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ABDUCENT NERVE

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

Nucleus
 The nerve gets origin from abducent nucleus which is located in the lower
part of pons deep to the facial colliculus in the floor of fourth ventricle.
 The nerve cell bodies in abducent nucleus are of two types-
 Large sized typical motor neurons supply lateral rectus muscle.
 Small sized interneurons whose axons ascend in contralateral MLF and
end in oculomotor nucleus (the part which supply medial rectus of
contralateral side). These connections ensure coordinated conjugate
movements of right and left eyes.

Functional components
 General somatic efferent (GSE) fibers originate from abducent nucleus to
supply lateral rectus muscle.Therefore, the nerve’s primary function is to
abduct or move the eye towards the temporal field in the horizontal plane.
However, CN VI also facilitates a phenomenon known as conjugate eye
movement.This process ensures that both eyes move in the same direction
on the horizontal plane (i.e. to the left or right).

Note: That the lateral rectus of the left eye would turn the eye to the left,
while the same muscle of the right eye would shift that eye to the right.

 Therefore, in the absence of conjugate gaze, the eyes would diverge and
the ability to focus on an image would be challenging. Therefore, CN VI not
only supplies the ipsilateral lateral rectus muscle but also influences the
contralateral medial rectus muscle. This is made possible by the
internuclear neurons found in the CN VI nucleus. They form synapses
between the motor neurons of CN VI nucleus with the fibers of the medial
longitudinal fasciculus. The medial longitudinal fasciculus then synapses
with oculomotor (CN III) nucleus, which innervates the medial rectus
muscle.

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Course and distribution

 Intraneural course
 The axons of the abducent nucleus travel anteriorly through tegmentum
and basilar part of pons close to midline and emerges from pontomedullary
junction above pyramid.

 Intra cranial course

 The abducent nerve pierces meninges lie lateral to dorsum sellae (fold of
duramater forms the roof of pituitary fossa) crosses the apex of petrous
part of temporal bone in a fibro-0ssseous canal and enters the cavernous
sinus from its posterior aspect. In the sinus it is lateral to internal carotid
artery.
 In the cavernous sinus the abducent nerve is vulnerable to compression
in conditions due to increased intracranial pressure.
 It exits the cranium through the middle part of superior orbital fissure
enclosed in common tendinous ring.
 Intra orbital course
 In the orbit the abducent nerve travels forwards and laterally to supply
lateral rectus muscle.

Clinical insight
 Unilateral lesion of abducent nerve is common due to increased intracranial
pressure. Resulting paralysis of lateral rectus which is characterized by
medial squint due to unopposed action of medial rectus muscle.The most
common causes in children are tumors, trauma, increased intracranial
pressure (ICP), and congenital causes.
 Horizontal diplopia when patient attempts to look towards paralyzed side.
 Lesion of MLF causes ipsilateral medial rectus weakness
 Most isolated sixth nerve palsies will recover spontaneously. Treatment
modalities for those with persistent disability may include patching, prism
therapy, strabismus surgery, and/or botulinum toxin. The goal is to
maximize visual function, including alignment.

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