Head And Neck Part 3 Flashcards
Where does the internal jugular vein begin?
The Jugular Foramen
*CN IX- glossopharyngeal
*CN X- Vagus
*CN XI- Accessory nerve
*These nerves all pass out the jugular foramen
Where does CN XI (Accessory Nerve) pass through?
Passes through
1. Foramen magnum then INTO
2. Posterior Cranial Fossa next passes OUT TO
3. Jugular foramen and into neck
*Supplies the SCM and Trapezius
Does the Vagus Nerve (CN X) supply the stylopharyngeus muscle?
No
*CN X motor to most pharyngeal muscles
What does the Glossopharyngeal Nerve (CN IX) supply?
- Stylopharyngeus muscle
- Sensory to pharyngeal mucosa
*sensory limb of gag reflex
Where is the sympathetic trunk located on the posterior side of the pharynx?
Between the pharynx and prevertebral muscles inthe neck
To get to the target of Superior Cervical ganglion where do the axons come from? (Pharynx posterior aspect)
Preganglionic sympathetic axons from T1 spinal cord
Where do the postganglionic sympathetic axons go to?
They jump on the Internal Carotid Artery to
1. Enter the head and SUPPLY
*Superior Tarsus muscle
*Dilator Pupillae
*Sweat glands
*Smooth muscle of skin vasculature
If there is a lesion of the sympathetic pathway of the head what will happen?
Horners syndrome ipsilateral
1. Mild ptosis of the upper eyelid
2. Pupillary contradiction
3. Anhidrosis (no sweating)
4. Flushed skin
What are the functions of the Larynx?
- Valve to regulate air flow to and from lungs
- Traps air during cough, sneeze or increase intrabdominal pressure
- Protects the airway during swallowing
- Phonation- sounds generated by vocal cord vibration
What is the difference between phonation, articulation and resonance?
Articulation and Resonance involve the
1. Tongue
2. Soft palate
3. Lips
4. Pharynx
5. Oral and nasal cavities
What is the origin and insertion of the Cricothyroid muscle?
O: Cricoid cartilage
I: Thyroid cartilage
What is the nerve supply and action of the cricothyroid muscle?
A: Tilts thyroid cartilage forward, lengthening the vocal folds, putting tension on them
Nerve Supply: External Laryngeal Nerve
At the Cricoarytenoid joint what movements can the Arytenoid cartilages do?
- Move medially and laterally
- Rotate in horizontal plane
- Move anteriorly and posteriorly
What are the vocal ligament differences between men and women?
Men:
1. visible laryngeal prominence
2. Longer vocal cords
Women:
1. Difficult to see laryngeal prominence
2. Shorter vocal cords
What is the vestibule between?
- Laryngeal inlet
- vestibular fold
What is the space between the vestibular folds called?
Ventricle
What is the Rima Glottids?
Slit between the vocal folds
What is the infraglottic cavity
Inferior to vocal folds
*between the vocal fold and trachea
What is the origin and insertion of the Posterior Cricoarytenoid muscle?
I: muscular process of the arytenoid cartilage
O: Cricoid cartilage
What is the action of the posterior Cricoarytenoid muscle?
Sole abductor of the vocal folds
1. Muscular process rotates in
2. Vocal process rotates out
3. Vocal folds move away from midline
What is the attachment point of the Arytenoid muscle?
Arytenoid cartilages
What is the action of the arytenoid muscles?
Adducts vocal folds
1. Arytenoid cartilages are drawn closer together
2. Rima glottidis becomes narrower
What is the origin and insertion of the lateral Cricoarytenoid muscle?
I: muscular process of the arytenoid cartilage
O: Cricoid cartilage
What is the action of the Lateral Cricoarytenoid muscle?
Adducts the vocal folds
1. Muscular process is pulled forward and laterally
2. vocal process is rotated toward the midline
3. Vocal folds are brought closer together reducing the width of the Rima glottidis
What is the origin and insertion of the thyroarytenoid muscle?
I: arytenoid cartilage
O: Thyroid cartilage
What is the action of the thyroarytenoid muscle?
Relaxes the vocal folds
1. vocal folds are shortened and laced
2. Arytenoid cartilage is pulled anteriorly
How is the Rima Glottidis in its normal position/
Narrow
How is the Rima Glottidis during forced respiration?
Wide
How is the Rima Glottidis during whispering?
Narrow anteriorly BUT
1. Open between the arytenoid cartilages
*allowed by the lateral Cricoarytenoid muscles
How is the Rima Glottidis during phonation (speech)?
narrow
*allowed by the Arytenoid muscles
During coughing what happens?
- Abduction of the vocal cords to allow for a gasp of air
- muscles contract to close off the Rima Glottidis
*there will be increased thoracic pressure - Sudden abduction of the vocal foes causes the trapped air to erupt as a cough
What happens during micturition, defecation and parturition?
- Rima glottidis is closed by the adductors of the vocal folds
- Abdominal musculature contract to build up intra-abdominal pressure
- Aids in the performance of the three actions
What is the nerve supply of the Cricothyroid muscle?
External Laryngeal nerve (branch of CN X (Vagus))
What pierces through the Thyrohyoid membrane?
Internal Laryngeal Nerve (branch of CN X (vagus))
*sensory to laryngeal mucosa superior to the vocal folds
What happens if the internal laryngeal nerve is damaged?
Diminished cough reflex
Where is the inferior and recurrent laryngeal nerve located?
Inferior: distal to cricothyroid joint
Recurrent: Proximal to Cricothyroid joint
What happens is there is unilateral or bilateral damage to the Recurrent laryngeal nerve?
Unilateral: Hoarseness of speech
Bilateral: Obstruction or airway
What is the blood supply of the larynx?
- Superior Laryngeal Artery
- Inferior Laryngeal Artery
What is the function of the auditory tub?
- Communication between Nasopharynx and middle ear cavity
- Allows pressure within the middle ear to be equalized with ambient pressure
Why is otitis media more common in children?
BC the auditory tube is more horizontal making drainage les efficient
What are the different way that Otitis Media can spread?
- Inferiorly into the Internal Jugular vein=Trombophlebitis
- Superiorly through the Tegmen Tympani=Meningitis
- Posteriorly into the Mastoid Air Cells= mastoiditis
What is deep to the Torus Levatorius?
Levator Veli Palatini Muscle
What is the action of the Levator Veli Palatini muscle?
Elevates the soft palate
*CN X (vagus)
What is Tensor Veli Palatini muscle deep to?
Medial plate
*CN V3 (trigeminal-mandibular)
Where does Tensor Veli Palatini muscle hook around?
The Hamulus of the medial plate
What is the action of the Tensor Veli Palatini Muscle?
Elevates the soft palate by putting lateral tension on it
What are the soft palate muscles?
- Tensor Veli Palatini muscle
- Levator veli Palatini muscle
What is the motor supply of the tensor Veli Palatini muscle and Levator Veli Palatini muscle?
Tensor: CN V3 (trigeminal-mandibular)
Levator: CN X (vagus)
What is the origin of the Tensor Veli Palatini muscle?
O: Scaphoid Fossa
What is the Choana (Posterior Nares)
Opening between the Nasopharynx and Nasal Cavity
What bones comprise the nasal septum?
- Septal cartilage
- vomer
- Ethmoid bone
What are the bones on the Lateral Nasal Wall?
- Frontal Bone
- Crista Galli
- Ethmoid bone
*superior/middle Concha - Inferior concha
- Palatine Process of the maxilla
- Palatine bone
- Sphenoid bone
What are the Superior, Middle, and inferior Conchae covered with?
Mucosa that humidifies air as it passes into the respiratory system
What is the superior meatus space between?
- Superior Concha
- Middle Concha
What is the middle meatus (space) between?
- Middle Concha
- Inferior Concha
What is the inferior meatus (space) between?
- Inferior Concha
- Hard palate
What is the Hard Palate composed of?
- Palatine process of the Maxilla
- Horizontal Plate of the Palatine bone
What does the Cribriform Plate of the Ethmoid Bone contain?
Olfactory Foramina For CN I (olfactory)
Where do the olfactory nerve pass through?
Olfactory Foramina
*In Cribriform Plate
What does the Frontal Sinus have access to?
- Semilunar Hiatus (in Middle Meatus)
What is the Ethmoidal Bulla?
Opening between
1. Ethmoid Air Cells
2. Middle meatus
What does the Nasolacrimal duct have access to?
Inferior Meatus
What does the maxillary Sinus have access to?
Semilunar Hiatus (In middle meatus)
What does the Ethmoid air cells have access to?
Superior meatus
What does the Spehnoid sinus have access to?
Sphenoethmoidal recess
How does CSF Rhinorrhea happen?
- Fracture of the Cribriform Plate with tearing of the attaché Dura and Arachnoid mater
- CSF can leak into the nasal cavity then
- Drain from the anterior nares
What is the oropharynx between?
- Soft palate
- Epiglottis
*oral cavity and pharynx
What is deep to the Palatoglossal fold?
Palatoglossus muscle
What is deep to the palatopharyngeal fold?
Palatopharyngeus muscle
Where is CN IX (Glossopharyngeal nerve) located in the oropharynx
Deep to Palatine Tonsil
*General sensory (touch and pain)
*Special sensory (taste buds)
-Supplies the posterior (1/3) of the tongue and mucosa
What does the mucosa cover?
Pharyngeal constrictor muscles
Why does the Gag reflex happen?
Sensory: CN IX (glossopharyngeal nerve)
Motor: CN X (vagus), CN IX (motor to stylopharyngeus muscle)
What is the fauces?
Opening between Oropharynx and Oral cavity
*between tongue, soft palate, and left and right palatoglossal folds
What supplies the Root of the tongue?
CN IX (glossopharyngeal nerve)
*General sensory (touch and pain)
*Special sensory (tase buds)
What supplies the body of the Tongue?
- General sensory (Lingual nerve (branch of CN V3- trigeminal (mandibular)))
- Special sensory (Chorda Tympani (branch of CN VII (facial))
What is the Terminal Sulcus
Separates Body and Root of the Tongue
What muscles help move the tongue?
- Palatoglossus muscle
- Styloglossus muscle
- Hyoglossus muscle
- Genioglossus muscle
What is the action of the Palatoglossus muscle?
Elevates the tongue
*CN X (vagus)
What is the action of the styloglossus muscle?
Retracts and elevates the tongue
*CN XII (Hypoglossal)
What is the action of the hyoglossus muscle?
Retracts and Depresses the Tongue
*CN XII (Hypoglossal)
what is the action of the genloglossus muscle?
Protrudes the tongue
*CN XII (hypoglossal)
What is Ankyloglossia?
Congential condition where
1. The Frenulum of the tongue is short and thickened restricting tongue movements
What is the Sublingual Caruncle?
Opening of submandibular duct from submandibular gland
What is the parasympathetic innervation of the oral cavity?
- Chorda tympani (joins lingual nerve)
*Preganglionic axons parasympathetic to submandibular and sublingual glands
Where does the Chorda tympani and lingual nerve synapse?
Submandibular Ganglion
*contain postganglionic neuronal cell bodies that SUPPLY
*Submandibular and sublingual glands
Where does the lingual artery run deep to? (In oral cavity)
Deep to the hyoglossus muscle
Where does the Hypoglossal nerve (CN XII) run? (In oral cavity)
Superficial to hyoglossus muscle
What is the nerve supply of the tongue?
Hypoglossal nerve (CN XII)
*motor to tongue (mainly Genioglossus muscle)
If there is a CN XII lesion where does the tongue point to?
To the side of the damaged CN XII (hypoglossal) lesion or weak muscle
What happens if there is a CN X lesion?
Ipsilateral Levator Veli Palatini Muscle is weakened
*Uvula is pulled away from midline (away from lesion)
What is the nerve supply of the Palatoglossus muscle?
CN X (Vagus)
What are the laryngeal muscles?
- Cricothyroid muscle
- Posterior cricothyroid muscle
- Arytenoid muscle
- Lateral Cricoarytenoid muscle
- Thyroarytenoid muscle
What are the pharyngeal muscles?
Pharyngeal Constrictor Muscles
Stylopharyngeus Muscle
Palatopharyngeus Muscle
