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Sistem Saraf Tepi

: Nervi Craniales
Bok. DMS. Anatomi Kuliah 3
Fitranto Arjadi .

16/11/2014

Nervous system organization

Sistem Saraf Tepi (SST)


1. Sistem saraf somatik
a. Nervi Spinalis
1) neuron afferent (sensory)
2) neuron efferent (motor)
3) interneuron
b. Cranial nerves

2. Sistem saraf Otonom


a. Sistem saraf simpatis
nervous system
b. Sistem saraf parasimpatis

Divisi Motorik Division: 2 Bagian Besar


1. Sistem Saraf
Somatis
Pusat kesadaran
otot skelet
2. Sistem saraf
otonom
Mengatur otot
polos, otot
jantung dan
kelenjar
2 bagian :
Simpatis
Parasimpatis

Saraf kranialis
Penamaan :
dengan angka
Romawi, berdasarkan
urutan dari anterior ke
posterior,
dengan nama,
menunjukkan
distribusi dari saraf
ataupun fungsinya
Asal
hidung (I),
mata (II),
brainstem (III XII)
dan
medulla spinalis
(sebagian dari XI).

12 Pasang
Saraf Kranialis

Fungsi
Sensorik&
Motorik
Pada Leher
& Kepala

Special Sense Nerves


NERVE

TARGET

EXIT FROM
CRANIAL CAVITY

I. Olfactory

Olfactory
epithelium

Cribiform plate
(ethmoid)

II. Optic

Retina

Optic canal
(sphenoid)

VIII. Auditory Inner ear

Internal auditory
meatus (temporal)

Somatic Motor Nerves


(eye muscles and tongue)
NERVE

TARGET

EXIT CR. CAVITY

IV. Trochlear

Superior oblique m. (with


trochlea)

Sup. Orbital fissure


(sphenoid)

VI. Abducens

Lateral rectus

Sup.,med.,inf.rectus
Inferior Oblique
(Also parasympathetic
to ciliary mm, constrictor Levator palpebrae superioris
III. Oculomotor

pupillae)
XII. Hypoglossal

Intrinsic, extrinsic mm. of


tongue

Hypoglossal canal
(occipital)

Rest of body nerves


(all exit from jugular foramen)
NERVE

TARGET

Somatic motor to larynx/pharynx


Parasympathetic to most of gut
Taste to back posterior pharynx
XI: (Spinal) Motor to traps,
Accesory
sternocleidomastoid
IX: Glosso- Sensory to carotid body/sinus
pharyngeal Taste to posterior tongue
Sensory to ear opening/middle
ear
Parotid salivary gland

X: Vagus

N. Olfactorius

Function:
Special sensory (special visceral afferent) ---special sense of smell.
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.
Via lamina cribriformis os ethmoid, fibers run through the olfactory bulb and
terminate in the primary olfactory cortex

N. opticus

Fungsi: Special sensory (special somatic


afferent) special sense of vision.
Berjalan posteromedial mata
Keluar melalui canalis optikus menuju
fossa kranialis media membentuk kiasma
optika dari sebagian pars nasal (medial)
retina menyilang chiasma dan bergabung
dengan serabut yang lurus/ dari serabut
sebagian pars (lateral) retina untuk
membentuk traktus optikus.
Separo serabut saraf II yang menyilang
kiasma optika = penglihatan inocular,
persepsi kedalaman penglihatan
( penglihatan 3 dimensi).
Serabut dari separo kanan retina
membentuk
traktus
optikus
kiri.
Penyiangan
serabut
saraf
kiasma
membentuk traktus optikus kanan yang
membawa impuls dari lapngan pandang
kiri dan sebaliknya.
Sbgn besar serabut traktus optikus berakhir
di nuclei geniculatum laterale thalamus --dibawa ke lobus ccipitalis

N. Occulomotorius, N. Trochlearis, N. Abduscen

Oculomotor Nerve (CN III)


Functions:
Somatic motor (general somatic efferent)
Visceral motor (general visceral efferent parasympathetic).
Fibers extend from the ventral midbrain, pass through the
superior orbital fissure, and go to the extrinsic eye muscles
Nuclei: 2 oculomotor nuclei,
a.Somatic motor nucleus of the oculomotor nerve is in the
midbrain.
b.Visceral motor (parasympathetic) accessory (Edinger-Westphal)
nucleus of the oculomotor nerve lies dorsal to the rostral two
thirds of the somatic motor nucleus
Proprioceptive and Motor to the striated muscle of four of the six
extraocular muscles (superior, medial, and inferior recti and
inferior oblique) and superior eyelid (L. levator palpebrae
superioris)

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
Postsynaptic fibers from ciliary ganglion pass to the
eyeball in the short ciliary nerves to innervate
the ciliary body and sphincter of the pupil.

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
wall of the cavernous sinus -- pass through the superior orbital
fissure into the orbit ---supplies the superior oblique muscle

Cranial Nerve IV: Trochlear

Abducent Nerve (CN VI)


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.
emerge from the brainstem between the pons and the
medulla --- traverse the pontine cistern of the subarachnoid
space, straddling the basilar artery -- pierces the dura --intradural course --- bends sharply over the crest of the
petrous part of the temporal bone --- Cavernous sinus -traverses
anulus tendineus communis orbita --penetrating the medial surface of the lateral rectus - abducts
the eye ( function = basis for the name of the nerve)

Cranial Nerve VI: Abdcuens

Trigeminal Nerve (CN V)


Functions: General sensory (general somatic afferent)
and branchial motor (special visceral efferent) to
derivatives of the 1st pharyngeal arch.
Nuclei: There are four trigeminal nuclei one motor and
three sensory.
The trigeminal nerve (CN V) is the largest cranial
nerve.
Emerges from the lateral aspect of the pons by a large
sensory root and a small motor root.
Principal general sensory nerve for the head (face,
teeth, mouth, nasal cavity, and dura of the cranial
cavity).
The trigeminal ganglion is flattened and crescent
shaped (=semilunar ganglion) and is housed within a
dural recess (trigeminal cave) lateral to the cavernous
sinus.

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

Nerve VII: Facial


Mixed nerve with five major branches
Temporal
Buccal
Cervical

Zygomatic
Mandibular

chorda tympani (crosses interior ear drum


to join V3 )
Taste to anterior 2/3 of tongue
Submandibular, sublingual salivary glands

Lacrimal glands
Motor functions include facial expression,
and the transmittal of autonomic impulses
to lacrimal and salivary glands
Sensory function is taste from the anterior
two-thirds of the tongue
Facial muscles (five branches fan out over
face from stylomastoid foramen)

VII. = N. facialis
3 nuclei in pons
somatomotor branchial (2nd arch) ncl. n. VII
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)

Functions: Sensory (special visceral afferent and general somatic afferent), motor
(branchial motor or special visceral efferent), and parasympathetic (general visceral
efferent). It also carries proprioceptive fibers from the muscles it innervates.
Nuclei: The motor nucleus branchiomotor nucleus in the ventrolateral part of the pons.
The cell bodies = eniculate ganglion. The central processes of those concerned with taste
end in the nuclei of the solitary tract in the medulla. The processes of those concerned
with general sensations (pain, touch, and thermal) from around the external ear end in the
spinal nucleus of the trigeminal nerve.
The facial nerve (CN VII) emerges from the junction of the pons and medulla as two
divisions, the motor root and the intermediate nerve. The larger motor root (facial nerve
proper) innervates the muscles of facial expression, and the smaller intermediate nerve
(L. nervus intermedius) carries taste, parasympathetic, and somatic sensory fibers. During
its course, CN VII traverses the posterior cranial fossa, internal acoustic meatus, facial
canal, stylomastoid foramen of the temporal bone, and parotid gland. After traversing the
internal acoustic meatus, the nerve proceeds a short distance anteriorly within the
temporal bone and then turns abruptly posteriorly to course along the medial wall of the
tympanic cavity. The sharp bend is the geniculum of the facial nerve (L. genu, knee),
sometimes called the external genu of CN VII, the site of the geniculate ganglion (sensory
ganglion of CN VII). While traversing the temporal bone within the facial canal, CN VII
gives rise to the: Greater petrosal nerve. Nerve to the stapedius. Chorda tympani
nerve.
.

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 V2), which distributes its postsynaptic fibers, whereas
the submandibular ganglion is associated with the mandibular nerve (CN V3). Parasympathetic
fibers synapse in these ganglia, whereas sympathetic and other fibers pass through them.
General Sensory Some fibers from the geniculate ganglion supply a small area of the skin of
the concha of the auricle, close to external acoustic meatus.
Taste (Special Sensory) Fibers carried by the chorda tympani join the lingual nerve to convey
taste sensation from the anterior two thirds of the tongue and soft palate

VII. = N. facialis - branches


outside skull
n. auricularis posterior somatomotor fibres
rudimentary muscles of auricle + 3 mm. auriculares
nn. for m. stylohyoideus + venter post. m. digastrici
plexus intraparotideus 5 branches

VII. = N. facialis branches courses in canalis


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
eminetia pyramidalis: m. stapedius

chorda tympani parasympathetic + taste


canaliculus ch.t. posterior cavitas tympani canaliculus

ch.t. anterior fissura petrotympanica Glaseri fossa


infratemporalis n. lingualis

gg. submandibulare via branches of n. V3 to gll. linguales,


submandibularis + sublingualis
ventral 2/3 of tongue = dorsum linguae - taste

Innervation of tongue
somatosensory x sensory (taste)

Vestibulocochlear Nerve (CN VIII)


Functions: Special sensory (special somatic afferent) that is, special
sensations of hearing and equilibrium.
Nuclei: Four vestibular nuclei are located at the junction of the pons and
medulla in the lateral part of the floor of the 4th ventricle; two cochlear
nuclei are in the medulla.
The vestibulocochlear nerve (CN VIII) emerges from the junction of the
pons and medulla and enters the internal acoustic meatus. Here it
separates into the vestibular and cochlear nerves.
The vestibular nerve is concerned with equilibrium. It is composed of the
central processes of bipolar neurons in the vestibular ganglion; the
peripheral processes of the neurons extend to the maculae of the utricle
and saccule (sensitive to the line of linear acceleration relative to the
position of the head) and to the ampullae of the semicircular ducts
(sensitive to rotational acceleration).
The cochlear nerve is concerned with hearing. It is composed of the
central processes of bipolar neurons in the spinal ganglion; the peripheral
processes of the neurons extend to the spiral organ.

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

6 nuclei in pons (under recessus lat. fossae


rhomboidae)
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.
pars vestibularis ganglion vestibulare Scarpae on
floor of meatus.a.i. (bipolar neurons)
pars cochlearis ganglion cochleare Corti inside
bony cochlea (spiral shape, bipolar neurons)

VIII. - Nervus vestibulocochlearis


obsolete term: n. statoacusticus
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)
CN IX is afferent from the tongue and pharynx (hence its name)
and efferent to the stylopharyngeus and parotid gland.

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 V3), 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).
The pharyngeal, tonsillar, and lingual nerves to
the mucosa of the oropharynx and isthmus of the
fauces (L. throat), including palatine tonsil, soft
palate, and posterior third of the tongue.
Taste (Special Sensory) Taste fibers are conveyed
from the posterior third of the tongue to the sensory
ganglia.

Innervation of tongue
somatosensory + sensory (taste)

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,
which is actually a palatine muscle based on its derivation and
innervation.
Proprioceptive to the muscles
Parasympathetic to thoracic and abdominal viscera.
Nuclei:
Four nuclei of CN X in the medulla send or receive fibers via CN IX two
motor and two sensory. Three of these nuclei are shared with CN IX.

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,
which is formed by branches of the vagi and sympathetic
trunks -- follows the esophagus through the diaphragm
into the abdomen -- anterior and posterior vagal trunks
break up into branches -- innervate esophagus, stomach,
and intestinal tract.

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 of pharynx , foregit and
midgut + liver, gallbladder, pancreas; spleen, kidneys,
suprarenal glands, testis/ovaries, of uterine tube
taste: part of root of tongue, epiglottis
VM: glands and smooth muscles of pharynx, lower
respiratory tract, foregut and midgut, heart, thymus

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
rr. coeliaci, hepatici, renales, gastrici ant.+post.

Innervation of tongue
somatosensory x sensory (taste)

Spinal Accessory Nerve (CN XI)


Functions:
Motor
to
the
striated
sternocleidomastoid and trapezius muscles.
Nuclei: nucleus of the accessory nerve, a column of
anterior horn motor neurons in MS segmen 5-6

combined nerv (2 independent components grown in


one trunk)
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
direct fibres via n. spinalis C2-4 loop between both
ways = ansa Maubraci

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:
A meningeal branch -- returns to the cranium through the hypoglossal canal
and innervates the dura mater on the floor and posterior wall of the posterior
cranial fossa.
The superior root of the ansa cervicalis -- branches from CN XII to supply
the infrahyoid muscles (sternohyoid, sternothyroid, and omohyoid). -- some
fibers continue past the descending branch to reach the thyrohyoid muscle.
Terminal lingual branches supply the styloglossus, hyoglossus, genioglossus,
and intrinsic muscles of the tongue.

XII. = N. hypoglossus

1 nucleus in medulla
oblongata: ncl. n. XII
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

Sistem Saraf Tepi


: Nervi Spinales

16/11/2014

Nerve Plexus
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

4 Major Nerve Plexuses


Cervical plexus
Brachial plexus
Lumbar plexus
Sacral plexus

Fig 14.9

Figure 13-10 Peripheral Nerves and Nerve Plexuses

Cervical
plexus
Brachial
plexus

C1
C2
C3
C4
C5
C6
C7
C8
T1
T2
T3
T4
T5
T6
T7
T8
T9
T10
T11

2012 Pearson Education, Inc.

Lesser occipital nerve


Great auricular nerve
Transverse cervical nerve
Supraclavicular nerve
Phrenic nerve

Axillary nerve

Musculocutaneous
nerve
Thoracic nerves

Figure 13-10 Peripheral Nerves and Nerve Plexuses

T12

L1
Lumbar
plexus

Sacral
plexus

Radial nerve

L2
L3
L4
L5
S1
S2
S3
S4
S5
Co1

Ulnar nerve
Median nerve
Iliohypogastric
nerve
Ilioinguinal
nerve
Lateral femoral
cutaneous nerve
Genitofemoral
nerve
Femoral nerve
Obturator nerve
Superior
Inferior

Gluteal nerves

Pudendal nerve
Saphenous nerve

Sciatic nerve
2012 Pearson Education, Inc.

Copyright 2009, John Wiley & Sons, Inc.

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

Major nerve of this plexus the phrenic nerve provides the

entire nerve supply to the diaphragm

Cervical
Plexus
Branches

Cutaneous branches:

Lesser occipital
Great auricular
Transverse nerve of neck
Supraclavicular nerves

Emerge around middle of


posterior border of
sternocleidomastoid, to
supply skin of neck and
scalp between auricle and
external occipital
protuberance

Figure 13.8

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
Sensory fibers supply to pleurae,
pericardium and peritoneum of
diaphragm; usually right phrenic
nerve may be distributed on live,
gallbladder and biliary system.

The Cervical Plexus

Copyright 2009, John Wiley & Sons, Inc.

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

Brachial Plexus
5 ventral rami form
3 trunkus
separate into 6 divisi
then form 3 corda
that give rise to

branches/nerve
a. Musculocutaneous nerve (lateral
cord)
b. Median nerve (lateral and medial
cords)
c. Ulnar nerve (medial cord)
d. Axillary nerve (posterior cord)
e. Radial nerve (posterior cord)

Brachial plexus

Copyright 2009, John Wiley & Sons, Inc.

Brachial Plexus Organization

Flow chart summarizing relationships within the brachial

plexus - dashed lines to the posterior cord merely indicate


that the posterior division lie posterior to the anterior
divisions

Cervical and Brachial Plexuses

Fig 14.12

N. musculocutaneous
Distribusi: Biceps brachii,
brachalis and
coracobrachialis BBC nerve;
skin on anterior aspect of
forearm

Median nerve
Distribusi:
Flexor of forearm except
brachioradialis,
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

Ulnar nerve
Distribusi:
Flexor carpi ulnaris,
ulnar half of flexor digitorum

profundus,
hypothenar muscles,
interossei, 3rd and 4th
lumbricals and adductor
pollicis;
skin of hypothenar, palmar
surface of ulnar one and onehalf fingers,
ulnar half of dorsum of hand,
posterior aspect of ulnar two
and one-half fingers

Injury: clawhand
Ulnar nerve palsy- inability to

abduct or adduct fingers

Radial
Distribution:
Extensor muscles of arm
and forearm,
brachioradialis;
skin on back of arm,
forearm, and
radial side of dorsum of
hand and radial two and
one-half fingers

Wrist drop- inability to extend the wrist and


fingers

Axillary
Distribution:

Deltoid and teres


minor muscle;
skin over deltoid and
upper posterior aspect
of arm
Injury:
result in deltoid and
teres minor paralysis
(loss of shoulder
abdution and external
rotation) with loss of
sensation over the
deltoid

Anterior branches of thoracic nerves


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

The Trunks and Cords of


the Brachial Plexus

Figure 13-12b The Brachial Plexus

Anterior

Posterior
Radial
nerve
Ulnar
nerve

Median
nerve

Areas of the hands serviced by


nerves of the right brachial plexus

2012 Pearson Education, Inc.

Table 13-2 The Brachial Plexus

2012 Pearson Education, Inc.

Copyright 2009, John Wiley & Sons, Inc.

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

Major nerves of the sacral plexus


- the sciatic nerve which branches into the common fibular nerve and
the tibial nerveand the pudendal nerve

Copyright 2009, John Wiley & Sons, Inc.

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
Lateral femoral cutaneous
Genitofemoral

n. femoralis
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. obturatorius
Masuk ke paha via
foramen obturatorius
Innervasi medial group
otot paha , m.
obturator externus,
dan kulit sisi medial
paha

Copyright 2009, John Wiley & Sons, Inc.

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
N. Pudendal
N. Posterior femoral cutaneou
N. Sciatic , bercabang dua

1. Fibular nerve
2. Tibial nerve
.

Figure 13-13b The Lumbar and Sacral Plexuses

Spinal Nerves
Forming the
Sacral Plexus
Lumbosacral trunk

L4 nerve
L5 nerve

Nerves of the
Sacral Plexus
S1 nerve

Superior gluteal

S2 nerve

Inferior gluteal

S3 nerve
Sciatic
Posterior femoral
cutaneous

S5

S4 nerve
Co1

Pudendal

Sacral plexus, anterior view


2012 Pearson Education, Inc.

N. Sciatica

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
m. semitendinosus,
m. semimembranosus
m. biceps femoris
Cabang articular panggul dan sendi lutut

N. tibialis

Turun ke fossa popliteal


dan terletak di m.
popliteus; berjalan
inferior dengan a. tibialis
posterior dan berakhir
dibawah flexor
retinaculum dan terbagi
mjd n. plantaris medial
dan lateral
Menginervasi otot bagian
posterior tungkai bawah
dan sendi lutut

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
Timbul diantara n. peroneus longus dan colum
fibula, turun pada kompartment latreal tungkai
bawah; menginervasi m. peroneus longus dan
brevis dan kulit permukaan anterior surface
tungkai bawah dan dorsum kaki.

Fig 14.13

Nerves of the lower extermity

Lumbar and Sacral Plexuses

Fig 14.14

Table 13-3 The Lumbar and Sacral Plexuses

2012 Pearson Education, Inc.

Plexus Coccygeal
Dibentuk oleh rami

anterior S4-S5 dan n.


coccygeus
Innervasi kulit sekitar
regio coccygeus

Copyright 2009, John Wiley & Sons, Inc.

2. Sistem Saraf Otonom


Untuk
kewaspadaan
dan kesadaran.
Persiapan lawan
atau lari / fight
or flee from a
scene (fight or
flight).
Sympatis:
Persiapan aksi.
Parasimpatis :
persiapan
menyimpan
energi
Mempengaruhi
banyak organ

. Sistem Saraf Otonom


Rangsang kelenjar dan komando ke
otot polos
Tak bisa ditur oleh pikiran sadar
Terdiri atas komponen yang
berlawanan
Parasimpatis
Kontrol fungsi normal
Menyimpan energi melalui
perlambatan proses
Simpatis
Saat stress
Mengatur reaksi fight-or-flight
Meningkatakan denyut jantung,
nadi, dan napas

AUTONOMIC MOTOR SYSTEM

Spinal Cord

-Simpatis: T1L3 /torakolumbal

-Parasimpatis:
S2-S4
/craniosacral

Brain Stem
Parasimpatis
NC X
NC IX
NC VII
NC III

Simpatis
a. Pengeluaran adrenalin& noradrenalin
b. Peningkatan detak jantung & tekanan
c.
d.
e.
f.
g.
h.

darah& rata2 pernapasan & produksi


keringat
Peningkatan aliran darah ke otot
skeletal
Menghambat fungsi digestif
Meningkatkan diamater sal. Napas
Dilatasi pupil
Kontriksi spingter kandung kemih
Respons Fight or flight

CENTRAL NERVOUS SYSTEM SYMPATHETIC


Brain

Dilates pupil
Stimulates salivation
Relaxes bronchi
Spinal
cord

Salivary
glands
Lungs

Accelerates heartbeat
Inhibits activity

Heart
Stomach
Pancreas

Stimulates glucose
Secretion of adrenaline,
nonadrenaline
Relaxes bladder
Sympathetic Stimulates ejaculation
ganglia
in male

Liver
Adrenal
gland
Kidney

Parasimpatis

CENTRAL NERVOUS SYSTEM

PARASYMPATHETIC

Brain

a.
b.

c.
d.
e.
f.
g.
h.

Sistem Istirahat & cerna


Menurunkan gerak tubuh
untuk menyimpan dan
mempertahankan energi
Menurunkan detak jantung,
respirasi rate & tekanan darah
Meningkatkan aktivitas umum
sistem cerna
Meningkatkan sekresi kelenjar
sistem cerna
Meningkatkan produksi urin
dan merelaksasi sfingter
Ereksi
Kontriksi pupil

Contracts pupil
Stimulates salivation
Spinal
cord

Constricts bronchi

Slows heartbeat

Stimulates activity

Stimulates gallbladder
Gallbladder
Contracts bladder

Stimulates erection
of sex organs

Sekian dan terimakasih


16/11/2014