Head & Neck Week 3 Flashcards
What bones make up the border of the medial orbital margin?
Anterior - Frontal bone, frontal process of Maxillary
(Lacrimal makes up Posterior of the border)
What bones makes up the Lateral wall of the orbit?
What bones makes up the Medial wall of the orbit?
Lateral - zygomatic and sphenoid (greater wing)
Medial - maxillary, lacrimal, Ethmoid, Sphenoid
Go to your skull and identify the anterior and posterior ethmoid foramen and the zygomatico-orbital foramen from the orbit.
Says your past self
What is the function and innervation of the orbicularis oculi?
Close eyelids.
CN VII
What muscle in the eye is under sympathetic control?
The Superior Tarsal m., which is a portion of the Levator palpebrae superioris
What is the function and innervation of the Levator Palpebrae m.?
Opens upper eyelid
CN III
What CN keeps the eye open?
Closes eye?
III opens
VII closes
What is the connective tissue skeleton of the eyelid?
Tarsal Plate
What do tarsal glands secrete?
Fatty subst. prevents eyelids from sticking together.
What are the sebaceous glands of the eyelid?
Ciliary glands
What is the mucous membrane of the eyelid and eyeball called?
Conjunctiva
What are two types of Conjunctiva?
Palpebral (continuous with skin)
Bulbar (continuous with cornea and is transparent)
What is the general sensory innervation for the upper eyelid/lower eyelid?
V1
V2
Blood supply upper eyelid:
Lower eyelid:
Branches of Opthalmic
Maxillary and maybe facial angular a.
Trace a tear from eye to nose:
Lacrimal gland > puncta (superior or inferior) > lacrimal canal > lacrimal sac > nasolacrimal duct > Inferior meatus of the nasal cavity
The optic nerve dura is continuous with what in the eye?
The sclera
The cornea is continuous with…
The sclera
What lies between the sclera and the retina?
The Choroid
What is the inner posterior layer of the eye?
The Retina
What is the termination of the choroid that connects with the iris?
Ciliary body
What produces aqueous humor?
Ciliary process
folds in the ciliary body
What separates the anterior and posterior chambers of the eye?
The Iris
What 2 mm. control the diameter of the pupil?
Sphincter pupillae (parasympathetic, CNIII) Dilator pupillae (sympathetic)
T/F
The lens is transparent and vascular.
False.
Lens transparent and avascular
T/F
The anterior and posterior chambers are separated by the Lens.
False.
Iris separates chambers.
What function of what nerve controls the ciliary mm.?
Parasympathetic
CN III
What effect does contraction of the ciliary mm. have on the Lens?
Rounds lens
What effect does relaxation of the ciliary mm. have on the Lens?
Flatten lens
What is the Macula Lutea, what does it contain, and why is it significant?
disc on retina
Fovea centralis
most acute vision.
What is the optic disc?
Where optic n. enters eye.
What are the 2 mm. in the eye that aren’t innervated by CN III?
Superior oblique (CN IV - trochlear) Lateral rectus (CN VI - abducens)
What is the CTR?
Common Tendinous Ring
convergence of most eye muscles near optic canal
What muscles:
Adduct (elevate)?
Adduct?
Abduct?
Superior rectus
Medial rectus and Inferior Rectus
Lateral rectus
(all CN III)
What is the origin, innervation, and function of the Superior Oblique m.?
CTR (then trochlea to superior orbit)
CN IV
Lowers and Abducts (down and out)
The trochlea is medial/lateral to the eye?
Medial
What is the function and innervation of the Levator palpebrae superioris?
Opens eyelid (superior tarsal m.) CN III
(runs over the superior rectus to the eyelid)
Origin, function, innervation of the Inferior Oblique.
Maxillary bone
Elevate and Abducts (up and out)
CN III
What is the function of the Inferior rectus?
Lowers (adducts)
Trace the Motor innervation of CN III to the eye mm. to the point of division:
Occulomotor complex > cavernous sinus > superior orbital fissure > Superior and Inferior divisions
The Superior division of the Occulomotor CN III pathway innervate what mm.?
Superior rectus
Levator palpebrae superioris
The Inferior division of the Occulomotor CN III pathway innervate what mm.?
Medial rectus
Inferior rectus
Inferior oblique
What nuclei do CN IV and CN VI use?
Trochlear nucleus
Abducens nucleus
What are the 4 Ciliary aa. and what do they branch from?
Long posterior ciliary aa.
Short posterior ciliary aa.
Central a. of the Retina
(branch from Ciliary aa. division of opthalmic)
Anterior ciliary aa.
(branch from Lacrimal a. of opthalmic)
see slide 15 eye and orbit
The superior opthalmic and inferior opthalmic vv. anastomose with?
The facial v.
What supplies special sensory and general sensory innervation to the orbit?
Special - II
General - V
(mainly opthalmic division V1, but some maxillary division V2)
L
F
N
What are the nasociliary divisions?
Long ciliary nn. (eyeball)
Posterior ethmoidal n. (sphenoid sinus, ethmoid air cells and nasal cavity)
Ant. Ethmoid n. > External nasal branches
Infratrochlear n.
What do the Long Ciliary nn. innervate?
Eyeball
What does the Infratrochlear n. innervate?
Medial upper eyelid and lacrimal sac.
What innervates the Special Sensory and General Sensory functions in the orbit?
Special - optic nerve CN II via optic canal
General - Mostly V1 (some maxillary division of V2)
What innervates the lower eyelid / eyeball?
Inferior palpebral n.
V2
Oculomotor Parasympathetic mm. and ganglion?
mm. - ciliary m. and sphincter pupillae
ganglion - ciliary
What is the parasympathetic nucleus of III?
Edinger Westphal nucleus
What post-ganglionic fibers innervate the ciliary mm. and the constrictor pupillae mm.?
Short ciliary nn.
What is the nucleus, ganglion, and target for VII’s parasympathetic function?
Superior Salivatory nucleus
Pterygopalatine ganglion
Lacrimal gland
What nn.’s does VII’s parasympathetic function ride on from the pterygopalatine fossa to the lacrimal gland?
Zygomatic V2
Lacrimal V1
Pathway Parasympathetic to Lacrimal (VII)
Superior Salivatory nucleus > internal acoustic meatus > facial canal > greater petrosal > joins deep petrosal at pterygoid canal > pterygopalatine fossa > V2 zygomatic > V1 lacrimal > lacrimal gland
Does VII’s parasympathetic pathway to the lacrimal pass through the infratemporal fossa?
NO
greater petrosal goes right to the PPF via pterygoid canal
What 2 muscles of the eye need Sympathetic innervation?
Dilator pupillae
Superior tarsal muscle
Sympathetic pathway to the eye.
T1-L2 > superior cervical ganglia (synapse) > post-ganglionic fibers hitchhike on IC to opthalmic > long ciliary nn. or muscular branches of III to dilator pupillae and superior tarsal muscle
What cranial nn. does the Corneal Reflex involve, and what function do they perform?
V - sensory component
VII - motor component
Corneal reflex:
Absent ipsilateral with normal contralateral response
V - normal
VII - abnormal ipsilateral
Corneal reflex:
Absent bilateral response
either V OR VII (bilateral) abnormal
Corneal reflex:
Absent contralateral response
contralateral VII abnormal
The long ciliary is (function/nerve)?
The short ciliary is (fiber type)?
Sensory V1 Post ganglionic (parasympathetic III to constrictor pupillae)
What bone is the mandibular fossa in?
Temporal
The articular eminence is in what bone?
Temporal
The TMJ is made up of what articular surfaces (of bone)?
Condyle
Articular eminence
Mandibular fossa
The mandibular Condyle is angled _________ from medial to lateral poles.
Anteriorly
TMJ boundaries: Lateral Medial Anterior Posterior
Lateral: Zygomatic process of Temporal
Medial: Spine of Sphenoid
Anterior: Articular Eminence
Posterior: Sphenotympanic/Petrotympanic fissure & Tympanic Plate
What are the attachments of the TMJ capsule?
Temporal bone to the neck of the mandible
What does the superior part of the capsular attachment of the TMJ surround?
The mandibular fossa
What is the TMJ’s capsules superior anterior and superior posterior attachment?
Anterior - Articular eminence
Posterior - squamotympanic fissure
What is the temporomandibular ligament, and what is its function?
Thick part of capsular part of TMJ (runs diagonally from anterior temporal around the condyle)
Prevents post and inferior displacement (prevents jaw from going back too far)
What nerve exits the petrotympanic fissure?
Chorda Tympani
What attaches the styloid process to the mandible?
Stylomandibular ligament
What attaches the spine of the sphenoid to the lingula of the mandible?
Sphenomadibular ligament
Do synovial membranes line load-bearing surfaces?
NO
What are some characteristics of the Articular Disc in the TMJ?
Bi-concave
fibrous tissue
Synovial membrane lining the upper and lower compartments
The disc provides “reciprocal articular surfaces” for…
The fossa and the condyle
T/F
The disc is avascular
True
T/F
The mandibular condyle articulates with the mandibular fossa.
False.
Condyle articulates with the disc
Disc articulates with both
Which thickening of the articular disc is larger?
Posterior
also, sits on top of condyle when at rest
Where does the anterior thickening of the articular disc of the TMJ reside?
below articular eminence
What attaches the articular disc to the capsule of the TMJ?
superior and inferior sheets/lamellae
Explain Articular disc attachments to the capsule in the TMJ.
Lateral: disc attaches directly to capsule
Anterior: disc attaches to capsule fibers and splits upward to articular eminence and down to the condyle head
Posterior: lamella split Superior to squamotympanic fissure and inferior to neck of condyle
What space does the posterior split of the articular disc of the TMJ create?
Retro-discal space
Describe the difference in the disc’s attachment to the capsule superiorly and inferiorly.
Superior - loose
Inferior - tight
What type of movement takes place in the lower compartment of the TMJ?
ROTATION in the first 20-27mm of opening the mouth.
What type of movement takes place in the upper compartment of the TMJ?
Translation
What is the alignment during Translation (condyle, disc, etc)
Condyles and Disc are on the articular eminence.
What causes popping noises in jaw (one thing)?
If the posterior thickening slides anterior to the condyle.
What is the general sensory innervation of the TMJ?
Auriculotemporal
Masseteric
Temporalis n.
What provides the blood supply to the TMJ?
Superficial Temporal (EC) Branches of Maxillary
Name 3 mm. that protrude the mandible.
Lateral pterygoid
Medial pterygoid
Superficial Head of the Masseter
Name 2 mm. that retrude the mandible.
Temporalis
Deep heads of Masseter (from protruded position)
think fiber angles
What are 3 mm. that Depress the mandible?
Lateral Pterygoid Inferior Head
Suprahyoid
Infrahyoid
What are 3 mm. that elevate the mandible?
Temporalis
Masseter
Medial Pterygoids
Why will the Masseter and Temporalis cause lateral excursion to their side?
Their origin is lateral to their insertion on the mandible.
Why will the Right medial and lateral pterygoids cause lateral excursion to the opposite side?
Their origin is medial to their insertion on the mandible
4 important structures that appear in the 4th week around the stamodeum.
Frontonasal prominence
Maxillary prominences
Mandibulary prominences
Nasal (olfactory) placodes - thickening of ectoderm
The nasal placodes invaginate to form what?
Lateral and Medial nasal prominences
along with the nasal pits
What do the maxillary prominences fuse with in the midline?
Medial nasal prominences
What do the medial nasal prominences form in the midline?
philthrum
What 4 things form the upper lip?
2 medial nasal prominences
2 maxillary prominences
T/F
The lateral nasal prominences participate in formation of the upper lip.
False
They do not participate
What 5 structures form the nasolacrimal duct from the nasolacrimal groove?
Frontal prominence (bridge)
Medial nasal prominences (crest and tip)
Lateral nasal prominences (sides)
What embryologically makes up the intermaxillary segment?
2 medial nasal prominences
What are the 3 components of the intermaxillary segment?
Labial component (philthrim upper lip) upper jaw (4 incisor teeth) Palatal component (triangular PRIMARY palate)
What makes up the secondary palate?
2 maxillary prominences fusing
What intersects at the incisive foramen?
Primary triangular and Secondary palates
What bone joins the midline of the palate?
The nasal septum (vomer)
What causes clefts anterior to the incisive foramen?
lack of fusion between maxillary prominence with medial nasal prominence on one or both sides
Name 3 types of clefts anterior to the incisive foramen.
Lateral cleft lip
Cleft upper jaw
Cleft between primary and secondary palates
(there is also bilateral cleft of lip and jaw)
Name 2 clefts posterior to the incisive foramen
Cleft Palate
(this is cleft secondary palate)
Cleft uvula
What is the incidence of cleft lip?
1/1000
more frequent in males, increases slightly with maternal age
What is the incidence of cleft palate?
1/2500
more frequent in females - not related to maternal age
What are the boundaries of the larynx?
C3-C6
base of tongue to first tracheal arch
epiglottis is superior
Name 5 types of laryngeal cartilage.
Epiglottic Thyroid Cricoid Arytenoid Corniculate
Superior to Inferior - name vocal cords.
Ventricular (false)
Vocal (true)
What 3 structures make up the conus elasticus?
Median cricothyroid ligament
lateral cricothyroid ligament
Vocal ligament
What does the thyrohyoid membrane connect?
Thyroid to hyoid bone
What are the 2 epiglottic ligaments?
Hyoepiglottic ligament
Thyroepiglottic ligament
What makes up the quadrangular membrane?
Ventricular ligament
Aryepiglottic ligament
Where is the Aryepiglottic fold?
superior to the ventricular and vocal folds.
What are the 3 levels of the interior Larynx?
Level 1: Glottis and rima glottis vestibule
Level 2: ventricular folds, ventricle, and vocal folds
Level 3: vocal folds to tracheal rings
Name the action of these extrinsic muscles
Suprahyoid
Infrahyoid
Pharyngeal
Elevate
Depress
Retract
ALL the intrinsic muscles of the larynx are innervated by:
Vagus
What innervates the cricothryroid?
What innervates all other mm. of larynx?
(motor)
External laryngeal
Recurrent laryngeal
Cricothyroid innervation and action:
External laryngeal n.
Stretches and tenses vocal cords (increases pitch)
Posterior Cricoarytenoid innervation and action:
Recurrent laryngeal n.
Abducts
Lateral Cricoarytenoid innervation and action:
Recurrent laryngeal n.
Adducts (closes cords)
Thyroarytenoid innervation and action:
Recurrent laryngeal n.
relaxes cords
Transverse arytenoids innervation and action:
Recurrent laryngeal n.
Adducts arytenoids and cords (closes glottis)
Oblique arytenoids innervation and action:
Recurrent laryngeal n.
closes glottis
Vocalis innervation and action:
Recurrent laryngeal n.
shortens cords and provides selective tensing and relaxing
Trace the vasculature around the larynx from its origins:
External carotid > Superior Thyroid > Superior Laryngeal > Larynx
Subclavian > Thyrocervical trunk > Inferior thyroid > Inferior laryngeal > larynx
What provides motor, general sensory, and parasympathetic innervation to the larynx?
All Vagus
What is the general sensory innervation pathway for structures above the vocal cords in the Larynx?
Superior laryngeal > Internal laryngeal
Name 4 innervations to the Auricle:
Great auricular n. (from Cervical Plexus)
Auriculotemporal n. (V3)
Small auricular branches (VII, X)
Name 3 arteries that supply the ear:
Posterior auricular (EC) Superficial temporal (EC) Deep auricular (Maxillary)
two parts tympanic membrane:
Flaccid
Tense
What innervates the external/internal surfaces of the tympanic membrane?
External:
Great auricular from cervical plexus
Auriculotemporal from V3
Small auricular branches from VII and X
Internal:
Tympanic plexus
What separates the middle ear from the middle cranial fossa?
Tegman tympani
What separates the middle ear from the internal jugular vein?
Floor
What makes up the lateral wall of the middle ear?
Tympanic membrane
Epitympanic recess
Chorda tympani
What makes up the medial wall of the middle ear?
promontory, tympanic plexus, oval window, round window
What makes up the anterior wall of the middle ear?
Auditory tube
Canal for tensor tympani
What makes up the posterior wall of the middle ear?
Aditus leading to mastoid antrum and mastoid cells
pyramid
What are the 3 auditory ossicles?
Malleus
Incus
Stapes
Which ossicle is most medial?
Stapes
What is the innervation and the action of the Tensor Tympani?
CN V3
Pulls malleus medially
What is the innervation and action of the Stapedius?
CN VII
Decreases vibrations of stapes
What are the two parts of the pharyngotympanic (auditory) tube?
Bony
Cartilaginous
What 3 mm. open the auditory tube?
Tensor veli palatine
Levator veli palatini
Salpingopharyngeus
