muscles inferior to it .t. superolateral: omohyoid 2. > • • CNV. eN XII omohyoid: has 2 bellies united by an intermediate tendon that is by a fascial sling sternothyroid is wider than sternohyoid ~><""$'>}"'l"""'(C:N)(!Il - infrahyoid muscles • n • • .mn. medial: midline • contents 1. by! facial nerve. by mandibular nerve. . 1d I """"• mc u es: "'''''''''''''_'. thyroid + parathyroid glands MM in the anterior f':j.:y__~~ o !illYlohyoidJ.3. • • • ~:. sternothyroid + sternohyoid muscles 2. by Wacialnerve.tCl"<l • post. belly inn. by ansa cervicalis • omohyoid: inn. by h _ 0 lossal ne. inferolateral: SCM 3. .ve eN XII o stylohoid: inn. by ansa cervicalis o deepplane: • sternothyroid: inn. CN V o geniohyoid: inn. CN VII) as a group these muscles make up the floor of the mouth o provide a base from which the tongue functions each digastric muscle has 2 bellies joined by an intermediate tendon a fibro»: sling allows the tendon to slide anteriorly & posteriorly as it COI111ectshis tendon to t the body & greater horn of the hyoid bone arranged in 2 planes: o sltpetjicial plane: • sternohyoid: inn. CN VII o digastric muscles: ·~-ll~y~in~n-)y mandibular nerve. by hypoglossalncrve. muscular boundaries 1.

are the main arterial vessels in the carotid j'j_ • each common carotid artery ascends within the carotid sheath (with IJV & vagus nerve) to the level of the superior border of the thryroid cartilage • here. superior to origin of facial artery passes posteriorly. 3.artery small posterior branch ascends posteriorly between the external acoustic meatus & the mastoid process 2. where it is embedded in the parotid gland o here it divides into 2 terminal branches: maxillary & sl.is the only medial branch ascends on the pharynx & sends branches to: • pharynx • prevertebral mm • middle ear • cranial meninges occipital artery arises from posterior aspect.tpe~ticialtemporal arteries o before these terminal branches.CN XI posterior auricular. . immediately medial & parallel to the attachment of the post. of the brain & structures in the orbits o carotid bocjy is located in the cleft between the internal & external carotid arteries • external carotid arteries ~ 0 supply most structures external to the cranium o orbit & part of the forehead & scalp supplied by the supraorbital artery are the major exceptions o runs posterosuperiorly to the region between the neck of the mandible & the lobule of the auricle. & internal + external carotid arteries • common carotid artery & one of its terminal branches. the external carotid arteIJI. ending in the posterior part of the scalp during its course. attaching it the oblique line of the lamino of the thyroid cartilage superior to the gland o this muscle limits superior expansion of an enlarged thyroid gland thyrohyoid is a continuation of the sternothyroid muscle IJ. belly of the digastric muscle. 6 arteries arise from the external carotid artery: Lalf subelavtan artery· Rlg111 subclavian artery '_"""'~~-Left axillary a(lezy A Anterior views 1. ~otid system of arteries • consists of common carotid artery + terminal branches. ascending pharyngeal artery arises as the 1st or 2nd branch of the external carotid artery . it bifurcates into internal + external carotid arteries • right common carotid artery begins at the bifurcation of the brachiocephalic trunk • left common carotid artery arises from the arch of the aorta ~lnternal carotid arteries o have no branches in the neck o enter cranium through the carotid canals & become main aa. it passes superficial to internal carotid artery & CN IX .• • • I\A in anterior sternothyroid covers the lateral lobe of the thyroid gland.

contributes to blood supply of: • adjacent muscles • parotid gland • facial nerve. IJV unites with subclavian to form the brachiocephalic lJein inferior end of IJV dilates to form the inferior bulb of the IJV • this bulb has a bicuspid valve that permits blood to flow toward the heart while preventing backflow into the vein . posteriorly to the carotid sheath & is embedded in theprevertebral of the deep cervical fascia IJV leave. facial artery arises anteriorly.. which supplies the larynx lingual artery arises from the anterior aspect lies in the middle constrictor muscle of the pharynx at its origin arches superoanteriorly & passes deep to: • sc:rvl 5.. • eN XII • stylohyoid muscle • posterior belly of digastric muscle disappears deep the hyoglossus muscle gives branches to posterior tongue bifurcates into the deep lingual & sublingual aa._/ deep rnm of the neck IJV commences at jugular foramen in posterior cranial fossa as the direct continuation of the sigmpid sinus superior bulb of IJV is the superior dilatation at its origin and tuns inferiorly through the neck in the carotid y anterior V cervical sheath - - lies laterally within the sheath.4.. eN VII • structures in the temporal bone.:-he anterior fj_ by passing deep to the SCM t posterior to the sternal end of clavicle. with the nerve located posteriorly 0 cervical !)impathetic trunk lies. auricle & scalp superior thyroid artery most inferior of the 3 anterior branches runs anteroinferiorly deep to the infrahyoid rnm to reach the thyroid gland supplies: • thyroid gland • infrahyoid mm gives rise to the superior laryngeal artery. 6. either in common with the lingual artery or immediately superior to it gives rise to ascendingpalatine artery & tonsillar branch then passes superiorly under the cover the digastric & stylohyoid muscles & L of the mandible loops anteriorly & enters a deep groove in and supplies the submandibular gland then gives rise to the submental artery to the floor of the mouth & hooks around the middle of the inferior border of the mandible to enter the face 'External aco"sti"mea\us~ • VV in the anterior A - tributaries of IJV IJV drains blood from y? brain c> - face! viscera .

instead it &~\?-~--&::~r.levator scapulae .brachiocephalic trunk • covered anteriorly by the sternohyoid & sternothyroid mm • largest branch of aorta • lies in the midline behind manubrium • passes superolaterally to the right and divides into the right common carotid & right subclavian arteries ..eV\I . drained by the deep cervical vein & vertebral vein but may drain into 1JV NN in anterior 8transverse cervical nerve (e2. . hypoglossal nerve (eN XII) is the motor nerve of the tongue & enters the submandibular deep to the posterior belly of the digastric muscle to supply the mm of the tongue branches of the glossopharyngeal (eN IX) & vagus (eN X) nn are located in the submandibular & carotid I1s - 11 Deep Structures of the Neck • .anteriorly: manubrium of sternum -:: posteriorly: body of the Tl vertebra • AA in the root of the neck lateral cervical '... Prevertebral MM • anterior vertebral muscles $> :__--ongus colli l ~ longus capitis ." lies in the floor of the posterior 11 Root of the Neck • junctional area between the thorax & neck • inferior boundary . superior + middle thyroid veins .rectus capitis anterior :::! anterior scalene mm • all these lie directly posterior to the retropharyngea! space "f lateral vertebral muscles .. .. the root of the neck -I.eglon.occipital vein usually drains into the sNboccipital venous plexus. C3) supplies skin covering the anterior t.. la...laterally: 1'1 pair of ribs & their costal cartilages .al vl. .middle + posterior scalene mm • all these lie posterior the neurovascular plane of the cervical & brachial plexuses & subclavian artery ~ • rectus capitis lateralis does not lie posterior..rectus capitis lateralis splenius capitis .._ 2.• tributaries of I]V: • inferior petrosal sinus • facial..te. + t> -_ . pharyngeal..erature.subclavian aa • supply upperlimb & send branches to the neck & brain • right subclavian from brachiocephalic trunk • left subclavian from arch of aorta • name changes to axzllary arteries when they cross the outer margin of the 1st ribs An!er~\llC!lw I. prevertebral mm posterior to the cervical viscera & anterolateral to the vertebral column • structures located on the cervical side of the superior thoracic ap.. lingual.

~~ the neck 2. '/ trunk passes posteriosuperiorly & divides into the superior intercostals & /y ~ deep cervical aa '\ .superior intercostals: supply 1sr 2 intercostal spaces .n c' n the anterior scalene muscle divides each subclavian artery into 3 parts: 1.may come from the subclavian artery as well .participates in arterial anastomoses around scapula • VV in the root of the neck .has no branches in the neck • thyrocervical trunk . largest branch is inferior thyroid artery .often arises as the deep descending branch of the transverse cervical artery . suprascapular artery often arises from here and supplies muscles on posterior aspect of scapula G~ -0 3.part is tr.. from 3'd part: di_jiiDf_@_u!arartery • vertebral artery cervical part of the vertebral artery: passes through the foramina of the transverse processes of vertebrae Cl-C6 vertebral part of the vertebral artery: may enter a foramen more superior than the C6 vertebra . the right & left AJV s unite across the midline to form the jugular venous arch . i".2 large veins terminate in the root of the neck • external jugular vein (EJV): drains blood mostly from scalp & face • anterior jugular vein (AJV): variable • typically arises near hyoid bone from the union of superficial submandibular veins • at root of neck. from 1" part: vertebralattery. 2nd part is 12gst~ior to it 3.cranial part of the vertebral artery: begins when the artery enters through InW!1<J-ltnoractc the foramen ma(!11um Brachiocepha1ic trunk ~ • internal thoracic artery passes inferomedially into the thorax: .suboccipital part of the vertebral artery: courses in a groove on the posterior arch of the atlas before it enters the cranial cavity .l~4i_::J_Jo_the_lPuscle 2.1.primary visceral artery of ~ -'vA.\ • costocervical trunk "). AJV opens to terminate in the EJV or subclavian • superior to manubrium.subclavian vein begins at the lateral border of the 1st rib & ends when it unites with IJV to form the brachiocephalic vein • this union is commonly referred to as the venous L I • S .deep cervical: deep cervical rum • dorsal scapular artery .has 3 branches ~ ~ 1. (the trapezius & medial scapular rum) "..tuns deep to supply the levator scapulae & rhomboid rum . internal jhoracic artery & tf?yW'ff1Jicaltmnk 2. 3rr1 part is lateral to it Common carotid • branches of subclavian artery Ascending cervical . from 2nd part: costocenncai tplnk 3. transverse cenica! arte~J' supplies muscles in the posterior t:.

\ > Oi6+ f"b F (\ - ~\ ~re.relatively thin isthmus unites the lobes over the trachea (anterior to 2nd & 3m tracheal rings) . anterolateral to the larynx & trachea . alimentary Iqyer.Q~_ v\-\t-. - \ "S_. endocrine layer: thyroid & parathyroid glands 2.r(O 0 o sinking in of the eyeball (enophthalmos whi~ possiBly' caused by paralysis of smooth (orbitalisr muscle in the floor of the orbit) o vasodilation & absence of sweating on the face & neck (caused by a lack of vasoconstrictive nerve supply to the BVs & sweat glands) K-: dcs ~\~ (Jscera • of the Neck no s. hormone-secreting glands • thyroid gland: tf?yroid hormone (regulates rate of metabolism) & calcitonin (controls Ca ++ metabolism) • parathyroid gland: paratbormone (pTH. . .(! levator palpebrae superioris) V pOS1e. o large SIZe::: ood landmark for locating sympathetic trunk g CLINICAL CORRELATION Cervicothoracic Ganglion Block anesth~ti~ injecte~ aro_und the cervicoth~racic (stella.f Cl & C2 vertebrae. controls metabolism of P & Ca ++ in the blood) • ~~yroid Glan9_ ----=-lies deep to sternohyoid & sternothyroid rom frol1LCS-Tl vetteb~ .A0 ~ . lesion of a sympathetic trunk ill ~he~eck results ill Horner syndrome. transmission of stimuli thorugh the cervical & supenor thoracic ganglia S.this ganglion block may relieve vascular spasmsinvolving brain & upper (1tA (_cx(6'" \ L &..surrounded by a thin fibrous capsule...nh_j'*yos"\s.consists primarily of right & left lobes. . pierce the pre tracheal layer of deep cervical fascia.. which sends septa deep into the gland .-te. t'--I\ 10SIS· . o pupil constricuon (paralysis of dilator pupillae muscle) o £tos1S (drooping of superior eyelid which results from paralysis of the smooth muscle intermingled with the striated muscle ?f the .descend to the superior poles of the gland.. attaches the fibrous capsule to the cricoid cartilage & superior tracheal rings .\ ~ (0-' ~ 00\[\ 0. 0 level o.te) gangli~n bloc~s V C CL c:il-o.-superior thyroid arteries .lie in between the capsule & loose fascial sheath _g.. occasionally absent 0 lies on the anterior aspect of the inferior thyroid artery at the level of the cricoid cartilage and the transverse process of C6 vertebra superior cervical ganglion o f>-.D.T. \0. - star-shaped glanglion that lies anterior to the transverse process of the C7 vertebra (superior to neck of l't rib) middle cervical ganglion 0 usually small. .C. organized into 3 layers from superficial to deep: 1. ~nferior - thyroid arteries largest branches of the thyrocervical trunks .o (''0\ r i::: . which 1S characterized by: . respiratory layer: larynx & trachea 3. - of. > ~Ij~\ '( '" J limb ~sion \'t.\vN-' 'v j\ .we_o:t 9 +. pharynx & esophagus Endocrine Layer 0 f Cervical Viscera • part of the body's endocrine system of ductless..x ~ 1'.. & divide into anterior & posterior branches 1..vasculature • arterial supply: o superior & inferior thyroid arteries . Cervical Sympat~etic Tr~nk ..

.c~ & the part of the respiratory tract between the lower part of the pharynx & the trachea acts as a compound sphincter to prevent the passage of food or drink into the airway in swallm .usually consist of 4 to 6 small ovoid bodies that lie against the dorsum of the thyroid under its sheath but with their own capsule . • nerve supply o derived from superior. you will have neuromuscular disorders) ..presence of this artery must be considered when performing procedures in the midline of the neck venous drainage o superior.endocrine glands that playa vital role in th4 regulation of Ca++ & P metabolistl} . micturition. which is generalized convulsive muscle spasms due to de_creased blood Ca++ levels Accessory Thyroid Glandular Tissue o usually lies on the thyrohyoid muscle o originates from the remnants of the tf?yroglossal duct . subclavian or internal thoracic arteries .- run superomedially posterior to the carotid sheaths to reach posterior aspect of the thyroid gland o • • ~ 10% population. middle & inferior cervical rympathetic ganglia o reach gland through the cardiac & j'uperior & inferior tf?yroidperiarterial piexuses that accompany the thyroid arteries o these fibers are vasomotor.superior & inferior deep cervical lymph nodes o inferior to thyroid. causing blood vessel constriction Thyroidectomy _.!¥.vasculature • supplied chiefly b~'ior thyroid art<m'J • drained by parathyroid veins that drain into the tbyroid plexus of veins that drain into the thyroid gland & trachea Respiratory Layer of Cervical Viscera • ~x -- • ~.brachiocephaiic !ymph nodes or the thoracic duct . " _-_ o during total~hyroidectom] the parathyroid glands are in danger of being inadvertentl d ged or remOved o if the arath 'roid lands are remov~ the patient suffers from tela.inferior deep cervical lymph nodes o some lymphatic vessels .a transitory endodermal tube extending from the posterior tongue region of the embryo carrying the thyroidforming tissue at its descending end - CLINICAL CORRELATION > > 2.secrete PTH (if there are low levels ofPTH. or parturition) regulates flow of air to & from the lungs for vocalization (phonation) C - . para tracheal lymph nodes . pre tracheal. oses the rimaglottidi during the Valsalva maneuver (buildup of air pressure during coughing. Parathyroid Glands . sneezing. the arch of the aorta.prelaryngeal. ' organ 0 voiceprodu.this small artery ascends on the anterior surface of the trachea (supplies it) and goes to isthmus of thyroid gland . or from the right common carotid.A L.teral"l'"". lymphatic vessels . defecation.:. middle & inferior thyroid veins drain the thyroid plexus of veins on the anterior surface of the thyroid gland & trachea lymphatic drainage o capsular network of lymphatic vessels . a thyroid ima artery arises from the brachiocephalic trunk.

. and its lateral portion is pierced by the internal laryngeal nerve & superior laryngeal vessels • eric tf!yrold ligament o extends from the arch of the cricoid cartilage to the thyroid cartilage & the vocal processes of the arytenoid cartilages vocal ligament =~J~:~I • o o . sternothyroid & thyrohyoid muscles • cricoid cartilage o lm£/e cart-ilajd that is shaped like a signet ring o @ C6level & articulates with the thyroid cartilage o lower border marks ends • epiglot.. Ijy..)-. o extends from the posterior surface of the thyroid cartilage to the vocal pwcess of the arytenoid cartilage 0 considered the upper border of the conus elasticus • oestibzdar (i entricular) ligament o extends from the thyroid cartilage to the anterior lateral surface of the arytenoid cartilage paired lateral portion of the fibroelastic membrane that extends between the superior border of the entire arch of the cricoid cartilage & the vocal ligaments formed by the cricothyroid..IhyrQhyoid l. corniculate & cuneiform) • thyroid cartilage~_. cricoid & epiglottic) & 3 are paired (arytenoid.-.-_ r-----..consists of 9 cartilages: 3 are single (thyroid.. median cricothyroid.---i-' !nlerior hom Capsul<col A LOle'.>_..1 laryngeal skeleton .. o ~ingle elastic O"artilajJ that is a spoon-shaped plate o lies behind the root of the tongue & forms the superior part of the v..tt::. _~Ilage ~i1)e crico!t.:::· s -_.ow anterior wall of the larynx o lower end is attached to the back of the thyroid cartilage • arytenoid cartilages o paired 1m/it & f?yaline cartila e o shaped e pyramids with bases that articulate & rotate on cricoid cart.--.yro'id jojnl l S"P~~ -->. 0 Jingle f?yaline cartifa e hat forms a median elevation called the laryngeal prominence (Adam's apple) o has an oblique line on the lateral surface of its lamina that gives attachment for the inferior pharyngeal constrictor..gamanl 1.'-..>-1.'. which give attachment to the vocal ligament & vocalis muscle & muscular processes. which give attachment to the thyroarytenoid muscle & lateral & posterior cricoarytenoid muscles o sits on top of the cricoid cartilage & rotates to change the opening of the cal folds (the rima glottidis) te carL_!tl!i1a~~~--. o have vocal processes. . & vocal ligaments conus elasticus (cricovocalligament) .... o B Posterior view -~-=-~ hat lie in the aryepiglottic folds anterior to the - laryngeal ligaments • tbyrobyoid membran ' o o extends fr m the thyroid cartilage to the medial surface of the hyoid bone its middle (thicker) part is called the middle thyrohyoid ligament.' T~I!Gcal ca~lage TIlyt<>ld Ob~que~.

..Omiculllte !ubercte tubercle • ventricles o • • • • itifraglottic cavi!y o o o o extends from the rima glottidis to the lower border of the cricoid cartilage spaces between the vocal folds & arytenoid cartilages narrowest part of the laryngeal cavity extend from the thyroid cartilage above the vocal ligament to the arytenoid cartilage lima glotlidis vestibltlarJoldJ' (false oocal cords) vocalfolds (true vocal cords) o - - - extend from the L of the thyroid cartilage to the vocal processes of the arytenoid cartilages o contain the vocal ligament near their free margin & the vocalis muscle.LJl.( '-"Y"''' ..ry-~tt#i~ V.a9\1~ membrane & rom in the inferior part of the larynx veins accompany arteries lymphatic drainage • superiorly to superior deep cervical lymph nodes • inferiorly to-inferior deep cervicallymph nodes 7 . which forms the bulk of the vocal cord o important in voice production because they control the stream of air passing through the rima glottidis o alter the shape & size of the rima glottidis by movement of the arytenoids to facilitate respiration & phonation o note: rima glottidis is wide during inspiration & narrow & wedge-shaped during expiration & sound production muscles of the larynx yextrinsic laryngeal muscles o move the larynx as a whole o infit1lryoid muscles are depressors of the larynx & hyoid •/ 0 slIpralryoid mltsc/cs are elevators of the larynx & hyoid Intrinsic laryngeal muscles ..~-(:. o move the laryngeal parts..- laryngeal cavities & folds • vestibule o extends from the laryngeal inlet to the vestibular (ventricular folds) extend between the vestibular fold & the vocal fold -#!-~w.cricothryoid muscle is supplied by the external laryngeal nerve (one of the 2 terminal branches of the superior laryngeal nerve arterial supply: • laryngeal arteries are branches of the superior + inferior thyroid arteries • superior laryngeal artery supplies internal surface of the larynx • inferior laryngeal artery supplies the mucous Supo". making alterations in length & tension of the vocal folds & in size and shape of the rima glottidis o all but one of the muscles are supplied by the rC{lImnt laryngeal nerue .c\Jneiilorm O?-..'".".

x -. however.0 • . C4.. postsynaptic neurons send fibers to the: 1.f-.::l[nf"'''---:~ 2 x phrenic nerve eY .inferior cervical ganglion usually fuse with 1st thoracic glanglion to form the large cervicothoracic ganglion (stellate ganglion) - .i. ::) v/ brachiocephalic vein to enter thorax ' G • left vagus nerve descends between the left common carotid & left subclavian arteries to . ~ ~o . _'\._ '~.site where the thoracic duct (left side) .originate in the neck as well as' in the thorax .-" .~ V'v. 0-. .l~xus after synapsing with the postsynaptic neuron in the cervical sympathetic gangle.(v-.. where they ascend in the tracheoesophageal groovesupplYll1g both the trachea & esophagus and all the intrinsic rom of the larynx except the rf Jf-Y • "..~..li~ thoracic sP'inal nn perlarte rial p.'· . both nerves asc~fl:d s..~:~n:~caro\id receive presynaptic fibers conveyed to sympathetic trunk by the superior sympalh. the IJV is enclosed by the carotid shuala r:-.right vagus nerve passes anterior to the 1" part of the subclavian artery & posterior to the I.. between subclavian arteries & veins • proceed through thorax on each side of the mediastinum to supply the diaphragm • they are the sole motor supply to their own half of the diaphragm . head & neck viscera via cephalic arterial branches .2 X vagus nerve p". rtJ • throughout its course.[' .~~_--:-t.f' / 0< ._ J...convey presynaptic parasympathetic & visceral afferent fibers to the cardiac plexus of nerves !~. middle & inferior IIrti. cervical spinal nn via greg (Otllmutlicating branches 2.\ fA'0U'(loop around) different structures & at different levels on the two sides j • right recurrent laryngeal nerve loops inferior to the right subclavian artery \--CF' • left recurrent laryngeal nerve loops inferior to' the arch of the aorta • after looping.. they arise & recur ~IA. NN in the root of the neck ~ •!~ -.vagus nerves (eN X) (r. C5 • descend anterior the an terior scalJne muscles posterior to SCMs & IJVs • pass deep to the prevertebrallayer of the deepcervical fascia. \ cricothyroid • A-~riQrrMl'li wmitlgroqlSO! )I~~$.r 0'><..~xit ~rom jug~..' W) 1') •• ~'5-~r' ."\ carotid artery P.. r :> ..Q. '\000'''''' f' i..~t &~h~ti~-duct (right side) drain lymph collected CL 0. (':\..t1aroramen on the posterior aspect of the f fQJ 1/ /' 'carotid sheath ill the L between the IJV & com~~p." enter thorax \ . • formed at the lateral border of the anterior scalene muscles • C3.upcriorly to the posteromedial aspect of the thyroid gland.2 x sympathetic trunk (). sympathetic hunks • receive no white communicating branches in the neck • cervical portion of sympathetic trunk • extend superiorly to the level of the Cl vertebra or the cranial base • contains 3 cervical sympathetic ganglia: superior.~ • recurrent laryngeal nerves arise from the vagus nerves in the inferior part of the neck 0 Dd \ \ I ' • nerves oftlietwo sides have the same distribution. .f'v:) ~.J''' /-.f' throughout the body into the venous circulation ~ ('j .~:. cardiac branches of CN . thoracic viscera via cardiopulmotlary splanchnic nenes 3..

inferior laryngeal artery • internal layer consists of palatopharyngeus.- - mm of the pharynx • external layer consists of 3 pharyngeal constrictors: superior.iow swallowing & speaking vessels of the pharynx • arterial supply o tonsillar artery (branch of the facial artery) .:'trictor. superior laryngeal artery + vein . descending palatine arteries. 2.'. levator veti palatini :g::.dOl. middle & inferior o have a strong internal fascial lining: pharyngobaJilar [ascia o a thin external fascial lining: buccopharyngealfasda o contraction is involuntary o all 3 supplied by pharyngeal plexuJ' ofnenes on lateral wall of pharynx o overlapping of the constrictor muscles leaves 4 gaps in the musculature for structures to enter or leave the pharynx superior to the superior c0ll. ascending palatine branch of the facial arteq. pharyngeal branches of the maxillary artery & branches of the superior & inferior thyroid arteries • venous drainage by large external palatine vein o descends from the soft palate & passes close to the lateral surface of the tonsil before it enters the pharyngeal venous plexus • V ~ymphatics 0 tonsillar o o lymphatic vessels pass to the jugulodigasttic node (referred to as the tonsillar node because it enlarges when the tonsil is inflamed palatine.anteriorly by lingual tonsil (collection of lymphoid tissue on dorsum of tongue . an incomplete circular band of lymphoid tissue around superior part of pharynx ring is formed: .lloy"' o these mm elevate the larynx & shorten the pharynx during Post.posteriorly & superiorly by pharyngeal tonsil .passes through the superior constrictor muscle & enters inferior pole of the tonsil o also ascending pharyngeal artery. stylopharyngeus o«'F'W!bone 2. pba1·ygotympanic tub~ "\ 3. stylopharyngeus. glossopharyngeal nerve (CNIX) 3. recurrent laryngeal nerve 2. lingual & pharyngeal tonsils form the pharyngeal tonsillar ring (of Waldeyer).gap inferior to the inferior constrictor 1. internal laryngeal nerve 2.gap between the middle & inferior constrictors. & salpingopharyngeus E. stylohyoid ligament pOe .gap between superior & middle constrictors.laterally by palatine & tubal tonsils .. ascending palatine artertJ • pass through gap between superior constrictor & cranium • here the pharyngobasilar & buccopharyngeal fascia blend to form the thin wall of the pharyngeal recess . structures that pass are: 1. structures that pass are: 1. structures that pass are: 1.m.

in adult. soft palate is elevated. . the bolus is compressed against the palate & pushed from the mouth in the oropharyx mainly by movements of the mm of the tongue & soft palate 2. trachea is 2. where it bifurcates .0 inn.inferior to the isthmus of the thyroid gland are the jugular venous arch & inferior thyroid veins 3.. on each side of the opening of the larynx. all of the intrinsic mm except crico~o-_ S thyroid. the-cricothyroid & inferior pharyngeal constrictor (cncopharyngeus part) mm.conducts food to the esophagus & air to the larynx & lungs .extends from inferior end oflarynx to sternal L. the mucous membrane above the vocal cord & taste buds on the ep1glottis o accompanied by the superior laryngeal artery & pierces the thyrohyoid membrane .- innervation • recurrent laryngeal nerve o inn.subdivisions • /nasopharynx o situated behind the nasal cavity above the soft palate & communicates with the nasal cavities through the nasal choanae o contains the pharyngeal tonsils on its posterior wall it is connected to the tympanic cavity through the auditory tube extends between the soft palate above & the superior border of the epiglottis below & communicates with the mouth through the oropharyngeal isthmus o contains the palatine tonsils.lateral to trachea are the common carotid arteries & thyroid lobules ./iii'ternallaryngeal nerve / --./ extema.funnel-shaped fibromuscular tube that extends from the base of the skull to the inferior border of the cricoid cartilage . . in which swallowed foreign bodies may be lodged . Alimentary Layer of Cervical Viscera • pharynx .llarynge~l nerve. sequential contraction of all 3 pharyngeal constrictor mm forces the food bolus inferiorly into the esophagus • o o • varyngopharynx o extends from the upper border of the epiglottis to the lower border of the cricoid cartilage o contains the piriform recess. voluntary. which are lodged in the tonsillar fossae & are bounded by the palatoglossal & palatopharyngeal folds oropharynx carries out deglutition (process of swallowing) deglutition has 3 stages 1. involuntary. which is inn. by extemallaryngeal branch~O~ of the superior lal)rngeal branch of the vagus nerve o supplies sensory inn. o is accompanied by the superior thyroid artery Trachea .5cm in diameter & in infant it is ~ pencil thickness . below vocal cord o has a terminal portion above the lower border of the cricoid cartilage called the inferior laryngeal nerve •~perior laryngeal nerve / -0 branch of the vagus nerve & divides into the internal & external laryngeal branches • . sealing off nasopharynx from oropharynx & laryngopharynx 3. involuntary & rapid. o inn. .

-.supply all the mm of the pharynx except s!Jlopharyngeus (supplied by CN IX) & tensor velIz .tJa!atiniJ...li-W----by::CN V J. c.tL. o sensory fr~ eN IX (glossopharyngeal nerve) o tonsillar nerves formed by branches of eN IX & CN X ALL DONE (THE NECK)!!!! • ~\--l.\ o_ r \s \ OO". 6 ~ v au. e . :\:'S\<-l.~ ocihe..sl1pcp...• nerves o motor & sensory from pharyngeal plexus of nerves ~ motor fibers from vagus nerve via its pharyngeal branch(es) ....re. ..- ~\4y\ v <1 ct u -1{.v-.

rn-ctlj Yl9iOf(lo. mab\ht'l +e srneu _" \N'r)ere co. Frun\at '~OlfaC(Qr}' b~~b. roof poss or :fili9 In me I)Qs-al plate! septuM . ___".cn \1 n f-orm p \o{tf....J. )f "r.. -tltif) f CS F m'ft)~h the br·\ Fo¥ rn p 10ft ~ DIj+ -t-\re ..* 01 fo. (..-'. +or 'I org:m..neNes ci>! bcl.tor~ ~'1e.11t ceo r ? . . l<.(l()S e.lesion DIPQc.ed 1YIltYo.tens iom 0 F. nerve (eN I) I: _ "'\ ::J J l[m:lory lfaGt Laleral' ..se fibers o P me. oWac tor 'I re ceprcr ('IQso\ CO\}I1---f \1e. .U reos 0 re 1'()cot ed Hl the along 01fae.oge .e lea I:.in 9 .1y '1'aK. ce n bod' e s In r- or-~\ WI e.. ales C~ F F!hlnorr . n +VJe.v. 4 -t--tx'_.fa~tory. ..XOnS brQJn C\JNI CP.)s\'tlce menl ngcs 0 front \()'Oe ner'll-e.fmUlationl r o! ol. J s. of.l . o." " up olfaotorY \ '\...ynapse. t fYlP c lses to 1.o!'CtC\ory strja 'f r> . .. lOy) .L.t'Oe fC)re" rain 1)\fac:tor'j lC sleeves ·otlocated It) ~ st ·Fne. eond. ~ CflbnfDrm of tne.ctnr'l bo \ bs.St cen s fDrMf H1e o \ fact cr'l no CT \N h I Ch cony e\js.:f 1'Y1Cdla! Wall Or t\ie superI or nQsol conchli fllJeJ':S t-rnlJugn +(h~ foramina cllJtQ sUlround.Y1bWY'i o s.-\-omor of .:t ho.I . SlJrrouYld t\1e cil 1on woUld \"IeQ caus.me con couse potren-r +o present 0 wI AYlOSmia Ie s.I cells bi • bGlb:.wl TY)e. ~r~ ". -t\"\e.~eo! te.n or ex.• CO'i1\1~ sense. ethmDld bOne:" orne 1100id.O-s ore a ote.. ttte:.

.--._---.Frontal Central processes Of olfaCtory receptor neurons ~ olfa<.-----.tory nerves (collectlveiy.---------~------. Ir') ... olfactory nerve eN I) B Medial view of sagittal section through cribriform plate of ethmoid bone ---_.------L __ -------------_ . -----.

deep to rne op-nc d~_~.lls ~ :. +roc+ seen b'J a ~Json -termlnare In open 4- IDo\<.k-WI.t opnc. Of +ne fore braIn (d len cepha1on) " sun ourded ~ l'YlerHnges :t s obarQchnQ"d <&:pacE f! !led v. flbet"s profV' +he hasql half of each retina de cosso+e (..eft Right ~. +ne~ are fIber +rocrs fanned b"l ox DOS ret-Inol ganglion eenc scle (C! ~ be come myel mote d. \ 0 ptlc pl-erce --.'J.SLJOI . cana) to 111t+-. \t turms T\12. . fY_OYYI tt)·ese fH~ld!. __ nerve pas se '5 pD s+er o mco I at 1'1 I nor bIt lex itt ng tnrt)ugh tne. P") IS: opi1c...--I.t-Yle brenn.GrU.. vlsual.. mq IO.hlOtsf(l ~ jon') ret1nQ to form ~ \. uncrossed fIbers f(Dm t:\lt tcmptral haIr of wi boTYl e'ies \Nlde the . I r=: -~ . n vi$u~Ulerd Left Flight visualtield t..)c'ei! o.hl QSiYl --"l> rere.e ei"1+tV hHcld \e crOOlC'l1 fossa! W\1Cft.0P.tIlno.. nenrc-:.. mos-tf\bers .F.L NEI2\je ]I - OpTIC n 'conve'lS BI'ii:~nfonl1atJtll'1 .c\P\tQ\ loves {)f-.GRj\NIP.c c.'1ed +o trlc VISlJQ\ cort-Ices H1e. •. gcn'lcu\Qte of boo1es\ o ~ h"(: -ttlu\Qmus I'\l. oC. relo. eNS ontenbf ex tens )01')<.(ng srro \ ':fht 0 head tYQc+ are.field y~&uaHie:Jq .are pmfe 4....J f cs F " opnc -rerve beg"1l15' I}JY"ltl1 unm~e\mared oxons of retmal gang J"ICflic ct. OpTIC.

.-- "...-.~ rves are I 6 v.O . cons e..-. Mu!tlple . __ (MS) . 0 1I...ior view Vi B super.ior .Left visual field Right visual field A S!lPt.----- DISEASES :t TH~ OPTIc..__ _._.scept1 bte to -I-Ylt e ff cc ts 6clerosls .e _.:\TeS (g\lo\ P T1G celiS) form mye\I\\ gheat-h +ftlt.surfm.lr.-.\L: DEM~EUNA"INf:\ --~----.::::. 'transverse section ----~---.}Y1ds ~ opt Ie I"IeNe o:~ "s. CL1NICJ._-. NEg\lE . --------.---' . _ _------- ...__ .q_\Je:(rr\~ . 0 f ---_.. . dem~\\l]atlng drsease s Of -t""ht CNS SUCh as ---- -_..OPT\C nerves ore eNS rrocrs :. t. -_. o\lgodendr(!)c.__ .jew..

bllndne$~ If) nerve on R lqnt e'le nasal fIeld Of Rlgnt e'le .Intervpted 'Ri~ht mdnocula.:!'" d \ ffer er"It par ts of tljt VIS: IJQ 1 PQth \1\1.\< of '!h 'If) righT Op'tIC tract -v iSUQ I IQSS similar ·Fe IdS' ..• ClINICPo.0..J\jmre t\1e po.r· blindness Vis.lia Left' homonymoushemlanopsia Visual .L FlEoLD DEFE ("TS .th\N(..\ f\'C.~ be In -V - penpheral Of VI'ioIO¥'\ los"> of Yz of \lIS Uo.r 0. ..\d Gf bot:y\ e:"Ies ® Lef+ nomon~rnD\Js hefl'll ~nop::.. fields fie_Ids J.Section of right o~ic nerve -- Seftion of ..res \J \'h r-rOl'Y) 1es \ens t1I o. _--_ .) le!:IO\I of r'l)o.ual Bit~mpoi'al hemianOP!.emp Oral (>1:'" nenu anopS \Cl due v{sion b\ocK.r1d~ ef) l..ies ion] b\o(.\'1IS . n ~ 1-'lpe or.right optic tract --_ _ .'1 .MOSt common form Of vi~ual fle\d los'S .L-·· VIS\JPI.\a . _- n ® 5\-1. ffee.Df ten seen In pot ler)ts wH-n Slra'(es e (j0 Left hem! QOopSla .blOCK Of temporal .-- ..defect dept'..

b\OCK' reston of (""'\II.bioc« Of temporal nerve on .--.---- ---..most' cDmmbl') form Of vi~ual fle\d loss ."I be due t'D a P\tu\-r-or'i In .blind nesc In nasal f\e\d Of :. in E. -.-------~- ..nopSIQ mo..v - penpherQI v(siotl los') Of VI~IO'i\ of Yz of VIS UQ\ f-l'C\d @ LeF-+ homon~rnolJs netY\\~nopi\a ....of ten seen 1 n pot lef)t5 \Nt t-n st tOKes e ffi Left heml anopsIa R Iqnt e'le RtgY1t e'le .'> ·IF.iml\Qr fl·eld~ .-.visual 10<..--~--- . --.-- ---'--- . nrr{)or grow\nq l' (jf bo-th e'les ."-" '51-ren pora\ ~lem\ o.ie s ion] blocK Of ngni- optIC -rract ..

l) fIssure. la\\oI.' \e\foto"f po. supp ues rec+m.at1t>n YOUrlded') re. IIltenor Db\\gJ.NII\:L NeRve - 1l. supenons supplies micld \e rectus" pC\m.ngl ibfl ) roo.ular • 6CCU\ omo tor.s t'ne c. n~ \11f"enor d\\llsto('l 0\'50 cernes {'-YDm ttns.ter p\)p\\\Qe --'l> ::f cl\'1af\jbod'i Of COY'ls+flc+iDn aC(.e>trrq ..cept-\\Ie Inferior rectus InnervaTIOn y{): • supef\Qr.Jce • Sp\'1Wlc.! -::t.s: (elc vc+or of superior e'Je tid) IbV) at"Y)t. . pr ovioes tne fo\lO\Nlng ~ 1 - 00 mOi\:}'( InneY\Jot\On ~ p'ropnore. Co.t1C 1(lney'Vot CQ\. oc.ranlClI Co.JSes (tnT Dll::j \1 C I \lar'l g Q.' gal191ion t>ers +o +ne ttle cWw T'I gang Hof\ posT6ynQP11C flben nerves +0 Innervate 'I\VCICVS to the eye ball -M1e c.b"NlOd.N pUpIl mg lens to be come.I Ylf-en Ii.le .Q<P.sion·. l'{\\dd\e.vlhI ~ enters +ne orbIt" +'rlYOogh-the ~upenQr DflOlto.iex nerve._ue fl . dura ~ rons throogh the.QK .CLJLO~QJ".. pora&'1Mp \e'Vamr pa\pebt o.e supenQrI. -more oelll-ar rnm fDr reor V1S\tJD to T'oe o(.slOl'): llit\) a: superur lOfenor ~ ~ SVl>enor oiiv".. . spnmcrer pup"\Hae pass s: 1Y1 shorr c'lliar'j of ttHS nerve 6dlYlger-west-phUl (IOCQted IY\ 5upencr GO\IIGlilus lMldbfOlI1')) n.vernovs s mus "_Iea_ve.!l..d\\/Ides or dW'. I nfeno'f Obl'lq. '4 d\\ar'l bod'i +o prcx..l ~SJ:Uf~ • \N\t\'). 1s -ne C\llef nlOt-or 4..\pe'Omt.L-- _.roof 9r lateral walls Of -me.if'Qr'l bOd.s~mpcl(fuet1G -:\. . presynClpttc.f. emerqe~from ~ f'{lido'COln / plerce~tv1e.

lof\ 0- p{).SPP\tES.u. error d\\l\ston a \ so cornes pres\.:t 'of>. " sup-encr rec+os Infenor.:t t \e'io-ror pOt' peD roc.i'fir en " "f'" . G\ -1O. pOlrG\:5~mpC\-IIJettc. so penons I ~ or d\v\ SIDn: supphes JDidcl\e rectus Infenof Db\'KllJe \1fl c.n c:t(.f'i' gang.'('1 bod. fl bers +o ~ I JK:.! .VS at nC'rve ~6dlY\jer- eSTphO.. r-YDM -rhlS rc r:efVes +0 roncrvc+e -ttl 1 S -M'le ci \\0. ..n ttle Sh()fr.[ sp\l\'r\ct-er +re eye pvpi\\ae If\ ball .c'll iarv .s-t-syn.joapt1c gang lion pass .U?t1C f\ be n. \ {located :su penor co H luG tus (n1tdbrat~1~) Latera! view -----------_------- ( .

h..t~ s 10w nes.'. ' ~. prcqre sSlve\'\f :i +bere !:) \ PS'\ICl. .aneur~'S m..s.brQJ D(~5\jperlbr cere beltar a r ter~ mo.j-ed i chrec+ed s \\ gn.r. e ~f f.s Of ptJp1llar'J re s ponse +0 Iiqnr /'up\ l\ar'l Reflt'tAfteren-t"" OpTIC ner . Dbflq.\ &'-]l'i1jJC1tre\1C fibers unopposed of +V1e 1 Cl fReted re_HJ\ti09 IrrterruptlOYl Of the p:lra~ to sp'()lnc..y a ftt:c t eN 111 I CQ CAS '1 \\e.sopener .--ne m aYl The Injured side It$ C1 result' ptipII.-~. In' Urles 1 0\' tumors In CCWerflo\Js Sln'JS mo.)~' \) q bdl. poro.I5~? . C LIN 1C ~L.!>ses c~ pet-ravS' part In (M of t-etrlPon:J1 out-on OI'lHe rlbers are supa-f1c0 \ .>r \'1 mfcn on~ (down 4 OoT) ole Or tYle uD@pposed a ctHJOS Of the lateral rectus 5\.)(..te.~~ .cnorcc rens nc '&19f\~ C I)lYlplere \es:m·n Of eN TIl are: (D Pt{)~\'i. '''-. ---=:. w no.! ever+ pre 5S ure Or) eN 111 0.. {"he.r pupll\Oe leoving t\1e dilator puplllQe for '@ no CI-CCOfOOdOt-l!m Of lens (QdJ. 0 CU \ 0 motor !=tl \s'l Of0.ve @ No p\lP\\lQr>j ltIght) reflex ') 1n l C0I'15'r'f\Ct10h of e'le from t\1e I +he pUPIl In response to bngnt llgn'r ® DIla+mt'l P\)P.l-t-"i near VI slon') be ca.)~ent 10 l' conve..L·: COWl pre s s ion of occulomOTOr Ner\le from an hxtT(~d\)rC!1 bOOG l)erYlCl~ .v'. lote(Q\ .6t a· pO$~nor cere.>se 5 Of D cevl o MotO'( po..+e. .. l' 11'\ pre ssure of lot-en'lQ ratio -c LlN\C.I>..g.. (d roaplng') o r 'Supenaf e'1e \Id \ CQllS eo 10'1 paYCii:\'fsl~ Of \eVQ roy I pol pe brQe soper: OI\S ® c'teoo\) tp\. .) se of _. re s Omt pOS:SJb Ie CQt.\e .ereri t •~ = occe Iom oror =1' s nme light In one e'le ~ so..I p. s \ -t passes bl\Kl· +hese vessels l!'If CCt-II)'ClS. \'1S1S 0 f C In en ~ Tn \Jsc..) result1ng 09C11flS+ orren - corn pre.ll./ ti'!c 2 e-w Or olJClei .._ ~.lY1e ei G c on sttl c+s ~ snioe light I'll •~ one e'4e 4 bo+n exes COnstrIct blc conneCt-IOI1 !J\l.s 1f'I \n.rapld\1j ~ lnt-YGlcraClI'o. nl /I .eJe-. dIlate!.\.5"ll. 0..y ore at f-e eyed -fllSt -.r.

.----"@ 2 @3 '1es. . \. @> t» . \n ()-r otto.r snme Iignt ~ 10_ ~ one e'l-e ~ SQlYle e''1e c.re Of f-e e"ted fws-r .--_.·cI.no e ff" ereo+ on .i->: I ..te~ pn:gre sSlye\~ on +ne Injured 15 \ps\\o. .s.: LSSION._-. __ . __ . •.=.. no dIrect reSPDnse .ses. -_..tphQ I ¥'\Vtle\l~ bo-rn e'le's CD'CIstnCT ole corme-CHon bt\N tile.S Q :t Or (pt\ros\lmpJ f-e..i qet11t'~ ._-_..u\·omotG. pr-e.pressure l' In carotid Q..Qcc.e . viet bodies .Af feren-t' co nc nerve \'1\.co s-mcrs sh\ne hght In one e"le 'E:dU')qer. OiJt":' &-.. 'le!. eN1Il ogo.-As Cl re surr --r--ne pupu dl\o.d"'l l' 1nt"TG! cranla\ pre SS\Jre (e. 2 e-w f\\Jc\ei CUNI CA\....+here ~fJti . -rhey o.f-~rent = .wes. I fr om Q n orren ctlm. C0\1)1P re $ S IOn 0 f occul 0 n1 o+or N er \I e .IN\CAl. flo 'I Q t-ero.ra p.ls pan .'----- II no . .g.mst are sIJpert1c0\ pet"fol..""ch reet re'spons~ I ('.! e~ert pressure Or) eNm as IT posses affected ~el b\\i\l 1-llese 'Ie sse\s . dura 1 herncrto!l'lt!J t-E'JYlPorql bone .Inf t. \nj \)ne~ \ or rumors .---.GulomOfu'f nerve c\oMPreSSlOl\J . _ .aut-on ornle fibers eN m sde :.IndireCt" I't&PCfls..n ·cNlll coverneos os \-t \\e5 ....) re s t) \11 nq S\n\lS I() \~ ffiCUj of 0 rf-ect \otero\ \Na\ls 1f'lt-ernCl\ ___"._.C-\'-IOW.-reral slowness Of popIllar't response m\iqn"t ::4.i->: ffkrent riqnr sitle /ef ferent lef"T 00 ..---- .~lrect" respons-e I s \de (oc.or sepenor cere be\1ar 0 I ter~ mo._.. ._-_.IPopl\\a1"'1 •~ •~ -.

damage to eN 1'/ Its nvc. In clownlNofd) :$ isthe only musce T9 me 1 _gOing (dOOblE.ne +be.'b f tel\ ! pqjui''1 f\ SS\. 'i neOd !oV)g Qe.ed toy n dor "19 seli.. Q persol'l rYIC\~ incline headl Qnterlorly -----. _ depress trioy Oblique. n · Il)ntr"otes q...eN I\' upen Qr o.1fS} Os~1 st<i. -.rera\ \N. rnusete nfe rl or rcet U~ I"i'I U!ela e~ebQ11 ~---IS .------.S ttle. uno pPQG. Other ~V~n ~ DOT +0 Of +he e~e P_C\\l1 the p)"inror_y muscle prOdUCln9 I~n P{!lrlC4r3 rYl()sCle prodoc"ng ex+ or sror: (the Inferror ObI tq_uc) 1. l'rs n·.mo.IN I CA L...llt-/ TO i.J {e..\.: .~ a tane .lro morer @ margin of cerebellar \o.~ laterallv to ~lde of~-------- ttJe normal e"le .ohplOp\1i\ cccor s ole If)r p7i?IOPIQ normolly.)j~ cloVJOSta. 5 upenD (" c b I ique to eN N lS rorei'i parahrz. sopenor otJll q_ve pupil so When.. -rne. c.s!nus Cocr se t-h roug h t"\t1e: 'C )_. t\1e Ob..VISI".-thus +he gene Vi 11\ be dl f feren+ for the two e'lt:s .ompenseie.-. $ brams tefYl +ne dl.ed VJ nen HlL. 10 P~ +ne. I.-- . 0'1"1"'1eN to eme fge (lnm\on~ around cOllrsi · pIerces 11'\ me.nowl bec.."-. the To do (d Ire cTiY1g +ne.ed VIO Injorlj to eN I V ..Ql2a l_§Q[f~(. I . of of (_D\...e Or tentorium S I.Quse +he s up er ror Db II"q_Ue.)(Se . SlJpef!Of obI iq_ve IS I para /tj"Z.)"rle~ bI c. longest · tY\e.) P 4 pa5SES or)teflOf\~ af ttJe IccwemD\JS .g. I.cncmc+ensnc sign Df eN IV In)F'I \Nnen lool<ing dDwn le.d IflEerO-lY\cdlall" - '<.. Inferiorobllqu.) when .OIl me front ii'1e' s!.. gene pupil /s aDclucted .one will be norrnct 4 the... • slY\o\\e sr nerve IN.\eus IMpOlr t~n ~~Cte.upentlr OOII~ ~ runs e:Je\ dowt'lw()rd lY1tracranlQ\ 5\-t-he laterallY tvltdtm::u n =f +hen passe<. I n') \..

. of the. nose) fac.II. +\12 -\'\13 90 to sensors nuc\euc.\\lJding . Of eN \j . ~__.__Jf Of..head . '-t-I'-e:OIV)gcal branch: supplies dura oamQge " to VI . \\~ [J_r.OWIQes irrro.· senscrq nerve fDr tt1e face ~ motor • (3 dWIslom Of I.n'O\lfbSSG\ • C1. eN \J Op hthalmlc (VI) .loss.UJ1 to .fran t-a.Cille \ -tl'1erMCtllor reo ~:ce \ painful serJSett!bl1S I .e..on\'j - sen&OI"t "tt<:.\lerq\ SMull l'i)T\'l.ethrnoldal sinuses).X\\\CH'I a.e a bDve the e'l:e l~cYlmClI ~ s \(.cl)es supplies: smose s (spneY10Idol.Fro'('l-t. tv\o.1N\CAL.X t.-er-l:nrctl~ s .\'1\ of· branches -. t. to mm Of mCK'OCCl11Dn 4.\ ob. :f sx.Ii seft to.-N().. Motor fibers of v3 go to me+or nucleus Of eN v Frontal neNe · funs In +he dlJro. .: d-\'\IJclCS 1rltn~ _---=-..~\:'(lcnmall1erv~.al'1d\ bu\ar lV'L) Qn\~ sensor\j MetoHseYlsor~ tVa) - · sen SN\\ fIbers Df '1:.feel .up!0.Supratrochlear .ant'enor cro. .. se.\ie.."qH::m.C1:\ gloM.rnotJS SlhUS\ ~ en+ers orbIt · proV1des '\. sensotlj ~ Intle("'iQt1tlVl eta \I ~ nDS~C~c. Q Jot of. lat-eral \Nail To: Dr the lo.ler'l. +Vlt _--- 11p Df The._-\1::lt.t"-rr:l~tNe:: -----'!> Sup?''! s cal fore. dllato)'" pupillae If\ postenor/onTenor.n Df upper eyelid (.SCCI\\O.L KHius 4 upper e:~elld PI .. conjUCtlVO.l..

:Je\i~s .e \ltnb. come.: .ab\ 1\1 .ebrY'leotl.ll1gca\ brQl'1ch: SupplIes cronICi'll fbssa • C 1. Glosu~Of +he e.I~f!.tf-t ss _re.r~. --_ . +ht s If sens cry If Impulse.O.a results frDlYl cornea sef'l$or~ +c ty}e lY'1 blm.---- reo 1\ orea.orneal yefl~x ' Qrrereo-t .fC" . 111-rerne.fee.&upratlccn\eor· _ t'lGts'OCIllo. " \rrto~ S l}PP''i <seal PI --_~_:--S-IJPt9d)f$'~-:::1- t . .Klng of e~ehds .. nocte us of- \) r.uron" tne. bra'') t.. of fClc. L-.\.e a bDve -r'ne e~e CJ~ cT1VO.IYHYlal nerve +aKe. SeY1Sc. (H) C\Uding Tip Of +ne.tJes.tme~.n -"'. nose) . () f- i-Yle.----'-----~---. -~~~u~roo.s ~ supp)ies: 6\n\Jse.SF:m of....X)h optnQlmlG ~.<:. -. S· ~ +\'Je d \.Qffexcm ne.+V1t: rClc. w nat I s t'ne (DfneO I r~f1t.)"'!)Ou) Sin us 4 ~n-ters or-orr . trlge.o.\II' Impulses I +rovet thfOl.-\"Yle Mcio.pupillae .. (6pY'ltYloidClI.ldes.J i 0. 1<1+e rei 1 \N a \I o~ t:~ e.t?..\Dt or bro.\ Y'1erve-: I QcYlI'Ylol d'!'vldL:$ ~l()r1d. I!\l hlci1 S" upp!les _ Of VI oJlons {)CU\ i.. 4- SKIn Df upper eyelid forehead ). posteriOr/anTerior dura·\ nantenor eitlmolclClI Sinuses). dIlator..'{'J'e.t e t::CA H .frontal s mos -Er911-tq·\. 10 +ne motor nUCleus.)s~~_ \ y\ei"Je.r'l upper E~e!\d nerve OWIQes lTYro 0.. SDr+ tact-'\\e \ -tYlOMal. or paInful sel1sat!bl')S ~> Of c.l1._ \ os s to .r~ .Che.no)'e.1Nl LA L: ~ II dOVYIC!g-e to \\-IIj VI _ toss Of.-poe mr)e("\lQt1t)\'l to: e-. .-~~~:{?.:'"'rerlex _ lIghT Tauthlng of tile. x ? ?*'''" ._.

s.-t:::".n-t"eqor .. parQI)QSClI SII1USeS.o.I-tClSe nasal cavity) reStll+lr1g powerful Dr 0.h. st -r'ne Y1 ose.1'i verve .:. . foraMen IVIldfC\ce (beltlw +'rte eye PI.Clrr~ t-l1IS IMpulse to motor nucleus eN y.. or nerve. 41Yl~f\1 'Ageoll 'IZl:XanCh .la+e Ore!i1Y1.ii1::...vie l-en-t. sensor" h tvle.- . nuc.rel)'\'cn.l+ abO\le the Upper IIp.lot-ln' Or soft Of SOfT CN. \otecl QS a fore!9n body enters T\'1e nose.\I of -me cavernous b ll'"\Us...po..! · l'(]teH"ltuYons c.+ens or veil pa\at-lIIi ~"'''Non· . · afferent 4 "12 fivers ii')en ort.1tclcl melYlbfQnC b'l ~teYlS\n'j1< to deflecr loud ."Uj 90rnatlc .tensor tymponi.. 0)1\'1 V'2 n . the \VI0 l..2.. large OpeJ1lng CHr ova\c -+ ..:.pdlare.s~es +'nroug r otUl'lduYVl. e 'f'1lUSCl-€ Pi the '(Y)rf) SOrT palOte all except ere po... mo.lY\uscles of mo.Inrrc.-t-he eN\l of 'WIe SeI1Sar-IOv\S are"carned bact:: to tY1e sensor.:. ..·l o.cl')ecl to -\-he · proter. · eN x cr the actl vo+es p\lQryn~a! ~ tracheal mlYl· In Q 4 creo+es re. :4.c\e a It Q. t~ +he tynrpaolc SIJIJ\1cls Or = IC\iCitor pah'Hni soft pctlcrt-e== of +ensor ve\i p:::t Icrti t) 1 Ie eGlr IT r mall eus bone J'.. tenses (aJf-t1gnt seal) .oud &t1f\1\J ole el{p Uts Ion of all fur 0 ugh.v'J +evisor ye\\ pa._~--.-tnrotqYl +re. -. :\.nee'Le t'efl~ I ref • J y\ V 0 \ U fl-T-Clr'l I lex? S\J q den.+o qSA ..\eus oF. M OJ( \ 11o..lll\\ory teeTh bron()'Ies: ."'..ner'le .feral Wo.....st1catlOn . · iV\uo..JtV.X VQ~\O'(\ palat"e .posterior I~upencr nerve bltQl Q.

ma\Jt\'\) f \'Oer<.X except ttY)sor ye\\ pa.or hjmponi..1.nlc me.t~ tne tyJlt"lpo.C-I'Ieclm Malleu$.r ________ .~. lateral dl9Q5TnC pt'e. . __ . to: _._ .&y hlpathe 'r\t ~ t-as re fl bers seYlsat1oY\ I 4 supplIes or+error !f6\lbn1C1nd\bLl\o. senso'hon Sa I \vary secretwn .~---_---.Jatof patt-\1Y\\ Seql) tt)e · tenses (Olf-t\gnt or oof+ pqlare= +erssor ve\i of TVllddle ecr lit eY\s\fl~" \T.----~-~----------' _-. to deflect" .ry~Dld 4 m':JID h\jo\d ·_&:' mw'd 1~.~~_~M_~--.Or'!-tenc._~ Isub lIngual 2/3 iUnglje fDY for +os+e.l\)&r~~~ - of anterior 2J3 of ffie 'rongue j\)\ns: +ne cYlorda tIimpani Il\IY'iI en contalYts pregQngliom~c paro.O'JC\\c .Muscles 0 r lY\<\st\CatlOn +em pDre lis ~~~~~ .. (be\o\N the lower \lP::4.bell'l of too Rmfl~~ij:'M··"tfjtB.ort palate )l. WI!Jscle III the s. .lower ptAn· of tQce...c\e alio. S" E tIber s TV : .I._ .. prot.!!:1ml\~~J:g}J • (] s p.rYlbrane b'l 5\J\lWS loud . · Nott'· Oil nltV) of sOft pOtI ate ore 1 nn. . Jiil.tens.@.+ens or ve \i pa\ at-III\ . W\\.l<..- .et. bore .\ClTlni SOfT · ere vo-r\OY\ Of pa\are ~ IC. I?'J CN..

tene bUCCG\l nerve nerve Il1feno"( Q We.f) over +ne ehln • me isrve bmnCY't: <supplies CarllOe 4 \ Y'I. t(l(( Q IYlen 8 pInos tJf1i\ carnes pos.l. spil-ts Q~ter!j 4· re j oms . PDST. 'Deto re +hl~ t-ne. nerve ~ IncIsive )'(lent-oil nerve. lnfenor dental 0) +ee+r. tylYJ po ni n.(jsor (01\0./ C.found middle menlYigeOl) .rohcl 9\QCrl nerve en t-£r s the.ol.e..1\'lQnol bulor teetrl SK. nerve totenwr "'" .. reqrons ..t-gang~\on\c pcm:A&yropo.t-het1c fIbers to . po.n S. \(Ifl 1'(1 on buccm error ~ -H!e. IT wraps o. muc. 0\ or nerve.sse.Js meMbrane .pC! !Ginn 1 ANT. 1t tn dDlhg sc.lJ pter~gOld deep t-el'Ylporo. .l nerve Mo. veIl.lotefC. forcl'\"eO spmosulYl ii~_'- ~fler'le to renser n am! ell 10 - +eropora! n." ' .y"ve To .

0: frereY1t 4 ef ferel1T liMbe. '~/""il:-~ ~ (CN I Inner ear mIddle ear I! .\1V atory rWC\e\... gangllof) .. _ parOhd gland I QUI \ OJ I\) .tY\e rn(m~lb\e'l or lower jaw s\lghtly .Infeno r so.. .In IS." I pat1eot's eN v dDwnll'{ar-d angle l\loUth IS hel d .wlB J'erK the moncHtle upwards -~ () .e 1 ~\V" I' I' »: j !I" i . op tre +ne jaw JerIC.L: Je&lon Of manclJ at! c bUl«rneT\re.pped at a be\D\N t\'1C' !l'ps o+ the.I ErlosSOphQfl_fr1geal .0. chIn VlJn\'e fut: open respOI1S-e. ll)dl btllQf nerve. t-eoopora neP!. nerve IX) 1\ j \/1 I for am01 ova Ie ".ma. 1.tY1e mQsse-ter"./4 (j • _CUN \ CA. J aw re f-I ex What IS V3 ' med!ate"> +ne.TQ.--~~ (. reflex? \)Sed +0 tesT _"h~ srOrru$ Jus t OF.

jhICh alJdocts • C.+11e.()GVS In Sft1VS br lI_j To b\ood. Or eN VI co oscs the. ((il eN CQY! ~01 s 0.IIIOS 0 S \Nell blc ObCltJcent run)" parallel tv -tt:e Interneti COlrbtJd o.5hOrp\~ Intradural course Of ~\\ the. L: . manner os t:. SUbarachnoId £:po. .e.n . tone after entenng H1edurq spoce - OCCVPjIY1<.Nef\le.the ---.'1e In j u r'l VI +-he lateral Tec.I'1 -\-er s terna! ar+ery I which para lIels .s+ Ca(otld Of-. C N \I \ +h en or bit +hr ou'] Su renO! orb IrG\\ fl S~ur~ ~ ru I'J 5 an ten +he... pe -t-rOIJ S It Of +ne. __ .ete.c. LIN I CPo. prOV\ des mcrcr + propnocept-\\Ie I nforMQt"1011 lsense '4 or. t'ne 4 tne cramal j:Qrt c\sre:.pOSI hOI) or bod.DN'presslbl1 ma.l t to +oe A b d u cen.) rransvel'se>. pon'S pt:l'{'rnnE Co.. muscle ~-.rt-cr9 \() me coverroos sInus.craolaJ ore ssure.y occur In Lateral re~Ws m~scle the c av er'nous S.1 \es.'j compress eN VI9 lareral ~---- ~':'---Ferr ou s pet r t teM paral bone ca. . 11'\ t'fQ b .vs·lng paro.\ltT4 du -tY)e mcdu\\o. eNs I It (1'!)9 1'r'.st-rQCldhng ~ runs oosllcwan-ery INlthlYl The .ru>. of.------rec +o ~ f(\U s ere corop. SUPPly n same. \ cc\Jrse +ne longe~T . long rnt crarnat COl)YSe be s t-ret.n pIerces +ne dura dur".. .l'lSl>. parol\lS\( C)fl't\edlOl delflO:t1ol!) eye -==:':.cl1ed \AI hell mtn::.ternporql • G\ r--~-~_~. c.. toYlporol I)') bene t +t1en courses ±prougb In :rtIe cavernous Sj()\JS I surrounded D\f ve. The.e .J()1\ sllch as a bra"m turotlT mo. a-f-fecte£i Unable to ObdLC-t c~e .It -\-Y)e. ti1e e.lateral rec+os -=eMerges from +ne br()m~Teom b!w fue. +0 one exrra-ocotcr muscle . !tIc .eros --I-t)e h over +oe C re. '" r PQrH~ blc Of irs bend o\ler +ne pertcus por r Dr Sharp -rt-.rn oy..

lDtJ such as a bram t"VlYllJf ma.r. [t eN VI nOls 0 IDl1g /{Jt (01 ctarnat COUrse co n be s +re+ cneo w lien tntrQoanJctJ ?resS"llre.y occur )11 the cnv ernous sInus as well blc ObdLi c(rd.:-~jII~~..ete.1) porH~ . petrDIJ s par t tet'Yl para! bone or~-.rt1:J9 I{\ tne cevemoos SHIVS . unable to 0 bdoct c~e.occ\}~m9 \es. n t\'\e..! S 1< (J f- eN \1\ c a uses .'j compress eN "\9 Co.us"lng pa fO\'lSl<.. para!.11ofl of -file affected etje ~ ." 0 the \O!rerCll r musc:. tenrporql bone •Q .blc of 1 t s sharp bend twa ttle pet\DUS parT ot tf'e Oft-er en1"enn9 ttJecjurq - ·_1 ___.___ -----~---rect-us /' space .t..dlQ\ dtV\O.run') par aile) to -tt..'bJc.le cornp. CON)preSStt1Y1 ma.e Internal COirbtJdo.

.~e pon".\wt-e gong. Slte.tJC. st"eritlt =t I ent-en 1-Yie pqrOTld gland n · form<.cot-en inner WIThIn the ~V"'- ' ear Clbrup'd~ \nTernC\1 cc OlJst'lcN\eattJs..:. f01cia\ canal ___. ~ tnt.1 the.5 pressIOn ~ ros+e (semor. ). / · tht s rooHer 1nt-er med 1ore nerve. of r~C1Cll expressIon .).-- rVi'\fllnq sherr.'13 iflGlI !¥land 1 bvla r ~ · also s\lRP\!es bell .e nev-ve.yg Dmot Ie. .\\ .~~~~..n IG co. cernes ta 50t"e.. plexus IN' nieh gives rrse +o i rs 5 terminal branches: muscle bu oco I.C1Q.f.r)lctl .J.lM -rempOYClI bone.. QhtenDrly Me d fOol CjefllCUh.sC! t. Inn. In +ne fCtLlC-l1 cana) .. parotid rem pow \ \ -z. +ne.nt erme dl ate nerve · toe larger MOTor r oor . s ~ h1 pa-the.\ (jCJVI-V-. dI'JISIOI"lS'. faciOl._.· O\lP?\\(.\lOn lsen<.7-'1'1 ~ Viscera. 'i)'P/es ~f -7 t'nt. . then ent-er~ t\le.. 0. It eives rtse to the ~~~~~~~~~~I~~ 'ill the. ra. rrnv erses +. to....~Cyn~or~..Q\STcmCe.ne. 1 po.e'f.t-enor Cro.I Y101lt I ear) -Itle sharp bend IS -tile • geOlc\... of -tt'e "(cGtV(\o.. ::t mscl\.~~~~~'~v · t.HIC\ as 2.. IT +urrrs FO$teqor to COUT"S{! a long -t\'le -'3 \1110..+'lit motor root 4 +he ..c Of f HlC t"'j t'llpo... ::t ~ Cey VI eelI ~="._po-.) · eN Ti1e Junc:tmn Df...l meter ~ Special sensory _General sen$or~ n j< et'1he.c::. lYI Q f.... ' .1-<'\\ k- V 'rn..dAaN. ~ SO I'{'Qi1C sensorlj f\\::::ers / -r (\. eN C .-. rYHy\. .\Me:rve Sf •f 't'&\\r '") .>Jli'tj ((Yl \dcl'e the:..N . .()(~ gangliQn of eN W) tY. • Clunnglf"$ 1TIV'Ocgn • after course.. or -racial 'ill emerges Fro'l11 \"o\n1 /' .?s.

.. _ .·!.\ wett-ory e of r-aClo.'" --~. .----~ . --_ G .IJS : l'1e\\o\~) _ brancYIIOmot"o( +o rom· .-------_-------.r th an s 0.. ·1.---~-----. MQtor NlJC\e.fY ympCl ttlel1c.._.t)1Qqe. ~ secre -rOMOto'( _ re._----------_ .oliS on ant er ior ? 13 +argue from c.cewes ..s - \ Supentlf So\\vatDry NU().e. _.$\C)f\ c.-.-.horda -tymp:tni rv.\eu.pres. f\!J ex.the f{H'\c~\uerve. ~-------- ---~-----~ .... --~-------.--~-. lOfongeJ _ ~ paras • SO\lrfo.E:US. J N\Jc. .' .{1J +os rc sensat1._ NUc\ei of.\e\l$ L<jf{'._-----..

. smell! area of +he S!::IO .some dose • To. <. imgual nove -to GlYrtenor 213 Of +he. svppl\e5 -tne pos-terlOT bdly (\l15cerClI )Ylbtti) Or dig a. h:logu-e * sofT p:Altll-e· ciover lOOK at +ne fQClq! nerve .~l'\qp11G 4 91ands pro'Jldes for 1nn. to on+.eN 'ill pro\Jlcles pr-eJ!jgopalctt\(\e pC\\Ot1f"e pG\(CtSymputhri1C fIbers rc the gang H~n fof Inll. also MIJSCIe. 213 Tongoe_.submtlOdI bo!ar I ljangllon \I ! I -rQs're f tunc.(]13rC\nCYl. · tu lacrlma.s~r.fibers cC\rrled \3vj +nc car-del +um corwe" +o. -=::--... II I I sv'ol]!')g 1.)po.s I M Oll1ly The mm· 0 r" faC.eN Y!I pres qnop+ic parasympathetic gangflOn 'Of -me S I.s... o!f. f.\ MDtor -the n - Qs Nerve.2nd.ne. .lbmal'lcllbular sa 11 vary 9 \0 rlcls. ~rV1e S:Tno.sodeJm \Yll\1.stfl 0 . 213 . t-o ?QS +en or a Uri c'c .1 gla. ~cner(i11 sensory . presslbn . Supply nerve 0. .tem 0.r s:oppl9 CI To -me. Q rcYl leN m svppll·e.o. S\.+\')e I acrlrool1 r1uS"all pharyngeal pre.. pbaDj agee!! derived troru l+~ ~e.s\-e fiberS fVDlYl +ne gen! cola-t-e gangrtao OlGOlJS-rIC to tile e'f.nds Y\e. ted rY11Js:Cle 4- Qunc..meT1c .p)e -t SenSdi1ClYl tv ant.$:t-c <sellsCtt\D11 from the p. styltlnyotd ~ c+npcdtus • ParQ.-IClI ex.V\cn -...131ancts m+ern ul a cocsrtc mea+us +o nasal 9\Cll\ds Yes t-\ b\JI \ (I cochlear )')tNt.JblinguC\ \ fIbers ~ DO brnanchbuJo. 1 je-OSDrlj) Meatus (sp('Clal .. pani We jOl ned JJ~ -the.)0.

land -t-QS t-e to Ot ani".rotl d g la.rve 1-0 ras +e» or Q.. I +0 nasal g\~l\ds cochlear J r sv'ollng unl glctrX1S o ne.r S or fO!l:e 0 r -rne+tjm panic. Meatus {-0 \ocxm~£l.11 ne. 213 tunCj\Je -t seflsat\o'l1 OIl1-· 2 to L~tongoe. syn apse.VOC'e.. .1glands CN:m (-"-/. bolar to po.nds rUIlilID9 bQCK In the SCH}Jelrectton d k.fA CW" er lOOK at tne.submtlnd.00 tl"'" -rympcmi on Ttlc 1.Ilg11011 +o broH1i e ----~------------ . ftbers 6r o.. · l'Y'lt~r\"lal aCOustic.rUn". • Note: eh or-dQ 0. tQC1QI nerve . @ 6 em coio+e 6 angHon ~ post"-gOl1g)iOh·'C ftblYl 6enl cu\are.fld I 9angHon S\ib\\10I1thO· g. mem brCtne 2 r\bers Q)secretblYlotor (1) sensor~ it:::> SUbmOncilb01cH ~ bu~\ir)gvO\\ g\o.

.n-rrct! loc a+ioo> leSIon of CN~ ..t\t>ns =... \'10 'n'ipex ac.\ Of OO)Cl\ sec. .2cley ~"""" \N\ \\ tas're on Ql1teno'( get.') @: Sen' 5 Pats. geolcolfllte 9Q09110n I.Je.. • \')0 ~ secre -nons from ~ .Nn\ get -7 CD-+ @t-@ +\9j +t2)-t ..OQS\s.'flO Tongue.no \ ocn·mo.! ® --" (1j ~ -gS!) potlSllL!b S]!lle \NIH qet CD + .nd~ tungVE__ s-ee3 =-~Ie. o IS he. Os K p 9-11e. medJo) addlJcted Nore-· leSlOT1 of ct« ill @ \TS ongm -:::: near \eSlon Of eN.2J su'ol'nond.\\ ®~ W \ \\ .onls e"les·-=: C\}t 0t~f st-robls mus..armg 1t\.9r.rrt I f--.nD \1eoy'\nC3 :=: ® d eo rne.s <.CONS \DE:~ .L ~it~?~· q e T '(]) t ® t ~ -t®"': . \lll ftl ce. eq_u\l \br\\)f'{\ . . () ~~ w. . b\ood Slipp\'l ~ 'lb\) ro -tlw~ reg. . bo\ar 2[3 I s\Jbl1Ylquo....=\S l:lr~.r'lie(s.CD +\V + .I.\ q Ia.)d s()oocis. se\Jeraqe Or ne.reJ~\')e get \I)+~+®+ ..

oc.0 neo.ors or lOS~..CRANH\L Nf.Of\duc. here.. Impatfl'l')enT cen tl""a I d IV'S le~lon::. nerve emerges of- l1eoying frDM -l-he lUl1ct<on of -trIe pot)') 4 Mcdulla.nc.Il'I~I)\\)es .the.r '(\eurons 111 T\1e.lo.d-na COChle(.ss .hICClffl~qe aco_ CW ~1){j r--) i l \ ~ ~~_. Ve.::} c.hICQ or -K1e.S. LI N1 C~L"· I N.gyE- Q'\u.cs 1111')er \nedlO or t'I) CD c...of ~ ver+\go ._J \ i \fe.bo.0 Or ~~ cenrrql prOc.f .ol QCDust[C meatus .iness.r llnrl<JImmo.esse<.ing or nng Ins of. co'(\~y)osed -:.. :4 enters Inner ear tnrooglt1 Interl1.tl Q) \af YJer'ie CNr \ I . fnc.OChlcor nerves b..d\L:z.noD .. e. '-- \ -. cccm ecr ner-ie.s Or 9(xo~hQn ..Oeo..eN may nWolve WI of de.e • tInl'lltu~ - bu-z..+we I \dd\e ec...lesion'S Ot- \ eN'VJIT_ cavse·· lOSS of.. pa+yj'NCA'J to +\:Ie.f-ne~.Qse cbChlcOi it'). deo.STlbv\Oir ves+molor nerve -:. (~ • C. • 2 klnds o.i1glion r~-7\I~~' INNeR CO(.\11 Semicircular canals . l t separates rnrc +hc 'JtstlbO\aT. splwl qo. .?o\Q. flOM tro!Y\ +-Y)e c. lor 0.. e.sed of cenrrot processe.n fig I ! ions r..compq.:rVi?I E-S 0 F "iffif 'Mo.! .ucaI ctea tes\Jlt<.o~~~ ..:z.w or vcst-Ibu\o.a-nt\S of 1Y11ct:lle eOlf) In CD s e ns orr V1e.fnc'i. - yesn bulb cochlear ~ eq_ullibnum \SeNS~~ _. \ ssp.: ofE"'R blpolaf YElJfO\"ts In i\'Ie. f ness d\se.

ver+i qo .r or m IbeHe eq'f .> ne.hlcCf or In +rte.ot\T\S rnecho llnf-\o. Basal turn Ofcoc·hlea . .I'OmOltlDY1 of.o.nteClI' or vest-Ibular - cen-tr'o.c.ause'. ..~o:.'1 c. IoY61111 Vestibular nerve} ear CochI.~'S In .JuR\E-S . e.".i1)9 or r mCj eN VIII .y IY)Volve \ en YiJI de.+v1No...i nes s • lfftpatfMent or ic s s l Or OF w1'1\ \ g 0 f.- ~ Cochlea.:z...Deo.-.c.sron » ma. deC\fnc.. nerve' ' nerve (eN VIII) .fne.LINI CAL'.---.ars lOSS \ 1 or. IN.+he.ear l ..~ VestibuIOCooh .('mct)le eOlrJ ® se ns onneero I ctea.bCh\COI to The.+lve .bu"Z.\I trom d\sectse If'! +-Y)e coc. 1-'110') • 2 K\f')cl~ Ot- CD conduc.\f1vo\ve.l dtvHi{On~ or- tc. ~~~~~~~ Spiral canal. site of spiral organ -.d\'Z-z. f ness r esui+s r lCH'\{\ po.balanc.e of he~nog edna Coc. + 11'\ YlI tu~ .\e sions YV\a..

rrercnt fro"'! the. mlJcoso Of -HIe ·oropnOPjn)l ::t -i lStmlls Of '\-ne.~----~----.'1e.ontn b\. supphed Cf'l'~..If'!fe-nor gangllGl.. '9G\t1g\\Orl ~ . " eN R the fo\\ ow <. what +he. tonsillar & lingual branches (of eN IX) .." prcsljoapnc.ep"Klf. -t-dl9ue ~ pnor~ 11K :t -ef-terent -ro STIj\O phGW~ngeu$ mllstJe 4. eN ~ \S o. ore a 6lJpC'f\o'f 4. WhICh tvtK€S P1~ .". ~ ('$ t~II. ~ \Oes.c:i1Qh tne Throat r~flex l:> r ol.re.n • cu o R e!\1erge~ from 1i'le \a\-oo..J&cl.. -~ ~.8fo-hd glaYld • 1tc.. fue.s .thlC\ \be~ prt)\I\cled +o rnc OT1C.tympanIC .Carot\d !nn. to A 'S Phaq'ngcal.. cOfQt1d (seos it1Ve..§:i1d glattl \ • vrscemt sensor'j S\(lIJS braflChes: nerve nerve. for tre rrefen'\ (seOsor~") COMponents of- nerve... ' Jugular Foramen ..voKe -tYJe.b Of .\ throuql1 0.rGl:II~ to leave cranium (jugular forafflen~ foramen j\Js~ pefpre +ne nerve ~~\tStnls W\11Ul cont-om t\1e cell bodies T\\'IS tbe.the. --- 1-0 b\ood gus \e'lelscnemo receptor') 1> eflSIt1'of:..) \'Jeer or.: I i . 900 reflex or even YOryil-Mng .. t-nfoat' .. stHYtuli +naT IS ore deemed to tx:. posse i' -bl IN supey'lor w\ldcl\e coot)"lctorf.p0\fCl_ ~: _..otor·· (viscerar mutor): .con +ra. vnp1eosOI!l+ tYlo..lgnt on b'f b"I +bUCl'1II'Jc3 +nc SIJ-f+ potate the afferem '- \'Il'<1.fotlbWlOg a C IfClJl t OU~ route \\"\'JG\\Ilng Imt-IGII'l .reQGh orDpharynx t ftlngOB pnorynqect\ pICY..Jt'es m +he • BrOl'lchlql Tympanic Nerve fl bels. 9"'9 ref1e:)(? of -TtIe bac\::: Of . .ses a(\ruD\Cttc.phor~()ge~l') tonsillar. _ .._.\J of rerves s .. Of. IY1CdlJIlo.. M.StjlYlpo. _------_ . =t \In~uctl nerves to the.e rr t-'>harynx supplie.Glossopharyngeal Nerve the tgmpamc qre n::r'Je. 'I ••• \> ttJe_ 1<. to $II)VS 111 BP +he...tne to .!i. l'nc\udinq PCl\o.~IY\ l. -t-he.+!l1e tons" I SOft pot o+e :4 post-et\orY3 tongue.)phar~nqevs~ t'ne ()\')\. -I bur a-ore c.

s o...'ncl\)C\inq PGl1o.:~..~ 1 WhiCh TctKe..") 6P ~ baro-recepMf. I t'Ht\o'l1'{ 1l'\'J O\\J .Corot\d Carotid Branch (of eN IX) sH'H)S' nerve.)f'e tl:lmp:. . \Nho.l' I .bl gO\Js A osencc +0 +ne nucteus Ilmt> of the reflex IS CNX frt:ny) +ne nocieus +ne 0a9 re..~~~~~~'T""""~.---. seOSJtlu:. .tlt1e sOft 4 pos+enor 909 refle)l Y3 tongue Or even ..1I11G . to blood 90s \e'le\s- enema receptor') n '""p\)Clry(}ge~l~ ronsvu or .the ... Glos~opbaryngeal J):\\Jt.-__. Sryloph". ..n g\\On ~ mo.". Of the..-.".:l1on of S oft- Of. Jugclar Foramen ore I -to ttle.r.ryJ1geus muscle supplied by a branch from Ing ttle F' .. to +ne...C1 I CD I)cl i":lD 115 I .r\{c<....-.___"..s v C h qs: damtlqe tD d ~1Yl aqe.10 .con -trac. ClrCUI DO. IStmlJ5 to the mucosa +ons II I Of +ne oro pharynx poro+e +\1e.. 4 Of t\le 1"Or-oo..so!n+ l'rlOl. M~ po 1(l teafferenteP-fere.. pClrottd 9\alrll brat1cnes: • VIsCeral sensor" I I ...SljlYlPQthlC OYc)V\cled I pO\ra\\JeW ICNIX ..x sourorws 1<.-~=:"i:':~=-=~=--~~~---:'~.h(i\ve Cl gag ref-Ie)' ...flex can be symp rom of.s~oapnc ..t \s +ne 9Ci.enSGlt1blH qm. tonsillar & lingual branches (of eN D. go....n~ pCOP\-c do no-t....a nomber or- severe n'leC1ic.. corot'\d sirws !O (seos iT'ive.~? The baCK ..the....lJoKe '10n11t\1'9 ._...i'\impOf\\C ner'le .:.me throat brought on b~ +cucnmq tne.~-- \119 o.nt" Or '·II'(1b..g ref\e... to A IS Pharyngeal. CJtIc.Not~' eN IX CNX • bratn deat-h opt'O Y3 of \Jco.~~~~E'-:::::=-"""'="'="___".. '4 \lnquCl.st-l(Ytu\i t-YIQt' ore deemed to \)z \Jop1eo.'je:..". - refle." Nerve pre.' {Ol. sopplled suppled C! b"l b'l crs....n t.l ne.

J \OIr fofCl. ~taste . clurG! post'.pl7irot'ld gland 9C\ogllon reno\" Sotna+lc motor STylo n phC1f:1nqeos para..---------. '13 tongue. from C~i* ~..T1QOS hIp of' sr-ru c+ores -traver sm~ G '0" s"..: for'rQed by slJpenor end.. pas t .lY'en . : . aris'.90 '1<) lion rc f\ ber s rruvet ft'DIVl S UpeflDt:t +0 tfw~ 1n-renor gang It I.nucteus OmlJ)90lJs ~- PQfsympCHfle"he ~!oClev~: In fenDr s a It 'Ja1-or~ nue ieos sensOf\.-tos)-'c to MI. roo: 01 l)'mpanJcca"hy'(legmer.'... cOfweyeo f.)ncommon . -""""=~~ 3 150\ Q ted \e sion <.use \II thl s pass -tnrollCJh j o :3 I.. y~torque side r Cf 1e}" IS bsent on TtIe CNU .us : oc feus Of -the tf_ act'tls SO]lt anus i.llls lucleus SOMQtlC sensory ==» .etJc lone rVQnOn \ling eN \x t (visC<!ral molo') .P<L·· - LesIONS a F eN W 0 T~mpanic'ne"'.csser pI'.i _tympani) fossa. or. tu roors 2 5 re 91'~.sgm IfWD\ Ps'asylT'pa'he!ic pa+r.Iid 4 '* gag Or \S Q en C\ post.o. ~~rVe: .al'ne o!e.r"liddl~ ".motn 6cJ1sory 9C1n91ia (N n mot or nurC1e os..n pi t:ducc mulTIple pct\51e:. !. . from tne pos r-enor Y3 0 t the tongue ttl the NuClei ot . beco.~~'ool(aies .. (5NallowiYlg) ·CLtNle..(CN jUCjllk\f foramen iXi' gI¢S$OptiaWg-e S"p~rioqiai1g liooor. .h"Jne(ges i'f. ''M.• Taste (speCIal sensor'll to. eN].«._ bsent r eN U are ..external ear. t.-Ih incom "jugut.phctrynil: I .st"e FIbers.1(' \e~\on eN TIt .j n!JCJe. o~e. nerve 3 6 Re-l.pt!3_\Yngea' 'MN"..1'\ '{IS CerCI' 'motor .aJ r"Olam"erf.

------------- n laryngeal .\lIX.u. Ie s 1'00 on post. Lesserpmrosa as a brahch of tyrnp.lli_culus the in p'itro us part oUeFP:porn I' .¥l.i'rVia tympan'~:9.parasympathetic (vi$cera_l motor) ·CI. V... .1U~rf-o(alYlen Mastoid ceus O!icganglion Tympanic nerve (eN IX) Parotid gland ~nd dlle: Auriculotemporal nerve (eN V3) Secretomotor branch 10parOlid stand rn!Crl)al(. I nerve-ao-sE!s ."m~(ges wlttr'lt!ror1l . RelQTlOl1S hlp of s't1"u c-ores +r(l'Jer s.i! fossa._ unc ommon ..amel).. at. jugularJ".J. L6Sl0NS OF eN 1"l Cp..~:' "... c- irmpanic nerveeo(e(s mIddle ~a:.peO!!tra.. } eN 1.. \i. 4 ref1e7'. leSIon':> of- .tn~ jUt. Q. because CtJ.eND t TY!11P. a rond artery Lateralview ---- -----. parotid P05tsynapl'C Ut)'e[s pass to. 6 . lY. L I ! iymp~~ic nerve aris~~:I(~F.j i are.:.d.·.\.de pass tu roors Or- +Vic. mrque Gl. tYlI'S rc 910(1 or t:duce V)')ult"lp\c p:.ati.' .d>ranChes '~u ricu~tempD[al ne rve {eN..:'liic: ~!e~. 912 ric!vi.:nerve 2 [olms_tYmpanic plexus:~~Bcomonlo')'btmido\e -t\lrou~h j u 9 IJ \0\ r fora men 5 \ I') ear.n.s 'GOtoltympapic c:ayit'l(tegrtW[I' ' tympani) to ente:rflii_odlo-crtln_i.L.-'rasre ~ 9a9 IS absent IS liOna. .bsen+ on +\Ie s'. Iso\Qt"€d 3 Lesser petrosar n"tye.INICA.t\S\es nerve..

!gl1'J e60pooge.Dr+PClIUTe. The prOX)lYlCd e~opm9lJS.ct-lons lD . COflt1e. sef'tls~'tl • sensory from of .rLJI1X.. '(cqlOI"l tvlt Sl.rlor Or j .€SOp nCl9\)$1 t\iJraic 1 I pen pYl~ra I ganglion 101'1 ! V1Scerol! I11ct"Or .he.pOlotoglOS£)s. COIJrse ..rt. -froro I'00 r of 1"1J1') 906.( ~SljmpCl+t)et1Lw thoracic A. \on~\'\){ .lC\el Or Ct-l. re t\ CU\!Af format \'i. follow t\1e.(1)t'lt\OlJtS InferiOr1\j \I:) t'ne cafOt1c\ sheatil -to the rOot or t-he. pilCH Y M .:. m pOl \ o. iilorClcJc 51al?d.:if-~d b4 o!.ory (ext€rTXl! "". .lYlu!iCIL. •..s oF medulla that.119\iol1 In t\\e JugO]Ol'( rDfome-n zz \OSA\ nos (11'"1 eo.t1 nt . .l'n·tj1e. prop '(It) ceptlVe +o The. abdtWY1cn -lfOlC..__ ~--~ ___~ __ scmcrrc s-cnc. . 1f}r)eJ \Qlltl n . eN $f .-\'it branc. -4 QbdDMina! of9ans +esre. VIscera ---.1-0 on t\1e ® ~ 18 sides 5UPpl\b . NI. CNIX ~ +re . neor+ J t broncr» ~ lungs . .\ MOTO~ +.s oS.cWm) t-ro. :.Jde uS ambtgulls of.. TYC1VlSverse Spl I'1(j I n uc leur oF- C..e .~1 breClK up pltX. Jaryrn. tas t t bud ~ on e PI 9Ip-H\.cles. ·::.mcdul101 oblongata!f .ctllQlI'f a IY\M O! .>.. '(fIer ge ~ fora men .\1\ +YIe.inn.Y) • . The anrenoY -+ t'tHOUgh +h::..fabdblY\H10i1 V\SCerCl "Clqu~ef\'t.esophQ9US Ih10 ~'ne. · p 0. SO)"YJ C\ t1 G !'VI oto r .CN3_.it--.-0 .de. neC:K O\}pp'y·ing brancl1es to tne larynx) pDorynx i p0i!61te Sopenor mfe.S ect D ~ +he p leQ\le ttle UClnlIJlYI Thrbugh +hfougn i11tjugolar 9D.t uptu Wf\cr-e.\log\ jQ\n dlOphfC.pl1o. pl)stenof c. C \let!.\)( d1-rrets .f19·u~-.lpdlDf gQngllbn o.. leva tor ~ ~\ i j:D1C1i1n·1 (]) main motor nucreoc .N'l\JS CIt based Df) \+s een vO-ri t)'() :4..__.cJ1.O\'O\'"). .cl c...c.arise s rfDnl 0 sen e. Sen S'<'• Moter lofenM p!1ar~)[ I. a bD\(t m us.s\l.m.ogWon lOfen{)[ -to t110 Jugolar fo'{orY)en:o [t\vP<) . 11'"1ri n~i!c ! W9 ngeal t tne (lonnal e'l tijDS.CN!- Or CNY H~ the Thor(..penor ~elVI ((AI (s~ mpOi+l1et1c) gang 1[0\1 . b\~ eN IT 1 eN XI (oar\ e rs fY oM +1Ie 10terOl] D.has 0.the. "4 tharq.obdolY)ina 1 viscer~ lphonat1 0\1'\)9 ~ lV'J hI CI'1 IS o. -4 Iotest\Y)(lI ot ttlQt.s lilO) -tne.( super rcr gQn01!OI1 pnaryxj1ar9n..ep \N\t'n.us sj:.N~ JU9U~Qrforamen ."\I!scera\ sensorlj • eplQIDttlS eClY.. vagal trllnK~ inrc branCl'JGs 2)3 S1uWlO.

. lB"i11t' C61Lt10 -snetli1 -ru -mc..10 sicks .s branc.tus ~oh--tClri\J.f~1e.rClcfc 'i! a\?d· VIscera 51 .l')i.ti p:lICltin' .Y)\J G\evs of The. bronch! ~ lungs . 1.( CD mOrn motor pey\ph~ral I \lIScerOlt me+or 'i-ho.soPI"OL9US. levator ve...: 9angllon' IDYl .st:\\'\cd lIQlC. f\ber~ TO ('o\Jsc\e or.J1e5 . .:.t opro '2)3 Ot pYOX)lYla\ -rt'OfI'lSverse. 5-"I. JCH~J1i. re.deep W\thn'l tnt.- nlJclev~ Jugular foramen ~~~~.ro iht.t\ Cll\CH for mar . colp'{) (pYQxn'Y)O\D JIlYalo]l-ra'flj nuc\eU$ ® Sen4Q!lj . The esop'r.. stomo.aph'(ogm (_ -flo) 10:'0 -the..s.'ng at sut>t-flC\ Cl-1 y i\\.D har~n~ ~ nuc\e us of \nTf\f\s\C ffim.. .. Df larymt +ne. . esopoo0e~1 plexus 4 foHow tne eS()phCl~US i11rDVgh-t-te. . .t'fteH:n-r mro· {)t.rym) -t'fCl cnea.OJ!. heart.(.rynx..bronc.ne-art.. e~r) cl.s-cnsory (exterOOJ --. 6\)pp\y'.) ph or~ OX pOilatt .v rq) VIsceral sensor~ • epIglottIs ~pharyx Ilo. __ somatIc . (\1) oro r Y1ucleLJO. d _ ne'{\lcs enttnug -Trac.\fog'_ jtim -tnt.'ett-efef'lT To of- mcdullOf obloYlgatul 4- @ paras'lmpatYle-11c.ic\e\iS ra~s To t\'1e" spmol O\lcteus 'I' .n0 i 'v s-tDWOCn - 4 lIite. suPP\\e. d. pho. CQ\ifSe of CNX If) the -mofG\)!: d\f'-fer:s Or) +ne ® 1. "".h..os /. colon· SplYlClI Or eN '1.n IJ .~ flJn:ne cl by OlJCltus amblguus . Q'odonltnoll VlscerC! sor» C\ tlC.do'(sal fm ctecs . up lntD' brunChes tt\Grr \DD.$h. VlA9.r-e +re clYItenor ~ pDstenor vagal trlJnK~ breC\K. abdomen I wne. A sy nClps.eN._.l UG=r0F Ii bran cnes to -me larynx.. f6\tJ_' neO'( \ i'l .)J3 iiCll1sverse. e. _esDpn~9l)s Ifuraic • NIJC\el or.aglls..

us ~18·~e....eIIQC bran chu (from • ?ljlm 1c..ties (ftDn1 ant.s."... esaphagectJ branche~ • gastrIc branChes post. .s • lnte:st1hal 2J3 btanche. bral1Gnes • c. -trunK. b rane.... Left bracl1!ocephafic vein ...seris Dr.. . hepattc.Jl..') CD \on (to prox·..Jnuljugu!<l:rvein Di!e!:1fonal Md COIM-<:ocled arrows indicate mooal iries oi re.) ...ctlrren t lal'lflga<U! ner....tern(l\ ~ motor plexus. rena! bYarx::t)e.n -Bran cl1es of eN X- CD CranIal · meninqeo ..0 ...'...! brG\I1Ch .. --7 \ orer I()'f .·· =1ii'£U!-. -7 e:x.. mal transverse: -i Left jni<..+roflKj ...Ulmc Olaf branch -® CerVlca\ · pnaryngeal • te rVIC-0I1 ple.

. c.eft internal jugu larvein Dilsc1iOrljl.esophageal • 9(ftstr.c Q branches hepattc branches .us branChe<. ·trun~) • PIj\DU C b YD.. \n res floo I bI a nthes 213 (to pro'il met\ tlansve.rst: co\oY) L.Abdomlnal ·mmID ~~~ piex.(1) .e lrnc branCi1CS (from post.nl-· -I-roOK) renct\ brar.l1Giles (ft DWl a..U::''Ci!lvian artery Left sul:eiavian artery .d1e5 ~.l aad color-coded afro'us IrJdicate I1wdaiitie'S{}j reclIrrent raryngeal nervee left b raci1iocephalic vein Rilli1t (..

to tne sens ory no Clc'1J5 eN ')( . for X'lt-i<' vagal 'uv nerve dama. are.tJUS CON'T\ D • C\.eHere. OF THE \jl\q\JS NeR\lE.ESION<.CN)t ctr1S\l'\. 1 CRf'tNIAL NcR\I E: 'X" - 'JP-. r::els air oo+ of.ttle nerve (bn:'ll1c.ls. en cot\'1~rO\d.g from f\uCJe u) st o.tes icn ~ Df supertor ttleS1c\ IQtyngeal nerve ~ ones DF supencr porT of larynx s) pClral~sls Nott·....qe nOflY1Cl]5 id e loc - u Ia will ctev 10.tra C1\Js so\ r+oru.== .:.s .both VOice Or 5f ~ ~peakfnq) b lc (j sj.oT9c.supenor larynqcC1) nerve ofCtJ~).. 'IT can voc.: 1(1 +\1e IOrynx.m ..t-e -to ffie • cO\Jgh reflex . ex.+ motor r\'oerJ Of. Ie SIDns Oc.oIClt-ed Ie srons of eN X.+est - or larynx.n .. ~ In+-ernCiI laryngeal Or or COrob\l1td cc+ lO.prrotory rom.1.O')f? CD necK surgcr1~ ® can cer Of @ Qne.JsenagiG\}CdlfflCUI+y In SWClllov. Cf1GfDtY\YfO\d +enses \I 0 co.INICAL: L.r) t-no')e of I r iqn+ \-'low futH' a lonc:f.srret-cl1ts pest.-. area above -tile glotl1. cernes +ne SQln£ory InformQt{bl1 QWa:1 f10'01 --\-he.h +ne .lunCjs: at o\[cr lDtr('11ph.LJse.teslO\') of aclcluC rs Ybcal fo\ds (dIffICUlty pl recurrent lar~ngeol nerve ~ -7 cauces - of poral~sl5 parQ\~ SIS ot.. .. .() n Ot re.~-e.\ lJgG1ment VQcol o. beCCl. of ~ cnc..offl~f()\c\ .r coorse tne.mblgou...t-s folds lat.n -tho.ul folds con T Iaf oj n rv s CQuse~ ~ {lOSS of ( (C1 i1qrsn VJIg I') pi tcJJed (esp' raTDr~ SOlJYld) lClrll riJect I nerve more commr. +hyroid Qor+q ."mg) . on COl'VlWlOi'l Injury resulTS ll"'}h.bd\Jc.

If) · weaKness Chil?_ IS d'SrlQced +cwurds +he oppnsli-e sioe ~hr\jq9ing seen as 0.q Kness \ n tro.4 po. such as lymph I 0"" V n{)(!e 0+ · 0\. 5 or b cevvlcal -.<l +he mt"erno t caroile:! ClrTer~ I penc.sen$ory 10spinal acoessoryrisrva Trapezius libers ·.L: 111\".-.rector • C~anlO. Y)(LK of(S(..ius 5} (oct IS sterno c\t:\ do mOs-tDld (SCM) come as CNi rYDD1 emerqes....jXl1\.t's H for CLlNle.\Mo~l n . tTo. sses deep to the 6upen or b 0 rcler uf ce nds along Or tnt.p. .roi1d P') enclar te rectomy ~ · teslOY)-:.JPS\j conn 0lai1on t.JS .nef\. 4 Innef\tltes EtYlt:rges frDm t\1e muscle near +ne mldd\e \ts pDS-t. pfcdlJCe.l proCedlJre<:. ~b\n~ eNK oS TI1e.MJ ~ Ca.root\ers segments Or spinal cord te-mpoYQnly agoln once they c~rt ~e5 the __ fIrst -.\1J5 Il'Y1pOlrmeot rota ry nnv\.-~_~-----{==--T raditf.lscep-t-\b\e to \Y1jvry I dl)f\f'l9 s\.) \)\f.Postericr view -------- ~- . --- . «s a series op.N \Nee Knes'i. border ost"efloy cenll ca I b.otQ resull'. +no. Dr- C.~!f • ClosSe.onaJ "craniat oal r of eN Xl~-partot eN x Posterior rootlets qf:C3 and C4 Branches of cervical plexus (C2~C4)brfngin}'l.. CNll i1\e.n-glco.l"C 1 IN\J\)i?'i nnervate 1 t" TO CNll · Sl.t-es. I · eN'D to +rope z. reso: r Of lfle. tTq .-.~ paes thrDugh tt1eLiugular foramen J sepavat-J'nj . trQpez.

the. OY'i1Dbyod • t-\')Y(O '!l~olci ® terlYliY1~ J \ lngua1 branches • styloglDssDs · nyp09\DSSUS • ge.Sh!I\.l- N§R\le rn ~ H.l nerve. SP1nG\1 rm.\I!> Dr ® so.§f(O'\')~o \cl mn~ · st·eJllbhYOld • stema-t\'ty (o\d .pence roDt =- nDT ot· aYlsa·- CNTIf . o~ +-ne -tong cc .nerve.pmal 9Ctn91 ton cerv: co.s ens Dry &. l'YIl'Yl.AL 1MOiOF \ • MDtor rc \l'rrY\'(\sIC e'l-trII'lSlt. opses P several froM ::t !eo.+onque Hyoglossus ) .gent og\OSSOS "'$1>< ~ Po. OFrereKitli'\q I ca.CRe.I'\G\1 +ne crQntlJlY\ eN 'ill P\t:t.)gIO>:S~s _ .hypoglossus .\ 9cmg \Ion Df.nl ngea\ branch -reTUfn~ to me Crar1lVfn -.. _" +rese • PQsS{:".ble ~ -Tt1en corvec an-t-enor\~ to erwer tv'It brQnC\)eS: -mngue CDI'()e...LO&S. IYlCdIOl! fl be j" \'J\TCna fide L 0 i-V"l eN &II to reocn -me h~Oldl\1f\) .\omg\O~S:l)S rcone rs C \f~tJ. ctl)rCl rnater (j ."Nlf>. cervIcal ca :t C2. C O'tl\leljing 6$ E fnxn "5pl no. from Jomed b\j 0 branCh or brcmClle'i of.j: Ion. \nrenort~ To me f me rYlCtl""'cl1.l')lbglD)S{)S • mrn (ISle mrn. fIbers C2 conveyed are frorn Tne .b) he med vIla 1$ .ves CfCII'\llll'h Through -\"t\e h~P()qtoSS'G\1 .. of.-t\[OUC}h the h~poglDSSa\CQnQI . ~ qSA fibers f-rolY\ +ne \N \ Spmo.{POg.C2.uo.

.n C2 ~ ® svpe'(\oc root TO mf( 0.+ongoe nerve (eN XII) G1 Nerve roots-of cervical plexus C2 Hyoglossus HypogJossaJ { Gs . Intnf)siC mm.a... of."""-"--Gel'l·iohyOld Nerve to thyrohyoid Internal C. S " {'lnterior " ' UPenor L....... Ansa cervlcalls .. n~o mm \cl ~ $TeXnOi1yold of ansa CNg cervI ClA\ls.t~falview Sternothyroid I ---~ n . · st-erntrtny • D\'Y\O (0\0 nyo\C\ · r\"lY(O \J~ 010 @ terr{\inc~:l lln9\Jol pranches • styloglDSSUS • 'ny?Og\OSSD~ 6 gCf)\bg\05Sl)S .....-.tfo!id arte .

1Ri TO CNTIf " d~m~~e$ {parOJ. of. prCTtI.cle· m Extrinsic CaroM sinus E:ctemal carQtid arieJY Preter. ge..._.l1logloSSI) s on +ne unopposed action normo: I sIde Of +he Tongue. ipSl\oteral (scmc side as The lesion cccures) VJQlf .yZ... u::.. \t'> o pex deviates towo. me . When -the. 'l( ~ ~ ._ ... of.1j1loliyoJd musGI"" Anteriar digastric muscle ~--.-..es +-he.J3\.the of-+he./ be]gyoJ Hyoid ibOr1e .rd para.I'I zed side blt...im belly of digastric muscle (cut) r.. • CLINICAL: It.)(l. Jr'ne -roogce ~:..-~---.es tDnqUt outward.. ~-.-.n Inttinsjc musculatur€· musculature: St>f!qgIQp5USmuscl~ G:e'nioglos5us mu:sde HyOgI05~US....

Slae Oil. d QYY10qes f paralyz...es +re ipSl\oteral \riQi f Of -\-he.-----~-. tne. rung ue 1..ra\'1zed <gex)!ogtossus . +orquc prl)l1'\)C\e~ i+s apex devIQtes po.-------------------------- .)R1 "TO CNW .:.> of-The.. of.3"!.. CLINICAL: IN::.sIde blc.the unopposed octTOn on +be normal sIde Df +lie· -ton90€.r) t'rle. ~)-.:. (scmc Olltward. me iesron cccured) toward Whe.