ABDUCENT NERVE

By Dr. Abu Mohammed Alsudani

FUNCTIONAL COMPONENTS

The abducent (sixth cranial) nerve is a small, entirely motor nerve that supplies the
lateral rectus muscle of the eyeball:

1. Somatic efferent, for lateral movement of the eye.

2. General somatic afferent, for proprioceptive impulses from the lateral rectus
muscle. These impulses ultimately reach the mesencephalic nucleus of the
trigeminal nerve.
NUCLEUS

The abducent nucleus is situated in the lower part of pons, close to the midline,

beneath the floor of the fourth ventricle. It is closely related to the fasciculus of the
facial nerve. It consists of two types of multipolar cells—large and small. The large
multipolar cells give rise to fibres of the abducent nerve,

while the fibres of the small multipolar cells relay in the oculomotor nucleus via the
medial longitudinal fasciculus. The small multipolar cells are believed to form the
para-abducent nucleus. Since the abducent nucleus belongs to the group of
somatic efferent nuclei, it lies in line with nuclei of fourth and third nerves above
and with the nucleus of hypoglossal nerve below.
Connections of the nucleus
1. Cerebral cortex Motor cortex (precentral gyrus) through the afferent corticonuclear
fibres from both cerebral hemispheres (principally contralateral).
Visual cortex, through the superior colliculus and tactobulbar tract.
Frontal cortex (frontal eye fields).
2. Nuclei of 3rd, 4th and 8th cranial nerves through the medial longitudinal bundle.
3. Pretectal nucleus of both sides through the tectobulbar tract.
4. Horizontal gaze centre (paramedian pontine reticular formation—PPRF) through the
medial longitudinal bundle.
5. Cerebellum through vestibular nuclei.
 CLINICALLY APPLIED ASPECTS
Clinical features of sixth nerve palsy Deviation. In primary position, eyeball is converged due to
unopposed action of the medial rectus muscle.
Ocular movements. Abduction is limited due to weakness of the lateral rectus muscle.
Diplopia. Uncrossed horizontal diplopia occurs, which becomes worse toward the action of
paralysed muscle.
Head posture. The face is turned towards the action of paralysed muscle to minimize diplopia.
Localizing causes of 6th nerve palsy

Myasthenia gravis.

Restrictive thyroid myopathy.

Medial orbital wall, blow-out-fracture Orbital myositis.

Duane’s syndrome (type 1).

Convergence spasm Divergence paralysis.

Acute onset esotropia Mobius syndrome

Nonlocalizing causes of 6th nerve palsy

Collier’s sphenoidal palsy.

Superior orbital fissure syndrome.

Arteriosclerosis.

Hypertension.

Diabetes.

Trauma and raised ICT.