Thorax Flashcards
Pectoral region, vessels and nerves in superior mediastinum, heart and posterior mediastinum, anterior neck and thyroid, pharynx and larynx, nasal sinuses and oral cavity. (109 cards)
1
Q
How does contraction of pectoralis major assist in breathing?
A
Pectoralis major contracts during active inspiration to pull the ribs outwards
2
Q
Which bony structures lie subcutaneously in the anterior chest wall?
A
sternum (manubrium, body, xiphi sternum)
clavicle
3
Q
what are the articulations of the clavicle?
A
medial end: synovial joint with the clavicular notch of the manubrium (sternoclavicular joint).
lateral end: articulates with the acromial process of the scapula via the acromioclavicular joint.
acromion process of scapula
4
Q
what forms the anterior axillary fold?
A
lower edge of pectoralis major muscle
5
Q
what lies deep to the pectoralis minor muscle
A
axilla
6
Q
where does lymph from the upper outer quadrant of the breast drain?
A
Axillary lymph nodes receive 75-90% of breasts’ lymph.
10-25% of the breasts’ lymph will drain into the internal mammary lymph nodes.
7
Q
Which costal cartilage connects to sternum at the sternal angle
A
second costal cartilage
8
Q
What are the 4 pectoralis muscles?
A
- pectoralis major
- pectoralis minor
- serratus anterior
- subclavius
9
Q
On it’s distal end, pec major attaches to where on the humerus?
A
Intertubercular sulcus
10
Q
what is the primary function of pec major?
A
adduct and medially rotate the upper limb (eg. throwing a ball) and brings the scapula antero-inferiorly
11
Q
What ribs does pec minor span and where does it attach? what is pec minors main function?
A
3-5th ribs and inserts onto the coracoid process of the scapula.
Main function = stabilise the scapula by bringing it antero-inferiorly against the thoracic wall.
12
Q
Where is subclavius located?
A
small muscle located directly underneath the clavicle, running horizontally.
13
Q
what ribs does serratus anterior span? where does it insert? what is it’s main function?
A
1-10 ribs and inserts onto the anterior surface of the scapula.
It’s main function is to rotate the scapula, lift the arm above 90 degrees and hold the scapula against the rib cage.
14
Q
A ‘winged’ scapula can occur due to damage to what nerve? What muscle does this nerve innervate?
A
Long thoracic nerve - it innervates serratus anterior
15
Q
What ribs does external oblique span? What is the main function?
A
From lower 8 (4-12) ribs to iliac crest and pubic tubercle
Function: pull the chest downwards and compress the abdominal cavity, which increases the intra-abdominal pressure and performs ipsilateral bending and contralateral rotation.
16
Q
Which nerves carry sensation from the parietal and visceral pleura?
A
Parietal pleura = spinal nerves T1-12
Visceral pleura = vagus nerve and sympathetic nerve
17
Q
At what level does the trachea commence and terminate?
A
C6 - level of the cricoid cartilage
Terminates at Angle of Louis - T4/5 where it bifurcates into left and right
18
Q
Does the oesophagus lie anterior or posterior to the trachea?
A
Posterior
19
Q
External intercostal muscles facilitate in forced inspiration or expiration?
A
forced inspiration
20
Q
internal intercostals facilitate in forced inspiration or forced expiration?
A
forced expiration
21
Q
Which direction do external intercostal fibres run?
A
anteriorly and inferiorly (hands in pockets)
22
Q
Which direction do internal intercostal muscle fibres run?
A
postero-inferiorly from the sternum towards the angle of ribs at the back
23
Q
What are the 2 main muscles used in the process of normal inspiration? What do they do & how does the air move into the lungs?
A
Diaphragm - flattens
External intercostal muscles - elevates ribs
Increase in thevolumeof the thoracic cavity. As the lungs are held against the inner thoracic wall by the pleural seal, they also undergo an increase in volume
Boyle’s law - an increase in lung volume results in a decrease in thepressurewithin the lungs. The pressure of the environment external to the lungs is nowgreaterthan the environment within the lungs, meaning air moves into the lungsdown the pressure gradient.
24
Q
How many lobes are there in the right and left lungs? What fissures separate the lobes?
A
Right: 3 lobes (superior, middle and inferior) separated by the horizontal and oblique fissure
Left: 2 lobes (superior and inferior) separated by the oblique fissure
25
What are the 3 surfaces of the lungs?
Costal
Mediastinal
Diaphragmatic
26
What structures pass through the hilum of the lung?
- principle bronchus
- lobar bronchi
- 1 pulmonary artery
- 2 pulmonary veins
- bronchial arteries and. veins
- pulmonary nerve plexus
- lymphatics
- pulmonary lymph nodes
27
What is a broncho pulmonary segment?
| How many broncho-pulmonary segments are there in each lung?
Portion of the lung supplied by a specific segmental bronchus, lymphatics and arteries.
10 broncho-pulmonary segments in each lung.
28
Which main bronchus is shorter, wider and takes a more vertical course? Why is this clinically relevant?
Right bronchus, inhaled foreign bodies will usually end up in the right middle / lower lobe bronchi.
29
What are the main divisions of the main bronchi in left and right lungs?
- Left: bronchus enters hilum, divides into superior and inferior lobar bronchi
- Right: bronchus enters hilum, divides into superior, middle and inferior lobar bronchi
- Each lobar bronchi divides into segmental bronchi
- Each segmental bronchi enters a broncho-pulmonary segment
30
What is the pleural cavity? Are there one or 2 pleural cavities?
What is the pleura?
Fluid filled space that surrounds the lungs, there are 2 pleural cavities for each lung (prevents infection spreading)
It separates the lungs from the surrounding structures (thoracic cage, intercostal spaces, mediastinum, diaphragm)
The pleura is a double layered serous membrane made of squamous cells which surrounds the lungs. Visceral pleura is the more delicate inner layer of pleura that covers the lungs, parietal pleura is thicker and more durable and lines the inner aspect of the thoracic cavity.
31
What is a pleural recess, why are they important?
When 2 parietal pleura are close to each other and form a space (eg. at the side of the diaphragm between the costal pleura)
Important as we can look for them on an X-ray, we look for sharp angles, if fluid is collecting in the lungs (pleural effusion) it will appear as a blunt angle in the recess.
32
What is a pneumothorax? How is it treated?
'Collapsed lung' - air or gas enters the pleural space (rib fracture) and this removes the surface tension and reduces lung extension.
Treatment is via a chest drain into the pleural cavity to remove the air inside the lungs.
33
What is the most common carcinoma in men in the UK?
Bronchial carcinoma
34
Function of the diaphragm?
| Blood supply to the diaphragm?
Primary muscle involved in inspiration
Contraction of the muscle facilitates expansion of the thoracic cavity to increase the volume of the cavity, decreasing intrathoracic pressure and allowing lungs to expand and inspiration to occur.
Blood supply
- Inferior phrenic arteries is the main vascular supply
- Superior phrenic arteries supply superior surface of the diaphragm
35
How does contraction of the diaphragm assist in returning blood to the heart?
Contraction of the diaphragm decreases intra-thoracic pressure and increases intra-abdominal pressure. The net effect is for blood to flow from the abdomen into the chest.
36
What is the sensory and motor nerve supply to the diaphragm?
Phrenic nerve is the motor and sensory nerve of the diaphragm. It originates from the cervical nerves in the neck (c3,c4,c5) and descends through the thorax to innervate the diaphragm. It is the only source of motor innervation to the diaphragm and therefore, plays a crucial role in breathing.
37
What is the surface markings of the lowest extent of the lungs?
At the midclavicular line to lowest part of the lung lies at the tip of the 6th rib, at the midaxillary line the 8th rib and posteriorly the 10th rib
38
What is intercostal recession?
When you have a partial blockage in your upper airway or the small airways in your lungs, air can't flow freely and the pressure in this part of your body decreases. As a result, your intercostal muscles pull sharply inward. These movements are known as intercostal retractions, also called intercostal recession.
39
What is the developmental significance of the ligamentum arteriosum?
The ligamentum arteriosum is a small ligament that is the remnant of the ductus arteriosus formed within 3 weeks after birth. At the superior end, the ligamentum attaches to the aorta and at the inferior end it attaches to the pulmonary artery. The ligamentum arteriosum acts as a tether that holds the aorta and pulmonary artery close to each other. While this is a vestigal structure in an adult, during foetal development, the ductus arteriosus' function is to bypass the lungs.
40
What are the main branches of the following arteries and what organs/tissues do these vessels supply:
(a) Left common carotid artery
(b) Left subclavian artery
Left common carotid: Ascends from the arch of the aorta directly up the neck and head, lateral to the trachea and oesophagus.
- It does not give off any branches. It supplies blood to the face and brain.
Left subclavian: left arm, chest, shoulders, back and CNS.
- It gives rise to 3 major branches - internal thoracic artery (supplies thymus, pericardium of heart, anterior chest wall), the vertebral artery (passes through the vertebral foramen in the cervical vertebrae and then through the foramen magnum to supply the brain and spinal cord) and the thyrocervical artery (thyroid, cervical region of the neck and upper back and shoulder)
41
What are the nerve roots of the phrenic nerve? Why is this clinically important?
The phrenic nerve is mostly composed of motor fibres which supply the diaphragm. They also supply sensory fibres to the pericardium, mediastinal pleura, peritoneum and the central part of the diaphragm. This means that upper abdominal pathology such as a perforated duodenal ulcer often results in shoulder tip pain.
42
What structures are supplied by the vagus nerve?
Vagus nerve has sensory, motor and parasympathetic functions.
- Sensory: innervates skin of external acoustic meatus and internal surfaces of laryngopharynx and larynx and provides visceral sensation to the heart and abdomen viscera
- Special sensory: taste to epiglottis
- Motor: innervation to majority of muscles of the pharynx, soft palate and larynx
- Parasympathetic: smooth muscle of trachea, bronchi and GI tract and regulated heart rhythm
43
What are the eight vessels which connect the heart to other structures?
```
aorta
pulmonary artery
4 pulmonary veins
superior vena cava
inferior vena cava
```
44
surface marking for the apex of the heart?
5th intercostal space, mid clavicular line
45
How may the fibrous pericardium contribute to a reduction in ventricular filling?
Constrictive pericarditis is long term inflammation of the pericardium which causes thick lining and scarring of the pericardium. This limits the diastolic filling of the ventricles. This can be a complication of acute pericarditis. Also common in patients with TB and following cardiac surgery. Pt usually present with fluid overload, jugular venous distension, hepatomegaly and peripheral oedema.
46
What is the first branch form the aorta? What are the other branches from the aorta?
Coronary arteries
- brachiocephalic trunk
- left common carotid artery
- left subclavian artery
47
Which veins join together to form the inferior vena cava?
common iliac joining - flows through the abdomen and collects blood from the hepatic, lumbar, gonadal, renal and phrenic veins and drains into the inferior portion of the right atrium
48
Describe the course of the right and left phrenic nerves
Right
- Passes anteriorly over the lateral part of the right subclavian artery.
- Enters the thorax via the superior thoracic aperture.
- Descends anteriorly along the right lung root.
- Courses along the pericardium of the right atrium of the heart.
- Pierces the diaphragm at the inferior vena cava opening.
- Innervates the inferior surface of the diaphragm.
Left
- Passes anteriorly over the medial part of the left subclavian artery.
- Enters the thorax via the superior thoracic aperture.
- Descends anterior to the left lung root.
- Crosses the aortic arch and bypasses the vagus nerve.
- Courses along the pericardium of the left ventricle.
- Pierces and innervates the inferior surface of the diaphragm.
49
Where does the vagus nerve originate from and what foramen does it pass out of in the cranium?
Originates in the medulla oblongata and passes through the jugular foramen with cranial nerves 9 and 11.
50
What muscles do the pharyngeal branches of the vagus nerve innervate?
All the muscles of the soft palate except 1, and innervation to the pharynx.
51
What muscles do the laryngeal branches of the vagus innervate?
All muscles of larynx to make sound by moving the local cords.
Superior laryngeal: sensory innervation to the larynx above the vocal cords
External branch of superior laryngeal supplies cricothyroid.
52
What does the recurrent laryngeal innervate?
Sensation to larynx below the voice cords. Important for swallowing, vocalisation and breathing.
Innervates intrinsic muscles of the larynx muscles except cricothyroid.
53
Describe the path of the right and left vagus nerves
Right: anterior to right subclavian artery and posterior to the hilum of the lung. Once it passes the subclavian artery, it will branch off and loop around it and it makes its way back to the trachea and larynx where it innervates the muscles of the larynx (right recurrent laryngeal)
Left: anterior to the left subclavian artery and posterior to the hilum of the lung and branch off around the arch of the aorta and ascends up the neck between the trachea and the oesophagus (left recurrent laryngeal)
54
Describe the foetal circulation
- Oxygen rich Hb is received from the mother via the umbilical veins
- In the foetal lung, the alveolar sacks are full of fluid and this means they have very little oxygen. This causes the capillaries in the lungs to constrict (hypoxic pulmonary vasoconstriction) and increases the resistance in the capillaries, pulmonary arteries, right atrium and right ventricle. As a result, the foetal circulation finds ways to bypass the lungs.
- foramen ovale is a flap between the right and left atria which develop due to increased pressure in the right atrium and this shunts blood from right to left atrium
- Some blood passes into pulmonary arteries to develop muscles
- As the pressure in the pulmonary arteries increases, blood shunts from the pulmonary artery to the aorta to bypass the lungs (ductus arteriosus)
55
At what stage in the cardiac cycle to the coronary arteries fill?
During diastole as the pressure in the aorta is greater than the coronaries so blood flows back down and into the coronaries
56
What structures of the heart does the right coronary artery supply? What branches does the RCA give off?
Right ventricle, right atrium, SA node, intraventricular septum.
Branches:
- Marginal branch supplying the lateral portion of the right ventricle
- Posterior descending artery (supplied by RCA in 90% hearts)
57
What structures of the heart does the LCA supply and what are it's branches?
Left atrium, left ventricle, part of right ventricle, anterior 2/3rds of interventicular septum include branches of AV and SA node in 40% patients.
Branches
- Left anterior descending (between left and right ventricle anteriorly)
- Circumflex (between left atrium and ventricle)
- Diagonal branch
- 30% patients the posterior descending artery is supplied by either the LAD or circumflex meaning in 20% of patients, there are 2 posterior descending arteries.
58
Where does blood drain from the heart?
Coronary sinus which drains into RA.
59
Describe the anatomy of the tricuspid and mitral valves. What happens if they are incompetent?
The mitral and tricuspid valves are atrioventricular valves. They are located between the atria and corresponding ventricle.
- Tricuspid valve is located between the right atrium and right ventricle. It consists of 3 cusps (anterior, septal and posterior), with the base of each cusp anchored to a fibrous ring that surrounds the orifice.
- Mitral valve is located between the left atrium and left ventricle. It is also known as the bicuspid valve because it has 2 cusps. The base of each cusp is secured to fibrous ring that surrounds the orifice.
Both the mitral and tricuspid valves are supported by the attachment of fibrous cords (cordae tendineae) to the free edges of the valve cusps. The cordae tendinaea are then attached to papillary muscles located on the interior surface of the ventricles. These muscles contract during ventricular systole to prevent prolapse of the valve leaflets into the atria.
If these are incompetent, blood may flow into the atrium. This can lead to symptoms such as dizziness, breathlessness, tiredness, chest pain and irregular heartbeats.
60
Describe the anatomy of the aortic and pulmonary. What happens if they are incompetent?
The aortic and pulmonary valves are semi lunar valves with 3 cusps. They are located between the ventricles and their corresponding artery, regulating the flow of blood leaving the heart.
Incompetent valves - Aortic stenosis - narrowing of the aortic valve which restricts the blood flow out of the heart. This can cause SOB, syncope and angina. This can increase workload for the left ventricle and can result in left ventricle hypertrophy. Treatment involves valve replacement via surgery or balloon valvuloplasty.
61
Describe the conducting system of the heart and its function
The conduction system of the heart consists of: Sinoatrial node, atrioventricular node, Bundle of His, Purkinje fibres.
1. Excitation signal from the SA node created
2. Excitation spreads to atria, causing contraction
3. Signal is delayed upon reaching the AV node
4. Signal is then conducted to the Bundle of His, down the interventricular septum
5. Bundle of His and purkinje fibres spread the impulse along the ventricles and this causes them to contract.
62
What is the blood supply of the sinoatrial node and the atrioventricular node
SA node = RCA in 60% hearts, LCA in 40% hearts.
AV node = posterior interventricular artery in all hearts (90% from RCA, 30% from LCA)
63
What is the location of the SA Node?
In the upper wall of the right atrium at the junction where the superior vena cava enters the right atruim - crista terminalis.
64
On a chest X-ray which chambers and vessels form the right and left borders of the cardiac shadow?
Right border: right atrium, SVC and IVC can be seen entering
Left border: left ventricle and left atrial appendage
65
What is the thoracic duct and where does it join the vascular system?
The thoracic duct is the largest lymphatic vessel in the human body. 75% of all lymph from the entire body (except right upper limb, right breast, right lung and right side of head and neck which are drained by the right lymphatic duct) pass through the thoracic duct. It ranges from T12 to the root of the neck. It is important that it drains from the bowel as this is the only route for fat absorption into the lymphatics.
Fluid drains between the left subclavian vein and the left internal jugular vein where it rejoins circulation.
66
What structures are supplied by the three splanchnic nerves and where does a patient appreciate pain felt by these nerves?
- Greater splanchnic nerve (T5-T9); fore gut, epigastrium.
- Lesser splanchnic nerve (T10-11): midgut, round the umbilicus.
- Least splanchnic nerve (T12), hind gut, suprapubic area.
67
What structures lie immediately behind the trachea in the upper thorax and the left atria in the lower thorax?
oesophagus
68
What structures drain blood into the azygous system?
Lateral and posterior chest wall and lateral and posterior abdominal wall. It arises from the posterior part of the inferior vena cava and passes through the diaphragm, reaches the mediastinum and finally drains into the superior vena cava.
69
Why is the left recurrent laryngeal nerve at risk from thoracic disease but not the right?
The right recurrent laryngeal nerve loops around the right subclavian artery and passes back to the trachea and runs up to the larynx and innervates it. The left loops around the arch of the aorta and runs back up to the larynx.
70
Where do the sympathetic nerves attach to the CNS?
Thoracic 1-12 and lumber 1-2 spinal segmental nerves
71
What happens if the sympathetic nerves to the head and neck are damaged?
- No sweating of face (anhidrosis)
- eye lids will droop (ptosis)
- pupil will be constricted (miosis)
- Slightly withdrawn eyeball (enopthalmos) - Horner's syndrome and usually affects only 1 eye.
72
What effect will a PE have on the heart?
Will be harder to move blood through the arteries so the patient will experience SOB, chest pain, increased pulse because the heart is having to try and pump more blood to get effective blood flow.
73
What is the function of the extrinsic laryngeal muscles (sternothyroid, thyrohyoid etc.)?
The move the larynx up and down the neck and support its central position which is important in swallowing.
74
Where can you create an emergency airway?
Cricothyroid membrane between the cricoid and thyroid cartilage
75
Why does the thyroid gland have such a good blood supply?
Thyroid needs iodine to make thyroid hormone. There is very little iodine in the blood so it required a rich blood supply to get the iodine needed
76
Which structure might be compressed by an enlarged thyroid?
Trachea
77
What is the location of the parathyroid glands, how many are there?
They are positioned on the posterior surface of the thyroid gland, there are four.
Parathyroid glands are part of the endocrine system and regulate the calcium in our bodies. They continuously monitor and regulate calcium levels
78
What is the only complete cartilage ring around the airway?
cricoid cartilage surrounds the trachea
79
why might a patient develop hypocalcaemia after thyroid surgery?
the parathyroid glands might be accidentally or purposely removed during thyroid surgery and can lead to sudden hypoparathyroidism
80
What nerve innervates platysma
Facial Nerve (VII)
81
What does the facial nerve do?
It provides motor innervation to the facial muscles responsible for facial expressions, parasympathetic innervation of the glands of the oral cavity and the lacrimal gland, and sensory innervation of the anterior two thirds of the tongue.
82
What are the infra-hyoid muscles?
```
sternohyoid
sternothyroid
thyrohyoid
omohyoid
They depress the hyoid while swallowing
```
83
What blood vessels supply thyroid gland?
External carotid - superior thyroid artery
| Subclavian - inferior thyroid artery
84
What does the carotid sheath contain?
Internal jugular vein
Common carotid artery
Vagus nerve
85
What are the 3 parts of the pharynx?
Nasopharynx - conditions the air inspired and propagates into larynx
Oropharynx - involved in swallowing
Laryngopharynx / Hypopharynx
86
What is the blood supply to and from the pharynx?
Blood supply: external carotid artery
| Venous drainage: pharyngeal plexus which drains into internal jugular vein
87
What are the 2 groups of pharyngeal muscles?
Longitudinal - shorten and widen the pharynx, elevating the pharynx while swallowing
Circular - superior, middle and inferior constrictor muscles contract from top to bottom to constrict the lumen and propel the bolus of food inferiorly to the oesophagus
88
Nerve supply to pharynx?
Motor: pharyngeal branch of the vagus nerve
Sensory: glossopharyngeal n
89
What is the function of the larynx? What cervical vertebrae does it span? what lies behind the larynx?
Functions in phonation, cough reflex and protection of the lower Respiratory tract.
Spans C3-C6 and is suspended from he hyoid bone
Oesophagus lies behind the larynx
90
Arterial supply and venous drainage from larynx?
| Innervation to larynx?
Atrial supply: superior and inferior laryngeal arteries
(superior from external carotid and inferior from inferior thyroid which is a branch from thyrocervical trunk)
Venous drainage: superior and inferior laryngeal veins (superior drains into internal jugular and inferior drains into left brachiocephalic)
Innervation: vagus (recurrent laryngeal sensory to infra glottis and motor to all internal muscles of larynx except cricothyroid, superior laryngeal sensory to supra glottis and external branch provides innervation to cricothyroid muscle)
91
Name the supra hyoid muscles
- stylohyoid
- digastric
- mylohyoid
- stylopharyngeus
92
Where is the thyroid located? (spans which vertebrae)
In the anterior neck spanning C5-T1 vertebrae
93
Blood supply to and from the thyroid gland?
Blood supply to the thyroid
- The superior and inferior thyroid arteries supply blood to the thyroid gland.
- Superior thyroid branches from the external carotid artery
- Inferior thyroid branches from the thyrocervical trunk which comes from the subclavian artery.
- 10% people have thyroid ima also
Venous drainage
- Venous drainage is via the superior, middle and inferior thyroid veins forming a venous plexus.
- The superior and middle drain into the internal jugular veins
- The inferior drains into the brachiocephalic vein.
94
Innervation to the thyroid?
| If a patient presented with hoarseness, what nerve would likely be damaged?
Sympathetic: cervical ganglionic chain
Parasympathetic: vagus nerve
Recurrent laryngeal: Branch from the vagus that supplies all the intrinsic muscles of the larynx except cricothyroid.
Hoarseness: If the recurrent laryngeal nerve is damaged, the patient would present with hoarseness.
95
Where does the inguinal cancel run?
The Inguinal ligament runs between the anterior superior iliac spine at the end of the iliac crest to the pubic tubicle.
96
What forms the a) Roof b) Floor c) Anterior Wall d) Posterior wall of the inguinal canal?
Roof: transversalis fascia, internal oblique and transversus abdominis.
Floor: inguinal ligament
Anterior wall: aponeurosis of external oblique, reinforced by the internal oblique muscle laterally.
Posterior wall: transversalis fascia.
97
What is the surface markings of the deep ring and superficial ring?
- Deep ring is located just above the midpoint of the inguinal ligament
- Superficial ring is located just superior to the pubic tubercle
98
What does 3,7,9,10 and S2,3,4 mean to you?
- 3,7,9,10 = parasympathetic nerves
| - Pudenal nerve - S2, S3, S4 keeps poo off the floor.
99
What nerve passes through the maxillary sinus?
Maxillary branch of the trigeminal nerve
100
What sits above the sphenoidal sinus?
hypophyseal fossa
101
Describe the innervation to the tongue (taste, general sensation and muscles)
Taste Sensation of tongue:
Anterior 2/3rds: facial nerve (7th)
Posterior 1/3rd: glossopharyngeal nerve (9th)
General Sensation of tongue:
Anterior 2/3rds: trigeminal
Posterior 1/3rd: glossopharyngeal.
```
Muscles of the tongue:
Hypoglossal nerve (12th)
```
102
How is reflux of food into the nasopharynx prevented?
Elevation of the soft palate closes the orifice during swallowing
103
The Eustachian tube connects which 2 areas?
middle ear with the nasopharynx
104
Under which conchae would you find the opening of the nasolacrimal duct?
under the inferior conchae
105
the bulla ethmoidalis and hiatus semilunaris lie posterior to which conchae?
middle conchae
106
what lies under the superior conchae?
opening of the posterior ethmoidal air cell sinuses
107
how can disease of the sinus lead to cheek pain?
if the roof of the sinus, under the mucosa, there is a branch of the maxillary division of the trigeminal nerve which supplies the cheek.
108
Why are children with a cleft palate more prone to ear infections and conductive deafness?
Children born with a cleft palate may not have function in the soft palate muscles to open the Eustachian tube during swallowing. They will be at risk of recurrent middle ear infections and conductive deafness.
109
What nerve carries smell sense? Where does the olfactory bulb lie?
olfactory nerve
| olfactory bulb lies on the superior surface of the cribriform plate above the nasal cavity.
