Anatomical

organization of
cranial nerves
3
Like all peripheral nerves, each cranial nerve chiasm:
has a beginning, a trajectory and a the optic (II)
termination. olfactory bulb:
the olfactory (1).
3.1 ORIGIN
We consider the origin of a cranial nerve to Note for manual therapists
be the point at which it emerges from the
surface of the encephalon (Fig. 3.1). All the Seven cranial nerves are observed to arise from
nerves arise from the ventral surface of the the brain stem. This anatomical arrangement
encephalon except the trochlear nerve, which lends great signicance to the manipulation of
the occipital dura mater and the upper
arises from the posterior surface.
cervicals, and to techniques which open the
The most signicant concentration of posterior cranial orices (foramen magnum,
cranial nerves originates in the middle and jugular foramen).
posterior cerebral fossae.
Here are the localizations, from posterior
to anterior:
medulla:
3.2 PATHWAY
the abducent (VI) The pathway of a cranial nerve is intracranial,
the facial (VII) then cranial, and nally extracranial.
the vestibulocochlear (VIII)
the glossopharyngeal (IX) 3.2.1 Intracranial pathway
the vagus (X)
On its intracranial course, the nerve is sur-
the accessory (XI) (also at the level of
rounded by pia mater and is located in the
the spinal cord)
cisterns of the subarachnoid space.
the hypoglossal (XII)
protuberance: The optic nerve (II) crosses the
the trigeminal (V) chiasmatic cistern.
isthmus of the encephalon (superior The oculomotor nerve (III) is situated
surface): in the interpeduncular cistern.
the trochlear (IV) The trigeminal (V), facial (VII),
cerebral peduncle: vestibulocochlear (VIII), glossopharyngeal
the oculomotor (III) (IX), vagus (X) and accessory (XI) nerves 15
 Theoretical principles

Olfactory nerve

Optic chiasm

Oculomotor nerve
Trochlear nerve
Intermediary nerve
of Wrisberg Trigeminal nerve
(nervus intermedius) Abducent nerve

Glossopharyngeal Facial nerve

nerve
Vagus nerve Vestibulocochlear
Accessory nerve nerve

Hypoglossal nerve

Spinal nerve

Fig. 3.1 Cephalic origins of the cranial nerves.

are found in the cerebellomedullary
cistern.
The oculomotor (III), trochlear (IV),
abducent (VI) and ophthalmic (VI)
nerves cross the cavernous sinus.
3.2.2 Pathway through the cranium
or orices
The cranial nerves pass through openings
(Fig. 3.2) in the skull to extracranial
structures:
the olfactory foramen for I
the optic canal for II
the superior orbital ssure for III, IV, VI
and V1 (ophthalmic nerve)
the foramen rotundum for the maxillary
nerve (V2)
the foramen ovale for the mandibular
16 nerve (V3)
the internal acoustic meatus for VII and
VIII
the jugular foramen for IX, X and XI
the hypoglossal canal for XII.
As they exit the cranium, the nerves are
enveloped by the pia mater, the arachnoid
and the dura mater so that they can pass
through the various foramina, ssures and
slits of the skull without injury.
Some passages are common to several
nerves. This accounts for the possibility of
their simultaneous compression by way of
tumors or aneurysms, manifesting clinically
as the principal basilar syndromes.
3.2.3 Extracranial pathway
The extracranial trajectory may be facial,
cervical, or even thoracic and abdominal
(Fig. 3.3).
 Anatomical organization of cranial nerves 3

Foramen cecum (one-eyed)

Foramen rotundum
and its groove
Optic canal

Foramen lacerum

Foramen ovale
Foramen spinosum

Internal acoustic meatus Fallopian hiatus (hiatus of

the canal of the lesser and
greater petrosal nerves)
Jugular foramen
Aqueduct of the vestibule

Posterior condylar foramen

Mastoid foramen

Anterior condylar foramen

Foramen magnum

Fig. 3.2 Endocranial orices.

3.3 BRANCHES the facial nerve: geniculate ganglion

The terminal and collateral branches are des-
ignated to various bony and soft-tissue struc-
tures of the head and neck, as well as thoracic
and digestive viscera. Peripheral connections
are numerous and explain the multiplicity of
functions and the many interactions of the
cranial nerves.
3.4 GANGLIONS
The sensory ganglions are located on:
the trigeminal nerve: trigeminal ganglion
of Gasser
the acoustic nerve: spiral and vestibular
ganglions
the glossopharyngeal nerve: superior
(Ehrenritter1) and inferior (Andersch2)
ganglions
the vagus nerve: superior (jugular) and
inferior (plexiform) ganglions.
Autonomic ganglions, true local plexuses,
are appended to certain cranial nerves. For
1. Johannes Ehrenritter (d. 1790): Austrian anatomist
(Vienna).
2. Carol Samuel Andersch (17321777): German physi-
cian and anatomist. 17
 Theoretical principles

Incisive fossa

Infra-orbital foramen

Inferior orbital fissure Greater palatine foramen

Foramen ovale

Foramen spinosum

Carotid canal

Bony canal of the

Eustachian tube
External acoustic
meatus
Fissure of Glaser

Jugular fossa
Mastoid foramen

Groove for the digastric

Jacobsons canal

Aquaduct of the cochlea

Posterior condylar foramen

Anterior condylar foramen

Foramen magnum

Fig. 3.3 Exocranial orices.

example, the major parasympathetic is sup-
plied by these neurobers:
the oculomotor nerve to the ciliary
ganglion
the facial nerve to the pterygopalatine,
submandibular and sublingual
ganglions
the glossopharyngeal nerve to the otic
ganglion.

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