Head Anatomy 2

Question 1

What are intra-cranial causes of facial nerve palsy?

Answer 1

-middle/ inner ear infection

Question 2

What are extra-cranial causes of facial nerve palsy?

Answer 2

-forceps delivery
-viral infection
-parotid gland pathology

Question 3

What is Bell’s palsy?

Answer 3

It’s a condition causing paralysis of facial muscles by affecting the facial nerve, cause is unknown.
Can last up to 6 months and may be due to:
-Autoimmune/ inflammatory causes
-infection
-diabetes

Question 4

What are the symptoms of intra-cranial facial nerve palsy?

Answer 4

Parasympathetic:
Dry eyes (greater petrosal nerve)
Dry mouth + altered taste in anterior 2/3rds (chorda tympani)

Motor:
Hyperacusis (nerve to stapedius)

Question 5

What are the symptoms of EXTRA-cranial facial nerve palsy?

Answer 5

Motor:
Paralysis of facial muscles = drooping face, drooling

Question 6

Damage to which 2 nerves can cause hyperacusis and what are the muscles they supply?

Answer 6

Trigeminal = tensor tympani
Facial/ nerve to stapedius = stapedius

Question 7

How can you tell the difference between a stroke and Bell’s palsy?

Answer 7

Stroke (UMN):
-Forehead spared (can wrinkle)
-Facial droop on opposite side of lesion

Bell’s palsy:
-No forehead sparing
-facial droop on same side as lesion
-other sx present = dry eyes & mouth, loss of taste in ant 2/3rds tongue

Question 8

What are the structures found passing through the parotid gland?

Answer 8

Facial nerve
Retro mandibular vein
External carotid artery
(Order= superficial to deep)

Question 9

What nerve is damaged during a parotidectomy?

Answer 9

Marginal mandibular branch of facial nerve

Question 10

Describe where the incision would be for excision of submandibular gland?

Answer 10

4cm below the mandible

Question 11

What are the structures that can be damaged during excision of the submandibular gland.

Answer 11

Marginal mandibular branch of CN7
lingual nerve
Hypoglossal nerve

Question 12

What are the names of the ducts of the
-parotid gland
-submandibular gland

Answer 12

Parotid= stensons duct
Submandibular = whartons duct

Question 13

Describe the clinical symptoms for a patient presenting with vestibular schwannoma

Answer 13

Hearing loss + tinnitus
Ataxia
Facial paresis

Question 15

What cranial nerves are found at the cerebello-pontine angle?

Answer 15

CN 5, 7, 8

Question 16

Where does CN9 provide sensation to?

Answer 16

General sensation & taste to posterior 1/3rd of tongue
Afferent limb of gag reflex

Question 17

What muscle(s) does CN9 innervate?

Answer 17

Stylopharyngeus

Question 18

What is the parasympathetic function of CN9?

Answer 18

Controls secretions from parotid gland

Question 19

What surgery can cause damage to the glossopharyngeal nerve?
What sx would they present with?

Answer 19

Removal of tonsils

Sx:
-mild dysphasia
Loss of taste and sensation in posterior 1/3rd tongue
Ear pain

Question 20

Patient has a surgery in the oropharyngeal area and has otalgia post-op.

How can you determine which nerve has been injured to cause the otalgia?

Answer 20

Site of surgery:
Site at tongue base= CN9
Site at back of throat= CN10

Both can cause ear pain if damaged

Question 21

What are the branches of the vagus nerve that supply the larynx and described their anatomical path.

Answer 21

Recurrent laryngeal nerves

Both = exit skull via jugular foramen, enter carotid sheath

Right:
In front of SCJ
Loops around right subclavian artery
Travels back up to larynx

Left:
Travels down to arch of aorta and loops back up to larynx

Question 22

What are the laryngeal muscles innervated by vagus nerve?

Answer 22

Recurrent laryngeal nerve innervates:
-transverse & oblique arytenoids
-posterior & lateral cricoarytenoids
Thyroarytenoids
Vocalis

Question 23

Which muscle in the tongue is innervated by CN10

Answer 23

Palatoglossus

Question 24

What are the areas the vagus provides sensation to?

Answer 24

-external auditory meatus
-larynx
-pharynx

Question 25

Which laryngeal muscle is NOT supplied by the recurrent laryngeal nerve? Which nerve supplies it?

Answer 25

Cricothyroid Superior laryngeal nerve

Question 26

What are the parasympathetic functions of CN10?

Answer 26

-reduces resting HR -increases gastric secretions Increased gastric emptying -increased gastric acid production

Question 27

Uvula is deviated to which side in left sided vagus nerve palsy

Answer 27

Right sided deviation

Question 28

What are the afferent and efferent limbs of the gag reflex?

Answer 28

Afferent = CN9 Efferent= CN 10

Question 29

What are the landmarks for the CN11?

Answer 29

1/3rd of way down SCM 2/3rd of way down trapezius

Question 30

What are the symptoms in CN11 palsy?

Answer 30

Weakness in shrugging ipisilateral shoulder Weakness in turning neck to contra lateral side

Question 31

What nerve palsy causes tongue deviation? Deviation is to which side?

Answer 31

Hypoglossal nerve Deviates TO side of lesion

Question 32

What are the cranial nerves found in the -midbrain -pons -medulla

Answer 32

-midbrain= CN3, 4 -pons = CN 5, 6, 7, 8 -medulla= CN 9, 10, 11, 12

Question 33

What nerve innervates the following ear parts -Tragus -lobule -back of ear -concha

Answer 33

-tragus= auriculotemporal -lobule= great auricular -back= lesser occipital -concha= vagus +/-facial nerve

Question 34

What nerves innervate the muscles of the tongue?

Answer 34

Hypoglossal except for palatoglossus (CN10)

Question 35

What are the intrinsic muscles of the tongue?

Answer 35

-superior longitudinal -inferior longitudinal Vertical Transverse

Question 36

What are the extrinsic muscles of the tongue and their actions?

Answer 36

-genioglossus (stick out -palatoglossus (up) -styloglossus (up) -hyoglossus (down)

Question 37

In the following reflexes, name the Afferent and efferent limbs!

Answer 37

-corneal