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Head II Flashcards

1
Q

Innervation of the masseter muscle

A

Innervated by the massateric nerve which is a branch of the anterior trunk of the mandibular nerve V3

O: Zygomatic arch and maxillary process of the zygomatic bone

I: Lateral surface of the ramus of the mandible

F: Elevation of the mandible

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2
Q

Innervation of temporalis muscle

A

Innervated by the deep temporal nerves from the anterior tunk of the mandibular nerve V3

O: Temproal fossa and temporal fascia

I: Coronoid process of the mandible and anterio rmargin of the ramus of mkandible

F: Elevation and retraction of the mandible

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3
Q

Innervation of the medial pterygid muscle

A

Innervated by the nerve to the medial pterygoid from the mandibular nerve V3

O:
Deep head - Medial surface of lateral plate of pterygoid process and pyramidal process of palatine bone
Superficial head - tuberosity and pyramidal process of the maxilla

I: Medial surfcae of mandible near angle

F: Elevation and side-to-side movements of the mandible

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4
Q

Innervation of the lateral pterygoid muscle

A

Innervated by the nerve to the lateral pterygoid muscle which is a branch of the anterior trunk of the mandibular nerve V3 or from the buccal branch

O:
Upper - roof of infratemporal fossa
Lower - lateral surface of the lateral plate of the pterygoid process

I: Capsule of the temporomandibular joint in the region of the articular disc and to pterygoid fovea on neck of mandible

F: Protrusion and side-to-side movements of mandible

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5
Q

Blood supply to the temporalis

A

Deep temporal arteries

Middle temporal artery (penetrates temporal fascia at the posterior end of the zygomatic arch)

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6
Q

Deep temporal nerves

A

Two in number

Branches of anterior trunk of mandibular nerve V3

Pass superiorly around infratemporal crest of greater wing of sphenoid to enter temporal fossa deep to temporalis

Supply temporalis

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7
Q

Zygomaticotemporal nerve

A

Branch of the zygomatic nerve

Zygomatic nerve is a branch of the maxillary nerve V2 which originates in the pterygopalatine fossa and passes into the orbit

Zygomaticotemporal nerbe enters the temporal fossa through foramine in temporal surface of the zygomatic bone

Supply skin of the temple

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8
Q

Deep temporal arteries

A

Normally two in number, branch from the maxillary artery in the infratemporal fossa

Pass with the two deep temporal nerves around the infratemporal crest of the greater wing of sphenoid

Supplies temporalis and anastomoses with middle temporal artery

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9
Q

Middle tempora artery

A

Branch of the superficial temporal artery just superior to zygomatic arch

Penetrates temporal fasciua and under temporalis muscle

Supplies temporalis and anastomoses with deep temporal arteries

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10
Q

Borders of the infratemporal fossa

A

Roof: Greater wing of sphenoid and temporal bone
-foramen spinosum, foramen ivale and pterygomandibular fissure

Lateral: Medial surface of ramus of mandible

Medial: lateral plate of pterygoid process and pharynx and levator veni palatini and tensor veli palatini

Anterior: Maxilla

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11
Q

Contents of the infratemporal fossa

A

Sphenomandibular ligament

Medial pterygoid muscle

Lateral pterygoid muscle

Maxillary artery

Mandibular neve V3

Branches of facial nerve

Branches of glossopharyngeal nerve

Pterygoid plexus of veins

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12
Q

Sphenomandibular ligament

A

Spine of sphenid bone –> lingula of mandible

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13
Q

Mandibular nerve V3

A

Largest branch of trigeminal nerve

Passes through formane ovale

Motor and sensory

Sensory:

  • Teeth and gingivae of mandible
  • Anterior 2/3rds of tongue
  • Mucosa on the floor of the oral cavity
  • Lower lip
  • Skin over the temple (zygomaticotemporal nerve)
  • Lower face
  • Cranial dura mater

Motor:

  • Muscles of mastication
  • Tensor tympani
  • Tensor vali palatini
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14
Q

Branches of the mandibular nerve V3

A

Motor and sensory component join in between the lateral pterygoid muscle and tensor vali palatini muscle in the infratemporal fossa

Branches:
Meningeal nerve
Nerve to medial pterygoid muscle

Then divides into anterior and posterior trunks

Anterior: Predominantly motor
Buccal nerve (sensory + motor)
Massateric nerve
Nerve to lateral pterydoid
Posterior: predominantly sensory
Auriculotemporal nerve
Lingual nerve
Inferior alveolar nerves
- branch from inferior alveola nerve = Nerve to mylohyoid (motor)
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15
Q

Path of the lingual nerve into oral cavity

A

Passes between posterior attachment of mylohyoid muscle to the mylohyoid line AND teh attachment of the superior constrictor to the pterygomandibular raphe

Lies in shallow groove on floor of oral cavity on medial side of mandible inferior to last molar tooth

At risk during dentistry in this position

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16
Q

Submandibular ganglion

A

Ganglion of the lingual nerve on the lateral surface of the hyoglossus

Contains post-ganglionic fibres for the parasympathetic nerve of the facial nerve (chorda tympani) to synapse with

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17
Q

Innervation of the mylohyoid and the anterior belly of the digastric

A

Inferior alveolar nerve of the posterior trunk of the mandibular nerve V3 of the trigeminal nerve

Branches to form the nerve to the mylohyoid muscle just prior to entering the mandibular formane
–> passes into mylohyoid groove

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18
Q

Branches of the inferior alveolar nerve

A

Itself is a branch of the posterior trunk of the mandibular nerve V3

It branches first to give off the nerve to mylohyoid which innervates the mylohyoid and anterior belly of the digastric

Then terminates as the incisive nerve and submental nerve

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19
Q

Branches of crnaial nerves joining the mandibular nerve in the infratemporal fossa

A

Chroda tympani
-Facial nerve

Lesser petrosal nerve
-Branch of tympanic plexus which originates fromthe glossopharyngeal nerve

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20
Q

Chorda tympani

A

Branch of the facial nerve within the temporal bone
Passes anteriorly through a canal and enters lateral aspect of the middle ear
Crosses middle ear between handle of malleus

Leaves through petrotympanic fissure into infratemporal fossa

Joins lingual nerve

Carries TASTE to anterior 2/3rds of the tongue
Parasympathetic supply to the salivary galnds below the level of the oral fissure

SA taste fibres do not pass through the submandibular ganglion
The parasympathetic fibres synapse in the submandibular ganglion

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21
Q

Lesser petrosal nerve

A

Contains parasynpathetic fibres destined for the parotid

Pre-ganglionic parasympathetic fibres in the glossopharyngealnerve exits the cranial cavity via the jugular foramen

Tympanic nerve branches from the glossopharyngeal either within or immediately outside of the jugular foramen

Tympanic nevre then re-enters the cranial cavity through inferor tymapnic canaliculus to the promontory of the labyrunthine wall of middle ear

Tympanic plexus occurs here

Lesser petrosal nerve is a branch containing preganglion parasympathetic fibres

Leaves the middle ear into middle cranial cavity through th lesser petrosal foramen

Passes back out via the forman ovale into the infratemporal fossa

Passes into otic ganglion, post-ganglionic fibres leave the ganglion and enter the auriculotemporal nerve which is a branch of the mandibular nerve

Carries parasympathetic fivres to the parotid gland

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22
Q

Branches of the maxillary artery

A

Three distinct parts

First part: between neck of mandible and spenomandibular ligament
-Middle meningeal artery
-Inferior alveolar arteries
(Deep auricular artery)
(Anterior tympanic artery)
(Accessory meningeal artery)

Second part: related to lateral pterygoid muscle

  • Deep temporal arteries
  • Massteric artery
  • Buccal artery
  • Pterygoid artery

Third part: pterygopalatine fossa

  • Posterior superior alveolar artery
  • Infra-orbital artery
  • Greater palatine artery
  • Pharyngeal branch
  • Sphenopalatine artery
  • Artery of the pterygopalatine canal
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23
Q

Middle menigeal artery

A

Ascends vertically from the first portion of the maxillary artery

Infratemporal fossa: passes between lateral pterygoid and spenomandibular ligament
Auriculotemporal nerve splits into two and wraps around it

Enters cranial cavity through the foramen spinosum

Travels in periosteal layer of the dura

Supplies much of the dura mater and bone

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24
Q

Inferior alveolar artery

A

Branch of the first branch of the maxillary artery
-supplies lower teeth, gingivae, chin and lower lip

Branch for the mylohyoid artery (with nerve to mylohyoid) prior to entery into mandible

Descends to enter the mandibular foramen with inferior alvolar nerve

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25
Connecting veins of the pterygoid plexus
Short maxillary vein connects to the retromandibular vein in the neck Deep facial vein connects to the facial vein on the face
26
Pterygopalatine ganglion
Within pterygopalatine fossa Contains Nerve of pterygopalatine canal joins containing (formed by greater petrosal and deep petrosal nevre): Preganglionic fibres from the greater petrosal branch of the facial nerve VII Postganglionic sympathetic fibres from the deep petrosal branch of the carotid plexus Fibres pass into the branches of the maxillary nerve V2
27
Maxillary nerve
Exits cranial cavtity through the formane rotundum and immediately enters the ptergopalatine fossa Meets pterygopalatine ganglion Branches: - Zygomatic nerve: divides into zygomaticotemporal and zygomaticofacial nerves - Posterior superior alveolar nerve - Orbital branches - Palatine branches: greater and lessser palatine nerves - Nasal branches - Pharyngeal branches Passes anteriorly through the fossa and exits as the infra-orbital nerve through the inferior orbital fissure -Branches into nasal, papebral and superior labial branches
28
Nerve of the pterygoid canal
Formed in the middle cranial fossa by union of: - Greater petrosal nerve (branch of facial nerve) - Deep petrosal nerve (branch of internal carotid plexus) Passes into pterygopalatine fossa to join with the pterygopalatine ganglion
29
Greater petrosal nerve
Originates fromt the geniculate ganglion of the facial nerve in the temporal bone Passes into middle cranial cavity via the greater petorsal foramen / fissure Passes under the interbal carotid artery by the formane lacerum Joins the deep petrosal nerve to form the nerve of the pterygoapalatine canal Greater petrosal nerve carries parasympathetic supply to all the glands above the oral fissure: - Mucous glands in the nasal cavity - Salivary glands in upper oral cavity - Lacrimal gland Also carries soem taste fibres for the lesser palatine nerve
30
Deep petrosal nerve
Formed by post-ganglionic fibres of the superior cervical sympathetic ganglion Pre-ganglionic fibres from T1 pass with the carotid artery --> superior cervical sympathetic ganglion Post-ganglionic fibres branch off the carotid nerve at the netrance to cranial cavity as the deep petrosal nerve Deep petrosal nevr ejoins greater petrosal nerve to form the nerve of the pterygopalatine canal Carries sympathetic post-ganglionic fibres destined for blood veseels
31
Branches of the first part of the maxilarry artery
First part: between neck of mandible and spenomandibular ligament - Middle meningeal artery - Inferior alveolar arteries (Deep auricular artery) (Anterior tympanic artery) (Accessory meningeal artery)
32
Branches of the second part of the maxillary artery
Second part: related to lateral pterygoid muscle - Deep temporal arteries - Massteric artery - Buccal artery - Pterygoid artery
33
Branches of the third part of the maxillary artery
Third part: pterygopalatine fossa - Posterior superior alveolar artery - Infra-orbital artery - Greater palatine artery - Pharyngeal branch - Sphenopalatine artery - Artery of the pterygopalatine canal
34
Branchial arches
Lie in side walls and floor of fetal pharynx Support lateral walls of cranial foregut and primitive pharynx Arches separated by ectodermal bronchial clefts Primitive pharynx: five endodermal pharyngeal POUCHES
35
Components of a branchial arch
Mesordermal core covered by ectoderm and an internal layer of endoderm Typical branchial arch contains: - skeletal element (cartilaginous bar) --> form bones and ligaments - artery - nerve - striated muscle supplied by that given nerve
36
Derivatives of first pharyngeal POUCH
Eustachian tube Middle ear Mastoid antrum
37
Derivatives of second pharyngeal POUCH
Tonsillar fossa | palatine fossa
38
Derivatives of third pharyngeal POUCH
Thymus Inferior parathyroid
39
Derivatives of fourth pharyngeal POUCH
Superior parathyroid
40
Derivatives of first branchial ARCHES
1st = mandibular Cranial nerve V = Trigeminal Skeletal: incus and malleus (Meckel's cartilage) Muscles: - Mastication - Mylohyoid - Anterior belly of digastric - Tensory tympani - Tensor palati Ligamenbts: - Sphenomandibular ligament - Anterior ligament of malleus
41
Sphenomandibular ligament
From spine of sphenoid (spina angularis) --> lingula of mandibular foramen Derivative of first branchial ARCH
42
Derivares of second branchial ARCHES
2nd = hyoid Cranial nerve VII = Facial ``` Skeletal: Stapes Styloid process Upper part of body of hyoid Lesser Cornu of hyoid ``` Muscles: Facial expression Posterior belly of digastric Stylohyoid Ligaments: Stylohyoid
43
Derivates of third branchial ARCHES
3rd Cranial nerve IX = Glossopharyngeal Skeletal: Lower part of body of hyoid Greater Cornu of hyoid Muscle: Stylopharyngeus
44
Derivates of branchial ARCHES fourth - sixth
4th - 6th Cranial nerve X: recurrent laryngeal nerve and superior laryngeal nerve ``` Skeletal: Thyroid cartilage Arytenoid cartilage Corniculate cartilage Cuneiform cartilage ``` Muscles of: - Pharynx - Larynx - Palate
45
Formation of tongue
Nodule = tuberculum impar Develops in the floor of the pharynx Covered by two lingual swellings which arise from either side of first branchial arch to fuse in the midline and forms anterior two-thirds of tongue Part of second branchial arch (chord tympani) forms anterior two-thirds Posterior third formed by third branchial arch (CN IX) Musculature developed from migrating occipital myotomes dragging their nerve supply with them (CN XII) Nerve supply = Trigeminal
46
Nerve supply to tongue
From development arches General sensation anterior 2/3ds: Lingual nerve of trigeminal nerve Taste sensation anterior 2/3rds: chord tympani of facial nerve General and taste posterior 1/3rd: glossopharyngeal
47
Development of face
Develops from primitive mouth - stomodaeum Frononasal process Maxillary process Mandibular process
48
Frontonasal process of developing face
Frontonasal process grows down from the cranium Forms: - nose - nasal septum - nostril - philtrum - premaxilla (bearing four incisor teeth)
49
Maxillary process of developing face
Maxillary process fuses with Frontonasal process Forms: - cheeks - upper lip (except philtrum) - upper jaw - palate (except premaxilla)
50
Mandibular process of developing face
Mandibular processes meet in midline, forms: | -lower jaw
51
Abnormalities of the developing face
Tend to occur with failure of fusion Abnormalities of stomodeaum: - macrostomia - microstomia Cleft lip Cleft palate Inclusion dermoids
52
Cleft lip
One or both sides of philtrum -occurring as a failure of fusion of maxillary and frontonasal processes May extend into nostril or alongside nose as far as orbit May be associated with cleft palate Median cleft is rare (midline) - occurs when failure of development of philtrum from frontonasal process
53
Cleft palate
Fusion normally occurs between primary palate (anterior premaxilla) and secondary palate (hard and soft palate) Failure of fusion may result in: -cleft of soft palate = bifid uvula -partial cleft of posterior hard palate -unilateral complete cleft -bilateral complete cleft = running full length of maxilla and on both aspects of premaxilla, separating it completely
54
Inclusion dermoids
Form along lines of facial fusion Commonest is at the lateral extremity of the eyebrow, i.e. external angular dermoid
55
Development of the thyroid
Develops as diverticulum from floor of embryonic pharynx just caudal to tuberculum impar = foramen caecum of tongue Grows caudally superficial to branchial arches and hence to hyoid and larynx to its definitive position As lobes expand, they come into contact with the ventral part of the fourth pharyngeal pouch, which contributes the parafollicular (C) cells.
56
Management of thyroglossal cyst
Thyroglossal duct attaches to body of hyoid bone This part of the body of the hyoid must be excised when dealing with the thyroglossal ducts surgically Orr when dealing with a thyroglossal cyst, which is adherent to the body of the hyoid bone
57
Development of the parathyroids
Superior parathyroids: 4th pharyngeal arch Inferior parathyroids: 3rd pharyngeal arch --> inferior parathyroid may be dragged beyond the thyroid into the superior mediastinum and be found in association with (or even within) the thymus
58
Fusion of vertebral bodies
Vertebral bodies develop around notocord Three primary centres Two halves of arch fuse, starting in thoracic region --> this spreads up and down the column Failure of the two arches to fuse posteriorly results in spina bifida, which is most common in the lumbar region
59
Hydrocephalus and myelomengingocele
Spinal cord tethered at site of lesion Differential growth between spinal cord and vertebral column pulls the hindbrain down into foramen magnum --> Arnold-Chiari malformation This causes impeded CSF circulation --> hydrocephalus
60
Greater auricular nerve
Supply to face is entirely trigeminal nerve EXCEPT: - small area over parotid = greater auricular nerve - branch of cervical plexus
61
Supraorbital nerve
Branch of opthalmic division of trigeminal nerve V1 Passes through supraorbital foramen and ascends to scalp Supplies the skin of the scalp as far back as the vertex, the skin of the forehead, the skin of the upper eyelid, the skin of the front of the nose, the cornea
62
Infraorbital nerve
Branch of maxillary division of trigeminal nerve V2 Passes through infraorbital foramen Supplies the skin of the cheek, side of the nose, mucous membrane of the inside of the corresponding part of the cheek, outer surface of the gum
63
Mental nerve
Branch of mandibular division of trigeminal nerve V3 Passes through mental foramen Supplies skin of chin, mucous membrane of lower lip, outer surface of gums
64
Sensation to scalp
Anterior to auricle -Trigeminal nevre Posterior to aurcle - Greater occpital C2, C3 - Lesser occipital C2
65
Structures passing through the cribriform plate
Olfactory nerves Emissay veins Anterior ethmoidal nerves and veins
66
Floor of anterior cranial fossa
Orbital plate of frontal bone Ethmoidal bone - cribriform plate Lesser wing of sphenoid
67
Floor of middle cranial fossa
Body of sphenoid Greater wing of sphenoid Squamous parts of temporal bone
68
Foramina of middle cranial fossa
- optic canal - superior orbital fissure - foramen rotundum - foramen ovale - foramen spinosum - foramen lacerum
69
Floor of posterior cranial fossa
Body of sphenoid Petrous temporal bone Basilar part of occipital bone
70
Components of clivus
Body of sphenoid Basilar part of occipital bone
71
Foramina of the posterior fossa
Jugular foramen Hypoglossal canal Foramen magnum Internal acoustic meatus
72
Drainage of lacrimal sac
Drains into nasolacrimal duct Opens up into anterior part of inferior meatus of nose
73
Muscles of the middle ear
Stapedius: attached to the neck of stapes -supplied by facial nerve Tensor tympani: inserts into handle of malleus -supplied by mandibular division of trigeminal CN V3
74
Lining of eustachian tube
Line by columnar ciliated epithelial cells
75
Opening of sphenoidal sinus
Opens into sphenoethmoidal recess | above superior concha
76
Opening of posterior ethmoidal air cells
Open into superior meatus | just below superior concha
77
Openings into middle meatus
Middle meatus = just below middle concha Bulla of ethmoid - middle ethmoidal cells Hiatus semilunaris: - infundibulum of frontal sinus - anterior ethmoidal air cells (in front) - maxillary ostium (behind)
78
Lower limit of olfactory mucosa
Upper part of middle concha = simple columnar
79
Blood supply to the nose
Upper: ethmoidal branches of ophthalmic artery Lower: sphenopalatine branch of maxillary artery Septal branch of facial artery --> anastomoses with sphenopalatine branch on anteroinferior part of septum = Little's area
80
Venous drainage of nose
Facial vein OR Ethmoidal tributaries of ophthalmic vein --> cavernous sinus
81
Paranasal sinuses
Maxillary sinuses Ethmoidal air cells - anterior - middle - posterior Frontal sinus Sphenoidal
82
Openings of paranasal sinuses
Maxillary --> middle meatus Ethmoidal anterior and middle --> middle meatus posterior --> superior meatus Frontal --> middle meatus via infundibulum Sphenoidal --> sphenoethmoidal recess
83
Caldwell-Luc operation
for maxillary sinusitis Anterior wall of maxilla removed, mucosa stripped and permanent drainage hole made into inferior meatus
84
Innervation of maxillary sinus
Maxillary division of trigeminal - infraorbital nerve - superior dental nerve
85
Lymphatic drainage of maxillary sinus
Upper deep cervical nodes
86
Ethmoidal air cells
Group of 8-10 air cells Lateral mass of ethmoid Lie between side walls of upper nasal cavity and orbits Above --> each side of cribriform plate and are related to frontal lobe of brain Anterior and middle air cells --> middle meatus Posterior air cells --> SUPERIOR meatus
87
Structures lying on hyoglossus
Above --> down Lingual nerve Deep part of submandibular gland and duct Hypoglossal nerve
88
Floor of mouth
Formed by the mylohyoid, which separates the oral cavity from the neck Mylohyoid muscles of both sides meet along a midline raphe Mylohyoids are reinforced superiorly by geniohyoids
89
Lingual nerve
Branch of mandibular division of trigeminal nerve Runs forward above mylohyoid Gives off gingival branch, which supplies the lingual gingiva and the mucous membrane of the floor of the mouth Winds round submandibular duct before being distributed to the mucosa of the anterior two-thirds of the tongue --> Submandibular ganglion is suspended from lingual nerve as it lies on hyoglossus -Preganglionic fibres in the chorda tympani synapse in submandibular ganglion. -Before reaching the floor of the mouth, the lingual nerve lies against the periosteum of the alveolar process closely related to the third molar tooth. The nerve can be damaged here during dental extraction.
90
Hypoglossal nerve
Descends between internal jugular vein and internal carotid artery Supplies superior limb of ansa cervicalis C1 --> infrahyoid muscles Reaches surface of hyoglossus by passing deep to posterior belly of diagastric On hyoglossus, breaks up into branches to supply all muscles of the tongue except palatoglossus
91
Extrinsic muscles of the tongue
Genioglossus --> protrudes tongue Styloglossus --> retracts tongue Hyoglossus --> depresses the tongue
92
Blood supply to tongue
Lingual branch of external carotid
93
Lymphatic drainage of the tongue
Tip drains to submental nodes Anterior 2/3rds drain to submental and submandibular nodes - -> then to lower deep cervical nodes - no cross drainage Posterior 1/3rd - -> upper deep cervical nodes - cross-drainage, therefore cancers can spread to bilateral nodes
94
Jaw thrust
Genioglossus attaches togue to mandible In jaw thrust, you can physically move tongue forwards and away from airway
95
Structures passing through the parotid gland
Traversing the gland from superficial to deep are: -facial nerve -retromandibular vein -external carotid artery, dividing into the superficial temporal and maxillary branches.
96
Nerve most at-risk during parotidectomy
The mandibular division is the longest, thinnest and | therefore most vulnerable branch
97
Submandibular excision
Mandibular branch of facial nerve reaches angle of mandible before ascending again Surgical incision at least 2.5 below angle of mandible to miss mandibular branch
98
External jugular vein pierces investing facia...
Below omohyoid, just above midpoint of clavicle If cut here, fascia will hold external jugular open --> air embolism

Anatomy (22 decks)

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