Cranial Nerves

Overview
12 pairs identified by their named and by Roman numerals I-XII
Can have sensory, motor or mixed functions
Numbered from rostral to caudal according to their attachments to the brain
Sensory or motor fibers that innervate muscles or glands
Emerge from foramina or fissures in the cranium and are covered by tubular sheaths from the cranial meninges
Carry one or more of five main functional components
1.
Motor (efferent) fibers to voluntary muscle.
2.
Motor fibers to involuntary muscles or gland
3.
Sensory (afferent) fibers transmitting general sensation from the skin and mucous membranes
4.
Sensory fibers conveying sensation from the viscera
5.
Special sensory (afferent) fibers transmitting unique sensations. Divided into special visceral afferent fibers
conveying taste and smell and those serving the special senses of vision, hearing, and balance called special
somatic afferent fibers.
Fibers of cranial nerves connect centrally to cranial nerves nuclei groups of neurons
in which sensory or afferent fibers terminate and
from which motor or efferent fibers originate
CN I and II arise from the forebrain and are really tracts of the brain for the special senses of smell and sight.
CN III, IV, and VI move the extra-ocular skeletal muscles of the eyeball.
CN V has three divisions: V1 and V2 are sensory, and V3 is both motor to skeletal muscle and sensory.
CN VII, IX and X are both motor and sensory.
CN VIII is the special sense of hearing and balance. CN XI and XII are motor to skeletal muscle.
CN III, VII, IX, and X also contain parasympathetic fibers of origin (visceral), although many of the ANS fibers will
jump onto the branches of CN V to reach their targets.

Olfactory Nerve (CN I)

Cranial Exit: Foramina in cribriform plate of ethmoid bone

Components: Special sensory

Special sensory: Smell from nasal mucosa of roof of each nasal cavity and superior sides of nasal septum and superior
concha

Main distribution: the central processes of the neurons ascend through the cribriform plate to reach the olfactory bulbs in
the anterior cranial fossa. These nerves synapse on neurons in the bulbs, and the processes of these neurons follow the
olfactory tracts to the primary and associated areas of the cerebral cortex
Optic Nerve (CN II)

Cranial Opening: Optic canal

Component: Special sensory

Sensory: vision from retina

Main distribution: nerve fibers exit via the orbit via the optic canals; fibers from the nasal half of the retina cross to the
contralateral side at the optic chiasm. Then the fibers pass via the optic tracts to the geniculate of the thalamus, where they
synapse neurons whose processes form the optic radiations to the primary visual cortex of the occipital lobe

Paired, anterior extensions of the forebrain

CN II is surrounded by extensions of the cranial meninges and subarachnoid space. The meninges extend all the way to the
eyeball

Carries special somatic afferent fibers for vision from the retina to the brain.

Joins the optic nerve from the corresponding eye to form the optic chiasm
Oculomotor Nerve (CN III)

Cranial Opening: Superior orbital fissure

Component: Somatic motor and visceral motor

Location of nerve cell bodies: midbrain for somatic motor, visceral motor: midbrain then ciliary ganglion

Motor to extrinsic muscles of the eye except the superior oblique and lateral rectus muscles, and the superior eyelid

Parasympathetic through ciliary ganglion to sphincter pupillae, which causes constriction of the pupil and ciliary muscle

Main Distribution: These nerves originate from the brainstem, emerging medial to the cerebral peduncles, and run in the
lateral wall of the cavernous sinus.

Enter the orbit through the superior orbital fissures and divide into:
superior branch: supplies superior rectus and levator palpebrae superioris muscle
inferior branch: supplies inferior and medial rectus and inferior oblique.
Trochlear Nerve (CN IV)

Cranial Opening: Superficial Orbital fissure

Components: Somatic motor

Motor to superior oblique muscle of the eye

Smallest cranial nerve

Main distribution: Emerge from the posterior aspect of the brainstem. Run a long intracranial course, passing around the
brainstem to enter the dura mater in the free edge of the tentorium cerebelli close to the posterior clinoid process. Then run
in the lateral wall of the cavernous sinus, entering the orbit via the orbital fissure

Trigeminal Nerve (CN V)

Largest cranial nerve, excluding CN II

Divisions

Distributions

Branches

Ophthalmic nerve (CN V1)

Somatic sensory only

Tentorial nerve (a meningeal

branch)

Passes through superior orbital

fissure
Supplies cornea, upper
conjunctiva, mucosa of anterosuperior nasal cavity, frontal
and ethmoidal sinuses, anterior
and supratentorial dura mater,
skin of dorsum of external
nose, superior eyelid, forehead,
and scalp
Testing CN V1: checking the
corneal reflex touching the
cornea, with a wisp of cotton
will evoke a reflective blink if
the nerve is functional

Maxillary nerve (CN V2)

Lacrimal nerve
Communicating branch from
zygomatic n.
Frontal nerve
Supra-orbital nerve
Supratrochlear nerve
Nasociliary nerve
Sensory root of ciliary ganglion
Short ciliary nerves
Long ciliary nerves
Anterior and posterior
ethmoidal nerves
Infratrochlear nerves

Somatic sensory only

Meningeal branch

Passes through foramen

rotundum

Zygomatic nerve
Zygomaticofacial branch
Zygomaticotemporal branch
Communicating branch to
lacrimal nerve

Supplies dura mater of anterior

part of middle cranial fossa;
conjunctiva of inferior eyelid;
mucosa of postero-inferior
nasal cavity, maxillary sinus,
palate, and anterior part of
superior oral vestibule;
maxillary teeth; and skin of
lateral external nose, inferior
eyelid, anterior cheek, and
upper lip

Ganglionic branches to (sensory

root of) pterygopalatine ganglion
Posterior superior alveolar
branches
Infra-orbital nerve
Anterior and middle superior
alveolar branches
Superior labial branches
Inferior palpebral branches
External nasal branches
Greater palatine nerves
Posterior inferior lateral nasal
nerves
Lesser palatine nerves
Posterior superior lateral nasal
branches
Nasopalatine nerve
Pharyngeal nerve

Mandibular nerve (CN V3)

Somatic sensory and somatic

(branchial) motor
Passes through the foramen
ovale
Supplies sensory innervation to
mucosa of anterior two thirds of
tongue, floor of mouth, and
posterior and anterior inferior
oral vestibule; mandibular
teeth; and skin of lower lip,
buccal, parotid, and temporal
regions of face; and external ear
(auricle, upper external
auditory meatus, and tympanic
membrane)

Somatic sensory branches

Meningeal branch (nervus
spinosum)
Buccal nerve
Auriculotemporal nerve
Lingual nerve
Inferior alveolar nerve
Inferior dental plexus
Mental nerve
Somatic (branchial) motor
branches
Masseteric nerve
Deep Temporal nerves

Supplies motor innervation to

muscles of mastication,
mylohyoid, anterior belly of
digastric, tensor tympani, and
tensor veli palatini

Nerves to medial and lateral

pterygoid
Nerve to mylohyoid (and anterior
belly of digastric m)
Nerve to tensor veli palatine
Nerve to tensor tympani

Abducent Nerve (CN VI)

Cranial Opening: Superior orbital fissure

Components: Somatic motor

Motor to lateral rectus muscle of eye

Main Distribution: originate from the brainstem between the pons and the medulla, pierce the dura mater on the clivus,
transverse the cavernous sinuses and superior orbital fissures, and enter the orbits.
Facial Nerve (CN VII)

Cranial Opening: Internal acoustic meatus; facial canal; stylomastoid foramen

Components: Somatic motor; special sensory visceral motor

Motor: muscles of facial expression and scalp; supplies stapedius of middle ear, stylohyoid, and posterior belly of digastric

Special sensory: taste from anterior two thirds of tongue and palae

Parasympathetic innervation of submandibular and sublingual salivary glands, lacrimal gland, and glands of nose and
palate

Main Distribution: Originate from the posterior border of the pons and runs through the internal acoustic meatus and
facial canal in the petrous part of the temporal bone. Then exits via the stylomastoid foramen; its main trunk forms the
intraparotid nerve plexus.
Vestibulocochlear Nerve (VIII)

Cranial Opening: Internal acoustic meatus

Components: Special sensory

Special sensory for hearing and equilibrium.

Divisions

Vestibular = vestibular sensation from semicircular ducts, utricle, and saccule related to position and
movements of head.

Cochlear = hearing from spiral organ

Main Distribution: originate from the grooves between the pons and medulla. Run through the internal acoustic meatus
and divide into the cochlear and vestibular nerves
Glossopharyngeal Nerve (CN IX)

Cranial Opening: Jugular foramen

Components: somatic motor; visceral motor; visceral sensory; special sensory; somatic sensory

Location of Nerve Cell Bodies: vestibular ganglion

Motor: stylopharyngeus and parotid gland

Sensory:

Taste from posterior third of tongue

General sensation to pharynx, tonsillar sinus, pharyngotympanic tube, middle ear cavity
Main Distribution: Originate form the rostral end of the medulla and exit from the cranium via the jugular foramina. They
pass between the superior and middle pharyngeal constrictors to the tonsillar sinus and enter the posterior third of the
tongue

Vagus Nerve (CN X)

Cranial Opening: Jugular foramen

Components: Somatic motor; visceral motor; visceral sensory; special sensory; somatic sensory

Motor: palate, pharynx, larynx, trachea, bronchial tree, heart, GI tract to left colic flexure

Sensory: pharynx, larynx, reflex sensory from tracheobronchial tree, lungs, heart, GI tract to left colic flexure
Divisions
Cranial
Vagi arise via 8-10rootlets from medulla (includes traditional
cranial root of CN XI)

Branches
Meningeal branch to dura mater (sensory; actual fibers of C2
spinal ganglion neurons that hitch a ride with vagus nerve)
Auricular branch

Cervical
Exit cranium/enter neck through jugular foramen; right and left
vagus nerves enter carotid sheaths and continue to root of neck

Pharyngeal branches to pharyngeal plexus (motor)

Cervical cardiac branches (parasympathetic, visceral afferent)
Superior laryngeal nerve (mixed), internal (sensory) and external
(motor) branches
Right recurrent laryngeal nerve (mixed)

Thoracic
Vagi enter thorax through superior thoracic aperture; left vagus
contributes to anterior esophageal plexus; right vagus to
posterior plexus; form anterior and posterior vagal trunks

Left recurrent laryngeal nerve (mixed); all distal branches convey

parasympathetic and visceral afferent fibers for reflex stimuli)
Thoracic cardiac branches
Pulmonary branches
Esophageal plexus

Abdominal
Anterior and posterior vagal trunks enter abdomen through
esophageal hiatus in diaphragm

Esophageal branches
Gastric branches
Hepatic branches
Celiac branches (from posterior trunk)
Pyloric branch (from anterior trunk)
Renal branches
Intestinal branches (to left colic flexure)

Spinal Accessory Nerve (CN XI)

Cranial Opening: Jugular foramen

Components: Somatic motor

Motor: sternoclenomastoid and trapezius

Main Distribution: Nerves arise as rootlets form the sides of the spinal cord in the superior five or six cervical segments..
They ascend into the cranial cavity via the foramen magnum and exit through the jugular foramina, crossing the lateral
cervical region, where pain and proprioceptive fibers from the cervical plexus join the nerves
Hypoglossal Nerve (CN XII)

Cranial Opening: Hypoglossal canal

Components: Somatic motor
Location of Nerve Cell Bodies: Medulla
Motor: all intrinsic and extrinsic muscles of tongue (excluding palatoglossus, a palatine muscle)
Main Distribution: Arise by several rootlets between the pyramids and the olives of the medulla. Then pass through the
hypoglossal canals and run inferiorly and anteriorly, passing medial to the angles of the mandible between the mylohyoid
and the hyoglossus to reach the muscles of the tongue
Branches

Meningeal branch returns to the cranium through the hypoglossal canal and innervaes the dura mater on the
floor and posterior wall of the posterior canial fossa.

Superior root of the ansa cervicalis supplies the infrahyoid muscles.

Terminal lingual branches supply the styloglossus, hyoglossus, genioglossus, and intrinsic muscles of the
tongue

Summary of Cranial Nerve Lesions

Nerve
CN I
CN II

CN III
CN IV
CN V

Type(s) and or Site(s) of Lesion

Fracture of cribiform plate
Direct trauma to orbit or eyeball; fracture
involving optic canal
Pressure on optic pathway; laceration or
intracerebral clot in temporal, parietal, or
occipital lobes of brain
Pressure from herniating uncus on nerve;
fracture involving cavernous sinus;
aneurysms
Stretching of nerve during its course
around the brainstem; fracture of orbit
Injury to terminal branches (particularly

Abnormal Finding(s)
Anosmia (loss of smell); cerebrospinal
fluid rhinorrhea
Loss of pupillary constriction
Visual fields defects
Dilated pupil; ptosis; eye turns down and
out; pupillary reflex on side of lesion will
be lost
Inability to look down when eye isa
dducted
Loss of pain and touch sensations;

V2) in roof of maxillary sinus;

pathological processes affecting
trigeminal ganglion
CN VI

Base of brain or fracture involving

cavernous sinus or orbit

CN VII

Laceration or contusion in parotid region

Fracture of temporal bone

Intracranial hematoma (stroke)

CN VIII

Tumor of nerve (acoustic neuroma)

CN IX

Brainstem lesion or deep laceration of

neck

CN X

Brainstem lesion or deep laceration of

neck

CN XI

Laceration of neck

CN XII

Neck laceration; fractures of cranial base

paraesthesia; masseter and temporalis

muscles do not contract; deviation of
mandible to side of lesion when mouth is
opened
Eye falls to move laterally; diplopia on
lateral gaze
Paralysis of facial muscles; eye remains
open; angle of mouth droops; forehead
does not wrinkle
As above, plus associated involvement of
cochlear nerve and chorda tympani; dry
cornea; loss of taste on anterior two thirds
of tongue
Forehead wrinkles because of bilateral
innervation of frontalis muscle; otherwise
paralysis of contralateral facial muscles
Progressive unilateral hearing loss;
tinnitus (noises in ear)
Loss of taste on posterior third of tongue;
loss of sensation on affected side of soft
palate
Sagging of soft palate; deviation of uvula
to normal side; hoarseness owing to
paralysis of vocal fold
Paralysis of sternocleidomastoid and
descending fibers of trapezius; drooping
of shoulder
Protruded tongue deviates toward affected
side; moderate dysarthria