The Cranial Nerves - PLCNeT

The Cranial Nerves - PLCNeT

Cranial nerves Assoc. prof. Stefan Sivkov, MD, PhD Names I N. olfactorius II N. opticus III N. oculomotorius IV N. trochlearis V N. trigeminus VI N. abducens VII N. facialis VIII N.vestibulocochlearis IX N. glossopharyngeus X N. vagus

XI N. accessorius XII N. hypoglossus Nuclei, components, course Cranial nerves Somatic Somatomotor Somatosensory General somatosensory Specific somatosensory

Autonomic Visceromotor General visceromotor Specific visceromotor Viscerosensory General viscerosensory Specific viscerosensory Components

General somatosensory fibers (GSS): extero- and proprioseptive impulses from head and face 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. Nuclei Columns Medial. Somatomotor. In the central grey matter; derive from basal plate of neural tube; supply striated muscles with myotomic origin; (, V, V, ). Ventrolateral. Specific

visceromotor. Migrate ventrolaterally forming inner genu; derive from basal plate; supply muscles with branchiogenic origin; (V, V). Visceromotor column. Lateral to medial and dorsal to ventrolateral clmn; derive from basal plate next to sulcus limitans; origin to efferent preganglionic fibers; parasympathetic supply of smooth muscles; (, V, , ).

Sensory column. Lateral to sulcus limitans; derive from alar plate; accept central processes of sensory ganlia cells; General viscerosensory close to sulcus limitans (V, , ). General somatosensory - intermediate, general sensation from head/face (V) Specific somatosensory - lateral, hearing

and balance impulses (V) Organization of brain stem (after Herrick) Appearance of brain surface Course within skull Exit of skull Motor, sensory, mixed Classification

Sensory: only afferent (sensory) fibers Motor: only efferent (motor) fibers

N. Olfactorius N. Opticus N. Vestibulocochlearis N. N. N. N. N. Oculomotorius Trochlearis Abducens Accessorius Hypoglossus Mixed: sensory and motor fibers

N. N. N. N. Trigeminalis Facialis Glossopharyngeus Vagus

N. () Foramina Bulbus cribrifom olfactorius is

() Canalis opticus Nucleus geniculatu m lateralis

Meatus acusticus internus Canalis spiralis Nuclei vestibulare s V Ganglion vestibulare () Ganglion

cochleare () Nuclei cochleares N. olfactorius () For. cribriformes Bulbus olfactorius N. opticus

Ganglion cell Canalis opticus Corpus geniculatum laterale N. vestibulocochlearis Ganglion Vestibulare (SSA) - Meatus internus acusticus - Nuclei Vestibulares Ganglion Cochlear (SSA) - Canalis spiralis - Nuclei Cochleares N. Origin Exit

Supply Nucleus n. oculomotorii () Fissura orbitalis superior Mm. recti superior, inferior, medialis; inferior obliquus; levator palpebrae

superioris Nucleus accessorius n.oculomotorii () M. sphincter pupillae m. ciliaris V Nucleus n. trochlearis () Fissura

orbitalis superior M. obliquus superior V Nucleus n. abducentis () Fissura orbitalis superior M. rectus lateralis

XI Nucleus n. accessorii () Foramen jugulare M.sternocleidomastoi deus m. trapezius XI I Nucleus n. hypoglossi ()

Canalis hypoglossi M N. oculomotorius N. oculomotorius

Fissura orbitalis superior

sinus cavernosus sulcus cruris medialis nucl. oculomotorius nucl. accessorius

Mm. recti superior, inferior, medialis; m. obliquus inferior; m. levator palpebrae superioris M. sphincter pupillae & m. ciliaris Ganglion ciliare : n. opticus & m. rectus lateralis

nucleus accessorius n. oculomotorii ganglion ciliare n. oculomotorius (radix parasympathica) . n. nasociliaris (radix sensoria) plexus caroticus internus (radix sympathica) . ( nervi ciliares breves) m. cliliaris () m. sphincter pupillae ( ). 20/2/10

Ganglion ciliare Damage of n. oculomotorius Diverging strabismus (squinting) Double vision Dilated pupil (mydriasis) Impaired accomodation N. trochlearis [IV] Nucleus

Nucl. n. trochlearis () Appearance Below colliculus inferior Course Lateral wall of sinus cavernosus Fissura orbitalis superior

Exit Supply Somatomotor: M. obliquus superior N. abducens [VI] Nucleus Appearance Course Exit Supply Somatomotor:

Nucl. n. abducentis () Fissura pontomedullaris, Thru sinus cavernosus, lateral to . carotis int. Fissura orbitalis superior M. rectus lateralis N. abducens 20/2/10 Converging strabismus (squinting) Double vision

Damage of n. abducens N. accessorius N. accessorius Nucleus 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 cranialis Exit 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 anterolateralis btw oliva & pyramis Cisterna basalis Canalis n. hypoglossi Course Exit 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 : from head and face to sensory nuclei of n.trigeminus; neurons in ganglion trigeminale, lying on pars petrosa 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 nose Sympathetic 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. N. N. N.

infraorbitalis zygomaticus alveolaris superior pterygopalatinus Supply: Dura mater cerebri Teeth upper jaw Nasal& oral mucosa Skin btwn eyes and mouth

N. mandibularis (V3, mixed) Exit thru foramen ovale 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 2/3s of tongue Damage produces sagging facial muscles and disturbed sense of taste (no sweet and salty) Branches of Facial Nerve

Clinical test: Test anterior 2/3s 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

for. stylomastoideum, enters gl. arotidea, 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 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 jugular 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 (3) 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 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. brachiocephalic 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 in

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 internus Ramus externus

Thoracic branches N. laryngeus recurrens Right around . 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 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

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