The Anatomy of the

Cranial nerves
VII-XII
 Cranial nerves
Like spinal nerves, cranial nerves are bundles of
sensory or motor fibers that innervate muscles or
glands; carry impulses from sensory receptors, or
show a combination of these fiber types.
They are called cranial nerves because they emerge
through foramina or fissures in the cranium and are
covered by tubular sheaths derived from the cranial
meninges.
There are twelve pairs of cranial nerves, which are
numbered I to XII, from rostral to caudal, according
to their attachment to the brain and penetration of
the cranial dura. Their names reflect their general
distribution or function.
Cranial nerves
Cranial nerves
Cranial nerves
 FACIAL NERVE (CN VII)
Functions: Sensory (special visceral
afferent and general somatic afferent),
motor (branchial motor or special
visceral efferent), and parasympathetic
(general visceral efferent). It also carries
proprioceptive fibers from the muscles
it innervates.

Nuclei: The motor nucleus of the facial

nerve is a branchiomotor nucleus in the
ventrolateral part of the pons. The cell
bodies of the primary sensory neurons
are in the geniculate ganglion. The
central processes of those concerned
with taste end in the nuclei of the
solitary tract in the medulla. The
processes of those concerned with
general sensations (pain, touch, and
thermal) from around the external ear
end in the spinal nucleus of the
trigeminal nerve. The facial nerve (CN
VII) emerges from the junction of the
pons and medulla as two divisions, the
motor root and the intermediate nerve
The larger motor root (facial nerve
proper) innervates the muscles of facial
expression, and the smaller intermediate
nerve (L. nervus intermedius) carries
taste, parasympathetic, and somatic
sensory fibers. During its course, CN VII
traverses the posterior cranial fossa,
internal acoustic meatus, facial canal,
stylomastoid foramen of the temporal
bone, and parotid gland. After traversing
the internal acoustic meatus, the nerve
proceeds a short distance anteriorly
within the temporal bone and then turns
abruptly posteriorly to course along the
medial wall of the tympanic cavity.
The sharp bend is the geniculum of the
facial nerve, sometimes called the
external genu of CN VII, the site of the
geniculate ganglion (sensory ganglion of
CN VII). While traversing the temporal
bone within the facial canal, CN VII gives
rise to the: Greater petrosal nerve,
Nerve to the stapedius, and Chorda
tympani nerve.
Then, after running the longest
intraosseous course of any
cranial nerve, CN VII emerges
from the cranium via the
stylomastoid foramen; gives off
the posterior auricular branch;
enters the parotid gland; and
forms the parotid plexus, which
gives rise to the following five
terminal motor branches:
temporal, zygomatic, buccal,
marginal mandibular, and
cervical.
Branchial Motor As the nerve of
the 2nd pharyngeal arch, the
facial nerve supplies striated
muscles derived from its
mesoderm, mainly the muscles
of facial expression and
auricular muscles. It also
supplies the posterior bellies of
the digastric, stylohyoid, and
stapedius muscles. and soft
palate.
Presynaptic Parasympathetic
CN VII provides presynaptic
parasympathetic fibers to the
pterygopalatine ganglion for innervation
of the lacrimal mucous glands and to the
submandibular ganglion for innervation of
the sublingual and submandibular salivary
glands. The pterygopalatine ganglion is
associated with the maxillary nerve (CN
V2), which distributes its postsynaptic
fibers, whereas the submandibular
ganglion is associated with the mandibular
nerve (CN V3). Parasympathetic fibers
synapse in these ganglia, whereas
sympathetic and other fibers pass through
them.
General Sensory Some fibers from the
geniculate ganglion supply a small area of
the skin of the concha of the auricle, close
to external acoustic meatus.
Taste (Special Sensory) Fibers carried by the
chorda tympani join the lingual nerve to
convey taste sensation from the anterior
two thirds of the tongue
Korelasi Klinis
Nukleus fascialis menerima serabut syaraf
yang menyilang dan tidak menyilang
traktus kortikobulbar
Otot-otot wajah dibawah dahi inervasi
secara kontralateral (hanya jaras kortikobulbar
yang menyilang)
Lesi N.VII sentral paralisis otot wajah
kontralateral kecuali m.frontalis dan
m.orbicularis oculi (inervasi bilateral)
Destruksi komplit dari nukleus fascialis
paralisis otot wajah ipsilateral lesi N.VII
perifer Bells palsy
 Bells Palsy
Tanda dan gejala
tergantung lokasi lesi
Lesi di dalam/luar
for.stylomastoideus
paralisis LMN
Lesi di dalam canalis
fascialis termasuk korda
timpani saliva <<,
kehilangan sensasi rasa
lidah
Lesi di atas canalis
fascialis pralisis
m.stapedius
 Vestibulocochlear Nerve (CN VIII)
Functions: Special sensory
(special somatic afferent) that
is, special sensations of
hearing and equilibrium.
Nuclei: Four vestibular nuclei
are located at the junction of
the pons and medulla in the
lateral part of the floor of the
4th ventricle; two cochlear
nuclei are in the medulla.
The vestibulocochlear nerve
(CN VIII) emerges from the
junction of the pons and
medulla and enters the
internal acoustic meatus. Here
it separates into the vestibular
and cochlear nerves.
The vestibular nerve is concerned
with equilibrium. It is composed
of the central processes of bipolar
neurons in the vestibular
ganglion; the peripheral processes
of the neurons extend to the
maculae of the utricle and saccule
(sensitive to the line of linear
acceleration relative to the
position of the head) and to the
ampullae of the semicircular ducts
(sensitive to rotational
acceleration).
The cochlear nerve is concerned
with hearing. It is composed of
the central processes of bipolar
neurons in the spinal ganglion;
the peripheral processes of the
neurons extend to the spiral
organ.
 Nervus Vestibulocochlearis (N.VIII)

maintains balance and

mediates hearing.
consists of two
functional divisions:
the vestibular nerve
and the cochlear
nerve
exits the brainstem at
the CP angle.
enters the internal
auditory meatus and
is confined to the
temporal bone
 Vestibulocochlear (VIII) Nerve
Sensory cranial nerve.
Originates in the
inner ear.
Vestibular branch
carries impulses for
equilibrium.
Cochlear branch
carries impulses for
hearing.

16
 Nervus Cochlearis
serves audition (hearing)
has first-order sensory bipolar neurons in the
spiral (cochlear) ganglion of the modiolus of the
cochlea, within the temporal bone
projects peripheral processes to the hair cells of
the organ of Corti
projects central processes to the dorsal and
ventral cochlear nuclei of the brainstem
conducts efferent fibers to the hair cells from the
brainstem
 Nervus Vestibularis
plays a role in equilibrium and balance.
is associated functionally with the cerebellum (flocculonodular
lobe).
has first-order sensory bipolar neurons in the vestibular ganglion
of the internal auditory meatus
projects peripheral processes to the hair cells of the cristae
ampullares of the semicircular ducts and to hair cells of the
utricular and saccular maculae.
projects central processes to the four vestibular nuclei of the
brainstem and to the flocculonodular lobe of the cerebellum
conducts efferent fibers to hair cells from the brainstem.
 Glossopharyngeal
Nerve (CN IX)
Functions: Sensory (general somatic
afferent, special visceral afferent,
general visceral afferent), motor
(special visceral efferent), and
parasympathetic (general visceral
efferent) for derivatives of the 3rd
pharyngeal arch.
Nuclei: Four nuclei in the medulla
send or receive fibers via CN IX: two
motor and two sensory. Three of
these nuclei are shared with CN X.
The glossopharyngeal nerve (CN IX)
emerges from the lateral aspect of the
medulla and passes anterolaterally to
leave the cranium through the
anterior aspect of the jugular. At this
foramen are superior and inferior
(sensory) ganglia, which contain the
pseudounipolar cell bodies for the
afferent components of the nerve.
CN IX follows the stylopharyngeus, the
only muscle the nerve supplies, and passes
between the superior and the middle
constrictor muscles of the pharynx to reach
the oropharynx and tongue. It contributes
sensory fibers to the pharyngeal plexus of
nerves.
CN IX is afferent from the tongue and
pharynx (hence its name) and efferent to
the stylopharyngeus and parotid gland.
Branchial Motor Motor fibers pass to one
muscle, the stylopharyngeus, derived from
the 3rd pharyngeal arch.
Parasympathetic (Visceral Motor)
Following a circuitous route initially
involving the tympanic nerve, presynaptic
parasympathetic fibers are provided to the
otic ganglion for innervation of the parotid
gland. The otic ganglion is associated with
the mandibular nerve (CN V3), branches of
which convey the postsynaptic
parasympathetic fibers to the parotid gland
.
The general sensory branches of CN IX are
as follows : The tympanic nerve. The
carotid sinus nerve to the carotid sinus, a
baro- (presso) receptor sensitive to
changes in blood pressure, and the carotid
body, a chemoreceptor sensitive to blood
gas (oxygen and carbon dioxide levels).
The pharyngeal, tonsillar, and lingual
nerves to the mucosa of the oropharynx
and isthmus of the fauces (L. throat),
including palatine tonsil, soft palate, and
posterior third of the tongue. In addition
to general sensation (touch, pain,
temperature), tactile (actual or
threatened) stimuli determined to be
unusual or unpleasant here may evoke the
gag reflex or even vomiting.
Taste (Special Sensory) Taste fibers are
conveyed from the posterior third of the
tongue to the sensory ganglia.
 Lesi N.IX
Loss of the gag (pharyngeal) reflex
Loss of the carotid sinus reflex (interruption of
the sinus nerve)
Loss of taste from the posterior third of the
tongue
Glossopharyngeal neuralgia
 Vagus Nerve (CN X)
Functions: Sensory (general somatic
afferent, special visceral afferent, general
visceral afferent), motor (special visceral
efferent), and parasympathetic (general
visceral efferent).
Sensory from the inferior pharynx, larynx,
and thoracic and abdominal organs.
Sense of taste from the root of the tongue
and taste buds on the epiglottis. Branches of
the internal laryngeal nerve (a branch of CN
X) supply a small area, mostly general but
some special sensation; most general and
special sensation to the root is supplied by
CN IX.
Motor to the soft palate; pharynx; intrinsic
laryngeal muscles (phonation); and a
nominal extrinsic tongue muscle, the
palatoglossus, which is actually a palatine
muscle based on its derivation and
innervation.
is the nerve of the fourth and sixth branchial
arches exits the brainstem (medulla) from
the postolivary sulcus, exits the skull via the
jugular foramen with CN IX and CN XI
Proprioceptive to the muscles listed above.
Parasympathetic to thoracic and abdominal
viscera.
Nuclei: Four nuclei of CN X in the
medulla send or receive fibers
via CN IX two motor and two
sensory. Three of these nuclei
are shared with CN IX.
The vagus nerve (CN X) has the
longest course and most
extensive distribution of all the
cranial nerves, most of which is
outside of (inferior to) the head.
The term vagus is derived from
the Latin word vagari meaning
wandering. CN X was so called
because of its extensive
distribution. It arises by a series
of rootlets from the lateral
aspect of the medulla that
merge and leave the cranium
through the jugular foramen
positioned between CN IX and
CN XI.
CN X has a superior ganglion in the jugular
foramen that is mainly concerned with the general
sensory component of the nerve. Inferior to the
foramen is an inferior ganglion (nodose ganglion)
concerned with the visceral sensory components
of the nerve. In the region of the superior ganglion
are connections to CN IX and the superior cervical
(sympathetic) ganglion. CN X continues inferiorly
in the carotid sheath to the root of the neck,
supplying branches to the palate, pharynx
The course of CN X in the thorax differs on the two
sides, a consequence of rotation of the midgut
during development. CN X supplies branches to
the heart, bronchi, and lungs. The vagi join the
esophageal plexus surrounding the esophagus,
which is formed by branches of the vagi and
sympathetic trunks. This plexus follows the
esophagus through the diaphragm into the
abdomen, where the anterior and posterior vagal
trunks break up into branches that innervate the
esophagus, stomach, and intestinal tract as far as
the left colic flexure.
Cranial nerves
 Lesi N.X
Ipsilateral paralysis of the soft palate, pharynx,
and larynx leading to dysphonia (hoarseness),
dyspnea, dysarthria, and dysphagia
Loss of the gag (palatal) reflex (efferent limb)
Anesthesia of the pharynx and larynx, leading
to unilateral loss of the cough reflex
Aortic aneurysms and tumors of the neck and
thorax
frequently compress the vagal nerve.
 Spinal Accessory
Nerve (CN XI)
Functions: Motor to the
striated sternocleidomastoid
and trapezius muscles.
Nuclei: The spinal accessory
nerve arises from the nucleus
of the accessory nerve, a
column of anterior horn motor
neurons in the superior five or
six cervical segments of the
spinal cord .
 Nervus Accessorius (N.XI)
mediates head and shoulder
movement and innervates
laryngeal muscles
includes the following
divisions:
1.Cranial division
arises from the nucleus
ambiguus of the medulla
exits the medulla from the
postolivary sulcus and joins
the vagal nerve (CN X)
exits the skull via the jugular
foramen with CN IX and CN
X
innervates the intrinsic
muscles of the larynx via the
inferior (recurrent) laryngeal
nerve, with the exception of
the cricothyroid muscle.
2. Spinal division
arises from the ventral
horn of cervical segments
C1 to C6
Spinal roots exit the
spinal cord laterally
between the ventral and
dorsal spinal roots,
ascend through the
foramen magnum, and
exit the skull via the
jugular foramen
innervates the
sternocleidomastoid
(with C2) and trapezius
muscles (with C3 and C4).
 Accessory (XI) Nerve
Motor cranial nerve.
Divided into cranial
accessory and spinal
accessory nerves.
Supplies
sternocleidomastoid
and trapezius muscles
to coordinate head
movements.

34
 Lesi N.XI
1. Paralysis of the sternocleidomastoid muscle
results in difficulty in turning the head to the side
opposite the lesion
2. Paralysis of the trapezius muscle
results in a shoulder droop
results in the inability to shrug the ipsilateral shoulder
3. Paralysis of the larynx occurs if the cranial root is
involved
 Hypoglossal Nerve (CN XII)
Functions: Motor (general somatic efferent) to the intrinsic and extrinsic muscles of
the tongue (G. glossa) styloglossus, hyoglossus, and genioglossus.
The hypoglossal nerve (CN XII) arises as a purely motor nerve by several rootlets
from the medulla and leaves the cranium through the hypoglossal canal. After
exiting the cranial cavity, CN XII is joined by a branch or branches of the cervical
plexus conveying general somatic motor fibers from C1 and C2 spinal nerves and
general somatic sensory fibers from the spinal ganglion of C2. These spinal nerve
fibers hitch a ride with CN XII to reach the hyoid muscles, with some of the sensory
fibers passing retrograde along it to reach the dura mater of the posterior cranial
fossa. CN XII passes inferiorly medial to the angle of the mandible and then curves
anteriorly to enter the tongue.
CN XII ends in many branches that supply all the
extrinsic muscles of the tongue, except the
palatoglossus (which is actually a palatine
muscle). CN XII has the following branches:
A meningeal branch returns to the cranium
through the hypoglossal canal and innervates
the dura mater on the floor and posterior wall of
the posterior cranial fossa. The nerve fibers
conveyed are from the sensory spinal ganglion of
spinal nerve C2 and are not hypoglossal fibers.
The superior root of the ansa cervicalis
branches from CN XII to supply the infrahyoid
muscles (sternohyoid, sternothyroid, and
omohyoid). This branch actually conveys only
fibers from the cervical plexus (the loop
between the anterior rami of C1 and C2) that
joined the nerve outside the cranial cavity, not
hypoglossal fibers. Some fibers continue past the
descending branch to reach the thyrohyoid
muscle.
Terminal lingual branches supply the
styloglossus, hyoglossus, genioglossus, and
intrinsic muscles of the tongue
Lesi N.XII