4050 final review Face PowerPoint Which cranial supply sensory and motor functions of the face Sensory from face Trigeminal nerve V Motor from face Facial nerve VII Sensory from face Trigeminal nerve V Cutaneous sensations from face pain touch trigeminal V o Proprioception from face Facial VII Touch from cornea of eye and nasal mucosa Trigeminal V off ophthalmic branch Teeth and gums trigeminal V Skin of external ear and EAC Vagus X with some V Branching of V Trigeminal V has 3 branches o Ophthalmic sensory o Maxillary sensory o Mandibular sensory and motor for mastication Testing sensory of V in face With eyes closed stroke above eyebrows to test ophthalmic branch Stroke upper lip to test maxillary branch Stroke between lower lip and chin to test mandibular branch Touching pinna or EAC test vagus nerve X Motor innervation to muscles of facial expression facial nerve VII Bilateral UMN innervation to the upper face Unilateral UMN innervation is contralateral to the lower face LMNs innervate the whole face on the same side as the cranial nerve Branching of VII VII facial branches o SVE to muscles of facial expression including muscles to close the eye o GVE to lacrimal glands nasal mucosa and some salivary glands Facial nerve VII also mediates visceral innervation to lacrimal glands nasal mucosa and sali vary glands Facial nerve VII also innervates stapedius muscle o VII dampens vibrations of the ossicles associated with loud noises stapedius muscle o V dampens vibrations of the ossicles associated with noise of chewing tensor tympani Pathology of motor of face VII UMN lesion cerebral stroke o Complete involvement below eye some involvement around eye little difficulty with forehead only applies for voluntary movement not emotionally initiated movement LMN lesion Moebius syndrome bilateral congenital atrophy of VII Bell s palsy unilateral com pression o Paralysis of the entire side of face ipsilateral to compression site Testing motor of VII in face Look for asymmetry of face at rest Wrinkle forehead and look up Close eyes as tightly as possible Smile pucker lips pout lips Whole side of face affected lesion on ipsilateral side associated with dysarthria Lower face affected with some weakness of upper face lesion on the contralat eral side associated with dysarthria corticospinal tract UMN TONGUE 4050 final review nerves nerve nerve Which cranial nerves supply sensory and motor functions of the tongue Tongue has 2 types of sensa tion taste and touch and is also able to move Each of these functions is filled by different cranial Sensory trigeminal V mandibular branch Glossopharyngeal IX Motor Hypoglossal XII General Sensory touch on tongue General sensory touch anterior 2 3 of tongue V trigeminal nerve General and special sensory touch and taste posterior 1 3 of tongue IX glossopharyngeal Special sensory taste on tongue Special sensory taste anterior 2 3 of tongue VII facial nerve General and special sensory touch and taste posterior 1 3 of tongue IX glossopharyngeal Clinical testing of sensory functions of tongue Swab dipped in flavored solution o Tests taste function of special sensory branch of VII o Tests touch function of mandibular branch general sensory of V Motor functions of tongue All tongue movement XII hypoglossal nerve Motor input to muscles that change the tongue s shape o Shorten narrow elongate flatten and make concave Move the tongue through space o Protrude draw tongue up and back Retract and depress Testing tongue movement Protrude tongue deviation to side of injured cranial nerve Lateralize tongue to corners of mouth or to internal cheek inability to lateralize on side of in jured cranial nerve Elevate tongue while you hold chin down Look for involuntary movements and wasting away of the tongue Clinical pathology of tongue in different dysarthrias Flaccid dysarthria look for atrophy changes in functional ability and involuntary movement Spastic dysarthria articulation in imprecise and distorted because muscles are too tight Ataxic dysarthria articulation is sometimes precise sometimes not due to discoordination Hyperkinetic dysarthria tongue may move involuntarily Lower jaw Which cranial nerves supply muscles used for movement of mandible Sensory Trigeminal V proprioception from jaw Motor trigeminal V mandibular branch movement of jaw Jaw movement Trigeminal V mandibular branch motor input to muscles that close and open jaw and more the jaw laterally Pathology of motor V LMN lesion of mandibular branch flaccid paresis or paralysis of the ipsilateral muscles of masti cation Slight deviation of jaw to the same side as the damaged LMN Unilateral UMN disease is unlikely to affect function because of bilateral innervation Testing motor of trigeminal nerve LMN damages Palpate area of masseter as patient bites down as hard as possible then relaxes Look for atrophy of the temporal muscle Jaw closing while you hold chin down and forehead in place Client bites down hard against re 4050 final review sistance Soft palate able to move Jaw opening with resistance under chin Patient moves jaw side to side Sensory Glossopharyngeal nerve IX Motor Trigeminal V and Vagus nerve X Which cranial nerves supply muscles used for movements of soft palate Soft palate has sensation and is Sensory innervation of soft palate Glossopharyngeal IX mediates sensation from soft palate posterior 1 3 of tongue tonsils and pharynx Also mediates sensation from the middle ear Motor innervation of soft palate Vagus X provides provides primary innervation of soft palate Trigeminal V partially responsible for flattening and tensing of soft palate and opens Eu stachian tube Motor V X soft palate should raise symmetrically when producing a raise so no nasality is Testing soft palate movement heard on oral sounds Clinical presentation of dysarthria of soft palate Flaccid dysarthria consistently hypernasal because soft palate cannot lift at all Spastic dysarthria consistently hypernasal muscles cannot reach posterior pharynx Ataxic dysarthria inconsistent hypernasality cannot coordinate timing of palate lifting Pharynx Which cranial nerves supply muscles for sensation and movements of pharynx Sensory Glossopharyngeal IX Motor Glossopharyngeal IX lateral dilation and Vagus X constrictors Sensory innervation of pharynx Motor innervation of pharynx Glossopharyngeal IX mediates sensation from soft palate posterior 1 3 of tongue tonsils and pharynx Glossopharyngeal IX is responsible for lateral dilation some