week 2 Flashcards

1
Q

Name 4 MOTOR CN

A
  1. trigeminal (CN V) third branch
  2. Facial (CN VII)
  3. Vagus (CN X)
  4. Hypoglossal (CN XII)
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2
Q

Describe simplified motor pathway

A

signal passes through motor cortex into the brainstem –> signals cross paths and travel brain stem nucleus –> into motor nucleus –> lower motor neurons –> project through cranial nerve

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3
Q

Name 4 SENSORY CN

A
  1. trigeminal CN V (2nd and 3rd branches)
  2. facial (CN VII)
  3. Vagus (CN X)*
  4. Glossopharyngeal (CN IX)*
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4
Q

Describe simplified sensory pathway

A

being at sensory receptors –> project to the sensory nuclei in brainstem –> and up to sensory to cortex

reversed pathway

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5
Q

Name the 2 major branches of Vagus nerve CN X

A
  • Superior Laryngeal Nerve (SLN)
  • Recurrent Laryngeal Nerve (RLN)
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6
Q

What is SLN

A

Superior Laryngeal Nerve

sensory branch of CN X

internal branch - sensory above VF (think penetration)

External branch - motor to cricothyroid muscle (lengthen VFs)

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7
Q

What is RLN

A

Recurrent Laryngeal Nerve

motor branch of CN X

sensory below VF (think aspiration)

motor to all intrinsic laryngeal muscles EXCEPT cricothyroid

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8
Q

T/F

Hypoglossal is a motor only CN involved in swallowing

A

true

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9
Q

of branches

CN V Trigeminal:
function
clinical importance including swallowing phase

A

sensory and motor nerve

sensory: oral prep phase - bolus sensation and pocketing in sulci (V2 & V3)

motor: muscles of mastication (Masseter, soft palate); involved in all 3 swallow phases
oral prep - swallowing
oral phase - prevents nasal regurgitation
pharyngeal - stabilizes jaw for hyoid movement

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10
Q

How to test CN V trigeminal

A

sensory: touch areas of face
V1 - ventral, forehead, nose
V2* - upper lip, cheek, temple
V3* - lower lip, chin, above ear

motor:
clench teeth, open close against resistance

*important branches for swallowing

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11
Q

CN VII Facial

function
clinical importance including swallowing phase

A

Sensory and motor

sensory: taste; important taste is motivator; sour boluses have increased pharyngeal swallow

Motor: muscles of facial expression; salivary glands; create oral seal, saliva production and bolus containment in oral prep stage and UES opening via hyolaryngeal traction during pharyngeal phase

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12
Q

How to test CN VII Facial

Sensory and motor

A

sensory - do not test taste sensation typically

motor - smile and pucker

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13
Q

What is the pharyngeal plexus

A

Glossopharyngeal (CN IX) & Vagus (CN X) travel together in pharyngeal complex

difficult to tease apart in CN exam

sensory info that travel along pharyngeal plexus are very important

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14
Q

CN IX Glossopharyngeal
CN X Vagus

function
clinical importance including swallowing phase

A

travel together in pharyngeal plexus

Sensory and motor

sensory:
CN IX - taste and touch sensation of mucosa (soft palate) and facial pillars
CN X - tactile sensation of pharynx, larynx, esophagus and external ear

important because initiation of pharyngeal swallow (sensation of bolus in pharynx) and airway protection (sensation of post swallow residue)

Motor:
CN IX: stylopharyngeus (shorten pharynx) and salivary gland
CN X: vellum and palatoglossus, larnygeal muscles, cricothyroid, pharngyeal and upper esophagus

difficult to test in CN exam

important in all swallow stages mostly Pharyngeal including bolus propulsion, laryngeal elevation, and UES opening

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15
Q

CN XII Hypoglossal

function
clinical importance including swallowing phase

A

Hypo - below
Glossal - tongue

motor only CN - both intrinsic (insert one example) and extrinsic (insert one example) tongue muscles except palatoglossus (which is CN X)

important for bolus manipulation and containment and transfer (oral prep phase)

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16
Q

Pharyngeal swallowing is controlled and triggered by a complex system of neurons in the reticular formation of the brain steam called the _____

A

central pattern generator (CPG): a biological neural network that produces rhythmic patterned outputs without sensory feedback (can’t stop swallow once it begins)

17
Q

the swallowing CPG is organized into 2 main groups of interneurons:

A

Dorsal swallowing group (DSG)
- sensory
- received sensory input to shape and time the sequential swallow pattern

Ventral swallowing group (VSG)
- motor
- distributes the motor drive to other motor neurons into the brainstem to execute swallow

These are swallowing reflexive movement modulated by brainstem

18
Q

where does central pattern generator (CPG) occur

A

pharyngeal plexus

The pharyngeal plexus lies on the posterolateral wall of the pharynx, mainly over the middle pharyngeal constrictor and is the main motor and sensory nerve supply to the muscles of the pharynx and soft palate and acts to coordinate swallowing and speech

19
Q

Location of DSG

A

dorsal swallowing group is located in the nucleus tractus solitarus (NTS) of the medulla

20
Q

Location of VSG

A

ventrolateral medulla

21
Q

T/F

In the CPG, sensory drives motor response

A

true

sensory input comes before motor

22
Q

V: Trigeminal Tongue (anterior 2/3)
Area of Innervation
Effect on Swallowing

A

Mandible

  • Loss of sensation
  • Inability to mobilize the mandible for chewing
23
Q

VII: Facial
structures
Area of Innervation
Effect on Swallowing

A

Lips, cheeks

  • Difficulty closing lips firmly: Drooling, problems controlling food position in the mouth
  • Loss of taste
24
Q

IX: Glossopharyngeal
Area of Innervation
Effect on Swallowing

A

Posterior part of the tongue
and oropharynx

  • Loss of taste, loss of sensation from posterior 1/3 tongue, palate, pharynx
  • Absent gag
  • Delay in swallow triggering
25
Q

X: Vagus Pharynx
Area of Innervation
Effect on Swallowing

A

Larynx
Upper esophagus

  • Limitations in protecting/closing off respiratory tract:
  • Risk for aspiration
  • Esophageal dysmotility (impairment)