Exam 3 - Cranial Nerves***MOST IMPORTANT*** Flashcards
Each cranial nerve has a number indicating the order, from ____ to____, in which it arises from the brain
anterior to posterior
Each has a name that designates the nerve’s ___
function
Cranial nerves are functionally either sensory (afferent) neurons only, or mixed (some combination of afferent (sensory) and efferent (motor) neurons)
TRUE
Those that are mixed may be primarily ___ or primarily ____
primarily motor OR primarily sensory
Two cranial nerves contain only sensory neurons:
Cranial nerve I (olfactory)
Cranial nerve II (optic)
One cranial nerve is so predominantly sensory that its motor function is frequently overlooked:
Cranial nerve VIII (vestibulocochlear)
Cranial nerves I, II, and VIII are thus called…
sensory nerves (even though CN VIII is not exclusively sensory)
Motor Cranial Nerves
There are no cranial nerves that are exclusively motor throughout their entire length, however ______ are commonly called motor nerves because their function is predominantly motor
cranial nerves III, IV, VI, XI, and XII
They are often said to be “mixed, mainly motor” or “mixed, primarily motor” (as in the following slides)
Motor Cranial Nerves
It is a general principle that the sensory function of such nerves is ______ of the muscles over which they exert motor control (the following slides assume that fact, and do not necessarily repeat proprioceptive functions)
proprioception
Mixed cranial nerves
Cranial nerves ________ are termed mixed nerves because they have substantial motor and sensory functions, and contain axons of both sensory and motor neurons
Cranial nerves V, VII, IX, and X
Single function motor cranial nerves
Most cranial nerves that have a motor function innervate more than one muscle, but the sole mission of two cranial nerves is to innervate a single muscle each:
Trochlear (IV) innervates the superior oblique
Abducens (VI) innervates the lateral rectus
Trochlear (IV) innervates the superior oblique
Abducens (VI) innervates the lateral rectus
Both muscles are extrinsic muscles of the eye
Each nerve is primarily motor, with proprioception of its muscle being its sensory function
No motor function nerves?
Cranial Nerve I and II
Olfactory and Optic
Remember this cranial nerve is predominantly sensory, but DOES have a motor function
CN VIII
vestibulocochlear
Somatic and autonomic
All motor cranial nerves have neurons that innervate ____ (skeletal) muscles
somatic
Some motor cranial nerves also have autonomic motor axons:
III (oculomotor)
VII (facial)
IX (glossopharyngeal)
X (vagus)
The autonomic axons are part of the parasympathetic division, and innervate….
glands, smooth muscle, and cardiac muscle
Entirely sensory
Contains axons that conduct nerve impulses for the sense of smell (olfaction)
Olfactory bulb and olfactory tract are not CN I
Short function: smell
I – Olfactory
Olfactory bulb and olfactory tract are NOT…
CN I
CN I is sensory or motor?
sensory ENTIRELY
Olfactory receptors are bipolar neurons:
CN I (olfactory)
Bundles of axons of the receptors extend through the ____of the ____
Those bundles taken together are the ____
cribriform plate of the ethmoid
olfactory nerve
Olfaction is assessed by having patient state whether or not they can perceive a common….
non-offensive smell such as soap, cloves, flavored Chapstick®, coffee, or vanilla
Loss of the sense of smell is called…
anosmia
Entirely sensory
Contains myelinated axons that conduct nerve impulses for vision
Optic nerve versus optic tract; optic chiasma
Short function: vision
CN II - Optic
Assessment of peripheral vision is one test associated with
cranial nerve II
Mainly motor
Controls extrinsic eye muscles not innervated by IV and VI
Innervates intrinsic eye muscles: ciliary muscle (on lens) sphincter pupillae (iris)
Short function: eye movement
III – Oculomotor
Innervates intrinsic eye muscles: ciliary muscle (on lens) sphincter pupillae (iris)
III – Oculomotor
III – Oculomotor Innervates intrinsic eye muscles:
ciliary muscle (on lens) sphincter pupillae (iris)
Innervates most extrinsic eye muscles
Parasympathetic innervation to intrinsic eye muscles
Innervates levator palpebrae superioris (muscle of the upper eyelid)
III – Oculomotor
Innervates most extrinsic eye muscles
III – Oculomotor
III – Oculomotor Innervates…
Innervates levator palpebrae superioris (muscle of the upper eyelid)
This is the pupillary light response test
Both pupils should constrict when light is shined in only one eye
III – Oculomotor
Mainly motor
Smallest of the cranial nerves
Innervates superior oblique muscle of the eye
Only cranial nerve to arise from the posterior aspect of the brain stem
Short function: eye movement
IV – Trochlear
Smallest of the cranial nerves
IV – Trochlear
Innervates superior oblique muscle of the eye
IV – Trochlear
Only cranial nerve to arise from the posterior aspect of the brain stem
IV – Trochlear
Short function: eye movement
IV – Trochlear
IV – Trochlear
The trochlea (trochle = pulley) is a pulleylike loop through which the tendon of the _____ muscle passes
The superior oblique moves the eyeball…
The trochlea (trochle = pulley) is a pulleylike loop through which the tendon of the superior oblique muscle passes
The superior oblique moves the eyeball inferiorly and laterally
The superior oblique moves the eyeball
inferiorly and laterally
The trochlea (trochle = pulley) is a pulleylike loop through which the tendon of the _____ muscle passes
superior oblique
Following a moving object with the eyes assesses cranial nerves III, IV, and VI since all three innervate extrinsic muscles of the eye
IV – Trochlear
Mixed
Largest of the cranial nerves
Emerges from pons isolated from other cranial nerves
Provides sensory neurons to face, head, and anterior 2/3 tongue
Motor neurons control chewing movements
Short function: mastication, facial sensation
V – Trigeminal
Short function: mastication, facial sensation
V – Trigeminal
Provides sensory neurons to face, head, and anterior 2/3 tongue
V – Trigeminal
Emerges from pons isolated from other cranial nerves
V – Trigeminal
Largest of the cranial nerves
V – Trigeminal
The trigeminal has two roots:
smaller motor root supplying the muscles of ______
Larger sensory root, which has three branches:
Ophthalmic nerve
Maxillary nerve
Mandibular nerve
mastication
The trigeminal has two roots:
smaller motor root supplying the muscles of mastication
Larger sensory root, which has three branches:
Ophthalmic nerve
Maxillary nerve
Mandibular nerve
V – Trigeminal
Larger sensory root, which has three branches:
Ophthalmic nerve
Maxillary nerve
Mandibular nerve
The trigeminal has two roots:
smaller motor root supplying the muscles of mastication
Larger sensory root, which has three branches:
Ophthalmic nerve (V1) Maxillary nerve (V2) Mandibular nerve (V3)
TRIGEMINAL
(V1) ?
(V2) ?
(V3) ?
Ophthalmic nerve
Maxillary nerve
Mandibular nerve
…. anesthesia is a local anesthetic technique used by dentists and physicians.
Maxillary nerve
An assessment of motor function is to have the patient bite down while feeling the ____ muscle, then to have the patient attempt to open their mouth against resistance applied by the examiner
masseter
Trigeminal is NOT taste… it’s tacticle
TRUE DAT
An assessment of sensory function is to have the patient close their eyes, then the examiner touches the face with different objects (light pin touch, handle end of reflex hammer, Q-tip) and the patient describes the type of sensation as sharp, dull, soft, etc., the degree of pressure, and where it is on the face
NEAT
The corneal reflex is a test for the ophthalmic nerve (CN V 1):
touching the cornea with a wisp of cotton evokes a reflexive blink.
_____ is the dermatome for most of the skin of the face and scalp
Cranial nerve V
Mainly motor
Innervates lateral rectus muscle of the eye
Nerve is also called the abducent
Short function: eye movement
VI – Abducens
The _____ muscle moves the eye laterally
It causes ______, hence the name of the nerve that supplies it
lateral rectus
abduction of the eye (movement away from the midline of the body)
Following a moving object with the eyes assesses cranial nerves III, IV, and VI since all three innervate extrinsic muscles of the eye
VI – Abducens
Mixed
Somatic motor axons innervate muscles of facial expression, and stylohyoid, posterior belly of digastric, and stapedius muscles
Parasympathetic axons extend to lacrimal glands, nasal glands, and saliva-producing sublingual and submandibular glands
VII – Facial
VII – Facial
Somatic motor axons innervate muscles of facial expression, and _____, posterior belly of, and _____ muscles
stylohyoid
digastric
stapedius
VII – Facial
Parasympathetic axons extend to lacrimal glands, nasal glands, and saliva-producing ____
sublingual and submandibular glands
Sensory axons extend from taste buds in the anterior two-thirds of the tongue (the mobile tongue)
Short function: facial expression, taste, salivation, lacrimation
VII – Facial
Branches of the facial nerve:
Temporal Zygomatic Buccal Mandibular Cervical
Having the patient exercise the muscles of facial expression by smiling, frowning and puffing both cheeks, and noting any asymmetries, drooping, sagging or smoothing of normal facial creases is an assessment of motor function
VII – Facial
Mainly sensory
Formerly known as the acoustic, or auditory nerve
Vestibular branch carries impulses for equilibrium
Cochlear branch carries impulses for hearing
Short function: balance, hearing
VIII – Vestibulocochlear
facial EXPRESSION
CN VII
Formerly known as the acoustic, or auditory nerve
VIII – Vestibulocochlear
Vestibular branch carries impulses for equilibrium
VIII – Vestibulocochlear
Cochlear branch carries impulses for hearing
VIII – Vestibulocochlear
Short function: balance, hearing
VIII – Vestibulocochlear
TASTE BUDS ON WHICH NERVE
VII - FACIAL = TASTE on portion of tongue
The examiner rubs fingers together both alternately and simultaneously very near to, yet not touching, each ear as one assessment of hearing
VIII – Vestibulocochlear
Mixed
Sensory axons to: posterior 1/3 of tongue for taste from taste buds, and for tactile sensation; baroreceptors in carotid sinus and chemoreceptors in carotid bodies
Motor fibers to: parotid gland
Short function: taste, salivation, innervation of pharynx
IX – Glossopharyngeal
Sensory axons to: posterior 1/3 of tongue for taste from taste buds, and for tactile sensation; baroreceptors in carotid sinus and chemoreceptors in carotid bodies
IX – Glossopharyngeal
Motor fibers to: parotid gland
IX – Glossopharyngeal
Short function: taste, salivation, innervation of pharynx
IX – Glossopharyngeal
The carotid sinus is a dilated region of the internal carotid artery. It contains the carotid body, which is a cluster of chemoreceptors that respond to changes in blood levels of oxygen, carbon dioxide, and hydrogen ions.
IX – Glossopharyngeal
Having the patient open their mouth, protrude their tongue, and say “Ahh” while the examiner observes the soft palate, uvula, and pharynx, as well as listens to the voice for evidence of hoarseness, is an assessment of both cranial nerves IX and X
IX – Glossopharyngeal
Mixed
The longest cranial nerve
Short function: swallowing, talking, cardiac, GI tract, respiration, taste
X – Vagus
The longest cranial nerve
X – Vagus
Short function: swallowing, talking, cardiac, GI tract, respiration, taste
X – Vagus
____ is widely distributed in the head, neck, thorax, and abdomen
The vagus nerve
X – Vagus
Sensory function in taste, touch, pain, temperature, and proprioception from the epiglottis and pharynx; monitoring of blood pressure, oxygen, and carbon dioxide
Somatic motor function in swallowing, coughing, and voice production
Autonomic motor function (parasympathetic) in smooth muscle contraction and relaxation of GI tract, slowing of the heart rate, and secretion of digestive fluids
X – Vagus
Sensory function in taste, touch, pain, temperature, and proprioception from the epiglottis and pharynx; monitoring of blood pressure, oxygen, and carbon dioxide
X – Vagus
Somatic motor function in swallowing, coughing, and voice production
X – Vagus
Autonomic motor function (parasympathetic) in smooth muscle contraction and relaxation of GI tract, slowing of the heart rate, and secretion of digestive fluids
X – Vagus
Hyperactivity of the vagus nerves causes hypersecretion of acidic gastric fluids, which results in ulceration of the stomach wall. Patients with persistent and/or recurring ulcers can be treated with a selective vagotomy (partial severing of the right and left gastric nerves) to relieve this condition.
X – Vagus
Ulcers may be treated with?
Vagotomy - CN X - Vagus
Mixed
Originates from both the brain stem and the spinal cord, so it is sometimes called the spinal accessory (only cranial nerve to have a spinal cord component)
Impulses to voluntary muscles used in swallowing, and to trapezius and sternocleidomastoid
Short function: pharynx & larynx muscles, neck & shoulder movement
XI – Accessory
Originates from both the brain stem and the spinal cord, so it is sometimes called the spinal accessory (only cranial nerve to have a spinal cord component)
XI – Accessory
Impulses to voluntary muscles used in swallowing, and to trapezius and sternocleidomastoid
XI – Accessory
Short function: pharynx & larynx muscles, neck & shoulder movement
XI – Accessory
Shrugging of the shoulders by the trapezius muscle against resistance from the examiner, as well as turning the head to the side, again against resistance
XI – Accessory
Mixed
Innervates all intrinsic muscles of the tongue as well as all extrinsic tongue muscles except the ______, for movements in speech and swallowing
Short function: tongue movement
palatoglossus
XII – Hypoglossal
(The palatoglossus is supplied by
CN X)
Innervates all intrinsic muscles of the tongue as well as all extrinsic tongue muscles except the palatoglossus, for movements in speech and swallowing
XII – Hypoglossal
Short function: tongue movement
XII – Hypoglossal
Protrusion and side-to-side movement of the tongue is an assessment of the hypoglossal nerve
XII – Hypoglossal
Balanced action of the paired genioglossi muscles is required to protrude the tongue straight out. If one genioglossus muscle is inactive, the action of the intact muscle is unopposed. The tongue then deviates toward the side of the inactive muscle
XII – Hypoglossal
Genioglossus
XII – Hypoglossal
taste posterior 1/3 of tongue
glossopharyngeal - IX
Which two CN’s deal with taste?
CN VII and CN IX
CN VII - Facial - Anterior 2/3 tongue taste
CN IX - Glossopharyngeal - Posterior 1/3 tongue taste
Anterior 2/3 of tongue for taste
CN VII - Facial - anterior 2/3 tongue taste
short function: taste, lacrimation, salivation + one more
facial muscle movement
CN VII - facial
Stylohoid
Digastric
Stapedius
Facial CN VII
salivation of parotid gland
CN IX - glossopharyngeal
swallowing, talking, cardiac, GI tract, respiration, taste
CN X - vagus
speech and swallowing = which muscle and which CN?
palatoglossus - movements in speech and swallowing
CN X - Vagus