Applied Head & Neck Flashcards

Question

What innervates superior rectus, inferior rectus and medial rectus muscles?

Answer 1

Oculomotor nerve CNIII

Answer 2

Elevation of eyeball

Answer 3

Depression of eyeball

Answer 4

Adducts eyeball

Answer 5

Abducens nerve CNVI

Answer 6

Abducts the eyeball

Answer 7

Trochlear nerve CNIV

Answer 8

Depresses, abducts and medially rotates eyeball

Answer 9

Oculomotor nerve CNIII

Answer 10

Elevates, abducts and laterally rotates eyeball

Answer 11

Temporal fossa in lateral skull Covered by a tough fascia Can be harvested surgically and used to repair a perforated tympanic membrane (myringoplasty)

Answer 12

Inflammation of the facial nerve near its exit from the cranium at the stylomastoid foramen Inflammation causes oedema and compression of the nerve (Bells palsy) in the intracranial facial canal

Answer 13

Inflammation of facial nerve near its exit from the cranium at the stylomastoid foramen (Bells palsy) due to infection Damage to superficial branches of facial nerve in wounds, cuts and in child birth Damage to parotid gland/ parotitis as facial nerve passes through the parotid gland

Answer 14

Pain in auricle of ear, external acoustic meatus, temporal region and TMJ

Answer 15

As the artery winds around the inferior border of the mandible

Answer 16

As the facial artery has many anastamoses with other arteries of the face

Answer 17

Suprahyoid and infrahyoids | In relation to the hyoid bone

Answer 18

Elevates the hyoid bone - initiating swallowing

Answer 19

Stylohyoid Digastric Mylohyoid Geniohyoid

Answer 20

Facial nerve CNVII

Answer 21

Anterior belly- Trigeminal nerve CNV | Posterior belly- Facial nerve CNVII

Answer 22

Trigeminal nerve CNV

Answer 23

C1 roots that run with the hypoglossal nerve

Answer 24

Depresses the hyoid bone (or thyroid cartilage- sternothyroid)

Answer 25

Sternohyoid Sternothyroid Omohyoid Thyrohyoid

Answer 26

Anterior rami of C1-C3 (ansa cervicalis branch)

Answer 27

Anterior rami of C1-C3 (ansa cervicalis branch)

Answer 28

Anterior rami of C1-C3 (ansa cervicalis branch)

Answer 29

Anterior ramis of C1 (with hypoglossal nerve)

Answer 30

Superficial cervical fascia | Deep cervical fascia

Answer 31

Skin and subcutaneous fat | Containing: cutaneous nerves, blood/lymphatic vessels, superficial lymph nodes, fat, platysma

Answer 32

Investing layer of fascia Prevertebral fascia Pretracheal fascia Carotid sheath (comprised of all three fascia above)

Answer 33

Trapezius SCM Submandibular and parotid salivary glands

Answer 34

Vertebra (base of skull to T2/3) | Muscles surrounding the vertebra

Answer 35

Visceral part- Thyroid, oesophagus and trachea | Muscular part- muscles surrounding the visceral part

Answer 36

Common carotid artery Internal jugular vein Vagus nerve Deep cervical lymph nodes

Answer 37

Potential space between the pretracheal fascia and alar fascia Manifests in presence of retropharyngeal abscesses Extends down into mediastinum but not as low as prevertebral/ danger space- potential route of spread of infection to mediastinum

Answer 38

Potential space between the alar fascia and the prevertebral fascia Extends down into mediastinum lower than retropharyngeal space- potential route of spread of infection to mediastinum

Answer 39

Medial - imaginary Sagittal line down the midline of the body Lateral - medial/ anterior border of SCM Superior - inferior border of mandible

Answer 40

Medial/ anterior- lateral/ posterior border of SCM Lateral/posterior- anterior border of trapezius Inferior- middle 1/3 of clavicle

Answer 41

Submandibular Su mental Carotid Muscular (omotracheal)

Answer 42

Superior- Inferior mandible Medial- Omohyoid Lateral- Posterior belly of digastric muscle

Answer 43

Submandibular gland Submandibular lymph nodes Hypoglossal and mylohyoid nerves Parts of facial artery and vein

Answer 44

Medial- midline of neck Lateral- omohyoid Inferior- Posterior belly of digastric muscle

Answer 45

Submental lymph nodes | Small veins which unite to form anterior jugular vein

Answer 46

Superior- posterior belly of digastric muscle Medial- omohyoid Lateral- SCM

Answer 47

``` Carotid sheath (CCA- bifurcation, IJV, deep cervical lymph nodes and vagus nerve) Thyroid Larynx Pharynx Hypoglossal nerve Spinal accessory nerve ```

Answer 48

Medial- posterior belly of digastric muscle Lateral- omohyoid Inferior- SCM

Answer 49

Sternohyoid Sternothyroid Thyroid Parathyroid

Answer 50

Occipital | Subclavian/ omoclavicular

Answer 51

``` Spinal accessory nerve Trunks of brachial plexus Parts of EJV Posterior branches of cervical plexus Cervicodorsal trunk Cervical lymph nodes ```

Answer 52

Third part of subclavian artery Part if subclavian vein Suprascapular artery Supraclavicular lymph nodes

Answer 53

Made from 22 discrete bones Bones joined by fibrous joints- sutures Trilaminar - inner and outer compact bone, with middle layer of spongy bone - diploe

Answer 54

Spongy bone layer found in the middle of the trilaminar skull bone helps reduce the weight of the cranium- contains lots of bone marrow

Answer 55

Encloses and protects - brain and special sense organs (eyes, ears, vestibular, taste, olfaction) Creates a specialised environment - in which the brain thrives- cranial cavity Acts as a site of attachment of muscles and meninges (periosteal layer of dura mater)

Answer 56

Facial bones - supports the soft tissues of the face and determine facial appearance

Answer 57

Superior aspect of the skull- encloses and protects the brain, meninges and cerebral Vasculature

Answer 58

Connective tissue of the body- undifferentiated tissues of mesenchymal origin It has many functions - enveloping all organs - provides lining to organs - separates tissues of organs - provides slipperiness between tissues allowing them to move over one another

Answer 59

``` Frontal Occipital 2 Parietal 2 Sphenoid 2 Ethmoid 2 Temporal ```

Answer 60

``` 2 Zygomatic 2 Lacrimal 2 Nasal Inferior nasal conchae Palatine 2 Maxilla Vomer Mandible ```

Answer 61

Lower lateral walls of the skull Contains middle and inner portions of ear and is crossed by majority of the cranial nerves Lower part articulates with mandible at TMJ Comprised of 5 parts

Answer 62

``` Squamous Zygomatic process Tympanic Petromastoid Styloid process ```

Answer 63

Largest part, flat plate like superiorly located Outer facing surface is convex --> temporal fossa Lower part is the site of origin of the Temporalis muscle Articulates with sphenoid bone anteriorly and parietal bone laterally

Answer 64

Lower part of the squamous part of the temporal bone Projects anteriorly - articulating w/ temporal process of zygomatic bone -forms the zygomatic arch which is palpable as cheekbones One of the processes attachments to the temporal bone forms the articular tubercle - anterior boundary of mandibular fossa, part of TMJ Masseter muscles attaches some fibres to its lateral surface

Answer 65

Inferior to the squamous part Anterior to Petromastoid part Surrounds external auditory opening - leads to external auditory meatus of the external ear

Answer 66

Posterior most part Can be split into mastoid and petrous parts On lateral view- only mastoid part is visible MASTOID Mastoid process - inferior projection of bone palpable behind the ear/ SCM attachment Mastoid air cells- hollowed out area within the temporal bone; act as a reservoir of air - equalising pressure within the middle ear in case of auditory tube dysfunction PETROUS Pyramidal shape, base of temporal bone, contains inner ear

Answer 67

Located underneath opening to the auditory meatus | Attachment point for muscles and ligaments - e.g. Stylomandibular ligament of TMJ

Answer 68

Mastoid air cells can become damaged and full of pus as middle ear infections can spread to the mastoid air cells and replicate This can thus spread to the mastoid process, middle cranial fossa and meninges causing meningitis Pus must be drained from the air cells - be careful not to damage the facial nerve

Answer 69

Coronal suture Sagittal suture Lambdoid suture

Answer 70

Frontal / Bregma fontanelle | Occipital / Lambda fontanelle

Answer 71

Blunt force | Penetrating trauma

Answer 72

Visible injuries and bleeding

Answer 73

Clear fluid draining from ears and nose (CSF), poor balance, confusion, slurred speech, stiff neck

Answer 74

Pterion Anterior cranial fossa Middle cranial fossa Posterior cranial fossa

Answer 75

H shaped junction between the temporal, parietal, frontal and sphenoid bones which forms the thinnest part of the skull

Answer 76

Depression of the skull formed by frontal, ethmoid and sphenoid bones

Answer 77

Depression formed by sphenoid, temporal and parietal bones

Answer 78

Depression formed by squamous and mastoid temporal bone and occipital bone

Answer 79

Maxillofacial fracture/ Le Forts fracture - due to trauma with large amounts of force, affects maxilla bones Profuse bleeding, swelling, deformity, anaesthesia of skin, fracture of nasal bones

Answer 80

Caused by a very strong blunt trauma Varied presentation - ear related disorders - vertigo or hearing loss Damage to facial nerve (as it travels throughout he temporal bone) - paralysis of muscles of facial expression Bruising around mastoid process Bleeding from ear

Answer 81

Simple- break in bone / no break in skin Linear- thin line with out splintering, depression or distortion of bone Depressed- bone pushed towards brain Compound- break in/ loss of skin, splintering of bone --> brain injury and bleeding

Answer 82

Affects the base of the skull Presents with bruising behind the ears - Battle's sign (mastoid ecchymosis) Presents with bruising around eyes - Raccoons eyes

Answer 83

Fracture along the suture line - widening of the suture | Most often in children

Answer 84

C3- C6 Triangular vertebral foramen Bifid spinous processes Transverse foramina - give passage to vertebral artery, vein and sympathetic nerves

Answer 85

C1, C2 and C7

Answer 86

Atlas No vertebral body No spinous process Articular facet anteriorly articulates with dens of the axis Lateral masses on either side of vertebral arch- attachment for transverse ligament of atlas Posterior arch- groove for vertebral artery and C1 spinal nerve

Answer 87

Axis Dens/ Odontoid process- extends superiorly from anterior portion of vertebra Articulates with articular facet of atlas Medial atlanto-axial joint- rotation of head independent of torso

Answer 88

Lateral atlanto-axial joint Medial atlanto-axial joint Atlanto-occipital joint

Answer 89

Joint of vertebral bodies | Vertebral arch joints

Answer 90

Nuchae ligament - C7 upwards, continuation of supraspinous ligaments, attaches tips of spinous processes Transverse ligament of the atlas - attaches lateral masses of atlas- anchors dens in place

Answer 91

``` Interspinous ligament (adjacent spinous processes) Anterior and posterior longitudinal ligaments (anterior and posterior vertebral bodies) Ligamentum flavum (adjacent laminae) ```

Answer 92

Extend from above respective vertebrae through intervertebral foramen created by joints at articular processes C7 is an exception- has spinal nerves extending above (C7) and below (C8) So there are 8 cervical nerves with 7 cervical vertebra

Answer 93

Prominent spinous process, not bifid (easily palpable) Large transverse process Vertebral artery runs around vertebra instead of passing through transverse foramen

Answer 94

Vertical fall on extended neck (diving into shallow water) Compresses lateral masses of atlas between occipital condyles and atlas - fractures half of anterior or posterior arches Transverse ligament of atlas may also be damaged Unlikely C1 damage- as the vertebral foramen is large - but damage down the column is likely

Answer 95

Anterior longitudinal ligament damaged in minor injury Any cervical vertebrae can be fractures in severe injury Unlikely spinal nerve damage as vertebral foramen is large Worst case- subluxation/ dislocation of C2/C3 or C6/C7 Causes quadriplegia and death- affects phrenic nerve which supplies diaphragm- important in breathing

Answer 96

Sudden deceleration Fracture of pars interarticularis (bony column between superior and inferior articular facets of axis (C2)) Lethal injury - fracture fragments/ force --> rupture spinal cord - deep unconsciousness, resp and cardiac failure and death

Answer 97

In traffic collisions or falls High risk of avascular necrosis (isolation of distal fragment from any blood supply) Long healing time- may have spinal cord involvement (low risk)

Answer 98

Adjacent fascial compartments of the neck are normally so close to one another as to be adherent And normally there are no anatomical spaces between tissues Blood from perforated vessels or pus from infections can collect in these potential spaces making them into actual spaces

Answer 99

Allows us to understand how infections or metastases may spread in the neck from one site to another

Answer 100

In forceps delivery- compression damage of SCM or being pulled in a difficult birth

Answer 101

Head will be slanted and rotated towards side of affected muscle - due to SCM being in a spasm This is called true torticollis

Answer 102

Head rotated and tilted to normal side, due to unopposed action of functioning SCM muscle

Answer 103

Rotation of the neck and tilting to the side

Answer 104

Spinal accessory nerve CNXI

Answer 105

Facial nerve CNVII

Answer 106

Spinal accessory nerve CNVII

Answer 107

Mastoid air cells don't develop until the 2nd/3rd years- small mastoid process leaves facial nerve exposed as it leaves for the stylomastoid foramen- superficially placed nerve can be damaged in forceps delivery Children with significantly smaller mastoid cells are more often susceptible to complications of glue ear

Answer 108

Maxillary sinus

Answer 109

Rapid irregular and exaggerated reabsorption and replacement of bone, causing thickening, swelling and increased vascularity often with severe pain When skull is involved, it slowly enlarges Mandible and maxilla enlarge, maxilla at a faster rate so that adjustment of dentures occurs Teeth may become displaced and become fused with bone; oral surgery may become complicated by sever haemorrhage

Answer 110

Fracture may easily involve the inferior alveolar nerve that lies within the bone. It's terminal branches exit the mandible via the mental foramen where they supply the mucous membrane of the lower lip and chin. The numbness is reminiscent of what happens following an inferior alveolar nerve block while undergoing dental treatment.

Answer 111

Retropharyngeal space is anterior to the alar fascia and ends more superiorly than the prevertebral space The prevertebral space is posterior to the alar fascia and extends right the way down to the mediastinum

Answer 112

Carotid sinus massage- stimulates the spinal accessory nerve which has a reflex arc to the vagus nerve stimulating that- only on one side otherwise person may faint Cold water- dunk kids head in an ice bucket stimulating the vagus nerve Valsalver manoeuvre reflex-expirate against a closed glottis- blow into a syringe; increases intrathoracic pressure- increases blood flow to the area- stretches walls and baroreceptors and stimulates vagus nerve

Answer 113

Trauma and difficult birth Tumour Parotitis Infection in general- Bell's palsy

Answer 114

Extradural haematoma Subdural haematoma Subarachnoid haematoma

Answer 115

Right common carotid artery | Subclavian artery

Answer 116

Thyrocervical trunk Vertebral arteries Internal thoracic artery

Answer 117

Axillary artery

Answer 118

Suprascapular artery Ascending cervical artery Transverse cervical artery Inferior thyroid artery

Answer 119

At level of the sternoclavicular joint

Answer 120

Ascends laterally to the oesophagus and trachea and gives off NO branches in the neck

Answer 121

Superior margin of thyroid cartilage (C4) | Carotid triangle

Answer 122

Bifurcation of the CCA into ICA and ECA CCA and ICA are slightly dilated in this region- carotid sinus, has baroreceptors which detect changes in blood pressure here- carotid sinus massage Outside the arteries in the region, there are peripheral chemoreceptors which detect changes in pO2 of the blood

Answer 123

Arise from the subclavian arteries - medial to anterior scalene muscles Ascend up posterior neck through transverse foramina in cervical vertebra Enter the cranial cavity via foramen magnum / carotid canal Give rise to basilar arteries which supply the brain Give off no branches to the neck or extracranial structures)

Answer 124

``` Posterior auricular artery Lingual artery Occipital artery Ascending pharyngeal artery Facial artery Superior thyroid artery ```

Answer 125

Superficial temporal artery | Maxillary artery

Answer 126

Travels up the neck posterior to the mandible and anterior to the lobule of the ear

Answer 127

Parotid gland

Answer 128

Brain, eyes and forehead within the cranial cavity | Does not supply any structures in the neck

Answer 129

Via carotid canal in the petrous part of the temporal bone

Answer 130

ECA via PLOAFS

Answer 131

Internal carotid artery

Answer 132

Superorbital artery | Supertrochlear artery

Answer 133

Subclavian artery via thyrocervical trunk and 3 of its branches

Answer 134

Branches of ECA - posterior auricular, occipital, superficial temporal) Branches of ICA - superorbital and supertrochlear

Answer 135

``` Skin Connective tissue Aponeurosis Loos connective tissue Periosteum ```

Answer 136

Inferior thyroid artery from TCT | Superior thyroid from ECA

Answer 137

Inferior thyroid artery gives rise to the ascending cervical artery which supplies them

Answer 138

Transverse cervical artery from TCT

Answer 139

Suprascapular artery

Answer 140

In some people baroreceptors are hypersensitive to touch and stretch So when an external pressure is applied on the carotid sinus--> slowing HR and lowering BP occurs Brain therefore becomes under perfused And syncope can result Therefore it is not advised to check pulses at the carotid triangle

Answer 141

ECA - maxillary artery - middle meningeal artery

Answer 142

Fracture at the Pterion (weakest point)- completely lacerated MMA Blood collects between the dura mater and the skull Dangerous increase in intracranial pressure - extradural haematoma Symptoms of nausea, vomiting, seizures, bradycardia, limb weakness Treated by diuretics (minor) and draining burr holes (major)

Answer 143

Walls of arteries are tightly and closely bound to the undying connective tissue of the scalp- preventing them from constricting to limit blood loss following injury or laceration Numerous anastamoses formed by arteries produce a very densely vascularised area Deep lacerations can involve epicranial aponeurosis - worsened by opposing pulls of occipital and frontalis muscle

Answer 144

Swelling and bifurcation of CCA produces turbulent blood flow in this region Increases the risk of atheroma (ICA more susceptible than others) Mild- headache, dizziness, muscular weakness Severe- stroke/ cerebral Ischaemia Doppler study- can assess the severity of the thickening Severe cases- artery opened and atheroma removed - CAROTID ENDATERECTOMY

Answer 145

Gain access to the cranial cavity - bone and scalp flax reflected inferiorly to preserve blood supply

Answer 146

Face drained by superficial temporal and maxillary veins which drain into posterior auricular vein and retromandibular vein Posterior auricular vein and retromandibular veins unite to form EJV Receives tributary veins- posterior external jugular, transverse cervical and suprascapular veins Sigmoid sinus continues as IJV Receives tributary veins- facial, lingual, occipital, superior, middle thyroid veins draining blood from face, trachea, thyroid, oesophagus, larynx and neck muscles

Answer 147

EJV is a continuation to posterior auricular vein and retromandibular vein EJV descends down the neck within the superficial fascia Runs anterior to SCM crossing it in an oblique, posterior and inferior direction At the root of the neck the vein passes under clavicle Vein terminates by draining into the subclavian vein

Answer 148

Begins in cranial cavity as a continuation of sigmoid sinus The initial part is dilated (superior bulb) Vein exits the skull via the jugular foramen and descends within the carotid sheath, deep to SCM and lateral to CCA At the bottom of the neck, posterior to sternal end of the clavicle - IJV combines with SCV to form the brachiocephalic vein End part is dilated (inferior bulb) - has a valve that stops the back flow of blood

Answer 149

Anterior jugular vein- drains anterior neck, communicates with jugular venous arch and descends down the midline of the neck into the subclavian artery

Answer 150

Via dural venous sinuses which drain into the IJV

Answer 151

Spaces between periosteal and meningeal layers of the dura mater - lined by endothelial cells They collect blood from veins that drain the brain and bony skull And drain into IJV

Answer 152

Severance of the EJV EJV has a superficial course down the neck which makes it vulnerable to damage In a knife slash- lumen is opened and held open - due to a thick layer of investing fascia Air can be drawn into the veins producing cyanosis and stopping blood flow through the right atrium It can be a medical emergency managed by application of pressure to the wound, stopping bleeding and entry of air Air embolism

Answer 153

IJV can be observed for pulsations - estimates RA pressure When the heart contracts pressure wave passes upwards which can be observed No valves in the brachiocephalic trunk or subclavian vein and so pulsations are fairly accurate indication of RA pressure

Answer 154

Clinically important pair of dural sinuses, located next to the lateral aspect of the body of the sphenoid bone

Answer 155

Sinus receives blood from the superior and inferior opthalmic veins, middle superficial cerebral veins and from the sphenoparietal sinus

Answer 156

ICA Abducens nerve (VI) In wall of sinus- oculomotor nerve (III), trochlear nerve (IV), opthalmic nerve (Vi) and maxillary nerve (Vii)

Answer 157

Nerves are at risk of damage Facial vein is connected to the cavernous sinus via the superior opthalmic vein Facial vein is valveless so blood can reverse direction and flow from facial vein to cavernous sinus - providing a potential route of infection spread

Answer 158

``` Temporal nerve Zygomatic nerve Buccal nerve Mandibular nerve Cervical nerve Posterior auricular nerve ```

Answer 159

Superficial temporal, occipital, posterior auricular, superorbital and supertrochlear veins 1) Drain into angular vein at medial angle of the eye and then into the facial vein OR 2) Drain via the emissary veins into diploid veins of skull into dural venous sinuses (between periosteal and meningeal layers of dura)

Answer 160

Facial and superior opthalmic vein Drain into the cavernous sinus at the medial angle of the eye Deep facial veins which drain into the pterygoid plexus

Answer 161

``` Occipital nodes Posterior auricular nodes Anterior auricular nodes Parotid nodes Facial nodes Deep facial nodes Lingual nodes Retropharyngeal nodes ```

Answer 162

``` Submaxillary nodes Submental nodes Anterior cervical nodes Deep cervical nodes (superior and inferior) Superficial cervical ```

Answer 163

Occipital, posterior auricular, anterior auricular, parotid, deep facial and retropharyngeal nodes drain to the superior deep cervical nodes Then to inferior deep cervical nodes Jugular trunk

Answer 164

Into the submaxillary nodes Then to superior deep cervical nodes Then to inferior deep cervical nodes Jugular trunk

Answer 165

To the Submaxillary nodes Then to the superior deep cervical nodes Then to inferior deep cervical nodes Jugular trunk

Answer 166

Superficial cervical nodes drain to the superior deep cervical nodes Then to inferior deep cervical nodes Jugular trunk

Answer 167

Jugular trunk

Answer 168

Right lymphatic duct And Thoracic duct

Answer 169

Jugulodigastric node or tomsillar node | - found in the angle between the lower body of the mandible and anterior border of SCM

Answer 170

Juguloomohyoid node or lingual node | - found in angle between SCM and clavicle

Answer 171

``` Lymphatic capillary --> Lymphatic vessel --> Lymph node --> Lymphatic vessel --> Lymphatic trunk --> Collecting duct --> Subclavian vein ```

Answer 172

Subclavian vein

Answer 173

Right half of the head, the neck, the trunk of the body and the right upper limb

Answer 174

Left half of the head, the neck, the trunk of the body, the left upper limb and both left and right lower limbs

Answer 175

Spinal nerves & Cranial nerves

Answer 176

Issued from the spinal cord There are 31 pairs Supply: - general motor function to rest of the body - general sensation to rest of the body - autonomic functions to the rest of the body -* NONE HAVE SPECIAL SENSE FUNCTIONS

Answer 177

Embryonic precursors of skin and muscle units Each one eventually differentiates into skin and muscle in the adult Develop in relation to a specific neural level of the embryonic neural tube tissue that will become the adult spinal cord Differentiated skin and muscle units of a dermomyotome will always have a common source of neural supply

Answer 178

Issued from the brain 12 pairs - largely bilaterally symmetrical All axons apart from 2 lie in the PNS - 2 are atypical - they are the brain tracts and not nerves Supply largely the head and neck region - muscles (efferent), viscera (afferent and efferent), general sensation (afferent) and special sense organs (afferent) Exit brain from its inferior surface apart from one Short sections attaching the nerve to the brain are found within the cranium

Answer 179

They are holes in the base of the cranium though which nerves and blood vessels pass Due to them being large- reduce the mass of the cranium, making it lighter; make the skull base physically weak Trauma to the skull often leads to fractures at the base Nerves can be compressed as they pass through the foramina Peripheral nerve diseases and metastases can pass to the brain via the foramina

Answer 180

Olfactory nerve (not a true nerve- it's a brain tract) Sensory Subserves sense of smell Derived from prosencephalon

Answer 181

Using smelling salts (coffee, peppermint, vanilla) can be used to reboot the brain after loss of consciousness Some hallucinations involve sensation of smell without sensory source Smell tested from each nostril separately

Answer 182

Loss of sense of smell

Answer 183

Optic nerve Sensory Subserves sense of vision Derived from diencephalon

Answer 184

Examination - apparatus of eye itself- fundoscopy, visual acuity, colour vision - reflexes of pupils - connection of retina (eye) to visual cortex Assessing visual field defects, early signs of meningitis, tumour of hypothalamus (disturbance of vision)

Answer 185

Oculomotor nerve Mixed nerve- somatic MOTOR (levator palpebrae superioris muscle of upper eyelid and all extra ocular muscles except superior oblique and lateral rectus); autonomic PS (constrictor pupillae of eye); autonomic S (dilator pupillae of eye) Subserves movement of eye Derived from mid brain

Answer 186

Patient asked to look upwards- test elevation of eyelid Patient asked to look at finger as it moves in Gearbox shape (test for adduction, abduction, elevation and depression) Shining light in patients eye- should constrict Shielding light from patients eye- should dilate

Answer 187

Droopy eyelid- seen in patients with damage to CNIII

Answer 188

Eye would be down and out at rest Eye would be drooping Pupil would be dilated

Answer 189

Trochlear nerve Motor Subserves superior oblique muscle only Derived from dorsal aspect of midbrain- pons

Answer 190

Ask patient to look downwards and inwards

Answer 191

Patient would look medially and upwards as they would get double vision upon looking downwards and inwards - diplopia In particular patient would get double vision when going down stairs

Answer 192

Trigeminal nerve Largest cranial nerve in the body Mixed - 3 divisions: - Vi- Opthalmic- Sensory- supplies scalp forehead, dorsum of nose and upper eyelid and sensations of the eye (cornea and conjunctiva) - Vii- Maxillary- Sensory- supplies lower eyelid, cheek, upper lip, mucosa of nasal cavity and paranasal sinuses and lining of palate and toots of upper teeth - Viii- Mandibular- Mixed- Sensory and Motor- skin of temples, cheek, chin, mucosa of inner cheek, anterior 2/3s of tongue and roots of lower teeth muscles of mastication - opening (medial pterygoids and anterior digastric) and closing (Temporalis, masseter and lateral pterygoids) Derived from pons

Answer 193

Responsiveness of skin and forehead- soft and sharp touch | Defective corneal reflex - neither eyelid blinks

Answer 194

Responsiveness of cheek skin to soft and sharp touch (rest of sensory supply not routinely tested)

Answer 195

Responsiveness to skin of cheek side and over the chin General sensation in front of the tongue - lingual nerve Strength of masseter and pterygoids

Answer 196

Abducent nerve Motor Supplies lateral rectus muscle only Derived from medulla pontine junction

Answer 197

Tested with CNIII by asking patient to follow finger making a gearbox shape in the air Patient unable to look outward - squint on looking outward Therefore liable to damage in cases of raised intracranial pressure

Answer 198

Facial nerve Mixed nerve: - Facial nerve - Motor (muscles of facial expression) - Nervus intermedius - Sensory (general sensation of concha of auricle and behind ear and taste in anterior 2/3 via chorda tympanii) - Part of Nervus intermedius and Greater Petrosal Nerve- Autonomic (glands- lacrimal, submandibular, sublingual) (mucous membranes- nasopharynx, paranasal sinuses, hard and soft palate) Derived from medulla pontine junction

Answer 199

Raise eyebrows Shut your eyes as tight as possible I'm going to try and open them, don't let me Puff out cheeks; Don't let me squeeze them Big smile Loss of facial expression Loss of sphincter function Loss of nasolabial fold Loss of taste in anterior 2/3 of tongue on salivation and lacrimation

Answer 200

Bell's palsy- strangulation of nerve in petrous part of temporal bone - loss of muscles of facial expression and altered sensation Facial nerve palsy- strangulation outside cranial cavity - only loss of muscles of facial expression

Answer 201

Vestibulocochlear nerve - vestibular nerve (balance) and cochlear nerve (hearing) Sensory Derived from medulla pontine junction

Answer 202

Simple tests of hearing- whisper something in ear and ask them to repeat it Rinne's test and Weber's test- used to differentiate type of deafness (below) (Cannot isolate cochlear in terms of balance tests as many other parts of the brain contribute to balance such as cerebellum) Loss of balance, vertigo, nausea, nystagmus, impairment of caloric response (don't compare with cerebellar damage- stroke) Deafness: sensorineural (nerve) conductive (blockage)

Answer 203

Glossopharyngeal nerve Mixed: - motor - branchiomotor- stylopharyngeus - visceromotor/ autonomic/ PSNS- (parotid gland) - sensory- visceral sensory (carotid body and sinus), pharynx and middle ear - special sensory- posterior 1/3 of tongue

Answer 204

Swallowing reflex- ask patient to drink some water Gag reflex/ pharyngeal reflex - consists of reflex pharyngeal constriction when back wall of oropharynx is touched by non food substances Loss if taste in posterior 1/3 tongue Lack of salivation (parotid gland)

Answer 205

Vagus nerve Mixed nerve: - motor - intrinsic muscles of larynx and pharynx, muscles of palate, smooth muscle of bronchi and digestive tract, secretomotor- thoracic and abdominal viscera - sensory - external ear, auditory canal and ear drum, pharynx and larynx, visceral sensation- thorax and abdomen Derived from medulla

Answer 206

``` Check phonation, cough Ask them to drink a drink Sing in high pitched voice Inspect soft palate and uvula (any deviation) Gag reflex ``` Right recurrent laryngeal nerve damage - vocal cord on that side slightly adducted - hoarse voice, weak cough and risk of aspiration of fluids Left recurrent laryngeal nerve damage - in bronchial or oesophageal carcinoma/ enlarged mediastinal lymph nodes or aortic arch

Answer 207

Accessory nerve (anatomically has 2 divisions) Combined divisions exit brain via jugular foramen Motor Subserves sternocleidomastoid and trapezius Derived from spinal cord

Answer 208

Shrug shoulders I'm going to push them down resist it Rotate your head and I'm going to push it, resist it Inspect for wasting SCM and trapezius Compare 2 sides Patient will find it difficult to rotate head and shrug shoulder on affected side

Answer 209

Hypoglossal nerve Motor Supplies muscles of tongue Derived from Medulla

Answer 210

Stick tongue out, wiggle it from side to side, inspect tongue for wasting and fasisculation Any deviation? Able to wiggle it? Damage- dysarthria Lower motor neurone lesions - tongue deviates to side of weakness

Answer 211

General somatic afferents (general sensation) General visceral afferents (visceral sensation) General somatic efferents (supply skeletal muscle) General autonomic efferents (autonomic fibres innervating visceral structures)

Answer 212

Those of spinal nerves: General somatic afferents (general sensation) General visceral afferents (visceral sensation) General somatic efferents (supply skeletal muscle) General autonomic efferents (autonomic fibres innervating visceral structures) And Special visceral efferents (muscles derived from branchial arches CNV, VII, IX, X) Special somatic afferents- equilibration, sight and hearing Special visceral afferents- taste

Answer 213

Craniosacral outflow | CNIII,VII, IX, X (only CNS with autonomic supply) and S2,S3 and S4

Answer 214

CNIII - oculomotor CNVII - facial CNIX glossopharyngeal CNX - vagus

Answer 215

Edinger Westphal nucleus

Answer 216

Travels within the motor root of the oculomotor nerve

Answer 217

Ciliary ganglion

Answer 218

Travels via short ciliary nerves to target: | - Spinchter pupillae and ciliary muscles

Answer 219

Superior salivatory nucleus

Answer 220

Travels within the greater petrosal nerve and nerve to pterygoid canal Or Travels within chorda tympanii a branch of facial nerve

Answer 221

Ptergyopalantine ganglion Or Submandibular ganglion

Answer 222

Hitchhikes on branches of the maxillary nerve to lacrimal glands, nasopharynx, palate and nasal cavity Or Fibres travel directly to target organs - submandibular and sublingual glands

Answer 223

Inferior salivatory nucleus

Answer 224

Travels within the lesser petrosal nerve

Answer 225

Otic ganglion

Answer 226

Hitchhikes on the auriculotemporal nerve to the parotid gland

Answer 227

Dorsal Vagal motor nucleus

Answer 228

Travels within the vagus nerve

Answer 229

Many- located within the target organs

Answer 230

Ganglion is located on target organs (there are no postganglionic nerve fibres) Smooth muscles of trachea, bronchi and digestive tract

Answer 231

Ciliary ganglion- sympathetic nerves for internal carotid plexus and sensory fibres from nasociliary nerve Pterygopalantine ganglion- sympathetic nerves for internal carotid plexus and sensory fibres from maxillary nerve Submandibular ganglion- sympathetic branches from facial artery plexus Otic ganglion- sympathetic branches from superior cervical chain

Answer 232

Ciliary Pterygopalantine Submandibular Otic

Answer 233

Superior cervical Middle cervical Inferior cervical

Answer 234

As a general simplification axons of most preganglionic neurones terminate immediately in the para/prevertebral chain of ganglia (sympathetic trunk) Chain of ganglia extends from base of the skull to coccyx Fusion of ganglia reduces their number: - 2/3 cervical (8 cervical neural levels) - 11 thoracic (12 thoracic neural levels) - 4 lumbar (5 lumbar neural levels) - 4 sacral (5 sacral neural levels) Sympathetic ganglia give rise to 2 sets of branches with 2 destinations - somatic: travel alongside segmental nerves - visceral: ganglionated trunks

Answer 235

Paravertebral- lie alongside the vertebral column bilaterally Prevertebral- lie anteriorly to vertebral bodies in relation to carotids and anterior to AA (SMA and IMA)

Answer 236

Anterior to C1-C4

Answer 237

Common, external and internal carotid arteries

Answer 238

``` Eyeballs Face Nasal gland Pharynx Glands in the palate and nasal cavity Salivatory gland Lacrimal gland Sweat glands Pineal gland Dilator pupillae Superior tarsal muscle Carotid body Heart Artery smooth muscle ```

Answer 239

Inferior thyroid artery

Answer 240

``` Larynx Trachea Pharynx Upper oesophagus Heart Artery smooth muscle ```

Answer 241

Vertebral and subclavian arteries

Answer 242

Heart | Artery smooth muscle

Answer 243

No- they (superior middle and inferior cervical ganglia) are displaced upper 3 thoracic ganglia from the thoracic sympathetic trunk

Answer 244

Mandible and temporal bone

Answer 245

Anterior and roughly at level of tragus of the ear

Answer 246

Superior (cranial) articular surface (on under surface of squamous part of temporal bone) - -> has 2 articular sites - mandibular fossa of temporal bone (medial and concave) - articular tubercle of temporal bone (anterior and convex) (aka. eminentia articularis) Inferior (mandible) - condyle of the mandible has a rounded superior edge and ellipsoid circumference with its major axis posteromedial

Answer 247

Fibrocartilage (not hyaline)

Answer 248

Aka meniscus Dense fibrous connective tissue Has same position as fibrocartilage lining the articular surfaces Intervenes between superior and inferior articular surfaces of bones of TMJ - upper surface: concave-convex to fit both the mandibular fossa and articular tubercle - under surface: concave for reception of condyle of the mandible Thicker at its periphery where it attaches to its articular capsule Can recoil or stretch a little with movement Thinner centrally- sometimes almost perforated Function is to make the articular surfaces congruent (as superior and inferior articular surfaces are morphologically incongruent) and to create 2 cavities within the TMJ- allow for particular movements

Answer 249

Fibrous capsule- very strong but thin to permit movements of the joint Capsular attachments- superior- circumference of mandibular fossa and articular tubercle // inferior- neck of condyle of mandible Strengthened by extracapsular ligaments

Answer 250

Temporomandibular ligament - laterally placed - strongest ligament of TMJ - deep fibres blend with capsule - lower border of zygoma to posterior border of neck and ramus of mandible - it tightens the head in retrusion (closing and pulling the jaw backwards) 2 medial ligaments / accessory ligaments that strengthen the joint capsule but a re relatively less significant - sphenomandibular ligament (remains constant in length and tension for all positions of mandible) - stylomandibular ligament (extends from near apex of styloid process to posterior border of ramus of mandible nears it's angle; thickening of deep parotid fascia, separates parotid gland from submandibular gland)

Answer 251

It's always the mandible that moves in relation to the cranium in order for movements to occur Movements occur by displacement in the: - superior joint cavity - gliding, translation, protusion, retrusion - inferior joint cavity - hinge, rotation Opening movements- simple movement - 1. Condyles pulled forward - protrusion / gliding - lateral pterygoids (x3), upper joint cavity 2. Chin pulled down and back - hinge - digastric muscles- not a prime mover in jaw opening, lower joint cavity Closing movements- 1. Mandible moves backwards - posterior fibres of Temporalis muscle pull the mandible backwards, superior joint cavity 2. Mandible elevates - remainder of Temporalis muscle, masseter muscles (all it's layers), medial pterygoid muscles, inferior joint cavity

Answer 252

Bruxism- grinding teeth when asleep Temporomandibular pain dysfunction disorders: muscular pain Malocclusion syndromes: muscular pain

Answer 253

Irregularly shaped cavity of anatomical and clinical importance - lies below the middle cranial fossa, medial and deep to the zygomatic arch and behind the maxilla - communicates with the Temporal fossa through the interval between the zygomatic arch and cranial bones

Answer 254

Anterior border- infra temporal surface of maxilla and descending ridge of its zygomatic process Posterior border- articular tubercle of temporal bone and spina angularis of sphenoid Superior border- infratemporal surface of greater wing of sphenoid Inferior border- alveolar border of maxilla Medial border- lateral pterygoid muscle

Answer 255

``` Muscles Nerves Arteries Veins Foramina Canals Fissures ```

Answer 256

Lower part of medial pterygoid muscle Lower part of lateral pterygoid muscle Lower part of Temporalis muscle

Answer 257

Mandibular nerve and most of its branches (auriculotemporal, inferior alveolar, lingual, buccal, chorda tympanii) and otic ganglion

Answer 258

Main deep artery - maxillary artery - middle meningeal artery- anterior branch is clinically significant (Pterion fracture) Main superficial artery - superficial temporal artery

Answer 259

Maxillary veins, middle meningeal vein, pterygoid venous plexus

Answer 260

``` Foramen ovale (mandibular division of 5th nerve) Foramen spinosum (middle meningeal artery) ```

Answer 261

Alveolar canal

Answer 262

Inferior orbital fissure and pterygomaxillary fissure

Answer 263

Pathologies within this region can evolve without detection up until it is too late - tumour growth- likely to be advanced when symptomatic Mandibular nerve block- anaesthetic injected adjacent to nerve as it enters infratemporal fossa- nerves affected are inferior alveolar, lingual, buccal and auriculotemporal nerves Inferior alveolar nerve block- during dental treatment, anaesthetic is injected around the mandibular foramen on medial side of mandible; all mandibular teeth anaethetised to medial side and skin and MM of lower lip also anaesthetised (supplied by mental branch)

Answer 264

Angle of the eyeball along the optic nerve

Answer 265

Cross over point for some nerves - above which L-->L and R-->R - below which L-->R and R-->L Therefore a stroke/ high motor nerve lesion on one side will result in sensation in the forehead on the expected side, but rest of the body will be affected on the other side

Answer 266

Frontal and sphenoid bone

Answer 267

Maxilla, zygomatic (and palatine) bones

Answer 268

Ethmoid, maxilla and lacrimal bones

Answer 269

Zygomatic and sphenoid bone

Answer 270

Medial and inferior (floor) walls because they are the ethmoid and maxilla bones which both contain air filled sinus spaces

Answer 271

``` Fossa for the lacrimal gland Fossa for lacrimal sac to nasolacrimal duct Superior orbital fissure Inferior orbital canal Optic canal ```

Answer 272

Lacrimal gland - where tears are produced, then move across the eye in a downwards, medial direction

Answer 273

Lacrimal sac, where tears pool forming a lacrimal lake, before leaving the eye at the medial canthus

Answer 274

``` Large- Lacrimal nerve French- Frontal nerve Teenagers- Trochlear nerve Sit- Superior branch of oculomotor nerve Numb- Nasociliary nerve In- Inferior branch of oculomotor nerve Anticipation- Abducent nerve Of- Opthalmic veins Sweets- Sympathetic nerve ```

Answer 275

Infra orbital nerve

Answer 276

``` Optic nerve (CNII) Opthalmic artery ```

Answer 277

1.2m axons from retinal cells

Answer 278

Coverings of the brain- pia mater, arachnoid mater and dura mater are continuous with the brain Infection can spread in the back of the eye socket via the optic nerve Raise ICP, venous engorgement, Papilloedema (optic nerve and disk pushed forward- swelling on the optic disk)

Answer 279

Usually at bony sutures - medial (ethmoid sinuses) and inferior (maxillary sinus) walls are weakest and most likely to fracture BLOW OUT FRACTURE- displaces the wall and contents of the orbit - muscle entrapment, double vision, infection, enopthalmos, infra orbital bleeding, pulsatile exopthalmos (eye beats with HR)

Answer 280

Medial, lateral, superior and inferior recti | Superior and inferior oblique

Answer 281

Attach to the eye socket - tendons go through the annular ring

Answer 282

Elevation of eye- eye looks up | Intorsion- superomedially

Answer 283

Depression of eye- eye looks down | Extorsion- inferomedially

Answer 284

Abduction of eye- eye looks laterally

Answer 285

Adduction of eye- eye looks medially

Answer 286

1) Intorsion - inferolaterally 2) Depression 3) Abduction When the eye is turned toward the nose, the superior oblique muscle is responsible for depressing the eye When looking directly forward superior oblique assists other muscles (SR, IO, IR) in vertical movement

Answer 287

1) Extorsion- superolaterally 2) Elevation 3) Abduction When the eye is turned toward the nose, the inferior oblique muscle is responsible for elevating the eye When looking directly forward inferior oblique assists other muscles (SR, SO, IR) in vertical movement

Answer 288

Lateral rectus

Answer 289

Superior oblique

Answer 290

Superior rectus

Answer 291

Inferior rectus Medial rectus Inferior oblique

Answer 292

ICA- opthalmic arteries | ECA- infra orbital artery

Answer 293

Central artery of the retina - terminal branches- supra trochlear and supraorbital artery Lacrimal artery Posterior ciliary artery Muscular branches to extraocular muscles Other separate branches to ethmoidal and frontal sinuses, eyelids, forehead and scalp etc.

Answer 294

Superior opthalmic vein- drains from inner angle of the orbit to the superior orbital fissure Inferior opthalmic vein- drains from the venous plexus on the floor and medial wall of the orbit to the superior or inferior orbital fissure Central vein of the retina either drains into the superior or inferior opthalmic veins or directly into the cavernous sinus Inferior and superior orbital fissure drain into the cavernous sinus

Answer 295

Slow, painless loss of vision

Answer 296

Danger triangle around nose- communication between facial vein to the cavernous sinus via the opthalmic veins - cavernous sinus thrombosis, meningitis or abscess

Answer 297

Protecting from light and injury | Prevent corneal drying, through controlled spread of lacrimal fluid (tears)

Answer 298

Opening = palpebral fissure - left and right not often equal in size

Answer 299

Part of the conjunctiva which covers the outer surface of the eye and lines the eyelids

Answer 300

Covers the eyeball over the anterior sclera

Answer 301

Forms junction between the palpebral and bulbar conjunctiva

Answer 302

``` Skin Areolar tissue Fibres of orbicularis oculi Levator palpebrae superioris Superior tarsus- dense CT strengthening the skeleton (inferior lower lid) Tarsal (Meibomian) glands- secrete oil- dry eye Ciliary glands (sebaceous) - stye Palpebral conjunctiva ```

Answer 303

Involuntary blinking of eyelids stimulated by stimulation of cornea Triggers- corneal drying, corneal irritation/contact (perceived as pain), expectation of contact Controlled by CNVi - opthalmic division of Trigeminal nerve & CNVII - facial nerve

Answer 304

Levator palpabrae superioris | Superior tarsal muscles (Muller's muscle)

Answer 305

Orbicularis oculi

Answer 306

Paralysis when oculomotor nerve CNIII becomes DAMAGED - drooping of upper eyelid- ptosis - vision compromised - residual opening of eye due to presence of superior tarsal muscle (smooth muscles)

Answer 307

Paralysis (smooth muscle of upper eyelids) Minor drooping of upper eyelid - partial ptosis Vision usually okay Eye opening okay due to levator palpabrae superioris Horner's syndrome- paralysis of superior tarsal muscles with pupil constriction

Answer 308

Paralysis of superior tarsal muscles with pupil constriction

Answer 309

``` Paralysis (facial nerve CNVII DAMAGE) Failure to close eyes- Bell's palsy Loss of blink and corneal reflex Dry eyes- need eye drops Infection likely ```

Answer 310

Crying Lacrimal fluid/ tears are produced in the lacrimal gland in the fossa for the lacrimal gland under the influence of the PSNS fibres of the facial nerve CNVII Eyes close lateral to medial, pushing tears across the anterior surface of the eye, and towards the medial canthus, where the fluid collects in the lacrimal sac/ lake in the fossa for the lacrimal sac Sensory supply via lacrimal branch of the opthalmic division of the Trigeminal nerve (CNVi) to the eyelid and conjunctiva

Answer 311

Outer/ external ear Middle ear Inner/ internal ear

Answer 312

Auricle/ pinna | External acoustic meatus

Answer 313

External, lateral, paired structure | All cartilaginous except lobe

Answer 314

``` Helix Anti helix- superoposterior and inferoanterior crus Triangular fossa Concha Tragus Antitragus Lobe ```

Answer 315

Cutaneous innervation - greater auricular, lesser occipital and branches of the facial and vagus nerves

Answer 316

Posterior auricular, superficial temporal and occipital arteries and veins

Answer 317

Auricular branch of the vagus nerve may be stimulated causing a cough too

Answer 318

Blood collects between cartilage and overlying perichondrium Usually due to trauma (contact sports) Accumulation of blood disrupts the vascular supply to the cartilage of the auricle - necrosis of the cartilage If not drained quickly - gross deformity results as cauliflower ear I

Answer 319

Sigmoid shaped tube which connects the deep part of the concha of the auricle to the tympanic membrane Support given to walls from the auricle and the temporal bone

Answer 320

Initially superoanterior in direction Turns slightly to move superoposteriorly Ends in an inferoanterior direction

Answer 321

Double layered- (skin and MM) membrane which marks the division between the outer and middle ear

Answer 322

Connected to temporal bone by fibrocartilaginous ring

Answer 323

Translucent - so structures within the middle ear can be seen

Answer 324

Malleus - most superiorly- lateral process of malleus - extending down from lateral process- handle of malleus - most inferiorly- Umbo Parts of tympanic membrane moving away from the lateral processes are called the anterior and posterior malleolar folds Pars flaccida and pars tensor Cone of reflex

Answer 325

Sensory innervation from branches of mandibular and vagus nerves

Answer 326

Caused by trauma or infection - infection of middle ear/ otitis media - causes pus and fluid build up - causes an increase in pressure and rupture of the eardrum - many cases it heals itself - large perforations - a surgical intervention might be necessary

Answer 327

Tympanic cavity- malleus, incus and stapes Epitympanic recess- mastoid air cells Extends from tympanic membrane to oval and round window of inner ear

Answer 328

Tympanic cavity | Epitympanic recess

Answer 329

Roof- petrous part of temporal bone Floor- jugular wall (thin layer of bone) Lateral- tympanic membrane and lateral wall of epithelia of recess Medial- lateral wall of internal ear Anterior- thin bony wall with 2 openings- for auditory tube and tensor tympani muscle Posterior- mastoid wall- bony partition between tympanic cavity and mastoid air cells- superiorly has a hole (aditus to mastoid antrum) allowing communication with mastoid air cells

Answer 330

Largest most lateral auditory ossicle Attaches to tympanic membrane via handle of malleus Head of malleus lies in the epitympanic recess where it articulates with next auditory ossicle - incus

Answer 331

Middle auditory ossicle Has a body and two limbs Body articulates with the malleus Short limb attaches to the posterior wall of the middle ear cavity Long limb joins the last ossicle - stapes

Answer 332

``` Smallest bone in the body Medial most auditory ossicle Head, base and two limbs in a stirrup shape Head articulates with long limb of incus Base joins with the oval window ```

Answer 333

Malleus, incus and stapes are connected in a chain like manner linking the tympanic membrane to the oval window of the inner ear

Answer 334

Tensor tympani | Stapedius

Answer 335

Tensor tympani and Stapedius Both serve protective function of the middle ear Contract on response to a loud noise inhibiting vibrations of malleus incus and stapes to such a degree to cause damage- reduces the transmission of sound to the inner ear - acoustic reflex

Answer 336

Originates from the auditory tube and attaches to the handle of malleus, pulling it medially when contracting

Answer 337

Mandibular nerve branch of Trigeminal nerve (CNViii)

Answer 338

Attaches to the stapes

Answer 339

Facial nerve

Answer 340

Located posterior to the epitympanic recess Collection of air filled spaces in the mastoid process of the temporal bone Contained within the mastoid Antrum cavity - communicates with the middle ear via the aditus of the mastoid Antrum in posterior wall Acts as a buffer system of air - releasing air into the tympanic cavity when the pressure is too low

Answer 341

Cartilage and bony tube that connects the middle ear to the nasopharynx Acts to equalise the pressure of the middle ear to that of the EAM Extends from anterior wall of middle ear in an anterior, medioinferior direction opening onto the lateral wall of the nasopharynx

Answer 342

Growth of stratified squamous epithelia of middle ear- congenital or acquired Destructive growth- causes damage to bones of middle ear by increased pressure or release of osteolytic enzymes Hearing loss/ facial nerve palsy

Answer 343

Otitis media spreads to mastoid air cells (porous nature) Infection of mastoid process --> middle cranial fossa --> brain: Meningitis Drainage of pus necessary- careful not to damage the facial nerve

Answer 344

Otitis media with effusion Dysfunction of Eustachian tube Inflammation, blockage or genetic mutation Fluid build up in middle ear causes a negative pressure Transudate from mucosa drawn out by NP- pathogens Upon inspection - tympanic membrane appears inverted and fluid can be seen in middle ear

Answer 345

Vestibulocochlear organs Bony labyrinth- vestibule, cochlea, 3 semi circular canals Membranous labyrinth- cochlear duct, saccule, utricle, semicircular ducts

Answer 346

Convert mechanical signals from the middle ear into electrical signals which can transfer information to the auditory pathway in the brain Maintains balance by detecting position and motion

Answer 347

Located within the petrous part of the temporal bone | Between the middle ear and internal acoustic meatus

Answer 348

Consists of a series of bony cavities within the petrous part of the temporal bone; comprised of the cochlea, vestibule and 3 semicircular canals- all these structures lined internally with periosteum and contain a fluid- perilymph

Answer 349

Central part of the bony labyrinth - separated from the middle ear by oval window Communicates anteriorly with cochlea and posteriorly with semicircular canals Saccule and utricle (parts of the membranous canal) are located I the vestibule

Answer 350

Houses the cochlear duct of the membranous labyrinth - auditory part of ear Twists around itself around a central portion of bone called the modiolus, producing a cone shape that points in an anterolateral direction Branches of cochlear portion of the Vestibulocochlear nerve (VIII) are found at the base of the modiolus Extending outwards from the modiolus is a ledge of bone - spiral lamina- which attaches to the cochlear duct holding it in position

Answer 351

Above- scala vestibuli (continuous with vestibule) | Below- scala tympani (ends at round window)

Answer 352

Anterior, lateral and posterior canals in the bony labyrinth Contain semicircular ducts (membranous labyrinth) responsible for balance (saccule and utricle) Canals are superoposterior to the vestibule and at right angles to one another Swelling at one end is known as the ampulla

Answer 353

Lies within the bony labyrinth, It consists of the cochlear duct, semicircular ducts, utricle and saccule- filled with the endo lymph

Answer 354

Located within the bony scaffolding of the cochlea Held in place by spiral lamina Presence of duct creates two canals above (scala vestibuli) and below (scala tympani) Triangular in shape

Answer 355

Triangular shape Lateral- thickened periosteum= spiral ligament Roof- membrane that separates cochlear duct from scala vestibuli- Reissners Floor- membrane that separates cochlear duct from scala tympani- Basillar

Answer 356

2 membranous sacs in the vestibule Utricle- larger of the two receiving 3 semicircular ducts Saccule- globular in shape and receives the cochlear duct Endolymph drains from the saccule and utricle into the endo lymphatic duct- travels through the aqueduct to posterior aspect of the petrous part of temporal bone- here it expands into a sac where endolymph can be secreted and absorbed

Answer 357

Located within the semicircular canals and share their orientation Upon movement of the head, flow of endo lymph within these ducts changes speed and/or direction Sensory receptors in the ampullae of the semicircular canals send signals to the brain allowing for processing of balance

Answer 358

Vestibulocochlear nerve (CNVIII) - enters inner ear via interal acoustic meatus where it divides into the vestibular nerve and the cochlear nerve - vestibular nerve enters to form the vestibular ganglion which then splits into superior and inferior parts to supply the utricle, saccule and 3 semi circular ducts - cochlear nerve enters at the base of the modiolus and it's branches pass through the lamina to supply receptors of organ of Corti Facial nerve (CNVII) - passes through inner ear but does not innervate any of the structures present

Answer 359

3 arteries which supply the surrounding temporal bone - anterior tympani branch (maxillary artery) - petrosal branch (middle meningeal artery) - stylomastoid branch (posterior auricular artery)

Answer 360

Labyrinthine artery (inferior cerebellar artery/ basillar artery) Divides in pro 3 branches - cochlear branch --> cochlear duct - 2x vestibular branches --> vestibular apparatus

Answer 361

Labyrinthine vein- empties into the sigmoid sinus or inferior petrosal sinus

Answer 362

Disorder of the inner ear characterised by episodes of vertigo, low pitched tinnitus and hearing loss Symptoms caused by excess accumulation of endo lymph within the membranous labyrinth, causing progressive distension of the ducts Resulting pressure fluctuations damage thin membranes of the ear that detect balance and sound.

Answer 363

External - auriculotemporal branch of mandibular division of Trigeminal nerve (CNViii) and small branch of vagus nerve (CNX) Internal- Glossopharyngeal nerve (CNIX)

Answer 364

Sound travels through EAM and is transmitted to movement via the 3 auditory ossicles which move upon receiving sound signals Stapes then presses on the oval window transmitting movement in the perilymph of the scala vestibuli and then tympani Hairs found in the scala vestibuli pick up movement of perilymph/ sounds at different frequencies - high pitched sounds are absorbed proximally to Oval window - low pitched sounds are absorbed more distally to Oval window Sound Is absorbed into the endo lymph of the cochlear duct and transferred to the brain Excessive sound leaves via the round window to relieve any pressure

Answer 365

Fluid in the semicircular ducts move when we become unbalanced and restore our balance

Answer 366

``` Warms and humidifies air Filters air- removes and traps pathogens and particulate matter from the inspired air Olfaction- sense of smell Drains and clears paranasal sinuses Respiration ```

Answer 367

Vestibule Olfactory region Respiratory region

Answer 368

Area surrounding external opening to nasal cavity

Answer 369

Area located next to the apex of the nasal cavity- lined by olfactory cells with olfactory receptors

Answer 370

Largest area - lined by ciliated pseudostratified columnar epithelia - within which the mucus secreting goblet cells are interspersed

Answer 371

``` Frontal Nasal Ethmoid Sphenoid Vomer Palatine process of maxilla Horizontal process of palatine bone Inferior concha ```

Answer 372

Curved shelves of bone that project out the lateral walls of the nasal cavity - inferior, middle and superior

Answer 373

Inferior meatus Middle meatus Superior meatus Sphenoethmoidal recess

Answer 374

Between inferior meatus and floor of nasal cavity

Answer 375

Between middle and inferior conchae

Answer 376

Between the middle and superior conchae

Answer 377

Superior and posterior to superior concha

Answer 378

Increases SA of the nasal cavity. - increasing the amount of inspired air that can come into contact withthecavity walls Disrupt fast, laminar flow of air- making it slow and turbulent so that air spends longer in the nasal cavity and can be humidified

Answer 379

``` Frontal sinus Maxillary sinus Anterior, posterior and middle ethmoidal sinuses Sphenoid sinus Nasolacrimal duct Eustachian tube ```

Answer 380

Superior meatus

Answer 381

Semilunar hiatus in middle meatus

Answer 382

Ethmoid bulla of the middle meatus

Answer 383

Base of semilunar hiatus of middle meatus

Answer 384

Middle meatus

Answer 385

Sphenoethmoidal recess

Answer 386

Inferior meatus

Answer 387

Inferior meatus

Answer 388

Crista galli Cribriform plate Perpendicular plate

Answer 389

Part of the ethmoid bone Forms portion of the roof of the nasal cavity Contains very small perforations allowing fibres of the olfactory nerve to enter and exit

Answer 390

Opening that allows communication between nasal cavity and pterygopalatine fossa

Answer 391

Sphenopalatine artery, nasopalatine nerve and greater palatine artery pass through here

Answer 392

Pathway between the nasal cavity and incisive fossa of the oral cavity

Answer 393

Nasopalatine nerve and greater palatine artery

Answer 394

Allows it to effectively change the humidity and temperature of inspired air

Answer 395

Anterior and posterior ethmoidal arteries (branches of the opthalmic artery)

Answer 396

Sphenopalatine artery, greater palatine artery, superior labial artery, lateral nasal artery

Answer 397

Drain into pterygoid plexus, facial nerve of cavernous sinus In some individuals a few nasal veins join with the Sagittal sinus (a dural venous sinus - represents potential pathway via which infection can spread)

Answer 398

Ability of nose to smell Olfactory nerves Olfactory bulb (part if brain - lies on superior surface of Cribriform plate) --> olfactory nerve branches via the Cribriform plate perforations --> nose = SMELL

Answer 399

Sensation to septum and lateral walls - Nasopalatine nerve - branch of maxillary nerve - Nasociliary nerve - branch of opthalmic nerve Sensation to external skin of nose - Trigeminal nerve

Answer 400

Unclear Contribute to humidifying of inspired Air Reduce weight of skull

Answer 401

In childhood by nasal cavity eroding into the surrounding bone

Answer 402

The Right and Left Frontal Sinuses are between the outer and inner tables of the frontal bone, posterior to the superciliary arches and the root of the nose. They are usually detectable in children by 7 years of age (not present at birth). They each drain through a Frontonasal Duct into the ethmoidal infundibulum, which opens into the semilunar hiatus of the Middle Nasal Recess.

Answer 403

``` Ethmoidal Cells (Sinuses) The Ethmoidal cells (Sinuses) are small invaginations of the mucous membrane of the middle and superior nasal recesses into the Ethmoid bone. The Ethmoidal cells usually are not visible in plain radiographs before 2 years of age. The Anterior Ethmoidal Cells drain directly or indirectly into the middle nasal recess through the ethmoidal infundibulum. The Middle Ethmoidal Cells open directly into the middle nasal recess. The Posterior Ethmoidal Cells open directly into the superior nasal recess. ```

Answer 404

The Sphenoidal Sinuses are located in the body of the sphenoid and may extend into the wings of the bone. The body of the sphenoid is fragile, and only thin plates of bone separate the sinuses from several important structures (Optic nerves and chiasm, the pituitary gland, internal carotid arteries). They are small at birth, enlarging after puberty. They drain directly into the Sphenoethmoidal Recess.

Answer 405

The Maxillary Sinuses are the largest of the paranasal sinuses. They occupy the bodies of the Maxillae. They drain by one or more openings, the Maxillary Ostium (ostia), into the middle nasal recess by way of the semilunar hiatus.

Answer 406

Most common fracture of face bones History of force to face May resulting a deformity Complications include septal haematoma, abscess formation, septal deviation, CSF leakage

Answer 407

Can occur as a result of nose trauma Fractured directly by trauma or by fragments of the ethmoid bone Fracture can penetrate meningeal linings of the brain causing leakage of CSF - increases risks of meningitis, encephalitis and brain abscesses Olfactory bulb lies on the Cribriform plate and can be damages irreversibly in the fracture - in which case the patient presents with anosmia - loss of smell

Answer 408

Lies in Kiesselbach's/ Little's area Region in the anterior ferero part of nasal septum where 4 arteries anastamose: - anterior ethmoidal artery (opthalmic) - sphenopalatine artery (maxillary artery terminal branch) - greater palatine artery - septal branch of superior labial artery (facial artery) * 90% nose bleeds (epistaxis) occur in this area as it is exposed to drying- the effect of the inspiratory current

Answer 409

Bleeding from the nose - very common Cause can be local (trauma) or systemic (hypertension) Anterior - 90% in Kiesselbach's area Posterior- sphenopalatine artery

Answer 410

Can be congenital or acquired | Narrowing / obstruction

Answer 411

Injury to nasal septum | Saddle nose deformity

Answer 412

Anterior cranial fossa --> sinuses Middle ear --> Eustachian tube Paranasal sinuses Lacrimal apparatus and conjunctiva --> nasolacrimal duct

Answer 413

Inflammation of nasal mucosa Leads to swelling and increased volume of secretion Causes include: infective (viral), allergic and nasal polyps

Answer 414

Prevalence - ~2-4% Linked to chronic rhinosinusitis Grows close to ostiomeatal complex of the nasopharynx Nasal obstruction - snoring/ obstructive sleep apnoea

Answer 415

Inflammation of mucosal lining of sinuses Acute 7-30 days Subacute 4-12 weeks Chronic >90 days Infection-viral with secondary bacterial infection, S.Pneumoniae and H.Influenzae

Answer 416

Trauma, tumours, EToH, coagulation defects, vascular abnormalities mucosal drying, infections, NSAID's, granulomas

Answer 417

1) Pinch nose and lean forward 2) Cautery (silver nitrate of electro) 3) Nasal tampons 4) Bolster- support 5) Posterior packing 6) Surgical intervention with ligation of branches - SPA ligation, maxillary ligation, ECA ligation 7) Radiological embolisation