NERVE

PARENT NERVE

MOTOR INNERVATION Lateral Rectus muscle of the eye

SENSORY INNERVATION

PATHWAY / DESCRIPTION / CLINICAL / NOTES / ETC

Abducens (CN VI) Ansa Cervicales Anterior Ethmoidal Auriculotemporal Cervical Plexus ---> Ansa Cervicales; Hypoglossal (XII) --> Ansa Cervicales Trigeminal (V) ---> Ophthalmic (V1) ---> Nasociliary ---> Anterior Ethmoidal Trigeminal (V) ---> Mandibular (V3) ---> Auriculotemporal Trigeminal (V) ---> Mandibular (V3) ---> Buccal Facial (VII) ---> Chorda Tympani

Strap (Infrahyoid) muscles External Nose, anterior nasal cavity Parasympathetic secretomotor to Parotid Gland via LESSER PETROSAL (IX) Outer ear and temporal region. Cheek and oral mucosa Parasympathetic secretomotor innervation to submandibular and sublingual glands Taste to anterior 2/3 of tongue

Runs through the CAVERNOUS SINUS IN THE MIDDLE -- NOT ALONG THE LATERAL WALL; Injury = eye on affected side rotates inward Superior (C1-C2) hitch along Hypoglossus (XII) to innervate Strap Muscles Gives off internal and external nasal branches to supply sensory innervation to nose Gives off Superficial Temporal Branches to supply sensory to the temporal region going up the side of the head; Receives parasympathetic fibers from Lesser Petrosal via OTIC GANGLION; It wraps around the MIDDLE MENINGEAL ARTERY Runs parallel with the Parotid duct One of the two parasympathetic branches of Facial N. (VII); Taste innervation excludes the Circumvallate Papillae; Exits middle ear out the PETROTYMPANIC FISSURE, before the Facial Canal. Then it synapses in SUBMANDIBULAR GANGLION, where it (1) joins up with Lingual N. (V3) to provide taste, and (2) sends secretomotor branches to target glands Carries SYMPATHETIC innervation from the Internal Carotid Plexus; Joins with Greater Petrosal to form Nerve of Pterygoid Canal; passes through the Sphenopalatine Ganglion but does NOT SYNAPSE; Gives branches to Nasopalatine N. Given off of the Superior Laryngeal Nerve while it is within the CAROTID SHEATH Has anastomotic branches from both Ophthalmic (via Anterior Ethmoidal and Infratrochlear) and Maxillary (via Infraorbital) branches of the Trigeminal

Buccal Chorda Tympani

Deep Petrosal Nerve

Internal Carotid Plexus ---> Deep Petrosal Vagus (X) ---> Superior Laryngeal ---> External Laryngeal Trigeminal (V) ---> Ophthalmic (V1) ---> Nasociliary ---> Anterior Ethmoidal ---> External Nasal; Trigeminal (V) ---> Maxillary (V2) ---> Infraorbital --> External Nasal

Sympathetic (inhibitory) to nasal mucosa and lacrimal glands Inferior Pharyngeal Muscle and Cricothyroid External surface of nose

External Laryngeal External Nasal

Facial (CN VII)

BRANCHIAL motor (Arch II) to all muscles of facial expression; Secretomotor to all glands in head EXCEPT Parotid; Stapedius muscle

Taste to anterior 2/3 of tongue (SVA); Somatic sensation to ear canal and ear drum

TASTE Cell bodies are housed in GENICULATE GANGLION; Passes through Parotid Gland but does not innervate it; BELL'S PALSY = loss of facial expression; Branchial motor branches go out the STYLOMASTOID FORAMEN, and secretomotor branches DON'T.

Frontal Glossopharyngeal (CN IX)

Trigeminal (V) ---> Ophthalmic (V1) ---> Frontal Parasympathetic secretomotor to Parotid Gland; BRANCHIAL motor to Stylopharyngeus Muscle (Branchial Arch III) Taste to posterior 1/3 of tongue; Somatic sensation to posterior tongue, pharynx, and inner part of ear; Visceral Sensation to baroreceptors in the CAROTID SINUS; Somatic sensation to tympanic membrane External ear, region inferior to ear Back of neck Parasympathetic secretomotor to nasal mucosa and lacrimal glands All intrinsic and extrinsic muscles of the tongue, EXCEPT the Palatoglossus Mylohyoid and Anterior Belly of Digastric Mandibular (lower) teeth

Gives off Supratrochlear and Supraorbital branches. Exits Posterior Cranial Fossa through JUGULAR FORAMEN; Damage may ruin sensory to Oropharynx, which impairs SWALLOWING REFLEX; The nerve travels adhered to the STYLOPHARYNGEUS MUSCLE, then penetrates pharynx between Superior and Middle Constrictor muscles; Watch it when performing TONSILLECTOMY

Great Auricular Greater Occipital Greater Petrosal Nerve Hypoglossal (CN XII) Inferior Alveolar

Cervical Plexus (C2-C3) ---> Great Auricular Cervical Dorsal Primary Ramus (C1) ---> Greater Occipital Facial (VII) ---> Greater Petrosal

Trigeminal (V) ---> Mandibular (V3) ---> Inferior Alveolar

Infraorbital Infratrochlear Internal Laryngeal Internal Nasal, Medial and Lateral Lacrimal

Trigeminal (V) ---> Maxillary (V2) Trigeminal (V) ---> Ophthalmic (V1) ---> Nasociliary ---> Infratrochlear Vagus (X) ---> Superior Laryngeal ---> Internal Laryngeal Trigeminal (V) ---> Ophthalmic (V1) ---> Nasociliary ---> Anterior Ethmoidal ---> Internal Nasal Trigeminal (V) ---> Ophthalmic (V1) ---> Frontal ---> Lacrimal

Cutaneous region beneath the eyes; external nose via External Nasal Inferomedial orbit, sometimes external nose via External Nasal Visceral sensory from larynx and laryngeal mucosa in Supraglottic Cavity Internal surface of nose, lower dorsum of nose Parasympathetic secretomotor to Lacrimal glands via GREATER PETROSAL VII)

2nd nerve to penetrate investing fascia of Posterior Triangle of neck; Crosses Sternocleidomastoid and heads upward and toward anterior triangle Distinguished from Lesser Occipital in that it is DORSAL PRIMARY RAMUS; Penetrates Trapezius to innervate back of neck One of the two parasympathetic branches of the Facial N,; Forms Nerve of Pterygoid Canal; synapses in PTERYGOPALATINE GANGLION, then gives branches to Nasopalatine N. (from V2) Exits the posterior cranial fossa through HYPOGLOSSAL CANAL; a portion of Ansa Cervicales hangs off the Hypoglossal but does not intermix with it. Can be found lateral to and below the tongue, near the Lingual Nerve The continuation of the mandibular branch of the Trigeminal, after it has exited through FORAMEN OVALE. It reaches the lower teeth through the MANDIBULAR FORAMEN; Gives off a MYLOHYOID nerve and INCISIVE nerve to incisor teeth and continues onto Mental Foramen and out as Mental Nerve Exits INFRAORBITAL FORAMEN; gives off Superior Alveolar and External Nasal branches Divides into Internal and External nasal branches; it is the primary SENSORY supplier to the external nose Passes between the MIDDLE and INFERIOR pharyngeal constrictors; Pierces the THYROHYOID MEMBRANE The Lateral Internal Nasal nerve continues to become the External Nasal Nerve, to innervate the tip of the nose Parasympathetic fibers originate from the Greater Petrosal Nerve, which joins with the Ophthalmic (V1) in the orbit

Lesser Occipital Lesser Petrosal

Cervical Plexus (C2-C3) ---> Lesser Occipital Glossopharyngeal (IX) ---> Tympanic ---> Lesser Petrosal Trigeminal (V) ---> Mandibular (V3) ---> Lingual Trigeminal (V) ---> Ophthalmic (V1) ---> Nasociliary ---> Long Ciliary Trigeminal (V) ---> Mandibular (V3)

Posterior to ear and back of neck Secretomotor to Parotid Gland

1st nerve to penetrates investing fascia of Posterior Triangle of neck Passes out the LESSER PETROSAL HIATUS of Temporal Bone, then passes forward and out FORAMEN OVALE; Synapses in OTIC GANGLION, and then innervates the Parotid Gland via Auriculotemporal Nerve (V3) Chorda Tympani (from CN VII) joins the Lingual Nerve to provide the SVA fibers to the tongue; it wraps around the Submandibular Duct in the mouth Carries SYMPATHETIC innervation from the Internal Carotid Plexus to the dilator muscle from the sympathetic Internal Carotid Plexus Sensory components exit through FORAMEN OVALE of the Sphenoid; motor components do not; It is the only branch of CN IIIVI to NOT go through cavernous sinus Exits skull through FORAMEN ROTUNDUM to enter Sphenopalatine Fossa; Sensory innervation to nasopharynx is important during SWALLOWING; Branches into Zygomatic, Posterior Superior Alveolar, Greater and Lesser Palatine, and Nasopalatine branches; Runs through CAVERNOUS SINUS along lateral wall Ultimately from Mandibular (V3), a terminal branch of the Inferior Alveolar past the MENTAL FORAMEN of the mandible Runs along the medial side of the orbit, and divides into anterior ethmoidal and infratrochlear. It also gives off posterior ethmoidal; it is the sensory root to the CILIARY GANGLION Receives Greater Petrosal and Deep Petrosal fibers from SPHENOPALATINE GANGLION; Enters nasal cavity through SPHENOPALATINE FORAMEN, where it gives off lateral and septal branches to nose; Continues through INCISIVE FORAMEN along the SEPTAL WALL, to innervate anterior hard palate Enters the orbit through the SUPERIOR ORBITAL FISSURE; Synapses in Ciliary Ganglion; Carries PARASYMPATHETIC innervation to the Sphincter Pupillae and Ciliary Muscles; Runs through the CAVERNOUS SINUS along the lateral wall Cell bodies are in Olfactory Mucosa of Superior Conchae; axons go through CRIBRIFORM PLATE of Ethmoid; Then they go back to CNS along OLFACTORY TRACTS

Lingual

Long Ciliary Mandibular (V3)

SYMPATHETIC to the Dilator Pupillae Muscle, via Internal Carotid Plexus BRANCHIAL motor to Muscles of Mastication; Tensor Tympani; Tensor Palati; Mylohyoid and Anterior Belly of Digastric

Somatic sensation to anterior 2/3 of tongue; Taste to anterior 2/3 via the Chorda Tympani Pain information from the surface of the Cornea Somatic sensation to anterior 2/3 of tongue; cutaneous chin; mandibular teeth Cutaneous upper lip, nose, and infraorbital region; maxillary teeth; Nasopharynx; Soft Palate Cutaneous chin, lower lip, and side of mandible Nose, and pain information from cornea

Maxillary (V2)

Trigeminal (V) ---> Maxillary (V2)

Mental Nasociliary Nasopalatine

Trigeminal (V) ---> Mandibular (V3) ---> Inferior Alveolar ---> Mental Trigeminal (V) ---> Ophthalmic (V1) ---> Nasociliary Trigeminal (V) ---> Maxillary (V2) ---> Nasopalatine Both parasympathetic and sympathetic to Nasal Mucosa, via GREATER PETROSAL (VII) and DEEP PETROSAL, respectively Extrinsic eye muscles, EXCEPT Lateral Rectus and Superior Oblique; Intrinsic Sphincter Pupillae and Ciliary Muscles

Anterior potion of hard palate behind incisors (front teeth); perhaps some internal nasal cavity

Oculomotor (CN III)

Olfactory (CN I)

Olfaction

Ophthalmic Optic (CN II) Palatine, Greater and Lesser Pharyngeal Phrenic Recurrent Laryngeal Short CIliary

Trigeminal (V) ---> Ophthalmic (V1)

Cutaneous nose, supraorbital region, and forehead Sight

Trigeminal (V) ---> Maxillary (V2) ---> Infraorbital ---> Descending Palatine Vagus (X) ---> Pharyngeal Cervical Plexus (C3-C5) ---> Phrenic Vagus (X) ---> Recurrent Laryngeal Trigeminal (V) ---> Ophthalmic (V1) ---> Nasociliary ---> Short Ciliary

Hard and soft palate, lateral nasal wall Branchial motor to all muscles of the pharynx and soft palate Diaphragm All intrinsic muscles of the Larynx EXCEPT the Cricothyroid Parasympathetic to Constrictor Pupillae and Ciliary Muscle, via OCULOMOTOR (III). Also carried SYMPATHETICS Trapezius and Sternocleidomastoid BRANCHIAL Muscles Laryngeal Mucosa in Infraglottic Cavity

Runs through the CAVERNOUS SINUS along the lateral wall; Synapses in CILIARY GANGLION. Enters the orbit in the SUPERIOR ORBITAL FISSURE Enters the orbit through the OPTIC CANAL, in the Lesser Wing of the Sphenoid; The optic nerve is only that portion between the eye and the Optic Chiasm; TUNNEL VISION = lesion at Optic Chiasm Also called descending Palatine Branches of the Infraorbital; Goes through PALATINE FORAMEN to reach hard palate in back of mouth Enters the pharynx between the superior and middle pharyngeal constrictors It is plastered on top of the Anterior Scalene muscle Travels under Subclavian Artery and the right side, and under the Aortic Arch on the left side; can be found inferior to the Inferior Pharyngeal Constrictor; Easily damaged due to long course Receives PARASYMPATHETIC fibers from the Oculomotor (III), via the Ciliary Ganglion. Also some sensory to the cornea + sympathetic to dilator Cell Bodies are in SPINAL CHORD (C1-C5): They enter skull through FORAMEN MAGNUM, and then exit again through JUGULAR FORAMEN. Gives off Anterior, Middle (through infraorbital sulcus) and Posterior (in pterygopalatine fossa) branches Divides into Internal Laryngeal and External Laryngeal branches; Damage can be tested by touching laryngeal mucosa to test for sensation

Spinal Accessory (CN XI) Superior Alveolar Superior Laryngeal Supraorbital Supratrochlear Supraclavicular Transverse Cervical Trigeminal (V) ---> Maxillary (V2) ---> Infraorbital ---> Superior Alveolar Vagus (X) ---> Superior Laryngeal Trigeminal (V) ---> Ophthalmic (V1) ---> Frontal ---> Supraorbital Trigeminal (V) ---> Ophthalmic (V1) ---> Frontal ---> Supratrochlear Cervical Plexus (C3-C4) ---> Supraclavicular Cervical Plexus (C2-C3) ---> Transverse Cervical

Maxillary teeth Inferior Pharyngeal Muscle and Cricothyroid Visceral sensory from larynx, via the Internal Laryngeal Cutaneous region above the eyes Superolateral portion of orbit Anterolateral shoulder, clavicular region Neck around sternocleidomastoid

4th nerve to penetrate investing fascia of Posterior Triangle of neck; heads downward and anteriorly 3rd nerve to penetrate investing fascia of Posterior Triangle of neck; Crosses Sternocleidomastoid and heads directly anteriorly.

Trigeminal (CN V)

BRANCHIAL motor (Arch I)

All sensory innervation for

The four parasympathetic ganglia hang off the various branches of

Trochlear (CN IV)

to Muscles of Mastication; Tensor Tympani; Tensor Palati; Mylohyoid and Anterior Belly of Digastric Superior Oblique muscle of the eye Glossopharyngeal (IX) ---> Tympanic Secretomotor to Parotid Gland BRANCHIAL (Arches IV-VI) motor to all muscles of larynx, pharynx, and palate, EXCEPT Stylopharyngeus and Tensor Veli Palati; Parasympathetics to Thoracic and Abdominal viscera

the face

the trigeminal; Divides into three principle branches: Opthalmic (V1), Maxillary (V2), and Mandibular (V3) It is easily injured due to its long tortuous path (it arises from opposite side of brain and exits dorsally); it is difficult to test due to redundant action; Runs through CAVERNOUS SINUS along lateral wall Given off from CN IX at Jugular Foramen; forms TYMPANIC PLEXUS; Exits out LESSER PETROSAL HIATUS, after which it is known as Lesser Petrosal Nerve Exits posterior cranial fossa through JUGULAR FORAMEN; Travels in CAROTID SHEATH; Some say Vagus carries SVA taste fibers from a few taste buds in the tongue; Superior and Inferior Vagus Ganglia house SENSORY cell bodies, located inside and just beneath the Jugular Foramen, respectively Really two nerves: Auditory innervates the cochlea and Vestibular innervates the semi-circular canals; exits cranium through INTERNAL ACOUSTIC MEATUS Goes through PTERYGOID CANAL to PTERYGOPALATINE GANGLION, and on to innervate nasal + lacrimal glands via nasopalatine and lacrimal nerves, respectively; Parasympathetic from Greater Petrosal (VII) and sympathetic from Deep Petrosal Splits into zygomaticofacial and zygomaticotemporal branches; carries PARASYMPATHETICS to the lacrimal glands for a short time, before they join with the Lacrimal N. Goes out ZYGOMATICOFACIAL FORAMEN, in the prominence of the Zygomatic bone, right past Pterygopalatine Ganglion Goes out ZYGOMATICOFACIAL FORAMEN, right past Pterygopalatine Ganglion

Tympanic Vagus (CN X)

Vestibulocochlear (CN VIII) Vidian's (Nerve of Pterygoid Canal) Zygomatic Zygomaticofacial Zygomaticotemporal FACIAL (VII) ---> Greater Petrosal; and INTERNAL CAROTID PLEXUS ---> Deep Petrosal Trigeminal (V) ---> Maxillary (V2) ---> Zygomatic Trigeminal (V) ---> Maxillary (V2) ---> Zygomatic ---> Zygomaticofacial Trigeminal (V) ---> Maxillary (V2) ---> Zygomatic ---> Zygomaticotemporal Nasal, Lacrimal.

Visceral from part of tongue, pharynx and larynx, lungs and heart, CAROTID BODY, stomach; General sensory from larynx, pharynx, and part of external auditory canal Visceral sensory from Semicircular Canals, Utricle, and Saccule; SSA from cochlea = Hearing

Parasympathetics to the Lacrimal Glands

Facial and temporal regions inferolateral to eyes Facial (anterior) part of Zygomatic arch Temporal (posterior) part of Zygomatic arch