NAME: OBANSA JOHN

MATRIC NUMBER: 15MD1027

CLASS: 300L

DATE: 20th JUNE, 2020

COURSE: ANATOMY

ASSIGNMENT

QUESTIONS:

1. Enumerate with examples the functional classification of cranial nerves.

2. Name the point of emergence/exit of cranial nerves.

3. Write short note on any five (5) cranial nerves.

4. Write short notes on applied anatomy of cranial nerves.

ANSWERS:

Q1.

Functional Classification of Cranial Nerves

i. Special Somatic Afferents (SSA): These neurons receive sensations of hearing and balance
and sight. Examples are CN II and CN VIII.

ii. Special Visceral Afferents (SVA): These neurons receive sensation of taste and smell.
Examples are CN VII, IX & X (the nucleus of tractus solitarius receives taste fibers these
nervers) and CN I (for smell).

iii. General Somatic Afferent (GSA): neurons receive sensations from skin like touch, pain,
temperature, vibration, proprioception and stereognosis. Examples are CN X, IX, VII & V.

iv. General Visceral Afferent (GVA): These neurons receive sensations from the viscerals and
structures like the mucous membranes of the nasal and oral cavities, thoracic and the
carotid sinus . Examples are CN IX, X.
 v. General Somatic Efferents (GSE): These neurons are closer to the midline and supply the
skeletal muscles developed from somites ( extrinsic muscles of the eyes and movement of
the tongue). Examples are CN III, IV, VI & XII.

vi. General Visceral Efferents (GVE): These neurons consist of parasympathetic cranial outflow
for the glands and smooth muscles (like the control the constriction of the pupils and
changes in the shape of the lens of the eye, lacrimal and salivary glands, and the muscles
related to visceral organs such as the heart and diaphragm). Examples are CN III, VII, IX & X.

vii. Special Visceral Efferents (SVE): These neurons are lateral to GSE column. They supply the
skeletal muscles developed from mesoderm of the branchial arches and have control over
“special” visceral or “brachial” motor functions such as chewing, facial expressions and
tension on the stapedius muscle and tympanic membrane; the muscles of the larynx and
pharynx used in speaking; and turning of the head by the sternocleidomastoid muscle and
shrugging of the shoulders by trapezius muscle. Examples are CN V, VII, IX, X & XI.

Q2.

Point of Emergence/Exit of the Cranial Nerves

i. CN I (Olfactory Nerve) : They pass through the cribriform plate of the ethmoid to enter the
anterior cranial fossa and terminate into the olfactory bulb.

ii. CN II (Optic Nerve): It emerges from the retina at the optic disc and is composed of axons of the
ganglion cells of retina and stratum opticum.

iii. CN III (Occulomotor Nerve): It emerges from the ventral aspect of midbrain by piercing the
medial aspect of cerebral peduncle then appears in the posterior part of the interpeduncular
fossa.

iv. CN IV (Trochlear Nerve): It emerges from the posterior aspect of midbrain just below the inferior
colliculus on each side of the frenulum veli.

v. CN V (Trigerminal Nerve): Its motor and sensory roots emerges from the ventrolateral aspect of
the pons at its junction with the middle cerebellar peduncle.

vi. CN VI (Abducent Nerve): It emerges from the pontomedullary junction cranial to the pyramid.

vii. CN VII (Facial Nerve): It leaves the cranium through stylomastoid foramen.

viii. CN VIII (Vestibulocochlear Nerve): The vestibular nerve enters the posterior cranial fossa and
passes through the cerebellopontine angle to reach the brainstem. It enters the brainstem at
the pontomedullary junction slightly lateral and posterior to the facial nerve. The cochlear nerve
 (along with the vestibular and facial nerves) passes through the pontocerebellar angle to reach
the lateral aspect of pontomedullary junction where it enters the pons.

ix. CN IX (Glossopharyngeal Nerve): It leaves the medulla oblongata as 5 to 6 rootlets at the

posterolateral sulcus between the olive and the inferior cerebellar peduncle just above the
rootlets of vagus nerve. It leaves the cranium through the central part of jugular foramen lying
in front of the vagus and accessory nerves but in a separate dural sheath.

x. CN X: (Vagus Nerve): It emerges from the medulla by 10 to 12 rootlets in series with the cranial
part of accessory and glossopharyngeal nerve in the posterolateral sulcus between the olive
and inferior cerebellar peduncle and exits through the central part of jugular foramen along with
glossopharyngeal and accessory nerves.

xi. CN XI (Spinal Accessory Nerve): In the posterior cranial fossa it joins the cranial accessory nerve
to form the trunk of the accessory nerve near the jugular foramen. The spinal part of the
accessory nerve ascends in the cervical vertebral canal and enters the cranium through the
foramen magnum while the cranial part emerges from the ventral surface of medulla oblongata
through posterolateral sulcus below the rootlets of vagus nerve.

xii. CN XII (Hypoglossal Nerve): It emerges as a series of rootlets from the anterolateral sulcus
between the pyramid and olive. It leaves the posterior cranial fossa through anterior condylar
foramen.

Q3.

i. Abducent Nerve:

The abducent nerve is the sixth cranial nerve. It has a long course in the subarachnoid space.

Nucleus of Origin

Its nuclues is located in the lower part of the pons (deep to the facial colliculus in the floor of fourth
ventricle). There are two types of neurons in the abducent nucleus, large sized typical motor neurons
(supplying lateral rectus muscle of the same side) and smaller interneurons or internuclear or para-
abducent neurons (whose axons ascend in contralateral MLF and terminate upon specific cells in the
oculomotor nucleus supplying medial rectus muscle of the opposite side).

Functional Component

The general somatic efferent fibers originate in abducent nucleus for the supply of lateral rectus muscle
(developed from preotic somite).

Intrapontine Course
The axons of the abducent neurons pass anteriorly through the tegmentum and basilar part of pons
lying close to the midline.

Point of Emergence

The abducent nerve emerges from the pontomedullary junction cranial to the pyramid.

Intracranial Course

It runs upwards, forwards and laterally to pierce the duramater lateral to the dorsum sellae of the
sphenoid. Having reached the upper border of petrous temporal bone it takes a sharp bend to enter the
middle cranial fossa. At the apex of the petrous temporal bone, it enters a fibroosseous canal (Dorello’s
canal) formed by the apex of petrous temporal and petrosphenoid ligament. Then it enters the
cavernous sinus, where it lies in the floor of the cavernous sinus in lateral relation to internal carotid
artery. It is vulnerable to compression in conditions of raised intracranial tension due to its long
subarchnoid course and sharp bend over the petrous temporal bone.

Exit from Cranium

It passes through the medial part of the superior orbital fissure enclosed in the tendinous ring.

Intraorbital Course

Inside the orbit, it travels forwards and laterally to enter the ocular surface of the lateral rectus muscle.

Clinical Anatomy

 Lesion of Abducent Nerve: In unilateral lesion of the abducent nerve or its fibers in the pons, the
affected eye is adducted (turned towards the nose) due to paralysis of lateral rectus muscle.

ii. Trochlear Nerve:

It is the fourth cranial nerve.

Unique Features

 It is the most slender among the cranial nerves.

 It is the only nerve to emerge from the dorsal aspect of the brainstem.

 It is the only nerve that shows decussation of fibers before emerging from the midbrain so that
the left trochlear nerve contains fibers originating in right trochlear nucleus.

Nucleus of Origin
The trochlear nucleus lies immediately caudal to the oculomotor nucleus in the periaqueductal gray
matter at the level of inferior colliculus. The nucleus receives corticonuclear fibers and medial
longitudinal bundle.

Functional Component

The general somatic efferent fibers originate in trochlear nucleus for the supply of superior oblique
muscle (developing from preotic somite).

Intraneural Course

The nerve fibers curve round the periaqueductal gray matter in backward direction and decussate with
fibers from the opposite nucleus in the superior medullary velum.

Point of Emergence

It emerges from the posterior aspect of midbrain just below the inferior colliculus on each side of the
frenulum veli.

Intracranial Course

Each nerve winds round the cerebral peduncle to reach the front of the midbrain. While crossing the
cerebral peduncle it lies between the posterior cerebral and superior cerebellar arteries. The trochlear
nerve pierces the dura mater just below the free margin of tentorium cerebelli and enters the lateral
wall of the cavernous sinus. Here, it is located between the oculomotor nerve above and the
ophthalmic nerve below.

Exit from Cranium

It enters the orbit through the lateral part of the superior orbital fissure lying outside the tendinous
ring.

Intraorbital Course

The trochlear nerve travels anteromedially above the superior rectus muscle to supply the superior
oblique muscle.

Clinical Anatomy

 Lesion of Trochlear Nerve: In injury to trochlear nerve, the eyeball turns medially and there is
diplopia on looking laterally, when the eyeball is depressed (e.g. while descending the steps).

iii. Glossopharyngeal Nerve:

The glossopharyngeal nerve is the ninth cranial nerve, it is a mixed nerve with larger sensory component
and smaller motor component and it bears two sensory ganglia (superior and inferior).
Nuclei of Origin

 Nucleus ambiguus

 Inferior salivatory nucleus

 Nucleus of tractus solitarius

 Spinal nucleus of trigeminal nerve.

Functional Components

 The special visceral efferent fibers arise in nucleus ambiguus for the supply of stylopharyngeus
muscle.

 The general visceral efferent fibers arise in inferior salivatory nucleus. Its postganglionic fibers
supply the parotid gland.

 The special visceral afferent fibers terminate on nucleus of tractus solitarius. Its peripheral
processes bring taste sensation from the posterior one-third of the tongue (including
circumvallate papillae).

 The general visceral afferent fibers are the central processes of inferior ganglion terminate on
nucleus of tractus solitarius. Its peripheral processes of the ganglion bring sensations from the
carotid body and carotid sinus.

 The general somatic afferent fibers bring pain and temperature sensations from posterior one-
third of tongue, tonsil, auditory tube and middle ear to the sensory nucleus of trigeminal nerve.

Point of Emergence

The glossopharyngeal nerve leaves the medulla oblongata as five to six rootlets at the posterolateral
sulcus between the olive and the inferior cerebellar peduncle (just above the rootlets of vagus nerve).

Course in Posterior Cranial Fossa

After emerging into posterior cranial fossa the rootlets unite to form nerve trunk. Then the nerve passes
laterally and anteriorly. On its way to the jugular foramen, it grooves the jugular tubercle of occipital
bone and then turns abruptly down to enter the jugular foramen.

Exit from Cranium

It passes through the central part of jugular foramen lying in front of the vagus and accessory nerves but
in a separate dural sheath.

Extracranial Course
Below the jugular foramen the glossopharyngeal nerve courses downward and forward between the
internal carotid artery and the internal jugular vein and then between the external and internal carotid
arteries. It then turns anteriorly and winds around the lateral aspect of stylopharyngeus muscle to reach
its anterior aspect. On their way to the pharyngeal wall, the nerve and the muscle are related to the
superior constrictor at the tonsillar fossa. They enter the pharynx in the gap between the superior and
middle constrictor muscles.

Branches

 Tympanic nerve (Jacobson’s nerve)

 Carotid sinus nerve

 Pharyngeal branche

 Muscular branch

 Tonsillar branche

 Lingual branche

Clinical Anatomy

 The gag reflex is elicited by applying stimulus to the posterior pharyngeal wall or soft palate.
This results in elevation of pharynx, elevation of soft palate and retraction of tongue. The gag
reflex is lost in lesion of either of the nerves.

iv. Spinal Accessory Nerve:

The accessory nerve is eleventh cranial nerve, consisting of two parts

 The cranial part: It arises from nucleus ambiguus and is composed of brachial efferent fibers. It
emerges from the ventral surface of medulla oblongata through posterolateral sulcus below the
rootlets of vagus nerve.

 The spinal part: It arises from ventral horns of C1 to C5 segments of the spinal cord by separate
rootlets midway between the attachments of the cervical ventral and dorsal rootlets. The
rootlets join to form the nerve, which ascends in the cervical vertebral canal and enters the
cranium through the foramen magnum.

Formation of Accessory Nerve

In the posterior cranial fossa the spinal accessory nerve joins the cranial accessory nerve to form the
trunk of the accessory nerve near the jugular foramen. The nerve trunk leaves through the middle
compartment of the jugular foramen.

After reaching the base of cranium the accessory nerve divides into the spinal and cranial parts. The
cranial part joins the vagus nerve and is distributed through its branches to pharyngeal, palatal and
laryngeal muscles.

Extracranial Course of Spinal Part

As the nerve descends it lies anterior to the tip of the transverse process of the atlas. From here it
descends in posterior direction deep to the styloid process, stylohyoid muscle and posterior belly of
digastric muscle. It passes through the upper part of the carotid triangle and then enters the substance
of the sternomastoid muscle, to which it gives branches. The nerve enters the posterior triangle around
the midpoint of the posterior margin of the sternomastoid. The spinal accessory nerve descends in the
posterior triangle from medial to lateral side between the fascial floor and fascial roof, but lying
adherent to the roof. It enters the trapezius about five centimeter above the clavicle. It gives branches
to the trapezius.

Clinical Anatomy

 Lesion of Spinal Accessory Nerve: In the posterior cranial fossa the spinal accessory nerve joins
the cranial accessory nerve to form the trunk of the accessory nerve near the jugular foramen.
If the spinal accessory nerve is injured before entering the sternomastoid muscle or inside
the muscle, the nerve supply of sternomastoid and trapezius muscle is endangered. If the spinal
accessory nerve is injured in posterior triangle, branch to sternomastoid muscle escapes but
trapezius is affected.

v. Olfactory Nerve:

The olfactory nerves are the first pair of cranial nerves. They begin in the olfactory mucosa of the nasal
cavity, which consists of bipolar olfactory receptor cells (first order neurons of the olfactory path). They
pass through the cribriform plate of the ethmoid to enter the anterior cranial fossa, where they
terminate into the olfactory bulb.

Olfactory Bulb

This is situated in the anterior cranial fossa, below the olfactory sulcus on the orbital surface of the
frontal lobe of cerebrum. The main neurons of the olfactory bulb are the mitral and tufted cells with
which the fibers in the olfactory nerve make synaptic contacts. They are the second order neurons in the
olfactory path.
Olfactory Tract

The axons of the mitral and tufted neurons form the olfactory tract on each side. The olfactory tract runs
backwards and widens in olfactory trigone at the anterior perforated substance. The lateral and medial
olfactory striae extend from the angles of this trigone on either side of the anterior perforated
substance. The medial olfactory stria is covered with a thin sheet of gray matter called medial olfactory
gyrus. It terminates into paraterminal gyrus in front of the lamina terminalis. The lateral olfactory stria is
covered with a thin layer of gray matter called lateral olfactory gyrus. It terminates into the primary
olfactory cortex.

Olfactory Cortex

The primary olfactory cortex consists of anterior perforated substance, lateral olfactory gyrus, gyrus
ambiens and part of amygdaloid body. From the primary cortex, the fibers are projected to the
secondary olfactory cortex constituted by entorhinal area (area 28). This area includes the uncus and
the adjacent anterior part of parahippocampal gyrus of the temporal lobe. The sense of smell is
perceived in both primary and secondary olfactory cortices.

Q4.

i. Lesion of Optic Nerve: The lesion of optic nerve results in optic atrophy and eventually in
ipsilateral total blindness (anopia)

ii. Lesion of Oculomotor Nerve: It causes the following

 Ptosis is due to paralysis of levator palpebrae superioris.

 External strabismus is due to unopposed action of lateral rectus and superior oblique
muscles as the rest of the muscles (medial rectus, inferior rectus and inferior oblique) are
paralyzed.

iii. Lesions of Trigeminal Ganglion: results in:

 The trigeminal neuralgia or tic doloureux: characterized by paroxysms of acute pain in the
sensory area of one of the divisions of the trigeminal nerve on one side.

 The viral infection of neurons of trigeminal ganglion results in herpes zoster or

shingles.

iv. Lesions of Vagus Nerve: Effects of unilateral complete section of vagus nerve are as follows:
  Unilateral paralysis of soft palate muscles (except tensor palati).

 Unilateral paralysis of pharyngeal muscles.

 There is ipsilateral loss of gag reflex.

 There is ipsilateral loss of sensations in the pharyngeal mucosa.

 There is paralysis of laryngeal muscles.

v. Lesion of Vestibular Nerve: Lesion of this nerve results in disequilibrium, vertigo and nystagmus.
Vertigo is a feeling of giddiness with a sense of rotation of head. It may occur due to
excessive stimulation of semicircular canals and is associated with nystagmus (involuntary and
inco-ordinated eye movements).