Clinical Supplement for Head and Neck Flashcards
if you move your eyes upward from normal what muscles are you testing
left and right Inferior oblique and superior rectus
if you move your eyes downward from normal what are you testing
left and right superior oblique and inferior rectus
what muscles are you testing when you look to the left
left medial rectus and right lateral rectus
what muscles are you testing when you look to the right
left lateral rectus and right medial rectus
what muscles are you testing when you look up and out
left inferior oblique and right superior rectus
what muscles are you testing when you look down and to the right
right superior oblique and left inferior rectus
what muscles are you testing when you look down and to the left
left sO
right IR
what muscles are you testing when you look up and to the right
right IO and left SR
diplopia
double vision
hyperacusis
hypersensitivty to soud
to test for facial nerve how would you do it
sensation on face
corneal reflex
clench teeth, palpate masseter
what nerves is really responsible for swallowing
glossopharyngeal
what musles of the tongue is NOT innervated by cn XII
palatoglossus
what nerve is affected by demyelination in MS
CN II
compressive injury of CN III injures
GVE
diabetic infarct of CN III injures
GSE
vertibal diplopia is associated with
trochear nerve injury ; improved by tilting head away from affected eye ( if left eye is injured you tilt your head to the right) eye is hypertropic and extorted
mandibular nerve V3 can be injured in what foramen
foramen ovale
maxiillary nerve V2 can be injured
within the formanen rotundum
opthalmic nerve can be injured
SOF
signs of injury to the abducens CN VI nerve
horizontal diplopia, cannot abduct eye, esotropia (parially adducted)
greater petrosal nerve forms with the deep petrosal nerve to form
nerve of the pterygoid canal
chorda tympani joins _______ and synapses in ______________ to distribute with branches of that nerve.
lingual, submandibular ganglion
vestibular schwannoma can impact which cranial nerves
CN V and VII
what is the spinal cord level of spinal accessory nerve
C1-C4
injury in the posterior triangle of the neck spares what muscle
sternocleidomastoid
C1 is off what nerve
hypoglossal n
C1 carried on hypoglossal innervates
thyrohyoid, geniohyoid and contributes to the superior root of ansa cervicalis
what are the four sensory ganglia in the head
trigeminal
geniculate
superior and inferior
superior and inferior
trigeminal sensory ganglia is associated with what cranial nerve
CN V
geniculare sensory ganglia is associated with what nerve
VII
superior and inferior ganglia are associated with
CN IX and CN X
ciliary ganglia is
parasympathetic for CN III
otic ganglia is parasympathetic to
CN IX
pterygopalatine is parasympathetic to
CN VII
submandibular is parasympathetic to
CN VII
injury to jugular foramen may result in injury to what nerves
9 10 and 11
infections in the deep, loose connective tissue layer can spread into the cranial cavity via
emissary veins
what nerve transverses the parotid gland
facial VII
autonomic innervation of the parotid gland is by
CN IX otic ganglion hitchhiking auriculotemporal nerve
where does the parotid gland get its sensory information from
CN V
freys syndrome
sweating when seeing or smelling food
what type of join is TMJ
plane gliding AND hinge
sensory innervation of TMJ is
auriculotemporal nerve
accomodation requires what three things for near vision
bilateral contraction of medial rectus
constriction of the pupil (GVE)
contraction of ciliary muscles (GVE) and subsequent thickening of the lens gives more refractive power
what is anisocoria
left right asymmetry in the size of the pupils
cranial nerve injury III results in…..
mydrasis (abnormal dilation) and possible ptosis and diplopia
The pupil in horner’s syndrome
miosis in affected eye and ptosis(mild)
argyll-robertson pupil
associated with neurosyhillis, pupil reepons to accomodation but not to light
marcus gunn pupil
swinging light test, affected eye dialates
pupilary reflex
in by 2 out by 3
corneal reflex
in by 5 out by 7
tearing reflex
in by 5 out by 7
jaw jerk reflex
in by 5 out by 5
blink to startle reflex
in by 2 out by 7
tracheostomy
trachea is incised in the midline between the infrahyoid and between the 1,2 or 2 through 4th rings
structures in danger in a tracheostomy
inferior thyroid veins, thyroid ima artery, left brachiocephalic and thymus
recurrent laryngeal nerve innervates all muscles of the larynx except for
cricothyroid muscle
cricothryoid innervated by
external laryngeal nerve
injury to external laryngeal nerve results in…
monotonous speech
dehiscence of killian
unsupported region along the posterior pharyngeal wall between the crico and thyropharyngeus muscles
zenker’s diverticulum
pouch of pharyngeal mucosa that emerges through killians dehiscence
all pharyngeal muscles are innervated by ___ except for _________ which is innervated by ______-
vagus, stylopharyneus, glossopharyngeal
Waldeyer’s ring
ring of lymphatic tissue guarding entry into the pharynyx composed of lingual tonsil, palatine tonsils, tubal tonsils and pharyngeal tonsils and diffuse lymphatic tissue
what two structures are in danger when the palatine tonscils are removed
glossopharyngeal and tonsilar artery from facial
adenoiditis
enlargement of pharyngeal tonsils, can obstruct blood flow from the nasal cavity and spread to the middle ear via the pharyngotympanic tube
ludwigs angina
tooth main from infection
motor innervation of the tongue muscle s
hypoglossus
palatoglossus innervated by
vagus
anterior 2/3 taste of tongue is
CN VII via lingual nerve geniculate ganglion
posterior 1/3 taste of tongue
CN IX
special sensory of root of tongue is
CN X internal laryngeal
tip of tongue lymph drainage
bilaterally to submental nodes
body center of tongue lymph drainage
inferior deep cerival (juguloomohyoid)
right and left portions of tongue drain to
submandibular nodes
center root of tongue drains
bilaterally to superior deep cervical (jugulodigastric)
right and left portions of root of tongue lymph drainage
deep cervical nodes
mastoid lymph nodes drain
most of the external ear and external meatus
parotid lymph nodes drain
middle ear and external meatus
submandibular lymph nodes drain
paranasal sinus, oral cavity, tongue
submental lymph nodes drain
tip of tongue, median part of oral cavity, and central part of lower lip
retropharyngeal lymph nodes drain
auditory tube
all lymph from thehead converges to
deep cervical lymph nodes
what are the two deep cervical lymph nodes
superior. jugulodigastric
inferior-juguloomohyoid
jugulodigastric receives lymph from
palatine tonsils, paranasal sinuses and oral cavity drain submandibular lymph nodes, upper pharynx and drain to jugular lymph trunk
juguloomohyoid
receives lymph from median portion of body of tongue, lower larynx, superior deep cervical nodes and drains to jugular lymph trunk
level 1 lymph nodes
submental, submandibular
level 2 lymph nodes
superior deep cervical, from skull base to hyoid
level 3 lymph nodes
nodes along the middle 1/3 of the internal jugular
level 4 lymph nodes
inferior deep cervical; lower 1/3 of the internal jugular to clavicla
level 5 lymph nodes
posterior triangle
level 6 lymph nodes
prelaryngeal, pretracheal, midline between hyoid and sternal notch
level 7 lymph nodes
superior mediastinal, below sternal notch between common carotid artery
frontal sinus drains to
middle meatus via frontonasal duct
ethmoid sinus drains to
posterior air cell to superior meatus
middle and anterior air cell to middle meatus
maxillary sinus drains to
nasal cavity via hiatus semilunaris
sphenoid sinus drains to
anterior wall to sphenoethmoidal recess
sphenoid sinus is medial to
cavernous sinus
what nerve runs along the sphenoid sinus floor
nerve to pterygoid canal
what is the plexus associated with nose bleeds
kiesselbach’s plexus
kiesselbach’s plexus has contributions from what arterys
sphenopalatine
greater palatine
anterior ethmoidal
superior labial
shape of subdural hematoma
cresent shaped hematome
epidrual hematome
damage to middle meningeal arteyr
shape of epidural hematoma
lens shaped
subarahcnoid hematome
damage to arteries from circle of wilis
which cranial nerve actually passes through the cavernous network of veins
CN VI
which cranial nerves pass laterally through the cavernous sinus
3,4,5 (only parts)
myopia
nearsightedness; focus of objects is in front of the retina
hypperopia
farsightedness; focus of objects is behind the retina
retinal detachment
seperationg of the neural retina from the pigmented epithelium -blindness in parts of the field
macula
only contains coans-highest visual acuity
glaucoma
increased intraocular pressure from poor drainage or over production of aqueous humor
cataract
opacity of the lens
optic disc
no photoreceptors in this region-blind spot
papilledma
building of optic disc from intracranial pressure
central artery of the retina
terminal from ICA, blockage will result in sudden blindness
tear production is controleed by
VII
middle ear infection can spread to the
mastoid sinus, pharnyx, endager chorda tympani, CNVII and CN IX, middle cranial fossa
myringotomy/tympanostomy
perforation of the inferior aspect to the tympanic membrane to release pus from otitis media or place tubes
hyperacusis
parlysis of the nerve to stapedius (CN VII injury) resulting in increased perception of loundess
cranial nerve 5 and 6 palsy from ititis media called
gradenigos syndrome
infections between the investing fascia and the pretracheal fascia can spread
into superior mediastinum
infections within the prevertebral fascia can
extend laterally to posterior border of SCM
infections between the buccopharyngeal fasia and the alar fascia can extend
lower cervical levels
infections between alar/buccopharyngeal fascia and the prevertebral elvel can extend
to diaphragm
subclavian vein puncture can injur
first rib, phreniv nerve, subclavian arteyr and cupula of lung
right IJV can be punctured
lateral to common carotid between sternal and clavicular heads of SCM
what muscle does the phrenic nerve course along
anterior scalene
the descending branch of the occipital artery anastomoses with
vertebral and deep cervical arteries
during a carotid endarterectomy what nerves can be injured
9, 10,11, 12 and sympathetic trunk
symptoms of horner’s syndrome
flushing of face
ptosis
anhydrosis
miosis
horner’s without anhydrosis and flushing is
lesion of internal carotid nerve sparses the carotid nerve
when superior thyroid artery is ligated what nerve is at risk
external larngeal
when the inferior thyroid artery is ligated what nerve is at risk
recurrent laryngeal
