Snímek lidského mozku na neurologické klinice Clinical anatomy of cranial nerves MUDr. Erik Kročka Development of the CNS – neural tube G:\Anatómia - rozvrhy\Jarný semester 2022\Klinická anatomie hlavy a nervových drah\Klinická anatomie hlavových nervů\Vývoj CNS obecně 1.JPG Neural plate Neural groove Neural tube G:\Anatómia - rozvrhy\Jarný semester 2022\Klinická anatomie hlavy a nervových drah\Klinická anatomie hlavových nervů\Vývoj CNS obecně 3.JPG G:\Anatómia - rozvrhy\Jarný semester 2022\Klinická anatomie hlavy a nervových drah\Klinická anatomie hlavových nervů\Vývoj CNS obecně 4.JPG •Basal plate (roof plate) •Alar plate (floor plate) •Sulcus limitans •Neural crest •Ventricular (ependymal) layer •Intermediate (mantle) layer •Marginal layer Development of the CNS – neural tube G:\Anatómia - rozvrhy\Jarný semester 2022\Klinická anatomie hlavy a nervových drah\Klinická anatomie hlavových nervů\Vývoj hlavových nervov 5.PNG G:\Anatómia - rozvrhy\Jarný semester 2022\Klinická anatomie hlavy a nervových drah\Klinická anatomie hlavových nervů\Vývoj hlavových nervov 2.PNG G:\Anatómia - rozvrhy\Jarný semester 2022\Klinická anatomie hlavy a nervových drah\Klinická anatomie hlavových nervů\Vývoj hlavových nervov 3.PNG Dorsal column (Alar plate) General visceral afferent column General somatic afferent column Special somatic afferent column Special visceral afferent column Ventral column (Basal plate) General somatic efferent column Branchial efferent column General visceral efferent column G:\Anatómia - rozvrhy\Jarný semester 2022\Klinická anatomie hlavy a nervových drah\Klinická anatomie hlavových nervů\Vývoj hlavových nervov 1.PNG G:\Anatómia - rozvrhy\Jarný semester 2022\Klinická anatomie hlavy a nervových drah\Klinická anatomie hlavových nervů\Hlavové nervy C.JPG G:\Anatómia - rozvrhy\Jarný semester 2022\Klinická anatomie hlavy a nervových drah\Klinická anatomie hlavových nervů\Hlavové nervy B.JPG G:\Anatómia - rozvrhy\Jarný semester 2022\Klinická anatomie hlavy a nervových drah\Klinická anatomie hlavových nervů\Hlavové nervy A.JPG G:\Anatómia - rozvrhy\Jarný semester 2022\Klinická anatomie hlavy a nervových drah\Klinická anatomie hlavových nervů\Vývoj hlavových nervov 4.PNG > Obsah obrázku strom, exteriér, osoba, stojící Popis byl vytvořen automaticky Olfactory nerve (n. I) •part of the telencephalon, not really a cranial nerve in the conventional sense •humans belong to microsmatic vertebrates → a poor sense of smell •olfactory area is approximately 5 cm2 (107 olfactory cells) •humans can distinguish ca. 10 000 smells •the olfactory neurons can regenerate Obsah obrázku text Popis byl vytvořen automaticky •hyposmia/mikrosmia •anosmia •parosmia (cacosmia) •uncinate seizure SYMPTOMS OF OLFACTORY NERVE LESION Obsah obrázku text, dav Popis byl vytvořen automaticky Optic nerve (n. II) •part of the diencephalon, not really a cranial nerve in the conventional sense •doesn´t regenerate after injury •is formed from the central processes of the ganglionic cells (3th neuron of the optic pathway) •contains approximately 1,2 milions of the afferent fibers (1/3 come from central 5° of the retina) •80% fibers ends in the lateral geniculate nucleus, remain fibers leads to the mesencephalon and hypothalamus Obsah obrázku text Popis byl vytvořen automaticky The extrageniculate visual pathway •10-20% fibers •radix optica mesencephalica •radix optica hypothalamica - retinohypothalamic tract •amaurosis •heteronymous hemianopsia •homonymous hemianopsia •quadrantopsia •scotoma •phosphene SYMPTOMS OF OPTIC NERVE LESION Obsah obrázku lampa, oranžová Popis byl vytvořen automaticky Obsah obrázku zavřít Popis byl vytvořen automaticky Physiological finding Papilledema (optic disc swelling) Obsah obrázku text Popis byl vytvořen automaticky Optic coherence tomography – physiological finding INTRODUCTION TO EYE MOVEMENT I INTRODUCTION TO EYE MOVEMENT II > Obsah obrázku interiér, zuby, osoba, čištění Popis byl vytvořen automaticky Oculomotor nerve (n. III) •arises from the interpeduncular fossa (sulcus nervi oculomotorii) of the midbrain •innervates all of the extraocular muscules except superior obliquus muscle and lateral rectus muscle •preganglionic parasympathetic fibers from the accessory nucleus of n. III (Edinger-Westphali) synapse in the cilliary ganglion and supply sphincter pupillae muscle (miosis) a ciliary muscle (accommodation) •passes through subarachnoid space (interpeduncular cistern) lateral to the posterior communicating artery •pierces dura mater lateral from the posterior clinoid process a enters the cavernous sinus CAVE: oculomotor nerve palsy caused by posterior communicating artery aneurysm! Obsah obrázku text Popis byl vytvořen automaticky In the cavernous sinus: •receives sympathetic branches from internal carotid plexus for innervation of superior tarsal muscle (ncl. intermediolateralis Th1-Th5 → ganglion cervicale superius → n. caroticus internus → plexus caroticus internus) •proprioceptive fibers hitchhike along the ophthalmic nerve to the mesencephalic trigeminal nucleus Obsah obrázku oranžová, zavřít, kosmetické, oči Popis byl vytvořen automaticky SYMPTOMS OF OCULOMOTOR NERVE LESION •ptosis •exotropia (outward) and hypotropia (downward) •limitations of eye movements •diplopia •mydriasis OVERVIEW OF THE OCULOMOTOR NERVE BRANCHES 1. Ramus superior (innervation of m. levator palpebrae superioris a m. rectus superior) §rr. orbitales 2. Ramus inferior (innervation of m. rectus medialis, m. rectus inferior a m. obliquus inferior) §ramus ad ganglion ciliare / radix parasympathica (oculomotoria) ganglii ciliaris •nn. ciliares breves > Obsah obrázku panenka, hračka, osoba, bílá Popis byl vytvořen automaticky Trochlear nerve (n. IV) •the trochlear motor nucleus in the midbrain •fibers decussate within the brainstem •arises as only cranial nerve from the dorsal aspect of the brainstem •innervates the superior oblique muscle SYMPTOMS OF TROCHLEAR NERVE LESION •central (contralateral) x periferal (ipsilateral) palsy •endotropia (inward) and hypertropia (upward) •mediocaudal limitation of eye movement •diplopia Trigeminal nerve (n. V) > Obsah obrázku text, osoba, muž, interiér Popis byl vytvořen automaticky 1. Motor nucleus of trigeminal nerve (masticatory) •branchiomotor nucleus supplies muscules derived from 1th pharyngeal arch (muscles of mastication, m. mylohyoideus, venter anterior m. digastrici, m. tensor tympani, m. tensor veli palatini) 2. Principal sensory nucleus of trigeminal nerve (pontine) •somatosensory nucleus, receives discriminative sensations, proprioception, light touch and vibration 3. Spinal nucleus of trigeminal nerve •somatosensory nucleus for perception of cold, heat, pain and partial proprioception from n. V, VII, IX, X 4. Mesencephalic nucleus of trigeminal nerve •ganglion with pseudounipolar neurons, receives proprioception from periodontium, hard palate, temporomandibular joint and from extraocular, masticatory, mimic and lingual muscles too •the biggest cranial nerve •mixed nerve with large nuclear complex Spinal nucleus of the trigeminal nerve 1.Subnucleus (pars) oralis 2.Subnucleus (pars) interpolaris 3.Subnucleus (pars) caudalis § termination of the Aδ and C fibers Somatotopic arrangement of spinal nucleus of n. V •arises from the middle part of pons •enters the trigeminal cave (Meckel´s cave), a dura mater pouch containing trigeminal ganglion (semilunare, Gasseri) •motor root (portio minor trigemini) underruns the ganglion and joins the mandibular nerve directly Ophthalmic nerve •1th branch of the trigeminal nerve •counts approx. 26 000 myelinated fibers •the most medial branch of the trigeminal ganglion •passes through the lateral wall of cavernous sinus •supplies (somatosensory): Øorbit with periosteum, ocular bulb, lacrimal gland Øconjunctiva of the upper eyelid Øskin of nasal dorsum and tip, upper eyelid and forehead to the interauricular line Øethmoidal cells mucosa, sphenoid sinus and ventral part of nasal cavity Obsah obrázku text Popis byl vytvořen automaticky Nervus frontalis •n. supraorbitalis → r. medialis → r. lateralis •n. supratrochlearis Nervus lacrimalis •r. communicans cum nervo zygomatico Nervus nasociliaris •r. communicans cum ganglio ciliari •nn. ciliares longi •n. ethmoidalis posterior •n. ethmoidalis anterior → rr. nasales → r. nasalis externus •divides in superior ophthalmic fissure to: Ønervus frontalis Ønervus lacrimalis Ønervus nasociliaris Ophthalmic nerve Ølacrimal nerve carries also autonomic fibers for innervation of lacrimal gland (plexus caroticus internus → n. petrosus profundus → n. canalis pterygoidei → rr. ganglionares → n. zygomaticus → r. communicans cum nervo zygomatico → n. lacrimalis) (n. VII → n. petrosus major → n. canalis pterygoidei → ganglion pterygopalatinum → rr. ganglionares → n. zygomaticus → r. communicans cum nervo zygomatico → n. lacrimalis) Ophthalmic nerve § a small number of the meningeal branch supplying dura mater of the cranial venous sinuses pass through cranial sutures and innervate extracranial periost ANATOMICAL BACKROUND OF THE TENSION HEADACHE ! Corneal reflex (trigeminofacial) •differential diagnosis of bulbar vs. pseudobulbar syndrome •hyperreflexia: supranuclear lesion of the corticobulbar tract •hypo/areflexia: lesion of spinal nucleus of trigeminal nerve, facial motor nucleus, pontine fibers or trunks of n. V / n. VII Herpes zoster ophthalmicus > Obsah obrázku osoba, zavřít Popis byl vytvořen automaticky OVERVIEW OF THE OPHTHALMIC NERVE BRANCHES 1. Ramus meningeus recurrens / ramus tentorius (tentorii) 2. Nervus lacrimalis §r. communicans cum nervo zygomatico 3. Nervus frontalis §n. supraorbitalis •r. lateralis •r. medialis §n. supratrochlearis 4. Nervus nasociliaris §r. communicans cum ganglio ciliari (radix sensoria / nasociliaris ganglii ciliaris) §nn. ciliares longi §n. ethmoidalis posterior •r. meningeus anterior §n. ethmoidales anterior •rr. nasales interni •rr. nasales laterales •rr. nasales mediales •r. nasalis externus §n. infratrochlearis •rr. palpebrales Maxillary nerve •2nd branch of the trigeminal nerve •counts approx. 50 000 myelinated fibers •passes through the lateral wall of cavernous sinus, enters fossa through the foramen rotundto the pterygopalatine um •supplies (somatosensory): Ødura mater in the middle cranial fossa Øcheek skin between the palpebral and oral fissure Ømucosa of the upper cheeks Ømucosa of the maxillary sinus and posterior 2/3 of the nasal cavity Ømucosa of the palate, isthmus faucium, nasopharynx and adjacent part of the Eustachian tube Ømaxilla and upper teeth Percutaneous intervention on the Gasserian ganglion Neurosurgeric decompression of the trigeminal nerve OVERVIEW OF THE MAXILLARY NERVE BRANCHES 1. R. meningeus 2. Rr. ganglionares ad ganglion pterygopalatinum / radix sensoria ganglii pterygopalatini §rr. orbitales §rr. nasales posteriores superiores laterales §rr. nasales posteriores superiores mediales §n. nasopalatinus (incisivus) §n. pharyngeus §n. palatinus major §rr. nasales posteriores inferiores §nn. palatini minores •rr. tonsillares 3. N. zygomaticus §r. communicans cum nervo lacrimali §r. zygomaticotemporalis §r. zygomaticofacialis 4. N. infraorbitalis §rr. alveolares superiores posteriores §r. alveolaris superior medius §rr. alveolares superiores anteriores •plexus dentalis superior -rr. dentales superiores -rr. gingivales superiores §rr. palpabrales inferiores §rr. nasales externi §rr. nasales interni §rr. labiales superiores Mandibular nerve •3th branch of the trigeminal nerve •counts approx. 26 000 myelinated fibers •the most lateral branch of the trigeminal ganglion •receives motor root •enters to the infratemporal fossa through the foramen ovale •supplies (somatosensory): Ødura mater near the posterior branches of middle meningeal artery Øskin of temporal region and around mandibula Ømucosa of the lower cheeks, isthmus faucium, palatine tonsil and the floor of the oral cavity Ømucosa of the ventral 2/3 Ømandible and lower teeth •innervates (branchiomotor): Ømasticatory muscles (m. masseter, m. temporalis, m. pterygoideus medialis et lateralis) Øm. mylohyoideus, venter anterior m. digastrici Øm. tensor tympani, m. tensor veli palatini Jaw jerk (masseter) reflex •differential diagnosis of bulbar vs. pseudobulbar syndrome •hyperreflexia: supranuclear lesion of the corticobulbar tract •hypo/areflexia: lesion of mesencephalic nucleus of trigeminal nerve, motor nucleus of trigeminal nerve, pontine fibers or trunk of n. V OVERVIEW OF THE MANDIBULAR NERVE BRANCHES 1. Ramus meningeus (nervus spinosus) 2. Nervus pterygoideus medialis 3. Rami ganglionares ad ganglion oticum / radix sensoria ganglii otici 4. Nervus musculi tensoris veli palatini 5. Nervus musculi tensoris tympani 6. Nervus massetericus 7. Nervi temporales profundi 8. Nervus pterygoideus lateralis 9. Nervus buccalis 10. Nervus auriculotemporalis §n. meatus acustici externi §rr. membranae tympani §rr. parotidei §rr. communicantes cum nervo faciali §nn. auriculares anteriores §rr. temporales superficiales 11. Nervus lingualis §rr. isthmi faucium §rr. communicantes cum nervo hypoglosso §chorda tympani §n. sublingualis §rr. linguales §rr. ganglionares ad ganglion submandibulare / radix sensoria ganglii submandibularis §rr. ganglionares ad ganglion sublinguale / radix sensoria ganglii sublingualis 12. Nervus alveolaris inferior §n. mylohyoideus §plexus dentalis inferior •rr. dentales inferiores •rr. gingivales inferiores §n. mentalis •rr. mentales •rr. labiales inferiores •rr. gingivales Abducens nerve (n. VI) Obsah obrázku text, oblek, bílá, staré Popis byl vytvořen automaticky •the abducens motor nucleus in the pons •arises from the bulbopontine groove medial to the n. VII •innervates the lateral rectus muscle Obsah obrázku text Popis byl vytvořen automaticky •runs upward between the pons and the clivus •pierces the dura at the tip of petrous bone •runs alongside the internal carotide artery in the cavernous sinus Obsah obrázku text, interiér Popis byl vytvořen automaticky → fissura orbitalis superior → anulus tendineus communis Zinni •endotropia •lateral limitation of eye movement •diplopia Etiology: → trauma → tumor compression → internal carotide artery aneurysm → arteriovenous fistula of the cavernous sinus → intracranial hypertension → iatrogenic (after lumbal puncture) → Tolosa-Hunt syndrome → meningitis, basal tuberculosis, sarkoidosis → Guillan-Barré syndrome → diabetic poly(mono)neuropathy → sclerosis multiplex → febrile state in children → thrombophlebitis of the cavernous sinus SYMPTOMS OF ABDUCENS NERVE LESION Obsah obrázku text Popis byl vytvořen automaticky Facial nerve (n. VII) 1. Motor nucleus of facial nerve •branchiomotor nucleus for innervation of muscles derived from 2nd pharyngeal arch (mimic muscles, platysma, m. stylohyoideus, m. stapedius a venter posterior m. digastrici) • 2. Superior salivatory nucleus •visceromotor nucleus for parasymphatic innervation lacrimal / submandibular / sublingual glands, glands in nasal mucosa, nasopharynx and isthmus faucium 3. Solitary nucleus (gustatory) •viscerosensory nucleus (rostral part) for taste from ventral 2/3 of the lingua • 4. Spinal nucleus of trigeminal nerve •somatosensory nucleus for perception from auricle, external auditory meatus • 5. Mesencephalic nucleus of trigeminal nerve •ganglion with the pseudounipolar neurons, receives proprioception from mimic muscles Arising of the n. VII •trigonum pontocerebellare (cerebellopontine angle) •fibers turn around the nucleus of abducens nerve as genu nervi facialis (base of facial colliculus) •intermediate nerve carries parasymphatic and gustatory fibers Obsah obrázku jídlo Popis byl vytvořen automaticky •enters the pyrimid through fundus meatus acustici interni (area nervi facialis ventrocranial) •receives fibers from the intermediate nerve Course of the facial nerve in the petrous bone I Course of the facial nerve in the petrous bone II •exit from the petrous bone: stylomastoid foramen •enters the parotid gland •runs dorsally and laterally from the retromandibular vein and external carotid artery •creates the (intra)parotid plexus 1. Temporal branches - muscles of the frontal and temporal region - 2. Zygomatic branches - m. orbicularis oculi, mm. zygomatici and muscles of the nose 3. Buccal branches - muscles of the upper lip and buccal region - 4. Marginal mandibular branches - muscles of the chin and lower lip - 5. Cervical branches - m. platysma, ansa cervicalis superficialis Obsah obrázku zelenina Popis byl vytvořen automaticky Symptoms Obrys plačícího obličeje se souvislou výplní •mimic muscles palsy •lagophthalmos •ageusia, hyposecretion of saliva •hyperacusis •hyposecretion of tears Čokoláda se souvislou výplní Ucho obrys Obrys zmateného obličeje se souvislou výplní Peripheral palsy of n. VII 5. Ipsilateral mimic muscles palsy 4. Ipsilateral mimic muscles palsy + ageusia (anterior 2/3 of the tongue) + hyposecretion of saliva 3. Ipsilateral mimic muscles palsy + ageusia (anterior 2/3 of the tongue) + hyposecretion of saliva + hyperacusis 2. Ipsilateral mimic muscles palsy + ageusia (anterior 2/3 of the tongue) + hyposecretion of saliva and tears + hyperacusis Central and peripheral palsy of n. VII … or why seems the peripheral palsy of n. VII more dramatic? Obsah obrázku text, perokresba Popis byl vytvořen automaticky Obsah obrázku perokresba Popis byl vytvořen automaticky Central palsy → oral commissure drooping Peripheral palsy → oral commissure drooping → ptosis Obsah obrázku text, osoba, zeď, interiér Popis byl vytvořen automaticky „BELL´S SIGN“ OVERVIEW OF THE FACIAL NERVE BRANCHES 1. Nervus petrosus major / radix parasympathica (intermedia) ganglii pterygopalatini §n. canalis pterygoidei (vzniká spojením s n. petrosus profundus) •vede pregangliové parasympatické (n. petrosus major) a postgangliové sympatické vlákna (n. petrosus profundus) do ganglion pterygopalatinum •inervace glandula lacrimalis a malých žláz nosu a patra 2. Nervus stapedius 3. Chorda tympani §pregangliové parasympatické vlákna do ganglion submandibulare (inervace glandula submandibularis a glandula sublingualis) §senzorické (chuťové) vlákna z předních 2/3 jazyka skrze ganglion geniculi 4. Ramus communicans cum plexu tympanico 5. Ramus communicans cum nervo vago 6. Ramus communicans cum nervo glossopharyngeo 7. Nervus auricularis posterior §r. occipitalis §r. auricularis 8. Ramus digastricus 9. Ramus stylohyoideus 10. Plexus (intra)parotideus §rr. temporales §rr. zygomatici §rr. buccales §r. marginalis mandibulae §r. colli Vestibulocochlear nerve (n. VIII) > Obsah obrázku text, osoba Popis byl vytvořen automaticky Nervus cochlearis Area cochlae (tractus spiralis foraminosus) •central fibers of the spiral ganglion Nervus ampullaris posterior Nervus saccularis Nervus utriculoampullaris Nervus cochlearis (tractus spiralis foraminosus) Nervus facialis Screening sluchu novorozenců •definovaný ve vyhlášce č. 70/2021 Sb. o preventivních prohlídkách ve znění pozdějších předpisů (nabytí účinnosti zákonu č. 45/2021 Sb. dne 24.2.2021) •fáze screeningu: 1.screeningové vyšetření sluchu novorozenců (TEOAE, AABR) 2.screeningové vyšetření sluchu dětí metodou tónové audiometrie ve věku 5 let Vestibular nerve → utriculoampullary nerve •utricular nerve •anterior ampullary nerve •lateral ampullary nerve → saccular nerve → posterior ampullary nerve Area vestibularis superior → n. utriculoampullaris Area vestibularis inferior → n. saccularis Foramen singulare → n. ampullaris posterior Vestibulum Recessus ellipticus (utriculi) •macula cribrosa superior •aqueductus vestibuli Recessus sphericus (sacculi) •macula cribrosa media Recessus cochlearis •macula cribrosa inferior Perception of head orientation Canales semicirculares ossei •3 bony semicircular canals in the petrous temporal bone •occupy 3 planes in space Anterior (superior) semicircular canal •transversely to the long axis of the petrous bone •dorsal angulation by 30 degrees Posterior semicircular canal •parallel to the long axis of the petrous bone Lateral (horizontal) semicircular canal •transversely to the anterior semicircular canal •dorsal angulation by 30 degrees Perception of head rotation Obsah obrázku text, osoba, dav Popis byl vytvořen automaticky Dix-Hallpikeův test SYMPTOMS OF VESTIBULOCOCHLEAR NERVE LESION •vertigo •nystagmus •nauzea, vomitus Obsah obrázku text, různé, řetěz Popis byl vytvořen automaticky Acustic neurinoma •benign tumor from the Schwann´s cells •symptoms: hypacusis, tinitus, vertigo, peripheral palsy of n. VII, hypesthesia of the n. V OVERVIEW OF THE VESTIBULOCOCHLEAR NERVE BRANCHES NERVUS COCHLEARIS Ganglion spirale cochleae §aferentní vlákna (95%) •bipolární neurony (90%, dendrity inervují vnitřní vláskové buňky) •pseudounipolární neurony (10%, periferní raménka inervují zevní vláskové buňky) §eferentní vlákna (5%) •tractus olivococlearis lateralis (synapse na dendritech bipolárních buněk) •tractus olivocochlearis medialis (synapse na zevních vláskových buňkách) NERVUS VESTIBULARIS Ganglion vestibulare §pars superior •n. utriculoampullaris -n. utricularis -n. ampullaris anterior -n. ampullaris lateralis §pars inferior •n. ampullaris posterior •n. saccularis Glossopharyngeal nerve (n. IX) > Obsah obrázku text, černá Popis byl vytvořen automaticky 1. Nucleus ambiguus (rostral part) •branchiomotor nucleus for innervation of the muscles derived from the 3rd – 4th branchial arch (muscles of the pharynx, soft palate except of m. tensor veli palatini) 2. Dorsal nucleus of glossopharyngeal nerve (salivatorius inferior) •visceromotor nucleus for parasympathetic innervation of the parotide gland 3. Solitary nucleus (gustatory) •viscerosensory nucleus (rostral part) for taste perception from dorsal 1/3 of the tongue 4. Spinal nucleus of trigeminal nerve •somatosensory nucleus for perception from the pharynx, palatine tonsil, dorsal 1/3 of the tongue, tympanic cavity and adjacent part of the Eustachian tube Obsah obrázku text Popis byl vytvořen automaticky OVERVIEW OF THE GLOSSOPHARYNGEAL NERVE BRANCHES 1. Nervus tympanicus §plexus tympanicus (ganglion tympanicum) •r. tubarius •n. petrosus minor → ganglion oticum (innervation of glandula parotis through n. auriculotemporalis → rr. parotidei) -r. communicans cum ramo meningeo -r. communicans cum nervo auriculotemporali -r. communicans cum chorda tympani 2. Ramus communicans cum ramo auriculari nervi vagi 3. Ramus communicans cum trunco tympanico / nervus jugularis 4. Ramus stylopharyngeus (ramus musculi stylopharyngei) 5. Rami pharyngei 6. Ramus sinus carotici 7. Rami tonsillares 8. Rami linguales Obsah obrázku text, klipart Popis byl vytvořen automaticky Vagus nerve (n. X) 1. Nucleus ambiguus (middle part) •branchiomotor nucleus for innervation of the muscles derived from the 3rd – 4th branchial arch (muscles of the pharynx, esophagus and m. cricothyroideus) 2. Dorsal nucleus of vagus nerve •visceromotor nucleus for parasympathetic innervation of the digestive tract to flexura coli sinistra, thyroid gland, lungs, heart, kidneys and gonads 3. Solitary nucleus (gustatory) •viscerosensory nucleus (rostral part) for taste perception from the epiglottis and epiglottic valleculae •also for viscerosensoric afferents from mentioned innervation zones • 4. Spinal nucleus of trigeminal nerve •somatosensory nucleus for perception from the root of the tongue, small part of the posterior and inferior wall of the external auditory canal and upper part of the auricle DYSPHONIA APHONIA „PŘÍZNAK OPONY“ Vagal stimulation OVERVIEW OF THE VAGUS NERVE BRANCHES 1. Ramus meningeus 2. Ramus auricularis (Arnoldův nerv) 3. Ramus communicans cum nervo glossopharyngei 4. Ramus pharyngeus 5. Ramus glomi carotici 6. Nervus laryngeus superior §r. externus §r. internus §r. communicans cum nervo laryngeo recurrenti (Galen´s anastomosis) 7. Rami cardiaci cervicales superiores 8. Rami cardiaci cervicales inferiores 9. Nervus laryngeus reccurens §rr. tracheales §rr. oesophagei §rr. pharyngei §n. laryngeus inferior 10. Rami cardiaci thoracici 11. Rami bronchiales / pulmonales 12. Plexus oesophageus 13. Truncus vagalis anterior §plexus gastricus anterior (rr. gastrici anteriores) §n. curvaturae minoris anterior §r. pyloricus §rr. hepatici §rr. coeliaci 14. Truncus vagalis posterior §plexus gastricus posterior (rr. gastrici posteriores) §n. curvaturae minoris posterior §rr. coeliaci •rr. hepatici, rr. pancreatici, rr. lienales, rr. renales, rr. suprarenales, rr. intestinales, rr. ovarici, rr. testiculares Obsah obrázku osoba, muž Popis byl vytvořen automaticky Accessory nerve (n. XI) 1. Nucleus ambiguus (caudal part) •branchiomotor nucleus for innervation of the muscles derived from the 3rd – 4th branchial arch (muscles of the larynx except of m. cricothyroideus) •fibers create cranial root of the n. XI • 2. The spinal accessory nucleus (C1-C4/C6) •somatomotor nucleus for innervation of the sternocleidomastoid and trapezius muscles •fibers create spinal root of the n. XI OVERVIEW OF THE ACCESSORY NERVE BRANCHES 1. Radix cranialis (pars vagalis) 2. Radix spinalis (pars spinalis) 3. Truncus nervi accessorii §ramus internus •motor fibers for n. vagus (rr. pharyngei and n. laryngeus reccurens) §ramus externus •rr. musculares for m. sternocleidomastoideus a m. trapezius Obsah obrázku text, černá, zavřít, zírající Popis byl vytvořen automaticky Hypoglossal nerve (n. XII) 1. The hypoglossal nucleus •somatomotor nucleus for intrinsic and extrinsic muscles of the tongue (except of m. palatoglossus) 2. Dorsal nucleus of vagus nerve •visceromotor nucleus for parasympathetic innervation of the lingual vessels 3. Mesencephalic nucleus of trigeminal nerve •ganglion with the pseudounipolar neurons, receives proprioception from the muscles of the tongue PALSY ATROPHY FASCICULATION PALSY OVERVIEW OF THE HYPOGLOSSAL NERVE BRANCHES 1. Spojka z ansa cervicalis prima (ventrální větve C1 a C2) 2. Spojky z truncus sympathicus a nervus vagus 3. Radix superior ansae cervicalis (ramus descendens nervi hypoglossi) §motorické vlákna z ansa cervicalis prima §spojením s radix inferior ansae cervicalis (ventrální větve C2 a C3) vzniká ansa cervicalis sekunda §inervace některých infrahyoidních svalů 4. Rami musculares §inervace m. geniohyoideus a m. thyrohyoideus (vlákna původem z ansa cervicalis prima) 5. Rami communicantes cum nervo hypoglosso §somatosenzorické a propriocepční vlákna z n. lingualis 6. Rami linguales §inervace intraglosálních svalů a m. genioglossus, m. hyoglossus a m. styloglossus References: HOMBACH-KLONISCH, S., T. KLONISCH and J. PEELER. Sobotta: Clinical Atlas of Human Anatomy. Munich, Germany: Elsevier Science, 2019, 680 s. ISBN 978-0-7020-5273-6. STANDRING, S, et al. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 41st. Philadelphia: Elsevier, 2016, 1562 s. ISBN 978-0-7020-5230-9. DRAKE, R. L., A. WAYNE VOGL and A. W. M. MITCHELL. Gray's Anatomy for Students. 4th. Philadelphia: Elsevier, 2020. 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