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Anatomy Test 3 > Orbits, Eyeball, Ear, Nose, Oral Cavity and Airway > Flashcards

Orbits, Eyeball, Ear, Nose, Oral Cavity and Airway Flashcards

1
Q

How does the lacrimal apparatus work?

A
  • Lacrimal gland secretes lacrimal fluid (tears)
    • via PSNS innervation of CN VII via pterygopalatine ganglion
  • Lacrimal ducts convey tears to conjunctival sac
  • Lacrimal canaliculi convey tears to lacrimal sac
  • Nasolacrimal duct conveys tears to nasal cavity
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2
Q

What is pathway for PSNS innervation of the lacrimal gland?

A
  • Pre-ganglionic Facial nerve VII via greater petrosal nerve
  • Synapses in pterygopalatine ganglion
  • Continues on zygomaticotemporal nerve to join with lacrimal nerve (part V1) to lacrimal gland
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3
Q

All eye muscles come together to form what?

A

Common tendinous ring

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4
Q

What nerves provide innervation for extra-ocular muscles?

A

IV- Superior oblique musscle

VI- Lateral rectus

III- all other extra-ocular muscles

SO4, LR6 all other by III

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5
Q

What contents pass through superior orbital fissure?

A
  • III -Oculomotor
  • IV- Trocholear
  • VI- Abducense
  • V1- opthalmic branch of trigeminal nerve
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6
Q

What contents pass through optic canal?

A
  • Optic Nerve (CN I )
  • Opthalmic artery (branch of internal carotid artery)
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7
Q

What passes through common tendinous ring

A
  • II
  • III
  • VI
  • Ophthalmic artery
  • V1-ttrigeminal(has components inside and outside of common tendinous ring)
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8
Q

Why is common tendinous ring important?

A

Serves to out benefit in anesthesia. Can give local anesthetic surrounding eye and the common tendinous ring serves as a “holding point” for anesthetic and prevents it from going further down optic canal

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9
Q

What are the 2 layers of the eye?

A

Fibrous layer

Vascular layer

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10
Q

What makes up the fibrous layer of the eye? Purpose?

A
  • Sclera
    • tough, opaque part
    • muscular attachement to eye
    • mostly avascular
    • “white of the eye”
  • Cornea
    • transparent
    • completely avascular
    • innervated by CN V1
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11
Q

What makes up vascular layer of the eye? Purposes?

A
  • Choroid
    • highly perfused
  • Ciliary body
    • attachment for lens and controls thickness of lens (focus-accomodation)
    • Ciliary process secretes aqueous humor which fills posterior chamber
  • Iris
    • thin, contractile diaphragm on anterior surface of lens. Sympathetic and PSNS control
      • color of eye
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12
Q

What makes inner layer of eye? What are the 2 main parts?

A
  • Retina
    • fundus: part where light entering the eyeball is focused
      • optic part: sensitive to visual light rays
        • macula of the retina with fovea centralis: most acute vision
          • where we see best
      • Nonvisual part
        • optic disk: where CNII and vessels enter eye; no photoreceptors, blind spot
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13
Q

In what part of eye do we see best?

A

Macula of retina with fovea centralis

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14
Q

What does retrobulbar block, block? (Don’t need to know for test)

A

Block sympathetic and PSNS as enter eye

II, III, IV, VI

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15
Q

Pathway of vesitbulocochlear once exits skull?

A

Vestibulocochlear nerve stops in inner ear to innervate semilunar canal and posteiror apparatus (for balance)

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16
Q

Where does facial nerve continue after internal acoustic meatus?

A

Through facial canal and exits out at stylomastoid foramen

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17
Q

Function of nose?

A
  • Olfaction
  • Respiration
  • Filtration
  • Humidification
  • Reception and elimination of secretions from nasal mucosa, paranasal sinuses, and masolacrimal ducts
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18
Q

9 bones that make up nasal region?

A
  1. frontal
  2. nasal
  3. ethmoid
  4. sphenoid
  5. palatine
  6. maxillary
  7. inferior nasal concha
  8. lacrimal
  9. vomer
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19
Q

Bones that make up septum?

A
  • Ethmoid
  • Vomer
  • Nasal/septal cartilage
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20
Q

What makes up nasal cavities?

A
  • Lined by nasal mucosa
  • Inferior 2/3 is respiratory area
  • superior 1/3 is olfactory area
  • Three nasal concha divide cavity into 4 air passages
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21
Q

What are the 4 air passages in your nose (divide by concha)?

A
  • Superior ethmoidal recess
  • superior nasal meatus
  • middle nasal meatus
  • inferior nasal meatus
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22
Q

How do we smell?

A

Stagnate air in spheno-ethmoid recess allows air to go to olfactory nerve and allow smeel

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23
Q

What is the purpose of paranasal sinuses?

A
  • Air filled extension of repsiraotyr part of nasal cavity
    • voice resonance
    • decrease weight of head
    • protection in trauma (air filled cavities will crush first)
  • Drain into nasal cavity via multiple openings
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24
Q

What are the sinuses? Innervation?

A
  • Frontal sinus- V1
  • Ethmoidal -V1
  • Sphenoidal sinuses- V1
    • very thin bone separates from several important structures
    • transphenoidal pituitary resection
  • Maxillary- V2
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25
Nasal cavity innervation?
* Olfactory nerve CN1 provides olfaction * Trigeminal nerve * Ophthalmic division (CN V1) Anterosuperior part * Maxillary division (V2) Postero-inferior half to 2/3 of nasal mucosa
26
Can you put a NPA into anticoagulated patient?
No, nose highly vascularized, you will rupture vessels and they will bleed. Case will end up being cancelled
27
What forms oral cavity?
* Dental arches anteriorly and laterally * palate * communicates posteriorly with oropharynx * occupied by tongue
28
What are the 2 arches in the oral cavity?
* Palatopharyngeal arch- palate to pharynx * Platoglassal arch- palate to tongue * Betwen 2 arches is palatine tonsil
29
What bones make up oral cavity?
Mandible Maxilla Palatine bone 32 adult teeth
30
How are teeth numbered? Innervation?
Numbered: * 1-16 right to left on maxilla * 17-32 left to right on mandible Innervation: * 1-16 supplied by CN V2 (superior alveolar nerve) * 17-32 supplied by CN V3 (inferior alveolar nerve)
31
What forms palates of mouth?
* Hard palate * ant 2/3 * palatine process of maxilla and horizontal plates of palatine bones * incisive fossa and greater palatine foramen allow vessels of maxillary artery (External carotid) and nerves of CN V2 * Soft palate * moveable post 1/3 * uvula * continuous with wall of pharynx and joined to tongue and pharynx by palatoglossal and palatopharyngeal arches * Palatine tonsils- lymphoid tissue on each sie of oropharynx between the two arches
32
A/I of tenso veli palatini?
Action: * tense soft palate * opens mouth of pharyngotympanic tube during swallowing and yawning Innervation: * V3 (trigeminal nerve, mandibular division) **THIS IS WHAT BLOCKS AIRWAY WHEN IT RELAXES D/T OBSTRUCTION OF SOFT PALATE**
33
A/I of levator veli palatini?
Action: * Elevates soft palate during swallowing and yawning Innervation: * Vagus
34
A/I of palatoglossus?
Action: * Elevates posterior part of tongue *(one muscle of the tongue)* * draws soft palate onto tongue (*also one of the muscles of the soft palate)* Innervation: Vagus (X)
35
A/I of palatopharyngeus?
Action: * Tenses soft palate * pulls walls of pharynx superiorly, anteriorly and medially with swallowing Innervation: Vagus (X)
36
A/I of musculus uvulae?
Action: * Shortens uvula and pulls it superiorly Innervation * Vagus
37
What are the muscles of the soft palate?
* Tensor villi palatini * Levator veli palatini * Palatoglossus * Palatopharyngeus * Musculus uvulae All innervated by vagus EXCEPT tensor villi palatini (V3)
38
PSNS Innervation for mouth?
* Facial nerve * greater petrosal--\> pterygopalatine ganglion--\> palatine and nasopalatine nerve to glands on palate * Chorda tympani joins with lingual nerve (V3)--\> submandibular ganglion--\> submandibular gland and sublingual gland
39
Sympathetic innervation of mouth?
* T1-T3 interomediolateral cell column--\> superior cervical ganglion and synapse--\> * submandibular region travels along facial artery plexus * other branch travels on internal carotid plexus, up to greater petrosal nerve, passes through pterygopalatine--\> lacrimal gland/glands on palate * last branch on external carotid artery plexus--\> parotid gland
40
What are the tongue extrinsic muscles? Innervations?
* Hypoglossus (XII) innervates * **genioglossus**- obstruction of airway from tongue when asleep * **hyoglossus** * **styloglossus** * Vagus (X) innervates * **Palatoglossus-** *(this is also a part of the soft palate)*
41
What are the tongue intrinsic muscles? Innervation?
* Longitudinal * transverse * vertical muscles * Innervation: CN XII
42
What provides somatic motor innervation to tongue?
* Hypoglossal nerve (XII) * Palatoglossus- (X) (Vagus)
43
What provides general somatic sensory innervation to tongue?
* Touch and temperature * anterior 2/3- mandibular divison of trigeminal nerve (V3) * lingual nerve * Posterior 1/3 tongue and anterior epiglottis * glossopharyngeal nerve (IX) * Inferior epiglottis- Vagus nerve X * internal larngeal nerve
44
What nerves provide special sensory to tongue?
* Taste * Ant 2/3 facila nerve * chorda tympani * Posterior 1/3 and anterior epiglottis- glossopharyngeal nerve (IX)
45
Where is pharynx located?
* Posterior to nasal, oral and laryngeal cavities * Cranail base to C6- continuous with esophagus * Consists of * nasopharynx * oropharyn * laryngopharynx * vallecula
46
What is the nasoparhynx?
* Posterior to nose (choanae) superior to soft palate * Respiratory function * pharyngeal tonsils (adenoids when enlarrged)
47
Where is the oropharynx?
* Posterior to mouth, soft palate superior, base of tongue inferior and palatoglossal and palatoparyngeal arches laterally, ends at superior border of epiglottis * uvula--\> epiglottis * Digestive function * palatine tonsils
48
Where is the laryngopharynx?
* Posterior to larynx, extends from superior border of epiglottis to inferior border of cricoid cartilage (C4-C6)
49
What are the muscles of pharynx and their innervation?
* Superior, middle and inferior pharyngeal constrictors * motor via vagus (X) * Palatopharyngeus(X) * Salpingopharngeus (X) * **Stylopharyngeus (IX)**
50
What innervates sensory information to pharynx?
* Nasopharynx * sensory V2 * Oropharynx * sensory IX * topside of epiglottis * Laryngopharynx * sensory CN X * inferior aspect of epiglottis
51
Functions and location of larynx?
* Functions * airway protection * respiration * phonation * Location * C3-C6 * Connects oropharynx with trachea
52
What forms laryngeal skeleton?
3 paired and 3 unpaired cartilages 3 paired are: 1. arytenoid 2. croniculate 3. cuneiform 3 unpaired are: 1. thyroid 2. cricoid 3. epiglottis
53
What is the thyroid cartilage?
* Level of c4 * Largest and most prominent * anterior attachment for vocal cords
54
What is the epiglottis cartilage?
Covers opening to larynx during swallowing
55
What is the cricoid cartilage?
* Only complete cartilaginous ring * signet- shaped * arches faces anteriorly
56
What are the arytenoid cartialges?
Posterior attachment for vocal cords
57
What are the corniculate cartilages?
* Attach to apices of the arytenoid cartialges * Posterior portion of the aryepiglottic fold **_Cor_**niculate forms the _core_
58
What are the cuneiform cartilages?
* Do not directly attach to any other cartilages * In the aryepiglottic fold, not always present * lateral to corniculates
59
Do you see aytenoids on DL?
No, you're seeing corniculate cartilages most likely and maybe cuneiform Arytenoids are not visible from direct laryngoscopy, but visualizing the cords is commonly referred to as the "arytenoids"
60
What are the vocal cords?
* True vocal cord- control sound produciton with audible vibration * appear pearly white * formed by vocal ligaments * attach anteriorly to thryoid cartilage and posteriorly to arytenoid cartilages
61
What is the glottic opening?
(Rima glottidis) * Triangular aperture between the cords * Variation in tension and length of vocal folds, width of the rima glottidis and intensity of expiratory effort produces changes in voice pitch
62
What do the intrinsic laryngeal muscles do? Innervated by?
* Control the movement of laryngeal cartilages * control length and tension of the vocal cords and size of glottic opening * Cricothyroid muscle inntervated by external branch of superior laryngeal nerve (branch of Vagus nerve) * All others are innervated by recurrent laryngeal nerve, branch of vagus nerve (X)
63
A/I of cricothyroid muscle?
Action * **c**ords **t**ense= **c**rico**t**hyroid * stretches and tenses vocal ligament Innervation -External laryngeal nerve
64
A/I of thyro-artyenoid muscle?
Action: * **t**hey **r**elax= **t**hyroa**r**tyenoid * relaxes vocal ligament Innervation -Recurrent laryngeal nerve
65
a/i posterior crico arytenoid?
Action * **P**lease **c**ome **a**part (pull cords apart)= **p**osterior **c**rico-**a**rytenoid * Abducts vocal cords Innervation -Reccurent larngeal nerve
66
A/I Lateral Crico-Arytenoid
Action * **l**et's **c**lose the **a**irway= **l**ateral **c**rico **a**rytenoid * adducts vocal folds Innervation Recurrent laryngeal nerve
67
A/I of transverse and oblique arytenoids?
Action - adducts vocal folds Innervation Recurrent laryngeal nerve
68
A/I Vocalis?
Action: Relaxes vocal ligament Innervation: Recurrent laryngeal nerve
69
How is larynx innervated?
* Vagus * superior laryngeal nerve * internal laryngeal nerve * motor: none * sensory: posterior epiglottis to vocal cords/thyroepiglottic joint/cricothyroid joint * external laryngeal nerve * motor: cricothyroid muscle * sensory: none * Recurrent laryngeal nerve * motor: all other intrinsic laryngeal muscles * sensory: below vocal cords and trachea
70
Which muscle is our only abductor?
Posterior crico arytenoids
71
What are the intrinsic laryngeal muscles?
Cricothyroid Thyro-artyenoid Posterior crico-arytenoid Lateral crico-arytenoid Transverse and oblique arytenoids vocalis
72
What happens with nerve injury of external branch of superior larngeal nerve?
Controls the cricothyroid muscle- responsible for tensing vocal cords * injury leads to hoarseness
73
What happens in a recurrent laryngeal nerve injury?
**Unilateral injury--\>** Paralysis of ipsilateral vocal cord abductor--\> not airway emergency **Chronic unilateral injury--\>** generally well tolerated **Acute bilateral injury--\>** bilateral paralysis of VC abductors (posterior cricoarytenoids)--\> unopposed tensing by cricothyroid muscle--\> stidor and respiratory distress--\> AIRWAY EMERGENCY!!!
74
How can you check to see status of recurrent laryngeal nerve after surgery?
- place blad into throat, tell pt to say "E" - pt will attempt to breath around ETT - should see vocal cords flutter - Then ok to extubate
75
Laryngeal arteries are branches of ___ and ____ thyroid arteries
superior inferior
76
What is the superior thyroid artery?
* First branch of external carotid artery * **accompanied by external branch of superior laryngeal nerve** * Gives rise to: superior larngeal artery which accompanies internal branch of superior larngeal nerve
77
What is the inferior thyroid artery?
* Branch of thyrocervical trunk * Gives rise to: inferior larngeal artery which accompanies recurrent laryngeal nerve
78
Defining characteristics of trachea?
* Extends from end of larynx into thorax, terminates at sternal angle (T4) where bifurcates (carina) into right and left bronchi * 2.5 cm diameter * 10-20 cm in length * 16-20 U shaped cartilagenous rings * posterior gap is spanned by the involuntary trachealis muscle * Innervated by recurrent laryngeal nerve of vagus
79
What do you see on grade I lehane-cormack view?
anterior and posterior vocal cords PUSH
80
Grade II lehane cormack laryngeal view?
Posterior tie on vocal cords only = USH
81
Grade III lehane cormack
epiglottis, tongue SH
82
Grade IV lehand-cormack view?
Tongue only
83
What two muscles are causing obstruction of airway for anesthestized patient?
Genioglossus Tensor villi palatini

Anatomy Test 3 (2 decks)

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