Cranial Nerves and OME Findings

Question 1

What muscles are innervated by cranial nerve V (trigeminal)?

Answer 1

Masseter, temporalis, lateral pterygoid, medial pterygoid, tensor veli palatini, mylohyoid

Question 2

What muscles are innervated by cranial nerve VII (facial)?

Answer 2

Obicularis oris, buccinator, posterior belly of digastric (elevates + retracts hyoid), frontalis (forehead and eyebrow raising), stylohyoid (elevates hyoid)

Question 3

What muscles are innervated by cranial nerve IX (glossopharyngeal)?

Answer 3

Stylopharyngeus (elevates and shortens pharynx)

Question 4

What muscles are innervated by cranial nerve X (vagus)?

Answer 4

Uvula, levator tensor palatini (raises soft palate), palatoglossal (anterior faucial pillars), palatopharyngeal (posterior faucial pillars), superior + medial constrictors (muscles of pharynx), thyropharyngeus (lower part of pharynx, forms UES), cricopharyngeus (main part of UES), salpingopharyngeus (elevates pharynx), palatopharyngeus (elevates pharynx + narrows oropharynx)

Question 5

What muscles are innervated by cranial nerve XII (hypoglossal)?

Answer 5

Intrinsic muscles of the tongue (superior longitudinal, inferior longitudinal, verticalis, transverse), geniohyoid (moves hyoid anterior + superior), thyrohyoid (elevates larynx)

Question 6

If it was an UMN lesion, what would you expect to see in a patient’s jaw?

Answer 6

Jaw deviates contralateral to side of injury

Question 7

If it was a LMN injury, what would you expect to see in a patient’s jaw?

Answer 7

Jaw might hang lower, jaw deviates ipsilateral to side of lesion, might feel atrophy/weakness when palpating

Question 8

If a patient had a UMN lesion, what would you expect to see in the face?

Answer 8

Drooping on contralateral side of lesion (includes nasolabial flattening), contralateral weakness (pucker/smile), able to raise eyebrows

Question 9

If a patient had a LMN lesion, what would you expect to see in the face?

Answer 9

Drooping on ipsilateral side of lesion (includes nasolabial flattening), ipsilateral facial weakness (smile, pucker), UNable to raise eyebrows

Question 10

If a patient had a UMN lesion, what would you expect to see in the palate/uvula?

Answer 10

Uvula deviates ipsilateral to side of lesion (side of strength), no elevation on contralateral side, potentially hyperactive gag reflex

(E.g. R side lesion = uvula deviates R, L side paralysis if CN X involved)

Question 11

If a patient had a LMN lesion, what would you expect to see in the palate/uvula?

Answer 11

Uvula deviates to contralateral side (side of strength), no elevation on ipsilateral side

(E.g. R side lesion = uvula deviates to L, paralysis on R side)

Question 12

If a patient had a UMN lesion, what would you expect to see in the tongue?

Answer 12

Tongue deviates to contralateral side of lesion on protrusion

Question 13

If a patient had a LMN lesion, what would you expect to see in the tongue?

Answer 13

Tongue deviates to ipsilateral side of lesion on protrusion, fasciculations

Question 14

If the client had a strained/strangled voice quality, what type of lesion is that associated with?

Answer 14

Bilateral UMN damage

Question 15

If the patient had a weak/breathy voice, what type of lesion is that associated with?

Answer 15

Unilateral or bilateral LMN damage

Question 16

If the client had a harsh voice, what type of lesion is that associated with?

Answer 16

Unilateral UMN damage

Question 17

How would you assess CN X (vagus)?

Answer 17

Voluntary cough + coup, look for presence of voluntary swallow, observe secretion management, vocal resonance, vocal quality

Question 18

How would you assess CN XII (hypoglossal)?

Answer 18

Observe tongue at rest (fasciculations? atrophy?), ask patient to protrude (tongue will deviate to side of weakness) and lateralize (assess ROM) tongue, DDK /ta/, infer strength with tongue depressor/resistance

Question 19

How would you assess CN V (trigeminal)?

Answer 19

Observe jaw at rest and open, jaw resistance (infer strength), lateralize jaw (e.g. if unable to move L = R side paralysis), DDKs (expect /pa/ 10-15x in 5s trial), bite down to palpate bulk of masseter + temporalis

Question 20

How would you assess CN VII (facial)?

Answer 20

Observe face and lips at rest, get pt. to wrinkle eyebrows (if they can’t = LMN), pucker lips and puff cheeks (obicularis oris), smile and oo-ee-oo (ROM)