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188 Cards in this Set

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Which major cranial nerve that has only motor functions can be found in the posterior triangle of the neck? Which muscles does it innervate?

CN XI – the spinal accessory nerve - It innervates the SCM and the trapezius
Is the following structure primarily located in the anterior or posterior triangles of the neck?
Brachial plexus roots
posterior
Is the following structure primarily located in the anterior or posterior triangles of the neck? Carotid arteries
anterior
Is the following structure primarily located in the anterior or posterior triangles of the neck? Internal jugular vein
anterior
Is the following structure primarily located in the anterior or posterior triangles of the neck? Hyoid bone
anterior
Is the following structure primarily located in the anterior or posterior triangles of the neck? Scalene muscles
posterior
Is the following suprahyoid or infrahyoid muscles? Mylohyoid
Suprahyoid
Is the following suprahyoid or infrahyoid muscles? Geniohyoid
Suprahyoid
Is the following suprahyoid or infrahyoid muscles? Stylohyoid
Suprahyoid
Is the following suprahyoid or infrahyoid muscles? Digastric
Suprahyoid
Is the following suprahyoid or infrahyoid muscles? omohyoid
Infrahyoid
Is the following suprahyoid or infrahyoid muscles? Sternohyoid
Infrahyoid
Is the following suprahyoid or infrahyoid muscles? Sternothyroid
Infrahyoid
Is the following suprahyoid or infrahyoid muscles? thyrohyoid
Infrahyoid
Which vascular structure in the anterior neck functions as a baroreceptor?
the carotid sinus
Which structure in the anterior neck functions as a chemoreceptor?
the carotid body
Which nerve runs down the anterior border of the anterior scalene muscle?
the phrenic nerve
What are the 3 major components found within the carotid sheath?
carotid artery
internal jugular vein
vagus nerve (CN X)
What are the 2 major thyroid arteries and from where do they arise?
the superior thyroid artery from the external carotid
inferior thyroid artery from the thyrocervical trunk off the subclavian
The isthmus of the thyroid gland usually lies immediately anterior to what structure?
the proximal trachea, just slightly below the cricoid cartilage anterior to the second and third tracheal rings
What percentage of people have a pyramidal lobe found on the thyroid gland?
~50%
Which nerve is typically endangered during surgical removal or dissection of the thyroid gland?
the recurrent laryngeal nerve
What are the common names for the first and second cervical vertebrae?
atlas (C1)
axis (C2)
What artery travels through the foramina of the transverse processes of the cervical vertebrae?
the vertebral artery
Damage to what structure in the neck will produce Horner’s syndrome?
Damage to the sympathetic nerves or sympathetic chain will cause Horner’s syndrome.
What is the name of the functionally and clinically important potential space between the prevertebral fascia and the buccopharyngeal fascia (behind the pharynx)?
the retropharyngeal space
Thoracic outlet syndrome refers to compression of the ________ and/or __________.
brachial plexus
subclavian artery
Where is the anterior fontanelle located?
In the midline, at the intersection of the parietal and frontal bones – or at the junction of the sagittal , coronal, and metopic sutures (the metopic suture is the temporary suture between the two frontal bones which remain paired for a short period after birth).
The mastoid process is a feature of which cranial bone?
temporal bone
The styloid process is a feature of which cranial bone?
temporal bone
Which of the following are muscles of facial expression and which are muscles of mastication?
Platysma
facial expression
Which of the following are muscles of facial expression and which are muscles of mastication?
Orbicularis oris
facial expression
Which of the following are muscles of facial expression and which are muscles of mastication?
Buccinator
facial expression
Which of the following are muscles of facial expression and which are muscles of mastication?
Medial pterygoid
mastication
Which of the following are muscles of facial expression and which are muscles of mastication?
masseter
mastication
Which of the following are muscles of facial expression and which are muscles of mastication?
Zygomatic major
facial expression
Which of the following are muscles of facial expression and which are muscles of mastication?
temporalis
mastication
Which cranial nerve innervates the muscles of facial expression?
CN VII- facial
which cranial nerve innervates the muscles of mastication?
CN V- trigeminal
Which cranial nerve is responsible for the sensory innervation of the face?
CN V- trigeminal
Which cranial nerve is damaged in the condition known as Bell’s palsy?
CN VII- facial
Which of the following arteries are not branches of the external carotid artery?
Facial, lingual, retromandibular, occipital, maxillary, superior thyroid, inferior thyroid
retromandibular- name of facial vein
inferior thyroid
By convention, how many layers of tissue make up the scalp? Which of these constitute the scalp proper?
The scalp is composed of 5 layers; layers 1-3 constitute the scalp proper
In which layer of the scalp are the nerves and vessels located?
layer 2
Which layer of the scalp is known as the dangerous area?
layer 4
In what anatomical region would you find the origin of the branches of the maxillary artery?
infratemporal fossa
In what anatomical region would you find the origin of the branches of the mandibular nerve (V3)?
infratemporal fossa
The parasympathetic fibers from the otic ganglion travel to which gland?
parotid gland
Which cranial nerve innervates the muscles that cause movement at the TM joint?
CN V- trigeminal
muscles that move the TMJ are the muscles of mastication
Which cranial nerve can be found dividing into several branches inside the parotid gland?
CN VII facial
Which small space inside the skull is situated between the nasal cavity and the infratemporal fossa?
pterygopalatine fossa
Where would you find the palpebral portion of the orbicularis oculi muscles?
on the eyelids
As it travels from the parotid gland to the oral cavity, which muscle (of mastication) does the parotid duct cross, and which muscle (of facial expression) does it pierce?
the duct crosses the masseter and pierces the buccinator
What is the calvaria?
The calvaria is the upper domelike portion of the bony skull (the skullcap).
Where is the coronal suture?
The coronal suture lies in the coronal plane between the unpaired frontal bone and the two parietal bones.
Where is the sagittal suture?
The sagittal suture is on the top of the skull between the two parietal bones.
Where is the pterion? Why is it a clinically important landmark?
The pterion is an “H”-shaped sutural junction located on the lateral aspect of the skull. It can be found at the junction of the greater wing of the sphenoid, the squamous temporal, the frontal, and the parietal bones.
It is clinically important because it lies over the course of a large middle meningeal artery branch. Fractures across the pterion can lead to epidural hematomas.
Where would one find the middle meningeal artery? From what artery does it arise?
The middle meningeal artery arises from the maxillary artery and enters the cranial cavity through the foramen spinosum. Its branches travel between the inside of the skull bones and the dura mater.
What type of hematoma typically results from tearing the middle meningeal artery?
Epidural hematomas
What cranial fossa contains the foramen magnum?
posterior cranial fossa
What cranial fossa contains the superior orbital fissure?
middle cranial
What is the sella turcica? What important glandular structure is associated with it?
The sella turcica is a saddle-like prominence on the upper surface of the sphenoid bone, situated in the middle cranial fossa and dividing it into two halves. It contains the pituitary gland
What is a gyrus? What is a sulcus?
A gyrus is one of the prominent rounded elevations that form the cerebral hemispheres. The gyri are separated by sulci, which are the grooves or furrows on the surface of the cerebrum.
Where is the pons located?
The pons is located on the ventral surface of the brainstem between the midbrain and the medulla oblongata, inferior to the cerebellum.
Where is the medulla oblongata located?
The medulla oblongata is that portion of the brainstem between the pons and the spinal cord. It is continuous with the spinal cord at the foramen magnum
What is the falx cerebri?
The falx cerebri is the sickle-shaped fold of dura mater in the longitudinal fissure between the two cerebral hemispheres.
What would one find within the superior sagittal sinus?
The superior sagittal sinus contains venous blood. It also contains the arachnoid granulations, which protrude into the sinus from beneath as the CSF pressure rises.
What is the predominant route by which cerebral blood drains from the cranial cavity?
The venous blood within the cranial cavity eventually collects in the larger cerebral veins which drain into one of several dural venous sinuses. The blood in the dural venous sinuses drains predominantly into the internal jugular vein.
What are emissary veins?
Why are they clinically important structures?
Emissary veins are venous channels located between the venous sinuses of the dura mater and the veins of the diploë and the scalp. They are clinically important in that they provide a potential passage for the spread of infection between the scalp and the intracranial venous sinuses.
Where is cerebrospinal fluid (CSF) produced?
CSF is produced within the ventricles of the brain by the choroid plexus.
What is the name of the structure that produces CSF?
choroid plexus
How does the CSF eventually drain into the venous system?
The main passageway of CSF drainage is through the arachnoid granulations and into the venous blood of the superior sagittal sinus.
What is hydrocephalus?
Hydrocephalus is any condition marked by an excessive accumulation of CSF within the cranial cavity. One common type of hydrocephalus, caused by a congenital blockage of the cerebral aqueduct, results in dilation of the cerebral ventricles, thinning of the brain tissues and separation of cranial bones
Which two pairs of major arteries enter the cranial cavity to supply blood to the brain?
The internal carotid arteries and the vertebral arteries.
What is the major unpaired artery that is formed from the two vertebral arteries within the cranial cavity?
The basilar artery.
How do the anterior, middle, and posterior cerebral arteries arise?
The internal carotid arteries terminate within the cranial cavity by dividing into the anterior and middle cerebral arteries. The single basilar artery ends by dividing into two posterior cerebral arteries.
What is the Circle of Willis?
The Circle of Willis is an anastomotic “circle” of arteries (roughly pentagonal in outline) at the base of the brain, formed, sequentially (in anterior to posterior direction) by the anterior communicating artery, the two anterior cerebral, the two internal carotid, the two posterior communicating, and the two posterior cerebral arteries.
How many pairs of cranial nerves are there?
12
What is the name of the seventh cranial nerve?
facial
What is the name of the tenth cranial nerve?
vagus
What is the cranial nerve number of the glossopharyngeal nerve?
CN IX
Which cranial nerves travel through a foramen associated with the internal jugular vein?
CNs IX, X, and XI
Which cranial nerves travel through the cribriform plate openings?
CN I
Which cranial nerves travel through the superior orbital fissure?
CNs III, IV, V1, VI
In which cranial fossa is the internal auditory meatus located? Which cranial nerves travel through it?
The internal auditory meatus, for CNs VII and VIII, is in the posterior cranial fossa.
Which cranial nerve has a component that travels through the foramen magnum?
CN XI (spinal accessory nerve) has a spinal root that travels through the foramen magnum.
How do postganglionic sympathetic nerves get into the cranial cavity?
Sympathetic nerves enter the cranial cavity in a plexus on the major arteries traveling from the neck into the cranial cavity – especially the internal carotid arteries.
What important glandular structure lies immediately inferior to the optic chiasm?
The pituitary gland lies immediately below the optic chiasm
Which unique cranial nerve structure lies within the Circle of Willis?
The optic chiasm of CN II lies within the Circle of Willis.
Where is the cavernous sinus located?
The cavernous sinuses are located on either side of the sella turcica in the middle cranial fossae.
Which artery travels directly through the cavernous sinus?
The internal carotid arteries travel through the cavernous sinus.
How is the eyelid elevated and closed?
What nerves are responsible for this movement?
The tarsal plate of the eyelid is attached to the levator palpebrae superioris muscle that contracts and elevates the eyelid. It is closed by contraction of the palpebral fibers of the orbicularis oculi muscle (and gravity).
Levator palpebrae superioris is innervated by branches of the oculomotor nerve (CN III) while orbicularis oculi is innervated by the facial nerve (CN VII).
Where are tears produced and how do they travel to the nasal cavity?
What structures do they pass through?
Tears are produced by stimulation of the lacrimal gland (parasympathetic fibers from facial) that flow through small ducts and enter the upper outer fornix area of the eye.
They flow across the conjunctiva of the eyeball and eyelid toward the medial aspect. They exit through the superior and inferior puncta in the lacrimal papillae of the eyelids. The tears flow through small canaliculi to the lacrimal sac. The sac drains through the nasolacrimal duct that opens in the inferior meatus of the nose.
What are the conjunctiva of the eye?
The conjunctiva is the mucous covering of the eyeball and inner surface of the eyelid.
What are the sclera and cornea of the eye?
The sclera is the connective tissue layer that makes up the wall of the eyeball (white of the eye) and is continuous with the cornea which is the clear layer through which light enters the bulb.
What muscles either singly or together act to move the eye up (elevate)?
superior rectus and inferior oblique muscles
What are the iris and the lens of the eye?
The iris is the diaphragm at the front of the eyeball and the lens sits just behind and changes shape to focus the light on the retina.
What muscles either singly or together act to move the eye down (depress)?
inferior rectus and superior oblique
What are the pupil of the eye?
The pupil is the opening adjusted by movement of the iris.
What muscles either singly or together act to move the eye medially (adduct)?
medial rectus muscle
What muscles either singly or together act to move the eye laterally (abduct)?
lateral rectus muscle
What nerves innervate these muscles? Superior oblique
trochlear (CN IV)
What nerves innervate these muscles? Lateral rectus
abducens (CN VI)
What nerves innervate these muscles? all other oculomotor
(CN III)
What are the layers of the eyeball?
The outer fibrous layer is composed of the sclera and cornea. The middle vascular layer that is made of the choroids, ciliary body, ciliary processes, and iris. The inner layer made up of the retina.
What is the ciliary body?
The ciliary body is an anterior thickening of the middle layer containing muscles which control the shape of the lens, movement of the iris and serves as a point of attachment for suspensory ligaments of the lens.
What is the function of the retina?
The function of the retina is to translate light into neural impulses for transmission through the optic nerve to the optic centers of the brain.
Where vision is the most acute?
Vision is most acute in the fovea centralis of the macula lutea
What is the blind spot?
The blind spot is the optic disc where the optic nerve and ophthalmic vessels enter the eyeball. It is not covered with a sensory layer
How the blood is distributed to the orbit and eyeball?
Blood enters the posterior of the orbit in the ophthalmic artery (branch of the internal carotid) through the optic foramen with the optic nerve. It then travels somewhat medially giving off branches to the posterior of the eyeball, the muscles and then ending with superior and medial branches. It also gives off the central artery of the retina that travels through the center of the optic nerve to emerge at the optic disc.
What are the major branches of the ophthalmic division of the trigeminal nerve in the orbit?
Frontal with supraorbital and supratrochlear branches; lacrimal; nasociliary.
What nerve is sensory to the cornea? (specific branch)
The ophthalmic division of the trigeminal by way of the branches from the nasociliary is sensory to the cornea.
How does the iris open and close?
What muscles and nerves are responsible?
The iris is a diaphragm that is opened by radial muscles, dilator pupillae, innervated by postganglionic sympathetic fibers from the cervical sympathetic trunk. The iris is closed by circular sphincteric fibers, sphincter pupillae, innervated by parasympathetic fibers from the oculomotor nerve. These postganglionic parasympathetic fibers originate in the ciliary ganglion posterior to the eyeball.
How does the lens changes shape? What muscle and nerve is responsible?
The lens is stretched into an elongated shape by tension on the suspensory fibers that connect it to the ciliary body. This shape is used for far vision. Contraction of the ciliary muscle in the ciliary body releases that tension and allows the lens to become rounded, the shape needed for near vision. The ciliary muscle is innervated by parasympathetic fibers from the oculomotor nerve (CNIII).
What structures transmit and focus light on the retina?
Light is focused on the retina by the cornea, lens, and to a lesser extent by the vitreous humor. The lens is the only one that is adjustable.
What is relationship of the facial vein and the venous drainage in the orbit?
The ophthalmic vein drains from the posterior orbit through the superior orbital fissure and then into the cavernous sinus. However it has numerous connections anteriorly with the facial vein. Thus it is possible for infection to travel from the facial vein into the ophthalmic vein and then to the cavernous sinus where it can expand and in some cases cause meningitis.
What are the openings in the posterior wall of the orbit and what passes through them?
Optic foramen – optic nerve, ophthalmic artery;
Superior orbital fissure – oculomotor, trochlear, abducens, and trigeminal (ophthalmic division), and ophthalmic vein.
What cranial nerves are found in the eye and orbit and in general what they do?
Optic nerve (CN II) – vision. Oculomotor nerve (CN III) – movement of muscles of the eye, parasympathetic fibers to the muscles in iris and ciliary body. Trochlear nerve (CN IV) – motor nerve to the superior oblique muscle.
Trigeminal nerve (CN V) – ophthalmic division V1 is sensory to the skin over the orbit, the surface of the eyeball and cornea. Abducens nerve (CN VI) – motor nerve to the lateral rectus muscle. Facial nerve (CN VII) – small branch that provide parasympathetic fibers to stimulate the lacrimal gland to secrete, motor nerves to the orbicularis oculi.
where does the auditory (Eustachian) tube open?
It opens into the lateral wall of the nasopharynx just posterior to the nasal cavity.
What structure surrounds this opening?
The torus tubarius is a cartilage tube-like structure that creates a rounded elevation around the opening that helps maintain patency of the auditory tube.
where are the sinuses surrounding the nasal cavities located and where do they drain?
Frontal sinuses are found in the frontal bone anteriorly – drain through frontonasal duct to the middle meatus at the anterior hiatus semilunaris.
Ethmoid sinuses in the ethmoid bulla and upper lateral nasal area – they drain through numerous small openings into the middle meatus and some posterior ones into the superior meatus.
Sphenoid sinuses are in the body of the sphenoid bone posterior superior to the nasal cavity – drain to the space above the superior conchae (sphenoethmoidal recess).
Maxillary sinus in each maxillary bone lateral to the nasal cavity – drain to the middle meatus at the posterior hiatus semilunaris.
how is the maxillary sinus different?
The opening of the maxillary sinus is in the superior aspect of the sinus, therefore mucus must be directed upward by the ciliated epithelium to the opening. It is difficult to drain when the sinus is filled and the individual is upright. In addition roots of the teeth form conical elevations that protrude into the floor of the sinus, thus infections at the roots of the teeth can penetrate into the sinus cause complications.
what other major structures are related to the maxillary sinus?
The orbit is separated from the sinus by a thin sheet of bone. The close proximity of teeth to the floor of the sinus is also important.
what nerves innervate the walls of the nasal cavity?
The maxillary division of the trigeminal nerve (CN V2) provides branches to the mucosa through nasal branches and the nasopalatine nerve that supplies the nasal septum.
The upper portion of the nasal cavity is supplied by olfactory nerves that penetrate the cribriform plate from the olfactory bulbs.
what nerves stimulate mucous secretion in the nasal cavity?
Parasympathetic fibers stimulate the numerous mucous glands in the nasal cavity to secrete. These fibers come from the facial nerve (CN VII) through its greater petrosal branch as preganglionic fibers. The fibers synapse in the pterygopalatine ganglion, which is attached to maxillary nerve in the pterygopalatine fossa. The postganglionic parasympathetic fibers travel with regular branches of the maxillary to the nasal mucosa and with the greater and lesser palatine nerves to the surface of the hard and soft palates.
where does the blood supply to the nasal cavity originates?
The blood supply of the septal and lateral walls of the nasal cavity comes from branches of the sphenopalatine artery that is a continuation of the maxillary artery. The blood vessels enter the posterior area of the nasal cavity and spread anteriorly.
what muscles are associated with the soft palate and what do they do?
The primary muscles associated with the soft palate are the levator veli palatini and the tensor veli palatini.
Their function is what their name indicates, i.e., the levator veli palatini elevates the soft palate or increases its curvature while the tensor palatine tenses the palate and flattens it. The palatopharyngeus helps tense the palate and pulls up on the walls of the pharynx effectively narrowing the opening between the oropharynx and nasopharynx.
what are the three areas of the pharynx?
nasopharynx
oropharynx
laryngopharynx
what is the function of the pharyngeal constrictors?
The pharyngeal constrictors (superior, middle, and inferior) contract involuntarily in a superior to inferior pattern such that the sequential constriction helps propel food into the opening of the esophagus
what innervates the wall of the pharynx?
A plexus of nerves called the pharyngeal plexus is formed by fibers from pharyngeal branches of the vagus (CN X) and contributions from the spinal accessory (CN XI) nerves. These include motor fibers to muscles of the wall of the pharynx (and sensory fibers from the vagus).
where are the major tonsilar structures located?
The major lymphoid accumulations are arranged in a ring-like manner around the openings of the naso- and oropharynx into the alimentary tract.
The pharyngeal tonsils (adenoids if inflamed) are located adjacent Eustachian tube openings on the lateral wall of the nasopharynx while the palatine tonsils are located on the lateral walls of the oropharynx and the lingual tonsils are found on the posterior surface of the tongue.
what two bones are primarily responsible for side-to-side movement of the skull, and nodding of the head?
Side to side movement is due to the articulation of the atlas and axis. Nodding (flexion-extension) is due to the articulation of the occipital bone of the skull with the atlas.
what does the alar (check) ligament do?
The alar ligament connects the dens with the occipital bone and limits rotation of the skull on the vertebral column.
what does the dens (odontoid process) do and what holds it in place?
The dens is the modified vertebral body of the atlas that became attached to the axis.
It forms the point of rotation of the atlas on the axis.
It is held in place against the anterior arch of the atlas by the transverse fibers of the cruciate ligament.
what is the space between the cervical vertebral bodies and the posterior pharyngeal wall, and its clinical significance?
The retropharyngeal space lies between the prevertebral and buccopharyngeal fascias of the neck.
It is a potential route for spread of infection from the deep neck structures into the superior mediastinum.
What is the vestibule of the mouth?
The oral vestibule is the space between the lateral surfaces of the teeth (and gums) and the inside of the cheeks and lips.
How many permanent teeth are there? deciduous teeth?
32
20
Branches from which cranial nerve provide sensation to the upper and lower teeth?
Trigeminal (CN V).
V2 supplies branches to the upper teeth
V3 branches to the lower teeth
Which muscle of the palate is innervated by CN V?
Tensor veli palatini m.
Which muscle of the palate appears to emerge from the auditory tube opening in the nasopharynx?
Levator veli palatini m
Which cranial nerve provides taste sensation to the taste buds in the circumvallate papillae and posterior 1/3 of the tongue? general sensation?
Glossopharyngeal (CN IX) provides taste sensation to the circumvallate papillae and general sensation to the posterior 1/3.
Which cranial nerve innervates virtually all the muscles of the tongue?
Hypoglossal (CN XII) innervates every tongue muscle except the palatoglossus (vagus)
Which cranial nerve provides taste sensation to the anterior 2/3 of the tongue?
Facial (CN VII) through the chorda tympani branch (that travels with the lingual n. from V3)
Which cranial nerve provides general sensation to the anterior 2/3 of the tongue?
Trigeminal (mandibular branch - CN V3) via the lingual nerve
What is the major artery that supplies blood to the tongue? From what artery does it arise
The lingual artery – a branch of the external carotid.
Which salivary glands have ducts that pierce the buccinator muscles?
On each side of the face, the duct of the parotid gland pierces the buccinator m.
Which salivary glands have ducts that open on either side of the frenulum of the tongue?
The submandibular glands
What structure lies between the palatoglossal and palatopharyngeal folds?
The tonsil (or palatine tonsil)
How can you determine if the right hypoglossal nerve is damaged?
If the right hypoglossal nerve is damaged, the protruded tongue will deviate to the right.
where are the valleculae, vestibule, and piriform recesses are located?
The valleculae are spaces located on either side of the midline posterior to the tongue and anterior to the epiglottis.
The piriform recess is the space in the laryngopharynx just posterior to the larynx between the thyroid cartilage and the aryepiglottic fold. The vestibule is the space posterior to the epiglottis between the aryepiglottic folds and above the false vocal folds. It is the entryway to the respiratory tract
know the pathway for food material as it passes to the esophagus without passing into the airway.
Food passes over the posterior surface of the tongue as it is swallowed and into the valleculae. It then passes to either side of the epiglottis and around it into the piriform recesses and then enters the upper portion of the esophagus
what is the narrowest part of the airway and where is it located?
The narrowest part of the airway is the rima glottidis, which is the space found between the true vocal cords (vocal ligaments). This space changes shape when speaking, coughing, or breathing heavily
what nerves innervate the mucosal surface of the larynx and where do they originate? (above and below vocal chords)
The mucosal surface down to the level of the vocal cords is innervated by the internal laryngeal branch of the superior laryngeal nerve.
The mucosa up to the level of the vocal cords is innervated by branches of the inferior (recurrent) laryngeal nerve.
Both laryngeal nerves are derived from the vagus nerve.
what composes the laryngeal skeleton (cartilages)? How do these cartilages articulate with one another?
The major cartilage components of the larynx are the thyroid cartilage, cricoid cartilage, the epiglottis, and the arytenoid cartilages.
The thyroid cartilage and cricoid cartilage articulate with one another laterally while the arytenoid cartilages articulate with the upper posterior surface of the cricoid
where are the thyrohyoid, cricothyroid, and quadrangular membranes located and how do they shape the laryngeal complex?
The thyrohyoid membrane is a connective tissue membrane stretching between the thyroid cartilage and the hyoid bone and is perforated by the internal laryngeal nerve and superior laryngeal artery.
The cricothyroid membrane connects the thyroid and cricoid cartilages and helps form the anterior aspect of the complex. The quadrangular membrane stretches from the epiglottis to the aryteoid cartilages. It free inferior margin helps form the false vocal fold and this connective tissue membrane helps form the backing for the wall of the vestibule.
what are the muscles that change the position and tension of the vocal cords, how this is accomplished, and what nerve innervates them?
The muscles are innervated by the inferior (recurrent) nerve that is a branch of the vagus.
The vocal cord or ligament is attached to the thyroid cartilage anteriorly and to the vocal process of the arytenoid posteriorly. The vocal cords are approximated (adduct) or separated (abduct) by the movement of the vocal process or stretched (tensed) by the movement of the cricoid and thyroid cartilages.
Abduction of cords – posterior cricoarytenoid muscle.
Adduction of cords – lateral cricoarytenoid, arytenoids.
Stretch vocal cords – cricothyroid muscle.
The vocalis portion of thyroarytenoid muscle alters tension of vocal fold, relaxes it, and changes pitch.
when are the vocal cords opened and closed?
Why are they closed to cough?
The vocal cords are closed when attempting to increase intra-thoracic and/or intra-abdominal pressure or just prior to coughing. They are opened slightly when producing sound for speaking, opened slightly wider for normal breathing, and opened very wide during forced respiration.
how sound is produced?
Sound is produced when the vocal cords (or ligaments) are approximated, and air is moved from the thoracic cavity through the narrow gap between them, the rima glottides. Movement of air causes the cord to vibrate which produces sounds. The pitch is changed as a result of contraction of the vocalis muscle that changes the tension along the cords. The sound produced is then modified by the mouth, tongue, lips, etc.
what is the difference between true and false vocal folds?
What is found between them?
The true vocal folds are the more inferior and are where sound is actually produced.
The space or gap between the two vocal cords is known as the rima glottidis.
The false vocal folds are located at the inferior edge of the vestibule just above the true vocal folds. The space between the true and false vocal folds is known as the ventricle.
where is the vocal ligament or cord is located?
The actual vocal cord or ligament is located at the free medial edge of the fold so that it is exposed to the air rushing by and can therefore vibrate.
what is the function of the vocalis muscle?
The vocalis muscle is the midline fibers or portion of the larger thyroarytenoid muscle. It is responsible for altering the tension of the vocal ligament and thus changing the pitch of the voice.
why is damage to the inferior laryngeal nerves important?
The inferior laryngeal nerves control movement of the intrinsic muscles of the larynx. Therefore damage to the nerve results in muscle malfunction and loss of control of air movement and, of course, voice.
what happens if only one nerve is damaged in the vocal cords?
Damage to only one nerve results in impaired movement of cords on one side resulting in hoarseness
how does the Heimlich maneuver work?
Foreign objects often lodge in the vestibule just above the vocal folds. During the Heimlich maneuver the thoracic cavity is squeezed quickly, increasing thoracic pressure and forcing air up against the lodged object. Hopefully enough pressure is exerted that the object is moved out of the airway and the air can begin moving back and forth in normal respiration
what is done during a cricothyrotomy?
a cricothyrotomy is done to open an airway in an emergency. The airway is very close to the surface at the level of the vocal cords. It is separated from the outside only by the thickness of the skin and the cricothyroid membrane. These are incised and a hollow object is placed in the opening to maintain patency and allow air to move in and out. This position is usually below the level of the blockage so air movement can take place.
What are the major features of the medial and lateral ‘walls’ of the middle ear?
The lateral wall is made up primarily of the tympanic membrane and the structures attached to it such as the chorda tympani nerve.
The medial wall is composed primarily of the promontory, which is covered by fibers of the tympanic plexus. It also has two small openings, the oval window where the footplate of the stapes is inserted, and the round window sealed with a thin membrane.
The promontory is the bulge formed by the first turn of the cochlea of the inner ear.
In which bone is the middle ear located?
The petrous portion of the temporal bone
What are the mastoid air cells and why they are important?
The mastoid air cells are airspaces lined with mucosa that occupy the mastoid process of the temporal bone. They are connected with each other and are continuous with the middle ear cavity at the aditus to the mastoid antrum. The antrum is an enlarged space into which the air cells open. The cells are important since a middle ear infection (otitis media) may spread to these spaces where the infection can proliferate and access is limited. They can thus act as a reservoir of infection.
What is the roof of the tympanic cavity and what structure is close to it?
The roof of the tympanic cavity is known as the tegmen tympani. It is relatively thin and is adjacent to the dural lining of the cranial cavity. Infection can erode through the tegmen and then can spread to and through the meningial lining causing meningitis.
What are the openings into the middle ear cavity?
The openings to the cavity are the auditory or pharyngotympanic tube anteriorly and the aditus to the mastoid antrum posteriorly.
What are the ossicles and how do they function?
The ossicles are the malleus, incus, and stapes. They articulate with one another, beginning with the malleus whose handle is attached to the tympanic membrane. The head of the malleus articulates with the incus, which in turn articulates with the stapes that is inserted into the oval window of the medial wall and transmits movement to the cochlea of the inner ear.
What muscles dampen movement of the ossicles?
Why is that important?
The tensor tympani is attached by a tendon to the handle of the malleus. It is innervated by the mandibular division of the trigeminal nerve (V3). The tendon of the stapedius extends out of the apex of the pyramid which enclosed the stapedius muscle and attaches to the stapes. It is innervated by a small branch of the facial nerve (VII). When these muscles contract they reduce the movement of the ossicles and thus reduce the amplitude of transmission and dampen the sound transmitted to the inner ear.
This is a reflex function that helps protect the auditory apparatus from excessive noise and subsequent damage.
What is the function of the tympanic membrane, what structures cross it?
The tympanic membrane vibrates with the sound pressure waves that hit it. It transmits that movement into movement of the ossicles, which convey the sound energy to the inner ear where it is translated. The chorda tympani nerve from the facial nerve (VII) crosses the upper inner surface of the tympanic membrane. Damage to this portion of the middle ear can damage the nerve, which interferes with the taste function of the anterior 2/3 of the tongue
How does the membrane change with a middle ear infection?
During middle ear infections (otitis media) the tympanic membrane will become reddened and the presence of fluid in the tympanic cavity behind the membrane will cause it to change shape. This causes a change in the light reflective character of the membrane and results in the no longer being able to see the ‘cone of light’ present on a normal membrane. This is accompanied by pain or discomfort due to irritation of the sensory nerves of the cavity.
What is the auricle?
The auricle is the external ear structure that functions to collect sound and funnel it into the external meatus where it contacts the tympanic membrane. It is composed of skin covering an elastic cartilage core.
Where is sound converted to neural impulses in the ear?
Sound is converted into neural impulses within the inner ear. Movement of the footplate of the stapes causes movement of fluid in the turns of the cochlea of the middle ear. This fluid movement is sensed by neural cells within the cochlear duct that then transmit signals to the brain via the vestibulocochlear nerve (CN VIII).
What are the main functions of the inner ear?
The main functions of the inner ear are hearing, detection of the position of the head in space and balance (semicircular canals), and movement, i.e., acceleration and deceleration.
What is otitis media?
Otitis media is an inflammation and accumulation of fluid within the tympanic cavity caused in many cases by the closure or swelling of the musosa of the auditory tube.
What are the two types of hearing loss?
Two type of hearing loss are conductive hearing loss, that is, loss due to impaired movement of the ossicles or damage to the tympanic membrane and thus interference with transmission of the sound energy to the inner ear. The other is sensorineural loss that in due to problems within the cochlea, the nerve cells there, or within the brain.
Will patients with head trauma be more likely to receive plain X-ray imaging or CT?
CT
What 2 different “windows” are used in CT imaging?
bone window
soft tissue window
Which of the following can be readily imaged with CT scans of the cranium? Optic canal, Foramen rotundum, Foramen ovale, Internal acoustic meatus, Jugular foramen
all of them
What advantage does MRI provide when imaging the skull and CNS?
MRI usually provides much better resolution of the brain and spinal cord tissues than other imaging modalities. Also, many types of CNS pathology can be better visualized with MRI.
In which MRI mode will the CSF be dark?
T1
What mode of MRI is most useful in visualizing CNS pathology related to hemorrhagic bleeding?
T2
Name three imaging methods used to gain information about the function or functional states of different regions of the brain.
F-MRI
PET
SPECT
which imaging methods require the use of radioactive compounds out of F-MRI, PET and SPECT?
PET
SPECT
what component of blood does F-MRI make use of to generate images?
the iron in the hemoglobin molecules