Cranial and Peripheral Nerves - Martin

PERIPHERAL NERVOUS
SYSTEM:
CRANIAL AND PERIPHERAL
NERVES
PRESENTED BY:
DR. GEORGIE A. MARTIN, JR

DEPARTMENT OF ANESTHESIOLOGY - WVMC
Preceptors:
Dr. Maria Vanessa Cristi
Dr. Ceres Laud
Dr. Christian Jefferson
PERIPHERAL NERVOUS SYSTEM
• Nerves and ganglia outside the brain and spinal cord
• Connects the CNS to limbs and organs
• Somatic Nervous System – voluntary movements
• Autonomic Nervous System – involuntary

movements
• Sympathetic Nervous System
• Parasympathetic Nervous System
CRANIAL
NERVES
CRANIAL NERVES
 12 pairs
 Exits skull through the foramina
 Mainly innervate the head and neck
 3 groups:
 Sensory
 Motor
 Mixed
CRANIAL NERVES: OLFACTORY
NERVE (I)
 First and shortest cranial nerve
 Transmits information relating to SMELL
 Special visceral afferent nerve
 Fibers of the olfactory nerve are the

central processes of the olfactory cells
CRANIAL NERVES: OLFACTORY
NERVE (I)
 Sense smell detected by olfactory receptors at the
nasal epithelium
 Signal is sent through the filia olfactoria
 Synapse with the Mitral Cells
 Pass on the second order neurons to the primary

olfactory cortex
CRANIAL NERVES: OPTIC NERVE (II)
 Nerve of Vision
 Developed from the optic vesicle, an out

pocketing of the fore brain
 Devoid of neurilemmal sheath
 Surrounded by the extension of the

meninges and subarachnoid space
CRANIAL NERVES: OPTIC NERVE (II)
 Carries afferent impulses for vison
 Convergence of axons from the retinal ganglion
 Enter the optic canal and converge at the optic

chiasm
 Left optic tract – contains fibers from left temporal

(lateral) retina and right nasal (medial) retina
 Right optic tract – contains fibers from right

temporal (lateral) retina and left nasal (medial)
retina
CRANIAL NERVES: OCULOMOTOR (III)
 Motor
 Extraocular muscles of the eye (levator
palpebrae superioris, superior rectus, inferior
rectus, medial rectus and inferior oblique)
 Parasympathetic
 Sphincter pupillae and the ciliary muscles of
the eye
CRANIAL NERVES: OCULOMOTOR (III)
 Originates from the oculomotor nucleus
 Emerge at the anterior aspect of the midbrain
 Pierces the dura mater and enters the

cavernous sinus
 Leaves the cranial cavity via superior orbital

fissure
 Superior branch
 Inferior branch
CRANIAL NERVES: TROCHLEAR (IV)
 Smallest cranial nerve but with the longest
intracranial course
 Purely a motor
 supplies the superior oblique
 Arise from the trochlear nucleus and emerged

on the posterior surface of the midbrain
 Passes through the cranial middle fossa
 Enters the orbit to superior orbital fissure

CRANIAL NERVES: TROCHLEAR (IV)
 Motor innervation to the superior oblique

 Moves eye downward and laterally
 A lesion of the trochlear nerve results in

paralysis of the superior oblique muscle with
the result that diplopia occurs when the patient
attempts to turn the eye downwards and
laterally.
CRANIAL NERVES: TRIGEMINAL (V)
 Largest cranial nerve
 Principal sensory nerve of the face, orbit, nose

and mouth, and because its branches are
eminently suitable for accurate anesthetic
blockade
 Leaves the anterior aspect of the pons as a

small motor root and a large sensory root
 Passes forward out of the posterior cranial

fossa and rest on the apex of the middle
cranial fossa
 In the middle cranial fossa

 Sensory root expands into 3 trigeminal
ganglion supplying 3 facial division
 Motor root supplies the mandibular

division
V1 OPHTHALMIC NERVE
 First division of the CN V and is entirely sensory
 Innervates skin and mucous membrane of:

 Forehead, scalp, frontal and ethmoid sinus,
upper eyelid and its conjunctiva, cornea and
dorsum of the nose
 Provides parasympathetic supply to:

 Lacrimal gland
V2 MAXILLARY NERVE
 Second division of the trigeminal nerve,

entirely sensory
 Innervates the skin, mucous membrane and

sinuses of:
 Lower eyelid and its conjunctiva, cheeks
and maxillary sinus nasal cavity and
lateral nose, upper lip upper molar,
incisor and canine and associated
gingiva, superior palate
 Provides parasympathetic supply to:

 Lacrimal gland and nasal gland
CRANIAL NERVES: TRIGEMINAL(V)
V3 MANDIBULAR NERVE
 Sensory supply: mucous membrane and floor of the oral

cavity, external ear, lower lip, chin, anterior 2/3 of
tongue, lower molar, incisor and canine teeth and the
associated ganglia
 Motor supply: muscle of mastication (medial pterygoid,

masseter, temporalis), Anterior belly of the digastric
muscle and the mylohyoid muscle (these are suprahyoid
muscle), Tensor veli palatini, Tensor tympani
 Parasympathetic supply: submandibular, sublingual and

parotid
TRIGEMINAL NERVE BLOCK
Indication: Trigeminal neuralgia, intractable facial cancer,
cluster headache
Target: Depending on the site of pain
 Gasserian Ganglion Block
 Maxillary Nerve Block
 Mandibular Nerve Block
 Inferior Alveolar Nerve Block

SEMILUNAR (GASSERIAN) NERVE BLOCK
 Most comprehensive blockade of the trigeminal nerve
 Performed under fluoroscopic guidance
 Injection site: posterior 1/3 of the zygomatic bone, opposite the

second upper molar tooth
MAXILLARY NERVE BLOCK
 Maxillary nerve block is performed for acute or
chronic herpetic neuralgia, trigeminal neuralgia and
cancer pain.
 Injection site: pterygopalatine fossa after emerging

from the foramen rotundum.
 It is reached by inserting a needle through the mid-

point of the coronoid notch beneath the zygomatic
arch.
 MANDIBULAR NERVE BLOCK
 Indication: dental and maxillary surgery, for

inferior dental pain, trigeminal neuralgia on
the third branch, Temporomandibular
junction dysfunction
 Needle inserted midpoint of the coronoid

process beneath the zygomatic arch
 Target: muscles of mastication, lower jaw,

the side of the tongue and the skin overlying
the mandible
 INFERIOR ALVEOLAR NERVE BLOCK
 Injection site: medial to the anterior border

of the mandibular ramus
 Anaesthesia of the lower teeth, the skin and

mucosa of the lower lip
 Loss of sensation of the side of the tongue

owing to involvement of the lingual nerve
CRANIAL NERVES: ABDUCENS (VI)
 Purely somatic motor nerve supplying the Lateral
Rectus
 Arises from the abducens nucleus in the pons
 Exits at the junction of the pons and medulla
 Passes through the cavernous sinus, lying below

and lateral to the internal carotid artery
 Enters the orbit through the superior orbital

fissure
 When damaged, it gives rise to diplopia and a

convergent squint
CRANIAL NERVES: FACIAL NERVE (VII)
 The facial nerve supplies the muscles of facial expression, conveys secretomotor fibers to the
lacrimal gland, and to the submandibular and sublingual salivary glands, and transmits taste
fibers from the anterior two-thirds of the tongue.
CRANIAL NERVES: FACIAL NERVE (VII)
 Damage to the facial nerve or its central pathway results

in facial palsy
 Both nuclear and infranuclear palsies – complete facial

paralysis involving all facial muscles on one side
 Supranuclear palsies – no involvement of the muscles

above the palpebral fissure
CRANIAL NERVES:
VESTIBULOCOCHLEAR NERVE
(VIII)
 COCHLEAR FIBERS – concerned with hearing
 Arises from the ventral and dorsal
cochlear nuclei in the inferior
cerebellar peduncle
 VESTIBULAR FIBER – concerned with

balance
 Arises from the vestibular nuclei
complex in the pons and medulla
CRANIAL NERVES:
VESTIBULOCOCHLEAR NERVE
(VIII)
 Lesions of the vestibular division of the labyrinth or of
the vestibulocerebellar pathway result in vertigo,
ataxia and nystagmus
 Lesions of the cochlear division result in deafness that

may or may not be accompanied by tinnitus
 Temporal lobe tumors may give rise to auditory

hallucinations if they encroach upon the auditory
radiation or superior temporal gyrus.
CRANIAL NERVES:
GLOSSOPHARYNGEAL NERVE
(IX)
 Leaves the anterolateral surface of the upper part of the
medulla oblongata as several rootlets
 Leaves the cranial cavity via the jugular foramen

 Superior and inferior glossopharyngeal sensory
ganglia
 Give rise to carotid sinus nerve

CRANIAL NERVES:
(IX)
 Sensory: Innervates the oropharynx, carotid body and
sinus, posterior 1/3 of the tongue, middle ear cavity and
Eustachian tube.
 Special sensory: Provides taste sensation to the

posterior 1/3 of the tongue.
 Parasympathetic: Provides parasympathetic innervation

to the parotid gland.
 Motor: Innervates the stylopharyngeus muscle of the

pharynx.
CRANIAL NERVES:
(IX)
GLOSSOPHARYNGEAL NERVE BLOCK
 Indication: glossopharyngeal neuralgia,

palliative care for patients with head and neck
malignancy
 Injection site: midpoint through mastoid

process and angle of mandible
 Targets the nerve as it emerges the

jugular foramen
 Anesthesia may spread to CN X (Vagus), XI

(Accessory) and XII (Hypoglossal)
CRANIAL NERVES: VAGUS NERVE (X)
 Largest and most widely distributed of the
cranial nerves
 Originates from the medulla of the brainstem
 Exits through the jugular foramen after giving off

the auricular branch
CRANIAL NERVES: VAGUS NERVE (X)
 Sensory: skin of the external acoustic meatus, internal

surfaces of the laryngopharynx and larynx, visceral sensation
to the heart and abdominal viscera
 Special Sensory: taste sensation to the epiglottis and root of

the tongue
 Motor: majority of the muscles of the pharynx, soft palate

and larynx
 Parasympathetic: smooth muscle of the trachea, bronchi

and gastro-intestinal tract and regulates heart rhythm
CRANIAL NERVES: ACCESSORY NERVE (XI)
 Purely somatic nerve that provides motor innervation

to the sternocleidomastoid and trapezius muscle
 Cranial Component – arise from the lateral aspect of

the medulla oblongata
 Exits through the jugular foramen
 Combines with the Vagus Nerve
CRANIAL NERVES: ACCESSORY NERVE (XI)
 Spinal Component – arise from the neurons of

the upper spinal cord (C1 – C5/6)
 Runs superiorly and enter the foramen
magnum
 Exits through the jugular foramen
 Descend along the internal carotid artery to
the sternocleidomastoid and moves to the
trapezius
CRANIAL NERVES: HYPOGLOSSAL NERVE
(XII)
 Supplies all intrinsic and extrinsic muscle of the
tongue except the palatoglossus
 Arise from the hypoglossal nucleus of the

medulla oblongata of the brainstem
 Exits the cranium via the hypoglossal canal
 Travels along with branches from the cervical

plexus, C1/C2 spinal nerve root
 Pass inferiorly to the angle of the mandible and

moves to the direction of the tongue
CRANIAL NERVES: HYPOGLOSSAL NERVE
(XII)
 Division of the hypoglossal nerve, or lesions involving its nucleus, result in ipsilateral paralysis
and wasting of the muscles of the tongue.
 This is detected clinically by deviation of the protruded tongue to the affected side.
SPINAL NERVES
SPINAL NERVES
 31 Pairs
 8 Cervical
 12 Thoracic
 5 Lumbar
 5 Sacral
 1 Coccygeal
 Pass through the Intervetebral Foramina
 Divides into Branches or Rami
 Posterior Ramus
 Anterior Ramus
SPINAL NERVES
 Dorsal (Posterior) Root
 Afferent (Sensory) Fibers
 Ventral (Anterior) Root
 Efferent (Motor) Fibers
 Mixed Spinal Nerve
 Anterior Ramus
 Posterior Ramus
Afferent fibers Arrive - SENSORY

Efferent fibers Exit - MOTOR
SPINAL NERVES
 Paravertebral Space
 A potential space along the outside of the vertebral

canal
 Filled with loose fat and areolar tissue
 Contains the nerve roots issuing from the spinal cord

and blood vessels
 Allows access for blocking the nerve without invading

the epidural or subarachnoid space
 Provide unilateral nerve blocks extending two to four

segments
SPINAL NERVES
 Nerve Plexus
 A network of intersecting nerve serving
the same part of the body
 Composed of afferent and efferent fibers

that arise from the merging of anterior
rami of spinal nerves
 Nerve Plexuses except in the thoracic region

 Cervical Plexus
 Brachial Plexus
 Lumbar Plexus
 Sacral and Coccygeal Plexus
SPINAL NERVES
 Myotome
 Specific muscle/s supplied by motor

innervation
 Dermatome
 Specific area of the skin supplied by sensory

innervation
SPINAL NERVES: CERVICAL PLEXUS
 Formed by the upper four Cervical Nerves, C1 – C4
 Provides innervation to skin and muscles of the neck

and the diaphragm
 Located on the posterior triangle of the neck
 Divided into two groups:
 Deep Muscular Branch
 Sensory Superficial Branch

 Deep Muscular Branch
 Nerve Root: C1
 Nerves to geniohyoid and
thyrohyoid
 Travels along with the hypoglossal
nerve
 Ansa Cervicalis (C1 – C3)

 Give off four branches to the
infrahyoid muscles
 Phrenic Nerve (C3 – C5)

 Motor innervation to the diaphragm
 Sensory Branches
 Greater Auricular Nerve (C2 – C3)

 External ear, skin over the parotid gland
 Largest ascending plexus branch
 Transverse Cervical Nerve(C2 – C3)

 Sensation to the anterior neck
 Lesser Occipital Nerve (C2, contribution from C3)

 Posterosuperior scalp
 Supraclavicular Nerve (C3 – C4)

 Skin overlying the supraclavicular fossa,
upper thoracic region, sternoclavicular joint
 SUPERFICIAL AND DEEP CERVICAL NERVE BLOCK
 Indication: provides regional anesthesia for

neck surgery (e.g. carotid endarectomy,
thyroidectomy, and cervical lymph node
dissection)
 Superficial plexus: behind the posterior

border of the middle portion of the
sternocleidomastoid
 Deep Plexus: transverse process of the 2nd, 3rd

and 4th cervical vertebrae
 OCCIPITAL NERVE BLOCK
 Indication: Diagnostic step in evaluating head

and neck pain
 Complications: rare, intravascular injection

SPINAL NERVES: BRACHIAL PLEXUS
 Provides motor innervation and nearly all sensory supply of the upper limb
 Pass through the anterior and medial scalene muscles
 Covered sheaths of fibrous tissue
 Upper Trunk – root of C5 and C6
 Middle trunk – C7
 Lower Trunk – root of C8 and T1

 Lateral border of the first rib
 3 Anterior Division
 3 Posterior Division
 Leave through the posterior triangle and

pass into the axilla
 Enter the apex of the axilla
 Grouped together:
 Medial Cords
 Lateral Cords
 Posterior Cords
BRACHIAL PLEXUS : MAJOR BRANCHES
MUSCULOCUTANEOUS NERVE
• Roots: C5, C6, C7.
• Motor Functions: Innervates the brachialis,

biceps brachii and coracobrachialis muscles.
• Sensory Functions: Gives off the lateral

cutaneous branch of the forearm, which
innervates the lateral half of the anterior
forearm, and a small lateral portion of the
posterior forearm.


posterior forearm.


posterior forearm.
AXILLARY NERVE
• Roots: C5 and C6.
• Motor Functions: Innervates the teres minor

and deltoid muscles.
• Sensory Functions: Gives off the superior

lateral cutaneous nerve of arm, which
innervates the inferior region of the deltoid
(“regimental badge area”).
AXILLARY NERVE


AXILLARY NERVE


RADIAL NERVE
• Nerve roots – C5-T1.
• Sensory – Innervates most of the skin of the

posterior forearm, the lateral aspect of the
dorsum of the hand, and the dorsal surface of
the lateral three and a half digits.
• Motor – Innervates the triceps brachii and the

extensor muscles in the forearm.
RADIAL NERVE


RADIAL NERVE


MEDIAN NERVE
• Nerve roots: C6 – T1 (may contain C5 fibers)
• Motor functions: Innervates the flexor and

pronator muscles; thenar muscles and lateral two
lumbricals in the hand
• Sensory functions:
palmar cutaneous branch – lateral aspect of
the palm
digital cutaneous branch – lateral three and a
half fingers on the anterior (palmar) surface of the
hand.
MEDIAN NERVE

the palm
hand.
MEDIAN NERVE

the palm
hand.
• ULNAR NERVE
• Spinal roots: C8-T1.
• Motor functions:
• Two muscles of the anterior forearm – flexor carpi
ulnaris and medial half of flexor digitorum
profundus
• Intrinsic muscles of the hand (apart from the
thenar muscles and two lateral lumbricals)
• Sensory functions: Medial one and half fingers and the

associated palm area.
• ULNAR NERVE
profundus

• ULNAR NERVE
profundus

BRACHIAL PLEXUS NERVE BLOCK
INTERSCALENE NERVE BLOCK
 procedure of upper arm and shoulder.
SUBCLAVIAN NERVE BLOCK

 Procedure at the distal elbow
INFRACLAVICULAR NERVE BLOCK

 Procedure at the distal elbow
AXILLARY NERVE BLOCK

 Procedure at elbow, forearm and hand
AXILLARY BRACHIAL PLEXUS BLOCK
 Indication: for procedures of the elbow,

forearm and hand
 Targets the Ulnar, Radial, and Median

Nerve
MEDIAN NERVE BLOCK
• Indication: for injuries requiring procedure on the

radial side of the palm, palmar surface and tip of
the thumb, index, middle and ring finger
ULNAR BLOCK
• Indication: for rescue analgesia or surgical

anesthesia for surgery on the fifth digit
SPINAL NERVES: THORACIC NERVE
 12 pairs of thoracic anterior primary rami
 11 intercostal nerve
 1 subcostal nerve
 Nerve Root: T1 – T12
 Motor: muscles of the intercostal space, anterior abdominal wall
 Sensory: skin of the medial aspect of the upper arm, anterior

and lateral aspects of the trunk from the level of the angle of
Louis to just above the groin
 Intercostal nerve travels together with the ribs on the

inferior aspect
 Between intercostal muscle and innermost intercostal

muscle
 Sensory innervation to the parietal pleura

 Motor and sensory functions - determined by its
vertebral level
 T1 and T2 - top of the chest, arm and hand
 T3, T4, and T5 - chest wall and aid in breathing
 T6, T7, and T8 - chest and/or down into the abdomen
 T9, T10, T11, and T12 - abdomen and/or lower in the

back
INTERCOSTAL NERVE BLOCK
 Indication: for relief of pain associated with

rib fractures, herpes zoster, and cancer
 Targeted to the various vertebral level that

correspond to the area of the body wall to
be anesthetized
 Complication: intravascular local injection,

pneumothorax.
SPINAL NERVES: CERVICOTHORACIC
BLOCK
 STELLATE GANGLION BLOCK
 Combined structure of the inferior cervical

sympathetic and the first thoracic ganglion
 Indications:
 Pain syndrome (refractory angina pectoris,

phantom limb, etc)
 Vascular insufficiency in the arm
 Adequate block develops Horner’s Syndrome

SPINAL NERVES: LUMBAR PLEXUS
 Nerve Root: L1, L2, L3, L4 (contribution from L4)
 Divide into several cords to form six major

peripheral branches:
1. Iliohypogastric
2. Ilioinguinal
3. Genitofemoral
4. Dorsal division:
1. Lateral cutaneous nerve
2. Femoral nerve
5. Ventral Division
1. obturator nerve
2. accessory obturator nerve
LUMBAR PLEXUS: MAJOR BRANCHES
ILIOHYPOGASTRIC NERVE
• Roots: L1 (with contributions from T12)
• Motor Functions: Innervates the internal oblique

and transversus abdominis
• Sensory functions: innervates the posterolateral

gluteal skin in the pubic region
ILIOINGUINAL NERVE
• Roots: L1
• Motor Functions: Innervates the internal oblique

and transversus abdominis.
• Sensory Functions: Innervates the skin on the

superior antero-medial thigh.
• Males - over the root of the penis and anterior
scrotum
• Females - skin over mons pubis and labia
majora
GENITOFEMORAL NERVE
• Roots: L1, L2
• Motor Functions: The genital branch innervates the

cremasteric muscle.
• Sensory Functions:
• genital branch innervates the skin of the anterior
scrotum (in males) or the skin over mons pubis
and labia majora (in females)
• femoral branch innervates the skin on the upper
anterior thigh.
LATERAL CUTANEOUS NERVE
• Roots: L2, L3
• Sensory Functions: Innervates the anterior and

lateral thigh down to the level of the knee.
• Anterior branch – skin over the anterolateral
aspect of the thigh down to the knee
• Posterior branch – lateral aspect of the leg from
the greater trochanter to the mid-thigh
FEMORAL NERVE
• Roots: L2, L3, L4.
• Motor Functions: Innervates the muscles of the

anterior thigh – the illiacus, pectineus, sartorius
and quadriceps femoris.

anterior thigh and the medial leg.
OBTURATOR NERVE
• Roots: L2, L3, L4

medial thigh – the obturator externus, adductor
longus, adductor brevis, adductor magnus and
gracilis.
• Sensory Functions: Innervates the skin over the

medial thigh.
OBTURATOR NERVE

gracilis.

medial thigh.
OBTURATOR NERVE

gracilis.

medial thigh.
LUMBAR PLEXUS BLOCK
LUMBAR PLEXUS NERVE BLOCK
 Indication: hip surgery and for intermittent or continuous

analgesia in selected patients
 Blocks the femoral, obturator and lateral cutaneous nerve

of the thigh
LUMBAR PLEXUS BLOCK
FEMORAL NERVE BLOCK
 Indication: provide postoperative analgesia for hip, thigh,

knee, and ankle (for the saphenous nerve) procedures
 Blocks the entire anterior thigh and most of the femur and
knee joint, skin on the medial aspect of the leg below the
knee joint
LUMBAR PLEXUS BLOCK
OBTURATOR NERVE BLOCK
 Indication: hip joint pain, relief of adductor muscle

spasm associated with hemi- or paraplegia
 Anesthesia of the adductor muscles and knee

SACRAL AND COCCYGEAL PLEXUSES
SACRAL PLEXUS
 Nerve Root: L5 – S3, contributions from L4 and
S4
COCCYGEAL PLEXUS
 Nerve Root: S4, S5 and anterior primary ramus
of the coccygeal nerve
SACRAL PLEXUS: MAJOR BRANCHES
SUPERIOR GLUTEAL NERVE
• Roots: L4, L5, S1
• Motor Functions: Innervates the gluteus minimus,

gluteus medius and tensor fascia lata.
INFERIOR GLUTEAL NERVE
• Roots: L5, S1, S2.
• Motor Functions: Innervates gluteus maximus

POSTERIOR FEMORAL CUTANEOUS
(POSTERIOR CUTANEOUS NERVE OF THE THIGH)
• Roots: Roots: S1, S2, S3

posterior surface of the thigh and leg. Also
innervates the skin of the perineum.
PUDENDAL NERVE
• Roots: S2, S3, S4
• Motor Functions: Innervates the skeletal muscles in the

perineum, the external urethral sphincter, the external anal
sphincter, levator ani.
• Sensory Functions: Innervates the penis and the clitoris and

most of the skin of the perineum.
SCIATIC NERVE
• Roots: L4, L5, S1, S2, S3
• Largest peripheral nerve of the body
• Made up of two nerves: the tibial nerve and the

peroneal nerve
SCIATIC NERVE
The branches of the sciatic nerve can be grouped into

the following:
1. Muscular – semitendinous, semimembranous,

adductor magnus, biceps femoris
2. Articular to the hip joint
3. Terminal – common peroneal and tibial nerve
SCIATIC NERVE
• Motor Functions:
• Tibial portion – muscles in the posterior

compartment of the thigh, leg and sole of the
feet
• Common fibular portion – Short head of

biceps femoris, all muscles in the anterior and
lateral compartments of the leg and extensor
digitorum brevis.
SCIATIC NERVE
• Sensory Functions:
• Tibial portion: supplies the skin of the

posterolateral leg, lateral foot and the sole of
the foot.
• Common Peroneal portion: supplies the skin

of the lateral leg and the dorsum of the foot.
BRANCHES OF SCIATIC NERVE: TIBIAL NERVE
• Nerve roots: L4-S3
• Sensory: Innervates the skin of the posterolateral

leg, lateral foot and the sole of the foot.
• Motor: Innervates the posterior compartment of

the leg and the majority of the intrinsic foot
muscles.
BRANCHES OF SCIATIC NERVE: TIBIAL NERVE
• Nerve roots: L4-S3
• Sensory: Innervates the skin of the posterolateral

leg, lateral foot and the sole of the foot.
• Motor: Innervates the posterior compartment of

the leg and the majority of the intrinsic foot
muscles.
BRANCHES OF SCIATIC NERVE: COMMON PERONEAL
NERVE
• Nerve roots: L4 – S2
• Motor: Innervates the short head of the biceps femoris

directly. Also supplies (via branches) the muscles in the
lateral and anterior compartments of the leg.
• Sensory: Innervates the skin of the lateral leg and the

dorsum of the foot.
BRANCHES OF SCIATIC NERVE: COMMON PERONEAL
NERVE
• Superficial Peroneal nerve: Innervates the muscles of

the lateral compartment of the leg; fibularis longus and
brevis.
• Deep Peroneal nerve: Innervates the muscles of the

anterior compartment of the leg; tibialis anterior,
extensor digitorum longus and extensor hallucis longus.
SPINAL NERVE: SACRAL PLEXUS BLOCK
SCIATIC NERVE BLOCK
 Indication: for surgical procedures involving the hip,

thigh, knee, lower leg, and foot
 Posterior approach – most popular and reliable

PUDENDAL NERVE BLOCK
 Indication: for evaluating patients with perineal

somatosensory pain
 Numbness of the genitalia

NERVE BLOCKS TO THE ANKLE
 Five nerves pass the malleoli at the ankle:

 posterior tibial nerve,
 sural nerve
 deep peroneal nerve
 superficial peroneal nerve
 saphenous nerve
SPINAL NERVES: COCCYGEAL PLEXUS
• Nerve Root: part of S4, S5 and Co. 1
• Forms a single trunk – Anococcygeal Nerve
• Sensory Function: supply the skin over the coccyx

References:
• Barash Clinical Anesthesia 8th ed
• Anatomy for Anaesthetists 9th ed
• Snell’s Clinical Neuroanatomy 8th ed
END. . .
THANK YOU!

Cranial and Peripheral Nerves - Martin

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Cranial and Peripheral Nerves - Martin

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PERIPHERAL NERVOUS

DR. GEORGIE A. MARTIN, JR

• Connects the CNS to limbs and organs

• Somatic Nervous System – voluntary movements

• Autonomic Nervous System – involuntary

 Exits skull through the foramina

 Mainly innervate the head and neck

 First and shortest cranial nerve

 Transmits information relating to SMELL

 Special visceral afferent nerve

 Fibers of the olfactory nerve are the

 Signal is sent through the filia olfactoria

 Synapse with the Mitral Cells

 Pass on the second order neurons to the primary

 Developed from the optic vesicle, an out

 Devoid of neurilemmal sheath

 Surrounded by the extension of the

 Convergence of axons from the retinal ganglion

 Enter the optic canal and converge at the optic

 Left optic tract – contains fibers from left temporal

 Right optic tract – contains fibers from right

 Emerge at the anterior aspect of the midbrain

 Pierces the dura mater and enters the

 Leaves the cranial cavity via superior orbital

 supplies the superior oblique

 Arise from the trochlear nucleus and emerged

 Passes through the cranial middle fossa

 Enters the orbit to superior orbital fissure

 Motor innervation to the superior oblique

 A lesion of the trochlear nerve results in

 Largest cranial nerve

 Principal sensory nerve of the face, orbit, nose

 Leaves the anterior aspect of the pons as a

 Passes forward out of the posterior cranial

 In the middle cranial fossa

 Motor root supplies the mandibular

 First division of the CN V and is entirely sensory

 Innervates skin and mucous membrane of:

 Provides parasympathetic supply to:

 Second division of the trigeminal nerve,

 Innervates the skin, mucous membrane and

 Provides parasympathetic supply to:

 Sensory supply: mucous membrane and floor of the oral

 Motor supply: muscle of mastication (medial pterygoid,

 Parasympathetic supply: submandibular, sublingual and

Target: Depending on the site of pain

 Gasserian Ganglion Block

 Maxillary Nerve Block

 Mandibular Nerve Block

 Inferior Alveolar Nerve Block

 Performed under fluoroscopic guidance

 Injection site: posterior 1/3 of the zygomatic bone, opposite the

 Injection site: pterygopalatine fossa after emerging

 It is reached by inserting a needle through the mid-

 Indication: dental and maxillary surgery, for

 Needle inserted midpoint of the coronoid

 Target: muscles of mastication, lower jaw,

 INFERIOR ALVEOLAR NERVE BLOCK

 Injection site: medial to the anterior border

 Anaesthesia of the lower teeth, the skin and

 Loss of sensation of the side of the tongue

 Arises from the abducens nucleus in the pons

 Exits at the junction of the pons and medulla

 Passes through the cavernous sinus, lying below