Head and Neck Flashcards
what are the borders of the anterior triangle
superior: inferior border of mandible
lateral: anterior border of SCM
medial: imaginary line down the midline of the neck
which layers of fascia form the roof and floor of the anterior triangle
roof: investing fascia
floor: visceral fascia
what are the general contents of the anterior triangle
muscles
nerves
blood vessels
lymph nodes
which groups of muscles are in the anterior triangle
supra hyoid
infra hyoid
what are the supra hyoid muscles
stylohyoid
digastric
mylohyoid
geniohyoid
what are the infra hyoid muscles
omohyoid
sternohyoid
thyrohyoid
sternothyroid
which nerves are found in the anterior triangle of the neck
cranial nerves CN VII CN IX CN X CN XI CN XII
which blood vessels are found in the anterior triangle
common carotid artery, which bifurcates into the internal and external carotids
internal jugular vein
what are the subdivisions of the anterior triangle
carotid triangle
submental triangle
submandibular triangle
muscular triangle
borders of the carotid triangle
superior: posterior belly of digastric
lateral: medial border of SCM
inferior: superior belly of omohyoid
what are the contents of the carotid triangles
common carotid artery and its bifurcation
internal jugular vein
hypoglossal, accessory and vagus nerves
where is the submittal triangle
underneath the chin
contents of the submental triangle
submental lymph nodes
beginning of anterior jugular vein
boundaries of the submental triangle
inferior: hyoid
medial: midline of neck
lateral: anterior belly of digastric
what forms the floor of the submental triangle
mylohyoid muscle, from the mandible to the hyoid bone
contents of the submandibular triangle
submandibular salivary gland lymph nodes facial artery and vein carotid sheath hypoglossal nerve
borders of the submandibular triangle
superior: body of mandible
anterior: anterior belly of digastric
posterior: posterior belly of digastric
borders of the muscular triangle
superior: hyoid
medial: imaginary midline of neck
superolateral: superior belly of omohyoid
inferolateral: inferior part of SCM
attachments of platysma
from fascia above pectoralis major and clavicle to lateral neck and onto mandible
innervation of platysma
facial nerve CN VII
describe the course of the jugular veins in relation to SCM
external jugular vein runs anterior/superficial to SCM
internal jugular vein runs posterior/deep to SCM
anterior jugular runs in the midline
which nerve roots make up the cervical plexus
anterior rami C1-C4
within which fascial layer do the branches of the cervical plexus lie
prevertebral fascia
which modalities are carried in the cervical plexus
somatic motor and sensory
sympathetic
what are the main sensory branches of the cervical plexus
lesser occipital
great auricular
transverse cervical
supraclavicular
what are the main motor branches of the cervical plexus
nerves to geniohyoid and thyrohyoid
ansa cervicalis
phrenic nerve
which muscles are innervated by branches from C1
geniohyoid
thyrohyoid
with which nerve do fibres from C1 travel to reach geniohyoid and thyrohyoid
hypoglossal nerve
what roots make up the ansa cervicalis
C1-C3
which muscles are supplied by ansa cervicalis
omohyoid
sternohyoid
sternothyroid
(infra hyoid muscles apart from thyrohyoid)
nerve roots of greater auricular nerve
C2-C3
what does the greater auricular nerve supply
sensation to skin of external ear and skin over parotid gland
nerve roots of transverse cervical nerve
C2-C3
what does the transverse cervical nerve supply
sensation to skin of anterior and anterolateral neck and upper sternum
nerve toots of lesser occipital nerve
C2
what does the lesser occipital nerve supply
posterosuperior scalp
nerve roots of supraclavicular nerves
C3-C4
what do the supraclavicular nerves supply
skin overlying the supraclavicular fossa and upper thoracic region and sternoclavicular joint
which muscles does the cervical plexus supply with proprioception
SCM C2-C3
trapezius C3-C4
nerve roots of phrenic
C3,4,5
what does the phrenic nerve supply
diaphragm
course of phrenic nerve in neck
travels on the anterior surface of the anterior scalene and through the thoracic inlet
what are the actions of the supra hyoid muscles
elevate hyoid bone
necessary for swallowing
attachments of stylohyoid
styloid process of temporal bone
TO
lateral aspect of hyoid bone
action of stylohyoid
initiates swallowing action by pulling hyoid posterosuperiorly
innervation of stylohyoid
facial nerve CN VII
attachments of digastric
anterior belly from digastric fossa or mandible
posterior belly from mastoid process of temporal bone
intermediate tendon attaches both bellies to hyoid via fibrous sling
actions of digastric
depress mandible and elevates hyoid
innervation of digastric
anterior belly: CN V3
posterior belly: CN VII
attachments of mylohyoid
mandible
TO
hyoid
actions of mylohyoid
elevate hyoid bone and floor of mouth
innervation of mylohyoid
CN V3
attachments of geniohyoid
inferior mental spine of mandible
TO
hyoid bone
actions of geniohyoid
depresses the mandible and elevates hyoid bone
innervation of geniohyoid
C1 nerve roots via hypoglossal nerve
actions of infra hyoid muscles
depress hyoid and thyroid cartilage
attachments of omohyoid
inferior belly: scapula
superior belly: hyoid
intermediate tendon attach to clavicle by deep cervical fascia
actions of omohyoid
depresses the hyoid
innervation of omohyoid
ansa cervicalis (C1-C3)
attachments of sternohyoid
sternum
TO
hyoid bone
actions of sternohyoid
depress the hyoid
innervation of sternohyoid
ansa cervicalis, C1-C3
attachments of sternothyroid
sternum (manubrium)
TO
thyroid cartilage
actions of sternothyroid
depresses the thyroid cartilage
innervation of sternothyroid
ansa cervicalis, C1-C3
attachments of thyrohyoid
thyroid cartilage
TO
hyoid
actions of thyrohyoid
depresses the hyoid and elevates larynx when hyoid is fixed
innervation of thyrohyoid
C1 via hypoglossal nerve
which roots contribute to the superior and inferior roots of ansa cervicalis
superior root = C1
inferior root = C2,3
where does the left common carotid arise from
arch of aorta
where does the right common carotid arise from
brachiocephalic
what are the branches of the common carotid arteries in the neck
NO BRANCHES U FOOL
terminates by dividing into internal and external carotids
general supply of they internal and external carotids
internal: brain and intracranial structures
external: head, face, neck
what does the common carotid travel within in the neck
carotid sheath
along with internal jugular and vagus nerve
which branches of the external carotid are found in the anterior triangle
facial artery
lingual artery
superior thyroid artery
which other artery (not a carotid) gives branches to supply the neck
subclavian artery via thyrocervical trunk
branches of the thyrocervical trunk
inferior thyroid artery
transverse cervical artery
supra scapular artery
which cranial nerve descends in the carotid sheath
vagus nerve
which branches of the vagus nerve are given off in the neck
recurrent laryngeal branches
- left wraps around the arch of aorta
- right wraps around subclavian artery
internal and external laryngeal branches
what are the main parts of the thyroid gland
2 lobes
isthmus
capsule
borders of the thyroid gland
from lamina of thyroid cartilage to 6th trachea ring
where is the isthmus located
over tracheal ring 2/3
arterial supply of thyroid
superior thyroid artery: branch of external carotid
inferior thyroid artery: thyrocervical trunk of subclavian artery
venous drainage of thyroid
superior thyroid vein: internal jugular
middle thyroid vein: internal jugular
inferior jugular: left bracnhiocephalic
where is the submandibular salivary gland located
inferior to mylohyoid
with part in floor of mouth superior to mylohyoid
where fo the ducts of the submandibular salivary gland open
between first and second lower incisor
either side of frenulum
borders of posterior triangle
anterior: posterior border of SCM
posterior: anterior border of trapezius
inferior: middle 1/3 of clavicle
what makes up the roof and floor of posterior triangle
roof: investing fascia
floor: prevertebral fascia
contents of posterior triangles
external jugular vein roots of brachial plexus accessory nerve cervical and supraclavicular lymph nodes supraclavicular nerves
which nerves can be found the posterior triangle
lesser occipital C2
greater auricular C2,3
supraclavicular (lateral, intermediate and medial) C3,4
transverse cervical C2,3
which nerve supplies the upper, posterior scalp
greater occipital
which nerve supplies the lateral scalp, posterior to ear
lesser occipital
which nerve supplies the outer ear, and skin over parotids
great auricular
which nerve supplies the anterior neck
transverse cutaneous nerve
which nerves supply the lower lateral neck and upper shoulders
supraclavicular nerves
which veins join to form the external jugular
posterior auricular and retromandibular veins
which veins form the retromandibular vein
maxillary and superficial temporal veins
where does the external jugular vein form
posterior to the angle of mandible
inferior to the outer ear
where does the external jugular vein travel within the neck
descends in superficial fascia
runs anterior to SCM, crosses it in a posteroinferior direction
which vein does the external jugular drain into
subclavian vein (passes under clavicle)
attachments of sternocleidomastoid
sternum and clavicle
mastoid process of temporal bone
innervation of SCM
motor via CN XI
pain/proprioception via C2/3
attachments of trapezius
superior nuchal line nuchal ligament spinous process T1-T12 TO lateral clavicle, acromion and spine of scapula
innervation of trapezius
CN XI
proprioception via C3,4
attachments of levator scapulae
transverse processes of C1-C4
TO
medial border of scapula at scapular spine
innervation of levator scapulae
C3,4,5 via dorsal scapular nerve
attachments of anterior scalene
transverse processes C3-6
TO
rib 1 at scalene tubercle
attachments of middle scalene
transverse processes of C2-7
TO
rib 1, behind subclavian artery
attachments of posterior scalene
transverse processes of C4-6
TO
rib 2
innervation of anterior scalene
anterior rami C4-7
innervation of middle scalene
anterior rami C3-7
innervation of posterior scalene
anterior rami C5-7
nerve root of sub occipital nerve
posterior ramus of C1
course of suboccipital nerve
runs between cranium and C1 vertebra to reach sub occipital triangle
what does the sub occipital nerve innervate
muscles of the sub occipital triangle
nerve roots of the greater occipital nerve
posterior ramus of C2
course of the greater occipital nerve
emerges inferior to obliquus capitis inferior and ascends to posterior scalp
what does the greater occipital nerve innervate
skin over posterior neck and occipital bone
nerve roots of lesser occipital nerve
anterior rami C2-3
course of the lesser occipital nerve
passes directly to skin
what does the lesser occipital nerve innervate
skin of superior posterolateral neck and scalp posterior to external ear
what do the posterior rami of C3-C7 innervate
intrinsic muscles of the back and overlying skin
attachments of splenius capitis
ligamentum niche and C7-T3 spinous processes
TO
superior nuchal line and mastoid process
attachments of splenius cervicis
T3-T6 spinous processes
TO
C1-C2 transverse processes
innervation of splenius muscles
posterior rami C1-C6
actions of splenius muscles
bilateral: extension of head and neck
unilateral: ipsilateral rotation and flexion of neck
attachments of semispinalis capitis
C4-T7 transverse processes
TO
occipital bone between nuchal lines
actions of semispinalis capitis
extension of cervical spine
ipsilateral lateral flexion
contralateral rotation
attachments of longissimus capitis
T1-T3 plus C4-C7 transverse processes
TO
mastoid process
actions of longissimus capitis
extension of head
ipsilateral flexion and rotation
what are the sub occipital muscles
rectus capitis posterior major
rectus capitis posterior minor
obliquus capitis inferior
obliquus capitis superior
attachments of rectus capitis posterior major
C2 spinous process
TO
inferior nuchal line
attachments of rectus capitis posterior minor
C1 posterior tubercle (no no spinous process on C1)
TO
inferior nuchal line
actions of rectus capitis posterior muscles
extension of head
ipsilateral rotation
innervation of rectus capitis posterior muscles
suboccipital nerve C1 posterior rami
attachments of obliquus capitis superior
C1 transverse process
TO
occipital bone above inferior nuchal line
actions of obliquus capitis superior
extension of head
ipsilateral lateral flexion
contralateral rotation
attachments of obliqqus capitis inferior
C2 spinous process
TO
C1 transverse process
action of obliquus capitis inferior
extension of head
ipsilateral rotation
innervation of obliquus capitis muscles
suboccipital nerve posterior rami C1
the occipital artery is a branch of
external carotid
the vertebral artery is a branch of
subclavian artery
what is the course of the vertebral artery
ascends neck in foramen transversarium of cervical vertebrae (C6-C1)
crosses the superior surface of C1 to enter foramen magnum
unite to form basilar artery
which structure runs along with the sub occipital nerve
deep cervical vein
which veins drain into the deep cervical vein
occipital veins
where does the deep cervical vein end
near transverse process of C7 in vertebral vein
what are the vertebral veins
vertebral veins are small veins of the internal vertebral plexus, which form a vessel passing through the foramen transversarium
where do the vertebral veins drain
runs until C6 when it leaves foramen to joint brachiocephalic vein
which ligaments are associated with the atlantoaxial and atlantooccipital joints
cruciate ligament
alar ligament
anterior/posterior Atlanto-axial membrane
anterior/posterior Atlanto-occipital membrane
which ligaments are associated with the entire cervical vertebra
anterior and posterior longitudinal ligament
what are the main muscles flexing the neck at the atlantooccipital joint
longus capitis
recuts capitis anterior
anterior fibres of SCM
supra hyoid and infra hyoid muscles
main muscles extending the neck at the atlantooccipital joint
rectus capitis posterior (major and minor) obliquus capitis superior splenius capitis longissimus capitis trapezius
muscles laterally flexing the neck at the atlantooccipital joint
SCM obliquus capitis superior reactus capitis lateralis longissimus capitis splenius capitis
muscles creating ipsilateral rotation at atlantoaxial joint
obliquus capitis inferior
rectus capitis posterior (major and minor)
longissimus capitis
splenic capitis
muscles creating contralateral rotation at atlantoaxial joint
SCM
semispinalis capitis
main muscles flexing the cervical IV joints
bilateral action of longus coli, scalene and SCM
main muscles extending the cervical IV joints
deep neck muscles semispinalis cervicis and iliocostalis cervicis splenius cervicis and levator scapulae splenius capitis multifidus longissimus capitis semispinalis capitis trapezius
main muscles of lateral flexion of the cervical IV joints
unilateral action of iliocostalis cervicis longissimus capitis and cervicis splenius capitis and cervicis intertransversari and scalene
main muscles rotating the cervical IV joints
unilateral action of rotatores semispinalis capitis and cervicis mutifidus splenius cervicis
what its he stylomandibular ligament made of
what is its purpose
extension of dense fibrous capsule surrounding parotid gland
separates parotid and submandibular glands
where is the parotid duct located
1 fingers breadth below the zygomatic arch
describe the course of the parotid duct
crosses masseter
takes a sharp, medial turn to pierce buccal fat pad and buccinator to enter oral cavity at upper second molar
which nerve divides into its terminal branches within the parotid gland
facial nerve
what are the main branches of the facial nerve arising within the parotid gland
posterior auricular (behind the ear) temporal (anterior to ea, superior) zygomatic (along zygoma) buccal (across cheeks) marginal mandibular (along border of mandible) cervical (down neck)
transverse facial artery is a branch of…
superficial temporal artery (terminal branch of external carotid)
what is the course of the transverse facial artery
arises from superficial temporal artery
crosses cheek, close to parotid duct
terminal branches of external carotid artery
superficial temporal and maxillary arteries
which veins join to form retromandibular vein
superficial temporal and maxillary veins
which nerve divides the parotid gland into deep and superficial parts
facial nerve
which neurovascular structures pass through the parotid gland
auriculotemporal nerve (CN V3)
external carotid artery
retromendibular vein
facial nerve
which muscles are innervated by the facial nerve before it passes through the parotid gland
stylohyoid
posterior belly of digastric
describe how parasympathetic fibres reach the parotid gland
parasympathetic fibres of CN IX travel in tympanic branch, through tympanic plexus (without synapsing)
via the lesser petrosal nerve, they pass through the foramen ovale to the otic ganglion, where they synapse
they are then carried to the parotid by the auriculotemporal branch of the CN V3
which structure do the two roots of the auriculotemporal nerve wrap around on their way to the parotid gland
middle meningeal artery
what are the muscles of mastication
temporalis
masseter
medial pterygoid
lateral pterygoid
innervation of muscles of mastication
CN V3
what are the movement of the mandible
elevation depression protrusion recursion lateral sliding
how is depression of the mandible achieved
gravity or against force using the supra hyoid muscles
temporalis is covered in
temporalis fascia
attachments of temporals
temporal fossa and fascia
TO
coronoid process and anterior border of ramus of mandible
actions of temporalis
anterior and superior fibres elevate mandible
posterior fibres retract mandible
innervation of temporalis
deep temporal nerve (x2) from anterior division of CN V3
attachments of masseter
zygomatic arch
TO
lateral aspect of ramus of mandible
action of masseter
elevated mandible
innervation of masseter
masseteric nerve from anterior division of CN V3
attachments of lateral pterygoid
upper head: infratemporal surface of greater wing of sphenoid
lower head: lateral surface of lateral pterygoid plate
TO
neck of mandible and articular disc
actions of lateral pterygoid
bilateral: protrusion (pulls neck of mandible forwards with articular disc)
unilateral: helps in lateral chewing movements with medial pterygoid
innervation of lateral pterygoid
nerve to lateral pterygoid from anterior division of CNV3
attachments of medial pterygoid
superficial head: tubercle of maxilla
deep head: medial surface of lateral pterygoid plate
TO
medial surface of angle of mandible
action of medial pterygoid
assists in elevation
innervation of medial pterygoid
nerve to medial pterygoid from main trunk of CN V3
what occurs during elevation of the mandible
head of mandible and disc move backward and head rotates on lower surface of disc
which muscles elevate the mandible
temporalis
masseter
medial pterygoid
what occurs during depression of the mandible
head of mandible rotates on undersurface of articular disc and middle is pulled forward
which muscles cause depression of mandible
lateral pterygoid digastric geniohyoid mylohyoid GRAVITY
what occurs during protrusion of the mandible
articular disc and head of mandible move forward
movement occurs in the upper part of the cavity
which muscles cause protrusion of the mandible
lateral pterygoid
medial assists
what occurs during retrusion of the mandible
articular disc and head of mandible are pulled backwards into mandibular fossa
which muscles retract the mandible
posterior fibres of temporalis
what occurs during lateral chewing
protrusion and retraction combined
which muscles cause lateral chewing
pterygoids
briefly describe the branches of CN V3
main nerve trunk: meningeal branch, nerve to medial pterygoid, tensor tympani and tensor vela palatini
anterior division: masseteric, nerve to lateral pterygoid, deep temporal (x2), buccal
posterior division: auriculotemporal, lingual, inferior alveolar (with mylohyoid branch)
which branch of CN V3 passes through the otic ganglion
part of nerve to medial pterygoid
no synapse
passes on to tensor veli palatini and tensor tympani
which branches of CN V3 act as carriers of parasympathetic fibres
auriculotemporal
lingual
the auriculotemporal nerve carries parasympathetic fibres
where do they originate and where are they travelling
fibres originate from CN IX
auriculotemporal nerve carries them from the otic ganglion to the parotid gland
the lingual nerve carries parasympathetic fibres
where do they originate and where are they travelling
they originate from the chordates tympani (CN VII)
carried to the submandibular and sublingual glands
what are the posterior branches of the external carotid artery
occipital
posterior auricular
course of occipital artery
posterior branch of ECA
origin close to facial artery
passes under posterior belly of digastric to enter posterior triangke
what does the occipital artery supply
back of scalp
describe course of posterior auricular artery
posterior branch of ECA
originates superior to occipital artery
passes posterior to ear
what does the posterior auricular artery supply
scalp
which artery arises from deep surface of ECA
ascending pharyngeal
describe course of ascending pharyngeal artery
deep/medial branch of ECA
ascends between internal carotid and pharynx
gives branches to pharynx
what are the anterior branches of the ECA
superior thyroid
lingual
facial
describe the course of the superior thyroid artery
anterior branch of ECA
arises near origin of ECA
gives branches to SCM and superior laryngeal artery
describe the course of the lingual artery
anterior branch of ECA
arises between superior thyroid and facial arteries, at level of hyoid bone
passes deep to hyoglossus
crossed by the hypoglossal nerve
what does the lingual artery supply
oral cavity
describe the course of the facial artery
anterior branch of ECA
arises above level of hyoid
passes deep to posterior belly of digastric
which branches does the facial artery give off
superior and inferior labial branches
angular artery to face
what is the angular artery of the face
branch of facial
reaches up to medial corner of eye
what are the terminal branches of the ECA
superficial temporal
maxillary
describe the course of the superficial temporal artery
smaller terminal branch of ECA
ascends anterior to auricle
gives off transverse facial artery below zygoma
divides into anterior and posterior branches
supply of the superficial temporal artery
skin over frontal and temporal regions
describe the course of the maxillary artery
larger terminal division of ECA
arises behind neck of mandible
passes through infra temporal fossa
passes between 2 heads of lateral pterygoid to go into pterygomaxillary fissure/fossa
supply of maxillary artery
branches to muscles of mastication, tympanic membrane, upper and lower teeth, palate, nasal cavity, nasopharynx and meninges
what are the main lymph nodes of the head/neck
occipital parotid submandibular submental superficial cervical deep cervical
what is the infra temporal fossa
space beneath the base of the skull between the skull and the ramus of the mandible
what are the boundaries of the infra temporal fossa
anterior: posterior surface of maxilla
posterior: styloid process
superior: infratemporal surface of the greater wing of sphenoid bone
meidal: lateral pterygoid plate
lateral: ramus of the mandible
what are the contents of the infra temporal fossa
pterygoids mandibular division of CN V maxillary artery and branches pterygoid venous plexus chordates tympani otic ganglion
branches of anterior division of CN V3
x2 deep temporal
masseteric
nerve to lateral pterygoid
buccal
branches of posterior division of CN V3
lingual
inferior alveolar
mylohyoid
auriculotemporal
pre-division branches of CN V3
meningeal branch
nerve to medial pterygoid
communicating branch (tensors tympani and deli palatini)
describe the course of they inferior alveolar nerve
arises from anterior division of CN V3
descends infra temporal fossa and passes through mandibular fossa
gives of nerve to mylohyoid as a branch
what does the inferior alveolar nerve innervate
sensory: lower teeth and gums
motor: mylohyoid and anterior belly of digastric via nerve to mylohyoid
describe the course of the lingual nerve
posterior division of CNV3
descends infra temporal fossa
what is innervated by the lingual nerve
general sensory: anterior 2/3 tongue and oral cavity
carries special sensory to anterior 2/3 of tongue from cord tympani
innervation of buccal nerve
sensory to inside of cheek
what are the three parts of the maxillary artery
mandibular
pterygoid
pterygopalatine
what branches arise from the mandibular part of the maxillary artery
deep auricular and anterior tympanic arteries
middle meningeal
inferior alveolar (gives off mylohyoid artery)
where does the middle meningeal artery travel
through the foramen spinosum to reach the meninges
branches of the pterygoid part of maxillary artery
deep temporal X2
buccal branches
branches of pterygopalatine part of maxillary artery
posterior superior alveolar
infraorbital
anterior superior alveolar branches
palatine, pharyngeal and sphenoplatine branches
where its he pterygoid venous plexus
surrounds lateral pterygoid
which areas drain into the pterygoid venous plexus
veins from orbit, nasal and oral cavities
which vein drains the pterygoid venous plexus
maxillary vein
which other venous structures does the pterygoid venous plexus communicate with and why is this clinically relevant
cavernous sinus
facial vein
route for infection
which nerve carries parasympathetic fibres from chordates tympani to the tongue
lingual nerve of CN V3
what type of joint is the TMJ
synovial joint between head of mandible and mandibular fossa and articular tubercle on squamous part of temporal bone
what are the articular surfaces of the TMJ covered in
fibrocartilage
which nerves supply the TMJ
auriculotemporal and masseteric
which ligaments support the TMJ
lateral: tempormandibular ligament
medial: sphenomandibular and stylomandibular ligaments
what is the purpose of the articular disc of TMJ
increases congruity of articular surfaces and is involved in movements
head of mandible and disc: elevation and depression
disc and mandibular fossa/articular process: protrusion and retraction
describe movements of the disc/mandible duding opening of the mouth
depression and protrusion of both sides to slide disc and condyle forwards towards tubercle
describe movement of disc/mandible to close mouth
elevation and fracture pull condyle and disc backwards
the mastoid and styloid processes are features of which bone
temporal bone
what are the two parts of the temporal bone
petrous (strong, houses middle/inner ear)
squamous (thin)
where do the muscles of facial expression insert
into the skin
what is covered by the deep cervical fascia (in the face)
masseter is covered
invests parotid gland
where is frontalis
forehead
what is frontalis also known as and why
anterior belly of fronto-occipitalis
attached to occipitalis via aponeurosis which forms layer of scalp
which nerve innervates the muscles of facial expression
CN VII
action of frontalis
raises eyebrows
where is corrigator supercili
deep to frontalis
runs obliquely from lateral bridge of nose skin of medial eyebrow
action of corrigator supercilious
brings eyebrows together (eg frowning)
function of platysma
tenses skin of neck
where is procerus
over superior part of bridge of nose, between eyebrows
vertically orientated fibres
action of procerus
wrinkles top of nose, and eyebrows
where is nasalis
over bridge and nose and extends down alas of nose
transverse part = across bridge of nose
alar part = around alae
actions of nasalis
transverse part = wrinkles nose
alar part = flares nostrils
where is buccinator
deep to muscles of mastication
forms lateral wall of oral cavity
action of buccinator
aids chewing by pushing food towards teeth
which structure pierces buccinator
parotid duct
where is orbiculares oculi
around eye
function of orbicularis oculi
circular fibres contract around eye to tightly shit eyelid
where are zygomaticus major and minor
originate from maxilla and insert near corner of mouth
action of zygomaticus muscles
does little smirky Elvis face
where is orbicularis oris
around mouth
action of orbicularis oris
purses lips
where is levator labii superioris
lateral to nose, medial to zygomaticus muscles
action of levator labii superioris
raises upper lip
where is levator anguli superioris
deep to levator labii superioris, inserts to corner of mouth
action of levator anguli superioris
lifts corner of mouth
where is risorius
transverse fibres from ramus of mandible to corner of mouth
action of risorius
pulls corners of mouth out
where is levator labii superioris alaeque naise
runs from top of nose, down its sides to below nostrils
what does levator labii superioris alaequae nase do
flares nostrils and lifts top lip a bit
where is depressor anguli oris
attaches along lower border of mandible to corner of mouth
action of depressor anguli oris
pulls down corner of mouth
where is depressor labii inferiors
from anterior mandible to bottom lip
action of depressor labii inferiors
pulls down lower lip
where is mentalis
deep to depressor labii inferioris
action of mentalis
elevates and protrudes lower lip (pouting)
which muscles are innervated by the posterior auricular branches of facial n.
occipitalis
stylohyoid
posterior belly of digastric
which muscles are innervated by the temporal branches of facial n
frontalis
orbicularis oculi
which muscles are innervated by the zygomatic branch of facial nerve
orbicularis oculi
which muscles are innervated by the buccal branch of facial n.
zygomaticus major and minor levator labii superioris levator anguli oris buccinator orbicularis oris nasalis
which muscles are innervated by the marginal mandibular branch of facial nerve
depressor anguli oris
depressor labii oris
mentalis
which muscles are innervated by the cervical branch of facial nerve
platysma
describe the course of the facial artery
goes through anterior triangle of neck, around angle of mandible, courses superomedially across face towards inner eye
branches of the facial nerve
submental
superior and inferior labial
lateral nasal
angular
what are the layers of the scalp
skin connective tissue aponeurosis (between frontalis and occipitalis) loose areolar connective tissue periosteum (pericranium)
describe the blood supply of the scalp
supratrochlear (medial forehead)
supratrochlear (lateral forehead)
superficial temporal (temporal region, anterolateral scalp)
posterior auricular (posterolateral scalp, behind ear)
occipital (posterior scalp)
what are emissary veins
serve communication between superficial veins of the scalp (in connective tissue layer) and dural venous sinuses
what is the clinical significance of the emissary veins
possible route for infection to spread to intracranial structures
describe nerve supply to the scalp
supratrochlear and supraorbital: forehead and medial scalp (from anterior to posterior)
zygomaticotemporal: anterior temporal region
auriculotemporal: temporal region in front of ears
lesser occipital: behind ears
greater occipital: posterior scalp/occipital region
lobes of the brain
frontal temporal parietal occipital (cerebellum)
where is the longitudinal fissure
along the sagittal midline of the brain
splits it into 2 hemispheres
where is the lateral fissure
between the frontal/parietal and temporal lobes
where is the central sulcus
runs from longitudinal fissure to lateral fissure, dividing the frontal and parietal lobes
define:
sulcus
gyrus
fissure
gyrus = outward 'bump' of brain sulcus = inward 'groove' of brain fissure = deeper sulcus
which structure connects the two hemispheres
corpus callous (white matter tract)
where are the primary motor and sensory cortices
primary motor: anterior to central sulcus aka pre-central gyrus
somatosensory: posterior to central sulcus aka post-central gyrus
where is the auditory cortex
superior gyrus of temporal lobe, inferior to lateral fissure
where is Broca’s area
frontal lobe, above middle part of lateral fissure
what is the function of Broca’s area
motor part of speech
expressive, production of speech
where is werneke’s area
posterior aspect of lateral fissure
what is the function of werneke’s area
recognition of speech
understanding
where is the visual cortex
occipital lobe
what is connected by association tracts
between gyro of the same hemisphere
what is connected by commissural tracts/fibres
corresponding regions of different hemispheres
what is connected by projection fibres
cerebrum to thalamus/brainstem etc
what is the main action of the basal ganglia
regulate initiation and termination of body movements
also maybe involved in memory, planning and emotional response
what are the main parts of the basal ganglia
caudate nucleus
putamen
globus pallidum
substantia nigra
which structures make up the lenitform nucleus
globus pallidus and putamen
where are the basal ganglia located
deep in the bran
except substantia nigra which is in the brainstem
which structures does the substantia nigra communicate with
caudate nucleus and putamen
which structure do sub-thalamic nuclei communicate with
globus pallidus
what is the internal capsule
white matter pathway
which basal ganglia are separated by the internal capsule
putamen and globus pallidus (lentiform nucleus) separated from the caudate nucleus
what are the three areas of the diencephalon
thalamus
hypothalamus
pineal gland
function of the thalamus
sensory relay station
signals pass from spinal cord/midbrain through thalamus then to cerebral hemispheres
also motor pathways
function of the hypothalamus
regulation of autonomic nerve system and homeostasis (body temp, thirst etc)
production of hormones (connection to pituitary)
where is the pineal gland
posterior aspect of thalamus
function of pineal gland
produces melatonin to regulate body clock
contain habenular nucleus (olfaction and emotional response)
pineal gland aka
epithalamus
which cranial nerve originate from midbrain
CN III and CN IV
external features of midbrain
superior and inferior colliculi
what is the function of the superior colliculi
visual scanning, tracking
function of inferior colliculi
auditory startle reflex
which part of the basal ganglia is found in the midbrain
substantia nigra
function o substantia nigra
control of subconscious muscle action
where are the red nuclei located
what is their function
midbrain
coordinate muscle movement
function of pons
coordination and maximising voluntary motor output
pneumotaxic tract to control breathing
which cranial nerve originate from pas
CN V, VI, VII and vestibular part of CN VIII
functions of medulla
contains pyramids (motor tracts) CV centra (rate/force heartbeat and diameter of vessels) breathing centres sensory nuclei (touch, pressure, vibration) olives = proprioception
which CNs originate from medulla
CN IX, X, XI, XII and cochlear part of CN VIII
not spinal part of CN XI
where are the olives of the medulla
lateral to pyramids
what are the parts of the cerebellum
vermis (midline)
2 lobes
function of cerebellum
controls subconscious aspects of skeletal muscle movements and coordinates complex sequences
regulates posture and balance
how does the cerebellum communication with the rest of the brain
via peduncles
which cerebellar peduncles communicate with which bit of brain
superior: midbrain
middle: pons
inferior: medulla
what are the folds of the cerebellum called
folia
where is the pituitary gland located
connected to hypothalamus via pituitary stalk
sits in pituitary fossa beneath dural covering (sella turcica)
function of pituitary gland
produces hormones to regulate endocrine system
which arteries contribute to circle of willis
internal carotids basilar artery (vertebral arteries)
what are the main branches of the circle of willis
anterior cerebral (from internal carotids) middle cerebral (from internal carotids) posterior cerebral (from basilar)
how are the main bracnhes of the circle of willis connected
anterior communicating branch between anterior cerebral arteries
posterior communicating branches (x2) between posterior cerebral and internal carotids
where do the anterior cerebral arteries supply
frontal and parietal lobes
runs in longitudinal fissure
where do the middle cerebral arteries supply
temporal lobes
runs in lateral fissure
where do the posterior cerebral arteries supply
occipital lobe and base of brain
what other branches of the basilar artery are there
cerebellar, pontine and medullary branches
layers of the meninges
pia mater (covers neural tissue, run over/between sulci/gyri) arachnoid mater (middle layer, SAS is deep to it) dura mater (outer layer, fought connective sheath covering inside of skull)
what is the falx cerebri
fold of dura that lies between the cerebral hemispheres
what is carried in the falx cerebri
inferior sagittal venous dural sinus
where is the falx cerebelli
sits on top of the cerebellum
separates cerebellum from cerebrum
blood supply to the meninges
anterior meningeal: from ethmoid branch of ICA (anterior fossa)
middle meningeal: from maxillary artery (major vessel)
posterior meningeal: branch fo occipital artery (posterior fossa)
how does the middle meningeal artery enter the cranium
foramen spinosum
damage to the MMA leads to
extradural haematoma and compression of brain
what is the main nerve supply to the dura
trigeminal nerve
describe innervation of dura of anterior fossa
anterior meningeal of ethmoidal (CN V1): anterior, medial
meningeal branch of maxillary (CN V2): middle part of anterior fossa/bit of middle fossa
meningeal branch of mandibular (CN V3): most of middle fossa + lateral edge of anterior fossa
describe innervation of dura of middle fossa
mostly meningeal branches of mandibular nerve CNV3
describe innervation of dura of falx cerebelli
tentorial nerve (recurrent meningeal branch of ophthalmic nerve, CN V1)
describe innervation of dura of posterior fossa
fibres of C2,3
some distributed by CN XII/X
what is the function of the dural venous sinuses
act as veins of the meninges and brain
how are the dural venous sinuses related to spread of infection
connection between the cavernous venous sinus, pterygoid venous plexus, ophthalmic veins and facial veins allow spread of bacteria from superficial veins to venous sinuses
where do the dural venous sinuses drain to
internal jugular vein
how are the dural venous sinuses formed
between periosteum of skull and dura (eg sigmoid sinus)
between two layers of dura (inferior sagittal sinus)
describe flow of CSF though the ventricles
lateral ventricles through inter ventricular foramina of monro third ventricle cerebral aqueduct 4th ventricles lateral and median apertures SAS/central canal of spinal cord
where is CSF made
ependymal cells of choroid plexus
how is CSF drained
arachnoid granulations to the dural venous sinuses
what is the purpose of CSF
mechanical and physical protection of the brain and spinal cord
how does the frontal bone contribute to the borders of the bony orbit
roof, parts of medial and lateral
what other features of the orbit are on the frontal bone and what are their function
supraorbital ridges: protects orbit from direct trauma
supraorbital notch: passage of supraorbital nerve and artery
how does the anterior orientation of the orbit affect the field of view
allows eyes to face more forward and allows overlap of field of view
can compare each visual field to create depth perception
how does the zygoma contribute to the borders of the bony orbit
lateral wall
how does the maxilla contribute to the borders of the bony orbit
forms the floor of the orbit
which foramen passes through the maxilla (associated with the orbit)
and what structures pass through
infraorbital foramen
infraorbital branch of CN V2 passes through it
how does the lacrimal bone contribute to the bony orbit
associated with the lacrimal apparatus and nasolacrimal duct that carries excess lacrimal fluid into the nasal cavity
how does the ethmoid bone contribute to the bony orbit
forms part of medial wall and contributes to nasal cavities
how does the sphenoid bone contribute to the bony orbit
forms optic canal and superior orbital fissure
contributes to inferior orbital fissure
what structures support the eye
tarsal plates orbital septum palpebral ligament check ligaments suspensory ligaments
what are the tarsal plates and what is their function
dense connective tissue plates that support the eyelid
contain glands that release oily and watery secretions to lubricate surface of eye
where is the orbital septum found and what is it made of
deep to skin and orbicularis oculi
strong connective tissue
where are the palpebral ligaments and what is their function
medial and lateral palpebral ligaments at corners of eye
support corners of eye
where are the check ligaments found and what is their function
close to insertion of medial and lateral rectus muscles
restrict movements of extra ocular muscles
where is the suspensory ligament found int he orbit and what is its function
creates a hammocky band under the eyeball
supports position of eyeball
what are the three layers of the orbit
outer fibrous layer
middle vascular layer
inner photoreceptive layer
what structures make up the outer layer of the eye
cornea (anteriorly, over iris and pupil)
sclera (white part of eye)
what structures make up the middle vascular layer of the eye
iris
ciliary body
choroid (blood vessels)
what makes up the inner layer of the eye
retina contains photoreceptors (rods and cones)
what are some features of the retina
optic disc = point optic nerve leaves retina (no rods or cones = blind spot)
macula = area rich in rods and cones (fovea in centre)
where is the anterior chamber of the eye and what is it filled with
space between lens and cornea
aqueous humour
where is aqueous humour of the anterior chamber produced, and how is it removed
ciliary body
recycled into veins at the junctions of the cornea and sclera
where is the posterior chamber of the eye and what is it filled with
posterior to the lens vitreous humour (gel-like)
what is the function of the vitreous humour
supports retina by pressing it up against the choroid
choroid contains blood vessels so helps prevent damage to them
what are the intraocular muscles of the eye
dilator pupillae
sphincter pupillae
ciliary muscles
describe dilator pupillae (attachments, action, innervation)
small radial fibres attaching from edge of pupil to outer margin of iris
contraction to pull iris out and increase diameter of pupil
sympathetic
describe sphincter pupillae (attachments, action, innervation)
circular fibres around edge of pupil
contraction narrows the pupil
parasympathetic fibres from CN III
how is the ciliary muscle attached to the lens
circular fibres around lens, attached by radial fibres
describe the effect of relaxation of the ciliary muscle
when muscle is relaxed, the distance between the muscle and lens is greatest, so the fibres between them are taut
this pulls the edges of the lens out, making it flat and wide
describe the effect of contraction of the ciliary muscle
when muscle contracts, the distance between the lens and the muscle decreases so the fibres are relaxed
due to internal pressure, lens becomes more spherical
how does the shape of the lens affect vision
shape of lens changes how light is refracted and focused on the retina
flat lens is better for distance vision
round lens better for close up
innervation of the ciliary muscle
parasympathetic via CN III
what are the extra ocular muscles
levator palpebrae superioris
superior, inferior, medial and lateral rectus
superior and inferior oblique
what is the equator of the eye and how does it affect the action of the extra ocular muscles
its a circle around the diameter of the eye in the coronal plane
muscles attaching anterior to the equator pull the eye in its expected direction
muscles posterior to it pull it in the opposite direction (eg inferior oblique elevates the eye)
describe levator palpebrae superioris (attachments, action, innervation)
roof of orbit to upper eyelid
raises upper eyelid
CN III
describe superior rectus (attachments, action, innervation)
annular ring to superior sclera, anterior to equator
elevates, adducts, intorts eye
CN III
describe medial rectus (attachments, action, innervation)
annular ring to medial sclera, anterior to equator
adducts eye
CN III
describe lateral rectus (attachments, action, innervation)
annular ring to lateral sclera, anterior to equator
abducts eye
CN VI
describe inferior rectus (attachments, action, innervation)
annular ring to inferior sclera, anterior to equator
depresses, extorts and adducts eye
CN III
describe inferior oblique (attachments, action, innervation)
floor of orbit to inferior sclera, posterior to equator
elevates, extorts and abducts eye
CN III
describe superior oblique (attachments, action, innervation)
lesser wing of sphenoid to superior sclera, posterior to equator (via trochlea)
depresses, intorts and abducts eye
CN IV
what is the annular ring
common insertion for rectus muscles
what mnemonic helps remember the actions of extra ocular muscles
RADSIN Rectus Adducts (apart from lateral rectus) Superior Intorts (inferior extorts)
describe the course of the optic nerve
enters cranial cavity in the optic canal (sphenoid bone)
nasal fibres cross over above pituitary fossa to form chiasm
optic tracts extend posteriorly to lateral geniculate nucleus (thalamus)
optic radiations travel to primary visual cortex (occipital lobe)
what is the purpose of association areas in the visual cortex
give images context
which nerves pass through the superior orbital fissure
CN III, CN IV, CN V1 and CN VI
describe the course of cranial nerves through the cavernous sinus
CN III, CN IV and CN V1 pass close to lateral wall
CN VI passes through middle with internal carotid artery
which nerves pass through the annular ring and which dont
frontal, lacrimal (CN V1) and CN IV DO NOT
CN III, rest of CN V1 and CN VI DO PASS
how does CN V1 leave skull
superior orbital fissure
which branches of CN V1 is most easily visualised and what are its branches
frontal branch
divides into supraorbital and supratrochlear which leave via supraorbital notch
what are the branches of CN V1
frontal: lies superior to extraocular muscles
nasociliary: passes through ethmoid bone to supply nasal cavities
lacrimal: travels to lacrimal gland
what are the divisions of the CN III
superior: LPS and SR
inferior: MR, IR, IO and parasympathetic fibres
how do parasympathetic fibres of CN III reach the ciliary muscles
travel in inferior division to ciliary ganglion
then via short ciliary nerves
what is the main blood supply of the orbit and where is its origin
ophthalmic artery
ICA
enters in optic canal
branches of the ophthalmic artery
forehead and scalp: supraorbital, supratrochelar and zygomaticotemproal
nose: dorsal nasal and. ethmoidal
describe venous drainage of the orbit
superior ophthalmic vein drains to cavernous sinus
inferior ophthalmic vein drains to pterygoid venus plexus
communicated via the inferior orbital fissure with the facial vein = spread of infection
what is the puropse of the lacrimal gland
secretes thin watery fluid to lubricate surface of eye and remove debris
where is the lacrimal gland
lateral edge of orbit
how is lacrimal fluid drained from eye
tears wash across surface of eye and gathered though lacrimal punctum into the lacrimal canaliculi
drains via lacrimal sac to inferior meatus of nose via nasolacrimal duct
innervation of the lacrimal gland
parasympathetic secretomotor fibres from CN VII via CN V1 and CN V2
facial nerve branches to form greater petrosal nerve carrying parasympathetic fibres
joins deep petrosal nerve (sympathetic fibres from internal carotid plexus) to form nerve of pterygoid canal
passes to pterygopalatine ganglion to join CN V2 (zygomatic branch) which joins the lacrimal nerve (CN V1) to reach lacrimal gland
which muscles of facial expression overlie the nose
nasalis
levator labii superioris alaeque nasi
procerus (superior bridge)
what are the named bits of nasal cartialge
septal cartilage separates nasal cavities
alar cartialge makes up nostrils
blood supply of the external nose
anterior and posterior ethmoidal (ophthalmic)
sphenopalatine and greater palatine (maxillary)
septal branches of labial artery (facial)
lateral nasal (facial)
nerve supply of external nose (skin of nose)
bridge: CN V (infratrochlear and anterior ethmoidal)
alae: CN V2 (nasal branches of infraorbital)
what structures make up the nasal septum
cartilage anteriorly
perpendicular plate of ethmoid superiorly
vomer inferiorly
sphenoid posteriorly
palatine and maxilla contributes to nferior part
which bones make up the lateral wall of nasal cavity
maxilla, sphenoid, ethmoid, frontal
which bones make up the conchae
ethmoid: superior and middle
inferior concha is separate bone
describe passage of air through the nasal cavity
in nostrils to vestibule of nose
air passes between conchae/meati towards choanae to nasopharynx
what is the choanae
posterior part of nasal canal, at entrance of nasopharynx
the opening of which structure is found in the nasopharynx and what is its purpose
(related to ear)
auditory tube
leads to middle ear and allows passage of air to equalise pressure on either side of the tympanic membrane
what is the purpose of the conchae
create air turbulence, which swirls air around the nasal cavity and helps to warm it
what is the nasal cavity lined with
respiratory epithelium
olfactory epilthelium in roof
what are features of respiratory epithelium
has cili and produces mucous to trap airborne particles and filter air
what are the spaces underneath the conchae called
meatus
what is the sphenoethmoidal recess
space above the superior concha
where are the paranasal sinuses found
frontal
maxillary
ethmoid
sphenoids
what is the function of the paranasal sinuses
makes head lighter so is easier to balance on top of VC
can absorb force from direct trauma to help protect cranial cavity
describe the paranasal sinuses
frontal: may be 2 separate cavities or 1 large one
sphenoid: in body of sphenoid bone
maxillary: either side of nasal cavities
ethmoid: made up of many small air cells instead of 1 large space
what can be visualised if the conchae are removed
openings of the paranasal sinuses and nasolacrimal duct
where does the nasolacrimal duct open into
inferior meatus
where do the sinuses open into
frontal: middle meatus anterior and middle ethmoidal: middle meatus maxillary: middle meatus posterior ethmoidal: superior meatus sphenoidal: sphenoethmoidal recess
innervation of the paranasal sinuses
frontal: supraorbital CN V1
all ethmoidal: nasociliary CN V1
maxillary: superior alveolar CN V2
sphenoidal: posterior ethmoidal CN V1
how does sinusitis occur
sinuses create mucous which can become backed up if the openings to the nasal cavity are blocked by inflammation
blood supply of the lateral wall of nasal cavity
anterior and posterior ethmoidal branches (ophthalmic)
sphenopalatine (maxillary)
lateral nasal (facial)
greater palatine (maxillary
blood supply to medial wall of nasal cavity
anterior and posteiror ethmoidal (ophthalmic)
sphenopalatine and greater palatine (maxillary)
septal branch of superio labial artery (facial)
what is Kiesselbach’s area
area of anastomosis in the medial wall of nasal cavity (septum)
nerve supply of nasal cavities
anterosuperior: CN V1
posteroinferior: CN V2
olfactory mucosa: CN V1
describe venous drainage of the nasal cavities
facial, sphenopalatine and ophthalmic viens
communicates with pterygoid plexus and cavernous sinus
what is a frenulum
fold of tissue attaching upper lip and under tongue
what are the names of the arch of the oral cavity
palatoglossal arch (anterior) palatopharyngeal arch (posterior)
what is found in the space between the arches of the oral cavity
palatine tonsil
what is the fauces
opening of the oral cavity aka mouth
lateral wall of the oral cavity
buccinator
what makes up the floor of the oral cavity
mylohyoid
digastric below
geniohyoid above
describe mylohyoid (attachments, innervation and action)
hyoid line of mandible to hyoid bone
mylohyoid branch CN V3
elevates the hyoid and oral floor OR depresses the mandible
describe anterior belly of digastric (attachments, innervation and action)
digastric fossa of mandible to hyoid via fibrous sling
mylohyoid branch CN V3
elevate hyoid or depress mandible
describe stylohyoid (attachments, innervation and action)
styloid process to hyoid bone
facial nerve CN VII
elevates hyoid
describe posterior belly of digastric (attachments, innervation and action)
mastoid process to hyoid bone via fibrous sling
facial nerve CN VII
describe geniohyoid (attachments, innervation and action)
inferior genial tubercle of mandible to hyoid bone
C1 carried by hypoglossal nerve
elevates hyoid bone
where does the parotid duct open
at upper second molar
innervation of parotid duct
CN IX parasympathetic fibres
where is the submandibular gland
outer part posterior to mandible, inner part crosses hylohyoid to lie in floor of the mouth
where does the submandibular duct open in the oral cavity
opens between 1st and 2nd incisors either side of the frenulum
where is the sublingual gland
entirely in the floor of the mouth
under the tongue
where does the sublingual gland open
many small ducts that open directly into the floor of the mouth
what are the vallate papillae
largest papillae (detect taste) form a line 2/3 of the way along tongue
describe the surface of the posterior tongue
why is it like this
bumpy appearance
presence of lingual tonsil
innervation of the anterior 2/3 of tongue
general sensation from lingual nerve CN V3
taste from chorda tympani CN VII via lingual nerve CN V3
where does chorda tympani meet the lingual nerve
infra temporal fossa
innervation of posterior 1/3 of tongue
general sensory and taste from CN IX
what is the function of the intrinsic muscles of the tongue
how are they oriented
change the shape of the tongue
fibres in different orientations, but all within the tongue
what are the extrinsic muscles of the tongue
what are their general function
palatoglossus, styloglossus, genioglossus, hyoglossus
change position of tongue in mouth
originate in oral cavity and insert into mouth
describe palatoglossus (attachments, innervation and action)
palatine aponeurosis to tongue
CN X
elevates tongue, moves soft palate
describe styloglossus (attachments, innervation and action)
styloid process to tongue
CN XII
elevates and retracts tongue
describe genioglossus (attachments, innervation and action)
superior genial tubercle of mandible to tongue
CN XII
depresses tongue, protrude
describe hyoplgossus
attachments, innervation and action
hyoid bone to tongue
CN XII
depress tongue
blood supply of the tongue
what is its course
via lingual artery (branch of external carotid artery)
arises from ECA, is crossed by hypoglossal nerve, passes under hyoglossus and enters floor of mouth
venous drainage of the tongue
lingual vein to internal jugular
dorsal, deep and sublingual branches
what is the course of the hypoglossal nerve
passes from hypoglossal canal at the base of the skull and passes over hyoglossus but under mylohyoid to enter the floor of mouth
describe lymph drainage of the tongue
tip: submental nodes
lateral edges: submandibular nodes
central/posterior: deep cervical
which bones make up the hard palate
mostly maxilla
palatine bones contribute posteriorly
features of the hard palate
glands embedded in mucosa (produce mucus)
rugae at anterior part of hard palate
palatine raphe in midline
innervation of the mucus glands of hard palate
CN VII
innervation of hard palate
greater palatine nerve
branch of CN V2
descends in palatine canal and enter greater palatine foramen
arterial supply of the hard palate
greater palatine artery (branch of maxillary artery)
descends in palatine canal to enter palate via greater palatine foramen
what is the soft palate
muscular core covered in mucous lining hanging from posterior border of hard palate
what is the palatine aponeurosis
what is its function
tough connective tissue attaching soft palate to hard palate
strengthens soft palate and site of muscle attachment
how many muscles are associated with the sfot palate
what are they
5 palatoglossus palatopharyngeus levator veli palatini tensor veli palatini musculus uvulae
describe levator veli palatini (attachments, innervation and action)
petrous temporal bone and cartilage of auditory tube to palatine aponeurosis
CN X
raises soft palate
musculus uvuluae
attachments, innervation and action
palatine bone to palatine aponeurosis
CN X
elevates/retracts uvula
palatoglossus (attachments, innervation and action)
palatine aponeurosis to tongue
CN X
elevates tongue/closes oropharynx
forms anterior arch of oral cavity
palatopharyngeus (attachments, innervation and action)
wall of pharynx to palatine aponeurosis
CN X
elevates pharynx and moves pharyngeal wall towards soft palate
forms posterior arch in oral cavity
tensor veli palatini (attachments, innervation and action)
cartilage of auditory tube, wraps a tendon around pterygoid hamulus to palatine aponeurosis
CN V3
tenses soft palate
blood and nerves supply of soft palate
lesser palatine branches of greater palatine artery/nerve
uvula sensroy innervation by CN IX
how does the facial nerve innervate the mucus glands of the palate
sends fibres to pterygopalatine ganglion (via greater petrosal nerve) which joins CN V2 to supply glands
how do missing teeth affect the bony structure of the face
alveolar bone that supported the tooth is resorbed
how many permanent teeth
32
innervation of teeth
top teeth: CN V2 superior alveolar branches
bottom teeth: CN V3 inferior alveolar branches
blood supply of teeth
anterior and posterior alveolar
inferior alveolar
branches of maxillary artery
where is the pharynx located
runs from the base of skull to the oesophagus C6
posterior to nasal and oral cavities and larynx
what are the layers of the pharynx
mucosa
fibrous layer
muscular layer
where is the fibrous layer connected
base of skull and submucosal layer of oesophagus
what are the divisions of the pharynx and where are they located
nasopharynx: posterior to nasal cavities, above soft palate
oropharynx: posterior to oral cavity, between soft palate and epiglottis
laryngopharynx: posterior to larynx, meet oesophagus at C6
borders of the nasopharynx
roof: sphenoid and occipital bone, pharyngeal tonsil
floor: soft palate
anterior: nasal passages
posterior: roof and C1 level
lateral: auditory tube, salpingoparyngeal fold
borders of the oropharynx
roof: soft palate
floor: posterior 1/3 tongue, lingual tonsil, glossoepiglottic folds
anterior: motuh
posterior: C2/3 level
lateral: palatoglossal and palatopharyngeal arches and palatine tonsil
borders of the laryngopharynx
anterior: larynx
posterior: C3-6 vertebral bodies
lateral: thyroid cartilage, aryepiglottic flods and thyrohyoid membrane
what are the two subdivisions of pharyngeal muscles
constrictors (x3) and longitudinal muscles (x3)
describe superior constrictor muscle (attachments, action and innervation)
lower medial pterygoid plate, hamulus, pterygomandibular ligament, mandible, side of tongue TO pharyngeal tubercle of occipital bone, fibrous raphe and middle constrictor
push food towards middle constrictor and upper fibres pull pharynx anteriorly to close nasopharynx
vagus nerve via pharyngeal plexus
describe middle constrictor
attachments, action and innervation
lower part of stylohyoid ligament, hyoid bone TO raphe and blend with other constrictors
propel food to lower constrictor
vagus via pharyngeal plexus
describe inferior constrictor
attachments, action and innervation
lamin of thyroid and cricoid cartilages TO raphe and middle onstrictor/oesophagus
propel food to oesophagus
vagus nerve via phasryngeal plexus
what are the two parts of inferior constrictor
thyropharyngeus = fibres that pass to midline cricopharynxgeus = circular fibres at inferior part (act a bit like a sphincter)
what are the longitudinal muscles of pharynx
stylopharyngeus
salpingopharyngeus
palatopharyngeus
describe stylopharyngess (attachments, action and innervation)
styloid TO thyroid cartilage
elevates larynx and pharynx in swallowing
CN IX
describe salpingopharyngeus (attachments, action and innervation)
cartialge of auditory tube TO palatopharyngeus
elevates pharynx and forms lateral wall of nasopharynx
vagus via pharyngeal plexus
describe palatopharyngeus (attachments, action and innervation)
hard palate and palatine aponeurosis TO lamina of thyroid cartilage
elevates pharynx and forms lateral wall of oropharynx
vagus nerve via pharyngeal plexus
describe the movements of soft palate/pharynx etc involved in swallowing
food moulded by togue/hard palate and pushed to back of mouth
soft palate raised and pharynx elevates to keep food away from nasopharynx
larynx raised and epiglottis passively bends over opening to larynx
aryepiglottic folds move toether to ensure food doesnt go down larynx
peristalsis
course of recurrent laryngeal nerve in pharynx
travels between oesophagus and trachea and then passes deep to inferior constrictor of pharynx
which nerve runs alongside stylopharyngeus
CN IX
what is the innervation of the lymphoid tissue associated with each region of the pharynx
nasopharynx: CN V2
oropharynx: CN IX
laryngopharynx: CN X
which nerves are involved in the pharyngeal plexus
CN IX and CN X fibres supply he pharynx
cranial part of CN XI joins and supply soft palate via vagus nerve
arterial supply of pharynx
greater palatine and pharyngeal branches of maxillary artery
ascending pharyngeal branches of facial
ascending pharyngeal branches of external carotid
venous drainage of pharynx
pharyngeal plexus to internal jugular vein
lymphatic drainage of pharynx
retropharygneal and paratracheal nodes
deep cervical nodes
were are prevertebral structures located and what are they
posterior to pharynx, anterior to vertebrae
muscles and sympathetic ganglia
what are the prevertebral muscles
longus capitis
longus colli
rectus capitis anterior
rectus capitis lateralis
describe longus capitis
attachments, action and innervation
transverse processes of C3-6 to base of occipital bone
flexion of head
anterior rami C1-3
what are the parts of longus colli and what are their attachments
inferior oblique: T2-3 bodies TO anterior tubercle of transverse processes C5/6
superior oblique: anterior tubercle C3-5 to anterior tubercle of atlas
vertical: anterior aspect T1-3 to C4-6
describe longus colli (attachments, action and innervation)
atlas to T3
flexion of neck
contrlateral rotation by inferior obliue part
anterior rami C2-6
describe rectus capitis anterior
attachments, action and innervation
anterior sruface and root of transverse processes of atlas to occipital bone
flexion of atlanto-occipital joint
anterior rami C1-2
describe rectus capitis lateralis (attachments, action and innervation)
transverse process of atlas to occipital bone
lateral flexion of head
anterior rami C1-2
where are the cervical sympathetic ganglia found
embedded in deep fascia between carotid sheath and fascia over longus capitis and longus colli
describe superior cervical ganglia
large, immediately below skull
C1-4
internal carotid nerve to internal carotid plexus
pharyngeal branches to pharyngeal plexus
superior cardiac branch to cardiac pelxus
describe middle cervical glanlgion
level of cricoid cartilage
C5/6
thyroid branches along inferior thyroid artery to gland
middle cardiac branch to cardiac pelxus
describe inferior cervical ganglion
usually fused with 1st thoracic ganglion (stellate ganglion)
behind vertebral artery between C7 TP and head of 1st rib
C7/8
arterial branches to subclavian nand vertebral arteries
inferior cardiac branch to cardiac plexus
what is the ansa subclavia
nerve cord connecting the middle and inferior cervical sympathetic ganglia
loops around subclavian artery
