NECK Flashcards
(122 cards)
1
Q
Posterior Triangle
A
- Bounded by
- posterior border: SCM
- anterior: Trapezius
- superior: clavicle
- roof: platysma and the inersiting layer of the deep cervical fascia
- Floor: Splenius capitis and levator scapulae muscles anterior, middle and posterior scalene muscle
2
Q
The posterio triangle contains the ________
A
- accessory nerve
- cutaneous branches of the cervical plexus
- External jugular vein
- transverse cervical and suprascapular vessels
- subclavian vein (occasionally) and artery
- posterior (inferior) belly og the omohyoid, and roots and trunks of the brachial plexus
3
Q
The posterior traingle is further divided into _______by the omohoyoid posterior belly
A
- Occipital
- subclavian (supraclavicular or omoclavicular)
4
Q
Anteriot triangle
A
- Bounded by
- anterior borfer of the SCM
- anterior midline of the neck\
- inferior border of the mandible
- Roof: Platysma and the investing layer of the deep cervical fascia
5
Q
The anterior border is further divided by the omohyoid anterior belly and the digastic anterior and posterior bellies into ______________
A
- Digastric (submandibular)
- Submental (suprahyoid)
- carotid
- muscular (inferior carotid) triangles
6
Q
spasmodic contraction or shortening of the neck muscle, producing twisting of the neck with the chin pointing upward and to the opposite side
A
Torticollis (wryneck)
- due to injury of the SCM muscle or avulsion of the accessory nerve at the time of borth and unilateral fibrosis in the muscle)
7
Q
U shaped bone consisting of a median body, paired lesser horns (cornua) laterally, and paired greater horns posteriorly
A
Hyoid bone
8
Q
The ____ of the hyoid bone provides attachment for the geniohyoid, mylohyoid, omohyoid, and sternohyoid muscles
A
Body
9
Q
The greater horn provides attachment for the ________
A
- Middle cosntrictor
- hyologlossus
- digastric (anterior and posterior) bellies
- stylohyoid
- thyrohyoid
10
Q
The lesser horn provides attachment for the _________
A
- stylohyoid ligament
- Runs from the styloid process to the lesser horn of the hyoid bone
11
Q
Is a slender projection of variable length and extends downward and forward from the temporal bone
A
Styloid Process
12
Q
The styloid process gives origin to 3 muscles __________ and 2 ligaments _______
A
- stylohyoid
- styloglossus
- stylopharyngeus
- stylohyoid Ligaments
- stylomandibular ligaments
13
Q
Elongation of the styloid process or excessive calcification of the styloid process or stylohyoid ligament that causes neck, throat, or facial pain and dysphagia
A
Eagle’s syndrome
- may occur due to compression of the glossopharyngeal nerve, which winds around the styloid process or stylohyoid ligament as it descends to supply the tongue, pharynx, and neck
- Can also be caused by pressure on the internal and external carotid arteries by a deviated and elongated styloid process
14
Q
Accessory nerve
A
- formed by the union of cranial and spinal roots
-
Cranial roots
- from medulla oblongata below the roots of the vagus
-
Spinal Roots
- from the lateral aspect of the cervical segment of the spinal cord between C1 and C3 (or C1 and C7)
- unites to form a trunk that ascends between the dorsal and ventral roots
15
Q
The accessory nerves has both ______ and _____ portions, which traverse the jugular foramen, where they interchange fibers.
A
- Cranial Portion
- motor fibers that join the vagus nerve
- innervate
- soft palate
- pharyngeal constrictors
- larynx
- Spinal portion
- innervates the
- SCM
- Trapezius
- innervates the
16
Q
Platysma
A
O: Superficial fascia over upper part of deltoid and pectoralis major
I: Mandibles; skin and muscles over mandible and angle of mouth
N: Facial nerve
A: Depresses lower jaw and lip and angle of mouth; wrinkles skin of neck
17
Q
Sternocleidomastoid
A
O: manubrium sterni and medial 1/3 of clavicle
I: Mastoid process and lateral half of superior nuchal line
N: Spinal accessory nerve; C2-C8
A: Singly turns face toward opposite side; together flex head, raise thorax
18
Q
Digastric
A
O: anterior belly from digastric fossa of mandible; posterior belly from mastoid notch
I: intermediate tendon attached to body of hyoid
N: Posterior belly by facial nerve; anterior belly by mylohyoid nerve of the trigeminal nerve
A: Elevates hyoid and floor of mouth; depresses mandible
19
Q
Mylohyoid
A
O: Mylohyoid line of mandbile
I: Median raphe and body of hyoid bone
N: Mylohypoid nerve of trigeminal nerve
A: Elevates hyoid and floor of mouth; depresses mandible
20
Q
Stylohyoid
A
O: styloid process
I: body of hyoid
N: Facial nerve
A: elevates hyoid
21
Q
Geniohyoid
A
O: Genial tubercle of the mandible
I: Body odf hyoid
N: c1 via hypohlossal nerve
A: Elevates hyoid and floor of mouth
22
Q
Sternohyoid
A
O: Manubrium sterni and medial end of clavicle
I: Body of hyoid
N: Ansa cervicalis
A: Depresses hyoid and larynx
23
Q
Sternothyroid
A
O: Manubrium stern; first corstal cartilage
I: oblique line of thyorid cartilage
N: ansa cervicalis
A: Depresses hyoid and larynx
24
Q
Thyrohyoid
A
O: oblique line of thyroid cartilage
I: Body and greater horn of hyoid
N: C1 via hypoglossal nerve
A: Depresses hyoid and elevates larynx
25
Omohyoid
O: inferior belly from medial lip of suprascapular notch and suprascapular ligament; superior belly from intermediate tendon
I: Inferior belly to intermediate tendon; su[eriror belly to body of hyoid
N: Ansa cervicalis
A: depresses and retracts hyoid and larynx
26
Cervical Plexus is formed by the ventral rami of \_\_\_\_\_\_\_
C1 to C4
27
Cutaneous Branches of the Cervical Plexus
* **Lesser Occipital nerve (C2)**
* ascends along posterior border of the SCM to the scalp behind the auricle
* **Greater Auricular nerve (C2-C3)**
* Ascends on the SCM to innervate the **skin behind the auricle and on the parotid gland**
* **transverse Cervical Nerve (C2-C3)**
* Turns around the psoterior border of SCM and innervates the **skin of the anterior cervical triangle**
* **Supraclavicular nerve (C3-C4)**
* Emerges as a common trunk from under the SCM then divides into anterior, middle, and lateral branches to the **skin over the clavicle and the shoulder**
28
Motor Branches of the Cervical Plexus
* Ansa cervicalis
* Phrenic Nerve (C3-C5)
* Twigs from the Plexus
* Accessory phrenic Nerve (C5)
29
Is a nerve loop formed by the union of the superior root (C1 or C1 and C2 ; **descendens hypoglossi**) and the inferior root (c2 and C3; **descendens cervicalis**)
Ansa Cervicalis
* superficial or within the carotid sheath in the anterior triangle
* Innervates
* infrahyoid muscles
* omohyoid
* sternohyoid
* sternothyroid
30
Arises from the 3rd, 4th, and 5th (mainly 4th) cervical nerve that contains motor, sensory, and sympathetic nerve fibers and provides motor supply to the diaphragm
Phrenic nerve
* Passes between the subclavian artery and vein at the root of the neck
* Enters the thorax by crossing in front of the origin of the internal thoracic artery
* Passes anterior to the root of the lung and between the mediastinal pleura and fibrous pericardium to supply sensory fibers to these structures
31
Twigs from the Plexus
Supply the longus capitis, cervicis or colli, SCM, trapexius, levator scapular and scalene muscles
32
Occassionally arises as a contribution of C5 to the phrenic nerve or a branch of the nerve to the subclavius (C5), descends lateral to the phrenic nerve, enters the thorax by passing posterior to the subclavian vein, and joins the phrenic nerve below the 1st rib to supply the diaphragm
Accessory phrenic nerv
33
The Brachial plexus is formed by the union of the ventral primary rami of _____ to ____ and passes between the anterior scalene and middle scalene muscles
C5 to T1
34
Dorsal Scapular Nerve (C5)
* Emerges from behind the anterior scalene muscle and runs downward and backward through the middle scalene muscle and then deep to the trapezius.
* Passes deep to or through the levator scapulae and descends along with the dorsal scapular artery on the deep surface of the rhomboid muscles along the medial border of the scapula, innervating the levator scapulae and rhomboid muscles.
35
Pierces the middle scalene muscle, descends behind the brachial plexus, and enters the axilla to innervate the serratus anterior
Long thoracic nerce (C5-C7)
36
The upper trunk gives rise to the
Suprascapular nerve (C5-C6)
Nerve to the subclavius muscle (C5)
37
Passes deep to the trapezius and joins the suprascapular artery in a course toward the shoulder
Passes through the scapular notch under the superior transverse scapular ligament
Supplies the supraspinatus and infraspinatus muscles
Suprascapular nerve (C5-C6)
38
Nerves to the subclavius muscle (c5)
Descends in front of the plexus and behind the clavicle to innervate the subclavius
Communicates with the phrenic nerve as the acccessory phrenic nerve in many cases
39
Subclavian Artery is a branch of the \_\_\_\_\_\_\_\_\_\_on the right but arises directly from the _________ on the left
Brachiocephalic
Arch of the aorta
40
The subclavian artery is divided into three parts by the \_\_\_\_\_\_\_\_\_\_
Scalene muscles
* **first part**
* passes from the origin of the vessel to the median margin of the anterior scalene
* **second part**
* lies behind the anterior scalene
* **third part**
* lateral margin of the muscle to the outer border of the first rib
41
Branches of the Subclavian Artery
* Vertebral Artery
* Thyrocervical Trunk
* Internal Thoracic artery
* Costocervical Trunk
* Dorsal (Descending) Scapular Artery
42
Vertebral artery
* Arises from the first part of the subclavian artery and ascends between the anterior scalene and longus colli muscles
* Ascends through the transverse foramina of C1 - C6 winds around the superior articular process of the atlas and passes through the foramen magnum into the cranial cavity
43
Short trunk from the first part of the first part of the subclavian artery that divides into 3 arteries
Thyrocervical Trunk
44
Division of the thyrocervical trunk
* Inferior Thyroid artery
* Transverse cervical artery
* Suprascapular artery
45
Inferior thyroid Artery
* Ascends infornt of the anterior scalene muscle
* Gives rise to an
* ascending cervical artery
* Ascends on the anterior scaline muscle medial to the phrenic nerve
46
Transverse Cevical artery
* Runs laterally across the anterior scalene muscle, phrenic nerve and trunks of the brachial plexus passing deep to the trapezius
* Divides into a superficial branch and a deep branch
* In the absence of the deep branch
* Superficial cervical artery
47
Suprascapular artery
* Passes infront of the anterior scalene muscle and the brachial plexus parallel to but below the transverse cervical artery
* Passes superior to the superior transverse scapular ligament
* Suprascapular nerve passes inferior to this ligament
48
Produces symptoms of nerve compression of the brachial plexus and the subclavian vessels. It is caused by abnormal insertion of the **anterior** and **middle scalene muscles** and by the **cervical rib**
Neurovascular compression (thoracic outlet) syndrome
49
Cerebral and brain stem ischemia caused by reversal of blood flow from the basilar artery through the vertebral artery into the subclavian artery in the presence of occlusive disease of the subclavian artery proximal to the origin of the vertebral artery
Subclavian steal
50
Internal Thoracic Artery
* Arises from th e1st part of the subclavian artery
* Descends behind the upper 6 costal cartilages
* Ends athe the 6th intercostal space by dividing into the superior epigastric and musculophrenic arteries
51
Arises from the posterior aspect of the second part of the subclavian artery behind the anterior scalene muscle
Costocervical trunk
52
The Costocervical Trunk Divides into \_\_\_\_\_\_
* **Deep cervical Artery**
* Passes between the transverse process of vertebra C7 and the neck of the first rib
* ascends between the semispinalis capitis and semispinalis cervicis muscles
* Anastomoses with the deep branch of the descending occipital artery
* **Superior Intercostal artery**
* Descends behind the cervical pleura anterior to the necks of the first 2 ribs and gives rise to the first 2 posterior intercostal arteries
53
Arises from the 3rd part of the subclavian artery or arises as the deep (descending) branch of the transverse cervical artery
Dorsal (Descending) Scapular Artery
54
Origin of the Right common carotid artery
Bifurcation of the brachiocephalic artery
55
Origin of the left common carotid artery
Aortic arch
56
Lies at the bifurcation of the common carotid artery asn an ovoid body
Chemoreceptor
Carotid body
57
The carotid body is innervated by the \_\_\_\_\_\_\_\_\_\_
* **Nerve to the carotid body**
* arises from the pharygeal branch of the vagus nerve
* **Carotid sinus branch**
* from the glossopharyngeal nerve
58
SPindle shaped dilatation located at the origin of the internal carotid artery, which functions as a pressoreceptor (baroreceptor) and is stimulated by changes in blood pressure.
Carotid sinus
(Innervated primarily by the carotid sinus branch of the glossopharyngeal nerve and by the nerve to the carotid body of the vagus nerve)
59
Has no branches in the neck, ascends within the carotid sheath in company with the vagus nerve and the internal jugular vein, and enters the cranium thorugh the carotid canal in the petrous oart of the temporal bone
Internal carotid artery
60
The ICA gives rise to ______ , \_\_\_\_\_and the _______ in the middle cranial fossa
Opthalmic artery
Anterior and middle cerebral arteries
61
The circle of willis is formed by the
* Posterior cerebral
* Posterior communicating
* internal carotid
* anterior cerebral
* Anterior communicating arteries
62
Extends from the level of the upper border of the thyroid cartilage to the neck of the mandible, where it ends in the parotid gland by dividing into the maxillary and superficial temporal arteries
External Carotid artery
63
The external carotid artery has _____ branches
8
* Superior thyroid artery
* Lingual artery
* Facial Artery
* Ascending pharyngeal artery
* Occipital artery
* Posterior Auricular artery
* Maxillary artery
* Superficial Temporal artery
64
Superior Thyroid Artery
* Arises below the level of the greater horn of the hyoid bone
* Descends obliquely forward in the carotid triangle and passes deep to the infrahyoid muscles to reach the superior pole of the thyroid gland
* Gives rise to an
* infrahyoid
* SCM
* superior laryngeal
* cricothyroid
* several glandular branches
65
Lingual artery
* Arises at the level of the tip of the gretaer horn of the hyoid bone and passes deep to the hyoglossus to reach the tongue
* Gives rise to
* suprahyoid
* dorsal lingual
* sublingual
* deep lingual branches
66
Facial Artery
* Arises just above the lingual artery and ascends forward deep to the posterior belly of the digastric and stylohyoid muscles
* Hooks around the lower border of the mandible at the anterior margin of the masseter to enter the face
67
Ascending Pharyngeal artery
* Arises from the deep surface of the external carotid artery in the carotid triangle and ascends between the internal carotid artery and the wall of the pharynx
* Gives rise to
* Pharyngeal
* Palatine
* Inferior tympanic
* meningeal
68
Occipital artery
* Arises from the posterior surface of the ECA; just above the level of the hyoid bone
* Passes deep to the digastric posterior belly
* Gives rise to
* SCM branch
* Descending branch
69
Posterior Auricular artery
* Arises from the posterior surface of the external carotid artery just aboce the digastric posterior belly
* Ascends superficial to the styloid process and deep to the parotid gland and ends between the mastoid process and the external acoustic meatus
* Gives rise to
* Stylomastoid
* auricular
* occipital
70
Maxillary artery
* Arises behind the neck of the mandible as the larger terminal branch of the external carotid artery
* Runs deep to the neck of the manible and enters the
* Infratermporal fossa
71
Superficial Temporal Artery
* Arises behind the neck of the mandible as the smaller terminal branch of the ECA
* gives rise to the
* transverse facial artery
* runs between the zygomatic arch above the parotid duct below
72
Formed by the superficial temporal and maxillary veins
Dividies into an anterior branch, which joins the facial vein to form the common facial vein, and a posterior branch, which joins the posterior auricular vein form the External jugular vein
Retromandibular vein
73
Formed by the union of the posterior auricular vein and the posterior branch of the retromandibular vein
Crosses the SCM obliquely under the platysma and ends in the subclavian vein
Receives the suprascapular, transverse, cervical and anterior jugular veins
External Jugular veins
74
Begins in the jugular foramen as the continuation of the sigmoid sinus, descends in the carotid sheath and ends in the brachiocephalic vein
Receives the facial, lingual and superior and middle thyroid veins
Internal Jugular vein
75
Superficial Lymph nodes of the Head
* Face
* scalp
* ear
Drain into the occipital, retroauricualr, parotid, buccal, submandibular,submental and superficial cervical nodes
76
The middle ear drains into the \_\_\_\_\_\_\_\_\_\_
Retropharyngeal and upper deep cervical nodes
77
The nasal cavity and the paranasal sinuses drain into the
Submandibular, retropharyngeal, and upper deep cervical
78
The tongue drains into the
Submental, submandibular, and upper and lower cervical
79
The larynx drains into the
Upper and lower deep cervical
80
The pharynx drains into
Retropharyngeal and upper and lower deep cervical
81
The thyroid gland drains into
lower deep cervical, prelaryngeal, pretracheal, and paratracheal nodes
82
The superficial cervical lymphnodes lies along the ____________ and \_\_\_\_\_\_\_\_\_\_\_\_\_\_
External jugular vein
Anterior jugular vein
83
The superior deep cervical nodes lie along the \_\_\_\_\_\_\_\_\_\_\_
Internal jugular vein
84
The inferior deep cervical nodes Lie on the \_\_\_\_\_\_\_\_\_\_\_\_
Internal jugular veins
85
The trachea begins at the \_\_\_\_\_\_\_\_\_\_\_\_
Inferior border of the cricoid cartilage (C6)
86
The trachea has _______ incomplete hyaline cartilaginous rings
16 to 20
87
The esophagus beins at the \_\_\_\_\_\_\_\_\_\_\_
Lower border of the pharyns
at the level of the cricoid cartilage (C6)
88
The sophagus ends at around\_\_\_\_
T11
89
remnant of the thyroglossal ductm extends upward from the isthmus, usually to the left of the midline, and may be anchored to the hyoid bone by a fibrous muscular band known as the **levator glandulae thyroideae**
Pyramidal lobe
90
The thyroid gland is supplied by the superior and inferior thyroid arteries and sometimes the **\_\_\_\_\_\_\_\_\_,** an inconsistent branch from the brachiocephalic trunk
Thyroid IMA
91
the thyroid gland drains via the _____ and ______ to the internal jugular veins and via the ______ to the brachiocephalic vein
* Superior and middle thyroid vein
* Inferior thyroid vein
92
Endorcrine glands that play a vital role in the regulation of calicum and phophorus metabolism and are controlled by the pituitary and hypothalamus
Parathyroid gland
* Usually consist of four (2 to 6) small ovoid bodies that lie agaisnt the dorsum of the thyroid under its sheath but with their own capsule
93
The parathyroid glands are supplied by the \_\_\_\_\_\_\_\_\_\_\_\_\_\_-
Inferior thyroid artery
94
hyaline cartilage that forms a laryngeal prominence known as the adam's apple, which is particularly apparent in males
Thyroid cartilage
* Has a **superior horn** that is joined to the tip of the greater horn of the hyoid bone by the lateral thyroid ligament and an **inferior horn** that articulates with the cricoid cartilage
95
Runs through the jugular foramen and gives rise to the superior laryngeal nerve
Vagus nerve
96
The Vagus nerve is divided into
* **External laryngeal nerve**
* Runs along with the superior thyroid artery
* Supplies the cricothyroid and inferior pharyngeal constrictor muscles
* **Internal Laryngeal nerve**
* Accompanies the superior laryngeal artery
* Supplies the sensory fibers to the larynx above the vocal cord and taste fibers to the epiglottis
97
Sympathetic Trunk bears the following cervical ganglia
* Superior Cervical ganglion
* Middle Cervical ganglion
* Inferior cervical ganglion
* Ansa Subclavia
98
Superior cervical ganglion
* Infront of the transverse processes of the verebrae C1 to C2
* Contains all cell bodies of postganglionic symlathetic fibers that pass to the visceral structures of the head and neck
* Gives rise to the
* internal carotid nerve
* external carotid nerve
* pharyngeal branches
* superior cervical cardiac nerve
99
Middle Cervical ganglion
* Lies at the level of the cricoid cartilage (vertebra C6)
* Gives rise to
* middle cervical cardiac nerve
* largest of the three cervical sympathetic cardiac nerves
100
Inferior cervical Ganglion
* Fuses with the first thoracic ganglion to become the cervicothoracic(stellate) ganglion
* Lies infront of rhe neck of the 1st rib and the transverse process of vertebra C7 and behind the dome of the pleura and the vertebral artery
* Gives rise to the
* Inferior cervical cardiac nerve
101
Cord conencting the middle and inferior cervical sympathetic ganglia, forming a loop around the first [art of the subclavian artery
Ansa Subclavia
102
Thoracic Duct
* Ascends through the **posterior mediastinum** between the aorta and azygos vein
* Arches **laterally over the apex of the left pleura,** posterior to the left carotid sheath, and anterior to the sympathetic trunk and vertebral and subclavian arteries
* Runs behind the left internal jugular vein
* Usually empties into left **brachiocephalic vein** at the junction of the left internal jugular and subclavian veins
103
Surrounds the deeper parts of the neck
Splits to enclose the SCM and trapezius muscles
Attached superiorly to the mandible, mastoid process, external occipital protuberance and superior nuchal line of the occipital bone
Attached inferiorly along the acromion and spine of the scapula, clavicle, and manubrium sterni
Superficial (Investing) LAyer of Deep cervical fascia
104
Cylindrical and ecloses the vertebral column and its associated muscles
Covers the scalene muscles and the deep muscles of the back
Attaches to the external occipital protuberance and the basilar part of the occiitla bone and becomes continuous with the endothoracic fascia and the anterior longitudinal ligament of the bodies of the vertebrae in the thorax
Prevertebral Layer of Deep Cervical Fascia
105
COntains the common and internal carotid arteries, internal jugular vein and vagus nerve
Carotid sheath
* Does not contain the sympathetic trunk
106
nvests the larynx and trachea, encloses the thyroid gland, is continuous with the bucopharyngeal fascia, and contributes to the formation of the carotid sheath
Pretracheal Layer of Deep Cervical Fascia
`
107
Is an ancillary layer of the deep cervical fascia between the pretracheal or (buccopharyngeal) and prevertebral fasciae and forms as subdivision of the retropharyngeal space
Alar fascia
* Blends with the carotid sheath laterally and extends from the base of the skull to the level of the 7th cervical vertebra, where it merges with the pretracheal fascia
108
Covers the buccinator muscles and the pharynx and blends with the pretracheal fascia
Attached to the pharyngeal tubercle and the pterygomandibular raphe
Buccopharyngeal fascia
109
Fibrous coat in the wall of the pharynx and is situated between the mucous membrane and the pharyngeal constrictor muscles
Fibrous coat in the wall of the pharynx
110
Space between the prevertebral fascia and buccopharyngeal fascia, extending from the base of the skull into the posterior mediastinum
Retropharyngeal space
111
Anterior Scalene
O: transverse porcesses of CV4-CV6
I: Scalene tubercle on first rib
N: lower cervical (C5-C8)
A: elevates first ribl bends neck
112
Middle scalene
O: transverse processes of CV2-CV7
I: Upper surface of first rib
N; Lower cervical (C5-C8)
A: Levates first rib; bends neck
113
Posterior scalene
O: transverse processes of CV4 a-CV6
I: Outer surface of second rib
N: lower cervical (C6-C8)
A: Elvates second rib; bends neck
114
Longus Capitis
O: transverse process of CV3-CV6
I: basilar part of occipital bone
N: C1-C4
A: flexes and rotates head
115
Longus colli (L. cervicis)
O: transverse Processes and bodies of CV3-TV3
I: Anterior tubercle of atlas; bodies of CV2-CV4; transverse process of CV5-CV6
N: C2-C6
A: FLexes and rotates neck
116
Rectus capitis anterior
O: lateral mass of Atlas
I: basilar Part of occipital
N: C1-C2
A: flexes and rotates head
117
Rectus capitis laterlis
O: Trnaverse process of atlas
I: Jugular process of occipital bone
N: C1-C2
A: Flexes head laterally
118
Thyroid gland develops from the thyroid diverticulum, which forms from the ____ in the floor of the foregut and divides into right and left loves that are conencted by the isthmus of the gland
Endoderm
119
The thyroiglossal duct is later obliterated and the site of the duct is marked by the \_\_\_\_\_\_\_\_\_\_\_
foramen cecum
120
Inferior parathyroid glands develop as the result of proliferation of \_\_\_\_\_\_\_\_\_\_\_cells in the 3rd pharyngeal pouch
Endodermal
121
Superior parathyroid glands develop as the result of proliferation of endodermal cells in the \_\_\_\_\_\_\_
fourth pharyngeal pouch
122
