CN IX, X: Glossopharyngeal, Vagus

B. procedure I. gag reflex ( Gag reflex [sensory IX, motor X]: 1. by touching the pharynx with a tongue depressor 2. watching the elevation of the palate and gagging reflex (tendency to vomit). II. sensation (taste sensation of posterior one third of the tongue): 1. Ask the patient to protrude his tongue 2. Use a small bottles and a dropper. The bottles usually contain sugar or salt solution. 3. Apply to one side then the other side of the extended tongue 4. ask the patient to tell you the taste before they pull their tongue back in the mouth III. Motor: 1. Ask the patient to open their mouth wide and to say 'ahh ". Observe the movement of the palate (symmetrical soft palate movement). The palate should rise symmetrically and there should be little nasal air escape 2. Examine the palate for uvular displacement, the uvula should be central in position (unilateral lesion: uvula drawn to normal side). 3. Ask the patient to swallow. Is there any difficulty. 4. Phonation should be clear

N.B. lesion of both nerve results in deviation of the uvula to the healthy side, difficulty in swallowing, loss of sensations from the pharynx with loss of taste sensation from posterior one third of tongue