GOOD MORNING

NERVE SUPPLY OF HEAD

AND NECK
-KOMAL GHIYA
 CONTENTS
 CRANIAL NERVES
 NERVE SUPPLY OF NECK REGION
 POSTEIOR TRIANGLE OF NECK
 ANTERIOR TRIANGLE OF NECK
 BACK OF NECK
 NERVE SUPPLY OF HEAD
 CUTANEOUS NERVE SUPPLY
 NERVE SUPPLY OF SCALP
 NERVE SUPPLY OF FACE
 NERVE SUPPLY OF STRUCTURES RELATED TO ORAL CAVITY
 INNERVATION OF MUSCLES OF MASTICATION
 INNERVATION OF SUPRAHYOID MUSCLES
 LARYNX
 TONSILS
 TONGUE
 SOFT PALATE
 HARD PALATE
 TEETH
 SALIVARY GLANDS
 REFERENCES
CRANIAL NERVES
 1-----OLFACTORY
 2----OPTIC
 3----OCCULOMOTOR
 4----TROCHLEAR
 5----TRIGEMINAL
 6---ABDUCENT
 7----FACIAL
 8---VESTIBULOCOCHLEAR
 9---GLOSSOPHARYNGEAL
 10----VAGUS
 11----ACCESSORY
 12----HYPOGLOSSAL

 OLFACTORY NERVE:TERMINATE IN ANTERIOR CRANIAL FOSSA

 OPTIC:MIDDLE CRANIAL FOSSA
 3 TO 12 CRANIAL NERVE PASS THROUGH POSTERIOR CRANIAL FOSSA
 OLFACTORY NERVE
 The olfactory nerve [I] carries special afferent (SA) fibers for the sense of
smell. Its sensory neurons have:
 peripheral processes that act as receptors in the nasal mucosa; and
 central processes that return information to the brain
 CLINICAL APPLICATIONS: DAMAGE: ANOSMIA
 CAUSE:
 Injury to the cribriform plate; congenital absence

REF:S Standring in Gray’s anatomy 40 th edition

 OPTIC NERVE

 Optic nerve [II]

 The optic nerve carries SA fibers for vision.
 These fibers return information to the brain from photoreceptors in the
retina.
 nerves enter the cranial cavity through the optic canals

 CLINICAL APPLICATIONS:
DAMAGE RESULTS IN COMPLETE BLINDNESS OF EYE

REF:S Standring in Gray’s anatomy 40 th edition

 OCCULOMOTOR NERVE
 The oculomotor nerve [III] carries two types of fibers:
 general somatic efferent (GSE) fibers innervate most of the extra-ocular
muscles;
 general visceral efferent (GVE) fibers are part of the parasympathetic part.

REF:S Standring in Gray’s anatomy 40 th edition

 NERVE SUPPLY OF OCULAR MUSCLES

OCCULOMOTOR
NERVE
TROCHLEAR ABDUCEN
NERVE T NERVE
SUPERIOR
INFERIOR DIVISION
DIVIVSION

SUPERIOR LATERAL
INFERIOR RECTUS OBLIQUE RECTUS
LPS
MEDIAL RECTUS
SUPERIOR RECTUS
INFERIOR OBLIQUE

REF:B D Chaurasia in Human Anatomy,vol 3,fourth edition

Clinical applications
Abducent nerve Trochlear nerve Occulomotor nerve
Fully adducted eye (due Inability to look Ipsilateral slowness of
to unopposed MR)results downward when eye is pupillary response to light
into internal strabismus adducted Loss of pupillary reflex
Inability to abduct eye Diplopia on looking down Dilation of pupil
Diplopia in all ranges of Loss of accommodation
movement of the eyeball External strabismus
on lateral gaze except on ptosis
looking to the side
opposite to lesion(i.e on
normal side)

REF:B D Chaurasia in Human Anatomy,vol 3,fourth edition

REF:P Abrahams,S Marks,R Hutching in Mc Minn’s colour atlas,Fifth edition,2003
TROCHLEAR NERVE

 CROSSED CRANIAL NERVE

 FIBRES ORIGINATE COMPLETELY FROM CONTRALATERAL NUCLEUS
 LONGEST INTRACRANIAL NERVE
 MOST SLENDER CRANIAL NERVE
 PURE MOTOR NERVE
 SUPPLIES:SUPERIOR OBLIQUE MUSCLE

REF: B D Chaurasia in Human Anatomy,vol 3,fourth edition

CLINICAL APPLICATIONS
 When trochlear nerve is damaged ,diplopia occurs on looking
downwards;vision is single so long as the eyes look above horizontal plane.
 Rare condition

REF: B D Chaurasia in Human Anatomy,vol 3,fourth edition

TRIGEMINAL NERVE
NUCLEI

SPINAL NUCLEUS:continuous
superiorly with sensory
MAIN SENSORY nucleus and extends inferiorly
NUCLEUS:SITUATED IN PONS in medulla oblongata and
upper part of spinal cord as far
as 2nd cervical (c2 )segment

MESENCEPHALIC NUCLEUS:
composed of column of
MOTOR NUCLEUS:Situated in unipolar nerve cells situated in
pons medial to main sensory lateral part of grey matter
nucleus around cerebral aqueduct .it
extends inferiorly into pons as
far as main sensory nucleus

REF:S Malamed in Handbook of Local Anesthesia ,Fifth edition,2011

 MOTOR :SUPPLIES SENSORY DIVISION:
 MASTICATORY: OPTHALMIC DIVISION:SUPPLIES
 MASSETER EYEBALL,CONJUCTIVA,LACRIMAL

 TEMPORALIS GLAND,PART OF MUCOUS

 PTERYGOIDEUS MEDIALIS MEMBRANE OF NOSE,PARANASAL

SINUSES,SKIN OF FOREHEAD,EYELIDS, NOSE
 PTERYGOIDEUS LATERALIS
 MYLOHYOID MAXILLARY DIVISION
 ANTERIOR BELLY OF DIGASTRIC
MANDIBULAR DIVISION
 TENSOR TYMPANI
 TENSOR VELI PALATINI

REF:S Malamed in Handbook of Local Anesthesia ,Fifth edition,2011

Clinical application

Testing trigeminal
nerve

MOTOR:
On clenching of teeth the REFLEX:
Sensory:loss of ability to temporal & masseter muscle Loss of sneezing reflex
recognize should stand out with equal Loss of corneal reflex
light,touch,thermal&pain prominence on both side;if there
is paralysis the muscle on that Afferent:nasociliary
sensation in face branch of ophthalmic
side will fail to become
prominent division of 5 th nerve
On opening mouth jaw will Efferent:facial nerve
deviate towards normal side
being pushed over by healthy
lateral pterygoid muscle

REF: B D Chaurasia in Human Anatomy,vol 3,fourth edition

Corneal reflex
 Ask the patient to look up and away from you.Bring a piece of cotton wool
twisted to a point in to touch the cornea from the side .Watch both eyes
close.If there is a unilateral facial palsy the sensation of the cornea can be
demonstrated if the opposite eye is watched. Absent corneal reflex can be an
early and objective sign of sensory trigeminal lesion.

Corneal reflex

Failure of only one Subjective reduction

side to contract=VII in corneal
Failure of either lesion sensation=partial V1
side of face to
contract=V1lesion

REF:B D Chaurasia in Human Anatomy,vol 3,fourth edition

 Maxillary nerve

WITHIN CRANIUM PTERYGOPALATINE INFRAORBITAL FISSURE FACE

FOSSA
SUPERIOR EXTERNAL INFERIOR
Middle ANTERIOR SUPERIOR MIDDLE
meningeal ALVEOLAR SUPERIOR LABIAL NASAL PALPEBRAL
nerve ALVEOLAR
ZYGOMATIC PTERYGOPALATIN POSTERIOR SUPERIOR
E ALVEOLAR

PALATINE PHARYNGEAL
ORBITAL NASAL BRANCHES
BRANCHES
BRANCHES BRANCHES
REF:S Malamed in Handbook of
MIDDLE PALATINE Local Anesthesia ,Fifth
GREATER PALATINE
LESSER PALATINE
POSTERIOR PALATINE edition,2011
1 posterior superior alveolar
2infraorbital nerve nerve
3maxillary nerve
4foramen rotundum nerve
5greater palatine nerve
6nasopalatine nerve
REF:S Malamed in Handbook of Local Anesthesia ,Fifth
MANDIBULAR NERVE

UNDIVIDED DIVIDED NERVE TRUNK

NERVE TRUNK

NERVE TO MEDIAL ANTERIOR DIVISION

PTERYGOID POSTERIOR
DIVISION
DEEP BUCCAL MASSETRIC NERVE TO
TEMPORAL
LATERAL
PTERYGOID

LINGUAL NERVE
INFERIOR ALVEOLAR
AURICULOTEMPORAL
NERVE
NERVE

MENTAL NERVE INCISIVE NERVE TO MYLOHYOID

NERVE

REF:S Malamed in Handbook of Local Anesthesia ,Fifth edition,2011

REF:S Malamed in Handbook of Local Anesthesia ,Fifth edition,2011
CLINICAL APPLICATION
 THE MOTOR PART OF MANDIBULAR NERVE IS TESTED CLINICALLY BY ASKING
THE PATIENT TO CLENCH HIS/HER TEETH AND THEN FEEELING FOR THE
CONTRACTING MASSETER AND TEMORALIS MUSCLES ON TWO SIDES.ACTIVITY
OF PTERYGOID IS TESTED BY ASKING PATIENT TO MOVE CHIN FROM SIDE TO
SIDE
 REFFERED PAIN:IN CASES WITH CANCER OF TONGUE,PAIN RADIATES TO THE
EAR AND TO TEMPORAL FOSSA ,OVER DISTRIBUTION OF AURICULOTEMPORAL
NERVE
 MANDIBULAR NEURALGIA:TRIGEMINAL NEURALGIA OF THE MANDIBULAR
DIVISION IS OFTEN DIFFICULT TO TREAT.
 LINGUAL NERVE LIES IN CONTACT WITH THE MANDIBLE MEDIAL TO THIRD
MOLAR.IN EXTRACTION ,CARE MUST BE TAKEN NOT TO INJURE LINGUAL NERVE

REF: B D Chaurasia in Human Anatomy,vol 3,fourth edition

REF:S Standring in Gray’s anatomy 40 th edition
 ACCESORY NERVE

ACCESORY NERVE

SPINAL CRANIAL

PHARYNX EXCEPT
STYLOPHARYNGEUS
STERNOCLIEDOMASTOID TRAPEZIUS
SOFT PALATE EXCEPT
TENSOR VELI PALATINI

REF: B D Chaurasia in Human Anatomy,vol 3,fourth edition

CLINICAL APPLICATIONS
 TORTICOLLIS/WRY NECK:
 ABNORMAL SUSTAINED CONTRACTION OF THE
MUSCULATURE(STERNOCLIEDOMASTOID AND TRAPEZEUS) SUPPLIED BY THE
SPINAL ACCESSORY NERVE CAUSING THE HEAD TO BE PULLED TO ONE SIDE
 HEAD IS BENT TO ONE SIDE AND THE CHIN POINTS TO THE OTHER

 ACCESSORY NERVE PARALYSIS:cause stab wounds;spread from malignancy

Paralysis :sternocleidomastoid;trapezius------weakness in shoulder;permanent
droop;difficulty in turning head

REF:P Abrahams,S Marks,R Hutching in Mc Minn’s colour atlas,Fifth

edition,2003
FACIAL NERVE
FUNCTIONAL COMPONENT RESPONSIBLE NUCLEI &PATH
SPECIAL VISCERAL EFFERENT SUPPLY MUSCLES OF 2ND BRACHIOFACIAL MOTOR NUCLEUS LIES IN
CAUDAL PONTINE RETICULAR
PHARYNGEAL ARCH For FACIAL FORMATION.NEURONS SUPPLYING SCALP
EXPRESSION AND ELEVATION &UPPER FACIAL MUSCLES ARE DORSAL
&RECEIVE BILATERAL CORTICO BULBAR
FIBRES.WHEREAS NEURONS SUPPLYING LOWER
FACIAL MUSCULATURE ARE VENTRAL AND
RECEIVE CORTICONUCLEAR FIBRES ONLY FROM
CONTRALATERAL SIDE.MOTOR NEURONS OF
FACIAL NERVECURVE AROUND ABDUCENT
NUCLEUS

GENERAL VISCERAL EFFERENT SECRETOMOTOR:SUBMANDIBUL SUPERIOR SALIVATORY

AR &SUBLINGUAL SALIVARY NUCLEUS---NERVUS
GLAND,LACRIMAL INTERMEDIUS---
GLAND,GLANDS OF LACRIMAL&SUBMANDIBULAR
NOSE,PALATE,PHARYNX
GENERAL SOMATIC AFFERENT SENSORY SUPPLY TO CELL BODIES OF GSA NEURON
POSTERIOR SURFACE TO LIES IN GENICULATE GANGLION
EXTERNAL EAR ,CHONCHA AND PROJECTS CENTRALLY
 BRANCHES OF FACIAL NERVE
WITHIN TEMPORAL BONE AT ITS EXIT THROUGH TERMINAL MOTOR
CRANIUM FROM BRANCHES
STYLOMASTOID
FORAMEN
GREATER PETROSAL POSTERIOR AURICULAR ZYGOMATIC
NERVE NERVE
NR TO STAPEDIUS MUSCLE BR TO STYLOHYOID TEMPORAL
&POSTERIOR BELLY OF
DIGASTRIC
CHORDA TYMPANI BUCCAL
MANDIBULAR
CERVICAL

REF: B D Chaurasia in Human Anatomy,vol 3,fourth edition

REF:From Drake, Vogl
and Mitchell 2005 in S
Standring in Gray’s
anatomy 40 th edition
 STUDIES
Six distinctive
anastomotic patterns
were originally classified
by Davis et al (1956)

REF:S Standring in Gray’s anatomy 40 th edition

 CLINICAL APPLICATIONS

REF:B D Chaurasia in Human Anatomy,vol 3,fourth edition

 VESTIBULOCOCHLEAR NERVE
 The vestibulocochlear nerve [VIII] carries SA fibers for hearing and balance,
and consists of two
 divisions:
 a vestibular component for balance;
 a cochlear component for hearing.

 CLINICAL APPLICATION :DAMAGE RESULTS INTO:VERTIGO,MOTION

SICKNESS,LOSS OF EQUILIBRIUM

REF:S Standring in Gray’s anatomy 40 th edition

GLOSSOPHARYNGEAL NERVE

GENERAL VISCERAL AFFERENT sensory input from the carotid body

and sinus;

GENERAL SENSORY AFFERENT sensory input from posterior one-third

of the tongue, palatine tonsils,
oropharynx, and mucosa of the middle
ear and pharyngotympanic tube
SPECIAL AFFERENT taste from the posterior one-third of
the tongue
GENERAL VISCERAL EFFERENT part of the parasympathetic part of the REF:S Standring in
autonomic division of the PNS and Gray’s anatomy
secretomotor activity in the parotid 40 th edition
salivary gland;
innervate the muscle derived from the
third pharyngeal arch (the
stylopharyngeus muscle).
 CLINICAL
APPLICATIONS
DAMAGE:Loss of taste
to the posterior one-
third of the tongue
and sensation of the
soft palate

REF:S Standring in Gray’s anatomy 40 th edition

 VAGUS NERVE
GENERAL SENSORY AFFERENT sensory input from the larynx, laryngopharynx,
deeper parts of the
auricle, part of the external acoustic meatus, and
the dura mater in the posterior cranial fossa
GENERAL VISCERAL AFFERENT sensory input from the aortic body
chemoreceptors and aortic arch
baroreceptors, and the esophagus, bronchi, lungs,
heart, and abdominal viscera in the foregut and
midgut
SPECIAL AFFERENT for taste around the epiglottis and pharynx;
GENERAL VISCERAL EFFERENT fibers are part of the parasympathetic part of the
autonomic division of the PNS and
stimulate smooth muscle and glands in the
pharynx, larynx, thoracic viscera, and abdominal
viscera of the foregut and midgut;
fibers innervate one muscle of the tongue
(palatoglossus), the muscles of the soft palate
(except tensor veli palatini), pharynx (except
stylopharyngeus), and larynx

REF:S Standring in Gray’s anatomy 40 th edition

 CLINICAL APPLICATIONS
 DAMAGE:
 Soft palate deviation with deviation of the uvula to the
normal side;
 vocal cord paralysis
 CAUSE:
 Brainstem lesion; penetrating neck injury

REF:S Standring in Gray’s anatomy 40 th edition

HYPOGLOSSAL NERVE
 The hypoglossal nerve [XII] carries GSE fibers to innervate all intrinsic and
most of the extrinsic muscles of the tongue.
CLINICAL APPLICATIONS:
 DAMAGE:
 Atrophy of ipsilateral muscles of the tongue
 deviation toward the affected side;
 speech disturbance
 CAUSE:
 Penetrating injury to the neck and skull base pathology

REF:S Standring in Gray’s anatomy 40 th edition

NERVE SUPPLY OF NECK REGION
 Posterior triangle
OCCIPITAL TRIANGLE SUBCLAVIAN TRIANGLE
Spinal accessory nerve Three trunks of brachial plexus
Four cutaneous branches of cervical Nerve to serratus anterior
plexus
Lesser occipital,great auricular,anterior
cutaneous nerve of
neck,supraclavicular nerve
Muscular branches:two branches to Nerve to subclavius
levator scapulae
Two branches to trapezius
Nerve to rhomboideus
Upper part of brachial plexus Suprascapular nerve

REF:REF: B D Chaurasia in Human Anatomy,vol 3,fourth edition

 Back of neck:suboccipital triangle
 Nerve supply of:
 Rectus capitis posterior major
 Rectus capitis posterior minor suboccipital nerve or dorsal ramus c1
 Obliqus capitis superior
 Obliqus capitis inferior

 CONTENT:
 Third occipital nerve

REF: B D Chaurasia in Human Anatomy,vol 3,fourth edition

 CLINICAL APPLICATION
 NECK RIGIDITY:seen in meningitis is due to spasm of the extensor muscles.this
is caused by irritation of the nerve roots during their passage through
subarachnoid space which is infected
 Cisternal puncture is done when lumbar puncture fails
 Neurosurgeons approach the posterior cranial fossa through this region

REF:P Abrahams,S Marks,R Hutching in Mc Minn’s colour atlas,Fifth edition,2003

Anterior triangle of neck
 Nerve supply of

muscle Nerve supply

Sternohyoid Ansa cervicalis
Sternothyroid Ansa cervicalis
Thyrohyoid C1 through hypoglossal nerve
Omohyoid Superior belly:superior root of ansa
cervicalis
Inferior belly:ansa cervicalis

REF:B D Chaurasia in Human Anatomy,vol 3,fourth edition

 DIGASTRIC TRIANGLE
MYLOHYOID NERVE and HYPOGLOSSAL
SUBMENTAL TRIANGLE NERVE:anteriorly
PHARYNGEAL BRANCH OF VAGUS
NERVE:posteriorly

ANTERIOR TRIANGLE
OF NECK

CAROTID TRIANGLE
VAGUS NERVE: superior laryngeal nerve MUSCULAR TRIANGLE
SPINAL ACCESSORY NERVE VENTRAL RAMI OF 1,2,3 CERVICAL SPINAL
HYPOGLOSSAL NERVE NERVE
SYMPATHETIC CHAIN

REF:B D Chaurasia in Human Anatomy,vol 3,fourth edition

REF:S Standring in Gray’s anatomy
40 th edition
NERVE SUPPLY OF HEAD REGION
CUTANEOUS NERVE SUPPLY

NERVE
OPTHALAMIC DIVISION SUPRATROCHLEAR Scalp upto
OF TRIGEMINAL NERVE NERVE,SUPRAORBITAL vertex,forehead,upper
NERVE,LACRIMAL eyelid,conjunctiva,small
NERVE,INFRATROCHLEAR part of lower eyelid and
NERVE,EXTERNAL MASAL root ,dorsum and tip of
NERVE the nose
Maxillary division of Infraorbital nerve Upper lip,ala of
trigeminal nerve Zygomaticofacaial nerve nose,most lower
Zygomaticotemporal eyelid,upper part of
nerve cheek,anterior part of
temple
Mandibular division of Auriculotemporal nerve Lower lip;chin;lower
trigeminal nerve Buccal nerve part of cheek,lower jaw
Mental nerve except over angle;upper
2/3 of lateral surface of REF:B D Chaurasia in
auricle,side of head Human Anatomy,vol
3,fourth edition
 Cervical plexus(great Anterior division of Skin over angle of jaw
auricular nerve c2,c3) great auricular and over parotid gland
nerve(c2,c3),upper ;lower margin of lower
division of transverse jaw
cutaneous nerve of neck

CLINICAL APPLICATIONS:
The sensory distribution of the trigeminal nerve explains why headache is a
uniformly common symptom in involvement of nose,paranasal air
sinuses,infections,inflammation of teeth and gums,refractive errors of the
eyes,glaucoma
TRIGEMINAL NEURALGIA

REF:B D Chaurasia in Human Anatomy,vol 3,fourth edition

REF:B D Chaurasia in Human Anatomy,vol 3,fourth edition
NERVE SUPPLY OF SCALP
IN FRONT OF AURICLE BEHIND THE AURICLE

SENSORY NERVES SENSORY NERVES

SUPRATROCHLEAR ,branch of the frontal Posterior division of GREAT AURICULAR
(ophthalmic division of trigeminal nerve) NERVE from cervical plexus
SUPRAORBITAL, branch of frontal Lesser occipital nerve,from cervical
(opthalamic division of trigeminal nerve) plexus
ZYGOMATICOTEMPORAL branch of Greater occipital nerve
zygomatic nerve(maxillary division of
trigeminal nerve)
AURICULOTEMPORAL BRANCH of Third occipital nerve
mandibular division of trigeminal nerve
MOTOR NERVE MOTOR NERVE
Temporal branch of facial nerve Posterior auricular branch of facial nerve REF:B D Chaurasia in
Human Anatomy,vol
3,fourth edition
REF:B D Chaurasia in Human Anatomy,vol 3,fourth edition
 NERVE SUPPLY OF FACE

 MOTOR NERVE SUPPLY OF FACE:

 TEMPORAL:FRONTALIS,AURICULAR MUSCLES,ORBICULARIS OCULI
 ZYGOMATIC:ORBICULARIS OCULI
 BUCCAL:MUSCLES OF CHEEK AND UPPER LIP
 MARGINAL MANDIBULAR:MUSCLES OF LOWER LIP
 CERVICAL:PLATYSMA
 CLINICAL APPLICATION:
 INFRANUCLEAR LESION:BELL’S PALSY
 SUPRANUCLEAR LESION:ususally a part of hemiplegia,only the lower part of
the opposite side of face is paralyse.

REF:B D Chaurasia in Human Anatomy,vol 3,fourth edition

REF:B D Chaurasia in Human Anatomy,vol 3,fourth edition
NERVE SUPPLY OF STRUCTURES
RELATED TO ORAL CAVITY
NERVE SUPPLY OF HARD PALATE
PARASYMPATHETIC
SPECIAL(GUSTATORY OR
GENERAL SENSATION POSTGANGLONIC SECRETOMOTOR TASTE)SENSATION
FIBRES
• GREATER PALATINE AND • FROM PTERYGOPALATINE • BY FACIAL NERVE
NASOPALATINE BRANCHES OF GANGLION RUN WITH GREATER • TASTE IMPULSES PASS VIA
MAXILLARY DIVISION OF AND NASOPALATINE NERVES GREATER AND NASOPALATINE
TRIGEMINAL NEREVE WHICH SUPPLY PALATINE NERVES TO PTERYGOPALATINE
• BOTH NERVE PASS THROUGH MUCOSAL GLANDS GANGLION(WITHOUT SYNAPSING
PTERYGOPALATINE GANGLION TO NERVE OF PTERYGOID
AND SYPPLY GUMS,MUCOSA AND CANAL)AND THEN TO GREATER
GLANDS OF HARD PALATE PETROSAL NERVE TO FACIAL
ALMOST TO INCISOR TEETH (BY GANGLION(CELL BODIES ARE
GREATER PALATINE)AND SITUATED HERE)
ANTERIOR PART OF HARD • NOW TASTE IMPULSE PASS
PALATE JUST BEHIND INCISOR THROUGH SENSORY ROOT OF
TEETH(BY NASOPALTINE NERVE) FACIAL NERVE(NERVUS
INTERMIEDIUS)TO GUSTATORY
NUCLEUS TRACTUS SOLITARIUS

REF:B D Chaurasia in Human Anatomy,vol 3,fourth edition

NERVE SUPPLY OF SOFT PALATE
SPECIAL
SENSORY(GUSTATORY):
MOTOR: FACIAL NERVE
GENERAL
ALL MUSCLES ECXEPT SENSORY:MAXILLARY NERVE
TENSOR VELI PALATINI ARE THROUGH PTERYGOPALATINE GREATER PETROSAL NERVE
SUPPLIED BY PHARYNGEAL NERVES SUPPLY HARD
PLEXUS DERIVED FROM PALATE ;LESSER PALATINE
CRANIAL ACCESSORY NERVE GENICULATE GANGLION
NERVE SUPPLY SOFT PALATE
THROUGH VAGUS
(NUCLEUS OF SOLITARY
TRACT)

SECRETOMOTOR
LESSER PALATINE NERVE
GREATER PETROSAL NERVE
SUPERIOR SALIVATORY NUCLEUS

REF:B D Chaurasia in Human Anatomy,vol 3,fourth edition

CLINICAL APPLICATIONS

 PARALYSIS OF SOFT PALATE IN LESIONS OF VAGUS NERVE PRODUCES:

 NASAL REGURGITATION
 NASAL TWANG IN VOICE
 FLATTENING OF THE PALATAL ARCH

REF:REF:P Abrahams,S Marks,R Hutching in Mc Minn’s colour atlas,Fifth

edition,2003;
NERVE SUPPLY OF TONGUE
PART DEVELOP FROM TASTE GENERAL
(SPECIAL SENSORY
SENSORY)
ANTERIOR 2/3 1st pharyngeal arch Chorda Lingual
(BODY,ORAL OR tympani nerve(br of
PRESULCAL)PART mandibular
trigeminal
nerve)
POSTERIOR 3 rd pharyngeal arch Glossopharyngeal nerve
1/3(BASE,ROOT,
PHARYNGEAL OR POST
SULCAL)PART INCLUDING
VALLATE PAPILLA
POSTERIOR MOST(ROOT 4th pharyngeal arch Internal laryngeal branch
NEAR EPIGLOTTIS)OR of vagus
VALLECULAE

REF:B D Chaurasia in Human Anatomy,vol 3,fourth edition

 MUSCLES OF TONGUE
MUSCLE DEVELOP FROM NERVE SUPPLY
PALATOGLOSSAL 6th pharyngeal arch Cranial accessory nerve
through pharyngeal
plexus
All other intrinsic and Ocipital myotomes Hypoglossal nerve
extrinsic
muscles(except
palatoglossal)

REF:B D Chaurasia in Human Anatomy,vol 3,fourth edition

CLINICAL APPLICATIONS
CLINICAL APPLICATION:GENIOGLOSSUS is the safety muscle of tongue
Its function can be used to test hypoglossal nerve:

INJURY TO HYPOGLOSSAL
NERVE

REF:P Abrahams,S
INFRANUCLEAR LESIONS SUPRANUCLEAR LESIONS Marks,R Hutching in
Mc Minn’s colour
atlas,Fifth
GRADUAL ATROPHY,MUSCULAR
TWITCHINGS
PARALYSIS edition,2003
Nerve supply of tonsils
 Plexus circularis tonsillaris formed by
glossopharyngeal and lesser palatine nerve
 Clinicalapplication : glossopharyngeal nerve is
the main supply.it also supplies mucous lining of
tympanic cavity(i.e middle ear) through
tympanic branches.so tonsillar problems may
cause referred pain in the ear.

REF:B D Chaurasia in Human Anatomy,vol 3,fourth edition

NERVE SUPPLY OF LARYNX

LARYNX

SENSORY MOTOR

All intrinsic muscles are

Upto the level of vocal Below the level of supplied by recurrent
folds:internal laryngeal vocal folds:recurrent laryngeal nerve except
nerve laryngeal nerve for cricothyroid which
is supplied by external
laryngeal nerve

REF:B D Chaurasia in Human Anatomy,vol 3,fourth edition

S Standring in Gray’s anatomy 40 th edition
CLINICAL APPLICATIONS
 DAMAGE TO
 INTERNAL LARYNGEAL NERVE:anesthesia to the mucous membrane in the
supraglottic part of larynx breaking the reflex arc so that foreign bodies can
easily enter it
 External laryngeal nerve:weakness of phonation(due to thightening effect of
cricothyroid)
 Both recurrent laryngeal nerve:vocal cords lie in the cadaveric position in
between abduction and aduction and phonation is lost completely
 SEMON’S LAW:in progressive lesions of the recurrent laryngeal nerve the only
abductors of the vocal cords,the posterior cricoarytenoids are the first to be
paralysed and the last to recover as compared to adductors
 In functional paralysis:adductors are first to be paralysed

REF:B D Chaurasia in Human Anatomy,vol 3,fourth edition

 NERVE SUPPLY OF SALIVARY GLANDS

PAROTID GLAND
SUBMANDIBLAR AND SUBLINGUAL GLANDS
PS:-GLOSSOPHARYNGEAL
(9th)NERVE (THROUGH FACIAL NERVE(THROUGH
AURICULOTEMPORAL NERVE LINGUAL NERVE----CHORDA
FROM OTIC GANGLION) TYMPANI----SUBMANDIBUALR
S:-CERVICAL GANGLIA GANGLION)
THROUGH EXTERNAL
CAROTID NERVE PLEXUS

REF:B D Chaurasia in Human Anatomy,vol 3,fourth edition

 CLINICAL APPLICATIONS
 EXCISION OF SUBMANDIBULAR GLAND IS DONE BY INCISION PLACED MORE
THAN 2.5 cm BELOW ANGLE OF MANDIBLE SINCE MARGINAL MANDIBULAR
BRANCH OF FACIAL NERVE PASSES POSTEROINFERIOR TO THE MANDIBLE
 CHORDA TYMPANI AND AURCULOTEMPORAL NERVE IS RELATED TO THE MEDIAL
AND LATERAL SURFACE OF SPINE OF SPHENOID RESPECTIVELY ,INJURY TO
SPINE WILL CAUSE LOSS OF SECRETION FROM ALL THE SALIVARY GLANDS

REF:B D Chaurasia in Human Anatomy,vol 3,fourth edition

NERVE SUPPLY
MUSCLES OF MASTICATION

MUSCLES NERVE SUPPLY

MASSETER MASSETRIC NERVE
TEMPORALIS TWO DEEP TEMPORAL BRANCHES
FROM ANTERIOR DIVISION OF
MANDIBULAR NERVE
LATERAL PTERYGOID A BRANCH FROM ANTERIOR
DIVISION OF MANDIBULAR NERVE
MEDIAL PTERYGOID NERVE TO MEDIAL
PTERYGOID:MANDIBULAR NERVE

REF:REF:B D Chaurasia in Human Anatomy,vol 3,fourth edition

 NERVE SUPPLY
 SUPRAHYOID MUSCLES
MUSCLES NERVE SUPPLY
DIGASTRIC ANTERIOR BELLY:NERVE TO
MYLOHYOID
POSTERIOR BELLY:FACIAL
NERVE
STYLOHYOID FACIAL NERVE
MYLOHYOID NERVE TO MYLOHYOID
GENIOHYOID HYPOGLOSSAL NERVE
HYPOGLOSSAL HYPOGLOSSAL NERVE

REF:B D Chaurasia in Human Anatomy,vol 3,fourth edition

 NERVE SUPPLY TO THE TEETH

REF:S Malamed in Handbook of Local Anesthesia ,Fifth edition,2011

S Malamed ,medical emergencies in dental office,edition4
REF:S Malamed
in Handbook of
Local
Anesthesia
,Fifth
edition,2011
Clinical application

REF:F Hanretig Pediatric emergency procedure,2001

INFERIOR ALVEOLAR NERVE BLOCK

 BELOW OCCLUSAL PLANE :4 YEARS OR YOUNGER

 AT OCCLUSAL PLANE:5 YEARS OR ABOVE
 7-14 MM ABOVE OCCLUSAL PLANE :AS CHILD GROWS TO ADULTHOOD

REF:F Hanretig Pediatric emergency procedure,2001

CONCLUSION
NERVE SUPPLY OF HEAD AND NECK IS IMPORTANT FOR DENTIST IN TERMS OF
TREATING DISEASES RELATED TO IT,PAIN MANAGEMENT, SURGERY,THUS HAVING
COMPLETE KNOWLEDGE OF IT IS INECESSITY FOR US.
REFERENCES

S Standring in Gray’s anatomy 40 th

edition
P Abrahams,S Marks,R Hutching in Mc
Minn’s colour atlas,Fifth edition,2003
S Malamed in Handbook of Local
Anesthesia ,Fifth edition,2011
S Malamed ,medical emergencies in
dental office,edition4
B D Chaurasia in Human Anatomy,vol
3,fourth edition
Benjamin cummings,adsley longman
inc,2001
F Hanretig Pediatric emergency
procedure,2001
THANKYOU