INTRODUCTION TO BRAIN AN CRANIAL NERVES

FUNCTIONAL COMPONENTS OF SPINAL NERVES

1. General somatic efferent (GSE)

 They transmits motor supply for skeletal muscle contraction (voluntary) from the CNS
 The cell bodies in the CNS (ventral horn) synapse on skeletal muscle

2. General somatic afferent (GSA)

 They transmit sensation from the body to the CNS
o This may be sensation from the skin (pain, temperature, touch, pressure) sensation from muscles, tendons, joint pain
(proprioception)
 The cell bodies are in the dorsal root ganglia (DRG) or cranial nerve sensory ganglia

3. General visceral efferent (GVE)

 They provide motor supply to smooth (involuntary) muscle, cardiac muscle, and glands
 This is the autonomic nervous system and is composed of:
o Sympathetics (thoracolumbar) & parasympathetics (craniosacral)
 It functions with 2 types of neuron chainpreganglionic and postganglionic axons
o The cell bodies of the preganglionic sympathetic are found in the CNS (lateral horn/IMLCC) between the levels of T1 –
L2, whereas the cell bodies of the postganglionic sympathetic are found in the paravertebral and prevertebral ganglia

o The preganglionic parasympathetic cell bodies in the CNS (various nuclei of the brain and grey matter of spinal cord
between the levels of S2 – S4), whereas the postganglionic parasympathetic cell bodies in the cranial ganglia or ganglia
adjacent to, on, or within the walls of viscera

4. General visceral afferent (GVA)

 They transmit pain or subconscious visceral reflex sensation (e.g., blood gas, blood pressure) from hallow organs and blood
vessels to the CNS
 The cell bodies are found in dorsal root ganglion (DRG) or cranial nerve sensory ganglia

5. Special somatic afferent (SSA)

 They carry information from special senses of vision, hearing, and balance
  These special senses respond to a physical stimulus (light and sound)
 The cell bodies are located in the retina, and vestibular and spiral ganglia

6. Special visceral afferent (SVA)

 They carry the special senses of smell and taste.
 These special senses respond to chemical stimulus (volatile compounds in liquid or aerosolized forms)
 The cell bodies found in the olfactory organ and associated cranial nerve sensory ganglia

7. Special visceral efferent (SVE)

 They provide motor innervation for muscle contraction to muscles derived from the pharyngeal arches.
o NB = Skeletal muscles originate from the somites, however in the muscles head and neck do not originate from there,
they originate from pharyngeal arches
 The cell bodies are found in various nuclei of the brain

CRANIAL NERVES
 There are 12 pairs of cranial nerves
 Represented by Roman numerals (e.g., CN X not CN 10)
 They are heterogeneous in composition
o Some are motor; some are sensory; some are mixed

1. Olfactory nerve (CN I) Oh 7. Facial nerve (CN VII) Finals

2. Optic nerve (CN II) Once 8. Vestibulocochlear nerve (CN VIII) Very
3. Oculomotor nerve (CN III) One 9. Glossopharyngeal nerve (CN IX) Good
4. Trochlear nerve (CN IV) Takes 10. Vagus nerve (CN X) Vacations
5. Trigeminal nerve (CN V) The 11. Accessory nerve (CN XI) Are
6. Abducent nerve (CN VI) Anatomy 12. Hypoglossal nerve (CN XII) Heavenly
  In terms of the location and where the cranial nerves originate from, you move from anterior to posterior, or from rostra to caudal,
and you also move from superior to inferior as you move up the cranial nerve chain
CN IV is the only CN that exit
posteriorly.

It has the longest intercranial

course because it goes out
posteriorly and wraps around

For each CN, you must know

the foramen or hole from which
each CN leave the skull, the
functional component of the
CN, and what they do

VISUALIZE THE THREE-DIMENSIONAL RELATIONSHIPS OF THE CRANIAL NERVES ON THEIR COURSE THROUGH THE
SKULL

Olfactory nerve (CN I)

 Its functional component is the SVA (sensory)
o Special sense  smell
 It exits the skull through cribriform plate of the ethmoid (sits at the top of the nasal cavity)
 Injury to the oculomotor (CN III) nerve causes ptosis (i.e., it
causes the upper eyelid to droop over the eye), dilate the
Optic nerve (CN II) pupil and result in loss of accommodation. Also leads to
ciliary muscle paralysis.
 Its functional component is the SSA (sensory)
o Special sense  vision Injury of trochlear (CN IV) causes inability to look inferiorly
 It exits through the optic canal or optic foramen of the sphenoid when adducted seen especially when going down the stairs.

Oculomotor nerve (CN III)

 Its functional component are GSE and GVE (motor)
o The GSE component innervates the eye muscles (4 of the 6 extrinsic ocular muscles) + levator palpebrae superioris
(moves upper eyelid)
 GSEsuperior rectus, medial rectus, inferior rectus, and inferior oblique muscles plus levator palpebrae superioris
muscle
o GVE sends parasympathetic motor to constrictor pupillae and ciliary muscles
 The preganglionic cell bodies located in Edinger-Westphal nucleus
 The postganglionic cell bodies located in ciliary ganglion
 Target constrictor/sphincter pupillae (closes the pupil) and ciliary muscles (allow for accommodation).
 Recall that sympathetic response dilates the pupil while a parasympathetic response constrict the pupil
 Recall that a collection of cell bodies outside the CNS is called a ganglia; a collection of cell bodies within
the CNS is called a nucleus
 It exits through the superior orbital fissure of the sphenoid bone Mnemonics (SO4LR6)3 = Superior oblique muscle
 Clinically significant relationships is supplied by CN IV; lateral rectus is supplied by
o It courses through cavernous sinus CN VI and other muscles are supplied by CN III
o It exit between posterior cerebral and superior cerebellar arteries

Trochlear nerve (CN IV)

 Its functional component is the GSE (motor)
o It innervates a single muscle associated with eye movementsuperior oblique muscle
 Injury to this nerve causes a patient to not be able to turn their eye inferiorlaterally.
 NB = The superior oblique muscle is not formed from the pharyngeal arch; it is formed by the occipital somites, and
they migrate into the eye
 NB = NO CN has both GSE and SVE. They are mutually exclusive.
  NB = Also, no CN has both SSA and SVA.

 It exits through the superior orbital fissure of sphenoid bone; exits dorsally through lateral wall of cavernous sinus (dura
venous sinus) and has the longest intracranial course of any cranial nerve

Trigeminal nerve (CN V)

 Its functional component are GSA and SVE (mixed)
 The ganglion associated with CN V is called the trigeminal or semilunar or Gasserian ganglion
o All the pseudo-polar cell bodies associated with the trigeminal nerve are located here

Ophthalmic (V1)
 Its functional component is the GSA (sensory)
o Somatic sensory from skin of upper face, scalp, forehead, dorsum of nose,
upper nasal mucosa, eyeball, cornea, upper eyelid, meninges of anterior
cranial fossa, tentorium cerebelli, falx cerebri
 It exit through the superior orbital fissure;
 Clinically significant relationship
o courses through the lateral wall of cavernous sinus
 Branches of the ophthalmic V1 division
1. Nasociliary nerveprovides sensory innervation to the cornea. Injury may abolish the corneal reflex.
o Suspends ciliary ganglion
2. Frontal nerve
3. Lacrimal nerve

Maxillary (V2)
 Its functional component is the GSA (sensory)
o Somatic sensory from skin of mid-face, nasal & palatal mucosa,
anterosuperior nasopharyngeal mucosa, upper teeth & gums,
lower eyelid, meninges of middle cranial fossa
 It exits through the foramen rotundum
 Clinically significant relationships
o It courses through lateral wall of cavernous sinus and pterygopalatine fossa
  Branches of the maxillary V2 division
1. Meningeal nerve 6. Nasopalatine nerve
2. Pharyngeal nerve 7. Zygomatic nerve
3. Infraorbital nerve 8. Suspends pterygopalatine fossa
4. Greater and lesser palatine nerves
5. Superior alveolar nerve

Mandibular (V3)
 Its functional component is the GSA and SVE
o GSAsomatic sensory from skin of lower face, mucosa of
anterior 2/3 of tongue, floor of mouth, lower teeth, and gums,
external ear, meninges of middle cranial fossa
o SVEskeletal motor to the muscles of mastication (4 of them),
anterior belly of digastric muscle, tensor tympani & tensor veli
palatini muscles, mylohyoid muscle
 All 8 of these muscles come from the 1st pharyngeal arch (mandibular arch).
 NB = all muscles supplied by an SVE component comes from the pharyngeal arch with which that nerve is
associated with
 It exits through the foramen ovale
 Clinically significant relationship
o It courses through infratemporal fossa (not cavernous sinus)
Branches of the mandibular V3 division
Anterior division Posterior division
Undivided trunk
 (Long) Buccal nerve  Auriculotemporal nerve
 Recurrent meningeal n.
 Deep temporal nerve o Associated with tympanic/lesser
 N. to tensor tympani
 Masseteric nerve petrosal nerve of CN IX
 N. to tensor veli palatine
 Nerve to lateral pterygoid
 N. to medial pterygoid
 Lingual nerve
 Suspends Otic parasympathetic ganglion
o Associated with chorda tympani
nerve of CN VII
NB = While CN V (trigeminal) conveys a lot of things, it only does 2n o Suspends submandibular para-
things:
1. General sensory sympathetic ganglion
2. Motor innervation to 8 muscles (as described above)  Inferior alveolar nerve
o Nerve to the mylohyoid
o Continues as mental nerve
Abducens nerve (CN VI)
 Its functional component is the GSE (motor) Lesion of abducent nerve (CN VI) causes the eyeball
o It innervates the lateral rectus (abduct the pupil away from the midline) deviates medially (internal strabismus)
 It exits through the superior orbital fissure of the sphenoid bone
 Clinically significant relationshipcourses through cavernous sinus

Facial nerve (CN VII)

 Its functional components are SVE, SVA, GVE, GSA (mixed)
o SVEskeletal motor to muscles of facial expression, posterior belly of the digastric m., stylohyoid m., and stapedius m.
 The muscles of facial expression comes from 2nd pharyngeal arch
o SVA special sensory, taste, from the anterior 2/3 of the tongue (supplied by the chorda tympani)
o GSAsomatic sensory from skin of a small part of the external ear
o GVEparasympathetic motor to glands of the nasal, palatal, buccal, labial and lingual mucosa, lacrimal, submandibular,
and sublingual glands
 The preganglionic cell bodies located in superior salvatory nucleus
 The postganglionic cell bodies located in submandibular or pterygopalatine ganglion
 Targetsalvatory glands (submandibular ganglion) and lacrimal gland (pterygopalatine ganglion)
 The parasympathetic fibers are traveling in the chorda tympani for the submandibular ganglion. Hence the
chorda tympani has presynaptic parasympathetics and taste fibers.
 Question: a patient presents with an injury to chorda tympani nerve, what symptoms will the patient have? The
patient will have loss of taste and dry mouth (loss of salvatory production)

 The ganglion is called geniculate (sensory). It is the only sensory nucleus associated with CN VII
 The facial nerve exits the endocranial cavity via internal acoustic meatus and exit the skull via stylomastoid foramen (motor
division). The chorda tympani nerve exit the skull through the petrotympanic fissure of the temporal bone. While the greater
petrosal nerve exit through the hiatus in temporal bone
o If you have an injury in the stylomastoid foramen, what symptoms will the patient present with? The patient will present
with unilateral facial paralysis called Bell’s palsy. The patient will no loose sense of taste because the chorda tympani that
convey taste fibers does not emerge from the stylomastoid foramen.
o Injury at the internal acoustic meatus would affect taste as the CN VII (which later give rise to other branches) exit from
there.
  Clinically significant relationships
o It exits endocranial cavity alongside CN VIII
o It courses adjacent to inner and middle ear
o It courses through parotid gland (motor division)
o It courses through middle ear (chorda tympani n.)
o It courses through infratemporal fossa (chorda tympani n.)
o It courses through middle cranial fossa (greater petrosal n.)
o It courses through pterygopalatine fossa (greater petrosal n.)
Branches
 Motor (temporofacial & cervicofacial – posterior auricular, temporal,
zygomatic, buccal, marginal mandibular, and cervical nn.)
 N. to the stapedius
Greater petrosal nerve
 It emerges from the region of the geniculate sensory ganglion
 It is conveyed to targets via branches of V1 and V2
o GVE
 Preganglionic cell bodies located in superior salivatory
nucleus
 Postganglionic cell bodies located in the pterygopalatine
ganglion
 Parasympathetic motor to glands of the nasal and palatal
mucosa and lacrimal gland
Chorda tympani nerve
 It emerges within the petrous portion of the temporal bone and traverses
tympanic cavity
 It is conveyed to targets via lingual n.
o SVA
 Taste from anterior 2/3 of the tongue
o GVE
The chorda tympani joins the lingual nerve in infratemporal
fossa. Hence, an injury in the infratemporal fossa may be
affect these nerves.
An injury in the infratemporal fossa, and the patient
presents with a loss of taste, and loss of sensation from the
anterior 2/3 of the tongue. What structure was affected and
where was it affected?
 The injury occurred after the chorda tympani joined
the lingual nerve.
If a patient has an injury to the infratemporal fossa and
presents with loss of taste and dry mouth but no other
issues. What structures were affected?
 The injury occurred only at the chorda tympani (i.e.,
before it joined lingual nerve)
If a patient presents with loss of pain, temperature, and
touch, on the anterior 2/3 of the tongue. And that is the only
complaint.
 The lingual nerve is affected before the chorda
tympani joined.
 One would expect the injury to occur adjacent to the
foramen ovale from which V3 (gives rise to lingual)
emerges from.
A patient with an injury to the foramen ovale will have
sensation to upper teeth, but not in the lower teeth, not in
the inner skin of the cheek (supplied by buccal nerve).
Also taste from anterior 2/3 of tongue will not be affected
as chorda tympanic is unaffected. Muscles of mastication
will be affected.
  Preganglionic cell bodies located in superior salivatory
nucleus
 Postganglionic cell bodies located in the submandibular
ganglion
 Parasympathetic motor to glands of the labial, buccal, and lingual mucosa and sublingual and submandibular
salivary glands

Vestibulocochlear nerve (CN VIII)

 Its functional component is the SSA (sensory)
o Special sense – hearing & balance
 It exits the endocranial cavity (inside of the skull) via internal acoustic meatus and then goes into the inner ear and stays there
within the temporal bone
o It, however, DOES NOT EXIT THE SKULL
 Clinically significant relationships
o It exits endocranial cavity alongside CN VII
o It never exits the skull; remains within petrous portion of temporal bone

Glossopharyngeal nerve (CN IX) ---- know very well (Dr. Mussell’ s favorite)
 Its functional component are the SVE, GSA, SVA, GVA, and GVE (mixed)
o SVE—skeletal motor to stylopharyngeus muscle
 The stylopharyngeus is derived from the 3rd pharyngeal arch.
o GSA—somatic sensory from skin of a small part of the external ear, mucosa of the posterior third of the tongue,
palatine tonsil, tonsillar fossa, pharynx, and middle ear (mucosa of auditory tube, internal layer of tympanic membrane,
tympanic cavity, mastoid air cells)
 ClassGSA—sensory supply to tympanic cavity, pharyngotympanic tube, pharynx and posterior 1/3 of tongue
o SVA—special sensory, taste, from the posterior 1/3 of the tongue
 Unlike the anterior 2/3 of the tongue which gets general sensation via lingual nerve (V3 branch), and taste via
chorda tympani (branch of VII), the posterior 1/3 of the tongue is supplied by CN IX.
 The branch of CN IX that supplies posterior 1/3 travels just deep to the pharyngeal tonsils and that may be a
concern when one has their tonsils removed. Damage to that nerve may result to losing taste and sensation
from the posterior 1/3 of the tongue
o GVA—from the carotid sinus (baroreception), and carotid body (chemoreception)
o GVE—parasympathetic motor to parotid salivary gland
  Preganglionic cell bodies located in inferior salvatory nucleus
 Postganglionic cell bodies located in otic ganglion
 Targetparotid salivary gland
 Recall that the otic ganglion is located at the infratemporal fossa, on the medial aspect of V3 after it goes
through foramen ovale
 Recall that the postganglionic parasympathetics gets from the otic ganglion to the parotid gland by traveling
with the auriculotemporal nerve (which is a branch of CN V). Remember that both fibers at distinct even
though they travel together
 Question-will an injury to trigeminal nerve cause dry mouth? The answer is no because the trigeminal nerve
does not supply parasympathetics. However, injury to the glossopharyngeal nerve will cause dry mouth.
 Clinically significant relationships
o It exits skull via jugular foramen alongside CNs X and XI
o It courses through middle ear (tympanic and lesser petrosal nerves)
o It courses through middle cranial fossa (lesser petrosal nerves)
o It courses through infratemporal fossa (lesser petrosal nerve)

 NB = After the CN IX exit the skull via the jugular foramen. It gives off a branch called the tympanic nerve (destined for the
middle ear in the tympanic cavity). The tympanic branch, which will go back into the skull (bringing the branch from outside the
skull back into the middle ear), once the tympanic nerve is in the middle ear, it will form the tympanic plexus, which will have
GSA fibers and pre-synaptic parasympathetic (GVE) fibers. The presynaptic parasympathetic fibers will exit the middle ear
as the lesser petrosal nerve, which is in the middle cranial fossa. The lesser petrosal nerve exits the skull via the foramen
ovale alongside CN V3 and will synapse immediately medial/internal to CN V3 in the otic ganglion. Now, the postsynaptic
parasympathetic fibers will travel from the otic ganglion to the parotid gland via the auriculotemporal nerve

 Branches NB = Question: if a patient has an injury to the auriculotemporal

o Carotid sinus nerve nerve, what symptoms will they have?
 The patient will have dry mouth and loss of sensation
 Hering’s nerve around the area supplied by the nerve
 GVA  An injury to auriculotemporal nerve also affect postsynaptic
 Tympanic nerve (presynaptic parasympathetic fibers) parasympathetic fibers simultaneously unlike with injury to
lingual and chorda tympanic where there is little space that
o GSA and GVE the chorda tympanic has not joined the lingual nerve. With
o Reenters skull via tympanic canaliculus into tympanic cavity auriculotemporal nerve, the postsynaptic parasympathetic
fibers are there from the start.
o Forms tympanic plexus along with caroticotympanic nerves  However, injury to the auriculotemporal nerve distal to the
o Gives rises to lesser petrosal nerve parotid gland will only affect sensation of the skin supplied
by the nerve and not the parotid gland

NB = Glossopharyngeal nerve is associated with gag reflex

  Lesser petrosal nerve (presynaptic parasympathetic fibers)
o Conveyed to target via auriculotemporal nerve
o GVE
 Preganglionic cell bodies located in inferior salivatory nucleus
 Postganglionic cell bodies located in the otic ganglion
 Parasympathetic motor to parotid salivary gland

Vagus nerve (CN X)

 Its functional component are the SVE, GSA, SVA, GVA, and GVE (mixed)
o SVE—skeletal motor to mm. of soft palate (except tensor veli palatini m.), mm. of pharynx (except stylopharyngeus m.),
intrinsic mm. of the larynx
 Muscles are derived from 4th and 6th pharyngeal arches
o GSA—somatic sensory from skin of external ear and external acoustic meatus, external layer of tympanic membrane,
larynx, laryngopharynx, and meninges of posterior cranial fossa
o SVA – special sensory, taste, from the epiglottis and base of tongue
o GVA—from the mucosa of the trachea, esophagus, and thoracic and abdominal viscera (to the left colic flexure)
o GVE – parasympathetic motor to glands and smooth muscle of thoracic and abdominal viscera
 Preganglionic cell bodies located in dorsal motor nucleus of X
 Postganglionic cell bodies located in ganglia adjacent to, on, or within target viscera (intramural)
 Targetcardiac muscle; smooth muscle (GI tract and bronchial pathways); glands (mucous glands of GI tract and
bronchial pathways). That is all the visceral up to the left colic flexure
 Ganglia – Superior/Jugular (GSA) and Inferior/Nodose (GVA and SVA) of CN X NB = The ganglion associated with all
 Clinically significant relationships the sympathetics destined for the head
are located in the superior cervical
o It exit the skull through jugular foramen alongside CNs IX and XI
ganglia which lies against the internal
o It is the only CN within carotid sheath carotid artery
 Branches
o Auricular branch of X o Superior laryngeal nerve The postsynaptic sympathetic use the
 GSA, SVE, SVA vasculature of both the internal and
 GSA
external carotid artery to get distributed
 Reenters skull via mastoid canaliculus o Recurrent laryngeal nerve where they need to go
 Arnold’s nerve  GSA, SVE
The deep petrosal is a branch of the
Accessory nerve (CN XI) internal carotid plexus
 Its functional component is the GSE (motor)
 o It innervates the sternocleidomastoid and trapezius muscle
o To test for CN XI, ask your patients to shrug shoulders
 It exits through the skull via jugular foramen (interosseous)
 Clinically significant relationships
o It exits the endocranial cavity alongside CN IX and X

Hypoglossal nerve (CN XII)

 Its functional component is the GSE (motor)
o It innervates muscles of the tongue (7 of the 8)
 Specifically, all intrinsic and extrinsic muscles of the tongue, except palatoglossus muscle
 NB = A lesion of the hypoglossal nerve causes deviation of the tongue toward the injured side on protrusion
 It exit the skull via hypoglossal canal of the occipital bone

CNs coming out of superior orbital fissure CNs coming out of jugular foramen CNs within carotid sheath
1. CN III 3. CN V1 1. CN IX 3. CN XI 1. CN X
2. CN IV 4. CN VI 2. CN X

CNs coming out of internal acoustic meatus CNs carry parasympathetics fibers CNs that didn’t exit skull
1. CN VII 2. CN VIII 1. CN III 3. CN IX 1. CN VIII
2. CN VII 4. CN X

CNs associated with pharyngeal arches CNs with 4 functional

CNs carry parasympathetics fibers
(i.e., SVE) components
1. CN III 3. CN IX
1. CN V3—1st arch 1. CN VIIGSA, GVE, SVA, SVE
2. CN VII 4. CN X
2. CN VII—2nd arch
3. CN IX—3rd arch
4. CN X—4th and 6th arches CNs with 5 functional
components
CNs with 2 functional components
CNs with 1 functional component 1. CN IXGSA, GVE, GVA, SVA,
1. CN IIIGSE, GVE
1. CN ISVA 6. CN VIGSE SVE
2. CN V3GSA, SVE
2. CN IISSA 7. CN VIIISSA 2. CN XGSA, GVE, GVA, SVA,
3. CN IVGSE 9. CN XIGSE SVE
4. CN V1GSA 10. CN XIIGSE
5. CN V2GSA

Nerve Cranial Exit Components Main Actions

CN I: Olfactory Cribriform Plate of Ethmoid Bone SVA SVA: Smell
Optic Canal/Foramen of Sphenoid
CN II: Optic SSA SSA: Vision
Bone
GSE: Levator palpebrae superioris,
superior rectus, medial rectus, inferior
rectus, and inferior oblique mm.
CN III: Superior Orbital Fissure of Sphenoid
GSE, GVE (4/6 eye muscles)
Oculomotor Bone
GVE: parasympathetic to constrictor
pupillae and ciliary mm.
Superior Orbital Fissure of Sphenoid
CN IV: Trochlear GSE GSE: Superior oblique m.
Bone
V1 V1-GSA: eyeball, upper eyelid,
(Ophthalmic): forehead, bridge of nose, sinuses
GSA
V1: Superior Orbital Fissure of V2-GSA: region of maxilla
Sphenoid Bone V2
CN V:
V2: Foramen Rotundum of Sphenoid (Maxillary): V3-GSA: region of mandible and up
Trigeminal
Bone GSA laterally
V3: Foramen Ovale of Sphenoid Bone
V3 V3-SVE: muscles of mastication, ant.
(Mandibular): belly of digastric m., tensor tympani &
GSA & SVE tensor veli palatini mm., mylohyoid m.
Superior Orbital Fissure of Sphenoid
CN VI: Abducens GSE GSE: Lateral rectus m.
Bone
GSA: parts of ear

Exits endocranial cavity via internal
acoustic meatus
GSA, SVA,
CN VII: Facial Exits skull via stylomastoid foramen
SVE, GVE
(motor-main trunk), petrotympanic
fissure (chorda tympani n.) or hiatus in
temporal bone (greater petrosal n.)
SVA: Taste for anterior 2/3 of tongue
and palate
SVE: muscles of facial expression,
posterior belly of the digastric m.,
stylohyoid m., and stapedius m.
GVE: sublingual and submandibular
salivary glands and lacrimal gland
 CN VIII:
Exits endocranial cavity via internal
Vestibulocochlea SSA SSA: Hearing & balance
acoustic meatus (does not exit skull)
r
GSA: parts of ear

GVA: sensory to pharynx and middle

ear, chemoreception, and baroreception
CN IX: GSA, GVA,
Glossopharyngeal Jugular Foramen SVA, SVE,
SVA: taste to posterior 1/3 of tongue
GVE
SVE: stylopharyngeus m.

GVE: parotid salivary gland

GSA: parts of ear and dura mater

GVA: sensory to larynx and abdominal

and thoracic viscera

SVA: taste of epiglottis and base of

SVE, GVA,
tongue
CN X: Vagus Jugular Foramen GVE, GSA,
SVA
SVE: muscles of soft palate (except
tensor veli palatini m.), mm. of pharynx
(except stylopharyngeus m.), intrinsic
mm. of the larynx

GVE: abdominal and thoracic viscera

CN XI: Spinal
GSE: Trapezius and sternocleidomastoid
Accessory Jugular Foramen GSE
mm.
CN XII: GSE: Tongue muscles (except
Hypoglossal Canal of Occipital Bone GSE
Hypoglossal palatoglossus m.)

Carotid sheath
 It is a a tube of fascia that that envelopes the common and internal carotid arteries, internal jugular vein, and the vagus
nerve.
o The vagus nerve travels throughout the extent of the carotid sheath.
o CN IX, XI, and XII pass through the sheath, but are not part or found within carotid sheath
DETAIL THE PARASYMPATHETIC PATHWAY, FROM NUCLEUS TO TARGET ORGAN, FOR CNS III, VII, IX, AND X.
CN III
 The nucleus is called Edinger-Westphal nucleus. Its ganglion is called the ciliary ganglion
o Target constrictor/sphincter pupillae (closes the pupil) and ciliary muscles (allow for accommodation).

CN VII
 The nucleus is the called the superior salivatory nucleus. Its ganglion is called Pterygopalatine ganglia (for greater petrosal
nerve) and Submandibular (for chorda tympani nerve) ganglia
o The greater petrosal nerve exits via the hiatus of temporal bone. It contains preganglionic parasympathetic fibers that
synapse in the pterygopalatine ganglion and innervate the lacrimal glands (produces tears that wash the eye) and
palatonasal glands (produces mucus to line the nasal cavity and palate).
o The chorda tympani nerve exits the skull through the petrotympanic fissure and joins the lingual nerve from CN V3 in the
infratemporal fossa.
 The chorda tympani nerve contains the preganglionic parasympathetic fibers that synapse in the submandibular
ganglion en route to innervate the submandibular and the sublingual salivary glands (produces saliva).

CN IX
 The nucleus is called the Inferior salivatory nucleus. Its ganglion is called the otic ganglion
o The lesser petrosal nerve passes through the middle cranial fossa and foramen ovale carrying presynaptic/preganglionic
parasympathetics fibers that synapse in the otic ganglion.
o Postganglionic fibers travel with the auriculotemporal nerve (CN V3) to innervate the parotid gland.

CN X
 The nucleus is called the Dorsal motor nucleus of X. Its ganglia is located outside of head and neck
o Target smooth muscle and glands of the pharynx, larynx, thoracic organs, and abdominal foregut and midgut.

NB = The difference between sensory and parasympathetic ganglia is that there is a synapse at the parasympathetic ganglia which
does not occur in the sensory ganglia
 CN V – trigeminal ganglion
 CN VII – geniculate ganglion
 CN VIII – spiral and vestibular ganglia
 CN IX – superior and inferior ganglia of CN IX
 CN X – superior and inferior ganglia of CN X