You are on page 1of 87

CRANIAL NERVES (VII-XII)

CONTENTS

INTRODUCTION DEVELOPMENT INDIVIDUAL NERVE APPLIED ANATOMY REFERENCES

DEVELOPMENT
-ARISES FROM NUCLEI -NUCLEI APPEAR IN 5th WEEK

LOCATION OF NUCLEI
BRAIN REGION ASSOCIATED CRANIAL NERVE VII VIII

METENCEPHALON

MYELENCEPHALON IX X XI XII

ARRANGEMENT OF NUCLEI
MOTOR(BASAL COLUMNS) 1.General somatic efferent 2.Special visceral efferent (Branchial) 3.General visceral efferent

SENSORY(ALAR COLUMNS) 1.General visceral afferent 2.General somatic afferent 3.Special afferent -Somatic -Visceral

MOTOR NUCLEUS

A.SOMATIC EFFERENT -OCCULOMOTOR N. -TROCHLEAR N. -ABDUCENT N. -HYPOGLOSSAL N.

MOTOR NUCLEUS

A.SOMATIC EFFERENT -OCCULOMOTOR N. -TROCHLEAR N. -ABDUCENT N. -HYPOGLOSSAL N. B.SPECIAL VISCERAL EFFERENT (BRANCHIAL) -MOTOR NUCLEUS OF V n. -NUCLEUS OF FACIAL NERVE -NUCLEUS AMBIGUUS

C.GENERAL VISCERAL EFFERENT -EDINGER WESTPHAL N. -SUPERIOR SALIVATORY N. -INFERIOR SALIVATORY N. -LACRIMATORY N. -DORSAL NUCLEUS OF VAGUS

SENSORY NUCLEUS
A. VISCERAL AFFERENT - N. OF SOLITARY TRACT B. GENERAL SOMATIC AFFERENT -RELATED TO V n. C. SPECIAL SOMATIC AFFERENT -COCHLEAR N. -VESTIBULAR N.

ORIGIN OF NEURONES IN GANGLIA

PARASYMPATHETIC - NEURAL CREST SENSORY - NEURAL CREST - ECTODERMAL PLACODES

PARASYMPATHETIC GANGLION
CRANIAL NERVE VII IX GANGLION -Sphenopalatine -Submandibular Otic ORIGIN Neural crest Neural crest

Enteric

Neural crest

SENSORY GANGLIA
CRANIAL NERVE VII GANGLION Superior Inferior/Geniculate Cochlear Vestibular Superior Inferior/Petrosal ORIGIN Neural crest -1st epibranchial placode
-

VIII

Otic placode

IX

-Neural crest -2nd placode

Superior Inferior/Nodose

-Neural crest -3rd and 4th placode

Functional component of facial nerve

INTRA CRANIAL COURSE LENGTH, mm NA NA

SEGMENT Supra nuc. Brain stem

LOCATION Cerebral cortex Motor nucleus of VII n. ,superior salivatory nucleus of tractus solitarius Brain stem to IAC

Meatal

13-15 3-4 8-11 10-14

Labyrinthne Fundus of IAC to facial hiatus Tympanic Mastoid Geniculate ganglion to pyramidal eminence Pyramidal Process to stylomastoid foramen

SUPRANUCLEAR SEGMENT

BRAIN STEM

FACIAL NERVE

MEATAL SEGMENT

PROXIMAL SEGMENT

TYMPANIC AND MASTOID SEGMENT

TYMPANIC

MASTOID

EXTRA CRANIAL COURSE

MOTOR COMPONENT OF FACIAL NERVE

PATTERNS OF BRANCHING

COURSE OF FACIAL N.

BRANCHES A.Within the facial canal1.Greater petrosal nerve 2.Nerve to stapedius 3. Chorda tympani B.At its exit from stylomastoid foramen 1.Posterior auricular 2.Digastric 3.Stylohyoid C.Terminal branches within parotid gland 1.Temporal 2.Zygomatic 3. Buccal 4.Mandibular 5.Cervical D.Communicating branches with adjacent cranial and spinal nerves

BRANCHES OF COMMUNICATION 1.In I.A.C.- With acoustic nerve 2.At genicular ganglion- With sphenopalatine gang . - With otic ganlion - With sympathetic trunk 3.In facial canal With auricular branch of vagus 4.At its exit from foramen- With IX ,X nerve, great auricular ,ATN 5.Behind ear- With lesser occipital nerve 6.On face- With the trigeminal 7.In the neck- With cutaneous cervical

DISTRIBUTION OF NERVE

FIGURE LEGEND 1. Facial nerve nucleus 2. Trigeminal nerve: Spinal nucleus 3. Superior salivary nucleus 4. Solitary tract 5. Porus acusticus internus 6. Meatal foramen 7. Greater petrosal nerve 8. Sphenopalatine ganglion 9. Maxillary nerve 10. Lacrimal gland 11. Deep petrosal nerve 12. Vidian nerve 13. Nerve to glands of nose and palate (motor fibers to levator palati muscles) 14.Minor petrosal nerve anastamosis 15. Stapedial nerve 16. Chorda tympani 17. Auricular branch 18. Stylomastoid foramen 19. Lingual nerve 20. Submandibular ganglion 21. Submandibular gland 22. Sublingual gland

1. Facial n. nuc. 2. Vnerve: Spinal nuc. 3. Sup. salivar.nucleus 4. Solitary tract 5. Porus acusticus internus 6. Meatal foramen 7. Greater petro.nerve 8. Sphenopal.ganglion 9. Maxillary nerve 10. Lacrimal gland 11. Deep petros. nerve 12. Vidian nerve 13. N. to glands of nose and palate 14.Minor petr.n.anast. 15. Stapedial nerve 16. Chorda tympani 17. Auricular branch 18. Stylomast.foramen 19. Lingual nerve 20. Submand ganglion 21. Submand.gland 22. Sublingual gland

GANGLION RELATED TO NERVE

APPLIED ANATOMY
GENICULATE GANGLION RAMSAY HUNT SYNDROMEHERPES ZOSTER INFECTION OF GANGLION SIGNS VESICLES ON EAR, ORAL MUCOSA, TONSIL, POSTERIOR ONE THIRD OF TONGUE LOSS OF TASTE PAIN DECREASE SALIVATION PALATAL PARALYSIS

PTERYGOPALATINE GANGLION

APPLIED ANATOMY
- PTERYGOPALATINE NEURALGIA (SLUDER SYNDROME) Localized facial pain Vasomotor abnormalities like - lacrimation, rhinorrhea and salivation Pain involveseye, nose, palate ,ear, temple, maxillary teeth

SUBMANDIBULAR GANGLION

IDENTIFICATION OF NERVE

FIRST, MIDDLE OF ANTERIOR BORDER OF MASTOID SECOND, BEHIND NECK OF MANDIBLE IDENTIFY MARGINAL MANDIBULAR

UPPER MOTOR NEURON LESION

LOWER MOTOR NEURON LESION

UMN vs LMN
UMN PARALYSIS
MUSCLE GP. AFFECTED DIFFUSELY ATROPHY SLIGHT NO FASCICULATIONS RETAINED-EMOTIONAL MOV. OF FACE -BLINK REFLEX -WRINKLE FOREHEAD NORMAL TONGUE PROTRUSION

LMN PARALYSIS
INDIVIDUAL MUSCLE AFFECTED ATROPHY PRONOUNCED PRESENT LOST

TONGUE DEVIATES TO UNAFFECTED SIDE

SYNDROMES WITH CENTRAL LESIONS


SYNDROME FOVILE MEIGE MILLARD-GUBLER MOEBIUS LOCATION OF LESION LATERAL PONS BASAL GANGLION PONTINE NUCLEUS FUNDUS OF IAC TO FACIAL HIATUS EXTRAPY. CLINICAL FEATURE PARESIS,DEAFNESS, ANALGESIA DYSTONIA UNILATERAL 6th NERVE PALSY, 7th N. PALSY FACIAL PARESIS, VI NERVE PALSY

PARKINSON

MASKED FACIES

WEBER
PSEUDOB.PALSY

UPPER MIDBRAIN
PONTINE

STRABISMUS 3rd NERVE PALSY


PARESIS,CN DEFECTS

HOUSE BRACKMAN VII N. GRADING


GRADE DESCRIPTN. FEATURE

I II III IV V VI

Normal Mild dys. Moderate dysfunction Moderate Severe dys. Severe dys. Total paralysis

Normal facial functions Slight weakness Hemifacial spasm Disfuguring asymmetry Asymmetry at rest No movement

TUMOURS
TYPES Neuroma Meningioma Hemangioma Parotid gland Metastasis Cholesteatoma LOCATIONMost common- Geniculate ganglion and Tympanic region

TRAUMA
1.INTRACRANIAL SUPRANUCLEAR NUCLEAR INFRANUCLEAR 2.CRANIAL FRACTURES OF BASE AND MIDDLE EAR DISEASE 3.EXTRACRANIAL BELLS PALSY

BELLS PALSY

ETIOLOGYI.CENTRAL OR INTRACRANIAL REGION Vascular abnormalities Tumours of intracranial cavity Trauma to brain II.TEMPORAL BONE REGION Bacterial and viral infections Trauma Tumours III.PAROTID GLAND REGION -Tumours -Trauma -Iatrogenic factors (surgical injury)

CLINICAL FEATURES Facial asymmetry Drooping of corner of mouth Inability to close eye Uncontrolled tearing Facial muscle atrophy Eyebrow droop Loss of forehead and nasolabial folds Pain near mastoid process Sensory loss Others- Hyperacusis,Dysgeusia

TREATMENT

DRUG THERAPY-CORTICOSTEROIDSAdults-Prednisone 80 mg qd*5days Child-Prednisone 1 mg/kg/day -ACYCLOVIR Adults-2000 mg/day*7 days Children-80mg/kg /day*5 days SURGICAL NERVE GRAFTING

Intratemporal course VESTIBULAR N.

INTRATEMPORAL (COCHLEAR NERVE)

CONNECTS ORGAN OF CORTI TO COCHLEAR NUCLEI

A. AFFERENT COCHLEAR INNERVATION GANGLION CELLS-TYPE I TYPE II FIBERS ARE-INNER RADIAL -BASILAR -SPIRAL B. EFFERENT COCHLEAR FIBRES-LATERAL -MEDIAL

AFFERENT COCHLEAR INNERVATION

TYPE I

TYPE II

INN. RADIAL F.

INN. SPIRAL F.

AUDITORY PATHWAY

BALANCE
VESTIBULAR APPARATUS1.KINETIC LABYRINTH SEMICIRCULAR CANAL AND CRISTAE 2.STATIC LABYRINTH MACCULE OF UTRICLE AND SACCULE

KINETIC LABYRINTH

STATIC LABYRINTH

APPLIED ANATOMY
1.Lesions- Hearing defects 2.Tests Rinnes Webers 3.MENIERES SYNDROME 4.BENIGN POSITIONAL VERTIGO 5.ASSOCIATED SYNDROMES (7 n.ALSO INVOLVED) -GRADENIGO - TUMOURS OF PETROUS BONE -VERNET- TUMOURS AND ANEURYSMS 6.TRAUMA - IN FRACTURE OF MIDDLE FOSSA - COMPRESSED BY TUMOUR

Functional components
1.Special visceral efferent 2.General visceral efferent 3.General visceral afferent 4.Special visceral afferent

INTRACRANIAL COURSE

EXTRACRANIAL COURSE

BRANCHES
1.TYMPANIC NERVE 2.CAROTID 3.PHARYNGEAL 4.MUSCULAR 5.TONSILLAR 6.LINGUAL

APPLIED ANATOMY
1.Tested clinically Tickling posterior wall of pharynx Taste sensibility on posterior one third of tongue 2.Isolated lesions- Unknown 3.Neuralgia

GLOSSOPHARYNGEAL NEURALGIA HISTORYFIRST DESCRIBED BY- Weisenburg TERM COINED BY- Harris DEF.-It consists of recurring attacks of severe pain in back of throat near the tonsils and back of tongue due to malfunction of cranial nerve IX.

CLINICAL FEATURES

ATTACKS ARE BRIEF TRIGGERED BY

CHEWING,SWALLOWING,COUGHING OR SNEZNG PAIN BEGINS AT BACK OF TONGUE OR BACK OF THROAT PAIN- UNILATERAL,SEVERE AND PAROXYSMAL OLDER AGE GROUP IS AFFECTED PAIN MAY FELT IN EAR(VAGO-COLLET-SICARD SYNDROME) HEART BEAT AFFECTED IN 1to 2% CARDIAC SYMPTOMS- BRADYCARDIA, HYPOTENSION , FAINTING CLINICAL TYPESA.TYMPANIC TYPE B. OROPHARYNGEAL

PATHOGENESIS

VASCULAR COMPRESSION CEREBELLOPONTINE ANGLE TUMOURS PARAPHARYNGEAL SPACE LESIONS POST TONSILLECTOMY LOCAL INFECTION CARCINOMA OF PHARYNX NASOPHARYNGEAL CARCINOMA CARCINOMA OF PARAPHARYNGRAL SPACE

DIAGNOSIS

EXCLUDE OTHER CAUSES OF PAIN DUE TO INFLAMMATION AND NEOPLASIA DISTRIBUTION OF PAIN SITE OF TRIGGER ZONES RELIEVE PAIN BY ANESTHESISING TRIGGER POINT TO KNOW THE CAUSE

TREATMENT
CARBAMAZEPINE CARDIOGENIC DRUGS SURGICAL- INTRACRANIAL SECTION OF IX AND UPPER VAGAL ROOTLETS - MICROVASCULAR DECOMPRESSION - PERCUTANEOUS LESIONING OF IX NERVE

Functional components

Special visceral efferent General visceral efferent General visceral afferent Special visceral afferent General somatic afferent

COURSE OF VAGUS n.

BRANCHES IN HEAD AND NECKA.In jugular foramen1.Meningeal 2.Auricular B.In neck1.Pharyngeal 2.Carotid 3.Superior laryngeal 4.Right recurrent laryngeal 5.Cardiac

APPLIED ANATOMY 1.Tested clinically- Comparing palatal arches 2.Paralysis Nasal regurgitation Nasal twang in voice Hoarseness of voice Flattened palatal arch Dysphagia 3.Irritation of auricular br.-Cough,vomitting,death 4.Stimulation of auticular br.- Increase appetite 5.Herpes zoster 6.Irritation of recurrent laryngeal nerve- Cough

Functional component

Cranial root-Special visceral efferent Spinal root- Special visceral efferent

COURSE OF ACCESSORY NERVE

COURSE IN POSTERIOR TRIANGLE

APPLIED ANATOMY
IT IS TESTED CLINICALLY1.ASKING PT. TO SHRUG HIS SHOULDERS 2.TURN FACE TO OPPOSITE SIDE WRY NECK

Functional Component

Somatic efferent

INTRACRANIAL COURSE

EXTRACRANIAL Course

Course of nerve

BRANCHES
A.Branches containing fibres of nerve proper B.Branches of nerve containing fibres of C1 1.Meningeal branch 2.Descending 3.Thyrohyoid 4.Geniohyoid

APPLIED ANATOMY
1.Tested clinically- Protrude tongue 2.Lesion of nerve- Paralysis of tongue A.Infranuclear lesions Gradual atrophy In motor neuron disease , syringobulbia B.Supranuclear lesions Paralysis without wasting Seen in pseudobulbar palsy 3. SYNDROMES (ALSO INVOLVED 9,10,11 n.) COLLET-SICARD VILLARET TAPIA MACKENZIE

MULTIPLE CRANIAL NERVE PALSIES TRAUMA LOCALIZED INFECTIONS AS HERPES ZOSTER GRANULOMATOUS DISEASES(WEGENER) BEHCETS DISEASE TUMOURS

REFERENCES

CHAURASIA- TEXTBOOK OF HUMAN ANATOMY LARSEN- TEXTBOOK OF EMBRYOLOGY GRAYS- TEXTBOOK OF ANATOMY ROBERTSONS- TEXTBOOK OF CRANIAL SURGERY HARRISONS- TEXTBOOK OF MEDICINE SCULLY AND CAWSON-MEDICAL PROBLEMS IN DENTISTRY

THANK YOU