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VW Eliot HeadAnatomy
IS-B1-Eliot Head Anatomy
| Question | Answer |
|---|---|
| What bone forms the forehead? | Frontal Bone |
| The zygomatic processes of the frontal bone contact the zygomatic bones. Relative to the orbital wall, where are these zygomatic processes located? | Lateral Margin of the Orbit |
| Does the maxillary bone articulate with the frontal bone? | Yes |
| Does the ethmoid bone articulate with the nasal bones on the external surface of the skull? | No, the internal surface of the ethmoid bone articulates with the nasal bone |
| What is the lamina papyracea of the ethmoid bone? | Thin, medial wall of the orbit |
| What part of the bony orbit is formed by the maxillary bone? | The floor of the orbit |
| What part of the bony orbit is formed by the sphenoid bone? | The lateral wall and apex |
| What part of the bony orbit is formed by the zygomatic bone? | The lateral margin |
| The maxillary bone does not make up all of the lateral nasal wall. List the three other bones that are there | Ethmoid, palatine and nasal concha |
| What part of the nasal septum is part of the ethmoid bone? | The superior part |
| Where is the incisive foramen (or fossa) of the maxillary bone? | Anterior part of palate, posterior to the incisor teeth |
| Where is the part of the hard palate that is not part of the maxillary bone? What bone is that part of the hard palate? | Posterior third of the palatine bone |
| Relative to the foramen magnum, where are the occipital condyles located? | Lateral to the anterior third |
| What is the squamous part of the occipital bone? What major features are found on the deep surface of the bone there? What major features are found on its external surface? | Broad flat part posterior and superior to the foramen magnum. Internal occipital protuberance, external occipital protuberance |
| What bones unite at pterion? What other two bones are separated by that meeting? | Parietal bone, greater wing of sphenoid bone. Frontal bone, temporal bone. |
| What sutures meet at bregma? | Coronal suture, sagittal suture |
| Which bones unite at the coronal suture? | Parietal bones and frontal bones |
| Which bones unite at the sagittal suture? | Parietal bones |
| Which bones unite at the lamboid suture? | Occipital bones, parietal bones |
| Which bones unite at the squamous suture? | Temporal bone with sphenoid bone, temporal bone with parietal bone |
| Which bones unite at the spheno-occipital synchondrosis (aka sphenobasilar synchondrosis)? | Sphenoid bone and occipital bone |
| Which of these sutures continues anteriorly as the metopic suture between the right and left frontal bones of a child? | Sagittal suture |
| In which cranial fossa is the superior surface of the lesser wing of the sphenoid bone located? | Anterior cranial fossa |
| Where in skull is the optic canal located? Where in the sphenoid bone is it located? What spaces does it connect? | Apex of the orbit, base of the lesser wing of the sphenoid bone, between the orbital and cranial cavity. |
| Name the gap that separates the lesser wing of the sphenoid bone from the greater wing of the sphenoid bone | Superior Orbital Fissure |
| In which cranial fossa is the superior surface of the greater wing of the sphenoid bone located? | Middle Cranial Fossa |
| What part of the sphenoid bone forms the posterolateral wall of the bony orbit? | Greater Wing of Sphenoid |
| Relative to the sphenoid air sinus, where is the hypophyseal fossa located? | Superior |
| The sphenomandibular ligament attaches where? | Inferior side of the skull, posterolateral corner of the greater wing of the sphenoid bone. |
| What foramen is immediately anteromedial to the sphenoid spine? | Foramen spinosum |
| Which cranial fossa are separated by the petrous ridge of the temporal bone? | Middle cranial fossa, posterior cranial fossa |
| A cranial nerve lies atop the medial part of the petrous ridge on its way to enter foramina in the sphenoid bone. What cranial nerve is this? | Trigeminal Nerve |
| What is the foramen lacerum? | Gap between anteromedial tip of the petrous part of the temporal bone and body of sphenoid bone |
| Where does the auditory canal lead within the bone? | Middle ear cavity |
| A deep, abrupt groove called the digastric groove is medial to the mastoid process. The muscle that attaches there was on lab study lists last spring. Name it | Posterior Digastric Muscle |
| What artery does the occipital artery branch from? | External Carotid Artery |
| With what bone does the zygomatic process of the temporal bone articulate, and what structure is formed by the union? | Temporal process of the zygomatic bone, zygomatic arch |
| External auditory meatus -> _ _ -> inner ear -> internal auditory meatus | Middle Ear |
| What suture is prematurely fused in a scaphocephalic skull? | Sagittal Suture |
| What term is used to describe a skull with premature fusion of the either the right or left side of the lamboid suture or coronal suture? | Plagiocephalic skull |
| What term is used to describe a skull with premature fusion of the frontal and lamboid sutures? | Oxycephalic skull |
| Relative to the adult tympanic membrane, how large is an infant's tympanic membrane? | Almost the same size |
| How deep into the head is the infants tympanic membrane? | Not very deep |
| How well does the infants mastoid process protect the tympanic membrane and middle ear? | Not well |
| What nerve emerges from the stylomastoid foramen deep to the mastoid process? | Facial Nerve |
| What passes through the cribriform foramina of the ethmoid bone? | Filaments of the olfactory nerve |
| How does the optic nerve exit the skull? In what space is it found outside the skull? Describe the angle that the optic nerve assumes in that space. | Optic canal. Orbit. from posterior and medial it runs anterior and lateral to meet the eye |
| What structures accompany the optic nerve through the passage you just named? | All three meninges, ophthalmic artery |
| What space do CN III, IV, first division of V and VI use to pass from the middle cranial fossa into the orbit? | Superior orbital fissure |
| Name the bone that the whole trigeminal nerve rests upon as it crosses from the posterior cranial fossa to the middle cranial fossa. | Temporal Bone |
| Where does the abducent nerve exit the brainstem? | Pontomedullary junction |
| On what surface of what bone does the abducent nerve pierce the dura mater and pass between meninges and bone? Through what dural venous sinus does CN VI pass? | Clivus of the sphenoid bone, Cavernous sinus. |
| What cranial nerve enters the temporal bone through the internal auditory meatus and “never comes out again?” | Vestibulocochlear Nerve (CN VIII) |
| What cranial nerve enters the temporal bone through the internal auditory meatus and exits by the stylomastoid foramen? Is the stylomastoid foramen the only exit used by this nerve or its branches? | Facial Nerve – No. |
| What hole does the hypoglossal nerve use to exit the skull? | Hypoglossal Canal |
| What nerve is inferior to the hypoglossal nerve (i.e., immediately inferior to this part of the skull)? | First cervical spinal nerve |
| In what part of what bone does the carotid canal traverse? | Petrous temporal bone |
| The plexus of nerves that surrounds the internal carotid artery in the carotid canal are the same as those found in the adventitia of any artery. What two words best describe the autonomic fibers there? | Postganglionic sympathetic |
| Both muscles in the head with tensor in their name are innervated by the mandibular division of the trigeminal nerve. Name them. | Tensor veli palatini (tensor palati) Tensor tympani |
| Unless it would violate rule #1, all muscles with “palat ” in their name are innervated by the vagus nerve. Name them. | Palatoglossus Palatopharyngeus Levator veli palatini (levator palati) |
| Unless it would violate rule #2, all muscles with “glossus” in their name are innervated by the hypoglossal nerve. Name Them. | Musculus uvulae Salpingopharyngeus Laryngeal muscles, |
| Only one skeletal muscle is innervated by the glossopharyngeal nerve. | Stylopharyngeus |
| What do the trigeminal nerve, facial nerve, glossopharyngeal nerve and vagus nerve have in common? | The four cranial nerves with general sensory innervation, also the four nerves that cover sensory innervation of the tongue |
| Of the twelve cranial nerves, which four convey general sensory information (from somatic and/or visceral structures)? | Trigeminal, facial, Glossopharyngeal and vagus |
| Of the twelve cranial nerves, which three are special sensory only? | Olfactory, Optic and Vestibulocochlear |
| Name the 12 Cranial Nerves in order | Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulocochlear, Glossopharyngeal, Vagus, Accessory, Hypoglossal |
| List the nine cranial nerves that innervate striated muscles. | Oculomotor, trochlear, trigeminal, abducens, facial, glossopharyngeal, vagus, accessory, hypoglossal |
| List the four parasympathetic cranial nerves. | Oculomotor, facial, glossopharyngeal, vagus |
| Of the twelve cranial nerves, which three are the “everything nerves” that convey all four types of information? | Facial, Glossopharyngeal, Vagus |
| Of the three “everything nerves”, which one carries much of each of the four modalities? Explain. | Vagus. General sensory from pharynx (some), larynx and airway, other viscera; special sensory from viscera; motor impulses to many small laryngeal muscles, parasympathetics to thoracic and abdominal viscera |
| For the first of the other two “everything nerves,” state which modalities have extensive representation and which have little representation. | Facial nerve. Extensive striated muscle, taste, parasympathetic. Facial nerve – little sensory general. |
| Does the second of the other two “everything nerves” have extensive representation of any modality? | the glossopharyngeal nerve is not extensive in any modality, because everything it does is done more by another nerve. You could say that parasympathetics to the parotid gland, or general sensory from the pharynx are “extensive representation.” |
| Name the four cranial nerves that carry parasympathetic preganglionic fibers away from the brainstem. | Oculomotor, Facial, Glossopharyngeal, Vagus |
| What ganglion is associated with the first one of the four nerves? Where is it located? | Ciliary ganglion. Lateral side of the meningeal sleeve of the optic nerve. |
| Neurons in ciliary ganglion stimulate two different smooth muscle cell populations to affect the pupil and the lens. They also stimulate secretion or flow of aqueous humor within the eye. Is this last part a function of the iris, or of the ciliary body? | Ciliary Body |
| Name the two parasympathetic ganglia that are associated with the second nerve on your list of four. | Pterygopalatine ganglion, submandibular ganglion |
| Which of these two ganglia is located deep in the head, in the pterygopalatine fossa? | Pterygopalatine ganglion |
| Which one of these two ganglia is located deep to the mandible, attached to the lingual nerve? How do preganglionic fibers get to that ganglion? This is the most dissectible parasympathetic ganglion, and we saw it on a lab exam last spring | Submandibular ganglion. Facial nerve, chorda tympani, lingual nerve |
| What two salivary glands do the postganglionic fibers from that ganglion innervate? | Submandibular ganglion, sublingual ganglion |
| What parasympathetic ganglion is associated with the Glossopharyngeal Nerve? | Otic ganglion (rarely dissected) |
| Where is the otic ganglion located? | Medial to the Mandibular division of the trigeminal nerve |
| What salivary gland do the postganglionic nerve fibers of the lesser petrosal nerve innervate? | Parotid Gland |
| Describe the locations of each of the sensory ganglia of the head and neck: the semilunar ganglion, the geniculate ganglion, the spiral and vestibular ganglia, the superior and inferior ganglia of these two nerves. | Semilunar Ganglion – Trigeminal nerve Geniculate Ganglion – Facial Nerve Spiral and Vestibular Ganglion – Vestibulocochlear Superior and Inferior Ganglion – Vagus and Glossopharyngeal Nerves each have them |
| Are there synapses in these sensory ganglia? | No |
| what modality and what region is served by the semilunar ganglion? | General sensory from the superficial face, deep face and meninges |
| what two modalities and what regions are served by the geniculate ganglion? | Taste from the tongue and palate, general sensory from the outer ear |
| what modalities are served by the vestibular ganglia and the spiral ganglion of the cochlear nerve? | Balance, hearing |
| Cranial nerves IX and X both have superior ganglia and inferior ganglia in or near the jugular foramen. In general, what two modalities and what regions are served? | General sensory and special sensory from the posterior third of the tongue, the pharynx and larynx and the viscera |
| For cranial nerve I, know the location, passage through the skull, functional correlates and manifestations of disease or injury that can be detected in a physical examination. | Olfactory – cribriform plate of the ethmoid bone |
| Name the abnormal findings for a lesion with CN I – Olfactory Nerve. Fracture of cribriform plate | Abnormal Findings: Anosmia (loss of smell), CSF Rhinorrhea |
| Name the abnormal findings for a lesion with CN II – Optic Nerve. Direct trauma to orbit or fracture involving optic canal. | Loss of pupillary constriction |
| Name the abnormal findings for a lesion with CN II – Optic Nerve. Pressure on optic pathway; laceration or intracerebral clot in temporal, parietal or occipital lobes of the brain. | Visual field defects |
| Name the abnormal findings for a lesion with CN III – Oculomotor. Pressure from herniating uncus on nerve, fracture involving cavernous sinus, aneurysms | Dilated pupil; ptosis; eye turns down and out; pupillary reflex on the side of the lesion will be lost. |
| Name the abnormal findings for a lesion with CN IV – Trochlear. Stretching of nerve during its course around brainstem, fracture of orbit. | Inability to look down when eye is adducted |
| Name the abnormal findings for a lesion with CN V – Trigeminal. Injury to terminal branches (esp V2) in root of maxillary sinus. | Loss of pain and touch sensations, paraesthesia, Masseter and temporalis muscles do not contract, deviation of mandible to side of lesion when mouth is open. |
| Name the abnormal findings for a lesion with CN VI – Abducens. Base of brain or fracture involving cavernous sinus or orbit | Eye falls to move laterally; diplopia (double vision) on lateral gaze. |
| Name the abnormal findings for a lesion with CN VII – Facial. Laceration or contusion in parietal region. | Paralysis of facial muscles, eye remains open, angle of mouth droops, forehead does not wrinkle. |
| Name the abnormal findings for a lesion with CN VII – Facial. Fracture of temporal bone. | Involvement of cochlear nerve and chorda tympani, dry cornea, loss of taste on anterior 2/3 of tongue. |
| Name the abnormal findings for a lesion with CN VII – Facial. Intracranial Hematoma (Stroke) | Forehead wrinkles because of bilateral innervation of frontalis muscle, otherwise paralysis of contralateral facial muscles. |
| Name the abnormal findings for a lesion with CN VIII – Vestibulocochlear. Tumor of nerve (acoustic neuroma). | Progressive unilateral hearing loss, tinnitus |
| Name the abnormal findings for a lesion with CN IX – Glossopharyngeal. Brainstem lesion or deep laceration of the neck | Loss of taste on posterior third of tongue, loss of sensation on affected side of soft palate |
| Name the abnormal findings for a lesion with CN X – Vagus. Brainstem lesion or deep laceration of the neck. | Sagging of soft palate, deviation of uvula to normal side, hoarseness owing to paralysis of vocal fold. |
| Name the abnormal findings for a lesion with CN XI – Accessory. Laceration of neck | Paralysis of SCM and superior fibers of trapezius, drooping of shoulder. |
| Name the abnormal findings for a lesion with CN XII – Hypoglossal, neck lacerations, basal skull fractures. | Protruded tongue deviates toward affected side, moderate dysarthria (disturbance of articulation) |
| Which cranial nerves and nerve branches in the orbit pass through the annulus tendineus of the extraocular muscles? | Optic nerve, oculomotor nerve, abducent nerve |
| Which cranial nerves and major nerve branches in the orbit do not pass through the annulus tendineus of the extraocular muscles? | Ophthalmic division branches, trochlear nerve |
| Is the nasociliary nerve on the medial side of the orbit or the lateral side? | Medial side |
| Is the lacrimal nerve on the medial side of the orbit or the lateral side? | Lateral side |
| What nerves convey general sensory information from the eye? | Long and short Ciliary branches of V1 – Ophthalamic Nerve (of Trigeminal) |
| Describe the locations, attachments, innervations and actions of Levator Palpebrae superioris. | Origin – lesser wing of sphenoid. Insertion superior tarsus/eyelid. Innervation – Oculomotor III. Action – elevates superior eyelid. |
| Describe the locations, attachments, innervations and actions of superior oblique. | Origin – body of sphenoid. Insertion – tendon passes through trochlea, u-turns and inserts into sclera deep to superior rectus muscle. Innervation – Trochlear Nerve IV. Action – abducts, DEPRESSES and MEDIALLY rotates eyeball. |
| Describe the locations, attachments, innervations and actions of inferior oblique. | Origin – anterior part of floor of orbit. Insertion – sclera deep to lateral rectus muscle. Innervation – Oculomotor III. Action – Abducts, ELEVATES and LATERALLY rotates eyeball |
| Describe the locations, attachments, innervations and actions of superior rectus. | Origin – common tendinous ring. Insertion – sclera just posterior to corneoscleral junction. Innervation – Oculomotor III. Action – ELEVATES, ADDUCTS and rotates eyeball MEDIALLY |
| Describe the locations, attachments, innervations and actions of inferior rectus. | Origin – common tendinous ring. Insertion – sclera just posterior to corneoscleral junction. Innervation – Oculomotor III. Action – DEPRESSES, ADDUCTS and rotates eyeball LATERALLY |
| Describe the locations, attachments, innervations and actions of medial rectus. | Origin – common tendinous ring. Insertion – sclera just posterior to corneoscleral junction. Innervation – Oculomotor III. Action – ADDUCTS eyeball |
| Describe the locations, attachments, innervations and actions of lateral rectus. | Origin – common tendinous ring. Insertion – sclera just posterior to corneoscleral junction. Innervation – Abducens IV. Action – ABDUCTS eyeball. (Abducens Abducts) |
| What are the six ways an eye can move? These six terms are the possible anatomical actions. | Elevation, depression, adduction, abduction, intorsion (internal rotation), extorsion (external rotation) |
| What muscle is best thought of as having only an adducting action? What muscle is best thought of as having only an abducting action? | Medial rectus, Lateral rectus |
| What muscle’s actions are elevation and adduction of the eye? What is its other anatomical action? | Superior rectus. Intorsion |
| What muscle’s actions are elevation and abduction of the eye? What is its other anatomical action? | Inferior oblique. Extorsion |
| What muscle depresses and adducts the eye? What is its other anatomical action? | Inferior rectus. Extorsion (external rotation) |
| What muscle depresses and abducts the eye? What is its other anatomical action? | Superior oblique. Intorsion (internal rotation) |
| What pair of muscles will be used to elevate the eye? | Superior rectus, inferior oblique |
| What pair of muscles will be used to depress the eye? | Inferior rectus, superior oblique |
| Make a rule that either elevation or depression is the primary action for any of our four muscles. Think of the other movements as necessarily secondary actions. What are those four other movements? | Adduction, abduction, intorsion (internal rotation), extorsion (external rotation) |
| Will the superior rectus lose its secondary actions on the eye when the eye is adducted, or abducted? Will it be used to elevate the adducted eye or the abducted eye? | When the eye is abducted. Abducted eye |
| What muscle will be used to elevate the opposite eye at the same time? | Inferior oblique |
| Will the superior oblique exert its secondary actions on the eye when the eye is adducted? Will it exert its secondary actions on the eye when the eye is abducted? Will it be used to depress the adducted eye or to depress the abducted eye? | No, or very little. Yes. Adducted eye |
| What muscle will be used to depress the opposite eye at the same time? What position of that opposite eye will make it an appropriate muscle to use? | Inferior rectus. Abduction |
| What muscle is tested to get the eye properly positioned to test the superior oblique muscle? | Medial rectus |
| What muscle is tested first to get the eye properly positioned to test the inferior rectus muscle? | Lateral rectus |
| What nerve innervates the superior oblique muscle? | |
| What position is the eye unable to achieve if the superior oblique muscle is paralyzed? | Depressed from adducted position |
| As the patient uses another muscle to try to achieve that position, the eye will extort. What muscle is substituting for the superior oblique? | Inferior rectus |
| If a patient cannot abduct her left eye, what muscle is paralyzed and what nerve might be injured? Will she “see double” (see two images at once) if she looks to the right, or if she looks to the left? | Lateral rectus, abducens nerve. To the left |
| Divide the surface of the orbit into four quadrants: superior lateral, superior medial, inferior lateral, inferior medial. Where is the lacrimal gland? | Superior lateral quadrant |
| Relative to the palpebrae and sclera, where are the openings of the lacrimal ducts that deliver tear fluid to the surface? | Superior recess where the palpebrae and sclera meet |
| Don't be fooled by the lacrimal nerve. From which cranial nerve does it branch? What is its functional role with the lacrimal gland and tissues nearby? What function does it not have? | Ophthalmic division of trigeminal nerve. General sensory. Not parasympathetic. |
| List the arteries that blood flows through on its way from the common carotid artery to the lacrimal gland. | Common carotid artery, internal carotid artery, ophthalmic artery, lacrimal artery |
| In which quadrant of orbital surface anatomy is the nasolacrimal duct located? | Inferior medial |
| Leaving the interpeduncular fossa, the oculomotor nerve pierces the dura mater and inhabits the lateral wall of the cavernous sinus. From there, how does it get from the cranial cavity to the orbit? | inferior alveolar artery (inferior alveolar foramen), infraorbital artery (infraorbital foramen), middle meningeal artery (foramen spinosum) |
| Is sympathetically-innervated smooth muscle well suited to maintaining some elevation of the upper eyelid while one is awake, or is it better for raising the upper eyelid quickly at the end of a blink? Explain. | Maintaining some elevation. Smooth muscle can remain contracted without expending energy and without constant nerve stimulation. |
| Describe two clinically observable effects in the orbit if a Pancoast tumor of a patient's right upper lung lobe impairs nerve transmission in the sympathetic trunk at the level of the T1 spinal nerve. | Ptosis of superior palpebrum, constriction of pupil (miosis) |
| Will a patient with a pancoast tumor in the right upper lung lobe perspire more or less on the right side of his face? | Less |
| Name the three branches of the maxillary artery that are on the lab study list, and name the osseous foramen that each passes through. | inferior alveolar artery (inferior alveolar foramen), infraorbital artery (infraorbital foramen), middle meningeal artery (foramen spinosum) |
| What tissue receives most of the blood that flows in the middle meningeal artery? (Hint: where does hematopoiesis occur in the adult?) | Bone of the cranial vault |
| what arteries reach the face through the supraorbital, infraorbital and mental foramina of the skull? | Supraorbital artery, infraorbital artery, mental artery |
| name the artery from which the supraorbital, infraorbital and mental branches, and state whether it carries blood from the internal carotid artery or from the external carotid artery. | Supraorbital artery: ophthalmic artery (internal carotid artery); infraorbital artery: maxillary artery (external carotid artery); mental artery: maxillary artery (external carotid artery) |
| In the lateral nasal wall there is an anastomosis between the external carotid artery and the internal carotid artery. What branch of the external carotid artery has branches that approach this line of anastomosis from a posteroinferior direction? | Maxillary artery |
| In the lateral nasal wall there is an anastomosis between the external carotid artery and the internal carotid artery. What branch of the internal carotid artery has branches that approach this line of anastomosis from an anterosuperior direction? | Ethmoidal branches of ophthalmic artery |
| What branch of the internal carotid artery has branches that supply internal structures of the orbit? | Ophthalmic Artery |
| What parts of the face does the ophthalmic artery supply? | Forehead, eyelids, bridge and ridge of nose |
| What aspect of the intracranial course of the abducent nerve makes it particularly vulnerable to injury caused by dissemination of infectious material from the face? | It is in the middle of the cavernous sinus, surrounded by venous blood |
| In what canal of the temporal bone is the internal carotid artery located? | Carotid canal |
| What nerves accompany the ICA there? | Sympathetic nerve plexus (including deep petrosal nerve) |
| At the anteromedial end of the petrous temporal bone, the internal carotid artery crosses superior to a cartilage-covered foramen. What is this foramen called? | Foramen lacerum |
| In the anatomy lab you can find quite a long length of the internal carotid artery within the cranial cavity. What blood-filled space are you opening when you reveal the artery there? | Cavernous sinus |
| What cranial nerve is in contact with the internal carotid artery in that space? | Abducens Nerve |
| What branch of the internal carotid artery could be used to explain why the internal carotid artery has to pass so close to the optic canal? We will call this the first significant branch of the internal carotid artery. | Ophthalmic artery |
| Is blood in the right vertebral artery expected to supply both sides of the brain, or the right side only? | Both sides of the brain |
| Is blood in the vertebral arteries expected to supply the cerebrum, or only the brainstem and cerebellum? | Posterior part of cerebrum, too |
| Relative to the teeth, where does the parotid duct enter the oral cavity? | Lateral to the second upper molar tooth |
| Relative to the tongue, where does the submandibular duct enter the oral cavity? | Immediately lateral to the lingual frenulum inferior to the tongue |
| In the oral cavity, a single nerve carries the general sensory and special sensory innervation of the anterior two-thirds of the tongue. What is that nerve? What foramen is it headed for as it leaves the tongue? What direction does that make it go? | Lingual nerve. Foramen ovale. Superiorly and posteriorly |
| Describe the general sensory and special sensory innervation of the posterior one-third of the tongue. | Glossopharyngeal nerve |
| Is they hypoglossal nerve superior to the lingual nerve or inferior to the lingual nerve? | Inferior to the lingual nerve |
| Where is the trigeminal nerve attached to the brainstem? | Pons (middle cerebellar peduncle) |
| How does the maxillary division of the trigeminal nerve exit the skull? | Foramen ovale |
| The supraorbital foramen, infraorbital foramen and mental foramen are all about the same distance from the midline of the skull. Name the trigeminal nerve division for the nerves that pass through each of these three foramina. | Supraorbital foramen (notch): supraorbital nerve; infraorbital foramen: infraorbital nerve; mental foramen: mental nerve |
| The maxillary nerve does not get all that much attention in anatomy lab and theory. Describe, in general terms, where it is after it goes through the foramen rotundum. | It is deep in the face; it can access the nasal cavity, palate, nasopharynx and cheek skin surface |
| Which of the maxillary nerve branches conveys general sensory information from the infraorbital region? | Infraorbital nerve |
| The other cutaneous branch of the maxillary division is the zygomatic nerve. What bone of the cheek do its tiny branches pass through to reach the skin? | Zygomatic bone |
| Name three deep regions or tissues the maxillary division serves. | Nasal cavity (lateral wall, septum, floor), maxillary sinus, upper teeth, palate, pharynx |
| What does the location of the foramen ovale tell us about the regions the mandibular division of the trigeminal nerve serves? | It will find muscles in the infratemporal fossa, some deep tissues to innervate (cheek, bone, teeth); it will have to get branches around to the superficial side of the mandible to innervate the masseter muscle and skin near the ear |
| What does the shape of the foramen ovale tell us about the shape and arrangement of the mandibular division of the trigeminal nerve? | Expect it to have multiple branches, arranged in a line |
| Imagine a little hand reaching downward through the foramen ovale with the thumb anterior. Name five branches of the mandibular division from thumb to fifth digit. | Buccal nerve, lingual nerve inferior alveolar nerve, nerve to mylohyoid, auriculotemporal nerve |
| How are the mandibular foramen, mandibular canal and mental foramen related to each other? | The inferior alveolar nerve enters the mandibular foramen and is housed in the mandibular canal; the mental nerve (a branch of the inferior alveolar nerve) emerges from the mental foramen |
| What branch of what nerve is at greatest risk for being lacerated (direct trauma) during extraction of a lower molar tooth? Where will pain be perceived? | Inferior alveolar nerve. In the mandible, in the teeth, on the chin |
| Which one of the three divisions of the trigeminal nerve has a motor component? | Mandibular division of trigeminal nerve |
| Give three examples of a branch of the ophthalmic division of the trigeminal nerve that innervates tissues outside of the orbit, stating the field of innervation. | Supraorbital nerve, forehead, Supratrochlear nerve, medial part of forehead, Lacrimal nerve, lateral part of eyelid |
| What nerve conveys sensory information from the lower lip and skin of the chin? | Mental nerve |
| What nerve conveys sensory information from the skin of the cheek, the nose and the upper lip? What trigeminal nerve division is this? | Infraorbital nerve. Maxillary |
| What nerves convey sensory information from the upper teeth and the gingiva around the upper teeth? What trigeminal nerve division is this? | Superior alveolar nerves. Maxillary division |
| What nerve conveys sensory information from the oral vestibule, including the gingiva around some of the lower teeth? What trigeminal nerve division is this? | Buccal nerve. Mandibular division |
| A dentist may use just one anesthetic injection to work on a lower tooth. What osseous feature is the target of the needle? | Mandibular foramen of mandible |
| That anesthetic will anesthetize the tooth itself by affecting the little nerves that go into each tooth root; a few small injections around the tooth may or may not be needed. Name the nerve involved for those gingiva injections. | Buccal nerve |
| A dentist may apply a anesthetic injection to the entire mandibular division (mandibular nerve block). What osseous target is approached by directing the needle from near the upper molar teeth toward the ear? | Foramen ovale |
| What nerve conveys general sensory information from the anterior two-thirds of the tongue? What trigeminal nerve division is this? | Lingual nerve. Mandibular division |
| Herpes simplex virus infects neurons. The cold sores they produce often appear on the lower lip. What nerve supplies general sensory innervation to this surface? | Mental nerve |
| Relative to the temporal bone, how does the head of the mandible move when the mouth opens? | Anteriorly |
| What muscle achieves the action in question “b” by inserting on the fovea of the condylar process of the mandible? | Lateral pterygoid muscle |
| What two muscles insert near the angle of the mandible? | Masseter muscle, medial pterygoid muscle |
| Which of these inserts on the superficial surface of the mandible? Which inserts on the deep surface of the mandible? | Masseter muscle. Medial pterygoid muscle |
| What two muscles close the mouth by pulling anteriorly and superiorly on the angle of the mandible? | Masseter muscle, medial pterygoid muscle |
| What muscle closes the mouth by pulling superiorly and posteriorly on the coronoid process of the mandible? | Temporalis Muscle |
| Which teeth are used for incising (cutting) food or other objects in the oral cavity? | Incisors |
| Which teeth are most responsible for grinding food or other objects in the oral cavity? | Molars |
| What does “plus MATT” in the mnemonic “muscles of mastication plus MATT” mean? | Mylohyoid, Anterior digastric, Tensor veli palatini, Tensor tympani |
| Where are the facial nerve and vestibulocochlear nerve attached to the brainstem? | Pontomedullary junction, the trough between the inferior part of the pons and the superior part of the medulla |
| Where are the two nerves close together? And where do they separate? | in the internal auditory meatus. at the lateral end of the meatus. |
| Describe the locations, attachments, and actions of the following muscles of facial expression: frontalis | Origin – epicranial aponeurosis. Insertion – skin and subcutaneous tissue of eyebrows and forehead. Action – elevates eyebrows and wrinkles skin of forehead – protracts scalp (surprise) |
| Describe the locations, attachments, and actions of the following muscles of facial expression: orbicularis oculi | Origin – medial orbital margin, medial palpebral ligament, lacrimal bone. Insertion – skin around margin of orbit, superior and inferior tarsal plates. Action – closes eyelids. Orbital part tightly closes (winking) |
| Describe the locations, attachments, and actions of the following muscles of facial expression: levator labii superioris | Origin – infra-orbital margin (maxilla). Insertion – skin of upper lip. Action – part of dilators of mouth. Elevate upper lip, deepen nasolabial sulcus (sadness) |
| Describe the locations, attachments, and actions of the following muscles of facial expression: zygomaticus major | Origin – lateral zygomatic bone. Insertion – angle of mouth. Action – part of dilators of mouth. Elevate labial commissure – bilaterally to smile, unilaterally to sneer (disdain). |
| Describe the locations, attachments, and actions of the following muscles of facial expression: orbicularis oris | Origin – medial maxilla and mandible; deep surface of Perioral skin, angle of mouth. Insertion – mucous membranes of lips. Actions – tonus closes oral fissure, phasic contraction compresses and protrudes lips (kissing) or resists distension (blowing) |
| Describe the locations, attachments, and actions of the following muscles of facial expression: buccinators | Origin – alveolar processes of maxilla and mandible, pterygo-mandibular raphe. Insertion – Angle of mouth, orbicularis oris. Action – presses cheek against molar teeth, works with tongue to keep food out of oral vestibule, resists distension (blowing) |
| Describe the locations, attachments, and actions of the following muscles of facial expression: depressor anguli oris | Origin – Anterolateral base of mandible. Insertion – angle of mouth. Action – part of dilators of mouth, depresses labial commissure bilaterally to frown (sadness) |
| Describe the locations, attachments, and actions of the following muscles of facial expression: mentalis | Origin – body of mandible Insertion – skin of chin. Action – elevates and protrudes lower lip. Elevates skin of chin (showing doubt). |
| What muscle raises the upper eyelid? Is it innervated by cranial nerve VII? | Levator palpebrae superioris muscle. No |
| If the levator palpebrae superioris muscle is paralyzed, you might try to keep your eye open by raising your eyebrow. What muscle does that, and what nerve branch innervates it? Does this work very well? | Frontalis muscle, Temporal branch of facial nerve. No |
| A Bell palsy patient who cannot keep his eye closed might wear an eye patch at night to avoid scratching his conjunctiva and cornea on pillows, blankets or sheets. What muscle does he miss right about now? | Orbicularis oculi muscle |
| What ring of muscle keeps your lips tightly closed when you puff up your cheeks with air? | Orbicularis oris muscle |
| What desirable function does this muscle serve during mastication? | Keeps food from spilling out of one's mouth |
| What wall of muscle can you use to prevent your cheeks from inflating when you blow a very thin stream of air out between your lips? | Buccinator |
| What muscle is paralyzed if your patient’s left cheek always inflates when he makes a squeaking sound by blowing a thin stream of air between his lips? | Buccinator |
| Buccinator is not classified as a muscle of mastication, but what valuable function does it serve during mastication? | It moves ingested food from the oral vestibule to the space between the teeth |
| Corrugator supercilii is included because it is a target of an aesthetic medicine procedure. Explain. | Corrugator is deep to the inferior medial part of frontalis; it pulls the more lateral parts of the forehead medially to produce a wrinkle that some people find unattractive, so they get the muscle paralyzed |
| What does “plus PSS” in the mnemonic “muscles of facial expression plus PSS” mean? | Posterior digastric, Stylohyoid, Stapedius |
| Name the two salivary glands the chorda tympani serves. | Sublingual salivary gland, submandibular salivary gland |
| The chorda tympani also serves an important sensory role. What field? General sensory or special sensory? | Anterior two thirds of the tongue. Special sensory (gustation) |
| Which of these two ganglia (submandibular and pterygopalatine) is located deep in the head, in the pterygopalatine fossa? | Pterygopalatine ganglion |
| Name the three nerves along the course that preganglionic fibers use to reach the pterygopalatine ganglion. | Facial nerve, greater petrosal nerve, nerve of pterygoid canal |
| From there, what organ does that ganglion supply by sending nerve fibers into the orbit? What tissue does it supply by sending fibers into the pharynx nasal cavity? What does it supply by sending fibers inferiorly to reach the palate? | Lacrimal gland, nasal mucosa and glands, pharyngeal mucosa and glands, palatine salivary glands. |
| On submandibular and pterygopalatine postganglionic pathways, the fibers have joined general sensory nerve fibers that send signals in the opposite direction, to the brain. What cranial nerve will most of those sensory fibers end up in? | Trigeminal Nerve |
| List the branches of the facial nerve within the temporal bone in order starting with the branches that are closest to the face | Chorda tympani, nerve to stapedius, greater petrosal nerve |
| If inflammation in the facial canal of the temporal bone is only as deep as the stylomastoid foramen, what aspect of the facial nerve's many functions will be impaired? | Control of muscles of facial expression |
| If the lesion is deep enough to involve most of the facial canal, conduction in fibers that travel in the __________ nerve will be impaired. | Chorda tympani |
| An even deeper lesion may paralyze the stapedius muscle. What nerve branch innervates the stapedius? What is hyperacusis? | Nerve to stapedius. Being overly sensitive to loud sounds. This does not often happen with inflammation that starts peripherally. |
| The most common cause of a lesion of the entire facial nerve is a tumor of the vestibulocochlear nerve. In what feature of the temporal bone are the facial nerve and the vestibulocochlear nerve together, such that the tumor can compress its neighbor? | Internal auditory meatus |
| That is a part of the facial nerve proximal to the first branch of the facial nerve. What is that first branch, and what is its destination? | Greater petrosal nerve; lacrimal gland, nasal cavity, pharynx, oral cavity by way of pterygopalatine ganglion |
| Which cranial nerve has the most significant role in delivering sensory information for the gag reflex? Which cranial nerve has the most significant role in stimulating the muscles that elevate the pharynx in the gag reflex? | Glossopharyngeal nerve. Vagus nerve. But both muscles are involved in both limbs of this reflex |
| Which cranial nerve innervates the stylopharyngeus muscle? | Glossopharyngeal nerve. (This is the CN IX part of the motor limb of the gag reflex.) |
| Which cranial nerve innervates the levator palati muscle? If your patient’s uvula deviates to the left when he elevates his soft palate which levator palati muscle appears to be paralyzed, and which nerve may be lesioned? | Vagus. Right levator palati, right vagus nerve |
| Which of the three main muscles of the larynx (cricothyroid, the posterior cricoarytenoid and the transverse/oblique arytenoid/aryepiglotticus complex) is innervated by the external laryngeal branch of the superior laryngeal branch of the vagus nerve? | Cricothryroid muscle |
| Where along the course of the vagus nerve does the superior laryngeal nerve arise? | A few centimeters inferior to the jugular foramen. |
| If a surgeon divides the vagus nerve between the superior laryngeal nerve and the recurrent laryngeal nerve, which muscle (cricothyroid, posterior cricoarytenoid, or transverse arytenoid/oblique/aryepiglotticus complex) will remain innervated? | Cricothryroid retained |
| What is the other branch of the superior laryngeal nerve? Between which two parts of the laryngeal skeleton does it pass to enter the larynx? | Internal laryngeal nerve. Hyoid bone and thryroid cartilage |
| By preventing prolapse of the tongue, one of the muscles the hypoglossal nerve innervates lets you fall sleep while lying supine. What muscle is that? | Genioglossus |
| The cricothyroid muscle pulls the laryngeal prominence anteriorly relative to the cricoid cartilage and arytenoid cartilages. What effect does this have on the vocal folds? | Tenses the vocal folds |
| What is the position of the vocal folds that is used for ordinary speech? Is the pitch of a voice controlled by tension in the true vocal fold or by abduction and adduction? | Adducted, tense. Tension |
| What is the only muscle that can abduct the vocal folds? Does this occur when one shouts? When one holds one's breath? When one breathes deeply? | Posterior cricoarytenoid muscle. No. No. Yes |
| Know how the recurrent laryngeal nerve can be injured in the neck or the thorax. Name a site where the entire vagus nerve can be injured. | Emerging from the medulla; jugular foramen, immediately inferior to jugular foramen |
| What nerve provides the motor innervation to the transverse arytenoid/oblique arytenoid/aryepiglotticus complex? Restate the functions this allows. | Recurrent laryngeal nerve. Closing the aditus of the larynx during swallowing; adducting the false vocal folds to seal the airway in preparation for a cough; adducting the true vocal folds for speech |
| Name and describe the position of the left and right vocal folds in a patient with a recent left unilateral recurrent laryngeal nerve lesion. | Left fold: paralyzed in paramedian position, tense; right fold: abducted during breathing, hyperadducted during speech |
| Paralysis of what muscle is the key to understanding the position of the left true vocal fold in that case? | Posterior cricoarytenoid muscle |
| Does a unilateral recurrent laryngeal nerve injury necessarily eliminate the ability to breathe? To breathe deeply? To breathe deeply and quietly? To speak? To speak normally? | No. No. Yes. No. Yes |
| What is stridor? Why does unilateral recurrent laryngeal nerve lesion produce stridor? | The vocal fold on the affected side is adducted and tense, so air whistles past it |
| How freely does air move through the larynx if there are bilateral recurrent laryngeal nerve lesions? Explain. Is speech possible? Explain. | Not very well. Both true vocal folds are adducted to near the midline (the rima glottidis is narrow). Speech is possible because the cricothyroid muscles can tense the vocal folds, but speech is weak and “breathy” |
| How freely does air move through the larynx if there is a superior laryngeal nerve lesion? Explain. Is the cough reflex impaired? Explain whether this is a sensory issue or a motor issue. | Very well. The posterior cricoarytenoid muscle retains its function. Yes. The ability to sense irritants in the vestibule is impaired |
| Explain why stridor may not be an effect of unilateral total vagal lesion on the vocal apparatus. Is coughing impaired? | Yes. General sensory innervation on the ipsilateral side of the larynx is lost; ipsilateral adductors of the vocal folds are paralyzed so the patient cannot seal the airway effectively to initiate a cough |
| What is the unfortunate ultimate result of most permanent injuries to one or more nerves supplying the larynx? Explain. | The ability to cough effectively is impaired or lost in most cases of any of these nerve lesions. Gradual loss of ability to speak as laryngeal tissues become inflamed and scarred |
| In mammals, which one of the numbered pharyngeal arches degenerates as the others are starting to form? | Fifth |
| Where is the sixth arch located, in the head or in the thorax? | Thorax |
| Are pharyngeal clefts on the organism’s outside surface, or inside the developing pharynx? | Outside surface |
| Are pharyngeal pouches on the organism’s outside surface, or inside the developing pharynx? | Inside the developing pharynx |
| What large bone will be most markedly underdeveloped if there is insufficiency of the first arch? | Mandible |
| What will be a likely physiological consequence of malformation of the other bones that develop from the first arch cartilage? | Deafness or poor hearing from malformation of middle ear structures including the malleus and incus |
| What nerve recurs around the derivatives of the right and left fourth aortic arch arteries? | Recurrent laryngeal nerve |
| Relative to the incisive foramen, where is the part of the hard palate that develops from the premaxillary segment? What superficial part of the mouth is derived from the superficial part of the premaxillary segment? | Anterior. Medial part of upper lip. |
| Relative to the incisive foramen, where is the part of the hard palate that develops from the right and left lateral palatine processes? What bones contribute to this part of the palate? | Posterior to the incisive foramen. Maxillary, palatine |
| Which of the fontanelles is largest? Relative to the sutures, where is it? | Anterior fontanelle. Intersection of metopic, coronal and sagittal sutures |
| Which two are on the midline of the body? Relative to the sutures, where is the second one? | Anterior fontanelle, posterior fontanelle. Intersection of sagittal and lambdoid sutures |
| Which one is a pair of fontanelles, one on the right and the other on the left? Relative to the sutures, where is it? | Right and left posterolateral fontanelles. At asterion, intersection of lambdoid and occipitomastoid sutures |
| From skin to brain, what tissue layers cover over the fontanelles? | Skin, subcutaneous fascia, galea aponeurotica, cranial membrane, dura mater, arachnoid mater, pia mater, brain |
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