Cranial nerves

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Львовский национальный медицинский университет им. Д. Галицкого

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Нормальная анатомия

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	320				Cranial nerves
						Pars peripherica	14	Decussation of trochlear nerve. Decussatio
		1
1					Peripheral nervous system.
					(systema nervosum periphericum). The periph-			nervorum trochlearium. The crossing of
				eralpartofthenervoussystemwhichincludesall				trochlear nerve fibers in the superior medul-
2				peripheral conducting tracts (nerves). The				lary velum. B
				border between it and the central nervous sys-			15	TRIGEMINAL NERVE (V). N. trigeminus [V]. Fifth
3				temliesatthesurfaceofthebrainandspinalcord.				cranial nerve (nerve of the 1st pharyngeal arch).
		2		CRANIAL NERVES. Nervi craniales (en-				Nerve that exits laterally from the pons with
				cephalici). The 12 pairs of nerves connected				two groups of fibers, supplies the masticatory
4				with the brain. With the exception of the				muscles and provides sensory innervation to
				trochlear (IV), all of them emerge from the base				the face. B C
5				of the brain and exit through the base of the			16	Sensory root of trigeminal nerve. Radix sen-
				skull (in contrast to the spinal nerves). Area of				soria [portio major]. Sensory part which exits
				distribution: head, neck, as well as the thorax				from the pons caudally and enters the trigemi-
6				and abdomen (via vagus nerve).				nal ganglion. C
		3		OLFACTORY NERVE (I). Nn. olfactorii (I). First			17
								Trigeminal (semilunar, gasserian)			ganglion.
7				cranial nerve, which is formed by about 20				Ganglion trigeminale [[semilunare;			Gasseri]].
				small bundles of nonmyelinated axons from the				Semilunar ganglion that is equivalent to a spi-
				olfactory cells. It passes through the cribriform				nal ganglion. It is located in an outpocketing of
8				plate of the ethmoid into the olfactory bulb				the subarachnoid space (cavum trigeminale)
				(synaptic site). A				above the foramen lacerum at the medial, ante-
9			4 OPTIC NERVE (II). N. opticus [II]. Second cranial					rior border of the petrous part of the temporal
				nerve which leaves the eyeball medial to the				bone. C
				posterior optic pole and extends up to the optic			18	Motor root. Radix motoria [portio minor].
10				chiasm. B C				Motor portion of trigeminal nerve for innerva-
		5		OCULOMOTOR NERVE (III). N. oculomotorius				tion of the masticatory muscles. It is situated
11				[III]. Third cranial nerve, which exits from the				cranially at the exit of the trigeminal nerve and
				sulcus on the medial side of the cerebral				below the trigeminal ganglion. C
				peduncle. This motor nerve (somatic and			19	Ophthalmic nerve. N. ophthalmicus. First divi-
12				visceral) passes into the orbit through the su-				sion (branch) of trigeminal nerve. It passes
				perior orbital fissure. B C				through the superior orbital fissure. C
13		6		Superior ramus (division). Ramus superior.			20	Tentorial (meningeal) branch. Ramus ten-
				Superior branch for the superior rectus and le-				torii (meningeus). Recurrent nerve for the ten-
14				vator palpebrae superioris muscles. B				torium cerebelli and falx cerebri. C
		7		Inferior ramus (division). Ramus inferior. In-			21	Lacrimal nerve. N. lacrimalis. Passes laterally
				ferior branch for the medial and inferior recti				through the superior orbital fissure and sup-
15				and inferior oblique muscles. B				plies the lacrimal gland, conjunctiva and lateral
		8		Ciliary ganglion. Ganglion ciliare. Located				portion of upper eyelid. C

16				about 2 cm behind the eyeball and lateral to the			22	Communicating	ramus	with zygomatic
				optic nerve. This parasympathetic ganglion				nerve. Ramus communicans [cum. n. zygomat-
				serves as a relay station for fibers innervating				ico]. Connection to the zygomatic nerve with
17				the ciliary and sphincter pupillae muscles. B				autonomic fibers extending from the pterygo-
		9		Parasympathetic (motor) root. Radix para-				palatine ganglion to the lacrimal gland. C

				sympathetica (oculomotoria). Branch of the			23	Frontal nerve. N. frontalis. Nerve that enters

18
				oculomotor nerve with preganglionic, para-				the orbit through the superior orbital fissure. It
				sympathetic fibers projecting to the ciliary gan-				lies on the levator palpebrae superioris and

19				glion. B				continues toward the forehead. C; see also
	10			Short ciliary nerves. Nn. ciliares breves.				p. 323 A
				Several (up to 20) nerves penetrating the sclera			24	Supraorbital nerve. N. supraorbitalis. Thickest
20
				above and below the optic nerve and carrying				branch of the frontal nerve. It supplies the con-
				postganglionic, parasympathetic and sympa-				junctiva, upper eyelid, frontal sinus and the

21				thetic fibers. B				skin of the forehead. C
	11			Sympathetic root. Radix sympathetica. Fine,			25	Lateral branch. Ramus lateralis. It passes
				postganglionic fiber tract from the internal				through the supra-orbital notch. C
22
				carotid plexus with no synapses in the ciliary			26	Medial branch. Ramus medialis. It passes medi-
				ganglion. B				ally through the frontal notch. C
23	12			Sensory root. Radix sensoria (nasociliaris).			27	Supratrochlear	nerve.	N. supratrochlearis.
				Fine, long connection with afferent fibers to the				Thin, medial branch of frontal nerve. It divides
				nasociliary nerve. B				at the medial angle of the eye to form an as-
24
	13			TROCHLEAR NERVE (IV). N. trochlearis [IV].				cending and descending branch. C
				Fourth cranial nerve. Thin nerve exiting dorsal

25and caudal to the tectal lamina and supplying the superior oblique muscle. B

Cranial nerves 321

			3	3							4
											4


											5


											6


		Olfactory nerve									7
	A	Olfactory nerve									7

											8
				6

											9
		12	11	4
		12	11	4
13		5			8						10
13		5



14											11
				10


						9
											12


15
15											13
											13
				7

											14
											14


											15
		Oculomotor and trochlear nerves

	B								24	26	16
											16

										25
				23				21			17
											17
										27

											18
											18
			20	5
				5				4	22		19

				19



18							322.1				20

15 17

C Ophthalmic nerve

322 Cranial nerves

1Nasociliary nerve. N. nasociliaris. Most medial 1 branch of the ophthalmic nerve. It courses below the superior rectus and between the superior ob-

2lique and medial rectus. A

2Communicating branch of nasociliary nerve

with ciliary ganglion. Ramus communicans

3[cum ganglio ciliari]. Any branch carrying

		sensory fibers from the eye through the ciliary
	4	ganglion to the nasociliary nerve. A
	4	Long ciliary nerves. Nn. ciliares longi. Two long,
	3	Long ciliary nerves. Nn. ciliares longi. Two long,

fine twigs with sympathetic fibers supplying the

5dilatator pupillae muscle and afferent fibers from the iris, ciliary body and cornea. A

64 Posterior ethmoidal nerve. N. ethmoidalis posterior. Thin nerve at the posterior end of the orbit supplying the sphenoidal sinus and poste-

7rior ethmoidal cells. A

5Anterior ethmoidal nerve. N. ethmoidalis ante-

8rior. Nerve that enters the cranial cavity (extradural part) through the anterior ethmoidal foramen. It then courses through the cribriform

9plate of the ethmoid into the nasal cavity. A B C

6Nasal branches of anterior ethmoidal nerve. Rami

10nasales [n. ethmoidalis anterior]. Collective term for the following four branches of the anterior ethmoidal nerve.

117 Internal nasal branches. Rami nasales interni.

		Rami that innervate the nasal mucosa in front of
12	8	the conchae and for the anterior nasal septum. B
		Lateral nasal branches. Rami nasales laterales. In-
		Lateral nasal branches. Rami nasales laterales. In-
13	9	nervate the anterior part of lateral nasal wall. B
13		Medial nasal branches. Rami nasales mediales. In-
		Medial nasal branches. Rami nasales mediales. In-

nervate the anterior part of the nasal septum. C

1410 External nasal branch. Ramus nasalis externus. Innervates the skin on the tip of the nose and the

15nasal ala; it passes through the ethmoidal sulcus of the nasal bone. B

16	11	Infratrochlear nerve. N. infratrochlearis. It
16		passes below the trochlea of the superior oblique

	at the inner angle of the eye and supplies the lacri-
17	mal sac, lacrimal caruncle and surrounding skin. A
17

12Palpebral branches. Rami palpebrales. Rami for part of the upper and lower eyelids. A

1813 Maxillary nerve. N. maxillaris. Second division (branch) of trigeminal nerve. It passes through the

19foramen rotundum to the pterygopalatine fossa and subsequently through the inferior orbital fissure into the orbit. A C

2014 Meningeal nerve. Ramus meningeus [medius]. Branch given off in front of the foramen rotundum.

21It supplies the dura in the region of the frontal branch of the middle meningeal artery. A

2215 Ganglionic branches. Rami ganglionici (ganglionares). Usually two rami from the pterygopalatine ganglion. They contain autonomic fibers for the

23lacrimal gland and sensory fibers from the periosteum of the orbit. A

24	16	Pterygopalatine ganglion. Ganglion pterygo-
		palatinum. Parasympathetic ganglion located in
		the corresponding fossa close to the spheno-
25		palatine foramen. Their postganglionic fibers in-
		nervate the lacrimal and nasal glands. A B C

16 a	Parasympathetic root. Radix parasympathetica.
	Communicates with the greater petrosal nerve.
16 b	Sympathetic root. Radix sympathetica. Com-
	municates with the deep petrosal nerve.
16 c	Sensory root. Radix sensoria. Communicates
	with the maxillary nerve.

17Orbital branches. Rami orbitales. Two to three fine rami which pass into the orbit through the inferior orbital fissure, then through the bone to the posterior ethmoidal cells and to the sphenoidal sinus. B C

18Lateral posterior superior nasal branches.

Rami nasales posteriores superiores laterales. Up to 10 fine rami which pass through the sphenopalatine foramen to the superior and middle nasal conchae and to the posterior ethmoidal cells. B

19Medial posterior superior nasal branches.

Rami nasales posteriores superiores mediales. Two to three branches which pass through the sphenopalatine foramen to the upper part of the nasal septum. C

20Nasopalatine nerve. N. nasopalatinus [[incisivus]]. It passes between the periosteum and mucosa of the nasal septum, then through the incisive canal to the anterior part of the palatine mucosa and the gingiva of the upper incisor teeth. C

20 a Long nasopalatine nerve. Nervus nasopalatinus longus.

20 b Branches to nasal septum. Rami septales nasales.

20 c Short nasopalatine nerves. Nervi nasopalatini breves.

20 d Lateral nasal branches. Rami nasales laterales.

20 e Branches to maxillary sinus. Rami sinus maxillaris.

21Pharyngeal nerve. Nervus pharyngeus. Fine nerve for the pharyngeal mucosa. B

22Greater palatine nerve. N. palatinus major. After passing through the greater palatine canal, it courses through the corresponding foramen and supplies the mucosa of the hard palate and its glands. B

23Posterior inferior nasal branches. Rami nasales posteriores inferiores. Rami for the middle and inferior nasal meatuses as well as the inferior nasal concha. B

24Lesser palatine nerves. Nn. palatini minores. They travel in their respective, slender canals, exit through the lesser palatine foramina and supply the soft palate. B

24 a Tonsillar branches. Rami tonsillares. Branches to the palatine tonsil.

25Zygomatic nerve. N. zygomaticus. It branches into the pterygopalatine fossa, passes through the inferior orbital fissure to the lateral wall of the orbit and provides an anastomotic branch to the lacrimal gland. A

26Zygomaticotemporal branch. Ramus zygomaticotemporalis. It passes through the respective foramen to the lateral wall of the orbit. A

27Zygomaticofacial branch. Ramus zygomticofacialis. It passes through the corresponding foramen to the skin on the zygomatic bone. A

Cranial nerves 323

320.23		2	3
			3
			12
			12
			25
13	15


	16		26
14			27
14
5				A Nasociliary

and maxillary nerves

	17
7	16
7

				21
				21
23				22
				22
				24
				24

B Pterygopalatine ganglion and anterior ethmoidal nerve

	17
	19	9
	19
16		20

C Nerves of nasal septum

	324		Cranial nerves
		1 Infraorbital nerve. N. infraorbitalis. Terminal		17 Nerve to lateral pterygoid. N. pterygoideus
1		1 Infraorbital nerve. N. infraorbitalis. Terminal		17 Nerve to lateral pterygoid. N. pterygoideus
1			branch of maxillary nerve. It passes through the	lateralis. Motor nerve for the corresponding
			inferior orbital fissure and corresponding sul-	muscle. It frequently arises together with the
2			cus and foramen to the skin of the upper eyelid,	buccal nerve. A
			nose, upper lip and cheek. C	18 Nerve to medial pterygoid. N. pterygoideus
			nose, upper lip and cheek. C	18 Nerve to medial pterygoid. N. pterygoideus
3		2 Superior alveolar nerves. Nn. alveolares super-		medialis. Motor nerve for the corresponding
3			iores. Branches to the maxillary teeth.	muscle. It also sends small twigs to the tensor
			iores. Branches to the maxillary teeth.	muscle. It also sends small twigs to the tensor
		3 Posterior superior alveolar branches. Rami		veli palatini and tensor tympani muscles. A
4				veli palatini and tensor tympani muscles. A
				19 Otic ganglion. Ganglion oticum. Parasympa-
			alveolares superiores posteriores. Two to three	19 Otic ganglion. Ganglion oticum. Parasympa-
			branches passing through the alveolar	thetic ganglion located medial to the mandibu-
			branches passing through the alveolar	thetic ganglion located medial to the mandibu-
5			foramina to the inner surface of the maxilla.	lar nerve below the foramen ovale. It receives
5			They supply the maxillary sinus and the molars	tributaries from the glossopharyngeal nerve via
			They supply the maxillary sinus and the molars	tributaries from the glossopharyngeal nerve via
			including their buccal gingiva. C	the lesser petrosal nerve and sends secretory
6			including their buccal gingiva. C	the lesser petrosal nerve and sends secretory
6	4		Middle superior alveolar branch. R. alve-	fibers to the parotid gland. B
			olaris superior medius. It courses through the	20 Ramus communicans [cum nervo ptery-
7			infraorbital sulcus to the maxilla and passes	goideo mediali]. Branch which communicates
			along the lateral wall of the maxillary sinus up	with the nerve to the medial pterygoid muscle.
			to the superior dental plexus. C	B

85 Anterior superior alveolar branches. Rami 21 Nerve to tensor veli palatini muscle. N.

		alveolares superiores anteriores. They run in		musculi tensoris veli palatini. It sometimes
9		their respective canals and via the superior		arises from the nerve to the medial pterygoid
		dental plexus to the incisors, canines, pre-		muscle. B
		molars and first molar tooth. C	22	Nerve to tensor tympani muscle. N. musculi
10		molars and first molar tooth. C	22	Nerve to tensor tympani muscle. N. musculi
10	6	Superior dental plexus. Plexus dentalis superior.		tensoris tympani. It also sometimes arises from
	6	Superior dental plexus. Plexus dentalis superior.		tensoris tympani. It also sometimes arises from
		Nerve plexus in the bone above the roots of the		the nerve to the medial pterygoid muscle. B
11		Nerve plexus in the bone above the roots of the		the nerve to the medial pterygoid muscle. B
11		teeth formed by the superior alveolar rami. C	23	Buccal nerve. N. buccalis. Sensory nerve for the
	7 Superior dental branches. Rami dentales super-			skin and mucosa of the cheek and the buccal
12		iores. Branches to the individual roots of the		gingiva in the region of the first molar. A
12		teeth. C	24	Auriculotemporal nerve. N. auriculotem-


13	8	Superior gingival branches. Rami gingivales su-		poralis. It usually encircles the middle mening-
13		periores. Rami to the gingiva. C		eal artery, sends a small branch to the temporo-
	9	Inferior palpebral branches. Rami palpe-		mandibular joint and then passes upward be-
14	9	Inferior palpebral branches. Rami palpe-		tween the ear and superficial temporal artery
14		brales inferiores. Rami given off to the lower		tween the ear and superficial temporal artery
		eyelid outside of the infraorbital foramen. C		to the skin of the temporal region. A
		eyelid outside of the infraorbital foramen. C	25	Nerve to external acoustic meatus. N. mea-
15	10	External nasal branches. Rami nasales ex-	25	Nerve to external acoustic meatus. N. mea-
15	10	External nasal branches. Rami nasales ex-		tus acustici externi. Usually two small branches
		terni. Branches to the outside of the nasal ala. C		tus acustici externi. Usually two small branches
		terni. Branches to the outside of the nasal ala. C		for the skin of the external acoustic meatus. A
	11	Internal nasal branches. Rami nasales interni.
16
16			26	Fine branches to the tympanic membrane.
		Branches to the skin of the nasal vestibule. C		Rami membranae tympani. A
	12 Superior labial branches. Rami labiales su-			Rami membranae tympani. A
17	12 Superior labial branches. Rami labiales su-		27	Parotid branches. Rami parotidei. Small
17		periores. Rami to the skin and mucosa of the	27	Parotid branches. Rami parotidei. Small
		upper lip. C		branches supplying the parotid gland. A
				branches supplying the parotid gland. A
18			28	Branches communicating with the facial
	13	Mandibular nerve. N. mandibularis. Third divi-	28	Branches communicating with the facial
	13	Mandibular nerve. N. mandibularis. Third divi-		nerve. Rami communicantes [cum n. faciali].
		sion (branch) of the trigeminal nerve. It passes		nerve. Rami communicantes [cum n. faciali].
		sion (branch) of the trigeminal nerve. It passes		They carry parasympathetic fibers from the otic
19		through the foramen ovale and into the in-		They carry parasympathetic fibers from the otic
		through the foramen ovale and into the in-		ganglion to the parotid gland via the facial
		fratemporal fossa. Besides sensory fibers, it		ganglion to the parotid gland via the facial
		fratemporal fossa. Besides sensory fibers, it		nerve. A
		contains motor fibers for the masticatory		nerve. A
20		muscles. A	29	Anterior auricular nerves. Nn. auriculares
	14 Meningeal branch (nervus spinosus). Ramus			anteriores. They supply the anterior surface of
	14 Meningeal branch (nervus spinosus). Ramus			the pinna. A
21		meningeus (n. spinosus). It passes through the		the pinna. A
		meningeus (n. spinosus). It passes through the		Superficial temporal rami. Rami temporales
		foramen spinosum accompanied by both 30
		foramen spinosum accompanied by both 30
		branches of the middle meningeal artery and		superficialis. Branches supplying the skin of the
22		supplies the dura, a part of the sphenoidal sinus		temporal region in front of and above the ear. A
		and the mastoid air cells. A
		and the mastoid air cells. A

2315 Masseteric nerve. N. massetericus. Motor nerve for the masseter muscle passing above the lateral pterygoid muscle and through the

24mandibular notch. A

16 Deep temporal nerves. Nn. temporales pro-

25fundi. Motor nerves passing to the temporalis muscle from below. A

Cranial nerves 325

		13
26 14			16
29	24


25		15		17


28		18
		27	23
			23

A Mandibular nerve

B Otic ganglion

3		4	9
			9

	11
	11


	5

8		7

			12
7	8

C Maxillary nerve

	326		Cranial nerves
		1	Lingual nerve. N. lingualis. A branch of the 17			Otic ganglion. Ganglion oticum. Parasympa-
1		1	Lingual nerve. N. lingualis. A branch of the 17			Otic ganglion. Ganglion oticum. Parasympa-
1			mandibular nerve that arches anteriorly be-			thetic ganglion located medial to the mandibu-
			tween the lateral and medial pterygoid muscles			lar nerve below the foramen ovale. It communi-
2			to the floor of the mouth where it lies near a			cates with the glossopharyngeal nerve via the
			wisdom tooth directly below the mucosa. A B C			lesser petrosal nerve and sends secretory fibers
	2		Branches to isthmus	of	the fauces. Rami	into the parotid gland. C
3						into the parotid gland. C

			isthmi faucium (rami fauciales). It also 18			ABDUCENT NERVE (VI). N. abducens [VI]. Sixth
			isthmi faucium (rami fauciales). It also 18			ABDUCENT NERVE (VI). N. abducens [VI]. Sixth
			branches to the tonsils. A			cranial nerve. It exits the brain in the angle be-
4			branches to the tonsils. A			cranial nerve. It exits the brain in the angle be-
4	3		Communicating rami	to	the hypoglosal	tween the pons and pyramid, penetrates the
	3		Communicating rami	to	the hypoglosal	dura at the level of the middle of the clivus,
			nerve. Rami communicantes [cum n. hypo-			dura at the level of the middle of the clivus,
5			glosso]. It lies on the hyoglossus muscle. A			passes laterally into the cavernous sinus and
5			glosso]. It lies on the hyoglossus muscle. A			then through the inferior orbital fissure into
	4		Communicating ramus to the chorda tym-			then through the inferior orbital fissure into
	4		Communicating ramus to the chorda tym-			the orbit where it supplies the rectus lateralis
6			pani nerve. Ramus communicans [cum chorda			muscle. D
			tympani]. A

75 Sublingual nerve. N. sublingualis. It passes lateral to the sublingual gland into the mucosa of the floor of the mouth and into the gingiva of

8the anterior mandibular teeth. A

6Lingual branches. Rami linguales. Numerous

9rami containing sensory and taste fibers from the anterior two-thirds of the lingual mucosa. A

107 Ganglionic branches. Rami ganglionares. Rami communicating with the submandibular

11		ganglion. A
11	8 Submandibular ganglion. Ganglion subman-
	8 Submandibular ganglion. Ganglion subman-
		dibulare. Parasympathetic ganglion above or in
12		dibulare. Parasympathetic ganglion above or in
12		front of the submandibular gland. Synaptic sta-
		tion for preganglionic fibers of the chorda tym-
		tion for preganglionic fibers of the chorda tym-
13		pani with postganglionic fibers for the sublin-
13		gual and submandibular glands. A
		gual and submandibular glands. A
	9 Inferior alveolar nerve. N. alveolaris inferior.
14	9 Inferior alveolar nerve. N. alveolaris inferior.
14		Largest branch of mandibular nerve with
		Largest branch of mandibular nerve with
		sensory and motor components. It passes 1 cm
15		behind the lingual nerve and through the man-
		dibular foramen into the mandibular canal. A B
		dibular foramen into the mandibular canal. A B
		C
16		C
16	10	Mylohyoid nerve. N. mylohyoideus. Coursing
		in the mylohyoid groove and then below the
17		in the mylohyoid groove and then below the
17		mylohyoid muscle, this motor nerve supplies
		the mylohyloid muscle and the anterior belly of
		the mylohyloid muscle and the anterior belly of
18		the digastric. A B C
18	11 Inferior dental plexus. Plexus dentalis infe-


19		rior. Plexus of nerves within the mandibular
19		canal. B
		canal. B
	12	Inferior dental branches. Rami dentales inferi-
20	12	Inferior dental branches. Rami dentales inferi-
20		ores. Rami for the mandibular teeth. B

13 Inferior gingival branches. Rami gingivales inferi-

21ores. Rami for the buccal gingiva of the mandibular teeth (except for the first molar). B

2214 Mental nerve. N. mentalis. Sensory nerve exiting from the mental foramen below the 2nd pre-

23molar tooth. B

15 Mental branches. Rami mentales. Branches

supplying the chin. B

16 Labial branches. Rami labiales. Branches sup-

plying the lower lip. B

16 a Gingival branches. Rami gingivales. B

Cranial nerves 327

	1


	2


	3


9	4

4	1	5
	1


10
		6

2

8		6
1	7	5	9
9	7
9
10			10
10
		3	11

			A	Lingual nerve	12
12			16a
12			16a
11			16
11			16		13
		15



					14
B Inferior alveolar nerve	13 14

1					20
		9
		9
	10				21
	10				21


				18	22
				18	22

					23


					24
C Otic ganglion and branches			D Abducent nerve
C Otic ganglion and branches			D Abducent nerve

328 Cranial nerves

1 FACIAL NERVE (VII). N. facialis (n. intermedio- 1 facialis) [VII]. Seventh cranial nerve (nerve of the 2nd pharyngeal arch). It exits between the pons

2and olive, passes with the vestibulocochlear

nerve into the petrous temporal bone and leaves it through the stylomastoid foramen. It supplies

3the muscles of facial expression. A B C D

2Genu of facial nerve. Geniculum [n. facialis].

	4	Bend in the facial nerve just below the anterior
	4	wall of the petrous temporal bone. A
		wall of the petrous temporal bone. A

3 Nerve to the stapedius. N. stapedius. Slender

5branch supplying the stapedius muscle. A

4Communicating branch of facial never with

6tympanic plexus. Ramus communicans [cum plexus tympanico]. A

7	5 Communicating branch of facial nerve with
	vagus nerve. Ramus communicans [cum nervo

vago]. Located directly below the stylomastoid

8foramen.

6Posterior auricular nerve. N. auricularis posterior. Ramifies beneath the stylomastoid foramen,

9passes upward between the mastoid process and

the external acoustic meatus and supplies the

10posterior ear muscles and the occipital belly of the occipitofrontalis muscle. B

11	7	Occipital branch. Ramus occipitalis. Ramus sup-
11		plying the occipital belly of the occipitofrontalis
	8	muscle. B
		muscle. B
12		Auricular branch. Ramus auricularis. Branch to
		the muscles of the pinna. B

9Digastric branch. Ramus digastricus. It supplies

13		the posterior belly of the digastric muscle. A B
	10	Stylohyoid branch. Ramus stylohyoideus.
14	10	Stylohyoid branch. Ramus stylohyoideus.
14		Branch that often arises together with the lingual
		branch. It supplies the stylohyoid muscle. A
		branch. It supplies the stylohyoid muscle. A

15 11 Communicating branch of facial nerve with glossopharyngeal nerve. Ramus communicans [cum n. glossopharyngeo]. A

1612 Intraparotid plexus. Plexus intraparotideus. Facial nerve plexus situated in the space accessible

17anteriorly between the two parotid lobes. B

13Temporal branches. Rami temporales. Rami ascending over the zygomatic arch to the muscles

18of facial expression above the palpebral fissure and along the ear. B

1914 Zygomatic branches. Rami zygomatici. Rami

supplying the lateral part of the orbicularis oculi and the muscles of facial expression between the

20 palpebral and oral fissures. B

15 Buccal branches. Rami buccales. Rami supplying

21the buccinator muscle and the muscles of facial expression around the mouth. B

22	16	Lingual branch. Ramus lingualis. Inconstant
22		ramus to the tongue. It sometimes arises in to-
		gether with the stylohyoid ramus.
23		gether with the stylohyoid ramus.
23	17	Marginal mandibular branch. Ramus marginalis
		mandibularis. It passes to the chin and supplies
		mandibularis. It passes to the chin and supplies
		the muscles of facial expression below the oral
24		the muscles of facial expression below the oral
24		fissure. B

18 Cervical branch. Ramus colli (cervicalis). Motor

25branch for the platysma. It anastomoses with the transverse cervical nerve. B

19Sensory root of facial nerve. N. intermedius. It arises from the brainstem independently between the facial and vestibular nerves and transports autonomic and taste fibers. After anastomosing with various vessels, it ultimately unites with the facial nerve in the petrous part of the temporal bone. D

20Geniculate (facial) ganglion. Ganglion geniculi (geniculatum). Equivalent to a spinal ganglion with pseudo-unipolar ganglion cells. It is located in the petrous part of the temporal bone at the bend of the facial nerve. It receives taste fibers from the chorda tympani. A

21Chorda tympani. Nerve bundle with parasympathetic fibers for the submandibular gland and sensory fibers from the taste buds occupying the anterior two-thirds of the tongue. It returns to the tympanic cavity where it passes between the malleus and incus, then goes through the petrotympanic fissure [[Glaser] or sphenopetrosal fissure to subsequently join the lingual nerve. A

22Pterygopalatine ganglion. Ganglion pterygopalatinum. Parasympathetic ganglion located in its respective fossa near the sphenopalatine foramen. It receives preganglionic fibers from the facial nerve via the greater petrosal nerve and sends postganglionic secretory fibers to the lacrimal and nasal glands. C

23Nerve of pterygoid canal. N. canalis pterygoidei [Radix facialis]. Located in the pterygoid canal at the root of the pterygoid process. It contains parasympathetic (facial nerve), sympathetic and sensory fibers destined for the pterygopalatine ganglion. C

24Greater petrosal nerve. N. petrosus major. Branch of facial nerve emerging from the anterior wall of the petrous part of the temporal bone. It incorporates parasympathetic and sensory fibers, and penetrates the covering plate of the foramen lacerum lateral to the internal carotid artery where it is joined by the deep petrosal nerve. A C

25Deep petrosal nerve. N. petrosus profundus. Nerve carrying sympathetic fibers from the internal carotid plexus; it joins the greater petrosal nerve to form the nerve of the pterygoid canal. C

26Submandibular ganglion. Ganglion submandibulare. Located above or in front of the submandibular gland. This parasympathetic ganglion is the synaptic site between preganglionic fibers from the chorda tympani and postganglionic fibers to the sublingual and submandibular glands. C

27Sympathetic branch (to the submandibular ganglion). Ramus sympatheticus (ad ganglion submandibulare). Branch from the internal carotid plexus. Its fibers arrive at the submandibular ganglion above the facial artery and pass through the ganglion without synapsing. C

28Glandular branches. Rami glandulares. Small rami at the inferior margin of the submandibular ganglion that supply the submandibular gland. C

29Sublingual ganglion. [Ganglion sublinguale]. Small group of cells occasionally present on the glandular rami. C

Cranial nerves 329

3 1 2 20

9 11 10

B Facial nerve

1 24 23

AFacial nerve

in temporal bone

1 19 330.1

29
C Pterygopalatine and submandibular	D Facial and
ganglia	vestibulocochlear nerves

330 Cranial nerves

1VESTIBULOCOCHLEAR NERVE (VIII). N. vestibulo-

1 cochlearis [VIII]. Eighth cranial nerve. Nerve that exits at the lower margin of the pons and passes

2through the internal acoustic meatus to the vestibular (equilibrium) and auditory organs. A

2Vestibular nerve.N.vestibularis.Superior,ventral,

3	vestibular portion of vestibulocochlear nerve. A

3		Cochlear nerve.Nervuscochlearis.Inferior,dorsal,
4		cochlear part of vestibulocochlear nerve. A
	4	Vestibular nerve. Nervus vestibularis. Portion of

VIII nerve passing from the vestibular nucleus to

5the maculae and ampullary crest. A

5Vestibular ganglion. Ganglion vestibulare. Gan-

6glion located in the floor of the internal acoustic meatus. It contains bipolar neurons associated with the vestibular nerve. A

76 Communicating branch with cochlear nerve.

Ramus communicans cochlearis.

7 Upper part of vestibular ganglion. Pars super-

8ior. It supplies the anterior and lateral semicircular canals, utricle and anterior part of saccule. A

98 Utriculoampullar nerve. N. utriculoampullaris. Superior branch of vestibular nerve with fibers

10		from the macuala and ampullary crest of the su-
10		perior (anterior) and lateral semicircular canals. A
	9	Utricular nerve. N. utricularis. Branch from the
11		macula utriculi. A
	10 Anterior ampullar nerve. N. ampullaris anterior.
	10 Anterior ampullar nerve. N. ampullaris anterior.
12		Branch from the ampullary crest of the anterior
12		semicircular canal. A

11 Lateral ampullar nerve. N. ampullaris lateralis.

13Branch from the ampullary crest of the lateral semicircular canal. A

12 Inferior part of the vestibular ganglion. Pars

14inferior. It supplies the posterior semicircular canal and a part of the sacculus. A

1513 Posterior ampullar nerve. N. ampullaris poste-

rior. Branch from the ampullary crest of the posterior semicircular canal. A

1614 Saccular nerve. N. saccularis. Branch from the macula sacculi. A

1715 Cochlear nerve. Nervus cochlearis. Part of the vestibulocochlear nerve for the auditory organ in the cochlea. A

1816 Cochlear (spiral) ganglion. Ganglion cochleare (spiral cochleae). Helical band of ganglion cells

19directed towards the axis of the cochlea and situated along the base of the osseous spiral lamina. A

17 GLOSSOPHARYNGEAL NERVE (IX). N. glossopha-

20ryngeus [IX]. Ninth cranial nerve (nerve of the 3rd pharyngeal arch). It leaves the brain through the posterolateral sulcus behind the olive, courses

21through the jugular foramen and passes obliquely downward posterior to the stylopharyngeus

22muscle. It contains motor fibers for the pharyngeal constrictors and stylopharyngeus muscle and sensory fibers for the pharyngeal mucosa, tonsils

23and posterior third of the tongue (taste fibers) and parasympathetic fibers to the otic ganglion via the tympanic and lesser petrosal nerves. B

2418 Superior (jugular) ganglion. Ganglion superius [[intracraniale]]. Smaller ganglion in the jugular

25foramen. It contains cell bodies of afferent fibers. B C

19Inferior (petrous) ganglion. Ganglion inferius [[extracraniale]]. Larger ganglion situated directly below the jugular foramen. It contains cell bodies of afferent fibers. B C

20Tympanic nerve. N. tympanicus. First branch of the IX nerve. It branches off from the inferior ganglion and passes between the jugular foramen and carotid canal, then through the tympanic canaliculus to the tympanic cavity. C

21Tympanic englargement (ganglion). Intumescentia tympanica (ganglion tympanicum). Irregularly scattered ganglion cells forming a dilatation in the course of the tympanic nerve. C

22Tympanic plexus. Plexus tympanicus. N. plexus in the mucosa over the promontory. It is formed by the tympanic n., internal carotid plexus and communicating ramus of the facial n. with the tympanic plexus. C

23Tubal branch of tympanic plexus. Ramus tubarius (tubalis). Ramus for the auditory tube. C

24Caroticotympanic nerves. Nn. caroticotympanici. Sympathetic fibers of the tympanic plexus derived from the internal carotid plexus. C

25Communicating branch of glossopharyngeal nerve with auricular branch of the vagus nerve. Ramus communicans [cum ramo auriculari nervi vagi]. Fine branch from the inferior ganglion to the auricular ramus of the vagus. B

26Pharyngeal branches of IX nerve. Rami pharyngeales (pharyngei). Three to four rami passing into the pharyngeal plexus. B

27Ramus to stylopharyngeus muscle. Ramus m. stylopharyngei. B

28Branch to carotid sinus. Ramus sinus carotici. It also passes to the carotid body and communicates with the sympathetic trunk and vagus nerve. B

29Tonsillar branches. Rami tonsillares. Branches supplying the mucosa of the palatine tonsil and its surroundings. B

30Lingual branches. Rami linguales. Taste fibers from the posterior third of the tongue including the valate papillae which are also supplied by the lingual nerve via the chorda tympani. B

31Otic ganglion. Ganglion oticum. Parasympathetic ganglion located medial to the mandibular nerve below the foramen ovale. It receives preganglionic fibers from the glossopharyngeal nerve via the lesser petrosal nerve and sends postganglionic secretory fibers to the parotid gland. D

32Lesser petrosal nerve. N. petrosus minor. Nerve containing parasympathetic fibers from the glossopharyngeal nerve. It emerges from the tympanic plexus, penetrates the anterior wall of the petrous temporal bone and leaves the middle cranial fossa through the sphenopetrosal fissure. Its fibers synapse in the otic ganglion. C D

33Communicating branch with the meningeal branch. Ramus communicans [cum ramo meningeo]. D

34Communicating branch with auriculo-tem- poral nerve. Ramus communicans [cum n. auriculotemporali]. It includes postganglionic parasympathetic fibers that supply the parotid gland. D

35Communicating branch with chorda tympani.

Ramus communicans [cum chorda tympani]. It contains sensory nerve fibers. D

Cranial nerves 331

										1


										2
								3

										3
										3
11	10	9	8			4

								1		4
									2	4
				7	5		15

										5
					12
					12

AVestibulocochlear nerve, schematic

27 29

14			7
			7

				8


16		32		9
				9


				10


	22			11
				11


				12
	21			12
	21

				13
	20	24	23

18				14
18				14
	19
	19

C Tympanic nerve with branches

	32	17
	32
		18
		19
		33
		20
34		31
34		21
35		21
35

				22


				23


				24
B	Glossopharyngeal and vagus nerves	D	Otic ganglion	24
B	Glossopharyngeal and vagus nerves	D	Otic ganglion

332 Cranial nerves

1 VAGUS NERVE (X). N. vagus [X]. Tenth cranial nerve 1 (nerve of 4th and 5th pharyngeal arches). Together with the IX nerve, it exits the brain in the

2poserolateral sulcus and passes through the jugular foramen. Its supply region extends into the thoracic and abdominal cavities. A

32 Superior (jugular) ganglion. Ganglion superius. Small superior sensory ganglion of vagus situated

4in the jugular foramen. A

3Inferior (nodose) ganglion. Ganglion inferius. Large inferior, spindle-shaped ganglion of the

5vagus nerve. A

4Meningeal branch. Ramus meningeus. Recurrent

6branch from the superior ganglion supplying the dura of the posterior cranial fossa in the region of the transverse and occipital sinuses. A

75 Auricular branch. Ramus auricularis. Branch that arises from the superior ganglion of the vagus

8nerve, passes through the mastoid canal, exits through the tympanomastoid fissure and supplies

the posterior surface of the pinna and the posterio-

9inferior wall of the external acoustic meatus. A

6Communicating branch with IX nerve. Ramus

10communicans [cum. n. glossopharyngeo]. Anastomotic branch from the auricular ramus to the glossopharyngeal nerve. A

117 Pharyngeal branch. Ramus pharyngealis

	(pharyngei). Branch radiating into the pharyngeal
12	plexus. A
12

8Pharyngeal plexus. Plexus pharyngealis. Nerve plexus below the middle pharyngeal constrictor

13formed by the glossopharyngeal and vagus nerves and the cervical sympathetic trunk. A

149 Superior cervical cardiac branches. Rami cardi-

	aci cervicales superiores. Branches given off at
15	variably high cervical levels; they travel to the
15	deep part of the cardiac plexus. A

10 Superior laryngeal nerve. N. laryngealis superior.

16Nerve that arises from the inferior ganglion and passes downward medial to the internal carotid artery to supply the larynx. A

1711 External branch of superior laryngeal nerve

(external laryngeal nerve). Ramus externus.

18Nerve that branches to the inferior pharyngeal constrictor and then, covered by the infrahyoid musculature, passes to the cricothyroid muscle.

19A

12 Internal branch (internal laryngeal nerve).

20Ramus internus. Together with the superior laryngeal artery, it penetrates the thyrohyoid membrane and emerges below the mucosa of the

21piriform recess. It supplies the mucosae of the epiglottic valleculae, the epiglottis and the larynx as far down as the level of the vocal folds.

22A

13 Branch communicating with the recurrent laryngeal

23nerve. Ramus communicans [cum. n. laryngeali recurrenti]. A

24	14	Inferior cervical cardiac branches. Rami cardiaci
		cervicales inferiores. On the right, they pass to
		the deep part of the cardiac plexus; on the left,
25		they pass to the superficial part of the cardiac
		plexus accompanied by the vagus nerve. A

15Recurrent laryngeal nerve. N. laryngealis recurrens. On the right, it loops around the subclavian artery whereas, on the left, it curves around the arch of the aorta before ascending in the groove between the trachea and esophagus. Its terminal branch penetrates the inferior pharyngeal constrictor and enters the larynx, where it supplies the mucosa up to the vocal folds and all intrinsic laryngeal muscles except the cricothyroid. It also provides a communicating branch to the internal laryngeal nerve. A

16Tracheal branches. Rami tracheales. A

17Esophageal branches. Rami oesophageales. A

17 a Rami pharyngeales. Pharyngeal branches to the inferior pharyngeal constrictor.

18Inferior laryngeal nerve. [[N. laryngeus inferior]]. Term sometimes used to denote the terminal branch of the recurrent laryngeal nerve, which supplies the intrinsic muscles of the larynx except the cricothyoid and projects a communicating branch to the internal laryngeal nerve. A

19[[R. communicans [cum ramo laryngeo interno]].

Communicating branch of the inferior (recurrent) laryngeal nerve to the internal laryngeal nerve. A

20Thoracic cardiac branches. Rami cardiaci thoracici. Rami to the thoracic inlet. A

21Bronchial branches. Rami bronchiales. Rami projected to the hilum of the lung below the recurrent laryngeal nerve. A

22Pulmonary plexus. Plexus pulmonalis. Nerve plexus located anterior and posterior to the hilum of the lung for innervation of bronchi, vessels and visceral pleura. A

23Esophageal plexus. Plexus oesophagealis. Nerve plexus around the esophagus formed directly by the two vagus nerves and superiorly also by the left recurrent laryngeal nerve. A

24Anterior vagal trunk. Truncus vagalis anterior. Weak anterior plexus emerging from the esophageal plexus and containing fibers from the both vagi. A

25Posterior vagal trunk. Truncus vagalis posterior. Better developed posterior nerve plexus arising from the esophageal plexus and containing fibers from both vagi. A

26Anterior gastric branches. Rami gastrici anteriores. Rami extending from the anterior vagal trunk to the anterior surface of the stomach. A

27Posterior gastric branches. Rami gastrici posteriores. Rami extending from the posterior vagal trunk to the posterior surface of the stomach. A

28Hepatic branches. Rami hepatici. Rami to the hilum of the liver. A

29Celiac branches. Rami coeliaci. Rami to the celiac plexus. A

30Renal branches. Rami renales. Rami to the renal plexus. A

31ACCESSORY NERVE (XI). N. accessorius [XI]. Eleventh cranial nerve. Its two roots unite in the skull and pass through the jugular foramen together with the IX and X nerves. B

				Cranial nerves							333
32	Cranial roots (vagal part). Radices craniales	1						4
32	Cranial roots (vagal part). Radices craniales											1
	(pars vagalis). Fibers from the nucleus ambiguus
	(pars vagalis). Fibers from the nucleus ambiguus	2
	which leave the accessory nerve in the jugular	2						5
	which leave the accessory nerve in the jugular							5
	foramen and join the vagus nerve. B	3	6									2
	foramen and join the vagus nerve. B	3	6									2
33 Spinal roots (spinal part). Radices spinales (pars
	spinalis). They arise from the base of the anterior
	spinalis). They arise from the base of the anterior	7										3
	horn of the cervical spinal cord (C1−6) and form
	horn of the cervical spinal cord (C1−6) and form
	a trunk which ascends into the subarachnoid	10
	a trunk which ascends into the subarachnoid
	space of the skull where it unites temporarily		8									4
	space of the skull where it unites temporarily
	with fibers from the cranial roots. B
34 Accessory nerve trunk. Truncus nervi accessorii.		11
34 Accessory nerve trunk. Truncus nervi accessorii.												5
	It is formed by the union of both roots. B
	It is formed by the union of both roots. B
35	Internal branch. Ramus internus. Fiber tract as-	12
35	Internal branch. Ramus internus. Fiber tract as-	12
	sociated with the vagus nerve and formed by the						13					6
	united cranial roots of the accessory nerve. B	18	19									6
	united cranial roots of the accessory nerve. B	18	19
36	External branch. Ramus externus. United spinal	9					14
												7

	root fibers of the accessory nerve. They supply		16
	the sternocleidomastoid and trapezius muscles.								20
	the sternocleidomastoid and trapezius muscles.
	B	15										8
	B
37 Muscular branches. Rami musculares. Branches										17
37 Muscular branches. Rami musculares. Branches										17
	supplying the sternocleidomastoid and trapezius
	muscles. B				15							9
					15
						21
												10
												10


												11
												11

				22
34	35		23
			23	25
			24	25
				27

32			29
32
33		36		26


33	28			28
	28			28

33			30


				30

A Vagus nerves with branches

B Accessory nerve

Spinal nerves

334

1		1	HYPOGLOSSAL NERVE (XII). N. hypoglossus			15 Posterior (dorsal) branches. Rami posteriores.
1			[XII]. Twelfth cranial nerve. Formed by numer-				Posterior branches of the spinal nerve that
			ous roots emerging from the brain between the				supply the nuchal muscles and the skin lateral
2			pyramid and olive. It passes through the hypo-				to the nuchal region and near the occiput. A
			glossal canal and descends between the inter-			16	Medial branch of posterior ramus. Ramus
3			nal jugular vein and internal carotid artery. At				medialis. Branch with motor and sensory fibers
3			the level of the angle of the mandible it then				supplying the muscles and skin. A
			proceeds anteriorly above the posterior margin			17	Lateral branch of posterior ramus. Ramus
4			of the floor of the mouth to enter the tongue. B				lateralis. Purely motor branch passing obliquely
4		2 Lingual branches. Rami linguales. Rami begin-					lateralis. Purely motor branch passing obliquely
		2 Lingual branches. Rami linguales. Rami begin-					laterad into the muscles. A
5			ning lateral to the hyoglossus muscle and sup-			18	Suboccipital nerve. N. suboccipitalis. Poste-
5			plying the styloglossus, hyoglossus and genio-				rior branch of the first cervical spinal nerve. It
			glossus muscles as well as the intrinsic muscles				rior branch of the first cervical spinal nerve. It
			glossus muscles as well as the intrinsic muscles				exits between the vertebral artery and poste-
			of the tongue. B				exits between the vertebral artery and poste-
6			of the tongue. B				rior arch of the atlas and supplies the short
6		3	SPINAL NERVES. Nervi spinales. They are				rior arch of the atlas and supplies the short
		3	SPINAL NERVES. Nervi spinales. They are				muscles of the neck. D
7			formed by two roots and, in contrast to the			19	Greater occipital nerve. N. occipitalis major.
7			cranial nerves, they exit through the interverte-				Posterior branch of the second cervical spinal
			bral foramina. A C				Posterior branch of the second cervical spinal
			bral foramina. A C				nerve. It emerges between the axis and ob-
		4	Root filaments. Fila radicularia. Fine root fibers				nerve. It emerges between the axis and ob-
8		4	Root filaments. Fila radicularia. Fine root fibers				liquus capitis inferior muscle, pierces the
			emerging from the spinal cord within the ante-				trapezius and supplies the nuchal muscles and
9			rior and posterior roots of the individual spinal				skin of the occipital region. D
9			nerves. A			20	Third occipital nerve. N. occipitalis tertius.
		5 Anterior (ventral) root. Radix anterior (mo-					Posterior branch of the third cervical spinal
10			toria). Motor root. A				nerve. It supplies the skin of the nuchal region
		6 Posterior (dorsal) root. Radix posterior (sen-					close to the midline. D
11			soria). Sensory root. A			21 Anterior (ventral) branches. Rami anteriores.
11		7	Spinal (dorsal root) ganglion. Ganglion spinale				Anterior rami of cervical spinal nerves. They
			(sensorium). Ganglion situated in the inter-				form the cervical and brachial plexuses. A
12			vertebral foramen, composed of pseudo-uni-			22 Cervical plexus. Plexus cervicalis. Nerve plexus
			polar cells. It lies in the posterior root just in				formed by the anterior rami of spinal nerves
13			front of the site where it joins the anterior root. A				C1−4. They supply the skin and muscles of the
13		8	Spinal nerve trunk. Truncus nervi spinalis.				neck.
		8	Spinal nerve trunk. Truncus nervi spinalis.				neck.
			Segment between the union of the two roots			23 Nerve loop from C1−3. Ansa cervicalis [hypo-
14			and the first branch of the spinal nerve. A C				glossi]. A nerve loop in the neck (C1-C3) that
		9	Anterior (ventral) branch. Ramus anterior.				supplies the infrahyoid muscles. B
15			Larger anterior branch of a spinal nerve. It com-			24	Anterior (ventral) root. Radix anterior. The
15			municates with adjacent anterior rami to form				anterior root, part of which supplies the genio-
			municates with adjacent anterior rami to form				anterior root, part of which supplies the genio-
			large plexuses. In the thoracic region it be-				hyoid and thyrohyoid muscles via the hypo-
16			comes continuous with an intercostal nerve. A				glossal nerve. B
		10	Posterior (dorsal) branch. Ramus posterior.			25	Posterior (dorsal) root. Radix posterior. Pos-
17			Weaker branch supplying the skin of the back				terior root. B
17			and autochthonous back muscles. A			26	Thyrohyoid branch of the ansa cervicalis.
			and autochthonous back muscles. A			26	Thyrohyoid branch of the ansa cervicalis.
18		11	Rami	communicantes.	Communicating		Ramus thyrohyoideus. Branch supplying the
18			branches connecting the spinal nerve and the				thyrohyoid muscle. B
			sympathetic trunk. A			27	Lesser occipital nerve. N. occipitalis minor.
			sympathetic trunk. A			27	Lesser occipital nerve. N. occipitalis minor.
19		11 a	Gray communicating ramus. Ramus griseus.				Uppermost cutaneous branch of the cervical
			Postganglionic part. A				plexus. It passes upward at the posterior mar-
		11 b	White communicating ramus. Ramus albus.				gin of the sternocleidomastoid and, at the oc-
20		11 b	White communicating ramus. Ramus albus.				gin of the sternocleidomastoid and, at the oc-
20			Preganglionic part. A				ciput, ramifies as a lateral communicating
		12 Meningeal branch. Ramus meningeus. Deli-					nerve of the greater occipital nerve. D
		12 Meningeal branch. Ramus meningeus. Deli-					nerve of the greater occipital nerve. D
21			cate, recurrent ramus. It passes in front of the			28 Great auricular nerve. N. auricularis magnus. It
			spinal nerve to re-enter the vertebral canal				courses to the ear, thereby crossing the sterno-
			through the intervertebral foramen and supply				cleidomastoid vertically somewhat above its
22			through the intervertebral foramen and supply				cleidomastoid vertically somewhat above its
22			the meninges of the spinal cord, where it unites				middle. D
			with other meningeal rami to form a plexus. It			29	Posterior (dorsal) branch. Ramus posterior. It
23			contains sensory and sympathetic fibers. A				supplies the skin of the posterior surface of the
23		13 Cauda equina. Collection of all spinal nerve					pinna and the adjacent area. D
		13 Cauda equina. Collection of all spinal nerve					pinna and the adjacent area. D
			roots extending from L1−2 caudally in addition			30	Anterior (ventral) ramus. Ramus anterior. It
24			roots extending from L1−2 caudally in addition			30	Anterior (ventral) ramus. Ramus anterior. It
24			to the filum terminale. C				supplies the skin of the anterior surface of the
	14		CERVICAL NERVES. Nervi cervicales. Eight spi-				ear up to the angle of the mandible. D

25nal nerves emerging from the cervical spinal cord. B

Spinal nerves 335

3;8

4	7	10;15
		10;15

11a 11b 9;21

ASpinal nerve with roots and branches

B Hypoglossal nerve

2and ansa cervicalis

	18
19		29

		30

		27

20		28

Cauda equina

Nerves of the nape of the neck

336 Spinal nerves

1Transverse cervical (colli) nerve. N. transversus

1 colli. Arises from C3 and is the third nerve occupying the “nerve point” at the posterior margin

2of the middle third of the sternocleidomastoid

muscle where it turns anteriorly and passes beneath the platysma to supply the skin. It re-

3ceives motor fibers for the platysma from the cervical branch of the facial nerve. B

4	2	Superior branches. Rami superiores. They as-
4		cend to the suprahyoid region. B
		cend to the suprahyoid region. B

3 Inferior branches. Rami inferiores. They de-

5scend to the infrahyoid region. B

4Supraclavicular nerves. Nn. supraclaviculares.

6Cutaneous branches from C3−4. They spread out fanlike to the shoulder and clavicular regions. B

5 Medial supraclavicular nerves. Nn. supra-

7claviculares mediales. They pass over the middle third of the clavicle and supply the skin of the

8neck in this region and the thorax as far as the sternal angle, as well as the sternoclavicular joint. B

9 6 Intermediate supraclavicular nerves. Nn. supraclaviculares intermedii. They descend beneath the platysma and over the middle third

10 of the clavicle to supply the skin up to the 4th rib. B

11 7 Lateral (posterior) supraclavicular nerves.

Nn. supraclaviculares laterales (posteriores). Posterior group of nerves supplying the skin over

12the acromion, deltoid muscle and the acromioclavicular joint. B

138 Phrenic nerve. N. phrenicus. It arises from C4

with additional rami from C3 and C5, extends on the scalenus anterior muscle, then passes

14through the middle mediastinum to the diaphragm. Some of its fibers extend further into the

15peritoneum. A C

	9	Pericardial branch. Ramus pericardiacus.
16		Slender branch to the anterior surface of the peri-
16		cardium. A
	10	Phrenicoabdominal branches. Rami phreni-
17		coabdominales. Fibers supplying the peritoneum
		up to the gallbladder and pancreas. On the right
		up to the gallbladder and pancreas. On the right
		side they pass through the foramen for the vena
18		side they pass through the foramen for the vena
18		cava, on the left side further anteriorly through
		the diaphragm near the left margin of the heart. A
		the diaphragm near the left margin of the heart. A
19	11	Accessory phrenic nerves. Nn. phrenici acces-
		sorii. Frequent additional roots of the phrenic
20		nerve from C5 and C6 via the nerve to the sub-
20		clavius. A C

12 BRACHIAL PLEXUS. Plexus brachialis. Nerve

21plexus formed by the anterior rami of spinal nerves C5−T1. Supplying the arm and part of the shoulder girdle, it passes between the scalenus

22anterior and medius extending as far as the head of the humerus. C

2312 a Nerve roots. Radices.

13 Trunks. Trunci. Three primary trunks make up the brachial plexus and each is usually formed

24from one or two anterior rami of spinal nerves.

14 Upper trunk. Truncus superior. Formed by the

25union of C5 and C6 spinal nerves, it generally arises lateral to the scalenus gap. C

15Middle trunk. Truncus medius. A continuation of C7 spinal nerve itself. C

16Lower trunk. Truncus inferior. Formed by the union of C8 and T1 spinal nerves; it lies within the scalenus gap posterior to the subclavian artery. C

17Anterior divisions. Divisiones anteriores. Portions of brachial plexus formed by the anterior branches of the three trunks. They supply the flexor muscles.

18Posterior divisions. Divisiones posteriores. Portions of brachial plexus formed by the posterior branchesofthethreetrunks.Theyunitetoformthe posterior cord and supply the extensor muscles.

18 a Cords. Fasciculi. Three nerve bundles formed by the union of branches (anterior and/or posterior) from the three trunks.

19SUPRACLAVICULAR PART. Pars supraclavicularis. Part of brachial plexus extending up to the superior margin of the clavicle. C

20Dorsal scapular nerve. N. dorsalis scapulae. Nerve that arises from C5 directly lateral to the intervertebral foramen, penetrates the scalenus medius and then courses below the levator scapulae and the two rhomboid muscles, which it innervates. C

21Long thoracic nerve. N. thoracicus longus. Nerve that arises from C5−7, penetrates the scalenus medius and travels on the serratus anterior, which it supplies. C

22Nerve to subclavius. N. subclavius. Slender nerve from the upper trunk with fibers from C4−6 for the subclavius muscle. It frequently sends a branch (11) to the phrenic nerve. C

23Suprascapular nerve. N. suprascapularis. Nerve that arises from C5−6, passes over the brachial plexus to the scapular notch and then goes under the superior transverse ligament of the scapula to innervate the supraand infraspinatus muscles. C

24INFRACLAVICULAR PART. Pars infraclaviculares. Portion of brachial plexus below the clavicle. It extends from the upper margin of the clavicle to the level where the cords divide into the individual nerves. C

25Lateral cord. Fasciculus lateralis. Located lateral to the axillary artery, it is formed by the union of the anterior divisions of the upper and middle trunks, thus from C5−7. C

26Medial cord. Fasciculus medialis. Cord located medial to the axillary artery. It is formed solely by the anterior division of the lower trunk, thus from C8−T1. C

27Posterior cord. Fasciculus posterior. Cord located posterior to the axillary artery; it is formed by the union of the posterior divisions of all three trunks, thus from C5−T1. C

28Medial pectoral nerve. N. pectoralis medialis. Nerve formed by fibers from the medial cord, thus from C8−T1. It supplies the pectoralis major and minor muscles. C

29Lateral pectoral nerve. N. pectoralis lateralis. Fibers from C5−7 that supply the two pectoral muscles. C

Spinal nerves 337

								1	2
8									3



11					7			4	5
11								4

								6
9				9
9				9		B	Nerves forming the “nerve point”
						B	Nerves forming the “nerve point”
10
				8
10
								20		C V
								20
					14
	A	Phrenic nerve			14					C VI
	A	Phrenic nerve			19					C VI
					19
				23	15					C VII
				25						C VII

					16
					16					Th I
					22					Th I
					22
				27	28			8
				27				8




				26	12			11
				29	12			11
24					21




								11
								11
								8
			C	Brachial plexus				8
			C	Brachial plexus

	338		Spinal nerves
		1	Musculocutaneous nerve. N. musculocu15		Common digital nerves. Nn. digitales com-
1		1	Musculocutaneous nerve. N. musculocu15		Common digital nerves. Nn. digitales com-
1			taneus. Nerve that arises from the lateral cord		munes. Nerves that run in the spaces between
			(C5−7), penetrates the coracobrachialis and		the first four fingers and then divide. A
2			supplies it as well as the biceps and brachialis	16	Proper palmar digital nerves. Nn. digitales
			muscles. It ends as the lateral antebrachial cu-		palmares proprii. Terminal branches of com-
			taneous nerve. A		palmares proprii. Terminal branches of com-
3			taneous nerve. A		mon palmar digital nerves. They supply the
					mon palmar digital nerves. They supply the
	2		Muscular branches. Rami musculares.		palmar aspect of the skin of the radial 31/2 fin-
			Branches to the coracobrachialis, biceps and		gers and dorsal aspect of the skin of the radial
4			Branches to the coracobrachialis, biceps and		gers and dorsal aspect of the skin of the radial
4			brachialis muscles. A		21/2 distal phalanges. A
	3		Lateral antebrachial cutaneous nerve. N. cu-	17	Ulnar nerve. N. ulnaris. Nerve that arises from
	3		Lateral antebrachial cutaneous nerve. N. cu-	17	Ulnar nerve. N. ulnaris. Nerve that arises from
5			taneus antebrachii lateralis. Terminal branch of		the medial cord (C8, T1). It initially lies in the
			musculocutaneous nerve. It penetrates the fas-		medial bicipital groove, breaks through the me-
			cia at the bend of the elbow and supplies the		dial intermuscular septum and then, after pas-
6			cia at the bend of the elbow and supplies the		dial intermuscular septum and then, after pas-
6			skin of the lateral forearm. A		sage in the groove for the ulnar nerve, pene-
					trates the flexor carpi ulnaris. C

4Medial brachial cutaneous nerve. N. cutaneus

7		brachii medialis. Nerve that arises from the me-				18	Muscular branches. Rami musculares. They
		dial cord (C8, T1) and supplies the skin of the					supply the flexor carpi ulnaris and the ulnar
8		medial upper arm together with the interco-					part of the flexor digitorum profundus. C

		stobrachial nerve. A				19	Dorsal branch of ulnar nerve. Ramus dorsalis

	5 Medial antebrachial cutaneous nerve. N. cu-						n. ulnaris. Cutaneous branch passing between
9
							the distal	and middle	third of	the forearm
		taneus antebrachii medialis. Nerve that arises
		from the medial cord (C8, T1) and penetrates					beneath the flexor carpi ulnaris to innervate the
10							dorsum of the hand. B C
		the fascia at about the middle of the upper arm
		and accompanies the basilic vein. It supplies				20	Dorsal digital nerves. Nn. digitales dorsales.

11		the skin on the medial side of both the distal					Individual branches to the little finger, ring fin-
		upper arm and the forearm. A					ger and the ulnar side of the middle finger. This

	6 Anterior branch. Ramus anterior. It supplies						area of innervation can be displaced by the

12							radial nerve. B
		the medial flexor side of the forearm. A
	7	Posterior (ulnar) branch. Ramus posterior [[ul-				21 Palmar branch of ulnar nerver. Ramus pal-
13							maris nervi ulnaris. Nerve that arises in the dis-
		naris]]. It supplies the medial upper 2/3 of the
							tal third of the forearm, penetrates the deep
		posterior aspect of the forearm. A B					fascia and supplies the skin on the palmar sur-
14

	8	Median nerve. N. medianus. Nerve formed by					face of the hand. C
		the union of medial and lateral roots from the				22	Superficial	branch.	Ramus	superficialis.
15		medial and lateral cords (C6−T1). A
							Branch that courses beneath the palmar

	9 Medial root. Radix medialis. Part of the median						aponeurosis and divides to form the common

16		nerve coming from the medial cord with fibers					palmar distal nerves and a fine branch to the
		from C8 and T1. A					palmaris brevis. C

	10	Lateral root. Radix lateralis. Part of the median				23	Common palmar digital nerves. Nn. digitales
17
		nerve arising from the lateral cord with fibers					palmares communes. Usually only one branch
		from C6−7. A					which runs in the region between the ring and
18	11	Anterior interosseous nerve of forearm. N. in-					little fingers. C
						24	Proper palmar digital nerves. Nn. digitales pal-
		terosseus	(antebrachii)	anterior.	Nerve that
19		arises from the bend of the elbow from the					mares proprii. Cutaneous nerves to the little
							finger and the ulnar side of the ring finger. They
		posterior side of the median nerve, runs on the
		interosseous membrane and supplies the					also supply the dorsal aspect of the middle and
20							distal phalanges of the 11/2 ulnar fingers. C
		radiocarpal joint, intercarpal joints, flexor polli-
		cis longus, flexor digitorum profundus (radial				25	Deep branch (of ulnar nerve). Ramus profun-
21		part) and pronator quadratus. A					dus. Branch that curves around the hamulus to
	12	Muscular	branches.	Rami	musculares.		supply the	muscles of	the hypothenar emi-

							nence, the interossei, the two ulnar lumbricals,
22		Branches that supply the pronator teres, flexor
							the adductor pollicis and the deep head of the
		carpi radialis, palmaris longus and flexor digi-
							flexor pollicis brevis. C
		torum superficialis muscles. A

2313 Palmar branch of median nerve. Ramus palmaris n. mediani. Nerve that arises in the distal

24third of the forearm and supplies the skin of the lateral palm. A

2514 Communicating branch to the ulnar nerve.

Ramus communicans [cum nervo ulnari]. A

Spinal nerves 339

		9
		9
1	10			3


		4
		4
		8	17	4
		8		4

			5

7			6
7			6


			7


5			8

				6	18			12
				6

					19
					19
11		12					19	13
11								13
3

								14




							21	15
							21	15
					20
					20			16
								16


15	14					22		17
						22		17

			13		25
			13		25

		23
		19
B	Cutaneous nerves	24
B	Cutaneous nerves
	of forearm	20
16

	Nerves of upper limb, frontal view		Ulnar nerve
A	Nerves of upper limb, frontal view	C	Ulnar nerve	23


				24


				25

340

Spinal nerves

1 Radial nerve. N. radialis. Nerve that originates

13 Axillary nerve. N. axillaris. Nerve that arises

from the posterior cord (usually with fibers

from the posterior cord (C5−6) and passes to-

from C5−T1), takes a spiral course around the

gether with the posterior circumflex humeral

posterior aspect of the humerus while within

artery through the axilla to the teres minor and

the groove for the radial nerve, then proceeds

deltoid muscles. D

laterally between the brachialis and bra-

14 Muscular branches. Rami musculares. Fibers to

chioradialis

well as

both

extensor carpi

radialis muscles. At the elbow it divides to form

the teres minor and deltoid muscles. D

its deep and superficial rami. A B D

15 Superior lateral brachial cutaneous nerve. N.

Posterior

brachial cutaneous

nerve. N. cu-

cutaneus brachii lateralis superior. It supplies

the area of the skin located somewhat over the

taneus brachii

posterior.

Small

cutaneous

deltoid muscle. D

branch supplying the skin on the extensor side

THORACIC NERVES. Nn. thoracici. Twelve

of the upper arm. A

3 Lateral brachial cutaneous nerve. N. cutaneus

thoracic spinal nerves emerging below thoracic

vertebrae 1−12, respectively. C

brachii laterialis inferior. Second cutaneous

Posterior branches. Rami posteriores. Rami

branch for the lateral and dorsal surfaces of the

upper arm below the deltoid muscle. A

that pass dorsally through the autochthonous

Posterior antebrachial cutaneous nerve. N.

muscles of the back, then divide to form lateral

and medial cutaneous branches. C

cutaneus

antebrachii

posterior.

Cutaneous

Lateral/medial

muscular branches. Ramus

branch for the field between the lateral and

medial antebrachial cutaneous nerves. B

muscularis lateralis/medialis. C

5 Muscular branches. Rami musculares. Motor

19 Posterior cutaneous branch. Ramus cutaneus

rami to the triceps, anconeus, brachioradialis

posterior. C

and extensor carpi radialis longus muscles. A

20 Anterior branches (intercostal nerves). Rami

6 Deep branch. Ramus profundus. Branch that

anteriores (nn. intercostales). Rami forming the

intercostal nerves ventrally in the thoracic re-

supplies the extensors of the forearm. It pene-

gion. C

trates the supinator, supplying it and all exten-

sors (except the extensor carpi radialis longus)

Lateral cutaneous branch (pectoral/abdomi-

and the abductor pollicis longus. A B

nal). Ramus

cutaneus lateralis (pectoralis/

Posterior interosseous nerve of forearm. N.

abdominalis). Nerve arising from the middle of

the intercostal nerve. It passes obliquely ven-

interosseus

(antebrachii)

posterior. Terminal

trad and appears between the slips of the serra-

branch of the deep ramus that lies on the inter-

osseous membrane in the distal third of the

tus anterior muscle and the latissimus dorsi. C

forearm beneath the extensors and extends to

Lateral mammary branches. Rami mammarii

the wrist joint. A

laterales. Rami of lateral cutaneous branches

Superficial

branch.

Ramus

superficialis.

arising from T4−6 and passing anteriorly to the

mammary region. C

Branch that runs along the brachioradialis to-

gether with the radial artery, crosses under its

Intercostobrachial nerves. Nn. intercostobr-

accompanying muscle and then arrives at the

achiales. Lateral cutaneous rami arising usually

dorsum of the hand and fingers as a cutaneous

from T1, but also from T1−3 and passing to the

nerve. A B

upper arm. C

9 Communicating branch to the ulnar nerve.

24 Anterior cutaneous branch (pectoral/abdomi-

Ramus communicans ulnaris. It joins the dorsal

nal). Ramus

cutaneus anterior (pectoralis/

ramus of the ulnar nerve on the dorsum and the

abdominalis). Branch that emerges medially

hand. A

and anteriorly and divides to form medial and

Dorsal digital nerves. Nn. digitales dorsales.

lateral branches. C

Medial mammary branches. Rami mammarii

Terminal rami of the superficial branch passing

on the radial and ulnar sides of the extensor

mediales. Medial branches from the anterior

aspect of the lateral 21/2, sometimes also 31/2

cutaneous rami of intercostal nerves 2−4. C

fingers. A

Subcostal nerve. N. subcostalis. Anterior

11 Subscapular nerves. Nervi subscapulares. Two

branch of the 12th thoracic nerve located below

to three branches from the brachial plexus (su-

the 12th rib.

23praclavicular part or posterior cord) supplying the subscapularis and teres major muscles. D

2412 Thoracodorsal nerve. N. thoracodorsalis. Longest subscapular nerve with fibers from C6−

258. It courses along the lateral margin of the scapula and supplies the latissimus dorsi. D

Spinal nerves 341

											19			18			1
											17			16			2
																	2
								20									3
								20									3
1																	4
1				23											III		5
															III

															IV		6
															IV		6
				21													7
2			3														8



														24			9
			5											25			10
																24

			6														11



			8
				22													12
				22

7																	13
7

								Intercostal nerves
							C	Intercostal nerves									14
						1											14
																	15


				6													16
						8											17




				4										11			18
				4

9													12

				15							13						19



								14									20
10								14				1					20
10												1

																	21


																	22


																	23


		Radial nerve			Posterior antebrachial					Axillary nerve							24
	A	Radial nerve		B	Posterior antebrachial				D	Axillary nerve							24
					cutaneous nerve

	342		Spinal nerves
		1	LUMBAR NERVES. Nn. lumbales (lumbares). 18	Ilioinguinal nerve. N. ilioinguinalis. Nerve aris-
1		1	LUMBAR NERVES. Nn. lumbales (lumbares). 18	Ilioinguinal nerve. N. ilioinguinalis. Nerve aris-
1			Five lumbar spinal nerves each emerging below	ing from L1, possibly also T12. It appears at the
			its respective lumbar vertebra.	lateral margin of the psoas and courses between
2	2		Posterior branches. Rami posteriores. They	the kidney and quadratus lumborum, then be-
			supply the autochthonous back muscles and	tween the transversus abdominis and internal
			supply the autochthonous back muscles and	abdominal oblique (muscular branches) to enter
3			the skin overlying them. C	abdominal oblique (muscular branches) to enter
			the skin overlying them. C	the inguinal canal. C
				the inguinal canal. C

3Medial branch. Ramus medialis. Weak motor

		branch in the lumbar region. C	19	Anterior scrotal nerves. Nn. scrotales anteri-
4
	4	Lateral branch. Ramus lateralis. Predominantly		ores. Sensory branches to the anterior skin of the
				scrotum, mons pubis and adjacent skin of the
		sensory. C
5				thigh. C
	5	Superior clunial (gluteal) branches. Rami
			20	Anterior labial nerves. Nn. labiales anteriores.
		clunium (gluteales) superiores. Lateral rami of
				Sensory rami to the labium majus, mons pubis
6		L1−3 supplying the skin up to the greater tro-
				and adjacent skin of the thigh. C
		chanter (buttock region). B	21 Genitofemoral nerve. N. genitofemoralis. Nerve
7	6	Anterior branches. Rami anteriores. Ventral
				that arises from L1−2, penetrates the psoas
		branches forming the lumbar plexus. C
				major and courses on top of it. C

7SACRAL NERVES AND COCCYGEAL NERVE. Nn.

8sacrales et n. coccygeus. Five sacral and one 22 Genital branch. Ramus genitalis. Branch that

			coccygeal nerve.					courses through the inguinal canal and supplies
9	8		Posterior branches. Rami posteriores. Sensory					the cremaster muscle, skin of scrotum (labium
								majus) and adjacent skin of the thigh. C
			and motor rami emerging from the posterior
							23	Femoral branch. Ramus femoralis. Branch that
10			sacral foramina. A B
	9		Medial branch. Ramus medialis. It supplies the					passes through the vascular lacuna (between
								femoral artery and iliopectineal arch), then
			multifidus and the skin over the sacrum and
11								through the saphenous hiatus to supply the skin
			coccyx. A B
		10 Lateral branch. Ramus lateralis. Sensory branch						located there. C
12							24 Lateral femoral cutaneous nerve. N. cutaneus
			for the skin over the coccyx formed by the union
								femoris lateralis. Nerve that arises from L2−3. It
			of sensory fibers from the posterior rami of S1−3.
								appears at the lateral margin of the psoas and
13			A B
								courses beneath the iliac fascia and through the
	11		Medial	clunial	(gluteal)	nerves. Rami
								lateral part of the muscular lacuna into the thigh,
			clunium (gluteales) mediales. Sensory nerves
14								where it proceeds below or above the sartorius
			from S1−3. They penetrate the gluteus maximus
								to the lateral skin of the thigh. C
			and supply the skin of the medial, upper gluteal				25	Obturator nerve. N. obturatorius. Nerve that
15			region. B
	12		Anterior branches. Rami anteriores. They pass					arises from L2−4. It passes beneath the psoas, be-
								hind the internal iliac artery and lateral to the
16			through the anterior sacral foramina and form					ureter, then through the obturator canal to the
			the sacral plexus. A C
								adductor group and to the medial skin of the
	13		LUMBOSACRAL PLEXUS. Plexus lumbosacralis.					thigh. C
17
			Collective term for the combined lumbar and				26 Anterior branch. Ramus anterior. Nerve that
			sacral plexuses joined together by fibers from L4
								courses on top of the adductor brevis and obtura-
18			and mutually supplying the lower limb. C
								tor externus muscles and beneath the adductor
	14		LUMBAR PLEXUS. Plexus lumbalis (lumbaris).
								longus and pectineus muscles. It supplies these

			Nerve network formed by spinal nerves L1−4					and the gracilis muscles. C
19
			which lie at the anterior side of the leg.				27	Cutaneous branch. Ramus cutaneus. Variable
		15	Iliohypogastric nerve. N.			iliohypogastricus.
20								terminal branch which appears between the ad-
			Nerve that contains sensory and motor fibers
								ductor longus and gracilis muscles and supplies
			from T12 and L1 for the abdominal muscles. It					the distal 2/3 of the skin of the thigh. C
21			traverses the psoas major, then courses between
							28	Posterior branch. Ramus posterior. It pierces
			the transversus abdominis and internal abdomi-
			nal muscles and pierces the latter medial to the					the obturator externus and supplies it and the
22			anterior superior iliac spine. C					adductor magnus and brevis. Via a sensory
		16	Lateral	cutaneous	branch. Ramus cutaneus			branch it extends as far as the posterior wall of
								the knee joint. C
23			lateralis. It can reach as far as the lateral gluteal
							29	Muscular branches. Rami musculares. Branches
			region. C

24		17	Anterior cutaneous branch. Ramus cutaneus					supplying the previously named muscles. C
							30	Accessory obturator nerve. N. obturatorius ac-
			anterior. It frequently penetrates the aponeuro-
			sis of the external oblique just above the superfi-					cessorius. It frequently arises as an additional
25			cial inguinal ring and supplies the skin in this					obturator nerve from L3−4 to supply the pec-
			area. C					tineus and hip joint.

													Spinal nerves	343

			12												1

													5		2
															2


								L III							3
								L III



															4
				8


															5
															5
							8


															6
9			10				11								6
							11

							9								7
							9								7
	A	Exit of a sacral nerve
			3		4										8
			3		4		10
							10
						2									9
															9

												B	Middle and superior

						6									10
21						6							clunial nerves		10


									15						11
15															11

										18

18															12

											21
											21

23			13
23
22			14
			14
13		24	15
	12	17	16
	12	16	16
25	22	16
25	23
	23		17

			17
			17		18
28				18
				18
					19
29

					20
					20
				19;20

	26				21



					22
		27

					23
					23

				24

C Lumbosacral plexus

344 Spinal nerves

1Femoral nerve. N. femoralis. Nerve arising from 1 L2−4. It appears at the lateral margin of the psoas and runs between the iliac and psoas major

	2	muscles to pass through the muscular lacuna. A
	2	2 Muscular branches. Rami musculares. Branches
		2 Muscular branches. Rami musculares. Branches

to the sartorius, pectineus and quadriceps

3femoris muscles. A

3Anterior cutaneous branches. Rami cutanei anteriores. Main branches for the distal 3/4 of the

4	anterior surface of the thigh up to the patella. A

4Saphenous nerve. N. saphenus. Longest, purely

5sensory ramus of the femoral nerve. It begins in the femoral triangle, passes beneath the ”vasto-

adductor membrane”, which it pierces, arrives 6 beneath the skin between the sartorius and gracilis muscles and, together with the great

7saphenous vein, proceeds as far as the medial side of the foot. A

5 Infrapatellar branch. Ramus infrapatellaris. It

8penetrates the sartorius and arrives at the skin below the patella. A

6 Medial cutaneous branches of the leg. Rami

9 cutanei cruris mediales. Branches of saphenous nerve to skin of the lower leg and foot. A

107 Lumbosacral trunk. Truncus lumbosacralis. Connection to the lumbar plexus formed by L5 and a part of L4. A

118 SACRAL PLEXUS. Plexus sacralis. Plexus arising from L5−S3 and a part of L4 and S4, lying anterior

12to and beneath the fascia of the piriformis muscle beneath its fascia. Its nerves pass to the posterior side of the lower limb. A

139 Nerve to obturator internus muscle. N. musculi obturatorii interni. Nerve that arises from L5−S2 and passes through the greater sciatic foramen

14into the ischioanal fossa from which it extends to the obturator internus muscle.

1510 Nerve to piriformis muscle. N. musculi piriformis. Nerve that arises from S1−2 and proceeds to the anterior side of the piriformis.

1611 Nerve to quadratus femoris. N. musculi quadrati femoris. Nerve that arises from L4−S1, passes

17through the greater sciatic foramen and proceeds down to the quadratus femoris and the hip joint.

12 Superior gluteal nerve. N. gluteus superior.

18Nerve that arises from L4−S1, passes through the greater sciatic foramen cranial to the piriformis [[“suprapiriform foramen”]] and then between

19the gluteus medius and minimus as far as the tensor fasciae latae. It supplies all of the above-

20mentioned muscles except the piriformis. B

13Inferior gluteal neve. N. gluteus inferior. Nerve that arises from L5−S2, passes through the in-

21frapiriform foramen and supplies the gluteus maximus. B

2214 Posterior femoral cutaneous nerve. N. cutaneus

femoralis posterior. Nerve that arises from S1−3, passes through the greater sciatic foramen below

23the piriformis [[“infrapiriform foramen”]] and supplies the skin on the posterior side of the thigh and proximal portion of lower leg. B

2415 Inferior clunial (gluteal) rami. Rami clunium

(gluteales) inferiores. Cutaneous branches pass-

25ing upward around the lower margin of the gluteus maximus. B

16Perineal branches. Rami perineales. Branches that arise from the lower margin of the gluteus maximus and pass beneath the ischial tuberosity medially to the scrotum (labia). One of the branches ascends as far as the coccyx. B

16 a Perforating cutaneous nerve. N. cutaneus perforans. Ramus of the posterior femoral cutaneous nerve supplying the skin of the anus. B

17Sciatic nerve. N. ischiadicus (sciaticus). Nerve that arises from L4−S3. It is the thickest nerve of the body. It leaves the pelvis through the greater sciatic foramen below the piriformis [[infrapiriform foramen]] and passes downward lateral to the ischial tuberosity, beneath the gluteus maximus and the long head of the biceps. B

18Common peroneal (fibular) nerve. N. fibularis communis. Nerve that arises from L4−S2, branches off from the sciatic nerve at a variable level, passes in company with the biceps tendon as far as the posterior aspect of the head of the fibula and then crosses obliquely forward between the skin and fibula. B

19Lateral sural cutaneous nerve. N. cutaneus surae lateralis. It usually arises in the popliteal fossa and supplies the skin on the lateral aspect of the proximal 2/3 of the posterior side of the lower leg. A B

20Communicating branch of common peroneal (fibular) nerve. Ramus communicans fibularis. It passes beneath the fascia over the lateral head of the gastrocnemius and joins the medial sural cutaneous nerve to form the sural nerve. B

21Superficial peroneal (fibular) nerve. N. fibularis superficialis. One of the terminal branches of the common fibular nerve. It descends between the peroneal muscles and extensor digitorum longus. A B

22Muscular branches. Rami musculares. Branches to the peroneus longus and brevis.

23Medial dorsal cutaneous nerve. N. cutaneus dorsalis medialis. It runs over the extensor retinacula and supplies the skin of the dorsum of the foot, the medial side of the big toe and the halves of the 2nd and 3rd toes facing one another. A

24Intermediate dorsal cutaneous nerve. N. cutaneus dorsalis intermedius. Lateral cutaneous branch of the superficial fibular nerve to the middle and lateral aspect of the dorsum of the foot. A

25Dorsal digital nerves of foot. Nn. digitales dorsales pedis. Branches for all toes except the distal phalanges. A

26Deep peroneal (fibular) nerve. N. fibularis profundus. It proceeds beneath the peroneus longus, then lateral to the tibialis anterior muscle to supply the dorsum of the foot. A B

27Muscular branches. Rami musculares. Rami passing to the tibialis anterior, extensor hallucis longus and brevis, and extensor digitorum longus and brevis muscles. A

28Dorsal digital nerves of lateral surface of great toe and of medial surface of second toe. Nn. digitales dorsales, hallucis lateralis et digiti secundi medialis. Sensory branches. A

Spinal nerves 345

7		8
1
		12
		13
	2	14
		14
		16a	15
		16

			14
			14
			2
			2
			4	17
			4


		5		18
				18
19					20


					21


					26
					26
19	6		19
					21

21

27 B Nerves of lower limb from behind

A Nerves of lower limb from front

	346			Spinal nerves
				Tibial nerve. N. tibialis. Nerve arising from L4−	14	Common plantar digital nerves. Nn. digitales
1		1		Tibial nerve. N. tibialis. Nerve arising from L4−	14	Common plantar digital nerves. Nn. digitales
1				S3. It is the second terminal branch of the sci-		plantares communes. Two branches, one pass-
				atic nerve. It passes through the popliteal fossa,		ing to the little toe and giving off a branch to the
2				disappears beneath the tendinous arch of the		flexor digiti minimi brevis, the other proceed-
				soleus muscle and proceeds, accompanied by		ing to the interval between the 4th and 5th toes.
3				the posterior tibial artery, around the medial		A
3				malleolus to the sole of the foot. A	15	Proper plantar digital nerves. Nn. digitales
					15	Proper plantar digital nerves. Nn. digitales
4		2		Muscular branches. Rami musculares. Rami to		plantares proprii. They pass to the fibular and
4				the gastrocnemius, plantaris, soleus and the		tibial sides of the little toe as well as to the fibu-
				deep flexors at the lower leg. A		lar side of the 4th toe. A
5		3		Interosseous nerve of leg. N. interosseus	16	Deep branch. Ramus profundus. Muscular
				cruris. It is accompanied by the anterior tibial		branch passing in company with the plantar
6				artery and contains fibers for the bones and ti-		arch to the interossei, adductor hallucis and the
6				biofibular joint. A		lateral three lumbrical muscles. A
7		4		Medial sural cutaneous nerve. N. cutaneus	17	Pudendal nerve. N. pudendus. Arising from
7				surae medialis. Nerve that arises from the tibial		S2−4, it passes through the greater sciatic fora-
				nerve in the popliteal fossa, then descends sub-		men below the piriformis [[”infrapiriform fora-
8				fascially lateral to the small saphenous vein and		men”]] to the ischioanal fossa. C
8				fascially lateral to the small saphenous vein and
				joins the communicating branch of the com-	18	Inferior rectal nerves. Nn. rectales (anales) in-
9				mon fibular nerve to form the sural nerve. A B		feriores. Fibers from S3−4 for the external anal
9		5		Sural nerve. N. suralis. Continuation of the		sphincter and the anal skin. C
						sphincter and the anal skin. C

10				medial sural cutaneous nerve after its union	19	Perineal nerves. Nn. perineales. Collective
10				with the communicating branch of the com-		term for the nerves of the perineum.
11				mon fibular nerve. B	20	Posterior scrotal (labial) nerves. Nn.
		6		Lateral dorsal cutaneous nerve. N. cutaneus	20	Posterior scrotal (labial) nerves. Nn.
		6		Lateral dorsal cutaneous nerve. N. cutaneus		scrotales/libiales posteriores. They reach the
				dorsalis lateralis. It passes to the lateral aspect		scrotum (labium majus) from behind. C
12				of the dorsum of the foot and anastomoses with	21	Muscular	branches. Rami musculares. They
12				the intermediate dorsal cutaneous nerve. B	21	Muscular	branches. Rami musculares. They
				the intermediate dorsal cutaneous nerve. B		supply the muscles of the perineum.
			7 Lateral calcaneal branches. Rami calcanei later-			supply the muscles of the perineum.
13			7 Lateral calcaneal branches. Rami calcanei later-		22	Dorsal nerve		of	penis. N. dorsalis penis.
13				ales. Lateral branches to the calcaneus. B	22	Dorsal nerve		of	penis. N. dorsalis penis.
				ales. Lateral branches to the calcaneus. B		Paired nerves lying on the dorsum of the penis
						Paired nerves lying on the dorsum of the penis
14		8		Medial calcaneal branches. Rami calcanei		with branches		also	to the underside of the
14				mediales. Branches arising directly from the ti-		penis. C
				mediales. Branches arising directly from the ti-		penis. C
15				bial nerve. They pass to the medial aspect of the	23	Dorsal nerve of clitoris. N. dorsalis clitoridis.
				calcaneus. B	23	Dorsal nerve of clitoris. N. dorsalis clitoridis.
				calcaneus. B		Smaller nerve corresponding to the dorsal
		9		Medial plantar nerve. N. plantaris medialis.		nerve of the penis. C
16				The larger terminal branch of the tibial nerve. It	24	Coccygeal	nerve. N. coccygeus. Last spinal
				proceeds beneath the flexor retinaculum and		nerve. It	emerges		between the coccyx and
17				the abductor hallucis to the sole of the foot		sacrum and anastomoses with S4−5 nerves. C
				which it supplies, as well as the skin and the		sacrum and anastomoses with S4−5 nerves. C
				which it supplies, as well as the skin and the	25	Coccygeal plexus. Plexus coccygeus. Nerve
				flexor hallucis brevis and flexor digitorum	25	Coccygeal plexus. Plexus coccygeus. Nerve
18				brevis. A		plexus formed by fibers from a part of S4, all of
18				brevis. A		S5 and the coccygeal nerve. It supplies the skin
		10		Common plantar digital nerves. Nn. digitales		S5 and the coccygeal nerve. It supplies the skin
						over the coccyx. C
						over the coccyx. C
19				plantares communes. They course in the inter-	26	Anococcygeal nerves. Nn. anococcygei. Several
19				val between toes 1−4 and divide to form the	26	Anococcygeal nerves. Nn. anococcygei. Several
				proper plantar digital nerves. A		fine nerves from the coccygeal plexus. They
20				proper plantar digital nerves. A		pierce the anococcygeal ligament and supply
	11			Proper plantar digital nerves. Nn. digitales plan-		pierce the anococcygeal ligament and supply
	11			Proper plantar digital nerves. Nn. digitales plan-		the skin lying over it. C
				tares proprii. Cutaneous nerves passing on the

21tibial and fibular sides of the flexor aspect of the medial 31/2 toes. They supply the distal

phalanges, including their dorsal aspect. A

12Lateral plantar nerve. N. plantaris lateralis. Smaller terminal branch of the tibial nerve. It

23passes beneath the flexor digitorum brevis medial to the lateral plantar artery as far as the

24base of the 5th metatarsal bone. A

13 Superficial branch. Ramus superficialis. Perdom-

25inantly sensory branch of lateral plantar nerve. A

Spinal nerves 347

							1
							2
		4					3
		4					4
							4
2		2	4				5
2


		1
							6


2							7
		2					8



							9
							10
							11
		3		5			12


							13
						Cutaneous nerves
					B	Cutaneous nerves	14
						of leg from behind	15
							15
			8				16
			7				17

9	12		6				18
			6

13				19
13		25

				20
14			24
			24
	22	26

				21

	23
	23
15		17		22
				22

20	18

				23

				24
A	Nerves of leg	C	Pudendal nerve	24
A	Nerves of leg	C	Pudendal nerve

and foot from behind

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