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MVST IB Head and Neck Anatomy

13 October 2015
Dr Cecilia Brassett


Twelve pairs of cranial nerves convey afferent (sensory) and efferent (motor) fibres between
the brain and structures in the head, neck and trunk. The nerves are numbered using Roman
numerals according to the rostrocaudal sequence of their central connections. The first two
attach directly to the forebrain, while the remaining ten are associated with nuclei in the brain
stem. The types of fibres carried by different cranial nerves comprise somatomotor, branchiomotor, visceromotor, somatosensory, viscerosensory and special sensory fibres.

The Olfactory Pathway (CN I)

Nerve fibres arise from neurones in the olfactory epithelium in the roof and adjacent parts of
the lateral wall of the nasal cavity and the septum. These ciliated neurones are stimulated by
aerosolised odour molecules which are dissolved in the surrounding mucus. These fibres form
bundles which pass upwards through the cribriform plate of the ethmoid bone via
approximately 20 olfactory nerves to reach the olfactory bulb on the frontal lobe of the brain.
They synapse with the cell bodies of neurones which pass posteriorly as the olfactory tract,
whose fibres terminate mainly in the primary olfactory cortex of the uncus in the temporal lobe.

The Visual Pathway (CN II)

Fibres from ganglion cells in the retina form the optic nerve, which passes backwards to the
optic canal. It is surrounded by the three meningeal layers: dura, arachnoid and pia mater. The
two optic nerves partially decussate to form the optic chiasma, from which the optic tracts
diverge, terminating in the lateral geniculate nucleus (LGN) and the superior colliculus of the
midbrain. Fibres from the LGN form the optic radiation, which ends in the primary visual cortex
of the occipital lobe.

Cranial Nerve Nuclei (CN III-XII)

The nuclei for the remaining ten cranial nerves (III to XII) are found in six longitudinal columns in
the brain stem, and are also located in the spinal cord for CN V (trigeminal) and XI (accessory).
Efferent (Motor) Nuclei
The motor nuclei can be divided into three groups according to their embryological origins, and
lie in discontinuous columns.

Introduction to the Cranial Nerves

This cell column lies close to the midline, comprising the nuclei of four cranial nerves. The
former two lie at the level of the superior and inferior colliculus in the midbrain, while the latter
two are located in the pons and medulla. Their fibres supply striated muscles, as follows:
III (oculomotor)
IV (trochlear)
VI (abducent)
XII (hypoglossal)

levator palpebrae superioris of the upper eyelid and four extraocular muscles
superior oblique muscle of the eye
lateral rectus muscle of the eye
intrinsic and extrinsic muscles of the tongue, except palatoglossus

This cell column comprises preganglionic parasympathetic neurones that give fibres to CN III, VII
(facial), IX (glossopharyngeal) and X (vagus). The nuclei and structures they supply are as follows:
III (Edinger-Westphal nucleus, midbrain)
VII (superior salivatory nucleus, pons)
IX (inferior salivatory nucleus, pons)
X (dorsal nucleus of the vagus, medulla)

sphincter pupillae and ciliary muscles of the eye

pterygopalatine and submandibular ganglia
otic ganglion to parotid gland
to thoracic and abdominal viscera

This cell column of nuclei lies more laterally and deeply, innervating striated muscle of branchial
arch origin. These involve CN V (trigeminal), VII, IX, X and the cranial part of XI (accessory):
V (trigeminal motor nucleus, mid-pons)
VII (facial motor nucleus, lower pons)
IX, X and cranial XI (nucleus ambiguus)

mainly muscles of mastication

muscles of facial expression and stapedius in ear
muscles of the pharynx and larynx

The following diagram shows the brain stem viewed from the dorsal aspect. The afferent
(sensory) cranial nerve nuclei are shown on the left and the efferent (motor) nuclei on the right.

Introduction to the Cranial Nerves

Afferent (Sensory) Nuclei

The sensory nuclei lie laterally, and can also be described in three groups.

The nucleus tractus solitarius lies most medially in the medulla, receiving sensory fibres from:

taste from anterior two-thirds of the tongue

taste from posterior third of the tongue
general visceral afferents from the pharynx
chemoreceptors and mechanoreceptors in carotid body and carotid sinus
taste from the epiglottic valleculae
general visceral afferents from pharynx, larynx, oesophagus, thoracic and abdominal viscera
chemoreceptors and mechanoreceptors in aortic bodies and aortic arch

Fibres conveying the special senses of hearing and equilibrium run in CN VIII (vestibulocochlear)
and end in the cochlear and vestibular nuclei in the medulla on the floor of the fourth ventricle.

All fibres conveying general sensation from structures in the head enter the brain through CN V
at the level of the pons to end in the trigeminal sensory nucleus. This is the largest cranial nerve
nucleus and has three components: the mesencephalic nucleus for proprioception, the pontine
(chief) nucleus for discriminative sensation and light touch, and the spinal trigeminal nucleus for
deep touch, pain and temperature.

Note that while all somatosensory fibres terminate in CN V nuclei, general sensation is conveyed
initially by other cranial nerves depending on the area being supplied:

from part of the external ear

from the posterior third of the tongue, pharynx, auditory tube and middle ear
from the pharynx, larynx, oesophagus, tympanic membrane, external auditory meatus

For individual cranial nerves, it is important to understand that they may comprise different
types of fibres, e.g. CN VII contains visceromotor (parasympathetic to glands), branchiomotor
(to facial muscles), viscerosensory (taste fibres) and somatosensory fibres.

At the Base of the Brain

The locations of the cranial nerves as they exit from the base of the brain correspond with those
of their nuclei in the same rostrocaudal sequence, and with motor nerves lying more medially.

Introduction to the Cranial Nerves

Special features of note are:

CN IV (trochlear) emerges from the dorsal surface of the midbrain and runs to the basal
surface around the cerebral peduncles, thus appearing to lie laterally.
CN VI (abducent) exits the brain at the junction between pons and medulla, but has to pass
anteriorly before entering the orbit to supply lateral rectus. It is therefore the cranial nerve
with the longest intracranial course and often the first to be affected by intracranial disease.
The spinal root of CN XI (accessory) arises from motor neurones in the ventral horn of the
spinal grey matter at levels C1-5. Their axons emerge as rootlets between the dorsal and
ventral roots, running upwards to pass through the foramen magnum. They join the cranial
root before exiting the cranium to supply sternocleidomastoid and trapezius.

At the Base of the Skull

After emerging from the base of the brain, the cranial nerves exit through the numerous
foramina at the base of the skull to be distributed to the structures of the head and neck. These
are illustrated in FIG.1.5 on p11 of the HNA Course Handbook.
CN III, IV, Va (ophthalmic nerve) and VI travel through the cavernous sinus lateral to the body of
the sphenoid, to pass into the orbit via the superior orbital fissure. CN Vb (maxillary) and Vc
(mandibular) leave via the foramen rotundum and foramen ovale in the sphenoid. The
relationship of CN III, IV, Va, Vb and VI to the cavernous sinus is shown in the diagram below.

CN VII and VIII run together to pass into the internal acoustic meatus. The fibres of CN VIII are
distributed to the organs of the inner ear, while CN VII passes through the middle ear to emerge
via the stylomastoid foramen to be distributed to the facial muscles.
CN IX, X and XI pass through the anterior part of the jugular foramen, which is occupied by the
sigmoid sinus posteriorly. CN XII exit through its hypoglossal canal in the occipital bone.

Branches and Distribution

The detailed anatomy of the branches and distribution of the cranial nerves will be covered in
the Prosections Sessions and described in the Course Handbook. Clinical applications will be
explained in two further lectures later this term, and in the Applied Anatomy Session. Central
connections will be discussed in more detail in the Neuroanatomy sessions of the NHB Course.

Introduction to the Cranial Nerves