A8. Examination of nerves IX, X, XI and XII

From greek.doctor
  • Glossopharyngeal nerve (IX)
    • Mixed sensory, motor, and parasympathetic
      • Motor function is shared with the vagus nerve
    • Examination of the gag reflex
      • Not routinely examined
      • By touching the posterior wall of the pharynx with something
    • Examination of taste sensation
      • From posterior third of tongue
      • Not routinely examined
    • Examination of parasympathetic function
      • Stimulates parotid gland
      • Not routinely examined
  • Vagus nerve (X)
    • Mixed sensory, motor, and parasympathetic
    • Examination of motor function
      • Pharyngeal muscles
        • Ask whether patient has problems swallowing
        • Observe the patient swallowing water
      • Soft palate and uvula
        • Check whether the uvula deviates to one side
          • In a palsy the uvula will deviate to the unaffected side
        • Check for symmetrical movement of soft palate when patient says “aah”
      • Vocal cords
        • Is the patient hoarse?
  • Accessory nerve (XI)
    • Pure motor
      • Trapezius is innervated contralaterally
      • Sternocleidomastoid is innervated ipsilaterally
    • Examination of trapezius function
      • Ask patient to lift their shoulders
      • Apply resistance against the movement
    • Examination of sternocleidomastoid function
      • Ask patient to turn their head
      • Apply resistance against the movement
  • Hypoglossal nerve (XII)
    • Pure motor
    • Examination of tongue muscles
      • Ask patient to protrude the tongue
      • In case of lesion it will deviate to the affected side
    • Examination of tongue trophy
      • Look for atrophy and fasciculations on the tongue
      • In case of lesion it will be apparent on the affected side
    • Examination of tongue spasticity
      • Ask patient to rapidly protrude and retract tongue
      • Observe for spasticity