Head and Neck Anatomy (5-6) Flashcards
State the structures in the mouth.
Name the 2 folds and 2 muscles in the oral cavity
State the location where fish bones are prone to piercing.
Does the posterior 1/3 of tongue make up this location?
- Vallecula = an anatomical depression located at the base of the tongue, just anterior to the epiglottis
- Pyriform recess at lateral wall of laryngopharynx
No, the posterior 1/3 does not contribute to this location.
State the structures of the tongue
Important:
- circumvillate papillae (TASTE BUDS) = anterior to terminal sulcus
- fungiform papillae = lateral aspect of anterior 2/3 of tongue
- filliform papillae = medial aspect of anterior 2/3 of tongue
- terminal slulcus
Recap: State the cranial nerves that supply tongue and its muscles
TONGUE
(1) SOMATOSENSORY
- anterior 2/3 of tongue = CN V (lingual N -V3)
- posterior 1/3 of tongue = CN IX
(2) SPECIAL SENSORY (TASTE)
- anterior 2/3 of tongue = CN VII (chorda tympani)
- posterior 1/3 of tongue = CN IX
(3) SOMATOMOTOR
- somatomotor = palatoglossus (along with mucles of pharynx except stylopharyngeus, muscles of larynx, muscles of palate except tensor tympani) (pharyngeal branch - CN X)
- somatomotor = all muscles of tongue (CN XII)
State the 4 extrinsic muscles of the tongue. State their actions, origin and insertion and motor supply.
(1) PALATOGLOSSUS
- elevation
- soft palate –> tongue
(2) GENIOGLOSSUS
- protrusion
- genioid tubercle (mandible) –> tongue
(3) HYOGLOSSUS
- depression
- hyoid bone –> tongue
(4) STYLOGLOSSUS
- retraction
- styloid process –> tongue
ALL tongue muscles are supplied by CN XII except palatoglossus which is supplied by CN X.
State the presentation of hemiparesis of genioglossus muscle
Deviation of tongue towards the paralysed side
State the blood supply/drainage and innervation to the muscles of tongue and mucosa of tongue.
MUSCLES OF TONGUE
Blood supply = lingual A + ascending pharyngeal A (branches of ECA)
Blood drainage = lingual V (branch of IJV)
Innervation = All muscles of tongue except palatoglossus innervated by CN XII (hypoglossal N), palatoglossus innervated by CN X (vagus N)
TONGUE
Blood supply = lingual A + ascending pharyngeal A (branches of ECA)
Innervation = anterior 2/3 (CN V -V3 lingual N), anterior 2/3 (CN VII - chorda tympani), posterior 1/3 of tongue (CN IX)
Mucosa = NKSSE (non-keratinised stratified squamous epithelium)
State the location of the soft and hard palates.
State the structures underlying the palates.
SOFT PALATE:
- location = posterior 1/3 (oropharynx)
- bones and muscles underlying
HARD PALATE:
- location = anterior 2/3 (oral cavity proper)
- bones underlying only
State the structure that separates the oral cavity proper and oropharynx. State the boundaries of this structure
OROPHARYNGEAL ISTHMUS
- laterally - palatoglossal folds
- inferiorly - posterior 1/3 of tongue
- superficially - soft palate
With regard to HARD PALATE and SOFT PALATE, state the
(1) Fossa
(2) Arteries, Veins, Nerves supplying
HARD PALATE
(1) INCISIVE FOSSA - nasopalatine N + sphenopalatine A (branch of maxillary A - branch of ECA)
(2) GREATER PALATINE FORAMEN - greater palatine N + greater palatine A
SOFT PALATE
(1) LESSER PALATINE FORAMEN - lesser palatine N + lesser palatine A
(2) Facial A (branch of ECA) –> ascending palatine A
(3) Ascending pharyngeal A (branch of ECA) –> palatine A
State the 5 muscles of the soft palate. State their functions.
- tensor veli palatini - tenses soft palate
- levator veli palatini - elevate soft palate
- palatopharyngeus - elevates pharynx if soft palate fixed, depresses soft palate if pharynx is fixed
- palatoglossus - elevates tongue if soft palate fixed, depresses soft palate if tongue is fixed
- musculus uvulae
ALL muscles of the palate are supplied by CN X (vagus N) except tensor veli palatini which is supplied by CN V since it is derived from 1st pharyngeal arch
Recall the location of submandibular and sublingual glands with respect to the mylohyoid.
Submandibular gland - hooks around mylohyoid
Sublingual gland - anterior to mylohyoid (mylohyoid forms the floor of the oral cavity)
State the 2 branches of V3 division of trigeminal N that splits in ____.
State the supply of the 2 branches.
State any further branches of the nerves.
V3 (mandibular) division of trigeminal N splits into 2 branches at infratemporal fossa
(1) INFERIOR ALVEOLAR N - supplies mandibular teeth and gingiva & nerve to mylohyoid (supplies mylohyoid + anterior belly of digastric muscle)
(2) LINGUAL N - supplies somatosensory innervation of anterior 2/3 of tongue
____ ____ of CN____ hitchhikes onto ____ nerve of CN ____
- Parasympathetic component of ____ ____ synapses onto ____ ganglion to supply the ____ and ____ glands
CHORDA TYMPANI of CN7 hitchhikes onto LINGUAL nerve of CN5
- Parasympathetic component of CHORDA TYMPANI synapses onto SUBMANDIBULAR ganglion to supply the SUBMANDIBULAR and SUBLINGUAL glands
Match each histological slide to
(1) Submandibular, (2) Sublingual, (3) Parotid gland
With reference to the TMJ (temporomandibular joint), state the
(1) Articulation
(2) Posterior relations
(3) Type of joint
With reference to the TMJ (temporomandibular joint), state the
(1) Articulation = Head of the mandible + mandibular fossa of the temporal bone + articular tubercle of temporal bone
(2) Posterior relations = external acoustic meatus, stylomastoid foramen, mastoid process, styloid process
(3) Type of joint = modified hinge-type synovial joint (covered by fibrocartilage instead of hualine cartilage as in a typical synovial joint)
Name the 2 structures that run through the mandibular foramen
- inferior alveolar N (branch of V3)
- inferior alveolar A
State the 2 structures that attach to genioid tubercles
- genioglossus
- geniohyoid
State the direct and indirect ligaments of the TMJ (temporomandibular joint).
Direct = lateral ligament and capsule
Indirect = stylomandibular (thickening of fibrous capsule of parotid gland) and sphenomandibular ligaments (runs from spine of sphenoid to lingula of mandible)
State the muscles involved in protrusion and retraction of mandible.
PROTRUSION
- lateral pterygoid
RETRACTION
- posterior fibres of temporalis
- deep part of masseter
- geniohyoid
- digastric muscles
State the muscles involved in elevation and depression of the mandible.
ELEVATION
- anterior fibres of temporalis
- masseter
- medial pterygoid
DEPRESSION
- gravity
- digastric muscles
- geniohyoid
- mylohyoid
- lateral pterygoid (jaya says main??)
State the muscles involved in protrusion, retraction, elevation and depression of mandible.
PROTRUSION
- lateral pterygoid
- medial pterygoid
RETRACTION
- posterior fibres of temporalis
- deep part of masseter
- geniohyoid
- digastric
ELEVATION
- anterior fibres of temporalis
- masseter
- medial pterygoid
DEPRESSION
- gravity
- geniohyoid
- mylohyoid
- digastric muscles
- lateral pterygoid (?? jaya says main muscle)
MUSCLES OF MASTICATION:
- ____ gland lies on ____, ____ gland pierces ____ in front of ____
- ____ pterygoid is attached to the ____ surface of ____ pterygoid ____
- ____ pterygoid is attached to the ____ surface of ____ pterygoid ____
- ____ fibres converge and attach to the ____ process of mandible
MUSCLES OF MASTICATION:
- PAROTID gland lies on MASSETER, PAROTID gland pierces BUCCINATOR in front of MASSETER
- LATERAL pterygoid is attached to the LATERAL surface of LATERAL pterygoid PLATE
- MEDIAL pterygoid is attached to the MEDIAL surface of LATERAL pterygoid PLATE
- TEMPORALIS fibres converge and attach to the CORONOID process of mandible
State the 4 branches of maxilary A that supply the oral cavity.
Maxillary A is a branch of ECA.
1. sphenopalatine A
2. greater palatine A
3. lesser palatine A
4. inferior alveolar A
State the 3 structures that pass through the parotid gland
- facial N (CN VII) - temporal, zygomatic, buccal, marginal mandibular, cervical
- retromandibular V
- ECA (branches into 8 branches only in parotid gland)
State the sensory and secretomotor innervation of the parotid gland
Sensory = auriculotemporal N (mandibular nerve (V3))
Secretomotor = salivatory ganglion –> otic ganglion –> parotid gland
State the contents of the pterygopalatine fossa
(1) Veins
(2) Nerves
(3) Arteries
PTERYGOPALATINE FOSSA
(1) Veins - pterygoid plexus of veins –> drains into cavernous sinus via emissary veins (risk of infection)
(2) Nerves - Pterygopalatine ganglion of lacrimal nucleus (CN7) + V2 of Trigeminal nerve exits from the foramen rotundum in the cranial cavity → Pterygopalatine fossa
(3) Arteries - sphenopalatine artery + Maxillary artery starts at the infra temporal fossa → then enters the pterygopalatine fossa
State the epithelium of nasopharynx, oropharynx and laryngopharynx.
nasopharynx = respiratory epithelium (pseudostratified ciliated columnar epithelium)
oropharynx = stratified squamous epithelium
laryngopharynx = stratified squamous epithelium
State the 3 openings of the pharynx.
State their sensory innervation
nasopharynx (CN V2) = posterior nasal aperture
oropharynx (CN IX) = oropharyngeal isthmus
laryngopharynx (CN X) = laryngeal inlet
State the stuctures that make up the WALDEYER’S RING
WALDEYER’S RING
1. palatine tonsils
2. pharyngeal tonsils
3. lingual tonsils
NASOPHARYNX
- runs from ____ nasal ____ to ____ ____
- ____ veli palatini runs from ____ ____ to ____ ____
NASOPHARYNX
- runs from POSTERIOR nasal APERTURE to SOFT PALATE
- LEVATOR veli palatini runs from SOFT PALATE to EUSTACHIAN TUBE
OROPHARYNX
- Runs from ____ ____ to upper end of ____
- Recap: State the structure that separates the oral cavity proper and the oropharynx
OROPHARYNX
- Runs from SOFT PALATE to upper end of EPIGLOTTIS
- Structure = oropharyngeal isthmus (laterally bounded by palatoglossal fold, superiorly bounded by soft palate, inferiorly bounded by posterior 1/3 of tongue)
State the 4 components of closure of oropharyngeal isthmus
- medial and downward movement of palatoglossal arches
- medial and downward movement of palatopharyngeal arches
- upward movement of tongue
- downward and forward movement of soft palate
State the 2 groups of muscles of the pharynx
LONGITUDINAL (SSP)
- salpingopharyngeus (from eustachian tube)
- stylopharyngeus (from styloid process)
- palatopharyngeus (from soft palate)
CONSTRICTOR/SPHINCTER
- superior, middle and inferior
With regard to longitudinal muscles, state their
(1) function
(2) motor supply
(3) blood supply
LONGITUDINAL MUSCLES (salpingopharyngeus, stylopharyngeus, palatopharyngeus)
(1) function = shorten and widens pharynx
(2) motor supply = ALL supplied by CN X except stylopharyngeus (CN IX)
(3) blood supply = pharyngeal branches from ECA and branches from lingual and facial artery
With reference to the larynx, state the
(1) Borders
(2) Lining epithelium
(3) Spaces + Folds
LARYNX
(1) Borders - from upper border of epiglottis to lower border of cricoid cartilage
(2) Lining epithelium - respiratory epithelium (pseudostratified ciliated columnar epithelium)
(3) Spaces + Folds - vestibular & vocal folds, rima vestibule (space between vestibular folds), rima glottidis (space between vocal folds)
Are the vocal folds and vestibular folds covered by epithelium? What kind of epithelium if they are covered?
vocal folds - SSNKE (stratified squamous non-keratinised epithelium)
vestibular folds - PCCE (pseudostratified ciliated columnar epithelium)
Name the unpaired and paired cartilages of the larynx
UNPAIRED - epiglottis, thyroid, cricoid
PAIRED - arytenoid, corniculate, cuneiform
Name and locate the laryngeal cartilages.
Name the intrinsic muscles of the larynx.
Hint: Draw table with thyroid, cricoid, epiglottis and arytenoid.
INTRINSIC MUSCLES OF THE LARYNX:
Thyroid - cricothyroid, thyroepiglottis, thyroarytenoid, vocalis
Cricoid - cricoarytenoid (lateral and posterior)
Epiglottis - aryepiglottis
Arytenoid - interarytenoid (transverse arytenoid), oblique arytenoid
State the intrinsic muscles involved in the adduction and abduction and tension of vocal folds.
adduction of vocal folds - all intrinsic muscles
abduction of vocal folds - posterior cricoarytenoid
tension of vocal folds - cricothyroid –> high pitch sounds by pushing thyroid cartilage forward
State the boundaries of the laryngeal inlet.
State the structure the laryngeal inlet opens into.
LARYNGEAL INLET:
Superiorly - epiglottis
Laterally - aryepiglottic folds
Posteriorly - interarytenoid folds
Laryngeal inlet opens into laryngopharynx
With reference to the LARYNX, state the
(1) nervous supply
(2) blood supply
LARYNX
(1) nervous supply = CN X (gives rise to superior laryngeal nerve + recurrent laryngeal nerve)
- superior laryngeal nerve branches into external laryngeal (supplies cricothyroid) and internal laryngeal (supplies area above vocal folds)
- recurrent laryngeal nerve supplies all other muscles in larynx and area below vocal folds
(2) blood supply = superior thyroid A (branch of ECA) + inferior thyroid A
State the type of cartilage epiglottis is. State if this is typical or atypical .
epiglottis = elastic cartilage
all other cartilage is hyaline
If patient presents with hoarseness of voice and inability to speak at higher pitches, what structure is likely to be affected and why?
CRICOTHYROID is likely affected
- cricothyroid acts to tense vocal folds by pushing thyroid cartilage outwards –> produce higher pitch sounds
EXTERNAL EAR:
- ____ 2/3 is ____ ____
- ____ 1/3 is ____ ____
- From ____ to ____
EXTERNAL EAR:
- LATERAL 2/3 is ELASTIC CARTILAGE
- MEDIAL 1/3 is BONEY STRUCTURES
- From AURICLE to TYMPANIC MEMBRANE
MIDDLE EAR
- Contains ____ ossicles =
- Between ____ and ____ = ____ joint
- Between ____ and ____ = ____ joint
- State the structure that sits on the oval window. State the pathway of vibrations.
MIDDLE EAR
- Contains 3 ossicles = malleus –> incus –> stapedes
- Between MALLEUS and INCUS = INCUDO-MALLEOLAR joint
- Between INCUS and STAPEDES = INCUDO-STAPEDIO joint
- STAPEDES sits on the oval window –> vibrates –> stimulate organ of corti found in cochlear duct
MUSCLES OF THE MIDDLE EAR
(1) Tensor tympani
- muscle of the ____ pharyngeal arch
- supplied by CN ____
- contration of muscle –> ____ ossicles ____ to stop sound from entering inner ear
(2) Chorda tympani
- muscle of the ____ pharyngeal arch
- supplied by CN ____
- contraction of muscle –> ____ ossicles ____ to stop sound from entering inner ear
MUSCLES OF THE MIDDLE EAR
(1) Tensor tympani
- muscle of the 1ST pharyngeal arch
- supplied by CN 5
- contration of muscle –> PULLS ossicles AWAY to stop sound from entering inner ear
(2) Chorda tympani
- muscle of the 2ND pharyngeal arch
- supplied by CN 7
- contraction of muscle –> PULLS ossicles AWAY to stop sound from entering inner ear
State the blood supply to the different parts of the ear
Inner ear: Labrynthine artery (remember passes through IAM with CN7 and CN8), is a branch of the basilar arteries
Middle and External ear: both maxillary
INNER EAR
- Is a _____ _____
- Consists of ____ and ____
- Cochlea =
- Vestibular system (____, ____, ____) =
- Cochlear N + Vestibular N = CN ___
INNER EAR
- Is a BONY LABYRINTH
- Consists of COCHLEA and VESTIBULAR SYSTEM
- Cochlea = hearing (impulses passed on through cochlear N to brain)
- Vestibular system (UTRICLE, SACCULE, SEMICIRCULAR CANALS) = balance and posture (impulse passed on to brain via vestibular N)
- Cochlear N + Vestibular N = CN 8
