Besides serving general motor and general sensory functions, cranial nerves use special

receptors and neurons to provide special functions. The general and special functional
components of the cranial nerves can be further classified by their
 innervation
(somatic muscles or visceral structures) and,
 type of information
(sensory [afferent] or motor [efferent]).
The somatic component of the cranial nerves with special functions contains only afferent
fibres, whereas the visceral component contains both afferent and efferent fibres. Thus, there
are seven functional types of cranial nerves

Somatic
Type of
General
innervation
Visceral
Afferent
(sensory)
Somatic
Special
Visceral
Type of
information
Somatic
General
Efferent Visceral
(motor)
SPECIAL VISCERAL

Afferent
General Somatic Afferent
The general somatic afferent (GSA) nuclei mediate somesthetic input, including pain, pressure,
temperature, and touch sensations from the skin and somatic muscles in the head, neck, and
face. This functional category primarily includes the trigeminal (CN V) sensory nuclei (chief
sensory nucleus and spinal descending nucleus).

General Visceral Afferent

The general visceral afferent (GVA) nuclei serve general sensation, including pain and
temperature, from the visceral structures of the pharynx, palate, larynx, aorta, and abdomen.
This functional category includes the glossopharyngeal nerve (CN IX) and the vagus nerve
(CN X).

Special Somatic Afferent

The special somatic afferent (SSA) nuclei regulate special senses, such as vision (optic [CN
II]) and audition and equilibrium (vestibulocochlear [CN VIII]). This functional component
includes proprioception and stretch afferents from muscle spindles.
Special Visceral Afferent
Special visceral afferent (SVA) nuclei mediate taste (gustation) and smell (olfaction). This
functional component includes the olfactory nerve (CN I), facial nerve (CN VII),
glossopharyngeal nerve (CN IX), and vagus nerve (CN X).

Efferent
General Somatic Efferent
The general somatic efferent (GSE) nuclei innervate the skeletal muscles derived from somites.
This functional category includes the innervation of the ocular muscles (oculomotor [CN III],
trochlear [CN IV], and abducens [CN VI]) and tongue muscles (hypoglossal [CN XII]).

General Visceral Efferent

The general visceral efferent (GVE) nuclei regulate the autonomic innervation of smooth
muscles and glands. In the cranial nerves, all these serve parasympathetic functions. The GVE
nuclei are the source of preganglionic parasympathetic fibres and include the Edinger-
Westphal nucleus (oculomotor [CN III]), superior salivatory nucleus (facial [CN VII]),
inferior salivary nucleus (glossopharyngeal [CN IX]), and dorsal motor nucleus (vagus [CN
X]). These nerves are responsible for pupillary constriction; gland secretion; and the regulation
of the muscles of the heart, trachea, bronchi, esophagus, and lower viscera.

Special Visceral Efferent or Branchial Efferent

The special visceral efferent (SVE), or branchial efferent (BE), nuclei control the muscles of
the face, pharynx, larynx, and some neck muscles, which evolve from the branchial arches.
This functional component consists of the motor nucleus of the trigeminal nerve (CN V), the
motor nucleus of the facial nerve (CN VII), the nucleus ambiguus of the glossopharyngeal
nerve (CN IX), the vagus nerve (CNX), and the accessory motor nuclei in the C1–C5 segments.
They are related to the spinal accessory nerve (CN XI) and control the muscles of expression,
mastication, phonation, deglutition, head turning, and shoulder elevation.
Origin: It arises from the brain stem and extends posteriorly to the abducens nerve and anteriorly to
the vestibulocochlear nerve.
Course: through the facial canal in the temporal bone and exits through the stylomastoid foramen
after which it divides into terminal branches at the posterior edge of the parotid gland.
Motor innervation of facial muscles that are responsible for facial expression, parasympathetic
innervation of the glands of the oral cavity and the lacrimal gland
Sensory innervation of the anterior two-thirds of the tongue.

Advanced 3D printed model of middle cerebral artery

aneurysms for neurosurgery simulation.
Nagassa RG1, McMenamin PG2, Adams JW2, Quayle MR2, Rosenfeld JV3,4,5.
Author information
Abstract
BACKGROUND:
Neurosurgical residents are finding it more difficult to obtain experience as the primary operator
in aneurysm surgery. The present study aimed to replicate patient-derived cranial anatomy,
pathology and human tissue properties relevant to cerebral aneurysm intervention through 3D
printing and 3D print-driven casting techniques. The final simulator was designed to provide
accurate simulation of a human head with a middle cerebral artery (MCA) aneurysm.

METHODS:
This study utilized living human and cadaver-derived medical imaging data including CT
angiography and MRI scans. Computer-aided design (CAD) models and pre-existing
computational 3D models were also incorporated in the development of the simulator. The
design was based on including anatomical components vital to the surgery of MCA aneurysms
while focusing on reproducibility, adaptability and functionality of the simulator. Various methods
of 3D printing were utilized for the direct development of anatomical replicas and moulds for
casting components that optimized the bio-mimicry and mechanical properties of human tissues.
Synthetic materials including various types of silicone and ballistics gelatin were cast in these
moulds. A novel technique utilizing water-soluble wax and silicone was used to establish hollow
patient-derived cerebrovascular models.

RESULTS:
A patient-derived 3D aneurysm model was constructed for a MCA aneurysm. Multiple cerebral
aneurysm models, patient-derived and CAD, were replicated as hollow high-fidelity models. The
final assembled simulator integrated six anatomical components relevant to the treatment of
cerebral aneurysms of the Circle of Willis in the left cerebral hemisphere. These included models
of the cerebral vasculature, cranial nerves, brain, meninges, skull and skin. The cerebral
circulation was modeled through the patient-derived vasculature within the brain model. Linear
and volumetric measurements of specific physical modular components were repeated,
averaged and compared to the original 3D meshes generated from the medical imaging data.
Calculation of the concordance correlation coefficient (ρc: 90.2%-99.0%) and percentage
difference (≤0.4%) confirmed the accuracy of the models.

CONCLUSIONS:
A multi-disciplinary approach involving 3D printing and casting techniques was used to
successfully construct a multi-component cerebral aneurysm surgery simulator. Further study is
planned to demonstrate the educational value of the proposed simulator for neurosurgery
residents

Otol Neurotol. 2019 Jun;40(5):e562-e565. doi: 10.1097/MAO.0000000000002195.

Facial Nerve Translocation for Low Tension

Neurorrhaphy to Masseteric Nerve.
Hetzler L1,2, MacDowell S2, Trahan J1, Arriaga M1,2, McDaniel LS3.
Author information
Abstract
INTRODUCTION:
The techniques of facial reanimation are continually evolving in search of the ideal method for
rehabilitating the paralyzed face. In the past, alternative cranial nerve motor nuclei have been
used to power facial musculature. The trigeminal nerve is gaining popularity as a
promising nerve to drive facial motion, particularly in the lower face.

OBJECTIVES:
This article describes a low-tension technique of using the transposed facial nerve to the
trigeminal nerve (masseteric branch) for facial reanimation.

METHODS:
Six patients over 2.5 years were treated with facial nerve translocation with division at the
geniculate and direct neurorrhaphy to the motor branch of the masseter. Patients were evaluated
by physical examination, measurement of oral commissure excursion using MEEI FACE-gram
software, video assessment, Sunnybrook Facial Grading System, Facial Disability Index,
and Facial Clinimetric Evaluation Scale (FaCE).

RESULTS:
Patients demonstrated early motion within 4 months postoperatively and were placed
into facial physical therapy. All demonstrated improvements in oral competence, strong oral
commissure excursion with good symmetry, speech improvements, and variable results
in facial tone. Synkinesis to the smile antagonists in the lower face was noted and treated with
chemodenervation in three of six. No upper division synkinesis was noted.

CONCLUSION:
The motor branch of the trigeminal nerve is an effective option for facial reanimation via facial
nerve translocation and end-to-end neurorrhaphy. Variable results in facial tone were noted with
excellent oral commissure excursion. This procedure is safe in the reoperated mastoid