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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
Q

Nasal cavity innervation?

A
  • 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
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26
Q

Can you put a NPA into anticoagulated patient?

A

No, nose highly vascularized, you will rupture vessels and they will bleed. Case will end up being cancelled

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27
Q

What forms oral cavity?

A
  • Dental arches anteriorly and laterally
  • palate
  • communicates posteriorly with oropharynx
  • occupied by tongue
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28
Q

What are the 2 arches in the oral cavity?

A
  • Palatopharyngeal arch- palate to pharynx
  • Platoglassal arch- palate to tongue
  • Betwen 2 arches is palatine tonsil
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29
Q

What bones make up oral cavity?

A

Mandible

Maxilla

Palatine bone

32 adult teeth

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30
Q

How are teeth numbered? Innervation?

A

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)
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31
Q

What forms palates of mouth?

A
  • 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
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32
Q

A/I of tenso veli palatini?

A

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

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33
Q

A/I of levator veli palatini?

A

Action:

  • Elevates soft palate during swallowing and yawning

Innervation:

  • Vagus
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34
Q

A/I of palatoglossus?

A

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
Q

A/I of palatopharyngeus?

A

Action:

  • Tenses soft palate
  • pulls walls of pharynx superiorly, anteriorly and medially with swallowing

Innervation:

Vagus (X)

36
Q

A/I of musculus uvulae?

A

Action:

  • Shortens uvula and pulls it superiorly

Innervation

  • Vagus
37
Q

What are the muscles of the soft palate?

A
  • Tensor villi palatini
  • Levator veli palatini
  • Palatoglossus
  • Palatopharyngeus
  • Musculus uvulae

All innervated by vagus EXCEPT tensor villi palatini (V3)

38
Q

PSNS Innervation for mouth?

A
  • 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
Q

Sympathetic innervation of mouth?

A
  • 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
Q

What are the tongue extrinsic muscles? Innervations?

A
  • 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
Q

What are the tongue intrinsic muscles? Innervation?

A
  • Longitudinal
  • transverse
  • vertical muscles
  • Innervation: CN XII
42
Q

What provides somatic motor innervation to tongue?

A
  • Hypoglossal nerve (XII)
  • Palatoglossus- (X) (Vagus)
43
Q

What provides general somatic sensory innervation to tongue?

A
  • 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
Q

What nerves provide special sensory to tongue?

A
  • Taste
  • Ant 2/3 facila nerve
    • chorda tympani
  • Posterior 1/3 and anterior epiglottis- glossopharyngeal nerve (IX)
45
Q

Where is pharynx located?

A
  • Posterior to nasal, oral and laryngeal cavities
  • Cranail base to C6- continuous with esophagus
  • Consists of
    • nasopharynx
    • oropharyn
    • laryngopharynx
    • vallecula
46
Q

What is the nasoparhynx?

A
  • Posterior to nose (choanae) superior to soft palate
  • Respiratory function
  • pharyngeal tonsils (adenoids when enlarrged)
47
Q

Where is the oropharynx?

A
  • 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
Q

Where is the laryngopharynx?

A
  • Posterior to larynx, extends from superior border of epiglottis to inferior border of cricoid cartilage (C4-C6)
49
Q

What are the muscles of pharynx and their innervation?

A
  • Superior, middle and inferior pharyngeal constrictors
    • motor via vagus (X)
  • Palatopharyngeus(X)
  • Salpingopharngeus (X)
  • Stylopharyngeus (IX)
50
Q

What innervates sensory information to pharynx?

A
  • Nasopharynx
    • sensory V2
  • Oropharynx
    • sensory IX
      • topside of epiglottis
  • Laryngopharynx
    • sensory CN X
      • inferior aspect of epiglottis
51
Q

Functions and location of larynx?

A
  • Functions
    • airway protection
    • respiration
    • phonation
  • Location
    • C3-C6
    • Connects oropharynx with trachea
52
Q

What forms laryngeal skeleton?

A

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
Q

What is the thyroid cartilage?

A
  • Level of c4
  • Largest and most prominent
  • anterior attachment for vocal cords
54
Q

What is the epiglottis cartilage?

A

Covers opening to larynx during swallowing

55
Q

What is the cricoid cartilage?

A
  • Only complete cartilaginous ring
  • signet- shaped
  • arches faces anteriorly
56
Q

What are the arytenoid cartialges?

A

Posterior attachment for vocal cords

57
Q

What are the corniculate cartilages?

A
  • Attach to apices of the arytenoid cartialges
  • Posterior portion of the aryepiglottic fold

Corniculate forms the core

58
Q

What are the cuneiform cartilages?

A
  • Do not directly attach to any other cartilages
  • In the aryepiglottic fold, not always present
  • lateral to corniculates
59
Q

Do you see aytenoids on DL?

A

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
Q

What are the vocal cords?

A
  • 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
Q

What is the glottic opening?

A

(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
Q

What do the intrinsic laryngeal muscles do? Innervated by?

A
  • 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
Q

A/I of cricothyroid muscle?

A

Action

  • cords tense= cricothyroid
  • stretches and tenses vocal ligament

Innervation

-External laryngeal nerve

64
Q

A/I of thyro-artyenoid muscle?

A

Action:

  • they relax= thyroartyenoid
  • relaxes vocal ligament

Innervation

-Recurrent laryngeal nerve

65
Q

a/i posterior crico arytenoid?

A

Action

  • Please come apart (pull cords apart)= posterior crico-arytenoid
  • Abducts vocal cords

Innervation

-Reccurent larngeal nerve

66
Q

A/I Lateral Crico-Arytenoid

A

Action

  • let’s close the airway= lateral crico arytenoid
  • adducts vocal folds

Innervation

Recurrent laryngeal nerve

67
Q

A/I of transverse and oblique arytenoids?

A

Action

  • adducts vocal folds

Innervation

Recurrent laryngeal nerve

68
Q

A/I Vocalis?

A

Action:

Relaxes vocal ligament

Innervation:

Recurrent laryngeal nerve

69
Q

How is larynx innervated?

A
  • 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
Q

Which muscle is our only abductor?

A

Posterior crico arytenoids

71
Q

What are the intrinsic laryngeal muscles?

A

Cricothyroid

Thyro-artyenoid

Posterior crico-arytenoid

Lateral crico-arytenoid

Transverse and oblique arytenoids

vocalis

72
Q

What happens with nerve injury of external branch of superior larngeal nerve?

A

Controls the cricothyroid muscle- responsible for tensing vocal cords

  • injury leads to hoarseness
73
Q

What happens in a recurrent laryngeal nerve injury?

A

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
Q

How can you check to see status of recurrent laryngeal nerve after surgery?

A
  • 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
Q

Laryngeal arteries are branches of ___ and ____ thyroid arteries

A

superior

inferior

76
Q

What is the superior thyroid artery?

A
  • 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
Q

What is the inferior thyroid artery?

A
  • Branch of thyrocervical trunk
  • Gives rise to: inferior larngeal artery which accompanies recurrent laryngeal nerve
78
Q

Defining characteristics of trachea?

A
  • 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
Q

What do you see on grade I lehane-cormack view?

A

anterior and posterior vocal cords

PUSH

80
Q

Grade II lehane cormack laryngeal view?

A

Posterior tie on vocal cords only

= USH

81
Q

Grade III lehane cormack

A

epiglottis, tongue

SH

82
Q

Grade IV lehand-cormack view?

A

Tongue only

83
Q

What two muscles are causing obstruction of airway for anesthestized patient?

A

Genioglossus

Tensor villi palatini

Anatomy Test 3 (2 decks)

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