Nerve supply of head & neck by Dr. Amit Suryawanshi .Oral & Maxillofacial Surgeon, Pune , India
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Description: Hi. This is Dr. Amit T. Suryawanshi. Oral & Maxillofacial surgeon from Pune, India. I am here on slideshare.com to share some of my own presentations presented at various levels in the field of OMFS. Hope this would somehow be helpful to you making your presentations. All the best & your replies are welcomed!
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Nerve supply of head & neck by Dr. Amit Suryawanshi .Oral & Maxillofacial Surgeon, Pune , India
- 1. Dr. Amit T. Suryawanshi Oral and Maxillofacial Surgeon Pune, India Contact details : Email ID - amitsuryawanshi999@gmail.com Mobile No - 9405622455
- 2. CONTENTS BASIC NEUROANATOMY Origin of nervous system Divisions of nervous system Cranial nerves
- 3. NEUROANATOMY Basic organization of the nervous system • Sensory stimuli Sensory Nerves BRAIN • Correlation • Coordination Motor Nerves • Muscles • Glands etc.
- 4. The Nervous system The nervous system is an organ system containing a network of specialized cells called neurons that transmit signals between different parts of the body. coordinate the actions . The nervous system consists of two parts, 1. Central nervous system 2. Peripheral nervous system.
- 5. Origin Of Nervous System
- 6. EMBRYONIC ECTODERM NERVOUS SYSTEM NEURAL PLATE NEURAL CREST CELLS PNS ANS NEURAL TUBE CNS Origin Of Nervous System
- 7. Divisions of Nervous system Nervousrsystem CENTRAL NERVOUS SYSTEM Brain & Spinal cord PERIPHERAL NERVOUS SYSTEM Cranial & Spinal nerves and their associated ganglia Autonomic Nervous system Sensory Divisions Somatic Nervous system Motor Divisions Parasympathetic N. system Sympathetic N. system Enteric N. System
- 8. Basic Functions of the Nervous System 1. Sensation- Events or changes occurring inside and outside the body. Such changes are known as STIMULI and the cells that monitor them are RECEPTORS. 2. Integration- The parallel processing and interpretation of sensory information to determine the appropriate response. 3. Reaction- Motor output. The activation of muscles or glands (typically via the release of neurotransmitters (NTs))
- 9. Organization of the Nervous System Divisions of Nervous System : 1. Central Nervous System – 2. Peripheral Nervous System - The nervous system outside the brain and spinal cord Consists of: 31 Spinal nerves - Carry information to and from the spinal cord. 12 Cranial nerves - Carry information to and from the brain. - Ganglia The brain the spinal cord The Main center of integration and control
- 10. Divisions of Nervous System -
- 11. 1. Central Nervous System The brain - Receives sensory input from the spinal cord as well as from its own nerves (e.g., Cranial nerves ) Devotes most of its volume (and computational power) to processing its various sensory inputs and initiating appropriate and coordinated — motor outputs.
- 12. Spinal Cord - - Conducts sensory information from the peripheral nervous system (both somatic and autonomic ) to the brain - Conducts motor information from the brain to our various effectors -skeletal muscles -cardiac muscle -smooth muscle -glands
- 13. Peripheral Nervous System Responsible for communication between the CNS and the rest of the body . It is divided into: Sensory division ( Afferent division ) Motor division ( Efferent division )
- 14. Sensory division ( Afferent division ) – -Conducts impulses from RECEPTORS to the CNS -Informs the CNS about the state of the body -( interior and exterior ) - Sensory nerve fibers can be , SOMATIC - Conduct impulses from skin, skeletal muscles and Joints to CNS VISCERAL –Conduct impulses from smooth muscles, cardiac muscles, and glands (Internal organs) to CNS.
- 15. Motor Division ( Efferent Division ) - It is divided into: Somatic nervous system - VOLUNTARY (generally) Conducts impulses from the CNS to skin , skeletal muscles , joints Autonomic nervous system - INVOLUNTARY (generally) Conducts impulses from the CNS to smooth muscles, cardiac muscles, and glands (Internal organs )
- 16. Autonomic Nervous System- Divided into: Sympathetic Nervous System - “Fight or Flight” Parasympathetic Nervous System - “Rest and Digest” These 2 systems are antagonistic.
- 17. Sympathetic Nervous System - The sympathetic nervous system aids in the control of most of the body's internal organs. Stress — as in the flight-or-fight response.
- 18. Parasympathetic Nervous System - “Rest and Digest” Phenomenon - generally works to promote maintenance of the body at rest.
- 19. Enteric Nervous System The enteric nervous system is a meshwork of nerve fibers that innervate the viscera Gastrointestinal tract, Pancreas Gall bladder.
- 20. NEURON-Neuron (nerve cell)– It is basic structural and functional unit of the nervous system.
- 21. Types of NEURON
- 22. NEUROANATOMY Neuron consists of : a cell body containing nucleus – the Neuronal soma. Multiple number of processes -dendrites and axons
- 23. NEUROANATOMY Function Of Neurons - Neurons produce and conduct nerve impulses. Dendrites conduct information towards the cell body Axons conduct impulses away from cell body
- 24. Synapse and Neurotransmitters A synapse is the site of functional contact between axon and another neuron or organ. Neurotransmitters are released at synapses and they help in transmission of impulses.
- 25. Afferent neurons - carry sensations of touch , pain, temperature and pressure. Therefore they are called as sensory fibers . Efferent neurons - carry impulses away from the central nervous system.
- 26. NUCLEUS & GANGLION NUCLEUS - is a compact group of nerve cell bodies of similar form and function, located inside the CNS. GANGLION – is a similar group of nerve cell bodies located outside the CNS.
- 27. NEUROANATOMY The PNS has three main types of nerves: 1. Cranial Nerves 2. Spinal Nerves and 3. Autonomic Nerves All cranial nerves are attached to the brainstem, except for cranial nerve XI, Accessory Nerve. which is attached to the spinal cord.
- 28. spinal nerves - All spinal nerves are attached to the spinal cord. All spinal nerves have dorsal and ventral roots.
- 29. The autonomic nerves run through the roots of cranial or spinal nerves to ganglia or autonomic plexuses in the walls of the viscera (smooth muscles and glands) They also return sensory impulses to CNS from sensory receptors in viscera.
- 30. Cranial Nerves I . Olfactory Nerve II . Optic Nerve III. Oculomotor Nerve IV. Trochlear Nerve V. Trigeminal Nerve VI. Abducent Nerve VII. Facial Nerve VIII. Vestibulocochlear Or Auditory N. IX. Glossopharyngeal Nerve X. Vagus Nerve XI. Accessory Nerve XII. Hypoglossal Nerve
- 32. OLFACTORY NERVE Entirely sensory in function. Arises from olfactory receptor nerve cells in the mucous membrane of nasal cavity. Bundles of these nerve fibers pass through openings of cribriform plate of ethmoid bone and synapse in the olfactory bulb.
- 33. From olfactory bulb ,the second order nerve fibers pass through the olfactory tract to the olfactory cortex in cerebrum. The olfactory cortex in cerebrum is responsible for appreciation of olfactory sensations. i.e. Sensation of Smell.
- 34. OPTIC NERVE Entirely sensory in function. • The Optic Nerve passes from the eyeball through the optic canal into the middle cranial fossa .
- 35. The two optic nerves join below the base of the diencephalon to form optic chiasma and then divides into two optic tracts
- 36. Optic nerve transmits visual information from light-sensitive receptors on the retina of the eye to the brain for analysis, interpretation .
- 37. OCULOMOTOR NERVE Entirely motor in function. Oculomotor nerve nuclei: Two nuclei – 1. the main motor nucleus situated in midbrain. 2. the parasympathetic nucleus situated posterior to the motor nucleus
- 38. Course of occulomotor nerve : The occulomotor nerve emerges from the midbrain- then continues in the middle cranial fossa in the lateral wall of cavernous sinus. Here it divides into superior and inferior ramus which enter the orbital cavity through superior orbital fissure.
- 40. The occulomotor nerve supplies parasympathetic innervation to the intraocular muscles. And somatic innervation to the extraocular muscles. Parasympathetic fibers synapse in ciliary ganglion.
- 41. The occulomtor nerve supplies the following extrinsic muscles of eye : 1. Levator palpebrae superioris 2. Superior, medial and inferior rectus 3. Inferior oblique
- 42. The oculomotor nerve is responsible for: 1. Lifting the upper eyelid. 2. Turning the eye upward, downward and medially. 3. Constricting the pupil and accomodating the eye.
- 43. TROCHLEAR NERVE Entirely motor in function. Trochlear nerve nucleus – Situated in midbrain and lies inferior to the Oculomotor nucleus.
- 44. Course of trochlear nerve : Leaves the brainstem and immediately decussates with the nerve of opposite side . It passes through the middle cranial fossa in the lateral wall of cavernous sinus and enters orbit through superior orbital fissure.
- 45. The nerve supplies superior oblique musle of eyeball. It assists in turning eye downward and laterally.
- 46. TRIGEMINAL NERVE Course & relations Anterior aspect of Pons ( sensory and Motor Root ) Middle Cranial Fossa Meckel’s cavity ( Trigeminal Ganglion) Ist Division Ophthalmic Superior orbital fissure IInd Division Maxillary Foramen Rotundum IIIrd Division Mandibular Foramen Ovale
- 49. OPHTHALMIC DIVISION Course & relations Trigeminal Ganglion Middle Cranial Fossa Lateral wall of Cavernous Sinus Superior Orbital Fissure Orbit -Lacrimal -Frontal -Nasociliary
- 51. LACRIMAL NERVE Course & Relations Superior Orbital Fissure Lateral wall of Orbit Above the Lateral Rectus muscle Lacrimal Gland
- 52. Frontal nerve Course & relations Superior Orbital Fissure Levator Palpebrae Superioris Rim of Orbit Supra-orbital Supra-trochlear Supra-orbital Foramen
- 53. NASO-CILIARY NERVE Course & relations Superior Orbital Fissure Within common tendinous ring of Recti Optic Nerve Below superior rectus & superior oblique Medial orbital wall Anterior Ethmoidal Posterior Ethmoidal Long Ciliary Infra-trochlear External nasal Internal nasal
- 54. MAXILLARY NERVE - Branches and Course - Gasserion Ganglion Foramen Rotundum Pterygopalatine Fossa Infra –Orbital Canal Infra –Orbital Foramen Face Middle Meningeal N. -Pterigopalatine N -Posterior superior alveolar N -Zygomatic N Anterior superior alveolar N Middle superior alveolar N -Inferior palpebral -External nasal -Superior labial
- 57. Maxillary Nerve Branches (within pterigopalatine fossa ) Zygomatic N Inferior Orbital Fissure Zygomatico-facial Supplies- Facial prominence Of cheek Zygomatico-temporal Supplies- Skin of temple
- 58. Continued - Pterygopalatine Nerves Orbital Nasal Palatine Nasopalatine N. Greater palatine n. middle palatine n. posterior palatine n. Posterior Hard palate Posterior superior Alveolar N. Soft palate, Tonsil,uvula Soft palate Maxillary molars , buccal Mucosa in molar region
- 59. Maxillary Nerve Branches ( within infraorbital canal ) Middle superior alveolar nerve Anterior superior alveolar nerve Supplies- Maxillary Incisors, canine Supplies – Maxillary premolars
- 60. Maxillary Nerve Branches ( on the face ) Inferior Palpebral branches External nasal branches Superior labial branches Lower Eyelid Upper Side of Lip,cheek Nose
- 61. - Superior dental plexus -
- 62. MANDIBULAR NERVE Course & Relations Gasserion Ganglion Motor root Foramen Ovale Main trunk Nerve to medial pterygoid Anterior division Posterior division Buccal Nerve to Masseter Nerve To Temporalis Nerve to Lateral Pterygoid Auriculo-temporal Mylohyoid Nerve Superficial temporal Cutaneous Mental Incisive Lingual Inferior alveolar sensory root Nervous spinosus-
- 64. ABDUCENT NERVE - ABDUCENT NERVE Entirely motor and supplies the lateral rectus muscle of the eyeball. Abducent nerve nucleus : situated in pons
- 65. Course of abducent nerve : The nerve fibers emerge from the pons from the groove between pons and medulla oblongata. It passes through cavernous sinus and lies below the internal carotid artery. The nerve enters the orbit through superior orbital fissure.
- 66. Abducent nerve :
- 67. FACIAL NERVE
- 68. Course and Branches of Facial Nerve
- 69. -Course- PONS Motor root Medulla oblongata Sensory root INTERNAL AUDITORY MEATUS PETROUS PART OF TEMPORAL BONE FACIAL CANAL STYLOMASTOID FORAMEN PAROTID GLAND FACIAL MUSCLES (GENICULATE GANGLION ) PAROTID PLEXUS GREATER PETROSAL NERVE TO STAPEDIUS CHORDA TYMPANI POSTERIOR AURICULAR N . POST. BELLY OF DIGASTRIC N . STYLOHYOID
- 70. • Greater petrosal nerve - - provides motor innervation to lacrimal gland , mucosal glands of the nose, palate, and pharynx. - carries special sensory taste fibers from the palate . • Nerve to stapedius - provides motor innervation for stapedius muscle in middle ear • Chorda tympani - carries special sensory taste fibers from the anterior 2/3rd of the tongue.
- 71. Outside skull - (Distal to stylomastoid foramen) • Posterior auricular nerve - • Nerve to Posterior belly of Digastric • Nerve to Stylohyoid muscle .
- 72. Facial nerve enters parotid gland and forms parotid plexus Parotid Plexus
- 73. Functions - • Its main function is motor control of most of the muscles of facial expression. • The facial nerve also supplies parasympathetic fibers to the submandibular gland and sublingual glands via chorda tympani
- 74. Vestibulocochlear Nerve Or Auditory Nerve -It is Sensory nerve . -It consists of two roots - Vestibular root - Cochlear root
- 75. Course -
- 76. Vestibular root -- Vestibular root transmits impulses from vestibular apparatus ( Balance ) Cochlear root -- Cochlear root transmits impulses from auditory apparatus (Sound )
- 77. Functions - • Auditory nerve transmits sound and equilibrium (balance) information from the Internal ear to the Brain .
- 78. Glossopharyngeal nerve It originates from medulla oblongata Nuclei - Inferior salivatory nucleus Nucleus ambiguus Nucleus of solitory tract
- 80. Glossopharyngeal nerve Superior Ganglion Inferior Ganglion •Branches - •Tympanic nerve (s) •Branch to carotid sinus (s) •Branch to Stylopharyngeus muscle (m) •Tonsillar branches (s) Lingual Branches •(S) •Pharyngeal branches (m)
- 81. •Tympanic nerve - Sensory fibers supply the middle ear. Secretory fibers supply the parotid gland •Nerve to carotid sinus - Receives sensory information from ‘ Chemoreceptors in Carotid body . Baroreceptors in carotid sinus . •Nerve to Stylopharyngeus muscle •Tonsillar branches (s)
- 82. Lingual Branches - Receives sensory information from posterior 1/3rd of the tongue. •Pharyngeal branches - Innervate constrictor muscles of the pharynx.
- 83. It originates from medulla oblongata Nuclei - -Nucleus ambiguus -Nucleus of solitory tract ( superior part & inferior part )
- 84. COURSE OF VAGUS NERVE
- 85. VAGUS NERVE (MIXED) BRANCHES - Superior Ganglion - Meningeal nerve - Auricular nerve Inferior Ganglion - Pharyngeal branches - Superior laryngeal nerve - external laryngeal n. - internal laryngeal n. - Recurrent laryngeal - Cervical Carotid branches -Anterior esophageal plexus -gastric, celiac, hepatic branches
- 86. •It supplies - •Cricothyroid muscle Levator veli palatini muscle •Salpingopharyngeus muscle •Palatoglossus muscle •Palatopharyngeus muscle •Superior, middle and inferior pharyngeal constrictors •Muscles of the larynx (speech)
- 87. Accessory nerve (motor) Course -
- 88. Cranial root – Cranial root joins Vagus nerve and innervates - all laryngeal muscles except cricothyroid Spinal root - Spinal root innervates -Trapezius -Sternocleidomastoid
- 89. Hypoglossal nerve (motor) COURSE & RELATIONS Medulla Oblongata (Hypoglossal Nucleus) Hypoglossal Canal Behind Vagus Nerve Between IJV & ICA Posterior Belly of Digastric Tongue(Intrinsic and extrinsic muscles)
- 91. It supplies -- Extrinsic muscles Genioglossus Hyoglossus Styloglossus Intrinsic muscles Superior longitudinal Inferior longitudinal Verticalis Transversus Except Palatoglossus which is supplied by cranial part of accessory nerve
- 92. References Gray’s Anatomy Oral and maxillofacial surgery – Laskin Atlas of Anatomy - Anne Gilroy LA – Malamed Guyton (physiology ) Ganong (physiology ) Internet
- 93. Thank you
Editor's Notes
- Formation of the neural tube (cross view). Early in an embryo’s development, a strip of specialized cells called the notochord.. in most vertebrates notochord becomes the vertebral body of the vertebral column. (A) induces the cells of the ectoderm directly above it to become the primitive nervous system (i.e., neuroepithelium). The neuroepithelium then wrinkles and folds over (B). As the tips of the folds fuse together, a hollow tube (i.e., the neural tube) forms (C)—the precursor of the brain and spinal cord. Meanwhile, the ectoderm and endoderm continue to curve around and fuse beneath the embryo to create the body cavity, completing the transformation of the embryo from a flattened disk to a three–dimensional body. Cells originating from the fused tips of the neuroectoderm (i.e., neural crest cells) migrate to various locations throughout the embryo, where they will initiate the development of diverse body structures (D). Researchers investigating fetal alcohol syndrome have extensively studied neural crest cells, because they are particularly sensitive to alcohol–induced injury and cell death.
- T1 to L5 ……..you are taking a nice walk in the park. Suddenly, an angry dog appears in your path. fight OR run away These are "Fight or Flight" responses. sympathetic nervous system is into action - it uses energy - your blood pressure increases, your heart beats faster, and digestion slows down.Notice in the picture on the left that the sympathetic nervous system originates in the spinal cord. Specifically, the cell bodies of the first neuron (the preganglionic neuron) are located in the thoracic and lumbar spinal cord. Axons from these neurons project to a chain of ganglia located near the spinal cord. In most cases, this neuron makes a synapse with another neuron (post-ganglionic neuron) in the ganglion. A few preganglionic neurons go to other ganglia outside of the sympathetic chain and synapse there. The post-ganglionic neuron then projects to the "target" - either a muscle or a gland. Two more facts about the sympathetic nervous system: the synapse in the sympathetic ganglion uses acetylcholine as a neurotransmitter; the synapse of the post-ganglionic neuron with the target organ uses the neurotransmitter called norepinephrine. (Of course, there is one exception: the sympathetic post-ganglionic neuron that terminates on the sweat glands uses acetylcholine.)
- If you decide to relax in comfortable chair.. "Rest and Digest" responses..parasympathetic nervous works to save energy - your blood pressure decreases, your heart beats slower, and digestion can start..Notice in the picture on the left, that the cell bodies of the parasympathetic nervous system are located in the spinal cord (sacral region) and in the medulla. In the medulla, the cranial nerves III occulo, VII facial, IX glosso and X vagus .form the preganglionic parasympathetic fibers. The preganglionic fiber from the medulla or spinal cord projects to ganglia very close to the target organ and makes a synapse. This synapse uses the neurotransmitter called acetylcholine. From this ganglion, the post-ganglionic neuron projects to the target organ and uses acetylcholine again at its terminal.symp n parasym are generally in opposition to each other.
- The motor fibers of the facial nerve arise from the facial nucleus & superior salivatory nucleus in the pons while the sensory fibers of the facial nerve arises from the nucleus of solitory tract .... The motor fibers and sensory fibers of the facial nerve pass through internal acoustic meatus into petrous part of temporal bone .Then it runs & emerges from the stylomastoid foramen and passes through the parotid gland, where it divides into five major branches. Though it passes through the parotid gland, it does not innervate the gland (This is the responsibility of cranial nerve IX, the glossopharyngeal nerve)
- Greater petrosal nerve –mixed Stapedius – motor Chorda tympani –sensory
- Posterior auricular nerve supplies , ………..MOTOR Posterior auricular muscle & occipitalis muscle
- Temporal branch supplies---- Frontalis, the Orbicularis oculi , Zygomatic Branch supplies ---the Orbicularis oculi Buccal Branch supplies-- Buccinator and Orbicularis oris, Procerus .. Zygomaticus major , Quadratus labii superioris Mandibular Branch supplies –triangularis ,depressor labi inferioris , mentalis Cervical branch supplies --Platysma.
- Increases flow of saliva in glands Musles of facial expression are ---- Occipitofrontalis Temporoparietalis muscle Procerus Nasalis muscle Depressor septi nasi, Orbicularis oculi, Corrugator supercilii , Depressor supercilii Auricular muscles, (anterior, superior, posterior) Orbicularis oris, Depressor anguli oris, Risorius , Zygomaticus major, Zygomaticus minor, Levator labii superioris , Levator labii superioris alaeque nasi , Depressor labii inferioris , Levator anguli oris , Buccinator , Mentalis
- Mixed nerve
- Mixed…From the anterior portion of the medulla oblongata, the glossopharyngeal nerve leaves the skull through the central part of the jugular foramen. the superior and inferior ganglia in jugular foramen ... On the inferior side, the glossopharyngeal nerve is lateral and anterior to the vagus nerve and accessory nerve. In its passage through the jugular foramen (with X and XI), it passes between the external carotid artery and internal carotid artery. It descends beneath the styloid process and stylopharyngeus. From there, it passes under cover of the hyoglossus muscle, and is finally distributed to the palatine tonsil, the mucous membrane of the fauces and base of the tongue, and the mucous glands of the mouth
- Mixed…From the anterior portion of the medulla oblongata, the glossopharyngeal nerve leaves the skull through the central part of the jugular foramen. the superior and inferior ganglia in jugular foramen ... On the inferior side, the glossopharyngeal nerve is lateral and anterior to the vagus nerve and accessory nerve. In its passage through the jugular foramen (with X and XI), it passes between the internal jugular vein and internal carotid artery. It descends beneath the styloid process and stylopharyngeus. From there, it passes under cover of the hyoglossus muscle, and is finally distributed to the palatine tonsil, the mucous membrane of the fauces and base of the tongue, and the mucous glands of the mouth
- Chemoreceptors -- partial pressure of oxygen , ph , temp
- mixed
- Mixed….Superior laryngeal nerve supplies all muscles if larynx excpt cricothyroid which si supplied by vagus nerve. Internal laryngeal nerve --.. pierces thyrohyoid membrane and is distributed to the mucous membrane of the larynx., glottis and laryngeal vestibule Above the vocal folds the sensory innervation of the larynx is via the internal laryngeal nerve. Below the vocal folds it is by way of branches of the recurrent laryngeal nerve. Motor innervation to all other muscles of the larynx and sensory innervation to the subglottis is by the recurrent laryngeal nerve
- Hooks around subclavian A.
- laryngeal muscles -----posterior cricoarytenoid muscles (lateral cricoarytenoid muscles, arytenoid muscles) and tensors (cricothyroid muscles, thyroarytenoid muscles).
- motor
- Ansa cervicalis… a loop of nerves that are part of the cervical plexus. Branches from the ansa cervicalis innervate three of the four infrahyoid muscles: the sternohyoid muscle, the sternothyroid muscle, and the omohyoid muscle.