H&N Flashcards
What muscle draws the eyebrows inferiorly and what branch of the facial nerve is this innervated by?
Corrugator supercilli, temporal nerve
What muscle dilates the nasal aperture?
Nasalis Alar
Which muscle is responsibel for compressing the nasal aperture
Nasalis Transverse
Which muscle on the model depresses the medial angle of the eyebrow resluting in wrinkles on the bridge of the nose and what branches fo the facial nerve innervates this?
- Procerus
- Temporal and zygomatic
What is the funciton of the depressor septi nasi?
Depresses the nasal cartilage
How many muscles raise the upper lip, what are these and the branches of the facial nerve that innervate them?
- 5
- Zygmaticus major and minor, Levator labii superioris, levator anguli oris, levator labii superioris alaeque nasi
- Zygmatic and buccal
Which muscle pulls the corner of the mouth laterally
Risorius
How many muscles depress the lower lip, what are they and the branch of the facial nerve innervating all of them?
- 3
- Depressor anguli Oris, depressor labii inferioris, mentalis
- Marginal mandibular branch
- The deepest is mentalis
Cranial nerve that passes through the formane ovale
Mandibular division of the trigeminal CNV2
WHat branch of the internal carotid artery passes through the optic canal?
Opthalmic artery
What structure in the middle cranial fossa houses th epituitary gland
Dorsum sellae (sella turcica)
WHat formaine is closedin by a cartilagenous plug?
Foramen lacerum
What formaen to the roots of the spinal accessory nerve tarvel through
Jugular foramen
4 arteries that provide branches to supply the face
- Maxillary artery
- Opthalmic
- Facial
- superficial temporal
What artery passes deep to the submandibular gland and gives branches that supply the lips and lateral aspect of the nose
Fcaial
WHat vessels lie superior to the frontalis muscle
- Supraorbital
- Supratrochlear
WHta artery can be felt pulsating immediately anterior to the ear
- Superficial temporal artery
What artery passes deep to the parotid gland
Transverse facial
What artery can be felt pulsating superficial to the inferior border of the mandible
Facial
Which dural venous sinus can the veins of the forehead, scalp and upper lid drain into?
Cavernous sinus
Which venous plexus can theveins upper lip and nose drian in to?
Pterygoid venous plexus
WHta veins come together to form the retromandibular vein
Superficial temporal vein
Maxillary vein
The retromandibular vein splits into anterior and posterior divisons. The anterior divison drains into common facial vein. WHat does the posterior division drain into?
External jugular vein
What vein passes superficial to the body of the mandible?
Facial vein
WHat vein does the facial vein join with to form the common facial vein
- Facial vein joins with the anterior division of the retromandibular vein = common facial vein.
What vein does the common facial vein drain into?
Internal jugular vein
Which type of lesion causes ipsilateral facial paralsysis with forehead sparing
UMN lesion to the motor area of the face. (Fcaial nerve)
(LMN -> parslysis of forehead too)
Layers of the Scalp and why are these important?
- S - Skin
- C - connective tissue (dense)
- A - Aponeurosis (epicranial Aponeurosis)
- L - Loose aereolar connective tissue
- P - Periosteum
Important:
- Loose CT is a dangeorus area as it drians the emissary veins which conenct extracranial veins with intracranial dural venous sinuses. Therefore emissary veins are a potential pathway for spread of infection
- Deep scalp lacertions tend to bleed profusely because blood vessels are adhered to dense CT, preventign vasoconstriction. There are also lots of anastomoses which bleed lots
What is intramembranous ossification
Direct depsoition of bon eon thin layers of connective tissue, characteristic of the bones on the top of the skull.
Which parts of the neurocranium ossifiy in cartilage?
The bones of the cranila bases are formed initially in the cartilage and then later transformed by endochondral ossification into bone.
What are the surface markings for the middle meningeal artery?
Pterion - region where the frontal, parietal, temporal, sphenoid bones join together on the side of the skull, just behind the temporal (anterior superior to ear)
What is an extradural haemorrhage
Collection of blood in the potential space between the skull and the outer protectiv elinings that covers the brain (dura mater).
Usually caused by head injuries.
What are the 5terminal branches of the facial nerve and what do they supply
- Temporal branches - frontalis, orbicularis oculi, corrugator supercilli
- Zygomatico branches - orbicularis occuli
- Buccla branches - orbicularis oris, buccinagtor, zygomaticus
- Marginal mandibular branches - mentalis, depressor labi inferiors, depressor angularis
- Cevrical branches - platysma
What pharyngeal arch is the facial nerve a derivate of?
- 1st arch
How would you test the integrity of the facial nerve
- Assess symmetry of the face at rest
- Raise eyebrows, close eyes tightly, blow out cheeks, smile
What is bell’s palsy and the common causes
- Unexplaines episode of facial muscle weakness or paralysis.
- Results from damage to the facial nerve
What are the branches of the external carotid artery
- Superior thyroid artery
- Ascending pharyngeal
- Lingual
- Facial
- Ocicpital
- Posterior auricular
- Maxillary
- Superficial temporal
How can an infection on the tip of the nose result in a cavernous sinus thrombosis
- The facial vein do not contain valves so flow is bidirectional. Veisn that connect the facial vein to the cavenrous sinus allow for infection/inflammaiton to spread to the cavernous sinus.
What cranial bone are th epterygoid plates a part of?
Sphenoid
What fossa would you ding the pterygoid venous plexus
Infratemporal fossa
What muscles of mastication are associated with the pterygoid venous plexus
Medial and laterla pterygoid muscles
Describe how blood reaches the internal jugular vein from the facial vein
- Fcaila veins travels inferiorly
- Anterior division of the retromandibular vein joints the facial vein to form the common facial vein.
- Common facial vein drains into the IJV
WHta veins joins to form the retromandibular vein
- Maxillary and superficial temporal veins
What veins do the retromandibular vein drain into
Common facial and external jugular
WHta is the blood supply to the Nasal cavtiy
- Internal carotid -> opthalmic artery -> anetioer/posterior ehtmoidal artery
- External carotid ->
- Maxillary -> sphenopalatnine/ greater palatine
- Facial -> labial and nasal branches
- Little’s area / kiesselbach’s plexus = anastomosis on the septal region of msot of the major arteries that supply the nose. Really common site for nose bleed (epistaxis)
Name the paransala sinuses and locate them
Where does the nasolacrimal duct drain
Inferior nasal meatus in the nasal cavity
What nerves are associated with the nose
FUncitons of the nasal cavity
- Warms and humidifes the inspired air
- Removes and traps pathogens and particulate matter from the inspired air
- Responsible for sense of smell
- Drains and clears the paranasal sinuses and lacrimal ducts.
Sensory innervation of pharynx
- glosospharyngeal snesory fibres
Motor supply of pharyngeal constrictors
Vagus nerve except stylopharyngeus which is glosospharyngeu s
WHat is the pharyngeal plexus
Network of nerve fibres innervatign most of the palate and pharynx. Located on the middle pharyngeal constrictor muscle.
What is the gag reflex?
Pharyngeal reflex = reflex muscular contraction of the back of the throat, evoked by touching the roof of the mouth, the back of the tongue, area around tonsils, uvula and back of the throat.
- Sensory receptor receives environmental stimulus – objects reaching nerves in back of the throat and sends a message via an afferent nerve to CNS. Sensory limb mediated by CNIX (glossopharyngeal) mostly
- CNS receives message and sends appropriate response via efferent nerve (motor neuron) to effector cells in same initial area that can then carry out the response appropriate. Motor limb by CNX (vagus nerve)
- Brisk and brief elevation of soft palate and bilateral contraction of pharyngeal muscles.
Where is the opening of the auditory tube
1.25cm behind and slightly below psoterior end of inferior turbinate.
Where are the palatien tonsils
Near the opening od the oral cavity into the pharynx.
Function of the soft palate
continuous with hard palate which forms anteiror roof of the mouth. Plays an essential role in blocking food and other substances form entering the nasal passages durign swallowing and is important in the formation of certain sounds in speech production
Funciton of the epiglottis
Movable ‘lid’ just above the larynx that prevents food and drink from entering your windpipe.
Describe the temporo-mandibular joint
Hinge that connects your jaw to the tmeporla bones of your skull. It lets you move your jaw up and done, side to side so you can chew, talk and yawn.
Types of teeth we have
What are the main muscles of mastication?
- Protrusion + Retraction of mandible = upper part of jaw allows this. Lateral pterygoid muscle for protrusion and posterior fibres of temporalis for retraction. Lateral movement by alternatively protruding and retracting mandible
- Elevation and depression of mandible = lower part of joint allows. Depression mostly by gravity but if resistance then digastric, geniohyoid and mylohyoid assist. Elevation is strong movement caused by contraction of temporalis, masseter and medial pterygoid muscles.
Muscles innervated by the mandibular nerve
- Muscles mastication (masseter, pterygoids, temporalis)
- mylohyoid
- Anterior belly of digastric
- Tensor tympani, tensory palati
Mian branche sof trigeminal nerve and what do they supply
- Opthalmic nerve -> frontal, lacrimal, nasociliary. SKin an dmucous memrbanes of forehead, scalp, frontal/ethmoidla sinus, upper eyelid, cornea, dorsu of nose. PS to lacrimal gland
- Maxillary nerve -> lower eyelid, cheeks + maxillary sinus, nasal cavity + laterla nose, uppe rlip, uppe rmolar, incisor + canine teeth, superior palate. PS to lacrimal and nasal glands
- Mnadibular ->bucca. infraalveolar nerve, auricotemporal nerve, lingual nerve. Snesory to mucous membranes, external ear, lower lip, chin, anteiror 2.3 tongue, lowe rmolars etc. Motoe to mastic=ation muscles, digastric, tensor veli palatini and tensory tympani. PS to submandibular + sublingual glands and parotid gland.
Testign trigeminal nerve
Palpating masseter muscles while they clench teeth and open mouth against resistance. Also sensory so touchig skin on face.
What muscle forms the floor of the mouth and nerve supply
Mylohyoid - mandibula rnerve CNV3
Where is the palatoglossal arch
- The palatoglossal arch contains the palatoglossus muscle.
Motor, sensory and special snesory innervation of the tongue
- Posterior 1/3glosospharyngeus
- Sesnory - trigmenian (lingua) anterior 2/3
- Special sensory - ant 1/2 chorda tympani
- motor - Hypoglossal except palatoglossus which is pharyngeal branch of vagus
Main pairs salivary glands and where they open into the mouth
- Parotid gland - secretions transported by stensen duct to oral cavity nesr second upper molar
- Sublingual gland - drain by minor siblingual ducs into sublingual folds.
- Submandibular - via submandibular duct (Whartons duct) which emerges anteromedially from depe arm of gland and open orifices on small sublingual papillr at bae of lingual frenulum.
Patient X has suffered a traumatic injury to the right side of their neck. They have a hoarse voice
with altered pitch, and this will not resolve with time. Which of the following nerves was most likely
damaged by this injury?
Recurrent laryngeal nerve
List the function and nerve supply of thyrohyoid and sternothyroid.
- Thyrohyoid: C1 via hypoglossal nerve, Depresses hyoid bone or elevates larynx
- Sternothyroid: Anterior rami of C1 to C3 through ansa cervicalis, Depresses larynx
The gag reflex tests for functioning of the glossopharyngeal nerve. Which other nerve can be
tested using this reflex?
Vagus nerve CNX
Muscles of the larynx
