Exam 1 Flashcards
0
Q
Relating to the covering of an organ
A
Visceral
1
Q
Relating to the lining of a body cavity
A
Parietal
2
Q
Motor innervation to the face muscles are from what?
Sensory?
A
Facial nerve CN VII
Trigeminal nerve CN V “great sensory nerve”
4
Q
What are the three major branches of the Trigeminal nerve before emerging into the face and where do they distribute to?
A
Ophthalmic Nerve - face and scalp
Maxillary Nerve - cheek and lateral to the orbit
Mandibular Nerve - chin and temporal region
5
Q
What is the name for facial nerve paralysis?
A
Bell’s Palsy
6
Q
What are the 5 subdivisions of the Opthalmic Nerve? Describe them
A
Supraorbital Supratrochlear External Nasal Nerve Infratrochlear Nerve Lacrimal Nerve
7
Q
Which nerve is very long out of the foramen above orbit. Scapula innervated
Shorter, above the trochlea of orbit, supplies eye and nose
external nose
below trochlea of orbit supplies medial orbit
lacrimal apparatus
A
Supraorbital Nerve
Supratrochlear Nerve
External Nasal Nerve
Infratrochlear Nerve
Lacrimal Nerve
8
Q
What are three subdivisions of the Maxillary nerve?
A
Zygomaticotemporal Nerve
Zygomaticofacial Nerve
Infraorbital Nerve
9
Q
Which nerve supplies the lateral to eye brow and is small?
SUpplies cheek region?
Large, infraorbital foramen, supplies region below eye and is most frequently inured in blows from boxing
A
Zygomaticotemporal Nerve
Zygomaticofacial Nerve
Infraorbital Nerve
10
Q
What are the three subdivisions of the Mandibular nerve?
A
Auriculotemporal nerve
Buccal Nerve
Mental Nerve
11
Q
Describe Trigeminal Neuralgia (Tic Doloureaux)
A
Condition of sudden attacks of severe pain occurring in an area of sensory distribution of the trigeminal nerve. hyper sensitive.
most common in maxillary division, second most is mandibular region
cause is unknown
12
Q
Where does the sensory information of the posterior aspect of the neck and scalp come from?
A
Dorsal primary rami of cervical nerves 2-4
13
Q
Name of posterior primary rams of C2 that supplies the occipital region?
Posterior primary rams of C3 and supplies upper part of the back and neck
Posterior Primary rams of C4 supplies lower part of back of the neck
A
Greater Occipital Nerve
Third Occipital Nerve
No name
14
Q
Does C1 nerve have a posterior root carrying sensory fibers?
A
No it is only motor nerve
15
Q
Where does the sensory innervation of the anterior and lateral aspect of the neck come from?
A
Ventral primary rami of cervical nerves 2-4
16
Q
Which nerves roots make up the Cervical plexus? Brachial Plexus
A
C1-4
C5-8
17
Q
What are the four sensory branches of the Cervical Plexus?
A
Lesser Occipital Nerve C2
Great Auricular Nerve C2,C3
Transverse Cervical Nerve C2.C3
Supraclavicular Nerve C3 C4
18
Q
What does the lesser occipital nerve supply?
Great Auricular Nerve?
Transverse Cervical Nerve
Supraclavicular ?
A
lateral part of occipital region posterior to ear
angle of mandible, area inferior to ear, accompanies jugular vein
anterior surface of the neck (throat)
lateral surface of neck and shoulder,
19
Q
What are the three subdivisions of the Supraclavicular Nerve?
A
Medial Supraclavicular Nerve
Intermediate Supraclivicular Nerve
Lateral Supraclivicular Nerve
20
Q
Where do the motor branches of the cervical plexus carry fibers to? where do they arise from? (loop)
A
infrahyoid (strap) muscles)
Ansa Cervicalis
21
Q
Describe the superior root of the Ansa Cervicalis
A
From C1 or C1&C2. descends from the hypoglossal nerve to join the inferior root
From C2 & C3. descends from cervical nerve branches to join the superior root
22
Q
Which muscles are supplied by the ansa cervicalis (C1,2,3)?
A
three of the four infra hyoid muscles: sternohyoid, sternothyroid, and omohyoid
thyrohyoid receives innervation from C1 fibers through hypoglossal nerves
23
Q
What is the Phrenic nerve considered a part of?
Originates from which Levels?
Motor to what? Sensory to What?
Where does it lie and run?
A
considered part of cervical plexus
originates from C3, C4, and C5
motor to the diaphragm and sensory to some of the membranes of the thorax and abdomen
found lying on anterior surface of the anterior scalene muscle. runs vertically down the muscle into the thorax
24
Q
Platysma OINF
A
superficial fascia over the pectorals major and deltoid muscles
lower border of the mandible and the angle of mouth
cervical branch of facial nerve (CN VII)
Function: depresses the mandible and draws down the corner of mouth
25
Sternocleidomastoid OINF
Sternal head from front of manubrium, clavicular head from medial third of clavicle
lateral surface of mastoid process, lateral half of the superior nuchal line
accessory nerve (CN XI)
chief flexor of the head
26
Describe Torticollis
what are the three types?
Pathological contraction of the sternocleidomastoid where head is tilted toward & face turned away from the affected side
Congenital : fibrous tissue tumor develop before birth
Muscluar : due to birth injury
Spasmodic : adults due to abnormal tonicity, responds well to chiro care
27
Trapezius OINF
EOP, ligamentum nuchae, spinous processes of C7 and all T vertebrae
Lateral third of clavicle, spine of scap, acromion
accessory nerve (CN XI) C3 and C4 from cervical plexus
upper portion elevates, middle retracts, lower depresses scapula
28
What does the External Jugular Vein drain?
What is it formed by and below where?
Where does it run and empty into?
It drains the face and scalp and obtains a large amount of cerebral blood
formed immediately below the parotid gland by union of the Retromandibular Vein and Posterior Auricular Vein
Runs downward and backward along lateral surface of Sternocleidomastoid and empties into subclavian vein
29
What are the 6 tributaries of the external jugular vein?
```
Retromandibular Vein
Anterior Jugular Vein
Transverse Cervical Vein
Suprascapular vein
Posterior Auricular Vein
Posterior External Jugular Vein
```
30
Describe the significance of a Prominent External Jugular Vein
In congestive heart failure or obstruction of superior vena cava the vein becomes very prominent.
Normally with normal venous pressure the external jugular is invisible or nearly so.
Opera singers or bagpipe players have prominent ones due to increased intrathoracic pressure during singing or playing
31
What structure divides the Anterior and Posterior triangles of the neck?
Sternocleidomastoid
Anterior lies in front of it and posterior lies behind it
32
What are the boundaries of the posterior triangle of the neck
Anterior boundary: posterior border of SCM
Posterior boundary: anterior border of trapezius
Inferior Boundary : superior border of middle third clavicle
33
What are the boundaries of the anterior triangle of the neck?
Where is apex located?
what are roof?
Superior boundary: inferior border mandible
Anterior boundary : anterior midline
Posterior boundary: anterior border of SCM
Apex is at the jugular notch
Roof is deep cervical fascia and superficial cervical fascia and platysma
34
What are the 4 subdivisions of the Anterior triangle of the neck?
Submental Triangle
Submandibular (Digastric) Triangle
Carotid Triangle
Muscular Triangle
35
Which subdivision of the anterior triangle is the only one that is unpaired?
What are its boundaries?
FLoor?
Contents?
Submental
left and right anterior bellies of digastric (submandibular triangle), and the body of the hyoid bone
the mylohyoid muscle
minor veins and lymph nodes
36
What are the boundaries of the Submandibular (digastric) triangle?
Floor?
Contents?
inferior border of the mandible, anterior belly of digastric, and the posterior belly of digastric
mylohyoid and hyoglossus muscles
submandibular gland, internal carotid artery, facial artery, internal jugular vein, glossopharyngeal nerve and vagus nerve
37
What are the boundaries of the Carotid Triangle?
Floor?
Contents?
posterior belly of digastric, superior belly of omohyoid, and anterior border of SCM
portions of thyrohyoid, hyoglossus, and inferior and middle constrictor muscles
parts of common and internal carotid arteries, external carotid artery and three of its branches: superior thyroid artery, lingual artery, and facial artery. Also corresponding tributaries of the internal jugular
38
Muscular Triangle boundaries?
Floor?
Contents?
Superior belly of omohyoid, anterior midline of neck, and anterior border of SCM
Posterior layer of pretracheal fascia
sternohyoid and sternothyroid muscles, thyroid gland, trachea, and esophagus
39
Where is the hyoid located?
Which bones does it articulate with?
What parts make it up?
Located between mandible and larynx, serves as point of attachment for many muscles.
Does not articulate with ANY other bones!
Made up of Body, Greater horn, and Lesser Horn
40
What are the four Infrhyoid muscles that attach to hyoid and primarily function to move it along with the larynx?
Which are superficial? Which a re deep?
Omohyoid - superficial
Sternohyoid - superficial
Sternothyroid - deep
Thyrohyoid - deep
41
Omohyoid OINF
Inferior belly of omohyoid originates from upper border of scapula. It ends in an intermediate tendon located deep to the SCM. Superior belly of omohyoid originates from this tendon
Body of the hyoid bone
Ansa cervicalis C1 C2 C3
Depresses the hyoid bone and larynx
42
Sternohyoid OIAF
Posterior surface of the manubrium, and medial end of clavicle
Body of the hyoid bone
Ansa cervicalis C1 C2 C3
Depresses the hyoid bone and larynx
43
Sternothyroid OIAF
Posterior surface of the manubrium, inferior to the origin of sternohyoid
Oblique line on the lamina of the thyroid cartilage
Ansa cervicalis C1-3
Depresses the larynx
44
Thyrohyoid OIAF
Oblique line on the lamina of the thyroid cartilage
Body of hyoid bone
C1 through hypoglossal nerve
Depresses the hyoid bone
45
Why do all of these muscles used to depress the hyoid bone and larynx? (3things used for)
Ih hyoid is fixed, what depresses the mandible?
Swallowing
Speech
Breathing
If hyoid is fixed, digastric depresses mandible
46
What are the two major layers of cervical fascia
The further subdivisions?
```
Superficial Cervical Fascia
Deep Cervical Fascia (divided further)
Investing layer of the Deep Cervical Fascia
Pretracheal Fascia
Prevertebral Fascia
Carotid Sheath
```
47
Is the superficial cervical fascia thick or thin?
What muscle does it enclose?
What three things does it contain?
Thin layer connective tissue
encloses platysma,
contains cutaneous nerves, superficial veins, and lymph does
48
Where does the Deep Cervical Facia lie?
What muscles does it enclose?
What do the four subdivisions of it each enclose?
Deep to the superficial cervical fascia
Investing layer - splits to enclose the SCM and trap
Pretracheal Fascia - layer encloses the thyroid gland, trachea, and esophagus
Prevertebral fascia - encloses vertebral column and the deep muscles of back
Carotid sheath - layer of cylindrical fascia whichever extends from the base of skull to the root of neck
49
What 5 thing does the carotid sheath contain?
Common carotid artery
Internal carotid artery
Internal jugular vein
Vagus nerve
Deep cervical lymph nodes
50
What is the function of fascia layers? The clinical significance?
To provide a slippery surface to reduce friction during gross movment of the head and neck, and swallowing.
May serve as channel for infection by allowing it to spread from the head and neck to the mediastinum directly. (Pretracheal facia)
Cancer involving deep cervical lymph nodes can compress the internal jugular vein
51
What is the superior thoracic aperture (thoracic inlet) and what are its boundaries?
The kidney shaped Opening through which structures of the neck pass into the thorax
1 first thoracic vertebra
2 first ribs and their cartilages
3 manubrium of sternum
52
Which arteries (4) go through the superior thoracic aperture?
Vein?
Nerves? (4)
Viscera (5)
Brchiocephalic, left common carotid, left subclavian, internal thoracic arteries
Brchiocephalic vein
Phrenic, vagus, recurrent laryngeal, nerves and sympathetic trunk
Trachea, esophagus, cervical plexus, apex of lung, thymus
53
What are two potential for lung collapse with neck injury?
Cervical pleura and lung apex pass through superior thoracic aperture right below the SCM origin
Also broken first rib or penetration wound may puncture lung and collapse. (Atelectasis)
54
The Thymus is part of what system? Produces what?
Made up of how many lobes?
Where is it located?
Blood supply?
Innervation?
Part of immune system, produces T - lymphocytes
2 irregular lobes,
behind manubrium and body of sternum Inferior to thyroid gland
Blood supply from Internal thoracic artery
Innervation from stellate ganglion of sympathetic trunk and vagus
55
What type of gland is the Thyroid Gland? What does it produce?
Where does it lie?
What shape is
Endocrine gland that produces thyroxine and calcitonin
Lies at the level of cervical vertebra 5 through thoracic vertebra 1
H or U shaped and consists of three parts
Left lobe, right lobe, and Isthmus connector
56
Is the thyroid highly vascular?
Yes
57
What are a couple of anatomical variations of the thyroid?
Bout half have aPyramidal lobe extending upward from isthmus as a finger of glandular tissue
Also the levator glandulae thyroideae muscle connects isthmus with hyoid bone
58
What are the two arteries supplying the thyroid gland?
What is a variation common?
Superior thyroid artery (from external carotid)
Inferior thyroid artery (from thyrocervical trunk)
Thyroid Ima Artery: any inconstant branch to thyroid gland, from the brachiocephalic trunk
59
What are the Three veins for the Thyroid GLand and what is the innervation of thyroid gland?
Superior Thyroid Vein (to the internal jugular vein)
Middle Thyroid Vein (to the internal jugular vein)
Inferior Thyroid Vein (to the brachiocephalic vein)
From superior, middle, and inferior cervical sympathetic ganglia
60
Describe a Goiter. What are two types?
Abnormal enlargement of the thyroid gland swelling anterior neck
Endemic Goiter : due to dietary deficiency iodine (produces thyroxin) Gland enlarges to increase output, Hormone INactive. Symptoms close to hypothyroidism
Etophtahlmic Goiter: due to autoimmune disease. thyroid stimulating immunoglobuins bind to receptor site leading to overactivity. Hormone active, symptoms close to Hyperthyoridism known as Gravese disease.
CHECK BRI NOTES!!!!
61
What type of glands are Parathyroid glands? What are they involved in?
Location? Number?
Blood Supply?
Innervation?
Endocrine glands involved in calcium homeostasis and are essential to life.
Small ovoid bodies on the posterior surface of thyroid gland. Usually 4 but can be 2-6.
Inferior Thyroid Artery and Superior Thyroid Artery
From inferior or middle cervical sympathetic ganglia
62
What are the three factors contributing to the Difficulty of Thyroid surgery?
Presence of parathyroid gland
Presence of the Reccurent Laryngeal Nerve
Vascularity
63
Where does the Trachea begin? What does it split into in thorax?
What are its walls supported by?
Which musle spans the posterior gap?
Blood Supply of trachea?
Innervation?
Begins at the larynx at C6 level. Within the thorax splits into the left and right main bronchii
Cartilaginous rings opening posterior (these rings permit expansion of esophagus during swallowing)
Trachealis Muscle
Inferior Thyroid Artery
Recurrent Laryngeal Nerve
64
What does the Esophagus connect? Where does it begin and lie?
Muscular tube connecting pharynx and stomach. Begins in neck at C6 and lies posterior to trachea
65
What are the main arteries of the head and neck?
Where do they ascend within and to?
What are the two divisions?
Left and right Common Carotid Arteries
Ascend within carotid sheath to the carotid triangle
Split into Internal and External Carotid Artery
66
How many branches in the neck does the Internal Carotid artery have? Where does it enter the skull and what does it supply?
External Carotid Artery number of branches in neck?
None. Enters skull through carotid canal (in temporal bone) to supply blood to brain.
8 branches. enters through carotid canal and is main source of blood to structures in neck, face, and scalp (structures external to skull) Has 8 branches.
67
What are the 8 branches of the External carotid artery?
```
Superior Thyroid Artery
Ascending Pharyngeal Artery
Lingual Artery
Facial Artery
Occipital Artery
Posterior Auricular Artery
Superficial Temporal Artery
Maxillary Artery
```
68
Describe the Carotid Sinus.
Function?
Innervation?
Slight dilation of internal carotid artery where it joins the common carotid.
Baroreceptor (blood pressure sensor)
Carotid sinus nerve, branch of the glossopharyngeal (CN IX)
69
Describe the Carotid Body
Function?
Innervation?
Small reddish-brown mass within or deep to the bifurcation of common carotid artery.
Chemoreceptor detects change in chemical makeup of blood in sinus.
Carotid sinus branch of the glossopharyngeal nerve (CN IX)
70
Describe the Internal Jugular Vein.
The superior jugular bulb?
The Inferior Jugular Bulb
Usually largest vein of the neck. Begins at jugular foramen as the direct continuation of the sigmoid sinus. Drains into brachiocephalic vain.
Dilation of the internal jugular vein at its origin below the jugular foramen.
Dilation of the internal jugular vein near its termination into the brachiocephalic vein.
71
What are the 6 tributaries of the Internal Jugular Vein?
```
Inferior Petrosal Sinus
Pharyngeal Veins
Facial Vein
Lingual Vein
Superior Thyroid Vein
Middle Thyroid Vein
```
72
Where does the Glossopharyngeal nerve emerge from and pass through?
List each branch and its function.
CN IX emerges from medulla oblongata and passes through jugular foramen.
1. Tympanic nerve: sensory to tympanic cavity and secretomotor to parotid gland
2. Branch to the Carotid Sinus: sensory to carotid sinus & body
3. Pharyngeal Branch: Unites with vagus branches and sympathetic trunk to form pharyngeal plexus. Sensory to pharynx
4. Branch to Stylopharyngeus: motor to styopharyngeus muscle
5. Tonsillar Branch: sensory to mucous membrane over tonsil and soft palate
6. Lingual Branch: taste and general sensation to posterior 3rd of tongue
73
Describe the Vagus Nerve and its two ganglia.
Longest cranial nerve, distributions in head, neck, thorax, and abdomen. Vagus means "wanderer." Emerges from MO and exits skull through jugular foramen.
1. Superior (jugular) Ganglion: inside the jugular foramen
2. Inferior (Nodose) Ganglion
74
What are the 5 Branches of the vagus in the head and neck?
1. Meningeal Branch - arises from superior gang. Supplies dura mater with sensory innervation
2. Auricular Branch - Arises from superior ganglion. Sensory to auricle, floor of external auditory meatus, and tympanic membrane.
3. Pharyngeal Branch - Arise from inferior gang. Chief motor nerve to pharynx and soft palate muscles. Joins with glossopharyngeal nerve branches and sympathetic trunk to make pharyngeal plexus.
4. Superior Laryngeal Neve - arise from inferior gang. divides into:
a. Internal Laryngeal Nerve - sensory mucous membrane of larynx to the true vocal cords
b. External Laryngeal Nerve - motor to cricothyroid and inferior constrictor muscles
5. Recurrent Laryngeal Nerve - arise from vagus within thorax then ascend to neck. Ascends through groove between trachea and esophagus closely applied to posterior surface of thyroid gland. sensory to mucous membrane of larynx below the true vocal folds and to the trachea. Motor to all muscles of larynx except cricothyroid.
75
What are the functions of the Pharyngeal Plexus?
Motor to all muscles of pharynx except for stylopharyngeus (innervated by glossopharyngeal), and to all muscles of soft palate except tensor veli palatini (innervated by trigeminal nerve).
76
What are two clinical consequences of damage to the recurrent laryngeal nerve?
Four causes of damage to it?
Unilateral damage: respiratory distress, hoarsness, partial aphonia
Bilateral: complete aphonia, may result in suffication
1. Trauma during thyroid surgery
2. Goiter or thyroid tumor
3. Lung tumor
4. Aortic Aneurysm (left side only)
77
What two parts form the Accessory Nerve?
Describe where they originate from and what they supply.
CN XI, formed by the union of two parts:
Cranial part - originate from MO, joins vagus just above inferior vagal ganglion, supplies vagus w motor fibers, which travel in the pharyngeal branch of vagus and recurrent laryngeal nerve
Spinal part - originate sides of spinal cord, ascends through foramen magnum to join cranial part where they both exit jugular foramen. Motor to SCM and Trap
78
What is the function of the Hypoglossus nerve?
Originate and exit from?
Where does it loop to?
CN XII is the motor nerve to the tongue.
Originates from the MO exits through hypoglossal canal
Loops downward and forward deep to posterior belly and intermediate tendon of digastric
79
What are the 4 major types of branches of the Hypoglossal Nerve?
Meningeal Branches - supply the dura mater
Superior root of Ansa Cervicalis - mainly C1 Fibers
Nerves to Thyrohyoid and Geniohyoid - C1 fibers motor to those muscles
Lingual branches - motor for extrinsic and intrinsic tongue muscles
80
Where does the Cervical part of the sympathetic trunk begin and continue with?
Where do preganglionic sympathetic fibers supplying head and neck originate?
Travel up to and synapes with?
Where dopostganglionic fibers distribute to then?
Begins at base of skull and is continuous with thoracic part of trunk
Originate from T1 - T3 travel up to several cervical ganglia
Synapse then distribute to blood vessels, smooth muscle, and glands of head and neck
81
Wha are the 4 major cervical sympathetic ganglia?
Superior Cervical Ganglion
Middle Cervical Ganglion
Vertebral Ganglion
Cervicothoracic (Stellate) Ganglion
82
Describe the Superior Cervical Ganglion and its branches.
Lies at level of C1 - C3. Branches :
Internal Carotid nerve - large nerve accompanies internal carotid artery into skull
Superior Cervical Cardiac Nerve - to cardiac plexus
Branches to the Pharyngeal Plexus
83
Describe the Middle Cervical Ganglion and its branch
Describe the Vertebral Ganglion and its Branches
Lies at level of C6, Middle Cervical Cardiac Nerve and Branch to Thyroid Gland
Variable and often fused with middle or inferior cervical ganglion
Lies at C7 and gives off branch to plexus along vertebral artery
84
Describe the Cervicothoracic (stellate) Ganglion and its Branch
Formed by fusion of inferior cervical ganglion to the first thoracic ganglion
Lies at C7 through T1 posterior to vertebral artery and anterior to transverse process of C7 and neck of first rib.
Branch is Inferior Cervical Cardiac Nerve (to cardiac Plexus)
85
What is the Ansa Subclavia?
neve bundle which loop santerior to the subclavian artery, connecting the vertebral ganglion to the Cervicothoracic ganglion.
86
WHat is the largest and sturdiest facial bone? Describe its 6 main parts.
Mandible.
Body - large horizontal part
Alveolar Process - upper border of body, has tooth sockets (alveoli)
Ramus - vertically ascending part
Angle - at posterior terminus of the body
Condylar Process - articulates with temporal bone to for TMJ
Coronoid Process - area of attachment for mastication muscles
87
What are the 6 internal (lingual) surface features of the mandible. Describe them
Superior Mental (genial) Spine - origin of Genioglossus muscle
Inferior Mental (genial) Spine - origin of Geniohyoid muscle
Digastric Fossa - origin of anterior belly of Digastric
Mylohyoid Line - origin of Mylohyoid muscle
Sublingual Fossal - location of sublingual gland
Submandibular Fossa - location of submandibular gland
88
What are the Suprahyoid Muscles and Extrinsic Muscles of the Tongue?
Diagastric
Mylohyoid
Geniohyoid
Genioglossus
Hyoglossus
Styloglossus
Stylohyoid
89
Digastric OINF
Posterior belly from mastoid process, anterior belly from digastric fossa
Both bellies "insert" into hyoid bone by connecting intermediate tendon. This tendon is strapped to hyoid by fibrous loop
Posterior belly by cervical branch of facial nerve (CN VII), anterior belly by nerve to mylohyoid (CN V)
Elevates hyoid and depresses mandible when hyoid fixed
90
Mylohyoid OINF
Mylohyoid line
Body of hyoid bone, median raphe (2muscles bound and fused)
Nerve to mylohyoid (CN V)
Elevates hyoid and floor of mouth
91
Geniohyoid Muscle OINF
Inferior mental spine
Body of hyoid
C1 fibers through hypoglossal
Elevates hyoid bone and tongue
92
Gnioglossus Muscle OINF (largest tongue muscle)
Superior Mental Spine
Tip and entire undersurface of tongue
Hypoglossal nerve
Draws tongue forward, protrudes tip of tongue
93
Hyoglossus OINF
What is unique about potential origin?
Body and greater horn of hyoid (upper surface).
Sides of tongue
Hypoglossal Nerve
Draws tongue downward
**Small portion of muscle may originate from lesser horn of hyoid. This muscle slip is called Chondroglossus.
94
Describe the Hypoglossal Nerve.
Originate and exit from?
Where does it loop to?
CN XII is the motor nerve to the tongue.
Originates from the MO exits through hypoglossal canal
Loops downward and forward deep to posterior belly and intermediate tendon of digastric
95
What are the 4 major types of branches of the Hypoglossal Nerve?
Meningeal Branches - supply the dura mater
Superior root of Ansa Cervicalis - mainly C1 Fibers
Nerves to Thyrohyoid and Geniohyoid - C1 fibers motor to those muscles
Lingual branches - motor for extrinsic and intrinsic tongue muscles
96
Describe the Cervical part of the Sympathetic Trunk.
Where do preganglionic sympathetic fibers supplying head and neck originate?
Travel up to and synapes with?
Where dopostganglionic fibers distribute to then?
Begins at base of skull and is continuous with thoracic part of trunk
Originate from T1 - T3 travel up to several cervical ganglia
Synapse then distribute to blood vessels, smooth muscle, and glands of head and neck
97
Styloglossus OINF
Styloid process
Sides of tongue
Hypoglossal nerve
Draws tongue upward and backward
98
```
Stylohyoid Muscle (pierced by intermediate tendon of digastric
OINF
```
Styloid process
Body of the hyoid
Facial Nerve
Elevates hyoid bone and tongue
99
Describe the Submandibular Gland.
Describe its two parts
Innervation?
One of three large paired salivary glands. Wraps around the posterior border of the mylohyoid.
Superficial part: large, lies within the submandibular triangle and in the submandibular fossa
Deep Part: Small and lies superior to the mylohyoid muscle
Parasympathetic fibers from the facial nerve (CN VII) via the submandibular ganglion
100
Describe the submandibular duct?
5 cm long. Opens into the oral cavity on the sublingual caruncle, located lateral to the frenulum of the tongue.
101
Describe the Sublingual gland
Where does it lie?
Empty? Located?
Innervation?
Smallest salivary gland.
Lies superior to the mylohyoid muscle, in the sublingual fossa
Empties into the floor of the mouth by 12 short ducts, located along the sublingual fold.
Parasympathetic fibers from the facial nerve (CN VII) via the submandibular ganglion
102
List the Nerves associated with the mandible
Blood Vessels
Lymphnodes
Lingual, Glossopharyngeal, and Hypoglossal
Lingual artery and vein, facial artery and vein
Submandibular and submental lymphnodes.
103
What are the 4 functions of the Nasal Cavity?
Describe the cavity
To provide an airway
Olfaction
Warming and moistening of inspired air
Cleansing of inspired air
Extends from nostirls anteriorly to the choanae posteriorly. Divided into left and right chamber by the nasal septum.
104
Describe Choanae
Posterior apertures of the nasal cavity which open into the nasopharynx.
105
What are the four features of the External nose?
Tip - free end of the nose
Root - connects the nose to the forehead
Nares - Nostrils
Alae - bound the nares laterally
106
Describe the Roof, Floor, Medial and Lateral Walls of Nasal Cavity
Roof: nasal bone, frontal bone, cribriform plate of ethmoid bone, body of sphenoid bone
Floor: palatine process of maxilla and horizontal plate of palatine bone, body of the sphenoid bone.
Medial Wall: septal cartilage, perpendicular plate of ethmoid, vomer
Lateral Wall: nasal bone, frontal process of maxilla, lacrimal bone, ethmoid bone, inferior nasal choncha, perpendicular plate of palatine, medial pterygoid plate of sphenoid.
107
List 10 important structures of the lateral wall of the nasal cavity.
Superior and Middle Nasal Concha (of ethmoid bone)
Inferior Nasal Concha (of a separate bone)
Sphenoethmoidal Recess - space above and behind superior nasal concha, receive opening to sphenoid sinus
Superior, Middle, Inferior Meatus. - next slide
Ethmoidal Bulla - rounded projection into middle meatus, middle ethmoidal cells open onto this structure.
Hiatus Semilunaris - curves slit lying below ethmoidal bulla within the middle meatus. Frontonasal duct, anterior ethmoidal cells and maxillary sinus open into this slit.
Nasolacrimal Duct - Connects lacrimal sac of orbit to the nasal cavity
108
Describe the Three main Meatus's in the nose
Superior - space below the superior nasal concha. Receives opening of the posterior ethmoidal cells
Middle - space below middle nasal concha. Receives openings of frontal sinus (frontonasal duct or infundibulum), maxillary sinus, middle ethmoidal cells and anterior ethmoidal cells
Inferior - Space below inferior nasal concha. Recieves opening of the nasolacrimal duct.
109
Describe a Deviated Septum.
What can happen with one?
Causes?
When the nasal septum does not lie in the median plane.
Increased snoring, if serious can touch lateral wall causing breathing difficulty.
Congenital malformation, Birth Injury, Postnatal Trauma.
110
Describe three major regions of the nasal cavity.
Nasal Vestibule: area just inside each nostril. Contains hair, sebaceous glands, and sweat glands.
Respiratory Region: Lower two thirds of the nasal cavity. (middle concha)
Olefactory region: Superior nasal concha and upper one third of nasal septum. Contains fibers of the olfactory nerve (CN 1) which pass down through cribriform plate.
111
Describe the Innervation for the Nasal Cavity
Blood Supply
Lymph Nodes
Special sensory innervation from olfactory nerve (CN 1)
General sensory from branches of maxillary and opthalmic divisions of the trigeminal nerve (CN V)
Autonomic innervation from the pterygopalatine ganglion.
Lots of blood supply. Sphenopalatine branch of the maxillary artery and anterior ethmoidal branch of the opthalmic artery.
They drain from the nasal cavity into the deep cervical nodes.
112
Describe Epistaxis and what are its two forms?
Nose Bleed
Mild form - involves small branches in or near the vestibule caused by minor trauma, low humidity.
Severe form - involves spurting of arterial blood. Result from rupture of the Sphenopalatine artery at one of its major anastomosis caused by trauma.
113
Where do the lymphin the nasal cavity drain to?
Lymph from the nasal cavity drains into the deep cervical nodes
114
Describe the paranasal sinuses.
What two factors influence the formation of sinuses?
List them and describe where they go to.
Cavities found within the bones of the face. Develop as outgrowths of the nasal cavity therfore all open to it.
Wolff's law and Weight of skull
Frontal - opens to hiatus semilunaris via frontonasal duct
Maxillary - opens to hiatus semilunaris. Only sinus present at birth
Sphenoidal - Opens into the sphenoethmoidal recess
Ethmoidal - Consists of several groups of ethmoidal cells lie in the bone between orbit and cavity
Posterior ethmoidal cells open to superior meatus
Middle ethmoidal cells open to ethmoidal bulla in middle
Anterior ethmoidal cells open to hiatus semilunaris
115
Where are the 6 places that infection of the nasal cavity can spread to?
Paranasal Sinuses - sinusitis
Lacrimal apparatus & conjuctiva via nasolacrimal duct - Conjunctivitis (pinkeye)
Nasopharynx via chonae - Acute pharyngitis
Middle ear via pharygotymanic tube - otitis media
Anterior cranial fossa via cribriform plate - meningitis, brain ameba
Mastoid process via aditos & antrum - mastoiditis
***CSF dripping out nose indicates brain damage
116
Describe the boundaries of the Oral Cavity and its two divisions.
Roof: the palate
Floor: the tongue and oral mucosa
Anterior and Lateral: lips and cheeks
Posterior: oropharyngeal isthmus, demarcated by pataloglossal arch
Divided into Oral vestibule and Oral Cavity Proper
117
Describe the Oral Vestibule, its openings to it.
Do same with Oral Cavity Proper
Vestibule: Portion between lips and gums or cheek and gums. Portion external to the tooth rows.
Labial glands: small salivary glands
Parotid Duct: opens lateral to maxillary second molar
Proper: Lies internal to the tooth rows.
118
What is the name for the median groove seen externally in the oral cavity from the nose to the vermillion border of the upper lip?
What are the names for the median folds internally connecting the upperlip with the gum and lower lip with gum
Philtrum
Frenulum of upper or lower lip
119
WHich muscle and glands do the lips contain?
THe cheeks?
Obicularis Oris and labial glands
Buccinator muscle and buccal glands
120
Describe the Palate and its two parts?
Forms the roof of the mouth and floor of nasal cavity.
Arched both tranverely and anteroposteriorly
Hard Palate: forms the anterior two thirds of palate
Soft Palate: forms the posterior one third
121
Describe the Hard palate, its two important features, along with three foramen within it.
Forms the bony partition between nasal and oral cavities.
Palatine Process of Maxilla (anteriorly)
Horizontal Plate of the Palatine Bone (posteriorly)
Incisive Foramen
Greater Palatine Foramen
Lesser Palatine Foramen
122
What is Mucoperiosteum?
Palatine Raphe?
Incisive Papilla?
Transverse Palatine Folds?
Covering of the hard palate
See drawing pg 35
Palatine Raphe endes into this
Extend laterally within mucoperiosteum and aid in gripping food
123
Describe the Soft Palate
Describe its two lateral arches and their components
Describe the Tonsillar Fossa
Mobile fibromuscular fold suspended from the posterior border of the hard palate. It is elevated during swallowing to close the opening between nasopharynx above and oropharynx below.
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Palatoglossal Arch
Palatoglossal Fold (superficial)
Palatoglossus Muscle (deep to fold)
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Palatopharyngeal Arch
Palatopharyngeal Fold (superficial)
Palatopharyngeus Muscle (deep to the fold)
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Lies between palatoglossal and palatopharyngeal arches on each side and contains the Palatine Tonsil
124
Musculus Uvulae OINF
Posterior Nasal Spine
Mucous membrane of uvula
Vagus nerve (X) via the pharyngeal plexus
Elevates the uvula
125
Levator Veli Palatini OINF
Inferior surface of temporal bone
Aponeurosis of soft palate
Vagus nerve (X) via pharyngeal plexus
Elevates soft palate
126
Tensor Veli Palatini OINF
Scaphoid fossa of the medial pterygoid plate, pharyngotympanic tube
Tendon winds around the pterygoid hamulus and inserts into the aponeurosis of the soft palate
Mandibular division of Trigeminal (V)
Tenses soft palate, opens pharyngotympanic tube
127
What is the innervation and blood supply of the hard palate and soft palate?
Hard Palate:
Greater Palatine Artery (from maxillary)
Greater Palatine and nasopalatine nerves
Soft Palate:
Lesser Palatine and Facial arteries
Lesser Palatine Nerve
128
What would you suspect if the uvula deviates to the right?
Possible damage to the left vagus nerve because paralysis of the Musculus Uvolus??? on the left side.
Check Bri notes
129
Describe the tongue
Its 4 functions?
Its 5 parts?
Muscular organ which attached to hyoid, mandible, styloid, palate, and pharynx by muscles.
Taste, Mastication, Swallowing, Speech
Apex: rests against incisor teeth
Margin: rests against teeth and upper gums on each side
Dorsum: upper surface of tongue
Inferior surface: lower surface of the tongue (not attached?)
Root: the attached base of the tongue
130
Where does the tongue lie?
What is the sulcus Terminalis?
Foramen Cecum?
Median groove
Partly in the oral cavity (anterior two thirds) and partly in the oropharynx
V shaped groove which divides tongue into two parts (above)
Shallow groove visible on surface
Located at the apex of V of sulcus terminalis. (Remnant of embryonic thyroglossal duct.
131
What are the four types of Lingual Papillae?
Filiform Papillae: conical projections sharp tips (sensory)
Fungiform Papillae: mushroom shaped. (Sweet T buds)
Vallate Papillae: Largest, arranged in V shaped row (Bitter T buds)
Foliate Papillae: Grooves and ridges along margin, poorly developed. (Sour T buds)
132
Which way does the Oropharyngeal part of the Dorsum of tongue face?
Describe the Lingual Tonsil
Which two folds connect the tongue to the epiglottis?
Name for the space on either side of the median glosoepiglottic fold?
Posteriorly
A mass of lymphoid tissue found on oropharyngeal surface of tongue
Median Glossoepiglottic Fold and Lateral Glossoepiglotic Fold
Vallecula
133
What is the inferior surface of the tongue connected to the floor of the mouth by?
Describe Ankyloglossia
Frenulum of the tongue
134
Describe the Root of the Tongue
Part of tongue that is anchored to floor of oral cavity
Nerves vessels and extrinsic muscles enter or leave the tongue through the root.
135
What do the intrinsic muscles of the tongue do? What are they innervated by? WHat do they form?
Originate within the tongue. Form the shape of the tongue and alter it. Innervated by hypoglossal
136
What are the 4 Extrinsic muscles of the Tongue?
What are they all (except one) innervated by?
Genioglossus
Hyoglossus
Styloglossus
Palatoglossus
Hypoglossal nerve
137
Palatoglossus OINF
Soft Palate
Sides of tongue
Vagus nerve (X) via pharyngeal plexus
Elevates Back of tongue
138
Clinical importances of Genioglossus
Pulls tongue forward
Prevents it from falling backward and blocking airway
Very important during general anesthesia and in seizure disorders
139
What is the innervation that provides general sensation to the anterior 2/3rds of the tongue?
Provides taste sensation to this location?
Both general sensation and taste to posterior 1/3?
Lingual nerve (branch of mandibular division of trigeminal)
Through the Chorda Tympani (branch of the facial nerve)
Glossopharyngeal nerve (this includes Vallate Papillae
140
Where do the Lingual Artery and Vein drain from and to the tongue?
Where do the Submental, submandibular and deep cervical nodes drain lymph to?
Artery from the External carotid
Vein to the Internal Jugular
All end up in the deep cervical nodes
141
What is the function of the teeth? Describe the following:
Enamel
Dentin
Pulp
Cementum
To break down food to increase its surface area for better digestion
Hardest substance in human body, covers the crown
Internal to the enamel
Fills central cavity. Has vessels, nerves and lymphatics which enter pulp through a foramen at apex of the root.
Bone-like substance which covers root.
142
What are the three parts of a tooth? Describe them
Also describe Gingivae (gums)
Crown: projects above gingivae and is covered by enamel
Neck: junction between crown and root
Root: embedded in the alveolar process of maxilla and mandible. Covered with cementum
Specialized oral mucosa which surrounds the teeth and covers adjacent alveolar bone
143
What are the four types of teeth. Describe them
Incisors: single rooted chisel shape used for cutting
Canines: single rooted pointed used for puncturing & tearing
Premolars: single or double root broad chewing surface for grinding
Molars: multiple root very broad surface for grinding
144
List and describe the 6 surfaces of the teeth.
Labial surface: (incisors and canines) only, side facing lip.
Buccal surface: (premolars and molars only), side facing cheek
Lingual surface: side facing tongue
Mesial surface: side facing anteriorly or toward midline
Distal surface: side facing posteriorly or away from midline
Occlusal surface: the chewing surface
145
WHat are the two sets of teeth? Differences?
List the teeth for each set and their location based on quadrant.
Deciduous (primary or baby) teeth and Permanent (adult) teeth.
Permanent are larger whiter and thicker enamel
Each draw can be separated into left and right quadrant. Number of teeth is usually stated by quadrant
Deciduous: two incisors, one canine, two molars each quadrant for total of 20
Permanent: two incisors, one canine, two premolars and three molars in each quadrant for 32 total
**deciduous molars are replaced by premolars
146
What is the innervation of the Maxillary teeth?
The Mandibular teeth?
Maxillary: innervated by superior alevolar branches from maxillary division of trigeminal (V)
Mandibular: inferior alveolar nerve from mandibular division of trigeminal
147
What is the common pathway for food and air? It is part of both the digestive and respiratory systems.
Where does it lie and what are its three parts?
Pharynx. A funnel-shaped fibromuscular tube extends from base of skull to inferior border of the cricoid cartilage.
Posterior to nasal cavity, oral cavity and larynx.
Nasopharynx: posterior to nasal cavity
Oropharynx: posterior to oral cavity
Laryngopharynx: posterior to larynx
148
What does the nasopharynx communicate with the nasa cavity through?
What does it communicate with the oropharynx through? Is this item opened or closed during swallowing
What are the boundaries of the Nasopharynx:
Choanae.
Pharyngeal isthmus. Closed.
Superior boundary: roof of pharynx
Inferior: soft palate
Anterior: posterior border of inferior nasal concha
Posterior: posterior wall of the pharynx
149
What is the name for the opening to the larynx found within the laryngopharynx?
What is it bounded laterally by? Inferiorly by?
What is a Piriform Fossa? WHat often gets stuck here? Causes what?
Laryngeal inlet
Aryepiglottic folds. Interarytenoid notch.
A recess in the anterior wall of laryngopharynx located on either side of laryngeal inlet. Fish bones often become lodged here and Deep piriform fossa are one cause of halitosis.
150
Which two layers do the muscles of the pharynx lie in? Which muscles lie in each layer?
External (circular) Layer
Inferior constrictor muscle
Middle constrictor muscle
Superior constrictor muscle
Longitudinal Layer
Stylopharyngeus muscle
Palatopharyngeus muscle
Salpngopharyngeus muscle
151
Superior Constrictor Muscle OINF
Name for specialized band of muscle formed by superior constrictor and helps seal pharyngeal isthmus during swallowing?
Medial pterygoid plate, alveolar part of mandible, side of tongue
Pharyngeal raphe
Vagus nerve (X) via pharyngeal plexus
Contracts the pharynx during swallowing
Palatopharyngeal Sphincter
152
Middle Constrictor Muscle OINF
Greater and lessor horns of the hyoid bone
pharyngeal raphe
Vagus nerve (X) via the pharyngeal plexus
Contracts the pharynx during swallowing
153
Inferior Constrictor Muscle OINF
Cricoid cartilage and thyroid cartilage
Pharyngeal raphe
Vagus nerve (CN X) via pharyngeal plexus and external laryngeal nerve
Contracts the pharynx during swallowing
154
Stylopharyngeus Muscle OINF
Styloid process
Thyroid cartilage, some fibers blend with those of the constrictors
Glossopharyngeal nerve (CN IX)
Elevates Pharynx
155
Palatopharyngeus Muscle OINF
Soft palate
Wall of pharynx, thyroid cartilage
Vagus nerve (X) via the pharyngeal plexus
Elevates pharynx, narrows oropharynx
156
Salpingopharyngeus Muscle OINF
Torus Tubarius and opening of pharyngotympanic tube
Wall of pharynx
Vagus nerve (CN X) via the pharyngeal plexus
Elevates pharynx, opens pharyngotympanic tube & tenor veli palitini
**fibers of palatopharyngeus and salpingopharyngeus blend together within the wall of the pharynx
157
Where is the pharyngeal plexus located and what three things make it up?
Lies on the middle constrictor muscle. Formed by the:
Pharyngeal branch of Vagus
Motor to all muscles of pharynx except stylopharyngeus which innervated by glossopharyngeal
Pharyngeal branch of Glossopharyngeal
Sensory to the mucosa of pharynx
Sympathetic fibers from the Superior Cervical Ganglion
158
What are the two arteries of the Pharynx?
Ascending Pharyngeal Artery
Maxillary Artery
159
Describe the following:
Buccopharyngeal Fascia
Pharyngobasilar Fascia
Retropharyngeal Space
Layer of fascia surrounding pharynx external to its muscles. Continuous with pretracheal fascia below
Layer which lies internal to pharynx muscles and external to mucosa.
Potential space between buccopharyngeal fascia (or pretracheal fascia) and prevertebral fascia. Extends down into thorax and permits free movment of the pharynx and esophagus during swallowing.
160
Clinical signifance of Retropharyngeal space
Hemorrhage from cervical trauma or abscess from pharyngeal insection???
LOOK AT BRI NOTES
161
What is Deglutition? Describe its 4 stages.
Swallowing.
Tongue moves bolus back into oropharyngeal isthmus
Palatoglossus and palatopharyngeus squeeze bolus back into oropharynx. Levator veli palatini and tensor veli palatini elevate the soft palate to close off pharyngeal isthmus
Stylo, palato, and salpingopharyngeus elevate the walls of the pharynx. Suprahyoid muscles elevate the hyoid bone and the larynx under the buldge of the tongue, which flexes the epiglottis back over laryngeal inlet.
Superior, middle, and inferior constrictors contract to move food through oropharynx and laryngopharynx and into the esophagus. Peristalsis then propels it toward stomach.
***If anything goes wrong with any of the above muscles, person ends up with Dyshagia. (difficulty swallowing)
