CRANIAL NERVES

Twelve pairs of cranial nerves branch off the brain and

upper spinal cord and pass through the cranial foramina.
These nerves are identified by name and/or Roman
numerals with the abbreviation CN
The cranial nerves are as follows:
I. Olfactory
II. Optic
III. Oculomotor
IV. Trochlear
V. Trigeminal
VI. Abducens
VII. Facial
VIII. Vestibulocochlear
IX. Glossopharyngeal
X. Vagus
XI. Spinal accessory
XII. Hypoglossal
The olfactory (CN I), optic (CN II), and vestibulocochlear
(CN VIII) nerves are entirely sensory. The oculomotor (CN
III), trochlear (CN IV), abducens (CN VI), accessory (CN
XI), and hypoglossal (CN XII) nerves are entirely
motor. The remaining nerves are mixed.
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Parasympathetic fibers in the head are carried out of the
brain as part of four cranial nerves—37910---the
oculomotor nerveIII], the facial nerve [VII], the
glossopharyngeal nerve [IX], and the vagus nerve [X].
Parasympathetic fibers in the oculomotor nerve [III], the
facial nerve [VII], and the glossopharyngeal nerve [IX]
destined for target tissues in the head leave these nerves,
and are distributed with branches of the trigeminal nerve
[V]. The vagus nerve [X] leaves the head and neck to
deliver parasympathetic fibers to the thoracic and
abdominal viscera.

 Olfactory Nerves (CN I)

Carries special afferent fibres for the sense of smell.
ORIGIN: olfactory receptor nerve cells in the olfactory
mucous membrane, located at the upper part of the nasal
cavity above the level of the superior concha.
COURSE: Bundles of these olfactory nerve fibers pass
through the openings of the cribriform plate of the ethmoid
bone to enter the olfactory bulb in the cranial cavity
where they synapse. The olfactory tract connects this
olfactory bulb to the olfactory area of the cerebral cortex.

 Optic Nerve (CN II)

A sensory nerve that carries special afferent fibres for
vision
ORIGIN: formed by the axons of the cells of the
ganglionic layer of the retina.
COURSE: Emerges from the back of the eyeball and
leaves the orbital cavity through the optic canal to enter
the cranial cavity. The optic nerve then unites with the
optic nerve of the opposite side to form the optic
chiasma.
In the chiasma, the fibers from the medial half of each
retina cross the midline and enter the optic tract of the
opposite side, whereas the fibers from the lateral half of
each retina pass posteriorly in the optic tract of the same
side. Most of the fibers of the optic tract terminate by
synapsing with nerve cells in the lateral geniculate body. A
few fibers pass to the pretectal nucleus and the superior
colliculus and are concerned with light reflexes.
The axons of the nerve cells of the lateral geniculate body
pass posteriorly as the optic radiation and terminate in the
visual cortex of the cerebral hemisphere.

 Oculomotor Nerve (CN III)

ORIGIN: Anterior surface of the midbrain
COURSE: Passes between the posterior cerebral and
superior cerebellar arteries into the middle cranial fossa in
the lateral wall of the cavernous sinus where it divides into
a superior ramus and an inferior ramus. These enter the
orbital cavity through the superior orbital fissure.
SUPPLY:
1. Extrinsic eye muscles: (levator palpebrae
superioris, superior rectus, medial rectus, inferior
rectus, and inferior oblique) by its somatic motor
fibers
2. Intrinsic eye muscles: (constrictor pupillae and the
ciliary muscles) by its parasympathetic fibres and
through the short ciliary nerves.
FUNCTIONS: The oculomotor nerve is entirely motor. It
is responsible for lifting the upper eyelid; turning the eye
upward, downward, and medially; constricting the pupil;
and accommodation of the eye.
  Trochlear Nerve (CN IV):
The trochlear nerve is the thinnest cranial nerve.
ORIGIN: posterior surface of the midbrain.
COURSE: After curving around the midbrain, it continues
in an anterior direction in the lateral wall of the cavernous
sinus and enters the orbit through the superior orbital
fissure.
SUPPLY: superior oblique muscle
FUNCTION: Entirely motor, assists in turning the eye
downward and laterally.

 Trigeminal Nerve (CN V):

The largest cranial nerve.
ORIGIN: anterior aspect of the pons, as a small motor root
and a large sensory root.
COURSE: goes through the posterior cranial fossa, to
reach the apex of the petrous part of the temporal bone in
the middle cranial fossa. Here, the large sensory root
expands to form the trigeminal ganglion. This ganglion lies
within a pouch of dura mater called the trigeminal cave.
The motor root of the trigeminal nerve is situated below
the sensory ganglion and is completely separated from it.
BRANCHES:
1. Ophthalmic Nerve (V1)
The ophthalmic nerve is purely sensory. It runs forward in
the lateral wall of the cavernous sinus in the middle cranial
fossa and divides into three branches:
 lacrimal
 frontal
 nasociliary nerves,
These enter the orbital cavity through the superior orbital
fissure
 The lacrimal nerve is joined by the
zygomaticotemporal branch of the maxillary nerve,
which contains the parasympathetic secretomotor
fibers to the lacrimal gland to supply the lacrimal
gland and also gives branches to the conjunctiva and
the skin of the upper eyelid.
 The frontal nerve divides into the supraorbital and
supratrochlear nerves, which leave the orbital
cavity to supply the frontal air sinus and the skin of
the forehead and the scalp.
 The nasociliary nerve: gives off:
 Sensory fibers to the ciliary ganglion
 Long ciliary nerves that contain sympathetic
fibers to the dilator pupillae muscle and sensory
fibers to the cornea
 Infratrochlear nerve that supplies the skin of the
eyelids
 Posterior ethmoidal nerve that is sensory to the
ethmoid and sphenoid sinuses
 anterior ethmoid nerve: the direct
continuation of the nasociliary nerve, gives off
two internal nasal branches, and then supplies
the skin of the tip of the nose with the external
nasal nerve.
2. Maxillary Nerve (V2)
The maxillary nerve is purely sensory. Arising from the
trigeminal ganglion, it passes forward in the lateral wall of
the cavernous sinus, and leaves the skull through the
foramen rotundum. It then enters the pterygopalatine
fossa, where it divides into:
 Meningeal branches (middle meningeal nerve)
 Zygomatic branch: divides into the
zygomaticotemporal (gives parasympathetic
secretomotor fibers to the lacrimal gland via the
lacrimal nerve) and the zygomaticofacial nerves
(supply the skin of the face).
 Infraorbital nerve: the main continuation of the
maxillary nerve into the infraorbital groove, gives off
the middle superior alveolar and anterior superior
alveolar nerves which supply the maxillary sinus,
the upper teeth and gums, and the cheek. Also gives
off sensory fibers to the skin of the face and the side
of the nose.
 Ganglionic branches: two short nerves that suspend
the pterygopalatine ganglion in the pterygopalatine
fossa.
 Posterior superior alveolar nerve (supplies the
maxillary sinus, upper molar teeth and adjoining parts
of the gum and the cheek).
 Orbital branches
 Greater and lesser palatine nerves: supply the
palate, tonsil, and the nasal cavity
 Pharyngeal nerve, which supplies the roof of the
nasopharynx
 Nasopalatine nerve
3. Mandibular Nerve (V3)
A mixed nerve, Branches include:
 Meningeal branch (spinous nerve). the major nerve
to the dura mater.
 Nerve to the medial pterygoid muscle, which
supplies both the medial pterygoid and the tensor veli
palatini muscles.
 Anterior Division of the mandibular nerve. Gives
off:
o Masseteric nerve to the masseter muscle
o Deep temporal nerves to the temporalis muscle
o Nerve to the lateral pterygoid muscle
o Buccal nerve to the skin and the mucous
membrane of the cheek. It is the only sensory
branch of the anterior division of the mandibular
nerve.
 Posterior division of the Mandibular Nerve: gives
off:
o Auriculotemporal nerve, which supplies the
skin of the auricle, the external auditory meatus,
the TMJ, and the scalp. This nerve also conveys
postganglionic parasympathetic secretomotor
fibers from the otic ganglion to the parotid
salivary gland.
o Lingual nerve: joined by the chorda tympani
nerve (a branch of the facial nerve) in the
infratemporal fossa. The lingual nerve fibers carry
general sensation from the mucous membrane of
the anterior two thirds of the tongue and the floor
of the mouth. The chorda tympani carry taste
fbres from the anterior two thirds of the tongue
and also give off preganglionic parasympathetic
 secretomotor fibers to the submandibular
ganglion.
o Inferior alveolar nerve, which enters the
mandibular foramen and canal to supply the teeth
of the lower jaw and emerges through the mental
foramen (mental nerve) to supply the skin of the
chin. Also gives off the mylohyoid nerve, which
supplies the mylohyoid muscle and the anterior
belly of the digastric muscle.
The branches of the posterior division of the
mandibular nerve are sensory (except the nerve to
the mylohyoid muscle).
FUNCTION: The trigeminal nerve is the main sensory
nerve of the head, innervates the 4 muscles of mastication
(temporalis, masseter, medial and lateral pterygoids),
tenses the soft palate and the tympanic membrane.

 Abducens Nerve (CN VI)

ORIGIN: anterior surface of the hindbrain between the
pons and the medulla oblongata
COURSE: runs with the internal carotid artery through the
cavernous sinus in the middle cranial fossa and enters the
orbit through the superior orbital fissure.
SUPPLY: lateral rectus muscle, responsible for turning
the eye laterally.

 Facial Nerve (CN VII)

Has a motor root and a sensory root (nervus
intermedius/intermediate nerve). The intermediate
nerve contains the Special Afferent fibers for taste, the
parasympathetic General Visceral Efferent fibers, and the
General Sensory Afferent fibers while the larger motor root
contains the Branchial Efferent fibers.
ORIGIN: anterior surface of the hindbrain between the
pons and the medulla oblongata.
COURSE: passes laterally in the posterior cranial fossa
with the vestibulocochlear nerve to enter the internal
acoustic meatus in the petrous part of the temporal bone
where it runs in the facial canal to reach the middle ear. At
the medial wall of the middle ear, the nerve swells to form
the sensory geniculate ganglion. After emerging from
the temporal bone through the stylomastoid foramen, The
facial nerve now passes forward through the parotid gland,
between its superficial and deep parts to its distribution
across the face.
Important Branches
 Greater petrosal nerve: contains preganglionic
parasympathetic fibers that synapse in the
pterygopalatine ganglion whose postganglionic
fibers are secretomotor to the lacrimal gland and the
glands of the nose and the palate. May also contain
taste fibers from the palate.
 Nerve to stapedius supplies the stapedius muscle in
the middle ear.
 Chorda tympani nerve: joins the lingual nerve and
contains preganglionic parasympathetic
secretomotor fibers to the submandibular and the
sublingual salivary glands. It also contains taste
fibers from the anterior two thirds of the tongue and
floor of the mouth.
  Posterior auricular nerve: supplies the back of the
auricle, external auditory meatus, tympanic
membrane, and posterior auricular muscle.
 Muscular branches to the posterior belly of digastric
and the stylohyoid muscles
 Five terminal branches to the muscles of facial
expression: the temporal, zygomatic, buccal,
mandibular, and the cervical branches.
The facial nerve controls facial expression, salivation,
and lacrimation; it is a pathway for taste sensation from
the anterior part of the tongue and floor of the mouth
and from the palate; it also affects hearing.

 Vestibulocochlear Nerve (CN VIII)

Carries Special afferent fibers for hearing and balance,
consists of two sets of fibers: vestibular and cochlear.
ORIGIN: anterior surface of the brain between the pons
and the medulla oblongata
COURSE: They cross the posterior cranial fossa to enter
the inner ear with the facial nerve
Vestibular Fibers
The vestibular fibers are the central processes of the
nerve cells of the vestibular ganglion situated in the
internal acoustic meatus. As they are from the vestibule
and semicircular canals, they are concerned with the
sense of position and with movement of the head.
Cochlear Fibers
The cochlear fibers are the central processes of the nerve
cells of the spiral ganglion of the cochlea. They
originate in the spiral organ of Corti and are therefore
concerned with hearing.
  Glossopharyngeal Nerve (CN IX)
A mixed motor and sensory nerve.
ORIGIN: anterior surface of the medulla oblongata
between the olive and the inferior cerebellar peduncle
COURSE: Passes through the posterior cranial fossa and
leaves the skull by passing through the jugular foramen.
Its superior and inferior sensory ganglia are located on
the nerve as it passes through the foramen. It then
descends through the upper part of the neck to the back of
the tongue.
Important Branches
 Tympanic nerve: passes to the tympanic plexus in
the middle ear. it provides sensory innervation to the
 mucosa of the tympanic cavity, pharyngotympanic
tube, and mastoid air cells. Preganglionic
parasympathetic fibers for the parotid salivary gland
leave the tympanic plexus as the lesser petrosal
nerve and synapse in the otic ganglion.
 Carotid nerve contains sensory fibers (GVA) from the
carotid sinus (pressoreceptor mechanism for the
regulation of blood pressure) and the carotid body
(chemoreceptor mechanism for the regulation of heart
rate and respiration).
 Nerve to the stylopharyngeus muscle, the sole
muscle supplied by the glossopharyngeal nerve.
 Pharyngeal branches to the pharyngeal plexus
 Lingual branch carries general sensory and taste
fibers (SA) from the mucous membrane of the
 posterior third of the tongue (including the vallate
papillae).
FUNCTIONS: The glossopharyngeal nerve assists
swallowing and promotes salivation. It also conducts
sensation from the pharynx and the back of the tongue
and carries impulses which influence the arterial blood
pressure and respiration from the carotid sinus and carotid
body.

 Vagus Nerve (CN X)

A mixed nerve, has the most extensive distribution of all
the cranial nerves.
ORIGIN: anterior surface of the medulla oblongata
between the olive and the inferior cerebellar peduncle.
COURSE: Passes laterally through the posterior cranial
fossa and leaves the skull through the jugular foramen.
Like the glossopharyngeal nerve, The vagus nerve has
both superior and inferior sensory ganglia. Below the
inferior ganglion, the cranial root of the accessory nerve
joins the vagus nerve and distributes mainly in its
pharyngeal and recurrent laryngeal branches. The vagus
nerve descends through the neck alongside the carotid
arteries and internal jugular vein within the carotid sheath.
It passes through the mediastinum of the thorax, passing
behind the root of the lung, and enters the abdomen
through the esophageal opening in the diaphragm.
Important Branches:
 Auricular branch supplies the pinna, external
auditory meatus, and tympanic membrane.
 Pharyngeal branch joins the pharyngeal plexus
and supplies all the muscles of the pharynx (except
 the stylopharyngeus) and of the soft palate (except
the tensor veli palatini).
 Superior laryngeal nerve divides into the internal
and the external laryngeal nerves. The internal
laryngeal nerve is sensory to the mucous membrane
of the piriform fossa and the larynx down as far as the
vocal cords. The external laryngeal nerve is closely
related to the superior thyroid artery and supplies the
cricothyroid muscle.
 Recurrent laryngeal nerve hooks around the first
part of the subclavian artery on the right side and
around the arch of the aorta on the left. Both then
ascend into the neck between the trachea and
esophagus. The nerve is closely related to the inferior
thyroid artery, and it supplies all the muscles of the
larynx (except the cricothyroid muscle), the mucous
membrane of the larynx below the vocal cords, and
the mucous membrane of the upper part of the
trachea.
 Cardiac branches to the cardiac plexus.
The vagus nerve thus innervates the external ear,
pharynx, larynx, trachea, and cervical esophagus. Below
the neck, the vagus supplies parasympathetic fibers to the
thoracic viscera and much of the GI tract, from the
esophagus to the splenic flexure of the colon. It also
supplies glands associated with the GI tract, such as the
liver and pancreas.

Accessory Nerve (CN XI)

A motor nerve. It consists of a cranial root (part) and
a spinal root (part)
The Cranial Root emerges from the anterior surface of
the medulla oblongata the olive and the inferior cerebellar
peduncle and runs laterally in the posterior cranial fossa to
joins the spinal root.
The Spinal Root on the other hand, arises from nerve
cells in the anterior gray column (horn) of the upper five
segments of the cervical part of the spinal cord and
ascends alongside the spinal cord to enter the skull
through the foramen magnum. The two roots then unite
and leave the skull through the jugular foramen.
Thereafter, the roots separate:
The cranial root joins the vagus nerve and is distributed
in its branches to the muscles of the soft palate and
pharynx (via the pharyngeal plexus) and to the muscles of
the larynx (except the cricothyroid muscle).
The spinal root runs downward and laterally and enters
the deep surface of the sternocleidomastoid muscle, which
it supplies, and then crosses the posterior triangle of the
neck to supply the trapezius muscle.

 Hypoglossal Nerve (CN XII)

ORIGIN: anterior surface of the medulla oblongata
between the pyramid and the olive
COURSE: crosses the posterior cranial fossa, and leaves
the skull through the hypoglossal canal. The nerve then
passes downward and forward in the neck and crosses
the internal and external carotid arteries to reach the
tongue. It is joined by C1 fibres from the cervical plexus in
the upper part of its course.
Important Branches:
 Meningeal branch.
 Descending branch (C1 fibers) passes downward
and joins the descending cervical nerve (C2 and 3) to
form the ansa cervicalis, which supplies the
omohyoid, sternohyoid, and sternothyroid muscles.
 Nerve to the thyrohyoid muscle (C1).
 Muscular branches to all the muscles of the
tongue except the palatoglossus.
 Nerve to the geniohyoid muscle (C1).
FUNCTION: controls the shape and movements of the
tongue.
Cranial nerve lesions
 Olfactory nerve: loss of smell (anosmia)
 Optic nerve: Blindness/visual field abnormalities e.g.
bitemporal hemianopia, homonymous hemianopia;
loss of pupillary constriction
 Oculomotor nerve: Dilated pupil, ptosis, loss of normal
pupillary reflex, eye moves down and out. At rest, the
eye looks laterally (external strabismus) -Due to the
activity of the lateral rectus; and downward because
of the activity of the superior oblique.
 Trochlear nerve: diplopia on looking downward
 Trigeminal nerve: Loss of sensation and pain in the
region supplied by the three divisions of the nerve,
loss of function of the muscles of mastication on the
side of the lesion
 Abducens nerve: Inability of lateral eye movement.
Unopposed medial rectus activity causes internal
strabismus
  Facial nerve: e.g. Bell’s palsy (LMN lesion)-Paralysis
of facial muscles; UMN lesion: Paralysis of
contralateral facial muscles below the eye – upper
spares upper
 Vestibulocochlear nerve: hearing loss
 Glossopharyngeal nerve: Loss of taste to the
posterior one-third of the tongue and sensation of the
soft palate
 Vagus nerve: Soft palate deviation with deviation of
the uvula to the normal side; vocal cord paralysis
(bilateral recurrent nerve paralysis: aphonia, unilateral
recurrent nerve paralysis: hoarseness, external
laryngeal nerve injury: dysphonia)
 Accessory nerve: inability to shrug shoulders against
resistance
 Hypoglossal nerve: Atrophy of ipsilateral muscles of
the tongue and deviation toward the affected side;
speech disturbance
Cranial nerve reflexes
Corneal (blink) reflex
■ Afferent—Trigeminal nerve (CN V)
■ Efferent—Facial nerve (CN VII)
Gag reflex
■ Afferent—Glossopharyngeal nerve (CN IX)
■ Efferent—Vagus nerve (CN X)
Pupillary (light) reflex
■ Afferent—optic nerve (CN II)
■ Efferent—oculomotor nerve (CN III)