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Cranial Nerve and Fracture Relationship 1

Cranial nerve and fracture relationship


Vignette: A 23-year-old male presents to the emergency department following a motor vehicle accident. His CT scan reveals a fracture of the middle cranial fossa. Which of the following cranial nerves is most likely to be affected?


A. Oculomotor nerve (CN III)

B. Trochlear nerve (CN IV)

C. Abducens nerve (CN VI)

D. Facial nerve (CN VII)

E. Vestibulocochlear nerve (CN VIII)


D. Facial nerve (CN VII)


The middle cranial fossa houses several cranial nerves, including the facial nerve (CN VII). This nerve is particularly vulnerable to fractures of the middle cranial fossa due to its long intratemporal course. Damage to the facial nerve can result in facial paralysis, loss of taste in the anterior two-thirds of the tongue, hyperacusis, and decreased lacrimation and salivation. The oculomotor (CN III), trochlear (CN IV), and abducens (CN VI) nerves are found in the cavernous sinus in the middle cranial fossa, and they are less likely to be injured by a fracture of the middle cranial fossa. The vestibulocochlear nerve (CN VIII) is situated more posteriorly in the internal acoustic meatus of the posterior cranial fossa, making it less susceptible to injury from a fracture in the middle cranial fossa.


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