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74 Cards in this Set
- Front
- Back
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Neurocranium
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Split into Calvaria (skull cap/dome like roof) and cranial base
Bones- frontal, parietal (superior and lateral walls), occipital (contains foramen magnum), temporal (4 parts- squamous, petrous, mastoid and tympanic), spenoid (greater and lesser wings, sinus in body, pterygoid process), Ethmoid (cribiform plae and perpendicular plate) |
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Fascial Skeleton
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bones surrounding the mouth, nose and orbits
Bones- vomer (mouth), zygomatic, palatine, nasal, maxilla, mandible, lacrimal, inferior nasal conchae |
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Cranial Sutures
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Frontal (coronal)- frontal and parietal bones
Sagittal- R/L parietal bones Lambdoid- occipital and R/L parietal Squamous suture- parietal and squamous portion of temporal bones |
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Junctions of Cranial Sutures
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Bregma- intersection of frontal and sagittal sutures
Lambda- intersection of lamdoid suture and sagittal sutures Pterion- intersection of frontal, temporal, parietal and sphenoid ("weak link of the skull") |
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Cranial Fossa and Landmarks
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Anterior cranial fossa, middle cranial fossa and posterior cranial fossa
cribiform plate, lesser and greater wings of sphenoid and sella turcica (pituitary gland is here) |
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CN1
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olfactory nerve, goes through foramina of cribiform plate
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CN2
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optic nerve, goes through optic canal
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CN3, 4, 6 & V1 of CN5
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all ocular nerves, come through superior orbital fissure
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V2 of CN5
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maxillary nerve, comes through foramen rotundum
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V3 of CN5
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mandibular nerve, comes through foramen ovale
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CN 7 & 8
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acoustic and facial nerves, come through internal acoustic meatus
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CN 9, 10 & 11
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come through jugular foramen
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CN12
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hypoglossal nerve, comes through hypoglossal canal
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Foramen Magnum
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HUGE, contains- medulla oblangata of brainstem and spinal roots of CN11
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Cranial Base
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Carotid canal (ICA), Jugular fossa/foramen, stylomastoid foramen (CN7)
Temporal bone- zygomatic process articulates with zygomatic bone to form zygomatic arch, external acoustic meatus, mastoid process, mastoid groove for digastric muscle, styloid process Occipital bone- EOP (external occipital protuberance), superior and inferior nuchal lines), occipital condyles (sit on vertebral column) |
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Fascial Skeleton landmarks
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Nasion- junciton of two nasal bones and frontal bone
Zygomatic arch- zygomatic + temporal bones Glabella- third eye region Foramen of anterior skull- supraorbital arch (V1), infraorbital arch (V2) Mandible- mental protuberance and foramen (V3) |
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Occipitofrontalis
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frontal and occipital bellies
elevates eyebrows, skin of forhead |
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Orbicularis oculi
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closes eyelids
palpebral- gently closes orbital- tightly closes |
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Nasalis
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draws sides of nose towards nasal septum
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Orbicularis oris
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compresses and protudes lips (purses lips to whistle)
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Mentalis
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elevates and protrudes lower lip (classic pouting)
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CN7
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innervates all fascial muscles (not of mastication)
5 branches: temporal, zygomatic, buccal, mandibular and cervical Bell's Palsy- injury to CN7 results in paralysis of facial muscles |
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CN5
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trigeminal nerve, supplies sensory component of the face
three branches- opthalmic (V1)- innervation to nose, eyes and skin of face above eyes maxillary (V2)- innervates mid face (lateral and below eye, above upper lip), palate, paranasal sinueses and maxillary teeth mandibular (V3)- innervates lateral and lower portion of face, jaw, mandibular teeth and anterior 2/3 of tongue, mastication (anterior digastric, mylohyoid, temporalis, masseter, pterygoids) Clinical- trigeminal neuralgia - sever facial pain among one of 3 (usually V2) |
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ECA in head
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many branches ascend and supply the face/scalp
major three- facial, maxillary and superficial temporal |
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ICA in head
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major blood supply to brain via circle of willis
opthalmic artery branches off ICA, exits the orbit and supplies the medial forehead via two branches (supraorbital artery and supratrochlear artery) |
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Orbit
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margins formed by frontal, maxillary and zygomatic bones (walls formed by 7)
Optic canal- contains CN2 Superior orbital fissure- contains CN3,4,6 and V1 of CN5 Inferior orbital fissure- contains V2 of CN5 |
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Eyelids & Conjunctiva
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protect eye
Conjunctiva is continuous- palpebral conjunctiva (lines eyelid), bulbar conjunctiva (lines eyeball), conjunctivitis is extrememly common lavator palpebrae superioris (raises upper eyelid) |
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Lacrimal Glands
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Produce tears
1. tears enter eye in upper orbit 2. circulate accross cornea 3. gather in lacrimal lake 4. pass through lacrimal punctum and go through lacrimal canaliculi 5. open into lacrimal sac 6. nasolacrimal duct then empties into inferior meatus of nose Lacrimal caruncle is round elevation in lacrimal lake (medial eye) |
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Outer layer of eyes
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sclera (covers posterior 5/6, white portion)
cornea (covers anterior 1/6) |
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Middle layer of eye
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choroid (lines sclera)
Ciliary body- connects choroid with iris, Ciliary muscle- attaches to lens via zonular fibers, contraction allows tension on lens to relax and increase convexity of lens (ALLOWS LENS TO FOCUS) |
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Ciliary Body
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fold- ciliary process which secrete aqueous humor that fills posterior and then anterior chambers of eye
aqueous humor is then drained via canal of schlemm impaired drainage= glaucoma (increased intraocular pressure leads to retina damage/blindness) |
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Iris
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thin, contractile diaphragm that lies on the lens- central part is pupil
sphincter pupillae closes pupil dilator pupillae opens pupil clinically- pupillary light reflex- shine light into one pupil and both should constrict (C2&3), accommodation- pupils constrict, lens thickens and medial rectus muscles adduct eyes (CN3) |
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Inner Layer of eye
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Retina lines inner eye
Fundus- posterior portion of eyeball Optic disc- location where optic nerve enters eyeball, known as blind spot- no rods or cones, closest to nose Macula lutea- slight depression in center is fovea centralis (area of most visual acuity), lateral to optic disc |
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Pathway of light to retina
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External light to cornea to aqueous humor to lens to vitreous body to retina
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Lens
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Zonular fibers hold lens in place
flatten lens to focus on distant objects (ZF pull lens) Increase convexity to accomodate the eye for near objects (ZF relax lens) Clinical- cataracts- opacity of the lens results in blurred and poor vision |
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CN3
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Occulomotor
Superior rectus- elevates Inferior rectus- depresses medial rectus- adducts eye inferior oblique- elevate and adduct levator palpebrae superioris- elevates superior eyelid |
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CN4
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trochlear
superior oblique- depresses and adducts |
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CN6
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abducens
lateral rectus- abducts eye |
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ICA in eye
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splits into opthalmic artery and then to central artery of retina which travels to the optic nerve
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Nose boundaries
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roof- cribiform plate (CN1 passes through sublingual glandsplate) of ethmoid bone,
floor- palatine process of maxilla and horizontal plate of palatine bone medial wall- formed by perpendicular plate of ethmoid, vomer and septal cartilage Lateral wall- superior and middle conchae of ethmoid bone, inferior nasal conchae |
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Nasal Cavity Regions
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Vestibule- region immediately posterior nostrils
Olfactory- upper 1/3, innervated by olfactory nerves, convey sense of smell via CN1 Respiratory- lower 2/3 of nasal cavity, warms, moistens and cleans air coming in |
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Ethmoid sinus
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located between nasal cavity and orbit, drains into superior and middle nasal meatus
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Frontal Sinus
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located in frontal bone, drains into middle nasal meatus
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Maxillary sinus
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located in maxilla, drains into middle nasal meatus
most common sinus to get infected, can spread to upper teeth (sinus infx plus tooth pain) |
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Sphenoidal sinus
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located in sphenoid, drains into sphenoethmoidal recess (posterior nasal cavity)
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Oral Cavity
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space between upper and lower dental arches,
hard palate (anterior 5/6), soft palate (posterior portion of tongue)- moves posterior to close off oropharynx from nasopharynx during swallowing or speaking uvula- process in posterior midline of soft palate (say Ahh= CN9 damage uvula will deviate to strong side) Floor is made of tongue and mylohyoid/geniohyoid muscles |
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Tongue
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divided into anterior 2/3 (ligual papillae/taste buds) and posterior 1/3 (lingual tonsils/lymphatic tissue)
lingual frenulum- midline fold, opening to submandibular duct- on right and left of frenulum |
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Genioglossus
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inferior muscle of tongue
N: CN12 A: protrudes and depresses tongue damage to CN12- tongue will deviate to weak side when stuck out |
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arches and tonsils
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palatoglossal arch (anterior)
palatine tonsil- lymphatic tissue between arches palatolarygneal arch (posterior arch) |
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Parotid Gland
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largest salivary gland, located in retromandibular space, passes through masseter and buccinator muscles, enters vestibule of the oral cavity near upper molars
Mumps- inflame parotid gland, could cause sterility secondarily Tumors/surgery- could damage CN7 and cause paralysis/weakness of facial muscles |
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Submandibular gland
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located in submandibular triangle, empties just lateral to lingual frenulum
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Sublingual gland
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smallest, located deep in mouth floor between mandible and genioglossus, empties into mouth via numerous small sublingual ducts in floor of mouth
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External Ear
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helix, antihelix, tragus, concha, lobule
External acoustic meatus- separated from middle ear by tympanic membrane |
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Middle Ear
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Ossicles- malleus (hammer), incus (anvil), stapes (stirrup)
otoscopic exam shows malleus and incus Eustachian tube connects middle ear to nasopharynx, equalizes pressure in middle ear |
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Inner Ear
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vestibule contains utricle and saccule (vestibular function)
semicircular canals (vestibular function cochlea (auditory function) |
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Weber's Test
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tuning fork on midline of head
if conductive HL- sound will be louder in blocked ear if sensorineural (usually CN8 damage like acoustic neuroma)- sound will be louder in normal ear |
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Rinne's Test
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confirm conductive hearing loss by placing fork on mastoid process and when it disappears place it near external acoustic meatus
normally sound will travel through air better than bone, but with conductive hearing loss it will be louder on bone |
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Cranium External Layers
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skin, close subcutaneous tissue, epicranial aponeurosis (gala aponeurotica- connect bellies of occipitofrontalis muscle), loose connective tissues for above layers to glide, pericranium/periosteum
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Cerebrum
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Telencephalon (R/L): frontal, parietal, temporal, occipital, insular and lumbar lobes
Diencephalon: core/deeper structures like thalamus, hypothalamus and epithalamus |
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Brainstem and Cerebellum
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midbrain, pons, medulla oblangata in row after diencephalon to spinal cord
Cerebellum in back below telencephalon |
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Cranial Meninges
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dura, arachnoid and pia (outside in)
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Epideural space
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dura-skull interface
epidural hemorrhage into space due to trauma, rupture of middle meningeal artery |
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Subdural space
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hemorrhage into space due to trauma, rupture of cerebral veins as they pass from brain to venous sinus
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Subarachnoid space
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arachnoid-pia interface, extens to 2nd sacral segment (how you can do a lumbar puncture at lumbar cistern)
CSF- protects brain, arachnoid trabeculae help to anchor brain in it, circulates through brain and spinal cord, maintains constant intracranial pressure Subarachnoid hemorrhage- due to saccular (berry) aneurysms, "worst headache ever" |
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ICA in brain
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enters cranial cavity via carotid canal, terminal branches are anterior and middle cerebral arteries, communicates with posterior cerebral artery- form circle of willis
opthalmic artery branches of ICA- anastomosis with ECA |
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Vertebral artery in brain
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enter cranial cavity via foramen magnum, R/L unite to form basilar artery, basilar artery divides in circle willis
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Circle of Willis
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R/L posterior cerebral arteries, R/L posterior communicating arteries, R/L internal carotid arteries, R/L middle cerebral arteries, R/L anterior cerebral arteries, anterior communicating artery
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Mandible Landmarks
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mental protuberance, mental foramen, body, angle, ramus, coronoid process, condylar process (neck & head), lingula, mandibular foramen (CN3 innervates teeth), mylohyoid line and groove, submandibular fossa
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Joint structure of temporomandibular joint
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1. head of condylar process of mandible
2. articular disc 3. mandibular fossa of temporal bone 4. articular tubercle of temporal bone 5. joint capsule |
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Temporalis Muscle
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O: temporal fossa and temporal fascia
I: coronoic process of mandible and anterior surface of the ramus of the mandible N: CN5 V3- deep temporal nerves A: elevates and retracts mandible |
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Masseter
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P: inferior border and medial surface of zygomatic arch
D: lateral surface of ramus of mandible and it's coronoid process N: CN5 V3 via masseteric nerve A: elevates and protrudes mandible, closes jaw |
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Medial pterygoid
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P: medial surface of lateral pterygoid plate of the sphenoid, palatine bone, pterygoid fossa
D: medial surface of mandibular ramus N: CN5 V3 via pterygoid nerve A; bilateral- elevates mandible, closes jaw, unilateral: can laterally deviate jaw to opposite side (grinding) |
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Lateral pterygoid
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P: superior head: greater wing of sphenoid, inferior head: lateral surface of lateral pterygoid plate
D: superior head: capsule and articular disk of TMJ, inferior head: neck of mandible N: CN5 V3 via lateral pterygoid branch A: protracts mandible, OPENS mouth, active in grinding actions of chewing |
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TMJ movement
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rotation, translation (gliding)
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