Neurology I

Nerve Cell
(Neuron)
Reflex Arc

afferent

efferent
Neuro-transmission
The Nervous System
Central Nervous System (CNS)
Brain & Brain Stem
Brain Stem
Spinal Cord
Peripheral nervous system
Sensory System
 Motor System
(The Pyramidal Tract)
Cranial Nerves
Anatomy
 Sensation (General Somatic ) :
 Ophthalmic division:
• anterior 1/2 of scalp
• Eye, cornea & conjunctiva
• Nasal mucosa & paranasal sinuses.
 Maxillary division:
• anterior Cheek
• hard & soft palate.
• upper teeth & gums
 Mandibular division:
• lower teeth and gums.
• floor of mouth Anterior
2/3
Tongue
• anterior 2/3 of the tongue ( general sensation )
 Motor to the muscles of mastication:

1. Temporalis muscle

2. Masseter muscle

3. Pterygoid muscles, Medial & lateral

 Nasal &
Oral
Cavities
TRIGEMINAL NERVE
V
Sensory
• Face, Scalp & Meninges
Anterior
2/3 • Oral & Nasal Cavities
Tongue
• Anterior 2/3 of Tongue
(general sensation )

TEMPORALIS Motor -
Muscles of Mastication

MASSETER
 Corneal Reflex

Touching the cornea

Blinking of both eyes

 Corneal Reflex

Afferent Facial 7th n

( Sensory )

Efferent
Trigeminal 5th n (Motor)
 Trigeminal Nerve Lesion
Loss of somatic (general) sensation over :
• Half of the face,
• Anterior 2/3 of the tongue ( general sensation )
Weakness of muscles of mastication
Loss of Corneal reflex
Anatomy
Motor Part:
•It supplies muscles of Facial Expression.
 Sensory Part:
It supplies the Taste of the anterior 2/3 of the tongue through
chorda tympani nerve

Taste
 VII FACIAL NERVE
VII
Motor
Muscles of Facial Expression
Anterior 2/3

Sensory
MUSCLES OF FACE TASTE –Tongue &
Taste - Anterior 2/3 of Tongue
Soft Palate

Parasympathetic
• Lacrimal Gland
• Submandibular &
Sublingual Glands

GLANDS: Lacrimal, Submandibular,

& Sublingual
Motor Part:
Its affection results in: Weakness of the muscles of facial expression
 Sensory Part:
Its affection results in:
Loss of taste to the anterior 2/3 of the tongue.

Taste
Loss of Corneal reflex:
Facial 7th n
Afferent
( motor )

Efferent
Trigeminal 5th
n
( sensory )
Pyramidal tract
Upper Motor Neuron Lesion
(UMNL)
&
UMNL
Lower Motor Neuron Lesion
( UMNL)

LMNL
LMNL & UMNL of Facial nerve
Upper Motor Neuron Lesion (UMNL)
of Facial Nerve
Upper Motor Neuron Lesion (UMNL)
of Facial Nerve
Causes: Cerebral
• Traumatic

• Vascular

• Infection

• Tumor
Lower Motor Neuron Lesion (LMNL)
of Facial Nerve
Causes of LMNL of facial nerve
 Bell's Palsy
LMNL of facial nerve
• Etiology: ???
• Idiopathic, Not well known.
• ?Viral infection, inflammatory swelling of the nerve in
the facial canal at stylomastoid foramen
Bell's palsy, Clinical picture :
on the affected side
absence of wrinkles in forehead
eye cannot close properly
Weakness of the cheek
• Inability to whistle or blow the cheek
• Accumulation of food between the teeth & paralyzed cheek.

The lips can not purse properly

• Patient is unable to show his teeth
• Deviation of the angle of the mouth
• Dripping of saliva from the corner of the mouth
Bell's palsy, Treatment:

• Majority recover spontaneously.

• Early Steroids reduce inflammatory swelling of the

nerve at stylomastoid foramen.
• Physiotherapy.
• Few cases permanent nerve affection

plastic surgery
 Management of a patient with Bell's palsy
in a Dental Clinic

• The Cornea should be protected during dental treatment.

• There may be accumulation of food debris between the cheek and
teeth which increase Dental Plaque. Instruct the patient to brush teeth
after eating.
• Leaking of saliva at the corners of the mouth may predispose to Angular
Cheilitis. An antifungal cream may be useful if fungal infection occurs.
Anatomy
 post 1/3 of the tongue

Posterior
1/3

Sensation

Pharynx Tonsils
 GLOSSOPHARYNGEAL
IX NERVE IX

Sensory
Posterior
PAROTID GLAND Posterior 1/3 of Tongue,
1/3
Pharynx, & Palate

TONGUE
Parasympathetic
Taste &
General Sensation
Parotid Gland

Pharynx , Soft Palate

Anatomy
Motor to:
•Palate.

•Pharynx.

•Larynx.
 Motor -
X • Muscles of Pharynx,
Larynx & Soft Palate
• Thoracic & Abdominal
Organs and Gut to the
Left Colic Flexure.

Sensory –
• Lower Pharynx & entire
Larynx
• fibers from thoracic &
abdominal viscera.
Motor function is tested by :

"Ah"

soft palate elevation

uvula central
movement
 Vagus Paralysis
1.Absent movement of the palate & Deviation of the Uvula towards
the healthy (Unaffected) side.
2.Dysphagia
3.Dysphonia or aphonia
 Gag reflex
Touching the back of the tongue or pharynx

Gagging; Elevation of the soft palate and tendency to vomit

 Gag reflex
Vagus
Afferent
9th Cr. N
sensory

Efferent
Glossopharyngeal motor
9th Cr. N
Anatomy
 Motor
Muscles
Tongue
Muscles of the Tongue
Paralysis of the XII nerve

Tongue deviated towards the affected side

Questions?
DR.ABDELWAHAB MOHAMED