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Facial Nerve (VII), IX & XIIFacial Nerve (VII), IX & XII
Alex ForrestAssoci ate Profess or of For ensic Od ontol ogyForensic Science Research & Innovation Centre, Griffith UniversityConsultant Forensic Odontologist,Queensland Health Forensic and Scientific Services,
39 Kessels Rd, Coopers Plains, Queensland, Australia 4108
Oral Biology
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Do not remove this notice
Learning ObjectivesLearning Objectives
You should be able to describe VII and its importance in
dental practice.
You should be able to understand and explain the role of IX in
the innervation of the tongue and oropharynx, and theimportance of the gag reflex.
You should be able to understand and explain the role of X in
the innervation of the oropharynx.
You should understand the basic functions of XII.
You should be able to discuss the cervical plexus and its
branches.
This session considers the facial nerve, cranial nerve VII.
This nerve is important to a dentist because it can
inadvertently be anaesthetized while an inferior dental
block injection is being performed.
VII - Facial NerveVII - Facial Nerve
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It can be injured both from trauma and from surgery.
There are various conditions that can affect this nerve.
We need to know its structure and its functions, so we can
diagnose problems and predict and manage the outcomesin our patients.
VII - Facial NerveVII - Facial Nerve Learning ObjectivesLearning Objectives
You should be able to understand and explain the
structural and functional aspects of the anatomy of VII
You should be able to understand and explain in detail
the role of the chorda tympani in taste and innervationof major and minor salivary glands
Learning ObjectivesLearning Objectives
You should understand and be able to explain the
causes, consequences and management of accidental
anaesthesia of VII.
The facial nerve contains a small general sensorycomponent which provides common sensation to parts of
the external ear, and also a special sensory component
which is responsible for innervating taste buds.
VII - Facial NerveVII - Facial Nerve
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The somatic motor component (the largest part of this
nerve) provides the motor supply to the muscles of facial
expression and other muscle derivatives of the second
branchial arch.
There is a parasympathetic secretomotor component that
travels with both the facial nerve and lingual nerve of the
trigeminal nerve to the sublingual, submandibular and
lacrimal glands.
VII - Facial NerveVII - Facial Nerve Facial Nerve OriginFacial Nerve Origin
The Facial Nerve
arises from the
pons caudal to
the trigeminal
nerve, close to
the position of the
internal acousticmeatus through
which it passes
with VIII.
From Grays Anatomy, Longman, London, 35 th Edition, 1973. p 1012.
Facial Nerve OriginFacial Nerve Origin
It comprises two
roots - a larger motor
root and a smaller
sensory root. The
motor root is simply
named the motor root
of VII, but thesensory root is
sometimes called
nervus intermedius
because it lies
sandwiched between
the motor root of VII
and the trunk of VIII
in this location. From Grays Anatomy, Longman, London, 35 th Edition, 1973. p 1012.
The large motor root carries the motor fibres to themuscles of facial expression, the posterior belly of the
digastric muscle, the stapedius and the stylohyoid,
because all of these structures are derived from the
second branchial arch.
VII - Facial NerveVII - Facial Nerve
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The sensory root carries general sensory fibres to parts of
the external ear, and also carries the special sensation of
taste to the anterior two-thirds of the tongue and also to
the palate.
VII - Facial NerveVII - Facial Nerve VII - Facial NerveVII - Facial Nerve
The sensory root contains some parasympathetic
secretomotor fibres as well, and these supply the
submandibular and sublingual salivary glands, as well as
the lacrimal glands and the minor mucous glands of thenose and palate.
Facial Nerve OriginFacial Nerve Origin
The motor root and
nervus intermedius
run together with the
vestibulocochlear
nerve (VIII, also
known as the auditorynerve) into the internal
acoustic meatus in the
temporal bone.
The facial nerve runs
superiorly to VIII in a
groove along its upper
surface. From Grays Anatomy, Longman, London, 35 th Edition, 1973. p 1012.
Facial Nerve OriginFacial Nerve Origin
The facial nerve and the
vestibulocochlear nerves
soon separate in their
courses.
VIII moves off towards theinner ear, but the two roots of
VII join soon after it enters
the internal acoustic meatus,
and they continue as a single
nerve trunk in the facial
canal which angles obliquely
forwards through the petrous
temporal bone.From Grays Anatomy, Longman, London, 35 th Edition,
1973. p 1012.
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Facial Nerve CourseFacial Nerve Course
The nerve runs forward and laterally in the facial canal
until it comes close to the cavity of the middle ear.
At this point, it turns sharply posteriorly and inferiorly and
heads downwards towards the stylomastoid foramen.
At the bend, the nerve trunk
becomes swollen into the
geniculate ganglion, where
the nerve cell bodies of the
somatic sensory nerves are
stored.
The bend is given the nameexternal genu, after the
Latin word for knee, genu
(from which the word
genuflect comes).
From Grays Anatomy, Longman, London, 35 th Edition,
1973. p 1012.
VII - Facial NerveVII - Facial Nerve
As the facial nerve
reaches the external
genu, it gives off an
important branch
called the greater
petrosal nerve, or
sometimes the
greater superficial
petrosal nerve.
This nerve arises
from the geniculate
ganglion.
From Grays Anatomy, Longman, London, 35 th Edition, 1973. p 1012.
VII - Facial NerveVII - Facial Nerve
Fibres from this ganglion are mainly taste fibres for the
palate, but it contains parasympathetic secretomotor
fibres for the lacrimal gland and minor salivary glands as
well.
VII - Facial NerveVII - Facial Nerve
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The greater petrosal nerve
runs forward and medially in
a small canal to emerge
from a tiny hole on the
cranial surface of the
petrous temporal bone
called the hiatus for the
greater superficial petrosalnerve, and runs medially
and slightly anteriorly in a
groove in the floor of the
middle cranial fossa.From Grays Anatomy, Longman, London, 35 th Edition,
1973. p 1012.
VII - Facial NerveVII - Facial Nerve
It continues
underneath the
trigeminal ganglion to
run over the roof of
foramen lacerum
towards a small
canal in its anterior
wall of foramen
lacerum called thepterygoid canal
which opens into the
pterygopalatine
fossa.From Grays Anatomy, Longman, London, 35 th Edition, 1973. p 1012.
VII - Facial NerveVII - Facial Nerve
Here the parasympathetic secretomotor fibres for the lacrimal
gland and the minor salivary glands of the palate and upper lip
synapse, and their postganglionic fibres follow the branches of the
trigeminal nerve to get to their final destinations.
From Grays Anatomy, Longman, London, 35 th Edition, 1973. p 1006.
VII - Facial NerveVII - Facial Nerve
Taste fibres do not synapse in the pterygopalatine ganglion
because they are not parasympathetic fibres, but pass to
the palate via the greater and lesser palatine nerves of V2.
From Grays Anatomy, Longman, London, 35 th Edition, 1973. p 1006.
VII - Facial NerveVII - Facial Nerve
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Parasympathetic secretomotor fibres to glands of the nasal
cavity travel in the sphenopalatine nerve.
From Grays Anatomy, Longman, London, 35 th Edition, 1973. p 1006.
VII - Facial NerveVII - Facial Nerve
After the external genu,
the trunk of the facial
nerve turns backwards
and downwards to run
towards the stylomastoid
foramen.
When it is about 5-6 mm
from this foramen, andstill in the facial canal, it
is very closely related to
the cavity of the middle
ear, which sits just
anterior to it.
From Grays Anatomy, Longman, London, 35 th Edition, 1973.
p 1012.
VII - Facial NerveVII - Facial Nerve
VII - Facial NerveVII - Facial Nerve
In this position, the facial
nerve is vulnerable to
damage arising from
operations performed onthe middle ear.
Here, it gives off a small
but very important
branch called the chorda
tympani.
From Grays Anatomy, Longman, London, 35 th Edition,
1973. p 1012.
Chorda TympaniChorda Tympani
This small nerve provides the parasympathetic
secretomotor fibres to the submandibular and sublingual
salivary glands and to the minor glands of the floor of the
mouth, as well as providing taste fibres to the anterior
two-thirds of the tongue.
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Facial NerveFacial Nerve
It does this by
"hitching a ride"
with the lingual
nerve of V3.
However, it needs
to get to the
lingual nerve, and
at this point it isstill deep within
the temporal
bone.
From Grays Anatomy, Longman, London, 35 th Edition, 1973. p 1008.From Grays Anatomy, Longman, London, 35th Edition, 1973. p 1008.
Facial BranchesFacial Branches
Once it is in the parotid gland, the nerve gives off motor
branches to the posterior belly of the digastric and
stylohyoid muscles.
Facial BranchesFacial Branches
The nerve nowgives off five
major branches
that spread to
cover the face.
Scott JH & Dixon AD. Anatomy for Students of Dentistry. 3 rd
Edition, Churchill Livingstone, Edinburgh, 1972. p. 512
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Facial BranchesFacial Branches
They contain the bulk of the motor fibres of the large
motor root of this nerve, and they are distributed to the
muscles of facial expression to which they supply motor
function.
ParalysisParalysis
Paralysis of this nerve can therefore occur if one
inadvertently deposits local anaesthetic solution into the
parotid gland.
ParalysisParalysis
Sometimes a deep lobe
of the gland occurs
close to the positionwhere the inferior dental
block is to be
administered.
Modified from: Haglund, J. & Evers, H Local
Anaesthesia in Dentistry, Astra Lkemedel
Sdertlje, 2nd Edition, 1975. p. 52.
ParalysisParalysis
When this happens, all
the branches of the
facial nerve in the
gland become
anaesthetized,
resulting in facial
paralysis on the
affected side.
Illustrated Handbook in Local Anaesthesia, Ed: E. Eriksson,
Munksgaard, Denmark, 1969, p.67.
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Motor SupplyMotor Supply
These branches supply motor fibres to muscles of facial
expression in their immediate vicinity.
IX Glossopharyngeal
Nerve
The glossopharyngeal nerve exits the upper part of the
medulla oblongata below the pons by a few filaments which
contain both sensory and motor fibres.
It supplies motor fibres to stylopharyngeus, secretomotor
fibres to the parotid gland, and sensory fibres to the pharynx,
tonsil, and the back of the tongue.
It also supplies taste fibres to the posterior 1/3 of the tongue.
IX - Glossopharyngeal NerveIX - Glossopharyngeal Nerve
From Grays Anatomy, Longman, London, 38 th Edition, 1989. p 1119.
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Sensory nuclei :
nucleus of the solitary tract (taste)
nucleus of the spinal tract (common sensation)
Motor nuclei :
nucleus ambiguus
inferior salivatory nucleus (parotid gland)
IX - Glossopharyngeal NerveIX - Glossopharyngeal Nerve
The nerve leaves the cranium through the anterior part of the
jugular canal together with X and XI, and becomes covered in
a layer of dura mater as it approaches the opening of the canal.
Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, Ciba-Geigy Medical, Plate 120.
IX - Glossopharyngeal NerveIX - Glossopharyngeal Nerve
Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, Ciba-Geigy Medical, Plate 120.
As it passes through the canal, it features two small swellings
called thejugular or super io r, and pet rosal or in fer ior
ganglia.
IX - Glossopharyngeal NerveIX - Glossopharyngeal Nerve IX - Glossopharyngeal NerveIX - Glossopharyngeal Nerve
Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey,
Ciba-Geigy Medical, Plate 119.
The superior ganglion
is regarded as a
detached part of the
larger inferior one so
they basically make upone single classical
sensory ganglion
between them, and
they therefore contain
the cell bodies of the
sensory fibres.
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Tympanic Branch of IXTympanic Branch of IX
The tympanic
branch is a
tiny branch
given off just
after IX leaves
the jugularcanal.
Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, Ciba-Geigy
Medical, Plate 119.
Tympanic Branch of IXTympanic Branch of IX
If you look carefully on a skull, you may see a small foramen in
between the jugular canal and the carotid canal, and it is
through this foramen that the tympanic branch passes into the
tympanic canaliculus.
Modified from:
McMinn, R &
Hutchings, R. A
Colour Atlas of
Human Anatomy.
Wolfe Medical
Publication,
Netherlands, 2nd
Edition 1988.
p.58.
Tympanic Branch of IXTympanic Branch of IX
The tympanic
canaliculus takes
the tympanic
nerve up to the
middle ear, and
here it joins witha branch of the
facial nerve (VII)
to form the
tympanic plexus
in the wall of the
middle ear.
Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, Ciba-Geigy
Medical, Plate 119.
Tympanic Branch of IXTympanic Branch of IX
Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, Ciba-Geigy
Medical, Plate 119.
The most
important branch
of this plexus is
the lesser
superficial
petrosal nerve,which contains
parasympathetic
secretomotor
fibres from IX
originating in the
inferior salivatory
nucleus.
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It runs in a small
canal to appear
on the floor of
the middle
cranial fossa just
laterally to the
hiatus for thegreater
superficial
petrosal nerve.
From Grays Anatomy, Longman, London, 38 th Edition, 1989. p 1107.
Lesser Petrosal NerveLesser Petrosal Nerve
Here it lies in a small
groove, parallel and
just laterally to the
greater petrosal
nerve, and passes
through foramen
ovale or sometimes
through the
canaliculus
innominatus, which
lies medial to
foramen spinosum.From Grays Anatomy, Longman, London, 38 th Edition, 1989. p 1107.
Lesser Petrosal NerveLesser Petrosal Nerve
From Grays Anatomy, Longman, London, 38 th Edition,
1989. p 1105.
It turns inferiorly to pass
through the canal or
foramen, and then runs to
the otic ganglion, aparasympathetic ganglion
associated with the
mandibular division of the
trigeminal nerve which lies
deep to the main nerve
trunk.
Lesser Petrosal NerveLesser Petrosal Nerve
From Grays Anatomy, Longman, London, 38 th Edition, 1989. p
1105.
Postganglionic
secretomotor fibres
then run in theauriculotemporal
nerve to reach and
supply the parotid
gland.
Lesser Petrosal NerveLesser Petrosal Nerve
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Tonsillar BranchesTonsillar Branches
The tonsillar branches ramify to form a plexus in the region
of the palatine tonsil, and are distributed to provide
sensation in the upper part of the pharyngeal wall and
around the auditory tube.
They are not important to us in this course.
Lingual BranchesLingual Branches
The lingual branches
run deep to the
hyoglossus muscle of
the tongue, and supply
general sensation and
taste to the posteriorone-third of the
tongue.
From Grays Anatomy, Longman, London, 38 th Edition, 1989. p 1119.
X Vagus NerveThis nerve contains both sensory and motor components,
and has a wider distribution than any other cranial nerve.
The term vagus means wandering.
It does not feature separate sensory and motor roots, but it
does have sensory ganglia like IX.
X - Vagus NerveX - Vagus Nerve
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Its sensory fibres are distributed to the larynx and
epiglottis.
It also contains visceral components distributed to the
autonomic muscles of the heart, bronchi, and most of the
digestive tract, and also some taste fibres.
It provides motor innervation to the muscles of the larynx,
and is important in speech.
X - Vagus NerveX - Vagus Nerve
The vagus nerve leaves the cranium through the jugular
canal with IX and XI. It has two ganglia like IX.
The superior ganglion lies in the jugular canal, and the
inferior ganglion is found after the nerve exits the canal.
Both ganglia contain the nerve cell-bodies of somaticsensory fibres.
X - Vagus NerveX - Vagus Nerve
It supplies sensory and
motor functions to the
larynx allowing us to
speak.
It works closely with V,
VII, IX and XII to allow
us to articulate words
properly.
From Grays Anatomy, Longman,
London, 38th Edition, 1989. p.
1117
It helps control the
heart rate, innervates
the organs ofrespiration, and has
sensors to help control
the blood pressure.
From Grays Anatomy, Longman,
London, 38th Edition, 1989. p.
1117
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It helps us control
digestion and the
movement of food
through most of the
digestive tract as far
down as the
mid-colon.
The distribution of the
vagus in the thorax
and abdomen neednot be known.
From Grays Anatomy, Longman,
London, 38th Edition, 1989. p.
1117
XII Hypoglossal Nerve
The hypoglossal nerve also arises from the medulla as a
series of filaments, which pass behind the vertebral arteryto form a common nerve trunk.
This nerve trunk exits the cranial cavity through the
anterior condylar (hypoglossal) canal.
XII - Hypoglossal NerveXII - Hypoglossal Nerve
It descends in the carotid
sheath and turns
forwards to hook around
the origin of the occipital
artery.
It passes deep to
stylohyoid and enters the
floor of the mouth
between mylohyoid and
hyoglossus muscles.
From Grays Anatomy, Longman,
London, 38th Edition, 1989. p 1119.
XII - Hypoglossal NerveXII - Hypoglossal Nerve
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It communicates with the
lingual nerve and then
penetrates the tongue
below the sublingual
gland.
It supplies the intrinsic
and all the extrinsic
muscles of the tongue
except the palatoglossus,which is supplied by XI
via the pharyngeal
plexus.
From Grays Anatomy, Longman,
London, 38th Edition, 1989. p 1119.
XII - Hypoglossal NerveXII - Hypoglossal Nerve XII - Hypoglossal NerveXII - Hypoglossal Nerve
It is responsible for most movements of the tongue and
plays a critical role in speech and mastication.
If it is injured, the tongue deviates towards the damaged
side when it is stuck out.Why do you think this might be?
Cervical Plexus
When spinal nerves exit the vertebral column, they split into
dorsal and ventral rami. In general, the ventral rami are larger
than the dorsal ones.
In the thoracic region, the ventral rami run independently of
each other and they retain, like all dorsal rami, a more-or-less
segmental distribution.
Nerve PlexiNerve Plexi
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However, in the
cervical, lumbar and
sacral regions, they
unite near their origins
to form plexuses.
http://www.esb.utexas.edu/quinn/
Bio416K/Nervous%20system/Ana
t%2014.7.jpeg
Nerve PlexiNerve Plexi
There are 8 cervical spinal
nerves.
The ventral rami of the upper 4
of these unite to form the
cervical plexus.
Those of the lower 4 unite with
part of the ventral ramus of thefirst thoracic nerve to form the
brachial plexus.
http://www.esb.utexas.edu/quinn/Bio416K/Nervous%20
system/Anat%2014.7.jpeg
Cervical PlexusCervical Plexus
Note that each nerve in the
cervical plexus receives at
least one grey ramus
communicans from the
sympathetic chain.The upper four nerves
receive theirs from the
superior cervical ganglion,
while the 5th and 6th receive
theirs from the middle
cervical ganglion.
http://www.bartleby.com/107/Images/large/image844.gif
Cervical PlexusCervical Plexus
The cervical plexus is
formed by the ventral
rami of the upper four
cervical spinal nerves.
It supplies branches to
some of the muscles of
the neck, and to parts of
the skin of the head,
neck and chest.
http://imc.gsm.com/integrated/haonline/haonline/ha/figimgs/25_3.gif
Cervical PlexusCervical Plexus
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To make it easier to
understand, we divide the
branches into superficial
and deep groups:
superficial branches
ascending
descending
deep branches
Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p.1128
ascending
descending
Cervical PlexusCervical Plexus
Superficial Ascending Branches:
Lesser Occipital Nerve
Great Auricular Nerve
Transverse Cervical Nerve
Superficial Descending Branches:
Medial Supraclavicular Nerve
Intermediate Supraclavicular Nerve
Lateral Supraclavicular Nerve
Cervical PlexusCervical Plexus
Superficial Ascending
Branches:
Lesser Occipital Nerve
Great Auricular Nerve
Transverse Cervical Nerve
Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p.1128
Modified from:
Grays Anatomy,
Longmans,
London, 38th Ed
1989 p.1129
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Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p.1128
Superficial
Descending Branches:
Medial Supraclavicular Nerve
Intermediate SupraclavicularNerve
Lateral Supraclavicular Nerve
Modified from:
Grays Anatomy,
Longmans,
London, 38th Ed
1989 p.1129
Cervical PlexusCervical Plexus
Medial Deep Branches:
communicating branches with X & XII
muscular branches inc. phrenic nerve & inferior root of ansa
cervicalis
Lateral Deep Branches:
communicating branches with XI
muscular branches
Modified from:
Grays Anatomy,
Longmans,
London, 38th Ed
1989 p.1128
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Modified from: Grays Anatomy, Longmans, London, 38th Ed
1989 p.1129
It loops around the
accessory nerve XI and
ascends along the
posterior border of the
sternocleidomastoid
muscle.
It passes upwards onthe side of the head
behind the auricle of the
ear, where it supplies
skin in this region.
Lesser Occipital Nerve
Superficial Ascending BranchesSuperficial Ascending Branches
Modified from: Grays Anatomy, Longmans, London, 38th Ed
1989 p.1129
It curves around the
posterior border of
sternocleidomastoid
muscle, just like the
lesser occipital and
ascends on
sternocleidomastoid
beneath the platysmamuscle with the external
jugular vein up to the
parotid gland, where it
divides into an anterior
and a posterior branch.
Great Auricular Nerve
Superficial Ascending BranchesSuperficial Ascending Branches
Modified from: Grays Anatomy, Longmans, London, 38th Ed
1989 p.1129
The anterior branch
supplies the skin of the
face in the region
overlying the parotid
gland.
The posterior branch
supplies skin over the
mastoid process and the
lower 2/3 of the back of
the auricle, as well as
the lobule and the
concha of the ear.
Great Aur icular Nerve
Superficial Ascending BranchesSuperficial Ascending Branches
Modified from: Grays Anatomy, Longmans, London, 38th Ed
1989 p.1129
This nerve curves
around the posterior
border ofsternocleidomastoid to
run obliquely forwards
deep to the external
jugular vein to reach the
anterior border of this
muscle.
Transverse Cervical
(Cutaneous) Nerve
Superficial Ascending BranchesSuperficial Ascending Branches
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Modified from: Grays Anatomy, Longmans, London, 38th Ed
1989 p.1129
Then it penetrates the
deep cervical fascia and
divides into ascending
and descending
branches deep to theplatysma.
Transverse Cervical
(Cutaneous) Nerve
Superficial Ascending BranchesSuperficial Ascending Branches
The ascending branches pass upwards to form a plexus with
the cervical branch of VII, and some pass through platysma to
supply the skin of the upper and front parts of the neck. They
sometimes also form an accessory nerve supply to the
lower incisor teeth.The descending branches pierce platysma to supply the skin
on the front and sides of the neck, as far down as the sternum.
Transverse Cervical (Cutaneous ) Nerve
Superficial Ascending BranchesSuperficial Ascending Branches
Modified from: Grays Anatomy, Longmans, London, 38th
Ed 1989 p.1129
These supply skin
down to the
second rib, and
medially to the
midline.
Medial Supraclavicular
Nerves
Superficial Descending BranchesSuperficial Descending Branches
Modified from: Grays Anatomy, Longmans, London, 38th
Ed 1989 p.1129
These supply skinoverlying pectoralis
major and the
deltoid muscle.
Intermediate Supra-
clavicular Nerves
Superficial Descending BranchesSuperficial Descending Branches
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Modified from: Grays Anatomy, Longmans, London, 38th
Ed 1989 p.1129
Superficial Descending BranchesSuperficial Descending Branches
These supply skin
over the upper and
posterior parts of
the shoulder.
Lateral Supra-
clavicular Nerves
Modified from: Grays Anatomy,
Longmans, London, 38th Ed 1989 p.1128
Descendens hypoglossi(superior root)
Descendens cervicalis(inferior root)
Ansa Cervical is
Two components:
Deep BranchesDeep Branches
Modified from: Grays Anatomy,
Longmans, London, 38th Ed 1989 p.1128
Deep BranchesDeep Branches
Motor to all the
infrahyoid strap
muscles with the
exception of the thyro-hyoid, which is supplied
by C1 via a branch
which travels with the
hypoglossal nerve.
Ansa Cervical is
Modified from: Grays Anatomy,
Longmans, London, 38th Ed 1989 p.1128
Deep BranchesDeep Branches
This is the only source
of motor innervation to
the diaphragm. It arises
mainly from C4, butreceives contributions
from C3 and C5.
Three, four and five
Keep the diaphragm
alive!
Phrenic Nerve
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The End