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CRANIAL NERVES

ACHMAD AMINUDDIN

OLFATORY NERVE ( CN I )
CONCERNED

WITH THE SPECIAL SENSE OF

SMELL.
THE OLFACTORY RECEPTOR NEURON ARE
IN THE OLFACTORY EPITHELIUM IN THE
ROOF OF THE NASAL CAVITY.
THE CENTRAL PROCESSES OF THE
OLFACTORY RECEPTOR NEURONS ASCEND
THROUGH FORAMINA IN THE CRIBRIFORM
PLATE OF THE ETHMOID TO REACH THE
OLFACTORY BULB IN THE ANTERIOR
CRANIAL FOSSA

OLFACTORY NERVE ( CN I )
THESE

NERVES SYNAPSE ON NEURONS IN


THE BULBS, AND THE PROCESSES OF
THESE NEURONS FOLLOW THE OLFACTORY
TRACT TO THE PRIMARY AND ASSOCIATED
AREAS OF THE CEREBRAL CORTEX.
FRACTURE OF THE CRANIAL BASE CAN
INJURE THE OLFACTORY NERVE FIBERS,
RESULTING IN ANOSMIA, TEARING OF THE
MENINGES, AND/OR CEREBROSPINAL
FLUID RINORRHEA.

THE OLFACTORY PATHWAY


Olfactory

tract
* The lateral olfactory stria, project to the
primary olfactory area, located at the
inferior and medial surface of the
temoral lobe, is where conscious aware
ness of smell begins.
* The medial olfactory stria, project to
limbic system and hypothalamus ; these
connections account for our emotional and
memory-evoked responses to odor.

THE OLFACTORY PATHWAY


From

the primary olfactory area ,


pathway also extend to the frontal
lobe , both directly and indirectly via
the thalamus . An important region for
odor identification and discrimination is
the orbitofrontal area ( area 11 ).
People who suffer damage in this area
have difficulty identifying different odor.

OPTIC NERVE ( II )

THE OPTIC NERVES HAVE SENSORY FIBERS


CONCERNED WITH THE SPECIAL ENSE OF VISION.
THE NERVE FIBERS ARISE FROM GANGLION CELL IN
THE RETINA.
THEY EXIT THE ORBIT VIA THE OPTIC CANALS.
FIBERS FROM THE NASAL HALF OF THE RETINA
CROSS TO THE CONTRALATERAL SIDE AT THE OPTIC
CHIASM.
FIBERS THE PASS VIA THE OPTIC TRACT TO THE
GENICULATE BODIES OF THE THALAMUS, WHERE
THEY SYNAPSE ON NEURONS WHOSE PROCESSES
FROM THE OPTIC RADIATION TO PRIMARY VISUAL
CORTEX OF THE OCCIPITAL LOBE.

fig 17.15 594 tortora


a,b

fig 17.15 tortora c , d

AXON COLLATERALS
To

the midbrain, they participate in neural


circuits that govern constriction pf the
pupil in response to light and coordination
of head and eye movements.
To the suprachiasmatic nucleus of the
hypothalamus, which establishes patterns
of sleep and other activities that occur on
a circadian or daily schedule in response
to intervals of light and darkness.

VISUAL FIELD DEFECTS

BLINDNESS
Color

blindness, an inherited inability to


distinguish between cetain color, result
from the absence or deficiency of one of
the three type of conus.
The most common type is red-green color
blindness.
Night blindness or nyctalopia, result from
prolonged vitamin A deficiency and the
resulting below normal amount of
rhodopsin

OCULOMOTOR NERVE (CN III)


Function:

Somatic motor ( G.S.E. )


Visceral motor ( g.v.e parasy )
Sensory, proprioception of the
movement and position of the
body.

Nuclei:

The somatic motor nucleus in the midbrn


The visceral motor (parasympathetic)
accessory (Edinger-Westphal) nucleus

OCULOMOTOR NERVE ( III )

THE OCULOMOTOR NERVES SEND SOMATIC MOTOR


FIBERS TO ALL EXTRA OCULAR MUSCLES, EXCEP
THE SUPERIOR OBLIQUE AND LATERAL RECTUS.
THEY ALSO SEND PRESYNAPTIC PARA SYMPATHETIC
FIBERS TO THE CILIARY GANGLION FOR
INNERVATION OF THE CILIARY BODY AND
SPHINCTER PUPILLAE
THESE NERVES ORIGINATE FROM BRAIN STEM
EMERGING MEDIAL TO THE CEREBRAL PEDUNCLES,
AND RUN IN THE LAERAL WALL OF THE
CAVERNOUS SINUS.
THEY ENTER THE ORBIT THROUGH THE SUPERIOR
ORBITAL FISSURE AND DEVIDE INTO SUPERIOR
AND INFERIOR BRANCHES

fig 14.20 503 tor

INJURY TO THE CN III


Types

/ sites of lesion
Pressure from herniating uncus on nerve;
fracture involving cavernous sinus;
aneurysm.
Abnormal findings
Dilated pupil; ptosis; eye turns down and
out; pupillary reflex on the side of the
lesion will be lost.

COMPRESSION OF THE CN III


Rapidly

increasing intracranial pressure


( extradural hematom ) often compress
CN III against the crest of the petrous part
of the temporal bone.
Result
- Pupil dilates progressively on the injured
side.
- Ipsilateral slowness of the pupillary
response to light

TROCHLEAR NERVE (CN III)


Functions

Somatic motor (general somatic


efferent)
and proprioceptive to superior oblique
m.
Nucleus
The nucleus of the trochlear nerve is
located in the midbrain, immediately
caudal to the oculomotor nucleus.

TROCHLEAR NERVE ( IV )

THE TROCHLEAR NERVE SUPPLY SOMATIC MOTOR FIBERS TO


THE SUPERIOR OBLIQUE MUSCLES AND SENDS
PROPRIOCEPTIVR FIBERS TO THIS MUSCLE, WHICH
ABDUCTS, DEPRESSES AND MEDIALLY ROTATES THE
EYEBALL.
THE NERVES EMERGE FROM THE POSTERIOR ASPECT OF
THE BRAIN STEM.
THEY RUN ALONG INTRA CRANIAL COURSE , PASSING
AROUND THE BRAIN STEM TO ENTER THE DURAMATER IN
THE FREE EDGE OF THE CEREBELLAR TENTORIUM CLOSE TO
THE POSTERIOR CLINOID PROCESS.
THE RUN IN THE LATERAL WALL OF THE CAVERNOUS SINUS,
ENTERING THE ORBIT VIA THE SUPERIOR ORBIT FISSURES.
STRETCHING DURING ITS COURSE AROUND THE BRAIN
STEM, OR FRACTURE OF THE ORBIT CAN RESULT IN AN
INABILITY TO LOOK DOWN WHEN THE EYE BALL IS
ADDUCTED.

THE CN IV IS UNIQUE
It

is the smallest.
It is the only nerve to exit from the
dorsal aspect of the brain stem.
It is the only nerve in which all of the
lower motor neuron axons decussate.
It has the longest intracranial course

CLINICAL CORRELATES
Lesions

of this nerve or its nucleus cause


paralysis of the superior oblique and
impair the ability to turn the affected
eyeball inferomedially.
The characteristic sign of trochlear nerve
injury is diplopia when looking down.
The person can compensate for the
diplopia by inclining the head anteriorly
and laterally toward the side of the normal
eye.

TRIGEMINAL NERVE (CN V)


Funcions

: General somatic afferent


Nuclei: there are 4 trigeminal nuclei, one
motor and three sensory.
Trigeminal ganglion
- Ophthalmic nerve ( CN V 1 )
- Maxillary nerve ( CN V 2 )
- Mandibular nerve ( CN V 3 )
The motor root of CN V
Four parasympatheic ganglia are
associated with the divisions of CN V ,
sensory and motor

TRIGEMINAL NERVE (CN V)


CN

V is the principal general sensory


nerve for the head ( face, teeth,
mouth, nasal cavity and dura of the
cranial cavity.
Branchial motor to the muscles of
mastication. Mylohyoid, anterior belly
of the digastric, tensor velipalatini
and tensor tympani ( 1st branchial
arch )

OPHTHALMIC NERVEW (CN


V1)
The

sensoy fibers are distributed to


skin and mucous membrane and
conjunctiva of the front of the head
and nose.
Testing CN V1 : checking the corneal
reflex , with a wisp of cotton to the
cornea will evoke a reflexive blink if
the nerve is functional.

MAXILLARY NERVE (CN V2)


CN

V2 innrvates derivates of the maxillary


prominence of the first pharyngeal arch.
Exiting the cranial cavity via the foramen
rotundum.
Distributed to skin and mucous membtane
associated with the upper jaw.
The pterygopalatine ganglion is
associated with CN V2, involved in
innervating the lacrimal and mucus
glands.

MANDIBUALR NERVE (CN V3)


CN

V3 innervates derivates of the


mandibular prominence of the 1st
pharyngeal arch.
CN V3 is the only division of the CN V to
convey motor to the striated muscle derived
from mandibular prominence mesoderm,
primarily the muscle of mastication.
The otic and submandibular ganglia are
associated with CN V3, both are concerned
with the innervation of salivary glands

INJURY TO THE ENTIRE


TRIGEMINAL NERVE
Paralysis

of the muscle of mastication


with deviation of the mandible toward
the side of the lesion.
Los of the ability to appreciate soft
tactile , thermal or painful sensations
in the face .
Los of corneal reflex and the sneezing
reflex

TRIGEMINAL NEURALGIA
TN

is a sensory disorder of the sensory


root of CN V that occur most often in
middle-aged and elderly person.
Characterized by sudden attacks of
exruciating, lightening-like jabs of facial
pain.
CN V2 is most frequently involved, then
CN V3, and least frequiently CN V1

THE CAUSE OF THE T.N. Is


unknown
Anomalous

blood vessel that


compresses the nerve.
Pathological process in the trigeminal
ganglion and in the nucleus of the
spinal tract

ABDUCENT NERVE ( CN VI )

THE ABDUCENT NERVES SUPPLY SOMATIC MOTOR


FIBERS TO THE LATERAL RECTUS MUSCLES OF
THE EYE BALL AND PROPRIOCEPTIVE FIBERS TO
THESE MUSCLES.
THE NERVES ORIGINATE FROM THE PONS, PIERCE
THE DURA ON THE CLIVIS TRAVERSE THE
CAVERNOUS SINUS AND SUPERIOR ORBITAL
FISSURES, AND ENTER THE ORBIT.
INJURY TO THE BASE OF THE BRAIN OR A
FRACTURE OF THE CRANIAL BASE INVOLVING THE
CAVERNOUS SINUS OR ORBIT CAN RESULT IN
INABILITY TO MOVE THE EYE LATERALLY, AND
DIPLOPIA OCCURS ON LATERAL GAZE
(1,2)

COORDINATION of the lateral


and medial rectus muscles
When

the eyes move to the right and to


the left, the lateral rectus muscle of one
eye and the medial rectus muscle of other
work together.
The action of these muscles is
coordinated by the center for lateral gaze
in the pons.
Higher center signal the center for lateral
gaze, which then sends simultaneous dual
signals to ( a ) and ( b ) :

DUAL SIGNAL TO
A.

Neuron in the ipsilateral abducens


which elicits contraction of the ipsilatera
rectus muscle
B. To neuron in the contralateral oculomomotor nucleus via the ascending medial
longitudinal fasciculus to elicits contrac tion of the contralateral medial rectus m

FACIAL NERVE ( CN VII)

FUNCTION
1. Sensory
- special visceral afferent ; special sensory
- general somatic afferent ; general sensory
2. Motor
- special visceral efferent or branchial
motor.
3. Parasympathetic
- general visceral eferent.
4. Proprioceptive
(1)

NUCLEI

Branchial motor nucleus


- in the pontine tegmentum
- movement of the facial muscles
- forehead bilaterally, and remaining only contralat
Superior salivatory nucleus
- inthe pontine tegmentum
- parasympathetic
- all the major glands , except integumentary and parotid
The nuclei of the solitary tract
- concerned with taste buds lingual n chorda tympani
facial n. geniculate ganglion tractus solitarius nucleus
solitarius in the brain stem
Spinal nucleus of the trigeminal nerve
- in the upper medulla
- concerned with general sensation from
arround the external ear
- the cell bodies of the sensory fibers in the geniculate ganglio
(1,2)

FACIAL NERVE (CN VII)


CN

VII emerge from the junctionof the


pons and medulla as
* The motor root ( facial nerve ) innerva
tes the muscles of facial expression.
* The intermediate nerve (n.intermedius )
carries taste.
-- parasympathetic
-- somatic sensory
(1)

FACIAL NERVE (CN VII)


CN

VII traverses the posterior cranial


fossa, internal acoustic meatus,
facial canal, stylomastoid foramen
and parotid gland.
Within the facial canal, CN VII give to
the : Greater petrosal nerve.
Nerve to the stapedius.
Chorda tympani nerve.
(1)

fig 9.7 A

FACIAL NERVE (CN VII)


CN

VII emerges from the cranium via the


stylomastoid foramen gives off
- the postrior auricular branch,
- the parotid plexus, which gives rise
five terminal motor branches :
- temporal
- zygomatic
- buccal
- marginal mandibular
- cervical
(1)

fig 9.7 B

FACIAL NERVE (CN VII)


The

temporal branch
- the superior part of the orbicularis oculi
- the frontal belly of the occipitofrontalis
- auricularis superior and anterior
The zygomatic branch
- inferior part of the orbicularis oculi
- facial muscles inferior to the orbit
The bucal branch
(1)

FACIAL NERVE (CN VII)


The

buccal branch
- buccinator and muscles of the upper lip
The marginal mandibular branch
- risorius and muscles of the lower lip
and
chin
The cervical branch
- platysma
(1)

fig 7.27 A

FIG 7.27 B

fig 7.27 C

NUCLEI
BRANCHIAL MOTOR ; in the ventrolataral part of the
pons (branchiomotor)
VISCERAL MOTOR is parasympathetic, control of
the major glands except the integumentary and
parotid gland. The cell bodies ar inthe pontine
tegmentum are called the superior salivatory nucleus
SENSORY ;
- taste ; in the nuclei of the solitary trac
in the medulla.
- general sensation ;
in the spinal nucleus of the
trigeminal nerve.

FACIAL NERVE
BRANCHIAL

MOTOR, SUPPLIES :
- STRIATED MUSCLES OF FACIAL
EXPRESSION AND AURICULAR
MUSCLE.
- THE POSTERIOR BELLIES OF THE DIGASTRIC MUSCLE.
- STYLOID M.
- STAPEDIUS M.

THE FACIAL NERVE

PRESYNAPTIC PARASYMPATHETIC ( GVE )


- pterygopalatine ganglion.
- the lacrimal mucous glands.
- submandibular ganglion,
- sublingual glands.
- submandibular glands.
GENERAL SOMATIC
- small area of the skin of aurical concha
TASTE ( SPECIAL SENSORY )
- chordatympani joint the lingual n to convey
taste sensation from the anterior twothird of
the tongue and soft palate.

VESTIBULOCOCHLEAR NERVE
FUNCTIONS

special sensory ( special somatic


afferent ) of hearing and equilibrium.
NUCLEI
- vestibular nuclei are located at the
junction of the pons and medulla in
the lateral part of the floor of 4th
ventricle.
- cochlear nuclei are in the medulla.

THE VESTIBULOCOCHLEAR
NERVE
ENTER

THE INTERNAL ACOUSTIC


MEATUS, SEPARATES INTO ;
- THE VESTIBULAR NERVE
- vestibular ganglion
- macula of the uticle and sacule
- ampula of the semicircular duc
- THE COCHLEAR NERVE
- spiral ganglion

COCHLEAR COMPONENT

Sensory receptor, the hair cells in the cochlear duct.


Primary sensory neuron, the (spiral) organ of corti,
are located around the modiolus (center) of the
cochlea, collectively consti- tute the cochlear
(spiral) ganglion. The central processes of these
neuron form
The auditory component of the vestibulo- cochlear
nerve. These axon leave the base of the cochlea,
joint with the vestibular fibers, enter the posterior
cranial fossa via the internal acustic meatus.The
primary sensory neurons terminate in the dorsal
(high frequencies) and ventral (low frequencies)
cochlear nuclei at the junction of the pons and
medulla

COCHLEAR COMPONENT
From the cochlear nuclei axon carrying audotory
signals project to the superior olivary nuclei in the pons
on both side.
Slight differences in the timing of impulses arriving
from the two ears at the olivary nuclei allow us to
locate the source of a sound.
From both the cochlear nuclei and and the olivary
nuclei, axons ascend to the inferior colliculus, and then
to the medial geniculate nucleus of the thalamus.
From the thalamus, auditory signals project to the
primary auditory area in the superior temporal gyrus ,
( Brodmann`s areas 41 and 42 )
(1,2,3)

SPIRAL ORGAN ( ORGAN OF


CORTI)
fig 17.19 c,d 600

fig 20.3 clin n 231

VESTIBULAR COMPONENT
The

vestibular apparatus consist of the


saccule and utricle, and three
semicircular canal.
The main function of the saccule and
utricle is to detect the position of the
head relative to gravity ( static
labyrinth ).
Both saccule and utricle have a
sensory receptors called the macula

VESTIBULAR COMPONENT
The

three semicircular canal sit at the


right angles to each other in the three
planes of the body.
The canal perceive angular movement
of the head in space ( kinetic
labyrinth ).
The canals are filled with endolymph.
Each canal has an ampula that contains
a patch of hair cells

VESTIBULAR COMPONENT
The

hair cells synapse withperipheral


processes of the primary sensory neuron ,
whose cell bodies form the vestibular ganglion.
Central processes of the ganglion cells form
form the vestibular division of the CN VIII.
These axons run with the cochlear division and
with CN VII through internal auditory meatus
toterminate in the vestibular nuclear complex
in the floor of the 4th venticle. ( 2 , 1 )

VESTIBULAR COMPONENT

A small number of these axons terminate in the


flocculonodular lobe of the cerebell
From the vestibular nuclei send their axons mainly
to the cerebellum and to lower motor neuron in
the brain stem and spinal cord to help direct
activity of the muscles that maintain balance.
The lateral vestibular nucleus sends a large group
of axons ipsilaterally down the spinal cord to forn
the lateral vestibulospinal tract. These axons
facilitate the action of the L.M.N. That innervate
the antigravity ( extensor ) muscles.
(2,1)

VESTIBULAR COMPONENT
The

medial and inferior vestibular nuclei


have reciprocal connection with the
cerebellum ( vestibulocerebelar tract ) that
allow the cerbellum to coordinate balance
during movement.
All nuclei in the vestibular complex
contribute fibers to the medial longitudinal
fasciculus. These pathway is primarily
cocerned with maintaining orientation in
space
(2,1)

VESTIBULAR COMPONENT
The

ascending MLF terminate bilaterally


mainly within the nuclei of CN III , IV and VI
and by coordinating the stimulation of extra
ocular muscles alow the eyes tomaintain
fixation 0n an object while the head is
moving.
Vestibular axon in the descending part of the
MLF referred to as the medial vestibulospinal
tract, influence lmn in the cervical pinal cord
bilaterally.
(2)

fig 17.21 tor 604

fig 17.22 tor

EQUILIBRIUM PATHWAYS
Most

of the vestibular branch axon enter


the medulla and pons and terminate in
several vesibular nuclei.
The remaining axons enter the cerebellum
through the inferior cerebellar peduncle.
Bidiretional pathways connect the
vestibular nuclei and cerebellum.
Axon from allthe vestibuar nuclei extend to
the nuclei of cranial nerves that control
eye movements, CN III, CN IV nd CN VI. the
axon extend to CN XI, which help control
head and neck movements

EQUILIBRIUM PATHWAYS

Axon from the lateral vestibular nucleus form the


vestibulospinal tract.
Various pathways between the vestibular nuclei,
cerebellum and cerebrum, enable the cerebellum to
play a role in maintaining equilibrium.
The cerebellum continuously receives updated
sensory information from the utricle and saccule,
and makes corrective adjustments.
In response to input from the utricle, saccule and
semicircular ducts, the cerebellum continuously
sends nerve impulses to the motor area of the
cerebrum.
Correction of signals from the motor cortex to
specific skeletal muscles to maintain equilibrium.

GLOSSOPHARYNGEAL NERVE
FUNCTION

SENSORY general somatic afferent.


-- special visceral afferent.
-- general visceral afferent.
MOTOR - special visceral efferent.
- general visceral efferent
( parasympathetic ) to deriv
of the 3rd pharyngeal arch.
NUCLEI
4 nuclei in the medulla, two motor and two
sensory

NULCEI OF THE CN IX
INFERIOR

SOLITARY NUCLEUS
ROSTRAL PART OF THE NUCLEUS
AMBIGUUS.
NUCLEUS OF THE SOLITARY TRACT
NUCLEUS OF THE SPINAL
TRIGEMINAL TRACT
(2,1)

COMPONENTS OF CN IX
Branchial

motor (SVE)
To the striated muscel, the stylopharyngs
Visceral motor (GVE)
To the otic ganglion, which sends fibers to
stimulate the parotid gland.
Visceral sensory (GVA)
Carries sensation (subconscious) from the
carotid body and from the carotid sinus
(2)

COMPONENTS OF CN IX
General

sensory (GSA)
Provides general sensation from the
posterior one-third of the tongue, the skin
of the external ear, and the internal
surface of the tympanic membane
Special sensory (SA)
For taste from the posterior one-third of
the tongue.
(2)

GLOSSOPHARYNGEAL NERVE
FROM

THE LATERAL ASPECT OF THE MEDULLA


THEN ENTER THE JUGULAR FORAMEN ARE
- SUPERIOR GANGLION.
- INFERIOR GANGLION ( SENSORY )
WHICH CONTAIN THE NERVE CELL BODIES
THAT MEDIATE GENERAL, VISCERAL, AND
SPECIAL SENSATION
The tympanic nerve is given off before the
main trunk exits the skull through the jugular
foramen
(2)

fig 9.11

1149

GLOSSOPHARYNGEAL NERVE
Carotid

nerves from the carotid body and


the sinus join the inferior ganglion, as do
the lingual and pharyngeal branches,
which bring sensation (general and
special) from the tongue and pharynx.
The branchial motor fibers supply one
muscel, the styliopharyngeus
(2,1)

BRANCHIAL MOTOR
Impulse

from cortex cerebri descend along


the corticobulbar fibers through the internal
capsule and through the basis pedunculi to
synapse bilaterally on the lower motor
neurons in the rostral part of the nucleus
ambiguus.
The lower motor neuron axons join the
other modalities of CN IX.
The CN IX emerge in the groove between
olive and the inferior cerebellar peduncle.
(2,1)

BRANCHIAL MOTOR
The

nerve passes laterally in the posterior


cranial fossa to exit through the jugular
foramen anterior to the vagus and the
accessory nerves.
From the jugular foramen branchial motor of
the CN IX descend in the neck deep to the
sttyloid process and then curve forward
around the posterior border of
stylopharyngeus muscle where the nerve
supplies the muscle.
The mucle elevates the pharynx during
swallowing speech.
(2,1)

VISCERAL MOTOR
Preganglionic

fibers of the parasympathetic


motor are located in the INFERIOR
SALIVATORY NUCLEUS in the medulla. Axon
from these nucleus join the other components
of of cranial nerve IX in the medulla and exit
with them through the jugular foramen.
The tympanic nerve leaves the inferior
ganglion to ascend through inferior tympanic
canaliulus. It reaches the tympanic cavity
where it forms a plexus on the surface of the
promontory of the middle ear cavity
( tympanic plexus )
(2,1)

VISCERAL MOTOR
From

this plexus branches supply sensation to


the mucous membrane of the cavity, auditory
tube and mastoid air cells and the visceral
motor fibers form the LESSER PETROSAL
NERVE.
This nerve travel back into the middle cranial
fossa, passes forward to descend through the
oval foramen to synape in the OTIC ganglion.
From this ganglion post ganglionic fibers join
the AURICULOTEMPORAL nerve (branch of V3)
to supply secretomotor fibers to the parotid
gland
(2,1)

fig 9.10 A 1148

VISCERAL SENSORY

Chemoreceptor from the carotid body monitor


oxygen tension in circulating blood and
baroreceptor (strech receptor) in the carotid sinus
monitor arterial blood pressure.
These sensation are relayed in the carotid nerve
toward the inferior ganglion.Central processes of
these neurons pass to the tractus solitarius to
descend to the more caudal part of the nucleus
solitarius.
From this nucleus connections are made with the
reticular formation and the hypothalamus for the
appropriate reflex responses for the control of
respiration, blood pressure and cardiac out put.
(2,1)

fig 9.10 B

GENERAL SENSORY

Axon for pain and temperature from the skin of


part of the external ear, the inner surface of the
tympanic membrane, the posterior third of the
tongue and the upper pharynx have their nerve
cell bodies in either the SUPERIOR or INFERIOR
GLOSSOPHARYNGEAL GANGLIA.
The central processes for pain enter the spinal
nucleus of trigeminal nerve.
From this nucleus, its axon cross the midline in
the medulla and ascend to the contralateral
ventral posterior nucleus of the thalmus
Axon of tertiary neuron project to the postcentral
sensory gyrus.
(2,1)

SPECIAL SENSORY
Taste

sensation from the posterior one-third


of the tongue including the vallate papillae, is
carried by special sensory processes towards
neurons in the inferior glossopharyngeal
ganglion.
Central processes from these neurons pass
through the jugular foramen, enter the
medulla and ascend in the central tegmental
tract of the brain stem to reach the ipsilateral
and contralateral ventral posterior nuclei of
thethalami.
Tertiary neuron project to reach the primary
sensory cortex in the inferior third of the
postcentral gyrus where the taste is
perceived.
(2,1)

VAGUS NERVE ( CN X )
FUNCTIONS

Sensory ( general somatic aferent, special


visceral afferent, general visceral
afferent ).
Motor ; special visceral efferent.
Parasympathethic ; geeral visceral efferen
NUCLEI
Four nuclei of CN X in the medulla, send or
receive fibers via CN IX two motor and two
sensory.
Three of these nuclei are shared with CN IX.

THE COURSE OF THE CN X


From

the medula, exit the skull through


the jugular foramen.
In the jugular fossa , two sensory ganglia
- the superior (jugular) ganglion
- the inferior (nodusum) ganglion
In the neck the vagus lies between the
internal jugular vein and the internal
carotid artery and descends within the
carotid sheath

THE COURSE OF CN X
From

the root of the neck down ward


to reach cardiac, pulmonary and
esophageal plexus.
From the esophageal plexus, righ and
left gastric nerves to supply the
abdominal viscera as far as the
splenic flexure.

COMPONENTS OF THE CN X
BRANCHIAL

MOTOR ( S. V . E )
To striated muscles of the pharynx, tongue (
palatoglossus ), and larynx
except stylpharyngeus ( IX ) and tensor veli
palatini ( V3 )
VISCERAL MOTOR ( G.V. E. )
To smooth muscle and glands of the
pharynx , larynx , and thoracic and
abdominal viscera
( 2, 1 )

COMPONENTS OF THE CN X
VISCERAL

SENSORY ( V . A )
From the larynx, trachea , esophagus, and
thoracic and abdominal viscera, stretch
receptors in the in the wall of the aortic
arch, chemoreceptor in the aortic bodies
adjacent to the arch
GENERAL SENSORY ( G . S. A.)
From the skin at the back of the ear and in
the external acoustic meatus, part of the
external surface of the tympanic
membrane, and the pharynx
(2,1)

BRANCHIAL MOTOR
The

nucleus ambiguus in the medula,


also receives sensory signals initiating
reflex eg coughing and vomiting
L M N axon leave the nucleus
ambiguus, exit the medulla and then
exit the skull through the jugular
foramen to reach the constrictor
muscles of the pharynxand and the
intrinsic muscles of the larynx
(2,1)

BRANCHIAL MOTOR
The branchial motor leaves the vagus as :
1. The pharyngeal branch
- The principle motor nerve
- Traverses the inferior ganglion
- Between the internal and external
carotid arteries
- Break up into the pharyngeal plexus
tosupply the superior, middle and inferior
constrictor, levator palati, salpingopharyngeu
,palatopharyngeus and palatoglossus
2. The superior laryngeal nerve
(2,1)

BRANCHIAL MOTOR
2. The superior laryngeal nerve
- From the inferior vagal ganglion
- Descends and dividing into :
* Internal laryngeal nerve
* External laryngeal nerve
- inferior constrictor muscle
- cricothyroid
- pharyngeal plexus
- superior cardiac nerve
3. The recurrent laryngeal nerve
(2,1)

BRANCHIAL MOTOR
3. The recurrent laryngeal nerve
The right recurrent laryngeal nerve
From the vagus nerve, anterior to subclavian artery, hook back, ascends
posterior to it then in the groove be
tween the trachea and esophagus
The left recurrent laryngeal nerve
From the left vagus, hook back posteri
orly under the arch and ascends through
the superior mediastinum to reach the
groove between the trachea and
esophagus
The recurrent nerve supply the intrinsic
muscles
of the larynx , except the cricothyroid
(2,1)

VISCERAL MOTOR

The dorsal motor nucleus of the vagus


- Parasympathetic nerve cell bodies
- Influenced by hypothalamus, olfactory
system, reticular formation and nucleus
of the tractus solitarius
- Secretomotor center of the vagus
- To the glands of the pharynx and
laryngeal mucosa.
- Within the thorax break up into many
braches that join with :
- Plexus around
(2,1)

VISCERAL MOTOR
- Plexus around the major blood
vessel to the lung and heart
Heart ; slow down the cardiac
cycle.
Lung ; bronchoconstriction
Esophagus ; speed up peristalt.
Right and left gastric nerves
(2,1)

VISCERAL MOTOR
Right and left gastric nerves
- from esophageal plexus.
- stimulate secretion of the gastric gl
- motor to stomach
Intestinal branches
- motor to smooth muscle of the
small intestine, cecum, appendix,
ascending colon and most of the
transverse colon
- in the gut, the synapses in ganglia of
- myenteric plexus ( plexus of Auerbach )
- submucosal plexuses ( plexus of Meissner )

VISCERALSENSORY

The inferior vagal ganglion


* Internal laryngeal nerve
Mucous membrane of the epiglottis,
Base of the tongue, aryepiglottic folds
and the majority of the larynx.
* Recurrent laryngeal nerve , senasatin
from below the vocal folds
* Sensory fibers from baroreceptor in the aortic
arch and chemoreceptor in the aortic body
* Plexus around the esophagus
- Olexus around the heart and lung
- Right and left gastric nerve, receives sensory
from plexus around the abdominal viscera
( 2, 1 )

GENERAL SENSORY
The

general sensory of CN X, carries


sensa tion from the larynx, pharynx,
the skin of the external ear and
external auditory canal, the external
surface of the tympanic membrane
and the meninges of the posterior
cranial fossa.
The recurrent laryngeal nerve, carries
sensation from the vocal fold and the
larynx below

GENERAL SENSATION
The

internal laryngeal nerve, carries


sensation from the larynx above the
vocal fold.
The auricular branch, carries
sensation from the skin of the
external ear
( 2, 1 )

CLINICAL CORRELATES

LMN Lesion
* A unilateral lesion of the vagus
- hoarseness
- difficulty in swallowing allowing
food to pass up into the nose.
- the arch of the soft palate drops on
the affected side.
- uvula deviates to the unaffected side
* A unilateral lesion of the recurrent
laryngeal nerve
- result in ipsilateral weakness or paralysis
of the focal fold thereby causing hoarsenes.

SPINAL ACCESSORY NERVE ( CN


XI )
Funtions

; motor to sternocleidomastoideu
and trapezius muscles.
Nuclei ; nucleus of the accessory nerve.
is located in the lateral part of the anterio
gray column of the upper 5 or 6 segment
CN XI, arise from the side of the spinal cord in
the superior five or six cervical segmen.
They ascend in the cranial cavity via the
foramen magnum and exit through the jugular
foramina, crossing the lateral cervical region

HYPOGLOSSAL NERVE (CN


XII)
Functions

: Motor ( general somatic


efferent ) to the intrinsic and extrinsic
muscles of the tongue styloglossus,
hyoglossus, and genioglossus.
The hypoglossal nucleus is located in
the tegmentum of the medulla
(1,2)

HYPOGLOSSAL NERVE
Arses

as a purely motor nerve from the


medulla and leaves the cranium through the
hypoglossal canal.
After exiting the cranial cavity, CN XII is
joined by branches of the cervical plexus
conveying general somatic motor fibers from
C1 and C2 spinal nerves and general somatic
sensory fibers from the spinal ganglion of
C2.
CN XII passes inferiorly close to the posterior
of the inferior ganglion of CN X to lie
between the internal carotid a and the
internal jugular v. Crossing lateral to the
bifurcatio of the common carotid a.
(1,2)

HYPOGLOSSAL NERVE
A meningeal branch, returns to the cranium through the
hypoglossal canal and innervates the duramater on the
floor and posterior wall of the posterior cranial fossa.
From the sensory spinal ganglion of spinal nerve C2.
The superior root of the ansa cervicalis, suply the
infrahyoid muscles (sternohyoid,sternothyroid, and
omohyoid)
From the cervical plexus ( the loop between the anterior
rami of C1 and C2 )
Lingual branches, supply the styloglossus, hyoglossus,
genioglossus and intrinsic muscles of the tongue.
(1,2)