CRANIAL NERVE EXAMINATION


Noted below are aspects of the anatomy which should be considered during the examination. For information about how to elicit motor and sensory abilities and how to analyse your observations, see chapter 6 of Daniels and Huckabee (2008).

Daniels and Huckabee (2008) organise the cranial nerve examination according to parts of the swallowing system, starting at the front and moving posteriorly.

  • Face: Observation of facial sensation and symmetry. Asymmetry, as characterised by facial grooving or folds, may indicate unilateral weakness.

  • Lips: Observation at rest, as well as in motion. Assessment of range of movement, symmetry and resistance.

  • Tongue: Observation at rest of atrophy and any involuntary movements, such as fasciculations. Assessment of range of movement, symmetry and resistance, as well as perception of taste and touch on lingual surface.

  • Palate: Evaluation of velopharyngeal sensation through touch. Observation of symmetry in motion during production of non-nasal phonemes. Assessment of velar elevation and movement of pharyngeal walls following elicitation of a gag reflex.

  • Pharynx: Palpation of the thyroid cartilage can provide a subjective marker of laryngeal movement during swallowing.

  • Larynx: Evaluation of phonation can be indicative of laryngeal structure and function. Vocal quality and cough are also markers of laryngeal function.

  • Speech: Information about muscular strength and coordination can be provided by the production of isolated phonemes, such as /k/ and /g/, followed by observation of connected speech.

  • Dry swallow: Observation of the initiation of voluntary swallow, as well as reflexive swallow for secretion management.

Groher and Crary (2010) list the components of the cranial nerve examination according to cranial nerve:

CN V
  • Jaw opening and closing
  • Jaw lateralisation
  • Muscle strength, bite down

CN VII
  • Facial muscles at rest
  • Pucker, smile
  • Raise eyebrow
  • Lips closed against resistance

CN IX, X
  • Gag reflex
  • Velum
  • Voice
  • Cough
  • Dry swallow

CN XII
  • Tongue range of motion
  • Tongue strength
  • Fasciculations, atrophy