Cranial Nerve V: Trigeminal Nerve

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Questions and Answers

Which cranial nerve is primarily responsible for sensory innervation of the face and motor innervation of the muscles of mastication?

  • Abducens nerve (CN VI)
  • Vestibulocochlear nerve (CN VIII)
  • Glossopharyngeal nerve (CN IX)
  • Trigeminal nerve (CN V) (correct)
  • Facial nerve (CN VII)

The ophthalmic branch (V1) of the trigeminal nerve exits the cranial cavity through which foramen?

  • Superior orbital fissure (correct)
  • Jugular foramen
  • Internal acoustic meatus
  • Foramen rotundum
  • Foramen ovale

Which of the following is NOT a branch of the trigeminal nerve?

  • Maxillary (V2)
  • Ophthalmic (V1)
  • Cervical (correct)
  • All are branches of the trigeminal nerve
  • Mandibular (V3)

The Gasserian ganglion, which houses the cell bodies of sensory neurons for the trigeminal nerve, is located in:

<p>The trigeminal cave (A)</p>
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Which trigeminal nucleus is primarily responsible for carrying pain and temperature sensation from the face?

<p>Spinal nucleus of V (B)</p>
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The corneal reflex, involving blinking in response to corneal touch, has which cranial nerve as its sensory component?

<p>Trigeminal nerve (CN V) (B)</p>
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What is the primary motor nerve responsible for the efferent limb of the corneal reflex, causing eye closure?

<p>Facial nerve (CN VII) (A)</p>
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Trigeminal neuralgia is often characterized by:

<p>Sudden, intense, brief episodes of facial pain (A)</p>
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Which muscle of mastication is responsible for elevating and retracting the mandible?

<p>Temporalis (D)</p>
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The facial nerve (CN VII) is responsible for:

<p>Motor innervation to the muscles of facial expression (B)</p>
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Which component of the facial nerve provides parasympathetic innervation to the lacrimal gland?

<p>Superior salivatory nucleus (A)</p>
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Taste sensation from the anterior two-thirds of the tongue is carried by which cranial nerve?

<p>Facial nerve (CN VII) (A)</p>
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A lesion at the cerebellopontine angle is MOST likely to affect which cranial nerves?

<p>CN V, CN VII, and CN VIII (B)</p>
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Bell's palsy, characterized by unilateral facial paralysis, is due to dysfunction of which cranial nerve?

<p>Facial nerve (CN VII) (D)</p>
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In upper motor neuron (UMN) facial nerve palsy, which part of the face is typically spared due to bilateral cortical innervation?

<p>Upper face (C)</p>
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The vestibulocochlear nerve (CN VIII) is primarily responsible for:

<p>Hearing and balance (D)</p>
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Which part of the inner ear is responsible for detecting linear acceleration of the head?

<p>Utricle and Saccule (B)</p>
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The auditory pathway involves a relay in which structure of the midbrain?

<p>Inferior colliculus (C)</p>
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Sensorineural hearing loss due to cochlear damage typically results in:

<p>High-frequency hearing loss (D)</p>
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Vestibular neuritis primarily affects which part of the vestibulocochlear nerve?

<p>Vestibular branch (B)</p>
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Which of the following symptoms is NOT typically associated with vestibular neuritis?

<p>Hearing loss (D)</p>
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Damage to the base of the skull in the posterior cranial fossa can potentially affect which cranial nerves?

<p>CN VII and CN VIII (B)</p>
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Which of the following muscles is responsible for pursing the lips?

<p>Orbicularis oris (B)</p>
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The jaw-jerk reflex is mediated by which cranial nerve?

<p>Trigeminal nerve (CN V) (C)</p>
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Which branch of the facial nerve is most likely to be affected in parotid gland surgery due to its passage through the gland?

<p>All terminal motor branches (D)</p>
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If a patient presents with loss of taste on the anterior 2/3 of the tongue, decreased lacrimation, and facial paralysis, where is the MOST likely location of the lesion along the facial nerve pathway?

<p>Facial canal proximal to geniculate ganglion (C)</p>
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A patient presents with vertigo and nystagmus, but no hearing loss. Which of the following is the MOST likely diagnosis?

<p>Vestibular neuritis (C)</p>
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Which of the following is a characteristic feature differentiating between UMN and LMN facial nerve palsy?

<p>Forehead sparing in UMN palsy (C)</p>
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Which of the following statements about the mandibular nerve (V3) is FALSE?

<p>It passes through the cavernous sinus. (A)</p>
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A patient is unable to wrinkle their forehead on the right side, but can wrinkle it on the left. They also have drooping of the right corner of their mouth. This presentation is MOST consistent with:

<p>Right LMN facial nerve palsy (A)</p>
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Which of the following cranial nerves is NOT involved in eye movements?

<p>Facial nerve (CN VII) (C)</p>
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Which of the following is LEAST likely to cause sensorineural hearing loss?

<p>Cerumen impaction in the external auditory canal (D)</p>
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In the auditory pathway, where does the first binaural processing of sound information occur?

<p>Superior olivary complex (A)</p>
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A lesion of the mesencephalic nucleus of the trigeminal nerve would MOST significantly impair:

<p>Unconscious proprioception from muscles of mastication (A)</p>
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Which of the following symptoms would be LEAST expected following complete transection of the facial nerve at the stylomastoid foramen?

<p>Dry eye (C)</p>
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Which of the following structures is responsible for transducing sound vibrations into neural signals?

<p>Organ of Corti (D)</p>
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Flashcards

CN V - Trigeminal Nerve

The Trigeminal Nerve (CN V); divides into ophthalmic, maxillary, and mandibular branches upon exiting the cranial cavity.

Gasserian ganglion

Sensory ganglion of the trigeminal nerve; located in the trigeminal cave; gives rise to the three divisions of the trigeminal nerve.

CN V1 - Ophthalmic br

The ophthalmic branch of CN V; progresses distally and exits the skull via the superior orbital fissure.

CN V2 - Maxillary br

The maxillary branch of CN V; exits the skull via the foramen rotundum.

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CN V3 - Mandibular br

The mandibular branch of CN V; exits via the foramen ovale; supplies the lower jaw, lower teeth, and muscles of mastication.

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Mesencephalic nucleus

Located in the midbrain; associated with unconscious proprioception from muscles of mastication.

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Main sensory nucleus

Vibrations and conscious proprioception of sensation from touch.

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Spinal nucleus of V

Pain and temperature sensation for the head and neck.

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Corneal Reflex

The corneal reflex is a protective reflex against foreign bodies touching the cornea and involves the trigeminal nerve.

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Trigeminal neuralgia

Vascular compression of the trigeminal nerve.

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Muscles of mastication

The Muscles of mastication innervated by the mandibular nerve include medial pterygoid, lateral pterygoid, masseter, temporalis.

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CN VII- Facial Nerve

The Facial Nerve (CN VII) is the motor supply to the muscles of facial expression and the stapedius muscle.

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Solitary nucleus and tract

The Solitary nucleus and tract carries its sensory taste to the anterior 2/3 tongue, a small skin area around the external auditory meatus.

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Facial Nerve location

Facial level is near the parotid gland.

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CN VII - Lesions

Lesions involving the Cerebellopontine angle, internal acoustic meatus, middle ear, and face can cause facial nerve issues.

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Cerebello-Pontine (CP) Angle

Middle Cerebellar Peduncle, trigeminal nerve and cerebellopontine angle cranial nerves.

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Facial nerve terminal branches

The branches divide into superior and inferior divisions and then into 5 main branches : Temporal, Zygomatic , Buccal, Mandibular and Cervical.

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Frontalis

Raise the eyebrows/Wrinkle the forehead with the frontalis.

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Orbicularis oculi

Close the eyes tightly with the orbicularis oculi.

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Cerebellopontine Angle Tumor

Lesions involving the cerebellopontine angle are more severe and will cause paralysis and damage.

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UMN vs LMN facial Nerve palsy

UMN only the lower face is affected while LMN entire face.

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CN VIII- Vestibulocochlear Nerve

The Vestibulocochlear Nerve (CN VIII) is for balance and for hearing.

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Semicircular canals

The Semicircular canals detects the spatial orientation of head, the vestibular apparatus bony and membranous labyrinth.

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skull fracture

Damage to Facial or vestibulocochlear nerve results from Base of skull fracture- posterior cranial fossa.

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Cochlea

The cochlea detects a vast range of sounds.

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Study Notes

CN V - Trigeminal Nerve

  • Emerges from the pons and enters the middle cranial fossa
  • It divides into three branches before exiting the cranial cavity
  • Ophthalmic (V1) exits via the superior orbital fissure
  • Maxillary (V2) exits via the foramen rotundum
  • Mandibular (V3) exits via the foramen ovale, not passing through the cavernous sinus
  • The nerve supplies the lower jaw, lower teeth, and muscles of mastication

CN V - Nuclei and Sensory Innervation

  • Branches of CN V are used by Parasympathetic cranial nerves to distribute parasympathetic fibres to the head region
  • Ophthalmic N (V1) supplies the upper face and forehead
  • Also facilitates the corneal reflex
  • Maxillary N (V2) supples the mid face and upper jaw
  • Mandibular N (V3) supplies the lower face and jaw
  • It is the only branch with both motor and sensory components

Clinical Testing of CN V

  • Pin prick/ touch with cotton wool test the 3 territories of the face
  • The corneal reflex tests facial muscle innervation
  • Not routinely tested unless sensory impairment
  • Sensations on the tongue are not routinely tested

Corneal Reflex

  • Operates at the level of the Pons
  • A protective reflex against foreign bodies touching the cornea
  • Sensory component is the main sensory nucleus of the trigeminal nerve
  • Motor component is in the Ophthalmic nerve

Herpes Zoster and Trigeminal Neuralgia

  • Herpes Zoster (Shingles) shows a characteristic rash
  • Vesicular, dermatomal pattern, and will not cross the midline
  • Opthalmic division impacts forehead, scalp, upper face, and cornea
  • Maxillary nerve affects the cheeks, nose, and upper lip
  • Trigeminal neuralgia is caused by vascular compression of the trigeminal nerve
  • Experience severe pain in bursts from mild stimuli
  • Treated with Carbamazepine (Tegretol)

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