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Cranial Nerves 5. 7 & 9, 10, 11, 12 (Week5) Capture
Sensory (Special)…
Cranial Nerves 5. 7 & 9, 10, 11, 12 (Week5) 
Sensory (Special)
CN1, CN2, CN8
Motor
CN3, CN4, CN6, CN11, CN12
Mixed
CN5, CN7, CN9, CN10
Parasympathetic
CN3, CN7, CN9, CN10
CN5: Trigeminal Nerve
- Sensory Somatic :check:
- 1st Order Sensory: Trigeminal Ganglion
- 2nd Order Sensory: Trigeminal Sensory Nuclei Complex (Decussation)
- Sensory Visceral :red_cross:
- Motor Somatic :check:
- Motor Visceral :red_cross:
Maxillary (5b)
- Pons
- Posterior CF
- Middle CF (Trigem Ganglion)
- Cavernous Sinus
- Foramen Rotandum
- Pterygo-palatine Fossa
Distribution: (Vertex Ear Chin Line)
- Maxilla / Sinus
- Teeth / Palate
- Face / Lips
- Nasal Cavity
- Pharynx
- Middle Cranial Fossa
Story Upper Molar
- Upper Molar
- Superior Alveolar Nerve
- Maxillary Nerve
- Pterygopalatine Fossa
- Foramen Rotadum
- Cavernous Sinus
- Trigeminal Ganglion
- Mid pons
- Trigeminal Sensory Nuclei (2nd Order)
- Decussate
- Thalamus
- Sensory Cortex
Pteryo-Palatine Fossa
1) Zygomatic Nerve
2) Inferior Orbital
Middle/Anterior Superior alveolar
3) Pterygo-palatine Ganglion
4) Posterior Superior Alveolar Nerve
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Injection: Pterygopalatine Fossa
- Block anesthesia of entire CN5b
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Mandibular (5c)
- Pons
- Postearior CF
- Middle CF (Trigem Ganglion)
- Foramen Ovale
- Infra-temporal Fossa
Distribution: (Vertex Ear Chin Line)
- Mandible / Teeth
- TMJ / Parotid
- Oral Cavity / Tongue / Cheek
- Chin / Lip
- Ear
- Scalp
- Middle Cranial Fossa
Story Lower Molar:
- Lower Molar
- Inferior Alveolar Nerve /Mandibular Nerve
- Mandibular Foramen
- Infratemporal Fossa
- Foramen Ovale
- Trigeminal Ganglion (1st Order / No Synapse)
- Posterior Cranial Fossa
- Mid pons
- Trigeminal Sensory Nuclei (2nd Order)
- Decussate
- Thalamus
- Sensory Cortex
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Ophthalmic (5a)
- Pons
- Posterior CF
- Middle CF (Trigem Ganglion)
- Cavernous Sinus
- Superior Orbital Fissure
Distribution (Vertex Ear Chin Line):
- Orbit / Eye
- Forehead / Scalp
- Nose
- Anterior Cranial Fossa
- Nasocilliary
- Frontal
- Lacrimal
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Muscles (Trigeminal Motor Nucleus):
- Tensor Palatini
- Tensor Tympani
- Anterior Digastric
- Mylohyoid
- Muscles of Mastication
Trigeminal Sensory Complex:
- 2nd order sensory cell body (relay)
- 1st order sensory cell body (ganglion - PNS)
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Principal (Chief) Sensory
CN 7: Facial Nerve
Facial nerve
- Pontomedullary Junction
- Posterior CF
- Middle CF
- Internal Acoustic Meatus (Enter Petrous Temporal Bone)
- Facial Canal
- Geniculate Ganglion (Within Facial Canal / Near Tympanic Cavity)
- Labyrinth: Greater Petrosal Nerve (Nasal / Palatine / --> Pterygopalatine ganglion Lacrimal + Taste)
- Tympanic: Runs through Tympanic Cavity
- Mastoid: Mixed Facial Proper: Stapedius & Chorda Tympani
- Communicating branch to Otic together with Lesser petrosal
- Stylomastoid Foramen
- Parotid Plexus
- Temporal
- Zygomatic
- Buccal
- Mandibular
- Cervical
Geniculate Ganglion
Mixed Facial Proper
- 1) Stapedius
- 2) Chorda Tympani (Travels with Lingual Nerve)
- Submandibular Ganglion (Secretmotor) (CNVc)
- Taste (Special Sensory)
- Exit through Stylomastoid Foramen
Greater Petrosal Nerve
- Joins with Deep Petrosal (Superior Cervical Ganglion -Sympathetic) (Within Foramen Lacerum)
- Joins with Nerve of Pterygoid Canal (Within Foramen Lacerum)
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Lacrimal Gland (CN7):
- Geniculate Ganglion
- Greater Petrosal / Pterygoid Canal
- Pterygopalatine Ganglion
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Sensory
- Sensory Somatic :check:
- Auricles
- 1st Order: Geniculate Ganglion
- 2nd Order: Spinal Nucleus of V
- 3rd Order: Thalamus
- Special Sensory :check:
- Taste
- 1st Order: Geniculate Ganglion
- 2nd Order: Facial Sensory Nucleus (Tractus Solitarius)
- Sensory Visceral :red_cross:
Motor
- Motor Somatic :check:
- Muscles of Facial Expression
- Stylohyoid, Posterior Belly
- Stapedius (Skeletal Muscle)
- LMN: Facial Motor Nucleus
- UMN: Motor Cortex
- Motor Visceral :check:
- Submandibular & Sublingual Glands
- Preganglionic: Salivary Nucleus
- Postganglionic: Submandibular Ganglion
- Lacrimal Glands
- Preganglionic: Lacrimal Nucleus
- Postganglionic: Pterygopalatine Ganglion
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UMN vs LMN lesion
- Facial Palsy test:
- Smile (Lower)
- Raise Eyebrow (Upper)
Upper Motor Neuron
- From: Motor Cortex To: Facial Motor Nucleus
- Supply both Contra-lateral & Ipsilateral UPPER Facial Motor Nucleus
- Lesion: Contra-lateral Lower Facial Palsy
Lower Motor Neuron
- From: Facial Motor Nucleus To: Muscles of Facial Expression
- Supply Ipsilateral Muscles of Facial Expression
- Lesion: Ipsilateral Upper & Lower Facial Palsy
Basic Neuroscience
Somatic-Motor
UMN
- Cell Body: Motor Cortex
- Motor Cortex to Ventral Horn / Brainstem Motor Nuclei
LMN
- Cell Body:
- Spinal Nerve: Ventral Horn
- Cranial Nerve: Brainstem Motor Nuclei
- To Effector
Somatic-Sensory
1st Order:
- Cell Body (Ganglia): Outside CNS
- Outside CNS to Dorsal Horn
2nd Order
- Cell Body (Nuclei) : Dorsal Horn
- Dorsal Horn to Thalamus
- Decussation
3rd Oder
- Cell Body: Thalamus
- Thalamus to Sensory Cortex
Autonomic
Preganglionic
- Cell Body: Autonomic Nuclei in Lateral Horn
Postganglionic
- Cell Body: Autonomic Ganglia
Recap of Parasympathetic Ganglions
Otic Ganglion
- From: CN9, Lesser Petrosal
- To: Parotid Glands, Auriculotemporal Nerve
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Exceptions
- Palatoglossus
- Tensor Palatini
Tongue (CN12)
- Palatoglossus
- Genioglossus
- Styloglossus
- Hyoglossus
- VTL (Vert-Trans-Long)
Soft Palate (Pharyngeal Plexus)
- Tensor Palatini
- Levator Palatini
- Palatoglossus
- Palatopharyngeus
- Muscular Uvulae
Larynx (All Vagus Nerve)
- AT / AA / AC / AE
- CT / TE
- Vocalis
Floor of Mouth (Near Ear/Mouth)
- Geniohyoid
- Mylohyoid
- Stylohyoid
- Ant. Digastric
- Post. Digastric
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Lymphatic Drainage
Jugular Lymphatic Trunk
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Upper Deep Cervical Lymph Nodes
- Submantle
- Submandibular
- Auricular
- Occipital
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9, 10, 11 after OSPE
Glossopharyngeal (CN9)
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Course & Relations
- Medulla Oblongata
- Jugular Foramen (Branching)
- Tympanic Nerve / Plexus
- Enters Petrous Temporal Bone
- Interferior tympanic canaliculus
- Tympanic Cavity, GSA
- Less Petrosal Nerve
- Re-enter, Exit (Foramen Ovale)
- Auriculotemporal Nerve
- Carotid Sinus
- Barroreceptors
- Chemoreceptors
- Pharyngeal (Plexus)
- Between ICA / IJV
- Pharynx & Tongue
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Somatic Sensory
- Skin of Ext ear
- Internal surface of tympanic membrane
- Walls of upper pharynx
- Posterior 1/3 of tongue
- Glossopharyngeal Ganglion
- Spinal Nucleus of V
Viscero Sensory
- Baroreceptors of carotid sinus
- Chemoreceptors of carotid sinus
- Glossopharyngeal Ganglion
- NTS --> Hypothalamus
Viscero Motor
- Parotid Gland
- Otic Ganglion
- Inferior Salivary Nucleus
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Vagus (CN10)
Course & Relations
- Medulla Oblongata
- Jugular Foramen
- Between CCA & IJV
- Thorax - Root of Lungs
- Esophagus
- Diaphragm
Effectors:
- GIT: To proximal 2/3 of Transverse Colon
- Pelvic Splanchnic 1/3: Splanchic, Ovary, Uterus, Urethra, Urether
- Laryngeal Nerves:
- Superior
- Recurrent
- Right in neck
- Left loop under arch of aorta
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Possible Complications
Ligating Superior Thyroid Artery
- Accidentally ligate External Laryngeal Nerve
- Hoarse Voice
- Cricothyroid muscle cannot function
Thyroid Operation
- Difficulty breathing
- Vocal Cords
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Accessory Nerve (CN11)
Spinal Course & Relations (Spinal):
- Upper Spinal Cord
- Foramen Magnum (Enter)
- Jugular Foramen (Exit
- Spinal Portion (Trapezius & SCM)
- Cranial Portion (Follows Vagus)
Spinal Course & Relations (Cranial)
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