Cranial Nerves Flashcards
What are the most important nerves in dentistry (dental-related nerves)? And why?
- Trigeminal nerve (CN V)
- Facia nerve (CN VII)
-As we deal with these nerves daily in the clinic either by anaesthetising them (pain control) to facilitate comfortable dental treatment or by avoiding damaging them during surgical procedures (avoid facial weaknesses and palsies
There are 12 cranial nerves, explain how were they named and numbered?
- Named based on their functions
- Numbered based on where they arise from in the brain
What are the parts of Brainstem?
- Midbrain
- Pons
- Medulla Oblangata
Cranial Nerve Nuclei (7 types of information transmitted by cranial nerves)?
Afferent (Sensory):
Transmit sensory info from sensory receptors of body towards CNS “Brain”
- GSS (General Somatic Sensory): receive sensory information from skin, skeletal muscles and joints
- GVS (General Visceral Sensory): receive sensory information from the viscera (organs)
- SSS (Special Somatic Sensory): receive sensory information (senses) derived from Ectoderm (ectodermal retina “sight”, cochlear “sound” and vestibular apparatus “balance”)
- SVS (Special Visceral Sensory): receive sensory information (senses) derived from Endoderm (endodermal nose “smell” and tongue “taste”)
Efferent (Motor):
Transmit motor information from CNS “Brain” towards muscles and glands “Body”
- GSM (General Somatic Motor): provide motor innervation to skeletal muscles
- GVM (General Visceral Motor): provide secreto-motor function to smooth muscle “gut” & glands
- SVM (Special Visceral Motor): provide motor innervation to skeletal muscles of pharyngeal arches
Definition of Foramina?
Openings (holes) in the cranium where the cranial nerves pass through to exit the cranium and go to perform their sensory and motor functions
What are the 3 Foramina where the cranial nerves pass through to exit the cranium?
- Foramen Rotundum (Passage of Maxillary nerve “2nd division of Trigeminal nerve / V2 of CN V”)
- Foramen Ovale (Passage of Mandibular nerve “3nd division of Trigeminal nerve / V3 of CN V”)
- Internal Acoustic Meatus (Passage of Facial nerve “CN VII”)
Answer below questions about the CN 1:
Name:
Arise from:
Function:
Clinical/Dental relevance:
How to examine:
Name: Olfactory
Arise from: Cerebrum
Function:
Sensory-
Transmits Smell info from Nose to Olfactory Area in Temporal Lobes (CNS)
Clinical/Dental relevance:
Limited relevance:
Anosmia (Partial or Full Loss of Smell)
How to examine:
*Ask if any changes in smell & taste
*Test each nostril (with the occluding of the other nostril) by asking to identify a specific smell (eg: coffee/mint) with eyes closed
Answer below questions about the CN 2:
Name:
Arise from:
Function:
Clinical/Dental relevance:
How to examine:
Name: Optic
Arise from: Cerebrum
Function:
Sensory-
Transmits Vision info from Retinas (Eyes) to Visual Cortex (CNS)
Clinical/Dental relevance:
Blindness (to one of the eyes or both)
How to examine:
Using Snellen chart by an optometrist
Regarding the Optic nerve:
Where do the paired optic nerves meet?
The optic chiasma:
- Nasal retinal axons will cross to the opposite side of the brain
- Whereas temporal retinal axons do not cross sides.
Answer below questions about the CN 3:
Name:
Arise from:
Function:
Clinical/Dental relevance:
How to examine:
Name: Oculo-motor
Arise from: Junction of Midbrain and Pons
Function:
Motor-
- GSM: Transmits info to 4 Extrinsic Eye muscles + Levator Palpebrae Superioris (Eyelid muscle to elevate the lid)
- GVM: Transmits info to Pupillary Sphincter (constricts pupil)
Clinical/Dental relevance:
1. Oculo-motor nerve palsy/damage due to:
*Raised intra-ocular pressure
*Aneurysm
*Cavernous sinus infection
*Trauma
- Down & Out position of the eye at rest due to paralysis of Some of the extrinsic muscles (Superior rectus, Inferior rectus, Medial rectus and Inferior oblique) without affecting Superior oblique and Lateral rectus activity
- Ptosis (drooping of upper eyelid) due to paralysis of eyelid muscle (Levator Palpebrae Superioris) without affecting Orbicularis Oculi activity (Eyelid muscle to close the lid)
- Dilated Pupil due to
Unopposed action of dilator pupillae muscle (this means with bright light, Pupils will keep in dilating “no constriction”, so no light reflex)
How to examine:
*Ask pt if having changes in vision (Blurring, Diplopia)
*Test eye movements by asking them to follow you finger/pen in H-shaped movement
Answer below questions about the CN 4:
Name:
Arise from:
Function:
Clinical/Dental relevance:
How to examine:
Name: Tro-chlear
Arise from: Midbrain
Function:
Motor-
Transmits info to Superior Oblique muscle (Eye muscle that depresses “sad eyes” and internally rotate the eyes)
Clinical/Dental relevance:
Tro-clear nerve palsy/damage due to:
*Raised ICP pressure
*Cavernous sinus thrombosis
*Micro-vascular damage (Hypertension & DM)
Leading to:
*Vertical Diplopia (Blurring or Double vision) that exacerbated when looking downwards & inwards (reading, walking downstairs)
*Head tilt away from the affected side
How to examine:
*Ask pt if having changes in vision (Blurring, Diplopia)
*Test eye movements by asking them to follow you finger/pen in H-shaped movement
Answer below questions about the CN 5:
Name:
Arise from:
Function:
Clinical/Dental relevance:
How to examine:
Name: Trigeminal
Arise from: Pons
Function:
Both (S+M) & Some Para-sympathetic -
S: Transmits info from skin, mucous membranes (All intra-oral tissues) and facial sinuses to CNS
M (Only by the Mandibular division “V3” due to having motor fibers):
Transmits info to MOM
Supplies/Innervates all derivatives of the FIRST pharyngeal arch (Anterior belly of digastric, Mylohyoid, Tensor veli palatini (soft palate) and Tensor tympani (ear))
Clinical/Dental relevance:
1. Highly-related to dentistry during LA and 3rd molar surgery so be careful
- Trigeminal neuralgia (Painful nerve malfunction in the distribution of Trigeminal nerve)
- Unexplained or new onset numbness in the distribution of the Trigeminal nerve (Red flag!!)
How to examine:
1.Test of ophthalmic nerve (Corneal reflex): Using cotton roll to touch the cornea (Lack of a reflex indicates damage to either the trigeminal “opthalmic” or facial nerves)
2.Test of Sensory supply: Ask pt to close eyes & introduce a cotton to areas of the face supplied by CN5 (all 3 divisions) to detect tactile sensory competence
3.Test of Motor supply: Ask pt to clench jaw and you palpate Temporalis and Masseter contractions competence. Then ask pt to open mouth and deviate it to left & right to check Medial and Lateral Pterygoid competence
Trigeminal nerve branches leave the cranium into 3 trunks (Divisions). Mention the 1st division and explain its function?
Opthalmic branch (V1):
Function:
1) S:
-General Somatic Sensory (GSS) innervation from Scalp, Forehead, Frontal, Ethmoid sinuses, Upper eyelids, Cornea and dorsum of the nose
-Corneal reflex: Opthalmic nerve detects a stimulus on the cornea, stimulating facial motor nerve to stimulate Orbicularis Oculi muscle (muscle to close eyelid) to contract and blink involuntary (So, the corneal reflex is detected by CN V but the reflex (reaction) will be produced by CN VII)
2) Para-sympathetic: Innervates Lacrimal gland
How to test the corneal reflex?
The corneal reflex is tested as part of a cranial nerve exam by using cotton roll to touch the cornea (lack of a reflex indicates damage to either the trigeminal “opthalmic” or facial nerves). This isn’t a test that is often required, particularly in dental practice
Trigeminal nerve branches leave the cranium into 3 trunks (Divisions). Mention the 2nd division and explain its function?
Maxillary branch (V2):
Function:
1) S:
-General Somatic Sensory (GSS) innervation from Lower eyelid, Cheeks, Nasal mucosa, Upper lip, Upper teeth and Palate
2) Para-sympathetic: Innervates Lacrimal gland