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Z N Anatomy > H AND N 1.7 > Flashcards

H AND N 1.7 Flashcards

1
Q

What is cutaneous innervation of the face by?

A

3 divisions of the trigeminal nerve

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2
Q

What is the ophthalmic division represented by?

A
  • Supraorbital nerve

- Supratrochlear nerve

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3
Q

What is the maxillary division represented by?

A
  • Infraorbital nerve

- Zygomaticotemporal nerve

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4
Q

What is the mandibular division represented by?

A
  • Mental buccal nerves

- Auriculotemporal nerve

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5
Q

Where does the skin on the back of the scalp receive cutaneous innervation from?

A

Greater occipital nerve (dorsal Ramus of C2)

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6
Q

Where does the skin on the back of the neck receive innervation from?

A

Dorsal rami of the cervical nerve

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7
Q

Does C1 have sensory nerve fibres?

A

The 1st cervical nerve (C1) has few if any sensory nerve fibers from the skin, so it is usually not shown on dermatome charts

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8
Q

Where is sensory innervation of the face provided by?

A

Via 3 divisions of CN V

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9
Q

What could trauma anywhere along the pathway of the CN. V result in?

A
  1. Trauma anywhere along the pathway of the nerve, including that on the face itself (e.g., facial lacerations), can lead to loss of sensation
  2. The innervation of the muscles of facial expression will not be affected unless a laceration also damages the terminal branches of the facial nerve
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10
Q

Where does the main trunk of the facial nerve exit through?

A

-Stylomastoid forame
-After giving off several small
small branches, courses through the substance of the parotid gland

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11
Q

How does the facial nerve trunk end?

A

It ends as a plexus of 5 major terminal branches that innervate the muscles of facial expression

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12
Q

What are the 5 groups of terminal branches?

A
  1. Temporal
  2. Zygomatic
  3. Buccal
  4. Marginal Mandibular
  5. Cervical branches
    (superior to inferior)
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13
Q

How could herpes simplex affect the facial nerve?

A
  1. An infection, usually caused by the herpes simplex virus, of the facial nerve (CN VII) can cause acute unilateral paralysis of the muscles of facial expression, a condition called Bell’s palsy
  2. Facial expression on the affected side is minimal.
  3. For example, it is difficult to smile or bare one’s teeth; the mouth is drawn to the unaffected (contralateral) side; and the person cannot wink, close the eyelid, or wrinkle the forehead on the affected side
  4. Often, over time, the symptoms will disappear, but this may take weeks or months to occur.
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14
Q

What is the motor innervation to the extraocular muscles?

A
  • CN III, CN IV, CN VI and autonomic fibres

- Parasympathetic fibres arise in the brainstem and source with the oculuomoter nerve to ciliary ganglion

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15
Q

What do the postganglionic parasympathetic innervate?

A

the ciliary muscle (which accommodates the lens) and the sphincter muscle of the pupil

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16
Q

What do the sympathetic fibres that synapse in the superior cervical ganglion do?

A

send postganglionic fibers to the dilator muscle of the pupil

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17
Q

Where does sensory innervation to the orbit arise from?

A

The ophthalmic division of the trigeminal nerve

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18
Q

What would unilateral damage to the oculomotor nerve cause?

A
  1. Can paralyse the 4 extra ocular muscles innervated by this nerve (superior, medial, inferior retus and inferior oblique muscle)
  2. And the levator palpebrae superiors muscle of the upper eyelid causing ophthalmoplegia and ptosis
  3. Parasympathetic fibres in CN III will be affected. causing pupillary dilation (unopposed by sympathetic innervation of the dilator of the pupil)
  4. An inability to accommodate the lens for close-up vision on the affected (ipsilateral) side
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19
Q

What are the major nerves in the opthalamic division of the trigeminal nerve?

A
  1. Nasociliary
  2. Frontal
  3. Lacrimal
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20
Q

Where do the sensory nerve cell bodies reside? (eye)

A

Trigeminal (semilunar) ganglion

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21
Q

Where does the motor innervation of the extra ocular muscles comes from?

A
  1. Oculomotor
  2. Trochelar
  3. Abducens
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22
Q

How does the optic nerve leave the orbit?

A

Via the optic canal

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23
Q

How does CN III, CN IV, CN V1, and CN VI transverse?

A

They transverses the superior orbital fissure

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24
Q

How big is the ophthalmic division?

A
  1. The ophthalmic division of the trigeminal nerve (CN V1) is the smallest division of CN V.
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25
Q

Why is the ophthalmic division special?

A
  1. In addition to its sensory role and, similar to the other 2 divisions of the trigeminal nerve, this division carries autonomic fibers to the eyeball via its nasociliary nerve and connections to the ciliary ganglion (long and short ciliary nerves).
  2. Additionally, it carries parasympathetics from the facial nerve (CN VII) that join the lacrimal branch and innervate the lacrimal glands, which produce tears that moisten the cornea of the eyeball
  3. Orbital trauma or infections in this confined compartment may affect these important autonomic pathways.
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26
Q

Where does the mandibular division of the trigeminal nerve exit?

A

Through the foramen ovale, and divides into sensory and motor compartment

27
Q

What does the mandibular division of the trigeminal nerve do?

A
  1. This nerve provides motor control to many of the muscles derived from the 1st branchial arch, most notably the muscles of mastication
  2. The sensory components are represented largely by the auriculotemporal, buccal, lingual, and inferior alveolar nerves (the nerve to the mylohyoid muscle branches off the inferior alveolar nerve
28
Q

What synapses in the submandibular ganglion? What do they innervate?

A
  1. Preganglionic parasympathetic fibers arising from the facial nerve join the lingual nerve via the chorda tympani nerve to synapse in the submandibular ganglion.
  2. These postganglionic parasympathetics then innervate the sublingual and submandibular salivary glands and the minor salivary glands of the mandibular submucosa.
29
Q

What is trigemnial neuralgia?

A
  1. Trigeminal neuralgia (tic douloureux) is a neurologic condition characterized by episodes of brief, intense facial pain over 1 of the 3 regions of distribution of CN V.
  2. The pain is so intense that the patient often “winces,” which produces a facial muscle tic.
  3. The etiology is uncertain but could be from vascular compression of the CN V sensory ganglion and usually is triggered by touch and drafts of cool air on the face.
30
Q

Where do the vessels of the nasal cavity receive innervation from?

A

Sympathetic and (lesser from) parasympathetic division of the autonomic nervous system

31
Q

How do the sympathetic contribution of the vessels of the nasal cavity travel?

A

In the deep petrosal nerve as postganglionic fibres that are largely vasomotor function

32
Q

How do the parasympathetic contribution of the vessels of the nasal cavity travel?

A

Travel in facial nerve as pregnalgionic course to the pterygopaltine ganglion in the greater petrosal and vidian nerves and synapse in the pterygopalantine region

33
Q

How do postganglionic fibres travel and innervate?

A
  • Postganglionic fibers pass to the nasal mucosa, the hard and soft palates, and the mucosa of the paranasal sinuses
  • These fibers innervate mucous glands and microsalivary glands in the mucosa of the hard palate
34
Q

What could facial fractures involve?

A

Facial fractures may involve a fracture of the cribriform plate, which transmits the axons of the olfactory bipolar neurons

35
Q

What could happen if there was a tear in the meninges?

A
  1. As a brain tract, CN I is covered by the 3 meningeal layers and contains cerebrospinal fluid (CSF) in its subarachnoid space around the olfactory bulb
  2. A tear of the meninges can cause a leakage of CSF into the nasal cavity and provide a route of infection from the nose to the brain.
36
Q

What is. the pterygopalantine fossa mostly supplied by?

A
  1. This region is largely supplied by branches of the maxillary nerve (V2) and by arterial branches of the maxillary artery from the external carotid
37
Q

What are the maxillary teeth and gums suppled by?

A

The maxillary teeth and gums are supplied by the posterior, middle, and anterior superior alveolar neurovascular bundles

38
Q

What could damage the maxillary nerve?

A

Midface fractures (Le Fort fractures) and/or blowout fractures of the orbital floor may damage the branches of the maxillary nerve, affecting not only sensory modalities related to the distribution of the nerve but also the parasympathetic postganglionic secretomotor fibers that join the branches of this nerve after they leave the pterygopalatine ganglion (site of the postganglionic parasympathetic neurons).

39
Q

What are the 4 parasympathetic ganglia in the head?

A
  1. Ciliary ganglion
  2. Otic ganglion
  3. Pterygopalantine ganglion
  4. Submandibular ganglion
40
Q

What does the Ciliary ganglion receive?

A

receives preganglionic parasympathetic fibers from the oculomotor nerve

41
Q

What does the otic ganglion receive?

A

receives preganglionic parasympathetic fibers that arise in the glossopharyngeal nerve

42
Q

What does the Pterygopalantine ganglion receive?

A

receive preganglionic parasympathetics that originate in the facial nerve

43
Q

What does the submandibular ganglion recive?

A

receive preganglionic parasympathetics that originate in the facial nerve

44
Q

Where do preganglionic sympathetic fibres arise and ascend?

A
  1. Preganglionic sympathetic fibers arise from the upper thoracic spinal cord levels
  2. They ascend the sympathetic trunk to synapse on postganglionic neurons in the superior cervical ganglion
45
Q

Where do postganglionic sympathetic fibres travel?

A
  1. Postganglionic sympathetic fibers travel on blood vessels or adjacent nerves (deep petrosal nerve) to reach their targets
  2. These sympathetic postganglionic fibers are largely vasomotor in function.
46
Q

What would a unilateral lesion anywhere along the pathway of the preganglionic sympathetic axons, from the upper thoracic spinal cord levels (T1-T4) to the superior cervical ganglion (where they synapse), or beyond this ganglion (postganglionic axons) result in?

A
  • ipsilateral Horner’s syndrome Its cardinal ipsilateral features are:
    1. miosis (constricted pupil)
    2. slight ptosis (drooping of the eyelid due to loss of the superior tarsal muscle)
    3. anhidrosis (loss of sweat gland function)
    4. flushing of the face (unopposed vasodilation).
47
Q

What is the pathway of the internal carotid artery (ICA)?

A
  1. enters skull via carotid canal in the petrous portion of temporal bone
  2. Then directed anteromedially and superiorly across the foramen lacerum (closed by cartilage)
  3. then ascends into cavernous sinus (just inferior to the. anterior crinoid reprocess) and makes 180 degrees turn to pass posteriorly to join in Circle of Willis
48
Q

What accompanies the circle of Willis?

A
  1. A venous plexus accompanies the ICA from the carotid canal to the cavernous sinus, as does a plexus of postganglionic sympathetic nerve fibers (called the deep petrosal nerve) from the superior cervical ganglion. 2. The deep petrosal nerve joins the greater petrosal nerve (preganglionic parasympathetic fibers from CN VII) to form the nerve of the pterygoid canal (vidian nerve)
49
Q

What could be involved in trauma of confined bony region?

A
  1. The close association of cranial nerves exiting the jugular foramen (CN IX, X, XI) and those associated with the cavernous sinus (CN III, IV, V1, V2, VI) may be involved in any trauma or pathology (e.g., tumor, abscess) that surrounds this confined bony region
50
Q

What does the facial and vestibulococlheasr nerve transverse together?

A

The internal acoustic meatus

51
Q

How does the facial nerve travel?

A

Makes a sharp bend at the level of the geniculate (sensory) ganglion of the facial nerve before descending and exiting the skill through the stylomastoid foramen

52
Q

What does the facial nerve send?

A

sends preganglionic parasympathetic fibers to the pterygopalatine ganglion (via the greater petrosal nerve) and to the submandibular ganglion (via the chorda tympani nerve).

53
Q

What does the vestibulocochlear nerve carry?

A
  1. The vestibulocochlear nerve carries special sensory fibers from the cochlea via the cochlear nerve (auditory) and from the vestibular apparatus via the vestibular nerve (balance)
  2. These 2 branches join and leave the inner ear via the internal acoustic meatus to pass to the brain.
54
Q

What is Vertigo?

A

Vertigo is a symptom involving the peripheral vestibular system or its central nervous system connections and is characterized by the illusion or perception of motion

55
Q

What can hearing loss be a result of?

A

Hearing loss can be

  1. sensorineural, suggesting a disorder of the inner ear or cochlear division of CN VIII
  2. Conductive hearing loss suggests a disorder of the external or middle ear (tympanic membrane and/or middle ear ossicles)
56
Q

What muscle does the glossopharyngeal innervate?

A

The stylopahryngeus muscle

57
Q

What does the glossopharyngeal receive?

A
  1. Significant general sensory distribution from the pharynx, posterior third of the tongue, middle ear, and auditory tube. 4. CN IX is the nerve of the 3rd pharyngeal (branchial) embryonic arch.
  2. It exits the skull via the jugular foramen.
58
Q

What else is the glossopharyngeal nerve involved in?

A
  1. The special sense of taste (posterior third of the tongue) also is conveyed by this nerve. 2. Cardiovascular sensory fibers include those associated with the carotid body (chemoreceptor) and carotid sinus (baroreceptor) region adjacent to the common carotid artery bifurcation.
59
Q

How do you test the glossopharyngeal nerve?

A

Placing a tongue depressor on the posterior third of the tongue elicits a gag reflex, mediated by the sensory fibers of CN IX on the posterior third of the tongue, which then triggers a gag and elevation of the soft palate, mediated largely by the vagus nerve (CN X).

60
Q

What does the cervical plexus arise from?

A

from anterior rami of C1-C4

61
Q

What does the cervical plexus provide?

A
  • It provides motor innervation for many of the muscles of the anterior and lateral compartments of the neck
  • This plexus also provides cutaneous innervation to the skin of the neck.
62
Q

Where does most of the motor contributions to the infra hyoid muscle arise from?

A

from a nerve loop called the ansa cervicalis (C1-C3)

63
Q

What does the cervical plexus give rise to?

A
  • The cervical plexus also gives rise to the first 2 of 3 roots contributing to the phrenic nerve (C3, C4, and C5).
  • The phrenic nerve innervates the respiratory diaphragm
64
Q

What would result from unilateral trauma to the posterior cervical triangle of the neck?

A

Unilateral trauma to the posterior cervical triangle of the neck may injure the accessory nerve (CN XI) (ipsilateral innervation of the sternocleidomastoid and trapezius muscles), the phrenic nerve (C3-C5) (innervates the ipsilateral hemi-diaphragm), or the trunks or cords of the brachial plexus.

Z N Anatomy (35 decks)

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