REPORTERS :

MARAWH, QASEM
BIN JAHLAN, SALEM
SAMANTHA BALLESTEROS
 The 12 pairs of cranial nerves arise from the
brain inside the cranial cavity and pass through
various foramina in the bones of the cranium.•
Divides into 3 functions: Sensory nerves, Motor
nerves and Mixed nerves.

Introduction

They are designated by Roman numerals, and all paired. There are 12
pairs of cranial nerve
Cranial Nerve I
 Component:
Sensory

 Function: Smell
 Origin: Olfactory receptor nerve
cells

 Opening to the Skull:

Openings in cribriform plate of
ethmoid
Cranial Nerve II
 Component:
Sensory

 Function: Vision

 Origin: Back of the

eyeball
 Opening to the Skull: Optic Canal
Cranial Nerve III
 Component: Motor

 Function:
 Raises upper eyelid
 Turns eyeball upward, downward and
medially
 Constricts pupil
 Accommodates the eye

 Origin: Anterior surface of the midbrain

 Opening to the Skull: Superior orbital

fissure
Cranial Nerve IV
 Component: Motor

 Function: Assisting in turning eyeball

downward and laterally

 Origin: Posterior surface of the midbrain

 Opening to the Skull: Superior orbital

fissure
TRIGEMINAL NERVE
The trigeminal nerve is one of the cranial nerves that has both
sensory and motor function. Cranial nerves are also classified
using Roman numerals based on their location. The trigeminal
nerve is also called cranial nerve V.

The trigeminal nerve is the largest of the 12 cranial nerves. Its

main function is transmitting sensory information to the skin,
sinuses, and mucous membranes in the face. It also stimulates
movement in the jaw muscles.
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 >
Cranial nerves can transmit two types of information:

Sensory information includes details about smells, sights, tastes, touch, and sounds to
the brain.

Motor information refers to signals that affect the movement or activity of muscles and
glands.
 The trigeminal nerve has three different
divisions:
Ophthalmic division
Origin Trigeminal ganglion
Type Sensory
Trigeminal ganglion -> cavernous sinus ->
Course superior orbital fissure -> lacrimal, frontal,
nasociliary nerves (terminal branches) ->
respective anatomical structures
Recurrent tentorial, lacrimal (communicating
branch with zygomatic nerve), frontal
(supraorbital and supratrochlear nerves),
Branches nasociliary nerves (communicating branch with
the ciliary ganglion, ciliary nerves, posterior
ethmoid nerves)

Eyes, conjunctiva, lacrimal gland, nasal cavity,

frontal sinus, ethmoidal cells, falx cerebri, dura
Innervation mater of anterior cranial fossa, superior parts of
tentorium cerebelli, upper eyelid, dorsum of
nose, anterior part of the scalp
>
Origin Trigeminal ganglion
Type Sensory

Trigeminal ganglion -> cavernous sinus ->

foramen rotundum -> pterygopalatine fossa
Course -> infratemporal fossa -> inferior orbital
fissure -> infraorbital nerve (terminal
branch) -> respective anatomical structures

Maxillary division
Meningeal, zygomatic, zygomaticofacial,
zygomaticotemporal, infraorbital, anterior,
middle, and posterior superior alveolar
Branches nerves, nasopalatine, greater palatine,
lesser palatine nerves ('My Zippy Zebra Zoe
Is A Majestic Princess, Naturally Gorgeous
Lady')

Dura mater of the middle cranial fossa;

mucosa of the nasopharynx, palate, nasal
Innervation cavity, and nasopharynx; teeth and upper
jaw; skin over the side of the nose, lower
eyelid, cheek, and upper lip 
>
 Mandibular division
The third division of the trigeminal nerve is the mandibular nerve. This division carries
sensory information from the lower third of the face which includes the lower lip, the
jaw, the preauricular area, the temporal area and the meninges of the anterior and
middle cranial fossa. Also, it is responsible for the motor innervation of the
muscles of mastication, the mylohyoid, tensor tympani, tensor veli palatini muscles and
the anterior belly of the digastric muscle.
 Deep temporal nerve
Nerve to the medial pterygoid muscle
Branches Nerve to the lateral pterygoid muscle
Masseteric nerve
Nerve to the tensor veli palatini muscle

>
Buccal skin, anterior two-thirds of the
tongue, temporal region; mastication
Supply
muscles, mylohyoid muscle and anterior
belly of the digastric muscle
>
 The Abducens Nerve (CN VI)
The abducens nerve is the sixth paired cranial nerve. It has a purely somatic motor
function – providing innervation to the lateral rectus muscle.
Origin
•Abducens nucleus originates from the tegmenum pontis at the level of facial colliculus.
•The nucleus is located;
1.anterior to the 4th ventricle,
2.posterior to the medial leminiscus,
3.Lateral to the medial longitudinal fasciculus,
4.Medial to facial nerve & trigeminal spinal nucleus.

•The facial colliculus is a focal bulge in the floor of the fourth ventricle formed by
looping fibers of the facial nerve around the abducens nucleus.
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>
Motor Function
The abducens nerve provides innervation to the lateral rectus muscle – one of the
extraocular muscles.
The lateral rectus originates from the lateral part of the common tendinous ring, and
attaches to the anterolateral aspect of the sclera. It acts to abduct the eyeball ( to
rotate the gaze away from the midline).
>
Facial nerve
the seventh pair of cranial nerves, supplying the facial muscles
and the tongue. The nerve arises in the facial canal, and travels
across the bones of the middle ear, exiting via the
petrotympanic fissure, and entering the infratemporal fossa.
 Mixed nerve (motor, sensory, autonomic
Type
fibers)
Origin Pons of the brainstem

Greater petrosal nerve, communicating

Intracranial branches branch with otic ganglion, nerve to
stapedius, chorda tympani
Posterior auricular nerve, branch to
posterior digastric belly, branch to
stylohyoid muscle, temporal branch,
Extracranial branches
zygomatic branch, buccal branch,
marginal mandibular branch, cervical
branch
 Motor: facial expression muscles,
posterior belly of digastric muscle,
stylohyoid muscle, stapedius muscle

>
Field of innervation Special sensory: taste from anterior
two-thirds of the tongue
Parasympathetic: submandibular gland,
sublingual gland, lacrimal glands

Clinical relations Palsy, inferior medial pontine syndome

>
Vestibulocochlear Nerve
The vestibulocochlear nerve (auditory vestibular nerve), known
as the eighth cranial nerve, transmits sound and equilibrium
(balance) information from the inner ear to the brain.

The vestibular nerve is primarily responsible for maintaining

body balance and eye movements, while the cochlear nerve is
responsible for hearing.
>
Type Special somatic afferent (SSA)

Origin Rhomboid fossa of the brainstem

>
Components
Vestibular component
Cochlear component

Vestibular for balance

Function
Cochlear for hearing
Glossophary
ngeal nerve
The glossopharyngeal nerve (cranial
nerve IX) serves many distinct functions,
including providing sensory innervation
to various head and neck structures.
Key Points
 The glossopharyngeal nerve (cranial nerve IX) is responsible for swallowing and the gag
reflex, along with other functions.
 The glossopharyngeal nerve receives input from the general and special sensory fibers in
the back of the throat.
 The glossopharyngeal nerve has five components: branchial
motor, visceral
motor, visceral sensory, general sensory, and special sensory
components.
Key Terms
 otic ganglion: A small parasympathetic ganglion located immediately below the foramen
ovale in the infratemporal fossa that is associated with the glossopharyngeal nerve.
 medulla: The lower half of the brainstem that contains the cardiac, respiratory, vomiting,
and vasomotor centers and is associated with autonomic, involuntary functions such as
breathing, heart rate, and blood pressure.
 stylopharyngeus muscle: A muscle in the head that stretches between the temporal styloid
process and the pharynx.
Structure
The glossopharyngeal nerve originates in the medulla oblongata of the brain. It
emerges from the anterior aspect of the medulla, moving laterally in the posterior
cranial fossa.  The nerve leaves the cranium via the jugular foramen. At this point,
the tympanic nerve arises. It has a mixed sensory and parasympathetic composition.
The motor division of the glossopharyngeal nerve is derived from the basal plate of the
embryonic medulla oblongata, while the sensory division originates from the cranial neural
crest.

Function
There are a number of functions of the glossopharyngeal nerve. It controls muscles in the oral
cavity and upper throat, as well as part of the sense of taste and the production of saliva.
Along with taste, the glossopharyngeal nerve relays general sensations from the pharyngeal
walls. The various functions of the glossopharyngeal nerve are that:
 It receives general sensory fibers (ventral trigeminothalamic tract) from the tonsils, the
pharynx, the middle ear, and the posterior 1/3 of the tongue.
 It receives special sensory fibers (taste) from the posterior 1/3 of the tongue.
 It receives visceral sensory fibers from the carotid bodies, carotid sinus.
 It supplies parasympathetic fibers to the parotid gland via the otic ganglion.
 It supplies motor fibers to the stylopharyngeus muscle.
 It contributes to the pharyngeal plexus.
Five Functional Components
The glossopharyngeal nerve consists of five components with distinct functions:
1. Branchial motor (special visceral efferent): Supplies the stylopharyngeus muscle.
2. Visceral motor (general visceral efferent): Provides parasympathetic innervation of the
parotid gland.
3. Visceral sensory (general visceral afferent): Carries visceral sensory information from the
carotid sinus and body.
4. General sensory (general somatic afferent): Provides general sensory information from the
skin of the external ear, internal surface of the tympanic membrane, upper pharynx, and
the posterior 1/3 of the tongue.
Special sensory (special afferent): Provides taste sensation from the posterior 1/3 of the
tongue.
Vagus nerve
The vagus nerve (cranial nerve X) is
responsible for parasympathetic output
to the heart and visceral organs.

The vagus nerve is a mixed nerve,

as it contains both afferent (sensory)
and efferent (motor) fibers.

Its name is derived from the

Latin 'vagary' – meaning
wandering. It is sometimes
referred to as the
wandering nerve
Key Points
 The vagus nerve (cranial nerve X) sends information about the body’s organs to the brain and carries
some motor information back to the organs.
 The vagus nerve originates from the medulla of the brainstem. It exits the cranium via the jugular
foramen, with the glossopharyngeal and accessory nerves (CN IX and XI respectively)
 The vagus nerve is responsible for heart rate, gastrointestinal peristalsis, and sweating, to name a few.
Key Terms
 nucleus ambiguus: A region of histologically disparate cells located just dorsal (posterior) to the
inferior olivary nucleus in the lateral portion of the upper (rostral) medulla. It receives upper motor
neuron innervation directly via the corticobulbar tract.
 Valsalva maneuver: Performed by making a moderately forceful attempt to exhale against a closed
airway; this is usually done by closing one’s mouth and pinching one’s nose shut while pressing out as
if blowing up a balloon.
 solitary nucleus: Structures in the brainstem that carry and receive visceral sensation and taste from
the facial (VII), glossopharyngeal (IX), and vagus (X) cranial nerves.
 dorsal nucleus of the vagus nerve: Also called the posterior motor nucleus of vagus, this is a cranial
nerve nucleus for the vagus nerve in the medulla that lies under the floor of the fourth ventricle. It
mostly serves parasympathetic vagal functions in the gastrointestinal tract, lungs, and other thoracic
and abdominal vagal innervations.
 spinal trigeminal nucleus: A nucleus in the medulla that receives information about deep/crude
touch, pain, and temperature from the ipsilateral face.
Vagus Nerve Anatomy
The vagus nerve, also known as the pneumogastric nerve or cranial nerve X, is the tenth of
twelve paired cranial nerves. Upon leaving the medulla between the medullary pyramid and
the inferior cerebellar peduncle, it extends through the jugular foramen, then passes into the
carotid sheath between the internal carotid artery and the internal jugular vein below the head,
to the neck, chest and abdomen, where it contributes to the innervation of the viscera. Besides
output to the various organs in the body, the vagus nerve conveys sensory information about
the state of the body’s organs to the central nervous system. Eighty to 90% of the nerve fibers
in the vagus nerve are afferent (sensory) nerves that communicate the state of the viscera to the
brain.
The vagus nerve includes axons that emerge from or converge onto four nuclei of the medulla.
 The dorsal nucleus of vagus nerve: Sends parasympathetic output to the viscera, especially
the intestines.
 The nucleus ambiguus: Sends parasympathetic output to the heart (slowing it down).
 The solitary nucleus: Receives afferent taste information and primary afferents from
visceral organs.
 The spinal trigeminal nucleus: Receives information about deep/crude touch, pain, and
temperature of the outer ear, the dura of the posterior cranial fossa, and the mucosa of the
larynx.
Function
The vagus nerve supplies motor parasympathetic fibers to all the organs, except the suprarenal
(adrenal) glands, from the neck down to the second segment of the transverse colon. The vagus
also controls a few skeletal muscles, most notably:
 Cricothyroid muscle.
 Levator veli palatini muscle.
 Salpingopharyngeus muscle.
 Palatoglossus muscle.
 Palatopharyngeus muscle.
 Superior, middle, and inferior pharyngeal constrictors.
 Muscles of the larynx (speech).
This means that the vagus nerve is responsible for such varied tasks as heart rate,
gastrointestinal peristalsis, sweating, and quite a few muscle movements in the mouth,
including speech (via the recurrent laryngeal nerve), swallowing, and keeping the larynx
open for breathing (via action of the posterior cricoarytenoid muscle, the only abductor
of the vocal folds).
It also has some afferent fibers that innervate the inner (canal) portion of the outer ear,
via the auricular branch (also known as Alderman’s nerve) and part of the meninges.
This explains why a person may cough when tickled on the ear (such as when trying to
remove ear wax with a cotton swab).
Afferent vagus nerve fibers that innervate the pharynx and back of the throat are
responsible for the gag reflex. In addition, 5-HT3 receptor-mediated afferent vagus
stimulation in the gut due to gastroenteritis and other insults is a cause of vomiting.
Cardiovascular Influence
Parasympathetic innervation of the heart is partially controlled by the vagus nerve and is
shared by the thoracic ganglia. Activation of the vagus nerve typically leads to a reduction in
heart rate and/or blood pressure.
This occurs commonly in cases of viral gastroenteritis, acute cholecystitis, or in response to
stimuli such as the Valsalva maneuver or pain. Excessive activation of the vagal nerve during
emotional stress can also cause vasovagal syncope due to a sudden drop in cardiac output,
causing cerebral hypoperfusion.
Accessor
y Nerve
The accessory nerve (cranial
nerve XI) is the eleventh paired
cranial nerve. It has a purely
somatic motor function,
innervating the
sternocleidomastoid and trapezius
muscles.
Key Points
 Cranial nerve XI is responsible for tilting and rotating the head, elevating the
shoulders, and adducting the scapula.
 Most of the fibers of the accessory nerve originate in neurons situated in the
upper spinal cord. The fibers that make up the accessory nerve enter the skull
through the foramen magnum and proceed to exit the jugular foramen with
cranial nerves IX and X.
 Due to its unusual course, the accessory nerve is the only nerve that enters and
exits the skull.
Key Terms
 sternocleidomastoid: A paired muscle in the superficial layers of the side of the
neck. Its actions of the muscle are rotation of the head to the opposite side and
flexion of the neck.
 trapezius: A large vertebrate skeletal muscle divided into an ascending,
descending, and transverse portion, attaching the neck and central spine to the
outer extremity of the scapula; it functions in scapular elevation, adduction, and
depression.
 accessory nerve: The 11th cranial nerve of higher vertebrates, it controls the
pharynx and the muscles of the upper chest and shoulders.
 foramen: An opening, an orifice, or a short passage.
Anatomic Description
The accessory nerve (cranial nerve XI) controls the sternocleidomastoid and trapezius
muscles of the shoulder and neck. It begins in the central nervous system (CNS) and
exits the cranium through a foramen.
Unlike the other 11 cranial nerves, the accessory nerve begins outside the skull. In
fact, most of the fibers of the nerve originate in neurons situated in the upper spinal
cord.

Accessory Nerve Function

The accessory nerve provides motor innervation from the CNS to the
sternocleidomastoid and trapezius muscles of the neck. The sternocleidomastoid
muscle tilts and rotates the head, while the trapezius muscle has several actions on
the scapula, including shoulder elevation and adduction of the scapula.
During neurological examinations, the function of the spinal accessory nerve is often
measured by testing the range of motion and strength of the aforementioned
muscles. Limited range of motion or diminished muscle strength often indicates injury
of the accessory nerve.
Patients with spinal accessory nerve palsy may exhibit signs of lower motor neuron
disease, such as atrophy and fasciculations of both the sternocleidomastoid and
trapezius muscles.
Hypoglossa
l Nerve
The hypoglossal
nerve (cranial nerve
XII) controls the
muscles of the
tongue.

It is a nerve with a
solely motor
function.
Key Points
 It controls tongue movements of speech, food manipulation, and swallowing.
 While the hypoglossal nerve controls the tongue’s involuntary activities of
swallowing to clear the mouth of saliva, most of the functions it controls are
voluntary, meaning that the execution of these activities requires conscious
thought.
 Proper function of the hypoglossal nerve is important for executing tongue
movements associated with speech. Many languages require specific uses of the
nerve to create unique speech sounds, which may contribute to the difficulties
some adults encounter when learning a new language.

Key Terms
 digastric muscle: A small muscle located under the jaw.
 hypoglossal nerve: The twelfth cranial nerve (XII) controls the muscles of the
tongue.
 olivary body: Located on the anterior surface of the medulla, lateral to the
pyramid.
 medullary pyramid: Paired white matter structures of the brainstem’s medulla
oblongata that contain motor fibers of the corticospinal and corticobulbar tracts.
Structure and Location
The hypoglossal nerve is the twelfth cranial nerve (XII) and innervates all extrinsic
and intrinsic muscles of the tongue, except for the palatoglossus. The hypoglossal
nerve emerges from the medulla oblongata in the preolivary sulcus where it
separates the olive (olivary body) and the pyramid (medullary pyramid).
It goes on to traverse the hypoglossal canal and, upon emerging, it branches and
merges with a branch from the anterior ramus of C1. It passes behind the vagus
nerve and between the internal carotid artery and internal jugular vein which lies on
the carotid sheath. After passing deep to the posterior belly of the digastric muscle it
proceeds to the submandibular region to enter the tongue.
Function
The hypoglossal nerve controls tongue movements of speech, food
manipulation, and swallowing. It supplies motor fibers to all of the muscles of the
tongue, with the exception of the palatoglossus muscle, which is innervated by the
vagus nerve (cranial nerve X) or, according to some classifications, by fibers from the
glossopharyngeal nerve (cranial nerve IX) that hitchhike within the vagus.
While the hypoglossal nerve controls the tongue’s involuntary activities of swallowing
to clear the mouth of saliva, most of the functions it controls are voluntary, meaning
that the execution of these activities requires conscious thought.
Proper function of the hypoglossal nerve is important for executing the tongue
movements associated with speech. Many languages require specific and sometimes
unusual uses of the nerve to create unique speech sounds, which may contribute to
the difficulties some adults encounter when learning a new language. Several
corticonuclear-originating fibers supply innervation and aid in the unconscious
movements required upon engaging in speech and articulation.
Progressive bulbar palsy is a neuromuscular atrophy associated with the combined
lesions of the hypoglossal nucleus and the nucleus ambiguous, upon atrophy of the
motor nerves of the pons and medulla. This condition causes dysfunctional tongue
movements that lead to speech and chewing impairments and swallowing difficulties.
Tongue muscle atrophy may also occur.
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