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Y2 LCRS 2 - NMH, Psych, Anatomy of Limbs, Head, Neck & Spine, Musculoskeletal > ANATOMY HNS; Lecture 4, 5 and 6 - Face and Oral cavity, Upper airway and digestive tract, Eye and orbit > Flashcards

ANATOMY HNS; Lecture 4, 5 and 6 - Face and Oral cavity, Upper airway and digestive tract, Eye and orbit Flashcards

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1
Q

What are the features observed in the mouth when oral cavity inspection occurs?

A

Uvula, oropharynx (posterior wall), frontal fold in mouth is palatoglossal and posterior is the palatopharyngeal which when contracted helps with swallowing; palatine tonsil is a lymph node

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2
Q

How do you test vagus nerve function in the oral cavity?

A

Uvula should move into the midline when saying ‘Ah’ -> if compromised uvula moves away from damaged side

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3
Q

How does the epiglottis aid in swallowing?

A

Retroflexes to cover the laryngeal inlet to stop you choking on food

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4
Q

How does the hard palate aid in swallowing?

A

Provides a hard surface on which to push food onto to break it up more easily

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5
Q

What are the features of the oral cavity which can be seen in a midline section?

A
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6
Q

What are the features of the oral cavity which can be seen in the posterior view?

A

NB: piriform fossa which is where a lot of fish bones get stuck and it is highly innervated causing a lot of pain

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7
Q

What are the sections of the pharynx?

A

Nasopharynx, oropharynx, laryngopharynx, superior; middle and inferior constrictors (sensory IX, X (pharyngeal plexus); motor X/xi,) all aiding in swallowing

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8
Q

How does swallowing work?

A

Lift and retract tongue (styloglossus, intrinsic muscles of tongue), bolus into oropharynx (palatoglossus retraction), close off nasopharynx by raising soft palate, raise larynx which is closed off by epiglottis, peristaltic wave of constrictor muscles, relax cricoharyngeus and open oesophagus

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9
Q

What are the 3 salivary glands?

A

Parotid (mainly serous) IX which goes through parotid duct, opening upper second molar; submandibular (mainly serous) VII, sublingual (mainly mucous) VII

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10
Q

What are the muscles in the tongue?

A

Syloglossus, hyoglossus, genioglossus (protraction of tongue), intrinsic muscles -> supplied by CN XII

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11
Q

What are the features of the tongue and surrounding muscles in a sagittal section?

A

NB: Mylohyoid is the floor of the mouth; submandibular ganglion is PS ganglion involved in saliva secretion

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12
Q

How do you test CN XII and what would you see if there was a lesion on one side?

A

Stick the tongue out, which should be in the middle and tongue moves toward the side of the lesion, if chronic, the muscle on that side will have atrophied

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13
Q

How is the tongue innervated?

A

Tactile sensation in the trigeminal nerve; with anterior 2/3rds is taste and facial nerve; and in posterior 1/3rd of tongue both touch and taste is pharyngeal; end of tongue is vagus which is both again

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14
Q

What are the superficial muscles of mastication?

A

Masseter (zygomatic arch to lat surface of ramus and angle of mandible); temporalis (temporal fossa to coronoid process of mandible)

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15
Q

What nerve supplies the superficial muscles of mastication?

A

Trigeminal except buccinator muscle which is supplied by the facial muscle

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16
Q

What are the deep muscles of mastication?

A

Lateral pterygoid -> sphenoid/lat pterygoid plate to neck of mandible; medial pterygoid -> lat pterygoid plate/maxilla/palate to angle of mandible

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17
Q

What is the function of the medial pterygoid?

A

Elevates, protracts and lateral movement of mandible for chewing

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18
Q

What is the function of the lateral pterygoid?

A

Depresses and protracts the mandible to open mouth

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19
Q

What is the function of the Masseter muscle?

A

Elevating mandible allowing forced closure of mouth

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20
Q

What is the function of the Temporalis muscle?

A

Elevates and retracts the mandible

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21
Q

What is the TMJ?

A

Articular disc and capsule around the joint -> hinge action on joint, gliding action on articular tubercle when opened a bit more -> anterior dislocation of jaw can be problematic due to the blood supply in the cavity

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22
Q

What is the blood supply to the face area coming off the external carotid artery (some anatomists like freaking out poor medical students)?

A

Superior thyroid artery, ascending pharyngeal, lingual, facial (big loop so that it doesn’t become tense when opening the jaw causing rupture of the artery), occipital, posterior auricular, maxillary, superficial temporal

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23
Q

What are the 5 main branches of the facial nerve going to the face?

A

NB: Parotid gland gets innervation from glossopharyngeal NOT from Facial

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24
Q

What is the mandibular nerve?

A

Inferior alveolar nerve (lies in mandible and emerges out onto chin - called mental nerve), stimulated by toothache; lingual nerve is sensation to ant 2/3rd of tongue, but joins to facial (chorda tympani) nerve

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25
How are the dermatomes organised in the head and neck?
26
How can you test function of V1?
Opthalmic division -\> touching forehead, nose
27
How can you test function of V2?
Maxillary division -\> On cheek
28
How can you test function of V3?
Mandibular division -\> on chin
29
What are the conchae (superior, middle and inferior)?
Increase SA to warm the air and expose the air to the immune system to trap pathogen, covered in respiratory epithelium
30
What are the nasal cavities?
Upper part of resp tract; ant and post regions; contain conchae
31
What is the function of nasal cavities?
Warm and humidify air, help trap pathogens
32
Which bones make up the conchae?
x
33
How is the nasal cavity innervated (olfaction, regions, glands and vascular smooth muscle)?
Olfaction: Olfactory nerve; Trigeminal nerve: V1 anterior region and V2 posterior region; Facial nerve innervates glands (mucous membrane); sympathetic nerves from T1 innervate vascular smooth muscle
34
What is the blood supply to the nasal cavities?
Internal/External carotid
35
How is the nasal cavity drained?
36
Where are the paranasal sinuses located?
Filled with air, decrease weight of skull, help with transmission of sound, acts as a crumple zone for protection of brain
37
What do the sinuses look like in an x-ray?
NB: maxillary sinus can be easily infected when teeth taken out or when dental abscess occurs
38
Where do the sinuses drain into?
Into the nasal cavity (lacrima drains into the (nasolacrimal) nasal cavity)
39
What is the larynx?
Hollow structure composed of cartilages, membrane and muscles
40
What is the function of the larynx?
Valve and sound producer
41
What are important cartilages of the larynx?
Laryngeal cartilage, thyroid cartilage, laryngeal prominence
42
What do the laryngeal cartilages look like?
Thyroid cartilage sits on top of cricoid cartilage, rocking backwards and forwards which can change the tension of the vocal cords (as well as action of muscles)
43
What are the vocal folds?
Vestibular fold (false vocal fold) and vocal fold (true vocal fold)
44
What is the rima glottidis?
Opening between the vocal folds
45
What are the muscles of the larynx?
46
What are the muscles of the larynx innervated by?
Vagus nerve branches - left recurrent laryngeal nerve when impinged can cause hoarseness of voice and coughing
47
What happens when the vagus nerve is damaged at the different levels?
x
48
Which vessels travel with the branches of the vagus nerves?
Int/ext laryngeal nerve travel with superior thyroid artery; recurrent laryngeal nerve travels with inferior thyroid artery. NB: bronchial/oesophageal tumour/swollen mediastinal lymph nodes can cause left recurrent laryngeal blockage/lesion
49
Which protective mechanisms exist for the airway?
Swallowing, gag reflex, sneezing, coughing
50
What is the different mechanism for sneezing and coughing?
Main difference is soft palate movement - raised or lowered
51
What are the different methods in which you can manage the airway?
Chin lift/jaw thrust, oropharyngeal/nasopharyngeal airway, endotracheal intubation, cricoidthyroidotomy, thracheostomy
52
What is the anatomy of the auditory apparatus?
Purpose to direct the sound
53
What is the anatomy of the ear?
NB: ear infection can take on forms that can damage the facial nerve as it goes through the ear (which can become damaged in infection or inflammation
54
What is the facial nerve emergence point?
Lateral surface of brainstem between pons and medulla
55
What is the motor component of the facial nerve?
Muscles of facial expression, stapedius, digastric (posterior belly), stylohyoid.
56
What is the sensory component of the facial nerve (smaller, intermediate nerve)?
Taste (ant 2/3 tongue), parasympathetic (lacrimal glands, mucous glands of nasal cavity, hard and soft palates, sublingual and submandibular glands). General sensation from external acoustic meatus and deeper parts of auricle.
57
What s the pathway of the facial nerve in the ear?
58
What is the importance of the mastoid bone in infection?
Ear infection can eat away at the bones of the mastoid sinus and cranial cavity, causing infection to move into cranial cavity (brain)
59
When might the airway be blocked by the tongue?
When unconscious, which could cause death -\> muscle tone is required to keep the airway open
60
What are the airway manoeuvres that can unblock a patent airway?
Head tilt and chin lift; jaw thrust; airway adjuncts (used to keep the upper airway open when you get tired - e.g. nasopharyngeal tube and oropharyngeal tube); LMA (laryngeal mask airway - gag reflex can be triggered); endotracheal intubation; cricothyroidotomy
61
What are the problems associated with airway adjuncts?
Oropharyngeal airway -\> gag reflex is triggered; nasopharyngeal airway -\> nose bleeds and basal skull fracture can be a problem when inserting
62
What is the best way to maintain a patent airway?
Endotracheal intubation -\> Prevents airway soiling as it has a balloon which inflates, keeping substances from entering the lungs/trachea
63
What are the important features of the larynx?
64
What are the 5 phases of swallowing?
Oral preparatory phase, oral transit phase; pharyngeal phase I; pharyngeal phase II; oesophageal phase
65
What is the oral preparatory phase in swallowing (Sensation needed, in/voluntary, CN used)?
Food/liquid chewed and formed into bolus, which is held on centre of tongue -\> lip, jaw, tongue and palate sensory and motor function needed (and dentition); VOLUNTARY - uses CN V, VII, IX, X, XII
66
What are the 12 CN? (Oh,Oh, Oh, to touch and feel very good velvet Ahhhh)
Olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibular, glossopharyngeal, vagus, accessory, hypoglossal
67
What is the oral transit phase in swallowing (Sensation needed, in/voluntary, CN used)?
Bolus propelled to back of mouth, palate seal entrance to nasal cavity, lip, jaw, tongue and palate sensory/motor function needed; VOLUNTARY - uses CN V, VII, IX, X, XII (OPEN AIRWAY)
68
What is the pharyngeal phase I in swallowing (Sensation needed, in/voluntary, CN used)?
Triggered when bolus reaches facial arch, palate stays elevated, tongue reacts - to push bolus to pharynx; tongue, palate and laryngeal sensory/motor function needed - REFLEX, with CN IX, X, XII (CLOSED AIRWAY)
69
What is the pharyngeal phase II in swallowing (Sensation needed, in/voluntary, CN used)?
Bolus propelled through pharynx; tongue, palate and laryngeal sensory motor function needed - REFLEX using CN IX, X, XII (CLOSED AIRWAY by epiglottis, vocal cords and arytenoid action)
70
What is the oesophageal phase in swallowing (Sensation needed, in/voluntary, CN used)?
Oesophagus opens, airway closed, breath held; bolus propelled through oesophagus - REFLEX CONTROL using IX, X - respiration then resumes with exhalation to clear any food particles away from airway entrance
71
How is a normal videofluoroscopy carried out?
Barium transit through mouth 1 sec, pharyngeal transit 1-2s, no residue in mouth/pharynx, no spillage from lips into airway
72
How does an ataxic swallow differ and what can cause it?
Cerebellar haematoma -\> uncoordinated tongue reaction to propel food, delayed airway closure so food enters airway, delayed and ineffective cough to clear airway so food aspirated to lungs
73
How can you fix an ataxic swallow?
Flex neck during swallow, preventing aspiration -\> also exercises to increase swallowing speed and strength
74
How can a lower motor neurone lesion cause impaired swallowing?
E.g. in an excised acoustic neuroma -\> ispilateral paresis of pharynx, larynx and tongue means there is weak bolus propulsion (pharyngeal/oral residue) and failed airway closure means aspiration occurs
75
How can you fix an impaired swallow caused by a lower motor neurone lesion?
Head rotation to direct bolus down strong side of pharynx and increase airway closure -\> also exercises to increase tongue and laryngeal muscle strength for 9m
76
How does Parkinson's disease affect swallowing?
Difficulty initiating swallow, typical repetitive tongue movements, linked with muscle rigidity, unable to lower back of tongue
77
How do you treat parkinson's disease for swallowing?
Active range of motion exercises of lips and tongue
78
How does a normal swallow/voice work?
Vocal cords adduct to produce voice and to close airway, saliva is cleared in a single swallow and doesn't accumulate, water swallowed in \<1s, no residue in pharynx/trachea
79
How does an impaired swallow from a severe head injury differ?
Myoclonus from anoxia, brainstem involvement, spastic pharynx and tongue so decreased movement, infrequent swallow 1 per 17 min, ineffective/weak swallow so residue in pahrynx and aspiration of saliva, ineffective cough so unable to clear saliva from airway
80
How would you treat an impaired swallow due to severe head injury?
Long term NBM (nothing by mouth) and tracheostomy
81
What are the bones of the orbit?
Roof -\> orbital plate of frontal bone; floor -\> orbital plate of maxilla; lateral wall -\> zygoma, greater wing of sphenoid; medial wall -\> frontal process of maxilla, lacrimal bone, orbital plate of ethmoid, lesser wing of sphenoid
82
What is present in the optic canal of the orbital foramina?
Optic nerve (II) (ganglion cell axon going to the cortex), ophthalmic artery
83
What is present in the inferior orbital fissure of the orbital foramina?
Maxillary nerve (V2), infraorbital vessels
84
What is present in the superior orbital fissure of the orbital foramina?
Ophthalmic nerve (V1), Oculomotor (III), Trochlear (IV), Abducens (VI), Ophthalmic vessels, sympathetic fibres
85
What are the orbital foramina?
x
86
What are the Recti muscles?
Extrinsic eye muscles, 4 recti muscles -\> inf, sup, medial, lateral
87
Where do the recti muscles originate from?
Common tendinous ring at the back of the orbit
88
Where do the recti eye muscles insert?
Sclera, 5mm behind corneal margin
89
What innervates the recti muscles?
Inferior, superior and medial (III) and lateral (VI)
90
What are the oblique extrinsic eye muscles?
2-\> inferior and superior
91
Where do the obliques originate from?
Inferior: orbital surface of maxilla; superior: body of sphenoid
92
Where do the obliques insert?
Inferior: post/inferior quadrant; superior: post/sup quadrant loops upwards via trochlea
93
How are the obliques innervated?
Inferior (III), superior (IV)
94
What is the levator palpebrae superioris?
Muscle of the upper eyelid
95
Where does the levator palpebrae superioris originate?
Lesser wing of sphenoid
96
Where does the levator palpebrae superioris insert?
Superior Tarsal plate and skin of eyelid
97
How is the levator palpebrae innervated?
CNIII and SNS to smooth muscle (Horner syndrome stops SNS innervation so eyelid droops)
98
What is the different parts of the anatomy of the eye?
Trochlea is a pulley system (sup oblique moves eyeball down and out)
99
What are the isolated muscle actions of the eye if muscles were just acting on its own?
LR = abducts (away from midline) MR = adducts (towards midline) IO = elevates and abducts SR = adducts and elevator IR = depresses and adducts SO = depresses and abducts
100
How do you test the isolated muscle actions in a clinical setting?
LR = lateral abduction in eye MR = adduction in eye SO = adduct eye and then look for depression to isolate muscle (in and out)
101
Which of nerves are present in the orbit?
Optic (ganglion cell axons), Oculomotor (two rami, motor fibres to MR, SR, IR, IO and LPS; parasympathetic fibres with oculomotor nerve), Trochlear (Motor fibres to SO), Abducens (Motor fibres to LR); Ophthalmic V1 branches -\> Lacrimal, Frontal (supertrochlear, supraorbital), Nasociliary (branch to ciliary ganglion, ethmoidal, infratrochlear)
102
What is the ciliary ganglion?
PSNS, preganglionic fibres in inferior ramus of oculomotor, postganglionic fibres in short ciliary nerves, sphincter pupillae and ciliary muscle
103
What are the blood vessels to the eye?
Ophthalmic artery and ophthalmic veins
104
What are the different ophthalmic arteries?
Central artery of retina, muscular branches, ciliary, lacrimal, supratrochlear, supraorbital
105
What are the different ophthalmic veins?
Superior (cavernous sinus - important due to infection) and inferior (pterygoid plexus)
106
What is the lacrimal system made up of?
Lacrimal gland, lacrimal sac and nasolacrimal duct
107
What is the lacrimal gland made up of?
Anterolateral superior orbit; PSNS secretomotor fibres (CNVII) from pterygopalatine ganglion via zygomaticotemporal and lacrimal nerves
108
What is the function of tears and where do they drain?
To keep the eye moist (can indicate problems in CN if eye is dry) -\> Drain to medial part of the eye in to the lacrimal sac via the lacrimal canaliculi and into the nasolacrimal duct into the nose
109
How do you test the corneal reflex?
Place cotton bud on eye and patient should blink. Afferent V1 and then efferent is facial nerve

Y2 LCRS 2 - NMH, Psych, Anatomy of Limbs, Head, Neck & Spine, Musculoskeletal (17 decks)

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