Transcript Slide 1
CN I Olfactory 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 Retina Special Sensory Lateral Geniculate Bodies Pituitary Papilledema – Moore, 1090 Optic Neuritis – Moore, 1090 Visual Field Defects – Moore, 1090 Optic Canals Optic Chiasm 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 Accessory Oculomotor (Edinger-Westphal) Nucleus Dilator Pupillae Ciliary Ganglion Ciliary Muscle Oculomotor Nucleus 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 Short Ciliary Nerves Sphincter Pupillae Medial Rectus Inferior Rectus Inferior Oblique CN IV Trochlear Motor Trochlear Nucleus Superior Oblique (Eye – Down and Out) Trochlear Nerve Injury (Rarely alone) - Diplopia LR6SO4 CN VI Abducent Motor Abducent Nucleus Abducent Nerve Injury - Long intercranial course - Stretched due to fluid pressure - Paralysis - Diplopia – except opposite side of lesion or Aneurism of “Willis” or Septic Thrombosis of Cavernous Sinus Lateral Rectus Supraorbital Foramen CN V Trigeminal V1 Opthalmic Lateral Scalp Forehead Frontal Sinus Internal Upper Eyelid Supraorbital N. Sensory Frontal Nerve Supratrochlear N. Meningeal Medial Scalp Forehead Medial Upper Eyelid Lacrimal Gland Skin Conjunctiva Lacrimal Nerve Nasociliary Nerve Trigeminal Ganglion Infratrochlear Post. Ethmoidal Foramen Ant. Ethmoidal Nerve Post. Ethmoidal Nerve Ethmoidal Air Cells Nasal Cavity Ant. 1/3 Nasal Septum Lat. Nasal Wall External Nasal Branch Iris, Cornea Sphenoid Sinus Post. Ethmoidal Air Cells Lateral Internal Nasal Eyeball Ant. Ethmoidal Foramen Medial Internal Nasal Short Ciliary Nerves Long Ciliary Nerve Ciliary Ganglion Sup. Ext. Nasal Wall Medial Eyelids Conjunctiva Lacrimal Sac Tip of Nose Lacrimal Nerve (v1) Lacrimal Gland CN V Trigeminal V2 Maxillary Zygomaticotemporal Foramen Temporal Fossa Sensory Zygomaticotemporal N. Parasympathetic dashed = preganglionic solid = postganglionic Sympathetic Zygomatic N. Zygomaticofacial Foramen Zygomatic Arch Zygomaticofacial N. Inferior Orbital Fissure Meningeal Infraorbital Foramen Upper Lip Medial Cheek Side of Nose Infraorbital Nerve Trigeminal Ganglion Post., Mid., & Ant. Superior Alveolar N. Upper Teeth Maxillary Sinus Greater Petrosal N. (from CN VII) Vidian N. Of Pterygoid Canal PterygoPalatine Ganglion Pharyngeal Branch Soft Palate Roof of Pharynx Sphenoid Sinus Greater Palatine Foramen Sensory to posterior 2/3 lateral nasal wall Nasal Concha Ethmoidal Air Cells Hard Palate Nasopalatine Nerve Lesser Palatine Foramen Sphenopalatine Foramen Greater Palatine N. Deep Petrosal N. (from Internal Carotid Plexus) Sensory to posterior 2/3 nasal septum Incisive Canal Sensory CN V Trigeminal V3 Mandibular Special Sensory Parasympathetic: dashed = preganglionic solid = postganglionic Motor Meningeal Trigeminal Ganglion Foramen Ovale Foramen Spinosum Lesser Petrosal Nerve (IX) Auricle Scalp Lateral Face Middle Meningeal Artery Muscles of Mastication Medial Pterygoid Lateral Pterygoid Temporalis Masseter ---------------------------------Tensor Veli Palatini Muscle Tensor Tympani Muscle Otic Ganglion Parotid Gland (Parasympathetics from CN IX) Buccal Nerve Skin over Buccinator Cheek Mucosa Gums Lingual Nerve VII Anterior 2/3 Tongue Chorda Tympani Submandibular Ganglion Submandibular Gland Sublingual Gland Mandibular Foramen Inferior Alveolar Nerve Lower Teeth Gums Lower Lip Mental Foramen Mental N. Mylohyoid Anterior Digastric Chin CN VII Facial Special Sensory Parasympathetic: dashed = preganglionic solid = postganglionic Motor Sympathetic Internal Acoustic Meatus Pterygoid Canal Containing Vidian Nerve Via V2 PterygoPalatine Ganglion Greater Petrosal N. Geniculate Ganglion Deep Petrosal Nerve Internal Carotid Plexus Motor Nucleus of Facial Nerve Lacrimal Gland Hiatus of Greater Petrosal 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 Auricular Muscles Submandibular & Sublingual Glands Stylomastoid Foramen Occipitalis Muscle Temporal Occiptial Branch Posterior Auricular Nerve Parotid Gland Zygomatic Buccal Mandibular Stylohyoid Posterior Digastric Cervical Post. Auricular Muscles Of Facial Expression (Including Buccinator & Platysma) CN VIII Vestibulocochlear Special Sensory Internal Acoustic Meatus Vestibular Nuclei Hearing Cochlear Ganglion Cochlea Balance Vestibular Ganglion Cochlear Nuclei Vestibular Apparatus 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 Inferior Salivatory Nucleus Motor Superior Glossopharyngeal Ganglion Jugular Foramen Internal Carotid Artery Inferior Glossopharyngeal Ganglion Tympanic Nerve Lesser Petrosal N. Otic Ganglion Parotid Gland Tympanic Plexus Solitary Tract Nucleus Pharyngotympanic tube & Pharyngeal Opening Nucleus Ambiguus Stylopharyngeus Pharyngeal Branch Pharynx Tonsillar Branch Palatine Tonsil Lingual Branch Carotid Branch Carotid Body Carotid Sinus Taste & Sensation of Posterior 1/3 of Tongue 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 CN X Vagus External Acoustic Meatus Sensory Parasympathetic 3 2 Motor Jugular Foramen 1 Superior & Inferior Ganglia of Vagus Nerve 1) Posterior Nucleus of Vagus (Parasympathetic) 2) Solitary Tract Nucleus (Visceral Afferents) Pharyngeal Branch 3) Nucleus Ambiguus (Motor to Pharyngeal & Laryngeal Muscles) Superior Laryngeal N. All Pharyngeal Muscles (except Stylopharyngeus – IX) All Palate Muscles (except Tensor Veli Palatini – V3) Internal Branch Sensory Above Vocal Cords Parasympathetic 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) CN XI Spinal Accesory Motor Sensory (Proprioceptive) Jugular Foramen Nucleus Ambiguus Injury During Special Procedures Lesions - Weakness and atrophy - Impairment of opposite side rotary movements (SCM) & shrugging movements - Scapular winging during shoulder abduction Foramen Magnum Sternocleidomastoid C1 C2 Trapezius C3 C4 CN XII Hypoglossal Motor Hypoglossal Canal Hypoglossal nucleus All Glossus Muscles (except Palatoglossus - X) C1 C2