Equine Cranial Nerves - Horse Anatomy

Cranial nerves arise from the brain and brain stem, rather than the spinal cord. Nerves arising from the spinal cord are the peripheral nerves. There are 12 pairs of cranial nerves and these pairs of nerves passage through foramina in the skull, either individually or in groups. Cranial nerves are traditionally referred to by Roman numerals and these numerals begin cranially and run caudally. The most cranial nerve is the Olfactory nerve (I) which runs from the nasal cavity through to the olfactory bulb. The next most cranial is the Optic nerve (II) which runs from the eyes to the thalamus. Cranial nerves III to XII all exit from the brain stem and innervate the head, neck and organs in the thorax and abdomen. In order of most cranial to caudal, these include the Oculomotor nerve (III), the Trochlear nerve (IV), the Trigeminal nerve (V), the Abducens nerve (VI), the Facial nerve (VII), the Vestibulocochlear nerve (VIII), the Glossopharyngeal nerve (IX), the Vagus nerve (X), the Accessory nerve (XI) and the Hypoglossal nerve (XII).

Many of the cranial nerves with nuclei within the brain stem contain sensory and motor neurone components. The sensory fibre components have their cell bodies located in ganglia outside the central nervous system and the motor fibre element have their cell bodies within the central nervous system. TheOlfactory nerve (I), Optic nerve (II) and Vestibulocochlear nerve (VIII) are sensory nerves. The , Oculomotor nerve (III), Trochlear nerve (IV),Abducens nerve (VI),Accessory nerve (XI) and Hypoglossal nerve (XII) are motor nerves. Finally, the Trigeminal nerve (V), Facial nerve (VII),Glossopharyngeal nerve (IX), and Vagus nerve (X) are mixed sensory and motor nerves.

Olfactory Nerve (I)

The olfactory nerve is involved in the conscious perception of smell. Primary afferent cell bodies are located within the olfactory epithelium of the nasal mucosa on ethmoturbiate bones,rather than in a ganglion like the other cranial nerves. Projections from these cell bodies are the olfactory nerve fibres. The olfactory nerve is a sensory nerve and is composed of many Special Visceral Afferent fibres. The fibres are formed into bundles that are referred to as 'Olfactory filaments'. The olfactory nerve passes through the Cribiform plate and is surrounded by meningeal sheets including the sub-arachnoid space. The olfactory nerve terminates at the olfactory bulb. The horse also has nerves which arise from the nasal septum that course into the olfactory bulb, along with the vomeronasal nerve arising from the vomeronasal organ. Secondary neurons within the olfactory bulb project through the olfactory tracts to synapse with third order neurons in the medial forebrain bundle, amygdala, septal nuclei and habenular nuclei.

In the horse, special consideration must be given to diseases of the guttural pouch when considering cranial nerve dysfunction. The Glossopharangeal (IX), Vagus (X)and Accessory (XII) nerves are located in the medial compartment of the guttural pouch. The Facial (VII) nerve runs along the lateral compartment. The Mandibular nerve (V2) has limited contact with the dorsal wall of the lateral compartment.. Guttural pouch mycosis commonly results in paresis of cranial nerves IX,V and XII as well as erosion of the internal carotid artery. Rarely, there is involvement of cranial nerves VII and VIII.

Optic Nerve (II)

The optic nerve represents the connection between the receptor cells of the retina and the forebrain. It is not a true nerve, but represents an extension of the brain. The optic nerve is sesory, and is composed of Special Somatic Afferent fibres.

The visual pathway' involves three consecutive neurons:

• The first order neuron is the bipolar cells of the retina, which are known as rods and cones.
• The second order neuron is the ganglion cells of the retina and axons within the optic nerve. The optic nerve passes through the optic chiasm, which is an area of the ventral brain where both optic nerves run in a medial direction and eventually decussate (cross). In the horse, approximately 85-88% of fibres decussate. The optic nerve then runs through the optic canal.
• The third order neuron has its cell body in the lateral geniculate nucleus in the diencephalon. Its axon projects to the visual cortex, which is mostly the contralateral occipital cortex, in the optic radiation. The occipital lobe is where visual processing takes place at a conscious level.

The nerve is also involved in modulation of parasympathetic tone to the iris. The first and second order neuron pathways are the same as those responsible for vision, however after synapsing with the lateral geniculate nucleus axons involved in modulation of parasympathetic tone synapse with a third order neuron in the pretectal nucleus. Most axons from the pretectal nucleus then decussate back to synapse in the parasympathetic component of the Occulomotor nerve (III) in the ipsilateral eye (because it has crossed once at the optic chiasm and then again at the pretectal nucleus).

The optic nerve can be examined clinically via the menace response and pupillary light reflex (PLR). Anopsia (loss of vision) can be seen, especially associated with shear injury to the nerve after head trauma.

Oculomotor nerve (III)

The oculomotor nerve is part of the group of cranial nerves responsible for innervating the muscles of the head. The nerve originates from the ventral midbrain and is a motor nerve. It is composed of general somatic efferent fibres and general visceral efferent fibres. The general somatic efferent fibres of the oculomotor nerve are responsible for the motor function of four of the six external muscles of the eyeball; the 'dorsal rectus', 'medial rectus', 'ventral rectus', 'ventral oblique' and 'levator palpebri superioris' (levator of the upper eyelid). The general visceral efferent fibres of the oculomotor nerve are responsible for the control of pupil diameter and therefore control the 'spincter pupillae' muscle and the 'ciliaris' muscle. These fibres control pupillary constriction via the parasympathetic component of the nerve.

The oculomotor nerve has a pre-ganglionic nucleus in the midbrain and the nerve passes through the orbital fissure, along with the trochlear, abducens and opthalmic branch (V1) of the trigeminal nerve. It synapses in the ciliary ganglion of the eye.

During a clinical examination, horizontal eye movements (strabismus) or an absent pupillary light reflex (PLR) may indicate a problem.

Trochlear nerve (IV)

The trochlear nerve is part of the cranial nerve group responsible for innervation of the muscles of the head. The trochlear nerve originates from the dorsal midbrain and is a motor nerve. It is composed of general somatic efferent fibres and is the smallest of the cranial nerves.

After leaving the dorsal midbrain, its axons decussate (cross) and then run in a rostral direction through the cavernous sinus before exiting the skill via the orbital fissure. In the horse, it may also exit via a seperate trochlear foramen. Finally, it runs to innervate the 'dorsal oblique muscle' muscle of the contralateral eye.

During a clinical examination, a dorso-lateral strabismus may indicate a problem with this nerve.

Trigeminal nerve (V)

The trigeminal nerve is part of the cranial nerve group responsible for innervation of structures originating from branchial arches. The trigeminal nerve nuclei is in the area of the pons and medulla oblongata and is the nerve of the 1st branchial arch. The trigeminal nerve provides sensory innervation of cutaneous elements of the face, cornea, mucosa of the nasal septum and mucosa of the oral cavity. It also provides motor fibres to structures also associated with the 1st branchial arch, which are the muscles of mastication (temporalis, masseter, medial and lateral pterygoids and rostral digastricus. There are three primary branches of the trigeminal nerve; the Opthalmic nerve (V1), the Maxillary nerve (V2) and the Mandibular nerve (V3).

Opthalmic nerve (V1)

The opthalmic nerve is a sensory nerve composed of general somatic afferent fibres. It passes along the cavernous sinus and exits via the orbital fissue. As it enters the orbit of the eye, it splits further into the lacrimal nerve, the frontal nerve, the nasociliary nerve and the infratrochlear nerve.

• The lacrimal nerve containes postganglionic parasympathetic fibres from the pterygopalatine ganglion that innervate the lacrimal gland. The lacrimal nerve also contains general somatic afferents that provide sensation to the lateral part of the upper eyelid.
• In the horse, the frontal nerve exits the medial aspect of the orbit via the supraorbital foramen, becoming the supraorbital nerve, and innervates the upper eyelid and forehead.
• The infratrochlear nerve innervates the medial aspects of the eyelids, third eyelid and frontal sinus.
• Nasociliary nerves, which carry parasympathetic fibres from the oculomotor nerve to the iris, also provide sensory innervation to the globe.

Maxillary nerve (V2)

The maxillary nerve is a sensory nerve composed of general somatic afferent fibres. The maxillary nerve passes along the cavernous sinus and exits through the round foramen before entering the alar canal. It also runs across the wall of the pterygopalatine fossa and enters the infraorbital canal via the maxillary foramen. Whilst in the infraorbital canal, the maxillary nerve branch then branches further into the infraorbital nerve which supplies sensory fibres to the upper dental arcade. On exiting the infraorbital canal via the infraorbital foramen, the maxillary nerve branches again into the zygomatic nerve and pterygopalatine nerve supplying sensory fibres to the palate, lower eyelid, upper lip, nasal planum, and dorsal face.

Mandibular nerve (V3)

The mandibular nerve is a mixed sensory general somatic afferent fibres and motor general somatic efferent nerves. The mandibular nerve passes through the foramen lacerum in the horse. It provides motor branches to the masticatory muscles, the ventral throat and muscles of the palate. The mandibular nerve further branches into the masticatory nerve, masseteric nerve and the temporal nerve. The mandibular nerve provides sensory branches called the buccal nerve, auriculotemporal nerve, and then itself divides into two smaller branches; the lingual nerve and the inferior alveolar nerve. The auriculotemporal nerve carries sensory information from the middle ear, temporal area and portions of the guttural pouch. The lingual nerve receives sensory taste fibres and also connects some sensory taste fibres to parasympathetic salivary glands via the chorda tympani. Via the chorda tympani branch, the mandibular branch supplies sensory fibres related to taste to the rostral 2/3 of the tongue. The lingual branch of the glossopharyngeal nerve supplies sensory fibres to the caudal 1/3 of the tongue.

Abducent nerve (VI)

The abducent nerve is part of the cranial nerve group responsible for innervation of the muscles of the head. The abducent nerve originates from the medulla oblongata and is a motor nerve. It is composed of general somatic efferent fibres which are responsible for controlling the lateral rectus and retractor bulbi muscles of the eye. The nerve passes through the orbital fissure and can be found within the same layer of the meninges as the opthalmic branch (V1) of the trigeminal nerve (V).

During a clinical examination, medial strabismus may indicate a problem with this nerve.

Facial nerve (VII)

The facial nerve is part of the cranial nerve group responsible for the innervation of structures originating from the branchial arches. It originates from the medulla oblongata and from the second branchial arch. It has a common dura sheet with the opthalmic (V1) branch of the trigeminal nerve. The facial nerve is of a mixed composite, made up of a number of different fibre types. It has a general somatic efferent fibre within the ear canal, a general visceral efferent fibre acting under parasympathetic control to some salivary glands, lacrimal glands, nasal cavity and palate, a special visceral afferent fibre providing taste to the rostral 2/3 of the tongue and finally it has a general somatic efferent fibre supplying motor function to the muscles of facial expression and caudal digastricus.

The facial nerve enters the petrosal bone via the internal acoustic meatus along with the vestibulocochlear nerve. The facial nerve also runs inside the facial canal. There are a number of intermediate branches which separate from the main facial nerve inside the facial canal including the greater petrosal nerve, stapedial nerve (motor) and the chorda tympani. These then emerge via the stylomastoid foramen at the caudoventral aspect of the skull. The chorda tympani of the facial nerve represents the special visceral afferent fibre supplying taste to the rostral 2/3 of the tongue.

There are also numerous external branches of the facial nerve once the facial nerve has left the facial canal. These include the internal auricular nerve, the auriculopalpebral nerve, the rostral auricular nerve, the palpebral nerve, the dorsal buccolabial nerve, the ventral buccolabial nerve, the ramus colli, the digastric nerve, the stylohoid nerve and the caudal auricular nerve.

The facial nerve supplies motor innervation to the muscles of facial expression. These are superficial flat, thin muscles that originate from bony areas of fascia and then radiate out around the skin. They may also often from sphincters such as around the mouth and eye.

During a clinical examination any facial paralysis, drooling or abscence of blinking may indicate a problem with the facial nerve.

Vestibulocochlear nerve (VIII)

The vestibulocochlear nerve is part of the special senses group of cranial nerves and is made up of two components; the vestibular nerve and the cochlear nerve. The vestibular nerve is responsible for balance whilst the cochlear nerve is responsible for hearing. The nerves send impulses from the inner ear which contains the vestibular apparatus and cochlea. The vestibulocochlear nerve is a sensory nerve made up of special somatic afferent fibres. It passes through the internal acoustic meatus and into the petrosal bone. The facial nerve also takes this route.

Clinical problems with the vestibulocochlear nerve would be indicated on examination by changes in hearing and/or strabismus and nystagmus. A head tilt is also associated with this nerve.

Glossopharyngeal nerve (IX)

The glossopharyngeal nerve is part of the group of cranial nerves responsible for innervation of structures derived from the branchial arches. This nerve innervates structures related to the third branchial arch. It is also part of a group, together with the vagus and accessory nerves, that passes through the jugular foramen which is termed the vagus group. The glossopharyngeal nerve has cell bodies that are referred to as nucleus ambiguus. The glossopharyngeal nerve originates from the medulla oblongata and has several branches including the pharyngeal nerve, the lingual nerve and the tympanic branches.

The glossopharyngeal nerve is composed of many fibre types including general somatic efferent fibres that innervate the stylopharyngeus muscle; the general visceral afferent fibres that provide sensory information from the carotid body, the pharynx and the middle ear; the general visceral efferent fibres that provide parasympathetic innervation to the parotid and zygomatic salivary glands; the special visceral afferent fibres that provide taste caudal to the tongue and finally the general somatic afferent fibres that provide sensory information from the external ear. The lingual branch of the glossopharyngeal nerve provides general somatic afferent fibres and special visceral afferent fibres to the caudal 1/3 of the tongue.

On clinical examination, choking or dysphagia as a result of malfunctioning or absent pharyngeal reflexes would indicate a problem with the glossopharyngeal nerve.

Vagus nerve (X)

The vagus nerve is part of the group of cranial nerves responsible for innervation of structures derived from the branchial arches. It is also part of a group, together with the glossopharyngeal and accessory nerves, that passes through the jugular foramen which is termed the vagus group. The vagus nerve innervates structures related to the fourth branchial arch. The vagus nerve has cell bodies that are referred to as nucleus ambiguus.

The vagus nerve is composed of many different types of nerve fibre including general somatic efferent fibres supplying motor function to the muscles of the larynx, pharynx, palate and oesophagus; general visceral afferent fibres to the base of the tongue, pharynx and larynx; general visceral efferent fibres for parasympathetic supply of the thoracic and abdominal viscera; special visceral afferent fibres supplying taste to regions of the epiglottis and palate and finally general somatic afferent fibres to the external ear and the dura mater. The vagus nerve also supplies general somatic afferent fibres and special visceral afferent fibres to the root of the tongue.

There are many functional components of the vagus nerve including the heart, larynx, pharynx and many other viscera. On clinical examination any changes related to gag reflexes, blood pressure or heart rate, changes in 'voice' (dysphonia) or inspiratory dyspnoea may indicate a problem with the vagus nerve.

Accessory nerve (XI)

The accessory nerve is part of the group of cranial nerves responsible for innervation of structures derived from the branchial arches. It is also part of a group, together with the glossopharyngeal and vagus, nerves that passes through the jugular foramen which is termed the vagus group. The accessory nerve supplies structures related to the fourth branchial arch. The accessory nerve has cell bodies that are referred to as nucleus ambiguus and originate in the medulla oblongata. The cranial root of the accessory nerve actually contributes to the vagus nerve and to the striated muscles of the pharynx, larynx, palate and oesophagus.

However, the accessory nerve also contributes to the cervical spinal cord and spinal root through the foramen magnum; providing innervation to muscles of the neck. The spinal root of the accessory nerve branches into the dorsal branch and the ventral branch. The dorsal branch innervates the brachiocephalicus, trapezius and omotransversarius muscles of the dorsal neck. The ventral branch innervates the sternocephalicus muscle.

During clinical examination any difficulties in turning the neck or muscle atrophy around the dorsal and ventral neck may indicate a problem with the accessory nerve.

Hypoglossal nerve (XII)

The hypoglossal nerve is part of the group of cranial nerves responsible for the control of muscles of the head. It is in part a cervical nerve due to its caudal position on the brain stem. The nerve is composed of general somatic efferent fibres which control the intrinsic and extrinsic muscles of the tongue (together with other nerves including the lingual nerve, facial nerve, lingual branch of the glossopharyngeal nerve and the vagus nerve). The nucleus of the nerve is located within the medulla oblongata of the brain stem and it passes through the hypoglossal canal.

During a clinical examination any deviation of the tongue may indicate a problem with this nerve. Deviation of the tongue is always to the side of the lesion initially.