Exam 1 Flashcards
Motor innervation to muscles of facial expression via branches of
Facial nerve (CN VII)
Sensory innervation to face via branches of
Trigeminal nerve (CN V)
3 major branches of trigeminal nerve
Ophthalmic
Maxillary
Mandibular
Ophthalmic Nerve distribution
Face and scalp
Maxillary nerve distribution
Cheek and area lateral to orbit
Mandibular nerve distribution
Chin and temporal Region
Branches of Ophthalmic Nerve
Supraorbital N Supratrochlear N External Nasal N Infratrochlear N Lacrimal N
Branches of Maxillary N
Zygomaticotemporal N
Zygomaticofacial N
Infraorbital N
Branches of Mandibular N
Auriculotemporal N
Buccal N
Mental N
Most frequently injured nerve with blows to face; common in boxers
Infraorbital nerve
Tear production
Lacrimal N
Supplies cheek
Buccal N
Supplies chin
Mental N
Trigeminal Neuralgia (Tic Douloureux)
Sudden attaches of severe pain occurring in area of sensory distribution of trigeminal nerve
Often due to touch
Branches of CN V affected in Trigeminal Neuralgia (Tic Douloureux)
Maxillary division (MC) Mandibular division (2nd MC) Ophthalmic division (lease common)
Spinal trigeminal nucleus extends down to ___ and is involved with ___ from the face
C4
Pain reception
Sensory innervation o posterior aspect of neck and scalp from
Dorsal primary rami of cervical nerves 2-4
Greater Occipital N from
Posterior primary ramus of C2
Greater Occipital N supplies
Occipital region
Third Occipital N from
Posterior primary ramus of C3
Third Occipital N supplies
Upper part of back of neck
Posterior Primary Ramus of C4 supplies
Lower part of back of neck
__ is strictly motor nerve
C1
Sensory innervation of anterior and lateral aspect of neck from
Ventral Primary rami of cervical nerves 2-4
Cervical Plexus formed by
Anterior primary rami of C1-C4
C5-C8 supply sensory innervation to skin of
Upper limb
*brachial plexus
Lesser Occipital N
C2
Lesser Occipital N supplies
Lateral part of occipital region, posterior to ear
Great Auricular N
C2
C3
Great Auricular N supplies
Angle of mandible
Area inferior to ear
*accompanies external jugular vein
Transverse Cervical N
C2
C3
Transverse Cervical N supplies
Anterior surface of neck (throat)
Supraclavicular N
C3
C4
Supraclavicular N supplies
Lateral surface of neck
3 subdivisions of Supraclavicular N
- Medial Supraclavicular N
- Intermediate Supraclavicular N
- Lateral Supraclavicular N
Parts of Ansa Cervicalis
Superior Root (C1 or C1 and C2)
Inferior Root (C2 and C3)
Ansa Cervicalis supplies 3 of 4 infrahyoid muscles:
Sternohyoid
Sternothyroid
Omohyoid
Thyrohyoid (4th infrahyoid muscle) receives innervation from
C1 via hypoglossal nerve
Phrenic N originates from
C3, C4, C5
Phrenic N is motor to ___ and sensory to some membranes of __ and ___
Diaphragm
Thorax and abdomen
Platysma
Origin
Superficial Fascia over pectoralis major and deltoid Muscles
Platysma
Insertion
Lower border of mandible and angle of mouth
Platysma
Nerve
Cervical branch of facial N (CN VII)
Platysma
Function
Depresses mandible and draws down corner of mouth
Sternocleidomastoid
Origin
Sternal head from front of manubrium, clavicular head from medial third of clavicle
Sternocleidomastoid
Insertion
Lateral surface of mastoid process, lateral half of superior nuchal line
Sternocleidomastoid
Nerve
Accessory N (CN XI)
Sternocleidomastoid
Function
Chief flexor of head
Torticollis
Pathological contraction of Sternocleidomastoid
Head tilted toward, face turned away from affected side
Types of Torticollis
- Congenital
- results from fibrous tissue tumor - Muscular
- due to birth injury - Spasmodic
- abnormal tonicity
Trapezius
Origin
External occipital protuberance
Ligamentum nuchal
Spinous process of 7th C and all T
Trapezius
Insertion
Lateral third of clavicle, spine of scapula, acromion process
Trapezius
Nerve
Accessory N (CN XI) C3 and C4 from cervical plexus
Trapezius
Function
Upper portion elevates, middle portion retracts, lower portion depresses scapula
External jugular vein drains
Face and scalp
External jugular vein formed immediately below
Parotid gland
Union of __ and __ makes up external jugular vein
Retromandibular vein
Posterior Auricular vein
Tributaries of external jugular vein
Retromandibular vein Posterior Auricular vein Posterior external jugular vein Anterior jugular vein Transverse cervical vein Suprascapular vein
Prominent external jugular vein can indicate
Congestive heart failure or obstruction of superior vena cava
___ triangle lies in front of sternocleidomastoid
Anterior triangle
___ triangle lies behind sternocleidomastoid
Posterior triangle
Boundaries of posterior triangle
Anterior : posterior border of sternocleidomastoid
Posterior: anterior border of trapezius
Inferior: superior border of middle third of clavicle
Important visceral structures of neck are found in
Anterior triangle
Boundaries of anterior triangle
Superior: inferior border of mandible
Anterior: anterior midline
Posterior: anterior border of sternocleidomastoid
Apex of anterior triangle lies inferiorly at
Jugular notch
Subdivisions of anterior triangle
- Submental
- Submandibular (digastric)
- Carotid
- Muscular
Only anterior triangle subdivision that is unpaired
Submental triangle
Boundaries of submental triangle
Left and right anterior bellies of digastric, body of hyoid bone
Floor of submental triangle
Mylohyoid muscle
Contents of submental triangle
Minor veins and lymph nodes
Boundaries of submandibular triangle
Infer border of mandible, anterior belly of digastric, posterior belly of digastric
Flood of submandibular triangle
Mylohoid and hyoglossus Muscles
Contents of submandibular triangle
Submandibular gland, internal carotid artery, facial artery, internal jugular vein, glossopharyngeal N (IX) and vagus N (X)
Boundaries of carotid triangle
Posterior belly of digastric, superior belly of omohyoid, anterior border of sternocleidomastoid
Floor of carotid triangle
Portions of thyrohyoid, hyoglossus, Inferior and middle constrictor Muscles
Contents of carotid triangle
External carotid artery Superior thyroid artery Lingual artery Facial artery Tributaries of internal jugular vein Parts of common and internal carotid arteries
Boundaries of muscular triangle
Superior belly of omohyoid
Anterior midline
Anterior border of SCM
Muscular triangle floor
Posterior layer of pretracheal fascia
Contents of muscular triangle
Sternohyoid Sternothyroid Thyroid gland Trachea Esophagus
___ does not articulate with any other bone
Hyoid bone
Parts of hyoid
Body
Greater horn
Lesser horn
Function of infrahyoid muscles
Move hyoid bone and larynx
4 infrahyoid Muscles
Omohyoid
Sternohyoid
Sternothyroid
Thyrohyoid
__ and ___ make up superficial layer of infrahyoid muscles
Omohyoid
Sternohyoid
__ and __ make up deep layer of infrahyoid muscles
Sternothyroid
Thyrohyoid
Why are there 4 muscles to depress hyoid bon and larynx
Swallowing
Breathing
Speech
If hyoid fixed, digastric depresses mandible
Superficial cervical fascia
Encloses platysma, contains cutaneous nerves, superficial veins and lymph nodes
Deep cervical fascia divisions
Investing layer of deep cervical fascia
Pretrachael fasica
Prevertebral fascia
Carotid sheath
Investing layer of deep cervical fascia
Encloses SCM and trapezius
Pretracheal fascia
Encloses thyroid gland, trachea, esophagus
Prevertebral fascia
Encloses vertebral column and deep muscles of back
Carotid sheath contains
Common carotid artery Internal carotid artery Internal jugular vein Vagus nerve Deep cervical lymph nodes
Functions of cervical fascia
Provide slippery surface to reduce friction during gross movements of neck and head and swallowing
Boundaries of superior thoracic aperature
First thoracic vertebra
First ribs and cartilages
Manubrium of sternum
Arteries that pass through superior thoracic aperature
Brachiocephalic trunk
Left common carotid artery
Left subclavian artery
Internal thoracic artery
Veins that pass through superior thoracic aperature
Brachiocephalic vein
Nerves that pass through superior thoracic aperature
Phrenic
Vagus
Recurrent laryngeal
Sympathetic trunk
Viscera that pass through superior thoracic aperature
Trachea Esophagus Cervical pleura Apex of lung Thymus
Thymus produces
T lymphocytes
Blood supply to thymus
Internal thoracic artery
Innervation of thymus
Stellate ganglion of sympathetic trunk and vagus
Thyroid produces
Thyroxine and calcitonin
___ percent of thyroid glands have pyramidal lobe
50%
Levator glandulae thyroideae muscle connects
Isthmus of thyroid gland to hyoid bone
Arteries to thyroid gland
Superior thyroid artery
(From external carotid artery)
Inferior thyroid artery
(From thyrocervical trunk)
Thyroid ima artery
Inconstant branch to thyroid gland, from brachiocephalic trunk
Veins to thyroid gland
Superior thyroid vein
(To internal jugular vein)
Middle thyroid vein
(To internal jugular vein)
Inferior thyroid vein
(To brachiocephalic vein)
Innervation to thyroid
From superior, middle, and inferior cervical sympathetic ganglia
Endemic goiter
Due to dietary deficiency of iodine
Gland enlarges to increase output- hormone largely inactive
Symptoms are those of hypothyroidism
Exophthalmic goiter
Due to autoimmune disease
Thyroid stimulating immunoglobulin bind to receptor site and cause overactivity of gland
Hormone active
Symptoms similar to those of hyperthyroidism (Graves Disease)
Parathyroid glands involved in
Calcium homeostasis
Blood supply to parathyroid glands
Inferior thyroid artery
Superior thyroid artery
Innervation to parathyroid glands
Inferior or middle cervical sympathetic ganglia
Factors that make thyroid surgery difficult
Parathyroid glands
Vascularity
Recurrent laryngeal nerve
Trachea begins at larynx at
C6
Posterior gap of incomplete cartilaginous rings of trachea spanned by
Trachealis muscle
Blood supply to trachea
Inferior thyroid artery
Innervation to trachea
Recurrent laryngeal nerve
Esophagus begins at neck at level
C6
Main arteries of head and neck are
Left and right common carotid arteries
Esophagus lies posterior to the
Trachea
2 branches of the common carotid artery
Internal carotid artery and external carotid artery
Pathway of the internal carotid artery
Enters the skull through the carotid canal (in the temporal bone) to supply blood to the brain
External carotid artery supplies:
Neck, face, and scalp (structures external to the skull)
Branches of the external carotid artery
- Superior thyroid
- Ascending pharyngeal
- Lingual
- Facial
- Occipital
- Posterior Auricular
- Superficial Temporal
- Maxillary
Terminal branches of the external carotid
Superficial temporal artery and maxillary artery
Carotid sinus
A slight dilation of the internal carotid artery where it joins the common carotid.
Is a baroreceptor (blood pressure sensor)
Carotid sinus innervation
Carotid sinus nerve, a branch of the glossopharyngeal nerve (CN IX)
Carotid Body
Small reddish-brown mass located within or deep to the bifurcation of the common carotid artery
A chemoreceptors that detects the changes in the chemical makeup of blood in the carotid.
Carotid Body innervation
Carotid sinus branch of the glossopharyngeal nerve (CN IX)
Internal Jugular vein
Largest vein of the neck
Internal jugular vein pathway
Begins at jugular foramen as the direct continuation of thee sigmoid sinus. It drains into the brachiocephalic vein
Superior jugular bulb
The dilation of the internal jugular vein at its origin blow the jugular foramen
Tributaries of the Internal Jugular Vein
- Inferior Petrosal Sinus
- Pharyngeal Veins
- Facial Vein
- Lingual Vein
- Superior Thyroid Vein
- Middle Thyroid Vein
Inferior Jugular Bulb
The dilation of the internal jugular vein near its termination into the brachiocephalic vein
Glossopharyngeal Nerve (CN IX)
Emerges from the medulla oblongata and passes through the jugular foramen.
Glossopharyngeal Nerve (CN IX) branches
- Tympanic Nerve
- Branch to the Carotid sinus
- Pharyngeal Branch
- Branch to the Stylopharyngeus
- Tonsillar Branch
- Lingual Branch
Tympanic Nerve
Sensory to the tympanic cavity and secretomotor to the parotid gland
Branch to the carotid sinus
Sensory to tooth the carotid sinus and carotid body
Pharyngeal Branch
Unites with branches from the vagus and sympathetic trunk to form the pharyngeal plexus. Sensory to the pharynx
Branch to the Stylopharyngeus
Motor to the stylopharyngeous muscle
Tonsillar branch
Sensory to the mucous membrane over the tonsil and to the soft palate
Lingual branch
Supplies taste and general sensation to the posterior third of the tongue
Vagus Nerve (CN X)
The longest cranial nerve
Vagus means
Wanderer
Pathway of vagus nerve
Emerges from the medulla oblongata, exits the skull through the jugular foramen, along with the gollosopharyngeal and accessory nerves
2 ganglia of the vagus
- Superior (jugular) ganglion: located in jugular foramen
2. Inferior (Nodose) ganglion
Branches of the vagus in the head and neck
- Meningeal branch
- Auricular branch
- Pharyngeal branch
- Superior Laryngeal Nerve
- Recurrent Laryngeal Nerve
Meningeal branch
Arises from the superior ganglion and supplies the dura mater with sensory innervation
Auricular branch
Arises form the superior ganglion. Provides sensory innervation to the auricle, floor of the external auditory meats, and the tympanic membrane
Pharyngeal branch
Arises from the inferior ganglion.
The chief motor nerve to the muscles of the pharynx and soft palate.
Pharyngeal plexus
Made when the pharyngeal branch of the vagus joins the branches of the glossopharyngeal nerve and sympathetic trunk.
Motor to all muscles of the pharynx (except Stylopharyngeus) and to all muscles of the soft palate (except tensor veli palatini)
Superior Laryngeal Nerve
Arises from the inferior ganglion and divides into the Internal Laryngeal nerve and external laryngeal nerve
Internal Laryngeal Nerve
Sensory to the mucous membrane of the larynx superior to the true vocal cords
External Laryngeal Nerve
Motor to the cricothyroid and inferior constrictor muscles
Recurrent Laryngeal Nerve
Sensory to the mucous membrane of the larynx below the true vocal folds, and to the trachea.
Motor to all muscles of the larynx except the cricothyroid
Unilateral Damage to the recurrent laryngeal nerve
Respiratory distress, hoarseness (partial aphonia)
Bilateral damage to the recurrent laryngeal nerve
Complete aphonia (muteness). May result in suffocation (in cases of spastic paralysis)
Causes of damage to the recurrent laryngeal nerve
- Trauma during thyroid surgery
- Goiter or thyroid tumor
- Lung tumor
- Aortic aneurysm (left side only)
2 Parts of the Accessory Nerve
Cranial: originates from Medualla Oblongata
Spinal: originates from the sides of the spinal cord
Pathway of cranial part of accessory nerve
The cranial party of the accessory nerve joins the vagus just about the inferior vagaries ganglion and supplies the vagus with motor fibers
Cranial Accessory nerve supplies motor fibers to:
- Pharyngeal branch of the vagus: to muscles of the pharynx and the soft palate
- Recurrent laryngeal nerve: to the muscles of the larynx
Hypoglossal Nerve
Motor nerve to the tongue
Hypoglossal pathway
Originates in medulla oblongata, exits the skull through the hypoglossal canal, loops downward and forward, deep to the posterior belly and intermediate tendon of the digastric
Branches of the hypoglossal
Meningeal branches
Superior root of the Ansa Cervicalis
Nerves to Thyrohyoid and Geniohyoid
Lingual branches
Meningeal branch of the hypoglossal
Sensory to the dura mater
Superior root of the Ansa Cervicalis branch of the hypoglossal
Motor to the infrahyoid muscles (sternohyoid, sternothyroid, omohyoid)
Nerves to thyrohyoid and geniohyoid of the hypoglossal nerve
Consist of C1 fibers. Motor to the thyrohyoid and geniorhyoid
Lingual branches of the hypoglossal nerve
Motor to the extrinsic and intrinsic muscles of the tongue
Cervical sympathetic ganglia
- Superior Cervical Ganglion
- Middle Cervical Ganglion
- Vertebral Ganglion
- Cervicothoracic (Stellate) Ganglion
Superior Cervical Ganglion
Lies at level of C1-3 and branches into:
- Internal Carotid Nerve- accompanies the internal carotid artery into the skull
- Superior CervicalCardiac Nerve- to the cardiac plexus
- Branches to the pharyngeal plexus
Middle Cervical Cardiac Nerve
Lies at C6 and branches to the cardio plexus
Vertebral Ganglion
Lies at C7 and gives off a branch to the plexus along the vertebral artery
Cervicothoracic (Stellate) Ganglion
Formed by the fusion of the inferior cervical ganglion to the first thoracic ganglion.
Lies at C7-T1 and branches to the inferior cervical cardiac nerve of the cardiac plexus
Ansa Subclavia
A nerve bundle which loops anterior to the subclavian artery, connection the vertebral ganglion to the cervicothoracic ganglion
Submandibular gland
One of 3 paired salivary glands. Consists of 2 parts: Superficial part and deep part
Superficial Part of the Submandibular gland
Larger part and lies within the submandibulaar triangle and in the submandibular fossa.
Deep part of the Submandibular Gland
Small and liessuperior to the mylohyoid muscle. 5 cm long and opens into the oral cavity on the sublingual caruncle
Submandibular gland innervation
Parasympathetic fibers from the facial nerve via the submandibular ganglion
Sublingual gland
Smallest of the 3 major salivary glands. Lies superior to the mylohyoid in the sublingual fossa. Empties into the floor of the mouth by 12 short ducts along the sublingual fold
Sublingual gland innervation
Parasympathetic fibers from the facial nerve (CN VII) via the submandibular ganglion
Nerves associated with the mandible
Lingual, glossopharyngeal, and hypoglossal
Blood vessels of the mandible
Lingual artery and vein and the facial artery and vein
Lymph Nodes of the mandible
Submandibular and submental lymph nodes