Trigeminal nerve

There are four functions of the V nerve: sensory, motor and two reflexes.
1. Sensory
STEP 1Ask the patient to close his eyes and say 'yes' each time he feels you lightly
touch them using the edge of a tissue. Do this in the areas of V1, V2 and V3.

STEP 2 Repeat, using a fresh neurological pin, e.g. Neurotip® to test superficial pain.

STEP 3 Use an orange stick to test touch on the anterior two-thirds of the tongue.
Ask the patient to close his eyes and indicate when they feel you touch the tongue.
 2. Motor

• Inspect for wasting of the muscles of mastication.

• Ask the patient to clench his teeth; feel the masseters, estimating their
bulk.

• Ask the patient to open his jaw against your hand, which is providing
resistance, and note any deviation.
 3. Corneal reflex

• Explain to the patient what you are going to do.

• Ask the patient to look upwards to the ceiling and gently depress the lower
eyelid.

• Very lightly touch the lateral edge of the cornea with a wisp of damp cotton
wool (Fig. 11.9).

• Look for both direct and consensual blinking.

 4. Jaw jerk

• Ask the patient to let his mouth hang loosely open.

• Place your forefinger in the midline between lower lip and chin.

• Percuss your finger gently with the tendon hammer (Fig. 11.10), noting any
reflex shutting of the jaw. The normal response is absent or just present