Head, Neck and Neuro Flashcards
Olfactory cortex in
bulbs are in…
Olfactory cortex is in temporal lobe of brain — part of the limbic system.
Bulbs are in forebrain
Optic canal:
Optic nerve Ophthalmic artery Central retinal artery and vein
Superior Orbital Fissure
Artery: Lacrimal artery - branch of ophthalmic artery
Veins: Superior and Inferior Ophthalmic Veins (joins cavernosu sinus)
Nerves - CN 3, CN 4, of CN 5 - V1 branches (lacrimal, nasociliary and frontal) CN 6 Sympathetic plexus
Extra occular muscle origin
all recti - Annulus of Zin
Superior Olique as well via trochlea
Inf - Maxillary bone
LPS - Sphenoid
Testings eyes
Sup/inf Obliques - look laterally and opposite to name
Sup/Inf Recti - look medially and same as name (Lateral rectus is only lateral gaze)
Superior tarsal muscle
Smooth muscle Sympathetic supply - superior cervical ganglion, and travel via the internal carotid plexus
Sympathetic and Parasympathetic to eye
Sympathetic - super cervical ganglion - long ciliary nerves, dialator
Parasympathetic - Ciliary ganglion - short ciliary nerves - sphincter pupillae
Foramen Ovale
Otic ganglion — IX, PS, ITF, parotid
V3 branch of CN5
Accessory middle meningeal artery (aka: pterygomeningeal artery)
Lesser petrosal nerve —from IX, PS, parotid
Emissary veins
What are the branches of the ophthalmic division of the trigeminal nerve?
- Lacrimal
- Frontal
• Supratrochlear medially
• Supraorbital laterally - Nasociliary:
• Infratrochlear
• Anterior + Post ethmoidal
• Long ciliary (NO INFRA-ORBITAL)
Branches of the maxillary division of the trigeminal nerve:
i) Infraorbital
ii) Zygomatic - zygomaticotemporal and zygomaticofacial
iii) Superior alveolar — anterior, middle and posterior
iv) Palatine — greater, lesser
v) Pharyngeal
vi) Superior labial
Main divisions of the mandibular division of the trigeminal nerve. Before it divides:
Tensor Tympani
Tensor Veli Palatini
N to Medial Pterygoid
Divisions of Mandibular
Anterior division:
- Motor - masseteric, deep temporal, lateral pterygoid
- Sensory - buccal
Posterior division:
• Motor — inferior alveolar; gives off the N to mylohyoid
• Sensory - inferior alveolar, auriculotemporal, lingual
(Buccal is the only anterior in BAIL)
The sensory branches of CN V3:
i) Buccal; ii) Auriculotemporal; iii) Inferior alveolar; iv) Lingual ‘BAIL’.
Structures that pass through the inferior orbital fissure:
Infraorbital artery and vein
Infraorbital nerve
Zygomatic nerve
Inferior ophthalmic vein (joining pterygoid venous plexus)
Structures that pass through the inferior orbital foramen:
Infraorbital artery, vein and nerve (Maxillary branch!)
Foreman Spinosum
Middle MENINGEAL artery
MENINGEAL branch of V3 (supplies the dura mater)
Foramen Lacerum
GPN (from CN VII) joins with DPN (sympathetic N) to form
The nerve of the pterygoid canal (Vidian nerve)
The ICA runs over it.
Parasympathetic to lacrimal gland and the mucosal glands of the nose, palate, and pharynx.
GPN (from CN VII)
Superior salivary nucleus - Preganglionic parasympathetic fibres arise
Join with somatic sensory - Nervus Intermedius
through IAM Through Geniculate ganglion - as GPN
Join DPN (sympathetic N) to form nerve of the pterygoid canal / Vidian Nerve
To reach pterygopalatine ganglion - lacrimal gland and the mucosal glands of the nose, palate, and pharynx.
Parotid Supply
Sensory - Greater Auricular Nerve
Preganglionic parasympathetic fibers: The inferior salivatory nucleus in IX via the lesser petrosal nerve (IX), transmitted to the otic ganglion.
There, they synapse with postganglionic fibers which reach the gland by hitch-hiking via the auriculotemporal nerve, a branch of the mandibular nerve.
Internal acoustic meatus
- CNs 7 and 8 Labyrinthine artery (br of basilar artery)
- Vestibular ganglion
estibular N — Equilibrium
Cochlear N —Auditory information
Parasympathetic to submandibular and sublingual glands
Superior salivary nucleus - Preganglionic parasympathetic fibres arise
Through Geniculate ganglion - as GPN
via chorda tympani as lingual nerve to submandibular ganglion
Ramsay Hunt syndrome
- Vesicular rash of the ear or mouth
- The rash might precede the onset of facial paresis/palsy • Ipsilateral lower motor neuron facial paresis/palsy (CN VII)
- Vertigo and ipsilateral hearing loss
- Tinnitus; Otalgia; Headache
- Dysarthria; Gait ataxia • Fever; Cervical lymphadenopathy
Self remitting: Conservative Supportive
Jugular foramen CN 9, 10 and 11
CN 9, 10 and 11
INFERIOR PETROSAL sinus and SIGMOID sinus unite to form the
Internal jugular vein
+ Ascending pharyngeal artery
CNXII
Hypoglossal canal
Foramen Magnum
Vertebral arteries forming the basilar artery, anterior and
Arteries - posterior spinal arteries
Veins - Spinal veins
Nerves - Spinal accessory nerve
Soft tissue - End of medulla & beginning of spinal cord, meninges
Areas supplied by ACA
• Part of the frontal lobe, specifically medial surface and upper border.
(where the legs are for the homunculus!)
Anterior 4/5th the corpus callosum
Anterior limb of the internal capsule, part of the caudate nucleus and globus pallidus.
Lesions of ACA
Contralateral paralysis of foot and leg
Contralateral sensory loss in foot and leg
Gait apraxia and foot drop
Abulia (absence of willpower or an inability to act decisively),
confusion, amnesia, apathy, short attention span
Urinary incontinence which with bilateral lesion •
Presence of frontal cortical release reflexes: contralateral grasp reflex, sucking reflex, paratonic rigidity
Areas supplied by MCA
- The bulk of the lateral surface of the hemisphere; except for the superior inch of the frontal and parietal lobe (ACA), and the inferior part of the temporal lobe (PCA).
- Superior division supplies Broca’s area
- Inferior division supplies Wernicke’s area • Deep branches supply the basal ganglia and internal capsule
Lesions of MCA
- Paralysis of contralateral face and arm
- Sensory loss of the contralateral face and arm
- Dominant hemisphere lesion — aphasia
Non-dominant hemisphere lesion - results in contralateral hemispatial neglect
- Deviation conjuguee (Prevost’s sign) - horizontal deviation of eyes towards the side of the lesion Contralateral homonymous hemianopia
- Dysphagia (medial temporal lobes and limbic system control the oral phase)
Neurogenic bladder
MCA occlusion site and resulting aphasia:
Global—trunk of MCA
Broca (expressive) — anterior branch of MCA
Wernicke (receptive/sensory/fluent) — posterior branch of MCA
Lateral medullary syndrome
• Blockage in PICA or one of its branches. • AKA: PICA syndrome, vertebral artery syndrome or Wallenberg’s syndrome
A. IPSILATERAL
- Xth cranial nerve palsy
- Cerebellar signs
- Horner’s syndrome
- Impaired pain, temperature and touch on the upper half of face
B. CONTRA LATERAL
1.Impaired pain and temperature over the body
Palatal myoclonus due to the central tegmental tract being affected
Lateral Pontine Syndrome
similar to the lateral medullary syndrome, but involves CNVII as well.
Caused by occlusion of anterior inferior cerebellar artery.
Stroke in pons.
Areas supplied by PCA
• Occipital and occipitoparietal cortices Parts of the midbrain Subthalamic nucleus Basal nucleus Thalamus Medial inferior temporal lobe
Lesions of PCA
- Contralateral loss of pain and temperature.
- Visual field defects (contralateral hemianopia with macular sparing).
- Prosopagnosia (face blindness).
- Superior alternating syndrome (Weber’s syndrome) - ipsilateral CNIII palsy and contralateral hemiparesis
Bálint’s syndrome (inability to perceive visual field as a whole, difficulty in fixating eyes (oculomotor apraxia), and inability to move hand to a specific object by using vision (optic ataxia)
Contralateral deficits of CNs VII, X and XII Horner’s Syndrome
Disorders of reading, colour vision and memory impairment
Medial Medullary Syndrome -
contralateral motor loss, contralateral dorsal column and ipsilateral CNXII injury.
Caused by occlusion of anterior spinal artery
Medial Pontine Syndrome
Liked Medial MEdullary - Minus hypoglossal + abducens
Contralateral motor loss, contralateral dorsal column
ipsilateral CNVI injury.
Caused by occlusion of paramedian branches of the basilar artery. Stroke in pons.
Weber’s Syndrome
Like Lateral Medullary + Facial Nerve
ipsilateral CNIII palsy and contralateral hemiplegia.
Caused by occlusion of posterior cerebral artery or its branches.
Stroke in the midbrain.
The following nerves are located in the lateral wall of the cavernous sinus except:
A. Occulomotor nerve B. Trochlear nerve C. Mandibular division of trigeminal nerve D. Maxillary division of trigeminal nerve E. Ophthalmic nerve
C. Mandibular division of trigeminal nerve D.
3,4,5(1),5(2)
And through it:
VI INFEROLATERAL to Internal carotid artery
All glossi supplied by
Except…
Hypoglossal
Except for Palatoglossus - Supplied Pharyngeal Plexus (Vagus Nerve)
REMEMBER:
(vagus takes one from hypoglossal (palatoglossus) and
glossopharyngeal takes on from vagus (stylopharyngeus)
The five main layers to the scalp are:
S :Skin
C: Connective tissue (blood supply lies in this layer)
A: Aponeurosis (lacerations below this layer can gape)
L: Loose areolar tissue
P: Periosteum (skin cancers excised to this layer)
Arterial supply to the scalp:
From internal carotid:
- Supratrochlear artery: branch of ophthalmic
- Supraorbital artery: branch of ophthalmic
- Zygomaticotemporal artery: branch of lacrimal (also branch of ophthalmic!)
From external carotid:
- Superficial temporal artery
- Posterior auricular artery
- Occipital artery
External ear
Blood supply and nerves
Blood supply: Posterior auricular and superficial temporal arteries.
Nerve supply of external ear:
- Great auricular nerve (a branch of the cervical plexus C2 and C3)
- Auriculotemporal nerve (branch of the mandibular division of the trigeminal CN V3)
- Auricular branch of the vagus nerve (Arnold’s nerve)
- Lesser occipital nerve
Kiesselbach’s plexus?
Kiesselbach’s plexus (‘Little’s area’) - anteroinferior part of the nasal septum where four arteries anastomose to form a vascular plexus:
- Anterior ethmoidal artery (from the ophthalmic artery)
- Sphenopalatine artery (terminal branch of the maxillary artery)
- Greater palatine artery (from the maxillary artery)
- Septa! branch of the superior labial artery (from the facial artery)
90% of all epistaxis arise from this plexus.
Sensory supply to nose:
Sensory supply to nose:
Tip: External nasal branch of the anterior ethmoidal nerve (V5.1 NC)
Bridge of nose: Infratrochlear nerve (V5.1 NC)
Sides and ala of nose: Infraorbital nerve (V5.2)
Nerve to lacrimal gland
Pons Facial Nerve lacrimatory nucleus runs in
Nervus Intermedius to the geniculate ganglion (but do not synapse)
Pre-G’s fibres run in GPN (joining DPN to make Vidian Nerve)
Through pterygoid canal to pterygopalatine ganglion and psynapse
Post-G’s fibres join Maxillary Nerve, branch off with the zygomatic nerve,
Finally joins lacrimal branch of V5 Opthlamic
V5 Opthlamic (which supplies sensory innervation to the lacrimal gland along with the eyelid and conjunctiva.)
Which amongst the following is the deepest structure in the parotid region?
Stylohyoid muscle (other muscles are stylopharyngeus and posterior belly of the digastric)
What are the branches of the facial artery?
The branches within the neck include the:
- Ascending palatine artery
- Tonsillar artery
- Submental artery
- Branch to the submandibular gland
The branches within the face include the:
•Inferior labial artery
•Superior labial artery
•Lateral nasal branch
•Angular artery
Boundaries of Infratemporal fossa
Boundaries:
- Medial: Lateral pterygoid plate
- Lateral: Mandible ramus and coronoid process
- Anterior: Infratemporal surface of the Maxilla
- Superior: Greater wing of sphenoid
- Posterior Mastoid and styloid processes of the temporal bone
Contents of Infratemporal Fossa
Muscles: 1. Medial pterygoid 2. Lateral pterygoid 3. Temporalis muscle
Infratemporal Fossa:
Vessels: 1. Maxillary artery 2. Pterygoid venous plexus 3. Retromandibular vein
Nerves: 1. Mandibular Nerve 2. Chorda tympani 3. Lingual nerve 4. Inferior alveolar nerve
Ganglion: Otic
PS Ganglia in the Head
PS Ganglia in the Head
- Ciliary ganglion: Located behind the eye in the posterior orbit, associated with the CNIII; contributes to the pupillary and accommodation reflexes.
- Pterygopalatine (Sphenopalatine) ganglion: Greater petrosal nerve (branch of VII) supplying the lacrimal gland, paranasal sinuses and glands in the palate and nasal cavity.
- Submandibular ganglion: Chorda tympani branch of VII and lingual branch of V, suppling submandibular and sublingual glands.
- Otic ganglion: Located just below foramen ovale in the associated with the IX nerve; secretomotor to the parotid.
Sympathetic Supply
Thoracolumbar
T1-L2
Sympathetic Trunks and Splanchnic Nerves
a) Greater splanchnic T5 - T9
b) Lesser splanchnic T10 - T11
c) Least splanchnic T12
Bladder Nerve Supply
The parasympathetic supply is via the Pelvic Splanchnic Nerve - S2 S3 S4 on vesical plexus. - detrusor muscle contraction, internal sphincter relaxation
Sympathetic supply from T10 to L2, synapsing on inferior mesenteric, hypogastric and vesical plexuses - detrusor muscle relaxation and internal sphincter contraction.
Somatic nerve supply, via Pudendal Nerve S2 S3 S4, may contract or relax external sphincter
In a full bladder
- Sensory pelvic nerves from detrusor muscle, due to stretch, sends fast signal to the sacral spinal cord
- Signal directly to Pontine micturition centre
- Parasympathetic fibres are stimulated — contracts the detrusor
- Hypogastric sympathetic N inhibited — opens the internal sphincter
- Pudendal N inhibited and relaxes the external sphincter
Bladder nerve receptors
- Sacral PSN: Acts on detrusor muscle muscarinic (M3) receptor—causes contraction of the detrusor
- Pudendal N (52, 3, 4): Acts on nicotinic receptor in the external sphincter causes contraction of the sphincter
• Sympathetic N: — Hypogastric Nerve
Acts on Beta Adrenergic (83) receptor of the detrusor muscle and causes relaxation of the muscle
Acts on Alpha Adrenergic (A3) receptor of the internal sphincter and contracts the sphincter
Anterior Cord Syndrome
- Complete motor paralysis
- Loss of pain and temperature sensation
- Position and vibration sense preserved
- Associated with severe flexion iniury
Tracts and Decussations
- The dorsal column-medial lemniscal pathway carries tactile sensation, vibration and proprioception — Decussates at level of medulla
- Anterior spinothalamic tract carries crude touch and pressure —Decussates 1-2 vertebral levels above the spinal nerve entry level (give a fondle from the front)
- Lateral spinothalamic tract carries pain and temperature - Decussates 1-2 vertebral levels above the spinal nerve entry level (pinch and burn from the side)
- The lateral corticospinal tract carries motor sensation (fine movements) - Decussates at the level of pyramids in the lower medulla (side step and glide elegantly up the pyramid)
- The anterior corticospinal tract carries motor sensation (controls central axial and girdle muscles) - Decussates at the level of spinal nerve
Posterior Cord Syndrome
• May result from hyper flexion injury.
Profound sensory loss Ataxic presentation without procrioceptive feed back ascending the cord.
• Motor functions is spared.
Central Cord Syndrome
UL Motor Loss > LL Limb
Older people can occur - hyperextension injuries
UL - LMN signs
LL - UMN signs
Brown-Sequard Spinal Cord Hemi Section
IPSILATERAL
- UMN Weakness
- Loss of position and vibration
CONTRALATERAL
- LOSS OF PAIN AND TEMPERATURE
Neurogenic shock
- Lesions at T6 level or higher
- Hypotension and bradycardia
- Warm peripheries
- Dry skin below injury level
- Management- IV fluids +/- vasopressors
Posterior Triangle of the Neck
Contents Nerves and plexuses:
- Spinal accessory nerve
- Branches of the cervical plexus
- Roots and trunks of the brachial plexus
• Phrenic nerve
Arteries : Third part of the subclavian artery
(transverse cervical and suprascapular arteries)
Veins: External jugular vein
Others: Lymph nodes Omohyoid muscle
All intrinsic muscles of the larynx supplied by…
With exception of…
All are supplied by the recurrent laryngeal nerve
Except for the cricothyroid
Which is supplied by the external branch of superior laryngeal nerve
From midline of the neck
Level
• Hyoid bone
Thyroid cartilage ….corresponds to
• Cricothyroid membrane — important for ….
• Cricoid cartilage — level of …
• Thyroid gland — isthmus over the …
From midline of the neck
3,4,6
• Hyoid bone — level of C3 vertebrae
- Thyroid cartilage — level of C4 vertebrae — C4 corresponds to bifurcation of common carotid arteries
- Cricothyroid membrane — important for cricothyroidectomy (surgical airway)
- Cricoid cartilage — level of C6 vertebrae, — junction of larynx with the trachea — junction of the pharynx with the oesophagus
- Thyroid gland — isthmus over the 2nd and 3rd tracheal rings
Cricothyroid
External Branch of Superior Laryngeal Nerve
Originates form cricoid
Pulls thyroids cartialge down and out
Tenses the vocal cord
Increases pitch
Cricoarytenoid
- Posterior and Lateral
Cricoid has 2 depressions - 2 muscle groups
Arytenoid - muscle procress posterolaterally
Arytenoid - vocal process anterior
Posterior Cricoarytenoid - lateral rotation - widens the rimma glottidis - only muscle. Vocal Cord Abduction.
Lateral cricoarytenoid - from the upper part of cricoid arch, inserts the same place.
But as it sits infront of the muscular process, it will INTERNALLY rotate,
closing the rimma glottidis, thus ABDUCTING the cords.
Thyroarytenoid
https://www.youtube.com/watch?v=GEMquo7qxpg
Thyroarytenoid muscle - thryoid cartialage to A/L of A.C.
(Vocalis) - runs lateral to vocal ligament.
Thyroarytenoid - upwards fibres - thyro-epiglottic muscle
When it contracts - it brings A.C. closure to T.C.
Surgical considerations
• Superior thyroid artery —
• Superior laryngeal artery —
• Inferior laryngeal artery and inferior thyroid artery—
Surgical considerations
• Superior thyroid artery — external laryngeal nerve
• Superior laryngeal artery — internal laryngeal nerve
• Inferior laryngeal artery and inferior thyroid artery— recurrent laryngeal nerve
All Muscles of the Pharynx Supplied by…
Except…
All by pharyngeal branch of Vagus
Except for Stylopharyngeus which is supplied by Glossopharyngeal Nerve
Ant 2/3 Tongue…
Nucleus Tractus Solitarius
Geniculuate Ganglion
Chorda tympania Nerve
Affarent taste fibres.
General Sensation - Lingual branch of CN 5.3
With it (Superior salivatory nucleus fibres that synapse on the submandibular ganglion.
Lymphatic drainage of the tongue
Tip: Submental nodes
Anterior 2/3 lateral border Ipsilateral Submandibular node
ANTERIOR 2/3 CENTRALLY Submandibular nodes on both sides
Posterior 1/3 Jugulo-omohyoid nodes
FINAL NODES TO BE INVOLVED ARE Jugulo-omohyoid and deep cervical nodes
Thyroid Lobe Levels
- Secretes thyroxine and calcitonin.
- Upper lobe - level of C5 vertebrae
- Lower lobe - C7/T1 vertebrae.
- Sternothyroid and sternohyoid muscles lie superficial to the thyroid gland.
Hyoid bone — level of C3 vertebrae
Thyroid cartilage — level of C4 vertebrae — C4 corresponds to bifurcation of common carotid arteries
Thyroid arterial and venous
Arterial supply
- Superior thyroid arteries (from the external carotid artery) supply the upper lobes.
- Inferior thyroid arteries (from the thyrocervical trunk) supply the lower lobes.
- Thyroid ima artery (from brachiocephalic artery) is present in some.
Venous drainage
• Superior thyroid veins (drains into IJV)
• Middle thyroid veins (drains into IJVV)
• Autonomic supply from cervical sympathetic ganglia
Lymphatic drainage • Into prelaryngeal, pretracheal, paratracheal, deep cervical lymph nodes • Sometimes into the brachiocephalic lymph nodes or into thoracic duct.
• Inferior thyroid veins (drains into brachiocephalic vein)
Tongue drainage
o Posterior tongue – BL Deep C Nodes, Anterior ipsilateral
o Tip – submental – DCNs
o Mid tongue – submandibular – DCNs
V3 - Lingual nerve – 3rd molar - anaesthesia
of the ipsilateral anterior ant 2/3 general sensation of tongue
Post tonsillectomy otalgia – damage to
Post tonsillectomy otalgia – glossopharyngeal
Pleomorphic adenoma – superficial thyroidectomy – conserve
superficial thyroidectomy – conserve facial nerve
Tumour with highest P() perineural spread – facial pain + weakness
denoid cystic carcinoma – highest P() perineural spread – facial pain + weakness
Mastoid infection surgery – altered taste –
chorda tympani (facial nerve)
Subclavian vein behind
anterior to …
with what behind that..
Subclavian vein behind middle third of clavicle, anterior to scalane, subclavian artery behind it.
Sensation to lateral nose
lateral nasal branches of anterior ethmoidal nerve.
Cervical rib – elongation of
C7 transverse process
Scalenus anterior separates
subclavian artery and veins
External tympanic membrane is made of…
- stratified squamous epithelium
Lymphatic drainage of the auricle
o Lateral surface of upper half drains - superficial parotid lymph nodes
o Cranial surface of superior half - mastoid nodes + deep cervical lymph nodes
o Lower half and lobule - superficial cervical lymph nodes.
Inf thyroid artery feeds thyroid @
Inf thyroid artery feeds thyroid @ C6
Para supply to parotid
– Inf salivary nucleus – IX - >less petrosal – otic ganglion – auricotemporal of v3
unaffected by facial nerve division in parotidectomy…
Facial nerve chorda tympani branch in facial canal
artery supplies lacrimal apparatus
Opthalmic artery supplies lacrimal apparatus
reactionary haemorrhage post-tonsillectomy (immediately lateral)
External palantine vein – reactionary haemorrhage post tonsillectomy (immediately lateral.
Mandibular V3 Muscles:
Mandibular V3 Muscles: Masseter, Temporalis, Medial + Lateral pterygoids
Other Mandibular V3 Muscles (2 Anteriors and 2 Tensors):
o Tensor veli palatini (soft palate)
o Tensor tympani (tympanic membrane)
o Anterior belly of digastric
o Mylohyoid – I’m not tense
Angle of the jaw - supplied by…
Angle of the jaw - Greater auricular nerve (C2-C3) NOT V3
Divide what to access the ansa crvicalis C1 + (C2/3)
Divide pretracheal fascia for ansa crvicalis C1 + (C2/3) – ant to carotid sheath
Type of joint for teeth
Gamphoses – peg/socket fibrous joint – teeth
Vertebral artery
Vertebral artery – transverse process of C1-6, vertebral canal + f. magnum. NOT intervertebral foramen.
The vertebral arteries travel across the posterior arch of C1 and through the suboccipital triangle before entering the foramen magnum.
Relation of common carotid to inferior thyroid
Common carotid – lateral to inferior thyroid
Post carotid endarectomy – tongue weakness secondary to
hypoglossal nerve damage
Submandibular swelling + halitosis = Blocked wharton’s
Submandibular swelling + halitosis
External Carotid branches
Sup Thyroid, Asc Pharyngeal, Lingual, Facial, Occip, post auricular, Maxillary, Sup temporal
Origin of inferior thyroid and thyroid ima
Inf thyroid via thyrocervical trunk, thyroid ima via brachiocephalic
Middle meningeal – branch of
Middle meningeal – branch of maxillary
Posterior Triangle Nerves and Vessels
Posterior Triangle Nerves – PLAG
o Phrenic, Lesser Occipital, Accessor and Greater auricular
o Vessels: External Jugular Vein + Subclavian artery
C6: Sympathetic change between carotid sheath and prevertebral fascia?
Carotid sheath closely related to which muscles…
Carotid sheath closely related to: sterno hy/thyroid + sup of omohyoid + X11
when tying MMA…
Auricotemporal temporal nerve damage – ipsi ear
Submandibular – % of spit
Submandibular – 70% of spit
Laynx sensation –
vagus.
basal skull # - lacrimation, no tears!
Greater petrosal nerve injry – basal skull # - lacrimation, no tears!
Branchial cyst excision at risk:
Mandibular branch of facial nerve, greater auricular nerve and accessory nerve.
Inferolateral lump on nose that cracks
Ameloblastoma
22 months – posterior triangle neck lump that transluminates =
22 months – posterior triangle neck lump that transluminates = cystic hygroma
Idiopathic epistaxis -
Kiesselbachs plexus supply derived from both carotids
The posterior scalp is supplied by
GOC C2-C3
Hypoglossal nerve – supplies all intrinsic and extrinsic muscles of the tongue except
palatoglossus (accessory and vagal)
Parotid duct…
stenson’s duct – opens at 2nd upper molar
Otalgia, facial nerve palsy without hearing loss
– malignant otitis externa - Usually pseudomonas
Chordia typani runs medially to
Chordia typani runs medially to pars flaccida not tensa
External branch Superior laryngeal supplies…
Cricothyroid – not recurrent
Internal carotid branches
Internal carotid – only press carotid arteries momentarily
Ophthalmic, post comm, choroidal, anterior cerebral, middle cerebral
Common carotid bifurcation at
Common carotid bifurcation at C4
Secondary haemorrhage post tonsillectomy – between days
Secondary haemorrhage post tonsillectomy – between days 5-10
Transverse cervical nerve lies within
Transverse cervical nerve lies within the posterior triangle
Middle Thyroid drains into
Middle Thyroid drains into internal jugular
Space between vocal cords –
Space between vocal cords – Rima Glottidis
Retromandibular vein is a confluence of…
Retromandibular vein = maxillary + superficial temporal
Parotid penetrates the
Parotid penetrates the buccinator
External jugular lies superficial to
to head and neck
Syringomyelia – loss of
oss of spinothalamic tract / pain and temperature
herniates causing back/leg pain
Nucleous polyposis
LPs – subarachnoid space, first encounter
supraspinous ligament
suspends SC in dural sheath (pia continuation)
Denticulate ligament
Ligamentum Flava –
– anterior to the spinous process
Adult SC terminates at
dural sac…
Adult SC terminates at L1, dursal sac at S2
Posterior longitudinal ligament separates
Posterior longitudinal ligament separates intervertebral disk from SC
Craniopharyngiomas – compression from above
Lower > upper quadrant defect
Lateral medullary syndrome – post/inf cerebellar artery –
Ipsi facial numbness, dysphagia, nystagmus + contra sensory loss
Loss of baroreceptor firing in
Loss of baroreceptor firing in hypotension
Neurological signs + abdominal pain =
Neurological signs + abdominal pain = acute intermittent porphyria or lead poisoning until proven otherwise.
first to go in raised ICP due to long intracranial course
CN VI first to go in raised ICP due to long intracranial course
CSF finding in bacterial meningitis
CSF Neutrophilia in bacterial meningitis
Frontal lesion crossing midline with central necrosis
Frontal lesion crossing midline with central necrosis – glioblastoma
Hyperhydrosis of hands and arms – divide sympathetic ganglia of
Hyperhydrosis of hands and arms – divide sympathetic ganglia of T2/T3
Large branch of Basilar artery-
Large branch of Basilar artery- post inf cerebellar artery
Nerve regrowth at a rate of..
Nerve regrowth 1mm/d
Lumbar vertebrae – have no…
Lumbar vertebrae – no transverse process
Spinous process – formed by
Spinous process – formed by 2 laminae posteriorly
Orbital apex syndrome =
Orbital apex syndrome = superior orbital fissure syndrome + optic nerve compression (+ipsilateral afferent pupillary defect).
Removing a parietal lobe tumour? CUSA device!
Cavitron ultrasonic surgical aspirator (CUSA) and …
3rd Nerve palsy, headache, meningism – exclude
3rd Nerve palsy, headache, meningism – exclude Post com artery aneurysm
separates optic chiasm from ant pituitary
Dural fold separates optic chiasm from ant pituitary
to test for CSF rhinorrhoea
Beta2 tranferrin assay - CSF rhinorrhoea
Origin of Trigeminal..
Trigeminal – broad base including pons
2yo with tumour on the floor of the 4th ventricle
Ependymoma
Can cause syringeomyelia
NFII
Parsonage-Turner syndrome
post viral peripheral neuropathy
Normal ICP is…
The Brain can tolerate up to…
Normal ICP 7 and 15 mm Hg. The brain can accommodate increases up to 24 mm Hg
Facial nerve – internal acoustic meatus to get to temporal bone, exits via …
Facial nerve – internal acoustic meatus to get to temporal bone, exits via stylomastoid foramen
Horners – spinal level
Horners – C8 T1
RA, recurrent dental sepsis symmetrically enlarged of both parotid and submandibular glands
Sjogren’s syndrome –
In a young adult with parotid swelling and pancreatitis/orchitis/reduced hearing/meningoencephalitis suspect
suspect mumps.
Bilateral parotid enlargement + facial nerve palsies + malaise =
Bilateral parotid enlargement + facial nerve palsies + malaise = Sarcoidosis!
Painless anterior lump (high altitude or COPD)
Painless anterior lump – carotid body tumour – sporadic, hyperplastic (high altitude or COPD), familial. MEN II, NF1
Neck Lump
above hyoid - multiloculated and heterogeneous, no swallowing movement
Dermoid cysts – above hyoid - multiloculated and heterogeneous, no swallowing movement
Neck Lump
thyroglossal cysts – below hyoid, tongue movement-
Sistrunk procedure (+ track)
o resection of cyst, associated track, central portion of the hyoid and wedge of tongue muscle behind the hyoid
EBV - tonsillitis presentation
Puts you at risk of…
EBV - tonsillitis, oropharyngeal petechial haemorrhages + splenomegaly
Penicillin rash,
all lymphomas and nasopharyngeal carcinoma.
to divide posteromedial thyroid…
be careful of…
Bipolar to divide posteromedial thyroid, avoid thermal recurrent LN damage.
Parathyroid cancers rates
nly 5% carcinoma, 85% adenomas, 10% ectopic, encapsulated
Berry’s sign –
carotid pulse absence due to thryomegaly
Peritonsellar abscess – typically cased by
Peritonsellar abscess – strep pyogenes
Carotid body tumours – usually
Carotid body tumours – usually paragangliomas
Most common parotid presentation
– mass posterior to angle of mandible
Post thyroid lobectomy – unable to sing high notes?
Cricothryoid – damage to superior laryngeal nerve. (Superior singers sing high notes)
psomoma bodies – clusters of calcification
Papillary carcinomas – psomoma bodies – clusters of calcification
Biphasic and mucinous mass
Biphasic and mucinous – pleomorphic adenoma
