Cranial Nerves

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 Cranial Nerves
• There are 12 pairs of cranial nerves, which leave the brain and
pass through foramina and fissures in the skull.
• All the nerves are distributed in the head and neck, except
cranial nerve X, which also supplies structures in the thorax and
abdomen.
• The cranial nerves are named as follows:
– 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
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 Organization of the Cranial Nerves
• The olfactory, optic, and vestibulocochlear nerves are
entirely sensory.
• The oculomotor, trochlear, abducent, accessory, and
hypoglossal nerves are entirely motor.
• The trigeminal, facial, glossopharyngeal, and vagus nerves
are both sensory and motor nerves.
• The cranial nerves have:
– central motor and/or sensory nuclei within the brain
– peripheral nerve fibers that emerge from the brain
• exit from the skull to reach their effector or sensory organs

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 Foramina of Exit
NERVE FORAMEN NERVE FORAMEN
1st Cribriform plate 7th Internal acoustic meatus,
of ethmoid stylomastoid foramen
2nd Optic canal 8th Internal acoustic meatus

3rd 9th
4th
Superior orbital fissure
5th(V1) 10th Jugular foramen
6th
5th(V2) Foramen rotundum 11th
5th(V3) Foramen ovale 12th Hypoglossal canal
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 Functional Components
• General somatic afferent fibers (GSA):
– transmit exteroceptive and proprioceptive impulses from head and
face to somatic sensory nuclei
• Special somatic afferent fibers (SSA):
– transmit sensory impulses from special sense organs of vision,
equilibrium and hearing to the brain
• General visceral afferent fibers (GVA):
– transmit interoceptive impulses from the viscera to the visceral
sensory nuclei
• Special visceral afferent fibers (SVA):
– transmit sensory impulses from special sense organs of smell and
taste to the brain
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 Functional Components…

• General somatic efferent fibers (GSE):

– innervate skeletal muscles of eye and tongue
• Special visceral efferent fibers (SVE):
– transmit motor impulses from the brain to skeletal muscles
derived from brachial (gill) arches of embryo
• Muscles of mastication, facial expression and swallowing
• General visceral efferent fibers (GVE):
– transmit motor impulses from the general visceral motor
nuclei and relayed in parasympathetic ganglions.
• The postganglionic fibers supply cardiac muscles,
smooth muscles and glands
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 Olfactory Nerves (CN I)
• Consist of approximately 20
bundles of unmyelinated afferent
fibers (special visceral afferent
[SVA]).
• Arise from neurons in the
olfactory area, the upper one-
third of the nasal mucosa, and
mediate the sense of smell
(olfaction).
• They pass through the foramina
in the cribriform plate of the
ethmoid bone and synapse in the
olfactory bulb.
Lesion :
• Leads to loss of sense of smell
(Anosmia) 9
 Optic Nerve (CN II)
• Arises from the retina of the eye
• Carry afferent fibers for vision (special somatic afferent [SSA]) from
the retina to brain.
• Optic nerves pass through the optic canals and converge at the optic
chiasm

Thalamus (lateral geniculate body) where they synapse

Optic radiation fibers run to the visual cortex (area 17)
– Functions solely by carrying afferent impulses for vision
• Lesion of the optic nerve
– may result in blindness or diminished visual acuity and no pupillary light reflex in
the effected eye.
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Optic pathway

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 Oculomotor Nerve (CN III)
• Emerges on the anterior surface of the midbrain.
• It passes forward between the posterior cerebral and the
superior cerebellar arteries.
• It then continues into the middle cranial fossa in the lateral
wall of the cavernous sinus.
• Here, it divides into a superior and an inferior ramus, which
enter the orbital cavity through the superior orbital fissure
within the tendinous ring.

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 Oculomotor Nerve (CN III)…
• Supplies efferent fibers (general somatic efferent [GSE]) for
contraction of the extraocular muscles
– i.e., medial, superior, and inferior recti; inferior oblique; and
levator palpebrae superioris.
• It also contains preganglionic parasympathetic fibers from
neuronal cell bodies located in the Edinger–Westphal nucleus
that supply the ciliary ganglion.
• Postganglionic fibers derived from the ciliary ganglion run in
the short ciliary nerves to supply the sphincter pupillae
(miosis) and the ciliary smooth muscle
(accommodation/near vision).
• These parasympathetic fibers mediate the efferent limb of
the pupillary light reflex. 13
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Functions in raising the eyelid, directing the eyeball, constricting the iris, and controlling
lens shape
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 Lesion of oculomotor nerve
• Causes paralysis of:
– the levator palpebrae superioris (ptosis),
– the medial rectus (external strabismus),
– sphincter pupillae, resulting in dilation of the pupil
(mydriasis is the result of unopposed sympathetic
supply to the dilator papillae muscles), and
– ciliary muscles, resulting in loss of accommodation (near
vision) because of damage to the preganglionic
parasympathetic fibers.
• Lesion also causes loss of pupillary light reflex because of
damage to parasympathetic fibers that mediate the
efferent limb of the pupillary light reflex.
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Lesion of oculomotor nerve

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 Trochlear Nerve (CN IV)
• Passes through the lateral wall
of the cavernous sinus in the
middle cranial fossa and
• Enters the orbit by passing
through the superior orbital
fissure.
• Motor fibers (GSE) supply
contralateral superior oblique
muscle.
• This is the smallest of all
cranial nerves and the only
CN that emerges from the
dorsal aspect of the brain
stem.
• Located at the level of the
inferior colliculus
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 Lesion of the trochlear nerve

• Causes paralysis of the

superior oblique muscle of
the eye, which causes:
– diplopia (double vision) and
– inability to look
inferolaterally.
• Injuries are seen with severe
head injuries or meningitis
because of its long
intracranial course.

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 Trigeminal Nerve (CN V)
• Is the largest cranial nerve and contains both sensory and
motor fibers.
• It is the sensory nerve to the greater part of the head.
• It is the motor nerve to several muscles, including the
muscles of mastication.
• Has four nuclei:
– the main sensory nucleus
– the spinal nucleus
– the mesencephalic nucleus
– the motor nucleus
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 Course of the Trigeminal Nerve
• The trigeminal nerve leaves the anterior aspect of the pons
as a small motor root and a large sensory root.
• The nerve passes forward out of the posterior cranial fossa
and rests on the upper surface of the apex of the petrous
part of the temporal bone in the middle cranial fossa.
• The large sensory root now expands to form the crescent
shaped trigeminal ganglion.
• The ganglion lies within a pouch of dura mater called the
trigeminal or Meckel cave.

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 Course of the Trigeminal Nerve…
• The ophthalmic, maxillary, and mandibular nerves arise from the
anterior border of the ganglion.
• The ophthalmic nerve (V1)
– contains only sensory fibers and leaves the skull through the superior
orbital fissure to enter the orbital cavity.
• The maxillary nerve (V2)
– also contains only sensory fibers and leaves the skull through the foramen
rotundum.
• The mandibular nerve (V3)
– contains both sensory and motor fibers and leaves the skull through the
foramen ovale.
• The sensory fibers to the skin of the face from each division supply
a distinct zone, there being little or no overlap of the dermatomes
(compare with the overlap of the dermatomes of the spinal nerves).
• The motor fibers in the mandibular division are mainly distributed to
muscles of mastication.
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Sensory nerve supply to the skin of the head and neck. Note that the skin over the angle of the
jaw is supplied by the great auricular nerve (C2 and C3) and not by branches of the trigeminal
nerve.

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 Abducens Nerve (CN VI)
• Is a small motor nerve that supplies the lateral rectus muscle of
the eyeball.
• Enters the orbit through superior orbital fissure.
• Abducent Nerve Nucleus
– The small motor nucleus is situated beneath the floor of the upper
part of the fourth ventricle, close to the midline and beneath the
colliculus facialis.
– The nucleus receives afferent corticonuclear fibers from both
cerebral hemispheres.
– It receives the tectobulbar tract from the superior colliculus, by
which the visual cortex is connected to the nucleus.
– It also receives fibers from the medial longitudinal fasciculus, by
which it is connected to the nuclei of the third, fourth, and eighth
cranial nerves.
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 Lesion of the abducens nerve
• Causes weakness/paralysis
of the lateral gaze
due to loss of the rectus
muscle of the eye.
• The patient will present with
a medial deviation of the
affected eye (internal
strabismus) or diplopia on
lateral.
• It may result from a sepsis or
thrombosis in the cavernous
sinus.
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 Facial Nerve (CN VII)

• The facial nerve is both a motor and a sensory nerve.

• The facial nerve has three nuclei:
– the main motor nucleus,
– the parasympathetic nuclei, and
– the sensory nucleus.

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 Main Motor Nucleus
• Lies deep in the reticular formation of the lower part of the
pons.
• The part of the nucleus that supplies the muscles of the upper
part of the face receives corticonuclear fibers from both
cerebral hemispheres.
• The part of the nucleus that supplies the muscles of the lower
part of the face receives only corticonuclear fibers from the
opposite cerebral hemisphere.
• These pathways explain the voluntary control of facial muscles.
• However, another involuntary pathway exists; it is separate
and controls mimetic or emotional changes in facial expression.
• This other pathway forms part of the reticular formation.
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 Parasympathetic Nuclei
• Lie posterolateral to the main motor nucleus.
• They are the superior salivatory and lacrimal nuclei.
• The superior salivatory nucleus receives afferent fibers
from the hypothalamus through the descending autonomic
pathways.
• Information concerning taste also is received from the nucleus
of the solitary tract from the mouth cavity.
• The lacrimal nucleus receives afferent fibers from the
hypothalamus for emotional responses and from the sensory
nuclei of the trigeminal nerve for reflex lacrimation
secondary to irritation of the cornea or conjunctiva.
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 Sensory Nucleus
• Is the upper part of the nucleus of the tractus solitarius and lies close to
the motor nucleus .
• Sensations of taste travel through the peripheral axons of nerve cells
situated in the geniculate ganglion on the seventh cranial nerve.
• The central processes of these cells synapse on nerve cells in the
nucleus.
• Efferent fibers cross the median plane and ascend to the ventral
posterior medial nucleus of the opposite thalamus and to a number of
hypothalamic nuclei.
• From the thalamus, the axons of the thalamic cells pass through the
internal capsule and corona radiata to end in the taste area of the
cortex in the lower part of the postcentral gyrus.

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Facial nerve nuclei and their central connections.
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 Course of the Facial Nerve
• The facial nerve consists of a motor and a sensory root.
• The fibers of the motor root first travel posteriorly around the medial
side of the abducent nucleus.
• They then pass around the nucleus beneath the colliculus facialis in the
floor of the fourth ventricle and, finally, pass anteriorly to emerge from
the brainstem.
• The sensory root (nervus intermedius) is formed of the central processes
of the unipolar cells of the geniculate ganglion.
• It also contains the efferent preganglionic parasympathetic fibers from
the parasympathetic nuclei.
• The two roots of the facial nerve emerge from the anterior surface of
the brain between the pons and the medulla oblongata.
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 Course of the Facial Nerve …
• They pass laterally in the posterior cranial fossa with the
vestibulocochlear nerve and enter the internal acoustic
meatus in the petrous part of the temporal bone.
• At the bottom of the meatus, the nerve enters the facial
canal and runs laterally through the inner ear.
• On reaching the medial wall of the tympanic cavity, the
nerve expands to form the sensory geniculate ganglion
and turns sharply backward above the promontory.
• At the posterior wall of the tympanic cavity, the facial nerve:
– turns downward on the medial side of the aditus of the mastoid antrum,
– descends behind the pyramid, and
– emerges from the stylomastoid foramen 35
 Distribution of the Facial Nerve
• The motor nucleus supplies the muscles of facial expression,
the auricular muscles, the stapedius, the posterior belly of
the digastric, and the stylohyoid muscles.
• The superior salivatory nucleus supplies the submandibular
and sublingual salivary glands and the nasal and palatine
glands.
• The lacrimal nucleus supplies the lacrimal gland.
• The sensory nucleus receives taste fibers from the anterior
two-thirds of the tongue, the floor of the mouth, and the
palate.

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 Lesion of the facial nerve
• Causes Bell’s palsy, which is marked
by characteristic distortion of the
face such as:
– no wrinkles on the forehead,
– drooping of the eyebrow,
– inability to close or blink the eye,
– sagging corner of the mouth,
– inability to smile, whistle,
or blow,
– loss of taste in the anterior two-
thirds of the tongue,
– Decreased salivary secretion and
lacrimation, painful sensitivity to
sounds, and
– deviation of the lower jaw.
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 Vestibulocochlear (Acoustic or Auditory) Nerve (CN VIII)

• Leaves the pontocerebellar angle laterally and enters the

internal acoustic meatus (with the facial nerve) and remains
within the temporal bone to supply sensory fibers to the
sensory cells of the inner ear.
• The cochlear portion (for hearing)
– derives from bipolar neurons in the spiral (cochlear) ganglion that
innervate the hair cells of the cochlea (organ of Corti).
• The vestibular portion (for equilibrium)
– arises from bipolar neurons in the vestibular ganglion that
innervate sensory cells of the ampullae of the semicircular ducts
as well as the utricle and saccule.

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Lesion of the vestibulocochlear nerve causes loss of hearing or
vestibular sense

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 Glossopharyngeal Nerve (CN IX)
• Is the nerve of the third branchial arch and contains the
following fibers:
– SVE fibers: originate from nucleus ambiguus, and supply stylopharygeus which
elevates the pharynx during swallowing and talking
– GVE fibers: arise from inferior salivatory nucleus and relayed in otic ganglion,
the postganglionic fibers supply parotid gland
– 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 caudal part of nucleus of solitary tract
– SVA fibers: arise from the cells of inferior ganglion, the central processes of these
cells terminate in rostral part of nucleus of solitary tract, the peripheral processes
supply the taste buds on posterior third of tongue
– GSA fibers: The cell bodies are located in the superior ganglion. The central
process carry impulse from skin of posterior surface of auricle to spinal nucleus of
trigeminal n.

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 Glossopharyngeal Nerve (CN IX)…

• The glossopharyngeal nerve is a motor and a sensory nerve.

• It has three nuclei:
– the main motor nucleus:
• is formed by the superior end of the nucleus ambiguus.
– the parasympathetic nucleus:
• Is inferior salivatory nucleus & it receives afferent fibers from
the hypothalamus through the descending autonomic pathways.
– the sensory nucleus:
• is part of the nucleus of the tractus solitarius.

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 Course of the Glossopharyngeal Nerve
• The glossopharyngeal nerve leaves the anterolateral surface of the
upper part of the medulla oblongata as a series of rootlets in a
groove between the olive and the inferior cerebellar peduncle.
• It passes laterally in the posterior cranial fossa and leaves the skull
through the jugular foramen.
• The superior and inferior glossopharyngeal sensory ganglia are
situated on the nerve here.
• The nerve then descends through the upper part of the neck in
company with the internal jugular vein and the internal carotid artery
to reach the posterior border of the stylopharyngeus muscle, which it
supplies.
• The nerve then passes forward between the superior and middle
constrictor muscles of the pharynx to give sensory branches to:
– the mucous membrane of the pharynx and
– the posterior third of the tongue 46
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 Vagus Nerve (CN X)

• The vagus nerve is a motor and a sensory nerve.

• The vagus nerve has three nuclei:
– the main motor nucleus:
• is formed by the nucleus ambiguus
• It receives corticonuclear fibers from both cerebral hemispheres.
– the parasympathetic nucleus:
• forms the dorsal nucleus of the vagus.
• It receives afferent fibers from the hypothalamus through the
descending autonomic pathways.
– the sensory nucleus:
• is the lower part of the nucleus of the tractus solitarius
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 Vagus Nerve (CN X)…
• The vagus nerve leaves the anterolateral surface of the
upper part of the medulla oblongata as a series of rootlets
in a groove between the olive and the inferior cerebellar
peduncle.
• The nerve passes laterally through the posterior cranial
fossa and leaves the skull through the jugular foramen.
• Passes out of the postolivary sulcus to exit the posterior
cranial fossa through the jugular foramen.
• Provides motor innervation (SVE) to:
– all muscles of the larynx, pharynx (except the stylopharyngeus), &
– palate (except the tensor veli palatini).
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 Vagus Nerve (CN X)…
• Also provides parasympathetic preganglionic innervation
(GVE) to:
– smooth muscles and glands of the pharynx,
– esophagus, and gastrointestinal track (from the stomach to the
transverse colon)
– the cardiac muscle of the heart.
• Visceral afferent fibers (GVA) from:
– all mucous membranes in the lower pharynx, larynx, trachea,
bronchus, esophagus, and thoracic and abdominal visceral
organs (except for the descending colon, sigmoid colon,
rectum, and other pelvic organs).
– Mediates the afferent and efferent limbs of the cough reflex
(caused by irritation of the bronchial mucosa) and the efferent
limbs of the gag (pharyngeal) reflex and sneeze reflex
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 Lesion of Vagus Nerve

• Leads to:
– Loss of gag reflex
– Difficulty in swallowing
– Loss of sensations from the abdominal viscera
– Loss of taste from the base of tongue & epiglottis
– Hoarseness or loss of voice
– Gastrointestinal dysfunction
– Blood pressure anomalies (with CN IX), fatal if both
are cut
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 Accessory Nerve (CN XI)
• The spinal root leaves the upper cervical spinal cord
laterally to pass into the posterior cranial fossa through the
foramen magnum before it passes out of the skull through
the jugular foramen.
• Provides motor fibers to the sternocleidomastoid and
trapezius muscles.
• The cranial portion contains motor fibers that exit the
medulla and pass through the jugular foramen where they
join the vagus nerve as the recurrent laryngeal nerve to
supply muscles of the pharynx and larynx.

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 Accessory Nerve (CN XI)…
• Function:
– Cranial part: unites with the
vagus and supplies voluntary
muscles of larynx, pharynx
and esophagus
– Spinal part: supplies
sternomastoid & Trapezius
• Lesion:
– Difficulty in swallowing, and speech.
– Inability to turn the head, and raise the
shoulder.

Torticollis
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 Hypoglossal Nerve (CN XII)
• Passes out of the medulla ventrally in the preolivary sulcus and passes
through the hypoglossal canal
• Type: Motor
• Function:
– Motor to all muscles of the tongue except palatoglossus.
– Allows movements of tongue during speech and swallowing
• Lesion:
– difficulty in chewing and speech
– The tongue paralyses, atrophies, becomes shrunken and furrowed
on the affected side, and on protrusion it deviates to the affected
side

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Thank You!

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