Cranial Nerves

Brief Overview.

 There are 12 pairs of cranial nerves that control much of the motor and sensory functions
of the head and neck.
 Cranial nerves emerge directly from the brain, relaying information between the brain
and other parts of the body.
 Each cranial nerve is paired and is present on both sides. The numbering of the cranial
nerves is based on the order in which they emerge from the brain, front to back
(brainstem).
 The terminal nerves, olfactory nerves (I) and optic nerves (II) emerge from the cerebrum
or forebrain, and the remaining ten pairs arise from the brainstem, which is the lower part
of the brain.

The locations of the cranial nerves within the brain.

1. The olfactory nerve (I): This is instrumental for the sense of smell, it is one of the few
nerves that are capable of regeneration.
2. The optic nerve (II): This nerve carries visual information from the retina of the eye to
the brain.
3. The oculomotor nerve (III): This controls most of the eye’s movements, the constriction
of the pupil, and maintains an open eyelid.
4. The trochlear nerve (IV): A motor nerve that innervates the superior oblique muscle of
the eye, which controls rotational movement.
5. The trigeminal nerve (V): This is responsible for sensation and motor function in the face
and mouth.
6. The abducens nerve (VI): A motor nerve that innervates the lateral rectus muscle of the
eye, which controls lateral movement.
7. The facial nerve (VII): This controls the muscles of facial expression, and functions in
the conveyance of taste sensations from the anterior two-thirds of the tongue and oral
cavity.
8. The vestibulocochlear nerve (VIII): This is responsible for transmitting sound and
equilibrium (balance) information from the inner ear to the brain.
9. The glossopharyngeal nerve (IX): This nerve receives sensory information from the
tonsils, the pharynx, the middle ear, and the rest of the tongue.
10. The vagus nerve (X): This is responsible for many tasks, including heart rate,
gastrointestinal peristalsis, sweating, and muscle movements in the mouth, including
speech and keeping the larynx open for breathing.
11. The spinal accessory (XI): This nerve controls specific muscles of the shoulder and neck.
12. The hypoglossal nerve (XII): This nerve controls the tongue movements of speech, food
manipulation, and swallowing.

There are many mnemonic devices to remember the cranial nerves. One that may be helpful is:
Old Opie Occasionally Tries Trigonometry and Feels Very Gloomy, Vague and Hypoactive.
Olfactory (I) Nerve

The olfactory nerve, or cranial nerve I, is the first of 12 cranial nerves and is responsible for the
sense of smell.

Olfactory bulb: Sagittal section of human head showing the olfactory bulb.

The olfactory nerve, or cranial nerve I, is the first of the 12 cranial nerves. It is instrumental in
the sense of smell. The olfactory nerve is the shortest of the 12 cranial nerves and only one of
two cranial nerves (the other being the optic nerve) that do not join with the brainstem.

The specialized olfactory receptor neurons of the olfactory nerve are located in the olfactory
mucosa of the upper parts of the nasal cavity. The olfactory nerves consist of a collection of
many sensory nerve fibers that extend from the olfactory epithelium to the olfactory bulb,
passing through the many openings of the cribriform plate of the ethmoid bone.

Olfactory receptor neurons continue to emerge throughout life and extend new axons to the
olfactory bulb. Olfactory-ensheathing glia wrap bundles of these axons and are thought to
facilitate their passage into the central nervous system.

The sense of smell (olfaction) arises from the stimulation of olfactory (or odorant) receptors by
small molecules of different spatial, chemical, and electrical properties that pass over the nasal
epithelium in the nasal cavity during inhalation. These interactions are transduced into electrical
activity in the olfactory bulb, which then transmits the electrical activity to other parts of the
olfactory system and the rest of the central nervous system via the olfactory tract.

Optic (II) Nerve

The optic nerve (cranial nerve II) receives visual information from photoreceptors in the retina
and transmits it to the brain.

Learning Objectives
Describe the optic nerve (cranial nerve II)

Key Takeaways

Key Points

 The optic nerve is considered part of the central nervous system. The myelin on the optic
nerve is produced by oligodendrocytes rather than Schwann cells and it is encased in the
meningeal layers instead of the standard endoneurium, perineurium, and epineurium of
the peripheral nervous system.
 The optic nerve travels through the optic canal, partially decussates in the optic chiasm,
and terminates in the lateral geniculate nucleus where information is transmitted to the
visual cortex.
 The axons responsible for reflexive eye movements terminate in the pretectal nucleus.

Key Terms

 oligodendrocyte: A type of neuroglia that provides support and insulation to axons in the
central nervous system.
 retina: The thin layer of cells at the back of the eyeball where light is converted into
neural signals sent to the brain.
 optic nerve: Either of a pair of nerves that carry visual information from the retina to the
brain.
 visual cortex: The visual cortex of the brain is the part of the cerebral cortex responsible
for processing visual information. It is located in the occipital lobe, in the back of the
brain.
 pretectal nucleus: This mediates behavioral responses to acute changes in ambient light,
such as the pupillary light reflex and the optokinetic reflex.

The optic nerve is also known as cranial nerve II. It transmits visual information from the retina
to the brain.

Each human optic nerve contains between 770,000 and 1.7 million nerve fibers. The eye’s blind
spot is a result of the absence of photoreceptors in the area of the retina where the optic nerve
leaves the eye.
Optic nerve: An illustration of the brain highlighting the optic nerve and optic tract.

The optic nerve is the second of twelve paired cranial nerves. It is considered by physiologists to
be part of the central nervous system, as it is derived from an outpouching of the diencephalon
during embryonic development.

As a consequence, the fibers are covered with myelin produced by oligodendrocytes, rather than
Schwann cells that are found in the peripheral nervous system. The optic nerve is ensheathed in
all three meningeal layers (dura, arachnoid, and pia mater) rather than the epineurium,
perineurium, and endoneurium found in the peripheral nerves.

The fiber tracks of the mammalian central nervous system are incapable of regeneration. As a
consequence, optic nerve damage produces irreversible blindness.

The optic nerve leaves the orbit, which is also known as an eye socket, via the optic canal,
running posteromedially toward the optic chiasm, where there is a partial decussation (crossing)
of fibers from the nasal visual fields of both eyes.
Most of the axons of the optic nerve terminate in the lateral geniculate nucleus (where
information is relayed to the visual cortex), while other axons terminate in the pretectal nucleus
and are involved in reflexive eye movements.

The optic nerve transmits all visual information including brightness perception, color
perception, and contrast. It also conducts the visual impulses that are responsible for two
important neurological reflexes: the light reflex and the accommodation reflex.

The light reflex refers to the constriction of both pupils that occurs when light is shone into either
eye; the accommodation reflex refers to the swelling of the lens of the eye that occurs when one
looks at a near object, as in reading.

Oculomotor (III) Nerve

The oculomoter nerve (cranial nerve III) controls eye movement, such as constriction of the
pupil and open eyelids.

Learning Objectives

Describe the oculomotor nerve (cranial nerve III)

Key Takeaways

Key Points

 The oculomotor nerve is the third paired cranial nerve.

 The oculomotor nerve contains two nuclei, including the Edinger-Westphal nucleus that
supplies parasympathetic nerve fibers to the eye to control pupil constriction and
accommodation.
 The oculomotor nerve originates at the superior colliculus and enters through the superior
orbital fissure to control the levator palpebrae superioris muscles that hold the eyelids
open.

Key Terms

 levator palpebrae superioris: A muscle that elevates the upper eyelid.

 superior colliculus: The primary integrating center for eye movements.
 cavernous sinus: A venous channel found between layers of dura mater in the brain.
 tentorium cerebelli: An extension of the dura mater that separates the cerebellum from
the inferior portion of the occipital lobes.
 superior orbital fissure: The superior orbital fissure is a foramen in the skull, although
strictly it is more of a cleft, lying between the lesser and greater wings of the sphenoid
bone.
 plexus: A network or interwoven mass, especially of nerves, blood vessels, or lymphatic
vessels.
The oculomotor nerve is the third paired cranial nerve. It enters the orbit via the superior orbital
fissure and controls most of the eye’s movements, including constriction of the pupil and
maintaining an open eyelid by innervating the levator palpebrae superiors muscle.

The occulomotor nerve is derived from the basal plate of the embryonic midbrain. Cranial nerves
IV and VI also participate in control of eye movement.

There are two nuclei for the oculomotor nerve:

1. The oculomotor nucleus originates at the level of the superior colliculus. The muscles it
controls are the striated muscle in the levator palpebrae superioris and all extraocular
muscles, except for the superior oblique muscle and the lateral rectus muscle.
2. The Edinger-Westphal nucleus supplies parasympathetic fibers to the eye via the ciliary
ganglion, and controls the pupillae muscle (affecting pupil constriction) and the ciliary
muscle (affecting accommodation).

Sympathetic postganglionic fibers also join the nerve from the plexus on the internal carotid
artery in the wall of the cavernous sinus and are distributed through the nerve, for example, to
the smooth muscle of levator palpebrae superioris.

Emergence from Brain

On emerging from the brain, the oculomotor nerve is invested with a sheath of pia mater and
enclosed in a prolongation from the arachnoid mater. It passes between the superior cerebellar
and posterior cerebral arteries, and then pierces the dura mater anterior and lateral to the
posterior clinoid process (to give attachment to the tectorium cerebella), passing between the free
and attached borders of the tentorium cerebelli.

It then runs along the lateral wall of the cavernous sinus, above the other orbital nerves, receiving
in its course one or two filaments from the cavernous plexus of the sympathetic nervous system,
and a communicating branch from the ophthalmic division of the trigeminal nerve.

It then divides into two branches that enter the orbit through the superior orbital fissure, between
the two heads of the lateral rectus (a muscle on the lateral side of the eyeball in the orbit). Here
the nerve is placed below the trochlear nerve and the frontal and lacrimal branches of the
ophthalmic nerve, while the nasociliary nerve is placed between its two rami (the superior and
inferior branch of oculomotor nerve).
Cranial nerves: Image of cranial nerves showing the position of the oculomotor nerve.

Trochlear (IV) Nerve

The trochlear nerve (cranial nerve IV) is a motor nerve that innervates a single muscle: the
superior oblique muscle of the eye.

Learning Objectives

Describe the trochlear nerve (cranial nerve IV)

Key Takeaways

Key Points

 The trochlear nerve innervates the superior oblique muscle of the eye.
  The trochlear nerve contains the smallest number of axons of all the cranial nerves and
has the greatest intracranial length.
 The two major clinical syndromes that can arise from damage to the trochlear nerve are
vertical and torsional diplopia.

Key Terms

 contralateral: On the opposite side of the body.

 cerebral aqueduct: The channel in the brain that connects the third ventricle to the
fourth ventricle. Also called the aqueduct of Sylvius, it is surrounded by periaqueductal
gray matter.

The trochlear nerve (cranial nerve IV) is a motor nerve that innervates a single muscle: the
superior oblique muscle of the eye.

The trochlear nerve: The trocheal nerve and where it innervates.

The trochlear nerve is unique among the cranial nerves in several respects.

 It is the smallest nerve in terms of the number of axons it contains and it has the greatest
intracranial length.
 Other than the optic nerve (cranial nerve II), it is the only cranial nerve that decussates
(crosses to the other side) before innervating its target.
 It is the only cranial nerve that exits from the dorsal aspect of the brainstem.

The nucleus of the trochlear nerve is located in the caudal mesencephalon beneath the cerebral
aqueduct. It is immediately below the nucleus of the oculomotor nerve (III) in the rostral
mesencephalon.

The trochlear nucleus is unique in that its axons run dorsally and cross the midline before
emerging from the brainstem—so a lesion of the trochlear nucleus affects the contralateral eye.
Lesions of all other cranial nuclei affect the ipsilateral side (except of course the optic nerve,
cranial nerve II, which innervates both eyes).

Homologous trochlear nerves are found in all jawed vertebrates. The unique features of the
trochlear nerve, including its dorsal exit from the brainstem and its contralateral innervation, are
seen in the primitive brains of sharks.

The human trochlear nerve is derived from the basal plate of the embryonic midbrain.

Clinical Syndromes

There are two major clinical syndromes that can manifest through damage to the trochlear nerve:

 Vertical diplopia: Injury to the trochlear nerve causes weakness of downward eye
movement with consequent vertical diplopia (double vision).
 Torsional diplopia: Weakness of intorsion results in torsional diplopia, in which two
different visual fields, tilted with respect to each other, are seen at the same time. To
compensate for this, patients with trochlear nerve palsies tilt their heads to the opposite
side, in order to fuse the two images into a single visual field.

The clinical syndromes can originate from both peripheral and central lesions. A peripheral
lesion is damage to the bundle of nerves, in contrast to a central lesion, which is damage to the
trochlear nucleus.

Trigeminal (V) Nerve

The trigeminal nerve is the fifth cranial nerve and it is responsible for sensation and motor
function in the face and mouth.

Learning Objectives

Describe the trigeminal nerve (cranial nerve V)

Key Takeaways

Key Points

 The sensory function of the trigeminal nerve is to provide tactile, motion, position, and
pain sensations for the face and mouth; its motor function activates the muscles of the
jaw, mouth, and inner ear.
 The trigeminal nerve has three major branches on each side—the opthalmic nerve,
maxillary nerve, and mandibular nerve—that converge on the trigeminal ganglion.
 The trigeminal ganglion is analogous to the dorsal root ganglia of the spinal cord, which
contain the cell bodies of incoming sensory fibers from the rest of the body.

Key Terms

 trigeminal ganglion: The trigeminal ganglion (also called the Gasserian ganglion,
semilunar ganglion, or Gasser’s ganglion) is a sensory ganglion of the trigeminal nerve
(cranial nerve V) that occupies a cavity (Meckel’s cave) in the dura mater, covering the
trigeminal impression near the apex of the petrous part of the temporal bone.
 trigeminal nerve: The nerve responsible for sensation and motor function in the face and
mouth.

The trigeminal nerve (cranial nerve V), and it contains both sensory and motor fibers. It is
responsible for sensation in the face and certain motor functions such as biting, chewing, and
swallowing.
Trigeminal nerve: Schematic illustration of the trigeminal nerve (labeled Sensory root above)
and the structures it innervates in the face and mouth.

The sensory function of the trigeminal nerve is to provide the tactile, motion, position, and pain
sensations of the face and mouth. The motor function activates the muscles of the jaw, mouth,
and inner ear.

Structure

The trigeminal nerve is the largest of the cranial nerves. Its name, trigeminal, means three twins.
It is derived from the fact that each nerve, one on each side of the pons, has three major
branches: the ophthalmic nerve (V1 in the illustration below), the maxillary nerve (V2), and the
mandibular nerve (V3).

The ophthalmic and maxillary nerves are purely sensory. The mandibular nerve has both sensory
and motor functions.

The three branches converge on the trigeminal ganglion that is located within the trigeminal cave
in the brain; it contains the cell bodies of incoming sensory nerve fibers. The trigeminal ganglion
is analogous to the dorsal root ganglia of the spinal cord, which contain the cell bodies of
incoming sensory fibers from the rest of the body.

Areas of the face innervated by the trigeminal nerve: The ophthalmic nerve branch (V1)
innervates the bright red area, the maxillary nerve branch (V2) innervates the light red area, and
the mandibular nerve branch (V3) innervates the yellow area.

From the trigeminal ganglion, a single large sensory root enters the brainstem at the level of the
pons. Immediately adjacent to the sensory root, a smaller motor root emerges from the pons at
the same level.

Motor fibers pass through the trigeminal ganglion on their way to peripheral muscles, but their
cell bodies are located in the nucleus of the trigeminal nerve, deep within the pons.

Function

The sensory function of the trigeminal nerve is to provide tactile, proprioceptive, and nociceptive
afferents to the face and mouth. The motor component of the mandibular division (V3) of the
trigeminal nerve controls the movement of eight muscles, including the four muscles of
mastication: the masseter, the temporal, and the medial and lateral pterygoids.

The other four muscles are the tensor veli palatini, the mylohyoid, the anterior belly of the
digastric, and the tensor tympani. With the exception of the tensor tympani, all of these muscles
are involved in biting, chewing and swallowing, and all have bilateral cortical representation.
Abducens (VI) Nerve
The abducens nerve (cranial nerve VI) controls the lateral movement of the eye through
innervation of the lateral rectus muscle.

Learning Objectives

Describe the abducens nerve (cranial nerve VI)

Key Takeaways

Key Points

 The abducens nerve exits the brainstem at the junction of the pons and the medulla and
runs upward to reach the eye, traveling between the dura and the skull.
 The long course of the abducens nerve between the brainstem and the eye makes it
vulnerable to injury at many levels.
 In most mammals besides humans, it also innervates the musculus retractor bulbi, which
can retract the eye for protection.

Key Terms

 abducens nerve: A nerve that controls the lateral rectus muscle in the eye.
 clivus: A part of the cranium at the base of the skull. It forms a gradual sloping process at
the anterior-most portion of the basilar occipital bone at its junction with the sphenoid
bone.
 petrous temporal bone: A pyramid-shaped bone that is wedged in at the base of the
skull between the sphenoid and occipital bones and is part of the endocranium.
 lateral rectus muscle: A muscle in the orbit. It is one of six extraocular muscles that
control the movements of the eye (abduction in this case) and the only muscle innervated
by the abducens nerve, cranial nerve VI, functioning to bring the pupil away from the
midline of the body.

The abducens nerve (cranial nerve VI) is a somatic efferent nerve that, in humans, controls the
movement of a single muscle: the lateral rectus muscle of the eye that moves the eye
horizontally. In most other mammals it also innervates the musculus retractor bulbi, which can
retract the eye for protection. Homologous abducens nerves are found in all vertebrates except
lampreys and hagfishes.
Abducens nerve: Schematic of cranial nerves showing cranial nerve VI, the abducens nerve.

The abducens nerve leaves the brainstem at the junction of the pons and the medulla, medial to
the facial nerve. In order to reach the eye, it runs upward (superiorly) and then bends forward
(anteriorly).

The nerve enters the subarachnoid space when it emerges from the brainstem. It runs upward
between the pons and the clivus, and then pierces the dura mater to run between the dura and the
skull.

At the tip of the petrous temporal bone, it makes a sharp turn forward to enter the cavernous
sinus. In the cavernous sinus it runs alongside the internal carotid artery. It then enters the orbit
through the superior orbital fissure and innervates the lateral rectus muscle of the eye.

The long course of the abducens nerve between the brainstem and the eye makes it vulnerable to
injury at many levels. For example, fractures of the petrous temporal bone can selectively
damage the nerve, as can aneurysms of the intracavernous carotid artery.
Mass lesions that push the brainstem downward can damage the nerve by stretching it between
the point where it emerges from the pons and the point where it hooks over the petrous temporal
bone.

Facial (VII) Nerve

The facial nerve (cranial nerve VII) determines facial expressions and the taste sensations of the
tongue.

Learning Objectives

Describe the facial nerve (cranial nerve VII)

Key Takeaways

Key Points

 The facial nerve (cranial nerve VII) is responsible for the muscles that determine facial
expression, as well as the sensation of taste in the front of the tongue and oral cavity.
 The facial nerve’s motor component begins in the facial nerve nucleus in the pons, and
the sensory component begins in the nervus intermedius. The nerve then runs through the
facial canal, passes through the parotid gland, and divides into five branches.
 Voluntary facial movements, such as wrinkling the brow, showing teeth, frowning,
closing the eyes tightly (inability to do so is called lagophthalmos), pursing the lips, and
puffing out the cheeks, all test the facial nerve.

Key Terms

 nervus intermedius: A part of the facial nerve (cranial nerve VII) located between the
motor component of the facial nerve and the vestibulocochlear nerve (cranial nerve VIII).
It contains the sensory and parasympathetic fibers of the facial nerve.
 Bell’s Palsy: Bell’s palsy is a form of facial paralysis resulting from a dysfunction of the
cranial nerve VII (the facial nerve) that results in the inability to control facial muscles on
the affected side.
The facial nerve: Illustration of the facial nerve and its branches.

The facial nerve is the seventh (cranial nerve VII) of the 12, paired cranial nerves. It emerges
from the brainstem between the pons and the medulla and controls the muscles of facial
expression.

It also functions in the conveyance of taste sensations from the anterior two-thirds of the tongue
and oral cavity, and it supplies preganglionic parasympathetic fibers to several head and neck
ganglia.

Location

The motor part of the facial nerve arises from the facial nerve nucleus in the pons, while the
sensory part of the facial nerve arises from the nervus intermedius. The motor and sensory parts
of the facial nerve enter the petrous temporal bone into the internal auditory meatus (intimately
close to the inner ear), then runs a tortuous course (including two tight turns) through the facial
canal, emerges from the stylomastoid foramen, and passes through the parotid gland, where it
divides into five major branches.
Although it passes through the parotid gland, it does not innervate the gland (this is the
responsibility of cranial nerve IX, the glossopharyngeal nerve). The facial nerve forms the
geniculate ganglion prior to entering the facial canal.

The path of the facial nerve can be divided into six segments.

1. The intracranial (cisternal) segment.

2. The meatal segment (brainstem to internal auditory canal).
3. The labyrinthine segment (internal auditory canal to geniculate ganglion),
4. The tympanic segment (from geniculate ganglion to pyramidal eminence).
5. The mastoid segment (from pyramidal eminence to stylomastoid foramen).
6. The extratemporal segment (from stylomastoid foramen to post parotid branches).

Function

Bell’s Palsy: A person attempting to show his teeth and raise his eyebrows with Bell’s palsy on
his right side (left side of the image).

Voluntary facial movements, such as wrinkling the brow, showing teeth, frowning, closing the
eyes tightly (inability to do so is called lagophthalmos), pursing the lips, and puffing out the
cheeks, all test the facial nerve. There should be no noticeable asymmetry.
In an upper motor neuron lesion, called central seven (central facial palsy ), only the lower part
of the face on the contralateral side will be affected due to the bilateral control to the upper facial
muscles (frontalis and orbicularis oculi).

Lower motor neuron lesions can result in a cranial nerve VII palsy (Bell’s palsy is the idiopathic
form of facial nerve palsy), manifested as both upper and lower facial weakness on the same side
of the lesion.

Taste can be tested on the anterior 2/3 of the tongue. This can be tested with a swab dipped in a
flavored solution, or with electronic stimulation (similar to putting your tongue on a battery).

In regards to the corneal reflex, the afferent arc is mediated by the general sensory afferents of
the trigeminal nerve. The efferent arc occurs via the facial nerve.

The reflex involves the consensual blinking of both eyes in response to stimulation of one eye.
This is due to the facial nerve’s innervation of the muscles of facial expression, namely the
orbicularis oculi, responsible for blinking. Thus, the corneal reflex effectively tests the proper
functioning of both cranial nerves V and VII.

Vestibulocochlear (VIII) Nerve

The vestibulocochlear nerve (cranial nerve VIII) carries information about hearing and balance.

Learning Objectives

Describe the vestibulocochlear nerve (cranial nerve VIII)

Key Takeaways

Key Points

 The vestibulocochlear nerve comprises the cochlear nerve that transmits hearing
information, and the vestibular nerve that transmits balance information.
 The cochlear nerve travels away from the cochlea of the inner ear where it starts as the
spiral ganglia.
 The vestibular nerve travels from the vestibular system of the inner ear.

Key Terms

 cochlear nerve: A sensory nerve that conducts information about the environment to the
brain, in this case acoustic energy impinging on the tympanic membrane (sound waves
reaching the ear drum). The cochlear nerve arises from within the cochlea and extends to
the brainstem where its fibers make contact with the cochlear nucleus, the next stage of
neural processing in the auditory system.
  vestibulocochlear nerve: Also known as the auditory vestibular nerve, this is the eighth
of twelve cranial nerves, and it is responsible for transmitting sound and equilibrium
(balance) information from the inner ear to the brain.
 vestibular nerve: One of the two branches of the vestibulocochlear nerve (the cochlear
nerve being the other). It connects to the semicircular canals via the vestibular ganglion
and receives positional information.

The vestibulocochlear nerve (also known as the auditory vestibular nerve and cranial nerve VIII)
has axons that carry the modalities of hearing and equilibrium.

It consists of the cochlear nerve that carries information about hearing, and the vestibular nerve
that carries information about balance.

This is the nerve along which the sensory cells (the hair cells) of the inner ear transmit
information to the brain. It emerges from the pons and exits the inner skull via the internal
acoustic meatus (or internal auditory meatus) in the temporal bone.

Vestibular system’s semicircular canal: An illustration of the inner ear showing its
semicircular canal, hair cells, ampulla, cupula, vestibular nerve, and fluid.

The vestibulocochlear nerve consists mostly of bipolar neurons and splits into two large
divisions: the cochlear nerve and the vestibular nerve. The cochlear nerve travels away from the
cochlea of the inner ear where it starts as the spiral ganglia.

Processes from the organ of Corti (the receptor organ for hearing) conduct afferent transmission
to the spiral ganglia. It is the inner hair cells of the organ of Corti that are responsible for
activating the afferent receptors in response to pressure waves reaching the basilar membrane
through the transduction of sound.
The vestibular nerve travels from the vestibular system of the inner ear. The vestibular ganglion
houses the cell bodies of the bipolar neurons and extends processes to five sensory organs.

Three of these are the cristae, located in the ampullae of the semicircular canals. Hair cells of the
cristae activate afferent receptors in response to rotational acceleration.

The other two sensory organs supplied by the vestibular neurons are the maculae of the saccule
and utricle. Hair cells of the maculae activate afferent receptors in response to linear
acceleration.

The vestibulocochlear nerve has axons that carry the modalities of hearing and equilibrium.
Damage to the vestibulocochlear nerve may cause hearing loss, vertigo, a false sense of motion,
loss of equilibrium in dark places, nystagmus, motion sickness, and gaze-evoked tinnitus.

A benign primary intracranial tumor of vestibulocochlear nerve is called a vestibular

schwannoma (also called acoustic neuroma).

Glossopharyngeal (IX) Nerve

The glossopharyngeal nerve (cranial nerve IX) serves many distinct functions,
including providing sensory innervation to various head and neck structures.

Learning Objectives

Describe the glossopharyngeal nerve (cranial nerve IX)

Key Takeaways

Key Points

 The glossopharyngeal nerve (cranial nerve IX) is responsible for swallowing and the gag
reflex, along with other functions.
 The glossopharyngeal nerve receives input from the general and special sensory fibers in
the back of the throat.
 The glossopharyngeal nerve has five components: branchial motor, visceral motor,
visceral sensory, general sensory, and special sensory components.

Key Terms

 otic ganglion: A small parasympathetic ganglion located immediately below the foramen
ovale in the infratemporal fossa that is associated with the glossopharyngeal nerve.
 medulla: The lower half of the brainstem that contains the cardiac, respiratory, vomiting,
and vasomotor centers and is associated with autonomic, involuntary functions such as
breathing, heart rate, and blood pressure.
 stylopharyngeus muscle: A muscle in the head that stretches between the temporal
styloid process and the pharynx.
Structure

The glossopharyngeal nerve is the ninth of 12 pairs of cranial nerves. It exits the brainstem out
from the sides of the upper medulla, just rostral (closer to the nose) to the vagus nerve.

Glossopharyngeal nerve: Image of head structures including the glossopharyngeal nerve.

The motor division of the glossopharyngeal nerve is derived from the basal plate of the
embryonic medulla oblongata, while the sensory division originates from the cranial neural crest.

Function

There are a number of functions of the glossopharyngeal nerve. It controls muscles in the oral
cavity and upper throat, as well as part of the sense of taste and the production of saliva.

Along with taste, the glossopharyngeal nerve relays general sensations from the pharyngeal
walls. The various functions of the glossopharyngeal nerve are that:

 It receives general sensory fibers (ventral trigeminothalamic tract) from the tonsils, the
pharynx, the middle ear, and the posterior 1/3 of the tongue.
 It receives special sensory fibers (taste) from the posterior 1/3 of the tongue.
  It receives visceral sensory fibers from the carotid bodies, carotid sinus.
 It supplies parasympathetic fibers to the parotid gland via the otic ganglion.
 It supplies motor fibers to the stylopharyngeus muscle.
 It contributes to the pharyngeal plexus.

Five Functional Components

The glossopharyngeal nerve consists of five components with distinct functions:

1. Branchial motor (special visceral efferent): Supplies the stylopharyngeus muscle.

2. Visceral motor (general visceral efferent): Provides parasympathetic innervation of the
parotid gland.
3. Visceral sensory (general visceral afferent): Carries visceral sensory information from the
carotid sinus and body.
4. General sensory (general somatic afferent): Provides general sensory information from
the skin of the external ear, internal surface of the tympanic membrane, upper pharynx,
and the posterior 1/3 of the tongue.
5. Special sensory (special afferent): Provides taste sensation from the posterior 1/3 of the
tongue.

Vagus (X) Nerve

The vagus nerve (cranial nerve X) is responsible for parasympathetic output to the heart and
visceral organs.

Learning Objectives

Describe the vagus nerve (cranial nerve X)

Key Takeaways

Key Points

 The vagus nerve (cranial nerve X) sends information about the body’s organs to the brain
and carries some motor information back to the organs.
 The vagus nerve has axons that originate from or enter the dorsal nucleus of the vagus
nerve, the nucleus ambiguus, the solitary nucleus in the medulla, and the spinal
trigeminal nucleus.
 The vagus nerve is responsible for heart rate, gastrointestinal peristalsis, and sweating, to
name a few.

Key Terms
  nucleus ambiguus: A region of histologically disparate cells located just dorsal
(posterior) to the inferior olivary nucleus in the lateral portion of the upper (rostral)
medulla. It receives upper motor neuron innervation directly via the corticobulbar tract.
 Valsalva maneuver: Performed by making a moderately forceful attempt to exhale
against a closed airway; this is usually done by closing one’s mouth and pinching one’s
nose shut while pressing out as if blowing up a balloon.
 solitary nucleus: Structures in the brainstem that carry and receive visceral sensation and
taste from the facial (VII), glossopharyngeal (IX), and vagus (X) cranial nerves.
 dorsal nucleus of the vagus nerve: Also called the posterior motor nucleus of vagus,
this is a cranial nerve nucleus for the vagus nerve in the medulla that lies under the floor
of the fourth ventricle. It mostly serves parasympathetic vagal functions in the
gastrointestinal tract, lungs, and other thoracic and abdominal vagal innervations.
 spinal trigeminal nucleus: A nucleus in the medulla that receives information about
deep/crude touch, pain, and temperature from the ipsilateral face.

Vagus Nerve Anatomy

The vagus nerve, also known as the pneumogastric nerve or cranial nerve X, is the tenth of
twelve paired cranial nerves. Upon leaving the medulla between the medullary pyramid and the
inferior cerebellar peduncle, it extends through the jugular foramen, then passes into the carotid
sheath between the internal carotid artery and the internal jugular vein below the head, to the
neck, chest and abdomen, where it contributes to the innervation of the viscera.
Vagus nerve: Diagram demonstrating the course of the vagus nerve.

Besides output to the various organs in the body, the vagus nerve conveys sensory information
about the state of the body’s organs to the central nervous system. Eighty to 90% of the nerve
fibers in the vagus nerve are afferent (sensory) nerves that communicate the state of the viscera
to the brain.

The vagus nerve includes axons that emerge from or converge onto four nuclei of the medulla.

 The dorsal nucleus of vagus nerve: Sends parasympathetic output to the viscera,
especially the intestines.
 The nucleus ambiguus: Sends parasympathetic output to the heart (slowing it down).
 The solitary nucleus: Receives afferent taste information and primary afferents from
visceral organs.
 The spinal trigeminal nucleus: Receives information about deep/crude touch, pain, and
temperature of the outer ear, the dura of the posterior cranial fossa, and the mucosa of the
larynx.
Function

The vagus nerve supplies motor parasympathetic fibers to all the organs, except the suprarenal
(adrenal) glands, from the neck down to the second segment of the transverse colon. The vagus
also controls a few skeletal muscles, most notably:

 Cricothyroid muscle.
 Levator veli palatini muscle.
 Salpingopharyngeus muscle.
 Palatoglossus muscle.
 Palatopharyngeus muscle.
 Superior, middle, and inferior pharyngeal constrictors.
 Muscles of the larynx (speech).

This means that the vagus nerve is responsible for such varied tasks as heart rate, gastrointestinal
peristalsis, sweating, and quite a few muscle movements in the mouth, including speech (via the
recurrent laryngeal nerve), swallowing, and keeping the larynx open for breathing (via action of
the posterior cricoarytenoid muscle, the only abductor of the vocal folds).

It also has some afferent fibers that innervate the inner (canal) portion of the outer ear, via the
auricular branch (also known as Alderman’s nerve) and part of the meninges. This explains why
a person may cough when tickled on the ear (such as when trying to remove ear wax with a
cotton swab).

Afferent vagus nerve fibers that innervate the pharynx and back of the throat are responsible for
the gag reflex. In addition, 5-HT3 receptor-mediated afferent vagus stimulation in the gut due to
gastroenteritis and other insults is a cause of vomiting.

Cardiovascular Influence

Parasympathetic innervation of the heart is partially controlled by the vagus nerve and is shared
by the thoracic ganglia. Activation of the vagus nerve typically leads to a reduction in heart rate
and/or blood pressure.

This occurs commonly in cases of viral gastroenteritis, acute cholecystitis, or in response to

stimuli such as the Valsalva maneuver or pain. Excessive activation of the vagal nerve during
emotional stress can also cause vasovagal syncope due to a sudden drop in cardiac output,
causing cerebral hypoperfusion.

Accessory (XI) Nerve

The accessory nerve (cranial nerve XI) controls the muscles of the shoulder and neck.

Learning Objectives
Describe the accessory nerve (cranial nerve XI)

Key Takeaways

Key Points

 Cranial nerve XI is responsible for tilting and rotating the head, elevating the shoulders,
and adducting the scapula.
 Most of the fibers of the accessory nerve originate in neurons situated in the upper spinal
cord. The fibers that make up the accessory nerve enter the skull through the foramen
magnum and proceed to exit the jugular foramen with cranial nerves IX and X.
 Due to its unusual course, the accessory nerve is the only nerve that enters and exits the
skull.

Key Terms

 sternocleidomastoid: A paired muscle in the superficial layers of the side of the neck. Its
actions of the muscle are rotation of the head to the opposite side and flexion of the neck.
 trapezius: A large vertebrate skeletal muscle divided into an ascending, descending, and
transverse portion, attaching the neck and central spine to the outer extremity of the
scapula; it functions in scapular elevation, adduction, and depression.
 accessory nerve: The 11th cranial nerve of higher vertebrates, it controls the pharynx and
the muscles of the upper chest and shoulders.
 foramen: An opening, an orifice, or a short passage.

Anatomic Description

The accessory nerve (cranial nerve XI) controls the sternocleidomastoid and trapezius muscles of
the shoulder and neck. It begins in the central nervous system (CNS) and exits the cranium
through a foramen.

Unlike the other 11 cranial nerves, the accessory nerve begins outside the skull. In fact, most of
the fibers of the nerve originate in neurons situated in the upper spinal cord.
The accessory nerve: Upon exiting the skull via the jugular foramen, the spinal accessory nerve
pierces the sternocleidomastoid muscle before terminating on the trapezius muscle.

The fibers that make up the accessory nerve enter the skull through the foramen magnum and
proceed to exit the jugular foramen with cranial nerves IX and X. Due to its unusual course, the
accessory nerve is the only nerve that enters and exits the skull.

Traditional descriptions of the accessory nerve divide it into two components: a spinal
component and a cranial component. However, more modern characterizations of the nerve
regard the cranial component as separate and part of the vagus nerve.

Therefore, in contemporary discussions of the accessory nerve, it is common to disregard the

cranial component when referencing the accessory nerve and assume reference to the spinal
accessory nerve.
Accessory Nerve Function

The accessory nerve provides motor innervation from the CNS to the sternocleidomastoid and
trapezius muscles of the neck. The sternocleidomastoid muscle tilts and rotates the head, while
the trapezius muscle has several actions on the scapula, including shoulder elevation and
adduction of the scapula.

During neurological examinations, the function of the spinal accessory nerve is often measured
by testing the range of motion and strength of the aforementioned muscles. Limited range of
motion or diminished muscle strength often indicates injury of the accessory nerve.

Patients with spinal accessory nerve palsy may exhibit signs of lower motor neuron disease, such
as atrophy and fasciculations of both the sternocleidomastoid and trapezius muscles.

Hypoglossal (XII) Nerve

The hypoglossal nerve (cranial nerve XII) controls the muscles of the tongue.

Learning Objectives

Describe the hypoglossal nerve (cranial nerve XII)

Key Takeaways

Key Points

 It controls tongue movements of speech, food manipulation, and swallowing.

 While the hypoglossal nerve controls the tongue’s involuntary activities of swallowing to
clear the mouth of saliva, most of the functions it controls are voluntary, meaning that the
execution of these activities requires conscious thought.
 Proper function of the hypoglossal nerve is important for executing tongue movements
associated with speech. Many languages require specific uses of the nerve to create
unique speech sounds, which may contribute to the difficulties some adults encounter
when learning a new language.

Key Terms

 digastric muscle: A small muscle located under the jaw.

 hypoglossal nerve: The twelfth cranial nerve (XII) controls the muscles of the tongue.
 olivary body: Located on the anterior surface of the medulla, lateral to the pyramid.
 medullary pyramid: Paired white matter structures of the brainstem’s medulla oblongata
that contain motor fibers of the corticospinal and corticobulbar tracts.

Structure and Location

The hypoglossal nerve is the twelfth cranial nerve (XII) and innervates all extrinsic and intrinsic
muscles of the tongue, except for the palatoglossus. The hypoglossal nerve emerges from the
medulla oblongata in the preolivary sulcus where it separates the olive (olivary body) and the
pyramid (medullary pyramid).

It goes on to traverse the hypoglossal canal and, upon emerging, it branches and merges with a
branch from the anterior ramus of C1. It passes behind the vagus nerve and between the internal
carotid artery and internal jugular vein which lies on the carotid sheath. After passing deep to the
posterior belly of the digastric muscle it proceeds to the submandibular region to enter the
tongue.

Hypoglossal nerve: Schematic image of the hypoglossal nerve and the structures it innervates.

Function

The hypoglossal nerve controls tongue movements of speech, food manipulation, and
swallowing. It supplies motor fibers to all of the muscles of the tongue, with the exception of the
palatoglossus muscle, which is innervated by the vagus nerve (cranial nerve X) or, according to
some classifications, by fibers from the glossopharyngeal nerve (cranial nerve IX) that hitchhike
within the vagus.
While the hypoglossal nerve controls the tongue’s involuntary activities of swallowing to clear
the mouth of saliva, most of the functions it controls are voluntary, meaning that the execution of
these activities requires conscious thought.

Proper function of the hypoglossal nerve is important for executing the tongue movements
associated with speech. Many languages require specific and sometimes unusual uses of the
nerve to create unique speech sounds, which may contribute to the difficulties some adults
encounter when learning a new language. Several corticonuclear-originating fibers supply
innervation and aid in the unconscious movements required upon engaging in speech and
articulation.

Progressive bulbar palsy is a neuromuscular atrophy associated with the combined lesions of the
hypoglossal nucleus and the nucleus ambiguous, upon atrophy of the motor nerves of the pons
and medulla. This condition causes dysfunctional tongue movements that lead to speech and
chewing impairments and swallowing difficulties. Tongue muscle atrophy may also occur.