Você está na página 1de 37

Cranial nerve 3rd

Glossopharyngeal nerve(IX)

*Mostly sensory
*Supplies
* only one muscle (stylopharyngeus)(SVE)
*secretomotor fibers to parotid gland(GVE)
*Carries general and taste sensations from the(SVA)
Posterior 1/3 of the tongue

*IT IS THE NERVE OF THIRD ARCH


FUNCTIONAL COMPONENTS
SVE
SVA
GVE
GVA
GSA
(Sensations from a small area of pinna)
NUCLEI
motor nucleus is in the medulla
called the nucleus ambiguus
Shared by IX,X,XI nerves
Taste goes to nucleus of tractus solitarius
parasympathetic nucleus is called
Inferior salivatory nucleus.
IX
Foramen of exit
the jugular foramen
along with X,XI nerves.
Jugular foramen
After its exit ,it passes between ICA and IJV
Follows the stylopharyngeus and passes
deep to hyoglossus
distributed to palatine tonsils and base of the tongue.
Test

Touching the soft palate evokes a strong gag reflex


in majority of people.
Absence of such `gag’ reflex may indicate
nerve injury.
Taste from the posterior 1/3 of the tongue
can also be tested
TheVAGUS nerve(X)
(the wandering nerve)vagabond

It wanders from the brain stem to the splenic flexure.


Functional components:
1.SVE
2.GVE
3.SVA(taste)
4.GSA
5.GVA
Exits through jugular foramen(along with IX andXI)
The branchial motor(SVE)
component of CN X supplies
1. all the muscles of pharynx
except stylopharyngeus.
2. all the muscles of palate except
tensor palati.
3. all the intrinsic muscles of
larynx.
Overview of Visceral Motor Component(GVE)
supplies the smooth muscle and glands of
the pharynx,
larynx,
viscera down to the splenic flexure.
In general, parasympathetic
stimulation leads to
increased secretion from glands
and smooth muscle contraction.
Specifically, CN X parasympathetic
stimulation has the following effects
(think "rest and digest"):
•Cardiac - Slows heart rate
Lungs - Stimulates increased
bronchiolar secretions and
bronchoconstriction
•GI tract- Stimulates increased
secretions and motility
Distribution of GVE fibres
- the Vagus nerve

Signs and Symptoms of Lesions

Loss of voice, (dysphonia)

Difficulty in swallowing
(dysphagia)

loss of gag reflex,

bradycardia, tachycardia and


dilation of stomach.
Vagus Nerve Test

Observe the
individual swallowing
Accessory nerve(XI)

It has two roots, cranial and spinal


Cranial root arises from the nucleus ambiguus.
Spinal root arise from
upper six segments of spinal cord.
The spinal root enters the cranial
cavity through the foramen magnum
To joins the cranial root
for a brief distance and then leaves the
skull through
the jugular foramen.
The cranial root is distributed to
muscles of pharynx and soft palate
through the vagus.(pharyngeal plexus) ?
The spinal root descends to supply
sternocleidomastoid and trapezius
Test

Asking the patient to shrug his shoulders(trapezius)


Or
Turning the face against resistance to the opposite side
(sternocleidomastoid)
Weakness of the sternocleidomastoid will result
in
difficulty in turning the head
opposite the side of the lesion.
This will be most noticeable when attempted
against resistance.
Damage to spinal accessory
causes torticollis(wry neck)
Hypoglossal nerve(XII)
Purely motor nerve
Supplies all the muscles of the tongue
except
palatoglossus
Functional component: SE
Nucleus is situated in the
hypoglossal trigone(triangle)
(in the floor of IV ventricle).
lies in line with other SE nerves(III,IV,VI)

p
Emerges as a series of rootlets between
olive and pyramid.
Picks up C1 fibers and exits through the
Hypoglossal canal

4 foramina from F. magnum


Course and origin of the
Hypoglossal Nerve (XII)
course
TEST
by asking the patient to put out his tongue

If the nerve is normal


the tip of the tongue does not deviate.

If damaged, the tip deviates to the same side as the lesion

VII

XII
Summary of testing
Nerve Function How to test
with an odorous
I olfaction
substance
II vision vision chart
"follow the moving
III most eye muscles
finger"
IV superior oblique look down at the nose
V facial sensation touch the face
muscles of mastication clench the teeth
VI lateral rectus look to the side
smile, raise the
VII facial expression
eyebrows
taste sugar or salt
VIII hearing a tuning fork
balance look for vertigo
IX pharynx sensation gag reflex
check for hoarseness,
muscles of larynx and
X open wide and say
pharynx, parasymp.
“AAH

trapezius and test shoulder raise or


XI
sternocleidomastoid turning the head

XII tongue muscles stick out the tongue


Thank You