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CUSS HEAD AND NECK SESSION (LSHTM) Wellington MScCN1 - OLF ACT O Shortest CN responsible for olfaction (special visceral afferent) (ectoderm) = Olfactory Placode Anatomical Course: 1) Nasal Epithelium (Fila Olfactoria → true olfactory nerves) 2) Olfactory Bulb 3) Mitral CellsCN1 - OLF ACT O RY Clinical Significance: • ANOSMIA • Bowman’s Glands = secrete mucus Clinical Examination: • Basal Cells = new stem cells for • Test each nostril for• Sustentacular Cells = structural change in smell support •cilia provides odour reactions whichc stimulate olfactory cellsCN2 - OPTIC Embryology = Optic Vesicle Surrounded by Cranial Meninges as opposed to neural layers Anatomical Course: 1) Retinal Ganglion Cells 2) Nerve forms + exits via Optic Canal 3) Middle Cranial Fossa + Optic Chiasm Clinical Relevance: 4) Optic Tracts • Inspect pupil size, symmetry, shape • Visual acuity – Snellen Chart 5) Lateral Geniculate Nuclei • Visual fields 6) Upper (Parietal) + Lower • Pupillary reflexes and fundoscopy (Temporal / Meyer’s Loop) Optic • Elicit accommodation reflex Radiations • Colour vision testing – Ishihara Chart 7) Visual CortexCN3 - OCUL OMO TMotor = LPS, SR, IR, MR, IO musclessphincter pupillae + ciliary Anatomical Course: 1) Oculomotor Nucleus (Midbrain) 2) Nerve forms + enters Cavernous Clinical Sinus Relevance: 3) Exits via Superior Orbital Fissure • ‘H’ Test + 4) Divides into Superior + Inferior abnormalities Branches • CN3 Palsy = ▪ Superior = SR + LPS Medical vs ▪ Inferior = IR, IO, MR SurgicalCN4 - TROCHLE Aintracranial course)gest Motor = SO Anatomical Course: 1) Trochlear Nucleus (Posterior Clinical Midbrain) • ‘H’ Test + 2) Runs within subarachnoid Ptosis / Gaze space into posterior clinoid abnormalities process of sphenoid • CN4 Palsy = 3) Lateral to Cavernous Sinus Head Tilt affected side 4) Superior Orbital FissureCN5 - TRIGEMIN ALargest CN Motor = mandibular (mastication) Sensory = 3 divisions (V1-3) Anatomical Course: 1) Principal Sensory, Spinal Nuclei) + Motor Nucleus 2) Forms into sensory root at Pons 3) In middle cranial fossa, Trigeminal Ganglion formed in Trigeminal Cave 4) Divisions formed: ▪ V1 – Superior Orbital Fissure ▪ V2 – Foramen Rotundum ▪ V3 – Foramen Ovale Corneal Reflex Arc Clinical Relevance: 1) Assess sensation in all CN5 - subdivisions (light-touch + pinprick) TRIGEMINA 2) subdivisions sensation in all • Temporalis • Masseter L • Jaw resistance 3) Reflexes = Jaw Jerk + CornealCN6 - ABDUCEN SMotor = LR Anatomical Course: 1) Abducens nuclei (Pons) 2) Enters subarachnoid Clinical space into Dorello’s Canal Relevance: • ‘H’ Test + 3) Leaves Dorello’s Canal abnormalities into Cavernous Sinus • CN6 Palsy = 4) Enters orbit via Superior adducted Orbital Fissure pupilCN7 - F ACIAL Motor = facial expression digastric belly, stylohyoid, stapedius Sensory = anterior 2/3 of tongue (chorda tympani) + concha PSNS = salivary, mucus + lacrimal glands complex!)l Course (veryCN8 – VESTIBUL OCOCHLEAR Sensory = Hearing + Equilibrium Anatomical Course: • Vestibular = vestibular Medulla)omplex (Pons + • Cochlear = ventral + dorsal cerebellar peduncle)erior Clinical Relevance: 1. Forms nerve in Pons • Conductive vs sensorineural hearing loss 2. Emerges from • Labyrinthitisuronitis Cerebellopontine Angle • Basilar Skull Fractures 3. Exits cranium via Internal Acoustic Meatus (temporal)CN9 – GL OSSOPHARYNGEAL Embryology = 3 pharyngeal arch posterior 1/3 of tongue, middle ear cavity,s, Eustachian tube PSNS = parotid gland Motor = stylopharyngeus Anatomical Course: 1. Anterior Medulla origins 2. Leaves cranium via Jugular foramen 3. 2 ganglia (Superior + Inferior) 4. Nerve descends neck anterolateral to ICA Clinical 5. Inferior margin of Stylopharyngeus – Relevance: branches arise • Gag Reflex 6. Enters pharynx between Superior + Middle (afferent) Pharyngeal Constrictors (terminates)CN10 - V AGUS Embryology = 4 + 6 th pharyngeal arches meatus skin + internalustic laryngopharynx/larynx surfaces, heart + abdominal visceral sensation, epiglottis + tongue root taste PSNS = SM of trachea, bronchi, GIT; regulates heart rhythm Motor = muscles of pharynx, soft palate + larynx Anatomical Course (longest course)CN11 - ACCESSORY Motor = Trapezius + SCM Anatomical Course: • Spinal = C1-C5/C6 spinal nerve roots (enters + leaves via foramen magnum + jugular Clinical Relevance: foramen, respectively) • Measure resistance of said muscles • Iatrogenic damage to CN11 most • Cranial = lateral medulla c▯ Cervical Lymph Node Biopsy + (leaves cranium via Central Line Insertion jugular foramen) + joins • May cause asymmetrical neckline CN10CN12 - HYPOGL OSSAL Motor = extrinsic + intrinsic tongue muscles (except Palatoglossus which is CN10) Anatomical Course: 1. Hypoglossal nucleus (medulla) 2. Exits cranium via Hypoglossal Canal 3. Receives branch of Cervical Plexus 4. Passes inferior to mandible angle to enter tongue SBA 1 A 55-year-old female presents post-operatively to her GP complaining of weakness in shoulder ‘shrugging’. You suspect a lesion to the Accessory Nerve. Which of the following procedures is this patient most likely to have undergone? A) Carotid endarterectomy B) Axillary node clearance C) Posterior triangle LN biopsy D) Percutaneous cholecystostomy E) Decompressive Hemicraniectomy SBA 2 A 65-year-old male presents with a gradually-progressive hearing loss. Both ears display normal Rinne’s and Weber’s tests. Corneal reflexes are absent in both eyes. Which of the following would be most likely in this patient’s past medical history? A) Vestibular Schwannoma B) Von Recklinghausen’s Disease C) Neurofibromatosis Type 2 D) Viral Labyrinthitis E) Vestibular Neuronitis