Anatomy Flashcards
1
Q
the SCALP
A
- Skin
- Connective tissue
- Aponeurotic tissue
- Loose Connective Tissue
- Pericranium
- extends over the neurocranium
- Innervation to the scalp is from the trigeminal nerve and spinal cutaneous nerves
2
Q
Bones of the skull
A
- the Neurocranium and the viscerocranium = 22 bones
- Neurcroniaum bones
- Occipital
- 2 x temporal
- 2x parietal
- Sphneoid
- ethmoid
- frontal
- Viscercranium
- 2x nasal conchae
- 2x nasal bones
- 2x maxilla
- 2x palatine bones
- 2x zygomatic bones
- 2x lacrimal bones
- vomer
- mandible
3
Q
Foramina of the cranium
A
Cribiform: plate CN 1
Optic Canal: CN 2, Ophthalmic A
Superior Orbital Fissure: CN 3,4,6, 5 V1 (LFTSNIA)
Rotundum: CN5 V2
Ovale: CN 5 V3, AMMA
Spinosum: Middle Meningeal Artery
Lacerum: *Carotid Artery
Internal Acoustic Meatus: CN 7 and 8
Jugular foramen: CN 9, 10,11, IJV
Hypoglossal Canal: CN12
Magnum: Spinal Cord
4
Q
Dura Mater
A
- 2 layers of dura mater around the brain: create a sinus
- endosteal layer: outer layer stops at the foreman magnum, only lines the skull
- Meningeal layer around the brain and the skull
- falx cerebri: separates cerebral hemispheres
- tentorium cerebelli: separates the cerebellar hemisphere from the cerebral hemispheres
- falx cerebelli- separates cerebellar hemispheres
- supplied by CNX 5 (trigeminal), 10(vagus), C1-3 and sympathetic
- blood supply is the middle meningeal artery
5
Q
Arachnoid Mater
A
- thin avascular layer between the pia and the dura
- loosely applied layer with projections
- all structures passing to/ from brain pass through the subarachnoid space
- Subarachnoid space contains cerebrospinal fluid produced by choroid plexus in brain ventricles
- the CSF provides buoyancy for the brains
- any excess CSG in the subarachnoid space goes to the arachnoid granulations which project into the superior sagittal sinus (the space between the two dura layers)
- these granulations affect the transfer of CFS into the venous system
6
Q
Pia Mater
A
- very delicate vascular membrane: nourishes
- closely invests brain following gyri/sulci
- Cerebral arteries entering the brain carry a bit of the pia with it
7
Q
Leptomengittis
A
- infection and inflammation in the arachnoid and the pia mater
- infection may enter the subarachnoid space and enter into the blood (septicemia)
8
Q
Dural Sinuses
A
- Sinuses sit between the dural folds.
- Drained blood and CSF from the brain via cerebral veins.
- Communicate with the veins of the skull and scalp.
- Thick-walled endothelium. No Valves or smooth muscle.
- Drain into the internal jugular vein.
9
Q
Blood supply to the brain
A
10
Q
Stroke
A
Occurs when the supply of blood to the brain is reduced or blocked completely, which prevents brain tissue from getting oxygen and nutrients.
11
Q
Describe the embryological stage of the face
A
- Development begins in week 4 and forms from 5 swellings.
- Frontonasal
- Maxillary X2
- Mandibular X2
- By week 5 two events;
- Maxillary prominences enlarge in medial direction
- Nasal placodes appear and form medial and lateral processes.
- The medial nasal processes merge towards each other and form intermaxillary segment
- The maxillary prominences fuse with the lateral and medial nasal processes to form the upper lip
12
Q
What are the key muscles of the face and what are there roles
A
- Occipitofrontalis- elevates eyebrows
- Orbicularis oculi- closes eyelids
- Orbicularis oris- closes mouth
- Zygomaticus major- elevates labial commissure
- Buccinator- compresses cheek
- Platysma- depresses mandible against resistance, tenses
13
Q
Innervation of the fascial muscles
A
- Cutaneous innervation by the Trigeminal nerve (Cranial nerve 5)
- All muscles of facial expression supplied by the Facial Nerve (Cranial nerve 7)
- Sensory, Taste and a general motor and visceral motor nerve
- Exits through:
- the internal acoustic meatus
- facial canal
- stylomastoid foramen
- Branches: Tempra facial and Vercofacial branch from the Posterior auricular nerve
- Motor-Posterior auricular, temporal, zygomatic, buccal, marginal mandibular, cervical
- Parasympathetic- branches: to pterygopalatine ganglion.
- Taste- via chorda tympani via lingual nerve from anterior two thirds of tongue.
- General sensory: skin over external auditory meatus.
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14
Q
The Parotid glands place in the face
A
- largest of the three salivary glands in the head and is superficial to the muscles in the face
- Parotid duct leaves gland at anterior edge and passes towards the corner of the mouth but turns deep through buccinator.
- The parotid duct opens into oral cavity at upper second molar tooth.
- The retromandibular vein and external carotid artery run through it.
- Facial nerve passes through the parotid gland.
15
Q
Muscles responsible for mastication (chewing)
A
- Temporalis- elevation, retraction
- Masseter- elevation
- Medial Pterygoid- elevation, side to side
- Lateral Pterygoid- protrusion and depression
16
Q
Innervation of the mastication muscles
A
- supplied by the motor nerve of V3
- the Mandibular branch of the trigeminal nerve
17
Q
Cranial NErve 5
A
- the Trigeminal Nerve
- it’s a somatic and somatic motor to derivatives of the 1st pharyngeal arch
- It has three main divisions
- Ophthalmic (V1): exits through the Superior orbital fissure
- Maxillary (V2): exits through the Foramen Rotundum
- Mandibular (V3): exits through the Foramen Ovale
18
Q
Explain the Ophthalmic Nerve V1
A
- Type: Sensory fibres skin, mucous membranes, conjunctiva, front of head and nose
- Path: Branches into lacrimal, nasociliary, frontal
- Exit: Superior Orbital Fissure
19
Q
Explain the Maxillary Nerve V2
A
- Type: Sensory fibres dura, nasal, upper cheek, lip, teeth
- Path: Enters pterygopalatine fossa, gives off branches to the pterygopalatine ganglion, through the inferior orbital fissure.
- Exit: Foramen rotundum
- Branches: Infraorbital, zygomatic, superior alveolar.
20
Q
Explain the Mandibular Nerve V3
A
- Type: Mixed, sensory, lower face, lip, teeth. Motor to muscles of mastication
- Exit: Foramen Ovale
- Branches:
- Sensory-auriculotemporal, buccal, lingual, inferior alveolar, mental
- Motor- temporalis, masseter, medial and lateral pterygoids, nerve to mylohyoid
- Parasympathetic (hitchhiking)- to salivary glands
21
Q
The Temporal and infratemporal fossa
A
- The temporal fossa is a fan-shaped space that is located on the lateral surface of the skull.
- The temporal fossa contains: temporalis muscle, branches of V2
- The infratemporal fossa is inferior to the temporal fossa.
- The infratemporal fossa contains: medial and lateral pterygoids, maxillary artery, V3, branches of the facial nerve, glossopharyngeal nerve and pterygoid plexus of veins.
22
Q
Describe the arterial supply to the face
A
arterial supply from the external carotid artery
- Lingual
- Facial
- Maxiallry
- Superficial temporal
in this order
23
Q
Venous drainage of the face
A
- the facial vein drains the majority of the face, starting near the eye
- the facial vein passes inferiorly and drains into the internal jugular vein
- the superficial temporal vein drains into the external jugular vein
24
Q
Draw out this image
A
25
Overview of the tongue
* The tongue is divided into an anterior two thirds (oral) and a posterior third (pharyngeal), demarked by a V shaped sulcus (terminal sulcus)
* _Papillae_ cover the tongue and all **except _filiform_** have taste buds on their surface.
* Undersurface contains medial fold (_frenulum_) which internally separates the right and left sides of the tongue.
26
Muscles of the tongue
* **Intrinsic muscle:** creates precise movement for speech, eating and swallowing.
* **Extrinsic:**
* **Genioglossus**: depresses and protrudes the tongue
* **Hyoglossus:** depresses tongue
* **Styloglossus:** retracts tongue
* **Patalglossus:** elevates back tongue and depresses soft palate
27
Innervation and supply of the tongue
_Supply_
* supplied by the lingual arteries and drained by the lingual veins
_Innervation: Motor_
* Hypoglossal nerve (CN12)
* general motor for the whole tongue apart from the palatoglossus
* Vagus (CN10)
* provides innervation to the palatoglossus
_Innervation: Sensory_
* Chordia timpani (from CN7 facial nerve via the lingual nerveV3)
* provides taste to the anterior 2/3 of the tongue
* Lingula Nerve (V3)
* provides sensation to anterior 2/3 of the tongue
* Glossopharyngeal (CN9)
* provides taste and general sensation to the posterior 1/3
28
Give an overview of Cranial Nerve 9: Glossopharyngeal
* Sensory (somatic), special sensory (taste), motor and visceral
* Exits through the Jugular Foramen
* Provides innervation to-
* Sensory- posterior 1/3 tongue, oropharynx
* Taste- posterior 1/3 tongue
* Motor- stylopharyngeus
* Visceral to the parotid gland to stimulate secretion to aid digestion.
* other salivary glands innervated via facial nerve (CN7)
29
Give an overview of Cranial Nerve 12: Hypoglossal
* provides motor function to intrinsic and extrinsic muscles of the tongue (save palatoglossus)
* exits through the hypoglossal canal: this is just lateral of the Foramen Magnum
30
Give an overview of the framework of the larynx
* Provides a protective sphincter for the air passages and produces phonation, made up of cartilages:
* Thyroid, Cricoid, Arytenoid, Cuneiform, Corniculate and Epiglottis
* Contains ligaments, most important:
* _Vestibular_ and the _Vocal_ ligament.
31
Give the innervation and supply of the larynx
* Nerve supply: sensory and motor from the **vagus**, via the _superior laryngeal branch and recurrent laryngeal branch_.
* Blood supply: upper half by the **superior thyroid artery** and lower half by **inferior thyroid artery**
32
Give an overview of the Pharynx
* the most posterior part of the neck, situated behind the nasal cavity and the larynx.
* It’s a funnel-shaped tube with three sections:
* Nasopharynx
* Laryngopharynx
* Oropharynx
* Muscles consist of three constrictors: Superior, Middle and Inferior
* also the stylopharyngeus
33
Innervation of the Pharynx
* Motor supply via vagus, EXCEPTstylopharyngeus which is through CN9
* Sensory supply via V2, CN 9, CN10
34
Give an overview of Cranial Nerve: Vagus
* Provides Sensory, taste, visceral sensory, motor and visceral motor
* Path: rootlets from medulla, through jugular foramen continues in carotid sheath, branches into head and thorax
* Exit: Jugular foramen
* Innervations
* _Sensory_- from larynx, dura mater
* _Taste_- epiglottis and pharynx
* _Visceral sensory_- aortic bodies, aortic arch chemoreceptors, bronchi, heart, lungs, midgut and foregut
* _Motor_- palatoglossus, muscles of pharynx and larynx
* _Visceral motor_- as part of parasympathetic to smooth muscle in glands in pharynx, larynx, thoracic viscera, foregut and midgut.
35
Give an overview of the neck Fascia
* The deep fascia of the neck creates three important layers
* Pretracheal fascia- Pink
* Prevertebral fascia- Blue
* Investing fascia- Green
* Important as reduces the spread of infection
* Enables structures to move past each other in movement and swallowing etc
* Carotid sheath (Red) blends with the pretracheal and prevertebral fascia. It contains the
* Common and internal carotid arteries.
* Internal jugular vein.
* Vagus nerve (CN 10).
* Some deep cercal lymph nodes.
* Carotid sinus nerve
36
Identify the surface anatomy of the Neck
- the triangles
* The neck is divided into the anterior and lateral/posterior compartment by the presence of the _sternocleidomastoid muscle_.
* The anterior compartment is further subdivided into three paired triangles and one unpaired;
* the unpaired **submental triangle**,
* the paired **submandibular**, **carotid** and **muscular triangle**.
* The posterior compartment is _bounded posteriorly by the trapezius_ muscle and is divided into two triangles by the presence of the _posterior belly of omohyoid_ into:
* the large **occipital triangle**
* the smaller **omoclavicular triangle.**
37
Muscles and contents of the Anterior triangle
* Submandibular triangle bounded by: anterior and posterior bellies of digastric.
* Contains: the submandibular gland, facial artery and vein.
* Submental triangle bounded by: digastric.
* Contains lymph nodes.
* Muscular triangle bounded by: omohyoid, Supraclavicular Muscles SCM
* Contains supra and infrahyoid muscles
* Carotid triangle bounded by: omohyoid, stylohyoid, digastric, SCM.
* Contains: common carotid artery, IJV, hypoglossal nerve, vagus nerve, accessory nerve.
38
Give details of the muscles of the muscular triangle
_Suprahyoid muscles_
* Stylohyoid, digastric, mylohyoid and geniohyoid
* Innervation:
* Facial nerve for the stylohyoid and posterior belly of digastric.
* Mylohyoid by CN 5 and
* Geniohyoid by CN 12
_Infrahyoid muscles_
* Omohyoid, sternohyoid, thyrohyoid, and sternothyroid
* Innervation: C1-C3 of ansa cervicalis
39
Muscles and contents of the posterior triangle?
* Posterior triangle contains: Subclavian artery, EJV, Brachial plexus, CN 11, Cervical plexus
* Occipital triangle bounded by: SCM, trapezius and omohyoid.
* Supraclavicular triangle bounded by: clavicular head of SCM, clavicle and omohyoid
40
Describe arterial supply of the neck and throat
* Brachiocephalic ÷ Common carotid ÷ Internal and external carotids
* External carotid ÷ 6 branches to supply the neck and head
* Superior thyroid,
* Ascending pharyngeal,
* Lingual,
* Facial,
* Maxillary,
* Superficial temporal
* Subclavian arteries supplied by the inferior thyroid
* Internal carotid forms no branches until it's inside skull
41
Describe the Venous Drainage of the face and neck
* The Internal jugular vein (IJV) drains the brain, face, cervical viscera and neck muscles.
* External jugular vein
* Anterior jugular vein
42
Give an Overview of Cranial Nerve 11: Accessory
* Motor to Sternocleidomastoid and Trapezius.
* Exit: Jugular foramen.
43
Give an Overview of Cranial Nerve 8: Vestibulaochlear Nerve
* Type: Sensory, special somatic afferent for hearing, equilibrium and motion.
* Path: Divides into Vestibular and Cochlear Nerves.
* Exit: Internal acoustic meatus.
44
Give an Overview of the Cervical Plexus
* Roots of cervical plexus C1-C4 lies anterior to Levator scapulae.
* The cervical plexus provides cutaneous branches and deep motor branches (ansa cervicalis and phrenic nerve)
45
Give an Overview of the Brachial Plexus
* Roots of the brachial plexus C5-T1 appear between the anterior and middle scalene muscles.
* Five rami unite to form the three trunks of the brachial plexus
* Supply cutaneous and motor to the upper limb.
46
What are the 12 Cranial Nerves?
1. Olfactory: Smell.
2. Optic: Sensory nerve of vision it is more correctly called a brain tract.
3. Oculomotor: innervates four of the extrinsic eye muscles—muscles that move the eyeball in the orbit.
4. Trochlear: innervates an extrinsic eye muscle that hooks through a pulley-shaped ligament in the orbit.
5. Trigeminal: The trigeminal nerve provides general sensory innervation to the face and motor innervation to the chewing muscles.
6. Abducens: innervates the muscle that abducts the eyeball (turns the eye laterally).
7. Facial: This nerve innervates the muscles of facial expression as well as other structures.
8. Vestibulocochlear: sensory nerve of hearing and equilibrium/ balance
9. Glossopharyngeal: innervates structures in the tongue and pharynx,
10. Vagus: this nerve “wanders” beyond the head into the thorax and abdomen.
11. Accessory: carries motor innervation to the trapezius and sternocleidomastoid muscles.
12. Hypoglossal: The name hypoglossal means “below the tongue.” This nerve runs inferior to the tongue and innervates the tongue muscles.
47
Give an overview of the structure of the Nose
* Bones: comprised of paired **Nasal bones**, **Maxillae**, **Frontal bone** and **Septum**.
* Cartilages: comprised of 3 main **lateral nasal cartilage**, **major alar cartilage** and **septal cartilage**• Septum divides the chamber into two cavities
* Internal surface: lateral wall has three projections; **superior, middle and inferior conchae**
* Nasal cavity opens into the nasopharynx
48
Give an overview of the innervation and supply of the nose
* Supplied arterial branches from ophthalmic and maxillary.
* Nerve supply from the olfactory nerve, ophthalmic( V1) and maxillary (V2)
49
Give an Overview of Cranial Nerve 1: Olfactory
* Special sensory afferent nerve
* Exits through the Cribiform Plate
50
Explain Olfaction
* Olfaction is aided by the airflow through the nasal cavity
* Conchae help warm and moisten the air
* Olfaction receptors are in the epithelium lining the roof and walls,
* The epithelium secretes a mucus fluid, odoriferous gases are dissolved into the fluid and then detected by the olfactory nerves
51
Explain the purpose and organisation of the Paranasal sinuses
* Paranasal sinuses are air filled extensions of the nasal cavity
* Paired **F****rontal sinuses** in frontal bone that drain through frontonasal duct.
* **Ethmoidal cells (sinuses)** are invaginations in the ethmoid bone and drain into middle meatus (if anterior, or middle) or superior meatus (if posterior).
* **Sphenoidal sinuses** in sphenoid bone that drain into spheno-ethmoidal recess.
* Paired M**axillary sinuses** in maxilla drain into middle meatus.
52
# 7 of them
Name the bones that make up the Orbit
Frontal, Maxilla, Ethmoidal, Lacrimal, Sphenoidal, Temporal-zygomatic, Nasal
53
What are the three layers of the eye?
* Outer fibrous- Sclera and Cornea
* Vascular- Iris
* Inner- Retina
54
Give an Overview of Cranial Nerve 2: Optic
* Special afferent – sensory
* Exit from the Optic canal
Special Embryology: Optic stalk grows out and lens vesicle grows in
55
What are the Extraocular muscles that control eye movement?
- and how does the movement occur?
* Levator Palpebrae, Superior Oblique, Superior Rectus, Medial Rectus, Lateral Rectus, Inferior Rectus, Inferior Oblique
* movement occurs around 3 axes: vertical, transverse and anterioposterior
56
Give an Overview of the Cranial Nerve 3: Oculomotor
* Somatic Motor (general somatic efferent) to extraocular muscles and general visceral efferent-parasympathetic via short ciliary nerves to the ciliary body and sphincter pupillae.
* doesn't provide motor supply to the _superior oblique_ and _lateral rectus_
* exits through the Superior orbital fissure
57
Give an Overview of Cranial Nerve 4: Trochlear
* Somatic Motor (general somatic efferent) to **Superior Oblique**
* Found on the posterior view of the pons
* Exits through Superior orbital fissure
58
Give an Overview of Cranial Nerve 6: Abducent
* Somatic Motor (general somatic efferent) to **Lateral Rectus**
* Found in the pons at the floor of the fourth ventricles, at the same level as the facial colliculus
* Exit: Superior orbital fissure
59
What are clinical considerations related to the motor function caused by cranial nerves?
* Inability of specific eye movements (CN 3, 4, 6),
* Dilated pupil (CN 3),
* Ptosis (CN 3),
* Abnormal pupil reflex (CN 3)
* example of lesion:
* CN 3 – Aneurysm of cerebral a.
* CN 4 – Arbital fracture
* CN 6 – Cavernous sinus lesion
60
Describe how crying is able to take place
- lacrimal apparatus
- innervation
* Lacrimal apparatus consists of lacrimal glands
* **Orbital**
* **Palpebral**
* secretes lacrimal fluid which passes across the eye and into the _lacrimal papilla_, _lacrimal sac_ and to the _inferior meatus_ via the _nasolacrimal duct_.
* Innervation
* Parasympathetic: Secretomotor (via facial nerve CN7)
* Sympathetic: Vasoconstrictive (superior cervical ganglion, via internal carotid)
61
Describe the parasympathetic supply of the lacrimal gland
62
Give an overview of the Nerve supply of the Orbit
* CN2, 3, 4, V1 (5), 6, 7
* Sympathetic: stimulates dilator pupillae to let more light in.
* Parasympathetic: stimulates constrictor pupillae to let less light in.
63
What is the arterial supply of the Orbit?
* Ophthalmic Artery
* Infraorbital artery
* Central artery
64
Give an Overview of Cranial Nerve 5: Trigeminal
* Somatic (general sensory) and somatic motor to derivatives of 1st pharyngeal arch.
* Three divisions-
* Ophthalmic- V1
* Maxillary- V2
* Mandibular- V3
* Exits through the
* V1: Superior orbital fissure
* V2: Foramen Rotundum
* V3: Foramen Ovale
65
Give an Overview of V1- the Ophthalmic branch
* Sensory fibres skin, mucous membranes, conjunctiva, front of head and nose
* Branches into the **lacrimal**, **nasociliary**, **frontal**
* Exits through the Superior Orbital Fissure
