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 NEURO-PSYCHIATRY MODULE

Tentir-21: Cranial Nerves

Helluwww it’s primmy and keyrun!!! Kita agak halu gitu sii pas lecture karena
ngantuk terus lecture nya pas jam bobo siang… biasalah ya defense mechanism
nya rationalization, jadi used to cari2 alesan in every possible ways :’)))

Objectives/Overview

1. Cranial nerves
2. Olfactory Nerves
3. Optic Nerves
4. CN III, IV, VI
5. CN V
6. CN VII
7. Etc :D u get the point

Introduction

Heyy guysss its primmy! Semangat yak, kita throwback BHNS lagi. Traumatizing
memoriesss… L

For introduction, the brain start working by receiving a stimulus from a receptor. The
stimulus will be forwarded by afferent nerve fibers. Then, the brain will process the
stimulus into a perception. Perception is the interpretation your brain makes based
on what you see, hear, smell, feel, taste and the information that is already stored
within your memory (cuma manusia aja guys yang punya!). The information will then
be delivered by the efferent nerve fibers to elicit a response. Nerve fibers that
transmit impulses from a stimulus to the brain are called afferent fibers, while nerve
fibers that transmit impulses to elicit a response from the brain are called efferent
fibers. Efferents are divided into two, namely peripheral nerves and cranial nerves.
The cranial nerves are a sensorimotor system. Cranial nerves contain nerves that
carry special sensory messages such as vision.

Cranial Nerve

A. 12 Cranial Nerves (Intro yak)

These cranial nerves arise from the brain as 12 pairs and they pass through or into the
cranial bones via the foramen in the skull.

• Some of these nerves contain ONLY sensory fibres, some contain ONLY
motor fibres, and some contain BOTH sensory & motor fibres
• Some cranial nerves convey parasympathetic fibres, some convey
taste fibres, some convey BOTH and some NEITHER

Fungsi saraf kranialis dapat dibagi jadi:

 A. Somatic Afferent: sensory yang disadari such as
sensory from the face (kayak pelakor ditampar
sama istri sah, kerasa nyut2an muka)
B. Visceral Afferent: sensorik yang berasal dari inner
organs such as swallowing reflex (pokoknya yang
gak bisa dikontrol/rasa)
C. Special Somatic Afferent: visual and vestibular
input
D. Somatic Efferent: facial muscles
E. Visceral Efferent: GI tract and glands

Ok next kita ngapalin 12 cranial nerves yaa biar jago

kayak @arqam dulu pas kelas offline.

Another Mnemonic

Guys ini kalau mau versi

not PG13 ya (I know u
guys lebih apal kalau
jorok2 HAHA)
Oh, Oh, Oh, To, Touch,
And, Feel, Virgin, Girl’s,
Vagina, Ah, Heaven

B. Foramen of the Skull

• CN III, CN IV, CN V, CN VI pass through the superior orbital fissure .
• CN VII and CN VIII pass through the internal acoustic meatus. The internal
acoustic meatus is located nearby the carotid canal
• CN IX, CN X, CN XI pass through the jugular foramen
C. Cranial Nerves as an Integrated System In the Brainstem
Ok as has been mentioned previously, ada 12 cranial nerves. They are divided into
three divisions: sensory, motor, and mixed neurons. Imma group them up to make
life easier (AMIN).
• Sensory neurons:
o Nerve I, II, VIII
o Special senses of seeing, smelling, and hearing
• Motoric neurons:
o Nerve III, IV, VI, XI, XII
• Mixed neurons (both sensory+motoric):
o Nerve V, VII, IX, X

The cranial nerves are an integrated system in the brainstem, especially the CN III –
CN XII. The brainstem can be divided into two, which are the medial and lateral
parts. The sensory nucleus is located in the lateral part of the brainstem. Whereas,
motor nucleus is located in the medial part of the brainstem. In shortà

• Lateral part of the brainstem: sensory function

• Medial part of the brainstem: motoric function
 Olfactory Nerve (CN I)

A. Olfactory Nerves (Intro yak)

Izin gado2 ya guys!
The first and shortest cranial nerve is olfactory nerves. It is a special afferent nerve that
transmit information of smell. Reseptornya tuh terletak pada nasal epithelium with
elongated shape to the nasal cavity. Setelah informasi dari olfactory receptor diterima,
the information will be delivered to the olfactory bulb in the cribiform plate (a part of
ethmoidal bones) which then be transmitted to the olfactory tract in the frontal lobe.
Semua informasi2 akan di accumulated and processed di primary olfactory cortex yaitu
prepyriform, enthorinal, dan periamygdaloid.

Moving on to the temporal lobe. Ada yang Namanya primary olfactory cortex, which is
also known as pyriform cortex (rhinecephalon). The location of this cortex is pretty deep
(inget2 lagi BHNS guys), makanya harus dibuka dulu. Pyriform cortex has a connection
with amygdala and hippocampus which regulate memory. This is the reason why a
memory or feeling that is correlated to the smell can be triggered even when we don’t
see the actual thing that triggered us. For example, lagi jalan bareng pacar baru terus
papasan sama cowo yang pake parfum persis mantan… Damn pas kecium baunya
langsung dah keinget masa2 di toxic in mantan (upssssss L). Another example makan
nasi goreng, terus keinget dulu sering makan sekeluarga di restoran pas ultah. J.
 B. Damage to the Olfactory Nerves
The most encountered damage to the olfactory nerves are anosmia and hyposmia.
Those conditions prevent our usual ability to smell things. Anosmia is defined as the
absence of the sense of smell. If there is only small disturbances in the ability to smell, the
condition is called hyposmia. Based on the etiology, anosmia can be differentiated as:
• Temporary Anosmia can be caused by infection such as meningitis or by local
disorders of the nose (common cold)
• Permanent Anosmia can be caused by head injury or tumor which occur in the
olfactory groove (for example meningioma)
• Progressive Anosmia occur as a result of neurodegenerative conditions such as
Parkinson’s or Alzheimer’s disease. In these conditions, the anosmia is progressive
and precedes motor symptoms but it is not often noticed by the patient
• Congenital Anosmia is also caused by genetic conditions such as Kallmann
Syndrome (failure to start or finish puberty) and Primary Ciliary Dyskinesia (defect
in cilia causing it to be immobile)

During COVID-19 pandemic, the symptoms that are often linked to COVID-19 is anosmia or
hyposmia (loss of smell and taste). This happens because SARS-CoV-2 has a predilection to the
olfactory bulb. Hence, it is more likely to be damaged if you have COVID (Stay safe guysss!)

Additional info from Harvard.edu: COVID-19-related anosmia may arise from a temporary loss
of function of supporting cells in the olfactory epithelium, which indirectly causes changes to
olfactory sensory neurons.
Olfactory nerves berdekatan dengan insula, hypothalamus, and amygdala. Juga
associated with nucleus tractus solitarius (NTS) dan dari situ dia terkoneksi dengan sistem
gustatory untuk merasa (lidah). Jadi kalau ada kerusakan dari sistem hidung, kita jadi gak
selera makan. Anosmia membuat napsu makan kita turun karena association dari sistem
mencium dan merasa. (keep your mask on guys!).

Optic Nerve (CN II)

A. Intro for Optic Nerves

Optic nerves serve a function to help us see. Not only that, but there are also
several functions that this nerve do. Such as dilatation and constriction (buat
ngebantu ngefokusin pandangan), visual field (kayak kalau kita minus/miopi
visual field kita kan ke impaired), and ngebedain warna. If you guys remember
from our KKD, fundoscopy can be used to examine our eye. To see the fundus of
the eye as well as the surrounding structures such as veins and arteries.

B. Pathway

Take a look at the picture above! Bismillah primmy gak halu. Based on the
picture, there are several pathway that we need to see. Retina à optic nerve à
optic tract à optic chiasm à geniculate nucleus tract à primary visual cortex.
 The retinas have a different function, temporal retina bakalan nangkap visual
fied yang sebelah medial, sementara nasal retina bakalan nangkap visual field
yang sebelah lateral. For example in the right eye, medial part of the visual field
dihantarkan oleh temporal retina (WARNA BIRU) ke lateral optic nerve,
sementara lateral part of the visual field dihantarkan oleh nasal retina ke medial
optic nerve (WARNA ORANGE). Pelan2 aja guys <33.

Setelah cahaya/lapang pandang ditangkap, optic nerve akan membawa

stimulus dan melakukan penyilangan di optic chiasma. Do take a note that
medial part of both optic nerves will cross each other, forming the optic chiasm.
Whereas the lateral part won’t cross each other, they will join the OPPOSITE
medial part of the optic nerve (the result of the crossover), forming optic tract
(LIAT WARNA BIRU ORANGE NYA).

Then, the stimulus will be transmitted to the lateral geniculate nucleus (LGN) in
the thalamus. These nucleus will finish the job and deliver the stimulus to the
primary visual cortex. Yukk lanjut!

C. Damages to the Optic Nerves

Jadi damagesnya depend on the location. Dibagi jadi 5 based on the picture: in
the optic nerve, optic chiasm, optic tract, geniculate nucleus, and visual cortex.

CONTOH SESUAI GAMBAR PAKE MATA KANAN.

• Di gambar A, kerusakan terjadi di right optic nerve, which causes all visual
field on the right eye to be impaired (buta kanan total). Kenapa mata
 kirinya gak kenapa2? Karena ini BEFORE THE OPTIC NERVES CROSS EACH
OTHER TO FORM OPTIC CHIASM. That’s why if the impairment happen in
the right optic nerve (blm persialangan), yang rusak mata kanan. Gw
mikirnya gini: mata kanan legit depend on the nerves from the right eye
ONLY and mata kiri depend on the nerves from the left eye ONLY. That’s
why kalau optic nerves kanan rusak, buta mata kanan.
• Di gambar B, the impairment take place at the optic chiasm so that we
lose half of the visual field but only in the temporal part of both eyes.
• Di gambar C, the impairment happen at the optic tract. This means that
the nerves ALREADY CROSS EACH OTHER and form optic chiasm. That’s
why when the right part of the optic tract is disturbed yang kena lateral
part of the left eye and the medial part of the right eye (jadi yang kena
setengah dari visual field bagian kanan).
• Di gambar D, the damage is located at the geniculate nucleus. This causes
quadrantanopia, which describes defects confined mostly to
approximately one-fourth of an eye's visual space. Karena yang kena
geniculate nucleus kanan, yang rusak seperempat visual field yang kanan.
• Di gambar E, the visual cortex is impaired. Jadi namanya macula sparring.
Macular sparing is visual field loss that preserves vision in the center of the
visual field, otherwise known as the macula (pin hole). Ada dua teori, yang
pertama daerah maculanya dapet persyarafan dari mata kiri yang sehat
makanya the center of the visual field is preserved. The next theory stated
that in patients with stroke due to a blockage in the posterior cerebral
artery, ada help from the contralateral part of the eye which comes from
middle cerebral artery (jadi bagian contralateralnya ngebantu). TBH sama
aja gasi HAHA, tapi dokternya ngomong gitu.

Monocular VS Binocular
Ini istilah yang dipake juga buat tau the location of the lesions. Monocular is a
pre-chiasmal lesions is detected. Whereas binocular happens if chiasmal, retro-
chiasmal, or bilateral pre-chiasmal lesions is detected.
D. Pupillary Light Reflex Pathway
We use the papillary reflex to examine the reflex pathway of the optic nerve.

1. Direct Pupillary Reflex

Jadi ada 2 hal yang harus dihighlight, AFFEREN (sensory) nya adalah optic nerve
(CN II) dan EFFERENT (motoric) nya adalah CN III. When we give a light to the right
eye, yang bakalan nerusin cahayanya to the optic tract and the geniculate body
adalah CN II. After that, the light will be delivered by accommodation pathway
(yang garis biru) to the Edinger Westphal Nucleus (EWN). Bisa juga langsung short
pathway dari optic tract langsung ke midbrain (liat garis kuning, ada 2 jalan). The
light will be carried on to the parasympathetic fibers of the CN III to contract the
right pupil (motoricnya, karena CN III yang kerja buat contract the pupils).

2. Indirect Pupillary Reflex

Inget lagi, AFFERENT/SENSORY CN II, EFFERENT/MOTORIC CN III. In this case, when we
give a light to the right eye, the stimulus will be transmitted by the optic nerve to the
contralateral side (liat garis orange!). Similarly with the direct pathway, the
accommodation pathway help to deliver the stimulus to the Edinger Westphal
Nucleus (EWN) and to the CN III. Respons kontriksi juga dari contralateral (mata kiri).
Sumpah gw gatau kenapa gak kelar2… bear with me guys:’)))
This is an example when the CN II of the right eye is impaired. INGET CN II
AFFERENT/SENSORY!!! On the first pair of eyes (gambar paling atas) adalah kondisi
eyes at rest. The left eye is contracted due to the presence of the CN II that
received the impulses and sent it to the CN III (direct pathway), whereas the right
eye cannot transmit any impulses AT ALL due to the impairment of the CN II.

The second case happen when we give the light to the left eye. The CN II of the left
eye will deliver the impulses to the CN III of both the right and the left eye (dua2nya
pulpilnya contract), this condition occur because the CN III of the right eye is still
preserved makanya bisa contract (direct pathway buat mata kiri and indirect
pathway buat mata kanan). However, in the last case, we try to give the light to the
right eye. It won’t elicit any responses because the nerve that is responsible to
deliver the impulse is no longer working (CN II nya rusak kan), makanya both eyes
gabisa contract pupilnya. Kenapa mata kiri juga gabisa?
Imagine: cahaya (koran), CN II (tukang koran), CN III (pembeli). Biar pembeli bisa
dapet koran, pastinya butuh dianterin kan korannya sama tukang koran. Nah kalau
tukang korannya sakit, pembelinya gabisa dapet koran dong. J

CN III, IV, VI

A. Oculomotor

Ini yang perlu dihighlight, nucleusnya terletak di midbrain. This nerves will be divided
into two:

1. Superior à for eye ball

• M. Rectus Superior à looking up
• M. Rectus Inferior à looking down
• M. Rectus Medial à looking medially
• M. Rectus Lateralis à looking laterally
• M. Oblique Inferior à externally rotates our eyes (ke arah luar and to
rotate it upwards (ke atas, elevation)
• M. Oblique Superior à lirik medial bawah (kalau arah mata angin
arah tenggara gitu I KNOW RANDOM tp takut salah pahamJ)
• M. Oblique Inferior à lirik medial atas (arah mata angin timur laut)
• M. Levator Palpebrae à open and close our eyelids
 2. Inferior
Innervates the sphincter pupillae and ciliary muscles

B. Trochlear (CN IV)

 C. Abducens (CN VI)
t

D. CN III, IV, VI

YEAYY KELAR!!! Goodluck guysss, primmy’s out <3333. Encok banget gw.
 Intermezzo dulu hue

Jancok ngantuk bgt anyways iya gausah lama2 lagi gw ketiduran again HAHAHA,
asshalomualaikum nama saya keyrun pasha ivan sana dari pbl c izin MENCOBA
menyampaikan rangkuman mengenai part 2 dari lecture 21 ini,,,

LANJOT CN. III, IV ,VI

A. How to Check for the 3rd, 4th, and 5th Cranial Nerve Palsies

• Okay so honestly ini si cmn tabel yg simple bgt buat dibaca,,, but for u lazy asses
gw jabarin satu2 <3
o

B. Clinical Relevancies
• Wokeh so here are some findings associated with CN. III palsies:
o PTOSIS à Due to paralysis of the LEVATOR PALPABRAE SUPERIORIS and
unopposed (gaada yg ngelawan ya berarti) activity of the orbicularis oculi
 § BE EXTREMELY CAREFUL HOWEVER, as there are other causes of ptosis
besides a CN. III lesion
• FRONTALIS MUSCLE à N. VII
• SUPERIOR TARSAL/MULLER’S MUSCLE à Sympathetic
innervation dari CN. III
• Gaada di ppt but wanna flex IMO studying HAHAH,
MYASTHENIA GRAVIS à an autoimmune disorder affecting
AChR à EYE MUSCLE WEAKNESS
§ IMPORTANT DDX!!! à PSEUDOPTOSIS (Horner’s syndrome à a
SYMPATHETIC disorder) (how de fuk do I differentiate it from ptosis
biasa,,,) à Levator palpabrae functions NORMALLY
• Other signs to look for are anhidrosis (face does not sweat) and
miosis (small pupil, unlike CN. III)
o “DOWN N’ OUT” EYE POSITION à Due to paralysis of the SUPERIOR, INFERIOR,
AND MEDIAL RECTUS, and the INFERIOR OBLIQUE
§ Patient therefore cannot ELEVATE, DEPRESS, OR ADDUCT the eye
o DILATED PUPIL à UNOPPOSED ACTIVITY OF DILATOR PUPILLAE (seharusnya
sphincter ngelawan)

CN. V, Trigeminal Nerve

A. Overview
• CN. V, or known as the trigeminal nerve, has its 4 nuclei originating from the
PONS (took this from 18)
 o PRINICPAL SENSORY: Touch and discrimination
o SPINAL: Pain and temperature
o MESENCEPHALIC: Proprioception
o MOTOR: Motor function (gaada di gambar yg bawah krn sebelahan sm
principal sensory)
o All of them will converge into the TRIGEMINAL GANGLION
§ A lesion here would cause FULL FACIAL NUMBNESS AND
WEAKNESS OF MASTICATION à Known as TRIGEMINAL
NEURALGIA (ya krn semua nucleusnya aja ngumpul kesitu)
• Remember back in BHNS yg ada CN 3 cabang itu? Yea its this one
o Ophthalmic (V1)
§ Exits the skull via the SUPERIOR ORBITAL FISSURE
§ Functions to supply sensory perception to the forehead region
down to the upper portion of the nose around the glabella
• Also has a role in the AFFERENT PORTION OF THE CORNEAL
REFLEX (kan kalo efferent di kasus ini kan berarti nutup
matanya krn silau shay,, nah yg nerima stimulus terlalu
silaunya si CN. V) à and cause u know jelas2 branch ini
kan namanya OPHTHALMIC

o Maxillary (V2)
§ Exits the skull via the FORAMEN ROTUNDUM
§ Functions to supply sensory perception as well to the lower
portions of the nose that the ophthalmic branch did not cover,
down to the maxillary region
o Mandibular (V3) à THE ONLY ONE WITH MOTORIC NERVES
§ Exits the skull via the FORAMEN OVALE
 § Functions to supply sensory perception for the cheeks and the
mandibular regions à and RESPONSIBLE FOR MASTICATION
• TWO EXECUTIVE FUNCTIONS + 1 idk what ur supposed to refer to it as:
o SENSORY (MAIN FUNCTION): udah dijelasin diatas ya,,
o MOTORIC: tadi kan udah dijelasin juga kalo V3 only has those motor
nerves, so they supply the muscles of mastication à MEDIAL AND
LATERAL PTERYGOIDS, MASSETER AND TEMPORALIS. Nice to knows are
that V3 also innervates the anterior belly of the digastricus, mylohyoid,
tensor velli palatini and tensor tympani
o PARASYMPATHETIC: Post ganglionic neurons of parasympathetic
ganglia TRAVEL WITH CN. V, however, CN. V DOES NOT supply the
portion of the PNS cranial outflow
• PATHWAYS (For some reason gaada di lecturenya??? Tp menurut gw penting
so gw ambil dari 18 aja ya)
o SOMATOSENSORY: V1-3 receives somatosensory inputs and will
terminate at the PRINCIPAL SENSORY NUCLEUS, later carried by the 2nd
order neurons, then crossing the midline and contralaterally ascending
to the medial lemniscus to the thalamus’ VPL (paling ada lah
gambarnya di buku kuning)
o PAIN AND TEMPERATURE: Impulses will terminate at the spinal nucleus,
later following the 2nd order neurons, ascending through the lateral
spinothalamic tract to the thalamus’ VPL
B. Table of CN. V Functions (for easy viewing ofc)

CN. VII, Facial :) Nerve

A. Overview
• CN. VII, or known as the facial nerve, has its nuclei located in the LOWER PONS
• FOUR EXECUTIVE FUNCTIONS:
o SENSORY: TIIIINY TINY area of sensory innervation just around the concha
of the auricle
o SPECIAL SENSORY: Provides the sensation of taste to the anterior two-
thirds of the tongue
o MOTORIC (MAIN): Innervates the muscle of facial expression, posterior
belly of the digastricus, stylohyoid, and the stapedius muscles
o PARASYMPATHETIC: LOOOOTS of glands
§ SALIVARY: Submandibular and sublingual
§ MUCOUS: Nasal, palatine, and pharyngeal
§ LACRIMAL: ya di lacrimal gland lah the fuq
• PATHWAYS
o BRACHIAL EFFERENT (MAIN)
§ Innervates the temporal, zygomatic, buccal, mandibular, and
cervical muscles à FOR FACIAL EXPRESSION (each muscle has
their own branch from CN. VII
§ Nice to knows are the platysma, stylohyoid, and posterior belly of
the digastricus
 § Pathway follows along the primary motor nucleus in the pons,
later travelling along the internal acoustic meatus (with CN. VIII
and n. Intermedius), laterally through the facial canal, into the
geniculate ganglion, and finally exiting the skull and innervating
the muscles
o VISCERAL EFFERENT
§ A PARASYMPATHETIC fiber
§ Innervates the glands stated above
§ Pathway follows along its origin, being that of the superior salivary
nucleus, into the geniculate ganglion, with some travelling to the
pterygopalatine ganglion to innervate the NASAL and LACRIMAL
glands, while other fibers travel along the chorda tympani to
innervate the SUBMANDIBULAR GANGLION, later innervating the
TWO SALIVARY GLANDS.
o SPECIAL VISCERAL AFFERENT
§ Innervates the sensory aspect of the taste buds of the anterior
two-thirds of the tongue
§ Pathway follows along the taste buds into the chorda tympani,
into the geniculate ganglion, to the superior NTS, into the central
gustatory pathway, into the thalamus, and ending at the inferior
portion of the post central gyrus into the insula

o SOMATIC AFFERENT
§ Innervates the sensory aspect of the area around the auricle,
parts of the auditory canal, and the external surface of the
eardrum (tympanic membrane)
§ Pathway follows along the auricular nerve along with the vagal
nerve, into the geniculate ganglion, and later merging with the
spinal nucleus of CN. V from n. Intermedius in the brainstem
• CLINICAL SIGNIFICANCES
o PATHWAY LESIONS (Tinggal disesuaiin aja kok sm pathway yg tadi)
 o CENTRAL (contra/UMN) & PERIPHERAL (ipsi/LMN) FACIAL PALSY

CN. VIII, Vestibulocochlear Nerve

A. Overview
• CN. VIII, or known as the vestibulocochlear nerve, has TWO DIVISIONS
o VESTIBULAR
§ NUCLEI LOCATION: The VESTIBULAR GANGLION is situated in the
MEDULLA
§ FUNCTIONS:
 • SPECIAL SOMATIC AFFERENT: Responsible for equilibrium,
cristae of semilunar canals (for head movement), macula
of the utricles and saccule (for head positioning)
o EQUILIBRIUM à By impulses to the ALPHA and
GAMMA motor neurons in spinal cord from LATERAL
VESTIBULAR NUCLEUS
o BALANCE à By impulses to the ANTERIOR HORN
CELLS OF THE CERVICAL AND UPPER THORACIC
SPINAL CORD, from the MEDIAL VESTIBULAR
NUCLEUS
§ PATHWAY: Follows with the cochlear nerve, into the internal
auditory canal and into the brainstem specifically in the
pontomedullary angle. Later terminates in the vestibular nuclei in
the medulla oblongata
o COCHLEAR
§ NUCLEI LOCATION: The COCHLEAR GANGLION is also situated in
the MEDULLA
§ FUNCTIONS:
• SPECIAL SOMATIC AFFERENT: Responsible for hearing and
innervation of the organ of Corti
§ PATHWAY: Nerves from the cochlear division travel with the
vestibular nerves and into the brainstem through the internal
auditory canal
• Some fibers later travel into the TRANSVERSE TEMPORAL
GYRI OF HESCHL through the ventral cochlear nucleus, into
the superior olivary nucleus by crossing the midline, into
the lateral lemniscus, into the inferior colliculi, and into the
thalamus
• CLINICAL SIGNIFICANCES (yeah ketemu ginian lagi UGH)
o DIZZINESS/VERTIGO à VESTIBULAR DIVISION
o LOSS OF BALANCE à COCHLEAR DIVISION (?)
o HEARLING LOSS à COCHLEAR DIVISION
 Vagal System à CN. IX, X

CN. IX, Glossopharyngeal Nerve

A. Overview
• CN. IX, or known as the glossopharyngeal nerve, shares the same origins of CN.
X, being that of the NUCLEUS AMBIGUOUS (BRACHIAL EFFERENT), SUPERIOR
GANGLION (SOMATIC AFFERENT), INFERIOR GANGLION (SPECIAL VISCERAL
AFFERENT), AND INFERIOR SALIVATORY NUCLEUS (VISCERAL AFFERENT)
• FUNCTIONS:
o BRACHIAL EFFERENT à Stylopharyngeal and pharyngeal muscles
o SOMATIC AFFERENT à Sensory for middle ear and eustachian tube
o SPECIAL VISCERAL AFFERENT à TASTE FOR 1/3 POSTERIOR OF THE TONGUE
o VISCERAL AFFERENT à SENSATION OF 1/3 POSTERIOR OF THE TONGUE
AND AFFERENT PORTION OF GAG REFLEX
• CLINICAL SIGNIFICANCES:
 o Absent gag reflex

CN. X, Vagal Nerve

A. Overview
• CN. X, or known as the vagal nerve, shares the same origins of CN. IX, being
that of the NUCLEUS AMBIGUOUS (BRACHIAL EFFERENT), SUPERIOR GANGLION
(VISCERAL AFFERENT), AND INFERIOR GANGLION (VISCERAL AFFERENT)
• FUNCTIONS:
o SENSORY: Innervates the skin of the EXTERNAL ACOUSTIC MEATUS and
LARYNGOPHARYNX AND PHARYNX. Also provides sensation for HEART
AND ABDOMINAL VISCERA
o MOTORIC: MUSCLES OF THE PHARYNX, SOFT PALATE, AND LARYNX
o PARASYMPATHETIC: SMOOTH MUSCLE innervation for trachea, bronchi,
GI tract, and HEART RHYTHM REGULATION
• CLINICAL SIGNIFICANCES:
o Absent gag reflex

CN. XI, Accessory Nerve

A. Overview
• CN. XI, or known as the accessory nerve, only has MOTORIC FUNCTIONS for the
sternocleidomastoid and trapezius muscles. Has a minor role in motoric
functions of the muscles of the larynx and pharynx
• FUNCTIONS:
o MOTORIC:
§ STERNOCLEIDOMASTOID à Neck turning left and right
§ TRAPZEIUS à Lifts shoulders
• CLINICAL SIGNIFICANCES
o NO TRAP GAME NO NECK GAME yea u weak

CN. XII, Hypoglossal Nerve

B. Overview
• CN. XII, or known as the hypoglossal nerve, only has MOTORIC FUNCTIONS for
the tongue, EXCEPT THE INNERVATION OF THE PALATOGLOSSUS MUSCLE à done
by CN. X
• FUNCTIONS:
o MOTORIC:
§ TONGUE MOVEMENT à tongue game stRONG ya feel 😉
%
$
#
"
• CLINICAL SIGNIFICANCES