NERVES OF HEAD AND NECK NIAL NERVES © There are 12 pais of cranial nerves (olfactory), If (optic), II (oculomotor), IV (trochlear), V (trigeminal), VI (abducent), ‘VI (facial), VIII (vestibulocochlear), IX (glossopharyngeal), X (vagus), XI (accessory) and XII (hypoglossal), Altachment of nerves are : Fand Ito forebrain ; Hl and IV to midbrain ; ¥; VI, VIL and VEIT to pons ; and 1X5X, ‘Xtand XEII to medutia#6s6ams7, CRANIAL NERVE NUCLE) © There are mainly two types of nuclei of eranial nerves = ') Efferent nuclei (motor nuclei or auclet of origin):- These are groups of neurons in brain from which the nerve fibers arise. And then the nerve supplies specific motor organ (gland, muscles etc). ii) Afferent nuclei (sensory nuclei or nuclei of termination) :- These are the nuclei to which eranial nerve carry sensation from peripheral organs. 9 Based on the type of efferent organ supplied by the nerve and/or sénsory organ from which the nerve carries sensation, these two types (efferent and afferent) of nucle are divided into following types := Efferent nu r A) General somatic efferent nuclei :- These nuclei supply skeletal wuscles of somatic origin. These are := 1) Oculomotor nucteus"* :- It lies in upper mid brain (neat superior colliculus) and supplies extraocular museles (except for lateral rectus and superior oblique) through oculomotor nerve. 2) Trochlear nucteus'®? = ¢ lies in lower mid brain (near inferior colliculus) and supplies superior oblique through trachlear nerve, 3) Abducent nucleus“ :- It lies in pons (lower part) and supplies lateral rectus through abducent nerve. 4) Hypoglossal nucleus zt lies in medulla and through hypoglossal nerve supplies muscles of tongue, except palatoglossus. B) Speciat visceral efferent (Branchial efferent) nuclel :-These nuclei supply skeletal (striated) muscles derived from the branchial arches, Those are 1) Motor nucleus of trigeminal =I lies in upper pons and supplies muscles of mastication and tensor tympani through mandibular nerve, 2) Motor nucleus of facial ner stapedis. 3) Nucleus ambiguus’ 1M 6 ran 26%. its fibers are distributed through three cranial nerves slossopharyngeal (IX)SEEEW sour 0.067, Vagus (KYA trar 0.00079 and aecessory (XIVSEEL A,r DFE", The destination is = ') To stylopharyngeus through glossopharyngeal fat UP, {i)To muscles of soft palate (except tenser vel palatini), pharynx (excep! stylopharyngeus) and larynx through ‘vagus and cranial part of aecessory nerve. ©, General visceral efferent nuclei (Parasympathetie) ;- These nuclei give origin to preganglionic parasympathetic nearons“™ that relay in peripheral autonomic ganglion. Postganglionic fibers arising in the ganglion supply smooth muscles” and glands, These are - i) Edinger-westphal nucleus in the midbrain - fibres pass through the 3rd nerve to the ciliary ganglion to supply the sphincter pupitiae and ciliary muscle, i) Lacrimatory nucleus in the pons ~ fibres pass through facial nerve and its greater petrosal nerve to relay in the pterygopalatine ganglion to supply lacrimal, nasal and palatal glands. iil) Superior sativatory nucleus in lower pons - fibres pass through facial nerve and its chorda tympani branch to the submandibular ganglion to supply submandibular and sublingual glands. iv) Inferior salivatory nucleus in lower pons - fibres pass through glossopharyngeal nerve to relay in the otic ganglion to supply parotid gland. ¥) Dorsal nucteus of vagus in medulla - fibres pass through vagus nerve to be distributed to the thoracic and abdominal viscera thorugh respective ganglia : Afferent auclei (Sensory nuclei) A) General visceral afferent nucleus :-Itreceives general sensations from viscera. This nucleus is 1a Nucleus of tractus solitarius :-It lies in medulla and its lower part receives general visceral sensations as follows- From tonsil, pharynx, posterior par of tongue, carotid body and sinus —> dhrough glossopharyngeal nerve, i) From pharynx, larynx, trachea, esophagus, and other thoracic and abdominal viscera -> through vagus nerve, Ties in lower pons and supplies muscles of facial expression, buecinator andNERVES OF HEAD AND NECK [315] B) Special visceral afferent nucteus :-Itrecsives sensations of taste (special viseeral sensations). This nucleus is :~ 1a Nucleus of tractus solitarius" :- It is the same nucleus as for general visceral afferent. Its upper part receives taste sensations (lower part receives general visceral sensations) ’) From anterior 2/3 of tongue (except circumvallate papillae) and palate ~> through facial nervettro”) 4i) From posterior 1/3 of tongue (including circumnvallae papillae) ~> through glossopharyngeal nerve", ii) From posterior most pert of tongue and epiglotis > through vagus ervel™?, © General somatic afferent nuclei :- These nuclei receives general somatic sensations (pain, touch) and temperature ‘sensations from face, and proprioceptions from muscles of mastications, face and from TM joint and all related to trigeminal nerve, These nuclei are i) Main sensory nucleus of trigeminal (superior sensory nucleus):~Lics in upper pons ~>for fine touch from face. i) ‘Spinal aucteus of trigeminal :-1t descends from main sensory nucleus of pons into medulla and reaches the upper two segments of spinal card —> for pain and temperature from face through trigeminal ii) Mesencephalic nueleus of trigeminal :- It extends from main sensory nucleus of pons into midbrain — for proprioception from muscles of mastication through trigeminal. “important fnets ‘9 These three nuclei of trigeminal nerve also reveive inputs from other nerves (beside trigeminal) - A) Mesencephalie nucleus B) Spinal mucl » 20 .ceives proprioceptive impulses (beside from muscles of mastication through trigeminal) {From extraocular muscles (except SO and LR) through oculomotor nerve, fi) From superior oblique through trochlesr nerve. ii) From lateral rectus through abducent nerve. iv) From stylopharyngeus through glossopharyngeal nerve. vv) Frommuscles of face through facial nerve, vv) From muscles of tongue through hypoglossal nerve. Ws receives exteroceptive sensations ie, of touch, pain, temperature (beside from face through trigeminal) from = i) Skin of ear through vagus (auricular branch). ii) Skin of ear through facial nerve. ii) Middle ear through glossopharyngeal nerve. Special somatic afferent nuclel :- These nuclei receive special somatic sensations (hearing and equilibrium) as follows 9) Cochlear nuclei (dorsal and ventral) := These lie at junction of pons and medulla, and receive impulses of hearing through Cochlear nerve (Cochlear division of vestibulocochlear nerve). ii) Vestibular nuclet (superior, spinal, medial, fateral):-'These lie at junction of pons and medulla that receive sense of equilibrium from semicircular canal, uticle and saccule through vestibular nerve (vestibular division of vestibulocochlear nerve). OLFACTORY () NERVE factory nerve is a special visceral afferent nerve that mediates sense of smell (olfaction), Olfactory nerve has following unique features:- ) a The primary olfactory neurons li at the body surface in the epithelium lining the roof of nasal cavity (olfactory epithelium), ‘The primary olfactory neurons undergo continuous turnover being replaced from stem cells in the olfactory epithelium. No other neuron in the nervous system is replaced from stem cells. ii) Lis the only eraniat nerve that projects directly to forebrain (tclencephalon). iv) Theolfactory neurons enter the allocrotex directly without relaying through thalamus, Inall other sensory ») © Optic nerve is a special somatic 4 systems, fibers relay through thalamus before projecting to cerebral cortex ‘The olfactory pathway to highest cortical centr is ipsilateral. All other sensory pathways have mainly or entirely crossed cortical representation OPTIC Ul) NERVE ferent nerve that subserves vision and form afferent limb of papillary and ‘accommodation reflexes.NERVES OF HEAD AND NECK [316] © Each optic nerve (second eranial nerve) stars from the optic disc and extends up to optie chiasma, where the two nerves meet. Its the backward continuation ofthe nerve fibre layer of the retina, which consists of the second order neurons Le., axon originating from the ganglion cells", It also contains the afferent fibres of the pupillary light reftex. Morphologically and embryotogically the optic nerve is comparable toa sensory tract. Unlike peripheral netves itis not covered by neurilemma (so it does not regenerate when cut). The fibres of optic nerve, numbering, about a (9010409, are very fine (2-10. min diameter as compared to 20 mm of sensory nerves). © Optic nerve is about 47-50 mm in length °°" and can be divided into 4 parts : - ') Intraocular part ({ mm) :-Itbegins at optic dise (optic nerve head) and exits the nerve through a hole in sclera ‘that is occupied by a mesh like structure called the Zamina cribrosa, The nerve fibres from the retina leave the eye through pores (holes) in lamina cribrosa, a sieve-like structure made up of collagen meshwork. ii) Entraorbital part (30 mm) :- Extends from back ofthe eyeball (a lamina cribrosa) to the optic foramina, ii) Intracanalicular part (6-9 mm) : I lies within the optic canal and closely related to ophthalmic artery which ‘crosses obliquely over it”, iv) Intracranial part (10 mm): -Itlies above the cavernous sinus and converges with its fellow from contralateral side to form optic chiasma, © Like other parts of CNS, the optic nerve is covered by meningeal sheaths (Pia, archnoid and dura mater) as soon as the nerve leaves the eyeball OCULOMOTOR (I) NERVE o This is purely motor (somatie motor) nerve. Ithas folowiig functional components = i) General somatic efferent": Through oculomotor nucleus for movement of eyeball supplying all extraocular muscles except SO and LR. 4) General viscera efferent (parasympatetie"™) and accommodation. ii) General somatic afferent - Caries pro of trigeminal © Oculomotor nucleus (for general somatic efferent) and Edinger-Westphal nacleus together form oculomotor nuclear complex. ‘9 Oculomotor nerve descends to the lateral wall of cavernous sinus and in the anterior part of sinus it divides, into "upper (superior) and lower (inferior) divisions, which enter the orbit through middle part of superior orbital fissure 08. 4) "Upper (superior) divisions" js smaller and supplies superior rectus" and levator palpebrae superioris. i) Lower (inferior) division is lager and supplies inferior oblique, inferior rectus, and medial rectus. Nerve to inferior oblique isthe longest of these and gives of parasympathetic root to ciliary ganglion before supplying the muscle. 9 All branches euter extraocular muscles ai their ocular surfaces except for inferior oblique which enters its posterior border. ‘Through Bidinger-Wesipha nucfeus for pupillary contraction ptive fibres from the extraocular muscles to mesencephalic nucleus © Paralysis of superior rectus, inferior rectus, medial rectus and inferior oblique. Eye is down and out due to ‘unopposed action of superior oblique and lateral rectus. Medial & upward gaze is not possible. «6 Paralysis of sphinctor pupillae ->1.0ss of ipsilateral direct and consensual pupillary light refie"*"*4"™ and there Is mydriasis?™.41™, 9 Paralysis of ciliary muscle -> Paralysis of accommodation and conversion reaetion"™"™, 9 Two extraocular muscles are spared :- ') Superior oblique --Intorsion, abduction’“® and depression remain active. ii) Lateral recius:- Abduction remains active. So eye is deviated laterally"™4"", © Paralysis of levator palpabrae superioris > Ptosis”@% 9, © Oculomotor nerves the most commonly involved eranial nerve in intracranial aneurysm, TROCHLEAR (IV) NERVE © Trochlear nerve is a pure motor (somatic motor) nerve. Its functional components are }) General somatic efferent!” :- Through trachlear nucleus for contraction of superior oblique. ii) General somatic afferent :- Carries proprioceptive fibers from superior oblique to mesencephalic nucleus of ‘trigeminal 0 Unique features of trochlear nerve are = ) Most selender cranial nerve.