Dysphagia anatomy

Question 1

How many cranial nerves are there

Answer 1

12

Question 2

What number is the trigeminal nerve

Answer 2

5 (V)

(sensory and motor on your face)

Question 3

What number is the facial nerve

Answer 3

7 (VII)

ear, facial expressions, neck, tongue, jaw

Question 4

What number is the glossopharyngeal nerve

Answer 4

9 (IX)

tongue, throat sinusesW

Question 5

What number is the vagus nerve

Answer 5

10 (X)

conveying sensation from ear canal and parts of your throat
sending sensory information from heart and intestines
motor control of throat muscles
stimulating the muscles of organs in your chest and trunk
providing a sense of taste

Question 6

What number is the hypoglossal nerve

Answer 6

12 (XII)

responsible for most muscles in the tongue

Question 7

Which 6 cranial nerves affect swallowing?

Answer 7

Trigeminal (cranial nerve 5)
Facial (cranial nerve 7)
Glossopharyngeal (cranial nerve 9)
Vagus (cranial nerve 10)
Accessory(11)
Hypoglossal nerve (cranial nerve 12)

Question 8

What is the pharynx and its function

Answer 8

• Muscle lined space
• Connects nasal and oral cavity to the oesophagus and larynx

Question 9

What is the larynx and where is it

Answer 9

• Voicebox
• Located above the trachea and in front of oesophagus

Question 10

What are the three sections of the pharynx

Answer 10

• nasopharynx
• oropharynx
• laryngopharynx

Question 11

What is the epiglottis

Answer 11

• a flap of tissue that sits beneath the tongue at the back of the throat
• closes over trachea to prevent aspiration

Question 12

What is the glottis

Answer 12

• the opening between the vocal folds in the larynx

this should close when we swallow

Question 13

What does the cranial nerve V innervate

Answer 13

(trigeminal)

The face and muscles that allow us to chew

Sensory and motor

Question 14

How do we test cranial nerve V

Answer 14

Get patient to close eyes and copy where you have touched their face

Get them to clench their jaw and palpate for muscle strength

Question 15

What does damage to cranial nerve V present like

Answer 15

• no sensation in parts of the face (touch, pain, temperature)
• sudden, intense pain on one side of the face caused by pressure on the nerve

Question 16

What does cranial nerve VII innervate

Answer 16

(facial)

• innervates facial movement and expression
• also provides taste to back 2/3 of tongue

Question 17

How could you test cranial nerve VII

Answer 17

• get them to make exaggerated facial expressions (eyebrows up, smile wide, pucker lips, puff cheeks up)
• how symmetrical are the facial expressions

Question 18

What does damage to cranial nerve VII look like

Answer 18

• drooping
• relaxed face
• weakness on one or both sides
• damage can be caused by stroke, infection, brain trauma
• unable to move face or making involuntary facial movements

Question 19

What does cranial nerve IX innervate

Answer 19

(glossopharyngeal)

• hyolaryngeal excursion
• innervates the oropharynx, front third of the tongue, muscles of the larynx and palate
• communicates with vagus to aid swallowing

Question 20

How to test cranial nerve IX

Answer 20

• look for strong cough
• symmetry of velum elevation when saying AH!
• appropriate volume and pitch
• can palpate for hyolaryngeal excursion

Question 21

What are common symptoms of cranial nerve damage

Answer 21

• Impairment in one or more of the five senses
• Difficulty speaking
• Difficulty swallowing
• Muscle weakness, pain and spasms
• Loss of balance

Question 22

What does CN X innervate

Answer 22

(vagus)

• Involuntary body functions (sneezing, coughing, vomiting, heart rate, digestion)
• Vocal folds coming together while swallowing
• Controls voice and resonance

Question 23

How do we test CN X

Answer 23

• Check gag reflex
• Test voice quality (measuring volume and pitch)

Question 24

What does damage to CN X look like

Answer 24

• No gag reflex
• Change/ loss of voice
• Difficulty speaking or swallowing

Question 25

what does CV XI innervate

Answer 25

- (accessory) - head, neck and shoulder movement - laryngeal muscle for correct movement of vocal cords

Question 26

How do we test CN XI

Answer 26

- head turn against resistance - check for symmetry of shrug

Question 27

what does CN XI damage look like

Answer 27

- sagging of the shoulders - weakness in head turn - asymmetrical shrug

Question 28

What does CN XII innervate

Answer 28

- the muscles of the tongue (hypoglossal)

Question 29

How to test CN XII

Answer 29

- ask patient to move tongue (out, up, down, lick around teeth and lips) - push tongue against cheek and feel for strength

Question 30

What does damage to CN XII look like

Answer 30

- tongue deviation (explain) - fasciculation (twitching, looks like bed of snakes)

Question 31

Which cranial nerve is involved with facial weakness? Why?

Answer 31

5 facial Explanation: because this cranial nerve innervates motor and sensory neurons in the face and jaw

Question 32

Which cranial nerve is involved with dysphonia (altered voice quality)? Why?

Answer 32

10 vagus Explanation: because the vagus innervates the larynx (and therefore voice)

Question 33

Which cranial nerve is involved with tongue movement on all planes? Why?

Answer 33

12 hypoglossal Explanation: because this cranial nerve innervates almost all movement in the tongue

Question 34

Which cranial nerve is involved with reduced mastication? Why?

Answer 34

5 trigeminal Explanation: because this cranial nerve innervates jaw movement and muscles involved in chewing

Question 35

Which cranial nerve is involved with reduced hyolaryngeal excursion? Why?

Answer 35

7 facial Explanation: because the facial nerve has a branch which innervates the hyoid (as well as CN IX)

Question 36

Which cranial nerve is involved with post swallow residue? Why?

Answer 36

9 glossopharyngeal Explanation: because we can evaluate this cranial nerve for strength of swallow and it innervates muscles of the palate

Question 37

Which cranial nerve is involved with difficulty in oral containment of the bolus? Why?

Answer 37

7 facial Explanation: because this cranial nerve innervates muscles around the mouth for lip seal (eg facial expressions)

Question 38

Which cranial nerve is involved with reduced bolus preparation? Why?

Answer 38

5 trigeminal Explanation: because this cranial nerve innervates muscles involved in chewing

Question 39

Which cranial nerve is involved with premature spilling of the bolus? Why?

Answer 39

12 hypoglossal Explanation: because this cranial nerve innervates all the muscles of the tongue, and the tongue controls movement of the bolus

Question 40

Which cranial nerve is involved with impaired supraglottic protection? Why?

Answer 40

9 glossopharyngeal Explanation: because this cranial nerve innervates the oropharynx and muscles of the larynx supraglottic = above glottis/larynx

Question 41

Which two cranial nerves are involved with impaired taste? Why?

Answer 41

7 and 9 facial and glossopharyngeal Explanation: (7 = innervates taste in back 2/3 of tongue 9= innervates taste in front 1/3 of tongue)

Question 42

Which cranial nerve is involved with reduced capacity of airway protection? Why?

Answer 42

10 vagus Explanation: because this cranial nerve innervates vocal folds coming together while swallowing AND coughing and gag reflex (aka airway protection)

Question 43

Which cranial nerve is involved with decreased movement between base of tongue to posterior pharyngeal wall? Why?

Answer 43

12 hypoglossal Explanation: because this cranial nerve innervates the majority of tongue movement

Question 44

Which cranial nerve is involved with impaired function of the Upper Oesophageal Sphincter (UES)? Why?

Answer 44

10 vagus Explanation: because the UES protects the airway from aspiration and that is one of the vagus' main roles (protect airway by closing vocal folds, coughing, gagging)