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semester 2 > Anatomy > Flashcards

Anatomy Flashcards

1
Q

what type of joint is the TMJ (temporomandibular joint)

A

-synovial (atypical due to linings as there are 2 synovial cavities)

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2
Q

where does the head of mandibular condyle articulate to in TMJ

A

mandibular (glenoid) fossa/articular tubercle (eminence) of the temporal bone

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3
Q

location of TMJ (2)

A
  • posterior to zygomatic arch

- anterior to EAM

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4
Q

what are articular surfaces of typical synovial joints lined with

A

hyaline cartilage

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5
Q

what are non articular surfaces of typical synovial joints lined with

A

synovial membrane (fluid,capsule and ligaments)

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6
Q

features of typical synovial joint (3)

A
  • articular surfaces lined with hyaline cartilage
  • non articular surfaces lined with synovial membrane (fluid, capsule and ligaments)
  • skeletal muscles to move the joint
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7
Q

function of the fluid in synovial membrane lining non articular surfaces of a typical synovial joint (4)

A
  • nourish articular surfaces
  • reduce friction
  • cool the joint
  • remove waste products
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8
Q

function of the capsule in synovial membrane lining non articular surfaces of a typical synovial joint (3)

A
  • encloses joint
  • retain fluid
  • prevents dislocation (articulates to eminence)
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9
Q

function of the ligaments in synovial membrane lining non articular surfaces of a typical synovial joint

A

strengthen the joint

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10
Q

what are the articular surfaces of the TMJ joint lined with

A

fibrous tissue

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11
Q

what is the intra-articular disc of the TMJ made of

A

dense fibrous tissue

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12
Q

what is the head of the mandibular condyle covered in

A

perichondrium

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13
Q

what is the name of the tubercle posterior to the TMJ

A

post-glenoid tubercle

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14
Q

what is the name of the tubercle anterior to the TMJ

A

articular tubercle (eminence)

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15
Q

clinical relevance of EAM and TMJ

A

clicking jaw appears to be very loud due to location of TMJ

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16
Q

attachment site for posterior fibres of buccinator

A

retro molar triangle

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17
Q

mandibular attachment site for sphenomandibular ligament

A

lingula

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18
Q

which ligament attaches to the pterygoid fovea

A

lateral pterygoid

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19
Q

which nerve passes down the mandibular foramen

A

inferior alveolar nerve (branch of CNV3)

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20
Q

bones involved in the temporal part of TMJ (3)

A
  • post-glenoid tubercle
  • glenoid fossa
  • articular eminence
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21
Q

position of mandibular condyle in TMJ (4)

A
  • tilted anteriorly
  • flattened A-P
  • elongated latero-medially
  • long axis points approx 10degrees posteriorly (L-M)
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22
Q

role of lateral temporomandibular ligament

A

prevents posterior dislocation of joint

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23
Q

location of TMJ joint capsule

A

attaches around the circumferences of the articular surfaces

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24
Q

attachment sites of stylomandibular ligament (2)

A
  • styloid process

- medial aspect of angle of mandible

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25
Q

what is the stylomandibular ligament derived from

A

= specialisation of the investing layer of deep cervical fascia surrounding the parotid gland

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26
Q

attachments of the lateral temporomandibular ligament (2)

A
  • zygomatic arch

- posterior lateral aspect of mandible and condyle

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27
Q

what is the sphenomandibular ligament derived from

A

= remains of Meckel’s cartilage

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28
Q

attachments of sphenomandibular ligament (2)

A
  • spine of sphenoid

- lingula of mandible

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29
Q

attachments of ptergomandibular raphe (2)

A
  • pterygoid hamulus of medial pterygoid plate

- retromolar triangle

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30
Q

which muscle originates from the pterygomandibular raphe (2)

A

buccinator

->superior pharyngeal constrictor also joins to raphe

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31
Q

what is the pterygomandibular raphe derived from

A

fibrous material

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32
Q

most important clinical landmarks used in the location of the inferior alveolar nerve block (2)

A
  • coronoid notch
  • pterygomandibular raphe
  • > preferred site of needle insertion lies between these 2 landmarks
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33
Q

location of intra-articular disc (2)

A
  • merges with joint capsule around circumference

- separates joint into 2 spaces (upper and lower joint spaces)

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34
Q

role of intra-articular disc

A

provides stability of joint during movement by improving ‘‘fit” of joint

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35
Q

histology of intra-articular disc

A

dense fibrous connective tissue

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36
Q

innervation of TMJ

A
  • mainly innervated by auriculotemporal nerve

- >very few if any nerve receptors in disc (many in capsule)

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37
Q

zones of intra-articular disc (5)

A
  • anterior extension
  • posterior extension
  • three bands in disc proper (anterior band, intermediate zone, posterior band)
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38
Q

what is the anterior extension of intra-articular disc continuous with (2)

A
  • joint capsule anteriorly

- tendon of lateral pterygoid muscle

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39
Q

what are the layers of bilaminar posterior extension of intra-articular disc made up of (2)

A
  • upper layer = elastic fibres (assist returning of disc to rest position)
  • upper and lower layer = vascular tissue (engorge with blood on opening and empties into pterygoid venous plexus on closing, adapting the shape of disc to space available within the joint capsule)
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40
Q

thickness of bands within disc proper of intra-articular disc (3)

A
  • anterior band = thick/3mm
  • intermediate zone = thin/1mm
  • posterior band = thick/3mm
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41
Q

what are the upper and lower joint spaces of the TMJ lined with

A

their own synovial membrane

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42
Q

mandibular condyle movement during initial jaw opening (3)

A
  • anterior rotation of head of condyle
  • movement occurs in lower joint space
  • disc remains in place
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43
Q

mandibular condyle movement during full jaw opening (to dislocation) (3)

A
  • after initial ant. rotation of condylar head in lower joint space
  • disc translates/slides anteriorly articulating with mandibular fossa and articular eminence
  • movement occurs in upper joint space
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44
Q

location condylar movement during initial joint opening

A

lower joint space

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45
Q

location of condylar movement during full jaw opening (to dislocation)

A

upper joint space

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46
Q

what causes clicking jaw (2)

A
  • posterior band of disc becomes ‘stuck’ during wide opening

- clicks back into place on jaw closing

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47
Q

clinical name of ‘clicking jaw’

A

‘internal derangement with reduction’

  • > internal derangement describes the disc becoming stuck anteriorly
  • > reduction describes the the disc returning to normal position
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48
Q

symptoms of clicking jaw (2)

A

-clicking and pain with chewing

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49
Q

which part of the intra-articular disc is associated with internal derangement

A

stretching of the posterior extension

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50
Q

causes of TMJ dislocation (2)

A
  • occurs when mandibular condyle becomes fixed in the anterior superior aspect of articular eminence
  • spasm of the masseter, temporalis, and internal pterygoid muscles result in trismus, preventing return of condyle to temporal fossa
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51
Q

how many TMJ’s are there

A

2 (only 1 mandible)

->movement of one TMJ will produce a movement in the other joint

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52
Q

movements of the TMJ (5)

A
  • jaw opening
  • jaw closing
  • lateral movements
  • protrusion and retrusion (translation)
  • chewing (complex combination of all above movements)
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53
Q

movement of the TMJ’s during jaw opening

A

-depression (bilateral and symmetrical)

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54
Q

movement of the TMJ’s in jaw closing

A

-elevation (bilateral and symmetrical)

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55
Q

movement of mandibular condyles/ location during jaw opening (initial and subsequent) (2)

A
  • initial anterior rotation (hinge within lower joint space)

- subsequent anterior translation (slide within upper joint space)

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56
Q

mandibular condyle movement and location during jaw closing (initial and subsequent) (2)

A
  • initial posterior translation (upper joint space)

- subsequent posterior rotation (lower joint space)

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57
Q

movement of TMJ’s during lateral movements

A

bilateral and asymmetrical

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58
Q

movement of mandibular condyle at working side of lateral TMJ movement

A

-lateral rotation/movement

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59
Q

movement of mandibular condyle at non working side of lateral TMJ movement

A

-anterior and medial rotation

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60
Q

protrusion

A

mandible is pulled forwards relative to maxilla

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61
Q

retrusion

A

mandible is pulled backwards relative to the maxilla

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62
Q

what is maximal retrusion called

A

the ligamentous position

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63
Q

importance of the infratemporal fossa (2)

A
  • local anaesthesia for restoration/extraction of mandibular teeth (inferior alveolar nerve is located within)
  • extraction of upper third molar teeth (if not done properly, can potentially displace posteriorly into infra-temporal fossa)
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64
Q

location of infra temporal fossa (3)

A
  • below the temporal fossa (depression on lateral aspect of skull containing temporalis muscle, which enters into infra temporal fossa beneath zygomatic arch)
  • posterior to lateral aspect of lateral pterygoid plate of sphenoid bone
  • medial to TMJ
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65
Q

boundaries of infratemporal fossa:

  • posterior
  • superior
  • medial
  • lateral
  • inferior
A
  • posterior = spine of sphenoid and articular tubercle
  • superior = greater wing of sphenoid
  • medial = lateral aspect of lateral pterygoid plate
  • lateral = medial side of mandibular ramus
  • inferior = medial pterygoid muscle, which inserts onto angle of mandible
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66
Q

contents of infratemporal fossa (6)

A
  • inferior part of temporalis
  • lateral pterygoid
  • medial pterygoid
  • pterygoid venous plexus
  • maxillary artery
  • nerves
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67
Q

where does the articular disc of TMJ drain

A

into pterygoid venous plexus, located within the infratemporal fossa

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68
Q

which nerves are located within infratemporal fossa (3)

A
  • CNV3 and its sensory/motor branches (sensory to skin of face, motor to muscles of mastication)
  • otic ganglion which hangs from nerve to medial pterygoid (CNIX/ secretomotor to parotid gland)
  • chorda tympani (branch of facial nerve which joins with the lingual nerve branch of CNV3)
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69
Q

synapse within otic ganglion (parotid gland nerve supply)

A

-preganglionic parasympathetic synapse in otic ganglion -> postganglionic in auriculotemporal nerve goes to supply parotid gland

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70
Q

heads of lateral pterygoid (2)

A
  • superior

- inferior

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71
Q

heads of medial pterygoid (2)

A
  • superficial

- deep

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72
Q

attachments of medial pterygoid muscle (2)

A
  • medial side of angle of mandible

- medial side of lateral pterygoid plate (deep head) and maxillary tuberosity (superficial head)

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73
Q

function of medial pterygoid muscle

A

-jaw closing (along with master and temporalis)

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74
Q

nerve innervation of medial pterygoid muscle

A

CNV motor root

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75
Q

attachments of lateral pterygoid muscle (2)

A
  • condyle of the mandible and the intra-articular disc and capsule of the TMJ
  • lateral side of the lateral pterygoid plate (inferior head) and infratemporal surface of the greater wing of sphenoid (superior head)
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76
Q

function of lateral pterygoid muscle

A

jaw opening

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77
Q

nerve innervation of lateral pterygoid muscle

A

CNV motor root

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78
Q

what is the pterygoid venous plexus

A

-plexus of veins around the lateral pterygoid muscle

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79
Q

connections of pterygoid venous plexus (2)

A
  • facial vein via deep facial vein (s)

- cavernous sinus

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80
Q

where does the pterygoid venous plexus drain into

A

maxillary vein

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81
Q

clinical significance of pterygoid venous plexus (3)

A
  • can cause troublesome bleeding in le fort fractures (le fort I)
  • displaced upper 8’s
  • infections of face can drain to brain via cavernous sinus
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82
Q

what two veins combine to form the retromandibular vein

A
  • superficial temporal vein

- maxillary vein (pterygoid venous plexus drains into maxillary vein)

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83
Q

what does the retromandibular vein drain into

A

external jugular vein -> subclavian vein

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84
Q

arterial blood supply to infratemporal fossa

A

maxillary artery (branch of external carotid)

  • > passes through parotid gland then between the neck of mandible and sphenomandibular ligament to enter infratemporal fossa
  • can either be situated superficial to pterygoid or within
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85
Q

branches of maxillary artery (3)

A
  • part 1 = before lateral pterygoid
  • part 2 = in relation to lateral pterygoid
  • part 3 = after lateral pterygoid
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86
Q

branches of part 1 of maxillary artery (4)

A
  • 2 branches to ear
  • many branches to TMJ
  • middle meningeal
  • inferior alveolar (to lower teeth)
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87
Q

branches of part 2 of maxillary artery (2)

A
  • branches to muscles of mastication (at least 1 branch to each of the four muscles, 2x deep temporal arteries)
  • buccal artery (cheek)
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88
Q

branches of part 3 of maxillary artery (4)

A
  • sphenopalatine (nose/palate)
  • palatine (palate)
  • superior alveolar (upper teeth)
  • infraorbital (upper teeth and skin of mid face)
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89
Q

what foramen does the middle meningeal artery (branch of 1st part of maxillary) pass through

A

foramen spinosum

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90
Q

anterior division of CNV3 nerve supply/branches (2)

A
  • many motor branches to masticatory muscles (masseter, temporalis, medial pterygoid, lateral pterygoid)
  • 1 sensory branch = long buccal nerve (supplies skin and mucosa of cheek)
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91
Q

where does CNV3 pass through

A

foramen ovale

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92
Q

branches of posterior division of CNV3 (3)

A
  • auriculotemporal nerve (sensory to skin in temple region and TMJ, also carries postganglionic parasympathetic fibres to parotid gland)
  • inferior alveolar nerve
  • lingual nerve
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93
Q

route of inferior alveolar nerve (long explanation) (5)

A
  • CNV3 and motor root of CNV join at and pass through foramen ovale in greater wing of sphenoid
  • auriculotemporal and lingual nerve branch
  • inferior alveolar nerve branches away from the nerve to mylohyoid and ABD in infratemporal fossa, then enters mandibular foramen
  • within mandibular canal, inferior alveolar nerve branches into dental branches, incisive branch and mental nerve which exits mental foramen
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94
Q

branches of inferior alveolar nerve (3)

A
  • dental branches
  • incisive branch
  • mental nerve
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95
Q

what do the dental branches of inferior alveolar nerve supply

A

sensory innervation to premolars and molars

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96
Q

what does the incisive branch of the inferior alveolar nerve supply

A

sensory innervation to incisors and canine

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97
Q

nerve supply of mental nerve (3)

A
  • sensory to skin and mucosa of lower lip
  • chin and labial mucosa
  • gingiva of lower 3-3
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98
Q

what is chorda tympani a branch of

A

CNVII (facial nerve)

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99
Q

what connects CNVII to the lingual nerve

A

chorda tympani

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100
Q

what foramen does CNVII pass through

A

stylomastoid

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101
Q

breakdown of vertebral column (5)

A
  • 7 cervical
  • 12 thoracic
  • 5 lumbar
  • 5 sacral (fused to form 1 sacrum)
  • 4 coccygeal (fused to form 1 coccyx)
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102
Q

why do the vertebrae become larger from superior to inferior then smaller again

A
  • become larger as they bear more weight

- become smaller again once weight has been transferred to hip bones

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103
Q

curvatures of vertebral column (4)

A
  • cervical secondary curvature
  • thoracic primary curvature
  • lumbar secondary curvature
  • sacral primary curvature
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104
Q

scoliosis

A

abnormal spinal curvature to the side

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105
Q

what is primary kyphosis

A

when thoracic primary curvature sticks out too much

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106
Q

what is secondary lordosis

A

when the lumbar secondary curvature curves in too much

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107
Q

functions of the spine (3)

A
  • support weight of head and trunk in upright position
  • protect spinal cord and spinal nerves
  • allow movements of the head on neck and of the trunk via muscle and joint attachments
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108
Q

location of spinal cord

A

within the vertebral canal formed by the joining of vertebral foraminae

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109
Q

location of intervertebral foramen

A

form between adjacent vertebrae

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110
Q

what passes through the intervertebral foramen

A

spinal nerves

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111
Q

location of vertebral facet joint

A

between articular processes of 2 adjacent vertebrae

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112
Q

clinical relevance of vertebral facet joint

A
  • affected by arthritis

- pain signals are transmitted via posterior rami

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113
Q

location of intervertebral discs

A
  • strong attachment between the bodies of adjacent vertebrae

- between all vertebrae except C1-C2 and the fused sacrum/coccyx

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114
Q

clinical relevance of intervertebral discs

A
  • can herniate

- pain signals transmitted via posterior rami

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115
Q

what type of cartilage are the intervertebral discs

A

secondary

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116
Q

length of spine made up by intervertebral discs

A

20-25%

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117
Q

breakdown of intervertebral disc structure (2)

A
  • outer fibrous ring = annulus fibrosus (fibrocartilage which provides strong bond)
  • inner soft pulp = nucleus pulposus (up to 90% water in babies, provides flexibility and protection)
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118
Q

herniated (slipped disc) (2)

A
  • protrusion of nucleus pulposus through annulus fibrosis (usually posterolaterally as annulus fibrosis is thinnest here)
  • this compresses the spinal nerve
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119
Q

spinal nerves most commonly affected by herniated (slipped) disc in the cervical region (2)

A

C6 and C7 (supply the upper arms)

-> important they supply the brachial plexus

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120
Q

ligaments of the vertebral column (5)

A
  • ligamentum flavus
  • posterior longitudinal ligament
  • anterior longitudinal ligament
  • supraspinous ligament
  • interspinous ligament
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121
Q

symptoms of slipped disc in cervical region of C6 and 7

A

-patient complains of ‘pins and needles’ or pain in arm if you ask them to turn head during treatment

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122
Q

function of vertebral column ligaments

A

stabilise joints and discs during movement

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123
Q

attachments of ligament flavum (of vertebral column)

A

connects adjacent laminae

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124
Q

attachments of posterior longitudinal ligament (of vertebral column)

A

attaches to posterior aspects of all vertebral bodies and intervertebral discs

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125
Q

attachments of anterior longitudinal ligament (of vertebral column)

A

attaches to anterior aspects of all vertebral bodies and intervertebral discs

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126
Q

at which vertebrae do the posterior longitudinal ligaments begin

A

C2 as C1 has no body

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127
Q

function of posterior longitudinal ligament (of the vertebral column)

A

prevents over leaning

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128
Q

function of anterior longitudinal ligament (of the vertebral column)

A

prevents over extension (bending too far back)

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129
Q

attachments of supraspinous ligament

A

connects tips of spinous processes

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130
Q

attachments of interspinous ligament

A

connects superior and inferior surfaces of adjacent spinous processes

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131
Q

transverse foramen

A

within each transverse process of all cervical vertebrae

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132
Q

why is C1/atlas an atypical vertebrae

A
  • does not have body/spinous process

- has posterior arch and anterior arch instead

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133
Q

why is C2/axis different to other vertebrae

A

has an odontoid process (C1s body) which projects superiorly from body

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134
Q

vertebrae prominens

A

= C7, which is the first palpable spinous process in 70% of people

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135
Q

what type of joint are atlanto-occipital joints

A

synovial

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136
Q

location of atlanto-occipital joints

A

between occipital condyles and the superior articular facets of the atlas

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137
Q

movements of atlanto-occipital joints

A
  • main movements = flexion and extension of neck (nodding or saying yes)
  • also permit some rotary movement (contributing to saying no)
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138
Q

location of atlanto-axial joints (3)

A
  • 3 synovial joints
  • > 2 between the inferior articular facets of the atlas and the superior articular facets of the axis
  • > 1 between the anterior arch of the atlas and the odontoid process of the axis
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139
Q

craniovertebral ligaments (3)

A
  • nuchal ligament (from external occipital protuberance attaching to all spinous processes)
  • anterior-occipital membrane
  • tectorial membrane
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140
Q

what does anterior longitudinal ligament become at the level of C2

A

anterior atlano-axial membrane which becomes anterior atlanto-occipitoal membrane above C1

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141
Q

what does the posterior longitudinal ligament become above the odontoid process of C2

A

tectorial membrane

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142
Q

what ligaments make up the ‘cruciate ligament’ (3)

A
  • superior longitudinal band
  • transverse ligament of atlas
  • inferior longitudinal band
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143
Q

‘check’ ligaments of the neck

A

alar ligaments

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144
Q

check ligament for TMJ

A

sphenomandibular ligament

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145
Q

important landmarks when performing inferior alveolar nerve block

A
  • pterygomandibular raphe

- coronoid notch

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146
Q

possible causes of difficulty moving neck during dental treatment

A
  • arthritis of facet joints (osteoarthritis, most common type = wear and tear)
  • herniated (slipped) disc in cervical region (pain may be felt locally, or referred into the upper limb)
  • rheumatoid arthritis weakening the capsule and ligaments of crania-vertebral joints
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147
Q

what is subluxation

A
  • partial dislocation
  • result of rheumatoid arthritis weakening the capsule and ligaments of crania-vertebral joints
  • spinal cord theoretically at risk
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148
Q

location of pharynx

A

space that connects the nose and mouth above to the larynx and oesophagus below

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149
Q

what is the pharynx involved in (7)

A
  • breathing
  • speech
  • coughing
  • sneezing
  • vomiting
  • swallowing
  • gagging
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150
Q

protective role of pharynx

A
  • protects agains aspiration:
  • > inhalation of solids/liquids into the lungs
  • > fragments of teeth, amalgam material, dental tools, orthodontic appliances etc
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151
Q

position of respiratory and alimentary tract in relation to each other

A
  • respiratory tract, trachea = anteriorly
  • alimentary canal, oesophagus = middle
  • retropharyngeal space = posteriorly
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152
Q

divisions of the pharynx (3)

A
  • nasopharynx
  • oropharynx
  • laryngopharynx
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153
Q

components of the respiratory tract (4)

A
  • nasal cavity
  • oral cavity
  • larynx
  • trachea
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154
Q

components of the alimentary tract (2)

A
  • oral cavity

- oesophagus

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155
Q

location of retropharyngeal space (2)

A
  • anterior to alar fascia

- posterior to buccopharyngeal fascia

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156
Q

circular muscles of the pharynx (3)

A
  • superior constrictor
  • middle constrictor
  • inferior constrictor
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157
Q

nerve supply to pharyngeal constrictors

A

CNX (pharyngeal plexus)

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158
Q

are the pharyngeal constrictors voluntary muscles

A

yes but they cannot control the sequential sequence of which they contract

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159
Q

attachments of superior pharyngeal constrictor (3)

A
  • pterygoid hamulus
  • pterygomandibular raphe
  • mylohyoid line
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160
Q

attachments of middle pharyngeal constrictor

A

greater horn of hyoid

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161
Q

attachments of the inferior pharyngeal constrictor (2)

A
  • thyroid cartilage (oblique line)

- cricoid cartilage

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162
Q

gateway to the mouth

A

gap between pharyngeal constrictors

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163
Q

contents of gaps between pharyngeal constrictors (4)

A
  • gateway to mouth
  • CN IX
  • lingual artery
  • stylopharyngeus muscle
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164
Q

location of stylopharyngeus muscle (2)

A
  • attaches to styloid process
  • passes through ‘gateway to the mouth’/gap between superior and middle constrictors along with the glossopharyngeal nerve
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165
Q

longitudinal muscles of the pharynx (3)

A
  • stylopharyngeus
  • palatopharyngeus
  • salpingopharyngeus
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166
Q

attachments of longitudinal muscles of pharynx (3)

A
  • stylopharyngeus (styloid process)
  • palatopharyngeus (palate)
  • salpingopharyngeus (cartilage of pharyngotympanic tube)
  • > all inser onto posterior border of thyroid cartilage
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167
Q

function of longitudinal muscles of the pharynx

A

elevate the pharynx and larynx

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168
Q

nerve innervation of the longitudinal muscles of the pharynx (2)

A
  • CNX to palatopharyngeus and salpingopharyngeus

- CN IX to stylopharyngeus

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169
Q

vallecula

A

depression anterior to epiglottis

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170
Q

opening into larynx

A

laryngeal inlet

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171
Q

choana

A

pair of posterior apertures of the nasal cavity that open into the nasopharynx

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172
Q

pharyngeal plexus

A
  • > nerve fibres from CNIX and CNX, sympathetic axons and parasympathetic axons
  • motor mainly from CN X
  • sensory mainly CN IX
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173
Q

nerve supply of muscles of pharynx (3)

A
  • motor supply
  • all supplied by CN X via pharyngeal plexus
  • except stylopharyngess (CN IX)
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174
Q

nerve supply to mucosa of pharynx (3)

A
  • mainly supplied by CNIX
  • CN V2 in parts of nasopharynx
  • CNX in parts of laryngopharynx
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175
Q

sensory nerve supply to the mucosa of the pharynx (nasopharynx, oropharynx, laryngopharynx)

A
  • nasopharynx = CNV2 (just anterior and superior to auditory tube) and CN IX
  • oropharynx = CN IX (includes tonsillar fossa and posterior tongue)
  • laryngopharynx = CN IX (just superior to epiglottis) and CNX
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176
Q

function of gag reflex

A

-protective, tries to close off oropharynx

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177
Q

areas that stimulate the sensory nerves of CN IX, resulting in gag reflex (3)

A
  • posterior 1/3 of tongue
  • tonsils
  • walls of oropharynx (also nasopharynx and auditory tube/middle ear)
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178
Q

muscles involved in gag reflex (3)

A
  • pharyngeal constrictors (CN X)
  • longitudinal muscles of the pharynx (CN IX and X)
  • tongue and soft palate
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179
Q

clinical relevance of gag reflex

A
  • patients with sensitive throats

- recurrent gag reflex can make treatment very difficult

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180
Q

how is gag reflex resolved in dental patients (2)

A
  • careful technique

- relaxed patient

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181
Q

deglutition

A

swallowing

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182
Q

stage 1 of swallowing

A
  • food bolus squeezed to back of mouth

- tongue against palate

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183
Q

stage 2 of swallowing

A
  • nasopharynx closed off
  • larynx elevated
  • pharynx enlarged to receive bolus
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184
Q

stage 3 of swallowing

A
  • pharyngeal constrictors contract sequentially

- epiglottis deflects bolus

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185
Q

stage 4 of swallowing

A

bolus moves into oesophagus

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186
Q

what type of cartilage is nasal cartilage

A

hyaline

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187
Q

why should you not use adrenaline-containing local anaesthetics near the nasal cartilages

A
  • cartilage is avascular (relies on nutrient diffusion from skin)
  • adrenaline = vasoconstrictor therefore prevents nutrient diffusion
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188
Q

indentation of upper lip =

A

filtrum

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189
Q

bony part of nasal septum (2)

A
  • perpendicular plate of ethmoid bone

- vomer

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190
Q

roof of nasal cavity (3)

A
  • cribriform plate
  • crista galli
  • anterior cranial fossa
  • > cribriform plate of ethmoid bone posteriorly and nasal bones anteriorly
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191
Q

lateral wall of nasal cavity (4)

A
  • superior and middle conchae
  • ethmoidal air cells
  • orbital plate of ethmoid
  • inferior conchae
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192
Q

clinical relevance of ethmoid bone and le fort fractures

A
  • le fort II and III can disrupt the cribriform plate of the ethmoid bone
  • this can result in a danger of infection spreading from the nasal cavity and paranasal sinuses into the anterior cranial fossa
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193
Q

why is a septal haematoma incised and drained

A

to prevent avascular necrosis of septal hyaline cartilage which depends on diffusion of nutrients from its attached nasal mucosa

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194
Q

mucosa of nasal vestibule (vestibule = anterior part of nasal cavity)

A

keratinised stratified squamous epithelium

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195
Q

mucosa of middle and inferior nasal concha

A

respiratory epithelium (cilia for protection and moisture, mucous secreting goblet cells)

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196
Q

mucosa of superior nasal concha

A

olfactory mucosa (smells won’t be detected until they have reached this point, has to be in (aq) to be detected by cells)

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197
Q

location of olfactory receptor cells (2)

A

=1st neurones in chain

  • within olfactory mucosa (in olfactory area on both the lateral and the septum)
  • pass through cribriform plate of ethmoid, to meet the olfactory bulb (contains ganglion/cell bodies of 2nd neurones)
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198
Q

somatic sensory nerve supply to nasal cavities (2)

A
  • CNV1 anterosuperiorly (via anterior/posterior ethmoidal branches of nasociliary nerve)
  • CNV2 posteroinferiorly (via nasopalatine and greater palatine nerves)
  • > dividing line = between anterior nasal spine and sphenoethmoidal recess
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199
Q

blood supply to nasal cavity

A

via:

  • external carotid artery (facial and maxillary arteries)
  • internal carotid artery (ophthalmic)
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200
Q

branches of ophthalmic artery which supply the nasal cavity (2) (ophthalmic = branch of int. carotid)

A

-anterior and posterior ethmoidal arteries

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201
Q

branches of the maxillary artery which supply the nasal cavities (2) (maxillary = branch of ext. carotid)

A
  • sphenopalatine artery

- greater palatine artery

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202
Q

branches of facial artery which supply the nasal cavity (2) (facial = branch of ext. carotid)

A

-lateral nasal branch of facial or septal branch of superior labial artery

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203
Q

clinical relevance of kiesselbach’s (little’s) area

A

= arterial anastomosis on nasal septum (anteroinferiorly)

-common site of epistaxis (nosebleeds)

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204
Q

arterial branches that contribute to kiesselbach’s (little’s) area (4)

A
  • labial (septal)
  • ethmoidal
  • greater palatine
  • sphenopalatine
  • > L.E.G.S
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205
Q

functions of the nasal conchae (4)

A
  • turbinate bones
  • > convey respiratory gases between the atmosphere and nasopharynx
  • > warm and humidify air (due to blood supply and mucous)
  • > remove particulate matter/bacteria etc (turbulent air flow, mucous, cilia)
  • > special sense of smell (olfactory area)
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206
Q

meatuses (4)

A

= spaces under each nasal concha

  • > sphenoethmoidal (recess)
  • > superior meatus
  • > middle meatus
  • > inferior meatus
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207
Q

how do you know if a nasogastric tube has been inserted correctly

A

-on X ray should be in stomach via oesophagus

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208
Q

what separates the right and left nasal cavities (2)

A
  • nasal septum posteriorly

- septal cartilage anteriorly

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209
Q

floor of nasal cavity (2)

A
  • hard palate formed from:
  • > right and left maxillae anteriorly
  • > palatine bones posteriorly
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210
Q

which type of epithelium lines the nasal cavities

A

-mainly respiratory epithelium (pseudo stratified columnar with cilia and goblet/mucous secreting cells)

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211
Q

drainage of mucous of paranasal sinuses

A

-via ostia/holes in the recesses and meatuses of the lateral walls of the nasal cavities

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212
Q

what is contained within the paranasal sinuses

A

air

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213
Q

name the paranasal sinuses (4 types, 7/8 in total)

A
  • 2 frontal sinuses (separated by bony septum)
  • 2 maxillary sinuses (antra)
  • 2 ethmoidal air cells
  • 1 or 2 sphenoidal sinuses
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214
Q

mucosa of paranasal sinuses

A

mucous-secreting respiratory mucosa

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215
Q

where does the frontal sinus drain into

A

middle meatus

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216
Q

where do the ethmoidal air cells drain into (2)

A

superior and middle meatuses

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217
Q

where does the maxillary sinus drain into

A

middle meatus

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218
Q

what drains into middle meatus (3)

A
  • frontal sinus
  • ethmoidal cells
  • maxillary sinus
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219
Q

where does the sphenoidal sinus drain into

A

sphenoethmoidal recess

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220
Q

lacrimal fluid drainage

A

inferior meatus of nasal cavity via nasolacrimal duct (continuous drainage)

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221
Q

what is sinusitis

A

inflammation of the mucosa of 1 or more of the paranasal sinuses

222
Q

degree of sinusitis (3)

A
  • acute
  • subchronic
  • chronic
223
Q

causes of sinusitis (6)

A
  • infection
  • allergy
  • autoimmune issues
  • > cold weather/smoking can interfere with cilia and their ability to waft mucous toward ostia
  • > viral URTI causes swelling of mucosa, reducing diameter of ostia
  • > sinuses can become filled with infected mucous
224
Q

symptoms of sinusitis (2)

A
  • painful (sensation provided by CNV1 and V2)
  • pain may be referred to the teeth (toothache of upper or lower tooth due to common sensory nerve supply from CNV of the maxilla/mandible,antral mucosa and all the teeth)
225
Q

why is the maxillary sinus likely to become inflamed (maxillary sinusitis) (2)

A
  • maxillary sinus ostia is located superiorly in the medial wall of the sinus compared to the floor
  • maxillary sinus mucous has to drain against gravity
226
Q

clinical relevance of maxillary sinus (2)

A
  • extraction of tooth may result in pro-antral fistula (communication between the oral cavity and the antrum via the tooth socket in alveolar bone, persistent fistula is surgically closed)
  • roots of upper teeth can spread infection of dental abscess into the antrum (e.g.. can cause sinusitis/sinus infection)
227
Q

pterion

A

H shaped suture/ fibrous joint on lateral aspect of skull (thinnest part therefore easily fractured)

228
Q

parts of temporal bone (2)

A
  • squamous

- petrous (like a rock, hard, tough, featured inferior part)

229
Q

clinical significance of pterion

A

middle meningeal artery runs directly behind, fracture to pterion can cause tear

230
Q

features of petrous part of temporal bone (6)

A
  • zygomatic process
  • mandibular fossa
  • styloid process
  • stylomastoid foramen
  • mastoid process
  • extracranial opening into carotid canal
231
Q

bones of anterior cranial fossa (3)

A
  • frontal
  • ethmoid
  • part of sphenoid (ends at lesser wings of sphenoid)
232
Q

bones of middle cranial fossa (2)

A
  • sphenoid (greater wings)

- temporal

233
Q

clinical significance of temporal bones

A

contain:

  • special sensory organs of hearing and balance
  • facial nerve (CNVII)
  • vestibulocochlear nerve (CN VIII)
234
Q

what nerve (s) passes through cribriform plate (anterior cranial fossa)

A

CN I (special sensory)

235
Q

what nerve (s) pass through optic canal (middle cranial fossa)

A

CN II (special sensory)

236
Q

what nerve (s) passes through superior orbital fissure (middle cranial fossa) (4)

A
  • CN III (mixed)
  • CN IV (motor)
  • CN VI (motor)
  • CN V1 (sensory)
237
Q

what nerve (s) passes through foramen rotundum (middle cranial fossa)

A

-CN V2 (sensory)

238
Q

what nerve (s) passes through foramen ovale (middle cranial fossa)

A

-CN V3 (mixed)

239
Q

what passes through carotid canal (middle cranial fossa)

A

carotid arteries

240
Q

what nerve (s) passes through internal acoustic meatus (posterior cranial fossa) (2)

A
  • CN VII (mixed)

- CN VIII (special sensory)

241
Q

what nerve (s) passes through jugular foramen (posterior cranial fossa) (3)

A
  • CN IX (mixed)
  • CN X (mixed)
  • CN XI (motor)
242
Q

what nerve (s) passes through hypoglossal canal (post. cranial fossa)

A

CN XII (motor)

243
Q

clinical signif. of pathology in the IAM (eg. acoustic neuroma)

A

can damage CNs VII and VIII

244
Q

function of external ear

A

-collects and conveys sound waves to tympanic membrane

245
Q

divisions of the ear and their boundaries (3)

A
  • external (auricle to tympanic membrane/ear drum via the external acoustic meatus)
  • middle (tympanic membrane to oval window, also eustachian tube)
  • internal (oval window to internal acoustic meatus)
246
Q

function of middle ear

A

amplifies and conducts sound waves to the internal ear

247
Q

function of internal ear

A

converts special sensory information on sound/balance into fluid waves then into APs and conducts the APs towards the brainstem

248
Q

what is the skeleton of external ear made up of, and why is this important clinically (2)

A
  • elastic cartilage
  • temporal bone
  • > elastic cartilage is avascular and relies on diffusion from skin, do not use adrenaline containing local anaesthetics on the external ear
249
Q

production of earwax

A

-ear canal/EAM is lined with skin and contains ceruminous glands that produce wax (lubricates ear/tympanic membrane, protects ear, antibacterial/kills off infection)

250
Q

general sensory supply to the skin of the external ear (4)

A
  • CN2,3 supply helix and earlobe
  • CN VII supply area just posterior to triages
  • CN V3 supplies superior parts of EAM and most of tympanic membrane
  • CN X supplies inferior parts of EAM and tympanic membrane
251
Q

lymphatic drainage of auricle/ear (6)

A
  • lateral surface of superior half (parotid lymph nodes)
  • cranial surface of superior half (mastoid lymph nodes, and deep cervical)
  • rest of auricle, including lobe (superficial cervical lymph nodes)
  • > all eventually drain into:
  • deep cervical lymph nodes (in carotid sheath)
  • thoracic duct or right lymphatic duct
  • venous angle
252
Q

parts of the tympanic membrane (3)

A
  • pars flaccida (thin part of tympanic membrane, superiorly)
  • umbo (most inwardly depressed part of the tympanic membrane)
  • pars tensa (thick part of tympanic membrane, posteroinferiorly)
253
Q

otoscopic exam technique in adults and children (examination of the EAM and tympanic membrane)

A
  • in child gently pull auricle posteroinferiorly (EAM s straight and short and speculum may damage tympanic membrane)
  • in adult gently pull the auricle posterosuperiorly (the adult EAM is curved)
254
Q

direction of cone of light within ear

A

normally anteroinferiorly

255
Q

bones of posterior cranial fossa (2)

A
  • temporal

- occipital

256
Q

function of eustachian tube

A

-connects the tympanic cavity/middle ear cavity to the lateral wall of the nasopharynx

257
Q

general sensory nerve supply to tympanic membrane (2)

A
  • external surface = mostly CN V3 (auriculotemporal branch)

- internal surface = CNIX

258
Q

what does the glossopharyngeal nerve (CNIX) provide sensory innervation to (5)

A
  • middle ear cavity
  • eustachian tube
  • nasopharynx
  • oropharynx
  • tonsils
259
Q

other names for eustachian tube (2)

A
  • auditory tube

- pharyngotympanic tube

260
Q

clinical significance of eustachian tube (2)

A
  • bacteria/viruses can spread between middle ear cavity and nasopharynx, ie. from pharynx/tonsils causing pain and hearing loss
  • common sensory nerve supply of CNIX of naso/oropharynx and laryngopharynx can cause tonsillitis/pharyngitis to mimic earache (common e.g.. of referred pain)
261
Q

adenoid

A

pharyngeal tonsil

262
Q

the ‘tonsil’

A

palatine tonsil

263
Q

auditory ossicles (3)

A
  • > 3 bones of the middle ear that articulate via synovial joints
  • malleus (mallet) (handle of malleus creates umbo)
  • incus (anvil)
  • stapes (stirrup) (base of stapes fits into oval window)
264
Q

epitympanic recess

A

superior to the tympanic membrane

265
Q

umbo

A

-the handle of the malleus which is adherent to the internal aspect of the tympanic membrane, creates the umbo

266
Q

location of tympanic cavity ‘proper’

A

posterior to tympanic membrane

267
Q

cause of mastoiditis of mastoid process

A

spread of infection from middle ear cavity

268
Q

aditus (within middle ear cavity)

A

doorway into the mastoid antrum from the epitympanic recess

269
Q

what is the promontory (middle ear cavity)

A

bony swelling on the medial wall formed by the cochlea of the internal ear

270
Q

nerve axons within facial nerve (4)

A
  • special sensory
  • sensory
  • motor
  • parasympathetic
271
Q

course of facial nerve (3)

A
  • connection to CNS (brainstem at junction between pons and medulla)
  • intracranial part of course (directly into IAM in posterior cranial fossa -> travels through facial canal in petrous temporal bone and chorda tympani branches off)
  • bass of skull foramen part of course (IAM -> stylomastoid foramen)
272
Q

chorda tympani nerve supply (2)

A
  • branch of CNVII (within middle ear cavity)
  • > supplies taste buds of the anterior 2/3rds of tongue
  • > parasympathetic supply to the submandibular and sublingual salivary glands for salivation
273
Q

function and nerve supply of stapedius

A
  • thinnest skeletal muscle in the body supplied by CNVII

- reduces stapes movement to protect the internal ear from excessive noise

274
Q

facial canal

A

connects IAM to stylomastoid foramen for course of facial nerve to travel through petrous temporal bone

275
Q

tensor tympani

A

dampens the noise produced by chewing (has the same nerve supply as the muscles of mastication)

276
Q

extra cranial course of facial nerve

A
  • exits stylomastoid foramen to supply muscles of facial expression
  • chorda tympani joins with CNV3 to supply sublingual and submandibular salivary glands
277
Q

clinical test of muscles of facial expression (4)

A
  • frown
  • close eyes tightly
  • smile
  • puff out cheeks
278
Q

clinical sign of malnutrition

A

loss of buccal fat pat in illness giving appearance of ‘sunken’ cheeks

279
Q

what part of temporal bone is the internal ear within

A

petrous

280
Q

2 parts of vestibulocochlear nerve (2)

A
  • cochlear nerve (for hearing)

- vestibular nerve (for balance)

281
Q

location of dense otic capsule of internal ear

A

sits in temporal bone (otic capsule bone is denser than the surrounding temporal bone)

282
Q

internal ear labyrinths

A
  • otic capsule within temporal bone contains bony labyrinth (fluid/perilymph filled, spaces inside the otic capsule)
  • within the perilymph of the bony labyrinth = membranous labyrinth made up of communicating sacs and ducts containing endolymph fluid
  • > perilymph is like ECF
  • > endolymph is like ICF
  • > membranous labyrinth floats in perilymph within the bony labyrinth
283
Q

shape of bony labyrinth (2)

A
  • cochlea made up of 1st turn, 2nd turn and cupula (apex of spiral)
  • anterior/lateral and posterior semicircular canal
284
Q

what are the cochlear and semicircular ducts filled with

A

endolymph

285
Q

location of cochlear and vestibular nerve axons (2)

A
  • cochlear duct = cochlear nerve axons

- semicircular duct = vestibular nerve axons

286
Q

steps involved in internal ear sound transmission (7)

A
  • sound waves make tympanic membrane vibrate
  • vibrations are transmitted through ossicles
  • base of stapes vibrates in oval window
  • vibration of stapes creates pressure waves in perilymph
  • hair cells in the cochlea are moved, neurotransmitter is released, APs stimulated and conveyed to brain by cochlear nerve
  • pressure waves descend and become vibrations again
  • pressure waves are dampened at the round window
287
Q

symptoms associated with pathology at the IAM (involving CNVII and CNVIII)

A
  • CN VII:
  • > ipsilateral loss of facial expression
  • > ipsilateral loss of taste
  • > dry mouth (reduced ipsilateral salivation)
  • > reduced general sensation in the auricle (immediately posterior to the triages)
  • CN VIII:
  • > ipsilateral loss of hearing (cochlear nerve)
  • > ipsilateral loss of balance (vestibular nerve)
288
Q

what is the lymphatic system made up of (4)

A
  • organs (bone marrow, spleen and thymus)
  • lymphatic vessels (e.g. thoracic duct)
  • lymph nodes
  • mucosa-associated lymphoid tissue (MALT e.g. tonsils)
289
Q

function of lymphatic system (3)

A
  • removes excess fluid (interstitial/tissue) from the tissues of the body and returns it as lymph to the venous system
  • carries fat from the GI tract
  • produces immune cells (lymphocyte, plasma cells and monocytes) in the defence against infection and cancer
290
Q

thoracic duct

A
  • major lymphatic vessel in the body

- returns lymph to large veins in the neck

291
Q

lymph

A

excess tissue fluid once it has been taken up by the lymphatic vessels

292
Q

daily volume of cardiac output

A

approx 8000L

293
Q

daily volume of plasma ultra-filtered

A

approx 20L

294
Q

daily volume of tissue fluid reabsorbed

A

approx 16-18L

295
Q

daily volume of lymph produced and returned to blood at venous angles

A

approx 2-4L

296
Q

daily volume of lymph produced in the head and neck

A

approx 400ml

297
Q

elephantiasis

A
  • accumulation of lymphatic tissue and fluid causing significant swelling, particularly in lower limb
  • due to insignificant drainage of lymphatic fluid from tissue fluid
298
Q

location of lymph nodes

A

along the pathways of the lymphatic vessels travelling from the anatomical structures of the head and neck back to the thoracic duct/right lymphatic duct

299
Q

function of lymph nodes

A
  • filter lymph

- lymphocytes and macrophages within the lymph nodes screen lymph for infectious agents/cancer cells

300
Q

state of lymph node if fighting an infection in the lymph

A
  • germinal centres produces

- lymph node enlarges and becomes painful due to stretching of capsule

301
Q

metastasis

A

growing of secondary tumour in lymph node following cancel cells becoming stuck and escaping the notice of the immune surveillance system

302
Q

regional lymph nodes

A

group of lymph nodes that first receive lymph from any given structure/area

303
Q

2 groups of lymph nodes found in the head and neck (2)

A
  • superficial ring

- deep cervical nodes

304
Q

superficial ring of regional lymph nodes (drain scalp, face and superficial neck region) (8)

A
  • parotid nodes
  • buccal nodes
  • submental nodes
  • submandibular nodes
  • occipital nodes
  • mastoid nodes
  • superficial cervical nodes
  • external jugular vein
305
Q

deep cervical lymph nodes (5)

A
  • > drain deep structures of head and neck/ final common pathway from head and neck
  • retropharyngeal nodes
  • submental nodes
  • submandibular nodes
  • deep cervical nodes
  • internal jugular vein
306
Q

location of left venous angle

A

between IJV and SCV

307
Q

tonsils of the head and neck (4)

A
  • palatine tonsil/’tonsil’ (in oropharynx)
  • ‘palate associated lymphoid tissue’
  • pharyngeal tonsil/’adenoid’ (superior aspect of nasopharynx,superior to auditory tube)
  • tubal tonsils (in nasopharynx, posterior to auditory tube)
308
Q

waldeyer’s (defensive) ring of lymphoid tissue

A
  • > first line of defence against exogenous aggressors
  • made up of:
  • > pharyngeal tonsil (adenoid)
  • > tubal tonsils
  • > ‘palate associated lymphoid tissue’
  • > palatine tonsil (‘tonsil’)
  • > lingual tonsil
309
Q

which cells do the germinal centres of the tonsil generate

A

B cells

310
Q

where does the lymph from the palatine tonsil drain to

A

-specific deep cervical lymph node = jugulodigastric node

311
Q

jugulo-digastric node

A
  • regional lymph node for the palatine tonsil

- commonly enlarged with tonsillitis

312
Q

lymphatic drainage of teeth/gingivae (3)

A
  • lower anterior teeth, alveolar bone, gingiva, middle of lower lip and chin, tip of tongue drain to submental nodes first before submandibular nodes
  • all other teeth, alveolar bone, and gingiva reminder of lips and anterior palate drain to the submandibular lymph nodes first
  • > submandibular lymph nodes then drain to the deep cervical nodes
313
Q

effect of dental abscesses on lymph nodes

A

may cause enlarged & painful submental and submandibular lymph nodes

314
Q

lymphatic drainage of tongue

A
  • posterior 1/3rd:
  • > drains bilaterally to superior deep cervical nodes
  • anterior 2/3rds:
  • > middle drains bilaterally to inferior deep cervical nodes
  • > sides drain unilaterally to submandibular nodes
  • > tip drains bilaterally to submental nodes
315
Q

state of lymph nodes due to infection, e.g.. dental abscess

A
  • swollen
  • painful
  • soft
  • smooth
  • not fixed (stuck to) adjacent structures
  • improve rapidly with antibiotics etc
316
Q

state of lymph nodes due to cancer e.g.. of tongue or gingiva

A
  • swollen
  • not painful
  • hard
  • irregular
  • fixed
  • do not improve with antibiotics
317
Q

clinical examination of lymph nodes during full examination of dental patient

A

-should include assessment of the submental, submandibular and deep cervical lymph nodes

318
Q

symptoms of hayfever (3)

A
  • sneezing and stuffy runny nose (due to activation of hay fever ganglion causing nasal glands to secrete mucous
  • watery eyes (activation of hay fever ganglion causes lacrimal gland to produce tears)
  • acute inflammation of nasal mucosa (dilated blood vessels)
319
Q

what causes hayfever

A

pollen allergy

320
Q

what is ‘allergic rhinitis’

A

hayfever

321
Q

location of the pterygopalatine fossa (6)

A
  • anterosuperiorly to foramen ovale within the infratemporal fossa
  • beneath the apex of the orbital cone (beneath posterior orbit)
  • anterior to the pterygoid process of the sphenoid bone
  • posterior to the maxilla
  • medial to the infratemporal fossa
  • lateral to the posterosuperior part of the lateral wall of the nasal cavity (conchae)
322
Q

communications of the pterygopalatine fossa (4)

A
  • the orbit (via inferior orbital fissure anteriorly, along with Vb-infraorbital, zygomatic)
  • middle cranial fossa (via foramen rotundum,Vb before branch and pterygoid canal nerve of pterygoid canal posteriorly)
  • infratemporal fossa (via pterygomaxillary fissure laterally)
  • nasal cavity (via sphenopalatine foramen,sphenopalatine artery from maxillary, which supplies lateral and medial walls of the nasal cavity medially)
323
Q

location of sphenopalatine foramen

A
  • from pterygopalatine fossa to the nasal cavity

- in lateral wall of nasal cavity, between body of sphenoid and perp. plate of palatine bone

324
Q

contents of pterygopalatine fossa (3)

A
  • terminal 1/3rd of maxillary artery
  • CN Vb (FR, pterygopalatine fossa)
  • pterygopalatine ganglion (‘ganglion of hay fever’) = parasympathetic ganglia of head and neck
325
Q

parasympathetic ganglia of head and neck (4)

A
  • pterygopalatine ganglia (ganglia of hay fever)
  • otic (secretomotor to parotid)
  • ciliary (oculomotor nerve associated with orbit)
  • submandibular ganglion (secretomotor supply to the submandibular and sublingual glands)
326
Q

branches of first part of maxillary artery (5)

A
  • superficial temporal
  • deep auricular
  • anterior tympanic
  • middle meningeal (+accessory) meningeal
  • inferior alveolar
327
Q

branches of 2nd part of maxillary artery (4)

A
  • masseteric
  • pterygoid
  • deep temporal
  • buccal
328
Q

branches of 3rd part of maxillary artery (5)

A
  • mental (branch of inferior alveolar = branch of 1st part)
  • sphenopalatine
  • descending palatine
  • posterior/middle/anterior superior alveolar
  • infraorbital
329
Q

location of 3rd part of maxillary artery

A

anterior to lateral pterygoid

330
Q

arterial blood supply to the maxillary teeth (3)

A
  • > third part of maxillary artery:
  • posterior superior alveolar artery supplies molars
  • middle superior alveolar artery supplies premolars
  • anterior superior alveolar artery supplies anteriors
331
Q

areas supplied by third part of maxillary artery

A
  • arterial blood supply to the maxillary teeth (posterior/middle/anterior superior alveolar artery)
  • arterial blood supply to the skin of the face (infraorbital artery)
  • arterial blood supply to the palate and nasal cavity (sphenopalatine artery and greater and lesser palatine arteries)
332
Q

arterial blood supply to the palate

A

greater and lesser palatine nerves (branches of 3rd part of maxillary artery)

333
Q

blood supply to the nasal cavities (3)

A
  • opthalmic artery via anterior and posterior ethmoidal arteries
  • maxillary artery via sphenopalatine and greater palatine arteries (maxillary becomes sphenopalatine @ sphenopalatine foramen)
  • facial artery (via lateral nasal branch of facial or septal branch of superior labial artery)
334
Q

nerve that accompanies the sphenopalatine artery

A

nasopalatine nerve

335
Q

(somatic) sensory innervation of nasal cavity (2)

A
  • CN V1 anterosuperiorly (anterior ethmoidal branch of nasociliary)
  • CN V2 posteroinferiorly (nasopalatine nerve supplies midline septum, lateral wall supplied by lateral nasal branches of greater palatine nerve)
336
Q

branches of maxillary division of trigeminal nerve (CNV2) ????

A
  • pterygopalatine ganglion after CNV2 enters foramen rotundum (ganglionic branches = nasopalatine supplying nasal septum and greater and lesser palatine supplying lateral wall of nasal cavity)
  • zygomatic branch passes through infraorbital fissure onto prominence of cheek and branches into zygomatigotemporal and zygomaticofacial
  • posterior superior alveolar nerve branches
  • as maxillary branches into infraorbital groove/canal, middle and anterior superior alveolar nerve passes off
  • > passes through infraorbital foramen
337
Q

branches of CNV3 (9)

A
  • From the pterygopalatine fossa:
  • > Infraorbital nerve through Infraorbital canal
  • > Zygomatic nerve (zygomaticotemporal nerve, zygomaticofacial nerve) through Inferior orbital fissure
  • > Nasal Branches (nasopalatine) through Sphenopalatine foramen
  • > Posterior superior alveolar nerve
  • > Palatine nerves (Greater palatine nerve, Lesser palatine nerve), including the Nasopalatine nerve
  • > Pharyngeal nerve
  • In the infraorbital canal[edit]
  • > Middle superior alveolar nerve
  • > Anterior superior alveolar nerve
  • > Infraorbital nerve
338
Q

where does V2 enter pterygopalatine fossa to reach the ganglion

A

foramen rotundum

339
Q

division of palate into hard and soft

A
  • anteriorly in line with maxillary 3rd molars = hard palate (extends to maxillary tuberosity)
  • posterior to this = soft palate
340
Q

bones of hard palate (2)

A
  • palatine processes of maxilla

- horizontal plates of palatine bone

341
Q

what passes through incisive canal

A

nerve and vessels from nasal cavity to oral cavity

342
Q

epithelial lining hard palate

A

keratinised stratified squamous

343
Q

epithelial lining soft palate

A

non keratinised stratified squamous

344
Q

incisive papilla

A

little bump over incisive foramen

345
Q

palatine raphe

A

midline joining of palatine shelves, almost looks like zip on mucosa

346
Q

why are palatal injections painful

A

mucosa is REALLY tightly bound to bone

347
Q

cause of cleft palate

A

-due to failure of lateral palatine processes to meet and fuse (to each other/septum/maxilla)

348
Q

complications of cleft palate (4)

A
  • speech
  • dental health (overcrowding, therefore tooth decay more likely)
  • feeding
  • hearing
349
Q

nerves and vessels of palate (3)

A
  • greater and lesser palatine arteries and nerves (CNV2)

- nasopalatine nerve

350
Q

do greater/lesser palatine nerves synapse in pterygopalatine ganglion

A
  • no

- only parasympathetics synapse here

351
Q

somatic sensory nerve supply to palate (3)

A
  • greater palatine nerves (most of anterior hard palate)
  • lesser palatine nerves (posterior hard palate)
  • a branch of nasopalatine nerve (passes through incisive foramen and supplies palatal gingiva of anterior teeth and mucosa of anterior palate)
352
Q

clinical importance of lymph nodes in retropharyngeal space

A

can travel all the way down to mediastinum and diaphragm therefore infection/cancer of palate can spread to these areas

353
Q

dorsum surface of tongue

A

posterior surface, lift tongue up to see anterior surface which touches floor of mouth

354
Q

uvula

A
  • (one of) skeletal muscles of soft palate

- 2 muscles coming together to form one

355
Q

arches of the soft palate

A

=skeletal muscles covered in mucosa

  • > palatoglossal arch (anterior)
  • > palatopharyngeal arch (posterior) from palate-pharynx
356
Q

5 pairs of muscles of the soft palate (5)

A
  • levator veli palatini (elevates palate)
  • tensor veli palatini (tenses palate)
  • palatoglossus (palate towards tongue)
  • palatopharyngeus (longitudinal muscle of pharynx,pulls pharynx up towards palate)
  • musculus uvulae
357
Q

nerve supply to muscles of soft palate

A
  • all supplied by CNsX/CNXI
  • except tensor veil palatini which is supplied by CNV3
  • > cranial part of accessory nerve comes up through foramen magnum and comes through jugular foramen with vagus, passes INTO vagus and comes down to the soft palate VIA vagus nerve
  • > CNX except tensor veil palatine = acceptable answer
358
Q

palatine aponeurosis

A
  • tensor veli palatini attaches superiorly to sphenoid bone
  • turns medially and enters soft palate
  • > loops under pterygoid hamulus
  • its tendon then flattens out within the soft palate and and joins with tendon of opposite muscle to form palatine aponeurosis (tendon that connects soft palate-hard palate)
359
Q

attachments of levator veil palatini

A

petrous temporal bone - soft palate

360
Q

attachments of tensor veil palatini

A

from sphenoid bone - soft palate

361
Q

attachments of salpingopharyngeus

A

auditory tube - pharynx

362
Q

attachments of palatopharyngeus

A

soft palate to pharynx posterior to palatoglossus

363
Q

clinical testing of muscles of soft palate (cranial nerves X and V3 and technically CNXI too)

A
  • ask patient to say ‘aaah’
  • > if nerves function normal the uvula should lift straight up in midline
  • > if there is unilateral nerve pathology, uvula will be pulled away from the non functioning side by the working side
364
Q

functions of soft palate (3)

A
  • stops food entering nose during swallowing (musculus uvula lifts up in middle and helps thicken/close off)
  • directs air into nose or mouth during speech, sneezing, coughing and vomiting
  • helps to close off entrance to oropharynx during gag reflex
365
Q

tonsillar crypt

A

palatine tonsil

366
Q

boundaries of the oral cavity:

  • > anterior
  • > posterior
  • > roof
  • > floor
A
  • > anterior (alveolar/dental arches of mandible/maxilla)
  • > posterior (oropharyngeal isthmus-space bounded laterally by palatoglossal folds)
  • > roof (hard palate/soft palate)
  • > floor (tongue, muscles of floor of mouth)
367
Q

palatoglossal folds

A

boundary between oral cavity anteriorly and oropharynx

368
Q

what travels within mandibular canal

A

inferior alveolar nerve (V3/c)

369
Q

lingual sulcus

A

deepest part of area between tongue and teeth

370
Q

buccal sulcus

A

deepest part of the cheek part of vestibule

371
Q

what is the buccinator lined with internally

A

buccal mucosa

372
Q

buccinator papilla

A

opening of parotid duct opposite the maxillary second molar tooth

373
Q

mucosa of hard palate

A

palatal mucoperiosteum (tightly bound directly to bone)

374
Q

alveolar mucosa (4)

A
  • upper labial alveolar mucosa (continuous with upper labial mucosa)
  • lower labial alveolar mucosa (continuous with lower labial mucosa)
  • buccal alveolar mucosa (continuous with buccal mucosa)
  • lingual alveolar mucosa (continuous with mucosa of floor of mouth)
375
Q

why is alveolar mucosa red in comparison to the pink gingiva

A
  • red = non keratinised stratified squamous (upper and lower labial alveolar mucosa)
  • keritinisation of gingiva and hard palate reduces transparency of mucosa so less redness from oxygenated blood shines through
376
Q

junction between gingiva and mucosa

A

mucogingival junction

377
Q

free gingivae groove

A

between free and attached gingivae

378
Q

labial frenula (frenulum = singular)

A

folds of mucosa connecting alveolar bone onto lips

379
Q

attached gingivae

A

directly associated/stuck to alveolar bone

380
Q

free gingivae

A

associated with superior extend of tooth

381
Q

gingival sulcus/ free gingival groove

A

->passing probe into free gingivae = passing into gingival sulcus, roof of sulcus = free gingival groove

382
Q

lingual sulcus

A

deepest part of floor of mouth, between tongue and mandibular teeth

383
Q

sublingual fold

A

openings for ducts of sublingual gland

384
Q

sublingual papillae

A

openings for submandibular gland duct

385
Q

fimbriated folds

A
  • embryological remnants of developing tongue, remains as soft tissue mucosal folds with no function
  • on inferior (anterior) surface of tongue
386
Q

location of deep lingual vein

A
  • on inferior (anterior) surface of tongue

- bilateral or maybe unilateral structure, can cause problems for tongue piercing

387
Q

frenulum of tongue

A

-fold of mucosa running from under surface of tongue to floor of the mouth

388
Q

gingiva/mucosa of internal aspect of mandibular teeth

A
  • lingual gingiva

- lingual alveolar mucosa, continuous with mucosa of floor of mouth

389
Q

location of sublingual papillae

A

lateral to frenulum

390
Q

anterior belly of digastric muscle origin

A
  • associated with floor of mouth (inferior view)

- extends from anterior aspect (digastric fossa)/depression in bone

391
Q

nerve supply to anterior belly of digastric

A

nerve to mylohyoid (branch of CNV3)

392
Q

muscle which forms diaphragm of floor of mouth

A
  • mylohyoid muscle

- >right and left meet in middle at midline raphe, extend from the body of mandible to midline

393
Q

nerve supply to mylohyoid muscle

A

CNV3 (nerve to mylohyoid)

394
Q

does the submandibular duct arise from the superficial or deep part of the gland

A

deep

395
Q

attachments of geniohyoid muscles

A

attach to genial mental spines/genial tubercles of mandible

396
Q

location of deep part of submandibular gland

A

deep to mylohyoid muscle

397
Q

location of sublingual gland (2)

A
  • deep to mylohyoid

- lateral to geniohyoid

398
Q

lingual nerve (CNV3)

A

relays general sensation of anterior 2/3rds of tongue back to brain, along with special sense of taste

399
Q

where does submandibular duct enter floor of mouth

A

sublingual papillae

->arises from deep part of submandibular gland and passes over lingual nerve

400
Q

location of lingual nerve

A

passes internal to rams of mandible

401
Q

submandibular ganglion

A

-associated with parasympathetic supply to sublingual and submandibular gland, secretomotor supply synapse here

402
Q

route of facial nerve CNVII (5)

A
  • leaves skull via IAM
  • travels through petrous part of temporal bone
  • greater petrosal nerve branches off (carries presynaptic parasympathetic fibres to ganglion of hay fever)
  • > before facial nerve passes through stylomastoid foramen, chorda tympani leaves petrous part of temporal bone and hitches a ride with lingual nerve)
  • facial passes through stylomastoid foramen to supply muscles of facial expression
403
Q

nerve supply of chorda tympani branch of CNVII (2)

A
  • parasympathetic secretomotor to submandibular and sublingual glands (preganglionic parasympathetic to ganglion)
  • special sense of taste to anterior 2/3rds of tongue
404
Q

function of tongue (5)

A
  • formation of food bolus
  • pushing food bolus to posterior part of oral cavity ready to be swallowed
  • keeping mouth clean
  • speech
  • tasting/sensing the food
405
Q

location of posterior 1/3rd of tongue

A
  • vertical part

- lies in oropharynx (cannot see when stick tongue out)

406
Q

groove dividing anterior and posterior tongue

A

terminal sulcus

407
Q

location of lingual tonsil

A

under mucosa on posterior part of tongue

408
Q

foramen caecum

A

at point of terminal sulcus on tongue

409
Q

nerve supply to tongue for general sensation and taste of anterior/posterior (3)

A
  • general sensation and taste both of posterior tongue supplied by CN IX
  • general sensation of anterior supplied by CNV3 (lingual nerve)
  • taste sensation of anterior supplied by CN VII (via lingual nerve and chorda tympani)
410
Q

papillae of tongue, function and nerve supply (4)

A
  • vallate papillae (taste buds, CN IX)
  • foliate papillae (taste buds CNVII)
  • filiform papillae (touch etc, CNV3)
  • fungiform papillae (taste buds, CNVII)
411
Q

motor supply to muscles of tongue

A

-CNXII, hypoglossal nerve (except palatoglossus muscle of the palate, supplied by vagus nerve, CN X)

412
Q

intrinsic muscles of the tongue

A
  • originate and insert within the tongue

- act to alter the shape of the tongue

413
Q

extrinsic muscles of the tongue

A

originate outwith the tongue from bone and insert into it

414
Q

4 pairs of extrinsic tongue muscles

A
  • palatoglossus
  • styloglossus
  • hypoglossus
  • genioglossus
415
Q

types of intrinsic muscles of tongue and functions (2)

A
  • > longitudinal muscles make the tongue short and thick

- >transverse and vertical muscles make tongue long and narrow

416
Q

attachments of palatoglossus muscle

A

-palatine aponeurosis down onto side of the tongue

417
Q

attachments of styloglossus muscle

A

from styloid process to side of tongue

418
Q

attachment of hyoglossus

A

from hyoid bone onto lateral aspect of tongue

419
Q

clinical testing of CNXII (hypoglossal nerve)

A
  • stick tongue straight out
  • > if both CN XIIs are normal the tongue should stick out remaining in midline
  • > if one CNXII is damaged, tongue points towards side of injured nerve
420
Q

function of genioglossus muscle

A

both genioglossus muscles contract in pushing the tongue tip forwards (sticking tongue out)

421
Q

functions of oral cavity (3)

A
  • preparation of food bolus for swallowing (involves: mastication/teeth and muscles of mastication, saliva, tongue)
  • defence against ingestion of toxins/infection (involves tonsils/lymphoid tissue, special sense of taste)
  • speech (oral/nasal sounds involving soft palate and articulation/making sounds of speech involving tongue/lips)
422
Q

location of larynx (4)

A
  • enclosed in the VISCERAL layer of the pretracheal fascia of neck
  • > anterior to laryngopharynx
  • > between carotid sheath structures
  • > between vertebral levels C4-C6 @cricoid cartilage
  • > just posterior to strap muscles
423
Q

layers of pretracheal fascia (2)

A
  • visceral

- muscular (very thin)

424
Q

contents of pretracheal fascia (5)

A
  • strap muscles
  • thyroid gland
  • trachea and larynx
  • oesophagus and pharynx
  • recurrant laryngeal nerves
425
Q

laryngopharynx

A

region of pharynx from epiglottis to oesophagus

426
Q

carotid sheath structures

A
  • internal jugular vein
  • common carotid artery
  • CN X
  • deep cervical lymph nodes
427
Q

communications of larynx (2)

A
  • communicates with oropharynx above (oral/nasal cavity)

- communicates with trachea below (at C6)

428
Q

role of larynx (3)

A
  • rigid skeleton helps keep URT open/maintains patency of URT due to cartilages
  • help prevent entry of foreign bodies into LRT (vocal cords and cough reflex)
  • produces sound (vocal cords)
429
Q

boundaries of nasal cavities (right and left)

  • > medial wall
  • > lateral wall
  • > floor
  • > roof
A
  • > medial wall = septum (ethmoid, vomer, cartilage, most people have deviated septum, relatively featureless)
  • > lateral wall = featured conchae
  • > floor = palate
  • > roof = anterior cranial fossa
430
Q

structure of larynx

A

composed of cartilages suspended from hyoid bone

431
Q

structure of trachea

A
  • > C shaped anterior rings of hyaline cartilage

- >tracheal smooth muscle completes the posterior wall of the trachea

432
Q

cricothyroid membrane

A
  • connects cricoid cartilage and thyroid cartilage

- >access point for cricothyroid puncture

433
Q

what type of cartilage is the laryngeal cartilages

A
  • > all = hyalin

- >EXCEPT for the epiglottis which is elastic cartilage

434
Q

which laryngeal cartilage is a full ring structure

A
  • cricoid cartilage

- >all other laryngeal cartilages = C shaped filled in with muscles

435
Q

why is cricothyroid membrane used for emergency breathing access rather than thyrohyoid membrane

A

below level of vocal cords therefore prevents damaging of vocal cords and there will be nothing blocking the access into trachea

436
Q

adams apple

A

=laryngeal prominence of thyroid cartilage

->more prominent in males, however also present in females

437
Q

what type of joint is the cricothyroid joint and what movement does this jaw allow

A
  • synovial

- nodding movement (A-P) between the thyroid and cricoid cartilages helping to change pitch of voice

438
Q

laryngeal inlet

A

entrance into larynx

439
Q

role of arytenoid cartilages

A
  • move vocal cords

- point at fromt = vocal process (attaching to vocal cords), point at back = muscular process (attaching to muscles)

440
Q

what is corniculate cartilage

A

little fold at top of arytenoid cartilages, diff.cartilage itself

441
Q

attachments of vocal cords (2)

A
  • anteriorly to internal aspect of thyroid cartilage

- posteriorly to vocal processes of arytenoid cartilages

442
Q

space between vocal cords through which air passes between

A

rima glottides of larynx

443
Q

mucosa lining internal aspect of epiglottis

A

laryngeal mucosa

444
Q

difference between ‘vocal cords’ and ‘vocal cartilages’

A

nothing, mean the same thing (vocal cords are thicker cartilages)

445
Q

muscles that support laryngeal inlet (2)

A
  • cuneiform cartilages
  • corniculate cartilages
  • > located deep to laryngeal mucosa at arytenoid cartilages
  • > have no role in moving vocal cords
446
Q

laryngeal cartilages (3 pairs, 3 single cartilages)

A
  • pairs:
  • > cuneiform
  • > corniculate
  • > vocal cords
  • single:
  • > epiglottis
  • > cricoid
  • > thyroid
447
Q

laryngoscopy insertion point (for viewing of interior larynx)

A

-laryngoscope blade inserted into posterior aspect of vallecula (space between the tongue and epiglottis)

448
Q

space between tongue and epiglottis

A

vallecula

449
Q

endotracheal intubation

A
  • > placing breathing tube inside teachea
  • endotracheal/ET tube inserted through mouth/pr wider nasal cavity -> oropharynx (or nasopharynx first) -> laryngeal inlet -> rima glottidis of the larynx -> trachea
450
Q

mucosa lining inside of larynx (2)

A
  • mainly respiratory epithelium

- >except for vocal cords = stratified squamous epithelium

451
Q

mucociliary escalator

A
  • most of mucosal lining of larynx = respiratory
  • > mucous glands secrete mucous onto epithelial surface
  • > cilia beat mucous and foreign bodies superiorly towards pharynx to be swallowed
  • > prevents build up of mucous in respiratory tract
452
Q

2 diff. sets of vocal cords (2)

A
  • superior = false vocal cords (vestibular folds)

- inferior = true vocal cords (vocal folds)

453
Q

why are the superior vocal cords (vestibular folds) called false vocal cords

A
  • they have nothing to do with producing sound, all they are is thickened folds of membrane
  • function = protecting airway from foreign bodies passing down
454
Q

diff between vocal cord and vocal ford

A
  • thickened ligament = vocal cord/vocal ligament

- when covered in mucosa = vocal fold

455
Q

space between vocal folds

A

ventricle

456
Q

nerve supply of laryngeal mucosa

A
  • all sensory innervation supplied by CNX (vagus nerves)
  • > everything superior to vocal fold supplied by internal laryngeal branches of superior laryngeal branch of CNX
  • > vocal fold and inferior supplied by recurrent laryngeal branches of CN X
457
Q

laryngeal branches of vagus nerve (4)

A
  • vagus nerve passes through jugular foramen
  • superior laryngeal nerve branches off (and splits into internal and external laryngeal branches)
  • vagus nerve descends through the neck within carotid sheath
  • recurrent laryngeal nerve (branches off CNX in mediastinum)
  • inferior laryngeal nerve = continuation of recurrent laryngeal
458
Q

loop of recurrent laryngeal nerves on left and right

A
  • left loops under arch of aorta

- right loops under subclavian

459
Q

motor and sensory innervation to larynx

A

both via vagus nerves and branches (CNX)

460
Q

intrinsic muscles of larynx (4)

A
  • > skeletal muscles (voluntary control)
  • tensors of vocal cords (cricothyroid muscles)
  • relaxers of vocal cords (thyro-arytenoid muscles)
  • adductors of vocal cords (lateral circo-arytenoids & arytenoid muscles)
  • abductors of vocal cords (posterior circo-arytenoid muscles)
461
Q

somatic motor supply to intrinsic muscles of larynx

A

via somatic motor branches of vagus nerve

462
Q

attachments of intrinsic muscles of larynx

A

attach between cartilages, act to move cartilages which move the vocal cords

463
Q

tensors of vocal cords

A

=cricothyroid muscles of larynx

  • ‘nodding’ the thyroid cartilage anteriorly at the cricothyroid joints, stretching the vocal cords
  • > produce high pitched sound
464
Q

relaxers of vocal cords

A
  • thyro-arytenoid muscles
  • relax vocal cords when they contract
  • pull arytenoid cartilages towards the thyroid cartilage
  • > produce low pitch voice (more relaxed vocal cords)
465
Q

vocalis muscles

A

tiny muscles between thyroarytenoid and vocal cord

466
Q

adductors of vocal cords (2)

A
  • > lateral crico-arytenoid muscles (rotate the arytenoid cartilages so that the vocal processes of the cartilages come together at the midline)
  • > arytenoid muscles (transverse and oblique arytenoids, assist the lateral cricoarytenoids to gently close the rima glottidis,sphincter function)
467
Q

what happens if lateral circo-arytenoid muscles, arytenoid muscles AND cricothyroid muscles contract at the same time

A

tight closure of airway sphincter can occur

468
Q

abductors of vocal cords

A

=posterior crico-arytenoid muscles

  • > rotate arytenoid cartilages so that the vocal processes of the cartilages move laterally
  • > widens the rima glottidis
469
Q

only muscle of larynx that can abduct vocal cords and help rima glottidis open

A

posterior crico-arytenoid muscles

470
Q

state of laryngeal muscles during normal resting respiration

A

laryngeal muscles are relaxed

471
Q

state of laryngeal muscles during forced respiration

A

posterior crico-arytenoids contract

472
Q

state of laryngeal muscles during phonation (talking/sound production)

A
  • arytenoids contract

- assist lateral crico-arytenoids

473
Q

state of laryngeal muscles during whispering

A
  • lateral crico-arytenoids contract

- >tiny posterior opening to allow air to pass over vocal cords and allow whispering

474
Q

anatomical steps involved in sound production (6)

A
  • inspiration
  • controlled expiration
  • phonation
  • articulation
  • > oral sounds
  • > nasal sounds
475
Q

what is involved in inspiration during sound production

A
  • diaphragm and/or intercostal muscles

- >phrenic and intercostal nerves

476
Q

phonation

A
  • producing a sound in the larynx

- stream of air expired over vocal cords

477
Q

what dictates the pitch of sound produced by vibration of vocal cords

A

the length/tension of vocal cords (controlled by intrinsic muscles)

  • > thyro-arytenoids produce low pitch by relaxing vocal cords
  • > cricothyroids produce high pitch by tensing/stretching vocal cords
478
Q

what happens in the articulation step of sound production

A

production of recognisable sound within oral/nasal cavities

479
Q

how are oral sounds produced during articulation of sounds (3)

A
  • soft palate tenses (CNV3) and elevates (CN X) to close off entrance into nasopharynx
  • directs steam of air through oral cavity
  • sound interrupted by tongue (CN XII) and the teeth/lips (CNVII) to produce most vowels/consonants in english
480
Q

how are nasal sounds produced during articulation of sounds (3)

A
  • soft palate tenses (CNV3) and descends (CNX) to close off entrance into oropharynx
  • directs steam of air through nasal cavities
  • produces one of three sounds (‘m’, ‘n’, ‘ing’) depending on position of tongue (CNXII) teeth and lips (CNVII)
481
Q

clinical testing of vagus nerves (CNX) (3)

A
  • > sensory and motor supply to the palate,pharynx and larynx
  • ASK PATIENT TO SWALLOW SMALL SIP OF WATER (watch larynx move up and down, do they splutter)
  • LISTEN TO PATIENT SPEAK (is voice hoarse? are the intrinsic muscles of larynx functioning normally to move vocal cords)
  • ASK PATIENT TO COUGH (is cough normal and powerful? also requires functioning diaphragm,phrenic nerves abdominal wall etc)
482
Q

stage 1 of swallowing (3)

A
  • close lips
  • food bolus squeezed to back of mouth
  • tongue against palate
483
Q

stage 2 of swallowing (4)

A
  • nasopharynx closed off
  • > soft palate tenses
  • larynx elevated
  • pharynx enlarged to receive bolus
484
Q

stage 3 of swallowing (2)

A
  • pharyngeal constrictors contract sequentially

- longitudinal muscles of pharynx raise larynx to close off laryngeal inlet

485
Q

stage 4 of swallowing (2)

A
  • epiglottis deflects bolus

- bolus moves into oesophagus

486
Q

what is deglutition

A

swallowing

487
Q

anatomy of coughing (5)

A
  • breath in using diaphragm (phrenic nerves)
  • close vocal ligaments (CNX)
  • contract abdominal wall to build up pressure beneath the closed vocal ligaments
  • suddenly open vocal ligaments (CN X)
  • tense (CNV3) and raise (CNXI) the soft palate to direct the steam of air through mouth
488
Q

the most important protective reflex in humans

A

coughing

489
Q

what triggers coughing reflex

A

-foreign bodies that hit the larynx (inside of larynx is acutely sensitive to touch, CNX)

490
Q

what is aspiration and what are the causes (2)

A
  • > inhalation of liquid or solid into lungs
  • caused by either:
  • > abnormal swallowing (accidental or pathological eg.following stroke)
  • > breathing in (abnormal coughing, pathological e.g. following stroke, cough reflex inhibited by general anaesthetic)
  • > especially stroke affecting CNX
491
Q

how does brainstem stroke affect cranial nerves

A

bleeding from, or blockage of, branches from the vertebral arteries or basilar artery which also supply the cranial nerves attaching to the brainstem

492
Q

symptoms of patient with damage to CNX (3)

A
  • hoarse voice
  • abnormal swallow
  • weak cough
493
Q

emergency airway management techniques (2)

A
  • heimlich manoeuvre

- cricothyroid puncture

494
Q

divisions of upper arm (2) and bones that make up both divisions

A
  • arm (humerus)

- forearm (radius + ulna)

495
Q

pectoral girdle

A

associated with clavicle and scapula

496
Q

location of ulna

A

medial in anatomical position (next to pinky finger)

497
Q

location of radius

A

lateral in anatomical position (thumb side)

498
Q

location of cubital fossa (2)

A
  • depression on anterior aspect of elbow

- anterior to distal humerus and elbow joint (which sit deep)

499
Q

most superficial structures of cubital fossa

A

veins

500
Q

boundaries of cubital fossa triangle (5)

  • > superior
  • > medial
  • > lateral
  • > floor
  • > roof
A
  • superior = imaginary line connecting medial and lateral epicondyles (bumps extending from distal end of humerus)
  • medially = flexor muscles arising from medial epicondyle
  • laterally = extensor muscles from lateral epicondyle
  • floor = brachial and supinator muscles of arm and forearm
  • roof = deep fascia, bicipital aponeurosis, superficial fascia, skin
501
Q

location of supinator muscle

A

deep to arteries and veins of cubital fossa on medial aspect of brachialis muscle

502
Q

bicipital aponeurosis

A

extension of tendon of bicep that then blends with deep fascia covering the muscles of the forearm

503
Q

contents of cubital fossa (4)

A
  • terminal brachial artery and commencement of radial and ulnar arteries
  • biceps brachii tendon
  • median nerve
  • radial nerve
504
Q

bifurcation of brachial artery

A

-into ulnar and radial artery within median cubital fossa

505
Q

biceps brachii tendon insertions

A

extends from muscle belly of biceps to its insertion site - tuberosity of radius

506
Q

where does median nerve arise

A

brachial plexus (median nerve = 1 of 5 named branches)

507
Q

superficial contents of fascia overlaying cubital fossa (3)

A
  • median cubital vein (anterior to brachial artery)
  • basilic (medial) and cephalic (lateral) veins
  • medial and lateral cutaneous nerves of forearm
508
Q

median cubital vein

A
  • connects cephalic vein to basilic
  • blood sample usually taken from here
  • not within cubital fossa (sits superficial to it)
509
Q

drainage of dorsal venous plexus (2)

A
  • > drains into basilica vein medially (side of pinky)

- >drains laterally into cephalic vein (side of thumb)

510
Q

drainage of cephalic and basilic vein (3)

A
  • basilic vein dives deep to become the brachial vein which then becomes the axillary vein upon entering the axilla (armpit)
  • cephalic vein drains into axillary vein after running through the delto-pectoral groove
  • > axillary vein then becomes subclavian vein at the lateral border of first rib
  • > subclavian vein + IJV = brachiocephalic vein, brachiocephalic veins -> SVC -> RA
511
Q

cycle of venous blood to lungs then back to arterial system including valves (6)

A
  • SVC and IVC -> RA
  • RA -> RV (via tricuspid valve)
  • RV->pulmonary trunk and arteries going to lungs (via pulmonary valve)
  • lungs ->LA via pulmonary veins
  • LA->LV (via mitral valve)
  • LV->arch of aorta (via aortic valve)
512
Q

clinical significance of structures deep to median cubital vein

A
  • common vein for taking blood

- potentially could miss target and hit important deep structures

513
Q

deep contents of cubital fossa (from lateral to medial) (5)

A
  • brachioradialis muscle (lateral border)
  • biceps brachii tendon/aponeurosis
  • brachial artery
  • median nerve
  • pronator teres muscle (medial border)
514
Q

origin of radial/ulnar arteries

A

-arch of aorta -> brachiocephalic trunk -> subclavian artery -> axillary artery -> brachial artery -> splits into radial artery (lateral on thumb side) and ulnar artery (medial on pinky side)

515
Q

which artery gives peripheral pulse

A

radial artery

516
Q

CNS

A

brain + spinal cord

517
Q

nerve plexuses (and 2 eg.’s of named branches)

A

=adjacent spinal nerves mix their fibres

  • > great auricular nerve (C2,3)
  • > phrenic nerve (C3,4,5)
518
Q

origin of brachial plexus

A

spinal nerves C5-T1

->terminal branches break off in armpit region

519
Q

nerve axons of median nerve

A
  • sensory (to skin of forearm, arm and palm)
  • motor (muscles of arm and forearm)
  • sympathetic
  • > supplies structures in distal upper arm (forearm, wrist and hand)
520
Q

nerve important in dental local anaesthesia injection

A
  • trigeminal nerve
  • > Vb maxillary division
  • > Vc mandibular division
521
Q

areas anaesthetised by dental local anaesthesia (8)

A
  • teeth
  • gingivae (labial/buccal/lingual/palatal)
  • alveolar mucosa
  • labial mucosa
  • buccal mucosa
  • lingual mucosa
  • floor of mouth
  • hard palate
522
Q

dental local anaesthesia techniques (4)

A
  • topical (surface anaesthetic via cream)
  • injection:
  • > infiltration (infiltrates target tissue)
  • > block (blocks particular nerve trunk)
  • > supplemental techniques (as not all techniques work)
523
Q

e.g. of dental LA infiltration injection

A
  • apex of tooth
  • > depends on density of surroundings
  • > maxilla is thinner/more porous than mandible
524
Q

eg. of block injection (dental LA) (4)

A
  • inferior alveolar nerve
  • lingual nerve
  • long buccal nerve
  • mental/incisive nerve blocks
525
Q

how do LA drugs work

A
  • REVERSIBLY block sodium channels (pass through axon membrane and bind to sodium channel from inside of nerve)
  • > sodium channels usually open, sodium enters, threshold is reached and action potential is fired (therefore to block action potentials, sodium channels are reversibly blocked)
526
Q

do LA drugs work well if infection is present

A

no

527
Q

eg’s of LA drugs (4)

A

=amide drugs

  • > lidocaine (gold standard)
  • > prilocaine, mepivacaine
  • > bupivacaine
  • > articaine (newish)
528
Q

dental procedures requiring use of LA drugs (3)

A
  • > restorations (pulp anaesthesia)
  • > extractions (pulpal anaesthesia and adjacent soft tissue anaesthesia)
  • > biopsies (gingivae or mucosa in the lesion site)
529
Q

buccal tissues (and innervation) (3)

A
  • buccal sulcus
  • buccal mucosa
  • buccal gingivae
  • > all innervated by long buccal nerve except upper buccal gingivae
530
Q

lingual tissues (and innervation) (4)

A
  • lingual sulcus
  • lingual mucosa
  • lingual gingivae
  • floor of mouth mucosa
  • > all innervated by lingual nerve
531
Q

location of lingual alveolar mucosa

A

between lingual sulcus and lingual gingivae

532
Q

nerves involved in maxillary anaesthesia of incisors and canines (3)

A
  • dental branches of anterior superior alveolar nerves supply teeth and gingival branches supply labial gingivae
  • incisive branch of nasopalatine nerve supplies palatal gingivae
533
Q

nerves involved in maxillary anaesthesia of premolars (3)

A
  • dental branches of middle superior alveolar nerves supply teeth and gingival branches supply buccal gingivae
  • branches of greater palatine nerve supply palatal gingivae
534
Q

nerves involved in maxillary anaesthesia of molars (3)

A
  • dental branches of posterior superior alveolar nerves supply teeth and gingival branches supply buccal gingivae
  • branches of greater palatine nerve supply palatal gingivae
535
Q

maxillary infiltration LA:
->labial/buccal infiltration
->palatal infiltration
(aim and results)

A
  • > labial/buccal infiltration:
  • into labial/buccal sulcus (alveolar mucosa)
  • aim for apex of tooth
  • result = pulpal anaesthesia (dental branches) and labial/buccal anaesthesia (gingival branches)
  • > palatal infiltration
  • into palatal mucoperiosteum
  • result = palatal soft tissue anaesthesia
536
Q

mandibular infiltrative anaesthesia

A

-only effective for anterior region (bone too dense for LA to reach posterior tooth apices)

537
Q

mandibular nerves blocked by LA (4)

A
  • inferior alveolar nerve
  • lingual nerve
  • long buccal nerve
  • mental and incisive nerve
538
Q

where does the inferior alveolar nerve enter mandibular canal

A

via mandibular foramen, in level with mandibular occlusal plane

539
Q

application of inferior alveolar nerve block (inc. landmarks)

A
  • aim to deposit LA close to IAN before it enters the mandible (within pterygomandibular space therefore complex anatomy)
  • > landmarks = retromolar triangle, pterygomandibular raphe, coronoid notch of ramus and opposing premolars
  • > thumb in coronoid notch, look into retromolar region, needle inserted between the two
  • > insert needle until bone is touched (2.5cm)
540
Q

borders of pterygomandibular space (lateral, medial, posterior, anterior, superior)

A
  • lateral = ramus
  • medial = medial pterygoid muscle
  • posterior = parotid (+VII nerve)
  • anterior = buccinator
  • superior = lateral pterygoid muscle
541
Q

lingual nerve block

A
  • same location as inferior alveolar nerve block

- insert needle until bone is touched (2.5cm) then withdraw needle by 1cm

542
Q

key sign of success of inferior alveolar nerve block

A

numb lip (mental nerve)

543
Q

dangers of injecting inferior alveolar nerve block too deep

A
  • inject into parotid
  • block facial nerve (CNVII) -> motor supply to muscles of facial expression, causing facial palsy (smiling on one side)
  • > risk of intravascular injection
544
Q

how common is it for inferior alveolar nerve blocks to fail

A

1/5

545
Q

mental and incisive nerve block

A
  • aim to deposit LA beside mental foramen (normally below lower premolars)
  • anaesthetise:
  • > mental nerve (soft tissues incl. lip, labial mucosa and gingivae)
  • > incisive nerve (anterior teeth)
546
Q

dental nerve innervation (maxillary and mandibular) (5)

A
  • maxillary 3-3 = anterior superior alveolar nerve
  • maxillary premolars and mesio buccal root of 1st molar = middle superior alveolar nerve
  • remainder of maxillary molars = posterior superior alveolar nerve
  • mandibular 3-3 = incisive nerve
  • mandibular premolars and molars = inferior alveolar nerve
547
Q

dental mucosal innervation (9)

A
  • upper labial mucosa = infraorbital nerve
  • hard palate = incisive branch of nasopalatine nerve and greater palatine nerve
  • soft palate = lesser palatine nerve
  • buccal mucosa = long buccal nerve
  • lingual mucosa = lingual nerve
  • inferior labial mucosa = mental nerve
  • gingivae of maxillary incisors = anterior superior alveolar nerve
  • gingivae of maxillary premolars and mesiobuccal root of molar = middle superior alveolar nerve
  • gingivae of remaining maxillary molars = posterior superior alveolar nerve
548
Q

application of maxillary infiltration LA injection

A
  • use mirror to retract lip
  • inject solution into alveolar mucosa, very slowly (over about a min)
  • > eventually anaesthetic diffuses through the bone and reaches apex of tooth
549
Q

why are upper 6’s difficult to anaesthetise

A

-divergent roots
bone around 6 is a lot thicker as zygomatic process of maxilla is above
->inject infront of 6, behind 6 and into palate to innervate all roots

550
Q

pterygomandibular space

A

space between pterygoid muscle and mandible

551
Q

pterygomandibular raphe

A

attachment of buccinator to superior constrictor

semester 2 (9 decks)

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