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Hi. This is Dr. Amit T. Suryawanshi. Oral & Maxillofacial surgeon from Pune, India. I am here on slideshare.com to share some of my own presentations presented at various levels in the field of OMFS. Hope this would somehow be helpful to you making your presentations. All the best & your replies are welcomed!
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Nerve supply of head & neck by Dr. Amit Suryawanshi .Oral & Maxillofacial Surgeon, Pune , India
1. Dr. Amit T. Suryawanshi
Oral and Maxillofacial Surgeon
Pune, India
Contact details :
Email ID - amitsuryawanshi999@gmail.com
Mobile No - 9405622455
2. CONTENTS
BASIC NEUROANATOMY
Origin of nervous system
Divisions of nervous system
Cranial nerves
3. NEUROANATOMY
Basic organization of the nervous system
• Sensory
stimuli
Sensory
Nerves
BRAIN
• Correlation
• Coordination
Motor Nerves
• Muscles
• Glands
etc.
4. The Nervous system
The nervous system is an organ system containing
a network of specialized cells called neurons that
transmit signals between different parts of the
body. coordinate the actions .
The nervous system consists of two parts,
1. Central nervous system
2. Peripheral nervous system.
6. EMBRYONIC
ECTODERM
NERVOUS
SYSTEM
NEURAL
PLATE
NEURAL
CREST CELLS
PNS ANS
NEURAL
TUBE
CNS
Origin Of Nervous System
7. Divisions of Nervous system
Nervousrsystem
CENTRAL NERVOUS SYSTEM
Brain & Spinal cord
PERIPHERAL NERVOUS SYSTEM
Cranial & Spinal nerves
and their associated ganglia
Autonomic
Nervous
system
Sensory
Divisions
Somatic
Nervous
system
Motor
Divisions
Parasympathetic
N. system
Sympathetic
N. system
Enteric N.
System
8. Basic Functions of the Nervous System
1. Sensation-
Events or changes occurring inside and outside the
body. Such changes are known as STIMULI and the cells
that monitor them are RECEPTORS.
2. Integration-
The parallel processing and interpretation of sensory
information to determine the appropriate response.
3. Reaction-
Motor output.
The activation of muscles or glands (typically
via the release of neurotransmitters (NTs))
9. Organization of the Nervous System
Divisions of Nervous System :
1. Central Nervous
System –
2. Peripheral Nervous
System -
The nervous system
outside the brain and
spinal cord
Consists of:
31 Spinal nerves
- Carry information
to and from the
spinal cord.
12 Cranial nerves
- Carry information
to and from the
brain.
- Ganglia
The brain
the spinal cord
The Main center
of integration
and control
11. 1. Central Nervous System
The brain -
Receives sensory input from the spinal cord as well as
from its own nerves (e.g., Cranial nerves )
Devotes most of its volume (and computational power)
to processing its various sensory inputs and initiating
appropriate and coordinated — motor outputs.
12. Spinal Cord -
- Conducts sensory information from
the peripheral nervous system (both somatic
and autonomic ) to the brain
- Conducts motor information from the brain to our
various effectors
-skeletal muscles
-cardiac muscle
-smooth muscle
-glands
13. Peripheral Nervous System
Responsible for communication between the CNS and
the rest of the body .
It is divided into:
Sensory division ( Afferent division )
Motor division ( Efferent division )
14. Sensory division ( Afferent division ) –
-Conducts impulses from RECEPTORS to the CNS
-Informs the CNS about the state of the body
-( interior and exterior )
- Sensory nerve fibers can be ,
SOMATIC - Conduct impulses from skin, skeletal
muscles and Joints to CNS
VISCERAL –Conduct impulses from smooth muscles,
cardiac muscles, and glands (Internal organs) to CNS.
15. Motor Division ( Efferent Division ) -
It is divided into:
Somatic nervous system -
VOLUNTARY (generally)
Conducts impulses from the CNS to skin , skeletal muscles ,
joints
Autonomic nervous system -
INVOLUNTARY (generally)
Conducts impulses from the CNS to smooth muscles, cardiac
muscles, and glands (Internal organs )
16. Autonomic Nervous System-
Divided into:
Sympathetic Nervous
System -
“Fight or Flight”
Parasympathetic
Nervous System -
“Rest and Digest”
These 2 systems are antagonistic.
17. Sympathetic Nervous System -
The
sympathetic
nervous
system aids in
the control of
most of the
body's internal
organs.
Stress — as in
the flight-or-fight
response.
18. Parasympathetic Nervous System -
“Rest and Digest”
Phenomenon
- generally works
to promote
maintenance of
the body at rest.
19. Enteric Nervous System
The enteric nervous system is a
meshwork of nerve fibers that
innervate the
viscera
Gastrointestinal tract,
Pancreas
Gall bladder.
22. NEUROANATOMY
Neuron consists of :
a cell body containing
nucleus – the
Neuronal soma.
Multiple number of
processes -dendrites
and axons
23. NEUROANATOMY
Function Of Neurons -
Neurons produce and
conduct nerve impulses.
Dendrites conduct
information towards the
cell body
Axons conduct impulses
away from cell body
24. Synapse and Neurotransmitters
A synapse is the site of
functional contact
between axon and
another neuron or
organ.
Neurotransmitters are
released at synapses
and they help in
transmission of
impulses.
25. Afferent neurons
- carry sensations of touch , pain, temperature
and pressure. Therefore they are called as
sensory fibers .
Efferent neurons
- carry impulses away from the central
nervous system.
26. NUCLEUS & GANGLION
NUCLEUS - is a compact
group of nerve cell bodies of
similar form and function,
located inside the CNS.
GANGLION – is a similar
group of nerve cell bodies
located outside the CNS.
27. NEUROANATOMY
The PNS has three main types of nerves:
1. Cranial Nerves
2. Spinal Nerves and
3. Autonomic Nerves
All cranial nerves are attached to the
brainstem, except for cranial nerve XI,
Accessory Nerve.
which is attached to the spinal cord.
28. spinal nerves -
All spinal nerves are attached to the spinal cord.
All spinal nerves have dorsal and ventral roots.
29. The autonomic nerves run through the roots
of cranial or spinal nerves to ganglia or
autonomic plexuses in the walls of the viscera
(smooth muscles and glands)
They also return sensory impulses to CNS from
sensory receptors in viscera.
30. Cranial Nerves
I . Olfactory Nerve
II . Optic Nerve
III. Oculomotor Nerve
IV. Trochlear Nerve
V. Trigeminal Nerve
VI. Abducent Nerve
VII. Facial Nerve
VIII. Vestibulocochlear Or Auditory N.
IX. Glossopharyngeal Nerve
X. Vagus Nerve
XI. Accessory Nerve
XII. Hypoglossal Nerve
31.
32. OLFACTORY NERVE
Entirely sensory in function.
Arises from olfactory
receptor nerve cells in
the
mucous membrane of nasal
cavity.
Bundles of these nerve
fibers pass through
openings of cribriform plate
of ethmoid bone
and synapse in the
olfactory bulb.
33. From olfactory bulb ,the second order nerve fibers
pass through the olfactory tract to the olfactory
cortex in cerebrum.
The olfactory cortex in cerebrum is
responsible for appreciation of olfactory
sensations. i.e. Sensation of Smell.
34. OPTIC NERVE
Entirely sensory in function.
• The Optic Nerve passes from the
eyeball through the optic canal into the
middle cranial fossa .
35. The two optic nerves
join below the base of
the diencephalon to
form optic chiasma
and then divides into
two optic tracts
36. Optic nerve transmits visual information from light-sensitive
receptors on the retina of the eye to the brain
for analysis, interpretation .
37. OCULOMOTOR NERVE
Entirely motor in function.
Oculomotor nerve nuclei:
Two nuclei –
1. the main motor nucleus situated in midbrain.
2. the parasympathetic nucleus situated
posterior to the motor nucleus
38. Course of occulomotor nerve :
The occulomotor nerve emerges from the
midbrain- then continues in the middle cranial
fossa in the lateral wall of cavernous sinus.
Here it divides into superior and inferior ramus
which enter the orbital cavity through superior
orbital fissure.
39.
40. The occulomotor nerve supplies parasympathetic innervation to
the intraocular muscles.
And somatic innervation to the extraocular muscles.
Parasympathetic fibers synapse in ciliary ganglion.
41. The occulomtor nerve
supplies the following
extrinsic muscles of
eye :
1. Levator palpebrae
superioris
2. Superior, medial and
inferior rectus
3. Inferior oblique
42. The oculomotor nerve is responsible for:
1. Lifting the upper eyelid.
2. Turning the eye upward, downward and
medially.
3. Constricting the pupil and accomodating the
eye.
43. TROCHLEAR NERVE
Entirely motor in
function.
Trochlear nerve
nucleus –
Situated in midbrain and
lies inferior to the
Oculomotor nucleus.
44. Course of trochlear nerve :
Leaves the brainstem and immediately decussates
with the nerve of opposite side .
It passes through the middle cranial fossa in the
lateral wall of cavernous sinus and enters orbit
through superior orbital fissure.
45. The nerve supplies superior oblique musle
of eyeball.
It assists in turning eye downward and laterally.
46. TRIGEMINAL NERVE
Course & relations
Anterior aspect of Pons
( sensory and Motor Root )
Middle Cranial Fossa
Meckel’s cavity ( Trigeminal Ganglion)
Ist Division
Ophthalmic
Superior orbital
fissure
IInd Division
Maxillary
Foramen Rotundum
IIIrd Division
Mandibular
Foramen Ovale
47.
48.
49. OPHTHALMIC DIVISION
Course & relations
Trigeminal Ganglion
Middle Cranial Fossa
Lateral wall of Cavernous Sinus
Superior Orbital Fissure
Orbit
-Lacrimal
-Frontal
-Nasociliary
51. LACRIMAL NERVE
Course & Relations
Superior Orbital Fissure
Lateral wall of Orbit
Above the Lateral Rectus muscle
Lacrimal Gland
52. Frontal nerve
Course & relations
Superior Orbital Fissure
Levator Palpebrae Superioris
Rim of Orbit
Supra-orbital Supra-trochlear
Supra-orbital Foramen
53. NASO-CILIARY NERVE
Course & relations
Superior Orbital Fissure
Within common tendinous ring of Recti
Optic Nerve
Below superior rectus & superior oblique
Medial orbital wall
Anterior
Ethmoidal
Posterior
Ethmoidal
Long
Ciliary
Infra-trochlear
External nasal Internal nasal
54. MAXILLARY NERVE
- Branches and Course -
Gasserion Ganglion
Foramen Rotundum
Pterygopalatine Fossa
Infra –Orbital Canal
Infra –Orbital Foramen
Face
Middle Meningeal N.
-Pterigopalatine N
-Posterior superior
alveolar N
-Zygomatic N
Anterior superior alveolar N
Middle superior alveolar N
-Inferior palpebral
-External nasal
-Superior labial
57. Maxillary Nerve Branches
(within pterigopalatine fossa )
Zygomatic N
Inferior Orbital
Fissure
Zygomatico-facial
Supplies-
Facial prominence
Of cheek
Zygomatico-temporal
Supplies-
Skin of temple
58. Continued -
Pterygopalatine Nerves
Orbital Nasal Palatine
Nasopalatine N. Greater
palatine n.
middle
palatine n.
posterior
palatine n.
Posterior
Hard
palate
Posterior superior Alveolar N.
Soft palate,
Tonsil,uvula
Soft
palate
Maxillary molars , buccal
Mucosa in molar region
59. Maxillary Nerve Branches
( within infraorbital canal )
Middle superior
alveolar nerve
Anterior superior
alveolar nerve
Supplies-
Maxillary Incisors,
canine
Supplies –
Maxillary premolars
60. Maxillary Nerve Branches ( on the face )
Inferior
Palpebral
branches
External
nasal
branches
Superior labial
branches
Lower
Eyelid
Upper
Side of Lip,cheek
Nose
62. MANDIBULAR NERVE
Course & Relations
Gasserion Ganglion
Motor root
Foramen Ovale
Main
trunk
Nerve to medial pterygoid
Anterior
division
Posterior
division
Buccal
Nerve to Masseter
Nerve To Temporalis
Nerve to Lateral
Pterygoid
Auriculo-temporal
Mylohyoid
Nerve
Superficial
temporal
Cutaneous
Mental
Incisive
Lingual
Inferior alveolar
sensory root
Nervous spinosus-
63.
64. ABDUCENT NERVE -
ABDUCENT NERVE
Entirely motor and supplies the lateral rectus
muscle of the eyeball.
Abducent nerve nucleus :
situated in pons
65. Course of abducent nerve :
The nerve fibers emerge from the pons from the
groove between pons and medulla oblongata.
It passes through cavernous sinus and lies below
the internal carotid artery.
The nerve enters the orbit through superior orbital
fissure.
69. -Course-
PONS
Motor
root
Medulla oblongata
Sensory
root
INTERNAL AUDITORY MEATUS
PETROUS PART OF TEMPORAL
BONE
FACIAL CANAL
STYLOMASTOID FORAMEN
PAROTID GLAND
FACIAL MUSCLES
(GENICULATE GANGLION )
PAROTID PLEXUS
GREATER PETROSAL
NERVE TO STAPEDIUS
CHORDA TYMPANI
POSTERIOR AURICULAR
N . POST. BELLY OF DIGASTRIC
N . STYLOHYOID
70. • Greater petrosal nerve -
- provides motor innervation to lacrimal
gland , mucosal glands of the nose, palate, and
pharynx.
- carries special sensory taste fibers from
the palate .
• Nerve to stapedius -
provides motor innervation
for stapedius muscle in middle ear
• Chorda tympani -
carries special sensory taste fibers from
the anterior 2/3rd of the tongue.
71. Outside skull -
(Distal to stylomastoid foramen)
• Posterior auricular nerve -
• Nerve to Posterior belly of Digastric
• Nerve to Stylohyoid muscle .
73. Functions -
• Its main function is motor
control of most of the muscles of
facial expression.
• The facial nerve also
supplies parasympathetic fibers
to the submandibular
gland and sublingual
glands via chorda tympani
74. Vestibulocochlear Nerve Or Auditory Nerve
-It is Sensory nerve .
-It consists of two
roots
- Vestibular root
- Cochlear root
80. Glossopharyngeal nerve
Superior Ganglion
Inferior Ganglion
•Branches -
•Tympanic nerve (s)
•Branch to carotid
sinus (s)
•Branch to
Stylopharyngeus
muscle (m)
•Tonsillar branches
(s)
Lingual Branches
•(S)
•Pharyngeal branches
(m)
81. •Tympanic nerve -
Sensory fibers supply the middle ear.
Secretory fibers supply the parotid gland
•Nerve to carotid sinus -
Receives sensory information from ‘
Chemoreceptors in Carotid body .
Baroreceptors in carotid sinus .
•Nerve to Stylopharyngeus muscle
•Tonsillar branches (s)
82. Lingual Branches -
Receives sensory information from posterior 1/3rd of the tongue.
•Pharyngeal branches -
Innervate constrictor muscles of the pharynx.
83. It originates from medulla oblongata
Nuclei -
-Nucleus ambiguus
-Nucleus of solitory tract
( superior part & inferior part )
89. Hypoglossal nerve (motor)
COURSE & RELATIONS
Medulla Oblongata
(Hypoglossal Nucleus)
Hypoglossal Canal
Behind Vagus Nerve
Between IJV & ICA
Posterior Belly of Digastric
Tongue(Intrinsic and extrinsic muscles)
90.
91. It supplies --
Extrinsic muscles
Genioglossus
Hyoglossus
Styloglossus
Intrinsic muscles
Superior longitudinal
Inferior longitudinal
Verticalis
Transversus
Except Palatoglossus which is supplied by cranial part of accessory nerve
92. References
Gray’s Anatomy
Oral and maxillofacial surgery – Laskin
Atlas of Anatomy - Anne Gilroy
LA – Malamed
Guyton (physiology )
Ganong (physiology )
Internet
Formation of the neural tube (cross view). Early in an embryo’s development, a strip of specialized cells called the notochord.. in most vertebrates notochord becomes the vertebral body of the vertebral column. (A) induces the cells of the ectoderm directly above it to become the primitive nervous system (i.e., neuroepithelium). The neuroepithelium then wrinkles and folds over (B). As the tips of the folds fuse together, a hollow tube (i.e., the neural tube) forms (C)—the precursor of the brain and spinal cord. Meanwhile, the ectoderm and endoderm continue to curve around and fuse beneath the embryo to create the body cavity, completing the transformation of the embryo from a flattened disk to a three–dimensional body. Cells originating from the fused tips of the neuroectoderm (i.e., neural crest cells) migrate to various locations throughout the embryo, where they will initiate the development of diverse body structures (D). Researchers investigating fetal alcohol syndrome have extensively studied neural crest cells, because they are particularly sensitive to alcohol–induced injury and cell death.
T1 to L5 ……..you are taking a nice walk in the park. Suddenly, an angry dog appears in your path. fight OR run away These are "Fight or Flight" responses. sympathetic nervous system is into action - it uses energy - your blood pressure increases, your heart beats faster, and digestion slows down.Notice in the picture on the left that the sympathetic nervous system originates in the spinal cord. Specifically, the cell bodies of the first neuron (the preganglionic neuron) are located in the thoracic and lumbar spinal cord. Axons from these neurons project to a chain of ganglia located near the spinal cord. In most cases, this neuron makes a synapse with another neuron (post-ganglionic neuron) in the ganglion. A few preganglionic neurons go to other ganglia outside of the sympathetic chain and synapse there. The post-ganglionic neuron then projects to the "target" - either a muscle or a gland.
Two more facts about the sympathetic nervous system: the synapse in the sympathetic ganglion uses acetylcholine as a neurotransmitter; the synapse of the post-ganglionic neuron with the target organ uses the neurotransmitter called norepinephrine. (Of course, there is one exception: the sympathetic post-ganglionic neuron that terminates on the sweat glands uses acetylcholine.)
If you decide to relax in comfortable chair.. "Rest and Digest" responses..parasympathetic nervous works to save energy - your blood pressure decreases, your heart beats slower, and digestion can start..Notice in the picture on the left, that the cell bodies of the parasympathetic nervous system are located in the spinal cord (sacral region) and in the medulla. In the medulla, the cranial nerves III occulo, VII facial, IX glosso and X vagus .form the preganglionic parasympathetic fibers. The preganglionic fiber from the medulla or spinal cord projects to ganglia very close to the target organ and makes a synapse. This synapse uses the neurotransmitter called acetylcholine. From this ganglion, the post-ganglionic neuron projects to the target organ and uses acetylcholine again at its terminal.symp n parasym are generally in opposition to each other.
The motor fibers of the facial nerve arise from the facial nucleus & superior salivatory nucleus in the pons while the sensory fibers of the facial nerve arises from the nucleus of solitory tract ....
The motor fibers and sensory fibers of the facial nerve pass through internal acoustic meatus into petrous part of temporal bone .Then it runs & emerges from the stylomastoid foramen and passes through the parotid gland, where it divides into five major branches. Though it passes through the parotid gland, it does not innervate the gland (This is the responsibility of cranial nerve IX, the glossopharyngeal nerve)
Greater petrosal nerve –mixed
Stapedius – motor
Chorda tympani –sensory
Mixed…From the anterior portion of the medulla oblongata, the glossopharyngeal nerve leaves the skull through the central part of the jugular foramen. the superior and inferior ganglia in jugular foramen ... On the inferior side, the glossopharyngeal nerve is lateral and anterior to the vagus nerve and accessory nerve.
In its passage through the jugular foramen (with X and XI), it passes between the external carotid artery and internal carotid artery. It descends beneath the styloid process and stylopharyngeus. From there, it passes under cover of the hyoglossus muscle, and is finally distributed to the palatine tonsil, the mucous membrane of the fauces and base of the tongue, and the mucous glands of the mouth
Mixed…From the anterior portion of the medulla oblongata, the glossopharyngeal nerve leaves the skull through the central part of the jugular foramen. the superior and inferior ganglia in jugular foramen ... On the inferior side, the glossopharyngeal nerve is lateral and anterior to the vagus nerve and accessory nerve.
In its passage through the jugular foramen (with X and XI), it passes between the internal jugular vein and internal carotid artery. It descends beneath the styloid process and stylopharyngeus. From there, it passes under cover of the hyoglossus muscle, and is finally distributed to the palatine tonsil, the mucous membrane of the fauces and base of the tongue, and the mucous glands of the mouth
Chemoreceptors -- partial pressure of oxygen , ph , temp
mixed
Mixed….Superior laryngeal nerve supplies all muscles if larynx excpt cricothyroid which si supplied by vagus nerve.
Internal laryngeal nerve --..
pierces thyrohyoid membrane and is distributed to the mucous membrane of the larynx., glottis and laryngeal vestibule
Above the vocal folds the sensory innervation of the larynx is via the internal laryngeal nerve. Below the vocal folds it is by way of branches of the recurrent laryngeal nerve.
Motor innervation to all other muscles of the larynx and sensory innervation to the subglottis is by the recurrent laryngeal nerve
Ansa cervicalis…
a loop of nerves that are part of the cervical plexus.
Branches from the ansa cervicalis innervate three of the four infrahyoid muscles: the sternohyoid muscle, the sternothyroid muscle, and the omohyoid muscle.