Notes Flashcards
Fracture of the lamina papyracea of the ethmoid bone could entrap what muscle? How would this affect gaze?
Entraps the medial rectus –> can’t gaze laterally
Fracture of the orbital plate of the maxilla can entrap what muscles? What would be the impact on gze?
Inferior rectus or inferior oblique muscles –> can’t gaze upward
Fracture of the cribiform plate would result in
Damage to olfactory nerves
Leakage of CSF through nose
What artery can cause nerve compression resulting in diplopia?
Anterior inferior cerebrellar artery compresses the abducens nerve.
Aneurysm of what artery can result in visual deficits of both eyes?
Anterior communicating artery compressing the optic chiasm
What two arteries can compress the ___ nerve, resulting in ptosis?
Superior cerebellar or posterior cerebral arteries compress the oculomotor n.
What artery can compress the _____ nerve, making it impossible to depress the adducted eye?
Superior cerebellar artery can compress the trochlear n –> can’t depress the adducted eye
Olfactory nerve cells’ processes pass through the cribiform plate and end in olfactory bulbs, which lie on either side of the
crista galli
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Oculomotor nerve innervates what muscles? So youc an look where?
Innervates
- superior, inferior, and medial rectus
- Inferior oblique
Look upward & inwards
Can’t depress the abducted eye - what nerve and muscle are responsible?
Trochlear nerve innervates the superior oblique muscle,
The superior tarsal muscle of Muller is innnrvated by ___ and helps elevate teh eyelids. Thus, loss of innervation would result in ____.
superior tarsal muscle of muller innervated by sympathetics; loss of sympathetic innervation would result in partial ptosis.
How to test the trochlear n?
Look with each eye toward the tip of the nose
What sinus is located immediatley laterlaly to the nasal cavity?
Maxillary sinus
Where are the sensory neuron cell bodies of the trigeminal nerve (CN V)?
Trigeminal ganglion
Tic douloureux (trigeminal neuralgia) damages this, causing pain over the area of the distribution of the trigeminal n branches
Miosis, ptosis, and anhydrosis of the head and neck indicate injury to the ___ ganglion
superior cervical ganglion
horner’s syndrome
____ provides sympathetic innervation to dilate the pupil.
____ provides paraysmpathetic innervation to constrict the pupil.
Superior cervical ganglion provides sympathetic innervation to dilate the pupil (reflex to light)
Oculomotor nerve provides paraysmpathetic innervation to constrict the pupil.
_____ nerve carries sympathetic innervation to the blood vessels and mucous glands of the head and neck
Deep petrosal n
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Orbicularis oculi is innervated by ____ and is responsible for ___ing the eye.
Two parts?
Innervated by facial nerve; responsible for closing the eyelid.
- Palpebral part closes it nromally
- Lacrimal part closes it forcibly
Horner’s vs Raynaud’s
Horner’s - absence of sympathetic innervation –> slight ptosis and miosis
Raynaud’s - excessive sympathetic vasoconstriction
Frey’s syndrome
Excessive facial sweating when thinking about food; caused in a parotidectomy that cuts the parasympathetics of the auriculotemporal nerve.
The postganglionic cholinergic axons establish synapses upon the cholinergic sweat glands post-op.
What runs in the mandibular foramen
The inferior alveolar branch of V3 passes into this foramen to drop down to the supply the mandibular teeth
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Easiest place to injure the facial nerve
Where it exits the stylomastoid foramen
Headaches are due to meninges.
What innervates meninges of the anterior, posterior, and middle cranial fossa?
- Meningeal branches of ethmoidal nerves (from ophthalmic nerve)- anterior
- Meningeal branches of maxillary nerve - middle
- Meningeal branches of mandibular - posterior
Where is the superior cervical ganglion relative to the carotid sheath?
Lies deep tot he sheath, but anterior to the longus capitis.
While the superior ophthalmic vein drains directly into the cavernous sinus, the pterygoid venous plexus communicates with teh cavernous sinus through the
emissary veins
Mastoiditis (infection of the mastoid air cells of the mastoid process) will affect what sinus?
Sigmoid sinus
Mastoiditis > mastoid emissary veins > sigmiod sinus > jugular vein
Arachnoid villi
Extensions of arachnoid mater into the superior sagittal sinus that allow drainage of CSF into venous bloodstream; crucial to maintaining proper intracranial pressure
What veins are responsible for communication between the veins of the scalp and the venous sinsues of the brain?
Diploic veins within the skull bone connects the emissary veins of scalp to _venous sinuse_s between the two layers of dura.
-> infection from laceration on scalp can reach venous sinuses
Labyrinthine or endolymphatic hydrops is known as
Meniere’s disease
- Intermittent hearing loss
- tinnitis
- spinning sensation
- ear fullness
Tumor at the cerebllopontine angle, such as an acoustic schwannoma, is most likely to affect what two nerves?
Vestibulochochlear n first, then facial n
Corneal (blink) reflex
Afferent - nasociliary n of CN5
Efferent - facial n (CN7)
Pupillary (light) reflex
Afferent - optic n (CN2)
Efferent - oculomotor n (CN3)
A lesion to ____ will cause the eye to remain in a “down and out” position, partial/complete ptosis, and dilated pupil.
Oculomotor nerve
Paralyzed oculomotor n
- –> lateral rectus & superior oblique unopposed
- –> no parasympathetics going to the levator palpebrae
- –> no parasympathetics goign to the constrictor pupillae
Where to insert anesthesia to anesthetize orbital contents and eyelid injury?
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The conjuctiva covering the sclera is supplied by the nasociliary branch, so you have to insert the needle through the upper eyelid deeply toward the orbital apex to infiltrate the nasociliary n, and also between the orbital septum and the palpebrae musculature laterally to anesthetize the lateral sensory supply from lacrimal n.
Most common location of trochlear n injury
Where it pierces the dura of the tentorium cerebelli in the tentorial notch –> adducted eye can’t look down
Ex) Dashboard injury
Chalazion
obstructed tarsal gland
Major blood supply to the intima of the eye
Central retinal artery
If the ____ nerve is damaged, then the uvula will deviate to the UNAFFECTED side
Vagus nerve –> uvula deviates to UNAFFECTED side
Infection can spread from the pharynx to the ___ via the pharyngotympanic tube
middle ear
In an inferior (blow-out) fractur eof the orbit, orbital structures would mostlikely be found inferiorly in th e___ sinus
Maxillary sinus is right below orbit
What muscle is more likely to be affected if the TMJ gets inflamed?
- Lateral pterygoid
- Medial pterygoid
- Masseter
- Temporalis
- Buccinator
Lateral pterygoid
What chamber of the eye receives aqueoud humor secreted by the ciliary body first?
Posterior chamber -> will increase intraocular pressure
What sinus provides the most direct access to the pituitary gland above it?
Sphenoidal sinus
Hypertrophy of what tonsil could block the drainage of the auditory/eustachian tube, resulting in fluid in the middle ear?
Pharyngeal tonsil
Main blood supply of the palatine tonsil
Facial artery’s tonsillar branch
Which muscle is most important in jaw protrusion and jaw opening (depressing the mandible)?
Lateral pterygoid
An eye infection (posterior orbit) drains into what lymph nodes?
Preauricular / Deep parotid nodes
What nodes drain the superior nodes of the face and the tonsils?
Jugulodigastric lymph nodes
What nodes drain the side of the cheek, lateral nose, and lips?
What nodes drain the tip of tongue and chin?
cheek, lateral nose, and lips = submandibular nodes
tip of tongue and chin = submental nodes
Zenker’s pharyngeal diverticulum is a pouch that can catch stuff, causing ifnlammation, infection, abscess, and coughing. Where is it?
Between cricopharyngeal and thyropharyngeal portions of the inferior pharyngeal constrictor
What nerve is in the tonsillar bed and is at risk in tonsillectomy?
Glossopharyngeal n
It’s in the tonsillar bed as it runs with the stylopharyngeus muscle
What nerves are between the two heads of the lateral pterygoid muscle?
Lingual nerve & Buccal nerve
What innervates the sternohyoid, sternothyroid, and omohyoid muscles?
Ansa cervicalis
