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ESA 4 > Session 4: Head and Neck > Flashcards

Session 4: Head and Neck Flashcards

1
Q

What are the cranial nerves ?

A 
These are 12 paired nerves which are a part of the peripheral nervous system. 
Their origin is from :
Anterior forebrain 
Midbrain 
Pons 
Medulla
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2
Q

What are the odd cranial nerves and why ?

A

Cranial nerve 1 (olfactory) and cranial nerve 2 (optic)
These are origins of the anterior forebrain.
Cranial nerve 11 (accessory)
This has components of the spinal chord, C1-C6

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3
Q

Which nerves arise from the midbrain?

A

Cranial nerve 3 occulomotor

Cranial nerve 4 Trochlea

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4
Q

Which nerves arise from the pons?

A

Cranial nerve 5 Trigeminal nerve
Cranial nerve 6 abducens nerve
Cranial nerve 7 facial nerve
Cranial nerve 8 vestibulocochlear nerve

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5
Q

Which nerves arise from the medulla?

A

Cranial nerve 9 glossopharyngeal
Cranial nerve 10 vagus
Cranial nerve 11 accessory
Cranial nerve 12 hypoglossal

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6
Q

What is the basic trajectory of the olfactory nerve ?

A

Nerves from the olfactory mucosa in the roof of the nose will ascend through the cribriform foramina in the ethmoid plate, and then form the olfactory bulb before travelling back as the olfactory tract.

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7
Q

What is anosmia and what are its common causes ?

A

The loss of the sense of smell.
This can be temporary, long term, or progressive.
Common causes: upper respiratory infection, basilar fracture to the frontal plate, ( neurodegenerative disease, tumours )

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8
Q

What is the trajectory of the optic nerve ?

A

The optic nerve travels back from the orbit in the back of the eye (the retina) through the optic canal, then it comes back and crosses over at the optic chiasm (a region anterior to the sella turcica) and travelling back as the optic tract.

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9
Q

Which three spaces does the branches of the Trigeminal nerve pass through ?

A

V1 ophthalmic branch - through the superior orbital fissure
V2 maxillary branch - foramen rotundum through the pterygoplalatine fossa
V3 mandibular branch - foramen ovale

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10
Q

Which nerves run in the cavernous sinus?

A

Trochlea
Occulomotor
Adducens
Trigeminal ophthalmic and maxillary branch (V1/2)

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11
Q

When testing the optic nerve, what do you look for?

A

Visual acuity
Visual fields
Pupillary responses

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12
Q

What common conditions can effect the optic nerve ?

A

Optic neuritis
Tumours and lesions
Pituatary tumours specifically as the optic chiasm is just anterior in close proximity to the Sella Turcica where the gland sits.

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13
Q

What kind of nerves are the cranial nerves?

A

Motor
Special sensory - vision, smell , taste.
General sensation - proprioception, pain Balance.

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14
Q

What is the route of the occulomotor nerve?

A

Nerve from the midbrain, travels through the cavernous sinus, and then through the superior orbital fissure to enter into the orbit of the eye.

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15
Q

What is the function of the occulomotor nerve ?

A

It carries motor innervation of 4/6 extraocular muscles

Parasympathetic innervation of the pupils. This will cause pupillary constriction.

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16
Q

What is the pupillary light reflex?

A

This is when bright light is shone on the eye the pupil will constrict.

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17
Q

When checking the occulomotor nerve , what do you test for?

A

Check for pupillary dilation to light
Check for movement of the eye in the orbit
Inspect the eyelids and the eyeball

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18
Q

Damage to this nerve (cranial nerve 3 )can result in what symptoms?

A

Ptosis - inability to raise the eyelid, therefore it is perceived as constantly drooping. This is as the muscle levator palpebrae superior is innervated by this nerve and is responsible for keeping the eyelid open.
Diplopia - eyes in a down and out position .
Pupils can be blown (constant dilation of the pupil despite light being shone on it)

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19
Q

What commonly causes pupils to be blown and why?

A

Raised ICP as a result of heamorrhage of Tumour.
This is as the autonomic fibres run on the outside of the nerve and are likely to effected first in any form of a compression of the nerve.

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20
Q

What are the common causes of damage to cranial nerve 3?

A

Raised ICP
Aneurysms of the posterior communicating artery as this runs parallel to the nerve.
Cavernous sinus thrombus (due to infection of the Face)
Diabetes / hypertension

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21
Q

What is the trajectory of the 4th cranial nerve?

A

Trochlear nerve will travel from the midbrain on the dorsal aspect of the midbrain, and has the longest intercranial route. It will travel through the cavernous sinus, to then enter the orbit via the superior orbital fissure.

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22
Q

What does the 4th cranial nerve innervate?

A

Innervates one of the muscles of the eye (extra ocular) called the superior oblique. This is the nerve responsible for intorsion & depression of the eye.

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23
Q

What commonly presents as damage to the 4th cranial nerve?

A

Vertical Diplopia.
The effected eye will be looking upward and will be extorting (looking away). This is worsened when the px is looking downwards (such as when they are reading or walking down the stairs)
Sometimes px can develop a tilt on the contralateral side to then help keep the eyes at the same level.

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24
Q

What are the common causes of damage to the 4th cranial nerve?

A

Head injury
Raised ICP causing the nerve to become stretched.
Congenital palsy :
1) muscle weakness or tendon weakness
2) developmental error of the nucleus of nerve or other parts of the nerve.
Palsy can also be secondary to diabetes, microvascular disease or hypertension.

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25
Q

How do you test (clinically) for the integrity of the 4th cranial nerve?

A

Tested alongside the optic nerve (eyeball movements)

26
Q

What does the Trigeminal nerve do?

A

Nerve is motor the muscles of mastication
Carries parasympathetic post ganglionic neurones to the glands etc
Carries sympathetic to the dialtor muscles of the eye.
Responsible for sensory innervation of the face, mucus membranes and the sinuses of the face.

27
Q

Which branch of the Trigeminal will give off motor innervation to the muscles of mastication ?

A

The mandibular branch (v3)

28
Q

What are the branches of the trigeminal V1?

A

(V1- opthalmic branch and is responsible for the sensory innervation of the frontonasal prominence)
Frontal nerve - > sensory to the forehead, the scalp & the roof of the orbit
Lacrimal nerve - > lacrimal gland
Nasocillary - > sensory to the external nose and the orbit . This is the branch responsible for the corneal reflux

29
Q

What are the branches of V2?

A

(V2 - Maxillary branch which innervates the area of the upper jaw , the skin derived from the maximally prominences & the nasal glands)
Infraorbital
Zygomatic
Superior alveolar

30
Q

What are the branches of V3?

A

(V3 - mandibular branch, innervates the lower jaw and face)
Auricotemporal - sensory to the side of the head & parotid gland
Buccal nerve - cheek and 2/3 molar teeth
Lingual nerve - sensory innervation and special sensory with facial nerve. ( Anterior 2/3 of tongue)
Mental nerve - branch of the inferior alvleolar nerve which had a cutaneous branch. Innervated lower jaw, lower lip.

Nerve to the muscle of mastication * anterior belly diagastric & mylohyoid & tensor tympani

31
Q

Why does a central nerve lesion of the facial nerve effect the muscles on the contralateral side of the face?

A

This is as the in the CNS the right hemisphere controls the left hand side of the body ( and vice versa) so central damage would effect the opposite side.

32
Q

What muscles do the 5 terminal branches of the facial nerve supply?

A

Temporal - auricular anterior, frontal belly of occipitofrontalis, superior orbicualris occuli
Zygomatic - inferior orbicualris occuli
Bucal - buccinator, zygomaticus & upper orbicualris oris
Mandibular (marginal) - mentalis, muscles of lower lip and chin and risorius
Cervical - platysma muscle

33
Q

What are the other motor branches of the facial nerve?

A

The nerve to stapedius
The nerve to posterior digastric belly (elevate hyoid)
The posterior auricular nerve
Nerve to stylohyoid (elevate hyoid)

34
Q

What is the chorda tympani?

A

Specialised sensory nerve which will hitchhike with the lingual nerve of the Trigeminal.
Arises distal to the geniculate ganglion, in the facial canal, carries special sense & ; parasympathetic. Travels out of the peterotympanic fissure to enter into the infratemporal fossa.
PS - travels with lingual nerve to the submandibular and sublingual glands
SS - travels initially on lingual before diverging in the infratemporal fossa.

35
Q

What is the greater pterosal nerve?

A

Arises distal to the gneinculate ganglion in the facial canal, travels anteriomedially to enter into the middle cranial fossa. Nerve will pass across the foramen lacerum (not through) before joining with the deep petrosal nerve to become the nerve of the pterygoid canal. Nerve travels in canal to exit via the pterygopalatine fissure into the pterygopalatine fossa.
PS - nasal mucosal glands, lacrimal gland, oral & pharyngeal glands.

36
Q

What is the geniculate ganglion ?

A

Sensory ganglion (not associated with PS)

37
Q

Which nerve is responsible for the afferent corneal reflux?

A

V1 ophthalmic branch —> nasocillary nerve

38
Q

What is the trajectory of the 12th cranial nerve ?

A

Nerve travels through the hypoglossal canal to exit the cranium , joins up with C1 & 2 to the travel inferiomedially to the angle of the mandible & will cross the external and internal carotid arteries to innervate the muscles of the tongue.

39
Q

What is the function of the 12th cranial nerve?

A

Function of the nerve is to innervate the somatic motor innervation to the tongue.

40
Q

When the hypoglossal nerve is damaged what can be seen in the mouth?

A

When there is damage there is atrophy to the side of the tongue innervated by the hypoglossal nerve (ipsilateral side)

41
Q

What are the functions of the 9th cranial nerve?

A

Sensory to the carotid sinus and carotid body
Taste of the posterior 1/3 of tongue & general sensation here
Sensory to the oropharynx, Eustachian tube, inner membrane of the tympanic cavity, soft palate & the tonsils.
Motor to the stylopharengeus
Autonomic innervation to the parotid gland

42
Q

What are the functions of the 10th cranial nerve?

A

Motor to muscles of pharynx and larynx
Sensory to the laryngopharynx, the outer ear (external acoustic meatus & the larynx.
Innervates the CVS to decrease HR
Innervates the GI to increase peristalsis and mucosal gland activity
Innervates the Resp to bronchoconstriction & increase mucosal gland activity.

43
Q

What is the function of the 11th cranial nerve ?

A

Motor to the trapezius

Motor to the SCM

44
Q

What is the route of the 11th cranial nerve?

A

Nerve comes form the C1-C5
Travels up through the foramen magnum
Travels into the jugular foramen with the 10th cranial nerve
Runs in the posterior triangle of the neck

45
Q

When is the 11th cranial nerve at risk of injury ?

A

During surgery : lymph node biopsy, cannulation of the internal jugular vein.
This can be damaged in a stab wound.

46
Q

How do you test the integrity of the 11th cranial nerve?

A

Shrug the shoulders against resistance

Turn the head in one direction against resistance.

47
Q

Which two reflexes / mechanisms does the 9th cranial nerve play a crucial role in?

A

The gag reflex :
9th cranial nerve sensory afferent -> brainstem -> 10th cranial nerve to cause pharyngeal constriction and to raise the soft palate.
Baroreceptor reflex :
9th cranial nerve senses physical pressure changes & alterations in the levels of oxygen -> cardioresp control centre in medulla oblongata -> 10th cranial nerve to the SAN/AVN to reduce HR.

48
Q

What is the trajectory of the 9th cranial nerve?

A

Nerve will run from the anterior surface of the medulla, laterally into the posterior cranial fossa before exiting via the jugular foramen.

49
Q

What is the trajectory of the 8th cranial nerve ?

A

Vestibulocochlear nerve originates from the pontomedullaru junction to pass through the internal acoustic meatus where it will divide into the vestibular and cochlear branches.

50
Q

What is the function of the 8th cranial nerve?

A

Aid in balance and equilibrium - vestibular nerve, bipolar neurones to the semicircular canals
Aid in hearing - cochlear nerve, bipolar neurones to the cochlear (spiral)

51
Q

Which nerve is also damaged commonly when the 8th cranial nerve is damaged?

A

The facial nerve is damaged alongside the vestibulocochlear nerve as both will exit via the IAM.

52
Q

What is Bell’s palsy?

A

This is an idiopathic disease of exclusion where there is facial drop on one side of the face, secondary to no other visible cause.

53
Q

What problems can effect the facial nerve?

A

Tumours and problems with the vestibulocochlear nerve
Parotid tumours or parotitis (S.aureus infection)
In neonates with forceps delivery it can damage the mastoid process which nearby can result in disruption of the stylomastois foramen.
Herpes zoster virus can effect this region resulting in a nerve palsy.

54
Q

What is an acoustic neuroma ? Which nerves can it effect?

A

It is a tumour of The vestibulocochlear nerve :
Neurolemma cells of the vestibular branch can be effected
This can also effect the facial nerve which also exits via the internal acoustic meatus

55
Q

How do you test the 9th cranial nerve ?

A

This is tested in conjunction with the 10th cranial nerve

Sensory part of the nerve can be tested in the gag reflex

56
Q

How do you test the 10th cranial nerve ?

A

Swallowing, noting speech , coughing

Efferent limb of the gag reflex

57
Q

What is the trajectory of the 10th cranial nerve ?

A

This nerve exits via the jugular foramen form the medulla
It will run in the carotid sheath in the neck and will give off different branches here,
The right vagus nerve will run anterior to the right subclavian artery and posterior to the sternoclavicular joint to enter the thorax
The left vagus nerve will pass inferiorly between the left common carotid and the left subclavian and posterior to the sternoclavicular joint to enter into the thorax.

58
Q

What is the recurrent laryngeal nerve a branch of and what does its damage potentially signify?

A

These nerves are branches of the vagus nerve
The left branch hooks around the ductus arteriosus descending further into the body, and is more susceptible to damage.
The right hooks around the right subclavian artery.
Damage can result in difficulty breathing, in phonation and in dysphagia. Hoarse voice
Damage could be the result of tumours in the thorax, (oesophageal, lung pancose, laryngeal) or other pathology in the thorax.
In some cases the hypertrophy of the left atrium as a result of mitral valve disease can compress the arch of the aorta against the nerve to also cause symptoms.

59
Q

Which branch of the vagus nerve is susceptible to injury in a thyroid surgery?

A

The superior laryngeal nerve runs with the superior thyroid artery , which when cut can result in damage to this nerve.
This can cause problems in phonation.

60
Q

Why do symptoms of a cold often result in ear ache pain as well?

A

The glossopharyngeal nerve which innervates the oropharynx, tonsils and the posterior 1/3 of tongue will also have sensory innervation of parts of the inner membrane of the tympanic cavity which means it can also be effected .

ESA 4 (15 decks)

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