![]() ![]() A report of trouble should result in the examiner looking for dental and/or TMJ causes for the trouble. If the patient is having trouble chewing, the muscles of mastication may be involved. In some cases, numbness may be a result of a previous facial surgery, which should also be reported during the history process. Patients are likely to report these findings as part of their recent history. Numbness and abnormal sensations are usually noticed during these activities. They wash their face, brush their teeth, apply makeup, shave, wear glasses, blow their nose, eat, etc. People touch their faces frequently during the course of a day. Patients with altered sensation of the face are likely to notice the abnormality quickly and report it. The fifth cranial nerve (trigeminal nerve) provides sensation for the face and innervates muscles of mastication. If the patient has pupils of unequal size and/or has ptosis, then a lesion of the third cranial nerve should be suspected. Cranial nerve three also deals with pupil size and elevation of the eyelid. ![]() It is easy to observe if the eyes move together in a coordinated manner during a conversation, making converging strabismus and diverging strabismus easy to detect. ![]() The patient's ability to drive to the office, read paperwork and navigate through the office are also clues.Ĭranial nerves three, four and six (oculomotor, trochlear and abducens nerves) deal with movement of the eyes. If the patient is wearing glasses or contacts, the examiner is alerted immediately to refractive problems of the eye. The second cranial nerve (optic nerve) deals with sight. Isolated lesions of the 10th cranial nerve are rare. The most common reasons for diminished sensation of the first cranial nerve are cold, flu, sinus trouble and the natural loss of the ability to smell that occurs with aging. This is also true for the 10th cranial nerve (vagus nerve). In fact, the bullet system for current procedural coding (CPT) does not recognize the first cranial with a bullet. The first cranial nerve (olfactory nerve) is seldom tested in general screening examination. A good general screening of the cranial nerves can be performed while observing the patient during the course of a conversation (case history) and understanding the likelihood of pathology for some of the nerves. Initial screening of the cranial nerves can actually be relatively easy.Įase in performing the assessment is associated with a common-sense approach that – much like the one taken in the earlier description of assessing mental status – relies heavily on observations. In truth, the examination is indeed the most complicated, but complicated does not always equate with difficulty or time commitment. Of the six components of the neurological examination, the cranial nerve examination is perceived as being the most complicated and thus the most difficult and time consuming. ![]()
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