Head And Neck Part 2 Flashcards
(188 cards)
1
Q
What are sutures bones?
A
Normal island-like bones within the lambdoid suture
-mistaken in X-rays for skull fractures
2
Q
What is the Pterion?
A
Junction of
1. Frontal
2. Parietal
3. Temporal
4. Sphenoid bones
3
Q
What is deep to the Pterion?
A
Middle meningeal artery
4
Q
How does an epidural hematoma happen?
A
Lateral head trauma causes
-A ruptured middle meningeal artery
5
Q
How does a Epidural Hematoma present on CT imaging?
A
Convex or lens shape due to the
-Dura mater separating from cranium forming a cavity containing blood
6
Q
What do the two layers of the dura mater spilt into?
A
Spilt to form dual venous sinuses containing venous blood
7
Q
What is deep to the dura mater?
A
Arachnoid mater
-subarachnoid space (with cerebrospinal fluid)
Pia mater (adheres directly to the brain)
8
Q
What goes into the sulcus of the cerebral cortex and what crosses the sulcus of the cerebral cortex?
A
Into: Pia mater
Crosses: Arachnoid mater
9
Q
What does the subarachnoid space contain?
A
Cerebrospinal fluid (CSF)
Cerebral arteries
Cerebral veins
10
Q
What is the bridging vein between?
A
Dura mater and arachnoid mater
11
Q
What is the middle meningeal artery between?
A
- Cranial bone
- Dura mater
*not in subarachnoid space
12
Q
What do the cerebral veins drain to?
A
Dural venous sinuses
-via bridging veins
13
Q
What do the bridging veins piece through?
A
- Arachnoid mater
- Meningeal (inner) layer of the dura mater
14
Q
How does a subdural hematoma happen?
A
Bridging vein rupture between Dura and Arachnoid mater
-by head trauma or rapid deceleration causing intra-cranial shearing forces
15
Q
How does a Subdural hematoma present on a CT?
A
Not strictly lens-shaped
-mixture of concave and convex
16
Q
How does a Subarachnoid hematoma happen?
A
rupture of cerebral arteries
-Caused by ruptured aneurysm
*worse headache of their life
17
Q
How does a Subarachnoid hematoma present on CT?
A
Blood will fill the subarachnoid space
-Highlighting the brain and brain stem contours
- Star shaped or asterisk
18
Q
What is the purpose of an Emissary vein?
A
Provide communications between dural venous sinuses and the scalp
-Route for potential spread of infection from scalp into cranial cavity
19
Q
Where does cerebrospinal fluid drain from?
A
Subarachnoid space into the dural venous sinuses BY THE
-Arachnoid granulations
20
Q
What are the arachnoid granulations within?
A
- Superior Sagittal sinus
- Lateral lacuna
21
Q
How does a Communicating Hydrocephalus happen?
A
Scarring of the Arachnoid Granulation due to a patient surviving
-A subarachnoid hemorrhage
-Will block resorption of CSF into dural venous
22
Q
What happens to the brain when a Communicating Hydrocephalus occurs?
A
The CSF will accumulate in cavities within the ventricles of the brain
23
Q
How does a Communicating Hydrocephalus present on CT imaging?
A
There will be an enlargement of the ventricles
-CSF filled spaces within the brain and brain stem
24
Q
What are the infolding of the dura mater?
A
- Tentorium Cerebelli
- Falx Cerebri
25
What is the tentorium cerebelli between?
Cerebrum and cerebellum
26
What is the falx cerebri between?
Between cerebral hemispheres
27
Where does the straight sinus run between?
1. Falx Cerebri
2. Tentorium Cerebelli
28
What does the straight sinus connect?
Inferior sagittal sinus with confluence of sinuses
29
Where does the confluence of sinuses receive venous blood from?
1. Superior sagittal sinus
2. Straight Sinus
30
Where does the transverse sinus run along?
The lateral edge of Tentorium Cerebelli
31
What does the sigmoid sinus drain blood from?
Drains venous sinus system TO
-Internal Jugular vein at Jugular Foramen
32
What does the Sphenoid Crest separate?
Anterior and Middle Cranial Fossae
33
What does the Petrous Ridge of Temporal Bone separate?
Middle and Posterior Cranial Fossae
34
What does the Falx Cerebri attach to?
Crista Galli
35
What does the Tentorium Cerebelli attach to?
1. Anterior Clinoid Process
2. Posterior Clinoid process
3. Petrous ridge of temporal bone
4. Groove for Transverse Sinus
36
Where is the olfactory foramina (CN I-Olfactory) located?
In the Cribriform plate of the ethmoid bone
37
Where is the optic canal (CN II-Optic and ophthalmic artery) located?
In the lesser wing of the sphenoid bone
38
Where is the foramen spinosum (middle meningeal artery) located?
In the Greater Wing of Sphenoid Bone
39
What does the Superior Orbital Fissure contain?
CN III- Oculomotor nerve
CN IV- Trochlear
CN V1- Trigeminal (ophthalmic)
CN VI- Abducens
40
Where is the superior orbital fissure located?
Between Lesser and Greater Wings of Sphenoid Bone
41
What does the Foramen Rotundum contain?
CN V2 (maxillary)
42
Where is the Foramen Rotundum located?
In the Greater Wing of Sphenoid Bone
43
What does the Foramen Ovale contain?
CN V3 (mandibular)
44
Where is the Foramen Ovale located?
In the Greater Wing of Sphenoid Bone
45
What does the Foramen Magnum contain?
The spinal cord
46
Where is the Foramen Magnum located?
The occipital bone
47
Where do the sinuses drain to?
The internal jugular vein VIA
-The Groove for Sigmoid Sinus
*Can be followed to Jugular Foramen
48
What does the Jugular Foramen contain?
CN IX- glossopharyngeal nerve
CN X- Vagus Nerve
CN XI- Accessory nerve
49
Where is the Jugular foramen located?
Between Petrous Temporal bone and Occipital Bone
50
What does the Internal Acoustic Meatus contain?
CN VII- Facial Nerve
CN VIII- Vestibulocochlear nerve
51
Where is the internal Acoustic Meatus located?
Petrous Temporal Bone
52
What does the Hypoglossal Canal contain?
CN XII- Hypoglossal
53
Where is the Hypoglossal canal located?
The occipital bone
54
What is the Sella Turcica composed of?
1. Anterior Clinoid Process
2. Hypophyseal Fossa
3. Posterior Clinoid Process
4. Dorsum Sellae
55
Where is the pituitary gland located?
The Hypophyseal Fossa
56
What is the Plica Semilunaris?
The remnant of 3rd eyelid or nictitating membrane
57
What is the Limbus?
The border between Cornea and Sclera
58
What does the optic nerve contain?
Axons of retinal ganglion cells
-Holds visual information
59
What is the Fovea?
The area of greatest visual acuity
-Center of visual field
60
Where is the Aqueous humor located?
Anterior to the lens on either side of the iris
61
What causes Glaucoma?
Impaired drainage of Aqueous humor
-There will be damaged to retina and optic nerve due to intraocular pressure
62
What muscle mediates blinking?
Palpebral part of Orbicularis Oculi muscle
-Motor innervation=CN VII (facial nerve)
63
What is the sensory innervation of the Cornea?
Ophthalmic Division of the Trigeminal Nerve
CN V1
64
What does the blink reflex test?
CN V1 (Ophalmic division of trigeminal nerve)
CN VII (Facial)
65
What bones of the orbit osteology are thin and fragile?
Ethmoid Bone
Maxilla
66
What does the Periorbita contain?
Fascia investing contents of the orbit
67
What surrounds CN II (optic nerve)
Subarachnoid space
68
If the optic disc is blurred what could that indicate?
Elevated Intracranial Pressure
-Papilloedema
69
Where is the lacrimal gland located?
Posterior to the Orbital Septum
70
What does the Supraorbital Nerve branch from?
Frontal Nerve
-branch of CN V1 (trigeminal nerve)
71
What is the nerve supply of the Levator Palpebrae Superioris muscle?
Oculomotor Nerve (CN III)
72
What muscles elevate the eyelid?
1. Levator Palpebrae Superioris Muscle
2. Superior Tarsus Muscle (sympathetic innervation)
73
What helps close the eyelid?
Palpebral Part of Orbicularis Oculi Muscle
-CN VII (facial nerve)
74
What are the palpebral glands?
1. Tarsal glands (Meibomian glands)
2. Ciliary glands
75
What is the purpose of the Tarsal glands (Meibomian glands)
1. Secrete oils that prevents lacrimal fluid from overflowing eyelids
76
How does a Chalazion happen?
When there is an obstructed Tarsal gland
-There will be an inflammatory nodule facing inward toward the eye
77
What is the purpose of the ciliary gland?
1. Secrete oil that prevents lacrimal fluid from overflowing eyelids
78
How does a Hordeolum (sty) happen?
From an obstructed Ciliary gland resulting in inflammatory nodule facing outward
79
What are the actions of the Superior Rectus muscle?
1. Elevation
2. Adduction
*CN III (oculomotor)
80
What are the actions of the inferior rectus muscle?
1. Depression
2. Adduction
*CN III (oculomotor)
81
What is the action of the Lateral Rectus muscle?
Abduction
*CN VI Abducens
82
What is the action of the medial rectus muscle?
Adduction
*CN III (Oculomotor nerve)
83
What are the actions of the Superior Oblique muscle?
1. Depression
2. Abduction
3. Intorsion
*CN IV (Trochlear nerve)
84
What are the actions of the inferior oblique muscle?
1. Elevation
2. Abduction
3. Extortion
*Oculomotor nerve CN III
85
Clinical eye testing of Abduction
Tests Lateral Rectus
*CN VI (Abducens)
86
Clinical eye testing of elevation while abducted
Test superior rectus
*CN III (oculomotor nerve)
87
Clinical eye testing of depression while abducted
Test Inferior Rectus
*CN III Oculomotor
88
Clinical eye testing of adduction
Medial Rectus
*CN III (Oculomotor)
89
Clinical eye testing of Elevation while adducted
Inferior Oblique
*CN III (oculomotor)
90
Clinical eye testing of depression while adducted
Superior oblique
*CN IV (Trochlear nerve)
91
What is the blood supply of the orbit?
1. Internal carotid artery BRANCHES INTO
2. Ophthalmic Artery BRANCHES INTO
3. Supraorbital Artery
92
Where does the Supraorbital artery pass into/
The scalp
93
Where does the Ophthalmic artery pass to?
Crosses over optic nerve from lateral to medial
94
What does the short ciliary nerves contain?
Postganglionic parasympathetic axons
95
What does the ciliary ganglion contain?
Cell bodies of postganglionic parasympathetic neurons
96
What does the oculomotor nerve contain?
Has preganglionic parasympathic axons
97
What does contraction of the ciliary muscle do? (Parasympathetic)
Removes tension on lens and causes it to ball up for near vision
98
What does contraction of the sphincter papillae muscle cause? (Parasympathetic)
Causes pupil to constrict
-Reduces light entering the eye
99
What does the long ciliary nerve contain?
Postganglionic sympathetic axons
100
What does the nasociliary nerve (branch of CN V1) contain?
Postganglionic sympathetic axons
101
What does contraction of the Dilator Pupillae muscle do? (Sympathetic)
Causes pupil to dilate
-increasing light entering the eye
102
What muscle aren’t weakened in Oculomotor Nerve Palsy
1. Lateral Rectus
2. Superior Oblique Muscles
103
What is the clinical presentation of Oculomotor nerve palsy
1. Eye oriented down and out
2. Pupil dilated
3. Ptosis
104
What muscle is weakened in Abducens Nerve Palsy?
1. Lateral Rectus muscle
*eye oriented inward
105
What does Trochlear nerve palsy present with?
Hypertropia and extortion
106
How will a patient with Trochlear nerve palsy try to correct the diplopia and hypertropia?
1. Patient will tilt their chin down and lateral flex neck away from affected to eye to correct for intorsion deficit
107
What does the Cavernous Sinus contain?
1. Internal carotid artery
2. CN III
3. CN IV
4. CN V1
5. CN V2
6. CN VI
108
What is the danger zone?
Border of the
1. Upper lip
2. Lateral aspect of the nose
3. Medial corner of the eye
109
If you pop a pimple in the danger zone what can happen?
Can drain to the ophthalmic vein which will lead into the cavernous sinus and infection can enter the sinus
-can cause thrombophlebitis, cerebral edema, death
110
What are the muscles of mastication located?
1. Parotid/masseteric
2. Temporal fossa
3. Infratemporal fossa
111
What is the origin and insertion of the Temporalis muscle?
O: Temporal Fossa
I: Coronoid Process
112
What is the origin and insertion of the Masseter muscle?
O: Zygomatic bone and Zygomatic arch
I: Ramus of the mandible
113
Where does the Temproalis muscle pass deep to?
Deep to the zygomatic arch
114
What muscles help assist mastication by maintain food between the teeth?
1. Orbicularis Oris
2. Buccinator
115
Where is the parotid duct located?
Near upper 2nd molar
116
What is the origin and insertion of the lateral pterygoid muscle?
O: Sphenoid bone
I: Condylar process
Fiber orientation: Anteroposterior
117
What is the origin and insertion of the medial pterygoid muscle?
O: Pterygoid Fossa of Sphenoid Bone
I: Ramus of Mandible
Fiber orientation: Anterosuperior
118
What are the muscles of mastication?
1. Temporalis Muscle
2. Masseter
3. Lateral Pterygoid Muscle
4. Medial Pterygoid Muscle
119
What are the actions of the Temporalis muscle?
Fibers pull up and posteriorly on Coronoid Process
1. Retrusion
2. Elevation
120
What are the actions of the Masseter Muscle?
Fibers directed anterosuperiorly
1. Elevation (major)
2. Protrusion (minor)
121
What are the actions of the Medial Pterygoid muscle?
Fibers directed anterosuperiorl
1. Elevation (Major)
2. Protrusion (Minor)
122
What are the actions of the Lateral Pterygoid muscle?
Pulls the mandible anteriorly
1. Protrusion (and opener)
123
What movement occurs between the head of the mandible and the articulation disc? (From open to 15 degrees)
Mandible depresses to 15 degrees
124
What movement occurs between the articular disc and temporal bone? >15 degrees
Protrusion
125
How does Temprormandibular joint dislocations happen?
Excessive depression of the Mandible
1. The head of the mandible and articular disc slide anterior to the articular tubercle
2. Jaw is stuck open
3. Pull mandible down and back to get un-stuck
126
During Linear translation what are the movements?
1. Protrusion=anterior glide
2. Retrusion=posterior glide
127
During circumduction what are the movements?
1. Mediotrusion=glide toward midline
2. Laterotrusion=glide away from midline
128
Where does the maxillary artery pass?
Superficial or deep to the lateral pterygoid muscle
129
Where does the middle meningeal artery pass?
Through foramen spinosum to Exeter the cranial cavity
130
Where does the Inferiror Alveolar Artery pass through?
Through Mandibular Foramen and into mandibular canal
131
What does the inferior alveolar artery supply?
The lower teeth
132
What does the masseteric artery supply?
Masseter muscle
133
What does the deep temporal artery supply?
Temporalis muscle
134
What does the Sphenopalatine artery supply?
Nasal cavity
135
What does the infraorbital artery supply?
Anterior upper teeth
136
What does the posterior superior alveolar artery supply?
Posterior upper teeth
137
What does the descending palatine artery supply?
The palate
138
What are the sensory nerves of the teeth, face, and tongue for touch and pain?
General somatic afferents
139
What are the nerves of the general somatic afferents?
THEY’RE ALL BRANCHES of CN V3 (trigeminal-mandibular nerve)
1. Auriculotemporal nerve
2. Inferior alveolar nerve
3. Lingual nerve
4. Buccal nerve
140
What do the inferior alveolar and lingual nerves separate?
Pterygoid muscles
141
What nerve supplies the lower teeth?
Inferior Alveolar Nerve
142
What branches from the inferior alveolar nerve?
Mental nerve
-exits by the mental foramen
143
What is in the mandibular canal?
Inferior alveolar N. A. V
144
What supplies the anterior 2/3 of the tongue?
1. Trigeminal ganglion
*touch and pain
2. Lingual Nerve
*touch and pain (GSA)n
145
What does the Buccinator muscle get supply by?
Buccal branch of CN VII (Facial nerve)
146
What supplies the sensory of the cheek mucosa?
Buccal Nerve (branch of CN V3-mandibular nerve)
147
What is deep and superficial to the masseter muscle of the Buccal Branch vs Buccal Nerve?
Superficial: Buccal Branch of CN VII
Deep: Buccal nerve (arises from infra temporal fossa)
148
What is the sensory innervation of the TMJ?
1. Auriculotemporal Nerve
2. Deep Temporal Nerves
3. Masseteric Nerve
149
What is motor to the muscles of mastication?
Branchial efferents (CN V3)
150
During embryonic formation what are the pharyngeal arches supplied by?
Arch 1: CN V- trigeminal nerve
Arch 2: CN VII- facial nerve
Arch 3: CN IX- glossopharyngeal nerve
Arch 4: CN X- vagus
151
What is the motor supply of the Temporalis muscle?
CN V3
152
What is the blood and nerve supply of the masseter muscle?
1. Masseteric nerve
2. Masseteric artery
*Pass through the mandibular notch
153
If there is a CN V3 (trigeminal- mandibular) lesion where does the chin deviate to?
TOWARD the side of the CN V3 lesion
*Ipsilateral Lateral pterygoid is weakened
154
What supplies the taste buds and salivary glands?
Taste buds: special afferents
Salivary glands: General visceral efferents
155
What is the Chorda Tympani a branch of?
CN VII (Facial nerve)
156
What does the Submandibular ganglion have?
Postganglionic parasympathetic neurons
157
What function does the trigeminal ganglion supply the tongue?
1. Touch
2. Pain
158
What function does the geniculate ganglion supply the tongue?
Taste
159
What information does the brain stem have for lingual nerve and Chorda tympani function
preganglionic parasympathetic neurons
160
What function does the Chorda Tympani supply the tongue?
1. Taste (anterior 2/3)
2. Preganglionic parasympathetic
161
What contains postganglionic neurons ?
Submandibular ganglion
-Parasympathetic ganglion
162
What is the function of the Lingual nerve?
1. General somatic afferents to anterior 2/3 of tongue
(Touch and pain)
163
What is the function of the Chorda tympani?
1. Taste for anterior 2/3 of tongue
2. Preganglionic parasympathetic to sublingual and submandibular glands
164
What is sensory to mucosa of the middle ear?
Tympanic plexus
165
What does the lesser petrosal nerve branch from?
CN IX- glossopharyngeal nerve
*Preganglionic parasympathetic
166
Where does the tympanic nerve come from?
CN IX (glossopharyngeal)
167
What does the Auriculotemporal nerve supply?
General somatic afferents to parotid-masseteric region of the face
168
What supplies the Parotid Gland?
1. CN IX (glossopharyngeal)
2. Lesser Petrosal Nerve
3. Otic Ganglion
4. Auriculotemporal nerve
169
Which nerve supplies the mylohyoid and digastric muscles (anterior)?
Trigeminal nerve (CN V3)
170
What nerves supply the stylohyoid and digastric (posterior) muscles?
Facial Nerve (CN VIII)
171
What does the greater Petrosal nerve have?
preganglionic parasympathetic to the lacrimal gland
172
What is the parasympathetic pathway to the Lacrimal and mucosal glands?
1. Facial Nerve
2. Greater Petrosal Nerve
3. Pterygopalatine ganglion
4. Lacrimal glands
173
What does the Pterygopalatine ganglion have?
Postganglionic parasympathic neurons
*Will supply the lacrimal and mucosal glands
174
What is the nerve supply of the stapedius muscle?
CN VII
-Facial
175
What is the purpose of the stapedius muscle?
Protects the innear ear
-Attenuates movement of the bone in response to loud sounds
176
What causes complex Bell’s palsy?
Damage to the Facial nerve proximal to internal acoustic meatus
177
What nerves are affected during Complex Bells Palsy?
1. Chorda Tympani
2. Greater Petrosal Nerve
3. Nerve to Stapedius muscle
178
If there is a TMJ Disc Dislocation (internal Derangement) what will and will not feel pain?
Main part of disc: NO pain
Retrodiscal Lamina: PAIN
179
What is the patient presentation of a TMJ Disc Dislocation?
1. Painful or tender temporomandibular joint
2. Popping or clicking
3. Patient prefers to chew on ipsilateral side
180
If there is TMJ dislocation where is the Disc located when the patients mouth is open or closed?
Open: Anterior to condylar process
Closed: Posterior to condylar process
181
During mastication which side is protruded or retruded?
Chewing side: retruded
Non-chewing side: Protruded
182
What muscle is working during mastication on the chewing side?
Temporalis muscle
183
What is the action of the Temporalis muscle?
Fibers pull up and posteriorly on Coronoid process
1. Retrusion
2. Elevation
3. Regulates intracapsular pressure
184
What is heard from TMJ Ostoarthritis?
Occurs from chronic TMJ dislocation
1. Painful with jaw movement and crepitus is heard
185
During Far vision what are the ciliary muscles and suspensory ligaments doing?
Ciliary: Relaxed
Suspensory ligaments: Tense
186
During Near vision what are the suspensory ligaments and ciliary muscles doing?
Ciliary muscles: contracted
Suspensory ligaments: Relaxed
187
What are the muscles of mastication?
1. Temporalis
2. Masseter
3. Lateral Pterygoid
4. Medial Pterygoid muscles
188
What CN contains axons that help mediate accommodation?
CN III (oculomotor)
