Anatomy exam 2 Flashcards
1
Q
list the muscles of facial expression and their actions
A
occipitofrontalis=elevates eyebrows
orbicularis oculi=palpebral part for blinking and sleeping and orbital part for squinting
orbicularis oris=closes and protrudes lips for speech and mastication
buccinator=sucking and whistling and mastication
zygomaticus major=elevates corners of mouth when smiling
zygomaticus minor=elevates corners of mouth when smiling
platysma=depresses lower lip and angle of mouth when pouting
depressor angularis oris=moves corners of mouth downwards
nasalis= controls shape of nostrils
2
Q
what nerve innervates the facial muscles?
A
facial nerve
3
Q
path of facial nerve through cranium
A
in through internal acoustic meatus then to facial canal then out through stylomastoid foramen
4
Q
what are the motor facial nerve branches
A
ten zebras bit my cheek
temporal
zygomatic
buccal branches
mandibular
cervical
posterior auricular
5
Q
what part of trigeminal nerve runs through the supraorbital notch?
A
V1-ophthalmic
6
Q
what part of the trigeminal nerve runs through the infraorbital foramen?
A
V2-maxillary
7
Q
what part of the trigeminal nerve runs through the mental foramen?
A
V3-mandibular
8
Q
what are the branches of V1
A
supraorbital
supratrochlear
lacrimal
infratrochlear
external nasal
9
Q
what are the branches of V2
A
zygomatic temporal
infraorbital
zygomatic facial
10
Q
what are the branches of V3
A
auriculotemporal
mental
buccal
lingual*
*inferioralveolar
11
Q
what infection typically affects V1 (ophthalmic portion of trigeminal nerve)
A
herpes zoster (shingles around eye)
12
Q
what nerve does trigeminal neuralgia affect?
A
V2
sudden and intense pain
tic douloureux
13
Q
describe bells palsy
A
muscles of facial expression paralyzed, drooping eyelid and mouth, corneal ulceration, weakend lips
14
Q
arteries of the face
A
facial artery
*branches from external carotid
*superior and inferior labial arteries
*terminates as angular artery
superficial temporal artery
*terminal branch of external carotid
internal carotid artery
*supraorbital branch
*supratrochlear branch
external carotid BRANCHES
*mental arteries
15
Q
arteritic anterior ischemic optic neuropathy
A
also known as giant cell arteritis, is caused by an ischemia of the posterior ciliary arteries and/or the ophthalmic artery. *associated with superficial temporal artery
16
Q
veins of the face
A
facial vein
*continuation of ANGULAR VEIN
*receives blood from SUPERIOR AND INFERIOR LABIAL VEINS
*joins COMMUNICATING BRANCH of RETROMANDIBULAR VEIN and drains into the INTERNAL JUGULAR VEIN
superficial temporal vein
*joins MAXILLARY vein to form RETROMANDIBULAR vein
*RETROMANDIBULAR joins POSTERIOR AURICULAR VEIN to form the EXTERNAL JUGULAR VEIN
17
Q
what passes through the parotid gland?
A
the facial nerve, retromandibular vein and external carotid artery
*remember postauricular FN branch doesnt go thru
18
Q
what emerges anterior out of the parotid galnd?
A
-5 terminal branches of facial nerve
-parotid duct
-transverse facial artery
19
Q
what emerges SUPERIOR of parotid gland?
A
-V3 auriculotemperol nerve
-superficial temporal vessels
20
Q
discuss parasympathetic innervation of parotid gland (preganglionic cell bodies, preganglionic fibers, postganglionic cell bodies, post ganglionic fibers)
A
preganglionic cb=brain
preganglionic fibers=lesser petrosal nerve, branch of CN 9 (glossopharyngeal)
postganglionic cb=otic ganglion
postganglionic fibers=track along auriculotemporal nerve (branch of V3)
21
Q
SCALP
A
s-skin
c-connective tissue
a-aponeurosis
l-loose connective tissue
p-pericranium
22
Q
what is the considered the danger area of the scalp?
A
the loose connective tissue layer because it is continuous with the root of the nose and fluid can spread in these areas
23
Q
why do scalp wounds bleed heavily and gape widely?
A
blead heavily because-anastomosis in layer 2
gape widely because-pull of 2 bellies of occipitofrontalis
24
Q
nerves of the scalp
A
spinal nerves
-greater auricular nerve (c2, c3) *anterior rami
-lesser occipital nerve (c2, c3) *anterior rami
-third occipital nerve (c3) *posterior rami
-greater occipital nerve (c2) *posterior rami
25
what connects sinuses to scalp and is a route for infections?
emissary veins
26
mumps
swelling of the parotid gland, parotiditis, aggravated by chewing
27
parotidectomy
partial or complete removal of the parotid gland, 80% of salivary gland tumors are in parotid
28
what type of joint is the temperomandibular joint?
TMJ is a synovial, condylar and hinge-type joint. The joint involves fibrocartilaginous surfaces and an articular disc which divides the joint into two cavities.
29
what are the articular surfaces that interact in the TMJ joint?
head of mandible, articular tubercle of temporal bone, mandibular fossa
30
what are the movements fo the TMJ joint?
elevation, depression, protrusion, retrusion, lateral mvmts
31
what are the muscles of mastication?
masseter, temporalis, lateral and medial pterygoid
32
origin, insertion and action of temporalis muscle
origin- neurocranial fossa
insertion- coronoid process of mandible
action- elevates and retrudes mandible
*CN V3= motor innervation
33
origin insertion and action masseter muscle
origin- zygomatic arch
insertion- ramus of mandible
action- elevates mandible and closes mouth
*CN V3= motor innervation
34
origin, insertion, and action of lateral pterygoid
origin-spehnoid
insertion-condylar process of mandible and joint capsul and articular disc of TMH
action-- bilaterally protrudes mandible and unilaterally moves side to side
35
origin, insertion, and action of medial pterygoid
origin-sphenoid
insertion- ramus of mandible
action- bilaterally elevates and protrudes mandible and unilaterally side to side mvmt
36
what divides TMJ into anterior and posterior sections?
articular disc of TMJ
37
what are the somatic sensory branches of V3 ?
auriculotemporal
-ear region
buccal
-maxillary gingivae, cheeks
lingual
-mandibular gingivae, floor of mouth, anterior 2/3 tongue
inferior alveolar*terminates into mental nerve
-mandibular teeth and gingivae, chin, lower lip
38
chorda tympani
-afferent special sensation from the anterior two-thirds of the tongue via the lingual nerve
- parasympathetic innervation to the submandibular and sublingual glands
39
what makes up the pterygoid venous plexus?
superficial temporal vein, maxillary vein, retromandibular vein
40
Regarding the cheeks what is the innervation of the buccinator muscle and the mucosa linin?
buccinator= facial nerve 7
mucosa lining= buccal branch V3, sensory
41
what is gingivae and what nerves innervate it?
-fibrous tissue lined w mucosa AKA gums
-upper teeth/gingivae innervated by maxillary sensory V2 *infraorbital and superior alveolar branches
-lower teeth/gingivae innervated by mandibular sensory CN V3 *mental and lingual branches
42
how many quadrants are the teeth divided into and what is in each quadrant?
4 quadrants
in each quadrant:
-2 incisors
-1 canine
-2 premolars
-3 molars *3rd molar is wisdom tooth
43
blood supply of maxillary teeth and mandibular teeth
maxillary=superior alveolar vessels which are branches of maxillary vessels
mandibular= inferior alveolar vessels which are branches of maxillary vessels also
44
lingual tonsil
lymphatic tissue in root of tongue
45
terminal sulcus
divides root and body of tongue
46
lingual papillae
taste buds in body of tongue
47
what are the extrinsic muscles of the tongue and their actions
-genioglossus=bilaterally protrudes tongue and unilaterally does side to side mvmt
-styloglossus=retrudes tongue
-hyoglossus=depresses tongue
48
what is the vasculature of the tongue?
lingual artery and lingual vein
49
somatic motor of tongue
CN 12 hypoglossal
50
somatic sensory of tongue
CN V3=lingual nerve, anterior 2/3
CN 9=glosspharyngeal, posterior 1/3
51
special sensory of tongue
CN 10=taste internal laryngeal near epiglottis (when taste goes down back of throat
CN 7=chorda tympani, taste anterior 2/3
CN 9=taste posterior 1/3
52
where does the parotid duct open?
2nd upper molar
53
parasympathetics of submandibular and sublingual glands
pregang bodies=brain
pregang fiber=CN 7/chorda tympani *track along LINGUAL NERVE (v3)
post gang bodies=wihing submandibular ganglion
54
pterygopalatine fossa
connects to nasal cavity and orbit, located between pterygoid plats of sphenoid and maxilla
55
nerves of the pterygopalatine fossa
CN V2-maxillary nerve
*goes from infraorbital nerve to maxillary teeth via superior alveolar nerves
*nasopalatine nerves
*posterior lateral nasal nerves
*greater/lesser palatine nerves
56
what nerves are responsible for muscular contraction of oropharynx (gag)
CN 9 and 10
57
genioglossus paralysis
-tongue shifts posteriorly
-why airway is inserted during general anesthesia
58
hypoglossal nerve injury
-possibly due to fractured mandible
-atrophy of ipsilateral side of tongue and tongue goes toward paralyzed side
***opposite if stroke
-lower motor neuron injury
59
what bones are on the roof of the nasal skeleton?
nasal bones, ethmoid and frontal bone
60
what bones make up the floor of the nasal skeleton
maxillae and palatine bones
61
what bones make up the lateral walls of the nasal skeleton?
maxillae, lacrimal bones, palatine bones, ethmoid, and inferior nasal conchae
62
what two conchae are in ethmoid bone
superior and middle concha
63
what drains into sphenoethmoidal recess?
sphenoidal sinus
64
what drains in superior meatus?
sphenopalatine foramen, ethmoid air cells
65
what drains into middle meatus?
semilunar hiatus; frontal, maxillary, anterior and middle ethmoid air cells
66
what drains into inferior meatus?
nasalacrimal duct and incisive canal
*which drains into oral cavity and why when you cry liquid comes out nose
67
function of sinuses
-air filled spaces lines w mucous membrane
-humidify air
-make skull lighter
-voice resonance
68
where does frontal sinus drain?
opens into semilunar hiatus via frontonasal duct
69
where do sphenoidal sinuses drain?
open into sphenoidal recess
70
where do ethmoidal sinuses drain?
they open into middle meatus and superior meatus
71
where do maxillary sinuses drain?
they open into semilunar hiatus of midle meatus
72
what sinuses are most commonly infected and why?
maxillary sinuses due to their superior position of their opening into the nasal cavity *can only drain when head is tilted to one side
73
somatic sensory of the nasal mucosa
V1
-anterior part
V2
-middle and posterior part
-nasopalatine nerve
-posterior lateral nasal nerves
74
what CN innervates smell in nasal mucose
CN 1 (cribiform foramina)
75
parasympathetics of the nasal mucosa
Preganglionic CB
-CN 7 (greater petrosal nerve) joins the DEEP PETROSAL NERVE (symp) to form NERVE OF PTERYGOID CANAL (mixed s and ps fibers)
Postganglionic CB= in pterygopalatine ganglion
Postganglionic fibers= hitch ride with V2
76
what is the blood supply of the nasal cavity?
-anterior and posterior ethmoidal arteries *branches of ophthalmic a
-facial artery
-sphenopalatine arteries *branches of maxillary artery via sphenopalatine foramen
77
Kiesselbach area
anastomosing arteries that are in nasal cavity; lots of nose bleeds here
78
venous drainage of nasal cavity
-facial vein
-sphenopalatine vein
-ophthalmic vein
79
what is the incisive fossa and what nerve innervates it?
-it is a pathway in the hard palate for nerves and blood supply to get into the oral cavity
-somatic sensory= nasopalatine nerve V2
80
what arteries/vessel are coming out of greater palatine foramina and what innervates it?
-greater palatine nerves V2 (somatic sensory)
-greater palatine vessels of maxillary artery
81
what arteries/vessel are coming out of lesser palatine foramina and what innervates it?
-lesser palatine nerves V2 (somatic sensory)
-lesser palatine vessels of maxillary artery
82
what movements occur in the soft palate?
elevation and depression
83
what are the muscles of the soft palate and what are they innervated by?
1 levator veli palatini (CN 10); ELEVATE PALATE
2 tensory veli palatini (CN V3); TENSE PALATE
3 palatoglossus (CN 10); DEPRESS PALATE AND ELEVATE TONGUE
4 palatopharyngeus (CN 10); TENSE PALATE
84
what is the blood supply to the palatine tonsils?
facial artery that branches into ascending pharyngeal artery
85
describe structure of oropharynx
bound by soft palate superiorly and epiglottis inferiorly, laterally it is bound by palatoglossal and palatopharyngeal arches
86
how does the nasopharynx communicate with the nasal cavity?
choanae
87
how does the nasopharynx connect with the middle ear?
the auditory tube which the muscles of the soft palate open and close during swallowing
88
where are the pharyngeal tonsils located and what are they called when they are inflamed?
nasopharynx, adenoids
89
what is the external acoustic meatus made up of?
1/3 cartilage
2/3 temporal bone
90
what structure seperates the external and middle ear?
tympanic membrane
91
describe the tympanic membrane through an otoscope
cone shaped, has cone of light that reflects when looking with otoscope, you can see impression of malleus
92
what are the 3 structures of the malleus?
lateral process, handle, umbo
**umbo forms center of eardrum
93
what is the sensory innervation for the internal and external surface of the tympanic membrane?
internal= glossopharyngeal nerve
external=auriculotemporal nerve V3 and SMALL portion is vagus
94
what structures make up the middle ear?
epitympanic cavity, auditory tube, tympanic cavity
95
boundaries of the middle ear
anterior =carotid canal and auditory tube
posterior=mastoid antrum/air cells
medial=promontory, oval, and round windows
lateral=tympanic membrane
roof= middle cranial fossa
floor=internal jugular vein
96
mastoiditis
occurs when otitis media spreads to mastoid air cells
97
what are the auditory ossicles?
malleus, incus, stapes
98
malleus 'hammer'
99
Your pt comes in experiencing hyperacusis, which cranial nerve is involved?
CN V3- innervates tensor tympani muscle
100
what are the two parts of the malleus and what muscle is involved?
handle (attached to tympanic membrane) and head; tensory tympani is innervated by CN V3
tensor tympani stops handle from shaking too much
101
what is the function of the incus?
transfers motion from tympanic membrane
102
what is the muscle that controls the stapes and what is it innervated by?
the stapedius muscle, innervated by CN VII
103
what are the nerves of the middle ear?
FACIAL NERVE
3 branches:
1-greater petrosal nerve PS=LACRIMAL GLAND, GLANDS IN NASAL AND PALATINE MUCOSA
*deep petrosal nerve
*nerve of pterygoid canal
2-nerve to stapedius
3-chorda tympani *TASTE ANTERIOR 2/3 *PS-SUBMANDIBULAR AND SUBLINGUAL GLANDS
GLOSSOPHARYNGEAL NERVE
3branches
-tympanic nerve (gives rise to tympanic plexus)
-lesser petrosal nerve (pregang PS fibers synapse in otic ganglion before innervating parotid gland)
-other branches of CN 9 which go to posterior 1/3 tongue, pharynx (gag) and stylopharyngeus muscle
104
what is the function of the stapes?
transmits sound vibrations from the incus to the oval window
105
where are the cell bodies for the special sensory taste of the chorda tympani (CN 7)
geniculate ganglion; taste to anterior 2/3 of tongue
106
tympanic plexus
-middle ear
-somatic sensory= surface tympanic membrane; mucosa of auditory tub
**how we get somatic sensory to middle ear
107
what are the 3 parts of the inner ear
petrous part of temporal, auditory apparatus, vestibular apparatus
108
what is the function of the round window in the inner ear?
allows fluid in the cochlea to move
109
what are the semicircular canals and what parts are they seperated into?
fluid filled ducts in the middle ear seperated into anterior, posterior, and lateral
110
what is the special sensory of the inner ear
hearing innervated by the vestibulocochlear nerve that exits through the internal acoustic meatus
*cochlear nerve is hearing
*vestibular nerve is balance
111
explain sound sound transmission through the ear
sound goes in external acoustic meatus and then hits tympanic membrane which activates stapes to hit oval window and vibrate fluid in cochlea which then travels out through cochlear nerve
112
what is the fibrous outer layer of the eye
sclera and cornea
113
what is the vascular middle layer of the eye
choroid, ciliary body, and iris
114
what is the inner layer of the eye
retina
115
functions of the sclera
-provides attachment for extraocular muscles
-keeps shape of the eye
-continuous with optic sheath (dura mater)
116
what are the chambers of the eye
anterior- between cornea and iris
posterior-between iris and lens
vitreous chamber- between lens and retina
117
cornea
-aids in light refraction
-innervated by CN V1 (ophthalmic)
-avascular
-nutrients and stuff go to cornea via fluids bc avascular
118
choroid
-the red layer
-blood supply to outer layers of retina
-branches of ophthalmic artery
119
ciliary body
-connects choroids with circumference of iris
-muscular and vascular function
-attaches to lens via ZONULAR FIBERS
-CILIARY PROCESSES secrete aqueous humor
120
zonular fibers
attach ciliary bodies to lens
121
how does the lens change shape and accomodate
the lens is flat when the ciliary muscle relaxes and it becomes spherical (or accomodates) when ciliary muscle contract *works with zonular fibers
innervated by CN 3- parasympathetic
122
what is accomodation?
change in curvature of lens to allow for focusing on objects as they approach the eye
123
describe the state of the zonular fibers for distant vision and for near vision
distant- zonular fibers under tension
near- zonular fibers relaxed
124
what is presbyopia?
cant focus on near objects bc inability for lens to accomodate due to it being less elastic with age
125
lens
avascular
no innervation
refracts light
126
what causes cataracts?
clusters of proteins build up in lens causes opacity of the lens
127
how do we get changes to pupil size?
iris sphincter pupillae and iris dilator pupillae
sphincter=PS CN 3
dilator=symp superior cervical ganglion
128
retina
-visual retina and non visual retina
129
blood supply of retina
inner retina=central retinal artery
outer retina=choroid
130
what structures are included in the retina?
optic disc (blind spot) fovea and macula
131
what part of the eye has the sharpest vision?
fovea/macula
132
detached retina
seperation of inner neural and outer pigemented layers
*retina will detach if vitreous humor leaks also
133
what is the function of aqueous humor?
-produced by ciliary processes
-nourishment to cornea and lens
**circulates posterior to anterior chamber and drained through canal of schlemm into scleral venous plexus
134
glaucoma
-generally caused by failure to drain aqueous humor via canal of schlemm
-this increases intraocular pressure
135
vitreous humor
-acellular viscous gel
-99% water
-fills space between lens and retina
136
what are the muscles of the EYELIDS
-orbicularis oculi (palpebral part)
-superior tarsal muscle
-levator palpebrae superioris
137
what cranial nerves open and close the eye?
CN 3- opens eye
CN 7- closes eye
138
what nerve transmits somatic sensory info through the upper and lower eyelid?
upper eyelid- CN V1
lower eyelid- CN V2
139
what muscle closes the eyelids
the orbicularis oculi
*palpebral part=blinking
*orbital part=squeezing
140
what muscles open the eyelids?
levator palpebrae superioris- CN 3
mullers (superior tarsal)-sympathetic
141
Ptosis
-drooping eyelid
-can happen if mullers is intact still
-CN 3 damage
142
Horner's syndrome
ptosis and pupil constriction
*can happen from stroke, tumor, or spinal chord injury
143
tarsal gland
responsible for lipid secretion on the eyelids
*eye boogers come from overactive tarsal glands
144
what are the 4 parts of the conjunctiva
bulbar conjuctiva (covering sclera), lateral angle, medial angle, palpebral conjunctiva (covering eyelid)
145
lacrimal appratus(what is it, where does it drain, innervation)
-drains into lacrimal sac and then nasal cavity
-tear system
-innervated by CN 7 (parasympathetic)
146
extraocular muscles
LR6, SO4, AO3
lateral rectus CN 6
superior oblique CN 4
all other CN 3
147
what are the actions of the extraocular muscles?
superior rectus=elevation, adduction, intorsion
inferior rectus=depression, adduction, extortion
medial rectus=adduction
inferior oblique=elevation, extortion, abduction
lateral rectus=abduction
superior oblique=depression, intorsion, abduction
148
what nerves and vessels go through the superior orbital fissure?
CN 3
CN 4
CN V1 and branches
CN 6
ophthalmic veins
sympathetic fibers
149
what nerves and fibers go through the optic canal?
CN 2
ophthalmic artery
central retinal artery
150
what nerves and fibers go through the inferior orbital fissure?
-infraorbital nerve (CN V2)
-infraorbital artery
-inferior ophthalmic vein ( PS branch from CN 7)
151
what is the superficial nerve supply of the orbit?
-supraorbital
-frontal (CN V1)
-CN 4
152
what is the deep nerve supply of the orbit?
-lacrimal
-CN 6
-CN V1
-CN 3
-nasociliary
- CN 2
cut part of trochlear (4) and frontal
153
what is the arterial supply of the orbit and where do the arteries branch from ?
*branch from internal carotid
-supratrochlear
-supraorbital
-ciliary
-lacrimal
-ophthalmic
-central artery of retina
154
what is the venous drainage of orbit?
-supraorbital vein
-vorticose veins
-superior ophthalmic vein
-inferior ophthalmic vein
-infraorbital vein
-angular vein
-facial vein
**** blood leaves orbit via cavernous sinuses, facial vein, and pterygoid plexus
155
what happens to eyesight if there is a blockage of central retinal artery?
-Anterior ischemic optic neuropathy (AION) is a sudden loss of vision
-unilateral
-older individuals
156
what happens to eye sight if there is a blockage of the central retinal vein?
-thrombophlebitis of cavernous sinus
-slow and painless vision loss
157
what is often the 1st sign of oculomotor nerve compression?
ipsilateral slowness of pupillary light response
158
oculomotor nerve palsy
-affects most of ocular muscles
-eye droops down and out
-dilated/nonreactive pupil
159
abducent nerve palsy
-lateral rectus paralyzed
-eye gets stuck inward
160
when eye ABducted what is elevation and depression achieved by?
superior (elevation) and inferior (depression) rectus
161
when eye is ADducted what is elevation and depression achieved by?
inferior (elevation) and superior (depression) oblique
162
what is clinically significant about the hyoid bone?
if hyoid broken it usually means someone was strangled or hung themself
163
what is in the superficial cervical fascia?
-fat
-cutaneous nerves
-superfiical vessels
-superficial lymph nodes
-platysma
164
what are the 3 layers of the deep cervical fascia?
-investing layer
-pretracheal layer
-prevertebral layer
*note the investing layer is what wraps around abs
165
what structures does the investing layer invest?
-trapezius
-SCM
-submandibular glands
-parotid glands
166
what does the pretracheal layer invest?
muscular part: infrahyoid muscles
visceral part:
-thyroid gland
-trachea
-esophagus and pharynx
167
what regions does the VISCERAL part of the pretracheal layer connect?
provides connections from the cervical region to the mediastinum
168
what regions does the prevertebral layer connect?
extends into the axillary sheath connecting the cervical region to the axillae
169
what structures does the prevertebral layer invest?
scalenes and intrinsic back muscles
*tp question about this
*know the prevertebral layer invests erector spinae
170
what does the carotid sheath connect?
cranial cavity to mediastinum
171
what does the carotid sheath invest?
-common/internal carotid arteries
-internal jugular vein
-VAGUS NERVE
-deep cervical lymphnodes
172
what does the retropharyngeal space connect?
cranial cavity to mediastinum
*like carotid sheath
173
what happens if there if an infection in you retropharyngeal space and why?
difficulty speaking and swallowing because infection swells the space and pushes up against structures
174
what might you see in a pt with a condition affecting their anterior triangle?
difficulty swallowing, goiter (enlargement of thyroid)
175
what is responsible for motor innervation to infrahyoid muscles?
ansa cervicalis (c1-c3)
176
what are the infrahyoid muscles and their actions?
-sternohyoid (depress hyoid)
-omohyoid *note inferior belly in posterior triangle
-sternothyroid (depresses hyoid and LARYNX)
-thyrohyoid (depresses hyoid and can ELEVATE LARYNX)
177
what part of neck are the infrahyoid and suprahyoid muscles located?
anterior triangle
178
what are the suprahyoid muscles innervated by?
mylohyoid= CN V3
digastric= CN V3 and 7
stylohyoid= CN 7
geniohyoid= cervical plexus
179
what are the suprahyoid muscles and what is their action?
elevate hyoid
-mylohyoid
-digastric
-stylohyoid
-geniohyoid
180
what is a subdivision of the anterior triangle and its significance?
-subdivision of anterior triangle
-bifercation of carotid artery
-this is where you can feel carotid pulse
181
what might you see clinically if a pt has something affecting posterior triangle?
neck pain, numbness, and tingling in upper extremities
182
what muscles are within the posterior triangle?
trapezius, SCM, spelinius capitis, levator scapulae, scalenes, omohyoid (inferior belly)
183
what is the action and innervation of the scalenes?
action=laterally flex neck or elevate ribs
innervation=cervical plexus
184
what nerve innervates the SCM and traps?
CN XI (spinal accesory)
185
cervical plexus
ventral rami c1-c4 (ansa cervicalis is part of this)
BRANCHES
-lesser occipital nerve
-greater auricular nerve
-transverse cervical nerves
-supraclavicular nerves
186
where would you inject a nerve block in the lateral cervical region?
a cervical plexus block would involved anesthetic being injected into several points along SCM
187
what nerve does the ansa cervicalis hitchike on to?
hypoglossal CN XII (not a branch of it tho)
188
phrenic nerve
C3-C5
-innervateds diaphragm, parietal pleura, fibrous pericardium, and parietal layer of serous pericardium
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what would happen if c4 was damaged?
diaphragm could be paralyzed bc damages phrenic nerve
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what makes up the brachial plexus and list the roots and trunks and branches
roots=ventral rami C5-T1
trunks=superior, middle inferior
branches=
musculocutatneous
axillary
radial
medial
ulnar
*posteiror triangle
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what structures are the roots of the brachial pelxus location between?
middle and anterior scalene
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what are the branches of the superior trunk of the brachial plexus?
suprascapular nerve
Army over Navy
-artery over ligament and nerve under ligament
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veins of the neck
Anterior jugular veins (empty into external jugular veins)
EXTERNAL JUGULAR VEINS*know its superficial to SCM
-Posterior auricular and retromandibular
*Receive blood from scalp and face
-Transverse cervical, suprascapular, anterior jugular
*Receive blood from neck and shoulder
INTERNAL JUGULAR VEINS
*Within carotid sheath
-Receive blood from face/neck via facial and lingual vein
-Join subclavian veins at venous angle to form brachiocephalic veins
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where would you insert a need to perform an internal jugular vein puncture (IJ)
insert need between sternal and clavicular head of SCM
*do on right side bc bigger and straighter
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where is a central line placed? aka subclavian vein puncture
between rib 1 and the clavical where the sublcavian vein goes to the axillary vein
*risk of subcalvian artery or pleura puncture
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ateries of the neck
-On right side= brachiocephalic trunk bifurcates and forms right subclavian artery and right common carotid artery
-On left side= arch of aorta breaks into left subclavian artery and left common carotid artery
COMMON CAROTID ARTERIES- you can feel carotid pulse here
**Divides into internal and external carotid artery
-External carotid artery branches
*Occipital artery, facial artery, lingual artery, ascending pharyngeal artery, superior thyroid artery
**Carotid body and sinus in carotid veins; carotid body has chemoreceptors for blood composition and carotid sinus has baroreceptors for blood pressure
SUBCLAVIAN ARTERIES
-Internal thoracic artery
-Vertebral artery
-Thyrocervical trunk
*Inferior thyroid artery, transverse cervical artery, suprascapular artery
*transverse cervical artery also has branches
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cartoid sinus massage
*NEVER DO BILATERALLY
-mechanical stimulation that lowers heart rate
-body fixes BP by sending signals through CN 9 to brainstem and then to CN 10 which lowers HR and therefore blood pressure
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your pt is on meds that suppress PS activity, how might this affect the heart?
could make tachycardic bc vagus slows down HR and this is being supressed
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which vessel directly supplies the rhomboids?
dorsal scapulary artery
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arterial supply of the shoulder
the subclavian artery branches into thyrocervical trunk which branches into transverse cervical artery and suprascapular artery
transverse cervical artery has 2 branches
1-superficial branch (trap)
2- deep branch aka dorsal scapular artery (rhomboids, levator scapulae)
Suprascapular artery
*army over navy like suprascapular nerve
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thoracic outlet syndrome
compression of subclavian artery that leads to edema, slow capillary refill, and distended superficial veins
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lymphatics of the neck
-Right lymphatic duct
o Entering right venous triangle
-Thoracic duct
o Entering left venous angle; this is where most things drain
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nodes of the neck
*Superficial cervical nodes
-Submental and submandibular nodes
*Deep cervical nodes
-Along internal jugular vein
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blood supply of the thyroid gland
*Superior thyroid artery (branches from external carotid artery)
*Inferior thyroid artery (from thyrocervical trunk)
*10% of ppl have thyroid ima artery that branches from brachiocephalic trunk
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drainage of the thyroid gland
-Superior thyroid vein (to IJV)
-Middle thyroid vein (to IJV)
-Inferior thyroid vein (to brachiocephalic vein)
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what are the different parts of the pharynx?
Nasopharynx
Oropharynx
laryngopharynx
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what is the thyroid gland invested by?
visceral part of the pretracheal layer
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constrictor muscles of the pharynx
Constrictor muscles divided into superior, middle, inferior (CN 10)
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Describe the motor and sensory innervation of the pharynx. Indicate the nerves responsible for the gag reflex (sensory and motor).
*Glossopharyngeal nerve
Sensory=mucosa of oropharynx
Motor=stylopharyngeus
*Vagus nerve
Sensory=mucosa of laryngopharynx
Motor=constrictor muscles of pharynx
*sensory and motor at piriform recesses
*Gag reflex
Sensory=CN 9
Motor=CN 10
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where do constrictor muscles of the pharynx fuse?
posteriorly at the RAPHE
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what is epiglottitis and why is it life threatening?
it is when epiglottis is inflamed, life threatening bc it can block airway
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what does air go through to produce sound in larynx?
it goes through rima glottidis to vibrate the vocal folds
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where would you perform a tracheotomy and cricothyrotomy?
tracheotomy-between tracheal rings
cricothryrotomy-cricothryoid membrane but only for emergency bc it is easier to palpate when you dont have imaging
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while performing tracheostomy you nick a vessel, where does this vessel branch from?
thyroid ima artery that branches from brachiocephalic trunk
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extrinsic muscles of the larynx (these work to move larynx as a whole)
*Suprahyoid muscles= elevate larynx
* Mylohyoid
* Digastric
* Stylohyoid
* geniohyoid
*Infrahyoid muscles= depress OR elevate larynx
* Elevator of larynx=thyrohyoid
* Depressor of larynx=sternothyroid
* Note these move as a whole and are majority motor innervated by ansa cervicalis
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intrinsic muscles of larynx (these move specific parts of larynx)
* Aryepiglottic= close laryngeal inlet
* Lateral cricoarytenoid=adduct vocal folds
* Transverse arytenoid=adduct vocal folds
* Oblique arytenoid=adduct vocal folds
* Posterior cricoarytenoid= abduct vocal folds
* Cricothyroid= stretch/tense vocal folds
* Thyroarytenoid=relax vocal folds
* Vocalis= fine control of vocal folds
***most innervated by INFERIOR LARYNGEAL NERVE
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Horner's syndrome
*Occurs from damage to sympathetic nervous system in cervical or thoracic level
*PAMela (patient presentation)
Ptosis
Anhidrosis
Miosis
*Heterochromia= varied iris pigmentation when occurs in infants
