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(4) Head & Neck - Sessions > Cranial Nerves > Flashcards

Cranial Nerves Flashcards

1
Q

Name all the Cranial Nerves.

A
  • CN I - Olfactory
  • CN II - Optic
  • CN III - Oculomotor
  • CN IV - Trochlear
  • CN V - Trigenminal (Opthalmic, Maxillary, Mandibular)
  • CN VI - Abducens
  • CN VII - Facial
  • CN VIII - Vestibulocochlear
  • CN IV - Glossopharyngeal
  • CN X - Vagus
  • CN XI - Accessory
  • CN XII - Hypoglossal
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2
Q

Name Cranial Nerve I and describe its innervation. How does it exit the cranium?

A

Olfactory

  • Special Sensory - Olfaction (smell)
  • through Cribiform Plate of Ethmoid Bone
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3
Q

Name Cranial Nerve I and describe its innervation. How does it exit the cranium?

A

Olfactory

  • Special Sensory - Olfaction (smell)
  • through Cribiform Plate of Ethmoid Bone
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4
Q

What may be the complications of fractured Cribiform Plate of the Ethmoid Bone?

A
  • Ansomnia

- Rhinorrhea

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5
Q

Name Cranial Nerve II and describe its innervation. How does it exit the cranium?

A

Optic

  • Special sensory - Vision
  • through Optic Canal
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6
Q

How may increased cranial pressure lead to blindness?

A
  • Optic nerve is a brain tract e.g. wrapped around with meninges
  • Raised ICP -> Swollen Optic Nerve
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7
Q

Name Cranial Nerve III and describe its innervation. How does it exit the cranium?

A

Oculomotor

  • Somatic Motor - Extraocular muscles (except Superior Oblique & Lateral Rectus) & Levator Palpebrae Superioris
  • PNS Motor - Constrictor Pupillae
  • through Superior Oribital Fissure
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8
Q

How may a Cranial Nerve III palsy represent?

A
  • Out and down eyeball
  • Complete Ptosis
  • Dilated Pupil
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9
Q

Name Cranial Nerve IV and describe its innervation. How does it exit the cranium?

A

Trochlear

  • Somatic Motor - Superior Oblique
  • through Superior Orbital Fissure
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10
Q

How do you test a Cranial Nerve IV palsy represent?

A
  • Extorted eyeball

- Patient unable to look medially when looked down e.g. unable to read book

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11
Q

Name Cranial Nerve V and describe its innervation. How does it exit the cranium?

A

Trigeminal

  • Opthalmic Br. leaves via Superior Orbital Fissure
  • Opthalmic Br. - general sensory - Upper Conjunctive & Cornea & Scalp & forehead & anteriosuperior nose & Frontal + Ethmoid sinuses
  • Maxillary Br. leaves via Foramen Rotundum
  • Maxillary Br. - general sensory - Maxillary sinuses & Posteroinferior nose & Palate & Upper teeth & upper lip
  • Mandibular Br. leaves via Forman Ovale
  • Mandibular Br. - general sensory - Auricles & External Acoustic Canal & External Eardrum membrane & skin of Temples & Cheeks & Lower Teeth & Anterior 2/3 tongue
  • Mandibular Br. - somatic motor - muscles of Mastication
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12
Q

A patient comes to you with rashes on his Upper forehead and complains about severe pain in of his eyes. What may be the diagnosis?

A

Varicella Zoster infection of Opthalmic Nerve (CN Vi)

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13
Q

What is the Corneal reflex?

A

irritation of cornea -> Opthalmic (CN Vi) efferent -> brain -> Facial (CN VII) afferent -> Orbicularis Oculi -> blinking

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14
Q

How do you test the Mandibular Nerve?

A

Palpate Temporalis and Masseter when patient clenches the teeth

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15
Q

Name Cranial Nerve VI and describe its innervation. How does it exit the cranium?

A

Abducens

  • Somatic Motor - Lateral Rectus
  • through Superior Orbital Fissure
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16
Q

How may an infection of Oculomotor Nerve spread to other nerves? Which nerves may be affected?

A
  • CN IV - Trochlear
  • CN Vi - Opthalmic
  • CN Vii - Maxillary
  • CN VI - Abducens
  • all these nerves are surrounded by Cavernous Sinus
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17
Q

What is the Corneal reflex?

A

irritation of cornea -> Opthalmic (CN Vi) Afferent -> brain -> Facial (CN VII) Efferent -> Orbicularis Oculi -> blinking

18
Q

Name Cranial Nerve VII and describe its innervation.

A

Facial Neve

  • General sensory - via CN Viii, Auricle & External Acoustic Meatus
  • Special sensory - Taste of anterior 2/3 of tongue
  • Somatic motor - muscles of Facial Expression
  • PNS - Greater Petrosal Br. - Mucous glands of oral cavity, nose, pharynx & Lacrimal glands
  • PNS - Chorda Tympani Br. - Submandibular & Sublingual salivary glands
19
Q

Name Cranial Nerve VIII and describe its innervation. How does it exit the cranium?

A

Vestibulocochlear

  • Vestibular Br. - special sensory - Balance
  • Cochlear Br. - special sensory - Hearing
  • through Internal Acoustic Canal
20
Q

Describe the course of Cranial Nerve VII.

A

Arise from brain with 3 nuclei:
- Facial Nucleus - motor
- Nucleus Salitarius PNS
3 roots travel within Temporal Bone first via Internal Acoustic Canal
- close to the inner ear
- also the Trochlear Nerve
Enter Facial Canal then:
- motor & sensory roots fuse to form Facial Nerve Proper
- Facial Nerve Proper & PNS fibres form the Geniculate Ganglion
They branch to give rise:
- Greater Petrosal Nerve -> PNS fibres to mucous glands
- Nerve to Stapedius
- Chorda Tympani PNS to Submandibular & Sublingual glands
Rest of fibres as Cranial Nerve exits cranium via Stylomastoid Foramen then
- 3 motor branches run posterior to the ear and neck
- main motor trunk travels through Parotid gland without innervating it, splits into 5 motor fibres to muscles of Facial expression

21
Q

Compare and contrast Lower Motor Neurone Facial Nerve Palsy and Bell’s Palsy.

A
  • Loss facial expression - Occipitofrontalis spared (caused by BILATERAL UPPER motor neurone Facial N palsy)
  • Complete Ptosis
  • Loss of lacrimation & secremotor function in oral and nasal mucosa
  • Changes in taste & hearing
  • Facial Nerve Palsy: often permanent & known causes
  • Bell’s Palsy: will recover & idiopathic causes
22
Q

Name Cranial Nerve IX and describe its innervation. How does it exit the cranium?

A

Glossopharyngeal

  • General sensory - Pharynx & Middle Ear & internal surface of Tympanic Membrane & posterior 1/3 Tongue
  • Special sensory - Taste of posterior 1/3 tongue
  • Visceral sensory - Carotid Body & Sinus
  • Somatic motor - Stylopharyngeus
  • PNS - Parotid Gland
  • through Jugular Foramen
23
Q

Name Cranial Nerve X and describe its innervation. How does it exit the cranium?

A

Vagus

  • General sensory - External Acoustic Canal & external surface of Tympanic Membrane
  • Motor - muscles of Pharynx, Larynx & Palate
  • PNS - smooth muscles & glands of Thorax (including bronchi) & Abdomen
24
Q

How may the Vagus Nerve be damaged? What complication may it cause?

A
  • Left Recurrent Laryngeal Br. is more vulnerable
  • Mitral Stenosis -> enlarged LA -> lifted L. Pulmonary A. -> push L. Recurrent Laryngeal N. against Aortic Arch
  • Paralysis of Vocal Cords -> hoarseness in voice
25
Q

Name Cranial Nerve XI and describe its innervation. What is special about this Cranial nerve? How does it exit the cranium?

A

Accessory

  • the only Cranial nerve arises from Spinal Cords, receives roots from C2-C4
  • Somatic motor (Cranial Br.) - muscles around neck
  • Somatic motor (Spinal Br. ) - Trapezius & Sternocleidomastoid
  • through Jugular Foramen
26
Q

Name Cranial Nerve XI and describe its innervation. How does it exit the cranium?

A

Hypoglossal

  • Somatic motor - Tongue
  • through Hypoglossal Canal
27
Q

How may damages to CN III at different locations present differently?

A
  • Distal to Ciliary Ganglion (affecting only efferent fibres): Out & down eyeball + Complete Ptosis
  • Proximal to Ciliary Ganglion (affecting both efferent & PNS fibres): above + Mydriasis + loss of accommodation reflex
28
Q

How may an infection of the Internal Carotid Artery spread to cranial nerves?

A
  • Through Cavernous Sinus, affecting:

- CN III, IV, Vi, Vii, VI

29
Q

How is the Opthalmic Nerve tested?

A

Corneal reflex

- irritation -> Opthalmic afferent -> brain -> Facial efferent -> Orbicularis Oculi

30
Q

Which branches of the Trigenminal nerve are hitch-hiked by Sympathetic fibres? What may a damage to their presynaptic fibres cause?

A
  • CN Vii Maxillary & CN Viii Mandibular

- Damage -> Harlequin Syndrome: Anhydrosis + Vasodilation of the affected sensory territories

31
Q

How do you test whether the CN VII is damaged?

A
  • Inspection of facial symmetry (forehead spared)
  • Changes in taste and hearing?
  • Dry mouth & nose?
  • Examination of motor function:
    Occipitofrontalis -> raise eyebrows
    Orbicularis Oculi -> close eyes
    Buccinator -> blow up cheeks
    Levator Labii Inferioris -> show teeth
32
Q

What are the possible causes of Facial Nerve palsy?

A
  • Parotid pathology (Parotiditis/Parotidectomy)
  • Trauma (Temporal bone fracture)
  • Neurological
  • Neoplasty
  • Cerebrovascular disease
  • often unilateral, if bilaterally: Parkinson’s Disease
33
Q

Describe the anatomical course of CN VII.

A
  1. Originates from brainstem with 3 nuclei:
    A. Facial Nucleus -> motor
    B. Solitary Nucleus PNS
  2. All fibres through Internal Acoustic Canal into Pterosal part of Temporal Bone (near inner ear)
  3. Enter Tympanic Cavity and split:
    A. Greater Petrosal N (only PNS) -> Pterygopalatine Ganglion -> Constrictor Pupillae
    B. Nerve to Stapedius
    C. Chorda Tympani (PNS + sensory) -> Submandicular Ganglion -> hitch-hikes on Lingual Nerve (br. of CN Viii) -> Submandibular + Sublingual Glands (PNS) and Taste of anterior 2/3 tongue
  4. Major branch of Facial Nerve exits through Stylomastoid Foramen near Mastoid process then splits:
    A. hjks Auriculotemporal Br of CN Viii -> sensory to Auricles
    B. Nerves to posterior belly of Digastric & Stylomastoid
    C. Motor Br -> Parotid Gland and splits:
    a. Temporal Br.
    a. Zygomatic Br.
    a. Buccal Br.
    a. Mandibular Br.
    a. Cervical Br.
34
Q

Describe the course and targets of the Cranial nerves that has brain stem Parasympathetic nuclei.

A
  • Edinger-Westphall nucleus -> Oculomotor N -> synapses at Ciliary ganglion -> Constrictor Pupillae
  • Superior Salivatory nucleus -> Facial N -> greater Petrosal N -> synapses at Pteryogopalatine nucleus -> Lacrimal glands & Mucous glands of oral and nasal cavities
  • Superior Salivatory nucleus -> Facial N -> Chorda Tympani N hitch-hikes on Lingual N (br. of CN Viii) -> synapses at Submandibular ganglion -> Submandibular & Sublingual glands
  • Inferior Salivatory nucleus -> Glossopharyngeal N -> hitch-hikes on Auriculotemporal N (br. of CN Viii) -> synapses at Otic ganglion -> Parotid glands
  • Inferior Salivatory nucleus -> Glossopharyngeal N -> directly -> Oropharynx glands
  • Dorsal Vagal Motor nucleus -> Vagus N -> directly -> Laryngopharyngeal glands
35
Q

How does the head and neck receive their Sympathetic inputs?

A
  • Presynaptic SNS fibres synapse at Superior/Middle/Inferior ganglion
  • Postsynaptic fibres travel along arteries (their main targets) to their targeting structures
36
Q

Describe briefly the target of Sympathetic inputs to the head and neck?

A
  • Superior ganglion -> Cardiac plexus + Pharyngeal plexus + C1-C4
  • Middle ganglion -> Cardiac plexus + C5-C6
  • Inferior ganglion -> Cardiac plexus + C7-T1
37
Q

What happens if the Sympathetic Trunk is damaged?

A

Horner’s syndrome:

  • Mitosis = constricted pupils
  • Partial Ptosis = lost of Superior Tarsal Muscles
  • Anhydrosis = lost of sweating
  • Vasodilation - redness + temperature
38
Q

The main targets of sympathetic fibres are blood vessels hence also travel along with them to other targets, through which vessels do they each travel with?

A
  • Superior Cervical Ganglion -> Internal & External Carotid Arteries
  • Middle Cervical Ganglion -> Inferior Thyroid Artery
  • Superior Cervical Ganglion -> Vertebral Artery
39
Q

Only the sympathetic fibres from the Superior Cervical Ganglion travel through the 4 Ganglia that Parasympathetic fibres synapse at, through which blood vessels do these sympathetic fibres each travels through? And what are each of their targets?

A
  • along External Carotid Artery -> Middle Meningeal Artery -> Otic Ganglion -> Parotid gland
  • along External Carotid Artery -> Facial Artery -> Submandibular Ganglion -> glands of Oral cavity
  • along Internal Carotid Artery -> Pterygopalatine Ganglion -> Nose & Nasopharynx & Palatine
  • along Internal Carotid Artery -> Opthalmic Artery -> Ciliary Ganglion -> Dilator Pupillae
40
Q

In some people, the Inferior Cervical Ganglion joins the first Thoracic ganglion, what is this ganglion called?

A

Stallate Ganglion

41
Q

Which cranial nerves are hitch-hiked by Sympathetic fibres? Describe their course and targets.

A
  • CN III: via Internal Carotid A -> Opthalmic A -> through Ciliary Ganglion -> Dilator Pupillae
  • CN Vii: via Internal Carotid A -> Pterygopalatine -> Palatine & Nasopharynx
  • CN Viii Mandibular : via External Carotid A -> Facial A -> through Submandibular Ganglion -> Nose & Oral cavity
  • CN IX Glosoopharyngeal : via External Carotid A -> Meningeal A -> through Otic Ganglion -> Parotid Gland
42
Q

Name the branches of Mandibular Nerve (CN Viii)

A
  • Buccal
  • Auriculotemporal
  • Inferior Alveolar
  • Lingual

(4) Head & Neck - Sessions (11 decks)

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