This presentation includes course of trigeminal nerve,facial nerve and glossopharyngeal nerve and its pedodontic implications

1. z
NEUROANATOMY OF CRANIOFACIAL
STRUCTURES WITH SPECIAL
REFERENCE TO
TRIGEMINAL NERVE ,
FACIAL NERVE ,
GLOSSOPHARYNGEAL NERVE
AND CERVICAL PLEXUS
KARISHMA.S
I MDS
Pedodontics
R.V Dental college

2. CONTENTS
 Terminologies
 Functional components
 Parts of nervous system
 Cranial nerves
 Trigeminal nerve
-course and branches
 Facial nerve
- course and branches
 Glossopharyngeal nerve
- course and branches
 Cervical plexus
 Conclusion
 References

3. TERMINOLOGIES
NEURON : Structural & Functional unit of Nervous
System.
NUCLEUS: Applies to an aggregate of nerve cell bodies
located within the CNS.
GANGLION: is a collection of nerve cell bodies outside the
brain and spinal cord(CNS)
e.g: a) sensory ganglia of cranial nerves
semilunar , geniculate
b) parasympathetic ganglia
ciliary, submandibular

4. TRACT: defined as a group of nerve cell processes within
the CNS.
NERVE: is a bundle of neuronal processes outside the
CNS.
Sensory,
Motor,
Mixed.
PLEXUS: site regrouping of peripheral nerve fibers
deriving from diverse origins.

5. FUNCTIONAL COMPONENTS:
A cranial nerve consists of motor fibers or
sensory fibers or both motor and sensory fibers
TYPES:
MOTOR:
1. GSE: They supply the striated muscles which develop
from somites.These fibers convey motor
impulses to skeletal muscles.
2. GVE: They supply the glands,smooth muscles of
viscera and vessels.They are preganglionic
parasympathetic fibers.
3. SVE: They supply the muscles which develop from
mesoderm (special) of pharyngeal arches.

6. SENSORY:
1.GSA: They carry general sensations of pain, touch and
temperature from skin and proprioceptive sensation
of vibration and muscle and joint sense.
2.GVA: They carry general sensation of distention and
ischemic pain from viscera.
3.SVA: They carry special sensation of taste from tongue.
(special)
4.SSA: They carry special sensation of smell,hearing and
(special somatic) balance.

7. PARTS OF THE NERVOUS SYSTEM

8. CENTRAL NERVOUS SYSTEM
Brain- control center of nervous system
receives sensory input from spinal cord as
well its own nerves.
Ex: olfactory, optic
It consists of six major parts
 Cerebrum
 Diencephalon
 Midbrain
 Pons
 Medulla oblongata
 Cerebrllum
Spinal cord- Conducts sensory information
from PNS to brain.Conducts motor
information from brain to
various effectors.

9. PERIPHERAL NERVOUS SYSTEM
It consists of
12 pairs of cranial nerves
31 pairs of spinal nerves
SPINAL NERVES :
8 pairs of cervical nerves (C1 – C8)
12 pairs of thorasic nerves (T1-T12)
5 pairs of lumbar nerves (L1-L5)
5 pairs of sacral nerves (S1-S5)
And one coccygeal pair of nerves

10. CRANIAL NERVES:
Ⅰ Olfactory nerve
Ⅱ Optic nerve
Ⅲ Oculomotor nerve
Ⅳ Trochlear nerve
Ⅴ Trigeminal nerve
Ⅵ Abducent nerve
Ⅶ Facial nerve
Ⅷ Vestibulocochlear nerve
Ⅸ Glossopharyngeal nerve
Ⅹ Vagus nerve
Ⅺ Spinal Accessory nerve
Ⅻ Hypoglossal nerve

11. The peripheral nervous system is further divided into
a) Somatic b) Visceral
The somatic part innervates structures derived from somites in
the embryo,and is mainly involved in receiving and responding
to information from external environment.
The visceral part innervates organs and other visceral elements
such as smooth muscles and glands, in peripheral regions of
the body.It is concerned with detecting and responding to
information from the internal environment.
The visceral motor component is commonly referred as the
autonomic division of peripheral nervous system.
The visceral component is further divide into
a)sympathetic b)Parasympathetic

12. DIVISIONS OF ANS
SYMPATHETIC NERVOUS
SYSTEM:
contains chiefly adrenergic
fibers and tends to depress
secretions, decrease the tone and
contractility, and increase heart
rate. E.g : increase in heart rate,
slowing the movement of intestines.
PARA SYMPATHETIC NERVOUS
SYSTEM:
the part that contains chiefly
cholinergic fibers, that tends to
induce secretion, to increase the
tone and contractility , and to slow
heart rate E.g. : slowing heart rate,
speeding up movement of intestines

13. The cranial nerves carry efferent fibres that innervate the
musculature derived from the pharyngeal arches
First arch – Trigeminal nerve
Second arch – Facial nerve
Third arch – Glossopharyngeal
Fourth arch – Superior laryngeal branch of vagus nerve
Sixth arch – Reccurent laryngeal branch of vagus nerve

14. TRIGEMINAL NERVE

15.  Largest cranial nerve
 Nerve of 1st brachial arch
 It carries general somatic afferent(GSA) and
brachial efferent fibres(BE)
 The trigeminal ganglion has a small motor and
larger sensory root.
 The trigeminal ganglion resides in the middle cranial fossa. It is
situated in a fold of dura mater that forms an invagination around
the posterior two-thirds of the ganglion. This region is referred to
as Meckel's cavity.
 The motor root of trigeminal is connected with the
motor nucleus in the pons.

16. The sensory root is connected with the three
nuclei
Mesenchephalic – proprioception from muscles of
mastication from mandibular
nerve
Central pontine – fine touch fibers from face,and
mucosal areas from nose and
palate
Spinal nucleus – pain and temperature fibres.
The ganglion divides to form 3 divisions:
OPTHALMIC – V1
MAXILLARY – V2
MANDIBULAR – V3

17. OPHTHALMIC DIVISION [V1]
Exclusively Sensory & Smallest (trunk 2.5cm).
Enters Cavernous Sinus and comes out through
Superior Orbital Fissure.
3 main branches before leaving cavernous sinus:
i. Lacrimal (lateral most)
ii. Frontal
iii. Nasociliary (medially)
Lacrimal & Frontal enter outside the Common Tendinous Ring,
where as the nasocilliary branch enters inside the common
tendinous ring between the superios and inferior branches of
oculomotor nerve

18. The Lacrimal Nerve
• Smallest Branch of the 3 branches
• In orbit it passes along the upper border of the lateral rectus
• Receives branch from zygomatico temporal nerve(inf.orbital fissure),
which carries Parasympathetic and sympathetic post ganglionic fibers
to lacrimal gland.
• Supplies the lacrimal gland, conjunctiva & lateral Part of the upper
eyelid.

19. The Frontal Nerve
• Largest branch of the 3 branches
• Receives sensory input from areas outside the orbit
• From superior orbital fissure it passes forward between levator
palpebrae superioris and roof of orbit
About midway it divides into
a) supra trochlear
b) supra orbital

20. • Supra trochlear exits medial to supra orbital foramen and
supplies Conjuctiva, skin of upper eyelid and skin on lower
medial part of forehead.
• Supra orbital exits through supra orbital notch and ascends
across the forehead, scalp, eyelids,conjunctiva,as posteriorly as
middle of scalp

21. The NasoCiliary Nerve
• First branch of opthalmic division.
• Placed between superior and inferior branch of oculomotor nerve
• In the orbit it first branches with the ciliary ganglion and then
Continues forward to give:

22. Long Ciliary Nerve : sensory to eyeball which are 2 or 3 in number
supply the Iris & Cornea(pupillary dilation)
Post. Ethmoidal : supplies Ethmoidal & Sphenoidal sinuses.
Infra Trochlear : supplies medial part of upper and lower eyelid,
Lacrimal Sac & skin of upper half of nose.
Ant. Ethmoidal : supplies anterior cranial fossa,nasal cavity,skin of
lower half of nose.

23. Ciliary ganglion :
 Located about 1cm anterior to the medial end of superior
orbital fissure.it is lateral to optic nerve and medial to
lateral rectus.
 Functionally related to oculomotor nerve and anatomically
to nasociliary nerve.
 Only parasympathetic branch rely in the ganglion where
as sensory and sympathetic only pass through the
ganglion
 Sympathetic root is dervied from
internal carotid artery which
contains postganglionic fibers of
superior cervical ganglion.

24.  Only parasympathetic rely in the ganglion where as sensory and
sympathetic only pass through the ganglion.
 The parasympathetic fibers supply the ciliaris muscle of eye ball
and constrictor pupili.
 Sensory nerves to the ciliary ganglion are through the maxillary
nerve which continues as nasociliary nerve.
 Long ciliary nerve carries the general
somatic sensations from cornea iris and
ciliary body
 Some general somatic fibers can also
enters the short ciliary nerve

25. Maxillary division [V2]
Purely sensory
Origin: middle of trigeminal ganglion
Exit from skull: through lateral wall of cavernous sinus exits
through foramen rotundum (located in sphenoid) supplying skin
of face, lower eyelid, nose & upper lip.
Leaves middle cranial fossa through rotundum into
Pterygopalatine Fossa and enters orbit through Inf. Orbital fissure
& becomes Infraorbital nerve
Branches in 4 regions:
- within the cranium
- in the pterygopalatine fossa
- in the infraorbital canal
- on the face.

26. Within the cranium
Small branch of the middle meningeal
nerve , which travels with middle
meningeal artery to provide sensory
innervations to duramater.
In the Pterygopalatine fossa
Branches given off are :
A) Zygomatic Nerve
(Z.facial,Z.temporal,communicating)
B) Pterygopalatine Nerves
C) Post. Superior Alveolar Nerve

27. In InfraOrbital Canal
Within this , it gives off 2 branches :
A) Middle Superior Alveolar nerve (infra orbital fissure)
B) Anterior Superior Alveolar nerve (infra orbital canal)
The superior dental plexus is formed by posterior, middle and
anterior alveolar nerves (PSA+MSA+ASA)

28. On Face
It emerges through the infraorbital foramen into it’s terminal
branches :
1. Inferior Palpebral-lower eyelid,conjuctiva
2. External Nasal-lateral part of nose
3. Superior Labial-upper lip

29. Pterygopalatine ganglion or sphenopalatine ganglion
 Largest parasympathetic ganglion.it is a rely station of secretomotor fibers for
lacrimal glands,mucosal glands of nose,paranasal sinuses,palate and pharynx.
 Anatomically related to maxillary nerve but functionally related to
• Internal carotid-through deep petrosal
• Facial nerve- through greater petrosal
 Lies in pterygopalatine fossa in front of pterygopalatine canal.
Sensory root – from maxillary nerve
Sympathetic root – internal carotid
plexus(vasomotor supply)
Parasympathetic root – superior
salivatory nucleus(supplies secretomotor
nerves)

30. Post ganglionic fibers(secretomotor)
from the pterygopalatine ganglion
exit through the
1. inferior orbital canal to reach the
orbit to supply orbital mucosa.
2. Sphenopalatine foramen to give
medial and lateral branches.
nasopalatine branch i.e one of the
medial nerve continues downward
to exit through the incisive canal.
3. Greater palatine canal and gives
greater palatine and lesser
palatine nerves
4. Pharyngeal branch passes
through the palatinovaginal canal
to supply part of nasopharynx

31. Mandibular division [V3]
 Unlike Ophthalmic[V1] and Maxillary[V2] which are purely
sensory,the mandibular nerve is both motor and sensory.
 All braches of the mandibular nerve orginate in the infra
temporal fossa
SENSORY – Drops vertically through foramen ovale and enters
infra temporal fossa between tensor veli palatine and
lateral pterygoid.
MOTOR – Passes medial to the trigeminal ganglion in cranial
cavity and passes through foramen ovale and joins the
sensory nerve.

32. Branches of mandibular division
Branches from
undivided nerve:
- Nerve to median
pterygoid muscle
- Also sends motor
branches to
tensor veli palatini
tensor tympani
Branches from
divided nerve:
Anterior division
- Nerve to lateral
pterygoid
- To masseter muscle
- To temporal muscles
- Long buccal nerve*
- Meningeal
Posterior division:
-Auriculotemporal
-Lingual
-Inferior alveolar
-Nerve to mylohyoid*

33. BRANCHES INNERVATIONS
MENINGEAL Sensory for duramater,middle cranial
fossa,middle ear
LATERAL PTERYGOID Branch of anterior trunk of V3 ,passes directly
into deep lateralpterygoid
TO MASSETER MUSCLE passes over lateral pterygoid to supply
masseter muscle
DEEP TEMPORAL MUSCLE two in number, supplies temporalis muscles
from inside
LONG BUCCAL sensory nerves to skin,oral mucosa ,buccal
gingivae of lower molars
AURICULO-TEMPORAL Sensory innervations to external ear and
auditory meatus,tympanic membrane and TMJ
LINGUAL Gen sensation frm ant. 2/3rd,oral mucosa
and lingual gingivae of lower teeth
INFERIOR ALVEOLAR Supplies to the mandibular molars and
second premolar,then divides to supply
anteriors
MYLOHYOID Motor supply to mylohyoid muscle and
anterior belly of digastric
POSTERIOR
ANTERIOR

34. Branches from the Anterior Division
Significantly smaller than posterior division.
Provides motor innervation to the muscles of
mastication & sensory innervation to mucous
membrane of cheek & mandibular molars.
Runs forward between the upper border of Lateral
Pterygoid & gives off Buccal Nerve.
Gives off several branches :
1. Deep Temporal Nerve to Temporal Muscle
2. Massetric Nerve to Masseter.
3. Nerve to Lateral Pterygoid.
Sensory fibers are distributed over the skin of
cheek & other fibres run into the retromolar
triangle.

35. Branches from the Posterior Division
Primarily sensory with a small motor
component
Descends downward & medially to lateral
pterygoid at which it branches :
1. Auriculotemporal Nerve : traverses upper
part of the parotid & gives off sensory ,
secretomotor & vasomotor fibres to parotid.
2. Lingual nerve : passes downward parallel
to Inf. Alveolar nerve passes along the
hyoglossus and genioglossus to reach the
tongue
It is sensory to the anterior 2/3rd of tongue &
gives sensory innervation to the floor of the
mouth and to gingiva.

36. 3.Inferior alveolar and Nerve to mylohyoid:
It originates deep to the lateral
pterygoid muscle from posterior trunk of mandibular nerve in
association with lingual nerve.
• It descends between sphenomandibular ligament and ramus of
mandible and enters the mandibular canal through mandibular
foramen.
• Just before entering it gives origin to nerve of the mylohyoid
which lies in mylohyoid groove to innervate mylohyoid muscle
and anterior belly of digastric muscle.
• It supplies to the three molars and second premolar and then
divides into
• Incisive nerves
• Mental nerves

37. Applied anatomy/ 5th nerve
TRIGEMINAL NEURALGIA : or tic douloureux
It is a complex sensory disorder of sensory root of trigeminal
nerve, characterized by extremely severe shock like or lancinating
pain limited to one or more branches of trigeminal nerve.
Etiology:
damage to myelin sheath,blood vessel compression,injury
during surgery or trauma
C/F: persons > 50 yrs
women > men
right side > left
Pain searing, stabbing or lancinating
Initiated by touching trigger zone
Spasmodic contractions of facial muscles
Types:
1.typical/classic
2.atypical

38.  1st line of treatment is medication like
Carbamezapine , Gaba pentin ,
Phenytoin.
 Tricyclic antidepressants like
amitriptyline,nortriptyline.
 Later other procedures can be
considered like
Rhizotomy/Rhizolysis(nerve fibers are
damaged to block the pain)
1. Ballon compression
2. Glycerol injection
3. Stereotactic radiosurgery
4. Microvascular decompression
5. Neurectomy
6. Compensatary approaches(botulin
toxin injection)

39. FREY’S SYNDROME
It is the damage to auriculotemporal nerve
& subsequent reinnervation of sweat glands.
Etiology: caused due to either sequelae of
parotidectomy or any other surgical
or traumatic injuries
C/F: Flushing & sweating on ipsilateral facial
skin during mastication
Treatment:
- By topical anticonvulsant medications
- Glycopyrolate roll-on lotion
- Intra cutaneous injection of botulinum
toxin

40. Refactory Trigeminal Neuralgia successfully treated by combination therapy
(Pregabalin plus Lamotrigine).Unit of Rehabilitation and Functional Recovery, IRCCS Istituti Clinici Scientifici Maugeri, Lissone
(MB), Italy. Electronic address: giorgio.ferriero@icsmaugeri.it.
Trigeminal Neuralgia (TN) that is probably the most widely recognized neurophatic pain syndrome with
a prevalence range from 1.9% to 6.3%.TN treatment primarily consists of antiepileptic medications
acting on voltage-dependent sodium channels, such as Carbamazepine (CBZ) and Lamotrigine (LTG).
CBZ is reported to be not well tolerated by Multiple sclerosis patients for its side effects that mimic an
Multiple sclerosis exacerbation. In order to reduce side effects occurrence both CBZ and LTG were
successfully used in association with Gabapentin suggesting combination therapy as a useful
therapeutic strategy.
Pregabalin (PGB) is an antiepileptic drug (AED), selective ligand for α2δ subunit dependent on voltage
calcium channels. Potential binding at this site reduces calcium influx at hyper-excited nerve terminals
and the release of several neurotransmitters, including glutamate, noradrenaline and substance.PGB
was successfully used in treating paroxysmal symptoms in Multiple sclerosis patients.

41. FACIAL NERVE

42. -Nerve of 2nd Brachial Arch.
-Motor nerve to the muscles of Facial Expression
-Has both Sensory & Motor Functions
Functional components
SVE – muscles of facial expressions
GVE – secretomotor to submandibular,lingual and
lacrimal glands,glands of nose,palate and pharynx
SVA – carry taste sensation from anterior 2/3rd of
tongue.
GSA – these fibers innervate the ear
Exit from skull: in a bony canal at stylomastoid
foramen
FACIAL NERVE

43. Facial nerve Nuclei
Arise from 4 nuclei situated in lower pons:
i. Motor nucleus : Branchiomotor nucleus
ii. ParaSympathetic: Superior salivatory
and lacrimatory
iii. Nucleus of tractus solitarius : is
Gustatory
Ganglia associated :
i. Geniculate ganglia
ii. Submandibular ganglia &
iii. Pterygopalatine ganglia.

44. Intracranial Course of Facial Nerve
Attached to the brainstem by 1 sensory & 1
motor root.
The 2 roots run laterally with the 8th nerve to
reach Int. Auditory Meatus, & at the bottom
fuse to form a single trunk.
Within the canal , the course can be divided
into 3 parts by 2 bends :
1. 1st part directed laterally over vestibule.
2. 2nd part runs backward above
Promontory.
3. 3rd part directed vertically downward
behind Promontory.
The 1st bend is sharp & is known as GENU as
Geniculate Ganglion is present.
1
2
3

45. Branches of distribution of Facial nerve
I. Within the
facial canal :
a) Greater Petrosal
Nerve
b) Nerve to Stapedius
c) The Chorda
Tympani
II. At its exit from
stylomastoid foramen
:
- Nerve to Stylohyoid
- Nerve to Digastric
- Posterior Auricular
Nerve
Terminal branches
within parotid :
-Temporal
-Zygomatic
-Buccal
-Marginal Mandibular
-Cervical

46. CHORDA TYMPANI:
Carries taste from anterior 2/3rd of the
tongue and parasympathetic innervations to all salivary
glands below the level of oral tissues.
Originates from facial nerve
Enters lateral aspect of middle ear
Leaves middle ear
Enters infratemporal fossa
Descends to join lingual nerve after 2cm below the skull

47. Extracranial course/ 7th nerve
Emerges from the base of the skull at stylomastoid
foramen and gives off nerve as posterior auricular
branch(back of ear) and supplies auricular muscle and
fronto-occipital muscle.
Posteriorly another branch to Anterior Belly of Digastric
& Stylohyoid.
Nerve then enters the parotid & within the gland
branches into Temporofacial & Cervicofacial branches.
The trunks branch further to form a Parotid Plexus.
5 terminal branches arise from the plexus , diverge &
supply the muscles of facial expression.
-Temporal -Zygomatic
-Buccal -Marginal mandibular
-Cervival

48. Ganglia associated with facial nerve
1) Geniculate ganglion:
sensory ganglion.
not a para symphathetic ganglion
as it has cell bodies of sensory
neurons.
After reaching here ,Salivatory fibres
into middle ear followed by ending
up in submandibular ganglion ,
whereas the Lacrimatory fibres go
to middle cranial fossa & enter
foramen lacerum to enter
Pterygopalatine Fossa

49. 2) Submandibular ganglion:
-parasympathetic
-relay of secretomotor
fibers to submandibular and
sublingual glands
3) Pterygopalatine ganglion:
-parasympathetic
-secretomotor fibers are relayed to
lacrimal gland.

50. Within Facial Canal & Stylomastoid Foramen
Nerve to stapedius : supplies the
stapedius muscle.
Chorda Tympani : enters the
middle ear and joins the lingual
nerve
Posterior auricular : arises below
the stylomastoid foramen &
supplies the a) orbicularis posterior
b) occipitalis c) intrinsic muscles
back of auricle.
Digastric Branch : supplies the
Post. Belly of Digastric.
Stylohyoid Branch : arises with
the digastric & supplies the
stylohyoid.

51. THE TERMINAL BRANCHES
Temporalis branch : crosses the
zygomatic arch & supplies the
Frontalis , Orbicularis Oculi ,
Corrugator Supercilii , Auricularis Sup.
& Anterior
Zygomatic : runs across the zygomatic
bone & Supplies the Orbicularis Oculi
Buccal Branch : above & below the
Parotid supplying the Buccinator.
Marginal Mandibular : runs deep to
the platysma & supplies muscles of
lower lip & chin.
Cervical : emerges from the apex of
parotid & supplies the platysma.

52. Applied anatomy of facial nerve
Infranuclear lesions: ex-
Bells palsy (at stylomastoid
foramen),upper and lower
quarters of face on same side
gets paralysed.
Supranuclear lesions: only
the lower quarter of opposite
side of face is paralysed
Crocodile tears : in proximal
part of nervous intermedius
some regenerating salivary
fibers find their way into
greater petrosal nerve

53. Acute crocodile tear syndrome without antecedent facial nerve palsy
Chi Yun Doreen Ho MBBS ,Thomas G Hardy FRANZCO
First published: 14 February 2018
The case of a 47-year-old male with an unremarkable past medical and ocular history who sustained
a motor vehicle accident in 1995 resulting in partial amputation of his left pinna that required partial
pinnectomy in 2000. In October 2013, he underwent residual left pinnectomy and implantation of
three osseointegrated implants for prosthetic ear reconstruction. These were uncovered in a second-
stage procedure in July 2014. Three weeks after the second-stage procedure, he described new left-
sided symptoms of otalgia, hearing loss and lacrimation stimulated only when eating. At no stage was
there any history or clinical evidence of facial weakness.
(a) Crocodile tear syndrome (CTS) with antecedent facial nerve palsy. Misdirection of regenerating
salivary fibres destined for the salivary glands become secretory fibres to the lacrimal gland thus
establishing a new reflex arc, causing ipsilateral tearing while the patient is eating. If the lesion is in
the facial nerve proximal to or involving the geniculate ganglion (explaining its association with an
antecedent facial nerve palsy) where the lacrimal and salivary fibres run together, abnormal
regeneration of gustatory fibres occurs through the greater superficial petrosal nerve to reach the
lacrimal gland. (b) CTS without antecedent facial nerve palsy. Misdirection of regenerating salivary
fibres of glossopharyngeal nerve where tympanic branch divides into tympanic plexus to aberrantly
reinnervate the sphenopalatine ganglion and thus stimulate the lacrimal gland.

54. BELLS PALSY & FACIAL PARALYSIS
A syndrome that consisted of
ipsilateral facial paralysis with intact
facial sensation that occurred after the
transection of facial nerve.
Etiology: Ischemia, edema and
compression of the nerve.
- Central lesion
- Infra nuclear lesion
- Lesion around geniculate
ganglion
- Lesion at or around stylomastoid
foramen

55. Treatment :
Proper care of the eye
-eyedrops/artificial tears
- ointment at bed time
-goggles for dust protection
Steroids
Antiviral agents
Alcohol injections
Physiotherapy
Clinical Features :
Lesion unilateral
Unable to laugh/ smile
Cannot blink his eyes
Unable to raise eyebrows
Absence of wrinkles on forehead
Corner of mouth droops
Infection of eye

56. GLOSSOPHARYNGEAL NERVE

57. GLOSSOPHARYNGEAL NERVE
 Nerve of the 3rd Brachial arch.
 It is the 9th cranial nerve.
 Mixed nerve
Exit from skull: jugular foramen.
functions:
 Secretomotor to parotid gland
 Gustatory to post. 1/3rd of tongue
 Motor to stylopharyngeus
 Sensory to pharynx, tonsil, post. 1/3rd of tongue.
NUCLEI PRESENT :
1. Nucleus Ambigius : Brachiomotor
2. Inf. Salivatory : Parasymphathetic
3. Nucleus of Tractus Solitarius :
Gustatory
Functional components;
SVE : supply stylopharyngeus
GVE : supply parotid
GVA : supply the oro & laryngo
pharynx
SVA : from post. 1/3rd of tongue.

58. Course of 9th nerve
Intracranial:
-Arises from the upper part of the lateral aspect of medulla by 3-4
rootlets
-Filaments unite to form a single trunk , passes lateraly to leave
cranial cavity through jugular foramen
-superior and inferior sensory ganglia are located on the nerve as it
passes through jugular foramen
-inferior ganglion contains most of the sensory fibers.

59. Extra cranial:
-Descends between Internal Jugular Vein & Internal Carotid
Artery
-Pass toward the lateral aspect of stylopharyngeous
-Pass between external & internal carotid arteries reaches side
of pharynx
-Then curves along the lateral aspect of stylopharyngeus muscle
deep to stylohyoid ligament and gives terminal branches

60. Ganglion associated with Glossopharyngeal
nerve & it’s Connections ‘OTIC’
• Peripheral parasympathetic
• Relays secretomotor fibers to parotid
gland
• Situated in infratemporal fossa
• Motor root formed by lesser petrosal nerve
• Sympathetic root by plexus around
middle meningeal artery
• Sensory root from auriculotemporal nerve

61. 1.Tymphanic Nerve : takes part in the formation of
tympanic plexus
1 branch of PLEXUS is called Lesser
Petrosal Nerve.
2. Carotid Branch : supplies the Carotid Sinus &
the Carotid Body.
3. Pharyngeal Branch : takes part in forming the
pharyngeal plexus.
4. Muscular Branch : Supplies the
Stylopharyngeus.
5 Tosillar Branches : supplies the tonsils , joins
the plexus with lesser palatine.
6. Lingual Branch : Carry Taste & General
sensation from the post. 1/3rd of the tongue.
Branches of 9th nerve

62. Applied anatomy/ 9th nerve
Glossopharyngeal neuralgia:
Rare condition – paroxysmal pain i.e
similar to trigeminal neuralgia.pain in ear,throat
and neck
Cause: oropharyngeal tumors,stylohyoid
ligament ossifications,multiple sclerosis.
Types: 1.classic/episodic pain
2.symptomatic/continuos pain
Trigger zones: pharynx, post. 1/3rd of tongue,
ear & infra auricular areas.
Treatment: similar to trigeminal neuralgia
-anticonvulsant drugs
-NSAIDS
-Surgical procedures(rhizotomy)

63. Orofacial neuralgia associated with a middle cerebral artery aneurysm
Raoul Julio Mascarenhas ,Narada Dhitimantha Hapangama ,Peter James Mews ,Arjun Burlakoti,Sarbin Ranjitkar First published: 07
December 2018
Case report A 62-year-old female patient presented for a general dental examination with a
chief concern of mild pain around the right mandible. Dental history revealed nocturnal bruxism,
for which the patient had been wearing an occlusal splint for 20 years.The masseter and
temporalis muscles as well as the lateral pole of the right mandibular condyle were tender to
palpation. There was no clicking or significant deviation or limitation to mandibular opening,
closing and lateral movements. Furthermore, multiple carious teeth and failing restorations were
identified, for which a management plan was formulated. The patient was counselled with
regards to the role of bruxism in the aetiology of facial pain, and her symptoms were monitored
over the course of restorative care. Three months after the initial appointment, the pattern and
severity of the pain changed. The pain became moderately intense and stabbing in nature. It
was precipitated by swallowing, and radiated through the right throat, posterior border of the
mandible, ear and temporomandibular joint (TMJ)Generally, differential diagnoses of chronic
facial pain (in decreasing order of occurrence) include odontogenic pain, temporomandibular
joint disorders, temporal arteritis, cranial nerve neuropathies, salivary gland pathology, and
Eagle’s Syndrome. subsequently an MRI scan of the head was obtained, which revealed a 7
mm × 6 mm aneurysm in the M2 segment of the Middle cranial artery (MCA). Differentiating
between TMD and other causes of facial pain can be a diagnostic challenge. It is the first case
of orofacial pain that was relieved by surgical clipping of an Middle cranial artery aneurysm.

64. CERVICAL PLEXUS

65. THE CERVICAL PLEXUS
Formed by the ventral rami of the upper 4
cervical nerves C1 – C4 with contribution
Of C5.
The plexus is related posteriorly to the
muscles that arise from the posterior
tubercle Of the transverse process i.e. the
Levator Scapulae and scalenus medius
Anteriorly, to the prevertebral fascia, the
Internal jugular vein and the
sternocleidomastoid.
The four roots forming the plexus connect to
each other to form three loops. E.g. C1-C2,
C2-C3, C3-C4.

66. Branches
1. Communicating branches:
a. Grey rami pass from superior cervical ganglion to the
roots of C1-4 nerves.
b. Branch from C1 that joins the hypoglossal nerve
c. Branch from C2 to sternocleidomastoid and
d. Branches from C3 and 4 to the spinal accessory nerve
which supplies the trapezius muscle

67. 2. Superficial (sensory) branches, which supply cutaneous fibers
to the neck.
a. Ascending branches; Lesser occipital (C2) and Greater
auricular (C2,3)
b. Transverse branch; Transverse (anterior) cutaneous nerve of
the neck (C2,3)
c. Descending branches; Supraclavicular (C3,4)
3. Deep branches, to the neck muscles.
4.The phrenic nerve, which is the motor nerve of the diaphragm.
5.Motor branches

68. CONCLUSION

69. REFERENCES
 GRAY’S anatomy for students (third edition)
 Anatomy of head neck and brain by VISHRAM SINGH
 Human anatomy-head and neck by B.D CHAURASIA
 Internet sources