Noses, Sinuses, Orbit & Nerves Flashcards

1
Q

What is the only sensory nerve arising from the anterior division ofV3?

A

Buccal nerve.

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2
Q

What are the 4 ganglia associated with the cranial parasympathetic system?

A

Ciliary, pterygopalatine, submandibular, and otic.

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3
Q

Preganglionic parasympathetic cell bodies are associated with which nerves in the head and neck?

A

Cranial nerves III, VII, IX, X and spinal nerves 2, 3, and 4.

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4
Q

What is the stellate ganglion?

A

Fusion of the of the first thoracic ganglion and the inferior cervical ganglion; it relays sympathetic input to the upper limbs.

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5
Q

What is the terminal branch ofV2?

A

Infraorbital nerve.

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6
Q

What is the function of the glossopharyngeal nerve?

A

Motor to the stylopharyngeus; taste to posterior 1/3 tongue; parotid gland stimulation; sensation of postauricular skin, pharynx, soft palate, tympanic cavity, and eustachian tube.

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7
Q

From what nerve do the anterior and posterior ethmoidal nerves arise?

A

Nasociliary nerve.

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8
Q

What nerve usually passes from lateral to medial over the optic nerve?

A

Nasociliary.

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9
Q

What are the nuclei of the vagus nerve?

A

Nucleus ambiguus, dorsal motor nucleus, and the nucleus of the solitary tract.

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10
Q

Which of these controls voluntary motor information?

A

Nucleus ambiguus.

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11
Q

Which of these receives sensory information?

A

Nucleus of the solitary tract.

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12
Q

What information is relayed through the inferior ganglion?

A

Sensation from the epiglottis and larynx.

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13
Q

What information is relayed through the superior ganglion?

A

Sensation from the external auditory canal and posterior auricle via Arnold’s nerve.

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14
Q

What are the two ganglia of the vagus nerve?

A

Superior (jugular) ganglion and inferior (nodose) ganglion.

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15
Q

Which cranial nerve has the longest intracranial course?

A

VI.

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16
Q

With one exception, all the muscles of the pharynx are innervated by what nerve?

A

X.

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17
Q

What is the distance from the posterior ethmoid artery to the optic foramen?

A

5-10 mm.

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18
Q

When does aeration of the frontal sinus begin?

A

Age 4-5 years, and continues into the late teens.

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19
Q

Where is the anterior ethmoid artery found intranasally?

A

Anterior to the vertical portion of basal lamella, immediately below the skull base, and posterior to the frontal recess.

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20
Q

Where does the maxillary sinus ostium lie in relation to the ethmoid infundibulum?

A

At the floor and lateral aspect of the infundibulum, between its middle and posterior 1/3.

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21
Q

What structure separates the anterior and posterior ethmoid complexes?

A

Basal lamella of the middle turbinate.

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22
Q

What is the most posterior part of the middle turbinate attached to?

A

Crista ethmoidalis of the perpendicular process of the palatine bone.

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23
Q

What recess does the suprabullar recess open into?

A

Frontal recess; anteriorly, it is separated from the recess by the bulla lamella.

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24
Q

What does the retrobullar recess drain into?

A

Hiatus semilunaris superior.

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25
Q

What are the borders of the ethmoid infundibulum?

A

Medially, the uncinate process; laterally, the lamina papyracea and frontal process of the maxilla; and posteriorly, the ethmoid bulla.

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26
Q

What is the narrowest portion of the nasal cavity?

A

Nasal valve.

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27
Q

What is the most common cause of taste loss?

A

Olfactory dysfunction.

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28
Q

What are the 4 possible configurations of the ethmoid roof described by Keros

A
  • Type 1: olfactory fossa I - 3 mm deep.
  • Type I I: olfactory fossa 4 - 7 mm deep.
  • Type III: olfactory fossa 8 - 16 mm deep.

Asymmetric skull base

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29
Q

Where does the sphenoid ostium lie in relation to the chonal bridge

A

1.5 em above or 1/3 distance from chonae to the skull base.

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30
Q

What percent of the population has a unilateral frontal sinus?

A

10%.

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31
Q

What % of people have a sphenoethmoid cell

A

12%.

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32
Q

Where are the natural ostia of the sphenoid sinus’

A

2/3 of the way from the vaginal process to the top of the anterior sphenoid wall.

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33
Q

What % of patients have a bony dehiscence of the canal covering the anterior ethmoid artery

A

20- 40%.

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34
Q

What % of patients have a bony dehiscence of the cavernous portion of the carotid canal

A

22%.

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35
Q

What are the normal dimensions of the frontal sinus

A

28 mm (length) x 24 mm (width) x 20 mm (depth) (Van Alyea).

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36
Q

Where does the nasolacrimal duct lie in relation to the ostium of the maxillary sinus

A

3 - 6 mm anteriorly.

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37
Q

What is the normal angle of a line drawn from the nasal spine to the sphenoid ostium

A

30 degrees.

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38
Q

Where does the nasolacrimal duct lie in relation to the ostium of the maxillary sinus?

A

3-6 mm anteriorly.

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39
Q

What % of patients have a very thin or absent bone of the optic canal

A

4%.

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40
Q

What is the distance from the posterior ethmoid artery to the optic foramen

A

5- 10 mm.

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41
Q

What percent of the population has a supreme nasal concha?

A

60%.

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42
Q

When does aeration of the frontal sinus begin

A

Age 4 - 5 and continues into the late teens.

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43
Q

At what age can the maxillary sinuses be visualized on a computed tomography (CT) scan?

A

Age 4-5 months.

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44
Q

Which muscles depress the nose?

A

Alar nasalis and depressor septi nasi muscles.

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45
Q

Where is the anterior ethmoid artery found intranasally

A

Anterior to the vertical portion of basal lamella, immediately below the skull base, and posterior to the frontal recess.

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46
Q

Where is the optic canal in relation to the sphenoid

A

Anterolateral aspect of the sphenoid roof.

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47
Q

Where does the maxillary sinus ostium lie in relation to the ethmoid infundibulum

A

At the floor and lateral aspect of the infundibulum between its middle and posterior I /3.

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48
Q

What structure separates the anterior and posterior ethmoid complexes

A

Basal lamella of the middle turbinate.

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49
Q

What are the nasal fontanelles

A

Bony dehiscences of the lateral nasal wall usually above the insertion of inferior turbinate where the nasal mucosa approximates the mucoperiosteum of the maxillary sinus.

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50
Q

What is the optic nerve tubercle

A

Bony protuberance on the medial surface of the optic foramen.

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51
Q

How is the sensory epithelium of the olfactory system different from the surrounding respiratory epithelium?

A

Both have cilia, but the cilia of the olfactory epithelium do not beat synchronously.

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52
Q

What is the term for a pneumatized second basal lamella?

A

Bulla ethmoidalis.

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53
Q

What is the term for a pneumatized second basal lamella

A

Bulla ethmoidalis.

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54
Q

What is the blood supply to the retina

A

Choroid chorio capillaries (outer half) and central retinal artery and branches.

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55
Q

What type of epithelium lines the nasal cavity?

A

Ciliated pseudostratified epithelium.

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56
Q

What bony structure is found posterior to the sphenoid

A

Clivus.

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57
Q

What are the major tip support mechanisms?

A

Contour, size, and strength of the lateral crura; attachment of the medial crural footplate to the caudal septum; and attachment of the caudal edge of the upper lateral cartilage to the upper edge of the alar cartilages (Scroll area)

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58
Q

What is the most posterior part of the middle turbinate attached to

A

Crista ethmoidalis of the perpendicular process of the palatine bone.

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59
Q

What is parosmia?

A

Distorted perception of an odor.

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60
Q

What are odorous substances made of?

A

Either gases or volatile liquids.

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61
Q

Where does the natural ostium of the maxillary sinus empty?

A

Ethmoid infundibulum.

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62
Q

Where does the natural ostium of the maxillary sinus empty

A

Ethmoid infundibulum.

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63
Q

T /F: Presence of a conchal sphenoid is an absolute contraindication to transsphenoidal hypophysectomy.

A

False (the bone can be drilled out to permit access).

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64
Q

T/F: Tumors isolated to the sphenoid sinus and sella are best approached trans palatally

A

False, best approach is transseptal or transethmoid unless the tumor extends into the nasopharynx.

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65
Q

T/F: The frontal recess is synonymous with the nasofrontal duct

A

False, the nasofrontal duct bridges the frontal recess with the frontal sinus.

66
Q

What is the osteomeatal complex

A

Final common pathway for drainage and ventilation of the frontal, maxillary, and anterior ethmoid cells.

67
Q

From anterior to posterior, what structures comprise the medial orbital wall

A

Frontal process of the maxilla, lacrimal bone, lamina papyracea, sphenoid bone to optic nerve foramen.

68
Q

What recess does the suprabullar recess open into

A

Frontal recess; anteriorly it is separated from the recess by the bulla lamella.

69
Q

Into what does the ethmoid infundibulum drain posteriorly?

A

Hiatus semilunaris inferior.

70
Q

Into what does the ethmoid infundibulum drain posteriorly

A

Hiatus semilunaris inferior.

71
Q

What does the retrobullar recess drain into

A

Hiatus semilunaris superior.

72
Q

Through which area can the suprabullar and retrobullar recesses be accessed medially and inferiorly

A

Hiatus semilunaris superior.

73
Q

What is the name of the space between the bulla ethmoidalis and the middle turbinate

A

Hiatus semilunaris superioris.

74
Q

When may the suprabullar recess extend into the retrobullar recess?

A

If the posterior wall of the bulla lamella is not in contact with the basal lamella of the middle turbinate.

75
Q

When may the suprabullar recess extend into the retrobullar recess

A

If the posterior wall of the bulla lamella is not in contact with the basal lamella of the middle turbinate.

76
Q

Where does the sphenoid sinus lie in relation to the most posterior ethmoid cell

A

Inferior and medial.

77
Q

What is a Haller cell

A

Infraorbital ethmoid cell at the roof of maxillary sinus.

78
Q

What structures are found within the cavernous sinus

A

Internal carotid artery, venous channels, III, lV, VI, VI, V2.

79
Q

What is the bulla lamella

A

Lamella of bone that when pneumatized forms the ethmoid bulla.

80
Q

What is the thinnest bone of the anterior skull base

A

Lateral lamella of the cribriform plate, where the anterior ethmoid artery crosses from the medial orbital wall to the cribriform.

81
Q

Where does the anterior portion of the middle turbinate most often attach superiorly?

A

Laterally onto the lamina papyracea (may also attach to the skull base).

82
Q

Where does the anterior portion of the middle turbinate most often attach superiorly

A

Laterally onto the lamina papyracea (may also attach to the skull base).

83
Q

What structures can a Haller cell potentially narrow

A

Maxillary sinus ostium or ethmoid infundibulum.

84
Q

Where is the natural ostium of the sphenoid sinus in relation to the superior turbinate

A

Medial, and within millimeters of its inferior border.

85
Q

What are the borders of the ethmoid infundibulum

A

Medially, the uncinate process; laterally, lamina papyracea and frontal process of the maxilla; posteriorly, ethmoid bulla.

86
Q

What problem can an enlarged agger nasi cell cause?

A

Narrowing of the frontal recess.

87
Q

What problem can an enlarged agger nasi cell cause

A

Narrowing of the frontal recess.

88
Q

What are the nasal anatomic subunits?

A

Nasal dorsum, nasal sidewalls, nasal tip, alar lobules, and depressions of the supra-alar facets.

89
Q

What are the minor tip support mechanisms?

A

Nasal tip ligamentous aponeurosis; cartilaginous septum; nasal spine; strength and resilience of the medial crura; thickness of tip skin and subcutaneous tissue; and supportive strength of the alar sidewalls.

90
Q

What important structures may run through an Onodi cell

A

Optic nerve and carotid artery.

91
Q

The____ is fully formed by the 5th week gestation and goes on to develop into the floor of the nose/palate.

A

Oronasal membrane.

92
Q

What is phantosmia?

A

Perception of an odor in the absence of a stimulus.

93
Q

What is dysosmia?

A

Perception of an unpleasant odor.

94
Q

What makes up the superior portion of the bony nasal septum?

A

Perpendicular plate of the ethmoid.

95
Q

What is an agger nasi cell?

A

Pneumatized area of the lateral nasal wall immediately anterior and superior to the insertion of the middle turbinate.

96
Q

What is an agger nasi cell

A

Pneumatized area of the lateral nasal wall immediately anterior and superior to the insertion of the middle turbinate.

97
Q

What is a concha bullosa

A

Pneumatized middle or superior turbinate.

98
Q

What are sphenoethmoid or Onodi cells

A

Pneumatized posterior ethmoid cells, superolateral to the sphenoid sinus.

99
Q

Which table of the frontal sinus is thinner?

A

Posterior.

100
Q

Which structures can narrow the frontal recess

A

Posteriorly, ethmoid bulla/bulla lamella; anteriorly, a pneumatized agger nasi cell.

101
Q

Which muscles elevate the nose?

A

Procerus, levator labii superioris alaeque nasi, and anomalous nasi muscles.

102
Q

What is the most posterior aspect of the anterior ethmoids?

A

Retrobullar recess.

103
Q

What is the most posterior aspect of the anterior ethmoids

A

Retrobullar recess.

104
Q

What are the 3 types of sphenoid sinuses as described by Hamberger

A

Sellar (67 - 76%): sella turcia bulges into a well-developed sinus; Presellar (23 - 28%): cancellous bone extends from under the sella to the anterior aspect of the floor; Concha (0 - 5°/o): sphenoid sinus is entirely filled with cancellous bone.

105
Q

In what ways is the middle turbinate an important surgical landmark

A

Separates the cribriform plate from the fovea ethmoidalis; anterior tip marks the limit of the anterior dissection of maxillary antrostomy; basal lamella identifies entrance into the posterior ethmoids; lower half and insertion into the choanae help identify entrance into the sphenoid sinus.

106
Q

What is another name for the retrobullar recess?

A

Sinus lateralis.

107
Q

What is another name for retrobullar recess

A

Sinus lateralis.

108
Q

What is the sphenoethmoid recess

A

Space between the superior (and supreme, if present) turbinate laterally, the cribriform plate superiorly, septum medially, anterior face of the sphenoid posteriorly, inferior margin of the superior turbinate inferolaterally.

109
Q

What neuropeptide is thought to be a mediator of pain in the nose and paranasal sinuses?

A

Substance P.

110
Q

The majority of posterior ethmoid cells empty into which meatus?

A

Superior meatus.

111
Q

The majority of posterior ethmoid cells empty into which meatus

A

Superior meatus.

112
Q

What are the borders of the suprabullar recess

A

Superiorly, the ethmoid roof; laterally, the lamina papyracea; inferiorly, the roof of the ethmoid bulla; posteriorly, the basal lamella of the middle turbinate.

113
Q

What is the nasal valve?

A

The angle between the caudal quadrangular cartilage and the distal upper lateral cartilages.

114
Q

What defines the configuration of the ethmoid roof

A

The length of the lateral lamella of the cribriform plate, which determines the depth of the olfactory fossa.

115
Q

What is the frontal recess

A

The most anterior and superior part of the anterior ethmoid complex.

116
Q

What is the only septal component that is paired?

A

The vomer, which may be bilaminar owing to its dual embryonic origin.

117
Q

What are Bowman’s glands?

A

They secrete mucus and yellow pigment in the olfactory epithelium; the odorant must dissolve in this layer of mucus to reach the sensory receptors.

118
Q

What are the major anatomic features that determine tip projection?

A

Thickness and character of tip skin; shape and strength of alar cartilages; length of infratip lobule and columella; anatomy of the quadrangular cartilage (especially the anterior septal angle); and size of the nasal spine and premaxilla.

119
Q

What is the term for a persistent, nonpneumatized second basal lamella?

A

Torus ethmoidalis lateralis.

120
Q

What is the term for a persistent, non-pneumatized second basal lamella

A

Torus ethmoidalis/lateralis.

121
Q

What are the other muscles of the nose (the compressor and dilators)?

A

Transverse nasalis, compressor narium minor, and dilator naris anterior muscles.

122
Q

What are the five basal or ground lamella of the paranasal sinuses?

A

Uncinate process, bulla ethmoidalis, basal lamella of the middle turbinate, lamella of the superior turbinate, and lamella of the supreme turbinate (if present).

123
Q

What are the 5 basal or ground lamella of the paranasal sinuses

A

Uncinate process, bulla ethmoidalis, basal lamella of the middle turbinate, lamella of the superior turbinate, lamella of the supreme turbinate (if present).

124
Q

What is the incidence of frontal sinus agenesis

A

Unilateral agenesis 4%; bilateral agenesis 5%.

125
Q

Which of these nerves is closely associated with the lateral wall of the ICA

A

VI.

126
Q

Where are the anterior and posterior ethmoid arteries and optic canal in relation to the anterior lacrimal crest?

A

24-12-6 rule: Anterior ethmoid artery is approximately 24 mm posterior to the lacrimal crest; the posterior ethmoid artery is 12 mm posterior to the anterior ethmoid artery; the optic canal is 6 mm posterior to the posterior ethmoid artery.

127
Q

What is the average volume of the orbit?

A

30 cm3.

128
Q

What is the average depth of the orbit?

A

40-50 mm.

129
Q

What is trichiasis?

A

Abnormal direction of the eyelashes.

130
Q

What provides dynamic support to the lower lid?

A

Adhesion of the pretarsal portion of the orbicularis to the tarsal plate.

131
Q

What are the three limbs of the medial canthal tendon?

A

Anterior, superior, and posterior limbs.

132
Q

What are the lower eyelid retractors?

A

Capsulopalpebral fascia and the inferior tarsal muscle.

133
Q

What structure in the lower lid is analogous to the levator aponeurosis of the upper lid?

A

Capsulopalpebral fascia.

134
Q

What structures make up the posterior lamella of the lid?

A

Conjunctiva and the tarsal plate.

135
Q

What is the origin of the superior tarsal muscle (of Muller)?

A

Deep side of the levator palpebrae superioris.

136
Q

What is the term for gross asymmetry of eye movement?

A

Heterotropia.

137
Q

What structures pass through the superior orbital fissure?

A

III, IV, VI, V1, and superior ophthalmic vein.

138
Q

Which skeletal muscles are innervated by the inferior division of III?

A

Inferior oblique, inferior rectus, and medial rectus muscles.

139
Q

What is Whitnall’s tubercle?

A

Insertion site of the lateral canthal tendon.

140
Q

What is the function of the deep head of the orbicularis oculi?

A

Inserts on the posterior lacrimal crest and provides structural support to the lid.

141
Q

What is the name of the fleshy, pink mound of tissue in the medial canthus?

A

Lacrimal caruncle.

142
Q

What does the medial epicanthal fold cover?

A

Lacrimal lake.

143
Q

What happens with disruption of the deep head?

A

Lateral and anterior displacement of the medial canthal angle.

144
Q

What structure divides the lacrimal gland into two lobes?

A

Levator aponeurosis.

145
Q

What is unique about the anatomy of the Asian eyelid?

A

Levator muscle lacks attachment to the pretarsal skin, resulting in an absent pretarsal fold.

146
Q

Periosteum and periorbita meet at the orbital margin and continue into the eyelids as what?

A

Orbital septum.

147
Q

Where does the lateral canthal tendon insert?

A

Orbital tubercle located 5 mm posterior to the lateral orbital rim.

148
Q

What lines the posterior surface of the eyelid?

A

Palpebral conjunctiva.

149
Q

What structures make up the anterior lamella of the lid?

A

Pretarsal orbicularis oculi muscle and the eyelid skin.

150
Q

What is Argyll Robertson pupil?

A

Pupil reacts to accommodation but not light; often associated with syphlis.

151
Q

What are the layers of the eyelid from superficial to deep?

A

Skin, subcutaneous tissue, voluntary muscle, orbital septum, tarsal plate, smooth muscle, and conjunctiva.

152
Q

Which of these covers the lacrimal fossa?

A

Superior limb.

153
Q

Which muscles are innervated by the superior division of III?

A

Superior rectus and levator palpebrae superioris muscles.

154
Q

What test may elicit a Marcus Gunn pupil?

A

Swinging flashlight test.

155
Q

What glands are contained within the tarsal plates?

A

Tarsal glands (Meibomian).

156
Q

What provides static support to the lower lid?

A

Tarsal plate and its associated medial and lateral canthal tendons.

157
Q

What does the gray line divide?

A

The anterior and posterior lamella.

158
Q

Which part of the lacrimal system is most vulnerable to injury?

A

The inferior canaliculus near the medial canthal tendon.

159
Q

What creates the gray line in the lid margin?

A

The muscle of Riolan.

160
Q

What structure forms the medial canthal tendon?

A

The superficial head of the pretarsal fibers of the orbicularis oculi muscle.