innervation of face. the main clinical syndromes of some cranial nerves’ (trigeminal, facial,...
TRANSCRIPT
Innervation of face. The main clinical syndromes of
some Cranial Nerves’ (Trigeminal, Facial,
Glossopharyngeal) lesion
Trigeminal nerve nuclei
Nucleus of Pons Nucleus of spinal cord
pathway Nucleus of midbrain
pathway Motor nucleus
Trigeminal nerve functions
Motor (innervation of masseter muscles)
Sensory Autonomic
Symptoms of Trigeminal nerve’s lesion
facial pain sensory disturbance in face corneal reflex is decreased or
absent temporal and masseter muscles are
atrophic or hypotrophic, atonic or hypotonic
jaw is deviated to the side of lesion
Trigeminal nerve branches
Ophthalmic nerve
Maxillary nerve
Mandibular nerve
Ophthalmic nerve
Lacrimal branch (innervation of lacrimal gland, upper eyelid, external corner of eye)
Frontal branch (n. Supraorbitalis – innervation of frontal skin, n. Supratrochlearis – upper eyelid, medial corner of eye)
Nasociliary branch (innervation of eyeball, mucous membrane of labyrinth,
frontal sinus)
Maxillary nerve Meningeal branch Sphenopalatine nerve (for sphenopalatine
ganglion) – major and minor palatine nerves, inferior posterior nasal nerves – mucous membrane of nasal cavity, palatal mucous membrane
Cheek bone nerve (anterior part of temporal and posterior part of frontal area, secretion parasympathetic fibers of lacrimal gland)
Nerve Infraorbitalis – upper alveolar nerves (posterior, medial, anterior), inferior branches of eyelids, external and internal nasal branches, upper branches of lips)
Mandibular nerve Meningeal branches Masticator nerve Deep temporal branches External sphenopalatine nerve Internal sphenopalatine nerve Buccal nerve Temporal-ear nerve Lingual nerve Inferior alveolar nerve Communicants branches for ear,
hypoglossal and submandibular ganglions
Innervation of teeth
N. Infraorbitalis upper alveolar nerves (posterior, medial, anterior) upper dental plexus (teeth, gums, paradontal, periodontal, mucous membrane of alveolar processes)
Mandibular nerve inferior alveolar nerves inferior dental plexus (at ½ of person)
Trigeminal nerveClinical examination
testing pain, thermal, and other sensations in the area supplied by the Trigeminal nerve
the corneal reflex test the temporal and masseter muscles
are examined by palpating the muscles and attempts to resist the jaw by applying pressure
Signs of lesion of the І branches of Trigeminal nerve
Pain, numbness in innervating zone
Mononeuritic type of sensory disorders of all kinds of sensation
Painful palpation of upper trigeminal point
Decreased or absent subeyebrow, corneal and conjunctival reflexes
Signs of lesion of the ІI branches of Trigeminal nerve
Pain and numbness in innervating zone
Mononeuritic type of sensory disorders of all kinds of sensation
Painful palpation of medial trigeminal point
Signs of lesion of the ІII branches of Trigeminal nerve
Pain, numbness in innervating zone
Mononeuritic type of sensory disorders of all kinds of sensation
Painful palpation of lower trigeminal point
Decreased or absent the mandibular reflexes
Disorders of jawing, atrophy or hypotrophy of masseter muscles
The cause of Trigeminal neuralgia
Idiopatic neuralgia - compression of the nerve’s root by upper cerebellar artery
Symptomatic neuralgia - Multiple sclerosis- Tumor of the brain stem- Cranial trauma- Inflammation diseases of nasal sinuses- Post-herpetic neuralgia- Lesion of temporal-mandible joint
Clinical features of Trigeminal neuralgia
Pain attack
Trigger zones
Painful paraspasm
Facial nerve
Facial asymmetry patient can’t wrinkle the forehead,
close eyes, purse the lips, retract the buccal angles in a smile
impairment of taste on the anterior two third of the tongue
Bell’s symptom corneal reflex is decreased or
absent
Signs of lesion of Facial nerve before the n. Petrosus major
Paresis of mimic muscles Dryness of eye, loss of lacrimation
(xerophtalmia) Hyperacusis Loss of taste over anterior 2/3 of
tongue Dryness of oral cavity (xerostomia)
Signs of lesion of Facial nerve before the n. Stapedius
Paresis of mimic muscles Lacrimation Hyperacusis Loss of taste over anterior 2/3 of
tongue Dryness of oral cavity (xerostomia)
Signs of lesion of Geniculate ganglion
(Ramsay-Hunt syndrome)Herpetic involvement of Geniculate ganglion Paresis of mimic muscles Lacrimation Hyperacusis Loss of taste over anterior 2/3 of tongue Dryness of oral cavity (xerostomia) Herpes vesicular eruption in the
throat or over the pinna
Signs of lesion of Facial nerve before the n. Chorda tympani
Paresis of mimic muscles
Tears Loss of taste
over anterior 2/3 of tongue
Dryness of oral cavity (xerostomia)
Signs of lesion of Facial nerve after the n. Chorda tympani
Paresis of mimic muscles
Lacrimation
Facial nerve
Clinical examination
observation of the patient while he talks and smiles.
The patient is asked to show his teeth by retracting the buccal angles,
to whistle to pyres the lips against the pressure of
the examiner’s fingers. slight unilateral weakness may be
detected by asking the patient to blow the cheeks out fully.
Facial nerveClinical examination
the platisma function - the patient makes a maximal effort to draw the lower lip and angle of the mouth downward and outward, at the same time tensing the skin over the anterior surface of the neck.
Taste is examined with the use of sugar, tartaric acid, sodium chloride, quinine, or similar substances. The patient is instructed to protrude the tongue; a small quantity of the test substance is gently rubbed on one side of the tongue and the patient signals identification of the test substance before drawing the tongue into the mouth to prevent diffusion of the taste to the opposite side or to the posterior third of the tongue, thus obscuring the test.
n. Glossopharyngeus n. Vagus
the voice is hoarse or brassy dysphagia and regurgitation of fluids
through the nose the testing of taste sensation on the
posterior one third of the tongue ipsilateral paralysis of the palatal,
pharyngeal, and laryngeal muscles bilateral lesion (dyspnea, apnea, periodic
respiration - Cheyne-Stokes breathing)
Function of n. Glossopharyngeus
motor sensory autonomic
Motor function of n. Glossopharyngeus
Motor nucleus (n. ambiguus, common with X Cranial nerve)
is located in medial part of oblong brain. Fibers from this nuclei are going on the back of olive, аfter
that — through the jugular fosse of scull and innervate m.
Stilopharyngeus
Sensory function of n. Glossopharyngeus
General sensation -g. jugularae superius
a) Dendrites innervated posterior 1/3 of the tongue, palatine muscles, pharyngs, otic membrane, otic cavity
b) Axons are finished in nucleus alae сіnеrеа
Sensory function of n. Glossopharyngeus
Taste sensation - inferior Jugular ganglion
a) Dendritis are going to the posterior 1/3 of the tongue
b) Axons are finished in nucleus tractus solitarii
Autonomic function of n. Glossopharyngeus
Secretion autonomic fibers start from nucleus salivatorius, which is located in lower part of the oblong brain, preganglion firbers are going to the Otic ganglion, postganglion firbers innervate Parotid gland
The cause of Glossopharyngeal neuralgia
Compression due to the hypertrophy of processus stiloideus
Compression due to the ossification of ligament stilopalatinum
Compression due to the posterior lower cerebellar artery
Cancer on base of the tongue, tumors of the larynx
Clinical features of Glossopharyngeal neuralgia
Paroxysmal pain in tongue radix, pharynx, tonsils, lateral part of the neck, angle of the mandible
Trigger zones (tonsils, base of the tongue)
Bulbar syndrome dysarthria dysphagia dysphonia gag reflex is absent or decreased the tongue is atrophic paralysis is unilateral or bilateral can be (dyspnea, apnea, periodic
Cheyne-Stokes respiration)
Pseudobulbar syndrome
dysarthria dysphagia dysphonia the pathologic oral reflexes are
present Involuntary crying, smiling paralysis is only bilateral