Cranial Nerves

Cranial (attach to forebrain + brainstem) and spinal (attach to spinal cord) nerves link CNS to periphery
- Sensory: input from head and neck sensory nucleus in brain (columnar) e.g. trigeminal thalamus (synapse) (3rd order) Cortex
Thalamo-cortico: sensory
- Motor: fibres from motor cortex synapse at motor nucleus of nerve e.g. trigeminal muscles (effector)
Cortico-spinal: motor
Cranial nerve cell bodies are in the medulla

Cranial General Location in relation Foramen Course Sensory , Function

nerve location to brain stem motor or
both
I Olfactory Anterior Above Cribriform Originates in olfactory mucosa (upper part of nasal Sensory Sense of smell
portion of plate cavity), travels up through cribriform plate to surface of
brain (ethmoid) brain. Here, fascicles olfactory bulb (synapse), from
anterior bulb, sensory info brain (via olfactory tract)
fossa
II Optic Anterior Out of the optic Optic Originates in optic disc, then extends to the optic chiasm, Sensory Transmits all visual information including
portion of chiasm, superior to it foramen continues to optic tract to lateral geniculate nucleus, brightness, perception, colour perception and
brain (with pretectal nuclei, and superior colliculus contrast (visual acuity).
ophthalmic Exception for location of soma = all in CNS (1 st order)
artery) Responsible for 2 neuro-reflexes:
1) Light reflex
2) Accommodation reflex

III Anterior Above pons (sides) SOF (with IV, Originates from 3rd nerve nucleus at the level of the Motor AUTONOMIC COMPONENT*
Oculomoto portion of V1, VI and superior colliculus in the mid-brain emerges from brain
r brain ophthalmic and passes between superior cerebellar and posterior Motor innervation to 4 out of 6 extraocular
veins) cerebellar arteries, pierces the dura mater and runs along muscles 2 exceptions (superior oblique
the lateral wall of the cavernous sinus CNIV, lateral rectus CNVI)
Also, supplies levator palpebrae superioris
IV Anterior Very small above pons SOF Arises from trochlear nucleus in brain, runs anteriorly and Motor Innervates the superior oblique muscle of the
Trochlear portion of (slightly to the sides) inferiorly within the subarachnoid space, then pierces the eye
brain dura mater adjacent to the clinoid process of the
Only nerve to exit sphenoid bone, then moves along lateral wall of
posterior side of cavernous sinus and then enters orbit of eye through SOF
brainstem
V Arise in Chunky comes out Originate from 3 sensory nuclei: Both
Trigeminal pons sides of pons, on 1 Mesencephalic
superior aspect 2 Principal sensory
3 Spinal
(these merge to form the sensory root in middle cranial
fossa this expands to form the trigeminal ganglion
[located lateral to cavernous sinus in a depression in the
temporal bone Meckels cave]

+ 1 motor nucleus motor nucleus of trigeminal

 These nuclei extend from the mid brain to the medulla.
Motor root passes inferior to the sensory root, along the
floor of the trigeminal (Meckels) cave.

V1 SOF Terminal branches: frontal, lacrimal and nasociliary Sensory Sensory to: forehead and scalp, frontal and
ethmoidal sinus, upper eyelid and its
Enters face: supraorbital and supratrochlear foraminae conjunctiva, cornea and bridge of nose,
antero-superior nasal cavity (mucosa)

Supraorbital n. front of scalp

Parasympathetic supply: lacrimal gland (from

facial n. after the pterygopalatine ganglion,
with V2 zygomatic branch joining lacrimal
branch of V1)
V2 Foramen 14 branches Sensory Sensory
rotundum incl. superior alveolar n. (upper teeth) Lower eyelid, and its conjunctiva, cheeks and
maxillary sinus, posterior-inferior nasal
Enters face through infraorbital foraminae cavity, upper lip, molar, incisor and canine
teach and superior palate

Parasympathetic supply: lacrimal gland (see

V1)
Nasal glands, post-ganglionic fibres travel
with nasopalatine and greater palatine nerves
(branches of V2)

V3 Foramen Enters the mandibular bone through the mandibular Both Sensory
ovale foramen Temple, mucous membranes and floor of oral
cavity, external ear, lower lip, chin, anterior
4 terminal branches: 2/3 tongue (general), lower molar, incisor and
Buccal, Inferior alveolar Auriculotemporal and lingual canine teeth
nerve NOT angle of jaw (C2)

Enters face (sensory) through mental, auricotemporal Auriculotemporal branch side of scalp
foraminae
Motor: muscles of mastication; medial and
lateral pterygoids, masseter and temporalis.
Anterior belly of digastric and mylohyoid
muscle (suprahyoid muscles). Tensor veli
palantini, tensor tympani

Parasympathetic supply: submandibular and

sublingual glands: post-ganglionic fibres from
submandibular ganglion (also facial n.), travel
with lingual nerve to innervate glands.

VI Arise in Above and sides of 2 SOF Arises from abducens nucleus in pons, exits brainstem at Motor Innervates lateral rectus muscle
Abducens pons pyramids, just below junction of pons and medulla, enters subarachnoid space oculomotion
pons (in front) and pierces the dura mater (This muscle origin in common tendinous
ring, abducts eye, rotates gaze away from
Passes by cavernous sinus at tip of petrous temporal bone midline)
before entering orbit of eye through SOF
VII Facial Arise in More lateral to IAM (with VIIi 2 roots Both Branchial motor (special visceral efferent)
pons abducens on pons and A. Large motor root branches move muscles of facial expression;
(lower aspect) labyrinthine B. Small sensory root posterior belly of digastric muscle; stylohyoid,
a.) - both travel within temporal bone and leave the IAM to and stapedius
enter facial canal, exits this canal via the stylomastoid Visceral motor (general visceral efferent):
foramen (except 1/2 of the visceral motor branches) parasympathetic innervation of lacrimal,
submandibular, and sublingual glands, as
Branchial motor branches: well as mucous membranes of nasopharynx,
1Temporal hard and soft palate.
2 Zygomatic Special sensory (special afferent): taste
3 Buccal sensation to anterior 2/3 tongue; hard and
4 Mandibular soft palates
5 Cervical General sensory (general somatic afferent):
skin of concha, of the auricle and from a
General sensory branch: posterior auricular branch small area behind the ear

Terminal branches in parotid gland ** For upper muscles of fascial expression:

temporal and zygomatic there is bilateral
control: so, motor neurones coming from both
hemispheres

For the lower muscles of facial expression,

contralateral control just motor neurones in
cortex from opposite hemisphere

Therefore, lesion at Stylomastoid foramen:

will affect all muscle
Whereas, an upper motor neuron lesion
spares the muscles at the top (due to
bilateral control)

Bells Palsy: lower motor neurone lesion

paralysis of muscles on one side of face due
to swelling of VII develops over a few days
and can slowly improve in 1-3 months.
(Adults 40s)

AUTONOMIC COMPONENT*
VIII Arise in Just behind facial nerve IAM Vestibular component: arises from the vestibular nuclei Sensory Vestibular part: vestibular system of inner ear
Vestibuloc inner ear complex in pons and medulla responsible for detecting balance
ochlear and goes to
the pons Cochlear part: travels to cochlea of inner ear
Cochlear component: arises from ventral and dorsal
forms spiral ganglia sense of hearing
cochlear nuclei, situated in inferior cerebellar peduncle

Both sets of fibres combine in pons, split again in distal

IAM
IX Attached to Below pons, on Jugular Originates in medulla oblongata emerges from anterior Both Sensory: oropharynx, carotid body + sinus,
Glossopha medulla medulla behind olive foramen aspect of medulla, moving laterally in posterior cranial post. 1/3 tongue, mid ear cavity, Eustachian
ryngeal oblongata (with X and fossa. Extracranially, this nerve descends down neck, tube
XI, inferior anterolateral to ICA and enters pharynx by passing
petrosal between the superior and middle pharyngeal constrictors Special sensory: provides taste sensation to
sinus, Terminates in the pharynx by dividing into: posterior 1/3 tongue
 sigmoid 1 Lingual
sinus) 2 Tonsil Parasympathetic: parotid
3 Pharyngeal
Motor: innervates stylopharyngeus muscle of
3 ganglia pharynx
A Superior
B inferior AUTONOMIC COMPONENT*
C Otic

X Vagus Attached to Below the Jugular Originates from medulla of brain stem exits cranium via Both Sensory somatic and visceral
medulla glossopharyngeal foramen jugular foramen Motor muscles in the pharynx and larynx
oblongata posterior of medulla Parasympathetic heart and GIT
Neck with IJV and CC in carotid sheath
Base of neck splits into Carries sensory information about BP in brain
A) Right Anterior to SA, posterior to sternoclavicular with glossopharyngeal
joint Taste: with facial and glossopharyngeal
B) Left inferior between LCC and LSA, posterior to SC
joint AUTONOMIC COMPONENT*

3 branches at neck
1 Pharyngeal
2 Superior laryngeal
Internal larynx above vocal cords, laryngopharynx
sensory
External cricothyroid (larynx) muscle
3 Recurrent laryngeal larynx below vocal cords, and R
only

Thorax oesophageal plexus, enters abdomen via R crus

(hiatus)
Abdomen terminates to supply viscera
XI Attached to Below the vagus nerve Jugular Spinal part from C1 C5/6 Motor Supplies
Accessory medulla posterior of medulla foramen Descends along ICA to SCM muscle which it innervates - Sternocleidomastoid runs from
oblongata many fibres in straight moves along posterior triangle of neck to supply trapezius mastoid process of temporal bone to
line down manubrium and medial 1/3 of
clavicle
Cranial part lateral aspect of medulla Lateral flexion and rotation of neck,
Combines with vagus, distributed supply soft palate + unilateral extends neck
pharyngeal muscles - Trapezius runs from base of skull to
spinous processes of C7-T12, lateral
1/3 of clavicle and acromion
Upper elevate scapula and rotate
during abduction
Mid-retraction
Lower pull scapular inf.
XII Attached to Between olive and Hypo- glossal Arises from hypoglossal nucleus in medulla, passes Motor Supplies all muscles of tongue, except
Hypogloss medulla pyramid on anterior foramen laterally across posterior cranial fossa within palatoglossus, (innervated by vagus) has
al oblongata part of medulla subarachnoid space, passes inferior to angle of mandible, C1/C2 contributions that travel in same
(anterior to olive, crossing internal and external CAs moves in anterior sheath and branch to Geniohyoid and
posterior to pyramid) direction to enter tongue thyrohyoid

*These 4 cranial nerves (III, VII, IX, X), Autonomic component carry cranial part of craniosacral autonomic/parasympathetic outflow from the CNS
Parasympathetic pathways:
A) Cranial outflow: CN III, VII, IX, X 4 ganglia in head
1. Ciliary ganglion oculomotor nerve (III)
2. Pterygopalatine ganglion facial nerve (VII)
3. Submandibular ganglion facial nerve (VII)
4. Otic ganglion glossopharyngeal nerve (IX)
The vagus nerve (CN X) is major preganglionic parasympathetic supply to thorax and abdomen, synapses in ganglia within the wall of the target organs (e.g. enteric plexus of GI tract)

B) Sacral outflow
- S2-S4 via pelvic splanchnics
- Hindgut, pelvic viscera, and external genitalia

Sensory: input from head and neck sensory nucleus in the brain (columnar) e.g. trigeminal nucleus (2nd order) thalamus (3rd order) cortex
Motor: fibres from motor cortex synapse at motor nucleus of nerve e.g. trigeminal nucleus muscles (effector)
- For somatic skeletomotor
- For autonomic (visceral) pre and post ganglionic
Afferents (sensory): 2nd order nuclei in CNS and 1st order out
Efferents (motor): skeletomotor to somatic or pre + post ganglionic to autonomic (visceral)
All 2nd order (nuclei) in CNS except trigeminal mesencephalic (1 st order in CNS) and optic nerve & retina all in CNS