Stage E Flashcards
Which nerves and other structures pass through the Superior Orbital Fissure?
CN III - Oculomotor
CN IV - Trochlear
CN VI - Abducen
CN V - Trigeminal - Opthalmic branch
Opthalmic Vein
Where does the Facial Nerve CN VII exit from the cranium?
Pons - facial canal of temporal bone and EXITS at stylo-mastoid foramen
How does the Optic Nerve relate anatomically to the pituitary gland and why might it be clinically significant?
The optic nerve travels posteriorly through the optic canal to the optic chiasma.
The optic chiasma is located anteriorly to the sella tercica in the sphenoid body which houses the pituitary gland.
A pituitary tumour affecting medial fibres within the chiasma can lead to tunnel vision.
Optic nerve compression caused by restrictions in sella turcica.
An important anatomical relation to the pituitary gland is the optic chiasma, which lies just above the pituitary fossa.
Therefore, any expanding lesion of the pituitary or hypothalamus can present with visual field defects.
Describe the origins, pathways and functions of CNXI - Spinal Accessory Nerve?
Split into a cranial division and spinal division:
cranial division - motor supply to pharynx; larynx and palate.
spinal division - motor supply to SC mastoid muscles and trapezius
Two separate divisions EXCEPT when they meet at jugular foramen.
Spinal Pathway - EMERGES C1-C4, roots join and pass up vertebral canal within dural membrane.
ENTERS cranium at foramen magnum and joins cranial division.
EXITS cranium through jugular foramen (with glosso-pharangeal and vagus) to supply trapezius and SC mastoid muscles.
Cranial Pathway -EMERGES medulla, joins spinal division and EXITS cranium through Jugular Foramen (with glosso-pharyngeal and vagus)
SEPARATES from spinal division to MERGE with vagus to pharynx; larynx and palate.
Which nerve pathways regulate:
1) pupil constriction
2) pupil dilation
1) pupil constriction - Oculomotor CN III - parasympathetic fibres
2) pupil dilation - sympathetic supply from sympathetic chain T1/T2
Describe the pathway of the Mandibular Branch of the Trigeminal nerve CN V from it’s root to final destination?
ORIGINATES - pons - Trigeminal ganglion
Mandibular division passes THROUGH foramen OVALE in sphenoid bone.
Mandibular division gives off a recurrent meningeal branch which passes back up through foramen SPINOSUM (with middle meningeal artery) into the cranium to supply the meninges.
THE MANDIBULAR DIVISION GIVES OFF 4 BRANCHES - ABLI
1) Auriculo-Temporal - Ear; ear canal; tympanic membrane, temporal
2) Buccal Branch - sensation from buccinator muscle cheek area)
3) Lingual Branch - touch sensations from tip of tongue
AND
4) INFERIOR AVELOLAR BRANCH -
ENTERS MANDIBULAR FORAMEN on medial surface of ramus of mandible, travels inside mandible to supply lower teeth and EMERGES at MENTAL FORAMEN on surface of mandible as the MENTAL NERVE to supply the lip and chin.
The mandibular branch giveS off MOTOR branches which supply the 4 muscles of mastication - temporalis, masseter, medial and lateral pterygoid muscles.
In addition to enabling mastication, the mandibular nerve also innervates the muscles below –
TENSOR TYMPANI: Dampens sounds, such as those created by chewing, by stabilizing the malleus bone in the middle ear
TENSOR VALI PALATINI: helps elevate the soft palate to prevent regurgitation of food and liquid into the nasopharynx.
SUPRAHYOID muscle involved in elevation of the hyoid bone during swallowing
MYLOHYOID - a suprahyoid muscle involved in elevation of the hyoid bone during swallowing
What is meant by a left side bending pattern of the Maxillae?
Front of maxillary turns to the left relative to the sphenoid as if there has been a blow from the right side of the mouth.
What are the symptoms of Bells Palsy and which cranial nerve is affected?
CN VII - Facial Nerve
Affects one side of face; lower eye lid droops; facial muscles on affected side don’t move - expressionless. Mouth of affected side droops.
What are the symptoms of Menieres disease and which cranial nerve is affected?
CN VIII - Vestibulo-Cochlear Nerve
Inner ear condition.
four main symptoms - severe vertigo; tinnitus; loss of hearing; fullness in ear;
Episodes of nausea and vomiting.
Aggravated by salt; alcohol; caffeine; tobacco
Describe the motion of the following bones during the flexion and extension phase of CS motion?
1) Maxillae
2) Zygoma
1) Maxillae -
Flexion - front portion of maxillae rises superiorly coming up to meet the frontal bone (as it arcs forward and down).
At same time, maxillae spread LATERALLY at posterior part of inter-maxillary suture (ie back teeth move apart).
Extension - front portion of maxilla moves inferiorly away from the frontal bone (as it arcs back and up).
At the same time the maxillae spread MEDIALLY at posterior part of inter-maxillary suture (ie back teeth draw back towards each other)
2) Zygoma -
Flexion - externally rotate with temporals and arching down and out (with frontal).
Extension - internally rotate with temporals and arching up and in.
Which bones does the Vomer articulate with?
Sphenoid, Maxillae, Palatines, Ethmoid.
Describe the CS motion of the orbit during flexion phase?
Orbits elongate along horizontal plane as they get squeezed between frontal and maxillae.
a) List 2 x CRANIAL contacts and 1 x FACIAL contact which might be specifically relevant to assist drainage of middle ear and treatment of ear infections and explain why you chose these
a) CRANIAL - NEED TO RELEASE E.TUBE = free drainage and fluent function - so temporal; spheno-temporal suture (which E.tube runs along).
Free drainage of fluids and mucus throughout cranium - venous sinuses and intracranial membranes; promote immune function.
Ear infections arise from an accumulation and stagnation of fluids in the middle ear, behind the ear drum, which leads to infection (often recurrent) and could result in partial or even total hearing loss.
The stagnation indicates lack of proper drainage from the middle ear of the accumulated fluids, which should normally pass via the eustachian tube (or auditory tube) running from the middle ear to empty into the nasopharyngeal cavity at the back of the mouth.
ROOT CAUSES OF EAR INFECTIONS IS BIRTH TRAUMA
1st Cranial Contact -
General Temporal - may be medially compressed by birth process. Free mobility of the temporal bone is essential because in external rotation, the temporal bone opens the Eustachian tube. The Eustachian tube is the tube connecting the middle ear to the nasopharynx which drains mucus into the back of the throat. If the temporals are restricted into internal rotation, through birth trauma, injury, tension - can contribute to Eustachian tube dysfunction.
2nd Cranial Contact -
Ear hold/ Mastoid Tip - to release restrictions in OM suture and spheno-temporal suture which the E tube runs along so want free mobility of sphenoid and temporals. This will also release constrictions and compression in JF, which will support healthy vagus nerve functioning and overall venous drainage which promotes a healthy system.
Other significant Cranial contact = Sub-Occipital Release. Physical forces are exerted through the babies cranium, leading to compression at base of cranium and sub-occiput. Shock effects of birth may create further tension in this area. A restricted sub-occiput will create tensions and restrictions in the structures passing through the internal jugular veins - including . Shock held in the rest of the system will be reflected in the sub-occiput (and with contracted intracranial membranes; shock held in solar plexus and heart centre).
FACE HOLD - MANDIBLE contact. Why?
If there is an imbalance at the TMJ, this will create an imbalance at the temporals which will create tensions and restrictions along the OM and spheno temporal sutures and impinge the JF. Also will affect the spheno-temporal suture which the E.tube runs along.
Any strain in mandible is passed to sub-occiput, SCM muscles (with attachments at the mastoid tip) which also attaches either side of the jugular foramen. Emotional tension will be reflected in intracranial membranes.
Tensions will be held in the muscles of mastication and TMJ contact addresses all four muscles. Tension in muscles of mastication will reflect in sub-occiput which will affect venous drainage back to heart and lead to a restricted Eustachian tube, contributing to ear ache and ear infections.
Mandible contact will also support the mandibular division of the Trigeminal nerve which innervates the Tensor Vali Palatine muscle which opens the Eustachian tube. If Trigeminal Nerve is over stimulated eg by teeth grinding may cause recurrent ear infections and glue ear.
How would you approach treatment of a client with sinusitis?
Face holds to cover sinus areas - frontal, ethmoidal, maxillary, sphenoid sinuses.
General face contact, maxillary contact., frontal contact;
Sub-occipital release - jugular foramen for which jugular vein carries venous blood back to the heart, main structure of drainage for overall health of the person.
Sinus contacts.
Mastoid tip and ear hold to enhance occipito-mastoid suture release.
Eustachian tube.
CN VII - Facial nerve for mucus secretions.
Whole CS integration.
Stress affecting immunity, causing allergies, causing congestion in mucus membranes.
Trigeminal Nerve - mandibular division for innervating tensor vali palatini muscle.
How might direct trauma to face affect rest of system?
Face becomes locked - restricted spheno-vomer articulation
Dental trauma causing ascending or descending patterns between jaw and pelvis.
Pressure exerted through TMJ - affecting temporals.
CS rhythm becomes blocked - locked up or compressed feeling.
Membranous restrictions in head - tensions and restrictions being reflected throughout body through reciprocal tension membrane system.
Emotional shock trauma being held elsewhere in body - solar plexus, heart centre, throat.
