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

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

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

Cranial Nerve VII: Facial Nerve

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

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

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.

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

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

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?

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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)

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

Answer! C) Medulla

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

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.

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

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.

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

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

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

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?

BONUS ANSWER SENSORY INFORMATION for touch, temperature and pressure

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

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)

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

ANSWER! C) CN X

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

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

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

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

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

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

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

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

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

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

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

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

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.

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.

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

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

Thank you for your attention and time! 