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2 - face and skull Flashcards

1
Q

sensory function of the trigeminal nerve

A

cutaneous sensation from the face and forehead

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2
Q

divisions of the trigeminal nerve

A

V1 - ophthalmic nerve
V2 - maxillary nerve
V3 - mandibular nerve

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3
Q

which nerve innervates facial sensataround the frontal bone

A

ophthalmic nerve

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4
Q

which nerve innervates facial sensation around the middle part of the face

A

maxillary nerve

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5
Q

which nerve innervates facial sensation around the chin and upwards

A

mandibular nerv

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6
Q

clinical examination of sensory innervation in the face

A

pinprick and light touch sensations over each region

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7
Q

3 groups of important muscles in the head

A
  • muscles of facial expression
  • muscles of mastication
  • extra ocular muscles
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8
Q

where do muscles of facial expression insert

A

the skin

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9
Q

function of the frontal belly of occipitofrontalis

A
  • pulls scalp anteriorly
  • wrinkles forehead
  • elevates eyebrows
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10
Q

function of occipital belly of occupitofrontalis

A

pulls scalp posteriorly

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11
Q

function of orbiculares oculi

A

closes eyelids

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12
Q

function of orbiculares oris

A

closes the mouth

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13
Q

function of buccinator

A
  • keeps cheek taught

- resists distension when whistling, sucking and blowing

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14
Q

function of platysma

A

tenses the skin of the inferior face and neck

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15
Q

function of zygomaticus major

A

draws the corner of the mouth upwards and laterally

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16
Q

which nerve innervates the muscles of facial expression

A

facial nerve

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17
Q

sensory functions of facial nerve

A
  • taste

- part of external acoustic meatus and deeper parts of auricle

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18
Q

autonomic functions of facial nerve

A
  • secretomotor to all salivary glands except parotid
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19
Q

circular muscle acting as a splinter around the eye

A

orbicularis oculi

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20
Q

dilators of the eyelid

A
  • levator palpebrae superiosis

- superior tarsal

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21
Q

what complication would arise due to paralysis of orbiculares oculi?

A

inability to close eyelids tightly

  • lower eyelid droops away and sags outwards (ectropion)
  • spillage of teards
  • drying of conjunctiva
  • ulcerations
  • secondary infection
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22
Q

largest salivary gland

A

parotid gland

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23
Q

how does the parotid duct travel

A

transversely across the face

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24
Q

where does the parotid duct open into

A

oral cavity near the second upper molar tooth

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25
Q

posterior boundary of parotid gland

A

mastoid process

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26
Q

anterior boundary of parotid gland

A

rams of mandible

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27
Q

conditions which result in parotid glands swelling

A

mumps

parotid gland stones

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28
Q

why is parotid gland stones painful

A

intense pain when salivating

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29
Q

functions of the parotid duct

A

carries secretions from the parotid gland into the mouth

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30
Q

5 terminal branches of the facial nerve

A 
temporal division
zygomatic division
buccal division
marginal mandibular division
cervical division
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31
Q

where does the facial nerve divide

A

the parotid gland

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32
Q

why is the facial nerve vulnerable to damage within the parotid gland

A

it lies superficially

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33
Q

why is surgical removal of the parotid gland difficult

A

the facial nerve and its branches lie superficial

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34
Q

when is the facial nerve at risk

A

surgery
blunt or penetrating trauma
temporal bone fractures

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35
Q

structures which lie within the substance of the parotid gland

A
  • facial nerve and divisions
  • retromandibular vein
  • external carotid artery and divisions
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36
Q

terminal branches of the external carotid artery

A

maxillary artery

superficial temporal artery

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37
Q

branches of the external carotid artery (in order going up)

A
  • superior thyroid artery
  • lingual artery
  • facial artery
  • maxillary artery
  • superficial temporal artery
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38
Q

important branch of the maxillary artery

A

middle meningeal artery

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39
Q

what does the middle meningeal artery supply

A

cranial dura mater

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40
Q

route of the middle meningeal artery

A

under the pterion of the skull

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41
Q

what is the pterion

A

where the frontal bone, temporal bone, parietal bone and sphenoid bone converge on the skull

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42
Q

where does the common carotid artery bifurcate

A

C3-4

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43
Q

why is the pterion weak

A

several bones converge here

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44
Q

what type of inter cranial bleeding may result from a fracture to the pterion?

A

extradural haematoma / extradural haemorrhage

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45
Q

how does a fracture to the pterion result in an extradural haemorrhage?

A
  • middle meningeal artery can be damaged
  • blood accumulation between the skull and dura matter (subarachnoid bleeding)
  • extradural haemorrhage
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46
Q

where to palpate for the superficial temporal artery (temporal pulse)

A
  • area anterior to the ear

- posterosuperior to the temporomandibular joint

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47
Q

where to palpate for the anterior branch of the superficial temporal artery (temporal pulse)

A
  • posterior to the zygomatic process of the frontal bone

- the artery is passing laterally to the temporal fascia

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48
Q

where to palpate for the carotid pulse

A
  • lateral to the thyroid cartilage

- medial to the sternocleidomastoid muscle

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49
Q

where to palpate for the facial pulse

A

adjacent to the anterior margin of the masseter muscle

50
Q

which cranial nerve loops around the internal and external carotid arteries

A

hypoglossal nerve (CN7)

51
Q

function of hypoglossal nerve

A

innervates motor functions of the tongue (apart from palatoglossus)

52
Q

eye socket

A

the orbit

53
Q

how many bones make up the orbit

A

7

54
Q

main foramina in the orbit

A
  • superior orbital fissure
  • interior orbital fissure
  • infraorbital foramen
  • lacrimal groove
  • optic canal
55
Q

bones making up the orbit

A
  • frontal bone
  • ethmoid bone
  • nasal bone
  • maxilla
  • zygomatic bone
  • sphenoid bone
56
Q

extra-ocular muscles

A
  • superior rectus
  • inferior rectus
  • medial rectus
  • lateral rectus
  • superior oblique
  • inferior oblique
  • levator palpebrae superiosis
57
Q

which nerve are most extraocular muscles innervated by

A

oculomotor (CN3)

58
Q

which 2 extra-ocular muscles are not innervated by the oculomotor nerve

A

lateral rectus

superior oblique

59
Q

what nerve innervates the lateral rectus muscle

A

abducens nerve (CN6)

60
Q

what nerve innervates the superior oblique muscle

A

trochlear nerve (CN4)

61
Q

superior rectus muscle

A

elevates eyeball

62
Q

inferior rectus muscle

A

depresses eyeball

63
Q

medial rectus muscle

A

adducts eyeball (pulls the eyeball medially to look towards the midline)

64
Q

lateral rectus muscle

A

abducts the eyeball (pulls eyeball laterally to look away from the midline)

65
Q

superior oblique muscle

A

inverts (medially rotates the eyeball)

66
Q

inferior oblique muscle

A

everts (laterally rotates the eyeball)

67
Q

levator palpebrae superiosis muscle

A

lifts the eyelids

68
Q

which nerves travel through the orbital fissure

A
  • oculomotor
  • trochlear
  • abducens
69
Q

which is the only cranial nerve to emerge from the dorsal aspect of the brainstem

A

trochlear nerve

70
Q

where does the trochlear nerve emerge

A

the dorsal aspect of the brainstem

71
Q

what is diplopia

A

double vision

72
Q

how do you examine a patient’s eye movements?

A

the H test

  • have a patient track an object, without moving their head, and move it in the shape of an H
  • start in the midline
73
Q

how to measure the function of the oculomotor nerve

A
  • ask the patient to look medially

- check the upper lid is fully retracted on upward gase

74
Q

how to measure the function of the abducens nerve

A

ask the patient to look laterally

75
Q

how to measure the function of the trochlear nerve

A

ask the patient to look medially then downwards

76
Q

ptosis

A

dropping of upper eyelid / lazy eye

77
Q

ptosis is the malfunction of which muscle?

A

complete: loss of oculomotor nerve function for levator palpebrae superiosis
partial: loss of sympathetic innervation to the superior tarsal muscle

78
Q

Horner’s Syndrome

A

Any lesion which leads to a loss of sympathetic function in the head

79
Q

clinical presentations of Horner’s syndrome

A
  • pupillary constriction
  • partial ptosis
  • absence of sweating
80
Q

intraocular muscles

A
  • ciliary muscle
  • sphincter pupillae muscle
  • dilator pupillae muscle
81
Q

which intraocular muscles are supplied by the oculomotor nerve

A

ciliary

splinter pupillae

82
Q

ciliary muscle

A

accommodation of the lens of the eye for near vision

  • constricts ciliary body
  • relaxes tension on lens
  • lens becomes more rounded
83
Q

dilator pupillae muscle

A

dilates pupil

84
Q

sphincter pupillae muscle

A

constricts pupil

85
Q

which muscles dilate and constrict the pupil

A

dilate: dilator pupillae muscle
construct: sphincter pupillae muscle

86
Q

which autonomic ganglion innervates the intraocular muscles

A

ciliary ganglion:

  • ciliary muscle
  • sphincter pupillae muscle

superior cervical ganglion:
- dilator pupillae muscle

87
Q

which structures articulate in the temporomandibular joint?

A
  • mandibular fossa of the temporal bone

- condylar process of the mandible

88
Q

what does the temporomandibular joint permit?

A

gliding, rotation, elevation and depression of the mandible

89
Q

how are the two articulating surfaces of the TMJ separates?

A

articular disc of the TMJ

- this creates the superior and inferior articular cavities

90
Q

how is the temporomandibular joint strengthened

A
  • ligaments

- articular tubercle

91
Q

TMJ when the mouth opens

A

protrusion:

condylar process glides anteriorly to lie directly beneath the articular tubercle

92
Q

how do grinding movements in the jaw occur

A

if protraction occurs unilaterally

- condylar process undergoes rotation on the inferior surface of the articular disc

93
Q

muscles of mastication

A

temporalis
masseter
lateral pterygoid
medial pterygoid

94
Q

superficial muscles of mastication

A

temporalis

masseter

95
Q

deep muscles of mastication

A

medial and lateral pterygoid

96
Q

origin of temporalis muscle

A

temporal fossa of the skull

97
Q

insertion of temporalis muscle

A

coronoid process of the mandible

98
Q

origin or the masseter

A

zygomatic process of the temporal bone

99
Q

insertion of the masseter muscle

A

external aspect of the ramus and angle of the mandible

100
Q

origin of the lateral pterygoid muscle

A

external / lateral aspect of the lateral pterygoid plate of the sphenoid bone

101
Q

insertion of the lateral pterygoid muscle

A

condyloid process of the mandible

102
Q

origin of the medial pterygoid muscle

A

internal / medial aspect of the lateral pterygoid plate

103
Q

insertion of the medial pterygoid muscle

A

internal aspect of the ramus and angle of the mandible

104
Q

which nerve innervates the muscles of mastication

A

mandibular branch of the trigeminal nerve

105
Q

what happens when the medial and lateral pterygoid muscles contract

A

the mandible moves laterally

106
Q

how does protrusion of the jaw occur

A

lateral pterydoid assisted by medial pterygoid

107
Q

how does retraction of the jaw occur

A
  • temporalis contracts
  • masseter muscle contracts
  • digastric muscles contract
108
Q

how does elevation of the jaw occur

A
  • temporalis contracts
  • masseter contacts
  • medial pterygoid contracts
109
Q

how does depression of the jaw occur

A
  • gravity

- digastric muscles

110
Q

route of the mandibular branch of the trigeminal nerve

A

from the brainstem to the face through the foramen oval in the base of the skull

111
Q

consequences of unilateral damage to the mandibular branch of the trigeminal nerve

A

the jaw will deviate to one side when opened against resistance (deviates towards the paralysed side)

112
Q

which side will the jaw deviate to if there is a lesion on the left mandibular branch of the trigeminal nerve?

A

left

113
Q

palpebral fissure

A

the gap between the eyelids

114
Q

origin of platysma

A

inferior edge of mandible

115
Q

attachments to orbicularis oris

A

near the midline to the mandible and maxilla

116
Q

route or facial nerve from brainstem out of the skull

A

brainstem
internal acoustic canal
gives off branches
stylomastoid foramen

117
Q

which structures does the facial artery supply

A

most superficial structures of the face

118
Q

sensory supply to the face

A

divisions of the trigeminal nerve

119
Q

dilators of the mouth group of muscles function

A

opens the mouth

120
Q

why is swelling of the parotid gland painful

A

because of the toughness of the surrounding fascia and it’s position between the mandible and the temporal bone behind

121
Q

which muscle of mastication is fan-shaped?

A

temporalis

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