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HNN > Session 5 > Flashcards

Session 5 Flashcards

1
Q

Describe embryo at 4 weeks

A

No face yet discernible
Head and neck take up almost half of body
Embryonic head is complex but follows similar segmental pattern
Each segment contains structures from various different systems

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2
Q

What are the bulges in embryonic neck called

A

Pharyngeal arches

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3
Q

What is on the outside and inside of a pharyngeal arch

A

Outside = ectoderm
Inside = endoderm

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4
Q

Pharyngeal arch contains

A

Artery- mesoderm, one of aortic arches
Cartilage bar- associated muscles, supports arch
Cranial nerve- each arch has a different nerve, motor to muscles associated with cartilage

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5
Q

Arch 1 features

A
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6
Q

Arch 2 features

A
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7
Q

Arch 3 features

A
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8
Q

Arch 4 + 6 features

A
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9
Q

Depression on outside is called

A
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10
Q

Depression on inside is called

A
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11
Q

What does the first cleft form

A

Tympanic membrane —> eternal acoustic meatus

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12
Q

What happens to clefts 2-6

A

Caudal border of second arch grows over more caudal arches and they disappear

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13
Q

What does the first pharyngeal pouch form

A

Tubotympanic recess —> Eustachian tube

Middle ear cavity

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14
Q

What does the second pharyngeal pouch form

A

Palatine tonsil

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15
Q

What does the third pharyngeal pouch form

A

Thymus and inferior parathyroid

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16
Q

Branchial/pharyngeal abnormalities

A

Cysts, sinuses and fistulas

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17
Q

Branchial cysts, sinuses and fistulas

A

Cyst = enclosed
Sinus = communicates with skin
Fistula = connects skin with pharynx

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18
Q

Branchial sinuses are usually found

A

As pits near the ear

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19
Q

Branchial cysts are usually found

A

Anterior to SCM in anterior triangle of neck

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20
Q

Features of fetal alcohol syndrome

A

Neural crest cells
Under developed jaw
Ears low set
Flat mid face
Small head

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21
Q

How does ear form

A
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22
Q

Innervation of the anterior 2/3 of tongue

A

Sensation from trigeminal
taste from facial

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23
Q

Innervation of posterior 1/3 of tongue

A

Sensation and taste from glossopharyngeal

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24
Q

Muscles arise from

A

Somites at the level of hypoglossal nerve

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25
Q

What separates the two parts of tongue

A

Sulcus terminalis

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26
Q

How does the thyroid gland develop

A

Thyroid diverticulum originates form Foramen cecum

Thyroglossal duct breaks down

Thyroid gland and cartilage is formed

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27
Q

Congenital problems with thyroid gland development

A

Failure of thyroglossal duct to break down can result in cysts and fistulae opening at foramen caecum

Ectopic thyroid gland tissue can sometimes be found anywhere along path of descent

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28
Q

How to detect a cyst or fistula at foramen caecum

A

Connected to tongue, stick tongue out = elevate the lump

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29
Q

Collectively, the pharyngeal arches, their grooves (clefts) and pouches are known as the

A

Pharyngeal apparatus

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30
Q

Rearrangement of developing structures explains why

A

Recurrent laryngeal nerve of faves becomes looped under the arch of the aorta on left side fan subclavian artery on right side

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31
Q

Facial skeleton arises from the

A

Frontonasal prominence and 1st pharyngeal arch

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32
Q

What does the fourth pharyngeal pouch form

A

Superior parathyroid and C cells of thyroid

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33
Q

Face develops from which 5 building blocks

A

Frontonasal prominence, two maxillary prominences and two mandibular prominences

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34
Q

First evidence of face development is the

A

Appearance of a depression in the ectoderm on the ventral aspect of the head- stomadaeum (site of future mouth)

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35
Q

Frontonasal prominence will form the

A

Forehead, bridge of nose, upper eyelids and centre of upper lip

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36
Q

Laterally paired maxillary prominences form the

A

Middle third of the face, upper jaw and most of lip and sides of nose

37
Q

Paired mandibular prominences form

A

Lower third of face, including lower jaw and lip

38
Q

First evidence of nose formation is appearance of

A

Two ectodermal thickenings - nasal placoderms

On ventrolateral aspect of Frontonasal prominence

39
Q

What is a placode

A

Area of ectoderm that starts to thicken and differentiate itself from the surrounding tissue and give rise to sensory structures

40
Q

Future ear develops from what placode

A

Otic

41
Q

Deepening nasal pits are separated by

A

Oronasal membrane which disappears and the oral and nasal cavities become one continuous space

42
Q

Palate development involves the

A

Maxillary prominences (merge in midline to form philtrum and primary palate) and medial nasal prominences

Fusion of palatal shelves form secondary palate and separates nasal cavity from oral cavity

43
Q

What must happen so the palatal shelves can fuse (and nasal septum)

A

Tongue must drop down

44
Q

Cleft lip arises from

A

Failure of fusion of medial nasal prominence and maxillary prominence

45
Q

Cleft palate is when

A

Failure of fusion of medial nasal prominence and maxillary prominence

AND

Failure of palatal shelves to meet in midline

(Genetic and environmental)

46
Q

Clefts of the lip and palate diagnosis

A

Antenatal with ultrasound, or after delivery

Difficulties with feeding or speech development, cosmetic

47
Q

Clefts treatment

A

Surgery

Cleft lips- around 3 months (for cosmetic reasons)

Cleft palate- 9-12 months (specialist feeding techniques can be used up until this point)

48
Q

From which pharyngeal arch are the maxillary and mandibular prominences formed

A

First arch

49
Q

Major sensory branches from Va

A

Frontal nerve- supraorbital and supratrochlear nerve (on to forehead)

Nasociliary nerve- eye and skin over nose and tip of nose

50
Q

Major sensory branches from Vb

A

Infra-orbital nerve (vulnerable in orbital floor fracture)

Superior alveolar nerves (supplies upper teeth and gums)

51
Q

Major sensory branches from Vc

A

Auriculotemporal nerve (sensory to side of scalp, part of ext ear and TMJ)

Lingual nerve (general sensation from anterior 2/3 tongue)

Inferior alveolar nerve (supplies lower teeth and gums) + mental nerve (both vulnerable in mandibular fractures)

52
Q

CN Va Opthalmic nerve division of trigeminal nerve key branches image

A
53
Q

Hutchinson’s sign

A

vesicles on tip of nose- very concerned about eye being affected by shingles

54
Q

Divisions of trigeminal nerve as seen on face

A
55
Q

CN Vb Maxillary nerve division of trigeminal nerve key branches image

A
56
Q

CN Vc Mandibular nerve division of trigeminal nerve key branches image

A
57
Q

Orbital blowout fracture clinical correlation and presentation

A

Sensory defect on lower eyelid and part of cheek

Numb gums and upper teeth

Infraoribital nerve runs within bone forming floor of orbital

58
Q

Mandibular fracture clinical relevance

A

Mental nerve exits mental foramen

Mental nerve enters into mandibular canal, becomes inferior alveolar nerve running within bone of mandible

Patch of sensation from lower lip and chin, gum and incisors affected

59
Q

Facial nerve CN VII supplies generally

A

Motor, special sensory (Taste), parasympathetic

60
Q

Facial nerve specific supplies

A

Motor (muscles of facial expression and nerve to stapedius)

Special sensory taste (anterior 2/3 tongue)

Parasympathetic to glands (lacrimal, nasal and salivary) (excluding parotid)

61
Q

How to test facial nerve

A

Muscles of facial expression

62
Q

Facial nerve lesion presentation

A

Unilateral facial droop +/- reporting symptoms due to absence of other facial nerve functions e.g. altered taste, dry mouth, can’t cry

On examination - whole half of affected side including forehead

63
Q

Causes of facial nerve problems

A

Lesions in/around internal acoustic meatus & posterior cranial fossa tumours

Basal skull fracture involving Petrous bone

Middle ear disease (inflammation in facial canal, facial nerve palsy)

Parotid disease

64
Q

Types of facial nerve palsy

A

Bell’s palsy, Ramsay-Hunt syndrome

65
Q

How to diagnosis Ramsay-Hunt syndrome or not

A

Look for vesicles- a little bit like shingles of facial nerve

Caused by VZ

Vesicles around external ear

66
Q

Facial nerve route

A
67
Q

Extracranial branches of facial nerve

A

Temporal
Zygomatic
Buccal
Marginal mandibular
Cervical

Two zebras bit my cock

68
Q

3 branches of facial nerve into Petrous bone

A

Nerve to stapedius - innervates muscle which dampens vibration of stapes

Greater Petrosal- carries parasympathetic fibres to lacrimal and nasal mucosal glands

Chorda tympani- taste from anterior 2/3 tongue, carries parasympathetic fibres to salivary glands (except parotid)

69
Q

Facial droop key difference between stroke and facial nerve lesion

A

In stroke:

Forehead sparing- can close eye and raise eyebrows

Brain neural connections between motor cortex and facial nerve nuclei have been damaged

Not a facial nerve lesion

70
Q

Forehead sparing explained

A

Pathology and injury involving motor pathways anywhere along path from primary motor cortex to where synapse with facial nerve motor nuclei in brainstem

Upper half of Contralateral face spared as has back up from ipsilateral cortex

71
Q

Why would forehead also be affected

A

Pathology and injury involving facial nerve anywhere from after exit from brain stem and along its route to target tissue

Whole half of ipsilateral face affected

72
Q

CN VIII Vestibulocochlear functions

A

Special sensory

Cochlea (organ of hearing)

Semicircular canals (organ of balance)

73
Q

presentation and test for CN VIII Vestibulocochlear lesion

A

Present with- hearing loss, dizziness, tinnitus

Test with- gross bedside hearing test (whisper/finger rub), tuning fork test (Weber’s and Rinne’s)

74
Q

Problems with CN VIII Vestibulocochlear

A

Vestibular shwannoma (or other posterior cranial fossa tumours)

Occlusion of labyrinthine artery (supplies the nerve)

Base of skull fracture (involving petrous bone)

Brainstem lesions (pons) rare

75
Q

What is Vestibular Schwannoma (acoustic neuroma)

A

Benign tumour involving Schwann cells associated with vestibulocochlear

Slow growing

Usually unilateral

76
Q

Vestibular Schwannoma (acoustic neuroma) signs and symptoms

A

Unilateral hearing loss
Tinnitus
Vertigo
Numbness, pain or weakness down one half of face

77
Q

CN IX and X Glossopharyngeal and Vagus nerves route

A

Arise from medulla
Run through posterior cranial fossa
Exit through jugular foramen
Both carry parasympathetic fibres (to different target tissues)

Enters into carotid sheath - close relationship with internal and external carotid arteries

Glossopharyngeal nerve leaves sheat superiorly, tend to be examined together

78
Q

CN IX Glossopharyngeal roles

A

Mainly sensory (oropharynx/tonsils/middle ear cavity)

Posterior 1/3 tongue (SS/GS)
1 swallowing muscle
Parasympathetic to parotid gland
Afferents from carotid sinus and body

79
Q

CN X Vagus nerve roles

A

Motor and sensory

Muscles of larynx/pharynx- including soft palette

Sensory (Larynx/laryngopharynx)

Parasympathetic to many tissues

80
Q

Presentation of patients with CN IX and X Glossopharyngeal and Vagus nerves problems

A

Difficulty with swallowing (CN X mainly)
Weak cough (CN X)
Difficulties with speech or changes in voice (CN X)

81
Q

Assessment of patients with problems with CN X and CN IX

A

Speech, swallow and cough assessed

Soft palate movement (ahhh = elevation) and uvula position (CNX) assessed

Gag reflex (IX afferent, X efferent)

82
Q

Problems with CN IX and X Glossopharyngeal and Vagus nerves

A

RLN branch of CN X (thyroid pathology or surgery, superior thorax/mediastinal pathology)

Pathology or surgery involving carotid sheath structures (e.g. common or internal carotid artery dissection, carotid endartectomy)

Posterior cranial fossa tumours , base of skull fractures (jugular foramen)

Brainstem (medullary) lesions e.g. infarct, MND

83
Q

Key branches of vagus in neck

A

Right recurrent laryngeal nerve

Left recurrent laryngeal nerve

84
Q

CN XI and XIII Accessory and Hypoglossal pathway

A

Arise from medulla (accessory nerve also has some contribution from upper cervical spinal nerves)

Runs through posterior cranial fossa

enter into carotid sheath (both leave superiorly in sheath)
- hypoglossal exits and travels towards tongue
- accessory exits and heads towards posterior triangle

85
Q

CN XII Hypoglossal functions

A

Motor, target tissues = muscles of tongue

86
Q

CN XII Hypoglossal examination and causes for problems

A

Examine tongue movements and protrusion

Surgery/pathology in proximity to or involving contents of upper carotid health, internal and external carotid arteries e.g. carotid endartectomy

Posterior cranial fossa tumours

Brainstem (medullary) lesions involving the hypoglossal nucleus e.g. brainstem infarct, MS

Can be affected in motor neurone disease

87
Q

Problem with CN XII Hypoglossal

A

Tongue deviates towards the weakest side

88
Q

CN XI Spinal Accessory pathway and action (and test)

A

Medulla (cranial roots) and spinal roots

Emerges deep to posterior border of SCM to enter posterior triangle, runs superficially in posterior triangle to reach trapezius

SCM (turn head) and Trapezius (shrug shoulders)

Causes shoulder drop

89
Q

CN XI Spinal Accessory nerve problems

A

Injury, surgery or pathology involving posterior triangle or structures within

Posterior cranial fossa tumours

Base of skull fractures (jugular foramen)

Brainstem (medullary) lesions e.g. infarct

HNN (19 decks)

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