HEENT Flashcards
What CN pass through Internal acoustic medius
VII, VIII
What CN passes through jugular foramen
IX, X, XI
What CN passes through Superior Orbital fissure
V1, III, IV, VI
What CN passes through Foramen rotundum
V2
What CN passes through foramen ovale
V3
Sella Turcica
Houses pituitary gland
What goes through foramen magnum
Spinal cord
Vertebral arteries
What passes through hypoglossal canal
CN XII
Nasion
Where nasal bone meets frontal bone
What passes through infraorbital foramen
Infraorbital nerve
Fontanelles
Space between bones in newborns (soft spots)
Coronal suture
Separates frontal and parietal
Sagittal suture
Separates parietal bones
Bregma
Where sagital suture meets coronal suture
When do sutures close
Between 20-30 years
Lambdoid suture
Separate parietal bones from occipital
Squamous suture
Separates parietal and temporal bones
Pterion
Where frontal, parietal, temporal, and sphenoid bones meet
Asterion
Where parietal, occipital, and temporal bones meet
Metopic suture
Splits frontal bone in half
Usually closed around nine months
What nerve exits through Infraorbital foramen
Infraorbital nerve (branch of V2 (maxillary))
What nerve exits through mental foramen
Mandibular nerve (branch of V3)
What nerve exits through supraorbital notch/foramen
Opthalmic nerve (branch of V1)
Temporomandibular joint (TMJ) motion
Elevatoin (closing)
Depression (opening)
Protrusion (underbite)
Retraction (overbite)
Lateral deviation (side to side for grinding)
Muscles used in mastication
Temporalis
Masseter
Meidal pterygoid
Lateral pterygoid
Uses V3 mandibular nerve
Temporalis
Elevation and retraction of mandible
Originates at temporal fossa
Insertion is coronoid process of mandible
Nerve is mandibular trigeminal nerve (V3)
Masseter
Elevation ad protrusion of mandible
Origin is zygomatic arch
Insertion is lateral aspect of ramus of mandible and angle of mandible
Nerve is mandibular division of trigeminal nerve (V3)
Medial Pterygoid
Elevatoin, protrusion, and lateral movement of mandible
Origin is medial surace of lateral pterygoid plate
Insertion is medial surface of mandible near angle
Neve is Mandibular division of trigeminal nerve (V3)
Lateral pterygoid
Protrusion of mandible, depression, and side-side motion.
Origin is IT fossa and lateral aspect of pterygoid plate
Insertion is TMJ, articular disc, and neck of mandible
Nerve is Mandibular division of trigeminal nerve (V3)
Infratemporal (IT) fossa muscles
Inferior temporalis
Lateral pterygoid
Medial pterygoid
Infratemporal (IT) fossa vessels
Maxillary artery
Pterygoid venous plexus
Only branch of trigeminal that is motor
V3 (also has sensory branches)
Infratemporal (IT) fossa nerves
Mandibular nerve (from V3)
Sensory branches of V1
Supratrochlear
Supraorbital
Lacrimal
Infratrochlear
External nasal
Sensory branches of V2
Zygomaticotemporal
Zygomaticofacial
Infraorbital
Sensory branches of V3
Auriculotemporal
Inferior alveolar
Lingual
Mental
Buccal
Motor branches of V3
Masseteric nerve
Deep temporal nerve
Nerve to lateral pterygoid
Nerve to medial pterygoid
Occipitofrontalis
Elevates eyebrows and wrinkles skin of forehead
Facial nerve
Orbicularis occuli
Palpebral does blinking
Orbital does closing eye tightly
Facial nerve
Procerus
Pulls skin between eyebrows downward.
Facial nerve
Corrugator supercilii
Brings eyebrows medial and downward.
Facial nerve
Zygomaticus major
Elevates corners of mouth. (closed lips smile)
Facial nerve
Orbicularis oris
Closes oral fissure (lips)
Protrudes lips
Facial nerve
Levator labii superioris
Elevates upper lip
Facial nerve
Levator anguli oris
Elevats angle of mouth (smile)
facial nerve
Depressor anguli oris
Depresses angle of mouth (frown)
Facial nerve
Depressor labii inferioris
Depresses lower lip
Facial nerve
Buccinator
Puff cheeks out but orbicularis oris stops air from coming out.
Hold food in place.
Facial nerve
Platysma
Tenses skin of inferior face and neck
Facial nerve
Parotid gland
Salivary gland that drains into mouth through Stensen’s duct aross masseter and run in buccal fat pad before piercing buccinator.
Empties intal oral cavity opposite second upper molar.
Layers of scalp
Skin
Connective tissue
Aponeurosis
Loose connective tissue
Pericranium
Scalp proper
firs three layers of scalp
Tightly bound and move as unit
Skin
CT
APoneurosis
Skin of scalp parts
Sweat glands
Sebaceous glands
Hair follicles
Where are the vessels of the scalp
Second layer of dense connective tissue
Galea aponeurotica
Connects frontal and occipital bellies of occipitofrontalis
Loose connective tissue of scalp
Where the veins of scalp are.
Allow for free movement of more superficial three layers of scalp
Emissionary veins
Pass through foraminsa of skull to provide venous communicationo between dural venous sinuses and veins of scalp.
Thin walled
Valveless
Route infection can spread to intracranial
Pericranium
Dense CT of scalp.
External periosteum of neurocranium.
Firmly attached to bone
Four main branchs of subclavian artery
Vertebral artery
Internal thoracic artery
Thyrocervical trunk
Costcocervical trunk
Branches of external carotid artery
Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Maxillary
Posterior auricular
Superficial temporal artery
Veins of head and neck
Superficial temporal
Retromandibular
Posterior auricular
External jugular
Supraorbital
Supratrochlear
Maxillary
Facial
Internal jugular
Facial nerve (CN VII) motor function
Muscles for facial expression
Stapedius
Stylohyoid and posterior belly digastric
Facial nerve (CN VII) sensory function
Taste to anterior 2/3 of tongue
Facial nerve (CN VII) parasympathetic function
Submandibular and sublingual salivary glands.
Lacriminal gland and minor mucosal glands of nasal cavity and palate.
Facial nerve (CN VII) pathway
Pons–> internal acoustic meatus –> facial canal–> stylomstoid foramen
Bones of roof of nasal cavity
Frontal bone
Ethmoid
Nasal bone
Sphenoid
Greater petrosal nerve
CN VII branch
Leaves facial canal early and innervates mucous glands to make mucous in nose.
(parasympathetic)
Bones of floor of nasal cavity
Horizontal plate of palatine bone
Palatine process of maxilla
Bones of lateral wall of nasal cavity
Superior and middle concha (ethmoid)
Inferior concha (independent bone)
Medial pterygoid plate of sphenoid
Perpendicular plate of palatine bone
Conchae (turbinates)
Increases surface area of nasal cavity
Warms and humidifies air
Superior, middle, and inferior
Four pairs of paranasal sinuses
Frontal
Ethmoid
Maxillary
Sphenoid
Sphenoethmoidal recess
pace between superior nasal concha (ethmoid) and sphenoid bone
Has openings for sphenoid sinus
Superior meatus
Space inferior to superior concha
Opening for posterior ethmoidal air cells
Middle meatus
Space inferior to middle nasal concha
Openings for frontal sinus, maxillary sinus, anterior and middle ethmoidal air cells.
Inferior meatus
Space inferior to inferior nasal concha
Opening for nasolacrimal duct
Semilunar hiatus
Openings for frontal, maxillary, and anterior ethmoidal cells
Ethmoid bulla
In the middle meatus
Contains openings or middle ethmoidal air cells
What bone does Olefactory nerve (CN I) pass through
Cribiform plate
Three main arteries of nasal cavity
Opthalmic (into anterior and osterior ethmoidal)
Maxillary (into sphenopalatine and greater palatine)
Facial (into septal branch of superior labial)
Kiesselbach’s plexus
Five artery aastomes in nasa l cavity
Anterior ethmoidal (opthalmic)
Posterior ethmoidal(opthalmic)
Sphenopalatine (maxillary)
Greater palatine (maxillary)
Septal branches of superior labial (facial)
Oral fissure
Opening to oral cavity (lips)
Oral vestibule
Slit-like space between teeth and gingivae
Hard palate
Anterior 2/3 of oral cavity roof
Maxilla
Palatine bone
Separates nasal and oral cavities
Soft palate
Muscle and CT
Uvula
How many teeth
32
How are the teeth devided in each quadrant
2 incisors
1 canine
2 premolars
3 molars
Palatoglossus
Elevates posterior tongue
Origin is soft palate
Insertion is broadly across tongue
Innervated by Vagus (CN X)
Genioglossus
Protrude, depress, deaw ack tip, lateral movement of tongue.
Origin is mandible
Insertion is Hyoid bone and tongue
Innervated by Hpoglossal (CN XII)
Styloglossus
Retract and elevate tongue
Origin is styloid process
Insertion is Lateral tongue
Innervated by hypoglossal (CN XII)
Hyoglossus
Depress and retract tongue
Origin is hyoid bone
Insertion is lateral tongue
Innervated by hypoglossal (CN XII)
Three pairs of salivary glands and nerves that innervate them
Parotid glands (CN IX)
Submandibular glands (CN VII)
Sublingual glands (CN VII)
Four sets of tonsils
Pharyngeal (adenoids) at roof of nasopharynx
Tubal posterior to opening of auditory tube
Palatine in tonsillar fossa
Lingual at root of tongue
Danger space
Posterior to retropharyngeal space and continuous with mediastinum.
Between alar fascia and prevertebral fascia.
Route for spread of infection between neck and posterior mediastinum
Choana
Posterior spaces connecting right and left nasal cavity to the nasopharynx
Eustachian tube
Equalizes pressure between middle ear and external environment.
Opens to nasopharynx
Torus tubarius
Cartilaginous opening of the auditory tube that opens into nasopharynx
Pharyngeal tonsils (adenoids)
On roof of nasopharynx.
Occlude nasopharynx when enlarged
Oropharynx
Posterior to oral cavity,
Between soft palate and epiglotis
Food and air
Palatine tonsil
On each side of oropharynx
Visibl through open mouth when tongue depressed
Lingual tonsil
Located on posterior 1/3 of tongue
Vallecula
Between base of tongue and epiglottis
Posterior to lingual tonsil
Laryngopharynx
Extends from superior margin of epiglottis to top of esophagus.
Air and food
Epiglottis
Folds over laryngeal inlet during wallowing to direct food into esophagu
Cricopharyngeus muscle
Makes upper esophageal sphincter
Esophagus
Muscular tube that is 10 inches lng.
Pharyngeal constrictors
Contract involuntarily to move food into esophagus
Zenker’s diverticulum
Between cricopharyngeus and inferior pharyngeal constrictor
Mucosal herniation (false)
Vomit undigested food
Need diverticulectomy
Larynx
Voice production
Continuous with trachea inferiorly
What cartilage makes up larynx
3 unpaired (epiglottic, thyroid, cricoid)
3 paired (arytenoids, corniculates, cuneiforms)
Epiglotic cartilage
Attached anteriorly to inner surface of anterior thyroid cartilage.
Epiglottis closes off laryngeal inlet during swallowing
Thyroid cartilage
Largest laryngeal cartilage
Laryngeal prominence (adam’s apple)
C shape opening posteriorly
Suspended from thyrohypiid membrane/ligament superiorly
Articulates with cricoid cartilage inferiorly
Vocal ligaments attache to inner wall
Cricothyroid joint
Inferior horn of thyroid cartilage articulates with cricoid cartilage.
Allows for movement of thyroid cartilage changing length of vocal ligaments (adduction and abduction)
Cricoid cartilage
Complete ring
Attaches superiorly to thyroid cartilage by cricothyroid ligament
Arytenoid cartilages
it on posterior portion of cricoid cartilage
Movements manipulate vocal ligaments and opening of rima glottids
Vocal ligaments
Attach to arytenoid and thyroid cartilage.
Cuneiform and Corniculate cartilages
Superior to arytenoid cartilages
Provide support and structure to aryepiglottic folds.
What is the only abductor of true vocal cord
Posterior cricoarytenoids
What is the main adductor of true volca cord
Lateral cricoarytenoid.
Aided by cricothyroid, thyroarytenoids, vocalis, transerse, oblique
Neck compartments
Visceral
Vascular (carotid sheath)
Vertebral
Superficial cervical fascia parts and function
Neurovascule supply to skin
Superficial veins
Superficial lymph nodes
Fat
Patysma
Deep cervical fascia layers
Investing
Pretrachial
Carotid sheath
Prevertebral
Investing layer of deep cervical fascia
Sternocleidomastoid
Trapezius
Pretracheal deep cervical fascia
Thyroid
Trachea
Larynx
Laryngopharynx
Esophagus
Infrahyoid muscles
Carotid sheath of deep cervical fascia
Common carotid artery
Internal carotid artery
Internal jugular vein
Vagus nerve
Glossopharyngeal nerve
Accessory nerve
Hypoglossal nerve
Prevertebral deep cervical fascia
Vertebral column
Paraspinous muscles
Scalenes
Cervical sympathetic trunk (depends)
Where is the retropharyngeal space
Between buccopharyngeal fascia and alar fascia
Ends at about T1
Sternocleidomastoid
Turning head and looking down
Attaches to sternum, clavicle, mastoid process
Inervated by CN XI
Trapezius
Elevate, depress, retract, protract, adn rotate scapulae
Attaches to occipital bone, nuchal ligament, C7-T12, clavicle, scapular spine
Innnervated by CN XI
Borders of anterior triangle
Midline
Sternocleidomastoid
Mandible
Where to listen to carotid for bruits
Anterior triangle
Posterior triangle borders
Middle one-third of clavicle
Anterior margen of trapezius
Sternocleidomastoid
What can be found in posterior triangle
Superficial cervical plexus
Spinal accessory nerve
Occipital artery
Subclavian artery
Subclavian vein
External jugular vein
Omohyoid muscle
Lymph nodes
Anterior and middle scalene muscle
Elevate rib 1
Innervated by anterior rami of C3-C8
Posterior scalene muscle
Elevate rib 2
Innervated by anterior rami of C3-C8
What runs between anterior and middle scalene muscles
Subclavian artery
Horner’s syndrome
Cervical Sympathetic Trunk
Ptosis (droopy eyes)
Miosis (pupils constrict)
Anhidrosis (no sweat)
Thyroid gland blood supply
Superior thyroid artery
Inferior thyroid artery
Thyroid gland venous drainage
Superior throid vein and Middle thyroid vein go to internal jugular
INferior thyroid veins go to brachiocephalic veins
Where to recurrent laryngeal nerves run
Tracheoesophageal grooves
Fibrous layer of globe
Sclera
Cornea
Sclera
Site of attachment for extraocular muscles
Helps shape eyeball
Continuous with optic sheath
Path of light
Cornea–> Anterior chamber–> Pupil–> Posterior chamber–> Lens–> vitreous chamber–> retina
Cornea
Continuous with sclera
Avascular
Refracts light
CN V1
Vascular layer of globe
Choroid
Ciliary body
Iris
Choroid
Blood supply to outer layers of retina
Branches of ophthalmic artery
Ciliary body
Connects coroids with iris
Attaches to lens via zonular fibers
Ciliary processes secrete aqueous humor
Aqueous humor flow
Posterior chamber to anterior chamber to canal of Schlemn into scleral venous plexus
Anterior chamber
Aqueous humor
Posterior to cornea and anterior to iris
Posterior chamber
Aqueous humor
Posterior to iris and anterior to lense
Sphincter pupillae
Constricts pupil.
Parasympathetic
Dilator pupillae
Dilates pupil
Two muscles of iris
Sphincter pupillae
Dilator pupillae
Lens
Avascular
No innervation
Refracts light
Retina
Pigmented
Neural
Macula lutea
Thinnest area of retina
Highest visual acuity (concentrated cones)
Contains fovea centralis
Fovea centralis
Lots of cones
No rods
Levator palpebrae superioris
Elevation of upper eyelid
Origin is lesser wing of sphenoid
Insertion is anterior surface of tarsal plate
Innervated by CN III
Supeior rectus
Elevation, adduction, internal rotation of eyeball
Origin is superior part of common tendinous ring
Insertion is anterior half of eyeball superiorly
Innervated by CN III
Inferior rectus
Depression, adduction, external rotation of eyeball
Origin is inferior part of common tendinous ring.
Innsertion is anterior half of eyeball inferiorly
Innervation is CN III
Medial rectus
Adduction of eyeball
Origin is medial part of common tendinous ring
Insertion is anterior half of eyeball medially
CN III
Lateral rectus
Abduction of eyeball
Origin is lateral part of common tendinous ring
Insertion is anterior half of eyeball laterally
Innervated by CN VI
Superior oblique
Depression, abduction, internal rotation of eyeball
Origin is body of sphenoid superior and medial to optic canal.
Insertion is outer posterior quadrant of eyeball (superior)
Innervated by CN IV
Inferior oblique
Elevation, abduction, external rotation of eyeball
Origin is medial floor of orbit posterior to rim
Insertion is outer posterior quadrant of eyeball (inferior)
Innervated by CN III
Presbyopia
Lens loses clarity and elasticity as we age.
Tensor tympani muscle
Tenses ossicles when around loud noises
Parathyroid glands
Superior pair and inferior pair
Supplied by inferior thyroid arteries
Drained by superior, middle, and inferior thyroid veins
Two drainage ducts of lymphatic system
Right
Thoracic
What all drains into thoracic duct
Everything below diaphragm
Left side of thorax
Left side of head and neck
Left upper limb
What all drains into right duct
Right side of thorax
Right side of head and neck
RIght upper limb
Terminal branches of external carotid artery
Maxillary
Superficial temporal
Nerves of superficial cervical plexus
Transverse cervical
Lesser occipital
Greater auricular
Supraclavicular
What innervates geniohyoid
C1
What innervates anterior belly of digastric
V3
What innervates stylohyoid
CN VII
What innervates posterior belly of digastric
CN VII
What innervates omohyoid
Ansa cervicalis
What innervates Sternohyoid
Ansa cervicalis
What innervates sternothyroid
Ansa cervicalis
What innervates thyrohyoid
Anterior ramus of C1
Stylohoid muscle
Pulls hyoid bone upward and back
Origin is styloid process
Insertion is lateral area of body of hyoid
Innervated by CN VII
Digastric anterior belly
Opens mouth by lowering mandible and raises hyoid
Origin is digastric fossa on lower insid eof mandible
Insertion is attachment of tendon between bellies of hyoid bone
Innervated by Inferior alveolar (V3)
Digastric posterior belly
Pulls hyoid bone upward and back
Origin is mastoid notch on medial side of mastoid process of temporal bone
Insertion is attachment of tendon between two bellies of hyoid bone
Innervated by CN VII
Mylohyoid
Supports and elevates floor of mouth and elevates hyoid
Origin is mylohyoid line on mandible
Insertion is body of hyoid bone and fibers from muscle on opposite side
Innervated by Inferior alveolar (V3)
Geniohyoid
Fixed mandible elevates and pulls hyoid bone forward
Fixed hyoid pulls mandible downward and inward
Origin is inferior mental spine on inner surface of mandible
Insertion is anterior surface of body of hyoid
Innervated by anterior ramus of C1
Sternohyoid
Depresses hyoid bone after swallowing.
Origin is posterior sternoclavicular joint.
Insertion is body of hyoid bone.
Innervated by ansa cervicalis
Omohyoid
Depresses and fixes hyoid bone
Origin is superior border of scapula
Insertion is lower border of body of hyoid
Innervated by ansa cervicalis
Thyrohyoid
Depresses hyoid bone.
Raises larynx when hyoid bone is fixed
Origin is thyroid cartilage
Insertion is greater horn of hyoid
Innervated by anterior ramus of C1
Sternothyroid
Draws larynx downward
Origin is posterior surface of manubrium sternum
Insertion is thyroid cartilage
Innervated by ansa cervicalis
