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Semester 4 > Head And Neck Session 8 > Flashcards

Head And Neck Session 8 Flashcards

1
Q

What is seen in a patient with complete oculomotor nerve palsy proximal to the ciliary ganglion?

A

Down and out pupil, ptosis, dilated pupil and loss of accommodation reflex

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2
Q

What is seen in a patient with complete oculomotor nerve palsy distal to the ciliary ganglion?

A

Down and out pupil, ptosis but not pupillary involvement

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3
Q

What is the anatomical oculomotor nerve proper?

A

Pure somatic efferent nerve that supplies all extra ocular muscles including LPS but excluding lateral rectus and superior oblique

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4
Q

Where is the origin of the anatomical oculomotor nerve proper?

A

Oculomotor nucleus in the midbrain

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5
Q

What are the important anatomical landmarks of the anatomical oculomotor nerve proper?

A

Cavernous sinus, uncus, tentorial notch, superior orbital fissure

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6
Q

What is the uncus?

A

Part of the temporal lobe

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7
Q

What is the tentorial notch?

A

Infolding of dura mater

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8
Q

What happens to the anatomical oculomotor nerve proper between the superior orbital fissure and tendinous ring of the orbit?

A

Divides into superior (dorsal) and inferior (ventral) branches

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9
Q

Which other cranial nerve is the oculomotor nerve closely associated with?

A

Optic

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10
Q

What is indicated by a patient presenting with unilateral pupil dilation, loss of accommodation reflex but normal oculomotion and palpebral fissure?

A

Damage to Edinger-Westphal nucleus fibres spare the anatomical oculomotor nerve proper

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11
Q

Why is the clinically examined oculomotor nerve different form the anatomical oculomotor nerve proper?

A

Close proximity of parasympathetic fibres means they are often implicated in CNIII damage

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12
Q

Why is the pupil dilated in complete palsy of CNIII proximal to the ciliary ganglion?

A

Sphincter pupillae is dennervated and intact sympathetics cause unapposed dilator pupillae action

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13
Q

Where does the clinical examined oculomotor nerve arise from?

A

Edinger-Westphal nucleus in midbrain

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14
Q

Which nerve is the longest cranial nerve carrying sensory, motor and autonomic fibres from the superior cervical ganglion?

A

Trigeminal

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15
Q

Where does the ophthalmic branch of the trigeminal nerve originate?

A

Trigeminal/semilunar/gasserion ganglion

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16
Q

What is the function of the ophthalmic branch of the trigeminal nerve?

A

Purely sensory to the skin of upper eyelid, eyebrow, forehead, nose, cornea conjunctiva, lacrimal gland, ciliary body, iris, mucous membrane of nasal cavities and meninges

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17
Q

What are the branches of the ophthalmic branch that arise after it has passed through the superior orbital fissure?

A

Supratrochlear, supraorbital, lacrimal, infratrochlear, external nasal

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18
Q

Where does the maxillary branch of the trigeminal nerve arise from?

A

Trigeminal/semilunar/Gasserion ganglion

19
Q

What is the function of the maxillary branch of the trigeminal nerve?

A

Purely sensory to the skin of the lower eyelid, side of nose, upper lip, cheek, nasal cavities, upper teeth and their gums

20
Q

What branches are formed after the maxillary branch and passed through the foramen rotundum?

A

Infraorbital, zygomatic official and zygomaticotemporal

21
Q

Where does the mandibular branch of the trigeminal nerve arise from?

A

Sensory from trigeminal ganglion, motor from 5th nerve motor nucleus in pons

22
Q

What branches are formed after the mandibular branch passes through the foramen ovale?

A

Auriculotemporal, buccal and mental

23
Q

How is the mandibular branch of the trigeminal nerve tested clinically?

A

Move jaw against resistance

24
Q

What components form the facial nerve?

A

Somatic and visceral efferents with special and general sensory afferents

25
Q

Which other cranial nerve does the facial nerve later join the afferents of?

A

Trigeminal

26
Q

Describe the somatic motor portion of the facial nerve.

A

Arises in facial motor nucleus in pons, forms large motor root, travels along facial nerve

27
Q

What forms the nervous intermedius that travels with the greater petrosal nerve?

A

Autonomic fibres from the superior salivatory nucleus

28
Q

What does nervous intermedius supply?

A

Lacrimal, submandibular, sublingual, nasal and palatine glands

29
Q

What forms the sensory root in the pons (nucleus solitarius)?

A

Sensory fibres of facial nerve and primary sensory neurones in geniculate ganglion

30
Q

What does the special sensory portion of nervous intermedius provide?

A

Taste to anterior 2/3 of tongue and soft palate

31
Q

What does the general sensory portion of nervus intermedius provide?

A

Sensation to auricle of ear via the trigeminal nerve

32
Q

What is the origin of the facial nerve?

A

Oculomotor nucleus in the midbrain

33
Q

Where is the cranial exit of the facial nerve?

A

Stylomastoid foramen

34
Q

What are the anatomical landmarks of the facial nerve?

A

IAM, petrous portion of temporal bone and facial canal

35
Q

Which are the targets of the facial nerve found in the middle ear along the length of malleus?

A

Chorda tympani and anterior 2/3 of tongue

36
Q

What are the targets of the branches from the pterygopalatine ganglion?

A

Lacrimal gland and nasal and oral cavity mucous membranes

37
Q

What are the targets for the fibres from the submandibular ganglion?

A

Sublingual and submandibular glands

38
Q

What are the targets of the fibres that pass through the stylomastoid foramen?

A

Effector organs, parotid sheath and gland

39
Q

What is Redlich-Obersteiner’s zone?

A

Boundary between CNS and PNS where Schwann cell myelin meets oligodendrocyte myelin therefore is a point of higher risk of neurovascular compression

40
Q

What are the branches of the facial nerve that arise in the parotid gland?

A

Temporal, zygomatic, buccal, mandibular, cervical

41
Q

What are the clinical signs of complete CNVII palsy?

A

Facial asymmetry with the following on the affected side: loss of naso-labial fold, lacrimation, oral and nasal secretomotor function, complete upper eyelid ptosis, loss of blink reflex, stasis of tears, oral incompetence

42
Q

Why can most people with complete CNVII palsy frown?

A

Frontalis muscles are bilaterally innervated and bilateral damage is rare

43
Q

How does Bell’s palsy differ from any other complete CNVII palsy in terms of symptoms?

A

Usually temporary (

44
Q

When is the motor aspect of CNVII at risk of damage?

A

Forceps delivery, parotid gland disease, inflammation of facial canal, tympanectomy, surgery at the infratemporal fossa

Semester 4 (33 decks)

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