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Head and Neck Anatomy > Lectures 21, 22, 23 & 24 Nose & Paranasal sinuses, pterygopalatine fossa and ganglion > Flashcards

Lectures 21, 22, 23 & 24 Nose & Paranasal sinuses, pterygopalatine fossa and ganglion Flashcards

1
Q

Name the bones on nose septum (medial wall of nasal cavity)

A
  • vomer (posteroinferior)

- ethmoid bone (anterosuperior)

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2
Q

Name the bones on floor, roof and lateral wall of nasal cavity

A
  • Maxilla
  • Palatine bone
  • frontal bone
  • nasal bone
  • ethmoid bone (middle & superior conchae & cribriform plate)
  • sphenoid
  • lacrimal bone
  • Inferior concha
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3
Q

Name the anterior bony opening of the nose

A

Single piriform aperture

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4
Q

T/F single piriform aperture is surrounded by nasal bones below and maxilla medially and above

A

False, nasal bones above, maxillae lateral and below

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5
Q

T/F Posterior bony openings have two choanae separated by bony septum

A

True

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6
Q

List all three cartilages of nose

A
  1. Septal (attached to bony septum)
  2. Lateral (attached to posteriorly to bony lateral walls, superior to alar cartilages
  3. Alar cartilages (curve to form nostril)
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7
Q

Name the three conchae in nose

A
  • Superior
  • Middle
  • Inferior
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8
Q

T/F Superior, middle and inferior meatuses lie below each concha

A

True

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9
Q

Describe superior nasal concha (ethmoid bone)

A

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.

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10
Q

Space posterosuperior to superior concha is _________

A

sphenoethmoidal recess

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11
Q

Middle meatus contains a longitudinal bulge - ______________ with a curved indentation below - _____________ (bulla is formed by middle ethmoid sinus.

A

Ethmoidal bulla, hiatus semilunaris

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12
Q

What is function of conchae?

A

Air movement to trap particles, warm air & possible improve olfaction

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13
Q

List the regions of nasal cavity lined with skin

A

1) Nares - anteroinferior opening onto face

2) Vestibule - space just inside nares

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14
Q

The atrium region of nassal cavity (above vestibule, in front of conchae) is lined with?

A

Non-keratinized stratified squamous epithelium

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15
Q

Which regions of nasal cavity are lined with respiratory epithelium?

A

1) respiratory region - between & including inferior & middle concha
2) choanae (with soft tissue in place - behind conchae & in front of auditory tube)

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16
Q

List regions of nasal cavity lined with olfactory epithelium

A

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

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17
Q

Blood supply to external nose?

A

Facial artery

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18
Q

Motor nerve supply to external nose?

A

Facial nerve

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19
Q

Sensory nerve supply to external nose?

A

Cutaneous branches of trigeminal nerve

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20
Q

Artery supply of nasal cavity

A
  • Branches of ophthalmic & maxillary arteries

- Branch of facial artery supplies vestibule

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21
Q

Vein supply to nasal cavity

A

Accompanying arteries

e.g. ophthalmic vein, facial vein

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22
Q

Where do lymph vessels in nasal cavity drain to?

A
  • Submandibular nodes (anterior nasal cavity & external nose)
  • Retropharyngeal & deep cervical nodes (posterior nose)
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23
Q

Sensory nerve supply to nasal cavity?

A

Trigeminal (ophthalmic & maxillary branches)

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24
Q

T/F sympathetic (vasomotor) & parasympathetic (secretomotor to mucosal glands) accompany sensory nerves

A

True

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25
Q

_______ enters nasal cavity from sphenopalatine foramen, crosses septum within thin mucosa & leaves via the incisive canal

A

Nasopalatine nerve

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26
Q

Describe nasopalatine nerve

A

Arises from the maxillary branch of the trigeminal nerve and travels through the sphenopalatine foramen to the nasal cavity.

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27
Q

T/F nasopalatine nerve supplies mucosa of anterior soft palate, including incisive papilla (over incisive foramen/foramina)

A

False, its hard palate

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28
Q

Describe paranasal sinuses

A
  • 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
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29
Q

Describe sphenoidal sinus

A
  • 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
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30
Q

Sensory innervation of sphenoidal sinus

A

Posterior ethmoid nerve

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31
Q

Describe frontal sinus

A
  • Paired
  • Posterosuperior to superciliary arches & within frontal bone
  • Open into middle meatus via infundibulum
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32
Q

Sensory innervation of frontal sinus

A

Supraorbital nerves

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33
Q

Describe between ethmoidal sinuses/air cells

A
  • 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
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34
Q

Sensory innervation of ethmoidal sinuses/air cells

A

Ethmoidal branches of nasociliary nerve

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35
Q

Sensory innervation of maxillary sinus

A

Infraorbital nerve & superior alveolar nerves

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36
Q

Features of maxillary sinus

A
  • Mostly develops after birth
  • Paired cavities of variable & irregular size & shape
  • Occupy much of the bodies of maxillae
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37
Q

Openings of maxillary sinus

A

1-2 openings (maxillary hiatus) in upper lateral wall drains into middle meatus. Opening is above floor of sinus - poor drainage

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38
Q

Borders of maxillary sinus

A

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
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39
Q

Innervation of maxillary sinus

A
  • Superior alveolar nerves pass down walls either deep to mucosa or in bony channels (sinus canals)
  • Sensory innervation: infraorbital nerve & superior alveolar nerves
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40
Q

T/F nasolacrimal duct opens into middle meatus

A

False, it opens into inferior meatus

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41
Q

T/F Tears drain from surface of eye via lacrimal canaliculi (one per medial corner or eye) into lacrimal sac

A

True

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42
Q

T/F nasolacrimal duct extends from lacrimal sac in lateral corner of eye through lacrimal bone, maxilla and inferior concha

A

False, medial corner of eye

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43
Q

Summary of sinus openings into meatuses

A
  • Sphenoethmoidal recess - sphenoidal sinus
  • Superior meatus - posterior ethmoidal sinus
  • Middle meatus -frontal (middle) and anterior ethmoidal, maxillary sinus
  • Inferior meatus - nasolacrimal duct.
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44
Q

T/F maxillary nerve transmitted via foramen lacerum into pterygopalatine fossa

A

False, foramen rotundum.

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45
Q

Maxillary nerve branch in infraorbital groove?

A

Middle superior alveolar nerve

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46
Q

Maxillary nerve branch in infraorbital canal

A

Anterior superior alveolar nerve

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47
Q

Maxillary nerve branches in pterygopalatine fossa

A
  • Ganglionic
  • Zygomatic/zygomaticoorbital
  • Posterior superior alveolar
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48
Q

Maxillary nerve branch in skull

A

Meningeal branch

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49
Q

T/F Once the maxillary nerve passes through infraorbital canal, name changes to infraorbital nerve

A

True

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50
Q

(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.

A

False, sensory branches and do not synapse in the pterygopalatine ganglion.

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51
Q

T/F zygomaticoorbital nerve usually arises prior to inferior orbital fissure

A

True

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52
Q

T/F zygomaticoorbital branch travels with maxillary nerve and together they enter the orbit via the superior orbital fissure

A

False, inferior orbital fissure

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53
Q

T/F zygomaticoorbital nerve supplies orbital endosteum & fascia

A

False, periosteum.

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54
Q

T/F zygomaticoorbital nerve gives rise to a lacrimal branch

A

True

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55
Q

Zygomaticoorbital nerve supplies orbital periosteum & fascia

A

True

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56
Q

Lacrimal branch carries __________ to the lacrimal gland

A

Facial parasympathetic fibres

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57
Q

Sensory innervation to lacrimal gland is from?

A

Lacrimal branch of the ophthalmic nerve

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58
Q

Zygomatic/zygomaticoorbital branch of maxillary passes to lateral wall of orbit and ultimately divides into cutaneous sensory nerves:

A

Zygomaticofacial and zygomaticotemporal branches. This may happen in orbit or in zygomatic bone

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59
Q

Typically the zygomaticoorbital nerve passes through the __________ on the lateral wall of the orbit

A

Zygomaticoorbital foramen

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60
Q

Once zygomaticoorbital nerve emerges from lateral wall of orbit, it emerges as two branches:

A
  • 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
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61
Q

How many posterior superior alveolar branches are there usually of maxillary nerve?

A

Usually 2

62
Q

Posterior superior alveolar branches enter maxilla via _________ on _____ surface of maxillary tuberosity. Accompanied by branches of the maxillary artery

A

Alveolar canals, posterior

63
Q

Posterior superior alveolar branches pass through anterior wall of maxillary sinus

A

False, posterior wall

64
Q

Posterior superior alveolar branches supply much of the _______ innervation of the maxillary sinus with contributions from _____ & _____ alveolar nerves

A

Sensory, middle, anterior

65
Q

Posterior superior alveolar branches supply ?

A
  • Molars
  • Adjacent buccal gingiva
  • Buccal mucosa
66
Q

After entering orbit through the inferior orbital fissure, infraorbital/maxillary nerve passes across floor of orbit, along the ____________ & into the ___________.

A

Infraorbital groove, infraorbital canal

67
Q

What type of nerve does infraorbital nerve emerge as from infraorbital foramen, initially deep to orbicularis oculi

A

Sensory cutaneous nerve

68
Q

Infraorbital nerve supplies sensory fibres to anterior face from ________ to _______ & _____.

A

Lower eyelid, upper lip, side of nose

69
Q

Middle superior alveolar nerve enter maxilla from infraorbital nerve in _______.

A

Infraorbital groove

70
Q

T/F Middle superior alveolar nerve passes through mucosa on medial wall of maxillary sinus

A

False, lateral wall.

71
Q

Middle superior alveolar nerves are always present

A

True

72
Q

Which teeth do middle superior alveolar nerves supply?

A

Premolars, if middle superior alveolar nerves are missing, the premolars are supplied by posterosuperior alveolar nerve.

73
Q

Middle superior alveolar nerves supply adjacent labial gingiva & mucosa if present

A

True

74
Q

Anterior superior alveolar nerve enter maxilla from infraorbital nerve’s ______

A

infraorbital canal

75
Q

T/F anterior superior alveolar nerves passes through mucosa of middle wall of maxillary sinus

A

False, anterior wall

76
Q

Which teeth do anterior superior alveolar nerves supply?

A

Incisors and canines and adjacent labial gingiva and mucosa

77
Q

What does the pterygopalatine fossa contain?

A
  • Pterygopalatine ganglion
  • Maxillary nerve
  • Maxillary artery
  • Fatty fascia
78
Q

Pterygopalatine ganglion is one of the ________ ganglia of the ______ nerve.

A

Parasympathetic, facial

79
Q

Parasympathetic fibres are the only ones which synapse in the pterygopalatine ganglion.

A

True

80
Q

Sympathetic and sensory fibres pass through pterygopalatine ganglion without synapsing

A

True

81
Q

________ enters pterygopalatine fossa from foramen rotundum and leaves via inferior orbital fissure.

A

Maxillary nerve

82
Q

__________ - 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.

A

Maxillary artery

83
Q

Opening from middle cranial fossa, passage of maxillary nerve into fossa?

A

Foramen rotundum

84
Q

T/F Maxillary nerve collects most of the motor fibres travelling in branches of the pterygopalatine ganglion

A

False, sensory fibres

85
Q

Opening into pterygopalatine fossa posteriorly carrying nerve of pterygoid canal

A

Pterygoid canal

86
Q

____________ - opens into orbit, transmits maxillary & zygomatico-orbital nerve to orbit

A

Inferior orbital fissure

87
Q

_____________ - opens into lateral wall of the nasal cavity at the level of & just posterior to the middle concha. Transmits nasopalatine nerve

A

Sphenopalatine foramen

88
Q

________________ - open onto posterior hard palate & carry greater & lesser nerves

A

Greater & lesser palatine foramina

89
Q

_______ - tiny, transmits nerve & artery to roof of pharynx

A

Palatopharyngeal (palatovaginal) canal

90
Q

T/F Roots of the pterygopalatine ganglion are parasympathetic, sympathetic and sensory

A

True

91
Q

Parasympathetic root: ______ from facial nerve to nerve of the pterygoid canal

A

Greater petrosal nerve

92
Q

Sympathetic root: _______ from internal carotid sympathetic plexus. Joins greater petrosal nerve to form nerve of pterygoid canal.

A

Deep petrosal nerve

93
Q

T/F sympathetic greater petrosal nerve leaves facial nerve at geniculate ganglion.

A

False, parasympathetic greater petrosal nerve

94
Q

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.

A

False, it’s deep to trigeminal ganglion and down into foramen lacerum.

95
Q

T/F - greater petrosal nerve emerges from foramen lacerum and passes to pterygoid canal along with or incorporating sympathetic fibres of deep petrosal nerve

A

True

96
Q

T/F deep petrosal nerve is derived from internal carotid plexus

A

True

97
Q

T/F lacrimal branches enter orbit in zygomaticoorbital nerve & are transferred to the lacrimal branch of the opthalmic nerve

A

True

98
Q

List the nerves that supply the nasal septum

A
  • Anterior ethmoid nerve
  • Greater palatine nerve
  • Nasopalatine nerve
99
Q

List the nerves that supply the nasal lateral wall

A
  • Anterior ethmoid nerve
  • Sphenopalatine nerve from the pterygopalatine ganglion pass through sphenopalatine foramen
  • Greater palatine nerve
100
Q

Pharyngeal branches arise from posterior ganglion & pass through palatopharyngeal canal to supply mucosa of nasopharynx

A

True

101
Q

T/F Greater and lesser palatine nerves descend from the ganglion initially both in lesser palatine canal

A

False, greater palatine canal

102
Q

T/F Greater palatine canal emerges through greater palatine foramen & runs in hard palate just medial to alveolar arch.

A

True

103
Q

Greater palatine canal communicates with _______

A

nasopalatine nerve

104
Q

Lesser palatine nerve diverges from the greater palatine nerve in the palatine canal & passes through the lesser palatine canal to supply the hard palate

A

False, soft palate.

105
Q

Where is the ciliary ganglion located and which cranial nerve is supplying it?

A
  • In orbit, near optic nerve

- Oculomotor supplies preganglionic nerves and parasympathetic fibres to nasociliary branch of ophthalmic nerve

106
Q

Location and cranial nerve supplying preganglionic fibres of pterygopalatine ganglion

A
  • In pterygopalatine fossa

- Facial nerve via greater petrosal nerve & nerve of pterygoid canal

107
Q

Location and cranial nerve supplying preganglionic fibres of submandibular ganglion

A
  • Adjacent to submandibular salivary gland

- Facial via chorda tympani - hitch-hikes on lingual branch of mandibular nerve

108
Q

Location and cranial nerve supplying preganglionic fibres of otic ganglion

A
  • Just below foramen ovale

- Glossopharyngeal nerve via lesser petrosal nerve

109
Q

Location of vagal ganglia

A

Thorax and abdomen

110
Q

________ goes from choana to tip of soft palate

A

Nasopharynx

111
Q

Features of nasopharynx

A
  • 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.
112
Q

Where is pharangeal isthmus located?

A
  • Between nasopharynx & oropharynx
113
Q

Pharyngeal isthmus is open during swallowing by soft palate

A

False, it is closed

114
Q

________ - tip of soft palate to tip of epiglottis

A

Oropharynx

115
Q

Features of oropharynx

A
  • palatine tonsils in tonsilar fossa
  • palatopharyngeal fold/muscle
  • pharyngeal part of tongue
  • valleculae, medial & lateral glossoepiglottic folds
116
Q

________ - tip of epiglottis to top of trachea

A

Laryngopharynx

117
Q

Features of laryngopharynx

A
  • Laryngeal inlet is in anterior wall

- Piriform fossae are on either side of larynx

118
Q

Type of epithelium in nasopharynx?

A

Respiratory epithelium

119
Q

Type of epithelium in oro- & laryngopharynx

A

Non-keratinized stratified squamous

120
Q

T/F there is no fibrous layer between mucosa & muscle.

A

False, there is

121
Q

T/F Fibrous layer thickens above superior constrictor to form pharyngobasilar fascia

A

True

122
Q

Where does pharyngobasilar fascia attach to?

A

Base of skull & pterygomandibular raphe

123
Q

What does pharyngobasilar fascia extend posteriorly into?

A

Pharyngeal raphe

124
Q

T/F buccopharyngeal fascia is internal to muscle, blends with pretracheal layer of deep cervical fascia.

A

False, external to muscle

125
Q

Name the pharyngeal muscles

A

Superior, middle and inferior constrictors blended with:

  • Stylopharyngeus
  • Salpingopharyngeus
  • Palatopharyngeus
126
Q

Describe pharyngeal constrictor muscles

A
  • 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
127
Q

Origin of superior constrictor?

A
  • Medial pterygoid plate (hamulus & posterior margin of medial pterygoid plate)
  • Pterygomandibular raphe (which is also posterior attachment of buccinator)
128
Q

Insertion of superior constrictor

A
  • Median pharyngeal raphe
  • Base of skull - at pharyngeal tubercle in midline, via pharyngobasilar fascia lateral to tubercle
  • Palatopharyngeal sphincter
129
Q

What is the palatopharyngeal sphincter?

A

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

130
Q

Landmarks of superior constrictor muscle

A

Above - pharyngobasilar fascia, levator & tensor palati.

131
Q

How is superior constrictor separated from middle constrictor muscle?

A

Separated inferiorly from middle constrictor by stylopharangeus muscle & glossopharyngeal nerve

132
Q

Origin of middle constrictor muscle

A
  • Horns of hyoid

- Stylohyoid ligament

133
Q

Insertion of middle constrictor muscle

A

Median raphe

134
Q

Landmarks of middle constrictor muscle

A

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.

135
Q

Origin of inferior constrictor muscle

A

Cricoid & thyroid cartilages of larynx

136
Q

Insertion of inferior constrictor muscle

A

Median pharyngeal raphe

137
Q

Landmarks of inferior constrictor muscle

A

Pierced by external branch of superior laryngeal nerve

138
Q

T/F Recurrent laryngeal nerve & inferior laryngeal artery pass under lower border of inferior constrictor muscle

A

True

139
Q

T/F Inferior laryngeal artery is a branch of the thyrocervical trunk arising from subclavian artery

A

True

140
Q

List two parts of inferior constrictor muscle

A
  • upper thyropharyngeus - propulsive

- lower cricopharyngeus - sphincter

141
Q

T/F Nerve supply of pharynx is mostly pharyngeal plexus which is made up of glossopharyngeal & vagus & sympathetic trunk

A

True

142
Q

Inferior constrictor muscle is innervated by?

A

External & recurrent laryngeal nerves

143
Q

Location of glossopharyngeal nerve

A

Passes between the superior & middle pharyngeal constrictors with stylopharyngeus muscle

144
Q

Where does glossopharyngeal nerve leave the skull?

A

Jugular foramen

145
Q

Glossopharyngeal nerve is _____ to stylopharyngeus

A

Motor

146
Q

Glossopharyngeal nerve is ________ and _____ to parotid gland.

A

Parasympathetic, secremotor

147
Q

Glossopharyngeal nerve is sensory to which regions?

A

Regions associated with pharynx & tongue

  • Tympanic cavity
  • naso- & oropharynx
  • Inferior soft palate
  • Posterior third of tongue
  • Vallate taste buds
148
Q

Otic ganglion is the sympathetic ganglion of glossopharyngeal nerve.

A

Parasympathetic ganglion

149
Q

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.

A

False, they are just posterior

150
Q

How do parasympathetic fibres from the glossopharyngeal nerve reach the otic ganglion?

A

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.

151
Q

What does the tympanic nerve’s branches supply?

A
  • 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)
152
Q

Otic ganglion sends several small parasympathetic branches to the adjacent auriculotemporal nerve that delivers them to the parotid.

A

True

Head and Neck Anatomy (13 decks)

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