Lectures 21, 22, 23 & 24 Nose & Paranasal sinuses, pterygopalatine fossa and ganglion Flashcards
Name the bones on nose septum (medial wall of nasal cavity)
- vomer (posteroinferior)
- ethmoid bone (anterosuperior)
Name the bones on floor, roof and lateral wall of nasal cavity
- Maxilla
- Palatine bone
- frontal bone
- nasal bone
- ethmoid bone (middle & superior conchae & cribriform plate)
- sphenoid
- lacrimal bone
- Inferior concha
Name the anterior bony opening of the nose
Single piriform aperture
T/F single piriform aperture is surrounded by nasal bones below and maxilla medially and above
False, nasal bones above, maxillae lateral and below
T/F Posterior bony openings have two choanae separated by bony septum
True
List all three cartilages of nose
- Septal (attached to bony septum)
- Lateral (attached to posteriorly to bony lateral walls, superior to alar cartilages
- Alar cartilages (curve to form nostril)
Name the three conchae in nose
- Superior
- Middle
- Inferior
T/F Superior, middle and inferior meatuses lie below each concha
True
Describe superior nasal concha (ethmoid bone)
Superior nasal concha are the uppermost spongy, bony plates which project from the lateral wall of the nasal cavity, separating the superior meatus from the sphenoethmoidal recess.
Space posterosuperior to superior concha is _________
sphenoethmoidal recess
Middle meatus contains a longitudinal bulge - ______________ with a curved indentation below - _____________ (bulla is formed by middle ethmoid sinus.
Ethmoidal bulla, hiatus semilunaris
What is function of conchae?
Air movement to trap particles, warm air & possible improve olfaction
List the regions of nasal cavity lined with skin
1) Nares - anteroinferior opening onto face
2) Vestibule - space just inside nares
The atrium region of nassal cavity (above vestibule, in front of conchae) is lined with?
Non-keratinized stratified squamous epithelium
Which regions of nasal cavity are lined with respiratory epithelium?
1) respiratory region - between & including inferior & middle concha
2) choanae (with soft tissue in place - behind conchae & in front of auditory tube)
List regions of nasal cavity lined with olfactory epithelium
Generally in human adults, located over superior concha, upper septum, roof over upper septum.
Olfactory axons from olfactory mucosa pass through the cribriform plate of ethmoid to olfactory bulb & tract
Blood supply to external nose?
Facial artery
Motor nerve supply to external nose?
Facial nerve
Sensory nerve supply to external nose?
Cutaneous branches of trigeminal nerve
Artery supply of nasal cavity
- Branches of ophthalmic & maxillary arteries
- Branch of facial artery supplies vestibule
Vein supply to nasal cavity
Accompanying arteries
e.g. ophthalmic vein, facial vein
Where do lymph vessels in nasal cavity drain to?
- Submandibular nodes (anterior nasal cavity & external nose)
- Retropharyngeal & deep cervical nodes (posterior nose)
Sensory nerve supply to nasal cavity?
Trigeminal (ophthalmic & maxillary branches)
T/F sympathetic (vasomotor) & parasympathetic (secretomotor to mucosal glands) accompany sensory nerves
True
_______ enters nasal cavity from sphenopalatine foramen, crosses septum within thin mucosa & leaves via the incisive canal
Nasopalatine nerve
Describe nasopalatine nerve
Arises from the maxillary branch of the trigeminal nerve and travels through the sphenopalatine foramen to the nasal cavity.
T/F nasopalatine nerve supplies mucosa of anterior soft palate, including incisive papilla (over incisive foramen/foramina)
False, its hard palate
Describe paranasal sinuses
- Function uncertain - vocal resonance??, reduction in bone mass??
- All paired
- There is septa dividing equivalent sinuses
- Lined with respiratory mucosa
- Develop as diverticulae (outgrowths from nasal cavity
Describe sphenoidal sinus
- Paired spaces in sphenoid bone - these are posterosuperior to upper nasal cavity
- Close relationship to internal carotid, pituitary, cavernous sinus, optic nerves
- Open into spheno-ethmoidal recess
Sensory innervation of sphenoidal sinus
Posterior ethmoid nerve
Describe frontal sinus
- Paired
- Posterosuperior to superciliary arches & within frontal bone
- Open into middle meatus via infundibulum
Sensory innervation of frontal sinus
Supraorbital nerves
Describe between ethmoidal sinuses/air cells
- Between upper nasal cavity & orbit
- Variable in number & size
- Divided into 2 groups - posterior and anterior
- Posterior opens into superior meatus, anterior into middle meatus via between frontal & maxillary openings
Sensory innervation of ethmoidal sinuses/air cells
Ethmoidal branches of nasociliary nerve
Sensory innervation of maxillary sinus
Infraorbital nerve & superior alveolar nerves
Features of maxillary sinus
- Mostly develops after birth
- Paired cavities of variable & irregular size & shape
- Occupy much of the bodies of maxillae
Openings of maxillary sinus
1-2 openings (maxillary hiatus) in upper lateral wall drains into middle meatus. Opening is above floor of sinus - poor drainage
Borders of maxillary sinus
Roof is floor of orbit & may be ridged by infraorbital canal.
Floor is maxillary alveolar process. Maxillary sinus overlies roots of the first & second molars which often form conical elevations on the floor of the sinus.
Some cases have conical elevations which can be recognised overlying premolars or occasionally canines. Roots may project into and even perforate bony sinus wall.
- Posterior wall anterior to pterygopalatine fossa
Innervation of maxillary sinus
- Superior alveolar nerves pass down walls either deep to mucosa or in bony channels (sinus canals)
- Sensory innervation: infraorbital nerve & superior alveolar nerves
T/F nasolacrimal duct opens into middle meatus
False, it opens into inferior meatus
T/F Tears drain from surface of eye via lacrimal canaliculi (one per medial corner or eye) into lacrimal sac
True
T/F nasolacrimal duct extends from lacrimal sac in lateral corner of eye through lacrimal bone, maxilla and inferior concha
False, medial corner of eye
Summary of sinus openings into meatuses
- Sphenoethmoidal recess - sphenoidal sinus
- Superior meatus - posterior ethmoidal sinus
- Middle meatus -frontal (middle) and anterior ethmoidal, maxillary sinus
- Inferior meatus - nasolacrimal duct.
T/F maxillary nerve transmitted via foramen lacerum into pterygopalatine fossa
False, foramen rotundum.
Maxillary nerve branch in infraorbital groove?
Middle superior alveolar nerve
Maxillary nerve branch in infraorbital canal
Anterior superior alveolar nerve
Maxillary nerve branches in pterygopalatine fossa
- Ganglionic
- Zygomatic/zygomaticoorbital
- Posterior superior alveolar
Maxillary nerve branch in skull
Meningeal branch
T/F Once the maxillary nerve passes through infraorbital canal, name changes to infraorbital nerve
True
(Maxillary nerve) Ganglion branches are motor branches which pass through and synapse in the pterygopalatine ganglion. These motor fibres travel with branches of the pterygopalatine ganglion.
False, sensory branches and do not synapse in the pterygopalatine ganglion.
T/F zygomaticoorbital nerve usually arises prior to inferior orbital fissure
True
T/F zygomaticoorbital branch travels with maxillary nerve and together they enter the orbit via the superior orbital fissure
False, inferior orbital fissure
T/F zygomaticoorbital nerve supplies orbital endosteum & fascia
False, periosteum.
T/F zygomaticoorbital nerve gives rise to a lacrimal branch
True
Zygomaticoorbital nerve supplies orbital periosteum & fascia
True
Lacrimal branch carries __________ to the lacrimal gland
Facial parasympathetic fibres
Sensory innervation to lacrimal gland is from?
Lacrimal branch of the ophthalmic nerve
Zygomatic/zygomaticoorbital branch of maxillary passes to lateral wall of orbit and ultimately divides into cutaneous sensory nerves:
Zygomaticofacial and zygomaticotemporal branches. This may happen in orbit or in zygomatic bone
Typically the zygomaticoorbital nerve passes through the __________ on the lateral wall of the orbit
Zygomaticoorbital foramen
Once zygomaticoorbital nerve emerges from lateral wall of orbit, it emerges as two branches:
- Zygomaticofacial (canal opens on lateral surface of z ygomatic bone)
- Zygomaticotemporal which emerges from a canal of the same name on the medial or temporal surface of the zygomer
How many posterior superior alveolar branches are there usually of maxillary nerve?
Usually 2
Posterior superior alveolar branches enter maxilla via _________ on _____ surface of maxillary tuberosity. Accompanied by branches of the maxillary artery
Alveolar canals, posterior
Posterior superior alveolar branches pass through anterior wall of maxillary sinus
False, posterior wall
Posterior superior alveolar branches supply much of the _______ innervation of the maxillary sinus with contributions from _____ & _____ alveolar nerves
Sensory, middle, anterior
Posterior superior alveolar branches supply ?
- Molars
- Adjacent buccal gingiva
- Buccal mucosa
After entering orbit through the inferior orbital fissure, infraorbital/maxillary nerve passes across floor of orbit, along the ____________ & into the ___________.
Infraorbital groove, infraorbital canal
What type of nerve does infraorbital nerve emerge as from infraorbital foramen, initially deep to orbicularis oculi
Sensory cutaneous nerve
Infraorbital nerve supplies sensory fibres to anterior face from ________ to _______ & _____.
Lower eyelid, upper lip, side of nose
Middle superior alveolar nerve enter maxilla from infraorbital nerve in _______.
Infraorbital groove
T/F Middle superior alveolar nerve passes through mucosa on medial wall of maxillary sinus
False, lateral wall.
Middle superior alveolar nerves are always present
True
Which teeth do middle superior alveolar nerves supply?
Premolars, if middle superior alveolar nerves are missing, the premolars are supplied by posterosuperior alveolar nerve.
Middle superior alveolar nerves supply adjacent labial gingiva & mucosa if present
True
Anterior superior alveolar nerve enter maxilla from infraorbital nerve’s ______
infraorbital canal
T/F anterior superior alveolar nerves passes through mucosa of middle wall of maxillary sinus
False, anterior wall
Which teeth do anterior superior alveolar nerves supply?
Incisors and canines and adjacent labial gingiva and mucosa
What does the pterygopalatine fossa contain?
- Pterygopalatine ganglion
- Maxillary nerve
- Maxillary artery
- Fatty fascia
Pterygopalatine ganglion is one of the ________ ganglia of the ______ nerve.
Parasympathetic, facial
Parasympathetic fibres are the only ones which synapse in the pterygopalatine ganglion.
True
Sympathetic and sensory fibres pass through pterygopalatine ganglion without synapsing
True
________ enters pterygopalatine fossa from foramen rotundum and leaves via inferior orbital fissure.
Maxillary nerve
__________ - enters pterygopalatine fossa after passing medial or lateral to lateral pterygoid. Small veins drain into the pterygoid venous plexus, lymph drains into superficial & deep cervical nodes.
Maxillary artery
Opening from middle cranial fossa, passage of maxillary nerve into fossa?
Foramen rotundum
T/F Maxillary nerve collects most of the motor fibres travelling in branches of the pterygopalatine ganglion
False, sensory fibres
Opening into pterygopalatine fossa posteriorly carrying nerve of pterygoid canal
Pterygoid canal
____________ - opens into orbit, transmits maxillary & zygomatico-orbital nerve to orbit
Inferior orbital fissure
_____________ - opens into lateral wall of the nasal cavity at the level of & just posterior to the middle concha. Transmits nasopalatine nerve
Sphenopalatine foramen
________________ - open onto posterior hard palate & carry greater & lesser nerves
Greater & lesser palatine foramina
_______ - tiny, transmits nerve & artery to roof of pharynx
Palatopharyngeal (palatovaginal) canal
T/F Roots of the pterygopalatine ganglion are parasympathetic, sympathetic and sensory
True
Parasympathetic root: ______ from facial nerve to nerve of the pterygoid canal
Greater petrosal nerve
Sympathetic root: _______ from internal carotid sympathetic plexus. Joins greater petrosal nerve to form nerve of pterygoid canal.
Deep petrosal nerve
T/F sympathetic greater petrosal nerve leaves facial nerve at geniculate ganglion.
False, parasympathetic greater petrosal nerve
T/F greater petrosal nerve passes to facial hiatus on floor of anterior petrous temporal bone (in middle cranial fossa), across floor of middle cranial fossa superficial to trigeminal ganglion & then down into foramen spinosum.
False, it’s deep to trigeminal ganglion and down into foramen lacerum.
T/F - greater petrosal nerve emerges from foramen lacerum and passes to pterygoid canal along with or incorporating sympathetic fibres of deep petrosal nerve
True
T/F deep petrosal nerve is derived from internal carotid plexus
True
T/F lacrimal branches enter orbit in zygomaticoorbital nerve & are transferred to the lacrimal branch of the opthalmic nerve
True
List the nerves that supply the nasal septum
- Anterior ethmoid nerve
- Greater palatine nerve
- Nasopalatine nerve
List the nerves that supply the nasal lateral wall
- Anterior ethmoid nerve
- Sphenopalatine nerve from the pterygopalatine ganglion pass through sphenopalatine foramen
- Greater palatine nerve
Pharyngeal branches arise from posterior ganglion & pass through palatopharyngeal canal to supply mucosa of nasopharynx
True
T/F Greater and lesser palatine nerves descend from the ganglion initially both in lesser palatine canal
False, greater palatine canal
T/F Greater palatine canal emerges through greater palatine foramen & runs in hard palate just medial to alveolar arch.
True
Greater palatine canal communicates with _______
nasopalatine nerve
Lesser palatine nerve diverges from the greater palatine nerve in the palatine canal & passes through the lesser palatine canal to supply the hard palate
False, soft palate.
Where is the ciliary ganglion located and which cranial nerve is supplying it?
- In orbit, near optic nerve
- Oculomotor supplies preganglionic nerves and parasympathetic fibres to nasociliary branch of ophthalmic nerve
Location and cranial nerve supplying preganglionic fibres of pterygopalatine ganglion
- In pterygopalatine fossa
- Facial nerve via greater petrosal nerve & nerve of pterygoid canal
Location and cranial nerve supplying preganglionic fibres of submandibular ganglion
- Adjacent to submandibular salivary gland
- Facial via chorda tympani - hitch-hikes on lingual branch of mandibular nerve
Location and cranial nerve supplying preganglionic fibres of otic ganglion
- Just below foramen ovale
- Glossopharyngeal nerve via lesser petrosal nerve
Location of vagal ganglia
Thorax and abdomen
________ goes from choana to tip of soft palate
Nasopharynx
Features of nasopharynx
- Paired openings of auditory tubes each surrounded by tubal elevation extending down into salpingopharangeal fold
- Pharangeal tonsil (adenoid) on roof & posterior wall above opening of auditory tube
- Inferior to body of sphenoid & anterior to pharyngobasilar fascia & superior constrictor.
Where is pharangeal isthmus located?
- Between nasopharynx & oropharynx
Pharyngeal isthmus is open during swallowing by soft palate
False, it is closed
________ - tip of soft palate to tip of epiglottis
Oropharynx
Features of oropharynx
- palatine tonsils in tonsilar fossa
- palatopharyngeal fold/muscle
- pharyngeal part of tongue
- valleculae, medial & lateral glossoepiglottic folds
________ - tip of epiglottis to top of trachea
Laryngopharynx
Features of laryngopharynx
- Laryngeal inlet is in anterior wall
- Piriform fossae are on either side of larynx
Type of epithelium in nasopharynx?
Respiratory epithelium
Type of epithelium in oro- & laryngopharynx
Non-keratinized stratified squamous
T/F there is no fibrous layer between mucosa & muscle.
False, there is
T/F Fibrous layer thickens above superior constrictor to form pharyngobasilar fascia
True
Where does pharyngobasilar fascia attach to?
Base of skull & pterygomandibular raphe
What does pharyngobasilar fascia extend posteriorly into?
Pharyngeal raphe
T/F buccopharyngeal fascia is internal to muscle, blends with pretracheal layer of deep cervical fascia.
False, external to muscle
Name the pharyngeal muscles
Superior, middle and inferior constrictors blended with:
- Stylopharyngeus
- Salpingopharyngeus
- Palatopharyngeus
Describe pharyngeal constrictor muscles
- Striated muscle
- Constrictors overlap from below
- Form posterolateral wall of all three regions of pharynx
- Constrictors are paired and join in the posterior midline at the median pharyngeal raphe
Origin of superior constrictor?
- Medial pterygoid plate (hamulus & posterior margin of medial pterygoid plate)
- Pterygomandibular raphe (which is also posterior attachment of buccinator)
Insertion of superior constrictor
- Median pharyngeal raphe
- Base of skull - at pharyngeal tubercle in midline, via pharyngobasilar fascia lateral to tubercle
- Palatopharyngeal sphincter
What is the palatopharyngeal sphincter?
Band of muscle extending from palatal aponeurosis to blend posteriorly with upper border of superior constrictor (lateral to levator palati). Forms a ridge on pharyngeal ridge when soft palate is elevated
Landmarks of superior constrictor muscle
Above - pharyngobasilar fascia, levator & tensor palati.
How is superior constrictor separated from middle constrictor muscle?
Separated inferiorly from middle constrictor by stylopharangeus muscle & glossopharyngeal nerve
Origin of middle constrictor muscle
- Horns of hyoid
- Stylohyoid ligament
Insertion of middle constrictor muscle
Median raphe
Landmarks of middle constrictor muscle
Superior laryngeal nerve & artery cross middle constrictor - internal branch of nerve passes through thyrohyoid membrane. External branch partly supplies inferior constrictor & cricothyroid muscle of larynx.
Origin of inferior constrictor muscle
Cricoid & thyroid cartilages of larynx
Insertion of inferior constrictor muscle
Median pharyngeal raphe
Landmarks of inferior constrictor muscle
Pierced by external branch of superior laryngeal nerve
T/F Recurrent laryngeal nerve & inferior laryngeal artery pass under lower border of inferior constrictor muscle
True
T/F Inferior laryngeal artery is a branch of the thyrocervical trunk arising from subclavian artery
True
List two parts of inferior constrictor muscle
- upper thyropharyngeus - propulsive
- lower cricopharyngeus - sphincter
T/F Nerve supply of pharynx is mostly pharyngeal plexus which is made up of glossopharyngeal & vagus & sympathetic trunk
True
Inferior constrictor muscle is innervated by?
External & recurrent laryngeal nerves
Location of glossopharyngeal nerve
Passes between the superior & middle pharyngeal constrictors with stylopharyngeus muscle
Where does glossopharyngeal nerve leave the skull?
Jugular foramen
Glossopharyngeal nerve is _____ to stylopharyngeus
Motor
Glossopharyngeal nerve is ________ and _____ to parotid gland.
Parasympathetic, secremotor
Glossopharyngeal nerve is sensory to which regions?
Regions associated with pharynx & tongue
- Tympanic cavity
- naso- & oropharynx
- Inferior soft palate
- Posterior third of tongue
- Vallate taste buds
Otic ganglion is the sympathetic ganglion of glossopharyngeal nerve.
Parasympathetic ganglion
T/F otic ganglion is some distance from glossopharyngeal nerve & actually just anterior to the trunk of the mandibular nerve after it emerges from foramen ovale.
False, they are just posterior
How do parasympathetic fibres from the glossopharyngeal nerve reach the otic ganglion?
Glossopharyngeal nerve gives off tympanic branch that enters the skull via a small opening called the canaliculus for tympanic nerve - between carotid canal & jugular foramen.
What does the tympanic nerve’s branches supply?
- Mucosa of middle ear, auditory tube & mastoid air cells
- ## Lesser petrosal branch passes through bone, onto floor of middle cranial fossa into foramen ovale to synapse on the otic ganglion (or via its own canal - canaliculus innominatus)
Otic ganglion sends several small parasympathetic branches to the adjacent auriculotemporal nerve that delivers them to the parotid.
True
