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Clinical Anatomy > Head and Neck I > Flashcards

Head and Neck I Flashcards

1
Q

What is the skull made up of?

A

Cranium and mandible

made up of 22 bones

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2
Q

Where are the upper and lower teeth located?

A

Upper on maxilla

Lower on mandible

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3
Q

What is the zygoma bone and what is it made up of?

A

Cheek bone

Zygomatic arch - Temporal process on zygomatic bone and zygomatic process on temporal bone

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4
Q

What is the orbital and what is made up of?

A

Aperture around the eye

Frontal, nasal and zygomatic bone

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5
Q

What are the boundaries of the orbital?

A

Root - formed by frontal bone and lesser wing of sphenoid (at back)
Floor - formed by maxilla, palatine, and zygomatic bones
Maxilla separates orbit from underlying maxillary sinus
Medial wall - ethmoid, maxilla, lacrimal and sphenoid bones
Ethmoid separates orbit from ethmoid sinus
Lateral wall - zygomatic bone and greater wing of sphenoid

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6
Q

What is the optic foramen?

Where are the supra and infraorbital foramina?

A

Opening through which optic nerve (CN2) runs
Supra = above optic foramina, infra = below
passageway for supra and infraorbital structures

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7
Q

Where is the temporal bone?

Which muscle is on top of this bone?

A

Above the auditory canal

Temporalis

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8
Q

Where does the parietal bone continue until?

A

Until it meets the occipital bone

Can feel ridges at the back of the head - occipital protuberance

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9
Q

What is the pterion and what is its significance?

A

Fusion point on side of head of temporal bone, sphenoid, parietal
Middle meningeal artery runs inferior to the area - passes through foramen spinosum and runs all way through inner surface
As pterion is v. weak structure, if hit head here can cause extradural haemorrhage

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10
Q

What are some features of the mandible?

A

Mental protuberance
Mental (mandibullar) foramina - allow transmission lingual nerve - comes out foramina as mental nerve (V3 - passes through to supply skin and muscle)
Head - forms tempero-mandibular joint (TMJ)

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11
Q

What are the actions of the mandible?

A

Protusion - pushing mandible out
Lateral pterygoid assisted by medial pterygoid

Retraction - moving back
Posterior fibres of temporalis, deep part of masseter and geniohyoid and digastric

Elevation - moving up
Muscles of mastication involved - temporalis, masseter and medial pterygoid

Depression - mandible moving down
Muscles of mastication involved - gravity, digastric, geniohyoid and mylohyoid

Left and right lateral deviation

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12
Q

What is the TMJ and where is it located?

A

Synovial joint w/ articular cartilage on bone surfaces and joint capsule that encloses synovial fluid

Between mandibular process of temporal bone and head of mandible - main connection between skull and lower jaw

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13
Q

What are the ligaments in the surrounding area of the TMJ?

A

Stylomandibular ligament - Inside space between ligament and border of mandible = passageway for lingual and inferior alveolar nerve

Inf. alveolar nerve helps supply sensation to teeth .˙. any damage to area can cause lots of effects in one go

Sphenomandibular ligament

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14
Q

What is the lacrimal fossa?

A

Concave depression on lacrimal bone - forms medial wall on orbital cavity - where lacrimal sac located
Lacrimal sac drains into nasolacrimal duct
Nasolacrimal canal is continuous with nasal cavity

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15
Q

What are the types of teeth?

A 
4 incisors
2 canines (1 each side)
4 premolars (2 each side)
6 molars(3 each side)
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16
Q

How can a patient get referred pain in the maxillar?

A

Contains maxillar sinus - if have superior alveolar nerve damage/inflammed at process - may hurt cheek bones
Occurs w/ sinusitis/ abcesses in teeth
vice versa also true - have polyps in maxillary sinus, can get a toothache

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17
Q

What do the pterygoid plates look like?

A

Hook like - medial and lateral, important for attachment of muscles (pterygoid muscles)

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18
Q

What do the occipital chondyles articulate with?

A

Articulate w/ C1 vertebrae

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19
Q

What does the stylomastoid foramena give transmission to?

A

Transmission to facial nerve as exits to supply muscles of face

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20
Q

Where is the cribiform plate and what is its significance?

A

Area on the ethmoid

Has multiple foramina allows passageway nerve (olfactory nerve)

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21
Q

What is the crista galli?

A

Attachment of dura mater - separates brain

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22
Q

What artery goes through the foramen lacerum?

A

Middle meningeal goes through foramen lacerum

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23
Q

What is the pterygopalatine fossa?

A

Cone shaped depression, extending deep into infratemporal fossa

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24
Q

What are the sutures of the skull?

A

Coronal suture = between frontal and parietal bones
Frontal suture = divides halves of frontal bone in infants and children
Sagittal suture = between 2 parietal bones
Lamboid suture = between parietal and occipital bone

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25
Q

What is the bregma?

A

Space for fusion

Important when checking development in GP - feel for bregma areas to assess whether they’re fused or not

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26
Q

What is needed to be seen on the radiograph?

A

Identify where sutures of the skull are, TMJ and different parts of the mandible - note gomphoses - joint between teeth and bone

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27
Q

What are the paranasal sinuses filled with?

A

They are filled with air - .˙. seen as black on the x-ray

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28
Q

What can sutures be misdiagnosed as?

A

May be misdiagnosed as fractures
Fractures = depressed w/ non-sclerotic edges and sharp lucencies
Sutures = zigzag, with interdigitations and sclerotic borders

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29
Q

What is the significance of cranial vault?

A

Distributes and minimises effects of a blow to it

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30
Q

What is the most common type of cranial fracture?

A

Linear cranial fracture - occurs at the point impact

other fracture lines radiate away from it

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31
Q

Describe a fracture of the mandible

A

Butterfly fracture - 2 fractures that occur on opposite sides

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32
Q

What is a blow out fracture?

A

Break of >1 bone surrounds the eye ˙.˙ force transmitted to the eye compartment - get very sunken eyes

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33
Q

What are the boundaries of the nasal aperture?

A

Roof - nasal, frontal, sphenoid and ethmoid bones
Cribiform plate - transmits CN1 for smell
Foor - palatine bones and maxilla
Medial wall - nasal septum
Lateral wall - superior, middle, inferior nasal conchae
maxillary and palatine bones contribute

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34
Q

Describe the masseter

A

Has a deep and superficial head
Origin = attached to zygomatic arch
Insertion = lateral surface of ramus and coronoid process

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35
Q

What is the action of the masseter?

A

Mandible elevation

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36
Q

What nerve is the masseter supplied by?

A 
Masseteric nerve (V3) 
Mandibular division trigeminal nerve - involved in teeth grinding
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37
Q

Describe the attachments of the temporalis

A

Lies over the entirety of the temporal bone
Passes downward and attaches to coronoid process (mandible)
Attaches to the anterior margin ramus mandible

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38
Q

What is the action of the temporalis and what nerve is it supplied by?

A

Mandible elevation and retraction (pushing jaw up and back)

Supplied by temporal nerve (V3)

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39
Q

Describe the medial pterygoid muscle

A

Deep head begins on pterygoid plate on sphenoid
Superficial head = tuberosity of maxilla
Inserts into underside of medial part ramus of mandible (near to angle)

Medial head sits in between ptergoid plate (between 2 spikes)

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40
Q

What is the action of medial pterygoid muscle?

What nerve is it supplied by?

A

Mandible elevation and side to side movements
mm sound brings mandible up
Medial pterygoid nerve of mandibular nerve V3

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41
Q

Describe the lateral pterygoid muscle

A

Upper head begins from roof of the intfratemporal fossa
Lower head - lateral surface of lateral plate of pterygoid process
Runs along to chondylar process
Goes from capsule of TMJ to pterygoid fovea

42
Q

What is the action of the lateral pterygoid muscle and what nerve is it supplied by?

A

Side to side and protrusion (forward and back)
laa - drop jaw lateral p contracts
Lateral pterygoid nerve of mandibular neve (v3)

43
Q

What do the superior and inferior alveolar nerve supply?

A

Sup. alveolar nerve - supplies tongue and top teeth

Inf. alveolar nerve- supplies bottom jaw

44
Q

Describe dislocation of TMJ

A

Can occur during yawning/taking a large bite
causes excessive contraction of lateral pterygoid muscles may cause heads of the mandible to dislocate anteriorly, passing anterior to articular tubercles
in this position mandible remains depressed and person may not be able to close their mouth

45
Q

What is TMJ degenerative arthritis?

A

Joint may lead to abnormal function and result in structural problems eg. dental occlusion and joint clicking (Crepitus)
Teeth joint = gomphosis

46
Q

How is the frontalis muscle attached to the occipitalis?

A

Attached to occipitalis by aponeurosis

scalp - skin, subcutaneous tissue and epicranial aponeurosis

47
Q

What does the procerus muscle do?

A

Aids in contractility, making frontal aspect of face furrow

48
Q

Describe the obicularis oculii

A

2 parts -
Orbital
Palebral
Large and allows open and close eyelids

49
Q

What does the buccinator do?

A

Allows whistle and has opening for parotid duct

Compresses cheek against teeth during chewing

50
Q

Describe the nasalis muscle

A

Muscle on the nose (nabella = bridge of nose)
Transverse - wrinkles nasal skin and compresses nasal aperture
Alar - dilates nostrils and pulls ala laterally

Depressor septi lowers midline of nose

51
Q

Describe the obicularis oris

A

Fibres travel circularly around mouth and blend with fibres of other muscles insert on mouth

52
Q

Descrive levator labii superioris and levator labii superioris alaeque nasi muscle
What is the function of these muscles?

A

Levator labii superioris - Extends from the side of the nose to zygomatic bone
Alaeque nasi - 1 muscles in group of muscles
Action - control shape, posture and movement of lips, elevates upper lip and expose maxillary teeth
Part of buccolabial muscles

53
Q

What is the function of the zygomaticus minor?

What is the function of the zygomaticus major?

A

Minor - Elevates upper lip and thus expose maxillary teeth - facilitates speech
Major - Pulls angle of mouth superolaterally -> facilitates speech and laughter

54
Q

What is the function of depressor labii inferioris?

A

Helps lower bottom lip

55
Q

What is the function of the depressor anguli oris?

Where does it originate and insert?

A

Pulls angle of mouth inferolaterally

Originates from mandible and inserts into angle of mouth = face expression

56
Q

What is the function of the platysma?

A

Enables extension of neck

Responsible for drawing skin around lower part of mouth down or out

57
Q

Is there any parietal muscle?

A

No parietal muscle, instead have aponeurosis - connection of one muscle to another

58
Q

What is the modiolus?

A

Centre point for everything come together
Held together by fibrous tissue
Obicularis oris, quadratus labii superioris + inferioris, buccinator = area of dimple

59
Q

Where are the constrictor muscles and what is their function?

A

Behind the mandible (inside) - pushes food bolus into oesophagus

60
Q

What is the nerve supply for facial expression?

A

CNVII - facial nerve

Motor innervation .˙. controls facial expression

61
Q

Describe the course of the facial nerve

A

Transmits out of stylomastoid foramen (behind styloid process)
Enters mandibular canal and leaves through mental foramen

62
Q

What is the nerve for sensory innervation of facial muscles?

A

Trigeminal nerve (CNV)

63
Q

What are the branches of the trigeminal nerve?

A

CNV1 - Ophthalmic nerve - External nasal nerve, supraorbital, supratrochlear

CNV2 - Maxillary nerve - Infraorbital, zygomatic nerve

CNV3 - Mandibular nerve - Inferior alveolar nerve (goes to teeth), lingual nerve, buccal nerve, mental nerve and auriculo-temporal nerve

64
Q

What is the clinical significance inferior alveolar nerve block?

A

Dentists anaesthetise inferior alveolar nerve before repairing/removing teeth, because mental and incisive nerves are terminal branches
.˙. chin and lower lip of affected side also lose sensation

65
Q

What is the positioning of the lingual nerve and the clinical significance?

A

Positioned anterior to inferior alveolar nerve
Risk of injury in floor of mouth during dental surgery
Lingual nerve - responsible general somatic afferent (sensory)

66
Q

What is the chorda tympani?

A

Carries presynaptic parasympathetic fibres to submandibular ganglion
Gives secretomotor innervation to salivary glands

67
Q

What are the branches of the facial nerve?

A

Has 5 branches:
Temporal - supplies all temporal region

Zygomatic - goes over zygoma, supplies nasalis and zygomaticus muscle

Buccal - supplies this muscle

Mandibular - facial skin in the lower third of the face, including the chin and lower lip. Inferior row of teeth and gingiva. The anterior two thirds of the tongue.

Cervical - supply upper aspect of neck

Also gives off posterior auricular nerve and passes through the parotid gland

68
Q

What is the clinical significance of the facial nerves going through the parotid gland?

A

Must be careful in surgery - if have tumour and need to transect gland need to be careful to not damage nerves

All traverse through parotid gland but gland is NOT supplied by facial nerve
Nerves run inferiorly along and away from the angle of the mandible

69
Q

What is Bell’s Palsy?

A 
Occurs when nerve becomes inflammed, swollen or compressed - causes temporary paralysis muscles on face 
Symptoms - 
Anhydrosis 
Myosis (constriction pupils)
Paralysis on one side
70
Q

How can you distinguish Bell’s palsy from a stroke?

A

Distinct from stroke because can’t move eyebrows

71
Q

What do higher lesions of CNVII cause?

A

Causes loss of taste anterior 2/3 tongue

72
Q

How can you anaesthetise part of the face?

A

Can do infraorbital nerve block as it leaves through infraorbital foramen

73
Q

At what level does the R+L common carotid bifurcate?

A

Bifurcate at C4

74
Q

What does the external and internal carotid supply?

A

External branch supplies face

Internal continues up through the foramen lacerum (carotid canal) to supply brain

75
Q

What are the branches of the external carotid?

A

1st branch - superior thyroid artery (supplies thyroid)

2nd branch - lingual artery (tongue)

3rd branch - facial artery (loops over and continues) and ascending palatine (soft palatte and hard palatte)

4th branch - ascending pharyngeal (supplies pharynx)

76
Q

Where do the branches of the external carotid go through?

A

Traverse through parotid gland
Travels with the retromandibular vein - from the external jugular
Gives off temporal and facial arteries

77
Q

Describe the course of the facial artery

A

Facial artery begins inferior and loops under mandible, anterior to masseter
Goes up (branches) help supply upper aspect of nose and branches to lips
Tortuous artery
Once goes through parotid = transverse facial artery

78
Q

Describe the course of the superficial temporal artery

A

Comes off external carotid, runs in front of ear (pulse in region)

79
Q

What is temporal arteritis?

A

Potentially serious inflammation arteries, can cause blindness/stroke/aneurysm/ischaemic attack

80
Q

Describe the course of the facial vein

A 
Facial vein drains into cavernous sinus 
Cavernous sinus (in cranial cavity - network small veins w/in infratemporal fossa) drains into pterygoid via emissary veins (network of trabeculae underneath)
Superior and inferiorly alveolar veins go back to pterygoid plexus 
All veins drain into retromandibular vein behind
Pass through parotid gland (w/external carotid and facial nerve)
Drains into internal and external jugular vein
81
Q

What is the danger triangle?

A

Facial vein connects with cavernous sinus and superior opthalmic vein
Pterygoid venous plexus connects through inferior opthalmic and deep facial veins
˙.˙ no valves - blood from face may enter sinus
Can cause cavernous sinus thrombosis, meningitis, brain abscess
Danger for spread of infection

82
Q

What are the branches of the maxillary artery?

A

Arises from the external carotid
Divided into 3 parts with 5 branches arise from each part
Relate to lateral pterygoid muscle - before, on and beyond

1st and 3rd part enter foramina in skull
Those from 2nd part supply muscles

83
Q

What is the foramen spinosum?

A

Opening in sphenoid area

84
Q

Through which foramena does the middle meningeal artery travel through?

A

Middle meningeal and accessory meningeal artery go through foramen spinosum and foramen ovale
Runs over pterion

85
Q

What is the practical implications of the middle meningeal artery?

A

Middle meningeal artery enters skull through foramen spinosum
Runs across sutures between temporal and other bones of the skull - pterion
.˙. blow to side of the head can damage walls of the artery -> can cause extradural haematoma being potentially fatal

86
Q

Describe the branches of the maxillary artery

A

1st part - branches to inferior alveoli loop down and come out through mental foramena
Supplies incisors and teeth

2nd part - for pterygoids (medial and lateral)
Masseterica branch also

3rd part - Goes deeper and gives off branches through infraorbital foramen
Gives off palatine branches (descending palatine)

87
Q

Describe the course of the lymph nodes

A

Have lymph nodes along entirety of jugular system

Allows drainage of lymph - important when dealing w/ cancer patient

88
Q

What are the cervical nodes?

A

Submental, submandibular and deep cervical nodes

89
Q

Where does the pharyngeal plexus drain into?

A

SVC

90
Q

What do we need to feel for when trying to examine raised interjugular venous pressure?

A

External jugular vein
Feel during heart failure
Jugular vein goes over SCM

91
Q

Describe the structures inside the oral cavity

A

Soft and hard palatte
Uvula - anyone w/ stroke can identify which CN been affected
Palatopharyngeal arch - inner aspect at back of pharynx
Palatoglossal arch - outer aspect
Posterior wall of the pharynx
Palatine tonsil - sits in between 2 arches

92
Q

What is the palatine foramena?

A

There is a greater and lesser foramena

Allows transmission veins and arteries

93
Q

What is at the back of the nasopharynx?

A

Opening of auditory canal (eustachian tube) - goes to middle ear cavity

94
Q

What is the frenulum of the tongue?

A

Lift tongue to roof

Big veins run either side

95
Q

What produces saliva?

A

Sublingual gland - 75%
Parotid gland - 25%
Submandibular

96
Q

Where does the saliva drain into?

A

Parotid papilla

97
Q

Where is the opening of the parotid duct?

A

By 2nd molar

Roughened area inside cheek, opening for saliva stimulated from parotid gland

98
Q

What is the blood supply, venous drainage and innervation of the parotid gland?

A

Blood supply -
Posterior auricular and superficial temporal arteries (branches external carotid)
Drainage via retromandibular vein

Innervation
Sensory - auriculotemporal nerve and great auricular nerve
Parasympathetic - begins with glossopharyngeal nerve CNIX
Synapses w/ otic ganglion to form the auriculotemporal nerve
Carries PS fibres to parotid gland - causes increase in saliva production

99
Q

What is the blood supply, venous drainage and innervation of the sublingual gland?

A

Blood supply:
Sublingual artery and submental artery (facial artery)
Venous drainage - sublingual and submental veins-> lingual and facial veins and internal jugular veins

Innervation:
PS - superior salivatory nucleus through pre-synpatic fibres via chordi tympani
Branch of facial nerve (CNVII)
Chorda tympani unifies w/ lingual branch mandibular nerve CNV2 before synapsing at submandibular ganglion and suspending it by z nerve filaments

Symp - originates superior cervical ganglion - where post-synaptic vasoconstriction fibres are a plexus on internal and external carotid arteries, facial artery, submental artery and sublingual arteries to enter each gland

100
Q

What is the innervation of the submandibular gland?

A

Innervation same as sublingual gland
Different portions chordi tympani come off facial nerve which exits through the stylomastoid foramen

Trigeminal ganglion fusion from other foramena eg. ovale, retundum
Gives off branches to lacrimal gland and face

101
Q

What is the hard palatte formed by?

A

Palatine process maxilla and horizontal plates of the palatine bones

102
Q

What is a papilloma and a tonsilith?

A

Papilloma = outgrowths on the tonsils (Aka. kissing tonsils)
get v. big
Krips in kids

Tonsilith = can grow and give indication of palatosis
Bacterial growths/pearls are pocketed

Clinical Anatomy (10 decks)

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