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Nerve supply of head & neck by Dr. Amit T. Suryawanshi, Oral Surgeon, Pune


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Hi. This is Dr. Amit T. Suryawanshi. Oral & Maxillofacial surgeon from Pune, India. I am here on 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.

Published in: Health & Medicine

Nerve supply of head & neck by Dr. Amit T. Suryawanshi, Oral Surgeon, Pune

  1. 1. Dr. Amit T. Suryawanshi Oral and Maxillofacial Surgeon Pune, India Contact details : Email ID - Mobile No - 9405622455
  2. 2. CONTENTS  BASIC NEUROANATOMY  Origin of nervous system  Divisions of nervous system  Cranial nerves
  3. 3. NEUROANATOMY Basic organization of the nervous system • Sensory stimuli Sensory Nerves BRAIN • Correlation • Coordination Motor Nerves • Muscles • Glands etc.
  4. 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.
  5. 5. Origin Of Nervous System
  7. 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. 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. 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
  10. 10. Divisions of Nervous System -
  11. 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. 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. 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. 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. 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. 16. Autonomic Nervous System-  Divided into:  Sympathetic Nervous System -  “Fight or Flight”  Parasympathetic Nervous System -  “Rest and Digest” These 2 systems are antagonistic.
  17. 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. 18. Parasympathetic Nervous System - “Rest and Digest” Phenomenon - generally works to promote maintenance of the body at rest.
  19. 19. Enteric Nervous System The enteric nervous system is a meshwork of nerve fibers that innervate the viscera Gastrointestinal tract,  Pancreas  Gall bladder.
  20. 20. NEURON-Neuron (nerve cell)– It is basic structural and functional unit of the nervous system.
  21. 21. Types of NEURON
  22. 22. NEUROANATOMY Neuron consists of :  a cell body containing nucleus – the Neuronal soma.  Multiple number of processes -dendrites and axons
  23. 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. 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. 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. 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. 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. 28. spinal nerves -  All spinal nerves are attached to the spinal cord. All spinal nerves have dorsal and ventral roots.
  29. 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. 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. 31. 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.
  32. 32.  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.
  33. 33. OPTIC NERVE  Entirely sensory in function. • The Optic Nerve passes from the eyeball through the optic canal into the middle cranial fossa .
  34. 34. The two optic nerves join below the base of the diencephalon to form optic chiasma and then divides into two optic tracts
  35. 35. Optic nerve transmits visual information from light-sensitive receptors on the retina of the eye to the brain for analysis, interpretation .
  36. 36. 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
  37. 37.  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.
  38. 38. The occulomotor nerve supplies parasympathetic innervation to the intraocular muscles. And somatic innervation to the extraocular muscles. Parasympathetic fibers synapse in ciliary ganglion.
  39. 39. The occulomtor nerve supplies the following extrinsic muscles of eye : 1. Levator palpebrae superioris 2. Superior, medial and inferior rectus 3. Inferior oblique
  40. 40.  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.
  41. 41. TROCHLEAR NERVE  Entirely motor in function.  Trochlear nerve nucleus – Situated in midbrain and lies inferior to the Oculomotor nucleus.
  42. 42.  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.
  43. 43.  The nerve supplies superior oblique musle of eyeball. It assists in turning eye downward and laterally.
  44. 44. 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
  45. 45. OPHTHALMIC DIVISION Course & relations Trigeminal Ganglion Middle Cranial Fossa Lateral wall of Cavernous Sinus Superior Orbital Fissure Orbit -Lacrimal -Frontal -Nasociliary
  47. 47. LACRIMAL NERVE Course & Relations Superior Orbital Fissure Lateral wall of Orbit Above the Lateral Rectus muscle Lacrimal Gland
  48. 48. Frontal nerve Course & relations Superior Orbital Fissure Levator Palpebrae Superioris Rim of Orbit Supra-orbital Supra-trochlear Supra-orbital Foramen
  49. 49. 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
  50. 50. 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
  52. 52. Maxillary Nerve Branches (within pterigopalatine fossa ) Zygomatic N Inferior Orbital Fissure Zygomatico-facial Supplies- Facial prominence Of cheek Zygomatico-temporal Supplies- Skin of temple
  53. 53. 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
  54. 54. Maxillary Nerve Branches ( within infraorbital canal ) Middle superior alveolar nerve Anterior superior alveolar nerve Supplies- Maxillary Incisors, canine Supplies – Maxillary premolars
  55. 55. Maxillary Nerve Branches ( on the face ) Inferior Palpebral branches External nasal branches Superior labial branches Lower Eyelid Upper Side of Lip,cheek Nose
  56. 56. - Superior dental plexus -
  57. 57. 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-
  58. 58. ABDUCENT NERVE - ABDUCENT NERVE  Entirely motor and supplies the lateral rectus muscle of the eyeball.  Abducent nerve nucleus : situated in pons
  59. 59.  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.
  60. 60.  Abducent nerve :
  61. 61. FACIAL NERVE
  62. 62. Course and Branches of Facial Nerve
  64. 64. • 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.
  65. 65. Outside skull - (Distal to stylomastoid foramen) • Posterior auricular nerve - • Nerve to Posterior belly of Digastric • Nerve to Stylohyoid muscle .
  66. 66. Facial nerve enters parotid gland and forms parotid plexus Parotid Plexus
  67. 67. 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
  68. 68. Vestibulocochlear Nerve Or Auditory Nerve -It is Sensory nerve . -It consists of two roots - Vestibular root - Cochlear root
  69. 69. Course -
  70. 70. Vestibular root -- Vestibular root transmits impulses from vestibular apparatus ( Balance ) Cochlear root -- Cochlear root transmits impulses from auditory apparatus (Sound )
  71. 71. Functions - • Auditory nerve transmits sound and equilibrium (balance) information from the Internal ear to the Brain .
  72. 72. Glossopharyngeal nerve It originates from medulla oblongata Nuclei - Inferior salivatory nucleus Nucleus ambiguus Nucleus of solitory tract
  73. 73. Glossopharyngeal nerve
  74. 74. 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)
  75. 75. •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)
  76. 76. Lingual Branches - Receives sensory information from posterior 1/3rd of the tongue. •Pharyngeal branches - Innervate constrictor muscles of the pharynx.
  77. 77. It originates from medulla oblongata Nuclei - -Nucleus ambiguus -Nucleus of solitory tract ( superior part & inferior part )
  79. 79. VAGUS NERVE (MIXED) BRANCHES - Superior Ganglion - Meningeal nerve - Auricular nerve Inferior Ganglion - Pharyngeal branches - Superior laryngeal nerve - external laryngeal n. - internal laryngeal n. - Recurrent laryngeal - Cervical Carotid branches -Anterior esophageal plexus -gastric, celiac, hepatic branches
  80. 80. •It supplies - •Cricothyroid muscle Levator veli palatini muscle •Salpingopharyngeus muscle •Palatoglossus muscle •Palatopharyngeus muscle •Superior, middle and inferior pharyngeal constrictors •Muscles of the larynx (speech)
  81. 81. Accessory nerve (motor) Course -
  82. 82. Cranial root – Cranial root joins Vagus nerve and innervates - all laryngeal muscles except cricothyroid Spinal root - Spinal root innervates -Trapezius -Sternocleidomastoid
  83. 83. 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)
  84. 84. 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
  85. 85. References  Gray’s Anatomy  Oral and maxillofacial surgery – Laskin  Atlas of Anatomy - Anne Gilroy  LA – Malamed  Guyton (physiology )  Ganong (physiology )  Internet
  86. 86. Thank you