Supranuclear

Number Purpose of Functional Surface Intracranial

Type Nuclei Connections of Intraneural Course Exit Extracranial Course Clinics
and Name Distribution Components Attachments Course
Motor Nuclei
III. Oculomotor Supplies 1. GSE – supplies 5/7 1. GSE nu. – main 1. SE nu. – 1. Nucleus – more Lateral wall of Fwd through • Middle 1. Superior division 1. Intracranial lesion –
Nerve intrinsic of extrinsic motor nu. – connection dorsally place midline sulcus the window compartment supplies – Causes –
(Motor) (SR, IR, MR, muscle of eye supply extrinsic from motor area 2. Passes ventrally b/w to halves (bounded by of Superior a. Superior rectus a. Head injury –
IO, LPS) 2. GVE – supply 2 muscle (Merge of cerebral through central of cerebral posterior Orbital Fissure b. Levator herniation of
and out of 3 intrinsic ventral to cortex – tegmental core peduncle cerebral artery • Superior and palpebrae uncus
extrinsic muscles cerebral corticobulbar/ Traverse following – above, inferior superioris b. Aneurysm –
(Sphincter (parasympathetic aqueduct) cortico - behind forward – superior divisions of 2. Inferior division basilar artery
pupillae, efferent) 2. GVE – Edinger – nuclear tract a. Red nu. cerebellar the nerve are supplies – and posterior
ciliaris) 3. GSA – carry Westphal nucleus 2. EWN – b. Substantia nigra artery below, separated by a. Medial rectus cerebral artery
muscles of proprioception of (parasympathetic connection c. Crus cerebri – lateral to nasociliary b. Inferior rectus Effects –
Eyes extrinsic muscle efferent nucleus) from pre – corticobulbar/ basilar artery nerve c. Inferior oblique a. Ptosis – LPS
→ end in (merge in peri – tectal nu. – corticospinal → pierces dura • Abducent 3. General Visceral paralysis –
mesencephalic aqueduct grey completion of tract mater at the nerve – (parasympathetic) drooping of
nu. of trigeminal matter – pathway of angle b/w inferolateral efferent – nerve to eyelid
nerve ventrolateral – pupillary light anterior free inferior oblique → b. Lateral
level of Sup. Colli) reflex and posterior ciliary ganglion strabismus/
3. Oculomotor nu. fixed margins squint –
– central of tentorium unopposed
tegmental cerebelli → action of LR (MR
chain of nerve lateral wall of – paralysis)
fibres – to nuclei cavernous c. Loss of
– IV, VI, VIII) sinus Oc., Tr., accommodation
Oph., Max. reflex (MR, SP,
Ciliaris)
d. Proptosis – fwd
bulging of
eyeball
e. Diplopia
 Supranuclear
Number and Purpose of Functional Surface Intracranial Extracranial
Type Nuclei Connections of Intraneural Course Exit Clinics
Name Distribution Components Attachments Course Course
Motor Nuclei
IV. Trochlear Supplies 1. GSE – supplies GSE – 1. Corticobulbar Nuclei → passes 1. Dorsal aspect 1. Curves around 2. Supero – Forward, Lesion – diplopia
Nerve Superior SO a. Ventromedial Tract – backwards → winds of brain stem – the superior lateral medially over (head moves
(Motor) Oblique 4. GSA – part – descending fibres around lateral below inferior cerebellar compartment the eyeball – downwards)
muscle – proprioceptive periaqueductal (motor areas of aspects of colliculus – peduncle – superior supply SO
extrinsic – end in grey matter cerebral cortex) aqueduct → pierces superior 2. Passes through orbital fissure (piercing
muscle of mesencephalic b. In front of 2. Medial reaches dorsal medullary arterial window – 3. Medial to exit superior orbital
eye nucleus cerebral Longitudinal tectal parts of velum on either above – posterior of frontal and fissure
aqueduct fasciculus – pass midbrain → fibres of side of frenulum cerebral artery, lacrimal
3. Level – inferior through central nerves decussate veli below – superior division –
colliculus tegmental core cerebellar artery, ophthalmic
of brainstem – medially – basilar nerve
connects artery
vestibular nuclei 3. Lateral wall of
at Ponto – cavernous sinus –
medullary postero – superior
junction (w/ aspect
nuclei of III, IV, VI 4. Supero – lateral
nerves) compartment –
4. Reflex superior orbital
movements of fissure
eye
 Number Supranuclear
Functional Surface Intracranial Extracranial
and Type Purpose of Distribution Nuclei Connections of Intraneural Course Exit Clinics
Components Attachments Course Course
Name Motor Nuclei
1. Posterior
cranial fossa –
origin →
superior
border –
petrous part of
1. SVE - travel
temporal →
through
apex (middle
mandibular
cranial fossa)
division – 1st
2. Middle cranial
branchial arch
1. Motor – SVE (1st fossa –
muscle –
branchial arch proximal and
nucleus is 1. Exit – ventral 1. Trigeminal
muscles) distal to
located – upper aspect of Neuralgia
2. Sensory – GSA trigeminal
half of pons brainstem 2. Trigeminal block
a. Exteroceptive – ganglion
2. GSA – 3 (middle – cure of
skin, mucosa –
different cerebral Motor and neuralgia
oral and nasal 3. Proximal to
nucleus – peduncle and sensory roots - 3. Localized nerve
cavity, Trigeminal
Trigeminal 1. Ophthalmic a. Nucleus of basilar part – junction of block – tooth
paranasal sinus, Corticobulbar to Ganglion
V. (motor + 2. Maxillary spinal tract – pons) basilar part – extraction
sensitive areas cerebral cortex a. Proximal
sensory) 3. Mandibular medulla 2. Midbrain nu. pons and 4. Generalized
of eyeball – concave –
oblongata, up Fibres – middle cerebral headache
conjunctiva, sensory root
to 2nd cervical descend peduncle 5. Referred pain –
cornea, ciliary ends
segment (pain, 3. Medullary - Frontal sinusitis
body, iris b.Convex
temperature) nucleus – - Dental caries
b. Proprioceptive anterior margin
b. Superior sensory ascend - Cancer of
– muscles of – 3 sensory
- pons (touch, tongue
mastication, divisions
pressure)
TMJ, gomphosis 4. Distal to
c. Mesencephalic
Trigeminal
–
Ganglion
proprioceptive
a.3 divisions –
(located in
cavernous sinus
midbrain)
– lateral wall
b.Motor division –
deep to
ganglion with
mandibular
sensory divisions
Ophthalmic Division – purely sensory division (orbital cavity)
- Origin – upper surface – convex distal margin (trigeminal ganglion)
- Intracranial Course – short, runs along lateral wall of cavernous sinus below trochlear nerve – reaches superior orbital fissure
- Division – before reaching superior orbital fissure
a. Lacrimal – lateral
b. Fontal – lateral
c. Nasociliary – central
- Exit from cranium – superior orbital fissure (reach orbit)

Lacrimal Nerve Frontal Nerve Nasociliary Nerve

• Lateral part – orbit – upper border of lateral rectus • Above LPS and below periosteum of orbital roof • Medial side of eyeball
• Terminates in lacrimal gland – branches – distributed to • 2 branches – supraorbital and supratrochlear n. • 2 terminal branches
conjunctiva, lateral part – upper eyelid 1. Supraorbital n. – supra – orbital notch 1. Communicating branch to ciliary ganglion
• Post – ganglionic parasympathetic secretomotor fibres a. Continuation of frontal n. - Attached to back of ciliary ganglion
(received from zygomaticotemporal n. – sphenopalatine b. Supply - Via the ganglion emerges – gives branches – short ciliary
ganglion) – lacrimal gland i. Skin – forehead, scalp (UPTO LAMBDOID SUTUTRE) nerves (sensory supply to eyeball)
• Motor (B) + SENSORY (S) COMPONENTS ii. Skin – upper eyelid 2. Long ciliary nerve
iii. Conjunctiva - Medial side of optic nerve
iv. Frontal air sinus - Pierce sclera
2. Supratrochlear n. - Sensory branches – sclera, choroid, ciliary body, iris,
a. Runs above trochlea – cornea
b. Supply – - Carry postganglionic sympathetic fibres – supply dilator
i. Skin – inferomedial forehead, upper eyelid pupillae
ii. Conjunctiva 3. Posterior ethmoidal branch
- Close to posterior part – medial wall
- Supply sinuses – posterior ethmoidal, sphenoidal
4. Infratrochlear nerve
- Continuation of main nerve
- Supply –
i. Skin – eyelids, root of nose, conjunctiva, lacrimal sac
5. Anterior Ethmoidal Nerve
- Orbit
- Nasal cavity – ethmoidal labyrinth
- Anterior cranial fossa – leaves fossa lateral to crista galli
to enter nasal cavity again
- Nasal cavity – 2 branches (internal nasal branches) –
medial and lateral
- Supply – skin of ala, vestibule and tip of nose as external
nasal branch
Maxillary Nerve – sensory
Sensory Branches –
a. Roots – teeth of upper jaw
b. Mucosa – palate, pharyngeal wall, nasal cavity, maxillary sinus
c. Skin – zygomatic area, lower eyelid, ala of nose and upper lip

1. Exit from Cranium – through foramen rotundum to reach pterygopalatine fossa

2. Parts –
i. Sphenopalatine fossa
ii. Intra – orbital groove + canal
iii. Beyond infra – orbital foramen

Sphenopalatine Fossa Intra – orbital groove + canal Beyond infraorbital foramen

• Direct Branches from trunk • Middle and anterior superior alveolar nerve • 3 terminal branches
a. Posterior superior alveolar nerves – supply roots of teeth, - Run along the body of maxilla - Palpebral – lower eyelid
small apertures on posterior surface – body of maxilla - Nasal – ala of nose
b. Zygomatic branch – inferior orbital fissure – branches – - Labial – skin – upper lip
zygomatico – facial, zygomatico – temporal – supply skin Anterior, middle and posterior superior alveolar nerves – supply
of zygomatic bone maxillary air sinus
• Branches traversing sphenopalatine ganglion
a. Pharyngeal branches – passes through Palatino - vaginal
canal (mucous membrane – pharynx)
b. Palatine branch – bony canal – greater and lesser
palatine nerves – mucous membrane – hard/soft palate
c. Nasal branches – medially to supply mucosa of nasal
cavity – sphenopalatine foramen
Mandibular Nerve – mixed nerve
Mandibular nerve supplies –
1. Muscles developed from mesoderm of first branchial arch which are 8 in number (4+2+2).
a) 4 muscles of mastication: Masseter, temporalis, lateral pterygoid and medial pterygoid.
b) 2 tensors: Tensor palatini and tensor tympani.
c) 2 muscles coupled in digastric triangle: Anterior belly of digastric and mylohyoid.
2. Skin of face overlying the area developed from mandibular process.
3. Roots of teeth of lower jaw.
4. Mucous membrane of floor of mouth and anterior two-thirds of tongue.
5. Proprioceptive sensory fibers from muscles of mastication, temporomandibular joints and root of teeth of lower jaw.
Intracranial Course
- Sensory root of mandibular division of trigeminal nerve arises from distal convex side of trigeminal ganglion.
- Motor root of trigeminal nerve is continued distally beneath trigeminal ganglion as motor root of mandibular nerve.
- Both motor and sensory root of the nerve descend vertically to approach foramen ovale.
Exit from Cranium
Separate motor and sensory roots of mandibular nerve comes out of cranial cavity through foramen ovale to reach infratemporal fossa.
Extracranial Course and Distribution
- In infratemporal fossa, motor and sensory roots unite to form trunk of mandibular nerve below foramen ovale. The trunk of the nerve is medially related to otic ganglion to which it is connected by small root.
- The trunk of the nerve immediately divides into anterior and posterior divisions.
- Before division, trunk gives following two branches–
i. Nerve to medial pterygoid: It supplies medial pterygoid muscle. This branch also sends motor branches to tensor palatini and tensor tympani muscles.
ii. Recurrent meningeal branch: It is the sensory branch to supply meninges of brain. It passes backward to re- enter cranial cavity with a recurrent course to pass through foramen spinosum which is in front of spine of sphenoid.
That is why this nerve is also called nervus spinous.
Distribution from the Divisions
- It can be compared with distributions from anterior and posterior divisions of femoral nerve.
- Anterior division of mandibular nerve gives all muscular branches and one sensory branch.
- But from posterior division one muscular branch arises with all sensory branches.
Branches from Anterior Division
They are related to lateral pterygoid muscle.
Muscular branches:
1. Nerve to masseter: Cones round posterior part of upper border of lateral pterygoid muscle to pass laterally and enter deep surface of masseter muscle.
2. Deep temporal nerves (anterior and posterior): Emerge deep to upper border of lateral pterygoid muscle to pass upwards and supply temporalis muscle.
3. Nerve to lateral pterygoid: It enters deep (medial) surface of the muscle.
Sensory branch
- It is known as buccal nerve.
- It becomes superficial emerging between two heads of lateral pterygoid.
- The nerve supplies skin over the buccal region of face.
- It is to be noted here that buccal branch of facial nerve is motor nerve which supplies buccinator muscle.
Branches from Posterior Division
Sensory branches
i. Lingual nerve
ii. Inferior alveolar nerve
iii. Auriculotemporal nerve.
Motor branch
• It is called mylohyoid nerve.
• It does not arise directly from posterior division but it is a branch of inferior alveolar nerve.
• It supplies anterior belly of digastric and mylohyoid muscles.
Lingual Nerve Inferior Alveolar Nerve Auriculotemporal Nerve
• Carries general sensation – anterior 2/3rd of tongue • Mixed component • Purely sensory
• Passes on hyoglossus muscle – looped course (convex • Motor branch – mylohyoid nerve • Arises in infra – temporal fossa – horizontally backward – encloses
downwards) • Lies deep to lateral pterygoid muscle – emerges from lower middle meningeal artery
• Terminal part – hooks around anterior end – submandibular duct border • Branches –
• Infratemporal fossa – joined by chorda tympani nerve • Lies b/w spheno - mandibular ligament – enter mandibular 1. Superficial temporal branch – supply skin of temple
Fibres distributed – foramen – mandibular canal – mental foramen 2. Auricular Branch – antero – superior part (lateral surface) –
a. SVA – upper part of nucleus tractus solitarius (1o neurons) • Branches auricle, anterior half – external auditory meatus, outer surface
– geniculate ganglion – taste sensations a. Muscular branches – mylohyoid nerve (digastric triangle) – – tympanic membrane
b. GVE – preganglionic fibres (superior salivatory nu. – supply mylohyoid and anterior belly of digastric 3. Articular branch – TMJ
submandibular and sublingual salivary glands b. Sensory branch 4. Secretomotor fibres (post – ganglionic) – parotid gland (from
- Articular branches otic ganglion) – {pre – ganglionic – inferior salivatory nucleus
- Cutaneous branches at medulla oblongata – tympanic br. – glossopharyngeal
nerve – lesser superficial petrosal nerve – otic ganglion}
 Supranuclear
Number Purpose of Functional Surface Extracranial
Type Nuclei Connections of Intraneural Course Intracranial Course Exit Clinics
and Name Distribution Components Attachments Course
Motor Nuclei
VI Abducent Supplies GSE – lateral Dorsal surface of 1. Motor area – 1. Trapezoid body Above olive of 1. Posterior cranial 1. Middle 1. Laterally b/w 1. Lesion – medial
Nerve - Lateral rectus (extra – pons – floor of 4th cerebral 2. Medial medulla fossa compartment optic nerve strabismus (non –
motor rectus – ocular) ventricle (GSE) – cortex lemniscus oblongata - Runs upwards, – superior and lateral function of LR;
abduction/ upper part of (corticobulbar 3. Basilar part - (pontomedullary forwards orbital fissure rectus unopposed
lateral medial tract) pons junction) - Pierces dura 2. Supply action – MR)
deviation eminence (facial 2. Abducent + mater – through
of eyeball colliculus) oculomotor + posterolateral medial
trochlear to posterior surface of LR
nuclei – clinoid process
connects to 2. Middle cranial
vestibular fossa
nucleus via - Crosses upper
border of
petrous
temporal
- Inferomedial –
cavernous
sinus
 Supranuclear
Number and Purpose of Functional Intraneural Surface Intracranial Extracranial
Type Nuclei Connections of Exit Clinics
Name Distribution Components Course Attachments Course Course
Motor Nuclei
VII Facial 1. Muscles of 2nd 1. SVE 1. Motor – special (i) Motor – dorsal • Motor fibres – Ponto – • Posterior Stylomastoid Parotid gland 1. Supranuclear
nerve branchial arch - Muscles visceral efferent (upper part of loop around medullary cranial fossa – foramen - Posterior lesion (ventral) –
(mixed) – 2. GVE – (lower half of face) and abducent junction – reach internal auricular n. paralysis of lower
- Scalp secretomotor pons) ventral (lower nerve (facial lateral to olive acoustic (occipital half of face and
- Auricle 3. GSA –- 2. GVE – part of face) colliculus) – meatus and upper half is not
- Facial a. Proprioceptive parasympathetic parts extends - Intrapetrous auricular br.) affected
expressions sensation from – (superior (ii)Contralateral through part – - Nerve to 2. Nerve to
- Platysma muscles – end salivatory corticobulbar tegmental and a. Laterally digastric, stapedius –
- Stapedius in nucleus)- lower fibres basilar part – above level of stylohyoid hyperacusis
- Posterior mesencephalic part of pons (iii) Cerebral pons vestibule of - Temporal br. 3. Nuclear lesion –
belly of nu. 3. SVA - NTS – cortex – • Appears – labyrinth - Zygomatic aneurysm of
digastric b. Exteroceptive – nucleus tractus motor – of ponto – b. Facial canal – br. basilar art.
- Stylohyoid from auricular solitarius – same side medullary jxn. – medial wall of - Buccal br. (contralateral
2. Secretomotor – (auricular br. medulla ventral surface tympanic cavity (upper, hemiplegia,
submandibular, Of vagus n.) – oblongata • Afferent fibres (genu) – lower) ipsilateral total
sublingual, enter (upper part of – NTS – ascend geniculate - Marginal face paralysis)
lacrimal gland, brainstem – nu.) – lateral ganglion mandibular 4. Infranuclear –
mucous glands spinal nucleus sensory root c. stylomastoid - Cervical br. a. Bell’s paralysis –
3. Taste sensation and superior foramen stylomastoid
– anterior 2/3rd sensory nu. Branches – foramen
of tongue 4. SVA – taste fibres a. Greater b. Chorda tympani
4. Proprioceptive superficial – loss of taste
– facial temporal n. sensation,
muscles b. Nerve to impaired
stapedius salivation
c. Chorda c. Greater
tympani n. – superficial
petrotympanic petrosal n. – loss
fissure of lacrimation,
- Chorda taste sensation
Tympani n. –
SVA (taste –
A2/3 of
Tongue), GVE –
submandibular
and sublingual
(secretomotor)
Nerves Branches in Cranium Nerves Branches outside Cranium

1. Greater Superficial Petrosal Nerve A. Posterior Auricular Nerve –

- Origin – geniculate ganglion (1st order neurons) - Auricular and occipital branches
- Comes out – hiatus on antero – superior surface of petrous temporal - Auricular – branches to extrinsic muscle of ear
- Run over foramen lacerum – joined by deep petrosal nerve (sympathetic fibres from internal carotid - Occipital – occipitalis m.
plexus) – forms nerve of pterygoid canal → enter pterygopalatine ganglion
- Postganglionic secretomotor fibres – lacrimal gland + mucous gland
- SVA – palate + upper part of pharyngeal wall + nasal cavity (taste sensation)
2. Nerve to Stapedius B. Nerve to stylohyoid and digastric
- Short nerve – vertical part of facial canal - Near stylomastoid foramen
- Enters the muscle lodged in pyramid - Stylohyoid and posterior belly of digastric muscle
- Dampens the conduction of sound waves
3. Chorda Tympani Nerve C. Temporal Branch – supplies frontalis, corrugator supercilli, muscles – external surface – auricle, upper part –
- Origin – 6mm above stylomastoid foramen orbicularis oculi
- Posterior wall to lateral wall – comes out through petrotympanic fissure (medial to spine of sphenoid)
- Join lingual nerve in infratemporal fossa
- Functional components:
a. SVA – peripheral processes of geniculate ganglion carry taste sensation – anterior 2/3rd of the
tongue (central processes – reach upper part of nucleus tractus solitarius)
b. GVE – preganglionic secretomotor parasympathetic – superior salivatory nucleus;
postganglionic fibres – submandibular ganglion – sublingual and submandibular glands
D. Zygomatic branch – lower part – orbicularis oculi, zygomaticus – major, minor

E. Buccal branch
- Upper – muscles of external nose and upper lip
- Lower – buccinator, orbicularis oculi
F. Marginal mandibular branch – lower lip, chin

G. Cervical branch – platysma

 Supranuclear
Number Purpose of Functional Connections Surface Intracranial
Type Nuclei Intraneural Course Exit Extracranial Course Clinics
and Name Distribution Components of Motor Attachments Course
Nuclei
IX Mixed Muscles Motor 1. Motor Nucleus Medulla 1. Dorsal aspect - Upper end Posterior Along with 1. 2 ganglia – superior and 1. Loss of taste
of 3rd - SVE – nucleus - SVE – nucleus Oblongata of medulla of a cranial fossa vagus and inferior – sensory fibres sensation from
branchial ambiguous – ambiguous – oblongata – vertical – runs fwd. accessory – 2. Inferior ganglion – posterior 1/3rd and
arch supplies only upper part (fibres fwd. & laterally sulcus b/w and laterally intermediate tympanic branch (forms circumvallate papilla
stylopharyngeus – – through olive and to approach compartment of tympanic plexus – – tongue
- GVE – stylopharyngeus) tegmental core inferior jugular jugular foramen promontory) – carries 2. Gag reflex – absent
preganglionic 2. Inferior Salivatory of medulla cerebellar foramen preganglionic 3. Jugular foramen
parasympathetic Nucleus – motor 2. Ventrolateral peduncle parasympathetic syndrome –
secretomotor nucleus course – secretomotor fibres – infection/ tumour in
fibres – inferior (parasympathetic emerging nerve parotid gland vicinity – multiple CN
salivatory nuclei) fibres related 3. Tympanic plexus → palsy
nucleus (parotid 3. Nucleus Tractus medially to lesser petrosal n. → otic
gland) Solitarius – medial ganglion
Sensory composite lemniscus and 4. Post – ganglionic n. –
- SVA – taste nucleus – SVA spinothalamic parotid gland
sensation – All are in medulla tract and (auriculotemporal n.)
posterior 1/3rd + oblongata lateral to 5. Carotid br. – carotid
circumvallate trigeminal nu. body and sinus
papillae – fibres 3. It traverses 6. Branches –
to nu. Tractus reticular a. Muscular branches –
solitarius formation of supply stylopharyngeus
- GVA – general medulla b. Pharyngeal branches –
sensation from oblongata wall of pharynx –
pharynx, carotid sensory fibres
body and sinus c. Tonsillar branches –
(fibres – NTS) somatic sensory –
- GSA – somatic tonsillar fossa
sensation from d. Palatal branch – plexus
posterior part of w/ lesser palatine n.
tongue, palate, e. Lingual br. – GSA &
tonsil, palate SVA – posterior 1/3rd of
tongue
 Number Purpose of Functional Intraneural Surface
Type Nuclei Intracranial Course Exit Extracranial Course Clinics
and Name Distribution Components Course Attachments
X Mixed Nerve of 1. SVE – supply 1. Nucleus 1. Dorsal part – Multiple roots 1. Nucleus – dorsal 1. Vertical sulcus 1. Middle compartment 1. Pharyngeal br –
6th muscles of 6th ambiguous – tegmentum – – vertical parts of tegmentum b/w olive and of jugular foramen dysphagia
branchial branchial arch SVE – supply medulla sulcus b/w of medulla inferior (joined by 12th) 2. Superior laryngeal br.
arch SVE + accessory – cricothyroid oblongata olive and oblongata cerebellar 2. HEAD AND NECK – supraglottic
muscles of palate, 2. Dorsal nu. – 2. Fibres pass inferior 2. Medial Relations – peduncle - Superior Ganglion anaesthesia
pharynx, larynx motor (GVE) + medial to cerebellar medial leminiscus, (9th, 10th, 11th) → Meningeal branch – 3. Paralysis of
2. GVE – sensory (GSA) medial peduncle intraneural part of meninges of posterior cricothyroid
parasympathetic, 3. NTS – taste lemniscus, (9th, 10th, hypoglossal nerve, cranial fossa 4. Recurrent laryngeal
preganglionic sensation – intraneural 11th nerves) medullary reticular → Auricular br. br. – hoarseness of
secretomotor – base of part – formation, → Pharyngeal br. – voice and
tracheobronchial tongue, hypoglossal spinothalamic tract palatal br. (soft dysphonia, bilateral –
tree, foregut, vallecula, n., medullary and inferior olivary palate muscle) + aphonia and
midgut epiglottis (SVA) reticular nucleus pharyngeal plexus – inspiratory stridor
3. GVA – general 4. Nucleus of formation, 3. Lateral relations – all muscles of pharynx 5. Central lesion –
sensation from spinal tract – spinothalamic nucleus of spinal → Carotid br. lateral medullary
areas above GSA – from tract and tract of trigeminal → Superior Laryngeal br. syndrome (aneurysm
4. SVA – taste external ear inferior olivary nerve and inferior – internal (upper part – posterior inferior
sensations from (nucleus of nucleus cerebellar peduncle of larynx upto vocal cerebellar artery) –
base of tongue, spinal tract of 3. Lateral 4. Multiple rootlets – cord) and external disorder of
vallecula, trigeminal n.) relations – run forwards and (pierces middle swallowing and
epiglottis nucleus of laterally across constrictor & supply speech + cerebellar
5. GSA – skin of spinal tract of jugular tubercle cricothryroid & ataxia
concha area of trigeminal n. towards jugular cricopharyngeus)
external ear and inferior foramen laryngeal br.
cerebellar → Right recurrent
peduncle laryngeal n. (trachea
– oesophageal
groove) – supplies all
laryngeal muscles;
cardiac plexus,
sensory branches
below vocal cord,
trachea, oesophagus
3. THORAX
- Cardiac branches
- Pulmonary branches
- Oesophageal branches
- Left recurrent laryngeal
4. ABDOMEN
- Parasympathetic
innervation (foregut and
midgut) via oesophageal
orifice of diaphragm –
Myenteric and Meissner’s
plexus
Number and Purpose of
Type Vestibular Pathway Cochlear Pathway Clinics
Name Distribution
VIII Sensory – 2 Vestibular – Vestibular Pathway: 1. Receptors – Organ of Corti - CP angle tumour affects facial and
Components maintenance - Receptor – in wall of membranous labyrinth 2. Neuron I – bipolar neurons vestibulocochlear nerve
- Vestibular of equilibrium - Neuron I – bipolar cells (from vestibular 3. Neuron II – pontomedullary junction – dorsal and ventral cochlear nucleus - Menier’s syndrome – increase of
- Cochlear Cochlear - ganglion) 4. Neuron III – Nucleus of trapezoid body – bilateral influence endolymphatic volume in membranous
hearing - Neuron II – pontomedullary junction 5. Neuron IV – Medial geniculate body labyrinth; Vertigo and tinnitus; nausea;
- EFFERENTS from nuclei – 6. Sensory area – Area 41, 42 (transverse gyrus and superior temporal gyrus) Progressive loss of hearing
1. Flocculo - nodular lobe of cerebellum 7. Cell bodies of bipolar 1st order neuron – spiral ganglion (spiral canal) - Deafness – injury of peripheral
2. Interconnect w/ nuclei – 3rd, 4th, 6th, 9th 8. Entry to brainstem – anterolateral aspect of pontomedullary junction vestibulocochlear system – vertigo,
3. Neuron III – Thalamus 9. Ventral and dorsal to inferior cerebellar peduncles (ventral and dorsal nuclei) tinnitus, conductive hearing loss, neural
4. Sensory area – Post central Gyrus 10. Decussation of fibres from trapezoid body (central tegmental part of pons) healing loss
- Vestibular ganglion – in internal auditory 11. Termination – Medial Geniculate body - Motion sickness
meatus 12. Inferior thalamic radiation – auditory radiation – sub - lentiform part of internal -
- Entry into Brainstem – lateral to olive of capsule – temporal lobe
medulla
- Vestibular nucleus – in vestibular trigone
 Number Purpose of Functional Surface Intracranial
Type Nuclei Intraneural Course Extracranial Course Clinics
and Name Distribution Components Attachments Course
XI Motor nerve – Cranial n. – SVE 1. Nucleus CRANIAL ROOT CRANIAL ROOT Intermediate CRANIAL ROOT 1. Lesion – lateral
muscles of 6th Brainstem CRANIAL ROOT ambiguous 1. Nucleus Posterolateral compartment of 1. Joins vagus nerve medullary syndrome
branchial arch + Spinal root – 1. All muscles of (special ambiguous – sulcus of jugular foramen 2. Joins proximal to inferior and jugular foramen
sternocleidomastoid C1 – C5 soft palate visceral ventrolaterally medulla (accompanied ganglion of vagus syndrome
& trapezius Segments (except tensor efferent) – through MO oblongata of vagus nerve in 3. Branches 2. Refle spasm –
veli palati) lower 3/4th of SPINAL ROOT (b/w olive & common dural - Pharyngeal branch of vagus sternocleidomastoid
2. All muscles of medulla 1. 5 roots b/w inferior sheath) – special visceral efferent 3. Congenital torticollis –
pharynx (except oblongata ventral and cerebellar (supply muscle of palate and fibrous tissue tumour in
stylopharyngeus) 2. Lower part – dorsal roots peduncle) larynx with exceptions) SCM (head turns away
3. All muscles of nucleus of 2. Enters cranium SPINAL ROOT - Recurrent laryngeal nerve – from affected side)
larynx (except cranial root – through 5 pairs of origin – SVE (all muscles of larynx) +
cricothyroid) 3. Central group foramen ascend cranially sensory (infraglottic part of
SPINAL ROOT of anterior magnum to join mucous membrane of
4. Sternomastoid horn cells – cranial root larynx)
5. Trapezius spinal nucleus SPINAL ROOT
(somatic 1. Between Internal
efferent) Carotid a. and internal
jugular vein
2. Pierces anterior border
of sternocleidomastoid
3. Appears in posterior
triangle of neck
4. Descend over levator
scapulae
5. Passes deep to anterior
border of trapezius –
forms a network – 3rd
and 4th nerves
6. Muscular br. And
proprioceptive br.
Number and Functional Connections of Surface Extracranial
Type Nuclei Intraneural Course Intracranial Course Exit Clinics
Name Components Motor Nuclei Attachments Course
XII Motor Somatic 1. Nuclei of 1. Supranuclear – 1. Traverse central Anterolateral Posterior cranial Hypoglossal/ 1. Behind IJV and 1. Lesion – occlusion
Efferents – hypoglossal n. – motor area of core of medulla sulcus b/w fossa – rootlets anterior lies b/w IJV and of medullary
supply subependymal opp. Hemisphere oblongata pyramid and unite to form 2 condylar ICA branches of
muscles of: 2. Lower part of 2. Sensory nuclei of 2. Medially – medial olive trunks canal 2. Descends in vertebral a.
- Occipital medial trigeminal n. lemniscus and front of vagus n. (ventral medullary
myotome eminence of 3. Nucleus tractus pyramid and joined by syndrome)
(paraxial floor of 4th solitarius 3. Laterally – C1 nerves - Contralateral
mesoderm) ventricle 4. Reticular spinothalamic tract 3. Lower border of hemiplegia
- All extrinsic (hypoglossal formation & inferior olivary posterior belly - Ipsilateral
and intrinsic trigone) 5. Cerebellum nucleus of digastric paralysis of
muscle of 4. Recurrent – muscles of
tongue – hook around tongue
except lower SCM - Spinal lemniscus
palatoglossus branches of – damaged
occipital a. (contralateral
5. Runs fwd over hemianesthesia)
hyoglossus
muscle
6. Terminal
Branches –
- Muscles of
tongue
except
palatoglossus
- Recurrent
meningeal
br. –
hypoglossal
canal –
posterior
cranial fossa
- Descendens
hypoglossi –
ansa
cervicalis
(embedded
in anterior
wall of
carotid
sheath)