III.

Mixed cranial nerves :

1. Oculomotor nerve (Cn.III)---- a mixture of motors
2. Trigeminal nerve (Cn.V) -- a mixture of motor
and sensory axons
3. Facial nerve (Cn. VII)-- a mixture of motor and
sensory axon.
4. Glossopharyngeal nerve (Cn.IX)
5. Vagus nerve (Cn. X)
2. Trigeminal nerve (Cn.V) -- a mixture of motor and sensory
axons

– contains a large sensory root,

which originates in the
trigeminal ganglion , and a
smaller motor root, which
originates in the motor nucleus
of Cn. V.
– Three divisions:
• Ophthalmic d. (V1)
• Maxillary d. (V2) sensory
• Mandibular d.(V3) mixed
⑴ Ophthalmic n. (pure sensory)
• Sensory distributions
– forehead
– upper eyelid
– conjunctiva
– cornea
– nose
– nasal mucosa
– frontal sinuses
– parts of the meninges.
Branches:
① frontal n.
② lacrimal n.
③ nasocilliary n.
Divisions of
Ophthalmic n.
(2) Maxillary n. (pure sensory)
• Sensory distributions:
– lower eyelid
– Cheek
– nares
– upper lip
– upper teeth and gums
– nasal mucosa
– palate and roof of the
pharynx
– maxillary, ethmoid and
sphenoid sinuses
– parts of the meninges.
(2) maxillary n.

Branchess:
① infraorbital n.
② zygomatic n.
③ superior alveolar n.
④ pterygopalatine n.
Pterygopalatine
ganglion
(3) Mandibular n.
• Sensory distributions:

– lower lip
– lower teeth and
gums,
– chin and jaw,
– Anterior 2/3 of
Tongue
– parts of the external
ear
– parts of the Anterior
2/3
meninges. Tongue
(3) Mandibular n. -- a mixture of motor and sensory axon

Braches:
• Sensory branches:
① auriculotemporal n.
② buccal n.
③ lingual n.
④ inferior alveolar n.
(3) Mandibular n.-- a mixture of motor and sensory axon
Braches:
• Motor branches:
These fibers originate in the
motor nucleus of trigeminal
nerve
① nerve to masticatory
muscles
② nerve to mylohyoid m.
and anterior belly of
digastric m.
③ nervde to tensor veli
palatini and tensor tympani
tensor veli palatini
tensor tympani
 CN V TRIGEMINAL

innervations
Sensory - Sensory to Face,
Scalp, Oral & Nasal Cavities,
Anterior
Teeth, Sinuses, Meninges, &
2/3
Tongue Anterior 2/3 of Tongue

TEMPORALIS

Motor - Muscles of
Mastication
MASSETER
3. Facial nerve (Cn. VII)-- a mixture of motor and
sensory axon
Components:
1) the special visceral efferent fibers originate in the facial
nucleus and innervate the muscles of expression
2) the general visceral efferent fibers arise from the
superior salivatory nucleus and control the secretion of
the lacrimal gland, the submandibular and sublingual
salivary glands
3) the special visceral afferent fibers convey the taste from
the anterior two-third of the tongue
Facial nerve
Course:
• The facial nerve passes
through the internal
acoustic meatus, and
enters the facial canal.
• The nerve leaves the
facial canal through the
stylomastoid foramen,
then runs forward into
the parotid gland, where
it divides into five major
branches to innervates
muscles of expression .
Branches--Inside Skull
①Greater petrosal nerve
• arise in the superior salivary
nucleus of the pontine
tegmentum.
• Preganglionic parasympathetic
fibres pass through the
geniculate ganglion and
become greater petrosal nerve
which synapses with the
pterygopalatine ganglion.

• parasympathetic postganglionic fibers innervate the lacrimal gland

and the mucosal glands of the nose, palate, and pharynx.
Branches--Inside Skull
② chorda tympani:
– Special sensory
fibers from the taste
buds in the front of
the tongue (anterior
2/3) .
– joins the facial nerve
inside the facial canal
where it runs from
posterior to anterior
across the tympanic
membrane
Branches--Inside Skull
② chorda tympani:
– Motor fibers (parasympathetic) innervate the submandibular
and sublingual glands.
Branches--Inside Skull
③ Stapedial nerve:
– Innervates the stapedius in the middle ear
Branches--Outside skull
① Posterior auricular nerve -
controls movements of some
of the scalp muscles around
the ear.
②Five major facial branches
(in parotid gland) - from top to
bottom:
– Temporal branch of the facial n.
– Zygomatic branch of the facial n. ③Branches to
– Buccal branch of the facial n. Posterior belly of
– Marginal mandibular branch of Digastric and
the facial n.
Stylohyoid muscle
– Cervical branch of the facial
nerve
Ganglions:
①Geniculate ganglion :
• an L-shaped collection
of fibers and sensory
neurons of the facial
nerve located in the
facial canal of the
petrous temporal
bone.
• contains fibres for
taste and somatic
sensation
②Parasympathetic ganglia connecting to facial nerves
(l) Pterygopalatine ganglion:
– The greater petrosal
nerves enter the
ganglion and are relayed
here.
– The postganglionic fibers
innervate the lacrimal
gland and glands in the
mucous membrane of
the nasal cavity and
palate and control their
secretions.
Parasympathetic ganglia connecting to facial nerves

(2) Submandibular ganglion:

– Chorda tympani fibers
enter the ganglion and
are relayed here.
– The postganglionic fibers
innervate the
submandibular and
sublingual glands and
control their secretions.
 VII CN VII FACIAL

Innervations
Motor :
•Muscles of Facial
Anterior 2/3
Expression
•Lacrimal Gland
-
MUSCLES OF FACE TASTE –Tongue & Submandibular &
Soft Palate
Sublingual Glands

Sensory:
Taste -Anterior 2/3
of Tongue

GLANDS: Lacrimal, Submandibular,

& Sublingual
Clinical features of the facial nerve lesion
(1) Lesion in the facial canal :
① wrinkles on the forehead are smoothed out, the eye can
not shut voluntarily, the nasolabial fold becomes smooth
on the affected side;
② when a smile is attempted ,the angle of mouth draw to
the unaffected side;
③ there is a loss of taste in the anterior 2/3 of the tongue;
④ reduced salivation;
⑤ the sounds are very loud in the affected ear due to the
paralysis of the stapedius .
(1) Lesion in the facial canal :
(2) Lesion outside the facial canal :
• there is paralysis of the muscles of expression only.
Glossopharyngeal nerve (Cn.IX)-a mixture of motor and
sensory axons
Components:
① Special visceral efferent (SVE) fibers arise from the ambiguous
nucleus and supply the stylopharyngeus m.
② General visceral efferent (GVE) fibers arise from inferior salivatory
nucleus and control the secretion of the parotid gland.
③ General visceral afferent (GVA) fibers arise from the inferior
ganglion to supply the mucous membrane of the pharynx, the
tonsil, the middle ear, the posterior 1/3 of the tongue, and the
carotid glomus and the carotid sinus
④ Special visceral afferent (SVA) fibers arise from inferior ganglion ,
and innervate the posterior 1/3 of the tongue (taste)
⑤General somatic afferent (GSA) fibers arise from the superior
ganglion and supply the skin of the posterior surface of the auricle.
Course:
• The nerve leaves the skull
through the jugular
foramen, and passes
forwards, beneath the
styloid process, and
between the external and
internal carotid arteries,
reach to the root of the
tongue.
Branches :
(l) tympanic nerve (GSA &GVE)
– It enters the tympanic cavity to
form the tympanic plexus.
– The plexus gives off many
branches to the mucous
membrane of the middle ear.
– The lesser petrosal nerve
arises from this plexus and is
relayed in the otic ganglion
(Parasympathetic ganglia)
– The cells in the ganglion send
the postganglionic fibers to
distribute to the parotid gland.
Branches :
(2) Carotid sinus b.(GVA)
– descends along the
internal carotid artery to
the wall of carotid sinus
and the carotid glomus.
(3) Lingual b.(GVA &SVA)
– distributed to the posterior
1/3 of the tongue. They
contains both fibers of pharyngeal b.
Lingual b.
special sense (taste) and of
general visceral sensations.
carotid sinus b.
(4) Pharyngeal b.(SVE)
– distributed to the pharynx
and the stylopharyngeus.
Innervations
• Sensory from taste & other receptors of rear 1/3 of
tongue, auditory tube and middle ear, & upper
throat
• Motor to muscle of the throat
• Parasymp. to parotid salivary gland
• Sensory from chemoreceptors (oxygen) of carotid
body and BP receptors of carotid sinus
Course:
• It leaves the skull through the
jugular foramen then passes jugular foramen
Vagus nerve
into the carotid sheath
between the internal carotid
artery and the internal jugular
vein down to the neck, chest
and abdomen,
Vagus nerve -a mixture of motor
and sensory axons
Components :
①GVE fibers arise from the dorsal
nucleus of vagus nerve, and are
relayed in the paraorganic or
interorganic parasympathetic
ganglions in the throacic and
abdominal cavities. The
postganglionic fibers supply the
smooth muscles, cardiac muscles
and glands of the viscera.
Components :

②GVA fibers arise from the inferior

ganglion of vagus nerve and
relayed in the nucleus of solitary
tract. The peripheral processes
of ganglionic cells are distributed
to the viscera of the neck, thorax,
and abdomen.
Components :

③GSA fibers originate from the

superior ganglion of vagus
nerve and relayed in the spinal
nucleus of trigeminal nerve.
The peripheral processes of
this ganglionic cells are
distributed in the skin of the
auricle and external acoustic
meatus and cerebral dura
mater.
Components :

④ SVE fibers arise from

the ambiguous nucleus
and supply the muscles
of the larynx and the
pharynx.
Branches:

(1) Branches in the neck

① Pharyngeal br.
② superior laryngeal n.

– distributed to the mucous

membrane of the larynx
above the level of the
fissure of glottis and the
cricothyroid .
 Sup. laryngeal n.

vagus n.

Recurrent laryngeal n.

Recurrent laryngeal n.
(2) Branches in the thorax
① Recurrent laryngeal n.
– supplies all the muscles
of larynx except for the
cricothyroid m.
– is distributed to the
mucous membrane of
the larynx below the
level of glottis.
② Broncheal br.,
③ Esophageal br.
④ Cervical cardiac br.
• form the cardiac plexuses and
distributed to the heart and
the wall of the aorta.
(3) Branches in the abdomen
• anterior vagal trunk divides into

①anterior gastric br

②hepatic br.
(3) Branches in the abdomen
• posterior vagal trunk divides into
③posterior gastric br.
④celiac br.
• innervate the stomach, liver and
gallbladder.
 Ant. trunk
Post. trunk

Hepatic branch
Celiac branch
Post. Gastric branch
Ant. gastric
branch
(3) Branches in the abdomen
• innervate the stomach, liver and
gallbladder.
Innervation:
• Sensory from taste and other
sensory receptors in lower
throat

• Sensory from the viscera

• Motor to muscles of larynx

and pharynx

• Parasympathetic to all organs

of chest and abdomen
Functions:
• a reduction in heart rate, blood pressure, or both.
• This occurs commonly in the setting of
gastrointestinal illness such as viral gastroenteritis or
acute cholecystitis,.
• When the circulatory changes are great enough,
vasovagal syncope results. Relative dehydration
tends to amplify these responses.
Clinical feature of the vagus lesion

• hoarse voice (injury of the recurrent laryngeal nerve )

• difficulty in swallowing (dysphagia)

• choking when drinking fluid,

• Uvula deviates away from the side of lesion

• failure of palate elevation.

Function summary of cranial nerves: