1. Cranial Nerves VII- XII Review
Brittany Zarse
Elizabeth Yeager
Nathan Webb

2. Cranial Nerve VII: Facial Nerve
Mixed Nerve
Motor:
muscles of facial expression
except mastication muscles- temporalis and masseter
stapedius muscle
secretor glands in mouth and nasal cavities
Sensory:
taste anterior 2/3 tongue, hard and soft palates
epidermis of the external ear

3. Cranial Nerve VII: Facial Nerve
Clinical Testing
Look for asymmetry in voluntary facial movements
Check taste sensation on anterior 2/3 tongue
Note excessive secretion of salivary glands
Check acoustic stapedial reflexes
Clinical Conditions
Pons- paralysis of ipsilateral facial muscles, loss of taste from anterior 2/3 tongue, excessive secretion from salivary glands
Unilateral UMN- paralysis of contralateral lower face
Bilateral UMN- paralysis of upper & lower face
LMN- paralysis of ipsilateral upper & lower face

4. Cranial Nerve VII: Facial Nerve

5. Cranial Nerve VIII: Vestibulocochlear Nerve
Sensory Nerve
Branches into vestibular and auditory nerves
Vestibular
Equilibrium
Head and body movements
Stable visual fixation point- “doll’s eye reflex”
Distal fibers innervate hair cells of semicircular canals
Auditory
Hearing
Distal fibers innervate hair cells of Organ of Corti

6. Cranial Nerve VIII: Vestibulocochlear Nerve
Clinical Conditions
Vestibular
Impaired equilibrium
Vertigo
Nystagmus
Auditory
Neural hearing loss
Tinnitus

7. Functions of CN IX
Receives general sensory fibers from the posterior 1/3rd of the tongue, the tonsils, soft palate, the pharynx, and the middle ear (through the tympanic nerve) and Eustachian tube.
Special sensory fibers mediating taste from the posterior 1/3rd of the tongue and oral pharynx
Supplies parasympathetic fibers to the parotid gland
Supplies motor fibers to stylopharyngeus muscle and the upper pharyngeal muscles.

8. Cranial Nerve X Is the longest CN
Mixed nerve although mostly sensory (90%).
CNs IX and X are important for phonation and swallowing.
Also innervates cardiac and smooth muscles of esophagus, stomach and intestine

9. Cranial Nerve XI: Spinal Accessory Nerve
Motor nerve
Head movement control
Tilting of the head forward and rotating to opposite side= sternocleidomastoid muscle contraction
Tilting of head back and to the side= trapezius muscle contraction
Clinical Testing –
Trapezius- ask to shrug shoulders while giving resistance
Sternocleidomastoid= ask to turn head while giving resistance

10. Cranial Nerve XII: Hypoglossal Nerve
Motor Nerve
Innervates all of the intrinsic and 3 of the 4 major extrinsic muscles of the tongue
The other extrinsic tongue muscles is innervated by what?

11. Hypoglossal Nerve Cont.
Clinical testing –
Check for paralysis by asking to stick out their tongue (will point towards paralyzed side during unilateral paralysis)
strength of the tongue measured by pushing a finger against their cheek and seeing how strongly they can push back
Also look for signs of fasciculation (Involuntary contractions and twitching of muscle) and muscular atrophy.

12. Clinical Conditions
Damages to the following cranial nerves result in:
CN VII, Facial: paralysis of ipsilateral facial muscles, excessive secretion from salivary glands, loss of taste from anterior 2/3 tongue
CN VIII, Auditory: impaired equilibrium, vertigo, nystagmus, and neural hearing loss
CN IX, Glosspharyngeal:   Affects elevation of pharynx during swallowing, Loss of gag reflex, Excessive saliva secretion
CN X, Vagus: Breathy voice, hoarseness and diplophonia; Difficulty in swallowing (also impairs parasympathetic functions such as heart-rate, function of smooth muscles of trachea and bronchus, reflexes such as vomiting, coughing, sneezing, sucking, and yawning.)
CN XI, Accessory: head movement problems
CN XII, Hypoglossal: tongue paralysis, atrophy, or fasciculation; dysarthria or chewing difficulties

13. 1. The facial nerve is _______________.
A. Only motor
B. Only sensory
C. Mixed but primarily motor
D. Mixed but primarily sensory

14. Answer! 1. The facial nerve is _______________. A. only motor
B. only sensory
C. mixed but primarily motor
Motor-facial muscles, stapeduis & secretor glands of mouth & nose
Sensory- taste 2/3 tongue, epidermis of outer ear
D. mixed but primarily sensory

15. 2. Which of the following facial muscles are not innervated by CN VII?
A. Orbicularis Oris
B. Mentalis
C. Masseter
D. Depressor Anguli Oris
E. Temporlais

16. Answer!
2. Which of the following facial muscles are not innervated by CN VII?
A. Orbicularis Oris
B. Mentalis
C. Masseter
CN V- Trigeminal
D. Depressor Anguli Oris
E. Temporlais

17. 3. Lesions of CN VII could result in all but which of the following:
A. impaired stapedial reflex
B. excessive secretion of salivary glands
C. impairment of voluntary facial movements
D. impaired equilbirium

18. Answer!
3. Lesions of CN VII could result in all but which of the following:
A. impaired stapedial reflex
B. excessive secretion of salivary glands
C. impairment of voluntary facial movements
D. impaired equilbirium
CN VIII- Vestibulocochlear

19. 4. A unilateral UMN lesion to CN VII will affect the __________.
A. contralateral lower half of the face
B. ipsilateral lower half of the face
C. contralateral side of the face
D. lower half of the face

20. Answer!
4. A unilateral UMN lesion to CN VII will affect the __________.
A. contralateral lower half of the face
The upper face remains unaffected because of bilateral innervation
The ipsilateral half remain unaffected because pathways come from unaffected side of cortex
B. ipsilateral lower half of the face
C. contralateral side of the face
D. lower half of the face

21. 5. Damage to the facial nerve at the level of the pons will result in __________.
A. only ipsilateral paralysis of facial muscles
B. only excessive secretions from salivary glands
C. only loss of taste from anterior 2/3 of tongue
D. all of the above

22. Answer!
5. Damage to the facial nerve at the level of the pons will result in __________.
A. only ipsilateral paralysis of facial muscles
B. only excessive secretions from salivary glands
C. only loss of taste from anterior 2/3 of tongue
D. all of the above

23. 6. Is Bell’s Palsy an example of an UMN or a LMN lesion?

24. Answer! 6. Is Bell’s Palsy an example of an UMN or a LMN lesion? LMN
ipsilateral paralysis of upper and lower facial muscles

25. 7. The __________ branch of CN VIII is responsible for maintaining the “doll’s eye reflex.”
A. Vestibular
B. Auditory
C. Maxillary
D. Mandibular

26. Answer!
7. The __________ branch of CN VIII is responsible for maintaining the “doll’s eye reflex.”
A. Vestibular
Also equilibrium and head and body movements
B. Auditory
hearing
C. Maxillary
CN V- Sensation from face, head, parts of the ear, oral & nasal cavities
D. Mandibular
CN V- general sensory from mouth

27. 8. Distal fibers of the vestibular nerve innervate what?
A. hair cells of the Organ of Corti
B. epidermis of the external ear
C. hair cells of the semicircular canals
D. stapedius muslce

28. Answer! 8. Distal fibers of the vestibular nerve innervate what?
A. hair cells of the Organ of Corti
Auditory branch of CN VIII-Vestibulocochlear
B. epidermis of the external ear
CN VII- Facial
C. hair cells of the semicircular canals
D. stapedius muslce

29. 9. A lesion to the auditory nerve will result in what?
A. vertigo
B. neural hearing loss
C. nystagmus
D. tinnitus

30. Answer! 9. A lesion to the auditory nerve will result in what?
A. vertigo
lesion to vestibular nerve
B. neural hearing loss
C. nystagmus
D. tinnitus

31. 10. What is the Main purpose of Cranial nerve IX?
A) Tongue and pharynx movement
B) Hearing and Balance
C) Sense of Smell
D) Visual information

32. Answer! A) Tongue and pharynx movement
B) Hearing and Balance (CN 8 Vestibulocochlear)
C) Sense of Smell (CN 1 Olfactory)
D) Visual information (CN 2 Optic)

33. 11. Cranial Nerve IX connects to the brain through the?
A. Midbrain
B. Pons
C. Medulla
D. Cerebrum

34. Answer!
C) Medulla

35. 12. Cranial Nerve IX is responsible for receiving?
A) Sensory information to 1/3 of the posterior tongue
B) General sensory information from the tonsils.
C) General sensory information from the soft palate and pharynx.
D) All of these

36. ANSWER!
D) ALL OF THESE
A) Sensory information to 1/3 of the posterior tongue
B) General sensory information from the tonsils.
C) General sensory information from the soft palate and pharynx.

37. 13. Which cranial nerve supplies parasympathetic fibers to the parotid gland?
A) CN X
B) CN IX
C) CN XI
D) CN V

38. ANSWER! B) Cranial nerve IX.
Supplies parasympathetic fibers to the parotid gland
Which is the largest of the salivary glands found in the subcutaneous tissue of the face which empties its secretion within the buccal cavity.

39. 14. Ipsilateral lesions of CN IX will result in?
A) Partial paresis (weakening) of the unilateral stylopharyngeal muscle.
B) Impaired cutaneous sensation from the posterior tongue.
C) Poor control of parotid gland
D) All of these
E) None of these

40. ANSWER!
D) ALL OF THESE
A) Partial paresis (weakening) of the unilateral stylopharyngeal muscle.
Affects elevation of pharynx during swallowing
B Impaired cutaneous sensation from the posterior tongue.
Loss of gag reflex
C Poor control of parotid gland
Excessive saliva secretion

41. 15. Which Cranial Nerve innervates the exterior portion of the EAC and the TM?
A) X
B) V
C) VIII
D) VII

42. ANSWER!
A) CN X supplies general sensory information from the external ear and parts of the external surface of the tympanic membrane.
BONUS: What kind of information?

43. BONUS ANSWER
SENSORY INFORMATION
for touch, temperature and pressure

44. 16. Unilateral LMN damage to CN X is charaterized by:
A) Breathy Voice
B) Hoarseness and diplophonia
C) Difficulty in swallowing
D) All of these

45. ANSWER!
D) ALL OF THESE
A) Breathy Voice and B) hoarseness and diplophonia are caused by paralysis of the intrinsic muscles of the larynx on the affected side.
C) difficulty in swallowing is cause by the inability to elevate the soft palate on the affected side (due to paralysis of the levator palatini muscle)

46. 17. Which cranial nerve is the longest?
A) V
B) VII
C) X
D) XI

47. ANSWER!
C) CN X

48. 18. When damaged, which CN causes impairment to parasympathetic functions such as heart-rate, function of smooth muscles of trachea and bronchus, reflexes such as vomiting, coughing, sneezing, sucking, and yawning?
A) I B) IX C) X D) XII

49. ANSWER!
C) X vagus nerve
A) I, damage could result in Anosmia/hyposmia – Reduction/loss of the ability to smell
Hyperosmia – Abnormally acute sensation of smell
B) IX, damage could result in loss of gag reflex, elevation of pharynx, and excessive saliva
D) XII, damage could result in paralysis of tongue

50. 19. Is the spinal accessory nerve a motor nerve, sensory nerve, or both?

51. Answer!
Both! The accessory nerve is both motor and sensory!

52. 20. You see a client who has difficulties with head movement
20. You see a client who has difficulties with head movement. What cranial nerve could be affected?
A. CN X
B. CN XII
C. CN XI
D. CN VII

53. Answer! A. CN X B. CN XII C. CN XI D. CN VII
The spinal accessory- It’s in charge of tilting the head forward, backward, and to the side!
D. CN VII

54. 21. The hypoglossal nerve innervates all of the extrinsic and 3 of the 4 major intrinsic muscles of the tongue. T or F?

55. Answer!
FALSE! The hypoglossal nerve innervates all INTRENSIC and 3 out of the 4 EXTRENSIC

56. 22. During unilateral tongue paralysis, what side of the mouth does the tongue point towards?
A. The paralyzed side
B. Always the right
C. The un-paralyzed side
D. Always the left

57. Answer! A. The paralyzed side B. Always the right
C. The un-paralyzed side
D. Always the left

58. 23. The ______ muscle is in charge of the tilting of the head back and to the side.
A. Sternocleidomastoid
B. Sternomastoid
C. Trapezius
D. Trapazoid

59. Answer!
A. Sternocleidomastoid (tilting of head forward and to opposite side)
B. Sternomastoid
C. Trapezius
D. Trapazoid (silly goose!)

60. 24. What is fasciculation?
A. Involuntary contractions and twitching of muscle
B. The fluid-like movement of cilia
C. Vomiting
D. Intense pain in the neck muscles due to damage to the CN XI.

61. Answer! A. Involuntary contractions and twitching of muscle
B. The fluid-like movement of cilia
C. Vomiting
D. Intense pain in the neck muscles due to damage to the CN XI.

62. 25. Tongue paralysis and/ or dysarthria can be a sign of damage to what cranial nerve?
A. CN VII
B. CN IX
C. CN X
D. CN XII

63. Answer!
A. CN VII
B. CN IX
C. CN X
D. CN XII- The hypoglossal nerve

64. Thank you for your attention and time! 