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46 Cards in this Set
- Front
- Back
Temporal Bone and Region
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squamous portion
zygomatic arch mastoid process styloid process Lateral Side of head- temporalis muscle and fascia, superficial temporal vessels, auriculotemporal nerve (V3) |
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Infratemporal Region/fossa
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Below and deep to temporal region, behind maxilla, deep to ramus of mandible, in front of mastoid process; behind molars, extends medially to middle of mouth/palate line
Foramen ovale, foramen spinosum, stylomastoid foramen in this region houses medial and lateral pterygoid(attach to wing of sphenoid), insertion of temporalis TMJ joint here Maxillary artery gives off Middle Meningeal artery here Venous drainage here is pterygoid plexus (communicates with cavernous sinus) Nerves: CN V, VII and IX ganglia: pterygopalatine, otic and submandibular (all salivary) |
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TMJ
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temporal-mandibular joint
Articular disc divides the joint cavity Sphenomandibular and stylomandibular ligament supports it Hinge joint, but ligament allows it to glide (creates popping) Depression: gravity, digastric, geniohyoid, mylohyoid, Lateral pterygoid Elevation: temporalis, masseter, medial pterygoid Retraction: temporalis, deep part of masseter, geniohyoid, digastric Protrusion: lateral pterygoid assisted by medial pterygoid Side to side: temporalis, masseter and contralateral pterygoids Dislocations: Forward dislocations more common (when yawning), or fraction of the mandible otic ganglion and auriculotemporal nerve are close to the TMJ |
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Pterygopalatine Fossa
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Depression on outside of skull in infratemporal region
Between sphenoid and palatine bone (palatine anterior to pterygoid plate) Deep to this is sphenopalatine foramen (where find pterygopalatine ganglia) Content: Maxillary artery, and maxillary artery is associated with nerve of pterygoid canal and pterygopalatine ganglion |
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Pharynx
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Fibromuscular tube running from base of skull to cricoid cartilage
With deficiencies anteriorly = Opening to nasal and oral cavity 3 sections: nasopharynx (olfactory/respiratory function), oropharynx (digestive function), laryngopharynx (purely respiratory) Extends to C6 where becomes continuous with esophagus |
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nasopharynx
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Communicates with middle ear by Eustachian Tube (aud tube, or pharyngotympanic tube), guarded by tubul elevation and salpingopharyngeal fold (mucous membrane folds)
Small muscle at opening of eustachian tube that contracts when swallowing (swallowing helps equalize pressure in ear) At base of skull there is pharyngeal tonsil (adenoids when inflammed) Infections can get here from middle ear lasts until level of soft palate |
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Eustachian Tube
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Connects and communicates with nasopharynx
Vertical in adults, horizontal in kids (prone to ear infections) Lateral 1/3 is bone, rest is cartilage |
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Oropharynx
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Opening of oropharynx guarded on either side by palatine tonsils consisting of lymphoid tissue
palatoglossal arch/fold and palatopharyngeus arch and between two are the tonsils palatine tonsils are just below the tongue |
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Risk of Tonsillectomies
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Internal Carotid Artery just posterior to tonsil
Have to take tonsil out from fibromuscular wall which is paper thin, behind is pharyngeal constrictors and ICA, vagus and internal jugular Sometimes can have an aneurysm right behind or tortuous internal carotid which are dangerous to operate on Tonsils also have tonsillar branch of ascending palatine artery, tonsillar branch of facial artery complications: bleeding from arterial supply, bleeding from veins, perforation of ICA Lateral side is highly vascularized |
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Vestibule (mouth)
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U shaped region between cheeks, lips, teeth and gums
Contains labia frenula and parotid papilla (where parotid ducts open) Function: grasping |
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Parotidectomy/benign tumor of parotid
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Encapsulated gland so tumor growth causes pain
Parotidectomy needed but watch out for facial nerve running through the gland |
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Philtrum
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Provides human quality to our face, groove in middle between nose and lip
Missing philtrum can occur with FAS and cleft lip |
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Squamous cell carcinoma of lip (Lymph drainage)
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Transitional Zone of lip most susceptible
Middle portion of lower lip drains to submental nodes upper lip to ipsilateral submandibular and lower lip drains to submandibular nodes (ipsilateral and contralateral) Submandibular and submental both superficial submental drains to submandibular and submandibular drains deep Cancer in lower middle lip is best outcome |
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Palate (including foramina, nerves...)
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Separates oral and nasal cavity
Hard/bony- anterior is palatine process of maxilla, posterior is horizontal process of palatine bone Soft/uvula region more posterior Muscles: Tensor Veli Palatine (V3)- inserts onto soft palate and stretches uvula Levator Veli Palatine (Vagus)- Elevates the uvula which closes the oropharynx from the nasopharynx/nasal cavity, palatopharyngeus, palatoglossus, muscular uvulae Incisive canal (near incisors)- nasopalatine nerve and sphenopalatine artery Greater palatine foramina- greater palatine nerve and vessels go through Lesser palatine foramina- Lesser palatine nerve and vessels go through innervation: branches of V2, greater palatine nerve and nasopalatine nerve, Muscles innervated by pharyngeal plexus (CN IX, X, XI) and tensor by V3 |
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Cleft Palate
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Palate bones fail to fuse
Face looks normal but difficulty swallowing in nursing, problems with phonation May occur without cleft lips 1/2500 births, more common in females may involve only uvula or extend to palate |
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Teeth
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32 in adults
2 Incisors 1 Canine 2 Premolars 3 Molars Joint is gomphosis- conical tooth inserted into socket like portion, grants mobility to teeth, mobility helps teeth from cracking while biting hard object |
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Lower Jaw (innervation/anesthesia) aka mandibular nerve block
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Innervation: Inferior alveolar nerve (V3), travels through Mandibular foramen guarded by lingula (bony tongue)
Numbing jaw then aim for lingula- 1 injection Inferior alveolar nerve becomes mental nerve so skin anteriorly 1/2 goes numb too |
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Upper Jaw (innervation/anesthesia)
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Nasopalatine nerve (incisive foramen, mucosa, gingivae and palate of anterior 6 teeth), greater palatine nerve (greater palatine foramen, mucosa, lingual gingivae, palate posterior to canine teeth)
3 Injections: Incisive canal (nasopalatine nerve)- palatal mucosa, lingual gingivae, alveolar bone of 6 anterior maxillary teeth, hard palate Greater palatine foramen (Greater palatine nere)- Palatal mucosa, lingual gingivae posterior to canine teeth, bone of palate Vestibular side of tooth (aim for mucosa above tooth) bc other two only get lingual side of teeth nb: needle in incisive canal very painful bc mucosa intimately related with bone of upper jaw Superior alveolar nerve: from V2 |
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Tongue (attachments, paralysis)
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Attached to bony and cartilaginous structures-
Root: joined to epiglottis by 1 median and 2 lateral glossoepiglottic folds Mandible, hyoid bone, styloid process and palate by muscles Inferior surface: lingual frenulum attaches surface to floor of mouth paralysis then tongue falls back, tilt head back to open airway When comatose, tongue falls into oropharynx Have to intubate during anesthesia bc paralysis body and root (posterior 1/3) and separated by sulcus limitans with foramen cecum (remnant of thyroglossal duct) at the middle of it |
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Under Tongue (glands/veins)
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Sublingual glands
submandibular ducts- on either side of frenulum deep lingual plexus of veins (absorption of drugs) ie nitroglycerin |
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Extrinsic muscles of Tongue
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Move the tongue
Palatoglossal (elevation of tongue- Vagus/pharyngeal plexus)- Fold guarding oropharynx and palatoglossus is behind it genioglossal- protrudes tongue forward, very large hypoglossal- depresses tongue Styloglossal- elevates and retracts |
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Intrinsic Muscles of Tongue
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Alter Shape the Tongue-curling of tongue
Attachments entirely within tongue Interweaving bundles termed superior longitudinal, inferior longitudinal, transverse and vertical muscles |
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Motor to Tongue
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Hypoglossal except palatoglossal (vagus)
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Special Sensory to Tongue (Taste)
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Anterior 2/3 by Chorda Tympani (Facial)
Posterior 1/3 by Glossopharyngeal Very posterior by Vagus |
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General Sensory to Tongue
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Anterior 2/3 by Lingual nerve (Trigeminal)
Posterior 1/3 by Glossopharyngeal Very posterior by vagus/ internal laryngeal |
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Gag Reflex
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Afferent is Glossopharyngeal
Efferent is Vagus |
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Hypoglossal Nerve Injury
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Tongue deviates to side of lesion
Can be injured in boxing |
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Arteries to Tongue/Oral cavity/palate
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Maxillary Artery- gives off (within infratemporal fossa) Inferior alveolar artery, descending palatine artery (accompanies greater and lesser palatine nerves) and sphenopalatine artery (through sphenopalatine foramen then enters oral cavity via incisive canal),
External Carotid artery- gives off lingual artery and facial artery Getting blood supply from the front and back Palate: sphenopalatine artery and palatine artery- blood supply travels with nerves Veins follow arteris |
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Sphenoid Bone
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Wedged shaped
Perpendicular to long axis of skull Houses superior orbital fissure and foramen rotundum etc Has pterygoid process (inferiorly) |
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Pterygoids
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Both are lateral to pterygoid plate (sphenoid bone)
Lateral is more superior(near TMJ), medial more inferior (By ramus of mandible, other attachement is more medial on sphenoid), fibers have similar alignment as masseter(but on inside of mandible) |
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Muscles of Mastication
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Temporalis: closure of jaw, retraction of lower jaw (attaches to coranoid process)
Masseter: Closure of jaw, Protraction of lower jaw (attaches from zygomatic arch/bone to angle of mandible) Lateral pterygoid (opening of lower jaw, Protraction of lower jaw, produces larger chewing movements) Medial Pterygoid (Closure of jaw, Protraction of lower jaw, produces smaller grinding movements) |
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Lips
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Begin at nasolabial groove
skin of transitional zone: very thin, have color there Vermillion border: where skin meets transitional zone philtrum |
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Missing a Philtrum
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Fetal alcohol syndrome compromises philtrum (more severe with increasing concentration of alcohol)
Cleft lip: congenital, 1/1000 births 60-80% in males Can be small, large, unilateral or bilateral |
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Oral Cavity
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for chewing, preparing food for digestion, phonation, grasping
consists of vestibule (between cheeks and lips superficially, and teeth and gingivae deep) and oral cavity proper oral cavity proper: bonded by teeth and gums, palate, floor of mouth, and continuous posteriorly with facial isthmus |
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Tongue (functions, papillae, tonsil)
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Mobile muscular organ
partly in oral cavity proper and partly in pharynx Assists with: mastication, deglutition, articulation, and oral cleansing Nerve damage to tongue...many more cavities Lingual Tonsils, on root of tongue Papilla on body of tongue: Vallate (Most posterior), foliate (folds on sides tongue, very posterior), fungiform (mid/sides in body) and filiform papillae (middle/body)- increase surface area of contact between surface of tongue and content of oral cavity, all except filiform have taste buds on surface |
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Tongue Lymphatics
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Smoking also causes tongue, throat cancer
Closer to midline, more chance of metastasis to deep cervical LN making treatment more difficult Malignant tumors of posterior/root of tongue to superior deep cervical LN, Middle of body drains to inferior deep cervical LN front tip to submental Sides of the body of tongue to submandibular LN |
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Deglutition
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Want to seal off nasal cavity so food doesn't go into nasal cavity- through tensor veli palatini (CN V3), then levator veli palatini (CN vagus) which seals off oropharynx from nasopharynx and nasal cavities
Superior, middle, and inferior pharyngeal constrictors will narrow oropharynx so uvula has small area to close off 1. Tongue forces compacted bolus into oropharynx (styloglossus) 2. Pharyngeal constrictors narrow oropharynx, Tensor and levator palatini raise uvula to seal off nasal cavity salpingopharyngeus and stylopharyngeus elevate laryngopharynx (eustachian tube opens) 3. Larynx closes, bolus moves along esophagus and larynx returns Epiglottis doesn't move, the pharynx elevates to meet the epiglottis and seal off the trachea (palatoglossus, palatopharyngeus and salpingopharyngeus all aid with this |
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Nerves of Pharynx
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pharyngeal plexus formed by glossopharyngeal and vagus nerves- innervates all pharyngeal muscles but 2
stylopharyngeus (IX) and tensor veli palatini (V3) Inferior constrictors may be from external laryngeal nerve (vagus) Sensory: nasopharynx- maxillary nerve Oropharynx- glossopharyngeal (gag reflex) laryngopharynx- internal laryngeal nerve |
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Damage to Pharyngeal Plexus
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Uvula deviates away from afflicted side due to unopposed action of levator veli palatini
Saying AHHHH |
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Maxillary artery
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terminal branch of ECA
Supplies all deep structures of face: lower jaw, upper jaw, eye sockets, palate, and a little part of orbital cavity Ends by going into pterygopalatine fossa |
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Mandibular nerve (divisions)
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V3 trunk divides into Anterior and Posterior division
Branches off trunk: nerve to medial pterygoid and n.spinosus (sensory to meninges) Anterior division (mostly motor): Deep temporal (to masseter and lateral pterygoid), Buccal (to mucos membrane of vestibule- tell if drinking something hot or cold) Posterior Division (mostly sensory): auriculotemporal nerve, inferior alveolar, nerve to mylohyoid (comes off inferior alveolar), lingual (joined by chorda tympani), submandibular ganglia |
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Palatine Tonsil (blood supply, lymph)
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Blood: branches of facial, maxillary, ascending pharyngeal, lingual arteries
venous: drains into a venous plexus which drains to the facial or internal jugular vein lymph: drains to upper deep cervical nodes |
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Laryngopharynx
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laryngeal inlet guarded by epiglottis
Lateral to epiglottis are two depressions called piriform recesses (foreign bodies can get lodged there, causing whistling noise, or infections) Internal laryngeal nerve is located deep to the mucosa of the piriform recess |
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Muscles of pharynx
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3 constrictors stacked like flowerpots
superior, middle and inferior constrictors Origins: superior - mandible/sphenoid, middle - hyoid bone, inferior- thyroid/cricoid cartilage muscles fan out and decussate posteriorly at fibromuscular insertion (raphe) which will attach to pharyngeal tubercle at base of skull |
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Pharynx (blood supply)
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Ascending pharyngeal, facial, superior thyroid and inferior thyroid arteries
venous: drains into a plexus which drains into facial or internal jugular vein Lymph: retropharyngeal LN (in front of spine), from there to deep cervical LN |
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Oral Cavity Innervation
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upper jaw: superior alveolar branch of maxillary nerve
Lower jaw: Inferior alveolar branch of mandibular nerve |