Base of Skull Tumors: Types, Treatment & Unique Rehabilitation Considerations TSHA Convention 2008 Gail L. Davie, M.A.

CCC/SLP & Denise Barringer, M.S. CCC/SLP

Cranial Nerves & Their Function

CRANIAL NERVE
I OLFACTORY II OPTIC III OCULOMOTOR

MOTOR/ SENSORY
Sensory Sensory Motor Motor Motor Sensory Smell Vision

FUNCTION

IV TROCHLEAR V TRIGEMINAL

Movement of eyeball, pupil and upper eyelid (All eye muscles except lateral rectus and superior oblique muscles) Eye movement (contralateral , superior oblique) Movement of muscles for mastication Tactile facial sensation Opens eyes. (ipsilateral lateral rectus) Movement of facial muscles Extrinsic and intrinsic ear muscles, stapedius muscle Taste (anterior 2/3 of tongue) Hearing Equilibrium and orientation of head in space Elevation of palate, movement of pharynx and larynx Contributes to swallowing by controlling the stylopharyngeus muscle General sensation from palate, posterior 1/3 of tongue and oropharynx Taste from posterior 1/3 of tongue and oral pharynx Muscles of soft palate, pharynx and larynx Base of tongue (palatoglossus muscle only) Sensation from pharynx and larynx Taste in the epiglottis and pharynx Movement of head and shoulders Movement of palate, pharynx and larynx All of the intrinsic muscles of the tongue All of the extrinsic muscles of the tongue except the palatoglossus

VI ABDUCENS VII FACIAL

Motor Motor Sensory Sensory Motor

VIII ACOUSTIC IX GLOSSOPHARYNGEAL

Sensory

X VAGUS

Motor Sensory

XI ACCESSORY XII HYPOGLOSSAL

Motor Motor

Bhatnagar 2001, p. 278-279; Shipley and McAfee 2004, p.286; Groher 1997, p. 29

Base of Skull: Divisions, Bones, Foramen and Cranial Nerves (Interior of skull)
DIVISION Anterior Middle Middle Middle Middle Middle Middle Middle Middle Posterior Posterior Posterior Posterior BONE Temporal Sphenoid Sphenoid Sphenoid Sphenoid Sphenoid Sphenoid Temporal Temporal Temporal/ Occipital Temporal/ Occipital Temporal/ Occipital Temporal/ Occipital FORAMEN Olfactory foramen Optic foramen Superior orbital fissure Superior orbital fissure Foramen rotundum Foramen ovale Superior orbital fissure Internal auditory meatus Internal auditory meatus Jugular foramen Jugular foramen Jugular foramen Jugular foramen CRANIAL NERVE I Olfactory II Optic III Occulomotor V1 Optic division of Trigeminal nerve V2 Maxillary division of Trigeminal nerve V3 Mandibular division of Trigeminal nerve VI Abducens VII Facial VIII Vestibular IX Glossopharyngeal X Vagus XI Accessory XII Hypoglossal

Foramina and Structures of the Skull Base

Duffy, J.R. Motor Speech Disorders Substrates, Differential Diagnosis, and Management. Mosby 1995. P. 16

Foramen lacerum

Foramen ovale

Sella turcica

Lesser wing of sphenoid

Clivus

Interior view of skull base

http://ect.downstate.edu/courseware/haonline/labs/l22/os0904.htm

Speech and Swallowing Impairments Associated with Each Cranial Nerve

CRANIAL NERVE CN V

DISORDERED PHYSIOLOGY
jaw movement face, mouth & jaw sensation facial movement & sensation salivation hearing balance

SWALLOWING SYMPTOMS
mastication oral containment

SPEECH SYMPTOMS
Unilateral: insignificant Bilateral: severely articulatory precision Mild distortion of b, p, f, v, Distortion of resonance articulatory precision of all sounds over time Hypernasality

CN VII CN VIII

Residue in the lateral sulci Drooling N/A

CN IX

Delayed pharyngeal trigger velopharyngeal closure laryngeal elevation palatal, pharyngeal, laryngeal excursion true vocal cord abduction and/ or adduction pharyngeal sensation lingual range of motion & strength

Aspiration before & during the swallow

CN X

CN XII

Stasis/residue in the valleculae, posterior pharyngeal wall & pyriform sinuses Aspiration during or after the swallow Inability to cough bolus consolidation anterior to posterior movement of the bolus oral residue

Hypernasality Breathiness & hoarseness pitch range vocal loudness Imprecise articulation of l, t, d, s, z, sh, ch, k, g,

REFERENCES
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18. Pollack, I.F.; Polinko, P.; Albright, A.L.; et al. Mutism and pseudobulbar symptoms after resection of posterior fossa tumors in children: incidence and pathophysiology. Neurosurgery. 1995, 37, 885-893. 19. Sherman, J.H.; Sheehan, J.P.; Elias, J.W.; et al. Cerebellar mutism in adults after posterior fossa surgery: a report of 2 cases. Surg. Neurol. 2005, 63, 476479. 20. Catsman-Berrevoets, C.E.; Van Dongen, H.R.; Mulder, P.G.; et al. Tumor type and size are high risk factors for the syndrome of cerebellar mutism and subsequent dysarthria. J Neurol. Neurosurg. Psychiatry. 1999, 67, 755-757. 21. Idlan, F.; Tuna, M.; Erman, T.; et al. The evaluation and comparison of cerebellar mutism in children and adults after posterior fossa surgery: report of two adult cases and review of the literature. Acta Neurochir (Wien). 2002, 144, 463-473. 22. Logemann, J.A. Imaging the oropharyngeal swallow. Adm. Radiology. 1993, 3, 20-24,43. 23. Logemann, J.A. Manual for the Videofluoroscopic Study of Swallowing, 2nd Ed.; Hyams, H., Ed.: Pro-Ed, Inc.: Austin, Texas, 1993. 24. Langmore, S.E.; Schatz, K.; Alson, N. Endoscopic and videofluroscopic evaluations of swallowing and aspiration. Ann. Otol. Rhinol. Larygol. 1991, 100, 678-681. 25. Kertz, A. The Western Aphasia Battery. The Psychological Corporation Harcourt Brace Jovanovich, Inc.: San Antonio, Texas, 1982. 26. Pimental, P.A.; Knight, J.A. Mini Inventory of Right Brain Injury (MIRBI-2). Pro-Ed, Inc.: Austin, Texas, 2006. 27. Bhatnagar, S.C.; Neuroscience for the Study of Communicative Disorders. Second Edition. LWW, 2001. 28. Shipley, K.G. and McAfee, J.G.; Assessment in Speech-Language Pathology: A Resource Manual. Third Edition, 2004. 29. Groher, M.E; Dysphagia Diagnosis and Mangagement. Third Edition, Butterworth-Heinemann, 1997.