Anatomy Updated Flashcards
Long bone - definition and example?
Longer than it is wide
Femur, Humerus, Tibia, Fibula
Short bone - definition and example?
Shorter than it is wide
Metatarsals, Tarsals
Flat bone - definition and example?
Flat surface
Scapular
Irregular - definition and example?
Doesn’t fit into any other category
Vertebrae
Sesamoid - definition and example?
Small, round and flat
Patella
Epiphysis - location?
Proximal and distal
Areas of the long bone
Diaphysis - location?
The long shaft of the long bone
Cortical bone - characteristic and function?
Compact bone
Gives strength to the bone
Weight bearing
Trabecular bone - characteristic and function?
Cancellous and spongy bone
Reduces chance of shatter
Integrity
Bone marrow - Location? Age differences? stem cells?
Medullary cavity
Changes with age: red in children and yellow in adults
Red has more stem cells
Yellow has less
Osteoporosis - definition? dental application?
Thinner bone
More brittle
Related to alveolar bone, mandible and maxilla
Possible fractures
Cervical vertebrae - articular facet orientation? permitted movements?
Articular facets orientated superior/inferior
Movement: rotation, extension and flexion
Thoracic vertebrae - articular facet orientation? permitted movements?
Articular facets orientated coronally
Limited rotation, left and right
Lumbar vertebrae - articular facet orientation? permitted movements?
Articular facets orientated sagittally
Flexion and extension but limited rotation
Atlas/axis - vertebrae? special anatomy? function?
Cervical C1/C2 Atypical vertebrae Odontoid process Pivot on axis to allow rotation No spines but arches
The thoracic wall - located? # of vertebrae and ribs? suprasternal notch located? sternal angle located? xiphisternal joint located? costal margin located?
Located in the thoracic cavity
12 thoracic vertebrae and 12 ribs
Sternum landmarks:- suprasternal notch (T2/3), sternal angle (T4/5), xiphisternal joint (T9) and costal margin (10th rib/L3)
Typical anatomy of the rib - Anatomy?
Middle rib:- superior and inferior articular facets (for ventral body), head, neck, tubercle, articular facets (transverse process of vertebrae), angle and costal groove
How to count the ribs - Process?
Start at the middle of the clavicle and count down
The anatomy of the sternum - articulation sites?
Articular sites for:- clavicle- rib I, II, II, III, IV, V, VI and VII
transverse ridges
xiphoid process
Articulation with the vertebrae - Joint anatomy? held together by? located between?
Anatomy: rib enters the vertebrae-connected by a joint capsule/cavity held together by the intra-articular ligament
between the vertebrae are discs
Joints of thoracic cage - examples? think cage bones?
manubriosternal joint (symphysis) (in sternum) fibrocartilaginous joint synovial joint xiphisternal joint (symphysis) interchondral joints
Muscles of the thorax - Types?
External intercostal
Internal intercostal
Innermost intercostal
Intercostal nerves - Names and location?
Intercostal nerve branches to: anterior primary rami of thoracic nerves posterior branch lateral cutaneous branch anterior branch small collateral branch lateral branch medial branch anterior cutaneous branch
Respiratory movements - Rib movements (middle rib and sternal rib)
Middle rib: superior and anterior movement of sternum (pump handle)
Rib at sternum: elevation of lateral shaft of rib (bucket handle)
Pleura and pleural cavity - derivation? visceral and parietal location? attachments? pleural cavity definition? pleura produce and function? surface tension provides?
Pleura:
mesothelial lining of each hemithorax derived from embryonic coelomic lining
Visceral pleura (lung)
parietal pleura (wall)
Costal, diaphragmatic, mediastinal and cervical attachment
Pleural cavity: space between visceral and parietal pleura
Capillary layer of serous fluid produced by mesothelium, reduces friction
Surfaces tension provides cohesion between lung and thoracic wall
Superior mediastinum - vessels? resp? lymph? nerves?
great vessel trachea oesophagus thoracic duct two vagi left recurrent laryngeal nerve phrenic nerves
Anterior mediastinum - gland?
- thymus
Middle mediastinum - organ? - vessels? resp? nerves?
- heart- pericardium- vessels, bronchi and nerves
Posterior mediastinum - - vessels? resp? nerves?
- oesophagus- aorta- vagus nerve
Diaphragm - Attachments? Ligaments? Openings T8, T10 and T12 and passage? Nerve supply (motor and sensory)?
Attachments:
- vertebral (from right crust and left crust)
- costal (from inner aspect of lower 6 ribs)
- sternal (from deep surfaces of xiphisternum)
Ligaments:
- medial, lateral and median
Openings:
Aortic (T12):
transmits abdominal aorta, thoracic duct and azygos vein
Oesophageal (T10):
transmits oesophagus, left gastric arterial branches and vein and 2 vagi
Inferior Vena Cava (T8);
transmits IVC and right phrenic nerve
Nerve supply:
motor: - phrenic C3/4/5)
sensory: - phrenic central and intercostal nerve
Lymphatic drainage - thoracic duct (drainage)? and right lymphatic duct (drainage)?
Thoracic duct:
from cisterna chyli to left brachiocephalic vein- drains abdomen and left thorax
Right thorax by right lymphatic duct
Name the cranial nerves? I-XII
CN I - olfactory CN II - optic CN III - oculomotor CN IV - trochlear CN V - trigeminal CN VI - abducens CN VII - facial CN VIII - vestibulocochlear CN IX - glossopharyngeal CN X - vagus CN XI - accessory CN XII - hypoglossal
Olfactory nerve - passage?
Cribriform plate
Optic canal - what passes through it? (2)
Optic nerve
Ophthalmic canal from the internal carotid artery
Superior orbital fissure - what passes through it? (4)
Abducens nerve VI
Trochlear nerve IV
Oculomotor nerve III
Ophthalmic division of trigeminal nerve V1
Inferior orbital fissure - what passes through it? (1)
Infraorbital nerve forms from the maxillary division of trigeminal nerve
Foramen rotundum - what passes through it? (1)
Maxillary division of trigeminal nerve V2
Foramen ovale - what passes through it? (1)
Mandibular division of trigeminal nerve V3
Foramen spinosum - what passes through it? (artery)
Middle meningeal artery
Foramen lacerum - what passes through it?
Covered by cartilage
Internal carotid artery runs above the foramen
Carotid canal - what passes through it? (1)
Internal carotid artery
Stylomastoid foramen - what passes through it? (1)
Facial nerve (extracranial part) after it leaves the superior orbital fissure
Internal acoustic meatus - what passes through it? (2)
Vestibulocochlear nerve
Facial nerve
Jugular foramen - what passes through it? (V and N) (4)
Internal jugular vein (and sigmoid sinus)
glossopharyngeal nerve
vagus nerve
accessory nerve
Hypoglossal canal - what passes through it?
Hypoglossal nerve
Foramen magnum - what passes through it? (3)
Spinal cord
Vertebral arteries
Spinal accessory nerve
Foramina of the mandible - branches of the mandibular nerve branch of trigeminal nerve? passage of the trigeminal nerve (foramen, split, supply, exits, forms)?
Branches: auriculotemporal, inferior alveolar, lingual and buccal nerves
Course: starts as a branch of the trigeminal nerve and passes out of the superior orbital fissure enters the mandibular foramen splits into the inferior alveolar nerve and supplies the teeth exits via the mental foramen forming the mental nerve
Foramina of the hard palate - incisive fossa? greater/lesser palatine foramen?
Incisive fossa - anterior palatine branch of the nasopalatine nerve
Greater palatine foramen - greater palatine nerve
Lesser palatine foramen - lesser palatine nerve
CN I - name? function? foramen?
Olfactory
Smell
Enters Cribriform plate
CN II - name? function? foramen?
Optic
Sight
Enters Optic canal
CN III - name? function? foramen?
Oculomotor
Moves the eye
Exits superior orbital fissure
CN IV - name? function? foramen?
Trochlear
Moves the eye down
Exits superior orbital fissure
CN V - name? function? foramen (V1/2/3)
Trigeminal Sensation to the face, and masticatory muscles V1 - enter superior orbital fissure V2 - enters via foramen rotundum V3 - enters foramen ovale
CN VI - name? function? foramen?
Abducens
Move eye laterally, innervates lateral rectus muscle
Exit via superior orbital fissure
CN VII - name? function? foramen?
Facial Muscle of facial expression Taste (tongue) Tear and salivary ducts Stapedius muscles (dampen sound) Exits internal acoustic meatus and the stylomastoid foramen
CN VIII - name? function? foramen?
Vestibulocochlear
Balance and hearing
Exits internal acoustic meatus
CN IX- name? function? foramen?
Glossopharyngeal
Tongue, pharynx sensation and innervates stylopharyngeus
Exits via jugular foramen
CN X - name? function? foramen?
Vagus
Parasympth innervation
Exits via jugular foramen
CN XI - name? function? foramen?
Accessory
Spinal portion innervates SCM and trapezius,
Cranial portion runs with vagus
Exits via jugular foramen
CN XII - name? function? foramen?
Hypoglossal
All tongue muscles bar 1 (palatoglossus)
Exits via hypoglossal canal
Vertebral foramina - Why is it large?
Due to the spinal cord being large, as the nerves have not shoot off to the limbs
Vertebral artery and vein entering the vertebrae?
Artery at C6
Vein at C7
Atlanto-occipital joint - Where? Motion? flexibility how?
Where: C1 and occipital bone
Motion: nodding little lateral neck flexion and rotation Characteristics: anterior and posterior atlanto-occipital membranes thin loose capsules (for flexibility)
Atlantoaxial joints - Where? Motion? 2 types of joints?
Where: C1 with C2
Motion: rotation
Characteristics: one pair of gliding joints and a single pivot joint dens of axis
Ligaments of the (atlantoaxial) odontoid process - transverse ligaments function? alar ligaments function? transverse ligaments split and form?
Transverse ligament of atlas holds the odontoid process Alar ligaments also aid the dens (from the dens to the occipital bone) for stability
Transverse ligaments have 2 bands: superior (occipital) and inferior (C2) longitudinal band - all together form the cruciate ligament
Occipitoaxial ligament complex - apical attachments? alar attachments? transverse attachments? complex covered by to become?
Apical ligament attached to the dens to C1
Alar ligaments from the dens to C1
Transverse ligaments covers the dens and the inferior and posterior bands attach occipital and C2 (forming the cruciate ligament)
The complex is fully covered by the tectorial membrane, becomes the posterior longitudinal ligament
Spinal nerves? # of nerves? 7 vertebrae and 8 nerves? Nerve supply (1)? Arterial supply (3)?
Neural foramina of cervical spine allow exit of cervical spinal nerves which are C1-8
First nerve comes out before C1 and so extra nerve at the bottom
Nerve supply: dorsal rami
Arterial supply: vertebral, ascending thoracic and deep cervical arteries (1 anterior and 2 posterior spinal arteries)
Cervical nerves - Numbers and roles 1-8?
C1 and C2: head and neck C3: diaphragm C4: upper body muscles C5 and C6: wrist extensors C7: triceps C8: hands
Names of cervical fractures - Jefferson T1/2/3? Hangman?
Jefferson: - type 1 is fracture of tip - type 2 is fracture of neck - type 3 is fracture of body C1: arch fractures Hangman: through neural arch of axis (between facets)
The neck - function? palpable points?
Connects head to trunk
Palpable points: mandible, mastoid process, hyoid bone, thyroid and cricoid cartilage, transverse process of C1
Neck landmarks - C3? C4/5? C6? T2/4?
C3: Hyoid bone
C4/5: Thyroid cartilage (upper)
C6: Cricoid cartilage and bifurcation of the carotid artery (carotid body for blood pressure)
T2/T4: Isthmus of thyroid gland - over 2nd and 3rd tracheal ring (tracheostomy)
Lower border of the Cricoid (C6) - junction of? pharynx? thyroid? omohyoid? symph gang? carotid?
Junction of larynx with trachea
Pharynx becomes oesophagus
Inferior and middle thyroid enter thyroid gland
Vertebral artery enters the transverse foramen of C Superior belly of the omohyoid crosses the carotid sheet
Level if the middle cervical sympathetic ganglion
Level at which carotid artery can be compressed
Muscular triangles of the neck - Types? Boundaries of post and ant?
Types:
posterior triangle and anterior triangle
Boundaries:
- posterior; post SCM, anterior trapezius and middle third clavicle
- anterior; anterior SCM and inferior mandible
Supplementary muscular triangles - Types?
Types: submental muscular carotid submandibular
Posterior triangle - The roof (fascia, M, V, N) The floor (fascia, M, V, N)? The contents (V, A, N, L)
Roof:
- layer of deep fascia
- superficial fascia
- platysma
- superficial veins
- cutaneous nerves and skin
Floor:
- facial and muscular
- splenius capitis, levator scapula, scalenus (post and anterior)
- covered by prevertebral layer of deep cervical fascia
Contents:
- veins; external jugular (superficial)
- arteries; subclavian, transverse cervical from the thyrocervical trunk and occipital
- nerves; accessory XI, lesser occipital nerve, roots of brachial plexus, cervical plexus and ansa cervicalis
- lymph nodes; posterior articular, occipital and supraclavicular
Nervous content of the posterior triangle - nerves? split by muscle?
Supraclavicular nerves (C3/4) Transverse cervical nerves (C2/3) Accessory nerve XI Lesser and greater occipital nerve Greater auricular nerve (C2/3) Split by: scalene muscle separates the veins and arteries
Internal jugular vein - Clinical use for medicine?
Can give a direct effect on the right side of the heart
Anterior triangle - Roof (M, fascia, N)? Subdivision and split by what muscle?
Roof:
- skin
- superficial fascia
- platysma
- investing layer of deep fascia
- cervical branch if facial nerve and the transverse cutaneous nerves runs across the triangle
Subdivided into 4 triangles by the anterior and posterior bellies of the digastric muscle and the superior belly of the omohyoid (submental, digastric, carotid and muscular triangles)
Muscles of the superficial neck - Trapezius (location, function and innervation)? SCM (location, function and innervation)?
Trapezius: lies at back of posterior triangle, shrugs the shoulder and rotates the glenoid fossa (faces up) innervation by the spinal accessory nerve
Sternocleidomastoid: forms the anterior border of the triangle, action to tilt the head towards the shoulder and rotates the head and face to the opposite side and innervated by the spinal accessory nerve
Cervical fascia - superficial surrounds? deep splits into?
Superficial cervical fascia - surrounds platysma muscle, fat and nerves
Deep cervical fascia; split into investing, pretracheal, prevertebral and carotid sheath
Deep fascia - Investing (content M), Pretracheal (Content), Carotid (content V and N) and Prevertebral (Content)?
Investing fascia: trapezius and sternocleidomastoid Pretracheal: oesophagus, trachea and thyroid gland Carotid fascia: carotid artery, jugular vein, carotid canal, jugular foramen and CN12
Prevertebral fascia: surround vertebral column
Infections of the neck - Infront of investing layer (not spread)? Between investing and pretracheal (spread to)? Behind prevertebral (forms behind, perforate and cause)? Behind oesophagus (spread)?
Infront of investing layer:
- not spread past manubrium
Between investing and pretracheal layer:
- spread to ant thorax and pericardium
Behind prevertebral:
- extend laterally to form abscess behind the sternocleidomastoid
- pus may perforated prevertebral layer and enter retropharyngeal space (bulge in pharynx) causes dysphagia (spread superior mediastinum)
Behind oesophagus: may spread to post and ant mediastinum
Axillary sheath - What is it? What is related to it?
Brachial plexus and subclavian artery emerge, they carry sheath of fascia, which extends into maxilla and called the axillary sheath
Platysma muscle - location? function? innervation?
Located in superficial fascia
Thin muscle which tenses the skin of neck
Supplied by cervical branch of facial nerve (VII)
Infrahyoid muscles - All located? Sternohyoid (function and innervation)? Sternothyroid (function and innervation)? Thyrohyoid (function and innervation)? Omohyoid (split, function and innervation)?
Located inferior to hyoid bone (all)
Sternohyoid: depresses hyoid bone (after swallow) and steadies the hyoid during move, innervated by C1/2/3 from ansa cervicalis
Sternothyroid: deeper than hyoid, open laryngeal orifice and depresses hyoid after swallow, innervated by C2/3, by branch of ansa cervicalis
Thyrohyoid muscle: super cont of sternohy, elevates larynx and depress hyoid, prevent food entering larynx, innervated by C1 via hypoglossal (XII)
Omohyoid: 2 bellies, united by intermediate tendon, connected to clavicle by facial sling, divides the anterior and posterior into smaller triangle, innervated by C1/2/3 by branch of ansa cervicalis, depresses, retracts and steadies hyoid
Scalene muscles - Anterior (function and innervation)? Medius (function and innervation)? Posterior (function and innervation)?
Scalenus anterior: elevates first rib and laterally flexes and rotates cervical part of verte and innervated by anterior rami of C4/5/6
Scalenus medius: elevates first rib and laterally flexes and rotates cervical verte and innervated by anterior rami of cervical nerves
Scalenus posterior: absent or blended with medius- innervated by anterior rami of lower cervical nerves- elevates 2nd rib, and laterally flexes the cervical part of vertebral column
Thyroid gland - Split by? Located deep to? Variations of shape?
2 lobes united by narrow isthmus anterior to the 2nd and 3rd tracheal cartilage
Lies deep to sternothyroid and sternohyoid muscle
Conical pyramidal lobes present in some people
Arterial supply to the thyroid gland - 2 supplies and where they branch from and have an intimate relation?
Superior thyroid artery: a branch of external carotid artery
Inferior thyroid artery: branch of thyrocervical trunk and has an intimate relation with recurrent laryngeal nerve
Venous drainage of the thyroid gland - thyroid veins? area of the thyroid they drain? vein drains into?
Superior thyroid veins: drain its superior poles and drains into the internal jugular vein
Middle thyroid vein: drains lateral parts and into the internal jugular vein
Inferior thyroid vein: drains its inferior poles and drains into brachiocephalic veins
External jugular vein - Formation? What does it cross and drain into?
Formed by junction of posterior division of retromandibular vein with posterior articular vein within the parotid gland
Crosses superficial to sternocleidomastoid to drain into subclavian vein
Carotid sheath - What is it? location? Contents (A, V and N)
This is a tubular, facial condensation that extends from the base of the skull to the root of the neck Components: - common carotid arteries medially - internal jugular vein laterally - vagus nerve X posteriorly - ansa cervicalis
Scalp - Location? layers or the scalp?
Located from the superior nunchal line on the posterior aspect of the skull to the supraorbital margins
Skin, CT, Aponeurosis, Loose CT and Pericranium (SCALP)
Occipitofrontalis - what is it? What it consists of?
The front and back of the scalp/face Consists: - epicranial aponeurosis - loose areolar tissue - pericranium - muscles and nerves
Layers of the brain?
Dura Mater Arachnoid Mater (subarachnoid space) Pia Mater Cerebral cortex
Epicranial aponeurosis - What is it?
A connection between the occipitalis and frontalis
Loose areolar tissue - Role and defintion?
It is loose CT
It allows free movement of the scalp (1-3 layers)
Pericranium - firmly attached by?
Firmly attached to the bones by CT fibres called Sharpeys fibres
Muscles of the occipitofrontalis - Supply? Branches of the facial nerve (V1/V2/V3)? other nerves?
Occipitofrontalis supplied by facial nerve
Other nerves:
- supraorbital and supratrochlear
V1- zygomaticotemporal
V2- auriculotemporal from lesser occipital from cervical plexus
V3- greater occipital from posterior primary rami
Arteries and veins of the occipitofrontalis? (Same names as nerves)
Arteries:
- supraorbital/trochlear from ophthalmic artery
- superficial temporal, posterior auricular and occipital form the external carotid artery
Veins:
- supraorbital/trochlear vein to facial vein
- superficial temporal, posterior auricular and occipital
Scalp - blood supply? wound? infection increased by?
Has a rich blood supply (small lacerations may bleed badly)
Wounds dividing aponeurosis will gape
Emissary veins do not have valves and open in the loose areolar tissue (infection transmitted from scalp to cranial cavity)
Arteries of the face? (5)
Facial Superficial temporal Transverse facial Supratrochlear Supraorbital
Veins of the face? (similar to arteries)
Facial Superficial temporal Retromandibular Supratrochlear Supraorbital
Muscles of facial expression - Location? Role? Action? Act as? Innervation?
Location:
- lie in the subcutaneous tissue and are attached to the skin of the face
Role:
- enable us to move our skin and change facial expressions
Action: by pulling on the skin
Act as: sphincters and dilators
Innervation: branches of the facial nerve
Muscles of facial expression (12)?
Occipitofrontalis Orbicularis oculi Nasalis Zygomaticus major/minor Orbicularis oris Mentalis Buccinator Depressor labii inferioris Depressor anguli oris Risorius Levator labii superioris
Muscles of the lips - main musc? elevators (3)? depressors (4)? retractors (4)?
Orbicularis oris - sphincter of mouth Elevators of the upper lip: - zygomaticus minor/major - levator labii superioris - nasalis Depressor of the lips: - depressor labii inferioris - platysma - depressor anguli oris - mentalis Retractors: - zygomaticus major - depressor anguli oris - risorius - platysma
Muscles attached to the nose?
Nasalis Levator labii Superioris alaeque nasi Levator labii superioris Zygomaticus minor Procerus
Muscles around the orbit and ear (6)?
Orbicularis oculi - orbital and palpebral Depressor/corrugator supercilli Temporoparietalis Procerus Occipitofrontalis
Muscles of the nose (4)?
Nasalis
Depressor septi nasi
Maris
Levator labii superioris alaeque nasi
Parotid gland - Superficial and deep lobe location? Split by? Deep lobe? ***
Superficial lobe: Nearly 80% is found between the mandible and the SCM
Superficial to the posterior aspect of the masseter muscle
Superiorly to the inferior margin of the zygomatic arch Split by the facial nerve becoming deep and superficial Deep lobe: 20%- extends medially through the stylomandibular tunnel - anteriorly by the posterior edge of Ramos- posteriorly by the anterior border of the SCM (posterior belly of digastric muscle)- deeply and dorsally by the stylomandibular ligament
Parotid duct - Formation of Stensen’s duct (collection)? how it enters the cavity (muscles and enter the oral cavity)?
Small ducts coalesce at the anterosuperior aspect of the PG to form Stensen’s duct (passes buccinator and lies with superficial to the masseter muscle)
Into the oral cavity opposite the maxillary second molar
Parotid fascia - What is it? separation between parotid gland and submand gland (by what)?
Gland encapsulated by a fascial layer that is continuous with the deep cervical fascia
- split by the stylomandibular ligament
Parotid lymphatics - drainage to the? preauricular nodes drain (8)?
Drainage:
- superficial and deep cervical nodes
Nodes:
- preauricular nodes in the superficial fascia drain the temporal scalp, upper face and anterior pins- preauricular node also drains parotid, nasopharynx, palate, middle ear and external auditory meatus
Parasympathetic innervation of the parotid gland? *****
Preganglionic parasympathetic (IX) arrives at optic ganglion via lesser petrosal nerve Postganglionic parasympathetic leaves the optic ganglion and distributed to the parotid gland via the auriculotemporal nerve
Sympathetic innervation of the parotid gland? ****
Postganglionic innervation is provided by the superior cervical ganglion and distributed with the arterial system
Parotid gland - great auricular nerve (II/III)? Emergence? Passes? supplies what?
Emergence:
- from the posterior border of the SCM
- passes parallel and superior to the external jugular vein to supply the rear and the preauricular region
Parotid gland - auriculotemporal nerve - Branch of? Course via? Emergence from? Role?
Branch:
- of V3 trigeminal nerve
Course:
- transverse upper part of parotid
Emergence:
- form the superior surface with the superficial temporal vessel
Role:- carries sensory fibres in the trigeminal and post-ganglionic parasympathetic fibres
Parotid gland - facial nerve - Emergence from? Division at? Branches into?
Emergence:
- at the level of digastric muscle through the stylomastoid foramen
Division:
- main trunk divides at the pes anserinus (VII) into the upper temporofacial and lower cervicofacial division
Branches:
- posterior auricular/digastric and stylohyoid
Parotid gland - vessels? examples? located? divides into?
Vessels:
- retromandibular (located within the gland)
- external carotid (inferior level of gland, divides into superficial temporal and internal maxillary artery)
Parotid bed - VANM?
V: internal jugular vein
A: external and internal carotid vein
N: glossopharyngeal, vague, spinal accessory and hypoglossal
M: styloid process, styloglossus muscle and stylohyoid muscle
Parotid pathology - Examples?
sialadenitis adenomas basal cell adenocarcinoma other carcinomas adenolymphoma
Facial nerve - function?
Purely motor (branchial motor) and supplies the muscle of facial expression
Facial nerve - motor fibres - divisions? supply muscles?
Facial nerve splits into the temporal, zygomatic, buccal, mandible and cervical
Before entering the parotid, the facial gives branches that supply:
- stapedius muscle (ear)
- occipital of OF muscle (post auricular)-
posterior belly of digastric and stylohyoid muscles
Distribution of the nervus intermedius (facial nerve) - parasympathetic innervation? greater petrosal supply? chorda tympani supply?
Parasympathetic:
- supplies a secretory gland of head and neck (except parotid)
Branches:
- greater petrosal nerve (supply all glands of nose and lacrimal gland)
- chorda tympani (supplies submand/lingual glands)
Distribution of the nervus intermedius - (facial nerve) - taste fibres? Supply?
Through the chorda tympani for the anterior 2/3 of tongue
Bell’s palsy - ipsilateral upper and lower facial asymmetry vs damage to neural cell bodies in the corticobulbar tract?
**
Ipsilateral asymmetry:
- lesion typically at is beyond the styloid foramen Damage to neuronal cell bodies:
- loss of voluntary control over lower muscles of facial expression on the contralateral side
Oral cavity - location? Oropharyngeal isthmus (bounded to) Subdivision?
Location:
- extends from the lips to the oropharyngeal isthmus
Oropharyngeal isthmus:
- junction of the mouth and pharynx - bounded; above by the soft palate and the palatoglossal folds and below the dorsum of the tongue
Subdivision:
- vestibule and oral cavity proper
Oral cavity - vestibule - what is it? Communication? Limited? Lateral wall of vestibule (formation)? Opening of parotid gland (oral cavity)?
What is it:
- slit like space between gums and the cheeks
Communication:
- with the exterior through the oral fissure - jaw closed; communicates with the oral cavity proper behind the 3rd molar tooth on each side
Limited:
- superiorly and inferiorly limited but the reflection of mucous membrane from lips and cheek onto the gums
Lateral wall of vestibule:
- formed by the cheek; composed of buccinator, covered laterally by the skin and medially by the mucous membrane
Parotid gland:
- small papilla on the mucosa opposite the upper 2nd molar
Oral cavity - oral cavity proper - location? Roof? Floor M?
Location:
- cavity within the alveolar margins of the maxilla and the mandible
Roof:
- formed by the hard palate and the soft palate
Floor:
- mylohyoid muscle and the anterior 2/3rd of the tongue
Oral cavity - floor of the mouth - covered by? at the midline? Each side of frenulum? Sublingual gland forms?
Covered by:
- mucous membrane
Midline:
- a mucosal fold, called the frenulum, connects the tongue to the floor of the mouth
Each side of midline:
- each side of frenulum a small papilla has the opening of the submandibular gland
Sublingual gland:
- rounded ridge extending backwards and laterally from the papilla
Oral cavity - nerve supply of the floor of the mouth - sensory and motor (roof, floor and cheek)?
Sensory:
- roof; greater palatine and nasopalatine nerves (branches of maxillary nerve)
- floor; by lingual nerve (branch of mandibular nerve)
- cheek: by buccal nerve (branch of mand)
Motor:
- muscle in the cheek (buccinator) and the lip (orbicularis oris) and supplied by branches of facial nerve
Oral cavity - tongue - what is it? Divided? 3 parts (2/3 and 1/3)? 2 surfaces?
What is it:
- mass of striated muscles covered with the mucous membrane
Divided:
- into right and left divided by a median septum
3 parts:
- oral (anterior 2/3), pharyngeal (posterior 1/3) and root (base)
2 surfaces:
- dorsal and ventral
Oral cavity - tongue - dorsal surface - divided into? artefact present? Ant 2/3 (taste buds)? Post 1/3 (nodes)?
Divided:
- into ant 2/3 and post 1/3 by a v-shaped sulcus
Artefact:
- apex of sulcus faces backward and marked by a pit called the foramen cecum
- foramen cecum, embryological remnant
Mark’s site of violet end of thyroglossal duct
Ant two thirds surface:
- papillae; filiform, fungiform and vallate
Posterior one third surface:
- no papilla but has modular surface of underlying lymphatic nodules (lingual tonsils)
Oral cavity - tongue - ventral surface - texture? Midline? Lateral to frenulum? Lateral to lingual vein?
Texture: - smooth Midline: - ant, a mucosal fold, frenulum connects tongue with floor of mouth Lateral to frenulum: - deep lingual vein Lateral to lingual vein: - fold of mucosa forms plica fimbriata
Oral cavity - tongue - drug absorption - characterisitics?
Quick absorption such as nitroglycerin is not under tongue where it can dissolve and enter quickly due to high vasc
Oral cavity - tongue - intrinsic muscles - innervated by? Attachment? Consists of? Function?
Innervated by: - superior laryngeal and recurrent laryngeal nerve (all intrinsic bar cricothyroid derived from vagus nerve - external laryngeal nerve supplies cricothyroid Attachment: - no bony Consists of: - longitudinal - transverse - vertical Function: - alter shape of tongue
Oral cavity - tongue - extrinsic muscles - connect to? muscles? Function?
Connect to: - soft palate, mandible, hyoid bone and styloid process Include: - palatoglossus - genioglossus - hyoglossus - styloglossus Functions: - help movement of the tongue
Oral cavity - tongue - muscles for protrusion? retraction? depression? elevation?
Protrusion:
- genioglossus both sides acting together
Retraction:
- styloglossus and hyoglossus both sides acting together
Depression:
- hyoglossus and genioglossus on both sides acting together
Elevation:
- styloglossus and palatoglossus in both sides acting together
Oral cavity - tongue - sensory nerve supply - anterior 2/3 (general and special)? Posterior 1/3 (general and special)? Base (general and special)?
Anterior 2/3:
- general sensations; lingual nerve
- special sensations; chorda tympani
Posterior 1/3:
- general and special sensation by glossopharyngeal Base:
- general and special sensation by internal laryngeal nerve
Oral cavity - tongue - motor nerve supply? Intrinsic and extrinsic? Palatoglossus? **
Intrinsic: - hypoglossal Extrinsic: - hypoglossal except palatoglossus Palatoglossus by the pharyngeal plexus
Oral cavity - tongue - blood supply - arteries and veins?
Arteries:
- lingual, tonsillar branch of facial nerve and ascending pharyngeal artery
Veins:
- lingual vein drains into internal jugular
Oral cavity - tongue - lymphatic drainage - Tips? Ant 2/3 and post 1/3? (nodes)
Tip:
- submental nodes bilateral and then deep cervical nodes
Ant 2/3:
- submandibular unilateral and then deep cervical nodes Post 1/3:
- deep cervical nodes
Oral cavity - tongue - function? Taste bud senses?
Function: - speech production - mechanism for taste Taste buds location: - edges for bitter, sour, salty and sweet
Oral cavity - tongue - clinical problems - tongue tie? lesion?
Clinical problems:
- tongue tie (ankyloglossia, due to large frenulum)
- lesion of hypoglossal nerve (protruded tongue deviates towards lesion and wrinkled)
Oral cavity - tongue - buccinator - origin? Ant border? Insertion (merge with?) Innervation? Sensation innervation? Function?
Origin:
- outer surface of alveolar process of maxilla and mandible
Ant border:
- of pterygomandibular raphe
Insertion:
- central fibres intersect before merging with orbicularis oris, upper and lower fibres continue without discussion Innervation:
- buccal branch of facial nerve
General sensation:
- the skin and oral mucosa of the cheeks carried by the buccal branch and mandibular nerve
Function:
- holds cheeks against the alveolar arches and keeps food between the teeth when chewing
- aids whistling, smiling and suckling
- masticatory
Oral cavity - palate - 2 parts? Location? Forms? Formed by? Bounded?
Hard and soft palate Location: - in the roof of the oral cavity Forms: - floor of the nasal cavity Formed by: - palatine processes of maxilla in front - horizontal plates of palatine bones behind Bounded: - by alveolar arches
Oral cavity - hard palate - location? Undersurface covered by? Transverse ridges?
Location: - post continuous with soft palate Under surface covered: - by mucoperiosteum Transverse ridges: - palatal rugae
Oral cavity - soft palate - location? Covered by? Composed of structures?
Location: - attached to the posterior border of hard palate Covered by: - upper and lower surfaces by mucous membrane Composed of: - muscle fibres - aponeurosis - lymphoid tissue - glands - blood vessels - nerves
Oral cavity - soft palate - palatine aponeurosis - what is it? Attached to? Tendon (expanded)? Split encloses? Origin and insertion to?
What is it: - fibrous sheath Attached to: - posterior border of hard palate Tendon: - expanded tendon of tensor veli palatini Splits: - enclose musculus uvulae Origin and insertion: - to palatine muscles
Oral cavity - soft palate - aponeurosis - Tensor veli palatini? Levator veli palatini? musculus uvulae? palatopharyngeus? palatoglossus? (Origin, insertion and action)
Tensor veli palatini: - origin; spine of sphenoid; auditory tube - insertion; forms palatine aponeurosis - action; tenses soft palate Levator veli palatini: - origin; petrous temporal bone, auditory tube and palatine aponeurosis - insertion; palatine aponeurosis - action; raises soft palate Musculus uvulae: - origin; post border of hard palate - insertion; mucosa of uvula - action; elevates uvula Palatopharyngeus: - origin; palatine aponeurosis - insertion; post border of thyroid cartilage - action; elevates wall of pharynx Palatoglossus: - origin; palatine aponeurosis - insertion; side of tongue - action; pulls root of tongue upward, narrowing oropharyngeal isthmus
Oral cavity - soft palate - sensory nerve supply - 2 branches?
Branches of maxillary: - greater palatine - lesser palatine - nasopalatine Glossopharyngeal nerve supplies some soft palate
Oral cavity - soft palate - motor nerve supplies muscles? tensor veli palatini?
All muscles, except tensor veli palatini, are supplied by pharyngeal plexus
- tensor veli palatini supplied by nerve to medial pterygoid (branch of mandibular division of trigeminal nerve)
Oral cavity - soft palate - branches of max? facial? ECA?
Branches of maxillary artery:
- greater palatine
- lesser palatine
- sphenopalatine
Ascending palatine: branch of facial artery
Ascending pharyngeal: branch of the external carotid artery
Oral cavity - cleft lip and palate - how? Application? Classifications? drug linkage?
How: - failure of fusion in development Application: - obturator Operations to fix Classifications: - developmental criteria (incisive fossa, as a reference landmark) Linked to antiepileptic drugs
Oral cavity - upper denture - vibrating line (where is it)?
Junction between soft palate and hard palate
Maximum extension of the denture bearing area
Oral cavity - lower denture - placement (not covering)?
Not covering the sulcus
Anatomy of mastication - V - sensory and motor innervation? 3 sensory divisions?
Trigeminal nerve:
- principal general sensory nerve for the head and is the motor nerve for muscle of mastication
- 3 sensory nerves and a motor root
- ophthalmic, maxillary and mandibular
Fibres in the sensory root are mainly axons of neurons in the trigeminal ganglion
Anatomy of mastication - CN V - ophthalmic division - function? passes through? divides into?
Role: - sensory in function Passes through: - superior orbital fissure Divides into: - lacrimal - frontal - nasociliary
Anatomy of mastication - CN V - maxillary division - function? Passes into? Branches? Assoc with? Branches within? **
Function:
- sensory
Passes into:
- pterygopalatine fossa through the foramen rotundum
Branches:
- within cranial fossa (meningeal)
- within pterygopalatine fossa (post, super, alveolar, zygomatic, ganglionic and infraorbital)
Assoc with:
- pterygopalatine ganglion
- pharyngeal, post, sup, nasal, post, late, sup, nasal, post, med, sup, nasal, greater palatine, lesser palatine and nasopalatine
Anatomy of mastication - CN V - mandibular division - function? branches into? ant branch (nerve type and examples)? post branch (nerve type and examples)?
Functions:
- motor and sensory functions
Branches:
- meningeal branch then divides into anterior and posterior
Anterior branch:
- mainly motor with one sensory branch
- masseteric, ant and post deep temporal, medial/lateral pterygoid, buccal (sensory)
Posterior branch: mainly sensory;
- auriculotemporal, lingual, inferior alveolar and mylohyoid (motor)
Anatomy of mastication - CN V - ophthalmic nerve - supplies structures? Type of nerve?
Nerve type:
- sensory
Supplies:
- superior region of face (eyeballs lacrimal gland, conjunctiva, nasal mucosal, and the skin of the scalp, forehead, upper eyelid and nose)
Anatomy of mastication - CN V - maxillary nerve - nerve type? innervates which structures?
Nerve type: - sensory Distribution: - middle part of face - all upper teeth - nasal cavity - paranasal air sinuses - nasopharynx - hard and soft palate
Anatomy of mastication - CN V - mandibular nerve - nerve type? contains all nerve? innervates which structures?
Nerve types:
- sensory and motor it contains all the motor fibres of CN V
Distribution:
- lower part of face, lower teeth and mouth
- ant 2/3 of tongue
- motor branches to muscle of mastication
Anatomy of mastication - CN V - lesions can cause widespread anaesthesia?
Widespread anaesthesia:
- anterior half of the scalp
- face except for an area around the angle of the mandible, the cornea and conjunctiva, mucous membrane of nose, mouth and ant part of nose
Paralysis of muscles of mastication
Anatomy of mastication - CN V - corneal reflex? motor? jaw jerk?
Corneal reflex:
- across lateral surface of eye from sclera to cornea
Motor V testing:
- symmetry of opening and closing of the mouth (clench the teeth, and attempt to force jaw open)
Jaw jerk:
- indicates UNL
Anatomy of mastication - infratemporal fossa - location? contents (M, N, A, V)? surgery? hazards?
Location:
- beneath the base of the skull between the pharynx and the ramus of mandible laterally
Contents:
- medial and lateral pterygoid muscles
- mand division of CN V
- chorda tympani branch of facial nerve
- otic ganglion
- maxillary and middle meningeal artery
- inferior alveolar vessels
- pterygoid venous plexus and maxillary vein
Surgery:
- frequently invaded by surgeons (anaesthesia of post, superior alveolar nerves or inferior alveolar nerve, pterygomandibular space and inferior recess of the infratemporal fossa)
Hazards:
- infected needles or penetration of the pterygoid plexus of veins forming large haematomas
Anatomy of mastication - pterygopalatine fossa - content (N)? shape? communicates to structures?
Content:
- terminal branch of maxillary
- nerve of pterygoid canal and pterygopalatine ganglion
Shape:
- small pyramidal space inferior to apex of orbit Communicates:
- infratemporal fossa, nasal cavity, orbit and middle cranial fossa
Anatomy of mastication - muscles? Supplementary muscles? Nerve supply? Movements?
Muscles: - temporalis - masseter - lateral pterygoid - medial pterygoid Supplementary: - digastric, geniohyoid and mylohyoid Nerve supply: - mandibular division of CN V Movements: - elevation, depression, protrusion, retrusion and lateral excursion
Anatomy of mastication - temporalis - origin? function? innervation? artery?
Origin: - entire temporal fossa to coronoid process Function: - elevate mandible and post fibres retrude mandible Innervation: - deep temporal nerve of the mand nerve Artery: - deep temporal artery
Anatomy of mastication - masseter - Splits into? Function? innervation? artery?
Split: - superficial and deep heads Function: - elevates the mandible Innervation: - mand nerve Artery: - masseteric artery
Anatomy of mastication - lateral pterygoid - Splits into? Functions? innervation? artery?
Split: - upper and lower heads Function: - depress and protrude mandible - lateral excursion of mandible Help from supplementary muscles Innervation: - lateral pterygoid nerve (V3) Artery: - pterygoid branch of maxillary artery
Anatomy of mastication - medial pterygoid - split? Function? innervation? artery?
Split: - superficial and deep heads Function: - elevate mandible - protrude mandible - lateral excursion of mandible Innervation: - medial pterygoid nerve (V3) Artery: - pterygoid branch of maxillary artery
Anatomy of mastication - movements and muscles - protrusion (1)? retraction (4)? elevation (3)? depression (3)?
Protrusion: - lateral assisted medial pterygoid Retraction: - post fibres of temporalis, deep part of masseter and geniohyoid and digastric Elevation: - temporalis, masseter and medial ptery Depression: - gravity - digastric, geniohyoid, and mylohyoid
Anatomy of mastication - buccinator - location? Group of muscles? Action? Nerve supply?
Location: - in the cheek Group: - accessory muscles Action: - returns food back to the mouth from the cheek pouch Nerve supply: - facial nerve
Anatomy of mastication - maxillary artery - split by? first part (deep auricular? ant tympanic? middle meningeal? inferior alveolar? accessory meningeal? supply what?) second part supplies? third part (branches and supplies)?
Supplies: - structures in the infratemporal fossa and is divided into 3 parts by the lateral pterygoid muscle First part: - deep auricular to external acoustic meatus - ant tympanic to tympanic mem - middle meningeal to dura and calvaria* - inferior alveolar to mandible, gingiva and the teeth* - accessory meningeal to cranial cavity Second part: supplies masticatory muscles; - masseteric - deep temporal - pterygoid - buccal Third part: supplies structures in the pterygopalatine fossa, maxillary teeth, parts of the face and orbit, palate and nasal cavity - post sup alveolar - middle sup alveolar - infraorbital - descending palatine - artery of pterygoid canal - pharyngeal - sphenopalatine
Innervation of the larynx - supraglottic innervation (branch from)? infraglottic innervation?
Sensory supply:
- supraglottic portion of laryngeal mucosa supplied by the internal laryngeal nerve (branch of superior laryngeal nerve)
- infraglottic portion of laryngeal mucosa supplied by recurrent laryngeal nerve
Pharynx - 3 parts? superior constrictor? middle constrictor? inferior constrictor? - (origin, innervation and insertion)
3 parts:
- nasopharynx, oropharynx and laryngopharynx
Muscles:
- superior constrictor (origin: pterygoid hamulus, pterygomandibular raphe, posterior end of the mylohyoid line of the mandible, and side of tongue. Insertion: median raphe of pharynx and pharyngeal tubercle)
- middle constrictor (Origin: stylohyoid ligament and greater and lesser horns of hyoid bone. Insertion: median raphe of pharynx
- inferior constrictor (origin: oblique line of thyroid cartilage and side of cricoid cartilage. Insertion: median raphe of pharynx
- All three constrictors of the pharynx are supplied by the pharyngeal plexus of nerves
Pharynx - muscles form the internal longitudinal muscle layer: stylopharyngeus? palatopharyngeus (action)?salpingopharyngeus? (origin, innervation and insertion)
Stylopharyngeus:
- origin: styloid process of temporal bone
- insertion: posterior and superior borders of thyroid cartilage with palatopharyngeus muscle
- innervation: glossopharyngeal nerve (CN IX).
Palatopharyngeus:
- this is a thin muscle and the overlying mucosa form the palatopharyngeal arch
- it arises from hard palate and palatine aponeurosis and inserted into the lateral wall of pharynx
- tenses the soft palate and pulls the walls of the pharynx superiorly, anteriorly and medially during swallowing
- supplied by cranial part of accessory nerve (CN XI) through the pharyngeal branch of vagus (CN X) via the pharyngeal plexus
Salpingopharyngeus:
- origin: cartilaginous part of the auditory tube
- insertion: blends with palatopharyngeus muscle
- innervation: through the pharyngeal plexus
Innervation of the pharynx - what is the pharyngeal plexus? plexus formed from CN? motor fibres derived from? which muscle supplied (exceptions?) innervation of nasopharynx/oropharynx/laryngopharynx (sensory)?
The plexus:
- motor and most of the sensory supply of the pharynx is derived from the pharyngeal plexus of nerves that lies on the lateral wall of the pharynx
Plexus formed from:
- plexus is formed by pharyngeal branches of the vagus (CN X) and the glossopharyngeal (CN IX) nerves, and by sympathetic branches from the superior cervical ganglion
Motor fibres:
- motor fibres in the pharyngeal plexus are derived from the cranial root of accessory nerve (CN XI), and are carried by the vagus nerve
Which muscles:
- to all muscles of the pharynx and soft palate except to the stylopharyngeus (supplied by CN IX) and the tensor veli palatini (supplied by CN V3)
Sensory:
- sensory supply of the nasopharynx is mainly from the maxillary nerve, oropharynx is mainly from the glossopharyngeal nerve and the laryngopharynx is supplied mainly by the internal laryngeal branch of the vagus nerve
Anatomy of mastication - Temporal fossa - bounded by (superior, post and ant)? 2 layers/split (? attached and continuous? floor? **
Bounded by:
- temporal fossa is bounded superiorly and posteriorly by the temporal lines and anteriorly by the frontal and zygomatic bones
2 layers/split:
- The temporal fascia stretches over the temporal fossa and the temporalis muscle.
- Inferiorly, the temporalis fascia splits into two layers, superficial and deep
Attached and continuous:
- The superficial layer is attached to the superior margin of the zygomatic arch.
- The deep layer passes medial to the arch to become continuous with the fascia deep to the masseter muscle
Floor:
- floor of the temporal fossa which gives origin to the temporalis muscle, is formed by portions of the four bones: parietal, frontal, greater wing of sphenoid, and squamous part of the temporal bone
Nasal cavity - walls of the nose - roof? floor? medial and lateral walls? conchae role?
Roof:
- curved and narrow and formed by the cribriform bone Floor:
- formed from the palatine process of the maxilla and the horizontal plate of the palatine bone
Medial wall:
- formed by the nasal septum
Lateral wall:
- uneven owing to the three longitudinal, scroll-shaped elevations, called the conchae or turbinates, the elevations are called the superior, middle and inferior conchae according to their position
Conchae role:
- inferior and middle conchae project medially and inferiorly, producing air passageways called the inferior and middle meatus.
Nasal cavity - nerve supply - upper cavity supply? inferior 2/3 cavity supply? mucous mem supply? anterior nasal septum supply? lateral walls supply?
Upper part:
- upper part (olfactory area) is supplied by the Olfactory nerve CN I
Inferior 2/3:
- inferior 2/3 of the nasal mucosa are supplied chiefly by the trigeminal nerve (CN V)
Mucous membrane:
- mucous membrane of the nasal septum is supplied chiefly by the nasopalatine nerve, a branch of the maxillary nerve (CN V2)
Anterior nasal septum:
- anterior portion is supplied by the anterior ethmoidal nerve (a branch of the nasociliary nerve) which is derived from the ophthalmic nerve (CN V1)
Lateral walls:
- lateral walls of the nasal cavity are supplied by branches of the maxillary nerve (CN V2); the greater palatine nerve, and the anterior ethmoidal nerve
Nasal cavity - arterial supply - branch from? nasal mucosa (artery supply?) nasal septum (artery supply?) anterosuperior part of the mucosa of the lateral wall of the nasal cavity? **
Derived:
- blood supply of the mucosa of the nasal septum is derived mainly from the maxillary artery
Nasal mucosa:
- sphenopalatine artery, a branch of the maxillary, supplies most of the blood of the nasal mucosa.
- It enters by the sphenopalatine foramen and sends branches to the posterior regions of the lateral wall and to the nasal septum
Nasal septum:
- greater palatine artery, also a branch of the maxillary, passes through the incisive foramen to supply the nasal septum
Antero-superior part of the mucosa of the lateral wall of the nasal cavity:
- anterior and posterior ethmoidal arteries, branches of the ophthalmic artery, supply the antero-superior part of the mucosa of the lateral wall of the nasal cavity and nasal septum
Nasal cavity - sinuses - frontal (innervation and location?), ethmoidal (innervation and location?), sphenoidal (innervation and location?), maxillary (location?)
Paranasal:
- frontal, ethmoidal, sphenoidal and maxillary
Frontal: CN V1
- located between the outer and inner tables of the frontal bone, posterior to the superciliary arches and the root of the nose
Ethmoidal: anterior, post and middle (CN V1)
- located between the nasal cavity and the orbit
- superiorly, they lie on each side of the cribriform plate and are related above to the frontal lobes of the brain
Sphenoidal: post ethmoidal nerve
- body of sphenoid bone
Maxillary: largest
- Its medial wall forms part of the lateral wall of the nasal cavity and bears on it the inferior concha
- particularly prone to infection because its drainage orifice is placed near the roof of the sinus.
Anterior triangle - Submental triangle - anterior? lateral? inferior? floor? content?
Anteriorly – midline of the neck Laterally – Ant. belly of the digastric Inferiorly – body of the hyoid bone Floor – Mylohyoid muscle Content – submental lymph nodes
Anterior triangle - Digastric triangle - anterior? posterior? above? floor? content?
Anteriorly – Anterior belly of the digastric. Posteriorly – Posterior belly of the digastric and the stylohyoid
Above – lower border of the body of the mandible
Floor – Mylohyoid and hyoglossus muscles
Contents – Anteriorly - submandibular salivary gland, facial artery, facial vein, submandibular lymph nodes, hypoglossal nerve, nerve and vessels to the mylohyoid. Posteriorly – carotid sheath (carotid arteries, internal jugular vein, vagus nerve)
Lower part of the parotid gland projects to the triangle
Anterior triangle - Carotid triangle - superior? inferior? posterior? floor? content?
Superiorly – Posterior belly of the digastric
Inferiorly – Superior belly of the omohyoid
Posteriorly – Anterior border of the sternocleidomastoid Floor – Portions of thyrohyoid, hyoglossus, middle and inferior constrictor muscles
Contents – Carotid sheath, division of the common carotid arteries, branches of the external carotid artery, internal jugular vein and its tributaries, hypoglossal nerve with its descending branch, external and internal laryngeal nerves, accessory and vagus nerves, part of the chain of deep cervical lymph nodes.
Anterior triangle - Muscular triangle - anterior? superior? inferior? floor?
Anteriorly – midline of the neck
Superiorly – superior belly of the omohyoid
Inferiorly – anterior border of the sternocleidomastoid muscle
Floor – sternohyoid, sternothyroid muscles, beneath the floor lie the thyroid gland, larynx, trachea and the esophagus
Sternocleidomastoid - innervation? function (alone and together)? head (attachment)? covers? attachment?
Innervation:
- spinal root of the accessory nerve (CN XI) and branches of the second and third cervical nerves (C2 and C3)
Role:
- acting alone, it tilts the head to its own side (face is turned superiorly toward the opposite side). Acting together, these muscles flex the neck.
Heads: inferior attachment
- sternal head
- by a rounded tendon, to the anterior surface of the manubrium of the sternum
- clavicular head superior surface of the medial third of the clavicle
Covers:
- it covers the great vessels of the neck and the cervical plexus of nerves
Attachment: superior
- mastoid process of the temporal bone and the lateral half of the superior nuchal line of the occipital bone
Lymphatic drainage of the thyroid gland p vessel pass to nodes? direct to? **
Vessels pass to nodes:
- to the prelaryngeal lymph nodes and to the pretracheal and paratracheal lymph nodes
Laterally, lymph vessels located along the superior thyroid veins pass to the inferior deep cervical lymph nodes
Direct:
- some lymph vessels may drain into the brachiocephalic lymph nodes or empty directly into the thoracic duct
TMJ - definition?
Definition:
- articulation between the condyle of the mandible and the squamous portion of the temporal bone
Mandibular - anatomy?
Anatomy:
- mental protuberance and foramen
- coronoid and condylar process
- mandibular ramus, neck and foramen
- sup and inf mental spine
- mylohyoid line
Autonomic functions (parasymph) - pupillary constriction? lacrimation? salivation? vagal?
Pupillary: - III Lacrimation: - VII Salivation: - submand and subling VII - parotid IX Vagal: - input to organs in thorax and abdomen
Olfactory nerve testing - nerves? smell?
Smell: CN I
- unilateral or bilateral
Can use something with a strong smell and close each nostril
Optic nerve testing - nerves? visual acuity? visual field? pupillary reactions? fundoscopy? colour vision?
Nerves:
- II, III, IV and VI
Visual acuity:
- snellen test, record both eye’s acuity
Pupillary reflex:
- look at shape and symmetry
- patient to focus on distant image
- shine light from side onto pupil to see constriction (direct) and then shine on the contralateral pupil (indirect) and repeat for other side
- accommodation; ask patient to focus on finger 15cm away then slowly bring it closer looking or eye convergence and pupil constriction
Visual fields:
- seat patient 1m away at eye level
- ask patient to cover L eye and you should cover R eye
- ask patient to look at my open eye
- position hand equidistant between me and patient
- extend arm and wiggle ginger from periphery of upper temporal quad moving inwards diagonally to centre of vision
- ask patient to say yes when finger is in view, to identify the edge of the visual field
- upper, lower nasal and temporal quadrants
Trigeminal nerve testing - facial sensation? motor function? corneal reflex?
Facial sensation:
- gently dab cotton wool ball on each side of face in turn for each of the 3 divisions (ask when felt)
- repeat with something sharp
Motor function:
- clench teeth - feel masseters
- inspect - temporalis wasting (hollow above zygoma)
- open mouth against resistance (place hand under patients chin) look for asymmetry or deviation
Corneal reflex: V1 afferent and VII as efferent
- create point from cotton wool
- look up and to one side and touch the corena gently and observe for a consensual blink
Facial nerve testing - inspection?
Inspection: - asymmetry of resting features - eye closure - involuntary movements Movements: - raise eyebrows and wrinkle forehead - bare teeth Motor function: - screw eyes up tightly against resistance (by pulling eyebrows) - blow cheeks out and press finger against force Taste: ant 2/3 - sweet, bitter, umami, salty and sour
Vestibulocochlear nerve testing - Rinne’s? Weber’s? Whisper? Balance?
Whisper:
- 50cms above ear, normally speak then whisper a number whilst closing the contralateral ear at the tragus and ask them to repeat
- Do the same with the other ear
Rinne: tuning fork
- place ned plate of fork on mastoid process then 1cm from EAM
- ask which noise is louder
- should be louder in air than bone
Weber: tuning fork
- place end plate of fork in midline of head
- ask where sound is loudest (should be same - but can be heard in one ear more)
Balance: Unterberger’s test
- patient to walk on the spot
- close eyes and continue
- patient drift to right with a R vestibular lesion
Glossopharyngeal and vagus nerve testing - functional ability observation? Inspection?
Observation:
- dysarthria or dysphonia
Inspection:
- open wide and say ‘aaah’ to observe soft palate and uvula movements (symmetrical, central and vertical upward movement)
- gag reflex by touching side of throat on either side
Accessory nerve testing - inspection? power tests?
Inspection:
- SCM - face patient and inspect muscle waste or hypertrophy
- trapezius - look for asymmetry
Power:
- SCM - patient psh each cheek against resistance of your hand, then palpate contralateral SCM
- Trapezius - muscle strength and symmetry of movement during patient shrugging against downward Pa of hands
Hypoglossal nerve testing - Inspection? functional ability observation? power tests?
Inspection:
- open mouth and stick tongue out to see any irregularities
Functional ability:
- waggle from side to side
- repeat red lorry, yellow lorry
Power:
- press tongue against cheek pressing against your finger
Cranial nerve reflexes - afferent and efferent pathways for - pupillary? corneal ? jaw jerk? gag?
Pupillary: - affertent II - efferent III Corneal: - afferent V - efferent VII Jaw: - afferent and efferent V Gag: - afferent IX and efferent X
Location of cranial nerve nuclei - III and IV? V, VI and VII? VIII? and IX, X, XI and XII?
III and IV: - midbrain V +: - pons VIII - pontomedullary IX +: - medulla
Optic neuritis - how it occurs? clinical signs?
How it occurs: - demyelination within optic nerve - optic disc swollen - MS CS: - monocular vision loss - pain on movement - reduced acuity and colour vision
Pupillary response - parasympathetic and sympathetic? causes of dilated and constricted pupils?
Parasympathetic: - constriction - loss = fixed and dilated pupil - complete 3rd nerve palsy Symph: - dilation - damage on sympth pathway lead to constricted pupil Dilated: - dim light - anxiety - myadric eye drops - amphetamine - brain death - 3rd nerve palsy Constricted: - bright light - miotic eye drips - opiates - Horner's
Isolated 3rd nerve palsy - microvasc? and compressive?
causes?
Microvasc: - diabetes or HT - painless Compressive: - post communicating artery aneurysm and raised ICP - painful
Isolated 6th nerve palsy - causes?
Idiopathic
Diabetes
Meningitis
Raised intracranial Pa
Nystagmus - causes?
Congenital Serious visual impairment Peripheral vestibular problem Brainstem/central vestibular disease Cerebellar disease Toxins
Trigeminal neuralgia - age? caused by? treated?
Age: - middle age to older Caused: - by vasc loop, compression of 5th nerve in post fossa Treated: - with carbamazepine
Bell’s Palsy - clinical signs? treatment? UMN vs LMN?
CS: - unilateral facial weakness - lower motor neurone type - preceded by pain behind the ear - eye closure affected - corneal damage Treatment: - steroid Vs: - UMN = stroke/tumour - LMN = Bell's palsy, Lyme or sarcoid
Vestibular neuritis - clinical signs? cause?
CS: - sudden onset - disabling vertigo - vomiting - gradual recovery Cause: - uncertain but poss viral
Definition of dysarthria and dysphagia?
Dysarthria:
- disordered articulation and speech slurring
Dysphagia:
- difficulty swallowing
Pseudobulbar palsy - cause? clinical signs?
Cause: - bilateral UMN lesions (in vasc lesions of both internal capsules) Clinical signs: - dysarthria - dysphonia - dysphagia - immobile tongue - brisk jaw jerk - brisk gag reflex
Bulbar Palsy - causes? clinical signs? warning?
Causes: - bilateral LMN lesions affecting IX - XII - polio, tumours, vasc lesions of medulla and syphilis Clinical signs: - wasted tongue - dysarthria - dysphonia - dysphagia Warning: - beware feeding patients
Oculomotor, Trochlear and Abducens nerve testing - history? inspection for? movements/tests?
History:
- diplopia (double vision)
Inspection
- ptosis (droopy eyelid)
- resting direction of gaze of each eye
- nystagmus (rapid eye movement in a single direction and back to centre)
Movements:
- ask patient about double vision
- follow a slow moving object (head still)
- move finger at arm’s length away in a H-shape starting at midline
