Noses, Sinuses, Orbit & Nerves Flashcards
(160 cards)
1
Q
What is the only sensory nerve arising from the anterior division ofV3?
A
Buccal nerve.
2
Q
What are the 4 ganglia associated with the cranial parasympathetic system?
A
Ciliary, pterygopalatine, submandibular, and otic.
3
Q
Preganglionic parasympathetic cell bodies are associated with which nerves in the head and neck?
A
Cranial nerves III, VII, IX, X and spinal nerves 2, 3, and 4.
4
Q
What is the stellate ganglion?
A
Fusion of the of the first thoracic ganglion and the inferior cervical ganglion; it relays sympathetic input to the upper limbs.
5
Q
What is the terminal branch ofV2?
A
Infraorbital nerve.
6
Q
What is the function of the glossopharyngeal nerve?
A
Motor to the stylopharyngeus; taste to posterior 1/3 tongue; parotid gland stimulation; sensation of postauricular skin, pharynx, soft palate, tympanic cavity, and eustachian tube.
7
Q
From what nerve do the anterior and posterior ethmoidal nerves arise?
A
Nasociliary nerve.
8
Q
What nerve usually passes from lateral to medial over the optic nerve?
A
Nasociliary.
9
Q
What are the nuclei of the vagus nerve?
A
Nucleus ambiguus, dorsal motor nucleus, and the nucleus of the solitary tract.
10
Q
Which of these controls voluntary motor information?
A
Nucleus ambiguus.
11
Q
Which of these receives sensory information?
A
Nucleus of the solitary tract.
12
Q
What information is relayed through the inferior ganglion?
A
Sensation from the epiglottis and larynx.
13
Q
What information is relayed through the superior ganglion?
A
Sensation from the external auditory canal and posterior auricle via Arnold’s nerve.
14
Q
What are the two ganglia of the vagus nerve?
A
Superior (jugular) ganglion and inferior (nodose) ganglion.
15
Q
Which cranial nerve has the longest intracranial course?
A
VI.
16
Q
With one exception, all the muscles of the pharynx are innervated by what nerve?
A
X.
17
Q
What is the distance from the posterior ethmoid artery to the optic foramen?
A
5-10 mm.
18
Q
When does aeration of the frontal sinus begin?
A
Age 4-5 years, and continues into the late teens.
19
Q
Where is the anterior ethmoid artery found intranasally?
A
Anterior to the vertical portion of basal lamella, immediately below the skull base, and posterior to the frontal recess.
20
Q
Where does the maxillary sinus ostium lie in relation to the ethmoid infundibulum?
A
At the floor and lateral aspect of the infundibulum, between its middle and posterior 1/3.
21
Q
What structure separates the anterior and posterior ethmoid complexes?
A
Basal lamella of the middle turbinate.
22
Q
What is the most posterior part of the middle turbinate attached to?
A
Crista ethmoidalis of the perpendicular process of the palatine bone.
23
Q
What recess does the suprabullar recess open into?
A
Frontal recess; anteriorly, it is separated from the recess by the bulla lamella.
24
Q
What does the retrobullar recess drain into?
A
Hiatus semilunaris superior.
25
What are the borders of the ethmoid infundibulum?
Medially, the uncinate process; laterally, the lamina papyracea and frontal process of the maxilla; and posteriorly, the ethmoid bulla.
26
What is the narrowest portion of the nasal cavity?
Nasal valve.
27
What is the most common cause of taste loss?
Olfactory dysfunction.
28
What are the 4 possible configurations of the ethmoid roof described by Keros
* Type 1: olfactory fossa I - 3 mm deep.
* Type I I: olfactory fossa 4 - 7 mm deep.
* Type III: olfactory fossa 8 - 16 mm deep.
Asymmetric skull base
29
Where does the sphenoid ostium lie in relation to the chonal bridge
1.5 em above or 1/3 distance from chonae to the skull base.
30
What percent of the population has a unilateral frontal sinus?
10%.
31
What % of people have a sphenoethmoid cell
12%.
32
Where are the natural ostia of the sphenoid sinus'
2/3 of the way from the vaginal process to the top of the anterior sphenoid wall.
33
What % of patients have a bony dehiscence of the canal covering the anterior ethmoid artery
20- 40%.
34
What % of patients have a bony dehiscence of the cavernous portion of the carotid canal
22%.
35
What are the normal dimensions of the frontal sinus
28 mm (length) x 24 mm (width) x 20 mm (depth) (Van Alyea).
36
Where does the nasolacrimal duct lie in relation to the ostium of the maxillary sinus
3 - 6 mm anteriorly.
37
What is the normal angle of a line drawn from the nasal spine to the sphenoid ostium
30 degrees.
38
Where does the nasolacrimal duct lie in relation to the ostium of the maxillary sinus?
3-6 mm anteriorly.
39
What % of patients have a very thin or absent bone of the optic canal
4%.
40
What is the distance from the posterior ethmoid artery to the optic foramen
5- 10 mm.
41
What percent of the population has a supreme nasal concha?
60%.
42
When does aeration of the frontal sinus begin
Age 4 - 5 and continues into the late teens.
43
At what age can the maxillary sinuses be visualized on a computed tomography (CT) scan?
Age 4-5 months.
44
Which muscles depress the nose?
Alar nasalis and depressor septi nasi muscles.
45
Where is the anterior ethmoid artery found intranasally
Anterior to the vertical portion of basal lamella, immediately below the skull base, and posterior to the frontal recess.
46
Where is the optic canal in relation to the sphenoid
Anterolateral aspect of the sphenoid roof.
47
Where does the maxillary sinus ostium lie in relation to the ethmoid infundibulum
At the floor and lateral aspect of the infundibulum between its middle and posterior I /3.
48
What structure separates the anterior and posterior ethmoid complexes
Basal lamella of the middle turbinate.
49
What are the nasal fontanelles
Bony dehiscences of the lateral nasal wall usually above the insertion of inferior turbinate where the nasal mucosa approximates the mucoperiosteum of the maxillary sinus.
50
What is the optic nerve tubercle
Bony protuberance on the medial surface of the optic foramen.
51
How is the sensory epithelium of the olfactory system different from the surrounding respiratory epithelium?
Both have cilia, but the cilia of the olfactory epithelium do not beat synchronously.
52
What is the term for a pneumatized second basal lamella?
Bulla ethmoidalis.
53
What is the term for a pneumatized second basal lamella
Bulla ethmoidalis.
54
What is the blood supply to the retina
Choroid chorio capillaries (outer half) and central retinal artery and branches.
55
What type of epithelium lines the nasal cavity?
Ciliated pseudostratified epithelium.
56
What bony structure is found posterior to the sphenoid
Clivus.
57
What are the major tip support mechanisms?
Contour, size, and strength of the lateral crura; attachment of the medial crural footplate to the caudal septum; and attachment of the caudal edge of the upper lateral cartilage to the upper edge of the alar cartilages (Scroll area)
58
What is the most posterior part of the middle turbinate attached to
Crista ethmoidalis of the perpendicular process of the palatine bone.
59
What is parosmia?
Distorted perception of an odor.
60
What are odorous substances made of?
Either gases or volatile liquids.
61
Where does the natural ostium of the maxillary sinus empty?
Ethmoid infundibulum.
62
Where does the natural ostium of the maxillary sinus empty
Ethmoid infundibulum.
63
T /F: Presence of a conchal sphenoid is an absolute contraindication to transsphenoidal hypophysectomy.
False (the bone can be drilled out to permit access).
64
T/F: Tumors isolated to the sphenoid sinus and sella are best approached trans palatally
False, best approach is transseptal or transethmoid unless the tumor extends into the nasopharynx.
65
T/F: The frontal recess is synonymous with the nasofrontal duct
False, the nasofrontal duct bridges the frontal recess with the frontal sinus.
66
What is the osteomeatal complex
Final common pathway for drainage and ventilation of the frontal, maxillary, and anterior ethmoid cells.
67
From anterior to posterior, what structures comprise the medial orbital wall
Frontal process of the maxilla, lacrimal bone, lamina papyracea, sphenoid bone to optic nerve foramen.
68
What recess does the suprabullar recess open into
Frontal recess; anteriorly it is separated from the recess by the bulla lamella.
69
Into what does the ethmoid infundibulum drain posteriorly?
Hiatus semilunaris inferior.
70
Into what does the ethmoid infundibulum drain posteriorly
Hiatus semilunaris inferior.
71
What does the retrobullar recess drain into
Hiatus semilunaris superior.
72
Through which area can the suprabullar and retrobullar recesses be accessed medially and inferiorly
Hiatus semilunaris superior.
73
What is the name of the space between the bulla ethmoidalis and the middle turbinate
Hiatus semilunaris superioris.
74
When may the suprabullar recess extend into the retrobullar recess?
If the posterior wall of the bulla lamella is not in contact with the basal lamella of the middle turbinate.
75
When may the suprabullar recess extend into the retrobullar recess
If the posterior wall of the bulla lamella is not in contact with the basal lamella of the middle turbinate.
76
Where does the sphenoid sinus lie in relation to the most posterior ethmoid cell
Inferior and medial.
77
What is a Haller cell
Infraorbital ethmoid cell at the roof of maxillary sinus.
78
What structures are found within the cavernous sinus
Internal carotid artery, venous channels, III, lV, VI, VI, V2.
79
What is the bulla lamella
Lamella of bone that when pneumatized forms the ethmoid bulla.
80
What is the thinnest bone of the anterior skull base
Lateral lamella of the cribriform plate, where the anterior ethmoid artery crosses from the medial orbital wall to the cribriform.
81
Where does the anterior portion of the middle turbinate most often attach superiorly?
Laterally onto the lamina papyracea (may also attach to the skull base).
82
Where does the anterior portion of the middle turbinate most often attach superiorly
Laterally onto the lamina papyracea (may also attach to the skull base).
83
What structures can a Haller cell potentially narrow
Maxillary sinus ostium or ethmoid infundibulum.
84
Where is the natural ostium of the sphenoid sinus in relation to the superior turbinate
Medial, and within millimeters of its inferior border.
85
What are the borders of the ethmoid infundibulum
Medially, the uncinate process; laterally, lamina papyracea and frontal process of the maxilla; posteriorly, ethmoid bulla.
86
What problem can an enlarged agger nasi cell cause?
Narrowing of the frontal recess.
87
What problem can an enlarged agger nasi cell cause
Narrowing of the frontal recess.
88
What are the nasal anatomic subunits?
Nasal dorsum, nasal sidewalls, nasal tip, alar lobules, and depressions of the supra-alar facets.
89
What are the minor tip support mechanisms?
Nasal tip ligamentous aponeurosis; cartilaginous septum; nasal spine; strength and resilience of the medial crura; thickness of tip skin and subcutaneous tissue; and supportive strength of the alar sidewalls.
90
What important structures may run through an Onodi cell
Optic nerve and carotid artery.
91
The\_\_\_\_ is fully formed by the 5th week gestation and goes on to develop into the floor of the nose/palate.
Oronasal membrane.
92
What is phantosmia?
Perception of an odor in the absence of a stimulus.
93
What is dysosmia?
Perception of an unpleasant odor.
94
What makes up the superior portion of the bony nasal septum?
Perpendicular plate of the ethmoid.
95
What is an agger nasi cell?
Pneumatized area of the lateral nasal wall immediately anterior and superior to the insertion of the middle turbinate.
96
What is an agger nasi cell
Pneumatized area of the lateral nasal wall immediately anterior and superior to the insertion of the middle turbinate.
97
What is a concha bullosa
Pneumatized middle or superior turbinate.
98
What are sphenoethmoid or Onodi cells
Pneumatized posterior ethmoid cells, superolateral to the sphenoid sinus.
99
Which table of the frontal sinus is thinner?
Posterior.
100
Which structures can narrow the frontal recess
Posteriorly, ethmoid bulla/bulla lamella; anteriorly, a pneumatized agger nasi cell.
101
Which muscles elevate the nose?
Procerus, levator labii superioris alaeque nasi, and anomalous nasi muscles.
102
What is the most posterior aspect of the anterior ethmoids?
Retrobullar recess.
103
What is the most posterior aspect of the anterior ethmoids
Retrobullar recess.
104
What are the 3 types of sphenoid sinuses as described by Hamberger
Sellar (67 - 76%): sella turcia bulges into a well-developed sinus; Presellar (23 - 28%): cancellous bone extends from under the sella to the anterior aspect of the floor; Concha (0 - 5°/o): sphenoid sinus is entirely filled with cancellous bone.
105
In what ways is the middle turbinate an important surgical landmark
Separates the cribriform plate from the fovea ethmoidalis; anterior tip marks the limit of the anterior dissection of maxillary antrostomy; basal lamella identifies entrance into the posterior ethmoids; lower half and insertion into the choanae help identify entrance into the sphenoid sinus.
106
What is another name for the retrobullar recess?
Sinus lateralis.
107
What is another name for retrobullar recess
Sinus lateralis.
108
What is the sphenoethmoid recess
Space between the superior (and supreme, if present) turbinate laterally, the cribriform plate superiorly, septum medially, anterior face of the sphenoid posteriorly, inferior margin of the superior turbinate inferolaterally.
109
What neuropeptide is thought to be a mediator of pain in the nose and paranasal sinuses?
Substance P.
110
The majority of posterior ethmoid cells empty into which meatus?
Superior meatus.
111
The majority of posterior ethmoid cells empty into which meatus
Superior meatus.
112
What are the borders of the suprabullar recess
Superiorly, the ethmoid roof; laterally, the lamina papyracea; inferiorly, the roof of the ethmoid bulla; posteriorly, the basal lamella of the middle turbinate.
113
What is the nasal valve?
The angle between the caudal quadrangular cartilage and the distal upper lateral cartilages.
114
What defines the configuration of the ethmoid roof
The length of the lateral lamella of the cribriform plate, which determines the depth of the olfactory fossa.
115
What is the frontal recess
The most anterior and superior part of the anterior ethmoid complex.
116
What is the only septal component that is paired?
The vomer, which may be bilaminar owing to its dual embryonic origin.
117
What are Bowman's glands?
They secrete mucus and yellow pigment in the olfactory epithelium; the odorant must dissolve in this layer of mucus to reach the sensory receptors.
118
What are the major anatomic features that determine tip projection?
Thickness and character of tip skin; shape and strength of alar cartilages; length of infratip lobule and columella; anatomy of the quadrangular cartilage (especially the anterior septal angle); and size of the nasal spine and premaxilla.
119
What is the term for a persistent, nonpneumatized second basal lamella?
Torus ethmoidalis lateralis.
120
What is the term for a persistent, non-pneumatized second basal lamella
Torus ethmoidalis/lateralis.
121
What are the other muscles of the nose (the compressor and dilators)?
Transverse nasalis, compressor narium minor, and dilator naris anterior muscles.
122
What are the five basal or ground lamella of the paranasal sinuses?
Uncinate process, bulla ethmoidalis, basal lamella of the middle turbinate, lamella of the superior turbinate, and lamella of the supreme turbinate (if present).
123
What are the 5 basal or ground lamella of the paranasal sinuses
Uncinate process, bulla ethmoidalis, basal lamella of the middle turbinate, lamella of the superior turbinate, lamella of the supreme turbinate (if present).
124
What is the incidence of frontal sinus agenesis
Unilateral agenesis 4%; bilateral agenesis 5%.
125
Which of these nerves is closely associated with the lateral wall of the ICA
VI.
126
Where are the anterior and posterior ethmoid arteries and optic canal in relation to the anterior lacrimal crest?
24-12-6 rule: Anterior ethmoid artery is approximately 24 mm posterior to the lacrimal crest; the posterior ethmoid artery is 12 mm posterior to the anterior ethmoid artery; the optic canal is 6 mm posterior to the posterior ethmoid artery.
127
What is the average volume of the orbit?
30 cm3.
128
What is the average depth of the orbit?
40-50 mm.
129
What is trichiasis?
Abnormal direction of the eyelashes.
130
What provides dynamic support to the lower lid?
Adhesion of the pretarsal portion of the orbicularis to the tarsal plate.
131
What are the three limbs of the medial canthal tendon?
Anterior, superior, and posterior limbs.
132
What are the lower eyelid retractors?
Capsulopalpebral fascia and the inferior tarsal muscle.
133
What structure in the lower lid is analogous to the levator aponeurosis of the upper lid?
Capsulopalpebral fascia.
134
What structures make up the posterior lamella of the lid?
Conjunctiva and the tarsal plate.
135
What is the origin of the superior tarsal muscle (of Muller)?
Deep side of the levator palpebrae superioris.
136
What is the term for gross asymmetry of eye movement?
Heterotropia.
137
What structures pass through the superior orbital fissure?
III, IV, VI, V1, and superior ophthalmic vein.
138
Which skeletal muscles are innervated by the inferior division of III?
Inferior oblique, inferior rectus, and medial rectus muscles.
139
What is Whitnall's tubercle?
Insertion site of the lateral canthal tendon.
140
What is the function of the deep head of the orbicularis oculi?
Inserts on the posterior lacrimal crest and provides structural support to the lid.
141
What is the name of the fleshy, pink mound of tissue in the medial canthus?
Lacrimal caruncle.
142
What does the medial epicanthal fold cover?
Lacrimal lake.
143
What happens with disruption of the deep head?
Lateral and anterior displacement of the medial canthal angle.
144
What structure divides the lacrimal gland into two lobes?
Levator aponeurosis.
145
What is unique about the anatomy of the Asian eyelid?
Levator muscle lacks attachment to the pretarsal skin, resulting in an absent pretarsal fold.
146
Periosteum and periorbita meet at the orbital margin and continue into the eyelids as what?
Orbital septum.
147
Where does the lateral canthal tendon insert?
Orbital tubercle located 5 mm posterior to the lateral orbital rim.
148
What lines the posterior surface of the eyelid?
Palpebral conjunctiva.
149
What structures make up the anterior lamella of the lid?
Pretarsal orbicularis oculi muscle and the eyelid skin.
150
What is Argyll Robertson pupil?
Pupil reacts to accommodation but not light; often associated with syphlis.
151
What are the layers of the eyelid from superficial to deep?
Skin, subcutaneous tissue, voluntary muscle, orbital septum, tarsal plate, smooth muscle, and conjunctiva.
152
Which of these covers the lacrimal fossa?
Superior limb.
153
Which muscles are innervated by the superior division of III?
Superior rectus and levator palpebrae superioris muscles.
154
What test may elicit a Marcus Gunn pupil?
Swinging flashlight test.
155
What glands are contained within the tarsal plates?
Tarsal glands (Meibomian).
156
What provides static support to the lower lid?
Tarsal plate and its associated medial and lateral canthal tendons.
157
What does the gray line divide?
The anterior and posterior lamella.
158
Which part of the lacrimal system is most vulnerable to injury?
The inferior canaliculus near the medial canthal tendon.
159
What creates the gray line in the lid margin?
The muscle of Riolan.
160
What structure forms the medial canthal tendon?
The superficial head of the pretarsal fibers of the orbicularis oculi muscle.
