Professional Documents
Culture Documents
Cranial Nerves 2010
Cranial Nerves 2010
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)
-
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!
3
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)
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).
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
Function
Accessory oculomotor
nucleus
(Westphal-Edinger)
Oculomotor nucleus
Course:
Brain exit
Subarachnoidal Course
Interpeduncular cistern
Dura penetration
Skull exit
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)
Subarachnoidal Course
Dura penetration
Skull exit
It enters the Superior Orbital fissure in the lateral section, together with the ophthalmic vein, and
reaches laterally to supply the superior oblique muscle
Location
Upper part of pons,
tegmentum, lateral part of
the reticular formation
Function
Epicritic sensibility (GSS)
Motor nucleus
* 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
Subarachnoidal Course
Dura penetration
Skull exit
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:
Haytham Bayadsi, 2009/2010
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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)
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11
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
Haytham Bayadsi, 2009/2010
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Abducent nucleus
Function
Course:
Brain exit
Subarachnoidal Course
Dura penetration
Skull exit
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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Function
Branchiomotor (BM) or
Special Visceromotor (SVM)
(2nd branchial arch muscles)
Parasympathetic
preganglionic fibers (GVM)
**
Taste (SVS) **
Subarachnoidal Course
Dura penetration
Skull exit
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)
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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)
Haytham Bayadsi, 2009/2010
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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
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
Subarachnoidal Course
Dura penetration
Skull exit
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
-
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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Function
Ambiguous nucleus
(cranial Part)
Branchiomotor (BM) or
Special Visceromotor (SVM)
(2nd branchial arch muscles)
Taste (SVS)
General Viscerosensory
(GVS)
(e.g. Baroreceptors/
Chemoreceptors)
Course:
Brain exit
Dura penetration
Skull exit
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
-
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
Haytham Bayadsi, 2009/2010
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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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Function
Ambiguous nucleus
(cranial Part)
Taste (SVS)
Medulla, elongated column
deep in reticular formation
Course:
Brain exit
Dura penetration
Skull exit
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.
Haytham Bayadsi, 2009/2010
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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
Haytham Bayadsi, 2009/2010
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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
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Ambiguous nucleus
(caudal part)
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
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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Function
** 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
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:
-
** 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
24
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
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)
- Trapezius m.
- Sternocleidomastoid m.
Accessory Nerve (CN-XI)
- All Laryngeal Muscles
(Except
25
Hypoglossal Nerve (CN-XII)
Hyoglossus m.
Styloglossus m.
Genioglossus m.
All Intrinsic muscles of
Tongue (Superior &
Inferior Longitudinal,
Vertical, Transverse)
- Thyrohyoid m. **
- Geniohyoid m. **
* 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