Head and Neck Anatomy (5-6)

Question 1

State the structures in the mouth.

Answer 1

Question 2

Name the 2 folds and 2 muscles in the oral cavity

Answer 2

Question 3

State the location where fish bones are prone to piercing.

Does the posterior 1/3 of tongue make up this location?

Answer 3

1. Vallecula = an anatomical depression located at the base of the tongue, just anterior to the epiglottis
2. Pyriform recess at lateral wall of laryngopharynx

No, the posterior 1/3 does not contribute to this location.

Question 4

State the structures of the tongue

Answer 4

Important:
- circumvillate papillae (TASTE BUDS) = anterior to terminal sulcus
- fungiform papillae = lateral aspect of anterior 2/3 of tongue
- filliform papillae = medial aspect of anterior 2/3 of tongue
- terminal slulcus

Question 5

Recap: State the cranial nerves that supply tongue and its muscles

Answer 5

TONGUE

(1) SOMATOSENSORY
- anterior 2/3 of tongue = CN V (lingual N -V3)
- posterior 1/3 of tongue = CN IX

(2) SPECIAL SENSORY (TASTE)
- anterior 2/3 of tongue = CN VII (chorda tympani)
- posterior 1/3 of tongue = CN IX

(3) SOMATOMOTOR
- somatomotor = palatoglossus (along with mucles of pharynx except stylopharyngeus, muscles of larynx, muscles of palate except tensor tympani) (pharyngeal branch - CN X)
- somatomotor = all muscles of tongue (CN XII)

Question 6

State the 4 extrinsic muscles of the tongue. State their actions, origin and insertion and motor supply.

Answer 6

(1) PALATOGLOSSUS
- elevation
- soft palate –> tongue

(2) GENIOGLOSSUS
- protrusion
- genioid tubercle (mandible) –> tongue

(3) HYOGLOSSUS
- depression
- hyoid bone –> tongue

(4) STYLOGLOSSUS
- retraction
- styloid process –> tongue

ALL tongue muscles are supplied by CN XII except palatoglossus which is supplied by CN X.

Question 7

State the presentation of hemiparesis of genioglossus muscle

Answer 7

Deviation of tongue towards the paralysed side

Question 8

State the blood supply/drainage and innervation to the muscles of tongue and mucosa of tongue.

Answer 8

MUSCLES OF TONGUE
Blood supply = lingual A + ascending pharyngeal A (branches of ECA)

Blood drainage = lingual V (branch of IJV)

Innervation = All muscles of tongue except palatoglossus innervated by CN XII (hypoglossal N), palatoglossus innervated by CN X (vagus N)

TONGUE
Blood supply = lingual A + ascending pharyngeal A (branches of ECA)
Innervation = anterior 2/3 (CN V -V3 lingual N), anterior 2/3 (CN VII - chorda tympani), posterior 1/3 of tongue (CN IX)
Mucosa = NKSSE (non-keratinised stratified squamous epithelium)

Question 9

State the location of the soft and hard palates.

State the structures underlying the palates.

Answer 9

SOFT PALATE:
- location = posterior 1/3 (oropharynx)
- bones and muscles underlying

HARD PALATE:
- location = anterior 2/3 (oral cavity proper)
- bones underlying only

Question 10

State the structure that separates the oral cavity proper and oropharynx. State the boundaries of this structure

Answer 10

OROPHARYNGEAL ISTHMUS
- laterally - palatoglossal folds
- inferiorly - posterior 1/3 of tongue
- superficially - soft palate

Question 11

With regard to HARD PALATE and SOFT PALATE, state the
(1) Fossa
(2) Arteries, Veins, Nerves supplying

Answer 11

HARD PALATE
(1) INCISIVE FOSSA - nasopalatine N + sphenopalatine A (branch of maxillary A - branch of ECA)
(2) GREATER PALATINE FORAMEN - greater palatine N + greater palatine A

SOFT PALATE
(1) LESSER PALATINE FORAMEN - lesser palatine N + lesser palatine A
(2) Facial A (branch of ECA) –> ascending palatine A
(3) Ascending pharyngeal A (branch of ECA) –> palatine A

Question 12

State the 5 muscles of the soft palate. State their functions.

Answer 12

1. tensor veli palatini - tenses soft palate
2. levator veli palatini - elevate soft palate
3. palatopharyngeus - elevates pharynx if soft palate fixed, depresses soft palate if pharynx is fixed
4. palatoglossus - elevates tongue if soft palate fixed, depresses soft palate if tongue is fixed
5. musculus uvulae

ALL muscles of the palate are supplied by CN X (vagus N) except tensor veli palatini which is supplied by CN V since it is derived from 1st pharyngeal arch

Question 13

Recall the location of submandibular and sublingual glands with respect to the mylohyoid.

Answer 13

Submandibular gland - hooks around mylohyoid

Sublingual gland - anterior to mylohyoid (mylohyoid forms the floor of the oral cavity)

Question 14

State the 2 branches of V3 division of trigeminal N that splits in ____.
State the supply of the 2 branches.

State any further branches of the nerves.

Answer 14

V3 (mandibular) division of trigeminal N splits into 2 branches at infratemporal fossa
(1) INFERIOR ALVEOLAR N - supplies mandibular teeth and gingiva & nerve to mylohyoid (supplies mylohyoid + anterior belly of digastric muscle)
(2) LINGUAL N - supplies somatosensory innervation of anterior 2/3 of tongue

Question 15

____ ____ of CN____ hitchhikes onto ____ nerve of CN ____
- Parasympathetic component of ____ ____ synapses onto ____ ganglion to supply the ____ and ____ glands

Answer 15

CHORDA TYMPANI of CN7 hitchhikes onto LINGUAL nerve of CN5
- Parasympathetic component of CHORDA TYMPANI synapses onto SUBMANDIBULAR ganglion to supply the SUBMANDIBULAR and SUBLINGUAL glands

Question 16

Match each histological slide to
(1) Submandibular, (2) Sublingual, (3) Parotid gland

Answer 16

Question 17

With reference to the TMJ (temporomandibular joint), state the
(1) Articulation
(2) Posterior relations
(3) Type of joint

Answer 17

With reference to the TMJ (temporomandibular joint), state the
(1) Articulation = Head of the mandible + mandibular fossa of the temporal bone + articular tubercle of temporal bone
(2) Posterior relations = external acoustic meatus, stylomastoid foramen, mastoid process, styloid process
(3) Type of joint = modified hinge-type synovial joint (covered by fibrocartilage instead of hualine cartilage as in a typical synovial joint)

Question 18

Name the 2 structures that run through the mandibular foramen

Answer 18

1. inferior alveolar N (branch of V3)
2. inferior alveolar A

Question 19

State the 2 structures that attach to genioid tubercles

Answer 19

1. genioglossus
2. geniohyoid

Question 20

State the direct and indirect ligaments of the TMJ (temporomandibular joint).

Answer 20

Direct = lateral ligament and capsule
Indirect = stylomandibular (thickening of fibrous capsule of parotid gland) and sphenomandibular ligaments (runs from spine of sphenoid to lingula of mandible)

Question 21

State the muscles involved in protrusion and retraction of mandible.

Answer 21

PROTRUSION
- lateral pterygoid

RETRACTION
- posterior fibres of temporalis
- deep part of masseter
- geniohyoid
- digastric muscles

Question 22

State the muscles involved in elevation and depression of the mandible.

Answer 22

ELEVATION
- anterior fibres of temporalis
- masseter
- medial pterygoid

DEPRESSION
- gravity
- digastric muscles
- geniohyoid
- mylohyoid
- lateral pterygoid (jaya says main??)

Question 23

State the muscles involved in protrusion, retraction, elevation and depression of mandible.

Answer 23

PROTRUSION
- lateral pterygoid
- medial pterygoid

RETRACTION
- posterior fibres of temporalis
- deep part of masseter
- geniohyoid
- digastric

ELEVATION
- anterior fibres of temporalis
- masseter
- medial pterygoid

DEPRESSION
- gravity
- geniohyoid
- mylohyoid
- digastric muscles
- lateral pterygoid (?? jaya says main muscle)

Question 24

MUSCLES OF MASTICATION:
- ____ gland lies on ____, ____ gland pierces ____ in front of ____
- ____ pterygoid is attached to the ____ surface of ____ pterygoid ____
- ____ pterygoid is attached to the ____ surface of ____ pterygoid ____
- ____ fibres converge and attach to the ____ process of mandible

Answer 24

MUSCLES OF MASTICATION:
- PAROTID gland lies on MASSETER, PAROTID gland pierces BUCCINATOR in front of MASSETER
- LATERAL pterygoid is attached to the LATERAL surface of LATERAL pterygoid PLATE
- MEDIAL pterygoid is attached to the MEDIAL surface of LATERAL pterygoid PLATE
- TEMPORALIS fibres converge and attach to the CORONOID process of mandible

Question 25

State the 4 branches of maxilary A that supply the oral cavity.

Answer 25

Maxillary A is a branch of ECA. 1. sphenopalatine A 2. greater palatine A 3. lesser palatine A 4. inferior alveolar A

Question 26

State the 3 structures that pass through the parotid gland

Answer 26

1. facial N (CN VII) - temporal, zygomatic, buccal, marginal mandibular, cervical 2. retromandibular V 3. ECA (branches into 8 branches only in parotid gland)

Question 27

State the sensory and secretomotor innervation of the parotid gland

Answer 27

Sensory = auriculotemporal N (mandibular nerve (V3)) Secretomotor = salivatory ganglion --> otic ganglion --> parotid gland

Question 28

State the contents of the pterygopalatine fossa (1) Veins (2) Nerves (3) Arteries

Answer 28

**PTERYGOPALATINE FOSSA** (1) **Veins** - ***pterygoid plexus of veins*** --> drains into cavernous sinus via emissary veins (risk of infection) (2) **Nerves** - ***Pterygopalatine ganglion of lacrimal nucleus (CN7)*** + ***V2 of Trigeminal nerve*** exits from the foramen rotundum in the cranial cavity → Pterygopalatine fossa (3) **Arteries** - ***sphenopalatine artery*** + ***Maxillary artery starts at the infra temporal fossa*** → then enters the pterygopalatine fossa

Question 29

State the epithelium of nasopharynx, oropharynx and laryngopharynx.

Answer 29

nasopharynx = respiratory epithelium (pseudostratified ciliated columnar epithelium) oropharynx = stratified squamous epithelium laryngopharynx = stratified squamous epithelium

Question 30

State the 3 openings of the pharynx. State their sensory innervation

Answer 30

nasopharynx (CN V2) = posterior nasal aperture oropharynx (CN IX) = oropharyngeal isthmus laryngopharynx (CN X) = laryngeal inlet

Question 31

State the stuctures that make up the WALDEYER'S RING

Answer 31

**WALDEYER'S RING** 1. palatine tonsils 2. pharyngeal tonsils 3. lingual tonsils

Question 32

**NASOPHARYNX** - runs from ____ nasal ____ to ____ ____ - ____ veli palatini runs from ____ ____ to ____ ____

Answer 32

**NASOPHARYNX** - runs from **POSTERIOR** nasal **APERTURE** to **SOFT PALATE** - **LEVATOR** veli palatini runs from **SOFT PALATE** to **EUSTACHIAN TUBE**

Question 33

**OROPHARYNX** - Runs from ____ ____ to upper end of ____ - Recap: State the structure that separates the oral cavity proper and the oropharynx

Answer 33

**OROPHARYNX** - Runs from **SOFT PALATE** to upper end of **EPIGLOTTIS** - **Structure** = oropharyngeal isthmus (laterally bounded by palatoglossal fold, superiorly bounded by soft palate, inferiorly bounded by posterior 1/3 of tongue)

Question 34

State the 4 components of closure of oropharyngeal isthmus

Answer 34

1. medial and downward movement of palatoglossal arches 2. medial and downward movement of palatopharyngeal arches 3. upward movement of tongue 4. downward and forward movement of soft palate

Question 35

State the 2 groups of muscles of the pharynx

Answer 35

**LONGITUDINAL (SSP)** - salpingopharyngeus (from eustachian tube) - stylopharyngeus (from styloid process) - palatopharyngeus (from soft palate) **CONSTRICTOR/SPHINCTER** - superior, middle and inferior

Question 36

With regard to **longitudinal muscles**, state their (1) function (2) motor supply (3) blood supply

Answer 36

LONGITUDINAL MUSCLES (salpingopharyngeus, stylopharyngeus, palatopharyngeus) (1) function = shorten and widens pharynx (2) motor supply = ALL supplied by CN X except stylopharyngeus (CN IX) (3) blood supply = pharyngeal branches from ECA and branches from lingual and facial artery

Question 37

With reference to the larynx, state the (1) Borders (2) Lining epithelium (3) Spaces + Folds

Answer 37

***LARYNX*** (1) **Borders** - from upper border of epiglottis to lower border of cricoid cartilage (2) **Lining epithelium** - respiratory epithelium (pseudostratified ciliated columnar epithelium) (3) **Spaces + Folds** - vestibular & vocal folds, ***rima vestibule*** (space between vestibular folds), ***rima glottidis*** (space between vocal folds)

Question 38

Are the vocal folds and vestibular folds covered by epithelium? What kind of epithelium if they are covered?

Answer 38

**vocal folds** - **SSNKE** (stratified squamous non-keratinised epithelium) **vestibular folds** - **PCCE** (pseudostratified ciliated columnar epithelium)

Question 39

Name the unpaired and paired cartilages of the larynx

Answer 39

UNPAIRED - epiglottis, thyroid, cricoid PAIRED - arytenoid, corniculate, cuneiform

Question 40

Name and locate the laryngeal cartilages.

Answer 40

Question 41

Name the intrinsic muscles of the larynx. Hint: Draw table with thyroid, cricoid, epiglottis and arytenoid.

Answer 41

**INTRINSIC MUSCLES OF THE LARYNX:** Thyroid - cricothyroid, thyroepiglottis, thyroarytenoid, vocalis Cricoid - cricoarytenoid (lateral and posterior) Epiglottis - aryepiglottis Arytenoid - interarytenoid (transverse arytenoid), oblique arytenoid

Question 42

State the intrinsic muscles involved in the **adduction** and **abduction** and **tension** of **vocal folds**.

Answer 42

adduction of vocal folds - **all intrinsic muscles** abduction of vocal folds - **posterior cricoarytenoid** tension of vocal folds - **cricothyroid** --> high pitch sounds by pushing thyroid cartilage forward

Question 43

State the boundaries of the laryngeal inlet. State the structure the laryngeal inlet opens into.

Answer 43

**LARYNGEAL INLET:** ***Superiorly*** - epiglottis ***Laterally*** - aryepiglottic folds ***Posteriorly*** - interarytenoid folds Laryngeal inlet opens into **laryngopharynx**

Question 44

With reference to the LARYNX, state the (1) nervous supply (2) blood supply

Answer 44

**LARYNX** **(1) nervous supply = CN X (gives rise to superior laryngeal nerve + recurrent laryngeal nerve)** - **superior laryngeal nerve** branches into ***external laryngeal*** (supplies *cricothyroid*) and ***internal laryngeal*** (supplies area *above vocal folds*) - ***recurrent laryngeal nerve*** supplies *all other muscles in larynx* and *area below vocal folds* **(2) blood supply = superior thyroid A (branch of ECA) + inferior thyroid A**

Question 45

State the type of cartilage epiglottis is. State if this is typical or atypical .

Answer 45

epiglottis = elastic cartilage all other cartilage is hyaline

Question 46

If patient presents with hoarseness of voice and inability to speak at higher pitches, what structure is likely to be affected and why?

Answer 46

CRICOTHYROID is likely affected - cricothyroid acts to tense vocal folds by pushing thyroid cartilage outwards --> produce higher pitch sounds

Question 47

**EXTERNAL EAR:** - ____ 2/3 is ____ ____ - ____ 1/3 is ____ ____ - From ____ to ____

Answer 47

***EXTERNAL EAR:*** - **LATERAL 2/3** is **ELASTIC CARTILAGE** - **MEDIAL 1/3** is **BONEY STRUCTURES** - From **AURICLE** to **TYMPANIC MEMBRANE**

Question 48

**MIDDLE EAR** - Contains ____ ossicles = - Between ____ and ____ = ____ joint - Between ____ and ____ = ____ joint - State the structure that sits on the oval window. State the pathway of vibrations.

Answer 48

**MIDDLE EAR** - Contains **3** ossicles = ***malleus --> incus --> stapedes*** - Between **MALLEUS** and **INCUS** = **INCUDO-MALLEOLAR** joint - Between **INCUS** and **STAPEDES** = **INCUDO-STAPEDIO** joint - **STAPEDES** sits on the oval window --> **vibrates** --> **stimulate organ of corti found in cochlear duct**

Question 49

**MUSCLES OF THE MIDDLE EAR** ***(1) Tensor tympani*** - muscle of the ____ pharyngeal arch - supplied by CN ____ - contration of muscle --> ____ ossicles ____ to stop sound from entering inner ear ***(2) Chorda tympani*** - muscle of the ____ pharyngeal arch - supplied by CN ____ - contraction of muscle --> ____ ossicles ____ to stop sound from entering inner ear

Answer 49

**MUSCLES OF THE MIDDLE EAR** ***(1) Tensor tympani*** - muscle of the **1ST** pharyngeal arch - supplied by **CN 5** - contration of muscle --> **PULLS** ossicles **AWAY** to stop sound from entering inner ear ***(2) Chorda tympani*** - muscle of the **2ND** pharyngeal arch - supplied by **CN 7** - contraction of muscle --> **PULLS** ossicles **AWAY** to stop sound from entering inner ear

Question 50

State the blood supply to the different parts of the ear

Answer 50

**Inner ear**: Labrynthine artery (remember passes through IAM with CN7 and CN8), is a branch of the basilar arteries **Middle and External ear:** both maxillary

Question 51

**INNER EAR** - Is a _____ _____ - Consists of ____ and ____ - Cochlea = - Vestibular system (____, ____, ____) = - Cochlear N + Vestibular N = CN ___

Answer 51

**INNER EAR** - Is a **BONY LABYRINTH** - Consists of **COCHLEA** and **VESTIBULAR SYSTEM** - Cochlea = **hearing (impulses passed on through cochlear N to brain)** - Vestibular system (**UTRICLE, SACCULE, SEMICIRCULAR CANALS**) = **balance and posture (impulse passed on to brain via vestibular N)** - Cochlear N + Vestibular N = **CN 8**