H&N Flashcards
(409 cards)
1
Q
What are the 4 human tissues?
A
Epithelia
Muscle
Nervous
Connective
2
Q
What are the 4 classifications of bone?
A
Long - femur
Short - fingers, tarsal
Flat - frontal
Irregular - vertebra
3
Q
What are the 3 types of joints?
A
Fibrous - no joint cavity; connected by CT
Cartilaginous - entirely cartilage between; usually lots of movement e.g. fingers
Synovial - synovial fluid lubricates joint, continuous with periosteum; lots of movement e.g. H&N, hips
4
Q
What does the medial plane separate the body into?
A
Vertical through midline of body Separates into equal L&R portions Lateral - away from midline Medial - towards midline Intermediate - between medial and lateral
5
Q
How is the body separated into anterior and posterior?
A
Coronal plane
Anterior - towards front
Posterior - towards back
6
Q
What does the transverse plane separate the body into?
A
Superior - above
Inferior - below
7
Q
Define proximal and distal
A
Proximal - close to P.O.O.
Distal - far from P.O.O.
8
Q
Define superficial and deep
A
Superficial - near/on surface
Deep - more internal
9
Q
What are the 2 surfaces of the hand called?
A
Palmer - palm
Dorsal - back
10
Q
What are the 2 surfaces of the feet called?
A
Plantar - sole
Dorsal - top
11
Q
What is meant by ipsilateral?
A
On the same side of median plane
12
Q
What is meant by contralateral?
A
On opposite sides of median plane
13
Q
Define flexion and extension
A
Flexion - towards P.O.O.
Extension - away from P.O.O.
14
Q
Define abduction and adduction
A
Abduction - away from body
Adduction - towards body
15
Q
What are medial and lateral rotations?
A
Medial - towards midline
Lateral - away from midline
16
Q
What is circumduction?
A
Movement in circular manner
17
Q
Define protraction and retraction
A
Protraction - move forward
Retraction - move back
18
Q
Define inversion and eversion
A
Inversion - big toe towards midline
Eversion - sole away from midline
19
Q
Define pronation and supination
A
Pronation - roll of foot inwards, arch flattening
Supination - outward roll of foot
20
Q
What is opposition of thumb?
A
Turning and rotating of thumb to touch each fingertip
21
Q
What are surface markings?
A
External, visual anatomical features
22
Q
What is the atlas?
A
FIRST of the cervical vertebrae
Does not have a vertebral body
23
Q
What is the axis?
A
SECOND cervical vertebrae
24
Q
What are the clavicle?
A
Collar bones
25
What are the scapula?
Shoulder blades
26
Describe a hinge joint
Synovial joint where 2 or more bones can only move along one axis to flex or extend
27
Describe a ball and socket joint
Synovial joint in which ball shaped surface of bone fits into cup like depression in another bone
Allows movement around indefinite number of axes
28
What is the name of the opening to the ear canal?
External auditory meatus
29
What are the 4 main sutures?
Coronal - frontal and parietal
Sagittal - parietals
Lambdoid - parietals and occipital
Squamous - parietal and temporal
30
What is Pterion and why is it important?
Join of frontal, parietal, temporal and sphenoid bones
| Weakest part of skull, traumatic blow may rupture meddle meningeal artery causing epidural haematoma
31
What are fontanelles and why are they important?
Unossified remnants of fibrous membranes between fetal bones
| Allow for rapid stretching and deformation of developing skull
32
What are foremen and notches?
Holes in bone where blood vessels and nerves enter, incomplete holes called notches
Supraorbital (frontal), infraorbital (maxilla), mental (mandible)
33
What bones make the hard palate?
Maxilla - palatine process
| Palatine - horizontal plate
34
What 7 bones make the orbital cavity?
Many Friendly Zebras Enjoy Lazy Summer Picnics
1. Frontal
2. Maxilla
3. Zygomatic
4. Lacrimal
5. Ethmoid
6. Sphenoid
7. Palatine
35
What 7 bones make the nasal cavity?
1. Nasal
2. Frontal
3. Ethmoid
4. Sphenoid
5. Maxilla
6. Lacrimal
7. Vomer
36
What 14 bones make the facial bones?
Virgil Can Not Make My Pet Zebra Laugh
1. Zygomatics
2. Maxillas
3. Nasals
4. Lacrimals
5. Vomer
6. Palatines
7. Inferior conchae
8. Mandible
37
What are the 8 bones of the neurocranium?
PEST OF 6
1. Frontal
2. Parietal (paired)
3. Temporal (paired)
4. Occipital
5. Sphenoid
6. Ethmoid
38
What 7 bones form the base of the skull?
1. Maxilla
2. Palatine
3. Zygomatic
4. Temporal
5. Vomer
6. Temporal
7. Sphenoid
39
What is the foramen magnum?
Large forum that connects brain to spinal cord
40
What are nuchal lines?
Protuberances in occipital bone due to muscle attachment
41
What bones make up the anterior cranial fossa?
1. Frontal
2. Ethmoid
3. Sphenoid
42
What is CSF rhinorrhoea?
Drainage of CSF though the nose
43
What 2 bones make up the middle crania fossa?
Sphenoid - greater wing
| Temporal
44
What are optic chiasma?
Optical nerves cross over, cause a depression
45
What is CSF otorrhea?
CSF leaks out ear caused by blow to internal acoustic meatus
46
What 2 bones make the posterior crania fossa?
Parietal bone
| Occipital
47
What are the 4 paranasal sinuses?
1. Frontal
2. Ethmoidal air cells
3. Sphenoid
4. Maxillary
48
What 6 bones make the nasal cavity?
1. Sphenoid
2. Palatine
3. Maxillary
4. Nasal
5. Inferior nasal concha
6. Ethmoid
49
What are the differences between fetal skull and adult skull?
```
More bones
Mandible, frontal infused
At birth, connected by fontanelles
Little space between oral cavity and orbital
Mandible is flat
No processes or prominences
Larger cranial structure, smaller facial
```
50
What are the 4 fontanelles?
Anterio
Posterior
Mastoid
Sphenoid
51
What are the 4 functions of the vertebral column?
Protect spinal cords
Permit movement
Site of muscle attachment
Transmits weight of trunk to lower limbs
52
What are the 26 vertebrae?
Cervical - 7
Thoracic - 12
Lumbar - 5
Sacrum and coccyx - 5 (fused so count as 1)
53
What are the 2 naturally occurring curves in the vertebral column?
Lordotic - lumbar region
| Kyphotic - upper thoracic, lower cervical
54
Describe lumbar lordosis and the symptoms
Exaggeration of lumbar curve
Associated w/ weakened abdominal muscles
Lower back pain due to weight being focused in single region
Prevalent in gymnasts, swimmers
55
Describe thoracic kyphosis
Exaggeration of thoracic curve
Occurs more frequently than lordosis
Vertebra becomes wedge shaped
Causes hunch back, pain due to muscles being in constant contraction, weight is not transmitted evenly
56
What is scoliosis and its symptoms?
Lateral deviation of spinal column
C or S shaped
Involved thoracic and/or lumbar
Repeated unilateral loading
Associated w disease, leg length abnormalities, muscular imbalances
57
What are the functions of vertebral disks?
Shock absorbers
Bear and distribute motion in vertebral segment
Withstand compression from torsional and bending loads
58
What happens to the intervertebral disks with age?
Integrity dec., lose ability to retain water, dry out thus ability to distribute load across disk changes
59
Describe a herniated intervertebral disk
NP provides out from between vertebrae
| Nerves impinged by budging lead to numbness and/or pain
60
What are the 6 ligaments of the vertebral column?
Flavour: connects adjacent vertebral arches
Supraspinous and interspinous: connect spinous processes
Ant. Longitudinal: connect to the body, hold in place
Post. Longitudinal: connect to body, prevent excessive movement
Short: connect vertebra to those above, below
61
Describe the C1 vertebra
```
Atlas
Has articulating processes
No body or spinous process
Ant and post. arches, 2 lateral masses
Sup. surfaces of lateral masses articulate with occipital condyles
```
62
Describe the axis
2nd cervical vertebra
Has dens that projects sup. into ant. arch of atlas
Allows pivot for rotation of atlas
63
What are the 2 movements involved in the vertebral column?
Atlanta-Occipital - nodding (yes)
| Atlantoaxial - rotation (no)
64
What is whiplash and how does it happen?
Rapid flexion/extension injury in cervical region
Strains post. ligaments
Can dislocate post. apophyseal joints
C7 likely site for fracture
65
Describe the structure of intervertebral disks
Nucleus pulposus- gel-like mass in centre, allows disk to expand
Annulus fibrosus - layers of fibrocartilaginous material
66
What is the TMJ?
Bilateral synovial joint formed from articulation of mandible and temporal bones
67
What are the 4 suprahyoid muscles?
Geniohyoid
Mylohyoid
Digastric
Stylohyoid
68
What is the function of the suprahyoid muscles?
Elevate or retract hyoid during swallowing
69
Describe the mandibular condyle
Has articulating surface/head covered with hyaline cartilage, narrows down to neck
Lateral and medial poles
Pterygoid fovea - depression left by muscles of mastication
Important growth site - grows forward and down
Articulates in mandibular fossa of temporal bone
70
What are the main features of the mandible?
```
Head/condyle process
Coronoid process
Mandibular notch
Ramus
Angle
Body
```
71
Describe where the mandibular fossa are and the articular surface
R and L temporal bones
| Articular surface covered by dense fibrous articular tissue
72
What are the lateral, medial, ant. and post. boundaries of the mandibular fossa?
Lateral: zygomatic process of temporal bone
Medial: spine of sphenoid bone
Ant: articular eminence
Post: squamotympanic and petrotympanic fissures
73
What is the function of the joint capsule of the TMJ?
Encloses joint like a sleeve, preventing it from slipping out of fossa
74
Describe the location and composition of the joint capsule
Runs post. from temporal bone to mandible condyle infer.
| Made of fibrous tissue
75
What are the superior attachments of the joint capsule?
Area surrounding mandibular fossa and articular eminence
| Extends ant. to ant. slope of articular eminence, post. to squamotympanic fissur
76
What is the attachment site of the joint capsule to the periphery condyle neck and below the medial and lateral poles of condylar neck?
Posterior attachment
77
Describe the temporomandibular ligament
Lateral thickening of the capsule strengthening the capsule laterally
Runs from zygomatic process of temporal bone to lateral surface of mandibular neck
78
What is the articulating dick?
Dense fibrous tissue lying inside joint capsule dividing joint cavity into sup. and infer. compartments allowing for separate movement in each compartment
79
Describe the location and anatomy of the articulating disk
Prominent post. thickening, less prominent ant. thickening
| Lies between condyle and mandibular fossa
80
What are the 2 accessory ligaments of the temporomandibular joint?
Stylomandibular: styloid process to angle of mandible
Sphenomandibular: spine of sphenoid to lingula
81
What are the 5 movements of the TMJ?
```
Depression
Elevation
Retraction
Protrusion
Lateral chewing
```
82
What nerve supplies the TMJ?
Sensory division of auriculotemporal nerve
83
What 2 arteries supply the TMJ?
Superficial temporal artery
| Small contribution from maxillary artery - supplies the ant. aspect of TMJ
84
How is TMJ dysfunction usually detected?
Pain and clicking/popping sound
85
What is arthritis?
Joint inflammation resulting in breakdown of articular cartilage
86
How can arthritis be caused?
Age - primary degenerative
| Abnormal function - 2ndary degenerative
87
What can cause 2ndary arthritis?
Bruxism - grinding teeth, stress on TMJ
| Malocclusion - X-bite; mandibular teeth enclose maxillary teeth
88
Describe internal disk derangement
Articulating disk doesn't move in sync with condyle
| Fibres pull disk through joint causing popping sound
89
Describe dislocation of the TMJ
Head of condyle comes out of mandibular fossa
| Can be caused by excessive pressure on mandible such as extraction, big yawn or by trauma
90
When and where do the branchial arches form?
Week 4
Development of frontal prominence forms stomodeum (primitive oral cavity) below which first branchial arch (mandibular arch) forms
91
Structurally, what do the arches do?
Separate stomodeum from developing heart
92
Describe the structure of the branchial arches
Ectoderm - lines outside
Endoderm - lines inside
Mesenchymal tissue - core
Each has own nerve, blood, muscle and cartilage
Nerve and blood supply structures formed
93
Describe branchial grooves and pouches
Groove: ectodermal cleft between adjacent arches
Pouch: endodermal outpocketing from rostral foregut
94
What is the branchial membrane?
Site of contact between groove and pouch
95
Describe the mandibular arch
Forms the face
Has mandible and maxillary processes
Surrounds stomodeum
96
What is the stomodeum?
Depression between brain and pericardium in embryo which is primitive oral and nasal cavity
Formed by ectoderm, contacts endoderm at oropharyngeal membrane
97
What is the palatoglossal arch?
Physical remnant of branchial arches
| Site of the oropharyngeal membrane separating oral cavity and pharynx
98
What are the cartilages of the mandibular arch?
Malleus
Incus
Ant. ligament of malleus
Sphenomandibular ligament
99
The stapes, styloid process, stylohyoid ligament and lesser horn and upper 1/2 body of hyoid bone are the cartilages of which arch?
2nd - hyoid arch
100
The 3rd arch has what cartilages,
Greater horn and lower 1/2 body of hyoid bone
101
The 4 and 6 arches have what cartilage?
Cartilages of pharynx
102
What are the derivatives of the pouch of each arch?
1. Tubotympanic recess - auditory tube, tympanic cavity
2. Lining (crypts of palatine tonsils)
3. Inf. parathyroid glands and thymus
4. Sup. parathyroid glands and C-cells (calcitonin)
103
The groove of which arch is the only one to form structures in adults and what does it form?
Mandibular
Groove - external auditory meatus
Membrane - tympanic membrane
Pouch - auditory tube
104
What does the face develop from? Name them
5 primordia
Frontonasal prominence - forehead, bridge of nose
2 maxillary prominences - cheeks, upper jaw
2 mandibular prominences - chin, lower jaw
105
What are nasal placodes?
Ectodermal thickenings on frontonasal prominence
106
How and when do the maxillary prominences grow?
Week 5
Ventrally (down)
Medically (toward midline)
107
How and when do nasal pits form?
Week 6
| Ectoderm in centre of each nasal placode invaginates
108
What does the formation of nasal pits do?
Divides frontonasal prominence into lateral and medial nasal processes on each side of embryonic face
109
Describe the growth of the face in week 6
Medial nasal processes grow medially, fuse in middle forming intermaxillary process
Maxillary prominences grow, fuse with intermaxillary process forming philtrum and primary palate
110
What can happen if the medial nasal prominences don't fuse?
Lead to formation of bifid nose
111
How is the primary palate formed?
From internal swelling of intermaxillary process
112
How does the 2ndary palate form?
From 2 lateral palatine shelves
Develop as internal projection of maxillary prominences
Shelves grow down on either side of tongue from maxillary prominences while nasal septum grows down from base of skull
When tongue descends into throat palatine shelves rotate upward
113
Where do the palatine shelves fuse and with what?
At midline with nasal septum
114
How does a cleft lip occur?
Failure of maxillary prominences to fuse with intermaxillary process
115
How can a cleft lip be restored?
Using nasal retainer
| Maintains shape of nasal passage after surgery, helps mound and approximate parts of cleft before surgery
116
What is a X-bite?
Abnormal occlusion in which mandibular teeth enclose the maxillary
117
How does a cleft palate occur?
Failure of palatine shelves to fuse OR
| tongue too large or oral cavity too small for palatine shelves to rotate up and fuse
118
What is Meckel's cartilage?
Cartilage of 1st branchial arch associated with formation of mandible
119
Describe the growth of the mandible in week 6
Meckel's cartilage develops rod surrounded by fibrocellular capsule
2 cartilages don't meet, separated by symphysis
On lateral aspect of symphysis condensation of mesenchymal forms
120
What happens to the mandible in week 7?
Intramembranous ossification beings in mesenchyme, spreads ant. and post. to form bone
Ant. to midline of developing jaw, don't fuse forms mandibular symphysis
121
What are the 3 secondary growth cartilages that influence growth of mandible until birth?
Condylar
Coronoid
Symphyseal
122
Describe the function of the condylar cartilage
Week 12
Developing ramus by endochondral ossification
Thick layer persists at birth on condylar head providing mechanism for post-natal growth of ramus
123
Describe the coronoid cartilage
Active at 4 months, disappears before birth
124
Describe the symphyseal growth cartilage
Appear in CT at ends of Meckel's cartilage
| Disappears 12 months after birth
125
Name the 2 parts of the tongue and describe the tongues development
During week 4
Localised proliferation of mesenchyme results in formation of several swellings on floor of oral cavity
```
Oral part (ant 2/3): fusion of lateral lingual swellings and tuberculum inpar
Pharyngeal part (post 1/3): from copula and hypobranchial eminence
```
126
Where do the muscles and mucosa of the tongue develop?
Muscle: occipital somites
Mucosa: endoderm of pharyngeal floor
127
Where does the mucosa of the 2 parts of the tongue develop?
Oral (ant 2/3): distal tongue buds of 1st branchial arch
| Pharyngeal (post 1/3): overgrowth of 2nd arch by hypobranchial eminence of 3+4 arches
128
What is the terminal sulcus?
Boundary between 1st and 3rd arch mucosa
129
Which common carotid artery arises directly from the aortic arch?
The L carotid artery
130
Where does the R common carotid artery arise?
From the brachiocephalic trunk that divides into R carotid and subclavian
131
What are the 2 branches of the carotid arteries?
External - H&N
| Internal - cranial
132
What is the carotid sheath?
Fibrous CT enclosing: carotid artery, IJV, vagus nerve and lymph nodes
133
What are the 7 branches of the external CA?
Some Like Fucking Others Prefer S&M
1. Sup. thyroid
2. Lingual
3. Facial
4. Occipital
5. Post. auricular
6. Superficial temporal
7. Maxillary
134
Describe the superficial temporal artery
Arises ant. to ext. auditory meatus (EAM), deep to parotid
Many branches to scalp
Transverse facial artery above parotid duct
135
What branch of the external CAs arises behind angle of mandible and supplies deep facial structures?
Maxillary
136
What are the 3 branches of the maxillary A?
Infraorbital
Posterior superior alveolar
Inferior alveolar
137
Describe the infraorbital A
Branches to ant. and middle sup. alveolar
| Ant. supplies upper incisors, canines, maxillary sinus
138
Describe the post. sup. alveolar A
Distributes to maxillary molar and premolars teeth and gingiva, lining of maxillary sinus and gums
139
Describe the infer. alveolar A
Descends close to medial surface of ramus to mandibular foreman
Has incisor, mental, lingual and mylohyoid branches
140
What branch of external CA arises from the ant. side of the CA?
Facial
141
Describe the facial A
Very tortuous and winding
Courses medially to mandible then ant.
Site of facial pulse
142
What are the 3 branches of the facial A?
Sup. and inf. labial A: upper and lower lips
| Angular A: nose, angle of eye
143
Where does the lingual artery arise?
Ant. of external CA at level of hyoid bone
144
What are the 4 branches of the lingual A and what do they supply?
1. Dorsal lingual
2. Deep lingual
3. Sublingual
4. Suprahyoid
Sully tissues sup. to hyoid bone: suprahyoid muscles, floor of mouth, tongue
145
Describe the entry of the internal CA to the cranium
Through carotid canal passing through cavernous sinus
146
What is the cavernous sinus?
Thin walled vein where blood pools and is drained
| Has CNs 3,4,51,52,6 running through
147
What are the 3 cranial cavity As?
Internal CA
Vertebral
Middle meningeal
148
Describe the internal CA
Enters through carotid canal
2 branches:
Supraorbital - to scalp, above orbit
Supratrochlear - medial of supraorbital, above trochlear
149
Describe the vertebral A
Branches from subclavian, enters through foramen magnum
150
Describe the middle meningeal
From maxillary A of external CA, enters through spinosum
| Courses outside dura, supplies calvarium
151
What can damage to the middle meningeal A lead to?
Tearing of A resulting in epidural haematoma - pooling of blood between dura and bone inc. pressure
152
What is the circle of Willis?
Cerebral arterial circle supplied by internal CA, post. by basilar and vertebral A
Branches to ant. middle and post cerebral
Provides uninterrupted, continuous blood supply to brain even if one A is blocked
153
What are the boundaries of the scalp?
Ant.: sup. orbital margin
Post.: sup. nuchal line
Laterally: zygomatic arch
154
What are the 5 layers of the scalp?
```
S - skin
C - CT
A - aponeurosis
L - loose areolar tissue
P - pericranium
```
155
Describe the skin layer of the scalp
Outer most layer
Contains hair, sebaceous and sweat glands
Blockage of glands leads to dryness and dandruff
156
Describe the CT layer of scalp
Dense network of fibro-fatty tissue
Connects skin with aponeurosis
Large blood vessels and nerves
Injury to scalp results in vessels being unable to contract so profuse bleeding which can cause haematoma causing pain
157
Describe the aponeurosis layer of scalp
Epicranius muscle and aponeurosis - raises eyebrows and causes horizontal wrinkles of forehead
Continual contraction results in headaches
Tightly attached to CT
158
Describe the pericranium
Periosteum of skull
| Continuous with endosteum at sutures
159
What are the 3 meninges of the cranium?
Cerebral dural mater
Cerebral pia mater
Cerebral arachnoid mater
160
Describe the dura mater
Thick, dense inelastic membrane
| 2 layers: inner/meningeal and outer/endosteal
161
What are the 4 folds of the dura mater?
Cerebri falx
Cerebri tentorium
Cerebelli falx
Diaphragma sellae
162
Describe the cerebri falx
Separates cerebral hemispheres
| Attaches ant. to crista galli of ethmoid; post. blends into cerebri tentorium
163
Describe the cerebri tentorium
Roof of post. cranial fossa
164
Describe the cerebelli falx
Between cerebellar hemispheres
| Along post. wall of post. cranial fossa
165
Describe the diaphragma sella
Fold Oliver sella turcica
166
What are the 3 falx cerebri sinuses?
Sup. sagittal: follows sagittal suture ant. from falx cerebri post.
Inf. sagittal
Straight: connects inf. to sup. at confluence
167
What are the sinuses of the falx cerebelli?
Trans: transverse along endosteal
Sigmoid: drains venous blood into IJV
168
Describe the cavernous sinuses
Lies bilaterally on either side of sella turcica
Internal CA and abducent nerve run through
Oculomotor, trochlear, ophthalmic and maxillary of trigeminal lie in lateral wall
169
Where are the sup. and inf. petrosal sinuses?
Petrous part of temporal bone
170
Describe the blood flow in dural sinus
Sup. sagittal drains directly to confluence
Inf. sagittal drains to confluence through straight
Confluence drains to transverse
Cavernous drains to sup. and inf. petrosal
Sup. drains into transverse
Inf. drains directly to IJV
Transverse drains to sigmoid
Sigmoid drains to IJV
171
What is the facial vein made up of?
Supraorbital and supratrochlear veins: collect blood from forehead and supraorbital regions
172
How does the facial vein communicate with cavernous sinus?
Through ophthalmic vein via supraorbital fissure
173
What happens to the facial vein as it descends?
Joined by: deep facial, ptyergoid, retromandibular to form common facial vein that drains to IJV
174
Where does the deep facial vein join?
Angle of mouth bringing pytergoid drainage
175
What is the pytergoid plexus?
Network of veins behind ramus
176
Describe the retromandibular vein
Made of maxillary and superficial temporal veins
Passes through parotid gland
Ant: joins facial vein
Post: joins post. auricular vein to form EJV
177
Where is the maxillary vein located?
Adjacent to sphenomandibular ligament
178
What is the function of the lymphatic system?
Drain excess interstitial fluid
Immune response
Transport dietary lipids and lipid soluble vits
179
What are the 5 regional groups of the lymphatic system?
1. Post of head
2. Ant of head
3. Beneath mandible
4. Along superficial jugular veins
5. Deep
180
The occipital and mastoid LNs are part of which LN region?
Post part of head
181
Describe the post head LNs
Occipital: over occipital bone at apex of occipital protuberance
Afferent vessels: collect at back of scalp
Efferent: DCLN
Mastoid: over lateral surface of mastoid process
Afferent: scalp above auricle, post. med. auricle, post. wall of EAM
Efferent: DCLN
182
Describe the ant. head LN
Parotid: on/in parotid gland
Afferent: scalp above parotid, lat. surface of auricle, ant. wall of EAM, lat. eyelids, middle ear
Efferent: DCLN
Buccal: over buccinator muscle, close to facial vein
Afferent: ant. scalp and forehead, ant. part of nose
Efferent: submandibular LN
183
What 2 LNs are found beneath the mandible?
Submandibular: superficial to submandibular salivary gland
Afferent: buccal, upper lip, lat. lower lip, frontal, max. and ethmoidal air sinuses, upper and lower teeth, gingival (except ant.), floor of mouth
Efferent: unknown
Submental
Afferent: tip of tongue, lower incisors and associated gums, central lower lip
Efferent: submandibular LN
184
Describe the ant. cervical and superficial cervical LNs
Along superficial jugular veins
Ant: along course of ant. jugular veins
Afferent: ant. neck
Efferent: DCLN
Superficial
Afferent: angle of mandible, lobule of auricle
Efferent: DCLN
185
What is the DCLN?
Deep cervical lymph node
Chain of LNs along lateral aspect of IJV
Runs from base of skull to root of neck in carotid sheath
Afferent: all lymphatic structures
Efferent: jugular lymph trunk -> lymphatic ducts -> sup. vena cava
186
What are the 3 lobes of the cerebrum?
Frontal
Parietal
Occipital
187
What are the functions of the cerebrum?
```
Sensory and motor
Emotion
Intellectual processes
Auditory
Visual
Speech
```
188
What are the functions of the cerebellum?
Smooth, coordinated movements
| Posture and balance
189
What are the 3 segments of the brain stem?
Midbrain
Pons
Medulla oblongata
190
What is the function of the medulla?
Relays sensory and motor info
| Regulates heartbeat, breathing, vessel dilation
191
What is the function of the pons?
Control breathing
192
What are the 12 cranial nerves?
1. Olfactory
2. Optic
3. Oculomotor
4. Trochlear
5. Trigeminal
6. Abducens
7. Facial
8. Vestibulocochlear
9. Glossopharyngeal
10. Vagus
11. Accessory
12. Hypoglossal
193
Name which nerves are sensory, motor or both
1. Olfactory - Sensory
2. Optic - Sensory
3. Oculomotor - Motor
4. Trochlear - Motor
5. Trigeminal - Both
6. Abducens - Motor
7. Facial - Both
8. Vestibulocochleae - Sensory
9. Glossopharyngeal - Both
10. Vagus - Both
11. Accessory - Motor
12. Hypoglossal - Motor
194
Describe the olfactory nerve
Travels up through cribriform plate of ethmoid bone and synapses in olfactory bulb
Shortest course of all nerves
Terminates in sensory receptors responsible for smell
195
What is anosmia, how can it arise and what are clinical tests for it?
Partial/whole loss of smell
Basal skull fracture - cribriform plate of ethmoid
Chronic nasal inflammation - medication can damage too
Tumour of olfactory region
Ask to identify common smells
196
Describe the optic nerve
Originates in diencephalon, passes through skull at optic foreman in sphenoid bone, terminates in retina
197
What are optic chiasma?
Crossing over of optic nerve fibres
Fibres from med. half cross midline, enter optic tract in opp. side
Fibres from lat. half pass post. in optic tract of same side
198
Where do nerves in the optic tract synapse?
Synapse in visual area of thalamus
| Run post. terminate in visual cortex
199
What do rod and cone cells sense?
Rod: dim light, high signal amplification
Cone: colour
200
Describe the oculomotor nerve
From ant. of midbrain, runs through cavernous sinus, enters orbit through sup. orbital fissure
201
What muscles does the oculomotor nerve supply?
Muscles controlling eye movement:
Ciliary ganglion: control ciliary muscle which controls size of lens
Med. and sup. rectus
Levator palpebrae superioris - eyelid
202
What is the effect of damage to the oculomotor nerve and can this be tested?
Effects: drooping eyelid, dilated pupil, double vision
Test: differences in pupil size, pupillary response to light, eye tracking (rectus muscle function)
203
Describe the trochlear
From post. midbrain, enters cavernous sinus enters orbit through sup. orbital fissure
204
What muscle does the trochlear supply?
Sup. oblique muscle function of eye movement
205
What is the effect of damage to the trochlear?
Double vision, tilt head towards side effected
Test: ability to rotate eye inferolaterally (inf. and lat.)
206
Describe the trigeminal nerve
Larger CN
From ant. pons
Sensory root gives off branches V1 (ophthalmic sensory), V2 (maxillary sensory), V3 (mandible sensomotor)
207
What is the function of the trigeminal?
Sensory: tactile, proprioception, nociceptive afference of face and mouth
Motor: muscles of mastication, tensor tympani, tensor veli palatini, mylohyoid, ant. belly of digastric
208
Describe the V1 nerve
Ophthalmic - sensory
Leaves skull through sup. orbital fissure to enter orbital cavity
209
What are the 3 branches of the ophthalmic nerve?
Forever Losing Notes
1. Frontal: supratrochlear, supraorbital
2. Lacrimal - runs ant., to lacrimal gland
3. Nasociliary - angle of nose
210
Describe the maxillary branch of the trigeminal nerve
Leave through foramen rotundum
211
What are the 4 branches of V2?
Infraorbital - skin of middle face, labial mucosa
Zygomatic
Sup. alveolar: post.(molars, gingivae, sinus), mid.(premolars, cheek, gums), ant.(canine, incisor, lat. wall + floor of nose)
Pyterygopalatine
212
Describe the mandibular branch of trigeminal
Leaves through foramen ovale enter infratemporal fossa exits as mental nerve through mandibular foramen
213
What are the 5 branches of V3?
Always Believe Lots (Info Actually) Matters
1. Auriculotemporal: sensory to auricle temporal regions (EAM, IJV, scalp), secretomotor to parotid gland
2. Buccal
3. Lingual: floor of mouth, ant. 2/3 of tongue
4. Inf. alveolar: mandible
5. Masticatory muscles
214
What is trigeminal neuralgia?
Uncommon cranial nerve disorder resulting in abrupt, excruciating pain in face
215
What are some therapies of trigeminal neuralgia?
Meditative: antiseizure, muscle relaxant
Conservative: nerve block
Surgery: microvascular decompression, radiofrequency rhizotomy, gamma-knife radio surgery, glycerol rhizotomy
216
Describe the abducens nerve
From hind brain b/w pons and medulla, exits through cavernous sinus to sup. orbital fissure to supply lateral rectus muscle
217
What is the effect of damage to the abducens and how can this be tested?
Inability to rotate eye laterally, at rest eye moves medially
Test: lateral movement of eye
218
What 3 nerves supply the eye?
| LR6 SO4 3
3. Oculomotor: eyelid and pupillary constriction
4. Trochlear: sup. oblique muscle; inferolateral eye movement
6. Abducens: lateral rectus muscle; lateral eye movement
219
Describe the facial nerve
Runs from bind brain through IAM forming geniculate nucleus, runs further, emerges through stylomastoid foramen but before gives off stapedius nerve, greater petrosal, chorda tympani before running to parotid gland
220
What is the function of the facial nerve?
Facial expression - motor
| Sense of taste - sensory
221
What is the effect of damage to the facial nerve and how can it be tested?
Inability to control facial muscles, distorted sense of taste, dry eyes
Test: motor functions (close eyes, raise brows, smile, whistle); taste
222
What are the 5 branches of the facial nerve outside the facial canal?
Two Zebras Behind My Car
1. Temporal
2. Zygomatic
3. Buccal
4. Mandibular - lower lip and chin
5. Cervical
223
What are the 3 branches of the facial nerve inside the facial canal?
Come Great Steed
1. Chorda tympani: joins lingual of mandibular, ant. 2/3 tongue
2. Greater petrosal: lacrimal, ant. palate
3. Stapedius: to stapedius muscle
224
Describe the glossopharyngeal
From medulla exits through jugular foramen
Motor innervates stylopharyngeus muscle
Sensory to oropharynx and post. tongue
225
Describe the vestibulocochlear
From hind brain exits through IAM gives off
Vestibular: balance; connects to semicircular canals, position relative to space
Cochlear: sound; vibrations from hairs
226
What is the function of the vestibulocochlear and what are the effects and tests for damage?
Function: balance and equilibrium
Damage: deafness, dizziness, nausea, loss of balance
Test: hearing, balance, walk in straight line
227
What are the functions of the glossopharyngeal?
Swallowing, salivation, gagging (motor); touch, pressure, taste, pain of tongue, pharynx, outer ear
228
What is the effect of damage to the glossopharyngeal and how is this tested?
difficulty swallowing
Test: gag reflex, swallowing, coughing
229
Describe the vagus nerve
From medulla exits through jugular foramen
230
What do the sensory fibres of the vagus supply?
EAM and tympanic membrane
231
What does the motor fibres of vagus supply?
Muscles of larynx, respiratory passages, lungs, heart, oesophagus, stomach, SI, most of large intestine and gallbladder
232
What is the function of the vagus nerve?
Swallowing; taste; speech; respiratory, CV, GI regulation
| Sensations of hunger, fullness, intestinal discomfort
233
What are the effects of damage to the vagus?
Hoarseness/loss of voice, impaired swallowing and GI motility
234
Describe the accessory nerve?
From medulla and spinal cord emerge through jugular foramen
235
What does the accessory nerve supply?
Trapezius (neck upright) and sternocleidomastoid (lat. move. of neck) muscles
236
What are the general functions of the accessory nerve?
H&N, shoulder movement
237
What are the effects of damage to accessory nerve and how to test for this?
Impaired movement of H&N + shoulders; paralysis of sternocleidomastoid
Test: rotate head, shrug shoulders against resistance
238
What is the function of the hypoglossal?
Innervates tongue muscles: movements of speech, swallowing, food manipulation
239
Describe the hypoglossal
From medulla, exits through hypoglossal canal
240
What are the effects of damage to the hypoglossal and how is this tested?
Difficulty in speech and swallowing, atrophy of tongue, inability to protrude tongue
Test: tongue function
241
Forever Losing Notes
V1 - ophthalmic branches
Frontal
Lacrimal
Nasociliary
242
Always Believe Lots Info Actually Matters
```
V3 mandibular branches
Auriculotemporal
Buccal
Lingual
Inf. alveolar
Masticatory muscles
```
243
Two Zebras Behind My Car
```
Branches of facial nerve outside facial canal
Temporal
Zygomatic
Buccal
Mandibular
Cervical
```
244
Come Great Steed
Branches of facial nerve inside facial canal
Chorda tympani
Greater petrosal
Stapedius muscles
245
Standing Room Only
Exits of V1-3
Superior orbital fissure
Foramen rotundum
Foramen ovale
246
O TOM CAT
Structures in cavernous sinus
Oculomotor
Trochlear
Ophthalmic - V1
Maxillary - V2
Carotid artery
Abducens
Trochlear
247
Live Frankly To See Absolutely No Insult
Nerves passing through sup. orbital fissure
```
Lacrimal - V1
Frontal - V1
Trochlear
Sup. of oculomotor
Abducens
Nasociliary - V1
Inf. oculomotor
```
248
LR6 SO4 3
Lateral rectus - VI abducens
Sup. oblique - IV trochlear
Other 4 (sup., med. rectus, levator palpebrae superioris, ciliary ganglion) - III oculomotor
249
My Ass Meets The Toilet
Muscles innervated by V3
```
Mylohyoid
Ant. belly of digastric
Muscles of mastication
Tensor tympani
Tensor veli palatini
```
250
Some Like Fucking, Others Prefer S and M
```
Sup. thyroid
Lingual
Facial
Occipital
Post. auricular
Maxillary
Superficial temporal
```
251
I See 10 CCs in the IV
Carotid sheath contents
I See = Internal Carotid
10 = X Vagus
CC = Common Carotid
IV = Internal Jugular Vein
252
What muscles make up the occipitofrontalis muscles?
Frontalis
| Occipitals
253
Describe the frontalis muscle
Origin: galea aponeurotica
Insertion: skin near eyebrows, root of nose
Action: raise eyebrows, wrinkle forehead
254
Describe the occipitals muscle
Origin: occipital bone
Insertion: galea aponeurotica
Action: scalp backwards
255
Describe the temporalis muscle
Origin: temporal fossa between inf. temporal line
Insertion: med. and ant. aspect of coronoid process of mandible
Action: elevate mandible (close jaw)
256
Describe the masseter muscle
Origin: ant. 2/3 of zygomatic arch and zygomatic process of maxilla
Insertion: lat. surface of angle and lower ramus
Action: elevate mandible - forced closure
257
Describe the auricularis muscle
Origin: galea aponeurotica
Insertion: cartilage of auricle
Action: ear position
258
Describe the buccinator
Origin: alveolar portion of maxilla and mandible
Insertion: orbicularis oris
Action: flatten cheek, retract angle of mouth
259
Describe the orbicularis oculi
Origin: med. orbital margin and lacrimal sac
Insertion: lid of eye
Action: close eye, aid passage and drainage of tears
260
Describe the orbicularis oris
Origin: ant. surface of maxilla and mandible, angle of mouth
Insertion: margin of lips
Action: narrows orifice of mouth, purses lips
261
Describe the zygomaticus major
Origin: frontal process of mandible
Insertion: angle of mouth
Action: lifts angle sup. and lat.
262
Describe the zygomaticus minor
Origin: lat. infra-orbital margin
Insertion: skin and muscle of upper lip
Action: draw skin between philtrum and lip corner obliquely upwards and lat.
263
What are the 3 major extrinsic tongue muscles?
Genioglossus
Hyoglossus
Styloglossus
264
Describe the genioglossus
Origin: sup. mental spine on post. surface of symphysis menti
Insertion: central mass of tongue and mucous membrane
Action: protracts tongue
265
Describe the hyglossus
Origin: sup. border of greater cornu of hyoid bone
Insertion: lat. sides of tongue
Action: depress tongue
266
Describe the styloglossus
Origin: ant. surface and apex of styloid process and upper 1/4 of stylohyoid process
Insertion: superolateral sides of tongue
Action: elevate, retract tongue, aids initiation of swallowing
267
What 4 muscles make up the suprahyoid?
Digastric, stylohyoid, mylohyoid, geniohyoid
268
What are the functions of the suprahyoid muscles?
Anchor tongue
Elevate hyoid
More larynx sup. during swallowing
269
What 4 muscles make up the infrahyoid muscles?
Omohyoid
Sternohyoid
Sternothyroid
Thyrohyoid
270
What is the function of the infrahyoid muscles?
Depress hyoid
271
Describe the platysma
Origin: skin over lower neck and upper lat. chest
Insertion: inf. border of mandible, skin over lower face and angle of mouth
Action: depress and wrinkle skin of lower face and mouth, aids forced depression of mandible
272
Describe the sternocleidomastoid
Origin: ant. and sup. manubrium and sup. medial 1/3 of clavicle
Insertion: mastoid process
Action: flex and lat. rotate cervical spine, extend neck when partially extended, protract head (together)
273
Describe the post. neck triangle
Boundaries: ant: sternocleidomastoid; post: trapezius; inf. clavicle
Contents
Nerves: accessory, cranial plexus, phrenic, branchial plexus
Artery: subclavian
Vein: external jugular
274
Describe the ant. neck triangle
Boundaries: ant: midline; post: sternocleidomastoid; sup: inf. margin of mandible
```
Contents
Glands: submandibular
Muscles: supra and infra hyoid
Artery: carotid
Vein: internal and external jugular vein
Nerve: accessory
```
275
Describe the masseter muscle
Thick, somewhat quadrilateral muscle
Deep and superficial heads
Action: elevate and protrude mandible (close), deep fibres retrude
Innervation: V3 through masseteric
Blood: masseteric artery from maxillary artery
276
Describe the superficial head of the masseter
Larger
Origin: ant. 2/3 lower border of zygomatic arch
Insertion: fibres down and back into angle and lower 1/2 of ramus
277
Describe the deep head of the masseter muscle
Small, more muscular
Origin: from post. 1/3 lower border and whole med. surface of zygomatic arch
Insertion: fibres down and forward to upper 1/2 ramus
Relation
Ant: superficial head
Post: parotid gland
278
Describe the origin, insertion and action of the temporalis muscle
Broad, radiating, situated at side of head
Origin: temporal fossa and deep surface of temporal fascia
Insertion: fibres des., converge end in tendon. Passed deep to zygomatic arch, inserted into med surface, apex and ant border of coronoid process and ant border of ramus
Action: ant, middle fibres elevate. Post. retrudes
279
Describe the innervation and blood supply of the frontalis
Innervation: deep temporal branches of mandibular
Blood: deep temporal branches of maxillary artery
280
What are the two heads of the lat. pterygoid muscle?
Sup.
| Inf.
281
Describe the origin of the sup. head
Greater wing of sphenoid bone
282
Describe the origin of the inf. head of lat. pterygoid muscle
Lat. surface of lat. pterygoid plate
283
Describe the action of the lat. pterygoid muscle when functioning alone and together
Together: protrude and depress mandible
Alone: side-side movement of mandible
284
Describe the insertion, innervation and blood supply of the lat. pterygoid
Insertion: fibres back into neck of mandible and articular disk of TMJ
Innervation: ant. division of mandibular nerve through lat. pterygoid nerve
Blood: maxillary artery through pterygoid branch
285
What are the 2 heads of the medial pterygoid muscle?
Superficial
| Deep
286
Describe the origin of the superficial head of the med. pterygoid muscle
Maxillary tuberosity
287
Describe the origin of the deep head of the med. pterygoid muscle
Med. surface of lat. pterygoid plate
288
Describe the action of the med. pterygoid muscle
Elevate and protrude mandible
| Act with lat. pterygoid of same side in rotating mandible
289
Describe the insertion, innervation and blood supply of the med. pterygoid muscle
Insertion: fibres down, back and lat. into med. surface of angle of mandible
Innervation: main trunk of mandibular nerve through nerve to med. pterygoid
Blood: maxillary artery through med. pytergoid artery
290
Describe the action of how the mandible is depressed
1A: muscles pull mandible back
1B: muscles pull mandible down
2: mandible rotates at TMJ
291
What 3 muscles are involved in depressing the mandible?
1. Digastric
2. Mylohyoid
3. Omohyoid
292
What are the 2 regions of the nose?
1. External
| 2. Internal nasal cavity
293
Describe the structure of the external nose
Nostrils separated by nasal septum
| Lat. margin: ala of nose; mobile and rounded
294
What 4 things is the external nose made of?
Nasal bones
Maxillae bone
Frontal bone
Plates of hyaline cartilage
295
Describe the internal nasal cavity
Separated by midline nasal septum
Ant. apertures are nares - open onto inf. surface of nose
Post. apertures are choanae - open into nasopharynx
296
Describe the medial wall of the internal nasal cavity
Nasal septum: vertical in median sagittal plane, separate into R and L nasal cavities
297
What does the nasal septum consist of?
1. Septal cartilage
2. Vertical plate of ethmoid
3. Vomer
298
Describe the floor of the internal nasal cavity
Palatine process of maxilla and horizontal plate of palatine bone forming hard palate
Naris opens ant. into floor
299
Describe the roof of the internal nasal cavity
Cribriform plate of ethmoid
Nasal and frontal bones
Post. by sphenoid bone
300
What are conchae and meatus?
Conchae: 3 curved, long bone projections in breathing passage
Meatus: spaces below each conchae
301
What are the 3 nasal conchae?
1. Sup.
2. Middle
3. Inf.
302
What are the 4 nasal meatus?
1. Spheno-ethmoidal recess (above sup. conchae)
2. Sup.
3. Middle
4. Inf.
303
Describe the innervation of the nasal cavity
Sensory: ophthalmic (V1) and maxillary (V2) of trigeminal
Olfactory: smell; supplies olfactory mucosa in roof of nasal cavity
304
What are the 3 arteries that supply the nasal cavity?
1. Branches of maxillary
2. Septal branch of facial
3. Ethmoidal branches of ophthalmic
305
What is the name for bleeding from the nose?
Epistaxis
306
What are paranasal air sinuses?
Cavities found in the ethmoid, frontal, sphenoid and maxilla bones
307
What are the 3 functions of the paranasal air sinuses?
1. Make skull lighter
2. Resonating chamber for voice
3. Increase SA of nasal mucous membrane (warm air before entering lung)
308
Describe the frontal air sinus
Separated by septum, variable in size
309
What are the 3 ethmoid air sinuses?
1. Ant.
2. Mid.
3. Post.
310
Where is the sphenoid air sinus located?
Body of sphenoid bone
311
What 2 air sinuses do NOT open into the middle meatus?
1. Sphenoidal sinus
| 2. Post. ethmoidal sinus
312
Where does the sphenoidal sinus open into?
Spheno-ethmoidal recess
313
Where does the post. ethmoidal sinus open into?
Sup. meatus
314
Describe the maxillary air sinus
Pyramidal cavity in body of maxilla
| Largest paranasal air sinus
315
What are the boundaries of the maxillary air sinus?
Roof: separates sinus from orbit and lodges infra-orbital nerve and vessels
Floor: formed by alveolar process of maxilla, roots of molars and premolars
316
What is the pharynx?
Musculo-membranous wall that connect mouth and nasal cavity sup. to oesophagus inf.
317
What 5 things is the pharynx composed of?
1. Mucosa
2. Submucosa
3. Pharyngobasilar fascia
4. Muscles: circular and longitudinal
5. Buccopharyngeal fascia
318
What is the buccopharyngeal separated from the prevertebral fascia by?
Retropharyngeal space
319
What is the retropharyngeal space?
Potential space between buccopharyngeal fascia and pre-vertebral fascia containing loose alveolar tissue
320
What does the retropharyngeal space allow for?
Movement of larynx, pharynx, oesophagus, and trachea during swallowing
321
Describe the location of the nasopharynx
Post. to nasal cavity
Inf. to sphenoid bone
Sup. to soft palate
Continuous with nasal cavity via post. nasal aperture
322
What is the function of the uvula?
During swallowing closes nasopharynx
323
What is the pharyngeal tonsil and what is its function?
Collection of lymph nodes
| Prevent spread of infection to nasal cavity
324
Where does the pharyngiotympanic tube open into?
Lat. wall of nasopharynx
325
What is the function of the pharyngiotympanic tube?
Connect middle ear cavity to nasopharynx
Drainage
Equalisation of pressure
326
Where is the oropharynx located?
Post. to OC
327
What is the fauces?
Arch like entrance of OC to oropharynx
328
Describe the path of the oropharynx
Extends inf. from soft palate to epiglottis
329
What is the function of the oropharynx?
Passage of food and air
330
Where are the palatine tonsils and lingual tonsils located?
Palatine: lat. wall of fauces
Lingual: post. surface of tongue
331
Describe the location and path of the laryngopharynx
Post. to epiglottis
| Extends to larynx - continuous with oesophagus
332
What is the function of laryngopharynx?
Passage of food and air
333
What are the 2 muscle types in the pharynx?
Constrictor
| Longitudinal
334
What are the 3 constrictor muscles of the pharynx?
Sup.
Middle
Inf.
335
Describe the constrictor muscles of the pharynx
Extend around pharynx, insert post. into fibrous raphe extending from pharyngeal tubercle on occipital bone to oesophagus
336
What is the phayngobasilar fascia?
Fibrous tissue filling gap between sup. border of sup. constrictor and occipital bone
337
What are the 3 longitudinal muscles of the pharynx?
Stylopharyngeus
Salpingopharyngeus
Palatopharyngeus
338
What is the function of the 3 longitudinal muscles of the pharynx?
Elevate larynx and pharynx during swallowing
339
What is adenoid facies?
Typical facial expression of patient with adenoids - enlarged pharyngeal tonsils causing obstruction of nasal breathing
340
Where does the larynx extend from and what are its boundaries?
Extends from 6th cervical vertebra
Sup. attached to hyoid bone and opens into laryngopharynx
Inf. continuous with trachea
341
What are the 3 functions of the larynx?
1. Provide patent airway
2. Route air and food into proper channels
3. Voice production
342
What are the 6 cartilages of the larynx?
1. Thyroid
2. Cricoid
3. Arytenoid (paired)
4. Cuneiform (paired)
5. Corniculate (paired)
6. Epiglottis
343
Which of the 6 cartilages of the larynx is not hyaline?
Epiglottis
344
Describe the thyroid cartilage
Largest
2 rectangular lamina fuse in midline forming thyroid notch
Forms Adam's apple
Ossified 20-30yo
345
Describe the cricoid cartilage
Strongest
Immediately below thyroid cartilage
Ring shaped - only laryngeal cartilage to completely encircle airway
Joins first tracheal ring inf.
346
Describe the arytenoid cartilage
Articulates with cricoid cartilage via cricoarytenoid joint - allows movement to open/close vocal cords
Processes for attachment of vocal cords
347
Describe the cuneiform and corniculate cartilages
Accessory
| Probably for structural support
348
Describe the epiglottis
Elastic fibrocartilage
Leaf shaped
Cover laryngeal inlet preventing aspiration during swallowing
349
What are intrinsic membranes and ligaments? Name 2
Membranes/ligaments that connect laryngeal cartilages with each other
Quadrangular membrane
Cricothyroid ligament
350
What are extrinsic membranes/ligaments? Name 3
Membranes/ligaments that connect laryngeal cartilages to other structures such as hyoid bone and trachea
Thyrohyoid membrane
Hyo-eppiglottic
Cricotracheal
351
What is cricothyrotomy?
Incision made through the skin and cricothyroid membrane in certain life threatening situations that cause obstruction of airway
352
In what situations might cricothyrotomy be required?
Obstruction by foreign body, angioedema, massive facial trauma
353
What is tracheotomy?
Cut between 1/2 or 2/3 tracheal cartilages to open airway to lungs below obstructed larynx
354
Describe the thyroid gland
Largest endocrine gland
Lobes are cone shaped
Highly vascular
355
What are the functions of the thyroid gland?
Produce thyroid hormones (T..., calcitonin): vital for growth and metabolism
Iodine storage: essential for T3/4 synthesis
356
Describe the function and T3/4 hormone and what it is stimulated by
Inc.: metabolic rate, protein synthesis, energy production
Stimuli: dec. metabolic rate
357
Describe the function of calcitonin and what it is stimulated by
Dec.: blood Ca conc., dec. reabsorption of Ca and P from bone
Stimuli: inc. blood Ca levels
358
Describe the location of the thyroid gland
Ant. and lat. to larynx and trachea
In ant. region of neck
Base located ~4/5 tracheal cartilage
359
Describe the lobes of the thyroid gland
Cone shaped, connected by isthmus
Attached to cricoid cartilage by ligaments
Med. surface adapted to larynx and trachea
360
Describe the isthmus of the thyroid gland
Connect 2 lobes
Occasionally absent
Crosses at ~2-4 tracheal rings
Pyramidal lobe - small projection
361
Describe the blood supply of the thyroid gland
R and L inf. and sup. thyroid arteries
362
Describe the effect thyroid hormones can have on the cardiovascular system
1. Inc. HR
2. Inc. cardiac contraction force
3. Inc. cardiac output
363
Describe the effect thyroid hormones can have on O2 carrying capacity
Inc. O2 dissociation from haemoglobin
364
Describe the effect thyroid hormones can have on intermediary metabolism
Inc. glucose absorption from GIT
| Inc. carb, protein, lipid turnover
365
Describe the effect thyroid hormones can have on the nervous system
Enhance wakefulness and alertness
Enhance memory and learning capacity
Required for normal CNS neuronal development and normal emotional tone
366
Describe the parathyroid glands
Usually 2-4 on each side
Lie on post. surface of thyroid gland
May be embedded within thyroid
Regulate Ca/PO4 levels
367
What are the 6 general components of saliva?
1. Salivary glands: water, electrolytes, small organic molecules
2. Blood and blood derivatives: intra-oral bleeding, gingival cervicular fluid (serum and inflammatory cells)
3. Extrinsic substances: food debris, toothpaste, m/w
4. Fluids: bronchial and nasal secretions
5. Lining cells: epithelial keratin
6. Microbiota
368
What are the 6 general functions of saliva?
1. Protection
2. Buffering
3. Digestion
4. Antimicrobial
5. Maintenance of tooth integrity
6. Taste
369
What 5 factors can affect saliva production,
1. Local disease
2. Systemic disease
3. Medications
4. HandN radiation
5. Chemotherapy
370
What are the 3 major salivary glands?
1. Parotid
2. Submandibular
3. Sublingual
371
Describe the shape and location of the parotid gland
Pyramidal shape
Sup: external auditory meatus, TMJ
Ant: overflows mandible with overlying masseter
Inf: overflows post. belly of digastric
Med: styloid process and muscles separating parotid from IJV, internal carotid artery
372
Describe the blood supply, venous and lymph drainage of the parotid gland
Blood: branches of carotid artery
Venous: retromandibular vein
Lymph: LN within parotid sheath :> DCLN
373
Describe the the parotid capsule
2 capsules: CT capsule, dense fascial capsule of investing layer of deep cervical fascia
374
Describe the parotid duct
Stensen's duct
5cm long
Appears in ant. border of gland
Run ant. and down on masseter
Pierces buccinator
Opens opposite 2nd maxillary molar
375
From superficial to deep list the 4 structures within the parotid gland
1. Facial nerve
2. Retromandibular vein
3. External carotid artery
4. Auriculotemporal nerve - from V3
376
Describe the submandibular gland
Irregular gland with 2 parts: large superficial part, small deep part
377
Describe the location and boundaries of the superficial part of the mandibular gland
Digastric between mylohyoid muscle and body of mandible
Ant: ant. belly of digastric
Post: post. belly of digastric and stylohyoid
Med: mylohyoid
Lat: in contact with submandibular fossa on med. surface of mandible
378
Describe the location and boundaries deep part of the submandibular gland
Superficial to hyoglossus
Med: hyoglossus and styloglossus
Lat: mylohyoid and superficial part of gland
Sup: lingual nerve and submandibular ganglion
Inf: hypoglossal nerve
379
Describe the blood supply, venous and lymph drainage of the submandibular gland
Blood: facial artery
Venous: facial vein
Lymph: submandibular LN, DCLN
380
Describe Whartons duct
Submandibular duct
5cm long
Emerges at ant. end of deep part of gland
Runs forward on hyoglossus and mylohyoid
Crossed by lingual nerve and then opens in floor of mouth at side of frenulum of tongue
381
Describe the sublingual gland
Smallest of major glands
| Beneath oral mucosa, in contact with sublingual fossa in lingual aspect of mandible
382
Describe the blood supply, venous and lymph drainage of the sublingual gland
Blood: sublingual and submental arteries
Venous: sublingual and submental veins
Lymph: submandibular LNs
383
Describe the ducts of rivinus
Sublingual duct
8-20 ducts
Most open directly onto floor of mouth
Some join submandibular duct
384
What are 3 salivary disorders?
1. Sialadenitis: inflammation of glands
2. Submandibular duct obstruction: usually by infection
3. Xerostomia: caries, dry, fissured tongue
385
What are the 3 portions of the tongue?
1. Root: post. 1/3
2. Body: ant. 2/3
3. Apex
386
What are the 5 structures found on the mucous membrane layer of the tongue?
1. Sulcus terminalis
2. Foramen cecum - thyroglossal duct
3. Papillae
4. Lymph nodules
5. Frenulum
387
What are the 4 types of tongue papillae?
1. Filiform
2. Fungiform
3. Foliate
4. Vallate
388
Describe filiform papillae
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Most numerous - ant. 2/3
Tiny, pointed parakeratinised projections
Pink/grey colour
Aid in food handling
Touch sensory nerve endings
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389
Describe fungiform papillae
Tiny, globular and raised red spots
Scattered among filiform
Ant 2/3 and mainly lat. and tip
Taste buds
390
Describe foliate papillae
Lat. margins of tongue
From 3/4 short vertical folds (folia linguae)
Rudimentary in humans
Few taste buds
391
Describe vallate papillae
Circular and large (2mm diameter)
About 12/13 in V-shaped arrow (towards oropharynx)
Each surrounded by circular depression (valley)
Numerous taste buds
Von Ebner minor salivary glands
392
What are the 2 types of tongue muscle?
Intrinsic
| Extrinsic
393
Name the 3 intrinsic tongue muscles
1. Longitudinal
2. Transverse
3. Vertical
394
Name the 4 extrinsic tongue muscles
1. Genioglossus
2. Hyoglossus
3. Styloglossus
4. Palatoglossus
395
What are the 4 movements of the tongue and what muscles are responsible for each?
1. Protrusion: genioglossus
2. Retraction: styloglossus, hyoglossus
3. Depression: hyoglossus, genioglossus
4. Retraction and elevation: styloglossus, palatoglossus
396
Describe the motor innervation of the tongue muscles
All supplied by hypoglossal EXCEPT palatoglossus supplied by pharyngeal plexus
397
Describe the taste sensory innervation of the tongue muscles
Ant. 2/3 by facial nerve via chorda tympani
| Post. 1/3 glossopharyngeal
398
What nerves supply general sensation to the tongue?
Ant. 2/3 lingual from mandibular nerve (V3)
| Post. 1/3 glossopharyngeal
399
Describe the lymph drainage of the tongue
Apex: submental LN
Ant 2/3: submandibular and DCLN
Post. 1/3: DCLN
400
Name 3 clinical conditions affecting the tongue
Hairy tongue: filiform grow long trapping food, OB causing malodour
Glossitis: inflammation of tongue, tongue smooth and painful
Oral cancer: can initiate from foliate papillae
401
Describe acute tonsillitis
Inflammation of the tonsils usually due to infection
Swollen tonsils
Fever
Painful, sore throat
Difficulty swallowing
402
What nerves innervate the maxillary teeth?
1-3: ant. sup. alveolar
4-5: mid. sup. alveolar
6-8: post. sup. alveolar
403
What nerve innervates the mandibular teeth?
Inf. alveolar
404
What nerves innervate the maxillary soft tissue?
Ant., mid., post. sup. alveolar
405
What nerves innervate the mandibular soft tissue?
1-5: mental nerve (branch of inf. alveolar)
| 6-8: buccal
406
What nerves innervate the maxillary palate?
1-3: nasopalatine (branch of V2)
| 4-8: greater palatine (branch V2)
407
What nerve innervates the floor of the mouth?
Lingual
408
Compare infiltration and block LA
Target nerve ends; target main nerve supply
| Localised affect; all sensation downstream lost
409
What are some of the complications that may arise from LA?
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Pain, swelling when injected into muscle
Trauma as can't feel burning/chewing
Facial nerve palsy
Bleeding
Acute infection
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