This document discusses the clinical examination of various cranial nerves. It begins by noting there are 12 cranial nerves that can be motor, sensory, or mixed. It then examines specific cranial nerves - the facial nerve, vestibulocochlear nerve, glossopharyngeal nerve, accessory nerve, and hypoglossal nerve - and describes tests to assess their motor and sensory functions, such as testing taste, eye and facial muscle movement, and tongue movement.

1. Clinical Examination of
Cranial Nerves- II
Dr. Sai Sailesh Kumar G
Associate Professor
Department of Physiology
RDGMC

2. Cranial nerves
 There are 12 cranial nerves.
 Motor, sensory and mixed nerves.
 3rd to 12th nerves arise from brain stem and
innervates facial, cranial and cervical tissues.
 The 1st and 2nd nerves consist of central nervous
tissues.

3. Cranial nerves
Motor Sensory Mixed
Occulomotor Olfactory Trochlear
Optic Vestibulo-cochlear Trigeminal
Abducent Facial
Accessory Glossopharyngeal
Hypoglossal vagus

4. Facial Nerve
(Seventh Cranial Nerve)

5. Facial Nerve
 Sensory functions
 Make the subject to sit comfortably
 Instruct the subject to identify the taste by pointing to the word “ sweet, salt,
bitter and sour” written on the cards
 Ask the subject to protrude his tongue
 Apply the test solution with the help of a glass rod to the surface of the
protruded tongue
 Record the observation
 Ask the subject to rinse his mouth
 Repeat the procedure with each test solution and record the observation

6. Facial Nerve
 Motor functions
 Occipito - frontalis
 Ask the subject to frown
 Observe the wrinkles on the forehead
 Orbicularis occuli
 Ask the subject to shut his eyes tightly
 Try to open the eyes while the subject attempts to keep them close
 Observe that it is impossible to open the eyes against the subject effort

7. Facial Nerve
 Motor functions
 Buccinator
 Ask the subject to inflate his mouth with air and blowout the cheeks
 Tap with finger on each inflated cheek
 Observe that no air escapes from the mouth
 Orbicularis oris
 Ask the subject to show his upper teeth
 Observe that subject is able to do it

8. Facial Nerve
 Motor functions
 Platysma
 Ask the subject to clench his teeth
 Observe the prominence of platysma in the neck

9. Vestibulo cochlear Nerve
(Eighth Cranial Nerve)

10. Vestibulo cochlear Nerve
 Rinne’s test
 Make the subject to sit comfortably
 Instruct the subject to raise the index finger when sound is heard and to put down the
finger when sound is no longer heard
 Vibrate the tuning fork by striking the prongs against the hypithenar eminence
 Immediately place the base of the vibrating tuning fork on the subjects mastoid process
of one side
 Once the subject stops hearing, hold the vibrating tuning fork near to the subject’s
external ear
 Ask the subject to indicate if the sound is heard
 Record the observation and repeat the procedure on other side

11. Vestibulo cochlear Nerve
 Rinne’s test
 Positive- Air conduction is better than bone conduction
 Negative- Bone conduction is better than air conduction

12. Vestibulo cochlear Nerve
 Weber’s test
 Instruct the subject to raise both index fingers if sound heard by both the ears
is equal
 Instruct the subject to raise the two fingers on the side if sound is better heard
 Vibrate the tuning fork by striking the prongs against the hypithenar eminence
 Immediately place the base of the vibrating tuning fork on the subjects
forehead
 Record the observation
 Compares hearing by bone conduction of both the ears

13. Glossopharyngeal Nerve
(Ninth Cranial Nerve)

14. Glossopharyngeal Nerve
 Make the subject to sit comfortably
 Do the procedure as for testing sensory function of seventh cranial
nerve

15. Accessory Nerve
(Eleventh Cranial Nerve)

16. Accessory Nerve
 Trapezious
 Make the subject to sit comfortably
 Stand behind the subject
 Place your hands on subject’s shoulders
 Ask the subject to shrug both shoulders against resistance

17. Accessory Nerve
 Sternomastoid
 Place your hand on subject’s cheek
 Ask the subject to move the chin to side against resistance
 Observe that subject is able to do it
 Repeat the procedure on other side
 Record the observation

18. Hypoglossal Nerve
(Twelth Cranial Nerve)

19. Hypoglossal Nerve
 Hypoglossal nerve
 Make the subject to sit comfortably
 Ask the subject to protrude his tongue as far as possible
 Observe that tongue protrudes straight
 Ask the subject to move tongue from side to side and to lick each
cheek with it
 Observe that the subject is able to do it

20. THANK YOU