13. Head & Neck II Flashcards
What are the 3 regions that the nasal cavity is divided into?
- olfactory region
- respiratory region
- nasal vestibule
What is the nose split by?
- nasal septum (cartilage)
What are choanae?
- openings at the back of the nose
Label this image
What is the spheno-ethmoidal recess?
- connection between the sphenoid bone and the ethmoid bone
What is the cell type found in the meatuses?
- pseudo stratified ciliated columnar epithelium
Label this image
+ find sphenoethmoidal recess
Label this image
What are the 4 cartilages of the nose?
- nasal septal (lateral and septal processes)
- Major alar (medial and lateral crus)
- Minor alar
- Alar fibrofatty tissue
Which structures open into the three meatuses?
- superior : posterior ethmoidal sinus
- middle : frontal, maxillary and anterior ethmoidal sinuses
- inferior : nasolacrimal duct, eustachian tube
What are the paired and unpaired bones that make up the nasal septum?
- Paired bones: Nasal, maxillary and palatine bones.
- Unpaired bones: Ethmoid and vomer bones.
What is the frontonasal duct?
- connection between the frontal bone and nasal cavity
What does the frontonasal duct drain via?
- the infundibulum between the superior and middle nasal concha
Label 1-25
What are the 6 ethmoidal structures?
- Crista galli (attachment of the falx cerebri)
- Cribriform plate (has all the olfactory nerves)
- Perpendicular plate
- Superior nasal concha
- Middle nasal concha
- Uncinate process
What is found on the lower part of the uncinate process?
- opening into the maxillary sinus
Label this image
Where does the nasolacrimal canal open into?
- inferior concha
Label this image
Label this image
Where does the frontal sinus drain into?
- ethmoidal
What is the only way in and out of the maxillary sinus?
- uncinate process
If the maxillary sinus is inflamed then where can it caused pain?
- referred pain along alveolar nerve
What is the cell type of the lining of the sinuses?
- pseudo stratified columnar epithelium
What forms the medial walls of the orbits?
- middle ethmoidal cells and the bulla ethmoidali
What does the perpendicular plate attach to?
- vomer bone
Label this image
What muscle causes frowning and where is it?
- procerus
- between orbits
Where does the procerus attach?
- onto the glabella
Where does the nasalis muscle run?
- over the nasal bone
Label this image
Where is the nasalis muscle attached and what does it surround?
- attached to the maxilla
- surrounds the fibrofatty cartilage of the naris
What is the function of the levator muscle?
- lift nose up (scrunch it/ addison rae)
What is the torus tubaris?
- opening of the auditory tube which connects the middle ear cavity to the back of the nasopharynx
Label this image
What is the limen nasi?
- ridge after the nasal vestibule
What is the semilunar hiatus?
- space between the uncinate process and the ethmoid bulla
Where does the nasolacrimal duct open?
- inferior nasal meatus
Label this image
What is the foramen caecum and where is it found?
- embryological remnant at the back of the tongue
Where is the lingual tonsil?
- at the back of the tongue
What is the ethmoid supplied by?
- anterior and posterior ethmoidal arteries
Where do the ethmoidal arteries originate?
- branches of opthalmic which originate from the circle of willis
What does the maxillary artery supply?
- deep structures of the face, such as the mandible, maxilla, teeth, muscles of mastication, palate, nose
What is the ophthalmic artery a branch of?
- internal carotid
What is Littleโs area?
- An area on the nasal septum where branches of facial, maxillary and ophthalmic arteries anastomose
- common site of โnose-bleedsโ
How is the oral cavity divided?
- oral vestibule (small space between lips and teeth)
- oral cavity proper (space between teeth and gums)
- oropharynx (C2-C3)
Behind which arch is the palatine tonsil located?
the palatoglossal arch
Label this image
What do the palatoglossal and palatopharyngeal arches represent?
Projections of the palatoglossal and palatopharyngeal muscles
What are the palatopharyngeal and palatoglossal muscles covered in?
mucus
What does the palatopharyngeal arch represent?
Link between the oral cavity and oropharynx
What is the posteroinferior projection of the soft palate and what does it do?
Uvula, moves upwards to close off the nasopharynx during swallowing (movement aided by palatopharyngeus muscle)
What is the lingual frenulum and what does it do?
Fold of mucus membrane underneath the tongue
Anchors the tongue in the mouth and stabilizes its movements
The lips also have a frenulum which anchors them to the gum
What are the functions of saliva?
- lubrication
- defense against pathogens
- digestion (contains digestive enzymes like amylase and lipase)
Which salivary gland produces the most saliva?
Submandibular (75% of total saliva(
What is the location of the submandibular gland?
inferior to the mandibular body
How does the submandibular gland drain into the oral cavity?
via the submandibular (Wharton) duct
What stimulates salivary secretion?
- Thoughts
- smells
- vision
- taste
what nerve innervates the parotid gland?
Mandibular (V3) - branch of the trigeminal nerve (CN V)
Label
How does the sublingual gland drain into the oral cavity?
Via 8-20 small ducts called Rivinus ducts (2% of total saliva)
what is the location of the parotid gland?
On top of ramus of the mandible
what nerve can get damaged by the removal of the salivary gland (esp parotid)?
Facial nerve (CN VII) as it passes through the face, hence patient gets bellโs palsy (temporary weakening and paralysis of side of face)
Which salivary glands are 1, 2, and 3?
1) parotid gland
2) submandibular gland
3) sublingual gland
What is the location of the tubal tonsils?
Located in the nasopharynx (C1-C2), posterior to the eustachian tube
What are the tubal, pharyngeal (adenoid), palatine and lingual tonsils known as collectively?
Waldeyerโs tonsillar ring
How can adenoid tonsil cause an ear infection?
Infection travels through the eustachian tube to cause a middle ear infection
Which papillae have taste buds?
- Fungiform
- Vallate
- Foliate
Which papillae only have sense functions?
Filiform papillae
What does the terminal sulcus divide the tongue into?
Anterior 2/3
Posterior 1/3
Where are the Fungiform papillae located?
Tips and sides of the tongue, contain taste buds
Where are the foliate papillae located?
Sides and back of tongue, contain taste buds
Where are the vallate papillae located?
In front of the terminal sulcus, contain taste buds
Where are the filiform papillae?
Back of the tongue, no taste buds, just sense of touch
Label
What is the function of the intrinsic tongue muscles?
Change the shape of the tongue during deglutition (swallowing) and phonation
How are the fibres of the intrinsic tongue muscles named?
Named according to fibre direction
What are the intrinsic muscles of the tongue?
- Superior longitudinal lingual muscle
- Verticalis lingual muscle (vertical fibres)
- Transversus lingual muscle (transverse fibres)
- Inferior longitudinal lingual muscle
What do extrinsic lingual muscles do?
Attach the tongue to extrinsic regions of the palate and back of head and neck. Named according to the structures they attach to.
Label this image
what shape is the genioglossus muscle?
Fan-shaped, connecting the mandible to the tongue and hyoid bone.
Main muscle for sticking out the tongue
What is the hyoglossus muscle attached to?
Hyoid bone inferiorly, tongue superiorly
What does the styloglossus muscle connect?
Styloid process of temporal bone to the tongue
Are the extrinsic lingual muscles paired or unpaired?
paired
From which nerve do all lingual muscles receive their innervation (apart from one)?
- The hypoglossal nerve (CN XII)
- Except for the palatoglossus muscle (vagus nerve CN X)
What nerve is required for sensory innervation to the anterior 2/3 of the tongue?
Lingual nerve (Branch of the mandibular nerve V3)
What nerve is required for taste in the anterior 2/3 of the tongue?
Chorda tympany (branch of the facial nerve CN VII)
What nerve is required for taste and sensation in the posterior 1/3 of the tongue?
Glossopharyngeal nerve (CN IX)
Which artery is main source of blood for the tongue?
The lingual artery which is a branch of the external carotid artery
What other structure may be found near the parotid duct not far from the buchal fat pad?
Accessory parotid gland
What is the mental foramen?
A hole in the body of the mandible through which the terminal branches of the inferior alveolar nerves pass
Label this image
On what aspect of the mandibular body can the right and left mental tubercles be seen?
Anterior
Label
What was the mandibular symphysis originally?
- During embryological development, the mandible developed as a right and left side joined together in the midline by thin fibrocartilage
- By 1st or 2nd year of life this fibrocartilage becomes ossified into the mandibular symphysis
What can be seen on the posterior aspect of the mandibular body?
Depressions marking the sublingual fosse (where the sublingual gland sits) and the submandibular fossa (where the submandibular gland sits)
Can see posterior aspect of the mandibular symphysis
Label
What does the temporomandibular joint consist of?
The condylar process of the mandible (mandibular ramus) articulating with the mandibular fossa of the temporal bone
Why is the temporomandibular joint special?
It is a special hinge synovial joint in which there is not only backward and forwards motion but also side to side motion and up and down
How does the temporomandibular joint differ from a typical hinge joint like knee or elbow?
There is side to side motion and up and down motion as well as just anterior and posterior as the TMJ is a modified hinge type of synovial joint
What is the origin of the temporalis muscle?
Temporal fossa (depression along the temporal line)
What is the insertion of the temporalis muscle?
Coronoid process and ramus of the mandible
What are the functions of the temporalis muscle?
Retraction and elevation of the mandible
What is the origin of the masseter muscle?
Inferior border of the zygomatic arch
What is the insertion of the masster muscle?
Inferior ramus and a bit of the mandibular body
Label
What is the origin of the medial pterygoid muscle?
- posterior maxilla (superficial head)
- medial surface of lateral pterygoid plate of the sphenoid bone (deep head)
Where does the medial pterygoid muscle insert?
Medial surface of the ramus of mandible
What is the function of the medial pterygoid muscle?
Elevation of mandible (protraction a little bit too) and lateral movement
What is the origin of the lateral pterygoid muscles?
- crest of the greater wing of the sphenoid bone (superior head)
- lateral aspect of lateral pterygoid plate of the sphenoid bone (inferior head)
Where is the insertion of the lateral pterygoid muscles?
Neck of mandibular chondyle
Label
What is the origin of the superficial head of the medial pterygoid bone?
Posterior maxilla (maxillary tuberosity) and pyramidal process of palatine bone (not mentioned in lecture)
What is the origin of the deep head of the medial pterygoid muscle?
Medial aspect of the lateral pterygoid plate of the sphenoid bone (and pyramidal process of sphenoid bone - not mentioned in lecture)
What is the insertion of the medial pterygoid muscles?
Medial aspect of the ramus of the mandible
Label
Where do the lateral pterygoid muscles insert?
Neck of mandibular condyle
Which muscles of mastication are involved in elevation of the mandible?
- Temporalis
- Masseter
- Medial pterygoid
Which muscles of mastication are involved in lateral mandibular movements?
Medial and lateral pterygoid muscles
Which muscles of mastication are involved in protraction of mandible?
Mainly lateral pterygoid but also medial pterygoid
Which muscles of mastication are involved in retraction of the mandible?
Temporalis muscle
Which arteries โsupplyโ the muscles of mastication?
Branches of the maxillary artery:
- Pterygoid artery
- Deep anterior and posterior temporal artery
- Masseteric artery
What is the nerve supply to the muscles of mastication?
They are all branches of the mandibular nerve (V3):
- Deep anterior and posterior temporal nerve
- Masseteric nerve
- Nerve to lateral pterygoid muscle
- Nerve to medial pterygoid muscle
