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279 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What are the 5 motions of the temporomandibular joint? Which one is necessary for space for neck viscera?
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elevation and depression/protraction and retraction/lateral excursion
protraction |
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What 3 structures stabilize the temporomandibular joint?
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joint capsule, sphenomandibular ligament, and stylomandibular ligament
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What is the articular disc of the temporomandibular joint?
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divides the joint into an upper and lower chamber
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What occurs in the upper and lower chambers of the TMJ? What divides them? The first 10 degrees of jaw opening is simply ______. After that, it becomes _____ and _________.
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sliding motion in the upper chamber of the TMJ and a hinge motion in the lower chamber of the TMJ
articular disc rotation rotation and sliding |
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Branches of what nerve innervates all the muscles of mastication?
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mandibular division of the trigeminal nerve
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the largest muscle of mastication
anterior fibers- elevators, while posterior fibers- retractors insert onto coronoid process continuously active opposing the tendency of the mandible to fall open due to gravity |
temporalis muscle
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powerful jaw elevator
origin- zygomatic arch insertion- mandibular ramus deep fibers extend inferiorly superficial fibers extend postero-inferiorly and aid in protraction. |
masseter
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two heads: upper and lower
upper head origin- greater sphenoid wing insertion- TMJ The muscle draws the articular disc forward as the masseter and temporalis act, redistributing force to the thickened articular eminence. lower head origin- lateral pterygoid plate insertion- neck of the mandible. The muscle pulls the condyle downward and forward during opening of the mouth. |
lateral pterygoid muscle
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origin- medial aspect of the lateral pterygoid plate
insertion- medial border of the mandible at its angle. internal counterpart of the masseter muscle. |
medial pterygoid muscle
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If a ipsilateral pterygoid muscle fires, the chin moves _____________.
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contralaterally
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What two muscles have the proper embryological origin and innervation for mastication, but are not true mastication muscles? What are the qualifications?
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mylohyoid and anterior belly of the digastric
nerve to mylohyoid, branch of V3 mesoderm of the first pharyngeal arch |
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What are the tensor tympani and tensor veli palatini innervated by?
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branches of V3
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innervations:
styloglossus stylopharyngeus pharyngeal constrictors |
XII (most things with glossus)
IX X |
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pterygomandibular raphe joins which 2 muscles?
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joins the buccinator and superior pharyngeal constrictor muscle
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What comes off V3, organize by sensory vs motor and main/anterior/posterior trunk
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Mandibular Division (V3)
Main trunk S = Meningeal branch (n. spinosus) M = N. to med. pterygoid m. (and to tensors) Anterior trunk S = Buccal n. M = Masseteric, deep temporal, lateral pterygoid Posterior trunk S = Auriculotemporal, Lingual S,M = Inferior alveolar |
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Which nerve joins the middle meningeal artery to pass through foramen spinosum. It provides important sensory information from the meninges?
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meningeal nerve
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Motor to the medial pterygoid muscle as well as to the tensor veli palatine and tensor tympani muscles
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Nerve to medial pterygoid muscle (M)
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supply temporalis muscle
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Deep temporal n (M)
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Goes through the mandibular notch to enter the deep surface of the masseter
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masseter nerve (M)
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bring sensory fibers back from the mucosa of the oral cavity and the skin of the cheek
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buccal nerve of V3
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This important nerve conveys sensory information from the skin near the chin and lower lip via the mental nerve
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Inferior alveolar nerve (S,M)
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Application of anesthesia to the nerve as it enters the mandibular foramen effectively blocks sensation from the lower jaw
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inferior alveolar
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It branches off the inferior alveolar nerve just before that nerve enters the mandibular canal to provide motor to the mylohyoid muscle and the anterior belly of the digastric
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Nerve to the mylohyoid muscle (M)
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sensory and also carries postganglionic parasympathetic fibers to the parotid gland
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Auriculotemporal n. (S)
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roughly coequal in size with the inferior alveolar nerve. It brings general sensory fibers from the tongue
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lingual nerve
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bringing special sense fibers (taste) from the anterior 2/3 of the tongue
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chorda tympani, branch of the facial nerve
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a parasympathetic ganglion, functions in salivation. It is associated with the lingual nerve, and receives preganglionic parasympathetic fibers that leave the brain with the facial nerve (VII), travel to the chorda tympani, then to the lingual nerve
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submandibular ganglion
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Which cranial nerves contain preganglionic parasympathetic fibers? Which send their fibers to four (paired) head ganglia?
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III, VII, IX, and X
III, VII, IX |
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Preganglionics in CN III, postganglionic fibers travel on short ciliary nerves (branches of V1) to reach the sphincter pupillae and ciliary muscles.
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Ciliary ganglion.
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Preganglionics in CN VII, exit the petrous temporal as the greater petrosal nerve, enter the pterygoid canal of the sphenoid bone to reach the pterygopalatine ganglion. Postganglionics distribute on branches of V2 to palatine, pharyngeal and nasal mucous glands. Some fibers also take a convoluted path, eventually reaching the lacrimal gland (via the lacrimal nerve, a branch of V1) to function in the production of tears.
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Pterygopalatine ganglion.
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Preganglionics in CN IX, as it exits the jugular foramen a small tympanic branch enters the inferior tympanic canaliculus between the carotid canal and jugular foramen. The nerve travels as the tympanic plexus on the tympanic membrane and then exits the petrous temporal as the lesser petrosal nerve. The nerve exits the foramen ovale, synapses at the otic ganglion, and the postganglionics distribute to the parotid via the auriculotemporal nerve.
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Otic ganglion.
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Preganglionics in CN VII, chorda tympani (exit through petrotympanic fissure) to lingual nerve, synapse at ganglion and distribute to the sublingual and submandibular glands via branches of the lingual nerve.
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Submandibular ganglion.
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Where do parasympathetics from the chorda tympani ultimately reach?
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submandibular ganglion
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The nerve passes through the tympanic cavity, then emerges through the petrotympanic fissure to enter the infratemporal fossa. Here, it joins the lingual branch of V3, to the tongue
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chorda tympani
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“What are pretrematic nerves? Describe the three pretrematic nerves.
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Pretrematic nerves are sensory nerves of the branchial arches that invade tissue developing cranial to their associated arch.”
Ophthalmic division of trigeminal nerve Chorda tympani of facial nerve Tympanic branch of glossopharyngeal Superior laryngeal of vagus? |
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The main artery of the mid-face, nasal cavity, and infratemporal region
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maxillary artery
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supplies the infratemporal fossa, parts of the ear, mandible, nasal cavity, and face. The vessel passes deeply for a few millimeters, then runs medially between the mandibular neck and the sphenomandibular ligament, giving off numerous branches
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maxillary artery
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What is a concern for tooth extractions?
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septic thrombosis of the cavernous sinus
communications between the cavernous sinus and the pterygoid plexu |
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What makes up the retromandibular vein
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superficial temporal vein and maxillary vein (from pterygoid plexus of vein)
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CSF comes from and return to by?
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blood capillary beds
dural sinuses arachnoid villi |
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seperates the left and right hemispheres
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falx cerebri
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forms a "tent" over the cerebellar lobes
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tentorium cerebelli
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What veins are at the is at the superior and inferior aspects of the falx cerebri?
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superior sagittal sinus
inferior sagittal sinus |
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What forms the straight sinus?
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great cerebral vein
inferior sagittal sinus |
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What becomes the right transverse sinus? what connects the transverse sinus to the cavernous sinus system?
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superior sagittal sinus
Superior petrosal and inferior petrosal sinuses |
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What veins provide possible routes of infection that can reach the cavernous sinus?
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inferior opthalmic and emissary veins
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What cranial nerves can be compressed by a cavernous sinus thrombosis? Which one is especially vulnerable?
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3-6
VI |
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What is the sensory innervation to the dura above and below the tentorium cerebelli?
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trigeminal
cervical nerves |
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Where do theses nerves go through the skull?
olfactory bulbs optic nerve (II) The occulomotor (III), trochlear (IV), ophthalmic (V1), and the abducens nerve (VI) maxillary division of the trigeminal (V2) , mandibular division of the trigeminal The facial (VII) and vestibulocochlear (VIII) nerves enter the The glossopharyngeal (IX), vagus (X), and spinal accessory (XI) nerves The hypoglossal nerve (XII) |
cribriform plates
optic canal superior orbital fissure foramen rotundum foramen ovale internal auditory meatus jugular foramen (with the internal jugular vein) hypoglossal canal |
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Which nerves are associated with:
special sense capsules somitomeres or somites pharyngeal arches |
CN I, II, and VIII are associated with special sense capsules
CN III, IV, VI, XI, and XII are associated with somitomeres or somites CN V, VII, IX, and X are associated with pharyngeal arches |
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What is the path of the optic nerve after leaving the brain?
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fibers from right and left sides come together as the optic chiasma leaving a groove for the optic chiasma at the anterior border of the sella turcica in the sphenoid bone. The nerves then pass through the optic foramina to the orbit (also parts of the sphenoid)
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For the Vestibulocochlear Nerve, where are the hair cells for balance and hearing? Which part of the temporal bone are they in? Where does the nerve enter the temporal bone?
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balance- semicircular canals
hearing- cochlea both within the petrous portion of the temporal bone via the internal acoustic meatus. |
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how is CN III unusual?
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carries preganglionic parasympathetics.
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Which somitere nerves are pre otic and postotic?
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Nerves of Preotic Somitomeres
Oculomotor (III) Trochlear (IV) Abducens (VI) Postotic (occipital) Somites Spinal Accessory (XI) Hypoglossal (XII) |
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Nerves III, IV, and VI pathway
How can they be damaged? |
traverse the cavernous sinus to reach ocular musculature. Thus, they pass along the lateral edge of the sella turcica, and lateral to the anterior clinoid process to reach the superior orbital fissure.
skull fractures involving this region or in thrombosis of the cavernous sinus |
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innervation for levator palpebrae superioris, superior and inferior rectus, medial rectus and inferior oblique
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oculomotor CN III
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contains preganglionic parasympathetic neurons destined for the ciliary ganglion
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oculomotor (CN III)
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supplies somatomotor fibers only to the superior oblique muscle, which passes through a tendinous loop or trochlea that changes the direction of muscle pull
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trochlear nerve IV
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supplies somatomotor neurons only to the lateral rectus muscle. This muscle’s only action is to abduct the eye (turn the pupil laterally). It passes through the cavernous sinus and superior orbital fissure (another “easy nerve”).
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abducens nerve VI
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The nerve conveys fibers from upper cervical segments that join, travel to the skull through the foramen magnum, then pass out through the jugular foramen. These nerve roots are all spinal (“easy”). Somatomotor fibers from the spinal portion of XI contains fibers that supply the sternocleidomastoid and trapezius muscles.
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spinal accessory XI
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Is spinal accessory (CN XI) branchiomotor or somatomotor?
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somatomotor
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innervates all of the intrinsic and
extrinsic muscles of the tongue, except palatoglossus |
XII
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What innervates palatoglossus?
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X
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After hypoglossal nerve resection, the muscles it supplies degenerate and that half of the tongue becomes atrophied and wrinkled. When the tongue is protruded, the tip is deviated to the _________ side
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paralyzed side by the unopposed action of the muscles on the intact side, especially genioglossus.
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Match nerves to pharyngeal arches:
Trigeminal (V) – Facial (VII) – Glossopharyngeal (IX) – Vagus (X) – |
Trigeminal (V) – First arch
Facial (VII) – Second arch (chorda tympani is p.t.) Glossopharyngeal (IX) – Third arch Vagus (X) – Fourth (superior laryngeal) and Sixth arches (recurrent laryngeal) |
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Special sensory fibers conveying taste run from the posterior 1/3 of the tongue
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Glossopharyngeal (IX)
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Visceral sensory fibers serve the pharynx, the auditory tube, and the middle ear. In addition, it receives baroreceptors and chemoreceptors from the carotid sinus and carotid body, respectively. The nerve carries preganglionic parasympathetic fibers to the otic ganglion.
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Glossopharyngeal nerve IX
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Branchiomotor fibers serve a single muscle, the stylopharyngeus muscle, which arises from the styloid process and inserts into the pharynx.
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Glossopharyngeal nerve IX
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What are the branches of CNX?
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external laryngeal branch- cricothyroid (fourth arch)
cardiac nerves- parasympathetics to the heart recurrent laryngeal nerve- main motor nerve of the larynx (except the cricothyroid); it is sensory to the mucous membrane of the pharynx and larynx below the vocal folds. thoracic and abdominal branches- parasympathetic preganglionic and visceral sensory fibers from the esophagus, heart, lungs, stomach, etc. |
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carries special sensory taste fibers from the epiglottis and most posterior tongue. General sensory twigs arrive from the skin of the ear; visceral sensory from larynx, trachea, carotid body and other thoracic and abdominal viscera; branchiomotor fibers reach derivatives of the fourth and sixth arch muscles; and preganglionic parasympathetics are distributed to heart, lungs, gut, etc.
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CN X
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Organized by target tissues, always to V
Ciliary, sphinc. pup. mm: III -> V1 Lacrimal gland: VII -> V1 Naso-palatine mucosa: VII -> V2 Parotid gland: IX -> V3 Submandibular, sublingual glands: VII -> V3 Sympathetics Always postganglionic in the head, having synapsed in the superior cervical ganglion Follow arteries as carotid plexus |
bah
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What are the major branches of V2?
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infraorbital (its largest branch which gives off the anterior superior alveolar n.), the posterior superior alveolar nerve the zygomatic n., and the branches to the pterygopalatine ganglion
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Trigeminal neuralgia is related to what disease?
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herpes
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What are the branches of the facial nerve in deep head?
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greater petrosal nerve- carries preganglionic parasympathetics to the pterygopalatine ganglion.
After the greater petrosal nerve crosses foramen lacerum, it is joined by the deep petrosal nerve (carrying postganglionic sympathetics from the internal carotid plexus). These dip through foramen lacerum to become the nerve of the pterygoid canal. This is the nerve which actually runs to the pterygopalatine ganglion. The chorda tympani nerve (which crosses the upper part of the tympanic membrane after it branches from the facial nerve in the posterior wall of the middle ear) joins the lingual nerve (of V3). It carries taste fibers to the anterior 2/3 of the tongue and preganglionic parasympathetics to the submandibular ganglion. |
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What are the 7 bones of the orbit?
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the frontal, ethmoid, lacrimal, the small orbital process of the palatine bone, maxilla, zygomatic, and sphenoid
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What nerves and veins go through the superior orbital fissure?
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the superior and inferior branches of the oculomotor nerve (III), the trochlear nerve (IV), the abducens nerve (VI), the lacrimal, frontal and nasociliary branches of the ophthalmic nerve (V1) and the superior ophthalmic vein
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What nerves and vessels go through the inferior orbital fissure?
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infraorbital nerve and vessels and the maxillary nerve (V2) and its zygomatic branch
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What goes through the optic canal?
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optic nerve and ophthalmic artery
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the fibrous skeleton of the eyelid
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periorbita
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When does the optic nerve form the chiasm?
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after departing the orbit through the optic canal
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What is the optic nerve covered by as it travels to the eyeball?
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three layers of the meninges
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orbital axis is thus at ____________ to the midsagittal plane
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22.5º
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What is the anterior structure that disrupts the round shape of the eyeball?
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cornea
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What are the important structures of the eye, anterior to posterior?
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anterior chamber, the iris and pupil, the posterior chamber, the lens, the vitreous chamber and the retina
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What is filled with aqueous humor?
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anterior and posterior chambers
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What is filled with vitreous humor?
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vitreous body
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What moves to retain refractive ability?
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lens by muscles
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What are the 3 layers of the eyeball?
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sclera, choroid, and retina
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What is the site of most acute movement?
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fovea centralis
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What is an important structure at the apex of the orbit?
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Annulus tendinous
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What nerves pass through the Annulus tendinous? What nerves do not pass through?
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optic, nasociliary (V1), both divisions of the oculomotor (III), and abducens (VI)
trochlear (IV) and all other branches of the trigeminal aside from the nasociliary nerve (frontal, lacrimal, and zygomatic). |
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What muscles arise from the annulus tendinous?
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superior, lateral, medial, inferior recti
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What muscles arise from bone in the vicinity of the annulus tendinous and attach to it as they pass anteriorly?
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superior oblique and levator palpebrae superioris
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What muscle arises from the orbital rim, immediately lateral to the nasolacrimal foramen?
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inferior oblique
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Which ocular muscle does not insert on the eyeball?
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levator palpebrae superioris
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What innervates lateral rectus?
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abducens nerve (VI)
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What innervates superior oblique muscle?
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trochlear nerve (IV)
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What muscle is that inserts in to the tarsus of the upper eyelid and is composed of mostly skeletal muscle with some smooth muscle? What innervates this muscle?
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Levator palpebrae superioris
oculomotor CN III |
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Blinking necessitates rapid cessation of which muscle?
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Levator palpebrae superioris
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Voluntary lowering of the upper lid requires relaxation of the _______, along with slight activity of the ________________
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levator palpebrae superioris
palpebral portion of the orbicularis oculi. |
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What eye muscles have “pure” movements, and produce no torsion?
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The medial rectus (adductor) and lateral rectus (abductor) muscles
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What nerve divides in the superior orbital fissure into superior and inferior divisions that then pass through the tendinous ring with the nasociliary branch of V1 and the abducens nerve (VI)?
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oculomotor nerve (III)
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What nervepreganglionic carries parasympathetic fibers to the ciliary ganglion then to short ciliary nerves to control the shape of the lens and sphincter muscles of the iris
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oculomotor III
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What are the 3 branches of Ophthalmic nerve?
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frontal, lacrimal, nasal ciliary
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What are the branches of the frontal nerve?
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• Supraorbital nerve – upper eyelid and conjunctiva, forehead and onto scalp
• Supratrochlear nerve – conjunctiva and upper eyelid and lower medial forehead |
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What does the lacrimal nerve supply? What king of fiber foes it receive from the zygomaticotemporal nerve?
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• Supplies lacrimal gland, conjunctiva, skin of upper eyelid
• Receives parasympathetic postganglionic fibers from a branch of the zygomaticotemporal nerve |
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What are the long and short ciliary nerves off the nasal ciliary nerve?
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• Long ciliary nerves – carry postganglionic sympathetic to the dilator pupillae and afferent fibers from the iris and cornea
• Short ciliary nerves – carry postganglionic parasympathetics and sympathetics from the ciliary ganglion to the ciliary body, and iris, afferent fibers to iris and cornea |
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What are the 3 pharyngeal constrictors? Where does the left and right muscles for each each? Innervation?
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superior pharyngeal constrictor, the middle pharyngeal constrictor, and the inferior pharyngeal constrictor
posterior midline Pharyngeal branch of vagus nerve |
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Where is the opening for the auditory tube? What fold is just posterior to this opening?
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nasopharynx
salpingopharyngeal fold |
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Where is the palatopharyngeal arch? Where is the palatoglossal arch in comparison?
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oropharynx
just anterior |
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What does the palatoglossal arch divide?
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oral cavity from the oropharynx
anterior 2/3s and posterior 1/3 of tongue |
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What lymphoid tissue is located in the oropharynx and nasopharynx?
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lingual tonsils, the palatine tonsils between the palatoglossal and palatopharygeal arches, and the pharyngeal tonsils [adenoids]
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What are the actions of the extrinsic muscles of the tongue: hyoglossus, styloglossu, genioglossus, and palatoglossus? Which has a different innervation?
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Hyoglossus (XII) depresses the tongue, styloglossus (XII) elevates and retracts the tongue, genioglossus (XII) depresses and protrudes the tongue, and palatoglossus (X) elevates the posterior part of the tongue
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What drains in the inferior nasal meatus and the middle nasal meatus?
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The nasolacrimal duct (draining tears) opens into the inferior nasal meatus
frontonasal duct (draining mucous from the frontal sinus) and maxillary sinus open into the middle nasal meatus. |
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What parasympathetic fibers innervate the lacrimal gland?
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travel w/ facial CN VII to pterygopalatine ganglion to zygomatic nerve to lacrimal nerve
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Where is the lacrimal gland relative to the orbital septum and perioteum.
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superolateral part of the orbit between periosteum and the orbital septum
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Where does the lacrimal gland empty into? via?
What accumulates tears? |
superior fornix of the conjunctiva via orbital septum and conjunctiva
lacrimal canaliculi |
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How do tears reach the inferior meatus of the nasal cavity?
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lacrimal puncti --> the lacrimal canaliculi --> lacrimal sac --> nasolacrimal duct --> inferior meatus of the nasal cavity
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What is the Palpebral conjunctiva?
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thin membrane that covers the posterior surface of each eyelid
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What are the layers of the eyelid?
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• Skin and subcutaneous tissue
• Orbicularis oculi (VII), which closes the eyelids • Orbital septum, a thin sheet of fascia extending from the orbital margin into the tarsal plate of each lid • Tarsal plate or tarsus, a plate of dense connective tissue with tarsal glands • Levator palpebrae superioris and superior tarsal muscles in upper eyelid, which raise the lid (via sympathetic innervations) |
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How many weeks long must an "A' school be, to allow dependant travel?
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20 weeks
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What do the superior and inferior ophthalmic veins pass through to get to the cavernous sinus?
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the superior orbital fissure
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How does the inferior opthalamic veins exit the orbit?
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inferior ophthalmic veins may exit the orbit after joining with the superior ophthalmic vein, on its own to join the pterygoid plexus or own its on to join the cavernous sinus
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Why do the opthalamic veins carry carry infection either to or from the cavernous sinuses?
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valveless
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What are the branches of the opthalamic artery?
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• Central retinal artery, which is the only artery to the retina.
• Lacrimal artery to the lacrimal gland, eyelids, eyeball, etc. • Posterior long and short ciliary arteries supply the ciliary body, iris, sclera and the choroid. • Supraorbital to the skin of the forehead and scalp. • Medial palpebral arteries to the eyelids. • Branches not to orbital structures per se (supratrochlear, dorsal nasal, anterior and posterior ethmoids). |
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supplies lacrimal gland, conjunctiva, skin of upper eyelid
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lacrimal nerve
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parasympathetic postganglionic fibers from a branch of the zygomaticotemporal nerve
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lacrimal nerve
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Innervates lacrimal sac, eyelids, conjunctiva, and upper half of nose?
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infratrochlear nerve
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What are the branches of Anterior ethmoidal nerves?
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o Internal nasal branches – nasal septum and lateral walls of nasal cavity
o External nasal branches – skin of tip of the nose |
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What innervates posterior ethmoidal air cells and sphenoidal sinus?
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Posterior ethmoidal nerves
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What nerves carry postganglionic sympathetic to the dilator pupillae and afferent fibers from the iris and cornea?
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Long ciliary nerves
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What carries postganglionic parasympathetics and sympathetics from the ciliary ganglion to the ciliary body, and iris, afferent fibers to iris and cornea?
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Short ciliary nerves
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What does the frontal nerve split into halfway into the orbit?
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• Supraorbital nerve – upper eyelid and conjunctiva, forehead and onto scalp
• Supratrochlear nerve – conjunctiva and upper eyelid and lower medial forehead |
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What is the sole purpose of the abducens (CN VI)?
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supply the lateral rectus muscle
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What carries preganglionic parasympathetic fibers to the ciliary ganglion then to short ciliary nerves to control the shape of the lens and sphincter muscles of the iris?
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oculomotor
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When can the oblique muscles can depress or elevate the eye without producing torsion?
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When adducted by medial rectus
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What muscle runs posterolaterally below or superficial to the insertion of the inferior rectus? What's the CN?
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Inferior oblique (III).
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What are the 3 layers of the cervical viscera? (superficial to deep)
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endocrine –thyroid gland and parathyroid glands
respiratory layer- that contains the larynx and trachea alimentary layer that contains the esophagus |
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What connects the right and left lobes of the thyroid? What covers the thyroid gland anterior,posterior, and laterally?
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isthmus
pretracheal buccopharyngeal carotid sheath |
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That is a continuation of the tongue as a thyroglossal gland to the thyroid?
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pyramidal lobe
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What supplies blood to the thyroid?
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superior thyroid artery and the inferior thyroid artery
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What is drainage of the thyroid?
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superior thyroid vein and middle thyroid vein to the internal jugular vein
and via the inferior thyroid veins to the brachiocephalic veins |
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What artery runs on the anterior surface of the trachea, so it may cause extensive bleeding if damaged during a tracheotomy?
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thyroid ima artery
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What causes tetany which causes muscle spasms and twitches, and can eventually lead to suffocation because of the effect on laryngeal and respiratory muscles?
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loss of parathyroid glands (increased phosphate uptake)
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The cervical ganglion provide which type of innervation?
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vasomotor
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Where do the parathyroid and thyroid glands take signals?
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pituitary, not parasympathetics
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superior border is at the cranial base (sphenoid body and basioccipital) and its inferior border is at the inferior-most part of the uvu
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nasopharynx
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part of the pharynx between the inferior-most part of the uvula and the superior tip of the epiglottis?
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oropharynx
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tip of the epiglottis to the inferior border of the cricoid cartilage
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larynx and larynopharynx
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What is the anterior/posterior border between larynx and larynopharynx?
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between the anterior respiratory and posterior alimentary passages
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What has a cartilaginous skeleton suspended from the hyoid bone by the thyrohyoid membrane?
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larynx
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Superior to inferior, what are the 3 cartilages visible from the posterior?
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cuneiform
corniculate cricoid |
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What is the superior part of the (lateral) cricothyroid ligament?
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the vocal ligament
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What are the vocal process a part of?
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arytenoid cartilage.
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What membrance is superior to the cricothyroid ligament?
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quadrangular membrane
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Where is the vestibular ligament?
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inferior border of quadrangular membrane
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What makes the vestibular and vocal folds? Which one is superior?
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their respective ligaments
vestibular |
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What is between the vestibular and vocal folds? What is inferior to the vocal fold? What is the saccule?
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ventricle
infraglottic cavity anterior projection of the ventricle (on each side) rich in mucous glands to lubricate the vocal folds. |
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What is the intrinsic laryngeal muscle between cartilages? How are they named?
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cricothyroid (causes thyroid to pivot anteriorly on cricoid)
Aryepiglottic and thyroarytenoid origin to insertion |
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Most intrinsic laryngeal muscles are innervated by what nerve except which muscle (innervated by external branch of the superior laryngeal nerve)?
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recurrent laryngeal nerve
cricothyroid muscle |
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What are the cricoaryntenoid muscles?
What are the arytenoid muscles? What muscle is just lateral to the vocal ligament? |
posterior cricoarytenoid muscle and the lateral cricoarytenoid muscle.
superficial oblique arytenoid muscles and the deeper transverse arytenoid muscle. vocalis |
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What muscles narrow the laryngeal inlet?
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oblique arytenoid muscles and aryepiglottis
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What affects the rima glottis, space between vocal folds?
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The artyenoid muscles clearly adduct the vocal folds, as do the lateral cricoarytenoid muscles. The posterior cricoarytenoid muscles abduct the vocal folds
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What muscles Relax the Vocal Fold when they contract?
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Thyroarytenoid and vocalis muscles
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What muscle tenses the vocal folds by "rocking" the thyroid cartilage anterior and inferior on the cricoid cartilage?
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cricothyroid muscle
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Where can you puncture the throat to introduce air?
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Cricothyrotomy/tracheostomy
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What are the names and actions of the longitudinal muscles?
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stylopharyngeus
palatopharyngeus salpingopharyngeus elevate the pharynx |
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What muscle comes off the styloid process and passes through the anterior gap between the superior and middle pharyngeal constrictors? Innervation?
What muscle comes off of the soft palate and runs inferiorly deep to the constrictor muscles? innervation? What muscle comes off of the cartilage for the pharyngotympanic (auditory) tube to meet the palatopharyngeus muscle. Innervation? |
stylopharyngeus
glossopharyngeal nerve CN IX palatopharyngeus vagus salpingopharyngeus vagus |
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velar muscles
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Velar muscles – There are two pairs of muscles for the velum (soft palate): the levator veli palatini (innervated by vagus) and the tensor veli palatini (innervated by a branch of CN V3). Both muscles insert into the soft palate. The levator has its origin from the cartilage for the pharyngotympanic tube (and some adjacent petrous temporal). The tensor has its origin from the scaphoid fossa of the sphenoid, it then goes into a tendon that hooks around the pterygoid hamulus, and then runs medially as an aponeurosis to meet its antimere.
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Nasopharynx and Oropharynx
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opening for the auditory tube is visible in the nasopharynx
salpingopharyngeal fold that contains the like named muscle. In the oropharynx there is a palatopharyngeal arch for the like named muscle. Anterior to this arch is the palatoglossal arch that contains the palatoglossus muscle (innervated by the vagus, and our only exception to the rule that muscles with "glossus" in them are innervated by the hypoglossal nerve). The palatoglossal arch divides the oral cavity from the oropharynx (and the tongue into the anterior two-thirds [oral part of the tongue] versus the posterior third [pharyngeal part of the tongue]). There is lymphoid tissue located in the oropharynx and nasopharynx (specifically the lingual tonsils, the palatine tonsils between the palatoglossal and palatopharygeal arches, and the pharyngeal tonsils [adenoids]). |
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How is spinal dura different from cranial dura different?
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Unlike spinal dura, cranial dura mater opens into dural (venous) sinuses
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How do ventricles connect to dural sinuses?
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Ventricles --> foramina --> subarachnoid space --> arachnoid villi project --> dural sinuses
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What does the straight sinus go into?
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left transverse sinus
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What does the superior sagittal sinus turn into?
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right transverse sinus
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What do the Superior petrosal and inferior petrosal sinuses connect to the cavernous sinuses?
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transverse sinuses
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What CN is next to internal carotid in the cavernous sinus?
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VI Abducens
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What travels through the superior orbital fissue?
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oculomotor (III), trochlear (IV), ophthalmic (V1), and the abducens nerve (VI)
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What travels through the foramen rotundum?
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maxillary division of the trigeminal (V2)
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What travels through the foramen ovale?
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mandibular division of the trigeminal (V3)
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What goes through the internal acoustic meatus?
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facial (VII) and vestibulocochlear (VIII)
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Mean
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The arithmetic average of a distribution, obtained by adding the scores and then dividing by the number of scores.
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Mean because you have to do math to get it :S
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What goes through the hypoglossal canal?
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hypoglossal nerve
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What cranial nerves belong to special sense capsules, somites, and pharyngeal arches?
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CN I, II, and VIII- special sense capsules
CN III, IV, VI, XI, and XII- somitomeres or somites CN V, VII, IX, and X- pharyngeal arches. |
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Where are the hair cells?
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semicircular canals- balance hair cells
Cochlea- hearing hair cells |
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What innervates the anterior 2/3s of the tongue?
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facial
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What innervates the posterior 2/3 of the tongue?
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glossopharyngeal nerve
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What nerve travels to the ciliary ganglion --> ciliary muscle and sphincter pupillae?
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oculomotor III
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What arches are the accessory nerve related to?
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the fourth and sixth pharyngeal arches
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What muscle of the tongue is not innervated by hypoglossal?
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palatoglossal (X)
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What does the facial nerve supply ganglia to? What king of fibers does the postganglionic parasympathetic?
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Note that the facial supplies two head ganglia (pterygopalatine and submandibular) with preganglionic parasympathetics, while the trigeminal carries postganglionic parasympathetic fibers.
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What muscle is controlled by stylopharyngeus?
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Stylopharyngeus
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Where do the Preganglionic parasympathetics of glossopharyngeal go to?
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to otic ganglion
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What does the visceral sensory branch of glossopharyngeal supply?
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pharynx, auditory tube, middle ear, baro- and chemoreceptors
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What are the branches of the vagus?
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a. Special sensory taste fibers from the epiglottis and most posterior tongue.
b. General sensory twigs arrive from the skin of the ear; c. Visceral sensory from larynx, trachea, carotid body and other thoracic and abdominal viscera; d. Branchiomotor fibers reach derivatives of the fourth and sixth arch muscles e. Preganglionic parasympathetics originate in the dorsal motor nucleus, and are distributed to heart, lungs, gut, etc. |
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What are the parasympathetics of the face?
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Ciliary (III)
Pterygopalatine (VII) Otic (IX) Submandibular (VII) |
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Where did all the postganglionic sympathetics synapse?
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superior cervical ganglion
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What are the 4 places on the trigeminal nerve that parasympathetics of the head synapse?
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a) the ciliary ganglion (V1), b) the pterygopalatine ganglion (V2), c) the otic ganglion (V3), or d) the submandibular ganglion (V3)
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Where do all the parasympathetics synapse at the trigeminal?
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Ciliary, sphinc. pup. mm: III -> V1
Lacrimal gland: VII -> V1 Naso-palatine mucosa: VII -> V2 Parotid gland: IX -> V3 Submandibular, sublingual glands: VII -> V3 |
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For parasympthetics, thye must go to __________ if they are:
eye and lacrimal nasal oral |
v1
v2 v3 |
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What nerve communicates extensively with the glossopharyngeal (IX) and makes a small contribution to the glossopharyneal's carotid branch?
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vagus nerve
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What nerve carries special sensory taste fibers from the epiglottis and most posterior tongue?
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vagus
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What does the superior laryngeal (X) innervate?
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the cricothyroid
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Branches of what nerve supply parasympathetics to the heart?
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vagus
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What nerve is the the main motor nerve of the larynx (except the cricothyroid)?
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recurrent laryngeal nerve
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What is the sixth arch nerve?
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recurrent laryngeal
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What are the major branches of V2?
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major branches:
infraorbital (gives off the anterior superior alveolar n.) posterior superior alveolar nerve zygomatic n. branches to the pterygopalatine ganglion |
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What nerve carries preganglionic parasympathetics to the pterygopalatine ganglion?
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greater petrosal nerve
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what joins the greater petrosal nerve after it crosses foramen lacerum?
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deep petrosal nerve
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What carries taste fibers to the anterior 2/3 of the tongue and preganglionic parasympathetics to the submandibular ganglion?
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chorda tympani nerve
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What dips through the foramen lacerum to be nerve of the pterygoid canal?
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greater petrosal nerve and deep petrosal nerve
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How does the mandible connect to the temporal bone
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connects to mandibular fossa via an articular disc that also allows for anterior displacement onto the articular eminence
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When opening the mouth, what 2 actions occur together?
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protraction and depression
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Pterygoids cause the head to turn ipsilateral or contraleral?
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contra
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posterior belly of the digastric innervation
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facial nerve
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What are the 3 tonsils?
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lingual tonsils, the palatine tonsils between the palatoglossal and palatopharygeal arches, and the pharyngeal tonsils [adenoids])
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What structure the oral cavity from the oropharynx (and the tongue into the anterior two-thirds [oral] versus the posterior third [pharyngeal]?
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palatoglossal arch
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What are the layers of the eyelid?
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Skin and subcutaneous tissue
Orbicularis oculi (VII), which closes the eyelids Orbital septum, a thin sheet of fascia extending from the orbital margin into the tarsal plate of each lid Tarsal plate or tarsus, a plate of dense connective tissue with tarsal glands Levator palpebrae superioris and superior tarsal muscles in upper eyelid, which raise the lid (via sympathetic innervations) Palpebral conjunctiva, a thin membrane that covers the posterior surface of each eyelid |
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How does parasympathetic innervation reach the lacrimal gland?
|
brain facial nerve (VII) synapse in the pterygopalatine ganglion zygomatic nerve lacrimal nerve (V1)
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What space is described by "concha of the auricle to the tympanic membrane"?
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external acoustic meatus
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What handles superficial auricular sensation?
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great auricular
lesser occipital nerves auriculotemporal nerve (V3) |
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What handles deep auricular sensation?
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facial (VII) and vagus (X) nerves
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External acoustic meatus innervation?
|
: auriculotemporal (V3), auricular branch of the vagus (X), and the facial (VII) nerves
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Tympanic Membrane Sensory innervation
separate into outer and inner? |
outer surface- trigeminal (V), facial (VII) and vagus (X) nerves
inner surface- glossopharyngeal (IX) nerve. |
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Blood supply of external ear?
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posterior auricular artery
anterior auricular branches from the superficial temporal artery and the occipital artery |
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Which space includes the following structures?
tympanic cavity (the space immediately internal to the tympanic membrane) epitympanic recess (the space superior to the tympanic membrane that contains part of the auditory bones) pharyngotympanic tube, which connects to nasopharynx anteriorly and equalizes pressure on both sides of the tympanic membrane [opening on the anterior wall of the middle ear --> behind the inferior meatus of the nasal cavity] |
middle ear
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What are the boundaries of the middle ear?
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Roof: the tegmen tympani on the petrous part of the temporal bone
Floor: the jugular fossa Lateral wall (medial wall of the external ear): tympanic membrane Medial wall (lateral wall of the inner ear): promontory (produced by the basal coil of the cochlea), oval window, round window and the prominence of the facial canal and the lateral semicircular canal Posterior wall: mastoid air cells and mastoid antrum through the aditus ad antrum Anterior wall: carotid canal |
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What type of joints are the auditory ossicles?
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synovial
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What does the tensor tympani muscle attach to?
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malleus
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What muscle attached to malleus tightens the tympanic membrane?
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tensor tympani
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What muscle protects the internal ear from injury due to loud noises?
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stapedius
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What innervates stapedius?
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facial
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What innervates tensor tympani?
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V3
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What makes up the tympanic plexus?
|
tympanic branch of the glossopharyngeal (IX) nerve and caroticotympanic nerves of the internal carotid plexus (sympathetic fibers).
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What is the blood supply of the middle ear?
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maxillary artery
the occipital arteries posterior auricular arteries middle meningeal artery ascending pharyngeal artery artery of the pterygoid canal tympanic branches of the internal carotid artery |
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What drains the middle ear?
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pterygoid plexus and superior petrosal sinus.
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What innervates the inner ear?
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vestibulocochlear nerve (VIII).
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What is the blood supply of the bony labyrinth?
|
anterior tympanic branch of the maxillary artery
stylomastoid branch from the posterior auricular artery petrosal branch from the middle meningeal artery |
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What is the blood supply of the membraneous labyrinth?
|
labyrinthine artery that arises from the anterior inferior cerebellar artery
basilar artery |
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Which labyrinth has the cochlea?
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bony
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What cochlea has the cochlear ducts, utricle, and saccule?
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membraneous
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Which labyrinth is filled with endolymph?
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membraneous
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Which labyrinth is filled with perilymph?
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bony
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What is the purpose of the semicircular ducts, utricle and saccule?
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balance
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Following thyroid surgery, it was noted that a patient frequently aspirated fluid into her lungs. Upon examination it was determined that the area of the piriform recess above the vocal fold of the larynx was numb. What nerve may have been injured?
|
internal branch of superior laryngeal nerve
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|
the only muscle that abducts the vocal folds
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posterior cricoarytenoid
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What 3 muscles adduct the vocal folds?
|
Lateral cricoarytenoid, thyroarytenoid, and arytenoid
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The muscle most responsible for the abduction of the vocal folds is the :
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Posterior cricoarytenoid
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The nerve that innervates all but one muscle of larynx is the:
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Inferior laryngeal nerve
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The vocalis muscle is most responsible for the fine control of phonation because of its attachment into the:
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vocal ligament
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The constrictor muscles of the pharynx receive their motor nerve supply from the
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vagus nerve
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# Twenty-four hours following a partial thyroidectomy where the inferior thyroid artery was also ligated (tied off), the patient now spoke with a hoarse voice (whisper), and had difficulty in breathing. Which nerve was injured?
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Recurrent laryngeal
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In performing a thyroidectomy, caution should be exercised when ligating (tying) the inferior thyroid artery, as it lies in a very close relationship to which nerve?
|
recurrent laryngeal
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A 55-year-old woman has difficulty swallowing and frequently aspirates fluids while drinking. She is diagnosed as having a skull base tumor occupying the space behind the jugular foramen. Involvement of which structure is responsible for the findings?
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vagus nerve
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A sixty-four-year old man was diagnosed with an acoustic neuroma (tumor of the VIIIth cranial nerve) where it entered the temporal bone. What other cranial nerve might also be affected since this nerve uses the same foramen as the VIIIth in its course?
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facial
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Infections may spread from the nasal cavity to the meninges along the olfactory nerves, as its fibers pass from the mucosa of the nasal cavity to the olfactory bulb via the:
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Cribriform plate of the ethmoid
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What nerves may be damages by a hit to middle cranial fossa?
|
The trigeminal nerve (CN V) has three divisions that all leave through spaces in the middle cranial fossa. V1, the ophthalmic division, exits through the superior orbital fissure; V2, the maxillary division, leaves through foramen rotundum; V3, the mandibular division, leaves through foramen ovale. The oculomotor nerve (CN III) crosses through the superior orbital fissure, along with abducens (CN VI), the trochlear nerve (CN IV) and the ophthalmic division of the trigeminal nerve (CN V1)
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# During childbirth, an excessive anteroposterior compression of the head may tear the anterior attachment of the falx cerebri from the tentorium cerebelli. The bleeding that follows is likely to be from which of the following venous sinuses?
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straight sinus
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# The inferior sagittal sinus is found in the free edge of what structure?
|
falx cerebri
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The entry of bacteria through which space could lead to an infection in the mastoid air cells:
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Auditory (nasopharyngeal) tube
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Which structure is attached to the center of the tympanic membrane?
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handle (manubrium) of the malleus
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A 45-year old woman with recurrent left middle ear infection (otitis media) complained of partial dryness of her mouth to her ENT surgeon. Taste sensation and hearing were normal. After a thorough clinical examination at the hospital, the doctor concluded that the infection must have spread to a component of the glossopharyngeal nerve (CN IX) that supplies the parotid gland. On which of the following walls of the middle ear is this nerve component located?
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medial
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3-year-old girl ruptured her eardrum when she inserted a pencil into her ear. Her mother took her to the emergency department after noticing that the child was crying and complaining of pain in her ear with a few drops of blood in the external auditory meatus. The attending doctor examined the child for possible injury to a nerve that runs across the eardrum. The most likely nerve to be injured is the:
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chorda tympani
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A patient with a facial nerve paralysis suffers from inability to dampen loud noises (hyperacusis) due to denervation of which muscle?
|
stapedius
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A patient has sustained a fracture to the base of the skull. Thorough examination concluded that the right greater petrosal nerve, among other structures, has been injured. This conclusion was based on which of the patient's signs:
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dry eyes due to lack of lacrimal secretion
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The location of the otic ganglion is in the:
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infratemporal fossa
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A patient complains of loss of hearing in the right ear. Examination reveals ankylosis (otosclerosis) of the footplate of the stapes to the surrounding bone. Which part of the bony labyrinth is involved?
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vestibular window
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Repeated middle ear infections have destroyed the tympanic plexus in the middle ear cavity. The loss of preganglionic parasympathetic fibers that pass through the plexus diminish production of:
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saliva by parotid gland
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Most paranasal sinuses and/or air cells drain, directly or indirectly, into the:
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middle meatus
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What tonsils are found in the In the roof of the nasopharynx?
|
adenoids (pharyngeal tonsils)
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The communication between the pharynx and the nasal cavity is known as the:
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chonae
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|
You are testing the extraocular muscles and their innervation in a patient who periodically experiences double vision. When you ask him to turn his right eye inward toward his nose and look downward he is able to look inward, but not down. Which nerve is most likely involved?
|
trochlear IV
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Why do you ask the patient to intort their eye when testing the oblique muscles?
|
obliques can elevate/depress and intort/extort
sup, inf rectii elevate and depress and adduct. If the sup, inf recti are busy adducting the eye, only the obliques can elevate or depress the eyes |
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The outermost layer of the optic nerve sheath is a continuation of the:
|
meningeal dura
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The inner lining of the eyelid is called the:
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Palpebral conjunctiva
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You are asked to check the integrity of the trochlear nerve in the right eye of a patient. Starting with the eyes directed straight ahead, you would have the patient look:
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Inward, toward the nose and downward
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The ducts of the lacrimal gland open into the:
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superior cornix of the conjuctiva
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Starting from a position gazing straight ahead, to direct the gaze downward, the inferior rectus muscle must be active along with the
|
superior oblique
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The extraocular muscle that does not originate at or near the apex of the orbit is the :
|
inferior oblique
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An adolescent boy suffers from severe acne. As is often the case he frequently squeezed the pimples on his face. He subsequently develops a fever and deteriorates into a confused mental state and drowsiness. He is taken to his physician and after several tests a diagnosis of cavernous sinus infection and thrombosis is made. The route of entry to the cavernous sinus from the face was most likely the:
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opthalmic veins
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