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Cranial Nerve 6

Abducens Nerve
Abducens Nerve Physiology
• “somatic efferent” nerve that controls the
movement of a single muscle, the lateral
rectus muscle of the eye
Abducens Anatomy and Course
Peripheral Anatomy
Source
From cavernous
Abducens
ponsNucleussinus
to petrous to supraorbital
located
portion fissure
in the caudal pons
CN 6 Test and Impairment
Normal Lateral Rectus Movement

Ipsilateral Rectus Muscle Paralysis

Impaired Lateral Rectus Muscle


Diseases and Disorders
• Diplopia – medially pulled eye due to unopposed action
of medial rectus muscle.
• Tumors, Aneurysms and Fractures – damage of
peripheral 6th nerve due to nerve compression
• Diabetic Neuropathy – injury involving the small blood
vessels which supply blood to the CN 6.
• Wernicke-Korsakoff Syndrome - isolated CN 6 damage,
abnormalities are nystagmus and lateral rectus
weakness.
• Tolosa- Hunt Syndrome – idiopathic granulomatous
disease that causes oculomotor palsies
Cranial Nerve 7

Facial Nerve
Facial Nerve
• Four Divisions

3) Brancial Motor (Special Visceral Efferent)


4) Visceral Motor (General Visceral
Efferent)
5) Special Sensory (Special Afferent)
6) General Sensory (General Somatic
Efferent)
*General Anatomy
Brancial Motor
Physiology - Supplies the muscles of facial
expression; posterior belly of digastric
muscle; stylohyoid, and stapedius.

Anatomy
4) Originates at pons at facial nucleus
5) Circles centrally around 6th Cranial nerve
nucleus
*Facial Nerve
Visceral Motor
Physiology - Parasympathetic innervation of
the lcrimal, submandibular, and sublingual
glands, as well as mucous membranes of
nasopharynx, hard and soft palate.

Anatomy
1) Originates in medulla at superior
Salivatory nucleus.
*Facial Nerve
Special Sensory
Physiology - Taste sensation from the anterior 2/3
of tongue; hard and soft palates.

Anatomy
4) Originates in medulla at spinal nucleus of
Cranial Nerve 5
5) Peripheral Course along the taste bud
chemoreceptors on anterior 2/3 of tongue.
*Facial Nerve
General Sensory
Physiology - General sensation from the
skin of the concha of the auricle and from
a small area behind the ear.

Anatomy
4) Originates in medulla at solitary tract
nucleus.
*General Anatomy
General Anatomy
Geniculate Ganglion to Motor Branches
1. Ganglion within facial canal between labyrinthine and
tympanic segments
2. Facial nerve turns 90 degrees to travel inferiorly through
stylomastoid foramen
3. Facial nerve branches (motor innervation)
• Temporal branch (forehead and eye)
• Zygomatic branch (vicinity of zygomatic arch)
• Buccal branch (cheek)
• Marginal mandibular branch (jaw line)
• Cervical branch (neck)
General Anatomy
Innervation
1. Motor fibers
• Scalp, Face, and Auricula
• Buccinator, Platysma, Stapedius, Stapedius, and Posterior
Belly of Digastric Muscle
2. Autonomic motor fibers
• Vasodilatation and secretion of Salivary Glands
– Submaxillary gland
– Sublingual Gland
3. Sensory fibers
• Taste for anterior two thirds of Tongue
• Sensation to ear canal and behind ear
CN 7 Test
Facial Motor Exam
• Forehead and Upper lid Innervation
– Eyebrow elevation
– Forehead wrinkling
– Frowning
– Tight Closing of the eyes
• Lower Face innervation
– Showing teeth
– Whistling
– Puffing cheeks
– Natural smile
– Test or inquire about Taste Sensation
CN 7 Lesions
1. Upper Motor Neuron (UMN)
– Unless bilateral lesion, does not affect forehead
– Mouth paralysis is overcome by emotional
expression
2. Lower Motor Neuron (LMN)
– Ipsilateral forehead and lower face paralysis
CN 7 Diseases and Disorders
• Bell’s Palsy - idiopathic acute facial nerve paralysis described
as a multiple cranial nerve ganglionitis that involves the facial
nerve
• Melkersson–Rosenthal Syndrome - characterized by recurring
facial paralysis, swelling of the face and lips (usually the
upper lip), and the development of folds and furrows in the
tongue.
• Bulbar Polio - weakness of muscles innervated by cranial
nerves.
• Amyotrophic Lateral Sclerosis – progressive, fatal,
neurodegenerative disease caused by the degeneration of
motor neurons, the nerve cells in the central nervous system
that control voluntary muscle movement.
Cranial Nerve 8

Vestibulocochlear Nerve
Vestibulocochlear Nerve
General Physiology - responsible for transmitting sound
and equilibrium (balance) information from the inner ear
to the brain.

General Anatomy - emerges from the medulla oblongata


and enters the inner skull via the internal acoustic
meatus in the temporal bone, along with the facial nerve.

2 Parts
a) Cochlear Nerve
b) Vestibular Nerve
Cochlear Nerve
Physiology – concerned with the hearing process through
inner hair cells of the organ of Corti.

Anatomy
4) Originates from neurons of the spiral ganglion
5) Processes from the spiral ganglia and ends at the
organ of Corti.

*CN 7
Vestibulocochlear Nerve
Vestibulocochlear Nerve
Vestibular Nerve
Physiology – mediates the sense of balance and head
position.

Anatomy
4) Originates from the neurons of Scarpa’s ganglion.
5) Travels through the Vestibular System and extends
processes to 5 sensory organs; 3 are cristaes located
in the ampullae of the semicircular canals, 2 are in the
maculae of the saccule and utircle.
CN 8 Test
Cochlear Nerve
• Audiometer – use of headphones tuned with varying
frequencies (20dBSPL = normal hearing)
• Rinne and Weber Test – done by placing a vibrating tuning
fork behind the ear, on the mastoid process and afterwards on
the forehead.

Vestibular Nerve
f) Vestibular (Labyrinth) Testing - involves irrigating cold or
warm water or air into the external auditory canal. (FAST
horizontal nystagmus: COWS)
g) Spontaneous Nystagmus - presence indicates balance
disorder
CN 8 Diseases and Disorders
Vestibular/Cochlear Neuronitis - can be a
paroxysmal, single attack of vertigo, a series of
attacks, or a persistent condition which
diminishes over two weeks.
Acoustic Neuroma - a benign primary intracranial
tumor of the myelin-forming cells of the
vestibulocochlear nerve.
Measles, Meningitis and Autoimmune Diseases -
results in cochlear nerve damage which results
to deafness.