THE 12 CRANIAL NERVES

• CN 1 OLFACTORY
Function: Sense of Smell
Type: Sensory
Assessment Method:
After checking the patency of both
nostrils, have the patient close both eyes.
Then occlude one nostril, and hold a
familiar, pungent-smelling substance, such
as coffee, tobacco, soap, or peppermint,
under his nose and asks its identity.
Repeat this technique w/ the other nostril.
• If the patient reports detecting the smell
but cannot name it, offer a choice, such
as, “Do you smell lemon, coffee, or
peppermint?”
• CN II OPTIC
Function: Arises from retinas of the eyes
and carries impulses associated with
vision
Types: Sensory
Assessment method:
To assess the optic nerve, check visual
acuity, visual fields, and the retinal
structures.
• CN III OCULOMOTOR
Function: Controls extrinsic eye muscles
and regulates pupil size
Type: Motor and sensory
Assessment Method:
To assess the oculomotor nerve,
check pupil size, pupil shape, and pupillary
response to light.
• When assessing pupil size, be especially
alert for any trends. For example, watch
for a gradual increase in the size of one
pupil or the appearance of unequal pupils
in a patient whose pupils were previously
equal
• CN IV TROCHLEAR

Function: Aids voluntary movements of

eyeballs
Type: Motor and sensory
Assessment Method:
Assess six ocular movements. Eyes
should move smoothly and in a
coordinated manner.
• CN V TRIGEMINAL
Function: Controls major sensory nerves of
the face. Has 3 divisions: opthalmic
(sensory), maxillary (sensory), and
mandibular (motor and sensory)
Type: Motor and sensory
Assessment Method:
OPTHALMIC- while client looks
upward, lightly touch lateral sclera of the
eye to elicit blink reflex;
to test light sensation, have client close
eyes, wipe a wisp of cotton over the
client’s forehead and paranasal sinuses; to
test deep sensation, use alternating blunt
and sharp ends of a safety pin over same
areas.
MAXILLARY- assess skin sensation as
opthalmic branch
MANDIBULAR – ask client to clench
teeth
• CN VI ABDUCENS

Function: Supplies the lateral rectus

muscles of the eyes
Type: Motor and sensory
Assessment Method:
• CN VII FACIAL

Function: Supplies the muscles of the face,

scalp, taste buds, and lacrimal glands
Type: Motor and sensory
Assessment method: to test the motor
portion of this nerve, ask the patient to
wrinkle his forehead, raise and lower his
eyebrows, smile to show teeth, and puff
out his cheeks. Also, with the patient’s
• eyes tightly closed, attempt to open the
eyelids. With each of these movements,
observe closely for symmetry.
• To test the sensory portion of the facial
nerve, which supplies taste sensation to
the anterior two-thirds of the tongue, first
prepare four marked, closed containers,
with one containing salt, another sugar, a
third, vinegar (or lemon), and a fourth,
quinine (or bitters). Then, with the patient’s
eyes closed, place salt on the anterior
• Two-thirds of his tongue using a cotton
swab or dropper. Ask him to identify the
taste as sweet, salty, sour, or bitter. Rinse
his mouth with water. Repeat this
procedure, alternating favors and sides of
the tongue until all four flavors have been
tested on both sides. Taste sensations to
the posterior third of the tongue are
supplied by the glossopharyngeal nerve
(CN IX) and are usually tested at the same
time.
• CN VIII VESTIBULOCOCHLEAR

Function: Supplies the ears

Type: Sensory
Assessment method:to assess the
acoustic portion of this nerve, test the
patient’s hearing acuity. To assess the
vestibular portion of this nerve, observe for
nystagmus and disturbed balance and
note reports of dizziness or the room
spinning.
• CN IX GLOSSOPHARYNGEAL

Function: Supplies the tongue and pharynx,

taste buds, and carotid sinus
Type: Motor and sensory
Assessment method:to assess this nerve,
first listen to the patient’s voice for
indication of a hoarse or nasal quality.
Then, watch his soft palate and the uvula
rise when he says, “ah” and the uvula
should remain at the midline.
• CN X VAGUS

Function: Runs close to common carotid

arteries and internal jugular veins to the
thorax and lower abdomen; has a broad
parasympathetic distribution
Type: Motor and sensory
Assessment method: test for gag reflex.
To evoke this reflex, touch the posterior
wall of the pharynx with a cotton swab or
tongue depressor.
• CN XI SPINAL ACCESSORY

Function: Supplies the trapezius and

sternocleidomastoid muscles; responsible
for proprioception.
Type: Motor and sensory
Assessment method:press down on the
patient’s shoulders while he attempts to
shrug against this resistance. Note
shoulder strength and symmetry while
inspecting and palpating the trapezius
muscle. Then, apply resistance to his
turned head while he attempts to return to
a midline position. Note neck strength
while inspecting and palpating the
sternocleidomastoid muscle. Repeat for
the opposite side.
• CN 12 HYPOGLOSSAL

Function: Supplies intrinsic and extrinsic

muscles of tongue; involved in
proprioception
Type: Motor and sensory
Assessment Method: to assess this nerve,
observe the patient’s protruded tongue for
any deviation from midline, atrophy, or
fasciculations (very fine muscle flickerings
indicating lower motor neuron disease).
• Next, instruct the patient to move his
tongue rapidly from side to side with the
mouth open, to curl his tongue up toward
the nose, and to curl his tongue down
toward the chin.
• Then use a tongue depressor or folded
gauze pad to apply resistance to his
protruded tongue, and ask him to try to
push the depressor to one side. Repeat
this procedure on the other side and note
the patient’s tongue strength.
• Listen to the patient’s speech for the
sounds d, l, n, and t, which require use of
the tongue to articulate. If his general
speech suggests a problem, have him
repeat a phrase or a series of words
containing these sounds.