CRANIAL NERVES

ACHMAD AMINUDDIN

OLFATORY NERVE ( CN I )
CONCERNED

WITH THE SPECIAL SENSE OF

SMELL.
THE OLFACTORY RECEPTOR NEURON ARE
IN THE OLFACTORY EPITHELIUM IN THE
ROOF OF THE NASAL CAVITY.
THE CENTRAL PROCESSES OF THE
OLFACTORY RECEPTOR NEURONS ASCEND
THROUGH FORAMINA IN THE CRIBRIFORM
PLATE OF THE ETHMOID TO REACH THE
OLFACTORY BULB IN THE ANTERIOR
CRANIAL FOSSA

OLFACTORY NERVE ( CN I )
THESE

NERVES SYNAPSE ON NEURONS IN

THE BULBS, AND THE PROCESSES OF
THESE NEURONS FOLLOW THE OLFACTORY
TRACT TO THE PRIMARY AND ASSOCIATED
AREAS OF THE CEREBRAL CORTEX.
FRACTURE OF THE CRANIAL BASE CAN
INJURE THE OLFACTORY NERVE FIBERS,
RESULTING IN ANOSMIA, TEARING OF THE
MENINGES, AND/OR CEREBROSPINAL
FLUID RINORRHEA.

THE OLFACTORY PATHWAY

Olfactory

tract
* The lateral olfactory stria, project to the
primary olfactory area, located at the
inferior and medial surface of the
temoral lobe, is where conscious aware
ness of smell begins.
* The medial olfactory stria, project to
limbic system and hypothalamus ; these
connections account for our emotional and
memory-evoked responses to odor.

THE OLFACTORY PATHWAY

From

the primary olfactory area ,

pathway also extend to the frontal
lobe , both directly and indirectly via
the thalamus . An important region for
odor identification and discrimination is
the orbitofrontal area ( area 11 ).
People who suffer damage in this area
have difficulty identifying different odor.

OPTIC NERVE ( II )

THE OPTIC NERVES HAVE SENSORY FIBERS

CONCERNED WITH THE SPECIAL ENSE OF VISION.
THE NERVE FIBERS ARISE FROM GANGLION CELL IN
THE RETINA.
THEY EXIT THE ORBIT VIA THE OPTIC CANALS.
FIBERS FROM THE NASAL HALF OF THE RETINA
CROSS TO THE CONTRALATERAL SIDE AT THE OPTIC
CHIASM.
FIBERS THE PASS VIA THE OPTIC TRACT TO THE
GENICULATE BODIES OF THE THALAMUS, WHERE
THEY SYNAPSE ON NEURONS WHOSE PROCESSES
FROM THE OPTIC RADIATION TO PRIMARY VISUAL
CORTEX OF THE OCCIPITAL LOBE.

fig 17.15 594 tortora

a,b

fig 17.15 tortora c , d

AXON COLLATERALS
To

the midbrain, they participate in neural

circuits that govern constriction pf the
pupil in response to light and coordination
of head and eye movements.
To the suprachiasmatic nucleus of the
hypothalamus, which establishes patterns
of sleep and other activities that occur on
a circadian or daily schedule in response
to intervals of light and darkness.

VISUAL FIELD DEFECTS

BLINDNESS
Color

blindness, an inherited inability to

distinguish between cetain color, result
from the absence or deficiency of one of
the three type of conus.
The most common type is red-green color
blindness.
Night blindness or nyctalopia, result from
prolonged vitamin A deficiency and the
resulting below normal amount of
rhodopsin

OCULOMOTOR NERVE (CN III)

Function:

Somatic motor ( G.S.E. )

Visceral motor ( g.v.e parasy )

Nuclei:

The somatic motor nucleus in the midbrn

The visceral motor (parasympathetic)
accessory (Edinger-Westphal) nucleus

OCULOMOTOR NERVE ( III )

THE OCULOMOTOR NERVES SEND SOMATIC MOTOR

FIBERS TO ALL EXTRA OCULAR MUSCLES, EXCEP
THE SUPERIOR OBLIQUE AND LATERAL RECTUS.
THEY ALSO SEND PRESYNAPTIC PARA SYMPATHETIC
FIBERS TO THE CILIARY GANGLION FOR
INNERVATION OF THE CILIARY BODY AND
SPHINCTER PUPILLAE
THESE NERVES ORIGINATE FROM BRAIN STEM
EMERGING MEDIAL TO THE CEREBRAL PEDUNCLES,
AND RUN IN THE LAERAL WALL OF THE
CAVERNOUS SINUS.
THEY ENTER THE ORBIT THROUGH THE SUPERIOR
ORBITAL FISSURE AND DEVIDE INTO SUPERIOR
AND INFERIOR BRANCHES

fig 14.20 503 tor

INJURY TO THE CN III

Types

/ sites of lesion
Pressure from herniating uncus on nerve;
fracture involving cavernous sinus;
aneurysm.
Abnormal findings
Dilated pupil; ptosis; eye turns down and
out; pupillary reflex on the side of the
lesion will be lost.

COMPRESSION OF THE CN III

Rapidly

increasing intracranial pressure

( extradural hematom ) often compress
CN III against the crest of the petrous part
of the temporal bone.
Result
- Pupil dilates progressively on the injured
side.
- Ipsilateral slowness of the pupillary
response to light

TROCHLEAR NERVE (CN III)

Functions

Somatic motor (general somatic

efferent)
and proprioceptive to superior oblique
m.
Nucleus
The nucleus of the trochlear nerve is
located in the midbrain, immediately
caudal to the oculomotor nucleus.

TROCHLEAR NERVE ( IV )

THE TROCHLEAR NERVE SUPPLY SOMATIC MOTOR FIBERS TO

THE SUPERIOR OBLIQUE MUSCLES AND SENDS
PROPRIOCEPTIVR FIBERS TO THIS MUSCLE, WHICH
ABDUCTS, DEPRESSES AND MEDIALLY ROTATES THE
EYEBALL.
THE NERVES EMERGE FROM THE POSTERIOR ASPECT OF
THE BRAIN STEM.
THEY RUN ALONG INTRA CRANIAL COURSE , PASSING
AROUND THE BRAIN STEM TO ENTER THE DURAMATER IN
THE FREE EDGE OF THE CEREBELLAR TENTORIUM CLOSE TO
THE POSTERIOR CLINOID PROCESS.
THE RUN IN THE LATERAL WALL OF THE CAVERNOUS SINUS,
ENTERING THE ORBIT VIA THE SUPERIOR ORBIT FISSURES.
STRETCHING DURING ITS COURSE AROUND THE BRAIN
STEM, OR FRACTURE OF THE ORBIT CAN RESULT IN AN
INABILITY TO LOOK DOWN WHEN THE EYE BALL IS
ADDUCTED.

THE CN IV IS UNIQUE
It

is the smallest.
It is the only nerve to exit from the
dorsal aspect of the brain stem.
It is the only nerve in which all of the
lower motor neuron axons decussate.
It has the longest intracranial course

CLINICAL CORRELATES
Lesions

of this nerve or its nucleus cause

paralysis of the superior oblique and
impair the ability to turn the affected
eyeball inferomedially.
The characteristic sign of trochlear nerve
injury is diplopia when looking down.
The person can compensate for the
diplopia by inclining the head anteriorly
and laterally toward the side of the normal
eye.

TRIGEMINAL NERVE (CN V)

Funcions

: General somatic afferent

Nuclei: there are 4 trigeminal nuclei, one
motor and three sensory.
Trigeminal ganglion
- Ophthalmic nerve ( CN V 1 )
- Maxillary nerve ( CN V 2 )
- Mandibular nerve ( CN V 3 )
The motor root of CN V
Four parasympatheic ganglia are
associated with the divisions of CN V ,
sensory and motor

TRIGEMINAL NERVE (CN V)

CN

V is the principal general sensory

nerve for the head ( face, teeth,
mouth, nasal cavity and dura of the
cranial cavity.
Branchial motor to the muscles of
mastication. Mylohyoid, anterior belly
of the digastric, tensor velipalatini
and tensor tympani ( 1st branchial
arch )

OPHTHALMIC NERVEW (CN

V1)
The

sensoy fibers are distributed to

skin and mucous membrane and
conjunctiva of the front of the head
and nose.
Testing CN V1 : checking the corneal
reflex , with a wisp of cotton to the
cornea will evoke a reflexive blink if
the nerve is functional.

MAXILLARY NERVE (CN V2)

CN

V2 innrvates derivates of the maxillary

prominence of the first pharyngeal arch.
Exiting the cranial cavity via the foramen
rotundum.
Distributed to skin and mucous membtane
associated with the upper jaw.
The pterygopalatine ganglion is
associated with CN V2, involved in
innervating the lacrimal and mucus
glands.

MANDIBUALR NERVE (CN V3)

CN

V3 innervates derivates of the

mandibular prominence of the 1st
pharyngeal arch.
CN V3 is the only division of the CN V to
convey motor to the striated muscle derived
from mandibular prominence mesoderm,
primarily the muscle of mastication.
The otic and submandibular ganglia are
associated with CN V3, both are concerned
with the innervation of salivary glands

INJURY TO THE ENTIRE

TRIGEMINAL NERVE
Paralysis

of the muscle of mastication

with deviation of the mandible toward
the side of the lesion.
Los of the ability to appreciate soft
tactile , thermal or painful sensations
in the face .
Los of corneal reflex and the sneezing
reflex

TRIGEMINAL NEURALGIA
TN

is a sensory disorder of the sensory

root of CN V that occur most often in
middle-aged and elderly person.
Characterized by sudden attacks of
exruciating, lightening-like jabs of facial
pain.
CN V2 is most frequently involved, then
CN V3, and least frequiently CN V1

THE CAUSE OF THE T.N. Is

unknown
Anomalous

blood vessel that

compresses the nerve.
Pathological process in the trigeminal
ganglion and in the nucleus of the
spinal tract

ABDUCENT NERVE ( CN VI )

THE ABDUCENT NERVES SUPPLY SOMATIC MOTOR

FIBERS TO THE LATERAL RECTUS MUSCLES OF THE
EYE BALL AND PROPRIOCEPTIVE FIBERS TO THESE
MUSCLES.
THE NERVES ORIGINATE FROM THE PONS, PIERCE
THE DURA ON THE CLIVIS TRAVERSE THE
CAVERNOUS SINUS AND SUPERIOR ORBITAL
FISSURES, AND ENTER THE ORBIT.
INJURY TO THE BASE OF THE BRAIN OR A
FRACTURE OF THE CRANIAL BASE INVOLVING THE
CAVERNOUS SINUS OR ORBIT CAN RESULT IN
INABILITY TO MOVE THE EYE LATERALLY, AND
DIPLOPIA OCCURS ON LATERAL GAZE

FACIAL NERVE
FUNCTION

SENSORY ; - special visceral afferent.

- general somatic afferent.
MOTOR ; - special visceral afferent.
- general visceral efferent,
( parasympathetic ).
PROPRIOCEPTIVE.

FUNCTIONS
BRANCHIAL

MOTOR (S.V.E.)
Stapedius, stylohyoid, posterior belly of
digastric muscles.
Facial expression ; buccinator, platysma
and occipitalis muscles
VISCERAL MOTOR (G.V.E.)
Stimulation of the lacrimal, submandibula
and sublingual glands.
The mucous membrane of the nose, and
hard
and soft palates

FUNCTIONS
GENERAL

SENSORY (G.S.A.)
The skin of the concha of the auricle, a
small area of skin behind the ear, and
possibly to supplement V3, which supplies
the wall ofthe acousti cmeatus and
external tympanic membrane
SPECIAL SENSORY (S.A.)
For taste from the anterior two-thirds of
the tongue and the hard and soft palates.

NUCLEI
MOTOR

; in the ventrolataral part of the

pons ( branchiomotor ).
SENSORY ; in the geniculate ganglion.
- taste ; in the nuclei of the solitary trac
in the medulla.
- general sensation ;
in the spinal nucleus of the
trigeminal nerve.

THE FACIAL NERVE

From

the junction of the pons and

medulla
THE LARGE MOTOR ROOT
innervates the muscles of facial
expresion.
THE SMALLER INERMEDIATE NERVE
carries taste, parasympathetic,
somatic sensory fibers.

THE FACIAL NERVE

IN

THE TEMPORAL BONE, GIVE RISE TO ;

- greater petrosal n.
- nerve to the stapedius.
- chorda tympani n.
EMERGES FROM THE STYLOMSTOID
FORAMEN, GIVE OFF ;
- posterior auricular branch.
- the parotic plexus, give rise 5 terminal motor : temporal, zygomatic,
buccal,
marginal mandibular and cervical.

FACIAL NERVE
BRANCHIAL

MOTOR, SUPPLIES :
- STRIATED MUSCLES OF FACIAL
EXPRESSION AND AURICULAR
MUSCLE.
- THE POSTERIOR BELLIES OF THE DIGASTRIC MUSCLE.
- STYLOID M.
- STAPEDIUS M.

THE FACIAL NERVE

PRESYNAPTIC PARASYMPATHETIC ( GVE )

- pterygopalatine ganglion.
- the lacrimal mucous glands.
- submandibular ganglion,
- sublingual glands.
- submandibular glands.
GENERAL SOMATIC
- small area of the skin of aurical concha
TASTE ( SPECIAL SENSORY )
- chordatympani joint the lingual n to convey
taste sensation from the anterior twothird of
the tongue and soft palate.

VESTIBULOCOCHLEAR NERVE
FUNCTIONS

special sensory ( special somatic

afferent ) of hearing and equilibrium.
NUCLEI
- vestibular nuclei are located at the
junction of the pons and medulla in
the lateral part of the floor of 4th
ventricle.
- cochlear nuclei are in the medulla.

THE VESTIBULOCOCHLEAR
NERVE
ENTER

THE INTERNAL ACOUSTIC

MEATUS, SEPARATES INTO ;
- THE VESTIBULAR NERVE
- vestibular ganglion
- macula of the uticle and sacule
- ampula of the semicircular duc
- THE COCHLEAR NERVE
- spiral ganglion

COCHLEAR COMPONENT

Sensory receptor, the hair cells in the cochlear duct.

Primary sensory neuron, the (spiral) organ of corti,
are located around the modiolus (center) of the
cochlea, collectively consti- tute the cochlear
(spiral) ganglion. The central processes of these
neuron form
The auditory component of the vestibulo- cochlear
nerve. These axon leave the base of the cochlea,
joint with the vestibular fibers, enter the posterior
cranial fossa via the internal acustic meatus.The
primary sensory neurons terminate in the dorsal
(high frequencies) and ventral (low frequencies)
cochlear nuclei at the junction of the pons and
medulla

SPIRAL ORGAN ( ORGAN OF

CORTI)
fig 17.19 c,d 600

fig 20.3 clin n 231

VESTIBULAR COMPONENT
The

vestibular apparatus consist of the

saccule and utricle, and three
semicircular canal.
The main function of the saccule and
utricle is to detect the position of the
head relative to gravity ( static
labyrinth ).
Both saccule and utricle have a
sensory receptors called the macula

VESTIBULAR COMPONENT
The

three semicircular canal sit at the

right angles to each other in the three
planes of the body.
The canal perceive angular movement
of the head in space ( kinetic
labyrinth ).
The canals are filled with endolymph.
Each canal has an ampula that contains
a patch of hair cells

fig 17.21 tor 604

fig 17.22 tor

EQUILIBRIUM PATHWAYS
Most

of the vestibular branch axon enter

the medulla and pons and terminate in
several vesibular nuclei.
The remaining axons enter the cerebellum
through the inferior cerebellar peduncle.
Bidiretional pathways connect the
vestibular nuclei and cerebellum.
Axon from allthe vestibuar nuclei extend to
the nuclei of cranial nerves that control
eye movements, CN III, CN IV nd CN VI. the
axon extend to CN XI, which help control
head and neck movements

EQUILIBRIUM PATHWAYS

Axon from the lateral vestibular nucleus form the

vestibulospinal tract.
Various pathways between the vestibular nuclei,
cerebellum and cerebrum, enable the cerebellum to
play a role in maintaining equilibrium.
The cerebellum continuously receives updated
sensory information from the utricle and saccule,
and makes corrective adjustments.
In response to input from the utricle, saccule and
semicircular ducts, the cerebellum continuously
sends nerve impulses to the motor area of the
cerebrum.
Correction of signals from the motor cortex to
specific skeletal muscles to maintain equilibrium.

GLOSSOPHARYNGEAL NERVE
FUNCTION

SOMATIC general somatic afferent.

-- special visceral afferent.
-- general visceral afferent.
MOTOR - special visceral efferent.
- general visceral efferent
( parasympathetic ) to deriv
of the 3rd pharyngeal arch.
NUCLEI
4 nuclei in the medulla, two motor and two
sensory

COMPONENTS OF CN IX
Branchial

motor (SVE)
To the striated muscel, the stylopharyngs
Visceral motor (GVE)
To the otic ganglion, which sends fibers to
stimulate the parotid gland.
Visceral sensory (GVA)
Carries sensation (subconscious) from the
carotid body and from the carotid sinus

COMPONENTS OF CN IX
General

sensory (GSA)
Provides general sensation from the
posterior one-third of the tongue, the
skin
of the external ear, and the internal
surface of the tympanic membane
Special sensory (SA)
For taste from the posterior one-third of
the tongue.

GLOSSOPHARYNGEAL NERVE
FROM

THE LATERAL ASPECT OF THE MEDULLA

THEN ENTER THE JUGULAR FORAMEN ARE
- SUPERIOR GANGLION.
- INFERIOR GANGLION ( SENSORY )
WHICH CONTAIN THE NERVE CELL BODIES
THAT MEDIATE GENERAL, VISCERAL, AND
SPECIAL SENSATION
The tympanic nerve is given off before the
main trunk exits the skull through the jugular
foramen

fig 9.11

1149

GLOSSOPHARYNGEAL NERVE
Carotid

nerves from the carotid body

and the sinus join the inferior
ganglion, as do the lingual and
pharyngeal branches, which bring
sensation (general and special) from
the tongue and pharynx.
The branchial motor fibers supply
one muscel, the styliopharyngeus

BRANCHIAL MOTOR
Impulse

from cortex cerebri descend along

the corticobulbar fibers through the
internal capsule and through the basis
pedunculi to synapse bilaterally on the
lower motor neurons in the rostral part of
the nucleus ambiguus.
The lower motor neuron axons join the
other modalities of CN IX.
The CN IX emerge in the groove between
olive and the inferior cerebellar peduncle.

BRANCHIAL MOTOR
The

nerve passes laterally in the posterior

cranial fossa to exit through the jugular
foramen anterior to the vagus and the
accessory nerves.
From the jugular foramen branchial motor of
the CN IX descend in the neck deep to the
sttyloid process and then curve forward around
the posterior border of stylopharyngeus
muscle where the nerve supplies the muscle.
The mucle elevates the pharynx during
swallowing speech.

VISCERAL MOTOR
Preganglionic

fibers of the parasympathetic

motor are located in the INFERIOR SALIVATORY
NUCLEUS in the medulla. Axon from these
nucleus join the other components of of
cranial nerve IX in the medulla and exit with
them through the jugular foramen.
The tympanic nerve leaves the inferior
ganglion to ascend through inferior tympanic
canaliulus. It reaches the tympanic cavity
where it forms a plexus on the surface of the
promontory of the middle ear cavity

VISCERAL MOTOR
From

this plexus branches supply sensation to

the mucous membrane of the cavity, auditory
tube and mastoid air cells and the visceral
motor fibers form the LESSER PETROSAL
NERVE.
This nerve travel back into the middle cranial
fossa, passes forward to descend through the
oval foramen to synape in the OTIC ganglion.
From this ganglion post ganglionic fibers join
the AURICULOTEMPORAL nerve (branch of V3)
to supply secretomotor fibers to the parotid
gland

fig 9.10 A 1148

VISCERAL SENSORY

Chemoreceptor from the carotid body monitor

oxygen tension in circulating blood and
baroreceptor (strech receptor) in the carotid sinus
monitor arterial blood pressure.
These sensation are relayed in the carotid nerve
toward the inferior ganglion.Central processes of
these neurons pass to the tractus solitarius to
descend to the more caudal part of the nucleus
solitarius.
From this nucleus connections are made with the
reticular formation and the hypothalamus for the
appropriate reflex responses for the control of
respiration, blood pressure and cardiac out put.

fig 9.10 B

GENERAL SENSORY
Axon

for pain and temperature from the skin of

part of the external ear, the inner surface of the
tympanic membrane, the posterior third of the
tongue and the upper pharynx have their nerve
cell bodies in either the SUPERIOR or INFERIOR
GLOSSOPHARYNGEAL GANGLIA.
The central processes for pain enter the spinal
nucleus of trigeminal nerve.
From this nucleus, its axon cross the midline in
the medulla and ascend to the contralateral
ventral posterior nucleus of the thalmus
Axon of tertiary neuron project to the
postcentral sensory gyrus.

SPECIAL SENSORY
Taste

sensation from the posterior onethird of the tongue including the vallate
papillae, is carried by special sensory
processes towards neurons in the inferior
glossopharyngeal ganglion.
Central processes from these neurons pass
through the jugular foramen, enter the
medulla and ascend in the central
tegmental tract of the brain stem to reach
the ipsilateral and contralateral ventral
posterior nuclei of thethalami.
Tertiary neuron project to reach the
primary sensory cortex in the inferior third
of the postcentral gyrus where the taste is
perceived.

VAGUS NERVE ( CN X )
FUNCTIONS

Sensory ( general somatic aferent, special

visceral afferent, general visceral
afferent ).
Motor ; special visceral efferent.
Parasympathethic ; geeral visceral efferen
NUCLEI
Four nuclei of CN X in the medulla, send or
receive fibers via CN IX two motor and two
sensory.
Three of these nuclei are shared with CN IX.

VAGUS NERVE

SENSORY from ;
- inferior pharynx
- larynx.
- thoracic organ.
- abdominal organs
SENSE OF TASTE from ;
- the root of the tongue.
- taste buds on the epiglottis.
MOTOR to ;
- soft palate
- pharynx.
- intrinsic laryngeal muscles ( phonation ).
- extrinsic tongue muscle.
- palatoglossus
Proprioceptive to the muscles listed above.
Parasympathetic to thoracic and abdominal viscera.

THE VAGUS NERVE

In

the jugular foramen positioned

between
CN IX and CN X.
Superior ganglion ; general sensory.
Inferior ganglion ; visceral sensory.
In the regio of the superior ganglion are
connection to CN IX and the superior
cervical ganglion ( sympathetic )

SPINAL ACCESSORY NERVE ( CN

XI )
Funtions

; motor to
sternocleidomastoideu
and trapezius muscles.
Nuclei ; nucleus of the accessory nerve.
From the side of the spinal cord in the
superior five or six cervical segmen.
They ascend in the cranial cavity via the
foramen magnum and exit through the
jugular foramina, crossing the lateral
cervical region

HYPOGLOSSAL NERVE (CN

XII)
Functions

: Motor ( general somatic

efferent ) to the intrinsic and
extrinsic muscles of the tongue
styloglossus, hyoglossus, and
genioglossus.
The hypoglossal nucleus is located in
the tegmentum of the medulla

HYPOGLOSSAL NERVE
Arses

as a purely motor nerve from the

medulla and leaves the cranium through
the hypoglossal canal.
After exiting the cranial cavity, CN XII is
joined by branches of the cervical plexus
conveying general somatic motor fibers
from C1 and C2 spinal nerves and general
somatic sensory fibers from the spinal
ganglion of C2.
CN XII passes inferiorly medial to the angle
of the mandible and then curves anteriorly
to enter the tongue

HYPOGLOSSAL NERVE
A

meningeal branch, returns to the

cranium through the hypoglossal canal and
innervates the duramater on the floor and
posterior wall of the posterior cranial fossa.
The superior root of the ansa cervicalis,
suply the infrahyoid muscles
(sternohyoid,sternothyroid, and omohyoid
Lingual branches, supply the styloglossus,
hyoglossus, genioglossus and intrinsic
muscles of the tongue.

HYPOGLOSSAL NERVE ( CN XII

)
Supply

somatic motor fiber to the intrinsic

and extrinsic muscles of the tongue,
except the palatoglossus.
They arise by several rootlets between the
pyramids and the olives of the medulla.
They pass through the hypoglosal canals
and run inferiorly and anteriorly passing
medial to the angles of the mandible and
between the mylohyoid and the
hypoglossus to reach the muscles of the
tongue