Final revision Flashcards
Superior orbital fissure
internal acoustic meatus
foreamen ovale
SOF - V1, 3,4,6, sympathetic fibers of cavernous plexus
IAM - vestibulocochlea nerve, facial nerve, larbynthine A + V
FO - accesory menangial artery
*** What nerves are the auricle and external acoustic meatus and tympanic membrane innovated by?
Auricle - superficially - cervical plexus, V3, deeper parts - X and VII
External acoustic meatus - V3, X, VII
Tympanic membrane - outer surface by V3, X, VII, IX
If there is infection - then can get pain in neck ect. - where nerve is
The auricle and external acoustic meatus have differential innervation. The auricle is innervated by the lesser occipital nerve, the auriculotemporal branch of the mandibular nerve and the great auricular nerve. Consequently an infection on the auricle can lead to pain being referred to the whole head.
The vagus and facial nerves innervate some regions of the inner auricle.
Chorda tympani paper review
- Aim- To look at the course of the chorda tympani nerve
- Results – CT most commonly originates from within the facial canal 3.2mm above stylomastoid foramen
- Clinical relevance – Otitis media – need to ventilate middle ear, a groove is drilled (poster inferiorly), don’t want to damage CT, so should be drilled no deeper than necessary and as inferiorly as possible
- Side effects of damage – lose taste and dryness in mouth
what innovates the superior tarsal muscle
postganglionic sympathetic fibers from the superior cervical ganglion
diagram pg 18
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paper review - valves in opthalamic viens
- aim - determine weather opthalamic viens have valves or not and the role in periorbital abcess or cellulitis and cavernoius sinus thrombosis
- Reuslts – superior opthalamic, angular and supraorbital viens all have valvues, cuase of spread of infection is not due to no valves, but due to the fact that the blood from the facial vein inferiorly and supraorbital veins tract back to carvenous sinus via multiple pathways
- no correlations between absence of valves and increase risk of intracranial infection
erbs point branch of nerves
Transverse cervical
lesser occipital nerve
greater auricular
supra clavicular
Path of accessory and hypoglossal nerve
Hypoglossal - leaves hypoglossal foreamen, passes between internal carotid artery and internal cartoid vein, crosses the 3 arteries (occipital, external cartodi and lingual arteries) deep to posteiror belly of digastrci to reach the tongue. - goes to all intrisci muscles of tongue (except palatoglossus - vagus)
Accessory - leaves skull - midle part of jugular foreamen posterior to CNX, runs posterolaterally either medial or lateral to the internal jugular vien, crosses the transverse process of atlas and passes medial to the styloid process and posterior belly of digastric to perforate sternocleidomastoid muscle and reach the posterior triangle of the neck
is it internal or external carotdi that runs in carvenosu sinsu
internal cartoid
where does maxillary aretery branch come from?
external carotid artery
pterygopalatine fossa
- sphenopalatine artery (branch of maxillary artery)
- pterygoid ganglion (has some sympathetic fibers from around the internal carotid artery)
- V2 here (foramen rotundum enters here)
-need to know - infraorbital canal, sphenopalatine foramen, foreamen rotundum
what structures form the pterygopalatine fossa
palatine bone- medial wall
anterior - maxilary
roof - sphenoid (foreamen rotundum)
Lymph nodes of face - where things drain tho
diagram
Surface marking of partoid duct
Recently reviewed - surface anatomy of the parotid duct is most accurately measured by the middle half of a kine between the lower border of tragus and chilion. More than 90% of individuals it runs within 1.5cm of this line
Marginal mandibular nerve article
Conclusion and Key Points
When using 2cm rule, the marginal mandibular nerve is at risk of injury 23% of the time
When using 2 finger-breadth rule, it always below the lowest branch of the MMN and therefore no risk of injury
Consider low ICC for measuring TFB
Important to make incisions with enough clearance: 34mm was the average TFB distance
Muscles of soft palate
Tensor veli palate (V3) Levator veli palate Palatopharnageus Palatoglossus Muscular uvuale (rest by vagus)
Submandibular gland
- what layers you have to get through to incise it
- structures running across gland
- nerves at risk with excision
- where does lingual nerve run>?
TO get to it - skin, subcutaneous tissue, platysmea muscle, investing layer of deep cervical fascia
- Structures running across gland - facial vien, facial artery, lymph nodes
- nerves at risk with submandibular excision - marginal mandibular branch of facial, lignual, hypoglossal
-muscles - myohyloid, hyoglossus, posterior belly of digastric
Lingual nerve - lies above the deep portion of the submandibular gland, loops nder the duct deep to myohyoid on surface of hyoglossus
What makes up little area?
- labial artery
- anterior and posterior ethmoidal arteries
- greater palatine artery
- anastomose with spehopalatine artery
lymphatics of nose
submandibular –> deep cervical nodes
Medial and lateral wall - label diagram
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Muscle innovation to pharynx
All innovated by vagus, apar from stylopharangeal - this is innovated by no. 9.
Sensory - important -
Nasopharynx - V2
Oropharnx - IX
Laryngopharynx - X
Blood supply layrnx
- from inferior and superior thyroid artery - gives of suepriro larangeal artery and inferior larangeal artery
- these suplly the larynx
Veins - superior and inferior larangeal drains back to thyroid glands
lymphatics runs with arteries - can see that above vocal cords - ..??
Eye muscle movements
superior/inferior rectus - elevates and depresses
Lateral and medial rectus - adducts and abducts eyes (moves eye medially and laterally)
Superior optic - abducts intors (depresses)
Inferior optic - abducts extors (elevates)
-diagram page 12
Blood supply to skull - Exam - need to know what branches supply inferior part of skull
Anterior - supratrochlea, supraorbital A + V
Posterior - Aurciular V + A, SUperifical termporal A + V , occipital A + V
Sensory to scalp
Sensory to scalp - anterior - supratrochlea, supra-orbital N, Middle - auriculotemporal nerve
Posterior - greater occipital , lesser occipital, great auricular
