The Cranial Nerves &

Spinal nerves

Departemen Anatomi
Fakultas Kedokteran
USU
 Names of cranial nerves
• Ⅰ Olfactory nerve
• Ⅱ Optic nerve
• Ⅲ Oculomotor nerve
• Ⅳ Trochlear nerve
• Ⅴ Trigeminal nerve
• Ⅵ Abducent nerve
• Ⅶ Facial nerve
• Ⅷ Vestibulocochlear nerve
• Ⅸ Glossopharyngeal nerve
• Ⅹ Vagus nerve
• Ⅺ Accessory nerve
• Ⅻ Hypoglossal nerve
 Classification of cranial nerves
• Sensory cranial nerves: contain only afferent (sensory) fibers
– ⅠOlfactory nerve
– ⅡOptic nerve
– Ⅷ Vestibulocochlear nerve
• Motor cranial nerves: contain only efferent (motor) fibers
– Ⅲ Oculomotor nerve
– Ⅳ Trochlear nerve
– ⅥAbducent nerve
– Ⅺ Accessory nerv
– Ⅻ Hypoglossal nerve
• Mixed nerves: contain both sensory and motor fibers---
– ⅤTrigeminal nerve,
– Ⅶ Facial nerve,
– ⅨGlossopharyngeal nerve
– ⅩVagus nerve
 Sensory cranial nerves
N. Location of cell Cranial Terminal Main
body and axon exit nuclei action
categories
Ⅰ Olfactory cells Cribrifom Olfactory Smell
(SVA) foramina bulb
Ⅱ Ganglion cells Optic Lateral Vision
(SSA) canal geniculate
body
Ⅷ Vestibular Internal Vestibular Equilibri
ganglion(SSA) acoustic nuclei um
meatus
Cochlear Cochlear Hearing
ganglion (SSA) nuclei
 Olfactory nerve
Olfactory mucosa (SVA)→ Cribriform foramina → Olfactory bulb
 Optic nerve
Ganglion cell (SSA) → Optic canal → Lateral geniculate body
 Vestibulocochlear nerve
Vestibular ganglion(SSA) ↘ ↗ Vestibular nuclei
Internal acoustic meatus
Cochlear ganglion (SSA) ↗ ↘ Cochlear nuclei
 Motor cranial nerves
N. Nucleus of origin and Cranial exit Main action
axon categories
Ⅲ Nucleus of oculomotor Superior orbital Motot to superior, inferior
(GSE) fissure and medial recti; inferior
obliquus; levator
palpebrae superioris
Accessory nucleus of Parasympathetic to
oculomotor (GVE) sphincter pupillea and
ciliary muscl
Ⅳ Nucleus of trochlear Superior orbital Motor to superior obliquus
nerve (GSE) fissure
Ⅵ Nucleus of abducent Superior orbital Motor to lateral rectus
nerve (GSE) fissure
Ⅺ Nucleus of accessory Jugular foramen Motor to
nerve (SVE) sternocleidomastoid and
trapezius
Ⅻ Nucleus of hypoglossal Hypoglossal canal Motot to muscles of
nerve( GSE) tongue
 Oculomotor nerve
• Components
– General somatic efferent fibers (GSE)
– General visceral efferent fibers (GVE)
• Main action－supplies
– Superior, inferior and medial recti; inferior obliquus; levator palpebrae superioris
– Sphincter pupillea and ciliary muscle
• Ciliary ganglion: lies between optic nerve and lateral rectus

Oculomotor nerve
 Accessory nerve

Abducent nerve
 Hypoglossal nerve

Hypoglossal nerve
 Oculamotor paralysis

Abducent nerve injury

Mixed cranial nerves
 Trigeminal nerve
Components of fibers
• SVE fibers: originate from motor nucleus of
trigeminal nerve, and supply masticatory muscles
• GSA fibers: transmit facial sensation to sensory
nuclei of trigeminal nerve, the GSA fibers have their
cell bodies in trigeminal ganglion, which lies on the
apex of petrous part of temporal bone
Branches
• Ophthalmic nerve (Ⅴ1,
sensory) leave the skull
through the superior orbital
fissure, to enter orbital
cavity
• Branches
– Frontal nerve:
• Supratrochlear nerve
• Supraorbital nerve
– Lacrimal nerve
– Nasociliary nerve
Distribution:
• Sensation from cerebral
dura mater
• Visual organ
• Mucosa of nose
• Skin above the eye and
back of nose
Maxillary nerve (Ⅴ2,
sensory)
• Leave skull through
foramen rotundum
• Branches
– Infraorbital nerve
– Zygomatic nerve
– Superior alveolar nerve
– Pterygopalatine nerve
Distribution:
• Sensation from cerebral
dura mater
• Maxillary teeth
• Mucosa of nose and
mouth
• Skin between eye and
mouth
Mandibular nerve (Ⅴ3, mixed)
• Leave the skull through the foramen
ovale to enter the infratemporal
fossa
• Branches
– Auriculotemporal nerve
– Buccal nerve
– Lingual nerve
– Inferior alveolar nerve
– Nerve of masticatory muscles
Distribution:
• Sensation from cerebral dura
mater
• Teeth and gum of lower jaw
• Mucosa of floor of mouth
• Anterior 2/3 of tongue
• Skin of auricular and temporal
regions and below the mouth
• Motor to masticatory muscles,
mylohyoid, and anterior belly
of digastric
 Facial nerve (Ⅶ)
Components of fibers
• SVE fibers originate from nucleus of facial nerve, and supply facial
muscles
• GVE fibers derived from superior salivatory nucleus and relayed in
pterygopalatine ganglion and submandibular ganglion. The
postganglionic fibers supply lacrimal, submandibular and sublingual
glands
• SVA fiber from taste buds of anterior two-thirds of tongue which cell
bodies are in the geniculate ganglion of the facial nerve and end by
synapsing with cells of nucleus of solitary tract
• GSA fibers from skin of external ear
Course: leaves skull through
internal acoustic meatus,
facial canal and
stylomastoid foramen, it
then enters parotid gland
where it divides into five
branches which supply
facial muscles
Branches within the facial canal
• Chorda tympani : joins lingual branch of mandibular nerve
– To taste buds on anterior two-thirds of tongue
– Relayed in submandibular ganglion, the postganglionic fibers supply submandibular
and sublingual glands
• Greater petrosal nerve : GVE fibers pass to pterygopalatine ganglion and
there relayed through the zygomatic and lacrimal nerves to lacrimal gland
• Stapedial nerve : to stapedius
Branches outside of facial canal
• Temporal
• Zygomatic
• Buccal
• Marginal mandibular
• Cervical
• Pterygopalatine ganglion : lies in pterygopalatine fossa
under maxillary nerve
• Submandibular ganglion : lies between lingual nerve and
submandibular gland
Injury to the facial nerve
 Glossopharyngeal nerve (Ⅸ)
Components of fibers
• SVE fibers: originate from nucleus ambiguus, and supply
stylopharygeus
• GVE fibers: arise from inferior salivatory nucleus and ralyed in otic
ganglion, the postganglionic fibers supply parotid gland
• SVA fibers: arise from the cells of inferior ganglion, the central
processes of these cells terminate in nucleus of solitary tract, the
peripheral processes supply the taste buds on posterior third of
tongue
• GVA fibers: visceral sensation from mucosa of posterior third of
tongue, pharynx, auditory tube and tympanic cavity, carotid sinus
and glomus, and end by synapsing with cells of nucleus of solitary
tract
• GSA fibers: sensation from skin of posterior surface of auricle and
Course: leaves the skull via jugular foramen
Branches
• Lingual branches : to taste buds and mucosa of posterior third of tongue
• Pharyngeal branches : take part in forming the pharyngeal plexus
• Tympanic nerve : GVE fibers via tympanic and lesser petrosal nerves to
otic ganglion, with postganglionic fibers via auriculotemporal (Ⅴ3) to
parotid gland
• Carotid sinus branch : innervations to both carotid sinus and glomus
• Others: tonsillar and stylophayngeal branches
Otic ganglion : situated just below foramen ovale
 Vagus nerve (Ⅹ)
components of fibers
• GVE fibers: originate from dorsal nucleus of vagus
nerve, synapse in parasympathetic ganglion, short
postganglionic fibers innervate cardiac muscles,
smooth muscles and glands of viscera
• SVE fibers: originate from ambiguus, to muscles of
pharynx and larynx
• GVA fibers: carry impulse from viscera in neck,
thoracic and abdominal cavity to nucleus of solitary
tract
• GSA fiber: sensation from auricle, external acoustic
meatus and cerebral dura mater
Course
• Exits the skull from jugular foramen
• Descends in the neck in carotid sheath between internal
(or common) carotid artery and internal jugular vein
Right vagus nerve
• Enter thoracic inlet on right side of trachea
• Travels downward posterior to right brachiocephalic vein
and superior vena cava
• Passes posterior to right lung root
• Forms posterior esophageal plexus
• Forms posterior vagal trunk at esophageal hiatus where it
leaves thorax and passes into abdominal cavity, then
divides into posterior gastric and celiac branches
Left vagus nerve
• Enter thoracic inlet between left common carotid
and left subclavian arteries, posterior to left
brachiocephalic vein
• Crosses aortic arch where left recurrent laryngeal
nerve branches off
• Passes posterior to left lung root
• Forms anterior esophageal plexus
• Forms anterior vagal trunk at esophageal hiatus
where it leaves thorax and passes into abdominal
cavity , then divides into anterior gastric and
hepatic branches
Branches in neck
• Superior laryngeal nerve: passes down side
of pharynx and given rise to
– Internal branch, which pierces thyrohyoid
membrane to innervates mucous membrane of
larynx above fissure of glottis
– External branch, which innervates cricothyroid
• Cervical cardiac branches : descending to
terminate in cardiac plexus
• Others: auricular, pharyngeal and
meningeal branches
 Superior laryngeal nerve

Internal branch

External branch
Branches in thorax
• Recurrent laryngeal nerves
– Right one hooks around right subclavian
artery, left one hooks aortic arch
– Both ascend in tracheo-esophageal groove
– Nerves enter larynx posterior to
cricothyroid joint, the nerve is now called
inferior laryngeal nerve
– Innervations: laryngeal mucosa below
fissure of glottis , all laryngeal laryngeal
muscles except cricothyroid
• Bronchial and esophageal branches
Branches in abdomen
• Anterior and posterior gastric
branches
– Run close to lesser curvature and
innervate anterior and posterior
surfaces of stomach
– As far as pyloric antrum to fan out
into branches in a way like the
digits of a crow’s foot to supply
pyloric part
• Hepatic branches: join hepatic
plexus and then supply liver and
gallbladder
• Celiac branches: send branches to
celiac plexus to be distributed with
sympathetic fibers to liver,
pancreas, spleen, kidneys, intestine
as far as left colic flexure
 Spinal Nerves

 Thirty-one pairs of spinal

nerves
 First pair exit vertebral
column between skull and
atlas (C1)
 Last four pair exit via the
sacral foramina
 Others exit through
intervertebral foramina
 Eight pair cervical, twelve
pair thoracic, five pair
lumbar, five pair sacral,
one pair coccygeal
 Dermatomal Map
 Spinal nerves indicated by capital letter and number
 Dermatomal map: skin area supplied with sensory
innervation by spinal nerves
 Spinal Nerves
 Medially, give rise to the roots
that attach the nerve to the s.c.
 Laterally, give rise to the rami
that innervate the dorsal and
ventral regions of the body
› Dorsal ramus
 Contains both sensory
and motor neurons that
innervate the dorsal
regions of the body
› Ventral ramus
 Contains both sensory
and motor neurons that
innervate the ventral
regions of the body
 Braid together to form
plexuses (plexi)
 • Dorsal Ramus: innervate deep muscles of the trunk
Branches of responsible for movements of the vertebral
Spinal Nerves column and the C.T. and skin near the midline of
the back.
• Ventral Ramus: what they innervate depends upon
which part of the spinal cord is considered.
– Thoracic region: form intercostal nerves that
innervate the intercostal muscles and the skin
over the thorax
– Remaining spinal nerve ventral rami form five
plexuses (intermingling of nerves).
• Ventral rami of C1-C4= cervical plexus
• Ventral rami of C5-T1= brachial plexus
• Ventral rami of L1-L4= lumbar plexus
• Ventral rami of L4-S4= sacral plexus
• Ventral rami of S4 and S5= coccygeal
plexus
• Communicating Rami: communicate with
sympathetic chain of ganglia.
Cervical Plexus
• Formed by ventral rami of
spinal nerves C1-C4
• Motor: Innervates muscles
of the neck (SCM, trapezius),
laryngeal muscles
• Sensory: Skin of upper chest,
shoulder, neck, and ear
• Phrenic nerve
– From C3-C5 (cervical and
brachial plexuses)
– Innervates diaphragm
Brachial Plexus
• Formed by ventral rami of
spinal nerves C5-T1
• Five ventral rami form three
trunks that separate into six
divisions then form cords
that give rise to: (RTDC)
• Branches/nerves
– Axillary
– Radial
– Musculocutaneous
– Ulnar
– Median
Brachial Plexus: Axillary Nerve
• Motor: Innervates deltoid and
teres minor
– Deltoid - Abducts arm
– Teres - Laterally rotate arm
• Sensory: from skin of the lateral
shoulder
Brachial Plexus: Radial Nerve
• Motor: Stimulates extensor muscles of arm,
forearm, and hand
– Triceps, supinator, brachioradialis, ECR, ECU,
and some extensors of the fingers (extensor
digitorum)
– Cause extension movements at elbow and
wrist, thumb movements
• Sensory: From skin on posterior surface of
arm and forearm, lateral 2/3 of dorsum of
hand
• Damage due to compression results in crutch
paralysis
• Major symptom is ‘wrist drop’
– Failure of extensors of wrist and fingers to
function
– Elbow, wrist, and fingers constantly flexed
 Brachial Plexus:
Musculocutaneous Nerve
• Motor: Stimulates flexors in
anterior arm: (biceps brachii,
brachialis)
– Causes flexion movements at
shoulder and elbow
• Sensory: From skin along lateral
surface of forearm
Brachial Plexus: Ulnar Nerve
• Motor: Stimulates flexor
muscles in anterior forearm
(FCU, FDP, most intrinsic
muscles of hand)
– Results in wrist and finger
flexion
• Sensory: From skin on medial
surface of hand, little finger,
and medial surface of ring
finger
• Most easily damaged
– Hitting the “funny bone” excites
it
Brachial Plexus: Median Nerve
 Motor: Innervates all but one
of the flexors of the wrist and
fingers, and thenar muscles
at base of thumb (Palmaris
longus, FCR, FDS, FPL,
pronator)
› Causes flexion of the wrist and
fingers and thumb
 Sensory: From skin of
anterolateral 2/3 palm,
thumb, index and middle
fingers; lateral surface of ring
finger
 Damaged in carpal tunnel and
suicide attempts
 Lumbosacral Plexus
 Lumbar plexus: formed by
ventral rami of spinal nerves
L1-L4
 Sacral plexus: formed by
ventral rami of L4-S4
 Usually considered together
because of their close
relationship
 Four major nerves exit and
enter lower limb
› Obturator
› Femoral
› Tibial
› Common fibular (peroneal)
Lumbar Plexus:Obturator Nerve

• Motor: Innervates adductor

group and gracilis
– Causes adduction of the thigh
and knee (gracilis)
• Sensory: From skin of the
superior medial side of
thigh
Lumbar Plexus: Femoral Nerve
• Motor:
– Innervates anterior muscles of
thigh
• Quadriceps group and sartorius
• Cause extension of the knee
– Innervates flexors and
adductors of hip: Pectineus and
Iliopsoas
• Cause flexion of the hip
• Sensory: From skin of the
anterior and lateral thigh;
medial surface of leg and foot
Sacral Plexus: Sciatic Nerve
• Thickest and longest nerve of the body
• Innervates posterior thigh and entire lower
leg
• Composed of 2 nerves (tibial n. and common
fibular nerve (or peroneal nerve) in a
common sheath)
– Leaves pelvis via greater sciatic notch
– Courses deep to gluteus and enters
posterior thigh just medial to the hip
joint
• The 2 divisions diverge just above the knee.
• Sciatic Nerve Injury
• May be due to fall, disc herniation, impro-per
administration of injection into buttock
• When transected, leg is nearly useless
• Leg cannot be flexed (hamstrings
paralyzed)
• All foot and ankle movement is lost
• Foot drops into plantar flexion (footdrop)
Tibial Nerve
•Tibial
– Innervates muscles of:
– Posterior thigh -hamstrings
(knee flexors, hip extensors)
– Posterior leg(gastrocnemius, -
plantar flexors; FDL, FHL - toe flexors)
– Branches in foot to form medial and lateral
plantar nerves
• Tibial nerve injury, paralyzed calf
muscles
- cannot plantar flex foot;shuffling
gait develops
Common Fibular (Peroneal) Nerve
• Common Fibular Nerve
– Innervates anterior and lateral muscles
of the leg and foot
• Extensors that dorsiflex the foot-
Tibialis anterior, EDL, EHL)
– Sensory: From skin of the lateral and
anterior leg and dorsum of the foot.
• Common fibular nerve is susceptible to injury
because of its superficial location at the head
and neck of the fibula.
– Tight leg cast, remaining too long in a side-
lying position on a firm mattress may
compress this nerve and result in
footdrop
 Other Nerves of the Lumbosacral Plexus

• Nerves that innervate the skin of the suprapubic area,

external genitalia, superior medial thigh, posterior thigh
– Iliohypogastric nerve - Muscles of abdominal wall and
pubic region
– Genitofemoral nerve - Skin of scrotum (males) and
labia (females); inferior abdominal muscles
– Pudendal nerve - innervates muscles and skin of the
perineum (region encompasssing external genitalia
and anus); external anal sphincter; mediates
erection, and is involved in voluntary control of
urination; the “shameful” nerve
 Coccygeal Plexus
• S4-S5; coccygeal nerve
• Muscles of pelvic floor
• Sensory information from skin over coccyx
 Nature of Somatic Reflexes
• Quick, involuntary, stereotyped reactions of glands or
muscle to sensory stimulation
– automatic responses to sensory input that occur without our
intent or often even our awareness
• Functions by means of a somatic reflex arc
– stimulation of somatic receptors
– afferent fibers carry signal to dorsal horn of spinal cord
– one or more interneurons integrate the information
– efferent fibers carry impulses to skeletal muscles
– skeletal muscles respond
 The Muscle Spindle

 Sense organ (proprioceptor) that monitors length of muscle and

how fast muscles change in length
 Composed of intrafusal muscle fibers, afferent fibers and gamma
motorneurons
Stretch Reflex
Flexor Withdrawal Reflexes

• Occurs during
withdrawal of foot
from pain
• Polysynaptic reflex
arc
• Neural circuitry in
spinal cord controls
sequence and
duration of muscle
contractions
Crossed Extensor Reflexes
• Maintains balance by
extending other leg
• Intersegmental reflex extends
up and down the spinal cord
• Contralateral reflex arcs
explained by pain at one foot
causes muscle contraction in
other leg
Relationship of Brain and Spinal Cord
Reflexes
• Sensory information goes
to brain; e.g., pain.
• Descending tracts convey
motor impulses from
brain to effectors.