Lower four cranial nerves

and cervical plexus

Glossopharyngeal Nerve
• The glossopharyngeal nerve is a
motor and sensory nerve.
• It emerges from the medulla
oblongata.
• It passes laterally in the
posterior cranial fossa.
• It leaves the skull by passing
through the jugular foramen
then descends through the neck
to the back of the tongue.
Branches of Glossopharyngeal
Nerve:
1• Tympanic branch passes to the
tympanic plexus in the middle ear.
Preganglionic parasympathetic
fibers for the parotid salivary gland
leave the plexus as the lesser
petrosal nerve, and they synapse in
the otic ganglion.
It assists swallowing and promotes
salivation.
2• Carotid branch contains
sensory fibers from the carotid
sinus (for the regulation of blood
pressure) and the carotid body (for
the regulation of heart rate and
respiration).
Branches :
3•Nerve to the stylopharyngeus
muscle
4• Pharyngeal branches
(sensory) run to the pharyngeal
plexus and also receive branches
from the vagus nerve and the
sympathetic trunk.
5•Lingual branch (general and
taste sensation) passes to the
mucous membrane of the
posterior third of the tongue
(including the vallate papillae).
Vagus Nerve
• The vagus nerve is
composed of motor and
sensory fibers.
• It emerges from the
medulla oblongata.
• The nerve passes
laterally through the
posterior cranial fossa and
leaves the skull through
the jugular foramen.
• The cranial root of the accessory
nerve joins the vagus nerve and
is distributed mainly in its
pharyngeal and recurrent
laryngeal branches.
• The vagus nerve descends
through the neck alongside the
carotid arteries and internal
jugular vein within the carotid
sheath.
• It passes through the
mediastinum of the thorax,
passing behind the root of the
lung, and enters the abdomen
through the esophageal opening
in the diaphragm
Important Branches
of the Vagus Nerve in
the Neck
1-Meningeal and auricular
branches.
2- Pharyngeal branch contains
nerve fibers from the cranial part of
the accessory nerve.
This branch joins the pharyngeal
plexus and supplies all the muscles
of the pharynx (except the
stylopharyngeus) and of the soft
palate (except the tensor veli
palatini).
Important Branches of
the Vagus Nerve in the
Neck
3- Superior laryngeal nerve:
• It divides into the internal and the
external laryngeal nerves.
• The internal laryngeal nerve is sensory
to the mucous membrane of the larynx
down as far as the vocal cords.
• The external laryngeal nerve is motor
and is located close to the superior thyroid
artery; it supplies the cricothyroid muscle.
Important Branches
of the Vagus Nerve in
the Neck
4- Recurrent laryngeal nerve:
• On the right side, the nerve hooks
around the first part of the subclavian
artery and then ascends in the groove
between the trachea and the
esophagus.
• On the left side, the nerve hooks
around the arch of the aorta and then
ascends into the neck between the
trachea and the esophagus.
Important
Branches of the
Vagus Nerve in the
Neck
4- Recurrent laryngeal nerve:
• The nerve is closely related to
the inferior thyroid artery, and it
supplies all the muscles of the
larynx, except the cricothyroid
muscle, the mucous membrane of
the larynx below the vocal cords,
and the mucous membrane of the
upper part of the trachea.
• 5- Cardiac branches (two or
three) arise in the neck, descend
into the thorax, and end in the
cardiac plexus.
• The vagus nerve thus innervates
the heart and great vessels
within the thorax; the larynx,
trachea, bronchi, and lungs; and
much of the alimentary tract
from the pharynx to the splenic
flexure of the colon. It also
supplies glands associated with
the alimentary tract, such as the
liver and pancreas.
Accessory Nerve
The accessory nerve is a
motor nerve. It consists of a
cranial root (part) and a spinal
root (part).
Cranial Root
•The cranial root emerges
from the medulla oblongata.
•The nerve runs laterally in the
posterior cranial fossa and
joins the spinal root.
Accessory Nerve
Spinal Root
•The spinal root arises from the upper
five segments of the cervical part of the
spinal cord.
•The nerve ascends alongside the spinal
cord and enters the skull through the
foramen magnum.
•The two roots unite and leave the skull
through the jugular foramen.
•The roots then separate: The cranial
root joins the vagus nerves and is
distributed in its branches to the
muscles of the soft palate and
pharynx (via the pharyngeal plexus)
and to the muscles of the larynx
(except the cricothyroid muscle).
Accessory Nerve
The spinal root runs
downward and laterally and
enters the deep surface of the
sternocleidomastoid muscle,
which it supplies, and then
crosses the posterior triangle of
the neck to supply the trapezius
muscle.
Clinical Notes
Injury to the Spinal Part of the
Accessory Nerve
• The spinal part of the accessory nerve
crosses the posterior triangle in a relatively
superficial position.
• It can be injured at operation or from
penetrating wounds.
• The trapezius muscle is paralyzed, the
muscle will show wasting, and the
shoulder will drop. The patient will
experience difficulty in elevating the arm
above the head ( action of deltoid muscle
).
Hypoglossal Nerve
• The hypoglossal
nerve is a motor nerve.
• It emerges from the
medulla oblongata and
leaves the skull
through the
hypoglossal canal.
• The nerve then passes
downward and forward in
the neck and crosses the
internal and external
carotid arteries to reach the
tongue.
• In the upper part of its
course, it is joined by C1
fibers from the cervical
plexus.
Important Branches of the Hypoglossal
Nerve
• Meningeal branch
• Descending branch (C1 fibers) passes
downward and joins the descending
cervical nerve (C2 and 3) to form the ansa
cervicalis. Branches from this loop supply
the omohyoid, the sternohyoid, and the
sternothyroid muscles.
• Nerve to the thyrohyoid muscle (C1).
• Muscular branches to all the muscles
of the tongue except the palatoglossus
(pharyngeal plexus) and therefore
controls the shape and movements of the
tongue.
• Nerve to the geniohyoid muscle (C1).
The
• Hypoglossal
Nerve
Cervical Plexus
• The cervical plexus is formed by
the anterior rami of the first four
cervical nerves.
•The rami are joined by connecting
branches, which form loops that lie
in front of the origins of the levator
scapulae and the scalenus medius
muscles.
•The cervical plexus supplies the
skin and the muscles of the head, the
neck, and the shoulders.
Branches
• Cutaneous branches
1.The lesser occipital nerve (C2), which
supplies the back of the scalp and the auricle
2.The greater auricular nerve (C2 and3),
which supplies the skin over the angle of the
mandible.
3.The transverse cervical nerve (C2 and 3),
which supplies the skin over the front of the
neck.
4.The supraclavicular nerves (C3 and 4).
The medial, and intermediate, and lateral
branches supply the skin over the shoulder
region.
• Muscular branches to the neck muscles.
• Muscular branch to the
diaphragm: phrenic nerve
(C3, 4, 5).
• It runs vertically downward
across the front of the scalenus
anterior muscle
• It enters the thorax by passing
in front of the subclavian artery.
The Autonomic Nervous
System in the Head and
Neck
Cervical Part of the
Sympathetic Trunk
• It lies directly behind the
internal and common carotid
arteries.
• The sympathetic trunk
possesses three ganglia: the
superior, middle, and inferior
cervical ganglia.
• Superior Cervical
Ganglion
The superior cervical ganglion lies immediately below
the skull.
Branches
1. The internal carotid nerve: It divides into
branches around the internal carotid artery to form the
internal carotid plexus.
2. Gray rami communicantes to the upper four
anterior rami of the cervical nerves
3. Arterial branches to the common and external
carotid arteries: they form a plexus around the
arteries and are distributed along the branches of the
external carotid artery.
4. Cranial nerve branches, which join the 9th, 10th,
and 12th cranial nerves
5. Pharyngeal branches, which unite with the
pharyngeal branches of the glossopharyngeal and
vagus nerves to form the pharyngeal plexus
6. The superior cardiac branch, which descends in
the neck and ends in the cardiac plexus in the thorax.
Middle Cervical Ganglion
The middle cervical ganglion lies at the level
of the cricoid cartilage.
Branches
1. Gray rami communicantes to the
anterior rami of the fifth and sixth
cervical nerves.
2. Thyroid branches to the thyroid gland.
3. The middle cardiac branch ends in the
cardiac plexus in the thorax.
Inferior Cervical Ganglion
• The inferior cervical ganglion in most
people is fused with the first thoracic
ganglion to form the stellate ganglion.
• It lies in the interval between the
transverse process of the seventh
cervical vertebra and the neck of the first
rib, behind the vertebral artery.
Branches
1. Gray rami communicantes to the
anterior rami of the seventh and
eighth cervical nerves.
2. Arterial branches to the subclavian
and vertebral arteries.
3. The inferior cardiac branch join
the cardiac plexus in the thorax.
1- The glossopharyngeal nerve is :
a- Only sensory nerve.
b- It emerges from the pons.
c- It leaves the skull by passing through the carotid canal.
d- It carries general and taste sensation from the mucous membrane of the posterior third of the tongue.

2- Sensory pharyngeal branches forming the pharyngeal plexus arises from :

a- Glossopharyngeal nerve
b- Vagus nerve
c- Accessory nerve
d- Facial nerve

3- The incorrect statement about vagus nerve is:

a-It composed of motor and sensory fibers and emerges from the medulla oblongata.
b-It leaves the skull through the jugular foramen.
c-It descends through the neck alongside the carotid arteries and internal jugular vein within the carotid sheath.
d-It passes behind the root of the lung and enters the abdomen through the aortic opening in the diaphragm.
4-The incorrect statement about recurrent laryngeal nerve is :
a- On the right side, the nerve hooks around aortic arch the but the left one hooks around first part of the subclavian artery.
b- The nerve is closely related to the inferior thyroid artery.
c-It supplies all the muscles of the larynx except the cricothyroid muscle.
d- It supplies the mucous membrane of the larynx below the vocal cords, and upper part of the trachea.
5-The accessory nerve is:
a- It is mixed nerve.
b-The cranial root emerges from the pons and runs laterally in the posterior cranial fossa and joins the spinal root.
c-The spinal root arises from the upper five segments of the cervical part of the spinal cord.
d- The spinal root joins the vagus nerves and is distributed in its branches.
6- The spinal root of the accessory nerve supplies:
a- The mylohyoid and anterior belly of digastric muscle.
b- The sternocleidomastoid muscle and trapezius muscle.
c- Stylohyoid and posterior belly of digastric muscle.
d- Posterior belly of digastric muscle.
7- The incorrect statement about hypoglossal nerve is:
a-The hypoglossal nerve is a motor nerve.
b-It emerges from the medulla oblongata and leaves the skull through the jugular foramen.
c-The nerve passes downward and forward and crosses the internal and external carotid arteries to reach the tongue.
d-In the upper part of its course, it is joined by C1 fibers from the cervical plexus.

8- The hypoglossal nerve innervates all muscles of the tongue except:

a- Genioglossus b- palatoglossus c-styloglossus d- hyghoglossus

9- The cervical plexus is formed by the anterior rami of ….. nerves:

a-C1-3 b- C1-4 c- C1-5 d- C1-6

10- The incorrect statement about cervical sympathetic trunk:

a-It lies directly behind carotid arteries.
b-It consists of three ganglia: the superior, middle, and inferior cervical ganglia.
c-The internal carotid nerve is one of inferior cervical ganglionʼs branches.
d- Thyroid branches are branches from middle cervical ganglion.
Thank you