Anatomy Flashcards
What lies beneath the pterion?
Middle meningeal artery
Why is a blow to the pterion dangerous?
Can cause extradural haemorrhage as the pterion overlies the middle meningeal artery
Which nerve transmits through supraorbital notch?
Opthalmic nerve (CNV1)
What nerve transmits through the infraorbital foramen?
Maxillary nerve (CNV2)
What nerve transmits through the mental foramen?
Mandibular nerve (CNV3)
Which cervical vertebrae are typical?
C3-C6
Which cervical vertebrae are atypical and what are their names?
C1 Atlas
C2 Axis
C7 Vertebrae prominens
What is the atlanto-occipital joint and what is its function?
C1 and skull joint
Nodding
What is the joint of C1 and C2 called ant what is its function?
Lateral Atlanto axial joint
Rotation of the head (side to side)
What attaches to the spinous processes of the cervical vertebrae?
Ligamentum nuchae
What vertebrae level is the hyoid bone?
C3
Components of the carotid sheath (3)
Common carotid a
Internal jugular v
Vagus nerve
Muscles found in the superficial fascia of the neck and what is its function?
Platysma
Facial expression
What layer of fascia lies deep to the subcutaneous tissues?
Investing fascia
Fascia making up the carotid sheath
Boundaries with all three layers of deep cervical fascia - investing/pretracheal anteriorly, prevertberal posteriorly.
Path of the carotid sheath into the skull
Runs from aortic arch to foramen of carotid canal
Innervation of SCM
Accessory nerve
SCM function
Draws head forwards (bilaterally)
Tilts head towards ipsilateral shoulder
Turning face contralaterally (unilaterally)
What nerve does C3, C4 and C5 give rise to and what does it supply?
Phrenic nerve - supplies diaphragm
What nerve does C1, C2 and C3 give rise to and what does it supply?
Ansa cervicalis - innervates infrahyoid muscles
What nerve does C2 give rise to?
Lesser occipital nerve
What nerve does C2 and C3 give rise to ?
Great auricular, transverse cervical
What nerves do C3 and C4 give rise to?
Supraclavicular nerves
What triangle of the neck can the brachial plexus be seen in?
Omoclavicular triangle, within the posterior triangle of the neck
Which major vessels and nerves cross the SCM
EJV
Great auricular nerve
Transverse cervical nerve
Suprahyoid muscles
Mylohyoid
Geniohyoid
Stylohyoid
Digastric
Infrahydoid muscles
Sternothyroid
Sternohyoid
Thyrohyoid
Omohyoid
Which nerve gives rise to the nerve to mylohyoid?
Inferior alveolar nerve
What are 2 airway procedures and what are the anatomical landmarks for this procedure?
Cricothyrotomy - cricothyroid ligament
Tracheostomy - isthmus of the thyroid gland
Innervation of the carotid sinus?
Carotid sinus nerve from glossopharyngeal nerve
Where is the carotid sinus and what is its function?
Internal carotid artery, baroreceptors that regulate BP
What is Sibson’s fascia and what is its function?
Suprapleural membrane or fibrous connective tissue that acts as a barrier to prevent intrathoracic pressure changes
3 branches from aortic arch
Left subclavian
Left common carotid
Right brachicephalic
What muscle divides the subclavian artery into 3 parts?
Anterior scalene muscle
What are the branches of the first part of the subclavian artery?
Vertebral artery
Thyrocervical artery
Internal thoracic artery
What is the branch of the second part of the subclavian artery?
Costocervical artery
What is the branch of the third part of the subclavian artery?
Dorsal scapular artery
What are the 2 neurotransmitters released in the autonomic nervous system?
Acetylcholine
Noradrenaline
Where are the preganglionic neurons of the parasympathetic nervous system located?
Craniosacral: Spinal segments S2-S4
Cranial nerves (III VII IX X)
Where are the preganglionic neurons of the sympathetic nervous system located?
Thoracolumbar - spinal segments T1-L2 specifically in the lateral horn
What syndrome is caused by damage to the cervical part of the sympathetic trunk and list 3 signs of this syndrome
Horner’s syndrome
Constriction of pupil (miosis)
Drooping of superior eyelid (ptosis)
Anhydrosis
Why does the scalp have potential to spread infection?
Between the aponeurosis and pericranium there are potential spaces for accumulation of fluid (e.g. blood) or spread of infection
How do scalp infections spread to intracranial structures?
Via emissary veins
Why does the scalp bleed profusely when cut?
Arterial anastomoses are prevalent in the scalp and these lie superficially
With regards to lymphatic drainage of the skull. what nodes drain the scalp and external ear?
Parotid and mastoid nodes
What are the parts of the brainstem?
Midbrain
Pons
Medulla
What are the cranial meninges layers from innermost to outermost?
Pia mater
Arachnoid mater
Dura mater
What is the role of dura mater folds?
Limit the movement of the brain within the cavity
What lies beneath the lateral sulcus of the brain?
Insula
What is Broca’s area of the brain responsible for?
Speech production
What is Wernicke’s area of the brain responsible for?
Understanding speech
Hormones released by the pituitary gland
Growth hormone
Follicle stimulating hormone
Thyroid stimulating hormone
How do the lateral cerebral ventricles drain into the third ventricle?
Via interventricular foramen
How does the third cerebral ventricle drain into the fourth?
Via cerebral aqueduct
Sign of an anterior cerebral artery occlusion
Contralateral motor and sensory loss involving mainly leg and foot
Sign of a middle cerebral artery occlusion
Contralateral motor and sensory loss involving mainly the face and arm
Aphasia - difficulty with speech and language
Sign of posterior cerebral artery occlusion
Visual agnosia - inability to identify objects correctly
Sensory innervation of the angle of the mandible
Great auricular nerve (C2 C3)
CNVII facial nerve enters the skull vie the internal acoustic meatus, and exist via the stylomastoid foramen where it gives rise to which 2 branches?
Posterior auricular
Digastric
2 parts of orbicularis oculi muscle and their roles
Palpebral - involuntary or blinking reflex
Orbital - voluntarily or tightly closing
What muscle does the parotid duct pierce and where does it enter the mouth and secrete saliva?
Parotid duct lies over the masseter before reaching the buccinator and piercing it. It enters near the maxillary second molar
What muscle does the buccal fat pad lie over and what pierces it?
Buccinator
Parotid duct
Branches of the external carotid artery which supply the face
Maxillary - buccal, mental, infraorbital
Superficial temporal - transverse facial
Facial
What vein mainly drains the face and where to?
Facial vein to the IJV
Innervation of the parotid gland
Preganglionic - glossopharyngeal
Postganglionic - auriculotemporal (CNV3)
Innervation of the submandibular gland
Preganglionic - facial (chorda tympani)
Postganglionic - lingual (CNV3)
Innervation of the submandibular gland
Preganglionic - facial (chorda tympani)
Postganglionic - lingual (CNV3)
Innervation of the sublingual gland
Preganglionic - facial (chorda tympani)
Postganglionic - lingual (CNV3)
What nerve branches out of the facial nerve in the facial canal and what does it supply parasympathetic innervation to?
Greater petrosal nerve
Lacrimal and lingual glands
Most common idiopathic facial palsy and what does it present with?
Bell’s palsy
Inability to close eyelid
Drooping mouth
Viral infection which results in swelling of the parotid gland and what are 3 other symptoms?
Mumps
Fever
Headaches
Joint pain
Cerebral white matter
Corona radiata
A lesion affecting corticospinal fibres in the left side of the ventral pons impairs voluntary movement of the arm and the leg on which side? What clinical impact will this have?
Right side (contralateral)
Hemiplegia or paresis
Give an example of an upper motor neuron lesion and symptoms
Stroke
Spastic paralysis
Hyperreflexia
Hypertonia
Give an example of a lower motor neuron lesion and symptoms
Trauma or poliomyelitis
Flaccid paralysis
Hyporeflexia
Hypotonia
What type of joint is the TMJ?
Modified hinge (atypical) - synovial
What is the most common type of TMJ dislocation and how does the patient present?
Anterior dislocation
Open jaw unable to close
Origin, insertion, innervation and function of the temporalis muscle
Origin - temporal fossa and temporal fascia
Insertion - coronoid process of the mandible
Innervation - deep temporal nerves from CN V3
Function - elevation and retraction
Origin, insertion, innervation and function of the masseter
O - maxillary process of the zygomatic bone and arch
Insertion - ramus and angle of the mandible
Innervation - masseteric nerve from CNV3
Function - elevation and protrusion
Primary muscle involved in protrusion of the jaw
Lateral pterygoid
What is the origin, insertion, innervation and function of the medial pterygoid
Origin - medial surface of the later pterygoid plate (deep part) maxillary tuberosity
Insertion - medial aspect of the ramus and angle of the mandible
Innervation - nerve to medial pterygoid from CNV3
Function - lateral movement of the pterygoid
What is the origin, insertion, innervation and function of the lateral pterygoid?
Origin - greater wing of the sphenoid bone (upper head) lateral surface of the lateral pterygoid plate (lower head)
Insertion - pterygoid fovea
Innervation - nerve to lateral pterygoid from CNV3
Function - protrudes mandible and lateral movement
What muscle divides the maxillary artery into 3 parts?
Lateral pterygoid
What nerve passes postsynaptic parasympathetic secretomotor fibres to the parotid gland from the otic ganglion?
Auriculotemporal nerve from CNV3
Sensory innervation to the anterior 2/3rd of the tongue, floor of the mouth and lingual gingivae
Lingual nerve from CNV3
What supplies special sensory innervation (taste) to the anterior 2/3rd of the tongue?
Facial nerve via chorda tympani
What supplies sensory innervation to the posterior 1/3rd of the tongue?
Glossopharyngeal nerve
What main artery and venous plexus is located in the infratemporal region?
Maxillary artery
Pterygoid venous plexus
Where do upper motor neuron fibres of the corticobulbar tract pass through?
Genu of internal capsule
Where do the upper motor neuron fibres of the corticospinal tract pass through?
Posterior limb of internal capsule
Each upper motor neuron connects bilaterally to a cranial nerve nuclei in the corticobulbar tract. What are the 2 exceptions to this rule?
Facial nerve
Hypoglossal nerve
If a patient has drooping lower left face but can wrinkle his upper left forehead and all muscles on the right side what is the suspected lesion?
UMN lesion in the right side of the facial nerve of the corticobulbar tract
2 possible lesions causes patients tongue to protrude to the left
Lower left motor neuron lesion
Upper right motor neuron lesion of the hypoglossal nerve of the corticobulbar tract
Which vessel causes the groove on the parietal bone?
Middle meningeal artery
What does foramen rotundum transmit?
Maxillary nerve CNV2
What nerve is joined by chordae tympani nerve within the infratemporal fossa?
Lingual nerve
What is the sensory branch of the anterior division of the mandibular nerve?
Buccal nerve
Muscle originating from the infratemporal surface of greater wing of sphenoid bone
Upper head of the lateral pterygoid
What muscle attaches to the deep side of the ramus and into the angle of the mandible?
Medial pterygoid muscle
Which muscle protrudes the tongue?
Genioglossus
Nerve innervating the intrinsic muscles of the tongue
Hypoglossal nerve CNXII
What node drains the posterior of the tongue?
Superior deep cervical nodes
What node drains the maxillary sinus?
Submandibular node
87 year old woman has a fall and falls unconscious a couple of days after. Which vessel has ruptured and what type of haemorrhage is most likely?
Cerebral vein
Subdural haemorrhage
Pt comes in complaining of lack of sweating and drooping eyelid on right side. What is the diagnosis and what other signs are associated? What is the anatomical cause?
Horner’s syndrome
Constricted right pupil
Damage to cervical sympathetic trunk
When asking a pt to puff out their cheeks, which 2 branches of the facial nerve are tested?
Buccal nerve
Zygomatic nerve
What is modiolus and what is the dental significance?
Thick part in the angle of the mouth where middle fibres of the buccinator cross over
Have to be considered when making dentures
What nerve crosses anteriorly to the external and internal carotid artery?
Hypoglossal nerve
What nerve crosses posteriorly to the external and internal carotid artery?
Glossopharyngeal nerve
Patient had an infection of a maxillary tooth and is complaining of swollen eyes and fever. Which venous sinus has thrombosis and what other symptoms are seen in this?
Cavernous sinus thrombosis
A headache that feels worse when you lie or bend down
Rash that looks like small bruises or bleeding under the skin
A pt suffers from a brain aneurysm rupture which leads them to lose consciousness fast. What type of haemorrhage is suspected and what vessel is the cause of this?
Subarachnoid haemorrhage
Cerebral artery
What artery supplies the motor cortex?
Middle cerebral artery
What is the white matter area between the thalamus and lentiform nucleus that is a common site for strokes?
Internal capsule
What condition is caused by the overproduction of growth hormone by the pituitary gland?
Acromegaly
What two cerebral ventricles does the cerebral aqueduct connect?
Third and fourth
What structure makes CSF?
Choroid plexus
Drooping of the eyelid in Horner’s syndrome is caused by paralysis of which muscle?
Levator palpebrae superioris
Where does the submandibular duct open into the oral cavity?
Sublingual caruncle/papilla
What is the role of the buccinator during eating?
Press cheeks against molars
Move food to the occlusal surfaces of the teeth
What nerve is being tested when asking a patient to protrude their tongue?
Hypoglossal nerve
What carries parasympathetic secretomotor fibres to salivary glands in the tongue?
Internal laryngeal nerve (branch of vagus nerve)
Which salivary gland is arranged around the free edge of the mylohyoid muscle?
Submandibular gland
Which muscle retracts the mandible?
Temporalis
After an operation to remove stones in the submandibular duct, a pt reports the anterior 1/4 of the tongue is numb. What is the cause?
Damage to the lingual nerve which supplies general sensation to the anterior 2/3 of the tongue
Which muscle opens the mouth?
Lateral pterygoid
Bones making up the zygomatic arch
Temporal process of the zygomatic bone
Zygomatic process of the temporal bone
What is the anatomical basis of a pt having numb lower lip and tongue?
Damage to the mental nerve
2 structures that cross the submandibular gland
Facial vein
Marginal mandibular division of the facial nerve
Through what duct does most lymph of the body re-enter the vascular system? What is the exception?
Thoracic duct
Upper right quadrant which drains into right lymphatic duct
What node drains the parotd gland?
Deep parotid node
What node drains the pharynx, paranasal sinuses and nasal cavity?
Retropharyngeal nodes
What infections cause swelling of the submental nodes?
Epstein barr virus
Cytomegalovirus
Dental infections including periodontitis
What node drains the soft palate, oesophagus, trachea and thyroid gland?
Superior deep cervical nodes
What is a hard, painless lymph node generally indicative of?
Malignancy
What node drains the oral cavity and maxillary sinus?
Submandibular lymph nodes
When you have a cut to the lip why does it usually bleed from both sides?
The superior and inferior labial arteries anastomose across the midline
Which papillae of the tongue do not contain taste buds?
Filiform papillae
What vein is present on either side of the lingual frenulum?
Lingual vein
Where does the sublingual gland duct open?
Sublingual folds
What is the function of the intrinsic muscles of the tongue?
Change the shape and size of the tongue
What is the function of the extrinsic muscles of the tongue?
Protrude, elevate, retract and depress the tongue
What is the role of the genioglossus muscle?
Protrudes the tongue
What is the role of the hyoglossus muscle?
Depressing the sides of the tongue
What vessel enters the tongue between the hyoglossus and genioglossus muscles?
Lingual artery
What nerves enter the tongue on the external surface of the hyoglossus?
Hypoglossal and lingual
What is the function of the styloglossus muscle?
Elevate and retract the tongue
What is the motor innervation of the tongue and what is the exception?
All muscles of the tongue are supplied by the hypoglossal nerve except palatoglossus muscle which is supplied by the vagus nerve
What supplies the special sensory (taste) innervation of the posterior 1/3rd of the tongue?
Glossopharyngeal
What branch of the external carotid artery supplies the tongue?
Lingual artery
What two veins drain the tongue and to what vessel?
Deep lingual vein
Dorsal lingual vein
Both drain into the internal jugular vein
What two veins drain the tongue and to what vessel?
Deep lingual vein
Dorsal lingual vein
Both drain into the internal jugular vein
What nerve loops under the submandibular duct?
Lingual nerve