Head and neck Flashcards
Pharyngeal arch 1
CN: V
Skeleton: Meckel’s cartilage, maxilla, mandible, zygomatic, temporal, malleus, incus
Muscles: MOM, Mylohyoid, anterior digastric, tensor veli palatini, tensor tympani
Ligament: Sphenomandibular ligament
Pharyngeal arch 2
CN: VII
Skeleton: Reichet’s ligament, upper body of hyoid, lesser horns, stapes, styloid process
Muscles: MOF, posterior digastric, stapedius, stylohyoid
Ligament: stylohyoid
Pharyngeal arch 3
CN: IX
Skeleton: Greater horns, lower half of hyoid body
Muscles: stylopharengeus
Ligament:
Pharyngeal arch 4
CN: X
Skeleton: Thyroid
Muscles: Cricothyroid, palatoglossus, levator veli palatini, pharyngeal constrictors
Ligament:
Pharyngeal arch 6
CN: X
Skeleton: Cricoid
Muscles: Laryngeal muscles
Ligament:
Cranial Nerve 1,2,3,4
Cleft?
Pouch?
Placode?
CN1: EAM, Eusthecian tube and tympanic cavity, Trigeminal ganglion
CN2: Cervical sinus, Palatine tonsile, Geniculate ganglion
CN3: Cervical sinus, Inferior parathyroid and thyroid, Inferior sensory of 9th CN
CN4: Cervical sinus, superior parathyroid and ultimobranchial, Inferior sensory of 10th CN
Orbital bones
Zygomatic, maxilla, ethmoid, sphenoid, frontal, lacrimal, palatine
Nasal bone:
Ethmoid bone, septal cartilage, Vomer bone
Superior Meatus:
Sphenopalatine foramen, Posterior ethmoid sinus,
sphenoid sinus
Middle meatus:
Middle and anterior ethmoid sinus, maxillary and frontal sinus via SEMILUNAR HIATUS
Inferior meatus:
Nasolacrimal duct
Foramen in Frontal, maxillary and mandible, and ethmoid
Supraorbital: V1
Infraorbital: V2
Mental: V3
Cribriform plate: CN1
Foramen of sphenoid bone:
Optic canal: CN II , ophthalmic artery
Superior orbital fissure: CN III, IV, V1, and CNVI
Foramen Rotundum: V2
Foramen Ovale: V3, lesser petrosal
Foramen spinosum: middle menengial artery
Foramen lacerum: Greater and deep petrosal.
Foramen of temporal bone:
Carotid canal: Internal carotid artery
Internal auditory meatus: CN VII, VIII
Jugular foramen: CN IX,X,XI
Foramen of occipital bone:
Hypoglossal canal: CN XII
Foramen magnum: Spinal cord and spinal and vertebral arteries.
Temporal fossa contents:
Temporalis, auricotemporal nerve, superfacial temporal artery
Infratemporal fossa content:
MOM, pterygoid plexus, maxillary artery, PSA nerve, mandibular nerve ( IAN, buccal, auricotemporal, lingual), chorda tympani, otic ganglion
Pterygopalatine fossa:
Lateral: Pterygomaxillary fissure —> PSA nerve and maxillary artery
Medial: perpindicular of palatine bone—> Sphenopalatine foramen—> nasopalatine nerve, sphenopalatine artery
Superior: Greater wing of sphenoid—> inferior orbital fissure—> infraorbital nerve and artery , zygomatic nerve
inferior: Pyramidal of palatine—> greater palatine canal—> greater and lesser palatine nerve
anterior: maxilla
Posterior: Pterygoid process of sphenoid—> foramen rotundum ( V2), pterygoid canal ( nerve of pterygoid canal), pharyngeal canal ( pharyngeal nerve and artery)
Sublingual vs submandibular vs submental infection:
Sublingual : Floor of the mouth swelling, Incisor, canine, premolar and 1st molar. Above mylohyoid.
Submandibular: swelling submandibular triangle, 2nd and 3rd molar infection.
Submental: central mandibular incisor, chin swelling.
Masticator spaces:
Superficial/deep temporal space: Maxillary 2nd and 3rd molars ( “ hourglass”)
Submasseteric: Impacted 3rd molars (“ trismus”)
Pterygomandibular space: Mandibular 3rd molar HIGH risk
Neck region infections:
Lateral pharyngeal space: Mandibular 3rd molar. HIGH risk continuity with retropharyngeal space.
Retropharyngeal space: Very high risk due to highway of infection
Danger: EXTREMELY high risk goes to mediastinum and diaphragm
Parotid: Usually not dental related.
Masseter:
Elevates mandible, protrude and retract, same side
Temporalis:
Elevates and retract
Medial Pterygoid:
Elevates and protrude mandible. Opposite side
Lateral Pterygoid:
Superior head: infratemporal crest to articular disc
Inferior head: lateral pterygoid to pterygoid fova
DEPRESS and protrude. Opposite side
Suprahyoid muscles:
Stylohyoid: Elevate hyoid during swallowing (VII)
Geniohyoid: Elevate tongue and hyoid during swallowing. (C1)
Anterior and posterior digastric: Elevate the hyoid and help lateral pterygoid depress mandible. ( anterior V3, posterior VII)
Mylohyoid: Elevate hyoid and form floor of mouth.(V3)
Infrahyoid muscles:
Thyrohyoid: Elevate thyroid and depress hyoid bone. (C1)
Omohyoid: Depress hyoid bone and larynx. ( C1-3)
Sternothyroid: Depress thyroid cartilage. ( C1-3)
Sternohyoid: Depress hyoid bone. ( C1-3)
Extrinsic muscles of tongue:
Hyoglossus: Depress tongue ( CN XII)
Genioglossus: Protrude the tongue ( CN XII)
Styloglossus: Retract the tongue ( CN XII)
Palatoglossus: Elevate base of tongue ( CN X)
Soft palate muscles:
1) Palatopharyngeus : elevate larynx and pharynx ( CNX )
2) Muscle uvule: Broadens uvule to close of nasopharynx ( CNX)
3) Tensor levi palatini: Tenses soft palate, opens auditory tube. hooks around pterygoid hamulus to create palatine aponerousis. ( V3)
4) Levator levi palatini: elevates soft palate to close of nasopharynx. ( CNX)
5) Salpingopharyngeus: Equalize air pressure.
Muscles of Pharynx:
Outer circular layer: Superior constrictor, middle constrictor, inferior constrictor. Involuntary constrict pharynx to propel food down.
Inner circular layer: Involuntary elevate pharynx to when speaking.
Palatopharyngeus ( CNX)
Salpingopharyngeus ( CNX)
Stylopharyngeus ( CNIX)
Muscles of Larynx:
1) Posterior Cricoarytenoid: Open vocal cord, food can go down.
2) Oblique and Transverse arythenoid: Close vocal cords, during cough and swallowing.
3) Cricothyroid: tenses and elongate vocal folds, increase pitch. ( only one with superior laryngeal nerve)
4) Thyroarytenoid: reduces tension and shortens vocal fold, decrease pitch
Muscles of eye:
Extraocular:
1) Superior Oblique: Depress eye and move laterally ( CN IV)
2) Inferior Oblique: Elevates eye and move laterally. ( CN III)
3) Superior rectus: Elevate eye and move medially. ( CN III)
4) Inferior rectus: Depress eye and move medially. ( CN III)
5) Lateral rectus: Move eye laterally. ( CNVI)
6) Medial rectus: Move eye medially. (CN III)
Intraocular:
1) Ciliary muscles: accommodate near vision. PSNS of CN III via short ciliary nerve.
2) Spinchter pupillae: MIOSIS, PSNS of CN III via short ciliary nerve.
3) Dilator pupillae: MYDRIASIS, SNS of V1 via long ciliary nerve.
Cranial nerves PNS :
CNI: Special Visceral sensory, olfactory
CNII: Special sensory, Vision
CNIII: Somatic Motor AND PSNS (miosis) Eyes
CNIV: Somatic Motor to Superior Oblique. ONLY CN from dorsal side of brainstem
CNV: Somatic Sensory (orofacial) and Motor (MOM).
V1: Ophtalmic division: Frontal nerve ( Supraorbital and supratrochlear),
Lacrimal nerve, Nasocilliary Nerve ( Posterior and anterior ethmoid, long
cilliary, and infratrochlear.
V2: Maxillary division: Sphenopalatine N, Pharyngeal N, Greater and
lesser palatine, PSA, zygomatic N ( zygomatofacial and
zygomaticotemporal), Infraorbital N ( MSA, ASA)
V3: Mandibular division: Auricotemporal N, long buccal N, Lingual N, IAN
(Mental N, Incisive N, and Mylohyoid N), Medial pterygoid N ( Motor to
M.pterygoid and 2 tensor muscles.
CNVI: Somatic motor to Lateral rectus muscles.
CNVII: Somatic and Visceral sensory and Somatic and PSNS Motor.
Posterior auricular, Temporal, Zygomatic, Buccal, Mandibular, and cervical.
CNVIII: Somatic Sensory
CNIX: Somatic and Visceral sensory and Motor. Somatic and Motor to 2/3 end of tongue, Motor to stylopharyngeus muscle, sensory end of GAG reflux, HERING’s nerve ( baro and chemo receptors (PSNS and SNS) around common carotid artery bifurcation.)
CNX: Somatic and Visceral sensory and Motor. Sensory from laryngeal mucosa below vocal cords. Sensory and motor from heart, lungs and GI. Motor end of GAG reflux. Baro and chemo receptors (PSNS and SNS) around aortic arch.
CNXI: Somatic motor to SCM and Trapezius.
CNXII: Somatic motor to Tongue except Palatoglossus.
Parotid gland:
CN: IX, PSNS, Inferior salivatory nucleus, lesser petrosal nerve, otic ganglion, Auricotemporal nerve ( V3)
Largest salivary gland, Stensen’s duct, serous secretion. Includes VII branches, retromandibular vein, auricotemporal nerve ( V3) and termination of external carotid artery
Submandibular gland:
Wharton’s duct, produce majority of saliva, MIXED secretion.
CN: VII, PSNS, Superior salivatory nucleus, chorda tympani nerve, submandibular ganglion, lingual nerve (V3)
Sublingual gland:
Bartholin’s duct, Mucous secretion.
CN: VII, PSNS, Superior salivatory nucleus, chorda tympani nerve, submandibular ganglion, lingual nerve (V3)
Minor salivary glands:
Lacrimal, nasal, palatine, and pharyngeal.
CN: VII, PSNS, Superior salivatory nucleus, greater petrosal nerve, Pterygopalatine ganglion, Lacrimal N (V1) and Zygomatic N (V2).
Mucous gland:
SNS, Internal carotid plexus, Deep petrosal nerve, Pterygopalatine ganglion, Lacrimal N (V1) and Zygomatic N (V2)
pupil constriction pathway:
CN: III, PSNS, Edinger-Westphal nucleus, Inferior branch nerve, Ciliary ganglion, Ophtalmic (V1)
TMJ cartilage:
Fibrocartillage
Articular disc:
Avascular, Type I collagen, Upper compartment for translational movement and lower compartment for opening and closing.
Retrodiscal tissue:
Well innervated.
Superior retrodiscal: elastic fiber, prevent anterior displacement.
Inferior retrodiscal: collagen fiber, prevent rotating too much
Intermediate retrodiscal: loose areolar connective tissue
Intrinsic ligaments of TMJ:
Capsular, lateral ( temporomandibular), Collateral ( discal)
Capsular ligament:
Well innervated, retain synovial fluid.
Lateral ligament:
Outer Oblique limits opening
Inner transversal limits retrusion
Collateral ligament:
Divide into superior and inferior.
Well innervated
Extrinsic ligaments of TMJ:
Stylomandibular ligament: limit protrusion
Sphenomandibular: Nothing really
Neurovascular supply of TMJ:
Mostly auricotemporal of V3 ( some massetric and deep temporal of V3 as well)
Superfacial temporal and maxillary artery of external carotid artery.
