CRANIAL NERVES: PRINCIPLES
OF ORGANIZATION
1. Cranial nerves are parts of the PNS.
2. They are attached to the part of the CNS called the
brain stem (midbrain, pons and medulla).
3. Exceptions are I and II which connect directly to
higher levels of the brain.
4. Innervate:
• Skeletal muscles
• Sensory structures
• Smooth muscles, cardiac muscles and
secretory glands (ANS)
OVERVIEW OF THE NERVOUS SYSTEM
BRAIN
CRANIAL Head &
neck Skeletal
NERVES, including muscle,
S Plexuses & viscera
Ganglia Sensory
P
structures,
I
N SPINAL Head, neck, Smooth
thorax, muscle*,
A NERVES, abdomen,
L Plexuses & pelvis, Cardiac
C
Ganglia including
muscle*,
viscera,
O and limbs
PERIPHERAL Secretory
R
NERVOUS glands*
D SYSTEM (PNS)
REGIONS TARGET
STRUCTURES
CENTRAL NERVOUS *Innervated by the ANS
SYSTEM (CNS)
CRANIAL NERVES:
GENERAL FEATURES
• TWELVE PAIRS
ATTACHED TO
BRAIN STEM
Brain stem:
Midbrain,
Pons, and
Medulla
I
II
III V1 V2
V3
IV
VI
VII
VIII
IX
X
XI XII
CRANIAL NERVES:
GENERAL FEATURES
EXIT THROUGH FORAMINA AT THE BASE OF THE SKULL
Anterior cranial fossa
I
III
IV
II
V1
V2 VI
Middle cranial fossa
V3
VII
VIII
IX
X
XII XI
Posterior cranial fossa
XI
CRANIAL NERVES:
COMPOSITION
Some are motor nerves III, IV, VI, XI, XII
Some are sensory nerves I, II, VIII
Others are mixed nerves V, VII, IX, X
Some contain autonomic
(preganglionic III, VII, IX, X
parasympathetic) fibers
originating in the brain stem
CRANIAL NERVES:
MIDBRAIN
NUCLEI
Motor
Nucleus Skeletal
Muscle
Sensory
PONS Nucleus Skin
Mucosa
Sensory
Parasympathetic Ganglion
Nucleus
MEDULLA Smooth
OBLONGATA Parasympathetic Muscle
Ganglion Cardiac
Muscle
Glands
BRAIN STEM
AUTONOMIC NERVOUS SYSTEM
Innervates structures that are
not under voluntary control
Target structures are: smooth
muscles, cardiac muscles
and secretory glands
AUTONOMIC NERVOUS SYSTE
Sympathetic Nervous System (SNS)
= Thoracolumbar outflow
cell bodies of origin in T1-L2 cord segments
Parasympathetic nervous System (PSNS)
= Craniosacral outflow
cell bodies of origin in brain stem and S2-S4 cord
segments
Both SNS and PSNS have CNS and PNS
components
Two Neurons in series involved
in ANS innervations
Pre-ganglionic Ganglion Post-ganglionic
< < TARGETS
CNS:
PNS:
T1-L2 cord, Brain
stem, S 2-4 cord Head and neck,
thorax, abdomen,
pelvis
V: TRIGEMINAL S M
Mixed nerve with both sensory and motor
functions
Has a motor root and a sensory root
Because it has a sensory component, it
has a sensory ganglion, akin to the spinal
ganglion
Does NOT contain preganglionic
parasympathetic fibers as it leaves the brain
stem
TRIGEMINAL S M
Three branches:
• V1 (OPHTHALMIC): SENSORY
• V2 (MAXILLARY): SENSORY
• V3 (MANDIBULAR): SENSORY and MOTOR
CRANIAL NERVES:
GENERAL FEATURES
EXIT THROUGH FORAMINA AT THE BASE OF THE SKULL
I
III
IV
II
V1
V2 VI
V3
VII
VIII
IX
X
XII XI
XI
TRIGEMINAL:
COURSE AND FEATURES
V1 : Superior orbital fissure Orbit
Supraorbital notch
and foramen
V2 : Foramen rotundum Pterygopalatine fossa
Inferior orbital fissure
Infraorbital foramen
V3: Foramen ovale Infratemporal fossa
Mandibular canal
Mental foramen
Terminal branches in the face become cutaneous nerves in the head
including the face.
V TRIGEMINAL:
GIVES ATTACHMENT TO 4 PARASYMPATHETIC GANGLIA:
• CILIARY GANGLION, ATTACHED TO V1
• PTERYGOPALATINE GANGLION, ATTACHED TO V2
• SUBMANDIBULAR GANGLION, ATTACHED TO V3
• OTIC GANGLION ATTACHED TO V3
Preganglionic fibers for these ganglia come from other cranial
nerves and only the postganglionic fibers are conveyed by v to
the target structures. Trigeminal has no preganglionic
parasympathetic components arising from the brain stem.
MAJOR FUNCTIONS: MOTOR: V3 MUSCLES OF MASTICATION*
Not shown:
Medial & lateral
Pterygoids
Moves jaw
during
chewing/
Mastication;
under
voluntary and
reflex
conditions
* 4 others: Mylohyoid, ant. belly of Digastric, Tensor tympani, Tensor palati
SENSORY
DISTRIBUTION
OF V V1
V2
V3
V TRIGEMINAL:
SENSORY FUNCTIONS
Conveys sensations (touch, pain, pressure etc.)
from skin of the head (face and scalp) and
mucosa of cavities in the head
Responsible for consciously perceived pain
emanating from the head: toothache, headache
and sinus pain
Provides sensory input for for 2 reflexes often
tested during a neurologic examination:
Corneal reflex & Jaw jerk
V TRIGEMINAL
Parasympathetic Functions
Does not contain preganglionic
parasympathetic axons.
Gives attachment to 3 parasympathetic
ganglia.
Helps distribute postganglionic
parasympathetic fibers to lacrimal and two
salivary glands.
V TRIGEMINAL:
NEUROOGICAL EXAM-SENSORY
HAVE THE PATIENT RECOGNIZE TOUCH AND PAIN
FROM THE SKIN TERRITORIES SUPPLIED BY EACH
DIVISION.
COMPARE THE TWO SIDES FOR EQUAL/UNEQUAL
RESPONSES
Cranial Nerve Video # 5
V TRIGEMINAL:
NEUROOGICAL EXAM-SENSORY
CORNEAL REFLEX
• THE PATIENT LOOKS TO ONE SIDE
• THE OPPOSITE CORNEA IS GENTLY
STIMULATED BY A WISP OF COTTON.
• THE NORMAL RESPONSE IS A
BILATERAL CLOSURE OF THE EYES.
• V1 IS THE AFFERENT LIMB OF THE
REFLEX AND THE EFFERENT LIMB IS VII.
Cranial Nerve Video #6
V TRIGEMINAL:
NEUROOGICAL EXAM-MOTOR
Have the patient clench her teeth and
Palpate the contraction of the masseter
And temporalis muscles.
Have the patient move mandible, look for normal
movements without any deviation to either side
V TRIGEMINAL:
NEUROOGICAL EXAM-MOTOR
JAW JERK
• Keep the jaw relaxed and the mouth slightly open
• Tap the chin to stretch the temporalis and masseter
• Jaw closure in response
• Normally weak or absent, exaggerated in some
motor neuron diseases
Cranial Nerve Video # 7
V TRIGEMINAL:
DYSFUNCTIONS
1. Loss of sensations in areas innervated.
2. Loss of corneal reflex when affected eye
is stimulated. Stimulation of the intact eye will result in
a bilateral normal response.
3. Paralysis of muscles of mastication,
resulting in difficulty in chewing, and a
flattening of the side of the face
Neurol Clin. 2004 Feb;22(1):185-206.
Trigeminal neuralgia and glossopharyngeal neuralgia.
Rozen TD.
Related Articles, Links
Michigan Head-Pain and Neurological Institute, 3120 Professional Drive, Ann Arbor,
MI 48104, USA. trozen@[Link]
Trigeminal neuralgia and glossopharyngeal neuralgia are
extremely painful conditions that typically afflict an older
population. Distinct clinical characteristics guide the diagnosis
of these unique syndromes. Treatment involves medication
first and then surgical procedures if a patient is refractory to
medicinal therapy. Antiepileptic medications are the most
effective agents for these disorders.
V TRIGEMINAL:
DYSFUNCTIONS
THE MORE COMMONLY MANIFESTED CONDITIONS ARE:
• HERPES ZOSTER
AFFECTING TRIGEMINAL
GANGLION
• TRIGEMINAL NEURALGIA
