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Year 4 > Lachmans Head and Neck > Flashcards

Lachmans Head and Neck Flashcards

1
Q

In what part of the temporal bone does the facial nerve course, and through what opening does it emerge onto the face?

A

Passes through the facial canal within the petrous portion of the temporal bone

Emerges through the stylomastoid foramen onto the face.

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2
Q

Why does the face appear asymmetrical when there is a facial nerve lesion?

A

Muscles of facial expression on the normal side are unopposed by the paralyzed muscles on the side of the lesion.

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3
Q

Why is vision at risk when a patient has facial palsy?

A

Because the orbicularis oculi is paralyzed, the patient loses the blink reflex on the side of the lesion

(Therefore, the cornea is at risk for desiccation and ulceration.)

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4
Q

What is the function of the orbicularis oculi muscle

A

Closes eyelids and compresses lacrimal sac.

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5
Q

Why does food and saliva leak from the mouth of a patient with facial palsy?

A

Paralyzed orbicularis oris and the buccinator muscles

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6
Q

Orbicularis oris

O
I
I
A
A

A

O: Modiolus of angulus oris and vermillion line.

Insertion: Skin and fascia of lips.

Innervation: Buccal and marginal mandibular branches of facial nerve (CN VII).

Action: Compresses and protrudes lips.

Arterial: Superior and inferior labial, infraorbital, and transverse facial arteries.

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7
Q

Why might a patient with facial palsy experience hyperacusis?

(Hyperacusis is a rare hearing disorder that makes sounds that are normal for others seem uncomfortably loud)

A

The facial nerve innervates the stapedius- Paralysis of the stapedius eliminates this attenuation = Loud

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8
Q

In addition to the innervation of skeletal muscle, what other functions are served by the facial nerve?

A

Taste sensation from the palate and the anterior 2/3 of the tongue.

General sensation from skin behind the ear.

Secretion from the lacrimal gland, submandibular gland, and the sublingual gland

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9
Q

What are the 3 divisions of the trigeminal nerve, and what regions of skin do they innervate CNV1?

A

Ophthalmic- lateral angle of the eye up to the interauricular line

Maxillary CNV2
Mandiubluar CNV3

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10
Q

What are the 3 divisions of the trigeminal nerve, and what regions of skin do they innervate?

CNV2

A

Maxillary- lateral angle of the eye to the lateral angle of the mouth

Opthalamic CNV1
Mandiubluar CNV3

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11
Q

What are the 3 divisions of the trigeminal nerve, and what regions of skin do they innervate?

CNV3

A

Mandibular - angle of the mouth to the margin of the mandible and the skin anterior to the ear.

Opthalamic CNV1
Maxillary CNV2

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12
Q

The ophthalmic division innervates the??

A

Skin from the lateral angle of the eye up to the interauricular line.

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13
Q

The maxillary division innervates the ?

A

Skin from the lateral angle of the eye to the lateral angle of the mouth.

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14
Q

The mandibular division innervates the?

A

Skin from the angle of the mouth to the margin of the mandible and the skin anterior to the ear.

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15
Q

Where are the sensory cell bodies of the nerve fibers in the trigeminal nerve found?

A

Sensory cell bodies- in the trigeminal ganglion,

Which is on the anterior face of the petrous bone ( middle cranial fossa. )

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16
Q

What are emissary veins, and what role do they play into the transmission of infection?

A

Emissary veins communicate between
- Superficial regions of the face and scalp
- Dural venous sinuses.

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17
Q

What veins have no Valves?

A

Emissary veins (blood can flow in either direction)

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18
Q

Why can Infections of the skin of the face and scalp can travel into the dural venous sinuses??

A

Emissary veins no Valves, bidirectional flow

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19
Q

Why might a patient with cavernous sinus thrombosis have swelling of the eyelid and conjunctiva?

A

The ophthalmic veins, which drain the eyelids and conjunctiva, communicate with the cavernous sinus. Thrombosis in the sinus impedes venous drainage from these regions.

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20
Q

What nerve gets compressed in the cavernous sinus thrombosis?

A

Abducens nerve (CN VI)

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21
Q

Which cranial nerves pass through the cavernous sinus and could be affected by a cavernous sinus thrombosis?

A

Oculomotor nerve, Trochlear nerve, Abducens nerve, Trigeminal (CNV 1&2)

As they go to the superior orbital fissure and the orbit.

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22
Q

The _____ Nerve runs through the central part of the cavernous sinus, alongside the ______ , making it especially vulnerable to injury.

A

Abducens nerve (CN VI)
Internal carotid artery

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23
Q

What are the contents of the Cavernous Sinus ?

A

Abducens nerve (CN VI)
Carotid plexus (post-ganglionic sympathetic nerve fibres)
Internal carotid artery (cavernous portion)

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24
Q

What travels through lateral wall of cavernous sinus? (OTOM)

A

Oculomotor nerve (CN III)
Trochlear nerve (CN IV)
Ophthalmic (V1) and maxillary (V2) branches of the trigeminal nerve

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25
Q

What are the venous connections of the cavernous sinus through which infection could spread?

A

The cavernous sinus communicates with the superior ophthalmic vein anteriorly, the superior and inferior petrosal sinuses posteriorly, the anterior and posterior intercavernous sinus medially, and the cerebral and meningeal veins.

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26
Q

What are the venous connections of the cavernous sinus through which infection could spread?
(Anterior)

A

The cavernous sinus communicates with:

Superior ophthalmic vein anteriorly

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27
Q

What are the venous connections of the cavernous sinus through which infection could spread?

(Posteriorly)

A

The cavernous sinus communicates with:

Superior and inferior petrosal sinuses posteriorly

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28
Q

What are the venous connections of the cavernous sinus through which infection could spread?

(Medially)

A

The cavernous sinus communicates with:

Anterior and posterior intercavernous sinus medially,

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29
Q

Why might a cavernous sinus thrombosis cause loss of all eye movement and dilation of the pupil?

Nerve’s (3), and Functions

A

Extraocular muscles that move eyes are innervated by nerves that pass through the cavernous sinus.

The oculomotor nerve innervates the sup. rectus, medial rectus, inf. rectus, and the inf. oblique.

The trochlear nerve innervates the sup. oblique,

Abducens nerve innervates the lateral rectus.

Oculomotor nerve carries the preganglionic parasympathetic nerves = constriction of the pupil.

30
Q

What muscles does the oculomotor nerve innervate?

A

Levator palpebrae superioris
Superior rectus
Medial rectus
Inferior rectus
Inferior oblique
Ciliary muscle
Sphincter pupillae

31
Q

The occulomotor nerve innervates all the extraoculor motor muscles except?

A

Superior oblique muscle: Innervated by the trochlear nerve (CN IV)

Lateral rectus muscle: Innervated by the abducens nerve (CN VI)

32
Q

What are the bony openings in the back of the orbit, and what passes through them?

A

Optic canal, the superior orbital fissure, and the inferior orbital fissure.

33
Q

What passes through the superior orbital fissure?

A

The oculomotor, trochlear, abducens, and the ophthalmic division of the trigeminal nerve, along with the superior ophthalmic vein,

34
Q

What passes through the inferior orbital fissure.?

A

The infraorbital nerve and artery, the zygomatic nerve, and the inferior ophthalmic vein

35
Q

Superior rectus Muscle actions and nerve

A

Elevates, adducts, and medially rotates eyeball.

Oculomotor nerve (CN III).

36
Q

Inferior oblique Muscle actions and nerve

A

Elevates, abducts, and laterally rotates eyeball.

Oculomotor nerve (CN III).

37
Q

Which two extraocular muscles, when contracted together cause elevation of the eyeball?

A

Superior rectus and the inferior oblique muscles

When they contract together, the abduction and adduction actions cancel, and pure elevation results

38
Q

Why can damage to the floor of the orbit cause sensory disturbance to the upper teeth?

A

Infraorbital nerve travels along the floor of the orbit.

This nerve gives rise to the branches that descend through the floor of the orbit and pass through the wall of the maxillary sinus to reach the roots of the maxillary teeth and provide sensory innervation. If the infraorbital nerve is damaged in the floor of the orbit, disruption of the sensory pathway from the maxillary teeth may occur.

39
Q

What muscles are responsible for the movements at the TMJ?

A

4 muscles of mastication (masseter, temporalis, medial pterygoid, and lateral pterygoid)

Anterior digastric
Mylohyoid muscles.

40
Q

What are the 4 muscles of mastication ?

A

Masseter, temporalis, medial pterygoid, and lateral pterygoid

41
Q

Which muscles are responsible for closing the jaw?

A

Masseter, Temporalis, Medial Pterygoid

42
Q

Why might dislocation of the mandible occur during extreme opening of the jaw but not during closing of the jaw?

Opening/ Cloising/ condyle movement

A

Opening of the jaw: condyle of the mandible and the intraarticular disk move forward; this may cause the condyle to pass over the articular tubercle and thus dislocate from the joint.

Closing of the jaw : moves the condyle posteriorly, where it is well seated in the joint.

43
Q

At what location is an inferior alveolar nerve block done?

A

Inferior alveolar nerve enters the mandible at the mandibular foramen (medial side of the ramus of the mandible)

44
Q

The inferior alveolar nerve is a division of?

A

Mandibular nerve (Trigeminal Nerve)

45
Q
A
46
Q

In addition to the mandibular teeth and gums, what region of skin receives sensory innervation from the inferior alveolar nerve?

A

Terminal branch of the inferior alveolar nerve = mental nerve.

Mental Nerve merges from the mandibular canal through the mental foramen… (innervates the skin overlying the anterior portion of the mandible.)

47
Q

What are the accessory muscles of respiration?

A

Primary muscles - Diaphragm, Intercostal muscles.

Accessory muscles - Pectoralis major/minor, serratus anterior, scalene, SCM

48
Q

What are the accessory muscles of Inspiration?

A

Sternocleidomastoid,
Scalenus (Group)
Pectoralis major and minor,
Serratus anterior
Latissimus dorsi
Serratus posterior superior

49
Q

What are the accessory expiratory muscles?

A

Rectus abdominis
External oblique, internal oblique, and transversus abdominis.

50
Q

What are the major layers of the deep cervical fascia? (4 layers)
(IPtPvC)

A

Outermost layer of deep cervical fascia = investing layer
- Covers - trapezius and SCM muscles and encircles all the layers of cervical fascia.

Pretracheal fascia encloses the visceral compartment

Prevertebral fascia encloses the vertebral column and the paravertebral muscles.

Carotid sheath encloses the internal jugular vein, the common and internal carotid arteries, and the vagus nerve.

51
Q

What structure lies immediately posterior to the trachea and could be perforated if a tracheostomy tube is inserted too far?

A

The esophagus is located immediately posterior to the trachea.

(Because the cartilages of the trachea are incomplete posteriorly, the membranous posterior wall of the trachea can be penetrated.)

52
Q

Why does cricothyroidostomy avoid the possibility of injury to the esophagus?

A

The cricoid cartilage is a complete ring with a wide posterior lamina that prevents penetration of the esophagus. However, cricothyroidostomy presents the possibility of injury to the vocal mechanism.

53
Q

What are the bony and cartilaginous structures that can be palpated from the anterior midline of the neck?

A

From superior to inferior, the palpable midline structures are the hyoid bone, the thyroid cartilage with the superior thyroid notch in the midline, the cricoid cartilage, the tracheal rings, and the suprasternal notch of the manubrium

54
Q

Which infrahyoid muscles that are close to the midline must be retracted to gain access the thyroid gland?

A

Sternohyoid and sternothyroid (Close to the midline and lie anterior to the thyroid gland)

These muscles are retracted to gain access to the thyroid.

55
Q

What nerve crosses the inferior thyroid artery posterior to the thyroid gland, and what would be the result of injury to the nerve?

A

The recurrent laryngeal nerve, crosses the inferior thyroid artery.

Injury to the nerve results in hoarseness.

56
Q

The recurrent laryngeal nerve innervates all the intrinsic laryngeal muscles except for the ?

A

Cricothyroid

57
Q

What is the embryonic origin of the parathyroid gland, and how does this relate to the greater variability of the location of the inferior parathyroid gland?

A

Parathyroid glands are derived from the endoderm of the 3rd and 4th pharyngeal pouches.

Superior parathyroid comes from the 4th pouch
Inferior parathyroid comes from the 3rd pouch.

58
Q

The carotid pulse can be palpated at the anterior border of the SCM. What are the boundaries of the carotid triangle in which this pulse is felt?

A

The carotid triangle is a subdivision of the anterior triangle.

Posterior belly of the digastric, Superior belly of the omohyoid, and SCM.

59
Q

What is the retropharyngeal space, and what is the relationship of the carotid sheath to this space?

A

Retropharyngeal space =Fascial plane between the prevertebral fascia, and pretracheal fascia, R/L Carotid Sheath

(Prevertebral- Surrounds the vertebral column and paravertebral muscles) (Pretracheal fascia - Surrounds the visceral compartment of the neck.)

60
Q

What structures are in the carotid sheath?

A

Common and internal carotid arteries, internal jugular vein, and vagus nerve.

61
Q

When the common carotid artery bifurcates, What happens in the Sheath?

A

Internal carotid remains in the sheath,
External carotid exits the sheath.

62
Q

What are the contents of the carotid sheaths relationships to one another?

A

IJV is anterolateral
ICA/ Common Carotid anteromedial
Vagus posterior and between the 2 vessels.

63
Q

Within the carotid sheath are found the?

A

Common carotid artery, the internal jugular vein, and the vagus nerve

64
Q

Through what pathways do the right and left external carotid arteries anastomose with one another?

A

Branches of the ECA
- Superior thyroid artery
- Lingual artery
- Facial artery.

Each of these branches anastomoses with its counterpart from the contralateral side.

65
Q

What ligament resists hyperextension of the neck and may be sprained with a hyperextension injury?

A

Anterior Longitudinal Ligament

is the primary ligament that resists hyperextension of the neck.

66
Q

What ligaments resist hyperflexion of the neck and may be injured with a hyperflexion injury?

A

PLL, supraspinous ligament, interspinous ligament, ligamentum flavum.

ligaments that resist flexion of the neck

67
Q

What are the characteristics of the 2 parts of an intervertebral disc?

A

The outer part = annulus fibrosus.
(Made of concentric rings of fibrous tissue and fibrocartilage)

Inner portion = nucleus pulposus
(semi gelatinous material with high water content)

68
Q

What is the relationship between the vertebral artery and the cervical vertebrae?

A

Enters the transverse foramen of C6 and then ascends through the transverse foramina of all vertebrae above that level.

After exiting from the foramen in C1- Passes through foramen magnum to cranial cavity

69
Q

Describe the position of the subclavian vein where it may be accessed for central venous catheterization.

A

Passes under the medial 1/3 of the clavicle and over the 1st rib.

It passes anterior to the anterior scalene muscle and surface of the cervical pleura.

Injury to the pleura at this location can cause a pneumothorax.

70
Q

What surface landmark is used to locate the internal jugular vein for central venous catheterization.

A

Triangular gap between - sternal head and the clavicular head of the SCM = internal jugular location

About 5cm above the clavicle.

Year 4 (6 decks)

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