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Anatomy notes collection

The cranial nerves

This drawing was made by Nmeth


Pter (FOK, 2009) & revised by Dr.
Altdorfer, and contains a fine summary
of the cranial nerves and their
branches. It can be downloaded in high
resolution online from the departments
lecture page

Haytham
Bayadsi 2010/2011
Haytham Bayadsi,
2009/2010

Introduction:
False cranial nerves: terminal nerve, vomeronasal nerve of Jacobson, CN-I, CN-II
- They have no nuclei
- They emerge from the prosencephalon (archencephalon)
- i.e. the prechordal part from the neural tube, where the homology with the
spinal cord is not recognizable.
True cranial nerves:
- They have nuclei:
o Motor nuclei comprises perikarya belonging to motor axons
o Sensory nuclei receives synapses from primary sensory axons
o Perikarya belonging to primary sensory axons are in sensory ganglia
(Nucleus: neuron group in CNS / Ganglion: neuron group in PNS)
-

They emerge from the mesencephalon and rhombencephalon (together


deuterencephalon)
i.e. the epichordal part of the neural tube, where the homology with the spinal
cord is recognizable
More (rhombencephalon) or less (mesencephalon).

They form three groups:


III, IV, VI, XII purely (somato)motoric (except the accessory nucleus of n. III)
VIII purely (somato)sensory
V,VII,IX,X,XI mixed (except for XI, which is reduced to being motoric), socalled branchial nerves, positioned in the branchial (pharyngeal) arches.
Taken from: lecture to ED II, Sept. 28, 2007, Klmn Mihly

In this collection of notes we will deal with the true cranial nerves, (CN-I and CN-II will be dealt with during the
discussion of the visual and olfactory pathways and systems!

Functional classification of their nuclei and fibers


Nuclear groups:
(Motor nuclei are located medially, sensory nuclei are found laterally.)
Motor (or efferent) nuclei
They contain multipolar neurons; their axon leaves the brain and terminates on the
target (muscle, gland)
SM: Somatomotor nuclei (or GSE, general somatic efferent) form the dorsomedial
nuclear column (CN III., IV., VI., XII.). The multipolar neurons send their axons to
innervate striated muscles derived from somites (of the eye and tongue).
BM: Branchiomotor or special Visceromotor (SVM, SVE) nuclei form the ventrolateral
nuclear column (CN V., VII., IX-X-XI.). Like Somatomotor neurons, they innervate
striated muscles (but these muscles developed from branchial arches): muscles of

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mastication, facial expression, pharynx and larynx muscles. The other name
is special Visceromotor because they innervate the wall of viscera (mouth, nose, larynx,
pharynx) but striated muscles [instead of smooth muscles, see the next group] there.
GVM: General Visceromotor (GVM or GVE) / parasympathetic, secretomotor (CN III.,
VII., IX., X.). They innervate viscera: smooth muscles or glands (e.g. the sphincter
muscle of the pupil, salivary glands, glands and smooth muscles of abdominal and
thoracic viscera).
The innervation of viscera occurs always* in 2 steps:
1) The cranial nerve nuclei contain the Preganglionic parasympathetic neurons their axon leaves
the brain and ends in an autonomic (in case of cranial nerves: parasympathetic) ganglion; there it
synapses with the multipolar neuron located in the ganglion 2) And the axon of this [postganglionic] neuron will reach the target cells.
* The only exception is the adrenal medulla: it receives direct Preganglionic fibers from the spinal
Cord (explanation: the adrenal medulla can be classified as a modified sympathetic ganglion)

Sensory (or afferent) nuclei


They contain also multipolar nuclei** but they receive inputs (=afferent fibers) from
sensory nerves these fibers synapse on the neurons
** The only exception is the mesencephalic trigeminal nucleus: it contains pseudounipolar neurons (= a
ganglion which was put into the brainstem). Their peripheral processes arrive from the muscle spindles of
the muscles of mastication; the central processes terminate on the motor trigeminal nucleus (See also at the
Proprioceptive reflex Masseter reflex).

GVS: General Viscerosensory (or GVA) relay neurons lie lateral to the visceral motor.
They receive afferent fibers input from interceptors / chemo- and Baroreceptors (carotid
sinus, carotid body, abdominal and thoracic viscera).
SVS: Special Viscerosensory (or SVA): for taste (an organ of special senses). Also relay
neurons - they receive afferent inputs from the taste fibres coming from the taste buds
(e.g. from the tongue).
GSS: General Somatosensory (or GSA) relay neurons - they receive afferent fibers from
somatic (body) receptors: mechano-, noci- or thermoreceptors (from the skin, muscles
and joints of the head). Three different sensory subtypes exist:
1. Epicritic: fine / discriminative touch and pressure, vibration
2. Protopathic: vitally important information:
- Pain
- Rough (non discriminative, crude) touch
- Temperature
3. Proprioceptive: the position of the muscles, joints (information from the body
of the subject: proper=self) afferent inputs from muscle spindles, tendon
organs
SSS: Special Somatosensory (or SSA) relay neurons form the most lateral nuclear
column in the brainstem. They receive afferent fibers carrying vestibular and auditory
signals (from the ear). They belong to organs of special senses (hearing and balance).

Haytham Bayadsi, 2009/2010

SM: Somatomotor
BM: Branchiomotor or special Visceromotor (SVM)
GVM: General Visceromotor
GVS: General Viscerosensory
SVS: Special Viscerosensory
GSS: General Somatosensory
o Epicritic
o Protopathic
o Proprioceptive
SSS: Special Somatosensory
(+): these nerves contain Protopathic fibers but don't have separate (own) nuclei; their Protopathic fibers terminate on the Spinal
Trigeminal nucleus

Taken from: Dr. Altdorfer Kroly, Dr. Somogyi Gyrgy (2007)

Haytham Bayadsi, 2009/2010

Oculomotor Nerve, CN-III:


The third cranial nerve, it supplies all the extrinsic muscles of the eye, except the lateral rectus
and superior oblique muscles; it also supplies the levator palpebrae superioris (opens eyelid)
and conveys presynaptic parasympathetic fibers to the ciliary ganglion for innervation of the
ciliary muscle (Accommodation) and sphincter pupillae (constriction of the pupils)
Nuclei:
Location

Function

Accessory oculomotor
nucleus
(Westphal-Edinger)

In midbrain, closely related to the


Parasympathetic (GVM)
oculomotor nucleus complex

Oculomotor nucleus

Upper part of midbrain at the


level of superior colliculus, in the
Somatomotor (SM)
central grey mater, ventral to the
aqueduct, as a complex

Course:
Brain exit

Oculomotor sulcus (medial sulcus of crus cerebri)


in the interpeduncular fossa; between posterior
cerebral artery & superior cerebellar artery

Subarachnoidal Course

Interpeduncular cistern

Dura penetration

Cavernous sinus (lateral wall), between the


anterior and posterior Petro-clinoidal folds

Skull exit

Superior Orbital fissure

The nerve will enter the orbit in the medial section of the superior orbital fissure, and divides into
2 main branches between the 2 heads of Lateral Rectus muscles and the nerve will be placed
below the trochlear nerve and the frontal and lacrimal branches of the ophthalmic nerve, while
the nasociliary nerve is placed between its two rami:
1. Superior branch of oculomotor nerve: smaller, passes over the optic nerve and gives
branches to:
o Superior rectus muscle
o Levator palpebrae superioris muscle
2. Inferior branch of oculomotor nerve: larger, gives:
o Medial rectus muscle branch (under optic nerve)
o Inferior rectus muscle branch
o Inferior oblique muscle branch (Longest branch, running between the
inferior and lateral recti muscles). From this branch, a short thick branch is
given to the lower part of ciliary ganglion forming its short root:
Parasympathetic root of ciliary ganglion (Presynaptic
parasympathetic fibers form W-E nucleus)

Haytham Bayadsi, 2009/2010

Trochlear Nerve, CN-IV:


Nuclei:
Location
Function
Lower part of the midbrain at the
level of inferior colliculus,
Trochlear nucleus*
Somatomotor (SM)
ventral to the aqueduct in the
central grey mater
* Its origin is in the midbrain below the cerebral aqueduct, and its fibers decussate in the superior
medullary velum, and emerge from the brain at the side of the frenulum
Course:
Brain exit

Below inferior colliculi on both sides of the


frenulum of superior medullary velum, on the
dorsal aspect of brain!

Subarachnoidal Course

Quadrigeminal cistern, Ambient Cistern

Dura penetration

Cavernous sinus (lateral wall), within the anterior


Petro-clinoidal fold (frenulum)

Skull exit

Superior Orbital fissure

It enters the Superior Orbital fissure in the lateral section, together with the ophthalmic vein, and
reaches laterally to supply the superior oblique muscle

Haytham Bayadsi, 2009/2010

Trigeminal Nerve, CN-V:


The chief sensory nerve of the face and the motor nerve of the muscles of mastication; its nuclei
are in the mesencephalon and in the pons and medulla oblongata extending down into the
cervical portion of the spinal cord; it emerges by two roots, large sensory and small motor, from
the lateral portion of the surface of the pons, and enters a cavity of the dura mater, the trigeminal
cave, at the apex of the petrous portion of the temporal bone, where the sensory root expands to
form the trigeminal ganglion; from there the three divisions:
- Ophthalmic [CN V1],
- Maxillary [CN V2]
- Mandibular [CN V3]
Nuclei:
Principal sensory
(pontine) nucleus

Spinal trigeminal nucleus

Location
Upper part of pons,
tegmentum, lateral part of
the reticular formation

Function
Epicritic sensibility (GSS)

Extends from the principal


nucleus down into the
medulla, until C1-C2
segments of spinal cord
(Lower end is continuous
with substantia gelatinosa)*

Protopathic sensibility (GSS) **

Proprioceptive sensibility (GSS)


Mesencephalic nucleus

Extends cranially from the


principal nucleus into the
midbrain, where it lies in the
central grey matter lateral to
the cerebral aqueduct

Motor nucleus

Upper part of pons, medial


to the principal sensory
nucleus

(Its an indrawn ganglion,


consisting of pseudounipolar
neurons, which their processes
run through the trigeminal
ganglion without interruption)
Branchiomotor (BM) or Special
Visceromotor (SVM) (1st
branchial arch muscles)

* The spinal nucleus has different parts that correspond to different areas of innervated; it can be
divided into 3 sub-nuclei:
o Oralis
o Interpolaris
o Caudalis
** The Protopathic fibers of CN-VII, CN-IX, and CN-X terminate also the Spinal trigeminal
nucleus, because these nerves dont have separate nuclei for the Protopathic sensibility

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Course:
Brain exit

Between pons and brachium pontis anteriorly, as


a larger sensory root (GSS) inferiorly and a
smaller motor root (SVM) superiorly

Subarachnoidal Course

Lateral pontine cistern

Dura penetration

Trigeminal (Meckel's) cave (has the Gasserian


ganglion in it) and from it:
- V/1. (Ophthalmic): Cavernous sinus
(lateral wall)
- V/2. (Maxillary): Cavernous sinus
(lateral inferior wall)
- V/3. (Mandibular): Foramen Ovale

Skull exit

V/1.: Superior Orbital fissure


V/2.: Foramen Rotundum
V/3.: Foramen Ovale

Ganglia:
- Trigeminal Ganglion (Gasserian, Semilunar): lays in Meckel's cave, large flattened
sensory ganglion of the trigeminal nerve lying adjacent to the cavernous sinus along
the medial part of the middle cranial fossa in the trigeminal cave (Meckel's cavity) of
the dura mater on the semilunar impression
Divisions of Trigeminal nerve:
1) Ophthalmic nerve (CN-V1):
After leaving the Gasserian ganglion, it lies in the lateral wall of the cavernous sinus then it
enters the superior orbital fissure into the orbital cavity
Before entering the superior orbital fissure (SOF), it gives a recurrent tentorial branch for the
cerebellar tentorium, and after that it divides into 3 main branches:
1. Lacrimal nerve: through the lateral section of the SOF, runs to the lacrimal gland
(located superio-laterally in the orbital cavity) and innervates the skin of the lateral
corner of the eye
o Via communicating branch it receives postganglionic parasympathetic
guest fibers from the zygomatic nerve for the innervation of lacrimal gland
2. Frontal nerve: through the lateral section of the SOF, going closer to the midline of
the orbital cavity, it divides into:
o Supratrochlear nerve: supplying the medial part of the upper eyelid, the
central part of the skin of the forehead (glabella), and the root of the nose
o Supraorbital nerve: passes through the supraorbital notch for the
innervation of the conjunctiva, upper eyelid and skin of the forehead /
scalp + frontal sinus
3. Nasociliary nerve: through the medial section of the SOF, runs in the medial corner
of the orbital cavity gives:
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o Communicating branch (sensory root): sensory fibers
passing from the eyeball through the ciliary ganglion to their cell bodies in
the trigeminal ganglion via the nasociliary nerve
o Long Ciliary branches: bypass the ciliary ganglion, supplying
postsynaptic sympathetic fibers for the dilator pupillae muscle and sensory
fibers for the ciliary muscles, iris, and cornea
o Posterior Ethmoidal nerve: through the posterior ethmoidal foramen for
the sphenoidal sinus + posterior ethmoidal air cells
o Anterior Ethmoidal nerve: via the anterior ethmoidal foramen to the
cribriform plate for the anterior meningeal branches that innervate the
anterior part of dura and for the nasal cavity to innervate the anterosuperior nasal mucosa (Internal nasal branches). The anterior ethmoidal
nerve terminates as external Nasal branches for the skin of the dorsum
and tip of nose
o Infratrochlear nerve: terminal branch of the nasociliary nerve running
beneath the pulley of the superior oblique muscle to the front of the orbit,
and supplying the skin of the eyelids and root of the nose (medial corner
of eye)

2) Maxillary nerve (CN-V2):


The second division of the trigeminal nerve, passing from the trigeminal ganglion in the middle
cranial fossa through lateral wall of the cavernous sinus and then via foramen rotundum into the
pterygopalatine fossa, where it gives off ganglionic branches to the pterygopalatine ganglion and
continues forward to give off the zygomatic nerve and enter the orbit, where it continues as the
infraorbital nerve.
(Before it exits the skull, it gives the recurrent meningeal branch for the middle part of Dura
that accompanies the anterior branch of the middle meningeal artery)
Branches outside the skull:
1. Ganglionic branches (pterygopalatine nerves): two short sensory branches of the
maxillary nerve in the pterygopalatine fossa, the fibers of which pass through the
pterygopalatine ganglion without synapse, from the pterygopalatine ganglion (that
also receives the Vidian nerve of pterygoid canal) branches will arise:
o Nasal branches:
Posterior superior lateral: to upper posterior part of lateral wall of
nasal cavity, including superior and middle nasal conchae /
meatuses, and posterior ethmoidal sinuses
Nasopalatine nerve (Scarpa's nerve): passing through the
sphenopalatine foramen, crossing to and then down the nasal septum,
and through the incisive foramen to supply the mucous membrane of
the hard palate, at the incisive foramen it anastomoses with the
greater palatine nerve
Posterior superior medial: branches of the nasopalatine nerve to
posterior superior nasal septum
o Greater Palatine nerve: passes inferiorly through the greater palatine
canal to supply the mucosa and glands of the hard palate, and the anterior
part of the soft palate (postsynaptic parasympathetic and sensory fibers of
the maxillary nerve)

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Posterior inferior nasal nerves: branches of greater


palatine nerve to posterior inferior lateral wall of nasal cavity,
including posterior aspect of mucosa over posterior portion of
inferior nasal conchae and meatus; may arise independently from
pterygopalatine ganglion
o Lesser Palatine nerves: usually two, these nerves emerge through the
lesser palatine foramina and supply the mucosa and glands of the soft
palate and uvula (postsynaptic parasympathetic and sensory fibers of the
maxillary nerve)
o Pharyngeal nerve: passing posteriorly through pharyngeal canal
(Palatovaginal canal) to supply sensory and postsynaptic parasympathetic
fibers to mucus glands of nasopharynx behind the auditory tube entrance
** Important note: The nasopalatine nerve, the greater/lesser palatine nerves & the
Pharyngeal nerves are branches from the ganglionic branches, but do not synapse in
the pterygopalatine ganglion, just pass through it
2. Zygomatic nerve: reaches the lateral wall of the orbital cavity through the inferior
orbital fissure, then it gives rise to two sensory branches to go into the Y-shaped
zygomatic canal:
o Zygomaticotemporal nerve: exits through the zygomaticotemporal
foramen on the temporal surface of the zygomatic bone to supply skin of
face lateral to orbit (temporal region)
o Zygomaticofascial nerve: exits through the zygomaticofascial foramen on
the lateral surface of the zygomatic bone below the orbital margin to
supply skin of face over zygoma or cheekbone
* * After that the Zygomatic nerve continues as a communicating branch
containing postganglionic parasympathetic fibers from the pterygopalatine
ganglion for the lacrimal gland via the lacrimal nerve of CN-V1 (As guest
fibers)
3. Infraorbital nerve: enters the orbit, via the infraorbital fissure, it is then transmitted
by the infraorbital canal to reach the face & cheek (canine fossa) to supply the skin
between the lower eyelid and upper lip (from lateral eye corner to the lateral lip
corner). It gives superior alveolar branches for the innervation of the maxillary teeth
and related gingiva and the formation of the Superior dental plexus:
o Anterior superior alveolar branches: supply the incisors and canines
o Middle superior alveolar branches: for the premolars
o Posterior superior alveolar branches: for the maxillary sinus and the
molars

Mandibular nerve (CN-V3):


The third division of the trigeminal nerve formed by the union of sensory fibers from the
trigeminal ganglion and the motor root of the trigeminal nerve in the foramen ovale, through which

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the nerve emerges; as a main trunk, that divides into anterior & posterior divisions
in the infratemporal fossa.
Branches:
1. Main trunk:
o Recurrent meningeal branch: renters the skull together with the middle
meningeal artery through foramen spinosum to supply the posterior part of
the middle portion of dura accompanying the posterior branch of the
middle meningeal artery
o Medial pterygoid nerve: innervation of the medial pterygoid muscle
o Tensor tympani nerve: innervation of the tensor tympani muscle, runs
through the otic ganglion
o Tensor veli palatini nerve: innervation of the tensor veli palatini muscle
that also runs in the otic ganglion
2. Anterior division:
o Masseteric nerve: innervation of the masseter muscle
o Deep temporal nerves: two branches, anterior and posterior, supplying the
temporalis muscle and periosteum of the temporal fossa
o Lateral pterygoid nerve: innervation of the lateral pterygoid muscle
o Buccal nerve: a sensory branch that passes downward, emerging from
beneath the ramus of the mandible to run forward on the buccinator
muscle, piercing (but not supplying) it to supply the buccal mucous
membrane and skin of the cheek near the angle of the mouth
3. Posterior division:
o Auriculotemporal nerve: arises by two roots that embrace the middle
meningeal artery; it passes through the parotid gland conveying
postsynaptic parasympathetic secretomotor fibers from the otic ganglion
and continuing to terminate in the skin of the temple and scalp (Superficial
temporal branches); also sends branches to the external acoustic meatus,
tympanic membrane, and auricle (Auricular branch + anterior auricular
nerves)
o Lingual nerve: passing between the medial pterygoid and the mandible, it
descends as an arch beneath the mucous membrane of the floor of the
mouth to the side of the tongue (in the lateral lingual sulcus) to supply
Sensory innervation for the anterior 2/3 of it and also taste innervation for
the anterior 2/3 as well via guest fibers from the chorda tympani nerve
(CN-VII)
o Inferior Alveolar nerve: enters the mandibular canal to be distributed to
the lower teeth, periosteum, and gingiva of the mandible. Branches:
Nerve to mylohyoid: small branch given off posteriorly just
before the nerve enters the mandibular foramen, innervates the
anterior belly of the digastric muscle and the mylohyoid
muscle (found in the submandibular triangle)
Inferior dental plexus: formed by branches of the inferior
alveolar nerve meeting and mixing before they supply the
teeth; it gives off interior dental branches to the teeth and
inferior gingival branches to the gums
Mental nerve: Arising in the mandibular canal and passing
through the mental foramen to supply the chin, lower lip and
skin over body of mandible
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Abducent Nerve, CN-VI:


Nuclei:
Location

Abducent nucleus

Function

Lower part of the pons, in the


grey matter lining the floor of the
rhomboid fossa near the midline Somatomotor (SM)
(Facial colliculus, pontomedullary junction)

Course:
Brain exit

At the ponto-medullary junction (medullopontine


sulcus), on both sides of foramen cecum, above
the pyramids

Subarachnoidal Course

Prepontine cistern, then immediately into


Dorello's canal, to ascend on the clivus towards
cavernous sinus

Dura penetration

Cavernous sinus (Freely in the middle)

Skull exit

Superior orbital fissure

After entering the superior orbital fissure in the medial section, this small motor nerve supplies
the Lateral rectus muscle of the eye

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Facial Nerve, CN-VII:


Nuclei:
Location

Function

Facial nerve nucleus*

Lower part of pons, similar


position to that of the motor
nucleus of trigeminal nerve

Branchiomotor (BM) or
Special Visceromotor (SVM)
(2nd branchial arch muscles)

Superior salivary nucleus

Pons, just above junction with


medulla

Parasympathetic
preganglionic fibers (GVM)
**

Solitary tract nucleus (upper Medulla, elongated column


part, gustatory nucleus)
deep in reticular formation

Taste (SVS) **

Extends from the principal


nucleus down into the medulla, Protopathic sensibility (GSS)
Spinal Trigeminal Nucleus
until C1-C2 segments of spinal ***
cord
* Motor fibers originate from the large multipolar neurons in the nucleus of facial nerve and go
around the nucleus of abducent nerve forming the internal genu (knee) of facial nerve (making
the facial colliculos in the rhomboid fossa)
** The taste and visceroeffernt fibers (GVM) do not go around the nucleus of abducent, instead
they emerge as separate Intermediate nerve that accompanies the facial nerve into the Internal
acoustic meatus)
Both parts of the facial nerve (Motor root and intermediate nerve) enter the facial canal as Facial
trunk.
*** The GSS fibers (protopathic) are for sensory auricular branch of facial nerve for the
innervation of a small part of the tympanic membrane (1/3) and external acoustic meatus that
join the auricular branch of vagus nerve (cell bodies found in geniculate ganglion)
Course:
Brain exit

Between pons and brachium pontis, posteriorly in


the cerebello-pontine angle

Subarachnoidal Course

Lateral pontine cistern

Dura penetration

The fundus of the internal acoustic meatus

Skull exit

The fundus of the internal acoustic meatus, facial


canal, stylomastoid foramen

Ganglia:
- Geniculate Ganglion: a ganglion of the intermediate nerve fibers carried by the facial
nerve, located within the facial canal at the genu of the canal (External genu of facial
nerve). It contains the cell bodies of sensory neurons innervating the taste buds on the
anterior 2/3 of the tongue and a small area on the external ear (1/3)

Haytham Bayadsi, 2009/2010

Course of the Facial nerve in the facial canal, different parts:

14

At the lateral end of the of internal acoustic meatus, the nerve passes superior to a ridge called
the transverse crest, and after it the Labyrinthine segment of facial nerve (canal) begins. The
nerve travels anteriorly until the geniculate ganglion and after it bends as the 1st external genu of
facial nerve, it becomes the horizontal or tympanic segment that continues in the medial wall of
tympanic cavity superior to the oval window niche and then bends again around the oval window
(2nd external genu) turning caudally as the vertical or mastoid segment towards the stylomastoid
foramen, from which the nerve exits the skull and ramifies into terminal branches within the
parotid gland (Parotid plexus).
Branches of facial nerve:
A) Intra-cranial branches (within the skull, from the facial canal):
1. Greater petrosal nerve: branch from the genu of the facial nerve (carrying
preganglionic parasympathetic fibers from the superior salivary nucleus) exiting via
the hiatus of the facial canal and running in a groove on the anterior surface of the
petrous part of the temporal bone beside the foramen lacerum to join the deep
petrosal nerve (Carrying sympathetic fibers from the internal carotid plexus), thus
forming the nerve of the pterygoid canal (Vidian nerve), which passes through the
pterygoid canal to reach the pterygopalatine ganglion (Lacrimal gland, nasal glands,
soft and hard Palatal glands)
2. Sensory auricular branch of facial nerve: innervates the external acoustic meatus
and 1/3 of the tympanic membrane after meeting with auricular banch of vagus nerve
to form the Arnold's nerve
3. Chorda tympani nerve: given off in the facial canal which through the posterior
canaliculus of the chorda tympani into the tympanic cavity, crosses over the tympanic
membrane and handle of the malleus, and passes out through the anterior canaliculus
of the chorda tympani in the petrotympanic fissure to join the lingual branch of the
mandibular nerve in the infratemporal fossa. It carries taste sensation from the
anterior 2/3 of the tongue and carries parasympathetic preganglionic fibers to the
submandibular ganglion, for innervation of the submandibular and sublingual
salivary glands
4. Stapedial nerve: provides motor innervation for stapedius muscle in middle ear, It
passes through a small canal in pyramidal eminence to reach the muscle
B) Extra-cranial branches (Outside the skull):
1. Posterior auricular nerve: after exiting the facial canal through the stylomastoid
foramen, and before entering the parotid gland. This nerve supply the peri-auricular
muscles and has an occipital branch for occipital belly of Occipitofrontalis muscle
2. Branches for the posterior belly of digastric and stylohyoid muscles
3. Parotid plexus (Pes anserinus facialis): the main trunk of facial nerve ramifies
within the parotid gland forming the intraparotid plexus, from which branches for the
facial muscles are given:
o Temporal (frontal) branches: innervating the superior portion of the
orbicularis oculi muscle and other muscles of facial expression above
the eye (frontalis, corrugator supercilii, auricularis anterior)
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o Zygomatic branches: crossing upper cheek to lateral
angle of the orbit to supply orbicularis oculi muscle
o Buccal branches: motor branches of the facial nerve distributed to
buccina or muscle and other muscles of facial expression below orbit
and above chin (Risorius, buccinator, levator labii superioris, levator
labi alaque nasi, levator anguli oris, nasalis)
o Marginal mandibular branches: parallels the mandibular margin
innervating risorius muscle and muscles of lower lip and chin
o Cervical branch: most inferior branch of the parotid plexus of the
facial nerve, it descends to innervate the platysma muscle
** The superficial cervical ansa (moto-sensory ansa): formed by the
anastomosis between the cervical motor branch of the facial nerve and the sensory
transverse cervical nerve (from cervical plexus) over the Platysma

Vestibulocochlear Nerve, CN-VIII:


A composite sensory afferent nerve innervating the receptor cells of the membranous labyrinth;
it consists of two major, anatomically and functionally distinct components, each of which have
different central connections:
- The vestibular nerve: for the organ of balance
- The cochlear nerve: for the organ of hearing
Nuclei:
Cochlear nuclei (2 on each
side)
(dorsal & ventral)
Vestibular nuclei (4 on each
side)
- Medial (of Schwalbe)
- Lateral (of Deiter)
- Inferior
- Superior (of Bechterew)

Location
Dorsal and ventral to inferior
cerebellar peduncle at the level
of junction of the pons with
medulla
In the grey matter underlying
the lateral part of the fourth
ventricle + ponto-medullary
junction

Function
Special Somatosensory (SSS)

Special Somatosensory
(SSS)

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Course:
Brain exit

Between pons and brachium pontis, posteriorly in


the cerebello-pontine angle

Subarachnoidal Course

Lateral pontine cistern

Dura penetration

The fundus of the internal acoustic meatus

Skull exit

The fundus of the internal acoustic meatus

Ganglia:
- Spiral (cochlear) ganglion of Corti: an elongated ganglion of bipolar sensory nerve
cell bodies on the cochlear part of the vestibulocochlear nerve in the spiral canal of
the modulus; each ganglion cell gives rise to a peripheral process that passes between
the layers of the bony spiral lamina to the organ of Corti, and a central axon that
enters the hindbrain as a component of the inferior (cochlear) root of CN-VIII, which
conveys auditory sensation
-

Vestibular ganglion of Scarpa: a collection of bipolar sensory nerve cell bodies


concerned with equilibration and forming a swelling on the vestibular part of the
eighth cranial nerve in the fundus of the internal acoustic meatus; consists of a
superior part and an inferior part connected by a narrow isthmus (like an hourglass)

A) Cochlear nerve:
Part of the vestibulocochlear nerve peripheral to the cochlear root; composed of the
central nerve processes of the bipolar neurons of the Spiral ganglion (Spiral ganglion
Spiral tract Cochlear nerve Cochlear root of CN-VIII), which have their peripheral
processes on the four rows of neuroepithelial cells (hair cells) of the spiral organ of Corti
The fibers in the cochlear root project and terminate into the dorsal and ventral cochlear
nuclei,
- From ventral nucleus: Fibers cross to opposite side (As the trapezoid body) to the
superior olivary nucleus and after partial synapse in the trapezoid nuclei they ascend
as the lateral lemniscus
- From the dorsal nucleus: Fibers cross partly as the medullary stria bellow rhomboid
fossa superior olivary nucleus ascend in the lateral lemniscus as well
B) Vestibular nerve:
Part of the vestibulocochlear nerve peripheral to the vestibular root; it is composed of the
central processes of bipolar neurons that have their terminals of their peripheral processes
on the hair cells in the ampullae of the semicircular ducts and the maculae of the saccule
and utricle, and cell bodies of the vestibular ganglion
The central processes unit to give the vestibular nerve and root and terminates after
bifurcation in the 4 vestibular nuclei of medulla oblongata and a small portion reaches the
cerebellum via ICP to the flocculonodular lobe.

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17

Glossopharyngeal Nerve, CN-IX:


Nuclei:
Location

Function

Ambiguous nucleus
(cranial Part)

Medulla, similar position to


that of the motor nucleus of
trigeminal nerve

Branchiomotor (BM) or
Special Visceromotor (SVM)
(2nd branchial arch muscles)

Inferior salivary nucleus

Dorsal part of pons, just above Parasympathetic


junction with medulla
Preganglionic fibers (GVM)

Solitary tract nucleus


(Upper part, gustatory
nucleus)

Medulla, elongated column


deep in reticular formation

Taste (SVS)

Lateral ala cinerea nucleus

Lower end of solitary tract,


caudal Medulla

General Viscerosensory
(GVS)
(e.g. Baroreceptors/
Chemoreceptors)

Spinal trigeminal nucleus

Extends from the principal


nucleus down into the
medulla, until C1-C2
segments of spinal cord

Protopathic sensibility (GSS)

Course:
Brain exit

In the lateral paraolivary sulcus (superiorly)

Dura penetration
Skull exit

Jugular foramen (anterior smaller part: pars


nervosa)
Jugular foramen (anterior smaller part: pars
nervosa)

Ganglia:
- Superior (jugular) ganglion: the upper, smaller, and less significant of two ganglia
on the glossopharyngeal nerve as it traverses the jugular foramen; it is usually
regarded as a detached part of the inferior ganglion
-

Inferior (Petrosal, extracranial) ganglion: the lower, more significant, of two


sensory ganglions on the glossopharyngeal nerve immediately inferior to its exit from
the jugular foramen. The pseudounipolar neurons comprising the ganglia convey
taste and general sensation from the posterior third of the tongue, and general
sensation only from the fauces, soft palate, and oropharynx

From the superior and inferior ganglia in jugular foramen it has its own sheath of dura mater.
The inferior ganglion on the inferior surface of petrous part of temporal is related with a
triangular deppression into which the aqueduct of cochlea opens. Inferiorly the glossopharyngeal
nerve it lateral and anterior to the vagus nerve and accessory nerve.
In its passage through the jugular foramen it passes between the internal jugular vein and internal
carotid artery. It descends in front of the latter vessel, and beneath the styloid process and the
muscles connected with it, to the lower border of the stylopharyngeus. It then curves forward,
forming an arch on the side of the neck and lying upon the stylopharyngeus and middle
pharyngeal constrictor muscle. From there it passes under cover of the hyoglossus muscle, and is
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18
finally distributed to the palatine tonsil, the mucous membrane of the fauces and
base of the tongue, and the mucous glands of the mouth.
Branches:
1. Tympanic nerve of Jacobson: Originates from the inferior ganglion with
somatosensory & preganglionic secretory fibers in the fossula petrosa, then it runs
through the tympanic canaliculus into the tympanic cavity. There it receives fibers
from the sympathetic plexus of the carotid artery via the caroticotympanic nerve and
forms the tympanic Plexus. It supplies the mucosa of the tympanic cavity and
auditory (Eustachian) Tube with sensory innervation and only the secretory fibers
continue running outside the cavity as the lesser petrosal nerve to the otic ganglion
(for the parotid gland)
2. Communicating branch to auricular branch of Vagus nerve (Arnold's nerve):
Supply somatosensory innervation for 1/3 of the tympanic membrane & external
acoustic meatus (cell bodies in superior ganglion, central processes project to the
spinal trigeminal tract)
3. Carotid branch (Hering's sinus nerve): descends to the bifurcation of the common
carotid artery to innervate the baroreceptors in the wall of the carotid sinus and the
chemoreceptors in the carotid body (Glomus). The impulses are transmitted to the
lateral ala cinerea nucleus and via collaterals to the commissural nucleus of Vagus to
control the heart rate and blood pressure (Sinus reflex)
4. Pharyngeal plexus: A mixed motor / sensory plexus of nerves formed by branches of
the glossopharyngeal, Vagus, and (Indirectly: Accessory nerves, cranial root), that
lies along the posterior wall of the pharynx, the glossopharyngeal contribution from
this plexus:
o Pharyngeal branch: conveys general sensory fibers to the mucosa of
the oropharynx via the pharyngeal plexus
o Tonsillar branches: conducting sensory fibers from the palatine
tonsillar fossa and soft palate
o Lingual branches: conduct taste (Valate papillae) & somatosensory
(mucous membrane) innervation for the posterior 1/3 of tongue
o Motor branches for:
Stylopharyngeus muscle
Superior constrictor of pharynx + Upper 1/2 of middle
constrictor of pharynx

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Vagus Nerve, CN-X:


Nuclei:
Location

Function

Ambiguous nucleus
(cranial Part)

Medulla, similar position to that Branchiomotor (BM) or


of the motor nucleus of
Special Visceromotor (SVM)
trigeminal nerve
(2nd branchial arch muscles)

Medial ala cinerea nucleus


(Dorsal nucleus of Vagus)

Medulla, long nucleus lying


vertically, upper end lies deep
to the Vagal triangle in the floor
Parasympathetic
of rhomboid fossa,
Preganglionic fibers (GVM)
Lower end in lateral part of
central grey mater of closed
medulla

Solitary tract nucleus


(Upper part, gustatory
nucleus)
(Lower part, fused as
commissural nucleus of
Vagus)

Taste (SVS)
Medulla, elongated column
deep in reticular formation

Commissural nucleus plays a


role in heart rate & blood
pressure regulation
General Viscerosensory
(GVS)
(e.g. Baroreceptors/
Chemoreceptors)

Lateral ala cinerea nucleus

Part of solitary tract, in the


cranial open part of medulla

Spinal trigeminal nucleus

Extends from the principal


nucleus down into the medulla,
Protopathic sensibility (GSS)
until C1-C2 segments of spinal
cord

Course:
Brain exit
Dura penetration
Skull exit

In the lateral paraolivary sulcus (Between CN-IX


and CN-XI)
Jugular foramen (anterior smaller part: pars
nervosa)
Jugular foramen (anterior smaller part: pars
nervosa)

Ganglia:
- Superior (Jugular) ganglion: a small sensory ganglion on the Vagus as it traverses
the jugular foramen. Cell bodies are for protopathic sensibility of dura & external
ear, (terminate in spinal trigeminal nucleus)
-

Inferior (Nodose) ganglion: a large sensory ganglion of the Vagus, anterior to the
internal jugular vein. Cell bodies are for taste sensation (terminate in cranial portion
of solitary tract nucleus) and for viscerosensory sensation (terminate in Lateral ala
cinerea nucleus)
Both right and left vagus nerves descend from the brain in the carotid sheath, lateral to the
carotid artery, enter the thoracic cavity through the Thoracic Inlet.
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20
The right vagus nerve gives rise to the right recurrent laryngeal nerve which hooks around the
right subclavian artery and ascends into the neck between the trachea and esophagus. The right
vagus then crosses anteriorly to the right subclavian artery and runs posterior to the superior vena
cava and descends posterior to the right main bronchus and contributes to cardiac, pulmonary
and esophageal plexuses. It forms the posterior vagal trunk at lower part of the esophagus and
enters the diaphragm through the esophageal hiatus.
The left vagus nerve enters the thorax between left common carotid artery and left subclavian
artery and descends on the aortic arch. It gives rise to the left recurrent laryngeal nerve which
hooks around the aortic arch to the left of the ligamentum arteriosum and ascends between the
trachea and esophagus. The left vagus further gives off thoracic cardiac branches, breaks up into
pulmonary plexus, continues into the esophageal plexus and enters the abdomen as the anterior
vagal trunk in the esophageal hiatus of the diaphragm.
Branches:
1. Meningeal branch: Innervation of the posterior part of dura mater (from the
superior ganglion)
2. Auricular branch of Vagus nerve (Arnold's nerve): from the superior
ganglion, innervates 1/3 of the Tympanic membrane, and external acoustic
meatus and the pannus of Auricle + small dorsal part. Joined by branches of
glossopharyngeal & facial nerves (communicating)
3. Pharyngeal Branches: Combines in the pharynx with the pharyngeal
branches of Glossopharyngeal nerve to form the pharyngeal nerve plexus,
which is a mix motor / sensory plexus for:
o Sensory innervation of the mucosa of lower pharynx (Meso and Hypo)
and epiglottis
o Taste sensation of accessory taste buds on epiglottis
o Motor branches for soft palate and pharyngeal muscles:
Lower 1/2 of middle constrictor of pharynx
Inferior constrictor of pharynx
Palatopharyngeus muscle
Salpingopharyngeus muscle
Palatoglossus muscle
Levator veli palatini muscle
4. Superior Laryngeal Nerve: a branch of the Vagus nerve at the inferior
ganglion; at the thyroid cartilage it divides into two branches:
o Internal laryngeal nerve: a sensory branch that supplies the mucous
membrane of the larynx superior to the vocal folds (Sensory +
parasympathetic)
o External laryngeal nerve: a motor branch that supplies the
cricothyroid muscle
5. Recurrent Laryngeal nerves: see course description above, they have:
o Tracheal branches: Parasympathetic, sensory and motor innervation of
the mucousa and smooth muscle of trachea
o Esophageal branches: Paraympathetic, sensory and motor innervation
of the upper esophagus
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21
o Inferior laryngeal nerve: the terminal branch of the
recurrent laryngeal nerve as the latter passes deep to the inferior
pharyngeal constrictor; it supplies the laryngeal mucosa (Sensory &
parasympathetic) inferior to the vocal folds and all laryngeal muscles
except the cricothyroid muscle
6. Cardiac branches: conducting presynaptic parasympathetic fibers to, and
reflex afferent fibers from, the Cardiac plexus (Aortic sinus, body):
o Superior cervical cardiac branch: uppermost of the branches of Vagus
nerve branching close to the base of the skull
o Inferior cervical cardiac branch: the most inferior of the cervical
branches of Vagus nerve branching at root of neck
o Thoracic cardiac branches: branch from the Vagi at thoracic levels
7. Esophageal branches: includes both branches passing directly from Vagi
(Anterior & posterior trunks) and the branches from the recurrent laryngeal
nerves that form the esophageal nerve plexus which surrounds esophagus,
supplying it and adjacent portions of the pericardium
8. Pulmonary branches: bronchial branches of the Vagus nerve at the hilum,
from them various branches accompany the bronchi and arteries into the lung
9. Anteior & posterior Vagal trunks: the anterior mainly from the left vagus and
the posterior from the right as the stomach rotates, they supply
parasympathetic, secretomotor and afferent fibers for the entire GI tract untill
the Left colic flexure (Cannon-Bohms point). Contribute to:
o Gastric branches (anterior & posterior) (stomach)
o Celiac branches (celiac plexus, around trunk)
o Hepatic (in the lesser omentum), pyloric and gall-bladder branches
(hepatic plexus)
o Vagal fibers for small and large intestines up to the left colic flexure
accompanying the mesenteric arteries

Haytham Bayadsi, 2009/2010

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Accessory Nerve, CN-XI:


Nuclei:

Ambiguous nucleus
(caudal part)

Spinal accessory nucleus

Location
In the medulla, forming an
elongated column lying deep in
the reticular formation
(Inferiorly continues with the
spinal accessory nucleus)
Lateral part of anterior grey
column (horn) of C1-C5
segments

Function
Branchiomotor (BM) or
Special Visceromotor (SVM)

Somatomotor (SM)

Course:
Brain exit
Dura penetration
Skull exit

- In the lateral paraolivary sulcus (inferiorly): the


cranial roots of n. XI.
- From spinal segments C1-6: the cervical or
spinal roots of n. XI.
Jugular foramen (anterior smaller part: pars
nervosa)
Jugular foramen (anterior smaller part: pars
nervosa)

Arises by two sets of roots:


-

Cranial: from the caudal part of nucleus ambiguous, emerging from the side of the
medulla, from the lateral paraolivary sulcus

Spinal root: from the spinal nucleus of accessory nerve that forms a narrow column
at the level of C1-C5, large motor neuron cells lay in the lateral aspect of anterior
horn (Ventral cells of the nucleus supply the SCM m., and caudal cells supply the
trapezius m.) and the fibers will emerge from the ventrolateral part of the first five
cervical segments of the spinal cord between the 2 roots of spinal nerve to combine to
together and form the Spinal root of accessory nerve that ascends up into the cranium
via foramen magnum

These roots unite to form the Accessory nerve trunk, which divides again upon entering the
jugular foramen into two branches:
1. Internal branch: carrying fibers of the cranial root, unites with the Vagus in the
jugular foramen and supplies the all muscles of larynx (except the cricothyroid
muscle) via the recurrent laryngeal nerve, muscles of the pharynx and soft palate
2. External branch: continues independently through the jugular foramen to supply the
sternocleidomastoid and trapezius muscles.
** While the accessory nerve was originally believed to have cranial and spinal roots, it
is now the general view that the so-called cranial root is actually a portion of the Vagus
nerve

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Hypoglossal Nerve, CN-XII:


Nuclei:
Location
Hypoglossal nucleus

Function

Medulla, elongated column of


multipolar cells extending in both
Somatomotor (SM)
open and closed parts, in the floor
of the rhomboid fossa

** Some researchers report that the nerve might carry General Somatic Afferent fibers for
proprioception of tongue muscles. The location of cells of origin of these fibers is uncertain,
because during the embryonic development, a ganglion (of Froriep) can identified in relation to
the nerve but in the adults it cannot be identified
Course:
Brain exit

In the medial paraolivary sulcus

Dura penetration

Hypoglossal canal

Skull exit

Hypoglossal canal

The nerve spirals behind the vagus nerve and passes between the internal carotid artery and
internal jugular vein lying on the carotid sheath. After passing deep to the posterior belly of the
digastric muscle, descending in an arch forming the loop of hypoglossal nerve, the nerve will
reach the root of tongue slightly above the hyoid bone in the lateral lingual sulcus. Before
reaching the tongue, some fiber bundles from the 1st and 2nd cervical spinal nerves (Ventral rami
of cervical plexus) will adhere to the nerve and give fibers that will innervate some of the
Supra/infrahyoidal muscles. In the lateral lingual sulcus it ramifies into branches for:
-

Intrinsic muscles of tongue:


o Superior longitudinal muscle
o Inferior longitudinal muscle
o Verticalis muscle
o Transversus muscle

Extrinsic muscles of tongue: (3 out of 4)


o Genioglossus muscle
o Hyoglossus muscle
o Styloglossus muscle

Supra/infrahyoidal muscles (Via the C1/C2 cervical segments received from


the deep cervical Ansa)
o Geniohyoid muscle
o Thyrohyoid

** The other fibers from C1/C2 will continue as the superior root of cervical ansa and will meet
the inferior root of the ansa made the ventral rami of C2/C3 forming the deep cervical ansa that
will innervate the: Omohyoid, Sternothyroid and Sternohyoid muscles

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Summary of the Muscles innervated by cranial nerves:


Cranial Nerve

Oculomotor Nerve (CN-III)

Trochlear Nerve (CN-IV)

Trigeminal Nerve (CN-V)


Mandibular nerve
division (CN-V3)

Abducent Nerve (CN-VI)

Facial Nerve (CN-VII)

Glossopharyngeal Nerve
(CN-IX)

Muscles innervated
-

Superior Rectus m.
Inferior Rectus m.
Medial Rectus m.
Inferior Oblique m.
Levator Palpebrae
Superioris m.

- Superior Oblique m.
-

Tensor Tympani m.
Tensor Veli Palatini m.
Masticatory Muscles
Mylohyoid m.
Anterior Belly of
Digastric m.

- Lateral Rectus m.
-

Stapedial m.
Mimetic muscles
Stylohyoid m.
Posterior Belly of
Digastric m.

- Stylopharyngeus m.
- Superior Constrictor of
Pharynx m.
- Upper 1/2 of Middle
Constrictor of Pharynx
m.

Somatomotor by Oculomotor
Nucleus

Somatomotor by Trochlear
Nucleus

Branchiomotor by Trigeminal
motor Nucleus

Somatomotor by Abducent
Nucleus
Branchiomotor by Facial
Nucleus

Branchiomotor via Ambiguous


Nucleus

Vagus Nerve (CN-X)

Salpingopharyngeal m. *
Palatoglossus m. *
Palatopharyngeus m. *
Levator Veli Palatini m.
Inferior Constrictor of
Pharynx m.
- Lower 1/2 of Middle
Constrictor of Pharynx
m.
- All Laryngeal Muscles
(Via Internal branch of
CN-XI)

Innervation Type & Nucleus

- Trapezius m.
- Sternocleidomastoid m.
Accessory Nerve (CN-XI)
- All Laryngeal Muscles
(Except

Branchiomotor via Ambiguous


Nucleus

Trapezius & SCM mm. :


Somatomotor via Spinal root
fibers (External fibers)
Laryngeal Muscles:
Branchiomotor via Ambiguous
Nucleus (Internal fibers,
cranial)

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Hypoglossal Nerve (CN-XII)

Hyoglossus m.
Styloglossus m.
Genioglossus m.
All Intrinsic muscles of
Tongue (Superior &
Inferior Longitudinal,
Vertical, Transverse)
- Thyrohyoid m. **
- Geniohyoid m. **

Somatomotor via Hypoglossal


Nucleus

* These muscles are more innervated by the Pharyngeal Plexus rather the Vagus itself
** These muscles receive innervation via C1 fibers carried by the Hypoglossal nerve

Haytham Bayadsi, 2009/2010

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