Unit 4 comprehensive COPY Flashcards
What does investing fascia sourround
SCM and trapezius
What are the 3 parts of pretracheal fascia
Visceral
Muscular
Buccopharyngeal
Which fascia wraps around infrahyoid m
Musclar part of pretrachial fascia
What are key contents of posterior triangle of neck
EJV
Roots of brachial plexus
Accessory nerve
Cervical and supraclavicular lymph nodes
EJV is(superficial/deep) to SCM
Superficial
IJV is (superficial/deep) to SCM
Deep
The Phrenic nerve descends vertically across which muscle?
Anterior scalene
The phrenic nerve is crossed anteriorly by which arteries
Transverse cervical and sprascapular
The phrenic nerve enters the thorax between which artery and vein
Between Subclavian artery and vein
The phrenic nerve travels along what structure to supply the diaphragm
the pericardial sac
Where do the scalene muscles insert
First rib (anterior and middle scalene) and second rib (posterior scalene)
The retromandibular vein is formed by which veins
Superficial temporal and maxillary
Facial and posterior auricular veins flow into it
Where does the retromandibular vein drain into
Internal and external jugular vein
Which veins make up the common facial vein
Anterior division of retromandibular vein, facial vein.
Drains into internal jugular vein
Which cranial nerves are in the anterior cervical triangle
Facial (7)
Glossopharyngeal (9)
Vagus (10)
Accessory (11)
Hypoglossal (12)
All of the Infrahyoid muscles insert at the hyoid bone besides….
Sternothyroid muscle- insesrts at thyroid cartilage
What are the 3 posterior branches of the external carotid artery
- Ascending Pharyngeal
- Occipital
- Posterior Auricular
What are the 3 anterior branches of the external carotid artery
- Superior Thyroid
- Lingual
- Facial
The mylohyoid nerve off CNV3 suppplies which 2 muscles
Mylohyoid and anterior belly of digastric
The superior and middle thyroid veins drain into the __________ vein while the inferior thyroid vein drains into the __________ vein.
- internal jugular vein
- brachiocephalic vein
The vertebral vein drains into the
Brachiocephalic vein
The vertebral artery is posterior to the ___ v and ___ in the neck
Posterior to the vertebral vein, deep in the neck
The Vertebral artery arises from the ___ artery prior to the ___trunk
Subclavian artery, Thyrocervical trunk
The vertebral artery enters the transverse foramen of which vertebrae
C6 and superior
The sympathetic trunks of the neck are located anterior to which muscles
prevertebral muscles ( Longus colli, longus capitis, rectus capitis anterior, anterior scalene)
3 sympathetic ganglia are found in the cervical region. Name them
Superior cervical, middle cervical, and Cervical thoracic (stellate) ganglia
The superior cervical ganglia is anterior to which muscle
Longus capitis
The middle cervical ganglia is posterior to which gland
thyroid gland
The cervicothoracic ganglia is inside of what
thoracic inlet
The junction of the sphenoid, frontal , parietal, and temporal bones is significant for which reason
It is the junction of many bones merging, and it is a thin and weak area. The middle meningeal artery sits under here, which can cause a Epidural hematoma
Most of the muscles of facial expression originate on ___ and insert into ___
Facial bones
Skin and connective tissue of the face
Fascia in the scalp blends with what in the neck posteriorly?
Superficial fascia, extends into temporal regions laterally
Parotid fascia covers which muscle and invests the parotid gland?
Masseter
Which muscle lifts the eyebrows
Frontalis
Which muscle closes the eyelids and squints the eyebrows
Orbicularis oculi
Corrugator supercilli brings the ___ together
Eyebrows
Which muscles lift the side of the mouth into a passive smile?
Zygomaticus major and minor
The parotid duct crosses over which muscle and pierces through which muscle
Crosses over masseter and pierces buccinators
The parotid duct opens into the oral cavity where
Maxillary 2nd molar
Which nerve innervates the parotid gland
7- Facial
Which artery and vein are related to the parotid gland
Maxillary artery and Maxillary vein
The chorda tympani provides sensory innervation where
Taste to the anterior 2/3 of the tongue
Which nerve innervates
- Zygomaticus major & minor
- Levator labii superioris
- Levator anguli oris
- Buccinator
- orbicularis oris Nasalis
Buccal branch of facial nerve
If your patient is unable to raise their eyebrows, which nerve is likely implicated?
Temporal branch of facial nerve- innervates Frontalis and orbicularis oculi
A parotid gland tumor can cause what
paralysis of the facial muscles- the facial nerve is under/within the parotid gland, so can cause paralysis
Which layer of the scalp are emissary veins in
Loose areolar connective tissue
_____ veins are a communication between superficial veins of the scalp (in connective tissue layer) and dural venous sinuses
Emissary
The olfactor nerve exits through which foramena
Cribiform plate in anterior cranial fossa
The pituitary gland sits in which fossa
Hypophyseal fossa
If you see only veins, you are looking at the _______________ mater
If you only see sulca and gyra, you are looking at the __________ mater
Arachnoid mater
Pia mater
An epidural hematoma is caused by what most commonly
middle meningeal artery bleed
Which nerve supplies sensory information above the vocal cord to the pharynx
Internal branch of superior laryngeal nerve ( Not recurrent laryngeal)
Which nerve supplies sensory information below the vocal cord to the pharynx
Recurrent laryngeal nerve
Which muscle is most important for elongating the vocal cords
Cricothyroid
- Innervated by external branch of superior laryngeal nerve
Which muscle is responsible for abduction of the vocal cords
Posterior cricoarytenoid (recurrent laryngeal)
Which muscle is responsible for adducting the vocal cords
Lateral cricoarytenoid, thyroarytenoid, arytenoid
What is the attachment of the vocalis muscle
Right on the vocal ligament- provides very specific and fine control of tone because of insertion on the vocal ligament
The constrictor muscles of the pharynx are innervated by which nerve
Pharyngeal plexus- Vagus (X)
The Innervation to the pharynx and larynx is all done by one nerve, with the exception of one muscle. Which nerve provides the majority of innervation to this region, and what is the exception
Vagus provides most of the innervation through pharyngeal plexus. Stylopharyngeus is innervated by glossopharyngeal.
Which nerves provides sensory innervation to the pharynx
Nasopharynx- CN V2 (Maxillary of trigeminal)
Oropharynx- Glossopharyngeal
Laryngopharynx- Vagus
Which nerve runs with the inferior thyroid artery
Recurrent laryngeal nerve
Which nerve and artery pierce through the thyrohyoid membrane
Superior laryngeal (External laryngeal) nerve and artery
Which artery is in close proximity to the recurrent laryngeal nerve during a thyroidectomy
Recurrent laryngeal nerve crosses inferior thyroid artery
Which artery runs with the superior laryngeal nerve(External laryngeal)
Superior laryngeal artery
Where does the pretracheal space run
from the thyroid cartilage to the anterior mediastinum
Where does the prevertebral danger space run
Base of skull to posterior mediastinum
-Eating sharp food can damage the esophagus and cause a problem here
- Common place for inferior infections to spread
Where does the retropharyngeal space run
Base of skull to superior mediastinum
What spaces are anterior/posterior to alar fascia
Retropharyngeal space is ANTERIOR, from skull base to superior mediastinum
Prevertebral (danger) space is POSTERIOR, running from skull to POSTERIOR mediastinum
Split by alar fascia
If there is blood pooling in the carotid sheath, what structure can this implicate
The heart- blood pooling in the carotid sheath puts pressure on the heart.
After the bifercation of the common carotid artery into the external and internal carotid arteries, which one still runs in the carotid sheath?
Internal carotid- external has to split to supply face and scalp blood supply
Subclavian artery runs between which muscles and in which groove
Between anterior scalene and middle scalene muscles via the subclavian artery groove of the 1st rib
C1 from the ansa cervicalis joins which nerve on its way to where
C1 joins hypoglossal nerve to get to Thyrohyoid– Nerve to thyrohyoid innervates it- Not ansa cervicalis.
External carotid artery terminates as what
maxillary artery and superificial temporal artery
The superior cervical ganglion is located anterior to which muscle
longus capitis
The middle cervical ganglion is located posterior to what
thyroid gland
The cervicothoracic (stellate) ganglion is located inside of what
the thoracic inlet
The pterion is the point where which bones meet
Parietal, Frontal, Sphenoid, Temporal bones.
What does a breakage of the pterion commonly cause
Epidural hematoma– Middle meningeal artery runs right deep to it.
Skull bones are connected via which joints
suture joints
The Buccinator muscle is pierced by what
the parotid duct
What provides motor innervation to the muscles of facial expression
Buccal branch of Facial nerve (CN 7)– NOT buccal nerve from Trigeminal nerve.
The Chorda tympani nerve branches from the facial nerve where
As the facial nerve exits the stylomastoid foramen
What does the chorda tympani provide and what nerve does it travel with
Travels with the mandibular (V3) branch of trigeminal to get to the tongue where it provides special sensory innervation (taste)
Which veins travel through the bones of the skull connecting the deep connective tissue to the dural venal sinuses
emmissary veins
Where do emmissary veins run
between the deep connective tissue and dural venous sinuses
Where do bridging veins run
From brain surface to venous sinuses
Can cause subdural hematoma (Between Dura mater and arachnoid mater)
Where is an epidural hematoma
Between Skull and Dural mater
Epidural hematoma is more superifcial than subdural hematoma
Which muscle is responsible for ensuring that food does not go into the nasopharynx when swallowing
The levator veli palatini closes off the nasopharynx to food when elevating the soft palate.
Innervated by Pharyngeal branch of Vagus from pharyngeal plexus
Which papillae on the tongue do not have taste buds
filiform pipillae
What protects the larynx when swallowing
Epiglottis moves when swallowing to cover pharynx
False vocal cords cover larynx when food is swallowed
Which nerves provide sensation to the anterior 2/3 of the tongue
Special sensation (taste)- 7- Facial- chorda tympani
Sensory- V3- Lingual nerve
What nerve provides sensation to the posterior 1/3 of the tongue
Glossopharyngeal (9)
General sensation and taste
Which muscle does the parotid duct run over
masseter
Which muscle does the parotid duct pierce
buccinator
Where does the parotid duct enter the mouth
parotid papillae
Which nerve innervates muscles of mastication
V3 Mandibular of trigeminal
The lingual artery travels deep to which muscle on its way to the tongue
hyoglossus
The submandibular ganglion sits on top of which muscle
Hyoglossis- sits superficially to hyoglossus inbetween Lingual nerve and Hypoglossal nerve
If you get an infection in your posterior tongue and Lingual tonsil, where will your lymph nodes swell?
Superior deep cervical lymph nodes– Posterior 1/3 of tongue drain to superior deep cervical lymph nodes
Where will the anterior tip of your tongue drain if infected
submental lymph nodes
Where will the middle of your tongue (midline and in the middle 1/3) drain?
To Inferior deep cervical lymph nodes
Where will the lateral 1/3 in the medial 1/3 of your tongue drain (outside edges in the middle)
To submandibular lymph nodes
Which muscle does the hypoglossal nerve run on top of (superficially to) when going to the tongue
They hyloglossus
The lingual nerve (V3) and Chorda tympani (7) travel to which ganglion
Submandibular ganglion
- Preganglionic parasympathetic travel from 7 to submandibular gland and then to sublingual gland and submandibular glands
The chorda tympani serves what functions
Taste
Parasympathetic
The hard palate is formed by which bones
Maxilla (anterior) and Palatine bone (posteriorly)
Which muscle runs from the soft palate to the tongue
Palatoglossus
Which muscle runs from the soft palate to the pharynx
Palatopharyngeus
The hypoglossal nerve is inferior to which nerve when running to the tongue
Lingual nerve
The lingual nerve runs deep to what structure right below the tongue
The Sublingual and submandibular gland sits below the tongue, the lingual nerve runs to these glands, and the submandibular duct crosses over the lingual nerve
The mental foramen is located where and which nerve/artery travels through it
Located between 1st and 2nd premolars, the Mental nerve (branch off inferior alveolar, terminal branch of Mandibular nerve) pierces it.
Inferior alveolar artery runs through it ( Off maxillary artery)
Is the deep petrosal nerve sympathetic or parasympathetic
Sympathetic- Innervation goes from the spinal cord to the superior cervical ganglion, and postsynaptic sympathetic innervation travels on the deep petrosal nerve
Is the Greater petrosal nerve sympathetic or parasympathetic
Parasympathetic innervation. Parasympathetic from Facial (Saliva and tears) travel on this nerve. The
From the sympathetic trunk, where does the sympathetic innervation synapse before going to travel along the internal carotid artery
At the superior cervical ganglion, postsynaptic sympathetic innervation begins
Where does the Greater petrosal nerve’s sympathetic innervation become postsynaptic
At the pterygopalatine ganglion in the pytergopalatine fossa– Parasympathetic innervation traveled from the superior salivatory nucleus (Facial nerve) along the greater petrosal nerve to synapse in the pytergopalatine ganglion
What seperates the external and middle ear
Tympanic Membrane
Where is the pharyngotympanic tube connecting in the ear
Middle ear
Which branch of the external carotid artery supplies the ear
Superficial temporal
Branches into anterior auricular, posterior auricular
Which nerve innervates the external surface of the ear CANAL
9 and 10
Which nerve runs across the medial surface of the tympanic membrane
Chorda tympani
Where does the chorda tympani merge with the lingual nerve
By the medial and Lateral ptyergoid muscles, deep to Masseter, Risorius and buccinator
A middle ear infection can spread where that it is very hard to treat
Mastoid antrum (air filled space), extremely hard to fix if this happens.
Which muscles tense the tympanic membrane and what are they innervated by
Both reduces vibration to delicate inner ear
Tensor Tympani– Innervated by Mandibular of Trigeminal
Stapedius– Innervated by CN 7
What is the parasympathetic function of chorda typani
Sublingual and submandibular salivary glands
What is the special sense for chorda tympani
Taste for anterior 2/3 of tongue (along w Lingual nerve from trigeminal that gives general sensory)
Is chordatympani presynaptic or postsynaptic
Presynaptic, travels to submandibular ganglion to synapse
What happens when the tensor veli palatini contracts
For soft palate, tenses, so that food doesn’t enter nasopharynx
For ear, When we yawn, the tensor veli tenses and the lumen opens the auditory tube to equalize pressure between middle ear and nasopharynx
What makes up the chochlea
Scala vestibuli, cochlear duct, scala tympani
The membranous labyrinth is suspended in what and contains what
suspended in perilymph, contains endolymph
- Conduct sound vibrations, respond to mechanical forces (movement and accleeration)
The bony labyrinths are sourrounded by what and filled with what
Sourrounded by otic capsule (dense bone)
Suspended in Perilymph
Sound comes in which window and out which window
In through oval windown, to Vestibulocochlear (8) nerve, and out through scala tympani–> round window
The anterior and posterior semicircular canals are at what angle, and the lateral is at what angle?
Anterior and posterior are at a right angle
Lateral is horizontal
Where are equilibrium receptors housed and what are they called
Maculae are housed in ampullae, utricle, and saccule
What structures run between the base of the skull and superior constrictor
Pharyngotympanic tube
What structures run between superior and middle constrictor
Glossopharyngeal nerve, stylopharyngeus muscle
What strcutres are between middle and inferior constrictor muscles
Superior laryngeal vessels and Internal laryngeal nerve (Superior laryngeal nerve) (Sensory abvove VF)
What does salpingopharyngeus connect to
Opening of eustacian tube- Elevate pharynx
A CT scan shows a skull fracture and an accumulation of blood between dura and the cranial bone. What type of hemmorhage is this considered
Epidural- between dura and skull. Typically caused by rupture of middle meningeal artery, which supplies blood to the dura mater and bones of cranium.
A CT scan shows a skull fracture and an accumulation of blood between pia mater and the arachnoid mater. What type of hemmorhage is this considered
Subarachnoid hemorrhage
Which structure connects the third and fourth ventricles
Cerebral aquaduct
Which structure connects the lateral ventricles with the 3rd ventricle
Interventricular foramen
Where does CSF flow in relation to the layers of the meninges. Why do we care?
Between the pia and arachnoid mater (Subarachnoid space)
This is clinically relevent because meningitis is bacteria in the CSF between these layers.
Where does the middle meningeal artery supply blood to
The dura mater and cranial vault bones
Where does the middle cerebral artery supply blood to
The lateral surface of the cerebral hemispheres, most of temporal lobe.
Where does the anterior cerebral artery supply blood
medial and superior surfaces of brain- frontal pole
Where does the posterior cerebral artery supply the brain
Inferior surface of brain and occipital pole
A sixty-four-year old man was diagnosed with an acoustic neuroma (tumor of the VIIIth cranial nerve) where it entered the temporal bone. What other cranial nerve might also be affected since this nerve uses the same foramen as the VIIIth in its course?
Facial! Runs through the internal acoustic meatus.
The danger zone of the scalp is which layer?
Loose connective tissue- can pass quickly into brain and meninges.
Scalp layers are Skin, Connective tissue, Aponeurosis, Loose connective tissue, and Pericranium.
The presence of blood in a spinal tap taken from an individual with a closed head injury signals arterial bleeding into which brain space?
Subarachnoid space- CSF is taken for a spinal tap, and CSF runs in the brain in the subarachnoid space.
The most likely source of blood in a patient with an epidural hemorrhage is:
Middle meningeal artery
Vertebral arteries travel through the transverse foramina of which vertebral levels
C1-C6
Which cranial nerve runs under the Posterior inferior cerebellar artery
Spinal accessory nerve (CN 11)
An aneurysm of the superior cerebellar artery is in close proximity to which cranial nerve that might cause vision deficits?
CN 3- occulomotor
An aneurysm of the anterior communicating or anterior cerebellar arteries are in close proximity with which nerves and could cause which deficits?
Close to olfactory, could change smell. Close to Optic nerve- could change visual accuity and visual fields.
The posterior inferior cerebellar artery is in very close proximity to which nerve if it is ruptured
Accessory Nerve (CN 11)
You have been asked to assess the neurological deficit that might exist in a patient diagnosed with cavernous sinus thrombosis. You will focus your examination on cranial nerves related to the sinus, and that examination includes examination of which nerves?
CN 3
CN 4
CN V1/V2
6
The cavernous sinus is lateral to the body of which bone
Sphenoid bone
The structures that pass through which skull foramina enter the cavernous sinus
The superior orbital fissure
- Occulomotor nerve, trochlear nerve, Abducens nerve, V1 and V2.
During childbirth, an excessive anteroposterior compression of the head may tear the anterior attachment of the falx cerebri from the tentorium cerebelli. The bleeding that follows is likely to be from which of the following venous sinuses?
Straight sinus
- Drains the deep cerebrum- lies in junction of falx cerebri and tentorium cerebelli
Which sinus drains the cerebellum
Occipital sinus- lies in dura mater at base of falx cerebelli (inferior to straight sinus)
The inferior sagittal sinus is found in the free edge of what structure?
Falx cerebri- Sagital fold of dura mater lying between cerebral hemispheres.
Inferior saggital sinus runs on inferior margin of falx cerebri.
