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CN I Olfactory CN II Optic CN III Oculomotor Special Sensory
Efferent fibers to Olfactory Bulb Olfactory Tract Olfactory Bulb Cribiform Plate of Ethmoid Anosmia – Loss of sense of smell Uncinate Fits – olfactory hallucinations To Olfactory Epithelium on Superior Concha CN II Optic Special Sensory Retina Lateral Geniculate Bodies Pituitary Optic Canals Optic Chiasm Papilledema – Moore, 1090 Optic Neuritis – Moore, 1090 Visual Field Defects – Moore, 1090 Optic nerve CN III Oculomotor Motor Superior Rectus Parasympathetic: dashed = preganglionic solid = postganglionic Sympathetic (not part of CN III here, Coming from Internal Carotid Plexus) “Eyelid” Levator Palpebrae Superioris Superior Orbital Fissure Cavernous Sinus Accessory Oculomotor (Edinger-Westphal) Nucleus Nasociliary N. (V1) Long Ciliary N. Dilator Pupillae Ciliary Ganglion Ciliary Muscle Oculomotor Nucleus Short Ciliary Nerves Sphincter Pupillae Oculomotor Nerve Palsy Ptosis No Pupillary Reflex Dilation of the Pupil Eye Abducted No Lens Accomadation Compression of CN III Aneurism of Posterior Cerebral or Superior Cerebellar Artery Medial Rectus Inferior Rectus Inferior Oblique
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CN IV Trochlear LR6SO4 CN VI Abducent Motor Cavernous Sinus
Superior Orbital Fissure Trochlear Nucleus Superior Oblique (Eye – Down and Out) Trochlear Nerve Injury (Rarely alone) - Diplopia LR6SO4 CN VI Abducent Motor Superior Orbital Fissure Cavernous Sinus Abducent Nucleus Lateral Rectus Abducent Nerve Injury - Long intercranial course - Stretched due to fluid pressure - Paralysis - Diplopia – except opposite side of lesion or Aneurism of “Willis” Septic Thrombosis of Cavernous Sinus
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CN V Trigeminal V1 Opthalmic
Supraorbital Foramen CN V Trigeminal V1 Opthalmic Lateral Scalp Forehead Frontal Sinus Internal Upper Eyelid Supraorbital N. Sensory Frontal Nerve Supratrochlear N. Medial Scalp Forehead Medial Upper Eyelid Meningeal Lacrimal Nerve Lacrimal Gland Skin Conjunctiva Trigeminal Ganglion Cavernous Sinus Superior Orbital Fissure Nasociliary Nerve Sup. Ext. Nasal Wall Medial Eyelids Conjunctiva Lacrimal Sac Infratrochlear Post. Ethmoidal Foramen Ant. Ethmoidal Foramen Ethmoidal Post. Nerve Ciliary Ganglion Ethmoidal Ant. Nerve Short Ciliary Nerves Sphenoid Sinus Post. Ethmoidal Air Cells Ethmoidal Air Cells Eyeball Long Ciliary Nerve Nasal Cavity Iris, Cornea Medial Internal Nasal Lateral Internal Nasal External Nasal Branch Ant. 1/3 Nasal Septum Lat. Nasal Wall Tip of Nose
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Posterior Superior Lateral
Lacrimal Nerve (v1) Lacrimal Gland CN V Trigeminal V2 Maxillary Zygomaticotemporal Foramen Temporal Fossa Sensory Zygomaticotemporal N. Parasympathetic dashed = preganglionic solid = postganglionic Zygomatic N. Zygomaticofacial Foramen Sympathetic Zygomatic Arch Zygomaticofacial N. Foramen Rotundum Meningeal Inferior Orbital Fissure Infraorbital Foramen Trigeminal Ganglion Infraorbital Nerve Upper Lip Medial Cheek Side of Nose Post., Mid., & Ant. Superior Alveolar N. Cavernous Sinus Upper Teeth Maxillary Sinus Greater Petrosal N. (from CN VII) Vidian N. Of Pterygoid Canal Pterygo- Palatine Ganglion Deep Petrosal N. (from Internal Carotid Plexus) Sphenopalatine Foramen Lesser Palatine Nerve Greater Palatine N. Lesser Palatine Foramen Posterior Superior Lateral Nasal Branches Soft Palate Sensory to posterior 2/3 lateral nasal wall Nasal Concha Ethmoidal Air Cells Greater Palatine Foramen Nasopalatine Nerve Pharyngeal Branch Hard Palate Sensory to posterior 2/3 nasal septum Roof of Pharynx Sphenoid Sinus Incisive Canal
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Muscles of Mastication
CN V Trigeminal V3 Mandibular Sensory Special Sensory Parasympathetic: dashed = preganglionic solid = postganglionic Motor Meningeal Trigeminal Ganglion Foramen Ovale Foramen Spinosum Lesser Petrosal Nerve (IX) Muscles of Mastication Medial Pterygoid Lateral Pterygoid Temporalis Masseter Tensor Veli Palatini Muscle Tensor Tympani Muscle Auricle Scalp Lateral Face Middle Meningeal Artery Otic Ganglion Parotid Gland (Parasympathetics from CN IX) Auriculotemporal N. Buccal Nerve Skin over Buccinator Cheek Mucosa Gums Lingual Nerve Anterior 2/3 Tongue Chorda Tympani VII Submandibular Ganglion Submandibular Gland Sublingual Gland Mandibular Foramen Inferior Alveolar Nerve Lower Teeth Gums Lower Lip Mental Foramen Mental N. Chin Mylohyoid Anterior Digastric
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CN VII Facial Special Sensory Parasympathetic: dashed = preganglionic
solid = postganglionic Motor Sympathetic Lacrimal Gland Internal Acoustic Meatus Hiatus of Greater Petrosal Pterygoid Canal Containing Vidian Nerve Via V2 Motor Nucleus of Facial Nerve Geniculate Ganglion Greater Petrosal N. Pterygo- Palatine Ganglion Deep Petrosal Nerve Internal Carotid Plexus Superior Salivatory Nucleus Internal Carotid Artery Solitary Tract Nucleus Stapedius (Lingual Nerve of V3) Chorda Tympani Nerve Taste on Anterior 2/3 of Tongue Submandibular Ganglion Submandibular & Sublingual Glands Auricular Muscles Stylomastoid Foramen Occipitalis Muscle Temporal Parotid Gland Muscles Of Facial Expression (Including Buccinator & Platysma) Occiptial Branch Posterior Auricular Nerve Zygomatic Buccal Mandibular Stylohyoid Posterior Digastric Cervical Post. Auricular
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CN VIII Vestibulocochlear
Special Sensory Internal Acoustic Meatus Hearing Vestibular Nuclei Cochlear Ganglion Cochlear Nerve Cochlea Balance Vestibular Ganglion Vestibular Nerve Vestibular Apparatus Cochlear Nuclei Vestibulocochlear Nerve Injuries Tinnitus, vertigo, loss of Hearing Deafness (conductive & sensorineural) Acoustic Neuroma Trauma & Vertigo Méniére Syndrome – endolymphatic hydrops, tinnitus, vertigo, nausea Vestibular Disease – TIA – transient ischemic attack CN IX Glossopharyngeal Sensory Special Sensory Parasympathetic Spinal Tract & Spinal Nucleus of Trigeminal Nerve Motor Superior Glossopharyngeal Ganglion Inferior Salivatory Nucleus Internal Carotid Artery Jugular Foramen Inferior Glossopharyngeal Ganglion Tympanic Nerve Lesser Petrosal N. Otic Ganglion Parotid Gland Tympanic Plexus Tubal Branch of Tympanic Plexus Solitary Tract Nucleus Pharyngotympanic tube & Pharyngeal Opening Nucleus Ambiguus Stylopharyngeus Pharyngeal Branch Pharynx Lesions of CN IX (uncommon) Taste Absent – posterior 1/3 Gag Reflex missing on side of lesion Jugular Foramen Syndrome Glossopharyngeal Neuralgia (uncommon) - Pain Paroxysms – burning or stabbing Tonsillar Branch Palatine Tonsil Lingual Branch Taste & Sensation of Posterior 1/3 of Tongue Carotid Branch Carotid Body Carotid Sinus
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CN X Vagus External Acoustic Meatus Sensory 3 2 Parasympathetic
Auricular Branch 1 Motor Jugular Foramen Superior & Inferior Ganglia of Vagus Nerve 1) Posterior Nucleus of Vagus (Parasympathetic) 2) Solitary Tract Nucleus (Visceral Afferents) All Pharyngeal Muscles (except Stylopharyngeus – IX) All Palate Muscles (except Tensor Veli Palatini – V3) Pharyngeal Branch 3) Nucleus Ambiguus (Motor to Pharyngeal & Laryngeal Muscles) Communicating Branch of Vagus to Carotid Branch of CN IX Sensory Above Vocal Cords Parasympathetic Superior Laryngeal N. Internal Branch External Branch Cricothyroid Muscle (tenses, adducts, elongates vocal cords) Recurrent Laryngeal N. All Intrinsic Laryngeal Muscles (except Cricothyroid – Ext. branch) Sensory & Parasympathetic to Larynx below vocal cords; Parasympathetic (Efferent & Afferent) to Upper Esophagus & Trachea To Thorax & Abdominal Viscera Lesions of Vagus Nerve Injury to pharyngeal branch →Dysphagia (difficulty swallowing) Lesion of superior laryngeal nerve →Anesthia in upper larynx & paralysis of cricothyroid muscle →Voice is weak & tires easily Injury to Recurrent Laryngeal →Caused by aortic aneurysm or neck operations →Hoarseness, dysphonia (↓ voice quality) →If both sides, aphonia (no voice) & inspiratory stridor (crowing sound during inspiratory phase)
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CN XI Spinal Accesory CN XII Hypoglossal Motor
Sensory (Proprioceptive) Jugular Foramen Nucleus Ambiguus Foramen Magnum Sternocleidomastoid Injury During Special Procedures Lesions Weakness and atrophy Impairment of opposite side rotary movements (SCM) & shrugging movements Scapular winging during shoulder abduction C1 Trapezius C2 C3 C4 CN XII Hypoglossal Motor Hypoglossal Canal Hypoglossal nucleus All Glossus Muscles (except Palatoglossus - X) C1 C2
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