final anat revision Flashcards
what percent of tissue fluid is transported by the lymphatics and what percent is transported by veins?
20% vs 80”
Where does lymph empty into the venous system?
subclavian vein
Are lymph capillaries permeable, blindly ending tubes in connective tissue
yes they are
Is lymph found in dental pulp?
yes
Is lymph found in cartilage?
yes
Does the thoracic duct have lymph nodes?
no
What is the size of lymph nodes?
1-25mm long
What lymph trunks do not have valves
jugular lymph trunks
This is so lymph can flow from the thoracic duct to the left jugular trunk
List the superficial nodes of the head
ORB P occipital retroauricular parotid buccal
list the superficial nodes of the neck
SAS
submental
submandibular
anterior cervical
Name a deep node of the head
lingual node
Name the deep cervical nodes of the neck
Superior
jugulodigastric
retropharyngeal
Inferior
Jugulo-omohyoid
Virchow’s node/supraclavicular
Where does all the lymph from the head and neck drain into
jugular lymph trunks
Where does the lymph of the floor of mouth, mandibular teeth and gingivae drain?
submandibular and submental lymph nodes
where does the lymph of the tongue drain
submental, submandibular, upper and lower deep nodes
where does the lymph of the hard and soft palate, maxillary teeth and gingivae drain?
retropharyngeal nodes
Clinical nodes of virchow’s node
its also known as the left supraclavicular/anterior scalene group. It is closest to the jugular trunk and it means that there is retrograde flow from the thoracic duct-spread from the extensive territories of the thoracic duct drains there
Are anatomical nerves mixed
yes
difference between somatic motor and autonomic nerves
somatic motor neurons are found in the brain and spinal cord, but importantly there is NO SECOND NERVE CELL BODY.
Autonomic neuron has a preganglionic axon which synapses to post ganglionic axons
List the origin of the sympathetic nerve
thoracic and upper lumbar spinal cord
List the 4 parasympathetic ganglions of the head
Ciliary ganglion-in orbit
pterygopalatine ganglion in pterygopalatine fossa
submandibular ganglion
otic ganglion
Forehead muscles of facial expression
frontal belly occiptofrontalis
corregator supercilii
eye muscles of facial expression
orbicularis occuli
nose muscles of facial expression
procerus
nasalis
levator labii superioris alaque nasi
corregator supercilii function
frowning
orbicularis oculi function
closes eye, directs tear flow, lower eyelid
What is the modiolus
fibromuscular structure extending from skin to mucosa
Function of zygomaticus major
elevate corner of mouth
function of levator anguli oris
elevates corner of mouth
function of buccinator
draw in position cheeks to direct food over molars
buccinator attachments
arises outer surfaces of maxilla, mandible and ptergomandibular raphe to attach to modiolis
platysma function
depresses lower lip and corners of mouth
platysma attachments
body of mandible, modiolis and modiolar muscles to skin over pectoralis, depresses lower lip and corners of mouth. Tenses skin of anterior neck
depressor anguli oris function
moves corners of the mouth down
orbicularis oris
sphincter of mouth
alaeque nasi function
raises upper lip, dilates nostril
levator labii superioris
raises upper lip
zygomaticus minor function
raises upper lip
depressor labii inferioris
moves lower lip down
mentalis function
raises base of lower lip-protrusion and eversion
fat pad function
they are important for forming important contours of the face
buccal fat pad
lies between the midface muscles of expression and buccinator. The parotid duct and sensory buccal nerve pass through it.
Five layers of the scalp
Skin Connective tissue-superficial fascia Aponeurosis-epicranial aponeurosis Loose fascia Periosteum
what innervates face and scalp
be wary of sensory and motor innervations are different
Sensory innervation is from trigeminal nerve
motor is from facial nerve
What is the parotid capsule derived from
deep cervical fascia
list the structures which the parotid capsule is attached to
zygomatic arch, mandible, styloid process and tympanic plate
zuper mst
What part of the capsule forms the styloid process
The part of the capsule which is attached to the styloid process and angle of mandible forms the stylomandibular ligament
What is the parasympathetic supply to parotid
glossopharyngeal hitchiking on auriculotemporal nerve
Where is sensory innervation of parotid from
auriculotemporal nerves, and greater auricular branch of the cervical plexus
What is the origin of the sympathetic supply of the parotid
external carotid plexus
Name structures located in the parotid gland from deepest to most superficial
Deepest:external carotid enters-> maxillary artery and superficial temporal artery-?transverse facial artery. The posterior auricular artery may also arise within parotid
The intermediate: superficial temporal and maxillary veins/arteries and finally the retromandibular vein
Superficial: facial nerve and cutaneous motor branches
What nerve fibers anastamose at geniculate ganglion
taste fibres from chorda tympani
taste fibres from soft palate via greater petrosal nerve
cutaneous sensory fibres from skin of ear
parasympathetic fibres do not synapse
What part of the facial nerve leaves 5mm above stylomastoid foramen
sensory chorda tympani.
facial nerves emerges from the skull at the stylomastoid foramen and curves medially to give off:
1) posterior auricular nerve to occipital belly of occipitofrontalis
small branches to the posterior belly of digastric and stylohyoid
temporal branch supplies:
occipitofrontalis, orbicularis oculi
corregator supercilii
zygomatic branch supplies
orbicularis oculi
buccal branches supply
zygomaticus major, minor, procerus, nasalis, levator labii superioris alaque nasi, levator labii superioris, levator anguli oris, buccinator, orbicularis oris
marginal mandibular branches
risorius and all the muscles that depress lip
list the branches of the opthalmic division of the trigeminal nerve
supratrochlear supraorbital lacrimal infratrochlear external nasal
list the branches of the maxillary division
1) zygomatico-orbital
2) zygomaticofacial
3) zygomaticotemporal
4) infraorbital
branches of the mandibular division
deep sensory buccal
auriculotemporal
mental
origin of motor root in trigeminal nerve
pons
origin of facial nerve
different nuclei of the pons
what kind of neurons are the sensory processes of the trigeminal nerve
unipolar neurons
Where do the proprioceptive axons of the muscles of mastication have their cell bodies found?
They are found in the sensory nuclei of the trigeminal in the pons
meningeal branch of mandibular nerve
pass through foramen spinosum and supply meninges of middle cranial fossa and mastoid air cells
medial pterygoid nerve
arises from posterior surface of mandibular trunk and inserts into the medial pterygoid muscle
The medial pterygoid nerve has 2 tiny branches near its origin- the tensor palati and tensor tympani nerves
mandibular trunk divisions
meningeal branch and medial pterygoid nerve
mandibular nerve anterior division
muscles supplying muscles of mastication such as
1) masseteric nerve
2) deep temporal nerves
3) lateral pterygoid nerve
sensory buccal nerve
known to supply motor innervation to buccinator and also supply sensory fibres to cheek, buccal mucosa, buccal gingiva
mandibular branch posterior division
1) lingual nerve
auriculotemporal nerve
inferior alveolar nerve
mental nerve
What are the articular surfaces of tmj
of mandible-head of condyle
of temporal bone-mandibular/glenoid fossa, anterior articular tubercle
articular disc attached to joint capsule
what are the stabilising structures of the TMJ
JOINT capsule
post glenoid tubercle
stylomandibular ligament
sphenomandibular ligament
What kind of structures are the articular surfaces of the TMJ
The disc is fibrocartilage
The capsule is collagen
both superior and inferior internal surfaces of the capsule are lined with a synovial membrane. This is a specialised fibrocellular covering which produces synovial fluid and precise viscosity and chemical composition
the condyle
What makes the TMJ an atypical synovial joint
Atypical synovial joints are movable joints with membrane in protected locations. They are atypical because of the type covering the ends of the articulating bones. The ends of the bones in most synovial joints are covered with hyaline/articular cartilage.
what kind of joint is the TMJ
The TMJ is a ginglymoarthrosis- a sliding hinge joint
What is the function of the articular disc in the TMJ
help control movement and limit trauma
Innervation of the TMJ
MAD
masseteric
auriculotemporal
deep temporal
these are sensory
proprioception and pain fibres included
What is the blood supply to the TMJ
SAD
Superficial temporal
Ascending pharyngeal branch of the external carotid and the deep auricular
muscles of mastication vascular supply
arteries are superficial temporal artery and maxillary artery
Venous drainage is into the pterygoid venous plexus
Masseter attachments
medial surface of maxillary surface of zygomer and anterior zygomatic arch to angle and ramus of mandible
deep part also connects to coronoid process
temporalis muscle attachments
superior temporal line and zygomatic arch to medial coronoid process and upper ramus
temporalis vascular supply
superficial temporal artery and deep temporal branches maxillary artery
Muscles involved in depressing the TMJ
Lateral pterygoid, supra and infrahyoid
Muscles involved in elevating the TMJ
Temporalis, masseter and medial pterygoid
Lateral pterygoid muscle origins
smaller head arises from infratemporal surface of sphenoid
Lowerhead rises from lateral pterygoid plate, both insert ont neck of condyle of mandible and capsule of TMJ
Medial pterygoid origins
deep head arises medial side of lateral pterygoid plate, superficial head arises from pyramidal process of palatine bone both heads go to medial surface of ramus
summary of lateral and medial pterygoid relationships
-masseteric nerve-above upper head of lateral pterygoid-maxillary artery –VARIABLE -superficial (55 –70%)or deep (30 –45%)to lower head of lateral pterygoid, then between two heads into pterygopalatine fossa.-buccal nerve passes between 2 heads.-inferior alveolar nerve & artery & lingual nerve pass between lower border.MEDIAL PTERYGOID-lingual nerve & inferior alveolar artery & nerve are lateral.
Buccinator
attached to outer surfaces of posterior mandible & maxilla & to the pterygomandibular raphe* -posterior part of muscle is deep /medial to medial pterygoid, anterior part curves towards to modiolus where fibres cross over & insert into orbicularis oris.-dual innervation -buccal branch of facial nerve (motor) and probably long/sensory buccal branch of mandibular nerve.-buccal fat pad separates posterior buccinator & pterygomandibular raphe from ramus of mandible & masseter.
What are spaces between the eye, nerves, muscles and blood vessels filled with
Orbital fascia-coarsely loculated fat
origin of levator palpebrae superioris
arises lesser wing of sphenoid, above rectus superior and optic canal
Where do superior inferior and medial recti arise
tendinous ring around optic nerve
Where does lateral rectus arise
from lateral part of tendinous ring and from lateral margin of orbital fissure.
Where does the superior oblique arise from
body of sphenoid superomedial to optic canal and between superior and middle recti. Forms a tendon anteriorly that passes through a fibrocartilagenous sling
Inferior oblique
arises orbital surface of maxilla lateral to nasolacrimal groove. Passes between inferior rectus and orbital floor and then between orbit and lateral rectus. Inserts into sclera behind equator and between rectus inferior and lateral rectus
inferior oblique movement
eye up and out
superior oblique movement
down and out
tarsal plates
eyelid ligament things
what is the orbital septum?
A fascial sheet attached to periosteum of orbital rim and levator tendon
What does the conjunctiva contain
goblet cell
Meibom’s glands/ sebaceous tarsal glands
empty into the free margin of the eyelid. The oily secretion spreads out over the tear film and contributes to its stability
conjunctiva vs sclera
conjunctiva is a mucous membrane covering the outer part of the sclera
iris function
vary aperture to control amount of light into retina
how many cell layers is the lens
2 cell layers
what is the shape of the lens
anterior cuboidal
ciliary body function
production of aqueous humor
accomodation for far and near vision
What is the main refractive apparatus of the eye
cornea-not lens
accomodation notes
less tension on zonule fibres, less pull and this causes long vision
Tension, and rounder lens accomodates for near vision
What is the junction between sensory retina and non-sensory retina
ora serrata
Where does aqueous humour drain?
80% drains from eye via the trabecular meshwork into scleral venus sinus. the remainning 20% drains into the uveoscleral angle
Ophthalmic nerve innervation
lacrimal gland and skin
frontal side of face via supratrochlear and supraorbital
nasociliary division into the anterior and posterior ethmoidal foramina
autonomic innervation of iris and ciliary body
The ophthalmic nerve is not just sensory, as both the nasociliary and lacrimal branches carry parasympathetic fibres deriived from other nerves to iris-from occulomotor nerve via ciliary ganglion and to the lacrimal gland. The ophthalmic nerve itself is purely sensory
Parasympathetic innervation in the eye reasons?
contract sphincters of pupil and ciliary body
contraction of ciliary muscle decreases tension on zonule fibres connecting ciliary body and lens results in a decrease in the diameter of the ciliary body. This results in lens becoming more round which gives accomodation for near vision
sympathetic innervation in eye reasons
dilate pupil
vasomotor to blood vessels
Blood supply of eye
ophthalmic artery and venous drainage via retinal veins.
retinal veins converge on optic disc and enter optic nerve as central vein of retina. Drain into superior ophthalmic vein then into the cavernous sinus
Inferior ophthalmic vein drains orbit into the cavernous sinus
Larynx main functions
respiration
vocalisation
protection of respiratory passages during swallowing such as closure of epiglottis preventing food from passing into the larynx during swallowing
vocal process of arytenoid attachments
attaches to vocal ligament, vocalis muscle
Synovial joints of the larynx
cricothyroid
cricoarytenoid
What surrounds the laryngeal inlet
the upper border of epiglottis and aryepiglottic folds
What are the vocal folds made of
elastic vocal ligament, vocalis muscle, and its changes in width and shape of space between folds control sounds and flow of air
Vestibular folds
soft folds of mucous membrane. Play only a minor role in normal phonation but have a protective function and are used in conjunction with the vocal folds to produce specialised sounds
what are the 2 extrinsic membranes
Thyrohyoid membrane
cricotracheal membrane
What are the 2 intrinsic membranes
quadrangular membrane and cricothyroid membrane
What is special about quadrangular membrane
free inferior margin forms vestibular ligament
What is special about cricothyroid membrane
free superior margin forms vocal ligament
lateral cricoarytenoid function
rotate vocal processes of arytenoids medially
transverse arytenoid and oblique arytenoid function
pull the arytenoids together
What tenses and tighten vocal folds
cricothyroids
What relaxes vocal folds
thyroarytenoids and vocalis
What closes and widens inlet
aryepiglottic and oblique arytenoids close inlet, thyroepiglottics widen inlet
vagus and aorta left side
on the left side of the thorax the vagus crosses anterior surface of the arch of the aorta and gives off recurrent laryngeal nerve which loops under the arch of the aorta
recurrent laryngeal nerve and right side
vagus crosses the anterior surface of the subclavian artery and gives off recurrent laryngeal nerve which loops under the subclavian artery
recurrent laryngeal nerve and trachea
On both sides the recurrent laryngeal nerves run in the groove between oesophagus & trachea & then pass deep/posterior to thyroid gland (see below)In the thorax both vagi then divide up into plexuses (cardiac, pulmonary & oesophageal plexuses & then form anterior & posterior vagi & finally enter abdomen on oesophagus)
internal branch of superior laryngeal nerve function
pierces through thyrohyoid membrane and supplies mucosa down to level of and including vocal folds.
external branch of superior laryngeal nerve supplies
supplies cricothyroid muscle and inferior constrictor muscle
recurrent laryngeal nerve function
ascends in groove between trachea & oesophagus, behind thyroid , passes deep to lower border of inferior constrictor to enter larynx -supplies all laryngeal muscles except cricothyroid & also supplies mucus membrane below vocal fold
Thyroid
endocrine gland, two lateral lobes joined medially by an isthmus. May also have an extra pyramidal lobe.-lobes extend from thyroid cartilage of larynx to 4thor 5thtracheal cartilage-deep to infrahyoid musclesThyroid produces thyroid hormones (metabolic stimulation) & calcitonin (reduces blood calcium). Parathyroids (usually 4) are separate organs closely associated with the posterior surface of the thyroid (parathyroid hormone –elevates blood calcium, essential for life). Thyroid & parathyroids are in close proximity to the recurrent laryngeal nerves & care has to be taken to locate their exact position when thyroid surgery is being planned.
function of the external ear
collects mechanical sounds and vibrations
function of the eardrum and tympanic membrane
transmission, amplification
funcyion of inner ear
sensation and balance
What is found in the cartilagenous part of the external accoustic meatus
ceruminous glands (waxy sweat glands)
Ossicles
joints
bones
all joints are synovial joints covered with mucosa. MIS Malleus Incus Stapes
Stapedius
facial nerve–is a muscular part that lies in canal in post wall, supplied by the facial nerve
Function of tensor tympani
muscles usually work together in a reflex response to high intensity sounds. They contract and reduce the vibrations of the ossicles and in turn reduces sound intensity before it reaches the inner ear. The tensor tympani also pulls the tympanic membrane inward, which reduces intensity transmission. Tensor tympani also reduces intensity of sounds produced by chewing.
What kind of epithelium is the auditory tube?
respiratory epithelium
What is the function of the auditory tube
allows air into the middle ear and mucus out-it keeps the air pressure from both sides of the tympanic membrane the same.
attachment of superior pharyngeal constrictir
pharyngeal raphe, and skull and tongue and pterygomandibular raphe
attachment of pharyngeal constrictor
hyoid bone
attachment of inferior pharyngeal constrictor
thyroid and cricoid of larynx
salpingopharyngeus
salpinx means horn
it attaches to the auditory tube, blends with palatopharyngeus and attaches to thyroid and pharyngeal wall
stylopharyngeus muscle
it binds to the styloid process of temporal bone. Thyroid and pharyngeal wall
Palatopharyngeus muscle
attaches with soft palate, binds with thyroid and pharyngeal wall, blends with salpingopharyngeus muscle
