Head and NeckLower four cranial nerves

Professor Dr. Mohamed El Fiky

Professor of anatomy and embryology

Cranial Nerves

Motor Sensory mixed

3,4,6,11&12 1,2&8 5,7,9,10

Cranial nerves contain parasympathetic fibers

3,7,9&10Attachment of Cranial nerves to brain stem

3&4 midbrain

5,6,7&8 pons

9,10,11&12

Medulla oblongata

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Rootlets of the Hypoglossal Nerve

Olive

Preolivary Fissure

Pyramid

oculomtor

trochlear

abducent

facial

vestibulocochlearglossopharyngeal

vagus

accessory

trigeminal

Attachment of Cranial nerves to brain stem

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Vagus Nerve

Facial Nerve

GlossopharyngealNerve

qOrigin : It is a mixed cranial nerve attached tomedulla oblongataqCourse : The glossopharyngeal Nerve LeavesThe Skull Through jugular foramen .Course and Distribution :qLeaves the skull thorough the jugular formen.qPasses with the stylopharyngeus between the

external and internal carotid arteriesqPasses deep to the hyoglossus muscle.q Enters the pharynx between the superior and

middle constrictor muscles of the pharynx.

Branches: 1. Tympanic nerve (nerve of jacopson): carry

parasympathetic to to the parotid gland.

2. Carotid branch : to the carotid sinus andthe carotid body.

3. Pharyngeal branches : forms the sensory partof the of the pharyngeal plexus;carrying sensations from the pharynx.

4. Muscular branch : supplies thestylopharyngeus muscle.

5. Tonsillar branches : to the palatine tonsil6. Lingual branches : convey taste and generalsensations from the posterior 1/3 of the tongue.

Glossopharyngeal nerve

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qOrigin : It is mixed cranial nerve attached to medullaoblongataqCourse : The vagus Nerve Leaves The Skull Through Thejugular foramenqCourse and Distribution : It is present in the carotidsheath and it inter the thorax . It gives the follwingbranches in the neck :1- auricular branch .2- meningeal branch3- pharyngeal branch to share in the pharyngeal plexus4- superior laryngeal nerve which is subdivided into :

a. internal laryngeal which is sensory to cavity oflarynx above vocal cord .

b. external laryngeal which is motor to cricothyroidmuscle

Vagus Nerve

5- branch to carotid body6- cardiac branches to

cardiac plexus7- right recurrent

laryngeal ( the left onearise in the thorax)

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Unilateral ParalysisAccumulation

ofSaliva and Food

Paralyzed Side During PhonationRemoval of Arytenoid Cartilage

Injury of Vagus Nerves

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Accessory nerveAccessory NerveCranial Part

C1

C2

C3

C4

C5

Nucleus Ambiguous

Spinal Part

qIt is a purely motor attached to medulla oblongataqIt leave the skull through jugular foramen .qIt has two roots :

qCranial root from medulla oblongataqSpinal root from upper five cervical spinal segments

qThe cranial root : joins the vagus and isdistributed through its pharyngeal , laryngealbranches.qThe spinal root Descends in the neck to supplyboth sternomastoid and trapezius muscle

Branches : (A) Cranial accessory: joins the vagus and isdistributed through its:1. Pharyngeal branch : to supply all the muscles

of the pharynx except the stylopharyngeus andall muscles of palate except the tensor palati

2. Laryngeal branches : to the muscles of thelarynx.

(B) Spinal accessory : supplies 2 muscles:a. Sternomastoid muscle.b. Trapezius muscle.

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Thyro-hyoid

Hypoglossal Nucleus

Omohyoid

Sternothyroid

Hypoglossal Nerve

Hypoglossal nerve qOrigin : It is a motor cranial nerve attached to medulla oblongataqCourse : The Hypoglossal Nerve Leaves The Skull Through The Anterior Condylar Canal

(Hypoglossal Canal)qDistribution : It is the motor nerve of all muscles of the tongue EXCEPT The Palatoglossus

Muscle Which is supplied by Vagus Nerve

Intrinsic Muscles of The Tongue:1-Longutudinal2-Horizontal3- Oblique

Genioglossus

styloglossus

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The Tongue Points to The Affected Side

Tongue

HealthyGenioglissus

Mandible

ParalysedGenioglissus

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The Cervical Sympathetic Trunk

Superior Cervical Ganglion(At The Level of C2 and C3 Vertebrae)

Middle Cervical Ganglion(At The Level of C6 Vertebra)

Inferior Cervical Ganglion(Lies Between Transverse Process of C7

and First Rib)

Fused with The First Thoracic Ganglion(Stellate Ganglion)

The cervical portion of the sympathetic trunk consists of three ganglia, distinguished, according to their positions, as the superior, middle,and inferior ganglia, connected by intervening cords. This portion receives no white rami communicantes from the cervical spinal nerves; its spinal fibers are derived from the white rami of the upper thoracic nerves, and enter the corresponding thoracic ganglia of the sympathetic trunk, through which they ascend into the neck.

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1-C

omm

unic

atin

g

C1

C2

C3

C4

9TH

10TH

11TH

2- Cardiac(Superior Cervical Cardiac Nerve)

3- Vascular To

Internal CarotidAnd

External Carotid

4- VisceralTo

Pharynx and Larynx

A- Superior Cervical Ganglion

q The superior cervical ganglion thelargest of the three, is placed opposite thesecond and third cervical vertebræ.

qBranches :1- communicating with upper four

cervical nerves2- cardiac superior cervical cardiac

nerve3- vascular to internal carotid and

external carotid4- visceral to pharynx and larynx

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C5C6

1- Communicating

2- Cardiac(Middle Cervical Cardiac Sympathetic Nerve)

3- VascularAround Inferior Thyroid Artery

4- Visceral To Trachea and Esophagus

Trachea

Esoph.

B- Middle Cervical Ganglion

The middle cervical ganglion is thesmallest of the three cervical ganglia,and is occasionally wanting. It is placedopposite the sixth cervical vertebra,

qBranches :1- communicating with C5 &C62- cardiac ( Middle cervical cardiac nerve )3- Vascular around inferior thyroid artery4- visceral to trachea and esophagus

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C- Branches of Inferior Cervical Ganglion

C7C8

1- Communicatintg

2- CardiacInferior Cervical

Cardiac Sympathetic Nerve

3- VascularAround

Subclavian Arteryand

Vertebral Artery

Ansa Subclavia

The inferior cervical ganglion is situatedbetween the base of the transverseprocess of the last cervical vertebra andthe neck of the first rib,

qBranches :1- communicating with C7&C82- cardiac ( Inferior cervical cardiac nerve )3- Vascular around subclavian and vertebral

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Horner’s Syndrome

Ptosis

Miosis

Anhydrosis

Flushing(Redness)

Injury of Cervical Sympathetic Chain

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