Head and Neck Anatomy Flashcards
Layers of scalp
SCALP
1) Skin
2) subCutaneous tissue
3) galea Aponeurotica
4) Loose areolar tissue
5) Pericranium
Arteries supplying the scalp are branches of the (2)
1) External carotid artery
2) Ophthalmic from internal carotid artery
Dangerous area of the scalp
Emissary veins
Layer of the scalp that causes scalp wounds to gape
Galea aponeurotica
How many bones make up the cranium
8
Bones of the cranium
1) Frontal
2) Right and left parietal
3) Occipital
4) Right and left temporal
5) Sphenoid
6) Ethmoid
How many facial bones are there
14
Facial bones
1) 2 nasal
2) 2 lacrimal
3) Vomer
4) 2 inferior concha
5) 2 maxillae
6) 2 palatine
7) 2 zygomatic
8) Mandible
Most common facial bone fractures
1) Nasal
2) Zygomatic
3) Mandible
Anterior fontanelles is aka
Bregma
Posterior fontanelle is aka
Lambda
T/F Mastoid process is present at birth
F
Mastoid develops during
First 2 years of life
Significance of absence of mastoid at birth
Forceps delivery may result in facial nerve injury
Weakest fossa of the skull base
Middle cranial fossa
Signs of middle cranial fossa fracture
1) Bleeding into mouth if with sphenoid involvement
2) Bleeding or CSF leak from ear
3) Facial and auditory nerve injury
Raccoon eyes signify fracture of
Frontal portion of skull base
Extreme tenderness and bruising over the area of the mastoid process of the skull (behind the ear)
Battle sign
Battle sign signify fracture of
Temporal bone
Cranial fossa fractured in the presence of a Battle sign
Posterior
A temporary improvement in a patientโs condition after a traumatic brain injury, after which the condition deteriorates
Lucid interval
Lucid interval is indicative of
Epidural hematoma
Intracranial hemorrhage, involved blood vessel/s: Epidural
Anterior division of middle meningeal artery
Intracranial hemorrhage, involved blood vessel/s: Subdural
Cerebral veins/Bridging/Emissary vessels
Intracranial hemorrhage, involved blood vessel/s: Subarachnoid hemorrhage
Aneurysm/angioma
Intracranial hemorrhage, involved blood vessel/s: Intraparenchymal
Lenticulostriate artery
Adult vs young child: Skull fracture likened to an eggshell
Adult
Adult vs young child: Skull fracture likened to a pingpong ball
Young child
Adult vs young child: Splintering of bone
Adult
Adult vs young child: Pond fracture
Young child
Signs of anterior cranial fossa fracture
1) Epistaxis
2) Rhinorrhea
3) Racoonโs eye
4) Exophthalmos
Signs of middle cranial fossa fracture
1) Rhinorrhea/Otorrhea
2) CN 3,4,6,7,8 damage
Signs of posterior cranial fossa fracture
1) Battle sign
2) CN 9,10,11 damage
Anterior arterial circulation of the brain is derived from
Internal carotid artery
Posterior arterial circulation of the brain is derived from
Vertebral artery
Branches of the internal carotid artery (6)
ICA > CAMPOS
1) Choroidal
2) ACA
3) MCA
4) Posterior communicating
5) Ophthalmic
6) Superior hypophyseal
Branches of vertebral artery
MAPP
1) Meningeal branches
2) Anterior spinal
3) Posterior spinal
4) Posterior inferior cerebellar
Adult vs young child: Splintering of bone
Adult
Adult vs young child: Pond fracture
Young child
Signs of anterior cranial fossa fracture
1) Epistaxis
2) Rhinorrhea
3) Racoonโs eye
4) Exophthalmos
Signs of middle cranial fossa fracture
1) Rhinorrhea/Otorrhea
2) CN 3,4,6,7,8 damage
Signs of posterior cranial fossa fracture
1) Battle sign
2) CN 9,10,11 damage
Anterior arterial circulation of the brain is derived from
Internal carotid artery
Posterior arterial circulation of the brain is derived from
Vertebral artery
Branches of the internal carotid artery (6)
CAMPOS
1) Choroidal
2) ACA
3) MCA
4) PCA
5) Ophthalmic
6) Superior hypophyseal
3 primary vesicles of developing brain
1) Forebrain/prosencephalon
2) Midbrain/mesencephalon
3) Hindbrain/rhombencephalon
5 secondary vesicles of developing brain
From prosencephalon 1) Telencephalon 2) Diencephalon From Mesencephalon 3) Mesencephalon From Rhombencephalon 4) Metencephalon 5) Myelencephalon
Adult derivative: Telencephalon
1) Cerebral hemispheres
2) Lateral ventricles
Adult derivative: Diencephalon
1) Thalamus
2) 3rd ventricle
Adult derivative: Mesencephalon
1) Midbrain
2) Aqueduct of Sylvius
Adult derivative: Metencephalon
1) Pons
2) Cerebellum
3) Upper part of 4th ventricle
Adult derivative: Myelencephalon
1) Medulla
2) Lower part of 4th ventricle
Myelination begins at
___ weeks
Myelination is almost completed at
___ years
Adult derivative of notochord
Nucleus pulpous of intervertebral disc
Branches of basilar artery
PPALS
1) Pontine branches
2) Anterior inferior cerebellar
3) Labyrinthine
4) PCA
5) Superior cerebellar
Venous drainage of brain
Dural venous sinuses
1) Superior and inferior sagittal sinus
2) Great vein of Galen
3) Straight sinus
4) Transverse sinus
5) Sigmoid sinus
Dural venous sinuses ultimately empty into
IJV
Neural plate is formed at
___ days
Neural groove and tube are formed at
___ days
Myelination begins at
___ weeks
Myelination is almost completed at
___ years
Failure of dorsal induction in the development of nervous system results in
1) Anencephaly
2) Encephalocele
3) Myelomeningocele
Disorder of ventral induction in development of nervous system results in
Facial malformations
Result of failure of neuropores to fuse at 4th week AOG
NTD
NTD: Substance elevated in amniotic fluid and maternal serum
AFP
NTD: Helpful confirmatory test
Increased acetylcholinesterase in amniotic fluid
Failure of bony spinal canal to close but without structural herniation
Spina bifida occulta
Maternal conditions associated with anencephaly
1) Type I DM
2) Low folate levels
Spina bifida occulta: T/F Dura is intact
T
Spina bifida occulta: T/F Found in lower vertebral levels
T
Herniation of meninges through spinal canal defect
Meningocele
Herniation of meninges and spinal cord through spinal defect
Myelomeningocele
Malformation of anterior neural tube resulting in no forebrain
Anencephaly
Increased vs decreased AFP: Anencephaly
Increased
Poly vs oligohydramnios: Anencephaly
Poly
Maternal conditions associated with anencephaly
1) Type I DM
2) Low folate levels
Failure of left and right hemispheres to separate
Holoprosencephaly
Results from severe holoprosencephaly
Cyclopia
Significant cerebellar tonsillar and vermin herniation through foramen magnum with aqueductal stenosis and hydrocephalus
Arnold-Chiari malformation or Chiari II
Spinal defect associated with Arnold-Chiari malformation or Chiari II
Thoracolumbar myelomeningocele
Components of brainstem
1) Midbrain
2) Pons
3) Medulla
Spinal defect associated with Dandy-Walker
Spina bifida
Cystic enlargement of central canal of spinal cord
Syringomyelia
Syringomyelia: Spinal tract first damaged
Spinothalamic tract
Syringomyelia: Characteristic symptom
Cape-like bilateral loss of pain and temp sensation in upper extremities
Syringomyelia: Associated with what malformation
Chiari I
Cavernous sinus: Contents
1) CaVerNouS: CN III, IV, V1, V2, VI
2) Postganglionic SY fibers
3) ICA
Limbic system governs (5)
5 Fs Feeding Feeling Fighting Flight Sex
Components of brainstem
1) Midbrain
2) Pons
3) Medulla
Brainstem: Location of what CN nuclei
3-12
Brainstem: Arterial supply
1) Anterior circulation: ICA
2) Posterior circulation: Vertebral
Collection of sinuses on either side of the pituitary
Cavernous sinus
Cavernous sinus: Drains blood from
1) Eye
2) Superficial cortex
Cavernous sinus: Ultimately drains into
IJV
UMN signs are due to damage to
Corticospinal tract
Terminal portion of spinal cord
Conus medullaris
Fibrous extension of pia mater that anchors spinal cord to coccyx
Filum terminale
Brought about by hemisection of the spinal cord
Brown-Sequard syndrome
Brown-Sequard syndrome: T/F IPSILATERAL loss of all sensation at the level of the lesion
T
Brown-Sequard syndrome: T/F IPSILATERAL UMN signs below level of lesion
T
Brown-Sequard syndrome: T/F IPSILATERAL LMN signs below lesion
F, at the level of lesion
Foster-Kennedy syndrome
APO
1) Anosmia, ipsi
2) Papilledema, contra
3) Optic atrophy, ipsi
UMN signs are due to damage to
Corticospinal tract
Demyelination/degeneration of dorsal columns and roots causing impaired sensation and proprioception and progressive sensory ataxia (inability to sense or feel legs)
Tabes dorsalis
Tabes dorsalis: Cause
Tertiary syphilis/neurosyphilis
Tabes dorsalis: Small bilateral pupils that further constrict to accommodation but not to light
Argyll-Robertson pupil
Argyll-Robertson pupil is aka
Prostituteโs eye
Tabes dorsalis: DTRs
Absent
Tabes dorsalis: Romberg sign
Positive
Foster-Kennedy syndrome
APO
1) Anosmia
2) Papilledema
3) Optic atrophy
Most common site of blowout fracture
Inferior wall
Causes of cavernous sinus thrombosis (2)
1) Infections in the dangerous area of the face
2) Facial vein thrombosis
In infections of the dangerous area of face, organism ascends through
Inferior ophthalmic vein
Blowout fracture: Explodes into
Maxillary sinus
Blowout fracture: Injures
???
Blowout fracture: Entrapment of
Inferior rectus muscle
The eye is least protected from which side
Lateral
Eye trauma: Most common cause
Blunt head trauma
Most common site of blowout fracture
Inferior wall
Radiologic sign representing periorbital fat or entrapped EOM in the maxillary sinus
Teardrop sign
Muscles of eyelids: Sphincters
Orbicularis oculi (orbital, palpebral, and lacrimal parts)
Muscles of eyelids: Sphincters, nerve supply
Facial nerve
Muscles of eyelids: Dilators
1) Levator palpebrae superioris
2) ??? Occipitofrontalis (raises eyebrow)
Muscles of eyelids: Dilators, nerve supply
1) Striated muscle: Oculomotor nerve
2) Smooth muscle: SY
Muscles of facial expression: Situated in which layer of skin
Superficial fascia
Muscles of facial expression: Common origin
Skull
Muscles of facial expression: Common insertion
Skin
Muscles of facial expression: Common innervation
Facial nerve
Nerve damaged in Bellโs palsy
Facial nerve
Muscles of facial expression: Pulls eyebrow medially
Corrugator supercilli
Muscles of facial expression: Wrinkles skin at root of nose
Procerus
Muscles of facial expression: Compresses the cheeks and lips against teeth; blowing
Buccinator
Muscles of facial expression: Muscle involved in generalised tetanus resulting in sardonic grin
Risorius
Muscles of facial expression: Closes eyelids
Palpebral part of orbicular is oculi
Muscles of facial expression: Seen in aging
Crowโs feet
Muscles of facial expression: Involved in hemifacial spasm
Orbicularis oculi
Muscles of facial expression: Injected with botulinum A toxin
Orbicularis oculi
Muscles of mastication
1) Masseter
2) TeMporalis
3) Medial pterygoid
4) Lateral pterygoid
Muscles of mastication: Closes the jaw
3 Ms
1) Masseter
2) TeMporalis
3) Medial pterygoid
Muscles of mastication: Opens and protracts the jaw
Lateral pterygoid
Muscles of mastication: Common innervation
V3
Tongue: Origin of anterior 2/3
1st branchial arch
Tongue: Origin of posterior 1/3
3rd and 4th branchial arches
Tongue, nerve for tase: Anterior 2/3
CN VII
Tongue, nerve for tase: Posterior 1/3
CN IX
Tongue, sensory innervation: Anterior 2/3
CN V3
Tongue, sensory innervation: Posterior 1/3
CN IX
Tongue, taste and sensory innervation: Extreme posterior
CN X
Tongue: Motor innervation
CN XII EXCEPT palatoglossus (CN IX, X)
Group of nerves for taste
Nucleus solitarius
CN VII, IX, X
Acoustic schwannoma: Most common symptoms
1) Tinnitus
2) Hearing loss
Acoustic schwannoma: Associated with what hereditary condition
NF type 2
Most common cerebellopontine angle tumor
Acoustic schwannoma
Branch of glossopharyngeal nerve that supplies carotid sinus
Sinus nerve of Hering
Important branches of vagus nerve to the neck
X-CRAMP
1) Cardiac
2) Recurrent laryngeal
3) Auricular
4) Meningeal
5) Pharyngeal
All muscles of palate are supplied by
Pharyngeal plexus EXCEPT tensor velli palatini (CN V)
All muscles of pharynx are innervated by
CN X EXCEPT stylopharyngeus (CN IX)
All muscles of larynx are innervated by
CN X EXCEPT cricothyroid (external branch of superior laryngeal nerve)
Adult GCS
Image
Pediatric GCS
Image
Components of vertical buttress system
1) Zygomaticofrontomaxillary
2) Nasomaxillary
3) Pterygomaxillary
Components of the horizontal buttress system
1) Supraorbital bar
2) Inferior orbital rim/orbital floor
3) Alveolus