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Mohamed El Fiky, profile picture
Uploaded byMohamed El Fiky
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Lower four cranial nerves bmc

1) The document discusses several cranial nerves including their origin, course, and branches. It focuses on the glossopharyngeal nerve, vagus nerve, accessory nerve, and hypoglossal nerve. 2) It also discusses the cervical sympathetic trunk, including the three cervical ganglia (superior, middle, inferior) and their branches for communication, cardiac nerves, and blood vessels. 3) Horner's syndrome is mentioned as resulting from injury to the cervical sympathetic chain, causing ptosis, miosis, anhydrosis, and flushing.

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Cranial Nerves Overview•
Head and Neck Lower 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&10 Attachment of Cranial nerves to brain stem 3&4 midbrain 5,6,7&8 pons 9,10,11&12 Medulla oblongata Mohamed el fiky
Rootlets of the Hypoglossal Nerve Olive Preolivary Fissure Pyramid oculomtor trochlear abducent facial vestibulocochlear glossopharyngeal vagus accessory trigeminal Attachment of Cranial nerves to brain stem Mohamed el fiky
Vagus Nerve Facial Nerve Glossopharyngeal Nerve qOrigin : It is a mixed cranial nerve attached to medulla oblongata qCourse : The glossopharyngeal Nerve Leaves The Skull Through jugular foramen . Course and Distribution : qLeaves the skull thorough the jugular formen. qPasses with the stylopharyngeus between the external and internal carotid arteries qPasses 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 and the carotid body. 3. Pharyngeal branches : forms the sensory part of the of the pharyngeal plexus; carrying sensations from the pharynx. 4. Muscular branch : supplies the stylopharyngeus muscle. 5. Tonsillar branches : to the palatine tonsil 6. Lingual branches : convey taste and general sensations from the posterior 1/3 of the tongue. Glossopharyngeal nerve Mohamed el fiky
qOrigin : It is mixed cranial nerve attached to medulla oblongata qCourse : The vagus Nerve Leaves The Skull Through The jugular foramen qCourse and Distribution : It is present in the carotid sheath and it inter the thorax . It gives the follwing branches in the neck : 1- auricular branch . 2- meningeal branch 3- pharyngeal branch to share in the pharyngeal plexus 4- superior laryngeal nerve which is subdivided into : a. internal laryngeal which is sensory to cavity of larynx above vocal cord . b. external laryngeal which is motor to cricothyroid muscle Vagus Nerve 5- branch to carotid body 6- cardiac branches to cardiac plexus 7- right recurrent laryngeal ( the left one arise in the thorax) Mohamed el fiky
Unilateral Paralysis Accumulation of Saliva and Food Paralyzed Side During Phonation Removal of Arytenoid Cartilage Injury of Vagus Nerves Mohamed el fiky
Accessory nerve Accessory Nerve Cranial Part C1 C2 C3 C4 C5 Nucleus Ambiguous Spinal Part qIt is a purely motor attached to medulla oblongata qIt leave the skull through jugular foramen . qIt has two roots : qCranial root from medulla oblongata qSpinal root from upper five cervical spinal segments qThe cranial root : joins the vagus and is distributed through its pharyngeal , laryngeal branches. qThe spinal root Descends in the neck to supply both sternomastoid and trapezius muscle Branches : (A) Cranial accessory: joins the vagus and is distributed through its: 1. Pharyngeal branch : to supply all the muscles of the pharynx except the stylopharyngeus and all muscles of palate except the tensor palati 2. Laryngeal branches : to the muscles of the larynx. (B) Spinal accessory : supplies 2 muscles: a. Sternomastoid muscle. b. Trapezius muscle. Mohamed el fiky
Thyro- hyoid Hypoglossal Nucleus Omohyoid Sternothyroid Hypoglossal Nerve Hypoglossal nerve qOrigin : It is a motor cranial nerve attached to medulla oblongata qCourse : 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-Longutudinal 2-Horizontal 3- Oblique Genioglossus styloglossus Mohamed el fiky
The Tongue Points to The Affected Side Tongue Healthy Genioglissus Mandible Paralysed Genioglissus Mohamed el fiky
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. Mohamed el fiky
1-Communicating C1 C2 C3 C4 9TH 10TH 11TH 2- Cardiac (Superior Cervical Cardiac Nerve) 3- Vascular To Internal Carotid And External Carotid 4- Visceral To Pharynx and Larynx A- Superior Cervical Ganglion q The superior cervical ganglion the largest of the three, is placed opposite the second and third cervical vertebræ. qBranches : 1- communicating with upper four cervical nerves 2- cardiac superior cervical cardiac nerve 3- vascular to internal carotid and external carotid 4- visceral to pharynx and larynx Mohamed el fiky
C5 C6 1- Communicating 2- Cardiac (Middle Cervical Cardiac Sympathetic Nerve 3- Vascular Around Inferior Thyroid Artery 4- Visceral To Trachea and EsophagusTrachea Esoph. B- Middle Cervical Ganglion The middle cervical ganglion is the smallest of the three cervical ganglia, and is occasionally wanting. It is placed opposite the sixth cervical vertebra, qBranches : 1- communicating with C5 &C6 2- cardiac ( Middle cervical cardiac nerve ) 3- Vascular around inferior thyroid artery 4- visceral to trachea and esophagus Mohamed el fiky
C- Branches of Inferior Cervical Ganglion C7 C8 1- Communicatintg 2- Cardiac Inferior Cervical Cardiac Sympathetic Nerve 3- Vascular Around Subclavian Artery and Vertebral Artery Ansa Subclavia The inferior cervical ganglion is situated between the base of the transverse process of the last cervical vertebra and the neck of the first rib, qBranches : 1- communicating with C7&C8 2- cardiac ( Inferior cervical cardiac nerve ) 3- Vascular around subclavian and vertebral Mohamed el fiky
Horner’s Syndrome Ptosis Miosis Anhydrosis Flushing (Redness) Injury of Cervical Sympathetic Chain Mohamed el fiky