Head and neck original cards Flashcards
What is the nerve supply to the digastric muscle?
Anterior belly: V3–> inferior alveolar nerve–> nerve to mylohyoid
Posterior belly: facial nerve
Complications of thyroid surgery
Nerve injury
-Superior laryngeal: damage to cricothyroid, loss of high pitched voice
-Recurrent laryngeal: difficulty in phonation if unilateral, airway obstruction if b/l
-Hypocalcaemia
-Seroma
Nerves at risk during submandibular gland surgery
A facial sandwich
-Marginal mandibular branch of facial nerve
-Lingual nerve
-Hypoglossal
-Nerve to mylohyoid
Describe blood supply to thyroid gland
-superior thyroid arteries (branch external carotid)
-Inferior thyroid arteries (branch thyrocervical trunk of subclavian)
-Thyroid ima (<10%) (brachiocephalic, aortic arch)
Name nerves at risk during carotid endarterectomy
Ho’s like sucking great men’s anuses
- Hypoglossal
- Lingual
- Superior laryngeal branch (of vagus nerve)
4: greater auricular
5: Marginal mandibular
6: ansa cervicalis
Name branches ophthalmic division trigeminal
NFL
-Nasociliary
-Frontal –> supraorbital, supratrochelar
-Lacrimal –> anterior/post ethmoidal, infratrochlear
Name branches maxillary btranch trigeminal
-INfraorbital
-Zygomatic
-Superior alveolar
-Palatine
-Pharyngeal
-Superior labial
What muscles do the marginal mandibular branch facial nerve supply?
-Depressor labii inferioris
-Depressor anguli oris
-Mentalis
What is surgical significance of course of marginal mandibular nerve?
Nerve runs inferior to mandible, is at risk of injury during surgery to submandibular gland excision/carotid endarterectomy
Branches external carotid artery
Some Anatomists Like Freaking out poor medical students
-Superior thyroid
-Ascending pharyngeal
-Lingual
-Facial
-Occipital
-Posterior auricular
-Maxillary
-Superficial temporal
Name branches facial nerve before it exits stylomastoid foramen (and their functions)
-Greater petrosal (parasympathetic to lacrimal glands)
-Nerve to stapedius (controls amplitude of sound waves
-Chorda tympani
–> sensory (taste anterior 2/3rd tongue)
–> parasympathetic (submandibular/sublingual)
Name extracranial branches of facial nerve before it enters parotid gland
Arseholes die slowly
-posterior auricular
-Posterior belly digastric
-Branch to stylohyoid
Name branches of facial nerve within substance parotid gland
Ten zulus buggered my cat
temporal
zygomatic
buccal
marginal mandibular
cervical
Branches mandibular branch V after exiting foramen ovale
-Nerve to medial pterygoid
-Tensor tympani
-Tensor veli palatini
-Then divides into anterior and posterior division
Describe anterior and posterior division V3
Anterior: 3 motor, 1 sensory
Posterior: 1 motor, 3 sensory
Anterior
-Motor nerves: masseteric, deep temporal, lateral pterygoid
-Sensory: buccal
Posterior:
-Motor: inferior alveolar (mixed nerve that gives nerve to mylohyoid–> supplies mylohyoid and anterior belly digastric)
-Sensory: inferior alveolar, auriculotemporal, lingual
Describe sensory branches V3
BAIL
Buccal
Auriculotemporal
Inferior alveolar
Lingual
Describe branches V3
Branches after exiting foramen
-Medial pterygoid
-Tensor tympani
-Tensor veli palatini
-Then divides into anterior and posterior division
Anterior division:
-Motor: masseteric, deep temporal, lateral pterygoid
-Sensory: buccal
Posterior division
-Motor-inferior alveolar
-Sensory-inferior alveolar, auriculotemporal, lingual
Which nerves lie in cavernous sinus?
3, 4, V1, V2, 6 (6 lies in centre, others lie on lateral wall-therefore first to be affected in cavernous sinus thrombosis)
Which arteries supply kiesselbach’s plexus
LEGS
-Facial artery–>labial–> superior labial
-Ophthalmic –> ethmoidal –> anterior ethmoidal
-Maxillary –. greater palatine
-Maxillary artery –> sphenopalatine artery
Which nerves supply external ear?
Inferior: greater auricular (branch of cervical plexus C2,3)
Superior aspect: auriculotemporal (branch of V3)
Middle: lesser occipital (branch of cervical plexus C2)
External acoustic meatus: branches auriculotemporal + vagus (auricular branch vagus known as arnold’s nerve)
Name intrinsic muscles of tongue
Superior longutudinal
Inferior longitudinal
Transverse muscles
Vertical muscles
Name extrinsic muscles of tongue and their actions
Genioglossus: protrusion
Hyoglossus: depression
Styloglossus: elevation and retraction
Palatoglossus: depression of soft palate and elevation back of tongue
What is the motor supply of the tongue?
Hypoglossal nerve, except palatoglossus –> vagus nerve (via pharyngeal plexus)
What is sensory supply of tongue?
Anterior 2/3rd:
-General sensation: lingual nerve (branch V3)
-Taste sensation: chorda tympani (branch VII)
Posterior 2/3rd:
-Taste and general sensation: glossopharyngeal
Name muscles of mastication
Temporalis
Masseter
Lateral pterygoid
Medial Pterygoid
Which nerve supplies muscles of mastication?
Mandibular division (V3) of trigeminal nerve)
Name boundaries of infratemporal fossa
Medial: lateral pterygoid plate
Lateral: madibular ramus, coronoid process
Anterior: maxilla
POsterior: tympanic plate, mastoid and styloid processes temporal bone
Contents infratemporal fossa
Muscles: medial pterygoid, lateral pterygoid, temporalis and masseter originate and insert into its borders
Vessels: Maxillary artery, pterygoid venous plexus
Nerves: V3 and branches, otic ganglion, chorda tympani (follows course of lingual)
Nerves: contents of OVALE
What is function of ciliary ganglion
Associated with oculomotor nerve, contributes to pupillary and accommodation reflex
What is function of pterygopalatine/sphenopalatine ganglion
Associated with greater petrosal nerve (branch of facial nerve) supplying lacrimal gland, paranasal sinuses and glands in palate and nasal cavity
What is function of submandibular ganglion
Associated with chorda tympani and lingual nerve supplying submandibular and sublingual glands
Otic ganglion
Associated with glossopharyngeal nerve secretomotor to parotid gland
What are the 4 main ganglia in head and neck region
Otic
Pterygopalatine
Submandibular
Ciliary
Describe course of retromandibular vein
Superficial temporal + maxillary–>retromandibular vein–> anterior and posterior branches
Anterior + anterior facial vein–> common facial–> IJ
Posterior + posterior auricular–> external jugular–> subclavian
-Formed by superficial temporal + maxillary
-Descends within parotid deep to facial nerve
-Then divides into anterior + posterior branches
-Anterior branch joins anterior facial vein to form common facial vein –> drains into IJ
-Posterior branch units with post. auricular vein to form ext jugular, drains into subclavian
Structures that attach to styloid process
3 muscles, 2 ligament
Stylohyoid
Styloglossus
Stylopharyngeus
Stylohyoid ligament
Stylomandibular ligament
Structures attaching to mastoid process
Sternocleidomastoid
Posterior belly digastric
Splenius capitis
Longissimus capitis
Name the structures within the substance of the parotid gland
For REAL
Superficial to deep:
-Facial nerve: 5 branches of facial nerve divide within parotid
-Retromandibular vein
-External carotid
-Branches great auricular nerve
-Lymph nodes
What is Frey’s syndrome
-Gustatory sweating and erythema in territory auriculotemporal nerve
-Auriculotemporal nerve carries parasympathetic innervation to parotid gland
-Syndrome caused by misdirected healing, causing parasympathetic fibres to join sympathetic fibres of superior cervical ganglion which supply sweat glands and blood vessels
-Therefore erythema and sweating instead of salivation
What is the functional loss due to oculomotor nerve palsy?
-Loss of levator palpebrae superioris, inferior oblique, medial, superior and inferior recti, sphincter pupillae
-Down and out position of eye
-Ptosis + mydriasis (pupil dilatation)
-Pupillary dilatation is due to denervation of parasympathetic fibres carried along with oculomotor nerve
What is horner’s syndrome?
Caused by disruption of sympathetic trunk (arising from spinal cord in chest to supply head and neck) on ipsilateral side
Ptosis
Anhydrosis
Miosis (shrinking of pupil)
Enophthalmos (sunken eyes)
Loss of ciliospinal reflex: pupillary dilatation in response to pinching neck
What is anterior cord syndrome? what are its causes
Causes:
-trauma to vertebra
-spinal disc herniation
-damage to aorta
-Interruption anterior spinal artery, supplying anterior 2/3rd spinal cord
-Complete loss of muscle strength below level of injury due to loss of descending motor fibres in corticospinal tract
Sensation:
–> loss of pain and temperature
–> retain proprioception/vibration sense/fine touch
What is brown-sequard syndrome? what are its causes?
Causes:
-Spinal cord tumours
-Trauma
-Ischaemia
-Infections (TB)
-Inflammatory and autoimmune disease
Implications
-Loss of sensation and motor function due to lateral hemi-section spinal cord
-Ipsilateral spastic paralysis below level of lesion
-Ipsilateral loss vibration, proprioception and fine touch
-Contralateral loss of pain and temperature
Layers of lumbar puncture
- skin
- subcutaneous tissue
- supraspinous ligament
- interspinous ligament
- ligamentum flavum
- epidural space containing the internal vertebral venous plexus
- dura mater
- arachnoid mater
- subarachnoid space
Describe anatomy of cervical plexus
-Plexus of C1-C4
-Anastamose with accessory nerve, hypoglossal nerve, sympathetic trunk
-Has muscular and cutaneous branches
Name the four cutaneous branches of cervical plexus
-Lesser occipital nerve (C2 only): innervates lateral occipital region
-Greater auricular nerve (C2,3): Inferior external ear, parotid region
-Transverse cervical nerve (C2,3): anterior region of neck
-Supraclavicular (C3,4): clavicular region, shoulder
Name four muscular branches of cervical plexus and their innervation
Communicating branches (C1): geniohyoid and thyrohyoid
Ansa cervicalis (C1-3): innervates sternohyoid
Segmental (C1-4): supplies anterior and middle scalene
Phrenic (C3-5): diaphragm and pericardium
Horner’s syndrome vs 3rd nerve palsy
Eyelid
-Horner’s syndrome: partial ptosis –> symp fibres control superior tarsal muscle (maintains elevation of eyelid)
-3 Palsy-: complete ptosis –> controls levator palpebrae superioris–> opens eyelid
Pupil
-3: mydriasis
-Horners: miosis
Sweating
-Sweating vs non sweating
Horner’s: loss of ciliospinal reflex
Causes of horner’s
1st order neurone lesion:
-MS
-Brainstem tumour
2nd order neurone lesion
-Apical lung tumour
-Apical TB
3rd order neurone lesion
-Herpes zoster
