Head neck and spine Flashcards
(170 cards)
1
Q
Which cervical level is the hyoid bone?
A
C3
2
Q
Origin Insertion Action Nerve Special features Platysma
A
Lower border of mandible
Upper border of pec major and deltoid
Facial expression and opening the mouth
Cervical branch of facial nerve
Covers external jugular and anterior jugular veins. Blends with muscles of facial expression
3
Q
What are the four parts of deep cervical fascia?
A
Investing
Prevertebral
Pretracheal
Carotid sheath
4
Q
Where does the investing layer of the cervical fascia run and what does it attach to?
A
Splits around sternocleidomastoid and trapezius, subclavius, parotid gland and inferior belly of omohyoid- forming suprasternal space above jugular notch
Attaches to the skull, mandible and pelvic girdle
Forms roof of posterior triangle
Forms a fascial sling around omohyoid keeping it low in the beck
Fascia is pierced by external jugular vein
5
Q
Where does the prevertebral fascia runs and what are its anatomical relations?
A
Sits in front of anterior vertebrae and prevertebral muscles (longus capitus, rectus capitus lateralis, longus colli, scalenus anterior, scalenus medius and levator scapula)
Floor of posterior triangle
All cervical nerve roots, cervical plexus, brachial plexus, and trunks, and the 3rd part of subclavian artery are deep to it
Lymph nodes of posterior triangle, accessory nerve, subclavian bein and axillary vein are superficial to it
Pierced by cutaneous branches of cervical plexus (lesser occipital, greater auricular, transverse cervical and supraclavicular nerves)
6
Q
Where does the pretracheal fascia runs and what are its anatomical relations?
A
Sits behind infrahyoid strap muscles (sternothyroid, sternohyoid, omohyoid)
Splits around thyroid gland but only sticks on isthmus and 2/3/4 rings of trachea
Thymus and parathyroid gland lies deep
Pierced by thyroid vessels
7
Q
Where does the carotid sheath run and what are its anatomical relations?
A
Surrounds common and internal arteries, internal jugular vein and vagus nerve
Sympathetic trunk lies posterior
Contains; common carotid (bifurcation at C4, no branches in the neck, lies medial to the sheath), internal jugular vein, vagus nerve, ansa cervicalis (imbedded within carotid sheath)
Free posteriorly
Carotid pulse felt by pressing common carotid at TP of C6
8
Q
What are the key potential spaces of the neck?
A
Prevertebral space- pus from vertebrae can track down to superior mediastinum
Retropharyngeal space between prevertebral fascia and buccopharyngeal fascia-continuous with parapharyngeal space
Submandibular space- deep to investing fascia, communicates with mouth- relevant in Ludwig’s angina
9
Q
Origin Insertion Action Nerve Special features Sternocleidomastoid
A
Two heads from manubrium of clavicle
Lateral surface of mastoid process and superior nuchal line of occipital bone
Contraction of one side tilts muscle towards ipsilateral shoulder and rotates head to face opposite side
C2 and 3 of spinal part of accessory nerve
Crossed by great auricular nerve, external jugular vein and transverse cervical nerve. Internal jugular vein lies between the two heads
Posterior surface is carotid sheath overlying scalenus anterior
10
Q
What are the borders of the posterior triangle?
A
Posterior border of sternocleidomastoid Anterior border of trapezius Clavicle Roof is deep cervical fascia Floor is prevertebral fascia
11
Q
What are the contents of the posterior triangle?
A
Lymph nodes Accessory nerve Inferior belly of omohyid Transverse cervical, suprascapular and 3rd part of subclavian artery External jugular vein Brachial plexus Cervical plexus C1-4 Cutaneous branches of cervical plexus (lesser occipital, greater auricular, transverse cervical and supraclavicular)
12
Q
Origin
Insertion
Innervation
Digastric (suprahyoid muscle)
A
Posterior belly from medial surface of mastoid process. Intermediate tendon
to fibrous sling of hyoid bone
Anterior belly from inner surface of mandible
Posterior belly-facial nerve
Anterior belly- nerve to mylohyoid
13
Q
Origin
Insertion
Innervation
Stylohyoid (suprahyoid muscle)
A
Back of styloid process
Splits to enclose digatsric and goes into hyoid bone
Facial nerve
14
Q
Origin
Insertion
Innervation
Mylohyoid
A
Mandible back to 3rd molar
Hyoid bone
Mylohyoid nerve (only motor branch of posterior division of V3)
15
Q
Origin
Insertion
Innervation
Geniohyoid
A
Mandible
Hyoid bone
Hypoglossal nerve (C1)
Deep to mylohyoid and superficial to tongue
16
Q
Origin
Insertion
Innervation
Sternohyoid
A
Lower part of hyoid bone
Back of SCJ
Branch of ansa cervicalis (C1, C2, C3)
17
Q
Origin
Insertion
Innervation
Omohyoid
A
Lateral part of inferior hyoid bone (lies between sternohyoid and thyrohyoid)
Passes beneath sternocleidomastoid to insert onto transverse scapular ligament and scapula
Has two bellies -superior and inferior
Branch of ansa cervicalis C1 C2 C3
18
Q
Origin
Insertion
Innervation
Thyrohyoid
A
Under sternohyoid and omohyoid, originates from greater horn of hyoid bone
Thyroid cartilage
Hypoglossal nerve C1
19
Q
Origin
Insertion
Innervation
Sternothyroid
A
Posterior surface of manubrium of sternum
Thyroid cartilage
Branch of ansa cervicalis
20
Q
What lies lateral, medial and posterior to the thyroid gland?
A
Lateral-sternothryoid and sternohyoid superficially
Medial-larynx and upper trachea down to 6th tracheal ring, cricothyroid muscles, inferior constrictor of pharynx and external and recurrent laryngeal nerves
Posterior-parathyroid glands, common carotid artery, inferior thyroid artery (c6) ,left-thoracic duct at C7
21
Q
Describe the course of the recurrent laryngeal nerves
A
Hooks around ligamentum arteriorsum on left and subclavian artery on the right
Goes under inferior constrictor of pharynx
Usually lies in the groove betwen trachea and oesophagus
Left-more likely to lie POSTERIOR to inferior thyroid artery
Right- equal chance of being posterior or anterior to inferior thyroid artery
Nerve splits at level of isthmus into anterior (motor) and posterior (sensory)
1-2% of non recurrent right laryngeal nerve-abnormal right subclavian artery
22
Q
What does the external laryngeal nerve supply?
A
Runs behind superior thyroid artery
Supplies cricothyroid
23
Q
What is the blood supply of the thyroid?
A
Superior thyroid artery- branch of external carotid-pierces pretracheal fascia
Inferior thyroid artery- thyrocervical trunk- from thyrocervical trunk- pierces pretracheal fascia
Venous return into superior thyroid vein (internal jugular), middle thyroid (internal jugular) and inferior thyroid (left brachiocephalic vein)
24
Q
What is the nerve supply of thyroid?
A
Sympathetic from superior middle and inferior cervical ganglia
Thyroid glands weighs 25 grams
25
Where are the parathyroid glands?
Posterior to thyroid
90% of people have 4 glands (50 grams each)
Superior gland- 1st tracheal ring
Inferior gland- variable position sometimes behind lower pole below ITA
Supplied by ITA
26
What is the weird embryological development of the parathyroid glands?
Superior gland- aka parathyroid IV as comes from 4th pharyngeal pouch
Inferior gland- parathyroid III developed from 3rd pouch, but displaced caudally by descent of thymus so always ends up in weird places
27
Where is the oesophagus in relation to the thyroid and vessels of the neck?
Begins at C6
Attached to lower margin of cricoid cartilage
2 parts cervical and thoracic
Posterior- recurrent laryngeal nerve
Lateral- carotid sheath
Isthmus of thyroid adherent to 2/3/4 tracheal rings
Anterior-inferior thyroid vein and anterior jugular venous arch
28
Where is elective tracheostomy performed?
Transverse skin incision is made 2cm below cricoid cartilage
Between 2 sternohyoid muscles down sternothyroid muscle
Isthmus of thyroid divided and opening made by removing part of 2-3 tracheal rings
29
How long is the submandibular gland and what is its innervation?
5cm long
Superficial and deep part
Cell bodies in submandibular ganglion with preganglionic fibres in superior salivary nucleus in pons via nervus intermedius, chorda tympani and lingual nerve
Any incision must be 4cm away from mandible to avoid marginal mandibular branch of the facial nerve
30
List the 6 branches of the external carotid artery from C4 before it reaches the parotid gland
```
Superior thyroid artery
Lingual artery
Facial artery
Occipital
Posterior auricular
Ascending pharyngeal
```
Lies in front of sternocleidomastoid muscle accept initially
Some Large Facials Open Pussies up
31
What structures cross over internal carotid artery?
Crossed by lingual and facial veins, occipital artery and glossopharyngeal nerve
Posterior digastric, stylohyoid, posterior auricular artery
32
Where is the internal carotid in relation to the external carotid artery, vagus nerve and internal jugular vein?
Internal carotid initially lateral, then medial and deeper to external carotid
Ascends upwards in carotid sheath
IJV lies laterally within sheath
Vagus nerve is between artery and IJV
Behind the carotid trunk is sympathetic trunk (outside sheath)
carotid sinus lies at commencement- carotid body chemoreceptors
Internal carotid artery has no branches in the neck
33
Describe the course of the internal jugular vein
Emerges in the posterior compartment of jugular foramen
Lies on lateral mass of atlas
Lies on thoracic duct at C7
Crossed by accessory nerve
Crossed by omohyoid
First tributary-inferior petrosal sinus
Sits laterally in carotid sheath (starts off posteriorly)
34
What are the tributaries of the internal jugular vein?
```
Pharyngeal plexus
Facial
Lingual
Superior thyroid vein
Middle thyroid vein
```
35
What are the borders of the carotid triangle?
Sternocleidomastoid/ posterior belly of digastric
| Superior belly of omohyoid
36
What are the borders of the anterior triangle?
Sternocleidomastoid
mandible
Midline
37
what are the borders of the digastric/submandibular triangle?
Mandible
| Anterior and posterior bellies of digastric
38
What are the borders of the submental triangle?
Anterior body of digastrics
Body of hyoid bone
Midline
39
What are the boundaries of the muscular triangle?
Sternocleidomastoid
Superior belly of omohyoid
Midline
40
What is the contents of the carotid triangle?
```
Arteries:
Bifurcation of common carotid
Branches of external carotid (except pharyngeal artery)
Nerves:
Hypoglossal
Internal laryngeal nerve
External laryngeal nerve
Lymph nodes
```
41
What are the contents of the digastric triangle?
```
Submandibular gland
Lymph nodes
Facial a +v
Submental a+v
Mylohyoid artery
Hypoglossal nerve
mylohyoid nerve
```
42
What are the contents of the submental triangle?
Anterior jugular vein
| Lymph nodes
43
What are the contents of the muscular triangle?
Larynx
Thyroid gland
Lymph nodes
44
What are the prevertebral muscles of the neck?
```
Rectus capitus anterior
Rectus capitus lateralis
Longus capitus
Longus colli
All covered by prevertebral fascia
```
45
Where does the carotid sympathetic trunk lie and what does it consist of?
Sits anterior to prevertebral fascia
posterior to carotid sheath
Consists of
-superior cervical ganglion C1-4
-middle cervical ganglion C5-6
-inferior cervical ganglion C7-8
-stellate/cervicothoracic ganglion C7-T1
Somatic branches to cervical (C1-4)and brachial plexuses (C5-T1)
Visceral from each ganglion to cardiac plexus
Causes horner's syndrome (miosis, ptosis and no sweating of forehead)
46
Origin
Insertion
Nerve
Scalenus anterior
C3-6 anterior tubercles
Scalene tubercle of 1st rib
C4-6 anterior rami nerve
47
What lies anterior to scalenus anterior?
```
Phrenic nerve
Acsending cervical artery
Transverse cervical and suprascapular arteries
Vagus nerve
R) recurrent laryngeal artery
Internal jugular vein
Subclavian vein
```
48
What lies medial to the scalenus anterior?
```
Longus colli
Makes a pyramidal space;
-base is subclavian artery
-apex is common carotid artery
-stellate ganglion
-vertebral artery and veins
-inferior thyroid artery at C6
-thoracic duct
-first part of subclavian artery and its 3 branches (vertebral artery, thyrocervical trunk, internal thoracic artery)
-Vertebral vein
```
49
What are the branches of the thyrocervical trunk?
Superficial cervical (transverse cervical if gives off dorsal scapula)
Suprascapular
Inferior thyroid
Ascending cervical
50
What lies posterior to scalenus anterior?
Second part of subclavian artery-only branch is costocervical trunk- divides into superior intercostal artery and deep cervical artery
Anterior rami of lower cervical and first thoracic nerves
51
what lies laterally to scalenus anterior?
Trunks of brachial plexus
| Third part of subclavian artery- gives off dorsal scapula
52
Which nerve is the motor supply to the face?
Facial nerve
| No sensory fibres
53
Which nerve is the proprioceptive impulses of the face?
Trigeminal nerve
54
Describe the course of the facial nerve
Emerges from base of skull through stylomastoid foramen
Branches:
Posterior auricular (occipital belly of occipitofrontalis)
muscular branch to posterior belly of digastric and stylohyoid
Goes into parotid gland= divides into pes anserinus;
Temporal
Zygomatic
Buccal
Marginal mandibular (20% passes into neck below mandible)
Cervical
55
Which is the only part of the face that has sensation which does not come from the facial nerve?
Over angle of mandible
| -greater auricular nerve c2 C3
56
Describe the sensory supply of the ophthalmic nerve (V1)?
```
Lacrimal- lateral upper eyelid
Supraorbital- medial end of orbit
Supratrochlear-middle of forehead
Infratrochlear-skin over upper eyelid
External nasal-external nose down to tip
```
57
Describe the sensory supply of the maxillary V2 nerve?
Infraorbital nerve- lower eyelid
Zygomaticofacial- zygomatic bone
Zygomaticotemporal- hairless part of temple
58
Describe the sensory supply of the mandibular nerve V3?
Auriculotemporal nerve; external acoustic meatus and hairy skin over temple
Buccal- cheek
Mental nerve- through mental foramen
59
What is the blood supply of the face?
Facial artery (3rd branch of external carotid artery)
Goes up side wall of pharynx then hooks over posterior belly of digastric and hits mandibular gland
Hooks over inferior border of mandible at masseter
Then up to medial angle of the eye
Temple supplied by superficial temporal (terminating branch of carotid)
Forehead supplied by orbit by ophthalmic artery
60
What is the venous drainage of the face?
Forehead-facial vein
Temple- superficial temporal vein which forms retromandibular vein
Facial vein communicates with cavernous sinus and ophthalmic veins
If facial vein is blocked blood can flow through orbit into cavernous sinus
61
Describe the 5 layers of the scalp
```
Skin is thickest in the body
Connective tissue
Aponeurosis
Loose areolar tissue
Pericranium is firmly attached to suture lines
```
62
What is the origin of the occipitofrontalis muscle
Occipitalis- arises from highest nuchal line
Frontalis- arises from the front of the aponeurosis-has no bony attachment
R and L frontalis muscles meet in the midline- occipitalis does not
Innervated by facial nerve
Occipitalis- posterior auricular
Frontalis- temporal and zygomatic branches
63
What is the blood supply of the scalp?
External carotid via occipital, posterior auricular and superficial temporal
Internal carotid via supratrochlear and supraorbital branches
Freely anastomose
Bones of vault supplied by middle meningeal artery (therefore necrosis does not occur in scalping)
64
What can ear infections cause death?
Posterior auricular vein drains scalp behind the ear and receives mastoid emissary vein from sigmoid sinus
Retrograde thrombosis of cerebellar and medullary veins
65
Which bones meet at the pterion?
Frontal
Parietal
Temporal
Sphenoid
66
Which nerves cross the zygomatic arch?
Auriculotemporal nerve
| Temporal and zygomatic branches of facial nerve
67
Which is the only muscle to retract the mandible?
Temporalis
Converges towards coronoid process of mandible
Inserts on inner plate of the bone
Innervated by 2 deep temporal branches of the mandibular nerve
Blood supply temporal branches of maxillary artery
68
What runs between the 3 heads of the masseter muscle?
Between superficial and intermediate- superficial temporal or transverse facial artery
Between intermediate and deep- masseteric nerve (anterior division of mandibular nerve)
Muscle inserts onto mandibular ramus
69
What are the key relations of the parotid gland?
Surrounded by parotid sheath
| Attached to ramus of mandible with masseter outside and medial pterygoid inside
70
What structures are embedded within the parotid gland?
Facial nerve
Retromandibular vein
External carotid artery
71
Where does the parotid duct run?
5cm long
Crosses masseter and pierces buccinator
Opens into mucous membrane of cheek opposite second upper molar tooth
72
What is the innervation of the parotid duct?
Otic ganglion via auricotemporal nerve. Inferior salivary nucleus via glossopharyngeal nerve, tympanic plexus and lesser petrosal nerve
Sensory fibres from auricotemporal nerve
Parotid fascia from greater auricular nerve
73
What are the boundaries of the infratemporal fossa?
Medial-lateral pterygoid plate, tensor and levator palate muscles, superior constrictor
Lateral:Ramus of mandible and coronoid process
Anterior: posterior surface of maxilla
Roof: greater wing of sphenoid
Posterior: upper part of carotid sheath
74
What are the contents of the infratemporal fossa?
Medial pterygoid muscle (2 heads, inserts onto medial surface of angle of mandible, main chewing muscle for molar teeth, mandibular nerve)
Lateral pterygoid muscle (2 heads, inserts onto neck of mandible, mandibular nerve)
Insertion of temporalis on coronoid process
Maxillary artery and its branches
75
What is the course of the maxillary artery?
Terminal branch of external carotid
Winds around neck of mandible
Passes between two heads of lateral pterygoid
Enters pterygopalantine fossa
Has 3 parts; before, on and beyond the lateral pterygoid muscle
76
What are the 5 branches of the maxillary artery which come off before the lateral pterygoid and how do they enter the skull?
Inferior alveolar-mandibular foramen
Middle meningeal-foramen spinosum
Accessory meningeal- foramen ovale
Deep auricular-external acoustic meatus
Anterior tympanic artery- pretympanic fissure
77
What are the branches of the maxillary artery which come off on the lateral pterygoid?
Branches to the lateral and medial pterygoids
Deep temporal branches
Lingual/buccal branches
78
Which branches come off the maxillary artery within the pterygopalatine fossa?
```
Posterior superior alveolar
Greater palatine
Pharyngeal
Artery of pterygoid canal
Infraorbital
```
79
What lies between the sphenomandibular ligament and the neck of the mandible?
Auricotemporal nerve, maxillary artery and vein
80
What lies between the sphenomandibular ligament and the ramus of the mandible?
Inferior alveolar vessels and nerve
81
What is the contents of the carotid sheath?
Internal carotid artery
Internal jugular vein
CN IX X XI and XII
82
What is the path of the carotid sheath?
Runs from base of skull to arch of aorta
83
What are the relations of the carotid sheath?
Medial-pharynx
Lateral- deep parotid gland, styloid process and 3 muscles attached to it (stylopharyngeus, styloglossus, stylohyoid)
Anterior: infratemporal fossa
Posteriorly: Cervical sympathetic trunk on prevertebral fascia
At all levels vagus lies between internal jugular and common carotid
84
Name the structures that pass between the fork of the internal and external carotid
Stylohyoid process and stylohyoid ligament
styloglossus
stylopharyngeus
Glossopharyngeal nerve (branch to stylopharyngeus and pharyngeal branch)
Pharyngeal branch of vagus
85
What are the 6 branches of the glossopharyngeal nerve and what do they innervate?
Tympanic branch- supplies middle ear, mastoid ear cells and boney part of auditory tube with sensory fibres
Motor branch to stylopharyngeus
Pharyngeal branches- pharyngeal plexus
Carotid sinus nerve
Tonsillar branch-pallatine tonsil
Lingual branch-posterior 1/3 of tongue
86
What are the branches of the vagus nerve in the neck?
Meningeal branches
Auricular branch
Carotid body branch
Pharyngeal branch
Superior laryngeal- pharynx and larynx (splits into large internal laryngeal and small external laryngeal which supplies criothyroid)
Cervical cardiac branches
Recurrent laryngeal nerve- heart, trachea, oseophagus and laryngeal muscles EXCEPT cricothyroid
87
What does the accessory nerve supply?
Posterior belly of digastric
Sternocleidomastoid
Trapezius
88
Which nerve supplies the tongue?
Hypoglossal CN XII(C1) is motor. Hypoglossal has no sensory fibres. Innervates all muscles except palatoglossus Vagus CNX
Sensory and taste for posterior 1/3- glossopharyngeal CN IX
Sensory anterior 2/3- lingual nerve CNV
Taste anterior 2/3-chorda tympani CNVII
Sensation at the very back of the tongue is by internal laryngeal nerve CN X
89
What is innervation of the styloid muscles?
Stylopharyngeus-glossopharyngeal CN IX
Stylohyoid- facial CNVII
Styloglossus-hypoglossal CN XII
90
What travels through the jugular foramen?`
```
Junction of sigmoid sinus and internal jugular vein
Meningeal branch of occipital artery
Meningeal branch of ascending pharyngeal artery
Accessory nerve
Vagus nerve
Glossopharyngeal nerve
Inferior petrosal sinus
Emissary veins
```
91
What are the boundaries of the pterygopalatine fossa?
Posterior-sphenoid
Medially-palatine bone
Anterior-posterior wall of maxilla
Roof-body of sphenoid/palatine bone
92
What is the contents of the pterygopalatine fossa?
Maxillary vessels
Maxillary nerve- passes through foramen rotundum and splits into infraorbital, zygomatic and posterior superior alveolar nerve
Pterygopalantine ganglion (hayfever gland)
93
What are the 5 branches of the pterygopalatine ganglion?
```
Nasopalatine
Lateral posterior superior nasal
Greater palatine nerve
Lesser palatine nerve
Pharyngeal nerve
```
Acts as a relay station between superior salivary glands in the poms, lacrimal gland of palate, nose and paranasal sinuses
94
What are the three types of taste buds?
Filiform papillae: no tastebuds
Fungiform: some taste buds
Vallate papillae: forms sulcus terminalis- at apex is foramen caecum (remainder of thryoglossal duct)
Papillae on anterior 2/3 only
95
What are the four intrinsic muscles of the tongue?
Superior
Inferior longitudinal
Transverse
Vertical
No bony attachments
96
What are the four extrinsic muscles of the tongue?
Genioglossus- largest
Hyoglossus
Styloglossus
Palatoglossus
Blood supply: lingual artery
Lymph drainage to both sides of the neck
Innervation: all hypoglossal nerve except palatoglossus which is pharyngeal branch of vagus nerve
97
What are the muscles of the the floor of the mouth?
Mylohyoid-mass of tongue lies on it
| Geniohyoid
98
What structures lie between mylohyoid and hyoglossus?
Submandibular duct
Hypoglossal nerve
Lingual nerve
Submandibular ganglion (parasympathetic fibres in chorda tympani)
99
Which structures lie deep to hyoglossus?
Lingual artery
Glossopharyngeal nerve (post 1/3 of tongue)
Stylohyoid ligament
Sublingual gland- supplied by lingual artery
100
When does the pharynx become continuous with the esophagus?
C6
101
What are the muscular layers that make up the pharynx?
```
Superior constrictor
Middle constrictor
Inferior constrictor (thyropharyngeus and cricopharyngeus- continuous with esophagus)
Stylopharyngeus
Palatopharyngeus
Salpingopharyngeus
```
102
What lies in the gap between the superior constrictor and middle constrictor of the pharynx?
Stylopharyngeus
Styloglossus
Glossopharyngeal nerve
Lingual nerve
103
What lies in the gap between the inferior constrictor and middle constrictor of the pharynx?
Gap is closed by thyrohyoid membrane
| Internal laryngeal nerve and superior laryngeal vessels pierce
104
What is Killian's dehiscence of the pharynx?
Weakness in the wall
| Gives rise to pharyngeal diverticulum where a pouch of mucosa protudes between constrictors
105
What is the innervation of the pharynx?
Motor: Vagus except stylopharyngeus which is glossopharyngeal
Sensory:
Nasopharynx- maxillary nerve via pterygopalatine ganglion
Oropharynx: glossopharyngeal
everything else by internal and recurrent laryngeal nerves.
Cricopharyngeus: recurrent laryngeal, external laryngeal and pharyngeal plexus
106
Where is the palatine tonsil and what is its blood supply/nerve?
Between the palatopharyngeal and palatoglossal folds with superior constrictor beneath
Supplied by facial artery
Innervated by tonsillar branch of glossopharyngeal nerve
Drains to jugulodigastric nodes
107
What are the muscles of the soft palate?
Tensor palati- opens auditory tube and allows equalisation of air pressure
Levator palati- pulls palate up, equalisation of air pressure, shuts off nasopharynx from oropharynx
Palatoglossus- raises tongue
Palatopharyngeus- most internal, elevates larynx and pharynx
Palatopharyngeal sphincter
108
What is the blood supply to the soft palate?
Lesser palatine branches of maxillary
Ascending palatine branches of facial
Palatine brnches of ascending pharyngeal artery
109
What is the innervation of the soft palate?
All muscles of soft palate are innervated by pharyngeal plexus (vagus) EXCEPT TENSOR PALATI which is supplied by nerve to medial pterygoid (branch of mandibular nerve)
Sensory is by maxillary division of trigeminal nerve with some overlap from glossopharyngeal
110
Which nerves control the gag reflex?
Elevation of palate and contraction of pharyngeal muscles
Afferent- reflex glossopharyngeal
Efferent- vagus
111
What level does the larynx become continuous with the trachea?
C6
112
List the 6 cartilage that make up the larynx?
```
3 single;
Thyroid
Cricoid- only complete ring
Epiglottic
3 paired;
Cricothyroid
Arytenoid
Arytenocorniculate
```
113
What are the intrinsic muscles of the larynx?
```
Ones that change the inlet;
Aryepiglottic
Transverse arytenoids
Thyroepiglottic
Ones that move the chords;
Posterior cricoarytenoid- only muscle that ADBUCTS vocal folds. #1 muscle
Lateral cricoarytenoid
Cricothyroid
Thyroarytenoid
Vocalis
```
114
What is the blood supply/ sensory innervation to the larynx?
Above the vocal chords: superior laryngeal branch of STA/ internal laryngeal nerve
Below the vocal chords: inferior laryngeal branch of the ITA/recurrent laryngeal nerve
115
What is the motor nerve supply to the intrinsic muscles of the larynx?
All muscles supplied by recurrent laryngeal nerve except cricothyroid which is supplied by external laryngeal nerve
116
Where is the lacrimal gland?
Orbital part lies in lacrimal fossa
Kept in place by levator tendon and orbital fat
Secretomotor fibres travel in greater petrosal nerve
Postganglionic fibres run with zygomatic nerve
117
What are the 3 roots of the ciliary ganglion?
Sensory root: nasociliary (cornea/sclera/iris/ciliary body NOT CONJUNCTIVA)
Sympathetic root: branch from cavernous plexus (cell bodies in superior cervical ganglion)
Parasympathetic root: cell bodies in Edinger Westphal nucleus
118
What are the branches of the ciliary ganglion?
Ciliary ganglion lies on lateral side of the optic nerve
Branches are called short ciliary nerves
All contain fibres from all 3 roots
Mostly supply muscle of ciliary body for accommodation
Only short ciliary nerves are concerned with constricting the pupil and altering the shape of the lens
119
Describe the process of the direct light reflex
CNII detects light, nerve fires down optic nerve and chiasm to lateral geniculate bodies
Some fibres from lateral geniculate bodies move away and go down to pretectal nucleus in midbrain. Not all fibres go down optic radiations
Parasympathetic fibres go down CNII through ciliary ganglion
Activates sphincter papillae via short ciliary nerves
Pretectal nuclei talk to both Edinger-Westphal nuclei and bilateral constriction occurs
120
Which ligaments make up the temporomandibular joint?
Atypical synovial joint, lined by fibrocartilage not hyaline
Lateral temporomandibular ligament
Sphenomandibular ligament
121
In what position is the temporomandibular joint the most stable?
More stable with jaw shut
| Forwards disclocation is more common because backwards dislocation is opposed by contraction of lateral pterygoid
122
Which muscles cause the movements of the temporomandibular joint?
Protraction: lateral pterygoids
Depression: lateral pterygoids, digastrics, mylohyoid
Elevation: masseters, medial pterygoids and temporalis muscle
Side to side: medial/lateral pterygoid activity
123
What are the distinguishing features of cervical vertebrae?
Foramen in transverse process
no costal facets
Flexion, extension, no rotation
Bifid spinous process
124
What are the distinguishing features of thoracic vertebrae?
No foramen in TP
Costal facets
Rotation, flexion, extension, abduction
SP slope downwards
Heart shaped body
125
What are the distinguishing features of lumbar vertebrae?
```
No foramen in TP
No costal facets
Flexion, extension, abduction NO ROTATION
Roughly horizontal
Massive bodies, kidney shaped
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126
What is a cervical rib?
An elongation of the costal element of C7 passing down from C7 to first rib
127
What is special about the atlas vertebra?
Massive articular facets- concave and kidney shaped
Lower surface is round and flat
No obvious SP
128
What is special about the axis vertebra?
Dens and large bifid spinous process
| Dens articulates with anterior arch of atlas
129
What are the key differences between the atlanto-occipital joint and the atlantoaxial joints?
Altanto-occipital: no rotation, anterior+posterior atlanto-occipital membranes which are attached to the atlas. Posterior membrane deficient to allow for vertebral artery and C1
Atlantoaxial: Rotation caused by SCM, splenius capitus, inferior oblique. Cruciform ligament lies in front of tectorial membrane.
130
Why is the cruciform ligament of the atlantoaxial joint so crucial?
Attaches to the atlas and joins body of axis to foramen magnum.
Holds the dens in place. Rupture allows dislocation backwards =DEATH
131
What is the blood supply to the vertebral column?
Supplied by segmental arteries; ascending cervical, intercostals, lumbar
Basivertebral veins drain into internal vertebral venous plexus. Communicates with pelvic veings so blood flow can spread from prostate, uterus, breast and thyroid to the bodies of the vertebrae
132
What are the flexor and extensor muscles of the vertebrae?
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Flexor muscles;
Longus capitus
Longus colli
Psoas
Extensor muscles;
Erector spinae
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133
What is the ligamentum nuchae?
Fibroelastic tissue that attaches occiput to the bifid spines of cervical vertebrae
134
What are the boundaries of the suboccipital triangle and what does it contain?
Rectus capitus posterior major
Superior and inferior oblique muscles
```
Contains;
Second part of vertebral artery
Vertebral veins
C1 nerve
Occipital artery from external carotid artery
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Between pia mater and arachnoid mater contains CSF
135
What are the key features of pia mater?
Invests brain and spinal cord
| Contains blood vessels but no structure intervenes between pia mater and underlying neural tissue
136
What are the key features of arachnoid mater?
Impermeable membrane supported by dura mater
subdural space between arachnoid and dura
Arachnoid villi where CSF leaks back into venous sinuses
Subarachnoid cisterns; between base of brain and skull
137
What are the key subarachnoid cisterns?
Chiasmatic cistern- contains anterior carotid artery and optic nerves
Interpeduncular cistern- roofed by 3rd venticle. Contains terminus of basilar artery, stalk of pituitary gland, CN III and IV
Pontine cistern- clivus and front of pons/medulla. Contains basilar artery and its pontine and labyrinthine branches to CN V and XII
Cerebellomedullary cistern-located between cerebellum and medulla, recieves CSF from aperture of 4th ventricle
138
What are the key aspects of dura mater?
Inner layer-dense fibrous membrane
Separated from outer layer at venous sinuses and folds
Supplied by middle meningeal artery via foramen spinosum. 2 branches; frontal branch-over precentral gyrus, parietal branch-over superior temporal gyrus (haemorrhage may cause contralateral deafness)
Innervated by ophthalmic division of trigeminal nerve +tentorial nerves (V3) and CN IX and X in posterior fossa
139
Which venous sinuses do not lie between the inner and outer dural layers?
Inferior sagittal and straight sinuses
The venous sinuses don't have any valves
140
Where does the superior sagittal sinus lie?
Lies between the two layers of falx cerebri
| Turns at internal occipital protuberance and becomes the transverse sinus (generally right)
141
What does the inferior sagittal sinus drain?
Lower part of medial surface of each hemisphere
142
What does the straight sinus drain?
Inferior sagittal sinus, R and L basal cerebral veins and great cerebral vein. Turns into transverse sinus (generally left)
143
Describe the course of the transverse sinus?
Runs laterally and goes to inner surface of mastoid bone. Two transverse sinuses communicate at their commencement at internal occipital protuberance
Ends in sigmoid sinus, inferior petrosal sinus enters.
144
Describe the course of the sigmoid sinus?
Commences at the termination of the transverse sinus.
| Expands into the jugular bulb then passes through jugular foramen as the internal jugular vein
145
Describe the course of the occipital sinus
Runs down from transverse sinus to foramen magnum
| Receives tributaries from cerebellum/medulla and drains choroid plexus of 4th ventricle
146
Where is the basilar sinus?
Sits on the clivus
Network of veins connecting 2 inferior petrosal sinuses and receives veins from lower part of pons and from front of the medulla
Thrombosis is fatal
147
Which two structures lie within the cavernous sinus?
Internal carotid artery: curves upwards from foramen lacerum
Enters posterior sinus between periosteum of sphenoid bone and inner part of the dura
Goes upwards medial to anterior clinoud process
Abducens nerve CNVI: runs on lateral side of internal carotid artery
148
Which structures are embedded in the lateral wall of the cavernous sinus?
Occulomotor nerve: medial to other nerves, breaks into sup and inf
Trochlear nerve
CNV1: divides into lacrimal frontal and nasociliary in the lateral wall
CNV2: runs on medial side of lateral wall and leaves through foramen rotundum
Superior ophthalmic vein
Inferior ophthalmic vein
Superficial middle cerebral vein
Sphenoparietal sinus
Superior petrosal sinus- enters sigmoid sinus
Inferior petrosal sinus- enters jugular foramen
149
Which 2 veins connect the face skin and the cavernous sinus?
Deep facial vein vis pterygoid plexus
| Angular vein via superior ophthalmic vein
150
What are the contents of the anterior cranial fossa?
Frontal lobe
Olfactory nerve +cribiform plate
Anterior ethmoid nerve
151
What is the contents of the median part of the middle cranial fossa?
Pituitary gland
Optic nerves
Optic chiasma
Intercavernous sinuses
152
What is the contents of the lateral parts of the middle cranial fossa?
```
Cavernous sinus
CN III to VI
Internal carotid artery
Middle meningeal vessels
Greater and lesser petrosal nerves
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153
What is the contents of the posterior cranial fossa?
Convexities of cerebral hemispheres
Pons
Medulla oblongata
CN V to XII:
Trigeminal nerve leaves the pons by a large sensory and a small motor root
Abducens nerve-long course and susceptible to increases in ICP
Facial, vestibulocochlear and nervus intermedius- labyrinthine artery lies with them
Glossopharyngeal, vagus and accessory arise from root of medulla
Spinal root of accessory nerve, up through foramen magnum, posterior to denticulate ligament
154
Which cranial nerves exit through the superior orbital fissure?
CNIII
CN IV
CNV1
CNVl
155
How does the optic nerve leave the skull and which bones does it articulate with?
```
Via optic canal
Frontal
Ethmoid
Lacrimal
Zygoma
Sphenoid
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156
How does the trigeminal nerve leave the skull?
V1: superior orbital fissure
V2: foramen rotundum
V3: foramen ovale
Sphenoid bone
157
How does the facial nerve leave the skull?
Internal acoustic meatus
Facial canal
Stylomastoid foramen
Temporal bone
158
How does the vestibulcochlear nerve leave the skull?
Internal acoustic meatus
| Temporal bone
159
Which nerves travel through the jugular foramen?
CN VIIII
CNX
CN XI
Between petrous and occipital bones
160
How does the hypoglossal nerve leave the skull?
Via hypoglossal canal
| Occipital bone
161
Where are the primary motor, sensory and visual cortexes?
Motor: precentral gyrus in front of central sulcus
Sensory: Postcentral gyrus behind central sulcus-parietal lobe
Visual: Gyri which form walls of calcarine sulcus-occipital lobe
162
Which part of the brain is affected in non-fluent, fluent and conduction aphasia?
Non fluent: Broca's. Inferior frontal gyrus
Fluent: Wernicke's. Temporal lobe
Conduction: arcuate fasiculus
163
What are the ascending spinal cord tracts?
Dorsal columns: touch and proprioception
Lateral spinothalamic tract:
pain and temperature
Ventra; spinothalamic tract: light touch
164
What are the descending spinal cord tracts?
Lateral corticospinal tract: motor. Upper extremity motor pathways are more medial
165
Which cranial nerves exit from the forebrain and midbrain
Forebrain: 1, 2
Midbrain: 3, 4
CN IV only nerve to emerge from dorsal side of brainstem
166
Which cranial nerves exit from the pons and medulla?
Pons: 5, 6,7, 8
Medulla: 9, 10, 11, 12
167
When does the spinal cord end?
L1
168
What is the distribution of the anterior cerebral artery?
Anterior 2/3 of medial aspect
| Occlusion has greater effect on legs
169
What is the distribution of the middle cerebral artery?
All of lateral aspect of the brain
| Occlusion has the greatest effect on the arms and face
170
What is the distribution of the posterior cerebral artery?
Posterior 1/3 of medial brain
| Occlusion causes Contralateral homonymous hemianopia
