Innervation of face. The main clinical syndromes of some Cranial Nerves’ (Trigeminal, Facial, Glossopharyngeal) lesion

Trigeminal nerve nuclei Nucleus of Pons Nucleus of spinal cord pathway Nucleus of midbrain pathway Motor nucleus

Trigeminal nerve functions Motor (innervation of masseter muscles) Sensory Autonomic

Symptoms of Trigeminal nerve’s lesion facial pain sensory disturbance in face corneal reflex is decreased or absent temporal and masseter muscles are atrophic or hypotrophic, atonic or hypotonic jaw is deviated to the side of lesion

Trigeminal nerve branches Ophthalmic nerve Maxillary nerve Mandibular nerve

Ophthalmic nerve Lacrimal branch (innervation of lacrimal gland, upper eyelid, external corner of eye) Frontal branch (n. Supraorbitalis – innervation of frontal skin, n. Supratrochlearis – upper eyelid, medial corner of eye) Nasociliary branch (innervation of eyeball, mucous membrane of labyrinth, frontal sinus)

Maxillary nerve Meningeal branch Sphenopalatine nerve (for sphenopalatine ganglion) – major and minor palatine nerves, inferior posterior nasal nerves – mucous membrane of nasal cavity, palatal mucous membrane Cheek bone nerve (anterior part of temporal and posterior part of frontal area, secretion parasympathetic fibers of lacrimal gland) Nerve Infraorbitalis – upper alveolar nerves (posterior, medial, anterior), inferior branches of eyelids, external and internal nasal branches, upper branches of lips)

Mandibular nerve Meningeal branches Masticator nerve Deep temporal branches External sphenopalatine nerve Internal sphenopalatine nerve Buccal nerve Temporal-ear nerve Lingual nerve Inferior alveolar nerve Communicants branches for ear, hypoglossal and submandibular ganglions

Innervation of teeth N. Infraorbitalis upper alveolar nerves (posterior, medial, anterior) upper dental plexus (teeth, gums, paradontal, periodontal, mucous membrane of alveolar processes) Mandibular nerve inferior alveolar nerves inferior dental plexus (at ½ of person)

Trigeminal nerve Clinical examination testing pain, thermal, and other sensations in the area supplied by the Trigeminal nerve the corneal reflex test the temporal and masseter muscles are examined by palpating the muscles and attempts to resist the jaw by applying pressure

Signs of lesion of the І branches of Trigeminal nerve Pain, numbness in innervating zone Mononeuritic type of sensory disorders of all kinds of sensation Painful palpation of upper trigeminal point Decreased or absent subeyebrow, corneal and conjunctival reflexes

Signs of lesion of the ІI branches of Trigeminal nerve Pain and numbness in innervating zone Mononeuritic type of sensory disorders of all kinds of sensation Painful palpation of medial trigeminal point

Signs of lesion of the ІII branches of Trigeminal nerve Pain, numbness in innervating zone Mononeuritic type of sensory disorders of all kinds of sensation Painful palpation of lower trigeminal point Decreased or absent the mandibular reflexes Disorders of jawing, atrophy or hypotrophy of masseter muscles

The cause of Trigeminal neuralgia Idiopatic neuralgia - compression of the nerve’s root by upper cerebellar artery Symptomatic neuralgia - Multiple sclerosis - Tumor of the brain stem - Cranial trauma - Inflammation diseases of nasal sinuses - Post-herpetic neuralgia - Lesion of temporal-mandible joint

Clinical features of Trigeminal neuralgia Pain attack Trigger zones Painful paraspasm

Facial nerve Facial asymmetry patient can’t wrinkle the forehead, close eyes, purse the lips, retract the buccal angles in a smile impairment of taste on the anterior two third of the tongue Bell’s symptom corneal reflex is decreased or absent

Signs of lesion of Facial nerve before the n. Petrosus major Paresis of mimic muscles Dryness of eye, loss of lacrimation (xerophtalmia) Hyperacusis Loss of taste over anterior 2/3 of tongue Dryness of oral cavity (xerostomia)

Signs of lesion of Facial nerve before the n. Stapedius Paresis of mimic muscles Lacrimation Hyperacusis Loss of taste over anterior 2/3 of tongue Dryness of oral cavity (xerostomia)

Signs of lesion of Geniculate ganglion (Ramsay-Hunt syndrome) Herpetic involvement of Geniculate ganglion Paresis of mimic muscles Lacrimation Hyperacusis Loss of taste over anterior 2/3 of tongue Dryness of oral cavity (xerostomia) Herpes vesicular eruption in the throat or over the pinna

Signs of lesion of Facial nerve before the n. Chorda tympani Paresis of mimic muscles Tears Loss of taste over anterior 2/3 of tongue Dryness of oral cavity (xerostomia)

Signs of lesion of Facial nerve after the n. Chorda tympani Paresis of mimic muscles Lacrimation

Facial nerve Clinical examination observation of the patient while he talks and smiles. The patient is asked to show his teeth by retracting the buccal angles, to whistle to pyres the lips against the pressure of the examiner’s fingers. slight unilateral weakness may be detected by asking the patient to blow the cheeks out fully.

Facial nerve Clinical examination the platisma function - the patient makes a maximal effort to draw the lower lip and angle of the mouth downward and outward, at the same time tensing the skin over the anterior surface of the neck. Taste is examined with the use of sugar, tartaric acid, sodium chloride, quinine, or similar substances. The patient is instructed to protrude the tongue; a small quantity of the test substance is gently rubbed on one side of the tongue and the patient signals identification of the test substance before drawing the tongue into the mouth to prevent diffusion of the taste to the opposite side or to the posterior third of the tongue, thus obscuring the test.

n. Glossopharyngeus n. Vagus the voice is hoarse or brassy dysphagia and regurgitation of fluids through the nose the testing of taste sensation on the posterior one third of the tongue ipsilateral paralysis of the palatal, pharyngeal, and laryngeal muscles bilateral lesion (dyspnea, apnea, periodic respiration - Cheyne-Stokes breathing)

Function of n. Glossopharyngeus motor sensory autonomic

Motor function of n. Glossopharyngeus Motor nucleus (n. ambiguus, common with X Cranial nerve) is located in medial part of oblong brain. Fibers from this nuclei are going on the back of olive, аfter that — through the jugular fosse of scull and innervate m. Stilopharyngeus

Sensory function of n. Glossopharyngeus General sensation - g. jugularae superius a) Dendrites innervated posterior 1/3 of the tongue, palatine muscles, pharyngs, otic membrane, otic cavity b) Axons are finished in nucleus alae сіnеrеа

Sensory function of n. Glossopharyngeus Taste sensation - inferior Jugular ganglion a) Dendritis are going to the posterior 1/3 of the tongue b) Axons are finished in nucleus tractus solitarii

Autonomic function of n. Glossopharyngeus Secretion autonomic fibers start from nucleus salivatorius, which is located in lower part of the oblong brain, preganglion firbers are going to the Otic ganglion, postganglion firbers innervate Parotid gland

The cause of Glossopharyngeal neuralgia Compression due to the hypertrophy of processus stiloideus Compression due to the ossification of ligament stilopalatinum Compression due to the posterior lower cerebellar artery Cancer on base of the tongue, tumors of the larynx

Clinical features of Glossopharyngeal neuralgia Paroxysmal pain in tongue radix, pharynx, tonsils, lateral part of the neck, angle of the mandible Trigger zones (tonsils, base of the tongue)

Bulbar syndrome dysarthria dysphagia dysphonia gag reflex is absent or decreased the tongue is atrophic paralysis is unilateral or bilateral can be (dyspnea, apnea, periodic Cheyne-Stokes respiration)

Pseudobulbar syndrome dysarthria dysphagia dysphonia the pathologic oral reflexes are present Involuntary crying, smiling paralysis is only bilateral