HNS 1,2,3 Flashcards
What are the 6 main anterior bones of the skull?
Frontal Nasal Lacrimal Maxilla Zygomatic Mandible
Which bone is the infraorbital foramen located?
Maxillary bone
Which bone is the supraorbital foramen located?
Frontal bone
Where are the mental foramen located?
Mandible
Which are the four main bones on the lateral view of the skull?
Frontal bone Parietal bone Sphenoid bone, greater wing Temporal bone Occipital bone
Which part of the skull is the weakest?
Pterion
Which bones form the pterion?
Point where the greater sphenoid wing, temporal, parietal and frontal bones meet
Which types of bleeds are associated with damage to the pterion?
Intracranial bleeds
Which midline suture do the paired parietal bone articulate with?
Sagittal suture
Which suture do the parietal bones articulate with, with the occipital bone?
Lambdoid suture
What is the junction between the sagittal and coronal suture?
Bregma
What is the junction between the sagittal and lambdoid suture?
Lambda
Which is the main foramen that can be seen on the inferior aspect of the skull?
Foramen magnum
Which suture does the unpaired frontal bone pair up with the parietal bones?
Coronal suture
What is the large membranous and unossified structure between the bones of the skull found in infants?
Anterior fontanelles
What is the main focus of the fontanelles?
Head to deform during its passage through the birth canal, and postnatal growth.
What are the four main parts of the temporal bone?
Squamous part
Zygomatic process
Tympanic part
Petromastoid part
Which part of the temporal bone has a flat plate appearance and forms the superior regions of the temporal bone?
Squamous part
Which bone articulate with the squamous part of the temporal bone?
Greater wing of the sphenoid
Parietal bone at the squamous suture
Which suture does the sphenoid bone articulate with the squamous part of the temporal bone?
Sphenosquamous suture
Which bone does the zygomatic process anteriorly articulate with?
Zygomatic bone
Which part of the temporal bone forms part of the surface of the external acoustic opening?
Tympanic part
Which bone does the temporal bone articulate with posteriorly?
Occipital bone
Which bone forms forehead?
Frontal bone
What does the frontal bone form anteriorly?
Forehead, and the superior part of the rim of each orbit
Superior to the rim of the orbit on each side are the raised superciliary arches
What is the Glabella?
Depression within the raised superciliary arches
Which foramen are located on the superior rim of the orbit?
Supraorbital foramen
What is the lateral process of the frontal bone?
Zygomatic process
Which midline anterior bone is in the midline, rests on the sphenoid none and forms the nasal septum?
Vomer bone
What are the two wings of the sphenoid bone?
Greater sphenoid wing
Lesser sphenoid wing
Which bones do the body of the sphenoid bone articular with?
Ethmoid, vomer and palatine bone
What are two crania foramina found on the greater wing of the sphenoid bone?
Foramen ovale
Foramen spinosum
What are the three parts of the maxilla?
Body of maxilla
Zygomatic process
Alveolar process
What is included within the alveolar process of the maxilla?
Contains teeth, forms upper jaw
What are the three cranial fossa?
Anterior cranial fossa
Middle cranial fossa
Posterior cranial fossa
Which four bones form the anterior cranial fossa?
Frontal, ethmoid, sphenoid bones
Which parts of the brain are found within the anterior cranial fossa?
Frontal lobes
Cerebral hemispheres
Which two bones form the middle cranial fossa?
Sphenoid and temporal bone
Which lobe of the cerebrum resides within the middle cranial fossa?
Temporal bone
Which structures are found within the posterior cranial fossa?
Cerebellum and brainstem
What structures form the brainstem?
Midbrain
Pons
Medulla
Which bones form the floor of the posterior cranial fossa?
Occipital bone
Temporal bone
Which bone does pituitary gland reside within?
Sella turcica of the sphenoid bone
Which sinus is lateral to the sell turcica?
Cavenous sinus
Which bone contains the olfactory nerve bundles?
Foramina of the cribriform plate (within the ethmoid bone)
Which nerve bundles is associated with the cribriform plate?
Olfactory nerve bundles
Which foramen is the optic nerve associated with?
Optic chasm
Which structures are associated with the optic canal?
Ophthalmic artery
Optic nerve
Which structures pass through the superior orbital fissure?
Oculomotor nerve Trochlear nerve Ophthalmic nerve Abducens nerve Superior orbital vein
Which four cranial nerves pass through he superior orbital fissure?
Oculomotor nerve CN3
Trochlear nerve CN4
Abducens nerve CN6
ophthalmic nerve CNV1
Which foramen does the abducens nerve pass through?
Superior orbital fissure
Which foramen does the trochlear nerve pass through?
Superior orbital fissure
Which foramen does the maxillary nerve pass through?
Foramen rotundum
Which structure passes through the foramen rotundum?
Maxillary nerve (CNV2)
Which foramen is associated with the mandibular nerve?
Foramen ovale
Which artery and nerve passes through the foramen Ovale?
Mandibular nerve (CNV3) Accessory meningeal artery
Which foramen is characterised by its minute hole?
Foramen spinosum
Which foramen does the middle meningeal artery pass through?
Foramen spinosum
Which nerve passes through the foramen laecrum?
Greater petrosal nerve
Which foramen does the internal carotid artery pass through?
Carotid canal
Which two cranial nerves pass through the internal acoustic meatus?
Facial nerve (cn 7) Vesibulocochlear nerve (CN VIII)
Which foramen does the facial nerve pass through?
Internal acoustic meatus
Which foramen does the vestibulocochlear nerve pass through?
Internal acoustic meatus
Which cranial nerves pass through the jugular foramen?
9, 10,II
Glossopharyngeal nerve
Vagus nerve
Accessory nerve
Which meningeal artery passes through the jugular foramen?
Posterior meningeal artery
Which foramen does the vagus nerve pass through?
Jugular foramen
Which foramen does the glossopharyngeal nerve pass through?
Jugular foramen
Which foramen does the accessory nerve pass through?
Jugular foramen
Which foramen does the hypoglossal nerve pass through?
Hypoglossal canal
What are the 3 meningeal layers?
Dura mater
Arachnoid
Pia mater
Where does the sub-arachnoid space reside?
Between the arachnoid and Pia mater
Which two layers form the dura mater?
Perisoteal layer
Meningeal layer
Which meningeal space is located the CSF located within?
Subarachnoid space
Which layer is closely adherent to the brain?
The Pia mater
Which structure forms the CSF?
Choroid plexus
Which dura layer is adherent to the inner surface of the bone?
Periosteum
Which sinus forms. between the periosteal and meningeal layer of the dura mater?
Superior sagittal sinus
Which structures is formed from the fold and union of the two two dura mater layers?
Falx Cerebri
Upon CSF drainage with layer is collapsed onto the surface of the brain?
Arachnoid layer
What is the falx cerebri?
Falx cerebri is a crescent shaped downward projections of meningeal dura mater from the dura lining the calva that passes between the two cerebral hemispheres towards the corpus callosum.
What is the tentorium cerebelli?
Horizontal projections of meningeal dura mater that covers and separates the cerebellum in the posterior cranial fossa from the posterior regions from the posterior parts of the cerebral hemispheres.
What is the falx cerebelli?
Midline projections of meningeal dura mater in the posterior cranial fossa; attached posteriorly to the internal occipital crest of the occipital bone, and superiorly to the tentorium cerebelli.
What is the extra-dural space?
Extradural space is generated within the vertebral columns, the relationship of dura, the spinal dura mater is adherent to the foramen magnum, whereas the periosteal mater lines the vertebrae, this separation produces the extradural space Epidural anaesthesia is injected within this space.
Which arteries supply the anterior cranial fossa?
Anterior meningeal arteries
Which arteries supply the middle cranial fossa?
The middle meningeal artery, enters through the foramen spinosum
Which two branches arise from the middle meningeal artery?
Anterior and posterior branch
Which artery resides deep to the pterion?
Anterior branch of the middle meningeal artery
Which artery supplies the posterior cranial fossa?
Posterior meningeal artery
Which 2 main artery systems form the circle of Willis?
Internal carotid arteyres
Vertebral arteries
Which artery forms upon the union of the two vertebral arteries?
Basilar artery
Which artery birfucates to form the two posterior cerebral arteries?
Basilar artery
Which arteries arise from the internal carotid arteries?
Ophthalmic artery
Posterior communicating artery
Middle cerebral artery
Anterior cerebral artery
What is the role of the anterior communicating artery?
Connects the left and right anterior cerebral arteries to each other
What is the role of the two posterior communicating arteries?
Connects the internal carotid artery with the posterior cerebral artery
Which artery is deep to the pterion?
Middle meningeal artery
Which haemorrhage occurs due to pterion and middle meningeal artery damage?
Epidural bleed
What is the effect of the haemtoma on intracranial pressure?
Increases intracranial pressure
What is a subdural bleed?
Deep to the dura
Which artery provides impressions on the cranial cavity?
Middle meningeal artery
What are the five layers that form the scalp?
Skin Connective Aponeurotic layer Loose connective tissue Pericranium
What are the 8 branches of the external carotid artery?
Superior thyroid artery Ascending pharyngeal artery Lingual artery Facial artery Occipital artery Posterior auricular artery Maxillary artery Superficial temporal artery
Which carotid artery supplies the face?
External carotid artery
Which carotid artery supplies the cranial cavity?
Internal carotid artery
Which artery provides afferent information regarding vision?
Optic nerve
What are the three main functions of the neck?
Structural: Supports and moves the head
Visceral: Contains the trachea, and oesophagus
Conduit for blood vessels and nerves
What are the three main compartments within the neck?
Visceral compartment
Vertebral compartment
Vascular compartment
Which structures reside within the visceral compartments?
Oesophagus, trachea, pharynx, thyroid gland
Which structures reside within the vertebral compartment?
Posterior, contains the cervical vertebrae, spinal cord, cervical nerves, and muscles associated with the vertebral column.
Which structures reside within the vascular compartment?
Bilateral, contains carotid artery, internal jugular vein, and the vagus nerve [X].
Which fascia surrounds al the structures in the neck, enclosing the trapezius, sternocleidomastoid and infra hyoid muscles?
Investing layer
Which fascial layer is the most superficial within the neck?
Platysma
Which nerve innervates the platysma?
Facial nerve
What does the prevertebral layer enclose?
Surrounds the vertebral column, and deep muscles associated with the back (Scalene muscles)
What does the pretracheal layer enclose?
Encloses the viscera of the neck, and the carotid sheaths surround the neurovascular bundles
What is fascia?
Fascia is connective tissue predominantly consisting of collagen fibres deep to the skin, attaches, stabilises, encloses and separate muscles and other internal organs.
What are the two main triangles within the neck?
Anterior triangle
Posterior triangle
What forms the superior boundary of the anterior triangle?
Inferior margin of the mandible
What forms the posterior boundary of the anterior triangle?
The anterior border of the sternocleidomastoid muscle
Which muscles are found within the anterior triangle of the neck?
Suprahyoid muscles: Mylohyoid, geniohyoid, digastric, stylohyoid
Infrahyoid: Omohyoid, sternohyoid, thyrohyoid, sternothyroid
Where does the common carotid artery birfucate within the neck?
The anterior triangle of the neck into the external and internal branches
Which triangle is the internal jugular vein ?
Anterior triangle
Which cranial nerves pass through the anterior triangle of the neck?
Vagus nerve Glossopharyngeal Vagus Accessory Hypoglossal
What is the anterior boundary of the posterior triangle?
The posterior border of the sternocleidomastoid muscle
What is the posterior boundary of the posterior triangle?
The anterior border of the trapezius muscle
What is the inferior border of the posterior triangle?
The middle 1/3 of the clavicle
Which fascia covers the posterior triangle?
Investing layer of fascia
Which nerves pass through the posterior triangle?
Trunks of the brachial plexus
Vagus nerve
Spinal accessory nerv
Phrenic nerve
Which two muscles does the spinal accessory nerve innervate?
Sternocleidomastoid muscle
Trapezius muscle
What are the four main suprahyoid muscles?
Anterior and posterior belly of digastric muscle
Stylohyoid muscle
Geniohyoid
Mylohyoid
What are the four main infra hyoid muscles?
Omohyoid
Sternohyoid
Thyrohyoid
Sternothyroid
Which nerve innervates the posterior belly of the digastric muscle?
Facial nerve
Which vein is superficial to the sternocleidomastoid muscle?
External jugular vein
Which vessels are deep to the sternocleidomastoid muscle?
Carotid artery
Internal jugular vein
Which nerve innervates the muscles of facial expression?
Facial nerve
What are the three groups of the muscles of facial expression?
Orbital
Nasal
Oral
What are the two orbital muscles of facial expression?
Corrugator supercili
Orbicularis oculi
Which muscle controls the movement of the eyelids?
Orbicularis oculi
Which are the three parts of the orbiculares oculi?
Palpebral part
Lacrimal part
Orbital part
What are the attachments for the orbicularis oculi?
Originates from the medial orbital margin, the medial palpebral ligament
Lacrimal bone
What are the actions of the palpebral part oft he orbiculares oculi muscle?
Closes the eyelids gently
Which part of the orbiculares oculi muscle is involved in the drainage of tears?
Lacrima part
What is the function of the orbital part of the orbicularis oculi?
Tightly closes the eyelids
Where do the corrugator supercili muscles insert into?
Inserts into the eyebrow , originally from the superciliary arch
What are the actions of the corrugator supercilli muscles?
Draws the eyebrows together, creating vertical drinks on the bridge of the nose
What are the three main muscles of the nasal group?
Nasalis
Procerus
Depressor septi nasi
Where does the nasalis muscle attach?
Originate from the maxilla
What are the two parts of the nasalis muscle?
Alar and transverse
Which cartilage attaches the alar part of the nasalis to the nasal skeleton?
Alar cartilage
What is the function of the transverse nasalis?
Compresses the nares
What is the function of the alar nasalis?
Open the nares
Which nasal muscle is the most superior?
Procerus
Which bone does the procerus originate from?
Nasal bone
What is the action of the procerus?
Contraction of the muscle pulls the eyebrow downwards, producing transverse wrinkles on nose
What is the function of the depressor septi nasi?
Assist the alar part of the nasali in opening of the nostrils, runs from the maxilla to the nasal septum, pulls the nose inferiorly, opening th nares
What are the two oral group muscles?
Buccinator and orbicularis oris
What is the action of the orbicularis oris?
Purses the lips
Where does the buccinator muscle attach too?
Originate from the maxilla, mandible, fibrs run in the infernomedial direction blending with the orbicularis oris, and the skin of the lip
What are the actions of the buccinator?
Pulls the cheek inwards, against the teeth, preventing the accumulation of food in that area
What are the motor functions of the facial nerve?
Innervates the facial expression, the posterior belly of the digastric , the stylohyoid muscle
Stapedius muscles
What are the sensory functions of the facial nerve?
Area surrounding the concha of the auricle
What are the special sensory functions of the facial nerve?
Provides taste sensation to the anterior 2/3 of the tongue
What are the parasympathetic functions of the facial nerve?
Submandibular
Sublingual salivary glands
Lacrimal glands
Where does the facial nerve pass through?
Parotid gland
What are the 5 main branches of the facial nerve?
Temporal Zygomatic Bucal Mandibular Cervical branches
What is the temporomandibular joint?
Pair of joints connecting the mandible to the skull. Bilateral synovial articulation between the temporal bone, and mandible, assisting in mastication
The muscles of mastication move the mandible -> Trigeminal v3
What are the three main muscles of mastication?
Masseter
Temporalis
Lateral and medial pterygoids
Which nerve innervates the muscles of mastication?
Mandibular nerve V3
What are main functions of the muscles of mastication?
Movements of the mandible include protrusion (Jaw advances); retraction (Jaw retreats); elevation and depression. These movements are facilitated by the superficial muscles, the temporalis and masseter muscles.
What are the attachments of the master muscle?
The superficial part originates from the maxillary process of the zygomatic bone; deep part originates from the zygomatic arch of the temporal bone. Both parts attach to the ramus of the mandible.
What is the main action of the masseter muscle?
Elevates the mandible, closing the mouth (forced)
Where does the temporals muscle originate from?
Temporal fossa
What structure covers the temporals muscle?
Fascia
Where does the temporalis muscle insert into?
Coronoid process of the mandible
What is the main function of the temporalis muscle?
Elevates the mandible, closing the mouth. Retraction of the mandible, pull the jaw posteriorly
What is the function of the lateral pterygoid?
Depresses and protracts the mandible
What is the insertion of the lateral pterygoid?
Condyle of the mandible, and front margin
What is the origin of the mandible?
Infratemporal crest.
What is the function of the medial pterygoid muscle?
Elevation of the mandible
What is the insertion of the medial pterygoid?
Ramus and angle of the mandible
Which bone forms the roof to the orbits?
Orbital plate of the frontal bone, and the lesser thing of the sphenoid
Which bones form the inferior wall of the orbit?
Formed by the orbital plate of the maxilla, paladin and zygomatic bone
Which bones form the medial wall of the orbit?
Ethmoid
Maxilla
Lacrimal
Sphenoid bone
Which bones form the lateral wall of the orbit?
Zygomatic bone, and greater wing of the sphenoid bone
What are the three main foramina of the orbit?
Optic canal
Superior orbital fissure
Inferior orbital fissure
What are the 7 extra ocular muscles?
Levator palpebrae superioris Superior rectus medial rectus Lateral recuts inferior rectus Superior oblique Inferior oblique
Which extra ocular muscles are responsible for eye movements?
Recti and oblique muscles
Which muscle is responsible for superior eyelid movement?
Levator palpebrae superioris
What is the function of the levator palpebrae superiors?
Elevates the upper eyelid
Which nerve innervates the Levator palpebrae superioris?
Oculomotor nerve
What are the four recti muscles?
Superior rectus
Inferior rectus
Medial rectus
Lateral rectus
What is the action of the superior rectus?
Elevation of the eye contributes to adduction and medial rotation of the eyeball
What is the action of the inferior rectus?
Depression
Adduction and lateral rotation of the eyeball
What is the action of the medial rectus?
Adducts the eyeball
What is the action of the lateral rectus?
Abducts the eyeball
Which nerve innervates the lateral rectus?
Abducens nerve
Which recti muscles are innervated by the oculomotor nerve?
Medial, inferior and superior rectus
What are the actions of the superior oblique?
Depression and abduction of the eye
Medial rotation
Which nerve innervates the superior oblique?
Trochlear nerve
What is the function of the inferior oblique?
Elevates, abducts and laterally rotates the eyeball
Which nerve innervates the inferior oblique?
Oculomotor nerve
Which ganglion contains the cell bodies of the oculomotor nerve?
Ciliary ganglion
What is the role of the ciliary ganglion?
Innervation to the sphincter pupillae muscle, constriction pupil
Which paired dural venous sinus is located within the cranial cavity?
Cavernous cavity
Which cranial fossa is the cavernous sinus located within?
Middle cranial fossa on either side of the sella turcica of the sphenoid bone
Which veins supply the cavernous sinus?
Cerebral and ophthalmic veins
What are the four structures of the lacrimal system?
Lacrimal gland
Canaliculi
Sac
Nasolacrimal duct
What is the lacrimal gland?
Lacrimal gland is the tear-producing organ of the lacrimal apparatus. The gland secretes the serous transparent fluid through its excretory ducts into the lateral aspect of the superior fornix, in the space between the eyeball and the eyelids. Tears wash over the eyeball, and drain into the lacrimal canaliculi (inferior and superior)- Open in the medial corner of the eye with puncta lacrimalia.
Where does the lacrimal canaliculi open into?
Open into the medial corner of the eye
What is the function of the lacrimal canaliculi?
Conveys tears to the lacrimal sac, dilated portion of the nasolacrimal duct, lodged in a depression between the lacrimal bone and frontal process of the maxilla
Fluid drains further into the nasolacrimal duct, opens into the nasal meatus
Fluid from the nasolacrimal duct eventually drains into ____?
The nasal meatus
Which nerve contals the secretory functions of the lacrimal apparatus?
V1
What are the main functions of the nasal cavity? (4)
Warms & humidifies the inspired air
Removes and traps pathogens and particular matter from inspired air
Responsible for sense of smell (detected by chemo-olfactory receptors within the ehtmoid bone)
Drains and clears the paranasal sinuses and lacrimal ducts
What is the vestibule region of the nasal cavity?
Area surrounding the anterior external opening to the nasal cavity
Which cells line the respiratory region of the nasal cavity?
Ciliated pseduostratified epithelium interspersed with mucous secreting goblet cells
What is the olfactory region of the nasal cavity?
Located at the apex of the nasal cavity, lined by olfactory cells with olfactory receptors
Which cartilage forms the nasal septum?
Septal cartilage
What forms the floor of the nasal cavity?
Upper surface of the palatine process of the maxilla
Horizontal plane of the palatine bone, forming the hard palate
Which bone forms the roof of the nasal cavity?
Formed by the cribriform plate of the ethmoid bone
What are the nasal conchae?
Projecting out of the lateral walls of the nasal cavity. Inferior, middle and superior conchae. Project into the nasal cavity, resulting in the formation of four pathways for airflow. Passages are called meatuses.
What are the three meatuses?
Inferior meatus
Middle meatus
Superior meatus
What is the inferior meatus?
Between the inferior concha and floor of the nasal cavity
What is the middle meatus?
Between the inferior and middle concha
What is the superior meatus?
Between the middle and superior concha
What is the function of the conchae?
Conchae increases the surface area of the nasal cavity; increases the volume of inspired air coming into contact with the cavity walls. Disrupt the fast, laminar flow of the air, making it slow and turbulent. Air traverses through a longer period in the nasal cavity for humidification.
What are the four main paranasal sinuses?
Frontal sinuses
Ethmoidal cells
Maxillary sinuses
Sphenoidal sinuses
What are paranasal sinuses?
Air filled extensions of the respiratory region of the nasal cavity
Which nerve innervates the paranasal sinuses?
The trigeminal nerve
What is the main function of the paranasal sinuses?
Humidifying inspired air
Increasing resonance of voice
Which paranasal sinus is the most superior?
Frontal sinus
How does the frontal sinus drain into the nasal cavity?
Frontonasal duct opening out at the hiatus semilunaris of the lateral wall
Which part of the trigeminal nerve innervates the frontal sinus?
V1
Which artery supplies the frontal sinus?
Anterior ethmoidal arteries
What are ethmoidal cells?
Ethmoidal cells: Fill the ethmoidal labyrinth. Cluster of cells is separated from the orbit by the thin orbital plate of the ethmoidal labyrinth, and from the nasal cavity by the medial wall of the ethmoidal labyrinth.
Which two nerves innervate the ethmoidal cells?
V1 & V2
Where do the maxillary sinuses drain into?
drain into the hiatus semi-lunars
Which nerve innervates the maxillary sinuses?
V2, maxillary nerve
Which arteries supply the maxillary sinuses?
Maxillary arteries
Which nerves inveterate the sphenoidal sinuses?
V1 & V2
What is the purpose of the nasolacrimal duct?
Opens onto the lateral wall of the inferior nasal meatus, drains tears from the conjunctival sac for the eye into the nasal cavity
What three regions is the ear divided into?
External ear
Middle ear
Internal ear
Which canal forms the superficial surface of the external ear?
External acoustic meatus
What is the lateral projection from the head of the external ear?
Auricle
What is the auricle made out of?
Cartilage
What is the outer surface of the ear?
External auricular rim = helix
Where does the helix end?
Ends inferiorly at the fleshy lobule (not supported by cartilage)
What is the hollow centre of the auricle?
Concha of the auricle
Where does the external acoustic meatus retreat from?
Centre of the auricle
What structure is found anterior to the opening of the external acoustic meatus?
Tragus
what structure resides opposite to the tragus?
Anti-tragus
What structure forms a smaller curved inner rim, parallax and anterior to the helix?
Anti-helix
What does the pharyngotympanic tube connect?
Connects the middle ear with the nasopharynx
What is the role performed by the pharyngotympanic tube?
Equalises pressure on both sides of the tympanic membrane
Where does the pharyngotympanic tube enter?
Enter the nasopharynx, posterior to the inferior meatus of the nasal cavity
What forms the 1/3rd of the middle ear?
Bony part
What is the vasculature of the middle ear?
Branches arise from the ascending pharyngeal artery (Branch of the external artery), and from two branches o fi to the maxillary artery (Middle meningeal artery, and the artery of the pterygoid canal)
What is the venous drainage of the middle ear?
Pterygoid plexus of veins in the infra temporal fossa
Which plexus innervates the mucous membrane lining the pharyngotympanic tube?
Tympanic plexus
Which nerve innervates tympanic plexus?
Glossopharyngeal nerve [IX]
Which three bones form the ossicles of the middle ear?
Malleus
Incus
Stapes
Which ossicle is attached to the tympanic membrane?
Malleus
What are the three structures that form the malleus?
head of the malleus
Neck of the malleus
Anterior & lateral processes, and the handle
Which part of the malleus articulates with the incus?
Posterior surface of the head
What does the anterior process of the malleus attach onto?
Attached to the anterior wall of the middle ear by a ligament
What does the lateral process of the malleus attach onto?
Attached to the anterior and posterior malleolar folds of the tympanic membrane
Which part of the malleus is attached to the tympanic membrane?
The handle of the malleus
Which part of the incus articulates with the head of the malleus?
Enlarged body of the incus
What are the two limbs of the incus?
Short & long limb
What is the short limb of the incus?
Extends posteriorly and is attached by a ligament the upper posterior wall of the middle ear
What is the long limb of the incus?
Extends downwards from the body, paralleling the handle of the malleus, and ends by bending medially to article with the stapes
What is the stapes?
Joins the incus to the oval window of the inner ear, stirrup shaped with a head two limbs and a base, head articulates with the incus, and the base joints the oval window
What structure carries information regarding taste from the anterior 2/3 of the tongue, and contains secretory motor fibrs to the submandibular and sublingual glands?
Chorda tympani
What I the function of the oculomotor nerve?
Somatic motor function innervating the majority of extra-ocular muscles of the eye :
Superior rectus, inferior rectus, medial rectus, and inferior oblique
The levator palpebrae superioris
What is the parasympathetic function of the oculomotor nerve?
Innervates the sphincter pupillae and cilliary muscles of the eye, constricting the iris/pupil (pupilary light reflex)
Which foramina does the oculomotor nerve course through?
Superior orbital fissure
What does the superior branch supply for the oculomotor nerve?
Provides motor innervation to the superior rectus, and levator palpebrae superioris
What does the inferior branch of the oculomotor nerve supply?
Provides motor innervation to the inferior, medial rectus, and inferior oblique
Where do the pre ganglionic parasympathetic cell bodies reside?
Ciliary ganglion
What is the function of the trochlear nerve in terms of the eye?
Innervates the superior oblique, depresses and abducts the eye
Which extra ocular muscle is innervated by the abducens nerve?
Lateral rectus
How does one test for the lateral rectus?
Look out
How does one test for the medial rectus?
Look in
How does one test for the inferior rectus?
Look down when looking out
How does one test for the superior rectus?
Look up when looking out
How does one test for inferior oblique?
Look up when looking in
How does one test for the superior oblique?
Look down when looking in
What is the main motor function of the trigeminal nerve?
Innervates the muscle of mastication
What are the three divisions of the trigeminal nerve?
Ophthalmic division
Maxillary divison
Mandibular divison
Which nerve provides general sensation to the anterior 2/3 of the tongue?
Mandibular division
Which nerve innervates the medial and lateral pterygoids?
Mandibular divison
What three structures form the pharynx?
Nasopharynx
Oropharynx
Laryngopharynx
Which cranial nerve provides motor functions to the uvula (Levator vili palatini)?
Vagus nerve
A lesion to the right vagal nerve of the uvula results in what deviation?
Deviation to the opposing side
What closes the pharyngal isthmus during swallowing?
Elevation of the soft palate and constriction of the palatophayrngeal sphincter closes the pharyngal isthmus
Which pharynx is posterior to the oral cavity?
Oropharynx
What are the large collections of lymphoid tissues at the posterior aspect of the oral cavity?
Lingual and palatine tonsils
Where are the palatine tonsils?
Within the lateral walls of the oropharynx, the palatine tonsils are posterior to the palatoglossal folds
Between the palatoglossal and palatophayrngeal arches
Which folds are anterior to the palatine tonsils?
Palatoglossal folds
What is the palatoglossal fold?
Palate -> Tongue
Posterior is the palatopharyngeal fold : palate -> pharynx
Which palate is the most posterior?
Soft palate
What role is performed by the epiglottis during swallowing in relation to the laryngeal inlet?
The epiglottis during swallowing closes the laryngeal inlet, prevents substrate moving into the trachea
Laryngopharynx opens up into the oesophagus
The laryngopharynx opens up into which structure?
The oesophagus
What is the piriform fossa?
Has sensory innervation
Channel that directs solid & liquids from oral cavity around the raised laryngeal inlet and into the oesophagus
Which cranial nerves provides the majority of the motor and sensory innervation of the pharynx?
Vagus and glossopharyngeal nerve
What are the three main salivary glands within the oral cavity?
Submandibular
Sublingual
Parotid
What are salivary glands?
Are glands that secrete amylase into the oral cavity. Small glands reside within the submucosa or mucosa of the oral epithelial lining the tongue, palate, cheeks and lips
Which type of fluid is secreted from submandibular glands?
Serous
Where are the sub mandibular glands?
Reside within the floor of the mouth, secrete saliva into the mouth through the submandibular ducts
Which nerve innervates the submandibular gland?
The facial nerve
Which nerve innervates the sublingual gland?
Facial nerve
Where do the sublingual glands reside in relation to the tongue?
Inferior to the tongue
What type of secretions are released from the sublingual glands?
Mucous secretions
Which nerve innervates the parotid glands?
Glossopharyngeal nerve
What type of secretions are released by the parotid gland?
Serous secretions
Where are the parotid glands?
Reside between the skin and the masseter muscle, proximal to the ears.
Where does the parotid duct enter into the oral cavity?
Penetrates the buccinator muscle, which is located near the second upper molar tooth
What are the four main extrinsic muscles of the tongue?
Genioglossus
Hyoglossus
Styloglossus
Palatoglossus
Where is the root of the tongue attached to?
Attached to the mandible and hyoid bone
Which nerve innervates the intrinsic muscles?
Hypoglossal nerve [XII]
What are the four main intrinsic muscles of the tongue?
Superior longitudinal
Inferior longitudinal
Transverse
Vertical
Which extrinsic tongue muscles are innervated by the hypoglossal nerve?
Hyoglossus
Styloglossus
Genioglossus
Which nerve innervates the palatoglossus?
Vagus nerve
Which extrinsic tongue muscle protrudes the tongue out of the oral cavity, and depresses the centre?
Genioglossus
What is the function of the hyoglossus?
Depresses tongue
What is the function of the styloglossus?
Elevates and retracts the tongue
Which extrinsic tongue muscle elevates and retracts the tongue?
Styloglossus
What I the function of the palatoglossus?
Depresses the palate, moving the palatoglossal folds towards the midline, elevates back of the tongue
A lesion in the hypoglossal nerve results in a tongue deviation towards?
Towards the lesion
Which nerve provides general sensation to the anterior 2/3 of the tongue?
Trigeminal nerve
Which nerve provides taste to the anterior 2/3 of the tongue?
Facial nerve
Which nerve provides sensory touch and taste to the posterior 1/3 of the tongue?
Glossopharyngeal nerve
Which nucleus is the taste centre?
Nucleus solitarius
What are the four main phases of swallowing?
Oral preparatory phase
Oral transit phase
Pharyngeal phase (1 & 2)
Oesophageal phase
What happens during the oral preparatory phase?
Food is mechanically digested into bolus, jell at centre of the tongue
Lip, jaw, tongue and palate sensory & motor function required, facilitated by dentition ,voluntary process
Which 5 cranial nerves provide innervation during the oral preparatory phase?
Trigeminal (v) Facial Glossopharyngeal Vagus Hypoglossal
What is the oral transit phase?
Bolus propelled to oropharynx, soft palate seals entrance to the nasal cavity
Is the airway open during the oral transit phase?
Yes
When does the airway close during swallowing?
Pharyngeal phase 1
When is the pharyngeal phase triggered?
Triggered when the bolus reaches the faucial arch the soft palate remains elevated to prevent access to the nasopharynx
Which palate during the swallowing phases seals off the nasaopharynx?
Soft palate
Which nerve innervates the styloglossus?
Hypoglossal nerve
Which muscle retracts the tongue inwards pushing the bolus towards the oropharynx
Styloglossus
Which 3 nerves innervate the pharyngeal phase?
Glossopharyngeal
Vagus
Hypoglossal
Which structure closes the laryngeal inlet?
Epiglottis
What happens during the second pharyngeal phase?
Bolus propelled through the pharynx
Reflex control
What is the oesophageal phase?
Upper oesophageal sphincter relaxes, airway closed, breath held
Bolus is propelled through the oesophagus under reflex control of X & IX.
Respiration resume upon exhalation; clears food particles from airway entrance
Which technique can be used to monitor the swallowing phases?
Videofluroscopy
What is an ataxic swallow?
Uncoordinated tongue retraction (styloglossus) to propel the bolus into the oropharynx. There is a delayed airway closure (Epiglottis retroflexion onto the laryngeal inlet impaired)
Bolus enters into the airways
Why does the bolus aspirate into the lungs during a cerebellar haemotoma?
Delayed and ineffective cough to clear airway
What can be done to reduce aspiration of bolus for patients with a cerebellar haematoma?
Flexed neck during swallow
What is the pathology that arises from a cerebellar haematoma?
Ataxic swallow
What happens during gnarly excised acoustic neuroma?
Low motor lesion, causes ipsilateral paresis of pharynx ,larynx and tongue
There is a weak bolus propulsion -> Residue within oral cavity and pharynx
Failed airway closure causes aspiration
What can be done to help with an excised acoustic neuroma during swallowing?
Head rotation to direct bolus down strong side of pharynx
How does Parkinson’s disease cause swallow difficulty?
Difficult in initiating a swallow, repetitive tongue movements -> Linked with muscle rigidity , unable to lower back o the tongue
What treatment can be done to help with Parkinson’s patients with difficultly in swallowing?
Active range of motion exercises of lips & tongues (physiotherapy)
What is the main function of the larynx?
Is a sphincter to close the lower respiratory tract and an instrument to produce sound
Which bone is the larynx suspends from?
Hyoid bone
Which nerve supplies most of the motor and sensory innervation to the larynx?
Vagus nerve
What are the three main unpaired cartilages of the larynx?
Cricoid
Thyroid
Epiglottis
What are three pairs of smaller cartilages?
Arytenoid, corniculate and cuneiform
Which laryngeal cartilage is the most inferior?
Cricoid cartilage
What is the posterior broad region of the cricoid cartilage?
The lamina
What is the anterior region of the cricoid cartilage?
Narrow arch of the cricoid cartilage
Where are the two attachment facets on the cricoid cartilage which articulate with the arytenoid cartilage?
Posteriorly on the lamina
Which cartilage articulates with the lateral articulation facets on the cricoid facets?
Medial surface of the thyroid horn of the thyroid cartilage
Which two structures form a superior point of fusion of the thyroid cartilage?
Right and left lamina
What is the common name for the laryngeal prominence?
Adam’s apple
Which structure is formed upon the fusion of the right and left lamina anteriorly?
Laryngeal prominence
Which bone are the superior horns of the thyroid cartilage attached to?
Hyoid bone
Which structure do the inferior horns of the thyroid cartilage articulate with?
Articulates with the cricoid cartilage
Which ligament attaches the epiglottis to the thyroid cartilage?
Thyro-epiglottic ligament
Which paired cartilage are pyramidal shaped and reside on the superoposteriar articular facets of the cricoid cartilage?
Arytenoid cartilages
Which cartilage does the arytenoid cartilage articulate with at its base?
The cricoid cartilage
What are the two main processes of the arytenoid cartilages?
Vocal process
muscular process
What is the muscular process of the arytenoid cartilage?
Provides attachment for the posterior and lateral cricoarytenoid muscles
What is the vestibular fold?
False vocal cords and superior to the vocal folds
Which region is superior to the vocal cords?
Vestibule
Which region is inferior to the vocal folds?
Infraglottic space
Where is the cricothyroid muscle located?
Attached to the anterolateral surfaces of the arch of the cricoid cartilage
Expand superiorly and posteriorly to attach to the thyroid cartilage
Which muscle lengthens and stretches the vocal fold (tensor)?
Cricothyroid muscle
What is the function of the cricothyroid muscle?
Lengthens and stretches the vocal fold (tensor)
Which branch of the vagus nerve innervates the circothyroid muscle?
Superior laryngeal branch of the vagus nerve
What are the three main arytenoid muscles?
Transverse arytenoid
Oblique arytenoid
Posterior cricoarytenoid
What is the function of the oblique arytenoid muscle?
Narrows the laryngeal inlet.
What is the function of the transverse arytenoid muscled?
In coordination with the oblique arytenoid muscle, the transverse muscle pulls the arytenoid cartilage closes together -> Closure of the posterior glottis
Which muscle opens the glottis, and separates the vocal folds?
Posterior cricoarytenoid
What is the origin of the posterior crico-arytenoid muscle?
Posterior surface of lamina
What is the function of the lateral cricoarytenoid muscle?
Closes the glottis, and adducts the vocal folds.
What is the function of the thyroarytenoid muscle?
Relaxes the vocal fold
What are the four protective mechanisms of the airway?
Swallowing
Gag reflex
Sneezing
Coughing
How does the epiglottis prevent aspiration of bolus into the airway?
Retroflexion of the epiglottis closes the laryngeal inlet, and larynx is raised
Which nerve controls the gag reflex?
Glossopharyngeal nerve
How does sneezing protect the airway?
Expels air through the nose, clear obstruction within the nasal cavity
How does coughing protect the airways?
Reflex action to remove food away from trachea out through the oral cavity
What are the two branches of the superior laryngeal nerve?
External branch
Internal branch
Which ganglia contains the superior laryngeal nerve?
Originates from the inferior vagal ganglia
What is the function of the external branch of the superior laryngeal nerve?
Supplies the cricothyroid muscle
What is the function of the internal branch of the superior laryngeal nerve?
Supplies sensory innervation to the laryngeal cavity and vocal folds superior
What are the motor functions arising from the recurrent laryngeal nerve?
Motor to all intrinsic muscles of the larynx with the exception of the cricothryoid muscle
Which nerve provides motor function to the cricothyroid muscle?
External branch of the superior laryngeal nerve
What are the sensory functions of the recurrent laryngeal nerve?
Sensory to the laryngeal cavity below the level of the vocal folds
A lesion to the recurrent laryngeal nerve will result in what paralysis?
Paralysis of all muscles of larynx, except cricothyroid muscle,
Loss of sensation below the vocal folds
A lesion to the internal branch of the superior laryngeal nerve?
Lesion causes loss of sensation above the vocal folds
A lesion to the external branch of the superior laryngeal nerve results in what?
Lesion causes paralysis of the cricothyroid
Where are the thyroid glands located in relation to the thyroid cartilage?
Anterior in the neck, inferior and lateral to the thyroid cartilage.
Covers the cricoid cartilage and the inferior region of the thyroid cartilage
What is the thyroid isthmus?
Connects the lateral lobes
What is the first branch of the external carotid artery?
Superior thyroid artery
What are the two branches of the superior thyroid artery?
Anterior glandular branch
Posterior glandular branch
Which artery supplies the inferior pole of the thyroid gland, and the parathyroid glands?
Inferior thyroid artery
Where does the superior thyroid vein drain?
Drains the area supplied by the superior thyroid artery
Where do the middle and inferior thyroid veins drain?
Drains the rest of the thyroid gland
Which veins do the superior and medial thyroid veins drain into?
Internal jugular vein
Which vein does the inferior thyroid artery drain into?
Right & left brachiocephalic veins
Which is the main node for lymphatic drainage of the thyroid gland?
Paratracheal nodes
Which nerve is intimately associated with the current laryngeal nerve?
Recurrent laryngeal nerve
Which vein does the external jugular vein drain into?
Subclavian vein
Which vein does the facial vein drain into?
The subclavian vein
What are the 5 main superficial lymph nodes?
Submandibular Submental Occipital Mastoid Parotid
What are the submandibular nodes?
Inferior to the body of the mandible, and associated with the facial artery
What are the submental nodes?
Inferior and posterior to the chin
Where are the occipital lymph nodes located?
Located posterior to the head at the lateral border of the trapezium muscle, collects lymph from the occipital region of the scalp
Which lymph nodes are posterior to the ear, residing on the insertion of the sternocleidomastoid muscle into the mastoid process?
Mastoid nodes
Where are the parotid nodes located?
Superficially to the parotid gland, collects lymph from the nasal cavity, the external acoustic meatus, the tympanic cavity and the lateral borders of the orbit
What are the deep cervical lymph nodes?
Collection of lymph nodes that form a chain along the internal jugular vein. Divided into upper and lower groups where intermediate tendon of the omohyoid muscle crosses the common carotid artery & the internal jugular vein.
