Cranial nerve V - the Trigeminal nerve

Signs and Symptoms of Lesions

The individual may experience loss of sensation or shooting facial pain; paresthesia; paralysis of mastication muscles; loss of reflexes; impaired hearing; lockjaw; dryness of nose or ulceration’s of the face.

Trigeminal neuralgia (tic douloureux) is typified by a sharp lancinating pain of at least one of the branches of the trigeminal nerve. While it lasts only a short while, the pain is excruciating, and usually unilateral, and may be triggered by temperature change, a blast of air, chewing or stress.

Trigeminal Nerve Test

There are three steps in which to test Cranial Nerve V.

1.  Test sensation – With the individuals’ eyes closed, the practitioner will use a cotton swab or pointy object over the face and the anterior half of the scalp.  Have the individual tell you where they are feeling the object.

2.   Reflex – With the individual's eyes open and looking upward, the practitioner takes a strand of cotton, approaches the cornea from the side, and touches it with the cotton. This should initiate a blink response. Both eyes should be tested independently, with a failure to blink being presumptive of a positive response.

3.  Initially, the practitioner has the individual clinch his/her jaw and palpates contractile response of the masseter slightly superior to the mandibular ramus.  Then the practitioner applies moderate pressure to the mandibular symphysis and requests the individual to open against load.   Lateral deviations of the mandible should be noted for muscle weakness or uneven tensile compression, if so consider temporal mandibular joint dysfunction or Myofascial Pain Dysfunction Syndrome.  Inability to perform successfully, infers possible paralysis as observed in Bell’s palsy and Cerebral Vascular disorders. 

When accompanied by pain, consider trigeminal neuralgia (tic douloureux), post herpatic neuralgia (Ramsey Hunt syndrome or herpes zoster oticus), temporomandibular joint dysfunction or TrP referral from the SCM or the Masticatory muscles. With facial ulcers consider active herpes zoster (Ramsey Hunt Syndrome or herpes zoster oticus).  With impaired hearing, consider cerumen buildup and nerve deafness; and perform the Acoustic Nerve test - Cranial Nerve VIII.

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