14 Clinical Cases II

Question 1

Answer the questions in the purple boxes:

Answer 1

Question 2

Apart from motor fibres to th muscles of facial expression, what other functions are carried by the facial nerve?

Answer 2

• Taste - anterior 2/3 of tongue
• Parasympathetics
  
  • Lacrimal, nasal and salivary glands (sublingual and submandibular)
• Stapedius muscle (ear)
• General sensation to ear- relevant for ramsey hunt syndrome

Question 3

Which nerve carries general sensation to the tongue?

Answer 3

Posterior 1/3 = IX glossopharyngeal

Anterior 2/3= Vc- Lingual branch

Question 4

How might a doctor test the integrity of the facial nerve?

Answer 4

Test muscles of facial expression top to bottom

Use history- explore other feature/functions of facial nerve eg dry eyes?

Question 5

What other areas would you examine to find potential causes of referred pain to the ear?

Answer 5

Throat, tonsils, TMJ joint, lymph nodes

Question 6

If a patient with mastoiditis presents to their GP, what should the GP do?

Answer 6

Refer straight to ENT

IV antibiotics

may require surgery

Question 7

What other anatomical structures within the skull can potentially be affected by the spread of infection from the middle ear?

Answer 7

Dura- meningitis

Temporal lobe- absess

Sigmoid sinus- thrombosis