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Continuing Education

Head and Neck Anatomy:

Part III – Cranial Nerves

Course Author(s): Larry LoPresti, DMD

CE Credits: 2 hours
Intended Audience: Dentists, Dental Hygienists, Dental
Assistants, Dental Students, Dental Hygiene Students, Dental
Assistant Students
Date Course Online: 09/20/2022
Last Revision Date: N/A
Course Expiration Date: 09/19/2025
Cost: Free
Method: Self-instructional
AGD Subject Code(s): 10

Online Course: [Link]/en-us/ce-courses/ce598

Disclaimer:

• P&G is providing these resource materials to dental professionals. We do not own this content nor are we responsible for any material herein.
• Participants must always be aware of the hazards of using limited knowledge in integrating new techniques or procedures into their practice.
Only sound evidence-based dentistry should be used in patient therapy.

Conflict of Interest Disclosure Statement

• Dr. LoPresti reports no conflicts of interest associated with this course. He has no relevant
financial relationships to disclose.

Introduction
This course is an overview of the cranial nerves with special emphasis on the branches that are
important to the dental professional. This course can be used as a reference for the location and
function of the nerves of the head and neck. This is the last part of a three-part series including the
bony structures of the head and neck and the muscles of the head and neck.

Dental Students: Please note this is Part II of a three-part series. To gain the full benefit of the
concepts covered in this course, be sure to read “Head and Neck Anatomy: Part I – Bony Structures” and
“Head and Neck Anatomy: Part II – Musculature”.

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Course Contents study of anatomy but is a guide to review the
• Introduction basics of anatomy as it relates to the dental
• Glossary field. It is essential for all dental professionals to
• Basic Nervous System Structure recognize the normal appearance and functions
• Neurons of the head and neck. Nerves are of paramount
• Synapse importance to the proper functioning of all
• Nerves parts of the body as they sense the external and
• Supporting Cells internal environments and constantly adjust to
• Divisions maintain homeostasis. In the head and much of
• Nerve Nomenclature the neck the cranial nerves are the connections
• Cranial Nerves between the brain and the body. Therefore,
• Cranial Nerve I - Olfactory Nerve understanding their location and function is a
• Cranial Nerve II - Optic Nerve key to understanding the normal function of the
• Cranial Nerve III - Oculomotor Nerve stomatognathic system and many pathologies
• Cranial Nerve IV - Trochlear Nerve one might encounter as a dental professional.
• Cranial Nerve V - Trigeminal Nerve
• V1 – Ophthalmic Nerve A note to the student – The study of head and
• V2 - Maxillary Nerve neck anatomy is not a murder mystery where
• V3 – Mandibular Nerve you cannot stop reading to see which of the
• Cranial Nerve VI – Abducens characters was the killer and their motivation.
• Cranial Nerve VII - Facial Nerve Anatomy is full of terminology and should not
• Greater Petrosal Nerve be read as one would read a novel. It is easy to
• Chorda Tympani conflate the information if read all at once. You
• Facial Nerve - Main Trunk should take breaks on occasion to allow what
• Cranial Nerve VIII – Statoacoustic, you have read to sink in before attacking yet
Vestibulocochlear, Auditory Nerve another set of structures.
• Cranial Nerve IX – Glossopharyngeal Nerve
• Cranial Nerve X – Vagus Nerve Words are not sufficient to understand this topic
• Cranial Nerve XI - Spinal Accessory Nerve so referring to diagrams is absolutely necessary.
• Cranial Nerve XII - Hypoglossal Nerve The diagrams have been placed near the text
• Summary that it refers to and should be, if possible, on
• Appendices the screen as one reads the text and referred
• Course Test to often. As the pathways of the nerves refer to
• References - Additional Resources both bones and muscles plus the endpoint of
• About the Authors motor nerves is skeletal muscle you should be
familiar with the bony structures of the head
Learning Objectives covered in Head and Neck Anatomy: Part
Upon completion of this course, the dental I – Bony Structure (CE591) and the muscles
professional should be able to: covered in Head and Neck Anatomy: Part II –
• Understand the basic structure of a neuron Musculature (CE597) prior to attempting this
and how they function. course.
• Understand the basic function of the
nervous system. Glossary
• Possess foundational knowledge of the Organization terms
cranial nerves.
• Know the location and function of each Central nervous system (CNS) – This consists
important nerve found in the head and of the brain and spinal cord. This is where
neck. integration occurs and where the majority of
neuronal connection are found.
Introduction
This three-part course presents basic facts Peripheral nervous system (PNS) – This
and concepts of head and neck anatomy. The consists of all the nerves which are found
course is not intended to replace an in-depth exclusively outside the CNS. Nerves themselves

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are composed only of extensions from the body Synapse – A gap between neurons where
of the neuron. Nerves do not contain cell bodies. chemical mediators are released to affect the
adjacent neuron. This is the primary means for
Autonomic Nerves – These are motor nerves neurons to communicate with each other.
that control involuntary actions of the body
generally involved in maintaining homeostasis. Ganglion – This is an appendage to a peripheral
These nerves are connected to smooth muscle, nerve where neuronal cell bodies are found
cardiac muscle and glands. They are unique in outside the central nervous system. These are
having a synapse outside of the CNS. found associated with all sensory and autonomic
nerves.
Sympathetic Division – This division of the
autonomic nervous system is responsible for the Preganglionic fibers – These are the autonomic
ability to respond to perceived danger. This is neuronal fibers that enter a ganglion.
often called the “fight or flight” response.
Postganglionic fibers – These are the autonomic
Parasympathetic Division – This division of neuronal fibers that leave the ganglion after they
the autonomic nervous system opposes the synapse with the preganglionic fibers.
sympathetic division, lowering heart rate, blood
pressure and respiratory rate while increasing Basic Nervous System Structure
the motility of the digestive system. This is Neurons
sometimes referred to as the “rest and repose” Neurons are the working cells in the nervous
response. system. They are metabolically very active cells
and the vast majority of them are located in
Functional terms the central nervous system (CNS). The brain
uses energy at a prodigious rate. Anyone who
Afferent – In reference to nerves this denotes has taken a CPR course knows that in just
a nerve carrying signals to the CNS from the minutes the brain runs out of oxygen for proper
periphery. These are also known as sensory metabolism and the cells start to die off. To
nerves as the tissues are sending impulses understand the structure of nerves we must look
containing information from sensing cells in the at these unique cells that are so important to our
body. In the text sensory and afferent will be survival.
used interchangeably.
While there are differences in morphology
Efferent – In reference to nerves this denotes between neurons whose functions are different,
a nerve carrying signals from the CNS to the they all have some commonalities. They all have
periphery. These are also known as motor a central area known as the body which contains
nerves as the tissues stimulated perform an a nucleus and numerous organelles that
action and again motor and efferent will used as produce energy and make proteins.
equivalent terms in this course.
Projecting off the body are processes that extend
Integration – This is the interface between the away from the body. There are two types of
afferent and efferent system where incoming these appendages: axons of which each neuron
signals from sensory nerves are interpreted has exactly one and dendrites which are found
and responses generated by the CNS then sent in variable numbers from none to several
to the organs and muscle in the periphery to depending on the function of the neuron.
respond to the stimulus.
Neuronal membranes carry an electrical charge
Cellular terms based on the ionic movement across the
membrane. By alternating between depolarizing
Neuron – The cell that forms all nervous tissue. and repolarizing the membrane an electric wave
is created along the neuron. Directionally this
Fiber – An extension from the neuronal cell wave travels from the distal end of the dendrites,
body that carries signals to or from the neuronal through the cell body, and then passes down
cell body.

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the axon to its terminus. If the signal is strong You can see why the neuron has such high
enough, it will cause a release of proteins known metabolic requirements as it has to pump
as neurotransmitters from the end of the axon ions across the membrane against the
into the space between the neuronal ends which concentration gradient. It also has to produce
is called a synapse. The electrical signal down the proteins for release and transport them
axon is known as the action potential and if the down the axon in addition to removing the
voltage of the action potential reaches the point neurotransmitter from the synapse quickly so
at which it causes release of neurotransmitters it that it does not linger in the synapse and cause
is said to have reached the threshold potential. unwanted effects.

Figure 1 - Motor Neuron

Figure 2 - Action potential

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Synapse other neurons the net effect on any specific
Neurons generally do not touch each other neuron is the net result of all the excitatory
so despite carrying electrical charges they and inhibitory signals it is exposed to at any
communicate via neurotransmitters which are one time. Once the neurotransmitter is in the
proteins released into a small space known as cleft it must be rapidly removed from the cleft
the synaptic cleft between the neurons. There to keep the response from being persistent. As
are numerous neurotransmitters but most mentioned previously this is another process
synapses are mediated by just seven of them. where the neuron must use energy to reabsorb
Detailing the neurotransmitters is not within the and recycle these neurotransmitters.
scope of this course but they are a fascinating
area of research and many pharmacologic Nerves
interventions, especially for mental illness, As mentioned earlier the neuron cell bodies
focus on regulating these compounds. To give are generally located in the CNS and even
one quick example, Parkinson’s disease is due those outside the CNS are clustered into areas
to the inadequate production of one of these known as ganglia (singular – ganglion). Nerves,
proteins, dopamine, in the brain. which we will be looking at in this course
are constructed of axons and dendrites and
Once the neurotransmitter is released into associated supporting cells. It is important to
the synaptic cleft it attaches to receptors realize that the cell body that controls them
on the opposing neuron. This interaction can be quite distant from the terminal ends
between the neurotransmitter and its specific of the neuron and there is a time delay in
receptor will have one of two effects on the signaling due to the length of the fibers in
receiving neuron. It will either increase the addition to the delay caused by any synapses
action potential in the second neuron if it is involved.
an excitatory response, or if it is an inhibitory
response, it will decrease the action potential. To use an illustration to tie all of the above
As each neuron has many connections with together, think of the response to touching a
hot surface, which is a common human error.
Pain receptors in the skin of the finger create
an action potential in a sensory neuron. The
greater the number of receptors connected
to that neuron that are stimulated the larger
the action potential created. Depending on the
size of the burn there may be multiple neurons
involved but let us stay with just one for now.
The signal is carried back to the neuron cell
body located in a ganglion just outside the
spinal cord. There the signal is sent into the
CNS where there are multiple connections. The
sensory neurons synapse with neurons in the
spinal cord and the brain. The neurons in the
spinal cord are connected to motor neurons
in the spinal cord that control the flexor
muscles of the arm causing those muscles to
pull the hand back. This reflex is mediated in
the spinal cord as it is a shorter distance for
the signals to pass and therefore the hand
sustains less damage as it is pulled away faster.
The signal also passes to the brain area that
receives sensory information registering the
unfortunate event as a burn and then relays
Figure 3 - Synaptic cleft through other neurons in multiple areas of

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the brain that can process that you burned known as the blood-brain barrier which acts
yourself using stored memories of other burns to keep toxic substances and microbiological
and not only registers it but stores that new invaders out of the CNS but also makes
burn memory also. Other sensory neuronal delivering medications to the brain problematic.
information will be synthesized to determine
whether there are other people in the room or While those neuroglial cells are important in
some other reason that you should not swear. the CNS we are concerned with nerves in this
If this information does not send sufficient course and they are in the PNS. In the PNS
inhibitory signals to overcome the urge to each nerve fiber, whether dendrite or axon,
vocalize your displeasure, then you will use all is surrounded by a layer of connective tissue
of your favorite swear words pulled from yet known as the endoneurium. These fibers are
another area of the brain. But note that by the collected into bundles known as fascicles and
time you are choosing the proper words your surrounded by a connective tissue sheath
fingers have been away from the hot surface known as the perineurium. If this is reminding
for some time. you of the nomenclature used for the tissue
surrounding muscle fibers you have already
Supporting Cells deduced that the entire nerve has a connective
Neurons are very important to life and as tissue sheath called the epimysium. Nerves go
such are extraordinarily protected. The CNS is one step further and have a series of cells that
encased in bone with three layers of protective wrap around the individual fibers. These cells
coverings underneath the skull cap. In addition, are known as Schwann cells and come in two
the brain and spinal cord are surrounded and types depending on whether they contain a fatty
cushioned by cerebral spinal fluid (CSF). The substance known as myelin. Myelin is used as
brain has a lower specific gravity than the CSF an electrical insulator and its presence in the
so it actually floats in the skull. Beyond the Schwann cells increases the speed of nerve
physical barriers there are also physiological conduction. When myelin surrounds the fiber,
barriers. Neurons in the CNS have cells that depolarization of the membrane is restricted
support them known as neuroglial cells. There only to the small gaps known as the nodes of
are specific cell types that nourish the neurons, Ranvier where one Schwann cell ends and the
insulate them electrically from one another and next begins. This causes the electrical signal to
protect them from toxins and microbiological leap along the fiber from gap to gap rather than
invaders. They create, along with the less flowing along the whole length of the fiber. This
permeable capillaries in the brain, what is greatly speeds conduction on these fibers.

Figure 4 - Schwann cells & Nodes of Ranvier

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There are other fibers that do not have myelin general somatic sensory fibers, general visceral
surrounding them and these transmit the sensory and special sensory fibers. General
action potential more slowly. This difference sensations are those found throughout the body.
in transmission rates is the basis of the gate Somatic refers to their being on the body surface.
control theory of pain perception. We use this These sensations include touch, pressure, pain
by applying pressure to the injection point and temperature. Visceral sensations are from
prior to a palatal injection to lessen the pain of the internal organs and include not just the
the needle insertion. The pressure stimulates aforementioned but chemoreceptors, stretch
nerves that have a slow conduction path but receptors and baroreceptors. Special senses
act to inhibit the quicker pain signals that the are those senses that are only found in specific,
needle will cause. Pressure at the time of, or localized areas. These senses include sight,
after, the injection is much less effective as the hearing, equilibrium, smell and taste, which not
pain signal is already through the gate. coincidentally, are all found in the head and
neck. Their position in the head makes sense
Divisions as these organs are taking in vast quantities
Different neurons have different functions. This of information from the environment so their
section will explain in more detail many of the close proximity to the brain is crucial for timely
terms in the definition sections and how that responses to external events.
impacts the anatomy of the individual cranial
nerves. We have already been exposed to the On the motor side of the PNS there are also two
fact that there are sensory neurons and motor types of innervating fibers. The motor fibers are
neurons. To better understand the structure of divided into somatic motor fibers and autonomic
the cranial nerves we need to look more closely motor fibers. The somatic fibers provide
at the way the nervous system is organized. stimulation to skeletal muscle fibers. These fibers
The most basic division is into the central all have their cell bodies in the CNS. The axon
nervous system (CNS) and the peripheral leaving the CNS can be quite long as they must
nervous system (PNS). The CNS consists of the project from the spinal cord to the muscle they
brain and the spinal cord. All of the nerves control. Each axon and its associated muscle
found in the body compose the PNS. The PNS fibers is known as a motor unit. Each nerve fiber
consists of 12 pairs of cranial nerves that are controls a variable number of muscle fibers
the subject of this course and 31 spinal nerves depending on what the amount of fine control
which will be only briefly mentioned. needed. The eye muscles have small motor
units of about ten muscle fibers per axon while
Within the PNS there are differences in the postural muscles can have up to one hundred
function of the fibers contained in the nerves. times that number.
The main division used to classify them is into
afferent fibers which carry sensory impulses Autonomic fibers control smooth muscle, glands
towards the CNS and efferent fibers that and cardiac muscle. They are collectively known
carry impulses away from the CNS (Figure 5). as visceral efferent fibers. They come in two
Anatomically all sensory neurons have their varieties: sympathetic fibers and parasympathetic
cell bodies outside the CNS in ganglia. Each fibers. Each of these fibers have opposing actions
spinal nerve has a motor root and a sensory and organs controlled by these nerves generally
root adjacent to the area where they enter have dual innervation with the action taken by
the spinal cord. The sensory ganglia are found the organ depending not on the absolute level
attached to the sensory root of the spinal of either system but the degree to which one
nerve so are in close proximity to the CNS. predominates over the other.
Cranial nerves are not as uniform and we
will have to look at each of them individually. Sympathetic responses are geared to what
They generally have their sensory ganglia in is termed the “fight or flight” response. It
the cranial cavity where the root of the cranial turns down the digestive system activity while
nerve is found. increasing the heart rate and respiratory rate all
of which act to increase oxygenated blood flow to
To make matters more complex sensory fibers the muscles. This response is strong but once the
in the cranial nerves can be further divided into threat is gone the mediating neurotransmitters

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 Figure 5 - Central & Peripheral Nervous System

epinephrine and norepinephrine are rapidly sympathetic response. This is the reason that
eliminated. As an example of this, in dentistry patients often faint after the thing they are most
we use epinephrine to constrict blood vessels afraid of is over rather than during the threat.
in the area we are injecting the local anesthetic. The mechanism is as follows: in response to
This works because these blood vessels are not the threat the patient’s sympathetic system
going to muscles and therefore are constricted is activated, but in order to not look nervous,
by epinephrine as they are not crucial to their parasympathetic system is also activated.
providing oxygen to the muscles. Occasionally Due to the fact that the sympathetic system
the epinephrine ends up in a blood vessel and only slightly predominates, the patient’s pulse
can cause the patient to feel their heart racing and blood pressure are only slightly elevated.
as the epinephrine gets to the heart, stimulating The procedure is accomplished, and the
it to beat faster. This clears up in a few minutes patient perceives the threat is now passed.
due to the rapid metabolism of the epinephrine. The sympathetic outflow is turned off, but the
parasympathetic outflow reacts more slowly.
Parasympathetic responses on the other hand The heart rate and blood pressure plummet and
are the opposite. The digestive system blood the patient faints due to inadequate cerebral
supply and motility are increased and the circulation.
heart rate and respiratory rate are slowed. This
is mediated by a different neurotransmitter Autonomic fibers anatomically are different
and does not dissipate as rapidly as the than somatic fibers. All autonomic fibers that

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leave the spinal cord will synapse with a Nerve Nomenclature
second neuron in the periphery that then In this course, to avoid confusion we will try to
innervates the target organ. The outflow from be clear about the transitions from one nerve
the spinal cord is also regionally restricted. to another. Because the signals in sensory
All parasympathetic fibers leave the CNS only nerves are running towards the CNS as smaller
along cranial nerves III, VII, IX, X and spinal nerves merge together to form larger nerves,
nerves S2-S4 while sympathetic fibers leave we will speak of them as joining. Motor nerves
only from spinal nerves T1-L2. The sympathetic on the other hand start as larger nerves and
system covers the whole body by having a divide to form smaller nerves and we will refer
chain of ganglia that run along the spinal to that as splitting. Many nerves have both a
column bilaterally the entire length of the sensory and motor component and we will
spinal cord. These interconnected ganglia refer to those as branching. This is not perhaps
allow fibers that enter the chain at any level how all texts will use the nomenclature and it
to leave at a different level. In many cases the is only done here to try to alleviate confusion
second neuron is in the chain and the fiber within this course.
that leaves is known as a post-synaptic or post
ganglionic fiber. Some pass through the ganglia In the study of individual cranial nerves those
as pre-synaptic fibers heading to the digestive that are pure sensory nerves will be started
system and synapse in ganglia in the abdomen. at their origin in the sense organs and traced
The sympathetic fibers in the head and neck back to the CNS. Pure motor nerves and mixed
are all post-ganglionic and generally join and motor and sensory nerves will be traced from
travel with branches of cranial nerves to their the CNS to the periphery.
target organ. They are often not recognized as
separate nerves as they are small and often Another fine point that we will ignore in the
join other more substantial nerves on their quest for keeping the verbiage to a minimum
way. We will not often specifically mention is that many cranial nerves, even ones we will
them as we are more concerned with fibers classify as sensory will have some sympathetic
that originate in cranial nerves but they are motor fibers that are travelling with the nerve.
assumed to be following parasympathetic The ones classed as motor nerves carry visceral
fibers in the head and following other nerves sensory information from sense organs within
to the blood vessels in the head. the muscle that sense tension and muscle
length. However, these fibers are found in small
To be complete there is also a more recent numbers and generally originate elsewhere.
finding that there are a number of autonomic Therefore, here we will ignore them while
ganglion in the gut that act as a reflex center classifying nerves as sensory, mixed or motor.
for proper regulation of the many organs While some authors are very exacting and
that are involved in proper function of the classify them by all the fibers that are in a
digestive system. Some authors regard this nerve, most use the convention of using the
as a separate entity deserving equal billing types of fibers at the point of origin or, in the
with the CNS as it has numerous associative case of sensory nerves, the termination point.
neurons which are not found in the PNS. Thus,
it is believed to be largely autonomous though To make the text less repetitive the terms
it does communicate with the CNS through motor and efferent will be used interchangeably
cranial nerve X, which seems to modulate the as will sensory and afferent. We will also use
response of the gut. Therefore, this cranial the equivalent terms autonomic and visceral to
nerve may not have as much control of the break up the monotony when describing the
digestive system as previously believed. As the parasympathetic or sympathetic nerves but will
digestive system itself is outside of the scope use the specific terms for the division involved.
of this course we will not wade into the debate Pre-synaptic and pre-ganglionic will also be
about whether it is part of the PNS or a whole used to describe the fibers that have not yet
separate entity but will note the contribution of synapsed in an autonomic ganglion as will post-
cranial nerve X to its control. synaptic and post-ganglionic.

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Lastly it must be noted that all cranial nerves Cranial Nerve I - Olfactory Nerve
occur in pairs, one on the right and one on the The olfactory nerve originates as axons of the
left, as they are symmetrical often the text will olfactory cells found in the nasal cavity just
refer to a nerve in the singular but that means inferior to the cribriform plate of the ethmoid
we are just looking at one of the pair, not that bone. In fact, it is not a defined pair of nerves but
there is just a single entity. numerous fiber fascicles that pass through the
openings in the cribriform plate to reach an area
Cranial Nerves that sits just superior to the plate known as the
We finally turn of attention to the items in the olfactory bulb where they terminate. This means
title of this course. Knowing the background these fibers are very short. This arrangement
will make learning what follows easier as it will can be seen in Figure 7 above. Olfaction is the
make more sense to you. We will take each biologist’s word for the sense of smell so this,
nerve separately, explain its function and trace the shortest cranial nerve, carries only special
the course of the nerve and its main branches. sensory fibers for that specific sense. Cranial

Each cranial nerve is numbered with a Roman

numeral but also has a name and in the case
of a couple of them, more than one name. If
you look at the base of the brain (Figure 6) the
nerves are numbered by their connection point
to the brain with I being the furthest anterior in
the cerebrum and XII being the one closest to
where the spinal cord originates from the brain
stem. The names generally refer to the function
of the nerve as you will see. Students often use
a pneumonic as a guide to which name goes
with which Roman numeral. These are easily
found on the internet or you can make your
own. The key is to find one you will have little
trouble remembering. Figure 7 - Cranial Nerve I -Olfactory Nerve

Figure 6 - Cranial Nerves

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Cranial Nerve II - Optic Nerve Cranial Nerve III - Oculomotor Nerve
This nerve, like the olfactory is exclusively a The oculomotor nerve unlike the previous two
special sensory nerve and as can be surmised nerves has more than one type of fiber. As its
by its name it is involved with the sense of name indicates they are all motor fibers, in
vision. The nerve originates in the retinal this case, somatic motor and parasympathetic
ganglion cells which are the third neuron the motor. The nerve itself leaves the brain and
signal passes through in the retina. These travels through the superior orbital fissure into
axons gather at an area known as the optic the orbit. Once there it divides to innervate
disc in the medial portion of the retina and four of the six muscles that control eye
exit each eyeball as an optic nerve. The optic movement superior rectus, medial rectus,
disc has no light sensing cells so it corresponds inferior oblique, superior rectus, the muscle
to the blind spot of the eye. Having left the that controls the upper eyelid, the levator
eye each of the pair of nerves passes through palpebrae superioris plus provides autonomic
their respective optic canal. The two optic (visceral) innervation to the smooth muscles
nerves then join at the optic chiasm where, in the eye. The smooth muscles of the eye are
as one can see in the diagram, the fibers from the ciliary muscles which control the shape
the medial portion of retina cross the midline of the lens thus changing the focal length of
and continue with the lateral fibers from the the eye to adjust for the distance to the object
ipsilateral eye as the optic tract through the being observed and the iris which controls the
lateral geniculate body which mediates the size of the pupil to adjust for different light
“hunter’s reflex” to turn one’s head to better intensities. While the outflow of this nerve
see an object moving in our lateral vision. The is parasympathetic the nerve is joined by
signals then pass through the optic radiations sympathetic nerves along its course to those
to the occipital lobe of the brain for processing. two muscles.

Cranial Nerve IV - Trochlear Nerve

This small nerve carries somatic motor fibers
to a single muscle that moves the eye, the
superior oblique muscle. It passes like the
oculomotor nerve through the superior orbital
fissure and terminates at the target muscle.

Cranial Nerve V - Trigeminal Nerve

The trigeminal nerve is the largest cranial
nerve and as the name indicates it has three
[Link] are labeled as V1, V2, and
V3 (Figure 11) but each also has a name to
describe it also. Each branch follows a different
course out of the cranium but are collected
into a single nerve due to all the sensory nuclei
being in a single ganglion that is fed by the
three branches. This is the most important
nerve in dentistry and we will discuss each
division separately noting all the important
nerves associated with each.

Divisions of Cranial Nerve V -Trigeminal Nerve:

V1 – Ophthalmic Nerve
This is a purely sensory nerve that supplies
the skin over the upper 1/3rd of the face and
then in a narrow band down the center of the
Figure 8. Cranial Nerve II – Optic Nerve nose including the philtrum of the upper lip

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Figure 9. Cranial Nerve III - Oculomotor Nerve

Figure 10. Cranial Nerve IV - Trochlear Nerve

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through its frontal and lacrimal branches. It to join the maxillary nerve. Additionally post-
also supplies sensation to some of the nasal synaptic sympathetic fibers feed through the
mucous membranes and many structures of the ganglion to also pass into the maxillary nerve
eye including the cornea through its nasociliary V2. All of these visceral motor fibers join
branch. The lacrimal branch in addition travels the maxillary nerve and then pass into the
to the lacrimal gland not only providing sensory zygomatic nerve from which they connect via
fibers but also carrying parasympathetic fibers a communicating branch to the lacrimal nerve
that originate in the facial nerve but hitchhike on to innervate the lacrimal gland as mentioned in
branches of the trigeminal. In figure 15 below, the section on the ophthalmic nerve.
you can see the branches and can also see the
communicating branch with the zygomatic In addition, sensory fibers from a number of
nerve labeled. This small branch is carrying sensory branches pass through the ganglion
fibers that while they started in the facial nerve without synapsing. The first of these is the
are in branch of the second division of the greater palatine nerve which passes from the
trigeminal prior to connecting to the lacrimal palate through the greater palatine foramen
branch. We will discuss that further as we look and provides sensory innervation to much
at that division and again with the facial nerve. of the hard palate. The second is the lesser
palatine nerve which passes through the
The three branches of CN V join together in the lesser palatine foramen and provides the
vicinity of the superior orbital fissure and the same service to the soft palate. The next is
entire nerve enters the trigeminal ganglion the nasopalatine nerve which passes from
where the bodies of the sensory neurons are the anterior palatal tissue first through the
located. The axons then pass into the CNS. single incisive foramen then the left and right
fibers pass through individual nasopalatine
V2 – Maxillary Nerve foramina. It then joins with branches from the
The maxillary nerve like the ophthalmic nerve nasal septum and joins the maxillary nerve at
is sensory only in function. It is one of the crucial the pterygopalatine ganglion. This final pair of
nerves to learn in dentistry as it provides the nerves does the remaining area of the hard
sensation of the middle face which includes palate sensation anterior to the canine teeth
all of the upper teeth and their supporting along with the mucosa in the inferior part of
structures (Figure 17). It follows a complicated the nasal septum.
course and has many important branches so
hang on tight and make sure you refer to the There are also branches that are less important
diagram often. in dentistry whose areas of innervation can
be gleaned from their names. These are
It terminates like the ophthalmic at the the pharyngeal, posterior inferior nasal and
trigeminal ganglion but to get there passes posterior superior nasal branches. These all join
through the foramen rotundum. After passing the nerve and proceed to follow it back to the
through the foramen but before joining the trigeminal ganglion along with palatal branches.
trigeminal ganglion the maxillary nerve is joined
by the meningeal branch that carries sensory Anterior to the ganglion is another important
information from the meninges that surround sensory nerve that joins the maxillary after
the brain. passing into the space via foramina in the
posterior part of the maxillary tuberosity. This
Anterior to the foramen rotundum is the nerve, known as the posterior superior alveolar,
sphenopalatine fossa. In this space the nerve provides sensory innervation to the posterior
has an appendage known as the pterygopalatine maxilla including the maxillary sinus and the
ganglion which is a parasympathetic ganglion molar teeth and their supporting structures
associated with pre-ganglionic fibers from the including soft tissue on the facial side except
facial nerve that arrive at the ganglion on the the mesiobuccal root of the first molar in some
greater petrosal nerve. The post-synaptic fibers individuals. This nerve is often targeted for
exit the ganglion on the ganglionic branches obtaining anesthesia in the posterior maxilla.

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One can also see in the diagram that this nerve The infraorbital nerve passes through a
joins with the middle superior alveolar nerve foramen named for it just below the orbital
and the anterior superior alveolar nerve to rim. It gathers the anterior and middle superior
form a continuous network. However, this does alveolar branches within the orbit before passing
not seem to be clinically significant. through the inferior orbital fissure into the
pterygopalatine space. This is where it meets the
To complicate matters further the middle posterior superior alveolar to form the maxillary
superior alveolar and the anterior superior nerve.
alveolar do not join directly to the maxillary
nerve but rather to a large branch of the nerve The middle superior alveolar nerve is not always
that is found in the floor of the orbit. This nerve present but if it is it supplies sensory innervation
is known as the infraorbital nerve and begins in to the premolar teeth plus the mesial buccal root
the skin of the face inferior to the eye in several of the first molar, their supporting tissue and the
locations. There is an inferior palpebral branch facial soft tissue. The anterior superior alveolar
that carries sensations from the lower eyelid. serves the same function for the anterior teeth
There are internal and external nasal branches, and surrounding tissues. The infraorbital nerve
a branch known simply as the nasal branch is therefore very important in dental pain control
and a branch that runs to the upper lip known also. Block anesthesia of the infraorbital nerve
as the superior labial branch. The infraorbital numbs a large area of the face from the lower
nerve thus does most the sensation to the eyelid to the lip along with all of the teeth except
middle face. the molars.

Figure 11. Cranial Nerve V - Trigeminal Nerve Figure 12. Divisions of Trigeminal Nerve

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Figure 13. Cranial Nerve V1 – Ophthalmic Nerve Figure 14. Cranial Nerve V1 – Ophthalmic Nerve
(shown in blue)

Figure 15.

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Figure 16. Cranial Nerve V2 – Maxillary Nerve (shown in purple)

Figure 17. Cranial Nerve V2 – Maxillary Nerve

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 Figure 18. Cranial Nerve V2 – Maxillary Nerve (shown in purple)

V3 – Mandibular Nerve anterior to the ear plus some of the meninges

Unlike the first and second divisions of the surrounding the brain. As this is a motor nerve
trigeminal nerve the third division has a motor in addition to a sensory one we will start our
root in addition to the sensory one. The smaller tour of the nerve at the point where the two
motor root is separate from the sensory roots meet just past the foramen ovale.
root as they pass through the foramen ovale
which is the cranial exit of the mandibular In close proximity to the foramen ovale a
nerve. Once through the opening they unite number of branches of the nerve are seen.
to form a single nerve. The motor component The closest to the foramen is the sensory
of the nerve is responsible for innervating the meningeal branch carrying fibers originating
four muscles of mastication along with the in the meninges. The next branch is a mixed
mylohyoid, the tensor veli palatini, the tensor one that splits to form muscular branches and
tympani, and the anterior belly of the digastric then continues as a sensory nerve. These are
muscle. The sensory component carries sensory the nerves to the temporalis, masseteric,
information from the mandible, the mandibular the nerve to the medial and lateral
teeth, the periodontium and gingiva of the pterygoids. In addition, there are some very
lower jaw as well as the skin overlying the small branches serving the tensor tympani and
mandible including the lower lip and the skin tensor veli palatini. After these motor fibers

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leave the nerve continues as the buccal nerve joined by fibers carrying sensory fibers from
carrying sensation from the cheek and facial the posterior teeth and the surrounding bone.
gingiva posterior to the mental foramen. This At the other end of the canal is the mental
nerve is generally referred to in dentistry as foramen. This is the point at which the inferior
the long buccal nerve to distinguish it from alveolar nerve is formed by the union of the
an identically named buccal nerve that is a mental nerve which originates in the lower
branch of the facial nerve. lip and facial gingiva, anterior to the mental
foramen, plus the incisive nerve which
Entering the mandibular nerve posteriorly consists of small branches that originate in the
is the auriculotemporal nerve which is the mandible and the teeth anterior to the mental
afferent nerve from the ear, the temporal foramen. This can be confusing as in the
region and the TMJ. In addition, this nerve maxilla there is an incisive canal through which
carries parasympathetic fibers that originate passes the nasopalatine nerves. The incisive
from the glossopharyngeal nerve (cranial nerve, however, remains within the mandible
nerve IX) that it picks up while passing through so there is no opening associated with it.
the otic ganglion. These post-synaptic fibers
provide innervation to the parotid gland. Cranial Nerve VI – Abducens
The abducens nerve is a small, somatic
The mandibular nerve then splits into two efferent nerve that controls the lateral
terminal branches, inferior alveolar and the rectus muscle of the eye. This muscle when
lingual nerve which lie in close proximity contracted causes the eye to abduct hence the
to one another until the inferior alveolar name of the nerve. It leaves the orbit along
nerve enters the mandible at the mandibular with cranial nerve III, IV and V1 through the
foramen. The lingual nerve is the sensory superior orbital fissure.
nerve for the anterior two-thirds of the tongue
and the tissues on the lingual of the mandible. Cranial Nerve VII - Facial Nerve
Like the auriculotemporal nerve it carries Hopefully you were disappointed in the
postganglionic fibers that originate elsewhere. simplicity of the abducens nerve because
In this case they are fibers from the facial the facial nerve is a very complex one. It has
nerve and are destined for the submandibular all the possible fiber types: somatic motor,
and sublingual salivary glands. These merge visceral motor, general sensory and special
with the nerve at the submandibular ganglion sensory. We have already seen the autonomic
(see facial nerve diagram) which is attached fibers in the discussion of the maxillary and
to the lingual nerve. To make matters more ophthalmic nerves carrying its fibers to the
complicated as the general sensory fibers lacrimal gland and the mandibular nerve in
form the lingual nerve in the tongue and they regards to the submandibular and sublingual
are joined by fibers from the taste buds of the glands plus the special sensory component of
tongue. These fibers ultimately will join the taste. Now we get to see how the fibers got to
chordae tympani which is the same branch those nerves plus the other components that
of the facial nerve carrying parasympathetic we have not seen.
fibers to the submandibular ganglion.
As this is a mixed nerve we will start at the
The other branch, the inferior alveolar cranial exit. The facial nerve leaves the cranial
nerve passes into the mandible through the cavity through the internal acoustic meatus.
mandibular foramen but prior to that gives This leads into the petrous portion of the
off a couple of final motor branches, the temporal bone. Within the bone it gives off
nerve to the mylohyoid and the nerve to two branches which means that leaving the
the anterior belly of the digastric. Once those temporal bone there are three nerves, the
branches have separated the remaining fibers facial itself and two branches, each leaving
are all afferent. The nerve passes through the through a separate foramen. We will cover the
mandible in a tunnel in the bone known as the branches first before following the main nerve
mandibular canal. Throughout its passage it is trunk.

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Figure 19. Cranial Nerve V3 – Mandibular Nerve

Figure 20. Cranial Nerve V3 – Mandibular Nerve

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 Figure 21. Cranial Nerve VI – Abducens Nerve (shown in purple)

Greater Petrosal Nerve Chorda Tympani

The greater petrosal nerve is the first to The chorda tympani carries special sensory
branch within the temporal bone. It carries fibers from taste buds in the anterior 1/3 of
parasympathethic fibers out of the temporal the tongue and presynaptic parasympathetic
bone through the hiatus of the greater fibers to the sublingual and submandibular
petrosal nerve back into the middle cranial glands along with the minor salivary glands.
fossa. It then passes out of the cranium for It separates from the main trunk of the facial
good entering the foramen lacerum where nerve just before the latter passes out of
it joins the deep petrosal nerve to become the temporal bone through the stylomastoid
the nerve of the pterygoid canal. The deep foramen. The chorda tympani, however, travels
petrosal carries postganglionic sympathetic anteriorly into the middle ear. The nerve
fibers from spinal ganglia while the greater gets its name from its passage across the
petrosal is mostly composed of pre-ganglionic internal surface of the tympanic membrane
parasympathetic fibers. This combined nerve colloquially known as the ear drum. At the
of the pterygoid canal immediately enters anterior edge it leaves the temporal bone
the pterygoid canal in the sphenoid. After through the petrotympanic fissure into the
passing through the sphenoid the canal opens infratemporal fossa. At this point it associates
into the pterygopalatine fossa where the itself with the lingual nerve which as mentioned
nerve enters the pterygopalatine ganglion earlier is a branch of the mandibular nerve.
which is associated with the maxillary nerve The parasympathetic fibers will synapse in
as mentioned in the earlier section. The the submandibular ganglia and the post-
parasympathetic fibers synapse in the ganglion ganglionic fibers will follow the lingual nerve to
and the post ganglionic fibers pass into the the submandibular and sublingual salivary
maxillary nerve along with post-ganglionic glands. The sensory fibers do not synapse but
sympathetic fibers already traveling in the are directly attached to the taste buds in the
nerve. These fibers travel along the maxillary fungiform and foliate papillae.
nerve to the zygomatic nerve. Finally, they
travel through a communicating branch to the tnerve is mainly a somatic motor nerve with
ophthalmic nerve which gives off the lacrimal a minor somatic sensory component. The
nerve to the lacrimal gland. sensory component carries sensation from a

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small area of the pharynx and another small administration one injects into the capsule of
area of skin around the ear. Having noted the the parotid gland the patient will experience
small sensory contribution, we will follow the transient Bell’s palsy as that affliction is caused
somatic motor fibers. It must be mentioned by lack of function in the facial nerve serving
that the first somatic efferent branch of the the muscles of facial expression.
facial nerve is given off in the temporal bone.
This nerve carries somatic motor fibers to the Cranial Nerve VIII – Statoacoustic,
stapedius muscle which is located in the middle Vestibulocochlear, Auditory Nerve
ear. The remainder of the nerve passes through The eighth cranial nerve wins the most names
the stylomastoid foramen into the facial portion contest but if you are trying to remember
of the head. what the function of the nerve is remember
only the first two names as you will see that
From here, there is a branch serving muscle the third one on the list is incomplete. The
in the immediate vicinity named the posterior vestibulocochlear nerve passes like the facial
auricular which carries both somatic sensory nerve, through the internal acoustic meatus,
fibers as mentioned earlier to the area around but stays within the temporal bone. It originates
the ear and motor fibers to the muscles around at the cochlea, the semicircular canals, the
the ear as the name implies. These are in the maculae, the saccule and the utricle. The
muscles of facial expression group of muscles, cochlear is the area where the cells that sense
as they move soft tissue rather than a joint. vibrations that are ultimately translated into
auditory information so it carries fibers going
The next branch given off runs to muscles towards the brain. The other four organs
that are not in the group of muscles of facial mentioned are involved with the special sense
expression. This short branch goes to the of equilibrium and their afferent fibers form the
posterior belly of the digastric muscle. The vestibular branch of the nerve hence the name
anterior belly is connected to the mandibular vestibulocochlear as that is just the name of
nerve which makes this muscle more interesting the two nerves that form it. The statoacoustic
than ones with single innervation. There is also name comes from the two special senses that it
a short nerve that goes to a suprahyoid muscle, carries, those of equilibrium (stato) and hearing
the stylohyoid, which is also anatomically in the (acoustic). While some authors use the acoustic
path of the nerve as it exits the stylomastoid nerve for cranial nerve VIII that name neglects
foramen. an important function as anyone with vertigo
will attest as it carries special sensory fibers for
From there the facial nerve enters the parotid equilibrium as well as hearing.
gland and even while it is surrounded by the
gland, it does not innervate it. Within the Cranial Nerve IX – Glossopharyngeal Nerve
gland it splits into five terminal branches that The glossopharyngeal nerve contains, like
innervate all of the numerous muscles of the facial and along with the vagus nerve
facial expression except the ones innervated which we have not studied yet, all four
by the aforementioned posterior auricular types of nerve fibers. Unlike those other two
nerve. These branches are labeled by the area nerves where motor fibers predominate the
where they travel. These can be clearly seen glossopharyngeal nerve is mainly a sensory
in Figure 24 and from inferior to superior are nerve. The somatic motor fibers innervate only
the cervical, marginal mandibular, buccal, the stylopharyngeus muscle. The visceral motor
zygomatic and temporal. Confusion can fibers travel to the otic ganglion where they
sometimes result between the buccal branch of synapse and continue on mandibular nerve
the mandibular nerve and this buccal branch of branches to the parotid gland. The special
the facial nerve. The mandibular nerve branch sensory fibers carry fibers that originate in
is only sensory and the facial nerve branch is the taste buds in the posterior one-third of
only motor. So just remember if you are doing the tongue. The general sensory fibers convey
a buccal nerve block it would logically be the sensations from both internal receptors, the
sensory one. However, if during any anesthetic baroreceptors of the carotid sinus and the

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chemoreceptors found in the carotid body through a small opening between the carotid
which is in the area where the carotid artery canal and the jugular foramen orifices into the
splits into the internal and external carotids. body of the temporal bone. It passes into the
The carotid body importantly monitors blood tympanic cavity where it forms a network of
gases. There are also more conventional nerve fibers called the tympanic plexus. This
receptors it carries signals from. There are network collects general sensory fibers from
general sensory ones in the posterior one-third the internal surface of the tympanic membrane
of the tongue and the adjacent tissues covering and surrounding tissues. The remaining fibers,
the epiglottis, the upper pharyngeal walls and that are all pre-ganglionic parasympathetic
the skin of the ear and the deep surface of fibers, form the lesser petrosal nerve
the tympanic membrane. This is nerve that is which enters the otic ganglion where they
the main carrier of pain when you have a sore synapse. The post synaptic fibers pass into the
throat. mandibular nerve and are carried to the parotid
gland on the auriculotemporal nerve.
Having made a long introduction let us follow
the path of the nerve. Like the other mixed The main trunk continues after the branch
nerves we have discussed we will start with into the neck until it splits. It is formed mainly
the cranial exit but one should recognize of sensory fibers that join to form the trunk.
that the sensory nerves are not leaving there These come from general sensory fibers that
but are entering the cranium. The superior come from branches in the tonsillar region,
and inferior ganglia are sensory in function. the pharynx and receptors from the carotid
Only the otic ganglion is associated with artery and both the somatic sensory and taste
parasympathetic motor [Link] cranial exit/ sensory fibers from the posterior one-third
entrance of the glossopharyngeal nerve is the of the tongue. The small motor nerve to the
jugular foramen. The first branch of the nerve stylopharyngeus muscle is also included in the
is the small tympanic nerve which passes formation of the main trunk.

Figure 22. Cranial Nerve VII - Facial Nerve

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 Figure 23. Cranial Nerve VII - Facial Nerve

Figure 24. Cranial Nerve VII - Facial Nerve (main trunk)

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Figure 25. Cranial Nerve VIII – Statoacoustic, Vestibulocochlear, Auditory Nerve

Figure 26. Cranial Nerve IX – Glossopharyngeal Nerve

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 Figure 27. Cranial Nerve IX – Glossopharyngeal Nerve

Cranial Nerve X – Vagus Nerve Another early branch is the pharyngeal branch
The vagus nerve is the longest cranial nerve. It is which carries fibers from taste buds in the
like the facial and the glossopharyngeal in that pharynx. It is also of importance in the head
it carries fibers of all types. Most of these fibers and neck as it gives off branches that innervate
are either visceral motor or visceral sensory all of the palatal muscles except the tensor
fibers and most are not found in the head and veli palatini which, as mentioned earlier, is
neck. Nevertheless, anyone who has taken any connected to the mandibular nerve. It also
course in office emergencies is familiar with the contributes to the pharyngeal plexus which
term vasovagal syncope. So, despite the nerve supplies motor innervation to all the pharyngeal
having few branches in the area where dental muscles except the stylopharyngeus and parts
personal work it does play a role in dental care. of the inferior pharyngeal constrictor which is
supplied by laryngeal branches of the vagus.
As done previously with mixed nerves we will The stylopharyngeus muscle is supplied by the
start as the cranial exit which in the case of the glossopharyngeal nerve.
vagus nerve is the jugular foramen. Through
the neck it is found in the carotid sheath with The next branches are a couple of nerves
the common carotid artery and the internal that serve the larynx. The first is the superior
jugular vein. Before it enters the sheath it laryngeal which gives rise to the external
sometimes gives off a branch that splits off an laryngeal, and the internal laryngeal nerves
area where IX, X, and XI all join together. It then and the later branch is the recurrent laryngeal.
passes to the area around ear. We have already The external laryngeal is a motor nerve to the
seen components of the trigeminal, facial and cricothyroid muscle which allows one to vary
glossopharyngeal nerve in the vicinity of the ear the pitch of one’s voice. The internal laryngeal
so you can appreciate that the external ear is is a sensory nerve carrying fibers that originate
an area where several nerves are involved with in the tissues within the superior portion larynx
general sensation. The vagus provides fibers and the laryngeal surface of the epiglottis.
to the external acoustic meatus but all of the This will also carry taste sensation from the
nerves involved overlap to some extent. epiglottis. The recurrent laryngeal is motor to

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Figure 28. Cranial Nerve X - Vagus Nerve

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all the other small muscles in the larynx and rate slows down greatly and blood pressure
sensory to the membranes found below the falls precipitously. Not only are there autonomic
vocal folds. These nerves provide virtually all of motor fibers to the thorax but the vagus also has
the motor and sensory innervation to the larynx. sensory fibers from all the thoracic organs.
After giving off branches to ganglia in the thorax
The vagus gives off no more branches in the the vagi (this is the plural of vagus to remind one
neck and enters the thorax where it supplies that there are both a left and right vagus) follow
pre-synaptic parasympathetic fibers to the the aorta into the abdominal cavity where it
viscera, most importantly the heart. It is these connects with the nerves that control the motility
fibers that are implicated in vasovagal syncope of the digestive system. It receives sensory
as they slow down the heart rate. If these information from the digestive organs except
fibers provide vastly more stimulation than from the distal portion of the transverse colon to
countered by the sympathetic fibers the heart the rectum.

Figure 29. Cranial Nerve XI - Spinal Accessory, Accessory

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Cranial Nerve XI - Spinal Accessory Nerve magnum, joins up with cranial nerves IX and
This an odd cranial nerve hence one of its X briefly and then cranial root from the brain
names containing the word spinal. The reason stem then leaves with IX and X through the
for the name is that the main portion of nerve jugular foramen. It is purely somatic efferent in
originates in the spinal cord. The nerve passes function supplying motor innervation branches
from the spinal cord back through the foramen to the trapezius and sternocleidomastoid
magnum, joins up with cranial nerves IX and muscles.
X briefly and then cranial root from the brain
stem then leaves with IX and X through the Cranial Nerve XII - Hypoglossal Nerve
jugular foramen. It is purely somatic efferent in The hypoglossal nerve which is considered a
function supplying motor innervation branches somatic efferent nerve leaves the brain stem
to the trapezius and sternocleidomastoid just prior to the origin of the spinal cord. It
muscles. passes laterally through the hypoglossal canal,
and travels in the carotid sheath for a short
Cranial Nerve XI - Spinal Accessory Nerve distance before running towards the angle of
This an odd cranial nerve hence one of its the mandible. It then sends fibers to all of the
names containing the word spinal. The reason intrinsic muscles of the tongue and to all of
for the name is that the main portion of nerve the extrinsic muscles of the tongue except the
originates in the spinal cord. The nerve passes palatoglossus which as mentioned earlier is
from the spinal cord back through the foramen innervated by the vagus nerve.

Figure 30. Cranial Nerve XII – Hypoglossal

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Summary
The best way to summarize the cranial nerves is with a table showing the major attributes of each.

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Appendices

Appendix A

Appendix B

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 Appendix C

Appendix D

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 Appendix E

Appendix F

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 Appendix G

Appendix H

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 Appendix I

Appendix J

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 Appendix K

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 Appendix L

Appendix M

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 Appendix N

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 Appendix O

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Appendix P
Course Test Preview
To receive Continuing Education credit for this course, you must complete the online test. Please
go to: [Link]/en-us/professional-education/ce-courses/ce598/test

1. What type of nerve causes contraction of skeletal muscle fibers?

A. Parasympathetic motor
B. Somatic motor
C. Sympathetic motor
D. All of the above

2. Which of the divisions of the trigeminal nerve have somatic motor fibers?
A. Mandibular
B. Maxillary
C. Ophthalmic
D. All of the above

3. Neurotransmitters are released into the synaptic cleft under what condition?
A. More than half of the dendrites are stimulated by other neurons.
B. The action potential in the axon is above the threshold potential.
C. The action potential in the dendrite reaches the neuron cell body.
D. The neuron has transported excess neurotransmitter to the axon.

4. Which of the cranial nerves is the longest?

A. Facial
B. Oculomotor
C. Trigeminal
D. Vagus

5. Which of the following nerves pass though the ethmoid bone?

A. Oculomotor
B. Olfactory
C. Optic
D. Vagus

6. Bell’s palsy which results in drooping of the affected side of the face is due to damage
to the nerve which supplies motor innervation to the muscle of facial expression. Which
nerve is damaged if the patient exhibits Bell’s palsy symptoms?
A. Facial
B. Maxillary
C. Spinal accessory
D. Vagus

7. Which would be the proper path to the brain from a pain stimulus originating in the
maxillary central incisor.
A. Anterior superior alveolar >> infraorbital >> maxillary
B. Anterior superior alveolar >> inferior alveolar >> maxillary
C. Incisive >> infraorbital >> maxillary
D. Incisive >> inferior alveolar >> mandibular

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8. Damage to what nerve will affect the ability to change the pitch of speech?
A. External laryngeal
B. Glossopharyngeal
C. Hypoglossal
D. Recurrent laryngeal

9. Damage to what nerve will affect the ability properly change the shape of the tongue?
A. Glossopharygeal
B. Hypoglossal
C. Lingual
D. Vagus

10. Skin at the tip of the nose is innervated by branches directly from what nerve?
A. Infraorbital
B. Maxillary
C. Nasopalatine
D. Ophthalmic

11. The pterygopalatine ganglion is associated with which nerve?

A. Glossopharygeal
B. Lingual
C. Maxillary
D. Ophthalmic

12. Which is the branch of the facial nerve that carries pre-ganglionic fibers destined to
innervate the submandibular salivary gland?
A. Buccal
B. Chorda tympani
C. Lesser petrosal
D. Marginal mandibular

13. The term visceral efferent is synonymous with which of the following?
A. Autonomic motor
B. Somatic motor
C. Somatic sensory
D. Visceral sensory

14. The special sense of equilibrium is carried on which cranial nerve?

A. II
B. V
C. VII
D. VIII

15. Which nerves innervates a muscle that moves the eyeball within the socket?
A. II
B. V
C. VI
D. VII

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References
1. Brand, R.W., & Isselhard, D.E. (2003). Anatomy of Orofacial Sturctures (7th Edition). Mosby.
2. Fehrenbach, M.J., & Herring, S.W. (2021). Illustrated Anatomy of the Head and Neck (7th Edition).
Elsevier.
3. Hiatt, J.L., & Gartner, L.P. (2010). Textbook of Head & Neck Anatomy (4th Edition). Lippincott
Williams, & Wilkins.
4. Scheide, R.C., & Weiss, G. (2012). Woelfel’s Dental Anatomy (8th Edition). Lippincott Williams, &
Wilkins.
5. Schuenke, M., Schulte, E., & Schumacher, U. (2010). Head and Neck Anatomy for Dental Medicine
(E.W. Baker, Ed.). Thieme.
6. Weaker, F.J. (2014). Structures of the Head and Neck. F.A. Davis Company

Additional Resources
• [Link] - various articles

About the Authors

Larry LoPresti, DMD

Dr. LoPresti has a BA from Amherst College and a DMD from Boston University Henry M. Goldman
School of Dental Medicine. He has been an adjunct Professor teaching anatomy for over 20 years
and is currently employed by MCPHS University Forsyth School of Dental Hygiene. In addition, he
has practiced general dentistry both in private practice and FQHC dental centers. Most interestingly,
he is the consulting dentist for the Roger Williams Park Zoo in Providence, RI. For the past 6 years,
Dr. LoPresti has been a CODA site visitor for allied health.

[Link]@[Link]

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