Moderated by: Dr.

Vidhi Rathi
Presented by: Gauri Bargoti
 Introduction
 Cranial Nerve 0
 Cranial Nerve XIV
 7th to 12th Cranial Nerve
 References
 The peripheral nervous system of 12 pairs of cranial nerves emerging from
brain stem.
 Major innervation of the head and neck are supplied by cranial nerves.
 All the cranial nerves are distributed in head and neck except for vagus nerve
that supplies the thorax and abdomen also
 Traditionally 12 pairs of cranial nerves are counted.
 The examination of cranial nerves are an essential part of neurological
examination.
 Nervus terminalis (cranial nerve zero) in the adult human
 The plexus appeared in the region of the cribriform plate of the ethmoid and coursed
posteriorly to the vicinity of the olfactory trigone, medial olfactory gyrus, and lamina
terminalis
 The nervus terminalis was identified bilaterally as a microscopic plexus of
unmyelinated peripheral nerve fascicles in the subarachnoid space covering the gyrus
rectus of the orbital surface of the frontal lobes

 References : Fuller GN, Burger PC. Nervus terminalis (cranial nerve zero) in the adult
human. Clinical neuropathology. 1990 Nov 1;9(6):279-83.
 Cranial nerve XIV was first identified in 1563, but it was not until 1777 that
it was mentioned in a textbook as the nerve of Wrisberg.
 In modern textbooks, it is referred to as the nervus intermedius or
“intermediary nerve
 Its name is consistent with its intermediary location between the facial nerve
(cranial nerve VII) and the superior section of the vestibulocochlear nerve
(cranial nerve VIII)

 References: Bordoni B, Zanier E. Cranial nerves XIII and XIV: nerves in the shadows.
Journal of multidisciplinary healthcare. 2013;6:87.
Composite of two
nerves:

Somatized efferent fibers for

Facial facial expressions and also
nerve for stapedius, posterior belly
proper of digastric muscle and
stylohyoid.

Intermedi
ate nerve( It consist of general and
of special somatic afferent
Wrisberg) fibers and visceral
parasympathetic
efferent fibers
Auriculotemporal
nerve joins upper
part of facial nerve
Upper buccal branch
of facial nerve joins
infraorbital branch
in canine fossa
Cervical branch of facial
nerve exchanges fibers
with transverse colli
nerve of cervical plexus
  AT THE EXIT FROM STYLOMASTOID FORAMEN

Posterior
auricular-
auricularis
Digastric
posterior branch- Stylohyoid
occipitalis, branch-
intrinsic post
muscles on back
belly of stylohyoid
of auricle
digastric
 Terminal
Branches

Marginal
1.Temporal Zygomatic Buccal Cervical
Mandibular
UPPER MOTOR NEURON INJURY
Also called supranuclear
Lower part of the face is affected
Any other sensation not effected
Effect the upper part of face
LOWER MOTOR NEURON INJURY
Also called infranuclear
Both upper and lower part of the face is
effected.
Hyperacusis may happen
Do not effect upper face
Affected side lost its expression

Nasolabial fold is less pronounced

Furrows of the brow are smoothed out

Eye is more widely open than normal side

Mouth drools to the effected side

Absence of wrinkles
 Involve all the facial muscles or only a group of them.
 They occur as a result of aberrant regeneration of facial nerve fibers during
partial recovery from infranuclear lesion.
 By asking the patient to close the eyes
 Bell’s phenomenon
 Whistling and smiling test
 Inflation of mouth
 Taste sensation test
 Ageusia or loss of taste due to lesion in peripheral or central pathway.
 Test of it is done by using strong solution of sugar and common salt and
weak solution of citric acid and quinine.
 Have two parts :
a) Cochlear
b) Vestibular
• Cochlear part is more caudal and dorsal
• Vestibular part is more superior and anterior
 Tinnitus
 Hyperacusis
 Recruitment
 Auditory hallucination and delusion of voices
 Vertigo
 Arises in an elongated nucleus in 4th ventricle.
 They emerge by several roots along the lateral aspect of the medulla,
beginning rostrally in groove between olive and restiform bodies.
 Taste sensation to posterior third of tongue
  Rarely damaged alone.

Loss of taste
sensation in
posterior tongue Tickle test to
identify the
abnormality
 Largest parasympathetic cranial nerve.
 Contains visceral and somatic fibers.
 It sends somatized fibers to musculature of pharynx and larynx
 In jugular foramen: Branches arising in the neck:
a) Meningeal a) Pharyngeal
b) Auricular b) Carotid
c) Communicating branches c) Superior laryngeal
to glossopharyngeal & d) Right recurrent laryngeal
cranial root of accessory e) Cardiac
nerve.
 Damage to vagus nerve can be checked only through palatine and laryngeal
branches.
 In total paralysis of soft palate: Regurgitation of fluids
 Inability to pronounce words that require palatal closure.
 Dysphagia
 Direct
visualization

Observing the
movement
with AH!
 Unilateral damage is symptom less
 Bilateral damage cause vocal cords to be relaxed.
Oculo-Cardiac
Reflex
 Spinal
part

Accessory
nerve

Cranial
part

Indistinguishable
from VAGUS
NERVE
 It innervates laryngeal and pharyngeal muscles
 Gives supply to trapezius and sternocleidomastoid muscle.
 TRAPEZIUS: Ask the patient to shrug the shoulder while examiner push them
downwards

 STERNOMASTOID: Weakness of rotation of chin towards opposite side.

 Have nucleus in lower part of the floor of 4th ventricle.
 It emerges between anterior pyramid and olive
Branches of Hypoglossal nerve Branches arising from Hypoglossal
containing fibers of C1: nerve proper:
i. Meningeal branch
Supply all muscles of
ii. Descendens hypoglossi tongue except
Palatoglossus.
iii. Branches given to
thyrohyoid & geniohyoid.
 It supplies tongue and depressors of hyoid.
 Disturbance in nerve may cause:

 Tremor
 Fasciculation of tongue
 Amyotrohic lateral sclerosis
 Sicher’s & DuBrul’s oral anatomy-8th ed
 Huthcison’s clinical methods – Swash, M
 Anatomy for surgeons – W. Henry Hollinshead