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Hanna- CN IX-XII

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Affected Nerve in Clinical deficit: Absent gag reflex   CN IX via tonsillar N (sensory limb of gag reflex). CN X (motor limb of gag reflex via pharyngeal plexus)  
Affected Nerve in Clinical deficit: Absent taste on posterior 1/3 of tongue   CN IX (via Lingual branches)  
Affected Nerve in Clinical deficit: Paresis in swallowing and Dysphagia   CN IX (Stylopharyngeus) and CN X (all other muscles of soft palate and pharynx minus TVP. Without CN X, there is no motor limb to the pharyneal plexus: soft palate would sag, uvula deviated to contralateral side)  
Affected Nerve in Clinical deficit: Dysphonia and aphonia   CN X: External branch of superior laryngeal N: cricothyroid M, Inferior Laryngeal N (From Recurent Laryngeal Ns) provide somatic motor to the rest of the laryngeal muscles.  
Affected Nerve in Clinical deficit: Hoarseness   CN X (recurrent laryngeal N)  
Affected Nerve in Clinical deficit: Protrusion of the tongue to one side   CN XII (Genioglossus on one side will be inactive, tongue will deviate towards ipsilateral side of lesion since genioglossus wags the tongue towards contralateral side when activated)  
Ligaments associated with the Larynx   1.Cricothyroid: cricoid cartilage to thyroid cartilage (lateral). 2.Vocal: thing ligament running from vocal process of cricoid cartilage to the apex of thyroid cartilage. 3.Vestibular: runs same course as vocal ligament but lies superior.  
2 Main functions of the Larynx   1.Guarding the Airway (most important). 2.Phonation.  
Function of the Arytenoid cartilages in the larynx   (two horns coming up from the cricoid cartilage) Alter the position of the true vocal cords during phonation.  
Cartilages associated with the Larynx   1.Thyroid (C4). 2.Cricoid. 3.Epiglottic. 4.Artynoid.  
Location of the Hyoid bone   C3 within the superior part of Larynx  
Internal Larynx: Glottis   Vocal apparatus consisting of: 1.Vocal folds (all vocal muscles and ligaments). 2.Rima glottidis (space b/w the vocal and vestibular folds). 3.Vestibular folds (false vocal folds superior to true vocal folds. Protect the airway via Vestibular ligaments  
Muscles of the larynx: Adductors   1.Lateral Cricoarytenoid M, 2.Arytenoids (transverse and oblique). These are innervated by inferior laryngeal N (CN X). **Both adduct vocal cords to lower volume to whisper during phonation.  
Muscles of the larynx: Abductors   1.Posterior Cricoarytenoid: Innervated by the inferior Laryngeal N. **Actions: abducts vocal folds allowing more air to pass through and increasing the volume.  
Muscles of the larynx: Tensor   1.Cricothyroid M: Innervated by the External branch of superior Laryngeal N. Action: tilts the thyroid anteriorly which increases tension in vocal folds (RAISES PITCH)  
Muscles of the Larynx: Relaxer   1.Thyroatenoid M: Pulls arytenoid cartilages forward, shortening vocal cords & lowering pitch. 2.Vocalis M: Medial to thyroarytenoid, lateral to vocal fold, makes minute adjustments to volume and pitch. **Both Innervated by Inferior Laryngeal N  
Branches of CN X that innervate the Larynx   1.Superior Laryngeal N: gives off 2 branches: Internal and External Laryngeal N (they innervate the larynx as well as the root of the tongue and epiglottis). 2.Recurrent Laryngeal N: gives off the Inferior Laryngeal N that innervates the Larynx.  
Internal Laryngeal N   Sensory: Vestibule and middle cavity (Inferior pharynx and larynx, root of the tongue). It travels with the Superior laryngeal A into the Thyrohyoid membrane. **Taste from eiglottis region  
External Laryngeal N   MOTOR: to the Cricothyroid M, inferior pharyngeal constrictor M (via pharyngeal plexus). Travels the superior thyroid A.  
Inferior Laryngeal N   SENSORY: to infraglottic cavity. MOTOR: almost all the laryngeal muscles (except cricothyroid). Travels with inferior laryngeal A inferior to inferior border of pharyngeal constrictor.  
Lesions to CN X: effects on the thoraco-abdominal region   1.Increased HR. 2.Lack of peristalsis & sounds  
Lesions to CN X: effects on taste   Sensory taste cell bodies from the epiglottis lie in the inferior vagal ganglion. Therefore taste would be lost but would NOT be noticed unless tested.  
Lesions to CN X: effects on Ear and meninges   CN X has somatosensory fibers from the external auditory canal and the dura in the POSTERIOR cranial fossa. Both would be lost.  
Lesions to CN X: effects on the carotid body and sinus   Since CN X only give a minor fiber contribution, the carotid body and sinus would remain functional and relatively unaffected. **Damage to CN IX would cause BL pH and BP issues  
Arteries to the Larynx   1.Superior Laryngeal A (branch off Sup thyroid A) penetrates the thyrohyoid membrane. 2.Cricothyroid A (Branch off Sup Thyroid A.) 3.Inferior Thyroid A (From Thyrocervical Trunk) supplies the inferior larynx)  
Branches of the thyrocervical Trunk   Arises from the 1st part of Subclavian near medial border of Ant Scalene. 1.Inferior thyroid A. 2.Ascending cervical branch 3.Suprascapular A. 4.Cervicodorsal Trunk (bifricates into superficial cervical A and Dorsal scapular A).  
Lymphatics of Larynx   Located above and below the vocal folds. SUPERIOR: Superior deep cervical nodes. INFERIOR: Pretracheal and Paratracheal lymph nodes drain to the inferior cervical lymph nodes.  
Lesion on which nerve would cause a lack of sensation in the vestibule?   Internal Laryngeal N  
Lesion on which nerve would cause a lack of sensation in the middle laryngeal cavity?   Internal Laryngeal N  
Lesion on which nerve would cause a lack of sensation in the Infraglottic Cavity?   Inferior Laryngeal N  
Lesion on which nerve would cause an inability to raise pitch?   External Laryngeal N (Cricothyroid M)  
Lesion on which nerve would cause an inability to lower pitch, raise volume, and lower volume?   Inferior Laryngeal N  
Laryngeal Vestibule   The opening to the larynx  
Function of the Middle part of laryngeal cavity   Phonation. **Laryngeal Ventricle is the space b/w the sup and inf folds making up the middle laryngeal cavity.  
Ifraglottic cavity   Below the folds. Includes lateral thyroid cartilage and inferior cricoid cartilage.  
Pathway of CN IX   Medulla, Jugular foramen, Sup & Inf glossopharyngeal ganglia, to either: 1.Carotid sinus/body 2.Stylopharyngeus muscle 3.tympanic N.  
Parasymp innervation of Parotid Gland pathway   Medulla, Jugular foramen, Sup & Inf glosopharyngeal ganglia, tympanic N, Tympanic plexus, lesser petrosal N, foramen ovale, otic ganglia, Auriculotemporal N, Parotid gland  
Lesions on CN IX   1.(Carotid sinus N) Cause regulation issues of carotid sinus (BP) and carotid body (pH). 2.(lingual) Lose of SENSORY from post 1/3 of tongue. 3.(On tympanic N) Loss of GSA from middle ear and Eustacian tube, dec salivation of parotid  
Pathway of CN XI   Anterior Root C1-5, Superiorly through foramen magnum, jugular foramen, descends along internal carotid A, enters SCM, then Trapezius  
Pt presents with weakness in turning their head against resistance, where could the lesion be   Unilatreal CN XI lesion  
Pathway of CN XII   Medulla, Hypoglossal canal, travels with the cervical plexus (superior loop of Ansa Cervicalis) to middle angle of the mandible, enters the tongue **Innervates all glossus muscles except palatoglossus  
Lesion on CN XII   tongue will deviate TOWARDS the AFFECTED side. Also the tongue would protrude due to an inability to retrude. **Makes it hard to swallow**  


   


 
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