Cranial Nerve (CN) I. Olfactory II.

Optic

Type Sensory Sensory

Function Olfaction(5,000 types of smells, 5 million

olfactory neurons)

Specialty Shortest 1)Only CN to be covered by all 3 layers of menigies {outerinner}I. Dura matter, II. Archnoid III. Pia Matter( all other CN dont have Dura matter) 2) Only CN to transmit an artery within it. none

Vision

III. Occulomotor

Motor

IV. Trochelar

Motor

Eye Movements(7 muscles total supplies only 5 muscles) 1)Levator Palpebrae Superalis (LPS) 2)Superior Rectus (SR) 3)Inferior Retus (IR) 4)Medial Rectus (MR) 5)Laterial Rectus (LR)= CN 6 6)Superior Oblique(SO)= CN 4 7) Inferior Oblique(IO) Innervates Superior Oblique of eye 1)Thinnest CN 2)Emerges from dorsal surface of Brain stem 3)Only CN to decussate(cross
over to opposite side) 4) Has

V. Trigemional (If injured= HypoacusisReduced Hearing) V1 V2 V3 Cranial Nerve

3 Division of Nerves (2 sensory & 1 mixed) 1)Ophthalamic (S) 2)Maxillary(S) 3)Mandibular (M)

1)Muscles of Mastication a)Temporalis b)Masseter c)Medial Pterigoid d)Lateral Pterigoid 2)Anterior Belly of Digastrics(ABD) 3)Myloid Hyoid 4)TensorTympani,5)TensorPalatine Function

longest Subarachnoid course Largest & Thickest

Specialty

(CN) VI.Abducens (Nerve of Romance) VII. Facial (Injury= Hyperacusisincreased hearing sensitivity)

Type Motor Mixed Parasympathetic (taste for the anterior 2/3 of the tongue)

Innervates Lateral Rectus of Eyes (abduction of eyes) 1)Muscles of Facial Expression( 18

total,most important are 14) - 1.Frontalis, 2.Corrugator Supercilii(worried), 3.Orbicularis Oculi(close eye), 4.Procerus, 5.Dilator Naris, 6.Orbicularis Oris(give a kiss), 7.Depressor Anguli Oris (pulls down corner of mouth),8.Zygomatic Major, 9. Risorus, 10.Mentalis( raises and wrinkles skin of chin), 11.Platysma, 12.Buccinator, 13.Levator Angularis 14.Levator Labii Superioris (1-14 most important) 15)Nasalis, 16) Depressor Labii Inferioris 17) Occipitalis 18) Auricularis

Longest Intracranial Course none

VIII. Vestibulocochlear (Auditory) IX. Glossopharyngeal X. Vagus

2)Posterior Belly of Diagastric 3)Styloid Hyoid 4) Stapedius Sensory(taste for Hearing and Equilibrium the posteror 1/3 of the tongue) Mixed Stylo Pharyngealis Parasympathetic Mixed 1) Cardiac Muscle Parasympathetic 2) Smooth Muscle of GIT and Respiratory Tract

none none 1)Longest CN 2)Only CN to go beyond Head & Neck region 3)supplies right 2/3 and left 1/3 of transverse colon( midgut) none

XI. Accessory

Motor

XII. Hypoglossal

Motor

CN

Cranial a) Larynx b) Pharynx( excluding Stylo Pharyngealis, 9th CN) c) Paltoglossus Spinal a) Trapisius b) Sternocladomastoid 1) All muscles of Tongue (except Palotoglosus, 11th CN) 2) Ribbon Muscles of the Neck a) Sternothyroid b)Sternohyoid c)Thyrohyoid d)Omohyoid Type

none

1, 2, 8 3, 4, 6, 11, 12 5, 7, 9, 10 3,7, 9, 10 Nerve III. Occulomotor VII. Facial

Purely Sensory Purely Motor Mixed Parasympathetic Structure Supplied Sphincter Pupillae (constricts pupil) 1)a)Submandibular b) Sublingual c)Salivary Gland 2)Lacrimal Gland Parotid Gland 1)Cardiac Muscle 2)Smooth Muscle of GIT and Respiratory Tract

Parasympathetic Nucleus Ganglion Edinger Westphall Ciliary 1)Superior Salvitory(SSN) 2)Lacinatory (LN) Inferior Salivary (ISN) Dorsal Motor N.of Vagus ( DMNV) 1)Submandibular G 2) Pterygopalatine G Otic None

IX. Glossopharyngeal X. Vagus

HORNERS SYNDROME CLINICAL MANIFESTATIONS (SAME SIDE AS LESION) 1) PTOSIS - paralysis of the superior tarsal muscle drooping of upper eyelid 2)MIOSIS- paralysis of dilator pupillae muscle pupillary constriction 3)ANHYDROSIS- vasodilatation skin of face cold to touch, skin becomes red ,dry & scaly decreased sweating 4)ENOPHTHALMOS- paralysis & atrophy of smooth muscle in per orbital fat sunken eyeball PERIPHERAL FACIAL PARALYSIS (BELLS PALSY) 1) If the patients attempt to smile or show the teeth, the mouth draws to the unaffected side. 2) The patient can not wink, close the eye, or the wrinkle forehead on the affected side. 3) Salivary drooling due to impaired swallowing and poor facial muscle tone. 4) Difficulty in chewing and/or swallowing. BELLS PALSY Paralyzed Side Normal Side 1)eye unable to close 1) eye voluntarily closed 2) no wrinkles 2) wrinkles present 3) facial muscles flabby & 3) Normal muscles pull face paralyzed to normal side 4) Corner of mouth lower 4) Corner of mouth normal

INJURY TO FACIAL NERVE (VII) Peripheral Facial Paralysis (Bells Palsy) CAUSES Idiopathic (cause is not known) Complication of diabetes mellitus Tumors, e.g., parotid gland tumor Sarcoidosis (systemic granulomatous disease) AIDS Lyme Disease lower motor neuron lesion Cerebral Cortex

1. Cortico Nuclear Tract- are always motor, (Upper Motor Neuron, UMN, because its above nucleus. Ex) Spinal Cord= Corticospinal Tract Right UMN Lesion of Facial Nerve= Contra lateral Paralysis (Opposite side of Face, on Left Lower Face) 2. LMN Lesion of Facial Nerve- Ipsilaterial Paralysis (same side)= Bells Palsy

Contents of Orbit ( Outer to Inner) 1. Orbital Fascia 2. Orbital Pad of Fat (lots) 3. Extra Ocular Muscles( 7 total) 4. Eyeball 5. Optic Nerve 6. 3,4,6, Cranial Nerve(III. Occulomotor, IV. Trochelar, VI.Abducens) 7. Ophthalamic Division of Trigemional Nerve 8. Ophthalamic Artery & Branches 9. Superior & Inferior Ophthalamic Veins 10. Ciliary Ganglion 11. Lacrimal Apparatus Chronic Orbital Cellulitis- cellulitis that involves the tissue layers posterior to the orbital septum. May erode the roof resulting in an abcess in the frontal lobe of brain Cellulitis affecting the floor causes pain, in lower eyelid, lateral part of the nose, & upper lip. 6 Layers of Eyelids Outer to Inner 1. Skin 2. Loose Connective Tissue 3. Muscles- a) Obicularis Occuli Facial Nerve, found in both eyelids, upper &lower. b) Levator Palpebrae Superalis (LPS) Occulomotor Nerve, upper eyelid only. 4. Orbital Plate or Orbital Septum- a)Connective tissue, b)Superior & Inferior Tarsus(thicking of connective tissue) c) 3 Medial & 3 Lateral Palpebrae Ligaments d)Tarsal Glands (Meibomian Glands) 5. Fascia covering orbital septum 6. Conjunctiva Lacrimal Apparatus 1. 2. 3. 4. 5. 6. 7. Lacrimal Gland Lacrimal Ducts Conjunctiva Sac Lacrimal Puncta Lacrimal Cannaliculi Lacrimal Sac Nasal Lacrimal Duct (opens into the inferior meautus of nose)

STY (EXTERNAL HORDEOLUM) - inflammation of the sebaceous glands (Glands of Zeis) associated with the eyelashes

CHA

LAZION (INTERNAL HORDEOLUM)inflammation of the tarsal glands (Meibomian Glands) more painful than a sty protrudes towards eyeball rubs against eyeball as eyelids blink. Movements of Eyes

Muscle SR & IO IR & SO LR MR

Direction Up (Elevation) Down (Depression) Lateral Medially

LR6 (SO4) 3

CN III.Occulomotor Nerve Lesion gives you a lateral squint, because 5 muscles lost. 1)LPS- innervates upper eyelid, since it is lost gives tossis. 2)SR 3)IR 4)IO 5)MR depression of eyeball works because SO still works (CN 4) and LR (CN6) Lateral or Abduction still works. puplillary dilation no reflex to light no accommodation to light Diplopia- Double vision Exothalomos CN VI.Abducens Nerve Lesion(LR6) Lateral Rectus paralysis will cause eye to be pointed inwards (medially) unable to move laterally This will cause Diplopia (double vision) and patient will rotate head in order to restore correct visual field. (Head turned to side of Lesion) medial squint or medial strabismus Example) On right side, if there is a medial squint, patient will turn to right to compensate. IV.Trochelar Nerve Lesion (SO4) no visible squint involuntary movement of the eye, only when patient looks down, since there 2 muscles for depression (down direction) IR & SO but SO is not functioning, the 2 muscles for elevation (up direction) SR & IO are going to be stronger.

ParaSympathetic Pathway of Lacrimal Gland Pons Facial Nerve (CN VII) Geniculate Ganglion Greater Superficial Patrosal Nerve + Deep Patrosal Nerve (forms Vidians Nerve, Nerve of the Pterigoid Canal) Pterygoid Palatine Ganglion Maxillary Division of Trigeminal Nerve Zygomatic Nerve Zygomatic Temporal Nerve Lacrimal Nerve Lacrimal Gland

Parasympathetic Pathway of Sublingual Gland

Pons Super Salvitory Nucleus (SSN) CN VII (Facial Nerve) Chorda Tympani Branch (A branch from Facial Nerve, in middle ear & runs through middle ear) Infra Temporal Fossa, (location where Chorda Tympani Branch joins the Lingual Branch of Mandibular Division of Trigemional Nerve) Lingual Nerve (Suspends the Submandibular Ganglion) Supplies Submandibular & Sublingual Salvary Glands (note that that sometimes you may find a ganglion within Submandibular Gland= Langleys Ganglion)

ParaSympathetic Pathway of Parotid Gland

Inferior Salvitory Nucleus (ISN, located in the Medulla) CN IX (9TH CN, Glossopharyngeal) Tympanic Branch (Jacaupsons Nerve) (9TH CN gives Tympanic Branch that enters Middle Ear) Tympanic Plexus (In Middle Ear, formed by Tympanic Branch) Lesser Superficial Petrosal Nerve (leaves Foramen Ovale, & below Foramen Ovale, joins the Otic Ganglion) Otic Ganglion Mandibular Division of Trigemional Nerve (from Otic Ganglion, the fibers enter Mandibular Division of Trigemional Nerve, Posterior Division) Auricular Temporal Nerve Parotid Gland (supplied by Auricular Temporal Nerve Note that any lesion throughout the pathway will result in no salivation from Parotid Gland)

ParaSympathetic Pathway of Sphincter Pupillae or Pathway for Light & Accommodation Reflex Midbrain III rd Nerve Nucleus or Occulomotor Nucleus Complex (found in Midbrain, has 6 sub Nucleus) Edinger Westphall Nucleus (EWB Nucleus, one of the 6 sub nucleus, has parasympathetic Nucleus for Occulomotor Nerve) CN III, Inferior Division (3 rd CN, Occulomotor) Nerve to Inferior Oblique (for extra ocular muscle, will carry parasympathetic fibers with in it) Ciliary Ganglion Short Ciliary Branches Sphincter Pupillae