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Anatomy > Orbits, eye, ear, nose oral cavity and airway > Flashcards

Orbits, eye, ear, nose oral cavity and airway Flashcards

1
Q

Orbit

7 bones

A

frontal bone

zygomatic bone

spheniod

ethmoid bone

lacrimal bone

palatine bone (tiny part)

maxilla bone

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2
Q

Lacrimal Apparatus and Gland

A
  • Lacrinmal gland secretes lacrimal fluid (tears)
    • paraysmpathetic innervation by N VII (via pterygopalatine ganglion)
  • lactimal ducts convey tears to conjectival sac
  • lacrimal canaliculi convey tears to lacrimal sac
  • nasolacrimal duct converys tears to nasal cavity
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3
Q

Extra-ocular Muscles

(innervated by CN III)

A
  • CN III:
    • levetor palpebrae superioris
    • interior oblique
    • superior rectus
    • inferior rectus
    • medial rectus
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4
Q

Extra-occular muscles that are not innervated by CN III

A
  • SO4
    • superior oblique- CN IV (trochlear)
  • LR6
    • Lacteral Rectus - CN VI (abducent)
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5
Q

Optic Canal

(nerves and arteries)

A
  • optic nerve (CN II)
  • Opthalmic artery (branch of internal carotid artery)
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6
Q

Superior orbital fissure

(nerves)

A
  • Occulomotor (CNIII)
  • Trochlear (CN IV)
  • abducent (CNVI)
  • divisions of the opthalmic branch of trigeminal nerve (V1)
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7
Q

Common Tendinous Ring

(contents and importance)

A
  • Optic nerve (II)
  • Opthalimic artery
  • superior branch of oculomotor nerve (III)
  • nasocillary branch of opthalmic nerve (V1)
  • abducent nerve (VI)

“Just make sure you know CN 2, 3, 6, and opthalmic artery –> reason this is important: retrobulbar block

  • nerves are harder to hit bc they are protected by this ring”
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8
Q

Fibrous Layer of eyeball

A
  • sclera- rough opaque part
    • provides for muscular attachment to eye
    • mostly avascular
    • “white of the eye”
  • Cornea
    • transparent
    • completely avscular
    • innervated by CN V1
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9
Q

Vascular layerof eyeball

A
  • Choroid - highly perfused
  • ciliary body
    • provides attachement for the lens and controls the thickness of the lens (focus-accomadation)
    • ciliary process secrets aquesous humor which fills the posterior chamber
  • Iris
    • thin contractile diaphragm on the anterior surface of the lense
      • sympathetic and parasymathetic control

*take home: these surgeries require anesthesia providers to be present but you dont really give much sedation, just there to monitor

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10
Q

Inner Layer of Eyeball

A
  • retina
    • fundus: part where light enetering the eyeball is focused
  • 2 parts:
  • optic part- sensitive to visual light rays
    • macula of hte retina with fovea centralis: most acute vision
  • nonvisual parts- optic disk: CN II and vessels enter the eye; no photoreceptors, blind spot
    • white spot = aka blind spot
      • where the optic nerve and opthamic artery come into the eye

*take home: surgery of inner eye needs A VERY DEEP sedation, which means you will have BP issues and you need to support it (can’t have that eye ball moving)

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11
Q

retrobulbar block

A
  • find the maxillary bone and inject LA behind the eye
  • common tendinous ring - makes CN 2, 3, 6 harder to hit*
  • will block eye movement and sensation
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12
Q

peribulbar block

A
  • block is not as deep; will not inhibit the nerves as much (bc of the CTR)
  • mostly for pain sensation (will have min movement)
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13
Q

Ear

Facial nerve and Vestibulocochlear

A
  • facial nerve and vestibulocochlear nerve exit through the interal acoustic meatus together
    • CN 8 will innervate semicircular canals and cochlear for hearing and balance
    • CN 7 continues and passes through the facial cannal and exits via the stylomastoid formamen
      • surgery of inner ear: you cannot use muscle relaxants!
      • must be able to monitor CN 7 to make sure they do not injur it
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14
Q

Nose

(functions)

A
  • olfaction
  • respiration
  • filtration
  • humidification
  • reception and elemination of secretions from the nasal mucosa, paranasal sinuses, and nasolacrimal ducts
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15
Q

Nose

(8 bones)

A
  • frontal
  • nasal
  • sphenoid
  • ethmoid (makes up nasal septum)
  • palatine
  • inferior nasal concha
  • maxillary
  • vomer (makes up nasal septum)
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16
Q

Nasal Cavities

A
  • lined by nasal mucosa
  • superior 1/3 is the olfactory area
  • inferior 2/3 is the respiratory area
  • three nasal concha divide cavity into four air passages
    • spheno-ethmoidal recess (allows for sense of smell), superior nasal meatus, middle nasal meatus, and inferior nasal meatus
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17
Q

Paranasal Sinuses

(action and name the 4 sinuses/innervations)

A
  • air filled extension of the respiratoy part of the nasal cavity (allows protection/decreases weight of head)
  • drains into nasal cavity via mulpitle openings
  1. frontal sinus -CN V1
  2. ethmoid sinus (cells) - CN V1
  3. sphenoidal sinuses - very thin bone seperates from several important structures (CN V1)
  4. maxillary sinuses - CN V2
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18
Q

Nasal Cavity

(vasculature and innervation)

A
  • “highly vascularized”
  • innervation:
    • olfactory nerve (CN1) - smell
    • Trigeminal nerve
      • opthalic division (CN V1)- anterosuperior part
      • maxillary division (CN V2)-(*per Nicole) - postero-inferior half to 2/3 of the nasal mucosa
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19
Q

Oral Cavity

A
  • dental arches anteriorly and laterally (where teeth sit)
  • palates
  • occupied by the tongue
  • communicates posteriorly with the oropharynx
  • 2 arches
    • palatoglossal arch - anterior and attaches to tongue
    • palatopharyngeal arch - posterior; attaches to oral arch
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20
Q

Oral Cavity

(bones)

A
  • mandible
  • maxilla
  • palatine bone
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21
Q

Oral Cavity

(teeth)

A
  • 32 adult teeth
  • numbered 1-16 right to left on maxilla
    • supplied by CN V2 (superior alveolar nerve branch)
  • numbered 17-32 left to right on mandible
    • supplied by CN V2 (inferior alveolar nerve branch)
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22
Q

Palate

(generals)

A
  • arched roof of the oral cavity proper and floor of nasal cavities
  • hard palate
  • soft palate
  • palatine tonsils- lymphoid tissue on each side of the oropharynx between the two arches
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23
Q

Hard Palate

A
  • anterior 2/3
  • palatine processes of the maxillae and horizontal plates of the palatine bones
  • incisive fossa and greater palatine foramen allow for vessels of maxillary artery (external cartoid) and nerves of CN V2)
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24
Q

Soft Palate

A
  • movable posterior 1/3
  • uvula
  • continuous with wall of the pharynx and joined to tongue and pharynx by the platoglossal and palatopharyngeal arches

* if the right vagal nerve is damaged, you will see a left sided deviation of your uvula

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25
Q

Soft palate muscles:

Tensor Veli Palatini

A
  • only muscle innervated by CN V3
  • action:
    • tenses soft palate and opens mouth of pharygotoympanic tube during swallowing and yawning

*can cause occlusion of airway if damaged*

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26
Q

Soft Palate Muscles

Levator veli palatini

A
  • Action:
    • elevates soft palate during swallowing and yawning
  • Innervation:
    • Vagus Nerve
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27
Q

Soft Palate Muscles

Palatoglossus

A
  • Action:
    • elevates posterior part of tongue and draws soft palate onto tongue
  • Innervation:
    • Vagus Nerve
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28
Q

Soft Palate Muscles:

Palatopharyngeus

A
  • Action:
    • tenses soft palate
    • puls wall of pharynx superiorly, anteriorly, medially with swallowing
  • Innervation:
    • Vagus Nerve
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29
Q

Soft Palate Muscles:

Musculus Uvulae

A
  • Action:
    • shortens uvula and pulls it superiorly
  • Innervation:
    • Vagus Nerve
30
Q

Sublingual/submandibular Sympathetic Innervation

A
  • come from T1, T2, T3
  • travel to the superior cervical ganglion (synapses with postsynaptic nerve); exits by the grey rami
  • travel along the facial artery

“superior cervical ganglion in the facial plexus that innervates the submandibular and sublingual glands”

31
Q

Parotid Gland

(sympathetic innervation)

A
  • travels to superior cervical ganglion
  • then travels up the external carotid plexus
  • innervates the parotid gland
32
Q

Nasal, Palates and Lacrimal Glands

(sympathetic innervation)

A
  • superior cervical ganglion along the internal cartiod plexus
33
Q

Tongue: Extrinsic Muscles

(Names and innervations)

A
  • Genioglossus
  • Hyoglossus
  • Styloglossus
  • Palatoglossus (only one innervated by Vagus)

*all muscles innervated by hypoglossal (CN XII) except Palatoglossus

**if your right hypoglossal nerve is injured, will cause right side deviation on tongue

34
Q

Tongue Innervation

General somatic motor

A
  • hypoglossal nerve (CNXII)
  • palatoglossus - only one innervated by Vagus (CN X)
35
Q

Tongue Innervation:

General somatic sensory

A
  • aka touch and temp
  • anterior 2/3
    • Lingual nerve of V3
  • Posterior 1/3 tongue and anterior epiglottis
    • glossopharyngeal nerve (CNXI)
  • inferior epiglottis
    • Internal laryngeal nerve of Vagus Nerve
36
Q

Tongue Innervation:

special sensory

A
  • taste
  • anterior 2/3
    • chorda tympani via facial nerve (CN VII)
  • posterior 1/3 and anterior epiglottis
    • glossopharyngeal nerve (CN IX)
37
Q

Cervical Viscera:

Pharynx

(includes what? -generals)

A
  • cranial base to C6- continuous with esophagus
    • nasopharngyx
    • oropharynx
    • laryngopharynx
    • vallecula
38
Q

Nasopharynx

A
  • posterior to nose (choanae), superior to soft palate
  • respiratory function
  • pharyngeal tonsils, adenoids when enlarged
39
Q

Oropharynx

A
  • posterior to the mouth
  • soft palate -superior
  • base of tongue- inferior
  • palatoglossal and palatopharyngeal arches - laterally
  • ends at the superior border of epiglottis
  • digestive function
  • palatine tonsils
40
Q

Laryngopharynx

A
  • posterior to the larynx
  • extends from superior border of epiglottis
  • to inferior border of cricoid cartilage (C4-C6)
41
Q

superior, middle and inferior pharygeal constrictors

(innervation)

A

Motor via Vagus

42
Q

Palatopharygngeus and salpingopharyngeus

Stylopharyneus

(innervations)

A
  • “pharyngeal muscles”
  • Pala and salpi - Vagus Nerve
  • Stylopharyngeus -Glossopharyngeal (CN IX)
43
Q

Sensory innervation of pharynx

A
  • nasopharynx - V2
  • Oropharynx - CN IX (glossopharyngeal)
  • laryngopharynx - CN X
44
Q

Larynx

A
  • fucntions
    • airway protection
    • respiration
    • phonation
  • location
    • C3-C6
      • connects oropharynx with trachea
45
Q

Laryngeal cartilages

3 unpaired and 3 paired

A
  • paired
    • Arytenoid
    • Corniculate
    • Cuneform
  • unpaired
    • thyroid
    • cricoid
    • epiglottic
46
Q

Thyroid Cartilage

A
  • level of C4
  • largest and most prominent
  • anterior attachement for vocal cords
47
Q

Epiglottic Cartilage

A
  • covers opening to the larynx during swallowing
48
Q

Cricoid Cartilage

A
  • only complete cartilaginous ring
  • singet shaped
  • arch faces anteriorly (thickest part in the back)
49
Q

Arytenoid Cartilages

A
  • posterior attachement for vocal cords
50
Q

Corniculate Cartilages

A
  • attach to the apices of the arytenoid cartilages
  • posterior portion of the aryepiglottic fold
51
Q

Cuneiform Cartilages

A
  • do not directly attach to any other cartilages
  • in the aryepiglottic fold, not always present
  • lateral to corniculates
52
Q

True vocal cords

A
  • control sound production with audible vibrations
  • appear pearly white
  • formed by the vocal ligaments
  • attached anteriorly to the thyroid cartilage and posteriorly to the arytenoid cartilages
53
Q

Glottic Opening

(rima glottidis)

A
  • triangular aperture between the cords
  • variation in the:
    • tension and length of the vocal folds
    • width of the rima glottidis
    • intensity of expiratory effort
  • produces changes in voice pitch
54
Q

Intrinsic Laryngeal Muscles

A
  • control the movements of the lyrngeal cartilages
    • control the length ad tension of the vocal cords and the size of the glottic opening
  • cricothyroid muscle innervated by the external branch of the superior laryngeal nerve, a branch of the vagus nerve
  • all others innervated by the recurrent laryngeal nerve, a branch of the vagus nerve
55
Q

Cricothyroid Muscle

A
  • Crycothryoid = Cords tense
  • stretches and tenses vocal ligament
56
Q

Thyro-arytenoid

A
  • Thyro-arytenoid =They relax
  • relaxes vocal ligament
57
Q

Posterior crico-arytenoid

A
  • Posterior crico-arytenoid = Please come apart!
  • abducts vocal cords
58
Q

Lateral crico-arytenoid

A
  • Lateral crico-arytenoid = Let’s close the airway
  • adducts vocal folds
59
Q

Transverse and Oblique arytenoids

A
  • adducts vocal folds
60
Q

vocalis

A
  • relaxes vocal ligament

(vocalis is relaxing on vacation)

61
Q

Larynx Innervation:

Specific branches off the Vagus Nerve

A
  • Superior laryngeal nerve
    • internal larygneal nerve
      • motor - none
      • sensory- posterior epiglottis to vocal cords/thryoepiglottic joint/cricothyroid joint
    • external larngeal nerve
      • motor- cricothyroid muscle
      • sensory- none
  • recurrent laryngeal nerve
    • motor- all other intrinsic laryngeal muscles
    • sensory- below vocal cords and trachea
62
Q

Larynx innervation (motor and sensory)

Trigeminal (CN V)

A
  • Opthalmic
    • sensory- nares/anterior septum
  • maxillary
    • sensory - turbinates/posterior nasal septum/nasopharynx
  • mandibular
    • motor - muscle sof mastication
    • sensory - anteror 2/3 tongue
63
Q

Larynx Innervation (motor and sensory)

Glossopharyngeal (IX)

A
  • motor
    • stylopharyneus muscle
  • sensory
    • soft palate
    • oropharynx
    • posterior 1/3 tongue
    • tonsils
    • vallecula
    • topside (anterior) epiglottis
    • afferent limb of gag reflex
64
Q

Larynx Innervation (motor and sensory)

Vagus Nerve

A
  • Superior Laryngeal Nerve
    • external:
      • motor - criothyroid muscle
    • internal:
      • sensory - underside (posterior/inferior) epiglottis to VC/thyroepiglottic joint/cricothryoid joint
  • Reccurent Laryngeal Nerve
    • motor
      • thyroiaretenoid, vocalis, arytenoids (transverse and oblique), lateral cricoarytenoid, posterior cricoarytenoid
    • sensory
      • below the vocal cords to the trachea
65
Q

Nerve injury to the

external branch of the superior laryngeal nerve

A
  • controls the circothyroid muscle
  • responsible for tensing the vocal cords
  • injury (during a thyroidectomy) leads to hoarsenesss
  • one sided, or bilteral injury to this nerve is tolerated
    • injured muscle will just “flutter” and pt will sound hoarse
66
Q

Nerve injury to the

recurrent laryngeal nerve

(acute bilateral injury)

A
  • controls all other intrinsic muscles, besides crycothyroids (think posterior crico-arytenoids!)
    • acute bilateral injury
      • bilateral paralysis of VC abductors (prosterior crico-arytenoids) = unopposed tensing by cricothyroid muscles
        • causes stridor and respiratory distress
          • AIRWAY EMERGECNY!!
67
Q

Nerve injury to the

recurrent laryngeal nerve

(unilateral injury)

A
  • paralysis of ipsilateral vocal cord abductors
    • not an airway emergency
  • chronic unilateral injury
    • generally tolerated well
68
Q

Superior and Inferior Laryngeal Arteries are branches of what?

A
  • the superior and inferior thryoid arteries
69
Q

Superior Thryoid Artery

A
  • first branch of external carotid artery
  • accompanied by external branch of the superior largyneal nerve
  • gives rise to:
    • superior laryngeal artery
      • accompanies internal branch of the superior largyneal nerve
70
Q

Inferior Thyroid Artery

A
  • branch of the tyrocervical trunk
  • gives rise to:
    • inferior layrngeal artery
    • which accompanies recurrent laryngeal nerve
71
Q

Trachea

A
  • extends from inferior end of larynx into the thorax
  • teminates at the sternal angle (T4) where it bifurcates (carina) into left and right main bronchi
    • 2.5cm in diameter
    • 10-20 cm length
    • 16-20 U shaped cartilages
    • posterior side lacks cartilage
      • posterior gap is spanned by the involuntary trachealis muscle
  • innervated by the Recurrent Laryngeal Nerve of the Vagus Nerve
72
Q

Lehane-Cormack Laryngeal Views

A

Anatomy (9 decks)

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