Complicated Cranial Nerves Flashcards

1
Q

what are the 4 general efferent fibers that the Trigmenial nerve carries

A

to muscles of mastication, floor of mouth, on muscles of soft palate and one muscle to middle ear

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2
Q

what are the 6 general afferent (sensory) fibers that the trigeminal nerve carries

A

face, teeth, mouth, nasal cavity, orbit and dura

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3
Q

where is the trigeminal ganglion located

A

in the trigeminal (Meckel’s) cave under the dura in a depression on the petrous part of the temporal bone

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4
Q

where does V1 travel after leaving the middle cranial fossa

A

through the wall of the cavernous sinus

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5
Q

what branch does V1 give off before passing through the superior orbital fissure

A

a recurrent meningeal branch (general afferents from dura of anterior and posterior cranial fossae)

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6
Q

which branch of CN5 suspends the ciliary ganglion

A

V1- nasociliary nerve

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7
Q

what hitchhikers are carried with V1

A

visceral efferents to smooth muscle of the eye

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8
Q

what 2 fibers are associated with the lacrimal nerve

A

general afferents from lacrimal gland and visceral efferents from pterygopalatine ganglion for lacrimal gland

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9
Q

which branch of V1 innervates the frontal sinus

A

supraorbital nerve -> frontal nerve -> V1

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10
Q

which branch of CN5 carries the hitchhikers from the pterygopalatine ganglion

A

nasociliary nerve -> short ciliary nerves

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11
Q

which branch of CN5 innervates the sphenoidal sinus

A

posterior ethmoidal nerves -> nasociliary -> V1

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12
Q

what 4 areas does the anterior ethmoidal nerve innervate

A

GA from ethmoidal air cells, anterior/superior nasal cavity, tip of nose, and dura of anterior cranial fossa

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13
Q

what 2 areas do the posterior ethmoidal nerves innervate

A

GA from sphenoidal sinus and dura of anterior cranial fossa

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14
Q

where does V2 suspend the pterygopalatine ganglion

A

superior part of pterygopalatine fossa suspended by pterygopalatine nerves

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15
Q

how many branches does V2 give off before going into the inferior orbital fissure

A

3 general afferent branches

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16
Q

how many branches does V2 split into after becoming the infraorbital nerve

A

2 more branches before exiting onto the face through infraorbital foramen

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17
Q

what 2 branches does the zygomatic nerve have

A

zygomaticotemporal and zygomaticofacial

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18
Q

where does the zygomatic nerve of V2 enter the orbit

A

through inferior orbital fissure

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19
Q

where does the posterior alveolar nerve pass after the pterygopalatine fossa

A

through pterygomaxillary fissure and enters the infraorbital fossa then to posterior superior alveolar foramen

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20
Q

where are the ganglionic branches of V2

A

they pass from maxillary nerve inferiorly through pterygopalatine ganglion

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21
Q

what are the 5 branches of the infraorbital nerve of V2

A

anterior superior alveolar nerve, middle superior alveolar nerve, nasal, palpebral, and superior labial branches

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22
Q

where does the infraorbital nerve leave the pterygopalatine fossa through

A

the inferior orbital fissure

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23
Q

what does the anterior superior alveolar nerve of V2 supply innervation to

A

joins the superior dental plexus and carries GA from anterior maxillary teeth and labial gingivae

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24
Q

which branch of V2 supplies the maxillary sinus

A

middle superior alveolar nerve

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25
Q

what are the 3 terminal branches of the infraorbital nerve of V2

A

nasal, palpebral and superior labial branches

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26
Q

what 3 things do the branches of the pterygopalatine ganglion carry

A

GA, distribute hitchhiking VE to mucous glands and blood vessels in mucosa of nasal cavity and palate, hitchhiking special afferent (taste) from palate

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27
Q

where do the orbital branches of pterygopalatine ganlion pass through and what do they innervate

A

pass through inferior orbital fissure- supply orbital wall and sphenoidal/ethmoidal sinuses

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28
Q

whata re the 7 branches of the pterygopalatine ganglion

A

orbital, palatine, greater palatine nerve, lesser palatine nerve, nasopalatine nerve, posterior superior lateral nasal nerves, and pharyngeal branch

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29
Q

where does V3 suspend the otic ganglion

A

just inferior to foramen ovale

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30
Q

how many branches does V3 split into in the infratemporal fossa

A

4 major GA branches and numerous direct muscular branches

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31
Q

what branch of V3 suspends the submandibular ganglion

A

lingual nerve

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32
Q

what hitchhikers are associated with the auriculotemporal nerve

A

postganglionic parasympathetic fibers from otic ganglion

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33
Q

does the buccal nerve of V3 pierce the buccinator muscle

A

no it passes anteriorly but does not pierce or innervate it

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34
Q

what branch of CN7 joins the lingual nerve of V3 and where does it join

A

chorda tympani, infratemporal fossa

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35
Q

what are 2 hitchhikers that the lingual nerve of V3 carries

A

pre- and postganglionic parasympathetic fibers to the submandibular and sublingual salivary glands, and special afferent fibers from anterior 2/3 of tongue

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36
Q

what are 2 GE for muscles that the inferior alveolar nerve carries

A

nerve to mylohyoid and anterior belly of digastric muscles

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37
Q

What are the 4 muscles innervated by the descending branches, that arise in the infratemporal fossa, of V3

A

masseteric, temporal, medial pterygoid and lateral pterygoid

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38
Q

what 3 muscles does the medial pterygoid muscular branch of V3 go to

A

GE to medial pterygoid, tensor tympani, and tensor veli palatini muscles

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39
Q

what 5 things occur with a trigeminal nerve lesion

A

rare- paralysis of muscles of mastication and deviation of jaw to affected side; anesthesia of face; loss of corneal touch reflex; and loss of sneezing reflex

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40
Q

where do the 2 roots (sensory and motor) of CN7 fuse together

A

they enter the petrous part of temporal bone - through internal auditory meatus- and fuse in the facial canal

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41
Q

where is the geniculate ganglion located for CN7

A

at a sharp posteroinferior bend in the facial canal

42
Q

how many branches does CN7 give off in the facial canal and what are they

A

4: greater petrosal nerve, nerve to stapedius, chorda tympani and auricular branch

43
Q

where does the facial canal end

A

at the stylomastoid foramen

44
Q

how many branches does CN7 give off after leaving the stylomastoid foramen

A

1 more branch- GE nerves to stylohyoid muscle and posterior belly of digastric

45
Q

when does CN7 form the parotid plexus

A

after entering the parotid gland

46
Q

what are the 5 branches given off the parotid plexus from CN7

A

posterior auricular, temporal, buccal, mandibular and cervical branches

47
Q

how are the postganglionic parastympathetic fibers from the great petrosal nerve distributed to their targets

A

along with postganglionic sympathetic fibers from internal carotid plexus by GA branches of V2

48
Q

after branching at the geniculate ganglion and traveling through the petrous part of temporal bone, where does the greater petrosal nerve go

A

emerges through the hiatus for greater petrosal nerve and travels in groove towards foramen lacerum- there it is joined by DPN

49
Q

what do the greater petrosal nerve and the deep petrosal nerve form and where does it go

A

the nerve of the pterygoid canal- travels to the pterygopalatine fossa and synapses at the ganglion

50
Q

where does the chorda tympani branch of CN7 pass through

A

the middle ear cavity between malleus and incus bones- leaves petrous part via petrotympanic fissure and enters infratemporal fossa

51
Q

how do the postganglionic sympathetic fibers reach the salivary glands

A

along branches of the external carotid artery

52
Q

what CN is the most frequently damaged

A

CN 7 (facial nerve lesions)- vulnerable to swelling in facial canal

53
Q

what occurs if the lesion of CN7 is at or distal to stylomastoid foramen

A

facial paralysis- Bells Palsy

54
Q

what happens if the CN7 lesion is in the facial canal distal to geniculate ganglion but proximal to branching of chorda tympani

A

Bell’s palsy + decrease in salivation and loss of taste from anterior 2/3 of tongue (sometimes hyperacusis)

55
Q

what happens if the CN7 lesion is in the facial canal at or proximal to geniculate ganglion

A

Bells palsy + decrease in salivation and loss of taste from 2/3 anterior tongue + hyperacusis (paralysis of stapedius) + loss of lacrimation

56
Q

what happens if the CN7 lesion is in the infratemporal fossa- injury of lingual nerve proximal to junction of chorda tympani

A

anesthesia of anterior 2/3 tongue, floor of mouth, and lingual gums

57
Q

what happens if the CN7 lesion is in the infratemporal fossa- injury to chorda tympani prior to junction with lingual nerve

A

decrease salivary secretion and loss of taste from most of tongue on that side

58
Q

what happens if the CN7 lesion is in the infratemporal fossa- injury of the lingual nerve distal to the junction of chorda tympani

A

anesthesia of anterior 2/3 tongue, floor of mouth, lingual gums and decrease salivary secretion and loss of taste on that side

59
Q

what happens if the CN7 lesion is in the orbit- injury to communicating branch from zygomatic nerve

A

loss of lacrimation

60
Q

what happens if the CN7 lesion is in the orbit- and injures zygomatic nerve

A

loss of lacrimation and facial anesthesia of upper cheek and anterior temple

61
Q

which 2 nerves form the pharyngeal plexus

A

CN 9 and CN 10

62
Q

what are 6 GA fibers that CN 9 glossopharyngeal carries

A

afferent fibers from tongue, oropharynx, tonsils, middle ear, pharynogotympanic tube, and mastoid air cells

63
Q

what 2 GA and 3 GE fibers does CN 10 Vagus carry

A

GA fibers from laryngopharynx and larynx and GE fibers to soft palate, pharynx, and larynx

64
Q

what fibers do both CN 9 and CN 10 carry

A

visceral afferents from carotid body/sinus and participate in gagging and swallowing reflexes

65
Q

which CN 9 or 10 is the afferent part of the gagging and swallowing reflexes

A

9 is the afferent part and 10 is the efferent part

66
Q

what visceral efferent does CN 9 carry

A

VE for parotid gland

67
Q

what GE does CN 9 carry

A

GE to stylopharyngeal muscle

68
Q

what are the 3 branches off of CN 9

A

tympanic nerve, pharyngeal branches and carotid sinus branch

69
Q

where does the tympanic branch re-enter after leaving the jugular foramen

A

the petrous part of temporal bone - travels within the middle ear

70
Q

what type of fibers does the tympanic nerve of CN 9 carry

A

takes part in the tympanic plexus- providing GA and carries preganglionic parasympathetic axons destined to otic ganglion

71
Q

what joins the pharyngeal branch to form part of the pharyngeal plexus

A

vagus nerve

72
Q

what type of fibers do the pharyngeal branches of CN 9 carry

A

GA from mucous membranes of oropharynx

73
Q

what type of fibers does the carotid sinus branch of CN 9 carry

A

VA from carotid body and carotid sinus related to blood pressure

74
Q

what muscle does CN 9 travel with- providing GE along the way

A

stylopharyngeus muscle

75
Q

what connects the pharynx and middle ear

A

pharyngotympanic tube (eustachian tube/auditory tube) - cartilage and membranous tube

76
Q

where does the lesser petrosal nerve arise from

A

the tympanic plexus of CN 9

77
Q

where does the lesser petrosal nerve travel

A

leaves middle ear and enters middle cranial fossa via hiatus for for lesser petrosal nerve -> leaves MCF via foramen ovale to otic ganglion

78
Q

after synapsing in the otic ganglion, how are the postganglionic parasympathetic fibers distributed

A

with the auriculotemporal nerve of V3

79
Q

what happens with glossopharyngeal nerve lesions

A

usually not noticed unless combined with another nerve lesion: loss of taste from posterior 1/3 of tongue and loss of gag reflex on affected side

80
Q

what 2 other nerves are usually included with a CN 9 lesion

A

vagus and spinal accessory: lesion at jugular foramen

81
Q

what is glossopharyngeal neuraliga

A

rare: severe pain in back of tongue, throat, tonsillar area, and middle ear that last from a few seconds to minutes

82
Q

what causes glossopharyngeal neuralgia

A

chewing, swallowing, laughing, speaking and coughing

83
Q

what is the cause and treatment for glossopharyngeal nerualgia

A

cause is unknown, treatments= anti-seizure meds and surgery to compress nerve

84
Q

what are the 2 branches of CN 10 within the jugular foramen

A

meningeal branch and auricular branch

85
Q

what does the meningeal branch of CN 10 do

A

returns to posterior cranial fossa- carries GA from dura

86
Q

what does the auricular branch of CN 10 do

A

travels within the bones of skull and carries GA from skin of deep part of ear and external auditory meatus

87
Q

what are the 5 branches of CN 10 in the neck

A

pharyngal, carotid body, superior laryngeal nerve, cardiac, and recurrent laryngeal branches

88
Q

what 2 things does the pharyngeal branches of CN 10 carry

A

GE to most muscles of pharynx and soft palate and preganglionic parasympathetics to pharyngeal mucosa

89
Q

what fibers do the carotid body branch of CN 10 carry

A

visceral afferents from carotid body and sinus

90
Q

what are the 2 branches off the superior laryngeal nerve of CN 10

A

external and internal laryngeal branches

91
Q

what 2 things does the external laryngeal branch of the superior laryngeal nerve of CN 10 carry

A

GE to cricothyroid muscle and inferior pharyngeal constrictor muscle

92
Q

what 3 things does the internal laryngeal branch of the superior laryngeal nerve of CN 10 carry

A

preganglionic parasympathetic to mucosa of superior part of larynx; GA from laryngeal mucosa of superior larynx and piriform recess; and SA (taste) from epiglottis

93
Q

what does the cardiac branches of CN 10 carry

A

preganglionic parasympathetics to heart (cardiac plexus)

94
Q

what 2 things does the recurrent laryngeal branches of CN 10 carry

A

GE to intrinsic muscles of larynx, preganglionic parasympathetic to mucosa of inferior part of larynx; GA from laryngeal mucosa of inferior part of larynx

95
Q

why would a person get a vagus nerve lesion

A

rare- but typically a result of tumors or hemorrhages

96
Q

what are the symptoms of a vagus nerve lesion

A

related to motor functions of the vagus nerve and include impairment of speaking and/or swallowing

97
Q

what occurs if the pharyngeal branches of vagus are injured

A

disphagia

98
Q

what occurs if the laryngeal branches of vagus are injured

A

hoarseness, disphonia if damage is unilateral and aphonia if damage is bilateral

99
Q

what is jugular foramen syndrome

A

unilateral impairment of CN 9, 10, 11

100
Q

what causes jugular foramen syndrome

A

penetrating neck injuries, basilar skull fractures or glomus jugular tumors at the jugular foramen

101
Q

what are symptoms of jugular foramen syndrome

A

hoarseness, disphagia, deviation of uvula to the unaffected side, loss of gag reflex on affected side, and weakness of rotation of head towards aunaffected side