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CRANIAL NERVE TABLES Nerve Branches Important Function(S CRANIAL NERVE TABLES Nerve Branches Important Function(s) Test Miscellaneous Clinical CN I • Loss of olfactory fibers usually occurs Olfactory with aging; No named Ability to smell tested Special Sensory: Olfaction • Olfactory filaments can be sheared off branches bilaterally from traumatic blows to the bridge of the nose Nerve Branches Important Function(s) Test Miscellaneous Clinical CN II No named Afferent limb of the Optic Special Sensory: Vision See MBB “Vision Week” Resources branches pupillary light reflex Nerve Branches Important Function(s) Test Miscellaneous Clinical Somatic Motor: levator palpebrae superioris and extraocular muscles (S. rectus, I. H-test • An aneurysm of the post. cerebral or sup. rectus, M. rectus, I. oblique) cerebellar aa. may exert pressure on CN Visceral Motor: Preganglionic III where it passes between these vessels parasympathetic nerve fibers course to CN III None you need to • Cavernous sinus infections ciliary ganglion. Postganglionic fibers Efferent limb of the Oculomotor know by name • Rapidly increasing intracranial pressure course in short ciliary nerves to the oculus pupillary light reflex can compress CN III against petrous that innervate the following muscles: causing pupil temporal bone resulting in superficial • Pupillary constriction via constrictor constriction parasympathetic fibers being affected first pupillae muscle • Lens accommodation via ciliary muscle Nerve Branches Important Function(s) Test Miscellaneous Clinical CN IV No named H-test: (Eye depressed • CN IV rarely paralyzed alone Somatic Motor: Superior oblique m. Trochlear branches and adducted) • Cavernous sinus infections 1 Miscellaneous Nerve Branches Important Function(s) Test Clinical Frontal n. (branches = Somatic Sensory: upper eyelid, conjunctiva, forehead, and scalp supraorbital and • Afferent limb of supratrochlear) V1: corneal reflex Somatic Sensory: lacrimal gland conjunctiva, upper eyelid Ophthalmic • Perception of touch (Sensory Lacrimal n. on forehead (frontal Conduit: delivers postganglionic fibers from neurons in Only) n.) pterygopalatine ganglion on path to lacrimal gland Somatic Sensory: cornea, anterosuperior nasal cavity, frontal, Nasociliary n. sphenoid and ethmoid sinuses, dura, upper eyelid, and bridge of nose Infraorbital n. and Somatic Sensory: posteroinferior nasal cavity, maxillary sinus, its branches palate, maxillary teeth, inferior eyelid, anterior cheek, and upper lip • Perception of touch in V2: Maxillary Somatic Sensory: skin over zygomatic bone and anterior scalp of infraorbital region (sensory temporal region (skin from inferior Only) Zygomatic n. eyelid to upper lip) Conduit: communicating branch delivers postganglionic fibers from • Trauma neurons in pterygopalatine ganglion to lacrimal nerve on path to • Tumors lacrimal gland • Aneurysms Somatic sensory: anterior 2/3 of the tongue and floor of oral cavity • Meningeal Lingual infections Conduit: preganglionic parasympathetic fibers of chorda tympani (facial nerve) course along the lingual nerve to on destination to submandibular ganglion • Perception of touch Somatic sensory: skin of buccal (cheek) region, buccal mucous Buccal on chin membranes of oral cavity, buccal gingivae of the second and third • Jaw clench, medial mandibular molar teeth V3: and lateral protraction Mandibular Inferior alveolar Somatic Sensory: sensation to the mandibular teeth and gums of the jaw against (Sensory resistance (the “jaw Somatic Sensory: sensation to the skin over the chin and skin of and Motor) Mental jerk reflex” is used lower lip specifically to test for Somatic Sensory: provides general sensory innervation to the upper motor neuron temporal region, external ear, and external surface of tympanic lesions) membrane. Auriculotemporal Conduit: delivers postganglionic parasympathetic fibers from otic ganglion to parotid gland. Preganglionic fibers from CN IX. Branches to Branchial Motor: muscles of mastication mastication mm. 2 Nerve Branches Important Function(s) Test Clinical • Due to long intracranial course, it can be stretched when intracranial pressure CN VI H-test: (abduction of rises Abducens No named branches Somatic Motor: lateral rectus m. eye) • Space-occupying lesions within the cranial cavity (tumor) may compress the nerve Nerve Branches Important Function(s) Test Clinical Branches to muscles of facial expression Branchial Motor: muscles of facial • Posterior Auricular expression; motor to stapedius muscle • Temporal of middle ear • Zygomatic • Buccal Somatic Sensory: small area of auricle • Mandibular (posterior auricular n.) CN VII • Cervical • Most frequently injured cranial nerve: Facial motor branches are at risk in trauma Branchial Motor: Stabilizes stapes to injuries to the face Nerves to stapedius dampens sounds • Motor portion at stylomastoid foramen • Efferent limb of is at risk of injury during forceps corneal reflex delivery due to absence of mastoid and • Smile/squint, raising styloid processes in the neonatal skull Visceral Motor: Delivers preganglionic brow • Can be compressed proximal to its Greater petrosal parasympathetic fibers to • Sound sensitivity entry into the facial canal in space- pterygopalatine ganglion • Perception of taste on occupying lesions of the cranial cavity tongue • Chorda tympani can be affected in severe cases of otitis media Visceral Motor: Contains preganglionic parasympathetic fibers destined to submandibular ganglion Chorda tympani Special Sensory: taste sensation from anterior 2/3 of tongue (Nuclei of neurons located in geniculate ganglion.) 3 Nerve Branches Important Function(s) Test Clinical Special Sensory: Hearing and CN VIII balance • See neuroscience resources Vestibulocochlear (special sensory) Nerve Branches Important Function(s) Test Clinical Somatic Sensory: tympanic cavity & internal surface of tympanic membrane Tympanic nerve Visceral Motor: Contains preganglionic. parasympathetic fibers destined for otic ganglion via lesser petrosal nerve (see below). Visceral Motor: Contains preganglionic. CN IX parasympathetic fibers destined to otic Glossopharyngeal Lesser petrosal ganglion (postganglionic fibers course to parotid in auriculotemporal nerve) Afferent limb of • Isolated lesions of complete nerve are gag reflex uncommon Visceral Sensory: Carotid body and • May be injured along with CNs X and XI Carotid branch sinus (chemoreceptors and by tumors in the region of the jugular baroreceptors) foramen (jugular foramen syndrome) • lingual branch may be injured at tonsillar fossa during tonsillectomy Nerve to Branchial Motor: assists in swallowing stylopharyngeus m. Somatic Sensory: posterior 1/3 of tongue, posterior nasopharynx, oropharynx Terminal branches (lingual, pharyngeal, Special Sensory: taste from posterior and tonsillar) 1/3 of tongue; Visceral sensation from carotid body and carotid sinus 4 Nerve Branches Important Function(s) Test Clinical Meningeal and Somatic Sensory: dura, auricle, external auditory auricular branches meatus Branchial Motor: pharyngeal constrictors, uvula and elevator of soft palate (except tensor veli palatini) Pharyngeal branches Visceral sensory: branch from carotid sinus can join with pharyngeal branch Somatic Sensory (internal branch): mucosa Superior laryngeal laryngopharynx, epiglottis, and larynx superior to the nerve vocal folds • *Internal branch • *External branch Branchial Motor (external branch): cricothyroid and cricopharyngeus muscles • Isolated lesions of Visceral Sensory: aortic bodies (chemoreceptors) complete nerve are and baroreceptors (mechanical stretch receptors) of uncommon; Cardiac nerves aortic arch and heart • Efferent limb of gag • May be injured along with (superior and inferior) reflex CNs IX and XI in tumors in CN X Visceral Motor: preganglionic parasympathetic fibers • Motor component jugular foramen syndrome Vagus to terminal ganglia (postganglionic fibers innervate tested by looking for • Recurrent laryngeal nerve the SA and AV nodes) symmetrical elevation of at risk of injury in soft palate when patient thyroidectomies, aortic arch Visceral Sensory: mucosa inferior to vocal folds asked to say “Ahh” aneurysms and Recurrent laryngeal bronchogenic carcinomas nerve Branchial Motor: All intrinsic laryngeal muscles affecting the apex of the except cricothyroid lung. Visceral Sensory: airways and lungs Bronchial branches Visceral Motor: preganglionic parasympathetic innervation to terminal ganglia of airways and lungs Visceral Sensory: esophagus Esophageal plexus Visceral Motor: preganglionic parasympathetic innervation to terminal ganglia of esophagus Visceral Sensory: esophagus Vagal trunks Visceral Motor: preganglionic parasympathetic innervation to terminal ganglia of esophagus 5 Nerve Branches Important Function(s) Test Clinical CN XI • Trapezius: Shrug • May be injured along with CNs IX and X Spinal Somatic Motor: trapezius & shoulders in jugular foramen syndrome Accessory No named branches sternocleidomastoid mm. • SCM: rotate head • At risk of injury in surgical procedures against resistance within the posterior triangle of neck Nerve Branches Important Function(s) Test Clinical CN XII Somatic Motor: intrinsic and three of Protrude tongue Hypoglossal No named branches four extrinsic tongue muscles (deviates to side of (exception is palatoglossus = CN X) muscular weakness) Summary of Sensory Ganglia: Recall that all neuron cell bodies of first order (primary) sensory neurons are located outside of the CNS in ganglia. Cranial Nerve Sensory ganglia Functional Classification CN I Ganglion cells in olfactory mucosa
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