Clinical Head And Neck 1 Flashcards
What is the cavernous sinus?
The cavernous sinus, a large venous plexus, is located on each side of the sella turcica on the upper surface of the body of the sphenoid, which contains the sphenoid (air) sinus.
• The cavernous sinus consists of a venous plexus of extremely thin-walled veins that extends from the superior orbital fissure anteriorly to the apex of the petrous part of the temporal bone posteriorly. It receives blood from the superior and inferior ophthalmic veins, superficial middle cerebral vein, and sphenoparietal sinus.
What are cavernous sinus syndromes?
Cavernous sinus syndromes refer to constellations of clinical signs and symptoms referable to pathology within or adjacent to the cavernous sinus
Describe the clinical presentation of cavernous sinus syndrome
Patients present with multiple unilateral cranial neuropathies involving any combination of the following:
- ophthalmoplegia (cranial nerves III, IV, or VI), most commonly presenting as diplopia
- facial sensory loss (cranial nerves V1 and V2)
- Horner syndrome (oculosympathetic fibers)
- Pain can occur, especially with inflammatory processes.
- Additional symptoms may be vascular in origin:
* Chemosis
* Proptosis
What is the significance of herpes?
• Viral disease characterized by a painful skin rash with blisters in a localized area.
• The pre-eruptive phase:
Sensory phenomena along one or more dermatomes
• The acute eruptive phase:
Patchy erythema, occasionally accompanied by induration, in the dermatomal area
of involvement
Where were the viral particles lying dormant before the development of this condition?
What is the significance of inferior. Alveolar Nerve Damage?
Inferior alveolar nerve injuries are most common iatrogenic post third mandibular molar extraction although they can occur post dental implant or in mandibular fractures. This article is focused on iatrogenic injuries.
What are the functions and nuclei of an Oculomotor nerve?
Functions: Somatic motor (general somatic efferent) and visceral motor (general visceral efferent parasympathetic).
• Nuclei: There are two oculomotor nuclei, each serving one of the functional components of the nerve.
- The somatic motor nucleus of the oculomotor nerve is in the midbrain.
- The visceral motor (parasympathetic) accessory (Edinger-Westphal) nucleus of the oculomotor nerve lies dorsal to the rostral two thirds of the somatic motor nucleus
What are the types of aneurysm?
- Saccular - (most common, also called “berry”)
- Fusiform - the aneurysm bulges in all directions and has no distinct neck.
- Giant - may be saccular or fusiform and measures more than 2.5 cm in diameter
- Traumatic - caused by a closed head injury or penetrating trauma to the brain.
What are the most common sites of intracranial saccule aneurysms?
- Anterior communicating artery
- Posterior communicating artery
- Middle cerebral artery
- Internal carotid artery
- Basilar artery
What lies anteriorly of scalene anterior muscle?
Anteriorly
• phrenic nerve, vagus nerve
• ascending cervical artery, transverse cervical artery, suprascapular artery
• internal jugular vein, subclavian vein
• sternocleidomastoid muscle, omohyoid muscle
• clavicle
What lies posteriorly to the anterior scalene muscle?
- Posteriorly
- second portion of subclavian artery (which is divided in three parts by the muscle)
- scalenus medius muscle
- anterior rami of C3-T1
What lies medially to the scalene anterior muscle?
- common carotid artery, first portion of subclavian artery, thyrocervical trunk, vertebral artery and vein
• stellate ganglion
• thoracic duct (left) or right lymphatic duct (right
What lies Laterally to the scalene anterior?
Laterally
• trunks of brachial plexus
• third portion of subclavian artery
What is Horner syndrome?
• Pupillary constriction due to paralysis of the dilator pupillae muscle
• Partial ptosis (drooping of the upper eyelid) due to paralysis of the
tarsal muscle
- Absence of sweating on the ipsilateral side of the face and the neck due to absence of innervation of the sweat glands
- Dilation of blood vessels (flushing)
What causes Horner syndrome?
The ptosis is a consequence of paralysis of the smooth muscle fibers interdigitated with the aponeurosis of the levator palpebrae superioris that collectively constitute the superior tarsal muscle, supplied by sympathetic fibers
• Constriction of the pupil occurs because the parasympathetically stimulated sphincter of the pupil is unopposed
