Back, Head, & Neck Flashcards
Rostral
Front top of scalp
Caudal
Lower back of the head
Ipsalateral
Same side
Contralateral
Opposite side
Supine
Hold soup
Prone
Pro soup on floor
Suture
Joints connecting lines of head
Gomphosis
Joints in teeth
Synovial two kinds where are they found and what do they do
Synchrondosis (limbs) symphysis (vertebral discs w/ annulus fibrosis w/ nucleus pulses in the center of each allowing for various back movements
Pivot joint
Atlas and axis of cervical spine
Sensory vs. motor neuron
White matter Up and in sensory and down and out is motor forming myelinated white matter of spinal cord
Grey matter
Unmyelanted cell bodies with interneurons
Ganglion
Collection of cell bodies
Parasympathetic nervous system
Postganglionic neuron very close to its target organ
Sympathetic nervous system location of fibers
Pain fiber travel with (less myelinated) receptor density not high fiber pathways traveling all over the sympathetic inside nervous system T1-T4 innervate heart causing refereed pain C6, C7, T1-4, and l1
Dorsal vs. ventral horn vs. ramus
Dorsal horn sensory, ven
Thoracolumbar fascia
Latissimus dorsi comes off of
Semispinalus capitus
Deep to splenius innervated by dorsal rami
Splenius cervicus
Deep to spleniusinnervated by dorsal rami
Splenius cervicus
Deep to spleniusinnervated by dorsal rami
Erector spinae name three
Illicostalis (heading off to ribs) longisimus, spinalis (up against spine
Quadratics lumborum
Posterior wall of abdomen
epithelium
outer most layer or innermost layer of skin and organs no vasculature but providing cushioning and gets their nutrition from deep below
simple squamous epithelium
designed for gas exchange flat squeezed cells
simple cubdoidal
duct work, salivary or pancreas
simple columnar
guts, intestinal tract stomach down, long and stretched out polarity of cells
stratified squamous
keratinized (skin) and non-keratinized (esophagus)
transitional
rounds and flattened out bladder and ureter
pseudostrafied columnar
goblet cells making mucus in airways secretary w/ cilia
stratified cuboidal
specialized ducts ductus deferens
smooth muscle
distend and contract over time rather rapidly setup of it
striations in muscle
built up by actin and myosin sarcomere w/ different organizations
connective tissue
ask cell, fiber, extracellular matrix and background (ground substance) different connective tissue w/ different relationship
loose connective tissue
loose packing of fibers of both elastic and collagenous (areolar, adipose, and reticular tissue. allowing inflammatory cells run through found in joint capsule for strength and support
fibrous connective tissue
regularly lined up collagen lined up in tendon
fibroblasts
make collagen
cartilage
nonvascular w/ chrondocytes building it found in lacuna found in articular (joint) nonvascularized and have perichondrium allowing for vascularization w/ collagen.
elastic cartilage- elastic fibers
fibrocartilage- lots of strands of cartilage w/ lacuna and chrondocytes lined up in rows w/ collagen reinforcing making it flexible but strong
bone
mineralized calcium and potassium w/ osteocyte running through canaliculi keeping bone vascular and heal faster source for vessels and such is periosteum (compared to chondrocyte and lacuna)
stratum basale
multiplicative layer. metabolically active layer
stratum spinosum
skin cells fill with keratin to waterproof skin
papillary layer
volcano cone shaped and outcropping
dermis
loose connective layer of papillary layer w/ vasculatur
reticular layer
collagen below papillary layer and hair located in it
adipose layer
superficial fascia, major vascular layer in fat
retinaculumm cutus
skin ligaments prominent ones of suspensory ligaments of breast
1st degree
superficial affecting mostly the epidermis not hitting the dermis causing pink, light red, or tender affecting free nerve endings
partial thickness
red, weeping painful, in nerve endings into the vascularity and dermis layer very painful
3rd degree, full thickness
pale slightly moist less red, no sensation through hypodermic, dermis, superficial fascia, adipose tissue or down to muscle appearing pearly white or charred, parchmentlike, translucent (vein show through) no sensation, w/ eschar
langer lines
feel cutting across the grain because of arranged patterns of cleavage lines of skin
decubiti
based on moisture and positioning, pressure causes a loss of vascularity to an area epidermis from dermis, try to not have sustained pressure on capillary end of artery. prolonged skin pressure longer than 32 can lead to initial changes as involving more of skin and ulceration and deep tissue
melanoma-
integumentary evaluation lethal skin cancers. begins w/ melanocytes at basal layer dropping down to papillary layer first affecting lymphatic so by the time it gets to the epidermis and horny layer it is equal on either side of basal
spinous process
sticking up back part of vertebra
transverse process
stick out anchoring limbs and musculature anchoring and moving it around
pedicle
hold traverse process
foramen
spinal cord runs through this space
vertebral body
massive in lumbar vertebra smaller as you go up dependent on load
intervertabal disc
fibrocartilage big strands of cartilage offering flexibility w/ planes of motion delineated by articular facets
synovial joints in vertebra
depending on place facets have directional w/ lumbar have flexion, extension, and lateral bending w/ no rotation
facets are lateral in thoracic making it was to rotate but given spinous processes can’t flex or extend
cervical facets are in horizontal plane to turn head w/ most done at atlas and axis.
intervetebral disc structure
structurally annulus fibrosis or layers of febrile cartilage surrounding the nucleus pulpsosus (spinal column overgrowth of earlier notochord). w/ pumping activity, weight bearing, and causing drying of nucleus pulpous causing easy herniation or slipped disc. articular facets and synovial joints but most come from IV disc
spinal ligaments
keeping spine lined up,
anterior longitudinal ligament and posterior longitudinal ligmanet
ALL (wide) surrounding IV disc, cover over vertebral bodies resisting against hyperextension.
interspinous ligaments
holding spinous process together
supraspinous ligament
between cervical muscles expansion into nucle ligament w/ elastic fiber (helpful for prey to constantly look up and down)
ligamenta flava
connect vertebral arch connecting laminae. yellow elastic fiber.
C7
spinous process sticks out, nuchal groove and ligament
spondolostesis
should be able to feel spinous processes despite high BMI
spinal nerves
paired come out of vertebral foramina, cervical spinal nerves start on top side of atlas w/ 8 nerves instead of seven the rest are corresponding to the number of vertebrate
spinal cord ends
Spinal cord ends L1-L2because the bones and connective tissue grows faster than spinal tissue leading to the stretching of the lumbar spinal nerves
meninges
dura mater (tough mother) attenuates closer to spinal nerves arachnoid (webby w/ subarachnoid space having CSF flowing through pia (dear) mater is close to the spinal cord found to the denticulate ligaments holding it side to side forming it.
white matter
myelanted tracts running up and down the spinal cord
order of nerves
rootlet>roots>nerves>branch into dorsal or ventral rami
dorsal horn>dorsal roots>rami
spinal nerve travels
goes through vertebral foramen go off find section of skin or muscle (dermatome or myotome)
motor nerves
cell bodies of motor live in ventral or anterior horn axons run through ventral root go through spinal nerve running out ventral (most of body wall or limbs) or dorsal ramus innervation (deep back)
sensory nerves
free endings or structured ending go through mixed spinal nerves traveling through ventral rams or dorsal ramus creating cell bodies off to side forming dorsal root ganglion going into nerve tracts or interneuron.
parasympathetic
not in spinal cord, cranial nerves or sacral region of spinal cord S2, 3, 4 keeps things off the floor. short postganglionic neurons mean that they are closer to their target
sympathetic
come out T1-L2, thoraciclumbar outflow, come out of lateral or intermediate horn. two autonomic nerves hand off of sympathetic chain on either side of vertebral bodies or splanch nerve to ganglion in aorta. postganglionic nerves long to get whole body stimulated
splanchnic nerves
thorax and abdominal nerves
postganglionic nerves
go off to target neuron
white matter
white rami myelantate postganglionic unmyelinated
referred pain
sensory neurons from viscera are going similar to motor having visceral referred pain because they share so many pathways w/ short postganglionic feeding back to few vertebrate.
lumbar puncture
conus medlars tapers to end forming horses tail w/ stretched out ventral and dorsal roots of sacral nerves using Illiac crest L4 tap into there forming caudal equine roots out of the way. useful for collecting cerebral spinal fluid to find meningitis
epidural anesthesia
gets you chance local anesthetic numbing nerves as nerve roots pass through. epidural space fat filled w/ no into cerebrospinal fluids causing infection so need to flood w/ anesthesia for no pain allowing monitoring.
spina bifida
vertebral bodies form around notochord. the last to fuse is the first to mess up because not deadly w/ last step most apparent and common not formal closure causing interaction w/ them. most commonly tuft of hair.
kyphotic
flexing bend in thoracic region
lordosis
curvature in flexion of lumbar
scoliosis
lateral curvature causing respiratory compromise idiopathic (unknown origin)
osteoporosis of female
osteoclasts lead to breakdown in bones causing severe curvature of spine in thoracic addition to injury
sternocleidomasteud
…
burst fracture
atlas taking hit
forced hyperextensoin
hangman caused by MVA, knot to the side to break though lateral of bone
fracture of C2
vertebral canal expansive depending on direction of fracture dented
sponylolysis
fracture pattern in lumbar region get a lot of use. superior inferior articular process leading to limbs in pedicle in depth thought pars articulates, thoracic or cervical deadly not as impactful in lumbar.
spondylolisthesis
fracture pattern in lumbar region get a lot of use. therefore feel for steph off
epidermis
Keratinized stratified squamous epithelium, upper most layer of skin w/ stratum corneum and basalum, avascular noushed by dermis supplied by afferent nerve endings. from ectoderm
dermis
Dense layer of interlacing collagen and elastic fibers lower, connective tissue layer with vasculature, provide skin tone and strength deep layer contains hair follicles, arrestor muscles erect hair compressing sebaceous gland secreting onto skin. mesoderm
superficial fascia (subcutaneous tissue)
loose connective tissue underneath dermis contains deepest parts of sweat glands, blood and lymphatic vessels, and cutaneous nerves. Most fat storage. allows skin to glide over eachother
deep fascia
tougher dense organized connective tissue surrounding muscle (epimysium), devoid of fat envelops most of body deep to skin and subcutaneous tissue. W/ skin ligaments connecting and holding onto them. attaches to deep superficial fascia
an(n)ulus fibrosus
)layers of fibrile cartilage, stiffening causing herniated disc) connected to the vertebral bodies above and below. fibrocartilage ring holding in cushioning nucleus pulposus, can weaken with age to allow contents to herniate (“slipped disc”). Concentric lamellar of collagen fibers. / s a ring consisting of concentric lamellae of fibrocartilage forming the circumference of the IV disc. The anuli insert into the smooth, rounded. epiphysial rims on the articular surfaces of the vertebral bodies
anterior longitudinal ligament
: broad COVERS VERTEBRAL BODY, RESISTING AGAINST HYPEREXTENSION, WIDE.
a long ligament on the anterior (ventral) surface of the vertebral bodies that helps to prevent hyperextension damage, e.g., in “whiplash” injury. / a strong, broad fibrous band that covers and connects the anterolateral a spects of the vertebral bodies and IV discs
articular process (facet), superior and inferior
two superior and two inferior arise from junctions of pedicles and laminae bearing articular surfacesuperior and inferior processes that allow articulation (at the facet surface) of adjacent vertebrae. Osteophytes from the processes may lead to spinal nerve impingement. / hese joints slope inferiorly in the cervical spine (facilitate lexion and extension), are more vertically oriented in the thoracic region (limit lexion and extension but allow for rotation), and are interlocking in the lumbar spine (they do allow lexion and extension, but not to the degree present in the cervical spine)
atlanto-occipial and atlantoaxial joints
nodding and no joints, respectively. Neither have intervertebral discs, and both contain membranes and ligaments to limit the extent of those movements. / occipital=>The main movement is flexion, with a little lateral fl exion (sideways tilting of the head) and some rotation. These joints also permit sideways tilting of the head. The atlanto-occipital joints are synovial joints of the condyloid type and have thin, loose joint capsules, axial => There are three atlanto-axial articulations: two (right and left) lateral atlanto-axial joints between the lateral masses of C1 and the superior f acets of C2 (Fig. 4.12C) and one median atlanto-axial joint between the dens of C2 and the anterior arch and transverse ligament of the atlas (Fig. 4.12A,B). The median atlanto-axial joint is a pivot joint, whereas the lateral atlanto-axial joints are plane-type synovial joints. Movement at all three atlantoaxial joints permits the head to be turned from side to side, as occurs when rotating the head to indicate disapproval (the “no” movement).
atlas
C1 with two articular surfaces for occipital condyles and “yes” motion.
axis and dens (odontoid process)
C2 with its projection to allow swivel “no” motion / point on altas sticks up that allows to move head back and forward
epiphysial(eal) rim
smooth ring external to anulus fibrosus, can be the site for osteophytes, e.g., with osteoarthritis ring of smooth bone around rim of vetebra derived from anular epiphysis
facet (zygapophysial(eal) joint
four articular processes are in opposition w/ corresponding process of vertebrae superiot and inferor forimging small synovial joints between vertebrae (Gr: “together projection”) / allow for gliding and sliding movements. Slope inferiorly in the cervical spine
inion (external occipital protuberance)
projection of posterior occipital bone, landmark for posterior neck muscles
interspinous ligament
between spinous processes HOLDS . smaller connective tissue bands running between the spinous processes of adjacent vertebrae
intervertebral disc
With weight bearing an important function here, the intervertebral discs take on special consideration. They consist of an an(n)ulus fibrosus )layers of fibrile cartilage, stiffening causing herniated disc) connected to the vertebral bodies above and below, and a central nucleus pulposus within(gel in middle overgrowth of notochord when dries get herniated) . The discs allow movement between vertebral bodies, but they may degenerate with age. tough cushioning between discs, thickest in the mobile cervical and lumbar regions, made of anulus fibrosis and nucleus pulposus. w/ cartilage offer flexibility and delineated by facets.
intervertebral foramen
superior and inferior vertebral notches of adjacent vertebrae combine to form gap between vertebral notches of adjacent pedicles, where spinal nerves exit and accompanying vessels containing the spinal ganglia / the opening formed by the vertebral notches that is traversed by spinal nerve roots and associated vessels.
lamina
two broad, flat plates of bone, unite in the mdiline and meet the pedicles. the “roof” over the vertebral canal; cut into for a laminectomy / paired portions of the vertebral arch that connect the transverse processes to the spinous process.
ligamentum(a) flavum(a)
(“yellow ligaments”) are connective tissue bands that connect adjacent laminae. elastic, connecting laminae
nuchal ligament
median ligament of neck with lots of fibroelastic tissue; superior to supraspinous ligament; can ossify with cervical spondylosis
nucleus pulposus
within(gel in middle overgrowth of notochord when dries get herniated) . gooey internal contents of intervertebral disc, adult remnants of notochord. Central nuclear zone of collagen and hydrated proteoglycans. Acts as shock absorber compressing when load bearing and relaxing when removed. / usually herniates in a posterolateral direction, where it can impinge on the nerve roots passing through the intervertebral foramen. A disc herniating at the L4-L5 level usually impinges on the L5 roots, and herniation at the L5-S1 level involves the S1 roots.
occipital bone and occipital condyles
part of skull that contains foramen magnum; projections that allow “yes” motion / permit nodding of the head, such as the neck fl exion and extension that occurs when indicating approval (the “yes” movement). The main movement is fl exion, with a little lateral fl exion (sideways tilting of the head) and some rotation. These joints also permit sideways tilting of the head.
pedicle
short, stout processes join vertebral arch to body. project posteriorly to meet laminae. the “stalk” supporting the arch from the body / The pedicles project posteriorly to meet two broad, flat plates of bone, called laminae / paired portions of the vertebral arch that attach the transverse processes to the body.
posterior longitudinal ligament
narrow, lining the “floor” of the vertebral canal, BISECTS DISC. a long ligament on the posterior (dorsal) surface of the vertebral bodies (i.e., within the “floor” of the vertebral canal) that helps to prevent hyperflexion damage, e.g., in “whiplash” injury.
posterior tubercle
off of C1, instead of a spinous process
spinous process
one median projects posteriorly (and usually inferiorly) from vertebral arch at junction of laminae dorsal projection, those of C7 and T1particularly palpable
superior nuchal line
the ridge on the occipital bone that includes the inion, superior limit of neck / marking the superior limit of the neck, extends laterally from each side of this protuberance
supraspinous ligament
dorsal to spinous processes that merges into a large nuchal ligament in the cervical region
. tough connective tissue band running from the dorsal “peak” of one spinous process to another to help hold vertebrae together
synovial joint
synovial joints involving articularcartilage surfaces interacting with each other within synovial fluid (full of glycosaminoglycans, particularly hyaluronicacid) secreted by fibroblasts in the synovial membrane, all surrounded by a joint capsule of dense connective tissue. the spine will include a pivot joint between the first and second cervical vertebrae (C1 and C2; atlas and axis), and multiple plane joints between articular facets among vertebrae.
transverse foramen
hole in transverse process of a cervical vertebra, space for vertebral artery / covered with thick muscles and may or may not be palpable.
transverse process
project posterolaterally from junctions of pedicles and laminae. sticks out sideways for muscle attachment; “divides” hypaxial and epaxial muscle groups
uncus (uncinate process)
on C3-C7; hooked-shaped and on the top sides to prevent slippage and limit lateral flexion / lies posterior
to the superior mesenteric vessels
vertebra: cervical, thoracic, lumbar, sacral, coccyx
note overall differences; Sacral and thoracic are fetal curvatures (kyphosis), lumbar and cervical (lordosis)secondary cervical (C1-7) with foramina transversaria (contain vertebral aa.) and bifid spinous process flexion, swivel; thoracic (T1-12) have costal facets and inferior-pointing spinous processes thoracic rotation and overlapping processes suggest no extension; lumbar (L1-5) are large and weight-bearing, flexion, extension, and lateral bending no rotation large spinous and transverse processes anchor ligaments for muscle attachment
, large vertebral bodies to support weight
. placement of superior and inferior facets from the articular processes in a sagittal plane that allows more for
; sacral (S1-5) are fused into the curved sacrum; and the coccyx (Co1-4) is the fused remnant of caudal vertebrae (as well as painful to land on, being one cause of coccygodynia/coccydynia)
vertebral canal
the “tunnel” made by the vertebral foramina strewn together, for the spinal cord, meninges (protective membranes), fat, spinal nerve roots, and vessels / which contains the spinal cord, meninges (protective membranes), fat, spinal nerve roots, and vessels /
vertebral foramen
vertebral arch and posterior surface of vertebral body form walls of the hole made by the vertebral arch / the opening formed by the vertebral notches that is traversed by spinal nerve roots and associated
vessels. / a foramen formed from the vertebral arch and body that contains the spinal cord and its meningeal coverings
erector spinae m., consisting of iliocostalis m., longissimus m., spinalis m.
large block of epaxial muscle—major spine extensor and a lateral flexor. Note that epaxial mm. names refer more to patterns of attachment than to individual muscles, e.g., longissimus thoracis, cervicis, capitis. Erector spinae mm. refers to the following three components; iliocostalis most lateral, attached to ribs, longissimus attached to transverse processes, spinalis thin and most medial, attached to spinous processes. / The erector spinae muscles (sacrospinalis) lie in a “groove” on each side of the vertebral column between the spinous processes and the angles of the ribs (Fig. 4.22). The massive erector spinae, the chief extensor of the vertebral column, divides into three muscle columns: / layer of muscles is the largest group of the intrinsic back muscles and is important for maintaining posture, extending the spine, and laterally bending the spine. hese muscles are divided into three major groups, as follows
interspinales (interspinal) and intertransversarii (intertransverse) m.*
deepest back muscles, dorsal rami of spinal nerves, either between spinous process to extend or transverse processes to flex, respectively.
latissimus dorsi m.
inferior back, makes up posterior axillary wall, thoracodorsal n., antagonistic to pectoralis muscles, useful for butterfly swimmers / fan shaped, passes from trunk of humerus and acts directly o the glenohumeral (shoulder) joint and indirectly on the pectoral girdle. Raises the trunk t the arm, which occurs when limb is fixed and body moves, chinups or climbing tree
levatores costarum m.*
elevate ribs
serratus posterior inferior vs. superior m.
elevates ribs and so assists inspiration. The serratus posterior muscles are thin and are more layer landmarks to encourage careful dissection this first week than acting as active contributors to respiration.
splenius capitis m.
extend head/neck, or if singly, can rotate to one side. Palpable; also may be better seen as part of posterior triangle of neck.
splenius cervicis m.
extend, rotate cervical spine. / lies deep to the trapezius and semispinalis capitis muscles / muscle group in occipital region made of rectus capitis posterior major, minor, obliquus capitis inferrior and superior. The boundaries and contents are: Superomedially, rectus capitis posterior major • Superolaterally, obliquus capitis superior • Inferolaterally, obliquus capitis inferior • Floor, posterior atlanto-occipital membrane and posterior arch of C1 • Roof, semispinalis capitis • Contents, vertebral artery and suboccipital nerve (C1)
suboccipital triangle*
deep to semispinalis capitis, includes a number of muscles innervated by C1 (suboccipital n.); these include rectus capitis posterior major and minor m., and obliquus capitis superior and inferior m.; listed here as an objective as they may be involved in whiplash, or be trigger points to be addressed by massage therapy. Presumably, these small muscles are offering proprioceptive information regarding head and neck movements.
thoracolumbar fascia
fascia surrounding deep muscle, especially in lumbar region, blends in with other fascia, e.g., that of quadratus lumborum m. / extensive fascial complex that has anterior, middle, and posterior layers with muscles enclosed between them. It is thin and transparent where it covers thoracic parts of the deep muscles but is thick and strong in the lumbar region
transversospinalis m.: semispinalis, including semispinalis capitis, multifidus group (multifidi), rotatores m.
small, epaxial m. that contribute to an overall postural effect, even though small individually. These are in the order of superficial to deep and longer to shorter, e.g., rotatores run from the transverse process of one vertebra to the spinous process of the adjacent superior vertebra. Multifidus helps to stabilize the lumbar spine, so can be implicated in low back pain (LBP).
trapezius m.
large multifunction scapular muscle, remnant of gill-raising m. to explain its CN XI motor innervation
anterior vs. posterior spinal arteries
A survey of the blood supply and drainage of the spine and spinal cord can address other possible sources of back pain. The spinal cord is supplied by one anterior and two posterior spinal arteries off of the vertebral arteries. These are supported by many radicular arteries off of the aorta, in particular the great radicular artery (of Adamkiewicz). Extensive venous plexuses drain both inside and outside the vertebral canal.
major supplies to the spine, originally off of the vertebral arteries, but supplemented extensively with segmental medullary arteries / Posterior and anterior roots of the spinal nerves and their coverings are supplied by posterior and anterior radicular arteries, which run along the nerve roots. These vessels do not reach the posterior or anterior spinal arteries. Segmental medullary arteries occur irregularly in the place of radicular arteries; they are larger vessels that supply blood to the spinal arteries.
spinal veins and internal vertebral (epidural) plexus
will form plexuses, with the internal venous plexus in the epidural space / run the length of the cord and drain into segmental (medullary) radicular veins
arachnoid mater
a thinner middle meningeal layer, so named because of the trabeculations extending through the subarachnoid space / the fine, weblike avascular membrane directly beneath the dural surface.
cauda equina
The typical target for lumbar puncture is L3-L4, L4-L5; the cauda equina is located in that region, as the spinal cord terminates in the L1 range, so less risk of spinal cord damage. Given the nerve roots of the cauda equina in the CSF, they can “float away” as the needle is advanced. “horse’s tail” of dorsal and ventral roots reaching out to intervertebral foramina of lumbar and sacral nerves—a result of the continued growth of the vertebral column compared to that of the CNS. Hence, L3-4 and L4-5 make a useful site for lumbar puncture (spinal tap). / bundle of spinal nerve roots running inferior to the spinal cord through the lumbar cistern (subarachnoid space).
central canal
somewhat vestigial, contains CSF, contiguous with ventricles; cervical central canal may be enlarged with syringomyelia
conus medullaris
terminal portion of spinal cord, at about L1-2 in adults.
denticulate ligaments*
pegs of pia mater that help to hold the spinal cord into position in the vertebral canal. / run longitudinally along each side of the spinal cord. These ligaments consist of a fibrous sheet of pia mater extending midway between the posterior and the anterior nerve roots. Between 20 and 22 of these processes, shaped much like sharks’ teeth, attach to the internal surface of the arachnoid-lined dural sac. The superior processes (uppermost part) of the right and left denticulate ligament attach to the cranial dura mater immediately superior to the foramen magnum. The inferior process extends from the conus medullaris passing between the T12 and the L1 nerve roots.
dorsal and ventral ramus (i) of spinal nerves
autonomic components. include the (myelinated) white ramus communicans leading to the sympathetic trunk and the (unmyelinated) gray ramus communicans leading from it. after the mixed spinal nerve is formed at the point of the intervertebral foramen, it splits into a small. dorsal and larger ventral ramus to supply the deep back and the rest of the body wall and limbs, respectively. vertebral facet joints are innervated via branches of dorsal rami of spinal nerves that supply the synovial linings of capsules. Nociceptors are pain receptors that are often free nerve endings, and depending on the nociceptor, can be triggered by mechanical, thermal, chemical, or polymodal means
dorsal root (spinal) ganglion
ROOTLET>ROOT>NERVES FORMING RAMUS. home to the nerve cell bodies of sensory (affeerent neurons w/ cell bodies in dorsal root ganglion
dura mater
the outermost, tough connective tissue meningeal covering that will thin out as spinal nerves reach out peripherally / richly innervated by sensory nerve fibers
dural sac
that part of dura mater inferior to the conus medullaris, so a target for lumbar puncture (spinal tap).
epidural (extradural) space
space between the bony vertebral canal and the meninges covering the spinal cord; useful for epidural anesthesia, e.g., access through sacral hiatus (the “epidural” of labor and delivery)
gray matter with ventral, lateral (intermediate), dorsal horns
gray from neuron cell bodies, ventral horn with lower motor neurons, ventral horn associated with sensory tracts, and lateral horn, present from T1-L2, the location of the cell bodies of the sympathetic preganglionic neurons. (intermediate) horn in the thoracic and lumbar regions where preganglionic (presynaptic) neuron cell bodies originate for the sympathetic nervous system. fuse to form the spinal nerve (that will exit out of an intervertebral foramen between vertebrae). The spinal nerve will then split into a dorsal ramus (“branch”) to the intrinsic (deep) back muscles/overlying skin and a ventral ramus to the rest of the body.
pia mater
most internal meningeal layer, better seen on brain as a sheet, delicate and transparent covering the spinal cord
spinal cord
major component of CNS, 31 pairs of spinal nerves
subarachnoid space
between arachnoid and pia mater, site of CSF (cerebrospinal fluid). / Wispy threads of connective tissue extend from this layer to the underlying pia mater and span the subarachnoid space, which is illed with CSF.
suboccipital nerve (C1)
motor nerve from the posterior rami of C1 to the muscles of the suboccipital triangle
terminal filum (filum terminale)*
connective tissue that connects conus medullaris; may be the basis of tethered cord syndrome / attaches to coccyx
ventral and dorsal roots of spinal nerves
refers to the motor and sensory, respectively, to the mixed spinal nerves
vertebral artery
Vertebral arteries go through transverse foramen into medulla from cervical spine
Spinour process of vertebra- bifold chunk attaching to unchallenged ligament . visible in the suboccipital triangle before entering the foramen magnum / a branch of the subclavian artery. in the lower anterior neck, passes through the transverse foramen of the atlas and loops medially to enter the foramen magnum of the skull to supply the brainstem
white matter
surrounding gray mater region for spinal tracts. posterior funiculus, dominated by the dorsal columns (carries discriminatory senses); lateral funiculus, with corticospinal tract (major motor tract) and spinocerebellar tracts (unconscious proprioception), with anterolateral region dominated by spinothalamic tract (pain and temperature); anterior funiculus, dominated by “extrapyramidal” reticulospinal and vestibulospinal tracts that affect posture.
anterior nasal aperture; maxillary paranasal air sinuses
The paranasal sinuses are air-filled spaces in facial bones. They are lined by respiratory epithelium (pseudostratified, ciliated, epithelium). Palpable sinuses include the frontal and maxillary sinuses.
Sinuses- hollow things out and not so heavy and as resonating center.
Maxillary sinus goes upward causing it to yuck up and fill up before draining
(piriform aperatures); open up into nasal cavities, sinuses, found within many bones, frontal, maxillary, etc. may be better appreciated on x-ray (or on after-dinner commercials for various remedies!)
bregma
junction of coronal/sagittal sutures; used in skull measurement; adult remnant of anterior sagittal suture
calvaria
cranial vault or brain case vs. the facial skeleton vs. the skullcap (calotte) / Most calvarial bones are united by fibrous interlocking sutures; however, during childhood, some bones (sphenoid and occipital) are united by hyaline cartilage (synchondroses).
coronal suture
between frontal and parietal b.
external acoustic meatus
of ear and external acoustic meatus/canal. Auricle with elastic cartilage, and the canal lined with glands that produce cerumen (earwax) that ends in the tympanic membrane. Outer ear funneling sounds, middle ear bones magnify sounds, eustachian or pharyngeal tympanic or auditory tube to rain middle ear from around bone ossicles. Inner ear w/ auditory aspects of cochlea nad semicircular canal of vestibule to help w/ balancing. Much of this is facial nerve (stapedius saying high to faces). external ear canal, often with cerumen (wax) buildup. / leads to the tympanic membrane (eardrum)
frontal b.
in about 10% of population, there’s a remnant of a frontal suture / front of skull into eye holes
frontal sinus
behind superciliary arches within frontal bone; continue to enlarge through puberty and adolescence. If fractured, risk of CSF leakage. / sensory innervation from CN V1 (supraorbital nerve) / between the outer and inner tables of the frontal bone, posterior to the superciliary arches and the root of the nose. Each sinus drains through a frontonasal duct into the ethmoidal infundibulum, which opens into the semilunar hiatus of the middle meatus (Fig. 7.66). The frontal sinuses are innervated by branches of the supra-orbital nerves (CN V1).
hyoid b., body, greater and lesser horns
U-shaped attachment for many neck muscles, can be fractured in (manual) strangulation. Body main part with horns projecting from it.
lambda
junction of lamboid/sagittal sutures; used in skull measurement; adult remnant of posterior fontanel
lambdoid suture
between occipital and parietal b. / unites the occipital bone with the right and left parietal and temporal bones
mandible (body, ramus, angle, condylar process with head and neck, coronoid process)
horizontal body, two rami, angle the posterior body/ramus meeting spot, the head as the surface involved in TMJ (temporomandibular joint), coronoid process anterior to that, for mastication muscle attachment / U-shaped bone forming the lower jaw
mandible b.
single bone; can be dislocated at TMJ. / Lower jaw bone that contains 16 mandibular teeth
maxilla b.
Le Fort type I fracture horizontal through maxillae / Paired bones that form part of the cheek and contain 16 maxillary teeth
mental foramen
in mandible, site of mental n. (branch of CN V3) / side of lower jaw
nasal septum, nasal bone, nasal cartilages
the septum is predominantly perpendicular plate of ethmoid and vomer; think of deviated or perforated septum. The nasal bones make up the bridge of the nose, and several nasal cartilages support the nose shape, septum, etc. / dividing the nasal cavity into right and left parts
occipital b.
contains foramen magnum / The cranial base is formed posteriorly by the occipital bone, which articulates with the sphenoid anteriorly. The parts of the occipital bone encircle the large foramen magnum.
other facial bones: ethmoid b., lacrimal b., palatine b., sphenoid b. (greater and lesser wings), vomer b.
unpaired, midline, much of bony nasal septum
parietal b.
parietal b. parietal (L. wall)
pterion
lateral temporal region where frontal, parietal, temporal, sphenoid meet. Thin part of skull, with middle meningeal artery deep to it, hence risk of epidural hematoma with trauma. / anterior part of the temporal fossa, superior to the midpoint of the zygomatic arch, is the pterion (G. pteron, wing). It is usually indicated by a roughly H-shaped formation of sutures that unite the frontal, parietal, sphenoid (greater wing), and temporal bones.
sagittal suture
between parietal bones / unites the right and left parietal bones
sphenoid sinus
in sphenoid bone, most posterior of sinuses. Drains down into pharynx. One of four paired paranasal sinuses / sensory innervation from CN V2 (orbital branches); the blood supply is from the pharyngeal arteries (from the maxillary artery); the sphenoid sinus drains into the sphenoethmoidal recess above the superior concha.
stylomastoid foramen
pathway for CN VII, vulnerable point for Bell’s palsy within the facial canal that opens into this foramen / lies between the mastoid and styloid processes.
superciliary arch
bony ridge deep to eyebrows, may lead to skin laceration if struck hard
superior*, middle, inferior nasal conchae
the turbinates (covered by respiratory pseudostratified epithelia in situ); useful for humdification, especially large inferior conchae. Superior and middle conchae off of the ethmoid b., while the inferior conchae are separate bones. Superior conchae protect the olfactory bulb, middle conchae cover over the sinus openings.
teeth, alveolar processes
(L. alveolus-little bowl, basin), sockets for teeth, also constitute the supporting bone for the maxillary teeth
