head and neck Flashcards
(96 cards)
1
Q
foramen rotundum
A
V2 maxillary division of trigeminal
2
Q
foramen ovale
A
V3 mandibular division of trigeminal
3
Q
carotid canal
A
internal carotid artery
4
Q
foramen spinosum
A
middle meningeal artery
5
Q
jugular foramen
A
glossopharyngeal n
vagus n
accessory n
internal jugular vein
6
Q
cribiform plate
A
olfactory nerves
7
Q
optic canal
A
optic nerve
ophthalmic artery
8
Q
superior orbital fissure
A
V1 ophthalmic of trigeminal
oculomotor n
trochlear n
abducent n
superior ophthalmic vein
9
Q
internal acoustic meatus
A
facial n
vestibulocochlear n
10
Q
hypoglossal canal
A
hypoglossal n
11
Q
base of skull fractures / fracture through petrous portion of temporal bone
affects which nerves?
A
presents w cranial nerve palsy
commonly affects facial or vestibulocochlear nerves
12
Q
layers of SCALP
A
skin
connective tissue
aponeurosis (of occipitofrontalis)
loose connective tissue
periosteum
13
Q
classic epidural presentation
A
Loss of consciousness → lucid → deterioration
Brain shock → bleeding → cerebral herniation
14
Q
deep to pterion is ?
A
ant division of middle meningeal artery
15
Q
fracture of pterion leads to?
A
epidural haemorrhage
16
Q
pterion midpoint bw which bones?
A
frontal
parietal
temporal
sphenoid
17
Q
meningeal layers
A
bone / skull
dura mater - periosteal
dura mater - meningeal (has invaginations)
subdural space (potential space)
arachnoid mater
subarachnoid space
pia mater (covers brain)
18
Q
the flax cerebri has ?
A
superior sagittal sinus
inferior sagittal sinus
straight sinus (post)
19
Q
great cerebral vein bw?
A
straight sinus and inferior sagittal sinus
20
Q
cavernous sinus contents:
A
- oculomotor n
- trochlear n
- ophthalmic n
- abducent n
- maxillary n
21
Q
in cavernous sinus thrombosis which nerve is affected first?
A
abducens (closest to ICA)
22
Q
trigeminal nerve innervates which muscles?
A
innervates muscles of mastication + tensor veli palatini, tensor tympani, mylohoid
23
Q
opthalmic n type of innervation?
exits via?
A
purely sensory
exits via superior orbital fissure
24
Q
maxillary type of innerv?
exit?
A
purely sens
exits via foramen rotundum into pterygopalatine fossa
25
mandibular type of inner?
exit?
sens and motor innervation
exits via foremen ovale into infratemporal fossa
26
ophthalmic nerve branches
frontal - divides further to give sens to forehead
lacrimal - sens innervation of lacrimal gland
nasociliary - sensation of cornea + sinuses
27
lacrimal nerve hitchhiker
parasym fibers from facial n synapse at pterygopalatine ganglion and travel with zygomatic branch of V2 then with lacrimal branch
28
nasociliary n hitchhiker
sympathetics from superior cervical ganglion get to the dilator pupillae
29
trigeminal ganglion divided into
3 branches
V1 and V2 go through cavernous sinus then leave the skull
has motor and sensory root
30
maxillary nerve sens innerv
- lower eyelid and its conjunctiva
- inf post portion of nasal cavity
- lateral nose
- cheeks and maxillary sinus
- upper lip, teeth, gingiva and palate
31
maxillary n parasym inner
FIBERS DO NOT ORIGINATE FROM TRIGEMINAL N
- lacrimal gland ( fibers go from V2 zygomatic branch to V1 nasocilary)
- mucous glands of nasal mucosa (nasopalatine and greater palatine)
32
mandibular nerve branches
- auricolotemporal
- buccal
- inf alveolar
- lingual
33
auriculotemporal n innervates?
actually convergence of two separate roots
sup root - sens fibers:
- ant auricle, external acoustic meatus, and tympanic membrane
- lateral temple
inf root - parasym fibers from CN IX
- otic ganglion -> parotid
34
buccal n innervs?
- buccal membranes of the mouth (cheek)
- 2nd and 3rd molar teeth
35
inferior alveolar n innervs?
mylohyoid branch -> motor n to mylohyoid and ant digastric
sens fibers to mandibular teeth
emerges from mental foramen and becomes mental n
36
mental n
sensation to lower lip and chin
37
lingual n
gen sens - ant 2/3 tongue
(chorda tympani travels w lingual + autonom fibers from facial that go through submandibular ganglion to submandibular and sublingual glands)
38
V3 nerve (motor)
muscles of mastication - masseter, med + lat pterygoid, temporalis
- tensor tympani
- tensor veli palatine
- suprahyoid muscles:
- ant belly of digastric (pos innerv by facial n)
- mylohyoid m
39
artery coursing transversely just medial to the neck of the condyle of the mandible is ?
maxillary artery
40
all masseter muscles elevate except?
lateral pterygoids - protract mandible
41
infratemporal fossa bw?
ramus of mandible and wall of pharynx
42
pterygopalatine ganglion in?
pterygopalatine fossa
43
tmj dislocation almost always dislocates ?
anteriorly
44
middle meningeal is a branch of ?
ECA - maxillary
45
lingual and chorda tympani will link up in ?
infratemporal fossa somewhere
46
contents of the parotid gland
superficial to deep
- facial n - 5 terminal branch
- retromandibular vein
- external carotid artery
- lymph nodes
47
innervation of the parotid gland
pregang: lesser petrosal n branch of glossopharyngeal
ganglion: otic
postgang: auriculotemporal n
48
submandibular and sublingual glands sep by
mylohyoid m
49
below submandibular duct is
lingual n - prone to injury surgically
50
what artery courses through submandibular ganglion
facial a
51
optic canal contents
optic n and opthalmic artery
52
superior orbital fissure located bw
greater and lesser wing of sphenoid bone
53
inferior orbital fissure contents
- zygomatic branch of maxillary n
- inf ophthalmic vein
- SNS nerves
54
orbital rim fracture
fracture of the bones forming outer rim of bony orbit
55
blowout fracture
rim is intact but the walls of the orbit is fractured
partial herniation of orbital contents occurs due to blunt force trauma
if maxillary sinus involved then can lose sens to malar region
56
trap door
What is it: Happens in children due to the elasticity of their bones - rather than just snapping, the bone initially breaks outwards but returns to its original position
Why is it bad: Upon return, the fracture may entrap some soft tissue of the orbit, such as orbital fat or sometimes musculature (eg. inferior rectus)
57
CN IIII / oculomotor autnomics
- supplies PNS to sphincter pupillae (constricts) and cilary muscle (lens becomes more sperical, better for short range vision) via short ciliary n
- supplies SNS to sup tarsal m
58
CN III palsy presentation
down and out gaze
ptosis - inactive levator palpebrae
mydriasis - dilated pupil due to decreased tone of constrictor pupillae muscle
59
CN III palsy causes
- raised ICP
- post communicating artery aneurysm
- cavernous sinus infection/ trauma
60
vertical diplopia when walking down stairs due to ?
CN IV palsy
61
SO and IO function
SO - depression and abduction
IO - elevation and abduction
62
CN IV palsy causes
- microvascular disease (diabetes)
- raised ICP
- cavernous sinus thrombosis
63
CN VI palsy presents w
- medially deviated eye
- diplopia
64
accomodation distant vision
When ciliary muscle relaxes → suspensory ligaments taut → lens is pulled thin → distant vision
65
accommodation close vision
When ciliary muscle contracts → suspensory ligaments relax → lens becomes thick → close vision
66
vasculature of eye
ophthalmic artery - branch of ICA
arises immediately distal to cavernous sinus
venous drainage:
sup and inf ophthalmic veins drain into cavernous sinus
67
Macula - Responsible for what parts of vision?
the central, high-resolution, color vision that is possible in good light. Contains the central fovea
68
Central fovea
- tiny pit located in the macula of the retina that provides the clearest vision of all as light falls directly on the cones..
69
Optic disc -
where the optic nerve exits. This area has no rods or cones, so creates a blind spot.
70
Papilloedema
- swelling/blurring of the optic disc due to raised ICP
- Subarachnoid space extends into the optic nerve sheath
- So raised ICP → increased pressure transmitted into optic nerve sheath → pappiloedema
71
lacrimal gland blood supply
Arterial supply → ophthalmic artery → lacrimal artery
Venous: → superior ophthalmic vein → cavernous sinus
72
Corneal reflex
sens and motor comes from?
Sensory: to the eye (nasocilliary branch of ophthalmic nerve V1)
Motor: Orbicularis oculi (muscle of facial expression) - Facial nerve branches
73
A patient presents with gradual onset of vision loss. To determine if the defect is due to a brain or nerve problem, what is the MOST important thing to determine on examination?
a. Visual acuity
b. Cranial nerve 3,4 and 6 function
c. Visual fields
d. Blind spot testing
C visual fields
74
Anterior to the chiasm = ?
Posterior to the chiasm = ?
Anterior to the chiasm = unilateral visual field loss
Posterior to the chiasm = ALWAYS have visual field loss on both eyes (e.g. homonomous hemianopia)
So any problem with the brain that effects vision will cause a visual field defect on both eyes
75
middle ear boundaries
Medial - labyrinthine wall)
Separates tympanic cavity from internal ear
Contains oval window, round window, prominence lateral semicircular canal, facial nerve canal
Lateral - membranous wall - tympanic membrane
Roof - tegmen tympani separating cranium from middle ear
Floor - jugular wall
Posterior - mastoid wall
Pyramidal eminence (stapedius m.), aditus leading to mastoid anturm
Anterior - carotid wall
Pharyngotympanic tube to nasopharynx for pressure equalization. Also has tensor tympani muscle
76
Issue with vagus [X] = Uvula will deviate towards which side?
normal side (thats where the pull is)
77
issue with hypoglossal n. [XII] = Tongue deviates toward ?
abnormal side (lick your wounds)
78
stylopharyngeus is innervated by?
glossopharyngeal n
79
pharyngeal muscles all innerv by pharyngeal branch of vagus except
Except stylopharyngeus (CNIX)
80
gag reflex involves what nerves
Gag reflex = 9 sensory - 10 motor (pharyngeal/palate muscle response)
81
only voice related muscle that abducts?
Posterior crico-arytenoid only muscle that abducts!!! → important to know this
All other ones adduct, tense vocal cord
82
when you tense vocal cord pitch goes?
higher
83
larynx muscles pneumonic
SCAR
SCAR:
Superior laryngeal nerve (external branch)
Cricothyorid muscle
All other muscles
Recurrent laryngeal nerve
84
During a carotid endarterectomy, a surgeon accidentally injures the superior laryngeal nerve. Which of the following is MOST accurate with the defects seen post-operatively
a. The patient will have a hoarse voice
b. The patient will be unable to hit high notes
c. The patient will have a stridor
d. Nothing will happen as the other side can compensate
B
85
Pretracheal fascia →
pericardium
Pharynx/larynx, oesophagus, trachea
Thyroid
Recurrent laryngeal n.
Strap muscles
86
Carotid sheath
Common carotid, IJV, CN X
Pierced by glossopharyngeal n. And ansa cervicalis
Connected by alar fascia
87
Investing layer surrounds?
Traps, SCM
88
Retropharyngeal space - potential space
Bound by buccopharyngeal fascia anteriorly and alar fascia posterioly
Contains retropharyngeal lymph nodes
Continuous with posterior mediastinum → neck space infections here can spread down causing mediastinitis (not good)
89
Danger space
Continuous with posterior mediastinum
- can also spread to prevertebral space from here
90
surgery in posterior neck → injure
CN XI, subclavian and cervical plexus
91
Surgery in the anterior triangle → injury
cn 9, 10, 12
92
A patient is day 1 post-op total thyroidectomy. They complain of muscle spasms and have some perioral numbness. Which of the following is true?
a This may be the first sign of impending airway obstruction
b This presentation is likely due to parathyroid gland removal
c The patient should immediately have the sutures removed on the ward
d This is a normal side effect of anaesthetic
B
93
External laryngeal n. Damage -
lower pitch
cricothyroid
94
Recurrent laryngeal n. Damage –
hoarse voice if unilateral, airway obstruction if bilateral
95
Post-thyroidectomy haemorrhage
Bleeding beneath cervical fascia and strap muscle layer
Pressure obstructs lymphatic drainage → laryngeal oedema → airway emergency
If you are ever the surg intern and a post-thyroidectomy patient, this is such an emergency that should open up the sutures all the way down until you see trachea → at the bedside
96
Parathyroid gland removal →
hypocalcaemia
