CN I Olfactory Efferent fibers to Olfactory Bulb Olfactory Tract Olfactory Bulb Cribiform Plate of Ethmoid Anosmia Loss of sense of smell Uncinate Fits olfactory hallucinations To Olfactory Epithelium on Superior Concha CN II Optic Retina Lateral Geniculate Bodies Pituitary Optic Canals Papilledema Moore, 1090 Optic Neuritis Moore, 1090 Visual Field Defects Moore, 1090 Optic Chiasm Optic nerve CN III Oculomotor Parasympathetic: dashed = preganglionic solid = postganglionic Sympathetic (not part of CN III here, Coming from Carotid Plexus) Accessory Oculomotor (Edinger-Westphal) Oculomotor Oculomotor Palsy - Ptosis - No Pupillary Reflex - Dilation of the Pupil - Eye Abducted - No Lens Accomadation Compression of CN III Aneurism of Posterior Cerebral or Superior Cerebellar Artery Nasociliary N. (V 1 ) Ciliary Eyelid Superior Rectus Levator Palpebrae Superioris Long Ciliary N. Short Ciliary s Medial Rectus Inferior Rectus Inferior Oblique Dilator Pupillae Ciliary Muscle Sphincter Pupillae
CN IV Trochlear Trochlear Superior Oblique (Eye Down and Out) Trochlear Injury (Rarely alone) - Diplopia LR 6 SO 4 CN VI Abducent Abducent Lateral Rectus Abducent Injury - Long intercranial course - Stretched due to fluid pressure - Paralysis - Diplopia except opposite side of lesion or Aneurism of Willis or Septic Thrombosis of Cavernous Sinus
CN V Trigeminal V 1 Opthalmic Frontal Supraorbital N. Supraorbital Lateral Scalp Forehead Frontal Sinus Upper Eyelid Meningeal Supratrochlear N. Medial Scalp Forehead Medial Upper Eyelid Trigeminal Lacrimal Lacrimal Gland Skin Conjunctiva Nasociliary Short Ciliary s Ciliary Eyeball Long Ciliary Post. Ethmoidal Post. Ethmoidal Sphenoid Sinus Post. Ethmoidal Air Cells Infratrochlear Ant. Ethmoidal Ethmoidal Air Cells Ant. Ethmoidal Cavity Sup. Ext. Wall Medial Eyelids Conjunctiva Lacrimal Sac Iris, Cornea Medial Lateral External Branch Ant. 1/3 Septum Lat. Wall Tip of Nose
Lacrimal (v 1 ) Lacrimal Gland CN V Trigeminal V 2 Maxillary Zygomaticotemporal Parasympathetic dashed = preganglionic solid = postganglionic Sympathetic Zygomatic N. Zygomaticotemporal N. Zygomaticofacial N. Temporal Fossa Zygomaticofacial Zygomatic Arch Meningeal Inferior Orbital Fissure Infraorbital Trigeminal Infraorbital Post., Mid., & Ant. Superior Alveolar N. Upper Lip Medial Cheek Side of Nose Greater Petrosal N. (from CN VII) Vidian N. Of Pterygoid Canal Upper Teeth Maxillary Sinus Deep Petrosal N. (from Carotid Plexus) Lesser Palatine Pterygo- Palatine Greater Palatine N. Sphenopalatine Pharyngeal Branch Soft Palate Hard Palate Greater Palatine to posterior 2/3 lateral nasal wall Concha Ethmoidal Air Cells Nasopalatine to posterior 2/3 nasal septum Roof of Pharynx Sphenoid Sinus Incisive Canal
CN V Trigeminal V 3 Mandibular Parasympathetic: dashed = preganglionic solid = postganglionic Meningeal Lesser Petrosal (IX) Trigeminal Ovale Spinosum Auricle Scalp Lateral Face Middle Meningeal Artery Otic Muscles of Mastication Medial Pterygoid Lateral Pterygoid Temporalis Masseter ---------------------------------- Tensor Veli Palatini Muscle Tensor Tympani Muscle Parotid Gland (Parasympathetics from CN IX) Buccal Skin over Buccinator Cheek Mucosa Gums VII Chorda Tympani Lingual Taste Sensation Anterior 2/3 Tongue Submandibular Submandibular Gland Sublingual Gland Mandibular Inferior Alveolar Lower Teeth Gums Lower Lip Mental Mental N. Chin Mylohyoid Anterior Digastric
CN VII Facial Parasympathetic: dashed = preganglionic solid = postganglionic Sympathetic of Facial Superior Salivatory Acoustic Meatus Geniculate Hiatus of Greater Petrosal Greater Petrosal N. Carotid Plexus Deep Petrosal Pterygoid Canal Containing Vidian Lacrimal Gland Pterygo- Palatine Via V 2 Solitary Tract Carotid Artery Stapedius (Lingual of V 3 ) Chorda Tympani Taste on Anterior 2/3 of Tongue Auricular Muscles Stylomastoid Submandibular Submandibular & Sublingual Glands Occipitalis Muscle Occiptial Branch Posterior Auricular Parotid Gland Temporal Zygomatic Buccal Muscles Of Facial Expression Stylohyoid Posterior Digastric Mandibular Cervical (Including Buccinator & Platysma) Post. Auricular
CN VIII Vestibulocochlear Vestibular Nuclei Acoustic Meatus Cochlear Cochlear Hearing Cochlea Balance Cochlear Nuclei Vestibular Vestibular Vestibular Apparatus Vestibulocochlear Injuries - Tinnitus, vertigo, loss of Hearing Deafness (conductive & sensorineural) Acoustic Neuroma Trauma & Vertigo Méniére Syndrome endolymphatic hydrops, tinnitus, vertigo, nausea Vestibular Disease TIA transient ischemic attack CN IX Glossopharyngeal Spinal Tract & Spinal of Trigeminal Inferior Salivatory Superior Glossopharyngeal Jugular Parasympathetic Carotid Artery Inferior Glossopharyngeal Tympanic Lesser Petrosal N. Otic Parotid Gland Tympanic Plexus Solitary Tract Ambiguus Stylopharyngeus Pharyngotympanic tube & Pharyngeal Opening Pharyngeal Branch Tonsillar Branch Lingual Branch Pharynx Palatine Tonsil Lesions of CN IX (uncommon) - Taste Absent posterior 1/3 - Gag Reflex missing on side of lesion - Jugular Syndrome Carotid Branch Taste & Sensation of Posterior 1/3 of Tongue Glossopharyngeal Neuralgia (uncommon) - Pain Paroxysms burning or stabbing Carotid Body Carotid Sinus
CN X Vagus External Acoustic Meatus 1 2 3 Auricular Branch Jugular Parasympathetic Superior & Inferior Ganglia of Vagus 1) Posterior of Vagus (Parasympathetic) 2) Solitary Tract (Visceral Afferents) 3) Ambiguus ( to Pharyngeal & Laryngeal Muscles) Pharyngeal Branch All Pharyngeal Muscles (except Stylopharyngeus IX) All Palate Muscles (except Tensor Veli Palatini V 3 ) Superior Laryngeal N. Branch Above Vocal Cords Parasympathetic Cricothyroid Muscle (tenses, adducts, elongates vocal cords) Recurrent Laryngeal N. All Intrinsic Laryngeal Muscles (except Cricothyroid Ext. branch) & Parasympathetic to Larynx below vocal cords; Parasympathetic (Efferent & Afferent) to Upper Esophagus & Trachea To Thorax & Abdominal Viscera Lesions of Vagus - Injury to pharyngeal branch Dysphagia (difficulty swallowing) - Lesion of superior laryngeal nerve Anesthia in upper larynx & paralysis of cricothyroid muscle Voice is weak & tires easily - Injury to Recurrent Laryngeal Caused by aortic aneurysm or neck operations Hoarseness, dysphonia ( voice quality) If both sides, aphonia (no voice) & inspiratory stridor (crowing sound during inspiratory phase)
CN XI Spinal Accesory (Proprioceptive) Jugular Ambiguus Injury During Special Procedures Lesions - Weakness and atrophy - Impairment of opposite side rotary movements (SCM) & shrugging movements - Scapular winging during shoulder abduction C1 C2 C3 Magnum Sternocleidomastoid Trapezius C4 CN XII Hypoglossal Hypoglossal Canal Hypoglossal nucleus All Glossus Muscles (except Palatoglossus - X) C1 C2