Test - Part 4 - Dev Flashcards
Which nerves and other structures pass through the Superior Orbital Fissure?
2 marks
Lacrimal nerve branch of CNV1 Front nerve branch of CNV1 Trochlear - CNIV Superior branch Oculomotor Nerve Naso-ciliary nerve branch of CNV1 Inferior branch of CNIII Abducent nerve CNIV Ophthalmic Vein (Superior and Inferior branches) Lazy French Tarts Sit Nakedly In Anticipation (LFTSNIA) LFSTSoNIoAIov
Where does the Facial Nerve CN VII exit from the cranium?
1 mark
Stylo-mastoid foramen.
Notes; Pons -> Internal Auditory Meatus -> Facial Canal -> Geniculate nucleus -> Stylomastoid Foramen
How does the Optic Nerve relate anatomically to the pituitary gland and why might it be clinically significant?
2 marks
The optic nerve travels posteriorly through the optic canal to the optic chiasma. The optic chiasma is located just anteriorly and posteriorly to the pituitary fossa in the sella turcica of the sphenoid body which houses the pituitary gland.
An expanding pituitary tumour can impinge and compress the optic chiasma and cause visual defects. E.g. if medial fibres are compress they can lead to tunnel vision.
Describe the origins, pathways and functions of CNXI, Spinal Accessory Nerve?
2 marks
Split into a cranial division and spinal division. Spinal division originates in spinal cord at C1-C4, and Cranial division originates at the medulla oblongata.
The pathway of the spinal division is superiorly within the vertebral canal and dura through the Foramen magnum to merge with the cranial division as it emerges from its root at the MO and then exit the skull via the Jugular Foramen to branch and supply its target organs.
Function of spinal division - motor supply to Sternocleidomastoid and trapezius muscles.
Function of cranial division - motor supply to pharynx, larynx and palate assisting and merging with the Vagus nerve.
Which nerve pathways regulate:
1) pupil constriction
2) pupil dilation
2 marks
1) pupil constriction - Parasympathetic supply from midbrain - Oculomotor CN III - ciliary ganglion - short ciliary nerves to pupillary constrictor muscles.
2) pupil dilation - sympathetic supply T1/T2 - Superior Cervical Sympathetic Ganglion - carotid plexus - pupillary dilator.
Describe the pathway of the Mandibular Branch of the Trigeminal nerve CN V from it’s root to final destination?
3 marks
ORIGINATES - pons with a sensory and motor branch -> sensory branch has body in Trigeminal ganglion ->
motor branch bypasses trigeminal ganglion ->
both branches exit the cranium via the foramen OVALE of sphenoid bone and then merge.
ALBI TT RM My Hy Di
A recurrent meningeal branch passes back up through foramen SPINOSUM (with middle meningeal artery) back into the cranium to supply the meninges.
The sensory division gives off 4 BRANCHES - ABLI
1) Auriculo-Temporal - Ear; ear canal; tympanic membrane, skin of temporal area
2) Buccal Branch - sensation from buccinator muscle cheek area
3) Lingual Branch - touch sensations from anterior 2/3 of tongue
4) INFERIOR AVELOLAR BRANCH - ENTERS MANDIBULAR FORAMEN on medial surface of ramus of mandible, travels inside mandible to supply lower teeth and EMERGES at MENTAL FORAMEN on surface of mandible as the MENTAL NERVE to receive sensation from the lip and chin.
The motor branch supplies the muscles of mastication, temporalis, masseter, lateral and medial pterygoid muscles.
And also
TENSOR TYMPANI: Dampens sounds, such as those created by chewing, by stabilizing the malleus bone in the middle ear
TENSOR VALI PALATINI: helps elevate the soft palate to prevent regurgitation of food and liquid into the nasopharynx and opens the Eustachian tube.
MYLOHYOID
Anterior belly of the Digastric
Describe with the aid of a diagram, what is meant by a left side bending lesion pattern of the Maxillae?
2 marks
The anterior maxillary complex turns to the left on a horizontal plane (vertical axis), i.e. the front of the mouth turns to the left as in a blow to the right side of the maxilla. The sphenoid bends the opposite direction, gapping on the left side of the SBS.
What are the symptoms of Bells Palsy and which cranial nerve is affected?
3 marks
CN VII - Facial Nerve
Flaccid paralysis on on one side of the face; lower eye lid droops (not upper eye lid as this us supplied by CNIII), tears trickle; facial muscles become expressionless. Mouth of affected side droops, saliva may dribble, food tends to collect.
What are the symptoms of Menieres disease and which cranial nerve is affected?
2 marks
CN VIII - Vestibulo-Cochlear Nerve
Inner ear condition.
4 main symptoms - Severe vertigo; tinnitus; loss of hearing; fullness in ear;
Episodes of nausea and vomiting.
Aggravated by salt; alcohol; caffeine; tobacco.
Describe the motion of the following bones during the flexion phase of CS motion?
1) Maxillae
2) Zygomae
2 marks
1) Maxillae - Flexion - anterior portion rises superiorly coming up to meet the frontal bone (as it arcs forward and down). At same time, 2 maxillae spread LATERALLY at posterior part of intermaxillary suture (ie back teeth move apart).
2) Zygoma- flexion - externally rotate around an oblique axis from the nasion to the angle of the jaw. Externally rotating with temporals, and arcing down with the frontal and squeezed out by rising maxillae.
Which bones does the Vomer articulate with?
2 marks
Sphenoid (alar), Ethmoid (perpendicular plate), Palatines, Maxillae.
Describe the CS motion of the orbit during flexion phase?
2 marks
Orbits widen in an horizontal plane and flatten in a vertical plane as they get squeezed between frontal and maxillae bones.
13a - List 2 CRANIAL contacts and 1 FACIAL contact which might be specifically relevant to assist drainage of middle ear and treatment of ear infections.
3 marks
13b - explain why
3 marks
13a - CRANIAL - NEED TO RELEASE E.TUBE = free drainage and fluent function - so temporal; spheno-temporal suture (which E.tube runs along).
Ear infections arise from an accumulation and stagnation of fluids in the middle ear, behind the ear drum, which leads to infection (often recurrent) and could result in partial or even total hearing loss.
The stagnation indicates lack of proper drainage from the middle ear of the accumulated fluids, which should normally pass via the eustachian tube (or auditory tube) running from the middle ear to empty into the nasopharyngeal cavity at the back of the mouth.
ROOT CAUES OF EAR INFECTIONS IS BIRTH TRAUMA
1st Cranial Contact -
General Temporal - may be medially compressed by birth process. Free mobility of the temporal bone is essential because in external rotation, the temporal bone opens the Eustachian tube. The Eustachian tube is the tube connecting the middle ear to the nasopharynx which drains mucus into the back of the throat. If the temporals are restricted into internal rotation, through birth trauma, injury, tension - can contribute to Eustachian tube dysfunction.
2nd Cranial Contact -
Ear hold/ Mastoid Tip - to release restrictions in OM suture and spheno-temporal suture which the E tube runs along so want free mobility of sphenoid and temporals. This will also release constrictions and compression in JF, which will support healthy vagus nerve functioning and overall venous drainage which promotes a healthy system.
Other significant Cranial contact = Sub-Occipital Release. Physical forces are exerted through the babies cranium, leading to compression at base of cranium and sub-occiput. Shock effects of birth may create further tension in this area. A restricted sub-occiput will create tensions and restrictions in the structures passing through the internal jugular veins - including . Shock held in the rest of the system will be reflected in the sub-occiput (and with contracted intracranial membranes; shock held in solar plexus and heart centre).
FACE HOLD - MANDIBLE contact, mandibular compression/decompression.
The mandible exerts an influence on the temporal bones via the TMJ which articulate with the temporals and the muscles of mastication which attach to the temporals. The bony exit of the Eustachian tube is immediately medial to the TMJ. Thus releasing physical/emotional tension and contraction in the muscles and soft tissues around the TMJ will aid middle ear drainage. The mandible contract can also help the temporal bones into external rotation further helping ET drainage.
Mandible contact will also support the mandibular division of the Trigeminal nerve which innervates the Tensor Vali Palatini muscle which opens the Eustachian tube. If Trigeminal Nerve is over stimulated eg by teeth grinding may cause recurrent ear infections and glue ear.
How would you approach treatment of a client with sinusitis?
4 marks
1) improve drainage by restoring free mobility of bones, membranes and fluids. Suboccipital region for overall cranial drainage and arterial, venous, lymphatic flow. Mobility of sinus containing bones, Sphenoid, Frontal, ethmoid, maxilla and whole face and cranium. Zygoma wrings out the maxilla like a wet rag. Vomer is a plunger on the Sphenoidal sinuses.
Mobility of membranes via temporals and falx release.
2) reduce inflammation by promoting immune function. Heart Centre, thymus chakra.
3) addressing lifestyle factors. diet, smoking, allergies, stress, sleeping for drainage, etc.
4) reducing autonomic nerve overstimulation. Parasympathetic pathways via Facial nerve and Pterygopalatine ganglion for mucus secretions.
Sympathetic pathways via T1-T2 and SCSG.
Solar plexus centre for stress and sympathetic overstimulation.
Treat and integrate the whole person as well as specific sinuses.
How might direct trauma to face affect rest of system?
3 marks
Mechanical, Muscular, Emotional, Energetic.
Mechanical; e.g. Blow to jaw or dental issues -> TMJ -> Temporals -> Tentorium -> Dural tube -> sacrum -> Pelvis.
Face becomes locked - restricted spheno-vomer articulation.
Muscular; muscles of mandible -> throat (suprahyoid muscles) -> suboccipital muscles -> postural muscles of neck and spine.
Emotional; Vicious circle -> Physical injury -> emotional reaction -> physical tension -> emotional reaction. Emotional shock trauma being held elsewhere in body - solar plexus, heart centre, throat.
Energetic; Force of the impact is imprinted in the energetic system and whole matrix. CS rhythm becomes blocked - locked up or compressed feeling.
