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14. Head and Neck > 4. Cranial Nerves and Autonomic Innervation of the Head and Neck > Flashcards

4. Cranial Nerves and Autonomic Innervation of the Head and Neck Flashcards

1
Q

What are the cranial nerves?

A

The 12 pairs of nerves flowing directly from the brain that emerge through foramina or fissures in the cranium and are covered by tubular sheaths derived from cranial meninges.

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2
Q

What are the 12 cranial nerves?

A 
Oh, Oh, Oh, to touch and feel very girly vaginas so heavenly
CN I - olfactory
CN II - optic
CN III - oculomotor
CN IV - trochlear
CN V - trigeminal
CN VI - abducens
CN VII - facial
CN VIII - vestibulocochlear
CN IX - glossopharygneal
CN X - vagus
CN XI - spinal accessory
CN XII - hypoglossal
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3
Q

What are the functions of the 12 cranial nerves?

A

Some say marry money but my brother says big boobs matter most
CN I - sensory, CN II - sensory, CN III - motor, CN IV - motor, CN V - both, CN VI - motor, CN VII - both, CN VIII - sensory, CN IX - both, CN X - both, CN XI - motor, CN XII - motor

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4
Q

What is the function of CN I (olfactory nerve)?

A

Special sensory: in uppermost part of nasal cavity, sense of smell.

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5
Q

What is the route of CN I (olfactory nerve)?

A

From forebrain, through olfactory tract then olfactory bulb then goes through cribriform plate to nose.

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6
Q

What are potential sequelae of fracture of the cribriform plate?

A

Leakage of CSF from nose - rhinorrhoea. Or anosmia (loss of sense of smell).

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7
Q

What is the function of CN II (optic nerve)?

A

Sensory: vision.

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8
Q

What is the route of CN II (optic nerve)?

A

From retina, then passes through optic canal. Nerves cross over at optic chiasm so there is mixing of fibres. Then goes into forebrain as optic tracts.

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9
Q

How can a tumour affect the visual pathway?

A

Tumours squash optic chiasm so visual field deficit is present in both eyes.

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10
Q

What is the route of CN III (oculomotor)?

A

Comes off midbrain, enters orbit passing through superior orbital fissure then to the orbit.

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11
Q

What is the function of CN III (oculomotor)?

A

Motor innervation of ocular muscles to move eyeball (4 of 6 eye muscles).
Autonomic function to control pupil constriction.

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12
Q

What is the clinical relevance of the cavernous sinus?

A

It’s created by dura between periosteal and other layers of dura. Internal carotid artery, veins, and cranial nerves run through it.

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13
Q

How does CN III (oculomotor) nerve lesion present?

A

Eye goes down and out, ptosis.

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14
Q

What is the route of CN IV (trochlear nerve)?

A

From forebrain, dorsal aspect. Longest nerve as it has to travel further to get into orbit via superior orbital fissure. It passes through cavernous fissure.

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15
Q

What is the function CN IV (trochlear nerve)?

A

Motor for one of the six extraocular muscles - superior oblique.

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16
Q

What is the route of CN V (trigeminal nerve)?

A

From the pons, gives rise to sensory components in swelling - trigeminal ganglion, sensory nerves synapse and divide into three divisions: opthalmic, maxillary, and mandibular.

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17
Q

What are the routes of the branches of CN V?

A

V1 (opthalmic) -> superior orbital fissure to eye.
V2 (maxillary) -> foramen rotundum.
V3 (mandibular) -> foramen ovale to muscles of mastication.

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18
Q

What are the functions of CN V (trigeminal nerve)?

A

Special sensory: sensation to face (inside mouth, nasal cavities, sinus).
Motor: muscles of mastication.

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19
Q

What is the route of CN VI (abducens nerve)?

A

From the pons, then through cavernous sinus and enters orbit through superior orbital fissure.

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20
Q

What is the function of CN VI (abducens nerve)?

A

Motor to supply the lateral rectus muscle of eye.

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21
Q

How do CN VI lesions present?

A

Diplopia.

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22
Q

What is the route of CN VII (facial nerve)?

A

From the pons, complex route. Passes into petrous part of temporal bone through internal acoustic meatus then gives off branch to ear at petrous part of temporal bone. Exits through stylomastoid foramen and gives off five terminal branches that pass through parotid gland.

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23
Q

What are the functions of CN VII (facial nerve)?

A

Motor for muscles of facial expression, main function.
Special sensory of taste on anterior 2/3 of tongue.
Autonomic of parasympathetic to lacrimal and salivary glands.

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24
Q

What is Bell’s palsy?

A

Damage to CN VII (facial nerve) leading to muscles of facial expression becoming paralysed on that side.

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25
Q

What is the route of CN VIII (vestibulocochlear nerve)?

A

From pons, goes through internal acoustic meatus and terminates in petrous part of temporal bone. Gives off branch to semicircular canalas and cochlear.

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26
Q

What are the functions of CN VIII (vestibulocochlear nerve)?

A

Special sensory - hearing and balance.

27
Q

What is an acoustic neuroma?

A

Tumour that grows on the vestibulocochlear nerve (CN VIII) in the internal acoustic canal.

28
Q

What is the route of CN IX (glossopharyngeal nerve)?

A

From medulla and goes through jugular foramen.

29
Q

What are the functions of CN IX (glossopharyngeal nerve)?

A

General sensory for soft palate, tonsils, and oropharynx, also tympanic membrane.
Special sensory for taste and general sensation of posterior 1/3 of the tongue and sensory from carotid body and sinus.
Autonomic innervation to parotid gland.
Motor function for stylopharyngeus muscle.

30
Q

What is the route of CN X (vagus nerve)?

A

From the medulla then exits skull through jugular foramen and goes into carotid sheath and down neck.

31
Q

What are the functions of CN X (vagus nerve)?

A

General sensory to laryngopharynx, larynx, and to small part of ear.
Motor innervation to muscles of soft palate, pharynx, and larynx.
Autonomic parasympathetic innervation to thoracic and abdominal viscera to innervate glands.
Some special sensory.

32
Q

What is the route of CN XI (spinal accessory nerve)?

A

From medulla and goes through jugular foramen.

33
Q

What is the function of CN XI (spinal accessory nerve)?

A

Motor innervation of sternocleidomastoid and trapezius muscles.

34
Q

Where is the CN XI (spinal accessory nerve) vulnerable to damage?

A

In the posterior triangle of the neck.

35
Q

What is the route of CN XII (hypoglossal nerve)?

A

From the medulla then goes through the hypoglossal canal and runs medial to mandible, just behind.

36
Q

What is the function of CN XII (hypoglassal nerve)?

A

Motor innervation to the muscles of the tongue.

37
Q

What is the sympathetic innervation of the head and neck via?

A

The sympathetic trunk.

38
Q

Where is the sympathetic trunk?

A

Anterolateral to the vertebral column, lying on the prevertebral fascia and muscles, and deep to carotid sheath.

39
Q

Where do preganglionic fibres arise and synapse?

A

Arise - thoracic neural segment.

Synapse - one of the three cervical sympathetic ganglia.

40
Q

What are the cervical sympathetic ganglia?

A

Superior, middle, and inferior.

41
Q

How do postganglionic fibres travel after synapsing at the cervical sympathetic ganglia?

A

Travel as the internal and external carotid nerve along blood vessels to target tissues.

42
Q

What/where do postganglionic fibres from superior cervical ganglion pass with and to?

A

With internal and external carotid arteries and its branches to pharyngeal plexus, upper 4 cervical nerves, cardiac branch to cardiac plexus.

43
Q

What/where do postganglionic fibres from middle cervical ganglion pass with and to?

A

Inferior thyroid artery to 5th and 6th cervical nerves, cardiac branch to cardiac plexus.

44
Q

What/where do postganglionic fibres from inferior cervical ganglion pass with and to?

A

Vertebral artery to the 7th and 8th cervical nerve, cardiac branch to cardiac plexus. Combines with 1st thoracic ganglion to form Stellate ganglion in 80% of people.

45
Q

What are the four pairs of parasympathetic ganglia in the head?

A

Ciliary ganglion, pterygopalatine ganglion, submandibular ganglion, otic ganglion.

46
Q

What are the brainstem nuclei cranial nerves?

A

Oculomotor (CN III), facial (CN VII), glossopharyngeal (CN IX), and vagus (CN X).

47
Q

What are the three cranial nerves that have branches that reach the parasympathetic ganglia?

A

Oculomotor -> ciliary ganglion. Facial -> pterygopalatine/submandibular ganglion. Glossopharyngeal -> otic ganglion.

48
Q

Where is the ciliary ganglion?

A

Lies in orbital cavity, lateral to optic nerve.

49
Q

What are the parasympathetic fibres derived from oculomotor nerve (CN III)?

A

Sphincter papillae, and ciliary muscles.

50
Q

Where do the sympathetic fibres from the superior cervical ganglion travel?

A

Via the plexus on opthalmic artery to be distributed to eyeball.

51
Q

Which sensory fibres pass to nasociliary nerve?

A

One from the eyeball.

52
Q

Where is the pterygopalatine ganglion?

A

In the pterygopalatine fossa.

53
Q

What is the pterygopalatine ganglion connected to?

A

The maxillary nerve (CN V2) by small branches.

54
Q

What are the parasympathetic fibres derived from facial nerve (CN VII)?

A

Lacrimal glands, glands of the nose, palate, and nasopharynx via the greater pterosal nerve.

55
Q

Where do the sympathetic fibres from superior cervical ganglion travel?

A

Via the plexus on internal carotid artery to be distributed to nose, palate, and nasopharynx.

56
Q

Where is the submandibular ganglion?

A

Suspended from the lingual nerve by small branches.

57
Q

Where are parasympathetic fibres of the submandibular ganglion derived from?

A

The facial nerve (CN VII) via the chorda tympani then the lingual nerve - submandibular gland, sublingual gland.

58
Q

Where do sympathetic fibres from superior cervical ganglion in submandibular ganglion go?

A

Along facial nerve and pass to glands in floor or oral cavity.

59
Q

Where are parasympathetic fibres derived from in otic ganglion?

A

Glossopharyngeal nerve via auriculotemporal nerve to parotid gland.

60
Q

Where do sympathetic fibres from superior cervical ganglion of otic ganglion go?

A

Along middle meningeal artery and pass into parotid gland.

61
Q

What is the direct supply of the glossopharnygeal nerve (CN IX)?

A

Direct or via pharyngeal plexus to glands of oropharynx and posterior third of tongue.

62
Q

What is the direct supply from vagus nerve (CN X)?

A

Glands of laryngopharynx, larynx, oesophagus, and trachea.

63
Q

What is Horner’s syndrome?

A

Interruption of cervical sympathetic trunk.

64
Q

What are the signs in Horner’s syndrome?

A

Miosis - constriction of pupil as parasympathetic stimulation of sphincter papillae is unopposed.
Ptosis - drooping of superior eyelid due to paralysis of levator palpebrae superioris that constitutes superior tarsal muscle.
Vasodilation - redness and increased temperature of skin and loss of sympathetic tone.
Anhydrosis - absence of sweating.

14. Head and Neck (11 decks)

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