This document provides an overview of the 12 cranial nerves, including their origin, nuclei, course, branches, and clinical considerations. It discusses each cranial nerve individually, from CN I (Olfactory) through CN XII (Hypoglossal). For each nerve, it describes the embryonic development, key anatomical structures it is associated with or passes through, the structures it innervates, and clinical implications of damage to that nerve. The overall purpose is to review the nerve supply of the head and neck region through detailed examination of each cranial nerve.
Congenital third ( oculomotor )nerve palsyVinitkumar MJ
Ask about pregnancy & birth history due to the association with birth trauma & perinatal complications.
Inquire whether the patient is meeting their developmental milestones or if they are exhibiting any other neurologic signs or symptoms. Although additional focal neurologic abnormalities or generalized delays in development have been described in these patients, their presence may increase concerns of other neurologic etiologies.
Determine whether they have signs of oculomotor synkinesis, such as asking the parents if they notice eye or eyelid movement during feeding.
Question if they have any family history of strabismus.
Heritability may suggest other forms of strabismus with known genetic associations.
The facial nerve is the seventh (VII) of twelve paired cranial nerves.
It emerges from the brainstem between the Pons and the Medulla.
Facial nerve is a mixed nerve, having 2 roots:
1. Medial motor root.
2. Lateral sensory root (nervous intermedius),which contains sensory & parasympathetic fibers.
Waardenburg syndrome
Congenital third ( oculomotor )nerve palsyVinitkumar MJ
Ask about pregnancy & birth history due to the association with birth trauma & perinatal complications.
Inquire whether the patient is meeting their developmental milestones or if they are exhibiting any other neurologic signs or symptoms. Although additional focal neurologic abnormalities or generalized delays in development have been described in these patients, their presence may increase concerns of other neurologic etiologies.
Determine whether they have signs of oculomotor synkinesis, such as asking the parents if they notice eye or eyelid movement during feeding.
Question if they have any family history of strabismus.
Heritability may suggest other forms of strabismus with known genetic associations.
The facial nerve is the seventh (VII) of twelve paired cranial nerves.
It emerges from the brainstem between the Pons and the Medulla.
Facial nerve is a mixed nerve, having 2 roots:
1. Medial motor root.
2. Lateral sensory root (nervous intermedius),which contains sensory & parasympathetic fibers.
Waardenburg syndrome
The olfactory epithelium lines the roof of nasal cavity.
Olfactory epithelium lines the inferior surface of cribriform plate of ethmoidal bone (roof of the nasal cavity). The latter is related to the inferior surface of the brain.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
3. Introduction
There are 12 cranial nerves each
has a number and name as follows.
1. Olfactory.
2. Optic.
3. Oculomotor.
4. Trochlear.
5. Trigeminal.
6. Abducent.
7. Facial.
8. Vestibulocochlear.
9. Glossopharyngeal .
10. Vagus.
11. Accessory.
12. Hypoglossal.
4. embryology
The development of cranial nerves
starts as early as 4th week of
gestation period
In the beginning of 4th week cranial
nerve 3,5,7,8,9,10,11 and 12 develop
Followed by the formation of rest of
the cranial nerves.
5. Attachment of cranial nerves to brain stem
Pons
cerebellum
Middle cerebellar
peduncle
6. Sensory and motor nerves
PURELY SENSORY – 1 , 2 , 8
PURELY MOTOR - 3 , 4 , 6 , 12
MIXED(SENSORY AND MOTOR)- 5 , 7 , 9 , 10,11
8. Course and relation
Olfactory neurons are a bunch of
nerve fibers around 20 in number
They represent central process of
olfactory cells(16-20 million cells)
They doesn’t have a nuclei
The fibers reach the cerebral cortex
without synapsisng in any thalamic
nuclei.
9. Surgical consideration
Damaged in cases of:
In head injury and frontal bone
fractures due to tearing away of
olfactory bulb as cribrifrorm plate of
ethmoid is fractured
Frontal lobe tumors.
Surgical repair can lead to anosmia.
Properties: Nerve can regenerate.
11. CONTENTS OF OPTIC CANAL
OPTIC NERVE: It’s a group of axons
of ganglion cells of retina.
OPTIC CHIASMA:consists of nasal
fibers and temporal fibers.
OPTIC TRACT: it contains temporal
fibers of same side and nasal fibers of
the opposite side
VISUAL CORTEX: where color,
size,shape,motion ,illumination,and
transperancy are appreciated.
No ability to regenerate
12. VISUAL FEILD
It consists of temporal field of the
vision and nasal field of vision
Visual field is also upper field and
lower visual fields so there are 4
fields of vision
Upper temporal
Lower temporal
Upper nasal
Lower nasal
14. CLINICAL CONSIDERATION
Loss of vision in one half of visual
field is heminopia
If defect is in same side it is called
homonymous and heteronymous if
defect is in opposite side
Papilloedema:results due to increase
in intra cranial pressure
Optic nerve damage results in
complete blindness of that eye
15.
16. Cranial nerve:3- oculomotor
Origin: mid brain
Supplies:
Four intraocular muscle
One extraocular muscle
proprioceptive to above muscle
parasympathetic to pupils
Nuclei - oculomotor nucleus and
Edinger Westphal nucleus.
17. Course and relation
Attached to oculomotor sulcus at
base of the brain
Passes between superior and
posterior cerebellar artery on the
lateral side and reach cavernous sinus
On the later wall of sinus divides into
upper and lower divisions
And exists from superior orbital
fissure
The smaller upper divison supplies
superior rectus and part of levator
palpabre superiors
The large lower divison supplies
1. Medial rectus
2. Inferior rectus
3. Inferior oblique
18. Clinical consideration
Complete or total paralysis in 3rd nerve leads
to:
1. Ptosis; drooping of upper eyelid-paralysis
of voluntary part of levator palpebrae
superioris
2. Lateral squint- unopposed action of lateral
rectus and superior oblique
3. Dilatation of pupil-paralysis of
parasympathetic fibers
4. Loss of accommodation-paralysis of ciliary
muscle
5. Slight proptosis-unopposed action of
lateral rectus and superior oblique
6. diplopia
19. Cranial nerve:4- trochlear nerve
Origin: only cranial nerve which arise
from dorsal part of brain
Function :Supplies superior oblique
muscle
Nucleus : situated in ventromedial
part of central grey matter at
midbrain
Exit: superior orbital fissure
Damage causes diplopia when
looking downwards
20. Course and relation
The nerve winds around superior
cerebellar peduncle above the pons
Passes between posterior and
superior cerebellar artery
Enters cavernous sinus by piercing its
roof
Lies between oculomotor and
ophthalmic nerves
It is the longest cranial nerve
21. Clinical consideration
When damaged results in diplopia on
looking downward
Paralysis of this nerve results in
1. Defective depression of adducted
eye
2. diplopia
22. Cranial nerve:5- trigeminal
Origin: arise from lateral part of upper pons
Largest intra cranial course
Nuclear columns:
1. General somatic afferent column:
Spinal nucleus of 5th nerve:fibers convey pain
and temperature from face and relay in it
Superior sensory nucleus:carry touch and
pressure
Mesencephalic nucleus: proprioceptive
impulses from muscles of
mastication,TMJ,teeth.
2. Branchial efferent column:supply eight
muscles derived from 1st branchial arch
23. The cell bodies lie in the V
ganglion/semilunar
ganglion/gasserian ganglion.
Which lies in the petrous part of the
temporal bone in dural cave,the
meckel’ cave.
Supply 4 mucles of mastication and 4
other muscles-tensor veli
palatini,tensor tympani,mylohyoid
and anterior belly of digastric.
25. Clinical consideration
In injury to:
1. Opthalmic nerve: loss of corneal
blink reflex
2. Maxillary nerve:loss of sneeze reflex
3. Mandibular nerve: loss of jaw jerk
reflex
Trigeminal ganglion harbours herpes
zoaster virus causing shingles
Hypoacusis: partial deafness to low
pitched sounds due to paralysis of
tensor tympani muscle.
26. Surgical considerations
Lingual nerve is very close to mandibular 3rd molar
Risk of IAN injury during orthognathic surgery
Abnormal communication between mylohyoid nerve and lingual
nerve can delay local anesthetic action
Infraorbital nerve usually injured in infraorbital fracture.
Risk of injury to nerve medial to mandibular condyle during gap
arthroplasty.
27. Oculo cardiac reflex
Also called as trigemino cardiac reflex
When there is pressure on eye ball
due to trauma, hematoma
The signals travel through ciliary
muscles to gasserian ganglion
Then to nucleus of trigeminal and
vagus nerve
Resulting in increase in
parasymphathetic tone and
bradychardia in reflex
28. Arterial compression of nerve is the chief cause of trigeminal
neuralgia: neurolSci;(2014)
Trigeminal neuralgia:
Characterized by attacks of severe pain in area of
distribution of maxillary and mandibular divisions.
29. Cranial nerve 6: abducent
Origin: upper part of floor of 4th
ventricle in lower pons
Nucleus: lies in pons closely related
to medial longitudinal bundle.
Exist: medial part of superior orbital
fissure.
Function: supplies lateral rectus
muscle
30. Course and distribution
Nerve runs ventrally and downwards
and is attached to lower border of
pons
It runs anterior to the cerebellar
artery
Enters cavernous sinus by piercing
the posterior wall
Lies lateral to ICA in the cavernous
sinus
In orbit it ends by supplying lateral
rectus muscle
31. Clinical consideration
Nerve paralysis results in failure of
abduction of the affected eye
Diplopia occurs due to paralysis of
right lacteral rectus muscle
32. Cranial nerve 7:facial nerve
Queen of the face
Origin: lateral border of lower part of
pons
Nucleus:
1. Motor nucleus
2. Superior salivatory nucleus
3. Lacrimatory nucleus
4. Nucleus of tractus solitarius
33. Course and relation
1. Within the facial canal:
Greater petrosal nerve
The nerve to stapedius
Chorda tympani
2.At its exit from stylomastoid foramen:
Posterior auricular
Digastric
stylohyoid
3. terminal branches within the
parotid:
Temporal
Zygomatic
Buccal
Marginal mandibular
cervical
34. Ganglia associated:
Geniculate ganglion:Located at the
first bend of facial nerve.
Submandibular ganglion:
parasympathetic ganglion for relay of
scretomotor fibers to submandibular
and sublingual glands.
Pterygopalatine ganglion: the fibers
reach from nerve to pterygoid canal.
35. variations
In 22% cases the zygomatic and
buccal branch anastomose in their
path
In 21% 2 branches of the temporal
region are seen
36. Clinical consideration
BELLS PALSY
Infranuclear lesion of facial nerve
Ipsilateral paralysis of facial muscles
supra nuclear lesion causes-
contralateral paralysis of lower part
of face
37. “crocodile tear syndrome”
(lacrimation while eating)
A unilateral lesion causing damage
of the facial nerve proximal to the
geniculate ganglion,regenerating
fibers for submandibular salivary
gland grow in endoneural sheath of
preganglionic secretomotor fibers
supplying lacrimal glands
Freys syndrome:
•occurs due to injury to
auriculotemporal nerve
•which regenerates to attach
to sweat glands
•instead of parotid gland
38. Ramsay hunt syndrome
Involvement of geniculate ganglia by
herpes zoaster causing
Hyperacusis
Loss of lacrimation
Loss of sensation in anterior 2/3rd of
tongue
Bells palsy and lack of salivation
Vesicles on the auricle
41. Clinical consideration
Deafness :
1. Conductive loss-failure of sound waves to reach cochlea
2. Sensorineural deafness-production of transmission of action potential due to
cochlear disease
3. Cortical deafness-failure to understand the spoken language
Vertigo-illusion of rotary movements due to disturbed orientation of body in space
Tinnitus-ringing sensation in ear
Meniere’s syndrome-recurrent attacks fo tinnitus,vertigo,hearing loss
42. Cranial nerve 9- glossopharyngeal nerve
Nerve of the 3rd branchial arch
Origin: lower part of pons
Nuclei:
1. Nucleus ambigus
2. Inferior salivatory nucleus
3. Nucleus of tractus solitarius
Function: taste
Exist: jugular foramen
44. Clinical consideration
Lesion of nerve causes
1. Absence of secretion from parotid
gland
2. Absence of taste from posterior
2/3rd of the tongue
3. Loss of pain in
tongue,tonsil,pharynx and soft
palate
Glossopharyngeal neuralgia:
Short,sharp attack of pain affecting
posterior part of pharynx
Pharyngitis may be a refered pain in
the ear as both are supplied by the
same nerve.
45. Cranial nerve 10- vagus
‘Vague’- due to extensive course
Nuclei :
Nucleus ambigus
Dorsal nuclei of vagus
Nucleus of tractus solitarius
Nucleus of spinal tract of trigeminal
Exist: jugular foramen
47. Clinical considerations
Paralysis produce:
1. Nasal regurgitation
2. Nasal twang of voice
3. Hoarsness of voice
4. Flattening of palatal arch
5. Cadaveric position of vocal chords
6. dysphagia
48. Cranial nerve 11- accessory
Origin -Has 2 roots
1. Cranial root- arise from lower part
of nucleus ambigus
2. Spinal root-arise from long spinal
nucleus of spinal cord
49. Course and distribution
Arises from from 5 segments of
spinal cord
Closely related to internal jugular
veins and ICA
Enters posterior triangle of neck by
piercing through the
sternocledomastoid muscle
50. Clinical consideration
Lesion of spinal root causes drooping
of shoulder and inability to turn chin
to opposite side which is called as
whiplash injury
Nerve damage usually occurs during
neck dissections.
Irritation of nerve cause torticollis or
wry neck
Supranuclear connections act on
ipsilateral sterno cledomastoid and
on contralateral trapezius
51. Neurotization of the phrenic nerve with accessory nerve for high cervical spinal cord injury with respiratory distress: an
anatomic study.
AIM:
High cervical spinal cord injury is associated with high morbidity and mortality. Traditional treatments carry various
complications such as infection, pacemaker failure and undesirable movement The purpose of the study is to provide
anatomic details on the accessory nerve and phrenic nerve for neurotization in patients with high spinal cord injuries
CONCLUSION:
The accessory nerve and the phrenic were similar in width, thickness and the number of motor nerve fibers. And the lengths of
accessory nerve were long enough for neuritisation with phrenic nerve.
Turk neurosur july 2014: Wang, Zang, Nicholas
52. Cranial nerve 12- hypoglossal
Origin- hypoglossal nuclei of medulla
Nucleus:
Lies in the 4th ventricle beneath the
hypoglossal triangle
Function : supplies extrinsic(
genioglossus, hyoglossus,styloglossus
and palate glossus)and intrinsic(superior
and inferior longitudinal muscles, vertical
muscle and transverse) muscles of the
tongue
53. Clinical considerations
Infranuclear lesion produce paralysis
of tongue on that side with wasting
of muscles
Supranuclear lesion causes paralysis
without muscle wasting
54. HYPOGLOSSAL-FACIAL-JUMP-ANASTOMOSIS WITHOUT AN INTERPOSITION
NERVE GRAFT.
OBJECTIVES/HYPOTHESIS:
The hypoglossal-facial-anastomosis is the most often applied procedure for the reanimation of a long lasting
peripheral facial nerve paralysis. We describe the modified technique of the hypoglossal-facial-jump-
anastomosis without an interposition and present the first results.
RESULTS:
The reconstruction technique succeeded in all patients: The facial function improved within the
average time period of 10 months to the House-Brackmann score 3.
CONCLUSION:
This modified technique of the hypoglossal-facial reanimation is a valid method with good clinical
results, especially in cases of a preserved intramastoidal facial nerve.
Laryngoscope. 2013 Oct : BUETNER, LUERS
55.
56. Cranial nerve 13??
Known as cranial nerve zero or
terminal nerve
It is a microscopic plexus of
unmyelinated peripheral nerve
fascicles
Projects from nasal cavity enters
brain just a bit head of other cranial
nerves
57. conclusion
Head and neck consists of twelve cranial nerves which supply many closely associated structures
. These structures form the social picture of an individual .
Hence a proper understanding of the course of nerves of the facial planes and their relations
with their associated central nuclei is must for a maxillofacial surgeon to satisfactorily manage
any injury or pathology in the region
58. References
GRAY’S ANATOMY: 40TH EDITION
SURGICAL ANATOMY OF FACE: by Wayne F
COLOUR ATLAS OF ANTOMY : BY ROHEN
GRANT’S ATLAS OF ANATOMY : 12TH EDITION
HUMAN ANTOMY: B D CHAURASIA VOL-3
PRINCIPLES OF ANATOMY AND PHYSIOLOGY
GERARD TORTORA
REVIEW OF FACIAL NERVE ANTOMY: TERENCE SUSAN