Dr.

Sami Zaqout

Dr. Sami Zaqout

Faculty of Medicine

IUG

Dr. Sami Zaqout

Faculty of Medicine

IUG

I Sensory II VIII III IV Motor VI XI

Cranial Nerves

XII
V Mixed VII IX X
Dr. Sami Zaqout Faculty of Medicine IUG

Olfactory Nerves
Olfactory receptor nerve cells Olfactory bulb in the cranial cavity Olfactory tract Olfactory area of the cerebral cortex

Dr. Sami Zaqout

Faculty of Medicine

IUG

Olfactory Nerves

Dr. Sami Zaqout

Faculty of Medicine

IUG

Olfactory area of the cerebral cortex

Dr. Sami Zaqout

Faculty of Medicine

IUG

Testing the Integrity of the Olfactory Nerve

The olfactory nerve can be tested by applying substances with different odors to each nostril in turn. Fractures of the anterior cranial fossa or cerebral tumors of the frontal lobes may produce lesions of the olfactory nerves, with consequent loss of the sense of smell (anosmia).

Dr. Sami Zaqout

Faculty of Medicine

IUG

Optic Nerve
Ganglionic layer of the retina Optic nerve Optic chiasma Optic tract Lateral geniculate body Optic radiation Visual area of the cerebral cortex

Dr. Sami Zaqout

Faculty of Medicine

IUG

Visual area of the cerebral cortex

Dr. Sami Zaqout

Faculty of Medicine

IUG

Light reflexes
A few fibers pass to the pretectal nucleus and the superior colliculus and are concerned with light reflexes.

Dr. Sami Zaqout

Faculty of Medicine

IUG

Testing the Integrity of the Optic Nerve

Changes in eyesight Acuity of vision Retinas and optic discs Visual fields

Dr. Sami Zaqout

Faculty of Medicine

IUG

Testing the Integrity of the Optic Nerve (Optic Disc)

A rise in cerebrospinal fluid pressure in the subarachnoid space will compress the thin walls of the retinal vein as it crosses the space, resulting in congestion of the retinal veins, edema of the retina, and bulging of the optic disc (papilledema).

Dr. Sami Zaqout

Faculty of Medicine

IUG

Testing the Integrity of the Optic Nerve (Visual fields)

It is important not to miss loss or impairment of vision in the central area of the field (central scotoma).

Dr. Sami Zaqout

Faculty of Medicine

IUG

Motor cranial nerves

Dr. Sami Zaqout

Faculty of Medicine

IUG

Oculomotor Nerve
Emerges on the anterior surface of the midbrain Between the posterior cerebral and superior cerebellar arteries Middle cranial fossa in the lateral wall of the cavernous sinus Divides into a superior and an inferior ramus Enter the orbital cavity through the superior orbital fissure

Dr. Sami Zaqout

Faculty of Medicine

IUG

Oculomotor Nerve Paralysis

The eye cannot be moved upward, downward, or inward. At rest the eye looks laterally (external strabismus) because of the activity of the lateral rectus and downward because of the activity of the superior oblique. The patient sees double (diplopia). Drooping of the upper eyelid (ptosis) occurs because of paralysis of the levator palpebrae superioris. The pupil is widely dilated and nonreactive to light because of the paralysis of the sphincter pupillae and the unopposed action of the dilator pupillae (supplied by the sympathetic). Accommodation of the eye is paralyzed.
Dr. Sami Zaqout Faculty of Medicine IUG

Trochlear Nerve
The most slender of the cranial nerves Crossed the nerve of the opposite side Leaves the posterior surface of the midbrain Middle cranial fossa in the lateral wall of the cavernous sinus Enters the orbit through the superior orbital fissure

Dr. Sami Zaqout

Faculty of Medicine

IUG

Trochlear Nerve Paralysis

The patient complains of double vision on looking straight downward. This is because the superior oblique is paralyzed and the eye turns medially as the inferior rectus pulls the eye downward.

Dr. Sami Zaqout

Faculty of Medicine

IUG

Abducent Nerve
Small nerve Emerges from the anterior surface of the hindbrain between the pons and the medulla oblongata Passes forward with the internal carotid artery through the cavernous sinus in the middle cranial fossa Enters the orbit through the superior orbital fissure

Dr. Sami Zaqout

Faculty of Medicine

IUG

Abducent Nerve Paralysis

the patient cannot turn the eyeball laterally. When looking straight ahead, the lateral rectus is paralyzed, and the unopposed medial rectus pulls the eyeball medially, causing internal strabismus.

Dr. Sami Zaqout

Faculty of Medicine

IUG

Trigeminal Nerve
The largest cranial nerve 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, to reach the apex of the petrous part of the temporal bone in the middle cranial fossa Here, the large sensory root expands to form the trigeminal ganglion The trigeminal ganglion lies within a pouch of dura mater called the trigeminal cave. The motor root of the trigeminal nerve is situated below the sensory ganglion and is completely separate from it
Dr. Sami Zaqout Faculty of Medicine IUG

Trigeminal Nerve
The trigeminal nerve is the main sensory nerve of the head and innervates the muscles of mastication. It also tenses the soft palate and the tympanic membrane.

Dr. Sami Zaqout

Faculty of Medicine

IUG

Ophthalmic Nerve (V1)

Trigeminal Nerve

Maxillary Nerve (V2) Mandibular Nerve (V3)

Dr. Sami Zaqout

Faculty of Medicine

IUG

Lacrimal Nerve Supratrochlear n Frontal Nerve Supraorbital n Ophthalmic Nerve (V1) Communicating branch Long ciliary nn Nasociliary Nerve Infratrochlear n Posterior ethmoidal n Anterior ethmoidal n
Dr. Sami Zaqout Faculty of Medicine IUG

Internal nasal branches External nasal n

Ophthalmic Nerve (V1) Lacrimal and Frontal Nerves

21 Lacrimal Nerve 23 Frontal Nerve 22 Communicating ramus with zygomatic nerve. 24 Supraorbital nerve 27 Supratrochlear nerve

Dr. Sami Zaqout

Faculty of Medicine

IUG

Ophthalmic Nerve (V1) Nasociliary Nerves

1 Nasociliary nerve 2 Communicating branch with ciliary ganglion 3 Long ciliary nerves 4 Posterior ethmoidal nerve 5 Anterior ethmoidal nerve 11 Infratrochlear nerve

Dr. Sami Zaqout

Faculty of Medicine

IUG

Nasociliary Nerve
7 Internal nasal branches 10 External nasal branch

Dr. Sami Zaqout

Faculty of Medicine

IUG

Meningeal branches

Zygomatic branch

Ganglionic branches

Maxillary Nerve (V2)

Posterior superior alveolar n

Middle superior alveolar n

Anterior superior alveolar n

Dr. Sami Zaqout Faculty of Medicine IUG

Maxillary Nerve (V2)

Dr. Sami Zaqout

Faculty of Medicine

IUG

Pterygopalatine Ganglion
Parasympathetic ganglion suspended from the maxillary nerve in the pterygopalatine fossa. It is secretomotor to the lacrimal and nasal glands Branches Orbital branches
Enter the orbit through the inferior orbital fissure

Greater and lesser palatine nerves

Supply the palate, the tonsil, and the nasal cavity

Pharyngeal branch
Supplies the roof of the nasopharynx
Dr. Sami Zaqout Faculty of Medicine IUG

Pterygopalatine Ganglion

Dr. Sami Zaqout

Faculty of Medicine

IUG

Meningeal branch

Main Trunk
Nerve to the medial pterygoid muscle Masseteric nerve Deep temporal nerves

Mandibular Nerve (V3)

Anterior Division Nerve to the lateral pterygoid muscle Buccal nerve Auriculotemporal nerve Lingual nerve Posterior Division Inferior alveolar nerve Communicating branch Mylohyoid nerve

Dr. Sami Zaqout

Faculty of Medicine

IUG

Mandibular Nerve (V3)

13 Mandibular nerve 14 Meningeal branch 15 Masseteric nerve 16 Deep temporal nerves 17 Nerve to lateral pterygoid 18 Nerve to medial pterygoid 23 Buccal nerve 24 Auriculotemporal nerve
Dr. Sami Zaqout Faculty of Medicine IUG

Lingual nerve

1 Lingual nerve 3 Communicating rami to the hypoglossal nerve 4 Communicating ramus to the chorda tympani 5 Sublingual nerve 6 Lingual branches 8 Submandibular ganglion 9 Inferior alveolar nerve 10 Mylohyoid nerve
Dr. Sami Zaqout Faculty of Medicine IUG

Injury to the Lingual Nerve

The lingual runns beneath the origin of the superior constrictor muscle, which is attached to the posterior border of the mylohyoid line on the mandible. Here, it is closely related to the last molar tooth and is liable to be damaged in cases of clumsy extraction of an impacted third molar.
Dr. Sami Zaqout Faculty of Medicine IUG

Inferior alveolar nerve

1 Lingual nerve 9 Inferior alveolar nerve 10 Mylohyoid nerve 11 Inferior dental plexus 12 Inferior dental branches 13 Inferior gingival branches 14 Mental nerve 15 Mental branches 16 Labial branches 16a Gingival branches
Dr. Sami Zaqout Faculty of Medicine IUG

Distribution of trigeminal nerve

Dr. Sami Zaqout

Faculty of Medicine

IUG

Otic Ganglion
Parasympathetic ganglion located medial to the mandibular nerve just below the skull, and it is adherent to the nerve to the medial pterygoid muscle. Preganglionic fibers originate in the glossopharyngeal nerve, and they reach the ganglion via the lesser petrosal nerve. Postganglionic secretomotor fibers reach the parotid salivary gland via the auriculotemporal nerve.

Dr. Sami Zaqout

Faculty of Medicine

IUG

Otic Ganglion

Dr. Sami Zaqout

Faculty of Medicine

IUG

Submandibular Ganglion
Parasympathetic ganglion lies deep to the submandibular salivary gland and is attached to the lingual nerve by small nerves. Preganglionic parasympathetic fibers reach the ganglion from the facial nerve via the chorda tympani and the lingual nerves. Postganglionic secretomotor fibers pass to the submandibular and the sublingual salivary glands.

Dr. Sami Zaqout

Faculty of Medicine

IUG

Submandibular Ganglion

Dr. Sami Zaqout

Faculty of Medicine

IUG

Summary of Cranial Parasympathetic Ganglia

Dr. Sami Zaqout

Faculty of Medicine

IUG

Testing the Integrity of the Trigeminal Nerve

The sensory function can be tested by using a cotton wisp over each area of the face supplied by the divisions of the trigeminal nerve.

Dr. Sami Zaqout

Faculty of Medicine

IUG

Testing the Integrity of the Trigeminal Nerve

The motor function can be tested by asking the patient to clench the teeth.

Dr. Sami Zaqout

Faculty of Medicine

IUG

Dr. Sami Zaqout

Faculty of Medicine

IUG