The Clinical Anatomy of the Cranial Nerves The Clinical Anatomy of the Cranial Nerves The Nerves of “On Old Olympus Towering Top” Joel A. Vilensky, Ph.D. Professor of Anatomy and Cell Biology Indiana University School of Medicine Fort Wayne, IN Wendy M. Robertson, P.A., M.D. Senior Staff Neurologist Department of Neurology Henry Ford Hospital Detroit, MI Carlos A. Suárez-Quian, Ph.D. Professor Department of Biochemistry and Molecular & Cellular Biology Georgetown University Medical Center Washington, DC This edition first published 2015 © 2015 by John Wiley & Sons, Inc. Editorial Offices 1606 Golden Aspen Drive, Suites 103 and 104, Ames, Iowa 50010, USA The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 9600 Garsington Road, Oxford, OX4 2DQ, UK For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell. 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Suárez-Quian, Carlos Andrés, author. [DNLM: 1. Cranial Nerves–anatomy & histology. WL 330] QM471 612.8′19–dc23 2014030763 A catalogue record for this book is available from the British Library. Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. Set in 9.5/12.5pt Palatino by SPi Publisher Services, Pondicherry, India 1 2015 Dedication This book is dedicated to teacher, mentor, and friend, Dr. Sid Gilman. We thank him most sincerely for being all three and for revealing to us, through his knowledge and actions, the amazing neurological talents of his own mentor, Dr. Derek Denny-Brown. Contents Preface xi Contributors xiii Acknowledgments xv Introduction xvii 1 The Olfactory Nerve 1 Anatomy/Function Summary 1 Anatomy/Function 3 Clinical Aspects 5 References 16 2 The Optic Nerve 17 Anatomy/Function Summary 17 Anatomy/Function 19 Clinical Aspects 25 References 40 3 The Oculomotor Nerve 43 Anatomy/Function Summary 43 Anatomy/Function 45 Clinical Aspects 53 References 62 4 The Trochlear Nerve 65 Anatomy/Function Summary 65 Anatomy/Function 67 Clinical Aspects 70 References 74 5 The Trigeminal Nerve 75 Anatomy/Function Summary 75 Anatomy/Function 77 Clinical Aspects 90 References 108 6 The Abducent Nerve 111 Anatomy/Function Summary 111 Anatomy/Function 113 Clinical Aspects 117 References 121 vii viii Contents 7 The Facial Nerve 123 Anatomy/Function Summary 123 Anatomy/Function 125 Clinical Aspects 139 References 151 8 The Vestibulocochlear (Acoustic) Nerve 153 Anatomy/Function Summary 153 Anatomy/Function 155 Clinical Aspects 160 References 167 9 The Glossopharyngeal Nerve 169 Anatomy/Function Summary 169 Anatomy/Function 171 Clinical Aspects 179 References 186 10 The Vagus Nerve 187 Anatomy/Function Summary 187 Anatomy/Function 190 Clinical Aspects 197 References 214 11 The Accessory Nerve 217 Anatomy/Function Summary 217 Anatomy/Function 220 Clinical Aspects 225 References 228 12 The Hypoglossal Nerve 229 Anatomy/Function Summary 229 Anatomy/Function 230 Clinical Aspects 233 References 237 13 Nervus Terminalis (Cranial Nerve N) 239 Anatomy/Function 239 References 241 14 Concluding Remarks: The Past and Future and Magic of the Cranial Nerves 243 Cranial Nerve II: Take Care of your Sight 245 Howard P. Cupples Cranial Nerves II, III, IV, and VI: Visual Abnormalities in Children in a Developing Country 247 Ujjowala D. Shrestha Contents ix Cranial Nerves III, IV, and VI: Not all is as it seems with Eye Movements 249 Jonathan Trobe Cranial Nerve V: Be Careful What you ask for! 252 M. Anthony Pogrel Cranial Nerve V: The Best Laid Plans … 254 Raymond Sekula and Andrew Frederickson Cranial Nerve VII: Sometimes it is Hit or Miss 256 Raymond Sekula and Andrew Frederickson Cranial Nerve VII: Tragedy Behind a Facial Nerve Paralysis 258 Peter J. Koehler Cranial Nerve VII: Facial Nerve and Facial Function 261 Alex Senchenkov and John E. Woods Cranial Nerve VIII: Spinning Wheels 264 Laurie Swan Cranial Nerve X: Speak up, Please, I cannot hear you 266 Lucille Hess Cranial Nerve X: Vexing Vocals 268 Mohan K. Rao Cranial Nerve X: Vagotomy – Fond Memories of an Obsolete Operation 270 Carol E.H. Scott-Conner Cranial Nerve XII: Sometimes The Bad News is Really Bad 272 Mortimer Lorber References 277 Preface This book is about the most interesting nerves in the body. So interesting and also sometimes so frustrating that we repeatedly in this book refer to the cranial nerves as being “magical.” The traditional twelve cranial nerves defy logic by the amazing senses they convey, the convoluted intracranial paths they take and the problems they can cause when they do not function correctly. The title of our book, The Clinical Anatomy of the Cranial Nerves: The Nerves of “On Old Olympus Towering Top”, is derived from a mnemonic that virtually all clinicians learn to remember the numbers associated with each of the cranial nerves (see Introduction chapter). In The Clinical Anatomy of the Cranial Nerves: The Nerves of “On Old Olympus Towering Top” we have done our best to describe the anatomy and physiology of these nerves from a clinical perspective, but in a such a way that the reader does not need to be a clinician to understand our text. This is facilitated by general sections in our Introduction on the nervous system and on the osteol- ogy (bones) of the skull. We liberally sprinkle our chapters with case studies so that the reader can “feel” what patients experience when one or more of their cranial nerves don’t function correctly, as well as understand better intellectually what these nerves do compared to texts without such clinical cases. As with all anatomy books, this one has many illustrations. We searched many sources or drew our own (or commissioned an artist to draw them) to obtain images that we felt illuminate and simplify the complexity of these nerves in terms of anatomy and function. Further, and we think unique to this book, we present many images from actual anatomical dissections of the cranial nerves. The latter show the reader the real anatomy of these nerves rather than the sometimes simplified version that drawings may present. We believe this book is suitable for an undergraduate course on the cranial nerves, and is certainly a useful supplement to health professionals learning about these nerves for the first time, including first year medical students, or those wanting to review the anatomy of the cranial nerves for their clinical practice. We also believe interested lay persons and patients with cranial nerve disorders will find this book understandable, informative, and useful. Joel A. Vilensky Carlos A. Suárez-Quian Wendy M. Robertson xi Contributors Howard P. Cupples, M.D. Mohan K. Rao, M.D. Professor and Chair, Emeritus Staff Otolaryngologist Department of Ophthalmology Ear, Nose, & Throat Associates PC Georgetown University School of Medicine Dupont Medical Park Washington, DC Fort Wayne, Indiana Andrew Frederickson, M.S. Carol E.H. Scott-Conner, M.D., Ph.D. Researcher Professor of Surgery Center for Cranial Nerve and Brainstem Department of Surgery Disorders University of Iowa Carver College University of Pittsburgh School of Medicine of Medicine Pittsburgh, Pennsylvania Iowa City, Iowa Lucille Hess, Ph.D., CCC-SLP Raymond Sekula, M.D. Professor Emeritus Professor of Neurosurgery Communication Sciences and Disorders Department of Neurosurgery Indiana-Purdue University-FW University of Pittsburgh School Fort Wayne, Indiana of Medicine Pittsburgh, Pennsylvania Peter J. Koehler, M.D., Ph.D., FAAN Staff Neurologist Alex Senchenkov, M.D. Department of Neurology Staff Surgeon Atrium Medical Centre Mayo Clinic Heerlen, The Netherlands Rochester, Minnesota Mortimer Lorber, D.M.D., M.D. Professor Emeritus Ujjowala D. Shrestha, M.D. Department of Pharmacology and Physiology Consultant Pediatric Ophthalmologist Georgetown University School of Medicine Tilganga Institute of Ophthalmology Washington, D.C. Kathmandu, Nepal M. Anthony Pogrel, D.D.S., M.D. Laurie Swan, P.T., Ph.D., DPT William Ware Endowed Professor and Instructor, Pierce College Chairman Owner and CEO, Synaptic Seminars Associate Dean for Hospital Affairs Puyallup, Washington Department of Oral and Maxillofacial Surgery University of California San Francisco, California xiii xiv Contributors Jonathan Trobe, M.D.