{"id":93,"date":"2010-06-09T09:05:42","date_gmt":"2010-06-09T08:05:42","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/the-cranial-nerves-sp-86138083\/"},"modified":"2023-01-12T00:31:34","modified_gmt":"2023-01-12T00:31:34","slug":"the-cranial-nerves-sp-86138083","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/the-neurological-examination\/the-cranial-nerves\/the-cranial-nerves-sp-86138083\/","title":{"rendered":"The cranial nerves &#8211; CN V"},"content":{"rendered":"<p>CN V consists of sensory and motor fibres. This nerve transmits sensory stimuli from the face. Another important function that the CN V fulfils is innervation of the mastication muscles.<br \/>\nThe CN V has three branches: the ophthalmic branch, the maxillary branch and the mandibular branch. These come together in the trigeminal (Gasser\u2019s) ganglion, which is located near the apex of the petrous part of the temporal bone [Figure 18].<\/p>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-88\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-18.jpg\" alt=\"\" width=\"400\" height=\"551\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-18.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-18-218x300.jpg 218w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 18<\/span><\/span><\/p>\n<p><strong>Facial sensory function<\/strong><\/p>\n<p>The section concerning &#8216;The sensory function&#8217;&nbsp;describes how to carry out this examination.<\/p>\n<p><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/116864264?dnt=1&amp;app_id=122963\" width=\"640\" height=\"480\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture\" allowfullscreen><\/iframe><\/p>\n<p><strong>Corneal reflex<\/strong><\/p>\n<p>The trigeminal nerve is the afferent pathway for the corneal reflex. The efferent pathways are the facial nerve and the oculomotor nerve.<\/p>\n<h2>Procedure<\/h2>\n<ul>\n<li>Stand diagonally behind the sitting patient.<\/li>\n<li>Pull the upper eyelid up slightly with one finger on the patient\u2019s eyebrow<br \/>\n[Figure 19].&nbsp;<\/li>\n<li>Ask the patient to look away from you.<\/li>\n<li>Wipe a clean cotton bud across the sclera from the side to over the cornea.<\/li>\n<li>Observe whether the patient closes their eyes in a reflex reaction or whether they turn their eyes away in an upwards direction.<\/li>\n<li>Compare left and right and ask the patient whether they felt left and right to the same extent.<\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-89\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-19.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-19.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-19-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 19<\/span><\/span><\/p>\n<p><strong>Mastication muscles<\/strong><\/p>\n<h2>Procedure<\/h2>\n<p>The strength of the mastication muscles can be examined in two ways.<\/p>\n<p><em>Method 1<\/em><\/p>\n<ul>\n<li>Have the patient clamp their jaw tightly together [Figure 20].<\/li>\n<li>Palpate the masseter muscle on both sides and assess the muscle tone.<\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-90\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-20.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-20.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-20-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 20<\/span><\/span><\/p>\n<p><em>Method 2<\/em><\/p>\n<ul>\n<li>Place a spatula between the patient\u2019s molars [Figure 21].<\/li>\n<li>Ask the patient to bite down.<\/li>\n<li>Try to pull the spatula out the patient\u2019s mouth (be aware for dentures).<\/li>\n<li>Compare left and right.<\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-91\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-21.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-21.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-21-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 21<\/span><\/span><\/p>\n<p><strong>Masseter reflex<\/strong><\/p>\n<h2>Procedure<\/h2>\n<ul>\n<li>Ask the patient to open their mouth slight and to keep the lower jaw as relaxed as possible.<\/li>\n<li>Place one finger on the patient\u2019s chin [Figure 22].<\/li>\n<li>Strike your own finger with the reflex hammer.<\/li>\n<li>Look for a reflex closing movement of the lower jaw.<\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-92\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-22.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-22.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-22-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 22<\/span><\/span><\/p>\n<h3>Interpretation<\/h3>\n<p>Facial sensory function can be reduced by a lesion in the peripheral nerve, the brainstem or a supranuclear lesion. If the lesion is located in the peripheral nerve (for example due to compression caused by a cerebellopontine angle tumour), there will be loss of sensory function. There will also be loss of motor function. If the patient does not feel the left or right cornea being touched, the trigeminal nerve is affected. If the patient does feel the cornea being touched on both sides, but the left \/ right blink reaction differs, the facial nerve is involved.<\/p>\n<p>The masseter reflex will be stronger than usual if there is a lesion above the pons (corticobulbar pathway). It is practically impossible to compare left and right with this reflex.<br \/>\nThe most common conditions involving the CN V is trigeminal neuralgia, which can be diagnosed based on typical findings during specific history-taking. There are no physical diagnostic findings relevant to establishing the diagnosis.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>CN V consists of sensory and motor fibres. This nerve transmits sensory stimuli from the face. Another important function that the CN V fulfils is innervation of the mastication muscles. The CN V has three branches: the ophthalmic branch, the maxillary branch and the mandibular branch. These come together in the trigeminal (Gasser\u2019s) ganglion, which [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[105],"tags":[106,113],"class_list":["post-93","post","type-post","status-publish","format-standard","hentry","category-the-cranial-nerves","tag-cranial-nerves","tag-the-neurological-examination"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>The cranial nerves - CN V - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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