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94 Cards in this Set
- Front
- Back
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branches of the external carotid
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superior thyroid
ascending pharyngeal lingual occipital facial post. auricular maxillary superficial temporal |
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veins
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facial drains most of the face
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retromandibular vein
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near parotid
union of maxillary v. and superficial temporal vein veins usually do NOT branch, tributaries usually, this one branches |
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branches of retromandibular vein
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ant. branch - joins with facial --> common facial --> int. jugular v.
post. branch - joins with post. auricular --> ext. jugular v. |
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parotid gland
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conducts serous fluid
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muscles of facial expression
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general - derived from 2nd branchial arch, facial nerve innervations they both come from the same branchial arch.
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branches of facial n.
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post. auricular
temporal zygomatic buccal marginal mandibular cervical |
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langer lines
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healing of incisions --> improved if run along lines, if cut across the lines, the would will gape open and it will heal worse.
incisions made parallel to langers lines tend to heal better due to this process. |
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injury to facial nerve
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lose expression on that side of the face
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bells palsy
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motor branch is cut on one side of the face, resulting in paralysis of all muscles on the same side of the face, can be temp. or permenant. Also can happen if you anesthetize the facial nerve through the parotid gland and one whole side of the face might sag.
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groups of 2 for facial expression muscles
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set them up in similar type groups of 2 for remembering purposes.
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2 round landmarks
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orbicularis occuli - orbital part - encircles orbital orifice, forcefully closes eye.
palpebral part - eyelids, closes eye orbicularis oris - mouth, purses lips |
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2 with nose
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procerus - bridge nose, transverse wrinkle = frown
compressor - (transverse part) and dilator (alar part) - nasalis (move nostrils) |
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2 from the zygomatic bone
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zygomaticus major - runs from the eye to the corner of the mouth
action - smile muscles; moves it superior and lateral (the mouth) zygomaticus minor - not always present; more medial |
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2 lip elevators
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levator labii superioris - elevates the upper lip
levator labii superioris alaeque nasi - side (ala) of nose, elevates upper lip and dilates nostrils (elvis muscles) |
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2 at angle of mouth
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levator anguli oris - elevates angle of mouth ( SMILE )
depressor anguli oris - depresses angle of mouth (frown) |
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2 with lower lip
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depressor labii inferioris - depresses lower lip and moves it laterally
mentalis - wrinkles skin and protrudes lower lip wrinkles the skin of the chin and can protrude the lower lip; known as the pouting expression. |
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2 with the cheek
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buccinator - compresses cheek --> important in mastication ; keeps food between the molars when chewing, forceful expulsion of air, attaches to pterygomandibular raphe
accessory muscle of mastication - innervated by number 7 (buccal branch) not the buccal branch of 5 (this is a sensory nerve) RISORIOUS - many times absent, superficial, draws angle of mouth laterally (grin) |
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2 on top
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Frontalis - big above eye, raises eyebrow, wrinkes skin of the forehead
occipitalis - on back of head, draws the scalp backwards galea aponeurotica - the tendon that joins them. |
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2 exceptions to the 2 rule
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platysma - big broad flat muscle in the neck, blends with facial muscles, tenses skin of neck (shaving muscles)
corrugator supercilli - corner of the orbit (runs from medial end of supercilliary arch to skin in middle part of eyebrows) causes vertical wrinkles above nose. |
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scalp (layers)
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skin
conn. tissue - contains arteries, veins and nerve supply to scalp - aponeurosis - galea aponeurotica - loose connective tissue - layer where infections usually spread - periosteum - anchored to bone |
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neurovascular supply of scalp
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innervation ant. and post. to ears and arterial supply
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innervation ant. to ears
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supratrochlear
supraorbital zygomaticotemporal auriculotemporal |
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innervation post. to ears
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great auricular (ant. rami c2-3)
lesser occipital (ant. rami c2) greater occipital (post. rami C2) third occipital (post ramus C3) |
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arterial supply
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from ophthalmic artery
and from external carotid artery |
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from ophthalmic artery (scalp arterial supply)
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supratrochlear
supraorbital |
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from external carotid artery
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post. auricular
occipital superficial temporal |
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telencephalon
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2 cerebral hemispheres connected by corpus callossum
Cerebral cortex |
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cerebral cortex
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frontal lobe
parietal lobe temporal lobe oxxibpital lobe basal ganglia |
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frontal lobe
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-personality, judgement and intellect
-precentral gyrus - initiation of conscious motor activity (beginning of pyramidal motor system) - brocas area - speech (in dominant hemisphere in the frontal lobe--> left side for right handed people) - parietal lobe (post central gyrus) - primary sensory reception for touch, pressure, 2 point discrimination, snese of motion (kinesthesis ), position sense, pain and temparature |
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parietal lobe
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primary sensory reception for touch, pressure, 2 point discrimination, sense of motion (kinesthesis), position sense, pain and temparature
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temporal lobe
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auditory reception and association
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occipital lobe
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visual reception
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basal ganglia
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bundel of neurons outside the CNS - "extra pyramidal neurons" adjust and modify unconcsious motor activity
- includes caudate, putament and globus pallidus - should be called nuclear groups and not ganglia (nucleus - bundle of cells in CNS, ganglia - PNS - lesion causes resting tumors |
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Diencephalon
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- thalamus - major relay nuclei for sensory input to brain EXCEPT for sense of smell
- epithalamus (pineal) - function not well understood, possibly deals with sleep rhythms - may become calcified and show up on skull x rays - subthalamus - connections to basal ganglia - hypothalamus - connection with endocrine system and ans, known? connection with pituitary |
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Mesencephalon (midbrain)
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sup. colliculus - visual reflexes
inf. colliculus - auditory reflexes red nucleus - extrapyramidal system substantia nigra - extrapyramidal system - cerebral peduncle - lots of descending fibers from pyramidal region (white region) - nucleus for CN 3 and 4 |
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Metencephalon
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pons - includes
- many fiber tracts - ascending and descending - nuclei of cn5 (spinal principal, motor and mesencephalic; 4 all together) - nuclei of CN 6 - - nuclei of CN 7 - nuclei of cn 8 (vestibular and cochlear) - cerebellum - control and coordination of fine manipulative conscious movements - lesion - intention tremor; closer you get to something or try to do something, the worst the tremor gets. |
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myelencephalon
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medulla oblongota
- pyramids - motor fibers from area 4 travel through it, why called the pyramidal system - nucleus gracillus - functn. with general sensory systems - nucleus cuneatous - function with general sensory system - nuclei of CN 9 - (ambiguous, solitarius, inf. salivatory) - nuclei of CN 10 - nuc. of cn 12 |
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olfactory nerve
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innervates olfactory receptors (sense of smell)
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optic
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innervates retina (vision)
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occulomotor
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innervates everything but the superior oblique (4) and the lateral rectus (6)
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trochliar 4
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innervates the superior oblique muscle
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trigeminal 5
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- ophthalmic division - innervates upper face and cornea
- maxillary - sensory to middle face AND upper teeth - mandibular - sensory to temporal region and lower face and anterior 2/3 of the tongue - MOTOR to muscles of mastication, mylohyoid, ant. digastric, tensor valli palitini and tensor tympani |
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motor innervations of CN 5
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muscles of mastication
mylohyoid ant. digastric tensor valli palitini tensor tympani |
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abducens - 6
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lateral rectus
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facial 7 -
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Motor - innervates muscles of facial expression along with cn 5, stylohyoid, post. digastric and stapedius.
Nervous intermedius - sense of taste from ant. 2/3 of tongue and PNS to lacrimal, sublingual and submandibular glands. |
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vestibulocochlear
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vestibular part - innervates semicircular canals, utriculus, and sacculus (sense of equilibriam and balance)
- cochlear - innervates cochlea (sense of hearing) |
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glossopharyngeal 9
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motor to stylopharyngeus
sensory for taste from post. 1/3 of tongue. - sensory to mucous membrane of post. 1/3 of tongue and upper pharynx (gag reflex) - carotid sinus (reflex) and - parasympathetic to parotid gland |
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vagus 10
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motor to pharyngeal and laryngeal muscles
- sensory for taste buds on epiglottis and parasympathetic to thoracic and abdominal viscera. |
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spinal accessory - 11
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SCM and trapezius
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hypoglossal 12
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muscles of the tongue.
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Circle of willis
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four major arteries
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dura mater has 2 regions
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cranial region - 2 layers
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2 layers of cranial region of dura mater
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external layer - serves as internal periosteum of skull bones surrounding brain.
- internal layer - meningeal layer, continuous with spinal dura mater through foramen magnum - venous sinuses - above layers are fused except in certain areas where seperations will be filled with venous blood, between two layers of dura. |
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second region of dura mater = dural folds
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falx cerebri - attached to crista galli and front crest anteriorly
- blends with tentorium cerebelli posteriorly - tentorium cerebelli - attaches along grooves for transverse sinuses posteriorly - attaches to sup. part of temporal bone laterally - ant. and medial portion make up tentorial notch; area where the midbrain passes throught and can injure brain if there is increased cranial pressure. - falx cerebri - attaches to the internal occipital crest posteriorly - attaches to tentorium cerebelli superiorly. |
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arachnoid mater
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delicate avascular membrane, bridges across brain sulci.
- cranial regions - applied to nner surface of dura and attaches to underlying pia mater by delicate fibrous threads - spinal region - continuous with cranial region - subarachnoid space - CSF (between arachnoid and pia mater) - subarachnoid cisternae - expanded regions of subarachnoid space - arachnoid granulations - tufts of arachnoid tissue that protrude into the dura mater which surrounds venous sinuses. a mesothelial ining of arachnoid contacts the endothelium of the sinus and csf is returned to the blood plasma across these linings. |
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pia mater
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thin, delicate , vascular layer which adherse to the brain surface dipping into fissures and sulci
- cranial region - some blood vessels supplying nervous tissue are located in the pia - spinal region - thicker and less vascular - denticulate ligaments - attach the spinal cord (from between dorsal and ventral roots) to the dura along the lateral wall of teh spinal canal - filum terminale - from the conus medularis to the coccyx (made of pia and dura) |
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meningial spaces
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epidural space
subdural space subarachnoid space |
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epidural space , subdural space and subarachnoid space
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- potential space between skull and dura
- meningeal vessels - epidural hematoma - usually a rupture of the meningial arteries, high pressure so side effects appear rapidly and people can enter a coma - subdural space - potential space between dura and arachnoid - subdural hematoma - usually involves dural sinuses, low pressure so side effects are slow to develop - subarachnoid space - csf - only normally occuring fluid filled space associated with the meninges - subarachnoid hemmhorage - from cerebral arteries, mix of blood and csf, aneurysm. |
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ventricular system
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- lateral ventricles - 2
- interventricular foramen of monroe - 3rd ventricle - aqueduct of sylvius (connects 3 and 4) - lateral apperture of luchshka (2 of them in the 4th ventricle area) - medial foramen of magendie (only 1) - CSF goes out these foramen into the subarachnoid space, traves to the arachnoid granulations and enters venous systems through these veins - choroid plexus - tufts of blood vessels in each ventricle that creates CSF - flow of CSF - made by choroid ventricles in ventricles - leaves through 2 lateral foramens and medial foramen - enters the subarcachnoid space - eventually reaches the arachnoid granulations which penetrate dura - csf enters through these into the venous sinuses and enters blood flow. - obstructions to flow - puts pressure on parts of the brain. |
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dural venous sinuses
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- sup. saggital
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temporal fossa boundaries
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from teh fintal process of the zygo bone to the sup. temporal oine and zygomatic arch
- medial - frontal, parietal, sphenoid and temporal bones (FORM THE PTERION) |
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contents of temporal fossa
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temporalis muscle and neurovascular supply (innervated by deep temporal nerves from CN V3, blood supply from deep temporal arteries (branch of max. artery) and middle temporal artery (branch of superficial temporal artery)
- these 2 branches anastomose - zygomaticotemporal branch of CN V2 |
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infratemporal region boundaries
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- lateral - medial aspect of ramus of mandible (contains opening of mandibular canal)
- medial - lateral pterygoid plate of sphenoid and soft tissue of pharynx (contains pterygomaxillary fissure) - anterior - infratemporal surface of the maxillae - posterior - articular tubercle of temporal and spine of sphenoid - superior - great wing of sphenoid (contains foramen spinosum, foramen ovale and petrotympanic fissure) - inferior - blends with submandibular region, no particular landmark |
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openings and communication
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-seperated fromt eh temporal fossa above by a plane drawn from the zygo arch to the great wing of the sphenoid
- foramen ovale - mandibular branch of CN V - foramen spinosum - middle meningeal artery (spine of sphenoid --> medial to foramen spinosum; attachment for sphenomandibular ligament) - pterygomaxillary fissure - maxillary artery between pterygoid process and maxilla - inf. orbital fissure - infraorbital NVB between maxillae and the great wing of the sphenoid. - posterior superior alveolar foramen transmits the PSA nvb. |
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contents of infratemporal fossa
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TMJ
- condyle of mandible - mandibular fossa of temporal (can see disck between this and condyle in dissection) muscles of mastication - medial pterygoid - lateral pterygoid - temporalis - masseter maxillary artery - terminal branch of external carotid artery - travels in infratemporal fossa - may run deep or superficial to lateral pterygoid muscles - mandibular, muscular and pterygopalatine part Mandibular brandh of trigeminal nerve |
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mandibular branch (sensory and motor) of trigeminal in infratemporal fossa
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main trunk - divides into upper and post. trunk after it exits foramen ovale
- meningeal branch - slips over to foramen spinosum and reenters the cranial cavity with the middle meningial artery. - nerve to tensor velle palitini - muscles tense soft palate - nerve to tensory tympani - in middle ear, muscle that helps dampens oscillations of loud sounds, prevents ear ossicles from getting destroyed by loud noise. - anterior trunk - smaller than post. trunk, mostly motor to muscles of mastication - masseteric - innervates masseter muscle - deep temporal - innervates temporalis - medial pterygoid - innervates medial pterygoid m. - lateral pterygoid m. innervates lateral pterygoid muscle - buccal n. - SENSORY nerve to the buccal mucosa inside the cheek and buccal gingiva, does NOT provide motor innervation ot the buccinatory (CN 7 does this) - Posterior trunk - has MOTOR an d SENSORY nerves ... - auriculotemporal - makes a loop around middle meningeal a. sensory to TMJ - lingual - general sensory innervation to the antl. 2/3 of the tongue CN 7 provides special sense (taste to the ant. 2/3 of the tongue) - lingual nerve of post. trunk of the mandibular division of the trigeminal transmits the special sense fibers of CN 7 chorda tympani meets up with the lingual nerve which then takes it to the tongue for innervation. - parasympathetic fibers on the chorda tympani go to the submandibular glands via the submandibular ganglions too. - inf. alveolar and mylohyoid and mental nerves - inf. alveolar - enters teh mand. foramen and is the sensory n. in the mand. teeth (terminal branches --> mental foramen and incisive n.) - mental n. - sensory to the chin and lower lip after emerging from the mental foramen - mylohyoid - comes off ing. alveolar and runsa long groove of mylohyoid to innervate mylohyoid muscle and ant. digastric m. |
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muscles innervated by CN V3
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temporalis, medial pterygoid, lateral pterygoid , masseter, ant. digastric, mylohyoid, tensor vali palitine and tensor tympani
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otic ganglion
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located just deep to the (located on the medial side of CN V3 - inf. salivatory nucleus (in the medulla; preganglionic neurons ) --> CN IX fiber --> tympanic n. -->tympanic plexus --> lesser petrosal --> parasympathetic fibers synapse in otic ganglion --> fibers run in auriculotemporal n. (of cn5) does NOT innervate the parotid -->though it innervates glandular tissue of parotid gland.
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CN V as a highway for other nerves
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- CN IX uses auriculotemporal n. (CN V) to get its destination to innervate the parotid gland
- CN VII - uses the lingual n. CN V to take taste fibers from chorda tympani to the ant. 2/3 of the tongue. |
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Parotid region boundaries
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ant. - ramus of mandible, masseter and medial pterygoid
- post. - mastoid process and SCM - inf. - post. digastrics and stylohyoid medial floor - styloid process and attached muscles and ligaments (stylomandibular ligaments) |
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contents of the parotid region -
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1. parotid gland
2. facial nerve 3. retromandibular vein deep to the parotid gland 4. external carotid artery 5. auriculotemporal nerve |
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parotid gland
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serous fluid secreting salivary gland
- capsule - deep thickening of capsular tissue around parotid gland - forms stylomandibular ligament - parotid duct - travels anteriorly across masseter, dives deep to pierce buccinator and opens into oral cavity opposite the second maxillary molar. |
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facial nerve
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2nd branchial arch and comes out of the styomastoid foramen
- passes throught eh parotid gland WITHOUT innervating it. - 5 branches supply the muscle of facial expression temporal, zygomatic, buccal, mandibular and cervical |
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Retromandibular vein
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deep to the parotid gland
- union of the superficial temporal and maxillary arteries - descends through parotid gland - ant. division joins facial vein and forms the common facial vein --> empties into IJV - post. division joins post. auricular vein and forms external jugular vein |
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external carotid artery
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traveling just post. to the ramus of the mandible. has branches
- enters region at the deep aspect of the parotid gland - terminates as superficial temporal and maxillary branches. |
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auriculotemporal nerves ON TEST FOR SURE
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- branch of mandibular division of CN5
- this does NOT innervate the parotid gland but rather acts as a helper to direct the nerve to the pariteid gland; parotid gland innervations is through CN 9 - salivation - presynaptic psymp. fibers from inferior salivatory nuclues in brainstem --> c.n. 9 --> tympanic nerve which traveesl through tympanic canal ->tympanic plexus -->lesser petrosal/small superficial n. -->otic ganglion |
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external carotid artery
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this and the subclavian supply blood for visceral neck (thyroid and larynx)
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branching pattern
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superior thyroid - provides internal structures of larynx, thyroid gland
- ant and post. branch - ascending pharyngeal - runs next to pharynx, supplies pharyngeal muscles, soft palate and may go to middle ear - lingual - deep to mylohyoid and hyoglossus muscle, supplies tongue muscles and floor of oral cavity - facial - runs under mandible and mandibular body to supply the face, ends at the side of the nose as the angular artery - occipital - supplies occipital region - post. auricular - runs post. to ear, supplies mastoid process area and ear - superficial temporal - supplies temporal region - maxillary - divides into 3 regions - 1. mandibular 2. muscular 3. pterygopalatine - goes through the fissure and lays on the fossa - terminal branches - superficial and temporal artery and maxillary artery. |
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muscles of mastication
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derived from 1st branchical arch
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4 true muscles
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1. medial pterygoid
- primary part - medial surface of lateral pterygoid - secondary part - pyramidal process of palatine and tuberosity of maxilla inserts - medial surface of ramus and angle of mandible elevates mandible (side to side movements) 2. lateral (external) pterygoid (runs deep to superficial ) 0 - superior head - great wing of sphenoid (roof of infratemporal fossa) inf. head - lateral surface of lateral pterygoid plate insert - articular disc of TMJ and neck of mandibular condyle. actions - protrudes the mandbile and depression ; if you contract unilaterally, it shifts the mandible to the opposite side. 3. temporalis - o- temporal fossa i. coronoid process and ant. border of mandibular ramus actions - post. horizontal fibers - retract and elevation - deep temporal artery - normally two in number ( anastomoses with middle temporal artery) 4. masseter - 3 parts A. superficial part - o - zygomatic process of maxilla and ant. 2/3 of inf. border of the zygomatic arch i. angle and lower lateral ramus of the mandible. B. intermediate part - o. inner surface of ant. 2/3 of zygomatic arch i. - ramus of the mandible C. Deep part - o. - inner surface of post. 1/3 of zygomatic arch i. superior part of mandibular ramus and lateal surface of coronoid process. a. powerful eleveator of the mandible - deep fibers aid in retraction - massateric artery - travesl through mandibular notch with masseteric n. |
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accessory muscles of mastication
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1. buccinator (c.N. 7) -
- compression of the cheek - keeps food between molars |
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pterygomandibular space boundaries
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lateral - medial surface of mandibular ramus
- medial - lateral surface of medial pterygoid - superior - lateral pterygoid - inferior - insertion of medial pterygoid |
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contents of pterygomandibular space
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where we put anesthetics
- lingual nerve - lose sensaton of tongue lose taste in ant. 2/3 - inf. alveolar nerve and artery - maxillary artery is close by. |
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Types of joints
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gomphosis - teeth in the socket immovable like sutures; these are known as synarthrosis.
diarthrosis - freely movable - arthroidal - gliding joint, ex. part of tmj - ginglymus - hinge, motion in one plane, ex. elbow, part of tmj, interphalangeal joints - trochoid - pivot, rotation around an axis, ex. dens of axis in the atlas - condyloid - knuckle joint - concave on a convex surface; flexion, extension, abduction, adduction, and circumduction (drawing around a circle, NOT rotation enarthroidal - ball and socket, can rotate through a longitudinal axis, ex. shoulder, hip, can move through all planes and can move in any plane, can circumduct and rotate. - sellar - saddle joint, concave and convex on concave and convex, ex. metacarpal thumb joint. |
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TMJ joint type
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ginglymoarthroidal or hinge and gliding joint or hinge and gliding joint.
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condyle of mandible
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functional part of joint with articular eminence (shaped like a roller)
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articular eminence of temporal bone
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ant. aspect of mand. fossa, roof or fossa is thin and may not bear pressure at this point
- articular tubercle - lateral aspect of mandibular fossa |
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capsule - dense fibrous conn. tissue
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surrounds joint and lined by synovial membrane
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articular disc (meniscus)
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dense fibrous tissues divides interior of joint into superior and inferior compartments
- superior compartments - gliding motion - inf. compartment - hinge motion - creates combo. that produces the ginglo classification - periphery of disc attaches to capsule - periphery of disc is thicker than central area. 1` |
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ligaments of TMJ
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TMJ (lateral)
- from zygomatic process of temporal bone to neck of mandibular condyle - prevents from post. displacement and excess lateral displacement of condyle by lateral pterygoid. sphenomandibular - from spine of the sphenoid to lingula - becomes taut in excessive opening (depression) - stylomandibular - from styloid process of temporal to angle of mandible - becomes taut in excessive protrusion |
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blood supply of TMJ
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superficial temporal
- maxillary - deep auricular |
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motion of TMJ
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combo of hinge and gliding
- protrusion - condyles move forward and discs glide down articular eminence - retrusion - reverse of above discs slides up and condyle moves back to the original spot. - depression - condyles rotate anteriorly around a horizontal axis, articular discs glide down the articular eminence. when widely openint the mouth protrusion and depression occur together. - elevation - the discs glide back up the articular eminence and the condyles rotate posteriorly around a horizontal axis. lateral deviation - when moving mandlble to the right, the disc on teh lfet glides down the articular eminence and the right condyle rotates slightly anteriorly (and vice versa) |
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muscle summary of TMJ
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protrusion - lateral pterygoid
retrusion - post. or horizontal fibers of temporalis, deep fibers of masseter Depression - suprahyoid muscles, infrahyoid muscles, and lateral pterygoid since this action also includes protrusion when mouth is opened widely. elevation =- masseter - medial pterygoid and temporalis - lateral deviation - oposite lateral pterygoid. |
