Exam 2 Flashcards
(366 cards)
1
Q
Define denticulate ligaments.
A
- Denticulate ligaments are projections of pia mater that extend laterally, midway between anterior and posterior roots, from the spinal cord, and anchor to the dural sac boundary.
1
Q
What are the derivatives of the first pharyngeal arch?
A
- First arch = mandibular arch. Bones: maxilla and mandible from prominences named after them. Muscles: mastication, mylohyoid, ant. Belly of digastric, tensory tympani, tensor veli palatini. Nerve: CN V.
1
Q
What is the glottis?
A
- Vocal folds, rima glottidis and narrow part of larynx as level of vocal folds. Think about drawing a horizontal line through vocal folds.
2
Q
What supplies mucosa of hard palate?
A
- Greater palatine nerve
3
Q
What are the neurons contained within typical spinal nerves? What is the function of each type?
A
- General somatic afferents: transmit pain, temp, touch, pressure and proprioception to spinal cord - General somatic efferents: transmits impulses to skeletal muscle from spinal cord - General visceral afferents: transmits reflex pain from viscera, glands, mucous membranes and blood vessels to spinal cord - General visceral efferents: transmits impulses to smooth muscle and glandular tissue from spinal cord
4
Q
Damage to which of the following muscles would result in skin of the neck to sag and form folds? A. SCM B. Platysma C. Sternohyoid D. Trapezius
A
- B. SCM
4
Q
Sensory branches of CN V3?
A
- Mnemonic: Buccaneers Are Inferior Linguists - Buccal nerve - Auriculotemporal - Inferior alveolar nerve (mylohyoid, mental, incisive) - Lingual nerve
4
Q
Course of CN XII?
A
- Between internal carotid artery and internal jugular vein, loops around occipital artery to enter oral cavity
4
Q
Nerve supply of external auditory meatus
A
- Auriculotemporal (CN V3) - Vagus nerve
5
Q
What are rootlets? Where are they located on the spinal cord? What are contained in each?
A
- Rootlets are neurons branching off of the spinal cord on the dorsal and ventral aspects. Dorsal rootlets contain sensory neurons, while ventral rootlets contain motor neuron. Rootlets from each aspect join together into a root.
5
Q
What are the prevertebral ganglia, where are they located?
A
- These are collection of cell bodies and processes outside the CNS that are autonomic. They contain pre-synaptic cell processes that synpase onto their post-synaptic cell bodies. They contain post-synaptic cell bodies that depart this structure and travel to their target organ.
5
Q
What muscles abduct the vocal cords?
A
- Posterior cricoarytenoid
6
Q
Discuss the CT coverings of peripheral nerves and blood supply.
A
- Peripheral nerves are covered/protected by 3 CT layers: a.) Endoneurium: delicate CT sheath surrounding neurolemma cells and axons b.) Perineurium: dense CT that encloses fascicle (bundle) of peripheral nerve fibers providing effective barrier against penetration of the nerve fibers by foreign substances c.) Epineurium: thick CT that surrounds and encloses a bundle of fascicles, forming the outermost covering of the nerve. It includes fatty tissues, blood vessels and lymphatics. - Blood vessels that supply nerves are called vaso nervorum and are found within the epineurium layer (CT layer surrounding nerve fascicles).
6
Q
What do the pharyngeal muscles all insert onto?
A
- Insert and blend with their fellow muscles onto pharyngeal raphae at the posterior midline
7
Q
Branches of external carotid artery?
A
- Some anatomists like fornication, others prefer S&M - Sup thyroid, ascending pharyngeal, lingual, facial, occipital, post auricular, sup temporal, maxillary
8
Q
Innervation of sternothyroid.
A
- C2, 3 from ansa cervicalis (cervical plexus)
9
Q
What are the plexuses/major nerves formed by the ventral primary rami (that is the spinal nerve plexuses)? From what levels of spinal nerve are they formed?
A
- Cervical plexus (C1-C5) - Brachial plexus (C5-T2) - Intercostal nerves (T1-T11) - Lumbar plexus (T12-L4) - Sacral plexus (L4-S5) - Coccygeal nerve (Co)
9
Q
Function of CN VI? Course? Through what foramen does it travel?
A
- LR m - Leaves brain and traverses through cavernous sinus goes through superior orbital fissure
10
Q
Which CN arises from the first pharyngeal arch during embryological development?
A
- Trigeminal nerve, CN V
10
Q
Which CN arises from the second pharyngeal arch during embryological development?
A
- CN VII
11
Q
Course of spinal accessory nerve in neck?
A
- oblique course across posterior triangle
11
Q
Innvervation of trapezius
A
- CN XI (accessory)
11
Q
The base of the posterior triangle is formed by the? A. Clavicle B. SCM C. Trapezius D. Ant scalene
A
- A. Clavicle
11
Q
What forms pharyngeal plexus?
A
- CN IX, CN X, CN XI and post-ganglionic sympathetic fibers
12
Ptosis and dilation of pupils is caused by damage to what CN?
- CN III
13
Which cranial nerves do not arise from the brain stem?
- CN I and II
13
Which wall of the orbit is the thickest and strongest? Thinnest and least strong?
- Thickest/strongest: lateral wall - Thinnest/frail: medial and inferior walls
15
Explain the difference between the paravertebral ganglia and the prevertebral ganglia.
- Paravertebral ganglia also known as the sympathetic chain ganglia for right and left chains on each side of the vertebral column. They are contain incoming fibers sympathetic pre-ganglionic fibers arising from the spinal cord and also some sympathetic post-ganglionic cell bodies with processes that exit and travel to target organs. - Prevertebral ganglia are plexuses that surrounds origins of the main branches of the abdominal aorta for which they are named. They contain incoming sympathetic pre-ganglionic fibers from the spinal cord and some sympathetic post-ganglionic cells bodies with processes that exit and synapse at their target organs.
15
What landmark could you identify to perform a brachial plexus block?
- Supraclavicular brachial plexus block: superior to midpt of clavicle.
15
What forms the base, apex, floor, roof of the triangle?
- Apex is at the jugular notch - Base is inferior border of mandible - Roof = superficial fascia, platysma and skin - Floor = mylohyoid and hyoglossal muscles
16
What are pharyngeal membranes?
- Ectoderm of grooves on outside of pharyngeal wall make contact with endoderm of pouches to form these membranes. First membrane gives rise to tympanic membrane of ear. All other membranes disappear.
17
What innervates muscles of facial expression?
- CN VII
17
How is an emergency cricothyroidectomy performed?
- Find the thyroid notch - Move inferiorly to find the cricothyroid ligament (superior to cricoid cartilage) - Save a life
18
Branches of external carotid artery. Where does it begin, where does it terminate.
- Begins at superior border of thyroid cartilage and supplies structures outside skull - Terminates in parotid gland by bifurcating into superficial temporal and maxillary arteries - Branches - Some anatomists like fornicating on plush soft mattresses: Superior thyroid Ascending pharyngeal Lingual Facial Occipital Posterior auricular Superficial temporal Maxillary
19
What are the contents of the carotid sheath? Explain with directionality.
- CN X (posteriorly), common carotid (medially), internal jugular vein (laterally), internal carotid (medially superior branch)
20
Divisions of maxillary artery
- Mnemonic: DAM I AM Piss Drunk But PISD a.) 1st part: - Deep auricular - Ant tympanic - Middle meningeal - Inf alveolar - Accessory meningeal b.) 2nd part: - Masseteric - Pterygoid - Deep temporal - Buccal c.) 3rd part: - Post sup alveolar - Infraorbital - Sphenopalatine - Descending palatine
20
Blood supply to larynx
- Superior and inferior laryngeal artery (branches from superior and inferior thyroid arteries, which originate from external carotid and thyrocervical trunks (off subclavian) respectively)
21
Glands of external auditory meatus
- Ceruminous glands – produce cerumen
21
Which quadrant of the TM shows the cone of light?
- anteroinferior
22
Ansa cervicalis originates from all of the following levels except? A. C1 B. C2 C. C3 D. C4
- D. C4 – contributes to phrenic, not ansa
23
Structures of thyroid cartilage
- Laryngeal prominence: two quadrilateral laminae open posteriorly and fuse anteriorly to form this - Thyroid notch: V-shaped structure formed by superior laryngeal prominence - Superior and inferior horns: are posterior border projections
24
What are the boundaries of the anterior cervical triangle?
- Anterior midline of neck - Inferior border of mandible - Anterior border of SCM
24
What are the structures of the lateral wall of the nose?
- Conchae (superior, middle = ethmoid bone and inferior concha
26
Draw cross section of spinal cord and spinal nerve with various attachments and components necessary to receive and transmit signal. Do not include pathways.
27
What are 3 muscles in head/neck that have intermediate tendons?
- Omohyoid - Digastric - Occipitofrontalis
28
What muscles tense the vocal cords?
- Cricothyroid
29
What forms floor of posterior triangle?
- Prevertebral layer of deep cervical fascia - Splenius capitis m - Levator scapulae m - Posterior scalene m - Middle scalene m - Roots of brachial plexus
30
Innervation of omohyoid.
- C2, 3 from ansa cervicalis (cervical plexus)
30
What muscles laterally move the jaw?
- Temporalis (on side of lateral movement) with lateral pterygoid on opposite side
30
Damage to CN III will result in what?
- Ptosis (drooping of upper eye lid) - Dilation of pupils
30
What nerve carries smell from olfactory mucosa?
- Olfactory nerve CN I
31
Innervation of thyrohyoid.
- C1 from ansa cervicalis (cervical plexus)
31
Innervation of SCM
- CN XI (accessory)
33
What are the horns within the spinal cord? Are they found within the gray matter or white matter?
- Found within gray matter are the ventral horn, dorsal horn and lateral horn (only T1-L2). - Ventral horn contains motor fibers and gives rise to ventral rootlets and root. - Dorsal horn contains sensory fibers and gives rise to dorsal rootlets, root and DRG. - Lateral horn (T1-L2) contains autonomic sympathetic fibers.
33
Blood supply to external acoustic meatus?
- Deep auricular branch of maxillary artery
33
Function of tensor tympani and stapedius muscles?
- Dampen vibration of ossicles
34
Two parts of the oral cavity
- Oral vestibule - Oral cavity proper
35
From what does the tympanic membrane of the ear form?
- First pharyngeal membrane gives rise to this.
35
What the connecting area between the oral cavity and pharynx called?
- Oropharyngeal isthmus
36
What is the fold of mucus membrane that extends from gingiva to inferior aspect of tongue?
- Lingual frenulum
36
What muscles close the laryngeal inlet?
- Transverse arytenoid (unpaired) - Oblique arytenoid
37
Taste from tongue is carried in what nerves?
- Lingual of CN V3 to anterior 2/3rds (except circumvallate) - CN IX to posterior 1/3rd (plus circumvallate of tongue)
37
What are the two parts of the roof of the oral cavity?
- Hard and soft palate
37
3 Compartment of larynx
- Vestibule (superior to vestibular folds) - Ventricle (cavity on the lateral walls bw vestibular and vocal folds) - Infraglottic cavity (bw vocal folds and inferior border of the cricoid cartilage)
38
Function of CN IV?
- SO innervation
39
Dermatomal pattern for visceral afferent neurons from: a.) head and neck b.) heart and lungs c.) upper extremity d.) GI system: esophagus to rectum e.) Liver and GB f.) Pancreas and spleen g.) Urinary system h.) Testes/Ovaries i.) Uterus and cervix j.) Prostate k.) Lower extremities
- a.) T1-4 - b) T1-7 - c.) T5-7 - d.) T2 (esophagus) – L2 (rectum) - e.) T6-9 - f.) T5-11 - g.) T10-L2 - h.) T10-T11 - i.) T10-L2 - j.) L1-2 - k.) T10-L2
39
What occurs at the rima vestibuli?
- Closes during swallowing to prevent food from entering larynx
40
Describe 4 papillae of tongue
1.) Filiform papillae: hair-like structures containing nerve endings sensitive to touch 2.) Fungiform papillae: mushroom-like structures 3.) Vallate (circumvallate) papillae: largest papillae (12-18 of them) ant t sulcus terminale with high density of taste buds 4.) Foliate papillae: fold of mucosa along lateral side of tongue
41
PSNS fibers destined for lacrimal gland innervation enter orbit via branches of what CN?
- CN V
41
Structures of the oral vestibule
- Labial frenula - Pterygomandibular raphe = junction bw buccinator and sup. Constrictor muscles - Parotid pailla (opposite second maxillary molar)
42
Function of CN VIII?
- Hearing (cochlear) and equilibrium (vestibular)
42
Through what foramen does CN X travel?
- Jugular foramen
43
Course of CN XI?
- Cranial portion leaves lateral brain stem and unites with spinal part to pass through jugular foramen - Cranial part separates after leaving foramen and joins vagus to contribute to pharyngeal plexus - Spinal part originates from C1-C5 levels enters cranium through foramen magnum to join cranial. Leaves cranial after exiting foramen and proceeds towards posterior triangle
43
What structure does the buccopharyngeal fascia contain?
- Pharyngeal plexus
44
Course of chorda tympani. Origin, Function?
- Branch of CN VII - CN VII enters through internal acoustic meatus, travels into facial canal gives off chorda tympani which travels through the petrotympanic fissure and joins with lingual nerve (CN V3). Has preganglionic PSNS fibers to submandibular ganglion. CN VII leaves via stylomastoid foramen. - Function: taste from ant 2/3rds tongue (except taste to vallate papillae)
45
What structure does the stapes connect with on its medial side?
- Oval window
45
Musculus uvulae – O/I/I/F:
- O/I: posterior part of soft palate - I: pharyngeal plexus, X - F: ?
45
What is the ligament connecting the cricoid cartilage to the first tracheal ring?
- Cricotracheal ligament
47
O/I of SCM.
- O: sternal head into manubrium of sternum, clavicular head into clavicle medial third ant / sup - I: mastoid process of temporal bone
48
Location of sublingual gland?
- In floor of oral cavity between mandible and genioglossal muscle
49
Course of trochlear nerve?
- Dorsum of brain stem, penetrates dura to enter cavernous sinus then to superior orbital fissure to enter orbit.
50
Contents of infratemporal fossa
- Temporalis m (inf portion) - Medial pterygoid m - Lateral pterygoid m - Maxillary artery - Pterygoid venous plexus - Mandibular division of CN V with branches - Chorda tympani - Otic ganglion
50
Which muscle elevates the upper eyelid? Innervation?
- Levator palpebrae superioris, by CN III
51
Foramina through which CN I fibers travel?
- Cribriform plate of ethmoid
52
Which of the following muscles does not form the floor of the posterior triangle? A. Splenius capitis B. Semispinalis capitis C. Levator scapulae D. Post scalene
- B. Semispinalis capitis
53
Ligaments of TMJ
- Stylomandibular - Sphenomandibular - Lateral ligament
53
General sensation from tongue is carried in what nerves?
- Lingual of CN V3 to anterior 2/3rds - CN IX to posterior 1/3rd
54
What muscle divides maxillary artery?
- Lateral pterygoid m
55
3 parts of pharynx
- Nasopharynx: upper part (posterior to nose) - Oropharynx: middle part (posterior to mouth) - Laryngopharynx: inferior part (posterior to the larynx)
57
What is the function of fascia?
- Storage area for fat - superficial - Protection - Allows structures to move without friction
58
Tensor veli palatini – O/I/I/F:
- O: auditory tube - I: palatine aponeurosis (CT of soft palate), via tendon that hooks around pterygoid hamulus - I: CN V3 - F: tenses soft palate
59
Function of CN VII:
- Motor fibers to stapedius, post digastric, stylohyoid and muscles of facial expression - Taste fibers from ant 2/3rds of tongue (chorda tympani) and from palate - Secretory PSNS to sublingual, submandibular and lacrimal glands
60
Action of extraocular muscles?
- Superior rectus: rotate superiorly and medially - Medial rectus: rotate medially - Lateral rectus: rotate laterally - Inferior rectus: rotate inferiorly and medially - Superior oblique: abducts, depresses and rotates laterally - Inferior oblique: abducts, elevates and rotates laterally - Levator palpebrae: elevates superior eyelid
60
Nerve supply to TM
- Auriculotemporal (external surface) – from CN V3 - Tympanic branch of CN IX (internal surface)
60
What does each of the paranasal sinuses drain into?
- Frontal: into middle meatus - Maxillary: into hiatus semilunaris of middle meatus - Sphenoid: into sphenoethmoidal recess (above superior concha) - Ethmoidal air cells: Anterior/middle drain into middle meatus, posterior into superior meatus
60
What drains into the inferior meatus?
- None of them directly
60
Layers of the pharyngeal wall?
- Mucus membrane - Submucosa - Pharyngobasilar fascia - Skeletal muscle layer (constrictors) - Buccopharyngeal fascia
61
Where does common carotid terminate, ie. at what identifiable structure/level)? What does it terminate into?
- Terminates at superior border of thyroid cartilage at upper level of C5. - Terminates into internal and external carotid arteries
63
What is the pharyngeal apparatus? When does it start to develop? What are its contents?
- Early embryological structure that contributes to the formation of the head and neck, including face. - 4 week old embryo - Contents: pharyngeal arches, pharyngeal pouches, pharyngeal grooves, pharyngeal membranes
64
What are the derivatives of the third pharyngeal arch?
- Third arch. Bone: minor contribution to hyoid bone. Muscles: stylopharyngeus muscle. Nerve: CN IX.
65
What is the lining of the orbit called? What is this continuous with?
- Periorbita (same as periosteum) - Continuous with dura at optic canal and periosteum outside orbit
66
Coverings of TM
- Outside = skin - Inside = mucus membrane
66
Inferior constrictor – O/I/I
- O: thyroid cartilage - I: pharyngeal raphae and blends with esophagus inferiorly - I: pharyngeal plexus
67
Parts and Function of auricle
- Collect sounds waves and pass them to ext auditory meatus - Helix - Anti-helix - Lobule - Tragus
68
Bilateral papillae at base of lingual frenulum?
- Sublingual papilla
68
Middle constrictor – O/I/I
- O: hyoid bone - I: pharyngeal raphae - I: pharyngeal plexus
69
Divisions of labyrinth/inner ear. Describe each
- 1.) Bony labyrinth: a.) Vestibule: oval cavity which communicates anteriorly with cochlea and posteriorly with semicircular canals b.) Cochlea: bony snail-like structure coiled 2.25 times around pillar known as modiolus c.) Semicircular canals: three of these forms 2/3 of a circle and communicate with vestibule - 2.) Membranous labyrinth: membranous duct system located in bony labyrinth, contains endolymph. Consists of cochlear duct, three semicircular ducts and two sacs called utricle and saccule
70
What is the superior portion of the tongue called?
- Dorsum of tongue
71
Extraocular muscles? Innervation?
- SO4 LR6 rest III
72
Cervical sympathetic trunk. Where is it located? Where does it course? What are its components?
- Begins at level of C1 - Courses inferiorly through neck anterior to vertebral column and deep to carotid sheath - Components: Superior cervical ganglion (C1, C2), middle cervical ganglion (C6 at cricoid cartilage) and inferior cervical ganglion (C7, sup border of 1st rib)
73
What structures lie close to anterior scalene?
- Phrenic nerve - Subclavian artery - Brachial plexus
74
Palatopharyngeus – O/I/I/F:
- O/I: from palatine aponeurosis of soft palate to upper part of wall of pharynx - I: pharyngeal plexus, X - F: ?
75
Which of the following is not a branch of the external carotid? A. Lingual B. Facial C. Vertebral D. Superior thyroid C. Vertebral
- E. occipital
76
Branches of subclavian artery.
- Right subclavian branches from brachiocephalic artery - Left subclavian branches directly from aorta - Each divides into three parts (VIT = 1st, C = 2nd, D = 3rd) - Branches – VITamen C & D (without accounting form branches of thyrocervical) Vertebral Internal thoracic Thyrocervical trunk (inferior thyroid, suprascapular, transverse cervical) Costocervical trunk Dorsal scapular
76
What are the tarsal plates and glands of the eye?
- Tarsal plates: CT that form skeleton of the lids - Tarsal glands: embedded in tarsal plate, secrete lipid material to lubricate edges of lids
77
What are the cartilages of the larynx? Which are single, which are paired?
- Thyroid: single - Cricoid: single - Epiglottic: single - Arytenoid: paired - Corniculate: paired - Cuneiform: paired
78
What forms floor of nose?
- Hard palate (palatine processes of maxilla and horizontal plates of palatine bone) - Greater and lesser palatine foramina
79
Infratemporal fossa bounds
- Lat: ramus of mandible - Med: lateral pterygoid plate - Sup: infratemporal crest - Inf: angle of mandible
79
Through what foramina do the middle and accessory meningeal arteries travel?
- Middle: foramen spinosum - Accessory: foramen ovale
79
Two parts of inner ear
- Vestibular portion - Auditory portion
79
What is the ligament connecting the cricoid cartilage to the thyroid cartilage?
- Cricothyroid ligament
81
What are the subdivisions of the posterior triangle? Describe bounds
- Subclavian / supraclavicular triangle: base triangle - bounded by inferior belly of omohyoid, SCM and middle 1/3rd clavicle - Occipital triangle: apex triangle - bounded by omohyoid, SCM and trapezius
83
What cranial nerves contain autonomic fibers? Are these exclusively autonomic?
- CN III, VII, IX and X contain parasympathetic fibers
- Not exclusively autonomic, contain other efferent/afferent somatic and visceral fibers
85
How many spinal nerves are there? What is the breakdown for each region of the spine? How are they numbered? Provide examples.
- 31 pairs - 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal - Cervical high, thoracic lumbar sacral coccygeal low, C8 under C7. C1-7 come out above their respective vertebral number, C8 is under vertebra C7, every other spinal nerve comes out below their vertebral number. - L2 spinal nerve comes out below L2; C2 comes out above C2; etc.
87
What is important to know about posterolateral herniations of lumbar IV discs? Provide examples to show your understanding.
- These herniated discs impinge on the nerve that is at the next lower level and not that of the level where the herniation occurs. This is due to the arrangement of the cauda equina and also that the nerve of that level leaves the vertebral canal through the superior aspect of the intervertebral foramen. - L4-5 herniation impinges the L5 nerve. - L5 herniated disc (which is below the L5 vertebra) impinges on the S1 nerve.
88
What are the branches of the superior laryngeal nerve? Motor, sensory or both?
- Internal laryngeal: sensory - External laryngeal: motor
89
Divisions of CN V Function?
- CN V1 opthalmic (sensory) a.) Nasociliary: sensory to eyeball, several branches to orbit, face, paranasal sinuses, nasal cavity b.) Frontal: sensory innervation to superior eyelid, scalp and forehead c.) Lacrimal: sensory to conjunctiva and skin of superior eyelid, distal carries secretomotor from zygomatic nerve (CN V2) - CN V2 maxillary (sensory) a.) Zygomatic: sensory to skin over zygomatic bone and skin bw and incl lower eyelid and upper lip b.) Palatine: sensory to soft and hard palates c.) Nasal: sensory to mucosa of nose d.) Infraorbital: sensory to skin bw and incl lower eyelid and upper lip - CN V3 mandibular (mixed) – Mnemonic = buccaneers are inferior linguists a.) Motor branches: motor to masticatory muscles, tensor tympani and tensor veli palatini b.) Buccal: sensory to buccal mucosa and adjacent artery c.) Auriculotemporal: sensory to TMJ, ext acoustic meatus, skin of temple and scalp, has postG PSNS fibers for parotid d.) Inferior alveolar: motor to mylohyoid and ant belly digastric, sensory to mandibular teeth e.) Lingual: general sensation to ant 2/3rd tongue, taste fibers from ant 2/3rd of tongue and PSNS fibers to oral glands
91
What are the derivatives of the second pharyngeal arch?
- Second arch = hyoid arch. Bones: major contribution to hyoid bone. Muscles: facial expression, stapedius, stylohyoid, post. belly of digastric. Nerve: CN VII.
91
Function of CNXI?
- Pharyngeal plexus - Motor innervation to SCM and trapezius
91
What supplies sensory to conjunctiva?
- Lacrimal
91
Muscles of tongue, innervation, function?
1.) Intrinsic muscles: run longitudinally, vertically and transversally. Act to change shape of tongue. Innervated by CN XII 2.) Extrinsic muscles a.) Genioglossus: protrude tongue if bilateral, unilateral contraction pushes tongue towards contralateral side. Innervated by CN XII b.) Hyoglossus: depresses tongue. Innervated by CN XII c.) Styloglossus: retrudes tongue. Innervated by CN XII d.) Palatoglossus: elevates posterior part of tongue. Innervated by pharyngeal plexus
92
What glands are found in the eyelids?
- Ciliary glands: sebaceous glands - Tarsal glands (in tarsal plates): lipid secreting glands to lubricate edges of lids
93
What is the pharynx?
- Continuation of digestive tube below oral and nasal cavities
94
Entry point of internal carotid into skull?
- Carotid canal of temporal
94
What muscles open the mouth?
- Supra/infrahyoids
95
Quadrants of TM
- Anterosuperior - Anteroinferior: contains cone of light - Posteroinferior - Postersuperior
95
What muscles cause high pitch voices?
- Suprahyoird muscles
96
What is the opening between the vestibular folds known as?
- Rima vestibuli
97
Define synapse.
- functional communication between a series of neurons
97
CN III function?
- motor fibers to all extraocular muscles except SO and LR - Pre-ganglionic PSNS fibers to ciliary ganglion (for intrinsic eye muscles) and proprioception fibers
98
Walls of orbit?
- Medial wall - Lateral wall - Superior wall (aka roof) - Floor - Apex
99
What are typical cervical vertebrae? What are atypical?
- Typical C3-6 - Atypical C1, C2, C7
100
What are the divisions of the ANS? From what locations in the spinal cord do these divisions arise?
- Sympathetic: thoracolumbar - Parasympathetic: craniosacral
101
What is found between the palatopharyngeal and palatoglossal arches?
- Palatine tonsils
102
Two parts of CN VIII? Where does it divide?
- Cochlear and vestibular - In the internal acoustic meatus
103
Describe sensory innervation to tongue
1.) Anterior 2/3rd - Lingual nerve (CN V2) – general sensation - Chorda tympani (CN VII) = taste except to vallate papillae 2.) Posterior 1/3rd - CN IX – general sensation and taste (including to all vallate papillae) - CN X – area around epiglottis
104
What sinus drains into the middle meatus?
- Frontal, maxillary and ethmoidal air cells (ant and middle)
105
Structures of the middle ear/tympanic cavity?
- Opening of Eustachian (pharyngotympanic/auditory) tube - Ossicles (malleus, incus, stapes) - Tensor tympani m - Stapedius m - Oval and round windows - Tympanic plexus
107
What spinal nerve component is the cervical plexus made up of?
- Ventral primary rami only.
108
Which of the following is not a sensory nerve? a.) Transverse cervical b.) Phrenic c.) Lesser occipital d.) Supraclavicular
- B. Phrenic
110
What are splanchnic nerves?
- These convey visceral efferent (ANS) and afferent fibers to and from viscera of the body cavities.
112
Draw cross section of spinal cord with spinal nerve. Draw pathway of general somatic afferent neurons.
113
Through which foramen do the divisions of CN V travel?
- A.) Opthalmic = superior orbital fissure - B.) Maxillary = foramen rotundum - C.) Mandibular = foramen ovale
115
The internal laryngeal nerve is a branch of the \_\_\_\_\_\_? A. Recurrent laryngeal B. Superior laryngeal C. Sympathetic trunk D. External laryngeal
- B. Superior laryngeal
117
Describe 4 layers of deep cervical fascia.
- Investing layer: surrounds entire neck deep to superficial fascia, splits on both sides of trap, SCM and infrahyoid muscles. Anterior part is splits to surround submandibular gland and form parotid capsule. - Prevertebral layer: surrounds vertebral column and muscles closely associated with it. Forms floor of posterior triangle. - Pretracheal layer: in anterior part of anterior triangle. Surrounds trachea, esophagus and thyroid gland. Forms visceral compartment. Blends laterally with carotid sheath. - Carotid sheath: fascia surrounding great vessels of neck. Contains carotid a, internal jugular and CN X (vagus).
118
What is the sublingual fold?
- Raised area on each side of lingual frenulum formed by sublingual gland
119
What bones form floor/inferior wall of orbit?
- Maxilla, zygomatic, palatine
120
Two conjunctiva of eye?
- Palpebral conjunctiva (covering of eyelid) - Bulbar conjunctiva (covering of eyeball)
121
What vessel(s) lies over SCM?
- External jugular vein
122
Foramen through which CN III travels?
- Superior orbital fissure
124
What are the gray and white rami communicantes? What fibers do each contain and at what spinal cord levels are each found?
- They connect the sympathetic chain ganglia to the spinal nerves. White rami contain myelinated presynaptic axons (that originate in lateral horn of spinal cord and travel via ventral root into SCG) and are found at T1-L2 levels (same as SCG itself). - Gray rami contain unmyelinated postsynaptic axons that have their cell bodies in the SCG and are travelling via the gray rami into the spinal nerves or out into splanchnic nerves.
125
With what nerve does PSNS fibers to parotid travel?
- Auriculotemporal nerve of V3
126
Explain divisions of tympanic cavity
- Roof: thin layer of temporal bone called tegmen tympani - Floor: above carotid canal and beginning of int jugular vein - Posterior wall: entrance to mastoid air cells and entrance of stapedius muscle and chorda tympani - Lateral wall: tympanic membrane - Medial wall: tympanic plexus, oval and round windows - Anterior wall: separation from carotid canal, has opening to Eustachian tube
128
Muscles of temporal fossa
- Temporalis muscle (except inf portion) - Masseter muscle
129
What does the tensor tympani m attach to?
- Handle of malleus
130
What blood vessels supply orbit?
- Opthalmic artery (branch off int carotid) enters through optic canal and gives rise to supraorbital, supratrochlear, lacrimal and central artery of retina - Superior and inferior ophthalmic veins drain the eye through the superior orbital fissure and enter cavernous sinus inside the skull
132
The number of pharyngeal arches that start to develop in the embryo are: A. 2 B. 3 C. 5 D. 6
- D. 6
133
What muscles widen the laryngeal inlet?
- Thyroepiglottus
135
Draw / label cervical plexus, indicate the sensory and motor divisions. What do each innervate?
1.) Sensory: a.) Lesser occipital: skin of neck and scalp posterior to auricle b.) Great auricular: skin inferior to auricle over parotid gland and posterior part of auricle c.) Transverse cervical: skin over anterior triangle d.) Supraclavicular (lateral, intermediate, medial branches): skin over clavicle, sup wall of chest and anterolateral shoulder 2.) Motor: a.) Ansa cervicalis: motor for strap muscles (sternohyoid, sternothyroid, sup/inf bellies omohyoid); C1 supply thyrohyoid and geniohyoid muscles. b.) Phrenic nerve: motor for diaphragm
135
Someone presents to your clinic with ptosis of left eye, inferior lateral rotation of eye and dilated pupil. Explain what the problem is?
- Ptosis is result of loss of function of levator palpebrae superioris - Dilation is seen in SNS, so if SNS is dominating with output causing this, then PSNS innervation to intraocular eye muscles are lost. - Inferior lateral rotation of eye (down and out): MR, IR, SR, IO have lost their function. Lateral rectus and superior oblique still function, causing this movement. - All of these functions are contained within CN III – this is oculomotor palsy.
136
What bones form lateral wall of orbit
- sphenoid (greater wing), zygomatic
137
What supplies blood to the nose?
1.) Arteries - Anterior ethmoidal a – from opthalmic a - Posterior ethmoidal a – from opthalmic a - Sphenopalatine a – from maxillary a - Greater palatine a – from descending palatine branch of maxillary a - Superior labial a – from facial a 2.) Veins - Sphenopalatine v – drains into maxillary v - Facial v - Opthalmic v
137
Which sinus(es) is most commonly infected?
- Maxillary sinuses - Opening for sinus is small and located on superior part of sinus, making it difficult to drain. Mucus membrane of sinus when congested, blocks opening
138
Which is larger, ventral or dorsal primary rami? Why?
- Ventral rami. Dorsal primary rami carry sensory / motor fibers to/from deep back muscles, synovial joints of vertebral column and overlying skin of back. Ventral rami run everything else, which is remaining areas of trunk, upper and lower limbs. They form nerve plexuses.
139
Stylopharyngeus – O/I/I
- O: styloid process - I: thyroid cartilage and pharyngeal raphae - I: innervated by CN IX
140
What structure(s) overlies levator scapulae?
- CN IX
142
What is the definition of a nerve?
- collection of cell processes, dendrites and axons, surrounded by CT coverings.
143
What is the lumbar cistern?
- It is the area of subarachnoid space within the dural sac from L2 to S2 containing CSF, the cauda equina, including filum terminale.
144
Foramen through which CN II travels?
- Optic foramen
145
What nerve supplies the intrinsic muscles of the larynx?
- Recurrent laryngeal nerve innervates all intrinsic laryngeal muscles, with exception of cricothyroid
- Cricothyroid muscle is supplied by external laryngeal
147
Innervation of skin over clavicle, sup wall of chest and anterolateral shoulder
- Supraclavicular C3,4 (cervical plexus)
148
Muscles of the soft palate?
- Levator veli palatini - Tensor veli palatini - Palatoglossus - Palatopharyngeus - Muscular uvulae
149
What supplies sensory innervation to the soft palate?
- Lesser palatine (branch of maxillary of CN V)
150
Describe autonomic innervation to eye
1.) PSNS - PreG fibers for SM of eye travel with CN III - In orbit, preG fibers branch off CN III and enter into ciliary ganglion, located in orbit along posterolateral side of optic nerve - PostG fibers leave ganglion via short ciliary nerves (branches of CN V1) and enter eyeball, innervating SM of eyeball - Lacrimal gland: supplied by PSNS fibers from greater petrosal (preG fibers) of CN VII. Post G fibers originate from pterygopalatine ganglion and enter orbit via zygomatic branch of maxillary nerve (CN V2) 2.) SNS - PostG sympathetic fibers from sup cervical ganglion enter orbit with wall of blood vessels to eye
151
What forms the roof of the nose?
- Cribriform plate (ethmoid) - Nasal bones - Maxilla and frontal bones - Nasal cartilage
153
Describe fascial layers of neck.
- Superficial cervical fascia: fatty subQ tissue, bw skin and investing layer of deep fascia, has cutaneous nerves, blood vessels and lymphatics, platysma embeds anteriorly into this - Deep cervical fascia: supports organs and blood vessels. Contains 4 layers: investing, prevertebral, pretracheal, carotid sheath.
154
What neurons in the spinal cord are part of the ANS?
- General visceral efferents. Visceral motor division.
155
Draw cross section of spinal cord with spinal nerve. Draw pathway of general visceral efferent neurons.
155
What muscles relax the vocal cords?
- Thyroarytenoid
156
In what nerve do PSNS fibers to sublingual, submandibular glands travel?
- CN VII
158
Course and branches of CN X in neck?
- Exits skull from brainstem through jugular foramen and enters carotid sheath. - Branches in neck: Recurrent laryngeal Contribution of pharyngeal plexus Cardiac branches Superior laryngeal
159
What supplies sensory innervation to the hard palate?
- Anterior part = nasopalatine (branch of maxillary of CN V) - Greater palatine (branch of maxillary of CN V)
159
What are the two cartilages found in the aryepiglottic fold? What is the function?
- Corniculate (sits on apex of arytenoid cartilage) - Cuneiform - They both support the aryepiglottic fold
161
What is gray matter? What is white matter?
- Gray matter are collections of cell bodies and unmyelinated axons and dendrites within the CNS - White matter are collections of axons/dendrites within the CNS
162
Through what foramen does CN VIII travel?
- Internal acoustic meatus
164
Where is carotid pulse checked? Describe anatomically.
- Level of thyroid cartilage deep to anterior border of SCM
164
Innervation of muscles of mastication
- CN V3
165
What forms roof of posterior triangle?
- Investing layer of deep cervical fascial. - Superficial cervical fascia - Platysma - Skin
166
What is the carotid sinus?
- Dilated segment of internal carotid artery at proximal end that is innervated by CN IX and X. Acts as chemo and baroreceptor to monitor both blood gas composition and pressure.
167
Describe the spinal cord. Identify regions, enlargements and terminations.
- Starts: foramen magnum - Ends: at L2 vertebral body. Terminal portion known as conus medullaris, rootlets that exit the remaining lumbar intervertebral formina are are contained with the lumbar cistern (subarachnoid space adjacent and inferior to L2 extending to ~ S2) are known as the cauda equina. Contained within the cauda equina is an extension of pia mater that continues inferiorly and penetrates the most inferior end of the dural sac, taking with it arachnoid and dura mater, passes through sacral hiatus and anchors to posterior coccyx. - Contains myelinated axons/dendrites in outer portion of spinal cord (white matter) and unmyelinated cells bodies in inner portion of spinal cord (grey matter) - Enlargement to cervical cord for upper limb innervation - Enlargement to lumbosacral cord for lower limb innervation
169
Temporal Fossa bounds
- Ant: frontal, zygomatic bones - Post/sup: temporal lines - Lat: zygomatic arch - Inf: infratemporal crest - Floor: frontal, parietal, temporal and greater wing of sphenoid (pterion)
171
Which CN arises from the fourth pharyngeal arch during embryological development?
- CN X
172
From what do CN X, IX, VII and V arise?
- Pharyngeal arches. - CN X from 4th arch - CN IX from 3rd arch - CN VII from 2nd arch - CN V from 1st arch
173
Describe the external auditory meatus from a structural standpoint
- Lateral 1/3rd is cartilaginous - Medial 2/3rd is bony
174
Where is the apex of the orbit located?
- Optic canal in lesser wing of sphenoid bone
176
What is the SCG, where is it located?
- The sympathetic chain ganglion is a collection of cell bodies and processes outside of the CNS that are autonomic. Pre-synaptic cell bodies that arise in the CNS synapse with post-sympathetic cell bodies in this structure or bypass it via splanchnic nerves to the prevertebral ganglia. Some Post-sympathetic cell bodies are found her and travel directly to their target organ.
177
V-shaped groove on dorsum of the tongue?
- Sulcus terminalis = separation of anterior and posterior tongue
179
What cervical level do the thyroid/parathyroid glands correspond to?
- C6
180
What are the ligaments found in the “lumen” of the larynx?
- Vocal ligament/fold – extends from junction of laminae of thyroid cartilage (ant) to the vocal processes of arytenoid cartilage (post). These are true vocal cords - Vestibular ligament/fold – free edges of quadrangular membrane. These are false vocal cords
181
Draw cross section of spinal cord with spinal nerve. Draw pathway of general visceral afferent neurons.
182
Function of the pharyngeal muscles?
- Constrict wall of pharynx during swallowing
183
Nerves that run through superior orbital fissure?
- CN V1 - CN III - CN IV - CN VI
185
What type of joint is TMJ? Describe in detail
- Modified hinge joint w/ - Synovial joint between mandibular fossa / articular eminence of temporal bone & condyle of mandible - Articular surfaces covered by fibrous tissue - Articular disc = fibrous tissue - Upper = between articular eminence, mandibular fossa and articular disc = gliding joint - Lower = bw articular disc and condyle of mandible = hinge joint
186
Branches of frontal nerve?
- Supraorbital - Supratrochlear
187
List the paranasal sinuses.
- Frontal sinus - Maxillary sinus - Sphenoid sinus - Ethmoidal air cells
188
Describe the anatomical structures/features found within a cross section of spinal cord. Provide anatomical directionality when describing components found within the spinal cord.
- Gray matter (inner): contains the dorsal horn (posterior horn) and carries sensory fibers and gives rise to dorsal rootlets, roots and DRG arise. Contains the ventral horn (anterior horn) and carries motor fibers and gives rise to ventral rootlets and roots. At levels T1-L2, it contains the lateral horn (aka intermediolateral cell columns) which are autonomic sympathetic fibers. - White matter (outer)
188
Superior constrictor – O/I/I
- O: originates from pterygoid hamulus, pterygomandibular raphe and mandible - I: pharyngeal raphae, pharyngeal tubercle of occipital bone - I: pharyngeal plexus
189
Features of atypical cervical vertebrae.
189
What bones form the medial wall of orbit?
- Ethmoid, frontal, lacrimal and sphenoid
190
Describe characteristics of the parasympathetic division of the ANS. Include: function, NT involved, location of pre-synaptic and postsynaptic cell bodies, course of cell processes.
Parasympathetic division: think craniosacral - function: rest, digest, feed and assimilate - neurotransmitter: ACh - cell body locations: a.) pre-synaptic cell bodies are CNs III, VII, IX and X that have their cell bodies in gray matter of brainstem; also sacral segments 2-4 have their cell bodies in gray matter of spinal cord S2-S4 segments b.) post-synaptic cell bodies in target organ being innervated - course of cell processes: a.) pre-synaptic cell processes travel directly from cranium (as CNs) or from sacral spinal cord as pelvic splanchnic nerves directly onto target organs where they synapse with post-synaptic fibers embedded in the wall of their target organs b.) post-synaptic cell processes are embedded within the wall of their target organs
192
OI of splenius capitis m
- O: ligament nuchae/spinous process of C7-T3 - I: occipital bone and mastoid process
193
What is the definition of ganglion?
- collection of cell bodies outside the CNS
194
Describe the meninges of the spinal cord.
- consists of 3 layers: dura, arachnoid and pia mater - outer to inner (including spaces): a.) epidural space b.) dura mater c.) arachnoid mater (has projections known as arachnoid trabeculae that anchor it to the pia mater) d.) subarachnoid space (contains CSF and rootlets off of spinal cord) e.) pia mater: (denticulate ligaments are lateral extensions of pia that anchor into the dural sac boundary providing stability, filum terminale is inferior extension that pierces dural sac and anchors spinal cord to coccyx)
195
In what bone is the middle ear located?
- Petrous portion of temporal bone
195
What supplies structures of soft palate?
- Lesser palatine nerve
196
What fibers: sensory or motor, are contained within the: a.) Dorsal root? b.) Ventral root? c.) Spinal nerve? d.) Ventral primary rami e.) Dorsal primary rami
- a.) sensory - b.) motor - c.) mixed - d.) mixed - e.) mixed
197
What are the fascial layers of the neck?
- Superficial cervical fascia - Deep cervical fascia (investing, prevertebral, pretracheal, carotid sheath)
198
Describe PSNS pathways into and out of otic ganglion – what do these fibers innervate?
- In: preganglionic PSNS fibers from CN IX via tympanic nerve into tympanic plexus into lesser petrosal nerve
- Out: postganglionic PSNS fibers with auriculotemporal nerve (V3) to parotid gland
199
Blood supply to tongue
- Lingual artery (branch of ext carotid artery)
201
What is carotid occlusion, what does it lead to?
- Atherosclerotic thickening of tunica intima obstructs blood flow to brain and leads to stroke or TIA. ~80% of blood flow to brain is via internal carotid.
202
What bones form the superior wall of orbit?
- Frontal, sphenoid (lesser wing)
204
Innervation of skin over anterior triangle
- Transverse cervical C2,3 (cervical plexus)
206
What are the contents of each of the subtriangles of the anterior triangle, besides muscles?
- Submandibular: submandibular gland, salivary gland, submandidublar ganglion (PSNS ganglion next to submandibular gland), submandibular lymph nodes, hypoglossal CN XII, facial a and v - Submental: submental lymph nodes, beginning of ant jugular veins - Carotid: carotid sheath: vagus nerve (CN X), common carotid and internal carotid and internal jugular v; external carotid and branches - Muscular triangle: thyroid and parathyroid glands (C6 level)
207
What separates the two halves of the tongue?
- Median sulcus
209
Define filum terminale.
- inferior extension of pia mater that is part of the cauda equina, It extends inferiorly and runs through the sacral hiatus, pierces the dural sac, taking with it arachnoid and dura mater and anchors to the posterior coccyx.
210
What supplies sensory innervation to eyeball?
- Nasociliary
212
Branches of CN VII
A.) In facial canal: branch to stapedius, chorda tympani and great petrosal nerve B.) Exiting stylomastoid foramen: to post belly digastric, stylohyoid and branches to muscles of facial expression (To Zanzibar By Motor Car: Temporal, Zygomatic, Buccal, Mandibular, Cervical)
213
Trunks of brachial plexus. Where are these located anatomically?
- Sup, middle and inferior trunks - Between anterior and middle scalenes
215
What do lesions of CN XII cause?
- Protruded tongue deviation towards side of lesion
217
What muscle divides the neck into two cervical triangles? What are these triangles called?
- Sternocleidomastoid - Anterior and posterior triangle
217
Cartilage of ear auricle
- Elastic cartilage
218
What are dermatomes? What are myotomes?
- Dermatomes are sensory nerve distributions - Myotomes are motor nerve distributions
219
What provides sensory innervation to the pharynx?
- CN IX
220
Palatoglossus – O/I/I/F:
- O/I: from palatine aponeurosis of soft palate to side of tongue - I: pharyngeal plexus, X - F: muscle of palate, not tongue
221
What is the sublingual papilla?
- Opening of the ducts of submandibular gland
223
Foramen that CN V3 exits?
- Foramen ovale
224
What forms the hard palate?
- Palatine process of maxilla and horizontal plates of palatine bone
226
Which foramen does the CN XI travel through?
- Jugular foramen
227
Is CN V3 motor or sensory?
- Both
228
What movement occurs at cricothyroid joint?
- Rotation and gliding between thyroid and cricoid cartilage
230
Course of inferior alveolar nerve of V3
- Motor fibers leave before nerve enters mandibular foramen. Exits via mental foramen as mental nerve
231
What does the sphenoid sinus drain into?
- The sphenoethmoidal recess above the superior concha
232
Levator veli palatini – O/I/I/F:
- O: auditory tube - I: palatine aponeurosis (CT of soft palate) - I: pharyngeal plexus, X - F: raises soft palate during swallowing
234
What is exophthalmos?
- Protrusion of eyeball
235
What muscles adduct the vocal cords?
- Lateral cricothyroid (reinforced by transverse artenoid)
237
Do all extraocular muscles attach to sclera of eyeball?
- False. All four recti muscles attach to sclera of eyeball and originate from common tendinous ring, which is a fibrous structure that surrounds optic foramen and part of superior orbital fissure
238
What is the conus elasticus?
- Elastic membrane extending from cricoid cartilage of the vocal ligament, which consists of median cricothyroid ligament, vocal ligament and cricothyroid ligament
239
What is the quadrangular membrane?
- Thin submucosal sheet of CT extending from arytenoid cartilage to epiglottic cartilage and covered by aryepiglottic fold. Free edges of this membrane create the vestibular ligament / fold, which are the false vocal cords
240
Which CN has longest intracranial course?
- CN IV
241
Over what structure(s) does the ansa cervicalis lie?
- Internal jugular v, carotid a
242
What supplies sensory innervation to the nasal septum?
- Nasopalatine (branch of maxillary of CN V)
243
What does the stapedius m attach to?
- Neck of stapes
244
Function of CN XII?
- Motor to intrinsic and extrinsic muscles of tongue
244
What is the structure that connects the inferior end of the epiglottic cartilage to the thyroid cartilage?
- Thyroepiglottic ligament
246
OI middle scalene m
- O: transverse process of C4-6 - I: 1st rib
248
At what vertebral level is an LP/spinal tap performed? What space is being accessed?
- LPs are typically done by inserting needle between spinal processes of L3 and L4, can be between L4 and L5. One is accessing CSF contained in the subarachnoid space.
249
Two parts of tongue?
- Root – posterior 1/3rd - Body – anterior 2/3rds (most anterior = apex)
250
What contributes to the pharyngeal plexus?
- CN IX - CN X - CN XI - Sympathetic nerves
252
Damage to CN IV will cause what?
- double vision when pt looks downward and outward
253
OI anterior scalene m
- O: transverse process of C4-6 - I: 1st rib
254
Long and short ciliary nerves are branches from what CN?
- Opthalmic division of CN V
255
Innervation of sternohyoid.
- C2, 3 from ansa cervicalis (cervical plexus)
257
Nerve supply to TMJ?
- Masseteric - Auriculotemporal
258
Which blood vessels become prominent upon rising BP?
- External jugular veins
259
Function of CN V
- Sensory innervation to head - Motor innervation to muscles of mastication
260
What is the median plane of the nose called?
- Nasal septum
262
Foramen of the hard palate? What travels through each?
- Incisive foramen: nasopalatine nerve and sphenopalatine artery - Greater palatine foramen: greater palatine vessels and nerve - Lesser palatine foramen: lesser palatine vessels and nerve
264
Branches of nasociliary nerve?
- Posterior ethmoidal - Anterior ethmoidal - Infratrochlear
266
What CN forms the tympanic plexus?
- CN IX
267
What do the sensory branches of CN V3 carry?
- Buccal = skin of cheek, mucous membrane of cheek and lateral surface of oral gingival - Auriculotemporal (auricle, skin over temporal, TMJ, secretory PSNS parotid fibers belonging to CN IX, ext acoustic meatus and TM) - Inf alveolar (teeth on its side) - A.) mylohyoid n = ant belly digastric, mylohyoid m - B.) mental n = skin of chin - C.) incisive n = canine and incisive teeth - Lingual = sensory to tongue, floor of mouth and gingival
268
What is the opening between the vocal folds known as?
- Rima glottidis
269
What is the name of the potential space behind the pharynx? Boundary? Clinical significance?
- Retropharyngeal space located between buccopharyngeal fascia and prevertebral fascial (of deep cervical fascia)
271
Muscles of mastication
- Temporalis, masseter, lateral and medial pterygoids
272
Destination of maxillary artery branches
- Mnemonic: DAM I AM Piss Drunk But PISD d.) 1st part: - Deep auricular: ext acoustic meatus - Ant tympanic: to TM - Middle meningeal: to cranial meninges - Inf alveolar: mandibular teeth - Accessory meningeal: to cranial meninges e.) 2nd part: - Masseteric: masseter m - Pterygoid: pterygoid muscles - Deep temporal: temporalis m - Buccal: muscles of cheek f.) 3rd part: - Post sup alveolar - Infraorbital - Sphenopalatine - Descending palatine
273
What is the DRG? Where is it?
- Dorsal root ganglia are collection of sensory cell bodies outside the CNS. They receive sensory information from the periphery and transmit that back into the CNS. - It is found off the dorsal root before the ventral and dorsal root form the spinal nerve and lies within the intervertebral foramina.
274
Identify landmark where maxillary artery arises
- Post to neck of mandible (inferior to coronoid process)
276
Through which foramen does CN XII travel?
- Hypoglossal canal
277
Describe characteristics of the sympathetic division of the ANS. Include: function, NT involved, location of pre-synaptic and postsynaptic cell bodies, course of cell processes.
Sympathetic division: think thoracolumbar - function: flight, fright or fight - neurotransmitter: norepinephrine - cell body locations: a.) pre-synaptic cell bodies in lateral horn (grey matter of spinal cord) between T1 and L2/3; b.) post-synaptic cell bodies in SCG or prevertebral ganglion - course of cell processes: a.) pre-synaptic cell processes enter spinal nerve via ventral root, enter SCG via white rami communicantes, synapse immediately in SCG (1) at level of entry OR ascend/descend (2) trunk to synapse OR pass through SCG (3) without synapsing in splanchnic nerves and synpase in the prevertebral ganglion. Fibers innervating head, neck, body wall, limbs and thoracic cavity will follow courses 1 or 2. Fibers innervating viscera within abdominopelvic cavity follow course 3. b.) post-synaptic cell processes arising in SCG travel through gray rami communicantes and enter spinal nerve branching to either the ventral or the dorsal primary rami – they travel with all 31 pairs of spinal nerves. These fibers stimulation vasomotion, pilomotion and sudomotion. Post-synaptic fibers that perform these function in head (including dilate iris) have their cell bodies in sup. cervical canglion and branch to form periarterial plexuses of nerves which following branches of carotid arteries. Post-sympathetic cell processes that innervate viscera can travel either directly from SCG to organ or from their cell bodies in prevertebral ganglion to their organ. In the last two cases, these are in splanchnic nerves.
278
OI posterior scalene m
- O: transverse process of C4-C6 - I: 2nd rib
279
A 4 month old male child during physical exam is noted to have a stiff neck. Neck seems to be pulled to right so that right ear is tilted towards right shoulder. Childs face is also rotated towards the left. Palpation reveals nontender mass on right side of neck. What is most likely diagnosis? Explain.
- Congenital torticolis. SCM muscle is shortened on side opposite to rotation, but same as tilt, in this case on right.
280
Ptosis of the upper eyelid is produced by malfunction of what CN?
- CN III
281
What do the motor branches of CN V3 innervate?
- Masticatory muscles - Mylohyoid - Ant belly digastric - Tensor tympani - Tensor veli palatini
283
O/I/A/I of medial pterygoid muscle
- O: medial surface of lat pterygoid plate - I: internal surface of ramus - A: mastication - I: CN V3
284
What structures pierce the thyrohyoid membrane?
- Internal laryngeal nerve (from vagus) and superior laryngeal artery (from superior thyroid of external carotid)
285
O/I/A/I masseter muscle
- O: zygomatic arch/bone - I: ext surface of ramus and angle of mandible - A: elevates and protrudes mandible (mastication) - I: CN V3
286
What major vessels lie in the subclavian triangle?
- Ext jugular v - Subclavian a
287
What muscles close the mouth?
- Temporalis and masseter
288
Components of lacrimal apparatus? Location and Function?
- Lacrimal glands/ducts: in lacrimal fossa (superolateral part of orbit), secretes lacrimal fluid - Lacrimal lake: collecting area of tears at medial angle of eye - Lacrimal canaliculi: lateral opening = lacrimal papillae, conveys tears from lacrimal lake to sac - Lacrimal sac: dilated upper end of the nasolacrimal duct, canaliculi open here - Nasolacrimal duct: extends inferiorly into nose, opens at inferior meatus of nasal cavity
290
What are the boundaries of the posterior triangle?
- Anteriorly: posterior border of SCM - Posteriorly: anterior border of trapezius - Inferiorly: middle one third of clavicle - Base of triangle = clavicle - Apex = SCM and trapezius come together at occipital bone
292
Define afferent/efferent neuron.
- Afferent neurons sends impulses towards the CNS. These are sensory neurons. - Efferent neurons sends impulses away from the CNS. These are motor neurons.
293
From where does the right and left common carotids branch?
- Left: branch of the aorta - Right: branch of brachiocephalic trunk
294
What travels through the incisive foramen?
- Nasopalatine nerve and sphenopalatine artery
296
Through what foramen does CN IX leave the cranium?
- Jugular foramen
297
What cranial nerve(s) innervate carotid sinus?
- CN IX and X
298
Joints of larynx
- Cricothyroid: synovial joint bw inferior horn of thyroid and lateral surface of cricoid cartilage - Cricoarytenoid: synovial joint bw base of arytenoid cartilage and superior lamina of cricoid cartilage
300
What type of fibers (sensory or motor) do motor nerve branches from ventral rami contain? Cutaneous sensory nerve branches? Explain.
- Both are mixed nerves containing both sensory and motor fibers. Both contain ANS fibers.
301
Major inlets and outlets of pterygoid venous plexus
- Inlet: facial vein, cavernous sinus - Outlet: maxillary veins into sup temporal vein (in parotid) into retromandibular vein
302
Innervation of larynx. Describe branches and what they innervate
- Vagus – CNX
1. )Superior laryngeal nerve branches into internal laryngeal and external laryngeal
a. )Internal laryngeal (sensory only) supplies mucous membranes superior to vocal folds
b. )External laryngeal (motor only) innervates cricothyroid muscle
2. )Recurrent laryngeal nerve (sensory and motor) loops under subclavian on right and aortic arch on left
- Innervates all intrinsic laryngeal muscles (so, no cricothyroid innervation)
- Innervates mucous membranes inferior to vocal folds
303
What is the posterior part of the cricoid cartilage called? Anterior part?
- Posterior part = lamina – arytenoid cartilage sits on top of this - Anterior part = arch
305
Define somatic and visceral/splanchnic neurons.
- Somatic pertains to the body, typically the body wall - Splanchnic pertains to the gut, viscera
306
Divisions of ear
- External, middle (aka tympanic cavity) and inner ear
307
Innervation of skin of neck and scalp posterior to auricle.
- Lesser occipital C2 (cervical plexus)
309
What nerve encircles and artery on the head?
- Auriculotemporal (V3 division) encircles middle meningeal artery
310
Features of typical cervical vertebrae.
311
Two arches at the posterior oral cavity?
- Palatopharyngeal arch (covers palatopharyngeus muscle) - Palatoglossal arch (covers palatoglossus muscle)
313
Draw cross section of spinal cord with spinal nerve. Draw pathway of general somatic efferent neurons.
314
What are the spaces beneath each concha?
- Superior, middle and inferior meatus
315
What spaces normally exist within, underlying and overlying the meninges of the spinal cord? What spaces are abnormal?
- Normal: Epidural space, subarachnoid space - Abnormal: subdural space
316
Where do visceral afferent neurons course within the body?
- They travel with the sympathetic division of the ANS in a dermatomal pattern within splanchnic nerves.
317
Muscles of larynx. Function?
- Infrahyoid muscles: depress hyoid bone and therefore larynx, creating low pitch voices - Suprahyoid muscles: elevate hyoid bone and therefore larynx, creating high pitch voices - Transverse arytenoid (only unpaired): close laryngeal outlet, reinforce adducting vocal cords - Oblique arytenoid: close laryngeal outlet - Lateral cricoarytenoid: adduct vocal cords - Posterior cricoarytenoid: abduct vocal cords - Cricothyroid: tense vocal cords - Thyroarytenoid: relax vocal cords - Vocalis - Thyroepiglottus: widens laryngeal inlet
318
What major structure is found in the occipital triangle?
- CN XI (accessory)
319
Central depression of TM – function?
- UMBO: attachment of handle of malleus
320
Drainage of ext jugular v.
- into subclavian
322
Innervation of lacrimal gland?
- PSNS fibers carried in greater petrosal nerve of CN VII to pterygopalatine
323
O/I/A temporalis muscle
- O: floor of temporal fossa and fascia - I: tip and medial surface of coronoid process and ant border of ramus of mandible - A: elevates and retracts mandible - I: CN V3
324
This ligaments suspends the larynx
- Thyrohyoid membrane
325
What forms the nasal septum?
- Vomer - Perpendicular plate of ethmoid - Septal cartilage
326
Names of the pharyngeal muscles?
- Superior constrictor - Middle constrictor - Inferior constrictor - Stylopharyngeus
327
OI levator scapulae m
- O: transverse process of C2-C4 - I: superior medial angle of scapula
328
Two terminal divisions of ext carotid a? Which is largest?
- Maxillary and superficial temporal - Maxillary is largest
329
What happens to each spinal root as it travels laterally from the spinal cord?
- It gives rise to the dorsal and ventral primary rami, which are mixed nerves that distribute to the ventral and dorsal aspects of the body.
330
In reference to major blood vessels, where does vagus nerve run?
- Left vagus passes ant to arch of aorta and the right by passing over subclavian artery
331
Function of CN IX?
- Motor to stylopharyngeus - Posterior 1/3rd tongue general sensation with circumvallate of entire tongue - Small branch to carotid sinus
332
What muscles protrude the jaw?
- Lateral pterygoids and masseter
333
Which CN arises from the third pharyngeal arch during embryological development?
- CN IX
334
Veins of anterior triangle.
- Jugular bulb from jugular foramen forms internal jugular vein descends inferior in carotid sheath. Terminates by joining subclavian and forming brachiocephalic vein. - Anterior jugular begins in submental triangle descends along anterior midline of neck and drains into external jugular vein. - Subclavian vein drains medially and joins with external and internal jugular veins to form brachiocephalic vein.
335
What movement occurs at the cricoarytenoid joint?
- Sliding, tilting anterior and posterior, rotatory
336
Branches of CN X?
- Branches to pharyngeal plexus and soft palate - Superior laryngeal and recurrent laryngeal nerves to larynx - Cardiac branches - Branch to carotid sinus
337
Which form plexuses, the ventral or dorsal primary rami?
- Ventral primary rami form
338
What is contained within the subarachnoid space?
- CSF and spinal nerve rootlets.
339
Is recurrent laryngeal nerve motor or sensory?
- Both
341
What is the tegmen tympani?
- roof of tympanic cavity formed by thin layer of temporal bone
342
Innervation of geniohyoid.
- C1 from ansa cervicalis (cervical plexus)
343
What are the derivatives of the fourth pharyngeal arch?
- Fourth arch. Bone / muscles: muscles and cartilages of larynx. Nerve: CN X.
345
In what nerve do PSNS fibers to lacrimal glands travel?
- Greater petrosal nerve (preG fibers) of CN VII to pterygopalatine ganglion
346
What are spinal roots formed by? Explain what each contain. From what is the spinal nerve formed?
- Dorsal rootlets from the spinal cord form the dorsal root, which contain sensory neuronal processes in a CT sheath. Lateral from this are collections of sensory cell bodies (nuclei) contained with in structures/enlargements known as the dorsal root ganglia. These are within the intervertebral foramen. - Ventral rootlets from the spinal cord form the ventral root, which contain motor neuronal processes in a CT sheath. - Both dorsal and ventral roots come together to form spinal nerve, which is a mixed nerve, containing both motor and sensory fibers.
347
Parts of the external ear
- Auricle - External auditory meatus - Tympanic membrane
348
Innvervation of tensor tympani and stapedius muscles?
- Tensor tympani: CN V3 - Stapedius: CN VII
349
What muscles cause low pitch voices?
- Infrahyoid muscles
350
Describe difference between larynx between males and females/children?
- Shorter in women and children, slightly more superior - Men have longer, ant to vertebral bodies C3-6
351
What are ligaments beneath the first tracheal ring called?
- Tracheal ligaments
352
O/I/A/I of lat pterygoid muscle
- O: lat surface of lat pterygoid plate - I: TMJ and neck of condyloid process - A: mastication - I: CN V3
353
Which is the largest CN?
- Trigeminal
354
Bones of orbit?
- Mnemonic: Many Friendly Zebras Enjoy Lazy Picnics - Maxillary, Frontal, Zygomatic, Ethmoid, Lacrimal, Palatine
355
Damage to CN VI causes what?
- No lateral movement of eye beyond midpoint
356
Innervation of skin inferior to auricle over parotid gland and posterior part of auricle
- Great auricular C2,3 (cervical plexus)
357
Innervation of diaphragm
- Phrenic (C3,4,5) (cervical plexus)
358
Describe embryological development of the pharyngeal arches. Explain what each arch gives rise: CN, muscle, bone.
- Pharyngeal arches develop at lateral wall of cranial end of foregut - Stomodeum = anterior end of foregut and site of future mouth - Widening at stomodeum, narrowing inferiorly to form espophagus - Oropharyngeal membrane separates primordial pharynx and foregut from amniotic cavity, ruptures at 26th day to allow communication - End 4th week, 4 pairs of arches present. 5th / 6th never develop completely, not visible exteriorly - External arches separated by pharyngeal grooves = ectoderm - Internal arches separated by pharyngeal pouches = endoderm - Arches composed of mesenchyme also, result of neural crest cells - Each arch contains: blood vessel, cartilage (precursor to skeletal/bony components), muscular component (precursor to muscles of head and neck), nerve - First arch = mandibular arch. Bones: maxilla and mandible from prominences named after them. Muscles: mastication, mylohyoid, ant. Belly of digastric, tensory tympani, tensor veli palatini. Nerve: CN V. - Second arch = hyoid arch. Bones: major contribution to hyoid bone. Muscles: facial expression, stapedius, stylohyoid, post. belly of digastric. Nerve: CN VII. - Third arch. Bone: minor contribution to hyoid bone. Muscles: stylopharyngeus muscle. Nerve: CN IX. - Fourth arch. Bone / muscles: muscles and cartilages of larynx. Nerve: CN X.
359
Subdivisions of anterior cervical triangle. Draw and indicate boundaries.
- Submandibular triangle - Submental triangle - Carotid triangle - Muscular triangle
360
What are the folds of the mucus membrane of the hard palate?
- Palatine rugae
361
Platysma muscle: O, I, A, I:
- O: subcutaneous fascia over pectoral region of chest wall - I: subcutaneous fascia over lower face, mandible - A: facial expression - I: cervical branch of CN VII (facial)
362
What supplies sensory innervation to superior eyelid?
- Frontal, lacrimal
363
Tonsils found in oral/nasal cavity? Location?
- Palatine tonsils: between the palatoglossal and palatopharyngeal arches - Lingual tonsils: posterior 1/3rd of tongue - Pharyngeal tonsils: located in the posterior nasopharynx inferior to the sphenoid sinus, superior to the opening of the auditory tube
364
What muscles retrude the jaw?
- Posterior fibers of temporalis
365
Describe the arytenoid cartilage
- Pyramidal cartilage with anterior processes known as vocal processes - Lateral processes known as muscular processes - Apex = superior portion - Base = inferior portion
366
What nerve innervates mucous membrane of larynx?
- Mucous membranes superior to vocal folds innervated by internal laryngeal nerve
- Mucous membranes inferior to vocal folds innervated by recurrent laryngeal nerve
