FINAL EXAM Flashcards
transverse ligament of the atlas
prevents anterior displacement of the atlas and skull on C2 and lower vertebrae
posterior longitudinal ligament
prevents hyperflexion of spine
alar ligaments
connect dens to skull
nuchal ligament
connects spinous processes to nuchal lines
anterior longitudinal ligaments
prevents hyperextension of spine
hangmans fracture
bilateral fracture of posterior arch of C@ with anterior subluxation of C2 on C3 - from hyperextension
clay shoveler fracture
tip of spinous process C6-T1
Jefferson fracture
compression fracture of C1 anterior or posterior arch - lateral masses split and transverse ligament tears
pretracheal space
between pretracheal fasica and trachea
retropharyngeal space
between retropharyngeal and alar fascia
danger space
between alar and prevertebral fascia
internal jugular vein formed by joining of…
posterior auricular vein and retromandibular vein
platysma muscle innervated by….
cervical branch of facial nerve (CN VII)
trapezius muscle innervated by….
spinal accessory nerve - CN XI
sternocleidomastoid innervated by….
spinal accessory nerve - CN XI
torticollis
shortening of SCM or excessive stretching during childbirth
borders of posterior triangle
trapezius, SCM, clavicle (omohyoid splits occipital triangle and supraclavicular triangle)
nerves present in the nerve point of the neck
greater auricular, lesser occipital, supraclavicular nerves, transverse cervical, spinal accessory
list nerves of cervical plexus
lesser occipital - C2,C3 greater auricular - C2, C3 transverse cervical - C2, C3 supraaclavicular - C3, C4 phrenic - C3, C4, C5
cutaneous innervation of the head
from trigeminal nerve (CN V) and from C2-C4
arteries coming off of subclavian
internal thoracic, thyrocervical trunk (inferior thyroid, transverse cervical, suprascapular), vertebral, costocervical (deep cervical, intercostal)
nerves in suboccipital region
great occipital (C2 dorsal ramus), suboccipital (C1 dorsal ramus, least occipital (C3)
triangles of the anterior neck
mental triangle, submandibular triangle, muscular triangle, carotid triangle (SCM, omohyoid, digastric, mandible are major borders)
contents of submental triangle
between two anterior bellies of digastric, contains lymph nodes and small veins
contents of muscular triangle
contains infrahyoid muscles and anterior jugular veins and jugular venous arch
suprahyoid muscles
mylohyoid, anterior belly of digastric, stylohyoid, posterior belly of digastric
infrahyoid muscles
thyrohyoid, sternohyoid, omohyoid
innervation of anterior belly of digastric and mylohyoid
nerve to mylohyoid (branch of CN V3)
innervation of sylohyoid, posterior belly of digastric
supplied by branches of facial nerve (CN VII)
raphe
line that connects mylohyoid muscles
geniohyoid muslce action
pulls hyoid antero-superiorly
nerve to mylohyoid is a motor branch of ….
the inferior alveolar nerve from V3
innervation of the infrahyoid muscles comes from
ansa cervicalis
structures that ansa cervicalis supplies
sternohyoid, omohyoid (sup. belly), sternohyoid and omohyoid (inf. belly), sternothyroid
C1 branch reaches thyrohyoid and geniohyoid by piggybacking on which nerve
hypoglossal
innervation to geniohyoid and thyrohyoid
C1 via hypoglassal
facial nerve supplies which muscles
post. belly of digastric and stylohyoid
nerve to mylohyoid supplies which muscles
mylohyoid and ant. belly of digastric (branch of inferior alveolar nerve from CN V3)
C1 via hypolassal supplies which msucles
thyrohyoid and geniohyoid
common carotid splits at level of…
upper edge of thyroid cartilage
branches of external carotid
Superior thyroid Ascending pharyngeal Lingual Facial Occipital Posterior auricular Superficial temoral MAXillary
external carotid artery supplies everything outside dura mater except…
anterior forehead, from internal carotid artery from supraorbital, a branch of ophthalmic artery
arterial circle of Willis
vertebral, basilar, posterior cerebral, posterior communicating, internal carotid, middle cerebral, anterior cerebral
carotid body and sinus are supplied by
carotid sinus nerve, from CN IX - glossopharyngeal nerve
sympathetic chain lies _______ carotid sheath
behind
thyroid veins
superior and middle come from internal jugular, inferior from subclavian
pterion
where frontal, parietal, greater wing of spherion and temporal bones meet, lies above middle meningeal artery
mandibular foarmen is entrance for ……
inferior alveolar nerve
fontanelles
membranes that bridge over sutures in early life
lambdoid suture
join occipital and parietal bones
metopic suture
join two halves of frontal bone
craniosynostosis
premature fusion of sutures
scaphoncephaly - closure of sagittal suture
oxycephaly - closure of coronal suture
infratemporal fossa
bounded medially by lateral pterygoid plate, anteriorly by maxilla, posteriorly by occipital bone, superiorly by base of skull
nerve located in infratemporal fossa
the trunk of V3
foramen in front of the skull
supraorbital - suprorbital nerve from V1
infraorbital - infraorbital nerve from V2
mental - mental nerve from V3
superior orbital fissure
transmits branches of the ophthalmic nerve (V1) - also CN III, IV, VI
foramen rotundum
transmits branches of the maxillary nerve (V2)
foramen ovale
opening for V3
foramen spinosum
opening for middle meningeal artery
stylomastoid foramen
opening for trunk of facial nerve
petrotympanic fissure
opening for chorda tympani
jugular foramen
opening for IJV, IX, X and XI
cribiform plate
opening for CNI
optic canal
opening for CN II
internal acoustic meatus
opening for CN VII and VIII
hypoglossal canal
opening for CN XII
List the paranasal sinuses
frontal, ethmoidal, maxillary, sphenoidal
What empties into middle meatus
maxillary sinus, ethmoidal sinuses and frontal sinus
What empies into inferior meatus
nasolacrimal duct
two layers of dura
periostal and meningeal, fused except at sinuses and infoldings
falx cerebri
infolding of dura which separates cerebral hemisphere - attaches to crista galli and internal occipital protuberance
falx cerebelli
infolding of dura which lies between the cerebellar hemispheres - attaches to internal occipital crest
tentorium cerebelli
extension of dura which separates the occipital lobes of the cerebrum from the cerebellum - attaches to the posterior clinoid processes, petrous portion of temporal and occipital bones
diaphragma sellae
lies over the pituitary fossa and has opening for stalk
cranial nerves carrying parasympathetic fibers
3, 7, 9 and 10
two groups of ganglia that carry sensory gangila
trigeminal and geniculate ganglion
Sensory only cranial nerves
1, 2 and 8
Motor only cranial nerves
3 (somatic and visceral), 4, 6, 11, 12
mixed cranial nerves
5, 7, 9 and 10
Facts about cranial nerve #3
Starts at oculomotor nucleus, travels through superior orbital fissure, innervates 5 muscles of ocular movement, parasympathetic fibers synapse on ciliary ganglion to innervated ciliary muscle and sphincter pupillae
diagnostic value of CN III
can be compressed on ridge along petrous part of temporal bone, form brainstem damage or compression
CN III passes along which artery
posterior communicating artery, aneurysm may compress it
CN IV and VI
trochlear and abducens, travel through superior orbital fissure and innervate superior oblique and lateral rectus respectively
Which division of the trigeminal nerve contains motor fibers and what muscles does it innervate
V3, four muscle of mastication (temporalis, masseter, leteral and medial pterygoid) and four accessory muscles of mastication (mylohyoid, ant. belly of digastric, tensor tympani and tensor palatini
trigeminal ganglion
sensory only, pseudounipolar, analogous to DRG
Openings of the skull for trigeminal nerve
V1 - superior orbital fissure
V2 - foramen rotudum
V3 - foramen ovale
divisions of V1 (ophthalmic division)
tentorial, lacrimal, frontal, nasociliary, supraorbital, supratrochlear, infratrochlear
internal sensory regions of V1
nasal cavity, paranasal sinuses, meninges
divisions of V2 (maxillary division)
descending palatine, all superior alveolar, zygomatic, infraorbital
internal sensory regions of V2
nasal cavity, paranasal sinuses, maxillary teeth, hard/soft palate, meninges
divisions of V3 (mandibular division)
buccal, lingual, auriculotemporal, inferior alveolar, mental
internal sensory regions of V3
anterior 2/3 of tongue, lower teeth, external tympanic membrane, cheek, meninges
motor branches of facial nerve
temporal, zygomatic, buccal, mandibular, cervical, digastric, posterior auricular
motor component of facial nerve exits skull at…..
stylomastoid foramen
Path of the two parasympathetic nerves from CN VII
Both originate in the brainstem.
First travels along greater petrosal nerve, synapses at pterygopalatine ganglion then innervates nasal and palatine glands and lacrimal glands.
Second travels along chorda tympani, joins the lingual nerve (V3), synapses at submandibular ganglion and then innervates sublingual and submandibular glands
Path of the special sensory fibers of CN VII
Innervate anterior 2/3 of tongue, travel back along chorda tympani and down CN VII to synapse at geniculate gangion
What does CN IX innervate
taste and general sensory of 1/3 posterior of tongue, somatic sensory to pharynx, visceral sensory to carotid body/sinus, parasympathetic to parotid glands
tympanic canaliculus
where the parasympathetic fibers of CN IX reenter the skull
otic ganglion
lies just medial to V3, provides post-ganglionic fibers to parotid gland
glabella
unibrow
medial and lateral cnathi
corners of eyes
petrotympanic fissure
exit of chorda tympani
muscles innervated by facial nerve
muscle of facial expression and scalp, stylohyoid, posterior belly of digastric and stapedius
Two Zebras Bit My Cas Posteriorly
Temporal Zygomatic Buccal Mandivular Cervial Posterior auricular
Motor branches of facial nerve
buccinator innervated by…
buccal branch of the facial nerve
deep petrosal nerve
carries sympathetic fibers from the carotid artery and joins with the greater petrosal nerve
vidian nerve
greater petrosal never and deep petrosal nerve combine to form vidian nerve, which then reaches the pterygopalatine ganglion in the pterygopalatine fossa
anastamose of internal and external carotid
facial artery and superficial temporal artery joins with supraorbital artery (terminal branch of ophthalmic artery from ICA)
danger triangle of the face
infection in facial veins travel to opthalmic veins, to cavernous sinus to dural sinuses
structures in parotid
external carotid atery and branches, retromandibulr veins and tributaries, branches of facial nerve, auriculotemporal nerve (V3)
innervation of parotid
glossopharyngeal to tympanic nerve, through tympanic canniliculus, to lesser petrosal, synapse on otic ganglion, to parotid
What enters through the inferior orbital fissure
contains infraorbital and zygomatic nerves, branches of V2, also it connects the pterygopalatine fossa and infratemporal fossa
tarsal plates
fibrous connective tissue skeleton of eyelid, deep to orbital septum
orbicularis oculi
muscle of the eyelid (facial nerve) - deep to skin and subcutaneous layer, superficial to tarsal plate
external style or hordeolum
from the glands of Zeis, infection at the end of the eyelids
internal style or chalazion
from the melbomian glands, inside the tarsal plates, dysfunction of glands causes dry eyes
bulbar vs palperbral conjuctive
bulbar covers the sclera, palpebral lies deep to eyelid
conjunctiva
deep to tarsal plate, membrane that produces mucous and tears and prevents microbes from entering eyes
lacrimal caruncle
nodule at inner corner of eye, skin covering sebaceous and sweat glands
Tenon’s capsule
thin membrane that surround back of the eye and separates eye from periorbital fat
Which cranial nerve passes above tendinous ring of Zinn
CN IV - trochlear nerve
Mueller’s muscle
superior tarsal muscle with sympathetic innervation in the levator palpabrae superioiris that widens eyes
Superior and inferior rectus move eyes
In (either up or down)
superior and inferior oblique move eyes…
out down (superior) or out up (inferior)
How to clinically test trochlear nerve
look in then down, prevents use of inferior rectus to test superior oblique
strabismus
eyes are not properly aligned, can led to diplopia
symptoms of oculomotor nerve palsy
- eye down and out due to actions of superior oblique and lateral rectus
- ptosis, due to immobilized levator palpebrae superioris muscle
- dilated pupil due to unopposed sympathetic stimulation of dilator pupillae
three branches of V1
frontal, lacrimal and nasociliary
short ciliary neves
contain sensory, sympathetic and parasympathetic fibers (long ciliary have no parasympathetic fibers)
nerve that passes through cranial sinus that can be compressed by an anuerysm of the ICA
CN VI
accomodation
rounding of lens for near vision, parasympathetic stimulation from CN III
Edinger-Westphal nuclues
preganglionic parasympathetic axons in CN III to ciliary ganglia
Why both pupils should contract if light is shined in one eye
light travels on both sides of brain stimulating both Edinger Westphai nuclei
Horner’s syndrome
interruption of sympathetic innervation to head, leads to miosis (constricted pupil), ptosis (drooping eyelid), anhydrosis, and vasoodilation
muscles involved in accomodation
cilliary muscles
importance of central artery of retina
no anastamoses, occulsion will result in blindess
papilledema
increased cranial pressure, leading to swollen optic nerves
glaucoma
from increased intraocular pressure, overproduction of aqueous humor by ciliary body of eye
Canal of schlemm
drainage for aqueous humor, blockage can lead to glaucoma
pituitary tumor leads to loss of what type of vision first
peripheral vision, compression of optic chiasm
