Lecture 9- IX- XII

Question 1

CN IX

*

Answer 1

glossopharngheal

Question 2

where does the glossopharyngeal arise from

Answer 2

the medulla

Question 3

route of the glossopharngeal

Answer 3

1. Arise from medulla
2. Run through posterior cranial fossa
3. Exit through the jugular foramen
4. Enter into carotid sheath- close relationship with internal and external carotid artery
5. Glossopharyngeal leaves the sheath early

Question 4

glossopharygeal is mainly

Answer 4

mainly sensory (oropharynx and tonsils)

Question 5

where does the glossopharngeal innervate

Answer 5

1. Posterior 1/3 tongue (sensory smell and taste)
   
   • General and special sensory taste branches
2. 1 swallowing muscle
3. Parasympathetic to parotid gland

Question 6

X

Answer 6

vagus

Question 7

vagus nerve arises from

Answer 7

medulla

Question 8

route of the vagus nerve

Answer 8

1. Arise from medulla
2. Run through posterior cranial fossa
3. Exit through the jugular foramen
4. Enter into carotid sheath- close relationship with internal and external carotid artery
   
   • Vagus found throughout carotid sheath

Question 9

• Glossopharngeal and Vagus nerve are

Answer 9

• examined together- because if one has a lesion then the other is lightly to be affected
  
  • Bar some distal branches of the vagus nerve

Question 10

vagus nerve is both

Answer 10

motor and sensory (more motor)

Question 11

vagus nerve innervation

Answer 11

• All the muscle of the larynx/pharynx- including soft palate
• Sensory (larynx/laryngopharynx)
• Parasympathetic to many tissues

Question 12

lesions in Vagus and glossopharngeal

Answer 12

Lesions may present with

• Difficulty with swallow
• Weak cough
• Difficulties with speech or changes in voice

Question 13

examination of V and G nerve

Answer 13

• Speech
• Swallow
• Cough
• Soft palate movement
• Uvula position (CNX)
• Gag reflex (IX and X)

Question 14

G and V lesion and soft palate elevation

Answer 14

uvula lies- points to the opposite side of lesion

Question 15

Causes of lesions in G and V

*

Answer 15

• Recurrent laryngeal branch of vagus (CN X)
  
  • Thyroid pathology or surgery, superior thorax/mediastinal pathology)
  • Pathology involving carotid sheath structures
  • Posterior cranial fossa, bas eof skull
  • Brainstem (medullary) lesions e.g. infact, MMD

Question 16

key branches of vagus in the enck

Answer 16

Question 17

CN XI, XII- Accessory and hypoglossal route

• e
  *

Answer 17

• Arise from the medulla (accessory nerve also has some contribution from upper cervical spinal nerve)
• Run through posterior cranial fossa
  
  • Accessory nerve- through the jugular foramen
  • Hypoglossal- hypoglossal canal
• Enter into carotid sheath
  
  • Hypoglossal exits and travels towards the tongue
  • Accessory exits and heads towards posterior triangl

Question 18

CN XII hypoglossal is purely

Answer 18

motor

Question 19

target tissue of the hypoglossal

Answer 19

• Tongue movements and protrusion

Question 20

lesions of the hypoglossal

Answer 20

• Surgery/pathology in proximity to or involving upper carotid sheath, integral and external carotid artery
• Posterior cranial fossa tumours

Question 21

Hypoglossal and tongue movement

*

Answer 21

• Genioglossus= tongue muscles
  
  • Controlled by right and left CN XII
  • Tongue deviates to the weaker half “Lick your wound”

Question 23

CNXI

Answer 23

spinal accessory

Question 24

spinal accessory is purely

Answer 24

motor

Question 25

spinal accessory arises from

Answer 25

medulla (cranial roots and spinal roots)

Question 26

exam of accessory

Answer 26

• Test actions of SCM (turn head)
• Test action of trapezius (shrug shoulders)

Question 27

• Lesions of accessory

Answer 27

• Injuries, surgery or pathology involving posterior triangle (or structures within)
• Posterior cranial fossa tumours
• Base of skull (jugular foramen)
• Brainstem (medullary) lesions e.g. infract, Motor Neurone Disease

Question 28

accessory nerve injury

Answer 28

• Wasting of the muscle
  
  • E.g. shape of shoulder changes
• Weakness in scapula muscle