Review the origin, course, and function of the cranial and spinal nerves that are important for

speech production. Trigeminal Nerve (Vth Cranial nerve). The paired trigeminal nerve is the largest of the cranial nerves. The nerve emerges on the mid-lateral surface of the pons as a large sensory and smaller motor root. (pterygoid, temporalis, muscles for mastication; masseter-in the cheek that functions to close the jaw). It is divided into ophthalmic (eye), maxillary, and mandibular branches. Unilateral Vth nerve lesions do not have major effects on speech. Bilateral lesions will affect articulation because jaw hangs open, the mouth cannot be closed, or moves slowly with limited range, therefore, the bilabial and lingual movement required by articulation can not be achieved. Facial Nerve (VIIth Cranial nerve). The paired facial nerve is a mixed motor and sensory nerve. Motor fibers that innervate the muscles of facial expression constitute the large part of the nerve. They originate from the facial nucleus located in the lower third of the pons. LMN lesions of the nerve can lead to paralysis of the muscles on the entire ipsilateral side of the face. Such lesion can affect all voluntary, emotional and reflex movements, and atrophy occurs, resulting in facial asymmetry. (Fasciculation or localized, uncoordinated, uncontrollable muscle twitching may be seen). Glossopharyngeal Nerve (IXth Cranial nerve). The paired glossopharyngeal nerve is a mixed motor and sensory nerve. It is relevant to speech in that its motor supply to the stylopharyngeus muscle of the pharynx and its transmission of sensory information from the pharynx, tongue, and Eustachian tube. The motor component emerges from the medulla just above the rootlets of the Vagus nerve. Within the medulla there are reflex connections between pharyngeal sensory and motor neurons that mediate the Gag reflex. Damage to the Glossopharyngeal nerve is usually accompanied by damage to the Vagus nerve. Damage is most predictable when you see reduced pharyngeal sensation and a decrease in gag reflex.

Vagus Nerve (Xth Cranial nerve). The paired Vagus nerve is a complex and lengthy mixed motor and sensory nerve. It is very important to speech production. Its motor functions include the innervation of the striated muscles of the soft palate, pharynx, and larynx. Its sensory role includes transmission of sensation from soft palate, pharynx, and larynx. The Vagus nerve emerges from the lateral aspect of the medulla between the inferior cerebellar peduncle and the inferior olive. There are three branches: the pharyngeal branch, the superior laryngeal branch and the recurrent laryngeal branch. The pharyngeal branch travels down the neck between the internal and external carotid arteries and enters the pharynx at the upper border of the middle pharyngeal constrictor muscle. It is primarily responsible for pharyngeal constriction and for retraction and elevation of the soft palate during velopharyngeal closure for speech and swallowing. The superior laryngeal nerve branch of the Vagus further divides into internal and external laryngeal nerve. The internal laryngeal nerve is purely sensory. The external laryngeal nerve innervates the interior pharyngeal constrictor and cricothyroid muscles (important for phonation, lengthens the vocal folds for pitch). The right and left recurrent laryngeal nerves take different paths. Both the right and left recurrent laryngeal nerves innervate all of the intrinsic muscles of the larynx except the cricothyroid. The superior and recurrent laryngeal nerves are responsible for all laryngeal motor activities involved in phonation and swallowing. Therefore, damage to all branches of the Vagus nerve will produce weakness of the soft palate, pharynx and larynx. Hypoglossal Nerve (XIIth Cranial nerve). This paired sensory and motor nerve innervates all intrinsic and all but one extrinsic muscles of the tongue (palatoglossussupplied by Vagus nerve). Damage to this nerve can lead to atrophy, weakness and fasciculations of the tongue on the side of lesion. Unilateral weakness causes the tongue to deviate to the side of the lesion when protruded.

The Spinal nerves LMNs supplying the respiratory muscles are distributed widely, from the cervical through the thoracic divisions of the spinal cord. The diaphragm is supplied by LMNs arise from the 3rd, 4th and 5th cervical segments of the spinal cord. This muscle is most important to inhalation and speech. Damages to the 3rd, 4th and 5th cervical segment of the spinal cord can paralyze the diaphragm bilaterally and seriously affect breathing. As we know, that will affect voice production, loudness, phrase length and prosody.