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Anatomy Year 1 > Exam 1 Spring > Flashcards

Exam 1 Spring Flashcards

1
Q

mvmts @ TMJ: protrusion

A

protrude chin:

  • lateral pterygoid (prime)
  • masseter
  • medial pterygoid
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2
Q

•Muscular triangle

A

–Bounded by anterior border of SCM, superior belly of omohyoid, midline of neck

–Contains infrahyoid muscles, thyroid and parathyroid glands

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3
Q

mucus membrane of larynx

A

respiratory epith

  • except over true/aryepiglottic folds = stra-squa
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4
Q

pons

A

ant region of posterior cranial cav

4th ventricle

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5
Q

mylohyoid

A

N: N to mylohyoid - from inferior alveolar N - from CN V3 (madibular)

A: elevate hyoid, floor of mouth, tongue during swallow and speak

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6
Q

contents of infratemporal fossa

A
  • Inferior part of the temporalis muscle.
  • Lateral and medial pterygoid muscles.
  • Maxillary artery.
  • Pterygoid venous plexus.
  • Mandibular, inferior alveolar, lingual, buccal, and chorda tympani nerves
  • Otic ganglion.
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7
Q

boundaries Anterior Triangle of neck

A
  • Lateral—anterior border of SCM
  • Anterior—anterior midline of neck
  • Superior—inferior mandible
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8
Q

Pretracheal Layer of Deep Cervical fascia

A

Thin layer: muscular and visceral parts

laryngeal cartilages + hyoid bone –> (thorax) fib pericaridium

  • Blends laterally with carotid sheaths

Encloses:

  • thyroid
  • parathyroid
  • infrahyoid muscles
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9
Q

sensory and motor innervation of larynx

A

sensory

  • above vocal folds: internal laryngeal (branch of superior)
  • below vocal folds: inferior laryngeal (branch of recurr)

motor

  • external –> circothyroid
  • recurrent –> rest of intrinsic
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10
Q

dorsal scapular A

A

from either 2nd or 3rd part

passes backwards to supply levator scpulae, rhomboids

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11
Q

—Thyroid cartilage

A

two flat laminae

  • upper 1/3 = superior thyroid notch
  • lower 2/3 = fused –> laryngeal prominence (Adam’s apple)

posterior horns

  • Superior horns/laminae attach to hyoid bone by thyrohyoid membrane
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12
Q

Pharynx

A

M tube post to nasal and oral cav: continuous with esop and larynx

ant to C1-C6, prevert M

retropharyngeal space: potential space b/w pharynx and prevert fascia

3 parts: naso, oro, laryngo

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13
Q

•Vertebral arteries

A

1st branche of subclavian –> txverse foramen (c1-c6) –> pierce dura –> foramen magnum –> basilar A –> clivus –> 2 posterior cerebral arteries –> circle of Willis

connect to anterior cerebral A via posterior commun A

vasc supply to cerv-SC and neck

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14
Q

Cutaneous branches of the cervical plexus

A

posterior SCM

loop formed b/w anterior rami C2, C3

  • –Lesser occipital (C2) to skin of neck and scalp posterior to auricle

–Great auricular (C2 and C3) to skin over parotid gland, mastoid process, auricle, and between angle of mandible and mastoid process

–Transverse cervical nerve (C2 and C3) to skin over anterior cervical region

•Supraclavicular nerves

  • –Arise from C3–C4 loop

–Emerge from under SCM

–Supply skin over clavicle, superior thoracic wall, and shoulder

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15
Q

Cervical plexus block

A

posterior SCM @ around C2-C3

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16
Q

jugular foramen

A

b/w temporal & occipital

IX, X, XI

sigmoid sinus

inferior petrol sinus

posterior meningeal A

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17
Q

vertebral A

A

runs cranially in tx formaina of cerv-vert –> circle of wilis

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18
Q

Optic canal

A

lesser wing sphenoid

stuctures:

  • optic N
  • opthalmic A
  • sympathetic plexus
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19
Q

Ventricular system

A

ECF in brain: like blood but less protein & diff [ion]

formed by choroid plexus in 4 ventricles of brain

  • lateral ventricles –> intervent foramina –> 3rd ventricle –> cerebral aqueduct –> 4th ventricle –> apertures (2 lat, 1 midline) –>subarachnoid space

absorbed via arachnoid granulations (villi) into venous blood in dural venous sinuses

approx 400 mL/day CSF –> venous circ

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20
Q

general larynx

A

fx: phonation, sphincter guarding lower respir-tract

connects oropharynx with trachea

ant to prevert M, C3-C6 vert

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21
Q

otic ganglion

A

PNS

  • pre: (glossopharyngeal N) –> otic ganglion
  • post: –> auriculotemporal N –> parotid

location:

  • infratemporal fossa
    • inferior: foramen ovale
    • medial: CN V3
    • post: medial pterygoid
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22
Q

Cervical Ligaments

A

Stylohyoid:

  • styloid process –> lesser cornu of hyoid

Stylomandibular:

  • styloid process –> angle of mandible

Sphenomandibular:

  • spine of sphenoid –> lingula of mandible

Pterygomandibular:

  • hamular process of medial pterygoid plate –> posterior end of mylohyoid line of mandible
  • attachment to superior constrictor & buccinator muscles
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23
Q

thyrohyoid membrane

A

txverse superior border and superior horns of thryoid cartilage

pierced by superior larngeal vessels, interal laryngeal N

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24
Q

geniohyoid

A

N: C1 via CN XII (hypoglossal)

A:

  • pull hyoid ant-sup
  • shortens mouth floor
  • widens pharynx
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25
Q

soinus drainage

A
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26
Q

Laryngeal skeleton

A

—Unpaired cartilages

—Epiglottis

—Thyroid

—Cricoid cartilage

—Paired cartilages

—Arytenoid

—Corniculate

—Cuneiform

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27
Q

joints of larynx

A

circothyroid

  • gliding/rotation of thyroid cart
  • changes length of vocal folds

circoarytenoid

  • slide/rotate/tilting of arytenoid on circoid
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28
Q

posterior triangle of neck

•Boundaries:

A

•Boundaries:

–Posterior—anterior border of trapezius

–Anterior—posterior border of SCM

–Inferior—meddle 1/3 of the clavicle

–Roof—investing layer of deep cervical fascia

–Floor—muscles and prevertebral layer of the deep fascia

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29
Q

Torticollis/ Wry neck

A

•1.Congenital torticollois

–Malposition in utero

–Birth injury

–SCM tumor

•2. Acquired

–Tumors of skull base

–Trauma

–Transient spasm

•3.Spasmodic

–Cervical dystonia

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30
Q

Vasculature of duramater

A

middle menin A –> ant/post branch

veins accompany: –> foramen spinosum –> pterygoid venous plexus

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31
Q

Temporalis M

A

O: temporal fossa (broad)

I: coronoid process/anterior ramus of mandible (narrow)

N: CN V3 (deep temporal branhces)

A: elevates mandible, close jaws, primary retractors

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32
Q

mvmts @ TMJ: lateral mvmts

A

grind/chew

  • ipsi temporalis
  • contralat pterygoids
  • masseter
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33
Q

innervation of scalp

A

anterior –> auricle: CN V (trigeminal): ophthalmic, max, mandibular divisions

posterior –> auricle: cutaneous branches of C2-3 spinal N

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34
Q

Veins of the face

A

•Supratrochlear vein

  • desc forehead to nose –> + supraorbital –> angular

•Supraorbital vein

  • forehead –> medial –> supratrochlear
  • branch –> through supraorbital notch –> superior ophthalmic vein

•Facial vein

  • Two veins = main venous drainage of face
  • Follows facial artery
  • Drain directly or indirectly into internal jugular vein
  • –> superior ophthalmic vein –> pterygoid venous plexus and cavernous sinus

•Superficial temporal vein

  • Drains scalp and forehead –> + maxillary –> retromandibular

•Retromandibular vein

  • Descends through parotid gland
  • branch to facial vein
    • posterior auricular –> external jugular vein
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35
Q

Lymphatic drainage of larynx

A

—Above folds: to deep cervical nodes

—Below folds: to paratracheal nodes to deep cervical nodes

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36
Q

Vocal folds

A

paired

contains:

  • vocal lig: medial free edge of lateral cricothyroid ligament (conus elasticus)
  • Vocalis muscle—medial fibers of thyroid arytenoids muscle
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37
Q

facial expressions and M pic

A
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38
Q

Scalene muscle

A

O: TP c2-c7

I: 1-2 ribs (lateral vertebral M)

A: accessory M of respiration

  • anterior, middle: elevate 1st rib
  • posterior: elevate 2nd rib

N: c4-c6

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39
Q

•Submental triangle

A

–Between body of hyoid bone and right and left anterior bellies of the digastric muscles

–Apex is mandibular symphysis

–Contains submental lymph nodes

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40
Q

arteries of face

A

facial - major

from external carotid: cross mandible –> medial angle of eye

branches to lips & nose

  • superficial temporal
    • term branch external carotid –> temporal fossa –> ends in scalp
  • txverse facial
    • from superficial temporal –> below zygomatic arch
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41
Q

digastric

A

N: N to mylohyoid, CN VII (facial)

A: works with infrahyoid M

  • depress mandible against resistance
  • elev, steadies hyoid during swallow, speak
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42
Q

Prevertebral Layer of Deep Cervical fascia

A

thick tubular sheath for v-column & muscles

  • Behind pharynx & esophagus
  • longuses, scalenes & deep cervical muscles
  • Fixed to cranial base superiorly
  • Cervical part of sympathetic trunk

Fascial floor of posterior triangle

forms axillary sheath

  • ax A
  • brachial plexus
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43
Q

piriform recess

A

small depressions on either side of laryngeal inlet sep by aryepiglottic folds

bounded medial: throid cart, thyrohyoid memb

food:

  • sharp food: may injure internal laryngeal N (groove adj to recess)
  • anesthesai of laryngeal muc-memb as far inferior as vocal folds
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44
Q

Triangles of the Neck

A

SCM: each side into 2 triangles

–Anterior

•Lies in the anterior cervical region

–Posterior

•Lies in the lateral cervical region

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45
Q

carotid sinus massage

A
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46
Q

medulla oblongata

A

posterior cranial fossa

contin with SC

inferior portion of 4th ventricle

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47
Q

Superior orbital fissure

A

both wings sphenoid

structures:

  • V1
  • III, IV, VI
  • superior opthalmic vein
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48
Q

thyroid A

A

•Superior thyroid artery (from external carotid)

–Descends to superior poles

•Inferior thyroid artery (from thyrocerv trunk)

–Superomedially posterior to carotid sheath – posterior inferior poles

•10% thyroid ima –

–arises from brachiocephalic trunk , arch of aorta or right common carotid , subclavian or internal thoracic

–supplies anterior trachea and isthmus

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49
Q

maxillary artery: 2nd part

A

Mnemonic: muscles of mastication which are also derivatives of the 1st arch.

Deep temporal artery (ant/post): Temporalis

Pterygoid artery: Lateral and medial pterygoids

Masseteric artery: –> mand notch –> Masseter, TMJ

Buccal of Buccinator artery: Buccinator, runs with N

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50
Q

Oropharynx

A

soft palate –> superior epiglottis

boundary:

  • anterior: oropharyn opening, posterior 1/3 tongue epiglottis
  • lateral: palatoglossal and palatopharyngeal arches (containing palatoglossus and palatopharyngeus muscles)
  • superior: soft palate
  • posterior: sup/middle constrictor M

contents:

  • palatine tonsils (b/w arches)
  • tonsilar bed: superior constrictor M & paryngobasilar fascia
  • epiglottis
    • attached to tongue via median/lat glossoepiglottic folds
    • epiglottic valleculae: depression b/w medial/lateral folds
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51
Q
A
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52
Q

•Subarachnoid space

A

b/w arachnoid and pia: with CSF (ventricles) = cushion brain

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53
Q

Innervation to the dura

A

supratentorial: trigeminal (V1-3)
infratentorial: upper cerv

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54
Q

thyroid lymph

A

prelaryngeal, pretracheal, and paratracheal lymph nodes

Superior cervical nodes —inferior cervical nodes—inferior deep cervical nodes

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55
Q

Blood supply to the Pharynx

A

artery:

  • upper
    • •tonsillar from facial
  • Ascending pharyngeal from external carotid
  • Ascending and descending palatine from maxillary
  • lingual
  • lower
    • inferior thyroid

vein:

  • External palatine → pharyngeal plexus → IJV
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56
Q

Rima glottidis

A

space b/w vocal folds

normal breathing: narrow wedge

forced respiration: wide apart

  • abduct via contraction of posterior crico-arytenoid
    phonation: slit-like
  • adduct arytenoid cart, moderate adduct lateral crico-arytenoid M
    • stronger contraction = close rima glottidis: valsalva

whispering:

  • strong adduct lateral crico-arytenoid M of vocal ligaments
  • relaxed arytenoid M
    • allow air to pass –> toneless speech
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57
Q

laryngeal cavity

A

laryngeal inlet –> tracheal cavity (inferior border of cricoid)

parts:

  • vestibule: recess ext lateral
  • infraglottic cav: b/w vocal folds and inferior border of cricoid
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58
Q

•Subarachnoid cisterns

A

where pia & arachnoid are widely separated: pools of CSF usu @ brain base

cerebellomedullary:

  • largest: b/w cerebellum & medulla

pontocerebellar:

  • “pontine cistern” ventral to pons, contin infer with subarachnoid space

interpeduncular:

  • “basal” b/w cerebral peduncles of midbrain

chiasmatic:

  • @ cross of optic chiasm: inf/ant

quadrigeminal:

  • b/w corpus callosum and cerebellum

ambient:

  • lateral midbrain, contin post with quadrigeminal cistern
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59
Q

brain A pic

A
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60
Q

Temporal Region

A

superior to zygomatic arch

boundaries:

  • sup/post: squamous suture
  • ant: frontal, sphenoid, zygomatic bones
  • lat: zygomatic arch
  • inf: infratemporal crest
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61
Q

circle of Willis

A

subarach space

formed by:

  • anterior: commun, cerebral
  • ICA
  • posterior: commun, cerebral
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62
Q

Swallowing

A

3 stages:

1st

  • voluntary: 1-2s
  • breathing via nasopharynx
  • bolus food aga hard palate –> paltoglossal folds relax –> M of tongue and soft palate push bolus into oropharynx

2nd

  • involun/reflexive via glossopharyngeal N
  • nasopharynx closed by elevation of soft palate
    • tensor veli palatine & levator veli palatine M
  • suprahyoid & longitudinal pharyngeal M contract
    • elevate larynx, close epiglottis, propel bolus

3rd

  • involun via peristalsis (all 3 constrictors)
  • high P @ distal end –> relax circophrayngeus M (sup esop sphinctor) –> bolus to oesophagus –> P drops –> sphinctor closes –> normal positions of larynx and epiglottis
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63
Q

Carotid Sheath

A

cranial base –> root of neck

  • •Blends anteriorly with investing & pretracheal layers of fascia
  • •Blends posteriorly with prevertebral layer of fascia

•Contents:

–Common & internal carotid arteries & plexuses

–Internal jugular vein

–Vagus nerve CN X

*Ansa Cervicalis Nerve – embedded in the carotid sheath

–Some deep cervical lymph nodes

–Carotid sinus nerve

–Sympathetic nerve fibers

free communication: superior mediastinum –> cranial cavity

  • potential pathways for spread of infection & blood
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64
Q

Muscles related to the nose

A

nasalis

  • compressor naris: compresses
  • dilator naris: flares

procerus

  • forehead –> bridge of nose
  • medial eyebrow inferior
  • txverse wrinkles over nose (frown)
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65
Q

pharynx fascia

A

• reinforces the pharyngeal wall where muscles are missing

§Fascia splits to enclose muscles

§Buccopharyngeal outer surface

§Pharyngobasilar covers the inner surface

•

•

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66
Q

epiglottis

A

Leaf-shaped elastic cartilage

location: b/w hyoid/tongue and laryngeal inlet
* overlays laryngeal inlet during swallow

attachements:

  • superior: broad & free = aryepiglottic fold
  • inferior: thyroepiglottic ligament –> midline thyroid cart
  • lateral: quadragular memb –> arytenoid
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67
Q

Corniculate and cuneiform cartilages

A

—Nodules in posterior aryepiglottic folds

—Cuneiforms do not attach to other cartilages

—Corniculates attach to apices of arytenoids

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68
Q

Hypoglossal canal

A

occipital bone

CN XII (same name)

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69
Q

Venous drainage of temporal region

A

pterygoid venous plexus

  • partly b/w temporalis & pterygoids
  • drain most veins along maxillary A
  • anast
    • ant: –> deep facial vein –> facial vein
    • sup: emissary veins –> caverous sinus
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70
Q

•Lower molar dental infections

A

medially spread:

  • mandible –> submand & masticatory spaces –> push tongue fwd & up

downwards spread –> visc space

  • edema vocal cords
  • airway obstruction
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71
Q

Deep Cervical Fascia

A

3: Investing, Pretracheal, Prevertebral

support

  • thyroid gland, muscles, vessels & deep lymph nodes

condenses around carotid sheath

forms natural cleavage planes:

  • tissues may be separated during sx
  • limit spread of abscesses from infections
  • allows slipperiness = structures in neck to move & pass over one another without difficulty - swallowing & turning head & neck
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72
Q

temporal fossa

A

occupied primarily by upper portion of temporalis M

  • fascia attaches sup to temporal line, inferior splits to lateral/medial zygomatic arches

floor = 4 bones: frontal, pariental, temporal, greater wing of sphenoid

temporal A:

  • superficial: from external carotid
  • deep from maxillary

deep temporal N: from trigeminal (mandibular division)

zygomaticotermporal N: from trigeminal (maxillary branch)

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73
Q

face

A

highly vasc

sensory branches of CN V (trigeminal), upper cerv spinal N, motor branches of CN VII (facial)

skin ligaments (retiacula cutis)

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74
Q

Gaps in Pharyngeal Wall

A

b/w superior constrictor and base of skull: ALE

  • Ascending palatine artery
  • levator veli palitini
  • eustacian tube

b/w superior and middle constrictor: LMN

  • Stylohyoid ligament
  • Stylopharyngeus M
  • Glossopharyngeal N

b/w middle and inferior constrictor:

  • Superior laryngeal artery and vein
  • Internal laryngeal nerve

below inferior constrictor:

  • inferior laryngeal artery
  • recurrent laryngeal N
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75
Q

Foramen ovale

A

greater wing sphenoid

V3

lesser petrosal N

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76
Q

posterior triangle of neck: subdivisions

A
  • Subdivided by inferior belly of omohyoid into:
  • Occipital triangle:
  • Larger
  • occipital artery at its apex
  • superiorly crossed by Accessory nerve

•Supraclavicular/ subclavian triangle:

  • Smaller inferior
  • external jugular vein, suprascapular artery, and subclavian artery
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77
Q

Laryngopharynx

A

superior epiglottis –> inferior cricoid cartilage

stra-sqam

boundary:

–Inferiorly: continuous with esophagus

–Superiorly: continuous with oropharynx

–Anteriorly: larynx

–Posteriorly: middle and inferior constrictor muscles deep: Bodies of C4–C6 vertebrae

–Laterally: middle and inferior constrictor muscles

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78
Q

middle constrictor

A

O: upper border greater cornu of hyoid, lesser cornu, stylohyoid lig

and then….

  • upper: ascend & overlap superior constrictor
  • middle: txverse
  • lower: descend beneath inferior constrictor

I: post-median raphe

79
Q

vocalis M

A

*subsidiary of thyroarytenoid M

O: vocal proc os artenoid cart

I: vocal lig

N: recurr laryngeal

A: relax post vocal lig, tense ant vocal lig

blood: sup/inf thyroid

80
Q

Thyroid - nerves

A

from superior , middle ,inferior cervical sympathetic ganglia through cardiac ,superior and inferior thyroid periarterial plexus - vasomotor

81
Q

Internal acoustic meatus

A

temporal bone

VII, VIII

labyrinthine

82
Q

stylohyoid

A

N: CN VIII (facial)

A: elev, retract hyoid –> elong mouth floor

83
Q

Foramen lacerum

A

b/w temporal & sphenoid bone

pterygoid: A, N

84
Q

Internal carotid arteries: supply to brain

A

from common carotid @ upper border of thyroid cartilage

no branches to face/neck

carotid canal (temporal bone) –> carotid sinus (sphrenoid) –> ant/mid cerebral A

united to posterior cerebral A –> circle of willis (around interpeduncular fossa)

85
Q

Inferior constrictor

A

2 parts:

  • thyropharyngeal
    • obliq line
  • cricopharyngeal
    • b/w Cricothyreoideus (front) & inferior cornu (behind)

fibers spread back and medial to opposide side M of fibrous pharyngeal raphe

external laryngeal N

86
Q

thyroarytenoid M

A

O: post thyroid cartilage

I: M process of arytenoid cart

N: recurr laryngeal

A: shorten/relax VC

blood: sup/inf thyroid

87
Q

lingual nerve

A

anterior to inferior alveolar N

sensory –> ant 2/3 tongue, mouth floor, lingual gingiva

  • joined by chorda tympani N (CN VII - taste fibers) infratemporal fossa
    • secretomotor fiber from sub-mand/lingual salivary glands
88
Q

vessels of neck

A
  • External jugular vein
  • Subclavian vein
  • Third part of subclavian artery and its branches
  • Occipital artery (from external carotid)

Veins:

  • external jugular
  • subclavian
  • superficial temporal & maxillary –> retromandibular –> anterior & posterior
    • anterior: joins facial –> comm facial 00> IJV
    • posterior: joins auricular –> external jugular –> subclavian
89
Q

Muscles related to the orbit

A

•Orbicularis oculi

  • three parts:
    • lacrimal: draws eyelids/lacrimal puncta med to drain tears
    • palpebral: (inner) blink (gentle close)
    • orbital: (outer) squint (tightly close)

•Corrugator supercilii

  • Draws medial end of eyebrow medially and inferiorly for a concerned look
  • Wrinkles skin of forehead (furrowing eyebrows)

Frontalis portion of occipitofrontalis

  • Elevates the eyebrows (surprised)
  • Wrinkles the forehead
90
Q

thyrocervical trunk

A

short

divides into inferior throid, suprascapular, tx cerv

91
Q

Arterial supply to larynx

A

upper = superior laryngeal A (from superior thyroid)

  • thru gap in thyrohyoid memb
  • accomp by sup laryngeal N

lower = inferior laryngeal A ( from inferior thyroid)

  • accomp by recurrent laryngeal N
92
Q

cerebellum

A

dorsal to pons/medulla, inf to posterior cerebrum

2 lateral hemis conn by vermis (midline)

fx:

  • balance, posture, coord
  • timing/strength of M contraction
93
Q

Motor innervation to face

A

facial: sole motor supply to M of facial expression

5 branches: named to areas they supply

  • •Temporal
  • Zygomatic
  • Buccal
  • Mandibular
  • Cervical
94
Q

Internal jugular vein

A

signoid sinus –> jugular foramen (begin) –> desc carotid sheath –> joins subclavian to form brachiocephanic

•Tributaries

–Inferior petrosal sinus

–Pharyngeal vein

–Common facial vein

–Lingual vein

–Superior & middle thyroid vein

95
Q

Muscles related to mouth and lips

  • Orbicularis oris
  • Buccinator
  • Levator labii superioris alaeque nasi

Levator anguli oris

Depressor anguli oris

Mentali

  • Levator labii superioris
  • Depressor labii inferioris
  • Risorius
  • Zygomaticus major
  • Zygomaticus minor
  • Platysma
A

•Orbicularis oris

  • Sphincter of the mouth
  • speech, holding food between the teeth, whistling, blowing

•Buccinator

  • smiling
  • Holds food between teeth during chewing
  • whistling, sucking, and horn blowing

•Levator labii superioris alaeque nasi

  • Elevates nose and upper lip

Levator anguli oris

  • Elevates corner of mouth

Depressor anguli oris

  • Depresses angle of mouth

Levator labii superioris

  • Lifts and everts upper lip

Depressor labii inferioris

  • Draws lip down and laterally (impatience)

Risorius

  • Draws corner of mouth laterally (grinning)

Zygomaticus major

  • Draws angle of mouth up and laterally (smiling and laughing)

Zygomaticus minor

  • Raises upper lip (contempt)

Platysma

  • Depresses mandible
  • Draws corners of mouth down
  • grimacing

Mentalis

  • Wrinkles skin on chin
96
Q

innervation to pharynx

A

Motor = pharyngeal plexus:

  • Pharyngeal branches of X, IX
  • External laryngeal = inferior constrictor

sensory

  • •Nasophaynx by maxillary (2nd division of trigeminal CN V)
  • Oropharynx by glossopharyngeal CN IX - upper pharynx
  • Laryngopharynx by vagus CN X - lower pharynx
97
Q

•Muscles of facial expression

A

in superficial fascia: most from bone –> skin

sphincters/dilators around face

N: 1 of 5 main branches of CN VII (facial)

  • occipitalis N by posterior auricular branch
98
Q

cerebral hemispheres

A

largest: ant/middle cranial fossa, sep by cerebral fissure

connected via corpus callosum

cavity = ventricle

4 lobes:

  • frontal: high mental fx, speech/lang
  • parietal: init mvmt, perception
  • temporal: mem, hearing, speech
  • occipital: vision
99
Q

vestibular folds

A

false VC

thyroid –> arytenoid cart

fx: protection

100
Q

Skin of Neck

A

Natural lines of cleavage of skin:

  • constant
  • run almost horizontally around neck

Important clinically: incisions

  • along a cleavage: narrow scar
  • crosses lines = wide or heaped-up scar
101
Q

•Falx cerebelli

A

vertical fold: partially separates hemispheres

attached to internal occipital crest, inferior to tentorium cerebelli

102
Q

maxillary A: 1st part

A

Mnemonic: Remember the branches with the mnemonic “DAMIA”

  • Deep auricular artery: External acoustic meatus, TMJ
  • Anterior tympanic artery: internal tympanic membrane
  • Middle meningeal artery: –> foramen spinosum –> attaches to auric-temp N
    • dura mater and Skull bones
    • gang: trigem, geniculate
    • CN VII
    • tymp-cav & tensor tympani
  • Inferior alveolar artery: –> mandibular foramen –> Mandible
    • 3 branches: dental, mental, mylohyoid
    • runs alongside N
  • Accessory meningeal artery: –> foramen ovale –> infratemp-fossa
    • otic gang
    • mandibular N

Clinical significance: Middle meningeal artery injury results in Extradural hematoma (EDH).

103
Q

cerebral A

A

supplies cerebral hemisphere

anterior:

  • medial/upper lat
  • frontal

middle:

  • lower/lateral
  • temporal

posterior:

  • inferior surf
  • occipital
104
Q

TMJ bones

A

•superior: mandibular fossa and articular tubercle of the temporal bone

inferior: mandible head

  • capsule attaches to the margins of the articular cartilage on the temporal bone and around the neck of the mandible
  • Joint cavity is divided into two compartments by Articular disc
  • upper: gliding (protrusion/retrusion/retraction)
  • lower: hinge (depress/elevate), rotate, pivot
105
Q

Venous drainage of larynx

A

Superior laryngeal vein → superior thyroid vein → IJ → BC

Inferior laryngeal vein → inferior thyroid vein/plexus → BC

106
Q

diencephalon

A

–Composed of

  • Epithalamus
  • Thalamus
  • Hypothalamus

–Surrounds third ventricle of brain between right and left halves

107
Q

Retropharyngeal Space

A

•Largest & most important space in neck

  • between prevertebral fascia & buccopharyngeal fascia surrounding pharynx
  • spread down to superior mediastinum

•extent:

  • –Superiorly: base of skull
  • –Inferiorly: superior mediastinum
  • –Laterally : carotid sheath
108
Q

TMJ ligaments

A

stylomandibular: not significant to strength of joint
sphenomadibular: primary passive support of mandible
* swinging hinge

lateral ligament (thickened part of joint capsule)

    • postglenoid tuberle —> prevents posterior dislocation of jt
109
Q

Parotid gland

A

largest of 3 paired salivary glads

contains parotid plexus of CN VII (facial)

parts:

  • bed: ant/inf to external acoustic meatus b/w madible ramus & mastoid process
  • apex: posterior to mandible angle
  • base: zygomatic arch
  • duct: pierces buccinator –> oral cav through small hole opposite 2nd max molar tooth
110
Q

lymph drainage of pharynx

A

tonsillar tissue –> mandible nodes & tonsilar (jugulodigastric) node –> generally to deep cervical

111
Q

Suprasternal space of Burns

A

investing layer of deep cervical fascia remains divided into two layers -

  • Inferiorly between sternal heads of SCMs
  • superior to manubrium

encloses:

  • ends of jugular veins & arch
  • fat
  • deep lymph nodes
112
Q

Midbrain (mesencephalon)

A

@ jxn of middle and posterior cranial fossa

contains cerebral aqueduct

113
Q

Pus spread in the neck

A

abscess post to prevert layer –> ext lat –> swell post to SCM

may perf prevert layer –> retropharyngeal space –> bulge in pharynx

  • retropharyngeal abscess
  • Causes difficulty in swallowing - dysphagia & speaking - dysarthria
114
Q

post cricoarytenoid M

A

O: post cricoid cartilage

I: M process of arytenoid cart

N: recurr laryngeal

A: abduct vocal fold

blood: sup/inf thyroid

115
Q

Lateral pterygoid

A

O: 2 heads: infratemp surf & sphenoid, lateral pterygoid plate

I: joint capsule of TMJ, pteryoid fovea on condyloid process of mandible

A: bilateral = protract mandible & depress chin, unilat = contralat jaw swinging for chewing mvmts

N: lateral pterygoid

116
Q

Fascial Spaces

A

loose connective tissue forms potential spaces

  • Visceral
  • Retropharyngeal
  • Submandibular
  • Masticatory

infections spread: touch fascia = detm path

117
Q

Mode of distribution of the Ansa cervicalis to the hyoid muscles

A
118
Q

Modified parts of investing layer: fascia

A

encloses via splitting:

  • submandibular gland: inf to mandible
  • parotid gland: post to mandible

Stylomandibular ligament = thickened mod

119
Q

HORNERS SYNDROsME

A

•Damage to the sympathetic nervous system

ptosis, Anhydrosis, miosis, enopthalmos, loss of ciliospinal reflex

  • Ptosis: dmg superior tarsal muscle (muller muscle): eyelid droop
  • anhydrosis: lack of sweat
  • miosis: constrict pupil
  • enopthalmos: posterior displace eyeball
  • ciliospinal reflex: dilate ipsi pupil with pain to: face, neck, upper trunk
120
Q

cricothyroid M

A

O: anterior cricoid cartilage

I: inferior border/horn thyroid

N: superior laryngeal

A: lengthen/tense vocal lig

blood: sup/inf thyroid

121
Q

Arytenoid cartilages

A

paired

  • articulates with lat/sup cricoid lamina

3 processes:

  • apex (superior)
    • attacehd to aryepiglottic fold
    • corniculate cartilage sits sup
  • vocal (anterior)
    • posterior VC attachement
  • muscular (lateral)
    • post/lat cricoarytenoid M
122
Q

Medial pterygoid M

A

O: 2 heads: lateral pteryoid plate & palatine bone, maxilla tuberosity

I: mandible ramus below foramen - mirror img of masseter (2 M flanking the ramus)

N: CN V3 (mandibular N)

A: with masseter to elev mandible, protrustion, smaller lateral chewing mvmts than lateral pterygoid

123
Q

extrinsic M of larynx

A

attached to hyoid

infrahyoid: lower larynx & hyoid

  • sterno/omo/thyro-hyoid
  • sternothyroid

suprahyoid: fix hyoid/elevate hyoid & larynx

  • stylo/mylo-hyoid
  • disgastric

stylopharyngeus: elev hyoid bone & larynx

124
Q

Vascular supply of parotid

A

artery

  • main = txverse facial
  • branches of external carotid

veins

  • –> ext/internal jugular
  • maxillary + superficial temporal –> retromandibular
    • in parotid gland but od not drain it

lymph: mainly pre-auricular lymph nodes

125
Q

Inferior orbital fissure

A

b/w zygo & greater wing of sphenoid

structures: INFRAORBITAL
* VAN

126
Q

Masseter

A

O: maxillary process of zygomatic bone & zygomatic arch

I: mandible ramus

N: CN V3 (masseteric N)

A: elevates mandible, closes jaw, some protrustion of mandible

127
Q

Infratemporal fossa boundaries

A
  • Laterally: mandible the
  • Medially: lateral pterygoid plate.
  • Anteriorly: maxilla
  • Posteriorly: tympanic plate, mastoid and styloid processes
  • Superiorly: the inferior (infratemporal) surface of the greater wing of the sphenoid.
  • Inferiorly: where the medial pterygoid muscle attaches to the mandible
128
Q

Lymphatic drainage of the face

A

superfical with veins

deep with arteries

lateral –> parotid

upper lip/lateral lower lip –> sybmandibular

chin/central lowerlip –> submental

all –> deep cerv

129
Q

neck lymph nodes

A
130
Q

Foramen rotundum

A

greater wing sphenoid

structure: V2

131
Q

Foramen magnum

A

occipital bone

medulla

accessory N spinal roots

vert A

132
Q

nasopharynx lymph

A

roof of nasopharynx = tonsils: incomplete ring

roof/posterior wall = adenoid

opening of auditory tube = tubal

133
Q

Cervical plexus location and characteristics

A

anterior rami C1-C4

deep to SCM, ant-med to levator scuplae and middle scalene

loops & branches off

134
Q

maxillary A: 3rd part

A

Mnemonic:

  • Posterior superior alveolar: Maxilla
  • Infraorbital: –> inferior orb fissure –> infraorb region & incisors
  • Descending palatine: –> greater and lesser –> hard and soft palate respectively
  • Pharyngeal: –> palatovag canal –> pharynx
  • Pterygoid canal: Upper pharynx and tympanic cavity
  • Sphenopalatine: nasal cavity (term branch)
    • common cause of posterior epistaxis (nosebleed)
135
Q

costcervical trunk

A

splits into highest intercosstal & deep cerv

136
Q

longitudinal pharyngeal wall M

A

* shortens and widens pharynx and larynx during swallowing and speaking

salpingopharyngeus

  • auditory tube cartilage –> palatophyngeus M
  • CN XI (accessory) via vagus to pharyngeal plexus

palatophyngeus

  • superior: hard palate/palatine aponeur, inferior: lat pharynx wall –> thryoid cart/lateral pharynx wall
  • CN XI (accessory) via vagus to pharyngeal plexus

stylopharyngeus:

  • styloid process –> thryoid cart
  • CN IX
137
Q

Thyroid - Veins

A
  • Three pairs form thyroid plexus of veins, anterior to thyroid gland
  • Superior thyroid vein- accompany superior thyroid artery, drain superior pole
  • Middle thyroid vein – drain middle lobe
  • Inferior thyroid vein – drain the inferior lobe
  • Superior and middle drain into IJV
  • Inferior drain into brachiocephalic veins
138
Q

Vasculature of scalp

A

rich blood supply –> profuse bleeding

external carotid: posterior auricular, occipital, superficial temporal

intenral carotid: supra-trachlear/orbital

veins = same name as A

  • deep scalp –> deep temporal –> pterygoid venous plexus
139
Q

Innervation of larynx

A

vagus:

  • superior laryngeal –> internal (sensory) & external (motor)
    • from inferior vagal ganglion
    • cricothyroid
  • inferior laryngeal
    • continuation of recurrent laryngeal
    • enter larynx deep to inferior pharyngeal constrictor
    • anterior branch
      • thyro-arytenoid, vocalis, ary- epiglottic and thyro-epiglottic muscles
    • posterior branch
      • posterior crico- arytenoid, transverse and oblique arytenoid muscles
    • sens fib to infraglottic cav
140
Q

Dura mater

A

thick fibrous: 2 (v 1 of SC)

  • outer periosteal: inner surf of calvaria
  • inner meningeal: contious with dura of SC

folds:

  • Falx cerebri (cerebral falx).
  • Tentorium cerebelli (cerebellar tentorium).
  • Falx cerebelli (cerebellar falx).
  • Diaphragma sellae (sellar diaphragm).
141
Q

Cervical Subcutaneous Tissue & Platysma

A

Cervical subQ-

  • fatty connective tissue
  • between dermis & investing layer of deep cervical fascia
  • Usually thinner than in other regions - especially anteriorly

contents:

  • cutaneous nerves
  • bv
  • lymph v, superficial lymph nodes
  • ant/lat: platysma
142
Q

TEMPOROMANDIBULAR JOINT:

type of joint

mvmts possible

A
  • modified hinge type of synovial joint
  • Movments possible

– gliding (translation)

– rotation (pivoting)

–Flexion (elevation) and extension (depression)

143
Q

suprahyoid M

A

hyoid –> mandible/mastoid process

_____hyoid

  • mylo
  • genio
  • stylo

digastric

144
Q

Paralysis of Platysma

A

cervical branch of facial nerve (CN VII)

  • important not to cut during sx

= skin to fall away from neck in slack folds

145
Q

Anterior Triangle divisions

A

4 smaller triangles:

  • submand
  • submental
  • carotid
  • digastric
146
Q

Prevertebral Layer of Deep Cervical fascia splits ______ to form…

A

inferior

alar fascia - which blends with buccopharyngeal fascia

‘true’ prevertebral fascia

fuses with ALL @ T3 & extends into superior mediastinum

147
Q

DURAL VENOUS SINUSES

A

empty large veins of brain surf

endothelium lined: b/w periosteal @ meningeal layers of dura

148
Q

Subclavian artery in the neck

A

3 parts

1st:

  • origin –> medial border anterior scalene
  • brancheses: vertebral, internal thoracic, thyrocervical

2nd:

  • behind anterior scalene
  • costocervical trunk

3rd:

  • b/w lateral border anterior scalene –> outer border 1st rib
  • dorsal scapular
149
Q

nasopharynx

A

post to nose, above soft palate

ciliated epith

boundary:

  • anterior: choanae (contin with nasal cav)
  • roof/posterior: sphenoid, base of occipital bone
  • lateral: superior constrictor M
150
Q

Vessels in the anterior triangle

A
  • Common carotid artery
  • Internal & External carotid artery and its branches
  • Internal jugular vein
151
Q

internal thoracic A

A

runs behind ribs –> superior epigastric, musculophrenic

gives off anterior intercostal A & perforating vessels to breast

152
Q

FASCIA OF NECK

A
  • Structures in neck are surrounded by a layer of subcutaneous tissue - superficial fascia & are compartmentalized by layers of deep cervical fascia
  • Fascial planes determine direction in which an infection in neck may spread
153
Q

thyroid gland

A

location:

  • deep to sterno-thyroid/hyoid M
  • C5-T1
  • 2nd/3rd tracheal rings
154
Q

C-6 level is important

A
  • Level of cricoid cartilage
  • Pharynx and larynx end
  • Esophagus and trachea begins
  • Vertebral artery enters the foramen transversarium at this level
  • Carotid artery is palpated against transverse process of C6
155
Q

Pharyngeal Wall: Muscles

A

constrictors: sup, middle, inferior

paired via midline raphe - attaches to pharyngeal tub of occiptal bone

palatopharyn sphinctor: M from soft palate –> superior constrictor

N: vagus , inferior constrictor = external laryngeal N ( & cricothyroid - larynx)

156
Q

scalp

A

sup nuchal line –> sup orbital ridge, ext acoustic meatus –> zygomatic arch

5 layers:

*first 3 layers adhered to skull: move as one

  1. skin: sweat/seb glands, hair follicles, well-vasc
  2. dense connective tissues: well-vasc & innerv
  3. aponeur of oppicitofrontalis M: tendinous sheet: connects ocipitalis, frontalis, superior auricular M
  4. loose connective issue: emissary veins
  • scanty subaponeu space: collects fl in injury/infection
  • moves freely over first 3 layers
  1. external periosteum of calvaria (skullcap): firmly attached to bone
    * most tightly bound @ suture line
157
Q

Muscles that form the floor of the posterior triangle

A

splenius capitis

Levator scapulae

scalene: anterior, middle, posterior

158
Q

•Falx cerebri

A

largest of infoldings

longitudinal fissure: sep R and L hemisphere

  • medial plane: crista galli & frontal crest —> internal occipital protuberance
159
Q

Cavernous sinus

A

receives:

  • sup/inf ophthalmic veins –> sup orbital fissure
  • superficial cortical veins
  • basilar plexus

contains:

  • internal carotid A (carotid siphon)
  • CN: (w/in lateral wall of sinus) superior to inferior
    • III, oculomotor
    • IV, trochlear
    • V, trigeminal (V1: ophthalmic, V2: maxillary)
    • VI, abducens: runs in middle of sinus along internal carotid A

many anast –> infection from face –> bad

drains into:

  • sup/inf petrosal sinus –> –> internal jugular
160
Q

Emissary veins

A

connect dural venous sinuses with veins outside cranium

valveless: bidirectional flow (but usually blood away from brain)

veins:

  • frontal (children/some adults) - superior sag sinus –> frontal sinus
  • parietal: –> parietal foramen: superior sag sinus –> scalp veins
  • mastoid: –> mastoid foramen: sigmoid sinus –> occipital/posterior auricular vein
  • posterior condyloid: condylar canal: sigmoid sinus –> suboccipital venous plexus
161
Q

•Arachnoid mater

A

–Thin, nonvascular membrane

–Loosely attached to dura mater

–Separated from pia mater by subarachnoid space

162
Q

Quadrangular membrane

A

Inelastic connective tissue

  • extends from thyroid cart –> arytenoid cart
  • Attaches lateral aspects of arytenoids and epiglottis

borders:

  • upper = aryepiglottic fold/ligament
  • lower = vestibular ligament/fold (false vocal cord) - above VC
163
Q

•Diaphragma sella

A

smallest dural infolding: circular - partial roof of hypophyseal fossa

164
Q

nasopharynx cavities

A

lateral: opening to ear canal (pharyngotympanic tube)

Torus tubarius:fold covering pharyngotympanic tube

retropharyngeal recess behind torus tubarious

Salpingopharyngeal fold – salpingopharyngeal m

Torus levatorius mucosa overlying levator palatini m

165
Q

Parathyroid glands

A

external to thyroid capsule

usually 4

  • sup @ lvl of cricoid
  • inferior @ inferior poles of thyroid

A: inferior thyroid

V: parathyroid –> thyroid venous plexus

same lymph and N as thyroid

166
Q

emb origin of platysma

A

mesenchyme: 2nd phaaryngeal arch

167
Q

M related to ear

A

ant/sup/post auricular

168
Q

•Ludwig’s angina

A

–Acute infection of submandibular fascial space & is commonly secondary to dental infection

169
Q

superior constrictor

A

4 parts:

  • Pterygopharyngeal: lower 1/3 post-medial pterygoid plate & its hamulus
  • Buccopharyngeal: pterygomandibular raphe
  • Myolopharyngeal: alveolar process of the mandible above posterior mylohyoid line
  • Glossopharyngeal: side of tongue

inserts into median raphe, enlong by aponeuro to pharyngeal spine (base of occiput)

170
Q

instrinsic M of larynx pic

A
171
Q

mandibular nerve

A

from trigeminal ganglin in middle cranial fossa

  • immed gets motor root of trigeminal N

–> foramen ovale –> infratemporal fossa

branches:

  • buccal
  • auriculotemporal –> send postsynap PNS to parotid (encuirc mid-mening A)
  • mental
  • inferior alveolar –> mand foramen
  • lingual –> tongue: joined by chorda tympani (taste) @ intratemp fossa

supplies 4 M of mastication

172
Q

innervation of parotid gland

A

parotid plexus does not supply gland

PNS -inferior salivatory nucleus: PNS input (from CN IX: glossopharyngeal)

  • presynap – otic ganglion
  • auriculutemporal N (from ganglion): post synap

Stimulation of the parasympathetic fibers produces a thin, watery saliva

SNS = cerv gang –> external carotid plexus on ECA = dec secr from gland

great auricular (from cerv plexus - C2/C3) = sheath

173
Q

•Pia mater

A

–Adherent to brain and spinal cord

–Highly vascular connective tissue

174
Q

txverse/ obliq arytenoid M

A

*subsidiary of thyroarytenoid M

O: arytenoid cart

I: opposite arytenoid cart

N: recurr laryngeal

A: close rima glottis

blood: sup/inf thyroid

175
Q

N of neck

A
  • Accessory nerve (cranial nerve [CN] XI)
  • Ventral rami (roots) of brachial plexus
  • Suprascapular nerve
  • Cervical plexus
176
Q

Thoracic outlet syndrome

A

compression subclav A, V, trunks of brachial plexus –> arm pain

  • A: pallor, cold
  • V: swelling (also lymph)
  • plexus: parethesia

common cause = C7 cerv rib presence

177
Q

neck regions: central & lateral

A

•Central region:

–Respiratory system: larynx & trachea

–Alimentary system: pharynx & esophagus

•Lateral sides:

–Carotid arteries, internal jugular veins, vagus nerve & deep cervical lymph nodes

178
Q

inferior alveolar nerve

A

–> mandibular foramen

  • inferior dental plexus –> ipsilat teeth
  • –> mental N –> thru mental foramen:
    • lower lip
    • chin skin
    • gingiva of incisors
179
Q

•Submandibular triangle

A

–Between inferior mandible and anterior and posterior bellies of the digastric muscle

–submandibular gland, duct, lymph

180
Q

deep branches cerv plexus innervate prevertebral muscles like

A
  • Scalenes
  • Longus capitis
  • Longus coli
  • Rectus capitis anterior
  • Rectus capitis lateralis
181
Q

Clinical relevance of parotid

A

Parotitis (Mumps)

Salivary duct calculi

Pleomorphic adenoma, Warthin’s tumor: benign tumors

182
Q

Cricoid cartilage

A

Signet ring shaped, signet (lamina) facing posteriorly

  • Strong, thick, complete circle of cartilage

lig:

  • median & lateral (conus elasticus) cricothyroid ligament –> inferior thyroid
    • lateral (conus elasticus) free edge = vocal ligaments (true VC)
  • cricotracheal ligament –> 1st tracheal ring
183
Q

lateral cricoarytenoid M

A

O: arch of cricoid cartilage

I: M process of arytenoid cart

N: recurr laryngeal

A: adduct vocal fold

blood: sup/inf thyroid

184
Q

mvmts @ TMJ: depression

A

open mouth:

  • lateral ptergoid
  • supra/infra-hyoid
  • prime mover = gravity: M are mainly active aga resistance
185
Q

INVESTING LAYER OF DEEP CERVICAL FASCIA

A

•Most superficial part of deep fascial layer

  • •Deep to skin & subcutaneous tissue
  • •Surrounds entire neck

•Splits to enclose trapezius & SCM muscles

186
Q

PLATYSMA

A

Broad, thin sheet of muscle in subQ

Dev: mesenchyme - 2nd pharyngeal arch

N: branches of CN VII

External jugular vein

  • angle of mandible –> middle of clavicle
  • deep to platysma

Main cutaneous nerves of neck = deep to platysma

187
Q

carotid triangle

A

–Bounded by anterior belly of omohyoid, posterior belly of digastric, and anterior border of SCM

–Contains carotid sheath

  • common carotid artery
  • internal jugular vein
  • vagus nerve

–Carotid sinus

–Carotid body

188
Q

•Tentorium cerebelli

A

2nd largest infolding

cresent-shaped: sep cerebrum from cerebellum

attachment:

  • ant: clinoid processes of sphenoid
  • post/lat: occipital/parietal/temporal bones
  • falx cerebri: suspends tentorium
189
Q

ECA branches

A

●Superior thyroid artery

●Lingual artery

●Posterior auricular artery

●Facial artery

●Occipital artery

●Ascending pharyngeal artery

●Maxillary

●Superficial temporal

●Stany Lobo’s Pretty Face Often Attracts Medical Students

190
Q

mvmts @ TMJ: elevation

A

close mouth:

  • temporalis
  • masseter
  • medial pterygoid
191
Q

Infrahyoid muscles

A

TOSS:

thryohyoid

  • N: C1 via CN XII (hypoglossal)
  • A: depress hyoid, elev larynx

omohyoid

  • N: C1-C3 (ansa cervicalis)
  • A: depress, retract, steady hyoid

sternohyoid

  • N: C1-C3 (ansa cervicalis)
  • A: depress hyoid after swallowing evel

sternothyroid

  • N: C2, C3 (ansa cervicalis)
  • A: depress hyoid, larynx
192
Q

mvmts @ TMJ: retrusion

A

retrude chin:

  • temporalis (posterior oblique)
  • massester
193
Q

auriculotemporal nerve

A

encirc middle meningeal A

largest branch –> sensory fibers to its name

–> sensory to TMJ

–> postsynap PNS secretomotor from otic ganglion –> parotid gland

194
Q

Innervation of the face

A

•Cutaneous branches of the cervical nerves

  • From cervical plexus
  • posterior neck, ear, and area over parotid gland

Trigeminal nerve (CN V)

  • Sensory for face
  • Motor for mastication
  • Branches of ophthalmic nerve—CN V1
    • Nasociliary → external nasal nerve to skin on dorsum of nose
    • Nasociliary → infratrochlear nerve to skin and lower eyelid
    • Frontal → supratrochlear nerve to skin in midforehead
    • Frontal → supraorbital nerve to skin of forehead and upper eyelid

Branches of maxillary nerve—CN V2

  • Infraorbital nerve to skin of cheek, lower lid, lateral nose and mouth, upper lip
  • Zygomaticotemporal nerve to skin over anterior temple
  • Zygomaticofacial nerve to skin over zygomatic arch

Branches of mandibular nerve—CN V3

  • Auriculotemporal —skin of external ear, posterior temple, anterior ear
  • Buccal —skin of cheek
  • Mental —skin of chin and lower lip

Anatomy Year 1 (4 decks)

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