Head and Neck Flashcards
When does the anterior fontanelle close? Posterior?
18-24 months.
Around 9 months.
What is craniosynostosis?
Premature closing of sutures causing deformities of head inhibiting proper brain development.
3 layers of cranial meninges?
Dura mater (outer endosteal layer and inner meningeal layer)
Arachnoid mater
Pia Mater
What space houses CSF?
Subarachnoid space
What is an epidural hemorrhage?
Accumulation of blood outside dura mater within the bone. Can be caused by a blow to the head/skull fracture. Progresses to herniation or death.
What is a subdural hemorrhage?
Accumulation of blood between dura and arachnoid mater. Acute is life threatening while chronic is less severe. Greatest risk are children(thinner veins) and elderly(longer bridging veins) with brain atrophy.
What is a subarachnoid hemorrhage?
Accumulation of blood due to rupture of an aneurysm. Produces blood within the CSF (spinal tap will be bloody).
What is the function of CSF?
Mechanical and protective support of the brain (weighs 90% less in water than in air). Also serves as an ion sink for brain excitability
Flow of CSF?
Produces in choroid plexuses with later, 3rd, and 4th ventricles.
Interventricular foramina.
Third ventricle.
Cerebral aqueduct.
Fourth ventricle.
Median or lateral apertures.
Absorbed into venous blood through arachnoid villi.
2 arteries that supply the brain?
Internal carotid and vertebral arteries.
2 superficial intrinsic muscles of the suboccipital region and innervation?
Splenius capitis and cervicis both innervated by cervical spinal nerves.
2 intermediate intrinsic muscles of the suboccipital region and innervation?
Longissimus capitis and cervicis both innervated by cervical spinal nerves.
5 deep intrinsic muscles of the suboccipital region and innervation?
Semispinalis capitis- cervical spinal nerves.
Rectus capitis posterior minor and major.
Oblique capitis superior and inferior.
4 deep muscles are innervated by suboccipital nerve and dorsal ramus of C1.
What forms the suboccipital triangle and what is in it?
Rectus capitis posterior major, obliquus capitis inferior and superior.
Contains vertebral artery and suboccipital nerve.
What is the yes joint? No joint?
Yes- atlanto-occipital
No-atlanto-axial
What structures are stretched/torn by whiplash?
Anterior longitudinal ligament and anterior neck muscles.
Can lead to intervertebral disc rupture, Hangman’s fracture, and breakage of the Dens
5 branches of the facial nerve?
Temporal Zygomatic Buccal Mandibular Cervical
What is Bell’s Palsy?
Idiopathic paralysis of the facial muscles usually unilaterally.
Herpes is thought to be a cause.
Mouth draws to unaffected side, can’t wink, close eye, or wrinkle forehead.
Sensory innervation of the face comes from what nerve?
Trigeminal nerve and it’s 3 branches- ophthalmic, maxillary, and mandibular
Blood supply to the face?
All comes from either internal or external carotid arteries.
5 layers of the scalp
Skin, connective tissue, aponeurosis, loose connective tissue, and periosteum.
What causes acromegaly?
Increased growth hormone.
What causes Cushing’s syndrome?
Increased adrenal hormone.
Examination of the eye can find what problems?
Anemia, high BP, high CSF pressure, diabetes, and hyperthyroidism
Where do tears(parasympathetic) produced by the lacrimal gland (ophthalmic of V) accumulate?
Lacrimal caruncle
What is the difference between a sty and a chalazion?
Sty- acute inflammation of the eyelid. Tender pain. Smaller, less painful. Internal comes from the meibomian gland and external comes from the sebaceous gland.
Chalazion- Lump in the eyelid as a result of chronic blockage of the tarsal glands. Non-tender pain. Larger, more painful
Differences between allergic, viral, and bacterial conjuctivitis?
Allergic- itchy eye
Viral(most common)- usually associated with a cold, watery discharge, and itch
Bacterial- Grittiness or irritation and a stringy grey or yellowish discharge that can cause the eye to stick together
Muscles that raise and lower the eyelid?
Raise- levator palpebrae superioris, superior tarsal, and frontalis all innervated by oculomotor.
Lower- orbicularis oculi innervated by facial (T and Z branches)
What is a blow out fracture?
Orbital fracture that involves the maxillary bone protruding into the orbital contents of the maxillary sinus
Which extraocular muscles of the eye are not innervated by the oculomotor nerve?
Superior oblique (trochlear) and lateral rectus (abducens)
What is exophtalmos?
Eyes that protrude slightly from Grave’s disease due to increased size of extraocular muscles and edema within the orbit
What is glaucoma?
Excessive pressure within the eye leading to inadequate blood supply and slow onset blindness.
What is presbyopia?
Loss of lens elasticity with age and become farsighted
What is cataract?
Loss of transparency of the lens
What is papilledema?
Swelling of the optic disc and pooling of blood in the veins on the retina’s surface that is caused by excessive CSF pressure
What is Horner’s syndrome?
Caused by loss of sympathetic innervation of the head (usually unilaterally). Leads to ptosis, miosis(constriction), and anhidrosis.
What is sinusitis?
Inflammation of 1 or more of the paranasal sinus usually due to bacteria.
What is anosmia?
Loss of smell (shearing of oflactory nerves)
What is epistaxis?
Nose bleed. Kiesselback’s area is a frequent site(press on upper lip or inciser foramen) (anterior ethmoid, sphenopalatine, greater palatine, and superior labial arteries anastamose here)
Pain from frontal and maxillary sinuses?
Tapping on the bone superficial to the sinus will cause pain
Referred pain from the ethmoid sinus? Sphenoid sinus?
Lateral to the eyes.
Top of the head.
Muscles of mastication and their innervation
Temporalis, masseter, lateral/medial pterygoid all innervated by the mandibular branch of trigeminal nerve.
Buccinator isn’t considered a muscle of mastication (innervated by facial nerve)
Temporomandibular joint
The mandible, temporal bone, and fibrocartilaginous articular disc make up a hinge and gliding joint for opening, closing, protrusion, retraction, and lateral rotation of the jaw.
What causes a dislocated jaw?
Mouth open too wide, bumped when open, or over-contraction of lateral pterygoid. Leads to the head of the mandible sliding to far anteriorly over the articular tubercle. Must supply downward pressure to move it back posteriorly into place
What is chora tympani?
A branch of the facial nerve that joins the lingual nerve to provide sensory for taste to anterior 2/3 of tongue. Lingual nerve provides general sensation.
What nerve innervates salivary glands?
Facial nerve (except parotid gland-glossopharyngeal)
What extrinsic tongue muscle is not innervated by the hypoglossal nerve?
Palatoglossus innervated by the vagus nerve
Nerve supply to the tongue (5 nerves)
Motor- CN 12 except palatoglossus (CN10)
Sensory (anterior 2/3)- lingual nerve off CN V3
Taste (anterior 2/3)- chora tympani off of CN 7
Sensory and taste (posterior 1/3)- CN 9
3 regions of the pharynx
Oro, naso, and laryngopharynx
3 coverings of the pharynx pathway?
Soft palate, epiglottis, and glottis
Pharynx constrictors are innervated by what nerve?
Vagus nerve (superior, middle, inferior constrictors)
All muscles of the soft palate, except one, are innervated by what nerve?
Vagus- musculus uvulae, levator palate, palatopharyngeus, and palatoglossus
V3- tensor palati
What can cause sleep apnea or snoring?
Dropping of tongue, enlarged tonsils or soft palate
Uvuluar deviation indicates what?
Lower motor lesion of the vagus nerve
Oflactory nerve function and lesion
Smell
Anosmia (usually from skull fracture, early indicator of Alzheimer’s, Parkinson’s, or Huntington’s)
Optic nerve function and lesion
Sight Bitemporal hemianopsia (tunnel vision), homonymous hemianopsia, or eye blindness
Oculomotor nerve function and lesion
Movement of the eyeball and pupillary constriction/accomodation
Lateral trabismus (eye rotates down and abducted, double vision), ptosis, myadriasis (pupil dilation), and loss of accomodation
Trochlear nerve function and lesion
Movement of the eyeball (superior oblique)
Head tilts 5 degrees toward the unaffected side due to eye rotation
Trigeminal nerve function and lesion
General sensation of the face, open/close the mouth, and tension of the tympanic membrane.
Tic doloureux (severe pain in regions covered by trigeminal nerve)
Abducens nerve function and lesion
Movement of the eyeball (lateral rectus)
Weakness/paralysis of lateral rectus; eye rotates inward and medially (common in diabetes)
Facial nerve function and lesion
Facial expression and taste
Bell’s palsy
Vestibulocochlear function and lesion
Hearing and balance
Acoustic neuroma and Schwann cell tumor
Glossopharyngeal nerve function and lesion
Taste(posterior tongue), swallowing(posterior tongue), and salivation(parotid gland)
Test by eliciting a gag reflex
Vagus nerve function and lesion
General sensation, visceral sensation, control of heart rate, respiratory, and GI systems
Hoarseness, difficulty swallowing, and deviated uvula
Accessory nerve innervated what muscles?
Trapezius and sternocleidomastoid
Hypoglossal nerve function and lesion
Movement of tongue
Tongue deviation to same side as lesion when tongue is protruded
What does the carotid sheath surround?
Common carotid artery(medial-highest pressure), vagus nerve(posterior), and internal jugular vein(lateral)
What muscle separates anterior and posterior triangles?
Sternocleidomastoid