Cranial Nerve XI

(Accessory) & Cranial Nerve

XII (Hypoglosal)
PRE ADVANCED NURSE
FIK UMJ 2021
 Cranial Nerve XI (Accessory)
• The accessory nerve is the eleventh paired cranial
nerve. It has a purely somatic motor function,
innervating the sternocleidomastoid and trapezius
muscles.
Cranial Nerve XI (Accessory)
 Motor Function
• The spinal accessory nerve innervates two muscles
– the sternocleidomastoid and trapezius.
• Sternocleidomastoid
• Attachments – Runs from the mastoid process of
the temporal bone to the manubrium (sternal
head) and the medial third of the clavicle
(clavicular head).
• Actions – Lateral flexion and rotation of the neck
when acting unilaterally, and extension of the neck
at the atlanto-occipital joints when acting
bilaterally.
 Trapezius
• Attachments – Runs from the
base of the skull and the spinous
processes of the C7-T12
vertebrae to lateral third of the
clavicle and the acromion of the
scapula.
• Actions – It is made up of upper,
middle, and lower fibres. The
upper fibres of the trapezius
elevate the scapula and rotate it
during abduction of the arm. The
middle fibres retract the scapula
and the lower fibres pull the
scapula inferiorly.
 Cranial Nerve XII (Hypoglossal)
• Its name is derived from ancient Greek, ‘hypo‘
meaning under, and ‘glossal‘ meaning tongue. The
nerve has a purely somatic motor function,
innervating all the extrinsic and intrinsic muscles of
the tongue (except the palatoglossus, innervated by
vagus nerve).
 Motor Function

• The hypoglossal nerve is

responsible for motor
innervation of the vast
majority of the muscles of
the tongue (except for
palatoglossus). These
muscles can be subdivided
into two groups:
Motoric Functions

i) Extrinsic muscles ii) Intrinsic muscles

❖ Genioglossus (makes up the ❖ Superior longitudinal
bulk of the tongue) ❖ Inferior longitudinal
❖ Hyoglossus ❖ Transverse
❖ Styloglossus ❖ Vertical
❖ Palatoglossus (innervated by ❖ Together, these muscles are
vagus nerve) responsible for all
movements of the tongue.
Abnormalities Linked to CN XI & XII
• Accessory Nerve Palsy
The most common cause of accessory
nerve damage is iatrogenic. Procedures
such as cervical lymph node excision
biopsy or central line insertion can cause
trauma to the nerve.
Clinical features include muscle
wasting and partial paralysis of the
sternocleidomastoid, resulting in the
inability to rotate the head or weakness
in shrugging the shoulders. Damage to
the muscles may also result in
an asymmetrical neckline.
 Hypoglossal Nerve Palsy
Damage to the hypoglossal nerve is
a relatively uncommon cranial
nerve palsy. Possible causes
include head & neck
malignancy and penetrating
traumatic injuries. If the symptoms
are accompanied by acute pain, a
possible cause may be dissection of
the internal carotid artery.
Patients will present with
deviation of the tongue towards
the damaged side on protrusion, as
well as possible muscle wasting and
fasciculations (twitching of isolated
groups of muscle fibres) on the
affected side.
 CN XI & XII Examination
Cranial Nerve XI Examination
1. First, inspect for evidence
sternocleidomastoid or trapezius muscle
wasting.
2. Ask the patient to raise their shoulders and
resist you pushing them downwards: this
assesses the trapezius muscle (accessory nerve
palsy will result in weakness).
“Shrug your shoulder please?” “Don’t let me
push them down.”
• 3. Ask the patient to turn their head left whilst you
resist the movement and then repeat with the patient
turning their head to the right: this assesses the
sternocleidomastoid muscle (accessory nerve palsy
will result in weakness).
• “Could you look to the right and left?” “Don’t let
me stop you”
Cranial Nerve XII Examination
1. Ask the patient
to open their mouth and inspect the tongue for wastin
g and fasciculations at rest (minor fasciculations can
be normal).

Could you please open your

mouth?
2. Ask the patient
to protrude their tongue and observ
e for any deviation (which occurs
towards the side of a hypoglossal
lesion).

“Stick out your tongue

please” “Could you move
it from side to side?”
3. Place your finger on the patient’s cheek and ask
them to push their tongue against it. Repeat this on
each cheek to assess and compare power (weakness
would be present on the side of the lesion).

“Press your cheeks with

your tongue, please”
 REFERENCE
• https://teachmeanatomy.info/head/cranial-
nerves/accessory/
• https://www.wikem.org/wiki/Cranial_nerve_abnormal
ities