ENT Flashcards
What are the boundaries of the anterior triangle?
Inferior border of the mandible
Anterior border of the sternocleidomastoid
Sagittal line in the midline
What are the borders of the carotid triangle?
Posterior belly of the diagstric muscle
Medial belly of the sternocleidomastoid
Superior belly of the omohyoid muscle
What are the contents of the carotid triangle?
Common carotid bifircation into internal and external carotid
Internal jugular vein
Hypoglossal nerve
Vagus nerve
What are the borders of the submental triangle?
Hyoid bone
Midline
Anterior belly of the digastric muscle
What are the borders of the submandibular triangle?
Body of mandible
Anterior belly of digastric muscle
Posterior belly of digastric muscle
What are the boundaries of the muscular triangle?
Actually has 4 boundaries
Hyoid bone
Midline
Superior omohyoid
Inferior sternocleidomastoid
What are the 4 suprahyoid and 4 infrahyoid muscles in the anterior triangle of the neck?
Suprahyoid - stylohyoid, digastric, mylohyoid, geniohyoid
Infrahyoid - sternohyoid, sternothyroid, omohyoid, thyrohyoid
Within the parotid gland, the facial nerve divides into what 5 branches?
Temporal branch
Zygomatic branch
Buccal branch
Marginal mandibular branch
Cervical branch
Which nerves run through the anterior triangle?
Facial nerve CN 7
Glossopharyngeal CN 9
Vagus CN10
Accessory CN11
Hypoglossal C12
What is the most superficial structure on the parotid gland?
Facial nerve
What muscles are supplied by the ansa cervicalis?
Omohyoid
Sternohyoid
Sternothyroid
What blood vessel runs through the anterior triangle?
Common carotid artery
What are the borders of the posterior triangle of the neck?
Anterior - posterior border of the sternocleidomastoid muscle
Posterior - anterior border of the trapezius
Inferior - medial 1/3 of the clavicle bone
Where is the nerve point in the neck and what is it?
It is on the posterior border of the sternocleidomastoid, at the junction between the superior and middle 1/3 of the muscle.
It is where the 4 cutaneous nerves of the cervical plexus emerge.
What are the 4 cutaneous nerves of the cervical plexus?
Lesser occipital nerve
Greater auricular nerve
Transverse cervical nerve
Superior clavicular nerve
What are the 2 nerves involved in voice production?
Superior laryngeal nerve
Recurrent laryngeal nerve
What nerves are at risk during branchial cyst excision?
Greater auricular nerve
Accessory nerve
Marginal Mandibular branch of facial nerve
Facial nerve palsy and foul smelling ear discharge indicate what?
Cholesteatoma
Severe otalgia and facial nerve palsy in a diabetic would indicate what?
Malignant otitis externa
Which muscle is responsible for ability to sing high notes and which nerve is it innervated by?
Cricothyroid muscle
Superior laryngeal nerve
What salivary gland tumour is most likely in an elderly male smoker?
Warthin tumour
(papillary cystadenoma lymphoma or adenolymphoma)
Benign
Features of basal skull fracture
Hx of head injury
Battle’s sign
Racoon eyes
Unilateral facial nerve palsy
Leaking of CSF - would require antibiotics
What are the histological features of a pleomorphic adenoma?
Biphasic - mixed stromal and epithelial elements
Bilateral parotid swelling, bilateral facial nerve palsy, dry mouth and lethargy would indicate what?
Sarcoid
Where is sialolithiasis most likely to occur?
impacted stone in wharton’s duct (submandibular gland)
What type of cancer is most related to wood work?
Adenocarcinoma of the paranasal sinuses and nasopharynx is strongly linked to exposure to hard wood dust (after >10 years exposure). Most commonly occur in ethmoid sinus.
Presents with nasal pain, anosmia and rhinorrhoea.
Most common malignant tumour of the submandibular gland?
50% are malignant. Most common is adenoid cystic carcinoma
When are you most likely to see bleeding after tonsillectomy?
Primary - within 24 hours
Secondary - 5-10 days
Damage to what nerve causes diplophonia?
recurrent laryngeal nerve
Which nerve is responsible for sensation of the anterior two thirds of the tongue?
Lingual nerve.
Arises from mandibular branch of trigeminal nerve and from chorda tympani of facial nerve. Commonly injured during removal of 3rd molar (wisdom tooth)
Facial nerve bits are for taste sensation. Trigeminal bits are for pain, temperature and sensation
What provides the parasympathetic innervation to the lacrimal gland?
Pterygopalatine ganglion
What nerve is closely related to the middle meningeal artery?
Auriculotemporal nerve - arises from mandibular branch of trigeminal nerve.
It provides sensory innervation to ecternal ear, scalp and temporomandibular joint
At what vertebral level is the hyoid bone?
C3
What muscles does the buccal branch of the facial nerve innervate?
Zygomaticus minor
Buccinator
Levator anguli oris
Orbicularis oris
Nasalis
What nerve innervates the platysma?
Cervical branch of facial nerve
What lesion most commonly arises in the cerebello-pontine angle?
Acoustic neuroma
What nerve is most commonly affected with a cerebello-pontine angle lesion?
Trigeminal nerve
What are the borders of the parotid region?
Superior - zygomatic arch
Inferior - Mandible
Anterior - Masseter
Posterior - Sternocleidomastoid and external ear canal
What duct carries saliva from the parotid gland to the oral cavity and where does it open in the mouth?
Stensen’s duct
Enters oral cavity near 2nd upper molar
The facial nerve divides into what branches within the parotid gland?
Temporal
Zygomatic
Buccal
Marginal mandibular
Cervical
What muscles do the temporal branches of the facial nerve innervate?
Frontalis
Orbicularis oculi
Corrugator superficilli
What muscles do the marginal mandibular branches of the facial nerve innervate?
Mentalis
Depressor labii inferioris
Depressor anguli oris
What muscles do the buccal branches of the facial nerve innervate?
Orbucliaris oris
Buccinator
Zygomaticus
Levator anguli oris
Nasalis
What nerve innervates the masseter?
Mandibular branch of trigeminal nerve (CN V3)
What arteries provide blood supply to the parotid gland?
Posterior auricular artery
Superficial temporal artery
What nerves provide sensory innervation to the parotid gland?
Auriculotemporal nerve (gland)
Great auricular nerve (fascia)
Which nerves supply parasympathetic innervation to the parotid gland?
Glossopharyngeal -> Otic ganglion -> auriculotemporal nerve
Which nerve supplies sympathetic innervation to the parotid gland?
Superior cervical ganglion
Other than the facial nerve and it’s divisions, what structures pass through the parotid gland?
External carotid artery
Retromandibular vein
Auriculotemporal nerve
What is the venous and lymphatic drainage of the parotid gland?
Venous - retromandibular vein
Lymphatic - deep cervical nodes
Where does the common carotid artery bifurcate into the internal and external carotid arteries?
Within the carotid triangle at the level of the superior margin of the thyroid cartilage (C4)
What are the 8 branches of the external carotid artery?
Superior thyroid artery
Ascending pharyngeal artery
Lingual artery
Facial artery
Occipital artery
Posterior auricular artery
Maxillary artery
Superficial temporal artery
What 3 arteries supply the thyroid and what are their routes?
Superior thyroid artery - external carotid
Inferior thyroid artery - thyrocervical trunk (branch of subclavian)
Thyroid ima artery - brachiocephalic trunk
What is the lymphatic drainage of the auricle?
- Lateral surface of the upper half drains to the superficial parotid lymph nodes
- Cranial surface of the superior half drains to the mastoid nodes and deep cervical lymph nodes
- Lower half and lobule drain into the superficial cervical lymph nodes.
What structures pass through the parotid gland?
Facial nerve and branches
External carotid artery (and its branches; the maxillary and superficial temporal)
Retromandibular vein
Auriculotemporal nerve
Which blood vessel is located lateral to the inferior parathyroid gland?
Common carotid
Which nerve provides sensory innervation to the skin overlying the lateral aspect of the nose?
Lateral nasal branches of the anterior ethmoidal nerve
What is berry’s sign?
Absence of carotid pulse due to malignancy thyromegaly
What nerve innervates the buccinator?
Buccal branch of facial nerve
What muscles does the zygomatic nerve innervate?
Orbicularis oculi
What muscles does the marginal mandibular branch of the facial nerve innervate?
Depressor labii inferioris
Mentalis
Deperessor anguli oris
What nerve innervates the nasalis muscle?
Buccal branch of facial nerve
Which muscle and nerve is responsible for sticking out the bottom lip?
Depressor labii inferioris
Marginal mandibular branch of the facial nerve
A neck lump that is CD20 positive indicates what?
B cell lymphoma
What is trotter’s triad? And what does it indicate?
Unilateral conductive hearing loss
Ipsilateral facial & ear pain
Ipsilateral paralysis of soft palate
Nasopharyngeal carcinoma
What virus is associated with nasopharyngeal carcinoma
EBV
What artery supplies the tonsils with oxygenated blood?
Tonsillar artery <- facial artery <- external carotid artery
What nerve provides sensory innervation to the tonsils?
Glossopharyngeal nerve
What is the lymphatic drainage of the tonsils?
Jugulodigastric node and the deep cervical nodes
What are the intrinsic muscles of the larynx? and what are they innervated by?
Circothyroid
Thyroarytenoid
Posterior crcioarytenoid
Lateral cricoarytenoid
Transverse and oblique arytenoids
All the muscles above are supplied by the inferior laryngeal nerve which is the terminal branch of the recurrent laryngeal nerve. Except for the cricothyroid muscle which is innervated by the external branch of the superior laryngeal nerve.
Which laryngeal muscle is the only one to widen the rima glottidis?
Posterior cricoarytenoid
What is the lymphatic drainage of the thyroid?
Paratracheal and deep cervical lymph nodes
What artery is most likely to be injured when undergoing excision of submandibular gland?
Facial artery
What vessel is most likely to be damaged in a tonsillectomy?
External palatine vein
Which nerve wraps around wharton’s duct and as most likely to be damaged in submandibular excision?
Lingual
What organism causes malignant otitis externa?
Pseudomonas aeruginosa
What structures are at risk of injury during a submandibular gland excision?
Lingual nreve - wraps around wharton’s duct
Facial artery
