Final revision

Question 1

Superior orbital fissure
internal acoustic meatus
foreamen ovale

Answer 1

SOF - V1, 3,4,6, sympathetic fibers of cavernous plexus

IAM - vestibulocochlea nerve, facial nerve, larbynthine A + V

FO - accesory menangial artery

Question 2

*** What nerves are the auricle and external acoustic meatus and tympanic membrane innovated by?

Answer 2

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.

Question 3

Chorda tympani paper review

Answer 3

• 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

Question 4

what innovates the superior tarsal muscle

Answer 4

postganglionic sympathetic fibers from the superior cervical ganglion

Question 5

diagram pg 18

Answer 5

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Question 6

paper review - valves in opthalamic viens

Answer 6

• 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

Question 7

erbs point branch of nerves

Answer 7

Transverse cervical
lesser occipital nerve
greater auricular
supra clavicular

Question 8

Path of accessory and hypoglossal nerve

Answer 8

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

Question 9

is it internal or external carotdi that runs in carvenosu sinsu

Answer 9

internal cartoid

Question 10

where does maxillary aretery branch come from?

Answer 10

external carotid artery

Question 11

pterygopalatine fossa

Answer 11

• 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

Question 12

what structures form the pterygopalatine fossa

Answer 12

palatine bone- medial wall
anterior - maxilary
roof - sphenoid (foreamen rotundum)

Question 13

Lymph nodes of face - where things drain tho

Answer 13

diagram

Question 14

Surface marking of partoid duct

Answer 14

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

Question 15

Marginal mandibular nerve article

Answer 15

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

Question 16

Muscles of soft palate

Answer 16

Tensor veli palate (V3) 
Levator veli palate
Palatopharnageus
Palatoglossus
Muscular uvuale 
(rest by vagus)

Question 17

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>?

Answer 17

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

Question 18

What makes up little area?

Answer 18

• labial artery
• anterior and posterior ethmoidal arteries
• greater palatine artery
• anastomose with spehopalatine artery

Question 19

lymphatics of nose

Answer 19

submandibular –> deep cervical nodes

Question 20

Medial and lateral wall - label diagram

Answer 20

cards 321

Question 21

Muscle innovation to pharynx

Answer 21

All innovated by vagus, apar from stylopharangeal - this is innovated by no. 9.

Sensory - important -

Nasopharynx - V2

Oropharnx - IX

Laryngopharynx - X

Question 22

Blood supply layrnx

Answer 22

• 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 - ..??

Question 23

Eye muscle movements

Answer 23

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

Question 24

Blood supply to skull - Exam - need to know what branches supply inferior part of skull

Answer 24

Anterior - supratrochlea, supraorbital A + V

Posterior - Aurciular V + A, SUperifical termporal A + V , occipital A + V

Question 25

Sensory to scalp

Answer 25

Sensory to scalp - anterior - supratrochlea, supra-orbital N, Middle - auriculotemporal nerve
Posterior - greater occipital , lesser occipital, great auricular