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GSSE anatomy > Head & Neck > Flashcards

Head & Neck Flashcards

1
Q

What supplies the extensor muscles of the neck

A

Posterior rami of cervical nerves

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2
Q

What spinal level is the hard palate at

A

C1

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3
Q

Where does the pharynx start

A

C6

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4
Q

What nerves supply the prevertebral flexor musculature of the neck

A

Anterior rami

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5
Q

What level is the hyoid bone

A

C3

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6
Q

What is within and behind carotid sheath

A

CCA, ICA
IJV
Vagus
Cervical symp trunk is BEHIND

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7
Q

Most superficial structures in the neck

A

Platysma
Ext jugular V
Ant jugular V

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8
Q

Where is the platysma in terms of layers of the neck

A

Superficial to investing layer of deep cervical fascia

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9
Q

What vessels does platysma cover

A

all, but superficial vessels include EJV and ant jugular V

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10
Q

What nerve supplies platysma

A

Cervical branch of facial N

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11
Q

Tributaries of EJV

A

A continuation of retromandibular vein, and formed with posterior auricular V
Posterior external jugular
Suprascapular Vs
Transverse cervical V

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12
Q

Where does EJV terminate

A

Into subclavian V with ant jugular V just lateral to IJV

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13
Q

Tributaries of IJV

A

Inferior petrosal sinus
Pharyngeal plexus
Facial V
Lingual V
Superior and middle thyroid V

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14
Q

4 parts of the deep cervical fascia

A
  1. Investing layer
  2. Pre-tracheal layer
  3. Pre-vertebral
  4. Carotid sheath
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15
Q

What does the investing layer of fascia split to include

A

SCM
Trap
Parotid gland
Omohyoid

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16
Q

Suprasternal space contains

A

Lower ant jugular V
Sternal head of SCM
+/- LB

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17
Q

Where does the pretracheal fascia lie

A

Deep to infrahyoid (omohyoid, sternothyroid, sternohyoid) muscles

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18
Q

What does the pretracheal split to enclose

A

Thyroid gland

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19
Q

What is the thyroid gland adherent to

A

2,3,4 tracheal rings via isthmus

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20
Q

What does the pretracheal fascia fuse with

A

Carotid sheath

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21
Q

What vessels lie anterior the pre-vertebral fascia

A

Subclavian V
Axillary V

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22
Q

What lies deep to prevertebral fascia

A

Cervical plexus
Trunks of brachial plexus

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23
Q

What 4 cutaneous nerves pierce the prevertebral fascia

A

Greater auricular
Lesser occipital
Transverse cervical
Supraclavicular

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24
Q

Where does the carotid sheath attach

A

Margins of carotid and jugular fossa

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25
Q

What is the space anterior to the prevertebral fascia called

A

Para/retropharyngeal space
Connects base of skull to diaphragm

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26
Q

Boundaries of submandibular space

A

Mylohyoid, hyoid bone & mandible

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27
Q

Splenius capitis insert and origin

A

Lig nuchae, spinous process C7, T1-4

Mastoid process & occipital bones of skull

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28
Q

Nerve supply splenius capitis

A

Dorsal rami of middle cervical spial nerves

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29
Q

Splenius cervicis origin and insert

A

Spinous process T3-6
Transverse process C2-4

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30
Q

Nerve supply of splenius cervicis

A

Dorsal rami of lower cervical spinal nerves

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31
Q

Origin & insert levator scapulae

A

Transverse process of atlas & axis + post tubercles of C3/4

Insert: medial border of scapula from sup angle to spine

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32
Q

Nerve supply of levator scapulae

A

C3/4 reinforced by dorsal scapulae

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33
Q

Action of levator scapulae

A

Elevate scapula and laterally flex neck

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34
Q

What separates anterior and middle scalene muscles

A

Brachial plexus roots
Subclavian A

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35
Q

Nerve supply of the scalene muscles

A

Ventral rami of cervical spinal nerves

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36
Q

Origin & insert ant scalene

A

Transverse process C3-6

Insert 1st rib

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37
Q

Origin & Insert middle scalene

A

TP of C3-7

Insert 1st rib

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38
Q

Origin and insert post scalene

A

TP of C4-7

Insert 2nd rib

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39
Q

Trapezius origin & insert

A

Medial 1/3 of nuchal line + all 12 thoracic vertebra

Insert:
- lat 1/3rd of clavicle
- acromion, spine of scapula

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40
Q

Nerve supply of trapezius

A

Accessory nerve and branches of cervical plexus

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41
Q

Action of traps

A

Retract scapula, and rotate glenoid cavity

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42
Q

Posterior triangle of neck boundaries

A

Post border of SCM
Ant border of trapezius
Clavicle

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43
Q

Anterior triangle borders

A

Ant border of SCM
Lower border of mandible
Midline

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44
Q

SCM origin & insert

A

Sternal head - jugular notch
Clavicular head - medial 1/3rd of clavicle

Insert: mastoid process, to nuchal line

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45
Q

Crossed superficially (the SCM) by

A

Greater auricular nerve
EJV
Transverse cervical N

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46
Q

What nerve enters the SCM (and what A accompanies it)

A

Spinal accessory N
Branch of Occipital A

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47
Q

What encloses (fascia) the SCM

A

Investing layer of deep fascia

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48
Q

Nerve supply of SCM

A

Spinal accessory n

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49
Q

What is deep to the SCM

A

Upper = cervical plexus
Lower = carotid sheath, overlying scalenus ant

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50
Q

What forms the floor of posterior triangle

A

Splenis
Levator scapular
Scalenus medius

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51
Q

Contents of the posterior triangle

A

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

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52
Q

What forms the cervical plexus

A

Anterior rami of C1-4
Each has grey communicans from sup cervical ganglion

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53
Q

Where does the cervical plexus lie

A

Deep to prevertebral facia, alongside brachial plexus on scalene medius

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54
Q

Muscular branches of cervical plexus

A

C1 - hypoglossal
C2+3 - inf root of ansa cervicalis

Phrenic N C3,4,5

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55
Q

Course of phrenic nerve in neck

A

Passes over obliquity of ant scalene, from lateral to medial border (beneath prevertebal fascia)
Passes behind subclavian V

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56
Q

Cutaneous branches of Cervical plexus

A

“GLTS”
Greater auricular N
Lesser occipital N
Transverse cervical N
Supraclavicular N

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57
Q

Which cervical root has NO cutaneous distribution

A

C1

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58
Q

The posterior rami of C2/3 are not apart of cervical plexus because

A

They are POSTERIOR, cervical plexus only supplied by anterior/ventral branches

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59
Q

Posterior rami of C2/3 branches

A

Greater occipital
third occipital nerves

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60
Q

Boundaries of carotid triangle

A

SCM
Posterior belly of digastrics
Sup border of omohyoid

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61
Q

Contents of carotid triangle

A

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

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62
Q

Digastric triangle boundaries

A

Ant, post bellies of digastric
Mandible

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63
Q

Contents of digastric triangle

A

Submandibular gland and LN
Facial A
Submental and mylohyoid vessels
Hypoglossal and mylohyoid Ns

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64
Q

Submental triangle boundaries

A

Ant belly of digastric
Hyoid
Midline

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65
Q

Contents of submental triangle

A

Anterior jugular V
Lns

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66
Q

Suprahyoid muscles

A

“Dont say matts gay”
Digastric
Stylohyoid
Mylohyoid
Geniohyoid

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67
Q

Digastric muscle origin & insert

A

Ant belly - digastric fossa of mandible to hyoid
Post belly - digastric notch of mastoid to hyoid

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68
Q

Nerve supply of digastric

A

Ant - V3 (nerve to mylohyoid)
Post - facial

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69
Q

Stylohyoid muscle origin and insert

A

Styloid process to hyoid

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70
Q

Nerve supply of stylohyoid

A

Facial nerve

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71
Q

Mylohyoid origin and insert

A

Inner aspect of mandible => hyoid

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72
Q

Stylohyoid m nerve supply

A

Facial N

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73
Q

Mylohyoid n supply

A

V3 (n to mylohyoid)

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74
Q

Geniohyoid origin and insert

A

Genial tubercle of mandible to body of hyoid

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75
Q

Nerve supply of geniohyoid

A

Hypoglossal N

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76
Q

Infrahyoid muscles

A

Sternohyoid
Omohyoid
Thyrohyoid
Sternothyroid

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77
Q

What supplies sternohyoid

A

Ansa cervicalis

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78
Q

What supplies omohyoid

A

Ansa cervicalis

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79
Q

When does omohyoid become a flat tendon

A

When passing over IJV

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80
Q

What nerve supplies thyrohyoid

A

Hypoglossal but fibres hitchhiking from C1

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81
Q

What supplies sternothyroid

A

Ansa cervicalis

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82
Q

Actions of infrahyoid muscles

A

Depress larynx
Increase volume of resonating chambers during phonation

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83
Q

What does of production does the submandibular gland make

A

Mixed mucus and serous

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84
Q

What are the parts of the submandibular gland

A

Deep and superficial parts, continuous with one another around free posterior margin of mylohyoid

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85
Q

Blood supply to submandibular gland

A

Facial artery and vein

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86
Q

Nerve supply to submandibular gland

A

Lingual N (V3)

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87
Q

Submandibular duct opens into..

A

Floor of mouth, beside frenulum

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88
Q

Where does the thyroid gland lie

A

Infront of tracheal rings 2-4

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89
Q

How does the recurrent laryngeal nerve access the thryoid

A

The medial surface from below (travelling bw trachea and oesophagus)

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90
Q

Where does the ext laryngeal nerve lie in proximity to thyroid gland

A

On inferior constrictor behind sup thyroid A

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91
Q

Blood supply of thyroid gland

A

Superior thyroid (ECA)
Inferior thyroid (thyrocervical trunk)

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92
Q

Veins of the thyroid gland

A

Sup thyroid V => IJV/facial V
Middle thyroid => IJV
Inf thyroid => L brachiocephalic

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93
Q

Where does the parathyroid gland lie

A

Often 4 glands, embedded into trachea (note Sup PT glands from pharyngeal branch 4, and inferior from 3)

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94
Q

What runs in the groove b/w trachea and oesophagus

A

Recurrent laryngeal N

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95
Q

Where does trachea commence

A

C6

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96
Q

Where does oesophagus begin

A

C6

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97
Q

Where does the thoracic duct run in proximity to oesophagus

A

Runs behind lower part of L border

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98
Q

Where do the CCA arise

A

L = arch of aorta
R = brachiocephalic trunk

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99
Q

Where does the CCA lie

A

within medial part of carotid sheath
IJV lateral , vagus in between

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100
Q

Branches of the ECA

A

Some Anatomists like freaking out poor medical students

Sup thyroid
Asc pharyngeal
Lingual
Facial
Occipital
Post auricular
Maxillary
Superficial temporal

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101
Q

Where does the CCA bifurcate

A

C4

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102
Q

Where does the ECA terminate

A

In parotid gland

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103
Q

Terminal branches of ECA

A

Superficial temporal
Maxillary

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104
Q

What does occipital A supply

A

Back of scalp
2 branches to SCM

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105
Q

Carotid sinus vs carotid body

A

Sinus - baroreceptor
Body - chemoreceptor (peripheral)

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106
Q

Where does the carotid sinus lie

A

At commencement of ICA

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107
Q

Where does the carotid body lie

A

Behind bifurcation of common carotid A

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108
Q

What are the branches of ICA In the neck

A

None

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109
Q

What are the divisions of subclavian A and what makes that division

A

Medial, posterior and lateral to anterior scalene

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110
Q

Branches of subclavian A

A

VIT C + D
Vertebral A
Internal thoracic A
Thyrocervical trunk
Costocervical trunk
Dorsal scapular A

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111
Q

What are the branches of the thyrocervical trunk

A

Transverse cervical
Ascending cervical A
Suprascapular A
Inferior thyroid A

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112
Q

What arteries of the subclavian A are MEDIAL to scalene anterior

A

Vertebral A
Internal thoracic A
Thyrocervical A

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113
Q

What branches of subclavian are posterior to scalene anterior

A

Costocervical trunk
- with a deep cervical & supreme intervostal

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114
Q

What is the origin of the supreme intercostal

A

Costocervical trunk

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115
Q

What branches of subclavian lie lateral to scalene anterior

A

Dorsal sapular A

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116
Q

Where does the IJV emerge

A

From post compartment of jugular fossa

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117
Q

Posterior relation s of IJV

A

Cervical plexus
Phrenic nerve

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118
Q

Where does the iJV lie in proximity to ICA

A

Lies LATERAL

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119
Q

Surface marking of IJV

A

B/w ear lobule and 2heads of SCM

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120
Q

Tributaries of iJV

A

Inf pertrosal sinus
Pharyngeal
Lingual
Facial
Superior and middle thyroid veins

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121
Q

Where does the hypoglossal nerve arise in neck

A

B/w ICA and iJV, deep to post belly of digastric

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122
Q

Function of prevertebral muscles in the neck

A

Weak flexors

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123
Q

Prevertebral muscles of the neck

A

Rectus capitis anterior
Rectus capitis lateralis
Longus capitis
Longus coli

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124
Q

Cervical sympathetic trunk ganglion

A

Superior
Middle
Inferior

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125
Q

Where is superior cervical ganglion

A

Infront of C2,3

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126
Q

Where is middle cervical ganglion

A

Infront of inferior thyroid A

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127
Q

Where is inferior cervical ganglion

A

Behind commencement of vertebral A, often fuses with 1st thoracic ganglion to form stellate ganglio

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128
Q

Where does the cervical part of sympathetic trunk run in the neck

A

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

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129
Q

What is the root of the neck

A

TV1, 1st thoracic rib/cartilage and manubrium

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130
Q

What is function of anterior scalene

A

Flex and rotate neck, 1st rib stabiliser
Most important as landmark

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131
Q

Nerve supply anterior scalene

A

Ant rami of C4-6

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132
Q

Anterior relations to ant scalene

A

Phrenic N
Ascending cervical A
Transverse cervical and suprascapular A (cross over phrenic)
Vagus nerve
Subclavian V

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133
Q

Medial relations to anterior scalene

A

1st part of subclavian (+ vertebral, internal thoracic, thyrocervical trunk with suprascapular, inf thyroid, asc cervical, transverse cervical A)

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134
Q

Posterior relations of ant scalene

A

Subclavian A (2nd part) + costocervical trunk
brachial plexus roots

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135
Q

Lateral relations of ant scalene

A

Trunks of brachial plexus
3rd part of subclavian + dorsal scapular A

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136
Q

Which pharyngeal arch do muscles of facial expression develop

A

2nd arch

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137
Q

What are the muscles of the eyelids

A

Orbicularis
Levator palpebrae superioris

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138
Q

Muscles of the nose

A

Transverse part of nasalis
Alar part of nasalis

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139
Q

Muscles of lips and cheeks

A

Orbicularis oris
Levator labii superioris alaeque
Levator labii superioris
Levator anguli oris
Zygomaticus minor and major
Risorius
Depressor anguli oris
Depressor labii infeiroris
Mentails

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140
Q

What nerve supplies muscles of fascial expression

A

CN7

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141
Q

Facial nerve emerges from skull

A

Stylomastoid foramen

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142
Q

Branches of CN7 prior to parotid gland

A

Post auricular N
Muscular branch

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143
Q

Post auricular N origin

A

CN7

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144
Q

Post auricular n supplies

A

Occipital belly of occipitofrontalis

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145
Q

Muscular branch of CN7 supplies

A

Digastric & stylohyoid

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146
Q

What are the branches of CN7 in parotid gland

A

Upper temporofacial & lower cervicofacial divisions into 5 main branches
Temporal
Zygomatic
Buccal
Marginal mandibular
Cervical

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147
Q

Branches of facial nerve in parotid gland

A

Temporal
Zygomatic
Buccal
Marginal mandibular
Cervical

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148
Q

Temporal branch of CN7 supplies..

A

Auricularis ant, superior and frontalis

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149
Q

Zygomatic branch of CN7 supplies….

A

Orbicularis oris

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150
Q

Buccal branch of CN7 supplies..

A

Buccinator

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151
Q

Where is the marginal mandibular branch of CN7 at danger of being damaged, and result of such

A

In danger with an incision made at or near the lower border of the mandible

Results in detectable paralysis of lower lip & mouth angle

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152
Q

Cervical branch CN7 supplies

A

Platysma

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153
Q

Divisions of trigeminal nerve

A

V1 - ophthalmic
V2 - maxillary
V3 - mandibular

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154
Q

Cutaneous branches of CNV1

A

Lacrimal
Supraorbital
Supratrochlear
Infratrochlear
External nasal nerve

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155
Q

Branches of V2

A

Infraorbital nerve
Zygomaticofacial
Zygomaticotemporal

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156
Q

V3 branches (cutaneous)

A

Auriculotemporal
Buccal
Mental

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157
Q

Blood supply to the face

A

Facial A
Transverse fascial A
Supraorbital & Supratrochlear (from Ophthalmic A)

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158
Q

Where does the facial A travel in head

A

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

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159
Q

Where does the transverse facial A arise

A

Superficial temporal A

160
Q

Venous return of the face

A

Supraorbital & supratrochlear veins
To form angular vein => facial vein => IJV

161
Q

What aspects of the face drain into cavernous sinus

A

The ophthalmic veins

162
Q

What is the ‘danger area’ of the face, and why is this concerning

A

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

163
Q

Layers of the SCALP

A

Skin
Connective tissue
Aponeurosis (where occipitalis & frontalis insert)
Loose areolar tissue
Pericranium

164
Q

Occipitofrontalis origin & insert

A

Occipital part - from highest nuchal line, and into aponeurosis
Frontalis - from apoeurosis to orbicularis oculi

165
Q

Nerve suppy of occipitofrontalis

A

Facial N
- post auricular N to occipitalis
- temporal branch to frontalis

166
Q

Blood supply to scalp

A

3 from ECA
- superficial temporal A
- occipital A
- post auricular A

2 from ICA
- supratrochlear
- supraorbital

167
Q

Nerve supply to scalp

A

Zygomaticotemporal N (CNV2)
Greater occipital N (C2)
Lesser occipital N (C2)
Auriculotemporal N (CNV3)
Suptratrochlear, (V1)
supraorbital (V1)

“Z-glass”

168
Q

What makes up the Boundaries of temporal fossa

A

Roof - temporalis fascia
Floor - skull (pterion)
Anterior wall - zygomatic process of frontal bone

169
Q

Contents of temporal fossa

A

Temporalis mucles arises here

170
Q

What nerves cross the zygomatic arch

A

Auriculotemporal N
Temporal & zygomatic branches of CN7

171
Q

What lies beneath temporalis fascia (other than temporalis)

A

Branches of superficial temporal A
Zygomaticotemporal Branch V2
Temporal, zyogmatic branches CN7
Superficial temporal vessels
Auriculotemporal N

172
Q

Temporalis muscle origi & insertion

A

Arise from temporal fossa, spreads like a fan and inserts from alveolar process to mandible

173
Q

What nerves & arteries supply temporalis M

A

Temporal branches of maxillary A
Superficial temporal arteries

2-3 deep temporal branches of CNV3

174
Q

Where does the masseter muscle originate and insert

A

Arise from lower border of zygomatic arch, inserts into lateral surface of mandibular ramus

175
Q

What lies on top of masseter muscle

A

Aponeurosis and parotid ductb

176
Q

Blood supply of masseter muscle

A

Facial, maxillary, superifical temporal, transverse facial A

177
Q

Nerve supply of masseter

A

V3 - masseteric branch

178
Q

What nerve supplies the parotid fascia

A

Greater auricular N (C2,3)

179
Q

Where is pain transmitted from parotid gland

A

In greater auricular N C2,3

180
Q

What passes through the substance of parotid gland

A

Parotid duct
Facial N branches
ECA and terminal branches
Retromandibular V

181
Q

Blood supply of parotid gland

A

ECA

182
Q

Venous drainage of parotid gland

A

Retromandibular V
Anterior - IJV
Posterior - EJV

183
Q

Nerve supply of the parotid gland

A

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

184
Q

Infratemporal fossa boundaries

A

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

185
Q

Contents of infratemporal fossa

A

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

186
Q

Muscle content of infratemporal fossa

A

Medial, lateral pterygoid
Insertion of temporalis into coronoid process

187
Q

Vessels of infratemporal foss

A

Maxillary A and branches

Pteryogid venous plexus

188
Q

Nerves of infratemporal fossa

A

Otic ganglion + mandibular N

Chorda tympani

Post sup alveolar branches of maxillary N

189
Q

Lateral pterygoid muscle origin & insert

A

Upper roof of infratemporal fossa, lateral pterygoid plate
Insert into pterygoid fovea on front of the neck of mandible

190
Q

Nerve supply of lateral pterygoid

A

Ant div of mandibular n

191
Q

Fx of lateral pterygoid

A

Open the mouth

192
Q

Medial pterygoid muscle origin & insert

A

Lateral pterygoid plate & palatine bone

Insert: rough area of mandible

193
Q

Nerve supply of medial pterygoid

A

Branch of main trunk of mandibular n

194
Q

Action of medial pterygoid m

A

Close mouth

195
Q

Where does the maxillary A arise from

A

Terminal branch of ECA

196
Q

What are the parts of the maxillary A, and in relation to what

A

3 parts, related to lateral pterygoid M

Before, on and after

197
Q

Branches of maxillary A before lateral pterygoid

A

Inferior alveolar A
Middle meningeal A
Accessory meningeal A
Deep auricular A
Ant temporal A

198
Q

Branches of maxillary A ON the lateral pterygoid

A

Pterygoid A
Masseteric A
Ant temporal A
Post temporal A
Buccal A

199
Q

Branches of maxillary A AFTER lateral pterygoid

A

Infraorbital
Sphenopalatine
Post superior alveolar A
Greater palatine A
Pharyngeal A, artery to pterygoid canal

200
Q

What is the pterygoid venous plexus

A

Network of veins within and around lateral pterygoid m

201
Q

What drains into the pterygoid plexus

A

Corresponds to branches of maxillary A byt do not return all arterial blood

202
Q

Where does the pterygoid plexus drain INTO

A

Short maxillary vein with superficial temporal v to form retromandibular V

203
Q

How is the pterygoid plexus connected to cavernous sinus

A

Via emissary veins through Foramen OVALE and foramen LACERUM

204
Q

What is the sphenomandibular ligament and its significance

A

From sphenoid bone to mandible
Transmits multiple important vessels

205
Q

What passes b./w sphenomandibular lig & mandible

A

Auriculotemporal N
Maxillary A, V
Inferior alveolar vessels
Mylohyoid nerve (pierces the bottom of lig)

206
Q

Where does the V3 arise from in skull

A

Foramen ovale

207
Q

What are the divisions of V3

A

(Main trunk)
Small anterior (mainly motor)
Large posterior (mainly sensory)

208
Q

What branches of V3 come directly off main trunk

A

Meningeal branch
N to medial pterygoid

209
Q

Branches of ant div of V3

A

All motor except buccal
2 deep temporal branches
Masseteric N
N to lateral pterygoid
Buccal nerve

210
Q

Branches of post div of V3

A

All sensory except mylohyoid
Auriculotemporal N
Inferior alveolar (dental) nerve
Lingual n

211
Q

What is chorda tympani

A

From facial N

212
Q

What does chorda tympani CARRY

A

Ant 2/3rds of taste to tongue
PSNS to submandibular gland

213
Q

Where is the otic ganglion

A

B/w tensor palate & mandibular n, just below foramen ovale

214
Q

What is the role of otic ganglion

A

Relay station for PSNS secretomotor fibres to parotid by lesser petrosal branch of CN9

215
Q

What does the middle meningeal N supply

A

Via f.spinosum
Meningeal of middle cranial fossa
Mastoid air cells

216
Q

N of med pterygoid n supply

A

Medial pterygoid
Tensor palati
Tensor tympani

217
Q

What is contained w/in carotid sheath

A

ICA
IJV
CN9, 10, 11, 12

218
Q

What is medial to carotid sheath

A

Pharynx

219
Q

What is lateral to carotid sheath

A

Deepest part of parotid

220
Q

What lies behind carotid sheath

A

Cervical sympathetic trunk on prevertebral fascia

221
Q

What is embedded in anterior wall of sheath

A

Ansa cervicalis

222
Q

Glossopharyngeal nerve emerges from skull

A

Jugular foramen anterior part

223
Q

How does CN9 reach the tongue

A

From jugular foramen, lateral to ICA, deep to ECA and deep to hypoglossus

224
Q

Branches of glossopharyngeal n

A

Tympanic branch
Motor branch
Carotid sinus n
Pharyngeal branch
Tonsillar branch
Lingual branch

225
Q

Tympanic branch of CN9 supplies

A

Supply middle ear, mastoid cells, bony part of auditory tube with sensory fibres

226
Q

Motor branch CN9 supplies

A

Stylopharyngeus m

227
Q

Lingual branch of CN9 supplies

A

Taste & secretomotor fibres of post 1/3rd

228
Q

Vagus nerve emerges and travels in neck

A

Middle compartment jugular fossa
Within carotid sheath
Over subclavian a into thorax

229
Q

Neck branches of vagus n

A

Meningeal branches
Auricular branch
Carotid body
Pharyngeal branch (all except stylopharyngeus)
Superior laryngeal n (int, ext)
Cervical cardiac branches
Recurrent laryngeal N

230
Q

What n supplies muscles of pharynx

A

All except stylopharyngeus supplied by CN10. Stylopharygeus = CN9

231
Q

What nerve supples laryngeal muscles

A

All by recurrent laryngeal n EXCEPT cricothyroid *ext laryngeal N

232
Q

Accessory nerve emerges & travels in neck

A

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

233
Q

Hypoglossal N emerges and travels in neck

A

From hypoglossal canal
Spiral behind inf ganglion of vagus and pass through carotid sheath
Then travels anteriorly towards tongue

234
Q

What muscle emerge from styloid process

A

Stylopharyngeus
Stylohyoid
Styloglossus

235
Q

What is the styloid apparatus

A

Tip of temporal bone

236
Q

Where does the carotid sheath lie in proximity to styloid process

A

Lies medial to styloid process

237
Q

Pterygopalatine fossa boundaries

A

Roof - body of sphenoid
Medial - perpendicular plate of palatine
Ant - post wall of maxilla
Roof - pterygoid process of sphenoid

238
Q

Contents of pterygopalatine fossa

A

Maxillary vessels & nerve
Ptergyopalatine ganglion & fat

239
Q

Maxillary N V2 emerges and in the neck

A

From foramen rotundum into pterygopalatine foramen
Travels & branches
- infraorbital n
- zygomatic n
- posterior sup alveolar n

240
Q

Pterygopalatine ganglion FUNCTION

A

Parasympathetic ganglion
Relay station b.w superior salivary nucleus in pons &. Lacrimal gland & mucus & serous glands of the palate, nose, paranasal sinus

241
Q

Where does the pterygopalatine ganglion sit

A

In front of pterygoid canal

242
Q

What is the autonomic root of pterygopalatine canal

A

Nerve of pterygoid canal (Vidian n)

243
Q

How is the vidian n (nerve of pterygoid canal) formed

A

In foramen lacerum by greater petrosal N (PSNS, CN7) & deep petrosal N *SNS, from internal carotid plexus

244
Q

Fx of vidian n

A

Provide supply to lacrimal gland
Sensory

245
Q

Branches of pterygopalatine ganglion

A

Vidian n
Nasopalatine n
Lateral posterior superior nasal nerves
Greater palatine n
Lesser palatine n
Pharyngeal n

246
Q

Which bones do the nasal bones articulate with

A

Frontal
Maxilla

247
Q

Blood supply of ext nose

A

Dorsal nasal A (terminal branch ophthalmic)
Ext nasal A (ant ethmoidal)
Lateral, nasal, septal branches of facial

248
Q

What forms the lateral wall of nasal cavity

A

Maxilla
Perpendicular plate of palatine
Medial pterygoid plate
Ethmoid bone

249
Q

What does the sphenopalatine foramen communicate

A

Nasal cavity & pterygopalatine fossa

250
Q

Where does the nasolacrimal duct open into

A

The upper part of inf nasal meatus

251
Q

Which wall are the turbinates on: lateral or medial

A

Lateral

252
Q

What makes up the medial wall of nasal cavity

A

Bones - vomer, ethmoid (perpendicular plate)
Cartilage

253
Q

Floor of nasal cavity

A

Palatal process of maxilla
Horizontal plate of palatine bone

254
Q

Roof of nasal cavity

A

Cribiform plate of ethmoid
Frontal bone
Nasal bone
Sphenoid

255
Q

Blood supply to nasal cavity

A

Sphenopalatine branch
Septal branch of Superior labial A
Ascending branch of Greater palatine A
(Forms Kieselback’s plexus)

256
Q

What makes up kiselback’s plexus

A

Sphenopalatine
Ascending branch of greater palatine A
Septal branch of superior labial A

257
Q

What is the nerve supply to nasal cavity

A

Olfactor area - CN1
Vestibular Area = infraorbital (CNV1)
Resp area = ant ethmoid n V1, ant sup alveoar N V2
Pterygopalatine ganglion & greater palatine nerve

258
Q

What are the sinuses of the face

A

Maxillary
Ethmoidal
Frontal
Sphenoidal

259
Q

Where do the ant, middle and post ethmoidal air cells drain into

A

Middle meatus = ant, midle
Post = superior meatus

260
Q

What are the lateral, superior, posterior and inferior relations of sphenoidal sinus

A

Above: pit fossa, middle cranial fossa
Lateral: cavernous sinus, ICA
Posterior to sinus: post cranial fossa & pos
Below sinus: nasopharynx

261
Q

Which sinus is NOT present at birth?

A

Frontal sius

262
Q

What nerves supply the UPPER gums

A

Superior alveolar, greater palatine & nasopalatine n (V2)

263
Q

What nerve supplies the lower gums

A

Inferior alveolar, buccal, lingual n (V3)

264
Q

Upper teeth nerve supply

A

Superior alveolar N

265
Q

Lower teeth nerve supply

A

Lower alveolar N

266
Q

What bones make up the hard palate

A

Palatal process of maxilla, horizontal plate of palatine bone

267
Q

What are significant foramen in the hard palate

A

Greater palatine & lesser palatine foramen

268
Q

What does the greater palatine foramen transmit, and where does it travel

A

Greater palatine A which then passes forward up into nose via incisive canal

269
Q

What is the sulcus terminalis of the tongue

A

Marks site of junction b/w oral & pharyngeal parts of tongue

270
Q

What is the palatoglossal arch

A

Ridge of mucus membranes raised by palatoglossus muscle

271
Q

What is posterior palatoglossal arch

A

Palatine tonsils (aka THE tonsils)

272
Q

Extrinsic muscles of the tongue

A

Genioglossus
Hyoglossus
Styloglossus
Palatoglossus

273
Q

intrinsic muscles of the tongue

A

Superior longitudinal
Inferior longitudinal
Transverse
Vertical

274
Q

Where does the hyoglossus originate & insert

A

Hyoid bone into interdigitating with styloglossus

275
Q

What is superficial to hyoglossus

A

Lingual nerve
Submandibular duct
Hypoglossal n with accompanying vein

276
Q

What is deep to hyoglossus

A

Glossopharyngeal N
Stylohyoid lig
Lingual artery and accompanying vein

277
Q

Blood supply of tongue

A

Lingual A deep to hyoglossus M

278
Q

Blood drainage of tongue

A

Lingual V => IJV

279
Q

Lymph drainage of tongue

A

Submental
Submandibular
Jugulodigastric & jugulo-omohyoid
thoracic duct/R lymphatic duct

280
Q

Nerve supply of tongue

A

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

281
Q

What area the parts of the pharynx

A

Naso
Oro
Laryngopharynx

282
Q

Where does the pharynx attach to

A

Base of skull (note: not the muscles, but the fascia)

283
Q

What attaches pharynx to base of skull

A

Pharyngobasilar fascia

284
Q

What is the pharyngobasilar fascia

A

Rigid membrane, connecting pharyx to base of skull

Holds nasopharynx open for breathing (passes from 1 medial pterygoid plate to the other)

285
Q

Where does sup constrictor arise

A

Medial pterygoid plate
Hamulus
Pterygomandibular raphe

286
Q

What lies b/w superior and middle constrictors

A

Styloglossus, glossopharyngeal nere, lingual nerve
Stylopharyngeus

287
Q

Where does middle constrictor arise

A

Stylohyoid lig
Lesser horn of hyoid
Greater horn deep to hyoglossus

288
Q

What is anterior to middle & inferior constrictors

A

Thyrohyoid membrane

289
Q

What pierces (neurovascular structure) the thyrohyoid membrane

A

Internal laryngeal N
Superior laryngeal vessels

290
Q

What makes up the inferior constrictor

A

Thyropharyngeus
Cricopharyngeus

291
Q

What passes upward, deep to lower border of inf constrictor

A

Recurrent laryngeal N
Inferior laryngeal vessels

292
Q

What is killians dehiscence

A

Site b/w oblique & horziontal fibres of inferior constrictor muscle cricopharyngeus

Potential site of diverticulum

293
Q

Relationship b/w glossopharyngeal N and stylopharyngeus

A

Glossopharyngeal n curls around posterior border & supplies it

294
Q

What nerve supplies motor aspect of pharyngx

A

Mainly pharyngeal plexus (CNX)
Except stylopharyngeus (glossopharyngeal)
Cricopharyngeus (recurrent, ext laryngeal N)

295
Q

What nerves give rise to pharyngeal plexus & action of said nerves

A

Vagus and glossopharyngeal
Cervical sympathetic nerves

Afferent nerves = glossopharyngeal
Vagus = motor
Sympathetic fibres = vasoconstrictor

296
Q

Where does nasopharynx begin (vertebral level)

A

C1

297
Q

Key features of nasopharynx

A

Opening of auditory tubes (with tubal elevation)
Pharyngeal recess
Pharyngeal tonsils (adenoids)

298
Q

Where does oropharynx begin & end

A

From soft palate to epiglottis (C3)

299
Q

What are the ridges of the oropharynx associated with

A

Anteriorly, palatoglossal arch
Posteriorly palatopharyngeal arch
With palatine tonsils b/w

300
Q

What nerve & artery is near the tonsils, and what protects it

A

N: glossopharyngeal
A: facial A (superior constrictor protects from both)

301
Q

What is the valleculae & clinical importaNce

A

B/w epiglottis & post surface of tongue
Site of stuck food!

302
Q

Where does the laryngopharynx start & end

A

C3 at epiglottis
C6 at level of cricoid cartilage, becomes oesophagus

303
Q

What muscles make up the soft palate

A

Tensor palati
Levator palati
Palatoglossus
Palatopharyngeus
Uvula

304
Q

Action of tensor palati

A

It contracts, pull upon attachment to auditory tube to equalise middle ear pressure (impacted in patients w cleft palate)

305
Q

palatoglossus action

A

raises the tongue

306
Q

blood supply of the soft palate

A

lesser palatine A of maxillary A
ascending palatine branch of facial A
ascending pharyngeal branch of ECA

307
Q

nerve supply of soft palate *muscles

A

all by pharyngeal plexus EXCEPT tensor palati 0 n to medial pterygoid *CNV3

308
Q

afferent & efferent limb of gag reflex

A

afferent - glossopharyngeal
efferent - vagus

309
Q

what vertebral level does larynx lie

A

C4-6

310
Q

cartilages of larynx

A

3 single - thyroid, cricoid, epiglottis
3 paired - corniculate, artenyoid, cuneiform

311
Q

extrinsic ligaments & membranes of larynx

A

thyrohyoid membrane
cricotracheal
hyoepiglottic
thyroepiglottic

312
Q

what type of cartilage makes up the cartilage of larynx

A

hyaline cartilage - thyroid, cricoid, arytenoids

elastic fibrocartilage - epiglotts, corniculate, cuneiform

313
Q

what type of joint is b./w circoid & thyroid, cricoid & arytenoid

A

synovial joints

314
Q

where is the corniculate cartilage

A

on apex of arytenoid

315
Q

what is the gap b/w folds

A

glottis

316
Q

Which muscle work on the laryngeal inlet

A

Aryepiglottic
Oblique arytenoids

317
Q

What muscles work on vocal ligament

A

Posterior & lateral cricoarytenoids (note: posterior is ONly muscle to abduct!)

Oblique & transverse arytenoids

Thyroarytenoids

Vocalis

Cricothyroids

318
Q

Action of cricothyroid muscle

A

Lengthen (increase tension) of vocal cords

319
Q

Action of lateral cricoarytenoids

A

Adduction

320
Q

action of posterior cricoarytenoids

A

Abduction

321
Q

Action of transverse arytenoid muscle

A

Adduction

322
Q

Action of vocalis. & thyroarytenoid

A

Relax (shorten)vocal cords

323
Q

Blood supply of larynx

A

Above vocal cords - superior laryngeal branch from superior thyroid A

Below vocal cord - inferior laryngeal branch from inferior thyroid A

324
Q

What is nerve supply of muscles of larynx

A

All by recurrent laryngeal n EXCEPT cricothyroid (ext laryngeal N)

325
Q

What supplies the sensation fo the larynx (mucus membrane)

A

Above vocal = internal laryngeal N (branch of superior laryngeal N)
Below vocal = recurrent laryngeal nerves

326
Q

Where are the cell bodies of motor nerves for larynx

A

Nucleus ambiguus

327
Q

What is division of recurrent laryngeal n

A

Anterior = motor
Posterior = sensory

328
Q

What is the clinical impact of paralysis of recurrent laryngeal N

A

ADDUCTED vocal cord (unable to abduct)
Hoarse voice

329
Q

What makes up the roof of the orbit

A

Frontal bone, lesser wing of sphenoid

330
Q

What makes up medial wall of orbit

A

Anterior lacrimal crest of maxilla
Lacrimal bone
Orbital plate of ethmoid

331
Q

What makes up the lateral wall of orbit

A

Zygomatic bone
Greater wing of sphenoid

332
Q

What makes up floor of orbit

A

Orbital surface of maxilla
Zygomatic bone
Tiny orbital process of palatine bone

333
Q

Blood supply of eyelid

A

Medial palpaebral & lateral palpebral A of ophthalmic A

334
Q

Nerve supply to skin of upper lid

A

Lacrimal
Supraorbital
Supratrochlear
Infratrochlear

335
Q

Nerve supply to skin of lower lid

A

Infraorbital N

336
Q

Components of lacrimal apparatus

A

Lacrimal gland
Lacrimal canaliculi
Lacrimal sac
Nasolacrimal duct

337
Q

Where does the nasolacrimal duct open into

A

Inferior part of inferior meatus

338
Q

Nerve supply of the lacrimal apparatus

A

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

339
Q

What nerves pass THROUGH the SOF but OUTSIDE the ring

A

Lacrimal
Frontal
Trochlear

340
Q

What nerves pass through SOF & tendinous ring

A

Oculomotor (superior, inferior)
nasociliary
Abducens

341
Q

What nerve supplies levator palpebrae superioris

A

Superior branch of oculomotor

342
Q

What is the effect on ptosis in complete oculomotor palsy vs cervical sympathetic chain division

A

Complete oculomotor palsy = ptosis (complete)
Cervical sympathetic chain division = partial ptosis

343
Q

List the nerves of the orbit

A

Optic
Infraorbital V2
Zygomatic V2
Lacrimal V1
frontal V1
trochlear
oculomotor
abducens
nasocilliary
ciliary ganglion

344
Q

where does the ophthalmic artery travel in relation to optic N

A

the ophthalmic A is below & lateral to the Optic N in the optic canal

345
Q

how does the infraorbital N reach the orbit

A

via inferior orbital fissure

346
Q

what does the frontal nerve divide into?

A

supratrochlear
supraorbital (when passing through supraorbital fissure)

347
Q

trochlear nerve supplies

A

superior oblique

348
Q

oculomotor nerve divisions

A

superior
inferior

349
Q

what does the superior division of CN3 supply

A

above optic nerve to sup rectus, levator palpebrae

carries SNS fibres from Internal carotid cavernous plexus to smooth part of levator

350
Q

what does the inferior division of CN3 supply

A

middle rectus, inferior oblique
PSNS root to ciliary ganglion

351
Q

abducens nerve supplies

A

lateral rectus

352
Q

what are the branches/course of nasociliary N

A

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

353
Q

What do the long ciliary nerves supply

A

Ciliary body, iris, cornea

Carry SNS from superior cervical ganglion for dilator pupillae

354
Q

What are the roots of ciliary ganglion

A

Sensory - branch of nasociliary nerve, supply eye NOT conjunctive

SNS - vasoconstrictor to vessels of eye

PSNS - ciliary body for accommodation & sphincter pupillae

355
Q

Where does the ophthalmic A arise

A

From roof of cavernous sinus from ICA

356
Q

What does the ophthalmic A supply

A

Ethmoidal air cells
Nasal cavity
External nose
Eyelids
Forehead
Extraocular muscles
Lacrimal apparatus
Eye

357
Q

What drains the orbit

A

Superior ophthalmic V
inferior ophthalmic V

358
Q

What does the superior ophthalmic v drain into

A

Cavernous sinus via SOF

Communicates with angular V

359
Q

What does the inferior ophthalmic V drain into

A

Pterygoid plexus OR cavernous sinus

360
Q

Superior rectus movement

A

Up & in

361
Q

Inf oblique movement

A

Up & out

362
Q

Inf rectus movement

A

Down & in

363
Q

Sup oblqiue movement

A

Down & out

364
Q

Abducens palsy

A

Cannot look OUTWARDS

365
Q

Trochlear palsy

A

Eye cannot look down when eyes turned in

366
Q

Oculomotor palsy

A

Down & out eye
Ptosis
Dilated pupil

367
Q

How mant levels of nodes are there, and which correlate to DEEP cervical LNs

A

7 levels, levels 2-4 = deep

368
Q

What are the 7 levels of LNs of the neck

A

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

369
Q

what type of joint is TMJ

A

synovial b/w condyle of mandible & mandibular fossa on squamous part of temporal bone with fibrocartilaginous disc

370
Q

what muscles facilitate jaw opening

A

digastrics
mylohyoid
geniohyoid

371
Q

what muscles facilitate jaw elevation

A

masseter
medial pterygoid
temporalis

372
Q

muscles that facilitate grinding jaw motion

A

medial & lateral pterygoid

373
Q

protraction of jaw muscles

A

all pterygoids

374
Q

retraction of jaw muscles

A

passive recoil

temporalis
deep fibres of masseter

375
Q

what makes up the ext ear

A

auricle (pinna)
EAM

376
Q

what is major cutaneous supply og ext ear

A

greater auricular N

377
Q

what arteries supply ext ear

A

post auricular
superifical temporal A

378
Q

what makes up the middle ear

A

tympanic cavity!!!!

379
Q

what are the bones of the tympanic cavity

A

malleus
incus
stapes

380
Q

what nerve supplies stapedius & action

A

facial N action is to retract the stapes and tilt the foot piece in the oval window

381
Q

paralysis of stapedius

A

hyperacusis

382
Q

what does the nervous intermedius contain

A

fibres for pterygopalatine & submandibular ganglia
taste for ant part of tongue & soft palate

383
Q

where does the greater petrosal n arse from

A

facial n, through a canal in petrous bone

leaves through foramen lacerum to enter pterygoid canal

384
Q

what is the chorda tympani

A

mixed visceral n containing taste fibres from tongue & secretomotor fibres for salivary glands of floor of mouth

385
Q

where does the chorda tympani arise & travel to

A

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

386
Q

what do the greater petrosal & deep petrosal nerves form

A

vidian n

387
Q

what are the parts of the internal ear

A

osseous labyrinth with membranous labyrinth insider with the auditory & vestibular n receptors

388
Q

the parts of osseous labyrinth

A

cochlea
vestibule
semicircular canals

389
Q

what type of lymph circulates within osseous labyrinth

A

perilymph

390
Q

parts of the membranous labyrinth

A

cochlear duct
utricle & saccule
semicircular ducts

391
Q

where are the utricle & saccule

A

within vestibule

392
Q

what are the utricle & saccule concerned with

A

static balance

393
Q

what type of lymph is within membranous labyrinth

A

endolymph

394
Q

blood supply to labyrinth

A

labyrinthine artery (basilar OR AICA)

395
Q

what parts of the vesticular nerve supply which part of the vestibular canal

A

lower division = saccule
upper division = utricle & semicircular ducts

GSSE anatomy (8 decks)

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