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Cranial Nerve Examination
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.ind...
Contents
• Examination of each cranial nerve
individually along with its sensory and
motor components
• Examination of ref...
Introduction

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3
Olfactory Nerve
•Test
•Results
•Precautions

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4
Optic nerve
• Visual acuity
• Colour vision
• Visual field
• Fundoscopy
• Perimetry
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5
Visual acuity

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6
Colour vision

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7
Field of vision

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8
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9
Perimetry
Normal field of vision
Laterally – 90-100 deg
Medially – 60 deg
Superiorly – 50-60 deg
Inferiorly – 60-75 deg

w...
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11
Fundoscopy

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12
Optic atrophy

Papilloedema

Diabetic
retinopathy

Central artery occlusion

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Central vein occ...
III, IV, And VI Nerves

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14
Conjugate horizontal eye movement
Eye

III nu.

LR

MLF

MR

VI nu.
+
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PPRF
15
Conjugate horizontal eye movement
Eye

III nu.

LR

MLF

MR

VI nu.
+
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PPRF
16
Conjugate horizontal eye movement - Lesion near midline of p
Eye

LR

MLF

MR

III nu.

X
VI nu.
+
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III n. paralysis

VI n. paralysis

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18
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19
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20
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21
Trigeminal Nerve
Sensory
General
Sharp and dull
Temperature
Light touch

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22
Motor

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23
Corneal reflex

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24
Consensual corneal reflex
V nu.

pons

VII nu

V n.
Orbicularis oculi
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25
Consensual corneal reflex
V nu.

pons

VII nu

V n.

Orbicularis oculi
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26
Facial Nerve
Motor

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27
Innervation of
facial muscles

left

facial nu
Cortical innervation of left face
Upper half: bilateral
Lower half: predomi...
Innervation of
facial muscles

X
left

facial nu

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29
Innervation of
facial muscles

X
left

facial nu

Lesion causes paralysis of
contralateral lower face
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Innervation of
facial muscles

left

facial nu

X
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31
Innervation of
facial muscles

left

facial nu

X
Lesion causes paralysis of
ipsilateral forehead & lower
www.indiandental...
Innervation of
facial muscles

X

"Close your eyes and
smile"

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33
Lesion of
facial nerve

X
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34
UMN vs LMN

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35
Sensory

Jaw reflexes

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36
Vestibulocochlear Nerve
•Schwabach’s test
•Weber’s test
•Rinne’s test

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37
Transmission of sound

VIII n.

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middle ear

mastoid
38
Transmission of sound
Sound can be conducted by bone
(at mastoid)

VIII n.

mastoid
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39
Transmission of sound - Test 1

x

VIII n.

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40
Transmission of sound - Test 1

x

no transmission

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middle ear

mastoid

41
Transmission of sound - Test 2

no transmission

xVIII n.

www.indiandentalacademy.com

42
Transmission of sound - Test 2

x

VIII n.

the louder sound on this side may be due to
change in (i) bone micro-structure...
Glosopharyngeal Nerve

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44
Vagus Nerve

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45
Nerve IX

IX

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46
Nerve IX

solitary

hypoglossal

IX

ambiguus

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47
Gag reflex

IX
X

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48
Gag reflex

IX
X

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49
Lesion of Vagus Nerve

Vagus nerve:
soft palate

palate droops
uvula may deviate to normal side
nasal tone
food enters nos...
air
explains nasal tone

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51
air
explains nasal tone

www.indiandentalacademy.com

52
food

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explains regurgitation into respiratory passage

53
food

Disoordinated
pharyngeal
contraction
www.indiandentalacademy.com
explains regurgitation into respiratory passage

54
Accessory Nerve

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55
Hypoglossal Nerve

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56
A probable exlanation

WH
K

view from below jaw

genioglossus
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57
Normal

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58
Normal

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59
Left XII lesion

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60
Left XII lesion

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61
References
• The neurological examination; Dejong

• Chamberlain’s Symptoms and signs in clinical
medicine
• www.eustacian...
Thank you
www.indiandentalacademy.com

63
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Cranial nerve examination /certified fixed orthodontic courses by Indian dental academy

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Cranial nerve examination /certified fixed orthodontic courses by Indian dental academy

  1. 1. Cranial Nerve Examination INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com 1
  2. 2. Contents • Examination of each cranial nerve individually along with its sensory and motor components • Examination of reflexes associated with the cranial nerves • Common neurological disorders associated with the cranial nerves www.indiandentalacademy.com 2
  3. 3. Introduction www.indiandentalacademy.com 3
  4. 4. Olfactory Nerve •Test •Results •Precautions www.indiandentalacademy.com 4
  5. 5. Optic nerve • Visual acuity • Colour vision • Visual field • Fundoscopy • Perimetry www.indiandentalacademy.com 5
  6. 6. Visual acuity www.indiandentalacademy.com 6
  7. 7. Colour vision www.indiandentalacademy.com 7
  8. 8. Field of vision www.indiandentalacademy.com 8
  9. 9. www.indiandentalacademy.com 9
  10. 10. Perimetry Normal field of vision Laterally – 90-100 deg Medially – 60 deg Superiorly – 50-60 deg Inferiorly – 60-75 deg www.indiandentalacademy.com 10
  11. 11. www.indiandentalacademy.com 11
  12. 12. Fundoscopy www.indiandentalacademy.com 12
  13. 13. Optic atrophy Papilloedema Diabetic retinopathy Central artery occlusion www.indiandentalacademy.com Central vein occlusion 13
  14. 14. III, IV, And VI Nerves www.indiandentalacademy.com 14
  15. 15. Conjugate horizontal eye movement Eye III nu. LR MLF MR VI nu. + www.indiandentalacademy.com PPRF 15
  16. 16. Conjugate horizontal eye movement Eye III nu. LR MLF MR VI nu. + www.indiandentalacademy.com PPRF 16
  17. 17. Conjugate horizontal eye movement - Lesion near midline of p Eye LR MLF MR III nu. X VI nu. + www.indiandentalacademy.com PPRF 17
  18. 18. III n. paralysis VI n. paralysis www.indiandentalacademy.com 18
  19. 19. www.indiandentalacademy.com 19
  20. 20. www.indiandentalacademy.com 20
  21. 21. www.indiandentalacademy.com 21
  22. 22. Trigeminal Nerve Sensory General Sharp and dull Temperature Light touch www.indiandentalacademy.com 22
  23. 23. Motor www.indiandentalacademy.com 23
  24. 24. Corneal reflex www.indiandentalacademy.com 24
  25. 25. Consensual corneal reflex V nu. pons VII nu V n. Orbicularis oculi www.indiandentalacademy.com 25
  26. 26. Consensual corneal reflex V nu. pons VII nu V n. Orbicularis oculi www.indiandentalacademy.com 26
  27. 27. Facial Nerve Motor www.indiandentalacademy.com 27
  28. 28. Innervation of facial muscles left facial nu Cortical innervation of left face Upper half: bilateral Lower half: predominantly contralateral www.indiandentalacademy.com 28
  29. 29. Innervation of facial muscles X left facial nu www.indiandentalacademy.com 29
  30. 30. Innervation of facial muscles X left facial nu Lesion causes paralysis of contralateral lower face www.indiandentalacademy.com 30
  31. 31. Innervation of facial muscles left facial nu X www.indiandentalacademy.com 31
  32. 32. Innervation of facial muscles left facial nu X Lesion causes paralysis of ipsilateral forehead & lower www.indiandentalacademy.com 32 face
  33. 33. Innervation of facial muscles X "Close your eyes and smile" www.indiandentalacademy.com 33
  34. 34. Lesion of facial nerve X www.indiandentalacademy.com 34
  35. 35. UMN vs LMN www.indiandentalacademy.com 35
  36. 36. Sensory Jaw reflexes www.indiandentalacademy.com 36
  37. 37. Vestibulocochlear Nerve •Schwabach’s test •Weber’s test •Rinne’s test www.indiandentalacademy.com 37
  38. 38. Transmission of sound VIII n. www.indiandentalacademy.com middle ear mastoid 38
  39. 39. Transmission of sound Sound can be conducted by bone (at mastoid) VIII n. mastoid www.indiandentalacademy.com 39
  40. 40. Transmission of sound - Test 1 x VIII n. www.indiandentalacademy.com 40
  41. 41. Transmission of sound - Test 1 x no transmission www.indiandentalacademy.com middle ear mastoid 41
  42. 42. Transmission of sound - Test 2 no transmission xVIII n. www.indiandentalacademy.com 42
  43. 43. Transmission of sound - Test 2 x VIII n. the louder sound on this side may be due to change in (i) bone micro-structure; (ii) www.indiandentalacademy.com sensitivity of the nerve 43
  44. 44. Glosopharyngeal Nerve www.indiandentalacademy.com 44
  45. 45. Vagus Nerve www.indiandentalacademy.com 45
  46. 46. Nerve IX IX www.indiandentalacademy.com 46
  47. 47. Nerve IX solitary hypoglossal IX ambiguus www.indiandentalacademy.com 47
  48. 48. Gag reflex IX X www.indiandentalacademy.com 48
  49. 49. Gag reflex IX X www.indiandentalacademy.com 49
  50. 50. Lesion of Vagus Nerve Vagus nerve: soft palate palate droops uvula may deviate to normal side nasal tone food enters nose pharynx x gag reflex arches move to normal side dysphagia www.indiandentalacademy.com food enters larynx 50
  51. 51. air explains nasal tone www.indiandentalacademy.com 51
  52. 52. air explains nasal tone www.indiandentalacademy.com 52
  53. 53. food www.indiandentalacademy.com explains regurgitation into respiratory passage 53
  54. 54. food Disoordinated pharyngeal contraction www.indiandentalacademy.com explains regurgitation into respiratory passage 54
  55. 55. Accessory Nerve www.indiandentalacademy.com 55
  56. 56. Hypoglossal Nerve www.indiandentalacademy.com 56
  57. 57. A probable exlanation WH K view from below jaw genioglossus www.indiandentalacademy.com 57
  58. 58. Normal www.indiandentalacademy.com 58
  59. 59. Normal www.indiandentalacademy.com 59
  60. 60. Left XII lesion www.indiandentalacademy.com 60
  61. 61. Left XII lesion www.indiandentalacademy.com 61
  62. 62. References • The neurological examination; Dejong • Chamberlain’s Symptoms and signs in clinical medicine • www.eustaciantube.org www.indiandentalacademy.com 62
  63. 63. Thank you www.indiandentalacademy.com 63

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