Exam I Flashcards
Motor innervation to the muscles of facial expression is via branches of what nerve?
Facial nerve (C.N. VII)
This condition is characterized by facial nerve paralysis.
Bell’s Palsy
Sensory innervation to the face is via branches of what nerve?
Trigeminal nerve (C.N. V)
What are the three major branches of the trigeminal nerve (C.N. V)?
- Opthalmic nerve
- Maxillary nerve
- Mandibular nerve
What area of the face does the opthalmic nerve supply sensation?
Primarily to the face and scalp
What area of the face does the maxillary nerve supply sensation?
Primarily to the cheek and the area lateral to the orbit
What area of the face does the mandibular nerve supply sensation?
Primarily to the chin and temporal region.
What are the subdivisions of the opthalmic nerve?
- Supraorbital nerve
- Supratrochlear nerve
- External nasal nerve
- Infratrochlear nerve
- Lacrimal nerve
What are the subdivisions of the maxillary nerve?
- Zygomaticotemporal nerve
- Zygomaticofacial nerve
- Infraorbital nerve
What are the subdivisions of the mandibular nerve?
- Auriculotemporal nerve
- Buccal nerve
- Mental nerve
What nerve is most commonly injured with blows to the face?
Infraorbital nerve
This condition is characterized by a sudden attack of severe pain occurring in an area of sensory distribution of the trigeminal nerve. It is often aggravated by touch.
Trigeminal Neuralgia (Tic Douloureux)
Trigeminal Neuralgai most common occurs in what division of the trigeminal nerve?
Maxillary division. The second most common is the mandibular division and the least common is the opthalmic division.
The spinal trigeminal nucleus is involved with pain receptors from the face and extends down to what cord level?
C4
The sensory innervation of the posterior aspect of the neck and scalp is from what?
The posterior (dorsal) primary rami of cervical nerves 2-4
This nerve supplies the occipital region of the head.
Greater occipital nerve (posterior ramus of C2)
This nerve supplies the upper part of the back of the neck.
Third occipital nerve (posterior ramus of C3)
This nerve supplies the lower part of the back of the neck.
Posterior primary ramus of C4
C1 is strictly what type of nerve?
Motor
The sensory innervation of the anterior and lateral aspect of the neck is supplied by what?
The anterior (ventral) primary rami of cervical nerve 2-4
The cervical plexus is formed from what?
The anterior primary rami C1-C4
What are the sensory branches of the cervical plexus?
- Lesser occipital nerve (C2)
- Greater auricular nerve (C2, C3)
- Transverse cervical nerve (C2, C3)
- Supraclavicular nerve (C3, C4)
This nerve is part of the cervical plexus and supplies sensory innervation to the lateral part of the occipital region, posterior to the ear.
Lesser occipital nerve (C2)
This nerve is part of the cervical plexus and supplies sensory innervation to the angle of the mandible, and the area inferior to the ear. It accompanies the external jugular vein.
Great auricular nerve (C2, C3)
This nerve is part of the cervical plexus and supplies sensory innervation to the anterior surface of the neck (the throat).
Transverse cervical nerve (C2, C3)
This nerve is part of the cervical plexus and supplies sensory innervation to the lateral surface of the neck. There are three subdivisions of this nerve.
Supraclavicular nerve (C3, C4)
What are the three subdivisions of the supraclavicular nerve?
Medial, intermediate, and lateral supraclavicular nerves
In addition to sensory nerves the cervical plexus also carries motor fibers to what muscles?
Infrahyoid (strap) muscles
The motor fibers from the cervical plexus arises from a loop called what?
Ansa cervicalis
What are the two parts of the ansa cervicalis?
Superior root and Inferior root
What is the superior root of the ansa cervicalis composed of?
It runs from C1, or C1 and C2. It descends from the hypoglossal nerve to join the inferior root.
What is the inferior root of the ansa cervicalis composed of?
It runs from C2 and C3. It descends from the cervical nerve branches to join the superior root.
What is the segmental innervation of the ansa cervicalis?
C1, C2, C3
What muscles does the ansa cervicalis supply?
Three of the four infrahyoid muscles:
- sternohyoid
- sternothyroid
- omohyoid
The fourth infrahyoid muscle, the thyroyoid, receives its innervation exclusively from what?
C1 fibers through the hypoglossal nerve.
The phrenic nerve is usually considered to be part of the cervical plexus and originates from what spinal nerves?
C3, C4 (primarily), and C5
The phrenic nerve has motor supply to the ____ and sensory to _____.
Diaphragm; some of the membranes of the thorax and abdomen
Where can the phrenic nerve be found?
In the neck lying on the anterior surface of the anterior scalene muscle. It runs vertically down the muscle and into the thorax.
What is the origin of the platysma?
Superficial fascia over the pectoralis major and deltoid muscles
What is the insertion of the platysma?
Lower border of the mandible and the angle of the mouth
What is the innervation of the platysma?
Cervical branch of the facial nerve (C.N. VII)
What is the action of the platysma?
Depresses the mandible and draws down the corner of the mouth
What is the origin of the sternocleidomastoid?
- Sternal head from the front of the manubrium
- Clavicular head from the medial third of the clavicle
What is the insertion of the sternocleidomastoid?
- Lateral surface of the mastoid process
- Lateral half of the superior nuchal line
What is the innervation of the sternocleidomastoid?
Accessory nerve (C.N. XI)
What is the action of the sternocleidomastoid?
It is the chief flexor of the head
This condition is the pathological contraction of the sternocleidomastoid. The head is tilted toward and the face turned away from the affected side.
Torticollis (wry neck)
What are the three types of torticollis?
Type I: congenital torticollis
Type II: muscular torticollis
Type III: spasmodic torticollis
This type of torticollis results from a fibrous tissue tumor, which develops at or shortly before birth.
Type I: congenital torticollis
This type of torticollis is due to a birth injury.
Type II: muscular torticollis
This type of torticollis occurs in adults, is due to abnormal tonicity, and responds well to Chiropractic care.
Type III: spasmodic torticollis
What is the origin of the trapezius?
- External occipital protuberance
- Ligamentum nuchae
- Spinous processes of the seventh cervical and all thoracic vertebrae
What is the insertion of the trapezius?
- The lateral third of the clavicle
- Spine of the scapula
- Acromion process
What is the innervation of the trapezius?
- Accessory nerve (C.N. XI)
- C3 and C4 from the cervical plexus
What is the action of the trapezius?
Upper portion: elevates the scapula
Middle portion: retracts the scapula
Lower portion: depresses the scapula
This vein drains the face and scalp, and also contains a large amount of cerebral blood.
External jugular vein
What two veins form the external jugular vein?
Retromandibular and posterior auricular veins
Where does the external jugular vein run?
It runs downward and backward along the lateral surface of the sternocleidomastoid, and empties into the subclavian vein
What are the tributaries of the external jugular vein?
- Retromandibular vein
- Posterior auricular vein
- Posterior external jugular vein
- Anterior jugular vein
- Transverse cervical vein
- Suprascapular vein
What can cause a prominent external jugular vein?
- Congestive heart failure or obstruction of the superior vena cava
- Opera singers and bagpipe players may develop this due to increased intrathoracic pressure during singing or plalying.
What are the two major triangles of the neck?
Posterior and anterior triangles
What are the boundaries of the posterior triangle?
Anterior: the posterior border of the sternocleidomastoid
Posterior: the anterior border of the trapezius
Inferior: the superior border of the middle third of the clavicle
What are the boundaries of the anterior triangle?
Superior: the inferior border of the mandible
Anterior: the anterior midline
Posterior: the anterior border of the sternocleidomastoid
Where does the apex of the anterior triangle lie?
It lies inferiorly at the jugular notch
What forms the roof of the anterior triangle?
- Investing layer of the deep cervical fascia
- The superficial cervical fascia
- Platysma
What are the subdivisions of the anterior triangle?
- Submental triangle
- Submandibular (digastric) triangle
- Carotid triangle
- Muscular triangle
What are the boundaries of the submental triangle?
The left and right anterior bellies of digastric, and the body of the hyoid bone
What is the floor of the submental triangle?
The mylohyoid muscle
What are the contents of the submental triangle?
Minor veins and lymph nodes
What are the boundaries of the submandibular (digastric) triangle?
the inferior border of the mandible, the anterior belly of digastric , and the posterior belly of digastric
What is the floor of the submandibular (digastric) triangle?
The mylohyoid and hyoglossus muscles
What are the contents of the submandibular (digastric) triangle?
The submandibular gland, internal carotid artery, facial artery, internal jugular vein, glossopharyngeal nerve (C.N. IX), and the vagus nerve (C.N. X).
What subdivision of the anterior triangle must you use caution with when palpating or adjusting?
Submandibular (digastric) triangle. This is because there is a high concentration of vital neurovascular structures located here.
What are the boundaries of the carotid triangle?
The posterior belly of digastric, the superior belly of omohyoid, and the anterior border of the sternocleidomastoid
What is the floor of the carotid triangle?
Portions of the thyrohyoid, hyoglossus, and inferior and middle constrictor muscles
What are the contents of the carotid triangle?
- Parts of the common and internal carotid arteries
- External carotid artery and three of its branches (superior thyroid artery, lingual artery, and facial artery)
- Corresponding tributaries of the internal jugular vein
What are the boundaries of the muscular triangle?
The superior belly of the omohyoid, anterior midline of the neck, and the anterior border of the sternocleidomastoid
What is the floor of the muscular triangle?
Posterior layer of pretracheal fascia
What are the contents of the muscular triangle?
- Sternohyoid and sternohyoid muscles
- Thyroid gland
- Trachea
- Esophagus
This bone is located between the mandible and larynx, and serves as a point of attachment for many muscles. It does not articulate with any other bone and is broken in cases of strangulation.
Hyoid bone
What are the parts of the hyoid bone?
Body, greater horn, lesser horn
What muscles compose the infrahyoid muscles?
- Superficial layer: omohyoid and sternohyoid
- Deep layer: sternothyroid and thyrohyoid
What is the origin of the omohyoid?
- The inferior belly of omohyoid originates from the upper border of the scapula. It ends in an intermediate tendon located deep to the sternocleidomastoid.
- The superior belly extends upward from the intermediate tendon.
What is the insertion of the omohyoid?
Body of the hyoid bone
What is the innervation of the omohyoid?
Ansa cervicalis (C1, C2, C3)
What is the action of the omohyoid?
Depresses the hyoid bone and larynx
What is the origin of the sternohyoid?
The posterior surface of the manubrium, and the medial end of the clavicle
What is the insertion of the sternohyoid?
The body of the hyoid bone
What is the innervation of the sternohyoid?
Ansa cervicalis (C1, C2, C3)
What is the action of the sternohyoid?
Depresses the hyoid bone and larynx
What is the origin of the sternothyroid?
The posterior surface of the manubrium, inferior to the origin of the sternohyoid
What is the insertion of the sternothyroid?
The oblique line on the lamina of the thyroid cartilage
What is the innervation of the sternothyroid?
Ansa cervicalis (C1, C2, C3)
What is the action of the sternothyroid?
Depresses the larynx
What is the origin of the thyrohyoid?
The oblique line on the lamina of the thyroid cartilage
What is the insertion of the thyrohyoid?
The body of the hyoid bone
What is the innervation of the thyrohyoid?
C1 through the hypoglossal nerve
What is the action of the thyrohyoid?
Depresses the hyoid bone
What functions do the infrahyoid muscles play a role in when they depress the hyoid bone and larynx?
Swallowing, speech, breathing. If the hyoid is depressed the digastric muscle depresses the mandible.
This structure is a dense, sheet-like layer of connective tissue.
Fascia
This structure surrounds and supports both the superficial and deep structures of the neck.
Cervical fascia
This is a thin layer of connective tissue which encloses the platysma muscle and contains cutaneous nerves, superficial veins, and lymph nodes.
Superficial cervical fascia
What are the four parts of the deep cervical fascia?
Investing layer of the deep cervical fascia, pretracheal fascia, prevertebral fascia, and carotid sheath
This layer of the deep cervical fascia lies deep to the superficial cervical fascia, and splits to enclose the sternocleidomastoid and trapezieus.
Investing layer of the deep cervical fascia
This layer of the deep cervical fascia encloses the thyroid gland, trachea, and esophagus.
Pretracheal fascia
This layer of the deep cervical fascia encloses the vertebral column and the deep muscles of the back.
Prevertebral fascia
This layer of the deep cervical fascia is a cylinder of fascia which extends from the base of the skull to the root of the neck.
Carotid sheath
What structures does the carotid sheath contain?
Common carotid artery, internal carotid artery , internal jugular vein, vagus nerve, deep cervical lymph nodes
What is the function of the fascial layers?
To provide a slippery surface to reduce friction during gross movements of the head and neck as well as during swallowing.
What is the clinical significance of the fascial layers?
- It may serves as a channel for infection
- Cancer involving the deep cervical lymph nodes can compress the internal jugular vein.
What are the boundaries of the superior thoracic aperture?
- First thoracic vertebra
- First ribs and their cartilages
- Manubrium of the sternum
What are the major arteries that pass through the superior thoracic aperture?
- Brachiocephalic trunk
- Left common carotid artery
- Left subclavian artery
- Internal thoracic artery
What are the major veins that pass through the superior thoracic aperture?
Brachiocephalic vein
What are the major nerves that pass through the superior thoracic aperture?
- Phrenic nerve
- Vagus nerve
- Recurrent laryngeal nerve
- Sympathetic truck
What viscera pass through the superior thoracic aperture?
- Trachea
- Esophagus
- Cervical plexus
- Apex of the lung
- Thymus
This structure is part of the immune system and produces T-lymphocytes, lies primarily behind the manubrium, and gradually involutes after puberty.
Thymus gland
Where does the thymus receive its blood supply?
Internal thoracic artery
Where does the thymus receive its innervation?
From the stellate ganglion of the sympathetic trunk and vagus nerve
This is an endocrine organ which produces thyroxine and calcitonin. It lies at the level of C5 through T1
Thyroid gland
What are the three components of the thyroid gland?
Left lobe, right lobe, and the isthmus
Approximately 50% of thyroid glands have this structure, which extends upward from the isthmus as a finger of glandular tissue.
Pyramidal lobe
This is another common variation found associated with the thyroid gland, which connects the isthmus of the thyroid gland with the hyoid bone.
Levator glandulae thyroidae muscle
What arteries supply the thyroid gland?
- Superior thyroid artery (from the external carotid artery)
- Inferior thyroid artery (from the thyrocervical trunk)
This is an inconstant arterial branch to the thyroid gland, from the brachiocephalic trunk and may be damaged during tracheotomies.
Thyroid ima artery
What veins are a part of the thyroid gland?
- Superior thryoid vein (to the internal jugular vein)
- Middle thyroid vein (to the internal jugular vein)
- Inferior thyroid vein (to the brachiocephalic vein)
What is the innervation of the thyroid gland?
From the superior, middle, and inferior cervical sympathetic ganglia
This condition is characterized by an abnormal enlargement of the thyroid gland, which produces swelling in the anterior neck.
Goiter
This type of goiter is due to dietary deficiencies of iodine. The gland enlarges to increase output, the hormone is largely inactive, and symptoms are similar to hypothyroidism.
Endemic goiter
This type of goiter is due to an autoimmune disease. Thyroid stimulating immunoglobulins bind to receptor sites casing overactivity of the gland. The hormone is active in this case and symptoms are similar to hyperthyroidism (Grave’s disease).
Exopthalmic goiter
This nerve branches off of the vagus within the thorax, and then travels up into the neck to supply motor innervation to all but one of the laryngeal muscles.
Recurrent laryngeal nerve
These are endocrine glands located on the posterior surface of the thyroid gland and are involved in calcium homeostasis.
Parathyroid glands
Where do the parathyroid glands receive their blood supply?
- Inferior thyroid artery
- Superior thyroid artery
What is the innervation of the parathyroid glands?
From inferior or middle cervical sympathetic ganglia
What factors contribute to the difficulty of thyroid surgery?
- Prescence of parathyroid glands
- Highly vascular
- Presence of recurrent laryngeal nerve
This structure begins at the larynx at the level of C6 and then splits into left and right main bronchi within the thorax. Its walls are supported by a series of incomplete cartilaginous rings, which are open posteriorly.
Trachea or “windpipe”
The posterior gap of the trachea is spanned by what muscle?
Trachealis muscle (smooth muscle)
Where does the trachea receive its blood supply?
Inferior thyroid artery
What is the innervation of the trachea?
Recurrent laryngeal nerve
This structure is a muscular tube which connects the pharynx to the stomach. It begins in the neck at the C6 level and lies posterior to the trachea.
Esophagus
What are the main arteries of the head and neck?
Left and right common carotid arteries
What are the branches of the common carotid artery?
Internal and external carotid arteries
This branch of the common carotid artery is the main source of blood to structures of the neck, face, and scalp.
External carotid artery
What are the branches of the external carotid artery?
- Superior thyroid artery
- Ascending pharyngeal artery
- Lingual artery
- Facial artery
- Occipital artery
- Posterior auricular artery
- Superficial temporal artery
- Maxillary artery
This structure is a slight dilation of the internal carotid artery where it joins the common carotid. It acts as a baroreceptor (blood pressure sensor).
Carotid sinus
What is the innervation of the carotid sinus?
The carotid sinus nerve, which is a branch of the glossopharyngeal nerve (CN IX)
This structure is a small reddish-brown mass located within or deep to the bifurcation of the common carotid artery. It is a chemoreceptor, which detects changes in the chemical makeup of the blood within the carotid.
Carotid body
What is the innervation of the carotid body?
The carotid sinus nerve, which is a branch of the glossopharyngeal nerve (CN IX)
This is the largest vein of the neck. It begins at the jugular foramen as the direct continuation of the sigmoid sinus and drains into the brachiocephalic vein.
Internal jugular vein
This is the dilation of the internal jugular vein at its origin below the jugular foramen.
Superior jugular bulb
What are the tributaries of the internal jugular vein?
- Inferior petrosal sinus
- Pharyngeal veins
- Facial vein
- Lingual vein
- Superior thyroid vein
- Middle thyroid vein
This is the dilation of the internal jugular vein near its termination into the brachiocephalic vein.
Inferior jugular vein
What are the branches of the glossopharyngeal nerve?
- Tympanic nerve
- Branch to the carotid sinus
- Pharyngeal branch
- Branch to the stylopharyngeus
- Tonsillar branch
- Lingual branch
This branch of the glossopharyngeal nerve is sensory to the tympanic cavity and secretomotor to the parotid gland. Also it senses pain in otitis media or inflammation of the middle ear.
Tympanic nerve
This branch of the glossopharyngeal nerve is sensory to both the carotid sinus and carotid body.
Branch to the carotid sinus
This branch of the glossopharyngeal nerve unites with branches from the vagus and sympathetic trunk to form the pharyngeal plexus. It is sensory to the pharyx, sense pain in acute pharyngitis, and is the afferent limb of the gag reflex.
Pharyngeal branch
This branch of the glossopharyngeal nerve is motor to the stylopharyngeus muscle.
Branch to the stylopharngeus
What is the only muscle of the pharynx that is not supplied by the vagus nerve?
Stylopharyngeus muscle
This branch of the glossopharyngeal nerve is sensory to the mucous membrane over the tonsil and to the soft palate. It senses pain in tonsillitis.
Tonsillar branch
This branch of the glossopharyngeal nerve supplies taste and general sensation to the posterior third of the tongue.
Lingual branch
This is the longest cranial nerve, with an extensive distribution in the head, neck, thorax, and abdomen.
Vagus nerve (C.N. X)
What are the two gangila of the vagus nerve located in the neck?
- Superior (jugular) ganglion: located in the jugular foramen
- Inferior (nodose) ganglion
What are the branches of the vagus nerve found in the head and neck?
- Meningeal branch
- Auricular branch
- Pharyngeal branch
- Superior laryngeal branch
- Recurrent laryngeal nerve
This branch of the vagus nerve arises from the superior ganglion, supplies the dura mater with sensory innervation and is associated with cervicogenic headaches.
Meningeal branch
This branch of the vagus nerve arises from the superior ganglion, is sensory to the auricle, the floor of the external auditory meatus, and the tympanic membrane. It also senses pain in otitis externa (swimmer’s ear).
Auricular branch