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Head and Neck Anatomy Flashcards

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1
Q

CN I

A

Olfactory

Special sensory: smell

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2
Q

CN II

A

Optic

Special sensory: vision

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3
Q

CN III

A

Occulomotor

Motor: -

superior rectus

  • inferior rectus
  • medial rectus
  • inferior oblique
  • levator palpebrae superioris

Parasympathetic:

  • changes lens shape for accommodation
  • constricts pupil and ciliary muscle
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4
Q

CN IV

A

Trochlear

Motor: superior oblique

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5
Q

CN V

A

Trigeminal

SENSORY!!! and motor (V3 only)

V1 = Opthalmic

V2 = Maxillary

V3= Mandibular

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6
Q

CN VI

A

Abducens

Motor: lateral rectus

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7
Q

CN VII

A

Facial

Sensory: taste on anterior 2/3 of tongue

Motor:

  • facial expression
  • Stapedius muscle to dampen sound
  • Orbicularis occuli to close eyes

Parasympathetic: “spitting and crying” - lacrimal gland - nasal mucosa - 2/3 salivary gland

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8
Q

CN VIII

A

Vestibulocochlear

Sensory: balance and hearing

Motor: inhibitory efferents allow hair cells to modify sounds coming in

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9
Q

CN XI

A

Glossopharyngeal

Sensory: gag reflex, sensation in the back of the tongue, hearing,

Parasymathetic: parotid salivary glands

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10
Q

CN X

A

Vagus

Sensory: Parasympathetic: Motor:

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11
Q

CN XI

A

Spinal Accessory

Motor: to sternocleidomastooid then trapezius muscle to lift shoulders up and down, move head side to side

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12
Q

CN V1

A

Opthalmic nerve

Sensory: forehead, cornea, tip of nose

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13
Q

CN V2

A

Maxillary nerve

Sensory: cheek, upper lip, roof of mouth

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14
Q

CN V3

A

Mandibular nerve

Sensory: chin, bottom lip

Motor:

  • Anterior belly of digastric (nerve to myohyoid)
  • Myohyoid (nerve to myohyoid)
  • Temporalis (deep temporal)
  • Tensor palati
  • Tensor tympani- to dampen sound
  • Lateral pterygoid nerve
  • Medial pterygoid nerve
  • Masseter
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15
Q

Branches of V1

A

NFL

Nasocilliary

Frontal

Lacrimal

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16
Q

Branches of CN VII that innervate orbicularis occuli

A

Temporal branch: superior eyelid

Zygomatic branch: inferior eyelid

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17
Q

CN XII

A

Hypoglossal

Motor: movement of tongue

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18
Q

Three cranial nerves whose nuclei are not located in brainstem

A

CN I, II, XI

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19
Q

Spinal roots of CN XI

A

C1-C5

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20
Q

Cranial nerves that contain PRESYNAPTIC PARASYMPATHETIC fibers

A

3, 7, 9, 10

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21
Q

Special sense only CN

A

1, 2, 8

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22
Q

Motor only (striated)

A

IV, VI, XI, XII

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23
Q

Two layers of dura

A

Periosteal layer (continuous with bone) Intermeningial layer (continuous with spinal cord dura)

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24
Q

3 cranial meninges

A
  1. Pia mater 2. Arachnoid mater 3. Dura mater
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25
How is the arachnoid mater held against the dura?
pressure from CSF
26
3 parts of the arachnoid space
1. granulations (allow CSF absorption into venous structures) 2. trabeculae (merges with pia) 3. sub arachnoid space
27
rupture of middle meningeal artery due to hard blow to the head blood strips dura from cranium arterial in origin
Epidural hemorrhage
28
separates dura/arachnoid due to blow to head that jerks brain inside cranium venous in origin
Subdural hemorrhage
29
due to aneurysm arterial in origin
Subarachnoid hemorrhage
30
what exits the supraorbital foramen?
V1 supraorbiral branch
31
what exits the infraorbiral foramen?
V2
32
Portion of skull the middle meningial arteriy lies under
Pterion
33
skull fracture at middle meningial artery causes
epidural hematoma
34
is the groove/hiatus for greater or lesser petrosal more ANTERIOR?
Lesser petrosal nerve
35
Which is more ANTERIOR, jugular foramen or internal auditory meatus?
internal auditory meatus
36
What passes through the stylomastoid foramen?
Facial Nerve (CN VII)
37
What passes through the jugular foramen?
jugular vein CN IX, X, XI
38
What passes through the carotid canal?
internal carotid artery
39
What exits through the hypoglossal canal?
Hypoglossal nerve
40
What passes through the foramen spinosum?
Middle meningial artery
41
What exits through foramen rotundum?
V2
42
What exits through foramen ovale?
V3
43
What exits through the cribiform plate?
Olfactory nerve
44
What exits through the optic canal?
Optic nerve and opthalmic artery
45
What exits through the superior orbital fissure?
CN III, IV, V1, VI
46
What exits through the internal acoustic meatus?
CN VII, VIII
47
What exits through the hypoglossal canal?
CN XII
48
infection of the arachnoid and pia mater
meningitis
49
dizziness, nausea, fatgue, metalic taste in mouth
CSF leak from subarachnoid space to dura
50
interruption of normal SCF absorption through the arachnoid granulations
Hydrocephalous
51
Stroke vs TIA
Stoke: results in impaired neurological function after 24 hours TIA: Impairment resolves within 24 hours
52
CN I exits cranial cavity..
cribriform plate/foramina
53
CN II exits the cranial cavity...
Optic canals
54
CN III exits the cranial cavity...
superior orbital fissure
55
CN IV exits the cranial cavity...
suprior orbital fissure
56
V1 exits the cranial cavity...
superior orbital fissure
57
V2 exits the cranial cavity...
foramen rotundum
58
V3 exits the cranial cavity...
foramen ovale
59
CN VI exits the cranial cavity...
superior orbital fissure
60
CN VII exits the cranial cavity...
internal auditory meatus
61
CN VIII exits the cranial cavity...
internal auditory meatus
62
CN IX exits the cranial cavity...
jugular foramen
63
CN X exits the cranial cavity...
jugular foramen
64
CN XI exits the cranial cavity...
jugular foramen
65
CN XII exits the cranial cavity...
hypoglossal canal
66
levator palpebrae superioris innervation
CN III and sympathetics
67
what do the levator palpebrae superioris and superior tarsal muscles attach to?
tarsal plate
68
superior tarsal muscle innervation
sympathetics
69
layer of the eye that contains blood vessels to give "blood shot" appearance
bulbar conjunctiva
70
ptosis
drooping eyelid due to loss of sympathetics to superior tarsal muscle
71
2 symptoms of Horner's Syndrome
1. ptosis 2. miosis
72
Horner's syndrome results from
loss of sympathetic nerve supply to the head
73
Lesion to CN III (2 things)
1. completely closed eyelid 2. mydriasis (due to unopposed sympathetics)
74
Flow of tears
1. lacrimal gland 2. puncta 3. lacrimal canaliculi 4. lacrimal sac 5. nasolacrimal duct empties into nasal cavity
75
CN III innervates what eye muscles
levator palpebrae superioris superior rectus medial rectus inferior rectus inferior oblique
76
CN IV innervates what eye muscles
superior oblique
77
CN VI innervates what eye muscles
lateral rectus
78
Branches of the nasocilliary nerve
Short ciliary Long ciliary Anterior and Posterior Ethmoidals
79
branches of frontal nerve
supraorbital supratrochlear
80
Long and short ciliary nerves go to
globe of eye
81
ethmoidals of V1 nasociliary go to
nose
82
what branch of V1 supplies sensation to the forehead?
Frontal Supraorbital is more superior to supratrochlear
83
long ciliary nerve has what type of fibers from what ganglion
postsynaptic sympathetic superior cervical ganglion
84
short ciliary nerve has what two types of fibers
1. postsynaptic parasympathetic from ciliary ganglion (presynaptic fibers are from CNIII) 2. postsynaptic sympathetic (from superior cervical ganglion)
85
What do postsynaptic parasympathetic fibers in short ciliary nerves do?
accommodation and pupil constriction
86
where does the superior cervical gangion come from?
carotid plexus
87
what nerves are responsible for the corneal reflex?
long and short ciliary fibers of V1
88
Presynaptic parasympathetic fibers to the ciliary ganglion are from what?
CN III
89
4 things pass through the cavernous sinus
CN III, IV, VI on their way to the superior orbital fissure Internal Carotid Artery
90
Pathway of postsynaptic sympathetic fibers to orbit
- come from superior cervical ganglion - hitchhike on ICA - jump off ICA and hitchhike on long and short ciliary nerve fibers - go to globe of eye and to levator palpebrae superioris
91
Pathway of parasympathetic fibers to orbit
CN III to ciliary ganglion through SHORT ciliary fibers to globe of eye
92
4 parasympathetic ganglion to head
3977 COPS CN III: ciliary ganglion CN IX: otic ganglion CN VII: pterygopalatine ganglion CN VII: submandibular ganglion
93
Opthalmic venous drainage pathway
superior orbital fissure \> cavernous sinus \> internal jugular via superior and inferior petrosal sinuses
94
Pathway of opthalmic artery
internal carotid branch \> through optic canal \> ceneral artery of the retina dives into CN II
95
Lesion of CN VI will result in
adducted eye (due to unopposed action of MR)
96
CN III lesion results in...
1. closed eyelid (loss of innervation to levator palpebrae superioris) 2. mydriasis (loss of parasympathetics to iris, unopposed sympathetics) 3. abducted eye (unopposed action of lateral rectus, CN VI)
97
CN IV lesion results in...
1. extorted and slightly elevated eye (unopposed IO) 2. pt compensating by tilting away from the affected side and flexing head
98
Outer layer of the globe (3 parts)
1. sclera 2. cornea 3. (corneal) limbus
99
Middle layer of the globe/uveal tract (3 parts)
1. choroid 2. ciliary body with ciliary processes 3. iris stroma
100
embryonic origin of melanocytes of the iris
neural crest
101
Inner layer of the globe (5 parts)
1. retinal pigment epithelium (RPE) 2. neural retina 3. ora serrata 4. anterior projections of ciliary processes 5. posterior iris
102
Near Synkinesis Reflex is a response to stimulus consisting of: (3 things)
1. Acommodation 2. Convergence 3. Miosis
103
Lens looses elasticity with age and does not get FATTER despite the same contraction of circumfrential muscle in the ciliary body
presbyopia
104
Termination of the retina
ora serrata
105
2 vascular supplies to retina
1. central retinal artery to inner 2/3 2. choroidal vasculature to the outer 1/3
106
what does rhodopsin do?
It's in the photoreceptor cells of the retina... it phototransduces light into an electrical signal that excites neurons. These excite ganglion, which send AP through CN II VISION
107
Primarily for dim light, black and white
rods
108
Primarily for brigh light, color
Cones
109
where retinal nerve fibers come together to exit the eye as the optic nerve
optic disc
110
"blind spot"
optic disc
111
responsible for central vision
macula
112
greatest density of cones
macula
113
multiple layers of ganglion here as opposed to only one elsewere in the eye
macula
114
center of the macula
fovea centralis
115
Loss of central vision is due to
macular degeneration
116
neural retina attaches to the RPE by
ion pumping of the RPE
117
Histological components of the lens (3)
1. capsule (type IV collagen) 2. epithelium (simple cuboidal epithelium) 3. fibers (crystalin alpha, beta, gamma)
118
Embryologic origin of the lens
surface ectoderm
119
3 anatomical layers of the lens
1. capsule 2. cortex 3. nucleus
120
Disease associated with lens dislocation
Marfan's Syndrome
121
= a crystaline lens that has lost its transparency
cataract
122
Risk factors for cataracts
DM UV light Smoing Trauma Aging Meds (steroids) Systemic Dz (Down's, myotonic dystrophy)
123
Histology of the conjunctiva
stratified columnar epithelium with goblet cells
124
Embryologic origin and type of collagen in the sclera
neural crest; type 1 collagen
125
Why is the sclera opaque?
IRREGULAR distribution of type 1 collagen
126
Why is the cornea clear?
REGULAR distribution of type 1 collagen and complete avascularity
127
Where the sclera and the cornea meet
limbus
128
Major focusing power of the eye
cornea
129
curvature irregularities of the cornea causes
astygmatism
130
What nerve triggers the blink reflex?
V1
131
If the cornea is avascular, how does it recieve nurtrition? (3)
1. tear film 2. lateral diffusion from limbus vasculature 3. aqueous humor in anterior chamber
132
5 layers of the cornea
Elephants Bring Silly Dumbo Everywhere 1. Epithelium stratified, squamous non-keritonized 2. Bowman's layer 3. Stroma type I collagen 4. Descement's layer type IV collagen 5. Endothelium contains ATP-driven pumps that remove water from teh stromal matrix to preserve the spacing that maintains corneal optic clarity
133
degenerative dz that causes protrusion of the cornea into a cone shape
keratoconus
134
Which layer of the cornea is affected in keratoconus?
Bowman's layer
135
2 fun facts about corneal transplants
1. only part of the eye we can transplant 2. does not require HLA or blood type matching
136
the space formed where the cornea and the iris meet
the angle
137
Flow of aqueous humor
1. produced by epithelial cells of the ciliary processes in the posterior chamber 2. flows behind iris 3. flows through the iris into the anterior chamber 4. drained by Schlemm's canal in the angle
138
Formation of aqueous humor and secretion into the posterior chamber is the result of three things:
1. active secretion 2. ultrafiltration 3. simple diffusion
139
purpose of aqueous humor
to provide nutrients to the cornea and lens
140
2 major routes of aqueous humor outflow
1. trabecular outflow: pressure-dependent 2. uveoscleral outflow: pressure-independent
141
pathway of trabecular outflow for aqueous humor
out of anterior chamber through trabecular meshwork \> Schlemm's canal \> scleral veins \> cavernous sinus
142
Pathophysiology of open-angle glaucoma
dysfunctional outflow/obstruction leads to increased IOP, which kills optic nerve cells
143
Describe loss of vision in open-angle glaucoma
SLOW and painless. goes from periphery to the center. patients don't realize it's happening
144
3 main risk factors for open-angle glaucoma
increasing age FHx African American
145
4 portions of the optic nerve
1. nerve fiber 2. prelaminar 3. laminar 4. retrolaminar
146
the primary site of axonal injury to ganglion cells in glaucoma
lamina cribrosa
147
lamina cribrosa
= specialized part of the sclera where the optic nerve passes through
148
3 C's of a glocomatous optic nerve
Cupping: central depression of the optic disc is larger than normal Color: pale instead of pink Contour: sharp margins
149
2 muscles attach to to mastoid process
1. SCM 2. postior belly of digastric
150
What cranial nerve exits the skull through the stylomastoid foramen?
CN VII
151
Carotid canal terminates at articuation with the sphenoid bone to form what?
foramen lacerum
152
Where does corda tympani exit the temporal bone?
petrotympanic fissure
153
The gap between the petrous portion of temporal the bone and the occipital bone
jugular foramen
154
What runs in the hiatus of facial canal?
greater petrosal nerve
155
The petrous ridge of the petrous portion of the temporal bone is the location of two things:
1. attachment of the tentorium cerebelli 2. superior petrosal sinus
156
Real name for eustacian tube
pharyngotympanic tube
157
3 branches the facial nerve gives off before exiting the skull
1. greater petrosal nerve 2. chorda tympani 3. tiny branch to the stapedius muscle
158
Tensor tympani muscle innervation
CN V3
159
where does the largest portion of CN VII exit the skull?
stylomastoid foramen
160
the opening of the posterior wall of the middle ear cavity that leads to the mastoid air cells
aditus ad antrum
161
portion of the malleus that attaches to the tympanic membrane
handle of the malleus
162
tip of the handle of the malleus attaches to the...
umbo
163
hyperaccusis is associated with lesion of what cranial nerve?
VII (stapedius muscle)
164
stapedius originates from where?
posterior wall of the middle ear cavity
165
the head of the stapes articulates with what?
long process of incus
166
the base of the stapes attaches to the...
oval window
167
innervation of the stapedius muscle
CN VII
168
Mastoiditis endangers what nerve?
Facial nerve
169
the promontory in the middle ear cavity is due to what?
deeper lying cochlea
170
what nervous structure is found on the promontory in the middle ear cavity?
Tympanic plexus
171
the tympanic plexus is from what nerve?
sensory of CN XI
172
Some branches of CN XI go into the temporal bone via canaliculi. What's the risk?
otitis media
173
describe the fibers that make up the greater petrosal nerve
preganglionic parasympathetic from CN VII going to the lacrimal gland
174
describe the fibers that make up the lesser petrosal nerve
preganglionic parasympathetic from CN IX to the parotid gland continuation of the tympanic plexus
175
part of the tympanic membrane that doesn't vibrate as much
pars flacida
176
pars flaccida is in what quadrant of the TM?
posterosuperior
177
cone of light is in what quadrant of the TM?
anteroinferior
178
TM quadrant location for myringotomy and tube placement
posteroinferior
179
what provides general sensory innervation to the middle ear cavity?
tympanic plexus of CN IX
180
nerve that supplies sensation to the helix of the outer ear
auriculotemporal nerve - a branch of V3
181
nerve that supplies sensation to the lobe of the outer ear
greater auricular nerve - C2, C3
182
VERY thin bone creating the roof of the middle ear cavity
tegmen tympani
183
What sits on top of the tegmen tympani?
dura of the middle cranial fossa
184
what comes next if otitis media is not treated?
mastoiditis
185
swimmer's ear
otitis externa
186
signs of otitis externa
pulling on auricle and/or applying pressure to the tragus increases pain
187
what if you see a bulging red tympanic membrane on exam?
sign of otitis media
188
incision to release pus from a middle ear abscess
myringotomy
189
complication of mastoiditis
osteomyelitis of tegmen tympani
190
what part of the temporal bone forms the anterior wall of the external auditory canal?
tympanic plate
191
what separates the middle and posterior cranial fossa?
petrous ridge of the petrous portion of the temporal bone
192
pain info associated with otitis media will be carried by...
tympanic plexus of CN IX
193
special sensory innervation to the inner ear is provided by...
vestibular and cochlear portions of CN VIII
194
what features are located in the posterior wall of the middle ear cavity?
mastoid air cells and the facial nerve
195
the concavity of the TM is pointed...
anteriorly, laterally, inferiorly
196
where does the transmission of sound from bone to fluid occur?
oval window
197
stylohyoid is innervated by...
CN VII
198
posterior belly of digastric is innervated by...
CN VII
199
muscles of facial expression are innervated by...
CN VII
200
innervation of the anterior belly of digastric
nerve to myohyoid
201
Where does the greater petrosal nerve terminate/what is it's function?
1. lacrimal gland for tear production 2. nasal cavity for mucous production
202
describe the fibers of the deep petrosal nerve
postsynaptic sympathetic fibers that have jumped off the ICA
203
describe the fibers of the nerve of the pterygoid canal
postsynaptic sympathetic fibers of the deep petrosal nerve + presynaptic parasympathetic fibers of the greater petrosal nerve
204
greater petrosal nerve hitchhikes on what other nerve to get to the lacrimal gland and mucous glands of the nasal cavity?
V2
205
where does chorda tympani terminate/what is its function?
1. anterior 2/3 of tongue for taste sensation 2. submandibular gland for mucous production 3. sublingual gland for saliva secretion
206
chorda tympani hitchhikes on what nerve to the floor of the mouth?
lingual nerve of V3
207
synaps of chorda tympani's parasympathetic fibers occurs at which ganglion?
submandibular ganglion
208
synapse of greater petrosal nerve's parasympathetic fibers occurs at which ganglion?
pterygopalatine ganglion
209
describe the fibers of chorda tympani
parasympathetics to the submandibular and sublingual glands sympathetics for taste to the anterior 2/3 of the tongue
210
where does chorda tympani exit the skull?
petrotympanic fissure
211
In a lesion with facial paralysis/Bell's palsey: if there is preserved taste function, where did the lesion occur?
distal to chorda tympani
212
In a lesion with facial paralysis/Bell's palsey: with NO taste function, where did the lesion occur?
proximal to chorda tympani
213
If you have a lesion that is resulting in Bell's palsey, do you also have louder hearing on one side?
yes. an infection producing Bell's palsey also affects stapedius
214
Mumps has what consequence in the face?
enlarged parotid gland
215
parotid duct function
carries saliva from the parotid gland and dumps it into the mouth
216
parotid gland function
saliva synthesis and secretion
217
innervation of the parotid duct
lesser petrosal nerve (CN IX)
218
things that pass through the parotid gland
external carotid artery retromandibular vein major portion of facial nerve (will supply muscles of facial expression) auriculotemporal branch of V3 (with hitchhiking secretomotor fibers from otic ganglion (IX)) parotid duct
219
termination of the parotid duct? (Stenson't duct)
pierces the buccinator and ends opposite the upper second molar
220
6 named branches of the facial nerve to muscles of facial expression
"To Zanzibar By Motor Car" 1. Temporal 2. Zygomatic 3. Buccal 4. Maxillary 5. Cervical 6. Posterior Auricular
221
temporal branch of CN VII innervates...
upper eyelid of orbicularis occuli and superior to that
222
zygomatic branch of the facial nerve innervates...
the lower eyelid of orbicularis occuli
223
buccal branch of facial nerve innervates...
upper lip and buccinator muscle
224
mandibular branch of facial nerve innervates...
lower lip and chin
225
cervical branch of facial nerve innervates...
platysma
226
posterior auricular branch of facial nerve innervates...
occipitalis muscle
227
special sensory taste fibers going to the tongue have their soma in which ganglion?
geniculate ganglion
228
what defines the superficial and deep portions of the parotid gland?
passage of the facial nerve
229
what is the terminal branch of the nasocilliary nerve?
external nasal nerve
230
what branches of CN V2 carry hitchhiking fibers of CN VII to the lacrimal gland?
zygomaticofacial and zygomaticotemporal
231
nerve supplying sensation to the inside of the cheek
buccal branch of V3
232
nerve supplying sensation to the chin
mental branch of V3
233
named nerve supplying sensation to the tip of the nose
external nasal banch of V1
234
named nerve supplying sensation to the bridge of the nose
infratrochlear branch of V1
235
named nerve supplying sensation to the middle forehead
supratrochlear branch of V1
236
named nerve supplying sensation to just above the eyebrow
supraorbital branch of V1
237
named nerve supplying sensation to the lateral eyebrow
lacrimal branch of V1
238
named nerve that supplies sensation to the cheek just below the eye
infraorbital branch of V2
239
named nerve that supplies sensation to the temporal region
zygomaticotemporal branch of V2
240
named nerve that supplies sensation to the tip of cheek bone area
zygomaticofacial branch of V2
241
named nerve that supplies sensation to the jaw line
greater auricular nerve (C2, C3)
242
named nerve that supplies sensation to the ear lobe
greater auricular nerve (C2, C3)
243
Named nerve that supplies sensation to the proximal helix of the outer ear (concha?)
auriculotemporal branch of V3
244
named nerve that supplies sensation to the skin behind the ear
lesser occipital nerve (C2, C3)
245
named nerve that supplies sensation to the skin on the posterior head
greater occipital
246
frontalis muscle is innervated by...
CN VII temporal branch
247
occipitalis muscle is innervated by...
posterior auricular (occipital) branch of CN VII
248
orbicularis oris muscle is innervated by...
buccal and mandibular branches of CN VII
249
embryonic origin of the muscles of facial expression
2nd pharyngeal arch
250
5 layers of the scalp
SCALP 1. Skin 2. Connective tissue 3. aponeurosis (gala aponeurotica) 4. Loose areaolar tissue 5. pericranium
251
innervation of skin superficial to platysma
transverse cervical nerve
252
function of buccinator muscle
pushes food medially when eating, sucking on a straw. food accumulates between teeth and gums if buccinator muscle looses nerve supply
253
the retromandibuolar vein is formed by the junction of what two veins?
superficial temporal vein + maxillary vein
254
common facial vein is formed by the junction of what two veins?
anterior division of the retromandibular vein + facial vein
255
the anterior division of the retromandibular vein drains into...
internal jugular vein
256
the posterior division of the retromandibular vein drains into the...
external jugular vein
257
describe the clinical significance of the danger triangle
infections of the face near the nose may spread into the cranial cavity by passing through the emmissary veins associated with the pterygoid plexus of veins (may also spread through opthalmic veins of the orbit). Opthalmic veins and emmisary veins of the pterygoid plexus will drain into the cavernous sinus.
258
what makes the facial nerve of newborns so vulnerable and puts them at risk for facial paralysis (especially during the birthing process)?
their skulls lack a mastoid process, so the facial nerve is not well-protected
259
which cranial nerve does Bell's palsey affect?
CN VII
260
which muscle is important for swallowing without drooling?
orbicularis oris
261
which muscle plays a role in eating but NOT mastication??
buccinator
262
Where do the branches of CN V exit the cranial cavity?
"Standing Room Only" V1: Superior orbital fissure V2: foramen Rotundum V3: foramen Ovale
263
function of the masseter
elevation of the mandible
264
function of the temporalis muscle
elevation and retraction of the mandible
265
innervation of the temporalis muscle
DEEP temporal nerve of V3
266
what is the doorway from the infratemporal fossa to the pterygopalatine fossa?
pterygomaxillary fissure
267
the pterygomaxillary fissure connects the infratemporal fossa to the...
pterygopalatine fossa
268
petrotympanic fissure
where chorda tympani exits the skull
269
pterygopalatine fossa
houses the pterygopalatine ganglion (in which presynaptic parasympathetic fibers of GPN synapse onto postsynaptic parasympathetic fibers) located between the maxilla and the pterygoid process of the sphenoid bone
270
pterygomaxillary fissure
the doorway/connection between the infratemporal fossa and the pterygopalatine fossa
271
infratemporal fossa
inferior to zygomatic arch, medial to ramus of the mandible, lateral to the lateral pterygoid plate of the sphenoid bone
272
what exits the mental foramen?
inferior alveolar nerve
273
what is on the body of the mandible and holds the teeth in place?
alveolar process
274
what ENTERS the mandibular foramen?
inferior alveolar nerve
275
what does the inferior alveolar nerve supply?
sensation to lower teeth
276
what is the function of the lateral pterygoid muscle?
protraction and lateral grinding of the mandible
277
what is the function of the medial pterygoid muscle?
elevation and grinding of the mandible
278
does the lateral or medial pterigoid muscle have a vertical orientation?
medial pterygoid muscle
279
describe the differences in attachmets between the lateral and medial pterygoid muscles
Lateral: from LATERAL aspect of the lateral pterygoid plate and the inferior surface of greater wing of the sphenoid Medial: from MEDIAL aspect of the lateral pterygoid plate and posterior surface of the maxilla
280
These TWO muscles contribute to the protrusion and lateral grinding motion of teeth
medial and lateral pterygoid muscles
281
two things that live in the pterygopalatine fossa
1. branches of V2 2. pterygopalatine ganglion
282
Contraction of pterygoid muscles on the LEFT will move the mandible...
to the RIGHT
283
what two branches of V3 come out between the lateral and medial pterygoid muscles in the infatemporal fossa?
1. lingual 2. inferior alveolar
284
what is the function of the lingual nerve?
general sensory to the anterior 2/3 of the tongue (chorda tympani does TASTE here and hitchhikes on the lingual nerve to the tongue)
285
nerve to myohyoid is a branch of what nerve?
inferior alveolar nerve
286
auriculoemporal nerve forms a loop around what artery?
middle meningial artery
287
auriculotemporal nerve runs with what artery?
superficial temporal artery
288
what supplies sensation to the upper teeth and mandible?
posterior superior alveolar nerve
289
posterior superior alveolar is a branch of what nerve
V2
290
8 muscles with motor innervation from V3
1. anterior belly of digastric 2. temporalis 3. lateral pterygoid 4. medial pterygoid 5. masseter 6. myohyoid 7. tensor tympani 8. tenor palati
291
specific innervation of anterior belly of digastric (motor)
nerve to myohyoid (branch of V3)
292
specific name of motor innervation to lateral pterygoid muscle
lateral pterygoid nerve (branch of V3)
293
speciffic innervation of medial pterygoid muscle (motor)
medial pterygoid nerve (branch of V3)
294
specific innervation of masseter (motor)
masseteric nerve (branch of V3)
295
termination of the middle meningial artery
sphenopalatine artery
296
nasal cavity is supplied by which artery?
sphenopalatine artery
297
secretomotor parasympathetic fibers to the parotid gland are supplied by what?
CN IX
298
how do postsynaptic parasympathetic fibers of CN IX (coming from otic ganglion) get to the parotid gland?
they hitchhike on the auriculotemporal nerve
299
describe the lesser petrosal nerve
presynaptic parasympathetic nerves of CN IX coming from the tympanic plexus going to the otic ganglion
300
lateral wall of the temporal bone
squamous portion
301
floor of the temporal bone
petrous portion
302
what artery runs on the inside of the squamous portion of the temporal bone?
middle meningeal
303
what comes out of foramen spinosum?
middle meningeal artery
304
305
foramen lacerum is a gap between what two things?
greater wing of the sphenoid and the petrous portion of the temporal bone
306
jugular foramen is a gap between what two things?
occipital bone and the petrous portion of the temporal bone
307
lesser petrosal nerve exits the skull where after going through the middle ear and running along the petrous portion of the temporal bone?
foramen ovale
308
the common carotid bifurcates what what vertebral level?
C3/C4
309
what is the vertebral level of the lower pharynx/larynx?
C5/C6
310
what holds the dens against the anterior arch of the atlas?
cruciate ligament of the atlas
311
what joint turns the head side to side, "no"
atlantoaxial joints
312
what joint nonds the head "yes"
atlantooccipital joints
313
what prevents over extension of the head?
anterior atlanto-occipital membrane
314
what prevents hyperflexion of the head?
posterior atlanto-occipital membrane
315
what syndromes cause laxity of the the craniovertebral ligaments?
spinal cord injury Down's RA
316
25% of stroke occur...
in the vertebral artery
317
where does the vertebral artery enter the cranial cavity?
foramen magnum
318
right and left vertebral arteries form to become the...
basilar artery
319
hyoid bone sits at what vertebral level?
C3
320
clinical correlation of the cricothyroid ligament
important for emergency access to lower airway when the upper airway is blocked
321
cervical plexus includes what spinal cord levels?
C1-C4
322
C1-C7 exit the spinal canal above or below their respective vertebrae?
ABOVE. beginning with C8 spinal cord level, the nerves will exit above their corresponding vertebrae
323
motor portion of the cervical plexus
Ansa cervicalis
324
investing fascia of the neck contains what two muscles?
1. trapezius 2. SCM
325
which fascia layer extends laterally as the axillary sheeth?
prevertebral fascia
326
contents of the carotid sheath (3)
1. carotid arteries 2. internal jugular vein 3. vagus nerve
327
carotid bodies are innervated by CN...
IX and X
328
carotid sinus are innervated by CN...
IX
329
carotid sinus detect...
blood pressure (baroreceptors)
330
carotid bodies detect...
O2 content (chemoreceptors)
331
this vessel pierces the investing fascia just above the clavicle
external jugular vein
332
4 muscles of the suboccipital triangle
1. rectus capitus posterior major 2. rectus capitus posterior minor (doesn't define triangle) 3. obliquus capitus inferior obliquus capitus superior
333
2 important facts about the suboccipital triangle
1. it is the region of passageway for the vertebral artery FROM foramen transversarium of C1, PIERCES the posterior atlanto-occipital membrane, and goes INTO the vertebral foramina on it's way to the skull 2. only area where aspects of posterior rami are seen and given names
334
Named posterior ramus of C1
suboccipital nerve
335
named posterior ramus of C2
greater occipital nerve
336
named posterior ramus of C3
third occipital nerve
337
what nerve runs on the surface of anterior scalene muscle
phrenic nerve (C3, C4, C5)
338
two triangles of the lateral neck
1. occipital triangle (larger) 2. subclavian/omoclavicular triangle (smaller)
339
sensory branches of the cervical plexus (and spinal roots)
1. lesser occipital (C2) 2. greater auricular (C2, C3) 3. transverse cervical (C2, C3) 4. supraclavicular (C3, C4)
340
which lymph nodes lie along the EJV?
superficial cervical lymph nodes
341
which lymph nodes lie along the IJV?
deep cervical lymph nodes
342
sentinel lymph node of the tonsils
jugulodigastric
343
sentinel lymph node of the tongue
jugulo omo-hyoid
344
SCM innervation
CN XI
345
geniohyoid innervation
C1
346
stylohyoid innervation
CN VII
347
posterior belly of digastric innervation
CN VII
348
anterior belly of digastric innervation
V3
349
thyrohyoid innervation
C1
350
sternothyroid innervation
C1-C3, ansa cervicalis
351
sternohyoid innervation
C1-C3, ansa cervicalis
352
omohyoid innervation
C1-C3, ansa cervicalis
353
spinal cord levels of superior root of ansa cervicalis
C1, C2
354
spinal cord levels of inferior root of ansa cervicalis
C2, C3
355
boundaries of the submandibular triangle
1. hyoid 2. anterior bellies of digastric 3. myohyoid muscles (floor) 4. mandibular symphysis
356
muscular triangle boundaries
1. superior belly of omohyoid 2. anterior border of SCM 3. midline of the neck
357
carotid triangle borders
1. superior belly of omohyoid 2. posterior belly of digastric 3. anterior border of SCM
358
borders of submandibular triangle
1. inferior border of mandible 2. anterior and posterior bellies of digastric 3. mylohyoid (floor)
359
3 cervical ganglion and their roots
superior (C1, C2) middle (C6) inferior (C7) \*\*\* NO white rami communicans
360
embryologic origin of the thyroid gland
foramen cecum
361
superior thyroid artery is a branch off the..
external carotid artery
362
inferior thyroid artery is a branch off the...
thyrocervical trunk
363
the one muscle in the suprahyoid region innervated by C1
geniohyoid
364
C1 innervates what 2 muscles
geniohyoid thyrohyoid
365
Roots of the cervical plexus (dorsal/sensory + ventral/motor)
C1-C4
366
Roots of sensory branches of the cervical plexus
C2-C4
367
Roots of the motor branches of cervical plexus (=ansa cervicalis)
C1-C3
368
What nerve runs on the anterior surface of anterior scalene?
Phrenic (C3-C5)
369
Location of the jugulodigasctic deep cervical lymph node
Where the postior belly of the digastric crosses the internal jugular vein
370
Location of the Jugulo-omohyoid deep cervical lymph node
At the tendon of omohyoid
371
What drains to the Jugulodigastric lymph node?
Tonsils
372
What drains to the jugulo-omohyoid lymph node?
Tongue
373
What vertebral level does the cricoid cartilage sit at and what does it represent?
C6 End of the pharynx, beginning of the esophagus
374
Omohyoid innervation
Superior belly: superior root of ansa cervicalis Inferior belly: inferior root of ansa cercicalis
375
Embryological remnant of the thyroglossal duct
Foramen cecum
376
Which tonsil lies between the palatoglossal and palatopharyngeal folds?
Palatine tonsil
377
Four intrinic tongue muscles
1. Superior longitudinal 2. Inferior longitudinal 3. Transverse 4. Vertical
378
What do the intrinsic tongue muscles do?
Change the shape of the tongue | (no boney attachments)
379
Innervation on the intrinsic tongue muscles
Hypoglossal (CNXII)
380
Four extrinsic muscles of the tongue
1. Genioglossus 2. Hyoglossus 3. Styloglossus 4. Palatoglossus
381
What do the extrinsic tongue muscles do?
Move the tongue | (they have boney attachments)
382
Action on palatoglossus
Lift tongue up
383
Action of genioglossus
Stick tongue out
384
Styloglossus action
Bring tongue backwards
385
Hyoglossus action
Move tongue down, towards bottom of oral cavity
386
Innervation of the extrinsic tongue muscles
All are innervated by hypoglossal nerve (CN XII), EXCEPT... palatoglossus, which is innervated by glossopharyngeal (CN IX)
387
What would a patient with a lesion to the hypoglossal nerve present with?
Tongue deviating TO the AFFECTED side... away from the healthy side
388
Taste innervation of the tongue
Anterior 2/3: CN VII via chorda tympani Posterior 1/3: CN IX Epiglotis/behind tongue: CN X
389
Somatic sensation (touch, pain) innervation of the tongue
Anterior 2/3: Lingual nerve, CN V3 Posterior 1/3: CN IX Epiglotis/behind tongue: CN X
390
Arterial supply to the tongue
Lingual artery from the external carotid artery
391
submandibular, sublingual, and microscopic mucosal glands are innervated by what?
chorda tympani
392
3 structures superficial to hyoglossus muscle:
1. Lingual nerve (of CN V3) 2. Warton's duct 3. Hypoglossal nerve (CN IX)
393
2 structures deep to the hyoglossus muscle:
1. Glossopharyngeal nerve (CN IX) 2. lingual artery
394
What causes cleft palate?
failure of the mesenchymal masses in lateral palatine processes to meet and fuse... maxillary and palatine bones to fuse in the midline as the intermaxillary and interpalatine sutures
395
Four soft palate muscles
1. Tensor veli palatine (above) 2. Levator veli palatine (above) 3. Palatoglossus (below) 4. Palatopharyngeous (below)
396
Innervation of the soft palate muscles
All are innervated by Vagus nerve (CN X), EXCEPT... Tensor veli palatine, which is CNV3
397
If unilateral Vagus nerve is paralyzed, what would the patient present as?
Uvula deviating AWAY from the affected side, toward the healthy side
398
The Greater and Lesser Palatine Arteries come from where?
They come from the pterygopalatine fossa, and are branches of the maxillary artery (branchh of external carotid)
399
The Nasopalatine, Greater Palatine, and Lesser Palatine nerves contain what type of fibers?
1. Somatosensory from CN V2 2. Parasympathetic visceral motor from CN VII 3. Sympathetics
400
The hard palate recieves most of its sensory innervation from terminal branches of the Maxillary nerve division of the Trigeminal nerve (CNV2), what is the acception?
Buccal nerve is a branch of the Mandibular division of CN V3, and innervates the lateral, posterior teeth
401
Where do you administer nerve blocks for upper and lower teeth?
Upper: multiple injections Lower: one injection at mandibular foramen
402
Borders of the nasopharynx
Choana to the uvula
403
Borders of the oropharynx
Uvula to the epiglottis
404
Borders of the laryngopharynx
Epiglottis to cricoid cartilage
405
Anterior boundary of the nasopharynx
choana
406
anterior boundary of the oropharynx
palatoglossal arch
407
anterior boundary of the laryngopharynx
laryngeal inlet
408
origin of all 3 pharyngeal constrictors
pharyngeal raphe
409
anterior attachments of superior pharyngeal constrictor (3)
1. medial pterygoid plate 2. hamulus 3. pterygomandibular raphe
410
anterior attachments of the middle pharyngeal constrictor (2)
1. stylohyoid ligament 2. hyoid bone
411
anterior attachments of the inferior pharyngeal constrictor (2)
1. thyroid cartilage 2. cricoid cartilage
412
2 layers of the pharyngeal fascia
Buccopharyngeal fascia (outside) Pharyngobasilar fascia (inside)
413
Three pharyngeal lifters
1. Stylopharyngeus 2. Palatopharyngeus 3. Salpingopharyngeus
414
projection of the medial end of the cartilagenous pharyngeotympanic tube is called...
torus tubarius
415
Mucous membrane found just inferior to the pharyngeal orifice in the nasopharynx
lebator veli palatine
416
lies under the mucus membrane along the arch of the torus tubarius, deep to levator veli palatine
tensor veli palatine
417
2 functions that levator veli palatine and tensor veli palatine do together, at the same time
1. raise the soft palate 2. opent the PT tube
418
all muscles of the palate are innervated by \_\_\_\_\_, EXCEPT \_\_\_\_\_, which is innervated by \_\_\_\_\_.
Vagus Tensor veli palatine V3`
419
all muscles of the pharynx are innervated by \_\_\_\_\_, EXCEPT \_\_\_\_\_, which is innervated by \_\_\_\_\_\_.
Vagus stylopharyngeus only motor branch of IX
420
Boundary between the oral cavity and the pharynx
palatoglossal fold
421
Three muscles originate from the styloid process
1. stylohyoid 2. stylopharyngeous 3. styloglossus
422
Vertebral level of superior cervical ganglion
C2, C3
423
vertebral level of middle cervical ganglion
C6
424
vertebral level of inferior (Stellate) cervical ganglion
C7
425
All muscles of the larynx are innervated by \_\_\_\_\_, EXCEPT \_\_\_\_\_, which is innervated by \_\_\_\_\_\_.
recurrent laryngeal nerve (Vagus) cricothyroid superior laryngeal nerve (external branch)
426
8 muscles innervated by V3
1. masseter 2. temporalis 3. medial pterygoid 4. lateral pterygoid (4 muscles of mastication) 5. tensor tympani 6. tensor veli palatine (2 tensors) 7. mylohyoid 8. anterior belly of digastric (2 accessory muscles of mastication)
427
4 tonsils from superior to inferior
PTPL Pharyngeal Tubal Palatine Lingual
428
Where does lymph from the tonsils generally drain to?
jugulodigastric (superior deep) lymph nodes
429
6 locations of superficial lymph nodes
1. scattered along external jugular vein 2. occipital 3. posterior auricular (mastoid) 4. parotid 5. submandibular 6. submental
430
3 locations of deep lymph nodes
1. scattered along internal jugular vein 2. jugulodigastric: at posterior belly of digastric crossing the internal jugular vein 3. jugulo-omohyoid: at intermediate tendon of omohyoid
431
Sentinel lymph nodes primarily targeted by cancer mets
jugulodigastric juguloomohyoid
432
jugulodigastric gets drainage from where?
roof of oral cavity and posterior tongue
433
Floor of oral cavity and anterior tongue drains to which lymph nodes...
to submental or submandibular nodes, then to deep cervical nodes
434
what runs through the pterygoid canal (2)
1. parasympathetic greater petrosal nerve 2. sympathetic deep petrosal nerves Both \>\>\> to pterygopalatine ganglion
435
maxillary and sphenoid sinuses drain properly when head is in what position?
flexed spenoid ostium are higher than the floor of the phenoid sinues, which maes drainage in the erect position difficult
436
anterior and posterior ethmoidal arteries come from where?
opthalmic artery
437
sphenopalatine artery is the TERMINAL branch of what artery
TERMINAL branch of maxillary artery
438
Greater palatine artery is a branch of which artery
maxillary artery
439
septal branch of superior labial artery is a branch of which artery
facial artery
440
4 arteries of the nasal septum
1. ethmoidals (from opthalmic artery) 2. greater palatine artery (from maxillary artery) 3. sphenopalatine artery (terminal branch of mexillary artery) 4. septal branch of superior labial artery (from facial artery)
441
site of anastamoses of nasal arteries
Kiesselbach's area
442
Nasopalatine nerve contains... (3)
1. sensory fibers from V2 2. parasympathetic fibers from pterygopalatine ganglion (VII) 3. sympathetics from pterygopalatine ganglion
443
what nerves run at the very top of the nasal septum
anterior and posterior ethmoidals from V1 nasocilliary nerve
444
4 spaces on lateral wall of nasal cavity
1. inferior nasal meatus 2. middle nasal meatus 3. superior nasal meatus 4. spheno-ethmoidal meatus
445
what drains into spheno-ethmoidal meatus
sphenoid sinus
446
what drains into superior nasal meatus?
posterior ethmoidal sinus
447
what drains into middle nasal meatus?
frontal sinus maxillary sinus anterior ethmoidal sinus middle ethmoidal sinus
448
what drains into inferior nasal meatus
nasolacrimal duct
449
CN V2 sensory + VII p/s + sympathetics gives rise to 5 nerves of the nasal cavity:
1. superior nsal branch (on middle concha) 2. inferior nasal branch (on inferior concha) 3. nasopalatine nerve 4. greater palatine nerve 5. lesser palatine nerve
450
function on the nasal conchae
increase surface area of nasal canal for cleansing, warming, and humidifying incoming air
451
parasympathetics cause ______ of the nasal mucosal arteries
vasodilation
452
sympathetics cause ______ of the nasal mucosal arteries
vasoconstriction
453
4 sets of nasal sinuses
1. frontal (2) 2. maxillary (2) 3. sphenoid (1 or 2) 4. ethmoidal air cells (3 per side)
454
3 functions of sinuses
1. lighten skull 2. add resonance 3. protect brain from temperature of inspired air
455
drainage of frontal sinus
anterior hiatus semilunaris through ethmoidal infundibulum
456
Maxillary sinus drainage
middle hiatus semilunaris through maxillary ostium
457
Sphenoid sinus drainage
through spheno-ethmoidal recess
458
ethmoidal air cell sinus drainage
3. posterior ethmoidal air cells: superior nasal meatus 2. middle ethmoidal air cells: semilunar hiatus \>\> middle nasal meatus 3. anterior ethmoidal air cells: ethmoidal infundibulum \>\> middle nasal meatus
459
nasolacrimal duct drains into...
inferior nasal meatus
460
Maxillary, sphenoid, and poisterior ethmoidal sinuses ONLY drain when head is in ______ positoin
flexed
461
which sinus has the poorest drainage?
maxillary sinus: its location is lower than the drain opening
462
lymph from anterior nasal cavity drains to...
submandibular lymph nodes then to jugulodigastric nodes
463
posterior nasal cavity lymph drains to...
tonsils, then to jugulodigastric nodes
464
Length and thickness of the vocal cords are fixed, how do you change the tension?
1. stretch the strings by rocking the thyroid back and forth 2. harden the strings by contracting the muscle and stretching
465
2 muscles shorten the vocal cord
vocalis thyroarytenoid
466
what does the cricothyroid muscle do to the vocal cords
elongate and tense the vocal cords
467
muscles that adduct the vocal cords (4)
1. lateral cricoarytenoid 2. thyroarytenoid 3. oblique arytenoid 4. transverse arytenoid
468
ONLY muscle to abduct (open) the vocal cords
posterior cricoarytenoid
469
muscle that pulls the epiglottis toward the arytenoid cartilages and CLOSES the larynx
aryepiglottis muscle
470
what is the ligament at the inferior tip of the epiglottis?
thyroepiglottic ligament
471
what ligament is in the glossoepiglotic fold?
hyoepiglotic ligament
472
the hyoepiglottic ligament is in what fold?
glossoepiglottic fold
473
function of the hyoepiglottic ligament
pulls the epiglottis back into its vertical position
474
these are spaces that hold saliva to delay the swallowing reflex
valleculae
475
false vocal cord is in what fold?
vestibular fold
476
superior laryngeal artery brances from what?
superior thyroid artery
477
1. superior laryngeal nerve branches from what? 2. and gives off what branches?
1. Vagus 2. internal branch and external branch
478
internal branch of superior laryngeal nerve's function
sensory to vestibule
479
external branch of superior laryngeal nerve's function
motor to cricothyroid
480
All laryngeal muscles are are innervated by \_\_\_\_\_, EXCEPT \_\_\_\_\_\_, which is innervated by \_\_\_\_\_\_.
recurrent laryngeal nerve (from vagus) cricothyroid external branch of superior laryngeal nerve
481
Sensory innervation above the true vocal cord (entire vestibule)
internal branch of superior laryngeal nerve
482
Sensory innervation below the true vocal cords
recurrent (inferior) laryngeal nerve
483
484
485
486
487
488
489
490
491
492
493
494
495
496
497
498

BCM (8 decks)

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