Anatomy Test II Flashcards
1
Q
“Nerve Hoppers”
A
From the PP ganglion –> back to V2 –> Zygomatic N –> Lacrimal Nerve (from V1)
2
Q
3 types of Neurons from the pre-central gyrus
A
- 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
3
Q
Accessory Facial Nodes
A
-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
4
Q
Actions of Extrinsic Muscles of Tongue
A
- Palatoglossus: Elevation and Retrusion 2. Genioglossus: Depression and Protrusion 3. Hyoglossus: Depression and Retrusion 4. Styloglossus: Elevation and retrusion
5
Q
After synapsing in the Submandibular ganglion, where does the chorda tympani travel?
A
- 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
6
Q
Another name for the pterygomandibular depression
A
Pterygo-temporal depression
7
Q
Another name for the soft palate
A
Palatine velum (curtain)
8
Q
Another name for the sublingual duct
A
Bartholin’s Duct
9
Q
Another name for the submandibular duct
A
Wharton’s Duct
10
Q
Anterior Cranial Fossa
A
- Anterior Ethmoidal Canal 2. Posterior Ethmoidal Canal 3. Foramen Cecum 4. Cribriform Foramina or Perforations
11
Q
Anterior Ethmoidal Canal
A
Anterior Ethmoidal Nerve, Artery, and Vein
12
Q
Anterior wall of the Oropharynx
A
Posterior surface of the tongue
13
Q
Atkinosi-Veronzi Injection
A
-Closed-mouth injection -Slide needle oppposite maxillary teeth and keep going -Will always go through deep tendon of the temporalis
14
Q
Auditory Tube Length and location
A
-1.5” long -Tympanic cavity in middle ear to Nasopharynx
15
Q
Auditory Tube parts
A
- Cartilagenous part: Anteromedial 2/3 = 1” 2. Osseous Part (musculotubal canal): Posterolateral 1/3 = 1/2”
16
Q
Blood supply of TMJ
A
- 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
17
Q
Boundaries of the Nasopharynx
A
Choanae to Pharyngeal isthmus
18
Q
Branches after infraorbital artery passes through the infraorbital foramen
A
- Inferior palpebral N (to inf eyelid) 2. Lateral Nasal N (to lateral nose) 3. Superior Labial A (to upper lip)
19
Q
Branches of Anterior Ethmoidal Nerve
A
- External Nasal branch (to skin of nose) 2. Internal Nasal branch
20
Q
Branches of Nasociliary Nerve
A
- 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)
21
Q
Branches of the Anterior division of V3
A
- Masseteric N 2. Anterior and Posterior Deep temporal N’s 3. Nerves to the lateral pterygoids 4. Long Buccal N
22
Q
Branches of the Auriculotemporal N
A
- Parotid 2. Anterior Auricular 3. TMJ 4. Scalp
23
Q
Branches of the descending palatine A
A
- Greater Palatine A 2. Lesser Palatine A
24
Q
Branches of the frontal nerve
A
- Supratrochlear N 2. Supraorbital N (continuation of frontal N)
25
Branches of the IAA
1. Mylohyoid A (outside of Mandibular canal) 2. Dental Branches 3. Gingival branches 4. Mental Artery 5. Incisive Artery
26
Branches of the Incisive Artery
1. Dental branches 2. Gingival branches
27
Branches of the Infraorbital artery
1. MSA A 2. ASA A 3. Facial branches
28
Branches of the Mandibular part (and corresponding foramen)
1. 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)
29
Branches of the Maxillary Nerve
1. Meningeal N (in MCF) 2. Pterygopalatine branches 3. PSA N 4. Zygomatic N 5. Infraorbital N
30
Branches of the Ophthalmic Nerve and their relative location to one another
1. Frontal Nerve (superior and medial) 2. Lacrimal Nerve (superior and lateral) 3. Nasociliary Nerve (inferior) 4. Tentorial Branch
31
Branches of the Posterior division of V3
1. Auriculotemporal N 2. Lingual N 3. Inferior Alveolar N
32
Branches of the pterygoid part
1. Posterior deep temporal A 2. Pterygoid A's 3. Masseteric A 4. Buccal A 5. Anterior deep temporal A
33
Branches of the Pterygoid part
1. Posterior deep temporal A 2. Pterygoid A's 3. Masseteric A 4. Buccal A 5. Anterior deep temporal A
34
Branches of the Pterygopalatine branches of the Maxillary Nerve
1. Orbital N 2. Posterior Superior Nasal N 3. Nasopalatine N 4. (Descending) Palatine Nerves (Greater and Lesser) 5. Pharyngeal N
35
Branches of the pterygopalatine part
1. 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
36
Branches of the Pterygopalatine part
1. 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
37
Branches of the Sphenopalatine A
1. Posterior superior nasal A 2. Posterior inferior nasal A 3. Nasopalatine A
38
Branches of the Undivided Trunk of V3 and type
1. Recurrent Meningel Nerve (sensory) 2. Nerve to tensor tympani (motor) 3. Nerve to tensor veli palatini (motor) 4. Nerve to medial pterygoid (motor)
39
Branches of the Zygomatic Nerve
1. Zygomaticotemporal N 2. Zygomaticofacial N
40
Bridge of nose
bony dorsum of nose
41
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)
42
Carotid Foramen
1. Internal Carotid Artery and Internal Carotid Plexus
43
Cartilages of the nose
1. Septal cartilage with lateral processes 2. Major Alar cartilages 3. Minor Alar cartilages
44
Chief movements of the mandible
1. Depression 2. Elevation 3. Protrusion/Protraction 4. Retrusion/Retraction 5. Lateral movements
45
Condyloid Canal
Emissary Vein (from Veins of Suboccipital Triangle to Sigmoid Sinuses)
46
Cribriform Foramina or Perforations
Olfactory Nerve Fibers
47
Deep Cervical Lymph nodes
1. 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
48
Depression of mandible
1. Inferior head of the lateral pterygoid (sliding) 2. Anterior belly of the digastric (hinge) 3. Mylohyoid (hinge) 4. Geniohyoid (hinge)
49
Distribution of Pterygopalatine branches
1. Nasal cavity 2. Nasopharynx 3. Hard and soft palate 4. Orbit
50
Distribution of Submandibular Ganglion
1. Submandibular glands 2. sublingual glands
51
Distribution of the Pterygopalatine Ganglion
1. Lacrimal gland 2. nasal and palatine glands
52
Divisions of the Dorsum of the tongue
1. Superior surface/Oral part/Anterior 2/3 2. Posterior surface/Pharyngeal part/Posterior 1/3
53
Divisions of the Pharynx
1. Nasopharynx 2. Oropharynx 3. Laryngopharynx/Hypopharynx
54
Drainage Order of Lymphatics
1. 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
55
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.
56
Elevation of mandible
1. Temporalis 2. Masseter 3. Medial Pterygoid
57
Facial Nerve Function Tests
1. 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)
58
Fauces
Space in the oropharynx between palatoglossal and palatopharyngeal arches
59
Features of the Hard Palate
1. Median Palatine raphe 2. Incisive papilla 3. Transverse palatine folds (rugae) 4. Palatine fovea/monkey eyes/snake eyes
60
Features of the ventral surface of the tongue
1. (median) Lingual frenum 2. Profunda lingua V 3. Profunda Lingua A 4. Terminal branches of lingual N 5. Plicae fimbriata/fimbriated fold
61
Foramen Cecum
Emissary Vein (Veins of Frontal Sinus and Nose to Sup. Sagittal Sinus)
62
Foramen Lacerum
Emissary Vein
63
Foramen Magnum
1. 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
64
Foramen Ovale
1. V3: Mandibular Nerve 2. Accessory Meningeal Artery 3. Lesser Petrosal Nerve 4. Emissary Vein (from Cavernous Sinus to Pterygoid Plexus)
65
Foramen Rotundum
1. V2: Maxillary Nerve 2. Artery to Foramen Rotundum
66
Foramen Spinosum
1. Middle Meningeal Artery 2. Sympathetic Plexus 3. Recurrent Branch of V3 (Meningeal Branch)
67
Foramen Vesalii
Emissary Vein (from Cavernous Sinus to Pterygoid Plexus)
68
Frenula/Frena in the mouth
1. Superior Labial Frenulum 2. Inferior Labial Frenulum 3. Lateral Frena (usually near premolar area)
69
Function of the tensor tympani
controls vibration of the tympanic membrane to dampen loud noises
70
Functions of the Paranasal sinuses
1. 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
71
General Innervation of Muscles of Mastication
Mandibular Nerve V3
72
General rule of muscles of the soft palate
All muscles of soft palate originate or insert into the palatine aponeurosis
73
Glandular openings in the vestibule
1. Parotid Papilla (opposite 2nd maxillary molar) 2. Lingual and buccal glands
74
Gow-Gates injection
-Insert needle 27mm deep and hit pterygoid fovea -risk of hitting maxillary artery
75
Greater Palatine Foramen (Canal)
Greater Palatine Nerve, Artery, and Vein
76
Hiatus for Lesser Petrosal Nerve
Lesser Petrosal Nerve
77
Hiatus of Facial Canal
Greater Petrosal Nerve
78
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
79
How is a PSA block given?
45 degrees from second molar and 45 degrees lateral to the plane to a depth of 15 mm
80
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"
81
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
82
Hypoglossal Canal
Hypoglossal Nerve
83
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)
84
If the Lingual Nerve is cut near the 3rd molar, which functions are lost?
1. 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
85
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
86
If you apprach the TMJ from the lateral side, which compartment will you enter first?
The superior/temporodiscal compartment
87
If you have bleeding gums, from which source did the blood come from?
50% from the internal source and 50% from the external source
88
If your patient was experiencing ptosis (drooping) of the Left inferior quadrant of the face, what are the possible causes?
1. 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
89
Incisive Foramen
1. Greater Palatine Artery 2. Nasopalatine Nerve
90
Inferior Orbital Fissure
1. Infraorbital Artery and Vein 2. Zygomatic Nerve 3. Orbital Branch of Pterygopalatine Nerves 4. Vein from orbit to Pterygoid Plexus
91
Innervation of the Soft palate muscles and exception
-All innervated by CNs 9,10,&11 (mainly Vagus) -Tensor Veli Palatini innervated by V3
92
Internal Auditory Meatus
1. CN 8: Vestibulocochlear 2. CN 7: Facial Nerve
93
Internal Carotid Plexus/Nerve
Post ganglionic sympathetic fibers carried via blood vessels in the head and neck
94
Internal Opening of Carotid Canal
1. Internal Carotid Artery and Internal Carotid Plexus 2. Emissary Vein (from Cavernous Sinus to Pharyngeal Vein)
95
Joint compartments (shape and movement)
1. Superior/Temporodiscal space: Concavoconvex/sigmoid; Sliding movement 2. Inferior/Condylodiscal space: Concave; Hinge movement
96
Jugular Foramen
1. Internal Jugular Vein 2. Inferior Petrosal Sinus 3. CN 9: Glossopharyngeal Nerve 4. CN 10: Vagus Nerve 5. CN 11: Spinal Accessory Nerve
97
Kiesselbach's Area
Anterior aspect of nasal septum
98
Lateral movements of mandible
1. Inferior head of lateral pterygoid (on contralateral side) 2. Temporalis (both sides)
99
Lateral Pterygoid innervation
Lateral pterygoid nerves of V3 (travel together and then split to go to different heads)
100
Lateral Pterygoid names
1. Pterygoideus Lateralis 2. External Pterygoid (old name)
101
Lateral wall of Nasopharynx
1. Pharyngeal opening of auditory tube 2. Tubal Elevation/Torus Tubarius 3. Salpingopharyngeal Fold 4. Levator Veli Palatini 5. Pharyngeal Recess containing the tubal tonsils
102
Lateral wall of the Oropharynx
1. Double arches 2. Tonsillar fossa w/Palatine (Faucial) tonsils
103
Lesser Palatine Foramen
1. Lesser Palatine Nerve, Artery, and Vein 2. Middle Palatine Nerve, Artery, and Vein
104
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
105
Ligaments of TMJ
1. 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
106
Linea Alba
Line where teeth meet cheek
107
lingual n and IAN relationship
the lingual nerve is always medial and anterior to the IAN
108
Long Buccal Block
Given in the retromolar fossa area at the depth of the coronoid notch, but not usually required after high mandibular block
109
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.
110
Mandibular Foramen
Inferior Alveolar Nerve, Artery, and Vein
111
Masseter action
1. Elevates mandible 2. Deep head retracts/retrudes mandible 3. Superficial head protracts/protrudes mandible
112
Masseter innervation
Masseteric nerve of V3
113
Masseter insertion
1. Lateral surface of Ramus (deep fibers more superior and superficial fibers more inferior) 2. Lateral surface of inferior portion of coronoid process
114
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
115
Mastoid Foramen
Mastoid Emissary Vein (from Occipital Veins of Posterior Auricular Vein to Sigmoid Sinuses)
116
Medial pterygoid action
Elevates mandible
117
Medial pterygoid innervation
Medial pterygoid nerve of V3
118
Medial pterygoid insertion
Inferior and posterior part of the medial surface of the ramus (triangle formed by mylohyoid groove and angle of mandible)
119
Medial pterygoid names
1. Pterygoideus medialis 2. Internal Pterygoid (old name)
120
Middle Cranial Fossa
1. 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
121
Most medically or dentally important branches of maxillary artery
Medically: Middle Meningeal Artery Dentally: Inferior Alveolar Artery
122
Motor Innervation of the Tongue
Hypoglossal Nerve innervates all muscles of the tongue except the Palatoglossal muscle, which is innervated by the Vagus Nerve
123
Mucosal folds to epiglottis
1. 2 lateral glossoepiglottic folds 2. 1 median glossoepiglottic fold 3. Vallecula
124
Muscles innervated by the facial Nerve
1. Muscles of Facial Expression 2. Posterior belly of Digastric 3. Stapedius 4. Stylohyoid
125
Muscles of the Soft Palate
1. Palatoglossus 2. Palatopharyngeus 3. Musculus Uvulae 4. Levator Palatine 5. Tensor Veli Palatini
126
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)
127
Musculus Uvulae
Origin: Palatine Aponeurosis Insertion: Uvula
128
N function test for Genioglossus
Ask pt to protrude tongue. Deficiency will be on the side that the tongue deviates to.
129
Names for foreign material that embeds in the palatine tonsils?
Tonsilloliths/Tonsillar stones
130
Nasopalatine Foramen injection
Use endo-ice and inject into side of incisive papilla
131
Needle depth for PT technique
-Females: 15-18mm -Males: 18-22mm
132
Optic Foramen
1. CN 2: Optic Nerve 2. Ophthalmic Artery (w/Sympathetic Fibers of Internal Carotid Plexus)
133
Origin of PSNS fibers to PP ganglion
Superior Salivatory nucleus (medulla)
134
Origin of PSNS fibers to Submandibular ganglion
Superior Salivatory nucleus (medulla)
135
Origin of the Superior labial frenum
Tectolabial Frenum, which extended from the incisive papilla to the labial tubercle
136
Palatoglossus
Origin: Palatine aponeurosis Insertion: Posterior lateral tongue
137
Palatopharyngeus
Origin: Palatine Aponeurosis Insertion: Posterior lateral pharynx
138
Parasympathetic Ganglia
1. Otic 2. Ciliary 3. Submandibular 4. Pterygopalatine
139
Parietal Foramen
Parietal Emissary Vein (from Occipital Vein to Superior Sagittal Sinus)
140
Parts of the Maxillary Artery and number of branches
1. Mandibular (5 branches) 2. Pterygoid (5 branches) 3. Pterygopalatine (7 branches)
141
Parts of the Oral Cavity
1. Vestibule 2. Oral Cavity Proper
142
Parts of the Tongue
1. Body (Apex, Margin, Dorsum, and Inferior surface) 2. Root
143
Path of PSNS fibers to PP ganglion
Nervus intermedius --> Genniculate ganglion --> Greater Petrosal Nerve --> Hiatus of Facial Canal --> Groove for GPN --> Internal opening of the carotid canal --> carotid canal --> Foramen lacerum --> pterygoid canal (becomes nerve of the pterygoid canal as SNS nerve Deep petrosal nerve joins) --> Pterygopalatine fossa --> PP ganglion
144
Path of PSNS fibers to Submandibular Ganglion
Nervus intermedius --> Geniculate ganglion --> Facial canal --> chorda tympani given off --> tympanic cavity (btwn malleus and incus) --> petrotympanic fissure --> Infratemporal fossa --> joins lingual nerve --> Submandibular ganglion
145
Path of the Greater palatine A
GP canal --> GP foramen --> hard palate (palatine groove) --> Incisive fossa --> Incisive foramen --> Incisive canal --> Anastamoses with Nasopalatine A
146
Path of the Infraorbital artery
Inferior orbital fissure --> infraorbital groove --> infraorbital canal --> infraorbital foramen
147
Path of the Lesser palatine Artery
LP canal --> LP foramen --> Soft palate
148
Pathway of the Maxillary Nerve
Trigeminal Ganglion --> Dura in lateral wall of the Cavernous sinus --> Exits MCF via Foramen rotundum
149
Pathway of the Ophthalmic Nerve
Trigeminal ganglion --> dura in the lateral wall of the Cavernous Sinus --> gives off 3 branches
150
Pathway of the Zygomatic Nerve
Inferior Orbital fissure --> Orbit --> Zygomaticoorbital foramen --> splits into 2 branches
151
Petrosquamous Fissure
Location only
152
Petrotympanic Fissure
1. Chorda Tympani 2. Anterior Tympanic Artery 3. Medial Retrodiscal Ligament/Anterior Malleolar Ligament
153
Pharyngeal Canal
1. Pharyngeal Artery and Vein 2. Pharyngeal Branch of Pterygopalatine Nerve
154
Posterior Cranial Fossa
1. Foramen Magnum 2. Jugular Foramen 3. Hypoglossal Canal 4. Condyloid Canal 5. Internal Auditory Meatus 6. Mastoid Foramen
155
Posterior Ethmoidal Canal
Posterior Ethmoidal Nerve, Artery, and Vein
156
Posterior Superior Alveolar Foramen
Posterior Superior Alveolar Nerve, Artery, and Vein
157
Problems of Mandibular Blocks and Accessory Innervation (Potential Sources)
1. Long Buccal Nerve through retromolar fossa foramen to mandibular molars 2. Auriculotemporal N through Mandibular notch foramen to mandibular molars 3. Posterior dental branches from IAN through mandibular notch foramen to mandibular molars 4. Mylohyoid Nerve through mylohyoid groove foramen to mandiblar molars; through genial tubercle foramen to anterior teeth 5. Lingual nerve through any lingual foramen to any tooth
158
Protrusion/protraction of mandible
1. Inferior head of lateral pterygoid 2. Masseter 3. Temporalis
159
Pterygopalatine Canal
1. Descending Palatine Artery and Vein 2. Greater and Lesser Palatine Nerves
160
Pterygopalatine/Pterygomaxillary Fissure
1. Maxillary Artery 2. Pterygoid Plexus to Maxillary Vein
161
Pterygotuberosity angle
Space between the PM raphe and the Maxillary tuberosity (highest point at which you can access the PM space)
162
Retraction/Retrusion of mandible
1. Posterior fibers of Temporalis 2. Deep head of Masseter
163
Roof of Nasopharynx
Superior posterior curvature where pharyngeal tonsils (adenoids) are located
164
Root of the Nose
Where the nose connects to the rest of the skull (nasal bones to frontal bone)
165
Root of tongue
part of tongue not covered by mucosa and where all structures come in and out of the tongue
166
Rule for unusuccessful blocks
You are probably too medial and too low, go more lateral and higher
167
Rule of the Anterior division of V3 and exceptions
-Mainly a motor division with 1 tiny exception and 1 large exception -Tiny exception: Masseteric N supplies sensation to TMJ -Large Exception: Long Buccal N is purely sensory
168
Sensory Innervation of the Tongue (General sensation and taste)
Anterior 2/3 -Gen. Sensation: Lingual N -Taste: Chorda Tympani (exception: Circumvallate papilla are innervated by Glossopharyngeal) Posterior 1/3 -Gen. Sensation: Glossopharyngeal -Taste: Glossopharyngeal Epiglottis -Gen. Sensation: Vagus N -Taste: Vagus N
169
Sinus Lift
Procedure to raise the maxillary sinus by lifting the mucoperiosteal lining and adding boen underneath
170
Squamotympanic Fissure
Location only
171
Steps to perform low mandibular block
1. put thumb in coronoid notch 2. bisect thumb 3. find midpoint on bisection line between PM raphe and coronoid notch 4. Barrel of synringe on contralateral mandibular premolars 5. advance needle 6. Aspirate 7. Inject
172
Structures passing deep to the posterior/free border of the mylohyoid (superior to inferior)
1. Lingual N 2. Submandibular duct or deep process 3. Hypoglossal N
173
Stylomastoid Foramen
CN 7: Facial Nerve
174
Submandibular Gland (CN, Nucleus, Pregang fibers, Post gang fibers, structures innervated)
-CN: Facial N -Nucleus: Superior Salivatory nucleus -Pregang fibers: Chorda tympani, Lingual N -Postgang fibers: Lingual N -Structures innervated: submandibular gland, sublingual gland, misc lingual glands on anterior 2/3 of tongue
175
Superficial Lymph Nodes
1. Submental lymph nodes 2. Submandibular lymph nodes 3. Anterior Auricular/Superficial Parotid/Preauricular Lymph nodes 4. Retroauricular/Postauricular/Mastoid Lymph nodes 5. Occipital/Nuchal lymph nodes 6. Superfical Cervical lymph nodes
176
Superior Alveolar plexus
intermingling of MSAs, PSAs, and ASAs within the alveolar process
177
Superior and Inferior Deep Cervical Lymph nodes
Superior Deep Cervical 1. Jugulodigastric/Tonsillar Lymph nodes Inferior Deep Cervical 1. Juguloomohyoid Lymph nodes 2. Supraclavicular/Sentinel/Signal lymph nodes of Troissier or Virschow
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Superior Orbital Fissure
1. CN 3: Oculomotor Nerve 2. CN 4: Trochlear Nerve 3. V1: Ophthalmic Nerve 4. CN 6: Abducens Nerve 5. Nasociliary Nerve 6. Lacrimal Nerve 7. Meningeal Branch of Lacrimal Artery 8. Branch of Middle Meningeal Artery to Orbit 9. Sympathetic Fibers
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Supraorbital Foramen
Supraorbital Nerve, Artery, and Vein
180
Surfaces of sublingual gland and related structures
1. Superior: mucous membrane of the floor of the mouth (sublingual fold) 2. Inferior: mylohyoid 3. Anterior: mandible 4. Lateral: Sublingual fossa 5. Medial: Genioglossus (w/lingual N, submandibular duct, Lingual A & its 2 branches, and hypoglossal N) 6. Posterior: Deep process of the submandibular gland
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Surfaces of submandibular gland and related structures
1. Inferior: Skin, platysma, deep fascia, Facial Vein, Submandibular lymph nodes 2. Lateral: submandibular fossa and facial artery 3. Medial: mylohyoid, hyoglossus, Digastric muscles (both bellies), facial artery
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Surfaces of the Maxillary Sinus and associated structures
1. Facial (anterolateral) 2. Posterior (faces IT fossa laterally and PP fossa medially) 3. Medial (nasal cavity) 4. Roof (floor of orbit, mostly maxilla) 5. Floor (Maxillary molars, premolars, and canines)
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Temporalis Action
1. Elevates mandible 2. Posterior fibers pull the condyle backwards from the articular eminence to the glenoid fossa during mouth closure
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Temporalis Innervation
Anterior and Posterior Deep Temporal Nerves of V3
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Temporalis insertion
-Superficial tendon: superior 1/2 of coronoid notch and possibly to anterior 1/2 of mandibular notch -Deep tendon: Temporal crest (all the way down to the lingual of the 3rd molar) and Buccinator
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Temporalis Origin
1. Deep surface of temporalis fascia 2. Floor of temporal fossa 3. Inferior temporal line 4. Pterygopalatine Fossa (to the depth of the foramen rotundum)
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Tensor Veli Palatini
Origin: Base of medial pterygoid plate and spine of sphenoid Insertion: Palatine Aponeurosis (forms it after it goes around pterygoid hamulus) Action: Tenses the soft palate
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Tonsillar Crypts
Blind-ended mucosal tubules
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Tympanic Canaliculus
Tympanic Branch of CN IX: Glossopharyngeal Nerve
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Types of Lingual Papilla
1. Filiform papilla 2. Fungiform papilla 3. Circumvallate papilla 4. Foliate papilla
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Unique features of the TMJ
1. Only joint that can be dislocated without extrinsic forces 2. Only joint system with rigid point of closure (ie teeth) 3. Both joints must move at the same time
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V2 extraoral division block
through masseter and post 1/2 of mandibular notch --> turn needle anteriorly --> dead-end at lateral pterygoid plate --> reposition --> PP fissure --> PP fossa --> V2 in Foramen rotundum
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V2 intraoral division block
Bend needle and insert into greater palatine foramen --> GP canal --> Pterygopalatine canal --> PP fossa --> V2 in Foramen rotundum
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V3 extraoral division block
Through masseter and post 1/2 of mandibular notch --> continue to V3 in foramen ovale
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V3 intraoral division block
"accentuated PSA block" where you continue going past PSA foramen to V3 at foramen ovale
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Variations and relative occurrence of the external branch of the PSA A
1. Very small or Missing (33%) 2. Moderate size and supplies the buccal gingiva over the molars (external source) (33%) 3. Very large and supplies the buccal gingiva over all of the maxillary teeth (external source) (33%); may go all the way to infraorbital foramen and anastamose with infraorbital artery
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Waldeyer's Ring
4 pairs of tonsils (lingual, palatine, tubal, and pharyngeal)
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What are the spaces on either side of the PM space?
1. Buccal space (lateral) 2. Lateral pharyngeal space (medial)
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What are the suspensory ligaments of the TMJ?
1. Stylomandibular ligament 2. Sphenomandibular ligament
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What are the two possible sources to the gingiva and which one is the most important?
1. Primary source: from outside bone (most important) 2. Secondary source: from within bone
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What arteries are involved in anterior epistaxis and what are their parents?
1. Nasopalatine A (Sphenopalatine A) 2. Septal branch of the superior labial A (Sup. Labial A) 3. Anterior Ethmoid A (Ophthalmic A)
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What arteries are involved in posterior epistaxis?
Sphenopalatine A or its 3 branches posteriorly (Post sup nasal A, post inf nasal A, and Nasopalatine A)
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What branch may come off of the PSA A?
External branch of the PSA A
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What branches of the pterygopalatine part may form a common trunk?
the PSA A and the infraorbital artery
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What can appear in older TMJs?
Fibrocartilage
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What determines deep vs. superficial route and relative occurrence?
whether the pterygoid part passes superficial (60%) or deep (40%) to the inferior head of the lateral pterygoid
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What determines whether a deep cervical lymph node is superior or inferior?
Where the omohyoid crosses the carotid sheath
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What do the branches of the pterygoid part supply?
The four muscles of mastication or the four muscles of mastication and the Buccinator
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What do the dental and gingival branches of the IAA supply?
-Dental branches: molars and 2nd premolar -Gingival branches: buccal and lingual gingiva of molars and 2nd premolar (internal source)
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What do the dental and gingival branches of the incisive artery supply?
-Dental branches: 1st premolar and anterior teeth -Gingival branches: buccal and lingual gingiva over 1st premolar and anterior teeth (internal source)
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What do the Submental lymph nodes drain?
1. Tip of tongue 2. Central area of inferior surface of tongue 3. Central floor of mouth 4. Incisors 5. Central lower lip 6. Midline structures of lower face (lower eyelids and below)
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What does a PSA infiltration block?
1. Buccal and lingual gingiva (secondary source) 2. Buccal gingiva (primary source)
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What does the Anterior Auricular/Superficial parotid/Preauricular lymph node drain?
1. Parotid gland 2. skin over parotid gland 3. Lateral side of head (most forehead, upper eyelid, part of external ear)
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What does the ASA A supply?
1. Anterior teeth 2. buccal and lingual gingiva over the anterior teeth (internal source) 3. Maxillary sinus
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What does the ASA N supply?
1. Anterior teeth 2. Buccal and lingual gingiva over the anterior teeth (secondary source) 3. Maxillary sinus
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What does the external branch of the PSA N supply?
Buccal gingiva over the molars (primary source)
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What does the greater palatine artery supply?
1. Hard palate 2. all lingual gingiva (external source)
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What does the Greater palatine N supply?
1. Posterior 2/3 of hard palate 2. Lingual gingiva of molars and premolars (primary source)
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What does the IAA pass between before going into the mandibular foramen?
passes between the ramus of the mandible and the sphenomandibular ligament
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what does the incisive nerve supply?
1. 1st premolar and anterior teeth 2. buccal and lingual gingiva over anterior teeth and first premolar (secondary source)
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What does the Inferior Alveolar Nerve supply?
1. Molars and 2nd premolar 2. buccal and lingual gingiva over molars and premolars (secondary source)
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What does the Infratrochlear N supply?
1. Eyelids 2. skin of nose 3. Lacrimal sac
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What does the lacrimal gland supply?
1. Lacrimal gland 2. conjunctiva 3. skin to upper eyelid
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What does the Lesser Palatine A supply?
Soft Palate
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What does the Lesser palatine N supply?
the Soft Palate
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what does the lingual nerve run between after it loops around the submandibular duct?
the hyoglossus and genioglossus medially and the sublingual gland laterally
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What does the Long buccal N supply?
1. Full thickness of cheek (Buccinator, skin, and mucous membranes) 2. Buccal gingiva over mandibular molars (primary source)
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What does the mental artery supply?
the chin area
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What does the Mental nerve supply?
1. Lower lip and chin 2. Buccal gingiva over anterior teeth and premolars (primary source)
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What does the MSA A supply?
1. Premolars 2. buccal and lingual gingiva over the premolars (internal source) 3. Maxillary sinus
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What does the MSA N supply?
1. Premolars 2. Buccal and lingual gingiva over the premolars (secondary source) 3. Maxillary sinus
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What does the Mylohyoid A supply?
Area around the mylohyoid and sometimes the retromolar area
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What does the mylohyoid N supply?
1. Anterior belly of Digastric 2. Mylohyoid
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What does the Nasopalatine artery anastamose with?
1. Greater palatine artery in the incisive canal 2. Septal branch of the superior labial artery (from Facial A)
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What does the Nasopalatine Artery supply?
1. Anterior 1/3 of hard palate 2. Lingual gingiva of anterior teeth (primary source)
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What does the Occipital/Nuchal Lymph node drain?
Scalp of the occipital region
237
What does the Ophthalmic Nerve supply?
1. Eyeball and Conjunctiva 2. Lacrimal Gland and Sac 3. Nasal mucosa 4. Ethmoid, frontal, and part of sphenoid sinuses 5. Bridge of external nose, upper eyelid, scalp, and forehead
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What does the orbital N supply?
Sphenoid and Ethmoid Sinuses
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What does the pharyngeal artery supply?
The nasopharynx (via the pharyngeal canal)
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What does the pharyngeal N supply?
1. Superior part of nasopharynx 2. Sphenoid sinus
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What does the Posterior Ethmoidal N supply?
1. Ethmoid Sinus 2. Part of Sphenoid Sinus
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What does the posterior inferior nasal A supply?
the inferior nasal concha
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What does the posterior inferior nasal N supply?
The inferior nasal concha
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What does the posterior superior nasal A supply?
the superior and middle nasal concha
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What does the Posterior superior Nasal N supply?
1. Superior nasal concha 2. Inferior nasal concha
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What does the PSA A supply?
1. Maxillary Sinus 2. Maxillary molars 3. buccal and lingual gingiva over molars (internal source)
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What does the PSA N supply?
1. Molars 2. buccal and lingual gingiva over molars (secondary source) 3. Maxillary sinus
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What does the Pterygoid Plexus drain?
The deep face
249
What does the Retroauricular/Posterior Auricular/Mastoid lymph node drain?
1. Part of external ear 2. Scalp above and behind ear
250
What does the submandibular lymph node drain?
1. drainage from submental lymph nodes 2. Anterior face 3. All teeth and gingiva (directly or indirectly) 4. Lips, cheeks, and lower nose 5. Oral Cavity 6. Anterior nasal cavity 7. most of hard palate 8. Lateral aspect of anterior 2/3 of tongue
251
What does the superior labial N supply?
1. Full thickness of upper lip 2. Buccal gingiva over anterior and middle teeth (primary source)
252
What does the supraorbital N supply?
1. Forehead 2. Scalp 3. Upper eyelid 4. Frontal sinus
253
What does the Tentorial branch of the Ophthalmic N supply?
Meninges (may be involved in headaches)
254
What fascia is the medial pterygoid fascia?
Thickened investing fascia
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what functions does the chorda tympani have?
1. taste on the anterior 2/3 of tongue (except circumvallate papilla, which are innervates by the glossopharyngeal for taste) 2. parasympathetics (secretomotor) to submandibular gland, sublingual gland, and miscellaneous glands on the anterior 2/3 of the tongue
256
what functions does the lingual n have? (prior to chorda tympani joining)
1. supplies lingual gingiva of all mandibular teeth (primary source) 2. supplies floor of the mouth (sublingual sulcus) 3. supplies anterior 2/3 of the tongue
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What happens with loss of PSNS to Lacrimal gland
Corneal dryness and eventual blindness
258
What hole does the descending palatine A go through?
Pterygopalatine canal
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What is contained in the tonsillar fossa?
Palatine/Faucial tonsils
260
What is immediately lateral to the palatine tonsils and what is lateral to that?
1. Superior pharyngela constrictor 2. Medial Pterygoid
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What is important about the Supraclavicular and Transverse Cervical Lymph nodes?
They are used as evidence of visceral malignancy
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What is one exception to the rule that PSA supplies the maxillary molars and why is it important?
-The MB cusp of the maxillary 1st molar may be supplied by an MSA (5-65% of the time) -When working on a 1st molar, do a PSA and an MSA block
263
What is the Articular cartilage made of?
Dense fibrous connective tissue
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what is the lingual n between as it enters the floor of the mouth?
the mylohyoid laterally and the hyoglossus medially
265
What is the name for a communication between the maxillary sinus and the oral cavity?
Oroantral fistula
266
What is the only hole in the PP fossa not used by V2?
The pterygoid canal
267
What is the PSA canal?
a 3-sided bony canal with a mucoperiosteal lining
268
What kind of fascia is temporal fascia?
Investing fascia
269
What layers must a needle pass through to enter the PM space?
1. Oral mucosa 2. Buccinator 3. Buccopharyngeal fascia
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What marks the anterior boundary of the oropharynx?
The palatoglossal arch/anterior pillar
271
What muscles actively open the auditory tube?
1. Salpingopharyngeus 2. Tensor Veli Palatini 3. Levator Veli Palatini
272
What muscles are innervated by V3?
1. Masseter 2. Temporalis 3. Medial Pterygoid 4. Lateral Pterygoid 5. Tensor Veli Palatini 6. Tensor Tympani 7. Anterior belly of digastric 8. Mylohyoid
273
What Nerve does the posterior inferior nasal N come off of?
The Greater Palatine N
274
What Nerve may be damaged in a palatine tonsillectomy?
Glossopharyngeal Nerve
275
What nerves does a Mandibular block anesthetize?
1. Inferior Alveolar Nerve 2. Lingual N
276
What nerves leave the Facial nerve in the facial canal?
1. Greater Petrosal Nerve 2. Nerve to Stapedius 3. Chorda Tympani
277
What other name for the TMJ emphasizes its bilateralness?
Craniomandibular joint
278
What parts of the body have vestibules?
1. mouth 2. Nose 3. pharynx
279
What separates the anterior 2/3 of the tongue from the posterior 1/3?
The foramen cecum and the sulcus terminalis
280
What separates the dorsum of the tongue into longitudinal halves?
The (median) lingual sulcus
281
What separates the tongue into halves longitudinally on the ventral side?
Lingual frenum/frenulum
282
What type of Joint is the TMJ?
Ginglymoarthroidal Joint
283
What type of nerve is the maxillary nerve?
Pure sensory
284
What type of nerve is the Ophthalmic Nerve?
Pure sensory
285
What type of nerve is V3?
A mixed nerve
286
What vessel is usually involved in hemorrhage from a palatine tonsillectomy?
Palatine Vein/Paratonsillar vein
287
when would the lingual n be hit?
1. 3rd molar extraction 2. during mandibular block (very painful)
288
Where are the deep cervical lymph nodes located?
Vertically along internal jugular vein (most under SCM)
289
Where are the lingual tonsils located?
On the posterior surface of the tongue
290
Where are the superficial cervical lymph nodes located?
Along external jugular vein and along anterior jugular vein (anterior cervical lymph nodes)
291
Where do the sympathetic fibers to the head and neck come from?
Superior cervical ganglion
292
Where do you insert the needle in the pterygotuberosity technique?
4mm inferior to the maxilary tuberosity or at height of parotid papilla in edentulous patients
293
Where does the barrel of the syringe go in the PT technique?
On the contralateral maxillary canine to the first premolar
294
where does the chorda tympani join the lingual n?
deep to the inferior head of the lateral pterygoid
295
Where does the mandibular part run?
anteriorly and horizontally between the sphenomandibular ligament and the neck of the condyle
296
Where does the Posterior inferior nasal N come off the Greater palatine N?
In the greater palatine canal
297
Where does the PSA N come off?
In the pterygopalatine fossa
298
Where does the pterygopalatine part start?
In or just before the pterygopalatine fossa
299
Where does the sublingual gland empty?
10-30 orifices along the sublingul fold and the anterior 1-3 orifices empty via the sublingual papilla/caruncle
300
Where is the facial motor nucleus located
The pons
301
Where is the Jugulodigastric/Tonsillar lymph node located and what does it drain?
Location: Inferior to posterior belly of digastric, just posterior to greater horn of hyoid Drains oropharyngeal area (post 1/3 of tongue and palatine tonsils)
302
Where is the Juguloomohyoid lymph node located and what does it drain?
Location: Just superior to intermediate tendon of omohyoid Drains central area of ant 2/3 of tongue
303
Where is the PSA canal located?
the posterior lateral wall of the maxillary sinus
304
Where is the uvula located?
The oropharynx
305
Where would one give a greater palatine block?
As the greater palatine N travels through the greater palatine canal
306
Which arch are muscles of mastication derived from?
First branchial arch
307
Which branches of the mandibular part may form a common trunk?
Middle Meningeal artery and Accessory meningeal Artery
308
Which branches of the maxillary artery drain to the pterygoid plexus?
All 17 branches drain directly to pterygoid plexus, but the inferior alveolar V may bypass the pterygoid plexus and drain to the maxillary vein proper
309
Which branches of the pterygopalatine part may come off prior to entering the pterygopalatine fossa?
1. PSA A 2. Infraorbital A
310
Which nerves are commonly hit in a low mandibular block?
1. Lingual N (55% of the time) 2. IAN (45% of the time)
311
Which opening of the pterygopalatine fossa is not used by a branch of V3?
The pterygoid canal
312
Who developed the conventional approach/low mand block?
William Halsted in 1885
313
Why are External branch of PSA A variations improtant with regard to injections?
A large external branch of the PSA A may be hit during a PSA block and cause massive hemorrhage of the cheek
314
Why does a maxillary sinus infection cause molar pain?
Because the PSA N becomes impinged as it travels with the PSA A in the PSA canal
315
Why does the IAA supply the 2nd premolar and the Incisive artery supply the 1st premolar?
Because the mental foramen is located directly inferior or slightly inferior and anterior to the 2nd premolar
316
Why is the Long Buccal nerve not considered to be in the pterygomandibular space?
Because it emerges between the heads of the lateral pterygoid and then goes into the deep tendon of the temporalis
317
Why might 2 injections be required in the PM space?
a thick Sphenomandibular ligament
318
Zygomaticofacial Foramen
Zygomaticofacial Nerve
319
Zygomaticotemporal Foramen
Zygomaticotemporal Nerve
