ENT anatomy Flashcards
what are the small hairs in the nasal cavity called
vibrissae
what kind of cartilage is nasal cartilage
hyaline
what bone forms part of the roof, lateral walls and septum of the nasal cavity
ethmoid bone
what bone separates the nasal cavities from the anterior cranial fossa
cribriform plate of the ethmoid bone
what fractures can disrupt the cribriform plate of the ethmoid bone
le fort II and III
basilar skull fractures
what cells line the nasal vestibule
stratified squamous epithelium (keratinised to non-keratinised)
what 2 types of lining are found in the nasal cavity
respiratory epithelium (majority) olfactory epithelium
what cells make up respiratory epithelium
ciliated pseudo-stratified columnar epithelium with goblet cells
what is the special sensory nerve of olfaction
CN I (olfactory nerve)
olfactory pathway; receptor cells in the \_\_\_\_ \_\_\_\_ pass up through the \_\_\_\_ \_\_\_\_ synapse with the \_\_\_\_ \_\_\_\_ neurones pass along the \_\_\_\_ \_\_\_\_ to the \_\_\_\_ lobe and \_\_\_\_\_ \_\_\_\_\_
receptor cells in the olfactory epithelium pass up through the cribriform plate synapse with olfactory bulb (ganglion) neurones pass along the olfactory tract to temporal lobe and olfactory areas
what are the 3 somatic sensory nerves to the nasal cavities
anterior ethmoidal nerve
nasopalatine nerve
greater palatine nerves
what is the anterior ethmoidal nerve a branch of
the nasocilliary nerve which is a branch of CN V1
what are the nasopalatine nerve and greater palatine nerves a branch of
what do they pass through?
branch of CN V2
sphenopalatine foramen
the sphenopalatine and greater palatine arteries are branches of
maxillary artery from ECA
the superior labial artery and lateral nasal and septal branches are branches of
facial artery from ECA
anterior and posterior ethmoidal arteries are branches of
ophthalmic artery from ICA
what do you call the anastomosis between the septal branch of - superior labial - anterior and posterior ethmoidal - greater palatine - sphenopalatine arteries and where is it found?
Kiesselbach’s area (little’s)
anteroinferiorly on nasal septum
which of the nasal concha has its own bone and isn’t part of the ethmoidal bone?
inferior
what is the sensory supply of the inferior concha
CN V2
what can an untreated septal haematoma lead to
AVN of septal cartilage (relies on nutrient diffusion)
what is another name for the maxillary sinuses
antra
what is the lining of the sinuses
respiratory
where does the sphenoid sinus drain
sphenoethmoidal recess
where do the posterior ethmoidal air cells drain
superior meatus
where do the anterior ethmoidal air cells drain
semilunar hiatus in the middle meatus
where do the middle ethmoidal air cells drain
ethmoidal bulla in the middle meatus
where does the maxillary sinus drain
semilunar hiatus in the middle meatus
where does the frontal sinus drain
semilunar hiatus in the middle meatus
where does the nasolacrimal duct drain
inferior meatus
what causes facial pain that is worse on bending forward
sinusitis
why might sinusitis be referred to the teeth presenting as tooth ache
sensation provided by CN V1 and CN V2
what sinus would be effected if the pain from sinusitis was felt between the eyes
ethmoidal air cells
give 2 things that interfere with cilia movement and cause less mucous to be drained out leading to infection
cold weather
smoking
what sinus is predisposed to infection and why
maxillary
ostium is located superiorly so cilia have to work against gravity
what is the pterion
H shaped suture of frontal parietal temporal sphenoid bones
what 2 nerves go through the internal acoustic meatus
CN VII (facial nerve) CN VIII (Vestibulocochlear nerve)
what is the nerve of balance and hearing
CN VIII (Vestibulocochlear nerve)
what is the motor nerve supply of the face
CN VII (facial nerve)
what 2 blood vessels go through the internal acoustic meatus
labyrinthine artery and vein
what is the taste supply to the anterior 2/3 of the tongue
CN VII (facial nerve)
what makes up the external ear
auricle to tympanic membrane via external acoustic meatus
what part of the ear converts special sensory information into fluid waves –> then APs –> then to brain
inner ear
what part of ear collects and conveys sound waves to tympanic membrane
external ear
what part of the ear contains the eustachian tube
middle ear
what part of ear amplifies and conducts sound waves to the inner ear
middle ear
what makes up the middle ear
tympanic membrane to oval window
what makes up the inner ear
oval window to internal acoustic meatus
what kind of cartilage makes up the external ear
elastic
what are the glands called that produce ear wax
ceruminous glands
how does the external ear cartilage get nutrients
avascular so gets nutrients from skin
what proportion of the ear canal is cartilage and what is bone
1/3 cartilage
2/3 bone
what lines the ear canal
skin
are there ceruminous glands in the ear canal?
yes
what is the nerve supply of most of the tympanic membrane (external surface)
CN V3 (auriculotemporal nerve branch)
what is the nerve supply of superior parts of the external acoustic meatus
CN V3 (auriculotemporal nerve branch)
what is the main sensory supply of the auricle and ear lobe
C2 and C3 cranial nerves
greater auricular nerve and lesser occipital nerve - branches of cervical plexus
what nerve supplies small amount of sensory innervation around external acoustic meatus entrance
CN VII (facial nerve)
what nerve supplies inferior parts of external acoustic meatus and some tympanic membrane (external surface)
CN X (vagus nerve)
where does drainage of the auricle end up
deep cervical lymph nodes in carotid sheath
then left to thoracic duct, right to right lymphatic duct at venous angles
what 3 groups of lymph nodes drain the auricle
parotid lymph nodes
mastoid lymph nodes
superficial cervical lymph nodes
how should the auricle be pulled in the otoscopic examination of
- a child
- an adult
child - posteroinferiorly
adult - posterosuperiorly
what is the name for the most inwardly depressed part of tympanic membrane
umbo
of the pars tensa and pars flaccida which is thicker
pars tensa - thick part of tympanic membrane
pars flaccida - thin part of tympanic membrane (superiorly)
what nerve would cause referred pain to the ear from
- geniculate herpes
- sphenoid damage
- nasal pathology
CN VII (facial nerve) - post auricular branch
what nerve would cause referred pain to ear from
- tonsillitis
- posterior 1/3 tongue
- pharyngitis
CN IX (glossopharyngeal nerve) - tympanic branch
what nerve would cause referred pain to ear from
- piriform fossa/larynx
CN X (vagus nerve) - auricular branch
what nerve would cause referred pain to ear from
- tooth ache
- TMJ lesions
- salivary gland disease
CN V3
- auriculotemporal nerve
what nerve supplies the internal surface of the tympanic membrane
CN IX (glossopharyngeal)
what nerve supplies sensory innervation to the middle ear
CN IX (glossopharyngeal)
what are the 3 bones contained in the middle ear
malleus
incus
stapes
what are the 2 muscles contained in the middle ear
stapedius
tensor tympani
what is the motor supply of the stapedius?
what is the sensory supply of the stapedius?
CN VII (facial nerve CN IX (glossopharyngeal nerve)
what is the motor supply of the tensor tympani
CN V3
what 2 nerve branches does the middle ear contain
facial nerve (CN VII) glossopharyngeal nerve (CN IX)
what kind of joints are the joints between the auditory ossicles
synovial joints
what forms the umbo
handle of malleus adherent to internal aspect of tympanic membrane
where does the base (footplate) of the stapes fit
into oval window
what part of the temporal bone is the tympanic cavity located
petrous part
what is the connection from the epitympanic recess to the mastoid process called
aditus
what is the promontory
bony swelling on medial wall of tympanic cavity formed by cochlea of internal ear
what is the name of the tube that connects the anterior wall of the middle ear cavity to nasopharynx
eustachian tube
what is the sensory supply of the eustachian tube
CN IX (glossopharyngeal)
what is the sensory supply of the laryngopharynx
CN X (vagus nerve)
what nerve should be checked in any facial swelling
facial nerve
where is the connection of the facial nerve to the CNS
pontomedullary junction (only CN VII and CN VIII)
what cranial nerve has the longest base of skull foramen part of course
facial nerve
why might food be less pleasurable if the facial nerve was affected
supplies taste buds of anterior 2/3 of tongue via chorda tympani branch
why might you get dry eyes leading to infection in a facial nerve palsy
facial nerve supplies orbicularis oculi - muscle of facial expression responsible for blinking
what gland does the facial nerve pass into
parotid gland
true or false
the facial canal courses through petrous temporal bone of both internal and middle ear
true
what is the smallest skeletal muscle in the body
stapedius
what is the parasympathetic supply of the submandibular and sublingual salivary glands (secretomotor)
chorda tympani - branch of CN VII - joins with lingual nerve of CN V3
the motor function of what nerve would be tested by asking a patient to frown, close eyes tightly, smile and maintain puffed out cheeks
CN VII (facial nerve)
loss of what in the face in illness is an indication of malnutrition
buccal fat pad
what is the name of the border of the lips
vermillion border
what is the name of a facial nerve palsy
bells palsy
what fluid is contained in the bony labyrinth of the otic capsule
perilymph (like ECF)
what does the membranous labyrinth float in
perilymph
what fluid is contained in the membranous labyrinth of the otic capsule
endolymph (like ICF)
how many turns is the cochlea
2.5
what is the cupula
apex of spiral of cochlea
what nerve conducts APs to brainstem from cochlear duct
cochlear nerve (branch of CN VIII)
what nerve conducts APs to brainstem from semicircular ducts
vestibular nerve (branch of CN VIII)
what detects angular movement change
semicircular ducts
what detects liner movement change
- horizontal
- vertical
horizontal - utricle
vertical - saccule
how are hair cells in the vestibular apparatus stimulated
movement of endolymph
what detects auditory stimuli
receptor cells in organ of corti in cochlear apparatus
located on basilar membrane of cochlear duct
what are the 2 parts of the cochlear canal
scala vestiboli and scala tympani
sound transmission
sound waves make _ _ vibrate
vibrations are transmitted through _
base of _ vibrates in _ window
vibration of stapes creates pressure waves in _
_ cells in cochlea are moved –> APs are stimulated and conveyed to brain by _ nerve
pressure waves descend and become vibrations again
pressure waves are dampened at the _ window
sound transmission
sound waves make tympanic membrane vibrate
vibrations are transmitted through ossicles
base of stapes vibrates in oval window
vibration of stapes creates pressure waves in perilymph
hair cells in cochlea are moved –> APs are stimulated and conveyed to brain by cochlear nerve
pressure waves descend and become vibrations again
pressure waves are dampened at the round window
where do vestibular nerve axons come from
semicircular ducts, saccule and utricle
what are the muscles of the floor of the mouth
geniohyoid and mylohyoid
what is the nerve supply of the geniohyoid
C1 via hypoglossal nerve
what is the nerve supply of the mylohyoid
CN V3
what muscle does the parotid duct pierce
buccinator
where does the parotid duct secrete
by the upper 2nd molar
which duct enters floor of mouth and secretes via lingual caruncle
submandibular
which glands lay in floor of mouth and secrete via several ducts superiorly
sublingual
what is the parasympathetic nerve supply to the submandibular gland (secretomotor)
CN VII
what is the parasympathetic nerve supply to the parotid gland
CN IX (hitches a ride on auriculotemporal branch of CN V3)
what supplies taste and general sensory to posterior 1/3 tongue
CN IX
what supplies general sensory to anterior 2/3 tongue
CN V3
what are the 3 papillae with taste buds
follate vallate fungiform
what is the papillae without taste buds
filiform
what is the problem in someone who is ‘tongue tied’
frenulum is too short
what are the 4 extrinsic muscles of the tongue
hyoglossus
palatoglossus
styloglossus
genioglossus
what is the nerve supply of the palatoglossus
CN X
what is the nerve supply of the hyoglossus, styloglossus and genioglossus
CN XII (hypoglossal nerve)
where does the hypoglossal nerve attach to the CNS
many rootlets at medulla oblongata
what nerve is clinically tested by asking a person to stick their tongue straight out and what would happen in a palsy of this nerve?
nerve tested - hypoglossal CN XII
normal - tongue remains in midline
if unilateral damage, the tongue will point towards the side of injured nerve
what foramen does the hypoglossal nerve travel through
hypoglossal canal
arteries pass medial/lateral to the hyoglossus
nerves pass medial/lateral to the hyoglossus
arteries pass medial
nerves pass lateral
the lingual artery is a branch of the
ECA
what are the regional lymph nodes of the tongue
submental nodes
what cells make up the hard palate
keratinised squamous epithelium
what passes through the greater and lesser palatine foramina
branches of CN V2 and maxillary artery
what cells make up the soft palate
non-keratinised stratified squamous epithelium
what is the muscle that tenses the soft palate (tenses the palatine aponeurosis)
tensor veli palatini
what is the muscle that lifts the soft palate (lifts palatine aponeurosis)
levator veli palatini
what is the muscle that lifts pharynx and thyroid cartilage
palatopharyngeus (posterior arch)
what is the muscle that brings tongue and soft palate together
palatoglossus (anterior arch)
what is the muscle that shortens the uvula
musculus uvulae
what nerve innervates the muscles of the soft palate except the tensor veli palatini
CN X
what nerve innervates the tensor veil palatini
CN V3
how do you clinically test the CN X innervation of the soft palate
what is seen in a nerve palsy
get patient to say ahh
normally uvula should lift straight up
if unilateral damage the uvula will be pulled away from the non-functioning side
what are the outer circular muscles of the pharynx
are they skeletal?
3 constrictor muscles
skeletal (voluntary)
what does sequential contraction of these muscles do
pushes food bolus inferiorly towards the oesophagus
what nerve innervates the outer circular muscles of the pharynx
CN X
via pharyngeal plexus
where do the outer circular muscles of the pharynx insert posteriorly
midline raphe
what are the 3 paired inner longitudinal muscles of the pharynx
stylopharyngeus
palatopharyngeus
salpingopharyngeus
what nerve innervates all of the pharyngeal muscles except for stylopharyngeus
CN X
what nerve innversates the stylopharyngeus
CN IX
what is the function of the inner longitudinal muscles of the pharynx
elevate pharynx and larynx
what is the opening that connects the pharynx to the larynx
laryngeal aditus
what lymph nodes drain the palatine tonsil
jugulo-digastric node
where are the deep cervical nodes found
in the carotid sheath
features of an infected node
swollen painful soft smooth not fixed to adjacent structures improves with antibiotics
features of a cancerous node
swollen not painful hard irregular fixed to adjacent structures doesn't improve with antibiotics
what is the motor innervation of the larynx
CN X
what fascia is the larynx found in
visceral layer of pre tracheal fascia
the strap muscles, thyroid, trachea, larynx, oesophagus and pharynx and recurrent laryngeal nerves are all found in what fascia
pretracheal
what is the name of the space between the epiglottis and tongue
vallecula
what is the name of where the vocal cords meet
anterior commissure
what are the true vocal cords
vocal processes of arytenoid cartilage to thyroid cartilage
what are the false vocal cords
between arytenoid cartilage to epiglottis (vestibular folds)
are the true or false vocal cords more superior
false
what kind of epithelium are the true vocal cords
stratified squamous epithelium
what nerve innervates the intrinsic skeletal muscles of the larynx
CN X
tension of the vocal cords does what to sound
increases pitch
relaxation of the vocal cords does what to sound
decreases pitch
adduction of the vocal cords does what to sound
quieter
abduction of the vocal cords does what to sound
louder
what muscles are the tensors of the vocal cords
cricothyroid muscles
what muscles are the relaxers of the vocal cords
thyroarytenoid muscles
what muscles are the adductors of the vocal cords
lateral circo-arytenoid muscles arytenoid muscles (oblique and transverse bands)
what muscles are the abductors of the vocal cords
posterior circo-arytenoid muscles
what larynx muscles contract in forced respiration
posterior circo-arytenoid muscles
what larynx muscles contract in phonation
arytenoids contract - assist lateral crico-arytenoid muscles
what larynx muscles contract in whispering
lateral circo-arytenoid muscles
where would a supraglottic tumour drain
superior deep cervical lymph nodes
where would a glottic tumour present
on vocal cords
how might a glottic tumour present
voice changes / airway obstruction
where would a subglottic tumour spread
paratracheal nodes
how might a subglottic tumour present
voice changes / airway obstruction
what nerve would cause the soft palate to tense and elevate in oral sounds (most vowels and consonants) or descend in nasal sounds (m n or ing)
soft palate tense - CN V3
and elevate/descend - CN X
what nerve causes the tongue to interrupt sound
CN XII
what nerve causes the teeth/lips to interrupt sound
CN VII
CN X supplies the larynx
3 of its branches are the inferior, internal and external laryngeal nerves
what do they supply specifically?
inferior = all intrinsic muscles except cricothyroid and mucosa below folds internal = mucosa above folds external = motor to cricothyroid muscle
how can you clinically test the CN X to the pharynx
ask patient to swallow water and watch larynx move up and down - do they splutter?
how can you clinically test the CN X to the larynx
listen to patient speak
ask patient to cough - is it normal and powerful? - also requires functioning diapragm etc
what foramen does CN X pass through
jugular foramen
how does CN X descend in the neck
in carotid sheath
when do pharyngeal arches develop
weeks 4/5
what are the pharyngeal clefts made up of
ectoderm
what are the pharyngeal pouches made up of
endoderm
what prevents anterior dislocation of the TMJ
zygomatic process
where does the TMJ sit
mandibular fossa
what kind of fracture can damage the nasolacrimal duct
Le fort I
how would infection spread from the middle ear to the mastoid process causing mastoiditis
aditus
what bones make up the anterior cranial fossa
frontal
ethmoid
sphenoid
what bones make up the middle cranial fossa
sphenoid
temporal
parietal
what bones make up the posterior cranial fossa
temporal
occipital
parietal
what vertebra level is the hyoid bone
C3
what vertebra level is the cricoid cartilage
C6
what vertebra level is the larynx –> trachea
C6
what vertebral level is the pharynx –> oesophagus
C6
what kind of joint is the cricothyroid joint
synovial
what muscle makes up the upper oesophageal sphincter
cricopharyngeus
what is the name of the smooth muscle completing the posterior wall of the trachea
trachealis
what is the secretomotor supply to the lacrimal gland
CN VII
