THE CRANIAL NERVES

BY

JOSEPH KWERI
jkweri 2
 FUNCTIONAL COMPONENTS OF THE CRANIAL NERVES

EFFERENT (MOTOR) AFFERENT (SENSORY)

SOMATIC VISCERAL VISCERAL SOMATIC

GENERAL SPECIAL GENERAL GENERAL SPECIAL GENERAL SPECIAL

1 2 3 4 5 6 7

Accordingly, there are seven columns of cranial nerve nuclei arranged

from medial to lateral in the brain stem as shown above.

3
CRANIAL NERVES NUCLEI OCULOMOTOR N.

EDINGER WESTPHAL N.

SUPERIOR COLLICULUS

MID-BRAIN
MESENCEPHALIC N.

TROCLEAR N. INFERIOR COLLICULUS

MAIN SENSORY N.
MOTOR N. OF V

ABDUCENT N.
PONS MOTOR N. OF FACIAL

SUPERIOR SALIVATORY N.
VESTIBULAR N.

INFERIOR SALIVATORY N.
MEDULLA
HYPOGLASSAL N.
1-GSE NUCLEUS AMBIGUUS
2-GVE SPINAL N. OF TRIGEMINAL
3-SVE
DORSAL VAGAL N.
4-SVA
5-GVA
6-SSA 4
7-GSA 1 2 3 45 6 7
jkweri 5
 6

jkkweri
 WHAT IS MENT BY THESE TERMS?

1- General Somatic Efferent (GSE): Fibers supplying the muscles which does
not develop from the pharyngeal arches (muscles of the eye and of the
tongue).

2- Special Visceral Efferent (SVE): Fibers supplying Muscles developing from

the pharyngeal arches.
3- General Visceral Efferent (GVE): Fibers supplying structures developing
from the somatic mesoderm, somites and from endoderm
(PARASYMPATHETICS).
4- General Visceral Afferent (GVA): Fibers carrying sensations from different
organs and mucous membranes developing from splanchnic mesoderm
and from endoderm (Interoceptives).
5- Special Visceral Afferent (SVA): Fibers carrying smell and taste
sensations as these organs are covered by endodermal mucous
membranes.
6- General Somatic Afferent (GSA): Fibers carrying sensations from
structures developing from somatic mesoderm and from ectoderm
(Exteroceptives).
7- Special Somatic Afferent (SSA): Fibers carrying sensations from organs
developing from ectoderm; Vision and Hearing. 7
 CRANIAL NERVES UNDER EACH COLUMN:

1. GSE: III, IV, VI, XII.

2. SVE: V(1ST arch), VII (2nd arch), IX (3rd arch) and X & XI (cranial part) for (4th& 6th arch).
3. GVE: III, VII, IX, X.
4. GVA: VII, IX, X.
5. SVA: I,- VII, IX, X.
6. GSA: V, IX, X.
7. SSA; II, VIII.

NUCLEI RELATED TO EACH COLUMN:

1. GSE: Each nucleus takes the name of the nerve i.e., motor nucleus of
oculomotor nerve e.t.c,.
2. SVE: Motor nucleus of trigeminal for V, motor n. of fascial for VII and nucleus
ambiguous for IX, X, and cranial part of XI.
3. GVE: Edinger-Westphal nucleus for III, superior salivary nucleus for VII,
inferior salivary nucleus for IX, and dorsal motor nucleus of the vagus for X.
4. GVA: Nucleus of tractus solitarius for VII, IX AND X.
5. SVA: Nucleus of tractus solitarius receives also taste fibers carried by VII, IX
and X. Those for smell (I) has its pathway.
6. GSA: Nucleus of the spinal tract for V, IX and X, main sensory nucleus for V
and mesencephalic nucleus for V also.
7. SSA: Both have their own pathways.
8
EL-BADAWI 9
 Deep origin of III, IV and VI nerves
Functions and nuclei:
•The oculomotor: GSE , GVE
 Motor nucleus of III
 Edinger-Westphal nucleus.

•The trochlear: GSE

Motor nucleus of IV.

•The abducent: GSE

Motor nucleus of VI

VI nucleus IV nucleus

VII nucleus

VI IV III
EL-BADAWI 10
7
11
 Superficial origin (attachment) of III, IV and VI nerves

Interpeduncular fossa

Trochlear n. Oculomotor n.

Abducent n.

1 12
 Superficial origin (attachment) of III, IV and VI nerves

Interpeduncular fossa
Oculomotor n.

Trochlear n.

Abducent n.

1
13
 Dura at the Clivus of the skull
Abducent n.

Oculomotor n.
Trochlear n.

Trigeminal n
Free border
and
Attached border
Of the Tentorium
cerebelli

Relation of the III, IV and VI nerves to the dura matter

2 14
Relation of III, IV and VI nerves to the cavernous sinus
ICA
Temporal lobe

Oculomotor n.
Hypophysis cerebri
Trochlear n.

The cavernous Ophthalmic n.

sinus

Maxillary n.
Sphenoidal air sinus

ICA
Abducent n. Mandibular n.

3 15
Relations of the III, IV and VI nerves in the superior orbital fissure
Superior rectus Common tendinous ring

Lacrimal n.
Medial rectus

Frontal n.
Optic nerve
Trochlear n.

Ophthalmic artery
Superior ophthalmic vein

Lateral rectus Inferior rectus

Superior division of III n.

Nasociliary n.
Inferior ophthalmic vein
Inferior division of III n.

Abducent n.

4 16
 Relations of the III, IV and VI nerves in the orbit
Levator palpebrae superioris
Frontal n.
Superior rectus
Superior oblique
Lacrimal gland
Trochlear n.

Lacrimal n.
Nasociliary n

Lateral rectus

Medial rectus
Abducent n.

Superior division
of III n.
Optic nerve

Inferior division of III n.

Inferior rectus Inferior oblique

5 17
 Optic nerve

1 2 3

18
Course of III, IV, V and VI 4
5
 The Oculomotor nerve
a. Functions:
• GSE .GVE
b. Deep origin:
• Motor nucleus of III (GSE) . Edinger-Westphal nucleus (GVE) (both in the midbrain)
c. Superficial origin: To the interpeduncular fossa of the midbrain
d. Course and relations:
• It arises from the interpeduncular fossa of the midbrain on the medial side
of the cerebral peduncle between the superior cerebellar and the posterior
cerebral arteries (1)
• it pierces the pia and arachnoid then it pierces the dura matter in front of
the point of decussation between the free and the attached borders of the
tentorium cerebelli (2)
• it then passes within the lateral wall of the cavernous sinus above the
trochlear nerve (3)
• as it leaves the sinus, it divides into two divisions, superior and inferior.
Both will enter the orbital cavity through the superior orbital fissure
between the two heads of the lateral rectus (within the common tendinous
ring) having the nasociliary nerve in between (4)
• in the orbit (5),
The superior division passes above the optic nerve and ends by supplying:
. The superior rectus . The levator palpebrae superioris
The inferior division passes below the optic nerve and ends by supplying:
. The inferior rectus . The medial rectus . The inferior oblique
. Branch from the nerve to inferior oblique to the ciliary ganglion
19
 The Trochlear nerve
a. Function:
• GSE
b. Deep origin:
• The motor nucleus of the trochlear nerve in the midbrain
c. Superficial origin:
• From the back of the midbrain below the inferior colliculus on the sides of
the frenulum veli(1)
d. Course and relations:
• The nerve will curve around the lateral side of the cerebral peduncle
between the posterior cerebral and superior cerebellar arteries and
pierces the pia and the arachnoid, the dura matter at the point of
decussation between the free and the attached borders of the tentorium
cerebelli(2)
• It passes in the lateral wall of the cavernous sinus below the oculomotor
and above the ophthalmic nerves(3)
• It then enters the orbit through the superior orbital fissure outside the
common tendinous ring medial to the frontal nerve (4)
• In the orbit it passes medially to enter the orbital surface of the superior
oblique muscle(5)
20
 The Abducent nerve
a. Function:
• GSE
b. Deep origin:
• Motor nucleus of the abducent nerve in the pons
c. Superficial origin:
• From the pontomedullary angle above the pyramid (1)
d. Course and relations:
• It pierces the pia and the arachnoid then the dura matter at
the clivus of the skull (2)
• It then, enters the floor of the cavernous sinus lying lateral
to the internal carotid artery (3)
• It enters the orbit through the medial end of the superior
orbital fissure (4) within the common tendinous ring to
end by supplying the lateral rectus (5)

21
Functions and deep origin of the Trigeminal nerve

Functions:
•GSA to
Mesencephalic nucleus of V

Main sensory nucleus

Spinal nucleus of V

•SVE from
Motor nucleus of V
22
 TRIGERMINAL NERVE-SUPERFICIAL ORIGIN

Trigeminal n.
Body of Pons

Middle cerebellar peduncle

23
24
 The Trigeminal nerve

a. Functions:
• GSA . SVE
b. Deep origin:
• The mesencephalic nucleus, in the midbrain (GSA)
• The principal (main) sensory nucleus, in the pons (GSA)
• The spinal nucleus of the trigeminal nerve, in the medulla (GSA)
• The motor nucleus of the trigeminal in the pons (SVE)
c. Superficial origin:
• From the ventral surface of the pons at the origin of the middle
cerebellar peduncle (1)
d. Foramen: foramen ovale
e. Course and relations:
• It is the largest and shortest cranial nerve, its short trunk is formed
of small motor and large sensory roots. The sensory root is a
branch of the semilunar ganglion which lies near the apex of the
petrous part of the temporal bone covered by the cavum trigeminal.
• To the convex surface of the ganglion its three branches are
attached:
1. The ophthalmic nerve
2. The maxillary nerve
3. The mandibular nerve (which is joined with the motor root)
25
TRIGERMINAL NERVE-CUTANEOUS DISTRIBUTION

26
The Ophthalmic nerve Supraorbital n.
Supratrochlear n.
Infratrochlear n.

Palpebral branch
Anterior ethmoidal n.

Lacrimal gland

Long ciliary nn.

Short ciliary nn.

Ciliary ganglion
Posterior ethmoidal n.

Lacrimal n.
Nasociliary n.

Frontal n.

27
 The Ophthalmic nerve
a. Function:
• GSA (pure sensory)
b. Course and relations:
• It is the smallest of the three branches, passes forwards in the lateral wall of the cavernous sinus below the
trochlear nerve and above the maxillary nerve
• Just before it enters the orbit through the superior orbital fissure, it divides into three branches, l acrimal, frontal
and nasociliary.
1. The lacrimal nerve
• Enters the orbit through the lateral part of the superior orbital fissure outside the tendinous ring
• Passes along the lateral wall of the orbit, above the lateral rectus with the lacrimal artery
• Receives communication (parasympathetic) from the zygomaticotemporal nerve which carries secretory
fibres to the lacrimal gland
• It supplies the lacrimal gland, and gives a palpebral branch to the upper eyelid
2. The frontal nerve
• Is the largest branch of the ophthalmic nerve
• Enters the orbit through the superior orbital fissure outside the common tendinous ring medial to the
lacrimal nerve
• In the orbit, it runs below the roof above the levator palpebrae superioris
• It ends by dividing into:
• Supratrochlear nerve: to the forehead and the scalp
• Supraorbital nerve: to the frontal air sinus, face and the scalp
3. The nasociliary nerve
• Enters the orbit through the superior orbital fissure inside the common tendinous ring between the two
divisions of the oculomotor
• It crosses above the optic nerve from lateral to medial below the superior oblique above the medial rectus
• It ends by giving the following branches:
• Sensory branch to the ciliary ganglion
• Long ciliary nerves : to the eye ball
• Posterior ethmoidal nerve: through the posterior ethmoidal canal to the ethmoidal and sphenoidal
air sinuses Infratrochlear nerve: to the lower eyelid and the face
• Anterior ethmoidal nerve: passes to the anterior ethmoidal canal to the cranial cavity then to the
nasal cavity through a slit on the lateral side of the cribriform plate of ethmoid to be called the
internal nasal which supplies the nose and ends as the external nasal to the skin of the nose. 28
 Communication with
Lacrimal n. Zygomaticotemporal n.

Zygomaticofacial n.

Infraorbital n. Zygomatic n.
Maxillary nerve

Palpebral br. Deep petrosal n.

Nasal br. Great petrosal n.

Nerve to pterygoid canal

Labial br. Pterygopalatine ganglion

Middle and anterior Posterior superior

superior alveolar nn. alveolar n.

29
Maxillary nerve
 The maxillary nerve

a. Function: GSA (pure sensory)

b. Course and relations:
• It passes in the lateral wall of the cavernous sinus below the ophthalmic nerve
• Leaves the cranial cavity through the foramen rotundum to the pterygopalatine fossa,
then through the pterygomaxillary fissure to the infratemporal fossa to the inferior orbital
fissure
• It continues as the infraorbital nerve which passes through the infraorbital groove and
canal in the floor of the orbit, it appears in the face through the infraorbital foramen
c. Branches:
• In the cranial cavity: meningeal branch to the outer layer of the dura matter
• In the pterygopalatine fossa:
• Ganglionic: sensory branch to the pterygopalatine ganglion
• Zygomatic nerve: divides into zygomaticotemporal and zygomaticofacial nerves to
the face and scalp (the zygomaticotemporal nerve carries secretory fibers to the
lacrimal gland from the ganglion to the lacrimal nerve)
• Posterior superior alveolar nerve; pierces the infratemporal surface of the maxilla to
supply the maxillary sinus and the molar teeth, it give branches to the cheek and
gum
• In the infraorbital canal (branches of the infraorbital nerve):
• Middle superior alveolar: to the upper premolar teeth
• Anterior superior alveolar nerve: to the incisor and canine teeth, it sends a nasal
branch to the nose and the nasal septum
• In the face: to supply the face
• Palpebral
• Nasal
• Superior labial
30
The Mandibular nerve
Nervous spinosus
To temporalis m Foramen spinosum

To lateral pterygoid m

Buccal nerve

To medial pterygoid m
Auriculotemporal nerve Otic ganglion

Tensor tympani m
To masseter
Tensor palati m

Lingual nerve

Sbmandibular ganglion
Inferior alveolar nerve

Mental nerve 31
 Nervous spinosus

To medial pterygoid m Anterior division

Tensor tympani m
Otic ganglion Posterior division

Tensor palati m
Auriculotemporal nerve

Lingual nerve
To lateral pterygoid m

Inferior alveolar nerve

To temporalis m

To masseter

Buccal nerve

The Mandibular nerve 32

 The mandibular nerve
a. Functions: GSA, SVE (mixed nerve)
b. Course and relations:
• Is the largest branch of the trigeminal nerve, formed of two roots a large sensory and small
motor
• It leaves the skull through the foramen ovale to the infratemporal fossa where the two roots
unite to form the nerve trunk
• The trunk lies medial to the lateral pterygoid muscle
• It is very short trunk which divides into anterior and posterior divisions
c. Branches:
From the trunk
• Nervus spinosus (meningeal): it passes up to the cranial cavity to supply the outer layer of the
dura matter in the middle cranial fossa
• Nerve to medial pterygoid: is the motor branch to the medial pterygoid muscle, it give a branch
which passes through the otic ganglion without relay to supply the tensor palati and tensor
tympani muscles
From the anterior division
• Deep temporal nerves: to the temporalis muscle
• Nerve to lateral pterygoid: supplies the muscle
• masseteric nerves: pass through the mandibular notch to supply the masseter
• Buccal nerve: passes between the two heads of the lateral pterygoid to the face to supply the
skin over the cheek
From the posterior division
1. The auriculotemporal nerve:
• Arise by two roots which surrounds the middle meningeal artery
• Passes deep to the neck of the mandible within the substance of the parotid gland to leave
the gland through its upper end of the gland to the scalp, it carries postganglionic
secretormotor fibres from the otic ganglion to the parotid gland
• It is sensory to the external acoustic meatus, articular to the temporomandibular joint and
33
superficial temporal to the scalp
 The mandibular nerve (cont.)
2. The lingual nerve:
• It is joined by the chorda tympani branch of the facial nerve in the
infratemporal fossa
• It descends downwards between the medial pterygoid muscle and the ramus of
the mandible, then it lies behind the root of the third molar tooth where is
covered by the mucous membrane of the mouth (dangerous position).
• In the submandibular region, it passes between the mylohyoid laterally and the
hyoglossus muscles deep to the submandibular gland
• It curves around the duct of the gland (lateral, below and then medial to it)
• Its terminal branches carries sensations from the mucous membrane of the
mouth, the gum, the anterior 2/3 of the tongue.
• The chorda tympani through it, supplies the submandibular and the sublingual
glands and carries taste fibres from the anterior 2/3 of the tongue
3. The inferior alveolar nerve:
• It descends deep to the lateral pterygoid, then between the ramus of the
mandible and the sphenomandibular ligament to enter the mandibular canal
• It runs in the canal as far as the mental foramen where it divides into mental
and incisive branches
• Before it enters the mandibular canal it gives its mylohyoid branch which
pierces the sphenomandibular ligament and descends in a groove on the
medial side of the ramus of the mandible to end by supplying the mylohyoid
and the anterior belly of digastric

34
FACIAL NERVE
Functions and deep origin:
VI nucleus
•SVE from
•Motor nucleus of VII

•GVE (parasympathetic) from

•Superior salivary nucleus

•SVA
•GVA both to
•Nucleus solitarius
35
 Internal acoustic meatus Lacrimal
Facial nerve Great petrosal n Nerve to pterygoid canal gland

Deep petrosal n.

Nerve to stapedius m
Tympanic memb.

Chorda tympani n.
Pterygopalatine ganglion
Temporal br.

Stylomastoid foramen Lingual n.

Zygomatic br.

Auricularis superior
Auricularis inferior
Occipitalis
Submandibular ganglion
Buccal br.
Parotid gland
Mandibular br

Cervical br Sublingual gland

To Stylohyoid m
36
To posterior belly of digastric m Submandibular gland
 The Facial nerve

a. Functions: SVA GVA SVE GVE

b. Deep origin:
• Nucleus solitarius (SVA, GVA)
• Motor nucleus of facial nerve (SVE)
• Superior salivatory nucleus (GVE)
c. Internal course: the motor fibres passes dorsally and medially forming a loop around the
abducent nucleus in the floor of the fourth ventricle forming the facial colliculus
d. Superficial origin: at the pontomedullary angle above the inferior cerebellar peduncle
e. Course and relations:
The intrapetrous course
• The nerve passes laterally with the vestibulocochlear nerve to the internal acoustic
meatus
• At the bottom of the meatus the nerve enters the facial bony canal where it runs
laterally above the vestibule and reaching the medial wall of the middle ear it bends
sharply backwards above the promontory (forming its genu where the genicular
ganglion is found), it then arches downwards in the medial wall of the middle ear to
reach the stylomastoid foramen
Extracranial course
• As it emerges from the foramen, it runs forwards in the substance of the parotid
gland crosses the styloid process, the retromandibular nerve and the external
carotid artery and divides behind the neck of the mandible into its terminal branches
which come out of the anteromedial surface of the gland

37
 The Facial nerve (cont.)

f. Branches:
1. Within the facial canal
• Nerve to stapedius: supplies the stapedius muscle
• Greater petrosal nerve: arises from the genicular ganglion (contains parasympathetic
fibres to the pterygopalatine ganglion and taste fibres to the mucous membrane of the
palate), it reaches the cranial cavity through a hiatus on the anterior surface of the
petrous part of the temporal bone to the foramen lacerum. It is joined by the deep petrosal
nerve from the sympathetic plexus on the internal carotid artery to form the nerve of the
pterygoid canal which passes through the pterygoid canal to the pterygopalatine fossa
and ends in the pterygopalatine ganglion.
• Chorda tympani nerve: arises from the facial nerve 6 mm above the stylomastoid foramen
and runs upwards to perforate the posterior bony wall of the tympanic cavity. It then
passes forwards on the medial surface of the tympanic membrane between its fibrous
and mucous layers crossing the handle of the malleus. It comes out of the tympanic
cavity through the petrotympanic fissure to the infratemporal fossa where it joins the
lingual nerve. Through the lingual nerve, it supplies both the sbmandibular and sublingual
salivary glands by secretomotor fibres and taste fibers from the anterior 2/3 of the tongue
2. At the exit from the stylomastoid foramen
• Posterior auricular nerve: to the auricularis posterior and the occipital belly of the
occipitofrontalis muscle
• Digastric branch: to the posterior belly of digastric muscle
• Stylohyoid branch: to the stylohyoid muscle
3. On the face
• Temporal Zygomatic Buccal Mandibular Cervical
to supply the muscles of the face, buccinator and platysma muscles
38
 Facial nerve
Great petrosal n

Pterygopalatine ganglion

Middle ear cavity

Nerve to stapedius m
Chorda tympani n.

Lingual n. Temporal br.

Auricularis superior Zygomatic br.

Auricularis inferior Buccal br.

Occipitalis

To Stylohyoid m Parotid gland

Mandibular br

To posterior belly of digastric m Cervical br

39
 Posterior belly of digastric m
Styloid apparatus
Glossopharyngeal nerve
Accessory nerve

Internal carotid a
Hypoglossal nerve
External carotid a
Vagus nerve

Occipital a Lingual a

Ansa cervicalis Common carotid a

Internal jugular v

40
Common relations of the last four cranial nerves
 Common Relations of the Last Four Cranial Nerves
•The IX, X, XI leave the cranial cavity through the middle part of the
jugular foramen

• At the base of the skull, they lie between the internal carotid artery
and the internal jugular vein deep to the styloid process and the
structures attached to it and posterior belly of the digastric muscle.

•The XII nerve leaves the skull through the hypoglossal canal where
it lie deep to the internal jugular vein then it joins the other nerves

41
 Functions and Nuclei of IX and X nerves
GLOSSOPHARYNGEAL NERVE VAGUS NERVE
GVA GVA
SVA SVA
GSA GSA
SVE SVE
GVE GVE

Nucleus solitarius
(SVA&GVA) Inferior salivatory n

(GVE)

IX Nucleus Ambiguus
(SVE)

Spinal nucleus of V X
(GSA)

Dorsal motor nucleus of X

(GVE) 42
 Lesser petrosal n

Tympanic plexus
Parotid gland
Tympanic br
Auditory tube
Otic ganglion

To stylopharyngeus

Carotid br Tonsillar branches

Lingual branches

Pharyngeal branches

On the middle constrictor

43
Glossopharyngeal nerve
 The Glossopharyngeal nerve
a. Functions: GSA GVA SVA GVE SVE
b. Deep origin: in the medulla oblongata
• Spinal nucleus of trigeminal nerve (GSA)
• Nucleus of tractus solitarius (GVA SVA)
• Inferior salivatory nucleus (GVE)
• Nucleus ambiguus (SVE)
c. Foramen: middle of the jugular foramen
d. Course and relations:
• At the base of the skull the nerve lies between the internal jugular vein and the internal carotid
artery deep to the styloid process and structures attached to it and the posterior belly of
digastric
• The nerve passes between the internal and external carotid arteries to reach the posterior
border of the stylopharyngeus muscle.
• It then curves forwards lying on the muscle to pass between the superior and middle
constrictor muscles to end by breaking into its terminal branches
e. Ganglia:
• Superior ganglion: has no branches and considered a detached part of the inferior ganglion
• Inferior ganglion: its branches carry general sensations from the pharynx, soft palate and
tonsils as well as general and taste fibres from the posterior 1/3 of the tongue
f. Branches:
• Tympanic nerve: is a branch of the inferior ganglion reaches the tympanic cavity through the
tympanic canaliculus to form the tympanic plexus on the medial wall of the cavity, out of the
plexus , the lesser petrosal nerve arises to the cranial cavity and through the foramen ovale to
relay into the otic ganglion. Postganglionic fibres supplies the parotid gland
• Carotid branch: to the carotid sinus and body, it carry stimuli about blood pressure changes
• Pharyngeal branches: is the sensory root of the pharyngeal plexus, carry the general
sensations from the pharynx
• Muscular branch: to the stylopharyngeus muscle
• Tonsillar branches: carry sensory branches from the palate and the tonsils 44
• Lingual branches: carry general and taste fibres from the posterior 1/3 of the tongue
 Meningeal br
The Vagus nerve

Cranial part of XI

Auricular br

Pharyngeal br
To Carotid body

Internal laryngeal n.
Superior laryngeal n.

Cardiac br
External laryngeal n.

Recurrent laryngeal n.

45
 The Vagus nerve
a. Functions: GSA GVA SVA GVE SVE
b. Deep origin: in the medulla oblongata
Spinal nucleus of trigeminal nerve (GSA)
Nucleus of tractus solitarius (GVA SVA)
Dorsal motor nucleus of the vagus (GVE)
Nucleus ambiguus (SVE)
c. Superficial origin: from the side of the medulla between the olive and the ICP
d. Foramen: middle part of jugular foramen
e. Course and relations:
• At the base of the skull the nerve lies between the internal jugular vein and the internal
carotid artery deep to the styloid process and structures attached to it and the posterior
belly of digastric
• The nerve descends vertically within the carotid sheath between the common carotid
artery and the internal jugular vein until it reaches the root of the neck, it crosses in
front of the first part of the subclavian artery to the thorax
f. Ganglia:
• Superior ganglion: its branch is the auricular nerve
• Inferior ganglion: its branches carries general sensations from the larynx, trachea,
bronchial tree, lungs, and the alimentary tract down to the junction between the right
2/3 and left 1/3 of the transverse colon. It also carries taste fibres from the root of the
tongue and the epiglottis
g. Branches in the neck:
1. In the jugular foramen
• Meningeal branch: to the dura matter of the posterior cranial fossa
• Auricular branch: it passes through the mastoid canaliculus to supply the floor and the
posterior wall of the external auditory meatus and the outer surface of the drum

46
 The Vagus nerve (Cont.)

2. In the neck
• Pharyngeal: (consists principally of the cranial part of XI), is the motor part of the
pharyngeal plexus through which it supplies all muscles of the pharynx except the
stylopharyngeus (by XI) and all muscles of the palate except the tensor palati (by
mandibular nerve)
• Branch to the carotid body
• Superior laryngeal nerve: passes deep to the internal carotid artery on thee lateral wall of
the pharynx, it divides into:
 Internal laryngeal nerve: pierces the thyrohyoid membrane with the superior
laryngeal vessels, it carries sensations from the pharynx, epiglottis above the vocal
cords
 External laryngeal nerve: supplies the cricothyroid muscle
• Cardiac branches: superior and inferior branches to the cardiac plexuses
• Right recurrent laryngeal nerve: arises from the right vagus where it crosses in front of
the right subclavian artery, it curves around the artery and ascends upwards in a groove
between the trachea and oesophagus close to the medial surface of the thyroid gland . It
supplies all the intrinsic muscles of the larynx except the cricothyroid muscle (by external
laryngeal) and sensations from the larynx above the vocal cords
3. In the thorax
• Cardiac
• Left recurrent
• Pulmonary
• Oesophageal
4. In the abdomen
• Gastric
• Coeliac
• hepatic
47
THE ACCESSORY NERVE DEEP
ORIGIN

Cranial part

Nucleus Ambiguus
Vagus Nerve

Upper 5 spinal segments

Spinal part

48
 The Accessory nerve

a. Functions: SVE (cranial root), GSE (spinal root)

b. Deep origin:
• Nucleus ambiguus (SVE)
• Upper 5 cervical segments
c. Superficial origin: the cranial part from the side of the medulla, the spinal part
from the side of the spinal cord
d. Internal course: the spinal part ascends in the vertebral canal then through the
foramen magnum to join the cranial root and both leave the cranial cavity
through the middle part of the jugular foramen
e. Course and relations:
• Just below the base of the skull the cranial part separates to join the vagus
nerve
• The spinal part lies between the internal jugular vein and the internal
carotid artery deep to the styloid process and structures attached to it and
the posterior belly of digastric
• It curves laterally and backwards posterior or sometimes anterior to the
internal jugular vein
• it then passes through the upper part of the sternocliedomastoid muscle to
the posterior triangle lying on the levator scapulae and ends into the
trapezius muscle
f. Branches:
• The cranial part is distributed through the pharyngeal and laryngeal
branches of the vagus nerve
• The spinal part supplies the sternocleidomastoid and trapezius muscles

49
The Accessory Nerve
Jugular foramen

Vagus nerve

Cranial part of XI

Foramen magnum
Spinal part of XI

Trapezius m

Sternomastoid m
50
THE HYPOGLOSSAL NERVE -DEEP ORIGIN

Function: GSE

EL-BADAWI 51
HYPOGLOSSAL N.-SUPERFICIAL ORIGIN
The Hypoglossal Nerve
Hypoglossal canal

1C Hyoglossus m

2C

3C Genioglossus m

Descending hypoglossi
(superior limb)

Geniohyoid m
Descending cervicalis
(inferior limb) Thyrohyoid m

Sternohyoid m

Ansa cervicalis
Sternothyroid m

Omohyoid
(superior belly)
Omohyoid 52
(inferior belly)
 The Hypoglossal nerve

a. Functions: GSE
b. Deep origin: the motor nucleus of the XI in the medulla oblongata
c. Superficial origin: from the side of the medulla between the olive and the pyramid
d. Foramen: the hypoglossal canal
e. Course and relations:
• The XII nerve leaves the skull through the hypoglossal canal where it lie deep
to the internal jugular vein then it joins the other nerves (XI, X, XI)
• it lies between the internal jugular vein and the internal carotid artery deep to
the styloid process and structures attached to it and the posterior belly of
digastric
• In the carotid triangle, it curves medially crossing anterior to the internal and
external carotid arteries and the loop formed by the lingual artery
• It then ascends upwards behind the common tendon of the digastric muscle
• In the submandibular region it lies on the lateral surface of the hyoglossus
muscle deep to the mylohyoid muscle and the submandibular gland
• In the interval between the hyoglossus and mylohyoid it lies below the deep
part of the submandibular gland, the submandibular duct and the lingual nerve
• It passes next on the lateral aspect of the genioglossus and continue in its
substance where it breaks into its terminal branches
f. Branches: it supplies all the intrinsic and extrinsic muscles of the tongue except the
palatoglossus (by the cranial part of XI through the pharyngeal branch of X from the
pharyngeal plexus)
53