head 1 and 2 Flashcards
Layer of scalp with good lymph drainage
Skin
Layer of scalp with good supply of cutaneous nerve
Connective tissue
Layer of scalp with many potential spaces that can fill with fluid from injury/infection
Loose connective tissue
Importance of anterior fontanelle
Diamond shaped, closes by 18 months
Palpating this area can determine HR, ICP, and degree of hydration
Triangular shaped fontanelle
Posterior fontanelle
Accounts for half the cases of craniosynostosis and does not produce abnormal neuro development
Scaphocephaly (sagittal suture, “boat”)
Premature closure of the coronral or lambdoidal suture
Plagiocephaly “slanted”
More common in females, results in a tower shaped skull
Oxycephaly (coronal suture, “pointed”)
Tx of craniosynostosis
Helmit if suture is not fused
Bones of orbit of eye
Zygomatic Palatine Sphenoid Ethmoid Maxilla Lacrimal Frontal
What bone are the superior, middle, and inferior conchae from?
Superior and middle –> ethmoid
Inferior –> palatine
Bone that makes up part of the lateral walls of the nasal cavities and part of the floor of the orbit
Maxillae
Two maxillae meet in the middle to form this
Intermaxillary suture
Where you would give a nerve block during facial laceration repair
Infraorbital foramen
Carries upper teeth
alveolar arch
Parts of zygomatic arch
maxilla and zygomatic process of the temporal bone
Fracture that crosses bony septum and pterygoid plates of sphenoid. “floating plate”
LeFort I
Fracture that separates central part of the face from the skull. “Floating maxilla”
LeFort II
Fracture that goes horizontally through superior orbital fissures, separates maxilla and zygomatic bones from rest of skull. “floating face”
LeFort III
Fracture that is most likely to result in facial numbness from injury of infraorbital nerve
LeFort II “Floating maxilla”
Thinnest part of the lateral wall of the skull that overlies anterior division of the middle meningeal artery
Pterion
What condition are we concerned about the middle meningeal artery with?
Epidural hematoma
Bones that form the occiput
Occipital, parietal, temporal
Inion
External occipital protuberance
What structures pass through the foramen magnum?
Spinal cord Meninges Vertebral areries A + P spinal arteries Spinal branches of accessory nerve (CN 11)
Most superior part of the skull near the midpoint of the sagittal suture
Vertex
Landmark formed by the intersection of the sagittal and coronal sutures
Bregma
junction of sagittal and lamboidal sutures
Lambda
Bones that form the hard palate
Maxilla
Palatine
Above posterior edge are choanae, separated by vomer and bound by sphenoid (medial pterygoid plates)
Structures that pass through jugular foramen
Internal jugular vein
Cranial nerves 9, 10, and 11
Structures that pass through the internal acoustic meatus
Cranial nerves 7 and 8 (facial and vestibulocochlear)
Structures that pass through stylomastoid foramen
Cranial nerve 7 (facial) and stylomastoid artery
structures in anterior cranial fossa
frontal lobes
crista galli (cock’s comb)
Olfactory nerve
Structures of middle cranial fossa
Temporal lobes
Optic canal (optic nerve and opthalmic artery)
Sella turcica
Horn of the saddle
Tuberculum sella
Where pituitary gland sits
Hypophyseal fossa
Back of the saddle, makes posterior clinoid process
Dorsum sellae
Tentorium cerebelli attaches here
sella turcica
Connects pituitary to hypothalamus
Infundibulum
Anterior lobe of pituitary
Adenohypophysis
Posterior lobe of the pituitary
neruohypophysis
Route for pituitary surgery
Transsphenoidal (endonasal route)
Where is the optic chiasm in relation to the pituitary?
superior
Lateral to pituitary gland are what strucutres?
Cavernous sinus, which contains
CN 3, CN 4, CN 5, CN 6 and internal carotid artery
Structures in cavernous sinus
CN 3-6, internal carotid artery
Structures that pass through the superior orbital fissure
CN 2, 3, 4, 6 (just not trigeminal) and opthalmic VEIN
Where does the maxillary division (V2) of the trigeminal nerve pass through? What does it supply?
Foramen rotundum
Skin, teeth, cheek mucosa
Where does the mandibular division of the trigeminal nerve pass through?
Foramen ovale
What passes through the foramen spinosum?
Middle meningeal artery
What passes OVER the foramen lacerum?
Internal carotid artery
“battle signs”, “raccoon’s eyes”, clear fluid/blood from external ear canal/nose, and hemotympanum are signs of what?
basilar skull fracture (cranial base fx)
Shallowest and deepest cranial fossa
Shallow: anterior
Deep: Posterior
Structures in the posterior cranial fossa
hind brain (cerebellu, pons, medulla) Jugular foramen (CN 9.10.11) Internal acoustic meatus (CN7,8)
Where does the sigmoid sinus leave the skull to become the internal jugular vein?
Posterior cranial fossa
what lies between the periosteal and meningeal layer of the dura mater?
Dural venous sinuses
What do dural venous sinuses do?
Collect venous drainage and CSF and drain to internal jugular vein
Which meninge has direct communication with the 4th ventricle via Foramen of Magendie and the paired foramen of Luschka?
Subarachnoid space
Which layer gives rise to the falx cerebri?
Pia mater
Where is CSF produced?
Choroid plexus, in lateral, 3rd, and 4th ventricl.es
Leptomeninges
Arachnoid and pia mater. Both composed of loose CT
separates the cerebellum from the cerebral hemisphere.
Tentorium cerebelli
Allows communication between cerebellum and cerebral hemisphere
Tentorial incisure
Separates cerebellar hemispheres
Falx cerebelli
Dura mater blood supply
Middle meningeal artery
Blood supply of pituitary
Branches of internal carotid artery
Sup. and Iinf. hypophyseal artery
Which hormone stimulates spermatogenesis and follicle growth?
FSH
Which hormone stimulates ovulation?
LH
Which sinuses become the sigmoid sinuses?
Transverse sinuses
Which sinuses become the internal jugular veins?
sigmoid sinuses
Right transverse sinus is also made of what?
Superior sagittal sinus
Straight sinus is made of what?
Union of inferior sagittal sinus and great cerebral vein (junction of falx cerebri and tentorium cerebelli)
Left transverse sinus is a continuation of what?
straight sinus
What goes into the cavernous sinus?
Inferior ophthlamic vein and central vein of the retina
Where does the cavernous sinus drain?
Transverse sinus
What travels through the sella turcica connecting the two cavernous sinuses?
Internal carotid artery
CN 3-6
Hypophysis cerebri
Veins of the face
How can a sinus infection spread to the CNS if left untreated?
Through facial vein (NO VALVES) and inferior ophthalmic vein which drain into the cavernous sinus
“vowels” of bleeding in the head
Epidural
Arterial, oval, interval (lucid)
Middle meningeal artery
“consonants” of bleeding in the head
Subdural
Venous, crescent, shearing force
Emissary veins usually affected
Amorphous appearance in brain bleed
Subarachnoid hemorrhage
Fracture of jaw
Usually involves 2 fractures on opposing sides
Usually in region of opposite canine tooth
Nerve supply of muscles involved in mastication
Mandibular division of trigeminal nerve
Muscles that elevate the mandible
Medial pterygoid, anterior temporalis, masseter
Muscle that acts to protrude the jaw
lateral pterygoid
Retraction of jaw
Posterior temporalis
Depression of jaw
gravity, platysma
What nerve supplies periorbital structures?
Facial nerve
Pulls the eyes closed taught
orbital part of orbicularis oculi
Closes the eyelids gently
Palpebral part of orbicularis oculi
Empties tears from lacrimal sac
Lacrimal part of orbicularis oculi
Pulls eyebrows medially
Corrugator supercilli
Moves scalp on skull, raises eyebrows, furrows the forehead
Occipitofrontalis
Wrinkles skin at root of nose (for nasal breathers)
Procerus
Sphincter muscle of lips
Oricularis Oris
Dilator of lips
Levator labii superioris, levator labii inferioris, zygomaticus major, zygomaticus minor, levator angulii oris, risorius muscle
Compresses cheeks and lips against teeth preventing it from folding and being injured during chewing
Buccinatior
“Dicke turtleneck”
platysma
Most common location for facial nerve to be affected
Stylomastoid foramen
Lower lid everts, difficulty chewing, drooping of mouth are characteristic of what?
Injury to facial nerve
Food gets stuck in corners of mouth, dribbles out. What muscles are affected?
buccinator and orbicularis oris
Pt presents with sudden attacks of excruciating lightening like jabs of facial pain that last 15 minutes. What is this called and what nerve is affected?
Trigeminal neuralgia "Tic douloureux) Maxillary nerve (V2) most commonly involved.
Branches of facial nerve
Tell Ziggy Bob Marley Called Temporal Zygomatic Buccal Mandibular Cervical
Branch of facial nerve that supplies occipitofrontalis and superior part of orbicularis oculi, as well as auricularis
Temporal branch
Branch of facial nerve that supplies inferior part of orbicularis oculi. Injury here causes ectropion, corneal ulcer
Zygomatic branch
Branch of facial nerve that supplies buccinator and upper part of orbicularis oris and levator labii. Lesion prevents emptying of food from the vestibule of cheek
Buccal branch
Branch of facial nerve that supplies risorius and muscles of lower lip and chin. Paralysis causes drooping of the mouth
Mandibular branch
Branch of facial nerve that supplies the platysma
Cervical branch
Vascular supply to right side of head
Brachiocephalic trunk to
Right subclavian artery and right common carotid artery
External carotid artery in order from inferior to superior
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Superior thyroid Linugal Facial Maxillary (middle meningeal) Superficial temporal (major supply to scalp)
Vascular supply of left side of head
Left common carotid and left subclavian artery directly off the aorta. The rest follows the same as the right side
Trauma to the orbital walls causing fracture and displacement. What’s it called and what should you assess for?
“blowout fracture”
EOMs
Exophthalmos
Hyphema
What travels through the superior orbital fissure?
CN 3,4,5 (V1),6 and superior ophthlamic vein
What travels through the inferior orbital fissure?
CN 5 (V2, maxillary), and inferior ophthalmic vein
What passes through the optic canal?
Optic nerve and ophthalmic artery
What cranial nerve supplies lateral rectus?
6
What cranial nerve supplies superior oblique?
4
What nerve supplies all eye muscles besides lateral rectus and superior oblique?
3
Paralysis of EOM results in what?
diplopia
What EOM allows incyclotorsion?
Superior oblique (cornea looks downward and medial)
What EOM allows excyclotorsion?
Inferior oblique
cornea looks upward and lateral
Provides converging power for the eye, main refractive surface of eye.
Cornea
Area of sclera that is pierced by the nerve fibers of the optic nerve
Lamina cribrosa
Where sclera is directly continuous with the cornea
limbus
Blood supply to outer retina is from this
choroid
Changes shape of lens, secretes aqueous humor to fill anterior and posterior chambers of the eye
Ciliary body (sp. muscles and processes)
“blind spot” of the eye
optic disk; contains nerve fibers but no photoreceptors
Area of most acute vision
Fovea centralis (found in the macula)
What nerve allows accomodation of the lens?
CN 8
Cranial nerve that dilates pipil
CN2 (sympathetic control)
Cranial nerve that constricts pupil
CN 3 (parasympathetic control)
First sign of compression of CN3 (oculomotor) is what?
ipsilateral slowness of pupillary response to light
Where does the aqueous humor drain into?
Canal of Schlem
Circulation of aqeuous humor in the eye
Posterior chamber –> pupil –> anterior chamber –> canal of Schlemm –> venous system
Thickened structure at the lid margins to form the tarsal plates.
Ortibal septum
The orbital septum is thickened at the lid margins to form the ______.
Tarsal plates
Why does your nose run when you cry?
Tears enter lacrimal sac in upper end of nasolacrimal duct, which enters inferior meatus of the nose
Curved tube about 1 inch long that leads from auricle to TM.
External Auditory meatus
Middle ear is also known as…?
tympanic cavity
Located at the depth of the depression of the tympanic membrane
Umbo (can see cone of light)
Footplate of stapes contacts cochlea at _______.
oval window
What does the stapedius muscle do and what happens if it’s injured? Innervation?
dampens down vibrations of stapes
Hyperacusis
Facial nerve CN7
Contraction reduces sound pressure and transmission by dampening movement of ossicular chain. Muscle and innervation
Tensor tympani muscle
CV mandibular branch (V3)
Muscles that open the auditory/Eustachian tube
Soft palate muscles:
Levator veli palatine
Tensor veli palatine
Reception of sound and maintenance of balance
Vestibulocochlear organ
Contains endolymph
Membranous labyrinth
Contains perilymph
Bony labyrinth
Tx of external ear injury
Aspiration to avoid cauliflower ear
Pt has untreated middle ear infection. What can it cause and where can it spread?
Mastoiditis
Dural venous sinuses
Each nasal cavity extends from the nostril int eh front to the ______ behind
Choanae
Superior meatus lies (above, below) superior concha
Below
Where does the maxillary sinus, frontal sinus, and anterior and middle ethmoidal sinuses drain?
Middle meatus
Where does the nasolacrimal duct drain?
Inferior meatus
What is “Kiesselbach’s area”
Anterior third of the nose where someone is most likely to have a nosebleed
What does a nosebleed increase your chances for?
meningitis
Where do sphenoidal sinuses drain?
Sphenoethmoidal recess above superior conchae
Where do posterior ethmoidal sinuses drain to?
Superior meatus
Infection of the ethmoidal cells
Sinusitis
What can result from bacteria from sinusitis breaking through the thin plate between ethmoid and orbit?
Blindness or optic neuritis
What sinuses are most commonly infected?
Maxillary. Ostia here do not drain well.
What symptom do people with maxillary sinus infections often complain of?
toothache
How many teeth do children have? Adults?
20 deciduous teeth
32 secondary teeth
What type of muscle is the tongue?
striated
Where are different flavors detected on the tongue?
Sweetness: tip
Saltiness: Lateral margins
Bitterness: Posterior part
Intrinsic muscles of the tongue (after its shape)
Longitudinal
Transverse
Vertical
Extrinsic muscles of the tongue (after position)
Genioglossus, hyoglossus, styloglossus
Pts tongue is noted to fall posteriorly. You are worried about their airway becoming obstructed. What muscle is damaged?
genioglossus
Pts tongue is paralyzed and one side is atrophied. What muscle is affected?
hyoglossus
Retracts and draws tongue up to create trough for swallowing
Styloglossus (swallow “s)
Elevates posterior part and is related to the gag reflex. Muscle and innervation
Palatoglossus afferent of CN9 and efferent of CNX (vagus)
puke “p”
Tx of being “tongue tied”
frenectomy
