Cranial Nerve Examination

GLOSSOPHARYNGEAL NERVE (IX): VAGUS NERVE (X)

These nerves are considered jointly since they are examined together and their actions are seldom individually impaired.

Note patient's voice - if there is vocal cord paresis (X nerve palsy), voice may be high pitched. (Vocal cord examination is best left to an ENT specialist.) Note any swallowing difficulty or nasal regurgitation of fluids. Ask patient to open mouth and say 'Ah'. Note any asymmetry of palatal movements (X nerve palsy).

Gag reflex

Depress patient's tongue and touch palate, pharynx or tonsil on one side until the patient 'gags'. Compare sensitivity on each side (afferent route - IX nerve) and observe symmetry of palatal contraction {efferent route - X nerve).

Absent gag reflex = loss of sensation and/or loss of motor power. (Taste in the posterior third of the tongue (IX) is impractical to test.)

ACCESSORY NERVE (XI) Sternomastoid

Ask patient to rotate head against resistance. Compare power and muscle bulk on each side. Also compare each side with the patient pulling head forward against resistance.

N.B. The left sternomastoid turns the head to the right and vice versa.

Trapezius

Ask patient to 'shrug' shoulders and to hold them in this position against resistance. Compare power on each side. Patient should manage to resist any effort to depress shoulders.

Palatal weakness

Uvula swings due to unopposed muscle action on one side

Uvula swings due to unopposed muscle action on one side

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