Fitranto Arjadi .
1) neuron afferent (sensory) 2) neuron efferent (motor) 3)
interneuron
b. Cranial nerves
nervous system b. Sistem saraf parasimpatis
2 bagian :
Simpatis Parasimpatis
posterior, dengan nama,
Asal hidung (I), mata (II), brainstem
(III – XII)
dan medulla spinalis
(sebagian dari XI).
(eye muscles and tongue) EXIT CR. CAVITYTARGETNERVE
Hypoglossal canal
NERVE TARGET
Parasympathetic to most of gut
Taste to back posterior pharynx XI: (Spinal) Accesory
Motor to traps, sternocleidomastoid
Parotid salivary gland
Olfaction : sensation of odors from the detection of odorous
substances aerosolized in the environment
The cell bodies : olfactory organ in the roof of the nasal cavity
and along the nasal septum and medial wall of the superior nasal
concha.
Oculomotor Nerve (CN III) Functions: Somatic motor (general somatic
efferent)
Parasympathetic via ciliary ganglion to the smooth muscle
sphincter pupillae : constriction pupil and ciliary body --
accommodation lens to become more rounded) for near vision.
Chief motor nerve to the ocular and extraocular muscles.
Emerges from the midbrain --- pierces the dura lateral to the
sellar diaphragm roofing over the hypophysis --- runs through the
roof and lateral wall of the cavernous sinus --- enters the
orbit through the superior orbital fissure and divided into
a superior division (supplies the superior rectus and levator
palpebrae superioris) and
an inferior division (supplies the inferior and medial rectus and
inferior oblique)
carries presynaptic parasympathetic (visceral efferent) fibers to
the ciliary ganglion
Trochlear Nerve (CN IV) Functions: Somatic motor (general somatic
efferent) and proprioceptive to one extraocular muscle (superior
oblique).
Nucleus: midbrain, immediately caudal to the oculomotor
nucleus.
smallest cranial nerve.
from the posterior surface of the midbrain --- passing anteriorly
around the brainstem, running the longest intracranial
(subarachnoid) -- pierces the dura mater at the margin of tentorium
cerebelli -- passes anteriorly in the lateral
Functions: Somatic motor (general somatic efferent and
proprioceptive) to one extraocular muscle (lateral rectus).
Nucleus: pons near the median plane deep to colliculud in floor of
4 th ventricles for lateral rectus.
V: Trigeminal (3 nerves in 1!) Conveys sensory impulses from
various areas of the face (V1) and
(V2), and supplies motor fibers (V3) for mastication
Composed of three divisions:
V1. Ophthalmic Exits with eye muscle group (superior orbital
fissure, through orbit to
superior orbital notch/foramina)
Sensory to forehead, nasal cavity
V2. Maxillary Exits foramen rotundum through wall of
maxillary sinus to inferior orbital
foramina)
Sensory to cheek, upper lip, teeth, nasal cavity
V3. Mandibular Exits foramen ovale to mandibular foramen to
mental foramen
Motor to jaw muscles--Masseter, temporalis, pterygoids,
digastric
Sensory to chin
Sensory to tongue
Mixed nerve with five major branches Temporal Zygomatic Buccal
Mandibular Cervical
chorda tympani” (crosses interior ear drum to join V 3
) Taste to anterior 2/3 of tongue Submandibular, sublingual
salivary glands
Lacrimal glands Motor functions include facial expression,
“
visceromotor (parasympathetic) ncl. salivatorius
superior
ncl. gustatorius (rostral part of ncll. tractus solitarii)
sensory (taste)
n. intermedius = VM fibres + taste fibres
course: pons angulus pontocerebellaris fossa cranii
posterior porus acusticus internus meatus a.i.
fundus m.a.i. (vetrocranial quadrant) canalis nervi
facialis Falloppii foramen stylomastoideum
glandula parotidea
Facial Nerve (CN VII)
Then, after running the longest intraosseous course of any cranial
nerve, CN VII emerges from the cranium via the stylomastoid
foramen; gives off the posterior auricular branch; enters the
parotid gland; and forms the parotid plexus, which gives rise to
the following five terminal motor branches: temporal, zygomatic,
buccal, marginal mandibular, and cervical.
Branchial Motor As the nerve of the 2nd pharyngeal arch, the
facial nerve supplies striated muscles derived from its mesoderm,
mainly the muscles of facial expression and auricular muscles. It
also supplies the posterior bellies of the digastric, stylohyoid,
and stapedius muscles.
Presynaptic Parasympathetic CN VII provides presynaptic
parasympathetic fibers to the pterygopalatine ganglion for
innervation of the lacrimal mucous glands and to the submandibular
ganglion for innervation of the sublingual and submandibular
salivary glands. The pterygopalatine ganglion is associated with
the maxillary nerve (CN V 2), which distributes its
postsynaptic fibers, whereas the submandibular ganglion is
associated with the mandibular nerve (CN V 3). Parasympathetic
fibers synapse in these ganglia, whereas sympathetic and other
fibers pass through them.
VII. = N. facialis - branches outside skull n. auricularis
posterior – somatomotor fibres
nervi fasialis n. petrosus major
– parasympathetic
canalis n.p.m. sulcus n.p.m. foramen lacerum
canalis pterygoideus Vidii fossa pterygopalatina
ggl. pterygopalatinum via branches of n.V2 to gll.
lacrimalis, nasales, palatinae, nasopharyngeae
n. stapedius – somatomotor
submandibularis + sublingualis
Cranial Nerve VIII: Vestibulocochlear
Fibers arise from the hearing and equilibrium apparatus of the
inner ear, pass through the internal acoustic meatus, and enter the
brainstem at the pons-medulla border
Two divisions – cochlear (hearing) and vestibular
(balance)
Functions are solely sensory – equilibrium and hearing
2 cochlear: ncl. cochlearis ant.+post.
4 vestibular: ncl. vestibularis sup.+inf.+medi.+lat.
course: angulus pontocerebellaris fossa cranii posterior
porus acusticus internus meatus a.i. fundus
m.a.i.
special sensory – hearing + balance
Glossopharyngeal Nerve (CN IX ) Functions: Sensory (general
somatic afferent, special visceral afferent, general visceral
afferent), motor (special visceral efferent), and parasympathetic
(general visceral efferent)
Nuclei: Four nuclei in the medulla send or receive fibers via CN
IX: two motor and two sensory. Three of these nuclei are shared
with CN X.
Emerges from the lateral aspect of the medulla -- passes
anterolaterally to leave the cranium through the anterior aspect
foramen jugular -- superior and inferior (sensory) ganglia, --
followsm. stylopharyngeus, the only muscle the nerve supplies, -
-passses between the superior and the middle constrictor muscles of
the pharynx --creach the oropharynx and tongue (sensory
fibers)
Branchial Motor ; m.stylopharyngeus.
Parasympathetic (Visceral Motor)
Following a circuitous route initially involving the tympanic
nerve, presynaptic parasympathetic fibers are provided to the otic
ganglion for innervation of the parotid gland -- associated with
the mandibular nerve (CN V 3), branches of which convey the
postsynaptic parasympathetic fibers to the parotid gland .
Sensory (General Sensory)
The tympanic nerve. The carotid sinus nerve to the carotid sinus, a
baro- (presso) receptor sensitive to changes in blood pressure, and
the carotid body, a chemoreceptor sensitive to blood gas (oxygen
and carbon dioxide levels).
Vagus Nerve (CN X) Functions: Sensory (general somatic
afferent, special visceral afferent, general
visceral afferent), Motor (special visceral efferent), and
parasympathetic (general visceral efferent). Sensory from the
inferior pharynx, larynx, and thoracic and abdominal organs. Motor
to the soft palate; pharynx; intrinsic laryngeal muscles
(phonation); and a nominal extrinsic tongue muscle, the
palatoglossus,
The vagus nerve (CN X) -- longest course --- most extensive ---
Latin word vagari = wandering.
Arises from the lateral aspect of the medulla that merge and
leave the cranium through the jugular foramen positioned between CN
IX and CN XI
has a superior ganglion in the jugular foramen= general
sensory
Inferior foramen = inferior ganglion (nodose ganglion) =
visceral sensory .
CN X continues inferiorly in the carotid sheath to the root
of the neck, supplying branches to the palate, pharynx,
supplies branches to the heart, bronchi, and lungs. join the
esophageal plexus surrounding the esophagus,
X. - N. vagus SM: pharynx (except m. stylopharyngeus), soft
palate
(except m. tensor veli palatini), larynx (4th arch), upper half of
oesophagus
SS: part of meatus acusticus externus + of meninges
VS: ggl. superius n.X + inferius n.X.
mucosa of larynx, lower ½ of pharynx , foregit and midgut + liver,
gallbladder, pancreas; spleen, kidneys, suprarenal glands,
testis/ovaries, ½ of uterine tube
taste: part of root of tongue, epiglottis
Cabang rr. pharyngei – mucosa, glands,
muscles
n. laryngeus superior – mucosa, glands, muscles
n. laryngeus recurrens – idem right is shorter and passes
under a. subclavia dextra
left is longer and under arcus aortae
rr. cardiaci cervicales sup.+inf., thoracici
rr. bronchiales
Functions: Motor to the striated sternocleidomastoid and trapezius
muscles.
2 nuclei 2 roots 1 trunk 2 branches
somatomotor branchial (6th arch)/cranial root nucleus in medulla
oblongata: ncl. ambiguus radix
cranialis truncus n.XI ramus internus n. X
soft palate muscles (4) + lateral muscle group of larynx (3)
somatomotor somite (cervical somites)/spinal root nucleus in
cervical spinal cord: ncl. n. XI. medullae
spinalis radix spinalis truncus n.XI ramus
externus m. sternocleidomastoideus + m. trapezius
Hypoglossal Nerve (CN XII) Functions: Motor (general somatic
efferent) to the intrinsic and extrinsic muscles of the tongue (G.
glossa) styloglossus, hyoglossus, and genioglossus.
Arises as motor nerve -- leaves cranium through the
hypoglossal canal -- after exiting the cranial cavity, joined by
branches of the cervical plexus general somatic motor fibers from
C1 and C2 spinal nerves and general somatic sensory fibers from the
spinal ganglion of C2. -- hitch a ride with CN XII to reach the
hyoid muscles, ---CN XII passes inferiorly medial to the angle of
the mandible -- -curves anteriorly to enter the tongue --- ends in
many branches that supply all the extrinsic muscles of the tongue,
except the palatoglossus CN XII has the following branches:
course: ventrally to olive from medulla oblongata (= sulcus
preolivaris) fossa cranii posterior canalis nervi
hypoglossi spatium retrostyloideum (spatium parapharyngeum)
trigonum caroticum trigonum submandibulare
tongue
7 muscles of tongue 3 extraglossal and 4
intraglossal
Complex interwoven network of nerves
Occurs in segments that control skeletal musculature of the neck
and limbs - peripheral distribution of the ventral rami do not
directly proceed to their peripheral targets
Ventral rami of adjacent spinal nerves blend their fibers to
produce compound nerve trunks - formed during development when
small skeletal muscles fuse to form larger muscles with compound
origins
- compound muscles contain sensory and motor fibers
- ventral rami converge and branch to form compound nerves
Cervical plexus
Brachial plexus
T3 T4
Lumbar plexus
Sacral plexus
Radial nerve
Ulnar nerve
Median nerve
Iliohypogastric nerve
Ilioinguinal nerve
Cervical Plexus Consists of cutaneous and muscular branches in
the
ventral rami of spinal nerves C1-C4, some C5
Position: lies in front of the origin of levator scapulae and
scalenus medius and deep to the superior part of the
sternocleidomastoid
The cutaneous branches innervate areas on the head, neck, and
chest
The muscular branches innervate muscles of the neck and
shoulder
scalp between auricle and
Muscular branches: supply the deep muscles of neck
Phrenic nerve (anterior rami of C3-C5) to diaphragm (motor and
sensory): Descends over scalenus anterior
to enter thorax
Accompanied by pericardiophrenic vessels and passes anterior
to lung roots between mediastinal pleura and pericardium to supply
motor and sensory innervation to diaphragm
Brachial Plexus Larger, more complex innervates pectoral girdle
& upper limb
(except trapezius (accessory nerve) and skin of tip of
shoulder
Passes through the scalene fissure to posterosuperior of subclavian
artery, then enters the axilla to form three cords
Formed by the ventral rami of spinal nerves C5-T1
-Radiks → trunkus → divisi→ corda
→ nerve.
- membentuk trunkus superior, middle dan inferior
- trunks dibagi menjadi divisi anterior dan posterior
- Seluruh divisi 3 posterior bergabung mjd corda posterior
- Divisi anterior trunkus superior dan media bergabung mjd corda
lateral
- Corda medial dibentuk dari lanjutan divisi anterior trunkus
inferior
- Saraf keluar dari 1 atau lebih trunkus atau corda
b. Median nerve (lateral and medial cords)
c. Ulnar nerve (medial cord)
d. Axillary nerve (posterior cord)
e. Radial nerve (posterior cord)
Brachial Plexus Organization
flexor carpi ulnaris and ulnar half of flexor digitorum
profundus,
thenar except adductor pollicis, first two lumbricals;
skin of thenar, central part of palm,
palmar aspect of radial three and one-half fingers, including
middle and distal fingers on
dorsum
hypothenar muscles, interossei, 3rd and 4th lumbricals and adductor
pollicis;
skin of hypothenar, palmar surface of ulnar one and one- half
fingers,
ulnar half of dorsum of hand,
posterior aspect of ulnar two and one-half fingers
Injury : clawhand
Extensor muscles of arm and forearm, brachioradialis;
skin on back of arm, forearm, and
fingers
skin over deltoid and upper posterior aspect of arm
Injury :
Intercostal nerves (anterior rami of T1- T11)
Subcostal nerve (anterior ramus of T12)
Distribution: distributed to intercostales and anterolateral
abdominal muscles, skin of thoracic and abdominal wall, parietal
pleura and peritoneum
T2 Sternal angle T4 Nipple T6 Xiphoid process T8 Costal arch
T10 Umbilicus T12 Midpoint between umbilicus
and symphysis pubis
Fig 14.11
Anterior Posterior
Radial nerve
Ulnar nerve
Median nerve
Lumbar and Sacral Plexuses
Arises from L1-L4 & L4-S4 and innervates the thigh,
abdominal wall, psoas muscle, the buttock, lower limb, pelvic
structures, and the perineum
Ventral rami of these nerves supply the pelvis and lower limb
- ventral rami of both plexuses are distributed to the lower limb
(often referred to as the lumbosacral plexus)
Major nerves of the lumbar plexus - genitofemoral, lateral femoral
cutaneous, and femoral nerve
Lumbar plexus
Formation: formed by anterior rami of L1-L3, a part of anterior
rami of T12and L4
Position: lies within substance of psoas major
Branches
Femoral
Obturator
Iliohypogastric
Ilioinguinal
Berjalan ke bawah dan lateral diantara m. psoas dan m. iliacus,
menuju ke profunda lig inguinal
Innervasi m. paha anterior (quadriceps, sartorius and pectineus),
panggul dan sendi lutut, dan kulit pada sisi anteromedia l paha, n.
saphenous didistribusikan ke kulit di sisi medial tungkai atas dan
bawah
n. femoralis
Masuk ke paha via foramen obturatorius
.
Plexus Sacral Formation: formed by anterior rami of L4 and L5
spinal nerves (the lumbrosacral trunk) and anterior rami of sacral
and coccygeal nerves
Position: lies in pelvic cavity, anterior to sacrum and
piriformis
Pembuluh darah besar
N. Superior gluteal
Nerves of the Sacral Plexus
Lumbosacral trunk
Superior gluteal
Inferior gluteal
L4 nerve
L5 nerve
S1 nerve
S2 nerve
S3 nerve
Keluar dari foramen infrapiriformis menuju ke regio glutealis,
berjalan inferiolateral profunda ke m. gluteus maximus, jaan ke
tengah diantara trochanter mayor os femur dan tuberositas
ischiadika di belakang paha, terbentang di dalam caput longus m.
biceps femoris, normal terbagi menjadi n.tibialis dan n. peronealis
communis di atas fossa popliteal ;
Innervasi
N. peroneus communis
Timbul dari apeks fossa popliteal dan mengikuti tepi medial
m.biceps femoris dan tendonnya;
berjalan ke aspek caput fibula dan mengelilingi collum
fibula, menuju ke dalam m. peroneus longus, dan terbagi 2 mjd
:
a. n. peroneus profundus
Timbul dari n. peroneus longus dan collum fibula; turun pada
membrana interosseous dan masuk ke dorsum kaki, menginervasi otot
bagian anterior tungkai dan kulit pada celah interdigital
pertama
b. n. peroneus superficialis
Innervasi kulit sekitar regio coccygeus
2. Sistem Saraf Otonom
Untuk kewaspadaan dan kesadaran.
Persiapan lawan atau lari / fight or flee from a scene (fight or
flight).
Sympatis: Persiapan aksi.
. stem ara tonom
Rangsang kelenjar dan komando ke otot polos Tak bisa ditur oleh
pikiran sadar Terdiri atas komponen yang berlawanan
Parasimpatis
Simpatis
-Parasimpatis: S2-S 4 / craniosacral
darah& rata2 pernapasan & produksi keringat
c. Peningkatan aliran darah ke otot skeletal
d. Menghambat fungsi digestif e. Meningkatkan diamater sal. Napas
f. Dilatasi pupil g. Kontriksi spingter kandung kemih h. Respons“
Fight or flight”
CENTRAL NERVOUS SYSTEM
c. Menurunkan detak jantung, respirasi rate & tekanan
darah
d. Meningkatkan aktivitas umum sistem cerna
e. Meningkatkan sekresi kelenjar sistem cerna
f. Meningkatkan produksi urin dan merelaksasi sfingter
g. Ereksi
Stimulates gallbladder