Head Flashcards
1
Q
Key anatomy at CIII-IV
A
Superior border of the thyroiud cartilage of larynx
Common carotid bifurcates
2
Q
Key anatomy at CV-VI
A
Lower limit of pharynx and larynx
Superior limit of oesophagus and trachea
Indentation between cricoid cartilage of larynx and first tracheal ring
3
Q
Formation of cervical plexus
A
Spinal roots C1-C4
4
Q
Formation of brachial plexus
A
Spinal roots C5-T1
5
Q
Boundaries of anterior triangle of the neck
A
Median vertical line of th eneck
Inferior margin of the mandible
Anterior margin of sternocleidomastoid
6
Q
Boundaries of posterior triangle of the neck
A
Middle 1/3 of the clavicle
Anterior margin of trapezius
Posterior margin of sternocleidomastoid
7
Q
Borders of the forman lacerum
A
Medial: Basilar part of occpital bone
Anterior: body of sphenoid
Apex of petrous temporal bone
8
Q
Compoents of anterior cranial fossa
A
Frontal bone
Ethmoid bone in midline (crista galli)
Body and lesser wings of sphenoid
9
Q
Anterior clinoid process
A
Widening of lesser wing of sphenoid
Forms anterior attachment for tentorium cerebelli
10
Q
Foramina of anterior cranial fossa
A
Foramen caecum: emissary veins to nasal cavity
Olfactory foramina in cribriform plate: olfactory nerve (CN I
Optic canal: Optic nerve CN II and opthalmic artery
11
Q
Compenents of the middle cranial fossa
A
Body and greater wings of sphenoid
Squamous part of temporal bone
12
Q
Foramina of middle cranial fossa
A
Superior orbital fissure:
- -> Oculomotor nerve (III)
- -> Trochlear nerve (IV)
- -> Opthalmic division of trigeminal nerve V1
- -> Abducens (VI)
- ->Opthalmic veins
Foramen rotundum
–> Maxillary division of trigeminal nerve V2
Foramen ovale
- -> Mandibular division of trigeminal nerve V3
- -> Lesser petrosal nerve
Foramen spinosum
–> Middle meningeal artery
Hiatus for the greater petrosal nerve
–> Greater petrosal nerve
Hiatus for the lesser petrosal nerve
–> Lesser petrosal nerve
13
Q
Foramina of posterior cranial fossa
A
Foramen magnum
- -> End of brainstem
- -> Vertebral arteries
- -> Spinal roots of the accessory nerve
- -> Meninges
Internal acoustic meatus
- ->Facial nerve VII
- ->Vestibulocochlear nerve VIII
- -> Labyrinthine artery
Jugular foramen
- ->Glossopharyngeal nerve IX
- ->Vagus nerve X
- ->Accessory nerve XII
- -> Inferior petrosal sinus
- -> Sigmoid sinus
Hypoglossal canal
- -> Hypoglossal nerve VII
- -> Meningeal branch of ascending pharyngeal artery
Condylar canal
–> Emissary vein
14
Q
Anterior meningeal artery
A
BRanch of ethmoidal artery
15
Q
Middle meningeal artery
A
Branch of maxillary artery
Enters middle cranial fossa via the foramen spinosum
Divides into anterior and posterior branches
-Anterior branch crosses pterion
16
Q
Accessory meningeal artery
A
Branch of maxillary artery
Enters middle cranial fossa via foramen ovale
17
Q
Posterior meningeal artery
A
Terminal branch of ascening pharyngeal artery
–> enters through jugular foramen
18
Q
Innervation of the dura mater in the skull
A
Small meningeal branches of all three divisions of trigeminal nerve V1, V2, V3
Vagus nerve CN X
C1-C2 (+/- C3)
19
Q
Five developmental areas of brain
A
Telencephalon (cerebrum)
Diencephalon (thalamus, hypothalamus)
Mesencaphalon (midbrain)
Metencephalon (cerebellum and pons)
Myelencephalon (medulla oblongata)
20
Q
Course of the vertebral arteries
A
Branch of the first part of the subclavian artery
Pass superiorly through transverse foramina of C1-C6
Enter cranial cavity through foramen magnum
Give off meningeal artery branch
Give off anterior spinal artery (subsequently join)
Give off posterior spinal artery
Give off posterior inferior cerebral artery (which can also give rise to posterior spinal artery)
Join to form the basilar artery
21
Q
Branches of internal carotid artery
A
Enters cranial cavity through carotid canal
Gives off Opthalmic artery
Gives off Posterior communicating artery
Middle cerebral artery
Anterior cerebral artery
22
Q
Contents of the cavernois sinuses
A
Running through the cavernous sinus:
- -> Internal carotid artery
- -> Abducens nerve VI
In lateral wall:
- Oculomotor nerve III
- Trochlear nerve IV
- Opthalmic nerve V1
- Maxillary nerve V2
23
Q
Muscles that develop from second pharyngeal arch
A
Facial muscles
Innervated by Facial nerve
24
Q
Structures passing though the parotid
A
External carotid artery –> posterior auricular artery
Retromandibular vein
Facial nerve
25
Branches of the fascial nerve
Temporal
Zygomatic
Buccal
Marginal
Mandibular
Cervical branches
26
Innervation of the parotid gland
Auriculotemporal nerve
Branch of mandibular nerve V3 of CN V
-Post ganglionic parasympathetic fibres from otic ganglion
27
Innervation of first pharyngeal arch
Trigeminal nerve CN V
28
Innervation of second pharyngeal arch
Facial nerve CV VII
29
Branches of the ophthalmic nerve
Ophthalmic nerve V1 (of trigeminal nerve)
Ophthalmic nerve exits the cranial cavity through the superior orbital fissure
Branches:
- Supra-orbital and supra-trochlear nerves which leave the orbit superiorly and innervate:
- ->upper eyelid
- ->forehead
- ->scalp
- Infra-trochlear nerve, which exits the orbit in the medial angle to innervate the:
- medial half of the upper eyelid
- skin in the area of the medial angle
- side of nose
- Lacrimal nerve, which exits the orbit in the lateral angle to innervate the:
- ->lateral half of the upper eyelid
- ->skin in the area of the lateral angle
- External nasal nerve
- ->anterior part of the nose
30
Branches of the maxillary nerve
Maxillary nerve V2 of Trigeminal nerve
Exits cranial cavity through foramen rotundum
Zygomaticotemporal branch
-Exits zygomatic bone and supplies a small area of the anterior temporal bone
Zygomaticofacial bone
-Exits zygomatic bone and supplies a small area of skin over zygomatic bone
Infra-orbital bone
- Exits maxilla through infra-orbital foramen and immediately divides
- -> Lower eyelid
- -> Cheek
- -> Side of nose
- -> Upper lip
31
Branches of mandibular nerve
V3 of Trigeminal
Leaves cranial cavity through foramen ovale
Auriculotemporal branch
- Innervates face posterior to temporomandibular joint
- Passes through the parotid gland and ascends just anterior to the ear to supply the external acoustic meatus
- Surface of tympanic membrane
- Temple
Buccal nerve
-Surface over buccinator
Mental nerve
- Exits mandible through mental foramen
- Immediately divides into multiple branches to supply the skin and mucous membrane of the lower lip and skin of chin
32
Branches of the Facial Nerve
Temporal
Zygomatic
Buccal
Marginal mandibular
Cervical
33
Layers of the scalp
S-skin
C-connective tissue (dense)
A-aponeurotic layer
L-loose connective tissue
P-pericranium
34
Passes through foramen ovale
```
O tic ganglion
V3 (Mandibular nerve:3rd branch of trigeminal)
A ccessory meningeal artery
L esser petrosal nerve
E missary vein
```
35
Cranial nerves carrying parasympathetic fibres
X IX VII III (1973)
The parasympathetic functions served by the cranial nerves include:
III (oculomotor) Pupillary constriction and accommodation
VII (facial) Lacrimal gland, submandibular and sublingual glands
IX (glossopharyngeal) Parotid
X (vagus) Heart and abdominal viscera
36
Functions of the facial nerve
Supply - 'face, taste, ear, tear'
Face: muscles of facial expression
Ear: nerve to stapedius
Taste: supplies anterior two-thirds of tongue\
Tear: parasympathetic fibres to lacrimal glands, also salivary glands
37
Muscles of the orbit
Orbicularis oculi
- Palpebral part
- Orbital part
Corrugator supercollider
38
Muscles of the nose
Nasalis
- Transverse part
- Alar part
Procerus
Depressor septi
39
Muscles of the upper mouth
Risorius
Zygomaticus major
Zygomaticus minor
Levator labii superioris
Levator labii superiosis alaeque nasi
Levator anguli oris
40
Muscles of the lower mouth
Depressor anguli oris
Depressor labii inferioris
Mentalis
41
Muscles not confined to a single region of the face
Anterior auricular
Posterior auricular
Superior auricular
Occipitofrontalis
- Frontal belly
- Occipital belly
42
Origin, insertion and function of Obicularis oculi
Palpebral part
O: Medial palpebral ligament
I: Lateral palpebral raphe
F: Closes eyelid gently
Orbital part
O:Nasal part of frontal bone, frontal process of maxilla, medial palpebral ligament
I: Fibres form an eclipse around orbit
F: Forceful closure of eyelid
Innervated by facial nerve
Forms one of two muscles in orbital group
43
Origin, insertion and function of Corrugator supercilii
O: Medial end of superciliary arch
I: Skin around medial half of eyebrow
F: Draws eyebrows medially and downward, wrinkling skin between brows
Innervated by facial nerve
Forms one of two muscles in orbital group
44
Origin, insertion and function of Nasalis
Transverse part
O: Maxilla, just lateral to nose
I: Aponeurosis across nose with muscle on other side
F: Compress nasal aperture
Alar part
O: Maxilla over lateral incisor
I: Alar cartilage of nose
F: Flares nostrils
Innervated by facial nerve
Forms one of three muscles in nasal group
45
Origin, insertion and function of Procerus
O: Nasal bone and upper part of lateral nasal cartilage
I: Skin of lower forehead between eyebrows
F: Draws eyebrows together causing wrinkling
Innervated by facial nerve
Forms one of three muscles in nasal group
46
Origin, insertion and function of Depressor septi
O: Maxilla above medial incisor
I: Mobile part of nasal septum
F: Pulls nose inferiorly, flares nares
Innervated by facial nerve
Forms one of three muscles in nasal group
47
Origin, insertion and function of depressor anguli oris
O: Oblique line of mandible below canine, pre-molar and first molar
I: Skin at corner of mouth
F: Draws corner mouth down laterally
Innervated by facial nerve
Forms one of three muscles in inferior oris group
48
Origin, insertion and function of depressor labii inferioris
O: Anterior part of oblique line of mandible
I: Lower lip at midline, blends with muscle from opposite side
F: Draws lower lip downward
Innervated by facial nerve
Forms one of three muscles in inferior oris group
49
Origin, insertion and function of mentalis
O: Mandible inferior to incisors
I: Skin of chin
F: Raises and protrudes lower lip, wrinkle skin on chin
Innervated by facial nerve
Forms one of three muscles in inferior oris group
50
Origin, insertion and function of risorius
O: Fascia over massater muscle
I: Skin at lateral corner of mouth
F: Retracts corner of mouth, smiling
Innervated by facial nerve
Forms one of six muscles in superior oris group
51
Origin, insertion and function of zygomaticus major
O: Posterior part of lateral zygomatic bone
I: Skin ar lateral corner of mouth
F: Draws corner of mouth upward and laterally, smiling
Innervated by facial nerve
Forms one of six muscles in superior oris group
52
Origin, insertion and function of zygomaticus minor
O: Anterior part of lateral zygomatic bone
I: Upper lip just medial to corner of mouth
F: Draws upper lip upwards, smiling
Innervated by facial nerve
Forms one of six muscles in superior oris group
53
Origin, insertion and function of levator labii superioris
O: Infra-orbital margin of maxilla
I: Skin of upper lateral half of upper lip
F: Raises upper lip, forms nasolabial furrow
Innervated by facial nerve
Forms one of six muscles in superior oris group
54
Origin, insertion and function of levator labii superioris alaeque nasi
O: Frontal process of maxilla
I: Alar cartilage of nose and upper lip
F: Raises upper lip and opens nostril
Innervated by facial nerve
Forms one of six muscles in superior oris group
55
lOrigin, insertion and function of evator anguli oris
O: Maxilla below infra-orbital foramen
I: Skin at corner of mouth
F: Raises corner of lip and forms nasolabial furrow
Innervated by facial nerve
Forms one of six muscles in superior oris group
56
Origin, insertion and function of obricularis oris
O: From surround superior and inferior muscles in area, maxilla, mandible and midline
I: Forms ellipse
F: Closes and protrudes lips
Innervated by facial nerve
57
Origin, insertion and function of buccinator
O: Posterior part of maxilla and mandible, prerygomandibular raphe
I: Blends with orbicularis ocis and into lips
Central fibres cross superiorly-inferiorly
F: Compresses distended cheeks
Innervated by facial nerve
58
Origin, insertion and function of auricular muscles
Anterior auricular
Anterior part of temporal fascia --> helix of ear
Posterior auricular
Mastoid process --> convexity of concha
Superior auricular
Epicranial aponeurosis --> upper auricle
All innervated by facial nerve
59
Origin, insertion and function of occipitofrontalis
Frontal belly
O: Skin of eyebrows
I: Galae aponeurotica
F: Raises eyebrows
Occipital belly
O: Lateral part of superior nuchal line of occipital bone and mastoid process
I: Galea aponeurotica
F: Draws scalp backward
Innervated by facial nerve
60
Path of the parotid duct
Leaves anterior edge of parotid gland
Passes transverse over medial masseter muscle
Dives into buccinator, passing through it
Opens near second upper molar tooth
61
Structures passing through the parotid gland
Facial nerve
-Upper and lower trunks
External carotid artery
- Gives off posterior auricular artery
- Divides into two terminal branches: maxillary and superficial temporal artery
Retromandibular vein
- Formed from superfical temporal and maxillary veins
- After leaving parotid it branches into anterior and posterior branches
62
Innervation of the parotid gland
Sensory innervation by auriculotemporal nerve
- Branch of mandiular nerve V3 (Trigeminal)
- Carries secretomotor fibres to parotid
Secretomotor fibres are post-ganglionic fibres that are carried in V3 but arise in the otic ganglion
The pre-ganglionic fibres to the otic ganglion arise from the glossopharyngeal nerve IX
Sympathetic innervation originates from the superior cervical ganglion, part of the paravertebral chain. Fibres from this ganglion travel along the external carotid artery to reach the parotid gland. Increased activity of the sympathetic nervous system inhibits saliva secretion, via vasoconstriction.
63
Management of parotid stones
Distal near opening
-Incision in buccal muscoa and spuncterotomy + removal
Proximal / posterior stone close to or within gland
-Parotid gland excision
64
Arterial supply to the parotid gland
Posterior auricular artery
Superifical temporal artery
65
Referred pain from parotiditis
Pain produced can be referred to the external ear
Auriculotemporal nerve provides sensory innervation to the parotid gland and the external ear
66
Branches of the opthalmic nerve V1
Opthalmic nerve is V1 of the trigeminal nerve
It leaves through the superior orbital fissure
```
Branches:
Supra-orbital nerve
Supra-trochlear nerve
Infra-trochlear nerve
Lacrimal nerve
External nasal nerve
```
67
Branches of the the maxillary nerve V2
Maxillary nerve is V2 of the trigeminal nerve
It leaves through the foramen rotundum
Branches:
Zygomaticotemporal branch
Zygomaticofacial branch
Infra-orbital branch
68
Branches of the mandibular nerve V3
Mandibular nerve is V3 of the trigeminal nerve
Exits through the foramen ovale
Branches:
Auriculotemporal nerve: enters face posterior to temporomandibular joint and supplies external acoustic meatus, tympanic membrane, and temple
Buccal nerve
Mental nerve
69
Posterior auricular neve
Branch of facial nerve as it leaves the stylomastoid foramen
Passes upwards to supply the occipital belly of occipitofrontalis
AND
Posterior auricular muscle of the ear
70
Temproal branch of the facial nerve
First branch leaving at the superior border of the parotid
Supplies muscles in area of:
Temple
Forehead
Supra-orbital area
71
Zygomatic branch of the facial nerve
Second branch of the facial nerve emerging from the anterosuperior border of the parotid gland
Suuplies muscles in the area of:
Infra-orbital
Lateral nasal
Upper lip
72
Buccal branch of the facial nerve
Third branch of the facial nerve emerging from the anterior border of the parotid gland
Supplies muscles in the area of:
Cheek
Upper lip
Corner of the mouth
73
Marginal mandibular branch of the facial nerve
Fourth branch of the facial nerve which emerges from the anteroinferior border of the parotid gland
Supplies muscles in the area of:
Lower lip
Chin
74
Cervical branch of the facial nerve
Fifth branch of the facial nerve emerging from the inferior border of the parotid gland
Supplies the platysma
75
Path of the facial artery
Branch from anterior surface of external carotid artery
Passes upwards beneath submandibular gland
Wraps in front of mandible
Passes upwards, deep to:
- Platysma
- Risorius
- Zygomaticus major
- Zygomaticus minor
Superficial to:
- Buccinator
- Levator anguli oris
Branches
- -> Superior labial artery --> Upper lip and nasal septum
- -> Inferior labial artery --> Lower lip
- -> Lataeral nasal artery --> Lateral surface dorsum of nose
TERMINATES as Angular artery at medial corner of eye
NOTE: Superior and inferior labial arteries anastomose with corrosponding contralateral at midline
76
Transverse facial artery
Branch of superificial temporal artery within substance of parotid
Passes on superficial surface of masseter
77
Branches of the facial artery
Branches
- -> Superior labial artery --> Upper lip and nasal septum
- -> Inferior labial artery --> Lower lip
- -> Lataeral nasal artery --> Lateral surface dorsum of nose
TERMINATES as Angular artery at medial corner of eye
NOTE: Superior and inferior labial arteries anastomose with corrosponding contralateral at midline
78
Branches of the maxillary artery
Maxillary artery is larger of the two terminal arteries of the external carotid
Infra-orbital branch
- Enters face through infra-orbital foramen
- Supplies lower eyelid, upper lip and surrounding area
Buccal artery
-Enters face on superficial surface of buccinator
Mental artery
- Enters face through mental foramen
- Supplies chin
79
Branches of the opthalmic artery
Opthalmic artery is a branch of the internal carotid
It has five branches
Three for the face
Two for the scalp
Face
Zygomaticofacial artery
-Enters face through zygomaticofacial foramen
Zygomaticotemporal artery
-Enters face through zygomaticotemporal formamen
Dorsal nasal artery
- Terminal branch of the opthalmic artery
- Exits the orbit in the medial corner and supplies dordum of nose
Scalp
Supraorbital artery
Supratrochlear artery
80
Origin of the facial vein
Supratrochlear and supraorbital veins join to form the angular vein
The angular vein continues as the facial artery
81
Facial vein course
Passes with facial artery until it reaches mandible
Facial vein passes superiorly to submandibular gland to drain into the internal jugular vein
The artery passes posteriorly to submandibular gland
82
Drainage of the transverse facial vein
Drains into superficial temporal vein in substance of parotid
The superficial temporal vein then joins with the maxillary vein to form the retromandibular vein
83
Intracranial venous connections
Medial corner of orbit: communicates with opthalmic veins
Cheek: communicates with veins passing into the infra-orbital foramen
Communicates with pterygoid plexus of veins
All communicate with intracranial cavernous sinus
No valves
Infection can track
84
Submental nodes drain
Lower lip and chin
85
Submandibular nodes drain
Medial corner of the orbit
External nose
Medial cheek
Upper lip
Lateral lower lip
86
Pre-auricular and parotid nodes drain
Eyelids
Lateral cheek
Small part of external nose
87
Sensation to the scalp
Anterior to the ears
-Trigeminal nerve via supratrochlear, supraorbital, zygomaticotemporal and auriculotemporal nerve
Posterior to the ears
- Cervical nerve C2-C3
- Great auricular, lesser occipital, greater occipital and third occipital nerves
88
Bones making up the orbit
Superiorly: frontal bone
Medially: frontal prcoess of the maxilla
Inferiorly: zygomatic process of the maxilla and the zygomatic bone
Laterally: zygomatic bone. frontal process of zygomatic bone, zygomatic process of the frontal bone
Ethmoid bone medially
Lacrimal bone medially
Palatine bone medially
89
Superior tarsal muscle
Smooth muscle fibres passing from the inferior surface of levator papebrae superioris to upper edge of suprior tarsus
Innervated by post-ganglionic sympatheic fibres from the cervical ganglion
90
Inability to close eye tightly
Loss of innervation to orbicularis orbis from facial nerve
| CN VII
91
Ptosis of eye
Loss of function from levator papebrae superioris caused by oculomotor lesion
CN III
Constant partial ptosis from superior tarsal muscle caused by damage to sympathetic supply from cervical ganglion
92
Sensory innervation of the lacrimal gland
Sensory: lacrimal branch of the opthalmic nerve V1 of trigeminal nerve CN V
93
Parasympathetic innervation of the lacrimal gland
Secretomotor (parasympathetic)
- Pre-ganglionic parasympathetic fibres in facial nerve CN VII
- Enter greater petrosal nerve (branch of facial nerve)
- Contunes as nerve of the pterygoid canal
- Nerve of the pterygoid canal joins the pteygopalatine ganglion
- Post-ganglionic fibres join maxillary branch V2 of trigeminal nerve
- Zygomatic branch
- Zygomaticotemporal branch
- Lacrimal nerve
94
Synpathetic innervation of the lacrimal gland
Post-ganglionic fibres arise from superior cervical ganglion
- >Travel along plexus surrounding internal carotid
- >Leave plexus as deep petrosal nerve
- >Join parasympathetic fibres in the nerve of the pterygoif canal
- >Pass through pterygopalatine ganglion
- >Maxillary branch V2 of trigeminal
- >Zygomatic branch
- >Zygomaticotemporal nerve
->Lacrimal nerve
95
Arterial supply to lacrimal gland
Opathalmic artery
Drained by opthalmic vein
96
Periorbita
Periosteium surrounding orbit
Continuations of which extend into upper and lower eyelids as orbital septa
Continuum with periosteal layer of dura mater at points
Continuous with common tendinous ring of optic canal and superior orbital fissure
97
Path of opthalmic artery
Branch of internal carotid artery immediately after is emerges from the cavernous sinus
Passes into orbit through optic canal
Initally lies inferior and lateral to optic nerve, then passing superiorly and anteriorly to medial side
98
Branches of the opthalmic artery
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Lacrimal artery
Central retinal artery
Long posterior ciliary artery
Short posterior ciliary artery
Muscular arteries
Supra-orbital arteries
Posterior ethmoidal artery
Anterior ethmoidal artery
Medial palpebral arteries
Dorsal nasal artery
Supratrochlear artery
99
Central retinal artery
Branch of opthalmic artery which in turn is a branch of the internal carotid
Passes to centre of the optic nerve and proceeds centrally to the retina
Can be seen on opathlmoscopy
Occlusion causes blindness
100
Supra-orbital artery
Branch of the opthalmic artery as it passes over the optic nerve (from inferior lateral position to superior medial position)
Passes through supra-orbital foramen with supra-orbital nerve to supply the forehead and scalp
101
Anterior ethmoidal artery
Branch of opthalmic artery
Exits the orbit through the anterior ethmoidal foramen
Enters cranial cavity
Gives off anterior meningeal branch
Cotninues into nasal cavity supplying the septum and lateral wall
Ends as the dorsal nasal artery
102
Terminal branches of the opthalmic artery
Supra-trochlear artery
Dorsal nasal artery
103
Optic nerve subarachnoid space
Optic nerve is extension of brain
Surrounded by cranial meninges, including subarachnoid space
Increasing pressure impedes venous return along retinal veins
- -> Causing oedema of the optic disc
- -> Papilloedema
104
Superior branch of oculomotor nerve
Passes through common tendinous ring
Innervates:
Superior rectus muscle
Levator palpebrae superioris
105
Inferior branch of the oculomotor nerve
Passes through common tendinous ring
Divides into three branches:
1) One passing below the optic nerve to medial to innervate medial rectus muscle
2) Descening to innervate inferior rectus muscle
3) Runs along floor of orbit to innervate inferior oblique muscle
- -> gives off branch to ciliary glanglion as it descends
106
Trochlear nerve entry into orbit
Superior orbital fissure
ABOVE common tendinous ring
107
Sypathetic fibres to the orbit
Pre-ganglionic sumpathetic fibres arise from the thoracic spinal cord, mainly T1
Ascend in sumpathetic chain to the superior cervical plexus
Synpase with post-ganglionic neurons
These then ascend with the opthalmic artery into the orbit
Pass into short ciliary ganglion (without synapsing) or long ciliary nerve
108
Lacrimal nerve
Smallest of three branches of the opthalmic division V1 of trigeminal
Passes into orbit through the superior orbital fissure ABOVE the common tendinous ring
Recieves branch from the zygomaticotemporal nerve carrying parasympathetic + synpathetic fibres for the secretomotor function of the lacrimal gland
Supplies: lacrimal gland, conjunctiva, lateral upper eyelid
109
Frontal nerve
Largest branch of three branches of the opthalmic division V1 of the trigeminal nerve
Exits superior orbital fissure ABOVE common tendinous ring
Passes on top of levator palpebrae superioris
Divides into supra-orbital nerve and supra-trochlear nerve which leave orbit to gather sensory information from superior eyelid, forehead and scalp
110
Nasociliary nerve
First branch of the opthalmic division of the trigeminal nerve
Passes through the superior orbital fissure within the common tendinous ring
```
Many branches:
Communicating branch with ciliary ganglion
Long ciliary nerve
Posterior ethoidal nerve
Infratrochlear nerve
Anterior ethmoidal nerve
```
111
Position of ciliary ganglion
Lateral to optic nerve
Between optic nerve and lateral rectus muscle
112
Roots of the ciliary ganglion
Parasympathetic root
- Inferior branch of oculomotor nerve supplies parasympathetic branch carrying pre-ganglioni cfibres
- Post-ganglionic fibres leave via the short ciliary nerve
- Innervate spinchter pupillae muscle and ciliary muscle
Sympathetic root
- Post-ganglionic neurons from superior cervical ganglion
- Does not synapse, passes straight through into short ciliary nerve
- Innervate dilator pupillae muscle
Sensory root
- Nasociliary nere branch
- Pass through without synapsing
- Enter short ciliary nerve
113
Innervation of the ciliary muscle
Parasympathetic supply from the oculomotor nerve CN III
Constricts ciliary body, relaxes tension on lens, lens becomes more rounded
114
Innervation of the sphincter pupillae
Parasympathetic fibres from the oculomotor nerve CN III
Constricts pupil
115
Innervation of the dilator pupillae
Sympathetic fibres from the superior cervical ganglion (T1)
Dilates the pupil
116
Innervation to the external ear
Auriculotemporal nerve of the mandibukar branch of the trigeminal nerve V3
-Anterior superior portion
Great auricular nerve C2 C3
-Anterior and posterior inferior portion
Less occipital nerve C2
-Posterior superior portion
117
Innervation to the concha of the ear
Vagus nerve
-Auricular branch
Facial nerve
-Sends branch within auriuclar branch of vagus nerve
118
Arterial supply to the extenral ear
External carotid --> posterior suricular artery
Superficial temporal --> anterior auricular artery
Occipital artery
119
Sensory innervation for inner mucous membrane of tympanic membrane
Glossopharyngeal nerve
120
Innervation to tympanic tube
Glossopharyngeal nerve via tympanic nerve
121
Aterial supply to tympanic tube
Ascending pharyngeal artery which is a branch of the extenral carotid artery
122
Innervation of tensor tympani
Innervated by tensor tympani branch of the mandibular never V3 of the trigeminal
O: Cartilagenou spart of the pharyngotympanic tube. greater wing of sphenoid
I: Upper part of handle of malleus
F: Pulls handle of malleus medially
123
Innervation of stapedius
Innervated by branch of facial nerve VII
O: Attachment to pyramidal eminence
I: Neck of stapes
F: Contraction
124
Arterial supply to middle ear
Tympanic branch of the maxillary artery
Mastoid branch of the occipital or posterior auricular artery
125
Tympanic plexus
Formed by tympanic nerve of glossopharyngeal nerve and the branches from the internal carotid plexus
=Carotico-tympanic nerves
Supply mucous membrane of middle ear, pharyngotympanic tube, mastoid area
Gives off lesser petrosal nerve which passes into middle cranial fossa via hiatus
--> then passes through foramen ovale to otic ganglion
126
Arterial supply to bony labyrinth
Anterior tymapnic artery of maxillary artery
Stylomatoid branch from posterior auricular artery
Petrosal branch from middle meningeal artery
127
Arterial supply to the membranous labyrith
Labyrinthine artery
--> divides into cohlear branch and vestibular branch
Arises from anterior inferior cerebellar artery or as direct branch from basillar artery
Enters internal acoutstic meatus with facial and vestibulocochlear nerve
128
Branches of facial nerve within facial cancal
Greater petrosal nerve
Nerve to stapedius and chorda tympani
129
Greater petrosal nerve
Branch of facial nerve in the facial canal as it enalrges to form the geniculate ganglion
Passes out of the greater petrosal hiatus into middle cranial fossa
Carries pre-ganglion fibres to the pterygopalatine ganglion
130
Nerve to stapedius and chorda tympani
As facial nerve begins its vertical desscent in facial canal it gives off nerve to stapedius
Just prior to exit from the skull at stylomastoid foramen the facial nerve gives off nerve to chorda tympani
--> passes through middle ear between malleus and incus before exiting through the petrotympanic fissure to join lingual nerve
131
Nerve to stapedius
As facial nerve begins its vertical desscent in facial canal it gives off nerve to stapedius
132
Nerve to chorda tympani
Just prior to exit from the skull at stylomastoid foramen the facial nerve gives off nerve to chorda tympani
- -> passes through middle ear between malleus and incus before
- -> exiting through the petrotympanic fissure to join lingual nerve
133
Innervation of masseter
Innervated by masseteric nerve which is a branch of the mandibular nerve V3
O: Zygomatic arch and maxillary process of the zygomatic bone
I: Lateral surface of ramus of mandible
F: Elevation of the mandible
134
Arterial supply to the masseter
Masseteric artery, a branch of the maxillary artery
135
Innervation of temporalis
Innervated by the deep temporal nerves from the anterior trunk of the mandibular nerve V3
O: Bone of temporal fossa
I: Coronoid process of the mandible
F: Elevation and retraction of the mandible
136
Arterial supply to the massater
Deep temporal artery
Middle temporal artery
137
Innervation of the medial pterygoid muscle
Innervated by the nerve to the medial pterygoid which is a branch of the mandibular nerve V3
O:
Deep head: Medial surface of lateral pterygoid plate
Superficial head: Tuberosity and pyramidal process of the maxilla
I: Medial surface of the mandible near angle of mandible
F: Elevation and side-to-side movement
138
Innervation of the lateral pterygoid muscle
Innervated by nerve to lateral pterygoid which is a branch of the anterior trunk of the mandibular nerve V3
O: Roof of infratemporal fossa, lateral surface of lateral plate of pterygoid plate
I: Capsule of temporomandibular joint, pterygoid fovea on neck of mandible
F: Protrusion and side-to-side movement of mandible
139
Contents of the temporal fossa
Temporalis muscle and fascia
Zygomaticotemporal nerve branch of maxillary nerve V2
140
Borders of the infratemporal fossa
Roof: inferior surface of greater wing of sphenoid
Lateral: Medial surface of ramus of mandible
Medial: Lateral plate of pterygoid process and pharynx
Anterior: Posterior surface of maxilla
141
Contents of infratemporal fossa
Sphenomandibular ligament
Medial pterygoid muscle
Lateral pterygoid muscle
Maxillary artery
Pterygoid plexus of veins
Mandibular nerve V3
Branches of facial and glossopharyngeal nerves
142
Sphenomandibular ligament
Spine of sphenoid --> lingual of mandible and posterior margin of mandibular foramen
143
Anterior trunk of mandibular nerve
All motor except buccinator branch which is sensory in addition to motor
- -> Buccal nerve
- ->Massateric nerve
- -> Deep temporal nerves
- -> Nerve to lateral pterygoig
144
Posterior trunk of mandibular nerve
All sensory except motor supply to mylohyoid
- ->Auriculotemporal nerve
- -> Lingual nerve
- -> Inferior alveolar nerve
- -> Nerve to mylohyoid
145
Meningeal branch of the mandibular nerve
Branches off before division into anterior and posterior trunks
Ascends to leave the infra-temporal fossa with the middle meningeal artery
Through foramen spinosum --> cranial cavity
Sensory for the dura mater in middle cranial fossa + mastoid air cells
146
Nerve to the medial pterygoid
Branches off the mandibular artery prior to division into anterior and posterior trunks *as does meningeal branch
Two branches
- Tensor veli palatini muscle
- Tensor tympani muscle
147
Buccal nerve
Branch of anterior trunk of mandibular nerve
Sensory nerve
- Area over buccinator
- Buccal gingivae of lower molars
Motor innervation:
- Lateral pterygoid muscle
- Temporalis
148
Auriculotemporal nerve
First branch of the posterior trunk of the mandibular nerve
Originates as two roots
Pass around the middle meningeal artery
Ascends deep to parotid gland
--> supplies post-ganglionic parasympathetic fibres from glossopharyngeal nerve to parotid
Ascends between temporomandibular joint and ear
```
Sensory:
External ear
External auditory meatus
Tympanic membrane
Tempormandibular joint
```
149
Lingual nerve
Branch of posterior trunk of mandibular nerve
Sensory
- General sensation to anterior 2/3rds tongue
- Oral mucosa and floor of oral cavity
- Lignual gingiva associated with lower teeth
Lingual nerve joined in infra-temporal by the chord tympani which is a branch of the facial nerve
- Carries taste for anterior 2/3rds of tongue]
- Parasympathetic fibres to all salivary glands below the level of the oral fissure
