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 16/11/2014 Sistem Saraf Tepi : Nervi Craniales Bok. DMS. Anatomi Kuliah 3 Fitranto Arjadi .

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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
 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
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
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
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
 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
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 ;
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:  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”
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