Marcello Cherchis

Summary of cranial nerves

Last updated: 3/3/2000 (Please let me know of any errors! mcherc1@uic.edu) Generalizations concerning fiber types GSA SSA (G)SE GVA GVE SVA SVE General somatic afferent fibers transmit sensation from the skin of the face (CN V), the skin of the external ear (CN V, VII, IX, X), the mucosae of the oral cavity (CN V), and the meninges of the brain (CN V, X). Special somatic afferent fibers transmit signals from the visual system (CN II) and from the auditory and vestibular systems (CN VIII). Somatic efferent fibers provide motor innervation to the extraocular muscles (CN III, IV, VI), to the sternocleidomastoid and trapezius mm. (CN XI) and to all intrinsic and most extrinsic mm. of the tongue (CN XII). General visceral afferent fibers from a variety of viscera (CN IX, X). General visceral efferent fibers provide parasympathetic innervation to the sphincter pupillae m. (CN III), glands of the nasal and oral cavities (CN VII, IX), and viscera of thorax and abdomen (CN X). Special visceral afferent fibers transmit signals for the special (chemical) senses of olfaction (CN I) and gustation (CN VII, IX, X). Special visceral efferent fibers provide motor innervation to striated skeletal muscle derived from the branchiomeric arches, which includes muscles of mastication (CN V), muscles of facial expression (CN VII) and muscles of the larynx, pharynx and part of the esophagus (CN IX, X).

There are no SSE fibers. For charts of the cranial nerves see MA 446 ff.; BU 24, 404; HA 165; WP viii; SS 234, 1120; 426, 1252. For good illustrations of the brain stem and location of its nuclei see NE 110-111; HA 165. For illustrations of the pathways and distributions of each of the cranial nn. see NE 112-122. For a photograph of where most of the cranial nerves exit the brainstem see HA 22; BU 405. For illustrations of the cranial foramina see NE 5-7; CL 497-8.

The color-coded chart in HA 165 illustrates the position of the cranial nerve nuclei in the brainstem, and makes clear that the nuclei are arranged roughly into columns corresponding to fiber types. From medial to lateral, these colums are: GSE, GVE, SVE, SVA, GVA, SSA, GSA. (Note that the efferent nuclei are medial to the afferent ones, and this separation is demarcated by the sulcus limitans, BU 136.)

3 Here is a tabular presentation of the different fiber types: AFFERENT (sensory) GSA: general somatic afferent. Sensation from the skin of the face, the mucosae of the oral cavity, and the meninges of the brain. EFFERENT (motor) (G)SE: (general) somatic efferent. Motor supply to the extraocular muscles (CN III, IV, VI), to the sternocleidomastoid and trapezius mm. (CN XI) and to all intrinsic and most extrinsic mm. of the tongue (CN XII). [No SSE fibers.]

SOMATIC SSA: special somatic afferent. Signals from the visual system (CN II) and from the auditory and vestibular systems (CN VIII). GVA: general visceral afferent.

GVE: general visceral efferent. Parasympathetic motor supply to the sphincter pupillae m. (CN III), glands of the nasal and oral cavities (CN VII, IX), and viscera of thorax and abdomen (CN X).

VISCERAL SVA: special visceral afferent Signals for the special (chemical) senses of olfaction (CN I) and gustation (CN VII, IX, X). SVE: special visceral efferent. Motor innervation to striated skeletal muscle derived from the branchiomeric arches, which includes muscles of mastication (CN V), muscles of facial expression (CN VII) and muscles of the larynx, pharynx and part of the esophagus (CN IX, X).

Spinal nerves contain the four general components (GSA, [G]SE, GVA, GVE). Cranial nerves contain those four components plus the three special components (SSA, SVA, SVE) (BU 144).

General Somatic Afferent

Special Somatic Afferent

Somatic Efferent

General Visceral Afferent

General Visceral Efferent (parasympathetic)

Special Visceral Afferent (chemical)

Olfactory epithelium. Sense of smell.

Special Visceral Efferent (branchial)

I Olfactory II Optic III Oculomotor

Ganglion cells of retina. Vision. Motor innervation to 4 of 6 extraocular mm. Preganglionic: midbrain. Postganglionic: ciliary ganglion. Innervation to sphincter pupillae m. and m. of ciliary body.

IV Trochlear V Trigeminal
Trigeminal ganglion. Sensation from skin of face, scalp, eyelids, cornea, mucous membranes of mouth, tongue, palate, nose, teeth, gingiva, meninges of brain.

Midbrain. Innervation to superior oblique m. of eye. Pons. Motor innervation to masticatory, mylohyoid, ant. belly of digastric, tensor veli palatini, tensor tympani mm. (derivatives of branchiomeric arch 1). Pons. Motor to lateral rectus m. of eye.

VI Abducens

5 VII Facial
Geniculate ganglion. Sensation from skin of external acoustic meatus. [Probably sensory input from vasculature, although this is controversial (says Dr. Anderson).] Preganglionic: pons. Postganglionic: pterygopalatine ganglion. Innervation to lacrimal gland and glands of nasal cavity, palate. Preganglionic: pons. Postganglionic: submandibular ganglion. Upper pharynx innervation to submandibular and sublingual glands. Geniculate ganglion. Taste from ant. twothirds of tongue via chorda tympani. Pons. Motor to branchiomeric mm. of facial expression, post. belly of digastric, stylohyoid and stapedius mm. (derivatives of branchiomeric arch 2).

VIII Vestibulocochlear (or statoacoustic)

Spiral ganglion. (Exteroceptive) Hearing from the Organ of Corti. Vestibular ganglion. (Proprioceptive) Vestibular sensation from the semicircular ducts, utricle and saccule. Inferior ganglion. Cutaneous sensation from external ear. Superior ganglion. Visceral sensation from the parotid gland, carotid body and sinus, pharynx and middle ear. Inferior ganglion. Visceral sensation from carotid body, base of tongue, pharynx, larynx, trachea, bronchi, lungs, heart, esophagus, stomach and intestines. Preganglionic: medulla. Postganglionic: otic ganglion. Innervation to the parotid gland. Preganglionic: medulla. Postganglionic: cells on, in, or near viscus. Innervation to involuntary mm. and glands of heart, esophagus, stomach, trachea, bronchi, intestines and other abdominal viscera. Inferior ganglion. Taste from the posterior one-third of tongue. Medulla. Motor to stylopharyngeus m. (derivative of branchiomeric arch 3). Medulla. Motor to striated mm. of larynx, pharynx, palate (except tensor veli palatini) and upper two-thirds of esophagus (derivatives of branchiomeric arches 4-6).

IX Glossopharyngeal X Vagus

Superior ganglion. Cutaneous sensation from external ear and external acoustic meatus and dura mater of post. cranial fossa.

Inferior ganglion. Taste from epiglottis and palate.

6 XI Spinal accessory XII Hypoglossal

Spinal cord ventral horn gray. Motor to sternocleidomastoid and trapezius mm. Medulla. Motor to extrinsic and intrinsic mm. of tongue.

A note concerning the vestibulocochlear nerve: A group of efferent [sic!] axons form part of the eighth nerve. Their cell bodies form part of the superior olivary complex in the brain stem. These neurons receive input from the auditory cortex and inferior colliculus. They project to the ipsilateral and contralateral hair cells in the cochlea. Their function is not well understood, but since they act to reduce auditory nerve activity, it has been suggested that they act as a feedback loop to suppress unwanted auditory signals (WP 104). If one considers CN VII as having a GVA component (which is controversial according to Dr. Anderson), then there are three cranial nerves which have five components: CN VII, IX and X have GSA, GVA, GVE, SVA and SVE. A mnemonic for remembering which cranial nerves carry motor fibers, sensory fibers or both: Some say marry money, but my brother says big boobs matter more.

7 Courses of the cranial nerves I: Olfactory Olfactory neurosensory cells are in the olfactory epithelium in the superior part of the lateral and septal walls of the nasal cavity. The axons from these cells pass through foramina in the cribriform plate of the ethmoid bone, pierce the dura and arachnoid mater, and enter the olfactory bulbs in the anterior cranial fossa. The olfactory nerve is the only cranial nerve to enter the telencephalon directly (BU 283, 296). II: Optic This nerve begins where the axons of the retinal ganglion cells pierce the sclera. The optic nerve passes posteromedially through the orbit, runs through the optic canal to the middle cranial fossa and joins the optic chiasma. Posterior to the optic chiasma the optic nerves are instead called optic tracts. Most fibers in the optic tracts terminate in the lateral geniculate bodies of the thalamus. III: Oculomotor Emerges from the midbrain (HA 120), pierces the dura, runs in the lateral wall of the cavernous sinus. Exits the skull through the superior orbital fissure and enters the orbit. From here it splits into a superior division (which supplies the superior rectus m.) and an inferior division (which supplies the inferior and medial rectus and inferior oblique m. and also carries autonomic fibers to the ciliary ganglion). IV: Trochlear Emerges from the dorsal surface of the midbrain (see HA 112), winds around the brainstem, pierces the dura and passes anteriorly in the lateral wall of the cavernous sinus. Exits the cavernous sinus and passes through the superior orbital fissure into the orbit to supply the superior oblique m. The trochlear n. is the only CN which exits the dorsal side of the brain stem (SS 462, 1179). It is also the only CN which completely crosses (SS 270, 1128). It is the smallest cranial nerve (CH 296). (See WP 46 for a list of these unique characteristics.) V: Trigeminal Emerges from the pons by a small motor root and a large sensory root. The ophthalmic division (V1) is exclusively sensory and exits through the superior orbital fissure. The maxillary division (V2) is exclusively sensory and exits through the foramen rotundum. The mandibular division (V3) exits through the foramen ovale; it has a sensory component and a branchial motor component (SVE). See WP 52 for a complete list of the components of CN V.

8 VI: Abducent Exits brainstem at medullopontine junction between the pyramids and pons (BU 134). It then pierces the dura and passes through the cavernous sinus. Enters the orbit through the superior orbital fissure and runs anteriorly to supply the lateral rectus m. which abducts the eye. Dr. Lysakowski says that the abducent nerve has the longest intracranial course and is therefore the cranial nerve most subject to injury (resulting in strabismus). VII: Facial Exits brainstem at medullopontine junction between the olive and the pons (BU 134). The facial nerve then traverses the posterior cranial fossa, internal acoustic meatus, facial canal and parotid gland. At the medial wall of the tympanic cavity the facial canal bends posteroinferiorly where the geniculate ganglion is located. Within the facial canal, CN VII gives rise to the greater petrosal n., the n. to the stapedius, and the chorda tympani n. CN VII then emerges from the skull via the stylomastoid foramen and enters the parotid gland. Here it divides into the following terminal branches: posterior auricular, temporal, zygomatic, buccal, mandibular and cervical. VIII: Vestibulocochlear Exits brainstem at medullopontine junction at the medullopontine angle (BU 134). It then enters the internal acoustic meatus with the facial n. Here CN VIII separates into the vestibular nerve (which innervates the maculae of the utricle and saccule and the ampullae of the semicircular ducts) and the cochlear nerve (which innervates the spiral organ of Corti). IX: Glossopharyngeal Emerges from the medulla and passes anterolaterally to exit the skull through the jugular foramen. It follows the stylopharyngeaus m. and passes between the superior and middle constrictor mm. of the pharynx to reach the oropharynx and tongue. See HA 96 for a diagram of where the glossopharyngeal nerve exits the medulla. X: Vagus Arises by a series of rootlets from the medulla and exits the skull through the jugular foramen together with CN IX and XI. (All three nerves pass through the anteromedial portion of the jugular foramen; vascular structures pass through the posterolateral portion.) XI: Spinal accessory Has cranial and spinal roots (MA 462). The cranial root arises from the medulla by a series of rootlets; the spinal root emerges as a series of rootlets from the first five cervical segments of the spinal cord. (Dr. Lieska says that these rootlets are neither ventral nor dorsal; theyre in between.) It ascends through the foramen magnum. The cranial and spinal roots join as they pass through the

9 jugular foramen and then separate. The cranial root joins the vagus and its fibers are distributed by vagal branches to striated muscle of the sort palate, pharynx, larynx and esophagus. The spinal root descends to supply the sternocleidomastoid and trapezius mm. XII: Hypoglossal Arises by several rootlets in the medulla from the sulcus between the inferior olive and the pyramids (SS 315, 448). It then exits the skull through the hypoglossal canal. Passes inferolaterally to the angle of the mandible and then curves anteriorly to enter the tongue. Ends in many branches that supply all extrinsic and intrinsic mm. of the tongue (except the palatoglossus m.).

Points at which the cranial nerves exit the brainstem: Nerve CN III CN IV CN V CN VI CN VII CN VIII CN IX CN X CN XI CN XII Level midbrain midbrain pons medullopontine junction medullopontine junction medullopontine junction medulla medulla medulla (and spinal cord) medulla Azimuth dorsal surface between pyramids and pons between olive and pons medullopontine angle

between olive and pyramid

Cranial portion of the parasympathetic nervous system The GVE fibers provide parasympathetic innervation through CN III, VII, IX and X. The parasympathetic postganglionic distribution of the vagus (CN X) resides in cells on, in or near the viscera of the thorax and abdomen (heart, esophagus, stomach, trachea, bronchi, intestines, etc.). For the oculomotor n., facial n. and glossopharyngeal n. (CN III, VII and IX) the parasympathetic fibers pass through four ganglia as shown in the table below. Note, however, that these ganglia also contain sympathetic fibers (see MA 464-5). For a good illustration of the locations of these ganglia and of their autonomic pathways see NE 40-1, 125-8.

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PARASYMPATHETIC Ganglion Ciliary Location Located between optic nerve and lateral rectus, close to apex of orbit. Preganglionic fibers Inferior division of oculomotor n. (CN III). The 1 fibers then synapse in the ciliary ganglion (WP 35; NE 126) Postganglionic distribution and the 2 fibers pass from ciliary ganglion to ciliary muscle and sphincter pupillae of iris.

SYMPATHETIC Preganglionic fibers Branch from internal carotid plexus in cavernous sinus. These 2 fibers (from superior cervical ganglion) pass through the ciliary ganglion without synapsing (NE 126) Postganglionic distribution then the 2 fibers continue to dilator pupillae and blood vessels of eye.

11 Pterygopalatine Located in pterygopalatine fossa where it is attached by pterygopalatine branches of maxillary nerve. Located just anterior to opening of pterygoid canal and inferior to CN V2. Greater petrosal n. from facial n. (CN VII). The 1 fibers then synapse in the pterygopalatine ganglion (WP 83; NE 127) and the 2 fibers pass from pterygopalatine ganglion to lacrimal gland via zygomatic branch of CN V2. Deep petrosal n., a branch of internal carotid plexus that is continuation of postsynaptic fibers of cervical sympathetic trunk. These 2 fibers (from superior cervical ganglion) pass through pterygopalatine ganglion without synapsing (NE 127) and enter branches of CN V2 then these 2 fibers continue and accompany those branches of pterygopalatine n. that are distributed to the nasal cavity, palate and superior part of the pharynx.

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PARASYMPATHETIC Ganglion Otic Location Located between tensor veli palatini and mandibular n. (CNV3). Lies inferior to foramen ovale sphenoid bone. Preganglionic fibers Tympanic n. from glossopharyngeal n. (CN IX); from tympanic plexus the tympanic n. continues as the lesser petrosal n. The 1 fibers then synapse in the otic ganglion (WP 115; NE 128) Parasympathetic fibers join facial n. (CN VII) and leave it in its chorda tympanic branch, which unites with the lingual n. Postganglionic distribution and the 2 fibers pass from otic ganglion and are distributed to parotid gland via auriculotemporal n. (branch of CNV3).

SYMPATHETIC Preganglionic fibers Fibers from superior cervical ganglion come from plexus on middle meningeal a. (This pathway does not pass through the otic ganglion; see NE 128.) Postganglionic distribution Fibers pass from superior cervical ganglion to parotid gland and supply its blood vessels.

Submandibular

Suspended from lingual n. by two short roots (NE 127). Lies on surface of hyoglossus m. inferior to submandibular duct. The 1 fibers then synapse in the submandibular ganglion (WP 83; NE 127)

and the 2 fibers pass from submandibular ganglion and are distributed to the sublingual and submandibular glands.

Fibers from superior cervical ganglion come from the plexus on facial a. These 2 fibers pass without synapsing (NE 127) and

then these 2 fibers supply sublingual and submandibular glands and appear to be secretomotor.

13 Cranial nerve supply to derivatives of branchiomeric arches The trigeminal, facial, glossopharyngeal and vagus nn. (CN V, VII, IX and X) send special visceral efferent fibers to striated skeletal muscles derived from embryonic branchiomeric (pharyngeal) arches. The following table presents information from SA 315 (table 16.1), from DU 30 (table 9-1) and from Dr. Ashiru. The fifth branchiomeric arch is vestigial or degenerates completely in humans.

14 Derived from MESODERM: Arch 1 (mandibular) Innervation

Maxillary and mandibular branches of the trigeminal (CN V)

Derived from NEURAL CREST CELLS: Blood supply

Terminal branches of maxillary a.

Muscles
Mm. of mastication Mylohyoid Anterior belly of digastric Tensor tympani Tensor veli palatini Mm. of facial expression Stapedius Stylohyoid Posterior belly of digastric Stylopharyngeus

Skeletal structures
Malleus Incus

Ligamentous structures
Anterior ligament of malleus Sphenomandibular ligament

Cartilagenous structures
Meckels cartilage

2 (hyoid)

Facial n. (CN VII)

Stapedius a.

Glossopharyngeal n. (CN IX)

Common carotid a.

4 and 6

Arch 4 derivatives by the superior laryngeal branch of vagus (CN X) Arch 6 derivatives by the recurrent laryngeal branch of vagus (CN X)

Cricothyroid Levator veli palatini Constrictors of pharynx Intrinsic mm. of larynx Striated mm. of esophagus

Arch of aorta

Stapes Styloid process Lesser cornu of hyoid Upper part of body of the hyoid bone Greater cornu of hyoid Lower part of body of the hyoid bone [none]

Stylohyoid ligament

Reicherts cartilage

[none]

[none]

[none]

Thyroid Cricoid Arytenoid Corniculate Cuneiform

15 Tongue See illustrations (NE 56, 129; CL 532, 539) and discussion in MA 391-2. The skeletal muscles of the tongue are of occipital somatic origin (GR 152 fig. 2.58B), though its mucosa (epithelium) is of branchiomeric origin (BU 285). The genioglossus m. constitutes the bulk of the tongue. All muscles of the tongue, except the palatoglossus, are supplied with somatic efferent innervation by the hypoglossal n. (CN XII) (MA 391). Part of tongue Anterior 2/3 of tongue General sensory innervation (tactile) GSA fibers via the lingual nerve ( mandibular division of trigeminal CN V3). Special sensory innervation (taste) SVA fibers via: chorda tympani nerve ( facial n. CN VII) lingual branch ( glossopharyngeal n. CN IX). Derivation of epithelium Branchiomeric arch 1 (SA 328; BU 285). Motor innervation Motor innervation (SE) to nearly all parts of the tongue is by the hypoglossal nerve (CN XII). The exception is the palatoglossus m. (which is innervated by the pharyngeal branch of the vagus [CN X) (MA 392). Branchiomeric arches 2, 3 and part of 4 (SA 328).

Posterior 1/3 of tongue

Epiglottis and palate

GSA fibers via the lingual branch of the glossopharyngeal n. (CN IX). GSA fibers via the internal laryngeal n. ( superior laryngeal n. vagus n. CN X) (MA 392).

SVA fibers via the lingual branch ( glossopharyngeal n. CN IX). SVA fibers via the internal laryngeal n. ( superior laryngeal n. vagus n. CN X).

Branchiomeric arch 4 (SA 328).

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17 Ear There is a variety of cranial nerve innervation (CN V3, VII, VIII, IX, X) to the ear. Fiber type SSA SVE Nerve pathway Vestibulocochlear n. (CN VIII) Medial pterygoid n. ( CN V3 from the motor nucleus of trigeminal) (WP 56). N. to stapedius ( CN VII from the motor nucleus of the facial n.) (WP 84). Auriculotemporal n. ( CN V3 spinal nucleus of V) (WP 66). Nervus intermedius ( CN VII spinal nucleus of V) (WP 92). Branches from the tympanic plexus ( CN IX spinal nucleus of V) (WP 121). Auricular branch ( CN X spinal nucleus of V) (WP 137). GVA Branches from the tympanic plexus ( CN IX spinal nucleus of V) (WP 121) Target tissue Spiral organ of Corti Vestibular system Tensor tympani m. Stapedius m. External auditory meatus Most of the external surface of tympanic membrane Skin of concha of auricle Skin behind ear Wall of acoustic meatus Some of the external surface of tympanic membrane Skin of the external ear

GSA

Skin at the back of the ear External acoustic meatus Some of the external surface of tympanic membrane Internal surface of tympanic membrane

Concerning the GSA components from the ear (which are all listed in MA 402; also see CL 467; CH 338), note that all these fibers eventually project to the spinal nucleus of V, regardless of the cranial nerve along which they travel (V3, VII, IX or X). For a good illustration of these nerves see CL 571.

18 Cranial fossae Anterior and middle cranial fossae: GSA sensory innervation via the trigeminal (CN V) (FI 205). Specifically, the meningeal branch of V1 innervates the tentorium cerebelli, while the meningeal branches of V2 and V3 innervate the anterior and middle cranial fossae (WP 52). Posterior cranial fossa (specifically, the infratentorial dura): Meningeal branch from superior ganglion of the vagus n. (CN X) (CH 300) along with contributions from C2 and C3; FI 210).

References BU BURT, Alvin M., Textbook of Neuroanatomy. Philadelphia: W.B. Saunders Company, 1993. CH CHUNG, Kyung Won, Gross Anatomy, 3rd ed. Baltimore: Williams & Wilkins, 1995. CL CLEMENTE, Carmine, Anatomy: A Regional Atlas of the Human Body, 4th ed. Baltimore: Williams & Wilkins, 1997. FI FIX, James D., Board Review Series: Neuroanatomy, 2nd ed. Baltimore: Williams & Wilkins, 1995. GR WILLIAMS, Peter L. and Roger WARWICK (eds.), Grays Anatomy, 36th British ed. Philadelphia: W.B. Saunders Co., 1980. HA HAINES, Duane E., Neuroanatomy: An Atlas of Structures, Sections, and Systems, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2000. JH HANAWAY, Joseph, et al., The Brain Atlas: A Visual Guide to the Human Central Nervous System. Bethesda, Maryland: Fitzgerald Science Press, Inc., 1998. MA MOORE, Keith L. and Anne M. R. AGUR, Essential Clinical Anatomy. Baltimore: Williams & Wilkins, 1995. NE NETTER, Frank H., Atlas of Human Anatomy, 2nd ed. East Hanover, New Jersey: Novartis, 1998. SA SADLER, Thomas W., Langmans Medical Embryology, 7th ed. Baltimore: Williams & Wilkins, 1995. SS SIDMAN, Richard L. and Murray SIDMAN, Neuroanatomy: a programmed text, volume 1. Boston: Little, Brown and Company, 1965. [References include page number followed by item number.] WP WILSON-PAUWELS, Linda, et al., Sandoz Course: Cranial Nerves: Anatomy and Clinical Comments. Toronto: B.C. Decker, Inc., 1988.