Cranial Nerves and Clinical Testing Flashcards by Lucy Roberts

The Facial nerve arises from the _____ as a ________

pontomedullary junction

sensory and motor rootlet

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The 2 roots of the facial nerve travel through the __________ where they are in close proximity to the inner ear

internal acoustic meatus

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From the internal acoustic meatus the facial nerve enters the ______

facial canal

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What is the facial canal?

Canal that runs between the internal acoustic meatus and the stylomastoid foramen

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What 3 events occur to the facial nerve in the facial canal?

1) the two roots fuse to form the facial nerve, 2) the nerve forms the geniculate ganglion
3) the nerve gives rise to the greater petrosal nerve, nerve to stapedius and the chorda tympani

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What does the greater petrosal nerve supply?

parasympathetics fibres to the mucous and lacrimal glands

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What does the nerve to stapedius supply?

motor fibres to stapedius

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What does the chorda tympani supply?

special sensory fibres (taste) to the anterior 2/3 of tongue, parasympathetics to submandibular and sublingual glands

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The facial nerve exits the facial canal via the ________

stylomastoid foramen

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The glossopharyngeal nerve originates in the ___1___ and leaves the cranium via the ___2_____

1) medulla oblongata

2) jugular foramen

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The glossopharyngeal nerve descends _______ to the internal carotid artery and several branches arise

Anterolateral

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Describe sensory innervation via the glossopharyngeal nerve?

Tympanic nerve provides sensation to middle ear, internal surface of tympanic membrane and eustachian tube
Innervation to the carotid sinus
Pharyngeal branch innervation to the mucosa of the oropharynx
Lingual nerve provides posterior 1/3 of tongue with general taste and sensation
Tonsillar branch innervates the palatine tonsils

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Somatic motor provided by glossopharyngeal?

Stylopharyngeus

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Parasympathetic provided by glossopharyngeal?

Parotid gland secretomotor

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Sensory part of gag reflex is provided by?

Glossopharyngeal

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What nerve provides sensation to the middle ear, internal surface of tympanic membrane and eustachian tube?

Glossopharyngeal via the tympanic nerve

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What nerve provides posterior 1/3 of the tongue with general sensation and taste?

Glossopharyngeal nerve

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Palatine tonsils are innervated by the?

Glossopharyngeal nerve

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Parotid gland secretomotor function is by?

Glossopharyngeal nerve

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Glossopharyngeal nerve is associated with derivatives of the ______ pharyngeal arch

3rd

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The vagus nerve is associated with derivatives of the _____ pharyngeal arches

4th and 6th

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The vagus nerve originates from the ___1__ exiting the cranium via the ___2_____

1) medulla oblongata of the brainstem

2) jugular foramen

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In the neck the vagus nerve travels in the _____ with ______

carotid sheath

IJV and common carotid artery

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The left recurrent laryngeal nerve recurs under ___1__

The right recurrent laryngeal nerve recurs under ___2__

1) aortic arch

2) subclavian artery

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The vagus nerve supples somatic sensation to

posterior part of external auditory canal and external ear

The vagus nerve provides visceral sensation to

laryngopharynx superior aspect of larynx heart GI tract up to splenic flexure

Motor functions of the vagus nerve?

Majority of muscles of pharynx and larynx as well as palatoglossus of tongue and majority of muscles of soft palate

Parasympathetic functions of vagus nerve?

Heart, Lungs and GI Tract

What nerve provides parasympathetics to the heart and GI tract?

Vagus

What nerve provides majority of muscles of pharynx and larynx as well as palatoglossus of tongue and majority of muscles of soft palate?

Vagus

What nerve provides visceral sensation to the laryngopharynx, superior part of the larynx, heart and GI tract up to the splenic flexure?

Vagus

Special sensation supplied by the facial nerve? Via what nerve?

special sensory fibres for taste to anterior 2/3 of tongue via chorda tympani (GENERAL SENSATION IS SUPPLIED BY THE TRIGEMINAL)

Parasympathetics supplied by the facial nerve?

Mucous glands and lacrimal glands | Submandibular and sublingual salivary glands

What nerve supplies motor innervation to some of the muscles surrounding the ear?

Facial via the posterior auricular nerve

Facial nerve gives motor innervation to?

Muscles of facial expression

The hypoglossal nerve arises from the ___1_____ and exits the cranium via the __2____ It then travels down to enter the ___3____

1) medulla oblongata 2) hypoglossal canal 3) tongue

What is the function of hypoglossal nerve?

MOTOR FUNCTION Innervates all the muscles of the tongue except palatoglossus genioglossus, hyoglossus, styloglossus, superior longitudinal, inferior longitudinal, transverse and vertical

What nerve innervates all the extrinsic and intrinsic muscles of tongue EXCEPT palatoglossus?

Hypoglossal

The trigeminal nerve is associated with derivatives of the ________

1st pharyngeal arch

Trigeminal nerve originates off the __1____ CNV1 exits the cranium via __2__ CNV2 exits the cranium via ___3__ CNV3 exits the cranium via ___4____

1) Pons 2) the superior orbital fissure 3) Foramen rotundum 4) Foramen ovale

CNV1, 2 and 3 sensory innervations?

CNV1 roughly upper 1/3 of face skin and mucous membranes CNV2 roughly middle 1/3 including nasal cavity, maxillary sinus, teeth and gingiva in super 1/2 CNV3 Bottom 1/3 of face, also floor of oral cavity, ant 2/3 of tongue general sensation, lower teeth and gingiva

CNV3 motor function?

Motor to the muscles of mastication, some supra hyoid muscles, tensor veil palatini in the soft palate, tensor tympani in the ear

What nerve provides motor innervation to tensor tympani?

CNV3

The vestibulocochlear nerve originates at the __1___ and exits the cranium via the _2____

1) pontomedullary junction | 2) internal acoustic meatus

Function of vestibulocochlear nerve?

Vestibular nerve innervates the vestibular system responsible for balance The cochlear nerve travels to the cochlea forming the spiral ganglia which serve the sense of hearing

The spinal accessory nerve has a spinal component arising from ___1___ and cranial component arising from __2__ It leaves the cranium via the ____3____

1) C1-C5/C6 2) Medulla 3) Jugular foramen

Spinal accessory nerve provides motor innervation to?

Sternocleidomastoid and trapezius

What nerves leaves the cranium via the foramina in the cribriform plate of the ethmoid bone?

Olfactory

What nerves leave the cranium via the optic canal?

Optic

What nerves leave the cranium via the superior orbital fissure?

Oculomotor, Trochlear and CNV1, Abducent

What nerves leave the cranium via the foramen rotundum?

CNV2

What nerves leave the cranium via the foramen ovale?

CNV3

What nerves leave the cranium via the internal acoustic meatus?

Facial and Vestibulocochlear

What nerves leave the cranium via the jugular foramen? What else runs through here?

Glossopharyngeal, vagus and spinal accessory | The internal jugular vein

What nerves leave the cranium via the hypoglossal canal?

Hypoglossal

What modalities does the olfactory nerve have?

special sensory

What modalities does the optic nerve have?

special sensory

What modalities does the oculomotor nerve have?

motor and parasympathetic

What modalities does the trochlear nerve have?

motor

What modalities does the trigeminal nerve have?

CN V1 & V2: sensory only*; V3 is sensory & motor*

What modalities does the abducent nerve have?

motor

What modalities does the facial nerve have?

special sensory; motor & parasympathetic

What modalities does the vestibulocochlear nerve have?

special sensory

What modalities does the glossopharyngeal nerve have?

special sensory; sensory; motor & parasympathetic

What modalities does the vagus nerve have?

sensory; motor; parasympathetic

What modalities does the spinal accessory nerve have?

motor

What modalities does the hypoglossal nerve have?

motor

Describe how you would clinically test the sensory portion of the trigeminal nerve?

Sensory: Key points for clinical testing are Ophthalmic (CNV1): forehead, upper eyelid & tip of nose Maxillary (CNV2): mid-cheek, lower eyelid, upper lip & nostril of nose Mandibular (CNV3): mid-cheek, lower lip & chin Ask the patient to close their eyes Gently brush the skin in each dermatome with a fine tip of cotton wool Ask the patient to tell you when they feel their skin being touched Compare the 2 sides

Describe how you would clinically test the motor portion of the trigeminal nerve?

Palpate the strength of contraction of the masseter & temporalis by asking patient to clench their teeth Ask the patient to open their jaw against resistance

Describe how you would clinically test the motor function of the facial nerve?

``` Can clinically test motor function of CN VII by asking patient to: Frown (frontalis) close eyes tightly (orbicularis oculi) Smile (elevators of lips) puff out cheeks (buccinator) ```

Describe a few ways in which you can clinically test the vagus nerve?

ask patient to say ‘ah’ uvula should lift straight up in midline unilateral pathology will pull uvula away from the non-functioning side ask patient to swallow small amount of water watch larynx movement splutter may suggest abnormal swallow listen to speech hoarseness may suggest abnormal function of muscles of larynx ask patient to cough remember also requires diaphragm Cause have to adduct the vocal chords

Describe how you would clinically test the spinal accessory nerve?

ask patient to shrug shoulders | ask them to turn head to look up towards the opposite side

Describe how you would clinically test the hypoglossal nerve?

ask patient to stick tongue straight out if both CNXII’s are functioning normally the tongue tip remains in the midline on protrusion if there is unilateral CN XII pathology the tongue tip will point towards the side of the injured nerve

Describe how you would clinically test the optic nerve?

Light Reflexes; Visual Field Testing; Snellen Chart

Describe how you would clinically test the oculomotor nerve?

Extraocular eye movements

Describe how you would clinically test the trochlear nerve?

Extraocular eye movements (“down & in”)

Describe how you would clinically test the abducent nerve?

Extraocular eye movements (lateral gaze)

Describe how you would clinically test the vestibulocochlear nerve?

Rhinne’s & Weber’s hearing tests

What is the only cranial nerve to attach to the Pons?

trigeminal

What is the largest of all cranial nerves?

trigeminal

All the forimanae the divisions of the trigeminal nerve pass through are found in what bone?

sphenoid

Once facial nerve emerges from stylomastoid foramen it only contains _____________

somatic motor fibres

After exiting the stylomastoid foramen the facial nerve gives off _____________

branches to go around the ear as well as stylohyoid muscle and the posterior belly of digastric

The facial nerve goes into the parotid (although doesn't supply it) and it then gives off its five terminal branches which are _________

* To Zanzibar by Motor Car | * Temporal, Zygomatic, Buccal, Mandibular, Cervical

The muscles of facial expression originate on bone but insert onto __________

superficial fascia

List some of the muscles of facial expression

Frontalis, occipitalis, Orbicularis oculi, Elevators of the lips, Orbicularis oris

What is the vermillion border and what is the clinical significance?

border where thin skinned and hairless beginning of the lip itself, lacerations crossing the border need very careful suturing

The vagus nerve passes _________ to the root of the lung

posterior

The vagus nerve passes through diaphragm with oesophagus at _________

T10 vertebral level

What happens to the vagus nerve once it passes through the diaphragm?

The nerves become trunk like again and then referred to as anterior and posterior vagal trunks as opposed to left and right This is because they turn on themselves and emerge anterior and posterior to the stomach