Cranial Nerve Exam

Neuroanatomy Review
Basic Physiology of Nerve Cells
● Neurons deliver and receive electrical impulses
● Nerves are bundles of neuron fibers. They can diverge (‘branch’ off) to innervate various structures and create
complete communicative networks within the brain.
● Nucleus: a clearly distinguishable mass of neurons, deep within the brain (e.g., NTS, NA)

Basic Physiology of Nerve Cells

● Afferent nerves: detect environmental stimuli via mechano- and chemoreceptors, carrying action potentials
toward the CNS
● Efferent nerves: carry action potentials away from the CNS toward peripheral organs and muscles
● Interneurons: create neural circuits by facilitating communication between sensory and motor neurons and
various regions throughout the central nervous system

Major Anatomic Levels of the Nervous System

● Central Nervous System (CNS)
○ Cortical
○ Subcortical
○ Cerebellum
○ Brainstem
● Peripheral Nervous System (PNS)
○ Cranial Nerves
○ Spinal Nerves
Peripheral Nervous System
● Upper motor neurons (UMN) refer to interneurons with axons projecting from the cortex to the brainstem
● Lower motor neurons (LMN) refer to efferent nerves with axons projecting from the brainstem into the
peripheral muscles
● Cranial nerves refer specifically to the LMNs that innervate the bulbar muscles
● LMNs can receive input from UMNs either contralaterally or bilaterally

CN V: Trigeminal Nerve
● Bilateral UMN input
● Three branches emerge
○ Ophthalmic branch (V1) – sensory
○ Maxillary branch (V2) – sensory
○ Mandibular branch (V3) – both
● Motor Output:
○ muscles of mastication
○ tensor veli palatini
○ mylohyoid and anterior digastric
● Sensory Input: facial muscles, palate & teeth, anterior 2/3 of tongue (general/touch)

CN VII: Facial Nerve

 ● Bilateral UMN input to the upper face
● Contralateral UMN input to the lower face
● Motor Output:
○ Facial muscles
○ Posterior digastric & stylohyoid
● Sensory Input:
○ Anterior 2/3 of tongue (special/taste)
● Parasympathetic:
○ Submandibular salivary glands
○ Sublingual salivary glands

CN IX: Glossopharyngeal Nerve

● Bilateral UMN input
● Motor Output:
○ Stylopharyngeus
● Sensory Input:
○ Part of the pharyngeal plexus
○ Tonsils
○ Pharynx
○ Base of tongue
● Parasympathetic:
○ Parotid salivary glands

CN X: Vagus Nerve
● Bilateral UMN input
● Vagus Nerve:
○ Pharyngeal Nerve
○ SLN and RLN
● Sensation:
○ Pharynx, esophagus, larynx, trachea
● Motor:
○ Tongue: palatoglossus, glossopharyngeus
○ Palate: LVP, Musculus Uvuale
○ LPM: palatopharyngeus & salpingopharyngeus
○ Pharyngeal Constrictors
○ Intrinsic Laryngeal muscles
○ Esophageal Muscles

CN XII: Hypoglossal Nerve

● Contralateral UMN input
● Motor Output:
○ Intrinsic tongue muscles
○ Extrinsic tongue muscles (except palatoglossus)
○ Geniohyoid

CNS: Brainstem
 ● Medulla: Vital centers regulate heartbeat, blood vessel diameter, and breathing. Major contributor to
coordination of swallowing, vomiting, coughing, sneezing. Contains nuclei of CNs VIII-XII
● Pons: Relays impulses from one side of the cerebellum to the other, and between the medulla and midbrain.
Assists in respiratory control. Contains nuclei of CNs V-VII
● Midbrain: Relays motor output from the cerebral cortex to the pons and medulla, and sensory input from the
spinal cord to the thalamus. Contains nuclei of CNs III-IV

CNS: Cerebellum
● Coordinates timing and sequencing of movement and helps to scale size, velocity, and force of muscle actions
● Sensorimotor feedback loop
○ Smooths and coordinates complex, skilled movements by comparing intended movements to actual
movements
○ Error-based learning
● Regulates muscles tone, posture, balance, and steadiness
○ Controls scaling- controlling too big or too small, scale movement of finger to land on nose for ex

CNS: Basal Ganglia

● Regulates the initiation and termination of voluntary movements and cognitive processes (e.g., attention,
memory, planning)
● Suppresses unwanted movements
● Regulates muscle tone during movements and sustained contractions, and the amplitude, velocity, and initiation
of movement

CNS: Thalamus
● Receives sensory information from brainstem
● Gates out unimportant & redundant sensory information and passes on only necessary information to various
cortical areas
● Integrates and projects information from the basal ganglia, limbic system, and cerebellum to the primary motor
and premotor cortices

CNS: Limbic System

● “Emotional Brain”
○ Emotions: pain, pleasure, docility, affection, anger, fear
○ Motivation, long-term memory, and olfaction
○ “Behavior-Reward” & “Urge-to-act” systems

CNS: Sensory Cortices

● Primary Somatosensory Area receives nerve impulses for touch, proprioception, pain, itching, tickle, and thermal
sensation. The major function of the primary somatosensory area is to pinpoint the areas where sensation
originate
● Somatosensory Association Area permits you to determine the exact shape and texture of an object (without
looking at it), and determine and stores memories of past sensory experiences

CNS: Somatosensory System

CNS: Motor Cortex
● Primary Motor Cortex elicits nerve impulses required for contractions of specific muscles during voluntary
movement
● Supplementary Motor Area (SMA) and Premotor Cortex communicate with the primary motor cortex, sensory
association areas, basal ganglia, and thalamus. They deal with motor planning of learned, goal directed
movements, and serve as a “memory bank” for skilled movements
● Frontal Lobe is essential for initiating voluntary contractions and motor planning of movements
● Basal ganglia & Cerebellum (± thalamus) are essential to motor programming, which contribute to proper
coordination, sequencing, and smoothing of motor movements
● Motor circuitry is complex, and involves cortical and subcortical sensorimotor feedback loops, and direct and
indirect pathways to the LMNs
 The Cranial Nerve Exam
● Organized, goal-directed evaluation
● Useful in understanding the pathophysiology of speech and swallowing disorders
● Crucial for the development of targeted and individualized treatment
 - Cranial nerves important for face + neck
- This is how info is getting cranial nerves 5, 7, 9 (IX), 10, 12
- Lower face + tongue most susceptible peripherally after cortical stroke

LMN from Brainstem to the Muscles: uni-/ipsilaterally for all CNS

● Info gets from brainstem nuclei out to the tongue ipsilaterally
● Ex: right cortical stroke affecting cortex → info does not get to left cranial nerve in brainstem → left side of
tongue stops working
○ Right upper motor neuron lesion resulting in tongue deviation
● If it’s unilateral (one), it’s always contralateral (left to right, right to left in an X)
● Upper and lower face are innervated differently, lower face only receives contralateral info, so top of the face
might be fine but bottom half won’t

- Pseudobulbar affect- inappropriate emotions for situation

- Hyporeflexia- blunted reflexes
- Ex: Fasciculations means there is AT LEAST but maybe not only a lower motor neuron lesion
Fasciculations arise as a result of spontaneous depolarization of a LMN leading to the synchronous contraction of all the
skeletal muscle fibers within a single motor unit
 - Best to see when tongue is resting in the mouth, not with posture
- Cannot stop when you try to control

Cranial Nerve Exam

For all tasks: observe structure at rest, and during sustained movements with and without resistance, and during
repeated sequencing of movements
Then...
● Characterize the anatomy: symmetry, location, shape, size, color
● Characterize the movements: speed, accuracy, consistency, range of motion, force

- Directionality of movement is consistently off, you might implicate the cerebellum

- Basal ganglia- range of motion

Based on the history, what do you hypothesize the pathophysiology to be?

What do you expect to see during the CNE?
As you progress through the CNE, ask yourself: are these findings consistent with the initial hypotheses?
- Take what you learned from the cranial nerve exam together with history→ give clues for pathophysiology of
dysfunction. You expect to see problems when you review the chart and see a diagnosis like parkinson's disease.
If you see fasciculations, maybe they have PD but maybe they also have something else

Oral Cavity Anatomy

● Face, Cheeks, Lips
● Jaw, Teeth, Hard Palate
● Tongue, Soft Palate, Tonsillar arches
● Mucosa and gingiva
● Dentures/oral prostheses
Oral Hygiene
● Oral Care/Oral Hygiene Status
● Oral Secretions:
○ Secretion build-up & drooling
○ Xerostomia
● Oral Cavity:
○ Dentition intact, healthy mucosa
○ Partial/Completely edentulous, sores/lesions
○ Foul odor

Testing of CN V
Cranial Nerve V – Testing Sensory Function
● Task:
● 1. With the patient’s eyes closed, use cotton ball or loose end of gloves to lightly touch the left and right side of
the forehead, cheeks, and mandible – the tongue can be touched as well, but this is less common
● 2. Have the patient identify if and where they feel the touch (point or say)
● Testing sensation of the facial muscles – all innervated by the three branches of CN V (Trigeminal)
○ Ophthalmic Branch (CN V1)
○ Maxillary Branch (CN V2)
○ Mandibular Branch (CN V3)
Cranial Nerve V – Testing Motor Function
● Observe mandible at rest
● Clench Teeth: palpate left and right masseter muscle at the same time
● Open and close mouth
○ Sustained open and sustained closed without resistance
○ Sustained open and sustained closed with resistance
○ Repeated sequencing of opening and closing

Because unilateral contraction of the lateral pterygoid assists in contralateral jaw opening, the jaw will deviate towards
the weaker side during opening

Testing of CN VII
● Observe the face at rest
○ Open and close the upper face (eyebrows)
○ Sustained lift and sustained “scrunch” without resistance
○ Sustained lift and sustained “scrunch” with resistance
○ Repeated sequencing of lifting and “scrunching”
● Open and close the lower face (lips)
○ Sustained smile and sustained pucker without resistance
○ Sustained pucker with resistance
○ Repeated sequencing of smiling and pucker (or puff out cheeks and don’t let air escape)

- Bilaterally for upper face, only contralaterally for lower face

- When you talk about right/left, talk about the person’s right or left side, not the mirrored way you see them
- Example is facial palsy
- This is lower motor neuron lesion bc right half of the face upper and lower seems to be impaired
- You would say: lower motor neuron lesion affecting cranial nerve 7 on the right
- Lower motor neuron lesion are always ipsilateral to dysfunction in face
- Upper motor neuron lesions are always contralateral (opp) to dysfunction in face
- Upper face should be preserved for upper motor neuron lesion
-

-
 - If it's right upper motor neuron lesion affecting motor cortex, you will see dysfunction in contralateral lower face
and tongue
- When it’s lower motor neuron (cranial nuclei, the nerve coming out of it, and neuromuscular junction), it will
affect the entire half of face AND cranial nerve 7

Testing of CN X
Cranial Nerve X(10)- Testing Motor Function
● Velum (CN X):
○ Observe velum at rest
○ Sustain an /ah/
■ Soft palate will raise on the intact muscle, but not the impaired muscle. Uvula tip will “point”
AWAY from the impaired side (weaker side that does not lift up)
Less common:
● Hold mirror or finger under nares during vowel prolongation*.
○ Look/listen/feel for nasal airflow
● Repeat oral sounds /p∂/ or oral heavy phrases

● Voice (sometimes included in CN X assessment)

○ Maximum phonation time (MPT)
○ Pitch glide
○ Laryngeal Diadochokinesis (LDDK): repeated /i/ and /hi/ (5 seconds each, take average/sec)
■ Rapid movements
■ /i/-stop-/i/-stop rapidly
○ Voice quality (GRBAS, volume, pitch breaks/falsetto speaking voice, absent pitches above modal range,
inspiratory stridor) during spontaneous speech and MPT
■ GRBAS- way of assessing different aspects of voice- horse, breathy, pitch
■ This is perceptual

Testing of CN XII
Cranial nerve XII (12)- Hypoglossal Nerve
● Hypoglossal Nerve
● Parasympathetic
○ None
● Sensory
○ None
● Motor
○ All intrinsic tongue muscles
○ All extrinsic tongue muscles except...?
○ Geniohyoid

Cranial nerve VII (12)- Hypoglossal Nerve- Testing Motor Function

● Observe tongue at rest
● Observe during sustained protrusion and lateralization with and without resistance
● Observe during repetitive lateralization
● DDK: repeated /puh/, /tuh/, /kuh/, /puh-tuh-kuh/
Because the tongue provides symmetric, opposing forces during protrusion, the tongue will deviate TOWARDS the weak
side during protrusion
Because tongue tip lateralization is the result of contralateral tongue contraction, there will be reduced lateralization on
the side OPPOSITE to the tongue weakness

- Fasciculations of the right tongue

- Atrophy on the right side of the tongue (you see wrinkles on tongue from atrophy)
- Fasciculations and atrophy →
- Lower motor neuron lesion affection cranial nerve 12 on the right
- Lateralization to the right, when he tries to lateralize to the left he moves the jaw as a compensation
- Reduced force on left lateralization because right tongue is week he can't push the tongue in that direction

● Tongue protrusion to left, weakness on left side of the tongue

● Also see Some fasciculations —>
○ Lower motor neuron lesion on cranial nerve 12 on the left
What do you expect to find on a person’s CNE if they have the following lesion:
1. Right lower motor neuron lesion affecting the nuclei of cranial nerve XII.
Right lingual atrophy and fasiculations. Tongue deviation to the right on protrusion.
2. Right upper motor neuron lesion affecting motor cortex.
Left lower facial droop. Tongue deviation to the left on protrusion.
3. Left lower motor neuron lesion affecting the nuclei of cranial nerve V.
Jaw deviation to the left side.

Based on the CNE findings listed below - name the associated lesion (be as specific as possible).
1. Adequate force throughout orofacial structures. Slow speed of movement, reduced amplitude of
motion, difficulty initiating movements, across orofacial structures.
Basal ganglia
2. Complete right facial droop. Vocal quality unremarkable. Palatal function unremarkable. Tongue
protrudes at midline.
Right LMN lesion of CNVII
3. Adequate initiation of tasks during CNE, consistent difficulty with scaling movements, inadequate
direction of movement, across articulators.
Cerebellum
4. Tongue deviates to the right. Fasiculations and atrophy of the right tongue.
Right LMN lesion of CNXII.
5. Tongue deviates to the right, right lower facial droop. CNE otherwise unremarkable.
Left UMN lesion of motor cortex.
6. Uvula points to the right. Apparent atrophy, reduced force, and fasiculations of the left soft palate.
Hoarse vocal quality. CNE otherwise unremarkable.
Left LMN lesion of CNX.

List one task from the cranial nerve exam that can be used to test range of motion associated with cranial nerve XII.
Quickly lateralize the tongue to the left and the right
List one task from the cranial nerve exam that can be used to test speed associated with cranial nerve X.
perform /i/ laryngeal diadochokinesis in which you repeat /i/ sounds as rapidly as you can over a period of 7
seconds
List one task from the cranial nerve exam that can be used to test force generation ('strength') associated with cranial
nerve VII.
place outward pressure to the subject's eyebrows and cheeks during facial scrunching while they try to sustain
the scrunch
List two abnormal findings you would expect to find on a person’s cranial nerve exam if they have a left upper motor
neuron 'lesion' affecting motor cortex.*Example of an 'abnormal finding' answer - reduced force generation of the right
jaw during jaw opening against resistance
right lower facial droop during rest, tongue deviates to the right during lingual protrusion
List four abnormal findings you would expect to find on a person’s cranial nerve exam if they have a right lower motor
neuron 'lesion' affecting cranial nerve XII.
right lingual atrophy during rest, right lingual fasiculations during rest, tongue deviation to the right during
protrusion, reduce range of left tongue during lingual lateralization
Adequate force throughout orofacial structures. Slow speed of movement, reduced amplitude of motion, difficulty
initiating movements across orofacial structures.
 Lesion at the basal ganglia
Complete left facial droop at rest. No movement of the left eyebrow/forehead during eyebrow/forehead lifting task. No
movement of left lips during alternating smile and pucker. Vocal quality unremarkable. Palatal function unremarkable.
Tongue protrudes at midline.
left lower motor neuron lesion of the facial nerve, CN VII
Adequate initiation of tasks during CNE, consistent difficulty with scaling movements, inadequate direction of movement
across orofacial structures.
lesion at the cerebellum

Cranial Nerve Examination:

Instrumental Methods
Instrumental, Quantitative Approaches

Cranial Nerve/OME- Facial Muscles

● Interlabial compression: objective, quantitative measure of interlabial force generation
● Buccadental compression: objective, quantitative measure of left or right labial-buccal force generation
● Instrument: handheld manometer w intraoral balloon (Iowa Oral Performance Instrument/IOPI)
○ Quantitative measures from facial muscles esp force generation, physiologic reserve
○ Handheld manometer or pressure meter which allows us to assess force generation for
various structures of the head, neck, face
■ Interabial compression- putting in between the lips + get objective measure of
force generation of lips, place bulb between two tongue depressors, and place
those between the lips in front of teeth, have ppl pucker down on it
● Lips pursing against the resistance
■ Buccodental- quantitative measure of left + right check, placed between cheeks
and teeth, gently bite down, squeeze cheeks multiple times as hard as you can
● Do bilaterally to see if one side is stronger than other
○ The little bulb gives us value of how forcefully something is pressing against bulb

Cranial Nerve/OME- Tongue

● Tongue press: objective, quantitative measure predominantly measuring extrinsic tongue force, w some
influence of intrinsic tongue + suprahyoid muscles
● Tongue protrusion + lateralization: objective, quantitative measure predominately measuring intrinsic tongue
muscle force generation
● Instrument: IOPI
○ Maximal Isometric Press + Maximal Endurance
○ Mean Swallowing Pressure & Physiological reserve
○ Lingual protrusion + lateralization
● Initially device was developed to get lingual pressures- diff types-
○ Maximal isometric press (tongue tip against top of hard palate)
■ Balloon/bulb just behind the teeth, tongue press against bulb as forcefully as possible
● Squeeze squeeze squeeze squeeze
■ Mouth is open so they are not compensating with the job
○ Endurance (how long someone can hold that)
 ■ Asking them to be at 50% of their strength but keep the bulb right at mid-strength, to see how
long can they do that
■ Tell them try not to go too far above the arrow, we don’t want you to exert too much energy, and
if it drops below for more than half a second we stop, you can see the light
■ Ideally get above 30 seconds
○ Swallowing pressure (how tongue develops pressure during swallowing)
■ Diff between swallowing pressure + maximum isometric press values tells us about their
functional reserve - how much strength is in the tank? are they using all of their strength to
swallow or do they have a big buffer?
● Precise measure that can track changes over time, whether in positive direction with treatment, or negative with
worsening of disease

Cranial Nerve/OME- Perihyoid Strength

● Open Mouth- Maximal Isometric Press (OM-MIP): objective, quantitative measure of the strength of the
suprahyoid, infrahyoid, and chin tucking muscles
● Instrument: handheld dynamometer (analogue + digital versions)
○ Open your mouth and press against the open mouth with dynamometer to get value of strength of
muscles that support the jaw open (perihyoid muscles), relates to improvement in function

Reflex Cough
● Task: ”Breathe through your mouth, and cough if you need to.”
● Instrument: nebulizer + tussuive stimuli (e.g., fog, citric acid, capsaicin)
○ present/absent cough response
○ Urge-to-cough rating (0-10 Modified Borg Scale)
● Reflex cough testing- sense of sensory + somatosensory function of larynx

For your review

Muscles by Region
(most relevant to swallowing)

Facial Muscles
● Obicularis oris
○ Motor: CN VII
○ Actions: protrudes lips; assists in concentric contraction of lips (along w buccinator)
● Buccinator
○ Motor: CN VII
○ Actions: compresses the cheeks against the teeth; assists in concentric contraction of the lips (along w
obicularis oris)

Superficial Muscles
● Sternocleidomastoid
○ Motor: CN XI
○ Actions: cervical flexion; elevation of sternum (for forced inhalation)
● Platysma
○ Motor: CN VII
○ Actions: lowers + widens corners of mouth
Muscles of Mastication
● Temporalis
○ Motor: CN V
○ Actions: elevation + retraction of mandible
● Massater
○ Motor: CN V
○ Actions: elevation + protrusion of jaw
● Medial Pterygoid
○ Motor: CN V
○ Actions: elevation of jaw; jaw lateralization
● Lateral Pterygoid
○ Motor: CN V
○ Actions: depresses + protrudes jaw; lateralizes jaw

Suprahyoid Muscles
● Geniohyoid (CN XII (*C1 of Ansa Cervicalis*)
○ Actions: lifts hyoid superiorly & anteriorly
● Mylohyoid (CN V)
○ Actions: lifts hyoid superiorly & anteriorly
● Anterior Diagastric (CN V)
○ Actions: lefts hyoid superiorly & anteriorly
● Posterior Digastric (CN VII)
○ Actions: lifts hyoid superiorly & posteriorly
● Sylohyoid (CN VII)
○ Actions: lifts hyoid superiorly & posteriorly

Infrahyoid Muscles
● Sternohyoid (Ansa Cervicalis (C1-C4))
○ Actions: depresses larynx + hyoid
● Sternothyroid (Ansa Cervicalis (C!-C4))
○ Actions: depresses larynx + hyoid
● Omohyoid (C1-C3 of Ansa Cervicalis)
○ Actions: depresses larynx + hyoid
● Thryohoid (C! Of Ansa Cervicalis)
 ○ Actions: elevates thyroid; depresses hyoid

Laryngeal Muscles: ACTIONS

● Posterior Cricoarytenoid (CN X- RLN)
○ abducts the vocal folds
● Lateral, Transverse, Oblique Arytenoids (CN X- RLN)
○ adducts the vocal folds
● Thyroarytenoid (CN X - RLN)
○ shortens + tenses the vocal folds
● Cricothyroid (CN X - SLN)
○ lengthens the vocal folds
● Aryepiglottic (CN X - RLN)
○ assists in approximation of arytenoids to epiglottis; asists in
(vertical) epiglottic inversion
● Thyroepiglottic (CN X - RLN)
○ Assists in epiglottic inversion
● Thyroarytenoid (CN X – RLN)
○ Assists in ventricular fold closure

Tongue
● Oral tongue (anterior ⅔)
● Base of the tongue (posterior ⅓)
○ Circumvallate papullae
○ Lingual tonsils
○ Glossoepiglottic fold
○ Pharyngoepiglottic fold
○ Epiglottis
● Tongue: intrinsic + extrinsic muscles

Lingual Muscles - intrinsic

● Superior longitudinalis (CN XII)
○ Retracts + shortens
● Inferior longitundinalis (CN XII)
○ Retracts + shortens
● Transverus (CN XII)
○ Protrudes + narrows
● Verticais (CN XII)
○ Protrudes, flattens, and widens

Lingual Muscles - Extrinsic

● Syloglossus (Motor: XII)
○ Elevates + retracts posterior tongue
● Palatoglossus (Motor: X)
○ Elevates posterior tongue
● Hyoglossus (Motor: XII)
○ Retracts + depresses
 ● Genioglossus
○ Retracts + protrudes
● Glossopharyngeus (Motor: X)
○ Retracts
○ Note: superior hyoid displacement (significantly) contributes to tongue base retraction

Palatal Muscles
● Levator veli palatini
○ Motor- pharyngeal plexus via CN X
○ Actions- elevates the soft palate
● Tensor veli palantini
○ Motor- CN V
○ Actions- tenses the soft palate
● Musculus uvulae (not pictured)
○ Motor- CN X
○ Actions- shortens, broadens, tenses the
uvula
● Palatopharyngeus
○ Motor- pharyngeal plexus via CN X
○ Actions- retracts soft palate (transverse
fibers)
● Palatoglossus (not pictured)
○ Motor- pharyngeal plexus via CN X
○ Actions- elevates tongue to soft palate

Pharynx
● Collapsible lumen connecting the oral + nasal cavities w the larynx + esophagus
● Consists of 2 functional muscle groups
○ Long pharyngeal muscles: ‘long’ longitudinal muscles, lining the inner layer of pharynx
○ Pharyngeal constrictor muscles: ‘round’ constrictor muscles, lining outer layer of pharynx

Pharyngeal muscles- long pharyngeal muscles

3 longitudinal muscles: Palato-, Stylo-, and Salpingo- Pharyngeus

Palatopharyngeus (X)
● Elevates larynx: shortens + elevates pharynx
● *transverse + lateral fibers
Stylopharyngeus (IX)
● Elevates larynx; shortens + elevates pharynx
Salpingopharyngeus (X)
● Elevates larynx; shortens + elevates pharynx

Pharyngeal Muscles - Pharyngeal Constrictor Muscles

(Superior (SPC), Middle (MPC), and Inferior (IPC) Pharyngeal Constrictors)
Superior Pharyngeal Constrictor
● Motor: CN X
● 4 origins parts: pterygoid, cheeks, mandible, and tongue (glossopharyngeus)
● Insertion: pharyngeal raphe
● Actions: concentric contraction of pharyngeal lumen w minimal assistance in BoT-PPW

Middle Pharyngeal Constrictor

● Motor: CN X
● Origins: hyoid bone + stylohoid ligament
● Insertion: pharyngeal raphe
● Actions: concentric contraction of pharyngeal lumen

Inferior Pharyngeal Constrictor

● Motor: CN X
● Origin: thyroid + cricoid cartilage (thyropharyngeus + cricopharyngeus, respectively)
● Insertion: pharyngeal raphe
● Actions: concentric contraction of pharyngeal lumen

Sensory FIelds: Oral Cavity, Pharynx, Larynx, Esophagus

● CN V
○ V2 Branch: general sensation (tactile-proprioception, pain-thermal)
■ Palate
■ Upper teeth + gums
○ V3 Branch: general sensation
■ Anterior ⅔ of tongue
■ Lower teeth + gumes
● CN VII- special sensation (taste) to oral tongue
● CN IX- general + special sensation to glossopharyngeal arches, base of tongue (posterior ⅓); pharyngeal wall
● CN X
○ SLN: general sensation to base of tongue, pharyngeal wall, valleculae, piriforms, arytenoids, aryepiglottic
folds, epiglottis, ventricular folds, vocal folds
○ RLN: general sensation subglottal larynx, trachea, bronchi
● Esophageal Branch: esophagus

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