Head and Neck

Question 1

Free edges of tentorium cerebelli around the midbrain (across the tentorial notch) allows ____________ which will compress the ________________, affecting?

Answer 1

Herniation; brainstem; cardiorespiratory functions

• can be treated partially by hypertension to affect the acid base balance to decrease swelling, or using IV corticosteroids

Question 2

Danger area?

Answer 2

1. From facial vein via the superior and inferior ophthalmic veins to carvenous sinus
2. Deep facial vein to pterygoid venous plexus

Question 3

Inferior petrosal sinus drains to?

Answer 3

IJV directly

Question 4

Pterion?

Answer 4

• made up of frontal bone, sphenoid bone, parietal bone, temporal bone
• middle meningeal artery, epidural bleeding

Question 5

Dural sinuses are between?

Answer 5

The meningeal layer and periosteum laters of dura

Question 6

Aponeurosis layer of scalp?

Answer 6

Contains occiptofrontalis > occipitals and frontalis muscles

Question 7

Why is loose alveolar connective tissue the danger area of the scalp?

Answer 7

Pus or blood can spread easily in it. Can pass into the cranial cavity through emissary veins > through calvaria to reach intracranial sinuses

• cannot pass into neck because occipitalis attaches to occipital bone
• cannot pass through zygomatic arches because aponeurosis is continuous with temporal fascia
• can enter eyelids and root of nose because frontalis inserts into skin and subcutaneous tissue

Question 8

What holes do the greater and lesser wing of sphenoid contains?

Answer 8

Greater: foramen ovale, rotundum and spinosum;
Lesser: Optic canal, superior orbital fissure

Question 9

Layers of eyelid?

Answer 9

Skin, subcutaneous tissue, obicularis oculi, orbital septum, tarsal plates, palpebral conjunctiva

Question 10

Use of tarsal glands?

Answer 10

Secrete oily substance to slow evaporation of tear film; prevent eyes from sticking together when closed

Question 11

Horner’s syndrome symptoms?

Answer 11

• Partial ptosis;
• Miosis = pupillary constriction (due to unopposed parasympathetic)
• Anhidrosis (cannot sweat normally)
• Flushing of face （due to unopposed vasodilation)

Question 12

Horner’s syndrome major causes?

Answer 12

= disruption of the sympathetic pathways related to superior cervical ganglion
- apical lung tumor eroding the cervicothoracic ganglion/surgically induced in order to treat patients who suffered from severe hyperhidrosis

Question 13

Parotid gland is supplied by __________ artery.

Answer 13

Transverse facial

should be from ECA, superficial temporal artery and maxillary artery (web)

Question 14

Sensory innervation of the face?

Answer 14

Trigeminal nerve and cutaneous branches of cervical spinal nerves (C2-3)

Question 15

Bell’s palsy symptoms?

Answer 15

Facial nerve palsy

• inability to close eyes
• inability to lift corner of mouth

Question 16

Medial pterygoid muscles attachments?

Answer 16

Deep head: medial surface of lateral pterygoid plate;

Superficial head: tuberosity of maxilla

Question 17

Lateral pterygoid muscles attachment?

Answer 17

Upper head: roof of infratemporal fossa;

Lower head: lateral surface of lateral pterygoid

Question 18

Maxillary nerve and artery are from which holes?

Answer 18

Maxillary nerve: from foramen rotundum;

Maxillary artery: from infra temporal fossa via pterygomaxillary fissure

Question 19

Inferior alveolar nerve supplies what special muscles?

Answer 19

Mylohyoid and anterior belly of digastric

Question 20

Nerve to medial pterygoid (V3) also supplies?

Answer 20

Tensor palatini and tensor tympani

Question 21

Lingual nerve injury signs?

Answer 21

loss of somatic sensation of anterior 2/3 of tongue

if related to chorda:
Loss of taste and secretion from salivary glands depends on location of lesion > distal to site where it is joined by chorda tympani

Question 22

Phrenic nerve is in which fascia and lies on?

Answer 22

Prevertebral fascia on anterior scalene muscle (right)

Question 23

Alar fascia?

Answer 23

Fascia in front of prevertebral fascia

Question 24

Danger space? (between? and significance?

Answer 24

Between alar fascia and prevertebral fascia which extends downwards to the diaphragm (posterior mediastinum) - if infections of lymph nodes pierces through the alar fascia, infection may spread inferiorly to the mediastinum

Question 25

Thyroidectomy

Answer 25

damage recurrent laryngeal nerve (paralyse vocal cord related muscles)

Question 26

Injury to the external laryngeal nerve?

Answer 26

Supplies the cricothyroid muscles > unable to tense cord, thus monotonous

Question 27

Superior constrictor attachment? | Middle and inferior?

Answer 27

Superior: Pterygomandibular raphe; Middle: Hyoid bone Inferior: Cricoid and thyroid cartilages

Question 28

Internal jugular vein is a guide for surgeons to? | Facial vein?

Answer 28

Remove deep cervical lymph nodes.; | landmark in removal of jugulodigastric and upper anterior group of deep cervical lymph nodes

Question 29

Location of IJV? Injection there caution?

Answer 29

Lesser supraclavicular fossa, | needle pointed backwards and upwards to prevent puncture of cervical pleura > pneumothorax

Question 30

IJV is crossed by? (muscles , arteries and nerves)

Answer 30

posterior belly of digastric, inferior belly of omrohyoid; | occipital and posterior auricular artery, spinal accessory nerve and ansa cervicalis

Question 31

Right phrenic is near? | Left phrenic?

Answer 31

Right: 2nd part of subclavian (lateral to branches of cerebral, thyrocervical and internal thoracic arteries) Left: 1st part of subclavian

Question 32

How will infections from the ethmoidal sinus cells spread?

Answer 32

To orbit via fragile medial wall if the nasal drainage is blocked. May cause blindness due to proximity to optic canal.

Question 33

Inflammation of nasal mucosa will spread to?

Answer 33

1. Anterior cranial fossa via cribriform plate; 2. Nasopharynx and retropharyngeal soft tissues, middle ear through auditory tube 3. Paranasal sinuses, lacrimal apparatus, conjunctiva

Question 34

Kiesselbach area?

Answer 34

On nasal septum; anastomosis of arteries from: ophthalmic artery (ethmoidal artery, nasal branches) + maxillary artery (sphenopalatine artery, nasal palatine arteries) + facial arteries ) (labial and nasal branches)

Question 35

Which sinus is most commonly affected?

Answer 35

Maxillary sinus, because their ostia is small and located high on their superomedial walls. When mucus membrane of sinus is congested, the maxillary ostia are often obstructed; also because of its position, sinus is difficult to drain when person is upright

Question 36

If blockade of airway above vocal cord, which ligament can be perforated to allow air flow?

Answer 36

Median cricothyroid ligament

Question 37

Relations of hyoglossus.

Answer 37

Medial: CN9 and lingual artery; Lateral: CN12 and lingual nerve, submandibular gland

Question 38

Lingual artery arises from ECA, lies on _________ muscles of pharynx. It passes deep to?

Answer 38

Middle constrictor; | CN12; stylohyoid muscle, posterior belly of digastric muscle and disappears deep to hyoglossus muscle

Question 39

Cervical sympathetic trunk lies __________ to carotid sheath, in which fascia?

Answer 39

Posterior; | preveretbral layer of deep cervical fasciae

Question 40

Chorda tympani passes through the ____________ before entering the infratemporal fossa

Answer 40

petrotympanic fissure

Question 41

Fibers that passes through the ciliary ganglion.

Answer 41

1. Presynaptic parasympathetic fibers from EW nucleus via CN3, synapse to become short ciliary nerves 2. Nasociliary nerve (V1) - general sensory fibers 3. Postsynaptic sympathetic fibers from superior cervical ganglion > ICA > long ciliary nerves of nasociliary nerve

Question 42

Fibers that passes through the pterygopalatine ganglion in pterygopalatine fossa.

Answer 42

1. Greater petrosal branch of CN7 2. Postganglionic parasympathetic leave the ganglion and distribute with maxillary nerve (zygomatictemporal branch) to supply lacrimal gland and mucosal glands of oral cavity, nose and pharynx 3. Sympathetic fibers 4. General sensory fibers transverse the ganglion without synapsing

Question 43

Fibres that pass through submandibular ganglion.

Answer 43

1. Postsynaptic parasympathetic fibers in submandibular ganglion hangs off the lingual nerve (chorda tympani) in the floor of oral cavity 2. NO taste fibers!!

Question 44

Fibers that passes through the otic ganglion

Answer 44

1. Lesser petrosal nerve from CN9 | 2. Postganglionic parasympathetic travels along auriculotemporal nerve (V3)

Question 45

13. Taste fibres from the soft palatine carried by? a) Greater petrosal nerve b) Deep petrosal nerve c) Lesser petrosal nerve d) Chorda tympani

Answer 45

A