H/n Folder

Front 1

Cricothyroid

Back 1

O: Anterolateral aspect of arch of cricoid cartilage

Ins: Oblique part-lesser horn of hyoid; straight part-inferior margin of thyroid cartilage

Inv: External lanryngeal [X]

Action: Tenses vocal cords

Front 2

Posterior cricoarytenoid

Back 2

O: Oval depression on posterior surface of lamina of cricoid


Ins: Posterior surface of muscular process of arytenoid cartilage


INV: Recurrent laryngeal [X]


Action: Abducts vocal cords

Front 3

Lateral cricoarytenoid

Back 3

O: Superior surface of arch of cricoid cartilage

Ins: Anterior surface of muscular process of arytenoid cartilage

Inv: Recurrent laryngeal [X]

Action: Adducts vocal cords

Front 4

Oblique arytenoid

Back 4

O: Posterior surface of muscular process of arytenoid cartilage

Ins: Posterior surface of apex of adjacent arytenoid cartilage; extends into aryepiglottic fold

Action: Recurrent laryngeal [X]

Sphincter = closes laryngeal inlet

Front 5

Thyro-arytenoid

Back 5

O: Thyroid angle and adjacent cricothyroid ligament


Ins: Anterolateral surface of arytenoid cartilage


Inv: Recurrent laryngeal [X]


Action: Relaxes vocal cords

Front 6

Vocalis

Back 6

O: Lateral surface of vocal process of arytenoid cartilage

I: Vocal ligament and thyroid angle

INV: Recurrent laryngeal [X]

Action: Adjusts tension in vocal folds

Front 7

Transverse arytenoid

Back 7

O: Lateral border of posterior surface of arytenoid


Ins: Lateral border of posterior surface of opposite arytenoid


Inv: Recurrent laryngeal [X]


Action: Closes posterior rima glottidis

Front 8

Longus Coli

Back 8

O:Bodies C5-T3 TPs C3-C5

Ins: Ant tubercle C1,Bodies C2-C4

Inv: Ventral rami C2-C6

Action: Flexes Neck

Front 9

Longus Capitis

Back 9

O: C3-C6

Ins: Occipital Bone

Inv: Ventral Rami(C1-C3)

Action: Flexes Head

Front 10

Rectus Capitis Ant.

Back 10

O: C1

Ins: Occipital Bone

Inv: Ventral Rami (C1-C2)

Action: Flexes Head

Front 11

Rectus Capitis Lateralis

Back 11

O: TP of C1

Ins: Occipital Bone

Inv: Ventral Rami (C1-C2)

Action: Flexes Head and Lateral Flexion.

Front 12

Cranial Nerves Overview

Back 12

Cranial nerves are similar in some ways to spinal nerves, which are probably more familiar to you.

Both cranial and spinal nerves link the central nervous system (CNS) to the periphery.

Cranial nerves attach to the forebrain and brain stem; spinal nerves attach to the spinal cord.

Each cranial nerve is associated with a central nucleus containing neurons with either sensory or motor functions.

Front 13

Olfactory Nerve: CN 1

Back 13

Function:
SVA for special sense of smell or olfaction.

Foramen:
The olfactory nerve enters the skull through the cribiform plate in the ethmoid bone.

Features:
Innervates the olfactory epithelium above superior nasal conchae.

Olfactory bulb contains cell bodies of sensory neurons, & olfactory tract/nerve contains the axons.

Fibers terminate in 3 regions, only 2 are of significance in man:
cortex of the uncus and the anterior part of the hippocampal gyrus (primary olfactory cortes)
septal region of the medial surface of the frontal lobe (modulates emotional response to smell)

Front 14

Optic Nerve: CN 2

Back 14

Function:
SSA for visual information from the retina.

Foramen:
The optic nerve enters the skull through the optic canal in sphenoid bone.

Features:
Visual information enters the eye in the form of photons of light which are converted to electrical signals in the retina.

Signals are carried via the optic nerves, optic chiasm, & tract to the lateral geniculate nucleus of the thalamus & then to the brain visual centers in the occipital lobe (either side of the calcarine sulcus).

Before the vision information even reaches the brain, the signal from the eyes crosses in a part of the optic nerve called the ‘optic chiasm’. The result of this is that half of each eyes vision goes to the opposite brain.

Front 15

Oculomotor Nerve: CN 3

Back 15

Function

GSE, somatic to extrinsic eye muscles (except LR & SO)

GVE, visceral to intrinsic eye muscles

Foramen
Superior orbital fissure

Features
Somatic motor supplies 4 of the 6 extraocular muscles of the eye & levator of upper eyelid.

Visceral motor to constrictor pupillae & ciliary muscle.
Preganglionics arise from Edinger westphal nucleus
Postganglionics arise from ciliary ganglion & axons travel
in short ciliary nerves

Occulomotor nucleus located in the midbrain (pretectal area)
Nerve leave midbrain and travels in the cavernous sinus

Front 16

Trochlear Nerve: CN 4

Back 16

Function
GSE, innervates the superior oblique muscle.

Foramen
Exits through superior orbital fissure

Features
Innervates superior oblique muscle for visual tracking or fixation on an object.
Neurons arise from trochelar nucleus in tegmentum of midbrain (around level of inferior colliculus ventral to cerebral aqueduct). Caudal midbrain.

Nerve leaves midbrain and travels in cavernous sinus

Front 17

Trigeminal Nerve: V1, V2, V3

Back 17

Function
GSA, entire sensation from the face, the forehead, the cheeks, and the jaw

GVA, sensation from oral cavity & tongue

SVE, motor to muscles of mastication, tensor tympani, tensor veli palatini, ant. Belly digastric, mylohyoid

Foramen
V1 = Superior orbital fissure & supraorbital notch/foramen
V2 = Foramen rotundum & infraorbital foramen
V3 = Foramen ovale

Front 18

Trigeminal Nerve Features

Back 18

Features
3 branches to innervate each of 3 regions of the face:

V1 (opthalmic branch)
sensory to lateral nose, upper eyelid, forehead & scap to vertex + dura of anterior cranial fossa,

V2 (maxillary branch)
sensory to upper lip & upper oral cavity (upper teeth), paranasal sinuses, skin over cheek & temporal region, dura of middle cranial fossa,

V3 (mandibular branch) Motor Branch
sensory to lower lip, jaw, lower oral cavtiy (lower teeth & tongue), & area above ear, dura of middle cranial fossa.
Motor to muscles of mastication, tensor tympani, tensor veli palatini, anterior belly of digastric & mylohyoid

Cell bodies for sensory neurons (pain,temperature, touch) are located in the trigeminal ganglion (semilunar/gasserian ganglion)
Fibers terminate in spinal trigeminal nucleus (tract) in medulla oblongata

Exception to rule are sensory afferents from proprioceptors in jaw, cell bodies located in nucleus in midbrain & pons = mesencephalic nucleus

Front 19

Abduscens Nerve: CN 6

Back 19

Function
GSE, innervates the lateral rectus muscle.

Foramen
Exits through superior orbital fissure

Features
Axons have the longest intracranial course of all cranial nerves (clinically relevant, when intracranial pressure increases it is 1st nerve to be affected)
Fibers originate from abducens nucleus in Pons (just ventral to 4th ventricle)
Fibers exit at border of pons & medulla and course through the cavernous sinus

Front 20

Facial Nerve: CN 7

Back 20

Function
SVE, muscles of facial expression.
GVE, parasympathetic to lacrimal, sublingual & submandibular glands
SVA, taste anterior 2/3rd’s tongue & soft palate
GSA, skin of external ear & tympanic membrane

Foramen
Enters internal acoustic meatus, traverses the facial canal & exits through stylomastoid foramen

Features
SVE, To branchial arch muscles of facial expression (+platysma); posterior belly of digastric muscle; stylohyoid, & stapedius.
GVE. Provides parasympathetic innervation of the lacrimal, submandibular, & sublingual glands, mucous membranes of nasopharynx.
Parasympathetics in pterygopalatine & submandibular ganglion
SVA, for taste (gustation) from anterior 2/3 of tongue & soft palate
GSA from the skin of the concha of the auricle & tympanic membrane
Cell bodies for sensory neurons reside in geniculate ganglion & enter brainstem through nervus intermedius.

Front 21

Glossopharyngeal Nerve: CN 9

Back 21

Function
SVE, stylopharyngeus
GVE, parasympathetics to parotid gland
SVA, taste posterior 1/3rd of tongue & pharynx
GVA, carotid sinus & carotid body
GSA, posterior 1/3rd of tongue, skin of external ear & meatus

Foramen
Jugular foramen

Features
Motor innervation to stylopharyngeus muscle
Parasympathetics to parotid gland via lesser petrosal nerve
Cell bodies lie in otic ganglion.
Special sensation taste from the posterior 1/3rd of the tongue.

General sensation(pain, temperature & touch) from posterior 1/3rd of tongue, upper pharynx, eustachian tube & middle ear
Visceral afferents from carotid sinus baroreceptors & carotid body chemoreceptors.

Front 22

Vagus Nerve: CN 10

Back 22

Function

GVE, parasympathetic to smooth muscle and glands of the pharynx, larynx, and viscera of the thorax and abdomen

SVE, skeletal muscles of soft palate, pharynx & larynx, 1 extrinsic tongue muscle

GVA, baroreceptors in aortic arch & chemoreceptors in aortic bodies

SVA, visceral sensation from respiratory, cardiovascular & gastrointestinal systems

GSA, posterior wall of pharynx

Foramen
Jugular foramen

Features
"Vagus" is from the Latin meaning wandering. Vagus nerve wanders from the brainstem to left colic flexure
Supplies the voluntary muscles of the pharynx and most of the larynx, as well as one extrinsic muscle of the tongue.
Parasympathetic innervation of the smooth muscle and glands of the pharynx, larynx, and viscera of the thorax and abdomen.
Provides visceral sensory information from the larynx, esophagus, trachea, & abdominal & thoracic viscera.

Front 23

Accessory Nerve: CN 11

Back 23

Function
SVE, muscles of larynx & pharynx, trapezius & sternocleidomastoid

Foramen
Jugular foramen

Features
Has acranial root and a spinal root, both of which consist of motor fibers.

Cranial branch joins with vagus & innervates muscles of larynx & pharynx because this root travels with CNX some texts consider its fibers part of CNX
Spinal branch innervates the trapezius & sternocleidomastoid muscles.

Front 24

Hypoglossal Nerve: 12

Back 24

Function
GSE, muscles of tongue

Foramen
Hypoglossal canal

Features
Supplies all intrinsic muscle & 3 of the 4 extrinsic muscles of the tongue: genioglossus, styloglossus, & hyoglossus.

Front 25

Pretracheal/Danger Space

Back 25

Pretracheal/‘Danger’ space:

Extends from the base of the skull to the posterior mediastinum at the level of the diaphragm is limited laterally by its fusion with the prevertebral layer and the vertebral transverse process.

Front 26

Retropharyngeal Space

Back 26

Retropharyngeal space:

Extends from the base of the skull to the level of the 1st or 2nd thoracic vertebrae.

Contains two lateral chains of lymph nodes separated by a midline raphe

Front 27

Prevertebral Space

Back 27

Prevertebral space:

Lies between the vertebral bodies and the prevertebral layer of the deep cervical fascia.

It extends from the base of the skull to the level of the coccyx.

Front 28

Three Spaces limited by the Hyoid Bone

Back 28

3 Spaces:

Submaxillary

Sublingual

Parapharyngeal spaces

Front 29

Spaces limited to below the hyoid bone

Back 29

Anterior visceral space

Front 30

Superior Cervical Ganglion

Back 30

Opposite C2-C3, behind carotid art anterior to longus colli

6 Branches:
Gray rami to C1-C4
Internal carotid nerve to plexus
Artery to ext & int carotids
Pharyngeal branches join CNIX & X pharyngeal plex
Superior cardiac branch to cardiac plexus
Deep petrosal nerve

Front 31

Middle Cervical Ganglion

Back 31

Opposite C6, superior to inf. Thyroid artery

3 branches:
gray rami to ventral rami of C5 & C6

arterial branches to inferior thyroid artery

middle cardiac branch to cardiac plexus

Front 32

Inferior Cervical Ganglion

Back 32

Fused with thoracic ganglion = stellate ganglion, between TP of C7 & neck of 1st rib posterior to vertebral artery

3 Branches:
gray rami to ventral rami of C7-C8
arterial branches to subclavian & vertebral arteries
inferior cardiac branch to cardiac plexus

Front 33

Deep Layer

Back 33

The deep layer envelops the paraspinous muscles and vertebral bodies. More importantly, anterior to the vertebral bodies it divides into a prevertebral layer and a more anterior alar layer. This creates three potential spaces, namely the prevertebral space, the danger space and the retropharyngeal space. The carotid sheath is formed from contributions of all three layers of the deep cervical fascia and runs from the base of the skull to the level of the clavicle.

Front 34

Laryngopharynx

Back 34

Features:

Mucosal fossae/recesses
1. Laryngeal inlet

2. Piriform fossa (recess)

Sensory Innervation:
Vagus nerve (CNX) from pharyngeal plexus

Front 35

Oropharynx

Back 35

Features:
Lymphoid tissue

Palatine tonsils (arches)

Lingual tonsils (base of T)

Folds or Arches
1. Palatoglossal

2. Palatopharyngeal

Sensory Innervation:
Glossopharyngeal nerve (CNIX) via pharyngeal plexus

Front 36

Nasopharynx

Back 36

Features:
Lymphoid tissue:
Adenoids

Openings in Lateral Walls
1. 1st gap

2. Eustachian tube

Sensory Innervation:

Pharyngeal branch of maxillary nerve from trigeminal (CNV2)

Front 37

Longitudnal Pharyngeal Muscles

Back 37

3 Muscles:

Innervation = CNIX & CNX

Action = elevate pharynx & depress the palate

Stylopharyngeus
CNIX

Salpingopharyngeus
CNX

Palatopharyngeus
CNX

Front 38

Pharyngeal Constrictors

Back 38

Superior constrictor:
Contraction facilitates closing & sealing oropharynx from nasopharynx

Middle & Inferior constrictors:
Facilitate moving a bolus of food towards the esophagus

Front 39

Inf. Constrictor

Back 39

Cricoid cartilage, oblique line of thyroid cartilage, and a ligament that spans between these attachments and crosses the cricothyroid muscle

Invervation: Vagus Nerve

Posterior Attachment: Pharyngeal Raphe

Front 40

Sup. Constrictor

Back 40

Ant Attachment:

Pterygomandibular raphe and adjacent bone on the mandible and pterygoid hamulus

Innervation: Vagus Nerve

Posterior Attachment: Pharyngeal Raphe

Front 41

Mid. Constrictor

Back 41

Ant. Attachment:

Upper margin of greater horn of hyoid bone and adjacent margins of lesser horn and stylohyoid ligament

Innervation: Vagus Nerve

Posterior Attachment: Pharyngeal Raphe

Front 42

Pharyngeal Constrictors Action

Back 42

Constricts the Pharynx

Front 43

Cricoid Cartilage

Back 43

The cricoid cartilage sits just inferior to the thyroid cartilage in the neck, and is joined to it medially by the median cricothyroid ligament and postero-laterally by the cricothyroid joints.

Inferior to it are the rings of cartilage around the trachea.
The cricoid is joined to the first tracheal ring by the cricotracheal ligament, and this can be felt as a more yielding area between the firm thyroid cartilage and firmer cricoid.

Front 44

Artytenoid Cartilage

Back 44

Features:

A pair of small pyramidal laryngeal cartilages that articulate with the lamina of the cricoid cartilage and give attachment to the posterior part of the corresponding vocal ligament and to several muscles

Articulations:
2 joints = With Cricoid cartilage & with Corniculate cartilages

Attachments:
2 attachments = thyroid cartilage via vocal lig. & epiglottis quandrangular membrane

Front 45

Inlet of larynx

Back 45

Inlet of Larynx:

Anterior = epiglottis

Posterior = mucous membr between arytenoids

Laterally = aryepiglottic folds

Front 46

Communication of the Larynx

Back 46

Communications:

Superior = laryngopharynx

Inferior = trachea

Front 47

Parts of the Larynx

Back 47

Parts:
Vestibule (rima vestibuli = gap between vestibular folds)

Ventricle (rima glottidis = gap between vocal cords)

Infraepiglottic or subglottic

Glottis = vocal apparatus (vocal cords & rima glottidis)

Front 48

Epiglottis

Back 48

Elastic cartilage, projects superiorly to posterior aspect of tongue & hyoid bone.

Attached to thyroid cartilage via thyroepiglottic ligament

Front 49

Attachments of the Epiglottis

Back 49

Attachments (4):

Thyroepiglottic ligament

Hyoepiglottic ligament

Quadrangular membrane

Glossoepiglottic folds (2 lateral & 1 median)

Front 50

Attachments of the Arytenoid Cartilages

Back 50

Attachments of Arytenoid Cartilages:

2 attachments = thyroid cartilage via vocal lig. & epiglottis quandrangular membrane

Front 51

Articulations of the Arytenoid Cartilages

Back 51

Articulations:

2 joints = With Cricoid cartilage & with Corniculate cartilages

Front 52

External Ear Features

Back 52

External Ear Features:

1. Auricle

2. External auditory meatus/canal

3. Tympanic Membrane (eardrum)

Front 53

Middle Ear

Back 53

Middle Ear:

1. Ossicles

2. Eustachian tube or Pharyngotympanic duct

3.Auditory tube

Front 54

Inner Ear

Back 54

Inner Ear:

1. Oval window

2. Cochlear

3.Vestibular apparatus: Semicircular canals/Utricle & Saccule

4. Vestibulocochlear nerve (CNVIII)

Front 55

External Parts of Auricle

Back 55

External Parts of Auricle:

1. Branches of Cervical plexus (C2 & C3)
*Greater auricular and Lesser Occipital

2. Branch of Trigeminal (CNV)
*Auriculotemporal

Front 56

Internal Parts of Auricle

Back 56

Branch of Vagus (CNX)
*Auricular branch

Branch of Facial (CNVII)
*Auricular branch

Front 57

Extrinsic Muscles

Back 57

Extrinsic Muscles are Innervated by Facial nerve (CNVII)

Front 58

External Ear: External Acoustic Meatus & Tympanic Membrane Features

Back 58

External Acoustic Meatus & Tympanic Membrane Features:

1. Lateral 1/3rd: Cartilage

2. Medial 2/3rd’s: Hard

3. Ceruminous glands

Front 59

Innervation of the External Ear

Back 59

Innervation of External Ear:

CN V3 – auriclotemporal
CN X – auricular branch

Front 60

Blood Supply of the External Ear

Back 60

Blood Supply to the External Ear:

1. Maxillary artery – Deep auricular artery

2. External carotid – Posterior auricular artery

3. Superficial temporal artery – Anterior auricular artery

Front 61

Tympanum

Back 61

Tympanum:

1. ‘Pearlescent’ membrane

*Umbo = central depression

Innervation: CN V, CN X (External membrane) & CNIX
(Internal aspect of membrane)

Front 62

Middle Ear Features

Back 62

1. Roof: Epitympanic recess, tegmen tympani separating from middle cranial fossa

2. Floor: Thin bone separating from int. jugular vein

3. Anterior: Opening to auditory tube

4.Posterior: Aditus to mastoid antrum, pyramidal eminence with stapedius muscle

5.Medial: Oval & round window, prominence of facial canal, cochlea

6.Lateral: Tympanic membrane

Front 63

Contents of the Middle Ear

Back 63

Contents of the Middle Ear

1. Air

2. 3 ossicles

3. 2 muscles/2nerves

Front 64

Auditory Ossicles:

Malleus, Incus, Stapes (MIS)

Back 64

*Malleus attached to tympanum; Stapes connected to oval window
(fenestrae ovalis)

*1st bones to fully ossify in developing fetus

*Conduct & transmit sound to cochlear (magnifying sound waves ~18x’s)

*Muscles pulling on ossicles work to attenuate sound (dampen loud noises) but also give better frequency resolution at higher frequencies by reducing the transmission of low frequencies

Front 65

Tubes of the Inner Ear

Back 65

Inner ear is 2 tubes:

*Boney labyrinth: Outer tube made of bone

*Membranous labyrinth: Inner tube made of membrane

Front 66

Oval window of the Inner Ear

Back 66

Oval window to where the stapes is attached

Round or cochlear window sits below

Front 67

Inner Ear Tube Fluid(s)

Back 67

Each tube is filled with fluid.

*Boney labyrinth contains perilymph.

*Membranous labyrinth contains endolymph.

Front 68

Inner Ear Divisions

Back 68

Inner ear divided into 3 parts:

1. Vestibule (with Utricle & Saccule)

2. Semicircular canals

3. Cochlea.

Front 69

Sensory Cells of the Inner Ear

Back 69

Sensory cells:

*Hair cells with stereocilia.

*Supporting cells

Front 70

Features of the Cochlear

Back 70

Features of the Cochlear:

Snail shell’ attached to central pillar of bone, modiolus

Cochlear nerve penetrates modiolus

Front 71

Cochlear Labyrinths

Back 71

Labyrinths divided:

1. Cochlear duct (membranous labyrinth, endolymph)

2. Scala vestibuli & tympani (boney labyrinth, perilymph)

Front 72

Helicotrema

Back 72

Helicotrema:

End of snail shell, point where scala vestibuli & scala tympani are continuous

Front 73

Spiral organ (Organ of Corti)

Back 73

Spiral organ (Organ of Corti):

Organ of hearing, rests on the basilar membrane, and projects into the enclosed, endolymph-filled cochlear duct

Front 74

Anatomy of the Organ of Corti

Back 74

Cochlear duct contains hair cells that rest on a basement or basilar membrane & have their cilia embedded in the tectorial membrane.

Front 75

Sound Waves of the Ear

Back 75

*Sound waves compress vestibular membrane that in turn compresses fluid in cochlear duct. Compression of the fluid generates waves.

*Waves in the fluid move the tectorial membrane & basilar membrane, in turn stretching & moving the hair cells.

*These movements send electrical signals to the brain that are interpreted as sounds.

Front 76

High Frequency of Sound

Back 76

High frequency sounds selectively vibrate the basilar membrane of the inner ear near the entrance port (the oval window). Lower frequencies travel further along the membrane before causing appreciable excitation of the membrane

Front 77

Place Theory

Back 77

The place theory is the first step toward an understanding of pitch perception. But considering the extreme pitch sensitivity of the human ear, it is thought that there must be some additional "sharpening" mechanism to enhance the pitch resolution.

Front 78

Pitch

Back 78

Pitch is based on the location along the tectorial membrane where the hair cells are stimulated

Front 79

Schemetic View of Pitch Theory

Back 79

A schematic view of the place theory unrolls the cochlea & represents the distribution of sensitive hair cells on the organ of Corti.

Pressure waves are sent through the fluid of the inner ear by force from the stirrup .

Front 80

Semicircular Canals

Back 80

The semicircular canals are the body's balance organs, detecting acceleration in the 3 perpendicular planes (x, y, & z).

Front 81

Semi Circular Canals In Depth

Back 81

Each semicircular canal surrounds a semicircular duct.

(remember the 2 tubes 1 inside the other – outer tube = semicircular canal; inner tube = semicircular duct).

Front 82

Ampulla of the Ear

Back 82

Ampulla of the Ear:

At the base of each duct is a swollen region, ampulla.

Within ampulla hair cells are attached to the cristae, an elevated region.

Front 83

Hair Cells of the Organ of Corti

Back 83

These accelerometers make use of hair cells similar to those on the organ of Corti.

Hair cells sit on the crista within each semicircular duct.

From the hair cells are cilia that are embedded in an overlying gelatin matrix.

Hair cells detect movements of the fluid in the canals caused by angular acceleration about an axis perpendicular to the plane of the canal.

The canals are connected to the vestibular nerve.

Front 84

Utricle and Saccule

Back 84

Utricle & Saccule:

Continuous with semicircular canals are 2 other enlarged chambers at the base of the vestibular complex

Front 85

Fxns of the Utricle and Saccule

Back 85

Fxns of the Utricle and Saccule:

These structures also contain hair cells, & cilia of the hair cells are embedded in overlying gelatin.

Tiny floating particles aid the process of stimulating the hair cells as they move with the fluid (otoconia or statoconia).
Utricle & saccule detect gravity & linear acceleration

Front 86

Auditory Pathway

Back 86

Information from both ears goes to both sides of the brain - in fact, binaural information is present in all of the major relay stations illustrated here.

Front 87

Auditory Cortex

Back 87

Auditory Cortex:

Like the ‘homunculus’ in the sensory & motor cortices of the brain, the auditory cortex has a map of the cochlear duct with specific areas mapping specific sound frequencies.

Front 88

Auditory Nerve

Back 88

The auditory nerve from one ear takes information to the brain, that information is directly sent to both the processing areas on both sides of the brain

Front 89

Tinnitus & Noise Induced Hearing Loss

Back 89

Tinnitus & Noise Induced Hearing Loss

*Speech at range of ~50-70dB.

*>85dB for prolonged periods can cause hearing loss
(e.g. hairdryer ~85dB, chain
saw 100-110dB, rock concert 110-120, jet engine 120-140dB)

Front 90

Vertigo & Meniere’s Disease/Syndrome

Back 90

*AKA idiopathicendolymphatic hydrops

*An increase in endolymph volume: symptom complex of; episodic vertigo (vertigo being the sensation of spinning or whirling), tinnitus (hissing, ringing or roaring usually in one ear), fluctuating hearing loss (usually in the ear with tinnitus) and aural pressure (feeling of fullness or pressure in the involved ear)

Front 91

Vestibular rehabilitation

Back 91

Vestibular rehabilitation is an exercise approach to the remediation of disequilibrium and dizziness.

Front 92

External Nose Muscles

Back 92

3 External Nose Muscles:

1. Nasalis

2. Levator labii superiorus alaeque nasi

3. Depressor septi nasi

Front 93

Boney Parts of the External Nose

Back 93

Bony parts of the External Nose

1. Nasal bones

2. Maxillae

3. Frontal bones

Front 94

Anteriorly and Lateral Parts of the External Nose

Back 94

Anteriorly & Lateral Parts of the External Nose:

1. Lateral processes of septal cartilage

2. Major alar cartilages

3. 3 to 4 minor alar cartilages

4.1 septal cartilage

Front 95

Bones of the Nasal Cavities

Back 95

Bones of nasal cavities:

*Unpaired:
*Ethmoid, sphenoid, frontal bone, and vomer;

*Paired:
*Nasal, maxillary, palatine, lacrimal bones, & inferior conchae.

Front 96

Nose Boundaries

Back 96

Nose Boundaries:

1. Floor

2. Roof

3. Medial Wall

4. Lateral Wall

Front 97

Nasal Cavity Features

Back 97

Nasal Cavity Features:

1. Right & left halves divided by nasal septum

2. Each cavity extends from nostril (most anteriorly) to choane (most posterior)

3. Choanae are the oval-shaped openings between the nasal cavities and the nasopharynx

4. Posteriorly communicates with nasopharynx

Front 98

2 Main Divisions of the Nasal Cavity

Back 98

2 Main Divisions of the Nasal Cavity:

1. Vestibule: Lined by modified skin, with hair

2. Nasal Cavity Proper: Olfactory mucosa upper 1/3rd

*Respiratory mucosa lower 2/3rd’s, continuous with mucous membranes in sinuses & nasopharynx

Front 99

Functions of Concha

Back 99

Functions of Concha:

1. Slow down airflow by making turbulence

2. Increase surface area for humidifying air

Front 100

Superior Meatus

Back 100

Superior meatus:

Receives posterior ethmoidal sinuses

Front 101

Middle Meatus

Back 101

*Bulla ethmoidalis, rounded swelling caused by underlying middle ethmoidal sinuses

*Hiatus semilunaris, curved groove beneath bulla, opening for maxillary sinus

*Infundibulum for opening of frontal & anterior ethmoidal sinuses

Front 102

Inferior Meatus

Back 102

Receives nasolacrimal duct

Front 103

Blood Supply/Drainage of the Nasal Mucosa

Back 103

5 Branches of the Blood Supply of the Nasal Mucosa

1. Sphenopalatine artery (maxillary)

2. Greater palatine artery (maxillary)

3. Anterior & posterior ethmoidal arteries (opthalmic)

4. Superior labial artery (facial)

5. Lateral nasal artery (facial)

Front 104

Nose Bleeds

Back 104

Vessels that supply the nasal cavities form extensive anastomoses with each other.

*Particularly in anterior region of medial wall (Kiesselbach's area); anastomoses between greater palatine, sphenopalatine, superior labial, & anterior ethmoidal arteries.

* This area is the major site of 'nose bleeds' or epistaxis

Front 105

Clinical Implications of Nasal Cavity

Back 105

1.Sneezing reflex

2.Chronic infections

3. Rhinitis/sinusitis

Front 106

2 Subdivisions of the Oral Cavity

Back 106

2 Subdivisions of the Oral Cavity:

1. Oral Vestibule: Horseshoe shaped, is between the dental arches and the deep surfaces of the cheeks and lips

2. Oral Cavity proper: Enclosed by the dental arches

Front 107

Functions of the Oral Cavity

Back 107

Functions of the Oral Cavity

*Inlet for digestive system

*Manipulates sounds

*Breathing

Front 108

Features of the Oral Cavity

Back 108

Features of the Oral Cavity:

1. Opening for duct of Parotid gland (Stenson’s duct)

2. Frenulum of tongue

3. Frenulum of upper lip

4. Frenulum of lower lip

5. Sublingual fold over sublingual salivary gland

6. Sublingual papilla (caruncle) for opening of submandibular duct

Front 109

Skeletal Framework of the Oral Cavity

Back 109

6 Bones of the Oral Cavity:

1. (3 Paired) Maxillae, Palatine, Temporal

2. (3 Unpaired) Mandible, Sphenoid, Hyoid

Front 110

Maxillae

Back 110

Maxillae:

Contributes substantially to the architecture of the roof of the oral cavity. The parts involved are the alveolar and palatine processes

Front 111

Palatine

Back 111

Palatine:

Contribute to the roof of the oral cavity are the horizontal plate and the pyramidal process

Front 112

Sphenoid

Back 112

Sphenoid:

Pterygoid processes and spines of the sphenoid bone are associated with structures related to the soft palate, which forms part of the roof of the oral cavity

Front 113

Mandible

Back 113

Mandible:

Upper surface of the body of mandible bears the alveolar arch, which anchors the lower teeth, and on its external surface on each side is a small mental foramen.

Internal surface of the mandible are two pairs of small spines between the last molar tooth and the mylohyoid line is a shallow groove for the lingual nerve.

Medial surface of the ramus is a large mandibular foramen for transmission of the inferior alveolar nerve and vessels.

Front 114

Temporal Bone

Back 114

Temporal Bone:

Styloid process and inferior aspect of the petrous part of the temporal bone provide attachment for muscles associated with the tongue and soft palate, respectively.

Front 115

Hyoid Bone

Back 115

Hyoid:

Hyoid bone is a key bone in the neck because it connects the floor of the oral cavity in front with the pharynx behind and the larynx below

Front 116

Lower Teeth

Back 116

Lower Teeth:

CNV3/Inferior Alveolar Nerve: Molars directly

Incisive branch of Inferior Alveolar:
First premolar, the canine, and the incisor teeth

Mental branch of Inferior Alveolar

Front 117

Upper Teeth

Back 117

Upper Teeth:

CNV2/Anterior superior alveolar: Incisors & Canines

Middle superior alveolar: Premolars

Posterior superior alveolar nerves: Molars

Front 118

Intrinsic Muscles of the Tongue

Back 118

4 Intrinsic Muscles of the Tongue

1. Sup. Longitudinal

2. Vertical

3. Transverse

4. Inf. Longitudinal

Front 119

Extrinsic Muscles of the Tongue

Back 119

4 Extrinsic Muscles of the Tongue:

1. Sup. Longitudinal

2. Inf. Longitudinal

3.Transverse

4. Vertical

Front 120

Intrinsic Muscles of the Tongue

Back 120

Intrinsic Muscles of the Tongue:

Lengthening and shortening it;

curling and uncurling its apex and edges;

Flattening and rounding its surface

Front 121

Genioglossus

Back 121

Genioglossus:

Origin: Sup. Genial tubercles of mandible

Insertion: Fibers into tip & body of tongue

Action: Protrude tongue

Front 122

Hyoglossus

Back 122

Hyoglossus:

Origin: Upper border of body & greater horn of hyoid

Insertion: Posterior inferior surface of tongue

Action: Depresses the tongue

Front 123

Styloglossus

Back 123

Styloglossus:

Origin: Styloid process

Insertion: Side & inferior aspect of tongue

Action: Elevates and Retracts tongue

Front 124

Palatoglossus

Back 124

Palatoglossus:

Origin: Inferior surface of palatine aponeurosis

Insertion: Posterior lateral side of tongue

Action: Depress palate

Front 125

Innervation of the Tongue

Back 125

Innervation of Tongue:

*CN XII (Hypoglossal)

*CN X (Palatoglossus)

Front 126

Arterial Supply of the Tongue

Back 126

Arterial Supply of the Tongue:

Lingual artery

Front 127

Venous Drainage of the Tongue

Back 127

Venous Drainage of the Tongue:

*Deep lingual vein

Front 128

General Sensation of the Tongue

Back 128

General Sensation of the Tongue:

*CN V3: Anterior 2/3rd’s via lingual nerve

*CN IX: Posterior 1/3rd

Front 129

Special Sensation of the Tongue

Back 129

Special Sensation of the Tongue:

*CN VII, anterior 2/3rd’s via lingual nerve then chorda tympani

*CN IX, posterior 1/3rd

Front 130

General Sensation of the Tongue Overview

Back 130

General Sensation of the Tongue:

*Touch & Pressure (Mechanoception)

*Proprioception

*Thermoception

*Nociception

*Chemoception

Front 131

Special Sensation of the Tongue Overview

Back 131

Special Sensation:

4 special senses (vision, hearing, taste & smell)

Front 132

Taste Overview: SVA

Back 132

*CN VII: Anterior 2/3rd’s

*CN IX: Posterior 1/3rd

Front 133

Submandibular Gland

Back 133

Submandibular Gland:

Under body of mandible

Parts: large superficial & small deep part continuous around mylohyoid muscle

Submandibular duct = Wharton’s duct: emerges from deep part & opens in subligual papilla either side of frenulum of tongue (Lingual nerve passes below it)

Front 134

Sublingual Gland

Back 134

Sublingual Gland:

Under mucous membrane of floor of mouth

Sublingual ducts = Bartholin’s ducts (8-20) open into mouth at summit of sublingual fold

Front 135

Parasympathetic Innervation

Back 135

Parasympathetic Innervation

Parasympathetic Preganglionics: Runs in facial, chorda tympani & lingual nerves to submandibular ganglion

Postganglionics: Arise directly from submandibular ganglion, run in lingual nerve

Front 136

Sympathetic Innervation of the Salivary Glands

Back 136

Sympathetic:

Postganglionics; arise from superior cervical ganglion run in plexus around lingual artery

Front 137

Blood Supply of the Salivary Glands

Back 137

Blood Supply:

Facial & lingual artery branches

Front 138

Innervation of Oral Cavity

Back 138

5 Major Nerves of the Oral Cavity

1. Trigeminal (CNV)

2. Facial (CNVII)

3. Glossopharyngeal (CN IX)

4. Vagus (CN X)

5. Hypoglossal (CNXII)

Front 139

Innervation of the Oralpharynx

Back 139

Innervation of the Oropharynx: Glossopharyngeal Nerve

Front 140

Palatine Tonsils

Back 140

Palatine Tonsils:

Between palatoglossal & palatopharyngeal arches.

Front 141

OropharyngealIsthmus Innervation: Palatine Tonsils

Back 141

OropharyngealIsthmus Innervation:

Oropharynx innervated by CN IX (Glossopharyngeal Nerve) sensory afferents

Front 142

OropharyngealIsthmus borders

Back 142

OropharyngealIsthmus borders:

1. Lateral

2. Superior

3. Inferior

Front 143

Gag Reflex

Back 143

GAG” Reflex CN IX carries
SVA for taste & GSA for pain temperature & touch in mucosa of posterior 1/3rd of tongue, upper pharynx, eustachian tube & ear

Touching back of mouth (oropharynx) or soft palate stimulates
CN IX to initiate a “GAG” reflex associated with coughing/gagging

Front 144

When the Doctor says “Ah”

Back 144

Palate elevation and the gag reflex are impaired in lesions involving CN IX, CN X, the neuromuscular junction, or the pharyngeal muscles.

Front 145

Tensor veli palatini

Back 145

O: Scaphoid fossa of sphenoid bone; fibrous part of pharyngotympanic tube; spine of sphenoid

Ins: Palatine aponeurosis

Inv: Mandibular nerve [V3] via the branch to medial pterygoid muscle

Action: Tenses the soft palate; opens the pharyngotympanic tube

Front 146

Levator veli palatini

Back 146

O: Petrous part of temporal bone anterior to opening for carotid canal

Ins: Superior surface of palatine aponeurosis

Inv: Vagus nerve [X] via pharyngeal branch to pharyngeal plexus

Action: Only muscle to elevate the soft palate above the neutral position

Front 147

Palatopharyngeus

Back 147

O: Superior surface of palatine aponeurosis

Ins: Pharyngeal wall

Inv: Vagus nerve [X] via pharyngeal branch to pharyngeal plexus

Action: Depresses soft palate; moves palatopharyngeal arch toward midline; elevates pharynx

Front 148

Palatoglossus

Back 148

O: Inferior surface of palatine aponeurosis

Ins: Lateral margin of tongue

Inv: Vagus nerve [X] via pharyngeal branch to pharyngeal plexus

Action: Depresses palate; moves palatogossal arch toward midline; elevates back of the tongue

Front 149

Musculus uvulae

Back 149

O: Posterior nasal spine of hard palate

Ins: Connective tissue of uvula

Inv: Vagus nerve [X] via pharyngeal branch to pharyngeal plexus

Action: Elevates and retracts uvula; thickens central region of soft palate

Front 150

Teeth Overview

Back 150

32 teeth:

16 upper jaw & 16 lower jaw

Incisors

Canines (Cuspids),

Premolars (Bicuspids)

Molars (Tricuspids)

Front 151

Dental Formula

Back 151

Adult Dental Formula:

Incisors = 4

Canines = 2

Premolars = 4

Molars = 6 (2 may be removed)

Front 152

Pediatric Dental Formula

Back 152

Pediatric Dental Formula:

Incisiors = 4

Canines = 2

Molars = 4

Front 153

Teeth Misc

Back 153

On each side in both maxillary and mandibular arches are two incisor, one canine, two premolar, and three molar teeth.

The incisor teeth are the 'front teeth' and have one root and a chisel-shaped crown, which 'cuts';

The canine teeth are posterior to the incisors are the longest teeth, have a crown with a single pointed cusp, and 'grasp'.

The premolar teeth (bicuspids) have a crown with two pointed cusps, one on the buccal (cheek) side of the tooth and the other on the lingual (tongue) or palatal (palate) side, generally have one root (but the upper first premolar next to the canine may have two), and 'grind';

The molar teeth are behind the premolar teeth, have three roots and crowns with three to five cusps, and 'grind'.

Front 154

4 Major Foramina of the Nasal Cavity

Back 154

4 Major Foramina of the Nasal Cavity

1. Cribriform plate

2. Sphenopalatine foramen

3. Incisive canal

4. Small foramina in lateral wall & margin of nares

Front 155

Foramina of the Nasal Cavity

Back 155

For entry of vessels & nerves

Front 156

Innervations of the Nasal Mucosa

Back 156

1. Olfactory nerves (CNI); innervate olfactory mucosa

2. Opthlamic & Maxillary Nerve(s) (CNV) sensory to internal nose

3. Anterior ethmoidal Nerve (CNV1)

4.Nasopalatine Nerve (CNV1)

5. Lateral nasal Nerve (CNV2)

6. Greater petrosal Nerve (CNVII): nasal mucosal glands

Front 157

Paranasal Sinuses

Back 157

Paranasal Sinuses

1. Sphenoidal Sinus

2. Ethmoidal Sinus

3. Maxillary Sinus

4. Frontal Sinus

Front 158

Superficial Layer of the Cervical Fascia

Back 158

Thin layer of CT that connects dermis to deep fascia. Contains adipose tissue,

Front 159

Deep 4 Compartments of the Cervical Fascia

Back 159

1. Investing layer
2. Pretrachial layer
3. Preverteberal layer
4. Carotid Sheath

Front 160

Investing layer

Back 160

Thick layer, encircles the neck.
Divides to enclose the traps, SCM, parotid/submandibular glands, Infrahyoid muscles(SOT)

Front 161

Pretrachial layer

Back 161

Surrounds the the thyroid and parathyroid glands, esophagus/trachea.

Front 162

Prevertebral layer

Back 162

Thick layer, posterior to pharynx and esophagus.

Front 163

Platysma

Back 163

O: Fascia of the neck and chest
Ins: Inf. border of the mandible
Inv: Cranial nerve 7/Fascial nerve
Action: Draws corner of mouth inf./skin of the neck sup.

Front 164

Cutaneous nerves of the superficial structures of the neck
(GSA)

Back 164

1.Lesser Occipital
2. Greater Auricular
3. Transverse Cervical
4. Supraclavicular

Front 165

Sternocleidomastoid muscle

Back 165

O: Sternum and Ant./Sternal triangles.

Ins: Mastoid process of temporal bone.

Inv: Cranial nerve 9 (spinal acc)

Action: SS flexion, acc. respir.

Front 166

Omohyoid muscle

Back 166

O: Upper border of the scapula

Ins: Hyoid bone

Inv: Ansa Cervicalis (C1-C3)

Action: Depresses the larynx and the hyoid bone

Front 167

Digastric muscle

Back 167

O: Digastric Fossa/Mastoid Process

Ins:Int. tendon

Inv: V3, CN 5 and 7

Action: Opens jaw with Masseter and temporalis relaxed

Front 168

Sternohyoid muscle

Back 168

O: Manubrium of the Sternum

Ins: Hyoid bone

Inv: Ansa Cervicalis

Action: Depresses Hyoid

Front 169

Sternothyroid muscle

Back 169

O: Manubrium of the sternum

Ins: Thyroid cartilage

Inv: Ansa Cervicalis

Action: Depresses thyroid cartilage

Front 170

Thyrohyoid muscle

Back 170

O: Thyroid cartilage of the larynx

Ins: Hyoid bone

Inv: First cranial nerve(C1-C2)

Action: Elevates Thyroid/Depresses mandible

Front 171

Platysma

Back 171

O: subcutaneous tissue of infraclavicular and supraclavicular regions

Ins: Base of the mandible

Inv: Facial nerve(CN7)

Action: Draws the corners of the mouth inferiorly and widens it. Also draws the skin of the neck superiorly when teeth are clenched

Front 172

Intrinsic Eye Muscles: Adjusting

Back 172

Adjust Pupil:
Sphincter pupillae (Parasympathetic)

Dilator pupillae (Sympathetic)

Adjust Lens:

Ciliary muscles (Parasympathetic)

Dilator pupillae (Sympathetic)

Front 173

Innervation of the Eye: Pararsympathetic

Back 173

Innervation:
Parasympathetic
From CNIII (Pregang)

Short ciliary nerves (Postgang)
Sphincter pupillae
Ciliary muscle

Front 174

Innervation of the Eye: Sympathetic

Back 174

Sympathetic

From T1-T2, Sup Cervical Ganglion

Long ciliary nerves (Postgang)

Dilator pupillae

Front 175

Boney Walls of the Eye

Back 175

Boney Walls
Roof; frontal bone & lesser wing of sphenoid

Floor; maxilla, zygomatic bone, palatine bone

Lateral; zygomatic bone & greater wing of sphenoid

Medial; lacrimal, Ethmoid & frontal bones, & body of sphenoid.

Front 176

Contents of the Eye

Back 176

Contents

Eye ball

Extraocular (extrinsic) eye muscles

Nerves

Vessels

Lacrimal apparatus

Fat & fascia

Ciliary ganglion

Front 177

Intraorbital of the Eye

Back 177

Intraorbital:

Nasolacrimal canal

Zygomatico-orbital foramen

Ethmoidal foramina

Front 178

Periphery of the Orbit

Back 178

Periphery of Orbit

Supraorbital notch (foramen)

Infraorbital foramen

Front 179

Intraorbital of the Eye

Back 179

Intraorbital

Superior orbital fissure

Inferior orbital fissure

Optic canal

Front 180

Elevator of the Eye

Back 180

1 Elevator
Levator palpebrae superiorus

Front 181

Rectus muscles of the Eye

Back 181

4 Rectus
Superior rectus
Inferior rectus
Medial rectus
Lateral Rectus

Front 182

Oblique muscles of the Eye

Back 182

2 Oblique’s
Superior oblique
Inferior oblique

Front 183

Inf. Oblique of the Eye

Back 183

Inferior oblique
Origin: Anterior/medial part of orbit
NOTE: is the only extrinsic muscle that does not take origin from the posterior part of the orbit

Front 184

Sup. Oblique of the Eye

Back 184

Superior oblique
Orign: Body of sphenoid

Front 185

Rectus Muscles of the Eye

Back 185

ALL Rectus muscles
Origin: common tendinous ring in posterior orbit

Front 186

Levator Palpebrae Sup

Back 186

Levator palpebrae sup.
Origin: Lesser wing of sphenoid

Front 187

All eye muscles insert where

Back 187

ALL Muscles
Insert: sclera of eyeball

Front 188

Innervation of the Extrinsic Eye Muscles

Back 188

Innervation:
3 Cranial Nerves:
Occulomotor (CNIII)
Trochlear (CNIV)
Abducens (CNVI)

Front 189

Foramina of the Eye

Back 189

Foarmina:
Superior orbital fissure
Transmits ALL 3 cranial nerves to extrinsic eye muscles.

2 pass through common tendinous ring; CNIII & CNVI

Front 190

Innervation of the Extrinsic Eye Muscles Formula

Back 190

(LR6SO4)3

Front 191

Autonomic Innervation: Ciliary Ganglion

Back 191

Parasympathetic Innervation
to sphincter pupillae & ciliary muscles

Stimulation acts to constrict pupil & accommodate lens for near vision (e.g. reading a page, or in response to a bright light)

Front 192

Preganglionics of the Ciliary Ganglion

Back 192

Preganglionics:
Originate in nucleus in midbrain, Edinger Westphal nucleus

Fibers travel with occulomotor nerve (CNIII)

Front 193

Postganglionics of the Ciliary Ganglion

Back 193

Postganglionics:
Small ganglion behind eyeball, between optic nerve & lateral rectus muscle

Fibers travel with short ciliary nerves

Front 194

Lacrimal Nerve

Back 194

Lacrimal Nerve
Sensory & secretomotor to lacrimal gland
Lateral part of upper eyelid & conjunctiva

Front 195

Frontal Nerve

Back 195

Frontal Nerve
Supraorbital & supratrochlear branches

Upper eyelid, scalp to vertex & frontal sinus

Front 196

Nasociliary Nerve

Back 196

Nasociliary Nerve
Nasociliary nerve, long ciliary nerve, infratrochlear nerves, & ethmoidal nerves
Cornea, medial eyelids, root of nose, ehtmoidal & sphenoidal sinuses

Front 197

Optic Nerve

Back 197

Special Somatic Afferents (SSA)
Optic Nerve (CNII)

Front 198

9 Branches of the Opthalamic Artery

Back 198

Originates as branch of internal carotid artery:

Lacrimal artery

Supraorbital artery*

Supratrochlear artery*

Dorsal nasal artery*

Ethmoidal arteries (anterior & posterior)

Ciliary arteries

Muscular arteries

Central artery of retina*

Palpebreal arteries (eyelids)

Front 199

Drainage of the Eye

Back 199

2 Veins:

Superior opthalmic vein

Inferior opthalmic vein:
Drains into Sup. Opth. Vein

NOTE: orbital venous drainage is in direct communication with the cranial vault (fossa)

Front 200

Tributaries of the Eye

Back 200

Tributaries ultimately drain into cavernous venous sinus

Front 201

Blinking Reflex

Back 201

Blinking Reflex
Touching the cornea

Tests for:
Integrity of sensory afferents

Front 202

Pupillary Reflex of the Eye

Back 202

Pupillary Reflex:

Shining bright light into eye

Tests for:
Integrity of parasympathetic supply, as should constrict pupil

Front 203

Eye Movement Tests

Back 203

Eye Movements (Somatic)

Looking to corners etc
Tests for:

Integrity of CN III, IV, & VI

Front 204

Lesions of the Eye

Back 204

Lesions

CNIII Damage

Signs:
Ptosis, eyeball abducted & depressed

Pupil dilated

Front 205

Horner's Syndrome

Back 205

HORNER’s Syndrome

Cause:
Damage to cervical sympathetic trunk

Signs:
Drooping eyelid (ptosis), Paralysis of levator palpebrae superioris

Constriction of pupil

Warm skin on face, vasodilation of blood vessels of skin

Front 206

Weber's Syndrome

Back 206

WEBER’s Syndrome

Cause:

Damage to midbrain & CNIII

Signs:

Ipsilateral paralysis of eye & contralateral hemiplegia (paralysis of muscles on opposite side of body

Front 207

Rectus Muscles of the Eye

Back 207

Medial rectus = adduction (moves eye medial)

Lateral rectus = abduction (moves eye lateral)

Superior rectus = elevate eye (moves eye superior)

Inferior rectus = depresses eye (moves eye inferior)

Front 208

Oblique Muscles of the Eye

Back 208

Superior oblique = rotates eye downwards & outwards (inferiorly & lateral)

Inferior oblique = rotates eye upwards & outwards (superiorly & lateral)

Front 209

Superior Cerebral Veins

Back 209

Superior cerebral veins*
Empty into superior sagittal sinus

Head Trauma can tear these veins & lead to subdural hemorrhage

*Superficial middle cerebral vein

*Deep middle cerebral vein

Front 210

Ant. Cerebral Vein

Back 210

Anterior cerebral vein*

Accompany anterior cerebral artery, unite to form the Basal vein of Rosenthal

Front 211

Basal Vein

Back 211

Basal vein*

Runs back at base of brain curves around midbrain & empties into Great Cerebral Vein

Front 212

Stroke

Back 212

2 Categories:

Hemorrhagic (bleeding)
Hypertension
Aneurysm

Occlusive (closure)
Atherosclerosis
Thrombosis

Front 213

Ischemia

Back 213

Ischemia:

Insufficiency of blood supply (including lack of O2, decreased glucose, decreased waste removal).

Transient or prolonged

Front 214

Infarction

Back 214

Infarction:

Loss of blood supply with subsequent death of neural tissue.

Front 215

MCA Damage

Back 215

MCA

Contralateral paralysis in lower part of face & arm, with sensory deficits within cortex (aphasia, Wernicke’s & Broca’s area deficits for left middle cerebral artery infarction)

Front 216

ACA Damage

Back 216

ACA

Paralysis & sensory deficits in contralateral leg & perineum
Striatal deficits

Front 217

PCA Damage

Back 217

PCA

Blindness (calcarine artery infarction) in contralateral visual field

Thalamic & midbrain syndromes

Front 218

Effects of Brainstem Vascular Syndromes

Back 218

Effects:
Altered consciousness
Altered eye movements
Pupil action affected
Visual loss (including hallucinations)
Agitated delirium
Memory loss
Quadriplegia
Total paralysis except eye movements (“Locked in State”)
Spastic quadriparesis
Hyperactive gag reflex
Explosive crying or laughing

Front 219

Bilateral infarctions

Back 219

Bilateral infarctions of posterior cerebral artery can have devastating effects, Can cause COMA!!

Front 220

Great Cerebral Vein of Galen

Back 220

Great cerebral vein (of Galen)*

Receives basal veins, tributaries from cerebellum, & the internal cerebral veins
Empties into the straight sinus

Front 221

Internal Cerebral Vein

Back 221

Internal cerebral vein*

Runs posterior in the transverse fissure
2 internal cerebral veins unite in posterior part of corpus callosum & drain into great cerebral vein with the basal vein

Front 222

Venous Drainage of the Int. Cerebral Veins

Back 222

Thalamostriate vein
Choroidal vein

Front 223

Ext. Structures of the Eye

Back 223

External structures:

Eyelids/palpebrae & tarsal plates

Medial & lateral canthus
Caruncle & canal of schlemm

Front 224

Linings or Membranes of the Eye

Back 224

Linings or membranes:

Conjunctiva (palpebreal & ocular)

Cornea

Front 225

2 Chambers of the Eye

Back 225

2 Chambers:

Anterior chamber
Posterior to cornea but anterior to lens

Filled with aqueous humor

Posterior chamber
Posterior to lens (4/5th’s of eyeball)

Filled with vitreous humor

Front 226

3 Tunics/Layers of the Eye

Back 226

Fibrous Tunic:
Outer, tough fibrous coat, is sclera & cornea

Vascular Tunic:
Blood vessels, continuous with ciliary body & iris anteriorly

Neural Tunic:
Subdivided into neural & pigmented parts

Contains the nerve cells of the retina

Front 227

Cornea of the Eye

Back 227

Cornea:

Outward bulge of eye, behind this is the pupil

Front 228

Iris of the Eye

Back 228

Iris

Colored part of the eye
Central hole = pupil

Smooth muscle fibers adjust diameter of the pupil:

Sphincter pupillae
Dilator pupillae

Front 229

Lens of the Eye

Back 229

Lens

Located behind the iris

Composed of crystalline fibers that come from epithelial (hormone-producing) cells

Front 230

4 layers of the Lens

Back 230

Has 4 layers:
Capsule, subcapsular epithelium, cortex & nucleus

Front 231

Ciliary Body of the Eye

Back 231

Ciliary Body:

Forms a complete ring around the eyeball.

Divided into:
Ciliary muscle
Ciliary processes

Front 232

Ciliary Muscle

Back 232

Ciliary Muscle is smooth muscle fibers arranged longitudinally, circularly, and radially

Front 233

Ciliary Process

Back 233

Ciliary processes longitudinal ridges projecting from the inner surface of the ciliary body

Zonular fibers attach ciliary processes to the lens

Front 234

6 layers of cells of the Retina

Back 234

6 distinctive layers of cells:

1. Ganglion cells, axons form the optic nerve

2. Amacrine cells, interneurons


3. Bipolar cells, interneurons


4. Horizontal cells, interneurons


5. Photoreceptors (rods & cones), light sensitive neural cells


6. Pigmented, absorbs light prevents light refracting back into eye

Front 235

Optic Disc

Back 235

normal disk is 1.5 to 2.0 mm across and may be nearly round or oval in shape

optic nerves form a rim (like a hump) of nerve tissue over the edges of the disk before descending into the nerve

Front 236

Blind Spot

Back 236

no photoreceptors over the optic nerve head, so the disk area creates a small absolute blind spot in the visual field 15 degrees temporal to fixation

Front 237

Macula

Back 237

Macula:

Lateral to the optic disc a small area, yellow in color

Region of greatest visual acuity

Region is devoid of rods, highest concentration of cone photoreceptors

No overlying blood vessels, nor interneurons

Front 238

Fovea Centralis

Back 238

Fovea centralis:
central depression of the macula

Front 239

Short Posterior Ciliary Arteries

Back 239

Short posterior ciliary arteries:

ophthalmic artery branches pierces sclera around optic nerve

Front 240

Long Posterior Ciliary Arteries

Back 240

Long posterior ciliary arteries:

enter sclera on medial & lateral sides of optic nerve

Front 241

Anterior Ciliary Arteries

Back 241

Anterior ciliary arteries:

branches of arteries to muscles

Front 242

Central Retina Artery

Back 242

Central retinal artery:

Branch of opthalmic artery

Opthalmic artery originates from Internal Carotid artery

Front 243

Medial Side of the Palpebral Fissure

Back 243

At the medial side of the palpebral fissure and lateral to the medial palpebral commissure is a small triangular soft tissue structure (the lacrimal lake). The elevated mound of tissue on the medial side of the lacrimal lake is the lacrimal caruncle,

Front 244

Lacrimal Apparatus

Back 244

The lacrimal apparatus consists of the lacrimal gland and the system of ducts and channels that collect the tears and drain them into the nasal cavity. Tears hydrate and maintain the transparency of the cornea.

Front 245

Punctum of the Eye Orbit

Back 245

Each punctum is on a small raised mound of tissue (a lacrimal papilla), and is the opening of a small canal (lacrimal canaliculus) that connects with the lacrimal sac.

Front 246

Lacrimal Sac

Back 246

The lacrimal sac is in the lacrimal fossa on the medial side of the orbit. From the lacrimal sac, tears drain via the nasolacrimal duct into the nasal cavity

Front 247

Lacrimal Gland

Back 247

The lacrimal gland is associated with the upper eyelid and is in a small depression in the lateral roof of the orbit just posterior to the orbital margin.

The multiple small ducts of the gland open into the upper margin of the conjunctival sac, which is the thin gap between the deep surface of the eyelid and the cornea

Front 248

Tears of the Eye

Back 248

Tears are swept medially over the eye by blinking and are collected in small openings (lacrimal puncta), one on each of the upper and lower eyelids near the lacrimal lake

Front 249

Temporal Bone Picture

Back 249

Front 250

Temporal Bone: Squamous Part

Back 250

smooth thinner vertical part. Forms part of temporal fossa. On external surface gives rise to zygomatic process. Mandibular fossa articulates with condylar process of mandible.

Front 251

Temporal Bone: Tympanic Part

Back 251

contains external auditory (acoustic) meatus. Located between squamous part & mastoid process.

Front 252

Temporal Bone: Mastoid Part

Back 252

contains mastoid air cells. Mastoid process has 2 internal grooves, digastric fossa for origin of digastric muscle, & occipital groove for occipital artery.

Front 253

Temporal Bone: Petrous Part

Back 253

stony (hard) part of temporal bone. Contains; inner & middle ear. Contains auditory meatus for passage of vestibulocochlear nerve & facial canal (for passage of facial nerve which exits via stylomastoid)

Front 254

Temporal Bone: Styloid Process

Back 254

For attachment of 3 muscles, styloglossus, stylohyoid, & stylopharngeus.

Front 255

Temporal Bone: Mastoid Process

Back 255

For insertion of sternocleidomastoid m., origin of digastric m.

Front 256

Temporal Bone: Zygomatic Process

Back 256

Extension of temporal bone unites with zygomatic bone to form arch, with articular tubercle on inferior surface of zygomatic process.

Front 257

Temporal Bone: Fossae of the Temporal Bone

Back 257

1.Temporal Fossa
2.Mandibular Fossa
3.Digastric Fossa

Front 258

Temporal Bone: 3 Foramina

Back 258

1. Auditory meatus, external & internal parts

2. Stylomastoid F., between styloid process & mastoid process

3. Carotid canal, for internal carotid artery

Front 259

Ethmoid Bone Location

Back 259

Located in base of the cranium between orbits

Front 260

Cribiform Plate

Back 260

Superior horizontal part perforated by foramina for CNI(olfactory nerves)

Front 261

Crista Galli

Back 261

Superior vertical extension of ethmoid

Front 262

Perpendicular Plate

Back 262

Inferior vertical part of ethmoid

Front 263

Ethmoid Labyrinth

Back 263

Contains ethmoidal air sinuses(Paranasal not dural)

Front 264

Superior and Middle Conchae

Back 264

Medial lateral extensions projecting into the nasal cavity

Front 265

Orbital Plate

Back 265

Found in medial orbit aspect of orbit

Front 266

General Somatic Afferent

Back 266

The general somatic afferent fibers, afferent fibers, arise from cells in the spinal ganglia and are found in all the spinal nerves.

Front 267

Examples of GSA

Back 267

Examples of nerves containing GSA fibers include the trigeminal nerve, the facial nerve, the glossopharyngeal nerve, and the vagus nerve.

Front 268

General Visceral Afferent

Back 268

The general visceral afferent fibers conduct sensory impulses from the viscera through the rami communicantes and posterior roots to the spinal cord.
They are probably limited to the white rami connected with the spinal nerves in two groups, viz., the first thoracic to the second or third lumbar and the second sacral to the fourth sacral nerves.

Front 269

Examples of GVA

Back 269

Examples of nerves containing GVA fibers include the glossopharyngeal nerve and the vagus nerve.

Front 270

Sensory Somatic Afferent

Back 270

Special somatic afferent or "Special Sensory Afferent" (SSA) refers to afferent nerves of the special senses. Examples of nerves containing SSA fibers include the optic nerve and the vestibulocochlear nerve.

Front 271

Somatic Visceral Afferent

Back 271

Special visceral afferent (SVA) refers to afferent nerves that develop in association with the gastrointestinal tract.[1] Examples of nerves containing SVA fibers include the olfactory nerve, the facial nerve, the glossopharyngeal nerve, and the vagus nerve.

Front 272

General Somatic Efferent

Back 272

The somatic efferent neurons, arise from motor neuron cell bodies in the ventral horns of the gray matter within the spinal cord. They exit the spinal cord through the ventral roots, carrying motor impulses to skeletal muscle.

Front 273

Examples of GSE

Back 273

Examples of nerves that contain GSE fibers include the oculomotor nerve, the trochlear nerve, the abducens nerve, and the hypoglossal nerve.

Front 274

General Visceral Efferent

Back 274

The general visceral efferent fibers probably arise from cells in the lateral column or the base of the anterior column and emerge through the anterior roots and white rami communicantes.

Front 275

Examples of GVE

Back 275

L2).
Examples of nerves containing GVE fibers include the oculomotor nerve, the facial nerve, the glossopharyngeal nerve, and the vagus nerve. [1

Front 276

Somatic Visceral Efferent

Back 276

Special visceral efferent (SVE) refers to efferent nerves which supply muscles which derived from the branchial arches.[1]
Some sources prefer the term "branchiomotor", or "branchial efferent".

Front 277

Examples of SVE

Back 277

Examples of nerves that contain SVE fibers include the trigeminal nerve, the facial nerve, the glossopharyngeal nerve, the vagus nerve, and the accessory nerve.

Front 278

2 Divisions of the Frontal Bone

Back 278

Frontal squama: Forehead
Orbital part: Roof of orbit

Front 279

Frontal Bone: Frontal Eminence

Back 279

Frontal Eminence: Location of 1 degrees centers of ossification

Front 280

Frontal Bone: Supraorbital Margin

Back 280

Supraorbital Margin: Inferior border of frontal squama.

Front 281

Frontal bone: Supercilliary arches

Back 281

Supercillary Arches:
Elevation superior to supraorbital margin & overlie frontal sinuses. A defining feature to I.D. sex skeleton, also for evolution.

Front 282

Frontal bone: Glabella

Back 282

Glabella: Smooth median depression between superciliary arches.

Front 283

Frontal Bone: Zygomatic Process

Back 283

Zygomatic process:

Projects inferiorly & lateraly to nasal bones.

Front 284

Frontal Bone: Nasal Spine

Back 284

Nasal Spine:

Projects inferiorly & posteriorly to nasal bone.

Front 285

Frontal Bone: Lacrimal Groove

Back 285

Lacrimal Groove:

For lacrimal gland

Front 286

Frontal Bone: Frontal Crest

Back 286

Frontal Crest: Internal Surface for attachment of falx cerebri

Front 287

Frontal Bone Picture

Back 287

Front 288

Foramen Ovale

Back 288

Structure Conveyed:
Trigemenial Nerve (V3)

Front 289

Foramen Spinosum

Back 289

Structure Conveyed:
Middle Meningeal Artery

Front 290

Foramen Magnum

Back 290

Structure Conveyed:
Medulla Oblongata. Vert. Artery

Front 291

Foramen Rotundum

Back 291

Structure Conveyed:
Trigeminal Nerve (V2)

Front 292

Jugular Foramen

Back 292

Structure Conveyed:
Internal Jugular Vein

Front 293

Styloidmastoid Foramen

Back 293

Structure Conveyed:
Facial Nerve

Front 294

Carotid Canal

Back 294

Structure Conveyed:
Internal Carotid Artery

Front 295

Condylar Canal

Back 295

Structure Conveyed:
Emissary Veins

Front 296

Hypoglossal Canal

Back 296

Structure Conveyed:
Hypoglossal Nerve

Front 297

Optic Canal

Back 297

Structure Conveyed:
Hypoglossal Nerve

Front 298

F. Cribriform Plate

Back 298

Structure Conveyed:
Olfactory Nerve

Front 299

Auditory Meatus

Back 299

Structure Conveyed:
CN VII and CN VIII

Front 300

Foramen Cecum

Back 300

Structure Conveyed:
Emissary Veins

Front 301

Incisive Foramina

Back 301

Structure Conveyed:
Nasopalatine Nerve

Front 302

G. Palatine Foramen

Back 302

Structure Conveyed:
G. Palatine Nerve

Front 303

Pterygoid canal

Back 303

Structure Conveyed:
Pterygoid nerve

Front 304

Fossa

Back 304

Shallow depressions within the skull that house the brain

Front 305

3 major fossae of the cranium

Back 305

1. Anterior Cranial Fossa
2. Middle Cranial Fossa
3. Posterior Cranial Fossa

Front 306

Foramina

Back 306

Foramina are holes or passages in the skull allowing entry or exit of nerves or blood vessels.

Front 307

Foramen Magnum

Back 307

The largest in the base of the skull for passage of spinal cord.

Front 308

4 Major Sutures of the Cranium

Back 308

1.Coronal suture
(between parietal & frontal)
2.Lambdoidal suture
(between occipital & parietal)
3.Squamous suture
(between parietal & temporal)
4.Sagittal suture
(between 2 parietal)

Front 309

8 cranial bones

Back 309

Frontal (1)

Parietal (2)

Temporal (2)

Occipital (1)

Sphenoid (1)

Ethmoid (1)

Front 310

Occipital Bone

Back 310

Large posterior bone of skull. Contains largest foramen, Foramen Magnum (transmits medulla oblongata & upper part of spinal cord, vertebral arteries & spinal accessory nerve (CNXI).

Front 311

Three Parts of the Occipital Bone

Back 311

1. Squamous part, superior & posterior to F. magnum.

2. Basilar part, anterior to F. magnum.

3. Condylar part, lateral to each side of the F. magnum.

Front 312

Occipital Bone: Squamous Part

Back 312

1. External occipital protuberance, for attachment of Ligamentum Nuchae

2. External occipital crest, for attachment of ligamentum nuchae

3.Nuchal lines (superior, inferior & highest), for muscle attachment.
Sulci, for transverse sinus & sigmoid sinus.

Front 313

Occipital Bone: Squamous Part Fossae

Back 313

4 Fossae, 2 superior for occipital lobes, 2 inferior for cerebellum.

Front 314

Occipital Bone: Basilar Part

Back 314

1. Pharyngeal tubercle

2. Groove for medulla oblongata on internal surface.

Front 315

Parietal Bone: 3 Major External Features

Back 315

1.Parietal eminence, 1º center of ossification.

2.Superior & inferior temporal lines, for attachment of muscles (e.g. Temporalis m.).

3. Parietal Foramina, for emissary veins.

Front 316

Parietal Bone: 3 Major Internal Features

Back 316

1.Grooves, for middle meningeal artery.

2.Depressions, from impressions of arachnoid granulations.

3.Sulcus, for superior sagittal sinus.

Front 317

Parital Bone Shape

Back 317

2 bones form a quadrangle

Front 318

Lesser Wing of Sphenoid Bone

Back 318

Forms the floor of anterior crainal fossa

Front 319

Sphenoid Bone:
Superior Orbital

Back 319

Fissure separating lesser from greater wings

Front 320

Sphenoid Bone:
Clinoid Processes

Back 320

Form free medial ends

Front 321

Sphenoid Bone:
Optic Canal

Back 321

Lies at junction of lesser wings and body of sphenoid

Front 322

Greater Wing of Sphenoid Bone

Back 322

Forms parts of floor of middle cranial fossa, lateral wall of orbit, temporal fossa, infratemporal fossa and pterygopalatine fossa

Front 323

Sphenoid Bone: F. Rotundum

Back 323

For Trigeminal V2, F. Ovale, for trigeminal V3; F. Spinosum, for middle meningeal artery

Front 324

Spine of the Greater Wing of the Sphenoid Bone

Back 324

Projects inferiorly to F. Spinosum

Front 325

Groove for Deep Temporal Nerve

Back 325

Branch of the V3, sits just lateral to foramen ovale.

Front 326

Slide 3: Temporal/Infratemporal Fossae Overview

Back 326

Are interconnected spaces on the lateral side of the head

Front 327

Slide 3: Boney Frame:

Back 327

Temporal, zygomatic, sphenoid bones, maxilla and mandible

Front 328

Slide 3: Temporal Fossa

Back 328

1. Above the zygomatic arch
2. Communicates with the infratemporal fossa below the zygomatic arch

Front 329

Slide 3: Infratemporal fossa

Back 329

1. Wedge shaped space deep to the massetter muscle
2. Underlying ramus of the mandible

Front 330

Slide 4: Temporal Fossa

Back 330

Boundaries:
Sup: Superior temporal line

Ant: Frontal&Zygomatic bones

Inf: Infratemporal fossa

Front 331

Slide 4: Floor of the Temporal Fossa

Back 331

4 bones:

Front 332

Slide 4: Roof of the Temporal Fossa

Back 332

Temporal Fascia

Front 333

Slide 4: Contents of the Temporal Fossa

Back 333

1. Temporalis Muscle
2. Deep temporal VAN
3. Auriculotemporal nerve
4. Superficial temporal vessels

Front 334

Slide 5: Temporal Fossa

Back 334

O: Temporal Fossa

Ins: Coronoid process/ramus of the mandible

Inv: Deep temporal nerves from the mandibular nerve V3

Front 335

Slide 6: Infratemporal Fossa Sup. Boundary

Back 335

Infratemporal Surface of the greater wing of the sphenoid

Front 336

Slide 6: Infratemporal Fossa Post. Boundary

Back 336

Mastoid and Styloid Process

Front 337

Slide 6: Infratemporal Fossa Ant. Boundary

Back 337

Post. Maxilla

Front 338

Slide 6: Infratemporal Fossa Med. Border

Back 338

Lateral Pteryogoid Plate

Front 339

Slide 6: Infratemporal Fossa Lat. Border

Back 339

Ramus of the Mandible

Front 340

Slide 6: Infratemporal Fossa Communication

Back 340

1. Temporal fossa
2. Pterygopalatine fossa
3. Orbit
4. Middle Cranial Fossa

Front 341

Slide 7: Masseter

Back 341

O: Zygomatic arch and maxillary process of the zygomatic bone

Ins: Lateral surface of ramus of Mandible

Inv: Mandibular Nerve V3

Action: Elevation of Mandible

Front 342

Slide 7: Temporalis

Back 342

O: Bone of temporal fossa and temporal fascia.

Ins: Coronoid process of mandible and ramus of mandible almost to last molar tooth.

Inv: Mandibular Nerve V3

Action: Elevation and retraction of mandible

Front 343

Slide 7: Medial Pterygoid

Back 343

O: Lateral plate of pterygoid process and palatine bone; tuberosity and pyramidal process of maxilla

Ins: Medial surface of mandible

Inv: Mandibular nerve V3

Action: Elevation and side to side movements of the mandible

Front 344

Slide 7: Lateral Pterygoid

Back 344

O: Roof of infratemporal fossa; lateral plate of the pterygoid process

Ins: Capsule of tempromandibular joint to the pterygoid fovea on the neck of the mandible

Inv: Mandibular nerve V3

Action: Protrusion and side to side movements of the mandible

Front 345

Slide 8: 3rd Mandibular Division of Trigeminal Motor

Back 345

1. Muscles of Masticiation
2. Mylohyoid
3. Ant. Belly of Digastric
4. Tensor Tympani
5. Tensor Veli Palatini

Front 346

Slide 8: 3rd Mandibular Division of Trigeminal Sensory

Back 346

1. Teeth of the Mandible
2. Ant. 2/3 of tongue
3. Skin of the lower lip, mandible, and ant. to ear

Front 347

Slide 8: 3rd Mandibular Division of Trigeminal Ant. Trunk

Back 347

1. Buccal Nerve
2. Masseteric Nerve
3. Temporal Nerves
4. Nerve to lat. pterygoid

Front 348

Slide 8: 3rd Mandibular Division of Trigeminal Post. Trunk

Back 348

1. Auriculotemporal nerve
2. Lingual nerve
3. Inf. Alveolar nerve

Front 349

Slide 10: Buccal Nerve

Back 349

A branch of the anterior trunk of the mandibular nerve V3

Sensory nerve, but can carry motor to the lat. pterygoid and massetter

Front 350

Slide 11: Lingual Nerve

Back 350

A major sensory branch of the posterior trunk of the mandibular nerve V3

Joined high in the infratemporal fossa by the chorda tympani.

Front 351

Slide 11: Lingual Nerve Fxn

Back 351

1. Taste from the ant. 2/3 of the tongue
2. Parasympathetic fibers to all salivary glands below the level of the oral fissure

Front 352

Slide 12: Inf. Aveolar Nerve

Back 352

A major sensory branch of the post. trunk of the mandibular nerve V3

Front 353

Slide 12: Inf. Aveolar Nerve Innervation

Back 353

1. All lower teeth and much of the associated gingivae
2. Mucosa and skin of the lower lip and skin of the chin
3. 1 Motor branch: Innervates mylohyoid muscle and ant. belly of digastric

Front 354

Posterosuperiorly

Back 354

Middle cranial fossa via F. Rotundum and pterygoid canal

Front 355

Anterosuperiorly

Back 355

Floor of the orbit thru inferior orbital fissure

Front 356

Anteroinferiorly

Back 356

Oropharynx and roof of the oral cavity

Front 357

Laterally

Back 357

Infratemporal fossa thru pterygomaxillary fissure

Front 358

Medially

Back 358

Lateral wall of the nasal cavity thru sphenopalatine foramen.

Front 359

Foramen Rotundum

Back 359

Cranial nerve V2 Maxillary Branch, gives off 5 branches

Front 360

Pterygoid canal

Back 360

Nerve of pterygoid canal and artery of pterygoid canal from 3rd part of maxillary artery.

Front 361

Inferior Orbital Fissure

Back 361

Cranial nerve V2 superior alveolar and zygomatic branches and inferior opthalmic vien (drains into pterygoid venous plexus)

Front 362

Oropharynx and Roof of Oral Cavity

Back 362

Soft palate and musclar uvula

Front 363

Pterygomaxillary Fissure

Back 363

Transmits terminal part of maxillary artery

Front 364

Sphenopalatine Formamen

Back 364

Sphenoplatine artery from 3rd part of maxillary artery and sphenopalatine vein (draining into pterygoid plexus and closely related to pterygopalatine ganglion.

Front 365

5 branches of Maxillary Nerve (V2)

Back 365

1. Zygomatic nerve
2. Superior alveolar nerves
3. 2 Pterygopalatine nerves
4. Infraorbital nerve

Front 366

5 Branches of Maxillary Artery

Back 366

1. Posterior superior aveolar artery

2. Infraorbital artery

3. Descending palatine artery

4. Sphenopalatine artery

5. Artery of pterygoid canal

Front 367

Pterygopalatine Ganglion

Back 367

Parasympathetic fibers from the facial nerve(CN7)

Front 368

Facial Nerve emerges from the brainstem in 2 components

Back 368

1. Motor Root: To muscles of facial expression

2. Intermediate Root: Carries taste (SVA) parasympathetics (GVE) and somatic sensory (GSA)

Front 369

Cranial Nerve 7 emerges from stylomastoid foramen and gives off:

Back 369

1st branch : Posterior Auricular branch.

Front 370

Slide 13: Cranial Nerve 7 Terminal Branches

Back 370

1. Temporal Branch
2. Zygomatic Branch
3. Buccal Branch
4. Marginal Mandibular Branch
5. Cervical Branch

Front 371

Slide 13: Facial Nerve gives off 3 branches in the Facial Canal

Back 371

1. Greater Petrosal Nerve
2. Nerve to Stapedius
3. Chorda Tympani

Front 372

Slide 13: Greater Petrosal Nerve

Back 372

Runs in petrous part of the temporal bone, runs across foramen lacerum to join with deep petrosal nerve and exits pterygoid canal

Front 373

Slide 13: Chorda Tympani

Back 373

Passes through petrotympanic fissure.

Front 374

Slide 15: Nerve of Pterygoid Canal & Pterygopalatine Ganglion

Back 374

1. Enters PP fossa via the pterygoid canal

2. Nerve of the pterygoid canal is union of Greater Petrosal Nerve and Deep Petrosal Nerve

Front 375

Slide 15: Greater Petrosal Nerve

Back 375

A branch of the facial nerve, carrying parasympathetics to lacrimal gland and mucosa

Front 376

Slide 15: Deep Petrosal Nerve

Back 376

A branch of the internal carotid plexus, sympathetic fibers to blood vessels in the face

Front 377

Maxillary Artery's 3 parts

Back 377

1st: Mandibular Part
2nd: Pterygoid Part
3rd: Pterygopalatine Part

(First 2 parts sit in the infratemporal fossa and 3rd part in pterygopalatine fossa)

Front 378

Maxillary Artery Branches: Mandibular Part

Back 378

1. Deep Auricular Artery
2. Anterior Tympanic Artery
3. Middle Meningeal Artery
4. Accessory Meningeal Artery
5. Inferior Alveolar Artery

Front 379

Maxillary Artery Branches: Pterygoid Part

Back 379

1. Masseteric Artery
2. Deep Temporal Arteries
3. Pterygoid Branches
4. Buccal Artery

Front 380

Maxillary Artery Branches: Pytergopalatine Part

Back 380

1. Infraorbital artery
2. Artery of pterygoid canal
3. Pharyngeal branch
4. Descending palatine artery
5. Sphenopalatine artery

Front 381

Venous Plexus of PP Fossa

Back 381

Veins draining areas of supplied by branches of the terminal part of the maxillary artery travel back into the pterygoplantine fossa

Front 382

TMJ Prediposing factors

Back 382

Gender
Age
Posture
Occulsion
Sleep disorders
Life stress

Front 383

Dislocation of the TMJ

Back 383

Occurs when the condyle gets lodged in from of the prominence the articular eminence

Mandible dislocates anteriorly and subluxes the jaw is opened wide

Pain in the temporal fossae and there is difficulty swallowing

Front 384

Creptius

Back 384

Clicking or cracking from bone rubbing on bone from displacement of the articular disc

Front 385

Bruxing

Back 385

Grinding or clenching of teeth

Leads the Head aches, earaches, and neck aches.

Front 386

TMJ: Synovial joints

Back 386

Articulation between:
*Condylar head of the mandible
*Condylar fossa and Articular tubercle of the temporal bone

Front 387

TMJ: Joint capsule

Back 387

Joint capsule contains a fibrous disc which divides the joint capsule into distinct compartments.

Front 388

TMJ: Lateral temporomandibular ligament

Back 388

Prevents posterior dislocation of mandible

Front 389

TMJ: Sphenomandibular ligament

Back 389

Lies on medial side of joint from spine of sphenoid to lingula of mandibular foramen

Front 390

TMJ: Stylomandibular ligament

Back 390

Lies posteromedial to the joint, from styloid process to angle of the mandible.

Front 391

TMJ: Depression muscles

Back 391

1.Lateral pterygoid
2.Digastric
3.Geniohyoid
4.Mylohyoid
5.Infrahyoid muscles

Front 392

TMJ: Elevation muscles

Back 392

1.Temporalis(ant. part)
2.Masseter
3.Medial pterygoid

Front 393

TMJ: Protrusion/Protraction

Back 393

1. Lateral pterygoid
2. Medial pterygoid
3. Massetter

Front 394

TMJ: Retraction

Back 394

1. Temporalis
2. Digastric

Front 395

Lateral(Side to Side)

Back 395

1. Lateral pterygoid
2. Medial pterygoid
3. Masseter
4. Temporalis(same side)

Front 396

Slide 8: Blood Supply of TMJ

Back 396

Aterial supply:
1. Superficial temporal artery
2. Maxillary Artery

Front 397

Slide 8: Nerve inv of TMJ

Back 397

Nerve Supply:
1. Auricolotemporal nerve
2. Masseteric nerve

Front 398

Slide 9: Pterygopalatine Fossa

Back 398

An inverted tear drop shaped space between bones on the lateral side of the skull immeadiately posterior to the maxilla

Front 399

Slide 9: Walls of the Pterygopalatine Fossa

Back 399

The walls of the pterygopalatine fossa are formed by parts of the palatine, maxilla, and sphenoid bones

Front 400

Slide 9: Anterior wall of the Pterygopalatine Fossa

Back 400

Anterior wall is formed by the posterior surface of the maxilla

Front 401

Slide 9: Medial wall of the Pterygopalatine Fossa

Back 401

Medial wall of the ptyergopalatine fossa is formed by the lateral surface of the palatine bone

Front 402

Slide 9: Posterior wall of the Pterygopalatine Fossa

Back 402

Posterior wall and roof are formed by parts of the sphenoid bone

Front 403

Slide 3: Cranial Meninges

Back 403

1. Dura Mater
2. Arachnoid Mater
3. Pia Mater

Front 404

Slide 3: Dura Mater

Back 404

2 fibrous layers
Periosteal layer: Outer is fused to periosteum of cranial bones

Front 405

Slide 3: Extradural Space

Back 405

The outer or periosteal layer of dura mater is firmly attached to the bones surrounding the cranial cavity resulting to a potential space.

Front 406

Slide 3: Meningeal Layer

Back 406

Inner has spaces or sinuses(large venous drainage) dural sheaths and foldings, dural septa

Front 407

Slide 3: Arachnoid Mater

Back 407

Subarachnoid space has network of fibers, supports blood vessels, and has CSF flowing.

Front 408

Slide 3: Pia Mater

Back 408

Tightly attached to the brain surface and lines the sulci.

Front 409

Slide 4: Extradural space

Back 409

Potential space related to the dura mater

Front 410

Slide 4: Subdural space

Back 410

Potential space because the arachnoid mater clings to the inner surface of dura mater

Front 411

Slide 4: Subarachnoid space

Back 411

Deep to the arachnoid mater is the only normally occurring fluid filled space associated with the meninges

Front 412

Slide 4: Cisterns

Back 412

In certain locations the subarachnoid space enlarges into expanded areas

Front 413

Slide 4: Ventricles

Back 413

C Shaped(Chicago Bears)

Front 414

Slide 5: Falx Cerebri

Back 414

Folding of dura that lies in the longitudinal fissure and separtes left to right hemispheres.

Attached anteriorly to crista gali and frontal crest

Sup. border encloses sup. sagittal sinus and inf. border encloses inf. sagittal sinus

Front 415

Slide 5: Tentorium cerebelli

Back 415

Horizontal projection of the meningeal dura mater that covers and separates the cerebellum in the post. cranial fossa.

Post. border encloses tranverse sinus, ant. free ends attach to clinoid process.`

Front 416

Slide 6: Falx cerebellis

Back 416

Small midline projection of the meningeal dura mater in the post. cranial fossa

Front 417

Slide 6: Diaphragma Sellae

Back 417

Small horizontal shelf of the meningeal dura mater covers the hypophyseal fossa in the sella turcica of the sphenoid bone

Front 418

Slide 7: Arterial Supply Dura Mater

Back 418

Arteries:
1. Middle Meningeal Artery
2. Anterior Meningeal Artery
3. Posterior Meningeal Artery

Front 419

Slide 7: Drainage of Dura Mater

Back 419

Veins:
1. Middle Meningeal veins
2. Anterior and Posterior Meningeal veins
3. Emissary and Diploic veins

Front 420

Slide 8: Innervation of the Dura Mater

Back 420

1. Anterior Crainal Fossa by V1
2. Middle Cranial Fossa V2 and V3
3. Posterior Cranial Fossa by Vagus, C2 and C3 cervical nerves

Front 421

Slide 8: Dura Sensitivities

Back 421

Sensitive to stretch producing head aches

Via changes in blood vessels diameter and presence of space occupying lesions or tumors

Front 422

Slide 9: Arachnoid Mater and Subarachnoid Space

Back 422

Thin aveolar membrane, against, but not adherent to the inner surface of the dura mater.

Subarachnoid space and arachnoid treabeculae. In certain areas it enlarges into expanded areas.

Front 423

Slide 9: Arachnoid Villi

Back 423

The CSF returns to the venous system through here. These project as clumps
(arachnoid granulations) into the superior sagittal sinus, which is a dural venous sinus.

Front 424

Slide 12: Ventricles

Back 424

Fluid filled spaces within the brain through which the CSF flows

Front 425

Slide 12: CSF

Back 425

CSF transports nutrients, chemical messengers, and acts as a transport system to remove wastes

Front 426

Slide 12: CSF exits

Back 426

Fluid exits the ventricles by spaces at base of the cerebellum and 4th ventricle. From there the CSF flows around the brain and drains into the venous sinus

Front 427

Slide 14: Dural Sinuses

Back 427

Walls of sinuses formed by dura mater & periosteum lined with endothelium.

Front 428

Slide 14: Function of Dural Sinuses

Back 428

Function to drain venous blood from brain, orbit, skull bones & inner ear. Blood from sinuses drains into Internal Jugular Vein.

Front 429

Slide 14: Number of Dural Sinuses

Back 429

11 sinuses:
5 single: superior sagittal sinus, inferior sagittal sinus, straight sinus, basilar sinus, occipital sinus
6 paired: transverse sinus, sigmoid sinus, cavernous sinus, superior petrosal sinus, inferior petrosal sinus, sphenoparietal sinus.

Front 430

Slide 16: Cavernous Sinus

Back 430

Against the lateral aspect of the body of the sphenoid bone on either side of the sella turcica

Front 431

Slide 16:Cavernous Sinus Blood tributaries

Back 431

Receive blood from:
cerebral veins, ophthalmic veins emissary veins

Front 432

Slide 16: Structures Passing through Cavernous Sinus

Back 432

Structures passing through:
the internal carotid artery;
the abducent nerve [VI]

Front 433

Slide 16: Structures in Lateral Wall of Cavernous Sinus

Back 433

Structures in the lateral wall:
the oculomotor nerve [III];
the trochlear nerve [IV];
the ophthalmic nerve [V1];
the maxillary nerve [V2].

Front 434

Slide 16: Cavernous Sinus Overview

Back 434

The cavernous sinuses receive blood not only from cerebral veins, but also from the ophthalmic veins (from the orbit) and emissary veins (from the pterygoid plexus of veins in the infratemporal fossa). These connections provide pathways for infections to pass from extracranial sites into intracranial locations. In addition, because structures pass through the cavernous sinuses and are located in the walls of these sinuses they are vulnerable to injury due to inflammation.

Front 435

Slide 17: Blood Brain Barrier

Back 435

Necessary to maintain a constant environment for both control & proper functioning of the CNS

Front 436

Slide 17: Blood Brain Barrier Composition

Back 436

Endothelial cells of capillaries are tightly adjoined by tight junctions (only lipid soluble materials can cross),

Front 437

Slide 17: Basement membrane of BBB

Back 437

Basement membrane of the capillaries is continuous, &
End feet of astrocytes cover the capillaries reinforcing the barrier & acting as the ‘middle-man’ between substances in the capillaries & neurons.

Front 438

Slide 17: BBB Overview

Back 438

BBB prevents entry of toxins, bacteria, & limits immunological inflammatory processes.

Front 439

Slide 18: Hydrocephalous

Back 439

Hydrocephalus is a dilatation of the cerebral ventricular system, which is due to either an obstruction to the flow of CSF, overproduction of CSF, or a failure of reabsorption of CSF.

Front 440

Slide 18: Meningitis

Back 440

a rare infection of the leptomeninges (the leptomeninges are a combination of the arachnoid mater and the pia mater). Infection of the meninges typically occurs via a bloodborne route, though in some cases it may be by direct spread (e.g. trauma) or from the nasal cavities through the cribiform plate in the ethmoid bone

Front 441

Slide 18: Rupturing Middle Meningeal Artery/Pterion Fracture

Back 441

Bleeding into the extradural space due to rupture of a meningeal artery or a torn dural venous sinus results in an extradural hematoma.

Front 442

Slide3: Internal Carotid System Divisions

Back 442

1. Cervical
2. Petrous
3. Cavernous
4. Cerebral/Supraclinoid

Front 443

Slide 3: Carotid Canal

Back 443

Point of entry for artery in base of skull
*In petrous part of temporal bone

Front 444

Slide 3: Origin of the Carotid Canal

Back 444

Bifurcation of C. Carotid at C4

Front 445

Slide 3: Termination of Carotid Canal

Back 445

Subarachnoid space in middle cranial fossae and bifurcates into middle and anterior cerebral arteries

Front 446

Slide 3: 4 collateral Branches of Carotid Canal

Back 446

Arise from internal carotid before its bifurcation

Front 447

Slide 3: Carotid Siphon

Back 447

Series of turns/bends

Front 448

Slide 4: Interal Carotid System: Cervical Part

Back 448

Terminal branch of C. carotid bifurcation at C4

Front 449

Slide 4: Internal Carotid System: Petrous Part

Back 449

Enters middle cranial fossa, lateral to dorsum sellae of sphenoid

Front 450

Slide 4: Internal Carotid System: Cavernous Part

Back 450

Runs anterior in cavernous venous sinus with CN 6
*Turns upwards on medial side of clinoid process

Front 451

Slide 4: Cerebral/Supraclinoid Part

Back 451

Pierces dura mater and enters subarachnoid space coursing back below optic nerve.
*Terminates with bifurcation into middle and anterior cerebral arteries

Front 452

Slide 5: Collateral Branches of Internal Carotid

Back 452

Branches before bifurcation of Internal Carotid:
1. Hypophysial arteries
2. Opthalmic artery
3. Post. communicating artery
4. Ant. Chorodial artery

Front 453

Slide 6: Vertebral Artery

Back 453

1st branch of the subclavian artery.

Medial to the anterior scalene

Front 454

Slide 6: Vertebral Artery Course

Back 454

1. Ascends and enters the foramen in the transverse process of C6

2. Passes through the foramina of vertebrae C5-C1

3. At the superior border of C1, the artery turns medially and crosses the posterior arch of C1

4. Enters the skull through the Foramen Magnum

Front 455

Slide 7: Vertebral Artery First Division

Back 455

From the subclavian to TP of C6.

Travels with vertebral vein and sympathtic nerve plexus

Front 456

Slide 7: Vertebral Artery Second Division

Back 456

1.Ascends through transverse foramina of C6 to C1.

2.Travels with Emissary Veins and sympathetic nerve plexus

3. Extension with rotation of the head impairs blood flow through 2nd part of vertebral artery of other side

Front 457

Slide 8: Third Division of Vertebral Artery

Back 457

Begins at C1 & curves superior and posteriorly, lies in groove for vertebra artery in posterior below posterior atlanto-occipital membrane

Front 458

Slide 8: Fourth Division Vertebral Artery

Back 458

Begins as artery passes below bridge of posterior atlanto-occipital membrane

Runs medially, pierces dura mater, enters through F. Magnum

Front 459

Slide 8: 3 branches of the Fourth Division Vertebral Artery

Back 459

1. Ant. Spinal Artery

2. Post. Spinal Artery

3. Post. Inf. Cerebellar Arteries

Front 460

Slide 9: Congenital Tethering of Vertebral Artery

Back 460

Tethering of the vertebral artery in the arcuate foramen has been casually associated with dissection of this vessel following repetitive head injuries in children

Front 461

Slide 10: Basilar Artery

Back 461

Formed by the union of the 2 vertebral arteries at the lower border of the pons.

Front 462

Slide 10: 5 Branches of the Basilar Artery

Back 462

1.Anterior Inf. Cerebellar Arteries/AICA

2. Labyrinthine Arteries: To inner ear

3. Pontine Arteries

4. Superior Cerebellar Arteries

5. Posterior Cerebellar Arteries: Termination of the Basilar Artery at Circle of Willis

Front 463

Slide 12: Arterial Circle of Willis

Back 463

Formed by anastomic connections of branches of vertebral arteries and branches of internal carotid arteries

Front 464

Slide 12: Ant. Communicating Arteries

Back 464

Joins left and right cerebral arteries

Front 465

Slide 12: Post. Communicating Arteries

Back 465

Connecting the internal carotid artery with post. cerebral artery

Front 466

Slide 13: Branches from the Internal Carotid Arteries

Back 466

1. Ant. Cerebral Artery

2. Middle Cerebral Artery

3. Opthalmic Artery

Front 467

Slide 12: Branches from Vertebral Arteries

Back 467

Basilar Artery
-Post. Cerebral Artery

Front 468

Slide 14: Ant. Cerebral Artery

Back 468

Ascends in longitudinal fissure around corpus callosum

Branches: Many

Supplies: Orbital and medial surface of frontal lobe, medial and dorsomedial surface of parietal lobe, olfactory bulb and tract, striatum

Front 469

Slide 14: Middle Cerebral Artery

Back 469

Larger, more direct continuation of internal carotid, runs deep in lateral sulcus between frontal and temporal lobes

Branches: Many

Supplies: Motor and general sensory areas of parietal cortex

Front 470

Slide 14: Post. Cerebral Artery

Back 470

Curves around midbrain and medial surface of cortex posteriorly.

Branches: Many

Supplies: Medial and lateral occipital cortex, choroid plexus of lateral and 3rd ventricle, thalamus, tectum of midbrain