THE INNERVATION OF THE HEAD AND NECK

The head and the neck serve as origins but also as passing ways for a number of important
nerves of the body. Obviously, some of these nerves are destined to provide the proper
innervation of the cephalic extremity. The innervation of the head and neck is alike to the
allover innervation of the human body, namely general sensitive, special sensorial, motor and
vegetative.
The general sensitive innervation acts for collecting the superficial sensitive (nociceptive,
thermal, tactile) information from the tegument and lining mucosae, the profound stretching
and pressure (proprioceptive) stimuli from some deeply situated somatic structures like
muscles, ligaments and articular capsules and the sensitive-vegetative innervation (visceral
pain and plenitude) of visceral and glandular organs. The first sensitive neuron (protoneuron)
is situated outside the neuraxis, grouped in the sensitive ganglia. The peripheral sensitive
fibers are more-or-less myelinated dendrites, originating from the peripheral sensitive ganglia.
The sensory (or special sensitive) afferent innervation is developed for some particular types
of stimuli, one single for each of the specialized organs of the senses: the olfaction for odors,
the sight for the light, the hearing for mechanic waves, the vestibular for the position and
movements of the head and the taste for soluble chemicals. The special sensitive afferents can
be of somatic (vision, hearing, equilibrium) or of visceral nature (olfaction, taste).
The motor innervation targets the generic somatic effector organs, the striated muscles.
According to their ontogenetic origin, the striated muscles and their motor innervation can be
somitic or branchial. Branchially derived muscles can be encountered exclusively on the head
and on the neck. It is to be mentioned, that some branchial striated muscles are located in
various visceral organs, thus they deserve visceral functions. The motor innervation of the
striated muscles or, at least the initiation of the movements is typically deliberate and well
sensed by the proprioceptive sensitive system. Movements are subject to highly effective,
feedback-based regulation mechanisms.
The vegetative innervation is particular to the vegetative effectors, smooth muscles and
glands. The vegetative motor and excretory functions are largely autonomous with almost no
sensitive feedback and with certainly no purposeful control of the conscience. Unlike the
somatic nerves, in addition to the intra-neuraxial centers, the autonomic nerves possess extra-
neuraxial relay stations, the vegetative ganglia (ganglion, Ggl.). The vegetative nerve fibers
(axons) originating from the centers emerge from the neuraxis as pre-ganglionar fibers, than
they synapse in a vegetative ganglion with the post-ganglionar (in fact: ganglionar) neuron,
wherefrom the post-ganglionar fiber (axon) originates. According to their neuromediators and
their final physiological action, the vegetative nerves can be of two types, sympathetic
(orthosympathetic) or parasympathetic. A vegetative effector organ, by its receptor apparatus
usually is responsive to only one of these two types of stimuli.
The peripheral nervous system (Systema nervosum periphericum) by the means of the
cranial nerves (Nn. craniales seu encephalici), a number of spinal nerves (Nervi spinales) and
the autonomous nervous system (Systema nervosum vegetativum seu autonomicum) serves as
the anatomical basis of all these types of innervation.

THE CRANIAL NERVES

The cranial nerves in fact are nerves originating from the brain stem, and accordingly, their
correct name would be encephalic nerves. Ancient anatomic studies described 12 pairs of
cranial nerves, and despite it is not the case, this numbering prevails. Actually, the first pair is
not a unitary cranial nerve and the second pair is not a cranial nerve, but an outgrown pathway
(tract) of the neuraxis. Moreover, there are two other pairs of peripheral nerves which could
be regarded as individual cranial nerves too: the terminal nerve (N. terminalis) and the
vomeronasal nerve (N.vomeronasalis), but they are not included in this group. According to
the tradition, the cranial nerves are numbered from above to below in the order they leave the
surface of the neuraxis.
Descriptively, a cranial nerve has its origin in a (or some) nucleus (nucleus, nuclei, Nc., Ncc.)
situated in the brain stem. This is the so-called proper origin of the cranial nerve, that in some
cases ( N.IV., N. VI., XII.) is unique, but in other cases (N.III., N.V., N. VII., N.VIII., N. IX., N.
X., N. XI.) is multiple. Following the proper origin, the cranial nerve emerges on the surface of
the brain, at the site of its apparent origin. The upper cranial nerves appear as unitary trunks,
but the N.V., N. VII., N. VIII., N. IX., N. X., N. XI., XII.) rise under the form of convergent
roots (Radix) or multiple radicular filaments (Fila radicularia) which merge in a trunk at a
distance of several mm from the surface of the medulla. The cranial nerves are paired and
symmetrical on the midline and they emit collateral branches and endbranches. Exception
from under this rule of symmetry is the N. X.
Topographically, the real encephalic nerves have their origin on the brain stem, in the
posterior fossa of the neurocranium (Fossa cranii post.). After their apparent origin, the
cranial nerves travel various distances on the inner skull base (Basis cranii interna) until they
reach the corresponding exit orifice of the neurocranium. On their intracranial way, the cranial
nerves are ensheathed by the leptomeninges, the pia mater and the arachnoidea. They also
establish clinically important topographic relationships (syntopy) with other intracranial
structures. When leaving the cranial cavity, they might exit straight away or they course quite
for a distance inside the cranial base until eventually showing up extracranially. Than the
cranial nerves continue their way to the target organs and structures, branch exhaustively and
develop elaborated syntopy. The branches can be collaterals (sidebranches) or terminal
(endbranches).
Systematically, a nucleus of a cranial nerve can be a nucleus of origin (Nc. originis) for
somatic motor and vegetative nerves, or nucleus of termination (Nc. terminationis) for
sensitive or sensory nerves.
Functionally, a cranial nerve can be purely motor, purely sensitive or mixed. Branchiomotor
and somitic motor functions never mix. There is no pure vegetative cranial nerve.
Endbranches of mixed cranial nerves are pure. It is important to understand that regardless to
their functional composition at their origin, on the periphery, in their tree, cranial nerves
frequently exchange branches, completing eachothers effect. Usually some post-ganglionar
parasympathetic axons are swapped, and the typical accepting nerve is the N. V.
As for listing the cranial nerves, the anatomy uses roman numerals and/or proper names.
These, with the above-mentioned reserves are:

the N. I. or the olfactory nerve (Nn. olfactorii),
the N. II. or the optic nerve (N. opticus),
the N. III. or the oculomotor nerve (N. oculomotorius),
the N. IV. or the trochlear nerve (N. trochlearis),
the N. V. or the trigeminal (N. trigeminus),
the N. VI. or the abducent nerve (N. abducens),
the N. VII. or the intermediofacial nerve (N. intermediofacialis),
the N. VIII. or the vestibulocochlear nerve (N. vestibulocochlearis seu N. statoacusticus),
the N. IX. or the glossopharyngeal nerve (N. glossopharyngeus),
the N. X. or the vagal nerve (N. vagus),
the N. XI. or the accessory nerve (N. accessorius) and
the N. XII. or the hypoglossal nerve (N. hypoglossus).


The N. I . or the olfactory nerve (nerves) (Nn. olfactorii)

Despite from the view of the systematical anatomy they can be regarded as one single nerve
pair, descriptively the plural should be used. Systematically descirptively, the olfactory nerve
consists of approximately 20 slim bundles of axons penetrating into the cranial cavity. It is a
special visceral afferent nerve, as it conveys the olfactory information elicited by odoriferous
chemical compounds. The olfactory nerve in many ways is an exception from the usual
anatomy of the cranial nerves.
The proper origin is the first-order olfactory neuron (protoneuron), located inside the
olfactory region of the nasal mucosa (Tunica mucosa nasalis, Pars olfactoria). This neuron is
bipolar, and as an exception, with no intervening specialized receptor cell, it is directly
stimulated by the odoriferous chemicals. Thus, contrary to other visceral afferents, the fibers
of this nerve are not dendritic processes of sensitive ganglia, but unmyelinated axons.
The course of the nerves extracranially is hidden inside the olfacory mucosa, and then upon
approaching the cribriform plate of the ethmoid bone (Lamina cribrosa, Os ethmoidale) they
join each other in bundles of some 100 fibers each. About 20 such bundles are formed in this
way, and descriptively these are regarded as the proper olfactory nerves.
The olfactory nerves enter the neurocraniums anterior fossa through the Foramina cribrosa.
As passing the cribriform foramina, each bundle gains its own internal pial and external dural
envelope, extensions of the intracranial meninges. These layers form a tight seal around the
axon bundles and fix them to the bony foramina, isolating the subdural, CSF-filled spaces
from the nasal cavity. When entered the anterior fossa of the neurocranium (Fossa cranii
ant.), the dural envelope enlarges and it is detached from the bundles, whereas the pial sheath
remains in a continuous solidarity until reaching the nerves apparent origin. The nerve fibers
then enter the olfactory bulb (Bulbus olfactorius). The olfactory nerve does not form a trunk,
nor does emit branches.
The apparent origin is the olfactory bulb. This lies just on the cribriform plate and it is
linked to the basal surface of the cerebral hemisphere by the means of a slender fascicle, the
olfactory tract (Tractus olfactorius). This latter, being an exposed neuraxial tract, is not to be
confused with the olfactory nerve.

The N. I I . or the optic nerve (N. opticus)

By no means a nerve, it should be regarded an outdrawn tract of the diencephalon. It contains
the circa one million axons originating in the eyeball. However, given its position and course,
it is traditionally treated with the cranial nerves. Descriptively, the optic nerve is considered
that part of the optic pathways which is situated between the posterior surface of the eyeball
(Bulbus oculi) and the optic chiasm (Chiasma opticum) of the diencephalon. The tissue of the
optic nerve is built up by myelinated axons and it is populated by neuroglia, so that it equals
to the cerebral white matter. Thus, the term of optic nerve is purely descriptive.
The proper origin is in the eyeball, in the multipolar neurons of the nuclear layer of the
retina. Their axons converge toward the papilla of the optic nerve (Papilla nervi optici), pierce
the sclera and leave the eyeball.
The apparent origin is the optic disc, situated embedded in the sclera, somewhat medial to
the posterior pole of the eyeball.
The course is divided into four parts: intraocular, orbital, intracanalicular and intracranial.
During its run the optic nerve establishes important and complicated topographic
relationships. Meningeal layers, as extensions of the cerebral meninges envelope the nerve: an
outer dural sheath (Vagina externa nervi optici), inserting anterior on the sclera with whom it
merges, arachnoidea in the middle and pia mater on the neural surface (Vagina interna nervi
optici). The subdural space (Spatium intervaginale), filled with CSF is continuous along the
optic nerve up to the nerves origin from the sclera. The dural sheath tightly surrounds the
margins of the optic disc, thus the intracranial pressure is directly transmitted to the optic disc
and the intraocular papilla of the optic nerve.
The intraocular part (Pars intraocularis) of the nerve is the shortest, consisting of the axons
just transiting the layers of the eyeball. Here the axons form the optic disc, and this is
continuous with the optic nerve. The optic disc is pierced from posterior to anterior by the
central artery of the retina (A. centralis retinae). Beginning from the optic disc, the axons
acquire myelin sheath provided by oligodendroglia. The intraocular part is further divided in a
prelaminar (Pars prelaminaris), an intralaminar (Pars intralaminaris) and a postlaminar (Pars
postlaminaris) segments.
The orbital part (Pars orbitalis) of the nerve is the longest, of circa 25 mm. The nerve is
sinuous, being curved at first medially, then laterally. These windings provide an extra length
of the nerve, mandatory for avoiding its stretching during the rotational movements of the
eyeball. The nerve stretches towards the deepest point of the bony orbit (Apex orbitae), where
the optic canal (Canalis opticus) begins. The nerve and its sheaths are surrounded by the four
rectus muscles of the eyeball and the orbital fat pad (Corpus adiposum orbitae). 1 cm
posterior to the eyeball a branch of the ophthalmic artery (A. ophtalmica), the A. nervi optici
approaches of the nerve, perforates its sheaths, enters the neural white matter and travels in
the center of the nerve. Then, inside the optic disc this artery is continuous with the A.
centralis retinae.
The optic nerve enters the neurocraniums middle fossa through the optic canal.
The intracanalicular part (Pars intracanalicularis) of the nerve is short, occurring as it passes
through the narrow optic canal (Canalis opticus) and leads from the orbit into the middle
cranial fossa (Fossa cranii media). The canal imposes the nerve a postero-medial direction.
Here the dural sheath is fixed to the upper and medial bony wall of the canal. At the posterior
end of the canal the ophthalmic artery (A. ophtalmica) lies infero-lateral to the nerve.
Advancing forward, the artery makes a quarter of turn around the nerve, going inferiorly and
then medially. As the canal can accommodate the nerve and the artery only, there is no
reserve space, thus the nerve is prone to damage already at the least of compression or space-
occupying lesion.
The intracranial part (Pars intracranialis) is of 10 mm in its length. It begins at the cranial
(posterior) opening of the optic canal and ends at the optic chiasm (Chiasma opticum). Here
the dural sheath suddenly enlarges and continues in the dural lining of the middle cranial
fossa. The nerve turns even more medially, approaches from lateral the prechiasmatic furrow
(Sulcus prechiasmatis) and ends by joining the diencephalon. There is no clear-cut limit
between the optic nerve and the chiasma.
Naturally, in the case of the optic nerve there is no question of forming a nervous trunk or
emitting branches.

The N. I I I . or the oculomotor nerve (N. oculomotorius)

Functionally, this is a mixed somitic motor and vegetative parasympathetic efferent
encephalic nerve with some proprioceptive sensitive component hosted in its endbranches. It
is the thickest of the optomotor nerves (oculomotor, trochlear, abducent).
Its somitic somatomotor branches are axons which innervate some of the extrinsic muscles
of the eye and the elevator muscle of the upper eyelid, as follows:

the medial rectus (M. rectus medialis bulbi),
the superior rectus (M. rectus superior bulbi),
the inferior rectus (M. rectus inferior bulbi),
the inferior oblique (M. obliquus inferior bulbi) and
the elevator of the upper eyelid (M. levator palpebrae superioris)

Its autonomous division consists of vegetative motor parasympathetic preganglionar axons.
This component leaves the nerve in the orbit and joins some of the branches of the trigeminal
nerve, and via the trigeminal branches innervates some of the intrinsic muscles of the eyeball,
as follows:

the constrictor of the iris (M. sphincter pupillae seu M. constrictor pupillae) and
the circular muscles of the ciliary body (Fibrae circulares, M. ciliaris)

The proprioceptive component is only present at the very periphery of the axonal tree. It is
represented by a few dendritic fibers, which soon pass as communicating branches where they
truly belong, into the trigeminal system.
The proper origin lies in the midbrain (Mesencephalon) and it is multiple:

the Nc. n.-i oculomotorii - somatomotor for the extrinsic ocular muscles,
the Nc. centralis (of PERLIA) - somatomotor for the elevator of the upper eyelid and
the Nc. accessorius (of EDINGER WESTPHAL) - vegetative parasympathetic, origin for the
preganglionar vegetative axons

The apparent origin is the on the ventral surface of the neuraxis, on the mesencephalon, in
the interpeduncular fossa (Fossa interpeduncularis), lateral to the posterior perforated
substance (Substantia perforata post.), medial to the cerebral peduncles (Pedunculus cerebri).
The course of the nerve on the inner skull base is quite lengthy. It passes through the
interpeduncular cistern (Cisterna interpeduncularis) enveloped by its own pial sheath,
between the superior cerebellar artery (A. cerebellaris sup.) and the posterior cerebral artery
(A. cerebri post.). The nerve then pierces the dura lateral to the dorsum sellae and below the
posterior clinoid process (Processus clinoideus post.) and enters the cavernous sinus (Sinus
cavernosus). In the cavernous sinus the nerve runs under the internal carotid artery (A. carotis
int.), and on descent crosses the vessels lateral surface.
The oculomotor nerve exits the neurocraniums middle fossa through the superior orbital
fissure (Fissura orbitalis sup.).
Further, it stretches medial and then below to the ophthalmic (N. ophtalmicus), trochlear and
abducent nerves. Inside the cavernous sinus the oculomotor nerve emits its two terminal
branches.
Branches: the nerve gives rise to no collaterals, instead in the anterior part of the cavernous
sinus splits into two endbranches. These are the superior and the inferior branch, as follows:

The superior branch (R. superior) is the weaker one. Exits the cavernous sinus and becomes
evident under the lesser wing of the sphenoid (Ala minor ossis sphenoidalis). It transits the
superior orbital fissure (Fissura orbitalis sup.), enters the orbit. Further, it passes through the
tendinous ring (Anulus tendineus) of the extrinsic ocular muscles, lateral and then superior to
the optic nerve and the ophthalmic artery, arriving on the lower surface of the superior rectus
muscle. There it branches exhaustively for the M. rectus superior and the M. levator
palpebrae superioris.
The inferior branch (R. inferior) is thicker. Likewise, it leaves the cavernous sinus,
penetrates the orbit through the superior orbital fissure. The nerve passes the inferior part of
the tendinous ring, medial to the abducens nerve. Gaining on the upper surface of the M.
rectus inf. it gives off two short branches for this one and for the M. rectus med. A longer
terminal branch stretches further inferior to innervate the M. obliquus inf., but this is the one
carrying the vegetative component too. The vegetative motor fibers leave this branch and
enter the ciliary ganglion (Ggl. ciliare) as the preganglionar root of this ganglion (Radix
parasympathetica).
Delicate, sparse connections emerge from the above described motor branches and unite with
twigs of the ophtalmic nerve. These are proprioceptive sensitive dendrites, proper of the
trigeminal system, dispatched from here via the motor nerves into the extrinsic ocular
muscles.

The ciliary ganglion (Ggl. ciliare) is a small peripheral nervous structure situated in the orbit,
behind the eyeball, lateral to the optic nerve, medial to the M. rectus lat. bulbi. This ganglion
houses the ganglionar (postganglionar) neurons of the vegetative parasympathetic division
of the oculomotor nerve. It is morphologically linked by the means of roots and branches to
the oculomotor, the trigeminal and the sympathetic nervous trees, but functionally and
systematically belongs to the oculomotor system only. According to ARNOLDs rule, from the
point of view of the systematic anatomy, as the cephalic parasympathetic ganglia generically,
the ciliary ganglion has three roots and one set of branches. Out of the three roots one is real,
with functional value, the other two are spurious.
The parasympathetic root (Radix parasympathetica seu oculomotoria), conveying the
preganglionar axons, is the only proper root of the ganglion, originating in the Nc. accessorius
(of EDINGER WESTPHAL). This emerges from the inferior branch of the oculomotor nerve.
The preganglionar axons synapse on the ganglionar cells, which emit postganglionar axons
representing the output of the ciliary ganglion.
The sympathetic root (Radix sympathetica) only apparently belongs to the ganglion, because,
in fact, these axons merely transit it. Their origin resides in the superior cervical ganglion
(Ggl. cervicale sup.) of the cervical sympathetic chain, and they approach this ganglion via
the nervous plexus surrounding the internal carotid artery (Plexus caroticus internus) and its
continuation, the Plexus ophtalmicus. The fibers pass the ciliary ganglion without making any
functional connection with it and join the vegetative branches emerging from here, the short
ciliary nerves (Nn. ciliares breves).
The sensitive root (Radix sensitiva) is a trigeminal branch, passing through, but functionally
not linked to the ganglion. It originates from the nasociliary nerve (N. nasociliaris), a branch
of the ophthalmic nerve (N. ophtalmicus), which in turn is a primary branch of the trigeminal
nerve (N. trigeminus). Up to the ciliary ganglion this nerve is purely sensitive, built up by
some peripheral dendrites dispatched from the trigeminal sensitive ganglion (Ggl.
trigeminale). Obviously, these fibers do not synapse in the ciliary ganglion; instead they
directly enroll into its vegetative output.
The emerging branches of the ciliary ganglion are the short ciliary nerves (Nn. ciliares
breves), in a number of 8-10. They contain the postganglionar parasympathetic axons
originating in the ciliary ganglion, other postganglionar sympathetic axons just transiting it
and general somatic sensitive dendrites from the trigeminal system. These thin nerves then
penetrate the eyeball through its posterior pole and provide the motor innervation of the
intrinsic, smooth intraocular muscles.

The N. I V. or the trochlear nerve (N. trochlearis)

The trochlear nerve is a somitic somatomotor efferent encephalic nerve with the appearance of
a slender bundle. It is unique among the encephalic nerves by the facts that contains
intraneuraxially crossed fibers and arises on the posterior surface of the neuraxis.
It only innervates the superior oblique muscle of the eye (M. obliquus superior bulbi).
The proper origin lies in the mesencephalon, in the trochlear nucleus (Nc. nervi trochlearis).
From their origin, the axons turn posterior and decussate through the midline in the white
matter of the Velum medullare superius, part of the mesencephalic tectum (Tectum
mesencephali).
The apparent origin is to be found on the Velum medullare sup., below the inferior colliculi
(Colliculus inf.), nearby to the midline.
The course of the intracranial segment of the nerve begins with a half a turn around the
cerebral peduncles (Pedunculus cerebri), right above the superior border of the pons. As the
nerve encircles the posterior, then lateral surface of the mesencephalon, it passes the Cisterna
ambiens and then the pontine cistern (Cisterna pontis). On the lateral surface of the brain the
nerve stretches between the superior cerebellar artery (A. cerebellaris sup.) and the posterior
cerebral artery (A. cerebri post.) and pierces the dura mater near the medial, free margin of the
tentorium (Tentorium cerebelli), little above the trigeminal nerve, and penetrates the
cavernous sinus (Sinus cavernosus). Here the nerve runs anteriorly along the ophthalmic
nerve, above the abducent nerve. Then it leaves the cavernous sinus, shows up in the middle
cranial fossa, then disappears under he lesser wing (Ala minor) of the sphenoid bone.
The trochlear nerve exits the neurocraniums middle fossa by passing through the superior
orbital fissure (Fissura orbitalis sup.).
In the orbit the nerve is placed above the origin of the levator palpebrae superioris muscle and
stretches forward and medially to meet from above its target, the superior oblique muscle of
the eye (M. obliquus sup. bulbi).
The trochlear nerve does not emit branches.

The N. V. or the trigeminal nerve (N. trigeminus)

The trigeminal nerve is a branchial somatomotor efferent and general somatic sensitive
afferent encephalic nerve. Its endbranches are joined by twigs of other cranial nerves with
different functions. It is unique among the encephalic nerves by the fact that it does not form a
nervous trunk, instead its primary branches emerge directly from its sensitive ganglion.
Therefore, the concept of trigeminal nerve is a systematic and functional one, rather than
descriptive or topographic. Despite that the very distal branches of the nerve gather with
vegetative axons of different provenances, in its central and proximal parts the trigeminal
nerve has no vegetative component.
The branchial somatomotor division consists of axons from the motor nucleus and provides
the innervation of the striated muscles derived from the I. branchial arch (Arcus branchialis
I.). These are the gnathomotor muscles and some smaller muscles too, as follows:

the temporal muscle (M. temporalis),
the lateral pterygoid muscle (M. pterygoideus lat.),
the medial pterygoid muscle (M. pterygoideus med.),
the masseter muscle (M. masseter),
the anterior belly of the digastric muscle (M. digastricus, Venter ant.),
the mylohyoid muscle (M. mylohyoideus),
the tensor tympani muscle (M. tensor tympani) and
the tensor veli palatini muscle (M. tensor veli palatini).

The general sensitive function is fulfilled by means of the peripheral dendrites of the nervous
tree with their origin in the sensitive ganglion (Ggl. trigeminale seu semilunare) (of GASSER)
and the sensitive root of the nerve (Radix sensitiva seu Portio major).
The trigeminal nerve provides nociceptive innervation for the teguments of the head, the oral,
ocular and nasal mucosae, the dental arches, paranasal sinuses, the eyeball and the content of
the orbit, the meninges of the anterior and middle cranial fossae, the muscles of the head and
chin and the TMJ (Art. temporomandibularis).
The trigeminal nerve is protopathic and epicritic tactile by innervating the cephalic teguments,
mucosae and mainly the tongue (Lingua).
The trigeminal nerve supplies proprioceptive innervation for all the muscles located on the
head (gnathomotor, Diaphragma oris, ocular, facial and auricular), the tongue, the dental
arches and the TMJ.
The somatomotor function is exerted by the means of the efferent axons originating in the
pons, which at first run separately, then join a primary sensitive branch of the nerve, the N.
mandibularis, and directly innervate the target muscles.
The proper origin lies in four nuclei.

the Nc. tractus mesencephalici nervi trigemini proprioceptive, actually a centrally migrated
peripheral ganglion, in the mesencephalon,
the Nc. motorius nervi trigemini (Nc. masticatorius) origin of the somatomotor efferences,
in the pons,
the Nc. sensitivus principalis epicritic tactile and conscious proprioceptive, in the pons and
the Nc. tractus spinalis nervi trigemini nociceptive, in the medulla, descending into the
spinal chord, in the first 2-3 cervical segments.

The axons originating in the motor nucleus form a single bundle and will emerge separately to
the sensitive nerve fibers. The sensitive axons, originating in the trigeminal ganglion enter the
brainstem forming a single bundle with the proprioceptive sensitive dendrites which leave the
brainstem.
The apparent origin is to be found medially on the ventrolateral surface of the middle
cerebellar peduncle (Pedunculus cerebellaris medius), at their junction with the pons in the
form of two emergent white bundles, the two roots of the trigeminal nerve. The medial one is
the thinner motor root (Radix motoria seu Portio minor). The thicker lateral root is the
sensitive (Radix sensitiva seu Portio major). In fact, the motor root, as its structure and
systematic anatomy does not change during its run, could be considered a separate motor
nerve by itself.
The course of the intracranial segment of the nerve is marked by the fact that unlike in the
case of the other encephalic nerves, the two roots, motor and sensitive, do not merge into a
unitary nervous trunk. They have separate pial envelopes but a common arachnoid sheath. The
roots, keeping close, advance and ascend laterally in the pontine cistern (Cisterna pontis).
They then pierce together the basal dura mater just below the insertion of the tentorium. After
a run of 1 cm, the roots penetrate a duplication of the basal dura mater, the Cavum trigeminale
(of MECKEL). The trigeminal cavum is pocket-like, with an upper and a lower wall, and rests
in the Impressio trigeminalis, a shallow pit of the petrous part of the temporal bone (Pars
petrosa ossis temporalis), just lateral to its apex.
Inside the trigeminal cavity the sensitive root meets a flattened, crescent-shaped ganglion and
fuses with its concavity. This is the peripheral sensitive ganglion of the trigeminal nerve (Ggl.
trigeminale seu semilunare) (of GASSER). The lesser motor root passes under the ganglion
with no functional connection with it. Medial to the ganglion lays the cavernous sinus (Sinus
cavernosus) with the internal carotid artery inside, inferior to it stretch medially the two
petrosal nerves, toward the foramen lacerum.
The primary branches of the trigeminal nerve are its endbranches too: the ophthalmic nerve,
the maxillary nerve and the mandibular nerve. These all separate from the convexity of the
trigeminal ganglion. A trigeminal nerve, as a descriptive anatomical entity actually never
forms, because the main branches emerge directly from the sensitive ganglion. The primary
branches are short as they soon separate in their own endbranches. Next, these branches are
treated in the same manner as the individual encephalic nerves are.

The ophthalmic nerve (N. ophtalmicus)(V/1) is the first branch of the trigeminal nerve. It is
the thinnest, medial division. At its origin the nerve is purely somatosensitive, formed by
sensitive dendrites, originating in the trigeminal ganglion (nociceptive and tactile) or in the
Nc. tractus mesencephalici nervi trigemini (proprioceptive). The nerve provides sensitive
innervation for the content of the orbit, the skin of the eyelids (Palpebra) and forehead, for the
meninges in the anterior and the middle cranial fossae, for the nasal mucosa (Mucosa nasalis)
and the skin of the nasal pyramid (Pyramis nasi). However, some of its most distal branches
are parasitized by vegetative postganglionar axons of different provenance. Likewise, the
nerve cedes some proprioceptive dendrites to the nerves innervating the extrinsic ocular
muscles. Apparently, these dendrites are taken over from the motor nerves.
Immediately after its origin, the nerve enters the cavernous sinus (Sinus cavernosus). There
the ophthalmic nerve courses anteriorly, at first below and then lateral to the trochlear,
oculomotor and abducent nerves. After exiting the cavernous sinus at its anterior border, the
ophthalmic nerve becomes apparent for a short while in the middle cranial fossa. Here the
nerve emits a collateral branch and after that it splits in three endbranches.
The trifurcation of the nerve happens in the middle cranial fossa, under the lesser sphenoid
wing (Ala minor ossis sphenoidalis), thus in the view of the descriptive anatomy the
ophthalmic nerve does not enter the orbit. Systematically regarded, the nerve is present in the
orbit by its branches, as follows:

R. tentoris (R. meningeus) the only collateral branch of the ophthalmic nerve and does not
leave the cranial cavity. It turns posterior and medial for providing the sensitive innervation of
the tentorium and the posterior part of the falx (Falx cerebri).

The lacrimal nerve (N. lacrimalis) is the lateral endbranch of the nerve. Its origin is in the
middle cranial fossa, and then passes the superior orbital fissure through its lateralmost part.
Gaining into the orbit it maintains its anterior course, keeping laterally along the upper margin
of the lateral rectus muscle of the eyeball. It pierces the lacrimal gland (Glandula lacrimalis)
and branches exhaustively at the upper eyelid (Palpebra sup.) in its lateral part. These
endbranches serve for the sensitive innervation of the skin of the lateral angle of the eye and
the lateral conjunctiva (Angulus palpebralis lat.). On its way, the lacrimal nerve establishes a
functionally important communication with the zygomatic nerve (N. zygomaticus), the Ramus
communicans cum nervo zygomatico. By this bundle postganglionar parasympathetic axons
are transferred to the lacrimal nerve. These axons arrive from the pterygopalatine ganglion
(Ggl. pterygopalatinum), functionally belong to the system of the intermedius nerve (N.
intermedius) and supply the lacrimal gland (Glandula lacrimalis).

The frontal nerve (N. frontalis) is the strongest, middle endbranch of the ophthalmic nerve. It
also enters the orbit through the middle part of the superior orbital fissure and advances on the
elevator muscle of the upper eyelid under the ceiling of the orbit. It ends without emitting
collateral branches, by bifurcation into the supraorbital nerve, lateral, and the supratochlear
nerve, medial.

The supraorbital nerve (N. supraorbitalis) leaves the orbit through the supraorbital notch or
foramen (Incisura seu Foramen supraorbitale). It splits into two endbranches, the R. med. and
the R. lat. They ascend parallel in the skin of the forehead providing its general sensitive
innervation up to the vertex (Vertex).

The supratrochlear nerve (N. supratrochlearis) exits the orbit above the trochlea of the
superior oblique muscle of the eyeball (Trochlea m.-li obliqui superioris) and fits into the
supratrochlear notch or foramen (Incisura seu Foramen supratrochleare). It runs long in the
skin of the forehead, innervating it, but also provides branches for the skin and conjunctiva of
the interior angle of the eye (Angulus palpebralis med.).

The nasociliary nerve (N. nasociliaris) is the medial endbranch of the ophthalmic nerve. The
nerve passes the superior orbital fissure in its medial part and enters the orbit through the
tendinous ring of the extrinsic ocular muscles, above the optic nerve. It advances below the
superior oblique muscle of the eyeball, and then follows the medial wall of the orbit, joining
the ophthalmic artery up to the anterior ethmoidal foramen (Foramen ethmoidale ant.). There
the nerve bifurcates, but before that gives off several collateral branches. This nerve has
apparent anatomical connections with the ciliary ganglion. (see at the oculomotor nerve)

The R. communicans cum ganglione ciliari is a collateral branch of the nasociliary nerve. It
can be multiple, stretching anterior, lateral to the optic nerve. This nerve is the spurious
sensitive root of the ganglion. It conveys general sensitive dendrites, which merely transit the
parasympathetic ganglion and will join its output only, the Nn. ciliares breves.

The Nn. ciliares longi, 2-3, run parallel with the Nn. ciliares breves and penetrate the eyeball
above the optic nerve. They provide the highly sensitive nociceptive innervation of the cornea
(Cornea).

The posterior ethmoidal nerve (N. ethmoidalis post.) is a laterally oriented collateral branch of
the nasociliary nerve. Immediately after its origin it joins the homonymous artery with which
it enters the Foramen ethmoidale post. for innervating the mucosa of the sphenoid and
ethmoid sinuses (Sinus sphenoidalis), (Sinus ethmoidalis).

The anterior ethmoidal nerve (N. ethmoidalis ant.) is the medial endbranch of the nasociliary
nerve. It is is a functionally important branch, innervating meninges, nasal mucosa and skin.
The nerve commences at the anterior ethmoidal foramen, enters it, and passes through its
continuation, a sinuous tunnel connecting the orbit with the anterior cranial fossa (Fossa
cranii ant.) in the company of the homonymous artery. It shows up at the lateral margin of the
Lamina cribrosa, and gives off a thin branch, the anterior meningeal nerve (N. meningeus
ant.) for the innervation of the basal meninges in the anterior cranial fossa. Then the anterior
ethmoidal nerve runs forward along the lateral margin of the Lamina cribrosa till its anterior
end. Here it plunges into the nasal pit (Fossa nasalis) through a slit occurring between the
Crista galli and the Ala cristae galli, named the nasal fissure (fissura nasalis). In the nasal pit
the anterior ethmoidal nerve makes a short run laying in a groove on the concavity of the nasal
bone (Sulcus ethmoidalis, Os nasale). The anterior ethmoidal nerve gives off its endbranches
in the nasal mucosa (Rr. nasales interni) in two sets. The lateral nasal branches (Rr. nasales
latt.) innervate the mucosa of the lateral wall of the nasal pyramid. The medial branches (Rr.
nasales medd.) pass to the nasal septum (Septum nasi) for innervating the septal mucosa. The
other endbranch of the anterior ethmoidal nerve is the R. nasalis externus. This nerve passes
the Foramen nasale and becomes superficial, innervating the skin of the back of the nose
(Dorsum nasi).

The infratrochlear nerve (N. infratrochlearis) is the lateral endbranch of the nasociliary nerve,
continuing its trunk anteriorly along the medial wall of the orbit. It targets the trochlea of the
superior oblique muscle and exits the orbit in below. By its branches completes the
innervation of the conjunctiva of the internal angle of the eye, the Caruncula lacrimalis and
the fundus of the lacrimal sac (Fundus sacci lacrimalis). Its Rr. palpebrales concur at the
innervation of the skin of the eyelids at the internal angle of the eye.

The maxillary nerve (N. maxillaris) (V/2) is the second branch of the trigeminal nerve. It is
the intermediate division; at its origin is purely somatosensitive, formed by sensitive
dendrites, originating in the trigeminal ganglion (nociceptive and tactile) or in the Nc. tractus
mesencephalici nervi trigemini (proprioceptive). The nerve provides sensitive innervation for
the meninges in the middle cranial fossa, for some elements of the orbit, for the mucosa of the
palate and the upper dentoalveolar arch, for the vault of the pharynx (Fornix pharyngis), for
the nasal mucosa and skin of the nose and for the skin of the face. Like in the case of the other
trigeminal branches, vegetative postganglionar axons attach to its distalmost branches.
From its beginning, the nerve runs anteriorly in the middle cranial fossa on the lateral wall of
the cavernous sinus (Sinus cavernosus). Here the nerve emits a collateral branch, after that
leaves the neurocranium through the Foramen rotundum.
Two segments are defined in the extracranial course of the maxillary nerve, according to the
spaces traversed.
The first is the pterygopalatine segment. It is the shorter one and it begins when the nerve
enters the pterygopalatine fossa (Fossa pterygopalatina). This segment is laterally oriented,
stretching just below the ceiling of the bony pit, than the nerve leaves it through the inferior
orbital fissure (Fissura orbitalis inf.). Here the nerve encounters the homonymous artery (A.
maxillaris), the venous Plexus pterygoideus and the buccal fat pad (Corpus adiposum
buccae). Important collateral branches separate here. To this segment the vegetative
pterygopalatine ganglion (Ggl. pterygopalatinum) is morphologically (descriptively) related
(see N. intermedius). There are many links between the nerve and the ganglion, but not all of
them have functional significance.
The second is the infraorbital segment. Reaching the upper surface of the body of the
maxilla (Corpus maxillae), the maxillary nerve moulds into the Sulcus infraorbitalis, and then
enters the Canalis infraorbitalis. Here its name changes into infraorbital nerve (N.
infraorbitalis). This segment ends when the nerve gains on the face traversing the infraorbital
orifice (Foramen infraorbitale) and branches exhaustively. It is to be mentioned that despite
being apparent in the bony orbit (Orbita), remaining under its periosteum (Periorbita), the
nerve is not counted in the orbital region (Regio orbitalis). Collateral branches emerge from
this segment also.

The branches of the maxillary nerve:

R. meningeus medius is the only intracranial branch of the maxillary nerve. It joins the
frontal branch of the middle meningeal artery (A. meningea med.) for providing the sensitive
innervation of the convexital meninges in the middle and anterior cranial fossae.

The pterygopalatine branches of the maxillary nerve:

Rr. ganglionares in number of 2, are called by some authors pterygopalatine nerves (Nn.
pterygopalatini). These are equal to what in the systematic anatomy is termed the sensitive
root of the ganglion (Radix sensitiva). They are short branches, suspending the ganglion to the
maxillary nerve and contain sensitive dendrites derived from the maxillary nerve, only to pass
by the ganglion without establishing any connection. These dendrites are transferred
uninterruptedly to sensitive nerves belonging to the system of the maxillary nerve, which, in
this way have their apparent origin in the pterygopalatine ganglion. (see below) The Rr.
ganglionares also convey into the maxillary nerve efferent postganglionar parasympathetic
axons with the real origin in the ganglion. These vegetative efferents are transferred into the
sensitive nerves innervating the cephalic mucosae and into the zygomatic nerve (N.
zygomaticus).

Rr. orbitales, 2-3, are mixed, built up by sensitive dendrites of the maxillary nerve and
sympathetic postganglionar axons deriving from the cervical sympathetic chain. Having their
apparent origin in the pterygopalatine ganglion, they leave it upward, and passing the inferior
orbital fissure, reach the orbit. Here the nerves innervate the orbital periosteum (sensitively)
and provide the vegetative motor innervation of the smooth extrinsic muscle of the eyeball,
the M. orbitalis (of MLLER).

The zygomatic nerve (N. zygomaticus) emerges right after the maxillary nerve leaves the
neurocranium. It enters the orbit lateral to the main trunk (the infraorbital nerve), follows its
lateral wall and emits a collateral branch and two endbranches. The nerve is mixed, carries
general somatic afferent dendrites from the maxillary nerve and vegetative postganglionar
parasympathetic axons from the pterygopalatine ganglion. The latter division, as described
previously, is transferred to the lacrimal nerve as a communicating collateral branch (R.
communicans cum nervo zygomatico) (see there). Then, the zygomatic nerve enters a bony
canal of the zygomatic bone which begins with the zygomatico-orbital orifice (Foramen
zygomaticoorbitale). Inside the bone the zygomatic nerve splits in two endbranches. The
medial one is the R. zygomaticofacialis, exits the zygomatic bone through the homonymous
orifice (Foramen zygomaticofaciale) for innervating the skin in the zygomatic region (Regio
zygomatica). The lateral branch is the R. zygomaticotemporalis. This leaves the bone through
its homonymous orifice (Foramen zygomaticotemporale), pierces the temporal muscle (M.
temporalis) and its fascia (Fascia temporalis) and innervates the skin behind the lateral
margin of the orbit.

The posterior superior lateral nasal branches (Rr. nasales postt. supp. latt.) oriented medially,
apparently emerge entirely from the ganglion. But, these thin nerves contain not only sensitive
dendrites of the maxillary nerve, but vegetative postganglionar efferent axons too. Some of
these are parasympathetic with their origin in the pterygopalatine ganglion; others are
sympathetic, ascending from the neck. They leave the pterygopalatine fossa through the
sphenopalatine orifice (Foramen sphenopalatinum) and enter the nasal cavity, accompanied
by the homonymous arteries (Aa. nasales postt. supp.). Here they provide the sensitive
innervation of the mucosa of the upper and middle meatus (Meatus nasi sup., Meatus nasi
medius) and the upper two nasal cornets (Concha nasalis sup., Concha nasalis medius). These
nerves are responsible for the vegetative parasympathetic (and possibly the sympathetic as
well) innervation of the small glands and blood vessels of the lateral nasal mucosa. The
vegetative efferents are much longer than the sensitive branches by whom they enter the nasal
mucosa and thus the vegetative innervation area overlaps with sensitive branches of different
provenance.

The posterior superior medial nasal branches (Rr. nasales postt. supp. medd. seu septales) also
have their apparent origin in the pterygopalatine ganglion. This is again partially true, because
in addition to the postganglionar parasympathetic efferences, the real output of the ganglion,
the nerves contain, like in the previous case, sensitive dendrites and sympathetic
postganglionar axons. The slender nerves pass through the sphenopalatine orifice into the
nasal cavity. Here they continue their medial course in the nasal mucosa of the ceiling of the
nasal pit until reaching the septum, then descend anteriorly in the septal mucosa. These nerves
all participate in the sensitive and vegetative innervation of the mucosa of the nasal septum,
but one of the branches, the stronger nasopalatine nerve (N. nasopalatinus) has a longer
course. Together with the homonymous artery it targets the incisive foramen (Foramen
incisivum), passes it and ends up beneath the oral mucosa of the hard palate (Palatum durum).
The nasopalatine nerve, with its anterior and laterally turning branches innervates the gum till
the canine tooth. Some of its branches run posterior to intermingle with the branches of the N.
palatinus longus and innervate the remaining palatine mucosa.

The pharyngeal branch (N. pharyngeus) is a minor twig that detaches from the ganglion in the
posterior. It joins the homonymous artery and exits the pterygopalatine fossa on postero-
medial by traversing the palatinovaginal canal (Canalis palatinovaginalis). It is to be found on
the external skull base. The nerve provides a sensitive and possibly vegetative innervation for
the mucosa of the pharyngeal vault (Fornix pharyngis).

The greater palatine nerve (N. palatinus major) separates downwards from the pterygopalatine
ganglion and maintains its direction by entering the homonymous canal (Canalis palatinus
maj.), along other nerves and arteries. By exiting the canal through the Foramen palatinum
maj. it reaches the hard palate and splits in branches. The branches turn anteriorly on the
palate to intricate with similar branches from the nasopalatine nerve, with whom they should
not be confused. This nerve, likewise, carries sensitive dendrites and vegetative
postganglionar axons to the palatine mucosa.

The lesser palatine nerves (Nn. palatini minores) have a similar origin and functional
significance as the previous. They share the same exit way from the pterygopalatine fossa, but
traverse the Foramen palatinum minor. Ended up on the palate, these branches course
posteriorly to provide sensitive and vegetative innervation for the soft palate (Palatum molle,
Velum palatinum).

The posterior inferior lateral nasal branches (Rr. nasales postt. inff. latt.) segregate either from
the ganglion, either from the above mentioned palatine branches. They exit the palatine canal
anteriorly through minute, un-named orifices and reach the nasal pit. There they innervate the
mucosa of the lower meatus (Meatus nasi inf.), the lower nasal cornet (Concha nasalis inf.)
and the mucoperiosteum of the maxillary sinus (Sinus maxillaris). Their functional and
systematic provenance and significance is identical to the other nasal nerves.

The superior alveolar nerves (Nn. alveolares supp.) emerge from the trunk of the maxillary
nerve in three sets. All of them penetrate into the body of the maxilla and by branching and
recombination of the resulting branches form an extensive nervous plexus, the Plexus dentalis
sup. at the border between the body of the maxilla (Corpus maxillae) and its alveolar process
(Processus alveolaris sup.). This plexus contains somatosensitive dendrites of all functional
types. From the plexus delicate sensitive branches are sent into the alveoli of the teeth. Here
they segregate for the sensitive innervation of the teeth and the surrounding periodontium as
the superior dental branches (Rr. dentales supp.) and for the upper gum (Rr. gingivales supp.).

The Rr. alveolares supp. postt. in number of 2-3, are dispatched in the pterygopalatine fossa.
After their origin, they descend and leave the pterygopalatine fossa laterally, through the
sphenomaxillary fissure (Fissura pterygomaxillaris), together with the homonymous arteries.
The nerves then travel on the tuber of the maxilla (Tuber maxillae) until reaching their proper
orifices (Foramina alveolaria) for penetrating into the Corpus maxillae. By means of the
superior dental plexus they innervate the molar teeth, their periodontium and the neighboring
gum.

The following branches of the infraorbital part of the maxillary nerve actually originate from
the part bearing the name of N. infraorbitalis:

The R. alveolaris sup. medius proceeds downward fitting into a narrow canal of the lateral
wall of the maxillary sinus. It is the nerve of the premolar teeth and the corresponding
periodontium and gum. It might be absent.

The Rr. alveolares supp. antt. are constant branches. Like the previous branch, they remain
concealed in the Corpus maxillae. Their origin is close to the infraorbital orifice. They
descend in the anterior wall of the maxillary sinus, in their own bony canal, the canalis
sinuosus. These provide the innervation of the incisor teeth and their entourage. A twig of this
nerve reaches the nasal cavity and innervates the mucosa on the anterior part of its floor.

The infraorbital nerve (N. infraorbitalis) is the direct continuation of the maxillary nerve, but
it can be conceived as its endbranch. Exits the Corpus maxillae through the infraorbital orifice
and immediately splits off in its endbranches. On the face the nerve can be discovered
between the layers of the tegument, in a narrow space defined medially by the M. levator labii
superioris and laterally by the M. levator anguli oris. The branches released are all
somatosensitive:
The Rr. palpebrales inff. ascend to the lower eyelid, omit the M. orbicularis oculi for the
innervation of the skin and the conjunctiva.
The Rr. nasales externi innervate the skin of the Ala nasi.
The Rr. nasales interni enter the nasal pyramid at its base and innervate the skin lining the
nasal vestibule (Vestibulum nasi).
The Rr. labiales supp. descend on the bony surface of the Fossa canina and innervate the
covering skin and the mucosal lining of the upper lip (Labium sup.).

The mandibular nerve (N. mandibularis) (V/3) is the thickest, lateral branch of the
trigeminus. The trunk of the nerve is short, of only 2 cm. It takes its origin from the lateral
part of the convexity of the trigeminal ganglion, turns downward and exits the middle cranial
fossa through the Foramen ovale, reaching the infratemporal fossa (Fossa infratemporalis).
Here the mandibular nerve is placed antero-medial to the upper head of the lateral pterygoid
muscle and branches exhaustively. A vegetative parasympathetic ganglion, the Ggl. oticum is
attached to the nerve. (see at the glossopharyngeal nerve) The motor root of the trigeminal
nerve (Portio minor), passing beneath the trigeminal ganglion entirely joins the exiting
sensitive division of the nerve. This is a mixed nerve, because it is formed by peripheral
sensitive dendrites originating in the ganglion and the motor axons emerging from the pontine
motor nucleus.
It provides general sensitive afferent innervation for the meninges in the middle cranial fossa,
the outer auditory meatus (Meatus acusticus ext.), the inferior part of the mouth (including the
lower dentoalveolar arch, the tongue, the Diaphragma oris), the lateral wall of the mouth, the
skin of the chin and of the cheek up to the angle of the mandible (Angulus mandibulae), the
Isthmus faucium and the skin of the temple.
The mandibular nerve conveys sensitive proprioceptive dendrites for the masticator muscles,
whom it provides motor innervation too, and for the ATM. The nerve also transmits
proprioceptive dendrites for the facial and lingual muscles, but these fibers, at the periphery of
the nervous tree, are taken over by the nerves supplying the motor innervation for these
muscles.
The mandibular nerve, by its branch, the lingual nerve, serves as a guidewire the special
sensorial fibers into the lingual mucosa, along the trigeminal fibers for general sensitivity.
These sensorial fibers are peripheral dendrites belonging to the system of the intermediate
nerve, originating in its sensory ganglion, the Ggl. geniculi.
Similar to the other trigeminal branches, vegetative postganglionar axons attach to the
mandibular nerves distalmost branches.

The branches of the mandibular nerve are broadcasted only extracranially, where the nerve
branches in the form of a broom. Several branches (buccal, pterygoid, temporal and
masseteric nerves) usually have a common origin by means of a short primary trunk, the
antero-superior primary division of the mandibular nerve. Instead, the lingual, inferior
alveolar and auriculotemporal nerves emerge individually, and so do some smaller branches
also. Listed in a systematic anatomical approach, the branches of the mandibular nerve are:

The R. meningeus (or N. spinosus) is a collateral sensitive branch emerging in the
infratemporal region, just beneath the Foramen ovale. The nerve turns laterally, than re-enters
the middle cranial fossa through the Foramen spinosum, joins the middle meningeal artery
and completes the innervation of the convexital meninges of the middle cranial fossa by
splitting in two branches. These follow the temporal and, respectively, the parietal branch of
the artery.

There are two short, un-nominated branches sent to the otic ganglion. Containing sensitive
dendrites from the trigeminal ganglion, these nervelets serve as apparent, sensitive roots for
the ganglion. Naturally, these somatosensitive fibers are only tangent to the parasympathetic
otic ganglion and are incorporated in sensitive branches of the trigeminal system. On the
analogy to other similar ganglia, they could be named Rr. ganglionares.

The medial pterygoid nerve (N. pterygoideus med.) separates from the anterior primary trunk
of the mandibular nerve. This nerve contains somatomotor axons for the motor innervation of
the homonymous muscle (M. pterygoideus med.). The nerve also brings proprioceptive
sensitive dendrites for this muscle. Soon an after its origin, the medial pterygoid nerve gives
off two slender branches. These are the N. tensoris veli palatini and the N. tensoris tympani,
similarly somatomotor nerves, each for the homonymous muscle. The muscles are to be found
in the infratemporal region. These small nerves might apparently emerge from the otic
ganglion as its false branches.

The lateral pterygoid nerve (N. pterygoideus lat.), like the previous one, is a somatomotor
branch of the primary common trunk. It innervates the homonymous muscle (M. pterygoideus
lat.) with motor and proprioceptive innervation by penetrating the intermuscular space in
between the two heads of the muscle.

The Nn. temporales proff. (2-3) are given off in a lateral direction from the primary trunk of
the mandibular nerve. From the Foramen ovale they stretch laterally just beneath the outer
skull base, above the upper head of the lateral pterygoid muscle. Reaching the Crista
infratemporalis the nerves turn upwards into the temporal fossa (Fossa temporalis) on the
medial, profound surface of the temporal muscle (M. temporalis) and supply it with motor and
proprioceptive innervation.

The masseteric nerve (N. massetericus) is the next branch of the primary trunk. It has a lateral
direction between the outer skull base and the upper head of the lateral pterygoid muscle. It
emits 4 minute branches for the ATM, then leaves the infratemporal region by crossing from
behind the coronoid process (Processus coronoideus) and passing above the Incisura
mandibulae. The nerve transmits somatomotor axons for the masseter muscle (M.
massetericus), proprioceptive dendrites for the same muscle and for the ATM and its
surroundings.

The buccal nerve (N. buccalis) is the only sensitive branch of the anterior primary trunk of the
mandibular nerve. It has a relatively long course: descends at first, than sloping anteriorly it
passes the intermuscular slit between the upper and lower heads of the lateral pterygoid
muscle for entering the pterygomandibular space (Spatium pterygomandibulare). It is the
anteriormost formation of this space, then leaves and branches exhaustively on the lateral
surface of the buccinator muscle (M. buccinator). Some of these endbranches turn laterally
and innervate the skin of the cheek (Bucca), while others penetrate the muscle to innervate the
mucosa of the oral vestibule (Vestibulum oris) up to the Fornix vestibuli sup. and inf.
In addition to the sensitive dendrites for innervating the skin and the mucosa of the cheek, the
nerve also transports postganglionar parasympathetic and sympathetic axons for the
vegetative innervation of the small salivary glands of the buccal mucosa. The parasympathetic
postganglionar axons stem in the otic ganglion, whereas the sympathetic come from the
sympathetic plexus surrounding the external carotid artery (A. carotis ext.) by means of the
spurious sympathetic root of the otic ganglion.

The lingual nerve (N. lingualis) is a strong branch of the mandibular nerve. Three parts of it
are encountered, according to the spaces transited. The origin of the nerve is in the
infratemporal region, right underneath the Foramen ovale. Then the descending nerve enters
the space between the two pterygoid muscles, where its first segment lies. Here the lingual
nerve parallels the inferior alveolar nerve and the maxillary artery (A. maxillaris) and
incorporates an other nerve, the N. chorda tympani. This belongs to the system of the
intermediate nerve, carries specific sensorial dendrites originating in the geniculate ganglion
(Ggl. geniculi) and preganglionar parasympathetic axons stemming in the superior salivatory
nucleus (Nc. salivatorius sup.) of the pons. The slender Chorda tympani approaches the
lingual nerve from behind and below. Then the lingual nerve continues with its second
segment in the pterygomandibular space, between the medial pterygoid muscle and the medial
side of the upper part of the Ramus mandibulae. Here the lingual nerve courses together with
the inferior alveolar vessels and nerve and has an antero-inferior direction. The lingual nerve
leaves the pterygomandibular space, and by that the infratemporal region, just above the
posterior end of the Linea mylohyoidea by piercing the superior constrictor muscle of the
pharynx (M. constrictor pharyngis sup.), between its pterygopharyngeal and mylopharyngeal
parts (Pars pterygopharyngea, Pars mylopharyngea). Transiting the pharyngeal wall, the
lingual nerve commences its third, submandibular part. In the submandibular region at first it
is placed on the lateral side of the hyoglossus muscle (M. hyoglossus), then passes through the
upper part of the narrow slit between the hyoglossus and mylohyoideus muscles. Here the
nerve stretches in the company of the sublingual artery and vein (A., V. sublingualis), the
submandibular duct (Ductus submandibularis) and lymphatic vessels, well beyond the
hypoglossal nerve. The nerve then leaves the intermuscular space and continues with its
fourth and final sublingual part. This portion is placed in the Sulcus lat. linguae, a furrow
between the mylohyoid and the geniohyoid (M. geniohyoideus) muscles, where the nerve
becomes superficial, covered by the sublingual mucosa only.
Functionally, the lingual nerve is mixed. Descriptively, this stays for its more peripheral part
and its branches. It is general sensitive due to the dendrites emerging from the trigeminal
ganglion, specific sensorial for the sense of taste by the dendrites from the Chorda tympani
and vegetative parasympathetic preganglionar by the axons arriving by the means of the same
junction. The terminal branches of the lingual nerve contain postganglionar efferent axons
stemming in the submandibular ganglion (Ggl. submandibulare). The proprioceptive
dendrites travelling initially in the lingual nerve are transferred to the hypoglossal nerve.
The lingual nerve begins to emit branches from its third segment. The Rr. isthmi faucium are
sent off for the general sensitive innervation of the lateral wall of the throat (Isthmus faucium),
the compartment of the palatine tonsil (Tonsilla palatina) and the posterior part of the
Diaphragma oris.
The R. communicans cum nervo hypoglosso only contains the proprioceptive fibres exchanged
between the lingual and hypoglossal nerves.
The Rr. ganglionares are small twigs connecting the lingual nerve to the submandibular
ganglion. These tiny nerves are composed by the preganglionar parasympathetic axons which
joined the lingual nerve just previously via the N. chorda tympani, and represent the real,
parasympathetic root of the ganglion. It is important to realize, that a number of
postganglionar axons turn back into the lingual nerve approaching their targets together with
the sensitive dendrites. These are not specially designated branches, thus the Rr. ganglionares
from the point of view of the systematic anatomy are bi-directional, carrying preganglionar
axons from the lingual nerve to the ganglion and postganglionar axons from the ganglion to
the nerve. It is assumed that the posterior group of the ganglionar branches contain
preganglionar axons and the anterior set of the ganglionar branches convey postganglionar
fibres.
The lingual branches (Rr. linguales) penetrate the tongue and provide the nociceptive thermal,
tactile and specific sensorial innervation to the lingual mucosa. The vegetative innervation for
the lingual small glands is broadcasted by means of these branches also.
The sublingual nerve (N. sublingualis) continues the main trunk of the lingual nerve. It
courses anterior in the Sulcus lat. linguae and spreads off in branches providing sensitive
innervation for the sublingual mucosa, the gum of the inner slope of the inferior alveolar arch
(Arcus alveolaris) and vegetative postganglionar innervation for the submandibular and
sublingual salivary glands (Gl. submandibularis, Gl. sublingualis). Systematically these are
termed glandular branches (Rr. glandulares), but descriptively, they can emerge from the
lingual nerve or from the sublingual nerve or directly from the ganglion.

The inferior alveolar nerve (N. alveolaris inf.) is the thickest branch of the mandibular nerve.
It starts in the infratemporal region and passes anteriorly under the lateral pterygoid muscle.
Three segments are to be defined according to its anatomical environment. With its
interpterygoid segment the nerve lies between the two pterygoid muscles, lateral to the lingual
nerve, in the vicinity of the maxillary artery (A. maxillaris). The second, pterygomandibular
segment begins where stretching downwards, the inferior alveolar nerve passes between the
medial and lateral pterygoid muscles on its way to the Foramen mandibulae. In this space it is
shadowed from medial by the lingual nerve and the inferior alveolar artery (A. alveolaris inf.).
The third segment is the mandibular one, where the nerve courses in the mandibular canal
(Canalis mandibulae).
Functionally, the nerve is mixed by conveying dendrites for the general sensation and
somatomotor by its component of efferent axons. Likely, the nerve also conveys vegetative
postganglionar axons for the small salivary glands of the inferior labial mucosa.
The inferior alveolar nerve sends off branches beginning with its pterygomandibular segment.
The mylohyoid nerve (N. mylohyoideus) is the first collateral branch. It separates from the
nerve in the pterygomandibular space, surrounds from posterior and inferior the insertion of
the sphenomandibular ligament (Lig. sphenomandibulare) on the Lingula mandibulae. In the
case of a bifid ligament, the nerve escapes between the two inserting fascicles. Than the nerve
goes behind the posterior edge of the mylohyoid muscle and stretches further on its inferior
surface, on the medial side of the body of the mandible (Corpus mandibulae), in the Sulcus
mylohyoideus. It provides a branch for the anterior belly of the digastricus muscle (M.
digastricus, Venter anterior). In addition to the motor innervation, the mylohyoid nerve
probably provides proprioceptive innervation for these muscles.
All its way, in the mandibular canal, from the nerve split up branches which by recombination
elaborate a nervous plexus, the Plexus dentalis inf. This is situated inside the bony matter,
beyond the mandibular canal, between the body of the mandible (Corpus mandibulae) and its
alveolar process (Processus alveolaris inf.). From the plexus fine sensitive nervelets are
dispatched into the alveoli of the teeth. Here they break up in further branches and sensitively
innervate the teeth, the neighboring gum and the periodontium (Rr. dentales inff.), (Rr.
gingivales inff.). Like its superior homologue, this inferior dental plexus contains
somatosensitive dendrites of all functional types.
The main trunk of the inferior alveolar nerve bifurcates in two terminal branches, which for a
while run paralelly together in the bony canal. The lower one, the mental nerve (N. mentalis)
leaves the mandibular canal through the Foramen mentale and innervates the skin of the chin
with the Rr. mentales, the mucosa of the lower lip (Labium inf.) by the Rr. labiales and the
adjacent gum with the Rr. gingivales. The counterpart of the mental nerve, the incisive nerve
(n. incisivus) continues the way of the inferior alveolar nerve and by similar branching pattern
takes part in the inferior dental plexus. It concurs in the innervation of the canine and the
incisor teeth.

The lateralmost endbranch of the mandibular nerve is the auriculotemporal nerve (N.
auriculotemporalis). The nerve stems by two equal roots which surround the middle
meningeal artery and then unite latero-posterior to it. After its trunk is formed, the
auriculotemporal nerve courses backwards on the lateral surface of the lateral pterygoid
muscle, above the maxillary artery. Than the nerve escapes through the slit formed between
the neck of the mandible (Collum mandibulae) and the sphenomandibular ligament and enters
the parotid region (Regio parotidea). Here turns superficial just anterior the tragus (Tragus)
and becomes the posterior element of the superficial temporal vasculo-nervous bundle. The
nerve is purely sensitive at its origin but soon acquires vegetative postganglionar branches
from the otic ganglion, becoming in this way mixed, general sensitive and parasympathetic.
After its full development, the nerve begins to emit branches.
The N. meatus acustici externi penetrates between the bony and the cartilaginous parts into the
external auditory meatus (Meatus acusticus ext.), innervating its skin and the periosteum. A
branch of this, the R. membranae tympani innervates the outer (lateral), cutaneus surface of
the tympanic membrane.
The Rr. parotidei convey vegetative postganglionar parasympathetic axons with their origin in
the otic ganglion and others stemming in the cervical sympathetic, to the parotid gland
(Glandula parotidea).
The R. communicans cum nervo faciali is a route for the proprioceptive dendrites for
switching from the trigeminal system into the system of the facial nerve, for collecting the
proprioceptive information from the facial muscles.
The anterior auricular nerves (Nn. auriculares antt.) innervate the tragus and the surrounding
skin.
The superficial temporal nerves (Nn. temporales superff.) climb in the hypoderm into the
temporal region (Regio temporalis), where they follow the branches of the superficial
temporal artery (A. temp. superf.) and innervate the skin of the temple.

The N. VI . or the abducent nerve (N. abducens)

The abducent nerve is a somitic somatomotor efferent encephalic nerve with the appearance
of a slender bundle.
It only innervates the lateral rectus muscle of the eye (M. rectus lat. bulbi).
The proper origin lies in the pons, in the abducent nucleus (Nc. nervi abducentis).
The apparent origin is to be found in the sulcus bulbopontinus, just above the bulbar
pyramids (Pyramis bulbi).
The course of the intracranial segment of the nerve is the longest of all the encephalic nerves.
It advances in the pontine cistern (Cisterna pontis) just above the superior anterior cerebellar
artery (A. cerebellaris ant. sup.) and reaching the clivus ascends on its surface. The nerve then
pierces the dura mater a little below and medial to the exit point of the trigeminal nerve. It
penetrates the cavernous sinus and continues its anterior course within its lateral wall by
crossing from lateral the internal carotid artery and from medial the ophtalmic nerve. The
nerve leaves the cavernous sinus at its anterior side and after a very short run in the middle
cranial fossa enters the orbit through the superior orbital fissure. Here the abducent nerve
traverses the common tendinous ring of the extrinsic ocular muscles and reaches its target, the
medial side of the lateral rectus muscle (M. rectus bulbi lat.).
The abducent nerve has no branches.

The N. VI I . or the facial nerve (N. facialis)

The facial nerve is a somitic somatomotor efferent encephalic nerve. Sometimes it is listed as
the intermediofacial nerve (N. intermediofacialis) and it is attributed other function also. In
fact, in the descriptive anatomy the facial nerve is distinct to the intermediate nerve (N.
intermedius) and they segregate functionally too.
The facial nerve innervates the muscles of the facial expression and several other muscles of
the head and neck as well, as follows:

the mentalis muscle (M. mentalis),
the depressor of the lower lip muscle (M. depressor labii inf.-is),
the depressor of the corner of the mouth muscle (M. depressor anguli oris),
the orbicularis oris muscle (M. orbicularis oris),
the elevator of the upper lip muscle (M. levator labii sup.-is),
the elevator of the upper lip and of the ala nasi muscle (M. levator labii sup.-is aleque nasi),
the elevator of the corner of the mouth muscle (M. levator anguli oris),
the buccinator muscle (M. buccinator),
the risorius muscle (M. risorius),
the greater zygomatic muscle (M. zygomaticus maj.),
the lesser zygomatic muscle (M. zygomaticus min.),
the nasalis muscle (M. nasalis),
the procerus muscle (M. procerus),
the corrugator of the eyebrow muscle (M. corrugator supercilii),
the depressor of the eyebrow muscle (M. depressor supercilii),
the orbicularis of the eye muscle (M. orbicularis oculi),
the occipitofrontal muscle (M. occipitofrontalis),
the muscles of the external ear (M. auricularis ant., sup., post.),
the platysma muscle (M. platysma),
the stylohyoid muscle (M. stylohyoideus),
the posterior belly of the digastric muscle (M. digastricus, Venter post.) and
the stapedius muscle (M. stapedius).

The proper origin lies in the pons, in the facial nucleus (Nc. nervi facialis), the somitic
somatomotor nucleus, wherefrom the efferent axons emerge.
The apparent origin is to be found ventrally on the brain stem, in the sulcus bulbopontinus,
above the bulbar olives (Oliva bulbaris), below the middle cerebellar peduncle (Pedunculus
cerebellaris medius), in the cerebellopontine angle, antero-medial to the flocculus of the
cerebellum (Flocculus). Its emergence lies laterally to the origin of the abducent nerve, medial
to the vestibulocochlear nerve. The intermediate nerve has its origin just lateral to the facial
nerve, so close, that the two nerves apparently merge.
The course of the nerve is divided in three segments, according to its relationships to the
skull base and the petrous part of the temporal bone (Pars petrosa ossis temporalis):
intracranial, intrapetrous and extrapetrous.
The first, intracranial segment of the facial nerve begins at its apparent origin and keeps until
the nerve penetrates into the temporal bone. From its apparent origin, the nerve has a proper
pial envelope but is ensheathed by the arachnoidea together with the intermediate and the
vestibulocochlear nerves. The nerves are joined by the labyrinthic artery (A. labyrinthica) and
they run together upwards and mostly laterally for entering the internal auditory porus (Porus
acusticus int.), then its continuation, the internal auditory meatus (Meatus acusticus int.). Here
the facial nerve is situated anterior and superior and heads the facial area (Area nervi facialis)
of the fundus of the meatus (Fundus meatus acustici int.). It is to be mentioned, that the short
run in the internal auditory meatus is clinically significantly different, called intracanalar
segment.
The second, intrapetrous segment of the facial nerve commences where in the facial area the
nerve perforates the dura mater and enters its bony canal, the Canalis facialis (of FALLOPE).
Here the facial nerve is accompanied by the intermediate nerve and meets the ascending
stylomastoid artery (A. stylomastoidea). The facial canal is of circa 34 mm in length, being
divided in three parts according to the structures it passes by, delineated by two curvatures.
The first, proximal part of the canal is called labyrinthic, lies perpendicular to the longitudinal
axis of the petrous part of the temporal bone, namely antero-lateral and has a 4 mm length. In
the vicinity of the anterior side of the petrous bone, the canal makes a sharp posterior turn.
The nerve inside forms the knee (Geniculum nervi facialis) and at this level begins the second
part of the facial canal. This is the tympanic part of 12 mm in length, running laterally in the
vicinity of the tympanic cavity (Cavum tympani), where its ceiling (the Tegmen tympani)
meets the medial (labyrinthic) wall. The canal visibly bulges into the tympanic cavity, where
it could be identified as the Prominentia canalis facialis above the Promontorium and the oval
window (Fenestra vestibuli). Then, after a widely arching inferior turn the third portion of the
canal, called the mastoid part begins. This second turn lies above the Aditus ad antrum, and
sometimes is called the inferior knee of the facial canal. The mastoid part is of 18 mm,
descends vertically and ends inferiorly with its exit orifice, the Foramen stylomastoideum.
Here the bony canals wall is still formed by condensed bone but it is surrounded by the
pneumatized massive of the mastoid labyrinth. It is to be mentioned, that the facial canal has 4
additional exit openings where nervelets escape out from the temporal bone.
The third, extrapetrous segment of the facial nerve is extracranial also. It begins where the
nerve leaves through the stylomastoid foramen and is joined by the stylomastoid artery. The
nerve courses infero-lateral and enters the compartment of the parotid gland (Glandula
parotis) and breaks up into its endbranches. The glandular tissue moulds on the nerve and its
branches and it is not actually penetrated by the nerves.
Branches of the facial nerve are emitted from the intrapetrous part as collateral branches, and
the nerve, at the end of its extrapetrous segment bifurcates into two endbranches. In turn,
these two endbranches ramify again but the resulting nerves rejoin each other just to give birth
to tertiary branches. This nervous arbor is situated mainly in one single sagittal plane,
embedded in the parotid gland as the intraparotid plexus (Plexus intraparotideus). From the
trunk or from this plexus emerge the actual definitive branches of the facial nerve, as follows:

The stapedius nerve (N. stapedius) is a minute branch intended to the M. stapedius. It
emerges still in the intrapetrous segment, leaves the facial canal through its own orifice for
meeting the muscle whom it supplies with axons for the motor innervation.
The posterior auricular nerve (N. auricularis post.) exits the facial canal in its mastoid part
through another small lateral opening. Escaping from the bone just anterior to the mastoid
process, the nerve ascends behind the external ear. It gives birth to several muscular branches:
The R. occipitalis ascends to the occipital belly of the occipitofrontal muscle (M.
occipitofrontalis, Venter occipitalis).
The R. auricularis turns anterior and enters the external ear for innervating the auricular
muscles.
The R. digastricus is directed inferior for the posterior belly of the digastric muscle (M.
digastricus, Venter post.).
The R. stylohyoideus courses medially for the stylohyoid muscle. It might emerge from a
common trunk with the previous branch.
The R. communicans cum nervo glossopharyngeo stems from the inferior ganglion (Ggl. inf.)
of this nerve.
The temporofacial nerve and the cervicofacial nerve are the actual endbranches of
the facial nerve, arising below the stylomastoid orifice. They soon split up in further branches
which by repeated recombination form the intraparotid plexus. From this plexus originate the
branches of higher order exiting the gland and turning superficial on the side of the Ramus
mandibulae spread in a fan-like shape.
The Rr. temporales climb superficially in the skin of the masseteric region, then crossing the
zygomatic arch (Arcus zygomaticus) innervate the anterior muscle of the auricle, the frontal
belly of the occipitofrontal muscle (M. occipitofrontalis, Venter frontalis), the upper part of
the M. orbicularis oculi, the depressor of the eyebrow muscle (M. depressor supercilii) and
the M. corrugator supercilii.
The Rr. zygomatici course anterior and innervate the zygomatic muscles (M. zygomaticus
maj., M. zygomaticus min.) and the lower part of the M. orbicularis oculi.
The Rr. buccales are the motor nerves of the upper perioral and periorofacial muscles. They
are directed forward and spread for the orbicularis oris muscle (M. orbicularis oris), the
nasalis muscle (M. nasalis), the procerus muscle (M. procerus), the elevator of the upper lip
muscle (M. levator labii sup.-is), the elevator of the upper lip and of the ala nasi muscle (M.
levator labii sup.-is aleque nasi), the elevator of the corner of the mouth muscle (M. levator
anguli oris) and the buccinator muscle (M. buccinator).
The R. marginalis mandibulae parallels from above the basis of the mandible (Basis
mandibulae). It emits branches which innervate the lower perioral muscles, namely the
mentalis muscle (M. mentalis), the depressor of the lower lip muscle (M. depressor labii inf.-
is), the depressor of the corner of the mouth muscle (M. depressor anguli oris) and the risorius
muscle (M. risorius).
The R. colli (or R. cervicalis) descends from the corner of the mandible superficial to the
platysma muscle (Platysma) whom it innervates. This nerve has a communicating branch with
the cervical plexus (Plexus cervicalis) via the superior branch of the transverse cervical nerve
(R. sup., N. transversus colli), called the ansa cervicalis superficialis.

The N. VII. or the intermediate nerve (N. intermedius)

The intermediate nerve (of WRISBERG) is a general sensitive afferent, specific sensorial
afferent and a vegetative parasympathetic efferent encephalic nerve with the appearance of a
slender bundle, attached to the facial nerve, with whom descriptively forms the
intermediofacial nerve.
It sensitively innervates the inferior part of the external auditory meatus, provides sensorial
innervation for collecting the taste information from the anterior 2/3 of the dorsum of the
tongue and secretor parasympathetic innervation of the submandibular, sublingual and
lacrimal glands, as well for the small glands of the oral and nasal mucosae.
The proper origin lies in the pons, in the superior salivary nucleus (Nc. salivatorius sup.) and
in the medulla, in the nucleus of the solitary tract (Nc. tractus solitarii). At its origin, the
intermediate nerve consists of efferent vegetative preganglionar axons and afferent sensorial
and sensitive axons.
The apparent origin is in the sulcus bulbopontinus, above the bulbar olives (Oliva bulbaris),
below the middle cerebellar peduncle (Pedunculus cerebellaris medius), in the
cerebellopontine angle, antero-medial to the flocculus of the cerebellum (Flocculus). Its
emergence lies medial to the vestibulocochlear nerve, just lateral to the facial nerve, so close,
that the two nerves apparently merge.
The course of the intermediate nerve is divided into an intracranial and an intrapetrous
segment. By its intracranial segment the intermediate nerve has an intimate syntopy with the
facial and vestibulocochlear nerves with whom traces upward and lateral, in a common
arachnoid sheath. This nervous bunch is joined by the labyrinthic artery, with whom together
enter the internal auditory porus and meatus. Here is the nerves clinically defined intracanalar
segment.
The petrous segment commences at the bottom of the meatus, where the vestibulocochlear
nerve and the labyrinthic artery detach from the intermediofacial. Here the intermediate nerve
shares the same Canalis facialis with the facial nerve. At the knee of the facial canal the
intermediate nerve meets its sensitive and sensorial ganglion, the geniculate ganglion (Ggl.
geniculi seu Ggl. geniculatum). The ganglion contains the perikarya of the sensitive and
sensorial neurons and is bypassed by the preganglionar axons. The peripheral processes
(dendrites) of the ganglionar cells travel further in the branches of the intermediate nerve.
Branches: the nerve gives rise to no collaterals, instead, after leaving the geniculate ganglion,
it splits into two endbranches within the facial canal. These leave the facial canal through
small, proper orifices and travel on some extent inside the petrous part of the temporal bone.
In addition to its own branches, the intermediate nerve exchanges fibers with other encephalic
nerves. The branches are as follows:

The greater petrosal nerve (N. petrosus maj.) originates right after the geniculate ganglion.
It is built up by vegetative parasympathetic preganglionar axons. The nerve is engaged in its
own canal (Canalis nervi petrosi majoris) and penetrates through its homonymous orifice
(Hiatus canalis nervi petrosi majoris) into the middle cranial fossa. Here it courses postero-
medially on the anterior side of the petrous part of the temporal bone (Facies ant. partis
petrosae) in the homonymous groove (Sulcus nervi petrosi majoris), covered by the dura
mater (Dura mater encephali) towards the Foramen lacerum. Leaves the middle cranial fossa
through this orifice and shows up in the infratemporal region. Here the greater petrosal nerve
is joined by the deep petrosal nerve (N. petrosus prof.) and together form the nerve of the
pterygoid canal (N. canalis pterygoidei) (the Vidian nerve). This nerve, as its name suggests,
enters the pterygoid canal (Canalis pterygoideus), where it meets the homonymous artery (A.
canalis pterygoidei). The nerve exits into the pterygopalatine fossa and enters the
pterygopalatine ganglion (Ggl. pterygopalatinum), for whom it serves as the parasympathetic
root.

The pterygopalatine ganglion (Ggl. pterygopalatinum) is a small peripheral nervous
structure situated in the upper part of the pterygopalatine fossa, infero-medial to the maxillary
nerve. In the ganglion reside ganglionar (postganglionar) neurons of the vegetative
parasympathetic division of the intermediate nerve. It is morphologically bound by the means
of its branches to the intermediate, the trigeminal and the sympathetic nervous trees, but
functionally and systematically belongs to the system of the intermediate nerve only.
Systematically, it has three roots and one set of branches. Out of the three roots one is real,
with functional value, the other two are spurious.
The parasympathetic root (Radix parasympathetica) is the only proper root of the ganglion,
conveying the preganglionar axons, originating in the superior salivary nucleus. As shown, at
the beginning these fibers travel with the intermediate nerve, then they separate from it by the
greater petrosal nerve (N. petrosus maj.), by whom finally reach the ganglion. Here the
preganglionar axons synapse on the ganglionar cells, which in turn give rise to the
postganglionar axons, the output of the pterygopalatine ganglion.
The sympathetic root (Radix sympathetica), a generic feature of the parasympathetic
ganglions, only apparently belongs to the pterygopalatine ganglion, as these axons merely
transit it. Their origin is in the superior cervical ganglion (Ggl. cervicale sup.) of the cervical
sympathetic chain, then pass into the nervous plexus surrounding the internal carotid artery
(Plexus caroticus internus). From the latter, in the infratemporal fossa, a distinct structure, the
deep petrosal nerve (N. petrosus prof.) will separate and lead the postganglionar sympathetic
axons into the N. canalis pterygoidei. In the pterygopalatine fossa these fibers pass the
pterygopalatine ganglion without making any functional connection with it and join the
vegetative branches emerging from here. By the means of them, the sympathetic axons join
the Rr. orbitales and innervate the M. orbitalis (of MLLER). Obviously, these branches do
not belong to the functional output of the ganglion.
The sensitive root (Radix sensitiva) is represented by two trigeminal branches, the Rr.
ganglionares of the infraorbital nerve. The minute nerves, descriptively termed Nn.
pterygopalatini contain sensitive dendrites originating in the trigeminal ganglion, and they
pass through the pterygopalatine ganglion without being functionally linked to it. It is to be
mentioned, that these pterygopalatine nerves have a mixed composition and are not only
spurious roots of the pterygopalatine ganglion but its real exit ways also, as they, along the
incoming sensitive dendrites, carry out postganglionar axons originating here.
The functional output of the pterygopalatine ganglion is conveyed by some trigeminal
branches of the maxillary nerve, which passing near or through the ganglion take up the
postganglionar axons. These are the above mentioned Rr. ganglionares or pterygopalatine
nerves, the nerves innervating the nasal mucosa, the pharyngeal branch and the palatine
nerves, as listed at the maxillary nerve (see there). All these nerves contain the postganglionar
parasympathetic axons originating in the ciliary ganglion, other postganglionar sympathetic
axons just transiting it and general somatic sensitive dendrites from the trigeminal system.
One set of postganglionar axons, as seen, pass into the system of the maxillary nerve (the
zygomatic nerve) and from there to the system of the ophtalmic nerve and innervate the
lacrimal gland. Others remain in the maxillary twigs and supply the small glands of the nasal
and palatine mucosae and the vault of the pharynx.

The R. communicans cum plexo tympanico is a weak branch going in its own bony canal
into the tympanic cavity to the tympanic plexus (Plexus tympanicus). It represents a
connection to the otic ganglion (Ggl. oticum).

The R. communicans cum nervo vago is another small branch emitted for the vagus nerve at
the inferior part of the facial canal.

The chorda tympani nerve (N. chorda tympani) can be considered the endbranch of the
intermediate nerve. It leaves the facial canal just above the stylomastoid orifice and
immediately enters in its own bony canal, the Canaliculus chordae tympani. This has an
almost inverse course than the facial canal, ascends and turns anteriorly to open into the
tympanic cavity. The opening is a small orifice (Apertura tympanica canaliculi chordae
tympani) on the posterior (mastoid) wall of the middle ears cavity. Here, at first, the chorda
tympani runs free between the anvil (Incus) and the hammer (Malleus) and then around the
upper and anterior margin of the tympanic membrane (Membrana tympani), only covered by
the intratympanic mucosa. The nerve leaves the tympanic cavity through the petrotympanic
fissure (Fissura petrotympanica) where it meets the ascending anterior tympanic artery (A.
tympanica ant.). Exiting to the outer skull base, the nerve gains into the infratemporal region
and passing medial to the TMJ joins from posterior the lingual nerve (see there). The chorda
tympani convey preganglionar parasympathetic axons and sensorial dendrites originating in
the geniculate ganglion. The destination of the vegetative fibers is the submandibular ganglion
(Ggl. submandibulare).

The submandibular ganglion (Ggl. submandibulare) is a small peripheral nervous structure
situated between the layers of the floor of the mouth (diaphragma oris), at the posterior
margin of the mylohyoid muscle, under the lingual nerve, whom is morphologically attached.
The ganglion is made up by ganglionar (postganglionar) neurons of the vegetative
parasympathetic division of the intermediate nerve. Similarly to the pterygopalatine ganglion,
it is morphologically bound by the means of its branches to the intermediate, the trigeminal
and the sympathetic nervous trees, but functionally and systematically belongs to the system
of the intermediate nerve only. Descriptively, two roots and efferent branches of the ganglion
are encountered.
The parasympathetic root (Radix parasympathetica) is the only proper root of the ganglion,
bringing the preganglionar axons originating in the superior salivary nucleus. As shown
previously, at first these fibers travel with the intermediate nerve, then enter the chorda
tympani nerve. After the chorda tympani becomes incorporated into the lingual nerve, the
vegetative fibers travel within the latter until reaching the submandibular region (Regio
submandibularis). Here the vegetative fibers leave the lingual nerve. Descriptively, they are
grouped in the posterior set of the Rr. ganglionares by whom they finally enter the ganglion.
The preganglionar axons synapse on the ganglionar cells, which in turn give rise to the
postganglionar axons, the efferences of the submandibular ganglion.
A sympathetic root does not occur in the case of the submandibular ganglion. This is an
exception from under the general rule of ARNOLD. Some sympathetic axons stemming in the
superior cervical ganglion (Ggl. cervicale sup.) join the nervous plexus surrounding the
external carotid artery (Plexus caroticus externus). From here they continue in a similar
plexus of the facial artery (A. facialis) and reach the submandibular gland joining the arteries.
The sensitive root (Radix sensitiva), according to the rule, is spurious. This root is represented
by trigeminal branches, the posterior set of the Rr. ganglionares of the lingual nerve. The
delicate nerves consist of sensitive dendrites originating in the trigeminal ganglion, and they
pass through the submandibular ganglion with no functional link with it.
The functional output of the submandibular ganglion turns back into the lingual nerve as the
anterior set of the Rr. ganglionares. The postganglionar axons travel for a short while with
this nerve but then some of them separate from it as the Rr. glandulares and innervate the
submandibular and the sublingual glands. Other axons travel dispersed into the sensitive
branches of the lingual nerve and innervate the small salivary glands in the floor of the oral
mucosa.

The N. VI I I . or the vestibulocochlear nerve (N. vestibulocochlearis)

The vestibulocochlear nerve, also known as statoacoustic nerve, is a pure special sensory
afferent encephalic nerve composed by two distinct parts. The upper situated, vestibular part
is called the vestibular root (Radix vestibularis seu superior) as it carries the impulses of the
sense of equilibrium, acceleration and deceleration. The lower division is named acoustic root
(Radix cochlearis seu inferior), being the link to the hearing organ. It is to be mentioned, that
these so-called roots never really merge, nor are their functions related.
The proper origin is different for the two divisions. For the vestibular nerve there are three
main nuclei in the brainstem situated at the ponto-medullary border: the Nc. vestibularis sup.
(of BECHTEREW), the Nc. vestibularis med. (of SCHWALBE) and the Nc. vestibularis lat. (of
DEITERS).
The cochlear nerves two nuclei are described: the Nc. cochlearis ant. and the Nc. cochlearis
post. Similarly to the previous ones, the latter nuclei lie in the lateral recess of the floor of the
fossa rhomboidea (Fossa rhomboidea, Recessus lat.).
The apparent origin is in the sulcus bulbopontinus, above the bulbar olive (Oliva bulbaris),
below the middle cerebellar peduncle (Pedunculus cerebellaris medius), in the
cerebellopontine angle, antero-medial to the flocculus of the cerebellum (Flocculus). The
nerve becomes apparent lateral and posterior to the intermediate nerve.
The course of the vestibulocochlear nerve is divided into an intracranial and an intrapetrous
segment. In the posterior cranial fossa, after their apparent origin, the two functionally and
systematically distinct divisions keep allover together, forming the descriptively unitary nerve
trunk. The nerve swings anterolaterally in the cerebellopontine cistern together with the facial
and intermediate nerves. Heading the internal auditory pore (Porus acusticus int.), the nervous
setup is ensheathed by a common arachnoid envelope and it is shadowed from below by the
labyrinthic artery. Just as in the case of the facial and intermediate nerves, clinically an
intracanalar part of the vestibulocochlear nerve is distinguished inside the internal auditory
meatus.
The petrous segment commences at the bottom of the meatus, where the vestibulocochlear
nerve and the labyrinthic artery separate from the accompanying facial and intermediate
nerves. Approaching the Crista transversa of the fundus of the internal auditory meatus, the
yet apparently unitary vestibulocochlear nerve splits in its two endbranches, the acoustic and
the vestibular nerves. It is to be mentioned that there are no functional or systematic
differences between the radices and primary branches of the vestibulocochlear nerve.
Defining radices versus the primary branches is a descriptive approach only.
The anterior (or medial) division is the cochlear (or acoustic) nerve (N. cochlearis), that draws
anteroinferiorly toward the cochlear area (Area cochlearis) of the fundus and penetrates the
bony matter of the petrous part of the temporal bone. Embedded in the bone, in the spiral
canal of the modiolus of the cochlea lies the elaborate spiral ganglion (Ggl. cochleare seu Ggl.
cochleare spirale) (of CORTI), a sensorial (specific somatic sensitive) ganglion, composed of
the bipolar auditory nerve cells. Their axons bind into the cochlear nerve, whereas the
dendrites of them pass the minute holes of the Tractus spiralis foraminosus to enter the
cochlear space and there contact the sonic receptor cells.
The posterior (or lateral) branch of the vestibulocochlear nerve, the vestibular nerve (N.
vestibularis) joins the vestibular ganglion (Ggl. vestibulare) (of SCARPA) at the fundus of the
meatus. This is a sensorial (specific somatic sensitive) ganglion, nesting bipolar nerve cells.
The intrvening Crista transversa divides the ganglion into a superior and an inferior part
(Pars sup., Pars inf.). The axons of these neurons are collected in the above mentioned
vestibular nerve and run centripetally. The dendrites of the bipolar cells leave the ganglion in
two bundles that branch further. A thin branch, the R. communicans cochlearis connects the
two aformentioned ganglia.
Branches: the cochlear nerve does not form named branches. From the vestibular ganglion
stem some well defined branches, as follows:

The superior part of the vestibular ganglion is continuous in the utriculoampullar nerve (N.
utriculoampullaris). It further emits branches:
The utricular nerve (N. utricularis) directs for the innervation of the macula of the utriculus
(Macula utriculi).
The anterior ampullar nerve (N. ampullaris ant.) will connect to the receptors in the
membranous anterior semicircular canal (Ampulla canalis semicircularis ant.-is).
The lateral ampullar nerve (N. ampullaris lat.) innervates the homonimous receptor field
(Ampulla canalis semicircularis lat.-is).

The inferior part of the vestibular ganglion gives birth to two nerves:
The posterior ampullar nerve (N. ampullaris post.) targets the receptors in the ampulla of
the membranous posterior semicircular canal (Ampulla canalis semicircularis post.-is).
The saccular nerve (N. saccularis) is destined to the macula of the sacculus (Macula
sacculi).

The N. I X. or the glosopharyngeal nerve (N. glossopharyngeus)

Functionally, this is a mixed branchial motor, sensitive, sensorial and vegetative
parasympathetic efferent encephalic nerve.
Its sensitive function extends on nociception, protopathic sense, proprioception and the
specific sense of taste of the pharynx and the posterior third of the tongue.
Its branchial somatomotor branches are axons which innervate some striated muscles with
visceral and somatic functions of the pharynx (Pharynx) and of the isthmus of the fauces
(Isthmus faucium), as follows:

the superior, middle and inferior costrictor muscles of the pharynx (M. constrictor pharyngis
sup., med., inf. ), with the contribution of the X-th encephalic nerve,
the stylopharyngeus muscle (M. stylopharyngeus),
the posterior belly of the digastric muscle (M. digastricus, Venter post.) (contributes to the
facial nerve)
the levator veli palatini muscle (M. levator veli palatini),
the muscle of the uvula (M. uvulae)
the palatoglossus muscle (M. palatoglossus) and
the palatopharyngeus muscle (M. palatopharyngeus)

Its autonomous division consists of vegetative motor parasympathetic preganglionar axons.
The fibers staying within the nerves tree innervate glands of the pharynx. Some of the axons
leave the nerve and attach to certain trigeminal branches and innervate the parotid gland
(Glandula parotidea).
The proprioceptive component is proper to the glossopharyngial nerve tree. However,
dendritic fibers are swapped with the trigeminal system too.
The proper origin lies in the medulla (Medulla oblongata) and it is multiple:

the Nc. ambiguus - somatomotor for the aformentioned muscles,
the Nc.tractus solitarii sensorial for the sense of taste general sensitivity, and
the Nc. salivatorius inf. - vegetative parasympathetic, origin for the preganglionar vegetative
axons

The apparent origin is the on the ventral surface of the medulla, in the sulcus retroolivarius
either directly or by the means of 2 rootlets (Fila radicularia). These typically join eachother
after a short run and form the nervous trunk.
The course of the nerve has an intracranial and a cervical segment. The intracranial segment
has a lateral course on the inner skull base. Here the nerve is situated anteromedially to the
vagus nerve and the flocculus of the cerebellum, below the vestibulocochlear and above the
hypoglossus nerves. The posterior inferior cerebellar artery (A. cerebellaris post. inf.)
stretches in between the glossopharyngeal and vagus nerves. The glosopharyngeal nerve exits
the neurocraniums posterior fossa through the jugular foramens anterior, nervous part
(Foramen jugulare, Pars nervina), in the company of the encephalic nerves X and XI. In the
bony orifice the nerve encounters the entering posterior meningeal artery (A. meningea post.).
The cervical segment is much longer, and begins right under the jugular foramen. Here the
nerve is lodged in the lateropharyngeal space, anterior to the internal juglar vein (V. jugularis
int.), in lateral to the internal carotid artery (A. carotis int.), in the company of the other two
encephalic nerves with whom it exited the posterior fossa of the skull. The glossopharyngeal
nerve crosses obliquely from medial the styloid process of the temporal bone (Proc
styloideus) and then the stylopharyngeal muscle (M. stylopharyngeus), whom it joins from
lateral to form an anterior curve towards the lateral wall of the pharynx. Proceeding anteriorly,
the nerve finally is placed between the stylopharyngeal and styloglossus muscles (M.
styloglossus) and penetrates the body of the tongue (Corpus linguae) from lateral.
On its course, the glossopharyngeal nerve develops two ganglia. The first of them, the
superior ganglion (Ggl. sup.) (of EHRENRITTER) is intracranial, situated in the jugular foramen
right under the intrajugular process of the petrous part of the temporal bone (Proc.
intrajugularis). This upper ganglion is of general sensitive function, and it is built up by
pseudounipolar neurons. The inferior ganglion Ggl. inf. (of ANDERSCH) is situated
extracranially, in the Fossula petrosa. It contains pseudounipolar nerve cells also and it is
believed to be in the service of the sense of taste (viscero-sensorial specific).
Branches: the nerve gives off branches extracranially only:
The tympanic nerve (N. tympanicus) (of JACOBSON) is a small collateral twig of
parasympathetic visceral efferent function. It contains preganglionar axons. Immediately after
its origin, the nervelet enters the the petrous part of the temporal bone through the Canaliculus
tympanicus. Inside of this canal, the nerve meets the minute Ggl. tympanicum, a
parasympathetic ganglion. Some of the preganglionar axons make synapses on these
ganglionar cells, whose axons, in turn join the tympanic nerve. Traveling further in the
temporal bone, the tympanic nerve finally gains into the tympanic cavity (hence its name). On
the medial (labyrinthic) wall (Paries labyrinthicus) of the cavity the nerve spreads
exhaustively in fine branches on the Promontorium. By repeated recombinations, these
branches build up the tympanic plexus (Plexus tympanicus). Several branches emerge from
this plexus. One set of them is unnamed and contribute to the highly sensitive innervation of
the mucosa of the middle ear, including the inner, medial surface of the tympanic membrane.
Other branches are stronger and leave the tympanic cavity.
The lesser petrosal nerve (N. petrosus minor) exists the tympanic cavity trough its upper wall,
stretching in its own bony canal, the Canalis nervi petrosi minoris. This fine tunnel is
medially oriented and opens into the middle cranial fossa on the anterior surface of the the
petrous part of the temporal bone by the homonimous orifice (Hiatus canalis nervi petrosi
minoris). Here the nerve continues it medially oriented run covered by the basal dura mater,
leaving its mark on the bony surface as the Sulcus nervi petrosi minoris, then exists the
neurocranium through the Foramen lacerum or through the Foramen ovale. On the external
skull base, the nerve enters the otic ganglion, providing its parasympathetic root. (see below)
The R. tubarius enters the eustachian tube (Tuba auditiva) and innervates it mucosal lining.
The tympanic plexus receives the Nn. caroticotympanici, vegetative sympathetic nerve fibers
separated from the Plexus caroticus int. These nervelets originate in the carotid canal (Canalis
caroticus) and gain into the tympanic cavity through the homonimous foramina.
The R. communicans cum ramo auriculari nervi vagi connects the glossopharyngeal and the
vagus nerves. Function unknown.
The R. communicans cum nervo faciali connects the glossopharyngeal and the facial nerves.
It seems to be a connection through which proprioceptive fibers (dendrites) are exchanged.
The R. musculi stylopharyngei is a motor and probably proprioceptive branch for the
homonimous muscle.
The R. sinus carotici (of HERING) is an important vegetative sensitive afferent connection. It
innervates an intra-arterial receptor zone within the carotid bifurcation, the Sinus caroticus,
and a paraganglion, the carotid body (Glomus caroticum). This is a receptor organ mostly
composed of blood vessels, sensitive to changes in blood composition, pressure and
temperature.
The pharyngeal branches (Rr. pharyngei) are 3-4 nervous twigs of mixed, motor, sensitive
sensorial and vegetative function. They branch and reunite repeatadly and form a basket-like
plexus, the Plexus pharyngeus in the adventitia on the external surface of the pharynx. The
pharyngeal plexus receives similar branches from the vagus nerve (Rr. pharyngei) and
sympathetic efferents from the superior cervical ganglion (Ggl. cervicale sup.) via the carotid
plexus (Plexus caroticus). The plexus supplies the constrictor muscles of the pharynx, the M.
levator veli palatini, the M. uvulae and the M. palatopharyngeus, providing them motor and
proprioceptive innervation. Microganglia are scattered in this plexus and branches emerge
from here perforating the muscular coat for innervating the lining mucosa. These are sensorial
twigs for taste, general sensitive branches and vegetative nervelets for the small salivary
glands of the pharynx. The vault of the pharynx (Fornix pharyngis) is avoided by the
glossopharyngeal branches. It is to be mentioned that as the vagus nerve participates in the
build of the pharyngeal plexus, it concurs in the motor innervation of the pharyngeal and
palatal muscles too.
The tonsillar branches (Rr.tonsillares) are nerves for the palatine tonsil (Tonsilla palatina),
carrying sensitive and vegetative fibers. Microganglia are encountered attached to the nerve
twigs, providing secretory innervation for the small salivary glands of the mucosa lining the
tonsillar compartment.
The lingual branches (Rr. linguales) are the apparent endbranches of the glossopharyngeal
nerve of sensorial, general sensitive and vegetative function. They penetrate the tongue, and
by repeated branching and recombination form an extensive submucosal plexus, the Plexus
lingualis. Like in the above reviewed cases, this plexus contains a number of microganglia
also. Fine branches emerging from this plexus innervate the posterior (postsulcal) third of the
lingual mucosa. The sense of taste (special visceral afferents), general (somatic) sensitivity
and vegetative secretory innervation of the small lingual salivary glands is delivered by the
means of this neural meshwork.

The otic ganglion (Ggl. oticum) is a small peripheral nervous structure situated in the
infratemporal region, right underneath the foramen ovale, on the medial aspect of the
mandibular nerve, lateral to the eustachian tube (Tuba auditiva) and the M. tensor veli
palatini, posterior to the medial pterygoid muscle. This ganglion houses the ganglionar
(postganglionar) neurons of the vegetative parasympathetic division of the
glossopharyngeal nerve. It is morphologically linked by the means of roots and branches to
the glossopharyngeal, the trigeminal and the sympathetic nervous trees, but functionally and
systematically belongs to the glossopharyngeal system only. According to ARNOLDs rule,
from the point of view of the systematic anatomy, as the cephalic parasympathetic ganglia
generically, the otic ganglion has three roots and one set of branches. Out of the three roots
one is real, with functional value, the other two are spurious.
The parasympathetic root (Radix parasympathetica), conveying the preganglionar axons, is
the only proper root of the ganglion, originating in the Nc. salivatorius inf. This emerges from
the above mentioned lesser petrosal nerve. The preganglionar axons synapse on the ganglionar
cells, which in turn give rise to postganglionar axons, the output of the otic ganglion.
The sympathetic root (Radix sympathetica) (or n. petrosus prof. min.) only apparently belongs
to the ganglion, because, in fact, these axons merely transit it. They stem in the superior
cervical ganglion (Ggl. cervicale sup.) of the cervical sympathetic chain, and approach this
ganglion via the nervous plexus surrounding the internal carotid artery (Plexus caroticus
internus). A set of nervelets are described to split off this plexus and approach the otic
ganglion. The fibers pass the otic ganglion without making any functional connection with it
and join the vegetative branch emerging from here, the R. communicans cum nervo
auriculotemporali.
The sensitive root (Radix sensitiva) is represented by two trigeminal branches, passing
through, but functionally not linked to the ganglion. They originate from the auriculotemporal
nerve (N. auriculotemporalis), a branch of the mandibular nerve (N. mandibularis), which in
turn is a primary branch of the trigeminal nerve (N. trigeminus). These nervelets are partly
sensitive, built up by some peripheral dendrites dispatched from the trigeminal sensitive
ganglion (Ggl. trigeminale), but also contain efferent axons stemming in the motor nucleus of
the trigeminus. These come to the ganglion through the motor root of the trigeminal nerve
(Radix motoria n.-i trigemini). Obviously, these fibers do not synapse in the otic ganglion.
Rather, they separate as thin communicating twigs to the N. tensoris palatini and the N.
tensoris tympani. These latter nerves can appear as originating from the otic ganglion.
The main emerging branch of the otic ganglion is the R. communicans cum nervo
auriculotemporali, carrying the postganglionar parasympathetic axons to the trigeminal
system. They provide the secretory innervation of the parotid gland (Gl. parotis) (see the
auriculotemporal nerve). However, other smaller branches are dispatched also. The R.
communicans cum nervo buccali seemingly transports postganglionar axons to this nerve for
the innervation of the small salivary glands of the oral vestibule. The R. communicans cum
ramo meningeo links the otic ganglion with the meningeal branch of the mandibular nerve,
contributing perhaps to the vegetative innervation of the meninges of the middle cranial fossa.
The R. communicans cum nervo chorda tympani is a communication to the system of the
intermediate nerve, of uncertain functional importance.

The N. X. or the vagus nerve (N. vagus)

Functionally, this is a mixed branchial motor, sensitive and vegetative afferent and vegetative
parasympathetic efferent encephalic nerve. The nerves once attributed sensorial function
(taste) is doubted in adult.
Its sensitive function extends on nociception, proprioception as well as the vegetative, less
conscious sense of chemical, osmotic, thermal or pressure changes in the internal environment
(millieu interieur) of the body.
Its branchial somatomotor branches are axons which innervate the striated muscles of
visceral functions of the pharynx (Pharynx), larynx (Larynx) and of the upper third of the
esophagus (Esophagus), as follows:

the cricothyroid muscle (M. cricothyroideus),
the posterior cricoarytenoid muscle (M. cricoarytenoideus post.),
the lateral cricoarytenoid muscle (M. cricoarytenoideus lat.),
the vocalis muscle (M. vocalis),
the thyroarytenoid muscle (M. thyroarytenoideus)
the oblique arytenoid muscle (M. arytenoideus obliquus) and
the transverse arytenoid muscle (M. arytenoideus transversus)

Its autonomous division consists of vegetative motor parasympathetic preganglionar axons.
Their function includes innervation of all the possible vegetative effectors, namely glands and
smooth muscles.
The proprioceptive component is obviously extant, but less well understood. It is also likely
that the vagus provides proprioceptive innervation for striated muscles whose motor
innervation is accomplished by other nerves.
The proper origin lies in the medulla (Medulla oblongata) and it is multiple:

the Nc. ambiguus - somatomotor for the aformentioned muscles,
the Nc.tractus solitarii sensitive for the sense of general sensitivity, and perhaps for the
visceral sessitivity too
the Nc. salivatorius inf. preganglionar vegetative parasympathetic secretomotor for the
lower pharyngeal, the laryngeal and the esophageal glands
the Nc. dorsalis n.-i vagi. preganglionar vegetative parasympathetic, origin for the
preganglionar vegetative axons innervating smoth muscels and glands of the visceral organs

The apparent origin is the on the ventral surface of the medulla, in the sulcus retroolivarius
by the means of 8-10 rootlets (Fila radicularia), beween the rootlets of the glossopharyngeal
and the accessory nerves. These filaments merge after a short lateral run and form the nervous
trunk of the vagus.
The course of the nerve is very long, asimmetrical on the midline and divides into 6
segments. Up to the entrance in to the thorax, the Apertura thoracalis sup., the left and right
vagus nerves have similar syntopy. Inside the mediastinum (Mediastinum) and further down
in the abdomen striking differences are met.
The intracranial segment has a lateral course on the inner skull base. Here the nerve is
situated posterolaterally to the glossopharyngeal nerve and anterior to the flocculus of the
cerebellum, below the vestibulocochlear and above the hypoglossus nerves. As already
shown, the posterior inferior cerebellar artery (A. cerebellaris post. inf.) stretches in between
the glossopharyngeal and vagus nerves.
The cranial segment is the shortest, being that part of the nerve by which vagus nerve exits the
neurocraniums posterior fossa. The passageway is the jugular foramens antero-medial,
nervous part (Foramen jugulare, Pars nervina), shared between the encephalic nerves IX, X
and XI. In the bony orifice the nerve encounters the entering posterior meningeal artery (A.
meningea post.) and one of its own branches, the entering posterior meningeal nerve (N.
meningeus post.).
The cervical segment is much longer, and begins right under the jugular foramen. Here the
nerve is lodged in the retrostylic compartment of the lateropharyngeal space (Spatium
lateropharyngeum), anterior to the internal juglar vein (V. jugularis int.), lateral to the
pharynx and the internal carotid artery (A. carotis int.), in the company of the other two
encephalic nerves with whom it exited the posterior fossa of the skull. The nerve is also
accompanied by the main lymphatic ways of the neck (Truncus lymphaticus jugularis dexter
et sinister) and some of its own branches: throughout its cervical descent by the upper cervical
cardiac branches (Rr. cardiaci cervicales superiores) and down to the thyroid cartilage
(Cartilago thyroidea) by the superior laryngeal nerve (N. laryngeus sup.), all these emitted
just under the outer skull base. Surpassing the styloid diaphragm (Diaphragma stylica), the
nerve enters the region of the carotid trigone (Regio trigonum caroticum). Here it descends
anterior to the prevertebral sympathetic chain (Truncus sympathicus, Pars cervicalis), lateral
to the larynx (Larynx) and the esophagus (Esophagus), medial to the internal jugular vein and
posterior to the common carotid artery (A. carotis communis), enveloped together with these
large vessels by the carotid sheath (Vagina carotica). Then, below the cricoid cartilage
(Cartilago cricoidea) the nerve is to be found in the sternocleidomastoid region (regio
sternocleidomastoidea) lateral to the trachea (Trachea), maintaining its position to the great
vessels of the neck. Here the nerve passes close and parallel to the posterior edge of the
corresponding lobe of the thyroid gland (Glandula thyroidea). At the root of the neck the
syntopy of the vagus nerve changes. It is placed medial to the phrenic nerve (N. phrenicus),
posterior to the great veins and anterior to the great arteries, being crossed from anterior by
the subclavian vein (V. subclavia) and from posterior by the subclavian artery (A. subclavia).
On the right side it also comes in contact with the inferior cervical ganglion of the
sympathetic chain (Ggl. cervicale inf., or, in case, the Ggl. cervicothoracicum). On the left
side the nerve is crossed from lateral by the thoracic duct (Ductus thoracicus). Below, the
nerve is pushed anteriorly by the pleural dome (Cupula pleurae) which is its posterior.
The thoracal segment begins where the nerve passes inferiorly through the superior thoracal
opening (Apertura thoracalis superior). In the thorax the nerve descends in the mediastinum
and branches exhaustively. The endbranches of the nerves from the both sides recombine and
form an elaborate plexus surrounding the esophagus (Plexus esophageus). This plexus
contains nervous fibers of all functional types. From this plexus direct branches are sent off
for the innervation of the thoracal organs and finally, in the inferior posterior mediastinum
two main nervous trunks collect from the remaining esophageal plexus. These are the anterior
and the posterior vagal trunks (Truncus vagalis ant. et post.).
The diaphragmatic segment refers to the short passageway across the diaphragm
(Diaphragma) and concerns not the vagus nerves, but the resulting vagal trunks (Truncus
vagalis) only.
The abdominal segment is in fact retroperitoneal. From here the vagal branches may enter the
mesos to reach the target organs if they are intraperitoneal or search the retroperitonal organs
directly.
On its course, the vagus nerve develops two ganglia. The superior ganglion is the smaller,
shperical (Ggl. sup.) (Ggl. jugulare) situated extracranially, inferior the jugular foramen. This
ganglion has communicating branches with the VII-th, IX-th and the XI-th encephalic nerves.
The inferior ganglion (Ggl. inf.) (Ggl. nodosum) is larger, fusiform. This ganglion is linked by
the means of faint nervous loops with the XII-th encephalic nerve and with the cervical
sypmathetic chain.
Branches: the nerve gives off branches extracranially only:

The posterior meningeal nerve (N. meningeus post.) is a thin collateral sensitive twig,
stemming at the level of the superior ganglion. It turns upwards and penetrates the posterior
cranial fossa through the jugular foramen for innervating the meninges.

The auricular branch (R. auricularis), sensitive, also emerges from the superior ganglion. It
courses posteriorly for a short while and enters its own bony canal (Canaliculus mastoideus)
in the jugular fossa (Fossa jugularis). Te nervelet travels in the sinuous canal till its inferior
openig, the tymapnomastoid fissure (Fissura tympanomastoidea). It splits in two endbranches
and innervates the skin of the posterior side of the external auditory meatus (Meatus acusticus
ext.) and the skin of the back of the auricule (Auricula).

The R. communicans cum nervo glossopharyngeo creates a link to the XI-th encephalic
nerve.

The pharyngeal branches (Rr. pharyngei) are released from the inferior ganglion and in
addition to sensitive fibers (dendrites), contain motor fibers furnished by the accessory nerve
and vegetative efferents of the vaguss owns. The nerves descend and curve anterior crossing
from medial the internal and then the external carotid arteries to reach the lateral wall of the
pharynx. Here they split in branches which combine with the pharyngeal plexuss (Plexus
pharyngeus) other fibers of glossopharyngeal origin. The vagus nerve, by these fibers of
accessorial provenance innervates mainly the inferior constrictor muscle (M. constrictor
pharyngis inf.) and probably contributes to the motor innervation of the other pharyngeal
constrictor muscles too. The sensitive component of these nerves innervates the mucosa of the
hypopharynx (Hypopharynx), whereas the vegetative twigs act on the small salivary glands of
the same area. It is assumed that the muscles of the soft palate (Palatum molle), except the M.
tensor veli palatini also share in the vagal innervation.
The recurrent nerve (N. [laryngeus] recurrens) is a mixed, motor, sensitive and probably a
vegetative efferent nerve with different origin and course on the two sides. The right inferior
laryngeal nerve originates where the right vagus nerve crosses from anterior the right
subclavian artery (A. subclavia dextra). Then it surrounds this artery from below to posterior
and begins to ascend on the right side of the neck in the groove formed between the trachea
and the esophagus. The nerve travels in the close proximity of the medial side of the right lobe
of the thyroid gland (Lobus dexter glandulae thyroideae) upward to the larynx. The left
inferior laryngeal nerve begins more inferiorly, where the left vagus nerve crosses the aortic
arch (Arcus aortae) anteriorly. From here, the nerve ascends on the left side of the neck, in the
groove between the trachea and esophagus, more hidden than the other side due to the
rightward deviation of the esophagus. The syntopy established with the left lobe of the thyroid
gland (Lobus dexter glandulae thyroideae) is identical as on the other side. The recurrent
nerve branches exhaustively giving off twigs lateral to the trachea and on the larynx. As
shown, the recurrent nerve is morphologically linked with the superior laryngeal nerve.
The inferior laryngeal nerve or (N. laryngeus inf.) is the direct continuation of the recurrent
nerve. It penetrates the cricothyroid membrane and provides motor innervation for the major
part of the laryngeal muscles: the posterior cricoarytenoid muscle (M. cricoarytenoideus
post.), the lateral cricoarytenoid muscle (M. cricoarytenoideus lat.), the vocalis muscle (M.
vocalis), the thyroarytenoid muscle (M. thyroarytenoideus) the oblique arytenoid muscle (M.
arytenoideus obliquus) and the transverse arytenoid muscle (M. arytenoideus transversus).
The inferior laryngeal nerve also innervates the mucosa of the larynx inferior to the glottis,
supplying it sensitive innervation and probably vegetative motor innervation of its small
glands. The tracheal branches (Rr. tracheales) are intended for the innervation of the
mucosa of the trachea (sensitive, secretory) and possibly for the motor innervation of the M.
trachealis (vegetative motor) also.
The esophageal branches (Rr. esophageales) furnish sensitive and probably secretomotor
innervation for the uppermost part of the esophageal mucosa and the included glands. The
pharyngeal branches (Rr. pharyngeales) join the pharyngeal plexus (Plexus pharyngeus)
carrying fibers of all types: motor, sensitive and vegetative secretomotor.

The superior cardiac branches (Rr. cardiaci cervicales supp.) are usully detached just
below the inferior ganglion. They also can be released from the superior laryngeal nerves.
After their origin, these branches join the internal carotid artery and then the common carotid
artery. Further down the nerve on the right descends in the front of the brachiocephalic trunk
(Truncus brachiocephalicus) until the aortic arch (Arcus aortae). The nerves of both sides
split in branches which unite in the front of the aorta as the cardiac plexus (Plexus cardiacus).
This plexus will be joined by other branches of the vagus nerves (the inferior cardiac
branches) and by twigs of the cervical sympathetic chain.

The inferior cardiac branches (Rr. cardiaci cervicales inff.) are 1-2 twigs broadcasted from
the vagus nerve or from the recurrent nerve. Descending together with the superior cardiac
branches, the inferior ones have the same fate and destination, namely to break off in branches
which in turn enter the cardiac plexus. It is to be mentioned that the right vagus has a major
functional importance in the innervation of the heart.

The anterior and posterior bronchial branches (Rr. bronchiales antt. et postt.) are delicate
nerves of sensitive, secretomotor and visceral motor vegetative function. They are dispatched
in the mediastinum, from the thoracal segment of the vagus nerve, where it crosses from
anterior the principal bronchus (Bronchus principalis). These branches soonish dissipate by
breaking off into fine branches which travel along the bronchial tree and provide sensitive
innervation for the bronchial and pulmonar mucosae, vegetative secretomotor innervation for
the small mucosal glands as weel as the crucially important visceromotor innervation of the
smooth muscles of the bronchioli (Bronchioli). The vagal twigs are mixed with branches
stemming from the cevical sympathetic chain to form the pulmonary plexus (Pl. pulmonalis).

The esophageal branches (Rr. esophagei) are mixed nerves of sensitive and visceromotor
function. These nerves separate from the esophageal plexus (Pl. esophageus) and innervate
the mucosa of the esophagus in its lower 2/3-s (sensitively), its small glands (secretomotor)
and the muscular coat (visceromotor).

The gastric branches (Rr. gastrici) are mixed nerves of viscerosensitive, secretomotor and
visceromotor function. They are broadcasted in the retroperitoneum from the abdominal
segment of the vagus. However, instead of being branches of the vagus nerve, they stem from
the vagal trunks. The nervelets join the arteries of the stomach and innervate the mucosa with
sensitive afferents, the gastric glands with secretomotor efferents and for a lesser extent the
gastric smooth muscles with visceral motor efferents.

The celiac branches (Rr. celiaci) are functionally mixed twigs broadcasted in the
retroperitoneum. As the previous sets of branches, these are also of viscerosensitive,
secretomotor and visceromotor nature. The endbranches of the two (anterior and posterior)
vagal trunks mix in the visceral nervelets. Microganglia are described upon their course and
the vagal twigs are joined by sympthetic efferent fibers originating from the thoracal and the
abdominal sympathetic chain. The fine nervous fibers advance together with the arteries of the
abdominal organs to the liver (Hepar), the biliary vesicle (Vesicula biliaris), the pancreas
(Pancreas) the duodenum (Duodenum), the lesser intestine (Intestinum tenue), the kidney
(Ren) and the renal pelvis (Pelvis renalis). Similar nervelets innervate the colon (Colon seu
Intestinum crassum) on its proximal part, down to the left 1/3-rd of the transvese colon (Colon
transversum). Here, at the CANNON BOEHMs point the innervation of the digestive tract is
taken over by the sacral parasympathetic.
It is to be mentioned that the vagus effect on the innervation of the internal organs is
eminently secretory, with a certain but lesser involvement in the peristaltic motions. The
sensitive innervation is of vegetative type, diffuse and less conscious.

The N. XI . or the accessory nerve (N. accessorius)

The acessory nerve is a somitic somatomotor efferent encephalic nerve. It is unique among the
encephalic nerves by the fact that it originates from two distinct parts of the neuraxis, from the
medulla (Medulla oblongata seu Bulbus encephali) and the spinal chord (Medulla spinalis).
The main part of the nerve only innervates the trapezius and the sternocleidomastoid muscles
(M. trapezius), (M. sternocleidomastoideus). However, at its beginning, the nerve hosts much
different fibers, regarding both their origin and their function: branchial visceromotor
efferents. This component is soonish ceded to the nerve where it truly belongs, the vagus
nerve.
The proper origin lies in the medulla, in the ambiguus nucleus (Nc. ambiguus) and the
ventral horn (Cornu ant.) in the 1-6 cervical segments of the spinal chord. This latter part of
the spinal grey matter is the direct caudal continuation of the Nc. ambiguus.
The apparent origin is situated in the lower third of the retroolivar groove of the medulla
(sulcus retroolivarius) and its downward continuation on the spinal chord, the Sulcus postero-
lat. The encephalic part of the nerve begins with 3-6 rootlets (Fila radicularia), joined
together in the cranial root (Radix cranialis n.-i accesssorii) (Pars vagalis). The spinal
component stems with up to 6 groups of rootlets, united by the longitudinal spinal root (Radix
spinalis n.-i accessorii). The spinal root climbs on the lateral surface of the spinal chord and
enters the Foramen magnum behind the vertebral artery (A. vertebralis) to join the cranial
root.
The course of the accessory nerve is divided in an intracranial and an extracranial segment.
The intracranial segment commences where the nerve itself begins: lateral to the medulla, in
the proximity of the Foramen jugulare, where the two roots merge to form the bulk of the
nerve (Truncus n.-i accessorii). The nerve exits the posterior cranial fossa in the company of
the vagus nerve through the jugular foramen.
The extracranial segment begins just under the outer skull base (Basis cranii ext. seu
Exobasis). The nerve is placed anterior to the internal jugular vein, posterior to the internal
carotid artery and lateral to the glossopharyngeal, vagus and hypoglossus nerves. Here the
accessory nerve immediately splits into its two endbranches.
Branches: the nerve emits o collateral branches, instead it bifurcates right below the
jugular foramen into an internal and an external branch.

The internal branch (R. internus) is short and joins the vagus nerve. It carries the
branchial visceromotor efferent component of the accessory nerve, originating in its
encephalic nucleus. These fibers will be broadcasted as the vagus owns to the larynx and the
hypopharynx, for the striated muscles located there. This branch, regarding its real origin and
destination behaves as an aberrant division of the vagus nerve.

The external branch (R. externus) is composed of the spinal division of the accessory
nerve. It has an oblique, posterior and lateral course and crosses the occipital artery (A.
occipitalis). The nerve approaches from medial the upper insertion area of the
stranocleidomastoid muscle and travels further posteriorly on its deep surface. Then it reaches
the deep (anterior) surface of the trapezius muscle and descends obliquely covered by the
lateral margin of this. The nerve gradually tapers emitting muscular branches to these muscles
(Rr. musculares). This branch ends at approximately two fingerwidths above the clavicle
(Clavicula) where its last muscular branch vanishes by penetrating the muscular mass of the
trapezius.

The N. XI I . or the hypoglossal nerve (N. hypoglossus)

The hypoglossal nerve is a somitic somatomotor efferent encephalic nerve. Its endbranches
contain proprioceptive fibers also, but they are transferred to other cranial nerves with
sensitive function. This nerve innervates the muscles of the tongue, all of the intrinsic ones
and several of the extrinsic ones, as follows:

the genioglossus muscle (M. genioglossus),
the hyoglossus muscle (M. hyoglossus),
the styloglossus muscle (M. styloglossus),
the superior longitudinal muscle of the tongue (M. longitudinalis sup.),
the inferior longitudinal muscle of the tongue (M. longitudinalis inf.),
the transverse muscle of the tongue (M. transversus linguae) and
the vertical muscle of the tongue (M. verticalis linguae) and, additionally
the geniohyoideus muscle (M. geniohyoideus).

The proper origin lies in the medulla, in the hypoglossal nucleus (Nc. n.-i hypoglossi).
The apparent origin is situated in the preolivar groove of the medulla (sulcus preolivarius)
with 10-15 rootlets (Fila radicularia), joined together in the trunk of the nerve.
The course of the hypoglossal nerve is divided in an intracranial, a cranial and a cervical
segment. The intracranial segment, situated in the posterior cranial fossa, commences where
the nerve itself begins: anterolateral to the medulla, where the rootlets fuse to form the bulk of
the nerve. Thence, the nerve draws laterally, posterior to the vertebral artery (A. vertebralis)
that it crosses.
Entering its own bony canal, the Canalis nervi hypoglossi, the nerve is to be found in its
second, cranial segment, being accompanied by a satellite vein and the appended venous
plexus (V. canalis hypoglossi). Here a vestigial, rudimentar artery, the hypoglossal artery (a.
hypoglossica) might be also present, anastomotically linking the external and internal carotid
arterial systems.
The cervical segment begins under the outer skull base (Basis cranii ext. seu Exobasis). Here
the hypoglossal nerve is placed anterior to the internal jugular vein, posterior to the internal
carotid artery and lateral to the glossopharyngeal and the vagus nerves and medial to the
accessory nerve. Here the hypoglossal nerve receives a communicating nervous trunk built up
by some somatomotor branches issued by the 1-st and the 2-nd cervical spinal nerves.
Enriched with these fibers only temporally, the nerve winds forward and descend following
for a while medially the posterior belly of the digastric muscle (Venter posterior, M.
digastricus). Then the nerve arches to variable extent below this muscle and around the
commencement of the occipital artery (A. occipitalis), then crossing from lateral the external
carotid (A. carotis ext.) and the lingual (A. lingualis) arteries penetrates the vertical slit
between the hyoglossus and mylohyoideus muscles (M. hyoglossus, M. mylohyoideus).
Branches: the nerve discards the fibers accepted from the first two cervical spinal nerves,
gives off muscular twigs, establishes connections by the means of communicating branches
and ends by being dispersed in the tongue.

The superior root of the cervical loop (Radix sup. ansae cervicalis (profundi))
equals the descendent cervical branch of the hypoglossal nerve and is detached in the carotid
triangle (Regio trigonum caroticum). This is a connection to the system of the cervical plexus
(Plexus cervicalis), containing somatomotor efferents (axons) from the upper two cervical
segments of the spinal chord. This bundle is completed from below by the inferior root of the
cervical loop (Radix inf. ansae cervicalis (profundis)) built up by some ascending fibers
originating from the 2-nd and the 3-rd cervical spinal nerves. The upper and the lower roots
unite in the Ansa cervicalis (profunda) at the level of the intermediate tendon of the omohyoid
muscle (M. omohyoideus), lateral to the common carotid artery (A. carotis comm.). From the
convexity of this nervous complex, muscular branches are issued for the motor (somitic
somatomotor and perhaps proprioceptive too) innervation of the infrahyoid muscles: M.
thyrohyoideus, M. sternothyroideus and M. sternohyoideus. As demonstrated, functionally and
systematically these fibers are not of the hypoglossal nerves own, they are just parasitising it.
The Ansa cervicalis (profunda) should be differentiated to the Ansa cervicalis (superficialis),
a belonging of the facial nerve.

The lingual branches (Rr. linguales) are the muscular branches of the nerve for the
muscles listed above, providing a strictly unilateral innervation. Proprioceptive dendrites are
also hosted in these otherwise efferent twigs. After a short run, these dendrites are ceded to
where they belong, the trigeminal system. (see below)

The communicant branches (Rr. communicantes) contain the nerve fibers exchanged
with other nerves. These include the cervical plexus, the upper cervical sympathetic ganglion,
the vagus nerve and the lingual nerve. (see above)