Anatomy Test II Flashcards
“Nerve Hoppers”
From the PP ganglion –> back to V2 –> Zygomatic N –> Lacrimal Nerve (from V1)
3 types of Neurons from the pre-central gyrus
- Fibers to the superior portion of the contralateral facial motor nucleus 2. Fibers to the inferior portion of the contralateral facial motor nucleus 3. Fibers to the inferior portion of the ipsilateral facial motor nucleus
Accessory Facial Nodes
-Drain to Submandibular Lymph nodes 1. Mandibular: mody of mandible and anterior border of masseter 2. Buccal: In cheek between corner of mouth and anterior border of masseter 3. Infraorbital: Infraorbital area
Actions of Extrinsic Muscles of Tongue
- Palatoglossus: Elevation and Retrusion 2. Genioglossus: Depression and Protrusion 3. Hyoglossus: Depression and Retrusion 4. Styloglossus: Elevation and retrusion
After synapsing in the Submandibular ganglion, where does the chorda tympani travel?
- Back to the Lingual N and then to the sublingual gland and misc glands of the anterior 2/3 of the tongue 2. To the Submandibular gland
Another name for the pterygomandibular depression
Pterygo-temporal depression
Another name for the soft palate
Palatine velum (curtain)
Another name for the sublingual duct
Bartholin’s Duct
Another name for the submandibular duct
Wharton’s Duct
Anterior Cranial Fossa
- Anterior Ethmoidal Canal 2. Posterior Ethmoidal Canal 3. Foramen Cecum 4. Cribriform Foramina or Perforations
Anterior Ethmoidal Canal
Anterior Ethmoidal Nerve, Artery, and Vein
Anterior wall of the Oropharynx
Posterior surface of the tongue
Atkinosi-Veronzi Injection
-Closed-mouth injection -Slide needle oppposite maxillary teeth and keep going -Will always go through deep tendon of the temporalis
Auditory Tube Length and location
-1.5” long -Tympanic cavity in middle ear to Nasopharynx
Auditory Tube parts
- Cartilagenous part: Anteromedial 2/3 = 1” 2. Osseous Part (musculotubal canal): Posterolateral 1/3 = 1/2”
Blood supply of TMJ
- First 2 branches of maxillary artery (deep auricular artery and anterior tympanic artery) 2. Branches of the Superficial Temporal Artery 3. Directly from External Carotid Artery
Boundaries of the Nasopharynx
Choanae to Pharyngeal isthmus
Branches after infraorbital artery passes through the infraorbital foramen
- Inferior palpebral N (to inf eyelid) 2. Lateral Nasal N (to lateral nose) 3. Superior Labial A (to upper lip)
Branches of Anterior Ethmoidal Nerve
- External Nasal branch (to skin of nose) 2. Internal Nasal branch
Branches of Nasociliary Nerve
- Communicating branch (to ciliary ganglion) 2. 1 or 2 long ciliary nerves (SNS and afferents) 3. Infratrochlear N 4. Posterior Ethmoidal N 5. Anterior Ethmoidal N (continuation of Nasociliary Nerve)
Branches of the Anterior division of V3
- Masseteric N 2. Anterior and Posterior Deep temporal N’s 3. Nerves to the lateral pterygoids 4. Long Buccal N
Branches of the Auriculotemporal N
- Parotid 2. Anterior Auricular 3. TMJ 4. Scalp
Branches of the descending palatine A
- Greater Palatine A 2. Lesser Palatine A
Branches of the frontal nerve
- Supratrochlear N 2. Supraorbital N (continuation of frontal N)
Branches of the IAA
- Mylohyoid A (outside of Mandibular canal) 2. Dental Branches 3. Gingival branches 4. Mental Artery 5. Incisive Artery
Branches of the Incisive Artery
- Dental branches 2. Gingival branches
Branches of the Infraorbital artery
- MSA A 2. ASA A 3. Facial branches
Branches of the Mandibular part (and corresponding foramen)
- Deep Auricular A. (external auditory meatus and TMJ) 2. Anterior Tympanic A. (Petrotympanic fissure (w/chorda tympani) to middle ear) 3. Middle Meningeal A. (Foramen spinosum) 4. Accessory Meningeal A. (Foramen Ovale) 5. Inferior Alveolar A. (Mandibular foramen)
Branches of the Maxillary Nerve
- Meningeal N (in MCF) 2. Pterygopalatine branches 3. PSA N 4. Zygomatic N 5. Infraorbital N
Branches of the Ophthalmic Nerve and their relative location to one another
- Frontal Nerve (superior and medial) 2. Lacrimal Nerve (superior and lateral) 3. Nasociliary Nerve (inferior) 4. Tentorial Branch
Branches of the Posterior division of V3
- Auriculotemporal N 2. Lingual N 3. Inferior Alveolar N
Branches of the pterygoid part
- Posterior deep temporal A 2. Pterygoid A’s 3. Masseteric A 4. Buccal A 5. Anterior deep temporal A
Branches of the Pterygoid part
- Posterior deep temporal A 2. Pterygoid A’s 3. Masseteric A 4. Buccal A 5. Anterior deep temporal A
Branches of the Pterygopalatine branches of the Maxillary Nerve
- Orbital N 2. Posterior Superior Nasal N 3. Nasopalatine N 4. (Descending) Palatine Nerves (Greater and Lesser) 5. Pharyngeal N
Branches of the pterygopalatine part
- PSA A 2. Infraorbital A 3. Descending Palatine A 4. Pharyngeal A 5. Artery of pterygoid canal 6. Artery to foramen rotundum 7. Sphenopalatine A
Branches of the Pterygopalatine part
- PSA A 2. Infraorbital A 3. Descending palatine A 4. Pharyngeal A 5. Artery of the pterygoid canal 6. Artery to the foramen rotundum 7. Sphenopalatine A
Branches of the Sphenopalatine A
- Posterior superior nasal A 2. Posterior inferior nasal A 3. Nasopalatine A
Branches of the Undivided Trunk of V3 and type
- Recurrent Meningel Nerve (sensory) 2. Nerve to tensor tympani (motor) 3. Nerve to tensor veli palatini (motor) 4. Nerve to medial pterygoid (motor)
Branches of the Zygomatic Nerve
- Zygomaticotemporal N 2. Zygomaticofacial N
Bridge of nose
bony dorsum of nose
Caldwell Luc Procedure
-If you cut the sphenopalatine A or the Greater palatine A and it retracts back to the Pterygopalatine fossa -Make an incision “window” in the anterior wall of the maxillary sinus, then make an incision “window” in the posterior wall of the maxillary sinus and the artery should be visible in the pterygopalatine fossa (alternative would be to ligate Ext. Carotid)
Carotid Foramen
- Internal Carotid Artery and Internal Carotid Plexus
Cartilages of the nose
- Septal cartilage with lateral processes 2. Major Alar cartilages 3. Minor Alar cartilages
Chief movements of the mandible
- Depression 2. Elevation 3. Protrusion/Protraction 4. Retrusion/Retraction 5. Lateral movements
Condyloid Canal
Emissary Vein (from Veins of Suboccipital Triangle to Sigmoid Sinuses)
Cribriform Foramina or Perforations
Olfactory Nerve Fibers
Deep Cervical Lymph nodes
- Superior Deep Cervical Lymph Nodes 2. Inferior Deep Cervical Lymph Nodes 3. Pretracheal and Paratracheal lymph nodes 4. Accessory Lymph nodes 5. Transverse Cervical/Cervical Sentinel Lymph nodes
Depression of mandible
- Inferior head of the lateral pterygoid (sliding) 2. Anterior belly of the digastric (hinge) 3. Mylohyoid (hinge) 4. Geniohyoid (hinge)
Distribution of Pterygopalatine branches
- Nasal cavity 2. Nasopharynx 3. Hard and soft palate 4. Orbit
Distribution of Submandibular Ganglion
- Submandibular glands 2. sublingual glands
Distribution of the Pterygopalatine Ganglion
- Lacrimal gland 2. nasal and palatine glands
Divisions of the Dorsum of the tongue
- Superior surface/Oral part/Anterior 2/3 2. Posterior surface/Pharyngeal part/Posterior 1/3
Divisions of the Pharynx
- Nasopharynx 2. Oropharynx 3. Laryngopharynx/Hypopharynx
Drainage Order of Lymphatics
- Lymphatics all over H&N 2. Regional Superficial Lymph Nodes 3. Deep Cervical Lymph Nodes 4. Efferent lymph vessels form jugular lymph trunks 5. drain into Thoracic duct (L) or Right lymphatic duct (R) 6. Brachiocephalic vein on respective side
Eagle’s Syndrome and Palatine Tonsils
The palatine tonsils may cushion the calcified stylohyoid ligament and elongated styloid process, causing the pt to be aSxic. However, if the palatine tonsils are removed, they may cause the patient to be Sxic again.
Elevation of mandible
- Temporalis 2. Masseter 3. Medial Pterygoid
Facial Nerve Function Tests
- Muscles of Facial Expression 2. Stylohyoid and Post belly of digastric (swallowing) 3. Posterior Auricular Nerve (wiggling ears?) 4. Chorda tympani (Taste to ant 2/3 of tongue and PSNS to glands) 5. Nerve to Stapedius (Sensitivity to loud noises) 6. GPN (Lacrimal gland, nasal and palatine glands)
Fauces
Space in the oropharynx between palatoglossal and palatopharyngeal arches
Features of the Hard Palate
- Median Palatine raphe 2. Incisive papilla 3. Transverse palatine folds (rugae) 4. Palatine fovea/monkey eyes/snake eyes
Features of the ventral surface of the tongue
- (median) Lingual frenum 2. Profunda lingua V 3. Profunda Lingua A 4. Terminal branches of lingual N 5. Plicae fimbriata/fimbriated fold
Foramen Cecum
Emissary Vein (Veins of Frontal Sinus and Nose to Sup. Sagittal Sinus)
Foramen Lacerum
Emissary Vein
Foramen Magnum
- Junction of Brain and Spinal Cord 2. Junction of Dura Mater and Spinal Cord 3. Vertebral Arteries (w/Sympathetic Plexus) 4. Verterbal Veins 5. Blood Vessels of Spinal Cord
Foramen Ovale
- V3: Mandibular Nerve 2. Accessory Meningeal Artery 3. Lesser Petrosal Nerve 4. Emissary Vein (from Cavernous Sinus to Pterygoid Plexus)
Foramen Rotundum
- V2: Maxillary Nerve 2. Artery to Foramen Rotundum
Foramen Spinosum
- Middle Meningeal Artery 2. Sympathetic Plexus 3. Recurrent Branch of V3 (Meningeal Branch)
Foramen Vesalii
Emissary Vein (from Cavernous Sinus to Pterygoid Plexus)
Frenula/Frena in the mouth
- Superior Labial Frenulum 2. Inferior Labial Frenulum 3. Lateral Frena (usually near premolar area)
Function of the tensor tympani
controls vibration of the tympanic membrane to dampen loud noises
Functions of the Paranasal sinuses
- Decrease the weight of the skull while enlarging the face 2. Air jackets, protecting sensitive areas of the skull from cold air, etc. 3. Sound production/resonance
General Innervation of Muscles of Mastication
Mandibular Nerve V3
General rule of muscles of the soft palate
All muscles of soft palate originate or insert into the palatine aponeurosis
Glandular openings in the vestibule
- Parotid Papilla (opposite 2nd maxillary molar) 2. Lingual and buccal glands
Gow-Gates injection
-Insert needle 27mm deep and hit pterygoid fovea -risk of hitting maxillary artery
Greater Palatine Foramen (Canal)
Greater Palatine Nerve, Artery, and Vein
Hiatus for Lesser Petrosal Nerve
Lesser Petrosal Nerve
Hiatus of Facial Canal
Greater Petrosal Nerve
How can you tell if the maxillary artery is a superficial or deep route in the absence of muscle?
The deep route usually has a common trunk between the posterior deep temporal A and the IAA
How is a PSA block given?
45 degrees from second molar and 45 degrees lateral to the plane to a depth of 15 mm
How is a PSA infiltration given?
30 degrees from the maxillary 2nd molar at a depth of 3-7 mm into the “triangle of safety”
How long is the submandibular duct and where does it empty?
It is 2” long and empties via 1-3 orifices in the sublingual caruncle/papilla
Hypoglossal Canal
Hypoglossal Nerve
If a CVA occurred in the Right pre-central gyrus, what deficit would be evident?
The left inferior portion of the face would experience ptosis (drooping)
If the Lingual Nerve is cut near the 3rd molar, which functions are lost?
- Sensation to the anterior 2/3 of the tongue 2. Sensation to the lingual gingiva of all mandibular teeth 3. Sensation to the floor of the mouth (sublingual sulcus) 4. Taste to the Anterior 2/3 of the tongue 5. Parasympathetics (secretomotor) to the sublingual gland and misc. glands in the anterior 2/3 of the tongue
If the Lingual Nerve is damaged during a 3rd molar extraction, what is lost and what is retained?
4 and 1/2 functions lost 1/2. PSNS to sublingual and misc glands of ant 2/3 of tongue 1. Taste to ant 2/3 of tongue 2. Gen. sensation to ant 2/3 of tongue 3. Sensation to lingual gingiva of all mandibular teeth (primary source) 4. Sensation to floor of mouth (sublingual sulcus) Not lost 1. PSNS to submandibular gland
If you apprach the TMJ from the lateral side, which compartment will you enter first?
The superior/temporodiscal compartment
If you have bleeding gums, from which source did the blood come from?
50% from the internal source and 50% from the external source
If your patient was experiencing ptosis (drooping) of the Left inferior quadrant of the face, what are the possible causes?
- Upper motor neuron injury (ie CVA) in the Right pre-central gyrus 2. Lower motor neuron injury in the Superior portion of the Facial motor nucleus or the Cervicofacial division
Incisive Foramen
- Greater Palatine Artery 2. Nasopalatine Nerve
Inferior Orbital Fissure
- Infraorbital Artery and Vein 2. Zygomatic Nerve 3. Orbital Branch of Pterygopalatine Nerves 4. Vein from orbit to Pterygoid Plexus
Innervation of the Soft palate muscles and exception
-All innervated by CNs 9,10,&11 (mainly Vagus) -Tensor Veli Palatini innervated by V3
Internal Auditory Meatus
- CN 8: Vestibulocochlear 2. CN 7: Facial Nerve
Internal Carotid Plexus/Nerve
Post ganglionic sympathetic fibers carried via blood vessels in the head and neck
Internal Opening of Carotid Canal
- Internal Carotid Artery and Internal Carotid Plexus 2. Emissary Vein (from Cavernous Sinus to Pharyngeal Vein)
Joint compartments (shape and movement)
- Superior/Temporodiscal space: Concavoconvex/sigmoid; Sliding movement 2. Inferior/Condylodiscal space: Concave; Hinge movement
Jugular Foramen
- Internal Jugular Vein 2. Inferior Petrosal Sinus 3. CN 9: Glossopharyngeal Nerve 4. CN 10: Vagus Nerve 5. CN 11: Spinal Accessory Nerve
Kiesselbach’s Area
Anterior aspect of nasal septum
Lateral movements of mandible
- Inferior head of lateral pterygoid (on contralateral side) 2. Temporalis (both sides)
Lateral Pterygoid innervation
Lateral pterygoid nerves of V3 (travel together and then split to go to different heads)
Lateral Pterygoid names
- Pterygoideus Lateralis 2. External Pterygoid (old name)
Lateral wall of Nasopharynx
- Pharyngeal opening of auditory tube 2. Tubal Elevation/Torus Tubarius 3. Salpingopharyngeal Fold 4. Levator Veli Palatini 5. Pharyngeal Recess containing the tubal tonsils
Lateral wall of the Oropharynx
- Double arches 2. Tonsillar fossa w/Palatine (Faucial) tonsils
Lesser Palatine Foramen
- Lesser Palatine Nerve, Artery, and Vein 2. Middle Palatine Nerve, Artery, and Vein
Levator Palatine
Origin: Inferior surface of apex of petrous part of temporal bone and cartilagenous part of pharyngotympanic tube Insertion: Palatine Aponeurosis Action: Raises the soft palate
Ligaments of TMJ
- Temporomandibular/TM/Lateral ligament: Articular tubercle to posterior condylar neck 2. Stylomandibular Ligament: Styloid process to angle of mandible (blends with medial pterygoid fascia) 3. Sphenomandibular Ligament: Spine of sphenoid to ligula and free margin fo mandibular foramen 4. Medial retrodiscal ligament/anterior malleolar ligament
Linea Alba
Line where teeth meet cheek
lingual n and IAN relationship
the lingual nerve is always medial and anterior to the IAN
Long Buccal Block
Given in the retromolar fossa area at the depth of the coronoid notch, but not usually required after high mandibular block
Lower Motor Neuron Injuries and Upper Motor Neuron injuries
-Upper Motor Neuron: CVA -Lower Motor Neuron: Bell’s Palsy, Severe laceration to the face, etc.
Mandibular Foramen
Inferior Alveolar Nerve, Artery, and Vein
Masseter action
- Elevates mandible 2. Deep head retracts/retrudes mandible 3. Superficial head protracts/protrudes mandible
Masseter innervation
Masseteric nerve of V3
Masseter insertion
- Lateral surface of Ramus (deep fibers more superior and superficial fibers more inferior) 2. Lateral surface of inferior portion of coronoid process
Masseter Origin
-Superficial head: Anterior 2/3 of zygomatic arch, zygomatic bone, and sometimes the zygomatic process of maxilla -Deep head: Posterior 1/3 of zygomatic arch, medial surface of zygomatic arch, and from fascia over temporalis
Mastoid Foramen
Mastoid Emissary Vein (from Occipital Veins of Posterior Auricular Vein to Sigmoid Sinuses)
Medial pterygoid action
Elevates mandible
Medial pterygoid innervation
Medial pterygoid nerve of V3
Medial pterygoid insertion
Inferior and posterior part of the medial surface of the ramus (triangle formed by mylohyoid groove and angle of mandible)
Medial pterygoid names
- Pterygoideus medialis 2. Internal Pterygoid (old name)
Middle Cranial Fossa
- Superior Orbital Fissure 2. Foramen Rotundum 3. Foramen Ovale 4. Foramen Spinosum 5. Hiatus of Facial Canal 6. Hiatus for Lesser Petrosal Nerve 7. Internal Opening of Carotid Canal 8. Foramen Vesalii 9. Optic Foramen
Most medically or dentally important branches of maxillary artery
Medically: Middle Meningeal Artery Dentally: Inferior Alveolar Artery
Motor Innervation of the Tongue
Hypoglossal Nerve innervates all muscles of the tongue except the Palatoglossal muscle, which is innervated by the Vagus Nerve
Mucosal folds to epiglottis
- 2 lateral glossoepiglottic folds 2. 1 median glossoepiglottic fold 3. Vallecula
Muscles innervated by the facial Nerve
- Muscles of Facial Expression 2. Posterior belly of Digastric 3. Stapedius 4. Stylohyoid
Muscles of the Soft Palate
- Palatoglossus 2. Palatopharyngeus 3. Musculus Uvulae 4. Levator Palatine 5. Tensor Veli Palatini
Muscles of the Tongue
Intrinsic Muscles 1. Longitudinal Layer 2. Transverse Layer 3. Vertical Layer Extrinsic Muscles 1. Palatoglossus 2. Styloglossus (styloid process to post-lat tongue) 3. Genioglossus (superior genial tubercle to bulk of tongue inferiorly and body of hyoid) 4. Hyoglossus (Greater horn of hyoid to post-lat tongue)
Musculus Uvulae
Origin: Palatine Aponeurosis Insertion: Uvula