Sensory and Motor Cranial Nerves

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The cranial nerves can be organized into purely sensory, mainly motor, and mixed nerves based on their functions. The purely sensory nerves carry only special sensory information. The mainly motor nerves carry efferent impulses to skeletal muscles. The mixed nerves contain a mixture of sensory and motor fibers.

The purely sensory cranial nerves are the olfactory nerve (I), optic nerve (II), and vestibulocochlear nerve (VIII).

The mainly motor cranial nerves are the oculomotor nerve (III), trochlear nerve (IV), abducens nerve (VI), spinal accessory nerve (XI), and hypoglossal nerve (XII).

Investigation of cranial nerves:

Cranial nerve Investigation Symptoms of paresis


Oculomotor nerve(III) Put the hammer infront of the eyes and Strabismus, divergence and
move it up, down and sideways. Check midriasis is observed in case of
the movement of the eye. damage.
Trochlear nerve(IV) The patient is asked to look straight. The If there are any lesion, double
hammer is placed at his feet. The images is seen by the person.
patient is asked to look at the hammer. Strabismus, convergence is
observed.
Trigeminal nerve(V) Place both hands at the side of the face. In unilateral lesion, the jaw
Ask the patient to open and close the deviates to the affected side.
mouth, make a side to side movement There is hypotonus of the muscle
of the mouth, to move the mouth to and on the affected side.
fro. Observe the tonicity of the muscle
and symmetrical movement.
Abducens nerve(VI) The hammer or finger is moved side to If any lesions, strabismus and
side infront of the patient. convergence is observed.
Facial nerve(VII) For upper mimic muscle:
Ask the patient to contract his
eyebrows. Watch the arc formation.
Then try to contract the brows and
watch its medial approach.
For lower mimic muscle:
Ask the patient to mimic and show his
teeth without opening the mouth.
Observe the mouth angles.
Glossopharyngeal(IX) and 1.Ask the patient to close eyes and then 1.If there are some lesions, then
vagus(X) open the mouth. Pull the tongue tongue moves to the healthy side
forward and tell “AAA”. and soft palate movement is
Observe soft palate, uvula and tongue. restricted and hanging on
Normal: they will be symmetrical and affected side.
tongue will be on midline.
2. ask the patient to tell some
sentences. 2.if there are any lesion, his
3. ask the patient to drink some water. speech will appear to be nasal
speech.
3. if there are any lesion there
will be pain and dysphagia.
Accessory(XI) and Ask the patient to pull the tongue If any lesion, then the tongue
hypoglossal nerve(XII) forward. shift/deviate to the affected side.
In peripheral paralysis atrophy of
affected tongue leads to
dysarthria.
Organizing the Cranial Nerves by Function

Sensory cranial nerves

Some cranial nerves have a purely sensory function = they carry only special sensory
information (sense of smell, visual information, or hearing and balance information). The purely
sensory cranial nerves are:

Olfactory nerve (I)


Optic nerve (II)
Vestibulocochlear nerve (VIII)

Motor cranial nerves

Some cranial nerves are mainly motor nerves. When we say “mainly” motor – we mean that
most of the fibers within these nerves carry efferent impulses to skeletal muscles in the head and
neck.

NOTE: It should be understood that since these nerves serve skeletal muscles they probably also
contain some afferent fibers that carry proprioception = information about muscle stretch from
muscle spindles (yes – sorry – must return now to histology and physiology!). We will not
belabor this point any further – suffice it to say that any cranial nerve that supplies skeletal
muscles probably also contains some afferent proprioceptor fibers too. The mainly motor
cranial nerves are:

Oculomotor nerve (III)


Trochlear nerve (IV)
Abducens nerve (VI)
Spinal accessory nerve (XI)
Hypoglossal nerve (XII)

Mixed cranial nerves

The remaining four cranial nerves are mixed cranial nerves – meaning they contain a mixture of
sensory and motor nerve fibers. These nerves are the most complex and will demand much of
your attention when you study the cranial nerves. Mixed cranial nerves often carry mixtures of
efferent fibers that innervate skeletal or smooth muscles and afferent fibers that relay general
somatic or visceral information from skin, mucous membranes, or viscera, and perhaps special
visceral information from taste buds. The mixed cranial nerves are:

Trigeminal nerve (V)


Facial nerve (VII)
Glossopharyngeal nerve (IX)
Vagus nerve (X)
Here’s a graphic presentation of the cranial nerves organized by function:

Purely sensory Mainly motor Mixed

I III V

II IV VII

VIII VI IX

XI X

XII

Sensory ganglia of cranial nerves have special names:

Cranial nerve Sensory ganglion

Trigeminal nerve (V) Trigeminal ganglion (aka = semilunar


ganglion; Gasserian ganglion).

Geniculate ganglion.
Facial nerve (VII)

Cochlear ganglion (aka = spiral ganglion).


Vestibulocochlear nerve (VIII)
Vestibular ganglion (aka = Scarpa’s
ganglion).

Glossopharyngeal nerve (IX) Superior ganglion of IX (aka = jugular


ganglion of IX) and inferior ganglion of IX
(aka = petrous ganglion).

Vagus nerve (X) Superior ganglion of X (aka = jugular


ganglion of X) and inferior ganglion of X
(aka = nodose ganglion)

Parasympathetic ganglia associated with cranial nerves


Recall that another name for the parasympathetic division of the ANS was “craniosacral
outflow”. Preganglionic parasympathetic neurons whose cell bodies are in the brainstem have
axons that “flow out” of the brainstem in cranial nerves III, VII, IX and X. These preganglionic
fibers synapse on postganglionic neuron cells bodies located in parasympathetic ganglia in the
head. These ganglia have special names too:

Ciliary ganglion  preganglionic fibers associated with CN III synapse on neurons in the
ciliary ganglion.

Pterygopalatine ganglion (aka = sphenopalatine ganglion)  preganglionic fibers


associated with CN VII synapse on neurons in the pterygopalatine ganglion.

Submandibular ganglion  preganglionic fibers associated with CN VII synapse on


neurons in the submandibular ganglion.

Otic ganglion  preganglionic fibers associated with CN IX synapse on neurons in the otic
ganglion.

Note that preganglionic parasympathetic fibers carried in cranial nerve VII synapse on two
different parasympathetic ganglia in the head.

What about cranial nerve X (vagus)? Recall from the trunk course that preganglionic
parasympathetic neurons whose fibers course in the vagus nerves synapse on intramural ganglia
= parasympathetic ganglia in or near the walls of the target organs.

Sympathetic ganglia and cranial nerves

Recall that the sympathetic trunks extend from the base of the skull to the tip of the coccyx. The
trunks are composed of interconnected cervical, thoracic, lumbar, sacral and coccygeal chain
ganglia. Since visceral structures in the head and neck (smooth muscle, sweat glands) require
sympathetic innervation it is not surprising that most cranial nerves carry postganglionic
sympathetic fibers to their target tissues. However, the rule of thumb is that postganglionic
sympathetic fibers first form plexuses around the major arteries supplying the head and neck.
The arteries and associated plexuses form the “highways” by which sympathetic fibers reach
regions of the head and neck – then from the highways sympathetic fibers “hitch-a-ride” on
cranial nerve branches to their ultimate destinations. For example, since the trigeminal nerve
(cranial nerve V) supplies most of the skin of the face, postganglionic sympathetic fibers reach
regions of the face along branches of V.

Here’s a general schematic of the pathway:

Superior cervical ganglion  sympathetic plexuses on the carotid arteries 


cranial nerves and/or their branches  smooth muscle (blood vessels and arrector pili
muscles) and sweat glands of head and neck.

Cranial nerve I = Olfactory nerve.


Overview:

Function: -- Sensory.

Functional components: -- Special sensory fibers transmit smell.

NOTE the difference


between olfactory NERVE &
olfactory TRACT

Cranial nerve II = Optic nerve

Overview:

Function: -- Sensory.

Functional components: -- Special sensory fibers transmit vision.

Optic chiasma
Optic
Optic nerve (fibers from medial
tract
retinas cross over)

Olfactory nerves = bundles of


Optic canal
bipolar neurons with cell bodies
in the olfactory epithelium.

Thalamus
Ganglion cell
axons from
retina form

Cranial nerve III = Oculomotor nerve

Overview:

Function: -- Mainly motor.


Functional components: -- Skeletal motor.

-- Proprioception (afferents) from skeletal muscles.

-- Parasympathetic: smooth muscle in eye.

Skeletal motor component of III

The motor nucleus of III is in the midbrain. CN III emerges from the anterior surface of the
midbrain near its junction with the pons and passes anteriorly between the posterior cerebral
and superior cerebellar arteries. It then pierces the dura mater and passes through the
cavernous sinus (where it is bathed by venous blood!). As it leaves the cavernous sinus it divides
into a superior and an inferior division. The divisions then pass through the superior orbital
fissure and enter the orbit.

The superior division supplies the levator palpebrae superioris and the superior rectus muscles.
The inferior division supplies the medial rectus, inferior rectus, and inferior oblique muscles.

Parasympathetic component of III

Preganglionic parasympathetic neuron cell bodies are in the nucleus of Edinger-Westphal in the
midbrain. Preganglionic fibers follow the oculomotor nerve - then the inferior division - to
synapse in the ciliary ganglion within the orbit. Postganglionic fibers reach the eyeball through
the short ciliary nerves. These fibers cause contraction of smooth muscle in the ciliary muscle
(producing accommodation = shaping the lens so that objects nearby come into focus) and
stimulating smooth muscle in the constrictor pupillae (producing constriction of pupils so less
light enters the eye).

Cranial nerve IV = Trochlear nerve

Overview: Function: -- Mainly motor.

Functional components: -- Skeletal motor.

-- Proprioception (afferents) from skeletal muscle.

Cranial nerve IV supplies one extrinsic eye muscle = the superior oblique muscle. This nerve is
named because of the trochlea - a pulley-like structure made of cartilage in the upper medial
part of the orbit – through which the muscle tendon passes.

Skeletal motor component of IV

The motor nucleus of IV is in the midbrain. The motor fibers of IV decussate (cross) within the
midbrain then exit from the posterior surface of the midbrain below the inferior colliculus. The
nerve is very longer and slender – it winds around the midbrain and like CN III it passes
between the posterior cerebral and superior cerebellar arteries then traverses the cavernous
sinus. It enters the orbit through the superior orbital fissure and penetrates the superior surface
of the superior oblique muscle.

Cool factoid: The trochlear nerve is the ONLY motor nerve – cranial or spinal – that arises
from the posterior aspect of the central nervous system.

Cranial nerve V = Trigeminal nerve

Overview: Function: -- Mixed.

Functional components: -- General sensory: skin and mucous membranes.

-- Skeletal motor.

-- Proprioception (afferents) from skeletal muscles.

Cranial nerve V is large and complex. It is the major sensory nerve of the head. CN V emerges
from the lateral pons as two independent roots = a large sensory root (aka = portio major) and a
smaller motor root (aka = portio minor).

General sensory component of V

Central processes of pseudo-unipolar neurons make up the sensory root of V and these enter the
pons (similar to a posterior root of a spinal nerve entering the spinal cord) to relay on several
sensory nuclei in the brainstem (you will learn about these in your neuro class). CN V is sensory
to the face, teeth, anterior tongue, oral cavity, and nasal cavity.

Skeletal motor component of V

The motor nucleus of V is located in the pons. Axons of these neurons leave the pons just
anterior to the sensory root. CN V is motor to the muscles of mastication (chewing muscles) =
masseter, temporalis, and the medial and lateral pterygoid muscles (and a few other muscles to
be named later).

he cranial cavity, the upper teeth and gums, mucosa in the oral cavity and on the palate, the
maxillary air sinus, and skin of the upper cheek, side of the nose, lower eyelid, upper lip, and the
“temple” area on the side of the head. V2 is attached to the lateral wall of the cavernous sinus,
then passes through foramen rotundum to enter the pterygopalatine fossa. Within the
pterygopalatine fossa many branches of V2 are given off, most notably the zygomatic and infra-
orbital nerves (much more discussion of V2 and its branches will occur later in the course). Both
the zygomatic and infra-orbital nerves enter the orbit from the pterygopalatine fossa through
the inferior orbital fissure – more on this later.

V1 (ophthalmic nerve) is a sensory nerve that supplies the eyeball, conjunctiva, some of
the nasal mucosa, the frontal air sinus, and skin of the external nose, upper eyelid, forehead and
anterior scalp. It passes anteriorly in the lateral wall of the cavernous sinus and enters the orbit
through the superior orbital fissure. Near the superior orbital fissure V1 divides into the frontal,
nasociliary, and lacrimal nerves. We will discuss these nerves in detail when the orbit is
presented.
Parasympathetic fibers associated with V2

Within the pterygopalatine fossa V2 is connected to the pterygopalatine ganglion = a


parasympathetic ganglion. Preganglionic parasympathetic fibers derived from the facial nerve
(VII) synapse here. Postganglionic parasympathetic fibers “hitch-a-ride” on branches of V2 into
the orbit (within the orbit they then jump onto a branch of V1) where they innervate the lacrimal
gland, located in the upper lateral portion of the orbit. These secretomotor fibers cause the
lacrimal gland to secrete tears.

V3 (mandibular nerve) arises from the trigeminal ganglion and together with the motor root
of V passes through foramen ovale to the infratemporal fossa. Just inferior to foramen ovale V3
is joined by the motor root. V3 is therefore a mixed nerve. Within the infratemporal fossa V3
divides into many large nerves such as the auriculotemporal, lingual and inferior alveolar nerves
(the IT fossa will be discussed in a separate lecture).

Cranial nerve VI = Abducens nerve (aka = Abducent nerve)

Overview: Function: -- Mainly motor.

Functional components: -- Skeletal motor.

-- Proprioception (afferents) from skeletal muscle.

Cranial nerve VI supplies one extrinsic eye muscle = the lateral rectus muscle. When this muscle
contracts, the eye swivels laterally and the gaze is directed away from the midline. CN VI is
named from its role in abduction of the eye.

Motor component of VI

The motor nucleus of CN VI is in the lower pons. CN VI leaves the brainstem at the junction of
the pons and medulla. It passes superiorly and penetrates the dura, then bends sharply forward
– almost at a right angle – across the petrous part of the temporal bone to enter the cavernous
sinus. It runs within the center of the sinus alongside the internal carotid artery. It enters the
orbit through the superior orbital fissure. CN VI enters the medial surface of the lateral rectus
muscle.

Cranial nerve VI = Abducens nerve (aka = Abducent nerve)

Overview: Function: -- Mainly motor.

Functional components: -- Skeletal motor.

-- Proprioception (afferents) from skeletal muscle.


Cranial nerve VI supplies one extrinsic eye muscle = the lateral rectus muscle. When this muscle
contracts, the eye swivels laterally and the gaze is directed away from the midline. CN VI is
named from its role in abduction of the eye.

Motor component of VI

The motor nucleus of CN VI is in the lower pons. CN VI leaves the brainstem at the junction of
the pons and medulla. It passes superiorly and penetrates the dura, then bends sharply forward
– almost at a right angle – across the petrous part of the temporal bone to enter the cavernous
sinus. It runs within the center of the sinus alongside the internal carotid artery. It enters the
orbit through the superior orbital fissure. CN VI enters the medial surface of the lateral rectus
muscle.

Cranial nerve VII = Facial nerve

Overview: Function: -- Mixed.

Functional components:

-- Skeletal motor.

-- Proprioception (afferents) from skeletal muscles.

-- General sensory: skin.

-- Parasympathetic: secretomotor.

-- Taste.

Cranial nerve VII is a mixed nerve with a complicated course within the temporal bone. CN VII
leaves the lower border of the pons just lateral to CN VI. The facial nerve leaves the pons in two
pieces: a larger part called the motor root of VII and a smaller portion called the nervus
intermedius (so called because of its intermediate position between the motor root of VII and
CN VIII).

Nervus intermedius

The nervus intermedius contains 1) sensory fibers from a small region of skin of the external ear,
2) parasympathetic secretomotor fibers for the lacrimal gland and salivary glands
(submandibular and sublingual), and 3) taste fibers from the anterior two-thirds of the tongue.

There are three branches of the facial nerve given off within the facial canal:

The greater petrosal nerve leaves CN VII at the genu. It passes through the petrous temporal
bone and then enters the floor of the middle cranial fossa. Here it dives down through the
foramen lacerum, passes through the pterygoid canal, and ultimately enters the pterygopalatine
fossa (PP fossa – heh heh!). WHOA! This is complex stuff and we will cover this again later in
the course. The greater petrosal nerve carries preganglionic parasympathetic fibers of VII to the
pterygopalatine ganglion in the PP fossa. These fibers supply the lacrimal gland and mucous
glands in the nasal cavities and palate.

The nerve to the stapedius leaves the facial canal, passes through the temporal bone, and
supplies the stapedius muscle – which is in a bony canal adjacent to the middle ear cavity. More
on the stapedius muscle when we discuss the ear.

The chorda tympani nerve leaves the facial nerve at the distal end of the facial canal and
passes superiorly into the substance of the temporal bone via a bony canal. The chorda tympani
enters the tympanic cavity (middle ear cavity), crosses the medial surface of the eardrum
(tympanic membrane), then passes through another bony canal to enter the infratemporal fossa.
Here chorda tympani joins the lingual nerve of V3. The chorda tympani carries:

Taste fibers from the anterior two-thirds of the tongue. Cell bodies of these neurons
are in the geniculate ganglion.

Preganglionic parasympathetic fibers – these leave chorda tympani to “hitch-a-ride”


on the lingual nerve to the submandibular ganglion where they synapse. Postganglionic
fibers supply the submandibular and sublingual salivary glands.

Summary: Course of the facial nerve

Pons  Posterior cranial fossa  internal acoustic meatus  facial canal in the temporal bone
 parotid gland  face.

Cranial nerve VIII = Vestibulocochlear nerve

Overview: Function: -- Sensory.

Functional components: -- Special sensory fibers transmit hearing and balance.

CN VIII leaves the brainstem at the junction of the pons and medulla – posterior to the facial
nerve. It contains afferent fibers from the inner ear: from the cochlea (hearing) and from the
utricle, saccule, and semicircular ducts = organs that contain receptors for balance and
equilibrium.

CN VIII enters the internal acoustic meatus along with the facial nerve. Two sets up fibers make
up CN VIII and these fibers are kept separate throughout.

Vestibular part of CN VIII (also called the vestibular nerve). This part consists of bipolar
neurons. The cell bodies of these neurons are in the vestibular ganglion which is situated in the
internal acoustic meatus. The peripheral processes of the bipolar neurons penetrate the
temporal bone to be distributed to receptors in the utricle, saccule and semicircular ducts. The
central processes of the neurons enter the brainstem and synapse on vestibular nuclei at the
junction of the pons and medulla.
Cochlear part of CN VIII (also called the cochlear nerve). This part also consists of bipolar
neurons whose cell bodies are in the spiral ganglion which is lodged in the bony central core of
the cochlea in the inner ear. The peripheral processes of these neurons are distributed to hair
cells in the spiral organ (of Corti) in the cochlea. Central processes of neurons enter the
brainstem and synapse on cochlear nuclei in the medulla.

We will not be discussing the inner ear much in this course, but you should be familiar with the
terms cochlea, utricle, saccule, and semicircular ducts and be aware that special receptor cells
for hearing and balance are located within these structures.

Cranial nerve IX = Glossopharyngeal nerve

Overview: Function: -- Mixed.

Functional components:

-- Skeletal motor.

-- Proprioception (afferents) from one skeletal muscle.

-- General sensory: mucous membranes.

-- Visceral sensory: blood pressure and chemoreceptors.

-- Parasympathetic: secretomotor.

-- Taste.

Branches of CN IX:

Tympanic nerve (Jacobsen’s nerve) – arises from the inferior ganglion of IX and
passes superiorly into the tympanic cavity through a tympanic canaliculus. The tympanic
nerve carries sensory fibers from mucosa in the tympanic cavity and preganglionic
parasympathetic fibers that will innervate the parotid. In the tympanic cavity the
tympanic nerve contributes fibers to the tympanic plexus (more on this when we discuss
the ear). Some of the fibers of the tympanic nerve will reunite distal to the tympanic
plexus to form the lesser petrosal nerve = these contain preganglionic parasympathetic
fibers. The lesser petrosal nerve leaves the tympanic cavity, enters the middle cranial
fossa, then drops down into the infratemporal fossa through foramen ovale. Here
preganglionic fibers synapse on neurons in the otic ganglion. We will get back to this
later– don’t stress!

Carotid branch – supplies the carotid sinus and carotid body. Nuff said.

Pharyngeal branches – these become part of the pharyngeal plexus of nerves.


Pharyngeal branches of IX are sensory to the mucous membranes of the oropharynx,
nasopharynx, and pharyngotympanic (auditory) tube.
Motor branch to stylopharyngeus.

Tonsillar branches – sensory to mucosa of the fauces and palatine tonsils.

Lingual branches – taste and general sensation to posterior 1/3 of tongue.

Cranial nerve X = Vagus nerve

Overview: Function: -- Mixed.

Functional components:

-- Skeletal motor.

-- Proprioception (afferents) from skeletal muscles.

-- General sensory: skin.

-- General sensory: mucous membranes.

-- Visceral sensory: viscera and baro/chemoreceptors.

-- Parasympathetic: visceral motor and secretomotor.

-- Taste.

Branches of the CN X:

Meningeal branch = arises from the superior ganglion of X and supplies meninges in
the posterior cranial fossa.

Auricular branch = arises from the superior ganglion of X and passes through a
fissure in the skull to reach the external ear where it supplies the concha of the ear and
external acoustic meatus. Cool factoid: cleaning your external meatus can produce a
coughing fit – this a vagal reflex – the afferent limb of this reflex is transmitted through
the auricular branch of X.

Pharyngeal branches of X = arise from the inferior ganglion of X. These are motor
branches that join the pharyngeal branches of IX (sensory) to form the pharyngeal
plexus. Pharyngeal branches of X innervate muscles of the soft palate and pharynx.

Superior laryngeal nerves = arises from the inferior ganglion of X and later divides
into internal and external branches. The superior laryngeal is mainly a sensory nerve
(with one exception) to the superior larynx and laryngopharynx. More on this when we
discuss the larynx.

Cardiac branches = you know about these – they branch from the vagi in the neck and
descend into the thorax where they join the cardiac plexus. What is their function?

Recurrent laryngeal nerves = Nuff said – you know the story on these. They innervate
all the intrinsic muscles of the larynx (except one) and supply the mucosa of the inferior
larynx.

Cranial nerve XI = Spinal accessory nerve

Overview: Function: -- Motor.

Functional components: -- Skeletal motor: Innervates sternocleidomastoid & trapezius

Cranial nerve XII = Hypoglossal nerve

Overview: Function: -- Mainly motor.

Functional components: -- Skeletal motor

-- Proprioception from skeletal muscles.

Extrinsic muscles of the tongue supplied by CN XII:

Hyoglossus

Styloglossus

Genioglossus

Several nerves “hitch-a-ride” on the hypoglossal

Several branches of the cervical plexus ride along on CN XII to reach muscles of the neck.
NOTE: These are NOT hypoglossal nerve fibers – but fibers derived from the anterior rami of
cervical spinal nerves.

The superior root of the ansa cervicalis joins CN XII. The superior root contains motor fibers
from C-1. After hitching a ride, the superior root leaves XII to join the inferior root – thus
completing a loop-like nerve called the ansa cervicalis. The ansa innervates infrahyoid muscles
in the neck. There will be more discussion on this later.

Other C-1 fibers join the hypoglossal nerve and “ride-it” forward into the neck. These C-1
motor fibers leave the hypoglossal to innervate the geniohyoid muscle in the floor of the mouth
and the thyrohyoid muscle, one of the infrahyoid muscles (“strap” muscles) of the neck.

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