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Cranial Nerves Flashcards

1
Q

cranial nerves

A
  • Bundles of sensory, motor, or mixed fibers that innervate muscles or glands
  • They emerge through foramina or fissures in the cranium
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2
Q

motor CN

A

CN III – oculomotor
CN IV – trochlear
CN VI – abducent
CN XI – accessory
CN XII – hypoglossal

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3
Q

sensory CN

A

CN I – olfactory
CN II – optic
CN VIII – vestibulocochlear

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4
Q

mixed CN

A

CN V – trigeminal
CN VII – facial
CN X – vagus
CN XI – glossopharyngeal

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5
Q

CN I

A
  • Olfactory
  • Type: special sensory
  • Course: olfactory receptors on olfactory mucosa -> CN I arise through the foramina of the cribriform plate -> synapse on olfactory bulb -> axons of secondary nerve cells (mitral cells) become olfactory tract
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6
Q

CN II

A
  • Optic
  • Type: special sensory
  • Course: axons of 3rd order nerve cells in the retina (retinal ganglion cells) project back to the brain forming the optic nerve (CN II) ->enters cranium through the optic canal -> form the optic chiasm -> posterior to the chiasm becomes the optic tract
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7
Q

CN III

A
  • Oculomotor
  • Type: somatic motor and visceral motor (parasympathetic fibers)
  • Course: runs anteriorly in the lateral wall of the cavernous sinus -> enters the orbit through the superior orbital fissure -> branches out into superior and inferior divisions
  • Innervation
    • Superior division
      • Levator palpebrae superioris
      • Superior rectus
    • Inferior division
      • Medial rectus
      • Inferior rectus
      • Inferior oblique
    • Parasympathetic fibers (via short ciliary nerves of ciliary ganglion)
      • sphincter pupillae m. (constriction of pupil)
      • ciliary m. (accomodation of lens; for distance or close vision)
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8
Q

CN IV

A
  • Trochlear
  • Type: somatic motor
  • Smallest cranial nerve, with longest intracranial course
  • Course: runs anteriorly in the lateral wall of the cavernous sinus -> enters the orbit through the superior orbital fissure
  • Innervation
  • Superior oblique m. (uses a pulley or trochlea to redirect its line of action, giving name to CN IV)
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9
Q

CN VI

A
  • Abducent
  • Type: somatic motor
  • Course: runs through the cavernous sinus parallel and inferior to internal carotid artery -> enters the orbit through the superior orbital fissure
  • Innervation
  • Lateral rectus m (abducts the eye)
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10
Q

CN V

A
  • trigeminal
  • Type: somatic sensory and somatic motor
  • Principal somatic sensory nerve of the head (face, teeth, mouth, nasal cavity, and dura mater of cranial cavity). Motor root is distributed exclusively via the mandibular division (CN V3)
  • Branches or divisions
    • Ophthalmic (CN V1)
    • Maxillary (CN V2)
    • Mandibular (CN V3)
  • Opthalmic & maxillary ONLY SENSORY
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11
Q

CN V1

A
  • Ophthalmic
  • Type: sensory only
  • Course: runs anteriorly in the lateral wall of the cavernous sinus -> enters the orbit through the superior orbital fissure
  • Branches
    • Lacrimal n.
    • Frontal n.
    • Nasociliary n.
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12
Q

Lacrimal n.

A
  • runs anteriorly along lateral aspect of orbit
  • Supply: upper eyelid (sensory)
  • Supply: lacrimal gland (parasympathetic fiber from the pterygopalatine ganglion via the zygomatic n. of CN V2)
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13
Q

Frontal n.

A
  • runs anteriorly in the center of orbit
  • Supraorbital n. (exits through supraorbital foramen)
  • Supratrochlear n. (medial to supraorbital n.)
  • Supply: forehead, anterior scalp, and upper eyelid
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14
Q

Nasociliary n.

A
  • runs anteriorly along medial wall of orbit
  • Sensory root of ciliary ganglion: sensory fibers from the eyeball pass through
  • the ciliary ganglion and join the nasociliary n.
  • Long ciliary nerve: supply iris and cornea. Contains sympathetic fibers to
  • the dilator pupillae m.
  • Infratrochlear nerve: supplies skin of eyelid, side of nose, conjunctiva,
  • and lacrimal sac
  • Anterior & Posterior ethmoidal nerves: supply ethmoid and sphenoid
  • air sinuses and part of nasal cavity
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15
Q
A
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16
Q

CN V2

A
  • Maxillary
  • Type: sensory only
  • Course: goes through lateral wall of the cavernous sinus -> exits cranium via foramen rotundum -> travel in the pterygopalatine fossa
  • Major nerves and their branches:
    • Zygomatic n
    • Infraorbital n
    • Nasal branches
    • Pterygopalatine ganglion branches
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17
Q

Zygomatic nerve

A
  • Zygomaticofacial nerve: skin of upper cheek
  • Zygomaticotemporal nerve: skin over side of forehead. Carries communicating branch to lacrimal nerve
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18
Q

Infraorbital nerve

A
  • (exits through infraorbital foramen)
  • Supply: upper teeth, lower eyelid, upper lip, and part of nasal vestibule
  • Posterior superior alveolar nerve: molar teeth and associated gum area
  • Anterior & Middle superior alveolar: premolar, canine, and incisive teeth and associated gum
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19
Q

Nasal branches

A
  • Posterior superior and inferior lateral nasal nerves
  • Nasopalatine nerve
  • Supply walls and septum of nasal cavity
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20
Q

Pterygopalatine ganglion branches

A
  • Ganglion located inferior to the maxillary nerve in the pterygopalatine fossa
  • Receives parasympathetic fibers via the greater petrosal nerve from the Facial nerve (CN VII)
  • Greater & Lesser palatine nerve: enter nasal cavity and supply palate mucosa and glands
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21
Q
A
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22
Q

CN V3

A
  • Mandibular
  • Type: sensory and motor
  • Course: exits cranium via foramen ovale
  • Branches:
  • Motor
  • Sensory
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23
Q

Motor branch of Mandibular CN V3

A
  • Muscles of mastication (temporalis, masseter, & lateral and medial pterygoid)
  • Tensor veli palatini: in palate, tenses soft palate(when swallowing opens and covers nasal cavity)
  • Tensor tympani: in tympanic cavity, dampens sounds (reduce damage to ear)
  • Mylohyoid and anterior belly of digastric via mylohyoid nerve
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24
Q

Sensory branch of Mandibular CN V3

A
  • Auriculotemporal nerve: auricle, TMJ, and anterior temporal region
    • Parotid branches: parasympathetic fibers from the glossopharyngeal nerve (CN IX) via the lesser petrosal nerve -> otic ganglion->auriculotemporal n.
  • Buccal nerve: skin over buccinator m. (cheeks) and internal mucosa membrane of the same area
  • Lingual nerve: sensation to anterior 2/3rd of tongue
    • Submandibular ganglion branches: visceral fibers from the facial nerve (CN VII) via chorda tympani nerve join the lingual nerve posteriorly to reach the submandibular ganglion
    • Supply submandibular and sublingual glands and carry taste fibers from anterior 2/3rd of tongue
  • Inferior alveolar nerve: enters mandibular foramen -> runs anteriorly in the body of mandible -> emerges through the mental foramen as the mental nerve
    • Supply: mandibular teeth (IAN); skin of chin, and skin and mucosa of lower lip (MN)
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25
\*Parasympathetic ganglia and CNs
26
3 parasympathetic ganglia associated with the trigeminal nerve
* Pterygopalatine ganglion (from CN VII -\> CN V2) * Submandibular ganglion (CN VII -\> lingual nerve of CN V3) * Otic ganglion (CN IX -\> auriculotemporal n. of CN V3)
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cavernous sinus and associated structures
28
CN VIII
* Facial * Type: somatic and visceral motor and sensory * Course: enters cranium through internal acoustic meatus  runs in facial canal (geniculate nucleus)  exits cranium through stylomastoid foramen * Clinical: lesions lead to facial paralysis * Branches: * Sensory: * Geniculate ganglion (also carries taste) * Motor: * Stapedius n. * Post. auricular n. * Temporal branches * Zygomatic branch * Buccal branch * Mandibular branch * Cervical branch
29
Geniculate ganglion
* sensory * Greater petrosal nerve: from geniculate ganglion -\> to pterygopalatine ganglion (CN V2 in the pterygopalatine fossa) -\> via the zygomatic nerve to lacrimal nerve (CN V1) to lacrimal gland * Chorda tympani through petrotympanic fissure to submandibular ganglion via the lingual nerve (CN V3) -\> to sublingual and submandibular glands. It also carries taste (special sensory) fibers from anterior 2/3rd of tongue
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Stapedius nerve
to stapedius muscle in middle ear. Before coming out of stylomastoid foramen
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Posterior auricular n.
* runs posterior to auricle * Muscles of auricle and occipitalis m. * Posterior belly of digastric, stylohyoid m.
32
5 motor branches of CN VII that innervate the mm of facial expression after getting into the parotid gland
1. temporal branches 2. zygmatic branch 3. buchal branch 4. mandibular branch 5. cervical branch
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Temporal branches
Course: superior to parotid gland -\> crosses zygomatic arch -\> to temporal and frontal regions of scalp
34
Zygomatic branch
Course: anterior to parotid gland -\> innervates muscles as it goes forward on the upper cheek
35
Buccal branch
Course: medially through cheek Innervate: buccinator. This is motor, remember that CN V3 has a buccal branch as well, but it is sensory
36
Mandibular branch
Course: along lower border of mandible, innervates muscles on its course
37
Cervical branch
Course: courses inferiorly to innervate the platysma
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\*CN VII Facial
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CN VIII
* Vestibulocochlear * Type: special sensory (hearing and equilibrium and motion) * Course: Enters the internal auditory meatus with the facial nerve divides in two parts: * Divisions: * Cochlear * Vestibular
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cochlear division of CN VIII
Cochlear: to the cochlear or organ of hearing
41
vestibular division of CN VIII
Vestibular: to the semicircular canal for balance and equilibrium
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\*CN VIII vestibulocochlear
43
CN IX
* Glossopharyngeal * Type: somatic, visceral, and special sensory (taste) & somatic and visceral motor * Course: exits cranium through anterior aspect of the jugular foramen. At this foramen the CN IX has two ganglia * Branches * Somatic motor * Stylopharyngeous m. * Somatic sensory * Tympanic nerve * Carotid sinus nerve * Pharyngeal and tonsillar nerves * Lingual nerve * Visceral motor * Lesser petrosal nerve to otic ganglion
44
Stylopharyngeous m.
somatic motor branch of CN IX
45
Tympanic nerve
* somatic sensory branch of CN IX * sensory to middle ear (affected during ear infection)
46
Carotid sinus nerve
* somatic sensory branch of CN IX * sensory to carotid sinus (barorec.) and body (chemorec.)
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Pharyngeal and tonsillar nerves
* somatic sensory branch of CN IX * sensory to pharynx, palatine tonsils, and soft palate
48
Lingual nerve
* somatic sensory branch of CN IX * sensory and taste (special sensory) to posterior 1/3rd of tongue
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Lesser petrosal nerve to otic ganglion
* visceral motor branch of CN IX * (associated with CN V3) -\> auriculotemporal nerve -\> to parotid gland
50
\*CN IX Glossopharyngeal
51
CN X
* vagus * Type: somatic, special, and visceral sensory & somatic and visceral motor * Course: exits cranium through middle aspect of jugular foramen between CN IX and XI and travels inferiorly in the neck in the carotid sheath * Branches: * meningeal branch * auricular branch * pharyngeal branch * sup. laryngeal n. * cardiac branches * recurrent laryngeal n.
52
Meningeal branch
* sensory branch of CN X * sensory to dura mater of posterior cranial fossa, rest of dura mater (CN V)
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Auricular branch
* branch of CN X * tympanic membrane, part of ear canal, and auricle
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Pharyngeal branch
* motor and sensory branch of CN X * motor to pharyngeal mm., except stylopharyngeous (CN IX) & to soft palate, except tensor veli palatini (CN V3). Sensory to lower pharynx, rest of pharynx (CN IX)
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Superior laryngeal nerve
* branch of CN X * Internal laryngeal n.: sensory to larynx (above vocal folds), and soft palate. Taste to root of tongue and epiglottis * External laryngeal n.: motor to cricothyroid m.
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Cardiac branches
* branch of CN X * visceral motor and sensory to heart and lungs
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Recurrent laryngeal nerve
* branch of CN X * Course: goes inferiorly, wraps around subclavian artery (R) & around aortic arch (L)  ascends in the neck in the groove between the trachea and esophagus * Motor to laryngeal mm., except for cricothyroid. Clinical relevance: damage to this nerve could lead to lack of voice production * Sensory to larynx (below focal folds)
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\*CN X vagus
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CN XI
* Accessory * Type: somatic motor only * Course: ascends along upper cervical cord -\> enters skull through FM -\> loops around and exit cranial cavity through posterior part of jugular foramen * Innervates: SCM & trapezius mm.
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\*CN XI accessory
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CN XII
* Hypoglossal * Type: somatic motor * Course: Exits cranium through hypoglossal canal -\> goes anteriorly between ECA and IJV -\> runs deep to posterior belly of digastric and stylohyoid mm. to enter the submandibular triangle * Superior root of Ansa cervicalis runs with hypoglossal n. and provides motor innervation to thyrohyoid and geniohyoid mm. * Innervate: intrinsic and extrinsic tongue muscles
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\*CN XII Hypoglossal
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innervation of the tongue
* CN V3 (anterior 2/3rd of tongue  sensation) * CN VII (anterior 2/3rd via chorda tympani and lingual  taste) * CN IX (posterior 1/3rd sensation and taste) * CN X (taste to root of tongue and epiglottis) * CN XII (motor to extrinsic and intrinsic m.) * Clinical relevance: these functions can be used clinically to test the integrity of these nerves

Anatomy (10 decks)

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