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Raj Gross III review

NYCC final review exam 2 head and neck Winter 2010

contents of carotid sheath internal jugular vein, common carotid artery, Ansa cervicalis, CN X-Vagus
Through what opening does the opthalmic ARTERY pass? Optic canal (with CN II-Optic)
Name cranial nerves and structures passing through SupraOrbital Fissure (SOF): CN's III-Oculomotor (superior division), IV-Trochlear, V1 Ophthalmic branch of Trigeminal nerve, VI-Abducent, lacrimal nerve, frontal nerve, superior ophthalmic VEIN
Come On SOFia SOFia SOFia, Roll Over SOFia! I AM In A Mood for JUGs, JUGs, JUGs. Hey! (exits for cranial nerves) Cribriform (I), Optic (II), SupraOrbital Fissure (III), SOF (IV), SOF (V1 of Trigeminal), Rotundum (V2 of Trigeminal), Ovale (V3 of Trigeminal), SOF (VI), Internal Acoustic Meatus (VII), IAM (VIII), Jugular (IX), JUG (X), JUG (XI), Hypoglossal (XII)
The movement(s) of the eyeball which take place around the anteroposterior axis are/is: Intorsion, Extorsion
A male patient with increased intercranial pressure presents with a medial squint (strabismus). The lesion of which nerve is responsible? CN VI - Abducent (LR6, SO4)3
Name the branches of the external carotid artery: Superior thyroid, Lingual, Facial, Maxillary, Superficial Temporal, Ascending Pharyngeal, Occiptial
The superior laryngeal artery (branch of superior thyroid of external carotid) supplies the mucosa and inner laryngeal muscles. Principle laryngeal artery. Connected with inferior laryngeal artery.
Nerve running with Superior laryngeal artery that pierces the thyrohyoid membrane to innervate the mucosa of piriform recess (where it is seen in dissection). Supplies the mucosa of epiglottic valleculae, epiglottis, and superior larynx. Internal Laryngeal nerve from Superior Laryngeal Nerve of CN X-Vagus
Lesion of CN X - Vagus loss of parasympathetics to thoracic and abdominal viscera, loss of taste to post 1/3 tongue and epiglottis, dysphonia, dysphagia, deviation of uvula to strong side
Inferior oblique eye muscle movements: elevation, intorsion, abduction (look in and up)
Superior oblique eye muscle movements: depression, intorsion, abduction (look down and in, as reading the paper or walking down stairs)
Innervation of Medial rectus and lesion: CN III- Oculomotor, Lateral strabismus (eye looks outward because no medial rectus maintaining inward/center balance pulling force)
Inferior rectus eye muscle movements: depression, adduction, extorsion
A patient with a previous history of operation for a parotid tumor comes in with a complaint of sweating, pain, and redness over the skin of the parotid region during a meal. This may be due to injury of fibers of the? Auriculotemporal nerve (Frey's syndrome)
The carotid body acts as a ______________ chemoreceptor (B.O.D.y is Body Oxygen Dioxide)
The carotid sinus acts as a _____________ baroreceptor for blood pressure
The carotid body is usually seen on the ____________surface, opposite the ascending pharyngeal artery, at the bifurcation of the common carotid artery. anterior
2 nerves supplying carotid body Vagus and Glossopharyngeal
Carotid sinus shows thickening of the tunica _______________, reverse from most vessels. adventitia
Indirect laryngoscope examination permits the visualization of (3) base of tongue, vallecula, vocal folds
The submandibular salivary gland opens at the sublingual papilla
What nerve suspends the submandibular salivary gland above the submandibular ganglion and also supplies sublingual gland? Lingual nerve, division of V3 Maxillary branch of Trigeminal (right after Inferior Alveolar nerve)
Twig of Facial nerve running with Lingual nerve to provide special sensation to tongue (also seen in middle ear) chorda tympani
Submandibular ganglion provides __________________________________ fibers to the submandibular and sublingual glands. postganglionic parasympathetic (2nd synapse, Autonomic visceral rest and digest)
Where does the Parotid gland empty into the mouth? opposite the upper second molar tooth
Name cervical plexus branches of posterior/dorsal rami of C1-4 Suboccipital (C1), Greater Occipital (C2), Third Occipital (C3), posterior cervical plexus of posterior rami
Where does the Great Auricular nerve come from? cervical plexus
Where does the Auriculotemporal nerve come from? V2 Maxillary branch of Trigeminal
Where does the Posterior Auricular nerve come from? Facial nerve
Which nerve encircles the middle meningeal branch of Maxillary artery? Auriculotemporal nerver branch of V3 Maxillary
What does the Geniculate ganglion do? acts like a spinal ganglion for Facial nerve -contains the pseudounipolar ganglion cells that form the Chorda tympani
Vagus has a Meningeal branch and an ___________ branch coming off the Superior ganglion. Auricular
Posterior/Dorsal rami branches (basically to midline of back of head): 4 Suboccipital, Greater Occipital, Third Occipital, posterior/dorsal cervical plexus
Cervical Plexus nerves (basically from posterior ear to platysma to clavicle and deltoids - all superficial): 5 Ansa cervcialis, Lesser Occipital, Great Auricular, Transverse Cervical, Supraclavicular
What THREE occipital nerves have a common origin of dorsal rami? Suboccipital, Greater Occipital, THIRD Occipital
Ansa Cervicalis, Lesser occipital, Great Auricular, Transverse cervical, and Supraclavicular all share a common origin: anterior/ventral rami of cervical plexus
The pharynx is continuous with with esophagus at the level of what segment? C6
Inferior attachment of Scalenus anterior Superior surface of 1st rib between subclavian a. and subclavian v.
What two vessels does Scalenus anterior separate? by attaching where? Subclavian artery and Subclavian Vein, by attaching to the superior surface of the 1st rib
Folds of dura mater of the cranium Falx cerebri, Tentorium cerebelli, Falx cerebelli, Diaphragm sellae
What is the dorsum sellae? the "slide" of bone down from sella turcia (the dorsum or backside of sellae)
The nerve of the Pterygoid canal is formed by the union of? Origins? Optional name of nerve of Pterygoid canal? Termination? Greater petrosal n. and Deep petrosal nerve, because Greater petrosal is parasympathetic root of Facial VII. Deep petrosal is sympathetic root of internal carotid plexus. Unite to become VIDIAN/nerve of pterygoid canal. Stop at pterygopalatine ganglion.
Greater petrosal from __________ nerve and Deep petrosal from ________plexus unite to become Vidian nerve and reach pterygopalatine ganglion. Greater is Facial, Deep is Carotid
Which branch is sympathetic, Greater or Deep petrosal? with deepest sympathy
Sensory fibers from ___________ branch of Trigeminal go to pterygopalatine ganglion, along with Deep petrosal (deepest sympathy from carotid) and Greater petrosal (parasymp from Facial) V2 Maxillary
An enlarged jugulodigastric lymph node suggests an infection of the tonsil
Lymphatic drain of tonsil jugulodigastric
Man is admitted to ER after accident. He is alert and fully oriented, but witnesses reported temporary unresponsiveness at scene. Films: fracture temporal. CT scan: extradural hemorrhage. Unconscious again. Structure most commonly damaged in this case? Middle meningeal branch of maxillary artery
the Lesser Petrosal nerve is a branch of the tympanic plexus
The lesser petrosal nerve joins the __________ ganglion, conveying pre-ganglionic secretomotor fibers to this ganglia. otic
The posterior ganglionic fibers from the otic ganglion travel via the auriculotemporal nerve to supply the parotid gland
lesser petrosal (tympanic plexus) to otic ganglion to parotid
artery prone to injury when there is a cranial fracture causing epidural or extradural hematomas middle meningeal branch of maxillary artery
Stylohyoid innervation Facial (along with posterior belly of digastric -they run together)
Stylopharyngeus innervation Glossopharyngeal (pharyngeus=GlossoPharyngeal)
Styloglossus innervation Hypoglossal (glossus=HypoGlossal)
Test question will read: "the muscles originating from the styloid process are innervated by all of the following except:"What are the 3 nerves that innervate the muscles for certain? Facial=stylohyoid, Glossopharyngeal=stylopharyngeus, Hypoglossal=styloglossus
A cranial fracture through the foramen rotundum that compresses the enclosed nerve results in: Come On SOFia SOFia SOFia, Roll Over SOFia! I AM In A Mood for JUGS JUGS JUGS Hey! V2 is Maxillary branch of Trigeminal -"Roll" is Rotundum. Maxillary is sensory to upper lip, lower eyelids, upper cheek, anterior temple -NO MOTOR
sensory division of Trigeminal for upper eyelid, sides of nose, forehead, conjunctiva V1 Ophthalmic sensory
sensory division of Trigeminal for lower eyelid, back nostrils, upper cheek, anterior temple (basically where women apply blush plus upper lip) V2 Maxillary sensory
sensory division of Trigeminal to lower lip, chin, lower cheek, lower jaw, post temple (basically where men grow beards) V3 Mandibular sensory
if you lose sensation to upper lip, you may have injured your _________division of Trigeminal V2 Maxillary
Plexus which is sensory to skin over angle of mandible Anterior/Ventral Cervical plexus of nerves derived from Great Auricular (C2-C3)
If you nick your throat area while shaving, what sensory nerves tell you it hurts? Great Auricular N. from cervical plexus and Transverse Cutaneous n.
After going to gym, Frank complained of double vision (diplopia) and inability to synchronize movements of limbs (ataxia) during work out. Resting he was fine. Chiropractor suspects occasional transient ischemic attack perhaps caused by stenosis of: Left subclavian artery proximal to the origin of the vertebral artery
transient ischemic attacks causing diplopia and ataxia are caused by stenosis of L subclavian artery, proximal to origin of vertebral artery
Stenosis of subclavian artery can cause ataxia and diplopia, blood pressure differences between arms, and a bruit heard in the supraclavicular region of the affected side
the physiological blind spot is seen in the optic disc
The mucous membrane BELOW the level of the vocal cord is innervated by Recurrent Laryngeal Nerve sensory below vocal cord
what is sensory to mucous membrane above level of vocal cord? Internal laryngeal nerve
What is motor to the larynx? Exceptions? Recurrent Laryngeal n. except cricothyroid and inferior constrictor which are supplied by external laryngeal nerve
The thyroid gland receives the blood supply in part from branches of: External carotid is superior thyroid, Thyrocervical trunk is inferior thyroid, arch of the aorta/subclavian artery is thyroidea ima
thyroidea ima is a branch of the ____________arch, then the ____________artery that may supply thyroid aortic arch, subclavian artery
The pterygomandibular raphe gives attachment to superior pharyngeal constrictors and BUCCINATOR muscles
Gravity helps drain the paranasals when we stand erect. Which sinus is not aided by gravity in erect posture? Maxillary
A patient visiting your office complains of pain in the region of the nasal bridge. If an infection of the paranasal sinuses is suspected, the most probable sinus involved is the: ethmoidal
Anterior belly of digastrics is innervated by V3 Mandibular divison of Trigeminal, hence First Arch
What arch innervates the anterior belly of digastric muscle? first (CN V-Trigeminal) arch relationships First arch=V, Second arch=VII, Third arch=IX, Fourth arch=Xsuper, Sixth arch=Xrecurrent
Careless removal of a fishbone lodged in the piriform fossa may injure what nerve? Internal laryngeal nerve
The refractive media of the eyeball includes: (3) Cornea, aqueous humor, lens, vitreous body
"refractive media of the eyeball" means structures light must pass through before it hits the retina
If the cutaneous sensation is lost along the lower lip, which nerve is most likely damaged? v2 Mandibular division of Trigeminal V
Tension of the vocal cord is achieved by action of which muscle(s)? cricothyroid
which muscle opens the glottis? posterior cricoarytenoid
muscle that relaxes the vocal cords thyroarytenoid and vocalis
muscle that tenses the vocal cords cricothyroid
First pouch middle ear cavity (tympanic, mastoid ant, auditory tube)
Second pouch Palatine tonsil
THIRD POUCH is most important this tri Thymus, Inferior parathyroid gland (3rd parathyroids that may descend into thorax)
Fourth pouch was on old test superior parathyroid gland
Fifth pouch ultimobranchial body (forms thyroid)
Pouches: Third is for Thymus & Inferior parathyroids
cleft #1: external auditory meatus
cleft #2-5: cervical sinus disappears (fluid collection here instead of normal fusion would be called a cervical sinus)
only cleft that persists cleft #1 (external auditory meatus)
pharyngeal arches are also called branchial arches (adults)
no ________ for first and second pharyngeal/branchial arches arteries
third pharyngeal arch artery common carotid and internal c.a.
fourth pharyngeal arch artery left aortic arch, right subclavian artery
sixth pharyngeal arch artery pulmonary arch and ductus arteriosis left (P.A.D.A. left at 6pa)
PADA left at 6pa pulmonary arch and ductus arteriosis left of 6th pharyngeal arch
when an infection from middle ear cavity spreads through posterior wall , it will reach the mastoid antrum (first pouch)
Muscle partial inserted into the articular disc of TMJ lateral pterygoid (drops jaw)
A motorcycle victim rushed to ER had skull films, revealing a fracture passing through the foramen ovale and severing the nerve which enters it. The patient might present with: (Come On SOFia...) v3 Mandibular division of Trigeminal so muscles of mastication so deviation of jaw upon protrusion
The spinal root of CN IX Accessory enters the cranial cavity through the foramen magnum (before it exits through the JUGular foramen)
Physical exam of 46 yr old patient shows uvula drawn to right side and flattening of left palatal arch. Most probable nerve damaged? Left VAGUS (uvula deviates to good side, arch flattens on damaged side)
Left Hypoglossal damage would present with? Left tongue deviation
Little's area is a common area of epitaxis. It is located in the nasal septum (on floor where many vessels converge) in the anteroinferior part
Nerve providing sensory to nasal septum/Little's area/epitaxis Trigeminal is sensory (olfactory is smell)
bleeding through the nose is called ________ and frequently results when someone is punched in the nose. epitaxis
The ___________ is transparent, is the anterior boundary of the anterior chamber, and is part of the fibrous coat of the eyeball. Cornea
Is the cornea vascular or avascular? avascular
Internal jugular vein begins as a direct continuation of the sigmoid sinus
Man receives stab injury to neck. Tongue deviated to left when he tried to protrude it. Attending thought nerve which coursed the carotid and digastric triangles injured. Which nerve and what side? Left Hypoglossal (ipsilateral tongue deviation)
Sphincter papillae and Ciliaris are innervated by CN III Oculomotor
Muscle which protrudes the tongue genioglossus (big tongue muscle!)
MVA survivor suffers cranial fracture involving jugular foramen, severing the cranial nerves which pass through it. One muscle that would remain functional is (multiple choice question): Styloglossus because Hypoglossal N is not in JUGs- it exits through Hypoglossal canal
The muscle which opens the glottis/abducts the glottis (there is only 1) posterior cricoaryteniod
think of relatioship from top to bottom of glottis, aryteniods, vocal cords, thyroid, cricoid. Muscles that open glottis? posterior cricoarytenoid
a muscle going all the way from a big cartilage to a smaller cartilage would have to be pretty long and lever-like. Which muscle is long enough to open the inlet of larynx? thyroepiglotieus
which muscle tenses the vocal cords because it is right at the vocal cords, short and fat and strong? cricothyroid
If an infection from the face spreads through the deep facial vein into the cranial cavity, it may result in the venous thrombosis of cavernous sinus
Which of the peripheral parasympathetic ganglia does not send postganglionic secretomotor fibers to the glands? ciliary (contains postganglionic parasympathetic fibers to ocular muscles - the ciliaris and sphincter pupillae
what ganglion contains cells for postganglionic parasympathetic fibers to the lacrimal gland and small nasal and palatine glands? pterygopalatine ganglion
does the ciliary ganglion contain postgang parasymps for any glands whatsoever? no.
During swallowing, the soft palate elevates and closes the nasopharyngeal isthmus. Which muscle elevates the soft palate eLevator palati
which muscle tenses the soft palate tensor palati
name of muscle in uvula muscularus uvulae
the tonsilar fossa is bounded by two folds palatoglossal fold, palatopharyngeal fold
What muscles lie within the two arches that bound the tonsilar fossa? palatoglossus and palatopharyngeus
what muscle leads to torus tubarius salpingopharyngeus (or fold)
which nerve does general sensory to tongue Trigeminal (v3 Mandibular lingual branches)
Which nerve is special sensory to tongue? Facial - chorda tympani
where do chorda tympani parasympathetic fibers travel with the lingual nerve, to the the submandibular ganglion (remember from lab how lingual nerve suspends ganglion? then it makes sense for accompanying chorda tympani from VII to end there, too)
3 divisions of v3 Ophthalmic branch of Trigeminal N.F.L. - Nasociliary, Frontal, Lacrimal
What is the only muscle of the eyeball that is not invested in the global fascia/sclera? levator palpebrae superioris, because it is going to the upper eyelid (frontal nerve lies directly on top of it)
the nerve to stapedius goes to the stapedius. where does chorda tympani go, besides the submandibular ganglion? tympanic membrane
Review (R)The larynx paired cartilages (3) arytenoids, cuneiforms, corniculates
R: Larynx unpaired cartilages (3) thyroid, cricoid, epiglottis
R: cavity of larynx extends from ________of larynx to lower border of ____________cartilage. inlet, cricoid
composition of larynx cartilages, mucous membranes, muscles
intrinsic muscles of larynx cricothyroid, posterior cricoarytenoid, lateral cricoarytenoid, transverse arytenoid, aryepiglottis, thyroepiglottis, thyroarytenoid, oblique cricoarytenoid (remember 5 muscles from lab identification)
innervation of all muscles of larynx except cricothyroid Recurrent Laryngeal N. (of Vagus)
innervation of cricothyroid muscle of larynx External Laryngeal N. (of Vagus)
sensory supply to larynx Internal Laryngeal N. from mucuous membrane to vocal fold, then Recurrent down to inferior most part
action of posterior cricoarytenoid, innervation opens epiglottis, abducts vocal cords, and is innervated by recurrent laryngeal nerve
Recurrent laryngeal nerve is the nerve of which pharyngeal arch? 6th pharyngeal arch (5-7-9-10super/10recurrent for cranial nerve to pharyngeal arches)
know 5 characteristics of face HIGHLY VASCULAR, large number of sebaceous + sweat glands, skin is loosely attached but fixed to underlying cartilage, elastic/thick because facial muscles attached, wounds gap, NO deep fascia except parotid and submandibular gland
skin on face heals quickly because it is highly vascular
muscle of face which closes eye? innervation? orbicularis oculi, Facial n.
Facial nerve is the nerve of which pharyngeal arch? Second (5-7-9-10super/10recurrent)
Buccinator origin maxilla opposite molars , pterygomandibular raphe, mandible opposite lower molars
Buccinator insertion upper and lower lips
Buccinator innervation Buccal n. of Trigeminal (sensory), buccinator branch of Facial n. (motor)
C.O.P.S. ganglion of face: Ciliary, Otic, Pterygopalatine, Submandibular
C of COPS ganglion Ciliary - postgang parasymps to sphincter pupillae and ciliaris muscles (NO secretomotor)
O of COPS ganglion Otic - secretomotor fibers - postgang parasymps to ParOtid
P of COPS ganglion Pterygopalatine - secretomotor fibers - postgang parasymps to lacrimal, small nasal, palatine glands
S of COPS ganglion Submandibular - secretomotor fibers - postgang parasymps to salivary submandibular and sublingual glands
Buccinator muscle function flatten and blow (trumpeter's muscle)
Nerves of the face are usually ____________innervation. cutaneous (mostly affecting dermatomes)
drawing oblique lines across head, there are 3 distinct regions of __________ nerve (v1,v2, v2) and also small area under mandible innervated by _______ segments (Great Auricular N.) Trigeminal (Ophthalmic v1, Maxillary v2, Mandibular v3) and C2-C3 under angle of mandible (Great Auricular n.)
formation of retromandibular vein Superficial Temporal + Maxillary veins merging
formation of external jugular vein posterior retromandibular and posterior auricular veins
formation of common facial vein (which goes to internal jugular) anterior retromandibular and facial veins
external jugular drains into the subclavian vein
Cavernous sinus thrombosis is affected by either of two pathways to the brain from the external: Superior Ophthalmic vein or Facial vein through pterygoid plexus of veins
Infection can reach the cavernous sinus through 2 pathways of the face/external head: superior ophthalmic vein or facial vein through pterygoid plexus of veins
sepsis of the nasal cavity or paranasal air sinuses can manifest 2 forms: nervous symptoms (3,4,5 + pain), venous symptoms (edema of eye area + EXopthalmos - protrusion of eyeball)
infection of upper lip would drain to which lymphatic group submandibular (middle)
infection of ear would drain to which lymphatic group? preauricular (upper)
infection of chin drains to which group of lymphatics? submental (lower)
pathway of lacrimal fluid gland - L.duct - conjunctival sac - punctum - canaliculi - L.sac - N.duct - inferior meatus of nasal cavity
Glen ducked ConiS, Punched a Canadian LasS, but Never Did Insult Me! Gland (lacrimal) Duct (lacrimal) Conjunctival Sac, Punctum (lacrimal) Canaliculi (lacrimal), Nasolacrimal Duct Inferior Meatus!
fourth arch muscles Levator palati, cricothyroid, pharyngeal constrictors
fourth arch nerve 10 superior (5-7-9-10superior/10recurrent)
fourth arch muscles Levator palati, cricothyroid, pharyngeal constrictors
fourth arch nerve 10 superior (5-7-9-10superior/10recurrent)
injury to lateral eye or temporal drains to what group of lymph nodes? preauricular(upper territory)
injury to middle of forehead, down through middle of both eyes, out to mandible, all of this area except where a "soul patch" would be, drains to what group of lymph nodes? submandibular (middle territory)
Injury to "soul patch" area of chin from middle of bottom lip to mandible drains what area of lymph nodes? submental (lower territory)
upper lip infection -which lymph node will be enlarged? submandibular (middle)
innervation of lacrimal gland as far as pterygopalatine ganglion to get to pterygopalatine ganglion: Facial n. gives off Greater Petrosal n. from geniculate ganglion. It takes parasymp fibers through f. lacerum and travels with Deep Petrosal sympathetics through the pterygoid canal to the pterygopalatine plexus. Vidian
innervation of lacrimal gland from Vidian nerve to lacrimal gland the nerve of the pterygoid canal (Greater Petrosal parasymp + Deep Petrosal symp) to pterygopalatine ganglion. Enter into Maxillary nerve. Zygomatic branch. Zygomaticotemporal communicates with Lacrimal Nerve. LACRIMAL GLAND finally!
____-ganglionic fibers are relayed to pterygopalatine ganglion. ____-ganglionic fibers pre, post
Greater Petrosal of VII, Deep Petrosal of carotid plexus, Vidian (nerve of pterygoid canal), Pterygopalatine ganglion, Maxillary branch v2 of Trigeminal, Zygomatic branch, Zygomaticotemporal branch, Lacrimal n. (of Ophthalmic N.F.L. division of v1), to ? Lacrimal gland
the Lacrimal n. is sensory to lacrimal gland, conjunctiva, lateral portion of upper eyelid
largest salivary gland in body parotid
what layer of fascia covers parotid and submandibular glands? deep fascia
Stenson's duct opposite 2nd upper molar parotid duct
artery of parotid external carotid (superficial temporal and maxillary)
vein of parotid external jugular vein
nerve of parotid parasymp = otic ganglion (C.O.P.S.), sympathetic = external carotid plexus, sensory and parasymp = auriculotemporal n.
Parasympathetic root of Otic ganglion (parOtid): Lesser Petrosal n. preganglionics from tympanic (Facial) will synapse on Otic (parOtid)
Sympathetic root of Otic ganglion (parOtid): plexus around external carotid
Sensory root of Otic ganglion (parOtid): auriculotemporal and v3 Mandibular sensory communicating branch
all the nerves to the Otic ganglion (parOtid): Lesser petrosal from tympanic facial, external carotid plexus of nerves, Mandibular v3 sensory branches, Auriculotemporal encircling middle meningeal artery
Facial n. enters ______________________meatus. internal (Come On, SOFia...)
Branches of Facial n. between internal acoustic meatus (then facial canal), up to Stylomastoid foramen? Greater Petrosal n. (forms Vidian with Deep P.n.), Chorda Tympani, Nerve to Stapedius
Branches of Facial nerve after it exits stylomastiod foramen posterior auricular, nerve to stylohyoid, nerve to posterior belly of digastric, then Facial nerve emerges to Temporal, Zygomatic, Buccal, Marginal Mandibular, Cervical
If you injure facial nerve, you lose Greater petrosal n. (Vidian with Deep petrosal to pterygopalatine gang then lacrimalgland). What are symptoms? not going to have lacrimal secretions because facial cannot communicate with Maxillary division via pterygopalatine gang and zygomaticotemporal to lacrimal nerve of v1
What happens to chorda tympani if you injure Facial nerve? lose special sensation of taste
What happens to nerve to stapedius if you injure facial nerve? dampening effect gone so Hyperacousis
What three Facial CN VII nerves are injured before exiting the stylomastoid foramen but after entering the internal acoustic meatus? Greater Petrosal (eventually to Lacrimal so no tears), chorda tympani (loss of sensation anterior 2/3 tongue), nerve to stapedius (hyperacousis and loss of facial expression)
If the injury to Facial VII takes place after it exits stylomastoid foramen, what lives and what dies? Keep Greater Petrosal, nerve to stapedius, chorda tympani but will have Bell's Palsy
Cranial fossae - name the four folds of dura mater Falx cerebri, Tentorium cerebelli, Falx cerebelli, Diaphragma sellae
what does the diaphragma sellae contain? the anterior and posterior intercavernous sinuses
dumps blood between superior sagittal sinus and straight sinus Great cerebellar vein of Galen
Name the sinuses that run around the rim of the cranium, contained in the Tentorium cerebelli: Superior petrosal, Inferior petrosal, Transverse sinuses
sinuses in falx cerebri superior sagittal sinus, inferior sagittal sinus
Falx cerebelli contains occipital sinus
extradural hemorrhages usually involve what vessel (kind and name) and have what presentations ARTERY! middle meningeal of maxillary artery, lucid intervals, regular facial paralysis, no CSF blood
Subdural hemorrhages involve a vein. Which one and what is presentation? Superior sagittal sinus, irregular paralysis, no lucidity, lumbar tap shows blood in CSF (INside the dura means blood INside the CSF)
Extradural is ___________, Subdural is ___________ artery, vein
origin Levator Palpebrae superioris lesser wing of spheniod (most superior so that makes sense)
Origin of eyeball Recti muscles common tendinous ring (annulus Zim)
Origin superior oblique of eyeball body of sphenoid
origin inferior oblique of eyeball orbital surface of maxilla
all voluntary eye muscles insert on the _______ of the eyeball, except ___________________ which inserts on the upper eyelid. sclera, levator palpebrae superioris (isn't an 'eye' muscle! It's an upper lid muscle so it doesn't stop til it gets to the upper eyelid)
what nerves come through the SOF and IOF to innervate the eye? III, IV, v1 of V, VI, (N.F.L. are branches of v1 Ophthalmic but come through separately as Nasociliary, Frontal, and Lacrimal nerves)
(LR6, SO4)3 with Frontal to _____________, Lacrimal to ____________, Nasociliary to ______________ LR6=lateral rectus Abducent, SO4=superior oblique Trochlear, all the rest 3=Oculomotor. Frontal=skin over forehead and conjunctiva, Lacrimal=lacrimal gland and conjunctiva, Nasociliary=dialator pupillae, ciliary body, iris, cornea, lacrimal sac, n.e.s.s.
What nerve supplies frontal sinuses Frontal nerve
What nerve supplies ethmoidal and sphenoidal sinuses nasociliary nerve
what nerve supplies the lacrimal gland Lacrimal nerve
Draw an 'X' and describe movements of Superior Rectus, Inferior Rectus, Superior Oblique, and Inferior Oblique nah, you actually gotta do this one by hand so go get a shag ball and a sharpie and get to drawing those directions of eye movement!
We will become blind if anything goes wrong with the _____________artery. Ophthalmic
The Ophthalmic artery is a branch of the Internal Carotid artery
How does the Ophthalmic artery enter the orbital cavity? through the optic canal
branches of Ophthalmic artery lacrimal, supraorbital, ciliary, central artery of retina, ethmoidal, nasal, supertrochlear
A friend has had a kitchen knife accident in which the central artery of the eye was damaged. Will this person probably go blind? Yes, because it is the central artery of the retina, a branch of the ophthalmic artery
floor muscles of posterior triangle of neck semispinalis capitis, splenius capitis, Levator Scapulae, all three Scalene muscles (ant, mid, post)
the floor muscles of the posterior triangle of neck are all covered by ____________ layer of deep cervical fasica Prevertebral
Structures of the floor of posterior triangle Brachial plexus, subclavian artery and vein
4 layers of fasica of posterior triangle investing, pretracheal, prevertebral, carotid sheath
which layer of fasica suspends the thyroid pretracheal
investing layer of fasica has 2 muscles, 2 glands, 2 spaces 2 SCM/Trap, 2 parotid/submandibular, 2 suprasternal/supraclavicular
what great trunks of nerves are in the posterior triangle brachial plexuses - upper, middle, lower
the SCM is one of the muscles of forced inspiration
spinal accessory damage means torticollis
first lymph nodes to swell that indicate cancer of body supraclavicular lymph nodes of post triangle
what can be seen as a swelling of the costal element of C7 cervical rib
angulation of the subclavian artery or pressure irritation of lower trunk of brachial plexus due to cervical rib may cause transient ischemia, ataxia, loss of power to hand, blood loss causing gangrene
boundaries of digastric triangle anterior belly of digastric, posterior belly of digastric, base of mandible (imaginary line all the way to mastoid)
boundaries of carotid triangle anterior SCM, superior belly of omohyoid, posterior belly of digastric and stylohyoid, constrictors/hyoglossus/thyrohyoid membrane
innervation of anterior belly of digastric and mylohyoid nerve to mylohyoid from Trigeminal
innervation of posterior belly of digastric and stylohyoid Facial n.
infrahyoids are all innervated by Ansa Cervicalis (C1,2,3) except Thyrohyoid - branch with Hypoglossal carrying C1 fibers
does the HYpoglossal n. itself innervate any of the strap muscles? no, the C1 branch innervating Thyrohyoid is hitching a ride
both common carotids terminate at upper border of thyroid cartilage
what roots form Spinal Accessory n. C1-4
Where does the cranial root of Accessory come from? medulla
what structure is not enclosed within the carotid sheath cervical sympathetic chain
the Internal jugular vein begins as a branch of SIGMOID sinus
where does Internal jugular vein end? unites with subclavian to become brachicephalic vein
what is present at the junction of the internal jugular and subclavian vein on the left? Thoracic duct
Tributaries of Internal "Juggler" vein I Juggle In Places Commonly Found Lacking Superior Toilets and Merry Thespians (Inferior Jugular: Inferior Petrosal, Common Facial, Lingual, Superior Thyroid, Middle Thyroid)
SUPERIOR root of Ansa cervicalis contains what roots C1 for SUPERIOR belly of omohyoid, thryohyoid, geniohyoid
inferior root of ansa cervicalis contains C2,C3 for inferior belly of omohyoid
Hypoglossal is the innervator of all the muscles of the tongue, except palatoglossus (pharyngeal plexus of nerves)
Hypoglossal CN XII innervates all tongue muscles except? what does? Palatoglossus by pharyngeal plexus of nerves
what is the most important branch of Vagus and where does it run recurrent laryngeal within the tracheo-esophageal groove on both sides, although origin is different
right recurrent laryngeal nerve loops around R _____________, whereas left recurrent is in the thorax first, and goes around ___________ before entering larynx. subclavian, arch of aorta
if something is wrong with the Vagus, what test? compare palatal arches: affected side will be flat, uvula will be deviated to good side
glossopharyngeal n. is derived from which pharyngeal arch 3rd (5-7-9-10super/10/recurrent)
is Glossopharyngeal motor or sensory? sensory (taste), one motor branch to stylopharyngeus muscle (runs behind it)
Glossopharyngeal has preganglionic parasympathetic fibers to which ganglion? via the tympanic nerve and lesser petrosal nerve to the Otic ganglion (parOtid). Otic communicates with chorda tympani as well.
When you say Glossopharyngeal ganglion you want to think Otic (parOtid) via tympanic and lesser petrosal
origin masseter zygomatic arch
insertion masseter lateral ramus of mandible
origin temporalis temporal fascia and fossa
insertion temporalis coronoid process
origin MEDIAL pterygoid tuberosity of maxilla and MEDIAL surface of lateral pterygoid plate
insertion MEDIAL pterygoid inside surface of ramus of mandible, both heads unite
origin lateral pterygoid infratemporal surface and greater wing of sphenoid
insertion LATERAL pterygoid neck of mandible (2 heads form common tendinous insertion) and also a small portion into the TMJ articular disc!!!!
only infratemporal muscle that opens the jaw lateral pterygoid
Maxillary artery has 3 parts - which muscle divides the 2nd and 3rd parts? lateral pterygoid
branches of Maxillary artery in infratemporal fossa? (the ones I could see in the lab - these aren't all 12) middle meningeal (with auriculotemporal nerve encircling), accessory middle meningeal, inferior alveolar (with nerve to mylohyoid), muscular branches to masticators, infraorbital, posterior superior alveolar, pharyngeal branches
venous drain of the infratemporal fossa pterygoid plexus of veins (remember this is the danger of infection of upper lip or nose due to communication of facial vein with pharyngeal plexus, and infraorbital artery)
Mandibular nerve branches: anterior and posterior divisions: anterior gives Buccal nerve (sensory), posterior gives auriculotemporal (parotid), lingual, inferior alveolar (gives off nerve to mylohyoid for my.h. and ant. belly of digastric), Otic ganglion (parOtid)
Anterior division of v3 Mandibular is purely sensory except for nerve to mylohyoid for ant digastric and mylohyoid
3 structures on surface of Hyoglossus muscle lingual nerve, submandibular nerve and duct, HYpoglossal XII nerve
the thyroid gland regulates the ___________metabolic rate and stimulates _______ metabolism, apart from stimulating growth basal, calcium
ciliary ganglion sends fibers to two muscles ciliaris, sphincter pupillae
action of ciliaris muscle accomodation (focusing far and near)
action of sphincter pupillae shrinks pupil
arteries to thyroid superior thyroid, inferior thyroid, thyroidea ima (aortic arch)
veins of thyroid superior, middle, inferior and vein of KOCHER drain into internal jugular, then to brachiocephalic
innervation of thyroid sympathetic from middle and superior sympathetic ganglion
thyroid secretes thyrocalcitonin & thyroxin, so hypersecretion is too much as a goiter, hyperthyroidsim,
external laryngeal nerve accompanies superior thyroid artery
recurrent laryngeal nerve accompanies inferior thyroid artery
Created by: hecutler