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297 Cards in this Set

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1.
C3
2.
Investing (deep/superficial), pre-tracheal, carotid sheath, prevertebral
3.
i. External occipital protuberance, superior nuchal line, mastoid, lower border of the mandible (laterally), skull base medially. Thickened between styloid and mandible (stylomandib ligament). ii. Spine of scapula, acromion, clavicle, posterior surface of sternum.
4.
External jugular vein, anterior jugular vein.
5.
Two ends of AJV, sternal heads of SCM, lymph node.
6.
The deep part of the investing fascia splits to enclose the inferior belly.
7.
The anterior longitudinal ligament – at T4
8.
All are DEEP. It is pierced by the 4 brs of cervical plex (GA, LO, TC, SC)
9.
True
10.
Upper limit is hyoid. Limited by the anterior attachment of the straps to the hyoid (sternohyoid mainly)
11.
The pretracheal space (fascia) runs inferiorly behind the brachiocephalic veins to blend with the adventitia of the aortic arch and fibrous pericardium.
12.
Basically the boundaries of the carotid canal and jugular foramen.
13.
True
14.
Submandibular space – Bounded inferiorly by investing fascia between hyoid and mandible and superiorly by the mylohyoid muscle. Open posteriorly along free edge of mylohyoid where opens into sublingual space.
15.
Approx 6.
1.
The posterior border of the SCM.
2.
Digastric triangle, carotid triangle, submental, muscular triangles
3.
Clavicular head – flat fleshy mass from middle third of clavicle, sternal head – a rounded tendon from manubrium adjacent to jugular notch.
4.
Enters SCM under cover of lobule of ear, deep to IJV, in front of lateral mass of atlas, passes obliquely through at about 1/3rd of the way down, gives SCM branches and appears at posterior surface of muscle approx 1 cm above GA nerve (Erb’s point). Enters the trapezius 1/3rd from its lower end (3-5cm from clavicle).
5.
GA nerve, EJV, Transverse cervical nerve
6.
Cervical plexus is beneath top half, carotid sheath is beneath bottom half.
7.
Blood supply is from the superior thyroid and occipital arteries.
8.
Spinal accessory nerve – (from C2,3). Bilaterally innervated.
9.
Splenius, levator scapulae, medial and anterior scalenes. Occasionally can see serratus anterior below or semispinalis capitis above.
10.
Cervical plexus, brachial plexus, phrenic nerve and subclavian artery
11.
See answer 4
12.
Transverse cervical artery and suprascapular artery.
13.
Anterior rami. Grey ramus is from superior cervical ganglion (on carotid). It lies on the scalenius medius (in series with brachial plexus).
14.
Anterior triangle (remember it lies under SCM which is a content of anterior triangle)
15.
It gives muscular branches to the prevertebral muscles (longis capitis, longus colli and scalenes), also branches to SCM, trapezius (mainly proprioceptive).
16.
17.
Phrenic arises from anterior rami C3,4,5 (mainly C4). Forms on scalenius anterior and runs from lateral to medial, beneath prevertebral fascia. It is found approx 1cm lateral to IJV at root of neck. It is medial to the ascending cervical artery. It runs behind the subclavian vein.
18.
XII
19.
It supplies the cranial surface of the ear, skin from angle of mandible and parotid and mastoid, and lower half of lateral ear below canal.
20.
Digastric is held down by a sling of fibrous tissue – not the stylohyoid as you’d think from pictures. The fibrous sling goes from the body to the greater horn of the hyoid.
21.
It gets a branch from the nerve to mylohyoid.
22.
Mylohyoid originates from the mylohyoid line – from 3rd molar to midline on inner surface of mandible, anterior 3/4s of muscle forms raphe with contralateral muscle. Posterior quarter of each attaches to anterior surface of body of hyoid.
23.
Nerve is branch of inferior alveolar nerve and pierces the sphenomandibular ligament.
24.
Geniohyoid is between the mylohyoids and the floor of the mouth.
25.
Omohyoid originates on the lateral part of the inferior border of the body of hyoid and diverges laterally, lying over the carotid sheath. It has two bellies, the flat tendon between them lies over the IJV. The lower belly attaches to the scapula and the transverse scapular ligament.
26.
Infrahyoid muscles depress the larynx, increase the volume of the resonating chamber and deepen the voice. They also oppose the elevators of the larynx, fine tuning the whole system.
27.
2 parts (superficial and deep). Sup part has 3 surfaces – lateral, inferior and medial. Lateral surface abuts the submandibular fossa of mandible and is grooved by the facial artery.
28.
Facial vein, cervical br of facial nerve, occasionally the marginal mandib branch.
29.
Deep part is between mylohoid and hyoglossus. Lingual nerve and duct are lateral to hyoglossus.
30.
Duct originates from superficial part of gland near the posterior border of mylohyoid, runs forwards between mylohyoid and hyoglossus on the deep part of the gland and then between genioglossus and sublingual gland to open into floor of mouth on sublingual papilla next to frenulum. The lingual nerve is initially lateral to the duct and then swerves deep to the duct. Plate 47.
31.
Superior mental spines – genioglossus. Inferior mental spines – geniohyoid. Digastrics go to digastric fossa.
32.
Nerve supply via submandibular ganglion which hangs off lingual nerve on surface of hyoglossus. Parasympathetics from nervus intermedius (superior salivary nucleus) to chorda tympani to lingual nerve. Symps via facial artery plexus.
33.
From oblique line of thyroid to 6th tracheal ring.
34.
Sternohyoid, sternothyroid.
35.
Left side – PIA (posterior 50%, inbetween branches of artery 33%, Anterior 12%). Right side – IAP (in between 50%, anterior 33%, posterior 12%). Non-recurrent nerves occur on right in 1:200, left much rarer.
36.
Behind the pretracheal fascia
37.
RLN divides into anterior (motor nerve) and posterior (sensory nerve). Motor supplies all intrinsic muscles except for cricothyroid. Sensation is all of ipsilateral glottis up to level of true cords.
38.
As described by Lore – external branch of SLN may travel on surface of inferior constrictor (type 1), perforate the constrictor 1cm above its insertion (type II) or run deep to the inferior constrictor (type III)
39.
Superior laryngeal artery, sternocleidomastoid artery, infrahyoid and cricothyroid arteries.
40.
Directly behind.
41.
Inferior laryngeal, branches to pharynx, oesophagus and trachea.
42.
Facial and IJV
43.
Middle thyroid vein goes to IJV, inferior thyroid vein often enters brachiocephalic vein via numerous branches
44.
2%
45.
Superior parathyroid (gland IV) usually on middle of posterior surface of thyroid lobe level with 1st tracheal ring and above the inferior thyroid artery. It is usually within the pretracheal fascia.
46.
Inferior glands are more variable – behind lower pole but may be in gland, outside sheath, in neck, superior or posterior mediastinum. Not always same on each level.
47.
10cm. 5cm in neck, 5 in mediastinum
48.
Common carotid surface marking is from sternoclavicular joint to thyroid lamina
49.
Medial to post belly of digastric and stylohyoid. Bifurcates within substance of parotid
50.
Deep lobe parotid, styloid, stylohyoid, styloglossus, stylopharyngeus, pharyngeal br vagus, glossopharyngeal nerve.
51.
Lateral! – therefore in danger when operating lateral to vessels
52.
3 anterior branches – STA, lingual, facial. 2 posterior (post auricular and occipital), 1 medial (ascending pharyngeal)
53.
Occipital artery crosses over the XI (sandwiches the XI between the occipital artery and the IJV) and the artery is crossed nearer its origin by XII. The XII is held down by the branch of the occipital to the SCM.
54.
2 to tonsil and soft palate – tonsillar branch and ascending palatine. Also submental artery which runs with mylohyoid nerve to submandib fossa, giving branches which anastomose with sublingual branches of lingual
55.
Starts off lateral to the external carotid, then rotates to be medial and posterior. It runs beside the pharynx. Behind it is the sympathetic trunk, the pharyngeal veins and the superior laryngeal branch of vagus. IJV is lateral and the vagus in between. Near its origin it is crossed by lingual and facial veins, the occipital artery and XII. Higher in neck it is crossed by SCM, post belly of digastric and stylohyoid muscles. The structures that run between it and the ECA are in q.50.
56.
Posterior part
57.
Initially it is behind the ICA, lies on transverse process atlas, crossed by XI. It then courses lateral to the ICA with vagus in between. Posterior relations are cervical plexus and phrenic nerve. Thoracic duct courses behind the left vein at C7. Cervical plexus lies on its lateral surface. Omohyoid tendon lies on it. It terminates in subclavian (to form brachiocephalic) between two heads of SCM.
58.
First is inferior petrosal sinus, then pharyngeal, facial and lingual veins. Superior thyroid vein (variable), middle veins. Variable.
59.
It emerges between ICA and IJV deep to posterior belly of digastric. Gives off its branch to ansa just at tip of greater horn of hyoid. It hooks around the occipital artery runs superior to greater horn of hyoid and then on lateral surface of hyoglossus where it gives off branch to thyrohyoid and runs deep to mylohyoid to enter the mouth.
1.
They insert onto the lateral process of the atlas.
2.
Longus capitis runs from the occipital bone (behind the pharyngobasilar fascia) to the transverse process of the ‘true cervical vertebrae’ C3-C6.
3.
Longus coli is a triangular shape. It too attaches to transverse processes of C3-C6.
4.
Sympathetics are medial to vertebral artery and anterior to prevertebral fascia.
5.
Sup cervical ganglion is 3cm long and lies infront of C2-3 vertebral bodies.
6.
To C1-4 anterior rami (cervical plexus)
7.
They follow the carotid arteries and their branches. They supply all the vessels and viscera of the head. Internal carotid nerve – pterygopalatine ganglion and eyeball (dilator pupillae). External carotid nerve – pharyngeal plexus and submandibular & otic ganglia.
1.
Scalenus anterior goes from transverse processes C3-6 to scalene tubercle on first rib. More a landmark than a useful muscle.
2.
Crossed by 1. Phrenic nerve 2. Vagus 3.sympathetic chain, 1. Inferior thyroid artery , 2. Transverse cervical artery 3. Supraclavicular artery and subclavian vein.
3.
Longus colli medially and subclavian vein inferiorly
4.
Tubercle of Chassaignaic (C6 transverse process). Vertebral artery runs through it.
5.
Artery runs behind the symp chain.
6.
Subclavian artery (and ansa subclavia)
7.
Phrenic nerve
8.
Its divided by the scalenus anterior. Its branches are : 1. Vertebral artery, 2. Thyrocervical trunk and 3. Internal thoracic artery.
9.
Costocervical trunk
10.
From sternoclavicular joint to 2cm above midpoint of clavicle.
1.
False – no deep fascia in face
2.
Frontalis (part of occipitofrontalis) and levator palpabrae superioris
3.
Orbital part – from frontal process of maxilla, lacrimal bone and nasal process of frontal bone and circumscribes orbit, palpebral part – from medial palpebral ligament to lateral palpebral raphe. Deep lacrimal part is from posterior lacrimal crest and lacrimal sac and join lateral palpebral part.
4.
Compressor nasalis (transverse part of nasalis on bridge) and dilators - dilator naris (alar part of nasalis), levator labii superioris alaeque nasi and depressor septi.
5.
Buccinator
6.
Buccinator arises from maxillary tuberosity, pterygomandibular raphe and mandible just above mylohyoid line. Interdigitates with superior constrictor muscle.
7.
Lingual nerve
8.
Level with 3rd molar. Enters mouth opposite 2nd molar
9.
Facial nerve (buccal branch). Buccal branch of mandibular nerve supplies proprioception.
10.
i. Levator labii superioris, ii. Levator anguli oris, iii. Zygomaticus major iii. Zygomaticus minor iv. Risorius, vi. levator labii superioris alaeque nasi
11.
depressor anguli oris, depressor labii inferioris, mentalis.
12.
Trigeminal – terminal branches anastomose freely with VII brs.
13.
Arises from stylomastoid foramen, lateral to styloid, medial to mastoid. Courses anteriorly, gives off muscular branches (auricularis posterior, occipitalis), then branches to stylohyoid and post belly digastric. Forms pes anserinus within substance of parotid – cervicofacial and temporofacial division. Temporal nerve runs from upper border of gland, crosses zygoma and goes to auricularis ant/sup and frontalis. Zygomatic runs above arch directly on periosteum. Buccal runs along parotid duct. Marginal runs along angle of mandible along border. Cervical branch runs directly downwards.
14.
Chewing problems – cant get bolus back into mouth
15.
Superficial
16.
Supraorbital, lacrimal, supratrochlear, external nasal and infratrochlear.
17.
Supraorbital, supratrochlear
18.
Infraorbital, zygomaticofacial, zygomaticotemporal
19.
Mental nerve, auriculotemporal, buccal
20.
Arises from anterior surface of ECA, indents the posterior surface of submandib gland and then runs over its superficial surface over the inferior border of mandible just anterior to masseter. Then runs to medial canthus, lying on buccinator. Major branches are tonsillar, ascending palatine, submental and then inferior and superior labial arteries.
21.
Facial vein is continuation of angular vein (formed from supraorbital and supratrochlear veins). Facial vein runs to angle of mandible, pierces the investing fascia, joined by the anterior branch of the retromandibular vein and joins the internal jugular vein. The retromandibular vein is formed by the confluence of the superficial temporal and internal maxillary veins. Its posterior branch pierces the fascia and joins the posterior auricular vein to form the EJV. It travels over the surface of the SCM and then pierces the fascia of the posterior triangle and enters the subclavian.
22.
The angular vein communicates with the ophthalmic veins which drain directly to cavernous sinus. The deep facial vein between the masseter and buccinator to the pterygoid plexus. This communicates with the cavernous sinus via the Vesalian ‘communicating’ veins (foramen ovale and lacerum).
1.
Skin, Connective tissue, Aponeurosis, Loose areolar tissue, pericranium
2.
Lateral – zygomatic arch, medial – pterion, greater wing of sphenoid, squamous temporal bone, anterior – maxilla, zygomatic process of frontal and zygoma.
3.
Temporalis muscle
4.
Zygomatic part of squamous temporal bone, zygoma and zygomatic process of maxilla
5.
Posteriorly – auriculotemporal, then temporal br of facial, zygomatic br facial.
6.
Temporal fascia attaches superiorly to superior temporal line and down to superior surface of zygomatic arch where it splits in two.
7.
Zygomaticotemporal nerve and a branch of superficial temporal artery
8.
They are superficial or attached to outer layer
9.
By staying deep to the outer layer and reflecting it forward
10.
Superior temporal line, and inferiorly to coronoid. Also has 2 slips to the retromolar trigone, a deeper larger band attached to a small crest on the mandible
11.
Deep temporal branches from internal maxillary and superficial temporal arteries
12.
From mandibular nerve – deep temporal branches
1.
Parotid (Stensen’s) duct and accessory parotid gland
2.
Maxillary artery, superficial temporal (via transverse facial) and facial artery
3.
Mandibular nerve
4.
Lateral, anteromedial (large) and posteromedial (small)
5.
Great auricular C2,3
6.
Risorius (part of SMAS)
7.
8.
Its styloid muscles – stylohyoid, styloglossus and stylopharyngeus
9.
True
10.
Maxillary and superficial temporal
11.
From gland, runs horizontally across masseter, enters buccal fat pat and buccinator level with 3rd molar, curves into mucosa at level of 2nd molar. Small valve prevents air in gland. 5 cm course.
12.
1.
True
2.
Lateral pterygoid plate, tensor palati and superior constrictor
3.
Ramus of mandible
4.
Posterior wall of maxillary sinus (has inferior orbital fissure in it)
5.
Greater wing of sphenoid and crest of sphenoid (which turns 90 degrees)
6.
Styloid process and carotid sheath
7.
Hyoid
8.
Deep lobe parotid, lateral and medial pterygoids, insertion of temporalis, maxillary artery (and branches), mandibular nerve (and branches), pterygoid plexus.
9.
True
10.
2 heads – one from lateral aspect of lateral pterygoid, another from roof of infratemporal fossa (greater wing sphenoid), inserts into pterygoid fovea on neck of mandible. Also a slip to the articular disc.
11.
Two heads – large from medial aspect of lateral pterygoid, courses at 90 degrees to lat pterygoid down inner surface of the angle of mandible. Smaller slip from maxillary tuberosity and pyramidal process of palatine bone joins main mass.
12.
Lat pterygoid is from anterior division of mandibular nerve, medial is from main trunk.
13.
Neck of mandible and sphenomandibular ligament
14.
Above – auriculotemporal nerve, below maxillary vein
15.
Lat Pterygoid
16.
Five are before the lat pterygoid. They enter foraminae. 4 go superiorly and one goes inferiorly. Branches superior are deep auricular, anterior tympanic, middle meningeal and accessory meningeal. Inferior alveolar branch goes inferiorly
17.
Muscular (to mm of mastication). Ant and post deep temporal, 1 to medial pterygoid, one to lat pterygoid and one to buccal area.
18.
These are after the lat pterygoid, and are in the pterygopalatine fossa. Each one accompanies a nerve of the pterygopalatine ganglion. Branches are sphenopalatine, posterior/superior alveolar, greater palatine, pharyngeal artery (follows palatovaginal canal) and artery of pterygoid (vidian) canal.
19.
Mainly from corresponding maxillary artery branches. Ends in maxillary vein.
20.
False.
21.
True
22.
False. Meckel’s
23.
Auriculotemporal nerve, maxillary artery and vein
24.
Mylohyoideus nerve, artery and vein
25.
Branches off main trunk (2), off anterior (mainly motor division – 5) and off posterior (mainly sensory division -4) Main branches are i. meningeal, ii. Nerve to medial pterygoid. Anterior branches are : 2 to temporalis muscle, 1 to masseter, 1 to lateral pterygoid, 1 buccal (sensory nerve). Posterior branches are mainly sensory: - inferior alveolar, lingual, auriculotemporal and 1 motor (nerve to mylohyoid)
26.
Auricle (pinna, external canal and TM), temporal region- also carries secretomotor brs to parotid
27.
Runs between sphenomandibular ligament and ramus of mandible to enter its mandibular foramen
28.
Arises below lat pterygoid, runs on medial one, contacts mandible makes a groove and runs on superior surface of mylohyoid\, crosses over the submandibular duct and then medial toward tongue
29.
Exits bone via petrotympanic fissure, grooves the medial side of the spine of the sphenoid and joins the lingual nerve 2 cm below the skull base.
30.
True!
31.
No, lateral.
32.
Yep
33.
True
34.
Divided into 3 parts by folds of dura. Anterior part contains IX and IPS. IX runs on the lateral side of the sinus. Middle part contains the X and XI (XI is obviously lateral as has to go to shoulder). The posterior part contains the sigmoid sinus.
35.
Passes through anterior part of jugular bulb, runs on lateral surface of internal carotid (between ECA and ICA), then on lateral surface of stylopharyngeus and down under hyoglossus to reach the tongue.
36.
Arises from jugular fossa and runs into tympanic canaliculus and over promontory as part of tympanic plexus. Exits as lesser petrosal nerve through the roof of the middle ear and runs along middle cranial fossa toward foramen ovale which it passes through to reach the otic ganglion.
37.
Inferior is much larger. Inf ganglion gets motor fibres from the cranial part of the accessory nerve.
38.
Arnold’s nerve arises from superior vagal ganglion. Runs through lateral wall of jugular foramen (through a special little hole) and then runs over the promontory. Leaves the ear by supplying post/inf quadrant of TM, adjacent ear canal skin and a bit of the cranial surface of pinna.
39.
The pharyngeal branches of vagus and glossopharyngeal nerves. They lie on the middle pharyngeal constrictor. Supply all pharyngeal muscles apart from stylopharyngeus and tensor palati.
40.
False – in front!
41.
Sternocleidomastoid branch of occipital artery
42.
Stylohyoid (posterior base), Stylopharyngeus (medial base), Styloglossus (anterior tip)
43.
It is deep to stylohyoid and post belly of digaastric but superficial to the stylopharyngeus.
1.
It is the palatine bone (perpendicular plate)
2.
Pterygopalatine ganglion, maxillary nerve, artery, vein and fat.
3.
Zygomatic nerve and posterior superior alveolar (goes with the artery)
4.
It is formed in the foramen lacerum. It is made of the greater petrosal nerve and the sympathetics (deep petrosal nerve) on the surface of the carotid artery.
5.
i. Medial posterior/superior nasal nerves – runs through sphenopalatine foramen. Larges of these is the nasopalatine nerve. ii. Lateral posterior/superior nasal nerves – also run through the sphenopalatine foramen. Iii, greater palatine nerve. IV. Lesser palatine nerves (2) – one to soft palate, one to tonsil. These carry taste back to VII. V. Pharyngeal nerve (back through palatovaginal canal)
6.
True!
1.
External nasal (end of anterior ethmoid), infratrochlear (br. of nasociliary), infraorbital nerve.
2.
Sphenopalatine, via ascending branches of greater palatine (via incisive canal), from anterior and posterior ethmoids and via labial branches of facial.
3.
1%
4.
Superiorly – anterior ethmoidal nerve, posteriorly from branches of the pterygopalatine ganglion (lateral posterior superior nasal nerves), inferiorly – via greater palatine and its branches.
5.
Septal nerve supply – mainly from nasopalatine nerve and also from anterior ethmoidal nerves. Medial posterior superior nasal nerves. Don’t forget cranial nerve I.
1.
On gums, hard palate and tongue.
2.
Mainly the buccal nerve (via the anterior division of mandibular. It’s the only sensory part of the anterior division of the mandibular nerve) –see Part VIII q25. Upper gums are supplied by greater palatine nerves, superior alveolar nerves and nasopalatine nerves (all branches of maxillary) and Lower gums = inferior alveolar, buccal and lingual nerves.
3.
20 in total. 2 incisors, 1 canine and 2 molars (these are replaced with premolars). Adult molars have no childhood counterpart. Start at 6 months. Finished by 24 months.
4.
First molar, central incisor, lateral incisor, first premolar, 2nd premolar, canines and then second permanent molars and then wisdoms. Numerical code : 612 45 378
5.
True
6.
Dorsum, tip, inferior surface and root
7.
Filiform – very small causing the velvety appearance of tongue. Fungiform – much larger but look like pink pinheads. They have a few taste buds on them. Vallate – large a dozen in number. Form a V concave anteriorly, with apex at foramen cecum. Folliate- numerous small mucosal folds containing taste buds – on the posterior 3rd of the tongue.
8.
Superior and inferior longitudonal, transverse and vertical. Extrinsic (4) are genioglossus, hyoglossus, styloglossus and palatoglossus
9.
Lateral are lingual nerve, XII nerve, duct. Medial are IX, stylohyoid lig and lingual artery.
10.
Dorsal lingual branch, branch to sublingual gland.
11.
Deep lingual vein, sublingual veins (same as the arterial brs of the lingual artery)
12.
True – particularly the posterior part
13.
False – palatoglossus (a soft palate muscle) is supplied by pharyngeal plexus
14.
In the geniculate ganglion of VII
15.
IX
16.
In jugular foramen (anterior 1/3rd)
17.
By the nerve to vallecula - the internal laryngeal nerve (br. of vagus)
18.
Muscle is from occipital myotomes which advance anteriorly between the IJV and carotid vessels. Starts around week 4. Mucosa is from 1st, 3rd and 4th branchial arches. First arch gives mucosa over anterior 2/3rds (lingual nerve and chorda), 3rd gives posterior 1/3rd (IX) and 4th small area over vallecula (internal laryngeal nerve). Anteriorly the midline tuberculum impar joins the lateral lingual swellings. Posteriorly the midline hypobranchial eminence contributes mucosa. Key to development is fact that 3rd arch tissue overgrows second arch so VII has no contribution except for chorda supply to taste buds.
1.
About 12 cm.
2.
Starts off at pharyngeal tubercle just anterior to foramen magnum. Then sweeps over longus capitis to petrous temporal bone just medial to carotid canal. Then runs anteriorly toward the medial pterygoid plate. The cartilaginous auditory tube indents its superior border. Suspended from skull it sweeps from one medial pterygoid plate to the other.
3.
True. It is medial to the pharyngobasilar fascia. Arises from the quadrangular area at the apex of the petrous apex.
4.
Superiorly – anterior is to post edge of medial pterygoid and hamulus, down pterygomandibular raphe to mandible. Posteriorly to the pharyngeal tubercle and forming a midline posterior raphe. Inferiorly it attaches to the inside of the middle constrictor at the level of the false cords. It has a deficient area between it and the middle constrictor.
5.
Basically things that have to get from lateral to the pharyngobasilar fascia to the inside of the pharynx - Stylopharyngeus, stylohyoid lig, lingual nerve and IX.
6.
IT is based inferiorly on the hyoid- on the greater horn, the lesser horn and the stylohyoid ligament. It is deep to hyoglossus. It sweeps around to meet its mate on the other side and inserts inside the inferior constrictor at the level of the vocal cords.
7.
Thyrohyoid membrane. Superior laryngeal nerve (internal branch) and vessels.
8.
Thyropharyngeus – from oblique line of thyroid cartilage, spanning over the cricothyroid muscle back to midline raphe. Inferior part is cricopharyngeus. This is a continuous muscle, no raphe here. Continuously closed apart from swallowing.
9.
From superior aspect of back of styloid- down through gap in constrictors down in front of carotid and inserting into posterior aspect of thyroid cartilage.
10.
Ascending pharyngeal artery, ascending palatine, tonsillar branch, greater palatine, pharyngeal, lingual and superior and inferior laryngeal arteries.
11.
Mainly at the back of the middle constrictor.
12.
Motor supply is via the pharyngeal plexus except for stylopharyngeus (IX). Sensation is via the plexus (IX sensory+X motor, X (internal laryngeal nerve). Sympathetics also via the plexus.
13.
C1
14.
The palatoglossus. Thus the tonsils are in the oropharynx.
15.
2nd pharyngeal pouch.
16.
Facial. It supplies the tonsil, along with the tonsillar branch of the facial and branches from the lingual, greater palatatine, lesser palatine and ascending pharyngeal.
17.
It forms a plexus outside the capsule which pierces the superior constrictor to drain into the pharyngeal plexus. A single ‘paratonsillar’ or external palatine vein often coalesces to pierce the superior contrictor. Nerve supply is from the IX but a small amount from lesser palatine too.
18.
Because it stimulates the internal laryngeal nerve.
19.
Medially the quadrangular membrane, laterally the thyrohyoid membrane superiorly and the thyroid lamina inferiorly.
20.
Palatoglossus, palatopharyngeus, tensor and levator palati and muscularis uvulae
21.
Arises from high on medial pterygoid, scaphoid fosssa and lateral aspect of Eustachian tube. Has to be lateral to tube otherwise it couldn’t open it nor would it be an effective tensor of the soft palate.
22.
To tense the palate so other muscles can act upon it = i.e levator can elevate, and opening the Eustachian tube.
23.
From the quadrate are on the inferior aspect of the petrous apex and adjoining medial side of cartilaginous Eustachian tube. The pencil shaped muscle then runs anteromedially and converges on the midline between the two heads of palatopharyngeus. It acts to pull the soft palate posteriorly and superiorly. It also opens the Eustachian tube.
24.
True. Palatopharyngeus arises from the superior side.
25.
2 heads, anterior head from hard palate and posterior one from superior surface of aponeurosis. Runs backward and laterally and inserts into superior aspect of thyroid cartilage. Acts to elevate the larynx and pharynx during swallowing.
26.
Main actor is palatopharyngeus, which pulls the posterior pharyngeal wall as a ridge (Passavant’s ridge) which then meets the upper surface of an elevated soft palate.
27.
Main supply is lesser palatine artery, ascending palatine branch of facial and ascending pharyngeal artery.
28.
False – tensor palati is from V3 (nerve to medial pterygoid) – similar origin to the muscles.
29.
Vagus – cranial part of accessory nerve (nucleus ambiguus) and pharyngeal branch of vagus
30.
Secretomotor fibres to soft palate – from sup salivary nucleus to GSPN to pterygopalatine ganglion (and thus to lesser palatine nerves). Also mediates taste from that area. (Hence herpes zoster in the mouth)
31.
IX –> nucleus tractus solitarius -> X
32.
Oral surface and posterior surface up to part which contacts passavants ridge – non-keratinizing squamous epithelium. Anterior part of nasal surface – respiratory epithelium. Submucosa has scattered minor salivary glands. Scattered taste buds and lymph follicles.
1.
Thyrohyoid membrane, Cricotracheal membrane, hyoepiglottic ligament and thyroepiglottic ligament. Intrinsic is cricothyroid ligament (conus elasticus) and quadrangular membrane.
2.
Hyaline
Elastic Fibrocartilage
Arytenoid
Corniculate
3.
Posterior bit lamina, anterior bit arch. Has facets for arytenoid and thyroid cart
4.
Synovial
5.
It is a fibroelastic membrane which connects the epiglottis (from midway) to the lateral aspect of the arytenoid cartilage. It has a free inferior border which constitutes the false cord.
6.
The cricothyroid ligament has a thickened medial portion and a thinner lateral portion which proceeds cranially to produce the free edge vocal ligament.
7.
That space below the inlet (aryepiglottic folds) and the false cords.
8.
Usually 23mm in men, 17mm in women. Usually 8mm between them posteriorly with quiet breathing.
9.
Generally it is of the respiratory type however over the lingual surface of the epiglottis and down over the aryepiglottic folds it is stratified squamous. It is also stratified squamous over the vocal folds.
10.
From the saccular mucous glands. IF they get blocked – saccular cyst.
11.
Yep – on lingual surface of epiglottis and aryepiglottic folds. Essentially because the mucosa is dragged from the posterior tongue.
12.
Several muscles sit behind the arytenoids – transverse arytenoids, oblique arytenoids, and their direct continuation to the epiglottis – aryepiglottic muscles. One sits behind the cricoid and attaches to the muscular process of the ipsilateral muscle – posterior cricoarytenoid. Some arise from the cricoid anteriorly and oppose the posterior cricoarytenoid – lateral cricoarytenoid. Some arise from arytenoids and shorten (relax) the cords – thyroarytenoid and vocalis. A bit of the thyroarytenoid goes up to the epiglottis and is called the thyroepiglottic muscle. They pull the aryepiglottic fold laterally and open the inlet (along with the aryepiglottic muscle). Lastly there is the cricothyroid muscle which attaches the lower horn of the thyroid cartilage to the lateral side of the cricoid arch.
13.
Superiorly from the superior laryngeal branch of the superior thyroid artery. It enters below the internal laryngeal nerve. The lower half is supplied by inferior laryngeal artery from inferior thyroid artery. It accompanies the RLN. Venous drainage is by accompanying names of same name.
14.
A. All muscles are supplied by RLN except cricothyroid which is supplied by external branch of SLN. They get their supply from the nucleus ambiguus via the cranial part of XI then to the vagus. B. Sensation is via the superior laryngeal nerve down to the level of the cords (via its internal branch). Thereafter it is by the RLN (via its posterior division). Sympathetic supply is via supplying vessels (superior and inferior laryngeal arteries).
15.
At 4 weeks a midline vertical laryngotracheal groove appears which then deepens and forms a laryngotracheal diverticulum. The epithelium is derived from the endoderm from the cranial end of the laryngotracheal tube. The cartilage is from 4th and 6th branchial arches. Then arytenoid swellings appear. Proliferation there causes larynx to be just a slit. Then the epithelium proliferates more and occludes the larynx. Recanalization occurs at week 10. (failure causes webs) .In the meantime the ventricles and the vocal folds are formed. The epiglottis is from the hypobranchial eminence. Muscles are from the myoblasts in the 4th and 6th branchial arches and are innervated by brs. Of the vagus.
1.
True
2.
Middle
3.
Frontal bone and part of the lesser wing of sphenoid posteriorly.
4.
True
5.
Zygomatic bone (hardest part) and the greater wing of sphenoid posteriorly
6.
Between the two wings of the sphenoid (greater and lesser). Inferior runs from the medial spect of the superior orbital fissure laterally between the greater wing and the maxilla
7.
Mainly the roof of the maxillary sinus, but also the zyogmatic bone laterally and the orbital process of the palatine bone posteriorly.
8.
Superiorly the frontal bone (notched for supraorbital vessels), zygomatic bone, maxillary bone.
9.
In front
10.
False – dense fibrous tissue.
11.
To the marginal tubercle of Whitnall (on the zygomatic bone)
12.
Medially – from medial palpebral branch of ophthalmic, and laterally from the lateral palpebral branch of lacrimal. Venous drainage is to the ophthalmic and angular veins
13.
Upper : supraorbital, supratrochlear, infratrochlear and lacrimal. Lower – infraorbital.
14.
Superior salivary nucleus- nervus intermedius – GSPN – pterygopalatine ganglion – zygomatic branch of maxillary via its anastomotic branch with lacrimal
15.
In the lacrimal groove formed by the frontal process of the maxilla and the lacrimal bone. It is crossed anteriorly by the medial palpebral ligament. Some fibres of orbicularis (palpebral part) insert into it.
16.
2cm. Opens 2cm behind the nostril via inferior meatus. Ciliated columnar epithelium.
17.
Tendinous ring is below the lesser wing of sphenoid. It is medial to the superior orbital fissure and partly encompasses it. The edges of the ring are the origins of the 4 rectus muscles. Within the ring there are the Optic nerve and ophthalmic artery (medially) and the 2 divisions of III, VI and nasociliary nerve. Laterally outside the tendinous ring is the Lacrimal Frontal and Trochlear nerves. Superior to the ring is the LPS (laterally) and Superior oblique (medially).
18.
Yes, smooth and skeletal muscle. Supplied by the superior branch of III and sympathetics. Lose the symps you get partial ptosis, lose the motor supply you get complete ptosis.
19.
Arises from the lesser wing of sphenoid, runs anteriorly to the trochlear (pulley) then backwards and laterally, passing inferior to the superior rectus and inserting into he posterior superior lateral quadrant of the eye.
20.
It is inferior and lateral (lateral because the internal carotid is lateral)
21.
Lacrimal, frontal and nasociliary (all sensory)
22.
– it ends as the anterior ethmoid nerve - but also has posterior ethmoid branch and the infratrochlear nerve branch. It also sends the long ciliary nerves to the ciliary ganglion (symps)
23.
i. eye cannot abduct – and at rest the unopposed inferior middle and superior recti cause the eye to turn in. ii. The eye cannot look down maximally when turned in. Causes problems when reading or when walking down stairs. Unopposed action of inferior rectus causes eye to turn out (extort) and thus the patient tilts head to compensate.
24.
Eye is down and out (with ptosis) and dilated pupil (loss of parasymps)
25.
Starts off in hypothalamus, descends in brainstem to T1. Then ascends to the superior cervical ganglion and accompany the internal carotid and ophthalmic artery to the nasociliary and then long ciliary branches.
1.
Atypical synovial – as there is no hyaline cartilage found – only fibrocartilage
2.
fibrocartilage
3.
anteriorly – to the articular eminence of the temporal bone, posteriorly to the tympanosquamous suture line, medially and laterally to the boundaries of the mandibular fossa.
4.
The lateral pterygoid
5.
Auriculotemporal nerve and nerve to masseter (Hilton’s law)
6.
When mouth is open the condyle lies forward on the slope of the articular eminence. Once dislocated the temporalis, masseter and medial pterygoids go into spasm.
7.
Gliding occurs in the superior aspect of the joint, opening the jaw occurs through the lower compartment.
8.
Digastric muscle, geniohyoid and genioglossus depress the mandible, the infrahyoid muscles stabilize the hyoid and then the lateral pterygoids open the mouth (inferior head)
1.
Elastic cartilage
2.
i. posterior auricular, superficial temporal arteries, deep auricular arteries
3.
from nerve to medial pterygoid
4.
4 arteries – posterior (from stylomastoid), anterior (from maxillary), superior (from middle meningeal) and inferior (from ascending pharyngeal)
5.
Each tympanic vessel has a corresponding vein – these end up in the pterygoid plexus. Some in the mastoid coalesce and form a mastoid emissary vein. This vein communicates between the sigmoid sinus and the posterior auricular vein.
6.
Lesser petrosal. – it has preganglionic parasymps from inferior salivary nucleus via otic ganglion. Arises in ME from the tympanic plexus, exits throught the lesser petrosal hiatus and then exits the skull via the foramen ovale, joins the otic ganglion and hence supplies the parotid gland.