OCB04-2004 Flashcards

1
Q

Where are the bodies of the sensory aspect of the trigeminal nerve located?

A

Trigeminal/Gasserion/semilunar ganglion

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2
Q

What does the ophthalmic division of the trigeminal nerve supply?

A

Sensory to:

  • most of skin of forehead
  • conjunctiva
  • upper eyelid
  • bridge of node
  • frontal sinus
  • anterosuperior nasal cavity mucosa
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3
Q

What does the maxillary division of the trigeminal nerve supply?

A

Sensory to:
- most of skin of cheek, upper lip and all structures deep to them (upper teeth, gums, soft and hard palate, maxillary sinus, posteroinferior nasal cavity)

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4
Q

What does the mandibular division of the trigeminal nerve supply?

A

Sensory to:
- skin of temple and most of skin over lower jaw (except over angle) and structures deep to them (lower teeth, gums, tongue)

Motor to muscles of mastication, tensor tympani, tensor palatini and anterior belly of digastric

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5
Q

What innervates the upper teeth?

A

Superior dental plexuses of V2

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6
Q

What innervates the lower teeth?

A

Inferior dental plexuses of inferior alveolar/dental nerve of V3

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7
Q

What is the main difference in the way the upper and lower teeth are innervated?

A

Upper = separate plexuses supply multiple teeth

Lower = inferior dental plexus supplies each tooth individually

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8
Q

Describe trigeminal neuralgia.

A

Sudden bursts of severe pains coming from one of more branches of C.V - V2 and V3 most commonly affected

Usually unilateral (rarely bilateral)

Most cases caused by a blood vessel pressing on the root of the nerve where it exits the skull

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9
Q

How can trigeminal neuralgia be treated?

A

Carbamazepine (anticonvulsant) calms activity of nerve and therefore pain

If ineffective then surgery (vascular decompression)

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10
Q

Describe the surgery often used to treat trigeminal neuralgia.

A

Posterior fossa craniotomy at the confluence of the sigmoid and transverse sinuses

Enter Meckel’s Cave and try to conduct vascular decompression of affected branch

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11
Q

What is the supraorbital nerve a branch of?

A

V1

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12
Q

What is the supratrochlear nerve a branch of?

A

V1

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13
Q

What is the infraorbital nerve a branch of?

A

V2

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14
Q

What is the mental nerve a branch of?

A

V3 (after inferior alveolar nerve)

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15
Q

What is the auriculotemporal nerve a branch of?

A

V3

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16
Q

What are the two parts of the auriculotemporal nerve?

A

Superior = sensory

Inferior = secretory motor parasympathetic fibres

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17
Q

Describe the branching of the external carotid artery that supplies the head/face.

A

Branches into external (facial) and internal maxillary arteries

Internal maxillary artery branches into:

  • infraorbital artery
  • greater palatine artery
  • middle meningeal artery
  • inferior alveolar artery
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18
Q

Where does the facial artery end?

A

After a tortuous journey, ends as the angular artery at the commissure of the eye

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19
Q

What does the infraorbital artery supply?

A

Skin of orbital area

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20
Q

What does the greater palatine artery supply?

A

Roof of mouth

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21
Q

What arteries does the middle meningeal artery anastomose with?

A

Ophthalmic and lacrimal arteries

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22
Q

Where does the (anterior) facial vein start?

A

Side of the root of the nose, direct continuation of angular vein

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23
Q

Which of the facial vein and artery has a more tortuous route?

A

Facial artery

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24
Q

What vein drains into the (anterior) facial vein?

A

External palatine vein

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25
What are the possible courses for the (anterior) facial vein?
Join the anterior branch of the retromandibular vein to form the common facial vein Drain directly into the internal jugular vein
26
Why is the (anterior) facial vein important clinically?
Direct connection with ophthalmic vein which leads to the cavernous sinus Bacteria can reach the internal cranial structures from the pterygoid plexus via this route
27
Which muscle raises the eyebrows?
Epicranius (frontalis and occipitalis)
28
What makes up the epicranius?
Frontalis and occipitalis
29
Where is the origin and insertion of the epicranius?
Cranial aponeurosis Eyebrows
30
What does the epicranius do?
Raises the eyebrows
31
Which muscle blinks and closes the eyes?
Orbicularis oculi
32
What does orbicularis oculi do?
Blinks and closes the eyes
33
Where is the origin and insertion of the orbicularis oculi?
Portions of frontal and maxilla bones to skin around eyes
34
What does the orbicularis oris do?
Closes and protrudes lips
35
What muscle closes and protrudes the lips?
Orbicularis oris
36
Where is the origin and insertion of orbicularis oris?
Skin around mouth
37
What does the buccinator do?
Flattens cheek against teeth
38
What muscle flattens the cheek against teeth?
Buccinator
39
Where is the origin and insertion of the buccinator?
Mandible/maxilla to skin around mouth
40
What does the zygomaticus do?
Raises corner of mouth
41
What muscle raises the corner of the mouth?
Zygomaticus
42
Where is the origin and insertion of the zygomaticus?
Zygomatic bone to corner of lips
43
What does the platysma do?
Draws mouth downwards
44
What muscle draws the mouth downwards?
Platysma
45
Where is the origin and insertion of the platysma?
Fascia of chest to lower border of mandible
46
What are the four types of branches found in the facial nerve?
Branchial motor/special visceral efferent Visceral motor/general visceral efferent Special sensory/special afferent General sensory/general somatic afferent
47
Which part of the facial nerve has the main 5 branches?
Branchial motor/special visceral efferent
48
What does the branchial motor/special visceral efferent branch of the facial nerve innervate?
Muscles of facial expression Posterior belly of digastric Stylohyoid Stapedius
49
What does the visceral motor/general visceral efferent branch of the facial nerve innervate?
Parasympathetic to lacrimal, sublingual and submandibular glands and mucous membranes of nasopharynx, hard and soft palates
50
What does the special sensory/special afferent branch of the facial nerve innervate?
Taste for anterior 2/3 of tongue, hard and soft palate
51
What does the general sensory/general somatic afferent branch of the facial nerve innervate?
General sensation from skin of concha of the auricle and from a small area behind the ear
52
Which branches of the branchial motor/special visceral efferent facial nerve control the upper muscles of facial expression? Is it bi or unilateral control?
Temporal and zygomatic Bilateral control
53
Which branches of the branchial motor/special visceral efferent facial nerve control the lower muscles of facial expression? Is it contra or unilateral control?
Buccal and mandibular Contralateral control
54
Describe Bell's palsy.
Lower motor neuron lesion of facial nerve due to swelling, inflammation, infection... Develops quickly in 1-3 days Slowly improves or completely goes away in 1-3 months Most recover but some are left with weakness on affected side Most common in adults in their 40s Symptoms: - droopy eyelid, dry eye or excessive tears - unilateral facial paralysis, twitching or weakness - drooping of corner of mouth, dry mouth, impaired taste
55
Why is any swelling of the parotid gland painful?
Gland is tightly enclosed in fascia
56
What muscles does the Stensen duct lie on and pierce?
Lies on masseter Pierces buccinator
57
Which structures branch within/close to the parotid gland?
Facial nerve External carotid artery --> maxillary and superficial temporal
58
What are the layers of the scalp from superficial to deep?
Skin Connective tissue (dense) Aponeurosis of epicranius/occipitofrontalis Loose connective tissue Periosteum (SCALP is an acronym for the layers)
59
What is the cutaneous innervation for the scalp?
Supraorbital nerve of V1 = front (forehead) Auriculotemporal nerve of V3 = sides Lesser occipital nerve of C2 = sides Greater occipital nerve of C2 = back
60
Describe the arterial supply of the scalp.
Superficial temporal artery of ECA Supraorbital artery Occipital and posterior auricular artery of ECA Free anastomoses from side to side and they run through the dense connective tissue
61
How do "panda's eyes" arise?
Loose connective tissue of scalp allows fluid to pass freely from the posterior aspect to the eyelids anteriorly Trauma at the back of the head leads to blood in the eyelids
62
Where does the facial nerve leave the skull?
Stylomastoid foramen | IAM = exiting the intracranial region