anatomy review for NMBE Flashcards
blinking - what nerve?
facial nerve
The oculomotor nerve innervates the muscles moving the eyeball, except the rectus lateralis muscle, which is supplied by the abducens nerve. The supraorbital nerve and the lacrimal nerve are branches of the trigeminus nerve.
The optic nerve is part of a reflex protecting the cornea from visual danger but not at all involved in the process of blinking.
In the forearm, the lateral antebrachial cutaneous nerve arises from the
musculacutaneous
Which nerve arises from the medial cord and if injured results in numbness of the medial aspect of the forearm?
The medial antebrachial cutaneous nerve (medial cutaneous nerve of the forearm) arises from the medial cord of the brachial plexus. It lies between the axillary artery and vein, and descends medial to the brachial artery. Below the middle of the arm it pierces the fascia, becomes subcutaneous and divides into anterior and ulnar branches. The anterior branch supplies the skin on the anterior and medial side of the forearm and the ulnar branch supplies the skin on the medial and posteromedial aspects of the forearm.
The middle meningeal artery descends through which foramen?
F. spinosum
severe facial injuries; there is marked ptosis of her left eye. The left pupil is dilated, but the right eye is normal.
ciliary ganglion
Question Highlights
What muscle’s denervation is responsible for the blurred vision in this case?
Pupilloconstrictor
Correct Answer: Pupilloconstrictor
The correct response is the pupilloconstrictor. Injury to this muscle causes mydriasis and results in blurry vision and light sensitivity.
The clinical picture is suggestive of injury to the oculomotor nerve, which is the third cranial nerve. It innervates the following muscles:
Superior rectus Inferior rectus Medial rectus Inferior oblique Pupilloconstrictor Levator palpebrae superioris The superior rectus causes elevation of the eye with adduction.
The inferior rectus causes depression of the eye with adduction.
The medial rectus causes adduction of the eye.
The levator palpebrae superioris causes elevation of the eyelid.
Causes of third cranial nerve palsy include:
Intracranial and intraorbital lesions (e.g., neoplasms)
Head and orbital trauma
Ocular myopathies
Cerebral aneurysms
Transtentorial herniation
The valve of Thebesius
Is a semicircular fold of the lining membrane of the right atrium, protecting the orifice of the coronary sinus. It prevents the regurgitation of blood into the sinus during the contraction of the auricle. This valve is occasionally double
ankle jerk is a reflex twitch of the triceps surae (gastrocnemius and soleus) induced by tapping the tendo calcaneus (Achilles tendon). Where is the reflex center?
first or 2nd sacral spine
Which one of the following cranial nerves passes through the stylomastoid foramen
facial nerve
How does the lumbar spine differ from the cervical and thoracic vertebrae?
There is an absence of costal facets in the lumbar and sacral spine
?
Anterior to the trachea, anterior and medial to the vagus nerve, posterior and medial to the sternothyroid muscle, and medial to the jugular veins
The lower posterior part of the acetabulum is contributed by
the ischeum
The etiology of facial paralysis is multiple. If a patient has bilateral function of the frontalis and the orbicularis oculi but only unilateral function of the rest of the muscles of facial expression, the lesion is most likely to be at which level? Answer Choices Ico-marker Ico-abct 1 Stylomastoid foramen Ico-marker Ico-abct 2 Facial nucleus in the pons Ico-marker Ico-abct 3 Supranuclear level Ico-marker Ico-abct 4 Middle ear Ico-marker Ico-abct 5 Facial cana
Supranuclear level
Show Explanation
Which of the following ligaments arises from the floor of the acetabular fossa and attaches to the fovea capitus of the femur?
Ligament of the head of the femur
The temporalis muscle is innervated by which nerve?
Mandibular branch of the trigeminal nerve
A patient is not only unable to turn the eyeball laterally, but the eyeball seems to be pulled medially also. This problem indicates damage to the
If this nerve is damaged, not only will the patient be unable to turn the eyeball laterally, but because of the lack of muscle tonus to the lateral rectus muscle, the eyeball will be pulled medially.
Abducent nerve
The small abducent nerve (CN-VI) originates from a nucleus within the pons and emerges from the lower portion of the pons and the anterior border of the medulla oblongata. It is a mixed nerve that transverses the superior orbital fissure of the orbit to innervate the lateral rectus eye muscle. If this nerve is damaged, not only will the patient be unable to turn the eyeball laterally, but because of the lack of muscle tonus to the lateral rectus muscle, the eyeball will be pulled medially.
Damage to the trochlear nerve (CN-IV) impairs movement in the direction permitted by the superior oblique eye muscle. A person whose oculomotor nerve (CN-III) is damaged may have a drooping upper eyelid or a dilated pupil or be unable to move the eyeball in the directions permitted by the four extrinsic muscles innervated by this nerve. Trauma to the facial nerve (CN-VII) results in inability to contract facial muscles on the affected side of the face and distorts taste perception, particularly of sweets. Damage to both vagal nerves (CN-X) will cause death. The injury of one nerve causes vocal impairment, difficulty in swallowing, or other visceral disturbances.
The central perineal tendon
a mass of tissue present in central area in front of the anus and behind the perineal membrane.
All four mastication muscles are supplied by which of the following?
Mandibular division of the trigeminal nerve
Which one of the following muscles of the pharynx has its origin in the lower part of the stylohyoid ligament and from the lesser and greater cornua of the hyoid bone?
Middle Constrictor muscle
The ischiopubic or conjoint ramus is formed when the ischial ramus joins which of the following structures?
Inferior pubic ramus
Branches of the maxillary artery gain entrance to the pterygopalatine fossa via which of the following structures?
Pterygomaxillary fissure
A 42-year-old man sees his physician because of hearing loss and a sensation of the room spinning while he is standing. A lesion to which cranial nerve would most likely result in these symptoms?
CN VIII
A 14-year-old girl arrives at the dentist’s office to have a cavity in her lower right incisor filled. Which nerve will the dentist most likely block before beginning the procedure?
CN V-3
Sweat glands within the S2 dermatome along the posterior region of the thigh most likely receive innervation via preganglionic sympathetic neurons originating from which of the following central nervous system levels?
L2 spinal cord level
Radiographic imaging reveals puss building up around the ear ossicles. Which of the following is the most likely location of the puss?
middle ear
A 27-year-old man is brought to the emergency department after being involved in an automobile accident. Radiographic imaging studies indicate that he has sustained a fracture of the L1 vertebral arch and has a partially dislocated bone fragment impinging upon the underlying spinal cord. Which spinal cord level is most likely compressed by this bone fragment?
A
C1
s3
In an adult, the caudal end of the spinal cord is at the L1–L2 vertebral level. Therefore, a bone fragment from the L1 vertebra would have the potential of touching the caudal end of the spinal cord, not the L1 spinal cord level. C1, L2, and T4 are spinal cord levels superior to the fracture.
A blue dye is placed into the right eye of a patient to assess the patency of the tear duct system. Assuming the lacrimal system is patent, at which structure would the physician see the eventual flow of the dye?
Inferior nasal meatus
The nasolacrimal duct drains into the nasal cavity, into the space inferior to the inferior nasal concha called the inferior nasal meatus.
The pterygopalatine ganglion houses postganglionic neuronal cell bodies for visceral motor (parasympathetic) components of which of the following cranial nerves?
CN VII
The ganglia associated with the sympathetic trunk typically contain which of the following cell bodies?
Preganglionic sympathetic cell bodies are located in the lateral horn gray matter of the T1–L2 spinal cord levels.
Synapses occur with postganglionic sympathetic neurons within the paravertebral ganglia of the sympathetic trunk for sympathetics en route to blood vessels, sweat glands, and arrector pilae muscles in the associated dermatome. Preganglionic sympathetic cell bodies are located in the lateral horn gray matter of the T1–L2 spinal cord levels.
A 26-year-old woman presents with unilateral paralysis of facial muscles consistent with Bell’s palsy. Which of the following cranial nerves is most likely affected that would result in this patient’s condition?
Facial nerve
: The facial nerve (CN VII) innervates muscles of facial expression. Therefore, a lesion of CN VII would result in unilateral facial paralysis. The trigeminal nerve (CN V) is responsible for conducting sensory information from the skin of the face, but does not provide motor innervation.
During sexual arousal, an erection is caused by a dilation of arteries filling the erectile tissue of the penis. Innervation of the penile arteries is provided by which of the following nerves?
The genitofemoral, ilioinguinal, and pudendal nerves are all somatic and do not cause an erection.
The sacral splanchnics are responsible for transporting the sympathetics and will result in ejaculation.
Pelvic splanchnic nerves
Dilation of penile arteries resulting in blood filling erectile tissue is under parasympathetic innervation. Therefore, the pelvic splanchnic nerves carry parasympathetic nerves to the penile arteries. The genitofemoral, ilioinguinal, and pudendal nerves are all somatic and do not cause an erection. The sacral splanchnics are responsible for transporting the sympathetics and will result in ejaculation. Remember, “point” and “shoot” (“p” parasympathetic; “s” sympathetic)
For general surgical procedures, anesthetics and muscle relaxants are used routinely. However, anesthetics and muscle relaxants may decrease nerve stimulation to skeletal muscles, including the intrinsic muscles of the larynx, which results in closure of the vocal folds. Therefore, tracheal intubation is necessary. Which of the following intrinsic muscles of the larynx may be unable to maintain an open glottis because of the anesthetics?
Posterior cricoarytenoid muscles
The posterior cricoarytenoid is the only muscle in the list of choices, which, when stimulated to contract, will open the vocal folds and therefore open the glottis. The other muscles (i.e., cricothyroid, lateral cricoarytenoid, thyroarytenoid, and the transverse arytenoids) will either tense or close the vocal folds.
After surgery, a 62-year-old patient began experiencing complications. After examination, the physician determined that an important structure located immediately behind the ligamentum arteriosum was damaged during surgery. Which of the following symptoms was the patient most likely experiencing?
Hoarseness of voice
The left vagus nerve gives rise to the recurrent laryngeal nerve, located immediately behind the ligamentum arteriosum. The recurrent laryngeal nerve innervates laryngeal muscles that are associated with speaking. Therefore, if the recurrent laryngeal nerve is damaged, the patient will experience a raspy voice or hoarseness.
A 19-year-old woman is taken to the emergency department after falling and lacerating her scalp. The scalp bleeds profusely when cut because the arteries most likely:
Bleed from both cut ends due to rich anastomoses of scalp vessels.
Which of the following paired muscles of the back is primarily responsible for extension of the vertebral column?
Iliocostalis
A surgeon dissects through subcutaneous fat in the neck and identifies lobulated, slightly paler glandular tissue that will be surgically removed. A vein coursing superficial to the gland and an artery coursing deep to the gland are isolated. The hypoglossal nerve is retracted to avoid risk of damage during the procedure. This surgery is most likely occurring in which of the following cervical triangles?
Submandibular
The question outlines the course of the facial vessels in relation to the submandibular salivary gland (the vein is superficial and the artery is deep). The hypoglossal nerve (CN XII) courses within the submandibular triangle. Therefore, the relation of the facial vessels to the submandibular gland and identification of CN XII indicate the location of the surgery within the submandibular triangle.
nerve roots going with long thoracic?
c 5 6 7 - keeps the wing flying to heaven - scapula winging
foramina of V - mneumonic for this trigeminal nerve?
Standing Room Only (SRO) for the Superior orbital fissure, foramen Rotundum, and foramen Ovale, which transmit cranial nerves (CNs) V1, V2, and V3, respectively.
branches out of aorta?
three coming out -
heading to right - brachiocepahlic - that divides into the right subclavian and right common carotid (which then divides into external and internal carotid -
left common carotid
left subclavian
The arch of the aorta has three branches: the brachiocephalic artery, which itself divides into right common carotid artery and the right subclavian artery, the left common carotid artery, and the left subclavian artery. These arteries provide blood to both arms and the head
related to the rectouterine pouch - woman with endometriosus?
Dr sees: The uterosacral ligaments have nodules…
placing a central line?
aim the needle lateral to the common carotid artery because the line should be placed within the internal jugular vein
Within this sheath, the common carotid artery is medial, the internal jugular vein is lateral, and the vagus nerve runs posteriorly.
Placing a central line requires a needle to be inserted into the chosen vein; a wire is then threaded through the needle, and the catheter is passed over the wire and into the vein. The most common central veins used for access are the internal jugular, femoral, and subclavian veins. In the neck, the internal jugular vein runs alongside the common carotid artery and the vagus nerve within a fibrous, tubular sheath called the carotid sheath, shown in the red portion in the image.
Within this sheath, the common carotid artery is medial, the internal jugular vein is lateral, and the vagus nerve runs posteriorly. Therefore when placing the central line, the emergency physician should aim the needle lateral to the common carotid artery because the line should be placed within the internal jugular vein. This procedure can be performed by using ultrasound guidance or external judgment of anatomy. The emergency physician can easily palpate the common carotid and should aim the needle lateral to the pulse to enter the internal jugular.
straddle injuries to males?
can lead to damage of the urethra, specifically the bulbous urethra.
A complete rupture of the anterior part of the bladder wall could result in flow of urine into the retropubic space. A penile urethra rupture would most often occur following a penetrating injury or catheter insertion. Membranous urethra rupture typically occurs in high-velocity pelvic fractures as this is the weakest point of attachment. Prostatic urethra rupture rarely occurs and is caused by a fractured pelvis or improper catheter insertion.
sucking chest wound—
Pneumothorax is seen on x-ray of the chest as a collapsed lung.
a bubbling wound with surrounding skin moving in and out with respiration. These clinical features suggest a traumatic right pneumothorax.
most twin pregnancies?
Most twin pregnancies (about two thirds) are dizygotic, with two chorions, two amnions, and two zygotes (dichorionic diamniotic dizygotic twins). These “fraternal” twins are generally at lower risk for complications than monozygotic, “identical” twins.
There are four masticatory muscles;
Masseter.
Temporalis.
Lateral pterygoid.
Medial pterygoid.
In hand - 19 muscles - 5 innervated by median?
The abductor pollicis brevis muscle is a thenar (thumb) muscle innervated by the recurrent branch of the median nerve and functions in abduction and opposition of the thumb. The first and second lumbricals and opponens pollicis are also innervated by the median nerve.
slashing of wrist?
deep - median -
light - ulnar and can affect the Adductor pollicis -
and if the ulnar nerve is affected may be also (along with other ulnar nerve muscles)
the adductor pollicis muscle is a muscle in the hand that functions to adduct the thumb. It has two heads: transverse and oblique. It is a fleshy, flat, triangular, and fan-shaped muscle deep in the thenar compartment beneath the long flexor tendons and the lumbrical muscles at the center of the palm.
what one muscle opens the mouth - lower the jaw
Lateral lower
3 Ms MUNCH
lateral lowers Of the four muscles of mastication, only the lateral pterygoids lower the jaw; the other muscles close the jaw. Remember “Lateral Lowers” and “M’s Munch” (Medial pterygoids, Masseter, teMporalis)
smiling muscle?
buccinator muscle is involved in facial expressions, such as smiling. The masseter muscles elevate the jaw. The medial pterygoids allow for elevation and side-to-side movements of the mandible. The temporalis muscles elevate and retract the jaw.
20-year history of alcohol abuse. His abdomen is distended with shifting dullness to percussion, and the liver is palpated 7 cm below the right costal margin. Examination of the eye shows scleral icterus
Left gastric vein
`
This patient has a history of alcohol abuse, evidence of hepatomegaly, ascites (shifting dullness) and jaundice, and elevated liver function tests. He most likely has cirrhosis of the liver as a result of his alcoholism, which has resulted in hepatic portal hypertension and consequently the generation and rupture of esophageal varices.
sciatic pain in leg?
trouble plantar flexing - often occurs by hurting back - lifting things - at L4–L5 or the L5–S1
broad ligament?
cardinal?
round? - thru inguinal
ovarian suspensory?
UTERine artery and URETER - bridge goes over the water
The broad ligament contains the blood vessels to the ovaries, fallopian tubes, and uterus. The ovarian arteries branch from the abdominal aorta and run through the suspensory ligaments of the ovaries, also known as the infundibulopelvic ligaments. The suspensory ligaments attach each ovary to the pelvic sidewall.
lower back pain. He was lifting some heavy boxes
decreased pinprick sensation around the inguinal ligament region. A herniated disk is suspected, and an MRI confirms the diagnosis.
L1 dermatome is at the level of the inguinal ligament. This dermatome also includes the femoral triangle, the superolateral quadrant of the buttock, and the upper part of the medial thigh. Pain radiating to the groin and decreased sensation in the region around the inguinal ligament suggest L1 nerve root compression. Therefore, this patient has a T12-L1 disc herniation which is affect the L1 nerve root.
carpal tunnel - which muscles most often weakened?
carpal tunnel syndrome, which occurs in individuals whose work involves repetitive hand motions. The muscles supplied by the recurrent branch of the median nerve (opponens pollicis, flexor pollicis brevis, and abductor pollicis brevis) are most commonly weakened in patients with carpal tunnel syndrome.
3 branches coming out of aortic arch?
the brachiocephalic artery (which divides into right common carotid artery and the right subclavian artery), the left common carotid artery, and the left subclavian artery.
the patient’s left pupil is dilated compared with the right, and the patient’s left eye is deviated laterally and inferiorly compared with the right. His left eyelid appears lower than the right.
Which of the following muscles is functioning normally in this patient?
Lateral rectus muscle
CN III is the oculomotor nerve. It moves the eye superiorly and medially and innervates the levator palpebrae muscle, which is responsible for elevation of the eyelid. The levator palpebrae muscle is also responsible for pupillary constriction. When CN III is affected by an aneurysm, signs of a “blown pupil” (the patient’s left pupil more dilated than the right), a “down and out” gaze (patient’s left eye is deviated laterally and inferiorly compared to the right), and ptosis (drooping eyelid) can present.
and diaphoresis. The patient’s eye exam shows neurologic deficits (dilated left pupil and left eye deviation). The patient’s age, gender, race, and past medical history put him at a very high risk for a stroke or aneurysm.
A berry aneurysm,
S1-S2 — “buckle my shoe” (Achilles reflex)
L2-L4 — “kick the door” (patellar reflex)
C5-C6 — “pick up sticks” (biceps reflex)
C7-C8 — “lay them straight” (triceps reflex)
Other reflexes include:
L1-L2 — “testicles move” (cremaster reflex)
S3-S4 — “winks galore” (anal wink reflex)
lesion of the ascending colon. what lymph to check?
Superior mesenteric lymph nodes
The lymphatic drainage of the gastrointestinal tract follows supplying arteries.
diverticulitis?
focal areas of weakness in the muscularis propria layer of the colon.
The patient has a history of constipation, crampy pain, and tenderness in the left lower abdomen; diarrhea; a low fever; and blood in his stool. This clinical picture is consistent with diverticulitis. Diverticulitis is an inflammation of colonic diverticula, which are caused by focal areas of weakness in the muscularis propria layer of the colon.
midshaft fracture of the humerus
radial nerve problem - wrist drop
A protruding scapula is seen in damage to the long thoracic nerve usually due to injury to the axilla or lateral wall of the thorax.
Inability to fully abduct the arm is seen with axillary nerve injury due to injury to the surgical neck of the humerus or anterior dislocation of the shoulder. Inability to hold a piece of paper between fingers is seen with damage to the ulnar nerve, usually due to injury to the medial epicondyle of the humerus. Pain over the palmar aspects of the first three and a half digits is seen with median nerve injury usually due to injury to the distal end of the humerus.
epigastric abdominal pain, nausea, and vomiting for 2-3 weeks. The pain is relieved by eating.
duodenal ulcer. 1st section most common - brunner glands found there
2nd section - where bile enters
The common bile duct passes through the pancreas before it empties into the first part of the small intestine (duodenum). The lower part of the common bile duct joins the pancreatic duct to form a channel called the ampulla of Vater or it may enter the duodenum directly.
deviation of the uvula
(Cranial nerves 9 & 10) Description: When the patient says “ah” there is excessive nasal air escape. The palate elevates more on the left side and the uvula deviates toward the left side because the right side is weak.
Motor innervation of the palatal arches and uvula is mediated, in part, by the vagus nerve (CN X), which innervates one of the muscles of the soft palate, the levator veli palatini. Deviation of the uvula to one side implicates a lower motor neuron (LMN) lesion contralateral to the side to which the uvula is deviating. So damage to the left CN X leads to right-sided uvular deviation, whereas damage to the right CN X would lead to left-sided uvular deviation.
He is able to lift his right arm away from the body but grimaces in pain when bringing it back down to his side.
Subscapularis
This patient presents with a history of painless, bright red stools, nausea, vomiting, and an inability to pass gas.
arterial supply? SMA
These symptoms suggest Meckel diverticulum with intestinal obstruction. Meckel diverticulum results from failure of the vitelline duct to obliterate, a structure that connects the developing midgut lumen to the yolk sac. The diverticulum usually lies within 2 feet of the ileocecal valve.
patient’s jaw deviates to the right when he attempts to open his mouth
OVALE _ Standing Room Only (SRO) for the Superior orbital fissure, foramen Rotundum, and foramen Ovale, which transmit cranial nerves (CNs) V1, V2, and V3, respectively.
Jugular foramen? spinosum? stylomastoid?
The foramen spinosum houses the middle meningeal artery, while the jugular foramen houses CNs IX, X, and XI. CN VII exits through the stylomastoid foramen.
paralyzed right diaphragm?
paralyzed right hemidiaphragm. It is possible for the phrenic nerve to become damaged during heart surgery (as in this patient), since it runs along the fibrous pericardium. It is not unusual for a patient to remain asymptomatic, since there is sufficient movement of the diaphragm with only one nerve. However, symptoms may begin to manifest at times of significant physical exertion.
Appearance of a paralyzed diaphragm on the right side of the x-ray indicates a defect in the right phrenic nerve, not the left phrenic nerve.
hemerrhoids - venous drainage route?
In external hemorrhoids, the venous drainage of the tissue is from the inferior rectal vein, to the internal pudendal vein, to the internal iliac vein, to the common iliac vein, then to the inferior vena cava (IVC).
The superior rectal vein drains internal hemorrhoids, which are painless, not external hemorrhoids, as in this patient. Although the inferior rectal vein is the initial venous drainage for external hemorrhoids, it ultimately drains into the IVC and not the portal system. Similarly, although the internal pudendal vein is part of the external hemorrhoid drainage system, the final pathway is the IVC and not the portal system.
vitamin A analog, tagged with a radioactive isotope, is given orally to informed and consenting volunteers. Twenty-four hours later the isotope-labeled drug is detectable in hepatic stellate cells.
Through which of the following structures does this drug most likely pass first on the way to being stored in the liver?
most nutrients are drained from the gastrointestinal tract via the hepatic portal system. However, fats and fat-soluble substances (such as vitamin A) first enter lacteals, which are small lymphatic capillaries in the villi of the intestinal epithelium. From there, the lacteals merge, and the chyle flows into progressively larger lymphatics and ultimately the thoracic duct, which drains into the left jugular venous angle (the union of the internal jugular vein and subclavian vein). Vitamin A is then stored in the stellate cells (aka perisinusoidal cells, Ito cells) in the liver.
Esophageal atresia with distal tracheoesophageal fistula
This newborn has copious mucus and signs of aspiration (rattling sounds during inspiration, coughing, choking, and cyanosis), as well as evidence of air in his stomach (gastric distension and tympanic sounds). Spitting up of his feedings, and excess saliva with aspiration suggest that normal secretions and/or breast milk are unable to pass normally through the esophagus to the stomach, which in a newborn is most likely due to congenital esophageal atresia (ie, an esophagus that does not connect all the way from the mouth to the stomach). The air in his stomach further suggests that there is most likely an extra connection between the airway and the gastrointestinal tract, as may occur with a tracheoesophageal fistula (ie, an opening joining the trachea and esophagus).
Five types of tracheoesophageal anomalies may occur congenitally, as shown in the illustrations. Any one of these would likely manifest with significant coughing, choking, and cyanosis, because fluids either pass from the esophagus to the trachea through a proximal fistula or overflow from the proximal blind-ended esophageal pouch into the nearby trachea. Given this infant’s presentation with air in his stomach, the only possible variants are those that also involve a distal connection from the trachea to the stomach: Esophageal atresia with distal transesophageal fistula, isolated transesophageal fistula, and esophageal atresia with double transesophageal fistula.
Of the five types, the most common variant in newborns is esophageal atresia with distal transesophageal fistula. The presenting signs and symptoms also fit this diagnosis. So, this is the most likely cause of the patient’s condition.
Transposition of the great vessels
TGV is a cyanotic, right-to-left heart defect caused by a failure of the aorticopulmonary septum to spiral. In addition, the infant was born to a mother with diabetes, and TGV is a known complication in infants born to mothers with diabetes. This congenital anomaly is characterized by an aorta that arises from the right ventricle and a pulmonary artery that arises from the left ventricle. If left uncorrected, TGV is incompatible with life.
internal jugular catheter route?
Lateral to the common carotid artery and anterior to the vagus nerve, within the carotid sheath
The internal jugular vein is found within the carotid sheath lateral to the common carotid artery and anterior to the vagus nerve. (Its location is outlined in red in the image). The correct location for placement of an internal jugular line is found by palpating the carotid pulse and inserting the needle lateral to that pulse. Recall that it is the opposite in the femoral triangle, where the vein is medial to the artery. The sympathetic chain is also posterior to the internal jugular vein, but unlike the vagus nerve, the sympathetic chain is not contained within the carotid sheath.
cleft lip, palate? 4 - 6 weeks - nasal pit develops
1/1000 births - common
medial and lateral nasal process form
at 8 weeks failure of
failure of fusal of medial nasal processes to form intermaxillary nasal process - cleft lip
maxillary process with medial nasal process - failure to fuse - lateral cleft palate - can be uni or bilateral.
feeding issue if cleft palate
cervical cysts - midline mass below hyoid
moves when swallowing, remnant of thyroglossal canal
thyroid gland originally from epithelium of tongue
lateral cervical cysts - not midline
remnant of 2,3,4 grooves - filled up by ectoderm, along sternocleidomastoid muscle - DO NOT MOVE when swallowing
recurrent laryngeal nerve X - vocal cords?
6th ARCH
posterior cricoarytenoid abducts vocal folds - HOARSENESS - if problem if nerve interuption
cricothyrotomy - relieves airway obstruction
emergency procedure - needle just below midline of neck - below thyroid cartilage
more frequently - cricothyroid membrane - incision in skin - and antoher thru membrane between circo and thyroid cartilageg - tube insertion
posterior triangle of neck
STERNOclidomastoid m - face looks upward to opposite side - TURNS HEAD TO OPPOSITE SIDE
veins - external jugular, subclavian
arteries - occipital
nerves XI, trunks of brachial plexus, phrenic nerve
lymph- superficial cervical and external jugular
XI nerve -
STERNOclidomastoid m - face looks upward to opposite side - TURNS HEAD TO OPPOSITE SIDE
TRAPEZIUM - riase shoulders, depress
skull, scalp malformations - scaphocephaly LONG WEDGE
plagiocephaly TWISTED
oxycephaly HIGH TOWER
PREMATURE closure
scaphocephaly - premature sagital suture closure - long narrow wedge shape
plagiocephaly - premature closure one side only
oxycephaly - premature closure coronal - high tower like cranium
SCALP layers
top three moves as one
skin
CT dense - severe bleeding, not gape
Aponuerois epicranial - tape wide
Loose areolar - dangerous - infection can distend with fluid - potential space
Pericranium- bleed between this and calvaria (difficult birth) CEPHALHEMATOMA
3 cranial fosses
anterior
middle
posterior
anterior - frontal lobe - dura v1 and anterior meningeal A (from ethmoidal a)
middle - temporal lobe - dura v2, v3, middle meningeal (from maxillary a)
posterior - cerebellum, dura spinal nerves via X and XII, posterior meningeal aa - (from ascending pharangeal and occipital aa)
fracture of anterior cranial fossa?
cribriform plate of ethmoid - anosmia (loss sense of smell), periorbital bruising (raccoon eyes) and CSF leak from nose
epidural hematoma?
Talk and Die syndrome (lucid moment)
lemon biconvex pattern
Death rapid -
often near pterion - middle meningeal a (foramen spinosum) - from maxillary artery -
unconsciouness and death are rapid - strips dura from inner surface of skull because of rapid bleed
Biconvex pattern
subdural hematoma - crescent
rupture of bridging veins - crescent shape (shaken baby syndrome)
subarachnoid hematoma -
worst headache of life
rupture of aneruysm in circle of Willis -
intracerebral hemaoma
terminal branches of circle of willis rupture
cavernous sinus infection - dangerous triangle of face
infection can spread rapidly - leads to meningitus
spread thru facial (angular) vein to cavernous sinus via superior opthamic vein
or thru upper molars via pterygoid venous plexus
cavernous sinus thrombosis?
internal carotid artery (lacerations)
VI nerve - internal squint if lesion
raises eyelid, moves eyeball in all directions?
III, ciliary glanglion? constrict pupil
facial VII - travels thru?
internal auditory meatus -
VII parasympethic?
secretomotor for sumandibular, sublingual, lacrimal and nasal, palaline glands
Vii and taste?
2/3 - chora tympani
VII blink?
along w. V
dry red eye?
VII - lack of secretion
Bell Palsy?
temporary paralysis of the facial muscles, causing drooping and weakness on one side of the face, and is sometimes mistaken for a stroke
VII The cause of Bell’s palsy is unknown. Swelling and inflammation of the cranial nerve VII is seen in individuals with Bell’s palsy. Most scientists believe that reactivation of an existing (dormant) viral infection may cause the disorder
what travels thru internal auditory meaturs?
VII, VII
what travels thru jugular foramen?
IX, X, XII
loss of gag reflex?
IX and X
4 ganglion on head?
ciliary III (constricts pupil) submandibular VII (submandibular/sublingual glands) pterygopalatine VII (lacrimal, nasal/palaline glands) Otic (parotid) IX
different kind of ganglion - I am lost here
I think these are sensory ganglion??
trigeminal - v1, v2, v3
geniculate VII (taste 2/3)
spiral VIII (hearing) vestibular VII (linear and angular accelerator
superior and inferior gg - IX - post. 1/3 tongue, pharnyx, carotid sinus
sup and inf gg X - sensation in larynx and larynxgopharynx
geniculate ganglion is a sensory ganglion of the facial nerve (CN VII). It contains the cell bodies of the fibers responsible for conducting taste sensation from the anterior two-thirds of the tongue.
vagus problem?
dysphagia (diff swallowing), , palate droop, uvula pointing AWAY from lesion side, Horasreness/loss of voal cord ABDucion - loss of gag RF (+CNIX), loss of cough RF
XII problem?
deviation of tongue TOWARD lesion - licks its wound
trigeminal nerve - what area not cover on face?
SRO
opthalmic v1
maxillary v2
mandibular v3
angle of mandible (great auricular nerve c2,c3 - cervical plexus
v1 - opthalmic
forehead
external nasal intratrochlear
lacrimal
supragrochlear
supraorbitial
v3 mandible
buccal
mental
sygomaticofacial
auriculotemporal
v2 maxillary - upper lip
near eye
infraorti
parotid cancer - or other surgery?
stylomastoid foramen - unilateral facial paralysis
VII -
unable to close lips and eyelips - DRY EYE - can’t whistle, chew
epistaxis
nose blooed - most often in kiesselbach’s area - facial artery convergence - sphemopalatine, etc
Lateral wall of nasal cavity
lots of things open up here
ethmoiditis
infection of ehmoidal insurus can erod medial wall of obit - orbital cellulites - can spread to cranila cavity
parotid duct and gland perforate what muscle?
buccinator (cheek) - opposite 2nd upper molar
TMJ
muscles of mastication innervated by v3 - if damage, deviate toward side of lesion because lateral pteryhoid weakness
innervation of tongue?
sensory anterior 2/3 lingual v3, taste chorda tympani VII
sensory posterior 1/3 - IX
motor XII - likes its wounds
gag reflex?
afferent IX
efferent X
injury to IX will show negative gag reflex
blow out fracture?
blows out to maxillary sinus
v2,
infraorbital artery hemmorrage
lips and palate defects during fetal life?
intermaxillary segments form when two medial nsala prominences fuse at wk * - give rise to phitrum of lip, four incisor teeth and primary palate of adult
maxillary prominences fused with medial (palate)
stabismus
one eye not tracking
III
VI abducts pupil - looks laterally
IV - down and lateral
muscle raising eyelid?
levetor pulpebra III
oculomotor nerve palsy
down and out
trochlear nerve palsy
Up and out
Abducens Nerve palsy
adducted
horner syndrome
interruption of sympathetic fibers anywhere from T1
injury to nec, pancoast tumor, thyroid carcinoma -
interrupts ascending preganglionic sympathetic fibers
signs: constrictuion of pupil (miosis)
dropping of superior eyelig (ptosis)
redness and increased temp (vasodilation)
absense of sweating (anhydrosis)
Otitis Media
hearing diminshed, taste may be altered because chorda tympani affected
infection spreading posteriorly causing mastoitidis
infection to middel cranial fossa can cause meningitus
perforation of tympanic membrane
may also damage chorda tympani - loss of taste 2/3 and secretion of glands
minor perforations heal spontaneously, others require surgery
Inner ear - VIII
choclea - spiral organ of Corti - recptors for hearing
vetibulte
smicircular canals
thyroid and parathyroid -
thyroid largest endocrine glands - T3, T4 - inscreases temp of body, and calcitonin (reduce blood calcium)
after total thyroidectomy - may develop lower temp and hypercalcemia (increased calcium)
parathyroid glands produce PTH - increasee Cal
Thyroid - anatomical issues
infrahyoid muscles anterolateral
posterolateral - COMMON CAROTID Art
Medial - larynx, TRACHEA, recurrent layngeal nerve
posterio parathyroid gland
list of foramen w/ cranial nerves
1 - cribiform 2 - optic canal 3, 4,6 - SOF - Superior Orbital Fissure v - SRO SOF Rotundum Ovale VII - Internal Acoustic Meatus (sylomastoid f) VIII - Internal Acoustic Meatus IX, X, XI - jugular XII - Hypoglossal Canal
Muscles of face - groups
orbital, nasal, oral
orbital muscles of face?
ONE OTHER mentioned by Holla?
if facial nerve damaged - eyelids can’t shut - exposure keratitis
lower eyelid droop - can’t spreak tears - dry eye - failure to remove debris and ulceratin of corneal surface -
Test for palsy? raise eyebrows and close eyelids
Orbicularis Oculi -
surrounds eye socket and extends into eyelid
Palpebral (gently closes eyelid)
Lacrimal (drains tears)
Orbital part (tightly closes eyelids
VII
corrugator supcillii = draws eyebrows together - vertical wrinkles - concern
orbital muscles of face?
if facial nerve damaged - eyelids can’t shut - exposure keratitis
lower eyelid droop - can’t spreak tears - dry eye - failure to remove debris and ulceratin of corneal surface -
Test for palsy? raise eyebrows and close eyelids
Orbicularis Oculi -
surrounds eye socket and extends into eyelid
Palpebral (gently closes eyelid)
Lacrimal (drains tears)
Orbital part (tightly closes eyelids
VII
corrugator supcillii = draws eyebrows together - vertical wrinkles - concern
Nasal facial muscles?
nasalas - largest - trasnverse compresses nares - alar open
Procerus
Depressor Septi Nasi
Oral group
Orbicularis Oris and Buccinator
purses the lips
Buccinator - pulls teeth inwards toward cheeks - preventing accumulation of food
upper and lower groups around lips -
if muscle paralyzed , maybe be difficult to eat - tissue around mouth and cheeks sags - drawn across to opposite side while smiling
tongue tied?
frenulum - can do surgery - under tongue in midline
why tongue so tricky?
during development, four arches contribute - tiving rise to lontitudinal line (median sulcus) down centre of tongue - majority of tongue is V and IS
sulcus terminalis in back of tongue where in center meets median sulcus - pit. this is now closed top of deep pit (foramen cecum) - at end is thyroid gland - IF descent didn’t happen from tongue down to neck - doesn’t close - midline thyroglossal cysts main remain
lymph drainage of tongue?
2/3 - submental, submandibular - empty to deep cervical
posterior 1/3 directly into deep cervical
vasculature of tongue?
lingual artery (branch of ext carotid) mostly, tonsillar artery may supply aslo
drainage is lingual vein
vasculature of tongue?
lingual artery (branch of ext carotid) mostly, tonsillar artery may supply also
drainage is lingual vein
Pterygopalatine Fossa
TO DO - from 100 concepts? or from?? I don’t remember any more
Pterygopalatine Fossa
TO DO - from 100 concepts? or from?? I don’t remember any more
Posterior Triangle BRS
two triangles Large - occipital
smaller
subclavian
accessory nerve external jugular trunks of brachial plexus nerve to long thoracid, suprascapular, etc cutaneous branch of cervical plexus, sometimes subclavian vein etc
Torticollis - wryneck
at birth- accessory nerve damaged - sternocleido muscle can’t grown longer as body grows
Hyoid bone -
many muscles attached - body, greater horn, lesser horn (has STYLOHYOID LIG running from STYLOID process
styloid process
The styloid process is a cylindrical, slender, needle-like projection of varying lengths averaging 2 to 3 cm. The styloid process projects from the inferior part of the petrous temporal bone and offers attachment to the stylohyoid ligament, and the stylohyoid, stylopharyngeus, and styloglossus muscles
All muscles of tongue except one are supplied by XII -
palatoglossus, a muscle of the soft palate, is innervated by the pharyngeal branch of X.
tongue and sensation
The anterior two-thirds of the tongue receives its sensory supply from the lingual branch of V which also transmits the gustatory fibres of the chorda tympani (VII).
Common sensation and taste to the posterior one-third, including the vallate papillae, are derived from IX. Afew fibres of the superior laryngeal nerve (X) carry sensory fibres from the posterior part of the tongue.
harm to XII muscle?
hemiatrophy of the tongue and deviation of the projected organ towards the paralysed side. - licks the wound
floor of mouth formed by?
The floor of the mouth is formed principally by the mylohyoid muscles
Although lymphatics pierce the floor of the mouth (i.e. the mylohyoid muscle) to reach the submental and submandibular lymph nodes, it is an interesting fact that these tissues are not affected by lymphatic spread of malignant cells (although they may be invaded by direct extension of growth).
Ludwig’s angina
is a cellulitis of the floor of the mouth, usually originating from a carious molar tooth. The infection spreads above the mylohyoid.
Ludwig’s angina
is a cellulitis of the floor of the mouth, usually originating from a carious molar tooth. The infection spreads above the mylohyoid.
Edema forces the tongue upwards and the mylohyoid itself is pushed downwards so that there is swelling both below the chin and within the mouth.
There is considerable danger of spread of infection backwards with edema of the glottis and asphyxia.
deglutition
swallowing
Waldeyer’s ring
The nasopharyngeal tonsil (‘the adenoids’) consists of a collection of lymphoid tissue beneath the epithelium of the roof and posterior wall of this region. It helps to form a continuous lymphoid ring with the palatine tonsils and the lymphoid nodules on the dorsum of the tongue
pharyngotympanic or auditory tube (Eustachian canal)
lies on the side-wall of the nasopharynx level with the floor of the nose.
kids and tonsils
nasopharyngeal tonsils (adenoids) are prominent in children but usually undergo atrophy after puberty. When chronically inflamed they may all but fill the nasopharynx, causing mouth-breathing and also, by blocking the auditory tube, deafness and middle ear infection
The Eustachian tube
provides a ready pathway of sepsis from the pharynx to the middle ear and accounts for the frequency with which otitis media complicates infections of the throat.
quinsy?
a pocket filled with pus (abscess) between your tonsils and the wall of your throat. This is called quinsy.
. It is drained by an incision in the most prominent part of the abscess where softening can be felt.
common carotid? how to find?
The carotid sheath lies immediately deep to the junction between the sternal and clavicular heads of the sternocleidomastoid and is revealed either by retracting this muscle laterally or by splitting between its heads. Opening the sheath then reveals the artery lying medial to the internal jugular vein.
major branches of circle of willis?
clockwise from 12
anterior cerebral into ring
anterior
communicating
internal carotid
posterior communication
posterior cerebral
superior cerebellar
basilar (STEM)
anterior inferior cerebella
vertebral
posterior inferior cerebella (off of vertebral)
veins of head and neck - two pathways
superfilicial - nearest dural sinus - thin walled beins
deep structure - thru internal cerebral vein - choroid vein w/ thalamostriate vein (draining basal ganglia)
two internal cerebral veins unit to form great cerebral vein (of Gelan) which emerges under splenium to join inferior sagitall sinus
what cranial nerves are near the interal carotid artery?
5, 4, and 3 - also near sphenoid sinus
pituitary on top (nearest to 3)
sinus sepsis?
The cavernous sinus is liable to sepsis and thrombosis as a result of spread of superficial infection from the lips and face via the anterior facial and ophthalmic veins, or from deep infections of the face via the pterygoid venous plexus around the pterygoid muscles, or from suppuration in the orbit or accessory nasal sinuses along the ophthalmic vein and its tributaries.
A characteristic picture results—blockage of the venous drainage of the orbit causes edema of the conjunctiva and eyelids and marked exophthalmos, which demonstrates transmitted pulsations from the internal carotid artery.
Pressure on the contained cranial nerves results in ophthalmoplegia.
Examination of the fundus shows papilloedema, venous engorgement and retinal haemorrhages, all resulting from the acutely obstructed venous drainage.
fracture of skull?
Fractures of the skull or penetrating injuries of the skull base may rupture the internal carotid artery within the cavernous sinus.
A caroticocavernous arteriovenous fistula results with pulsating exophthalmos, a loud bruit easily heard over the eye and, again, ophthalmoplegia and marked orbital and conjunctival edema due to the venous pressure within the sinus being raised to arterial level.
sigmoid and transerse sinuses?
The sigmoid and transverse sinuses are often together termed the lateral sinus by clinicians. Close relationship to the mastoid and middle ear renders these sinuses liable to infective thrombosis secondary to otitis media.
It is also possible for sagittal sinus thrombosis to follow infections of the skull, nose, face or scalp because of its diploic and emissary vein connections.
if there were no emissary veins, infections of the face and scalp would never have achieved their sinister reputation.
internal jugular vein?
runs from its origin at the jugular foramen to its termination behind the sternal extremity of the clavicle, where it joins the subclavian vein to form the brachiocephalic vein.
What does the maxillary vein drain?
pterygoid plexus - starts at superficial temporal
Subclavian venepuncture?
under clavicle - between clavicle and first rib upward - will find subclavian vein
infraclavicular approach.
The needle is inserted below the clavicle of the junction of its medial and middle thirds.
The needle is advanced medially and upwards behind the clavicle in the direction of the sternoclavicular joint to puncture the subclavian vein at its junction with the internal jugular.
When a free flow of blood is obtained by syringe aspiration, a radio-opaque plastic catheter is threaded through the needle to pass into the brachiocephalic vein.
lymph nodes of neck can group in horizontal and vertical
The vertical nodes drain the deep structures of the head and neck.
The most important is the deep cervical group, which extends along the internal jugular vein from the base of the skull to the root of the neck
The lymph then passes via the jugular trunk to the thoracic duct or the right lymphatic duct.
The horizontal nodes form a number of groups which encircle the junction of the head with the neck and which are named, according to their position, the submental, submandibular, superficial parotid (or preauricular), mastoid and suboccipital nodes.
These nodes drain the superficial tissues of the head and efferents then pass to the deep cervical nodes
The superficial cervical nodes ?
A constant lymph node lies at the junction of the internal jugular and common facial veins—the jugulodigastric or tonsillar node.
This becomes enlarged in tonsillitis and is therefore the commonest swelling to be encountered in the neck.
lie along the external jugular vein, serve the parotid and lower part of the ear and drain into the deep cervical group.
removing lymph nodes in neck?
Tuberculous disease of the neck usually involves the upper part of the deep cervical chain (from tonsillar infection). These infected nodes may adhere very firmly to the internal jugular vein which may be wounded in the course of their excision.
styloid mastoid foramen?
between the styloid and mastoid processes of the temporal bone. It is the termination of the facial canal, and transmits the facial nerve and stylomastoid artery.
foramen spinosa?
all foreman of skull
https://teachmeanatomy.info/head/osteology/cranial-foramina/#:~:text=The%20Cranial%20Foramina&text=A%20foramen%20(pl.,to%20as%20the%20cranial%20foramina.
The foramen spinosum is located within the middle cranial fossa, laterally to the foramen ovale.
It allows the passage of the middle meningeal artery, the middle meningeal vein and the meningeal branch of CN V3.
foramen spinosa?
all foreman of skull
https://teachmeanatomy.info/ head/osteology/cranial-foramina/#:~:text=The%20 Cranial%20Foramina&text =A%20foramen%20(pl.,to% 20as%20the%20cranial% 20foramina.
The foramen spinosum is located within the middle cranial fossa, laterally to the foramen ovale.
It allows the passage of the middle meningeal artery, the middle meningeal vein and the meningeal branch of CN V3.
muscles of face
Orbicularis oris surrounds/closes lips
Orbicularis oculi muscle surrounds eye and closes eyelids
Platysma pulls mandible downward/ backward (mournful expression)
Muscles of mastication?
Muscles of Mastication are:
Masseter (most powerful), closes the jaw by elevating/drawing mandible backward, responsible for the tension felt by clenching jaw.
Pterygoid
Temporalis insert on mandible
nerves of face?
Trigeminal 5th CN carries sensory afferent fibers from face, oral cavity, teeth and efferent motor fibers to muscles of mastication
Facial Nerve 7th CN supplies motor function of facial muscles
anterior, posterior triangles
ANTERIOR TRIANGLE
POSTERIOR TRIANGLE
MIDLINE
Sternocleidomastoid muscle divides neck into Anterior (medial) and Posterior (lateral) Triangle.
Sternocleidomastoid muscle innervated by spinal accessory (11th CN)
Anterior Triangle formed by anterior border of Sternocleidomastoid muscle , clavicle inferiorly and midline anteriorly.
Posterior Triangle formed by posterior border Sternocleidomastoid muscle anteriorly, posteriorly by trapezius muscle and inferiorly by clavicle
Thyroid gland
produce thyroid hormone (T₃ & T₄
Thyroid gland (largest endocrine gland)
Wrapped around anterolateral larynx/trachea
Consists of two lobes (butterfly-shaped) connected by isthmus below laryngeal cricoid cartilage
Lateral lobes extend bilaterally on each side larynx
Lower margin reaches down to fifth to sixth tracheal ring
Upper margin extends upward to the middle of the thyroid cartilage, occasionally, may extend downwards and enlarge within thorax
Fascial envelope of the gland is continuous with the pretracheal fascia of both the hyoid and cricoid the isthmus will ascend and descend with the larynx upon swallowing.
Function of thyroid gland is to produce thyroid hormone(T₃ &T₄ production)
lymph drainage in head
Lymphatic Drainage is important enlarged lymph nodes may signal disease in drainage area
Posterior-to Anterior Occipital Posterior auricular Posterior cervical Superficial and deep cervical Tonsillar Submaxillary Submental (tip jaw in midline) Anterior auricular Supraclavicular (above clavicle)
Systemic disease? can see this in face?
Most common symptoms are Hair Problems Like Hair Loss Thinning Of Hair Coarse Hair Change In Facial Features Swelling Deformity Neck Stiffness Masses In The Neck
Most Symptoms of the face may be due to Systemic Disease(s)
Hoarseness?
recurrent laryngeal nerve impingement
If neck swelling
maybe thyroid cancer
neck stiffness?
Caused by cervical muscle spasm
Tension headache common cause
Sudden onset stiff neck, fever, headache suggests Meningeal irritation
Association with referred pain from chest suggests angina and myocardial infarction
trauma to skull?
Battle’s sign: Traumatic bruise over/behind the mastoid process due to basilar skull fracture
with bleeding into the middle cranial fossa. Can present at times as blood behind the eardrum. Battle’s sign may occur on the ipsilateral or contralateral side of the skull fracture.
Raccoon eyes: Periorbital bruises from external trauma to the eyes, basal skull fracture, and intracranial bleeding.
neck lumps - differential diagnosis?
Thyroglossal cyst – lump moves when patient sticks tongue out
Ask patient to protrude tongue – Thyroglossal cyst will rise / thyroid masses will not
The location of the lump within the neck can sometimes be useful in narrowing the differential diagnosis.
Mid-line
Thyroid isthmus swelling – most common cause in adults
Thyroglossal cyst – lump moves when patient sticks tongue out
Ask the patient to swallow some water – thyroid masses will rise / as will Thyroglossal cysts
Ask patient to protrude tongue – Thyroglossal cyst will rise / thyroid masses will not
Laryngeal swellings
Submental lymph nodes
Dermoid cysts
Lipoma –painless / smooth mass
Thyroglossal cysts
remnant of development
midline -
move when swallow
can be defined as an irregular neck mass or a lump which develops from cells and tissues left over after the formation of the thyroid gland during developmental stages. Thyroglossal cysts are the most common cause of midline neck masses and are generally located caudal to (below) the hyoid bone.
ASSESSING A NECK LUMP
Size – width / height / depth
Location – can help narrow the differential – anterior / posterior triangle / mid-line
Shape – well defined?
Consistency – smooth / rubbery / hard / nodular / irregular
Fluctuance –if fluctuant, this suggests it is a fluid filled lesion – cyst
Trans-illumination – suggests mass is fluid filled – e.g. cystic hygroma
Pulsatility –suggests vascular origin – e.g. carotid body tumour / aneurysm
Temperature – increased warmth may suggest inflammatory / infective cause
Overlying skin changes – erythema / ulceration/punctum
Relation to underlying / overlying tissue – tethering / mobility
Auscultation – to assess for bruits – e.g. carotid aneurysm
malignant nodule?
signs it is malignant vs. benig?
Malignant Nodule
Adult
Male
Previous x-ray treatment to head or neck
onset Rapid
change in voice Present
number of nodules One
ASSESSING A NECK LUMP
90 % thyroglossal cysts present before age 10
Size – width / height / depth
Location – can help narrow the differential – anterior / posterior triangle / mid-line
Shape – well defined?
Consistency – smooth / rubbery / hard / nodular / irregular
Fluctuance –if fluctuant, this suggests it is a fluid filled lesion – cyst
Trans-illumination – suggests mass is fluid filled – e.g. cystic hygroma
Pulsatility –suggests vascular origin – e.g. carotid body tumour / aneurysm
Temperature – increased warmth may suggest inflammatory / infective cause
Overlying skin changes – erythema / ulceration/punctum
Relation to underlying / overlying tissue – tethering / mobility
Auscultation – to assess for bruits – e.g. carotid aneurysm
congenital neck cyst
Location
Can occur anywhere along the course of the thyroglossal duct
Infrahyoid location is most common:
Typically located in the midline (~70%)
If off-midline characteristically tucked next to the thyroid cartilage
Almost all located within 2 cm of the midline
Pathophysiology
A swelling in the remnant of the thyroglossal duct
The duct usually disappears in the adult
Leaves a pit at its site of departure (the foramen cecum of the tongue)
Typically located in the midline
Most common midline neck mass in young patients.
Epidemiology
Thyroglossal duct cysts typically present during childhood (90% before the age of 10)
Remain asymptomatic until they become infected present at any time.
Account for 70% of all congenital neck anomalies
Second most common benign neck mass, after lymphadenopathy.
Clinical presentation
Typically a painless rounded midline anterior neck swelling
May move with swallowing and classically elevates on tongue protrusion
Branchial cyst
Common congenital and familial masses
Lateral aspect of the anterior triangle
Usually absent at birth
Becomes evident later on in life usually by early adulthood
At times bilaterally.
Pathophysiology
Failed closure of the second branchial cleft
Second pharyngeal arch grows downward covering the third and fourth arches burying clefts eventually disappear ~7th week
Failure of this process will lead to the formation of an epithelium-lined cyst (branchial cyst)
middle meningea artery enters skull thru?
The middle meningeal artery enters the skull through the foramen spinosum in the greater wing of the sphenoid bone. This vessel’s anterior division runs in close proximity to the pterion, a very thin area of the skull. Subsequently, it can easily rupture secondary to a skull fracture involving the pterion, as seen in this patient. An epidural hematoma is a medical emergency in which urgent craniotomy is essential.
Noise-induced hearing loss
is caused by the destruction of cochlear hair cells, also known as the organ of Corti. In a normally functioning ear, sound waves are transmitted mechanically through the tympanic membrane, via the ossicles, and through the oval window to the perilymph-filled inner ear. The resulting vibrations are transmitted to the cochlear hair cells, from where neurologic impulses are transmitted via the vestibulocochlear nerve.
bones that are pneumatized in viscerocranium -
frontal, temporal, sphenoid, ethmoid
