Head And Neck Flashcards

Question

What is the nerve supply to the platysma?

Answer 1

Facial nerve

Answer 2

The platysma covers the anterolateral aspect of the neck. Inferiorly, the fibres diverge, leaving a gap anterior to the larynx and trachea.

Answer 3

Acting from its superior attachment, the platysma tenses the skin. Acting from its inferior attachment, the platysma helps depress the mandible and draw the corners of the mouth inferiorly, as in a grimace.

Answer 4

Investing Pretracheal Prevertebral

Answer 5

common carotid arteries, internal jugular veins and vagus nerves

Answer 6

o Support • Viscera (e.g. thyroid gland) • Muscles, Vessels and deep Lymph Nodes o Limit the spread of abscesses that result from infections o Slipperiness that allows structures in the neck to move and pass over one another without difficulty • Swallowing • Turning the head and neck

Answer 7

most superficial, the investing layer surrounds the entire neck deep to the skin

Answer 8

o Sternocleidomastoid o Trapezius o Submandibular and Parotid Salivary Glands

Answer 9

A thin layer, limited to the anterior part of the neck. Inferiorly it extends into the thorax, where it blends with the fibrous pericardium. Laterally it blends with the carotid sheath.

Answer 10

``` o Muscular layer • Encloses infrahyoid muscles o Visceral layer • Thyroid gland • Trachea • Oesophagus ```

Answer 11

The innermost layer of the deep fascia, which forms a sheath for the vertebral column and the muscles associated with it. Extends from the base of the cranium of the 3rd thoracic vertebra and extends laterally as the axillary sheath that surrounds the axillary vessels and the brachial plexus.

Answer 12

A tubular, fibrous structure that extends from the base of the cranium to the root of the neck.

Answer 13

o The common carotid artery - medially o Internal jugular vein - laterally o The vagus nerve (CN X) - inbetween and posterior

Answer 14

Determine the direction in which abscesses in the neck may spread. If an infection occurs: o Between the Investing layer and the muscular part of the pretracheal surrounding the infrahyoid muscles, it will not spread beyond the manubrium. o Between the Investing and visceral Pretracheal layers, it can spread into the thoracic cavity anterior to the pericardium. o Pus from an abscess lying behind the Prevertebral layer of deep cervical fascia may extend laterally in the neck. • May perforate the fascial layer and enter the retropharyngeal space. • This will produce a bulge (retropharyngeal abscess) in the pharynx, resulting in dysphasia (difficulty swallowing) and dysphonia (difficulty speaking)

Answer 15

potential space between the Prevertebral layer of fascia and the fascia surrounding the pharynx superficially.

Answer 16

major route of spread of infection from the neck to the thorax. The space runs to the diaphragm.

Answer 17

o Anterior – Mid line o Posterior – The anterior border of SCM o Superior – Inferior border of the mandible o Apex – Jugular notch in the manubrium o Roof – Superficial cervical fascia, containing the platysma o Floor – Pharynx, larynx, thyroid gland

Answer 18

Submandibular triangle Submental triangle Carotid triangle Muscular triangle

Answer 19

* Submandibular gland * Submandibular lymph nodes * Hypoglossal and Mylohyoid nerves * Parts of facial artery and vein

Answer 20

* Submental lymph nodes | * Small veins which unite to form anterior jugular vein

Answer 21

``` • Carotid sheath o Common carotid artery o Internal jugular vein o Vagus nerve o Deep Cervical Lymph Nodes • Thyroid gland • Larynx • Pharynx • External carotid artery and some of its branches • Hypoglossal and Spinal accessory nerves • Branches of cervical plexus ```

Answer 22

* Sternothyroid * Sternohyoid * Thryoid * Parathyroid

Answer 23

o Anterior – Posterior border of SCM o Posterior – Anterior border of Trapezius o Inferiorly – Middle third of the clavicle, between Trapezius and SCM o Apex – Where SCM and Trapezius meet on the superior nuchal line of the occipital bone o Roof – Investing layer of deep cervical fascia o Floor – Muscles covered by the Prevertebral layer of deep cervical fascia

Answer 24

Occipital triangle | Omoclavicular (subclavian) triangle

Answer 25

* Spinal Accessory Nerve (CN XI) * Trunks of Brachial Plexus * Part of external jugular vein * Posterior branches of cervical plexus * Cervicodorsal trunk * Cervical lymph node

Answer 26

* 3rd part Subclavian Artery * Part of Subclavian Vein * Suprascapular artery * Supraclavicular lymph nodes

Answer 27

In the anterolateral part of the neck, the hyoid bone provides attachments for the Suprahyoid Muscles superiorly, and the Infrahyoid Muscles inferiorly.

Answer 28

steady or move the hyoid and larynx.

Answer 29

``` o Mylohyoid o Geniohyoid o Stylohyoid o Digastric Muscles • Two bellies (Anterior and Posterior) • Joined by an intermediate tendon • Fibrous sling, from Pretracheal layer of Deep Cervical Fascia allows the tendon to slide anteriorly and posteriorly ```

Answer 30

``` o Mylohyoid (inferior alveolar nerve) o Geniohyoid (Cranial nerve I) o Stylohyoid (Facial nerve) o Digastric Muscles • Anterior - Facial nerve • Posterior - Inferior alveolar nerve ```

Answer 31

Supporting the hyoid in providing a base from which the tongue functions. They also elevate the hyoid and larynx in relation to swallowing and tone production.

Answer 32

C1 - C3 innervation

Answer 33

o Superficial Plane • Sternohyoid • Omohyoid • Has two bellies (Superior and Inferior) • Joined by an intermediate tendon • Fascial sling for the tendon connects to the clavicle o Deep Plane • Sternothyroid • Thyrohyoid

Answer 34

Anchor the hyoid, sternum, clavicle and scapula, and depress the hyoid and larynx during swallowing and speaking. They also work with the Suprahyoid muscles to steady the hyoid, providing a firm base for the tongue.

Answer 35

Common Carotid Arteries and Vertebral Arteries.

Answer 36

Internal Jugular Vein, with the External Jugular Vein and Anterior Jugular Vein

Answer 37

Fusion of: o The Prevertebral layer of cervical fascia • Posteriorly o The Pretracheal layer of cervical fascia • Anteromedially o The Superficial layer of cervical fascia • Anterolaterally

Answer 38

Medially and posterior

Answer 39

bifurcation of the Brachiocephalic Trunk behind the right sternoclavicular joint.

Answer 40

Arch of the Aorta. Consequently, the left common carotid artery is slightly longer as it courses for about 2cm in the superior mediastinum before entering the neck.

Answer 41

midway between the angle of the mandible and the mastoid process of the temporal bone. A reliable anatomical landmark for this is the upper border of the thyroid cartilages.

Answer 42

Carotid sinus?

Answer 43

Baroreceptors, which detect changes in blood pressure.

Answer 44

used to Alleviate Supra-Ventricular Tachycardia through gentle rubbing. This is known as a Carotid Massage.

Answer 45

Peripheral Chemoreceptors, which detect arterial O2 concentrations

Answer 46

common site for atheroma formation. This causes narrowing (stenosis) of the artery. Rupture of the clot can cause an embolus to travel to the brain. This will cause a Transient Ischaemic Attack (TIA) or Stroke.

Answer 47

Lack branches in the neck

Answer 48

Through the carotid canal

Answer 49

8 branches Stop Superior Thyroid Alcohol Ascending Pharyngeal Late Lingual Friday Facial Or Occipital Puke Posterior Auricular More Maxillary Saturday Superficial Temporal

Answer 50

Maxillary and Superficial Temporal Arteries within the substance of the Parotid Gland. It is accompanied here by the Facial Nerve (CN VII) and the Retromandibular Vein.

Answer 51

Subclavian artery

Answer 52

ascend through the Transverse Foramen in Cervical Vertebrae 6 → 1

Answer 53

Supply brain along with internal carotid arteries

Answer 54

Vagus and Hypoglossal nerves

Answer 55

``` o Superiorly • Posterior Belly of the Digastric o Laterally • Sternocleidomastoid o Medially • Superior belly of Omohyoid ```

Answer 56

``` o Skin o Connective tissue (dense) o Aponeurosis o Loose connective tissue • Contains blood vessels o Periosteum ```

Answer 57

Supratrochlear and suborbital arteries | Which are branches of opthalmic arteries which arise from internal carotid arteries

Answer 58

Numerous anastomoses and the walls of the arteries being closely attached to connective tissue, limiting their constriction.

Answer 59

Opposing pull of occipitofrontalis

Answer 60

Different blood supply

Answer 61

Middle Meningeal artery

Answer 62

Superficial veins accompany arteries o Superficial Temporal Veins o Occipital Veins o Posterior Auricular Veins Some deep parts of the scalp in the temporal region have veins that drain into the Pterygoid Venous Plexus.

Answer 63

Supraorbital and Supratrochlear Veins unite at the medial angle of the eye to form the Angular Vein, which drains into the Facial Vein.

Answer 64

The veins of the scalp connect to the Diploic Veins of the Skull via several valve-less Emissary Veins and therefore connect to the Dural Venous Sinuses. This relationship means that infection from the scalp can spread to the cranial cavity and affect the meninges.

Answer 65

The Anterior and Posterior Branches of the Middle Meningeal Artery supplies the Dura and Skull. It is is a branch of the Maxillary Artery, which in turn is a branch of the External Carotid Artery.

Answer 66

bleeding deep to the cranium but superficial to the Dura.

Answer 67

gain access into the cranial cavity. When preformed the bone and skin flap are reflected inferiorly to preserve blood supply.

Answer 68

Endothelium-lined spaces between the periosteal and meningeal layers of the Dura.

Answer 69

o Superior Sagittal Sinus o Inferior Sagittal Sinus o Cavernous Sinus o Sigmoid Sinus • Continue as the Internal Jugular Veins • Exit the skull through the jugular foramen o Transverse Sinus

Answer 70

External Carotid Artery, except the Supraorbital and Supratrochlear that are from the Internal Carotid Artery via the Opthalmic Artery.

Answer 71

Facial •External Carotid •Muscles of facial expression and face Superior and Inferior Labial •Facial •Upper lip, side and septum of nose Lower lip Maxillary •External Carotid •Deep structures of the face Lateral Nasal •Facial •Skin on ala and dorsum of nose Angular •Facial •Superior cheek and lower eyelid Transverse Facial •Superficial Temporal •Facial muscles and skin of temporal frontal and temporal regions Supratrochlear •Opthalmic (Int. Carotid) •Muscles and skin of forehead and scalp Superior conjuctiva Supraorbital •Opthalmic (Int. Carotid) •Muscles and skin of forehead and scalp Superior conjuctiva

Answer 72

Facial Vein, which in turn drains into the Internal Jugular Vein. ``` Cavernous sinus Supratrochlear vein Supra-orbital vein Angular vein Deep facial vein Facial vein ```

Answer 73

plexus of extremely thin-walled veins on the upper surface of the spehnoid bone.

Answer 74

``` o Internal Carotid Artery o CN III – Oculomotor o CN IV – Trochlear o CN VI – Abducent o CN V – Trigeminal • CN V 1 – Opthalmic • CN V 2 – Maxillary ```

Answer 75

At the medial angle of the eye the Facial Vein and the Superior Opthalmic Vein communicate and drain into the Cavernous Sinus

Answer 76

* Infection can travel from Facial Vein → Dural Venous Sinuses * Thrombophlebitis of Facial Vein – Infected clot can travel to intracranial system

Answer 77

``` superior sagittal sinus Cavernous sinus Transverse sinus sigmoid sinus facial vein jugular vein ```

Answer 78

Under sternocleidomastoid

Answer 79

Internal jugular vein

Answer 80

o Use right IJV o Effectively like a direct connection to right atrium o Patient at 450 angle o Height from sternal angle + 5cm

Answer 81

``` o Occipital o Retroauricular (A.k.a. Mastoid) o Parotid o Buccal (A.k.a. Facial) o Submandibular o Submental o Anterior o Cervical o Superficial Cervical • Along the course of External Jugular Vein o Retropharyngeal o Laryngeal o Tracheal ```

Answer 82

o A.k.a. Deep Cervical Nodes • Receive all the afferent lymph vessels of the head and neck, either directly or indirectly, via one of the regional groups. • Closely related to the Carotid Sheath (Internal Jugular Vein) o Jugulo-Digastric • A.k.a. Tonsillar node • Located just below and behind the angle of the mandible • Lymphatic drainage of tonsil and tongue o Jugulo-Omohyoid • A.k.a. Tongue node • Lymphatic drainage of the tongue, oral cavity, trachea, oesophagus and the thyroid gland oDeep Cervical Nodes in the Posterior Triangle of the neck • Lie along the course of the Accessory Nerve. • Accessory Nerve may have to be removed in malignancy of the neck o Supraclavicular nodes • Root of the neck • Enlarge in late stages of malignancies of the thorax and abdomen • Virchow’s Node associated with Gastric Carcinoma

Answer 83

On the left side the Jugular Lymph Trunk usually joins the Thoracic Duct, which enters the Left Brachiocephalic Vein at the junction between the Subclavian and Internal Jugular Veins. On the right side the Jugular Lymph Trunk enters the venous system at the junction between the Subclavian and Internal Jugular Veins, but this time via a short Right Lymphatic Duct.

Answer 84

Thoracic Duct is the body’s main duct for the return of lymph to venous blood.

Answer 85

o Begins in the abdomen at the cisterna chyli (L2) o 38-45cm long o Extends vertically in the chest and curves posteriorly to the left Common Carotid Artery and left Internal Jugular Vein o Empties into the Left Brachiocephalic Vein at the junction between the Subclavian and Internal Jugular Veins • Left Venous Angle

Answer 86

o Drains the upper right side of the body • Right side of head and neck • Right upper limb • Right thorax

Answer 87

o Drains into the junction of the Subclavian Vein and Internal Jugular Vein • Right Venous Angle

Answer 88

Lymphadenopathy is the enlargement of lymph nodes

Answer 89

``` o Infection • Feel tender, smooth • Glandular Fever o Malignancy • Feel non-tender, craggy • Primary or Metastases • Lymphoma, Head and Neck Cancers ```

Answer 90

o Epstein Barr Virus (EBV) | o Viral infiltration produces atypical lymphocytes

Answer 91

o Swollen, painful lymph node, sore throat, fatigue, fever

Answer 92

block dissection of the cervical nodes. This procedure involves the removal, as a unit (en bloc), of the Internal Jugular Vein, Fascia, Lymph Nodes and the Submandibular Salivary Gland.

Answer 93

o Phagocytic cells act as filters for particulate matter and micro-organisms o Antigen is present to the immune system

Answer 94

``` Fibrous capsule o Lymphatic Sinuses o Blood vessels o Parenchyma (Cortex, paracortex, medulla) ```

Answer 95

In the cortex of the lymph nodes, B cells enter lymph nodes via post capillary venules that have High endothelial venules, and pass to follicles. Unstimulated B cells pass out rapidly to return to circulation with lymph. If activated by antigenic stimulation, B cells proliferate and stay in lymph nodes

Answer 96

Follicle centre cells

Answer 97

Pale staining central area of secondary follicle

Answer 98

Stimulated B cells proliferate and undergo somatic hypermutation and are selected for high affinity antibodies to the antigen displaced by follicular dendritic cells. They then take up the antigen, process and present it to T cells. T cells then further promote the development of B cells by releasing of cytokines (IL-4). B cells then become centrocytes and then centroblasts.

Answer 99

Follicle centre cells either have cleaved nuclei (Centrocytes) or more open/several nuclei (centroblasts).

Answer 100

The centroblasts leave the follicle and pass to the paracortex and medullary sinuses, where they become immunoblasts. Immunoblasts give rise to plasma cells or memory B cells.

Answer 101

The paracortex contains lymphocytes, accessory cells and supporting cells. The Paracortex is the predominant site for T-Lymphocytes in the lymph node.

Answer 102

The medulla is rich in macrophages and comprises: o Large blood vessels o Medullary cords • Rich in plasma cells • Produced Ab’s pass out of the node via the efferent lymphatic o Medullary sinuses

Answer 103

``` Ethmoid Frontal Inferior conchae Lacrimal Mandible Maxilla Nasal Parietal Sphenoid Temporal Vomer Zygomatic ```

Answer 104

``` Inferior nasal concha (2) Lacrimal bones (2) Mandible Maxilla (2) Nasal bones (2) Palatine bones (2) Vomer Zygomatic bones (2) ```

Answer 105

Parietal Temporal Sphenoid Frontal

Answer 106

Cranial Bones: ``` Calvaria • Frontal • Parietal (2) • Occipital • Ethmoid ``` Cranial Base • Sphenoid • Temporal (2)

Answer 107

The bones of the calvaria consist of 2 layers of compact bone separated by a layer of bone marrow, the Diploe.

Answer 108

1st cervical vertebra Facial skeleton Mandible

Answer 109

Coronal Sagittal Lamboidal

Answer 110

o Squamous Temporal Bone and Parietal Bone over the temples and sphenoid air sinus o Foramen Magnum and the inner parts of the Sphenoid Wing at the skull base o Anterior Cranial Fossa • Cribriform plate of the Ethmoid Bone, roof of the orbits o Middle Cranial Fossa • The weakest, with thin bones and multiple foramina o Posterior Cranial Fossa • Areas between the mastoid and dural sinuses

Answer 111

Bleeding from the wound, ear, nose or around eyes, bruising, draining of CSF from ears or nose, swelling, confusion, convulsions, difficulties with balance, drowsiness, headache, loss of consciousness, nausea, vomiting, visual disturbance, stuff neck and slurred speech.

Answer 112

Depressed Fracture A severe, localised blow may result in a local indentation, in which a fragment of bone may compress or injure the underlying brain. Linear Calvarial Fractures Trauma to the Calvaria often results in radiating linear fractures, the fracture lines radiating away from the point of impact in two or more directions. Comminuted Fractures The bone is broken into several pieces. Contrecoup (Counterblow) fracture No fracture occurs at the point of impact, but one occurs on the opposite side of the cranium. Simple Fracture A break in the bone without damage to the skin Compound Fracture Involves a break in, or loss of, skin and splintering of the bone accompanied by brain injury and bleeding. Basal Skull Fracture Presents with Battle’s Sign

Answer 113

Bone fragments from fractures may rupture the Middle Meningeal Artery, leading to an Extradural Haemorrhage

Answer 114

Bone inflammation due to infection

Answer 115

The Emissary Veins (see above) connect the superficial veins of the scalp with the Diploic Veins of the skull bones and with the Intracranial Venous Sinuses, providing a route for infection. Infection of the scalp may spread to the skull bones via these veins,

Answer 116

``` Foramen Magnum Foramen ovale Foramen spinosum Foramen Lacerum Carotid Canal Jugular Foramen ```

Answer 117

``` Frontal Zygomatic Orbits Nasal Region Maxillae Mandible ```

Answer 118

* Nasal bones * Zygomatic bones * Lacrimal bones * Ethmoid bone * Spehnoid bone

Answer 119

* Frontal bone * Sphenoid bone * Temporal bones * Maxillae

Answer 120

Temporomandibular joint

Answer 121

massive facial trauma. A hard blow to the lower jaw often results in a fracture of the neck of the mandible and may be associated with TMJ dislocation.

Answer 122

Skin bruising around the orbit causes tissue fluid and blood to accumulate in the surrounding connective tissue.

Answer 123

A trauma or blow to the Supraciliary Arches may cause laceration of the skin and cause profuse bleeding.

Answer 124

Redness of the skin covering the Zygomatic bones is associated with Mitral Stenosis.

Answer 125

Axis - Cervical vertebra 2

Answer 126

dislocated in neck injuries with relatively less force than is required to fracture them. Slight dislocations may not damage the spinal cord because of the large vertebral canal, but severe dislocation can cause serious injuries.

Answer 127

o May occur due to a fall on the head o Displacement of fractured dens may injure the spinal cord • Quadriplegia - paralysis leading to total loss of limb and torso movement o Displacement of fracture dens may injure the medulla of the brainstem • Death

Answer 128

o Head on collisions (car) o Rupture of lower intervertebral discs (C5/C6 and C6/C7) resulting in compression of spinal roots C6 and C7 o Pain is felt in the neck, shoulder, arm and hand

Answer 129

o Whiplash injury (rear-end car collision) o Tearing of anterior and posterior longitudinal ligaments, fracture of cervical spinous processes, disc rupture, neck muscle injury, blood vessel injury

Answer 130

o Joints of the vertebral arches (zygopophyseal joints) are close to intervertebral foramina through which spinal nerves emerge o When these joints are affected by Osteoarthritis (osteophyte formation), related spinal nerves are compressed, causing pain along dermatomes and muscle spasms along myotomes

Answer 131

o Compression of the cervical spine against the shoulder o May involve spinal cord damage • Partial or complete paralysis • Death o Most common at C2, C6 and C7 o The most fatal injuries occur in the upper part of the spine (C1 or C2)

Answer 132

o Head first fall from height | o Diving head first into a pool

Answer 133

o Hyperextension of the head on the neck

Answer 134

irregularly shaped space on the lateral aspect of the skull.

Answer 135

o Inferior part of the Temporalis muscle o Inferior parts of the Medial and Lateral Pterygoid muscles o Maxillary Artery • Larger terminal branch of External Carotid Artery o Middle Meningeal Artery • Branch of the Maxillary Artery o Superficial Temporal Artery • Smaller terminal branch of External Carotid Artery o Maxillary Vein o Middle Meningeal Vein(s) o Pterygoid Venous Plexus ``` o Mandibular Nerve • 3rd Branch of the Trigeminal (CN V3) o Branches of the Mandibular Nerve • Auriculotemporal Nerve • Inferior Alveolar Nerve • Lingual Nerve • Buccal Nerve • Chorda Tympani (Branch of Facial Nerve) o Otic Ganglion ```

Answer 136

``` o Foramen Ovale • Mandibular division of Trigeminal Nerve (CN V3) o Foramen Spinosum • Middle Meningeal Artery o Alveolar Canal o Inferior Orbital Fissure o Pterygomaxillary Fissure ```

Answer 137

``` o Anaesthetic is injected near the Mandibular Nerve, where it enters the Infratemporal fossa • Near to Foramen Ovale o Nerves affected: • Inferior Alveolar • Lingual • Buccal • Auriculotemporal ```

Answer 138

o Dental procedures o Anaesthetic is injected around the Mandibular Foramen • Passage for the inferior alveolar nerve and vessels • Medial side of the mandible o All mandibular teeth are anesthetised on the medial side o Skin and mucous membranes of the lower lip, the labial alveolar mucosa, gingivae and skin of the skin are also anesthetised • Mental Branch of the Inferior Alveolar Nerve

Answer 139

modified hinge type synovial joint between the Mandible and the Cranium.

Answer 140

``` Superiorly o Mandibular Fossa • Posterior and concave o Articular Tubercle • Anterior and convex ``` Inferiorly o Head of the mandible

Answer 141

It is always the mandible that displaces in order for movements to occur. Movements occur by displacements in either the Superior Joint Cavity (gliding) or Inferior Joint Cavity (hinge).

Answer 142

Flexion (Elevation) o Closing the mouth o Occurs in the inferior compartment o Temporalis, Masseter, Medial Pterygoid ``` Extension (Depression) o Opening the mouth o Occurs in the inferior compartment o Prime mover is gravity • Lateral Pterygoid, Suprahyoid, Infrahyoid • Active against resistance ``` ``` Gliding (Translation) o Protrusion and Retrusion of the jaw • Protrusion – Lateral Pterygoid, Medial Pterygoid, Masseter • Retrusion – Temporalis, Masseter o Occurs in the superior compartment ``` Rotation (Pivoting) o Occurs in the inferior compartment

Answer 143

``` Condyles are pulled forwards o Protrusion / Gliding • Superior compartment o Lateral Pterygoid Chin moves down and back o Hinge movement • Inferior compartment o Usually by gravity o Suprahyoid and Infrahoid can depress the mandible against resistance ```

Answer 144

``` Retraction of the mandible o Retrusion / Gliding • Superior compartment o Posterior fibres of temporalis muscle Elevation of the mandible o Hinge movement • Inferior compartment o Remainder of temporalis o Masseter o Medial Pterygoid ```

Answer 145

by extra-capsular ligaments.

Answer 146

Superiorly o Circumference of the mandibular fossa and articular tubercle Inferiorly o Neck of the condyle of the mandible

Answer 147

``` Lateral o 1, strong ligament o Temporomandibular ligament • Strongest ligament of the TMJ • Deep fibres blend with joint capcule Medial o 2, accessory ligaments o Sphenomandibular ligament o Stylomandibular ligament ```

Answer 148

The TMJ is most stable when the jaw is closed. o Mandibular condyle is in contact with the mandibular fossa o Teeth are in occlussal contact • Perfect occlusion further stabilises the TMJ

Answer 149

The TMJ is least stable when the jaw is open.

Answer 150

Yawning or taking a large bite, excessive contraction of the Lateral Pterygoids may cause the heads of the mandible to dislocate anteriorly (pass anterior to the articular tubercles). In this position the mouth remains depressed and the person is unable to close their mouth. Dislocation of the TMJ most commonly results from a side-ways blow to the chin when the mouth is open

Answer 151

o Grinding teeth when asleep

Answer 152

o Muscular pain

Answer 153

o Muscular pain

Answer 154

emerge through foramina or fissures in the cranium and are covered by tubular sheaths derived from the cranial meninges

Answer 155

``` No. Nerve I Olfactory II Optic III Oculomotor IV Trochlear V Trigeminal VI Abducent (Abducens) VII Facial VIII Vestibulocochlear IX Glossopharyngeal X Vagus XI Spinal Accessory XII Hypoglossal ```

Answer 156

Some Say Marry Money But My Brother Says Big Boobs Matter Most

Answer 157

o Special Sensory fibres • Distributed to the uppermost part of the nasal cavity • Smell

Answer 158

o Reaches the nose via the cribriform plate of the ethmoid bone • Fractures of the cribiform plate involving the dura mater may be associated with leakage of CSF from the nose (rhinorrhea). • Fractures of the cribiform plate may result in Anosmia

Answer 159

o Sensory | Innervates the eye

Answer 160

o Direct trauma to eye or orbit, fracture of optic canal or pressure on optic pathway may result in nerve lesions • Loss of pupillary constriction and visual field defects

Answer 161

o Motor • Innervates the Extraocular Muscles • Innervates the Ciliary Muscles • Innervates the Sphincter Pupillae

Answer 162

o Fractures involving the cavernous sinus or aneurysms may cause lesions o Dilated pupil, ptosis, eye turns down and out, pupillary reflex on side of lesion is lost

Answer 163

o Motor | • Innervates the Superior Oblique of the Eye

Answer 164

o Stretching of the nerve during its course around the brainstem or orbit fractures may lead to nerve lesions • Inability to look down when eye is adducted

Answer 165

o Both o Three divisions o Opthalmic • Sensory (Skin, cornea) • Corneal reflex o Maxillary • Sensory • Skin, mucous membrane of nose, palate and upper dental arcade ``` o Mandibular • Sensory o Skin, lower teeth, cheek and anterior 2/3rd of tongue (general sensation) • Motor o Innervates the muscles of mastication ```

Answer 166

o Nerve lesions lead to paralysis of muscles and sharp, intense facial pain

Answer 167

o Motor | • Innervates the Lateral Rectus

Answer 168

o Fractures involving the cavernous sinus or orbit may lead to nerve lesions • Eye fails to move laterally, diplopia on lateral gaze

Answer 169

o Both o Sensory • Special sensory (taste) anterior 2/3rds of tongue • General sensory fibres supply part of the external acoustic meatus and auricle o Motor • Muscles of facial expression • Parasympathetic secretomotor to submandibular and sublingual salivary glands via the chorda tympani • Parasymathetic secretomotor to glands of nasal mucosa, paranasal sinuses, palate and the lacrimal gland

Answer 170

o Lacteration or contusion in Parotid Region • Paralysis of facial muscles, eye remains open, angle of mouth droops, forehead does not wrinkle • Bell’s Palsy o Fracture of Temporal Bone • Bell’s Palsy • Involvement of cochlear nerve and chorda tympani; dry cornea; loss of taste in anterior 2/3rds tongue o Intracranial Haematoma • Forehead wrinkles because of bilateral innervation of frontalis muscle • Paralysis of contralateral facial muscles

Answer 171

o Sensory o Special Sensory – Balance and hearing • Vestibular Branch – Controls balance • Cochlear Branch – Hearing

Answer 172

o Skull fractures, ear infections, tumour of the nerve (acoustic neuroma) may all cause nerve lesions • Progressive, unilateral hearing loss, tinnitus (ringing in the ear), vertigo (sensation that environment is moving or spinning) • Acoustic neuroma frequently impairs Facial Nerve (CN VII) too

Answer 173

o Both o Sensory • General and Special sensory (taste) to posterior 1/3rd of tongue • General sensory widely distributed to the pharynx, oropharyngeal isthmus, dorsum of palate, the auditory tube and related structures, the mastoid antrum and mastoid air cells • Sensory to Carotid Body and Sinus o Motor • Innervates the Stylopharyngeus • Parasympathetic secretomotor fibres to Parotid salivary gland

Answer 174

o Deep lacerations of the neck may cause nerve lesions | • Loss of taste to posterior 1/3rd of tongue

Answer 175

o Both o Sensory • eGeneral Sensory lower pharynx and larynx, external auditory meatus and back of auricle • Special Sensory (taste) to epiglottis o Motor • Innervates all muscles of the pharynx, except Stylopharyngeus • Innervates muscles of airways, larynx, heart and GI tract • Innervates all of the palate muscles, except tensor veli palatine

Answer 176

o Nerve lesions in the neck affecting Recurrent Laryngeal branch of Vagus • Hoarseness of voice due to paralysis of vocal fold o Left recurrent laryngeal nerve is lower than the right o Bronchial or oesophageal carcinoma o Enlarged mediastinal lymph nodes o Stretched over an aneurysm of the aortic arch o Mitral stenosis → Enlarged LA → Pushed up left pulmonary artery, compressing the left recurrent laryngeal nerve against the aortic arch o Thyroidectomy causing damage to Superior Laryngeal Nerve • External branch lies close to superior thyroid artery and may be damaged when ligating the blood vessel

Answer 177

o Motor o Cranial Component • Innervates the Pharynx, Larynx and soft palate o Spinal Component (contains fibres from C2, C3, C4) • Innervates the Trapezius and Sternocleidomastoid muscle

Answer 178

o Surgery or lacerations to the neck can cause lesions to the nerve • Paralysis of sternocleidomastoid and superior fibers of trapezius • Shoulder droop

Answer 179

o Motor | • Innervation of all Extrinsic and intrinsic muscles of the tongue, with the exception of Palatoglossus

Answer 180

o Neck laceration and basal skull fractures may cause nerve lesions • Protruded tongue deviates towards the affected side due to the arrangement of the muscles

Answer 181

o Anterolateral to the vertebral column o Lying on the prevertebral fascia and muscles o Deep to the carotid sheath.

Answer 182

Preganglionic fibres arise mainly in the first thoracic neural segment and synapse in one of the three Cervical Sympathetic Ganglia, the Superior, Middle or Inferior. After synapsing, the postganglionic fibres travel as the Internal and External Carotid Nerves

Answer 183

pass with the Internal and External Carotid Arteries and its branches to: o The Pharyngeal Plexus o The Upper 4 Cervical Nerves o Cardiac Branch to the Cardiac Plexus

Answer 184

pass with the Inferior Thyroid Artery to: o The 5th and 6th Cervical Nerves o Cardiac Branch to the Cardiac Plexus

Answer 185

pass with the Vertebral Artery to: o The 7th and 8th Cervical Nerves o Cardiac Branch to the Cardiac Plexus

Answer 186

The inferior ganglion is a small ganglion, which in 80% of people combines with the 1st Thoracic Ganglion to form the Stellate Ganglion.

Answer 187

ciliary ganglion Pterygopalatine ganglion Submandibular ganglion Otic ganglion

Answer 188

* Oculomotor (CN III) * Facial (CN VII) * Glossopharyngeal (CN IX) * Vagus (CN X)

Answer 189

* Oculomotor → Ciliary Ganglion * Facial → Pterygopalatine / Submandibular Ganglion * Glossopharyngeal → Otic Ganglion * Vagus nerve does not have a discrete ganglion associated with it

Answer 190

o Lies in the Orbital Cavity, lateral to the optic nerve o Parasympathetic fibres derived from Oculomotor Nerve (CN III) • Sphincter Papillae • Ciliary Muscles o Sympathetic Fibres come from the Superior Cervical Ganglion • Via the plexus on the Opthalmic Artery (First branch of the Internal Carotid Artery) • Distributed to the eyeball o Sensory fibres from the eyeball pass to the nasociliary nerve

Answer 191

o Lies in the Pterygopalatine Fossa o Connected to the Maxillary Nerve (CN V2) by small branches o Parasympathetic fibres derived from Facial Nerve (CN VII) via the Greater Pterosal Nerve • Lacrimal glands • Glands of the nose, palate and nasopharynx o Sympathetic fibres come from the Superior Cervical Ganglion • Via the plexus on the Internal Carotid Artery • Distributed to the nose, palate and nasopharynx o Sensory fibres from the nose, palate and nasopharynx pass in the branches of the ganglion to the Maxillary Nerve (CN V2)

Answer 192

o Suspended from the Lingual Nerve by small branches o Parasympathetic fibres derived from the Facial Nerve (CN VII) via the Chorda Tympani, then the Lingual Nerve • Submandibular Gland • Sublingual Gland • Other glands on the floor of the oral cavity o Sympathetic fibres come from the Superior Cervical Ganglion • Along the Facial Artery • Pass to the glands in the floor of the oral cavity o Taste fibres may pass through the ganglion

Answer 193

o Parasympathetic fibres derived from the Glossopharyngeal Nerve via the Auriculotemporal Nerve • Parotid Gland o Sympathetic fibres come from the Superior Cervical Ganglion • Along the Middle Meningeal Artery • Pass into the Parotid Gland o Motor branches from the Mandibular Nerve (CN V3) pass through the ganglion without synapsing

Answer 194

Interruption of a cervical sympathetic trunk results in Horner’s Syndrome. It is manifested by the Absence of Sympathetically Stimulated functions on the Ipsilateral side of the head. o Miosis • Constriction of the pupil • Parasympathetically stimulated Sphincter Papillae of the pupil is unopposed o Ptosis • Drooping of superior eyelid • Paralysis of smooth muscle fibres interdigitated with the aponeurosis of the Levator Palpebrae Superioris that collectively constitute the Superior Tarsal muscle (innervated by Sympathetic fibres) o Vasodilation • Redness and increased temperature of the skin • Loss of sympathetic tone o Anhydrosis • Absence of sweating

Answer 195

``` o Roof • Frontal and Sphenoid o Floor • Maxilla, Zygomatic (and palatine) o Medial • Ethmoid, Maxilla, Lacrimal o Lateral • Zyogmatic, Sphenoid ```

Answer 196

o Usually at bony sutures o Medial and Inferior walls are thin • Medial wall Fractures – Can involve Ethmoidal and Sphenoidal Sinus • Inferior wall Fractures – Can involve Maxillary Sinus ``` o ‘Blow Out’ Fracture • A fracture that displaces the orbital walls and contents • Muscle entrapment • Diplopia (double vision) • Infection ``` o Enopthalmos • Depression of eye • Opposite of exophthalmos (bulging of the eye) • Infraorbital bleeding may push the eyeball back out (Pulsatile)

Answer 197

• Optic Nerve

Answer 198

* Lateral → Medial * Lacrimal Nerve * Frontal Nerve * Trochlear Nerve (CN IV) * Superior branch of Oculomotor Nerve (CN III) * Nasociliary Nerve * Inferior Branch of the Oculomotor Nerve (CN III) * Abducens Nerve (CN VI) * Opthalmic Veins * Sympathetic Nerves • Large French Teenagers Sit Numb In Anticipation Of Sweets

Answer 199

o Exits the orbit via the Optic Canal

Answer 200

``` 4 Recti o Superior • Look up • Muscle loops through the Trochlear o Inferior • Look down o Medial • Look medial (Adduct Pupil) o Lateral • Look lateral (Abduct Pupil) ``` ``` 2 Obliques o Superior • Look down o Inferior • Look up ``` Levator Palpebrae Superioris • Lifts upper Eyelid

Answer 201

``` LR6SO4R3 o Lateral Rectus • Cranial Nerve 6 • Abducens o Superior Oblique • Cranial Nerve 4 • Trochlear o All the Rest • Cranial Nerve 3 • Oculomotor ```

Answer 202

o Loss of innervation to the Lateral Rectus • Unable to move eye laterally (abduct pupil) • Pupil is fully adducted due to unopposed pull of medial rectus o Caused by fractures involving orbit or cavernous sinus

Answer 203

o Loss of innervation to the Superior Oblique • Unable to look eye down when eye is adducted o Caused by orbital fractures or stretching of the nerve during its course around the brainstem

Answer 204

o Loss of innervation to ‘All the Rest’ • Superior eyelid droops o Ptosis (drooping of eyelid) o Loss of innervation to Levator Palpebrae Superioris o Unopposed activity of Orbicularis Oculi (Facial nerve) • Pupil is fully dilated and non reactive o Loss of innervation to Sphincter Pupillae o Unopposed action of Dilator Pupillae • Eye has moved ‘Down and Out’ • Unopposed action of Lateral Rectus and Superior Oblique o Caused by fractures involving the cavernous sinus or aneurysms

Answer 205

Opthalmic Artery o Branch of the Internal Carotid Artery Central Artery of the Retina o Branch of the Opthalmic Artery o End arteries o Obstruction (e.g. by embolus) results in instant and total blindness

Answer 206

Superior and Inferior Opthalmic Veins o Exit via the Superior Orbital Fissure and drain into the Cavernous Sinus Central Vein of the Retina o Drains into the Cavernous Sinus, either directly or via Opthalmic Veins o Occlusion results in slow, painless loss of vision o Infections may also spread by this route from the eye to the brain

Answer 207

The eyelids protect the cornea and the eyeball from injury and keep the cornea moist by covering it with lacrimal fluid. Conjuctiva line the inner surface of the eyelids. The eye blinks when the cornea becomes dry and the eyelids carry a film of fluid over the cornea. Dust and other foreign material is also swept across to the medial angle of the eye and removed. The eyelids are strengthened by Tarsal Plates, dense bands of connective tissue that contain Tarsal Glands, which produce secretions that lubricate the edges of the eyelids and prevents them from sticking together when they close.

Answer 208

o Secretes Lacrimal Fluid (Tears) • Watery physiological saline • Contains the bacteriocidal lysozyme enzyme • Moistens and lubricates the surfaces of the conjuctiva and cornea • Provides some nutrients and dissolved oxygen to the cornea o Lies in a fossa on the superolateral part of the orbit

Answer 209

Conducts lacrimal fluid from the gland to the conjuctival sac

Answer 210

o Commence at the medial angle of the eye where lacrimal fluid is drained from the lacrimal lake → lacrimal sac

Answer 211

o Conveys lacrimal fluid to the inferior nasal meatus | • Inferior to the inferior nasal concha

Answer 212

o Levator Palpebrae Superioris • Innervated by Oculomotor Nerve (CN III) o Assisted by Superior Tarsal Muscles • Sympathetic innervation

Answer 213

o Orbicularis oculi | • Innervated by Facial Nerve (CN VII)

Answer 214

If the eyelids are prevented from closing properly the protective effect of blinking is lost. The cornea becomes dry and is left unprotected from dust and other particulate material. Irritation of the eyeball results in excessive tear formation

Answer 215

``` 1. Outer Protective layer o Sclera • Fibrous and provides attachment for the Extraocular muscles • White, relatively avascular o Cornea • Transparent, avascular • Nourishment from lacrimal glands and vascular beds • Sensitive – CN V1 ``` ``` 2. Middle Vascular layer o Choroid • Red of eye, continues anteriorly as the Ciliary Body o Ciliary Body • Anterior muscle thickening • Attaches and focuses the lens • Ciliary process secretes aqueous humor into the Anterior Chamber o Iris • Thin diaphragm, aperture is pupil • PSNS contracts the Sphincter Pupillae • SNS contracts the Dilator Pupillae o Rich network of blood vessels ``` ``` 3. Inner Retina layer o Optic part • Photosensitive • Neural and Pigmented layer o Non-visual part • Anterior ```

Answer 216

``` o Fundus • Posterior of eye • Seen with a fundoscope / opthalmoscope o Macula (a.k.a. macula lutea) • Fovea centralis o Optic Disc • Blind spot • Convergence of sensory fibres ```

Answer 217

Cornea Aqueous Humor Lens Vitreous Humor

Answer 218

``` o The cornea is the primary refractive medium o Myopia • Short or near-sight • Image focussed in front of retina o Hyeropia or Hypermetropia • Long or far-sight • Imaged focussed behind the retina o Presbyopia • Far sight due to age-related changes of lens ```

Answer 219

o Produced by the Ciliary process o Drains into scleral venous sinus via trabecular meshwork o Responsible for intraocular pressure • Glaucoma is caused by raised intraocular pressure (outflow of aqueous humor is blocked)

Answer 220

o Near vision • Accomodation • Parasympathetic activity in CN III → Sphincter like contraction of Ciliary muscle → Lens more globe like/fatter o Far vision • No parasympathetic activity to Ciliary muscles → Lens stretched → Flatter • Becomes thicker with age • Cataracts – Clouding of the lens

Answer 221

o Holds retina in place o Retina • Rods – Low light, black and white • Cones – Bright light, colour vision

Answer 222

o Afferent fibres • Opthalmic Branch of the Trigeminal Nerve (CN V1) o Efferent Fibres • Temporal and Zygomatic Branches of the Facial Nerve (CN VII) • Contraction of the Orbicularis Oculi, causing the eye to blink o Dirt and other extraneous particles cause corneal abrasions that result in sudden pain and excessive tears o Injury to the nerve removes this reflex, rendering the cornea vulnerable to foreign particles as they will not be felt o Loss of reflex may lead to Corneal Ulceration

Answer 223

People with scarred or opaque corneas may receive corneal transplants from donors (usually deceased). Corneal implants of non-reactive plastic material are also used.

Answer 224

Mydriasis is dilation of the pupil, sometimes referred to as a ‘Blown pupil’. o Under-activity of PSNS → Lack of innervation to Sphincter Pupillae o Over-activity of SNS → Increased innervation to Dilator Pupillae Raised intracranial pressure is a possible cause of mydriasis.

Answer 225

Outflow of aqueous humor through the scleral venous sinus into the blood circulation must occur at the same rate at which it is produced. If the outflow is decreased significantly because the pathway is blocked, pressure builds up in the anterior and posterior chambers of the eye. This is known as Glaucoma. Blindness can result from compression of the inner layer of the eyeball (retina) and the Central Artery of the Retina.

Answer 226

As people age, their lenses become harder and more flattened. These changes gradually reduce the focusing power of the lenses,

Answer 227

Some people also experience a loss of transparency (cloudiness) of the lens from areas of opaqueness (Cataracts). Cataract extraction combined with an intra-ocular lens implant has become a common operation.

Answer 228

The Intraretinal Space separates the layers of the retina in the developing embryo. During the early foetal period, the layers fuse, obliterating this space. However, although the Pigment Cell Layer becomes firmly fixed to the choroid, its attachment to the Neural Layer is not firm. Consequently, a blow to the eye may cause detachment of the retina, perhaps days or even weeks after trauma to the eye. Persons with retinal detachment may complain of flashes of light or specks floating in front of the eye.

Answer 229

Coloboma is the absence of a section of the iris. It may result from a birth defect, penetrating or non-penetrating injuries to the eyeball or a surgical iridectomy.

Answer 230

Haemorrhage within the anterior chamber of the eyeball (Hyphema or Hyphemia) usually results from blunt force trauma to the eyeball. Initially, the anterior chamber is tinged red, but blood soon accumulates. The initial haemorrhage usually stops in a few days and recovery is good.

Answer 231

``` Protrusion of the eye, causing the eyelids to part more than normal so that the whites of the sclera are visible all around the cornea and iris. o Bilateral • Grave’s Disease (Hyperthyroidism) o Unilateral • Aneurysm • Haematoma ```

Answer 232

o Optic nerve is surrounded by meninges with CSF in the subarcachnoid space o Increase in CSF pressure may compress the optic nerve → compress blood vessels supplying retina → blindness o Vein is occluded before the artery, leading to oedema of the retina (Papillodema)

Answer 233

The eye may appear bloodshot. This may result from trauma, infection, allergy or increased pressure in the eye. Severe coughing spells or recurrent vomiting may cause a patient to have a conjuctival haemorrhage.

Answer 234

Blocked Tarsal Gland, which lies behind the eyelash within the eyelid.

Answer 235

Infection of the Sebaceous Gland at the base of the eyelash.

Answer 236

External, Middle and Internal Ear

Answer 237

tympanic membrane

Answer 238

Middle ear to nasopharynx

Answer 239

The Auricle (Pinna) o Irregularly shaped plate of Elastic Cartilage covered by thick skin o Several depression and elevations, including the Helix (outer rim) and Tragus (small flap guarding the external acoustic meatus) o Non-cartilaginous Lobule (lobe) consists of fibrous tissue, fat and blood vessels. The External Acoustic Meatus (Canal) o Cartilaginous tube lateral 1/3rd, bony canal medial 2/3rds o Lies in the Temporal Bone o Lined by skin secreting Cerumen (modified sebum), which offers protection. The discarded cells of the skin together with cerumen form Wax

Answer 240

o Blood supply is from the Posterior Auricular and Superficial Temporal Arteries, which are both branches of the External Carotid Artery

Answer 241

o Sensory innervation Anterior to the External Acoustic Meatus is the Auriculotemporal Nerve, a branch of the Mandibular Nerve (CN V3) o Sensory innervation for the rest of the auricle is from the Great Auricular Nerve

Answer 242

o Sigmoid shaped, therefore Auricle is pulled upwards and backwards during ear examination to achieve a good internal view o In children, the canal should be straightened by pulling the canal downwards and back

Answer 243

o Shallow cone with its apex pointing medially o ~1cm diameter o Thin, oval, semi-transparent, pearly grey membrane • Allows for visualisation of some structures within the middle ear, most notably the malleus o Blood vessels visible around the periphery o Partition between external and middle ear

Answer 244

o External surface supplied by: • Auriculotemporal Nerve Branch of CN V3 • Auricular Branch of the Vagus Nerve (CN X) o Internal surface supplied by the Glossopharyngeal Nerve (CN IX)

Answer 245

o Stimulation of the Auricular Branch of the Vagus Nerve (CN X) • E.g. insertion of cotton bud o Cough reflex (some event vomit)

Answer 246

``` o Dull and become red or yellow o Blood vessels may be dilated • Injection of the drum o Dense, white plaques • Tympanosclerosis o Bulging of the membrane • Pus or fluid in middle ear o Retracted membrane • Infratympanic cavity pressures reduced • Obstruction of Eustachian tube o Perforation of the membrane • Trauma • Infection ```

Answer 247

The Cavity of the Middle Ear, or Tympanic Cavity is the narrow air-filled chamber in the Petrous part of the Temporal Bone.

Answer 248

o Tympanic Cavity Proper • The space directly internal to the tympanic membrane • Connected Anteromedially with the Nasopharynx by the Pharyngotympanic (Eustachian) Tube • Connected Posterolaterally with the Mastoid Air Cells through the Mastoid Antrum o Epitympanic Recess • Space superior to the membrane

Answer 249

``` o Auditory Ossicles • Malleus • Incus • Stapes o Stapedius and Tensor Tympani muscles o Chorda Tympani Nerve (Branch of the Facial Nerve (CN VII)) o Tympanic Plexus of Nerves ```

Answer 250

The ossicles serve to relay the vibrations encountered by the tympanic membrane to the internal ear, amplifying and concentrating sound energy to the oval window.

Answer 251

o Malleus • Handle is attached to the tympanic membrane • Body articulates with the body of the Incus o Incus • Articulates with the Stapes o Stapes • Articulates with the Bony Labyrinth of the inner ear at the Oval Window

Answer 252

Tensor Tympani o Inserts into the handle of the malleus • Pulls handle medially • Tenses the tympanic membrane, reducing the amplitude of its oscillations o Prevents damage to the inner ear when exposed to loud sounds Stapedius o Pulls the stages posteriorly and tilts its base in the oval window • Tightens the anular ligament and reduces the oscillatory range o Prevents excessive movement of the stapes o Nerve to Stapedius arises from the Facial Nerve (CN VII)

Answer 253

The nerve lies in the Facial Canal, separated from the tympanic cavity by a very thin bony partition. Because of this proximity, a middle ear infection may cause a lesion of the facial nerve.

Answer 254

o Vestibule • Small bony chamber, containing the Utricle and Saccule, which are sensitive to rotational acceleration and the static pull of gravity o Semi-circular Ducts and canals • Communicate with the vestibule • Contain receptors that respond to Rotational Acceleration in three different planes o Cochlea • Shell shaped portion of the bony labyrinth containing the Cochlear Duct o Cochlear Duct • Accommodates the spiral Organ of Corti o Organ of Corti • Contains the receptors of the auditory apparatus

Answer 255

A localised collection of blood forms between the Perichondrium and the Auricular Cartilage, causing distortion of the contours of the auricle. If the blood is not aspirated, fibrosis develops in the overlying skin, forming a deformed auricle (Cauliflower or Boxer’s ear).

Answer 256

o Antihelix deformity o Pinna malformation o Pre-auricular pit o Pre-auricular skin tag

Answer 257

o Infection / Inflammation of the external acoustic meatus o Often develops in swimmers who do not dry their meatus after swimming o Itching and pain in the external ear • Pulling the auricle or applying pressure on the tragus increases pain

Answer 258

o Infection of the middle ear o Often secondary to upper respiratory infections • Via the Pharyngotympanic (Eustachian Tube) • More common in children as their Eustachian tube is shorter and more horizontal, making it easier for organisms to travel up it and harder for fluid to drain away from the middle ear o Earache and bulging red tympanic membrane • Pus or fluid in the middle ear o Inflammation of the mucous membrane lining the tympanic cavity may cause partial or complete blockage of the Pharyngotympanic (Eustachian) tube.

Answer 259

o May result from otitis media, the insertion of foreign bodies, trauma, excessive pressure (e.g. from scuba diving) o One of several causes of middle ear deafness o Minor ruptures of the membrane often heal spontaneously o Large ruptures require surgical repair

Answer 260

o Infections of the mastoid antrum and mastoid air cells o Results from Otitis Media o Causes inflammation of the mastoid process • Swelling behind the ear o Infection may spread superiorly into the middle cranial fossa through the petrosquamous fissure in children • Osteomyelitis

Answer 261

o Easily blocked by swelling of mucus membrane • Even from mild infections, e.g. a cold as walls of its cartilaginous part are normally already in apposition o When tube is occluded, residual air in the tympanic cavity is absorbed into mucosal blood vessels • Lower pressure in the tympanic cavity • Retraction of the Tympanic Membrane o Interference with the free movement of the tympanic membrane (its retraction) affects hearing o Adenoidal hypertrophy can block the opening to the tube in the Nasopharynx • Children 3-8 • Epstein-Barr Virus (EBV)

Answer 262

o E.g. from lesion of the facial nerve o Loss of protective action against loud noises o Hyperacusis or Hyperacusia

Answer 263

o Discordance between vestibular and visual stimulation

Answer 264

``` Injuries of the peripheral auditory system cause three major symptoms: 1. Hearing loss • Usually conductive 2. Vertigo • (Dizziness) • When the injury involves the semicircular ducts 3. Tinnitus • Buzzing or ringing ```

Answer 265

o Results from anything in the external or middle ear that interferes with the conduction of sound or movement of the oval or round windows. o People with this type of hearing loss often speak with a soft voice • To them, their own voices sound louder than background sounds o May be improved surgically or by use of a hearing device

Answer 266

o Results from defects in the pathway from cochlea to brain • Defects of cochlea • Defects of cochlea nerve • Defects of brainstem o Cochlear implants can restore hearing • External microphone transmitting to an implanted receiver that sends electrical impulses to the cochlea, stimulating the cochlear nerve

Answer 267

o Blockage of the cochlear aqueduct o Recurrent attacks of tinnitus, hearing loss and vertigo o Accompanied by a sense of pressure in the ear, distortion of sounds and sensitivity to noise

Answer 268

o Blockage of the Eustachian tube leads to negative middle ear pressure o Negative pressure leads to retraction pockets o Dead skin cells accumulate in the pockets o Necrotic mass of dead skin • Colesteatoma o Erosion of middle ear structures and bone via lytic enzymes

Answer 269

o Ear pain o Infection / inflammation around the ear o Pain from teeth, pharynx or cervical spine commonly referred to the ear

Answer 270

o Itching | o May result from primary disorder of the external ear, or middle ear discharge

Answer 271

o Discharge from the ear o Indicates acute or chronic infection o Blood / CSF discharge associated with skull fracture

Answer 272

The external nose is the visible portion that projects from the face. It has both bony and (predominantly) cartilaginous components and provides the opening into the nasal cavity. The nostrils are bounded laterally by alae and the skin covering the nose extends upwards into the vestibule.

Answer 273

``` The supporting skeleton of the nose is composed of bone and hyaline cartilage. o Bony part of the nose • Nasal Bones • Maxillae frontal processes • Frontal Bone (nasal part and nasal spine) o Cartilaginous part of the nose • 2 Lateral cartilages • 2 Alar cartilages • 1 Septal cartilage ```

Answer 274

``` o Anterior Portion • Cartilaginous o Middle Portion • Perpendicular plate of the Ethmoid Bone o Posterior Portion • Vomer ``` Inferiorly, the hard palate, made up of the palatine and maxillary bones, separates the nasal and oral cavities.

Answer 275

Nasal fractures are the most common facial fracture, as the nose is an exposed organ. o History of force to the face o Deformity o Complications include septal haematoma

Answer 276

``` o Nostrils o Chonchae (terbinates) • Lateral wall • Create 5 passages within the cavity o Mucosal lining • Except for vestibule (skin) • Continuous with areas draining into the cavity ```

Answer 277

The superior, middle and inferior Nasal Conchae (or terbinates) curve inferiormedially, hanging like short curtains from the lateral wall of the nasal cavity. The conchae are scroll-like structures that offer a vast surface area for heat exchange. The inferior concha is the longest and broadest and is formed by an independent bone (the Inferior Concha). The middle and superior conchae are the medial processes of the Ethmoid Bone. A recess or nasal meatus underlies each of the terbinates, diving the nasal cavity into five passages. The Sphenoethmoidal Recess, lying superoposterior to the superior conca, receives the opening of the sphenoidal sinus.

Answer 278

o Spehnoethmoidal Recess o Lining epithlium of mucus membrane is modified for the purpose of olfaction o Axonal processes of the olfactory cell pass through the cribriform plate and penetrate the meninges before entering the olfactory bulb

Answer 279

o Cribiform plate • Olfactory Nerve (CN I) runs here • Fractures may result in CSF leakage and anosmia o Sphenopalatine foramen o Incisive foramen o Foramen cecum • Nasal veins to superior saggital sinus in some individuals

Answer 280

o Branches of the Opthalmic Artery • Branch of the Internal Carotid Artery o Branches of the Maxillary and Facial Arteries • Branches of the External Carotid Artery The blood supply to the medial and lateral wall of the nasal cavity is very rich. The anterior part of the nasal septum has an area (Kiesselbach or Little’s area) that is rich in capillaries where all the arteries supplying the septum anastomose. It is this area where profuse bleeding occurs in ‘nose bleeds’.

Answer 281

Epistaxis is bleeding from the nose. It is very common and can have a local or systemic cause. Anterior bleeds account for 90% of epistaxis. The Sphenopalatine Artery causes posterior bleeds

Answer 282

A rich submucosal venous plexus, deep to the nasal mucosa, drains into the: o Cavernous Sinus o Facial Vein o Pterygoid Plexus

Answer 283

o Special Sensory (Smell) • Olfactory Nerve (CN I) o General Sensory – Posteroinferior Nasal Mucosa • Maxillary Division of the Trigeminal Nerve (CN V2) • Nasopalatine Nerve o General Sensory – Anterosuperior Nasal Mucosa • Opthalmic Division of the Trigeminal Nerve (CN V1) • Anterior and Posterior Ethmoidal Nerves o General Sensory – External Nose • External Nasal Nose (CN V1) • Infraorbital Nerve (CN V2)

Answer 284

``` o Respiratory Region • Pseudostratified columnar ciliated • With goblet cells o Olfactory Region • Olfactory cells with olfactory receptors ```

Answer 285

The paranasal sinuses are air-filled extensions of the respiratory part of the nasal cavity into cranial bones (Frontal, Ethmoid, Sphenoid and Maxilla). The sinuses are named according to the bones in which they are located.

Answer 286

The Right and Left Frontal Sinuses are between the outer and inner tables of the frontal bone, posterior to the superciliary arches and the root of the nose. They are usually detectable in children by 7 years of age (not present at birth). They each drain through a Frontonasal Duct into the ethmoidal infundibulum, which opens into the semilunar hiatus of the Middle Nasal Recess.

Answer 287

The Ethmoidal cells (Sinuses) are small invaginations of the mucous membrane of the middle and superior nasal recesses into the Ethmoid bone. The Ethmoidal cells usually are not visible in plain radiographs before 2 years of age. The Anterior Ethmoidal Cells drain directly or indirectly into the middle nasal recess through the ethmoidal infundibulum. The Middle Ethmoidal Cells open directly into the middle nasal recess. The Posterior Ethmoidal Cells open directly into the superior nasal recess.

Answer 288

The Maxillary Sinuses are the largest of the paranasal sinuses. They occupy the bodies of the Maxillae. They drain by one or more openings, the Maxillary Ostium (ostia), into the middle nasal recess by way of the semilunar hiatus.

Answer 289

The Sphenoidal Sinuses are located in the body of the sphenoid and may extend into the wings of the bone. The body of the sphenoid is fragile, and only thin plates of bone separate the sinuses from several important structures (Optic nerves and chiasm, the pituitary gland, internal carotid arteries). They are small at birth, enlarging after puberty. They drain directly into the Sphenoethmoidal Recess.

Answer 290

o The Anterior Cranial Fossa • Via the cribriform plate of the ethmoid bone o The Paranasal Sinuses • Via their openings into the nasal cavity o The Lacrimal Apparatus and Conjuctiva • Via the opening of the Nasolacrimal duct o The Middle Ear • Via the Pharyngotympanic (Eustachian) tube

Answer 291

``` Inflammation of the nasal mucosa, leading to swelling and increased volume of secretion. Causes include: o Infective (Viral) • Adenovirus • Rhinovirus • Respiratory Syncytial Virus (RSV) o Allergic o Nasal Polyps ```

Answer 292

``` o Grow close to the ostiomeatal complex of the Nasopharynx o Linked to chronic rhinosinusitis o Prevalence of ~2-4% o Nasal obstruction • Snoring / Obstructive sleep apnoea ```

Answer 293

``` o Inflammation of the mucosal lining of the sinuses o Acute – 7 to 30 days o Sub-acute – 4 to 12 weeks o Chronic – >90 days o Infection • Viral with secondary bacterial infection • Streptococcus Pneumoniae • Haemophillus Influenzae ```

Answer 294

o May break through the medial wall of the orbit • Proximity to the optic canal, transmitting the Optic Nerve (CN II) and Opthalmic Artery • Visual disorders

Answer 295

o Most commonly infected • Ostia are small and located high on the supero-medial walls o When the mucus membrane of the sinus is congested, the maxillary ostia are often obstructed o Impossible for sinuses to drain when the head is erect until they are full o When lying on your side, the upper sinus drains

Answer 296

o The three maxillary molar teeth are close to the floor of the maxillary sinus o During removal a fracture of the root may occur • Piece of root may be driven superiorly into the maxillary sinus o Communication made between oral cavity and maxillary sinus o Infection may occur Because the superior alveolar nerves (Branches of the Maxillary Nerve (CN V2)) supply both the maxillary teeth and the mucous membrane of the maxillary sinuses, inflammation of the mucosa of the sinus is frequently accompanied by a sensation of toothache in the molar teeth.

Answer 297

The nasal septum is usually deviated to one side or the other. This could be the result of a birth injury, but more often the deviation occurs during adolescence and adulthood from trauma (e.g. fist fight). Sometimes the deviation is so severe that the nasal septum is in contact with the lateral wall of the nasal cavity and often obstructs breathing or exacerbates snoring. This deviation can be corrected surgically.

Answer 298

``` o Fifth Cranial Nerve o Largest Cranial Nerve o Mixed nerve • Sensation – Principal General Sensory nerve for the head • Motor o Transit for some Autonomic Nerves o Three main branches • Opthalmic (CN V1) • Maxillary (CN V2) • Mandibular (CN V3) ```

Answer 299

The Trigeminal Nerve arises from the Lateral Aspect of the Pons by a large sensory root and small motor root. The crescent shaped Trigeminal Ganglion sits within a Dural recess, the Trigeminal Cave, which sits laterally to the cavernous sinus.

Answer 300

``` o Exits skull through the Superior Orbital Fissure o Sensory Only • Cornea • Upper conjuctiva • Nasal Cavity (Anterosuperior) • Frontal Sinus • Ethmoid Sinus • External Nose • Upper Eyelids • Forehead and scalp o Tested via the Corneal Reflex o Three branches • Frontal • Nasocillary • Lacrimal • Lacrimal Gland • Conjuctiva • Post Ganglionic Parasympathetic Fibres to Lacrimal Gland ```

Answer 301

``` o Exits the skull through the Foramen Rotundum o Sensory Only • Conjunctiva • Nasal Cavity (Posteroinferior) • Lateral External Nose • Maxillary Sinus • Superior palate • Inferior eye lid • Upper lip o 14 Terminal Branches o Associated with a parasympathetic ganglion • Pterygopalatine • Innervation of lacrimal, nasal and palate glands ```

Answer 302

``` o Exits the skull through the Foramen Ovale o Sensory o Mucous membranes o Lower Lip o Chin o External Ear (Front of auricle) o Anterior two thirds of tongue (General Sensation, not taste!) o Motor • Masseter • Temporalis • Medial and Lateral Pterygoids • Mylohyoid • Digastric • Tensor Tympani • Tensor Vele Palatini o Associated with two parasympathetic ganglia • Submandibular Ganglion • Submandibular Salivary Gland • Sublingual Salivary Gland • Otic Ganglion • Parotid Salivary Gland ```

Answer 303

``` o Exits the skull through the Stylomastoid Foramen o Mixed Nerve o Motor • Muscles of facial expression • Digastric (posterior belly) • Stylohyoid • Stapedius o Sensory • General Sensory • Small area of skin close to external acoustic meatus • Special Sensory (Taste) • Corda Tympani from the Lingual Nerve • Taste Anterior 2/3rds of the tongue o Parasympathetic • Pterygopalatine Parasympathetic Ganglion • Lacrimal Gland • Submandibular Gland • Sublingual Gland ```

Answer 304

1. Motor Cortex 2. Pons • Facial Motor Nucleus 3. Internal Acoustic Meatus • Within Petrous Temporal Bone 4. Facial Canal • Within Temporal Bone • Gives rise to: • Greater Petrosal Nerve • Nerve to the Stapedius • Chorda Tympani Nerve 5. Stylomastoid Foramen • Exits Temporal Bone • Gives rise to Posterior Auricular Branch 6. Branches to face and neck • 5 Branches • Through Parotid Gland

Answer 305

``` o Temporal • Occipitofrontalis • Orbicularis Oculi (Superior) o Zygomatic • Orbicularis Oculi (Inferior) o Buccal • Orbicularis Oris • Buccinator • Zygomaticus o Marginal Mandicular • Mentalis o Cervical • Platysma ```

Answer 306

``` Non-Traumatic Causes o Inflammation o Infection • Viral (Herpes) • Parotitis (S. Aureus) o Compression • Parotid Tumour ``` ``` Traumatic Causes o Fractures • Temporal Bone o Stabbing o Gunshots o Childbirth ``` ``` Iatrogenic o Surgery (Parotidectomy) ```

Answer 307

All muscles of facial expression paralysed

Answer 308

* Frontal Sparing * Occipitofrontalis and Orbicularis Oculi not paralysed * Due to their Bilateral Innervation

Answer 309

The Pharynx is the superior, expanded part of the Alimentary System, posterior to the nasal and oral cavities and extending inferiorly past the larynx. The Pharynx extends from the Cranial Base to the Inferior Border of the Cricoid Cartilage Anteriorly and the Inferior Border of C6 Vertebra Posteriorly. It is widest (Approximately 5cm) opposite the hyoid and narrowest (approximately 1.5cm) at its inferior end, where it is continuous with the oesophagus.

Answer 310

The Pharynx is divided into Three Parts: o Nasopharynx • Posterior to the nose and superior to the soft palate • Respiratory Function as it is the posterior extension of the nasal cavities • Pseudostratified Ciliated Epithelium with Goblet Cells • Lymphoid tissue forms a Tonsillar ring around the superior part of the pharynx, which aggregates to form the Adenoids. The adenoids may become swollen during infection in children, blocking the Eustachian tube and leading to otitis media. o Oropharynx • Posterior to the mouth • Extends from the soft plate to the superior border of the epiglottis • Digestive Function • Stratified Squamous Epithelium non-Keratinised o Laryngopharynx • Posterior to the Larynx • Ends from the superior border of the epiglottis to the inferior border of the cricoid cartilage, where it becomes continuous with the oesophagus. • Stratified Squamous Epithelium non-keratinised

Answer 311

The wall of the Pharynx consists of an incomplete outer circular muscle layer and an inner longitudinal muscle layer. The muscle layer is covered internally by the Pharyngobasilar Fascia, which is in turn covered by the Mucous Membrane.

Answer 312

o Superior Constrictor o Middle Constrictor o Inferior Constrictor • Lower horizontal fibres known as Cricopharyngeus The outer muscle layer attaches posteriorly at the midline raphe. The muscles overlap each other and are incomplete anteriorly. During swallowing the muscle constrict to propel the bolus of food downwards (involuntarily during the swallowing reflex).

Answer 313

o Stylopharyngeus o Palatopharyngeus o Salpingopharyngeus During swallowing these muscles act to shorten and widen the pharynx.

Answer 314

Innervation of the Pharynx is by the Pharyngeal Plexus of nerves. This is formed by branches of the Vagus (CN X) and Glossopharyngeal (CN IX) nerves along with sympathetic fibres from the Superior Cervical Ganglion. Sensory Innervation o Glossopharyngeal Nerve o Nasopharynx is via the Opthalmic and Maxillary divisions of the Trigeminal Nerve (CN V1+2) Motor Innervation o Vagus Nerve (CN X) o Exception to this is the Stylopharyngeus Muscle • Glossopharyngeal Nerve (CN IX)

Answer 315

1. Voluntary Phase o Tongue moves the bolus back onto the pharynx 2. Pharyngeal Phase o Afferent information from pressure receptors in the palate and anterior pharynx reaches the swallowing centre in the brain stem. o A set of movements is triggered • Inhibition of breathing • Raising of the larynx – Suprahyoid and Longitudinal Muscles • Closure of the glottis • Opening of the upper oesophageal ‘sphincter’ 3. Oesophageal Phase o The muscle in the upper third of the oesophagus is voluntary striated muscle under somatic control o The muscle of the lower two thirds is smooth muscle under control of the parasympathetic nervous system. o A wave of peristalsis sweeps down the oesophagus, propelling the bolus to the stomach in ~9 seconds. o Coordinated by extrinsic nerves from the swallowing centre of the brain o Lower oesophageal ‘sphincter’ opens

Answer 316

``` The blood supply of the Pharynx is via branches of the External Carotid Artery o Ascending Pharyngeal Artery o Lingual Artery o Facial Artery o Maxillary Artery ```

Answer 317

Venous drainage of the Pharynx is via the Pharyngeal Venous Plexus → Internal Jugular Vein.

Answer 318

``` The gag reflex tests pharyngeal innervation and musculature. It is conducted by touching the back of the oropharynx, which result in a reflex contraction of the pharyngeal muscles (makes the person gag). o Afferent Pathway • Glossopharyngeal Nerve (CN IX) o Efferent Pathway • Vagus Nerve (CN X) ```

Answer 319

o Sub-epithelial collection of lymphoid tissue o Junction of roof and poster wall of Nasopharynx o Maximal size between 3 – 8 years then regress o Enlarge with viral / bacterial infections o Recurrent infections may lead to chronically enlarge adenoids

Answer 320

o Nasal obstruction o Mouth breathing, nasal speech o Feeding difficulty (especially infants) o Snoring / Obstructive Sleep Apnoea o Block the opening of the Eustachian Tube

Answer 321

o Lie in the Tonsillar fossa between two arches • Anterior – Palatoglossal Arch • Boundary between mouth and oropharynx • Posterior – Palatopharyngeal Arch • Contains the Palatopharyngeus Muscle that blends with walls of the pharynx o Lymphoid tissue covered by squamous epithelium o Enlarge with bacterial or viral infection o Lymphatic drainage is the Jugulo-Digastric (Tonsillar) node • Angle of the mandible

Answer 322

* Potential for bleeding as the palatine tonsils are very vascular * Bleeding often from the large External Palatine Vein * Internal Carotid Artery and Glossopharyngeal Nerve lie just lateral to Tonsillar fossa

Answer 323

* Peritonsillar Abscess * Infection spread to peritonsillar tissue and abscess formation * Uvula pushed to the other side * Requires abscess drainage

Answer 324

``` Oropharynx o Vallecula • Mucosal Pouch between the base of the tongue and epiglottis o Base of tongue o Region of palatine tonsil Laryngopharynx o Piriform Fossa • Mucosal Recess between the central part of the larynx and lateral lamina of the thyroid cartilage o Cricopharyngeus ```

Answer 325

The Larynx connects the inferior Oropharynx to the Trachea. It also contains the voice box. The Larynx extends from the Laryngeal Inlet, through which it communicates with the Laryngopharynx to the level of the inferior border of the cricoid cartilage. Here the laryngeal cavity is continuous with the Trachea

Answer 326

The Larynx’s most vital function is to guard the air passages, especially during swallowing when it serves as the sphincter/valve of the lower respiratory tract, thus maintaining the airway.

Answer 327

``` Made up of the Hyoid Bone and 9 Cartilages: o 3 Unpaired Cartilages • Epiglottis • Thyroid Cartilage • Cricoid Cartilage o 1 important set of Paired Cartilages • Arytenoid Cartilage(s) o 2 other sets of Paired Cartilages • Corniculate Cartilage(s) • Cuneiform Cartilage(s) ```

Answer 328

o Leaf shaped fibro cartilage | o Attached by ligaments to the back of the hyoid bone and thyroid cartilage

Answer 329

``` o Laryngeal Prominence (‘Adam’s Apple’) o Upper surface used to Mark C4 Level • Bifurcation of common carotid artery • Level of carotid body o 2 lamina o 2 horns • Superior Thyroid Horns → Ligament → Hyoid Bone • Inferior Thyroid Horn → Synovial Joint with Cricoid ```

Answer 330

``` o Signet Ring Shaped o 2 Articular facets on each side • Inferior horn of thyroid cartilage • Arytenoid Cartilage o Surface marking for C6 Level ```

Answer 331

``` o Pyramid shaped o Crucial in vocal cord movement o Concave base articulating with cricoid o Anterior – Vocal process o Lateral – Muscular process ```

Answer 332

o A.k.a. Conus Elasticus / Lateral Cricothyroid ligament o Consists mainly of elastic fibres o Lower border attached to cricoid cartilage o Upper, Free Border = Vocal Ligament • Attached to the deep surface of the angle of the thyroid cartilage • Vocal process of arytenoid cartilage

Answer 333

``` internal cavity of the larynx is divided into three spaces: o Supraglottic space • Laryngeal Inlet → Vestibular folds (false vocal cords) o Glottis • Vocal Cords and Rima Glottis (space between vocal cords) o Subglottic Space • Below vocal cords → Lower border of Cricoid Cartilage ```

Answer 334

``` Extrinsic Muscles, which move the entire larynx o Infrahyoid muscles • Depress larynx o Suprahyoid muscles • Elevate larynx ``` ``` Intrinsic Muscles, which act on the: o Vocal folds • Open and close glottis o Aryepiglottic folds • Help to close the laryngeal inlet ```

Answer 335

The Recurrent Laryngeal Nerve supplies the intrinsic muscles. The exception is the Cricothyroid Muscle, which is supplied by the External Laryngeal Nerve.

Answer 336

o Stratified Squamous Epithelium o Vocal Ligament o Vocalis Muscle The mucosa is firmly adherent to the vocal ligament, with no submucosa. This lack of a submucosa means that: o Vocal cords look pearly white on laryngoscopy o No oedema during infections o Delayed spread of carcinoma of vocal cords

Answer 337

Intrinsic Muscles of the Larynx move the vocal cords o Abduction – Posterior Cricoarytenoid • ONLY muscle which opens the true vocal cords o Adduction – Lateral Cricoarytenoid o Cricothyroid • Only intrinsic muscle on the outside • Increases vocal cord tension • Only intrinsic muscle not supplied by Recurrent Laryngeal Nerve • Supplied by External Laryngeal Nerve

Answer 338

The Larynx is innervated by Branches of the Vagus Nerve (CN X). Superior Laryngeal Nerve o Internal Laryngeal Nerve – Sensory to Larynx above true vocal cord o External Laryngeal Nerve – Motor to Cricothyroid Muscle Recurrent Laryngeal Nerve o Sensory below the true vocal cord o Motor to all intrinsic laryngeal muscles (except Cricothyroid)

Answer 339

``` The recurrent laryngeal nerve arises from the Vagus Nerve (CN X). o Right Recurrent Laryngeal Nerve • Descends to T2 • Curves around the Subclavian Artery o Left Recurrent Laryngeal Nerve • Descends to T4 • Curves around the Arch of the Aorta ``` The nerves then course back up the neck to the larynx, lying between the trachea and oesophagus.

Answer 340

Pathology in the neck and chest can cause Recurrent Laryngeal Nerve palsy, leading to intrinsic laryngeal muscle weakness. This presents as hoarseness of voice. Hoarseness for longer than three weeks is a red flag symptom and needs evaluation to exclude malignancy. Some causes of Hoarseness of Voice: o Infection • Laryngitis – Viral, Streptococcal o Overuse of the voice o GORD – Gastro Oesophageal Reflux o Benign nodules on vocal cords (Singers) o Apical Lung Tumour • Recurrent Laryngeal Nerve Palsy (Both sides) o Bronchial Carcinoma • Left Recurrent Laryngeal Nerve Palsy (right doesn’t go low enough)

Answer 341

The Larynx is supplied by the Superior and Inferior Laryngeal Arteries, which are branches of the Superior and Inferior Thyroid Arteries respectively. External Carotid Artery → Superior Thyroid Artery → Superior Laryngeal Artery Subclavian Artery → Inferior Thyroid Artery → Inferior Laryngeal Artery

Answer 342

The larynx is drained by the Superior and Inferior Laryngeal Veins, which accompany the corresponding arteries. The Superior Laryngeal Vein joins the Superior Thyroid Vein before draining into the Internal Jugular Vein. The Inferior Laryngeal Vein joins the Inferior Thyroid Vein, which empties into the Left Brachiocephalic Vein.

Answer 343

Upper airway / laryngeal obstruction may be caused by: o Laryngeal Oedema • Infection – Acute epiglottitis, croup, anaphylaxis o Inhalation of foreign body o Tumours In an emergency situation an aiway is opening through the Cricothyroid Membrane (Cricothyroidotomy). If less urgent, a Tracheostomy is performed (opening into the trachea).

Head And Neck Flashcards

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