Head & Neck Flashcards
What supplies the extensor muscles of the neck
Posterior rami of cervical nerves
What spinal level is the hard palate at
C1
Where does the pharynx start
C6
What nerves supply the prevertebral flexor musculature of the neck
Anterior rami
What level is the hyoid bone
C3
What is within and behind carotid sheath
CCA, ICA
IJV
Vagus
Cervical symp trunk is BEHIND
Most superficial structures in the neck
Platysma
Ext jugular V
Ant jugular V
Where is the platysma in terms of layers of the neck
Superficial to investing layer of deep cervical fascia
What vessels does platysma cover
all, but superficial vessels include EJV and ant jugular V
What nerve supplies platysma
Cervical branch of facial N
Tributaries of EJV
A continuation of retromandibular vein, and formed with posterior auricular V
Posterior external jugular
Suprascapular Vs
Transverse cervical V
Where does EJV terminate
Into subclavian V with ant jugular V just lateral to IJV
Tributaries of IJV
Inferior petrosal sinus
Pharyngeal plexus
Facial V
Lingual V
Superior and middle thyroid V
4 parts of the deep cervical fascia
- Investing layer
- Pre-tracheal layer
- Pre-vertebral
- Carotid sheath
What does the investing layer of fascia split to include
SCM
Trap
Parotid gland
Omohyoid
Suprasternal space contains
Lower ant jugular V
Sternal head of SCM
+/- LB
Where does the pretracheal fascia lie
Deep to infrahyoid (omohyoid, sternothyroid, sternohyoid) muscles
What does the pretracheal split to enclose
Thyroid gland
What is the thyroid gland adherent to
2,3,4 tracheal rings via isthmus
What does the pretracheal fascia fuse with
Carotid sheath
What vessels lie anterior the pre-vertebral fascia
Subclavian V
Axillary V
What lies deep to prevertebral fascia
Cervical plexus
Trunks of brachial plexus
What 4 cutaneous nerves pierce the prevertebral fascia
Greater auricular
Lesser occipital
Transverse cervical
Supraclavicular
Where does the carotid sheath attach
Margins of carotid and jugular fossa
What is the space anterior to the prevertebral fascia called
Para/retropharyngeal space
Connects base of skull to diaphragm
Boundaries of submandibular space
Mylohyoid, hyoid bone & mandible
Splenius capitis insert and origin
Lig nuchae, spinous process C7, T1-4
Mastoid process & occipital bones of skull
Nerve supply splenius capitis
Dorsal rami of middle cervical spial nerves
Splenius cervicis origin and insert
Spinous process T3-6
Transverse process C2-4
Nerve supply of splenius cervicis
Dorsal rami of lower cervical spinal nerves
Origin & insert levator scapulae
Transverse process of atlas & axis + post tubercles of C3/4
Insert: medial border of scapula from sup angle to spine
Nerve supply of levator scapulae
C3/4 reinforced by dorsal scapulae
Action of levator scapulae
Elevate scapula and laterally flex neck
What separates anterior and middle scalene muscles
Brachial plexus roots
Subclavian A
Nerve supply of the scalene muscles
Ventral rami of cervical spinal nerves
Origin & insert ant scalene
Transverse process C3-6
Insert 1st rib
Origin & Insert middle scalene
TP of C3-7
Insert 1st rib
Origin and insert post scalene
TP of C4-7
Insert 2nd rib
Trapezius origin & insert
Medial 1/3 of nuchal line + all 12 thoracic vertebra
Insert:
- lat 1/3rd of clavicle
- acromion, spine of scapula
Nerve supply of trapezius
Accessory nerve and branches of cervical plexus
Action of traps
Retract scapula, and rotate glenoid cavity
Posterior triangle of neck boundaries
Post border of SCM
Ant border of trapezius
Clavicle
Anterior triangle borders
Ant border of SCM
Lower border of mandible
Midline
SCM origin & insert
Sternal head - jugular notch
Clavicular head - medial 1/3rd of clavicle
Insert: mastoid process, to nuchal line
Crossed superficially (the SCM) by
Greater auricular nerve
EJV
Transverse cervical N
What nerve enters the SCM (and what A accompanies it)
Spinal accessory N
Branch of Occipital A
What encloses (fascia) the SCM
Investing layer of deep fascia
Nerve supply of SCM
Spinal accessory n
What is deep to the SCM
Upper = cervical plexus
Lower = carotid sheath, overlying scalenus ant
What forms the floor of posterior triangle
Splenis
Levator scapular
Scalenus medius
Contents of the posterior triangle
Arteries: occipital, transverse cervical, suprascapular, subclavian
Veins: transverse cervical, suprascapular, ext jugular
nerves: accessory, cervical plexus, brachial plexus trunks
Muscle; inf belly of omo-hyoid
What forms the cervical plexus
Anterior rami of C1-4
Each has grey communicans from sup cervical ganglion
Where does the cervical plexus lie
Deep to prevertebral facia, alongside brachial plexus on scalene medius
Muscular branches of cervical plexus
C1 - hypoglossal
C2+3 - inf root of ansa cervicalis
Phrenic N C3,4,5
Course of phrenic nerve in neck
Passes over obliquity of ant scalene, from lateral to medial border (beneath prevertebal fascia)
Passes behind subclavian V
Cutaneous branches of Cervical plexus
“GLTS”
Greater auricular N
Lesser occipital N
Transverse cervical N
Supraclavicular N
Which cervical root has NO cutaneous distribution
C1
The posterior rami of C2/3 are not apart of cervical plexus because
They are POSTERIOR, cervical plexus only supplied by anterior/ventral branches
Posterior rami of C2/3 branches
Greater occipital
third occipital nerves
Boundaries of carotid triangle
SCM
Posterior belly of digastrics
Sup border of omohyoid
Contents of carotid triangle
Bifurcation of CCA
Branches of ECA (except post auricular)
IJV, lingual, facial, sup thyroid V
Hypoglossal N, int + ext laryngeal N, superior root of ansa cervicalis, vagus nerve
Digastric triangle boundaries
Ant, post bellies of digastric
Mandible
Contents of digastric triangle
Submandibular gland and LN
Facial A
Submental and mylohyoid vessels
Hypoglossal and mylohyoid Ns
Submental triangle boundaries
Ant belly of digastric
Hyoid
Midline
Contents of submental triangle
Anterior jugular V
Lns
Suprahyoid muscles
“Dont say matts gay”
Digastric
Stylohyoid
Mylohyoid
Geniohyoid
Digastric muscle origin & insert
Ant belly - digastric fossa of mandible to hyoid
Post belly - digastric notch of mastoid to hyoid
Nerve supply of digastric
Ant - V3 (nerve to mylohyoid)
Post - facial
Stylohyoid muscle origin and insert
Styloid process to hyoid
Nerve supply of stylohyoid
Facial nerve
Mylohyoid origin and insert
Inner aspect of mandible => hyoid
Stylohyoid m nerve supply
Facial N
Mylohyoid n supply
V3 (n to mylohyoid)
Geniohyoid origin and insert
Genial tubercle of mandible to body of hyoid
Nerve supply of geniohyoid
Hypoglossal N
Infrahyoid muscles
Sternohyoid
Omohyoid
Thyrohyoid
Sternothyroid
What supplies sternohyoid
Ansa cervicalis
What supplies omohyoid
Ansa cervicalis
When does omohyoid become a flat tendon
When passing over IJV
What nerve supplies thyrohyoid
Hypoglossal but fibres hitchhiking from C1
What supplies sternothyroid
Ansa cervicalis
Actions of infrahyoid muscles
Depress larynx
Increase volume of resonating chambers during phonation
What does of production does the submandibular gland make
Mixed mucus and serous
What are the parts of the submandibular gland
Deep and superficial parts, continuous with one another around free posterior margin of mylohyoid
Blood supply to submandibular gland
Facial artery and vein
Nerve supply to submandibular gland
Lingual N (V3)
Submandibular duct opens into..
Floor of mouth, beside frenulum
Where does the thyroid gland lie
Infront of tracheal rings 2-4
How does the recurrent laryngeal nerve access the thryoid
The medial surface from below (travelling bw trachea and oesophagus)
Where does the ext laryngeal nerve lie in proximity to thyroid gland
On inferior constrictor behind sup thyroid A
Blood supply of thyroid gland
Superior thyroid (ECA)
Inferior thyroid (thyrocervical trunk)
Veins of the thyroid gland
Sup thyroid V => IJV/facial V
Middle thyroid => IJV
Inf thyroid => L brachiocephalic
Where does the parathyroid gland lie
Often 4 glands, embedded into trachea (note Sup PT glands from pharyngeal branch 4, and inferior from 3)
What runs in the groove b/w trachea and oesophagus
Recurrent laryngeal N
Where does trachea commence
C6
Where does oesophagus begin
C6
Where does the thoracic duct run in proximity to oesophagus
Runs behind lower part of L border
Where do the CCA arise
L = arch of aorta
R = brachiocephalic trunk
Where does the CCA lie
within medial part of carotid sheath
IJV lateral , vagus in between
Branches of the ECA
Some Anatomists like freaking out poor medical students
Sup thyroid
Asc pharyngeal
Lingual
Facial
Occipital
Post auricular
Maxillary
Superficial temporal
Where does the CCA bifurcate
C4
Where does the ECA terminate
In parotid gland
Terminal branches of ECA
Superficial temporal
Maxillary
What does occipital A supply
Back of scalp
2 branches to SCM
Carotid sinus vs carotid body
Sinus - baroreceptor
Body - chemoreceptor (peripheral)
Where does the carotid sinus lie
At commencement of ICA
Where does the carotid body lie
Behind bifurcation of common carotid A
What are the branches of ICA In the neck
None
What are the divisions of subclavian A and what makes that division
Medial, posterior and lateral to anterior scalene
Branches of subclavian A
VIT C + D
Vertebral A
Internal thoracic A
Thyrocervical trunk
Costocervical trunk
Dorsal scapular A
What are the branches of the thyrocervical trunk
Transverse cervical
Ascending cervical A
Suprascapular A
Inferior thyroid A
What arteries of the subclavian A are MEDIAL to scalene anterior
Vertebral A
Internal thoracic A
Thyrocervical A
What branches of subclavian are posterior to scalene anterior
Costocervical trunk
- with a deep cervical & supreme intervostal
What is the origin of the supreme intercostal
Costocervical trunk
What branches of subclavian lie lateral to scalene anterior
Dorsal sapular A
Where does the IJV emerge
From post compartment of jugular fossa
Posterior relation s of IJV
Cervical plexus
Phrenic nerve
Where does the iJV lie in proximity to ICA
Lies LATERAL
Surface marking of IJV
B/w ear lobule and 2heads of SCM
Tributaries of iJV
Inf pertrosal sinus
Pharyngeal
Lingual
Facial
Superior and middle thyroid veins
Where does the hypoglossal nerve arise in neck
B/w ICA and iJV, deep to post belly of digastric
Function of prevertebral muscles in the neck
Weak flexors
Prevertebral muscles of the neck
Rectus capitis anterior
Rectus capitis lateralis
Longus capitis
Longus coli
Cervical sympathetic trunk ganglion
Superior
Middle
Inferior
Where is superior cervical ganglion
Infront of C2,3
Where is middle cervical ganglion
Infront of inferior thyroid A
Where is inferior cervical ganglion
Behind commencement of vertebral A, often fuses with 1st thoracic ganglion to form stellate ganglio
Where does the cervical part of sympathetic trunk run in the neck
Ascends from thorax, across neck of 1st rib medial to highest intercostal V
Runs medial to the vertebral A and lies infront of prevertebral fascia
Behind carotid sheath, medial to vagus nerve
Ends as superior cervical ganglia
What is the root of the neck
TV1, 1st thoracic rib/cartilage and manubrium
What is function of anterior scalene
Flex and rotate neck, 1st rib stabiliser
Most important as landmark
Nerve supply anterior scalene
Ant rami of C4-6
Anterior relations to ant scalene
Phrenic N
Ascending cervical A
Transverse cervical and suprascapular A (cross over phrenic)
Vagus nerve
Subclavian V
Medial relations to anterior scalene
1st part of subclavian (+ vertebral, internal thoracic, thyrocervical trunk with suprascapular, inf thyroid, asc cervical, transverse cervical A)
Posterior relations of ant scalene
Subclavian A (2nd part) + costocervical trunk
brachial plexus roots
Lateral relations of ant scalene
Trunks of brachial plexus
3rd part of subclavian + dorsal scapular A
Which pharyngeal arch do muscles of facial expression develop
2nd arch
What are the muscles of the eyelids
Orbicularis
Levator palpebrae superioris
Muscles of the nose
Transverse part of nasalis
Alar part of nasalis
Muscles of lips and cheeks
Orbicularis oris
Levator labii superioris alaeque
Levator labii superioris
Levator anguli oris
Zygomaticus minor and major
Risorius
Depressor anguli oris
Depressor labii infeiroris
Mentails
What nerve supplies muscles of fascial expression
CN7
Facial nerve emerges from skull
Stylomastoid foramen
Branches of CN7 prior to parotid gland
Post auricular N
Muscular branch
Post auricular N origin
CN7
Post auricular n supplies
Occipital belly of occipitofrontalis
Muscular branch of CN7 supplies
Digastric & stylohyoid
What are the branches of CN7 in parotid gland
Upper temporofacial & lower cervicofacial divisions into 5 main branches
Temporal
Zygomatic
Buccal
Marginal mandibular
Cervical
Branches of facial nerve in parotid gland
Temporal
Zygomatic
Buccal
Marginal mandibular
Cervical
Temporal branch of CN7 supplies..
Auricularis ant, superior and frontalis
Zygomatic branch of CN7 supplies….
Orbicularis oris
Buccal branch of CN7 supplies..
Buccinator
Where is the marginal mandibular branch of CN7 at danger of being damaged, and result of such
In danger with an incision made at or near the lower border of the mandible
Results in detectable paralysis of lower lip & mouth angle
Cervical branch CN7 supplies
Platysma
Divisions of trigeminal nerve
V1 - ophthalmic
V2 - maxillary
V3 - mandibular
Cutaneous branches of CNV1
Lacrimal
Supraorbital
Supratrochlear
Infratrochlear
External nasal nerve
Branches of V2
Infraorbital nerve
Zygomaticofacial
Zygomaticotemporal
V3 branches (cutaneous)
Auriculotemporal
Buccal
Mental
Blood supply to the face
Facial A
Transverse fascial A
Supraorbital & Supratrochlear (from Ophthalmic A)
Where does the facial A travel in head
Hooks upwards over inferior border of mandible at ant border of mandible, then takes a tortuous course towards angle of eye, lies on buccinator & gives off labial branches
Where does the transverse facial A arise
Superficial temporal A
Venous return of the face
Supraorbital & supratrochlear veins
To form angular vein => facial vein => IJV
What aspects of the face drain into cavernous sinus
The ophthalmic veins
What is the ‘danger area’ of the face, and why is this concerning
Area of infection of cheek/upper lip, because communication to cavernous sinus can cause cavernous sinus impingement, b/w angular V and deep facial V
Layers of the SCALP
Skin
Connective tissue
Aponeurosis (where occipitalis & frontalis insert)
Loose areolar tissue
Pericranium
Occipitofrontalis origin & insert
Occipital part - from highest nuchal line, and into aponeurosis
Frontalis - from apoeurosis to orbicularis oculi
Nerve suppy of occipitofrontalis
Facial N
- post auricular N to occipitalis
- temporal branch to frontalis
Blood supply to scalp
3 from ECA
- superficial temporal A
- occipital A
- post auricular A
2 from ICA
- supratrochlear
- supraorbital
Nerve supply to scalp
Zygomaticotemporal N (CNV2)
Greater occipital N (C2)
Lesser occipital N (C2)
Auriculotemporal N (CNV3)
Suptratrochlear, (V1)
supraorbital (V1)
“Z-glass”
What makes up the Boundaries of temporal fossa
Roof - temporalis fascia
Floor - skull (pterion)
Anterior wall - zygomatic process of frontal bone
Contents of temporal fossa
Temporalis mucles arises here
What nerves cross the zygomatic arch
Auriculotemporal N
Temporal & zygomatic branches of CN7
What lies beneath temporalis fascia (other than temporalis)
Branches of superficial temporal A
Zygomaticotemporal Branch V2
Temporal, zyogmatic branches CN7
Superficial temporal vessels
Auriculotemporal N
Temporalis muscle origi & insertion
Arise from temporal fossa, spreads like a fan and inserts from alveolar process to mandible
What nerves & arteries supply temporalis M
Temporal branches of maxillary A
Superficial temporal arteries
2-3 deep temporal branches of CNV3
Where does the masseter muscle originate and insert
Arise from lower border of zygomatic arch, inserts into lateral surface of mandibular ramus
What lies on top of masseter muscle
Aponeurosis and parotid ductb
Blood supply of masseter muscle
Facial, maxillary, superifical temporal, transverse facial A
Nerve supply of masseter
V3 - masseteric branch
What nerve supplies the parotid fascia
Greater auricular N (C2,3)
Where is pain transmitted from parotid gland
In greater auricular N C2,3
What passes through the substance of parotid gland
Parotid duct
Facial N branches
ECA and terminal branches
Retromandibular V
Blood supply of parotid gland
ECA
Venous drainage of parotid gland
Retromandibular V
Anterior - IJV
Posterior - EJV
Nerve supply of the parotid gland
Secretomotor fibres from otic ganglion via auriculotemporal N
Glossopharyngeal N
Sympathetic fibres reach the gland from superior cervical ganglion on ECA and middle meningeal A
Infratemporal fossa boundaries
Space b/w side wall of pharynx & ramus of mandible
Medially = lateral surface of lateral pterygoid, tensor palate muscle, superior constrictor
Anteriorly = posterior surface of maxilla
Lateral = ramus of mandible & coronoid process
Roof = infratemporal surface of greater wing of sphenoid & squamous part of temporal bone
Posteriorly = styloid process w/ carotid sheath posteriorly
Contents of infratemporal fossa
Muscles - medial, lateral pterygoid; insertion of temporalis into coronoid process
Vessels - maxillary artery & branches, pterygoid venous plexus
Nerves - mandibular n, otic ganglion, chorda tympani, post sup alveolar branch of maxillary n
Deep part of parotid
Muscle content of infratemporal fossa
Medial, lateral pterygoid
Insertion of temporalis into coronoid process
Vessels of infratemporal foss
Maxillary A and branches
Pteryogid venous plexus
Nerves of infratemporal fossa
Otic ganglion + mandibular N
Chorda tympani
Post sup alveolar branches of maxillary N
Lateral pterygoid muscle origin & insert
Upper roof of infratemporal fossa, lateral pterygoid plate
Insert into pterygoid fovea on front of the neck of mandible
Nerve supply of lateral pterygoid
Ant div of mandibular n
Fx of lateral pterygoid
Open the mouth
Medial pterygoid muscle origin & insert
Lateral pterygoid plate & palatine bone
Insert: rough area of mandible
Nerve supply of medial pterygoid
Branch of main trunk of mandibular n
Action of medial pterygoid m
Close mouth
Where does the maxillary A arise from
Terminal branch of ECA
What are the parts of the maxillary A, and in relation to what
3 parts, related to lateral pterygoid M
Before, on and after
Branches of maxillary A before lateral pterygoid
Inferior alveolar A
Middle meningeal A
Accessory meningeal A
Deep auricular A
Ant temporal A
Branches of maxillary A ON the lateral pterygoid
Pterygoid A
Masseteric A
Ant temporal A
Post temporal A
Buccal A
Branches of maxillary A AFTER lateral pterygoid
Infraorbital
Sphenopalatine
Post superior alveolar A
Greater palatine A
Pharyngeal A, artery to pterygoid canal
What is the pterygoid venous plexus
Network of veins within and around lateral pterygoid m
What drains into the pterygoid plexus
Corresponds to branches of maxillary A byt do not return all arterial blood
Where does the pterygoid plexus drain INTO
Short maxillary vein with superficial temporal v to form retromandibular V
How is the pterygoid plexus connected to cavernous sinus
Via emissary veins through Foramen OVALE and foramen LACERUM
What is the sphenomandibular ligament and its significance
From sphenoid bone to mandible
Transmits multiple important vessels
What passes b./w sphenomandibular lig & mandible
Auriculotemporal N
Maxillary A, V
Inferior alveolar vessels
Mylohyoid nerve (pierces the bottom of lig)
Where does the V3 arise from in skull
Foramen ovale
What are the divisions of V3
(Main trunk)
Small anterior (mainly motor)
Large posterior (mainly sensory)
What branches of V3 come directly off main trunk
Meningeal branch
N to medial pterygoid
Branches of ant div of V3
All motor except buccal
2 deep temporal branches
Masseteric N
N to lateral pterygoid
Buccal nerve
Branches of post div of V3
All sensory except mylohyoid
Auriculotemporal N
Inferior alveolar (dental) nerve
Lingual n
What is chorda tympani
From facial N
What does chorda tympani CARRY
Ant 2/3rds of taste to tongue
PSNS to submandibular gland
Where is the otic ganglion
B/w tensor palate & mandibular n, just below foramen ovale
What is the role of otic ganglion
Relay station for PSNS secretomotor fibres to parotid by lesser petrosal branch of CN9
What does the middle meningeal N supply
Via f.spinosum
Meningeal of middle cranial fossa
Mastoid air cells
N of med pterygoid n supply
Medial pterygoid
Tensor palati
Tensor tympani
What is contained w/in carotid sheath
ICA
IJV
CN9, 10, 11, 12
What is medial to carotid sheath
Pharynx
What is lateral to carotid sheath
Deepest part of parotid
What lies behind carotid sheath
Cervical sympathetic trunk on prevertebral fascia
What is embedded in anterior wall of sheath
Ansa cervicalis
Glossopharyngeal nerve emerges from skull
Jugular foramen anterior part
How does CN9 reach the tongue
From jugular foramen, lateral to ICA, deep to ECA and deep to hypoglossus
Branches of glossopharyngeal n
Tympanic branch
Motor branch
Carotid sinus n
Pharyngeal branch
Tonsillar branch
Lingual branch
Tympanic branch of CN9 supplies
Supply middle ear, mastoid cells, bony part of auditory tube with sensory fibres
Motor branch CN9 supplies
Stylopharyngeus m
Lingual branch of CN9 supplies
Taste & secretomotor fibres of post 1/3rd
Vagus nerve emerges and travels in neck
Middle compartment jugular fossa
Within carotid sheath
Over subclavian a into thorax
Neck branches of vagus n
Meningeal branches
Auricular branch
Carotid body
Pharyngeal branch (all except stylopharyngeus)
Superior laryngeal n (int, ext)
Cervical cardiac branches
Recurrent laryngeal N
What n supplies muscles of pharynx
All except stylopharyngeus supplied by CN10. Stylopharygeus = CN9
What nerve supples laryngeal muscles
All by recurrent laryngeal n EXCEPT cricothyroid *ext laryngeal N
Accessory nerve emerges & travels in neck
Formed in post cranial fossa, spinal & cranial roots
Middle compartment of jugular foramen
Shares meningeal sleave with vagus
Pass deep to styloid and post belly of digasgtric
Enters SCM & passes through post triangle to supply trapezius
Hypoglossal N emerges and travels in neck
From hypoglossal canal
Spiral behind inf ganglion of vagus and pass through carotid sheath
Then travels anteriorly towards tongue
What muscle emerge from styloid process
Stylopharyngeus
Stylohyoid
Styloglossus
What is the styloid apparatus
Tip of temporal bone
Where does the carotid sheath lie in proximity to styloid process
Lies medial to styloid process
Pterygopalatine fossa boundaries
Roof - body of sphenoid
Medial - perpendicular plate of palatine
Ant - post wall of maxilla
Roof - pterygoid process of sphenoid
Contents of pterygopalatine fossa
Maxillary vessels & nerve
Ptergyopalatine ganglion & fat
Maxillary N V2 emerges and in the neck
From foramen rotundum into pterygopalatine foramen
Travels & branches
- infraorbital n
- zygomatic n
- posterior sup alveolar n
Pterygopalatine ganglion FUNCTION
Parasympathetic ganglion
Relay station b.w superior salivary nucleus in pons &. Lacrimal gland & mucus & serous glands of the palate, nose, paranasal sinus
Where does the pterygopalatine ganglion sit
In front of pterygoid canal
What is the autonomic root of pterygopalatine canal
Nerve of pterygoid canal (Vidian n)
How is the vidian n (nerve of pterygoid canal) formed
In foramen lacerum by greater petrosal N (PSNS, CN7) & deep petrosal N *SNS, from internal carotid plexus
Fx of vidian n
Provide supply to lacrimal gland
Sensory
Branches of pterygopalatine ganglion
Vidian n
Nasopalatine n
Lateral posterior superior nasal nerves
Greater palatine n
Lesser palatine n
Pharyngeal n
Which bones do the nasal bones articulate with
Frontal
Maxilla
Blood supply of ext nose
Dorsal nasal A (terminal branch ophthalmic)
Ext nasal A (ant ethmoidal)
Lateral, nasal, septal branches of facial
What forms the lateral wall of nasal cavity
Maxilla
Perpendicular plate of palatine
Medial pterygoid plate
Ethmoid bone
What does the sphenopalatine foramen communicate
Nasal cavity & pterygopalatine fossa
Where does the nasolacrimal duct open into
The upper part of inf nasal meatus
Which wall are the turbinates on: lateral or medial
Lateral
What makes up the medial wall of nasal cavity
Bones - vomer, ethmoid (perpendicular plate)
Cartilage
Floor of nasal cavity
Palatal process of maxilla
Horizontal plate of palatine bone
Roof of nasal cavity
Cribiform plate of ethmoid
Frontal bone
Nasal bone
Sphenoid
Blood supply to nasal cavity
Sphenopalatine branch
Septal branch of Superior labial A
Ascending branch of Greater palatine A
(Forms Kieselback’s plexus)
What makes up kiselback’s plexus
Sphenopalatine
Ascending branch of greater palatine A
Septal branch of superior labial A
What is the nerve supply to nasal cavity
Olfactor area - CN1
Vestibular Area = infraorbital (CNV1)
Resp area = ant ethmoid n V1, ant sup alveoar N V2
Pterygopalatine ganglion & greater palatine nerve
What are the sinuses of the face
Maxillary
Ethmoidal
Frontal
Sphenoidal
Where do the ant, middle and post ethmoidal air cells drain into
Middle meatus = ant, midle
Post = superior meatus
What are the lateral, superior, posterior and inferior relations of sphenoidal sinus
Above: pit fossa, middle cranial fossa
Lateral: cavernous sinus, ICA
Posterior to sinus: post cranial fossa & pos
Below sinus: nasopharynx
Which sinus is NOT present at birth?
Frontal sius
What nerves supply the UPPER gums
Superior alveolar, greater palatine & nasopalatine n (V2)
What nerve supplies the lower gums
Inferior alveolar, buccal, lingual n (V3)
Upper teeth nerve supply
Superior alveolar N
Lower teeth nerve supply
Lower alveolar N
What bones make up the hard palate
Palatal process of maxilla, horizontal plate of palatine bone
What are significant foramen in the hard palate
Greater palatine & lesser palatine foramen
What does the greater palatine foramen transmit, and where does it travel
Greater palatine A which then passes forward up into nose via incisive canal
What is the sulcus terminalis of the tongue
Marks site of junction b/w oral & pharyngeal parts of tongue
What is the palatoglossal arch
Ridge of mucus membranes raised by palatoglossus muscle
What is posterior palatoglossal arch
Palatine tonsils (aka THE tonsils)
Extrinsic muscles of the tongue
Genioglossus
Hyoglossus
Styloglossus
Palatoglossus
intrinsic muscles of the tongue
Superior longitudinal
Inferior longitudinal
Transverse
Vertical
Where does the hyoglossus originate & insert
Hyoid bone into interdigitating with styloglossus
What is superficial to hyoglossus
Lingual nerve
Submandibular duct
Hypoglossal n with accompanying vein
What is deep to hyoglossus
Glossopharyngeal N
Stylohyoid lig
Lingual artery and accompanying vein
Blood supply of tongue
Lingual A deep to hyoglossus M
Blood drainage of tongue
Lingual V => IJV
Lymph drainage of tongue
Submental
Submandibular
Jugulodigastric & jugulo-omohyoid
thoracic duct/R lymphatic duct
Nerve supply of tongue
Complex
Sensory , motor and taste
Anterior 2/3rd
- lingual N (CNV3) sense
- chorda tympani (CN7) taste
Post 1/3rd
- glossopharyngeal (taste & sense)
- int laryngeal N
MUSCLES (except palatoglossus - pharyngeal plexus) = hypoglossal N
What area the parts of the pharynx
Naso
Oro
Laryngopharynx
Where does the pharynx attach to
Base of skull (note: not the muscles, but the fascia)
What attaches pharynx to base of skull
Pharyngobasilar fascia
What is the pharyngobasilar fascia
Rigid membrane, connecting pharyx to base of skull
Holds nasopharynx open for breathing (passes from 1 medial pterygoid plate to the other)
Where does sup constrictor arise
Medial pterygoid plate
Hamulus
Pterygomandibular raphe
What lies b/w superior and middle constrictors
Styloglossus, glossopharyngeal nere, lingual nerve
Stylopharyngeus
Where does middle constrictor arise
Stylohyoid lig
Lesser horn of hyoid
Greater horn deep to hyoglossus
What is anterior to middle & inferior constrictors
Thyrohyoid membrane
What pierces (neurovascular structure) the thyrohyoid membrane
Internal laryngeal N
Superior laryngeal vessels
What makes up the inferior constrictor
Thyropharyngeus
Cricopharyngeus
What passes upward, deep to lower border of inf constrictor
Recurrent laryngeal N
Inferior laryngeal vessels
What is killians dehiscence
Site b/w oblique & horziontal fibres of inferior constrictor muscle cricopharyngeus
Potential site of diverticulum
Relationship b/w glossopharyngeal N and stylopharyngeus
Glossopharyngeal n curls around posterior border & supplies it
What nerve supplies motor aspect of pharyngx
Mainly pharyngeal plexus (CNX)
Except stylopharyngeus (glossopharyngeal)
Cricopharyngeus (recurrent, ext laryngeal N)
What nerves give rise to pharyngeal plexus & action of said nerves
Vagus and glossopharyngeal
Cervical sympathetic nerves
Afferent nerves = glossopharyngeal
Vagus = motor
Sympathetic fibres = vasoconstrictor
Where does nasopharynx begin (vertebral level)
C1
Key features of nasopharynx
Opening of auditory tubes (with tubal elevation)
Pharyngeal recess
Pharyngeal tonsils (adenoids)
Where does oropharynx begin & end
From soft palate to epiglottis (C3)
What are the ridges of the oropharynx associated with
Anteriorly, palatoglossal arch
Posteriorly palatopharyngeal arch
With palatine tonsils b/w
What nerve & artery is near the tonsils, and what protects it
N: glossopharyngeal
A: facial A (superior constrictor protects from both)
What is the valleculae & clinical importaNce
B/w epiglottis & post surface of tongue
Site of stuck food!
Where does the laryngopharynx start & end
C3 at epiglottis
C6 at level of cricoid cartilage, becomes oesophagus
What muscles make up the soft palate
Tensor palati
Levator palati
Palatoglossus
Palatopharyngeus
Uvula
Action of tensor palati
It contracts, pull upon attachment to auditory tube to equalise middle ear pressure (impacted in patients w cleft palate)
palatoglossus action
raises the tongue
blood supply of the soft palate
lesser palatine A of maxillary A
ascending palatine branch of facial A
ascending pharyngeal branch of ECA
nerve supply of soft palate *muscles
all by pharyngeal plexus EXCEPT tensor palati 0 n to medial pterygoid *CNV3
afferent & efferent limb of gag reflex
afferent - glossopharyngeal
efferent - vagus
what vertebral level does larynx lie
C4-6
cartilages of larynx
3 single - thyroid, cricoid, epiglottis
3 paired - corniculate, artenyoid, cuneiform
extrinsic ligaments & membranes of larynx
thyrohyoid membrane
cricotracheal
hyoepiglottic
thyroepiglottic
what type of cartilage makes up the cartilage of larynx
hyaline cartilage - thyroid, cricoid, arytenoids
elastic fibrocartilage - epiglotts, corniculate, cuneiform
what type of joint is b./w circoid & thyroid, cricoid & arytenoid
synovial joints
where is the corniculate cartilage
on apex of arytenoid
what is the gap b/w folds
glottis
Which muscle work on the laryngeal inlet
Aryepiglottic
Oblique arytenoids
What muscles work on vocal ligament
Posterior & lateral cricoarytenoids (note: posterior is ONly muscle to abduct!)
Oblique & transverse arytenoids
Thyroarytenoids
Vocalis
Cricothyroids
Action of cricothyroid muscle
Lengthen (increase tension) of vocal cords
Action of lateral cricoarytenoids
Adduction
action of posterior cricoarytenoids
Abduction
Action of transverse arytenoid muscle
Adduction
Action of vocalis. & thyroarytenoid
Relax (shorten)vocal cords
Blood supply of larynx
Above vocal cords - superior laryngeal branch from superior thyroid A
Below vocal cord - inferior laryngeal branch from inferior thyroid A
What is nerve supply of muscles of larynx
All by recurrent laryngeal n EXCEPT cricothyroid (ext laryngeal N)
What supplies the sensation fo the larynx (mucus membrane)
Above vocal = internal laryngeal N (branch of superior laryngeal N)
Below vocal = recurrent laryngeal nerves
Where are the cell bodies of motor nerves for larynx
Nucleus ambiguus
What is division of recurrent laryngeal n
Anterior = motor
Posterior = sensory
What is the clinical impact of paralysis of recurrent laryngeal N
ADDUCTED vocal cord (unable to abduct)
Hoarse voice
What makes up the roof of the orbit
Frontal bone, lesser wing of sphenoid
What makes up medial wall of orbit
Anterior lacrimal crest of maxilla
Lacrimal bone
Orbital plate of ethmoid
What makes up the lateral wall of orbit
Zygomatic bone
Greater wing of sphenoid
What makes up floor of orbit
Orbital surface of maxilla
Zygomatic bone
Tiny orbital process of palatine bone
Blood supply of eyelid
Medial palpaebral & lateral palpebral A of ophthalmic A
Nerve supply to skin of upper lid
Lacrimal
Supraorbital
Supratrochlear
Infratrochlear
Nerve supply to skin of lower lid
Infraorbital N
Components of lacrimal apparatus
Lacrimal gland
Lacrimal canaliculi
Lacrimal sac
Nasolacrimal duct
Where does the nasolacrimal duct open into
Inferior part of inferior meatus
Nerve supply of the lacrimal apparatus
Secretomotor fibres travel in greater petrosal n and relay in pterygopalatine ganglion
Post ganglionic fibres run with zygomatic branch of CNV2 and reach gland, anastomosis with lacrimal N
What nerves pass THROUGH the SOF but OUTSIDE the ring
Lacrimal
Frontal
Trochlear
What nerves pass through SOF & tendinous ring
Oculomotor (superior, inferior)
nasociliary
Abducens
What nerve supplies levator palpebrae superioris
Superior branch of oculomotor
What is the effect on ptosis in complete oculomotor palsy vs cervical sympathetic chain division
Complete oculomotor palsy = ptosis (complete)
Cervical sympathetic chain division = partial ptosis
List the nerves of the orbit
Optic
Infraorbital V2
Zygomatic V2
Lacrimal V1
frontal V1
trochlear
oculomotor
abducens
nasocilliary
ciliary ganglion
where does the ophthalmic artery travel in relation to optic N
the ophthalmic A is below & lateral to the Optic N in the optic canal
how does the infraorbital N reach the orbit
via inferior orbital fissure
what does the frontal nerve divide into?
supratrochlear
supraorbital (when passing through supraorbital fissure)
trochlear nerve supplies
superior oblique
oculomotor nerve divisions
superior
inferior
what does the superior division of CN3 supply
above optic nerve to sup rectus, levator palpebrae
carries SNS fibres from Internal carotid cavernous plexus to smooth part of levator
what does the inferior division of CN3 supply
middle rectus, inferior oblique
PSNS root to ciliary ganglion
abducens nerve supplies
lateral rectus
what are the branches/course of nasociliary N
becomes ant ethmoidal nerve by entering ant ethmoidal foramen
Before entering foramen, gives off infratrochlear N
Gives off post ethmoidal n
Sensory branch to ciliary ganglion
Long ciliary nerves
What do the long ciliary nerves supply
Ciliary body, iris, cornea
Carry SNS from superior cervical ganglion for dilator pupillae
What are the roots of ciliary ganglion
Sensory - branch of nasociliary nerve, supply eye NOT conjunctive
SNS - vasoconstrictor to vessels of eye
PSNS - ciliary body for accommodation & sphincter pupillae
Where does the ophthalmic A arise
From roof of cavernous sinus from ICA
What does the ophthalmic A supply
Ethmoidal air cells
Nasal cavity
External nose
Eyelids
Forehead
Extraocular muscles
Lacrimal apparatus
Eye
What drains the orbit
Superior ophthalmic V
inferior ophthalmic V
What does the superior ophthalmic v drain into
Cavernous sinus via SOF
Communicates with angular V
What does the inferior ophthalmic V drain into
Pterygoid plexus OR cavernous sinus
Superior rectus movement
Up & in
Inf oblique movement
Up & out
Inf rectus movement
Down & in
Sup oblqiue movement
Down & out
Abducens palsy
Cannot look OUTWARDS
Trochlear palsy
Eye cannot look down when eyes turned in
Oculomotor palsy
Down & out eye
Ptosis
Dilated pupil
How mant levels of nodes are there, and which correlate to DEEP cervical LNs
7 levels, levels 2-4 = deep
What are the 7 levels of LNs of the neck
1 = submental, submandibular
2 - base of skull to carotid bifurcation
3 - carotid bifurcation to circoid cartilage
4 - from cricoid to clavicle
5 - post triangle of neck
6 - midline structures incl pre & paratracheal
7 - superior mediastinum
what type of joint is TMJ
synovial b/w condyle of mandible & mandibular fossa on squamous part of temporal bone with fibrocartilaginous disc
what muscles facilitate jaw opening
digastrics
mylohyoid
geniohyoid
what muscles facilitate jaw elevation
masseter
medial pterygoid
temporalis
muscles that facilitate grinding jaw motion
medial & lateral pterygoid
protraction of jaw muscles
all pterygoids
retraction of jaw muscles
passive recoil
temporalis
deep fibres of masseter
what makes up the ext ear
auricle (pinna)
EAM
what is major cutaneous supply og ext ear
greater auricular N
what arteries supply ext ear
post auricular
superifical temporal A
what makes up the middle ear
tympanic cavity!!!!
what are the bones of the tympanic cavity
malleus
incus
stapes
what nerve supplies stapedius & action
facial N action is to retract the stapes and tilt the foot piece in the oval window
paralysis of stapedius
hyperacusis
what does the nervous intermedius contain
fibres for pterygopalatine & submandibular ganglia
taste for ant part of tongue & soft palate
where does the greater petrosal n arse from
facial n, through a canal in petrous bone
leaves through foramen lacerum to enter pterygoid canal
what is the chorda tympani
mixed visceral n containing taste fibres from tongue & secretomotor fibres for salivary glands of floor of mouth
where does the chorda tympani arise & travel to
from facial nerve, in facial canal, pierces posterior wall of tympanic cavity, through the front of the middle ear and joins the ligual nerve 2cm below base of skull
what do the greater petrosal & deep petrosal nerves form
vidian n
what are the parts of the internal ear
osseous labyrinth with membranous labyrinth insider with the auditory & vestibular n receptors
the parts of osseous labyrinth
cochlea
vestibule
semicircular canals
what type of lymph circulates within osseous labyrinth
perilymph
parts of the membranous labyrinth
cochlear duct
utricle & saccule
semicircular ducts
where are the utricle & saccule
within vestibule
what are the utricle & saccule concerned with
static balance
what type of lymph is within membranous labyrinth
endolymph
blood supply to labyrinth
labyrinthine artery (basilar OR AICA)
what parts of the vesticular nerve supply which part of the vestibular canal
lower division = saccule
upper division = utricle & semicircular ducts
