Applied Head and Neck Anatomy Flashcards
1
Q
What is the innervation of sternocleidomastoid?
A
Spinal accessory nerve
CNXI
2
Q
What are the attachments of trapezius?
A
Superior nuchal line
Mastoid processes
Lateral 1/3 of the clavicles
Down to T12
3
Q
What is the innervation of trapezius?
A
Spinal accessory nerve
CNXI
4
Q
What are the boundaries of the anterior triangle in the neck?
A
Median vertical line of the neck
Inferior margin of the mandible
Anterior margin of sternocleidomastoid
5
Q
What are the boundaries of the posterior triangle of the neck?
A
Middle 1/3 of the clavicle
Anterior margin of trapezius
Posterior margin of sternocleidomastoid
6
Q
What are the four small triangles that make up the anterior triangle?
A
Carotid triangle
Submandibular triangle
Submental triangle
Muscular triangle
7
Q
What are the contents of the anterior triangle in the neck?
A
Carotid artery Internal jugular vein Hypoglossal nerve Recurrent laryngeal nerve Vagus nerve Start of CNXI Trachea Larynx Pharynx Submandibular gland Thyroid gland Lymph nodes and vessels
8
Q
What are the contents of the posterior triangle in the neck?
A
External jugular vein
CNXI
Apex of the lung
Roots of the brachial plexus (under scalene)
9
Q
What muscle divides the posterior triangle?
A
Omohyoid
10
Q
Why are fascial planes important in the neck?
A
Create compartments
Ease of movement
Determine spread of infection
11
Q
What does the pretracheal fascia contain, and what is its function?
A
Trachea
Oesophageal
Thyroid
Associated nerves and vessels
Allows independent movement
12
Q
Describe the deep cervical fascia.
A
Wraps all the structures in the neck to hold them in place, allowing different planes of movement.
Wraps around sternocleidomastoid and trapezius twice.
13
Q
What are the contents of the carotid sheath in the neck?
A
Internal jugular vein (anterolateral)
Vagus nerve (posterior)
Carotid artery (anteromedial)
Deep cervical lymph nodes
14
Q
What does the prevertebral fascia contain, and where does it extend from and to?
A
Encloses the pre-, post- and paravertebral muscles and the vertebrae.
Extends from the base of the skull to T2/3
15
Q
What can cause a retropharyngeal abscess?
A
An upper respiratory tract infection in children under 5, causing inflammation of the node of Rouviere. Leads to pus production which drains into the retropharyngeal space
16
Q
What are the symptoms of a retropharyngeal abscess?
A
Neck pain on movement
Loss of cervical curvature
Difficulty swallowing/breathing
Likely to be septic
May have mediastinitis
17
Q
What are the problems with a parapharyngeal abscess?
A
Puts the contents of the carotid sheath at risk, such as potentially causing internal jugular vein thrombosis
18
Q
What are the symptoms of a parapharyngeal abscess?
A
Teeth and tonsils commonly affected
Causes a swelling in the neck which the patient has pain in when they turn towards it.
May have complications from involvement of carotid sheath contents
19
Q
What muscles allow upward movement of the hyoid bone?
A
Digastric
Mylohyoid
Stylohyoid
Geniohyoid
20
Q
What muscles allow downward movement of the hyoid bone?
A
Omohyoid
Sternohyoid
Sternothyroid
Thyrohyoid
21
Q
What is special about the digastric and omohyoid muscles when comparing them to the other muscles allowing movement of the hyoid bone?
A
They have two bellies, allowing them to act in two directions. They pass around a fascial sling
22
Q
What are the branches of the internal carotid artery in the neck?
A
There aren’t any
23
Q
What are the branches of the external carotid artery?
A
Ascending pharyngeal Superior thyroid Linguinal Facial Occipital Posterior auricular Maxillary Superficial temporal (terminal branch)
24
Q
What nerve supplies the muscles of facial expression?
A
Facial nerve
CNVII
25
What are the branches of the facial nerve (CNVII)?
```
Temporal
Zygomatic
Buccal
Mandibular
Cervical
```
(To Zanzibar By MotorCar)
26
What nerve supplies the muscles of mastication?
Trigeminal nerve (CNV)
27
What muscles does the trigeminal nerve (CNV) innervate?
Masseter
Temporalis
Buccinator
Pterygoid
28
What are the sensory regions supplied by the trigeminal nerve (CNV)
Ophthalmic region
Maxillary region
Mandibular region
(Anterior face)
29
How many pharyngeal arches are there?
5
| 1-6
30
What is in the core of each pharyngeal arch in development?
Artery
Cranial nerve
Cartilage bar
31
During development, what induces endodermal thickening to create the neural plate?
Notochord signals
32
What are the 3 areas of the primitive brain?
Forebrain (prosencephalon)
Midbrain (mesencephalon)
Hindbrain (rhombencephalon)
33
How are cranial nerves classified?
By function and embryological origin
34
What are the nerves of the pharyngeal arches?
CNV
CNVII
CNIX
CNX
35
What muscles derive from the first pharyngeal arch, and what nerve are they associated with?
```
Muscles of mastication
Trigeminal nerve (CNV)
```
36
What muscles derive from the second pharyngeal arch, and what nerve are they associated with?
```
Muscles of facial expression
Facial nerve (CNVII)
```
37
What muscles derive from the third pharyngeal arch, and what nerve are they associated with?
Stylopharyngeus
| Glossopharyngeal nerve
38
What muscles derive from the fourth pharyngeal arch, and what nerve are they associated with?
Cricothyroid
Levator palatini
Pharynx constrictors
Vagus nerve (superior laryngeal branch)
39
What muscles derive from the sixth pharyngeal arch, and what nerve are they associated with?
Intrinsic laryngeal muscles
Vagus nerve (recurrent laryngeal branch)
40
What is the sensory function of the glossopharyngeal nerve?
Posterior 1/3 of the tongue
41
What is the name of the cartilagenous bar in the first arch?
Meckel's
42
What is the name of the cartilagenous bar in the second arch?
Reichert's
43
What are the derivatives of Meckel's cartilage in the first pharyngeal arch?
Mandibular prominence - form the malleus and incus
| Template for the mandible (endochondral ossification)
44
What are the derivatives of Reichert's cartilage in the second pharyngeal arch?
Stapes
Styloid process
Hyoid bone (lesser Cornu and upper body)
45
What are the derivatives of the cartilage in the third pharyngeal arch?
Lower body of the hyoid bone
46
What are the derivatives of the cartilage in the fourth and sixth pharyngeal arches?
Thyroid
Arytenoid
Cricoid
47
What is the fate of the first and second arches of the pharyngeal arteries?
Regress
48
What is the fate of the third arch of the pharyngeal arteries?
Internal carotid
49
What is the fate of the fourth arch of the pharyngeal arteries?
```
Arch of the aorta (L)
Brachiocephalic artery (R)
```
50
What is the fate of the sixth arch of the pharyngeal arteries?
Pulmonary arch
51
What is the fate of the second pharyngeal pouch?
Epithelial proliferation and colonisation by lymphoid precursors to form the palatine tonsils
52
What is the fate of the third and fourth pharyngeal pouches?
3/4 dorsally become the parathyroid glands
| 3rd ventrally becomes the thymus
53
What pharyngeal pouch does the middle ear derive from?
First (cartilage bars)
54
What pharyngeal pouch do the tympanic cavity and auditory tube derive from?
First
55
What causes branchial cysts or fistulae?
The second pharyngeal arch grows down to cover the other clefts normally, so the first is the only one remaining.
If the sinuses aren't obliterated, a cyst or fistula can form.
They can form anywhere along the sternocleidomastoid
56
What are the attachments of sternocleidomastoid?
Superiorly to the mastoid process
Medial head to the sternum
Lateral head to the first 1/3 of the clavicle
57
Give the borders of the digastric triangle.
Posterior: posterior belly of digastric
Anterior: anterior belly of digastric
Base: body of the mandible
58
What triangle(s) of the neck is the submandibular gland found in?
Anterior triangle
| Digastric triangle
59
What is a patient with Bell's palsy at risk of if they are unable to fully close their eyelid?
Exposure keratitis
60
What does the investing layer of the deep cervical fascia enclose?
Parotid gland
Sternocleidomastoid
Submandibular gland
Trapezius
61
What triangle would you use to identify the vein for inserting a central venous catheter?
Carotid triangle
62
Where are lymphatic vessels not found?
Eyeball
Inner ear
Cartilage
63
Why does more fluid move out of the alveolar side of capillaries than moves in the venule side?
Some small proteins and cell debris are able to filter into the tissue fluid due to the high pressure on the alveolar side, but then are unable to move back in at the other end.
The oncotic pressure prevents the same amount of fluid moving back into the capillary at the other end.
64
Describe the passage of tissue fluid from tissues to the subclavian veins.
1. Lymphatic capillaries
2. Afferent lymphatic vessels
3. Lymph nodes
4. Efferent lymphatic vessels
5. Lymphatic trunks
6. L/R lymphatic ducts
65
What is the name of the left lymphatic duct?
Thoracic duct
66
What is lymphoedema?
Fluid retention and tissue swelling due to a compromised lymphatic system.
67
Give some examples of things which can compromise the lymphatic system, leading to lymphoedema.
```
Removal or enlargement of lymph nodes
Infection
Damage to vessels
Lack of limb movement
Congenital
```
68
Describe the structure of a lymph node.
A dense collagen capsule with a reticular connective tissue centre.
It contains lymphocytes and macrophages.
They can be up to 2-2.5cm, but the majority are microscopic.
69
What is the function of the lymph node?
Physical and phagocytic filter
70
What is lymphadenopathy?
Swollen lymph nodes
71
What is the difference between infective and malignant lymphadenopathy?
Infection - tender, firm, motile
| Malignancy - hard, matted, non-tender
72
What is the difference between regional and terminal lymph nodes?
Regional - superficial and drain specific areas
| Terminal - deep and drain a number of regional nodes
73
What separates the deep and superficial lymph nodes in the neck?
Deep cervical fascia
74
What structure do the deep cervical lymph nodes lie in?
Carotid sheath
75
What is waldeyer's ring?
An annular collection of lymphatic tissue surrounding the superior pharynx.
Pharyngeal tonsil, lingual tonsil, and palatine tonsils
76
What are the 8 surface lymph nodes?
```
Submental
Submandibular
Pre auricular
Post auricular
Occipital
Superficial cervical
Posterior cervical
Anterior cervical
```
77
What are the three deep lymph nodes?
Jugulodigastric (tonsillar node)
Jugulo-omohyoid
Supraclavicular
78
Which deep lymph node is most likely to be swollen with oral or thyroid cancers?
Juguloomohyoid
79
Which deep lymph nodes drain the thoracic cavity and abdomen?
Supraclavicular lymph nodes
80
Where does the right supraclavicular lymph node drain?
Mid section of the chest
Oesophagus
Lungs
81
What is the significance of the left supraclavicular lymph node?
It is Virchow's node. Swells with gastric cancer.
82
Where do the submandibular lymph nodes drain?
```
Upper lip and teeth
Lateral lower lip
Face
Anterior nasal cavity
Cheeks
Middle tongue
Submandibular and lingual glands
```
83
What areas do the occipital lymph nodes drain?
Posterior scalp and neck
84
What areas do the submental lymph nodes drain?
Lower lip and teeth
Anterior chin
Tip of the tongue
Floor of the mouth
85
What areas do the superficial cervical lymph nodes drain?
Skin of the neck
86
What areas do the pre auricular lymph nodes drain from?
Mid/posterior scalp
Lateral ear
Parotid gland
87
What areas do the posterior auricular glands drain from?
Posterior scalp
Pinna (cranial surface)
External acoustic meatus (back)
88
What does the jugulodiagastric lymph nodes drain?
Palatine tonsils
| Posterior third of the tongue
89
What does the Juguloomohyoid lymph nodes drain?
```
Anterior two thirds of the tongue
Oral cavity
Trachea
Larynx
Oesophagus
Thyroid
```
90
Describe the locations of the internal and external jugular veins in the neck.
External - superficial to sternocleidomastoid
| Internal - inferior to sternocleidomastoid
91
What arteries branch from the brachiocephalic trunk in the neck?
Subclavian
| Common carotid
92
What branches does the subclavian artery give in the neck?
Vertebral
Internal thoracic
Thyrocervical
93
What are the branches of the thyrocervical trunk?
Transverse cervical
Ascending cervical
Supra scapular
Inferior thyroid
94
Describe the arterial supply to the vertebra in the neck.
The vertebral arteries arise from the subclavian arteries and ascend through the transverse foramen of C6-1.
95
What is the fate of the vertebral arteries?
Become the basilar arteries as they enter the skull through the foramen magnum.
96
Where is the most likely location of a carotid artery atheroma?
Bifurcation of the common carotid.
97
What is the clinical significance of the carotid triangle?
Point of surgical approach to the great vessels (endartectomy)
Access the vagus and hypoglossal nerves
Feel the carotid pulse
Carotid sinus massage
98
Describe how a carotid sinus massage works and what it can be used to treat.
Supra ventricular tachycardia
It stimulates baroreceptors in the carotid sinus to increase fatal outflow, reducing heart rate.
99
What branches of the external carotid artery supply the scalp?
Posterior auricular
Superificial temporal
Maxillary
100
What arteries from the internal carotid artery supply the scalp?
Supraorbital
Supratrochlear
(Branch from the ophthalmic artery)
101
What are the layers of the scalp?
```
Skin
Connective tissue (loose)
Aponeurosis
Loose connective tissue
Periosteum
```
102
In what layer of the scalp do arteries lie?
Subcutaneous connective tissue
103
Why does bleeding in a laceration of the scalp tend to be profuse and difficult to stop?
The arteries form many anastomoses so it is difficult to block them off with pressure
The walls of the arteries are closely associated with connective tissue which can hold the artery open
If the laceration is deep and through the epicranial aponeurosis (occipitofrontalis), this will also hold the wound open due to opposing pull of the muscle
104
Why won't the loss of scalp over a region of skull cause bone necrosis?
The skull has a separate blood supply from the middle meningeal artery.
105
Describe drainage from the supraorbital and supratrochlear veins.
Into the angular vein at the medial angle of the eye
| Then into the facial vein
106
Where do deep temporal veins drain into?
Pterygoid venous plexus
107
Describe the venous drainage of the scalp
Veins of the scalp connect to the diploic veins of the skull
| Then through emissary veins to the dural venous sinuses.
108
Why can a superficial infection of the scalp cause meningitis?
The emissary veins connecting the veins of the scalp to the dural venous sinuses are valveless, which can allow a route for infection to spread.
109
Where is the middle meningeal artery particularly vulnerable?
At the pterion
110
What is the pterion?
A weak area of skull where the temporal, frontal, sphenoid, and parietal bones join.
111
Name the dural venous sinuses.
Superior saggital sinus
Inferior saggital sinus
Cavernous sinus
Transverse sinus
112
What sinus do the dural venous sinuses drain into?
Sigmoid sinus
113
What does the sigmoid sinus drain into?
Internal jugular vein after passing through the jugular foramen.
114
Explain the 'danger triangle' of the face.
Thrombophlebitis in the facial vein can travel to the dural venous sinuses through the pterygoid venous plexus.
115
What structures is the cavernous sinus closely associated with?
Internal carotid artery
CN III/IV/VI
Two branches of the trigeminal nerve (CNV1/V2)
116
Describe how to measure jugular venous pressure.
Sit the patient at 45 degrees and turn their head to the left
Look for pulsation of the internal jugular vein through the sternocleidomastoid
Measure the height from the sternal angle +5cm.
117
Describe the three atypical cervical vertebrae?
C1 (atlas) - no body or spinous process
C2 (axis) - odontoid process
C7 - non bifid, prominent spinous process. Large transverse processes
118
Describe a burst fracture of the cervical spine.
Occurs after a fall from a height or an RTC giving a high energy axial load.
The vertebrae fracture in multiple places.
Shards can penetrate surrounding tissue and the spinal canal.
119
Describe a hangmans fracture.
Hyperextension of the head on the neck, snapping the dens.
| This crushes the contents of the spinal cord.
120
What is the only moveable joint of the skull?
Temporomandibular joint.
121
What bone makes up the forehead and upper eye sockets?
Frontal bone
122
What bone makes up the majority of the top and back of the skull?
Parietal
123
What bone is at the base of the skull at the back?
Occipital bone
124
What bone makes up the front of the cheek bones?
Zygomatic bone
125
What is the function of the skull?
Protect the brain and special sensory organs
Provide a specialised environment
Attachment for muscles and the meninges
126
What are the thickest parts of the skull?
Occipital and frontal bones
127
What is the thinnest part of the skull?
Pterion
128
What is the calvaria?
The bony roof of the skull
129
What are the three fossa of the cranial floor, and what cranial nerves are associated with them?
Anterior fossa - CNI and part of CNII
Middle fossa - CNII-VI
Posterior fossa - CNVII-XII
130
What are the main bones of the cranial floor?
Palatine
Sphenoid
Temporal
Occipital
131
Describe the location of the frontal bone.
Anterior skull vault up to the supraorbital ridge.
132
What artery is the frontal bone associated with?
Superficial temporal artery
133
Describe the location of the ethmoid bone.
The midline of the anterior cranial fossa
134
Why might anosmia be found in a patient with an ethmoid bone fracture?
It is closely associated with CNI
135
Describe the important features of the sphenoid bone.
The central part has the sphenoid sinus
The optic nerve runs along the optic canal
The pituitary gland sits in the sella turcica
Pterygoid process projects downwards
Foramen rotundum contains CNII
Foramen ovale contains CNIII
136
What is the hardest part of the temporal bone?
Petrous part
137
What is the function of the condyles of the occipital bone?
Articulate with the atlas
138
What are the differences in a neonatal skull compared to an adult?
Large cranial sutures held together by a thick connective tissue matrix
Fontanelles in the region of the bregma and lambda
139
What is cerebral herniation?
Increased pressure in the skull causing the brain tissue to move down through the foramen magnum.
Tends to be caused by a head injury, stroke, or tumour.
Commonly fatal.
140
Describe a basilar skull fracture.
One which occurs in the floor of the cranial vault
| Causes 'battles sign', blood in the sinuses, CSF leaking from the nose, 'raccoon eyes'
141
Describe a compound skull fracture.
A fracture which puts the outside environment in direct contact with the cranial cavity.
The risk of infection is very high and it may cause pneumocephalus.
142
Describe a diastatic skull fracture.
When the fracture line traverses one or more sutures of the skull, causing the sutures to widen. They are most common in young children and infants.
In adults, the lambdoidal suture is most likely to be affected.
They are more common with cleidocranial dysphasia and osteogenesis imperfecta.
143
Describe cervical kyphosis.
Caused by degenerative disc disease, a congenital defect, iatrogenic, and trauma.
It is when the normal inward curvature reverses.
144
Describe cervical spinal stenosis.
Collapse of the intervertebral discs due to scarring of the annulus.
Causes abnormal pressure on the articulate cartilage, leading to bone spurs, thickened ligaments, and bulging discs.
This can cause pressure on the spinal cord or peripheral nerves, leading to myelopathy and radiculopathy respectively.
145
What is CNI?
Olfactory nerve
146
What is the path of the olfactory nerve?
Olfactory mucosa
Cribriform plate of the ethmoid bone
Olfactory tract
147
Give some causes of anosmia.
Trauma causing a fracture of the cribriform plate
Meningitis
Upper respiratory tract infection (transient)
148
What is CNII?
Optic nerve
149
Is the olfactory nerve sensory, motor, or both?
Sensory
150
Is the optic nerve sensory, motor, or both?
Sensory
151
Describe the course of the optic nerve.
```
Retina
Optic canal
Optic tract
Cross at the optic chiasm
Primary visual cortex in the occipital lobe
```
152
How do you examine the optic nerve?
```
Colour vision
Visual acuity
Visual fields
Pupillary reflexes
Fundoscopy
```
153
What is bilateral hemianopsia?
Visual deficiency of the outer fields due to lesions of the optic chiasm
154
What is papilloedema?
Optic disc swelling due to raised intracranial pressure
155
What is CNIII?
Oculomotor nerve
156
Is the oculomotor nerve sensory, motor, or both?
Motor
| Parasympathetic
157
What cranial nerves have parasympathetic contribution?
Oculomotor (III)
Facial (VII)
Glossopharyngeal (IX)
Vagus (X)
158
Describe the path of the oculomotor nerve.
Oculomotor nucleus
Supraorbital fissure
Extraocular muscles
159
What muscles does the oculomotor nerve supply?
```
Levator palpebrae superioris
Inferior oblique
Medial rectus
Superior rectus
Inferior rectus
```
160
What can cause an oculomotor nerve palsy?
Raised intracranial pressure
| Aneurysm
161
What are the symptoms of an oculomotor nerve palsy?
Down and out pupil
Mydriasis
Ptosos
162
What in CNIV?
Trochlear nerve
163
Is the trochlear nerve sensory, motor, or both?
Motor
164
Describe the course of the trochlear nerve.
Trochlear nucleus
Supraorbital fissure
Superior oblique muscle
165
What cranial nerve has the greatest intracranial length?
Trochlear nerve
166
What can cause damage to the trochlear nerve?
Raised intracranial pressure
Tumour
Cavernous sinus thrombosis
167
What neurovascular structures pass through the cavernous sinus?
Oculomotor nerve
Abducens nerve
Trigeminal nerve (V1/2)
Internal carotid artery
168
What are the symptoms of trochlear nerve palsy?
Diplopia when walking down stairs
| Subtle head tilt
169
What is CNV?
Trigeminal nerve
170
Is the trigeminal nerve sensory, motor, or both?
Both
171
Describe the route of the trigeminal nerve, including branches
Trigeminal sensory nuclei
Trigeminal ganglion
V1 - opthalmic
Through the supraorbital fissure to the forehead, eyes, and nose
V2 - maxillary
Through the foramen rotundum to the cheeks, maxilla, and upper teeth
V3 - mandibular
Through the foramen ovali to the mandible, ears, chin, and lower teeth
172
What hole in the skull does the opthalmic branch of the trigeminal nerve pass through?
Supraorbital fissure
173
Where does the opthalmic branch of the trigeminal nerve provide sensory innervation?
Forehead
Eyes
Nose
174
What hole in the skull does the maxillary branch of the trigeminal nerve pass through?
Foramen rotundum
175
Where does the maxillary branch of the trigeminal nerve provide sensory innervation to?
Cheeks
Maxilla
Upper teeth
176
What hole in the skull does the mandibular branch of the trigeminal nerve pas through?
Foramen ovali
177
What structures does the mandibular branch of the trigeminal nerve provide sensory innervation for?
Mandible
Ears
Lower teeth
Chin
178
What is trigeminal neuralgia?
Episodes of intense pain in the face due to overactive sensory fibres.
179
How do you check the afferent fibres of the trigeminal nerve?
Corneal reflex
180
How do you check the sensory function of the trigeminal nerve?
Touch lightly with cotton wool on each area, close to the midline
181
How do you test the motor function of the trigeminal nerve?
Clench the jaw and feel for the masseter, temporalis, and pterygoid muscle
182
What is CNVI
Abducens nerve
183
Is the abducens nerve sensory, motor, or both?
Motor
184
Describe the course of the abducens nerve.
Abducens nerve
Supraorbital fissure
Cavernous sinus
Lateral rectus muscle
185
What is the false localising sign?
In raised intracranial pressure, the abducens nerve is the first to be affected. It can falsely suggest that there is a lesion close to the nerve.
186
How do you check the function of the abducens nerve?
Ask the patient to follow your finger in a H formation
187
What is CNVII?
Facial nerve
188
What are the branches of the facial nerve?
```
Temporal
Zygomatic
Buccal
Maxillary
Cervical
```
189
What is the function of the facial nerve?
Anterior 2/3 taste buds
Expression
Salivation
Lacrimation
190
Describe how you would examine the facial nerve.
```
Raise eyebrows, forehead should wrinkle
Squeeze eyes shut and resist opening (orbicularis oculi)
Show teeth (orbicularis oris)
Blow cheeks (buccinator)
Taste
```
191
How can you tell whether a facial nerve lesion is intra or extracranial?
The forehead is only affected if the lesion is extracranial
192
What is Bell's palsy?
Idiopathic one-sided facial paralysis.
Potentially due to inflammation at the stylomastoid foramen
May not regain function
193
What is CNVII?
Vestibulocochlear nerve
194
Is the vestibulocochlear nerve sensory, motor, or both?
Sensory
195
Describe the course of the vestibulocochlear nerve.
Cerebellopontine angle
Acoustic meatus
Bifurcate to cochlear and vestibular nerves
Cochlea and semilunar canal
196
How do you test the vestibulocochlear nerve?
Whisper in each ear
Rinne's test for conduction
Weber's test for localisation
197
What is vertigo and what may cause it?
A feeling of spinning or swaying
Paroxysmal positional vertigo
Menieres disease
Labyrinthitis
198
What is Meniere's disease?
A disease of unknown cause which affects the membranous labyrinth of the ear, causing progessive deafness, tinnitis, and vertigo.
199
What is benign paroxysmal positional vertigo?
Brief episodes of mild to intense dizziness, triggered by specific changes in the position of your head
200
What is a vestibular schwannoma?
A benign intracranial tumour of Schwann cells surrounding CNVIII, which may also affect the facial nerve.
Causes unilateral sensorineural hearing loss
201
What is CNIX?
Glossopharyngeal nerve
202
Is the glossopharyngeal nerve sensory, motor, or both?
Both
| Parasympathetic
203
Where does the glossopharyngeal nerve originate?
Medulla oblongata
204
What is the sensory function of the glossopharyngeal nerve?
Oropharynx
Posterior third of the tongue
Carotid sinus and body
205
What is the parasympathetic function of the glossopharyngeal nerve?
Parotid gland (after otic ganglion)
206
What is the motor function of the glossopharyngeal nerve?
Stylopharyngeus to elevate the larynx and pharynx
207
What reflex can be initiated by the afferent branch of the glossopharyngeal nerve?
Gag
208
What is CNX?
Vagus nerve
209
Is the vagus nerve sensory, motor, or both?
Both
| Parasympathetic
210
Where does the vagus nerve originate?
Medulla
211
What hole in the skull does the vagus nerve pass through?
Jugular foramen
212
What is the sensory function of the vagus nerve?
Laryngopharynx
| Ear
213
What is the motor function of the vagus nerve?
Larynx and pharynx
214
What is the parasympathetic function of the vagus nerve?
Heart
Lungs
Gastrointestinal system
215
What reflex are the efferent fibres of the vagus nerve involved with?
Gag
216
What is CNXI?
Accessory nerve
217
Is the accessory nerve sensory, motor, or both?
Motor
218
Describe the course of the accessory nerve?
```
C1-6
Internal carotid artery
Foramen magnum
Jugular foramen
SCM and trapezius
```
219
What is CNXII?
Hypoglossal nerve
220
Describe the course of the hypoglossal nerve.
Hypoglossal nucleus
Hypoglossal canal
Tongue
221
What does the hypoglossal nerve supply?
Intrinsic and extrinsic muscles of the tongue
222
Is the hypoglossal nerve sensory, motor, or both?
Motor
223
What would you see if the hypoglossal nerve is damaged?
Fasciculations of the tongue
| Deviation towards the lesion
224
What is present in each pharyngeal gut tube?
Endoderm lining
Aortic arch
Vein
Cranial nerve
225
What are neural crest cells?
Specialised cell population which originates in the neuroectoderm.
They are in the lateral border and become displaced to enter the mesoderm, before migrating to contribute to head and neck structures.
226
What pharyngeal arch will develop to form the facial skeleton?
1st
227
What pharyngeal arch forms the muscles of mastication?
2nd
228
Describe the development of the nose.
1. Nasal placodes form on the frontonasal prominence.
2. Sink to form nasal pits
3. Medial and lateral prominence on either side of the pits
4. Maxillary prominences grow in medially, pushing the nasal prominences closer
5. Maxillary and medial nasal prominences then grow together and fuse in the midline
229
What are the components of the intermaxillary segment, formed during the fusion of the medial nasal prominences?
Philtrum
Four upper incisors
Primary palate
230
What does the secondary palate derive from?
From the palatal shelves which are derived from the maxillary prominences as they grow into the oral cavity.
231
What is the cause of a lateral cleft lip?
Failure of the palatal shelves to fuse
232
What is the cause of a cleft lip and palate?
Combined failure of the palatal shelves to fuse, and a failure to meet in the midline.
233
What is the fate of the frontonasal prominence?
Forehead
Bridge of the nose
Medial and lateral nasal prominences
234
What is the fate of the medial nasal prominence?
Philtrum
Primary palate
Mid-upper jaw
235
What is the fate of the lateral nasal prominence?
Cheeks
Lateral upper lip
Secondary palate
Lateral upper jaw
236
What is the fate of the mandibular prominence?
Lower lip and jaw
237
Describe the formation of the hard palate.
The maxillary prominence gives rise to 2 palatal shelves
As the mandible is underdeveloped the tongue is in the way so they grow down into the oral cavity
As the lower jaw develops, the tongue drops down into it, so the shelves can fuse.
238
What are the symptoms of a cleft lip or palate?
Difficulty swallowing, suckling and feeding
| Problems with speech development
239
Describe the development of the eyes.
Outpocketing of the forebrain occurs approximately week 4, coming into contact with the overlying ectoderm.
Optic placodes are there which become the lens
The placode invaginates and pinches off so the lens vesicle lies within the optic vesicle.
As the facial prominences grow, the eyes move to the front of the face
240
Describe the development of the external ear.
The external auditory meatus derives from the first pharyngeal cleft.
The auricles develop from proliferation of the first and second pharyngeal arches which surround the meatus
They initially develop as auricular hillocks in the neck
As the mandible grows, the ears ascend to the side of the head, in line with the eyes
241
Describe the development of the inner ear.
Otic placodes invaginate to form the auditory vesicles
| This creates a membranous labyrinth with cochlea and semilunar canal systems.
242
Describe the symptoms and signs of foetal alcohol syndrome.
```
Low nasal bridge
Small head
Epicanthal folds
Short nose
Smooth philtrum
```
243
What bones form the anterior cranial fossa?
Ethmoid and frontal
244
What bones form the middle cranial fossa?
Sphenoid and temporal
245
What is the only nerve to originate in the dorsal aspect of the brainstem?
Trochlear
246
What nucleus supplies the parasympathetic fibres accompanying the oculomotor nerve?
Edinger-Westphal nucleus
247
What nucleus supplies the parasympathetic fibres accompanying the facial nerve?
Superior salivatory nucleus
248
What nucleus supplies the parasympathetic fibres accompanying the glossopharyngeal nerve?
Inferior salivatory nucleus
249
What nucleus supplies the parasympathetic fibres accompanying the vagus nerve?
Dorsal vagal motor nucleus
250
What is Horner's syndrome?
Any lesion which leads to loss of sympathetic function in the head.
Commonly caused by a tumour in the apex of the lung which erodes the cervicothoracic ganglion
251
What ganglion(s) does the parasympathetic supply from the oculomotor nerve supply?
Ciliary ganglion
252
What ganglion(s) does the parasympathetic supply from the facial nerve supply?
Pterygopalatine ganglion
| Submandibular ganglion
253
Which branch of the facial nerve supplies the submandibular gland?
Chorda tympani
254
Which branch of the facial nerve supplies the lacrimal glands and mucus glands of the nose and palate?
Greater petrosal nerve
255
How many sympathetic ganglia are found in each spinal level?
2/3 cervical
11 thoracic
4 lumbar
4 sacral
256
Where does the sympathetic supply from the head and neck originate?
Superior, middle, and inferior cervical ganglion.
| Displaced upper thoracic ganglia because there is no sympathetic outflow from the cervical segments
257
How do sympathetic post-ganglionic fibres reach their head and neck targets?
Hitch-hike on the arterial system, outside the carotid sheath
258
What artery are fibres from the superior cervical ganglion associated with?
Internal and external carotids
259
What artery are fibres from the middle cervical ganglion associated with?
Inferior thyroid artery
260
What artery are fibres from the inferior cervical ganglion associated with?
Vertebral arteries
261
What are the targets of sympathetic fibres from the superior cervical ganglion?
Dilator pupillae
Smooth muscle of levator palpebrae superioris
Nasal glands
Salivatory glands
262
What are the targets of sympathetic fibres from the middle cervical ganglion?
Lower larynx
Trachea
Hypopharynx
Upper oesophagus
263
What what forms the apex of the orbit?
Optic canal
264
What bone(s) form the superior border of the orbit?
Frontal
| Sphenoid
265
What bone(s) form the lateral border of the orbit?
Zygomatic
| Sphenoid
266
What bone(s) form the medial border of the orbit?
Ethmoid
Maxillary
Lacrimal
Sphenoid
267
What bone(s) form the superior border of the orbit?
Maxillary
| Zygomatic
268
What fissures and canals are located in the sphenoid bone which are important for the orbit?
Superior orbital fissure
Inferior orbital fissure
Optic canal
269
What does the superior orbital fissure pass between?
Orbit to the middle cranial fossa
270
What does the inferior orbital fissure pass between?
Orbit to the:
Pterygopalatine fossa
Infratemporal fossa
Temporal fossa
271
What does the optic canal pass between?
Between the orbit and the middle cranial fossa
272
What structures pass through the superior orbital fissure?
```
Oculomotor nerve
Trochlear nerve
Abducens nerve
Opthalmic nerve
Superior opthalmic vein
```
273
What structures pass through the inferior orbital fissure?
```
Maxillary nerve (V2)
Inferior opthalmic vein
```
274
What is the main cause of a blowout fracture of the orbit?
Blunt force injury to the orbit
| E.g. Motor collision or sports injury
275
Why might a patient with a blowout fracture of the orbit have trouble with vertical movement of their eye?
The inferior rectus may become tethered in the maxillary sinus
276
What are the symptoms of a blowout fracture in the orbit?
Ecchymosis
Pain
Swelling
Double vision
277
What is the optic disc?
Where the optic nerve attaches with the retina, producing a blind spot
278
What is the sclera of the eye?
The fibrous layer (outer)
Keeps the shape of the eye
Forms the cornea
279
What is the choroid of the eye?
The highly vascularised layer which provides the retina with oxygen and nutrients
Includes the ciliary body which has a role in focussing the lens
280
What is the retina?
Inner layer of the eye which contains photoreceptors
| Has the macula and fovea
281
What are the symptoms of retinal detachment?
Sudden appearance of floaters
Sudden, short flashes of light
Blurring or distortion of vision
282
Why is a retinal detachment an emergency?
The retina has peeled away from the underlying support tissue, therefore losing its supply of oxygen and nutrients. It must be quickly reattached or sight will be permanently lost
283
What are the layers overlying the optic nerve?
Pia mata
Arachnoid mata
Dura mata
284
Describe the segments of the eye.
The posterior 4/5 of the eye is the posterior segment, containing vitreous humour.
The anterior 1/5 of the eye is the anterior segment, which is split into the anterior and posterior chambers. They contain aqueous humour.
285
What produces aqueous humour?
Ciliary body
286
What drains aqueous humour?
Trabecular meshwork
287
What is the cause and main symptom of open-angle glaucoma?
Slow clogging of the trabecular meshwork, creating increased pressure in the eye, which causes progressive optic nerve damage.
Slow, painless vision loss.
288
What is the cause and main symptom of closed-angle glaucoma?
The iris bows forward and causes physical contact between the iris and trabecular meshwork, blocking outflow.
Sudden and painful onset with lots of pain
289
What are cataracts?
Clouding of the lens in the eye
290
What are the symptoms of cataracts?
Faded colours
Blurry vision
Halos around light
Trouble seeing at night
291
What is the function of superior rectus in the eye?
Look upwards and laterally
292
What is the function of inferior rectus in the eye?
Look laterally and downwards
293
What is the innervation of the superior rectus?
Superior branch of the oculomotor nerve
294
What is the innervation of the inferior rectus?
Inferior branch of the oculomotor nerve
295
What is the innervation of the lateral rectus?
Abducens nerve
296
What is the innervation of the medial rectus?
Inferior branch of the oculomotor nerve
297
What is the innervation of the inferior oblique?
Inferior branch of the oculomotor nerve
298
What is the innervation of the superior oblique?
Trochlear nerve
299
What is the function of the inferior oblique in the eye?
Look medially and upward
300
What is the function of the superior oblique in the eye?
Look medially and downward
301
What are the symptoms of Horner's syndrome?
Pupillary constriction
Partial ptosis
Ipsilateral absence of sweating
May have
Ipsilateral vasodilation and enopthalmos
302
What is the origin of the central retinal artery?
The internal carotid branches to the opthalmic artery, which gives rise to it
303
Give an example of a cause of central retinal artery occlusion.
Carotid artery atherosclerosis
Dissecting aneurysm
Arterial spasm
304
Describe the course of drainage of the central retinal vein.
To the superior opthalmic vein, then cavernous sinus
305
Give the signs and symptoms of central retinal artery occlusion.
Sudden, acute, painless loss of vision
Red lesion with surrounding pale retina seen on fundoscopy
306
What can be seen on fundoscopy that is a cause of raised intracranial pressure?
Papilloedema
307
Give a cause of raised intracranial pressure.
Intracranial haematoma
Cerebral oedema
Tumour
308
What are the potential consequences of central retinal vein occlusion?
Ischaemia of the retina
Oedema of the retina
Glaucoma
Can therefore cause blindness
309
Describe how lacrimal secretions are produced and drained from the eye?
Produced by the lacrimal gland
Drain off the eye through the lacrimal canal
Into the lacrimal sac
Drain through the nasolacrimal duct
Into the inferior meatus of the nasal canal
310
What are the two layers of conjunctiva?
Palpebral conjunctiva on the inside of the eyelid
| Bulbar conjunctiva coating the surface of the eyeball (except the iris)
311
What is conjunctivitis?
Inflammation of the conjunctiva
Causes pinkness of the conjunctiva, conjunctival oedema, mucopurulent discharge
312
What is a tarsal gland cyst?
Blockage of a duct which drains the tarsal (meibomian) gland.
Causes a bump on the eyelid, swelling, and a reddened appearance
313
What is a sty?
Infection of the ciliary glands, usually by Staphylococcus aureus.
They often recur.
314
What is the function of levator palpebrae superioris?
Opens the eyelid
315
What is the innervation of levator palpebrae superioris?
Oculomotor nerve
316
What is the function of orbicularis oculi?
Close the eyelid
317
What is the innervation of orbicularis oculi?
Facial nerve
318
What are the symptoms of CNVI nerve palsy?
Unable to abduct the eyes
319
What are the symptoms of CNIII palsy?
Ptosis
Dilated pupil (if parasympathetic involvement)
Down and out eye
320
What are the symptoms of a CNIV nerve palsy?
Difficulty moving eyes superiolaterally.
| Diplopia walking down stairs
321
What are the symptoms and signs of an orbital fracture?
Lid swelling
Pain
Diplopia
Reduced vision
Restricted eye movement
Reduced vision
Reduced visual field
Enopthalmos
322
In what type of orbital fracture would you expect vertical diplopia, enopthalmos, and infraorbital anaesthesia?
Orbital floor fracture
323
In what type of orbital fracture would you expect horizontal diplopia and surgical emphysema?
Medial fractures
324
What are the symptoms of thyroid eye disease?
```
Upper eyelid lag and restriction
Exopthalmos
Optic irritation
Redness
Diplopia
Restrictive myopathy
Optic neuropathy
```
325
Describe the NOSPECS scoring in thyroid eye disease.
```
Nothing
Only signs
Soft tissue involvement
Proptosis
Extraocular muscle involvement
Corneal ulceration
Sight loss
```
326
What are the symptoms and signs of orbital cellulitis?
Pain
Sticky discharge
```
Fever
Painful or restrictive eye movement
Reduced vision and color
Relative afferent pupillary defect
Proptosis
```
327
What are the most common types of orbital mass lesions?
Inflammatory
Cystic
Vascular
328
What are the differential diagnoses for orbital cellulitis?
Preseptal cellulitis
| Conjunctivities
329
What are the symptoms of an orbital mass lesion?
Swelling in and around the orbit
```
Pain
Inflammation
Double vision
Proptosis
Chemosis
Restrictive eye movements
```
330
Give a few examples of an orbital mass lesion.
```
Wegener's granulomatosis
Pseudotumour
Dacryoadenitis (inflammation of the lacrimal gland)
Mucocoele (blocked sinus)
Dermoid cyst
Capillary haemangioma (children)
Cavernous haemangioma
```
331
How do you manipulate the ear to view the tympanic membrane with an otoscope in an adult?
Pull the ear up, out, and back
332
How do you manipulate the ear to view the tympanic membrane with an otoscope in a child?
Pull the ear back and down
333
What is the function of the grooves in the pinna?
Amplify sound
334
What regions of the external ear are supplied by the greater auricular nerve?
Anterior
| Posteroinferior
335
What regions of the external ear are supplied by the lesser auricular nerve?
Posterosuperior
336
What regions of the external ear are innervated by the vagus nerve?
Deep
337
What nerve are the greater and lesser auricular nerves branches of?
Auriculotemporal branch of the mandibular nerve (V3)
338
What is a pinna haematoma?
A collection of blood between the cartilage of the pinna and the perichondrium. This causes avascular necrosis of the cartilage.
Fix by aspirating the blood and stitching together.
339
What is cauliflower ear?
When a pinna haematoma has caused necrosis so the ear collapsed in on itself.
340
What gland of the ear produces wax?
Ceruminous gland
341
What is otitis externa?
Inflammation of the outer ear and auditory canal.
| Commonly caused swimmer's ear
342
What is the attachment of the tympanic membrane to the malleus?
Umbo
343
What bone of the middle ear can be seen through the tympanic membrane?
Malleus
344
What are the two parts of the tympanic membrane?
Pars tensa - majority of the membrane. Is thick and taut
Pars flaccida - collagen fibres are irregularly arranged, creating a thin and slack region.
345
What are the layers of the tympanic membrane?
Outer layer of skin
Middle epithelium
Inner collagen (radial from the midline out)
346
What are the symptoms of a tympanic perforation?
Temporary conductive hearing loss
Tinnitis
Earache
Discharge of mucus
347
If you needed to enter the middle ear through the tympanic membrane, what part would you have to go through?
Bottom third to avoid damage to the chorda tympani
348
Give a cause of tympanic retraction.
Negative middle ear pressure
Weakness of the tympanic membrane
Increased surface area of the tympanic membrane
349
What is surfer's ear?
A bony lump which develops in the external acoustic meatus. The growth eventually restricts the meatus, reducing hearing in the affected ear.
350
What are the two regions of the middle ear?
Tympanic cavity
| Epitympanic recess
351
From outside to in, what are the bones of the middle ear?
Malleus
Incus
Stapes
352
What does the stapes attach to the inner ear through?
Oval window
353
What connects the middle ear to the mastoid air cells?
Aditus then through the mastoid antrum
354
Why can middle ear infections easily spread into the mastoid air cells?
They are coated with the same mucosa as that of the middle ear
355
What is the function of the eustachian tube?
Maintain middle ear pressure
356
What two muscles are found in the middle ear and what is their innervation?
Tensor tympani - CNV
| Stapedius - CNVII
357
What branch of the facial nerve passes around the inner surface of the ear drum, and what is its function?
Chorda tympani
| Taste
358
What two nerves have branches which run through the middle ear?
Facial
| Glossopharyngeal
359
What is the consequence of the pressure in the middle ear not being equalised?
Sound is dampened
360
What is acute otitis media?
An acute infection of the middle ear, which is generally due to an URTI.
Can lead to retraction of the ear drum
361
What are potential complications of acute otitis media?
```
Perforation
Chronic infection
Local spread
Sensorineural hearing loss
Facial nerve palsy
Meningitis
Cerebral abscess
Labyrinthitis
```
362
What are the common infectious organisms in acute otitis media?
Pneumococcus
Haemophilus influenzae
Streptococcus
363
What are the potential consequences of mastoiditis?
Osteomyelitis, which can cause intracranial infection, leading to death if it enters the middle cranial fossa.
364
How can you check for mastoiditis?
Look behind the ear, the crease will be obliterated and it will be inflamed.
365
What is a cholesteatoma?
A necrotic mass of dead cells and keratin which can locally erode.
This can destroy the ossicles and may erode into the brain
366
What would be the effect of an intracranial lesion to the facial nerve?
Reduced facial expression
Reduced salivation and taste sensation
Ipsilateral hyperacusis
Ipsilateral reduced lacrimal fluid production
367
What is the most likely cause of an intracranial lesion of the facial nerve?
Tumour or infection of the middle ear
368
What is chronic otitis media and how can you treat it?
Fluid accumulation behind the ear drum, usually due to a dysfunctioning eustachian tube.
Place a grommit
369
Describe the course of the facial nerve
Pons (2 roots)
Internal acoustic meatus
Facial canal (form the geniculate ganglion. Give off greater petrosal nerve, nerve to stapedius, and chorda tympani)
Exit via the stylomastoid foramen (give off the posterior auricular nerve)
Through the parotid gland (branch into the TZBMC)
370
What artery supplies the inner ear?
Labyrinthine artery
371
Where does the vestibulocochlear nerve divide?
Distal end of the internal acoustic meatus
372
What two nerves pass through the internal acoustic meatus?
Facial and vestibulocochlear
373
What are the components of the membranous labyrinth?
Semicircular ducts
Cochlear duct
Utricle
Saccule
374
Describe the way in which the inner ear converts a sound wave to an electrical signal.
The footplate of the stapes is pushed into the oval window
Fluid in the scala vestibuli moves, pushing the adjacent, inner layer of fluid
The tectoral membrane vibrates in the area corresponding to the frequency
The round window reduces pssure
375
What part of the inner ear detects linear motion?
Utricle, saccule, and ductus reuniens
376
What part of the inner ear detects centrifugal accelleration?
Utricle
377
What parts of the inner ear detect rotation?
The three semicircular canals
378
How does the vestible convert movement to an electrical signal?
The gelatinous matrix and otoconia move when the head moves
| Stereocilia in the capula converts the movement into energy
379
What are the symptoms of benign postural paroxysmal vertigo?
The onset of a spinning feeling for a few seconds, especially on turning of the head
380
What is the cause of benign postural paroxysmal vertigo?
Otolith displacement so the sediment continues moving after actual movement has stopped.
381
What is the main cause of Menieres disease?
Too much fluid in the vestibule
382
What symptoms are seen in Menieres disease?
Vertigo
Hearing loss
Tinnitis
Feeling of bulging in the ear
383
What things contribute towards balance?
Vestibular end organ
Vision
Sensation (muscle tone, feet, higher centres of the brain)
384
What puts a person at risk of epistaxis?
```
Trauma
Tumour
Vascular abnormalities
Dried mucosa
Aspirin or NSAIDs
Coagulopathy
Hypertension
Elderly or very young
```
385
In the sequence that you would do them, what would you use to stop epistaxis?
```
Pinch the nose below the bone for 20 minutes
Cauterise
Nasal tampons
Nasal packing
Embolise the vessel
```
386
What blood vessels supply the inner nose?
```
Anterior ethmoid
Posterior ethmoid
Sphenopalatine
Superior labial
Greater palatine
```
387
What vessel will present a signficant problem if implicated in epistaxis as it is far back in the nose and is high pressure?
Sphenopalatine
388
Where do the majority of nose bleeds originate?
Kiesselbach's plexus
389
What are the functions of the nose?
Olfaction
Respiration
Filter and humidify
Drain and eliminate paranasal sinus and lacrimal duct secretions.
390
How far into the nose does the skin of the nose extend?
To the limen nasi
391
What makes air flow turbulent in the nose?
Conchae
392
From superior to inferior, what are the passages in the nasal cavity?
Sphenoethmoid recess
Superior meatus
Middle meatus
Inferior meatus
393
Describe the ethmoid bone
Two ethmoidal labyrinths connected by the cribriform plate.
394
What structures pass through the sphenopalatine foramen?
Sphenopalatine artery
Nasopalatine nerve
Superior nasal nerve
395
What structures does the sphenopalatine foramen connect?
Superior meatus and the pterygopalatine fossa
396
What structures does the incisive canal connect?
Nasal cavity and the incisive fossa of the oral cavity
397
What structures pass through the incisive canal?
Nasopalatine nerve
| Greater palatine artery
398
What nerves give sensory innervation to the lateral walls and septum of the nose?
```
Nasopalatine nerve (from maxillary)
Nasociliary nerve (from opthalmic)
```
399
What nerve give sensory innervation to the outer skin of the nose!
Trigeminal (V1-2)
400
What are the major problems that can be associated with a cribriform plate fracture?
Causes leakage of the CSF if it penetrates the meninges
Meningitis
Encephalitis
Brain abscess
401
Why might inflammation of the maxillary sinus cause toothache?
They are both supplied by the maxillary nerve
402
What are the common infectious organisms seen in sinusitis?
Streptococcus pneumoniae
| Haemophilus influenzae
403
What is a saddle nose deformity?
Scooping in of the nasal septum after a septal haematoma has caused necrosis
404
What are nasal polyps
Outgrowths of the epithelium inside the nose with a large group of highly eosinophilic cells. Generally appear close to the osteum of the paranasal sinuses
Commonly caused by chronic rhinosinitis.
Can cause nasal obstruction and sleep apnoea
405
What is rhinitis?
Inflammation of the nasal mucosa causing swelling and increased volume of secretions.
Can be caused by infection, allergy, and nasal polyps
406
Where can a nasal infection spread to?
Anterior cranial fossa
Middle ear
Paranasal sinuses
Lacrimal apparatus and conjunctiva
407
What would the eye look like if there was complete palsy of the anatomical oculomotor nerve?
Down and out
| Ptosis
408
What would the eye look like if there was complete palsy of the autonomic oculomotor nerve?
Dilation of the pupil
409
What would the difference in signs with complete palsy of the oculomotor nerve distal to the ciliary ganglion rather than proximal?
The pupillary size will be equal
| Normal accommodation reflex
410
What is harlequin syndrome?
Anaesthesia, anhydrosis, and vasomotor dysfunction over half the face.
Complete trigeminal nerve dysfunction, generally at the level of preganglionic neurons of the spinal cord
411
What is the only branch of the facial nerve to exit the stylomastoid foramen?
Motor
412
What muscle of facial expression has bilateral innervation?
Frontalis
413
What would be the effects of complete palsy of CNVII?
```
Loss of facial expression and asymmetry
Lose lacrimation and oral/nasal secretion
Total ptosis
Lose blink reflex
Stasis of tears
Drooling
Unable to frown if bilateral
```
414
What are potential causes of facial nerve palsy?
```
Forceps delivery
Parotid gland tumour
Parotitis
Facial nerve inflammation in the facia canal
Tympanectomy
Surgery in the infratemporal fossa
```
415
What type of joint is the temporomandibular joint?
Modified synovial joint with fibrocartilage
416
What movement does the superior cavity of the TMJ allow?
Translation
417
What movement does the inferior cavity of the TMJ allow?
Rotation
418
What is the function of the temporomandibular ligament?
Strengthen the TMJ laterally. It blends with the posterior capsule
419
What are the attachments of the temporomandibular ligament?
From the zygoma to the posterior neck and ramus of the mandible
420
What is the function of the sphenomandibular ligament?
Same length and tension as it is an accessory ligament.
| Prevents inferior dislocation
421
What is the function of the stylomandibular ligament?
Accessory ligament preventing inferior displacement of the jaw
Arises from a thickening of the deep parotid fascia
422
What prevents posterior dislocation of the TMJ?
Glenoid tubercle
423
What prevents anterior dislocation of the TMJ?
Articular tubercle
424
What muscles open the mouth?
Lateral pterygoid pulls the condyles forward
| Digastric pulls it down and back
425
What muscles close the mouth?
Retraction by the posterior fibres of temporalis
| Elevation by temporalis, masseter, and the medial pterygoid
426
What is bruxism?
Grinding of the teeth whilst sleeping
427
What muscles pass through the infratemporal fossa?
Lower temporalis
| Medial and lateral pterygoid
428
What nerves pass through the infratemporal fossa?
```
Mandibular - auriculotemporal, inferior alveolar, lingual, buccal
Chorda tympani (with the lingual)
Otic ganglion (with auriculotemporal)
```
429
What arteries pass through the infratemporal fossa?
Maxillary - from external carotid. Branches to the middle meningeal artery
Superficial temporal artery
430
What veins pass through the infratemporal fossa?
Pterygoid venous plexus
Maxillary
Middle meningeal
431
What are the borders of the oral cavity proper?
Superior: hard and soft palate
Anterior: teeth
Inferior: myohyoid
Posterior: end of soft palate/uvula, palatopharyngeal arches, epiglottis
432
What bones form the hard palate?
Maxillary and palatine
433
What is the reason for the intermaxillary suture in the hard palate?
The result of the palatine processes fusing in the midline during development
434
What are the muscles of the soft palate?
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Uvulae
Levator veli palatini
Tensor veli palatini
Palatoglossus
Palatopharyngeus
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435
What nerve innervates the majority of the muscles of the soft palate?
Vagus nerve
436
What muscle of the soft palate is also an extrinsic muscle of the tongue?
Palatoglossus
437
What structure holds the lip close to the gum?
Labial frenulum
438
What structure holds the tongue in the floor of the mouth?
Lingual frenulum
439
Name the teeth from front to back.
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Central incisor
Lateral incisor
Canine
First premolar
Second premolar
First molar
Second molar
Third molar (wisdom tooth)
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440
What is the function of the septum of the tongue?
Muscle attachments
441
What are the intrinsic muscles of the tongue?
Superior longitudinal
Inferior longitudinal
Vertical intrinsic
Transverse intrinsic
442
What is the function of the superior longitudinal muscle of the tongue?
Curl the sides up
443
What is the function of the inferior longitudinal muscle of the tongue?
Pulls the sides down
444
What is the function of the vertical intrinsic muscle of the tongue?
Flatten and broaden
445
What is the function of the transverse intrinsic muscles of the tongue?
Sides in, tongue out
446
What nerve innervates the intrinsic muscles of the tongue?
Hypoglossal nerve
447
What are the extrinsic muscles of the tongue?
Styloglossus
Hyoglossus
Genioglossus
448
What nerve gives general sensation to the anterior 2/3 of the tongue?
Lingual nerve (CNV)
449
What nerve gives special sensory innervation to the anterior 2/3 of the tongue?
Chorda tympani (CNVII)
450
What nerves innervate the posterior 1/3 of the tongue?
CNIX glossopharyngeal
| Internal laryngeal nerve
451
What is a complication of enlarged adenoids?
Otitis media with effusion
452
What is a peritonsillar abscess?
An emergency complication of tonsillitis or pharyngitis. It will cause the uvula to deviate to the opposite side. It requires drainage to remove the infection and prevent blockage of the airway.
453
Describe the development of the pituitary gland.
Downward outgrowth of the forebrain which grows into the roof of the pharynx.
Rathke's pouch grows upwards as an outpocketing of endoderm from the somatodeum and grows dorsally toward the forebrain
Rathke's pouch is pinched off from the roof of the pharynx by ossification of the sphenoid bone.
454
What pharyngeal arches give rise to the tongue?
All of them
455
What are the three median lingual swellings during development?
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Tuberculum impar (ph1)
Cupola (ph2,3,4,6)
Epiglottal swelling (ph4)
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456
Describe how the swellings of the primitive tongue form the mature tongue.
The lateral lingual swellings overgrow the tuberculum impar and form the anterior two-thirds of the tongue.
The third arch of the cupola overgrows the second arch.
Then there is extensive degeneration which frees the developing tongue from the floor of the lingual frenulum.
457
Describe the innervation of the mature tongue in relation to its development.
Anterior 2/3: from Ph1 and 3 so innervation is by V and IX
| Posterior 1/3: from Ph3 and 4 so innervation is by IX and X
458
How do the taste buds develop?
They develop in papillae with the chorda tympani, which passes into Ph1 from Ph2
459
What do the muscles of the tongue derive from?
Myogenic precursors which migrate from the occipital somites, innervated by CNXII
460
Describe the development of the thyroid gland.
The primordium appears in the floor of the pharynx, between the tuberculum impar and cupola.
Bifurcates and descends, remaining connected to the tongue by the thyroglossal duct.
461
What do follicular cells of the thyroid derive from?
Thyroid diverticulum
462
What do parafollicular cells of the thyroid derive from?
Body of the fourth pharyngeal pouch
463
What is a thyroglossal cyst?
A lump in the midline of the neck which is caused by the thyroglossal duct failing to lose patency
464
What is first arch syndrome?
A spectrum of defects in the development of the eyes, ears, mandible, and palate.
It is thought to be due to a failure of colonisation of the first arch with neural crest cells.
465
What is Treacher-Collins syndrome?
Hypoplasia of the mandible and facial bones
| An inherited, autosomal dominant condition
466
What is Di-George Syndrome?
Congenital thymic aplasia and absence of the parathyroid glands due to abnormal development of the neural crest.
Due to a deletion on chromosome 22
- Cardiac abnormality
- Abnormal facies
- Thymic aplasia
- Cleft palate
- Hypocalcaemia/hypoparathyroidism
467
What is CHARGE syndrome?
Colombia, heart defects, choanal atresia, growth and developmental retardation, genital hypoplasia, and ear defects.
Caused by a chromatin remodeller protein defect which is essential for multipotent neural crest cells.
468
What are the borders of the nasopharynx?
Skull base
Nasopharyngeal tonsil and C1
Soft palate
Posterior choanae
469
What are the contents of the nasopharynx?
Nasopharyngeal tonsil
| Eustachian tube orifice
470
What are the borders of the oropharynx?
Soft palate
C2/3
Tongue
Oral cavity
471
What are the contents of the oropharynx?
Palatine tonsils
| Anterior and posterior tonsillar pillars
472
What epithelium lines the nasopharynx?
Ciliated pseudostratified columnar epithelium
| 60% stratified squamous
473
What is the epithelia of the oropharynx?
Stratified squamous
474
What are the boundaries of the laryngopharynx?
Epiglottis
C4-6
Inferior cricoid cartilage
Larynx
475
What epithelia lines the laryngopharynx?
Stratified squamous
476
Describe the anterior tonsillar arch
It fuses with the lateral wall of the tongue
| Contains the palatoglossal muscle
477
Describe the posterior tonsillar arch
Blends with the wall of the pharynx
| Contains the palatopharyngeal muscle
478
What artery supplies the palatine tonsils?
Facial artery
479
What vein drains the palatine tonsils?
Pharyngeal plexus
480
What deep lymph node drains the palatine tonsils?
Jugulodigastric node
481
What are the pharyngeal muscles?
Superior constrictor
Middle constrictor
Inferior constrictor
482
Describe the structure of the pharyngeal muscles
Overlap
Open anteriorly
Attached posteriorly by the median raphe
483
Describe the process of swallowing
1. Bolus of food formed in the mouth
2. Pass to the anterior tonsillar arch where it triggers the pharyngeal phase
3. Soft palate rises to prevent nasal regurgitation
4. The epiglottis falls down so food is funnelled into the oesophagus
5. Pharyngeal constrictors contract and the cricopharyngeus relaxes.
484
What arteries supply the pharynx?
Branches of the external carotid.
Superior thyroid, ascending pharyngeal, ascending/descending palatine, lingual, facial, maxillary
485
What is the venous drainage of the pharynx?
Pharyngeal venous plexus
486
What nerves give motor supply to the pharynx?
VII
IX
X
XII
487
Which nerves give sensory supply to the pharynx?
V2
IX
XII
488
What spinal level is the hard palate at?
C1
489
What spinal level is the mandible at?
C2
490
What spinal level is the hyoid bone at?
C3
491
What spinal level is the thyroid cartilage at?
C4/5
492
What spinal level is the cricoid cartilage at?
C6
493
Describe the symptoms of enlarged adenoids.
Mouth breathing
Hyponasal speech
Difficulty feeding
Snoring and sleep apnoea
494
What are some complications of enlarged adenoids in children?
Chronic otitis media with effusion
| Recurrent acute otitis media
495
When would you consider a tonsillectomy?
Recurrent tonsillitis (5/yr for at least 2 years)
Previous peritonsillar abscess
Suspected cancer
OSA syndrome
496
What is a pharyngeal pouch?
Posterior herniation of the pharyngeal mucosa which occurs through Killian's dehiscence, between the inferior constrictor and cricopharyngeus.
Caused by weakness, incoordination of the pharyngeal phase of swallowing, and cricopharyngeal spasm
