CRANIAL NERVES: nd

Source: Gray’s Anatomy for Students, 2 Edition

• The 12 pairs of cranial nerves are part of the peripheral nervous system (PNS) and pass
through foramina or fissures in the cranial cavity.
• All nerves except the accessory nerve [XI], originate from the brain.
• In addition to having similar somatic and visceral components as spinal nerves, some
cranial nerves also contain special sensory and motor components.
• The special sensory components are associated with hearing, seeing, smelling,
balancing, and tasting.
• Special motor components include those that innervate skeletal muscles derived
embryologically from the pharyngeal arches and not from somites.

Fig. 33
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 v Table: Cranial nerves functional components:

Functional Component Abbreviation General function Cranial nerves containing component

General somatic GSA Perception of touch, Trigeminal nerve [V]; facial nerve [VII];
afferent pain, temperature glossopharyngeal nerve [IX]; vagus nerve
[X]

General visceral GVA Sensory input from Glossopharyngeal nerve [IX]; vagus nerve
afferent viscera [X]

Special afferent SA Smell, taste, vision, Olfactory nerve [I]; optic nerve [II]; facial
(Special sensory) *** hearing, and balance nerve [VII]; vestibulocochlear nerve [VIII];
glossopharyngeal nerve
((SVA & SSA)) [IX]; vagus nerve [X]

General somatic GSE Motor innervation to Oculomotor nerve [III]; trochlear nerve
efferent skeletal (voluntary) [IV]; abducent nerve [VI]; accessory nerve
muscles [XI]; hypoglossal nerve [XII]

General visceral GVE Motor innervation to Oculomotor nerve [III]; facial nerve
efferent smooth muscle, [VII]; glossopharyngeal nerve [IX]; vagus
heart muscle, and nerve [X]
glands

Special visceral BE Motor innervation to Trigeminal nerve [V]; facial nerve [VII];
efferent skeletal muscles glossopharyngeal nerve [IX]; vagus nerve
(Branchial Motor) derived from [X]
pharyngeal arch
mesoderm

NOTES:

Q In human embryology, six pharyngeal arches are designated, but the fifth pharyngeal arch
never develops.
Q Each of the five pharyngeal arches is associated with a developing cranial nerve or one of its
branches.
Q These cranial nerves carry efferent fibers that innervate the musculature derived from the
pharyngeal arch.

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Q Innervation of the musculature derived from the five pharyngeal arches that do develop is
as follows:
& First arch-trigeminal nerve [V 3].
& Second arch-facial nerve [VII].
& Third arch-glossopharyngeal nerve [IX].
& Fourth arch-superior laryngeal branch of the vagus nerve [X].
& Sixth arch-recurrent laryngeal branch of the vagus nerve [X].

Olfactory nerve [CN I]:

• The olfactory nerve [CN I] carries special afferent (SA) fibers for the sense of smell.
• Its sensory neurons have:
o Peripheral processes that act as receptors in the nasal mucosa.
o Central processes that return information to the brain.
• The receptors are in the roof and upper parts of the nasal cavity.
• The central processes, after joining into small bundles, enter the cranial cavity by
passing through the cribriform plate of the ethmoid bone. They terminate by synapsing
with secondary neurons in the olfactory bulbs.

Fig. 34

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Optic nerve [CN II]:

• The optic nerve [CN II] carries SA fibers for vision.

• These fibers return information to the brain from photoreceptors in the retina.
• Neuronal processes leave the retinal receptors, join into small bundles, and are carried
by the optic nerves to other components of the visual system in the brain.
• The optic nerves enter the cranial cavity through the optic canals.

Oculomotor nerve [CN III]:

• The oculomotor nerve [CN III] carries two types of fibers:

1. General somatic efferent (GSE) fibers innervate most of the extra-ocular muscles.
2. General visceral efferent (GVE) fibers are part of the parasympathetic system.
• The oculomotor nerve leaves the anterior surface of the brainstem between the
midbrain and the pons.
• It enters the anterior edge of the tentorium cerebelli, continues in an anterior direction
in the lateral wall of the cavernous sinus.
• It leaves the cranial cavity through the superior orbital fissure.
• In the orbit, the GSE fibers in the oculomotor nerve innervate:
o Levator palpebrae superioris muscle.
o Superior rectus muscle.
o Inferior rectus muscle.
o Medial rectus muscle.
o Inferior oblique muscle.

• The GVE fibers are preganglionic parasympathetic fibers that synapse in the ciliary
ganglion and ultimately innervate the sphincter pupillae muscle, responsible for
pupillary constriction, and the ciliary muscles, responsible for accommodation of the
lens for near vision.

Trochlear nerve [CN IV]:

• The trochlear nerve [CN IV] is a cranial nerve that carries GSE fibers to innervate the
superior oblique muscle (an extra-ocular muscle in the orbit).
• It arises in the midbrain and is the only cranial nerve to exit from the posterior surface
of the brainstem.
• After curving around the midbrain, it enters the inferior surface of the free edge of the
tentorium cerebelli, continues in an anterior direction in the lateral wall of the
cavernous sinus and enters the orbit, through the superior orbital fissure.

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Trigeminal nerve [CN V]:

• The trigeminal nerve [CN V] is the major general sensory nerve of the head.
• It also innervates muscles that move the lower jaw (muscles of mastication).
• It carries general somatic afferent (GSA) and branchial efferent (BE) fibers:
& The GSA fibers provide sensory input from the face, anterior one-half of the
scalp, mucous membranes of the oral and nasal cavities and the paranasal
sinuses, the nasopharynx, part of the ear and external acoustic meatus, part
of the tympanic membrane, orbital contents and conjunctiva, and the dura
mater in the anterior and middle cranial fossae.

& The BE fibers innervate the muscles of mastication, the tensor tympani, the
tensor veli palatini, the mylohyoid, and the anterior belly of the digastric.

• The trigeminal nerve exits from the anterolateral surface of the pons as a large sensory
root and a small motor root. These roots continue forward out of the posterior cranial
fossa and into the middle cranial fossa by passing over the medial tip of the petrous part
of the temporal bone.
• In the middle cranial fossa the sensory root expands into the trigeminal ganglion which
contains cell bodies for the sensory neurons in the trigeminal nerve.
• There are the three terminal divisions of the trigeminal nerve arising from the anterior
border of the trigeminal ganglion, which in descending order are:

Q The ophthalmic nerve (ophthalmic division [V 1]).

Q The maxillary nerve (maxillary division [V 2]).
Q The mandibular nerve (mandibular division [V 3]).

Ophthalmic nerve [V 1]:

• The ophthalmic nerve [V 1] passes forward in the dura of the lateral wall of the
cavernous sinus.
• It leaves the cranial cavity, and enters the orbit through the superior orbital fissure.
• The ophthalmic nerve [V 1] carries sensory branches from the eyes, conjunctiva, and
orbital contents, including the lacrimal gland.

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 • It also receives sensory branches from the nasal cavity, frontal sinus, ethmoidal cells,
falx cerebri, dura in the anterior cranial fossa and superior parts of the tentorium
cerebelli, upper eyelid, dorsum of the nose, and the anterior part of the scalp.

Maxillary nerve [V 2]:

• The maxillary nerve [V 2] passes forward in the dura mater of the lateral wall of the
cavernous sinus just inferior to the ophthalmic nerve [V 1].
• It leaves the cranial cavity through the foramen rotundum, and enters the
pterygopalatine fossa.
• The maxillary nerve [V 2] receives sensory branches from the dura in the middle cranial
fossa, the nasopharynx, the palate, the nasal cavity, teeth of the upper jaw, maxillary
sinus, and skin covering the side of the nose, the lower eyelid, the cheek, and the upper
lip.

Mandibular nerve [V 3]:

• The mandibular nerve [V 3] leaves the inferior margin of the trigeminal ganglion and
leaves the skull through the foramen ovale.
• The mandibular nerve [V 3] is the only division of the trigeminal nerve that contains a
motor component.
• Outside the skull the motor fibers of mandibular nerve innervate:
1. The four muscles of mastication (temporalis, masseter, and medial and lateral
pterygoid muscles).
2. The tensor tympani.
3. The tensor veli palatini.
4. The Anterior Belly of the Digastric.
5. The mylohyoid muscles.

• The mandibular nerve [V 3] also receives sensory branches from the skin of the lower
face, cheek, lower lip, anterior part of the external ear, part of the external acoustic
meatus and the temporal region, the anterior two-thirds of the tongue, the teeth of the
lower jaw, the mastoid air cells, the mucous membranes of the cheek, the mandible,
and dura in the middle cranial fossa.

Abducent nerve [CN VI]:

• The abducent nerve [CN VI] carries GSE fibers to innervate the lateral rectus muscle in
the orbit.

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• It arises from the brainstem between the pons and medulla and passes forward,
piercing the dura covering the clivus.
• It continues upward in a dural canal, it crosses the superior edge of the petrous bone,
and then it enters and crosses the cavernous sinus just inferolateral to the internal
carotid artery, and enters the orbit through the superior orbital fissure.

Fig. 34

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Facial nerve [CN VII]:

• The facial nerve [CN VII] carries GSA, SA, GVE, and BE fibers:
I. The GSA fibers provide sensory input from part of the external acoustic
meatus and deeper parts of the auricle.
II. The SA fibers are for taste from the anterior two-thirds of the tongue.
III. The GVE fibers are part of the parasympathetic part of the autonomic
division of the PNS and stimulate secretomotor activity in the lacrimal gland,
submandibular and sublingual salivary glands, and glands in the mucous
membranes of the nasal cavity, and hard and soft palates.
IV. The BE fibers innervate:
a) The muscles of the face (muscles of facial expression)
b) The muscle of scalp (occipitofrontalis muscle).
c) The Stapedius muscle.
d) The posterior belly of the digastric.
e) The Stylohyoid muscles.

• The facial nerve attaches to the lateral surface of the brainstem, between the pons and
medulla oblongata.
• The facial nerve crosses the posterior cranial fossa and leave the cranial cavity through
the internal acoustic meatus
• After entering the facial canal in the petrous part of the temporal bone, the nerve
enlarges as the geniculate ganglion (which is similar to a spinal ganglion) containing cell
bodies for sensory neurons.
• At the geniculate ganglion, the facial nerve turns and gives off the greater petrosal
nerve, which carries mainly preganglionic parasympathetic (GVE) fibers destined to
pterygopalatine ganglion. (see table in the next page)

• The facial nerve continues along the bony canal, giving off the nerve to stapedius muscle
and the chorda tympani, before exiting the skull through the stylomastoid foramen.

• The chorda tympani carries:

o The Taste (SA) fibers from the anterior two-thirds of the tongue.
o The Preganglionic Parasympathetic (GVE) fibers destined for the submandibular
ganglion.

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Vestibulocochlear nerve [CN VIII]:

• The vestibulocochlear nerve [CN VIII] carries SA fibers for hearing and balance.
• It consists of two divisions:
A. A vestibular component for balance.
B. A cochlear component for hearing.
• The vestibulocochlear nerve [VIII] attaches to the lateral surface of the brainstem,
between the pons and medulla.
• After emerging from the internal acoustic meatus and crossing the posterior cranial
fossa, the two divisions combine into the single nerve seen in the posterior cranial fossa
at the posterior surface of the petrous part of the temporal bone.

Glossopharyngeal nerve [CN IX]:

• The glossopharyngeal nerve [IX] arises as several rootlets on the anterolateral surface of
the upper medulla oblongata.
• The rootlets cross the posterior cranial fossa and enter the jugular foramen.
• Within the jugular foramen, and before exiting from it, the rootlets merge to form the
glossopharyngeal nerve.
• Within or immediately outside the jugular foramen are two ganglia (the superior and
inferior ganglia), which contain the cell bodies of the sensory neurons in the
glossopharyngeal nerve [IX].

Tympanic nerve:

• It is a branch of the glossopharyngeal nerve.

• The tympanic nerve emerges from the glossopharyngeal nerve either
within or immediately outside the jugular foramen.
• This branch re-enters the temporal bone, enters the middle ear cavity,
and participates in the formation of the tympanic plexus.
• Within the middle ear cavity the tympanic plexus provides sensory
innervation to the mucosa of the cavity, pharyngotympanic (Eustachian)
tube, and mastoid air cells.
• The tympanic nerve also contributes GVE fibers, which leave the
tympanic plexus in the lesser petrosal nerve.
• The lesser petrosal nerve is a small nerve that exits the temporal bone,
enters the middle cranial fossa, and descends through the foramen ovale
to exit the cranial cavity carrying preganglionic parasympathetic fibers to
the otic ganglion. (Note that the otic ganglion is located in infratemporal
fossa)

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Fig.35

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NOTE: The glossopharyngeal nerve [CN IX] carries, GVA, GSA, SA, GVE, and BE fibers:

A. The GVA fibers provide sensory input from the carotid body and sinus;
B. The GSA fibers provide sensory input from posterior one-third of the tongue,
palatine tonsils, oropharynx, and mucosa of the middle ear and
pharyngotympanic tube.
C. The SA fibers are for taste from the posterior one-third of the tongue.
D. The GVE fibers are part of the parasympathetic and stimulate secretomotor
activity in the parotid salivary gland.
E. The BE fibers innervate the muscle derived from the third pharyngeal arch
(the stylopharyngeus muscle).

Table: Parasympathetic ganglia of the head;

Ganglion Name Input Nerve Origin of Preganglionic Function

Fibers
Ciliary Oculomotor nerve [III] Oculomotor nerve Innervation of sphincter
[III] pupillae muscle for pupillary
constriction, and ciliary muscles
for accommodation of the lens
for near vision

Pterygopalatine Greater petrosal nerve Facial nerve [VII] Innervation of lacrimal gland,
and mucous glands of nasal
cavity, maxillary sinus, and
palate

Otic Lesser petrosal nerve Glossopharyngeal nerve Innervation of parotid gland

[IX]

Submandibular Chorda tympani to Facial nerve [VII] Innervation of submandibular

lingual nerve and sublingual glands

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Vagus nerve [X]:

• The vagus nerve [CN X] carries GSA, GVA, SA, GVE, and BE fibers:
• The GSA fibers provide sensory input from the larynx, laryngopharynx, deeper parts of the
auricle, part of the external acoustic meatus, and the dura mater in the posterior cranial
fossa.
• The GVA fibers provide sensory input from the aortic body chemoreceptors and aortic arch
baroreceptors, and the esophagus, bronchi, lungs, heart, and abdominal viscera in the
foregut and midgut.
• The SA fibers are for taste around the epiglottis and pharynx.
• The GVE fibers are part of the parasympathetic part of the autonomic division of the PNS
and stimulate smooth muscle and glands in the pharynx, larynx, thoracic viscera, and
abdominal viscera of the foregut and midgut.
• The BE fibers innervate the followings:
o One muscle of the tongue (palatoglossus muscle).
o All the muscles of the soft palate (except tensor veli palatini).
o All the muscles of pharynx (except stylopharyngeus).
o All the muscles of larynx.

• The vagus nerve arises as a group of rootlets on the anterolateral surface of the medulla
oblongata just inferior to the rootlets that form the glossopharyngeal nerve [CN IX].
• The rootlets of vagus nerve cross the posterior cranial fossa and enter the jugular foramen.
• Within this foramen, and before exiting from it, the rootlets merge to form the vagus nerve.
• Within or immediately outside the jugular foramen, there are two ganglia, the superior
(jugular) and inferior (nodose) ganglia, which contain the cell bodies of the sensory neurons
in the vagus nerve [X].

Accessory nerve [XI]:

• The accessory nerve [CN XI] is a cranial nerve that carries GSE fibers to innervate the
sternocleidomastoid and trapezius muscles.
• It is a unique cranial nerve because its roots arise from motor neurons in the upper five
segments of the cervical spinal cord.
• These fibers leave the lateral surface of the spinal cord and, joining together as they ascend,
enter the cranial cavity through the foramen magnum.
• The accessory nerve [XI] continues through the posterior cranial fossa and exits through the
jugular foramen. It then descends in the neck to innervate the sternocleidomastoid and
trapezius muscles from their deep surfaces.

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NOTE: Cranial root of the accessory nerve:

• Some descriptions of the accessory nerve refer to a few rootlets arising from the caudal
part of the medulla oblongata (on the anterolateral surface just inferior to the rootlets
that form the vagus nerve) as the "cranial" root of the accessory nerve.
• The cranial root then leaves the medulla oblongata and course with the "spinal" roots of
the accessory nerve into the jugular foramen.
• At the jugular foramen the cranial roots join the vagus nerve. Therefore, this cranial root
is described as being part of the vagus nerve.

Hypoglossal nerve [CN XII]:

• The hypoglossal nerve [CN XII] carries GSE fibers to innervate all intrinsic and most of
the extrinsic muscles of the tongue.
• It arises as several rootlets from the anterior surface of the medulla, and passes laterally
across the posterior cranial fossa and exits through the hypoglossal canal.
• This nerve innervates the hyoglossus, styloglossus, and genioglossus muscles and all
intrinsic muscles of the tongue.

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