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Facial Nerve (VII), IX & XII

Oral Biology

Alex Forrest
Associate Professor of Forensic Odontology Forensic Science Research & Innovation Centre, Griffith University Consultant Forensic Odontologist, Queensland Health Forensic and Scientific Services, 39 Kessels Rd, Coopers Plains, Queensland, Australia 4108

Learning Objectives

VII - Facial Nerve

You should be able to describe VII and its importance in dental practice. You should be able to understand and explain the role of IX in the innervation of the tongue and oropharynx, and the importance of the gag reflex. You should be able to understand and explain the role of X in the innervation of the oropharynx. You should understand the basic functions of XII. You should be able to discuss the cervical plexus and its branches. This session considers the facial nerve, cranial nerve VII. This nerve is important to a dentist because it can inadvertently be anaesthetized while an inferior dental block injection is being performed.

VII - Facial Nerve

Learning Objectives

It can be injured both from trauma and from surgery. There are various conditions that can affect this nerve. We need to know its structure and its functions, so we can diagnose problems and predict and manage the outcomes in our patients.

You should be able to understand and explain the structural and functional aspects of the anatomy of VII You should be able to understand and explain in detail the role of the chorda tympani in taste and innervation of major and minor salivary glands

Learning Objectives

VII - Facial Nerve

You should understand and be able to explain the causes, consequences and management of accidental anaesthesia of VII.

The facial nerve contains a small general sensory component which provides common sensation to parts of the external ear, and also a special sensory component which is responsible for innervating taste buds.

VII - Facial Nerve

Facial Nerve Origin

The somatic motor component (the largest part of this nerve) provides the motor supply to the muscles of facial expression and other muscle derivatives of the second branchial arch. There is a parasympathetic secretomotor component that travels with both the facial nerve and lingual nerve of the trigeminal nerve to the sublingual, submandibular and lacrimal glands.

The Facial Nerve arises from the pons caudal to the trigeminal nerve, close to the position of the internal acoustic meatus through which it passes with VIII.
From Grays Anatomy, Longman, London, 35th Edition, 1973. p 1012.

Facial Nerve Origin

It comprises two roots - a larger motor root and a smaller sensory root. The motor root is simply named the motor root of VII, but the sensory root is sometimes called nervus intermedius because it lies sandwiched between the motor root of VII and the trunk of VIII in this location.

VII - Facial Nerve

The large motor root carries the motor fibres to the muscles of facial expression, the posterior belly of the digastric muscle, the stapedius and the stylohyoid, because all of these structures are derived from the second branchial arch.

From Grays Anatomy, Longman, London, 35th Edition, 1973. p 1012.

VII - Facial Nerve

VII - Facial Nerve

The sensory root carries general sensory fibres to parts of the external ear, and also carries the special sensation of taste to the anterior two-thirds of the tongue and also to the palate.

The sensory root contains some parasympathetic secretomotor fibres as well, and these supply the submandibular and sublingual salivary glands, as well as the lacrimal glands and the minor mucous glands of the nose and palate.

Facial Nerve Origin

The motor root and nervus intermedius run together with the vestibulocochlear nerve (VIII, also known as the auditory nerve) into the internal acoustic meatus in the temporal bone. The facial nerve runs superiorly to VIII in a groove along its upper surface.

Facial Nerve Origin

The facial nerve and the vestibulocochlear nerves soon separate in their courses. VIII moves off towards the inner ear, but the two roots of VII join soon after it enters the internal acoustic meatus, and they continue as a single nerve trunk in the facial canal which angles obliquely forwards through the petrous temporal bone.

From Grays Anatomy, Longman, London, 35th Edition, 1973. p 1012.

From Grays Anatomy, Longman, London, 35th Edition, 1973. p 1012.

Facial Nerve Course

VII - Facial Nerve

The nerve runs forward and laterally in the facial canal until it comes close to the cavity of the middle ear. At this point, it turns sharply posteriorly and inferiorly and heads downwards towards the stylomastoid foramen.

At the bend, the nerve trunk becomes swollen into the geniculate ganglion, where the nerve cell bodies of the somatic sensory nerves are stored. The bend is given the name external genu, after the Latin word for knee, genu (from which the word genuflect comes).
From Grays Anatomy, Longman, London, 35th Edition, 1973. p 1012.

VII - Facial Nerve

As the facial nerve reaches the external genu, it gives off an important branch called the greater petrosal nerve, or sometimes the greater superficial petrosal nerve. This nerve arises from the geniculate ganglion.
From Grays Anatomy, Longman, London, 35th Edition, 1973. p 1012.

VII - Facial Nerve

Fibres from this ganglion are mainly taste fibres for the palate, but it contains parasympathetic secretomotor fibres for the lacrimal gland and minor salivary glands as well.

VII - Facial Nerve

VII - Facial Nerve

It continues underneath the trigeminal ganglion to run over the roof of foramen lacerum towards a small canal in its anterior wall of foramen lacerum called the pterygoid canal which opens into the pterygopalatine fossa.

The greater petrosal nerve runs forward and medially in a small canal to emerge from a tiny hole on the cranial surface of the petrous temporal bone called the hiatus for the greater superficial petrosal nerve, and runs medially and slightly anteriorly in a groove in the floor of the middle cranial fossa.
From Grays Anatomy, Longman, London, 35th Edition, 1973. p 1012.

From Grays Anatomy, Longman, London, 35th Edition, 1973. p 1012.

VII - Facial Nerve

VII - Facial Nerve

From Grays Anatomy, Longman, London, 35th Edition, 1973. p 1006.

From Grays Anatomy, Longman, London, 35th Edition, 1973. p 1006.

Here the parasympathetic secretomotor fibres for the lacrimal gland and the minor salivary glands of the palate and upper lip synapse, and their postganglionic fibres follow the branches of the trigeminal nerve to get to their final destinations.

Taste fibres do not synapse in the pterygopalatine ganglion because they are not parasympathetic fibres, but pass to the palate via the greater and lesser palatine nerves of V2.

VII - Facial Nerve

VII - Facial Nerve

After the external genu, the trunk of the facial nerve turns backwards and downwards to run towards the stylomastoid foramen. When it is about 5-6 mm from this foramen, and still in the facial canal, it is very closely related to the cavity of the middle ear, which sits just anterior to it.

From Grays Anatomy, Longman, London, 35th Edition, 1973. p 1006.

Parasympathetic secretomotor fibres to glands of the nasal cavity travel in the sphenopalatine nerve.

From Grays Anatomy, Longman, London, 35th Edition, 1973. p 1012.

VII - Facial Nerve

Chorda Tympani

In this position, the facial nerve is vulnerable to damage arising from operations performed on the middle ear. Here, it gives off a small but very important branch called the chorda tympani.
From Grays Anatomy, Longman, London, 35th Edition, 1973. p 1012.

This small nerve provides the parasympathetic secretomotor fibres to the submandibular and sublingual salivary glands and to the minor glands of the floor of the mouth, as well as providing taste fibres to the anterior two-thirds of the tongue.

Facial Nerve
It does this by "hitching a ride" with the lingual nerve of V3. However, it needs to get to the lingual nerve, and at this point it is still deep within the temporal bone.
From Grays Anatomy, Longman, London, 35th Edition, 1973. p 1008.
From Grays Anatomy, Longman, London, 35th Edition, 1973. p 1008.

Facial Branches

Facial Branches

Once it is in the parotid gland, the nerve gives off motor branches to the posterior belly of the digastric and stylohyoid muscles.

The nerve now gives off five major branches that spread to cover the face.

Scott JH & Dixon AD. Anatomy for Students of Dentistry. 3rd Edition, Churchill Livingstone, Edinburgh, 1972. p. 512

Facial Branches

Paralysis

They contain the bulk of the motor fibres of the large motor root of this nerve, and they are distributed to the muscles of facial expression to which they supply motor function.

Paralysis of this nerve can therefore occur if one inadvertently deposits local anaesthetic solution into the parotid gland.

Paralysis

Paralysis

Sometimes a deep lobe of the gland occurs close to the position where the inferior dental block is to be administered.

When this happens, all the branches of the facial nerve in the gland become anaesthetized, resulting in facial paralysis on the affected side.

Modified from: Haglund, J. & Evers, H Local Anaesthesia in Dentistry, Astra Lkemedel Sdertlje, 2nd Edition, 1975. p. 52.

Illustrated Handbook in Local Anaesthesia, Ed: E. Eriksson, Munksgaard, Denmark, 1969, p.67.

Motor Supply

These branches supply motor fibres to muscles of facial expression in their immediate vicinity.

IX Glossopharyngeal Nerve

IX - Glossopharyngeal Nerve

The glossopharyngeal nerve exits the upper part of the medulla oblongata below the pons by a few filaments which contain both sensory and motor fibres. It supplies motor fibres to stylopharyngeus, secretomotor fibres to the parotid gland, and sensory fibres to the pharynx, tonsil, and the back of the tongue. It also supplies taste fibres to the posterior 1/3 of the tongue.

From Grays Anatomy, Longman, London, 38th Edition, 1989. p 1119.

IX - Glossopharyngeal Nerve

IX - Glossopharyngeal Nerve

Sensory nuclei :
nucleus of the solitary tract (taste) nucleus of the spinal tract (common sensation)

Motor nuclei :
nucleus ambiguus inferior salivatory nucleus (parotid gland) Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, Ciba-Geigy Medical, Plate 120.

The nerve leaves the cranium through the anterior part of the jugular canal together with X and XI, and becomes covered in a layer of dura mater as it approaches the opening of the canal.

IX - Glossopharyngeal Nerve

IX - Glossopharyngeal Nerve

Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, Ciba-Geigy Medical, Plate 120.

As it passes through the canal, it features two small swellings called the jugular or superior, and petrosal or inferior ganglia.

The superior ganglion is regarded as a detached part of the larger inferior one so they basically make up one single classical sensory ganglion between them, and they therefore contain the cell bodies of the sensory fibres.
Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, Ciba-Geigy Medical, Plate 119.

Tympanic Branch of IX

Tympanic Branch of IX

The tympanic branch is a tiny branch given off just after IX leaves the jugular canal.

Modified from: McMinn, R & Hutchings, R. A Colour Atlas of Human Anatomy. Wolfe Medical Publication, Netherlands, 2nd Edition 1988. p.58.

Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, Ciba-Geigy Medical, Plate 119.

If you look carefully on a skull, you may see a small foramen in between the jugular canal and the carotid canal, and it is through this foramen that the tympanic branch passes into the tympanic canaliculus.

Tympanic Branch of IX
The tympanic canaliculus takes the tympanic nerve up to the middle ear, and here it joins with a branch of the facial nerve (VII) to form the tympanic plexus in the wall of the middle ear.
Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, Ciba-Geigy Medical, Plate 119.

Tympanic Branch of IX
The most important branch of this plexus is the lesser superficial petrosal nerve, which contains parasympathetic secretomotor fibres from IX originating in the inferior salivatory nucleus.

Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, Ciba-Geigy Medical, Plate 119.

Lesser Petrosal Nerve

Lesser Petrosal Nerve

It runs in a small canal to appear on the floor of the middle cranial fossa just laterally to the hiatus for the greater superficial petrosal nerve.
From Grays Anatomy, Longman, London, 38th Edition, 1989. p 1107.

Here it lies in a small groove, parallel and just laterally to the greater petrosal nerve, and passes through foramen ovale or sometimes through the canaliculus innominatus, which lies medial to foramen spinosum.

From Grays Anatomy, Longman, London, 38th Edition, 1989. p 1107.

Lesser Petrosal Nerve

Lesser Petrosal Nerve

It turns inferiorly to pass through the canal or foramen, and then runs to the otic ganglion, a parasympathetic ganglion associated with the mandibular division of the trigeminal nerve which lies deep to the main nerve trunk.
From Grays Anatomy, Longman, London, 38th Edition, 1989. p 1105.

Postganglionic secretomotor fibres then run in the auriculotemporal nerve to reach and supply the parotid gland.

From Grays Anatomy, Longman, London, 38th Edition, 1989. p 1105.

Tonsillar Branches

Lingual Branches

The tonsillar branches ramify to form a plexus in the region of the palatine tonsil, and are distributed to provide sensation in the upper part of the pharyngeal wall and around the auditory tube. They are not important to us in this course.

The lingual branches run deep to the hyoglossus muscle of the tongue, and supply general sensation and taste to the posterior one-third of the tongue.

From Grays Anatomy, Longman, London, 38th Edition, 1989. p 1119.

X - Vagus Nerve

X Vagus Nerve

This nerve contains both sensory and motor components, and has a wider distribution than any other cranial nerve. The term vagus means wandering. It does not feature separate sensory and motor roots, but it does have sensory ganglia like IX.

X - Vagus Nerve

X - Vagus Nerve

Its sensory fibres are distributed to the larynx and epiglottis. It also contains visceral components distributed to the autonomic muscles of the heart, bronchi, and most of the digestive tract, and also some taste fibres. It provides motor innervation to the muscles of the larynx, and is important in speech.

The vagus nerve leaves the cranium through the jugular canal with IX and XI. It has two ganglia like IX. The superior ganglion lies in the jugular canal, and the inferior ganglion is found after the nerve exits the canal. Both ganglia contain the nerve cell-bodies of somatic sensory fibres.

It supplies sensory and motor functions to the larynx allowing us to speak. It works closely with V, VII, IX and XII to allow us to articulate words properly.

It helps control the heart rate, innervates the organs of respiration, and has sensors to help control the blood pressure.

From Grays Anatomy, Longman, London, 38th Edition, 1989. p. 1117

From Grays Anatomy, Longman, London, 38th Edition, 1989. p. 1117

It helps us control digestion and the movement of food through most of the digestive tract as far down as the mid-colon. The distribution of the vagus in the thorax and abdomen need not be known.

XII Hypoglossal Nerve

From Grays Anatomy, Longman, London, 38th Edition, 1989. p. 1117

XII - Hypoglossal Nerve

XII - Hypoglossal Nerve

The hypoglossal nerve also arises from the medulla as a series of filaments, which pass behind the vertebral artery to form a common nerve trunk. This nerve trunk exits the cranial cavity through the anterior condylar (hypoglossal) canal.

It descends in the carotid sheath and turns forwards to hook around the origin of the occipital artery. It passes deep to stylohyoid and enters the floor of the mouth between mylohyoid and hyoglossus muscles.

From Grays Anatomy, Longman, London, 38th Edition, 1989. p 1119.

XII - Hypoglossal Nerve

XII - Hypoglossal Nerve

It communicates with the lingual nerve and then penetrates the tongue below the sublingual gland. It supplies the intrinsic and all the extrinsic muscles of the tongue except the palatoglossus, which is supplied by XI via the pharyngeal plexus.
From Grays Anatomy, Longman, London, 38th Edition, 1989. p 1119.

It is responsible for most movements of the tongue and plays a critical role in speech and mastication. If it is injured, the tongue deviates towards the damaged side when it is stuck out. Why do you think this might be?

Nerve Plexi

Cervical Plexus

When spinal nerves exit the vertebral column, they split into dorsal and ventral rami. In general, the ventral rami are larger than the dorsal ones. In the thoracic region, the ventral rami run independently of each other and they retain, like all dorsal rami, a more-or-less segmental distribution.

Nerve Plexi

Cervical Plexus

There are 8 cervical spinal nerves. However, in the cervical, lumbar and sacral regions, they unite near their origins to form plexuses. The ventral rami of the upper 4 of these unite to form the cervical plexus. Those of the lower 4 unite with part of the ventral ramus of the first thoracic nerve to form the brachial plexus.
http://www.esb.utexas.edu/quinn/Bio416K/Nervous%20 system/Anat%2014.7.jpeg

http://www.esb.utexas.edu/quinn/ Bio416K/Nervous%20system/Ana t%2014.7.jpeg

Cervical Plexus

Cervical Plexus

Note that each nerve in the cervical plexus receives at least one grey ramus communicans from the sympathetic chain. The upper four nerves receive theirs from the superior cervical ganglion, while the 5th and 6th receive theirs from the middle cervical ganglion.
http://www.bartleby.com/107/Images/large/image844.gif

The cervical plexus is formed by the ventral rami of the upper four cervical spinal nerves. It supplies branches to some of the muscles of the neck, and to parts of the skin of the head, neck and chest.
http://imc.gsm.com/integrated/haonline/haonline/ha/figimgs/25_3.gif

Cervical Plexus

Cervical Plexus

To make it easier to understand, we divide the branches into superficial and deep groups: superficial branches
ascending descending

Superficial Ascending Branches:

Lesser Occipital Nerve Great Auricular Nerve Transverse Cervical Nerve

Superficial Descending Branches:

Medial Supraclavicular Nerve Intermediate Supraclavicular Nerve Lateral Supraclavicular Nerve

deep branches
ascending descending
Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p.1128

Superficial Ascending Branches:

Lesser Occipital Nerve Great Auricular Nerve Transverse Cervical Nerve

Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p.1129 Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p.1128

Superficial Descending Branches:

Medial Supraclavicular Nerve Intermediate Supraclavicular Nerve Lateral Supraclavicular Nerve

Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p.1129 Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p.1128

Cervical Plexus

Medial Deep Branches:

communicating branches with X & XII
muscular branches inc. phrenic nerve & inferior root of ansa cervicalis

Lateral Deep Branches:

communicating branches with XI muscular branches Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p.1128

Superficial Ascending Branches

Lesser Occipital Nerve It loops around the accessory nerve XI and ascends along the posterior border of the sternocleidomastoid muscle. It passes upwards on the side of the head behind the auricle of the ear, where it supplies skin in this region.

Superficial Ascending Branches

Great Auricular Nerve It curves around the posterior border of sternocleidomastoid muscle, just like the lesser occipital and ascends on sternocleidomastoid beneath the platysma muscle with the external jugular vein up to the parotid gland, where it divides into an anterior and a posterior branch.

Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p.1129

Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p.1129

Superficial Ascending Branches

Great Auricular Nerve The anterior branch supplies the skin of the face in the region overlying the parotid gland. The posterior branch supplies skin over the mastoid process and the lower 2/3 of the back of the auricle, as well as the lobule and the concha of the ear.

Superficial Ascending Branches

Transverse Cervical (Cutaneous) Nerve This nerve curves around the posterior border of sternocleidomastoid to run obliquely forwards deep to the external jugular vein to reach the anterior border of this muscle.

Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p.1129

Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p.1129

Superficial Ascending Branches

Superficial Ascending Branches

Transverse Cervical (Cutaneous) Nerve Then it penetrates the deep cervical fascia and divides into ascending and descending branches deep to the platysma.

Transverse Cervical (Cutaneous) Nerve The ascending branches pass upwards to form a plexus with the cervical branch of VII, and some pass through platysma to supply the skin of the upper and front parts of the neck. They sometimes also form an accessory nerve supply to the lower incisor teeth. The descending branches pierce platysma to supply the skin on the front and sides of the neck, as far down as the sternum.
Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p.1129

Superficial Descending Branches

Superficial Descending Branches

Medial Supraclavicular Nerves These supply skin down to the second rib, and medially to the midline.

Intermediate Supraclavicular Nerves These supply skin overlying pectoralis major and the deltoid muscle.

Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p.1129

Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p.1129

Superficial Descending Branches

Deep Branches

Lateral Supraclavicular Nerves These supply skin over the upper and posterior parts of the shoulder.

Ansa Cervicalis Two components:

Descendens hypoglossi (superior root) Descendens cervicalis (inferior root)

Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p.1129

Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p.1128

Deep Branches

Deep Branches

Ansa Cervicalis Motor to all the infrahyoid strap muscles with the exception of the thyrohyoid, which is supplied by C1 via a branch which travels with the hypoglossal nerve.

Phrenic Nerve This is the only source of motor innervation to the diaphragm. It arises mainly from C4, but receives contributions from C3 and C5. Three, four and five Keep the diaphragm alive!
Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p.1128

Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p.1128

The End