Objectives



1. Review the components of a typical spinal nerve. How do those components compare and contrast to those of a cranial nerve.

Spinal Nerves
The 31 pairs of spinal nerves are attached to the spinal cord and use intervertebral foramen to go to their targets. Functionally, they are made up of somatic components (somatic afferents and efferents) and visceral components (autonomic efferents and afferents). Neuronal cell bodies of somatic afferents are located in the dorsal root ganglion. Neuronal cell bodies of somatic efferents are located in the ventral horn of the spinal cord. The ventral root and dorsal root meet to form the spinal nerve; this means that the spinal nerve is a mixed nerve with both somatic efferent (motor) and somatic afferent (sensory) fibers.

Cranial Nerves
The 12 pairs of cranial nerves are attached to the brain and use named foramena in the skull to go to their targets. Cranial nerves are mostly not mixed nerves, though they can be: they may be somatic afferent only (sensory), somatic efferent only (motor), or both.

Cranial Nerve Sensory (Afferent) Components
Cranial nerves may contain somatic afferent components (general sensation pain, touch, and temperature), special afferent components (smell, vision, hearing, taste), or visceral afferent components (sensory information from viscera).

Cranial Nerves Containing Somatic Afferent Components
Cranial Nerve
Name
Sensory Source
CN V1
Ophthalmic Branch
Sensory from forehead, eyeball
CN V2
Maxillary Branch
Sensory from cheek, nasal cavity, palate
CN V3
Mandibular Branch
Sensory from chin, anterior 2/3 of tongue
CN VII
Facial Nerve
Sensory from external auditory meatus
CN IX
Glossopharyngeal Nerve
Sensory from posterior ½ of tongue, middle ear
CN X
Vagus Nerve
Sensory from posterior ear, external auditory meats

Cranial Nerves Containing Special Afferent Components
Cranial Nerve
Name
Special Sense
CN I
Olfactory Nerve
Smell
CN II
Optic Nerve
Vision
CN VII
Facial Nerve
Taste – anterior 2/3 of tongue
CN VIII
Vestibulocholear Nerve
Hearing
CN IX
Glossopharyngeal Nerve
Taste – posterior 2/3 of tongue
CN X
Vagus Nerve
Taste – epiglottis

Cranial Nerves Containing Visceral Afferent Components
Cranial Nerve
Name
Sensory Source
CN IX
Glossopharyngeal
Sensory from pharynx, carotid body, and carotid sinus
CN X
Vagus Nerve
Sensory from larynx, carotid body, carotid sinus, and viscera

Cranial Nerve Sensory Ganglia
The afferent cell bodies of cranial nerves are located in named ganglia or are specialized in some way; three cranial nerves (facial, glossopharyngeal, and vagus) have more than one type of sensory component but are housed in the same ganglia.

Cranial Nerves and Associated Named Sensory Ganglia
Cranial Nerve
Name
Sensory Ganglia
CN I
Olfactory Nerve
Specialized cells in the olfactory epithelium (Anterior Olfactory Nuclei)
CN II
Optic Nerve
Specialized cells in the retina (Lateral Geniculate Nucleus)
CN V
Trigeminal Nerve
Trigeminal Ganglia
CN VII
Facial Nerve
Geniculate Ganglia
CN VIII
Vestibulocochlear Nerve
Specialized cells in the cochlea (Spiral Vestibular Ganglia)
CN IX
Glossopharyngeal Nerve
Superior and Inferior Glossopharyngeal Ganglia
CN X
Vagus Nerve
Superior and Inferior Jugular Ganglia

Cranial Nerve Motor (Efferent) Components
Cranial nerves may contain somatic efferent fibers (to skeletal muscle) or visceral efferent fibers (to smooth muscle and glands). Efferent fibers that go to skeletal muscle derived from the pharyngeal arches are called Special Visceral Efferents (SVE) but are similar in organization to other somatic efferents of the head.

Cranial Nerves Containing Somatic Efferent Components
Cranial Nerve
Name
Efferent Target
CN III
Oculomotor Nerve
To extrinsic muscles of the eye and levator palpebral superioris, except LR6 and SO4
CN IV
Trochlear Nerve
To Superior Oblique Muscle
CN VI
Abducens Nerve
To Lateral Rectus Muscle
CN XI
Accessory Nerve
To Sternocleidomastoid, trapezius
CN XII
Hypoglossal Nerve
To intrinsic and extrinsic muscles of the tongue

Cranial Nerves Containing Special Visceral Efferent Components
Cranial Nerve
Name
Efferent Target
CN V3
Mandibular Branch
To muscles of mastication
CN VII
Facial
To muscles of facial expression
CN IX
Glossopharyngeal
To stylopharyngeous muscle
CN X
Vagus nerve
To muscles of palate, pharynx, and larynx

2. Review the general plan for the sympathetic division of the autonomic nervous system. Describe the pathways for sympathetic fibers to the head and neck.

Sympathetics originate on the lateral horn of T1-L2 where they travel along the ventral root, go to a white ramus and ascend. Head and neck sympathetics typically come from the T1-T4 lateral horns. The fibers ascend to the cervical ganglion, typically the superior cervical ganglion where they synapse. The post ganglionic sympathetic then follows vasculature or named nerves until it reaches its target (sweat glands, papillary dilator muscle, etc).

3. Review the general plan for the organization of the parasympathetic division of the autonomic nervous system. What cranial nerves are associated with the parasympathetic division of the autonomic nervous system.

Cranial nerves may contain somatic efferent fibers (to skeletal muscle) or visceral efferent fibers (to smooth muscle and glands). Visceral efferent components are part of the parasympathetic division of the autonomic nervous system. Three of these ganglia are associated with branches of the trigeminal nerve (CN V) but do not arise from the trigeminal nerve. However, postganglionic fibers are distributed across branches of the maxillary and mandibular branches of the trigeminal nerve.

Cranial Nerves with Visceral Efferent Components
Cranial Nerve
Name
Efferent Target
CN III
Oculomotor Nerve
To sphincter pupillae and ciliary muscle
CN VII
Facial Nerve
To lacrimal gland, mucus membrane of the nose and palate, sublingual and submandibular glands
CN IX
Glossopharyngeal Nerve
To parotid gland
CN X
Vagus Nerve
To mucus membrane of the pharynx and larynx and muscles of thorax and upper GI tract

Cranial Nerve Autonomic Ganglia
Visceral afferents use a two chain system where a preganglion neuron in the CNS synapses to a postganglionic neuron in an autonomic ganglia.

Cranial Nerves and Associated Autonomic Ganglia
Cranial Nerve
Name
Autonomic Ganglia
CN III
Oculomotor Nerve
Ciliary ganglion
CN VII
Facial Nerve
Pterygopalatine ganglion and submandibular ganglion
CN IX
Glossopharyngeal Nerve
Otic ganglion
CN X
Vagus Nerve
Terminal ganglia in the wall of the organ

4. Diagram all the cranial nerves with a parasympathetic component. Identify the course of the preglanglionic and postganglionic fibers, as well as the location and the name of the ganglion associated with each nerve.

CN III – Oculomotor Nerve
Preganglionic parasympathic cell bodies residing in the CNS travel out along the oculomotor nerve through the superior orbital fissure and travel along the inferior division of the oculomotor nerve. It then gives off a parasympathetic root to the ciliary ganglion which travels to the ciliary ganglion located posterior to the eye. Preganglionic parasympathetic fibers synapse here and the postganglionic parasympathetic fibers travel out of the ciliary ganglion via short ciliary nerves to supply the papillary sphincter and ciliary muscles.

CN VII – Facial Nerve
The facial nerve has two associated parasympathetic ganglion.

Pterygopalatine Ganglion
Preganglionic parasympathetic cell bodies in the brain stem travel along the facial nerve through the internal auditory meatus where it reaches the geniculate ganglion. It continues through the geniculate ganglion along the greater petrosal nerve, exiting at the hiatus of the facial canal. At this point, postganglionic sympathetic nerve fibers traveling up from the deep etrosal nerve join the preganglionic parasympathetic fibers and form the nerve of the pterygoid canal as they transverse the pterygoid canal. After passing through the canal, the preganglionic parasympathetic fibers reach the pterygopalatine ganglion where they synapse. Postganglionic parasympathetic and sympathetic fibers then distribute along the maxillary branch of the trigeminal nerve.

Generally the parasympathetic fibers go to wherever there are mucus membranes while the sympathetic fibers go to the vasculature of the mucus glands, either travel with the parasympathetics or go along multiple different paths. Parasympathetics supply the glands of the nasal cavity, hard palate, and soft palate. It also gives off a communicating parasympathetic branch that joins the lacrimal nerve of the ophthalmic branch (CN V1) to supply the lacrimal gland.

Submandibular Ganglion
Preganglionic parasympathetic cell bodies in the brain stem travel along the facial nerve and pass through the internal auditory meatus into the geniculate ganglion where they take a right turn and enter the facial canal. As it travels the facial canal, it jumps off onto the chorda tympani. It continues with chorda tympani as the lingual nerve from the mandibular branch of trigeminal nerve joins it. Then the preganglionic parasympathetic fibers jump off at the submandibular ganglion and synapse. Postganglionic parasympathetic fibers then go to supply the submandibular gland the sublingual glands.

CN IX – Glossopharyngeal Nerve
Preganglion parasympathetic cell bodies in the brain stem travel out on the glossopharyngeal nerve through the jugular foramen and through the superior and inferior glossopharyngeal ganglion. It jumps off onto the tympanic branch and then to the lesser petrosal nerve where it continues until ire aches the otic ganglion. There the preganglionic parasympathetic fibers synapse and the postganglionic parasympathetic fibers go on to innervate the parotid gland.

CN X – Vagus Nerve
Preganglionic parasympathetic fibers in the CNS travel on the vagus nerve through the jugular foramen and through the superior and inferior jugular ganglion where they branch off to supply the mucosa of the pharynx, larynx, viscera of the neck, thorax, and abdomen via pharyngeal branch, superior laryngeal branch (external and internal divisions), recurrent laryngeal branch, superior and inferior cardiac branches, etc.

5. What role does the trigeminal nerve serve in the autonomic control of structures in the head and neck? Identify portions of the trigeminal nerve associated with the autonomic components of other cranial nerves.

Three of the cranial nerves have postganglionic parasympathetic components are associated with branches of the trigeminal nerve (CN V). However, these postganglionic parasympathetic fibers are distributed across branches of the trigeminal nerve and do not arise from the trigeminal nerve. The trigeminal nerve is basically like a highway on which postganglionic parasympathetic fibers from the facial (CN VII) and glossopharyngeal (CN IX) can travel along to reach their targets.

Lacrimal Gland (Maxillary Nerve, Lacrimal Nerve of Ophthalmic Nerve)
To reach the lacrimal gland, parasympathetic fibers must travel from the brain stem through the auditory meatus, geniculate ganglion, greater petrosal nerve, pterygoid canal and synapse at the pterygopalatine ganglion. There postganglionic fibers travel along branches of the maxillary nerve (CN V2), going up to the zygomatic branch, zygomaticotemporal branch and to a communicating branch of the zygomaticotemporal branch that joins with the lacrimal branch of the ophthalmic nerve (CN V1). It then travels along the lacrimal branch to reach the lacrimal gland.

Mucus Glands of the Nasal Cavity, Hard and Soft Palate (Maxillary Nerve)
To reach the mucus glands of the nasal cavity and palate, parasympathetic fibers must travel from the brain stem through the auditory meatus, geniculate ganglion, greater petrosal nerve, pterygoid canal and synapse at the pterygopalatine ganglion. There postganglionic fibers travel along branches of the maxillary nerve (CN V2), traveling along any branches that supply a mucus membrane: pharyngeal, nasal, nasal septum, greater and lesser palatine, anterior and posterior superior alveolar, and infraorbital branches.

Submandibular and Sublingual Glands (Lingual Nerve of Mandibular Nerve)
To reach the mucus submandibular and sublingual glands, parasympathetic fibers must travel from the brain stem through the auditory meatus, geniculate ganglion, facial canal, and chorda tympani. The chorda tympani joins with the lingual branch of the mandibular branch of the trigeminal nerve (CN V3). The parasympathetics continue on the lingual branch and jump off to synapse at the submandibular ganglion. Postganglionic parasympathetic fibers then either go to innervate the submandibular gland or jump back on the lingual branch, traveling to innervate the sublingual gland.

Parotid Gland (Auriculotemporal of Mandibular Nerve)
To reach the parotid gland, parasympathetic fibers must travel from the brain stem through the jugular foramen, superior and inferior glossopharyngeal ganglion, tympanic branch, lesser petrosal nerve and synapse in the otic ganglion. Postganglionic parasympathetic fibers then travel along the auriculotemporal branch of the mandibular branch of the trigeminal nerve (CN V3) and jump off to innervate the parotid gland.