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Anatomy > Module 2.2 > Flashcards

Module 2.2 Flashcards

1
Q

skeleton of the head

A

Cranium (Skull)

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2
Q

2 Parts of the Cranium

A
  1. Neurocranium

2. Viscerocranium

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3
Q
  • Cranial vault
  • Is the bony case of the brain plus the cranial meninges, proximal parts of cranial nerves and vasculature of the brain
  • encloses and protects the brain
A

Neurocranium

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4
Q

The neurocranium is formed by a series of 8 bones namely:

A
    • Sphenoidal
    • Temporal (2sets)
    • Occipital
    • Parietal (2 sets)
    • Frontal
    • Ethmoidal
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5
Q

The neurocranium is made up of:

A
  1. Calvaria or Skull Cap

2. Cranial Base or Basicranium

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6
Q

a dome like roof called the ___

A

calvaria or skullcap

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7
Q

a floor or cranial base called the ___

A

basicranium

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8
Q
  • facial skeleton
  • forms the anterior part of the cranium
  • consists of bones surrounding the orbits, nose and mouth
A

Viscerocranium

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9
Q

Viscerocranium is consists of 15 irregular bones namely

A 
A. 3 singular bones
-- Mandible
-- Ethmoid
-- Vomer
B. 6 bones as bilateral pairs
-- Lacrimal
-- Inferior nasal conchae
-- Maxillae
-- Palatine
-- Nasal
-- Zygomatic
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10
Q

In the anatomic position the inferior margin of the orbit and superior margin of the external acoustic meatus lie in the same horizontal plane

A

Orbitomeatal Plane or The Frankfort Horizontal Plane

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11
Q

Development of Cranium

A
    • bones of calvaria and cranial base develop by INTRAMEMBRANOUS OSSIFICATION and by ENDOCHONDRAL OSSIFICATION
    • at birth the bones of the calvaria are SMOOTH AND UNILAMINAR
    • disproportionately large; frontal and parietal eminences are prominent
    • facial aspect is small compared to calvaria
    • INCREASE IN SIZE OF CALVARIA is GREATEST during the FIRST 2 YRS. due to rapid brain development.
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12
Q

Development of Cranium

A
    • AT BIRTH the Frontal Bones consists of TWO HALVES; UNION begins in the 2ND YR.
    • halves of frontal bone are separated by frontal suture; obliterated by the 8th yr.
    • FRONTAL AND PARIETAL BONES ARE separated by the CORONAL SUTURE
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13
Q
    • remnant of frontal suture that persists
    • in the middle of the glabella
    • 8% of people
    • must not be interpreted as fracture in radiograph
A

Metopic Suture

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14
Q

Development of Cranium

A
    • intermaxillary suture separates the maxillae
  • -mandibular symphysis separates the mandible; halves of the mandible fuse early in the 2nd yr.
    • obliteration of sutures begin bet. ages 30 and 40 years on the internal surface and 10 years later on the external surface
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15
Q

Development of Cranium

A
    • no mastoid and styloid process in newborn; facial nerves are close to the surface and can be injured by forceps delivery
    • mastoid process forms during the 1st yr; SCM pulls on the petromastoid parts of temporal bones
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16
Q
  • diamond or star-shaped
  • bounded by frontal bone anteriorly and parietal bone posteriorly
  • 18 mos. no longer palpable
  • future site of bregma
A

Anterior Fontanelle

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17
Q
  • triangular
  • bounded by parietal bones anteriorly and occipital bone posteriorly
  • at junction of lambdoid and sagittal sutures; future site of lambda
  • no longer palpable at the end of 1st yr.
A

Posterior Fontanelle

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18
Q
  • temporal muscle overlies these fontanelles

- fuse during infancy

A

Sphenoid and Mastoid Fontanelles

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19
Q

palpation of fontanelles enables the physician to determine the:

A
    • progress of growth of frontal and parietal bones
    • degree of hydration (depressed fontanelle means dehydration)
    • level of intracranial pressure (bulging means increased pressure)
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20
Q

Rapid Growth of Face

A
    • coincides with the eruption of deciduous teeth
    • dento-alveolar development of the alveolar bone
    • associated with the increase in size of paranasal sinuses
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21
Q
    • premature closure of cranial sutures
    • 1 per 2000 births; unknown cause/genetic
    • more common in males usually does not affect brain development
A

Primary Craniosynostosis

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22
Q
    • premature closure of sagittal suture
    • anterior fontanelle is small or absent
    • long, narrow wedge-shaped cranium
A

Scaphocephaly

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23
Q
    • premature closure of the coronal or lambdoid suture on one side only
    • cranium is twisted and asymetrical
A

Plagiocephaly

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24
Q
    • premature closure of the coronal suture
    • high tower-like cranium
    • more common in females
A

Oxycephaly/Turricephaly

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25
Q

The anterior aspect of the cranium consists of:

A
    • Frontal Bone
  • -Orbits
    • Nasal Region
    • Zygomatic Bone
    • Maxillae
    • Mandible
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26
Q
    • squamous (flat)part
    • forms the skeleton of the forehead
    • articulates with nasal and zygomatic bones inferiorly
    • articulates with lacrimal, ethmoid and sphenoids
A

Frontal Bone

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27
Q

Part of the Frontal Bone

A
    • the intersection of the frontal and nasal bones is the NASION
    • the GLABELLA IS the smooth prominence superior to the root of the nose
    • SUPRAORBITAL MARGIN is the angular boundary between the squamous and orbital parts
    • SUPRAORBITAL FORAMEN at the supraorbital margin; for passage of supra-orbital nerve and vessels
    • the SUPERCILIARY ARCH is a prominent ridge superior to the supraorbital margin and deep to the eyebrows; extends laterally on each side from the glabella
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28
Q
    • a blow to the sharp bony ridges may lacerate the skin and cause bleeding
    • blood may accumulate in the superior eyelid and around the eye- black eye
A

Injury to Superciliary Arches

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29
Q
    • bilateral bony cavities
    • resemble quadrangular pyramids
    • contain and protect the eyeball and accessory visual structures
A

Orbits

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30
Q

Parts of the Orbits

A
    • SUPERIOR WALL (ROOF) -orbital part of horizontal bone; lesser wing of sphenoid
    • MEDIAL WALL - orbital plate of ethmoid; plus frontal process of maxilla, lacrimal and sphenoid bones
    • LATERAL WALL -frontal process of zygomatic bone; greater wing of sphenoid
    • INFERIOR WALL (ORBITAL FLOOR) - maxilla and partly by zygomatic and palatine bones; demarcated from the lateral wall by the inferior orbital fissure
    • FOSSA FOR THE LACRIMAL GLAND is the shallow depression in the orbital part of the frontal bone
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31
Q
    • cheek bones or malar bones; form prominences of cheeks
    • lie on inferolateral sides of orbits and rests on maxillaearticulates with the frontal, sphenoid, maxillae and temporal bones
A

Zygomatic Bone

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32
Q
    • pierces the lateral aspect of the zygomatic bones

- - passage of zygomaticofacial nerve and vessels

A

zygomaticofacial foramen

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33
Q

Part of Nasal Region

A

PIRIFORM APERTURE - pear-shaped anterior nasal opening in the cranium; inferior to the nasal bones
NASAL SEPTUM -divides the nasal cavity into right and left parts
NASAL CONCHAE -curved bony plates on the lateral wall of each nasal cavity (appear like elongated seashells)

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34
Q

Nasal Septum is made up of:

A
    • Perpendicular plate of the ethmoid
    • Vomer
    • Cartilage of the Septum
    • Crest of Maxillary Bone
    • Crest of the Palatine bone
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35
Q
    • form upper jaw; form the infraorbital margins medially
    • alveolar processes include the tooth sockets called alveoli
    • supporting bone for maxillary teeth
  • -surround piriform aperture
    • the two maxillae are united at the inter maxillary suture
A

Maxilla

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36
Q

Foramen found in the maxilla which is for the passage of infraorbital nerve and vessels

A

Infraorbital Foramen

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37
Q

Dr. Le Fort classified 3 variants of fractures of the

maxillae

A
    • Le Fort I Fracture
    • Le Fort II Fracture
    • Le Fort III Fracture
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38
Q
  • horizontal fracture of the maxillae

- passing superior to the maxillary alveolar process crossing the bony nasal septum

A

Le Fort I Fracture

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39
Q

-passes from the posterolateral parts of the maxillary sinuses through the infra-orbital foramina lacrimals or ethmoids to bridge of nose

A

Le Fort II Fracture

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40
Q
  • horizontal fracture
  • passes through the superior orbital fissures, ethmoid and nasal bones, extending to the greater wings of sphenoid and frontozygomatic sutures
A

Le Fort III Fracture

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41
Q
    • U-shaped bone
    • alveolar process that support mandibular teeth
    • consists of the body, angle and ramus
    • mental foramina inferior to the 2nd premolar teeth; for mental nerves and vessels
    • MENTAL PROTUBERANCE forming prominence of CHIN
A

Mandible

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42
Q

Fractures of the Mandible

A
    • FRACTURES OF THE NECK OF THE MANDIBLE are TRANSVERSE
    • FRACTURES OF THE ANGLE OF THE MANDIBLE are usually OBLIQUE
    • FRACTURES OF THE BODY OF MANDIBLE pass through socket of canine tooth
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43
Q

The lateral aspect of the cranium consists of:

A
    • Temporal Fossa
    • Zygomatic Arch
    • Ext. Acoustic Opening
    • Mastoid Process
    • Infratemporal Fossa
    • Lateral aspects of maxilla and mandible
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44
Q

bounded by:

  • superiorly and posteriorly: by the superior temporal line and inferior temporal line
  • anteriorly: by frontal and zygomatic bones
  • inferiorly by zygomatic arch
A

Temporal Fossa

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45
Q

– formed by the union of temporal process of zygomatic bone and zygomatic process of temporal bone

A

Zygomatic Arch

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46
Q

– entrance to external acoustic meatus or canal

A

External Acoustic Opening

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47
Q
    • posteroinferior to the external acoustic opening

- - anteromedial is a pointed projection, the styloid process

A

Mastoid Process

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48
Q
    • inferior and deep to the zygomatic arch and mandible

- - posterior to maxilla

A

Infratemporal Fossa

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49
Q

– is an H-shaped formation of sutures that unite the frontal, parietal, greater wing of sphenoid and temporal bones.

A

Pterion

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50
Q
    • hard blow to side of head life threatening because it lies over the anterior branches of middle meningeal vessels
    • if untreated may lead to middle meningeal artery hemorrhage
A

Fracture of the Pterion

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51
Q

The occipital aspect is composed of the:

A
    • Occiput
    • Parts of parietal bone
    • Mastoid parts of temporal bone
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52
Q

– the external protuberance of this bone is palpable in the median plane

A

Occipital Bone

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53
Q

most prominent point of the external occipital protuberance is the ___

A

Inion

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54
Q

Parts of the Occipital Bone

A
    • most prominent point of the external occipital protuberance is the INION
    • the EXTERNAL OCCIPITAL CREST descends from the protuberance toward the foramen magnum
    • the SUPERIOR NUCHAL LINE marks the superior limit of neck and extends laterally from each side of the protuberance
    • the INFERIOR NUCHAL LINE is less distinct
  • -the LAMBDA indicates the junction of sagittal and lambdoid sutures
    • ACCESSORY BONES OR SUTURAL BONES may be located at lambda or near the mastoid process
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55
Q

– is somewhat oval in form and broadens posterolaterally at the parietal eminences

A

Superior aspect of the Cranium

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56
Q

Cranial Sutures

A
  1. Coronal suture
  2. Sagittal suture
  3. Lamdoid suture
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57
Q

– a suture that separates the frontal and parietal bones

A

Coronal Suture

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58
Q

– a suture that separates the parietal bones

A

Sagittal suture

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59
Q

– a suture that separates parietal and temporal bones from occipital bone

A

Lamdoid suture

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60
Q

Craniometric Points

A

BREGMA – at junction of sagittal and coronal sutures
VERTEX – most superior point of the calvarianear the midpoint of the sagittal suture
LAMBDA – at junction of lambdoid and sagittal sutures

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61
Q

Parietal Landmarks

A

PARIETAL FORAMEN –located posteriorly in the parietal bone near the sagittal suture
EMISSARY FORAMINA – transmit emissary veins

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62
Q
    • also known as the Basicranium

- - inferior portion of neurocranium and viscerocranium minus the mandible

A

External Surface of Cranial Base

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63
Q

The external surface of the cranial base features:

A
    • Alveolar arch of maxillae
    • Palatine process of maxillae
    • Palatine
    • Sphenoid
    • Vomer
    • Temporal bone
    • Occipital bone
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64
Q
    • formed by palatal processes of maxillae anteriorly
    • formed by horizontal plates of palatine bones posteriorly
    • free posterior border projects as posterior nasal spine
A

Hard Palate

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65
Q

Foramens of the Hard Palate

A

A. INCISIVE FORAMEN – posterior to central incisor teeth
– depression in the midline of bony palate into which the INCISIVE CANALS OPEN
B. GREATER PALATINE FORAMEN – medial to 3rd molar tooth
– Transmit: GREATER PALATINE NERVES AND VESSELS
C. LESSER PALATINE FORAMEN – posterior to greater palatine foramen
– Transmit: LESSER PALATINE NERVES AND VESSELS

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66
Q
    • two large openings superior to the posterior edge of the palate
    • posterior nasal aperture
    • separated from each other by the vomer
A

Choanae

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67
Q
    • trapezoidal in shape
    • flat, unpaired bone
    • forms a major part of the bony nasal septum
A

Vomer

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68
Q
    • wedged between the frontal, temporal and occipital bones
    • unpaired bone that consists of:
      1. Body
      2. Greater wings and Lesser wings -spread laterally from the lateral aspects of the body of the sphenoid
      3. Pterygoid processes
A

Sphenoid Bone

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69
Q
    • consists of lateral and medial plates

- - extend on each side of the sphenoid

A

Pterygoid Processes

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70
Q

– the large opening in the basal part of the occipital bone

A

Foramen Magnum

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71
Q
    • large protuberances on the lateral parts of occipital bone
    • where the CRANIUM ARTICULATES WITH THE VERTEBRAL COLUMN
A

Occipital Condyle

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72
Q

– large opening between the occipital bone and petrous part of temporal bone

A

Jugular Foramen

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73
Q
    • anterior to the jugular foramen

- - ENTRANCE FOR THE INTERNAL CAROTID ARTERY

A

Carotid Canal

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74
Q
    • lies posterior to the base of the styloid process

- - TRANSMITS THE FACIAL NERVE AND STYLOMASTOID ARTERY

A

Stylomastoid Foramen

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75
Q

– provide for muscle attachments

A

Mastoid Process

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76
Q

The internal surface of the cranial base has 3 large depressions namely:

A
  1. Anterior Cranial Fossa
  2. Middle Cranial Fossa
  3. Posterior Cranial Fossa
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77
Q

– formed by: frontal bone (anteriorly); ethmoid (middle); body and lesser wings of sphenoid (posteriorly)
– anterior and inferior parts of frontal lobe of brain occupy this area
– Posterior Boundaries: Posterior margins of the lesser wing of the sphenoid
Anterior margin of the optic chiasmatic groove (sulcus) on the body of the sphenoid bone

A

Anterior Cranial Fossa

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78
Q

Parts of the Anterior Cranial Fossa

A
  1. Orbital Parts of the Frontal Bone
  2. Frontal Crest
  3. Foramen Cecum
  4. Crista Galli
  5. Cribiform Plate of the Ethmoid
  6. Anterior and Posterior Ethmoidal Foramen
  7. Lesser Wing of Sphenoid
  8. Sphenoidal Jugum
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79
Q
    • the horizontal part of the frontal bone forms the roof of the orbit and the floor of the anterior cranial fossa
    • forms the greatest part of the anterior cranial fossa
    • surface show brain markings of orbital gyri
A

Orbital Parts of the Frontal Bone

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80
Q

– median bony extension of the frontal bone

A

Frontal Crest

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81
Q
    • at the base of the frontal crest
    • gives passage to vessels during fetal development
    • insignificant postnatally
    • contains the nasal emissary vein (1% of population)
A

Foramen Cecum

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82
Q
    • thick, median ridge posterior to foramen cecum
    • projects superiorly from the ethmoid bone
    • Latin –cock’s comb
    • for the ATTACHEMENT OF THE FALX CEREBRI
A

Crista Galli

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83
Q
    • lie on each side of the crista galli
    • supports the OLFACTORY BULBS
    • means an anatomic structure pierced by many holes
A

Cribiform Plate of the Ethmoid

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84
Q
    • the TINY FORAMINA of this plate transmit the OLFACTORY NERVES (CN I) to the olfactory bulbs of the brain
    • form the median aspect of the floor of the anterior cranial fossa
    • separates the anterior fossa from the nasal cavity
    • transmit the ANTERIOR AND POSTERIOR ETHMOIDAL ARTERY, VEIN AND NERVE
A

Cribiform Plate of the Ethmoid

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85
Q
    • contribute to the posterior aspect of the floor of the anterior cranial fossa
    • separate the anterior cranial fossa from the orbits
    • extending from __ are the ANTERIOR CLINOID PROCESS for the attachment of the free margin of the TENTORIUM CEREBELLI
A

Lesser Wing of Sphenoid

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86
Q
  • -butterfly-shaped
    • postero-inferior to the anterior cranial fossa
    • has a central part, the sella turcica and depressed lateral parts on each side
    • lateral parts support the temporal lobes of brain
A

Middle Cranial Fossa

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87
Q

The lateral parts of the fossa are formed by:

A
    • Greater wings of the sphenoid
    • Squamous part of the temporal bone
    • Petrous part of the temporal bone
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88
Q

Separated from the anterior cranial fossa by the ff:

A

SPENOIDAL CRESTS – separates the anterior cranial fossa from the middle cranial fossa LATERALLY
SPHENOIDAL LIMBUS – separates the anterior cranial fossa from the middle cranial fossa CENTRALLY

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89
Q
    • saddle-like bony formation in middle cranial fossa
    • surrounded by the anterior and posterior clinoid processes
    • composed of 3 parts:
      1. Tuberculum sellae
      2. Hypophysial fossa
      3. Dorsum sellae
A

Sella turcica

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90
Q
    • lies posterior to the cribriform plate
    • connects the two lesser wings
    • it also helps FORM the ROOF of the SPHENOID PARANASAL SINUS
A

Sphenoidal Jugum

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91
Q
    • is an unpaired bone in the center of the middle cranial fossa
  • -wedged in between the frontal and ethmoid bones anteriorly and the two temporal bones and the occipital bone posteriorly
A

Sphenoid Bone

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92
Q
    • median elevation

- - forms the posterior boundary of the prechiasmatic sulcus and anterior boundary of hypophysial fossa

A

Tuberculum sellae

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93
Q
    • median depression in the body of the sphenoid

- - accomodates the pituitary gland

A

Hypophysial fossa

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94
Q
    • square plate of bone
    • forms the posterior boundary of the sella turcica
    • superolateral angles make up the posterior clinoid process which gives attachment to the TENTORIUM CEREBELLI
A

Dorsum Sellae

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95
Q

– transmits the: Optic nerve and Ophthalmic artery

A

Optic Canal

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96
Q

– located between the greater and lesser wing of sphenoid
– opens anteriorly in the orbit
– transmits:
»Superior ophthalmic vein
»Lacrimal, frontal, nasociliary br. of ophthalmic nerve
»Oculomotor nerve
»Trochlear nerve
»Abducens nerve

A

Superior Orbital Fissure

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97
Q
    • located posterior to the medial end of the superior orbital fissure
    • transmits: Maxillary nerve
A

Foramen Rotundum

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98
Q
    • large foramen postero-lateral to the foramen rotundum
    • opens into the infratemporal fossa
    • transmits: Mandibular nerve Accessory meningeal artery
A

Foramen Ovale

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99
Q
    • posterolateral to the foramen ovale
    • opens into the infra temporal fossa
    • transmits: Middle meningeal artery and vein; Meningeal branch of mandibular nerve
A

Foramen Spinosum

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100
Q
    • posterolateral to hypophysial foramen
    • in life it is closed by a cartilage plate
    • transmits: Meningeal arterial br.; Deep petrosal nerve; Small veins
A

Foramen Lacerum

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101
Q
    • lie on the anterosuperior surface of the petrous part of temporal bone
    • extends laterally from the foramen lacerum
    • contents: GREATER PETROSAL NERVE; PETROSAL BR. OF MIDDLE MENINGEAL ARTERY
A

Groove for the Greater and Lesser Petrosal Nerve

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102
Q
    • largest and deepest
    • formed mostly by the occipital bone
    • lodges the ff: CEREBELLUM, PONS AND MEDULLA OBLONGATA
    • the dorsum sellae of the sphenoid marks its anterior boundary centrally
    • petrous and mastoid parts of the temporal bones contributes its anterolateral walls.
A

Posterior Cranial Fossa

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103
Q

– located in the center of the anterior part of the fossa leading to the foramen magnum

A

Clivus

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104
Q

– bilateral concave impressions

A

Cerebellar Fossae

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105
Q

– divides the posterior cranial fossa into large bilateral concave impressions

A

Internal Occipital Crest

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106
Q

–where the internal occipital crest ends

A

Internal Occipital Protuberance

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107
Q
    • located anterosuperior to the jugular foramen

- - transmits: FACIAL NERVE; VESTIBULOCHOCLEAR NERVE; LABIRINTHINE ARTERY

A

Internal Acoustic Meatus

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108
Q

– located at the petrous ridge of the temporal bone
–transmits:
»Meningeal br. of ascending pharyngeal and occipital a.&raquo_space;Accessory nerve
»Sigmoid sinus
»Sup. bulb of int. jugular vein
»Inferior petrosal sinus
»Vagus nerve
»Glossopharyngeal nerve

A

Jugular Foramen

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109
Q

(Posterior Cranial Fossa)

    • located superior to the anterolateral margin of the foramen magnum
    • transmits: Hypoglossal nerve
A

Hypoglossal Canal

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110
Q 
(Posterior Cranial Fossa)
-- major structures passing through this large foramen are: >>Dural veins
>>Ant./post. Spinal arteries
>>Medulla and Meninges
>>Spinal accessory n.
>>Vertebral arteries
A

Foramen Magnum

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111
Q

Muscles Of Facial Expression 1

A 
>>Occipitofrontalis
>>Orbicularis Oculi
>>Corrugator Supercilli
>>Procerus Nasalis
>>Levator Labii Superioris Alae Que Nasi
>>Orbicularis Oris
>>Levator Labii Superioris
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112
Q

Muscles Of Facial Expression 2

A 
>>Zygomaticus Major And Minor
>>Levator Anguli Oris
>>Risorius
>>Buccinator
>>Depressor Anguli Oris
>>Depressor Labii Inferioris
>>Mentalis
>>Platysma
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113
Q

Epicranial Muscle Group

A

Occipitofrontalis

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114
Q
    • flat digastric muscle
    • (+) frontal and occipital bellies that share a common tendon the epicranial aponeurosis
    • covers the dome of the skull from the highest nuchal lines to the eyebrows
A

Occipitofrontalis

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115
Q

Occipitofrontalis (Frontal Belly)

A

origin: EPICRANIAL APONEUROSIS
insertion: SKIN AND SUBCUTANEOUS TISSUE OF EYEBROWS AND FOREHEAD

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116
Q

Occipitofrontalis (Occipital Belly)

A

origin: lateral 2/3 of SUPERIOR NUCHAL LINE
insertion: EPICRANIAL APONEUROSIS

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117
Q

Occipitofrontalis (Vascular supply and Innervation)

A

Vascular Supply: supplied by the branches of the SUPERFICIAL TEMPORAL, OPHTHALMIC, POSTERIOR AURICULAR and OCCIPITAL ARTERIES

Innervation: Occipital Part – supplied by the POSTERIOR AURICULAR BRANCH OF THE FACIAL NERVE
Frontal Part – TEMPORAL BRANCHES of the FACIAL NERVE

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118
Q

Occipitofrontalis Frontal Belly (Action)

A
    • elevates eyebrows
    • contraction of the frontal belly protracts the scalp
    • transverse wrinkles across the forehead
    • gives the face a surprised look
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119
Q

Occipitofrontalis Occipital Belly (Action)

A
    • contraction of the occipital belly retracts the scalp
    • the occipital belly with bony attachments works as a synergist with the frontal belly
    • retracts the scalp;increasing effectiveness of frontal belly
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120
Q

Circumorbital and Palpebral Muscle Group

A

Orbicularis Oculi

Corrugator Supercilli

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121
Q
    • borad, flat, elliptical muscles
    • concentric circles around orbital margin
    • closes eyelids and wrinkles forehead vertically
    • assists in the flow of lacrimal fluid (tears)
A

Orbicularis Oculi (Orbital Part)

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122
Q

Orbicularis Oculi (Orbital Part) - Origin, Insertion and Action

A 
origin:
-- medial orbital margin
-- medial palpebral ligament
-- lacrimal bone
insertion:
-- skin around margin of orbit
-- superior and inferior tarsal plates
action:
-- closes eyelids tightly(winking)
-- closes eyelids and wrinkles forehead vertically
-- assist in the flow of lacrimal fluid (tears)
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123
Q
    • concentric circles around the eyelids
  • -arises from the medial palpebral ligament, mainly from its superficial surface, and from the bone intermediately above and below the ligament
    • the muscle fibers sweep across the eyelid interlacing at the lateral commissure to form the lateral palpebral raphe
A

Orbicularis Oculi (Palpebral Part)

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124
Q

Orbicularis Oculi (Palpebral Part)

A

origin: MEDIAL PALPEBRAL LIGAMENT
insertion: LATERAL PALPEBRAL RAPHE
action:
– closes eyelids gently
– the palpebral portion can be contracted voluntarily, to close the lids gently as in sleep, or reflexly, to close the lids protectively in blinking

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125
Q

Orbicularis Oculi (vascular supply and innervation)

A

vascular supply: supplied by branches of the FACIAL, SUPERFICIAL TEMPORAL, MAXILLARY and OPHTHALMIC ARTERIES
innercation: supplied by TEMPORAL and ZYGOMATIC BRANCHES of the FACIAL NERVE

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126
Q
    • small pyramidal muscle
    • located at the medial end of each eyebrow
  • -lying deep to the frontal part of occipitofrontalis and orbicularis occult, with which it is partially blended
A

Corrugator Supercilli

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127
Q

Corrugator Supercilli

A

origin: medial end of SUPERCILIARY ARCH
insertion: SKIN superior to middle of SUPRAORBITAL MARGIN and SUPERCILIARY arch
vascular suppy: SUPERFICIAL TEMPORAL and OPHTHALMIC ARTERIES
innervation: TEMPORAL BRANCHES of the FACIAL NERVE
action:
– draws eyebrow medially and inferiorly creating vertical wrinkles above nose
– demonstrate concern or worry
– involved in frowning

128
Q

Nasal Muscle Group

A
    • Procerus

- - Nasalis (Transverse and Alar Part)

129
Q

– small pyramidal muscle that lies close to, and ins often partially blended with, the medial side of the frontal part of occipitofrontalis

A

Procerus

130
Q

Procerus

A

origin: fascia aponeurosis covering nasal bone and lateral nasal cartilage
insertion: skin of inferior forehead between eyebrows
vascular supply: branches of the FACIAL ARTERY
innervation: TEMPORAL and LOWER ZYGOMATIC branches from the FACIAL NERVE
action:
– draws down the medial angle of the eyebrow
– produces transverse wrinkle over the bridge of the nose
– active in FROWNING and CONCENTRATION and helps to reduce the glare of bright sunlight

131
Q
    • consists of traverse and alar
    • TRANSVERSE PART ( COMPRESSOR NARIS) is attached to the maxilla above and lateral to the incisive fossa, and lateral to the alar part
    • ALAR PART (PARS ALARIS OR DILATOR NARIS POSTERIOR) is attached to the maxilla above the lateral incisor and canine, lateral to bony attachment of depressor sept, and medial to the transverse part
    • vascular supply: branches from FACIAL ARTERY and from infraorbital branch of the MAXILLARY ARTERY
    • innervation: BUCCAL BRANCH of the FACIAL NERVE; ZYGOMATIC BRANCH of the FACIAL NERVE
A

Nasalis

132
Q

– helps to produce the upper ridge of the philtrum

A

Nasalis (Alar Part)

133
Q

Nasalis (Alar Part)

A

origin: MAXILLA
insertion: ALA of NOSE
action: assist in widening the nares and in elongating the nose

134
Q

Action of Nasalis (Transverse Part)

A

compresses the nasal aperture at the junction of the vestibule and the nasal cavity

135
Q

Buccolabial Muscle Group

A
    • Levator Labii Superioris Alae Que Nasi
    • Levator Labi Superioris
    • Zygomaticus Major
    • Zygomaticus Minor
    • Levator Anguli Oris
    • Depressor Labii Inferioris
    • Depressor Anguli Oris
    • Buccinator
    • Orbicularis Oris
    • Platysma
    • Risorious
136
Q

Levator Labii Superioris Alae Que Nasi

A

origin: FRONTAL PROCESS of MAXILLA
insertion: MAJOR ALAR CARTILAGE
vascular supply: FACIAL ARTERY and the INFRAORBITAL BRANCH of the MAXILLARY ARTERY
innervation: ZYGOMATIC and SUPERIOR BUCCAL branches of the FACIAL NERVE

137
Q

Alar Part Of Nasalis Plus Levator Labii Superioris Alae que Nasii (Action)

A
    • Depresses ala laterally dilating anterior nasal aperture

- - Flaring nostrils during anger or exertion

138
Q
    • Encircles the mouth within the lips
    • Control entry and exit throught oral fissure
    • Important during speech
A

Orbicularis Oris (Oral Sphincter)

139
Q

Orbicularis Oris (Oral Sphincter)

A

origin:
–medial maxilla and mandible
– deep surface of perioral skin
– angle of mouth
insertion: mucous membrane of LIPS
action:
– Closes oral fissure
– Compresses and protrudes lips (KISSING)
–Resists distention (when blowing)

140
Q

Levator Labi Superioris

A

origin: Infraorbital margin (maxilla)
insertion: skin of UPPER LIP
vascular supply: FACIAL ARTERY and the infraorbital branch of the MAXILLARY ARTERY
innervation: zygomatic buccal branches of FACIAL NERVE
action:
– Part of dilators of mouth
– Retract (elevate) / evert upper lip
– Deepen nasolabial sulcus (sadness)

141
Q

Zygomaticus Minor

A

origin: anterior aspect of ZYGOMATIC BONE
insertion: Skin of UPPER LIP
vascular supply: superior labial branch of the FACIAL ARTERY
innervation: zygomatic and buccal branches of the FACIAL NERVE
action:
– Part of dilators of mouth
– Retract (elevate) or evert upper lip
– Deepen the nasolabial sulcus (showing sadness)

142
Q

Zygomaticus Major

A

origin: lateral aspect of zygomatic bone
insertion: angle of mouth
vascular supply: superior labial branch of the facial artery
innervation: zygomatic and buccal branches of the facial nerve
action:
– part of dilators of mouth
– elevates labial commissure bilaterally to smile(happiness)
– unilaterally to sneer(disdain

143
Q
    • thin, flat rectangular
    • more closely related to the buccal mucosa
    • fibers mingle medially with orbicularis oris
    • latin word: trumpeter
A

Buccinator (Cheek Muscle)

144
Q

Buccinator (Cheek Muscle)

A

origin:
– mandible
– alveolar processes of maxilla and mandible
– pterygomandibular raphe
insertion: angle of mouth orbicularis oris
vascular supply: branches from facial artery and buccal branch or the maxillary artery
innervation: buccal branch of the facial nerve
action:
– presses cheeks against molar teeth
– works with tongue to keep food between occlusal surfaces and out of oral vestibule
– resists distention (when blowing)

145
Q

Levator Anguli Oris

A

origin: infra-orbital maxilla (canine fossa)
insertion: angle of mouth
vascular supply: superior labial branch of the facial artery and the infraorbital branch of the maxillary artery
action:
– part of dilators of mouth
–widens oral fissure (grinning or grimacing)

146
Q

Risorius

A

origin: parotid fascia; buccal skin
insertion: angle of mouth
vascular supply: superior labial branch of the facial artery
innervation: buccal branches of the facial nerve
action:
– part of dilators of mouth
– depresses labial commissure bilaterally to frown (sadness)

147
Q

Depressor Anguli Oris

A

origin: anterolateral base of the mandible
insertion: angle of mouth
vascular supply: inferior branch of the facial artery and the mental branch of the maxillary artery
innervation: buccal and mandibular branches of the facial nerve
action:
– part of dilators of mouth
– depresses labial commissure bilaterally to frown (sadness)

148
Q

– quadrilateral muscle that arises from the oblique line of the mandible, between the symphysis menti and the mental foramen
–passes upwards and medially into the skin and mucosa
of the lower lip, blending with its contralateral fellow and with orbicular Doris

A

Depressor Labii Inferioris

149
Q

Depressor Labii Inferioris

A

origin: platysma anterolateral; body of mandible
insertion: skin of lower lip
vascular supply: inferior labial branch of the facial artery and the mental branch of the maxillary artery
innervation: mandibular branch of the facial nerve
action:
–part of dilators of mouth
– retracts (depresses) and/or everts lower lip (pouting, sadness)

150
Q

– raise from the incisive fossa of the mandible descend to attach to the skin of the chin

A

Mentalis

151
Q

Mentalis

A

ORIGIN: Body of mandible (anterior to roots of inferior incisors)
INSERTION: Skin of chin (mentolabial sulcus)
VASCULAR SUPPLY: labial branch of the facial artery and the mental branch of the maxillary artery
INNERVATION: mandibular branch of the facial nerve
ACTION:
– Elevates and protrudes lower lip
– Elevates skin of chin (showing doubt)

152
Q
    • a broad sheet of muscle which arises from the fascia covering the upper part of pectorals major and deltoid
    • its fiber cross the clavicle and ascend medially in the side of the neck
A

Platysma

153
Q

Platysma

A

ORIGIN: Subcutaneous tissue of infraclavicular and supraclavicular regions
INSERTION:
– Base of mandible
– Skin of cheek and lower lip
– Angle of mouth
– Orbicularis oris
VASCULAR SUPPLY: submittal branch of the facial artery and by the supra capsular artery
INNERVATION: cervical branch of the Facial Nerve
ACTION:
– it can draw down the lower lip and corners of the mouth in expression of horror or surprise
– Depresses mandible against resistance
– Tenses skin of inferior face and neck (tension and stress)

154
Q

– injury to facial nerve (CN VII)
– paralysis of facial muscles on affected side result to:
sad look when face is relaxed; markedly contorted smile; weakened lips affect speech; food accumulation

A

Bell’s Palsy

155
Q
    • danger triangle of the face
  • triangular area from upper lip to bridge of nose
    • inflammation of facial vein with secondary thrombus formation and pieces of an infected clot
    • result from laceration of the nose by squeezing pimples
A

Thrombophlebitis of Facial Vein

156
Q

Cutaneous And Superficial Muscles Of The Neck

A
    • Platysma
    • Sternocleidomastoid
    • Trapezius
157
Q
    • (G. flat plate)
    • Broad thin sheet of muscle
    • Covers the anterolateral aspect of the neck
    • Decussate over the chin and blend with facial muscles
    • Inferiorly the fibers diverge
    • Deep to this muscle are the extenal jugular vein and cutaneous nerves of the neck
A

Platysma

158
Q

Platysma

A

SUPERIOR ATTACHMENT: Inferior border of the mandible, skin and subcutaneous tissues of lower face
INFERIOR ATTACHMENT: Fascia covering superior parts of pectoralis major and deltoid muscles
INNERVATION: Cervical branch of facial nerve (CN VII)
ACTION: Draws corners of mouth inferiorly and widens it (grimace/sadness/fright)
– Draws the skin of neck superiorly when teeth are clenched producing vertical skin ridges

159
Q

The __ can be seen as a sheet of muscle by asking the patient to clench the jaws firmly.

A

Platysma

160
Q
    • Divides each side of the neck into anterior and lateral cervical region
    • Broad strap-like muscle
    • Has two heads
      a. Sternal Head
      b. Clavicular Head
    • The two heads are separate inferiorly by a space called the lesser supraclavicular fossa
A

Sternocleidomastoid

161
Q

Sternocleidomastoid

A

SUPERIOR ATTACHMENT:
– Lateral surface of mastoid process of temporal bone
– Lateral half of superior nuchal line
INFERIOR ATTACHMENT:
– Sternal head: anterior surface of manubrium of sternum
– Clavicular head: superior surface of medial third of clavicle
INNERVATION: Spinal accessory nerve (CN XI, motor) C2 and C3 nerves (pain and proprioception)

162
Q

Sternocleidomastoid (Action)

A

ACTION

    • Unilateral contraction: tilts head to same side and rotates it so face is turned superiorly toward the opposite side
    • Bilateral contraction: (Flexion) Flexes cervical vertebrae so that the chin approaches the manubrium; Flexion also occur when lifting the head off the ground while lying supine protruding the chin while keeping the head level
    • Bilateral contraction: Extension (especially for posterior fibers of the SCM)&raquo_space; Extends neck at atlanto-occipital joints; elevating the chin
163
Q

How to test the Sternocleidomastoid?

A
  • -The head is turned to the opposite side against resistance (hand against the chin)
    • Normal when muscle is seen and palpated
164
Q
    • Large flat triangular muscle
  • muscle of neck
  • muscle of pectoral girdle
  • superficial muscle of back
    • Covers the posterolateral aspect of the neck and thorax
    • Attaches the pectoral girdle to the cranium and vertebral column
A

Trapezius

165
Q

Trapezius

A

ORIGIN:
– Medial third of superior nuchal line; External occipital protuberance; Nuchal ligament Spinous process (C7-T12); Lumbar and sacral spinous processes
INSERTION: Lateral third of clavicle, acromion and spine of scapula
INNERVATION: Spinal Accessory Nerve (CN XI; motor) C2 and C3 Nerves (pain and proprioception)
ACTION: Elevates, retracts and rotates scapula superiorly
– Unilateral contraction - produces lateral flexion on the same side
– Bilateral contraction - extends the neck

166
Q

How to test the Trapezius

A
    • The shoulder is shrugged against resistance
    • Normal when the superior border of the muscle is seen and palpated
    • If the muscle is paralyzed the shoulder droops
167
Q

Suprahyoid Muscles

A
    • Mylohyoid
    • Geniohyoid
    • Stylohyoid
    • Digastric
168
Q
    • Superior to the hyoid and connect it to the cranium
    • These muscles constitute the substance of the floor of the mouth
    • Support the hyoid in providing a base from which the tongue functions
    • Elevate the hyoid and larynx in relation to swallowing and tone production
A

Suprahyoid Muscles

169
Q

Mylohyoid

A

ORIGIN: Mylohyoid line of mandible
INSERTION: Mylohyoid raphe and body of hyoid
INNERVATION: Nerve to mylohyoid, a branch of inferior alveolar nerve (from mandibular nerve, CN V3)
ACTION:
Elevates the following during swallowing and speaking:
– Hyoid
– Floor of mouth
– Tongue

170
Q

Geniohyoid

A 
ORIGIN Inferior mental spine of mandible
INSERTION: Body of hyoid
INNERVATION: C1 via hypoglossal nerve
ACTION:
-- Pulls hyoid anterosuperiorly
-- Shortens floor of mouth
-- Widens pharynx
171
Q

Stylohyoid

A

ORIGIN: Styloid process of the temporal bone
INSERTION: Body of hyoid
INNERVATION: Stylohyoid branch of the preparotid facial nerve
ACTION: Elevates and retracts hyoid; elongating the floor of the mouth

172
Q

– Has two bellies joined by an intermediate tendon
A. Anterior Digastric
B. Posterior Digastric
– A fibrous sling connects the intermediate tendon to the body and greater horn of the hyoid

A

Digastric

173
Q

Digastric

A

ORIGIN:
Anterior Belly: digastric fossa of mandible
Posterior Belly: mastoid notch of temporal bone
INSERTION: Intermediate tendon to body and greater horn of hyoid
INNERVATION:
Anterior Belly: nerve to mylohyoid, a branch of inferior alveolar nerve
Posterior Belly: digastric (preparotid) branch of facial nerve
ACTION: – Working with infrahyoid muscles, depresses mandible against resistance
– Elevates and steadies hyoid during swallowing and speaking

174
Q

Infrahyoid Muscles

A
    • Sternohyoid
    • Omohyoid
    • Sternothyroid
    • Thyrohyoid
175
Q
    • Often called “strap muscles” because of their ribbon like appearance
    • Anchor the hyoid, sternum, clavicle and scapula
    • Depress the hyoid during swallowing and speaking
    • Work with the suprahyoid muscles to steady the hyoid providing a firm base for the tongue
A

Infrahyoid Muscles

176
Q

Infahyoid muscles are arranged in two planes namely

A 
A. Superficial Plane
- Sternohyoid
- Omohyoid
B. Deep Plane
- Sternothyroid
- Thyrohyoid
177
Q

Sternohyoid

A

ORIGIN: Manubrium of sternum and medial end of clavicle
INSERTION: Body of hyoid
INNERVATION: C1-C3 by a branch of ansa cervicalis
ACTION: Depresses hyoid after elevation during swallowing

178
Q

– Has two bellies united by an intermediate tendon
A. Superior Belly
B. Inferior Belly
– The fascial sling for the intermediate tendon connects to the clavicle

A

Omohyoid

179
Q

Omohyoid

A

ORIGIN: Superior border of scapula near suprascapular notch
INSERTION: Inferior border of hyoid
INNERVATION: C1-C3 by a branch of ansa cervicalis
ACTION: Depresses, retracts and steadies hyoid

180
Q

– covers the lateral lobes of the thyroid gland

A

Sternthyroid

181
Q

Sternothyroid

A

ORIGIN: Posterior surface of manubrium of sternum
INSERTION: Oblique line of thyroid cartilage
INNERVATION: C2 and C3 by a branch of ansa cervicalis
ACTION: Depresses hyoid and larynx

182
Q
    • Appears to be the continuation of the sternothyroid muscle
    • Runs superiorly from the oblique line of the thyroid cartilage to the hyoid
A

Thyrohyoid

183
Q

Thyrohyoid

A

ORIGIN: Oblique line of thyroid cartilage
INSERTION: Inferior border of body and greater horn of hyoid
INNERVATION: C1(via hypoglossal nerve-CN XII)
ACTION:
– Depresses hyoid
– Elevates larynx

184
Q

– Deep to prevertebral layer of deep cervical fascia
– Can be grouped to either:
A. Anterior Vertebral Muscles
-Longus colli
-Longus capitis
-Rectus capitis anterior
-Anterior scalene
B. Lateral Vertebral Muscles
-Rectus capitis lateralis
-Splenius capitis
-Levator scapulae
-Middle Scalene and Posterior Scalene

A

Prevertebral Muscle

185
Q

Longus colli

A 
SUPERIOR ATTACHMENT
anterior tubercle of C1
bodies of C1-C3
transverse processes of C3-C6 vertebrae
INFERIOR ATTACHMENT
bodies of C5-T3
transverse processes of C3-C5 vertebrae
INNERVATION: Anterior rami of C2-C6 spinal nerves
ACTION: Acting unilaterally: Flexes the neck with rotation (torsion) to opposite side
186
Q

Longus Capitis

A

SUPERIOR ATTACHMENT: Basilar part of occipital bone
INFERIOR ATTACHMENT: Anterior tubercles of C3-C6 transverse processes
INNERVATION: Anterior rami of C1-C3 spinal nerves
ACTION: Flex head

187
Q

Rectus Capitis Anterior

A

SUPERIOR ATTACHMENT: Base of cranium, anterior to occipital condyle
INFERIOR ATTACHMENT: Anterior surface of lateral mass of atlas C1 vertebra
INNERVATION: Branches from loop between C1 and C2 spinal nerves
ACTION: Flex head

188
Q

Anterior Scalene

A

SUPERIOR ATTACHMENT: Transverse processes of C3-C6 vertebrae
INFERIOR ATTACHMENT: 1st rib
INNERVATION: Cervical spinal nerves C4-C6
ACTION: Flex head

189
Q

Rectus Capitis Lateralis

A

SUPERIOR ATTACHMENT: jugular process of occipital bone
INFERIOR ATTACHMENT: transverse process of atlas (C1 vertebra)
INNERVATION: Branches from loop between C1 and C2 spinal nerves
ACTION: Flexes head and helps stabilize it

190
Q

Splenus Capitis

A

SUPERIOR ATTACHMENT: Inferior half of nuchal ligament spinous processes of superior 6 thoracic vert.
INFERIOR ATTACHMENT: lateral aspect of mastoid process lateral third of superior nuchal line
INNERVATION: Posterior rami of middle cervical spinal nerves
ACTION:
– laterally flexes and rotates head and neck to same side
– acting bilaterally, extends head and neck

191
Q

Levator Scapulae

A

SUPERIOR ATTACHMENT: Posterior tubercle of transverse processes C2-C6 vertebrae
INFERIOR ATTACHMENT: Superior part of medial border of scapula
INNERVATION: Dorsal scapular nerve C5 and cervical spinal nerves C3 and C4
ACTION: Downward rotation of scapula and tilts its glenoid cavity inferiorly by rotating scapula

192
Q

Middle Scalene

A

SUPERIOR ATTACHMENT posterior tubercles of transverse processes C5-C7 vertebrae
INFERIOR ATTACHMENT Superior surface of 1st rib; posterior to groove for subclavian artery
INNERVATION: Anterior rami of cervical spinal nerves
ACTION:
– Flexes neck laterally
– Elevates 1st rib during forced inspiration

193
Q

Posterior Scalene

A

SUPERIOR ATTACHMENT: posterior tubercles of transverse processes of C5-C7
INFERIOR ATTACHMENT: external border of 2nd rib
INNERVATION: Anterior rami of cervical spinal nerves C7 and C8
ACTION: Flexes neck laterally Elevates 2nd rib during forced inspiration

194
Q

Temporal fossa boundaries:

A
    • Posterior and superior: temporal lines
    • Anterior: frontal and zygomatic bones
    • Lateral: zygomatic arch
    • Inferior: infratemporal crest
195
Q

The floor of the temporal of the temporal fossa is formed by parts of the bones that form the pterion namely:

A
  1. Frontal
  2. Parietal
  3. Temporal
  4. Greater wing of Sphenoid
196
Q

– fan-shaped muscle arises from the bony for and overlying the temporal fascia which form the roof of the temporal fossa

A

Temporalis muscle

197
Q

– is an irregularly shaped space deep and inferior to the zygomatic arch, deep to the rams of the mandible, and posterior to the maxilla

A

Infratemporal Fossa

198
Q

The boundaries of the infra temporal fossa are as follows:

A
  1. Lateral - Ramus of mandible
  2. Medial - lateral pterygoid plate
  3. Anterior - Maxilla
  4. Posterior- Tympanic plate; Mastoid process; Styloid process
  5. Superior - Greater wing of Sphenoid
  6. Inferior - mandible near the angle
199
Q

Contents of the Infratemporal Fossa

A
  1. Muscles
  2. Arteries
  3. Veins
  4. Nerves
200
Q

Muscles of the Infratemporal Fossa

A
    • Temporalis
    • Lateral Pterygoid
    • Medial Pterygoid
201
Q

Temporalis

A

ORIGIN: Temporal Fossa
INSERTION: Coronoid process and Anterior border of Ramus
INNERVATION: Anterior trunk of mandibular nerve (CN V3) via Deep temporals branches
ACTION: Elevates mandible, closing jaws; posterior, more horizontal fibers are primary retractors of mandible

202
Q

Lateral Pterygoid

A

ORIGIN:
– greater wing of sphenoid
– lateral pterygoid plate
INSERTION: Condylar process of the mandible
INNERVATION: Anterior trunk of mandibular nerve (CN V3) via lateral pterygoid nerve
ACTION:
– bilateral: protracts mandible and depress chin
– unilateral: swing jaw toward contralateral side
– produces lateral chewing movement

203
Q

Medial Pterygoid

A

ORIGIN: Two heads embraces the Inferior head of L Pterygoid
INSERTION: Medial surface of Mandible near the angle
INNERVATION: Anterior trunk of mandibular nerve (CN V3) via medial pterygoid nerve
ACTION:
– acts synergistically with the masseter to elevate the mandible
– alternate unilateral activity produces smaller grinding movements

204
Q

Muscle of Mastication

A
  • Temporalis – Munches or Closes the Jaw
  • Medial Pterygoid – Munches or Closes the Jaw
  • Masseter – Munches or Closes the Jaw
  • Lateral Pterygoid –Lowers the jaw
205
Q

Masseter

A

ORIGIN: Zygomatic arch
INSERTION: Lateral surface of ramus coronoid
INNERVATION: Anterior trunk of mandibular nerve (CN V3) via masseteric nerve
ACTION: elevates mandible; closing jaws; superficial fibers make limited contribution to protrusion of the mandible

206
Q

Infratemporal fossa (Arteries)

    • branch of external carotid artery
    • arises posterior to the neck of the mandible
    • divided into 3 parts by the Lateral Pterygoid
A

Maxillary Artery

207
Q

– deep to the neck of mandibular condyle
– Branches:
» Deep auricular
» Anterior Tympanic
» Middle Meningeal
» Accessory Meningeal
» Inferior Aveolar

A

Maxillary Artery (First Part – Mandibular)

208
Q

– passes superficial or deep to the lateral pterygoid muscle
– Branches:
» Deep temporal
» Pterygoid
» Masseteric
» Buccal

A

Maxillary Artery (Second Part – Pterygoid)

209
Q

– disappears through the pterygomaxillary fissure
– enters the pterygopalatine fossa
– Branches:
» Inferior orbital
» Posterior superior alveolar/ Dental
» Descending palatine
» Artery of the pterygoid canal
» Pharyngeal
» Sphenopalatine

A

Maxillary Artery (Third Part – Pterygopalatine)

210
Q
  • Partly between the temporal and pterygoid
    muscles
  • Connected to the facial vein by the cavernous
    sinus
A

Infratemporal Fossa Contents: Veins

211
Q

Nerves (Infratemporal Fossa)

    • largest branch of the trigeminal nerve
    • Descends through the foramen ovale into the IT fossa
    • Supply the muscles of mastication
A

Mandibular Nerve

212
Q

Nerves (Infratemporal Fossa)

    • Encircles the middle meningeal artery
    • Largest branch passes posteriorly
    • Sensory to auricle and temple
    • Parasympathetic secretomotor to the parotid
A

Auricolotemporal Nerve

213
Q

Nerves (Infratemporal Fossa)
– enters the mouth between medial pterygoid, ramus of the mandible passes under the cover of the oral mucosa inferior to the third molar

A

Lingual Nerve

214
Q

Nerves (Infratemporal Fossa)

    • Runs anteriorly on the buccinator muscle
    • Piercing but not supplying
    • Supplies the mucous membrane of the cheek and posterior part of the buccal surface of the gingiva
A

Buccal Nerve

215
Q

Nerves (Infratemporal Fossa)

    • A branch of the Facial Nerve
    • Carries taste fibers to the anterior 2/3 of the tongue
    • Joins the lingual nerve in the IT fossa
    • Secretomotor to the submandibularand sublingual glands
A

Chorda tympani

216
Q

Nerves (Infratemporal Fossa)

    • Inferior to the foramen ovale
    • Medial to the mandibular nerve
    • Posterior to the medial pterygoid muscle
    • Parasympathetic functions
A

Otic ganglion

217
Q
    • Mandere - to masticate
    • U-shaped bone
    • Largest and strongest bone of the Face
    • Composed of two symmetrical halves
  • -Parts:
    1. Body - horizontal part
    2. Rami - vertical part; have 2 processes
    3. Angle
A

Mandible

218
Q
    • Posterior

- - Head and neck articulates w/ mandibular fossa of the temporal bone

A

Condylar Process

219
Q
    • Between Coronoid and Condylar processes

- - Transmit nerves and vessels to the masseter

A

Mandibular notch

220
Q
    • Located in the inner aspect of the ramus
    • Entrance to the mandibular canal
    • Transmit the inferior alveolar nerve and vessels
A

Mandibular foramen

221
Q

(Mandibular foramen)

– thin tonguelike projection of bone overlapping the foramen

A

Lingula

222
Q

(Mandibular foramen)

    • small groove that runs inferiorly and anteriorly
    • contains the mylohyoid nerve and artery
A

Mylohyoid groove

223
Q
    • Divides the internal surface of the mandible into 2 areas
    • Origin of the Mylohyoid muscle
A

Mylohyoid line

224
Q
    • located superior to anterior end of mylohyoid line

- - origin of genioglossus

A

Mental spine

225
Q

Genioglossus

A

ORIGIN: superior mental spine on posterior surface of symphesis menti
INSERTION: Central mass of tongue and mucous membrane
NERVE: Hypoglossal Nerve (XII)
ACTION: Protracts tongue

226
Q

(NEWBORN)
– fibrous tissue joint in the median plane that unites the 2 halves of the mandible
1ST YR- begin to fuse
2nd YR- completely fused

A

Symphysis Menti

227
Q

Fractures of the mandible

A

– occur on opposite sides of the mandible
» Coronoid process - single
» Neck - transverse, may be associated with dislocation of the Temporomandibular joint on the same side
» Angle – oblique, may involve the socket of the 3rd molar tooth
» Body – pass through the socket of the canine tooth

228
Q

– a hinge and gliding joint and is the most constantly used joint in the body

A

Temporomandibular Joint

229
Q

Temporomandibular joint: Normal VS Abnormal

A

Normal closed position – Jawbone is separated from skull by a soft disk that acts as a cushion when you chew, speak or swallow
Normal Open Position – Disk stay in place when jaw is in use
Abnormal – Disk is pulled forward when jaw is in use, causing the bone structures to grind together

230
Q

Temporomandibular Joint Disorder

A
  1. Trauma
    - - Bruxism - the involuntary or habitual grinding of the teeth, typically during sleep
    - - Teeth Loss
  2. Arthritis
    - - Degenerative
    - - Rheumatoid
231
Q

Borders of Abdominal wall

A

Superiorly-diaphragm
Inferiorly-pelvic inlet
Anteriorly
* above-lower part of T-cage
* below-rectus abdominis, ext & int oblique, transversus abdand fasciae
Posteriorly-lumbar vertebrae
* Lateral-12th ribs, upper bony pelvis, psoas, quadratus lumborum, aponeurosis transv abdomen

232
Q

Subdivisions of Abdomen

A
    • Anterior wall
    • Right lateral wall
    • Left lateral wall
    • Posterior wall
233
Q

Surface anatomy of the Abdomen

A

Landmarks:

    • Costal arches
    • Umbilicus
    • Iliac crest
    • Symphysis pubis
    • Inguinal fold
    • Linea alba
234
Q

Layers of the Abdomen

A
  1. Skin – loose except umbilicus
    - Lines of tension = transverse (transverse incision less obvious scar)
  2. Fascia
  3. Muscles
    - - 4 paired: 3 flat; 1 straplike
    - - Strengthens abdominal wall
    - - Decreases risk of protrusion of viscera
235
Q
    • fibrous raphe by decussation of 3 abd muscles
    • midline, fr xyphoid to symphysis pubis
    • few blood vessels
    • incision thru it has less bleeding
A

Linea alba

236
Q

Layers of Facsia

A

a. Superficial Fascia
1. Superficial fatty=CAMPER’s
- - blood vessels/nerves ramify
- - represented by Dartos musclein the scrotum
- - Panniculus adiposus
2. Deep membranous = SCARPA’s
- - attached to linea alba
- - equivalent to Colles’ fasciain the perineum

b. Deep Fascia – very thin

237
Q

– Most superficial
Free inferior margin = inguinal ligament (POUPART’S LIGAMENT)
LACUNAR LIGAMENT (GIMBERNAT’S) – reflected downward, backward and lateral
COOPER’S LIGAMENT - Lateral

A

External Oblique

238
Q
    • Interdigitate w/ serratus anterior and latissimus dorsi
    • Obliquely downward and medially
    • Form aponeurosis
A

External Oblique

239
Q

– triangular defect above & medial to pubic tubercle

A

Superficial inguinal ring

240
Q
    • Deep to external oblique
    • Upward and medial
    • Aponeurotic fibers of int oblique and transversus abdominis = conjoint tendon
    • Form aponeurosis w/c splits to form rectus sheath
    • The lower fibers forms the CREMASTER MUSCLE in the scrotum
A

Internal Oblique

241
Q
    • Innermost
    • Flat
    • Ends in aponeurosis
    • Contribute to conjoint tendon
A

Transversus Abdominis

242
Q
    • On either side of linea alba
    • Segmented = tendinous intersections
    • Lateral borders convex = linea semilunaris
A

Rectus Abdominis

243
Q
    • Not always present

- - Tenses linea alba

A

Pyramidals

244
Q

External Oblique

A 
ORIGIN: 5-12th ribs
INSERTION: Linea, Iliac crest pubic tubercle
ACTION:
-- compress/support abdominal viscera
-- flex/rotate trunch
245
Q

Internal Oblique

A 
ORIGIN: TL fascia iliac crest
INSERTION: 10-12th rib linea alba
ACTION: 
-- compress/support abdominal viscera
-- flex/rotate trunk
246
Q

Transversus Abdominis

A

ORIGIN: 7-12th costal catilage TLf, IC, IL
INSERTION: Linea pubic crest
ACTION: Compress/support abdominal viscera

247
Q

Rectus Abdominis

A

ORIGIN: Pubic symphysis; pubic cres
INSERTION: Xyphoid 5-7 costal cartilage
ACTION: flex trunk; compress abdominal viscera

248
Q

Contents of the Rectus Sheath

A
    • Pyramidalis
    • Superior and inferior epigastric vessels
    • Nerves that supply rectus and transversus abdominis
249
Q
    • Lines the transversus abdominis muscle
    • Continuous with diaphragmatic fascia, iliacus fascia, and pelvic fascia
    • Forms the femoral sheathfor the femoral vessels of the lower ext.
    • Endo-abdominal fascia
A

Transversalis Fascia

250
Q

Lies between the transversalis fascia and perotoneum

A

Properitoneal fat pad

251
Q

Internal lining of the abdomen

A

Parietal Peritoneum

252
Q

Other structures of the Abdomen

A
    • Median umbilical vein
    • Lateral umbilical vein
    • Ligamentum teres hepatis
253
Q

Functions of 3 Flat Anterior Abdominal Muscles

A
  1. Support abdominal contents during sitting and standing
  2. Muscle girdle that exerts pressure on abdominal contents
    Contraction = generates increased intraabdominal pressure for: expulsion of air [cough/ sneeze] ; bearing down -defecate/urinate/parturition
  3. Approximate rib cage to pelvis
  4. Stabilize vertebral column by raising IAP.
254
Q

Nerve Supply (Abdomen)

A

– Ventral rami of T6-12, L1 spinal nerves
– Sensory
– End as anterior cutaneous branches w/c emerge thru anterior rectus sheath (Numbness of abdominal incision)
– 2 branches of ventral ramus of L1 nerve
1] iliohypogastric –medial location; skin over inguinal location
2] ilioinguinal –anterior location; skin over superomedial thigh

255
Q

Blood Supply (Abdomen)

A
  1. Thoracic and abdominal aorta
  2. Superior epigastric artery -terminal branch of internal thoracic artery; Supplies the Rectus abdominis
  3. Inferior epigastric artery - branch of external iliac artery; Rectus abdominis
256
Q

Venous Drainage (Abdomen)

A
  1. Superior Vena Cava
    - superior epigastric vein
    - intercostal vein
    - subcostal vein
  2. Inferior Vena Cava
    - inferior epigastric vein
    - deep circumflex iliac vein
    - lumbar vein
    - thoracoepigastric vein
257
Q

– connect network of veins through the umbilicus and along the ligamentum teres to the portal vein (portal-systemic venous anastomosis)

A

Paraumbilical veins

258
Q
    • distended subcutaneous veins radiating from umbilicus

- - Seen in portal hypertension

A

Caput Medusae

259
Q

Lymphatics (Abdomen)

A
  1. Axillary nodes – above umbilicus

2. Inguinal nodes – below umbilicus

260
Q

– Forms a triangle
– Boundaries
Inferior –inguinal ligament
Superior –horizontal line ASIS to lateral margin of rectus
Medial –lateral margin of rectus

A

The Inguinal Region

261
Q
    • Oblique path thru inguino-abdominal region
    • 4 –5 cm
    • Entrance: abdominal deep inginal ring
    • Exit: superficial inguinal ring
    • Connects extraperitoneal space of abdomen to scrotum or labia major
    • Newborn-deep ring almost directly posterior from superficial ring
A

Inguinal Canal

262
Q

Wall of Inguinal Canal

A

Floor– inguinal and lacunar lig
Roof – arched fibers of int obl + transv and
Anterior – ext obl aponeurosis
Posterior– transversalis fascia + conjoint tendon

263
Q

Types of Abdominal Hernia

A
  1. Inguinal
    a) direct, b) indirect
  2. Femoral
  3. Umbilical
  4. Epigastric
  5. Incisional hernia
  6. Spigelian hernia-Linea semilunaris
  7. Petit’s triangle hernia-ext oblique, lat dorsi, iliac crest
  8. Internal hernia
  9. Littre’s hernia
264
Q

– protrusion of a structure, viscus or organ from the cavity where it belongs

  • -Parts:
    1. Orifice
    2. sac
    3. content
A

Hernia

265
Q

(Type of Hernia)

    • Leaves abd cavity lateral to inferior epigastric vessels
    • Common in males
    • Passes thru patent processus vaginalis
A

Indirect inguinal hernia

266
Q
    • hernia that is common in R side
    • Common in children & young adult
    • Neck is narrow
    • May extend to scrotum
A

Indirect inguinal hernia

267
Q
    • a type of hernia where it protrudes anteriorly thru posterior wall of inguinal canal
    • Leaves abd cavity medialto inf epigastric vessels
    • Due to weakening of anterior abd muscles and transversalis facia
    • Due to repeated inc. IAP(Intraabdominal Pressure) like coughing, straining
    • Common in elders; Neck is wide; Rare in women
A

Direct inguinal hernia

268
Q
    • a type of hernia that lies below and lateral to pubic tubercle
    • More common in women
    • Passes through the femoral canal
A

Femoral Hernia

269
Q

Type of Umbilical Hernia

exomphalos - failure of midgut to return to the abdominal cavity in fetal life. With membrane

A

Omphalocoele

270
Q

Type of Umbilical Hernia

– weakness in scar of umbilicus

A

Acquired infantile

271
Q

Type of Umbilical Hernia

  • paraumbilical hernia.
  • does not protrude through umbilical scar but linea alba
A

Acquired adult

272
Q

Type of Umbilical Hernia

- Defect through anterior abdominal wall which abdominal content freely protrude

A

Gastroschisis

273
Q

– Hernia located at the midline epigastric area

A

Epigastric Hernia

274
Q

– Hernia as a result non-closure of previous incision after surgery

A

Incisional Hernia

275
Q

– Hernia located in the linea semilunaris

A

Spigelian Hernia

276
Q

– Hernia from the inferior lumbar triangle

A

Petit’s Hernia

277
Q

– Hernia of the superior lumbar triangle

A

Grynfeltt’s Hernia

278
Q

– Hernia located intra-abdominally

A

Internal Hernia

279
Q

– Hernia wherein only one part of the wall protrudes out into the sac

A

Littre’s Hernia

280
Q

Division of Abdominal Wall (4 Quadrants)

A
    • R Upper Quadrant/RUQ
    • LUQ
    • R Lower Quadrant/RLQ
    • LLQ
281
Q

Division of Abdominal Wall - 9 Regions

A
    • Epigastric
    • R /L hypochondrium
    • R / L Lumbar
    • Umbilical
    • R/ L Iliac
    • Hypogastric
282
Q

Division of Abdominal Wall – Planes

A

Planes for regional division
Subcostal – thru costal margins
Transtubercular – thru iliac tubercles

Plane for quadrant division
Transumbilical – thru umb.

283
Q

Surgical Incisions (Abdomen) - Midline incision

A
  1. Xiphoid-pubic
  2. Supraumbilical
  3. Infraumbilical
284
Q

Surgical Incisions (Abdomen) - Longitudinal

A
    • Paramedian - lateral to the median plane
    • Pararectus
    • Transrectus
285
Q

Surgical Incisions – Transverse

A
  1. Supraumbilical – above the umbilical line
  2. Rockey-Davis - for appendectomy
  3. Pfannenstiel - bikini incision
286
Q

Surgical Incisions (Abdomen) - Oblique incision

A
  1. Kocher’s
  2. Gibson’s
  3. McBurney’s
  4. Lumbotomy
287
Q

Surgical Incisions (Abdomen) - Other incisions

A
  1. Chevron

2. Hockey stick

288
Q

Abdominal Surgical Incisions

A
  1. Midline –done rapidly; no blood vessels cut (less bleeding); incise at linea alba; entry for trauma
  2. Paramedian –lateral to midline; encounter bleeding; entry for complicated appendicitis
  3. Suprapubic – above pubic symphysis; below arcuate line; entry for pelvic organs, cesarian section
  4. Subcostal –below ribs [costal margin]; cut thru rectus muscle; bleeds [cut sup epig vessels]; entry for gallbladder[R]/spleen[L]
  5. McBurney –oblique at R lower area; cut thru all flat muscles; entry for appendicitis
289
Q

Posterior Abdominal Wall is composed of:

A
  1. Bones–Lumbar vertb., Sacrum , Ilium
  2. Muscles–Diaphragm, Psoas, Iliacus, Quadratus lumborum
  3. Fascia–Iliac, Quadratus lumborum, Thoracolumbar
  4. Blood vessels
  5. Nerves–Lumbosacral plexus
  6. Fats
  7. Lymph nodes
290
Q

Muscles of the Posterior Abdominal Wall

A
  • Diaphragm
  • Quadratus lumborum
  • Psoas major
  • Psoas minor
  • Iliacus
291
Q

Psoas Major

A

thick, fusiform ; “ muscle of the loin”
ORIGIN: Transverse processes of the lumbar vertb; sides of bodies of T12 –L5
INSERTION: Lesser trochanter of femur
ACTION: Flexes the vertb. Column, flexes the hip
NERVE SUPPLY: L2L3L4

292
Q

Iliacus

A

–large, triangular on the lateral side of Psoas major
ORIGIN: Superior 2/3 of iliac fossa; ala of sacrum; sacroiliac ligament
INSERTION: Lesser trochanter of femur
ACTION: Flexes thigh and stabilizes hip joint, flexes the trunk
NERVE SUPPLY: Femoral nerve (L2L3L4)

293
Q

Quadratus lumborum

A

ORIGIN: Inferior border of 12thrib; tips of lumbar transverse processes
INSERTION: Iliolumbar ligament; Iliac crest
ACTION: Extends and Laterally flexes the vertb. Column
NERVE SUPPLY: Ventral branches of T12 and L1 –L4

294
Q
    • Body is massive and kidney shaped
    • Intervertebral disc is thicker than other region
    • Wedge-shaped-responsible for normal lordosis
A

Lumbar Vertebrae

295
Q
    • Head has single facet
    • Anterior end is pointed
    • Has a small costal cartilage
A

Twelfth pair of Ribs

296
Q

Ventral Primary Divisions Of The Lumbar, Sacral And The Coccygeal Nerves

A
    • lumbar and sacral plexusessupply the lower limb

- - sacral nerves supply: the perineum (pudendal plexus) and the coccygeal region (coccygeal plexus)

297
Q
    • ventral primary divisions of 1st three and greater part of the 4th lumbar nerves - (+)contributions fr the 12th thoracic nerve
    • situated on either sides of the post. abd’l wall dorsal to the psoasor ventral to the transverse processes of the vertebrae
A

Lumbar plexus

298
Q

Branches Of The Lumbar Plexus

A
    • ilioinguinal
    • iliohypogastric
    • genitofemoral- supply the caudal part of the parieties of the abd’l wall
    • lateral femoral cutaneous
    • accessory obturator
    • obturator
    • femoral - supply the anterior thigh and medial part of the leg
299
Q

The Largest Branches Of The Lumbar Plexus

A
  1. Obturator
  2. Femoral
  3. Lumbosacral Trunk
300
Q

course: lateral border of psoas major, crosses quadratus and pierces post part of transversalis abddivides into:
1. lateral cutaneous br
2. anterior cutaneous br
3. muscular branches to int obliqueand transversus abdominis

A

Iliohypogastric

301
Q

course: similar to the hypogastric but caudal to it
areas of distribution:
1. skin over proximal and medial thigh,r oot of penis and scrotum, mons pubis and labia majora
2. muscular branches to the I.O. and transversus abdclinical

A

ilioinguinal nerve

302
Q 
-- Superior lumbar triangle (Grynfeltt-Lesshaft triangle)
Borders
superior: 12th rib
lateral: Internal oblique
medial: Quadratus lumborum
A

Hernia of the Back

303
Q 
Inferior lumbar triangle (Petit’s Triangle)
Borders
-lateral: external oblique
-medial: latissimus dorsi
-inferior: iliac crest
A

Hernia of the Back

304
Q

– has no diagnostic value on patients suspected of having neurologic disease

    • technique is insensitive and nonspecific
    • Abnormalities seen rarely provide sufficient information for patient’s management
    • Shows bone density changes in some metabolic and pathologic conditions
A

Plain skull radiography

305
Q

– technique of choice for the initial diagnostic evaluation of most patients with neurologic disease

A

CT Scan / MRI

306
Q
    • PA view with 15 degree tilt of the tube caudally

- - Permits visualization of orbital structures: superior orbital fissures; sphenoid wings and frontal sinuses

A

Caldwell’s X-Ray Projection

307
Q
    • AP view with a 30 degree tilt of the tube caudally

- - Visualizes: occipital bone; mandibular condyles and mastoids

A

Towne’s View

308
Q

What We Look For In A Routine Skull Radiograph

A
    • Check all calcifications, such as may be found in the dura, the falx cerebri, pineal gland, choroid plexuses, petroclinoid ligament and the habenular commissure
    • Carefully define the sella turcica, its anterior and posterior clinoid processes and tuberculum sellae
    • The petrous ridges, orbits, sphenoid ridges, temporal bones and facial bones are carefully studied bilaterally
309
Q

What To Study On Lateral Skull Views

A 
Blood Vessel Markings
- pattern of the blood vessels grooves should be observed closely on lateral view
- Middle Meningeal Artery (MMA)
- Diploic Veins
Sutures
310
Q
    • Lateral view shows an oval shaped central depression in the sphenoid bone
    • It contains the pituitary gland
    • Normal measurement are 16 to 17 mm in the AP diameter
A

Sella Turcica

311
Q

– Right mandible clearly showing right ramus, angle and alveolar margins of the mandible

A

Right Oblique X-Ray View Of Mandible

312
Q

Layers of the abdominal wall in Midline incision:

A

skin»fascia (camper’s and scarpa’s)»linea alba»transversalis fascia»
extraperitoneal fat»peritoneum

313
Q

Layers of the abdominal wall in Paramedian Incision

A
    • skin, fascia (camper’s and scarpa’s) and the anterior rectus sheath are incised
    • The anterior rectus muscle is freed from the anterior sheath and retracted laterally.
    • The posterior rectus sheath (if above the arcuate line) or transversalis fascia (if below the arcuate line), extraperitoneal fat and peritoneum are then excised allowing entry to the abdominal cavity.
314
Q

Layers of the abdomen in Transverse Incision

A

skin, fascia, anterior rectus sheath, rectus muscle (+/- internal oblique, depending on the length of the incision), transversus abdominus, transversalis fascia, extraperitoneal fat and peritoneum. The medial aspect of this incision will be through the layers just like as in the midline incision.

315
Q

Layers of the abdominal wall in Subcostal Incision

A

Skin, rectus sheath, rectus muscle, internal oblique, trasnversus abdominus, transversalis fascia, extraperitoneal fat and peritoneum.

316
Q

Layers of the abdominal wall in McBurney’s Incision

A

skin, fascia, internal oblique medially and external oblique laterally, transversus abdominus, transversalis fascia, extraperitoneal fat and peritoneum.

317
Q

Layers of the abdominal wall in Pfannenstiel incision

A

skin, fascia, anterior rectus sheath, rectus muscle, transversalis fascia, extraperitoneal fat, perineum.

Anatomy (10 decks)

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