Gross Anat. Block B

  1. pterion
    • junction of greater wing of the sphenoid, squamous temporal, frontal  & parietal bones
    • overlies course of anterior division of middle meningeal artery
  2. lambda
    point on calvaria at junction of lambdoid and sagittal sutures
  3. bregma
    point on calvaria at junction of coronal and sagittal sutures
  4. vertex
    • superior point of neurocranium
    • in middle with the cranium oriented in anatomical plane
  5. asterion
    • star shaped
    • located at junction of three sutures: parietomastoid, occipitomastoid & lamboid
  6. glabella
    • smooth prominence
    • most marked in males
    • on the frontal bones superior to the root of nose
    • most anterior projecting part of forehead
  7. inion
    most prominent point of external occipital protuberance
  8. nasion
    point on cranium where frontonasal & internasal sutures meet
  9. layers of scalp
    • skin
    • connective tissue (dense)
    • aponeurosis (galea aponeurotica)
    • loose connective tissue (danger area)
    • periosteum
  10. boundaries of scalp
    • extends from superior part of neck posteriorly to the eyebrows anteriorly & to the zygomatic arches laterally
    • covers the calvaria
  11. scalp proper
    • first 3 layers
    • skin, dense connective tissue, aponeurosis
  12. scalp: skin
    • contains many hair follicles, sebaceous glands & sweat glands
    • sebaceous glands may become obstructed leading to sebaceous cysts (more common in scalp than anywhere else)
  13. scalp: dense CT
    • richly vascularized & innervated
    • many collagenous & elastic fibers which attach to the skin and to the deeper galea aponeurosis
  14. scalp lacerations
    • most common type of head injury requiring surgical care
    • bleed profusely
    • profuse blood supply from multiple sources from multiple directions with large number of anastomoses
    • blood vessels not allowed to contract because they are imbedded in the dense cCT
  15. superficial infections of the scalp
    tend to remain superficial because of the density of the fibrous tissue
  16. scalp: aponeurosis
    • epicranial aponeurosis
    • galea aponeurosis
  17. muscles of the scalp aponeurosis
    • epicranius
    • frontalis
    • occipitalis
  18. scalp: loose connective tissue
    • "danger area"
    • limits of the loose CT space or subaponeurotic space is important in the spread of infection
  19. scalp: posterior loose CT
    infection is unable to spread into the neck because the galea aponeurosis is attached to the superior nuchal line
  20. scalp: lateral loose CT
    infection is unable to spread beyond the zygomatic arches because the galea aponeurosis is continuous here with the temporal fascia
  21. scalp: anterior loose CT
    fluid or pus can enter the eyelids and the root of the nose because the frontalis is inserted into the skin & dense subcutaneous tissue
  22. pericranium
    • the periosteum of the skull
    • a thin, fibrous sheet which is only loosely attached to the bone apart from along the sutures
    • continuous with the periosteal layer of the dura (endocranium) on the inside of the calvaria at the sutures & foramina
  23. bleeding under the periosteum
    will be confined to the limits of the bone underlying that portion of periosteum
  24. SMAS
    • superficial musculo-aponeurotic system of fascia
    • superficial fascia of face & neck - invests facial muscles
    • extends from platysma m. to galea aponeurotica
    • continuous with temporopartietal fascia & galea aponeurotica
    • connected to dermis by vertical septa
  25. muscles of facial expression
    • all innervated by VII (facial nerve) - nerve of 2nd pharyngeal arch
    • occipitofrontalis
    • procerus
    • nasalis
    • depressor septi nasi
    • orbicularis oculi - orbital & palpebral parts
    • corrugator supercilii
    • auricular - superior, anterior, posterior
    • orbicularis oris
    • depressor anguli oris
    • risorius
    • zygomaticus minor
    • zygomaticus major
    • levator labi superioris
    • levator labi superioris alaeque nasi
    • depressor labi inferioris
    • levator anguli anis
    • buccinator
    • mentalis
  26. divisions of trigeminal nerve
    • opthalmic (V1): sensory; innervates the skin of the forehead, upper eyelids & nose
    • maxillary (V2): sensory; innervates the skin of the lower eyelid, cheek, & upper lip
    • mandibular (V3): sensory & motor; sensory innervation of the skin of lower face & part of side of head; motor innervation of the muscles of mastication
  27. branches of the facial nerve
    • posterior auricular branch: passes posterior to the ear
    • temporal branch: crosses the zygomatic arch
    • zygomatic branch: crosses the zygomatic bone
    • buccal branches: cross the superficial surface of the masseter muscle
    • mandibular branch: parallels the inferior margin of the mandible
    • cervical branch: cross the angle of the mandible to enter the neck
  28. Bell's palsy
    • sudden loss of control of the muscles of facial expression on one side of the face
    • caused by injury to the facial nerve
    • presentation - drooping of mouth & inability to close eyelid on affected side
  29. trigeminal neuralgia
    • Tic douloureux
    • patient experiences excruciating pain along the distribution of the maxillary, mandibular or opthalmic divisions of the trigeminal nerve
    • spontaneous firing of the trigeminal nerve endings
  30. nerves of the scalp
    • scalp is innervated by both cranial nerves & spinal nerves
    • dorsal spinal nerve rami: greater occipital (C2) and third occipital (C3)
    • ventral spinal nerve rami: great auricular (C2, C3) and lesser occipital (C2,C3)
    • CN V: trigeminal nerve (V1, V2, V3)
  31. greater occipital nerve
    innervates the skin of the back of the head as far superiorly as the vertex
  32. lesser occipital nerve
    innervates the skin behind the ear
  33. great auricular nerve
    innervates the skin of the lower part of the ear and skin over the angle of the mandible and lower part of parotid gland
  34. CN V1
    • opthalmic division of trigeminal nerve
    • sensory innervation of skin of forehead, upper eyelids, and nose
    • branches: supraorbital nerve, supratrochlear nerve, palpebral branch of lacrimal nerve, infratrochlear nerve
  35. CN V2
    • maxillary division of trigeminal nerve
    • sensory innervation of skin of lower eyelid, cheek & upper lip
    • branches: infraorbital nerve, zygomaticofacial nerve, zygomaticotemporal nerve
  36. CN V3
    • mandibular division of trigeminal nerve
    • sensory innervation to skin of lower face and part of side of head
    • motor innervation to muscles of mastication
    • branches: mental nerve, buccal nerve, auriculotemporal nerve
  37. superficial arteries of face & scalp
    • external carotid branches: occipital artery, posterior auricular artery, superficial temporal artery
    • internal carotid branch: opthalmic artery (divides into supraorbital artery & supratrochlear artery)
  38. emissary veins
    • go between the dural venous sinuses and superficial veins on the outside of the skull
    • valveless but flow is usually away from the brain
    • infections can spread from the internal skull in dural venous sinuses to the meninges and cavernous sinuses (cavernous sinus thrombosis)
  39. diploic veins
    • run within flat bones of the skull
    • do not penetrate all the way through bone, but travel in and through diploe
    • may make connections with emissary veins
  40. trigeminal ganglion
    sensory ganglion of trigeminal nerve
  41. shingles of face
    • herpes zoster
    • area of V1
    • virus lies latently in trigeminal ganglion
  42. epidural hematoma
    • accumulation of blood between the skull & dura mater
    • pterion overlies middle meningeal artery
    • fractures along skull can tear artery
  43. danger area of the face
    • area of the face near the nose drained by the facial veins
    • facial veins have no valves, so blood can go in either direction
    • clotted blood & infectious material can travel to cavernous venous sinus in the skull from facial veins, pterygoid venous plexus & opthalmic veins
  44. parotid gland
    • serous salivary gland
    • wraps around behind mandible right in front of ear
    • contains facial nerve, retromandibular vein & external carotid artery
  45. parotid duct
    • goes across masseter muscle
    • pierces the buccinator muscle
    • opens up into the vestibule of the oral cavity opposite the second maxillary molar
  46. autonomic innervation to parotid gland
    • sympathetic: preganglionic neurons from IMLCC of T1-T4 synapse in superior cervical ganglion; unmyelinated postganglionic fibers travel out through the external carotid plexus to go to parotid
    • parasympathetic: inferior salivatory nucleus of CN IX (GVE) will synapse on otic ganglion, then go to parotid gland
  47. motor innervation to muscles of facial expression
    facial nerve
  48. structures found within parotid gland
    • facial nerve
    • external carotid artery
    • retromandibular vein
  49. supraorbital foramen: contents
    • supraorbital artery
    • supraorbital nerve
  50. supratrochlear notch: contents
    supratrochlear nerve
  51. infraorbital canal: contents
    • Infraorbital nerve (branch of V2)
    • infraorbital artery
  52. mental foramen
    mental nerve
  53. middle meningeal artery
    • lies deep to pterion
    • damage will cause epidural or extradural hematoma
    • largely responsible for multiple small impressions on the inside of the skull
  54. temporal fossa
    • located superior to the infratemporal fossa
    • provides area of origin for temporalis m.
    • houses the pterion - area between frontal, parietal, temporal and sphenoid bones; covers middle meningeal artery
  55. borders of infratemporal fossa
    • lateral: ramus of mandible
    • medial: lateral pterygoid plate of sphenoid bone
    • anterior: posterior aspect of maxilla
    • posterior: tympanic plate, mastoid process & styloid process of temporal bone
    • superior/roof: greater wing of sphenoid bone
    • inferior/floor: attachment of medial pterygoid muscle to mandible (medial aspect of angle
  56. foramen ovale
    • oval shape; anterior to foramen spinosum
    • Mandibular division of trigeminal nerve (V3)
    • Accessory meningeal artery
    • Lesser petrosal nerve
  57. foramen spinosum
    • posterior to & smaller than foramen ovale
    • Middle meningeal artery & vein
    • Meningeal branch of mandibular nerve (V3) - Recurrent meningeal nerve
  58. epidural hematoma
    • accumulation of blood between the skull & dura mater
    • ex. middle meningeal artery damaged
  59. subdural hematoma
    • accumulation of blood in the potential space between the dura mater and the arachnoid mater
    • ex. damage to bridging veins
  60. foramen rotundum: contents
    Maxillary division of trigeminal nerve (V2)
  61. superior orbital fissure: contents
    • Oculomotor nerve (CN III)
    • Trochlear nerve (CN IV)
    • Ophthalmic branch of trigeminal nerve (V1) – frontal , lacrimal, & nasociliary
    • Abducent nerve (CN VI)
    • Superior ophthalmic vein
    • Sympathetic fibers
  62. foramen magnum: contents
    • Medulla oblongata & Meninges
    • Vertebral arteries & meningeal branches of vertebral arteries
    • Dural veins
    • Anterior & posterior spinal arteries
    • Spinal roots of accessory nerve (CN XI)
  63. jugular foramen: contents
    • Glossopharyngeal nerve (CN IX)
    • Vagus nerve (CN X)
    • Accessory nerve (CN XI)
    • Superior bulb of internal jugular vein
    • Inferior petrosal sinus
    • Sigmoid sinus
    • Posterior meningeal artery
  64. contents of infratemporal fossa
    • temporomandibular joint
    • ligaments of TMJ
    • muscles of mastication
    • branches of V3
    • chorda tympani (CN VII)
    • lesser petrosal nerve (CN IX)
    • otic ganglion
    • branches of maxillary artery
    • superficial temporal vein
    • pterygoid venus plexus
    • maxillary vein
    • deep facial vein
    • retromandibular vein
  65. muscles of mastication
    • temporalis
    • masseter
    • medial pterygoid
    • lateral pterygoid
  66. embryologic origin of muscles of mastication
    first pharyngeal arch
  67. motor innervation of muscles of mastication
    trigeminal nerve (V3)
  68. bony landmarks of infratemporal fossa
    • ramus of the mandible
    • lateral pterygoid plate
    • posterior aspect of maxilla
    • tympanic plate, mastoid process & styloid process of temporal bone
    • infratemporal surface of greater wing of sphenoid
    • attachment of medial pterygoid muscle (medial aspect of mandibular angle) 
  69. ligaments of TMJ
    • intrinsic: joint capsule & lateral ligament
    • extrinsic: sphenomandibular & stylomandibular
  70. bones of TMJ
    • mandibular fossa of temporal bone
    • articular tubercle of temporal bone
    • condyle of mandible

    continuous with middle ear cavity
  71. movements of TMJ
    • modified hinge joint (gliding hinge)
    • two separate cavities separated by fibrocartilaginous disc
    • upper cavity allows protrusion & retrusion
    • lower cavity allows elevation & depression
  72. dislocation of TMJ
    • condyle sits anterior to temporal bone
    • pain transmitted by trigeminal nerve
  73. temporalis m.
    • origin: floor of temporal fossa & deep surface of temporalis fascia
    • insertion: coronoid process & anterior border of ramus of mandible
    • action: elevate & retrude mandible
    • innervation: anterior & posterior deep temporal nerves
  74. innervation of TMJ
    • branches of trigeminal nerve (V3)
    • auriculotemporal nerve
    • masseteric nerve
  75. masseter m.
    • origin: inferior border & medial surface of maxillary process of zygomatic bone; zygomatic arch
    • insertion: angle & lateral surface of ramus of mandible
    • action: elevate mandible; close jaw
    • innervation: masseteric nerve
  76. medial pterygoid
    • superficial origin: tuberosity of maxilla & pyramidal process of palatine bone
    • deep origin: medial surface of lateral pterygoid plate
    • insertion: medial surface of ramus of mandible
    • action: elevate mandible (close jaw); lateral mandibular movements
    • innervation: nerve to medial pterygoid
  77. lateral pterygoid m.
    • superior origin: infratemporal surface & crest of greater wing of sphenoid
    • inferior origin: lateral surface of lateral pterygoid plate
    • insertion: joint capsule & articular disc of TMJ; pterygoid fovea
    • action: protrudes mandible; initiates jaw opening (with GRAVITY); lateral manidibular movements
    • innervation: nerve to lateral pterygoid
  78. branches of trigeminal nerve
    • opthalmic
    • maxillary
    • mandibular
  79. functional components of CN V
    • GSA: sensory innervation to most of the face
    • SVE: motor to muscles of mastication, mylohyoid, anterior belly of digastric, tensor tympani, tensor veli palatini
    • other fibers may "hitch a ride" but did NOT originate from trigeminal nerve
  80. CN V3: motor
    • muscles of mastication: masseter, temporalis, medial & lateral pterygoid
    • mylohyoid
    • anterior belly of digastric
    • tensor tympani
    • tensor veli palatini
  81. CN V3: sensory
    • dura
    • skull
    • TMJ
    • outer tympanic membrane
    • mandibular teeth
    • skin of temporal region
    • skin of auricle
    • skin of external auditory meatus
    • skin of cheek
    • skin of lower lip
    • skin of lower face
    • mucosa of cheek
    • anterior 2/3 of tongue
    • floor of mouth
    • mastoid air cells
    • gingiva of mandible
    • lower lip
  82. anterior division of V3
    • masseteric nerve: motor to masseter; sensory to TMJ
    • deep temporal nerve: motor to temporalis m.
    • nerve to lateral pterygoid: motor
    • long buccal nerve: sensory to skin & mucosa of cheek
  83. posterior division of V3
    • nerve to mylohyoid: motor to mylohyoid & anterior belly of digastric
    • auriculotemporal nerve: sensory; splits around middle meningeal artery
    • lingual nerve: sensory; joins with chorda tympani of facial nerve
    • inferior alveolar nerve: sensory; enters mandibular foramen
    • mental nerve: sensory; terminal branch of inferior alveolar nerve; emerges from mental foramen
  84. chorda tympani
    • portion of facial nerve
    • carries fibers to lingual nerve - GVE (parasympathetic) & SVA (special sensory taste fibers)
  85. masseteric nerve
    • branch of anterior division of CN V3
    • motor to masseter
    • little bit of sensory to TMJ
  86. long buccal nerve
    • branch of anterior division of CN V3
    • sensory to skin & mucosa of cheek
  87. nerve to mylohyoid
    • branch of posterior division of CN V3
    • motor to mylohyoid & anterior belly of digastric
  88. auriculotemporal nerve
    • branch of posterior division of CN V3
    • sensory to TMJ, tympanic membrane, skin over parotid gland, skin of temporal region, skin of auricle, skin of external auditory canal
    • splits around middle meningeal artery
  89. lingual nerve
    • branch of posterior division of CN V3
    • sensory to anterior 2/3 of tongue, floor of mouth & gingiva of mandible
    • functional components - GSA
    • joins with chorda tympani (GVE & SVA)
  90. inferior alveolar nerve
    • branch of posterior division of  CN V3
    • sensory to mandible, mandibular teeth, & gingiva of mandible
    • enters mandibular foramen
  91. mental nerve
    • branch of posterior division of CN V3
    • terminal branch of inferior alveolar nerve
    • sensory to skin of chin, lower lip, mucosa of lower lip & gingiva of mandible
    • emerges from mental foramen
  92. functional components of CN VII
    • SVA: taste to anterior 2/3 of tongue
    • GVE: motor to submandibular gland, sublingual gland & mucosa of floor of mouth
  93. superior salivary nucleus
    cell bodies of preganglionic parasympathetic fibers from CN VII (facial nerve)
  94. submandibular ganglion
    houses cell bodies of postganglionic parasympathetic fibers of facial nerve (CN VII) that innervate submandibular & sublingual glands
  95. geniculate ganglion
    cell body origin of all sensory fibers (esp. special sensory taste SVA)
  96. lateral ligament of TMJ
    reinforces articular capsule surrounding the TMJ
  97. stylomandibular ligament
    • runs from styloid process of temporal bone to posterior aspect of mandible
    • support/accessory ligament
    • some prevention of anterior dislocation
    • essentially a thickening of cervical fascia
  98. sphenomandibular ligament
    • runs from spine of sphenoid to lingula of mandible
    • main ligament of TMJ: thick & strong
    • serves as check ligament - prevents excessive motion of the mandible
  99. lesser petrosal nerve
    • arises from CN IX (glossopharyngeal)
    • GVE: parasympathetic motor fibers; controls secretions of parotid gland
  100. inferior salivary nucleus
    cell bodies of preganglionic parasympathetic fibers of CN IX (glossopharyngeal nerve)
  101. otic ganglion
    postganglionic parasympathetic fibers from glossopharyngeal nerve (CN IX) to parotid gland (via auriculotemporal nerve)
  102. divisions of maxillary artery
    • mandibular: 5 branches
    • pterygoid: 4 branches
    • pterygopalatine: 6 branches
  103. branches of external carotid artery
    • superior thyroid a.
    • ascending pharyngeal a.
    • lingual a.
    • facial a.
    • occipital a.
    • posterior auricular a.
    • maxillary a.
    • superficial temporal a.
  104. branches of first part of maxillary artery
    • deep auricular a.
    • anterior tympanic a.
    • inferior alveolar a.
    • middle meningeal a.
    • accessory meningeal a.
  105. branches of second part of maxillary artery
    • deep temporalis aa.
    • pterygoid branches
    • masseteric a.
    • buccal a.
  106. branches of third part of maxillary artery
    • posterior superior alveolar a.
    • infraorbital a.
    • artery of pterygoid canal
    • pharyngeal branch
    • descending palatine a. - greater palatine a. & lesser palatine a.
    • sphenopalatine a.
  107. pterygoid venous plexus
    • communicates with cavernous sinus, orbital veins, pharyngeal venous plexus & facial vein
    • drains into maxillary vein then retromandibular vein
  108. ABCs of trauma
    • airway
    • breathing
    • circulation
  109. what to look for when checking airway
    • agitation
    • obtundation - disorientation/blacked out
    • tachypnea - fast breathing
    • chest retractions - chest muscle sinks due to attenuated breathing
    • cyanosis - blue discoloration
  110. what to listen for when checking airway
    • ability to talk & respond
    • noisy breathing and stridor
    • silence - NOT GOOD
  111. what to feel for when checking airway
    air movement
  112. manuevers to assist a patient's breathing
    • chin lift
    • jaw thrust
    • oral airway
    • nasal airway
    • ventilate - mask/mouth to mouth
  113. definitive airway
    • secure the airway with intubation
    • use laryngoscope to intubate patient with long flexible plastic tube
    • step is taken before utilization of surgical airway
  114. airway obstructions: larynx
    • stenosis
    • foreign body
    • tumor
    • trauma
    • inflammation
    • infection
  115. surgical airways
    • jet ventilation via needle cricothyroidotomy - requires special equipment in hospital
    • cricothryoidotomy
    • tracheotomy - done in controlled hospital settings or EXTREME emergencies
  116. cricothyroidotomy: procedure
    • palpate cricothyroid space
    • stabilize thryroid cartilage
    • horizontal incision
    • spread or retract opening
    • insert tube
    • inflate endotracheal tube & bag
    • confirm placement & stabilize tube
  117. eye orbit
    • pyramid
    • base: orbit
    • apex: optic canal
    • medial walls: parallel to each other
    • lateral walls: diverge at 45 degrees
    • closed space except at base
    • space occupying infections or tumors within orbit may cause the eyeball to bulge anteriorly
  118. proptosis/exophthalmos
    anterior protrusion of the eyeball
  119. bones of eye orbit
    • frontal bone: supraorbital foramen, zygomatic process, nasal process, orbital process
    • ethmoid bone: lamina papyrecea (thin orbital plate)
    • sphenoid: lesser & greater wing
    • maxilla: frontal aspect, orbital process
    • lacrimal bone: anterior & posterior lacrimal crest
    • palatine bone: orbital process
    • zygomatic bone: orbital process
  120. foramen of eye orbit
    • optic canal
    • superior orbital fissure
    • inferior orbital fissure
  121. orbital margins
    • lateral margin: strongest part of orbital margin
    • superior margin: roof of orbit
    • medial rim: not prominent, surgically important (lacrimal sac)
    • infraorbital margin: inferior palpebral
  122. orbital fractures
    • lateral margin: most injuries occur from the temporal side
    • superior margin: may damage trochlea & produce symptoms of superior oblique paralysis
  123. orbital roof injuries
    sharp objects may easily penetrate the roof of the orbit & enter the anterior cranial fossa and/or the frontal paranasal sinuses
  124. orbital roof relationships
    • anterior cranial fossa
    • meninges
    • frontal lobes of brain
    • frontal paranasal sinus
    • lesser wing of sphenoid
    • orbital plate of frontal
  125. orbital medial wall relationships
    • ethmoid paranasal sinuses
    • sphenoid paranasal sinuses
    • lacrimal bone
    • orbital plate of ethmoid bone
    • body of sphenoid bone
    • ethmoidal air cells
  126. orbital medial wall injuries
    • infections/tumors of the ethmoid paranasal sinuses may erode through thin medial wall
    • common route through which sinus infections may produce orbital cellulitis
    • vulnerable to operative procedure
  127. orbital cellulitis
    inflammation of cellular or connective tissue
  128. orbital lateral wall relationships
    • temporal fossa
    • temporalis muscle (ant.)
    • middle cranial fossa
    • meninges
    • temporal lobe of the brain (post.)
    • greater wing of sphenoid
  129. orbital floor relationships
    • maxillary sinus
    • infraorbital nerve & vessels
    • pterygopalatine fossa
    • temporal fossa
    • zygomatic bone
    • orbital surface of maxilla
    • orbital process of palatine
  130. blowout fractures
    • Orbit hit with something too large to penetrate orbit
    • Transmits force to floor of orbit
    • Contents of orbit end up in maxillary sinus
    • Accompanied by areas of parasthetia (nerves running through infraorbital canal)
  131. orbital floor injuries
    • blowout fractures
    • malignant tumors of the maxillary sinus can easily invade the orbit
    • necrosis of the bone from chronic inflammation of the maxillary sinus
  132. symptoms of a blowout fracture
    • bruising around the eye
    • diplopia - double vision
    • proptosis - anterior protrusion of the eye
    • numbness - damage to infraorbital nerve
  133. forced duction test
    • physician anesthesizes eye, grabs eye & tries to manually elevate eye
    • unable to elevate eye - entrapment of inferior rectus muscle
  134. optic canal
    • rounded opening at the apex of the orbit
    • surrounded by the body & lesser wing of sphenoid bone
    • connects middle cranial fossa with orbital cavity
    • lies almost directly posterior along the medial wall of the orbit
  135. contents of optic canal
    • optic nerve
    • opthalmic artery
    • sympathetic plexus
    • meninges
    • extension of subarachnoid space
  136. superior orbital fissure
    • located in upper lateral angle of apex of the orbit
    • between the greater & lesser wings of the sphenoid
    • connects the middle cranial fossa with the orbital cavity
  137. annular tendon
    • derivative of periorbital fascia
    • surround both the optic canal & part of the superior orbital fissure
  138. structures outside the annular tendon
    • lacrimal nerve (branch of V1)
    • frontal nerve (branch of V1)
    • superior opthalmic vein (danger zone)
    • trochlear nerve (CN IV)
  139. structures within the annular tendon
    • upper & lower divisions of oculomotor nerve (CN III)
    • nasociliary nerve (branch of V1)
    • abduscens nerve (CN VI)
    • inferior opthalmic vein
  140. contents of superior orbital fissure
    • oculomotor nerve (CN III)
    • trochlear nerve (CN IV)
    • opthalmic division of trigeminal nerve (CN V1) - frontal, lacrimal & nasociliary nerves
    • abducens nerve (CN VI)
    • sympathetic nerves
    • opthalmic veins
  141. contents of inferior orbital fissure
    • infraorbital nerve & artery
    • communication between inferior opthalmic vein & pterygoid venous plexus
    • orbital & zygomatic branches of maxillary division of trigeminal nerve (CN V2)
  142. supraorbital foramen
    • supraorbital artery
    • supraorbital nerve
  143. anterior ethmoidal foramen
    anterior ethmoidal artery, vein & nerve
  144. posterior ethmoidal foramen
    posterior ethmoidal artery, vein & nerve
  145. infraorbital canal
    • infraorbital nerve from CN V2
    • infraorbital artery
  146. periorbita
    • periosteum of orbit
    • loosely attached
    • continuous through various foramina of the orbit with the periosteum on outside of the skull
    • continuous through inner surface of the skull with periosteal layer of dura (endocranium)
    • with meninges, attached to dural sheath of optic nerve at optic canal
    • tightly attached at suture lines
  147. derivatives of periorbita
    • annular tendon: posterior periosteal thickening
    • orbital septa: enters eyelids; give upper & lower eylids continuity
  148. optic papilla
    • continuation of subarachnoid space  from inside cranial vault to posterior aspect of eye
    • where optic nerve attaches
  149. papilledema
    • disruption of normal pattern of retinal artery & vein distribution
    • indicative of increased intracranial (CSF) pressure
  150. fascia bulbi
    • AKA Tenon's capsule or bulbar sheath
    • separates eyeball from surrounding fat & other contents of orbit
    • attached to sclera at entrance of optic nerve
    • barrier to spread of infection or hemorrhage between eyeball & retroocular space
    • socket for prosthesis
  151. features of eyelid
    • meibomian (tarsal) glands
    • lacrimal aruncle
    • lacrimal papilla
    • lacrimal puncta - open to lacrimal canaliculi to drain tears
    • skin continuous with conjunctiva
    • sebaceous glands associated with eyelashes
    • orbicularis oculi muscle - orbital & palpebral portions
  152. sty
    • hordeolum of lower lid
    • infectionof sebaceous glands associated with cilia at edge of lid
    • highly innervated space - painful
  153. chalazion
    infection of meibomian (tarsal) glands at mid-upper lid
  154. lacrimal gland
    • largest component of lacrimal apparatus
    • occupies lacrimal fossa on the superiolateral aspect of orbit
    • subdivided by lateral horn of levator palpebrae superioris muscle aponeurosis
    • two portions: orbital & palpebral
    • dumps tears into orbit through lacrimal foramina
  155. palpebral lacrimal gland
    • extends down into upper lid
    • yellowish visible portion of gland
  156. orbital lacrimal gland
    found against the orbital process of the frontal bone in the roof of the orbit
  157. lacrimial apparatus
    • tears from lacrimal gland are extruded from lacrimal foramina into superior fornix of conjunctiva
    • tears collect in lacrimal lake, enter lacrimal canaliculi
    • through superior & inferior lacrimal punctum
    • lacrimal canaliculi dump into lacrimal sac, which occupies the lacrimal fossa (medial orbital wall)
    • tears drain down the nasolacrimal duct and into the inferior meatus of the nose
  158. epiphera
    • closes lacrimal canaliculi
    • tears will overflow lower lid
  159. infected tear duct
    • common in newborns
    • nasolacrimal sac has not yet canalized
  160. Bell's palsy
    • facial nerve lesion
    • lack of nasal lacrimal groove
    • cannot smile properly (half does not elevate)
    • cannot tightly close eyes
  161. extraocular muscles
    • levator palpebrae superioris
    • superior tarsal muscle (Muller's muscles)
    • superior rectus muscle
    • inferior rectus muscle
    • lateral rectus muscle
    • medial rectus muscle
    • superior oblique muscle
    • inferior oblique muscle
  162. axes of eye movement
    • vertical: ADduction & ABduction
    • horizontal: elevation & depresseion
    • anterior/posterior: rotation (intorsion & extorsion)
  163. adduction of eye
    pupil moves towards nose (medial)
  164. abduction of eye
    pupil moves towards ear (lateral)
  165. intorsion
    medial rotation of the pupil
  166. extorsion
    lateral rotation of the pupil
  167. adductors of the eye
    • superior rectus m.
    • medial rectus m.
    • inferior rectus m.
  168. abductors of the eye
    • inferior oblique m.
    • lateral rectus m.
    • superior oblique m.
  169. elevators of the eye
    • inferior oblique m.
    • superior rectus m.
  170. depressors of the eye
    • superior oblique m.
    • inferior rectus m.
  171. lateral rotators of the eye
    • inferior oblique m.
    • inferior rectus m.
  172. medial rotators of the eye
    • superior oblique m.
    • superior rectus m.
  173. clinical testing of medial & lateral rectus muscles
    • ask patient to follow finger tip away from nose & back towards nose
    • when one eye is adducting, the other should be abducting
    • testing integrity of muscle-nerve connection
    • medial rectus m: inferior division of CN III (oculomotor)
    • lateral rectus m: abducens nerve (CN VI)
  174. clinical testing of superior & inferior rectus muscles
    • have patient fully ABduct eye
    • test elevation & depression
    • superior rectus m: superior division of oculomotor (CN III)
    • inferior rectus m: inferior division of CN III (oculomotor)
  175. clinical testing of superior & inferior oblique muscles
    • have patient fully ADduct eye
    • test elevation & depression
    • superior oblique m: trochlear nerve (CN IV)
    • inferior oblique m: inferior division of CN III (oculomotor)
  176. CN III lesion
    • lateral strabismus: eye is down & out (loss of IR, MR, IO, SR)
    • dilated pupil: loss of constrictor pupilae m. (parasympathetic innervation); unopposed sympathetic stimulation
    • ptosis: can't elevate lid (levator papebrae superioris m. innervated by superior division of CN III)
    • loss of accomodation: loss of ciliary muscle (parasympathetics through short ciliary nerves)
  177. CN IV lesion
    • paralyzed superior oblique m.
    • affected eye is elevated & adducted
    • difficulty reading & going down stairs
  178. CN VI lesion
    • paralyzed lateral rectus m.
    • affected eye is medially deviated
    • cannot ABduct eye
  179. CN VII lesion
    • Bell's palsy
    • can't smile or wink
  180. parasympathetic ganglion of the head & neck
    • ciliary
    • pterygopalatine
    • otic
    • submandibular
  181. Horner's syndrome
    causes by interruption of sympathetic innervation to the head & neck
  182. symptoms of Horner's syndrome
    • ptosis of the lid: due to lack of innervation to the superior tarsal muscle
    • myosis: constriction of the pupil due to lack of innervation to dilator pupillae muscle
    • red face: due to dilation of superficial blood vessels (loss of sympathetic constriction of blood vessels)
    • dry face: due to inactive sweat glands (anhidrosis)
  183. Edinger Westphal nucleus
    • in mesencephalon
    • location of preganglionic parasympathetic cell bodies associated with CN III (occulomotor)
  184. ciliary ganglion
    made up of postganglionic parasympathetic cell bodies of neural crest cell origin
  185. pupillary light response
    • bright light stimulus causes bilateral pupil constriction
    • direct response in ipsilateral eye
    • consentual response in contralateral eye
  186. pupillary light reflex
    • afferent limb: CN II (optic nerve) fibers leave the optic tracts to enter the midbrain; synapse in Edinger-Westphal nucleus
    • efferent limb: CN III parasympathetic fibers from Edinger-Westphal nucleus synapse in ciliary ganglion; travel down short ciliary nerves to iris sphincters
  187. anisocoria
    • different sized pupils
    • the pupil on the affected size is larger than the normal pupil
    • CN III lesion (parasympathetic interruption)
  188. CN III palsy vs. CN VII paralysis
    • CN III palsy: cannot open eye (orbicularis oculi)
    • CN VII paralysis: cannot close eye (levator palpebrae superioris acts unopposed)
  189. branches of opthalmic division of trigeminal nerve (CN V1)
    • frontal n: supratrochlear & supraorbital
    • lacrimal n: sensory fibers to lacrimal gland
    • nasociliary n: sensory ramus to ciliary ganglion, long ciliary nerves, posterior ethmoidal nerve, anterior ethmoidal, meningeal, nasal, medial palpebral nerves
  190. corneal reflex
    • touch stimulation of cornea = blink
    • afferent limb: sensation from cornea via CN V1
    • efferent limb: blink via CN VII
  191. drainage of the head
    • angular vein of the face
    • superior & inferior ophtalmic veins
    • cavernous sinus
  192. angular vein
    • danger zone of face
    • valveless
    • communicates with superior opthalmic vein (ABOVE annular tendon)
  193. structures within cavernous sinus
    • internal carotid artery (cavernous portion)
    • abducens nerve (CN VI)
  194. structures in lateral wall of cavernous sinus
    • CN III: oculomotor nerve
    • CN IV: trochlear nerve
    • CN V1: opthalmic division of trigeminal nerve
    • CN V2: maxillary division of trigeminal nerve
  195. cavernous sinus thrombosis
    • late complication of an infection of the central face or paranasal sinuses
    • other causes - bacterial infection of the ear or maxillary teeth; trauma
    • marked eyelid edema
    • bluish purple discoloration: impeded venous drainage
  196. important vertebral levels of the neck
    • C2: superior cervical ganglion
    • C3: hyoid bone
    • C4: common carotid artery bifurcation & superior border of thyroid cartilage
    • C5: rest of thyroid cartilage
    • C6: vertebral artery enters transverse formen of C6; cricoid cartilage; middle cervical ganglion; larynx becomes trachea; pharynx become esophagus
    • C7: inferior cervical ganglion
  197. stellate ganglion
    • inferior cervical ganglion
    • fused with first thoracic ganglion near spinal nerve C8
  198. SMAS
    • superficial musculo-aponeurotic system
    • contains platysma muscle
    • continuous with temporal fascia & galea aponeurotica
  199. deep fascia of the neck
    • investing fascia: wraps around trapezius & sternocleidomastoid
    • prevertebral fascia: wraps around vertebrae & deep back muscles; continues as axillary sheath around brachial plexus
    • pretracheal fascia: covers anterior aspect of trachea; splits into visceral & buccopharyngeal fascia
    • carotid sheath: surrounds common carotids (bifurcate at C4)
    • alar fascia: surrounds retropharyngeal space
  200. spaces within fascia of the neck
    • retropharyngeal: between buccopharyngeal & prevertebral fascia
    • lateral pharyngeal: lateral to pharynx
    • submandibular: below mandible
  201. borders of posterior triangle of the neck
    • medial border: posterior border of sternocleidomastoid
    • lateral border: anterior borders of trapezius
    • inferior border: intermediate 1/3 of clavicle
    • roof: platysma & investing layer of deep cervical fascia
  202. contents of posterior triangle of the neck
    • accessory nerve
    • cutaneous branches of the cervical plexus
    • external jugular vein
    • transverse cervical vessels
    • suprascapular vessels
    • subclavian vein & artery
    • posterior belly of omohyoid m.
    • roots & trunks of branchial plexus
    • nerve to subclavius
    • dorsal scapular nerve
    • suprascapular nerve
    • long thoracic nerve
  203. Erb's point
    • common insertion of nerves on posterior border of sternocleidomastoid
    • lesser occipital n.
    • greater auricular n.
    • transverse cervical n.
    • lateral, intermediate & middle supraclavicular nn.
  204. anterior cervical region/ anterior triangle
    • carotid triangle
    • muscular triangle
    • submandibular/digastric triangle
    • submental triangle
  205. boundaries of anterior triangle
    • lateral border: anterior border of sternocleidomastoid
    • medial border: anterior midline of nec
    • superior border: inferior mandible
    • roof: platysma & investing layer of deep cervical fascia
  206. boundaries of carotid triangle
    • lateral border: anterior border of SCM
    • medial border: anterior belly of omohyoid
    • superior border: posterior belly of digastric
  207. boundaries of muscular triangle
    • lateral: anterior border of SCM
    • medial: midline of neck
    • superior: anterior belly of omohyoid
  208. contents of muscular triangle
    • STRAP muscles
    • sternohyoid, sternothyroid, thyrohyoid, omohyoid
  209. boundaries of submandibular triangle
    • lateral: posterior belly of digastric
    • medial: anterior belly of digastric
    • superior: inferior mandible
  210. boundaries of submental triangle
    • lateral: right & left anterior bellies of digastric
    • superior: inferior mandible
    • inferior: hyoid bone
  211. baroreceptors
    detect changes in blood pressure
  212. chemoreceptors
    detect hypoxia & hypercapnia
  213. carotid sinus
    • dilation of the proximal part of the internal carotid artery
    • GVA sensation from CN IX (glossopharyngeal)
    • contains baroreceptors
  214. carotid body
    • small epitheliod body within the bifurcation of the common carotid artery
    • GVA sensation from CN IX (glossopharyngeal)
    • uses chemoreceptors to detect hypoxia & hypercapnia
    • will elicit hormonal response to increase respiration, heart rate & blood pressure
  215. branches of superior cervical ganglion (sympathetic)
    • internal carotid plexus
    • external carotid plexus
    • gray rami communicans (C1-C4)
    • pharyngeal plexus branches
    • superior cervical cardiac nerve
  216. branches of middle cervical ganglion (sympathetic)
    • gray rami communicans (C5-C6)
    • branches to thyroid
    • middle cervical cardiac nerve
  217. branches of inferior cervical ganglion (sympathetic)
    • gray rami communicans (C7-C8)
    • inferior cervical cardiac nerve
  218. branches of internal carotid artery in neck
  219. branches of external carotid artery
    • superior thyroid a.
    • ascending pharyngeal a.
    • lingual a.
    • facial a.
    • occipital a.
    • posterior auricular a.
    • maxillary a.
    • superficial temporal a.
  220. branches of subclavian artery
    • vertebral artery
    • thyrocervical trunk
    • internal thoracic artery
    • costocervical trunk
    • dorsal scapular artery
  221. pterygopalatine fossa
    • small deep pyramidal shaped space
    • posterior to the maxilla
    • posterior & inferior to apex of the orbit
    • between the pterygoid process of the sphenoid bone & the perpendicular plate of the palatine bone
  222. borders of the pterygopalatine fossa
    • medial wall: perpendicular plate of palatine bone
    • roof: greater wing of sphenoid
    • anterior border: posterior aspect of the maxilla
    • posterior border: pterygoid process of the sphenoid bone
  223. bones that form the pterygopalatine fossa
    • palatine bone
    • maxilla
    • sphenoid bone
  224. foramina of the pterygopalatine fossa
    • infraorbital fissure
    • sphenopalatine foramen
    • foramen rotundum
    • pterygoid canal
    • pharyngeal canal
    • palatine canal
    • alveolar foramen
    • pterygomaxillary fissure
  225. communication of pterygopalatine fossa
    • anteriorly to floor of the orbit through inferior orbital fissure
    • posteriorly to the middle cranial fossa through the foramen rotundum and to the pharynx through the pharyngeal canal
    • laterally to the infratemporal fossa through the pterygomaxillary fissure
    • medially to the nasal cavity through the sphenopalatine foramen
    • inferiorly to hard palate through the greater & lesser palatine foramina
  226. pterygomaxillary fissure
    • allows communication of the pterygopalatine fossa laterally with infratemporal fossa
    • located between the back of the maxilla & the pterygoid process of sphenoid bone
    • transmits 3rd part of maxillary artery
  227. foramen rotundum
    • allows communication of pterygopalatine fossa posteriorly with middle cranial fossa
    • transmits maxillary nerve (V2) - courses through superior part of pterygopalatine fossa
  228. pterygoid canal
    • connects the superior part of foramen lacerum with the pterygopalatine fossa
    • transmits the nerve of the pterygoid canal & artery of the pterygoid canal
  229. pharyngeal canal
    • enters posterior aspect of pterygopalatine fossa
    • between horizontal plate of palatine bone & vaginal processes
    • transmits pharyngeal nerve & artery to the roof of the pharynx
  230. greater palatine canal
    • located at inferior aspect of pterygopalatine fossa at junction of anterior and posterior walls
    • ends inferiorly in the greater & lesser palatine foramina at level of hard palate
    • transmits greater & lesser palatine nerves and arteries
  231. sphenopalatine foramen
    • on medial wall of pterygopalatine fossa between sphenoid bone & perpendicular plate of the palatine bone
    • communicates medially with the nasal cavity
    • transmits the sphenopalatine artery & the nasopalatine nerve
  232. contents of the pterygopalatine fossa
    • pterygopalatine ganglion
    • branches of the maxillary nerve
    • nerves arising from the pterygopalatine ganglion
    • branches of the third part of the maxillary artery
    • accompanying veins
  233. pharynx
    • fibromuscular aerodigestive tube
    • extends from base of skull to the base of the cricoid cartilage at the level of the 6th cervical vertebra
  234. boundaries of the pharynx
    • superior: body of sphenoid & basilar occipital bone
    • inferior: esophageal inlet
  235. communication of the pharynx
    • two nasal cavities through posterior choanae
    • two tympanic cavities through pharyngotympanic tube
    • mouth
    • larynx through laryngeal aditus
    • esophagus (direct communication at level of C6)
  236. divisions of the pharynx
    • nasopharynx
    • oropharynx
    • laryngopharynx
  237. nasopharynx
    • posterior to the two nasal cavities
    • communicates with nasal cavities via posterior nasal choanae
    • inferior to the base of the skull (basisphenoid & basioccipital bones)
    • above the level of the soft palate
  238. oropharynx
    • posterior to the oral cavity or the mouth
    • anterior wall represented by the posterior 1/3 of the tongue
    • inferior to the soft palate
    • superior to the laryngeal aditus
  239. laryngopharynx
    • lies inferior to the oropharynx
    • posterior to the larynx
    • extends from the laryngeal aditus to the level of C6
  240. conchae
    ethmoid bone covered in mucosa
  241. pharyngeal isthmus
    • isthmus of fauces/oropharyngeal isthmus
    • narrowing of the pharynx at level of soft palate
    • separates the nasopharynx from the oropharynx
  242. pillars of fauces
    • anteriorly & posteriorly border palatine tonsils
    • palatoglossal fold: anterior pillar of the fauces
    • palatopharyngeal fold: posterior pillar of the fauces
  243. palatoglossal fold
    • anterior pillar of the fauces
    • boundary between the oral cavity & the oropharynx
    • formed by the palatoglossus m. covered by mucosa
    • runs from palatine aponeurosis to the posterolateral surface of the tongue
    • innervated by CN X
  244. palatopharyngeal fold
    • posterior pillar of the fauces
    • formed the palatopharyngeus m. covered with mucosa
    • runs from the hard palate & the palatine aponeurosis to the posterior border of the lamina of the thyroid cartilage & the side of the pharynx and esophagus
  245. adenoids
    • pharyngeal tonsils
    • lymphoid tissue in nasopharynx
  246. layers of the pharyngeal wall
    • mucosa: ciliated in nasopharynx; stratified squamous epithelium in oropharynx & laryngopharynx; tightly attached to the pharyngobasilar fascia
    • pharyngobasilar fascia: lines the inside of the pharynx between the muscle of the mucosa
    • muscular wall: superior, middle & inferior constrictors of the pharynx
    • buccopharyngeal fascia: external to the muscles of the pharyngeal wall above the C6 vertebral level
  247. pharyngeal constrictors
    • superior constrictor
    • middle constrictor
    • inferior constrictor
  248. retropharyngeal space
    space between prevertebral & buccopharyngeal fascia
  249. longitudinal pharyngeal muscles
    • stylopharyngeus
    • salpingopharyngeus
    • palatopharyngeus
  250. pharyngeal recess
    • area devoid of muscle
    • fusion of pharyngobasilar fascia & mucosa
    • most posterior/superior aspect of the pharynx
    • AKA sinus of Morgagni or fossa of Rosenmuller
  251. contributions to the pharyngeus plexus
    • CN IX - glossopharyngeal: GVA fibers to mucosa of pharynx; SVE fibers to stylopharyngeus muscle
    • CN X - vagus: SVE to muscles of pharynx & soft palate; GVE to glands of pharyngeal mucosa
    • Sympathetics: GVE to blood vessels in the pharyngeal mucosa
  252. gag reflex
    • afferent pathway: glossopharyngeal n (CN IX)
    • efferent pathway: vagus n (CN X) from nucleus ambiguus
  253. blood supply to tonsils
    • Tonsillar branch of lesser palatine artery
    • Tonsillar branch of ascending pharyngeal
    • Tonsillar branch of ascending palatine artery
    • Tonsillar branch of facial artery
    • Tonsillar branch of facial artery
  254. Waldeyer's tonsillar ring
    ring of lymph tissue protecting the pharyngeal body
  255. lateral pharyngeal bands
    connects the palatine, pharyngeal, and lingual tonsils
  256. degluttition
    • swallowing
    • process by which a bolus of food  or liquid is transferred from the mouth to the stomach
    • pattern-elicited response: both voluntary & reflex component
    • controlled by central program generator in the swallowing center of the medulla
  257. phases of normal swallowing
    • oral preparatory phase
    • oral transit phase
    • pharyngeal phase
    • esophageal phase
  258. oral prepatory phase
    • voluntary control: process of mastication
    • muscles of mastication (CN V3)
    • labial musculature, orbicularis oris, buccinator (CN VII)
    • tongue holds bolus against hard palate (CN XII)
    • taste (CN VII, IX)
    • temperature, touch, proprioception (CN V2, V3, IX)
  259. oral transit phase
    • voluntary phase controlled by cerebral cortex through corticobulbar tracts
    • manipulation of bolus to central portion of tongue & toward pharynx (CN VII & XII)
  260. pharyngeal phase
    • involuntary rapid reflex in which bolus moves through pharynx
    • triggered when bolus reaches palatoglossal fodl
    • CN VII, IX & X
    • swallowing reflex prevents interuption of posterior movement of the bolus
    • retraction of tongue  (CN XII)
    • tension (CN V3) & elevation (CN X) of palate
    • elevation of larynx (C1, CN V3, VII, IX, X)
  261. elevation of larynx (muscles & CN)
    • stylohyoid - VII
    • digastrics - V3 (anterior belly); VII (posterior belly)
    • geniohyoid - C1
    • thyrohyoid - C1
    • mylohyoid - V3
    • stylopharyngeus - IX
    • salpingopharyngeus - X
    • palatopharyngeus - X
  262. esophageal phase
    • final phase of swallowing process
    • under direct control of brain stem & myenterix plexus (CN X)
    • peristaltic wave beginning in pharynx pushes bolus from cervical esophagus through esophageal gastric sphincter & into stomach
  263. larynx
    • lies in the anterior neck in front of C3-C6 (disc of C7)
    • smaller & more superior placed in females & children
    • extends from laryngeal aditus to lower border of cricoid cartilage
    • lies between carotid sheaths
    • is covered by lops of the thyroid gland & infrahyoid muscles
    • continuous with trachea at level of C6 vertebra
  264. function of larynx
    • passageway for air
    • production of sound
    • protective mechanism - prevents things from entering respiratory tree
  265. laryngeal aditus
    opening located between the epiglottis & superior aspect of the lamina of the cricoid cartilage
  266. lamina of cricoid cartilage
    posterior protection during cricothyroidotomy
  267. laryngeal skeleton
    • made up of cartilages
    • free cartilages: thyroid, cricoid, epiglottic
    • paired cartilages: arytenoid, corniculate, cuneiform
  268. function of laryngeal cartilages
    • maintain patency of the airway
    • serve as attachment for muscles
  269. thyroid cartilage
    • two laminae - quadrangular shapes
    • laryngeal prominence: laminae fuse in anterior midline; "Adam's apple"
    • superior thryoid notch
    • superior horn/cornu
    • inferior horn/cornu
    • oblique line: attachment for sternothryoid, thyrohyoid & inferior constrictor muscles
    • attaches to the hyoid bone by thyrohyoid membrane and  median & lateral thyrohyoid ligaments
  270. structures that pierce the thryohyoid membrane
    • internal branch of superior laryngeal nerve
    • superior laryngeal artery
  271. thyrohyoid membrane
    • attaches thyroid cartilage to hyoid bone by suspending the thryoid cartilage inferiorly
    • pierced by internal branch of superior laryngeal nerve & superior laryngeal artery
  272. median thryohyoid ligament
    thickening in the midline of the thyrohyoid membrane
  273. lateral thyrohyoid ligaments
    • thickenings on either side of the thyrohyoid membrane
    • attach the superior horn of the thyroid cartilage to the hyoid bone
  274. triticea
    small cartilaginous nodule frequently found in lateral thyrohyoid ligament
  275. cricoid cartilage
    • "signet ring" shaped
    • forms the interior parts of the anterior & lateral walls of the larynx
    • anterior arch
    • posterior lamina
    • articulates with inferior cornu of thyroid cartilage via a synovial joint
  276. cricothyroid ligament
    • AKA cricothryoid membrane, cricovocal membrane
    • connects cricoid cartilage to thyroid cartilage
    • extends up medially and inserts on interior lamina of thyroid cartilage
  277. conus elasticus
    • superior extension of the cricothyroid membrane
    • superior free edge: forms vocal ligament
    • attaches posteriorly to vocal processes of arytenoids
  278. arytenoid cartilages
    • paired cartilages on either side of the median plane on the upper border of the lamina of the cricoid cartilage
    • forms a synovial joint with the lamina of the cricoid cartilage
    • vocal process: where vocal ligaments attach
    • muscular process: point of attachment of intrinsic muscles of the larynx
    • apex: apical process
    • base
    • cricoarytenoid joint
  279. cricoarytenoid joint
    synovial joint between superior aspect of lamina of cricoid cartilage and base of arytenoid cartilage
  280. corniculate cartilages
    • AKA Santorini's cartilages
    • wedge-shaped yellow elastic cartilage
    • located at apex of arytenoid cartilage
    • unknown function
  281. cuneiform cartilages
    • yellow elastic cartilage
    • rod-like cartilages in the aryepiglottic folds
  282. epiglottic cartilage
    • spoon-shaped yellow elastic cartilage
    • forms the anterior wall of the laryngeal aditus
    • small glands present (look like pits)
    • hooked onto posterior aspect of hyoid bone by hyoepiglottic ligament
    • closes off opening to larynx
  283. calcified laryngeal cartilages
    • cartilages become ossified with age & may be fractured during boxing, karate, or by a shoulder strap (seatbelt) in a car accident
    • the thyroid cartilage begins to ossify ~20 yrs
  284. aryepiglottic folds
    • attach epiglottis to arytenoid cartilages
    • forms the wall between the piriform recess & the larynx
    • partially bind the laryngeal aditus (opening to larynx)
    • cuneiform & corniculate tubercles present
  285. hyoepiglottic ligament
    connects thebody of the hyoid & the anterior surface of the epiglottis
  286. quadrangular membrane
    • extends from anterior surface of arytenoid cartilage to posterior aspect of epiglottis
    • superior free edge: form aryepiglottic fold
    • inferior free edge: forms vestibular ligament/ false vocal cords
  287. vocal ligament
    • thickened superior edge of the conus elasticus
    • extend between the vocal processes of the arytenoid cartilages to the inside of the thyroid cartilage
  288. vocal cord
    vocal ligaments covered with epithelium/mucosa
  289. boundaries of laryngeal aditus
    • anterior: epiglottis
    • lateral: aryepiglottic folds
    • posterior: corniculate cartilages & arytenoideus muscles
  290. folds that attach epiglottis to tongue
    • median glossoepiglottic fold: epiglottis to root of tongue
    • lateral glossoepiglottic fold: epiglottis to sides of tongue (2)
  291. epiglottic valleculae
    • lateral depressions on either side of median glossoepiglottic fold between posterior aspect of tongue and anterior aspect of epiglottis
    • place to look for foreign bodies (swallowed or aspirated)
  292. piriform recess
    • on either side of larynx posterior to laryngeal aditus
    • subdivisions of laryngopharynx/hypopharynx
  293. vestibule
    • triangular cavity posterior to the epiglottis & superior to the vestibular folds
    • extends from the laryngeal aditus to the vestibular folds
    • quadrangular membrane + mucosa
  294. rima glottidis
    narrow aperture between true vocal cords
  295. vestibular/false vocal cords
    • appear pink in the living; contained within the vestibule
    • superior to true vocal folds
  296. vestibular ligament
    free inferior edge of the quadrangular membrane
  297. rima vestibuli
    opening between the vestibular folds
  298. ventricle of the larynx
    • AKA ventricle of Morgagni, laryngeal sinus
    • diverticulum between the vestibular & vocal folds
  299. laryngeal saccule
    • appendix of the laryngeal ventricle
    • diverticulum from the anterior end of the ventricle upward between the vestibular fold & inner surface of the thyroid cartilage
  300. vocal folds/ true vocal cords
    • concerned with phonation
    • appear white in the living
    • formed by vocal ligament (anterior 3/5) & vocal processes of arytenoid cartilages (posterior 2/5)
  301. glottis
    vocal folds (true vocal cords and mucosa) + rima glottidis (aperature between true vocal folds)
  302. infraglottic compartment
    continuous inferiorly with the trachea
  303. function of extrinsic muscles of the larynx
    move the larynx as a whole (elevate or depress) because the hyoid bone is attached to the thryoid cartilage
  304. infrahyoid strap muscles
    • omohyoid, sternohyoid, sternothyroid & thyrohyoid
    • in general, depressors of the larynx (NOT thyrohyoid)
  305. suprahyoid strap muscles
    • stylohyoid, digastric, geniohyoid, mylohyoid
    • elevate the larynx w/ thyrohyoid, stylopharyngeus, salpingpharyngeus & palatopharyngeus
  306. function of intrinsic muscles of the larynx
    concerned with movements of laryngeal parts & alterations in the length & tension of the vocal folds
  307. extrinsic muscles of the larynx
    • stylohyoid
    • digastric
    • geniohyoid
    • mylohyoid
    • sternohyoid
    • thyrohyoid
    • sternothyroid
    • omohyoid
  308. intrinsic muscles of the larynx
    • cricothyroid
    • posterior cricoarytenoid
    • lateral cricoarytenoid
    • thryoarytenoid
    • transverse arytenoid
    • oblique arytenoid
    • vocalis
  309. movements of the vocal cords
    • abduction of vocal folds: posterior cricoarytenoid
    • adduction of vocal folds: lateral cricoarytenoid & transverse arytenoid
    • tension of vocal ligaments: cricothyroid
    • relaxation of vocal ligaments: vocalis
  310. blood supply to the larynx
    superior laryngeal a. & inferior laryngeal a.
  311. superior laryngeal artery
    • branch of superior thyroid artery
    • accompanies superior laryngeal nerve
    • penetrates thyrohyoid membrane
  312. inferior laryngeal artery
    • branch of inferior thyroid artery from thyrocervical trunk
    • passes with the inferior laryngeal nerve deep to lower border of inferior constrictor
    • supplies the mucosa & musculature
  313. innervation of the larynx
    • superior laryngeal nerve: largely sensory & secretory
    • external branch of superior laryngeal nerve - innervates the cricothyroid muscle
    • internal branch of superiro laryngeal nerve - penetrates thyrohyoid membrane along with superior laryngeal artery; innervates mucosa down as far as the vocal folds
    • recurrent/inferior laryngeal nerve: sensory & secretory fibers; voluntary motor to all intrinsic muscles of the larynx except the cricothyroid; innervates mucosa below level of vocal folds
  314. hemimandibulectomy
    • radical neck dissection
    • block dissection of cervical nodes
    • removal of all ipsilateral cervical lymph node groups from levels I through V together with spinal accessory nerve, SCM & IJV
  315. lymphangitis
    inflammation of lymph vessels
  316. lymphadenitis
    inflammation of the lymph nodes
  317. lymphogenous metastasis
    spread of malignant (cancer) cells through lymphatic vessels
  318. superficial cervical lymph nodes
    • lie along external jugular vein
    • are in the superficial fascia
    • are superficial or external to the SCM
  319. superficial cervical collar nodes
    • where scalp, including forehead, drains into ring of lymph nodes at junction of the head & neck
    • horizontal chain
    • occipital, mastoid/retromandibular, superficial parotid, mandibular, submental
  320. superficial parotid nodes
    drain lymphatic vessels from forehead, lateral parts of both eyelids, part of external nose
  321. buccal & mandibular nodes
    drain lymphatic vessels from the medial corner of the eye, most of the external nose, and lower part of face
  322. occipital nodes
    drain occipital region
  323. submental nodes
    • located between the anterior bellies of the digastric muscle
    • range from one to three nodes
  324. submandibular nodes
    • drain facial nodes of the face & submental node
    • are the primary nodes for lateral part of tongue
    • recirculate lymph fluid from nose, cheek, hard palate, upper lip, part of lower lip & floor of mouth
  325. parotid nodes
    • lie within the parotid gland
    • drain the face anterior to the gland & some of the pharynx
  326. preauricular nodes
    • anterior to the ear; located superficial to the parotid gland
    • drainage from the lymph plexus of the skin
  327. postauricular nodes
    • usually only one on either side
    • located on mastoid process or posterior external ear
    • carries lymph from skin & scalp and drains into superior deep cervical nodes
  328. occipital nodes
    • found along the course of the occipital artery
    • recirculates lymph from occipital region & drains into the superior cervical nodes
  329. deep cervical nodes
    • embedded in & around the CT of  the carotid sheath
    • associated with the internal jugular vein
    • upper (superior) deep cervical nodes: nodes lying above the level at which the omohyoid muscle crosses the carotid artery & the jugular vein
    • lower (inferior) deep cervical nodes: nodes lying below the level of the omohyoid
  330. superior deep cervical nodes
    • related to the internal jugular vein under the SCM
    • jugulodigastric node: where the posterior belly of the digastric crosses the IJV & ICA
    • jugulo-omohyoid node: where the omohyoid crosses the IJV & ICA
    • bounded by anterior & posterior triangles of the neck
    • made more apparent for examination by turning patient's head
    • lymph nodes lie deep to the superior aspect of the muscle
  331. inferior deep cervical nodes
    • posterior lateral nodes associated with the subclavian vessels & the brachial plexus
    • supraclavicular nodes
    • retroauricular nodes
  332. supraclavicular nodes
    6-10 nodes may be found in lower portion of posterior triangle
  333. retroauricular nodes
    • lie inferior to the omohyoid muscle
    • receive lymph vessels descending from the superior deep cervical nodes, larynx, trachea & scalp
    • last group of nodes through which lymph passes before entering the thoracic duct
  334. lymphatic drainage of the tongue
    • median glossoepiglottic fold: midline of tongue drain bilaterally
    • lateral tongue: drains ipsilaterally
    • lymphatics of base/root of tongue drain to jugulodigastric node
    • lymphatics from middle of tongue drain to submandibular nodes
    • lymphatics from lateral parts of tongue drain into submandibular nodes
    • lymphatics from medial tip of tongue drain bilaterally into submental nodes
  335. diseases that may cause lymphadenopathy
    • infection mononucleosis (kissing disease)
    • non-hodgkin's lymphoma
    • persistant generalized lymphadenopathy
    • cat scratch disease
    • metastatic carcinoma
  336. suprahyoid muscles
    • anterior & posterior bellies of digastric
    • mylohyoid
    • stylohyoid
    • geniohyoid
  337. structures related to inferior surface of mylohyoid
    • superficial part of submandibular gland
    • submandibular & submental lymph nodes
    • facial a & v
    • submental a & v
    • mylohyoid a & v
    • mylohyoid n.
    • branches of CN VII
  338. structures between mylohyoid & hyoglossus mm.
    • lingual n.
    • CN XII
    • submandibular ganglion
    • deep part of submandibular gland
    • submandibular duct
    • sublingual gland
  339. structures located deep to hyoglossus m.
    • lingual artery
    • deep lingual vv.
    • CN IX
  340. papillae of tongue
    • circumvallate: in front of terminal sulcus; taste buds
    • fungiform: numerous on sides & tip; taste buds
    • foliate: on margin; taste buds
    • filiform: most numerous; NO taste buds
  341. extrinsic tongue musculature
    • styloglossus
    • genioglossus
    • hyoglossus
    • palatoglossus
  342. where are there taste buds?
    • anterior 2/3 tongue
    • posterior 1/3 tongue
    • soft palate
    • portion of tongue just anterior to epiglottis
    • epiglottis
    • aryepiglottic fold
  343. muscles of the soft palate
    • palatoglossus
    • palatopharyngeus
    • musculus uvulae
    • levator veli palatini
    • tensor veli palatini
  344. arterial supply to palatine tonsils
    • facial a. - tonsillar a & ascending palatine a.
    • lingual a. - dorsal lingual a.
    • ascending pharyngeal a.
    • maxillary a. - descending palatine a. - lesser palatine a.
  345. drainage of paranasal sinuses
    • frontal: middle meatus
    • anterior ethmoidals: middle meatus
    • middle ethmoidals: middle meatus
    • posterior ethmoidals: superior meatus
    • maxillary: middle meatus
    • sphenoid: sphenoethmoidal recess
  346. nerve supply to frontal sinus
    supraorbital n.
  347. nerve supply to anterior & middle ethmoidal sinuses
    anterior ethmoidal branches of nasociliary n.
  348. nerve supply to posterior ethmoidal sinus
    • posterior ethmoidal branches of nasociliary n.
    • orbital branches of V2
  349. nerve supply to sphenoidal sinuses
    • posterior ethmoidal branches of nasociliary n.
    • orbital branches & pharyngeal branches of V2
  350. nerve supply to maxillary sinus
    anterior, middle & posterior superior alveolar nn.
Card Set
Gross Anat. Block B
head & neck