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389 Cards in this Set
- Front
- Back
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How is the ethmoid bone injured?
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Sharp upward blow to the nose
Usually automobile dashboard in a collision |
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How does an ethmoid bone injury hurt someone?
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Bone fragments blow through the cribriform plate into the meninges or brain tissue
Leakage of CSF into nasal cavity Infection can spread to nasal cavity to brain |
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A blow during a boxing match lacerates the skin. Tissue and fluid accumulates around the orbit and into the eyelids leaving a black eye. What caused this?
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Superciliary arches
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What is an ecchymosis?
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A black eye
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What is the premature closure of the cranial sutures?
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Craniosynostosis - results in cranial malformations
1 in 2000 births |
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What bones become more prevalent with hydrocephalus?
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Wormian bones
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What occurs if the pterion is fractured?
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Results in rupture of the anterior branch of the middle meningeal artery causing an extradural "epidural" hematoma.
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What is the thinnest part of the calvaria?
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Pterion
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What occurs with an epidural hematoma?
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It may compress the lateral part of the brain and result in herniation of the medial part of the temporal lobe through the tentorial notch of dura.
Compresses brainstem |
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What is indicated by: limb weakness, pupil dilation from compression of the oculomotor nerve, deterioration of cardiovascular and respiratory function?
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Epidural hematoma
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What is the window of time before an epidural hematoma becomes serious?
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Neurological signs can appear after several hours, as blood accumulates and puts pressure on the brain.
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What does palpation of the fontanelles indicate?
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Progress of growth
Degree of hydration - depressed after fever or diarrhea Level of intracranial pressure - bulging indicates increased pressure on brain |
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What could result from head trauma involving the cribiform plate of ethmoid bone?
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Lesion of CN I
Loss of smell = anosmia |
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What could chronic exposures to environmental toxins (lead, chlorine, and cadmium) do?
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Damage olfactory epithelium
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What nerve is damaged if a person presents with an eye looking down and out, eyelid closed, fixed dilated pupil?
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3rd (oculomotor) nerve palsy
Lateral rectus/superior oblique not innervated by it. Unopposed dilator pupillae muscle. Levator palpebrae muscle paralyzed. |
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Patient presents with diplopia, tilts head down and to the left. What nerve is damaged?
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CN IV, trochlear. Compensation for damage to right eye (compensation to opposite side of damage).
People also can't walk down stairs. |
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Causes of lesions to oculomotor nerve.
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Aneurysm: posterior communicating, posterior cerebral or superior cerebellar arteries
Herniation of uncus Cavernous sinus mass or thrombosis |
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What is the result of a lesion of the trochlear nerve?
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Inability to look down when eye is pulled inward (adducted).
Possible orbital fracture can be cause. |
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What nerve is damaged when there is a lateral gaze deficit?
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Abducens nerve
Brain lesion, cavernous sinus lesion |
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What is the presentation of a nerve palsy to the abducens nerve?
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Lateral gaze deficit, lateral rectus will not work, the eye cannot look laterally.
Compensation is turning head instead of eyes. |
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What is bell's palsy?
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Most common facial nerve disorder.
Spontaneous onset over hours or days. Gradual recovery, unknown cause (viral/ inflammatory) 80% patients recover in 3 wks |
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What disorder is characterized by loss of blink reflex, dry cornea, and face droop?
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Bell's palsy
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What is an acoustic neuroma?
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Slow growth (years) of a tumor at the cerebellopontine angle.
Benign but compresses nerves. |
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What causes ringing in the ears, hearing loss, vertigo, possible facial paralysis?
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Acoustic neuroma (Schwannoma) compressing the vestibulococclear and facial nerves.
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What nerve is damaged when there is a devation of uvula, "curtain sign"?
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Vagus nerve - deviates to normal side.
Palatoglossus cannot contract |
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What nerve is damaged when the tongue deviates to one side, muscle atrophies and speech is disturbed?
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Hypoglossal.
The tongue deviates to the injured side. |
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What can cause a lesion in the hypoglossal nerve?
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Injury to the neck
Intramural hematoma in left internal carotid |
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What is the corneal/blink reflex?
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Part of physical examination.
Involves touching cornea with cotton wisp. |
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What is the afferent limb of the corneal reflex?
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Trigeminal nerve
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What is the efferent limb of the corneal reflex?
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Facial nerve to orbicularis oculi
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If patient can voluntarily close their eye but corneal reflex is absent, what nerve is damaged?
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Nasociliary nerve (trigeminal)
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Tumors of the parotid gland
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Usually benign.
Resection can cause facial nerve injury Can cause facial paralysis |
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How does infection spread in the face?
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Anastomoses are valveless and therefore infection can spread to deep structure.
Spread to cavernous sinus extremely dangerous. |
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What is the most common cranial neuralgia?
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Trigeminal neuralgia AKA tic douloureux
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What is characterized by attacks of excruciating pain triggered by a zone. Light touch, a
Breeze, temperature change or facial movement may trigger pain. |
Trigeminal neuralgia - distribution of one or more branches on face
opthalmic, maxillary, mandibular nerve zones Blood vessels can also be compressing nerves |
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What are the symptoms of trigeminal neuralgia?
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Patient has episodes of lightning-like stabs of pain, most often in the areas of innervation of V2 or V3. The trigger zones are typically perioral or maxillary.
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What type of lesion is Bell's palsy?
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Idiopathic
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What occurs with a lesion of the facial nerve in the region of the brainstem to the geniculate ganglion?
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Ipsilateral facial paralysis, loss of taste on anterior 2/3rds of tongue, loss of lacrimation, decreased salivation and hyperacussis.
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What occurs with a lesion of the facial nerve between the geniculate ganglion and nerve to stapedius
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Ipsilateral facial paralysis, loss of taste on anterior 2/3rds of tongue, decreased salivation and hyperacussis.
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What occurs with a lesion of the facial nerve between nerve to stapedius and chorda tympani
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Ipsilateral facial paralysis, loss of taste on anterior 2/3rds of tongue, decreased salivation.
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What occurs with a lesion of the facial nerve at the stylomastoid foramen?
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Ipsilateral facial paralysis only
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Upper motor neuron lesion (facial)
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Motor cortex projects bilaterally to the upper part of the facial nucleus. Fibers go to both sides for the upper facial nucleus bilateral projection
Upper nucleus gets forehead. Projects contralaterally to the lower part of the facial nucleus. Upper motor neuron lesions (supranuclear paralysis central) will spare the forehead because of the bilateral projection, also cause paralysis of the contralateral lower face. |
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Lower motor neuron lesion (facial)
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Lesion at stylomastoid foramen is a lower motor neuron lesion (peripheral or infranuclear paralysis)
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Where are the cell bodies of sensory axons in the facial nerve?
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Geniculate ganglion
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He complains that he cannot close his right eye, which is very dry, has difficulty chewing his food, has sensitivity to sounds on the right, loss of taste and a dry mouth.
What cranial nerve is injured in this man? |
Facial, arising at the ponto-medullary junction
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An upper motor neuron lesion to the corticospinal tract results in?
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Contralateral paralysis - crossing at pyramidal decussation
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A UMN lesion below the pyramidal decussation results in?
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Ipsilateral paralysis - below crossing
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What kind of lesions occur to the basal ganglia?
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Extra pyramidal
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What does injury to the spinal cord cause?
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Below lesion:
Contralateral - pain and temp Ipsilateral - fine (discriminative) touch, proprioception, vibration |
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Occlusion of middle cerebral artery effects what?
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Lateral cerebrum
Upper limb |
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Occlusion of anterior cerebral artery effects what?
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Medial cerebrum
Lower limb |
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Occlusion of the striate arteries effects what?
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Basal ganglia or thalamus
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What is a usual sign of a lesion to the brainstem?
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Hiccups
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Occlusion of the posterior cerebral artery effects what?
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Visual system
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What are the common sites for intracerebral aneurysms?
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PICA
AICA Fusiform basilar SCA Basilar tip PCA (PComm) MCA AComm |
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What occurs in the brains of people with Alzheimer's?
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The ventricles become enlarged because of atrophied brain. Particularly the lateral ventricles.
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What occurs when the medial temporal lobe and uncus herniate through the tentorial notch?
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Transtentorial herniation
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What are the signs of an uncal herniation?
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Blown pupil –ipsilateral, dilated unresponsive pupil
Hemiplegia – compression of the cerebral peduncles (contralateral) Coma – due to distortion of the midbrain reticular system |
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Where does blood collect in an epidural bleed?
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Between the bone of the calvarium and the periosteal layer of the dura.
Separates it from bone |
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What is the presentation of an epidural hemorrhage?
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Lens-shaped accumulation of blood.
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What is one cause of headaches?
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Stretching of dura mater
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What type of hemorrhage results from blood filling the potential space between the dura and arachnoid mater?
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Subdural bleed
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Who do subdural bleeds typically occur in?
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Older individuals
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Why do subdural bleeds occur in older people?
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Brain becomes atrophied with age, so there is more space between the brain and arachnoid.
Strain is placed on veins from brain to dural venous sinuses. |
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Are subdural bleeds rapid or slow?
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Slow - venous bleeds.
Trivial injury may not lose conciousness. |
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What is the presentation of a subdural bleed?
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Cresent-shaped hemorrhage.
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What type of bleed occurs from the bursting of an aneurysm?
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Subarachnoid bleed - occuring in the subarachnoid space
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What type of hemorrhage results when arterial blood flows between the gyri of the brain and inbetween the sulci?
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Subarachnoid bleed
Usually the result of significant head trauma. |
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What is the presentation of a subarachnoid bleed?
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Brain appears very fuzzy in scan - from blood surrounding gyri and fililng sulci.
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What occurs when there is increased pressure from blood or mass in/around the brain?
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Regions of the brain herniate
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What are the four typical sites of herniation?
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Subfalcine
Central Uncal Tonsilar herniation |
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What occurs with a subfalcine hernation?
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under the falx cerebri, a portion of one of the hemispheres
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What occurs with a central herniation?
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downward herniation of the brainstem
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What occurs with an uncal hernation?
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herniation of the medial temporal lobe and the uncus through the tentorial notch
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What occurs with a tonsilar herniation?
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herniation of the cerebellar tonsil through the foramen magnum (quick death)
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Where does a carotid artery aneurysm normally affect?
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Cavernous sinus - compresses nerves
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What is cavernous sinus syndrome?
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Compression of nerves from metastasizing cancer (breast, prostate, lung) or aneurysm that causes diplopia, panful opthalmoplegia, sensory loss of trigeminal nerve
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What can result from congenital obstruction of the aqueduct of Sylvius?
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Hydrocephalus
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If a tumor in a child blocks the cerebral aqueduct what will occur?
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Hydrocephalus - the head can swell because the skull sutures are not fused
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If someone has hydrocephalus why is this serious?
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Causes severe damage to brain tissue.
If someone had a shut put in they CANNOT have head osteopathic manipulation done! |
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Where might you suspect is the location of an aneurysm, given history of one-week, intermittent bouts of diplopia?
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Superior cerebellar artery - compressing oculomotor nerve
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Sudden "thunderclap" headache is a key presentation of what?
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Subarachnoid bleed
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How does the corneal reflex work?
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Stimulus to cornea carried in afferent axons in the trigeminal nerve (CN V)
Efferent axons in the facial nerve contract orbicularis oculi muscle |
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What is the result of a loss of corneal reflex?
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Usually in a facial nerve injury:
causes corneal damage and ulceration |
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What occurs with a medial wall blowout fracture of the eye?
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Medial wall fractures can involve the ethmoid sinuses
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What occurs with a blowout fracture on the inferior surface of the orbit?
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Injury to the floor can involve the maxillary sinus
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What occurs with a blowout fracture on the roof of the orbit?
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Damage to the roof can involve the frontal lobe of the brain
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What does bleeding into the orbit following a blow out fracture cause?
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Bleeding into the orbit may cause eye to protrude –called exopthalmos.
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What is the manifestation of an abudcens injury?
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Lateral gaze deficit.
When staring straight ahead (primary gaze) affected eye pulled medially by unopposed medial rectus. |
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What is the result of trochlear palsy?
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Hypertropia – affected eye looks upward when patient asked to stare ahead
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What is going on if the patient suffers from diplopia, tilts head downward away from affected eye to compensate, cannot walk down stairs, better off closing eyes?
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Trochlear nerve palsy
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What is the manifestation of oculomotor nerve palsy?
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Affected eye stares down and out due to unopposed actions of lateral rectus and superior oblique muscles
Patient cannot elevated upper lid Cannot stare at object as it is moved toward face (impaired adduction) Diplopia Pupil of affected side dilated due to unopposed action of sympathetics on dilator pupillae muscle |
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What is the origin and course of the trochlear nerve?
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Dorsal mesencephalon in edge of tentorium cerebelli
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What muscle or muscles does the trochlear n innervate?
How do you test the function of this nerve and the muscle that it innervates? Have patient adduct the eye and look downward |
Superior oblique only
Have patient adduct the eye and look downward |
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What causes a fixed and dilated pupil?
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Unopposed action of the dilator pupillae muscle (sympathetics).
Brainstem damage to the Edinger-Westphal nucleus |
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What causes a "blown pupil" ?
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Complete injury to the Edinger-Westphal nucleus of the oculomotor complex in the midbrain.
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What is Horner's syndrome?
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Classic syndrome: (Damage T1)
Ptosis - drooping eyelid (Muller's muscle paralyzed) Anhidrosis - loss of sweating Miosis - constricted pupil |
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What is presbyopia?
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Lens can no longer thicken because it loses its flexibility - cannot focus on near objects (cannot return to natural state)
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What is a cataract?
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Opacity of the lens associated with advancing age.
Night vision reduced, will see halos |
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Why do people with diabetes mellitus get cataracts?
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High glucose or sorbitol levels in the lens stroma draws water into the region.
Can also thicken the lens. |
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What is a diabetic myopia?
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Thickening of the lens from high glucose levels drawing water into the stroma.
Person will be near-sighted |
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What is involved in retinitis pigmentosa?
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Failure of the retina's pigmented epithelial layer to remove membranous debris from the photoreceptor lamellae.
People go blind. |
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What occurs in an embolic occlusion of the central retinal artery?
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Small pieces of atherosclerotic plaques or clots travel to the central retinal artery and occlude it.
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What are the symptoms of an occluded central retinal artery?
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Ischemic death of retinal ganglion cells.
Sudden blindness. |
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What occurs in age related macular degeneration?
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The photoreceptors become separated from their blood supply.
Loss of central vision |
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What is dry ARMD?
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90% of cases
1.8 million in US affected Drusen accumulates between Bruch's membrane and the pigmented epithelium. |
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What is wet ARMD?
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10% of cases
.2 million, most severe, greatest loss of vision Drusen accumulates between layers, but BV grow to the area and push on the pigmented epithelium and cause further separation. |
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How do you test for macular degeneration?
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Amsler grid - patents will see distortion of lines and possibly a black spot in the middle.
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Where does detachment of the retina occur?
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Between the pigmented epithelium and the photoreceptors.
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What occurs when the retina detaches?
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The neural layer of the retina detaches from the pigmented layer.
The photoreceptors are deprived of oxygen and nutrients and the retina will die. |
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What is papilladema?
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Increased intracranial pressure that causes the optic disc or papilla to bulge into the eye.
Optic cup will be missing when looking at the retina. |
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What are the symptoms of glaucoma?
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Halos at night.
Headaches. Defects in visual field, scotomas. Blindness. |
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What causes primary open angle glaucoma?
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Slow blockage of the canal of Schlemm.
Angle of the anterior chamber appears normal, so this is a slow problem that goes unnoticed. |
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What is the most common form of glaucoma?
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Primary open angle
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Who is at risk for developing primary open-angle glaucoma?
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Persons with myopia (nearsightedness)
Diabetes mellitus (sugar) |
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What is primary-closed angle glaucoma?
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Narrow angle - Angle of anterior chamber is blocked by iris.
Pupil constricted = iris is flat and angle is open Pupil dilated = the angle is blocked Rapid progression, sudden onset, emergency situation. Severe ocular pain, blurred vision. |
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What is the term for constriction of the pupil?
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Miotic
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What is the term for dilation of the pupil?
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Mydriasis
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What is optic cupping?
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When the intraocular pressure climbs and pushes the optic disk out.
Pale disc Enlarged disc Retinal atrophy and neuronal death |
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What is a floater?
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A deposit in the vitreous humor of the eye.
Seen if staring at celing or wall without focusing. Benign, but many of them can indicate a serious eye disease. |
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What is a floater made out of?
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Aggregates of vitreal proteins - dust-like particles in vitreous humor.
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What results if your vitreous humor is reduced/lost?
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Must be replaced to maintain the shape of the eye and keep the retina in its appropriate position.
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What is a vitrectomy?
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Removal of cloudy or bloody vitreous humor, replaced with saline.
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What specific part of the eye is affected in ARMD?
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Macula and fovea centralis
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What nerves innervate the inner and outer surfaces of the tympanic membrane?
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outer – auriculotemporal (trigeminal) and small contribution from auricular branch of X
Inner – glossopharyngeal |
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What nerve must be avoided when making an incision into the tympanic membrane and placing the tympanostomy tube?
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Chorda tympani
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If this nerve were damaged, what deficits would it cause?
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Loss of taste from the anterior 2/3rds of the tongue and loss of salivation from the submandibular and sublingual glands
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What is otitis media?
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Bulging, red tympanic membrane that may indicate a middle ear infection.
Possible impaired drainage from middle ear cavity which can result in perforation of the tympanic membrane. |
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Who does otitis media predominately affect?
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Younger children because pharyngotympanic tubes have a narrower angle (more horizontal) and do not drain well.
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What is one of the huge risks with otitis media?
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That the ear infection can spread to the brain and cause meningitis
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How do you treat otitis media?
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Make an incision in the posteroinferior membrane and place a tympanostomy tube.
Risk damage to chorda tympani if not done in this area. |
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What is mastoiditis?
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Inflammation of the mastoid antrum and air cells.
Can spread superiorly into the middle cranial cavity and cause meningitis and encephalitis. |
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What causes pathologic nystagmus?
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Damage to the vestibulocochlear nerve, vestibular system or its cerebellar connections cause beating of eyes to side opposite nerve damage.
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What is beating nystagmus?
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Where eyes move slowly toward the side of damage and then rapidly snap back to the NORMAL side. (beating is to opposite side)
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What is another word for nystagmus?
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Saccade
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What would a left medullary lesion in the vestibular system cause?
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Right beating nystagmus
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What other things can cause nystagmus?
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Alcohol ( vertigo where room is spinning)
Toxins can cause a permanent nystagmus! |
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To drain an abscess (a closed collection of pus) affecting the cheek area, an emergency room physician used local anesthesia for the surgery. Which of the following nerves must be anesthetized because it carries pain sensation from the cheek area?
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The buccal nerve is a branch of the mandibular division of the trigeminal nerve that transmits sensory information from the skin of the cheek area and the oral mucosa of the cheek.
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What is the nerve that all dentists must numb when they are working on the mandibular teeth?
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The inferior alveolar nerve is another branch of V3 that penetrates the mandibular foramen and is the sensory nerve for the mandible and all mandibular teeth.
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Where does the lingual nerve come from?
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The lingual nerve is also a branch of V3--it transmits general sensation from the tongue. The lingual nerve also receives the chorda tympani, a branch of the facial nerve, which provides the lingual nerve with preganglionic parasympathetic fibers for the submandibular and and sublingual glands, as well as the taste fibers for the anterior 2/3 of the tongue.
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What provides sensory innervation to the skin, chin and lower lip?
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Mental nerve - branch of V3 from the inferior aveolar nerve.
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A patient who experienced bilateral anterior dislocation of the jaw (temporomandibular joints) could not swallow or talk since the mouth was held open. What is the position of the condyles of the mandible as a result of the dislocation?
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Against the anterior slope of the articular eminence
Caused by excessive contraction of the lateral pterygoids |
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n reducing an ankylosis of the TMJ, a surgeon provoked an intense hemorrhage by lacerating the artery coursing transversely just medial to the neck of the condyle. Which artery was involved in the accident?
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The maxillary artery is one of the terminal branches of the external carotid artery which is closely related with the TMJ.
Travels medially to neck of condyle. |
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What artery lies deep to the lateral pterygoid muscle?
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Middle meningeal artery.
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What is another terminal branch of the external carotid artery besides the maxillary?
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Superficial temporal artery.
Posterolateral to head of mandible. |
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The muscle which separates the submandibular triangle from the paralingual space is the:
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Mylohyoid muscle
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What is the paralingual space?
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Space found deep to the mylohyoid muscle, which makes the mylohyoid the dividing line between it and the submandibular triangle.
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The predominant muscle most associated with retraction of the mandible is the:
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Temporalis is the one muscle responsible for retracting the mandible
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Hinge movements between the TMJ occur where?
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Condyle and articular disc.
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What makes up the gliding component of the TMJ joint?
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The upper part of the joint, between the articular disc and the mandibular fossa and articular eminence of the temporal bone, creates the gliding component.
Moves after hinge movement. |
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Buccal nerve vs. buccal branch?
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The buccal nerve is NOT the same as the buccal branch of the facial nerve, which is a motor nerve innervating the buccinator and muscles of the upper lip!!!
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What does the mylohyoid branch innervate?
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it innervates the mylohyoid muscle and the anterior belly of the digastric.
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What is meniere's disease?
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Recurrent attacks of vertigo, hearing loss and tinnitus (ringing in ears).
Accompanied by nystagmus. Attacks from moments to hours. Continuous vertigo. |
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What is one cause of meniere's disease?
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Endolymphatic hydrops: increase in the volume of endolymph.
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How do you test for meniere's disease?
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COWS
Cold water, eyes beat to Opposite side Warm water, eyes beet to Same side |
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Constant exposure to loud sounds does what?
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Hair cells that detect those frequencies can be damaged.
These hair cells do not regenerate and you will go deaf at that frequency. |
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Injury to what nerve can result in hearing loss?
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Vestibulocochlear nerve
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What is a schwann cell tumor?
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A Schwannoma or Acoustic neuroma is a tumor that forms at the vestibulococclear nerve's entrance to the brainstem.
Causes hearing loss and possible facial palsy. |
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What is an acoustic neuroma?
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Growth of a tumor along the vestibulocochlear nerve that can result in brainstem compression (schwannoma).
May involve facial paralysis from damage to facial nerve. |
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What does Horner's syndrome develop from?
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Damage anywhere along the sympathetic pathway, involving a T1 white ramus communicantes, the superior cervical ganglion, the preganglionic or postganlionic axons.
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What is an alternate thing that horner's syndrome can develop from?
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PICA lesion in the lateral part of the medulla.
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What is the pupillary light reflex?
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Shine light in eye, the pupil constricts.
Tests integrity of parasympathetic innervation of the pupil. |
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What is the consensual reflex?
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Consensual reflex is the constriction of the pupil in the contralateral eye.
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What is the accomodation reflex?
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If patient looks at a near object, pupils will constrict bilaterally.
Ciliary muscles contract to let lenses thicken for near vision. |
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How can someone be cortically blind and still have the consensual reflex?
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The optic nerve connects to the pretectal nucleus of the upper midbrain, From the pretectal nucleus, axons connect to neurons in the Edinger-Westphal nucleus, whose axons run along both the left and right oculomotor nerves.
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If the ipsilateral consensual reflex is lost in both eyes what nerve might be damaged?
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Optic nerve
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The contralateral consensual reflex is lost?
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(because light shone into the eye on the damaged side cannot signal to the brain; therefore, despite the right eye's motor pathway (oculomotor nerve) being intact, no signals from the left eye are able to stimulate it due to the damage to the sensory pathway (optic nerve) of the left eye)
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Oculomotor damage's affect on consensual reflex?
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The ipsilateral direct reflex is lost (Example: when the left eye is stimulated, only the right pupil constricts)
The ipsilateral consensual reflex is lost (Example: when the right eye is stimulated, only the right pupil constricts) The contralateral direct reflex is intact (because light shone into both eyes can still signal to the brain, and the pupil on the undamaged side will still be able to constrict via its normal oculomotor nerve) The contralateral consensual reflex is intact (because light shone into the left eye can still signal to the brain via the normal optic nerve, causing attempted constriction of both pupils; the contralateral pupil constricts via its normal oculomotor nerve, but the ipsilateral pupil is unable to constrict due to its damaged oculomotor nerve) |
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Atrophy of right masseter muscle. Mass in infratemporal fossa, absence of saliva from Stenson's duct.
What autonomic ganglion is being compressed by the tumor? |
Otic
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What specific nerve carries the preganglionic axons of the otic ganglion?
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Lesser petrosal
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From where does the lessor petrosal nerve arise?
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Tympanic plexus
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What cranial nerve forms the tympanic plexus
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Glossopharyngeal from inferior salivary nucleus
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What specific nerve carries the postganglionic axons from the otic ganglion?
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Auriculotemporal branch of V3 to parotid gland
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What is leukoplakia?
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A white patch in the mouth that may be precancerous.
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What causes leukoplakia to form?
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Tobacco, alcohol, local irritation
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What is the most common malignancy of the oral cavity?
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Squamous cell carcinoma
Same risk factors as leukoplakia |
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What can lodge in stenson's duct?
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Salivary stones. Evident on upper inside of cheek beside teeth in duct.
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What is scurvy and how does it affect the mouth?
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Deficiency of proteins and vitamin C.
Causes atrophy of the periodontal ligament and consequent loss of teeth. |
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What is the bite reflex?
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Mechanoreceptors in the peridontal ligament that when activated by biting on something hard makes the jaw reflexively open to prevent damage to teeth.
Trigeminal nerve branches are involved in this. |
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What is a carie?
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A decalcification of the enamel on the tooth, bacteria can accumulate in them and cause defects in the enamel.
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What hardens enamel?
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Flouride
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Where do drugs like nitroglycerin get administered?
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Sublingually where they can get rapidly absorbed into the deep lingual veins.
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What muscle causes the tongue to point toward the site of nerve damage when the hypoglossal nerve is lesioned?
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Genioglossus
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What muscle in the mouth is paralyzed from a lesion to cranial nerve X?
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Palatoglossus muscle - so uvula will deviate to opposite side of injury.
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What is mumps?
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Single stranded RNA virus that only affects humans.
Can cause meningitis and epididymoorchitis (which can lead to sterility) |
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What sign characterizes a mumps infection?
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Swollen parotid glands
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Why can excessive bleeding occur following a tonsillectomy?
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External palatine vein or tonsillar artery being cut.
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What nerve is of concern during a tonsillectomy?
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Glossopharyngeal nerve - lies in the tonsillar bed
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Damage to the vagus nerve results in what?
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Uvula devating to opposite side of lesion because of paralyzed palatoglossus muscle.
Swallowing fluids results in going up nose. |
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The muscles of mastication are innervated by what?
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Mandibular branch of trigeminal nerve.
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What bony feature of the mandible can be used to find and palpate the facial artery?
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The facial artery arises from the external carotid artery and winds around the inferior border of the mandible deep to the platysma, immediately anterior to the insertion of masseter muscle. This is the area of the premasseteric notch.
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Which of the following suprahyoid muscles would be paralyzed if the inferior alveolar nerve were severed at its origin?
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Mylohyoid is innervated by the nerve to mylohyoid, which is a branch of the inferior alveolar nerve.
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Two nerves usually emerge from between the two heads of the lateral pterygoid muscle:
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the anterior deep temporal nerve and the buccal nerve
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Where does the chorda tympanae exit the skull?
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The chorda tympani exits the skull through the petrotympanic fissure.
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What muscle of mastication is innervated by the facial nerve?
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Buccinator is a muscle on the side of the cheek which is innervated by the facial nerve (VII). This muscle, which pulls the corner of mouth laterally and presses the cheek against the teeth, would still be functional even after disrupting the mandibular division of the trigeminal nerve.
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Which muscle is also known as the sphenomeniscus?
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The superior head of lateral pterygoid is sometimes called sphenomeniscus due to its insertion into the disc of the temporomandibular joint.
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What other nerve would be numbed if the inferior alveolar nerve was anesthetized?
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The mental nerve would be anesthetized, too. Then, the patient would lose sensory innervation to the skin of the chin.
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The middle meningeal artery has what relationships?
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The middle meningeal artery is always found deep to the lateral pterygoid muscle, so it is arising deep to the neck of the mandible. It enters the skull by passing through the foramen spinosum, it also passes through a fork in the auriculotemporal nerve.
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What side of the TMJ joint are the extracapsular ligaments?
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Lateral side
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Innervation of the tongue!
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The lingual nerve is a branch of V3, the mandibular division of the trigeminal nerve. It supplies general sensation (touch and temperature) to the anterior 2/3 of the tongue. (Taste sensation for the anterior 2/3 of the tongue arrives at the tongue by way of the lingual nerve, but the original fibers for taste came from the chorda tympani, a branch of CN VII.) The hypoglossal nerve (CN XII) provides motor innervation to the muscles of the tongue. The glossopharyngeal nerve (CN IX) provides taste sensation and general sensation to the posterior 1/3 of the tongue.
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Sympathetic fibers reach the tongue by way of the:
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Lingual artery
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What must one cut through to gain access to the duct of the submandibular gland?
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Mucous membranes only. It is superficial to the muscles of the floor of the mouth.
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What artery runs on the superficial surface of the tongue?
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The dorsal lingual artery runs on the superficial surface of the tongue--it is a branch of the lingual artery that delivers blood to the posterior superficial tongue.
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The loss of what muscle that elevates the tongue would result in difficulty swallowing?
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Styloglossus retracts and elevates the tongue.
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All of the tongue muscles are innervated by what nerve?
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Hypoglossal nerve
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The chorda tympani contains which component before it joins the lingual nerve?
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Preganglionic parasympathetics
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The cell bodies of the taste fibers from the anterior two-thirds of the tongue are located in the:
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The geniculate ganglion is the sensory ganglion of the facial nerve--it holds the cell bodies of the neurons that carry taste sensations from the anterior 2/3 of the tongue.
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To touch your tongue to your front teeth what muscle must you be using?
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The inferior fibers of genioglossus must be contracting.
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The muscle responsible for raising the floor of the mouth in the early stages of swallowing is the:
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Myohyoid
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You suspect a stone in the submandibular duct, and a plain film radiograph shows a density in that region consistent with a stone. In order to remove the stone, the duct must be incised in the floor of the mouth. What nerve, that loops around the duct, is in danger in such an incision?
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The lingual nerve is found in the floor of the mouth--it wraps around the submandibular duct.
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What two vessels course through the submandibular triangle?
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The facial artery and facial vein course through this triangle. The facial artery lies deep to the superficial part of the submandibular gland and wraps around the mandible. The facial vein is superficial to the gland-
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What are the parameters of the paralingual space?
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The space is bounded by the lateral tongue, the hyoid bone, and the oral mucosa.
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What does the middle cerebral artery supply blood to?
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The middle cerebral artery supplies blood to most of the lateral surface of cerebral hemispheres, and the temporal pole, including the frontal, parietal, and medial portions of the temporal lobes.
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What layer of the scalp is the most dangerous for injury?
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The place where infections can spread very quickly. And that layer is layer 4, the loose connective tissue. Pus or blood can spread easily in this layer, and infections in this layer can pass into the cranial cavity through emissary veins.
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What runs in the cavernous sinus that would be a concern if a thrombosis occured there?
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This includes the oculomotor nerve, the trochlear nerve, the ophthalmic division of the trigeminal nerve, and the abducens nerve. The internal carotid artery also passes through the cavernous sinus.
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What enters the skull via the jugular foramen?
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The posterior meningeal artery enters the skull through this space.
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Facial
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? |
The straight sinus drains the deep cerebrum--it lies within the junction of the falx cerebri and tentorium cerebelli.
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What are the two functions of the auriculotemporal nerve?
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First, it carries postganglionic parasympathetic fibers to the parotid gland. These fibers come from the otic ganglia, where they synapsed with the presynaptic fibers from the glossopharyngeal nerve (CN IX). Second, the auriculotemporal nerve provides sensory innervation to the skin of anterosuperior ear, part of the external auditory meatus, and the temporomandibular joint.
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An elderly man presented with severe pain beneath the left eye, radiating into the lower eyelid, lateral side of the nose and upper lip. What nerve was involved?
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Infraorbital
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If you cut the marginal mandibular branch of the facial nerve. Which of the following muscles would be paralyzed because of the injury?
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The marginal mandibular branch of the facial nerve provides motor innervation to the muscles of facial expression near the lower lip and chin--right where you find depressor anguli oris.
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What artery crosses over the submandibular gland?
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Facial artery
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What provides innervation to the posterior digastric belly and the stylohyoid?
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Facial nerve
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What is the function of the greater auricular nerve?
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The great auricular nerve is a branch of the cervical plexus that provides cutaneous innervation to the skin of the ear and skin below the ear, including the angle of the mandible.
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What muscle enables you to wink?
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Orbicularis oculi - innervated by temporal + zygomatic branches of facial
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What is the frontalis muscle innervated by?
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Temporal branches of the facial nerve, wrinkles forehead and elevates eyebrows
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What eye muscle can you test to check the integrity of the cervical sympathetic trunk?
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Superior tarsal muscle is another muscle that elevates the eyelid, but it lifts the eyelid invoulntarily.
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What structure lies deepest in the parotid gland?
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The external carotid artery.
Facial nerve, retromandibular vein also go thorugh the gland. Nerve --> vein --> artery superficial to deep |
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What muscles are innervated by V3 of trigeminal?
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Mylohyoid and the anterior belly of the digastric are innervated by a small branch of V3. They both elevate the hyoid and depress the mandible. Medial pterygoid and temporalis are muscles of mastication, and the muscles of mastication are innervated by V3
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What is the course of the parotid duct?
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The parotid duct opens into the vestibule of the mouth, draining into the mucosa of the cheek near the second upper molar tooth. The duct drains the parotid gland across the masseter and through the cheek. It passes through the buccinator muscle, and pours saliva into the vestibule of the mouth.
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Injury to what nerve causes Bell's palsy?
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Facial
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What is Frey's syndrome?
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Frey's syndrome is a condition in which the postganglionic parasympathetic nerves that are contained in the auriculotemporal nerve (which normally supply the parotid gland) are redirected toward the sweat glands overlying the parotid gland. This means that a patient with Frey's syndrome sweats in the area over the parotid gland while eating. Since the auriculotemporal nerve is a branch of V3, the nerve fibers involved in Frey's syndrome are from the trigeminal nerve.
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What is the smile muscle?
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Zygomaticus major - facial nerve
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How does a jaw dislocation occur?
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When the mandible is depressed, mouth is held open and the heads of the mandible lay in front of the tubercles.
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What is dangerous about the mandible being fully open?
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The head and articular disc are at the summit of the tubercle, here the joint is unstable because the disc can be pulled forward past the summit.
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What can cause TMJ dislocation?
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Minor blow on the chin, large yawn.
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How do you repair a jaw dislocation?
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Reduction of the joint: push down on lower molars and push the jaw backwards.
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What is at risk besides the jaw with traumatic dislocation?
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Injury of the auriculotemporal nerve
Rupture of the articular capsule and lateral ligaments. |
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What nerves are at risk with surgical procedures to the TMJ joint?
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Facial and auriculotemporal. Auriculotemporal branches enter the posterior part of the joint.
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Why does the TMJ joint click and pop?
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Structural problems from delayed articular disc movement.
The disc move suddenly when it lags behind the jaw opening and closing causing a pop. |
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What joints in the head can suffer from degenerative arthritis?
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TMJ and synovial joints between ossicles.
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What is lost with a lesion of the lingual nerve?
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Loss of taste and sensation to anterior 2/3 of the tongue, loss of submandibular/sublingual salivation (dry mouth).
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What is lost with a lesion to the mandibular branch of trigeminal in the infratemporal fossa?
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Loss of sensation to tongue, teeth, chin, ear, ear canal, tympanic membrane, temple, TMJ joint.
Paralysis of mylohyoid and anterior belly of digastric. |
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What is lost with a lesion to chorda tympani?
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Loss of salivation, loss of taste to anterior 2/3 of tongue.
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What is lost with a lesion to the facial nerve at the stylomastoid foramen?
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Ipsilateral paralysis of muscles of face
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What is lost with a lesion to the facial nerve before the branching of chorda tympani?
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Ipsilateral paralysis, hyperacussis from stapedius being knocked out, everything lost from chorda tympani.
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What is lost with a lesion at the geniculate ganglion?
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Everything from facial, chorda tympani, stapedius, and loss of mucous production in nose, tear production, and taste from the palate because of greater petrosal nerve.
Entire nerve is blown |
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What is dangerous about the pterygoid plexus?
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It is a valveless anastamoses with the emissary veins that connect to the cavernous sinus. An infection of the orbit or infratemporal fossa may enter the cranial cavity!
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How does a person get crocodile tears?
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Efferent fibers from the superior salivary nucleus become improperly connected to nerve axons projecting to the lacrimal glands (tear ducts), causing one to shed tears (lacrimate) during salivation while smelling foods or eating.
Basically fibers lesioned at greater petrosal re-grow into chorda tympani |
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What is lost with a lesion to the nerve of pterygoid canal?
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Lacrimation, nasal mucosa secretion, taste to palate lost.
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What is lost with a lesion below the superior cervical ganglion?
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Preganglionic sympathetics the deep petrosal nerve is knocked out.
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What will happen if there is a mass in the pterygopalatine fossa?
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Lose lacrimation, taste to palate, nasal mucosa secretion and general sensory branches from trigeminal V2
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What is the significance of the retropharyngeal space being immediately anterior to the prevertebral layer?
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Infection coming from some region of the pharynx can track all the way down to the bottom of the retropharyngeal fascia. It can erode through the anterior layer of prevertebral fascia it can enter the third space and can track all the way down to the diaphragm and the infection can spread even further
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What nerves can be damaged during a thyroidectomy?
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Laryngeal nerves
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What is a goiter?
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Is a condition in which the thyroid gland becomes enlarged & is endemic in certain parts of the world deficient in iodine
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What does one have to be careful of while performing a tracheostomy?
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Rich vascular supply to the thyroid gland, airway must be established in this location.
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What is Erb's point?
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Posterior boarder of SCM, near the inferior third where there is a congregation of nerves.
This is an excellent spot for a nerve block injection. |
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What nerves congregate at Erb's point?
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Greater auricular, lesser occipital, Accessory, Transverse cervical, supra-clavicular nerves
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What is congenital torticollis?
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Fibrous tissue that develops in SCM muscle. Most common before birth.
During birth tearing of fibers of the SCM can cause a hematoma that becomes a fibrotic mass. Mass entraps a branch of spinal accessory nerve and denervates SCM. |
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What is a common symptom of torticollis?
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Side bend to same side, head rotated to opposite side.
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What form of torticolis forms later in life?
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Spasmotic torticollis. Not a direct lesion or fibrous tissue but spasm of the SCM itself.
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What is transsphenoidal hypophysectomy?
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An incision is made in the mucosa of the mouth inferior to the nose and a speculum is inserted through the sphenoid sinus to the pituitary.
Gold standard of removing the pituitary gland. |
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What is essential for sinus drainage?
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Ciliary motility because the ostium is located near the upper part of the sinus
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What occurs with bilateral sinusitis?
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Sinuses become occluded, blocked ostium and eventually becomes filled with connective tissue.
The CT must be removed. |
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What are the complications of sinusitis?
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Deviated septum
Roots of molars extend up into maxillary sinus - spread of infection You can grow an oral fistua from the maxillary up into the sinus that causes inflammation |
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What is Kiesselbach's area?
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Site of anastamoses between ethmoidal arteries and greater palatine arteries - where nosebleeds occur
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What occurs with nosebleeds in the region of blood supply to the ethmoid bone?
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Very dangerous, have to be cauterized - nasal packing with Foley catheter
These are about 10% of nosebleeds. |
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How do you stop an epistaxis?
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This is a nosebleed, which is stopped by pinching nose. Occurs in Kiesselbach's plexus.
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How do infections spread from external nose or nasal cavity to the cavernous sinus?
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Via drainage into the pterygopalatine plexus into the cavernous sinus.
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What is cavernous sinus thrombosis?
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Late complication of infection of the anterior face or the paranasal sinuses.
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Why is the front of the face called the "maxillofacial death pyramid"?
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Infections in this triangular region can spread posteriorly via venous drainage inot hte cavernous sinus.
Can be the cause of cavernous sinus thrombosis. |
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A diagnosis of a posterior nosebleed is made and the boy is admitted for placement of a balloon nasal pack.
What blood vessels anastomose to form Kiesselbach’s plexus? What is the largest vessel supplying the nasal cavity? This artery is the terminal branch of what artery? Sphenopalatine, which is the terminal branch of the maxillary artery. |
Septal branches of anterior ethmoidal and sphenopalatine. nasal artery of superior labial artery, terminal branch of greater palatine
Sphenopalatine, which is the terminal branch of the maxillary artery. |
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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?
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Trochlear
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The ducts of the lacrimal gland open into the:
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The fluid from this gland enters the conjunctival sac through up to 12 lacrimal ducts that open into the superior conjunctival fornix. The tears then flow to the medial angle of the eye and collect in the lacrimal lake.
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During a physical examination it is noted that a patient has ptosis. What muscle must be paralyzed?
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Superior tarsal (muller's muscle)
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What are the origins of the eye muscles?
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The inferior oblique muscle does not originate at the apex of the orbit. It takes origin from the floor of the orbit, lateral to the lacrimal groove. The inferior rectus and superior rectus muscles take origin from the common tendinous ring at the apex of the orbit. The levator palpebrae superioris takes origin from the apex of the orbit above the optic canal. The superior oblique muscle takes origin from the apex of the orbit, above the optic canal.
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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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The ophthalmic veins are continuous with the facial vein and the pterygoid plexus of veins. These veins drain the face toward the cavernous sinus. They are valveless, so infections from the face can drain into the cavernous sinus.
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If a person is taking a sympathetic blocking agent, what would you notice in her or his eyes?
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Ptosis and myosis
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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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The auditory (nasopharyngeal) tube is a connection between the nasal portion of the pharynx and the tympanic cavity that allows pressure to equalize on either side of the tympanic membrane. It is located in the anterior wall of the middle ear and is comprised of bone at the tympanic end and cartilage on the pharyngeal end. The pharyngeal mucosa is continuous with the lining of the tympanic cavity and mastoid air cells. This allows infectious material to pass to the middle ear and mastoid area.
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An elderly patient with chronic otitis media (middle ear infection) might have all complications of nerves EXCEPT:
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Inabilty to chew food due to injury to the mandibular division of the trigeminal nerve (CN V)
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What is the route of the facial nerve through the middle ear?
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The facial nerve passes in a canal situated in the posterior and medial walls of the middle ear. It is not associated with the anterior wall.
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Orientations of structures around the middle ear cavity.
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The joints between ossicles are synovial
The chorda tympani nerve is related to the lateral wall The auditory tube connects the nasopharynx with the anterior wall Its mucous membrane is supplied by the glossopharyngeal nerve (CN IX) |
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The soft palate does not play a role in?
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Breathing
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Where do most of the paranasal sinuses or air cells drain?
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The middle meatus contains the semilunar hiatus, which receives drainage from the frontonasal duct (draining the frontal sinus), the anterior ethmoidal air cells, and the maxillary sinus.
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What drains into the inferior meatus?
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The inferior meatus receives the nasolacrimal duct which conducts tears from the orbit.
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What drains into the superior meatus?
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The superior meatus receives drainage from the posterior ethmoidal air cells.
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Where does the sphenoid sinus drain?
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The sphenoethmoidal recess is the opening for the sphenoethmoidal sinus.
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What is torus tubaris?
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Torus tubaris is a mucosal fold covering the anteromedial end of the auditory tube cartilage - it projects toward the midline from the lateral wall of the nasopharynx.
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A person receives a shallow knife wound just behind the sternocleidomastoid muscle and about 1 1/2 inches above the clavicle. There is an immediate numbness of the skin below the wound and over the acromion and clavicle. The nerve most likely severed was the
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The supraclavicular nerves come from C3 and C4 in the cervical plexus. These cutaneous nerves provide sensory innervation to the skin of the root of the neck, upper chest, and upper shoulder. These nerves innervate the skin right above the clavicle, so they are the correct answer.
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What is the primary source of blood for the parathyroid glands?
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The inferior thyroid arteries are branches of the thyrocervical trunk. (The superior thyroid arteries are branches of the external carotid artery.) The inferior thyroid arteries are closely associated with the middle cervical sympathetic ganglia and supply the inferior poles of the thyroid. They are found on the posterior surface of the thyroid gland, which is where the parathyroid glands are located. So, they are the primary source of blood for the four parathyroid glands.
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A 20 year old man was brought into the emergency room with a stab wound in the upper part of the neck. Although there was no major damage done, he lost sensation from the skin over the angle of the jaw. Which nerve has been cut?
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The great auricular nerve comes from C2 and C3 branches of the cervical plexus; it provides sensory innervation to the ear and the skin below the ear, including the angle of the jaw.
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The triangle in which the superior branch of the ansa cervicalis separates from the hypoglossal nerve is the:
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The superior branch of ansa cervicalis runs with the hypoglossal nerve until the carotid triangle. In this triangle, the superior branch of ansa cervicalis separates from the hypoglossal nerve and runs in the carotid sheath, anterior to the carotid artery.
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What muscle is best for locating the internal jugular vein?
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The internal jugular vein is found in the carotid triangle, which is bounded medially by omohyoid, laterally by sternocleidomastoid, and superiorly by the posterior belly of digastric.
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A 47-year-old woman is diagnosed as having a thyroid tumor. Surgery to remove the cancerous growth is undertaken. In which triangle of the neck will the surgeon make an incision to gain access to the gland?
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Muscular
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A 50-year-old woman is brought to the operating room for a biopsy of a suspicious looking nevus (mole) which is found along the anterior border of her sternocleidomastoid muscle at about its midlength. What nerve must be locally anesthetized for the operation to proceed without pain?
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Transverse cervical
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Following surgery on the upper pole of the right lobe of the thyroid gland, a patient complains of hoarseness and weakness of voice. What nerve may have been injured?
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The external branch of the superior laryngeal nerve innervates cricothyroid, the muscle responsible for elongating the vocal cords. The patient's symptoms of horseness and a weak voice would fit with an injury to this nerve and the denervation of this muscle.
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What is found in the superficial fascia of the neck?
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The external jugular vein is a small vein found in the superficial tissue on the lateral side of the neck. The platysma is a muscle of facial expression that draws down the corners of the mouth and depresses the mandible. It inserts into the skin, so it is found in the superficial fascia. The cervical branch of the facial nerve, which innervates the platysma, is also in the superficial fascia. Finally, the transverse cervical nerve is a branch of the cervical plexus that innervates the skin of the anterior neck.
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What vessel travels superficially in the omoclavicular triangle?
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External jugular
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Which structure or area receives NO nerve fibers from the cervical plexus?
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Skin over the external occipital protuberance
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A six-year-old child, whose medical history includes a rather difficult birth, has a permanently tilted head posture, with the right ear near the right shoulder and the face turned upward and to the left. Which of the following muscles was very likely damaged during birth?
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SCM
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What lies anterior to the anterior scalene muscle?
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Phrenic nerve
Subclavian vein Transverse and suprascapular arteries Cervical part of the thoracic duct |
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What vessel is associated with the posterior side of the thyroid gland?
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This artery approaches the posterior side of the thyroid gland, crossing the recurrent laryngeal nerve and coming near the middle cervical sympathetic ganglion. This artery also supplies blood to the parathyroid glands, which are on the posterior surface of the thyroid.
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What is the location of the cervical sympathetic trunk?
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The cervical sympathetic trunk lies in front of the prevertebral muscles in the prevertebral fascia.
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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?
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The internal branch of the superior laryngeal is a sensory nerve that pierces the thyrohyoid membrane along with the superior laryngeal artery. It supplies sensory fibers to the mucous membrane of the larynx, superior to the vocal folds. Since this area lost sensation, it appears that the internal branch of the superior laryngeal nerve must have been injured.
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The laryngeal muscle most responsible for stretching (elongating) the vocal ligament is the :
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Cricothyroid draws the thyroid cartilage forward, tensing the vocal ligaments. This is the one muscle innervated by the external branch of the superior 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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Vocalis 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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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?
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Recurrent laryngeal
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While doing a postoperative physical on a patient who has undergone carotid endarterectomy on the right side, it was noted that the tongue deviated toward the right when the patient was asked to point the tongue outward. What nerve crossing the carotid artery must have been injured?
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Hypoglossal
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Any manipulation of the superior thyroid artery must be undertaken with care not to damage its small companion nerve, the:
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External branch of superior laryngeal
If this nerve was damaged, the cricothyroid muscle would be paralyzed, and a patient would be unable to tense the vocal cords. |
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What are the glands in the mucous membrane covering the uvula innervated by?
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Pterygopalatine ganglion
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How do you test the obicularis oculi?
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Have patient close eye and physician tries to open it.
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What is the afferent limb of the gag reflex?
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Glossopharyngeal nerve
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If someone has a cut behind their ear, where can infection spread?
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Superficial cervical lymph nodes
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Vessels in the scalp bleed profusely because of what layer?
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Dense connective tissue
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Infection in the upper teeth goes to the cavernous sinus, how?
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Through the pterygoid plexus
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Loss of pain sensation from anterior tongue from a tumor would have to compress what ganglion?
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Trigeminal (semilunar)
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Where does the maxillary nerve carry sensory fibers?
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Middle face, lateral wall of septum, and nasal cavity
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Where are the cell bodies for taste to the anterior tongue located?
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Geniculate ganglion
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Problems chewing after a parotidectomy are from what nerve being damaged?
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Facial - buccal branch
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Lymphatic drainage of the tongue passes where?
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Deep cervical lymph nodes, the juguloomohyoid in particular
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What causes malocclusion (misalignment of teeth and jaw)?
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Damage to the trigeminal nerve innervating muscles of mastication V3
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Sensory innervation to the area above the laryngeal folds, including vestibule is from where?
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Superior laryngeal nerve
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What nerve provides sensory and motor innervation below vocal folds?
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Recurrent laryngeal
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What muscle abducts the vocal folds?
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Posterior cricoarytenoid
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Where does tonsillar tissue from the nasopharynx drain?
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Deep cervical nodes
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What muscle lies immediately lateral to the oral vestibule?
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Buccinator
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What ganglion do sensory fibers for pain from the anterior tongue and tip of tongue go to?
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Trigeminal ganglion
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What cranial nerves pass through the jugular foramen?
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IX, X, XI
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What two bones form the jugular foramen?
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Temporal and occipital
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What is the uvula innervated by?
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X
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Where does the vagus nerve arise?
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Medulla, posterior to the inferior olive.
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What are the SCM and the trapezius innervated by?
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Accessory nerve
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What is the path of the accessory nerve?
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Arises from the cervical spinal cord, travels up through foramen magnum into the skull, joins with other nerves and exits via jugular foramen, travels out to innervate muscles
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Where are the motor neurons that innervate the SCM and trapezius?
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Nucleus ambiguous
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What three locations does the trigeminal nerve exit the skull?
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V1 - Superior orbital fissure
V2 - foramen rotundum V3 - foramen ovale |
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What nerve provides general sensation to the posterior tongue?
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Vagus
Glossopharyngeal is taste |
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What muscles do the trigeminal nerve innervate?
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Muscles of mastication
Mylohyoid Anterior digastric Tensor veli palatini Tensor tympani |
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What does nervus intermedius carry?
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Taste, parasympathetic, and somatic sensory fibers
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How can you determine an upper vs. lower motor neuron to the facial nuclei?
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UMN - forehead spared, contralateral paralysis
LMN - Ipsilateral paralysis of entire face Nerve fibers cross in the pyramid of the medulla |
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What are the boundaries of the cavernous sinus?
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Sphenoid bone, temporal bone, and sella turcica
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What runs in the wall of the cavernous sinus?
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Trochlear n
Maxillary n Opthalmic n Oculomotor n |
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What runs in the middle of the cavernous sinus?
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Internal carotid artery and abducens nerve
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Where does the abducens exit the brain? Between what two arteries?
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Ponto-medullary junction
Between labirinthine and anterior inferior cerebellar arteries |
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What nerve would be affected first from a tumor within the cavernous sinus?
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Abducens
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Where does the trochlear nerve arise?
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Dorsal aspect of the mesencephalon inferior to the corpora quadragemina
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What carries axons for the afferent limb of the corneal reflex? Efferent?
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Opthalmic, trigeminal nerve
Facial |
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What nerve is damaged if patient has lost their accomodation reflex and has a "blown pupil"?
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Oculomotor
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What nerve is damaged if a patient has a aneurysm at the cerebral peduncles?
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Oculomotor
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What are the arteries that could constrict the oculomotor nerve?
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Posterior cerebral
Superior cerebellar |
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Patient presents with severe headaches, tinneus, vertigo, paralysis of right side of face and left beating nystagmus. What nerves are damaged? What is the likely diagnosis?
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Facial and Vestibulocochlear
Acoustic neuroma = tumor in the vestibular nerve while in internal meatus. OR tumor at cerebellopontine angle (schwannoma) |
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A tumor in the infratemporal fossa would compress what?
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Chorda tympani
Lesser petrosal Mandibular V3 |
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What are the boundaries of the infratemporal fossa?
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Anterior: Maxilla
Medial: Lateral pterygoid process, pharynx, veli palatini muscles Lateral: Mandible Roof: Inferior surface of greater wing of sphenoid and temporal bone |
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What are the muscles inside the infratemporal fossa?
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Medial pterygoid
Lateral pterygoid Tensor veli palatini Levator veli palatini |
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How could a tumor communicate with the infratemporal and pterygopalatine fossae?
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Through the pterygomaxillary fissure
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What would occur if a tumor compressed the maxillary division of the trigeminal nerve?
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Loss of sensation to:
Dura of anterior middle cranial fossa, conjunctive of inferior islet, mucosa of posterior inferior nasal cavity, maxillary sinus, palate and anterior part of superior oral vestibule, maxillary teeth, lateral external nose, inferior islet and anterior cheek and upper lip. |
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What visceral sensory loss would occur with a tumor in the pterygopalatine fossa?
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Loss of lacrimation, nasal secretions, pharyngeal secretions, glands of the palate
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What nerve carries pain from the eye?
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Opthalmic --> nasociliary --> long ciliary nerve
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What would compression of the abducens nerve cause?
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Lateral gaze deficit
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What forms the medial wall of the cavernous sinus?
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The body of the sphenoid bone (sella turcica)
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If an aneurysm of the internal carotid artery ruptures within the cavernous sinus, would the blood leak into the subarachnoid space?
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NO
It would stay in the venous sinus system |
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If you had a tumor in the cerebellopontine angle would would be posterior to it? Would it be supra or infratentorial?
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Cerebellum
Infratentorial |
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What part of the basilar membrane detects high frequency sounds?
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Base
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What are the tastebuds innervated by?
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Fungiform and foliate = facial
Circumvallate = glossopharyngeal |
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What does the membranous labyrinth develop from?
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Otic placode from ectoderm.
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Where are the utricle and saccule located in the bony labyrinth?
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Vestibule
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If the mandible was fractured just below the pterygoid fovea how would it be displaced?
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Anteriorly by the lateral pterygoid
Inferior boarder displaced superiorly by the masseter and medial pterygoids. |
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What are the attachments of the sphenomandibular ligament?
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Lingula of mandible and spine of sphenoid
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What is the action of the inferior oblique?
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TO look UP and OUT
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What does the optic canal run through?
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The lesser wing of the sphenoid bone
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What are the boarders of the superior orbital fissure?
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Greater wing of sphenoid
Ethmoid Palatine Maxilla |
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What part of the sphenoid bone is the optic canal in?
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Lesser wing
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How id the hyoid bone attached to the head?
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Via stylohyoid ligament
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What level is the thyroid gland at?
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C5-T1
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What muscles are anterior to the thyroid gland?
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Sternohyoid
Sternothyroid Omohyoid Platysma |
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What is tetany?
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Muscle spasms that result from decreased calcium - occurs when parathyroid glands are removed = DEATH
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What is the lymphatic drainage of the thyroid gland?
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Paratracheal --> deep cervical --> thoracic or right lymphatic ducts
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What does the pretrachial fascia lie between?
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Thyroid and the muscles overlying it
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What is the remnant of thyroid migration? What is the remnant in the oral cavity?
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Thyroglossal duct, the pyramidal lobe can be a remnant of this.
Foramen cecum in the tongue |
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Where in the pharynx do things get stuck?
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Piriform recess
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What is the most dangerous place for something to get lodged?
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On some occasions the fish bone may enter the larynx and lodge above the vocal folds (see inset, lower right).
Most serious, since it can cause laryngeal spasms that close off airway. |
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What concerns are there for a tonsillectomy?
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Excessive bleeding can occur from the external palatine vein or less frequently, from the tonsillar artery.
Another concern is the glossopharyngeal nerve, which lies within the tosillar bed. |
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What results in bilateral damage of recurrent laryngeal nerves?
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Paralysis of larynx
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What is the space between the posterior tongue and epiglottis where a fish bone can lodge?
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Valleculae
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What ligament attaches to the apex of the arytenoid cartilage?
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Vestibular ligament
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Where does one do a cricothyroidectomy in an emergency situation?
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Locate cricothyroid membrane between the thyroid cartilage and the cricoid cartilage.
It is inferior to the laryngeal prominence. Make a 3cm longitudinal skin incision. |
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Where does one place a tracheostomy tube?
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Between the 2nd and 4th tracheal cartilage rings.
Isthmus of thyroid is incised |
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Easy voice fatigue and decreased pitch range
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Superior laryngeal nerve
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What nerve carries sensation from the pharynx?
What nerve innervates the stylopharyngeus muscle? What nerve innervates the palatoglossus muscle? What nerve innervates the pharyngeal constrictors? |
Glossopharyngeal
Glossopharyngeal Vagus Vagus |
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What nerve carries sensation from the larynx above the vocal folds?
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Internal laryngeal
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