CRANIAL NERVES AND THEIR PATHWAYS

•12 pairs of cranial

nerves.

•All are distributed

in the head & neck,
except CN-X.

•All nerves except

CN-XI originate
from the brain.

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 CRANIAL NERVES
 The 12 pairs of cranial nerves can be grouped in several ways:
1. according to their central location:
 Cranial nerves I & II, (olfactory & optic nerves), are connected to
telencephalon & diencephalon, respectively
 Nerves III & IV (oculomotor & trochlear nerves), are connected
with the midbrain;
 trigeminal (V), abducens (VI), & facial (VII) nerves are located in
the pons;
 Cranial nerves (VIII, IX, X, XI, & XII) are associated with the
medulla oblongata.
 It is important to know this location plan because if a patient
exhibits signs of a specific cranial nerve injury, then the site of the
lesion can be pinpointed.

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 CRANIAL NERVES
2. Another way to group cranial nerves is according
to their functional neuronal components:
 Some have only sensory neurons:
 CN - I, the olfactory nerve, concerned with smell
 CN - II, the optic nerve, which deals with vision
 CN – VIII, the vestibulo-cochlear nerve, concerned
with hearing and equilibriun.
 Some others are composed only of motor
neurons:
 CN – III, CN – IV, CN – VI, CN – XI & CN – XII.
 Others are composed of mixed neurons:
 CN – V, CN – VII, CN – IX & CN – X.
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 CRANIAL NERVES
Nuclei of Cranial Nerves:
1. Somatic Motor Nuclei
2. General Visceral Motor Nuclei
3. Sensory Nuclei

1. Somatic Motor Nuclei:

 situated within brain stem & innervate skeletal muscles
 equivalent to anterior grey horn cells of spinal cord
 receive impulse from corticobulbar/corticonuclear fibers
 Receive bilateral connections, except:
- CN - VII – lower nucleus: supplying lower part of face
- CN - XII nucleus
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 CRANIAL NERVES
2. General Visceral Motor Nuclei:
 Forms parasympathetic part of ANS:
 Edinger –Westphal nucleus of CN-III
 Superior salivatory & lacrimatory nucleus of CN-VII
 Inferior salivatory nucleus of CN-IX
 Dorsal motor nucleus of Vagus
 Receive input from hypothalamus
3. Sensory Nuclei of Cranial Nerves:
o include somatic & visceral afferent nuclei
o First-Order Neurons: situated in ganglia on nerve trunks or
in a sensory organ, such as the nose, eye or ear.
o Second-order neurons of cranial nerves are in Brain- Stem.

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Purely Sensory Cranial Nerves

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Purely Sensory Cranial Nerves : CN-I
Olfactory Nerves (CN I):
 Originate from receptor cells in
olfactory mucosa.
 Each receptor has olfactory hair cells
which react to smell
 Consist bipolar nerve cells.
 Olfactory nerve arise from fine central
process
 fibers pass via cribriform plate &
terminate in olfactory bulb
 Olfactory tract – is a bundle of white
matter
- Arise from posterior end of olfactory
bulb
- divide into medial and lateral stria
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Olfactory pathway

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9
OLFACTORY PATHWAY
Olfactory tract:
- axon of mitral cells
- lateral staria ascend to primary and secondary
olfactory area of cortex
 amygdala , uncus and the hippocampal gyrus of both
sides

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 Purely Sensory Cranial Nerves: CN-II
Optic Nerve (CN II):

 Originate in
ganglion nerve layer
(ganglion cells) of
retina
 Converge on optic
disc
 Exit from the eye as
optic nerve
 Myelinated by
oligodendrocytes
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 Purely Sensory Cranial Nerves: CN-II
Optic chiasma
 Fibers from medial ½ of retina cross to opposite side
 Fibers from nasal half of each retina (nasal retinal field), cross &
enter optic tract of opposite side
Optic Tract:
 Most fibers terminate in lateral geniculate body  Optic radiation
 IC  visual cortex (B-17)
 Few terminate in superior colliculus
Neurons of vission: Four neurons conduct visual impulses:
 Rods & cons
 Bipolar neurons
 Ganglion cells
 Neurons of lateral geniculate body  to visual cortex

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 Cont..
• Visual area (area
17,18,19)
• Retrolenticular part of
internal capsule
• Optic radiation
• Lateral geniculate
• Optic tract
• Optic chiasma
• Optic nerve (temporal
and nasal field of
visual)
• Retina
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Special senses - Vision

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Lesions at different sites of visual pathway

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1. Circumferential
Blindnes

2. blindness of the right

eye
3. Right nasal hemianopia

4. Bitemporal hemianopia

5. Left temporal
hemianopia and right
nasal hemianopia
6. Left temporal and right
nasal hemianopia
7. Left temporal and right
nasal hemianopia
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 Purely Sensory Cranial Nerves: CN-VIII
 CN - VIII, Vestibulo-cochlear nerve, concerned with
hearing & equilibriun.
Vestibular Nerve (CN-VIII):
 Transmits information about position & movement of
head
 Arise from central processes of nerve cells in
vestibular ganglion
 Vestibular nuclear complex are four:
 medial, lateral, superior & inferior nuclei.
 are situated beneath floor of 4th ventricle.

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 Purely Sensory Cranial Nerves: CN-VIII

 Vestibular nuclei Receive

afferent fibers from:
 Vestibular apparatus via
vestibular n.
 Cerebellum via inferior
cerebellar peduncle
 Send Efferent fibers to:
spinal cord via vestibulo
spinal tract (Uncrossed)
CN III, IV, VI via medial
longitudinal fasiculus
 To cerebral cortex
 To cerebellum via inferior
cerebellar peduncle

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The Vestibular System

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Vestibulo-Ocular Connections

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Purely Sensory Cranial Nerves: CN-VIII

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 Purely Sensory Cranial Nerves: CN-VIII
Cochlear Nerve:
 conducts impulse of sound
 Two Nuclei: anterior &
posterior
 Cochlear Nerve Nuclei receive
sensory info. from cochlea
 Arises from central process of
nerve cell in spiral ganglion.
 enter posterior cranial fossa via
internal acoustic meatus from
inner ear
 terminates on inferior colliculus
or medial geniculate body

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 Purely Sensory Cranial Nerves: CN-VIII
•Spiral Organ  Spiral
Ganglia  Cochlear
Nerve  Cochlear N
Nuclei  Inferior
Colliculus  Medial
Geniculate Nucleus 
Primary Auditory Cortex
(A–41 & 42)  Hearing.
•Interpretation of sound
done by Auditory
Association Area (A-22).

•Recognition & interpretation

of sounds on the basis of
past experience takes place
in secondary auditory area.

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Auditory pathway

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Purely Sensory Cranial Nerves: CN-VIII

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Purely Sensory Cranial Nerves: CN-VIII

Injuries of the Vestibulocochlear Nerve:

 Lesions of vestibular n. or vestibulocerebellar pathway results in
vertigo (feeling of rotation), nausea, ataxia & nystagmus.
 Conductive Deafness, involving external or middle ear (e.g. otitis
media, autosclorosis, inflammation in the middle ear) and
 Sensory-Neural Deafness, from disease in cochlea or in the
pathway from cochlea to the brain.
 unilateral lesions of auditory pathway do not greatly affect
auditory acuity because of bilaterality of auditory projections.

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 Purely Motor Cranial Nerves: CN-III
OCULOMOTOR NERVE (CN - Ill):
 Has two motor nuclei in the
Midbrain:
1. Main motor nucleus
2. Accessory parasympathetic
nucleus (Edinger-Westphal
Nucleus)
Main motor nucleus:
 Located in anterior gray mater
surrounding cerebral aqueduct,
 Lies at level of superior colliculus
of Midbrain.
Accessory parasympathetic nucleus:
 located posterior to main motor
nucleus.

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Purely Motor Cranial Nerves: CN-III
Main motor nucleus of oculomotor nerve:
  Gives rise to voluntary motor fibers (lower motor
neurons
  supply four eyeball muscles: superior rectus, inferior
rectus, medial rectus, & inferior oblique muscles.
 also innervate levator palpebrae superioris,
responsible for lifting upper eyelid.
 Main motor nucleus receives:
 corticonuclear fibers from both cerebral hemispheres
 Tectobulbar fibers from superior colliculus
 Fibers from medial longitudinal fasciculus

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Purely Motor Cranial Nerves: CN-III

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 Purely Motor Cranial Nerves: C.N. III
2. Accessory parasympathetic
nucleus (Edinger –Westphal
Nucleus of CN - III):
 Lies posterior/dorsal to main
motor nucleus.
 Its fibers carried in inferior division
of CN – III & synapse in ciliary
ganglion
 Supply intrinsic mm of the eye,
constrictor pupillae & ciliary
mm
1. stimulate sphincter - pupillae m,
causing the pupil to constrict
2. pass to ciliary muscle, concerned
with lens accommodation for
near vision
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 Clinical Conditions of C.N. III
Upper Motor Neuron (supranuclear) Lesion of CN - III:
 Is rare, because oculomotor nucleus receives a bilateral upper motor neuron
supply via corticobulbar tract.
Lower Motor Neuron Lesion of CN – III (Oculomotor Nerve Palsy):
 If CN – III is damaged, there will be a lower motor neuron paralysis of
muscles it supplies:
Characteristic signs of a complete lesion of CN III (Oculomotor Nerve
Palsy):
 eyeball is pulled laterally (divergent squint) & downward (down &
out) by unopposed lateral rectus m (C.N. VI) & superior oblique muscle
(C.N. IV).
 upper eyelid droops (Ptosis):  because levator palpebrae is paralyzed.
 sphincter pupillae paralyzed: because Parasympathetic fibers are
damaged as a result, the
 dilator pupillae, supplied by sympathetics, is now unopposed 
the pupil is widely dilated & cannot constrict (a Fixed Pupil).
 difficulty in visual accommodation  ciliary muscle is paralyzed.

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 Purely Motor Cranial Nerves: CN - IV
CN IV: Trochlear Nerve
 Entirely motor;
 Nucleus located in gray mater
surrounding cerebral aqueduct.

 Receives:
- corticonuclear fibers from both CH
- tectobulbar fiber from sup.
colliculus
- Fibers of medial longitudinal
fasciculus.

 Emerge from posterior surface of

Midbrain & pass via superior orbital
fissure to the orbit
 Supply superior oblique muscle
  Move eye downward & laterally
 CN - IV Paralysis :- difficulty in turning
eye downward & laterally
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35
 Purely Motor Cranial Nerves: CN - VI
Abducens Nerve (CN VI):
 Small motor nerve; has small
motor nucleus
 Nuclei located in the Pons & lie
beneath 4th ventricle
 Nerve emerges from anterior
surface of Brain, in the groove b/n
lower border of Pons & Medulla
Oblongata.
 Enters orbital cavity thru lower part
of superior orbital fissure
 Runs forward & supplies lateral
rectus m.
 Receives:
- corticonuclear fiber from both CH
- tectobulbar fiber from sup
colliculus
- medial longitudinal fasciculus
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Purely Motor Cranial Nerves: CN - VI

Injury to the Abducent Nerve:

 Because CN VI has a long intracranial course
often stretched when intracranial pressure
rises.
 a brain tumor may compress CN VI, causing
paralysis of lateral rectus muscle.
 Complete paralysis or damage to its nucleus
 medial deviation of affected eye  fully
adducted;  person unable to abduct eye .
  unopposed medial rectus  eye pulled
medially, producing a medial (internal)
strabismus (convergent squint).

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 Purely Motor Cranial Nerves: CN - XI

Accessory Nerve
(CN XI):
 Purely Motor
 unique cranial nerve: its
spinal roots arise from
motor neurons in upper
five segments of cervical
spinal cord.

 Has spinal & cranial root

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 Purely Motor Cranial Nerves: CN - XI
Accessory Nerve CN XI:
Cranial Root:
 Originates from nucleus ambiguus
 Nucleus receives corticobulbar/corticonuclear
fibers from both hemispheres
 Become part of vagus nerve at Jugular Foramen &
distributes in its pharyngeal & recurrent laryngeal
branch to mm of soft palate, pharynx & larynx.
Spinal Root:
 Formed by C1- C5 spinal segments
 Enter post cranial fossa thru foramen magnum
join cranial root
 both exit thru jugular foramen
 then descends in the neck to innervate SCM &
Trapezius mm

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Purely Motor Cranial Nerves: CN - XI

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Purely Motor Cranial Nerves: CN - XI
Injury to the Spinal Accessory Nerve:
 CN XI is susceptible to injury during surgical procedures &
cannulation of vessels  nearly subcutaneous passage thru
posterior cervical region:
 CN - XI innervates trapezius & SCM mm  also supplied
by spinal nerves;
 thus, if CN - XI or its nucleus is damaged, the two
muscles will still function partially:
 However, patient will have difficulty shrugging shoulder
on affected side & turning head to opposite side as a result
of weakness of Trapezius & SCM mm, respectively.

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 Purely Motor Cranial Nerves: CN - XII

Hypoglossal Nerve CN XII:

Hypoglossal Nucleus:
 Lie close to midline,
immediately beneath lower
part of floor of 4th ventricle.

 Receives corticonuclear
fibers from contralateral
hemisphere.

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Purely Motor Cranial Nerves: CN - XII
Hypoglossal Nerve (CN - XII):
 Leave skull via hypoglossal
canal
 Control movement & shape of
tongue
 CN XII Supplies:
 All intrinsic mm of tongue &
 Styloglossus m
 Hyoglossus m
 Genioglossus m

 Upper part of its course

joined by C1 fibers from
cervical plexus

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Purely Motor Cranial Nerves: CN - XII

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Purely Motor Cranial Nerves: CN - XII
Injury to the Hypoglossal Nerve:
 Supranuclear lesion of Hypoglossal nerve 
contralateral paralysis of tongue mm.
 Damage to CN XII or its nucleus paralyzes
ipsilateral half of tongue.

 When tongue is protruded, its apex deviates

toward paralyzed side because of unopposed
action of genioglossus muscle on the normal side.

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Mixed Cranial Nerves: CN V
THE TRIGEMINAL NERVE (V): mixed & largest nerve
 has general sensory fibers & voluntary motor neurons.
 sensory fibers convey general sensations of pain,
temperature, touch, pressure, and proprioception
from the face, cornea, mouth, nose sinuses, tongue,
teeth, meninges, outer surface of the eardrum, and
temporomandibular joint.
 motor component consists of lower motor neurons that
supply muscles of mastication temporalis, masseter,
lateral & medial pterygoids.
 motor fibers innervate also anterior belly of digastric,
mylohyoid, & tensor tympani & tensor veil palatini
muscles. 46
Mixed Cranial Nerves: C.N V

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 Mixed Cranial Nerves: C.N. V
 CN – V Has 4 nuclei:
 Main sensory - lateral
to motor nuclei,
 Tactile sensation
 Spinal nucleus -
extend from main
sensory n. to C2, 
pain & temperature.
 Mesencephalic
nucleus - close to
cerebral aqueduct,
proprioceptive
 Motor nucleus -
medial to main sensory
nucleus

48
Mixed Cranial Nerves: C.N. V

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 Mixed Cranial Nerves: C.N. V
 axon of main sensory,
spinal & mescencephalic
nuclei cross the midline &
ascend as trigemino-
thalamic projection
(trigeminal lemniscus) to
 VPM internal capsule
 PCG/PSA (B 3, 1, 2).
 motor nucleus receives:
- Corticonuclear fibers
from both CH; Reticular
Formation, red nucleus,
tectum , medial
longitudinal fasciculus &
Mesencephalic nucleus.

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Mixed Cranial Nerves: C.N. V

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 Mixed Cranial Nerves: C.N. V
CN-V has three
branches:
1. V1 or ophthalmic -
pass via sup orbital
fissure

2. V2 -maxillary – via
foramen rotundum

3. V3- mandibular-
foramen ovale

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Mixed Cranial Nerves: C.N. V
Injury to the Trigeminal Nerve:
 CN - V may be injured by trauma, tumors, aneurysms, or meningeal
infections.
 If the entire nerve is cut or damaged:
 Ipsilateral paralysis of muscles of mastication (difficulty in
chewing & speaking), with deviation of mandible toward the side
of lesion.
 Ipsilateral anaesthesia of the face & anterior part of scalp, auricle &
mucous membranes of nose, (loss of fine tactile, thermal, or pain
sensations in the face) & loss of general sensation from ant 2/3rd of
tongue.
 Loss of corneal reflex (blinking in response to cornea being
touched) & sneezing reflex.

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 Mixed Cranial Nerves: C.N. VII
 Facial Nerve has 3 nuclei:
1. Main motor nuclei:- lie deep in lower part of pons
 Nucleus supplying upper part of face
receive corticonuclear fibers from both hemispheres
 Nucleus supplying lower part of face receives only from opposite side
2. Sensory nuclei :- upper part of nucleus tractus solitarius
 Lie close to motor nucleus
 Sensation of taste  in geniculate ganglion of CN VII  nucleus
solitarius
3. Parasympathetic nuclei:- lie posterolateral to motor nuclei
(i). Superior Salivatory Nucleus: receives afferent fibers from:
– Hypothalamus
– Nucleus of solitary tract  taste - oral cavity
(ii). Lacrimal Nucleus: receive afferent fibers from:
--Hypothalamus  for emotional response
--Sensory nuclei of CN-V for reflex lacrimation secondary to irritation of
cornea or conjunctiva
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56
 Mixed Cranial Nerves: C.N. VII
The FACIAL NERVE (VII):
1. Special Sensory Fibers:
 taste receptors on anterior two-thirds of tongue & their
fibers pass back to brainstem (Figures):
 Taste Receptors on anterior two-thirds of tongue 
Taste Fibers  merge with lingual branch of C.N. V 
then separate to form chorda tympani  This nerve
enters skull thru a small fissure & passes into temporal
bone, where geniculate ganglion (cell bodies of taste
neurons) is situated  axons pass into nucleus
solitarius in Pons:  second-order ascending
gustatory tracts arise that reach conscious levels.

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Mixed Cranial Nerves: C.N. VII

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 Mixed Cranial Nerves: C.N. VII

The FACIAL NERVE (VII):

 2. Parasympathetic Fibers: reflex pathways for taste sensations: 
reflex salivation.
 (i). From nucleus solitarius  interneurons to superior salivary
nucleus  synapse with preganglionic neurons (Figure)  axons
leave pons, enter internal auditory meatus  travel thru geniculate
ganglion  separate from rest of facial nerve fibers to form chorda
tympani, which merges with lingual nerve.
  With lingual nerve, preganglionic parasympathetics separate &
terminate in submandibular (submaxillary) ganglion  synapse
with postganglionic neurons  stimulate submandibular &
sublingual salivary glands.

60
Cont..
 (ii). From superior salivatory nucleus other
preganglionic parasympathetic neurons 
sphenopalatine (pterygopalatine) ganglion, as
greater petrosal nerve  synapse with
postganglionic neurons (Figure) 
postganglionic neurons reach lacrimal gland &
mucus glands of nose & mouth (nasal &
palatine glands).

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Innervation of Lacrimal Gland

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 Mixed Cranial Nerves : C.N. VII
The FACIAL NERVE (VII):
 3. Voluntary Motor Fibers:  to all muscles of facial expression.
 Nucleus is in tegmentum of pons below nucleus of CN - VI.
 Motor Nucleus  fibers pass up & loop around abducens
nucleus  a bulge on floor of 4th ventricle, known as facial
colliculus  motor fibers enter internal auditory meatus 
taste & parasympathetic neurons separate  voluntary motor
fibers leave skull at stylomastoid foramen  separate into five
main branches that supply all mm of facial expression &
stylohyoid & post belly of digastric mm.
 Within temporal bone motor fibers supply stapedius m of,
which prevents hyperacusis (i.e., normal sounds heard
abnormally loud on affected side), by pulling on the stapes.

63
Mixed C.Ns.: C.N. VII

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 CN - VII: Clinical Aspects
Characteristic features of a LMN lesion/Bell's Palsy of CN –
VII:
 Marked facial asymmetry
 Atrophy of facial muscles
 Patient is unable to close the affected eye because orbicularis-
oculi muscle is paralyzed
 Eyebrow droops
 Smoothing out of forehead & nasolabial folds
 Drooping of corner of mouth characteristic grotesque grin.
 Loss of efferent limb of corneal/conjunctival reflex  (cannot
blink)
 Lips cannot be held tightly together
 Difficulty keeping food in mouth while chewing on the
affected side
 Uncontrolled tearing
  there is no cure for Bell's Palsy , but in most cases, condition disappears slowly.

65
Lower Motor Neuron Lesion
 CN - VII: Clinical Aspects
 an upper motor or supranuclear lesion will
produce a contralateral spastic paralysis of muscles
of lower half of the face.
 patient with supranuclear lesion can still close eyes
& wrinkle forehead  muscles of upper half of
face have a bilateral nerve supply.
 These two actions help differentiate b/n Bell’s
palsy (a lower motor neuron paralysis) & an
upper motor neuron lesion.

67
68
 CN - VII: Clinical Aspects
Signs & Symptoms of CN – VII Paralysis:

 Sevierity of CN – VII paralysis depends on part & location of injury:

 A lesion b/n its origin & geniculate ganglion is accompanied by loss of
motor, gustatory (taste), & autonomic functions:
 Motor Loss includes:
 Paralysis & atrophy of facial muscles
 patient will suffer from hyperacusis  stapedius m. paralysis.
 Autonomic Function Loss includes:
 total loss of lacrimation on affected side  dry eye.
 Gustatory (Taste) Loss:
 partial loss of taste & salivation.

 Injury at stylomastoid foramen may cause paralysis of facial muscles

without loss of taste on anterior 2/3rd of tongue or no loss of secretion of
lacrimal & SM & SL salivary glands.

69
 Mixed Cranial Nerves : C.N. IX
CN – IX:
 Mixed nerve
 Has 3 nuclei:
1. Main motor
2. Parasympathetic
3. sensory

70
Mixed Cranial Nerves : C.N. IX

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 Mixed Cranial Nerves : C.N. IX
Main motor
 Lie deep in the reticular formation
 Formed by superior part of nucleus ambigus
 Receive corticonuclear fibers from both c. hemispheres
 Efferent fibers supply stylopharyngeus muscle
Parasympathetic nuclei:  Inferior Salivatory Nucleus
 Receive afferent fibers from :
 Hypothalamus via descending autonomic pathway
 Olfactory system via reticular formation
 Oral cavity/taste/: nucleus of solitary tract
 Efferent fibers route via tympanic nerve  Parotid gland
72
Mixed Cranial Nerves : C.N. IX
Sensory Nucleus:
 Part of nucleus of tractus solitarius (nucleus solitarius)
Afferent information
 Afferents from carotid sinus /baroreceptors
terminate in nucleus solitarius:  connected to
dorsal motor nucleus of CN X  Regulate arterial
blood pressure.

73
C.N. IX -Distribution

74
 Mixed Cranial Nerves : C.N. IX
Special sensory taste neurons:
 On posterior third of tongue: taste receptors of
9th cranial nerve  afferent fibers  Petrosal
Ganglion  Axons of petrosal ganglia  end in
nucleus solitarius, (extends from pons into
medulla)  ascending gustatory fibers
eventually reach conscious levels:  CNS.

75
Mixed Cranial Nerves : C.N. IX

76
Mixed Cranial Nerves : C.N. IX

77
 Mixed Cranial Nerves : C.N. IX
General sensory neurons of C.N. IX:
 general sensory component: involved in sensations of pain,
temperature, pressure & touch.
 Receptors are in tongue, auditory tube, middle ear, inner
surface of tympanic membrane, uvula, carotid sinus, & nasal &
oral pharynx:
fibers from receptors  to inferior or petrosal ganglia 
terminate in nucleus solitarius  Here, synapse with neurons
of various tracts & ascend:  e.g. Primary Sensory Area of the
brain (consciousness level).

78
Cont..
others set off important reflexes, such as the gag
reflex.
Another example involves carotid sinus
sensitive to blood pressure changes:
 A rise in blood pressure stimulates carotid sinus
(Baro-receptor), which fires off a compensatory
reflex:
From nucleus solitarius interneuron passes to
dorsal motor nucleus vagus nerve 
parasympathetic innervation of the Heart  slows
down heart rate, thus lowering the blood pressure.
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Mixed Cranial Nerves : C.N. IX

80
 CN – IX: Clinical Aspects
Lesions of the Glossopharyngeal Nerve:
 Isolated lesions of CN IX or its nuclei are uncommon:  no
clear disability  often involvement of CN - X or its nuclei.
 Complete section of glossopharyngeal nerve results in:
 sensory loss in pharynx,
 loss of taste & general sensation over posterior 1/3rd of
tongue,
 some pharyngeal weakness/weakness in swallowing
 loss of salivation from the parotid gland.
 the gag reflex is absent.

 Because CN IX, CN X & CN XI pass thru jugular foramen,

tumors in this region produce multiple cranial nerve palsies:
the jugular foramen syndrome.

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 Mixed Cranial Nerves : C.N. X

THE VAGUS NERVE (X):

 has three major components:
 1. Parasympathetic fibers to all autonomic structures of
thorax & abdomen, up to lt colic flexure (e.g. Heart,
coronary arteries, bronchioles, stomach, small & large
intestine, arterioles, glands, liver, pancreas, spleen, etc.)
 2. Voluntary motor fibers to muscles of Larynx & pharynx,
(involved in talking & swallowing); also to mm of soft palate.
 3. General sensory fibers: from all the larynx, lower part of
pharynx, viscera, carotid body (chemoreceptor), dura of
posterior cranial fossa.

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 Mixed Cranial Nerves : C.N. X
Vagus CN X:
 Has 3 nuclei
 Parasympathetic/dorsal
motor nucleus/
 Main motor nucleus
 Sensory nucleus
1. Main Motor Nucleus:
 Lies deep in reticular
formation
 Formed by nucleus
ambiguus
 Receive corticonuclear fibers
from both hemispheres
 Efferent fibers supply
constrictor mm of pharynx
& intrinsic mm of larynx

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 Mixed Cranial Nerves : C.N. X
2. Parasympathetic Nucleus:
 dorsal motor nucleus of vagus
 Lie below floor of 4th ventricle, just posterolateral
to hypoglossal nucleus
 Receive afferent fibers from hpothalamus &
glossopharyngeal nerve /carotid sinus/.

 Efferent fibers to thoracic & abdominal viscera:

bronchi, heart, esophagus, stomach, small
intestine, & large intestine as far as left colic
flecture.

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 Mixed Cranial Nerves : C.N. X
3. Sensory Nucleus:
 Lower part of nucleus of
tractus solitarius
 Sensation of taste pass via
inferior ganglion of CN X
 Common sensation via
superior ganglion & end in
spinal nucleus of CN – V.
 Superior ganglion located
in jugular foramen
 Inferior ganglion is outside
jugular foramen

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Vagus Nerve (CN-X): Clinical Aspects
 Isolated lesions of vagus nerve are uncommon.
 Injury to pharyngeal branches: dysphagia (difficulty in
swallowing).
 Lesions of superior laryngeal nerve: anesthesia of
superior part of larynx & paralysis of cricothyroid muscle:
 voice is weak & tires easily.
 Injury of a recurrent laryngeal nerve may be caused by
aneurysms of arch of aorta & during neck operations.
 Injury of recurrent laryngeal nerve:  hoarseness &
dysphonia (difficulty in speaking) because of paralysis of
mm of vocal folds (cords).
 Paralysis of both recurrent laryngeal nerves: 
aphonia (loss of voice) & inspiratory stridor (a harsh, high
pitched respiratory sound).
Vagus Nerve (CN-X): Clinical Aspects
 Because of its longer course, lesions of left
recurrent laryngeal nerve are more common.
 Proximal lesions of CN X affect pharyngeal &
superior laryngeal nerves, causing difficulty in
swallowing & speaking.
 A simple test for integrity of the vagus relies on its
innervation of muscles of soft palate.
  In unilateral paralysis, uvula deviates to the
normal side when patient says ‘Ahh’.
 Vagotomy: surgical cutting of vagus n. bilaterally
performed to control gastric or duodenal ulcers 
decreasing acid secretion of the stomach