Innervation of face.
The main clinical syndromes of
some Cranial Nerves’ (Trigeminal,
Facial, Glossopharyngeal) lesion
Trigeminal nerve nuclei
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Nucleus of Pons
Nucleus of spinal cord pathway
Nucleus of midbrain pathway
Motor nucleus
Trigeminal nerve functions
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Motor (innervation of masseter
muscles)
Sensory
Autonomic
Symptoms of Trigeminal
nerve’s lesion
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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
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Ophthalmic nerve
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Maxillary nerve
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Mandibular nerve
Ophthalmic nerve
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Lacrimal branch
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Frontal branch
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Nasociliary branch
(innervation of lacrimal gland,
upper eyelid, external corner of eye)
(n. Supraorbitalis – innervation
of frontal skin, n. Supratrochlearis – upper eyelid,
medial corner of eye)
(innervation of eyeball,
mucous membrane of labyrinth, frontal sinus)
Maxillary nerve
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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
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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
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N. Infraorbitalis
upper alveolar
nerves (posterior, medial, anterior)
upper dental plexus (teeth, gums, paradontal,
periodontal, mucous membrane of alveolar processes)
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Mandibular nerve
inferior
alveolar nerves
inferior dental
plexus (at ½ of person)
Trigeminal nerve
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Clinical 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
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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
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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
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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
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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
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Pain attack
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Trigger zones
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Painful paraspasm
Facial nerve
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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
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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
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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
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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
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Paresis of mimic
muscles
Lacrimation
Facial nerve
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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 nerve
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Clinical 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
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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
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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
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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
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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)
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Bulbar syndrome
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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
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dysarthria
dysphagia
dysphonia
the pathologic oral reflexes are present
Involuntary crying, smiling
paralysis is only bilateral