ianto jocks Flashcards
where are the only places movement in cranial skeleton occurs?
TMJ and Atlanta-occipital joint
which bones are formed by intramembranous ossification?
flat bones
which bones are formed by endochondreal ossification
irregular
what are pneumatised bones and give 4 examples?
bones with air spaces (sinus)
temporal, frontal, ethmoid, spenoid
what is the skull composed of
neurocranium and viscerocranium
what is the neurocranium?
bony case of the brain and meninges- skull cap (calvaria) and cranial base
what is viscerocranium?
facial skeleton
which bone is part of the skull but not included in neurocranium or viscerocranium?
the 3 ossicles of the ear - malleus, incus and stapes
how many bones are there in neurocranium?
8
2 pairs
-temporal
-parietal
4 single
-frontal
-occipital
-spenoid
-ethmoid
what are the borders of the temporal fossa?
superior - superior temporal line
posterior - inferior temporal line
anterior - frontal process of zygomatic bone
inferior- infra temporal crest deep to zygomatic arch
floor includes pterion
define norma lateralis
lateral view of skull
define norma frontalis
frontal view of skull
define norma basalis
view from base of skull
define norma verticalis
view from superior aspect
define norma occipitalis
view from behind the skull
what do the superior and inferior temporal lines provide attachment for?
temporalis muscle and temporal fascia
what is the vertex
superior part of neurocranium
define bregma
the junction between sagittal and coronal sutures
define lambda
where lambdoid and sagittal sutures join
define nasion
where frontonasal and internasal sutures meet
define inion
most prominent part of the external occipital protuberance
define asterion
star/Y shapes junction between the occipital parietal and temporal bones
define glabella
smooth part of frontal bone superior to the root of the nose and between supracilliary arches - most anterior part of forehead
what does it mean if the head is in anatomical position?
aka orbitomeatal or Frankfort horizontal plane
horizontal line can be drawn between superior margin of external acoustic meatus and inferior margin of the orbit
where is the pterion?
it is an H shaped junction between the temporal, parietal, frontal and greater wing of sphenoid bone
4cm superior to mid zygomatic arch and 3cm posterior to brontal process of zygomatic bone
what are the risks of pterion?
it is a weak area of the skull therefore vulnerable to injury
pterion overlies the anterior branch of the middle meningeal artery so trauma can cause rupture and epidural/extradural haematoma - a bleed between the skull and dura which puts pressure on the brain
what is the calvaria covered by?
pericranium and scalp
underneath lies the dura which is the outermost of the meninges
what is the calvaria covered by?
pericranium and scalp
underneath lies the dura which is the outermost of the meninges
what is the name gives to the small islands of bone found within cranial sutures?
wormian bones
aka sutural or accessory bones
what is the purpose of wormian bones?
they facilitate growth and development of brain
what is a suture?
a type of fibrous joint which has limited or no movement
what is a fontanelle?
flat bones are separated by fibrous membrane or soft spot which fuse to become sutures in post natal life
soft spots on babies head
there are anterior and posterior fontanelles and mastoid and sphenoidal (less important)
what is the purpose of fontanelles?
facilitate growth of the brain
when does the anterior fontanelle close?
by 18 months
when does the posterior fontanelle close?
by the end of the first year
when does the frontal suture fuse?
starts to fuse at 2 and is completely fused by 8
what is the metopic suture?
if the frontal suture remains which is the case in 8% of people it is then called the metopic suture
when does the mandibular symphysis close?
fuses in 2nd year
what bones make the nasal septum?
superiorly - perpendicular plate of ethmoid
inferiorly - vomer
what is the name given to the anterior nasal opening shaped like a pear?
perform aperture
what exits the supraorbital notch
ophthalmic branch of CNV
what exits the infra-orbital foramen?
maxillary branch of CNV5 - exits foramen rotunda interiorly and then infra-orbital foramen
what exits the mental foramen?
the mandibular branch of the CNV exits the mental foramen after it exits the cranium through foramen spinosum
what are the paranasal sinuses?
frontal sinuses
ethmoid sinuses
maxillary sinuses
name pneumatised bones in the skull
frontal
temporal
sphenoid
ethmoid
what separates the posterior and anterior nasal apertures?
vomer
where does the interior carotid artery enter the neurocranium?
carotid canal
where does the external jugular vein leave the neurocranium?
jugular foramen
what passes through the foramen magnum?
spinal cord, meninges, vertebral and spinal arches and spinal root of accessory nerve
what nerve does the hypoglossal canal carry?
hypoglossal nerve CNXII
what passes through the foramen spinosum?
middle meningeal artery and vein and meningeal branch of mandibular nerve
what exits the foramen ovale?
mandibular branch of CNV and accessory meningeal artery
what is the foramen lacerum?
an artefact of dry bone - only small veins and branches of meningeal artery pass through
what cervical vertebrae are typical and which are atypical?
typical C3-C6
atypical C1 atlas, C2 axis and C7 vertebral prominence
what ligament connects the spinous processes of the cervical vertebrae to the occipital bone and foramen magnum?
nuchal ligament
which ligament is the nuchal ligament continuous with?
supraspinous ligament
what connects the vertebral spinous processes from C7 to the sacrum
supraspinous ligament
what is the purpose of the nuchal ligament?
support the head, provide attachment for muscles and resist flexion
which cervical vertebrae are bifid?
C2-C6
which are the only vertebrae with transverse foramen?
cervical
what passes through vertebral foramen?
spinal cord
what passes through transverse foramen and which vertebrae has an exception?
vertebral blood vessels except in C7 where vertebral artery does not pass through
is C7 spinous process bifid or non-bifid
non-bifid
why has c7 got smaller or absent transverse foramen?
the vertebral artery does not need to pass through it
what replaces the spinous process in C1?
posterior tubercle
which vertebrae has a dens ans what is its function?
C2 - acts as an axis for the atlas
what does the atlanto-occipital joint enable?
flexion and extension - nodding
what does atlanto axial joint allow?
rotation of the head assisted by transverse ligament of atlas holding dens in position
what does the transverse ligament of the atlas do?
holds the dens of the axis in place
creates a socket for the dens as makes a posterior border for dens and the anterior border is the articular facet for the dens on the atlas
what do the alar ligaments do?
manage movement of the head within safe parameters
prevent excessive rotation
connect the dens to the occipital condyles
run from the side of the dens to lateral border of foramen magnum
between which cervical vertebrae is there no intervertebral disc?
C1 and C2
what does the articular surfaces of the atlas articulate with?
occipital condyles
what level of cervical vertebrae will you find the hyoid bone?
C3
what bone does the hyoid articulate with?
trick Q lol
it is suspended by muscles and ligaments
where does the hyoid connect to by muscles?
mandible, thyroid cartilage, sternum, manubrium, styloid process and scapula
what is the site of attachment for anterior neck muscles?
hyoid bone
What connects the oral cavity with the pharynx and larynx?
hyoid bone
where does the stylohyoid ligament connect?
lesser horn of the hyoid bone to the styloid process of the skull
what is the superior boundary of the neck?
base of skull and inferior border of mandible
what is the inferior boundary of the neck?
clavicle, sternum, acromion and C7
what is the risk of no bony protetion on the neck?
it houses critical structures and major BVs can be damaged
what is the risk of no bony protection on the neck?
it houses critical structures and major BVs can be damaged
what are the 3 compartments of the neck?
visceral, vascular, vertebral
what is contained within the visceral compartment?
trachea, oesophagus, thyroid and parathyroid gland
what is contained within the vascular compartment?
carotid sheath containing internal jugular vein and internal carotid artery and vagus nerve
what is contained within the vertebral compartment?
cervical spine, muscles of neck and back, nerves and nerve roots of cervical nerves
what is the role of fascia in the neck?
provides containment and protection
provides slipperiness so structures can slide over one another
prevents spread of infection
where will you find superficial fascia?
between dermis and investing layer
what will you find within the superficial fascia?
platysma muscle, cutaneous nerves, BVs and lymphatics
name the three deep cervical fascia
investing fascia
pretracheal
prevertebral
hat does the investing fascia surround and split to enclose?
surrounds neck
splits to enclose SCM, trapezius, parotid and submandibular glands
what vein pierces the deep investing fascia?
external juglar vein and anterior jugular vein
what is the platysma?
broad thin sheet of muscle covering the anterior of the neck
where does superficial fascia attach to?
mandible and facial muscles - continuous with thorax superficial fascia
where does the investing fascia attach superiorly?
superiorly to superior nuchal line of occipital bone, mastoid process of temporal bone,
anterioly to hyoid bone
where does the investing fascia attach inferiorly?
inferiorly to scapula, acromion, clavicle and manubrium
where does the investing fascia attach anteriory?
anterioly to hyoid bone
where does the investing fascia attach posteriorly?
continuous with ligamentum nuchae and periosteum of C7 spinous process
what is enclosed by the visceral part of the pretracheal fascia?
oesophagus, trachea, thyroid and parathyroid gland
what is enclosed by the muscle part of the pretracheal fascia?
infrahyoid muscles
where does the pre tracheal fascia extend from and to?
hyoid bone to upper thoracic cavity
base of skull to thoracic cavity
what does the pre tracheal fascia fuse with laterally?
alar fascia and carotid sheath
what fascia wraps around the omohyoid?
pretracheal
what fascia is pierced by the thyroid vessels?
pretracheal
what does the prevertebral fascia surround?
vertebral column and pre and post vertebral muscles
where is prevertebral fascia fixed to superiorly?
base of skull
what muscles does the prevertebral layer surround?
anteriorly
-longus colli
-longus capitus
laterally
-scalenes
posteriorly
-deep cervical muscles
which layers of cevical fascia blend with the carotid sheath?
all three layers of deep cervical fascia blend with the carotid sheath
pretracheal, investing and prevertebral
what does the carotid sheath surround?
common and internal carotid artery, internal jugular vein and vagus nerve
(also contains deep cervical lymphnodes and nerves)
where does the carotid sheath run from and therefore connect?
runs from carotid canal to aortic arch therefore connecting the cranial cavity with thorax
what are the boundaries of the anterior triangle of neck?
midline, inferior border of mandible and anterior border of SCM
another name for superior thoracic aperture
thoracic inlet
what are the boundaries of the posterior triangle of the neck?
posterior border of SCM, anterior border of trapezius, and mid third of clavicle
what provides connection between upper limb and head and neck?
axillary inlet
which nerves can be found in SCM region?
great auricular and transverse cervical
what vein can be found in the SCM region?
external jugular vein
what are the 4 regions in anterior triangle?
carotid
muscular
submandibular
submental
what nerves can be found in the carotid triangle?
CNX vagus
CNXI accessory
CNXII hypoglossal
superior root of ansa cervicalis
branches of cervical plexus
name the two subdivisions of posterior triangle
occipital
omoclavicular
what divides the posterior triangle into two subdivisions?
inf. belly omohyoid
what is the origin and insertion of SCM?
origin
sternal head - manubrium
clavicular head - mid 3rd of clavicle
insertion
mastoid process
what innervates the SCM?
motor - spinal accessory nerve CNXI
pain and proprioception C2 and C3 nerves
what is the name of the fossa between the two heads of SCM?
supraclavicular fossa
what is the action of the SCM?
draws head fwd
tips head towards ipsilateral shoulder
how would you test the SCM?
turn head to opposite side against resistance - can be seen/palpated if acting normal
what innervates the trapezius?
spinal accessory nerve CNXI
where is the origin and insertion of the trapezius?
origin
superior nuchal line
external occipital protuberance
ligamentum nuchae
spinous process T7-T12
insertion
spine of scapula
acromion
lateral 3rd of clavicle
what is the action of the trapezius?
assists in scapula rotation
upper fibres elevate scapula
middle fibres adduct scapula
lower fibres depress scapula
how to test trapezius?
shrug against resistance and should see superior border
what nerves make up the cervical plexus?
anterior rami of spinal nerves C1-C4
what are the muscular branches of cervical plexus?
phrenic nerve - C3 C4 C5
ansa cervicalise C1 C2 C3
what are the cutaneous branches of cervical plexus?
C2 – lesser occipital nerves
C2, C3 – great auricular & transverse cervical nerves
C3, C4 – supraclavicular nerves
what cervical nerves give rise to ansa cervicalis?
C1 C2 C3
where does the superior root of ansa cervicalis decend from
hypoglossal nerve
what does ansa cervicalis innervate?
infrahyoid muscles except for thyrohyoid
what innervates the thyrohyoid muscle?
C1 and C2 fibres which decend from hypoglossal nerve independently
where does the anterior jugular vein drain into?
external jugular vein
where does the external jugular vein drain into?
subclavian vein
which vein runs across SCM?
external jugular vein
what nerves and vasculature cross SCM
external jugular vein
great auricular and transverse cervical
which nerves cross the posterior triangle superficial to prevertebral fascia?
spinal accessory CNXI
lesser occipital
supraclavicular
what vasculature crosses the posterior triangle superficial to the prevertebral fascia?
external jugular vein
transverse cervical artery
transverse cervical vein
what roofs and floors the anterior triangle?
roof - investing fascia
floor- pretracheal fascia and carotid sheath posterolaterally
what is contained in the submandibular triangle of the anterior triangle?
submandibular gland, lymph nodes, parts of CNXII - hypoglossal, facial artery and vein, mylohyoid nerve
what is contained in the submental triangle of the anterior triangle?
submental lymph nodes, small veins which unite to form anterior jugular vein
what is contained in the carotid triangle of the anterior triangle?
carotid sheath, thyroid gland, larynx and pharynx, part of external carotid, part of cervical plexus, part of ansa cervicalis, deep cervical lymphnodes, parts of accessory and hypoglossal nerve
what is contained in the muscular triangle of the anterior triangle?
sternothyroid and sternohyoid muscles
larger part of thyroid and parathyroid glands
name the suprahyoid muscles
mylohyoid
digastric
stylohyoid
geniohyoid
name the infrahyoid muscles
sternohyoid
sternothyroid
thyrohyoid
omohyoid
all muscles of anterior triangle attach to the hyoid bone except for one. which?
sternothyroid
what seperates the mylohyoid?
mylohyoid raphe
where is the geniohyoid?
similar position to digastric but inserts directly into hyoid and is deep
where do infrahyoid muscles attach?
scapula, clavicle, sternum and thyroid cartilage
where does the mylohyoid originate and insert?
mylohyoid line of mandible
inserts into body of hyoid and fibres of the opposotr mylohyoid
what is the function of suprahyoidmuscles?
elevate hyoid and larynx and constitute to the floor of mouth
what is the action of the mylohyoid?
elevate hyoid and constitute to floor of mouth
where is the origin of the anterior belly of digastric?
digastric fossa on lower medial mandible
where is the origin of posterior belly of digastric
mastoid notch on medial mastoid process
where is the insertion of the digastric?
attach to their intermediate tendon at hyoid which is attached by a fascial sling
what is the action of the digastric?
anterior belly raises hyoid and opens mouth by lowering mandible
posterior belly elevates and retracts hyoid
what nerve innervates the mylohyoid?
branch of the trigeminal mandibular division inferior alveolar nerve called nerve to mylohyoid
what innervates the digastric muscle
anterior belly CNV3 nerve to mylohyoid
posterior belly CNVII facial nerve digastric branch
what is the origin and insertion of stylohyoid?
originates at styloid process and inserts into body of hyoid
what is the action of the stylohyoid
pulls the hyoid bone upwards and back
what innervates the stylohyoid?
facial nerve CNVII
what nerve innervates the mylohyoid?
CNV3 nerve to mylohyoid with is a branch of the inferior alveolar nerve branch of mandibular division
what innervates the digastric?
anterior belly innervated by nerve to mylohyoid CNV3
posterior belly innervated by facial nerve CNVII digastric branch
what innervates the geniohyoid?
anterior ramus of C1 which travels with hypoglossal nerve
what is the action of geniohyoid?
elevates and oulls hyoid forward
pulls mandible down and in
where is the insertion and origin of geniohyoid?
originates from mandible mental spine and inserts at body of hyoid
what is the purpose of the infrahyoid muscles aka strap muscles?
fix and depress hyoid
depress larynx
what are the superficial infrahyoid muscles?
sternohyoid
omohyoid
what is the origin and insertion of sternohyoid?
posterior surface of subclavicular joint and manubrium
insertion - body of hyoid medially
what is the action of sternohyoid?
depresses hyoid after elevation during swallow
what connects the superior and inferior bellies of omohyoid?
intermediate tendon
where does the superior belly of omohyoid originate and insert?
originates at tendon and inserts into body of hyoid laterally
where does the inferior belly of omohyoid originate and insert?
originates at superior body of scapula and inserts into tendon
where is the intermediate tendon of omohyoid attached to and how?
clavicle by a facial sling
what are the two deep infrahyoid muscles?
thyrohyoid and sternohyoid
where does thyrohyoid originate and insert?
originates at oblique line on thyroid cartilage and inserts into hyoid body and greater horn
where does sternothyroid originate and insert?
originates at posterior surface of manubrium and inserts into oblique line on thryroid cartilage
what is the action of sternothyroid?
draws larynx downwards
what is the action of thyrohyoid?
depresses hyoid and can raise larynx
which deep infrahyoid muscle draws larynx down?
sternothyroid
which deep infrahyoid muscle raises larynx?
thyrohyoid
what innervates infrahyoid muscles?
all infrahyoid muscles are innervated by the anterior rami of C1-C3 through the ansa cervicalis except for thyrohyoid which is a bit different
what innervates thyrohyoid?
C1 innervates thyrohyoid which runs with CNXII hypoglossal - same as geniohyoid
what compartment of the neck will you find the thyroid gland?
visceral
where does the thyroid cartilage begin and end?
from thyroid cartilage to 5th tracheal ring
what is the thyroid gland pyramidal lobe remenant of?
embryonic thyroglossal duct - lobe is present in 50%
what is the venous supply of the thyroid gland?
superior thyroid artery - 1st branch of external carotid artery
inferior thyroid artery - branch of the thyrocervical trunk from subclavian
superior middle and inferior thyroid vein
what is the venous drainage of the thyroid gland?
thyroid venous plexus
where does the superior thyroid vein drain to?
inferior jugular vein
where does the middle thyroid vein drain into?
internal jugular vein
where does the inferior thyroid vein drain into?
brachiocephalic
what is the name of the small thyroid artery in 10% of people?
ima thyroid artery
where does the ima artery usually but not always arise from?
brachiocephalic trunk
how many pairs of parathyroid glands are there?
2
what is the venous drainage of parathyroid?
thyroid venous plexus - same as thyroid
what blood vessel supplies the parathyroid?
inferior thyroid artery which is a branch of the thyrocervical trunk of the subclavian
what nerves innervate the thyroid and parathyroid gland?
thyroid branches from cervical sympathetic ganglia
what regulates the endocrine secretions of thyroid and parathyroid gland?
pituitary
what nerve runs posteromedial to thyroid gland?
recurrent laryngeal nerve from vagus nerve
what does the right recurrent laryngeal nerve loop around?
right subclavian artery at T1-T2 level
what does the left recurrent laryngeal nerve loop around?
arch of aorta at T4-T5 level
which recurrent laryngeal nerve is at risk of injury and why?
right recurrent laryngeal nerve as it runs close to the inferior thyroid artery and is at risk during neck surgery
e.g. bruising or pressure from accumulated blood or exudate
what symptoms will indicate one or both of the recurrent laryngeal nerves have been damaged?
hoarseness, temporary aphonia, phonation disturbance and laryngeal spasm
describe a cricothyrotomy
large bore needle pierces cricothyroid ligamenr
when does a cricothyrotomy become surgical?
if needle is replaced with a tracheostomy tube
describe a tracheostomy
retraction of infrahyoid muscle and incision of isthmus of thyroid to insert tube between 1st and 2nd or 2nd-4th tracheal rings
name a risk of tracheostomy
presence of ima artery
softness of trachea in children or neonates
what does the lymphoid system drain?
surplus tissue fluid and leaked plasma proteins
what does the lymphoid system remove?
debris from cellular decomposition and infection
how do lymphnodes indicate infection?
they are swollen if active, can palpate and feel harder
through what duct will most of the lymph of the body renter the bloodstream (except the superior right quadrant)?
thoracic duct
where does the lymph from the superior right quadrant enter the bloodstream?
right upper limb, right side of head and neck and right side of thorax drain into the right lymphatic duct
describe the chain of lymph drainage in the head
all lymphnodes except for the occipital nodes drain into superior deep cervical nodes and then into inferior deep cervical nodes (facial, anterior and posterior auricular, superficial and deep parotid, retropharyngeal)
occipital nodes drain directly to inferior deep cervical nodes
they then drain into left and right subclavian vein through thw thoracic duct or right lymphatic duct
name the 5 groups of paired superficial lymphnodes in the head
facial
occipital
superficial parotid
posterior auricular
anterior auricular
how many groups of paired superficial lymphnodes are there in the head?
5
how should lymphnodes be in healthy patients
small, soft, mobile
what do the superficial parotid, posterior and anterior auricular lymphnodes drain?
external ear, lacrimal gland, adjacent regions
what do the occipital nodes drain?
scalp of that region
where are facial lymphnodes located?
along the facial vein
what are the four subgroups of facial nodes?
malar or infraorbital (zygomatic region)
mandibular
nasiolabial
buccal
what and how do the facial nodes drain?
skin and mucous membranes in location of node and then they drain to eachother superior to inferiorly and then into deep cervical nodes
name deep lymphnodes of the head which can’t be palpated
deep parotid
retropharyngeal
what do deep partotid nodes drain?
middle ear, auditory tube, parotid gland
what do the retropharyngeal nodes drain?
palate, pharynx, paranasal sinises and nasal cavity
what lymphnodes on head disappear at age of 4-5?
retropharyngeal
what do the midline submental nodes drain?
tissue in the submental triangle bilaterally - the only superficial cervical lymphnode that drains bilaterally
how many groups of superficial cervical lymphnodes are there?
4
what are the four groups of superficial cervical lymphnodes?
submental
submandibular
external jugular
anterior jugular
what do the submental lymphnodes drain?
lower lip, chin, floor of mouth, apex of tongue, mandibular incisors with associated peridontium and gingivae
where do the submental nodes drain into?
directly to deep cervical or via submandibular lymphnodes firt
what could cause swelling of submental node?
Epstein Barr Virus, dental infection including periodontitis
what do the submandibular glands drain?
they unilaterally drain the cheeks
upper lip
body of tongue
anterior hard palate
most of teeth with periodontium and gingivae except for mandibular incisors (submental nodes) and maxillary third molars (superior deep cervical lymphnodes)
what is the most common cause of submandibular node enlargement?
infections of head, neck, sinuses, ears, eyes, scalp and pharynx
cancers from oral cavity, anterior nasal cavity, soft tissues and submandibular salivary gland
what do external jugular lymphnodes drain?
back of head
auricular and parotid region
what does the anterior jugular lymphnodes drain?
infrahyoid region
where are deep cervical lymphnodes located?
along the internal jugular vein
can deep cervical lymphnodes be palpated?
yes
what divides the deep cervical lymphnodes into inferior and superior?
the omohyoid crossing the internal jugular
what do the superior deep cervical lymphnodes drain?
posterior nasal cavity, posterior hard palate, soft palate, back of the tongue, maxillary third molars with associated periodontium and gingiva, TMJ, oesophagus, trachea and thyroid
is lymph drainage at the back of the tongue unilateral or bilateral
bilateral
what node drains the palatine tonsils?
jugulodigastric node
where are inferior deep cervical lymphnodes located?
inferior to where omohyoid crosses internal jugular vein
what do inferior deep cervical lymphnodes drain?
posterion scalp and neck, superficial pectoral region and part of the arm
what does the jugulo-omohyoid node drain?
tongue and submental triangle - enlargement may be a sign of pathology of tongue
why are inferior deep cervical lympnodes at greatest risk for involvement in spread of breast cancer?
they communicate with the axillary lymph nodes that drain the breast region
what lymphnodes drain lateral triangles of neck?
accessory and supraclavicular lymph nodes
what do enlarged lymphnodes indicate?
current or past pathology or area of immune activity
systemic or local disease
what is the most common route of initial spread of carcinomas?
lymphogenous
what do swollen and tender lymph nodes indicate?
infection or inflammation
what do hard painless lymph nodes indicate?
malignancy
if submandibular lymphnodes are enlarged, where is potential location of disease or malignancy?
oral cavity, face, nasal cavity and maxillary sinus
if supraclavicular lymphnodes are enlarged, where is potential location of disease or malignancy?
abdomen or thorax
what are the boundaries of the oral cavity?
hard and soft palates
tongue and soft tissues
cheeks
what are the two parts of the oral cavity?
oral cavity vestibule
oral cavity proper
where is the oral vestibule?
the slit like space created by teeth and gingivae and lips and cheeks
communicates with exterior through oral fissure (lips)
where is the oral cavity proper?
space between upper and lower dental arches which also limit it anteriorly and laterally
what does the oral cavity communicate with posteriorly?
oropharynx via oropharyngeal isthmus
what is a vestigial feature above the upper lips ?
philtrum
what muscle acts as a sphincter for the oral fissure?
orbicularis oris
what arteries anastomose in the lips to form an arterial ring?
superior and inferior labial arteries
where does the lip get sensory innervation form?
maxillary and mandibular branches of trigeminal
what is the main muscular component of the cheek?
buccinator
what supplies motor innervation to the buccinator?
facial nerve
what duct pierces the buccinator?
parotid duct
where does the parotid duct enter the oral cavity?
around maxillary 2nd molar
what muscles create the floor of the mouth?
the two mylohyoid
where does the geniohyiod attach?
inferior mental spine of mandible and the hyoid
superior to mylohyoid
what nerve supplies mylohyoid and anterior belly of digastric?
nerve to mylohyoid - branch of IAN
what separates anterior and posterior parts of tongue?
terminal sulcus - v shaped groove at dorsum of tongue
name the 4 papillae found on tongue
foliate
fungiform
vallate - largest
filiform
which is the only tongue papillae with no tastebuds?
filiform
where does the posterior 1/3 of tongue lie?
oropharynx
what is the foramen cecum of tongue?
small pit rememnant of embryonic structure - where thyroid developed
what is the root body and apex of the tongue?
root - attached posterior portion
body - anterior 2/3 between body and apex
apex - tip which rests against incisor teeth
where are fungiform papillae most numerous?
apex of tongue
what are foliate papillae?
folds of lingual mucosa
what are the lymphoid nodules at the posterior tongue?
lingual tonsil
what does waldeyers ring consist of?
4 pairs of tonsils
pharyngeal tonsil/adenoid
tubul tonsil
palatine tonsil
lingual tonsil
what vein can you see on each side of the frenulum of tongue?
lingual vein
what structure houses the opening of the submandibular duct from the submandibular salivary gland?
sublingual caruncle
what separates the extrinsic and intrinsic muscles of the tongue?
sagittal septum
what do intrinsic muscles of tongue do?
change size and shape of tongue
what are the four intrinsic muscles of the tongue?
superior longitudinal
inferior longitudinal
transverse
vertical
what are the four extrinsic muscles of the tongue?
genioglossus
styloglossus
hyoglossus
palatoglossus
what do extrinsic muscles of the tongue do?
move the tongue
what effect do the inferior and superior longitudinal muscles have on tongue?
make short and thick
what do the transverse and vertical muscles do to the tongue?
make it long and narrow
where does the genioglossus originate and attach?
superior mental spines of mandible
hyoid bone inferiorly and intrinsic muscles of tongue superiorly
what is the function of genioglossus?
protruding the tongue
what happens when genioglossus is not working?
falls posteriorly and obstructs airway - this is what happens in general anaesthesia hence why an airway is inserted
what is the origin and insertion of hyoglossus?
greater horn of hyoid
intrinsic muscles of tongue
lies lateral to genioglossus
what is the function of hyoglossus?
depressing lateral sides of tongue
where does the lingual artery enter the tongue?
between genioglossus and hyoglossus
what vessel gives rise to lingual artery?
external carotid
where does the lingual and hypoglossal nerve enter the tongue?
external surface of hyoglossus
where does styloglossus originate and insert?
styloid process of temporal bone
inserts to fibres of intrinsic muscles and hyoglossus
what is the function of styloglossus?
elevating and retracting the tongue
what is the origin and insertion of palatoglossus?
originates from palatine aponeurosis
blends with intrinsic muscles fibres
what is the function off palatoglossus?
depress the soft palate towards the tongue
what innervates the palatoglossus?
vagus - more a muscle of the palate than tongue
what nerve gives motor supply to the muscles of the tongue?
hypoglossal nerve supplies all muscles except for palatoglossus which is supplied by vagus
what nerves give general sensation to tongue - pain, pressure and temperature?
anterior 2/3 mandibular nerve of trigeminal
posterior 1/3 glossopharyngeal nerve
what nerve gives special sensation of taste to the tongue?
ant 2/3 facial nerve via chorda typani
posterior 1/3 glossopharyngeal
what blood vessels supply the tongue?
lingual artery from external carotid
what blood vessels drain the tongue?
deep lingual and dorsal lingual veins drain into internal jugular vein
What is found in the carotid body and what do they do?
chemoreceptors - monitor blood gases o2 and co2 and temperature and ph
Where are baroreceptors found in the arterial system and what do they do?
carotid sinus - sends signals along glossopharyngeal nerve to regulate blood pressure
What is the term for nucleus pulposis applying pressure to spinal nerves?
slipped disc
What is an indication of congestive heart failure?
dilation of external jugular
Which disease causes thickening of the bone of the vault of the skull?
Paget’s disease
The border of which bones make up the pterion?
frontal, temporal, parietal, sphenoid
What purpose does the circle of Willis provide?
equalises the blood pressure to the brain
Where are the muscles supplied by CN 3,4,6 and 12 formed from?
somites
Where are the muscles supplied by CN 5,7,9,10 and 11 formed from?
pharyngeal arches
Where do the motor neurons of the lower left side of the face receive their input?
RHS of brain
What is a common cause of extra Dural haemorrhage?
rupture of middle meningeal artery due to pterion fracture
what happens in a sub-dural haemorrhage?
superior cerebral veins detach from dura and rupture due to minor trauma
what causes a sub-arachnoid haemorrhage?
rupture of cerebral arteries usually due to brain aneurism
what is the cause and symptoms of cavernous sinus thrombosis?
Bacteria from an upper molar abscess travel through pterygoid venous plexus to sphenoidal emissary veins that join the cavernous sinus
symptoms - swellings, boils, visual problems etc
what causes osteoarthiritis of the spine?
osteophytes at facet joints
why might someone with osteoarthritis feel dizzy when turning their head?
osteophytes press against vertebral artery causing vertebrobasilar ischaemia
what is ptosis?
drooping eyelid
what is anhydrosis?
lack of sweating
ptosis and anyhydrosis are both diagnostic of Horners syndrome, what else may be a sign?
pupillary constriction
what causes Horners syndrome and its symptoms?
damage to the sympathetic trunk
which parasympathetic ganglion supplies the cilliary muscles and pupillary constrictor muscles?
ciliary ganglion
what is supplied by the submandibular ganglion?
sublingual and submandibular salivary glands
what is supplied by the pterygopalatine ganglion?
lacrimal glands
nasal mucosa
Palate general sensation
Nasal cavity
which ganglion supplies the parotid gland?
otic ganglion
what region will you find lymph nodes which drain into the parotid lymph nodes?
area above the line between eye and angle of mandible
why might profuse bleeding occur when a patient presents with a cut lip?
inferior and superior labial branches of facial artery anastomose
what causes the mediolus?
overlap of muscle fibres of the buccinator - posterior fibres cross to opposite side on labial side e.g. superiorly to inferiorly
what is ludwigs angina?
bacterial infection affecting floor of mouth
what muscle is responsible for retrusion of the mandible?
temporalis
along what do the fibres conveying taste travel from the lingual nerve to the facial nerve?
chorda tympani
which nerve supplies the geniogloosus, styloglossus and hyoglossus?
hypoglossal CN12
which nerve supplies palatoglossus?
vagus CN10
what risk is associated with surgery to remove stones from the submandibular duct?
laceration of lingual vein
damage to lingul nerve
where may food get trapped in the pharynx?
piriform fossa and vallecula
what is waldeyers ring and what is it composed of?
tonsillar ring
first line of defence
pairs of adenoid, lingual, palatal and tubul tonsils
what forms the palatal aponeurosis?
tendon of tensor veli paletini
which epithelial type lines inferior nasal cavity?
ciliated pseudostratefied columnar epithelium
which epithelial type lines superior nasal cavity?
olfactory epithelium
how might infection of frontal sinus spread?
infection can track through the frontal sinus opening in hiatus semilunaris to the maxillary sinus opening
what is supplied by maxillary branch of trigeminal?
skin over maxilla, upper teeth, hard and soft palate, nasal cavity and nasopharynx
Which gland may be affected by disease if you can see the sclera superior to the iris?
thyroid
