Nerve supply of head and neck

NERVE SUPPLY OF HEAD
AND NECK
-KOMAL GHIYA

CONTENTS
 CRANIAL NERVES
 NERVE SUPPLY OF NECK REGION
 POSTEIOR TRIANGLE OF NECK
 ANTERIOR TRIANGLE OF NECK
 BACK OF NECK
 NERVE SUPPLY OF HEAD
 CUTANEOUS NERVE SUPPLY
 NERVE SUPPLY OF SCALP
 NERVE SUPPLY OF FACE

 NERVE SUPPLY OF STRUCTURES RELATED TO ORAL CAVITY
 INNERVATION OF MUSCLES OF MASTICATION
 INNERVATION OF SUPRAHYOID MUSCLES
 LARYNX
 TONSILS
 TONGUE
 SOFT PALATE
 HARD PALATE
 TEETH
 SALIVARY GLANDS
 REFERENCES

CRANIAL NERVES
 1-----OLFACTORY
 2----OPTIC
 3----OCCULOMOTOR
 4----TROCHLEAR
 5----TRIGEMINAL
 6---ABDUCENT
 7----FACIAL
 8---VESTIBULOCOCHLEAR
 9---GLOSSOPHARYNGEAL
 10----VAGUS
 11----ACCESSORY
 12----HYPOGLOSSAL
 OLFACTORY NERVE:TERMINATE IN ANTERIOR CRANIAL FOSSA
 OPTIC:MIDDLE CRANIAL FOSSA
 3 TO 12 CRANIAL NERVE PASS THROUGH POSTERIOR CRANIAL FOSSA

OLFACTORY NERVE
 The olfactory nerve [I] carries special afferent (SA) fibers for the sense of
smell. Its sensory neurons have:
 peripheral processes that act as receptors in the nasal mucosa; and
 central processes that return information to the brain
 CLINICAL APPLICATIONS: DAMAGE: ANOSMIA
 CAUSE:
 Injury to the cribriform plate; congenital absence
REF:S Standring in Gray’s anatomy 40 th edition

OPTIC NERVE
 Optic nerve [II]
 The optic nerve carries SA fibers for vision.
 These fibers return information to the brain from photoreceptors in the
retina.
 nerves enter the cranial cavity through the optic canals
 CLINICAL APPLICATIONS:
DAMAGE RESULTS IN COMPLETE BLINDNESS OF EYE

 The oculomotor nerve [III] carries two types of fibers:
 general somatic efferent (GSE) fibers innervate most of the extra-ocular
muscles;
 general visceral efferent (GVE) fibers are part of the parasympathetic part.
OCCULOMOTOR NERVE

NERVE SUPPLY OF OCULAR MUSCLES
OCCULOMOTOR
NERVE
SUPERIOR
DIVIVSION
LPS
SUPERIOR RECTUS
INFERIOR DIVISION
INFERIOR RECTUS
MEDIAL RECTUS
INFERIOR OBLIQUE
TROCHLEAR
NERVE
SUPERIOR
OBLIQUE
ABDUCENT
NERVE
LATERAL
RECTUS
REF:B D Chaurasia in Human Anatomy,vol 3,fourth edition

Clinical applications
Abducent nerve Trochlear nerve Occulomotor nerve
Fully adducted eye (due
to unopposed MR)results
into internal strabismus
Inability to abduct eye
Diplopia in all ranges of
movement of the eyeball
on lateral gaze except on
looking to the side
opposite to lesion(i.e on
normal side)
Inability to look
downward when eye is
adducted
Diplopia on looking down
Ipsilateral slowness of
pupillary response to light
Loss of pupillary reflex
Dilation of pupil
Loss of accommodation
External strabismus
ptosis

REF:P Abrahams,S Marks,R Hutching in Mc Minn’s colour atlas,Fifth edition,2003

TROCHLEAR NERVE
 CROSSED CRANIAL NERVE
 FIBRES ORIGINATE COMPLETELY FROM CONTRALATERAL NUCLEUS
 LONGEST INTRACRANIAL NERVE
 MOST SLENDER CRANIAL NERVE
 PURE MOTOR NERVE
 SUPPLIES:SUPERIOR OBLIQUE MUSCLE
REF: B D Chaurasia in Human Anatomy,vol 3,fourth edition

CLINICAL APPLICATIONS
 When trochlear nerve is damaged ,diplopia occurs on looking
downwards;vision is single so long as the eyes look above horizontal plane.
 Rare condition

TRIGEMINAL NERVE
NUCLEI
MAIN SENSORY
NUCLEUS:SITUATED IN PONS
SPINAL NUCLEUS:continuous
superiorly with sensory
nucleus and extends inferiorly
in medulla oblongata and
upper part of spinal cord as far
as 2nd cervical (c2 )segment
MOTOR NUCLEUS:Situated in
pons medial to main sensory
nucleus
MESENCEPHALIC NUCLEUS:
composed of column of
unipolar nerve cells situated in
lateral part of grey matter
around cerebral aqueduct .it
extends inferiorly into pons as
far as main sensory nucleus
REF:S Malamed in Handbook of Local Anesthesia ,Fifth edition,2011

 MOTOR :SUPPLIES SENSORY DIVISION:
 MASTICATORY: OPTHALMIC DIVISION:SUPPLIES
 MASSETER EYEBALL,CONJUCTIVA,LACRIMAL
 TEMPORALIS GLAND,PART OF MUCOUS
 PTERYGOIDEUS MEDIALIS MEMBRANE OF NOSE,PARANASAL
 PTERYGOIDEUS LATERALIS
 MYLOHYOID
 ANTERIOR BELLY OF DIGASTRIC
 TENSOR TYMPANI
 TENSOR VELI PALATINI
SINUSES,SKIN OF FOREHEAD,EYELIDS, NOSE
MAXILLARY DIVISION
MANDIBULAR DIVISION

Clinical application
Testing trigeminal
nerve
Sensory:loss of ability to
recognize
light,touch,thermal&pain
sensation in face
MOTOR:
On clenching of teeth the
temporal & masseter muscle
should stand out with equal
prominence on both side;if there
is paralysis the muscle on that
side will fail to become
prominent
On opening mouth jaw will
deviate towards normal side
being pushed over by healthy
lateral pterygoid muscle
REFLEX:
Loss of sneezing reflex
Loss of corneal reflex
Afferent:nasociliary
branch of ophthalmic
division of 5 th nerve
Efferent:facial nerve

Corneal reflex
 Ask the patient to look up and away from you.Bring a piece of cotton wool
twisted to a point in to touch the cornea from the side .Watch both eyes
close.If there is a unilateral facial palsy the sensation of the cornea can be
demonstrated if the opposite eye is watched. Absent corneal reflex can be an
early and objective sign of sensory trigeminal lesion.
Corneal reflex
Failure of either
side of face to
contract=V1lesion
Failure of only one
side to contract=VII
lesion
Subjective reduction
in corneal
sensation=partial V1

Maxillary nerve
WITHIN CRANIUM PTERYGOPALATINE INFRAORBITAL FISSURE FACE
FOSSA
SUPERIOR EXTERNAL INFERIOR
LABIAL NASAL PALPEBRAL
ZYGOMATIC PTERYGOPALATINE POSTERIOR SUPERIOR
ALVEOLAR
ANTERIOR SUPERIOR
ALVEOLAR
MIDDLE
SUPERIOR
ALVEOLAR
ORBITAL
BRANCHES
NASAL
BRANCHES
PALATINE
BRANCHES
PHARYNGEAL
BRANCHES
LESSER PALATINE
GREATER PALATINE
MIDDLE PALATINE
POSTERIOR PALATINE
REF:S Malamed in Handbook of
Local Anesthesia ,Fifth
edition,2011
Middle
meningeal
nerve

1 posterior superior alveolar
2infraorbital nerve nerve
3maxillary nerve
4foramen rotundum nerve
5greater palatine nerve
6nasopalatine nerve
REF:S Malamed in Handbook of Local Anesthesia ,Fifth

MANDIBULAR NERVE
UNDIVIDED
NERVE TRUNK
DIVIDED NERVE TRUNK
ANTERIOR DIVISION
POSTERIOR
DIVISION
DEEP
TEMPORAL
BUCCAL MASSETRIC NERVE TO
LATERAL
PTERYGOID
AURICULOTEMPORAL
NERVE
LINGUAL NERVE
INFERIOR ALVEOLAR
NERVE
MENTAL NERVE NERVE TO MYLOHYOID
INCISIVE
NERVE
NERVE TO MEDIAL
PTERYGOID

CLINICAL APPLICATION
 THE MOTOR PART OF MANDIBULAR NERVE IS TESTED CLINICALLY BY ASKING THE
PATIENT TO CLENCH HIS/HER TEETH AND THEN FEEELING FOR THE
CONTRACTING MASSETER AND TEMORALIS MUSCLES ON TWO SIDES.ACTIVITY
OF PTERYGOID IS TESTED BY ASKING PATIENT TO MOVE CHIN FROM SIDE TO
SIDE
 REFFERED PAIN:IN CASES WITH CANCER OF TONGUE,PAIN RADIATES TO THE EAR
AND TO TEMPORAL FOSSA ,OVER DISTRIBUTION OF AURICULOTEMPORAL NERVE
 MANDIBULAR NEURALGIA:TRIGEMINAL NEURALGIA OF THE MANDIBULAR
DIVISION IS OFTEN DIFFICULT TO TREAT.
 LINGUAL NERVE LIES IN CONTACT WITH THE MANDIBLE MEDIAL TO THIRD
MOLAR.IN EXTRACTION ,CARE MUST BE TAKEN NOT TO INJURE LINGUAL NERVE

ACCESORY NERVE
ACCESORY NERVE
SPINAL
STERNOCLIEDOMASTOID TRAPEZIUS
CRANIAL
PHARYNX EXCEPT
STYLOPHARYNGEUS
SOFT PALATE EXCEPT
TENSOR VELI PALATINI

 TORTICOLLIS/WRY NECK:
 ABNORMAL SUSTAINED CONTRACTION OF THE
MUSCULATURE(STERNOCLIEDOMASTOID AND TRAPEZEUS) SUPPLIED BY THE
SPINAL ACCESSORY NERVE CAUSING THE HEAD TO BE PULLED TO ONE SIDE
 HEAD IS BENT TO ONE SIDE AND THE CHIN POINTS TO THE OTHER
 ACCESSORY NERVE PARALYSIS:cause stab wounds;spread from malignancy
Paralysis :sternocleidomastoid;trapezius------weakness in shoulder;permanent
droop;difficulty in turning head
REF:P Abrahams,S Marks,R Hutching in Mc Minn’s colour atlas,Fifth
edition,2003

FACIAL NERVE
FUNCTIONAL COMPONENT RESPONSIBLE NUCLEI &PATH
SPECIAL VISCERAL EFFERENT SUPPLY MUSCLES OF 2ND
PHARYNGEAL ARCH For FACIAL
EXPRESSION AND ELEVATION
BRACHIOFACIAL MOTOR NUCLEUS LIES IN
CAUDAL PONTINE RETICULAR
FORMATION.NEURONS SUPPLYING SCALP
&UPPER FACIAL MUSCLES ARE DORSAL
&RECEIVE BILATERAL CORTICO BULBAR
FIBRES.WHEREAS NEURONS SUPPLYING LOWER
FACIAL MUSCULATURE ARE VENTRAL AND
RECEIVE CORTICONUCLEAR FIBRES ONLY FROM
CONTRALATERAL SIDE.MOTOR NEURONS OF
FACIAL NERVECURVE AROUND ABDUCENT
NUCLEUS
GENERAL VISCERAL EFFERENT SECRETOMOTOR:SUBMANDIBUL
AR &SUBLINGUAL SALIVARY
GLAND,LACRIMAL
GLAND,GLANDS OF
NOSE,PALATE,PHARYNX
SUPERIOR SALIVATORY
NUCLEUS---NERVUS
INTERMEDIUS---
LACRIMAL&SUBMANDIBULAR
GENERAL SOMATIC AFFERENT SENSORY SUPPLY TO POSTERIOR
SURFACE TO EXTERNAL EAR
,CHONCHA
CELL BODIES OF GSA NEURON
LIES IN GENICULATE GANGLION
AND PROJECTS CENTRALLY

BRANCHES OF FACIAL NERVE
WITHIN TEMPORAL BONE AT ITS EXIT THROUGH
CRANIUM FROM
STYLOMASTOID
FORAMEN
TERMINAL MOTOR
BRANCHES
GREATER PETROSAL
NERVE
POSTERIOR AURICULAR
NERVE
ZYGOMATIC
NR TO STAPEDIUS MUSCLE BR TO STYLOHYOID
&POSTERIOR BELLY OF
DIGASTRIC
TEMPORAL
CHORDA TYMPANI BUCCAL
MANDIBULAR
CERVICAL

REF:From Drake, Vogl
and Mitchell 2005 in S
Standring in Gray’s
anatomy 40 th edition

STUDIES
Six distinctive
anastomotic patterns
were originally classified
by Davis et al (1956)

VESTIBULOCOCHLEAR NERVE
 The vestibulocochlear nerve [VIII] carries SA fibers for hearing and balance,
and consists of two
 divisions:
 a vestibular component for balance;
 a cochlear component for hearing.
 CLINICAL APPLICATION :DAMAGE RESULTS INTO:VERTIGO,MOTION
SICKNESS,LOSS OF EQUILIBRIUM

GLOSSOPHARYNGEAL NERVE
GENERAL VISCERAL AFFERENT sensory input from the carotid body
and sinus;
GENERAL SENSORY AFFERENT sensory input from posterior one-third
of the tongue, palatine tonsils,
oropharynx, and mucosa of the middle
ear and pharyngotympanic tube
SPECIAL AFFERENT taste from the posterior one-third of
the tongue
GENERAL VISCERAL EFFERENT part of the parasympathetic part of the
autonomic division of the PNS and
secretomotor activity in the parotid
salivary gland;
innervate the muscle derived from the
third pharyngeal arch (the
stylopharyngeus muscle).
REF:S Standring in
Gray’s anatomy 40
th edition

DAMAGE:Loss of taste
to the posterior one-
third of the tongue
and sensation of the
soft palate
CLINICAL
APPLICATIONS

VAGUS NERVE
GENERAL SENSORY AFFERENT sensory input from the larynx, laryngopharynx,
deeper parts of the
auricle, part of the external acoustic meatus, and
the dura mater in the posterior cranial fossa
GENERAL VISCERAL AFFERENT sensory input from the aortic body
chemoreceptors and aortic arch
baroreceptors, and the esophagus, bronchi, lungs,
heart, and abdominal viscera in the foregut and
midgut
SPECIAL AFFERENT for taste around the epiglottis and pharynx;
GENERAL VISCERAL EFFERENT fibers are part of the parasympathetic part of the
autonomic division of the PNS and
stimulate smooth muscle and glands in the
pharynx, larynx, thoracic viscera, and abdominal
viscera of the foregut and midgut;
fibers innervate one muscle of the tongue
(palatoglossus), the muscles of the soft palate
(except tensor veli palatini), pharynx (except
stylopharyngeus), and larynx

 DAMAGE:
 Soft palate deviation with deviation of the uvula to the
normal side;
 vocal cord paralysis
 CAUSE:
 Brainstem lesion; penetrating neck injury

HYPOGLOSSAL NERVE
 The hypoglossal nerve [XII] carries GSE fibers to innervate all intrinsic and
most of the extrinsic muscles of the tongue.
CLINICAL APPLICATIONS:
 DAMAGE:
 Atrophy of ipsilateral muscles of the tongue
 deviation toward the affected side;
 speech disturbance
 CAUSE:
 Penetrating injury to the neck and skull base pathology

Posterior triangle
OCCIPITAL TRIANGLE SUBCLAVIAN TRIANGLE
Spinal accessory nerve Three trunks of brachial plexus
Four cutaneous branches of cervical
plexus
Lesser occipital,great auricular,anterior
cutaneous nerve of
neck,supraclavicular nerve
Nerve to serratus anterior
Muscular branches:two branches to
levator scapulae
Two branches to trapezius
Nerve to rhomboideus
Nerve to subclavius
Upper part of brachial plexus Suprascapular nerve
REF:REF: B D Chaurasia in Human Anatomy,vol 3,fourth edition

Back of neck:suboccipital triangle
 Nerve supply of:
 Rectus capitis posterior major
 Rectus capitis posterior minor suboccipital nerve or dorsal ramus c1
 Obliqus capitis superior
 Obliqus capitis inferior
 CONTENT:
 Third occipital nerve

CLINICAL APPLICATION
 NECK RIGIDITY:seen in meningitis is due to spasm of the extensor muscles.this
is caused by irritation of the nerve roots during their passage through
subarachnoid space which is infected
 Cisternal puncture is done when lumbar puncture fails
 Neurosurgeons approach the posterior cranial fossa through this region
REF:P Abrahams,S Marks,R Hutching in Mc Minn’s colour atlas,Fifth edition,2003

Anterior triangle of neck
 Nerve supply of
muscle Nerve supply
Sternohyoid Ansa cervicalis
Sternothyroid Ansa cervicalis
Thyrohyoid C1 through hypoglossal nerve
Omohyoid Superior belly:superior root of ansa
cervicalis
Inferior belly:ansa cervicalis

SUBMENTAL TRIANGLE
DIGASTRIC TRIANGLE
MYLOHYOID NERVE and HYPOGLOSSAL
NERVE:anteriorly
PHARYNGEAL BRANCH OF VAGUS
NERVE:posteriorly
CAROTID TRIANGLE
VAGUS NERVE: superior laryngeal nerve
SPINAL ACCESSORY NERVE
HYPOGLOSSAL NERVE
SYMPATHETIC CHAIN
MUSCULAR TRIANGLE
VENTRAL RAMI OF 1,2,3 CERVICAL SPINAL
NERVE
ANTERIOR TRIANGLE OF
NECK

REF:S Standring in Gray’s anatomy
40 th edition

CUTANEOUS NERVE SUPPLY
NERVE
OPTHALAMIC DIVISION
OF TRIGEMINAL NERVE
SUPRATROCHLEAR
NERVE,SUPRAORBITAL
NERVE,LACRIMAL
NERVE,INFRATROCHLEAR
NERVE,EXTERNAL MASAL
NERVE
Scalp upto
vertex,forehead,upper
eyelid,conjunctiva,small
part of lower eyelid and
root ,dorsum and tip of
the nose
Maxillary division of
trigeminal nerve
Infraorbital nerve
Zygomaticofacaial nerve
Zygomaticotemporal
nerve
Upper lip,ala of
nose,most lower
eyelid,upper part of
cheek,anterior part of
temple
Mandibular division of
trigeminal nerve
Auriculotemporal nerve
Buccal nerve
Mental nerve
Lower lip;chin;lower
part of cheek,lower jaw
except over angle;upper
2/3 of lateral surface of
auricle,side of head
REF:B D Chaurasia in
Human Anatomy,vol
3,fourth edition

Cervical plexus(great
auricular nerve c2,c3)
Anterior division of
great auricular
nerve(c2,c3),upper
division of transverse
cutaneous nerve of neck
Skin over angle of jaw
and over parotid gland
;lower margin of lower
jaw
CLINICAL APPLICATIONS:
The sensory distribution of the trigeminal nerve explains why headache is a
uniformly common symptom in involvement of nose,paranasal air
sinuses,infections,inflammation of teeth and gums,refractive errors of the
eyes,glaucoma
TRIGEMINAL NEURALGIA

NERVE SUPPLY OF SCALP
IN FRONT OF AURICLE BEHIND THE AURICLE
SENSORY NERVES SENSORY NERVES
SUPRATROCHLEAR ,branch of the frontal
(ophthalmic division of trigeminal nerve)
Posterior division of GREAT AURICULAR
NERVE from cervical plexus
SUPRAORBITAL, branch of frontal
(opthalamic division of trigeminal nerve)
Lesser occipital nerve,from cervical
plexus
ZYGOMATICOTEMPORAL branch of
zygomatic nerve(maxillary division of
trigeminal nerve)
Greater occipital nerve
AURICULOTEMPORAL BRANCH of
mandibular division of trigeminal nerve
Third occipital nerve
MOTOR NERVE MOTOR NERVE
Temporal branch of facial nerve Posterior auricular branch of facial nerve
REF:B D Chaurasia in
Human Anatomy,vol
3,fourth edition

NERVE SUPPLY OF FACE
 MOTOR NERVE SUPPLY OF FACE:
 TEMPORAL:FRONTALIS,AURICULAR MUSCLES,ORBICULARIS OCULI
 ZYGOMATIC:ORBICULARIS OCULI
 BUCCAL:MUSCLES OF CHEEK AND UPPER LIP
 MARGINAL MANDIBULAR:MUSCLES OF LOWER LIP
 CERVICAL:PLATYSMA
 CLINICAL APPLICATION:
 INFRANUCLEAR LESION:BELL’S PALSY
 SUPRANUCLEAR LESION:ususally a part of hemiplegia,only the lower part of
the opposite side of face is paralyse.

NERVE SUPPLY OF STRUCTURES
RELATED TO ORAL CAVITY

NERVE SUPPLY OF HARD PALATE
GENERAL SENSATION
•GREATER PALATINE AND
NASOPALATINE BRANCHES OF
MAXILLARY DIVISION OF
TRIGEMINAL NEREVE
•BOTH NERVE PASS THROUGH
PTERYGOPALATINE GANGLION
AND SYPPLY GUMS,MUCOSA AND
GLANDS OF HARD PALATE
ALMOST TO INCISOR TEETH (BY
GREATER PALATINE)AND
ANTERIOR PART OF HARD PALATE
JUST BEHIND INCISOR TEETH(BY
NASOPALTINE NERVE)
PARASYMPATHETIC
POSTGANGLONIC SECRETOMOTOR
FIBRES
•FROM PTERYGOPALATINE
GANGLION RUN WITH GREATER
AND NASOPALATINE NERVES
WHICH SUPPLY PALATINE
MUCOSAL GLANDS
SPECIAL(GUSTATORY OR
TASTE)SENSATION
•BY FACIAL NERVE
•TASTE IMPULSES PASS VIA
GREATER AND NASOPALATINE
NERVES TO PTERYGOPALATINE
GANGLION(WITHOUT SYNAPSING
TO NERVE OF PTERYGOID
CANAL)AND THEN TO GREATER
PETROSAL NERVE TO FACIAL
GANGLION(CELL BODIES ARE
SITUATED HERE)
•NOW TASTE IMPULSE PASS
THROUGH SENSORY ROOT OF
FACIAL NERVE(NERVUS
INTERMIEDIUS)TO GUSTATORY
NUCLEUS TRACTUS SOLITARIUS

NERVE SUPPLY OF SOFT PALATE
MOTOR:
ALL MUSCLES ECXEPT
TENSOR VELI PALATINI ARE
SUPPLIED BY PHARYNGEAL
PLEXUS DERIVED FROM
CRANIAL ACCESSORY NERVE
THROUGH VAGUS
GENERAL
SENSORY:MAXILLARY NERVE
THROUGH PTERYGOPALATINE
NERVES SUPPLY HARD PALATE
;LESSER PALATINE NERVE
SUPPLY SOFT PALATE
SPECIAL
SENSORY(GUSTATORY):
FACIAL NERVE
GREATER PETROSAL NERVE
GENICULATE GANGLION
(NUCLEUS OF SOLITARY
TRACT)
SECRETOMOTOR
LESSER PALATINE NERVE
GREATER PETROSAL NERVE
SUPERIOR SALIVATORY NUCLEUS

 PARALYSIS OF SOFT PALATE IN LESIONS OF VAGUS NERVE PRODUCES:
 NASAL REGURGITATION
 NASAL TWANG IN VOICE
 FLATTENING OF THE PALATAL ARCH
REF:REF:P Abrahams,S Marks,R Hutching in Mc Minn’s colour atlas,Fifth
edition,2003;

NERVE SUPPLY OF TONGUE
PART DEVELOP FROM TASTE
(SPECIAL
SENSORY)
GENERAL
SENSORY
ANTERIOR 2/3
(BODY,ORAL OR
PRESULCAL)PART
1st pharyngeal arch Chorda
tympani
Lingual
nerve(br of
mandibular
trigeminal
nerve)
POSTERIOR
1/3(BASE,ROOT,
PHARYNGEAL OR POST
SULCAL)PART INCLUDING
VALLATE PAPILLA
3 rd pharyngeal arch Glossopharyngeal nerve
POSTERIOR MOST(ROOT
NEAR EPIGLOTTIS)OR
VALLECULAE
4th pharyngeal arch Internal laryngeal branch
of vagus

MUSCLES OF TONGUE
MUSCLE DEVELOP FROM NERVE SUPPLY
PALATOGLOSSAL 6th pharyngeal arch Cranial accessory nerve
through pharyngeal
plexus
All other intrinsic and
extrinsic
muscles(except
palatoglossal)
Ocipital myotomes Hypoglossal nerve

CLINICAL APPLICATION:GENIOGLOSSUS is the safety muscle of tongue
Its function can be used to test hypoglossal nerve:
INJURY TO HYPOGLOSSAL
NERVE
INFRANUCLEAR LESIONS
GRADUAL ATROPHY,MUSCULAR
TWITCHINGS
SUPRANUCLEAR LESIONS
PARALYSIS
REF:P Abrahams,S
Marks,R Hutching in
Mc Minn’s colour
atlas,Fifth
edition,2003

Nerve supply of tonsils
 Plexus circularis tonsillaris formed by
glossopharyngeal and lesser palatine nerve
 Clinical application : glossopharyngeal nerve is
the main supply.it also supplies mucous lining of
tympanic cavity(i.e middle ear) through
tympanic branches.so tonsillar problems may
cause referred pain in the ear.

NERVE SUPPLY OF LARYNX
LARYNX
SENSORY
Upto the level of vocal
folds:internal laryngeal
nerve
Below the level of vocal
folds:recurrent
laryngeal nerve
MOTOR
All intrinsic muscles are
supplied by recurrent
laryngeal nerve except
for cricothyroid which is
supplied by external
laryngeal nerve
S Standring in Gray’s anatomy 40 th edition

 DAMAGE TO
 INTERNAL LARYNGEAL NERVE:anesthesia to the mucous membrane in the
supraglottic part of larynx breaking the reflex arc so that foreign bodies can
easily enter it
 External laryngeal nerve:weakness of phonation(due to thightening effect of
cricothyroid)
 Both recurrent laryngeal nerve:vocal cords lie in the cadaveric position in
between abduction and aduction and phonation is lost completely
 SEMON’S LAW:in progressive lesions of the recurrent laryngeal nerve the only
abductors of the vocal cords,the posterior cricoarytenoids are the first to be
paralysed and the last to recover as compared to adductors
 In functional paralysis:adductors are first to be paralysed

NERVE SUPPLY OF SALIVARY GLANDS
PAROTID GLAND
PS:-GLOSSOPHARYNGEAL
(9th)NERVE (THROUGH
AURICULOTEMPORAL NERVE
FROM OTIC GANGLION)
S:-CERVICAL GANGLIA
THROUGH EXTERNAL
CAROTID NERVE PLEXUS
SUBMANDIBLAR AND SUBLINGUAL GLANDS
FACIAL NERVE(THROUGH
LINGUAL NERVE----CHORDA
TYMPANI----SUBMANDIBUALR
GANGLION)

 EXCISION OF SUBMANDIBULAR GLAND IS DONE BY INCISION PLACED MORE
THAN 2.5 cm BELOW ANGLE OF MANDIBLE SINCE MARGINAL MANDIBULAR
BRANCH OF FACIAL NERVE PASSES POSTEROINFERIOR TO THE MANDIBLE
 CHORDA TYMPANI AND AURCULOTEMPORAL NERVE IS RELATED TO THE MEDIAL
AND LATERAL SURFACE OF SPINE OF SPHENOID RESPECTIVELY ,INJURY TO SPINE
WILL CAUSE LOSS OF SECRETION FROM ALL THE SALIVARY GLANDS

NERVE SUPPLY
MUSCLES NERVE SUPPLY
MASSETER MASSETRIC NERVE
TEMPORALIS TWO DEEP TEMPORAL BRANCHES
FROM ANTERIOR DIVISION OF
MANDIBULAR NERVE
LATERAL PTERYGOID A BRANCH FROM ANTERIOR DIVISION
OF MANDIBULAR NERVE
MEDIAL PTERYGOID NERVE TO MEDIAL
PTERYGOID:MANDIBULAR NERVE
MUSCLES OF MASTICATION
REF:REF:B D Chaurasia in Human Anatomy,vol 3,fourth edition

NERVE SUPPLY
 SUPRAHYOID MUSCLES
MUSCLES NERVE SUPPLY
DIGASTRIC ANTERIOR BELLY:NERVE TO
MYLOHYOID
POSTERIOR BELLY:FACIAL NERVE
STYLOHYOID FACIAL NERVE
MYLOHYOID NERVE TO MYLOHYOID
GENIOHYOID HYPOGLOSSAL NERVE
HYPOGLOSSAL HYPOGLOSSAL NERVE

NERVE SUPPLY TO THE TEETH
S Malamed ,medical emergencies in dental office,edition4

REF:S
Malamed in
Handbook of
Local
Anesthesia
,Fifth
edition,2011

Clinical application
REF:F Hanretig Pediatric emergency procedure,2001

INFERIOR ALVEOLAR NERVE BLOCK
 BELOW OCCLUSAL PLANE :4 YEARS OR YOUNGER
 AT OCCLUSAL PLANE:5 YEARS OR ABOVE
 7-14 MM ABOVE OCCLUSAL PLANE :AS CHILD GROWS TO ADULTHOOD
REF:F Hanretig Pediatric emergency procedure,2001

CONCLUSION
NERVE SUPPLY OF HEAD AND NECK IS IMPORTANT FOR DENTIST IN TERMS OF
TREATING DISEASES RELATED TO IT,PAIN MANAGEMENT, SURGERY,THUS HAVING
COMPLETE KNOWLEDGE OF IT IS INECESSITY FOR US.

REFERENCES
S Standring in Gray’s anatomy 40 th
edition
P Abrahams,S Marks,R Hutching in Mc
Minn’s colour atlas,Fifth edition,2003
S Malamed in Handbook of Local
Anesthesia ,Fifth edition,2011

S Malamed ,medical emergencies in
dental office,edition4
B D Chaurasia in Human Anatomy,vol
3,fourth edition
Benjamin cummings,adsley longman
inc,2001

F Hanretig Pediatric emergency
procedure,2001

Nerve supply of head and neck

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