Oral Region, Nose, Paranasal Sinuses, and Ear Flashcards
What is included in the oral region?
- oral cavity
- teeth
- gingivae (gums)
- tongue
- palate
- region of the palatine tonsils
What does the mouth consist of?
- oral vestibule
- oral cavity proper
- What is the space between the teeth and lips/cheeks?
- What is the space internal to the teeth and gums?
- oral vestibule
- oral cavity proper
- What does the palate form?
- What consists of the anterior (concave) two thirds of the palate?
- What consists of the posterior third of the palate?
- the floor of the nasal cavity, the roof of the oral cavity
- hard palate
- soft palate
- What is the hard palate filled with?
- What is the hard palate formed by?
- What is the hard palate covered by?
- filled w/ tongue when it is at rest
- formed by: palatine processes of maxillae, horizontal plates of palatine bones
- covered by thick mucosa that overlies numerous mucus-secreting palatal glands
- What is the soft palate composed of?
- What do the muscles of the soft palate do?
- mucosa, mucosa-secreting palatal glands, 5 muscles contributing to its movements
- the muscles close of the nasopharynx when during swallowing
- What palate is filled with the tongue at rest?
- Which palate is important when we eat/swallow food?
- hard palate
- soft palate
- What are the 2 different bones that form the hard palate?
- What helps with airflow in the palate?
- What can be a big problem with sleep apnea due to it becoming enlarged and making it difficult to breathe while sleeping?
- palatine process of the maxilla (paired); palatine bone (paired)
- choana
- uvula
What allows for the connection between the ear and the oral cavity?
eustachian tube
What are the muscles of the soft palate and what are they innervated by?
- tensor veli palatini: CN V3 (n. to medial pterygoid via otic ganglion)
- levator veli palatini: CN X (pharyngeal branch)
- palatoglossus: CN X (pharyngeal branch)
- palatopharyngeus: CN X (pharyngeal branch)
- musculus uvulae: CN X (pharyngeal branch)
What opens the auditory/eustachian tube when swallowing?
tensor veli palatini
What is the function of the tensor veli palatini?
- tenses soft palate
- opens mouth of pharyngotympanic(eustachian) tube during swallowing and yawning
What is the function of the levator veli palatini?
elevates soft palate during swallowing and yawning
What is the function of the palatoglossus muscle?
- elevates posterior part of tongue
- draws soft palate onto tongue
What is the function of the palatopharyngeus muscle?
- tenses soft palate
- pulls walls of pharynx superiorly, anteriorly, and medially during swallowing
What is the function of the musculus uvulae?
- shortens uvula
- pulls uvula superiorly
- What are masses of lymphoid tissue?
- Where are these located?
- Each (…) lies in a (…) bounded by the palatoglossal and palatopharyngeal arches of the tongue
- palatine tonsils (“the tonsils”)
- one on each side of the oropharynx
- tonsil; tonsillar sinus
What is the tonsillar sinus bounded by?
palatoglossal and palatopharyngeal arches and the tongue
- What supplies blood to the palate?
- What is the sensory innervation of the hard palate?
- What is the sensory innervation of the soft palate?
- greater palatine arteries (br. of descending palatine arteries)
- nasopalatine and greater palatine nn (CN V2)
- lesser palatine nerves (CN V2)
- What is a strong, muscular organ (one of the strongest muscles in the body)?
- What does this muscle consist of?
- What are ^ innervated by?
- tongue
- intrinsic skeletal mm arranged in 4 different planes
- hypoglossal nerve (CN XII)
The tongue consists of intrinsic skeletal muscles arranged in 4 different planes, what are they?
- superior longitudinal muscle fibers
- inferior longitudinal muscle fibers
- transverse muscle fibers
- vertical muscle fibers
- What is the function of the intrinsic tongue muscles?
- What are they innervated by?
- change the shape of the tongue?
- hypoglossal n (CN XII)
What are the different extrinsic tongue muscles and what are they innervated by?
- genioglossus: CN XII
- hyoglossus: CN XII
- styloglossus: CN XII
- palatoglossus: CN X + pharyngeal plexus
- What is the function of the extrinsic tongue muscles?
- All extrinsic tongue muscles are innervated by (…) except for (…) which is innervated by (…)
- change the position of the tongue
- CN XII, except for palatoglossal m which is innervated by CN X
- What is the function of the genioglossus muscle?
- What is the function of the palatoglossus muscle?
- depresses/protrudes tongue
- elevates posterior tongue/depresses palate
What muscles retract the tongue during swallowing, pushing the bolus of food up against the palate as it is pushed posteriorly into the oropharynx ?
- hyoglossus m
- styloglossus m
What muscle can be considered both a muscle of the tongue and a muscle of the palate because it is innervated by the CN X rather than CN XII?
palatoglossus muscle
- What is the function of the hyoglossus muscle?
- What is the function of the styloglossus muscle?
- depresses/retracts tongue
- retracts tongue/draws it up for swallowing
How can you test the function of the hypoglossal nerve (CN XII)?
have pt protrude and laterally deviate their tongue
- The surface of the tongue is characterized by small (…) which is divided into four types.
- What are the four types?
- lingual papillae
four parts: - filiform
- fungiform
- circumvallate
- foliate
- What are the numerous slender projections that lack taste buds that give the tongue its rough or furry feel (has mechanical function)?
- What are large mushroom-shaped papillae scattered on the dorsum of the tongue’s surface that possess taste buds and are difficult to see grossly?
- filiform
- fungiform
- What are larger papillae that lie in a row just anterior to the sulcus terminalis and possess taste buds?
- What lie along the sides of the tongue and are rudimentary in humans and possess taste buds?
- circumvallate
- foliate
- Taste buds contain (…)
- They are primarily located on the (…) of the tongue
- They are also more sparsely scattered in the (…)
- taste receptor cells
- dorsum of the tongue
- epiglottis, palate, pharynx
The papillae of the tongue have what functions?
- taste (taste buds)
- mechanical function
- What part of the tongue is considered the pharyngeal tongue?
- What part of the tongue is considered the oral tongue?
- Where are there more tastebuds?
- posterior 1/3
- anterior 2/3
- Anterior tongue
- What provides taste (special sense) innervation to the anterior 2/3 of the tongue?
- What provides general somatic (touch, pressure, temperature) sensation to the anterior 2/3 of the tongue?
- chorda tympani n (facial n)
- lingual nerve (mandibular n - CN V3)
- What provides taste (special sense) sensation to the posterior 1/3 of the tongue?
- What provides general somatic (touch, pressure, temperature) to the posterior 1/3 of the tongue?
- glossopharyngeal n (CN IX)
- glossopharyngeal n (CN IX)
What plays a minor role in taste as it helps innervate the epiglottis?
vagus n (CN X)
- What are the motor nerves of the tongue?
- What do they innervate?
- vagus n (CN X) - palatoglossus n
- hypoglossal n (CN XII) - all other mm of the tongue
- What are the sensory nerves of the tongue?
- What sensation do they provide?
- internal laryngeal n (CN X) - taste
- glossopharyngeal n (CN IX) - general and special senses
- lingual n (CN V) - general sensory
- chorda tympani (CN VII) - special sensory
- What are hard, conical structures set in the dental alveoli of the upper and lower jaws that are used in mastication and assisting in articulation of speech?
- How many do children have?
- the teeth
- 20 pimary teeth
- When does the first tooth in children usually erupt?
- The last tooth?
- 6-8 months
- 20-24 months
Eruption of thepermanent (secondary) teeth, normally (…) in each jaw (3 molars, 2 premolars, 1 canine, and 2 incisors on each side), usually is complete by the (…), except for the third molars (wisdom teeth), which usually erupt during the (…)
- 16
- midteens
- late teens or early 20s
- What supplies blood to the maxillary (upper) and mandibular (lower) teeth?
- What vein(s) drain this region and into what?
- What innervates the maxillary and mandibular teeth?
- superior and inferior alveolar arteries (br. of maxillary artery)
- superior and inferior alveolar veins; drain into pterygoid venous plexus
- superior and inferior alveolar nn (br. of CN V2 and CN V3) which form superior and inferior dental plexuses
The(…) are composed of fibrous tissue covered with mucous membrane, which is firmly attached to the alveolar processes of the mandible and maxilla and the necks of the teeth
gingivae(gums)
- Thebuccal gingivaeof the mandibular molar teeth are supplied by the (…)
- Thelingual gingivaeof all mandibular teeth are supplied by the (…).
- Thepalatine gingivaeof the maxillary premolar and molar teeth are supplied by the(…)and the palatine gingivae of the incisors by the(…).
- The labial and buccal aspects of the maxillary gingivae are supplied by the (…)
- buccal nerve (br. of CN V3)
- lingual nerve
- greater palatine nerve
- nasopalatine nerve
- anterior, middle, and posteriorsuperior alveolar nerves
- What are air-filled extensions of the respiratory part of the nasal cavity into cranial bones (and are names in according to the bones they are located in)?
- What cranial bones do these extend into?
- paranasal sinuses
- frontal, ethmoid, sphenoid, and maxilla
What are the functions of the paranasal sinuses?
- lighten weight of the facial skeleton
- warming air
- humidifying inspired air
- add resonance to the voice
- drain mucus secretions into the nasal cavities
What helps drain paranasal sinuses of mucus?
- sneezing
- blowing nose
- gravity
- action of epithelial cilia
The (…) surround the nose and orbits and are lined with respiratory epithelium (pseudostratified columnar epithelium with cilia)
paranasal sinuses
- What provides sensory innervation to the frontal sinus?
- What provides sensory innervation to the ethmoid sinus?
- What provides sensory innervation to the sphenoid sinus?
- What provides sensory innervation to the maxillary sinus?
- CN V1
- CN V1 and CN V2
- CN V2
- CN V2
What is the blood supply to the sinuses?
- frontal sinus
- ethmoid sinus
- sphenoid sinus
- maxillary sinus
- anterior ethmoidal aa
- ethmoidal aa
- pharyngeal aa
- infraorbital and alveolar aa
What is the drainage of the frontal sinus?
frontal sinus drains via the frontonasal duct into the semilunaris hiatus
What is the drainage of the ethmoid sinus?
- anterior ethmoid drains into semilunaris hiatus
- middle ethmoid drains into ethmoid bulla
- posterior ethmoid drains into superior meatus
What is the drainage of the sphenoid sinus?
sphenoid sinus drains into sphenoethmoidal recess above superior concha
What is the drainage of the maxillary sinus?
maxillary sinus drains into semilunar hiatus
Which sinuses empty into the semilunaris hiatus?
- frontal
- ethmoid
- maxillary
What drains tears into theinferior meatus,which islocated beneath the inferior concha; thus your nose “runs” when you cry?
nasolacrimal duct
- What does the nasal region include?
- What happens in this region?
- What does the nasal cavity contain and what are they responsible for?
- nose, nasal cavity, paranasal sinuses
- air is filtered, humidified, and warmed before entering respiratory tract
- specialized olfactory mucosa responsible for the sense of smell
- What portion of the external nose is bony and is composed of paired nasal bones and the frontal processes of the maxillae?
- What portion of the external nose is cartilaginous and is formed by the major and minor alar cartilages and a variable number of accessory cartilages (and vomer)?
- superior portion
- inferior portion
- What does the nasal cavity extend from?
- What are the walls of the nasal cavity covered with?
- What is involved in the sense of smell, is present on the superior part of the nasal septum and superior conchae?
- the vestibule of the nose to the choanae
- respiratory epithelium
- olfactory epithelium
- What does the dorsum of the nose extend from?
- What part of the nose is pierced by two piriform openings and the nares (nostrils, anterior nasal apertures)?
- its superior angle, the root of the nose, to the apex of the nose
- inferior surface of the nose
What are the nares bounded by laterally and separated by?
- laterally bound by the alae (wings) of the nose
- separated from each other by the nasal septum
- The cartilaginous part of the nose consists of how many cartilages?
- What are they?
- Which cartilages are free and movable? What do they do?
- 5 main cartilages
- 2 lateral cartilages, 2 alar cartilages, and a septal cartilage
- U-shaped alar cartilages; they dilate/constrict the nares when the muscles acting on the nose contract
What are the boundaries of the nasal cavity? (roof, floor, anterior, posterior)
- roof: cribriform plate
- floor: hard palate (maxilla, palatine bones)
- anterior: nasal bone, nasal cartilage
- posterior: choana (opening to nasopharynx)
The floor of the nasal cavity is the (…) of the mouth
roof
- What does the nasal cavity open posteriorly into and through?
- What is firmly bound to the periosteum and perichondrium of the supporting bones and cartilages of the nose?
- The inferior two thirds of the nasal mucosa is the (…) area, and the superior one thirds is the (…) area
- posteriorly into the nasopharynx through the choanae
- nasal mucosa
- respiratory area; olfactory area
Theolfactory areais specialized mucosa containing the (…); sniffing draws air to the area. The central processes of the olfactory receptor neurons in the olfactory epithelium unite to form nerve bundles that pass through the (…) collectively constituting the(…) and enter the(…)
- peripheral organ of smell
- cribriform plate
- olfactory nerve
- olfactory bulb
The cell bodies of the (…) are located in the olfactory part of the nasal mucosa, or olfactory area, in the roof of the nasal cavity and along the nasal septum and medial wall of the superior nasal concha
olfactory receptor neurons
- What causes laminar nasal airflow?
- What causes turbulent nasal airflow?
- quiet inspiration
- sniffing
(…) is unusual for a sensory nerve in that it lack a discrete sensory ganglion.
CN I
- Olfactory fibers pass through foramina in the (…) of the ethmoid bone
- They enter the (…) in the anterior cranial fossa
- The olfactory fibers then synapse with (…) in the olfactory bulb
- The axons from these cells form the (…), which conveys the impulses to the brain
- Where is the olfactory center located?
- If the cribriform plate is damaged, what can this create a passage way for?
- cribriform plate
- olfactory bulb
- mitral cells
- olfactory tract
- temporal lobe
- pathway for infection/things to spread into brain, CSF leak
- What nerve is associated with olfaction?
- What is the fiber type?
- Where is its cranial exit?
- Where is its lesion site?
- What would be the clinical deficits/findings?
- olfactory n (CN I)
- special sensory
- cribriform plate of ethmoid bone
- fracture of cribriform plate
- anosmia (loss of smell), cerebrospinal rhinorrhea
What is the halo sign associated with?
CSF rhinorrhea
What is anosmia (loss of smell) associated with?
fracture of cribriform plate tearing olfactory nerve bundles
What is the GSA and special sense innervation of the nasal cavity?
- GSA: CN V1 and CN V2
- special sense: CN I via olfactory nn through cribriform plate
- Nerve supply of the postero-inferior half of two thirds of nasal mucosa is by (…)
- The antero-superior part of the nasal mucosa is supplied by the (…)
- CN V2 (nasopalatine n, br. of greater palatine n)
- anterior ethmoidal nerves from CN V1
What arteries supply the medial and lateral walls of the nasal cavity?
- sphenopalatine a
- posterior ethmoidal aa
- greater palatine a
- superior labial a
- lateral nasal br. of facial a
- On the anterior part of the nasal septum is an area rich in capillaries (…) where all five arteries supplying the septum anastomose. This area is often where profuse bleeding from the nose occurs
- A richplexus of veinsdrains deep to the nasal mucosa into the (…) veins
- Kiesselbach area
- sphenopalatine, facial, and ophthalmic
- The nasal cavity is supplied by blood via 3 main arteries, what are they?
- What is the common site for anterior nose bleed?
- What is the source of a posterior nosebleed?
branches:
- maxillary a. via sphenopalatine a + br.
- facial a. via superior labial a
- ophthalmic a via ethmoidal aa
- common site: Keisselbach’s plexus
- source: sphenopalatine a
- What nasal cavity arteries come off ICA?
- What about ECA?
- ophthalmic a
- facial a., maxillary a.
What are the 3 parts of the ear?
- external ear
- middle ear
- internal ear
- What does the external ear consist of?
- What is the middle ear (tympanic cavity) enclosed within and what does it contain?
- The internal ear is what part of the ear and is contained within what?
- auricle, external acoustic meatus
- enclosed w/in temporal bone; contains ossicles (bones of middle ear)
- neurologic part of the ear; contained w/in petrous portion of the temporal bone
What is a vestibulocochlear organ and allows for equilibrium and hearing?
internal ear
What parts of the ear are mainly concerned with the transference of sound to the internal ear?
external and middle ear
What part of the ear contains the organ for equilibrium as well as hearing?
internal ear
- What separates the external ear from the middle ear?
- What joins the middle ear to the nasopharynx?
- tympanic membrane (eardrum)
- pharyngotympanic (auditory) tube
What is housed mostly in the petrous portion of the temporal bone (“hard as a rock”)?
ear compartments
What are the 3 main portions of the temporal bone?
- petrous apex
- internal acoustic meatus
- foramen lacerum
- What part of the ear funnels and conducts sound to the tympanic membrane?
- When is a pearly grey, transparent partition separating the external and middle ear?
- What should you be able to see when looking in the external ear?
- What can you sometimes see in the external ear?
- The canal is slightly curved so what do you have to do to the ear to be able to best view the tympanic membrane through an otoscope?
- external ear
- tympanic membrane
- umbo, malleus, and long limb of the incus
- chorda tympani n
- pull up on the helix to straighten it out
- What innervates the auricle part of the ear?
- What innervates the external auditory canal?
- What innervates the middle ear?
- auriculotemporal n (CN V3), greater auricular n (C2, C3), lesser occipital n (C2, C3), some CN X and CN VII
- auriculotemporal n, CN X
- CN IX
What can cause referred pain in the ear and what can it cause?
any tumors, infection, or inflammation along the distribution of the different nerves that innervate the ear and can cause the brain to confuse the irritant for otalgia
Referred otalgia pathways can be from which nerves?
- CN V3 (mandibular n)
**anterior 2/3 tongue, inferior oral cavity, palate, lower teeth, mandible (TMJ), salivary glands - CN VII
**nasal mucosa, posterior ethmoid sinus, sphenoid sinus, soft palate - CN IX
**posterior 1/3 tongue, tonsillar fossa, inferior nasopharyngeal space, retropharyngeal space - CN X
**supraglottic larynx, lower pharynx, epiglottis
(…) is an air-filled cavity encased by the petrous bone and communicates with the nasopharynx through the eustachian tube (pharyngotympanic tube)
tympanic cavity
What are the contents of the middle ear?
- auditory ossicles (malleus, incus, stapes)
- tendons of the stapedius m (CN VII) and tensor tympani m (CN V3)
- chorda tympani n (CN VII)
- tympanic plexus (CN IX) to lesser petrosal n
- What does the chorda tympani n innervate?
- What does the lesser petrosal nerve innervate?
- anterior 2/3 of the tongue
- parotid glands
- The (…) serve as a mechanical way to amplify the vibrations of the tympanic membrane and transmit said vibrations to the oval window which is overlaid by the base of stapes
- The amplification is caused by the (…) having a much larger area than the oval window, this amplifies sound ~10-15%
- The ossicles themselves amplify sound through (…)
- This amplification is important as the force is moving from an (…) into a (…)
- This is also known as moving from (…) impedance to (…) impedance
- ossicles
- tympanic membrane
- leverage
- air cavity (tympanic cavity)
- fluid cavity (vestibulocochlear organ)
- low (air) to high (fluid)
- Describe conductive hearing loss
- missing bones/bone damage
- What muscles in the tympanic cavity serve to dampen loud sounds?
- Which muscle pulls on the malleus thus tensing the tympanic membrane, decreasing the vibrations to the ossicles?
- Which muscle pulls on the stapes, decreasing the vibrations onto the oval window?
- tensor tympani m, stapedius m
- tensor tympani m
- stapedius m
Which muscle is not attached to the tympanic membrane directly but is attached to the malleus that pulls on the tympanic membrane?
tensor tympani m
What are the different sound dampening reflex (also is anticipatory)?
- afferent limb (cochlear division of CN VIII)
- efferent limb (CN VII to stapedius m - consensual)
(…) causes tensor tympani m. to contract which causes (…) hearing while (…) as well as vibrations which are from (…) tensing
- Yawning
- dampened
- yawning
- tensor tympani m.
What are the eustachian tube functions? Describe each
ventilation
- regulation of pressure (atmospheric vs middle ear); tensor veli palatini m opens eustachian tube, swallowing and yawning open it
protection
- E.T. closed at rest to protect secretions and sound pressure from nasopharynx
drainage
- mucociliary clearance of middle ear secretions into nasopharynx
The inner ear consists of the (…) which is encased in the petrous portion of the temporal bone
vestibulocochlear organ
- What does the vestibulocochlear organ consist of?
- What innervates the inner ear? (2 division)
- What does the bony labyrinth consist of?
- a bony labyrinth and membranous labyrinth
- CN VIII (vestibular division for balance, cochlear division for hearing)
- vestibule, cochlea, semicircular canals
The bony labyrinth is filled with (…) which resembles (…) (high in Na, low in K)
- perilymph
- extracellular fluid
What foramen does CN VIII go through?
internal acoustic meatus
- What are the different parts of the membranous labyrinth?
- The membranous labyrinth is filled with (…) which resembles (…) (low in Na, high in K)
- saccule and utricle; cochlear duct, semicircular ducts
- endolymph
- intracellular fluid
- The membranous parts of the vestibule are the (…) and the (…) and are referred as (…) organs
- These otolithic structures are located in the (…) of the (…)
- (…) are attached to a thick mucoidal fluid which is attached to (…)
- This structures detect (…)
- Utricle
- Saccule
- otolithic
- maculae
- utricle and saccule
- Otoliths
- hair cells
- linear acceleration
- Horizontal acceleration (x axis, i.e. walking) is detected by the (…) (hair cell-otolith structure on the floor of the utricle)
- (…) also detects head tilt
- Vertical acceleration (y axis, i.e. jumping) is detected by the (…)(hair cell-otolith structure on the wall of saccule)
- utricle
- utricle
- saccule
- The hair cells of the vestibule have a (…) and (…) which are located in the utricle, saccule, cochlear duct, and semicircular ducts
- If the (…) bend towards the kinocilium, there will be an (…) in action potentials
- If the (…) bend away from the kinocilium, there will be a (…) in action potentials
- This is important because your brain uses this information to interpret (…)
- kinocilium
- stereocilia
- stereocilia
- increase
- stereocilia
- decrease
- what direction you are accelerating in (forward, backward, etc)
- What are three loops that connect the utricle?
- What type do you have?
- What do these detect?
- semicircular canals
- anterior, posterior, lateral canals
- angular acceleration
- The semicircular canals are (…) to each other, being they are at right angles to each other
- What does this allow for?
- (…) is in the horizontal plane (shaking head no)
- (…) are in the vertical plane (nodding head yes, and tilting head)
- orthogonal
- allows for detection of angular acceleration in 3 axes
- lateral
- anterior and posterior
- Balance relies on three sensory components, what are they?
- If one of these components is removes (…) is dramatically affected
- Standing on one leg is not too hard but once you close your (…) it gets very hard
- Vertigo happens when the (…) is affected
- visual input, vestibular input, somatosensory input (touch, proprioception)
- eyes
- vestibular input
- (…) transmits movement of the tympanic membrane to the oval window causing (…) in the perilymph
- The pressure waves come from the oval window to the (…), the waves then travel through the (…)
- The waves finally reach the (…) which is inferior to the oval window, there the waves transmit their energy through the round window into the (…) where it dissipates in air
- stapes
- hydraulic pressure waves
- scala vestibuli
- scala tympani
- round window
- tympanic cavity
- What is situated between the scala vestibuli and scala tympani?
- What is this filled with?
- cochlear duct
- filled with endolymph
- What is the sensory organ of the cochlear duct?
- Where is it located?
- organ of Corti
- located in basilar membrane
When pressure waves course through the perilymph they distort the (…) where it causes hair cells attached to the tectorial membrane to bend, sending off action potentials to (…)
- basilar membrane
- CN VIII
- The (…) has different degrees of flexibility along the cochlear duct allowing for detection of varying frequencies/pitch along the membrane
- The base the membrane is less flexible and thus (…) are able to distort the membrane here but not (…)
- Towards the apex of the membrane, it is more flexible allowing (…) to cause action potentials
- basilar membrane
- high pitch frequencies
- lower pitch sounds
- low pitched sounds
