CRANIAL NERVES

CN I – OLFACTORY Olfactory sulcus -> olfactory bulbs and tract -> ethmoid bone (cribriform plate) -> nose o SVA smell, from olfactory epithelium

CN II – OPTIC Optic chiasm (middle cranial fossa, sits on sella turcica) -> exit cranial cavity via optic canal o Optic canal is still within the subarachnoid space -> through posterior aspect of orbit Meninges become continuous with outer layer of eye -> increased CSF pressure can be transmitted along optic nerve to its entry in eye SSA vision, from retina

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CN III – OCULOMOTOR Cerebral part of midbrain (close to mammillary bodies) -> past clinoid processes (think temporal hernia) -> past lateral wall of cavernous sinus -> exits superior orbital fissure -> orbital cavity -> interior division o o o Medial Rectus Interior rectus Inferior oblique

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-> superior division o o Superior rectus Levator palpebrae superioris

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-> ciliary ganglion (parasympathetic fibers) -> SHORT CILIARY -> sphincter papillae and ciliary muscles o Accommodation and miosis

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GVE - parasymp

apex of petrous. submandibular gland. anterior fossa) DIVISIONS: o Mandibular Division V3 (SENSORY & MOTOR)  -> exits foramen ovale - SENSORY – CUTANEOUS BRANCHES (dermatone = santa’s beard)  Auriculotemporal nerve •  Dermatome -> up to temporal fossa Long buccal nerve • • Dermatome -> posterior body of ramus of mandible + full thickness of cheek from mucus membrane to the skin LONG BUCCAL NERVE BLOCK (via tissue adjacent to buccal side of 3rd molar) = buccal gingival of molars  Lingual nerve • Anterior 2/3 of tongue.- SE – eye muscles PUPILLARY LIGHT REFLEX – tests integrity of optic and oculomotor nerve which are its respective sensory and motor limbs CN IV – TROCHLEAR Exits midbrain (lateral to oculomotor) -> past cavernous sinus -> exit cranial cavity through superior orbital fissure (below oculomotor) SE fibers Innervates a single muscle!! o superior oblique muscle CN V – TRIGEMINAL arises from lateral aspect of midpons -> passed over petrous pyramid of temporal bone -> trigeminal ganglion (Meckle’s cave. and sublingual gland .

lateral pterygoid. and maxilla • MENTAL NERVE BLOCK (via mental foramen) = incisors. hooks around hamulus) . temporalis. taste. ramus of mandible (temporal crest).• LINGUAL NERVE BLOCK (via tissue adjacent to lingual side of 3rd molar) = lingual ginigva of mandibular arch ***Lesion BEFORE lingual joins chorda tympani  ONLY LOSE SENSATION ***Lesion AFTER lingual joins chorda tympani  lose sensation. medial pterygoid muscles  Inferior alveolar nerve • mylohyoid and anterior belly of digastrics (muscular floor of oral cavity)  Tensor tympani nerve • tensor tympani muscle (dampens sounds)  [Medial Pterygoid nerve] • tensor veli palatine (tenses soft palate. and parasymp to oral glands  Inferior alveolar nerve -> mental nerve • • • Exits -> mental foramen Dermatome -> chin + mandible INFERIOR ALVEOLAR NERVE BLOCK (via mandibular foramen) = half of mandibular arch teeth + buccal ginigva from midline to 1st molar o Pterygomandibular triangle. canines. premolars + buccal gingival from midline to 1st molar MOTOR – innervation  MUSCLES OF MASTICATION • masseter. borders = pterygomandibular raphe.

canines. ant half of 1st molar) + buccal-labial gingival midline to 1st molar  Superior alveolar nerves • Posterior superior alveolar nerve o POSTERIOR SUPERIOR ALVEOLAR NERVE BLOCK (via posterior superior alveolar) = 2nd & 3rd molars and posterior root of 1st molar + buccal-labial gingival of the same • •  Middle superior alveolar nerve Anterior superior alveolar Pterygopalatine ganglion • Palatine nerves o Greater palatine nerve -> hard palate (mucosal glands) & gums  NASALPALATINE NERVE BLOCK (via incisive foramen) = hard palate + lingual gingival of incisors and canines . premolars.o LESION: one tensor is paralyzed. ASA Infraorbital nerve • -> exits infraorbital foramen o INFRAORBITAL NERVE BLOCK (via infraorbital foramen) = MSA + ASA + infraorbital nerve = maxillary teeth (incisors. the unopposed pull of the opposite muscle will cause the uvula to be deviated “away from” the side of the lesion (toward the normal side) o Maxillary Division V2 (SENSORY)     -> exits foramen rotundum DERMATOME: inverted comma (upper lip to pterion-ish) INFILTRATION INJECTIONS = PSA. MSA.

& uvula Opthalmic Division V1 (SENSORY)  -> exits superior orbital fissure (exits as its three terminal branches) DERMATOME: Lady Gaga lobster headpiece (nose to anterior aspect of scalp) Nasociliary nerve • • • Direct . GREATER PALATINE NERVE BLOCK (via greater palatine foramen) = secondary hard palate + lingual gingival from 3rd molar forward to canine o o Lesser palatine nerve -> soft palate. has the greatest intracranial length SE fibers . tonsil.Long ciliary branches -> eyeball Indirect – Short ciliary nerves CORNEAL BLINK REFLEX – good test for integrity of trigeminal and facial nerves with provide its respective sensory and motor limbs    Lacrimal nerve • Sensory to lacrimal gland and lateral eyelid  Frontal nerve • Supraorbital branch -> skin of forehead o Bifuricates:   • Medial branch Lateral branch Supratrochlear CN VI – ABDUCENS Arises -> Medulla (pre Olivary Sulcus) Exits -> superior orbital fissure Of all the cranial nerves.

and parasymp to oral glands -> exits stylo-mastoid foramen o Innervates: posterior belly of digastrics and stylohyoid muscles -> turns laterally pierces parotid gland (DOES NOT INNERVATE) -> divides into 5 major branches of FACIAL EXPRESSION (SVE fibers) . lacrimal  NOTE: Vidian nerve – • • o o parasympathetics from greater petrosal sympathetic from deep petrosal (internal carotid plexus) Branch to stapedius -> innervates stapedius muscle Chorda tympani ->emerges from petrotympanic fissure -> joins with Lingual nerve   SVA taste anterior 2/3 of tongue parasympathetic preganglionic neurons to submandibular ganglion -> submandibular and sublingual glands ***Lesion BEFORE lingual joins chorda tympani  ONLY LOSE SENSATION ***Lesion AFTER lingual joins chorda tympani  lose sensation. GVE -> pterygopalatine ganglion -> palatine.- Innervates a single muscle!! o Lateral rectus muscle CN VII – FACIAL Runs with vestibulocochlear nerve Arises -> medulla (postolivary sulcus) -> medial end of internal auditory meatus o BEWARE of vestibular schwannoma -> enters interior of temporal bone -> facial canal -> genu -> geniculate ganglion (greater petrosal nerve branches) -> around stapedius (innervates stapedius muscle) -> descends posterior wall of tympanic cavity -> gives off chorda tympani o Greater Petrosal nerve -> parasympathethic fibers. nasal. taste.

blow out cheeks TEST: smile. purse lips) orbital part and palpebral part Zygomaticus major (draws angle of mouth superiorly and posteriorly – SMILE ) o Damage: decrease prominence in nasolabial fold. whistle. pucker up. cannot smile. pucker up lips. TEST: ask pt to close eyes tightly) o • Buccal nerve  Innervates: • • • • •  Buccinator (aids by chewing by holding cheeks flat) Levator Labii Superioris (elevates upper lip) Levator labii superioris alaeque nasi (snarl) Levator Anguli Oris (elevates angle of mouth. soft smile) Orbicularis Oris (upper lip part. wrinkle forehead) o Zygomatic nerve  Innervates: • orbicularlis oculi muscle (damage lower eyelids sag and pt will tear. gravitational cheek sag. TEST: raise eyebrows. show teeth. show teeth.o Temporal nerve  Innervates: • frontalis (allow you to wrinkle forehead. or blow out cheeks  ***Showing teeth good quick test for both buccal and mandibular branches of facial*** o Mandibular nerve  Innervates: • • Depressor anguli oris (depressor of the angle of the mouth) Mentalis (depressor of the lower lip) .

• Orbicularis Oris (lower lip part o allows you to tightly close mouth. Semi-circular canals of inner ear (equilibrium/balance) CN IX – GLOSSOPHARYNGEAL Arises -> medulla (post-olivary sulcus by multiple rootlets) Exits cranial cavity -> jugular foramen Branches: o Tympanic branch  sensory innervations to middle ear. mastoid air cells. DAMAGE – cause gravitational sag of lower lip and drooling o Cervical nerve  Innervates: • Platysma - Superficial Branches of Facial Nerve o GSA fibers for general sensation of skim from central part of auricle. Saccule. and auditory tube -> pathway for pain of middle ear infections sensory fibers -> join with auricular branch of CN X  . mastoid region. posterior wall of external auditory meatus CN VIII – VESTIBULOCOCHLEAR Runs with facial nerve Arises -> medulla (postolivary sulcus) -> medial end of internal auditory meatus -> enters interior of temporal bone o BEWARE of vestibular schwannoma SSA fibers o o Organ of Corti in cochlear duct (hearing) Utricle.

abdomen **Note: SVA fibers taste of valleculae and epiglottis o Auricular branch   immediate split after foramen sensory to skin over mastoid ->Superior and Inferior Ganglion (GSA + GVA) o Pharyngeal Branch  Communicating branch of vagus nerve -> carotid branch of glossopharyngeal (CN IX) •  GVA. parasympathic preganglionic neurons -> Otic Ganglion -> parotid gland (provides secretomotor control of parotid gland o Pharyngeal branch  Innervates stylopharyngeus muscle – elevates larynx and pharynx. facilitates swallowing o Carotid branch   Carotid sinus -> Baroreceptor Reflex Carotid body -> joins with vagus -> Chemoreceptor Reflex (response to hypoxia/CO2 levels) o Tonsillar branch -> Lingual branch  Posterior 1/3 of tongue .general sensory and taste CN X – VAGUS Arises -> medulla (post-olivary sulcus by multiple rootlets) Exits cranial cavity -> jugular foramen **Note: branches supply parasympathetics to visceral organs in thorax. Chemoreceptor reflex (hypoxia) Innervates – Muscles of pharynx (EXCEPT Stylopharyngeal muscle – glossopharyngeal) . Carotid body.

external superior laryngeal) • Posterior cricoarytenoid – o o • Abducts inspiration Arytenoid (transverse & oblique) o adducts vocal cords . V3) o Palatoglossus – elevates and retracts tongue. gives higher pitch Internal (SENSORY) • Innervation to supraglottic area of larynx & piriform recess o Recurrent Laryngeal (MOTOR)  Innervates muscle of larynx (EXCEPT cricothyroid. aids in swallowing Palatal Branch • Innervates – muscles of the palate (EXCEPT Tensor veli palatini. helps deliver bolus of food from oral cavity to oropharynx Palatopharyngeal – elevates pharynx.• •  Pharyngeal constrictors – helps move bolus of food down Salpingopharyngeal – off toris tubaris. depresses palate Levator veli palatine – on contraction elevates palate and oulls the palate to its own side  LESION: palate will be pulled “away from” side of lesion (toward the normal side) by the unopposed pull of the normal muscle o o o Superior Laryngeal  External (MOTOR) • Innervates: o  Cricothyroid – tenses vocal cords.

trapezius muscles o CN XII – HYPOGLOSSAL Arises from brain – medulla (rootlets. and palate Spinal root innervates sternocleidomastoid. valsalva maneuver. swallowing Lateral cricoarytenoid o o adducts vocal cords. preolivary sulcus) -> exits cranial cavity – hypoglossal canal o XII crosses foramen magnum so herniation of cerebellum down through foramen magnum (due to increased intracranial pressure) can encroach upon the nerve - Wraps posterior-anterior over carotid. valsalva maneuver. pharynx.o • talking. deep to posterior belly of digastrics -> passes submandibular region -> enters tongue . lowers pitch CN XI – ACCESSORY Exits cranial cavity -> jugular foramen Cranial root (SVE fibers) o arises-> medulla (postolivary sulcus by multiple rootlets) -> exits jugular foramen (with spinal portion) Spinal root (SE fibers) o Arises -> rootlets from lateral surface of upper five cervical segments of spinal cord -> ascends cervical canal -> enters cranial cavity via foramen magnum -> joins cranial root in posterior cranial fossa (near jugular foramen) -> exits jugular foramen (with cranial portion) - Splits almost immediately! o Cranial root joins vagus -> innervates muscles of larynx. swallowing • Thyroarytenoid o relaxes cords. pivet motion talking.

to test the left genioglossus.g. it will tend to deviate “away from” the side of a paralyzed styloglossus muscle/injured hyoglossal nerve GAG REFLEX Sensory – glosspharyngeal Motor – Vagus (via pharyngeal constrictors.- SE fibers o Innervates: (all tongue muscles EXCEPT PALATOGLOSSUS – CN X)  Hyoglossus muscle •  Depress the tongue Genioglossus muscle • • Protrude tongue + deviate tongue laterally to the opposite side RULE: Protruded tongue points “toward” the side of the paralyzed genioglossus muscle (side of the injured hypoglossal nerve) TEST: pushing tongue against opposite cheek (e. the tongue pushes out the right cheek) •  Styloglossus • • Elevates and retracts tongue RULE: When tongue is at rest in mouth or being retracted. posterior wall moves straight forward) Gag reflex is bilaterally symmetrical Probe elicits no gag reflex – likely glossopharyngeal (pt did not sense probe’s touch) Probe elicits asymmetric reflex – likely damage to one side of vagus Cranial Nerves with Parasympathetic Innervation III (Oculomotor) o lacrimal gland .

lacrimal gland via chorda tympani. submandibular & sublingual glands - IX (Glossopharyngeal) o parotid - X (Vagus) o visceral organs of thorax and abdomen .- VII (Facial) o o via greater petrosal.