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H and N Lecture > Head and neck anatomy- Trigeminal Nerve, exam 3 > Flashcards

Head and neck anatomy- Trigeminal Nerve, exam 3 Flashcards

1
Q

What is the V3 nerve?

A

mandibular

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2
Q

the mandibular nerve (V3) has 2 modalities which are

A
  1. somatic sensory: touch, temp, pain
  2. somatic motor: skeletal muscle movement
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3
Q

what are the 3 large branches of the trigeminal nerve?

A
  1. ophthalmic
  2. maxillary
  3. mandibular
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4
Q

the ophthalmic and maxillary are purely…

A

sensory

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5
Q

which branch of the trigeminal nerve is both sensory and motor

A

mandibular nerve

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6
Q
A
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7
Q

what is the front wall of the infratemporal fossa?

A

the maxilla

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8
Q

what is the ceiling of the infratemporal fossa?

A

the greater wing of the sphenoid

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9
Q

what is the ball for the modified ball and socket joint?

A

the condyle of the mandible

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10
Q

what is the socket for the modified ball and socket joint?

A

the glenoid fossa

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11
Q

where does the infratemporal fossa stop?

A

where the glenoid fossa of the socket for the TMJ starts

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12
Q

what is the medial boundary of the infratemporal fossa?

A

the lateral pterygoid plate

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13
Q

what is the space thats inside the the vertical part of the mandible?

A

the ramus between the maxilla and the lateral pterygoid plate

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14
Q

where does the infratemporal fossa stop?

A

the glenoid fossa

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15
Q

what is the largest hole that we’ll see in the sphenoid?

A

the foramen ovale

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16
Q

what is the foramen ovale?

A
  • oval shape
  • where V3 is going to exit
  • largest hole in sphenoid
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17
Q

how does V3 exit the skull?

A

it comes out of the cranial cavity where the brain is and where the trigeminal ganglion is. V3 will then come down that opening and as soon as it gets to the Infratemporal fossa it will come out and immediately divide into all its branches.

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18
Q

where are all of the somatic sensory cell bodies for the trigeminal nerve

A

Trigeminal ganglion

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19
Q

where do the dural branches go?

A

goes to the meninges or connective tissue around the brain

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20
Q

what does the trigeminal ganglion supply?

A

dura that’s inside your parietal bone and temporal bone on the side of your skull

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21
Q

where does V3 exit?

A

the foramen ovale where all of its branches will be in the infratemporal fossa

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22
Q

Auriculotemporal n.

A
  • goes posteriorly
  • purely sensory
  • goes right in front of the ear
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23
Q

what branch goes posteriorly and exits the infratemporal fossa?

A

the auriculotemporal n.

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24
Q

what kind of nerve is the auriculotemporal n.?

A

purely sensory

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25
Q

what does the auriculotemporal n. supply?

A

skin of the external ear, side of the head into the scalp, and skin above the external ear

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26
Q

what is the most important thing about the auriculotemporal n.?

A

it’s really important for people with TMJ problems

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27
Q

why is the auriculotemporal n. so important for people with TMJ problems?

A

because this nerve is the primary sensory innervation of the TMJ

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28
Q

what is the little branch that turns downward off the auriculotemporal n.?

A

it goes into the parotid salivary glands
- has NOTHING to do with the secretion of the glands
- carries sensory information from the gland

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29
Q

what cranial nerve makes the glands secrete?

A

glossopharyngeal

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30
Q

if somebody has a prodded gland tumor, or a little kid with mumps and their glands are swollen and painful, what nerve would case that?

A

the auriculotemporal nerve because it also carries sensory innervation to the prodded salivary gland

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31
Q

the auriculotemporal n. also has nerves that go into the…

A

the skin that lines your ear canal all the way to your eardrum( tympanic membrane)

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32
Q

Nn. to mm. of mastication

A

tend to be named to the muscle they go to
- 3 of them

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33
Q

what will you see immediately after coming through the foramen ovale

A

a lot of small nerves that are going to come out and be motor nerves that go to muscles of mastication

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34
Q

which nerve of mastication is a mixed nerve?

A

the inferior alveolar n.

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35
Q

Buccal n. (sometimes called the long buccal n.)

A
  • purely sensory
  • sensory nerve supply to buccal mucosa (cheek)
  • has little branches that will cross the boundaries of vestibule to supply gingiva along molars and premolars
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36
Q

where is this gingival branch located?

A

important for anesthesia when working on mandibular teeth
- most anterior

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37
Q

Lingual n.

A

somatic sensation to the tongue, NOT taste
- temp
- pain
- touch

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38
Q

what else does the lingual n. supply?

A
  • mucosa on the floor of the mouth underneath the tongue
  • sublingual mucosa
  • lingual gingiva for lower teeth
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39
Q

what part of the tongue is supplied through the lingual n.?

A

the anterior 2/3

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40
Q

is the buccal or lingual n. larger?

A

the lingual n.

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41
Q

inferior alveolar n.

A

most concerned about for anesthesia of the lower teeth due to this nerve being sensory to ALL of them
- mixed nerve

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42
Q

the inferior alveolar n. is going to tunnel through…

A

the mandibular foramen

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43
Q

the lingual nerve is always in the— of the inferior alveolar n.

A

front

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44
Q

N. to mylohyoid

A
  • takes all of the motor fibers with it and everything that’s left is purely sensory that enters the mandible
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45
Q

all of the motor that is in the inferior alveolar n. comes off into the…

A

N. to mylohyoid

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46
Q

whatever goes into the mandible and runs through the mandibular foramen in the mandibular canal to reach the lower teeth is

A

purely sensory

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47
Q

what happens when the nerve to mylohyoid comes off of the back edge of the inferior alveolar nerve?

A

it takes all of the inferior alveolar nerves motor axons with it

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48
Q

the nerve to mylohyoid is the motor nerve supply to

A

our anterior set of super hyoid muscles

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49
Q

how is our suprahyoid muscles divided into?

A

an anterior set and a posterior set

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50
Q

where does the N. to mylohyoid go through?

A

the mandibular canal and sends apical branches that go up into the tip of the tooth roots to supply the teeth for sensation

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51
Q

anterior set of suprahyoid

A
  1. mylohyoid
  2. anterior digastric muscle
    both supplied by the N. to mylohyoid
    supplied by V3
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52
Q

what else does the N. to mylohyoid supply

A

supplies the buccal and lingual gingiva of lower teeth

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53
Q

Mental N.

A

doesn’t supply any teeth but supplies the lower lip/skin and crosses over to also supply some labial gingiva underneath the incisors
- full thickness of the lower lip

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54
Q

what part of the dermatome does the mental N. supply?

A

sensory innervation of the chin as a whole

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55
Q

the mental nerve doesn’t supply any teeth, just the skin and mucosa? T/F

A

true

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56
Q

the buccal nerve supplies the full thickness of the…

A

cheek along with sensation inside the mucosa ( touching cheek with your tongue )and outside the cheek( touching your cheek with your finger)

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57
Q

the muscles innervated by the mandibular nerve are all…

A

skeletal muscle
voluntary activated (use somatic sensation)

58
Q

the mental nerve supplies the full thickness of the…

A

lower lip with sensation

59
Q

what muscles of mastication are going to move the mandible with respect to the cranium so that you apply forces to food between the teeth?

A
  1. temporalis muscle
  2. masseter (superficial and deep)
  3. medial pterygoid
  4. lateral pterygoid( superior and inferior heads)
60
Q

what type of nerve is the masseter nerve?

A

a mixed nerve because it has a little somatic sensory to i

61
Q

what is the somatic sensory territory for the masseter going to be part of?

A

the TMJ

62
Q

the auriculotemporal n. is the major nerve supply to the TMJ, whereas the n. to masseter is a — contributor

A

minor

63
Q

other muscles that are supplied

A
  1. tensor tympani
  2. tensor veli palatini
  3. mylohyoid (suprahyoid muscle)
  4. anterior digastric (suprahyoid)
64
Q

tensor tympani

A

muscle in the middle ear

65
Q

Tensor Veli Palatini

A

muscle of the soft palate that is needed for swallowing

66
Q

the nerve to mylohyoid does both the..

A

mylohyoid and the anterior digastric muscle

67
Q

medial pterygoid (lateral picture)

A

floor of the space and all the V3 branches are in the infratemporal fossa, so all of these branches are above the medial pterygoid plate

68
Q

auriculotemporal n.

A
  • exits out the back of the infratemporal fossa
  • purely sensory
  • comes off of V3 and squeezes out behind the TMJ and then comes up onto the front of the ear and side of the head
69
Q

Buccinator muscle

A

muscular wall of the cheek

70
Q

buccal N. (lateral view)

A

the buccal nerve is coming down through the infratemporal fossa and comes through the muscles really high ( between the 2 heads of lateral pterygoid)

71
Q

lingual N. (lateral view)

A

the floor of the infratemporal fossa and sits right on the medial pterygoid muscle
- purely sensory

72
Q

the medial pterygoid is the — of

A

the infratemporal fossa
floor

73
Q

chorda tymapni

A
  • a branch of the facial nerve
  • hearing things taste for the anterior 2/3 of tongue
74
Q

how do we get taste into the anterior 2/3 of the tongue through chorda tympani?

A

it joins the back of the lingual nerve

75
Q

an easy way for the facial nerve to send its taste fibers to the same part of the tongue is to hitchhike with a nerve that is already going there. T/F

A

true

76
Q

the n. to mylohyoid always comes off of the

A

inferior alveolar nerve

77
Q

the chorda tympani is always joining the

A

lingual nerve

78
Q

pterygoid plexus of veins

A

a big venous plexus that is also occupying that space

79
Q

pterygoid muscles and things like that, all the V3 branches in and around all that stuff is going to have a..

A

mesh or network of veins that are organized into a plexus

80
Q

what is a plexus?

A

interconnecting lots of connections that are like a net rather than just a singular linear vessel

81
Q

anytime you stick a needle into the infratemporal fossa, you are at risk of what

A

damaging the venous plexus

82
Q

what happens when the venous plexus gets “damaged”
it bleeds and you’ll generally see a pt complain of :

A
  • discomfort and swelling
  • stiffness with opening and closing
    this is from a hematoma (mass of blood) in their infratemporal fossa
83
Q

light touch impulses go back and are interpreted in one part of the brain but pain and temperature go to a…

A

different nucleus in the brain

84
Q

if you want to test the trigeminal nerve function completely you can’t just do touch. You have to do touch separately from pain and temperature. T/F

A

true

85
Q

V1 testing

A

test skin above eyebrow

86
Q
A
87
Q

v2 testing

A

come down to the cheek under the lower eyelid

88
Q

V3 test

A
  • test skin or lower lip
  • stay away from midline
89
Q

what does the dural branch do

A

sensory to meninges (stays inside of head)

90
Q

elevation

A

jaw closing

91
Q

depression

A

opening

92
Q

retrusion

A

position of the mandible posterior from the centric position as related to the maxilla

93
Q

protrusion

A

sticking mandible out

94
Q

Right lateral excursion

A

shifting mandible to the right

95
Q

Left lateral excursion

A

shifting mandible to the left

96
Q

temporalis insertion

A

coronoid process of mandible

97
Q

temporalis origin

A

inferior temporal line

98
Q

the brain uses parts of the temporalis muscle______
independently

A

independently

99
Q

what is the function of the superior temporal line

A

attachment for connective tissue that covers the temporalis muscle

100
Q

masseter origin

A

zygomatic arch

101
Q

masseter insertion

A

lateral surface and angle of mandibular ramus

102
Q

masseter muscle function

A

elevates mandible

103
Q

temporalis muscle function

A

elevates mandible

104
Q

what is the purpose of the temporalis fascia

A

it allows for greater strength of the temporalis muscle because muscle fibers of the temporalis muscle can attach here

105
Q

which muscle is most complicating

A

masseter

106
Q

which muscle is the most powerful closer

A

masseter

107
Q

medial pterygoid muscle insertion

A

deep surface of the angle

108
Q

medial pterygoid muscle origin

A

deep head: lateral pterygoid plate of sphenoid bone
superficial head: part of maxilla

109
Q

parts of the medial pterygoid muscle

A

deep head and superficial head

110
Q

medial pterygoid muscle function

A

elevates mandible

111
Q

which muscle is the 2nd most powerful closer

A

medial pterygoid

112
Q

Lateral pterygoid superior head origin

A

greater wing of sphenoid bone

113
Q

lateral pterygoid superior head function

A

positions the articular disk in opening AND closing; helps avoid pinching of the joint capsule

114
Q

lateral pterygoid superior head insertion

A

articular disc of TMJ

115
Q

lateral pterygoid inferior head origin

A

lateral surface of lateral pterygoid plate

116
Q

lateral pterygoid inferior head insertion

A

neck of mandible

117
Q

lateral pterygoid inferior head function

A

pulls condyle forward and causes OPENING

118
Q

which pterygoid muscle is more anterior

A

lateral

119
Q

what is the one muscle that is an important opener

A

inferior head of lateral pterygoid

120
Q

muscles ______ the mandible bone

A

sandwich

121
Q

what are the 3 layers of cartilage in the TMJ

A

cartilage coating the depth of the glenoid fossa, cartilage coating the head of the mandible, and the articular disk

122
Q

what kind of joint is the TMJ

A

synovial joint (ball and socket)

123
Q

what is the function of the articular disk of the TMJ

A

shock absorber

124
Q

what does the capsular ligament do

A

it is wrapped like a cone around the condyle and neck of mandible and it holds the joint together

125
Q

what is the articular eminence

A

thick strong bone that is well adapted in handling forces

126
Q

the ceiling of the fossa is ____

A

very thin

127
Q

the TMJ joint is divided in to

A

upper and lower compartments by the articular disk

128
Q

TMJ ligament

A

located on the lateral side of the joint and maintains the joint’s integrity. It also prevents backwards dislocation

129
Q

sphenomandibular and stylomandibular ligament

A

Guiding ligaments to keep condyle, disc and temporal bone firmly opposed

130
Q

what kind of forces are experienced by the TMJ

A

compressive

131
Q

compressive force means

A

two surfaces are pressing together; for every action there is an equal and opposite reaction

132
Q

what are the steps to opening the mouth

A

1) anterior posterior movement (translation) in the upper compartment
2) hinge movement (rotation) in the lower compartment

133
Q

what are the sensory innervations for the TMJ

A

ariculotemporal: primary on the back and sides
masseterice nerve: secondary on the front
other nerves: deep temporal nerves and mandibular nerve

134
Q
A
135
Q

anterior jaw dislocation

A

Someone opens excessively wide which can happen after a long dental appointment. Condyle hops over the articular eminence. Most common!!

136
Q
A
137
Q

What could you palpate extra-orally after an anterior jaw dislocation

A

coronoid process

138
Q

why is lateral excursion important

A

it helps create the normal lateral component of the chewing cycle

139
Q

other types of jaw dislocations

A

superior: punch in chin with the mouth open
posterior: punch in chin
lateral: usually only with jaw fractures

140
Q

if you activate the right inferior lateral pterygoid then…

A

the jaw moves left

141
Q

if you activate the left inferior lateral pterygoid then…

A

then the jaw moves right

142
Q

if a patient has a paralyzed lateral pterygoid then….

A

the chin will deviate to the same side of the paralyzed muscle when the mouth is opened

H and N Lecture (2 decks)

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