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The spinal accessory nerve is a unique cranial nerve that has both a cranial and spinal component. It originates from motor neurons in the upper cervical spinal cord and nucleus ambiguus. The cranial component joins with the vagus nerve after exiting the skull through the jugular foramen. The spinal component separates and innervates the sternocleidomastoid and trapezius muscles, supplying motor function to the neck and shoulder regions. Injury to the spinal accessory nerve can result in weakness of the sternocleidomastoid or trapezius muscles on the same side, causing issues with head and shoulder movement.
The accessory nerve has both a spinal and cranial component. The spinal component originates from spinal nerve roots C1-C6 and innervates the sternocleidomastoid and trapezius muscles. The cranial component originates in the medulla and joins with the vagus nerve. The accessory nerve is vulnerable to damage due to its superficial extracranial course.
The facial nerve has both sensory and motor components. It has nuclei in the pons that control muscles of facial expression, lacrimal and salivary glands, and taste sensation on the anterior tongue. The facial nerve exits the skull through the stylomastoid foramen and divides into branches that innervate muscles of the face, scalp and neck including the orbicularis oculi and orbicularis oris. It also communicates with adjacent cranial and spinal nerves to coordinate movements between branchial arches.
The document summarizes the key anatomical structures and contents of the temporal and infratemporal regions. The temporal fossa is bounded by bones and contains the temporalis muscle and arteries. The infratemporal fossa below contains muscles like the lateral and medial pterygoids and nerves like the mandibular nerve. The maxillary artery branches throughout these regions, including the pterygopalatine fossa which communicates between structures. The temporalis, masseter, and pterygoid muscles are involved in mastication.
The document discusses cranial nerves XI and XII. CN XI is the spinal accessory nerve which has a cranial and spinal portion. The cranial portion innervates muscles of the larynx while the spinal portion innervates the sternocleidomastoid and trapezius muscles. CN XII is the hypoglossal nerve which solely innervates the muscles of the tongue. Clinical examination of both nerves involves assessing strength and movement of their respective muscles. Lesions can occur at supranuclear, nuclear or infranuclear levels and cause varying patterns of weakness depending on the location.
The otic ganglia are small, reddish-grey, oval shaped ganglia located below the foramen ovale in the infratemporal fossa. They have parasympathetic, sympathetic, and sensory/motor connections. Parasympathetic fibers synapse in the otic ganglia and their post-ganglionic fibers supply the parotid gland via auriculotemporal nerve branches. Sympathetic fibers do not relay in the ganglia. Sensory fibers from the auriculotemporal nerve are sensory to the parotid gland, and motor fibers pass through to supply muscles without relaying. Damage to the auriculotemporal nerve can cause Frey's syndrome, where sal
This document discusses the glossopharyngeal, vagus, and accessory nerve complexes. It begins by explaining that the glossopharyngeal and vagus nerves arise from three nucleus columns in the medulla. It then provides diagrams of the nuclei and pathways of the vagus nerve. The rest of the document contains images demonstrating the anatomy and pathologies of these cranial nerve complexes.
The spinal accessory nerve is a unique cranial nerve that has both a cranial and spinal component. It originates from motor neurons in the upper cervical spinal cord and nucleus ambiguus. The cranial component joins with the vagus nerve after exiting the skull through the jugular foramen. The spinal component separates and innervates the sternocleidomastoid and trapezius muscles, supplying motor function to the neck and shoulder regions. Injury to the spinal accessory nerve can result in weakness of the sternocleidomastoid or trapezius muscles on the same side, causing issues with head and shoulder movement.
The accessory nerve has both a spinal and cranial component. The spinal component originates from spinal nerve roots C1-C6 and innervates the sternocleidomastoid and trapezius muscles. The cranial component originates in the medulla and joins with the vagus nerve. The accessory nerve is vulnerable to damage due to its superficial extracranial course.
The facial nerve has both sensory and motor components. It has nuclei in the pons that control muscles of facial expression, lacrimal and salivary glands, and taste sensation on the anterior tongue. The facial nerve exits the skull through the stylomastoid foramen and divides into branches that innervate muscles of the face, scalp and neck including the orbicularis oculi and orbicularis oris. It also communicates with adjacent cranial and spinal nerves to coordinate movements between branchial arches.
The document summarizes the key anatomical structures and contents of the temporal and infratemporal regions. The temporal fossa is bounded by bones and contains the temporalis muscle and arteries. The infratemporal fossa below contains muscles like the lateral and medial pterygoids and nerves like the mandibular nerve. The maxillary artery branches throughout these regions, including the pterygopalatine fossa which communicates between structures. The temporalis, masseter, and pterygoid muscles are involved in mastication.
The document discusses cranial nerves XI and XII. CN XI is the spinal accessory nerve which has a cranial and spinal portion. The cranial portion innervates muscles of the larynx while the spinal portion innervates the sternocleidomastoid and trapezius muscles. CN XII is the hypoglossal nerve which solely innervates the muscles of the tongue. Clinical examination of both nerves involves assessing strength and movement of their respective muscles. Lesions can occur at supranuclear, nuclear or infranuclear levels and cause varying patterns of weakness depending on the location.
The otic ganglia are small, reddish-grey, oval shaped ganglia located below the foramen ovale in the infratemporal fossa. They have parasympathetic, sympathetic, and sensory/motor connections. Parasympathetic fibers synapse in the otic ganglia and their post-ganglionic fibers supply the parotid gland via auriculotemporal nerve branches. Sympathetic fibers do not relay in the ganglia. Sensory fibers from the auriculotemporal nerve are sensory to the parotid gland, and motor fibers pass through to supply muscles without relaying. Damage to the auriculotemporal nerve can cause Frey's syndrome, where sal
This document discusses the glossopharyngeal, vagus, and accessory nerve complexes. It begins by explaining that the glossopharyngeal and vagus nerves arise from three nucleus columns in the medulla. It then provides diagrams of the nuclei and pathways of the vagus nerve. The rest of the document contains images demonstrating the anatomy and pathologies of these cranial nerve complexes.
hypoglossal nerve, origin course an termination of hypoglossal nerve, function of hypoglossal nerve, clinical examination of hypoglossal nerve, hypoglossal nerve palsy
The suboccipital triangle is located in the triangular area around the articulation of the skull and upper vertebral column. It is bounded by the occipital bone, posterior part of C1 (atlas), and C2 (axis) deep to neck muscles. Four muscles originate and insert in this region - the rectus capitis posterior major and minor, inferior oblique, and superior oblique muscles. The suboccipital triangle also contains the vertebral and occipital arteries and greater occipital and suboccipital nerves. The vertebral artery is susceptible to dissection as it enters the triangle, which can cause strokes in younger people.
The document provides information on the trigeminal nerve (CN V), including its nuclei, origin, course, branches, and functions. It describes the three main branches - ophthalmic, maxillary, and mandibular nerves. The ophthalmic nerve innervates the eye and upper face. The maxillary nerve contains sensory fibers and innervates the midface, nasal cavity, and maxillary teeth. The mandibular nerve is mixed, containing both sensory and motor fibers, and innervates the lower face, oral cavity, external ear, and muscles of mastication.
The glossopharyngeal nerve is the ninth cranial nerve. It is a mixed nerve that originates in the medulla oblongata and exits through the jugular foramen. It carries both sensory and motor fibers and innervates the middle ear, tonsils, back of the tongue, pharynx, and the stylopharyngeus muscle. Damage to the glossopharyngeal nerve can result in loss of sensation in these areas as well as difficulties swallowing and reduced salivation. Glossopharyngeal neuralgia is a condition characterized by severe pain in the throat and ear caused by compression of the nerve.
1. The document discusses the dural venous sinuses, their characteristics, classification, and the cavernous sinus in detail.
2. The dural venous sinuses drain blood from the brain and cranial cavity, absorb CSF, and receive valveless emissary veins. They are classified into unpaired and paired sinuses.
3. The cavernous sinus is a paired dural venous sinus located near the sphenoid bone. It contains the internal carotid artery and cranial nerves III and IV. Thrombosis or rupture of the cavernous sinus or internal carotid artery can cause symptoms like exophthalmos and ophthalmoplegia.
The document discusses the anatomy of the anterior triangle of the neck. It begins by outlining the boundaries and contents of the anterior triangle. It then describes how the triangle is divided into four smaller triangles - the submental, submandibular, carotid, and muscular triangles - by the digastric and omohyoid muscles. Each smaller triangle's boundaries, floor, contents, and structures are defined in detail. Key structures discussed include the thyroid gland, carotid sheath, carotid sinus, and carotid body. Blood supply and lymphatic drainage of the thyroid gland are also summarized.
The internal carotid artery has 7 segments from its origin at the common carotid artery bifurcation to where it enters the cranium. Each segment has unique anatomic features and branches. The segments are named cervical, petrous, lacerum, cavernous, clinoid, ophthalmic, and communicating. The petrous, cavernous, and ophthalmic segments each have important branches including the vidian artery, meningohypophyseal trunk, and ophthalmic artery respectively.
The pterygopalatine fossa is a small pyramidal space located below the apex of the orbit on the lateral side of the skull. It functions as a neurovascular conduit, containing the maxillary nerve, terminal part of the maxillary artery, pterygopalatine ganglion and their branches. The fossa has boundaries of the posterior maxilla anteriorly, pterygoid process posteriorly, perpendicular plate of palatine bone medially, and pterygomaxillary fissure laterally. It communicates with surrounding areas through various foramina and fissures. Due to its anatomic location and contents, the pterygopalatine fossa is clinically significant in spread of
introduction to skull, parts of skull, bones involved forming skull, different views of skull, norma basalis, anterio cranial middle cranial and posterior cranial fossa, clinical aspects of cranial fossa, foramens present in the cranial fossa
This document provides an overview of the facial nerve (cranial nerve VII). It begins with definitions of nerves and nerve conduction. It then discusses the classification of the nervous system and provides an introduction to the facial nerve. The remainder of the document details the embryology, nuclei of origin, functional components, course, branches and distribution, ganglia, blood supply, surgical anatomy, applied aspects, and conclusion of the facial nerve. It provides diagrams and explanations of these various aspects of the facial nerve's anatomy and function.
The cavernous sinus is a pair of venous channels located on each side of the body of the sphenoid bone in the middle cranial fossa. It is approximately 2 cm long and 1 cm wide. Several important structures pass through or are located within the cavernous sinus, including the internal carotid artery, cranial nerves III, IV, V1, and VI, and the inferior hypophyseal arteries. The cavernous sinus drains into various venous channels including the superior and inferior petrosal sinuses, which connect to the transverse sinus and internal jugular vein. Cavernous sinus thrombosis is a potential complication caused by sepsis that can spread from the face or paranasal sinuses,
The cavernous sinus is located on each side of the body of the sphenoid bone and sella turcica between the inner and outer layers of the dura mater. It is approximately 2cm long and 1cm wide, extending from the superior orbital fissure to the apex of the petrous part of the temporal bone. Structures passing through the cavernous sinus include the internal carotid artery, cranial nerves III, IV, V1, and VI. The two cavernous sinuses are connected by intercavernous sinuses located anteriorly and posteriorly around the diaphragma sellae, allowing for reversible blood flow between the sinuses.
The infratemporal fossa is a space deep to the ramus of the mandible that contains nerves, arteries and muscles. It communicates with the temporal fossa and pterygopalatine fossa. The mandibular nerve passes through the foramen ovale and gives off motor and sensory branches that innervate muscles of mastication and sensation to the face. The maxillary artery passes through supplying branches. The pterygoid venous plexus drains the area.
The glossopharyngeal nerve (IX cranial nerve) has five functional components: 1) It carries sensory fibers for taste from the posterior third of the tongue; 2) It carries general sensory fibers for structures like the pharynx and tonsils; 3) It carries sensory fibers for the external ear; 4) It carries motor fibers to control the stylopharyngeus muscle; 5) It carries parasympathetic fibers to control the parotid gland. The nuclei that control these functions include the nucleus ambiguus, nucleus salivatorius inferior, nucleus solitarius, and nucleus spinalis of the trigeminal nerve.
This document describes the muscles and structures in the back of the neck. It discusses the superficial and deep muscles in the back of the neck, including the trapezius, levator scapulae, splenius capitis, and suboccipital muscles. It then focuses on the suboccipital triangle, bounded superiorly by the rectus capitis posterior major and minor, superolaterally by the obliquus capitis superior, and inferiorly by the obliquus capitis inferior. The suboccipital triangle contains the suboccipital nerve, vertebral artery, and venous plexus and is the site of cisternal puncture to access the cisterna magna through the
The carotid sheath is located in the neck from the base of the skull to the root of the neck. It contains the internal carotid artery, internal jugular vein, vagus nerve, and branches of the sympathetic trunk. The common carotid artery bifurcates into the internal and external carotid arteries around the level of the thyroid cartilage between vertebrae C3 and C4. The structures within the carotid sheath have important relationships that provide pathways for infection spread.
The scalp has five layers - skin, superficial fascia, epicranial aponeurosis with the occipitofrontalis muscle, loose areolar tissue, and pericranium. It is supplied by branches of the external and internal carotid arteries and drains into facial and jugular veins. Lymphatic drainage is to preauricular, parotid, posterior auricular, occipital, and mastoid lymph nodes. The occipitofrontalis muscle allows movement of the scalp. The loose areolar tissue is a vulnerable area due to emissary veins connecting to intracranial sinuses.
This document provides information about the cranial nerves, including:
- There are traditionally twelve pairs of cranial nerves in humans, with the first two emerging from the cerebrum and the remaining ten from the brainstem.
- Cranial nerves I-XI are part of the peripheral nervous system, while cranial nerve II is a tract of the diencephalon.
- Cranial nerves XI and XII evolved in amniotes to total twelve pairs across vertebrate species.
- The accessory nerve or CN XI controls muscles of the neck and shoulder. Damage can cause weakness of the sternocleidomastoid and trapezius muscles.
- The hypoglossal nerve or CN X
The document discusses the 12 pairs of cranial nerves:
- It describes the origin, function, and key characteristics of each cranial nerve. The cranial nerves are classified as sensory, motor, or mixed.
- The cranial nerves include the olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, and hypoglossal nerves.
- Each cranial nerve is described in detail including its origin, function, and important clinical notes. Diagrams are included to illustrate some cranial nerves and their pathways.
hypoglossal nerve, origin course an termination of hypoglossal nerve, function of hypoglossal nerve, clinical examination of hypoglossal nerve, hypoglossal nerve palsy
The suboccipital triangle is located in the triangular area around the articulation of the skull and upper vertebral column. It is bounded by the occipital bone, posterior part of C1 (atlas), and C2 (axis) deep to neck muscles. Four muscles originate and insert in this region - the rectus capitis posterior major and minor, inferior oblique, and superior oblique muscles. The suboccipital triangle also contains the vertebral and occipital arteries and greater occipital and suboccipital nerves. The vertebral artery is susceptible to dissection as it enters the triangle, which can cause strokes in younger people.
The document provides information on the trigeminal nerve (CN V), including its nuclei, origin, course, branches, and functions. It describes the three main branches - ophthalmic, maxillary, and mandibular nerves. The ophthalmic nerve innervates the eye and upper face. The maxillary nerve contains sensory fibers and innervates the midface, nasal cavity, and maxillary teeth. The mandibular nerve is mixed, containing both sensory and motor fibers, and innervates the lower face, oral cavity, external ear, and muscles of mastication.
The glossopharyngeal nerve is the ninth cranial nerve. It is a mixed nerve that originates in the medulla oblongata and exits through the jugular foramen. It carries both sensory and motor fibers and innervates the middle ear, tonsils, back of the tongue, pharynx, and the stylopharyngeus muscle. Damage to the glossopharyngeal nerve can result in loss of sensation in these areas as well as difficulties swallowing and reduced salivation. Glossopharyngeal neuralgia is a condition characterized by severe pain in the throat and ear caused by compression of the nerve.
1. The document discusses the dural venous sinuses, their characteristics, classification, and the cavernous sinus in detail.
2. The dural venous sinuses drain blood from the brain and cranial cavity, absorb CSF, and receive valveless emissary veins. They are classified into unpaired and paired sinuses.
3. The cavernous sinus is a paired dural venous sinus located near the sphenoid bone. It contains the internal carotid artery and cranial nerves III and IV. Thrombosis or rupture of the cavernous sinus or internal carotid artery can cause symptoms like exophthalmos and ophthalmoplegia.
The document discusses the anatomy of the anterior triangle of the neck. It begins by outlining the boundaries and contents of the anterior triangle. It then describes how the triangle is divided into four smaller triangles - the submental, submandibular, carotid, and muscular triangles - by the digastric and omohyoid muscles. Each smaller triangle's boundaries, floor, contents, and structures are defined in detail. Key structures discussed include the thyroid gland, carotid sheath, carotid sinus, and carotid body. Blood supply and lymphatic drainage of the thyroid gland are also summarized.
The internal carotid artery has 7 segments from its origin at the common carotid artery bifurcation to where it enters the cranium. Each segment has unique anatomic features and branches. The segments are named cervical, petrous, lacerum, cavernous, clinoid, ophthalmic, and communicating. The petrous, cavernous, and ophthalmic segments each have important branches including the vidian artery, meningohypophyseal trunk, and ophthalmic artery respectively.
The pterygopalatine fossa is a small pyramidal space located below the apex of the orbit on the lateral side of the skull. It functions as a neurovascular conduit, containing the maxillary nerve, terminal part of the maxillary artery, pterygopalatine ganglion and their branches. The fossa has boundaries of the posterior maxilla anteriorly, pterygoid process posteriorly, perpendicular plate of palatine bone medially, and pterygomaxillary fissure laterally. It communicates with surrounding areas through various foramina and fissures. Due to its anatomic location and contents, the pterygopalatine fossa is clinically significant in spread of
introduction to skull, parts of skull, bones involved forming skull, different views of skull, norma basalis, anterio cranial middle cranial and posterior cranial fossa, clinical aspects of cranial fossa, foramens present in the cranial fossa
This document provides an overview of the facial nerve (cranial nerve VII). It begins with definitions of nerves and nerve conduction. It then discusses the classification of the nervous system and provides an introduction to the facial nerve. The remainder of the document details the embryology, nuclei of origin, functional components, course, branches and distribution, ganglia, blood supply, surgical anatomy, applied aspects, and conclusion of the facial nerve. It provides diagrams and explanations of these various aspects of the facial nerve's anatomy and function.
The cavernous sinus is a pair of venous channels located on each side of the body of the sphenoid bone in the middle cranial fossa. It is approximately 2 cm long and 1 cm wide. Several important structures pass through or are located within the cavernous sinus, including the internal carotid artery, cranial nerves III, IV, V1, and VI, and the inferior hypophyseal arteries. The cavernous sinus drains into various venous channels including the superior and inferior petrosal sinuses, which connect to the transverse sinus and internal jugular vein. Cavernous sinus thrombosis is a potential complication caused by sepsis that can spread from the face or paranasal sinuses,
The cavernous sinus is located on each side of the body of the sphenoid bone and sella turcica between the inner and outer layers of the dura mater. It is approximately 2cm long and 1cm wide, extending from the superior orbital fissure to the apex of the petrous part of the temporal bone. Structures passing through the cavernous sinus include the internal carotid artery, cranial nerves III, IV, V1, and VI. The two cavernous sinuses are connected by intercavernous sinuses located anteriorly and posteriorly around the diaphragma sellae, allowing for reversible blood flow between the sinuses.
The infratemporal fossa is a space deep to the ramus of the mandible that contains nerves, arteries and muscles. It communicates with the temporal fossa and pterygopalatine fossa. The mandibular nerve passes through the foramen ovale and gives off motor and sensory branches that innervate muscles of mastication and sensation to the face. The maxillary artery passes through supplying branches. The pterygoid venous plexus drains the area.
The glossopharyngeal nerve (IX cranial nerve) has five functional components: 1) It carries sensory fibers for taste from the posterior third of the tongue; 2) It carries general sensory fibers for structures like the pharynx and tonsils; 3) It carries sensory fibers for the external ear; 4) It carries motor fibers to control the stylopharyngeus muscle; 5) It carries parasympathetic fibers to control the parotid gland. The nuclei that control these functions include the nucleus ambiguus, nucleus salivatorius inferior, nucleus solitarius, and nucleus spinalis of the trigeminal nerve.
This document describes the muscles and structures in the back of the neck. It discusses the superficial and deep muscles in the back of the neck, including the trapezius, levator scapulae, splenius capitis, and suboccipital muscles. It then focuses on the suboccipital triangle, bounded superiorly by the rectus capitis posterior major and minor, superolaterally by the obliquus capitis superior, and inferiorly by the obliquus capitis inferior. The suboccipital triangle contains the suboccipital nerve, vertebral artery, and venous plexus and is the site of cisternal puncture to access the cisterna magna through the
The carotid sheath is located in the neck from the base of the skull to the root of the neck. It contains the internal carotid artery, internal jugular vein, vagus nerve, and branches of the sympathetic trunk. The common carotid artery bifurcates into the internal and external carotid arteries around the level of the thyroid cartilage between vertebrae C3 and C4. The structures within the carotid sheath have important relationships that provide pathways for infection spread.
The scalp has five layers - skin, superficial fascia, epicranial aponeurosis with the occipitofrontalis muscle, loose areolar tissue, and pericranium. It is supplied by branches of the external and internal carotid arteries and drains into facial and jugular veins. Lymphatic drainage is to preauricular, parotid, posterior auricular, occipital, and mastoid lymph nodes. The occipitofrontalis muscle allows movement of the scalp. The loose areolar tissue is a vulnerable area due to emissary veins connecting to intracranial sinuses.
This document provides information about the cranial nerves, including:
- There are traditionally twelve pairs of cranial nerves in humans, with the first two emerging from the cerebrum and the remaining ten from the brainstem.
- Cranial nerves I-XI are part of the peripheral nervous system, while cranial nerve II is a tract of the diencephalon.
- Cranial nerves XI and XII evolved in amniotes to total twelve pairs across vertebrate species.
- The accessory nerve or CN XI controls muscles of the neck and shoulder. Damage can cause weakness of the sternocleidomastoid and trapezius muscles.
- The hypoglossal nerve or CN X
The document discusses the 12 pairs of cranial nerves:
- It describes the origin, function, and key characteristics of each cranial nerve. The cranial nerves are classified as sensory, motor, or mixed.
- The cranial nerves include the olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, and hypoglossal nerves.
- Each cranial nerve is described in detail including its origin, function, and important clinical notes. Diagrams are included to illustrate some cranial nerves and their pathways.
There are 12 pairs of cranial nerves that originate from the brain. They are the olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, and hypoglossal nerves. Each nerve has specific functions, such as carrying sensory information for smell, vision, and taste, or controlling eye and facial muscle movement. Damage to certain cranial nerves can cause issues like Bell's palsy or an inability to speak or swallow.
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A Presentation for the anatomy of the orbit, from its embryological development till till the clinically-related cases.
Prepared by Second Year students at Faculty of medicine - Ain Shams university
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The document summarizes the trigeminal nerve, including its nuclear columns, trigeminal ganglion, three divisions of the nerve, and clinical considerations. The trigeminal nerve has three divisions - the ophthalmic, maxillary, and mandibular nerves. It discusses the branches and distributions of each division. Clinically, examination of the trigeminal nerve involves sensory and motor testing as well as trigeminal reflexes. Common conditions involving the trigeminal nerve like trigeminal neuralgia and postherpetic neuralgia are also mentioned.
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The hypoglossal nerve is a motor nerve that supplies all the intrinsic muscles of the tongue. It emerges from the medulla oblongata between the pyramid and olive and exits the skull through the hypoglossal canal between the internal carotid artery and internal jugular vein. Damage to the hypoglossal nerve in the neck would cause the tongue to deviate to the side of the lesion on protrusion due to paralysis of the muscles on that side.
Gram's stain is a method used to differentiate between two large groups of bacteria - Gram positive and Gram negative - based on their cell wall structure and composition. The staining process involves smearing a bacterial sample on a slide, treating it with crystal violet dye and iodine, then decolorizing it with alcohol or acetone before counterstaining with safranin. This allows bacteria to be classified based on whether they retain the primary violet stain (Gram positive) or take up the counterstain (Gram negative).
The external carotid arteries and internal carotid artery supply blood to the craniofacial complex. The external carotid arteries supply blood to the head, face, mouth and neck through branches like the occipital artery, posterior auricular artery, and various arteries of the lips and oral cavity. The internal carotid artery supplies the brain, eye, forehead and nose through branches like the ophthalmic artery. Veins like the internal jugular vein and external jugular vein drain blood from the craniofacial complex. Key arteries supply specific structures in the head and face with blood while corresponding veins drain blood from the same areas.
The accessory nerve (XI) has both a cranial and spinal root. The cranial root arises from the nucleus ambiguous and joins the vagus nerve, innervating pharyngeal muscles. The spinal root arises from the spinal cord from C1-C5 and exits the skull through the jugular foramen. It innervates the sternocleidomastoid and trapezius muscles. Lesions or injuries can cause paralysis of these muscles and symptoms like drooping shoulders, inability to turn the head, or draw it forward.
Development of palate, tongue, maxilla and mandibleAldrin Jerry
The document discusses the development of various structures in the oral cavity, including the palate, tongue, mandible, and maxilla. It describes:
- The palate develops from the primary and secondary palate between 5-9 weeks as the palatine shelves fuse in the midline.
- The tongue develops from the mandibular arches, with the anterior 2/3 forming from swellings that merge together and the posterior 1/3 forming from the 2nd, 3rd, and 4th arches.
- The mandible forms from the first pharyngeal arch, while the maxilla develops from the first pharyngeal prominence.
Developmental defects that can occur in
This document discusses normal flora and its relationship to the human body. It defines normal flora as microorganisms commonly found on and inside the human body. These microbes exist in either mutualistic, commensal, or opportunistic relationships with their human hosts. The document outlines several types of normal flora, including resident flora that always live on the body and transient flora that only remain for short periods. It also explains how normal flora can protect the body but also potentially cause disease.
Clinical anatomy of facial nerve and facial nerve palsy Ramesh Parajuli
The facial nerve is a mixed nerve that originates in the brainstem and has motor, sensory, and parasympathetic functions. It has several segments as it exits the brainstem and travels through the skull and internal auditory canal before exiting behind the ear. It gives off several branches and terminates in branches that innervate the muscles of facial expression. Facial nerve palsy can result from various causes like Bell's palsy, trauma, infection, tumors, or iatrogenic injuries. Clinical assessment and electrical tests can localize the site of injury which guides management including medications, physical therapy, or surgical interventions like decompression or repair.
The document describes the triangles of the neck. It discusses the anterior and posterior triangles, which are divided by the sternocleidomastoid muscle. The posterior triangle contains nerves like the spinal accessory nerve and brachial plexus. It is further divided by the omohyoid muscle into the supraclavicular and occipital triangles. The anterior triangle contains the carotid vessels and is divided into the submental, submandibular, carotid, and muscular triangles. Both triangles contain important muscles and nerves.
Immunoglobulins are glycoproteins called antibodies that are produced by plasma cells in response to antigens. There are five classes of immunoglobulins - IgG, IgA, IgM, IgD, and IgE - which have different structures and roles in the immune system. IgG is the most abundant antibody found in serum and body fluids. IgA is present in secretions like breast milk, saliva, and mucus to provide immunity at body surfaces. IgM is the first antibody produced during infection and activates the complement system. IgE mediates allergic reactions by binding to mast cells.
The document provides an overview of the arteries of the face. It notes that the face is supplied by branches of the external carotid artery including the facial artery, transverse facial artery, and maxillary artery. It also discusses the internal carotid artery and its terminal branch, the ophthalmic artery, which gives off the zygomaticofacial and dorsal nasal arteries that supply parts of the face. The anastomoses between the branches of the external and internal carotid arteries are mentioned as well.
Immunoglobulins, also known as antibodies, are Y-shaped glycoproteins produced by B cells that function to recognize and bind to foreign objects like antigens or pathogens. There are five classes of immunoglobulins - IgG, IgM, IgA, IgD, and IgE - which differ in size, sugar content, and biological function. Each immunoglobulin molecule contains two light chains and two heavy chains that form variable and constant regions. The variable regions are responsible for binding to antigens while the constant regions mediate different immune functions.
The document discusses the external carotid artery, its branches, and ligation. It begins with an introduction and overview of the embryological development of the external carotid artery. It then describes the common carotid arteries and their course in the neck. It discusses the bifurcation of the common carotid artery and structures located there - the carotid sinus and carotid body. The external carotid artery is then described in detail, including its course, branches, and relations. The branches discussed include the superior thyroid, lingual, facial, occipital, posterior auricular, ascending pharyngeal, maxillary, and superficial temporal arteries. Indications for ligation and surgical approaches are provided at the end.
The glossopharyngeal nerve is the ninth cranial nerve. It exits the brainstem between the olive and inferior cerebellar peduncle, passing through the jugular foramen. It has both sensory and motor functions, including taste sensation from the posterior tongue, sensation from the pharynx and middle ear, and motor innervation of the stylopharyngeus muscle. It also provides parasympathetic input to the parotid gland. Damage can cause loss of taste, swallowing issues, and impaired gag reflex.
Trigeminal nerve maxillary nerve and clinical implicationDr Ravneet Kour
The document discusses the maxillary branch of the trigeminal nerve and its clinical implications. It begins by describing the basic anatomy of neurons, nerves and cranial nerves. It then focuses on the trigeminal nerve as the fifth cranial nerve, describing its nuclei, ganglion and three main branches - the ophthalmic, maxillary and mandibular nerves. Most of the document details the anatomy and branches of the maxillary nerve, including those in the pterygopalatine fossa, orbit, infraorbital canal and face. It concludes by discussing three clinical implications - trigeminal neuralgia, herpes zoster ophthalmicus and Wallenberg syndrome.
The glossopharyngeal nerve (CN IX) exits the brainstem and has several functions:
- It provides general and special sensory innervation to the back third of the tongue (taste sensation), tonsils, middle ear, and pharynx.
- It supplies a parasympathetic branch that stimulates saliva production in the parotid gland.
- It provides motor innervation to the stylopharyngeus muscle, which elevates the pharynx during swallowing.
The nerve exits the skull via the jugular foramen and branches to innervate its target areas.
The trigeminal nerve is the largest of the cranial nerves. It has both sensory and motor functions. Sensory fibers carry general somatic afferent information from the face to the trigeminal ganglion. Motor fibers innervate the muscles of mastication. The trigeminal nerve emerges from the pons and divides into three main branches: the ophthalmic, maxillary, and mandibular nerves. These branches innervate different regions of the face and cranium, carrying sensory information and motor commands. Injuries or diseases of the trigeminal nerve can cause sensory deficits or neuropathic pain conditions like trigeminal neuralgia.
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The trigeminal nerve is the largest of the cranial nerves. It has both sensory and motor functions. It has three main divisions: the ophthalmic, maxillary, and mandibular nerves. The ophthalmic nerve innervates the eye and forehead. The maxillary nerve supplies sensation to the cheek, upper teeth, and nose. The mandibular nerve provides motor input to the muscles of mastication and sensation to the lower face, teeth, and chin.
Fifth cranial nerve
Have a large sensory root and a small motor root.
Motor root arises – arises from the lateral aspect of lower pons (cranially) the motor root cross the apex of the petrous temporal bone beneath the superior petrosal sinus, to enter the middle cranial fossa.
Sensory root – arises from the lateral aspect of lower pons (caudally).
RELATIONS
Medially
(a) internal carotid artery
(b) posterior part of cavernous sinus
Laterally - middle meningeal artery
Superiorly - parahippocampal gyrus
Inferiorly
motor root of trigeminal nerve
(b) greater petrosal nerve
(c) apex of the petrous temporal bone
(d) foramen lacerum.OPTHALIMIC DIVISION
Terminal branches of Ophthalmic division of trigeminal nerve, are
1. Frontal
Supratrochlear
Supraorbital
2. Nasociliary
Branch of ciliray ganglion
2-3 long ciliary nerves
Posterior ethmoidal
Infratrochlear
Anterior ethmoidal
3. Lacrimal
Branches
From main trunk
Meningeal branch
Nerve to medial pterygoid
From the anterior trunk
Sensory branch
Buccal nerve
Motor branch
Masseteric
Deep temporal nerve
Nerve to lateral pterygoid
From the posterior trunk
Auriculotemporal
Lingual
Inferior alveolar nerves
The trigeminal nerve is a mixed nerve that is the largest of the cranial nerves. It has both sensory and motor functions. Sensory branches provide sensation to the face and motor branches innervate the muscles of mastication. The trigeminal nerve has three major divisions - ophthalmic, maxillary, and mandibular nerves. These divisions branch further to innervate specific regions of the face. The trigeminal ganglion contains the cell bodies of pseudounipolar neurons that relay sensory information from the face to the brainstem trigeminal nuclei.
The trigeminal nerve is the largest of the cranial nerves. It has both sensory and motor components. It originates from four nuclei in the brainstem and exits the skull through three divisions - ophthalmic, maxillary, and mandibular. The ophthalmic division innervates parts of the face, eye, and nasal cavity. The maxillary division innervates parts of the face, nasal cavity, and palate. The mandibular division innervates muscles of mastication and parts of the face.
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The trigeminal nerve is the 5th cranial nerve and is a mixed nerve responsible for sensation in the face and motor function of muscles of mastication. It has 3 main divisions - the ophthalmic, maxillary, and mandibular nerves. The mandibular nerve is the largest division and supplies motor innervation to the muscles of mastication as well as sensory innervation to parts of the face and scalp.
The maxillary nerve is a branch of the trigeminal nerve that arises from the trigeminal ganglia and provides sensory innervation to parts of the face, nasal cavity, and palate. It passes through the foramen rotundum into the pterygopalatine fossa where it gives off branches including the nasopalatine nerve that supplies the hard palate and nasal septum, and the greater and lesser palatine nerves that innervate the palate. The infraorbital nerve is a terminal branch that emerges on the face through the infraorbital foramen and divides further to innervate the lower eyelid, nose, upper lip, and gums.
The document discusses the 12 pairs of cranial nerves. It describes the anatomy and functions of each nerve. The cranial nerves emerge from the brain and pass through openings in the skull, carrying sensory information from structures in the head and neck and motor signals to muscles like the extraocular muscles that control eye movement. The document focuses on describing the course and distribution of each cranial nerve pair.
This document describes the anatomy and function of cranial nerve VIII (vestibulocochlear nerve). It notes that CN VIII has two parts - the cochlear part which carries hearing impulses and the vestibular part which carries equilibrium impulses. The auditory pathways that transmit hearing signals from the inner ear to the brainstem and auditory cortex are then described. Finally, the document discusses some clinical correlations of lesions to CN VIII, including causes of hearing loss.
The glossopharyngeal nerve (CN IX) emerges from the medulla and exits the skull through the jugular foramen. It has sensory and motor functions. Sensory fibers innervate the posterior third of the tongue, tonsils, pharynx, and middle ear. Motor fibers innervate the stylopharyngeus muscle. Parasympathetic fibers pass to the otic ganglion to ultimately innervate the parotid gland and stimulate saliva secretion.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Cranial nerves x,xi & xii
1. COLLEGE OF DENTAL SCIENCES
DEPARTMENT OF PERIODONTICS
SEMINAR
ON
CRANIAL NERVERS
IXth
, XIth
AND XIIth
SUBMITTED BY:
DR. CHETAN CHANDRA
1
2. • ITRODUCTION
• ATTACHMENT OF THE CRANIAL NERVES TO THE
BRAINSTEM.
• GLOSOPHARYNGEAL NERVE (IXTH
CRANIAL NERVE)
• SPINAL ACCESSORY NERVE (XITH
CRANIAL NERVE)
• HYPOGLOSSAL NERVE (XIITH
CRANIAL NERVE)
• CONCLUSION
2
3. All cranial nerves are attached to the surface of the brain.
The olfactory and optic nerves are attached to the cerebral hemispheres. The
remaining nerves are attached to the brainstem.
The occulomotor nerve is attached to the midbrain on the anteromedial
aspect of the cerebral peduncle.
The trochlear nerve emerges from the posterior surface of the brainstem, just
below the inferior colliculus.
The trigeminal nerve is attached to the front of the pons where the latter
becomes continuous with the middle cerebellar peduncle.
The abducent nerve emerges at the lower border of the pons, immediately to
the pyramid.
The facial nerve (and nervus intermedius) also emerges at the lower border of
the pons, cranial to the olive.
The vestibulocochlear nerve is attached to the lower border of the pons just
later to the facial nerve.
The rootlets of the glossopharyngeal, vagus and accessory nerves emerge
through the posterolateral sulcus of the medulla (in line with dorsal nerve
roots of spinal nerves).
The rootlets of the hypoglossal nerve emerge through the anterolateral sulcus
of the medulla (in line with ventral nerve roots of spinal nerves).
3
4. INTRODUCTION
FUNCTIONAL COMPONENTS
COURSE AND RELATIONS
BRANCHES AND DISTRIBUTION
OTIC GANGLION
CLINICAL CONSIDERATIONS
CLINICAL TESTING OF GLOSSOPHARYNGEAL NERVE
I) INTRODUCTION:-
The glossopharyngeal or ninth cranial nerve (from glosso, “tongue”, and
pharynx, “throat”) is a mixed branchiomeric nerve.
It is the nerve of the third (III rd
) branchial arch.
It is attached to the lateral side of the upper part of the medulla (between the
olive and the inferior cerebellar peduncle) by three or four roots.
Glossopharyngeal Nerve
1) Motor to 2) Secretomotor to 3) Gustatory to 4) Sensory to:
Stylopharyngeus Parotid gland Post.1/3rd
of tongue Pharynx, tonsils &
Post.1/3rd
of tongue.
It runs forwards and laterally and leaves the cranial cavity by passing through
the middle part of the jugular foramen.
At the base of the skull IX th
nerve forms two sensory ganglia i.e superior and
inferior petrosal ganglia.
Superior petrosal ganglion is small and gives no branches.
4
5. Inferior petrosal ganglion is larger & occupies a notch on the lower border of
the petrous temporal bone.
II) FUNCTIONAL COMPONENTS :-
A) General visceral efferent fibers:-
Preganglionic fibers arise in the inferior salivary nucleus and travel to the otic
ganglion.
Postganglionic fibers arising in the otic ganglion supply the parotid gland.
B) Special visceral efferent fibers:-
Arises in nucleus ambiguus.
Supplies stylopharyngeous muscle.
C) General visceral afferent:-
Fibers are peripheral processes of cell in the inferior ganglion of the nerve.
They carry general sensations (touch, pain, temperature) from the pharynx
and the posterior part of the tongue to the ganglion.
The central processes convey these sensations to the nucleus of the solitary
tract.
D) Special visceral afferent:-
Fibers are also peripheral process of the cell in the inferior ganglion.
They carry sensations of taste from the posterior one third of the tongue to the
ganglion.
The central processes convey these sensations to the nucleus of solitary tract.
5
6. III) COURSE AND RELATIONS:-
Intracranial course
Fibers of nerve pass forwards and laterally between the Olivary
nucleus and the inferior cerebellar peduncle through the reticular
formation of the medulla.
At the base of brain
Nerve is attached by 3 to 4 filaments to the upper part of the posterolateral
sulcus of the medulla, just above the rootlets of the vagus nerve.
Leaves the skull
Filaments unite to form a single trunk and leave the skull by passing
through the middle part of the jugular foramen anterior to the X th
and XI th
cranial nerves. It has a separate sheath of duramater.
Extracranial course
Emerging at the base of the skull the nerve passes forwards and laterally between
the internal jugular vein (which is posterolateral to it) and Internal carotid Artery
(which is anterolateral to it). It then passes deep to styloid process and muscles
attached to it. Winds around stylopharyngeus & passes between external and
internal carotid arteries and reaches the side of pharynx. It enters the
submandibular region by passing deep to the hypoglossus, where it
breaks up into tonsillar and lingual branches.
6
7. IV) BRANCHES AND DISTRIBUTION:-
Tympanic Carotid Pharyngeal Muscular Tonsillar Lingual
1) Tympanic nerve (Jacobson’s nerve) :-
The tympanic nerve arises from the inferior sensory ganglion. It passes through a
canal (called the inferior tympanic canaliculus) within the petrous part of the
temporal bone and reaches the tympanic cavity and forms a plexus (Tympanic
plexus).
Branches arising from this plexus supply the :-
Mucous membrane of the tympanic cavity.
The auditory tube
The mastoid air cells.
The tympanic nerve then perforates the roof of the cavity and having lost its
sensory fibers, is known as the lesser petrosal nerve. It leaves the cranial cavity
by passing through the foramen ovale. The nerve ends by joining the otic
ganglion.
2) Carotid branch :-
The carotid branch arises soon after the glosso-pharyngeal nerve emerges on the
base of the skull. It supplies the baroreceptors of carotid sinus and
chemoreceptors of the carotid body.
These two tiny organs are blood pressure regulatory mechanisms that are located
close to the bifurcation of the common carotid artery.
3) Pharyngeal branches:-
Take pharyngeal nerve fibers join with vagus (Xth
) and the spinal accessory
(XIth
) nerves to form the pharyngeal plexus.
7
8. This network supplies the muscles of the pharynx and soft palate, except for the
tensor veli palatine and the stylopharyngeus muscles. Also this plexus provides
sensory fibers to the mucosa of the soft palate and the pharynx.
4) Muscular branch:-
As the glossopharyngeal nerve winds around the stylopharyngeus it supplies this
muscle. (Note= This is the only motor branch of the nerve).
5) Tonsillar branch:-
Supply the tonsil and join the lesser palatine nerves to form a plexus from which
fibers are distributed to the soft palate and to the palatoglossal arches.
6) Lingual branch:-
The lingual branches supply the part of the tongue (mucous membrane) behind
the sulcus terminalis. They also supply the vallate papillae. These branches carry
fibers for both general sensation and taste.
The glossopharyngeal nerve carries fibers that subserve special functions.
I. Secretomotor fibers for the parotid gland pass through the glossopharyngeal
nerve. The preganglionic neurons concerned are located in the inferior
salivatory nucleus which lies at the junction of the pons and medulla just
below the superior salivatory nucleus.
Preganglionic fibers pass successively through the proximal part of the
glossopharyngeal nerve, its tympanic branch, the tympanic plexus and the
lesser petrosal nerve to end in the otic ganglion. Postganglionic fibers arising
from neurons located in the otic ganglion pass through a nerve connecting the
otic ganglion to the auriculotemporal nerve, and then through the
auriculotemporal nerve itself. They leave the latter through its parotid branch
to reach the parotid gland.
8
9. II. Sensory fibers pass through the pharyngeal, tonsilar and lingual branches to
supply the mucous membrane of the pharynx, the posterior part of the tongue,
the tonsil and the soft palate.
III. The glossopharyngeal nerve also contains fibers carrying the sensations of
taste from the posterior one third of the tongue (part of the tongue behind the
sulcus terminalis, and the vallate papillae). The fibers pass through the
glossopharyngeal nerve and its lingual branches to reach the tongue.
V) THE OTIC GANGLION
The otic ganglion is related functionally to the glossopharyngeal nerve. It is
situated just below the foramen ovale medial to the trunk of the mandibular
nerve. It is connected to the nerve of the medial pterygoid muscle. The
middle meningeal artery and the roots of the auriculotemporal nerve lie close
to it.
The fibers passing through the otic ganglion are as follows:-
a) Functionally the ganglion is autonomic and is peripheral ganglion of
the cranial parasympathetic outflow. It is the relay station for the
secretomotor fibers to the parotid gland.
b) Sympathetic fibers reach the ganglion from the plexus on the middle
meningeal artery. They pass through the ganglion, without relay, and
travel to the parotid gland through the auriculotemporal nerve.
c) Motor fibers reach the ganglion through the nerve to the medial
pterygoid. These fibers are derived from the motor root of the
mandibular nerve. They pass through the ganglion (without relay) and
enter branches of the ganglion which supply the tensor tympani and the
tensor palate muscles.
9
10. VI) CLINICAL CONSIDERATIONS:-
1. Taste fibers from both the anterior two-thirds and the posterior one third of
the tongue have reflex connections with the salivatory nuclei and taste
impulses can give rise to an increased rate of salivation-the taste: salivation
reflex.
2. Increasing blood pressure stimulates the baroreceptors of the carotid sinus
and their reflex connections with the Xth
nerve produce a decrease in the heart
rate. Inhibition of sympathetic cells in the spinal cord produces peripheral
vasodilatation and a decrease in blood pressure. In some individuals the sinus
is very sensitive to pressure and syncopal attacks may be induced by light
pressure on the neck over the sinus.
3. Changes in the concentration of the blood gases stimulate the chemoreceptors
of the carotid body. Their central connection with the respiratory centre
influences the respiratory rate.
4. Stimulation of the posterior pharyngeal wall excites glossopharyngeal sensory
fibers and initiates the gag reflex. Reflex connections of these sensory fibers
with the nucleus ambiguous stimulates the motor fibers which leave the
nucleus via the IXth
and Xth
nerves to the muscles of the pharynx, larynx and
soft palate, causing a contraction and elevation of the palate.
5. Isolated lesions of the glossopharyngeal nerve are rare. Lesions which
involve the medulla, e.g. syringobulbia, or the nerve on its course towards or
within the jugular foramen, e.g. neoplasm of the posterior cranial fossa,
meningitis, thrombophlebitis of the internal jugular vein or trauma, usually
involving the Xth
and XIth
cranial nerve also, due to their proximity to the
glossopharyngeal nerve.
10
11. Involvement of the IXth
nerve will produce a loss of gag reflex, loss of
sensation of pharynx and the posterior one third of the tongue, loss of taste
sensations to posterior one third of the tongue, slight pharyngeal weakness
and dysphagia (from paralysis of stylopharyngeus muscle) and possibly loss
of salivation from the parotid.
VII) CLINICAL TESTING OF THE GLOSSOPHARYNGEAL NERVE:-
Glossopharyngeal nerve is clinically tested as follows:-
On tickling of posterior wall of pharynx, there is reflex contraction of the
throat muscles. No such contractions occur when the ninth nerve is
paralysed.
Taste sensibility on the posterior one third of the tongue can also be tested.
It is lost in ninth nerve lesions
Isolated lesions of the ninth nerve are almost unknown. They are usually
accompanied by lesions of the vagus nerve.
VIII) GLOSSOPHARYNGEAL / VAGOGLOSSOPHARYNGEAL
/ IDIOPATHIC GLOSSOPHARYNGEAL NEURALGIA
Neuralgia is characterized by a sudden paroxysmal pain that is felt radiating down
the peripheral distribution of the involved nerve. This pain is episodic, usually with
periods of total remission between the painful episodes. The paroxysmal pain is
often triggered by a mild, innocuous stimulus. The neuralgia is named according to
the nerve involved.
Glossopharyngeal neuralgia is similar in character to trigeminal neuralgia but is
present in the distribution of the glossopharyngeal nerve and may be present in the
distribution of the auricular and pharyngeal branches of the vagus nerve. The pain
11
12. is typically severe, transient and stabbing or burning, and located in the ear, base of the
tongue, tonsilar fossa, or beneath the angle of the jaw. The pain is unilateral, although
1% to 2% of parents may experience non-simultaneous bilateral pain. The paroxysm of
pain usually last seconds to 2 minutes and are proved by swallowing, chewing, talking
or yawning. It may relapse and remit like trigeminal neuralgias. The incidence of
glossopharyngeal neuralgia is estimated to be 50 to 100 times less than that of
trigeminal neuralgia. The neurologic examination is normal. The pathophysiology is
thought to be similar to that of idiopathic trigeminal neuralgia.
An imaging study as MRI needs to be obtained to exclude symptomatic.
Glossopharyngeal neuralgia, which may arise due to posterior fossa tumor, fusiform
(dolichoectatic) vertebral or basilar arteries, and vascular anomalies. Additional local
causes for the pain such as infection and nasopharyngeal tumor need to be excluded.
Effective treatment of glossopharyngeal neuralgia can often be accomplished with the
medications used for the treatment of trigeminal neuralgia. In patients who fail medical
treatment, a posterior fossa craniectomy with rhizotomy of cranial nerve IXth
and the
upper rootlets of cranial nerve Xth
can effectively treat the condition.
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13. INTRODUCTION.
FUNCTIONAL COMPONENTS.
COURSE AND DISTRIBUTION OF CRANIAL ROOT.
COURSE AND DISTRIBUTION OF SPINAL ROOT.
CLINICAL CONSIDERARTIONS.
CLINICAL TESTING OF THE ACCESSORY NERVE.
I) INTRODUCTION:-
The accessory or eleventh cranial nerve arises as two roots, cranial and spinal
Spinal accessory Nerve
1) Cranial root: - 2) Spinal root:-
Is accessory to vagus, and is Has more independent course
distributed through the branches
of the latter.
II) FUNCTIONAL COMPONENTS :-
A) The cranial root is special visceral (branchial) efferent:-
Arises from the lower part of nucleus Ambiguus.
The fibers join the vagus nerve and are distributed through its pharyngeal and
laryngeal branches to :-
Soft palate
13
14. Pharynx
Larynx &
Possibly the heart.
B) The spinal root is also special visceral efferent:-
Arises from a long spinal nucleus situated in the lateral part of the anterior
grey column of the spinal cord extending between segments C1 to C5.
Its fibers supply the sternocleidomastoid and the trapezius muscles.
II) COURSE AND DISTRIBUTION OF CRANIAL ROOT:-
Origin
It emerges in the form of 4 to 5 rootlets which are attached to the
posterolateral sulcus of the medulla just below the rootlets of the
vagus nerve. The rootlets soon join together to form a single trunk.
Within the cranium
It runs laterally with the 9th
and 10th
cranial nerves and the spinal
accessory, crosses the jugular tubercle, and reaches the jugular foramen.
Emergence
In the jugular foramen, the cranial root unites for a short distance with
the spinal root, and again separates from it as it passes out of the foramen.
The cranial root finally fuses with the vagus just below its inferior
ganglion, and is distributed through its pharyngeal and recurrent laryngeal branches of
the vagus and contribute to the innervations of the muscles of the pharynx and larynx
14
15. (except cricothyroid muscle). It is believed that the muscles of the soft palate (except
the tensor palati) are supplied exclusively by fibers derived from the accessory nerve.
III) COURSE AND DISTRIBUTION OF SPINAL
ROOT:-
Origin
Arises from the upper five segments of the spinal cord.
Emergence
Emerges in the form of a row of filaments attached to the
cord midway between the ventral and dorsal nerve roots.
In the vertebral canal
Filaments unite to form a single trunk which ascends in front
of the dorsal nerve roots and behind the ligamentum denticulatum.
Enters the cranium
The nerve enters the cranium through the foramen magnum
lying behind the vertebral artery.
Within the cranium
The nerve runs upwards and laterally, crosses the jugular tubercle
(with the 9th
and 10th
cranial nerves) and reaches the jugular foramen.
Leaves the skull
15
16. Through the middle part of the jugular foramen where it fuses with
a short length of the cranial root. It soon separates from the latter
and passes out of the for amen.
Extracranial course
As the spinal accessory nerve exits from the foramen, it divides into
two nerves again, each carrying representative of both roots but still
containing a majority of either spinal fibers or cranial fibers.
The cranial fibers pass backward and down to supply the
trapezius and sternocleidomastoideus muscle.
Distribution
The spinal accessory nerve supplies:-
• Sternomastoid
• Trapezius
V) CLINICAL CONSIDERARTIONS:-
1. Isolated lesions of the cranial root are rare and this portion of the nerve may
be involved in lesions which affect the IXth
and Xth
nerve also. Damage to the
vagus nerve, particularly its recurrent laryngeal branches, may affect fibers of
the cranial root of the XIth
nerve.
2. Lesions involving the spinal root of the nerve, e.g. trauma to, or operation
upon, the posterior triangle, results in paralysis and atrophy of Sternomastoid
and trapezius muscle with an inability to turn the head away from the affected
side and to shrug the shoulder on the affected side.
3. In upper motor neurone lesions, spasticity of the muscles but no atrophy is
present and, in unilateral damage, a torticollis (wry neck), may result.
16
17. 4. Torticollis may be congenital, following fibrosis within one Sternomastoid
muscle after haematoma, or may be due to local disease or trauma.
Spasmodic torticollis, with involuntary neck movements, may be caused by
extrapyramidal disease, and may be unresponsive to any treatment other that
surgical division of the spinal accessory nerve.
VI) CLINICAL TESTING OF THE ACCESSORY NERVE:-
1. To test the integrity of the cranial root the patient is examined as follows:-
• Sensations of the pharynx can be tested by touching these areas
with a wooden spatula.
• The gag reflex can be elicited by touching the posterior wall of
the pharynx on either side with the same instrument.
• The soft palate can be inspected directly through the open mouth
when the patient is asked to say, ‘ah’. In unilateral paralysis of
the muscles the paralysed side will not elevate and the uvula will
be pulled towards the normal side, i.e. away from the side of the
lesion.
• Inspection of the larynx and the vocal folds is possible,
indirectly, by using a laryngeal mirror. Paralysis of the vocal
folds can be seen during attempts at phonation.
2. To test the integrity of the spinal root the patient is examined for atrophy
or wasting of Sternomastoid and trapezius muscles and drooping of the
shoulder. The power of trapezius is tested by asking :-
• The patient to shrug his shoulders against resistance, and
comparing sides.
• Pressing the chin down against resistance outlines the
Sternomastoid muscles. Deviation may be noticed towards the
affected side during this procedure.
17
18. • The individual Sternomastoid muscles are tested by rotating the
head against resistance to either side. Paralysis or weakness is
noticed on an attempt to turn the head away from the affected
side.
INTRODUCTION.
FUNCTIONAL COMPONENT.
COURSE AND RELATIONS.
BRANCHES AND DISTRIBUTION.
CLINICAL CONSIDERATIONS.
CLINAL TESTING OF HYPOGLOSSAL NERVE.
I) INTRODUCTION:-
This is the twelfth cranial nerve. Its fibers are purely motor and they supply the
muscles of the tongue.
The neurons that give origin to these fibers are located in the hypoglossal
nucleus in the medulla.
The lower motor neuron fibers of hypoglossal, or twelfth cranial nerve,
originate in the nucleus of the hypoglossal nerve, which is 2-cm long column
of motor cells located underneath the floor of the fourth ventricle just lateral to
the midline.
In addition, the hypoglossal nerve carries proprioceptive impulses from the
muscles of the tongue to the brain.
II) FUNCTIONAL COMPONENT:-
18
19. It is a somatic efferent nerve. The fibers arise from the hypoglossal nucleus
which lies in the medulla, in the floor of the fourth ventricle deep to the
hypoglossal triangle.
III) COURSE AND RELATIONS:-
Intracranial course
The nerve is attached to the anterolateral sulcus of the medulla,
between the pyramid and the olive, by 10 to 15 rootlets.
At the base of the brain
The rootlets run laterally (behind the vertebral artery, and join
to form two bundles which pierce the duramater separately
near the hypoglossal canal.
Leaves the skull
The nerve leaves the skull through the hypoglossal canal and lies within
the carotid sheath and passes downwards between the internal jugular vein
and the internal carotid artery in front of the vagus, deep to the parotid gland
Extracranial course
It courses forward and is almost horizontal as it reaches a level deep to the
angle of the mandible. At the lower border of the posterior belly of the diagastric
it curves forwards, hooks round the lower Sternomastoid branch of the occipital
artery, crosses the internal and external carotid arteries and passes deep to the
posterior belly of the diagastric again to enter the submandibular region.
The nerve then continues forwards on the hypoglossus and genioglossus,
19
20. deep to the submandibular gland and the mylohyoid, and enters thesubstance
of the tongue to supply all the intrinsic and extrinsic muscles of the tongue
(except palatoglosssus which is supplied, along with other muscles of the
palate, by the cranial accessory nerve )
IV) BRANCHES AND DISTRIBUTION:-
In addition to its own fibers, the nerve also carries fibers that reach it from
spinal nerve C1, and are distributed through it.
Hypoglossal nerve
A) Branches containing fibers of B) Branches of the hypoglossal nerve
the hypoglossal nerve proper. containing fibers of nerve C1.
1)Meningeal br. 2)Descending br. 3)Branches given
to thyrohyoid &
geniohyoid
muscles.
A.Branches containing fibers of the hypoglossal nerve proper. They supply all
the intrinsic and extrinsic muscles of the tongue, except the palatoglossus which
is supplied by fibers of the cranial accessory nerve through the vagus and the
pharyngeal plexus.
B. Branches of the hypoglossal nerve containing fibers of nerve C1. These fibers
join the nerve at the base of the skull.
20
21. 1. The Meningeal branch contains sensory and sympathetic fibers. It enters
the skull through the hypoglossal canal, and supplies bone and meninges
in the anterior part of the posterior cranial fossa.
2. The descending branch continues as the descendens hypoglossi or the
upper root of the ansa cervicalis.
3. Branches are also given to thyrohyoid and geniohyoid muscles.
V) CLINICAL CONSIDERARTIONS:-
1. The XIIth
nerve may be damaged by trauma at or below its exit from
the skull, e.g. skull fracture, upper cervical fracture or dislocation. The
hypoglossal nucleus or its central connections may be involved in
intracranial lesions, e.g. haemorrhage, tumors, syringobulbia, multiple
sclerosis, infections of the posterior cranial fossa, etc.
2. Peripheral damage to the nerve, or damage to its nucleus, causes a
flaccid paralysis of the muscles of the tongue on the affected side,
atrophy of the paralysed muscles with ‘wrinkling’ of the tongue on
that side, and deviation of the tongue towards the side of the lesion on
protrusion. Fasciculation of the affected half of the tongue may also
be present.This deviation is due to the unopposed contraction of the
contralateral genioglossus, which pulls the base of the tongue forward.
Involvement of the hypoglossal nucleus is usually associated with
damage to related nerves or medullary structures.
3. Supranuclear damage, e.g. lesions of the corticobulbar tracts, results
in a spastic paralysis, without wasting or fibrillation, to the
contralateral side of the tongue
4. Hemiparalysis of the tongue may give rise to difficulty with speech,
mastication and swallowing.
21
22. 5. Bilateral lesions of the hypoglossal nerves results in an immobile
tongue which can be displaced into the throat, interfering with
respiration. Tracheotomy may be required.
VI) CLINICAL TESTING OF THE HYPOGLOSSAL NERVE :-
1. Observation of the tongue may reveal wasting, wrinkling or
fasciculation. Deviation of the tongue on protrusion should be noted.
2. The power of the tongue musculature can be tested by asking the
patient to push each cheek out with his tongue against resistance.
Comparison of both sides can be made.
1) Clinical anatomy for dentistry (dental series) by R.B Longmore and D.A Mcrae.
2) Atlas of human anatomy by inderbir singh.
3) Mc minn’s color atlas of head and neck anatomy by Bari.M.Logan, Patriciar A.
Reynolds and Ralph.T.Hutchings.
22