Chapter 10: Face and Thorax Flashcards
(216 cards)
1
Q
What nerve gives cutaneous sensation to the face?
A
trigeminal (V1-3)
2
Q
What are the three divisions of trigeminal nerve?
A
opthalmic, maxillary, mandibular
3
Q
Where does the trigeminal nerve come off of?
A
off of the brainstem on the pons, then divides into its three branches
4
Q
What is the only branch of trigeminal nerve to give motor innervation to the face?
A
mandibular: supplies muscles of mastication
5
Q
Facial nerve is what number of cranial nerve?
A
CN 7
6
Q
What cranial nerve is trigeminal?
A
CN 5
7
Q
If a patient has mumps, which gland is visably swollen?
A
parotid
8
Q
T/F: Facial nerve branches off into the face.
A
true
9
Q
Where does the facial nerve divide?
A
parotid gland
10
Q
What nerve is responsible for facial expression muscles?
A
facial nerve
11
Q
Discuss the path of CN 7.
A
facial nerve exits cranial cavity off of the brainstem, goes through the stylomastoid foramen, then divides into branches after it pierces through the parotid gland
12
Q
What kind of information does the facial nerve supply?
A
motor, general sensory, parasympathetic
13
Q
What nerve is known as the wandering nerve?
A
vagus
14
Q
What components are in the carotid triangle?
A
vagus nerve, internal jugular vein, and common carotid a.
15
Q
Which has branches, the internal or external carotid a.?
A
external has branches
16
Q
What is the largest salivary gland?
A
parotid
17
Q
What do the lymph nodes do?
A
protect the face and neck by collecting lymph; can get swollen here (beneath parotid gland, submandibular, and other areas)
18
Q
What artery takes a “tortuous course”?
A
facial artery
19
Q
The parotid gland’s duct will pierce what muscle?
A
parotid duct pierces buccinator to get into oral cavity
20
Q
T/F: The innervation to the parotid gland is autonomic.
A
true
21
Q
What are the three sources of innervation for the parotid gland? What do each do?
A
1) sympathetic fibers from cervical ganglia; decrease salivation
2) parasympathetic fibers from CN 9; increase salivation, prepare for digestion
3) great auricular nerve (C2, C3); general sensation
22
Q
What artery supplies the anterior half of the brain?
A
internal branch of the common carotid a.
23
Q
What gland crosses and pierces through muscle to get into the oral cavity?
A
parotid gland
24
Q
What are the salivary glands?
A
parotid, submandibular, sublingual
25
Which salivary gland is palpable?
submandibular
26
How does a dentist use nerve blocks involving the maxillary and mandibular nerves?
dentist hits V2-3 with anesthesia to numb them so he can work with the lip and oral cavity
27
If a patient complains of a tingling nose, which nerve would you suspect is the issue?
trigeminal V1 - opthalmic n.
28
If a patient feels tingling along the front of their cheeks, what nerve would you suspect is the issue?
trigeminal V2 - maxillary n.
29
What is herpes zoster? What does it affect?
reactivation of chicken pox in the body, causing a painful rash; can affect whole ganglia of trigeminal n., causing scarring of cornea
30
What is the pterion of the skull?
point where several bones come together; frontal, temporal, sphenoid, parietal
31
What is trigeminal neuralgia?
- very painful, stabbing pain; affects V2
- patient is sensitive to touch on face, esp. cheeks and nose
- can affect whole ganglia of trigeminal nerve
32
What are the boundaries of the infratemporal fossa?
```
lateral = ramus of mandible
anterior = maxilla
medial = lateral pterygoid plate
roof = sphenoid
```
33
What does the buccal nerve supply?
sensory to the cheek and gums
34
What does the inferior aveolar supply?
all teeth related to the mandible
35
What muscles are found in the infratemporal fossa?
inferior temporalis, lat. and med. pterygoids
36
What artery is in the infratemporal fossa?
maxillary a.
37
What nerves are in the infratemporal fossa? (7)
1) pterygoid venous plexus
2) mandibular
3) inferior alveolar
4) lingual
5) buccal
6) chorda tympani
7) otic ganglion
38
What is the maxillary a. a branch of?
comes off of external carotid a., found in infratemporal fossa
39
What does the mental nerve innervate?
skin of the chin
40
What does the lingual nerve innervate?
sensory to gums, tongue, and floor of mouth
41
What are the muscles of mastecation?
temporalis, masseter, lat. and med. pterygoids
42
What nerve innervates the muscles of mastecation?
trigeminal V3 - mandibular
43
If a patient is experiencing pain in their teeth, what nerve is alerting them of this?
inferior alveolar n.
44
What nerve is affected in Bell's palsy?
Facial nerve
45
What can result from Bell's palsy?
- best case: difficulty closing eye and smiling on one side (hit far from stylomastoid foramen)
- worse: loss of taste to tongue, lacking salivary and lacrimal gland function, and hearing loud sounds (if stress is severe enough, this can involve the entire facial nerve, causing all these things to happen)
46
Why is there amplified noise in some people with Bell's palsy?
- the stapedius is a muscle that dampens noise in the ear, and it's innervated by facial nerve
- when this nerve is damaged, so is the muscle
- this indicates severe Bell's palsy
47
How do we think trigeminal neuralgia occurs?
possibly because of an artery in the brain
48
What nerves innervate the lip and oral cavity?
maxillary and mandibular nerves
49
What does herpes zoster infection affect?
potentially the entire ganglia of trigeminal n.
50
What two clinical issues can affect the ganglia of trigeminal nerve?
herpes zoster, trigeminal neuralgia
51
Nerve blocks on what two nerves are commonly used by dentists to work on the oral cavity?
V2-3
52
What artery is in the infratemporal region?
maxillary a.
53
With left lateral excursion of the mandible, which muscles are working?
left temporalis and masseter, right pterygoids
54
What two muscles elevate and retract the mandible?
masseter and temporalis
55
Which muscle is the primary mover in protruding the jaw forward?
lateral pterygoid
56
Which mastication muscles do contralateral lateral motion?
pterygoids
57
What does the medial pterygoid do?
elevates and protracts mandible, contralateral lateral excursion
58
What forces open the mouth? (3)
gravity, hyoid muscles, and lateral pterygoid
59
T/F: All mastication muscles do protraction.
true; lateral pterygoid is the primary mover, but all the rest do a little
60
Which muscle can you only palpate inside the mouth?
lateral pterygoid
61
What are the supporting ligaments of TMJ?
1) stylomandibular ligament
| 2) sphenomandibular ligament
62
What does the sphenomandibular ligament prevent?
excessive forward translation; it's the check ligament for the joint; "swinging hinge" ligament
63
What bony articular surfaces are involved in TMJ?
mandibular fossa and articular tubercle of the temporal bone (superiorly), and the head of the mandible (inferiorly)
64
What muscle group is also referred to as the strap muscles?
infrahyoid muscles
65
What ligament is a thickening of the parotid gland?
stylomandibular joint; doesn't contribute much to the strength of the joint
66
What is the check ligament for TMJ?
sphenomandibular ligament
67
When is TMJ prone to dislocation?
during asymmetrical movements, because poor contact can cause stress to the disk
68
What nerve innervates the pterygoids?
CN 5
69
Where would referred pain be for TMJ?
face and jaw, because it's innervated by trigeminal nerve
70
What is the clicking of your jaw caused by?
the disk slipping forward when you open your mouth, and then clicking back into place when you close it
71
Why could forward head posture be a cause of TMJ pain?
it changes the position of the mandible, potentially putting it into a vulnerable position and causing pain
72
T/F: Excessive motion, or anterior dislocation, can cause stress to the TMJ disk.
true
73
The labial frenula connects what to what?
gums to lips
74
What nerves create the dental plexus that innervate the upper and lower teeth?
maxillary and mandibular
75
What nerves innervate the gums?
maxillary, mandibular, buccal, lingual
76
What is the space between the gums and teeth called?
the vestibule
77
The tongue is connected to the floor of the mouth by what structure?
lingula frenula
78
What two parts is the oral cavity divided into?
hard palate (anterior 2/3) and soft palate (posterior 1/3)
79
What are the openings in the palatine bone called? What are they for, and what palate are they in?
incisive foramen; openings in the palatine bone that allow nerves to pass through (hard palate)
80
What is the soft palate made up of? (general)
muscle
81
What 3 parts create the soft palate?
1) palatine aponeurosis
2) uvula
3) five muscles
82
What 2 parts make up the hard palate?
1) palatine process of maxillae
2) horizontal plates of palatine bone
• incisive foramen also in hard palate
83
What are taste buds called?
lingual papillae
84
What gives sensory innervation to the palate?
trigeminal nerve, both maxillary and mandibular?
85
What gives blood supply to the palate?
branches of maxillary
86
What nerve gives innervation to both intrinsic and extrinsic muscles? (all except palatoglossus)
hypoglossal (CN 12)
87
What are the 4 extrinsic muscles of the tongue?
1) palatoglossus
2) styloglossus
3) hyoglossus
4) genioglossus
88
What is palatoglossus innervated by?
pharangeal plexus, coming of CN 9 carried by CN 10
89
Which palate muscle relieves pressure on the tympanic membrane when it contracts?
tensor veli pallatini
90
What does the uvula do?
helps with articulation and speech; prevents food from entering nasal cavity or lungs
91
What muscles help elevate the palate?
1) levator veli pallatini
| 2) palatoglossal
92
What muscle elevates the oral pharynx?
palatopharyngeus
93
What tongue muscles depress and retract the tongue?
hyoglossus and genioglossus
94
What does palatoglossus do?
helps elevate oral cavity and posterior tongue
95
What does the sulcus terminalis do?
divides the tongue into anterior 2/3 and posterior 1/3
96
What muscles elevate the tongue?
palatoglossus
97
Describe the difference between general sensory and special sensory for the tongue.
- general = ability to touch/feel different temperatures
| - special = taste
98
What nerves cause the gag reflex?
CN 9 and 10 (glossopharyngeal and vagus)
99
What gives general sensory innervation to the anterior 2/3 and posterior 1/3 of the tongue?
```
anterior = V3 (lingual n.)
posterior = CN 9 (glossopharyngeal n.)
```
100
What's another name for the parotid gland?
stensons gland
101
What structure allows the front part of the tongue to move freely?
lingula frenula
102
What does the tensor veli pallatini do?
opens auditory tube; releases pressure on the tympanic membrane
103
What nerve allows you to feel something scratch against your palate?
trigeminal V2-3 (?)
104
Where is the lingual tonsil found? Palatine tonsil?
lingual tonsil = posterior rough surface of tongue
| palatine tonsil = on soft palate
105
Which muscle is further down the throat, palatopharyngeal or palatoglassal?
palatopharyngeal
106
What is Whartons gland?
submandibular gland
107
What divides the nasal cavity into medial and lateral halves?
septum
108
What makes up the roof of the nasal cavity?
frontal, ethmoid, and sphenoid bones
109
What structure in the nose helps humidify air and moisten it?
nasal conchae, on the lateral walls
110
What creates the floor of the nasal cavity?
part of maxilla and palatine bone
111
T/F: The hard palate makes up the floor of the nasal cavity.
true
112
What makes up the hard palate?
1) palatine process of maxilla
| 2) horizontal plates of palatine bone
113
The tiny nerves piercing through the frontal bone into the nasal cavity are part of what system?
olfactory system for smell
114
What is the olfactory bulb and what does it do?
pierces through the cribiform plate to communicate with meninges
115
What do the meatuses do?
- allow passageway/communication with other nasal structures (sinuses/lacrimal gland)
- they are the spaces inbetween the conchae
116
When you tear up, your nose often runs also. What structure causes this and why?
the inferior meatus communicates with the lacrimal sac, so when tears are produced, the inferior meatus is affected, causing mucous production
117
What meatus communicates with the ethmoid sinus?
superior
118
What does the middle meatus communicate with?
frontal and maxillary sinuses, some ethmoid
119
What meatus communicates with the lacrimal sac?
inferior
120
What are the purposes of the sinuses?
allow cranial cavity to be lighter, allow voice to resonate
121
What are the four sinuses?
maxillary, ethmoid, sphenoid, frontal
122
What nerve innervates the maxillary sinus?
trigeminal V2
123
What all does trigeminal innervate?
- sensory to the face (V1-3)
- motor to muscles of mastication (V3)
- sensory to ant. 2/3 of tongue (touch/feel temps) (V3)
- sensory to palate (V2-3)
- sensory to nasal cavity (V1-2)
- paranasal sinuses (V1 for frontal, ethmoid, sphenoid; V2 for maxillary)
- anterior digastric belly
- mylohyoid
124
What nerve does the buccinator get?
facial nerve b/c it's a facial muscle
125
Maxillary artery is a branch of what?
ext. carotid; it's in the infratemporal region and gives blood supply to the palate
126
Lower lip gets what nerve?
mandibular n.
127
What clinical issues are due to damaged CN 5? CN 7?
5
- herpes zoster
- trigeminal neuralgia
7
- bell's palsy
128
What gives innervation for special sensory in the nasal cavity?
olfactory neurons provide smell, which come from piercing the frontal bone into the nasal cavity
129
What's the largest sinus and what's its innervation?
maxillary sinus; innervated by V2
130
Why does the nose bleed so much when its fractured?
there's tons of tiny little blood vessels in there, cause lots of bleeding
131
What is CSF rhinorrhea?
fracture of the cribiform plate (where nerves come in for smell) or tearing of the meninges
132
T/F: Nasal cavity infection can spread to the anterior cranial fossa.
true; the anterior cranial fossa communicates with the frontal bone. If frontal bone cracks, meninges tear and CSF leaks into nasal cavity
133
How can CSF come through the nasal cavity due to an injury?
the frontal bone can crack, which can tear meninges and CSF can leak into the anterior cranial fossa and subsequently into the frontal bone, then through the nasal cavity
134
What do the nasal meatuses articulate with? Can these areas be affected in nasal cavity infections?
meatuses articulate with auditory tube, sinuses, and lacrimal apparatus; yes they can be affected
135
If the ethmoid bone is fractured, what can result?
loss of sense of smell because cribiform plate is probably broken, and that's where olfactory nerves pierce through
136
What are the innervations for the eye muscles? (remember formula)
[SO4(LR6)]3
- superior oblique = CN 4, trochlear
- lateral rectus = CN 6, abducens
- all others = CN 3, occulomotor
137
The superior oblique hooks onto what structure that acts as a pulley before it attaches to the eye?
trochlea
138
If the eyes look down in any direction (right/left/straight down), what two muscles are working?
superior oblique and inferior rectus
139
If either eye moves laterally, what nerve is innervating this?
CN 6, abducens (lateral rectus)
140
During elevation of the eye, what muscles and nerves are involved?
superior rectus and inferior oblique; CN 3, oculomotor
141
What muscles adduct the eye?
1) medial rectus
2) inferior rectus
3) superior rectus
142
If the a patient is looking down and to the left, what eye muscles are working on each eye? What nerves are working for those muscles?
- left eye is abducting and going down, so superior oblique and CN 4 (trochlear)
- right eye is adducting and going down, so inferior rectus and CN 3 (oculomotor)
143
If a patient is looking up and to the left, what eye muscles and corresponding nerves are working on each eye?
- left eye is abducting and going up, so inferior oblique and CN 3 (oculomotor)
- right eye is adducting and going up, so superior rectus and CN 3 (occulomotor)
144
If a patient is told to look to the ground, but their right eye is unable to do so while the left completes the action, what nerve and/or muscle is potentially damaged or weak?
potentially inferior rectus and/or superior oblique
145
Your patient is told to look down and to the right. His left eye is able to, while his right eye stays straight ahead. What nerve and/or muscle is potentially damaged or weak?
- right eye is supposed to abduct and go down, which is superior oblique's job
- so, CN 4 (trochlear) is maybe damaged
146
What eye muscles cause medial intorsion on eye?
superior oblique, superior rectus, inferior rectus
147
What eye muscles cause lateral intorsion on eye?
inferior oblique
148
Is the thyroid superior or inferior to the hyoid bone?
inferior
149
What is the laryngeal prominence?
extra thyroid cartilage on males from increased testosterone; adam's apple; creates deeper voice
150
At what vertebral levels are the thyroid cartilage and the hyoid bone?
```
hyoid = C3
thyroid = C4-5
```
151
T/F: The jugular notch is above the hyoid.
false, below b/c it's at T2
152
What muscle has two heads that are innervated by different things? What nerves are they?
digastric
- anterior belly = CN 5
- posterior belly = CN 7
153
What nerve gives motor to the intrinsic and extrinsic tongue?
hypoglossal n. (CN 12)
154
You have a patient come in that's experiencing slurred speech and difficulty chewing. You ask them to stick out their tongue and move it from side to side, and they do so with great difficulty. What nerve do you think is damaged?
hypoglossal n. (CN 12)
155
What hyoid muscle attaches to the suprascapular notch?
omohyoid
156
At what vertebral level is the thryoid gland?
between C5-T1
157
T/F: Infrahyoid muscles pull the mandible down.
False, suprahyoid pull mandible down
158
What nerve innervates sternocleidomastoid?
spinal accessory (CN 11); also does traps
159
What are the boundaries of the posterior triangle?
sternocleidomastoid, clavicle, trapezius
160
T/F: Ansa cervicalis is part of the cervical plexus.
true, C1-3 loops
161
What nerve roots make up the cervical plexus?
C1-4
162
What vein is found in the posterior triangle?
internal jugular vein
163
T/F: The brachial plexus is found in the anterior triangle.
false, posterior (between scalenes)
164
T/F: Spinal accessory n. can be found in the posterior triangle.
true, goes to traps and sternocleido
165
What arteries are in the posterior triangle of the neck? (4)
suprascapular a.
transverse cervical a.
occipital a.
subclavian a.
166
What 3 nerve structures are found in the posterior triangle?
brachial plexus, cervical plexus branches, spinal accessory
167
What are the motor branches of the cervical plexus?
1) phrenic (345 keepin diaphragm alive)
2) ansa cervicalis (to infrahyoids)
3) dorsal scap and long thoracic (b/c of C4)
168
What are the suprahyoid muscles?
1) digastric (ant = CN 5, post. = CN 7)
2) mylohyoid (CN 5)
3) geniohyoid (C1 via hypoglossal n.)
4) stylohyoid (CN 7)
169
Cervical plexus: Lesser occipital nerve gives sensory innervation to what area?
skin to back of neck and scalp towards ear (C2)
170
Skin on anterior neck has cutaneous innervation from what?
transverse cervical nerve (C2-3)
171
Greater auricular nerve gives sensory to where?
angle of mandible to mastoid process (C2-3 of cervical plexus)
172
What gives sensory innervation to top of shoulder?
C3-4, supraclavicular n. (cervical plexus)
173
T/F: Phrenic nerve is superficial to anterior scalene.
true
174
What is in the carotid triangle?
common carotid a., internal jugular vein, vagus n.
175
T/F: Ansa cervicalis overlies the posterior triangle.
false, carotid triangle
176
What are the boundaries between anterior triangle and carotid triangle?
- anterior triangle = sternocleidomastoid, mandible, midline of neck
- carotid triangle (in ant. triangle) = sternocleidomastoid, post. digastric belly, and omohyoid
177
What are the two main deep flexors of the cervical spine?
longus capitus (more lateral) and longus colli
178
Which deep flexor of C-spine does contralateral rotation?
longus colli
179
What superficial C-spine flexors are usually tight on people, causing forward head posture? (and underutilization of the deep flexors)
anterior scalene and sternocleidomastoid
180
What does dorsal scapular n. innervate?
rhomboids and levator scapula
181
What muscle covers the whole anterior portion of the cervical spine?
longus colli
182
T/F: All scalenes assist in respiration.
true
183
What actions do the scalenes do?
flexion, lateral side bend, rotation, elevate 1-2 ribs
184
The common carotid branches off of what artery on the right and left sides?
right: off brachiocephalic trunk
left: off branch of aorta
185
Submandibular gland, hypoglossal n., and parts of facial v. and a. are found in what triangle?
anterior triangle
186
What's in the posterior triangle?
external jugular vein, brachial/cervical plexuses, spinal accessory, suprascapular a., transverse cervical a. , occipital a., subclavian a.
187
What do the rectus capitus anterior and lateralis muscles do?
deep flexion of C-spine
188
Which deep flexor is sometimes associated with whiplash injury?
longus colli
189
What does CN 10 innervate?
vagus n. = thyroid, thorax ( heart and lungs), and most abdomen
190
Where do you see the bifurcation of common carotid artery?
at superior portion of the thyroid cartilage
191
What wraps around the structures in the carotid triangle?
carotid sheath
192
What nerves give special sensory to the anterior and posterior tongue?
anterior 2/3 = cortotympany n. (facial n. )
| posterior 1/3 = combo of CN 9 and 10
193
What vein drains blood from the brain and anterior portion of the face?
internal jugular vein
194
What is in the carotid sheath?
internal jugular v., common carotid a., vagus n.
195
Brachiocephalic v. is made of what two veins coming together?
internal jugular and subclavian v.
196
Where is the carotid sinus located? What does it do? Innervation?
- found at the proximal internal carotid a.
- innervated by CN 9 and 10
- has baroreceptors in it so it can detect BP changes
197
What's located in the carotid body?
chemoreceptors for O2 and CO2; direct line to the brain
198
What innervates the baroreceptors and chemoreceptors?
hypoglossal n.
199
What three things are in the anterior triangle?
1) submandibular gland
2) hypoglossal n.
3) facial a. and v.
200
What are the cutaneous branches of the cervical plexus?
greater auricular, lesser occipital, supraclavicular, transverse cervical n.
201
What two muscles are innervated by C1 via hypoglossal?
thyrohyoid and geniohyoid
202
What gives motor innervation to the infrahyoids?
ansa cervicalis
203
T/F: Phrenic does motor and sensory to the diaphragm.
true
204
Discuss the path of the internal jugular v.
drains sinuses of the cranium, exits through the jugular foramen, drains more of the face and neck, joins subclavian v. to form the brachiocephalic v.
205
T/F: The submental lymph nodes are palpable.
true
206
What does the thoracic duct do?
connect lymphatic drainage on left
207
Describe the lymphatic drainage systems on the left and right.
left: thoracic duct
right: right lymphatic duct
208
At what vertebral level does the trachea travel?
C6-T4, anterior to esophagus
209
Where is the thyroid gland along the vertebra?
C5-T1
210
What does the thyrocervical trunk branch off into?
1) inferior thyroid a.
2) transverse cervical a.
3) suprascapular a.
211
The vertebral a. is a branch off of what?
subclavian a.
212
Internal thoracic a. branches off of what?
subclavian a.
213
What are the branches off of the subclavian a.?
1) thyrocervical trunk
2) vertebral a.
3) internal thoracic
4) costocervical trunk
214
T/F: Esophagus runs from the pharynx to the stomach.
true
215
What is the thyroid important for?
metabolism; secretes calcitonin, a hormone that drives Ca2+ into bone
216
Where is parathyroid hormone secreted from? What's it do?
parathyroid; it
