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Cranial nerves
Assoc. prof. Stefan Sivkov, MD, PhD
NamesI N. olfactorius II N. opticusIII N. oculomotorius IV N. trochlearisV N. trigeminus VI N. abducens VII N. facialis VIII N.vestibulocochlearis IX N. glossopharyngeusX N. vagusXI N. accessorius XII N. hypoglossus
Nuclei,
components,
course
Cranial nervesCranial nerves
SomaticSomatic SomatomotorSomatomotor SomatosensorySomatosensory
General somatosensoryGeneral somatosensory Specific somatosensorySpecific somatosensory
AutonomicAutonomic VisceromotorVisceromotor
General visceromotorGeneral visceromotor Specific visceromotorSpecific visceromotor
ViscerosensoryViscerosensory General viscerosensoryGeneral viscerosensory Specific viscerosensorySpecific viscerosensory
Components General somatosensory fibers General somatosensory fibers (GSS): extero- and
proprioseptive impulses from head and face Specific somatosensory fibers Specific somatosensory fibers (SSS): specific
impulses from eye and ear General viscerosensory fibers (GVS): from
visceral organs to viscerosensory nuclei. Specific viscerosensory fibers(SVS): specific
impulses for smell and taste General somatomotor fibers (GSM): for skeletal
muscles of eye and tongue Specific visceromotor fibers (SVM): for skeletal
muscles with branchiogenic origin. Mastication, expression, swallowing
General visceromotor fibers (GVM): from visceromotor nuclei; relay in parasympathetic ganglia. Heart muscle , smooth muscles, glands.
NucleiNuclei
ColumnsColumns Medial.Medial. SomatomotorSomatomotor.. In the In the
central grey matter; derive from central grey matter; derive from basal platebasal plate of neural tube; supply of neural tube; supply striated muscles with striated muscles with myotomic myotomic origin; origin; (ІІІ, ІV, VІ, ХІІ).(ІІІ, ІV, VІ, ХІІ).
VentrolateralVentrolateral.. Specific Specific visceromotorvisceromotor.. Migrate Migrate ventrolaterally formingventrolaterally forming inner inner genugenu; ; derive from derive from basal platebasal plate; ; supply muscles withsupply muscles with branchiogenic branchiogenic originorigin; ; (V, VІІ).(V, VІІ).
Visceromotor column. Visceromotor column.
Lateral to medial and dorsal to ventrolateral Lateral to medial and dorsal to ventrolateral clmn; derive from clmn; derive from basal platebasal plate next to sulcus next to sulcus limitans; origin to efferent preganglionic limitans; origin to efferent preganglionic fibers; parasympathetic supply of smooth fibers; parasympathetic supply of smooth muscles; muscles; (ІІІ, VІІ, ІХ, Х).(ІІІ, VІІ, ІХ, Х).
Sensory columnSensory column..
Lateral toLateral to sulcus limitanssulcus limitans; ; derive fromderive from alar alar plateplate; ; accept central processes of sensory accept central processes of sensory ganlia cells;ganlia cells;
General viscerosensoryGeneral viscerosensory – – close toclose to sulcus sulcus limitans limitans (VІІ, ІХ, Х).(VІІ, ІХ, Х).
General somatosensoryGeneral somatosensory - intermediate, - intermediate, general sensation from head/face (V)general sensation from head/face (V)
Specific somatosensorySpecific somatosensory - lateral, hearing - lateral, hearing and balance impulses (VІІІ)and balance impulses (VІІІ)
Organization of brain stem (after Herrick)
Appearance of brain surfaceAppearance of brain surface
Course within skullCourse within skull
Exit of skullExit of skull
Motor, sensory, mixed
Classification Sensory: only afferent (sensory) fibers
N. Olfactorius N. Opticus N. Vestibulocochlearis
Motor: only efferent (motor) fibers N. Oculomotorius N. Trochlearis N. Abducens N. Accessorius N. Hypoglossus
Mixed: sensory and motor fibers N. Trigeminalis N. Facialis N. Glossopharyngeus N. Vagus
Сетивни нервиN. Първи неврон и
вид на влакната
Вход Терминални ядра
Модалност
І Обонятелен епител (СВС)
Foramina cribrifomis
Bulbus olfactorius
Обоняние
ІІ Ганглийни клетки в ретината (ССС)
Canalis opticus
Nucleus geniculatum lateralis
Зрение
VІІІ Ganglion vestibulare (ССС)
Meatus acusticus internusCanalisspiralis
Nucleivestibulares
Баланс
Ganglion cochleare (ССС)
Nuclei cochleares
Слух
N. olfactorius
Обонятелна лигавица (СВС)→ For. cribriformes → Bulbus olfactorius
N. opticusGanglion cell → Canalis opticus → Corpus
geniculatum laterale
N. vestibulocochlearisGanglion Vestibulare (SSA) - Meatus internus acusticus - Nuclei
Vestibulares
Ganglion Cochlearе (SSA) - Canalis spiralis - Nuclei Cochleares
Моторни нервиN. Origin Exit Supply
ІІІ Nucleus n. oculomotorii (ОСМ)
Fissura orbitalis superior
Mm. recti superior, inferior, medialis; inferior obliquus; levator palpebrae superioris
Nucleus accessorius n.oculomotorii (ОВМ)
M. sphincter pupillae и m. ciliaris
ІV Nucleus n. trochlearis (ОСМ)
Fissura orbitalis superior
M. obliquus superior
VІ Nucleus n. abducentis (ОСМ)
Fissura orbitalis superior
M. rectus lateralis
XI Nucleus n. accessorii (СВМ)
Foramen jugulare
M.sternocleidomastoideus и m. trapezius
XII
Nucleus n. hypoglossi (ОВМ)
Canalis hypoglossi
Mускули на езика
N. oculomotorius
Компоненти Общо соматомоторни влакна Общо висцеромоторни влакна
Ядра nucl. oculomotorius nucl. accessorius
Поява sulcus cruris medialis
Ход латерална стена на sinus cavernosus
Напускане на черепа Fissura orbitalis superior
Инервация Mm. recti superior, inferior, medialis; m. obliquus inferior;
m. levator palpebrae superioris M. sphincter pupillae & m. ciliaris
Ganglion ciliare : между n. opticus & m. rectus lateralis
N. oculomotorius
23/4/19
Ganglion ciliareGanglion ciliareПарасимпатикови влакна от nucleus accessorius n. oculomotorii достигат ganglion ciliare по n. oculomotorius (radix parasympathica) и се прекъсват в него.
Сетивни влакна от n. nasociliaris (radix sensoria) и симпатикови влакна от plexus caroticus internus (radix sympathica) преминават през ганглия без да се прекъсват.
Парасимпатикови влакна достигат (по nervi ciliares breves) до m. cliliaris (акомодация) и m. sphincter pupillae (свиване на зеницата).
Damage of n. oculomotorius
Diverging strabismus (squinting) Double vision Dilated pupil (mydriasis) Impaired accomodation
N. trochlearis [IV]
Nucleus Nucl. n. trochlearis (ОСМ)
Appearance Below colliculus inferior
Course Lateral wall of sinus cavernosus
Exit Fissura orbitalis superior
Supply Somatomotorа:
M. obliquus superior
23/4/19
N. abducens [VI]
Nucleus Nucl. n. abducentis (ОСМ)Appearance Fissura pontomedullaris,Course Thru sinus cavernosus,
lateral to а. carotis int.Exit Fissura orbitalis superiorSupply
Somatomotor: M. rectus lateralis
N. abducens
Damage of n. abducens
Converging strabismus (squinting) Double vision
N. accessorius N. accessoriusNucleus
Nucl. ambiguus - caudal (SVM)
Nucl. spinalis n. accessorii (GSM)
Appearance Sulcus retroolivaris – radix cranialis
Btw radices ventralis & dorsalis – radix spinalis
Course Radix spinalis enters skull thru for. magnum,
joins radix cranialisExit
For. Jugulare- pars cranialis – r. externus in n. vagus- pars spinalis – r. externus
Supply M. trapezius, m. sternocleidomastoideus
N. hypoglossus [XII]
Nucleus Nucl. n. hypoglossi(GSM)
Appearance Sulcus anterolateralisbtw oliva & pyramis
Course Cisterna basalisExit Canalis n. hypoglossi
Supply Somatomotor: Mm. styloglossus,
hyoglossus,
genioglossus, own muscles of toungue
N. hypoglossus
N. hypoglossus
Mixed nerves
N. trigeminus [V]
Components SVM: from nucleus motorius n. trigemini,
muscles of mastication. GSS влакна: from head and face to sensory
nuclei of n.trigeminus; neurons in ganglion trigeminale, lying on pars petrosa на os temporale.
Branches N. ophthalmicus
(V1, sensory) exits thru fissura orbitalis superior, enters orbit
Branches N. frontalis:
N. supratrochlearis N. supraorbitalis
N. lacrimalis N. nasociliaris
Supply:
Sensory: Dura mater cerebri Eye Nasal mucosa Skin epicranial & eye
area, back of noseSympathetic fibers for m.
dilator pupillae. From upper Th segments, thru superior cervical ganglion. Reach branches of a. carotis interna
N. maxillaris(V2, sensory) Exit thru foramen
rotundum Branches
N. infraorbitalis N. zygomaticus N. alveolaris superior N. pterygopalatinus
Supply: Dura mater cerebri Teeth – upper jaw Nasal& oral mucosa Skin btwn eyes and mouth
N. mandibularis(V3, mixed) Exit thru foramen ovale и
enters fossa infratemporalis Branches
N. auriculotemporalis N. buccalis N. lingual N. alveolaris inferior Nn. for masticatory muscles
Supply: Sensory:
Dura mater cerebri Teeth and gums of lower jaw Mucosa and floor of mouth Anterior 2/3 of tongue Skin temporal area, ear, below mouth
Motor: Muscles of mastication, m. mylohyoideus, venter anterior m. digastricus
Facial Nerve VII
Somatic Motor - facial expressions Autonomic Motor - salivary and lacrimal glands,
mucous membranes of nasal and palatine mucosa Special Sensory - taste on anterior 2/3’s of tongue Damage produces sagging facial muscles and
disturbed sense of taste (no sweet and salty)
Branches of Facial Nerve
Clinical test: Test anterior 2/3’s of tongue with substances such as sugar, salt, vinegar, and quinine; test response of tear glands to ammonia fumes; test motor functions by asking subject to close eyes, smile, whistle, frown, raise eyebrows, etc.
N. facialis [VII]Components SVM from nucleus n. facialis for muscles of expression GVM (n. intermedius) from nucleus salivatorius
superior, interrupt in ganglion pterygopalatinum & ganglion submandibulare. Postganglionic fibers reach glandulae lacrimalis, submandibularis & sublingualis
SVS (n. intermedius) from taste buds in anterior 2/3 of tongue, neurons in ganglion geniculi of n. facialis reaching nucleus tractus solitarii
GSS skin external ear
Course
Thru meatus acusticus internus, canalis facialis и for. stylomastoideum,
enters gl. рarotidea,
forming plexus intraparotideus and giving off five branches for muscles of expression
Branches in canalis n. facialis Chorda tympani: joins n. lingualis of n. mandibularis
Tate in anterior 2/3 of tongue Interrupt in ganglion submandibulare, postganglionic
fibers reaching gl. submandibularis и gl. sublingualis
N. petrosus major: GVM fibers to ganglion pterygopalatinum, postganglionic fibers thru n. zygomaticus & n. lacrimalis reach gl. lacrimalis
N. stapedius: for m. stapedius
Branches ouside the skull Rr. temporales Rr. zygomatici Rr. buccales R. marginalis mandibulae R. coli
Ganglion pterygopalatinum: in fossa pterygopalatine below n. maxillaris
Ganglion submandibulare: btw n. lingualis & gl. submandibularis
Damage of n. facialis
Glossopharyngeal Nerve IX Somatic motor – Swallowing and
voice production via pharyngeal muscles
Autonomic motor - salivation, gagging, control of BP and respiration
Sensations from posterior 1/3 of tongue including taste
Sensations from baroreceptors and chemoreceptors
Damage results in loss of bitter and sour taste and impaired swallowing, blood pressure anomalies (with CN X).
N. glossopharyngeus [IX]Components SVM: from nucleus ambiguus to m. stylopharygeus GVM: preganglionic from nucleus salivatorius
inferior to ganglion oticum, postganglionic to glandula parotidea
SVS: from ganglion inferior, central processes to nucleus tractus solitarii, peripheral processes to posterior 1/3 of tongue
GVS: from mucosa of posterior 1/3 of tongue, pharynx, palatine tonsils, tuba auditiva & cavitas tympanica, sinus & glomus caroticus, reach nucleus tractus solitarii
Course: exit thru foramen jugularе
Branches Rami linguales: taste buds and mucosa of posterior 1/3 of
tongue Rami pharyngei: plexus pharyngeus, sensory and
parasympathetic fibers N. tympanicus: GVM thru n. tympanicus & n. petrosus
minor reach ganglion oticum, postganglionic thru n. auriculotemporais (Ⅴ3) for glandula parotidea
Ramus sinus caroticus: for sinus & glomus caroticus Rami tonsillares & ramus m. stylophayngei
Ganglion oticum : below foramen ovale
Vagus Nerve X Sensations from skin at back of ear,
external acoustic meatus, part of tympanic membrane, larynx, trachea, espophagus, thoracic and abdominal viscera
Sensations from bararoceptors and chemoreceptors
Special sensory – taste from epiglottis and pharynx
Somatic motor – Swallowing and voice production via pharyngeal muscles
Autonomic motor – smooth muscle of abdominal viscera, visceral glands secretions, relaxation of airways, and normal or decreased heart rate.
Damage causes hoarseness or loss of voice, impaired swallowing, GI dysfunction, blood pressure anomalies (with CN IX), fatal if both are cut
N. vagus [X]Components GVM: nucleus dorsalis n. vagi, interrupt in
parasympathetic ganglion, short postganglionic fibers supply heart muscle, smooth muscles and glands
SVM: nucleus ambiguus, for muscles of pharynx и larynx
GVS: from organs in neck, thorax, abdomen to nucleus tractus solitarii
GSS: auricle, meatus acousticus externus &
dura mater cerebri
Course Exits thru foramen jugulare Descends in vagina carotica btw internal
a. carotis interna (communis) & v. jugularis interna
N. vagus dexter Enters thorax to the right of trachea Descends behind v. brachiocephalica
dextra & v. cava superior Passes behind the root of right lung Forms plexus esophageus posterior Forms truncus vagalis posterior in hiatus
esophageus, enters abdomen and gives off rami gastrici posteriores celiaci
N. vagus sinister Enters thorax btw a. carotis communis &
a. subclavia sinistra, behind v. brachiocephalicа sinistra
Passes anterior to arch of aorta, giving off n. laryngeus recurrens
Passes behind the root og lefht lung Forms plexus esophageus anterior Forms truncus vagalis anterior inв
hiatus esophageus, enters abdomen, gives off rr. gastrici anteriores & rr. hepatici
Branches in neck N. laryngeus superior: descens along
pharynx and gives off Ramus internus, pierces membrana
thyrohyoidea and supplies mucosa of larynx to rima glottis
Ramus externus, supplies m. cricothyroideus Rami cardiaci cervicales superiores:
descend to plexus cardiacus Ramus meningeus, ramus auricularis,
rami pharyngei (plexus pharyngeus)
N. laryngeus superior
Ramus externus
Ramus internus
Thoracic branches N. laryngeus recurrens
Right around а. subclavia sin., left around arcus aortae
Ascend in tracheo-esophageal sulcus Enter larynx behind art. cricothyroidea,
and turn into n. laryngeus inferior Supply: laryngeal mucosa below rima
glottis, laryngeal muscles except m. cricothyroideus Rami cardiaci inferiores Rami tracheales Rami esophagei
Rami bronchiales
Abdominal branches
Rr. gastrici anteriores и posteriores: Along lesser curvature of
stomach supply anterior and posterior walls
At antrum pyloricus bracnches for pars pylorica
Rr. hepatici: enter plexus hepaticus supply liver and gall bladder
Rr. celiaci: for plexus celiacus, reach liver, pancreas, spleen, kidneys and gut to flexura colica sisnistra