Exam 3 review

Which nerve carries postganglionic parasympathetic fibers to the parotid gland?

The lesser petrosal nerve leaves the skull and the preganglionic fibers will synapse in otic ganglion. The post ganglionic fibers will join the auricotemporal nerve and will supply the parotid gland for salivary secretion.

arterial supply of tongue

The lingual artery - a branch of the external carotid and divides into 2 parts: -1st part (supra hyoid artery) lies in the carotid triangle -2nd part (dorsal lingual arteries) passes deep t hyoglossus muscle and supplies posterior part of tongue and palatine tonsil -3rd part (deep lingual after) runs upwardsalong anterior border of hyoglossus and branches to sublingual artery supplies the sublingual gland

rhinitis

The nasal mucosa swollen andbecomesduring severe upperinflamed respiratory(rhinitis)infections and allergic reactions(e.g., hay fever). • Swelling of the mucosa occurs readily becauseof its vascularity and glandular nature.• Infections of the nasal cavities may spread to the : 1. Anterior cranial fossa through the cribriformplate 2. Nasopharynx and retropharyngeal soft tissues 3. Middle ear through the pharyngotympanic tube (auditory tube), which connects the tympanic cavity and nasopharynx 4. Paranasal sinuses 5. Lacrimal apparatus and conjunctiva

What is the anatomic reference point to locate the parotid duct opening?

The parotid gland secretes saliva which then enters the vestibule through the parotid duct so your anatomic reference to locate the parotid duct is at the parotid papilla which falls opposite the second maxillary molar. opens into the mouth on the inner surface of the cheek, usually opposite the maxillary second molar.(Mucosa of the cheek across the 2nd upper molar teeth)

constrictor muscles

The pharyngeal muscles(involuntary skeletal) pushing the food into the esophagus. There are two muscular layers of the pharynx: the outer circular layer and the inner longitudinal layer. The outer circular layer includes: Inferior constrictor muscle Middle constrictor muscle Superior constrictor muscle During swallowing, these muscles constrict to propel bolus downwards (an involuntary process). The inner longitudinal layer includes: Stylopharyngeus muscle Salpingopharyngeus muscle Palatopharyngeus muscle During swallowing, these muscles act to shorten and widen the pharynx. They are innervated by the pharyngeal branch of the Vagus nerve (CN X) with the exception of the stylopharyngeus muscle which is innervated by the glossopharyngeal nerve (CN IX)

vagus nerve

The preganglionic parasympathetic fibers of the vagus nerve synapse with postganglionic fibers (see below) to cause: ◦ bronchoconstriction, a speeding up of peristalsis a slowing of the cardiac cycle, and increase in secretion of the bronchi, stomach, pancreas, and intestines. ◦ The vagal ganglia, postganglionic neurons are intramural located in the target organ.

What muscles does the mandibular nerve supply?

The sensory fibers innervate several skin regions of the face, as well as mucosa of the oral cavity, the lower teeth and gingiva. The motor branches supply muscles of the first branchial arch, including all of the muscles of mastication. tensor tympani muscle

In which triangle of what region of the neck is the submandibular gland located?

The submandibular gland is in the posterior part of the submandibular triangle, one of the four subdivisions of the anterior cervical region.

What are the possible complications of a thyroidectomy?

The surgical removal of thyroid gland. This procedure will have inferior thyroid veins and thyroid ima artery that are most vulnerable. Complications of the surgery could be: hemorrhage because of injury to the interior jugular veins Nerve paralysis of the recurrent laryngeal nerve Pneumothorax due to damage to the cervical dome of the pleura Esophageal injury due to immediate posterior location to trachea

internal jugular vein pulsation

The vein's pulsations are transmitted through the surrounding tissues, and may be observed deep to the SCM superior to the medial end of the clavicle. Because there are no valves in the brachiocephalic vein or the superior vena cava, a wave of contraction passes up these vessels to the IJV. The pulsations are especially visible when the person's head is inferior to the feet (the Trendelenburg position).• The internal jugular pulse increases considerably in conditions such as mitral valve disease, which increases pressure in the pulmonary circulation and the right side of the heart.

the relationship between the Rima glottidis and inhalation.

The vocal folds act as the primary inspiratory laryngeal sphincter when they are closed, to block the passage of air -During regular breathing at rest, the rim glottides is a narrow wedge shape but during forced respiration it is a wide triangular shape and the vocal crds are as far apart as they can extend

carotid sheath

a tubular condensation of deep fascia around common and internal carotid arteries, internal jugular vein, and vagus nerve -extends from the base of skull to the arch of arta -thick around the common and internal carotid arteries and thin around internal jugular vein -Anse cervicales is embedded in the anterior wall of the carotid sheath -cervical part of sympathetic chain lies behind the carotid sheath and in front of prevertebral fascia

kyphosis

abnormal curvatures in some people result from development; anomalies and in others from pathological processes such as osteoporosis -excessive thoracic kyphosis "humpback". is characterized by an abnormal increase in the thoracic curvature; the vertebral column curves posteriorly -this abnormality can result from erosion of the anterior part of one or more vertebrae. Progressive erosion and collapse of vertebrae results in an overall loss of height

frontal paranasal sinus

above eyebrows supraorbital artery submandibular lymph nodes supraorbital nerve

facial nerve lesion at B

above origin of nerve to stapedius symptoms: -hyperacusis -decreased salvation -loss of taste sensation from anterior 2/3 of tongue

facial nerve lesion at C

above the origin of chords typani symptoms: -decreased salvation -loss of taste sensation from anterior 2/3 of tongue -marked facial asymmetry -atrophy of facial muscles -can't close eye -tears overflow - smoothing out of forehead and nasolabial folds -drooping of corner of mouth -food accumulation in vestibule of mouth

surgical removal of only palpebral part of lacrimal gland

absence of tears in eyes as the ducts of the orbital part pass through the palpebral part is removed surgically, the secretions from the orbital part cannot be drained into the conjunctival sac

lateral cervical region nerves

accessory nerve, ventral rami brachial plexus, cervical plexus, phrenic nerve

Which parathyroid gland(s) is/are most likely to be found in an ectopic position?

This migration is extremely variable, and as a result, the inferior glands are more likely to be in an ectopic position.

Cephalhematoma

accumulation of blood deep to th pericranium/periosteal layer of scalp due to injury. The swelling is localized over the particular bone and takes the shape of the bone involved because the pericranium is loosely attached over the bones except at the sutural lines where it is connected to the endosteum via sutural ligaments. The hematoma is bound by suture lines and the swelling has well-defined margins. often seen is the parietal region and will disappear after 4-7 days

Identify

Thyroid gland

Identify

Thyroidhyoid muscle

Buccal nerve block

To anesthetizemucous membranethe skin andof thecheek (e.g., to suture a knife wound), an anesthetic injection can be made into the mucosa covering the retromolar fossa, a triangular depression posterior3rdto the mandibular molartooth between the anterior border of the ramus and the temporal crest.

tracheostomy

To avoid complications during a tracheostomy, thefollowing anatomical relationships are important: 1. The inferior thyroid veins arise from a venous plexus on the thyroid gland and descend anterior to the trachea. 2. A small thyroid ima artery is present in approximately 10% of people; it ascends from the brachiocephalic trunk or the arch of the aorta to the isthmus of the thyroid gland. 3. The left brachiocephalic vein, jugular venous arch, and pleurae may be encountered, particularly in infants and children. 4. The thymus covers the inferior part of the trachea in infants and children. 5. The trachea is small, mobile, and soft in infants, making it easy to cut through its posterior wall and damage the esophagus.

Which of the following is a parasite found in cats?

Toxoplasma gondii

Identify

Trachea

Loose connective tissue layer of scalp

acts as a natural plane of cleavage during craniotomy

Lateral circa-arytenoids

adducts vocal cords

venous drainage of thyroid

all thyroid veins do not accompany arteries 3 Pais of veins arise from the venous plexus -Superior thyroid veins: emerges at the upper pole of thyroid gland and terminates in internal jugular vein -Middle thyroid veins: are short veins emerges at the middle of lobe of thyroid gland and drains into internal jugular vein - Inferior thyroid veins: emerges at lower border of isthmus, descends in front of trachea (right and left vein communicate and form plexus in front of trachea) to drain into left brachiocephalic vein -Vein of kosher: emerges between the middle and inferior thyroid veins which drains into internal jugular vein

epidural anesthesia

an anesthetic agent can be injected into the extradural space using the position described for lumbar spinal puncture -the anesthetic has a direct effect on the spinal nerve roots of the caudal equine after they exit from the dural sac -the patient loses sensation inferior to the level of the block

Congenital Torticollis treatment

an anesthetic agent is injected at several points along the posterior border of the SCM, mainly at the junction of its superior and middle thirds, the nerve point of the neck -for anesthesia of the upper limb, the anesthetic agent in a supraclavicular part of the brachial plexus (main injection site is superior to the midpoint of the clavicle)

subarachnoid hematoma

an extravasation of blood, usually arterial, not the subarachnoid space -result from rupture of a saccular aneurysm -associated with head trauma involving cranial fractures and cerebral lacerations -bleeding into the subarachnoid space results in meningeal irritation, a severe headache, stiff neck, and loss of consciousness

brachial plexus block

anesthetic agent can be injected around trunk of brachial plexus just above midpoint of clavicle

nerve supply of tongue (sensory)

anterior 2/3 of the tongue = inguinal nerve posterior 1/3 = glossopharyngeal nerve posterior part of tongue including vallecula = internal laryngeal nerve

boundaries of anterior cervical region

anterior = median line neck Posterior = anterior border of SCM Superior = Inferior border of mandible Apex = jugular notch Roof = Subcutaneous tissue (platysma muscle) Floor = pharynx, larynx, thyroid glands

boundaries of the lateral cervical region

anterior = posterior border of SCM Posterior = anterior border trapezius inferior (base) = middle third of clavicle roof = investing layer of deep fascia floor = prevertebral fascia and muscles

name structures that pass through anterior and posterior ethmoidal foramina

anterior and posterios ethmoidal vessels ad nerves

Accessory parotid gland

anterior extension of parotid gland that is detached from the remaining of the gland sometimes and is located between the zygomatic arch above the parotid duct

identify

anterior jugular vein

An eyeball that is abducted and depressed is a consequence of injury to what nerve?

Trochlear nerve

True of False The lesser petrosal nerve (small superficial petrosal nerve) is the General visceral efferent (GVE) component of the glossopharyngeal nerve (CN IX), carrying parasympathetic fibers from the tympanic plexus to the parotid gland.

True

True or False: A small triangular gap between the two heads of sternocleiomastoid contains the terminal part of internal jugular vein. A needle or catheter can be inserted into the internal jugular vein at this site

True

True or False: The zygomatic arch divides the two spaces

True

True or False: The sympathetic and parasympathetic roots reach the ganglion through the nerve o the pterygoid canal which is formed by the union of deep petrosal nerve (sympathetic) and greater superficial petrosal nerve (parasympathetic)

True

subclavian triangle: nerves, arteries, lymph nodes

Trunk of brachial plexus long thoracic nerve (C5-7) Suprascapular nerve (C5&6) Nerve to subclavius (C5&6) Third part of subclavial artery supraclavicular artery supraclvicular lymph nodes

Deep Neck Fascia: pre vertebral

Tubular sheath for pre vertebral muscle -longus Colli and capties (anteriorly) -Scalenes (laterally) -Deep cervical muscle (posteriorly) Extension: -Superior: base of skull -inferior: end-thoracic fasica -Lateral: axillary sheath (brachial plexus and vessels)

hyoid bone

U-shaped bone at the base of the tongue that supports the tongue and its muscles. C3 level suspended by muscles keeps airways open

lordosis

"hollow back" characterized by an anterior rotation of the pelvis, producing an abnormal increase in the lumbar curvature; the vertebral column becomes more convex anteriorly -this abnormal extension deformity may be associated with weakened trunk musculature, especially of the anterolateral abdominal wall -to compensate for alterations to their normal line of gravity, women develop a temporary lordosis during late pregnancy

Identify

Vagus nerve

vental rami brachial plexus

(C5-C8) between anterior and middle scalene C5-T1 trunks

Subdivision of Posterior Triangle

(inferior belly of the omohyoid) upper part = occipital triangle -include occipital artery lower part = subclavian (supraclavicular) triangle -includes subclavian artery

tonsillectomy

(removal of the palatine tonsil) is performed by dissecting the tonsil from the tonsillar sinus or by a guillotine or snare operation. • Each procedure involves removal of the tonsil andthe fascial sheet covering the tonsillar sinus. • Because of the rich blood supply of the tonsil, bleeding commonly arises from the large external palatine vein or less commonly from the tonsillar artery or other arterial twigs. • The glossopharyngeal nerve accompanies the tonsillar artery on the lateral wall of the pharynx and is vulnerable to injury because this wall is thin. • The internal carotid artery is especially vulnerable when it is tortuous as it lies directly lateral to the tonsil.

Maxillary artery - 3rd part (pterygopalatine)

- Posterior superior alveolar artery: maxillar molar and premolar teeth, maxillary sinus, buccal gingiva - Infraorbital artery: inferior eyelid, lacrimal sac, infraorbital region, nose and upper lip. - Descending palatine artery: palatinegingiva and roof of mouth - Artery of pterygoid canal: superior pharynx, pharyngotympanic tube and tympanic cavity - Pharyngeal artery: roof of pharynx, sphenoidal sinus and inferior part of auditory tube - Sphenopalatine artery: lateral nasal wall, nasal septum, paranasal sinus.

Cranial Nerve III: Oculomotor

--Function: motor - feyelid and eyeball movement Medial and vertical eye movements; sensory - proprioception of the eye GSE: eye movements GVE: Constriction of pupil and accommodation -Testing procedure: pupil sizes are compared for shape and equality, pupillary reflex is tested; visual tracking is tested-parasympathetic function too

mylohyoid muscle

-Accessory muscle of mastication -Comprises floor of mouth -Attaches to mylohyoid ridge (internal oblique extension) -moves and stabilizes floor of mouth

connective tissue layer of scalp

-Fibrous septa break up this layer into numerous small pockets containing lobules of fat -the named blood vessels and nerves of the scalp are located in this layer and the walls of the blood vessels are adherent to the fibrous network - if the blood vessels are torn or cut, the walls are unable to retract causing professed bleeding

cranial nerve IV: Trochlear

-Function motor: motor vision (turns downward and inward eye movements) GSE: Eye movement of superior oblique muscle -Testing procedure: tested with cranial nerve III relative to following moving objects

Cranial Nerve VI: Abducens

-Function: Lateral eye movements GSE: Eye movement of the lateral rectus muscle -Testing procedure: tested in conjunction with cranial nerve III relative to moving eye laterally

Cranial Nerve VII: Facial

-Function: mixed (sensory and motor) sensory fibers to taste buds and anterior 2/3 tongue; controls facial expression and salivary glands (tears and saliva) SVE: Muscles of facial expression Posterior belly of digastric stylohyoid muscle stapedius muscle GVE: Lacrimal and salivary secretion SVA: Taste from anterior 2/3 of tongue and palate GVA: Sensation from palate GSA: Auricle and external acoustic meatus-Testing procedure: check symmetry of face, ask person to attempt various facial expressions; sweet, salty, sour, and bitter substances are applied to tongue to test tasting ability

Cranial Nerve V: Trigeminal

-Function: motor and sensory for face, face and mouth touch and sensory pain Control of jaw movements (chewing) SVE: Muscles of mastication Mylohyoid muscle Anterior belly of digastric muscle Tensor veli palatini muscle Tensor tympani muscle GSA: Sensation on head (skin and mucous membranes of face and head) -Testing procedure: pain, touch, and temperature are tested with proper stimulus; corneal reflex tested with a wisp of cotton; person is asked to move jaw through full ranges of motion

Cranial nerve IX: Glossopharyngeal

-Function: motor fibers for pharynx and salivary glands; sensory fibers for pharynx, soft palate, and posterior tongue. -Sensory: Taste sensation for sweet, bitter and sour SVE: Elevation of pharynx (stylopharyngeus muscle) GVE: Secretion of saliva (parotid gland) GVA: carotid sinus and body tongue pharynx middle ear SVA: Taste from posterior 1/3 of tongue GSA: External ear -Testing procedure: gag and swallow reflexes are checked; posterior one third of tongue is tested for taste parasympathetic function

Cranial Nerve XII: Hypoglossal

-Function: motor/sensory fibers to/from tongue. Movement of tongue via intrinsic and extrinsic muscles -motor to strap muscles of the neck GSE: Muscles of movements of tongue -Testing procedure: ask person to stick out tongue, positional abnormalities are noted

Cranial Nerve X: Vagus

-Function: sensory to ear, pharynx, larynx, and viscera -motor to pharynx, larynx, tongue, smooth muscles of the viscera (2 parts: superior laryngeal branch and recurrent laryngeal branch) SVE: Muscles of pharynx, larynx, and palate GVE: Smooth muscles and glands in thoracic and abdominal viscera GVA: Sensation in lower pharynx, larynx, trachea, and other viscera SVA: Taste on epiglottis GSA: Auricle and external acoustic meatus -Testing procedure: tested in conjunction with cranial nerve IX

What are the actions of the muscles of the extrinsic eye?

-Medial rectus = inward movement of eye (towards nose) -Lateral rectus = moves eye outwards (away from nose) -Superior rectus = upward movement of eye, rotates the top of eye towards nose, and moves eye inward -Inferior rectus - downward movement of eye, rotates top of eye away from nose and inward movement of eye -Superior Oblique = rotates eye top of eye towards nose, moves eye downward and outward -Inferior oblique = rotates top of eye away from nose, moves eye upward and outwards

rupture of transverse ligament of atlas and alar ligament

-When the transverse ligament of the atlas ruptures, the dens is set free, resulting in atlanto-axial subluxation or incomplete dislocation of the median Atlanta-axial joint -When complete dislocation occurs, the dens may be driven into the upper cervical region of the spinal cord, causing quadriplegia (paralysis of all four limbs) or into the medulla of the brainstem causing death -Alar ligaments are weaker than the transverse ligament of atlas

the spread of infection from the middle ear may cause:

-acute mastoiditis and mastoid abscess: when infection spreads into mastoid antrum and mastoid air cells via adits to mastoid antrum -Meningitis: if infection spreads upward via the thin roof of tympanic cavity wall of facial canal -facial palsy: when infection erodes the thin bone wall of facial canal -Transverse and sigmoid thrombosis: when infection spreads via the floor of tympanic cavity Labyrinthitis: infection spreads across the medial wall and causes vomitting and vertigo

external carotid artery ligation

-decreases blood flow through the artery and its branches but does not eliminate it -blood flows in a retrograde direction into the artery from the external carotid artery on the other side through communications between its branches and across the midline -when the external carotid or subclavian arteries are ligated, the descending branch of the occipital artery provides the main collateral circulation, anastomosing with the vertebral and deep cervical arteries -ligated above the superior thyroid artery - Damage or compression of the vagus and/or recurrent laryngeal nerve during surgical dissection of the triangle may produce an alteration in the voice because these nerves supply laryngeal muscles -Carotid triangle is between SCM, superior belly of omrohyoid and posterior belly of digastric

infection spread in neck

-investing layer of deep cervical fascia helps preventing the spread of infection -if an infection occurs between the investing layer of deep cervical fascia and the muscular part of the pre tracheal fascia surrounding the infra hyoid muscles, the infection usually does not spread beyond the superior edge of manubrium -infection occurs between the investing fascia and the visceral part of the pre tracheal fascia and can spread into the thoracic cavity anterior to the pericardium -pus from an abscess posterior to the prevertebral layer of deep cervical fascia may extend laterally in the neck and form a swelling posterior to the SCM - the pus may perforate the prevertebral layer of deep cervical fascia and enter the retropharyngeal space, producing a bulge in the pharynx -cause difficulty in swallowing and speaking -air from a ruptured trachea, bronchus, or esophagus may pass superiorly in the neck

inferior attachments of deep neck fascia

-manubrium sternum -clavicle acromion and spine of scapula

cleft lip and cleft palate incidence

-most cases of cleft lip with or without cleft palate are multilfactorial -cleft palate and cleft lip are though to be etiology and pathogenically -cleft lip occur more frequently in males than in females -Asian and Native American have some of the highest incidence while African Americans have the lowest -isolated cleft palate incidence is lower than that of cleft lip occurs more often in females than males -associated genes as IPF6 and MSX1 -Associated to exposure to teratogenic compounds as anticonvulsant medications as valpronic acid -cigarette smoking during pregnancy also increases the risk for orofacial clefts

cranium linear calvarial fracture

-most frequent type - usually occur at impact point but fracture lines often radiate away from it in two or more directions. If the area of the calvaria is thick at the site of impact, the bone usually bends inward without fracturing; however, a fracture may occur some distance from the site of direct trauma where the calvaria is thinner

lumbar puncture

-obtain a sample of CSF from the lumbar cistern, a lumbar puncture needle, fitted with a stylist, is inserted into the subarachnoid space -performed with the patient leaning forward or lying on the side with the back flexed -flexion of the vertebral column facilitates insertion of the needle by spreading the laminae and spinous processes -apart, stretching the ligament flava -under aseptic conditions, the needle is inserted in the midline between the spinous processes of the L3 and L4 vertebrae (at these levels in adults, there is reduced danger of damaging the spinal cord)

superior attachments of deep neck fascia

-superior nuchal line -mastoid process -zygomatic arch -inferior border of mandible -hyoid bone -spinous process o vertebrae

geniohyoid muscle

-superior to mylohyoid -reinforce floor of mouth

Lip and palatal anomalies

-unilateral cleft lip extending into nose -unilateral cleft involving the lip and jaw and extending to the incisive foramen -bilateral cleft invovling the lip and jaw -isolated cleft palate -cleft

The malleus develops from cartilage of pharyngeal arch ____________.

1

Tracheostomy procedure

1- A transverse incision through the skin of the neck and anterior wall of the trachea (tracheostomy) establishes an airway in patients with upper airway obstruction or respiratory failure. 2- The infrahyoid muscles are retracted laterally, and the isthmus of the thyroid gland is either divided orretracted superiorly. 3- An opening is made in the trachea between the first and second tracheal rings or through the 2nd through 4th rings. A tracheostomy tube is then inserted into the trachea and secured.

Facial nerve injury

1. A lesion of the zygomatic branch of CN VII causes paralysis, including loss of tonus of the orbicularis oculi in the inferior eyelid. 2. Paralysis of the buccal branch of CN VII causes paralysis of the buccinator and superior portion of the orbicularis oris and upper lip muscles. 3. Paralysis branch of the marginal mandibular CN VII may occur when anincision is made along the inferior border of the mandible. Injury to this branch (e.g., during a surgical approach to the submandibular gland) causes paralysis of the inferior portion of the orbicularis oris and lower lip muscles.

A 72-year-old man was concerned about a pea-sized swelling posterior to his auricle. Physical examination of his external ear and scalp by a physician revealed an infected sebaceous cyst in the temporal region. How could an infection in the temporal region cause a swelling posterior to the auricle?

1. An infected sebaceous cyst in the temporal region could spread through the lymphatics to the mastoid lymph nodes located posterior to the auricle.

Why is swelling of the parotid gland painful, especially during chewing? What nerve conveys this pain?

1. Inflammation of the parotid gland (parotiditis) is painful because the gland is enclosed within a strong capsule that is continuous with the investing layer of deep cervical fascia and the capsule resists enlargement of the gland. The overlying skin may also be tightly stretched. The greater auricular nerve innervates the parotid sheath and overlying skin. Usually the pain is greater during chewing because the parotid gland is wrapped around the posterior border of the ramus of the mandible and compressed against the mastoid process when the mouth is open.

sublingual carcinoma

1. Malignant tumors in the posterior part of the tongue metastasize to the superior deep cervical lymph nodes on both sides. 2. In contrast, anterolateraltumors in the parts usuallyapex and do notmetastasize to the inferior deep cervical nodes until late in the disease. 3. Because the deep nodes are closely related to the IJVs, metastases from the carcinoma may spread to the submental and submandibular regions and along the IJVs into the neck.

Four distinct regions of the neural tube:

1. Prosencephalon (forebrain) 2. Mesencephalon (midbrain) 3. Rhombencephalon (hindbrain) 4. Future spinal cord

A 58-year-old man consulted his physician about difficulty in swallowing. He said that he first had difficulty swallowing solid foods, but recently, he has had difficulty swallowing soft foods and liquids. He also said that he has lost considerable weight in the last 2 months. Physical examination of the man's neck revealed a large, firm lump deep to the anterior border of the SCM. A biopsy of the tumor and surrounding tissues revealed a malignant tumor of the cervical esophagus that had begun to infiltrate the periesophageal tissues. Describe the path of lymphatic drainage from the cervical esophagus. Into which periesophageal tissues do you think the cancer would infiltrate?

1. The lymphatic drainage of the cervical esophagus is to the paratracheal and inferior deep cervical lymph nodes. Invasion of the trachea or main bronchi is likely to occur with advanced esophageal cancer.

Anterior cervical region - visceral thyroid ima artery

10% people unparied usually arises frombrachiocephlaic trunk, from aortic arch, right common carotid, and subclavian arteries ascends anterior surface of trachea to the isthmus

Viscerocranium bones

15 irregular bones Three singular bones: Mandible Ethmoid Vomer Six paired bones: maxilla Zygomatic Inferior nasal concha Palatine Nasal Lacrimal

The stapes develops from cartilage of pharyngeal arch ______________.

2

Neck fascia

Well-defined layers that play a role in where an infection can spread Superficial fascia & deep fascia

Heimlich maneuver

When a foreign object enters the vestibule, the laryngeal muscles go into spasm, tensing the vocal folds.• The rima glottidis closes and no air enters the trachea. • Asphyxiation occurs, and the person will die in approximately 5 minutes from lack of oxygen if the obstruction is not removed. • Emergency therapy must be given to open the airway. • The procedure used depends on the condition of the patient, the facilities available, and the experience of the person giving first aid. Because the lungs still contain air, sudden compression of theabdomen (Heimlich maneuver) causesdiaphragm to elevate and compress thethelungs,expelling air from the trachea into the larynx • This maneuver usually dislodges the food or other material from the

What surgical procedure do you think would be performed to support an airway over an extended period of time?

When an extended period of airway support is required and rapid entry into the trachea is not necessary, a tracheostomy is usually performed. This procedure may be performed either superior or inferior to the isthmus of the thyroid. Division of the isthmus allows exposure of the upper trachea (i.e., between the first and second tracheal rings). Some surgeons prefer to make a vertical incision through rings two to four.

abducent nerve palsy

When the abducent nerve (CN VI) supplying lateral rectus isonly thepupil on the affected sideparalyzed, the individual cannot abduct the (abducent nerve palsy or paralysis). • The pupil is fully adducted by the unopposed pull of the medial rectus

A loss of integrity of the mandible results in a change of bite. What is this condition called? What results from this malformation?

When the integrity of the jaw is lost, the teeth do not fit together normally (malocclusion). This leads to changes in speech patterns because the articulation of words is difficult (dental sounds, such as the "S" sound, may not be producible in the normal way or may be inadvertently produced, and the required movements of the jaw may be difficult and painful).

Identify

Zygomaticofacial nerve

How many parathyroid glands are usually present?

4

Anterior cervical region - visceral thyroid gland pyramidal lobe

50% thyroid glands remnant thyroglossal duct

Nerves of the scalp

8 sensory nerves (4 in front and 4 behind auricle) Front: -supratrochlear nerve (from ophthalmic division of trigeminal nerve) -supraorbital nerve (from ophthalmic division of trigeminal nerve) Zygomaticotemporal nerve (from maxillary division of trigeminal nerve) -auriculotemporal nerve (fromt mandibular division of trigerminal nerve) Behind: -great auricular (from ventral rami of C2-3) -lesser occiptal (from ventral ramus of C2 ) -greater occiptal (from dorsal ramus of C2) -third occipital (from dorsal ramus of C3) 2 motor nerves (1 in front and 1 behind auricle Behind: -Occiptal bellies of occipitofrontalis muscle (behind the auricle & supplying posterior auricular branch of facial nerve) Front: - Frontal bellies of occipitofrontalis muscles (front of the auricle & supplying temporal branch of facial nerve

What do you think might cause the gastric distension associated with the infant's esophageal and tracheal anomalies

A TEF forces air through the fistula into the gastrointestinal tract, causing gastric distension, which precipitates passage of gastric contents into the trachea and bronchi.

A 26-year-old man was examined in the emergency department after being hit in the eye with a pool cue during a brawl. Examination of the eyeball showed no serious injury except for bleeding into the anterior chamber. The physician was concerned about the appearance of the eyeball and referred the patient to an ophthalmologist. What type of orbital fracture may have occurred?

A blowout fracture of the orbit may have occurred as a result of the sudden pressure increase in the orbit caused by the hard blow from the pool cue

a blow to head causing black eye

a blow on the head leads to collection of blood in the fourth layer of scalp. The blood from this layer gravitates into the eyelid because the frontal muscle has no bony attachment. this leads to the formation of a hematoma ad black discoloration of skin around eyes few hours after the head injury resulting in black eye. The blood can not pass laterally or posteriorly due to the attachment of epicranial aponeurosis and occipitals muscle to the superficial temporal lines and superior nuchal lines

Does a deep wound of the scalp always require stitches? If yes, why?

A deep wound of the scalp involving the epicranius gapes widely because of the pull of the anterior and posterior parts of the occipitofrontalis and lateral pull of the temporoparietalis. Therefore, stitches must be used to close the gap in the epicranial aponeurosis

carotid sinus

A dilation of proximal internal carotid artery involved in regulation of systemic blood pressure - baroreceptor innervated by glossopharyngeal nerve (CN IX) and vagus nerve (CN X)

If you detected clear fluid dripping from the person's nose, what might be the source of the fluid?

A fracture of the cribriform plate of the ethmoid may tear the meninges and result in cerebral spinal fluid (CSF) rhinorrhea (loss of CSF through the nose).

internal jugular vein pulsation symptoms

A lesion of a sympathetic trunk in the neck results in a sympathetic disturbance called Horner syndrome, which is characterized by :-• Pupillary constriction, resulting from paralysis of the dilator pupillae muscle• Ptosis (drooping of the superior eyelid), resulting from paralysis of the smooth (tarsal) muscle intermingled with striated muscle of the levator palpebrae superioris• Sinking in of the eyeball (enophthalmos), possibly caused by paralysis of smooth (orbitalis) muscle in the floor of the orbit• Vasodilation and absence of sweating on the face and neck (anhydrosis), caused by a lack of sympathetic (vasoconstrictive) nerve supply to the blood vessels and sweat glands

What causes tongue protrusion?

A lesion of the hypoglossal nerve causes deviation of the tongue toward the injured side on protrusion

How would an injury/lesion to the lingual nerve present?

A lesion of the lingual nerve will cause a loss of general sensation and taste to the anterior 2/3 of the tongue, and will also cause a loss of salivary secretion from the submandibular and sublingual glands.

internal jugular vein pulsation treatment

A needle and catheter may be inserted into the IJV for diagnostic or therapeutic purposes. The right IJV is preferable because it is usually larger and straighter.• During this procedure, the clinician palpates the common carotid artery and inserts the needle into the IJV just lateral to it at a 30-degree angle, aiming at the apex of the triangle between the sternal and clavicular heads of the SCM.• The needle is then directed inferolaterally toward the ipsilateral nipple

How do you think a nonpenetrating blow to the eye could result in serious problems?

A nonpenetrating blow to the eye may produce herniation of the orbital contents inferiorly through a blowout fracture in the thin floor of the orbit into the maxillary sinus.

How is the palate formed?

A palate develops from the 1st pharyngeal arch and frontonasal process. Formed from: 2 palatine processes of the maxillary processes Primitive palate is formed the inter maxillary segment of the frontonasal process The primitive palate fuses with the 2 palatine processes and 2 palatine processes fuse to form secondary palate later the mesoderm inn the palate undergoes intramembranous ossification to form the hard palate Ossification does not occur in the posterior part which forms the soft palate the muscles of the soft palate are derived from the 4th pharyngeal arch

carotid body

A receptor in the common carotid artery red-brown tissue at medial (deep) side of bifurcation innervated by glossopharyngeal nerve (CN IX) and vagus nerve (CN X) Function as a chemoreceptor - sensitive to oxygen decrease and increase respiratory and cardiac rate and depth of respiration

Why are scalp wounds potentially dangerous?

A severe infection of the scalp may spread to the bones of the calvaria, meninges, and/or brain via diploic veins, possibly resulting in osteomyelitis (infection of the bone) or thrombosis of the dural sinuses or meningitis, which may be fatal.

Explain the embryological basis of this cyst.

A thyroglossal duct cyst develops from a remnant of the embryonic thyroglossal duct, which connects the thyroid gland with the base of the tongue in the embryo. Normally the thyroglossal duct atrophies and degenerates as the thyroid gland descends to its final site in the neck.

The tubotympanic recess gives rise to: A. A conduit that interconnects the middle ear and the nasopharynx B. The external auditory meatus C. The internal auditory meatus D. The facial canal E. A conduit that interconnects the perilymphatic space with the subarachnoid space

A. A conduit that interconnects the middle ear and the nasopharynx The tubotympanic recess is derived from pharyngeal pouch 1. It gives rise to the tympanic cavity and the auditory (eustachian) tube; the auditory tube interconnects the tympanic cavity with the nasopharynx

Match the following cranial nerves (presynaptic parasympathetic component) with its respective abnormal clinical finding. 1. 67-year-old male with mydriasis (dilated pupil) and near vision problems 2. 56-year-oldfemale with parotid gland secretomotor deficit 3. 45-year-old female with chronic eye dryness A. CN III B. CN V C. CN VII D. CN VIII E. CN IX

A. CN III

Patients with supraventricular tachycardia (SVT) are commonly treated with carotid sinus massage due to the baroreceptors ◦ present in this area. Which of the following innervates the carotid sinus? A. CN IX B. Ansa cervicalis C. CN XI D. Presynaptics sympathetic fibers from the superior cervical ganglion E. Postsynaptics sympathetic fibers from the superior cervical ganglion

A. CN IX carotid body -at bifurcation -chemoreceptor for O2 levels -visceral sensory: carotid sinus branch of glossopharyngeal nerve Carotid sinus -proximal internal carotid artery -baroreceptor sensitive to blood pressure -visceral sensory: carotid sinus branch of glossopharyngeal nerve

The auricle (pinna) of the external ear is innervated by which of the following nerves? A. CN V3 B. CN V2 C. CN XII D. CN III E. CN VIII

A. CN V3

A 32-year-old woman undergoes LASIK refractive surgery to improve her visual acuity and rid herself of eyeglasses. Tp combat dry eyes (a common application of this surgery), her ophthalmologist inserts a silicone plug into a structure that blocks drainage of tears from the patient's eye. What structure of the lacrimal apparatus was obstructed? A. Lacrimal punctum B. Lacrimal canaliculus C. Lacrimal sac D. Nasolacrimal duct E. Inferior nasal meatus

A. Lacrimal punctum

The saccular portion of the otic vesicle gives rise to the: A. Organ of Corti B. Endolymphatic duct C. Superior semicircular canal D. Crus commune nonampullare E. Lateral semicircular canal

A. Organ of Corti The saccular region of the otic vesicle gives rise to the cochlear duct, which houses the spiral organ of corti

A 25-year-old female shows multiple salivary ducts obstruction due to calculi. The physician determined that it could be secondary to a secretomotor problem of the parotid gland. Which of the following ganglion can be associated to this problem? A. Otic B. Pterygoalatine C. Submandibular D. Ciliary

A. Otic Otic ganglion- Parasympathetic nerve:• Presynaptic fibers from CN IX• Postsynaptic (secretory to parotid) travel with the auriculotemporal nerve- Inferior to foramen ovale &medial to mandibular nerve

Which pharyngeal arch is associated with Treacher Collins syndrome? A. Pharyngeal arch 1 B. Pharyngeal arch 2 C. Pharyngeal arch 3 D. Pharyngeal arch 4 E. Pharyngeal arch 6

A. Pharyngeal arch 1

bilateral complete cleft lip

a cleft that involves both sides of the lip and extends into and involves the nose failure of scion of both palatine processes with each other and with the primitive palate is in a Y shape

An 8-year-old boy comes to his physician with a painless and smooth mass located in the midline of the neck at the level of the hyoid bone. This palpable, midline neck mass was asymptomatic, but due to recent expansion, it has caused difficulty and pain when swallowing. When he swallows or protrudes his tongue, the mass move superiorly. What is the most likely diagnosis?A. Thyroglossal duct cyst B. Enlarged deep cervical lymph node C. Thyroid nodule D. Benign parathyroid adenoma E. Branchial cyst

A. Thyroglossal duct cyst -if fluid fluid thyoglossal duct cyst; ectopic thyroid tissue is just a mass not fluid

All of the following muscles of the larynx are innervated by the recurrent laryngeal nerve except... A. cricothyroid B. thryoartenoid C. thyroepiglottis D. vocalis

A. cricothyroid

A male 3rd-year medical student mistakenly texts his Internal Medicine attending "I love you". After realizing what he did, he is shocked and embarrassed by his mistake. Given his agitated state, what ganglion, housing neuron cell bodies, is experiencing an extremely high rate of activity? A. superior cervical ganglion B. ciliary ganglion C. trigeminal ganglion D. pterygopalatine ganglion E. inferior vagal ganglion

A. superior cervical ganglion

nerve supply lateral rectus

Abducent nerve - abduction

Identify

Accessory nerve

mandibular nerve

Affects the muscles of the chin, lower lip, and external ear has both sensory and motor fibers nerve of 1st pharyngeal arch and supplies all structures derived form the arch

Congenital Torticollis

a contraction of the cervical muscles that produces twisting of the neck and slanting of the head -results Fromm a fibrous tissue tumor that develops in the SCM before or shortly after birth -the SCM is injured when an infant's head is pulled excessively during a difficult birth, tearing its fiber -this tearing results in a hematoma that may develop into a fibrous mass entrapping a branch of the spinal accessory nerve, thus denervating part of the SCM -surgical release of partially fibrotic SCM from its distal attachments to the manubrium and clavicle may be necessary

Where would you expect to find a displaced or ectopic parathyroid gland?

An ectopic parathyroid gland is commonly found in association with the thymus or embedded in the inferior part of the thyroid gland.

Parotidectomy

An important step in parotidectomy is the identifi -cation, dissection, isolation, and preservation of the facial nerve. • A superficial portion of the gland (often erroneously referred toas a "lobe") is removed, after which the parotid plexus, which occupies a distinct plane within the gland, can be retracted to enable dissectionof the deep portion of parotid gland makesthe gland. The a substantial contribution to the posterolateral contour of the face, the extent of its contribution being especially evident after it has been surgically removed.

A young woman recovering from a severe cold with nasal congestion complained to her physician about pain in her upper jaw. She said that she had been to her dentist but he told her that her teeth were not infected. Infection of what dental structures could cause this type of facial pain?

An infection from an abscess in a maxillary molar tooth could spread to the maxillary sinus because the apex of its root is in the thin floor of the maxillary sinus.

A young boy was taken to a pediatrician because of a severe earache. An otoscopic examination revealed a bulging, inflamed tympanic membrane. His mother told the physician that the boy was recovering from a severe cold and throat infection. Where do you think the ear infection was located? What is this type of inflammation called?

An infection in the middle ear was most likely the cause of the inflamed tympanic membrane (otitis media).

otitis externa

An infection of the external acoustic meatus. Signs and symptoms include itching and pain in the external ear • Otitis externa is an inflammation of the external acoustic meatus. • The infection often develops in swimmers who do not dry their meatus after swimming and/or use ear drops, but it may also be the result of a bacterial infection of the skin lining the meatus. • The affected individual complains of itching and pain in the external ear. • Pulling the auricle or applying pressure on the tragus increases the pain.

identify

Angular artery

cervical plexus motor

Ansa Cervicalis (strap muscles) Rhomboid muscle (dorsal scapular C4-C5) Serratus anterior (long thoracic C5-C7) Prevertebral muscles nerves

boundaries of posterior triangle

Anterior - sternocleidomastoid muscle Posterior - trapezius muscle inferior - middle third of clavicle Superior - meeting point of sternocleidomastoid and trapezius muscle

kiesselback septum

Anterior 2/3 nasal mucosa (Kiesselback septum) is associated to post traumatic bleeding (epistaxis greater palatine artery)

Deep Neck Fascia: pre-tracheal

Anterior neck From the hyoid bone into the thorax (fibrous pericardium) Parts: -muscular layer (infra hyoid muscles) -visceral layer is continuous with the buccopharyngeal fascia (posteriorly and superiorly) *forms a pulley for the intermediate tendon of digastric muscles divides the omrohyoid muscle

What are the borders of the infratemporal fossa?

Anterior: Posterior surface of maxilla Posterior: Styloid/mastoid processes Medial: Lateral Pterygoid Plate Lateral: Ramus and coronoid process of mandible Roof: Greater wing of the sphenoid bone

What structures lie near, or adjacent to the infratemporal space?

Anterior: Posterior surface of maxilla Posterior: Styloid/mastoid processes Medial: Lateral Pterygoid Plate Lateral: Ramus and coronoid process of mandible Roof: Greater wing of the sphenoid bone

deep relations face

Anteromedial: -ramus of mandible -masseter muscle -medial perygoid muscle -lateral surface of temporomandibular joint -terminal branches of facial nerve Posteromedial: -mastoid process -sternocleidomastoid muscle -posterior belly of digastric muscle -styloid process and muscles attached to it -facial nerve enters te gland through this surface -external carotid artery is lodged in a groove its lower part -Styloid process separates the gland from internal carotid artery , internal jugular vein, and last four cranial nerves

inflammation of eyelid glands

Any of the glands in the eyelid may become infl amed and swollen from infection or obstruction of their ducts. • If the ducts of the ciliary glands are obstructed, a painful red suppurative (pus- producing) swelling, a sty develops on the eyelid. • Cysts of the sebaceous glands of the eyelid, called chalazia, may also form. • Obstruction of ainflammation, atarsal gland producestarsal chalazion, that rubsprotrudes toward the eyeball and against it as the eyelids blink.

Neurovasculature of inner ear

Arterial supply: -Labrynthine artery -Stlyomasoid branch of occiptal artery Organ of court has no blood vessels Venous Drainage: Veins of internal ear drain into the superior petrosal sinus Nerve supply: -urticle, saccule, and semicircular canals receive fibers from vestibular nerve -cochlear duct (organ of corti) receives fibers from cochlea nerve

What nerve/ artery supplies the palatoglossus muscle?

Artery Supply: Greater and lesser palatine arteries of descending palatine artery of maxillary artery ascending artery of the facial artery palatine branch of the ascending pharyngeal artery Sensory: Lesser palatine nerves Motor: Vagus Nerve (CN X)

internal carotid artery

Artery that supplies blood to the brain, eyes, eyelids, forehead, nose, and internal ear. no branches at neck

common carotid artery

Artery that supplies blood to the face, head, and neck. left = aortic arch right = brachiocephalic trunk divides at superior border of thyroid cartilage: -internal carotid artery -external carotid artery

presbyopia

As people age, their lenses become harder and more flattened. • These changes gradually reduce the focusing power of the lenses, a condition known as presbyopia (G. presbyos, old). Treatment with using a convex lenses.

What are the signs and symptoms of a pituitary tumor?

Associated with pituitary gland tumor (CN II) Most common sign and symptom of pituitary gland tumor is the bitemporal hemianopia which is loss of vision in temporal field of both eyes due to a lesion of the optic chiasm. Bitemporal hemianopia is also known as tunnel vision.

Identify

Axis

Abnormalities of the thymus and superior and inferior parathyroid glands are exhibited by infants suffering from DiGeorge syndrome. These specific malformations indicate that DiGeorge syndrome affects development of which of the following pharyngeal pouches? A. 1st and 2nd B. 3rd and 4th C. 2nd only D. 2nd and 3rd E. 3rd only

B. 3rd and 4th

The middle ear cavity: A. Is of mesodermal origin B. Develops from pharyngeal pouch 1 C. Develops from pharyngeal arch 1 D. Develops from pharyngeal arch 2 E. Develops from the otic vesicle

B. Develops from pharyngeal pouch 1

Pharyngeal groove 1 gives rise to the: A. Internal auditory meatus B. External auditory meatus C. Eustachian tube D. Cervical sinus E. Primary tympanic cavity

B. External auditory meatus

The otic vesicle: A. Gives rise to the bony labyrinth B. Is found adjacent to the rhombencephalon C. Is derived from neuroectoderm D. Gives rise to the auricle (pinna) E. Gives rise to the tympanic membrane

B. Is found adjacent to the rhombencephalon

Which of the following vessels is encircled by the auriculotemporal nerve? A. Inferior alveolar artery B. Middle meningeal artery C. Descending palatine artery D. Masseteric artery E. Sphenopalatine artery

B. Middle meningeal artery

There are four parasympathetic ganglia in the head, each of which receives preganglionic fibers from a single cranial nerve. Which of the following shows the correct relationship between a parasympathetic ganglion and the cranial nerve that supplies it with preganglionic parasympathetic fibers? A. Geniculate ganglion, facial nerve B. Otic ganglion, glossopharyngeal nerve C. Pterygopalatine ganglion, maxillary nerve D. Submandibular ganglion, lingual nerve

B. Otic ganglion, glossopharyngeal nerve

Inability to retract the mandible can be secondary to paralysis of A. Medial pterygoid muscle B. Temporalis muscle, posterior fibers C. Lateral pterygoid muscle D. Buccinator muscle

B. Temporalis muscle, posterior fibers

A small blind pit at the anterior border of the sternocleidomastoid muscle that drips mucus is likely the persistence of the embryonic opening of the: A. first pharyngeal pouch B. second branchial pouch and cervical sinus C. third pharyngeal pouch D. fourth pharyngeal pouch E. thyroglossal duct

B. second branchial pouch and cervical sinus

tumors in the orbit

Because of the closeness of the optic nerve to the sphenoidal and posterior ethmoidal sinuses, a malignant tumor in these sinuses may erode the thin bony walls of the orbit and compress the optic nerve and orbital contents. • Tumors in the orbit produce exophthalmos. • The easiest entrance to the orbital cavity for a tumor in the middle cranial fossa is through the superior orbital fissure; tumors in the temporal or infratemporal fossa gain access to this cavity through the inferior orbital fissure. • Although the lateral wall of the orbit is nearly as long as the medial wall because it extends laterally and anteriorly, it does not reach as far anteriorly as the medial wall does, which occupies essentially a sagittal plane. Nearly 2.5 cm of the eyeball is exposed when the pupil is turned medially as far as possible. This is why the lateral side affords a good approach for operations on the eyeball.

Orbital Fracture

Because of the thinness of the medial and inferior walls of the orbit, a blow to the eye may fracture the orbital walls while the margin remains intact.• Indirect traumatic injury that displaces theorbital walls is called a "blowout" fracture.• Orbital fractures often result in intra-orbital bleeding which exerts pressure on the eyeball, causing exophthalmos (protrusion of the eyeball).• Main complications for orbit fracture : 1. bleeding into the maxillary sinus. 2. Displacement of maxillary teeth. 3. fracture of nasal bones resulting in hemorrhage, airway obstruction 4. infection that could spread to the cavernous sinus through the ophthalmic vein

A young woman who was not wearing a seat belt hit her forehead on the dashboard of her 10-year-old car during a head-on collision. The frontal area of her scalp was lacerated and bleeding profusely. The wound was cleansed with a saline solution and covered with a sterile bandage. By the time the woman reached the hospital, she had two black eyes. Further examination revealed that there was no injury to her eyeballs. What is the anatomical basis for the circular dressing?

Because the arteries enter the scalp inferiorly and ascend toward to the vertex of the head, a horizontal headband type of bandage compresses the vertical arteries.

Facial nerve lesion at D

Bell's palsy at stylomastoid foramen paralysis of all the muscles of facial expression o the same side Symptoms: -marked facial asymmetry -atrophy of facial muscles -can't close eye -tears overflow - smoothing out of forehead and nasolabial folds -drooping of corner of mouth -food accumulation in vestibule of mouth

How can bleeding due to laceration of axillary or brachial artery be stopped?

Bleeding due to laceration of axillary or brachial artery can be controlled by compressing the subclavian artery downwards and backward again the 1st rb in the supraclavicular triangle

Carotid triangle boundaries and contents

Boundaries: •Superior - posterior belly of the digastric muscle. •Lateral - medial border of the sternocleidomastoid muscle. •Inferior - superior belly of the omohyoid muscle. Contents: Common carotid artery (branches into external and internal carotid arteries), internal jugular vein, hypoglossal and vagus nerve

identify

Bregma

A 72-year-old man comes into his physician's office complaining of fever, nausea, vomiting, and the worst headache of his life. Tests and imaging examination suggest hydrocephalus (widening ventricles) resulting from a decrease in the absorption of cerebrospinal fluid (CSF). A decrease of absorption of CSFF through which of the following structures could be responsible for these findings? A. Great cerebral vein B. Inferior sagittal sinus C. Arachnoid villi D. Choroid plexus E. Subarachnoid trabecular

C. Arachnoid villi Cerebrospinal fluid is absorbed into the venous system primarily through the arachnoid villi projecting into the cranial dural venous sinuses, particularly the superior sagittal sinus

What results when the palatine prominences fail to fuse with the other side? A. Ankyloglossia B. Cleft Lip C. Cleft Palate D. Pharyngeal Cyst

C. Cleft Palate

The fact that the general sensory information from the anterior two-thirds of the tongue is carried by the lingual nerve indicates that this part of the tongue is derived from branchial arch _____: A. I B. II C. III D. IV E. VI

C. III -The lingual nerve innervates the anterior 2/3rds of the tongue and is a branch of the trigeminal nerve

The arterial supply to the alveolar spaces of mandible are given by A. Posterior superior alveolar artery B. Sphenopalatine artery C. Inferior alveolar artery D. Buccal artery

C. Inferior alveolar artery

A 29-year-old baseball player is hit by a high-speed baseball and brought to the emergency department. Physical examination and radiographs reveal fracture of the temporal bone and damage to the lesser petrosal nerve. Which of the following conditions could occur as a result of injury to the lesser petrosal nerve? A. Lack of parotid gland secretion B. Lack of lacrimal secretion C. Lack of submandibular gland secretion D. Constriction of the pupil

C. Lack of submandibular gland secretion

The surface ectoderm gives rise to which of the following structures? A. Dilator pupillae muscle B. Retina C. Lens D. Sclera E. Choroid

C. Lens The lens forms from the lens placed that is induced by the optic cup

Perilymph enters the subarachnoid space via the: A. Cochlear duct B. Ductus reuniens C. Perilymphatic duct D. Vestibular aqueduct E. Utriculosaccular duct

C. Perilymphatic duct The perilymph enters the subarachnoid space of the posterior cranial fossa via the cochlear aqueduct, which contains the perilymphatic duct

The utricular portion of the otic vesicle gives rise to the: A. Ductus reuniens B. Cochlear duct C. Semicircular ducts D. Scala vestibuli E. Scala tympani

C. Semicircular ducts The utricular region of the otic vesicle gives rise to the end-lymphatic sac and duct and semicircular ducts

Which of the following is one of the boundaries of the carotid triangle? A. Middle third of clavicle B. Anterior belly of the digastric C. Sternocleidomastoid D. Inferior belly of the omohyoid E. Midline of the neck

C. Sternocleidomastoid

A 21-year-old woman presents to her physician with a swelling on her neck. On examination, she is diagnosed with an infection within the carotid sheath. Which of the following structures would most likely be involved? A. internal carotid artery and recurrent laryngeal nerve B. external carotid and ansa cervicalis C. internal jugular vein and vagus nerve D. vagus nerve and middle cervical ganglion E. sympathetic trunk and common carotid artery

C. internal jugular vein and vagus nerve internal jugular vein and vagus nerveare within the carotid sheath (ALSO the common and internal carotid arteries).The recurrent laryngeal nerve lies in a groove between the trachea and esophagus. The sympathetic trunk, with superior and middle cervical ganglia, lies behind the carotid sheath. The external carotid artery is not contained within the carotid sheath. The ansa cervicalis lies superficial to or within the carotid sheath.

Which of the following muscles is innervated by the ansa cervicalis? A. stylohyoid muscle B. posterior belly of the digastric muscle C. omohyoid muscle D. platysma muscle E. mylohyoid muscle

C. omohyoid muscle Cervical plexus: Ansa cervicalis The cervical plexus is a nerve loop traveling within the carotid sheath formed by the ventral rami of C1-C3: -superior root = C1-C2 -Inferior root: C2-C3 Ansa cervicales provides motor innervation to all the infrahyoid muscles except one. -omohyoid -sternohyoid -sternothyroid The 4th infra hyoid muscle (thyrohyoid) is innervated by a branch of the ventral rays of C1 that travels with the hypoglossal nerve

A 23-year-old student receive a hit with a ball in his orbital region, leading to fracture of his optic canal. Which of the following structures is most likely to be damaged? A. optic nerve and ophthalmic vein B. ophthalmic vein and ophthalmic nerve C. ophthalmic artery and optic nerve D. ophthalmic nerve and optic nerve E. ophthalmic vein and ophthalmic artery

C. ophthalmic artery and optic nerve

A 42-year-old woman noticed that her right upper eyelid was drooping, and her right pupil was constricted (see photo). She goes to her physician where a thorough examination revealed ptosis, miosis, anhidrosis and flushing of the right side of the patient's face. Which of the following structure is most likely damaged in this patient? A. ophthalmic division of trigeminal nerve B. ciliary ganglion C. superior cervical ganglion D. oculomotor nerve

C. superior cervical ganglion

cervical plexus sensory

C1-C4 (sensorial) Lesser occipital nerve (C2) greater auricular nerve (C2-C3) Transverse cervical nerve (C2-C3) Supraclavicular nerve (C3-C4)

phrenic nerve

C3-C5 innervates diaphragm sensorial pericardium, central diaphragm, mediastinal pleura right: anterior to 2nd part of subclavian artery Left: anterior to 1st part of subclavian artery Both: between anterior scalene and subclavian vein

Injury to the glossopharyngeal nerve

CN IX emerges from the anterior surface of the superior part of the medulla by 3 or 4 rootlets. It leaves the cranium through the jugular foramen and descends in the neck. Then winds around the stylopharyngess muscle and passes between the superior and middle constrctor muscles.

The stapedius muscle is innervated by ______________.

CN VII facial nerve

Identify the cranial nerve that is associated with the following functional component: SVA

CN X

An injury to which nerve will lead to deviation of uvula towards the normal side?

CN X Vagus nerve

An injury to which nerve will lead to tongue deviation towards the lesion side?

CN XII Hypoglossal nerve

Why do we perform carotid sinus massage? What structures are involved?

Carotid sinus is located at the origin of the internal carotid artery. The internal carotid artery is what functions as a baroreceptor which is essentially stimulated by changes in blood pressure. The carotid sinus is innervated by glossopharyngeal nerve and the vagus nerve. The vagus nerve is the most significant in this case. When the carotid sinus is stimulated (massage) it should cause slowing of the heart rate, vasodilation, and decrease in blood pressure. Clinically: Carotid sinus syncope will occur when patient will experience temporary LOC or faint due to diminished cerebral blood flow due to hypersensitivity of carotid sinus. These episodes can occur from appliance of pressure to the carotid sinus such as if you were to take their carotid pulse.

What are the actions of the muscles of the intrinsic eye?

Ciliary Muscle:Accommodation (changes the shape of the lens when your eyes focus on a near object); Innervated by parasympathetic fibers. Sphincter Pupillae Muscle: constrict the pupil in bright light via the pupillary light reflex or during accommodation; innervated by parasympathetic fibers. Dilator Pupillae Muscle: to increase the size of the pupil to allow more light to enter the eye; Innervated by sympathetic fibers.

Identify

Common Carotid artery

Anterior cervical region - artery

Common carotid artery, carotid sinus, carotid body, external carotid artery

oculomotor nerve injury

Complete oculomotor nerve palsy affects most of the ocular muscles, the levator palpebrae superioris, and the sphincter pupillae. • The superior eyelid droops and cannot be raised voluntarily because of the unopposed activity of the orbicularis oculi (supplied by the facial nerve). • The pupil is also fully dilated and non- reactive because of the unopposed dilator pupillae. • The pupil is fully abducted and depressed ("down and out") because of the unopposed activity of the lateral rectus and superior oblique, respectively.

What is the name for a contralateral optic tract lesion?

Contralateral Homonymous Hemianopia This is a condition where patients will only see one side of the world from each side of their eye because of the optic tract lesion. (loss of opposite visual field)

The stapedius muscle that moves the stapes ossicle is innervated by: A. CN V3 B. CN XII C. CN III D. CN VII E. Cervical nerves C2 and C3

D. CN VII

Aqueous humor enters the venous circulation via: A. Arachnoid villi B. Scleral canal C. Hyaloid canal D. Canal of Schlemm E. Cloquet's canal

D. Canal of Schlemm Aqueous humor is produced by the ciliary processes of the ciliary body. It flows from the posterior chamber, through the pupil, into the anterior chamber, and finally to the canal results in increased intraocular pressure (glaucoma)

Failure of the choroid fissure to close results in: A. Congenital detached retina B. Congenital aniridia C. Congenital aphakia D. Coloboma iridis E. Microphthalmos

D. Coloboma iridis Failure of the choroid (optic) fissure to close result in a cleft of the iris called a coloboma irises. this defect may extend into the ciliary body, choroid, optic nerve, or retina. Congenital aphasia -absence of the lens -may result from defective development of the lens

Failure of the choroid fissure to close results in: A. Congenital detached retina B. Congenital aniridia C. Congenital aphakia D. Coloboma iridis E. Microphthalmos

D. Coloboma iridis Failure of the choroid (optic) fissure to close results in a cleft of the iris—a coloboma iridis. This defect may extend into the ciliary body, choroid, optic nerve, or retina. Congenitalaphakia—absence of the lens—may result from defective development of the lens placode.

A physician examines a 53-year-old woman and notes deviation of the uvula to the right side and asymmetry in the elevation of the soft palate, with the palatal arch of the left side sagging when compared to the right. The muscles involved in these abnormal findings are most likely derived from the mesoderm of which pharyngeal arch? A. First B. Second C. Third D. Fourth E. None of the above

D. Fourth -invovled in soft palate except for tensor deli palatine which derives from arch 1

The source of mesenchyme in the face which forms the facial expression muscles derives from which of the following precursors?A. Second arch mesenchyme B. Third arch mesenchyme C. Paraxial mesoderm D. Prechordal mesoderm E. Intermediate mesoderm

D. Prechordal mesoderm

Hyper-oxygenation of premature infants may result in: A. Congenital glaucoma B. Microphthalmia C. Coloboma D. Retrolental fibroplasia E. Persistent pupillary membran

D. Retrolental fibroplasia -retolental fibeoplasia results from hyper oxygenation of premature infants. In premature infants, high oxygen concentration results in vaso-oliteration of the terinal arterioles, leading to hemorrhage and infarction of the retina. this phenomenon is peculiar to the incompletely vascularized peripheral retina

Hyperoxygenation of premature infants may result in: A. Congenital glaucoma B. Microphthalmia C. Coloboma D. Retrolental fibroplasia E. Persistent pupillary membrane

D. Retrolental fibroplasia Retrolental fibroplasia results from hyper oxygenation of premature infants. In premature infants, high oxygen concentration results in vaso-obliterationof the terminal afterioles, leading to hemorrhage and infarction of the retina.This phenomenon is perculiar to the incompletely vascularized peripheral retina

The subocciptal nerve is injured by knife wound at the point where it emerges fro between the vertebral artery and the posterior arch of the atlas. Which of the following muscles is spared from the paralysis? A. Semispinalis wapitis B. Obliquus capitis inferior C. Obliquus capitis superior D. Splenius capitis E. Rectus capitis posterior major

D. Splenius capitis The splenius capitis is inverted by Doral primary rami of the middle and lower cervical nerves. The sub occipital nerve supplies the muscles of the subocciptal area and the semispinalis capitis. The rectus capitis anterior is innervated by the ventral primary rami of the first and second cervical nerves

Maxillary -1st part retroandibular

Deep auricular artery: external acustic meatus • Anterior tympanic artery: tympanic membrane • Middle meningeal artery: dura and calvaria • Accesory meningeal artery: cranial cavity • Inferior alveolar artery: mandible, mouth

Maxillary artery - 2nd part (pterygoid)

Deep temporal artery (ant/post): temporal muscle • Pterygoid arteries: pterygoid muscles • Masseteric artery: masseter muscle • Buccal artery: buccinator muscle and mucosa

4th pharyngeal pouch

Dorsal wings --> superior parathyroids Ventral wings --> ultimopharyngeal body and parafollicular cells of thyroid

corneal reflex

During a neurological examination, the examiner touches the cornea with a wisp of cotton. • A normal (positive) response is a blink. • Absence of a blink suggests a lesion of CN V1; a lesion of CN VII (the motor nerve to the orbicularis oculi) may also impair this reflex. • The examiner must be certain to touch the cornea (not just the sclera) to evoke the reflex.

thyroidectomy

During a thyroidectomy (e.g., excision of a malignant thyroid gland), the parathyroid glands are in danger of being inadvertently damaged or removed.• These glands are safe during subtotal thyroidectomy because the most posterior part of the thyroid gland usually is preserved.• Variability in the position of the parathyroid glands, especially the inferior ones, puts them in danger of being removed during surgery on the thyroid gland.• If the parathyroid glands are inadvertently removed during surgery, the patient suffers from tetany, a severe convulsive disorder.• The generalized convulsive muscle spasms result from a fall in blood calcium levels.• Hormone replacement therapy is required.

A 58-year-old man consulted his physician about difficulty in swallowing. He said that he first had difficulty swallowing solid foods, but recently, he has had difficulty swallowing soft foods and liquids. He also said that he has lost considerable weight in the last 2 months. Physical examination of the man's neck revealed a large, firm lump deep to the anterior border of the SCM. A biopsy of the tumor and surrounding tissues revealed a malignant tumor of the cervical esophagus that had begun to infiltrate the periesophageal tissues. What caused the man's dysphagia? What do you think caused the large lump deep to the SCM?

Dysphagia, present in approximately 80% of patients with malignant tumors of the esophagus, is caused by gradual pressure from the tumor and closure of the esophageal lumen. The dysphagia is usually progressive. The hard lump deep to the SCM was likely a cancerous deep cervical lymph node located near the IJV. The malignancy had metastasized through the lymphatics to this node.

The optic nerve is a tract of the diencephalon that is not completely myelinated until: A. 5 years after birth B. 2 years after birth C. 1 year after birth D. 3 weeks after birth E. 3 months after birth

E. 3 months after birth

What structure is located anterolaterally to the carotid sheath? A. Vagus nerve B. Sympathetic trunk C. Recurrent laryngeal nerve D. Carotid body E. Ansa cervicalis

E. Ansa cervicalis a thin nerve loop that lies embedded in the anterior wall of carotid sheath Formation: -Superior root: continuation of descending branch of hypoglossal nerve -Inferior roo: second and third cervical spinal nerve -supplies infra hyoid muscles

In a detached retina, the site of detachment is found: A. Within the outer plexiform layer B. Within the inner plexiform layer C. Between the inner nuclear layer and the outer nuclear layer D. Between the choriocapillaris and the pigmentepithelial layer E. Between the pigment epithelial layer and the layer of outer segments of rods and cones

E. Between the pigment epithelial layer and the layer of outer segments of rods and cones The site of retinal detachment is between the pigment epithelial layer and the layer of outer segments of rods and cones; this corresponds to the intraretinal space between the inner and outer layers of the optic cup. Retinal detachment occurs when fluid from the vitreous compartment passes through a retinal hole and separates the pigment epithelial layer from the layer of outer segments of rods and cones

In a detached retina, the site of detachmentis found: A. Within the outer plexiform layer B. Within the inner plexiform layer C. Between the inner nuclear layer and the outer nuclear layer D. Between the chorio-capillaris and the pigment epithelial layer E. Between the pigment epithelial layer and the layer of outer segments of rods and cones

E. Between the pigment epithelial layer and the layer of outer segments of rods and cones The site of retinal detachment is between the pigment epithelial layer and the layer of outer segments of rods and cones; this corresponds to the intraretinal space between the inner and outer layers of the optic cup. Retinal detachment occurs when fluid from the vitreous compartment passes through a retinal hole and separates the pigment epithelial layer from the layer of outer segments of rods and cones

The cochlear duct contains the spiral organ of Corti and is derived from which of the following? A. Both ectoderm and mesoderm B. Neural crest C. Endoderm D. Mesoderm E. Ectoderm

E. Ectoderm

A 22-year-old man suffers a knife wound that saves the abducens nerve proximal to its entrance into the orbit. Which of the following will be observed in tis patient? A. Ptosis of the upper eyelid B. Miosis C. Lateral deviation D. Loss of accommodation E. Medial deviation

E. Medial deviation

A neonate is diagnosed with hemifacial microsomia. This disorder comprises several craniofacial malformations, including small and flattened maxillary, temporal, and zygomatic bones. What type of tissue is involved in this abnormality? A. Ectoderm B. Endoderm C. Mesoderm D. Ectoderm and mesoderm E. Neural crest

E. Neural crest

A 67-year-old woman visits her family physician with the primary complaint of a persistent sore throat. During examination, the physician gently touches the laryngeal wall and elicits a gag reflex. Which of the following muscles is an important participant in this reflex? A. Styloglossus B. Genioglossus C. Stylohyoid D. Hyoglossus E. Stylopharyngus

E. Stylopharyngus

Which of the following is contained within the submandibular triangle? A. glossopharyngeal nerve B. inferior alveolar nerve C. lingual nerve D. omohyoid muscle E. nerve to mylohyoid muscle

E. nerve to mylohyoid muscle

Your 17-year-old patient is frustrated because every time she ingests any food that is very cold, especially ice cream, she gets a headache. Such patients are believed to have a very sensitive parasympathetic ganglion that is located directly superior to the posterolateral aspect of the hard palate. Which is this ganglion? A. otic B. submandibular C. superior cervical D. Geniculate E. pterygopalatine

E. pterygopalatine

A 7-year-old girl was diagnosed with a Staphylococcus Aureus infection in her supraglottic region. Which of the following lymph ◦ nodes will most likely be involved in clearing this infection? A. pretracheal nodes B. paratracheal nodes C. submental nodes D. submandibular nodes E. superior deep cervical nodes

E. superior deep cervical nodes -Supraglottic area: Superior lymphatics drain to the upper deep vertical nodes -Glottic area (vocal cords) is devoid of lymphatics -Infraglottic area: drain to the pretrachel lymph nodes, paratracheal nodes laterally and then to the deep cervical and superior mediastinal nodes -Delphian node: a midline pre laryngeal lymph nodes indicative of metastasis from thyroid or laryngeal carcinoma

development of pituitary gland

Ectoderm - Rathke's pouch - anterior lobe of the hypophysis andenohypophysis: pars distills, pars intermedia pars tuberalis Neuroectoderm - infundibulum - posterior lobe of the hypophysis - neurohypophysis

If malignant cells from submandibular lymph nodes had metastasized, to which lymph nodes would they most likely go?

Efferent lymphatic vessels from the submandibular nodes pass to the superior and inferior deep cervical lymph nodes. Consequently, these nodes would also enlarge because of the spread of malignant cells from the primary tumor.

What is Troisier's sign?

Enlarged left supraclavicular lymph node

Left supraclavicaular lymph nodes (Virchow's nodes) may get enlarged in caner of abdominal organs.

Enlarged left supraclavicular nodes can be palpated in the supraclavicular region. These nodes are enlarged in caner of the following abdominal organs as a the lymph from these organs may reach Virchow's lymph nodes which drains into venous system at the junction of the left subclavian and left internal jugular vein. Metastasis of cancer cells along the thoracic duct may block drainage leading of thoracic duct to regurgitation into the surrounding Virchow's nodes. abdominal organs are: -stomach -colon -testis -lung mammary gland

identify

Epicranial aponeurosis

What anomaly is usually associated with this type of esophageal anomaly? Describe this condition.

Esophageal atresia in an infant is commonly associated with a tracheoesophageal fistula (TEF). Most often the esophagus forms a blind pouch, and the distal esophagus is connected to the tracheobronchial tree just superior to the carina, the ridge separating the openings of the right and left main bronchi at their junction with the trachea.

Identify

Ethmoid bone

What is the main vascular supply to the face?

Face receives arterial blood from facial artery. Sphenopalatine artery: terminal branch of maxillary artery, inferior and posterior aspects of the lateral nasal wall. inferior and posterior aspects of the lateral nasal wall, the most likely source of the bleeding. It will be drained by the facial vein which then drains into the internal jugular vein.

What are the Mesenchymal derivatives of the face?

Facial mesenchyme is derived from both the mesoderm and the neural crest cell populations and eventually forms the bone, cartilage, connective tissues and muscles of the face.

If the "wry neck" torticollis is not treated, what further developmental abnormalities may develop?

Failure to correct muscular torticollis results in asymmetrical development of the facial bones. Wedge-shaped deformities of the cervical vertebrae may also develop.

the signs and symptoms of meningitis

Fever, headache, stiff neck - is also known as nuchal rigidity bending neck causes extreme pain, altered mental status, Fear, altered level of consciousness (ALOC), confusion lethargy, inability to understand commands or interact appropriately. commonly associated among college students that live in dorms.

Infra-Orbital Nerve Block

For treating wounds of the upper lip and cheek or, more commonly, for repairing the maxillary incisor teeth, local anesthesia of the inferior part of the face is achieved by infiltration of the infra-orbital nerve with an anesthetic agent. • The injection is made in the region of the infra-orbital foramen, by elevating the upper lip and passing the needle through the junction of the oral mucosa and gingiva at the superior aspect of the oral vestibule. • Because the orbit is located just superior to the injection site, a careless injection could result in passage of anesthetic fluid into the orbit, causing temporary paralysis of the extra-ocular muscles.

laryngopharynx foreign body

Foreign bodies entering the pharynx may become lodged in the piriform fossae. If the object (e.g., a chickenbone) is sharp, it may pierce the mucous membrane and injure the internal laryngeal nerve. • The superior laryngeal nerve and its internal laryngeal branch are also vulnerable to injury if the instrument used to remove the foreign body accidentally pierces the mucous membrane. • Injury to these nerves may result in anesthesia of the laryngeal mucous membrane as far inferiorly as the vocal folds. • children swallow various objects, most of which reach the stomach and subsequently pass through the alimentary tract without difficulty. • In some cases, the foreign body stops at the inferior end of the laryngopharynx, its narrowest part. • Foreign bodies in the pharynx are often removed under direct vision through a pharyngoscope.

retromandibular vein

Formation: The superficial temporal vein and maxillary vein unite within the parotid gland to form the retromandibular vein Divisions- Before emerging from the parotid gland, the retromandibular vein divides into the anterior and posterior branches Termination- The anterior branch joins with the facial vein to form the common facial vein which in turn drains into the internal jugular vein. The posterior branch joins with the posterior auricular vein to form the eternal jugular vein which then drains into the subclavian vein

What bones form the neurocranium

Four Singular Bones: Frontal Sphenoid Eth`moid Occipital Two sets of Bones: Temporal Parietal

Cranial PSNS ganglia

Four nerves carry parasympathetic fibers to smooth muscle and glands: III, VII, IX and X. • There are four autonomic (PSNS) ganglia in the head: • ciliary(CN III) • Pter ygopalatine (CN VII) • Otic (CN IX)• Submandibular (CN VII) • Sympathetic fibers from the superior cervical ganglia hitchhike on the wall of the closest artery.

Transverse cervical (cervicodorsal)

From thyrocervical trunk cross superficial to anterior scalene and phrenic nerve cross root of brachial plexus

Cranial Nerve XI: Spinal accessory

Function: Motor - to sternocledomastoid and trapezius, pharynx, larynx, soft palate and neck; Foramen: foramen magnum, jugular foramen; SVE: Sternocleidomastoid and trapezius muscleConsequence ot Loss: difficulty elevating scapula or rotating neck

extrinsic muscles of the tongue

Genioglossus (mandible anterior) Hyoglossus (hyoid bone inferior) Styloglossus (styloid process posterior) Palatoglossus (palate superior)

What is the pterion of the skull?

Greater wing of the sphenoid bone

identify

Hyoglossus muscle

Anterior cervical region - Submental boundaries

Hyoid bone anterior belly of digastric floor = fibrous raphe of mylohyoid muscle apex = symphysis menti

Identify

Hypoglossal nerve

What nerve is involved based on left or right deviation or protrusion of the tongue?

Hypoglossal nerve

identify

Hypoglossal nerve

Cranial Nerve NucleiPSNS Brainstem Nuclei

III CN - Edinger Westphal nucleus. VII CN - Superior salivatory nucleus. IX CN - Inferior salivatory nucleus. X CN - Dorsal (posterior)vagal nucleus & ambiguus nucleus.

The laryngeal cartilages develop from the ______________ pharyngeal arch.

IV

How could an infection in the throat cause inflammation and bulging of the tympanic membrane?

If not adequately treated, a middle ear infection could spread through the mastoid antrum to the mastoid cells and produce mastoiditis.

If a tumor presents to the right side of the cavernous sinus what might be the presenting symptom?

If there is a tumor on either side of cavernous sinus then it will damage the oculomotor nerve, trochlear nerve, and the abducens nerve. Oculomotor damage will lead to ptosis, dilated pupil, and loss of accommodation. Trochlear nerve damage you wont be able to look inferiorly when the eye is adducted. Abducens damage will cause internal strabismus (medial deviation of the eye). Lateral gaze paralysis of the ipsilateral eye

A 27-year-old woman involved in a motorcycle accident was taken to the emergency department. She had facial lacerations but no obvious fractures. An eye examination revealed a medial strabismus of her right eyeball. Injury to which cranial nerve would cause this eye abnormality? Which muscle was paralyzed?

In this case, the right abducens nerve (CN VI) was injured, causing paralysis of the right lateral rectus muscle. The patient cannot turn her right eyeball laterally because the lateral rectus is paralyzed. In the absence of opposition by the lateral rectus, the medial rectus pulls the eyeball medially (medial strabismus)

An infant was referred by a family physician to a pediatrician because of respiratory distress and excessive salivation. The infant was coughing and choking during feeding. During the physical examination, the pediatrician observed an excessive amount of mucous secretion and saliva in the infant's mouth. She also observed that the infant experienced some difficulty in breathing and that gastric distension was present. As she was unable to pass a nasogastric tube very far along the esophagus, she told the mother that the infant had an esophageal anomaly. What congenital anomaly of the esophagus do you think was present?

Inability to pass a catheter through the esophagus of a newborn infant into the stomach indicates esophageal atresia.

A 72-year-old man was concerned about a pea-sized swelling posterior to his auricle. Physical examination of his external ear and scalp by a physician revealed an infected sebaceous cyst in the temporal region. An infection of what other structures could produce a larger, more painful swelling posterior to the external ear?

Inadequate treatment of a middle ear infection could spread through the mastoid antrum to the mastoid cells (acute mastoiditis) and produce a swelling posterior to the auricle.

A young woman recovering from a severe cold with nasal congestion complained to her physician about pain in her upper jaw. She said that she had been to her dentist but he told her that her teeth were not infected. Infection of which structures in the woman's upper jaw could cause pain in this area of her cheek?

Infection of the maxillary sinuses—maxillary sinusitis—is a common complication of nasal infections. Infection of these sinuses is common because their ostia are near the roofs of the sinuses. Hence, the sinuses must be full before they will drain when the person is standing.

Identify

Inferior Oblique muscle of eyeball

Identify

Inferior belly of Omohyoid muscle

The inferior sagittal sinus and the great vein form what structure?

Inferior sagittal sinus joins the great cerebral vein to form the straight sinus.

infratemporal region

Inferior to zygomatic arch• Boundaries:- Lateral: ramus of mandible- Medial: lateral pterygoid plate- Anterior: posterior aspect maxilla- Posterior: tympanic plate, mastoid and styloid processes- Superior: inferior surface greater wing- Inferior: attachment of medial pterygoid

adenitis

Inflammation of the pharyngeal tonsils (adenoids) is called adenoiditis. • This condition can obstruct the passage of air from the nasal cavities through the choanae into the nasopharynx, making mouth breathing necessary. • Infection from the enlarged pharyngeal tonsils may also spread to the tubal tonsils, causing swelling and closure of the pharyngotympanic tubes. • Impairment of hearing may result from nasal obstruction and blockage of the pharyngotympanic tubes. • Infection spreading from the nasopharynx to the middle ear causes otitis media (middle ear infection), which may produce temporary or permanent hearing loss.

What structures exit the inferior orbital fissure?

Infraorbital nerve Infraorbital vessels

How would an injury of the infraorbital nerve present?

Injury to infraorbital nerve will present as loss of sensation of skin of the cheek and gums.

Fascial VII nerve injury (Bell's palsy)

Injury to the facial nerve (CN VII) or its branches produces paralysis of some or all facial muscles on the affected side (Bell palsy).• May lead to : 1. corneal ulceration 2. dropping of the corner of mouth 3. food accumulation in affected side and may be spilled 4. impaired ability to produce labial sounds ( BMPW ) 5. Wiping of tear and saliva may lead to skin irritations

Horner's syndrome

a disorder resulting from damage to the sympathetic autonomic nervous pathway in the head. Damage of pre or post sympathetic fibers to face esults from interruption of a cervical sympathetic trunk and is manifest by the absence of sympathetically stimulated functions on the ipsilateral side of the head.• The syndrome includes the following signs: 1. constriction of the pupil (miosis) 2. drooping of the superior eyelid (ptosis) 3. redness and increased temperature of the skin (vasodilation) 4. absence of sweating (anhydrosis). • Constriction of the pupil occurs because thetheparasympathetically stimulated sphincter of pupil is unopposed. • The ptosis is a consequence of paralysis of the smooth muscle fi bers interdigitated with the aponeurosis of the levator palpebrae superioris that collectively constitute the superior tarsal muscle, supplied by sympathetic fibers.

sudural hematoma

a dural border hematoma not naturally occurring space at the dura-arachnoid junction The blood does not collect within a preexisting pace but rather creates a space at the dura-arachnoid junction Dural border hemorrhage usually follows a blow to the head that jerks the brain inside the cranium and injuries it The precipitating trauma ay be trivial or forgotten, but a hematoma may develop over many weeks from venous bleeding Dura border hemorrhage is typically venous in origin and commonly results from tearing of a superior cerebral vein bringing in as it enters the superior sagittal sinus

cranium depressed fractures

a fragment of bone is depressed inward compressing and/or injuring the brain

Anterior cervical region - vein

Internal jugular vein

Identify

Internal jugular vein

laryngeal nerve injury

Internal laryngeal nerve injury results in paralysis of the vocal fold. The voice is initially poor because the paralyzed fold cannot adduct to meet the normal vocal fold. • When bilateral paralysis of the vocal folds occurs, the voice is almost absent because the vocal folds are motionless in a position that is slightly narrower than the usual neutral respiratory position. They cannot be adducted for phonation, nor can they be abducted for increased respiration, resulting in stridor (high-pitched, noisy respiration) often accompanied by anxiety. • Injury to the external branch of the superiorlaryngeal nerve results in a voice that ismonotonous in character because the paralyzed cricothyroid muscle supplied by it is unable to vary the length and tension of the vocal fold. Hoarseness is the most common symptom of serious disorders of the larynx, such as carcinoma of the vocal folds.

Nerve supply of tongue (motor)

Intrinsic muscles: -superior (shorten the tongue and make the dorsal surface concave) and inferior (shorten the tongue and make dorsal surface convex) longitudinal nerve - transverse nerve (makes tongue narrow and elongated) -vertical nerve (makes tongue flat and broad) Extrinsic muscles: Genioglossus (protrude the tongue when both muscles contract) Hyoglossus (dress the side of tongue) Styloglossus (pulls the tongue upwards and backwards) Palatoglossus (closes the oropharyngeal isthmus)

What would injury to the lesser petrosal nerve present as?

Lack of secretion of parotid salivary gland

maxillary paranasal sinus

Largest sinus - lateral to nasal structure anterior, middle, and posterior superior alveolar arteries submandibular lymph nodes anterior, middle, posterior superior alveolar nerve

Identify

Larynx

infra temporal region contents

Lateral pterygoid muscle, medial pterygoid muscle, temporalis muscle Maxillary artery, and its branches, pterygoid venous plexus Mandibular nerve and its branches, chorda tympani, lesser petrosal nerves, optic ganglion

Identify

Lateral rectus muscle

supranuclear lesion

Lesion of UMN - damage occurs in pathway carrying impulses to LMN muscles of the lower part of face of opposite side are paralysed muscles of upper part of face are spared because they are controlled by both the cerebral hemispheres

What causes uvula deviation?

Lesion of the vagus nerve causes deviation of the uvula toward the opposite side of the lesion on phonation because of paralysis of the musculus uvulae.

identify

Levator Anguli Oris muscle

Identify

Levator scapulae muscle

The vagus nerve supplies which muscles?

Levator veli palatini Salpingopharyngeus Palatoglossus Palatopharyngeus Superior pharyngeal constrictor Middle pharyngeal constrictor Inferior pharyngeal constrictor Viscera

prevertebral fascia

Lies in front of the cervical and upper three thoracic vertebrae and prevertebral muscles and forms the floor of the posterior triangle Attachments: superior = attached to the base of skull in front of the foramen magnum inferior = attached to the anterior longitudinal ligament and body of T3 vertbera

What are the branches of the maxillary artery?

Mandibular Part: Deep Auricular Artery Anterior Tympanic Artery Middle Meningeal Artery Accessory Meningeal Artery Inferior Alveolar Artery Pterygoid Part: Anterior Deep Temporal Artery Posterior Deep Temporal Artery Pterygoid Artery Mesenteric Artery Buccal Artery Pterygopalatine Part: Posterior Superior Alveolar Arteries Infraorbital Artery Descending Palatine Artery Pharyngeal Artery Sphenopalatine Artery

What muscles would be affected in a trigeminal nerve injury?

Mandibular nerve would be injured, which innervates the facial muscles (masseter, temporals muscle, and the lateral and medial pterygoids)

What structures exit the foramen rotundum?

Maxillary nerve

What structures exit the inferior orbital fissure?

Maxillary nerve Zygomatic branch Infraorbital vessels

Identify

Median thyrohyoid ligament

What structures pass through the foramen spinosum?

Meningeal branch of mandibular nerve Middle meningeal vessels

What are the Mesodermal precursors of mouth and tongue?

Muscles of tongue (occipital somites) Pharyngeal arch muscles The oral part of the tongue forms from the median tongue bud and two distal tongue buds that develop in the pharynx floor due to a proliferation of mesoderm associated with pharyngeal arch 1.

supra hyoid muscles

Mylohyoid muscle Geniohyoid muscle Stylohyoid muscle Digastric

Identify

Nasociliary nerve

mental and incisive nerve blocks

Occasionally, it is desirable to anesthetize one side of the skin and mucous membrane of the lower lip, and the skin of the chin (e.g., to suture a severe laceration of the lip). • Injection of an anesthetic agent into the mental foramen blocks the mental nerve that supplies the skin and mucous membrane of the lower lip from the mental foramen to the midline, including the skin of the chin.

Goldenhar syndrome (oculoauriculovertebral spectrum)

Oculoauriculovertebral spectrum. usually involve the maxillary, temporal, and zygomatic bones anotia or microtia, dermis tumors in the eyeball fused and hemivertebra spina bifida in 50% of cases tetralogy of fallout and ventricular septal defects

What nerves exit the superior orbital fissure?

Oculomotor nerve Trochlear nerve Trigeminal nerve Abducens nerve Ophthalmic nerve

nerve supply levator palpebral superioris

Oculomotor nerve (CN III)

nerve supply medial rectus

Oculomotor nerve - adduction

nerve supply inferior rectus

Oculomotor nerve - depression, adduction & extorsion

nerve supply inferior oblique

Oculomotor nerve - elevation, abduction, & extorsion

Identify

Optic nerve

What is the relationship between the otic ganglion and the lesser petrosal nerve

Otic ganglion will receive parasympathetic fibers from the glossopharyngeal nerve (CN IX) and the lesser petrosal nerve

Glaucoma

Outflow of aqueous humor through the scleral venous sinus into the blood circulation must occur at the same rate at which the aqueous is produced. • If the outflow decreases significantly because the outflow pathway is blocked, pressure builds up in the anterior and posterior chambers of the eye, a condition called glaucoma. • Blindness can result from compression of the inner layer of the eyeball (retina) and the retinal arteries if aqueous humor production is not reduced to maintain normal intra-ocular pressure

Identify

Parotid gland

What muscles are affected if there is no cough reflex?

Patient with no cough reflex associate that with pharyngeal constrictor muscles being affected along with there being a potential problem with vagus nerve. Superior Constrictor: Constrict upper pharynx Middle and inferior:Lower pharynx constriction ***All of these are innervated by vagus nerve

Locate the sphenoid sinus, be able to describe all structures surrounding this structure

Pharyngeal artery provides blood supply to the sphenoid sinus. Sella turcica lies superior to the sphenoid sinus Sphenoid sinus is housed by the sphenoid bone Pituitary gland lies posterior and superior to the sphenoid sinu

Identify

Pituitary gland

neck region

Posterior cervical region (back) Lateral cervical region (posterior triangle) Sterocleidomastoid region Anterior cervical region (anterior triangle)

Sympathetic supply - head and neck

Preganglionic fibers T1-T5 segments of spinal cord ascends in sympathetic trunk synapse I cervical ganglia The SCG is the only ganglion in the sympathetic nervous system that innervates the head and neck. It is the largest and most rostral (superior) of the three cervical ganglia. The SCG innervates many organs, glands and parts of the carotid system in the head.

Where is the pterion of the skull located and what is its purpose?

Pterion is the junction that connects all of the cranial bones together. It is located in-between the frontal, parietal, temporal, and the greater wing of the sphenoid bone.

The adenohypophysis develops from

Rathke's pouch

Cranial Nerve II: Optic

SSA nerve fiber: sensory, vision

Cranial nerve VIII: vestibulocochlear

SSA: sensory for hearing and balance

Cranial Nerve I: Olfactory

SVA nerve fiber: sensory, smell

Vagus Nerve classification

SVE: controls muscles of larynx, pharynx, soft palate for phonation, swallowing, and resonance GVE: innervates glands, cardiac muscles, trachea, bronchi, esophagus, stomach, and intestine GVA: sensation from pharynx, laryngeal, thorax, abdomen and regulates nausea, oxygen intake and lung inflation SVA: mediates taste sensation from posterior pharynx and epiglottis

Identify

Semispinalis

What is the sensory and motor innervation of the tongue?

Sensory Innervation: Sensory innervation to anterior 2/3 of tongue receives innervation from lingual nerve and taste sensation from chorda tympani nerve. Posterior 1/3 of the tongue receives general and taste innervation from glossopharyngeal nerve. Motor Innervation: Extrinsic and intrinsic muscles innervated by hypoglossal nerve except for the palatoglossus which is innervated by the vagus nerve.

greater auricular nerve (C2-C3)

Sensory to the skin on the ear -cutaneous to parotid gland, posterior auricle, angle of mandible to mastoid

5 layers of the scalp

Skin: thick and has large number of hair follicles and associated with sebaceous glands (most common site) Connective tissue: composed of dense connective tissue that binds the skin to the underlying aponeurosis of occipitofrontalis muscle. Aponeurosis: composed of occiptalfrontalis and its aponeurosis Loose areolar tissue: transversed by emissary veins which connect the veins in the second layer of scalp with intracranial dural venous sinuses Pericranium: composed of the periosteum of bones of vault of skull

cataract

Some people also experience a loss of transparency (cloudiness) of the lens from areas of opaqueness (cataracts). • Cataract extraction combined with an intra- ocular lens implant has become a common operation.

A 6-year-old child was taken to a family physician for treatment of a persistent sore throat. During physical examination, the physician observed infection and hypertrophy of the tonsils and adenoids. He also detected an enlarged tonsillar lymph node. Although the boy's tonsils were the site of chronic infection, he was reluctant to recommend a tonsillectomy and adenoidectomy (T & A). Because of the vascularity of the palatine tonsils, tonsillectomy can be dangerous. Which vessels may bleed after tonsillectomy?

Sometimes the large tonsillar artery, a branch of the facial artery, may have to be ligated when bleeding occurs after a tonsillectomy. Bleeding often results from incising veins from the pharyngeal venous plexus, especially the large external palatine vein.

Identify

Sphenoid bone

identify

Sphenoid bone

squamous cell carcinoma lower lip

Squamous cell carcinoma (cancer) of the lip usually involves the lower lip. • Cancer cells from the central part of the lower lip, the floor of the mouth, and the apex of the tongue spread tothe submental lymph whereas cancer cells fromnodes, lateralparts of the lower lip drain to the submandibular lymph nodes.

Identify

Sternal head of sternocleidomastoid muscle

Identify

Sternohyoid muscle

What is the meaning of the term strabismus?

Strabismus is a deviation of an eye so that the visual axes of the eyes are not parallel, which the person cannot willfully overcome.

The ________ artery and the ______ passes through the space between the scalene's anterior and scalene's medius muscles

Subclavian & brachial plexus

Identify

Subclavian artery

Lateral cervical region arteries

Subclavian artery, transverse cervical artery, suprascapular artery, occipital artery

Identify

Submandibular gland

Identify

Submental artery

Lateral cervical region Omoclavicular triangle

Superficial -external jugular vein -suprascapular artery Deep -subclavian artery

branches of transverse cervical artery

Superficial = with accessory nerve deep = anterior to rhomboid muscle (dorsal scapular)

3 trunks of brachial plexus

Superior (C5-C6) Middle (C7) Inferior (C8-T1)

Identify

Superior Labial vein

identify

Superior Petrosal sinus

If the superior cervical ganglion is damaged how would the patient present?

Superior cervical ganglion injury you will have pupils that will remain small in a dimly lit room and so this is indicates that the postganglionic sympathetic fibers that originate from the superior cervical ganglion and innervate the dilator pupillae muscles are damaged. Ptosis, mitosis, anhydrous

Identify

Superior division of facial nerve

Anterior cervical region - visceral thyroid gland arteries

Superior thyroid artery (external carotid artery) Inferior thyroid gland (thyrocervical trunk) runs posterior to carotid sheath

temporal region

Superior to the zygomatic arch• Temporal fossa- Posterior & superior: superior and inferior temporal lines- Anterior: frontal and zygomatic bones- Lateral: zygomatic arch- Inferior: infratemporal crest- Floor: bones(frontal, parietal, sphenoid, temporal); pterion- Roof: temporal fascia

Identify

Temporalis muscle

role of C1 and C2 roots

The C1/C2 roots that travel with the hypoglossal nerve also have a motor function. They branch off to innervate the geniohyoid (elevates the hyoid bone) and thyrohyoid (depresses the hyoid bone) muscles.

neck midline landmarks

The U-shaped hyoid bone lies superior to the thyroid cartilage at the level of the C4 and C5 vertebrae. • The laryngeal prominence is produced by the fused laminae of the thyroid cartilage, which meet in the median plane. • The cricoid cartilage can be felt inferior to the laryngeal prominence. It lies at the level of the C6 vertebra. • The cartilaginous tracheal rings are palpable in theinferior part of the neck. • The second through fourth rings cannot be felt because the isthmus of the thyroid, connecting its right and left lobes, covers them. The first tracheal ring is just superior to the isthmus.

An infection within the carotid sheath would most likely affect which structures

The carotid sheath contains the internal jugular vein, vagus nerve, and common and internal carotid arteries. (The recurrent laryngeal nerve lies in a groove between the trachea and esophagus. The sympathetic trunk, with superior and middle cervical ganglia, lies behind the carotid sheath. The external carotid artery is not contained within the carotid sheath. The ansa cervicalis lies superficial to or within the carotid sheath.)

What are the endodermal precursors/derivatives of the ear?

The cartilage origin of the three middle ear ossicles arises from neural crest-derived mesenchyme of the first and second pharyngeal arches.

What is the embryological basses of cleft palate?

The defective fusion of three processes of developing palate result in cleft palate.

What is the relationship between emissary veins of the skull and the spread of infection?

The emissary veins connect the extracranial venous system with the intracranial venous sinuses. The most direct route for spread of infection from the eyebrow to the cavernous sinuses. They are the route for the spread of infection from the scalp, face, or the orbit.

Paranasal air sinuses

are air filled spaces present in the bones surrounding the nasal cavity -Frontal air sinus -Ethmoidal air sinus -Sphenoidal air sinus -Maxillary air sinus

preganglionic secretomotor fibers

arise from the lacrimatory nucleus located in the pons. the fibers pass through the sensory root and trunk of facial nerve, greater petrosal nerve, nerve of pterygoid canal and fibers are relayed in the pterygopalatine ganglion

thyroid primordium

arises as an epithelial (endoderm) in the midline of the pharynx (foramen cecum) immediately caudal to the tubercular impar broken line the path of migration, thyroglossal duct

Epidural hemorrhage

arterial in origin blood from torn branches of a middle meningeal artery collects between the external periostea layer of the dura and the calvaria, usually after a hard blow to the head. This results in the formation of an extradural hematoma. Typically a brief concussion (loss of consciousness) occurs followed by a lucid interval of some hours. later drowsiness and coma occur. The brain is compressed as the blood mass increases, necessitating evacuation of the blood and occlusion of the bleeding vessels

Le Fort fracture II

asses from the posterolateral parts of the maxillary sinuses (cavities in the maxillae) superomedially through the infra-orbital foramina, lacrimals, or ethmoids to the bridge of the nose. As a result, the entire central part of the face, including the hard palate and alveolar processes, is separated from the rest of the cranium.

Development of tongue

at 4th week, from first pharyngeal arch: two lateral lingual swelling and one medial swelling (tubercular impair) Lateral lingual swelling overgrow the tubercular impair and merge forming the anterior two-thirds of tongue From second, third, and part of fourth arches, the copula, hypo brachial eminence develops into the posterior thread part of the tongue and the epiglottis

The ______________________ is a cutaneous nerve derived from the mandibular division of the trigeminal nerve (CN V3). It runs upwardly in close relation to the superficial temporal artery.

auriculotemporal nerve

Identify #1

basilar artery

nasolacrimal duct

begins at the lower end of lacrimal sac, passes through an osseous canal to open in the inferior meatus of nose. its lower en is guarded by mucosal fold called valve of hanger which prevents air and nasal secretions from enter ion the nasolacrimal duct

Deep Neck Fascia: suprasternal space

between 2 layers of this fascia Enclosed -Anterior jugular vein -jugular venous artery -fat -lymph nodes

Superficial neck fascia

between dermis and investing fascia Contents: cutaneous nerves, lymphatic and blood vessels, fat Platysma muscle

Parts of the hyoid bone

body, greater and lesser horns

transverse cervical and suprascpular arteries

branch from thyrocervical trunk and is the first part of the subclavian artery

thyroideaima artery

branch of brachiocephalic trunk ascends in front of trachea to enter the isthmus

superior thyroid artery

branch of external carotid artery divides at the apex of the lateral lobe into anterior and posterior supplies 2/3rds of the upper lobe and has of the upper isthmus

tympanic branch

branch of the glossopharyngeal that carries preganglionic parasympathetic fibers to parotid gland

inferior thyroid artery

branch of thyrocervical trunk runs upward then passes behind carotid sheath descending to base of thyroid gland supplies lower 1/3rd of the lobe and lower half of the isthmus

occipital artery

branches from external carotid artery

external carotid artery

brings blood to the face occipital artery = posterior branch posterior auricular artery = between external acoustic meatus and mastoid -muscles, parotid gland, facial nerve, temporal bone, scar, auricle maxillary artery = terminal branch Superficial temporal artery = terminal branch

identify

buccinator

Identify

buccinator muscle

fracture of pterion

can be life threatening because it overlies the frontal branches of the middle meningeal vessels, which lie in grooves on the internal aspect of the lateral wall of the calvaria. A hard blow to the side of the head may fracture the thin bones forming the period, rupturing the frontal branches deep to the pterion. The resulting epidural hematoma exerts pressure on the underlying cerebral cortex Untreated middle meningeal artery hemorrhage may cause death in a few hours

identify #3

carotid artery

Valium falls into which category of drugs?

category D drugs

Warfarin falls into which category of drugs?

category X drugs

lesion of facial nerve

cause a paralysis of the facial muscles and would be an inability to tightly close the eye because of a loss of innervation to the orbiculares oculi muscle

fracture of roof of tympanic cavity

cause rupture of tympanic membrane discharge blood and cerebral spinal fluid occurs from ear

Meniere syndrome

caused by excess endolymph or obstruction of the end-lymphatic duct. It causes tinnitus, hearing loss, and vertigo. A characteristic sig is ballooning of the cochlear duct, utricle and saccule caused by an increase in end-lymphatic volume

myxedema

caused by extreme deficiency of thyroid secretion; also known as adult hypothyroidism

Craniofacial defects

caused by improper growth & development of the phayrgeal apparateus. In many cases due to abnormalities in the migration of proliferation of neural crest cells in the pharyngeal arches. Craniofacial defects due to neural crest defects are often accompanied by heart defects because neural crest cells contribute to the conotruncal endocranial cushions or septa in the developing heart.

boils in the chin

causes enlargement of submental nodes

pus in prevertebral space

causes midline bulge in the posterior pharyngeal wall

Where does the ophthalmic vein drain?

cavernous sinus

submandibular lymph nodes

central part of forehead medial halves of eyelids frontal air sinus nose with maxillary air sinus upper lip lateral part of lower lip medial part of cheek lower jaw drainage

subdural hematoma

characterized by an abnormal lateral curvature that is accompanied by rotation of the vertebrae -the spinous processes turn toward the cavity of the abnormal curvature -most common deformity of the vertebral column in pubertal girls (aged 12-15) -asymmetric weakness of the intrinsic back muscles, failure of half of a vertebra to develop, and a difference in the length of the lower limbs are causes of scoliosis

The ___________ ganglion distribute to the ciliary muscle and sphincter pupillae.

ciliary

Describe the relationship between the 4 parasympathetic ganglia in the head. Where do they receive the preganglionic fibers and from which Cranial nerves?

ciliary ganglion receive parasympathetic fibers from oculomotor nerve. Pterygopalatine ganglion withh receive parasympathetic fibers from the facial nerve (CN VII) and the greater petrosal nerve. If a pt presents with vasodilation, lack of secretion of nasal, lacrimal, and palatine glands and loss of general and taste sensation of palate it can be associated with pterygopalatine ganglion damage. Submandibular ganglion will receive parasympathetic fibers from facial nerve (CN VII), chorda tympani, and lingual nerve. Otic ganglion will receive parasympathetic fibers from the glossopharyngeal nerve (CN IX) and the lesser petrosal nerve

Which of the following produces aqueous humor?

ciliary processes

incomplete cleft lip

cleft limit to hard palate cleft limited to soft palate Bifid uvula

orbicularis oculi

closes eye attached to lacrimal fascia and its contraction pulls on lacrimal fascia leading to the expansion of lacrimal sac helping with drainage of lacrimal fluids

parts of bony labyrinth

cochlea, vestibule, 3 semicircular canals all contains perilymph in which the membranous labyrinth is suspended

caput succedaneum

collection of fluid in the loose areolar tissue layer of the scalp. The swelling is diffuse, crosses the sutures and the midline and is over the presenting part of the head at delivery. It occurs due to obstruction of venous return of scalp during the passage of head via birth canal. usually the edema subsides after 24-48 hours

major landmarks of anterior neck

common carotid artery internal carotid artery external carotid artery carotid sinus

contents of carotid sheath

common carotid artery: til the upper border of thyroid cartilage and internal carotid artery above this level internal jugular vein: in the entire extent vagus nerve: in the entire extent (posterior to the carotid arteries and internal jugular vein) superior disc branches, pharyngeal and superior laryngeal branches of vagus arise inside the carotid sheath

scala vestibuli and scala tympani

communicate with each other at the apex of the cochlea via small opening called helicotrema -scala tympani is closed by bony lamina, while Scala vestibule opens into th vestibule

unilateral cleft lip

confusion of one side palatine process of maxilla and the premaxilla

DiGeorge Syndrome

congenital absence of the thymus gland (congenital thyme aplasia) Velo-cardio-facial syndrome shprintzen syndrome conotruncal anomaly face syndrome frequent infections due to thyme hypoplasia or aplasia (disrupt the immune system's Cell mediated response) seizures due to hypocalcemia cause by abnormal development of the parathyroid glands

surface ectoderm

conjunctival epithelium, corneal epithelium, lacrimal glands, tarsal glands & lens

superior pharyngeal constrictor

constricts upper pharynx and inverted by vagus nerve plexus

muscular triangle

contains infra hyoid muscles, pharynx, and thyroid, and parathyroid glands Boundaries: •Superiorly - hyoid bone. •Medially - imaginary midline of the neck. •Supero-laterally - superior belly of the omohyoid muscle. •Infero-laterally - inferior portion of the sternocleidomastoid muscle.

Deep neck fascia: investing

continuous with periosteum of C7 Fibrous capsule of parotid gland sytlomandibular ligament

General visceral afferent (GVA)

convey visceral information such as distention of organs and chemical conditions from the blood vessels, heart, lungs, digestive system

neural crest

corneal stroma, keratocytes & endothelium; sclera; trabecular meshwork endothelium, iris stroma, ciliary muscles, choroidal stroma, part of vitreous, uveal & conjunctival melanocytes, meningeal sheaths of optic nerve, ciliary ganglion, Schwann cells of ciliary nerves, orbital bones, orbital connective tissue, connective tissue sheath & muscular layer of ocular & orbital vessels

subclavian artery part 2

costocervical trunk -supreme intercostal artery -deep cervical artery

identify

cricothyroid muscle

Superficial fascia contains

cutaneous cervical nerves: -lesser occipital nerve -great auricular nerve -transverse cervical nerve -supraclavicular nerves External jugular vein

The ___________ supplies the external acoustic meatus.

deep auricular artery

digastric muscle

depresses mandible, elevates hyoid -intermediate tendon anterior belly = CN V Posterior belly = CN VII

pharyngeal pouches

derived from endoderm pocketing appears along the lateral walls of the pharynx the most cranial part of the foregut

pharyngeal arches

derived from mesoderm (muscles and arteries) and neural crest (bones and cartilage) most distinctive feature in development of head and neck is the presence of pharyngeal arches consist of mesenchymal tissue separated by deep clefts called pharyngeal clefts each arch is lined internally by endoderm and externally by ectoderm the mesenchymal core is derived from mesoderm and neural crest cells each arch contains an artery, a cartilage and a cranial nerve

The optic cup is an evagination of the...

diencephalon

Clinical presentation of is paralysis of the temporalis

difficulty to retract its mandible. lateral pterygoid muscle: protrude the mandible medial pterygoid muscle elevate the mandible and laterally deviate it to the opposite side. buccinator muscle It holds the cheek to the teeth and assists with chewing

paralysis of superior oblique muscle

diplopia on looking down as in walking down stairs

What are the cranial sutures? What is the consequence of early closure of sagittal suture?

disproportionally long and narrow skull with frontal and occipital expansion. Sagital Sphenosquamous, Sphenoparietal, Lambdoid Coronal

superficial scalp wounds

do not gape, and the margins of the wound are held together.• Furthermore, deep sutures are not necessary when suturing superficialwounds because the epicranial aponeurosis does not allow wide separation of the skin.

facial vein communication

do not have valves, blood can flow in any direction communicates through cavernous sinus through: -angular vein and superior ophthalmic vein --> cavernous sinus - deep facial vein and pterygoid plexus --> emissary vein -->cavernous sinus

subclavian artery part 3

dorsal scapular artery (occasional) most superficial posterior relationship: brachial plexus ( inferior trunk), 1st rib, posterior scalene muscle Aberrant: dorsal scapular and suprascapular arteries

branches from roots of brachial plexus

dorsal scapular nerve (C5) pierces the scalene's medius and runs laterally across it passing deep to levator scapulae supplying it long thoracic nerve (C5-C7) passes downward behind the brachial plexus and third part of the subclavian artery passing deep to first rib to supply serrates anterior muscle

3rd pharyngeal pouch

dorsal wings --> inferior parathyroids ventral wings --> thymus -contributes to 3 structures (hymns, left and right inferior parathyroids) -ends up below 4th pouch structures

the lymph drainage of the supraglottic region.

drain lymph to the deep cervical lymph nodes

internal jugular vein

drains the brain begin at jugular foramen superior and inferior bulb Tributaries: inferior petrosal sinus, facial vein, pharyngeal vein, and superior and middle thyroid vein

ptosis

drooping of upper eyelid -paralysis of levator palpebral due to injury to oculomotor nerve -paralysis of muller's muscle due to injury of sympathetic fibers supplying it -Damage to the facial nerve involves paralysis of the orbicularis oculi, preventing the eyelids from closing fully. -Normal rapid protective blinking of the eye is also lost.

carotid pulse

easily felt by palpating the common carotid artery in the side of the neck, where it lies in a groove between the trachea and infra hyoid muscles -easily palpated just deep to the anterior border of the SCM at the level of the superior border of the thyroid cartilage routinely checked during cardiopulmonary resuscitation -absence of a carotid pulse indicates cardiac arrest

Rathke's pouch is derived from the

ectoderm

The internal ear develops from the ____________.

ectoderm

What is the function and innervation of the palatoglossus muscle?

elevate the posterior part of the tongue. vagus nerve

glossopharyngeal nerve

emerges from the ventral surface of the medulla posterior to the olive leaves the cranial cavity through the jugular foramen in the neck - lies medial to the styloid process and descends between the internal jugular vein and internal carotid artery between the internal and external carotid arteries passes along with stylopharyngess muscle through the gap between superior and middle constrictors of pharynx dividing into terminal branches

Anterior cervical region - visceral compartment

endocrine layer = thyroid and para thyroid glands respiratory layer = larynx and trachea alimentary layer = pharynx and esophagus

Goitre

enlargement of the thyroid gland (tend to grown backwards or downwards) occurs due to deficiency of iodine in diet and secretion of T3 and T4 Symptoms: -hyporthyroidism -hoarseness of voice -difficulty in breathing -diffculty in swallowing

2nd pharyngeal pouch

epithelial lining of palatine tonsil

Dowager's hump

excess thoracic kyphosis in older women resulting from osteoporosis and occurs in geriatric people of both sexes

Pharyngeal groove 1 gives rise to the ___________.

external auditory meatus

lateral cervical region veins

external jugular vein

lateral cervical region occipital triangle

external jugular vein accessory nerve occipital artery (apex) trunks of brachial plexus transverse cervical artery cervical plexus (post branches)

Mesoderm

extraocular muscles, corneal stroma, sclera, iris,vascular endothelium of eye & orbit, choroid, part of vitreous

The stylohyoid muscle is innervated by the ___________ nerve.

facial

Identify

facial artery

identify

facial nerve

If a patient cannot close the left eye which nerve is responsible?

facial nerve = bell palsy

Identify

facial vein

venous drainage of the face

facial vein and retromandibular vein Formation: facial vein begins as angular vein is formed by the union of supratochlear and supraorbital veins (drains the blood from forehead) near the medial angle of the eye Course: passes downwards and backward on the face behind the facial artery, crosses anteroinferior of the master muscle, then pierces the investing layer of deep cerival fascia and is superficial in the neck to the submandibular gland termination: terminates by joining the anterior division of retromandibular vein to for the common facial vein that drains into the internal jugular vein

submental lymph nodes

filter lymph draining from the floor of the mouth and parts of the tongue lower area of face comprising central part of lower lip and chin drains these lymph nodes

brachial fistula

fistula from the tonsillar fossa to the side of the neck

identify

foramen spinousum

Cartilage of the Fourth and Sixth Pharyngeal Arches

form the thyroid, cricoid, arytenoid, corniculate, and cuneiform cartilages of the larynx

lateral cervical region external jugular vein

formed at angle of mandible by: -posterior division of retromandibular -posterior auricular pierce investing fascia ends at subclavian vein receives -transverse cervical vein -suprascapular vein

floor of posterior triangle

formed by prevertebral fascia covering -semispinalis capitis -splenius capitus -levator scapulae -scalenus medius

root of brachial plexus

formed by ventral rami of C5-T1 spinal nerves

occipital artery

from external carotid artery to posterior scalp

How does the thyroid gland develop?

from midline endodermal diverticulum just behind the tubercular impar (foramen caecum in adults) the diverticulum grows downwards in the neck and is called the thryoglossbal duct The tip of the thyroglossal duct bifurcates and proliferation of cells of this bifid end gives rise to two thyroid lobes parafllicular cells are derived from the ultimobranchial body of pharyngeal complex

suprascapular artery

from thyrocervical trunk Inferolatera to anterior scalene Crosses 3rd part subclavian Posterior scapular muscles

Parts of the occipitofrontalis

frontal belly (anterior) and occipital belly (posterior) both parts inserted into the intervening galea aponeurotic or epicranial aponeurosis

deep scalp wounds

gape widely when the epicranial aponeurosis is lacerated in the coronal plane because of the pull of thefrontal and occipitaloccipitofrontalis musclebellies of thein oppositedirections (anteriorly and posteriorly).

inter maxillary segment

give rise to the philtrum of the upper lip, the median part of the maxillary bone with its four incisor teeth and the triangular primary palate Hence the upper lip is formed by two medial nasal prominences and the maxillary prominences

Taste sensation of the posterior one third of the tongue is carried by the

glossopharyngeal nerve

With regard to Cranial Nerves describe the presynaptic parasympathetic components. Describe the relationship between the 4 parasympathetic ganglia in the head. Where do they receive the preganglionic fibers and from which Cranial nerves?

greater petrosal nerve lesser petrosal nerve deep petrosal nerve

branches of facial nerve in the facial canal

greater petrosal nerve: supplies secretomotor fibers to lacrimal, nasal, and palatine glands nerve to stapedius: suplies stapdeius muscle chords tympani nerve: carries taste sensation from anterior2/3rd of tongue and supplies secretomotor fibers to submandibular and sublingual glands

otosclerosis

hardening of the bony tissue of the middle ear, fixation of stapes to oval window causing conduction deafness

laryngoscopy

he larynx may be examined visually by indirect laryngoscopy using a laryngeal mirror, or it may be viewed by direct laryngoscopy using a tubular endoscopic instrument, a laryngoscope. • The vestibular and vocal folds can be observed

ethmoid paranasal sinus

hollow cavities inside bone that produce mucus, lighten skull, voice resonance anterior ethmoidal artery posterior ethmoidal artery submandibular lymph nodes retropharyngeal lymph nodes anterior ethmoidal nerve posterior ethmoidal nerve orbital branch of pterygopalatine ganglia

le fort III fracture

horizontal fracture that passes through the superior orbital fissures and the ethmoid and nasal bones and extends laterally through the greater wings of the sphenoid and the frontozygomatic sutures. Concurrent fracturing of the zygomatic arches causes the maxillae and zygomatic bones to separate from the rest of the cranium.

Le fort fractures I

horizontal fractures of the maxillae, passing superior to the maxillary alveolar process (i.e., to the roots of the teeth), crossing the bony nasal septum and possibly the pterygoid plates of the sphenoid.

Identify

hyoid bone

Cretinism

hypofunction of thyroid infants and children

Identify

hypoglossal nerve

identify the two nerves that cross the hyoglossus laterally:

hypoglossal nerve & lingual nerve

Safety valve hematoma

in children the fracture of cranial vault may be accompanied by torn dura mater and pericranium. In such cases, the blood from intracranial hemorrhage escapes into the subaponeurotic/fourth layer of the scalp through fracture lines. As a result the signs of cerebral compression are not seen until the subaponeurotic space is completely full of blood

deep transverse wounds of scalp tend to gape

in deeps wounds of scalp if epicranial aponeurosis is cut transversely the wounds tend toggle because the aponeurosis is under tension in anteroposterior direction due to the tone of occipitofrontalis muscle -if the wound costs aponeurosis in anteroposterior direction it will not gape

Injury to Spinal Accessory Nerve

in the posterior triangle the spinal accessory nerve is adherent to the deep aspect of the fascial roof (former by prevertebral layer of deep cervical fascia) of the triangle and is surrounded by lymph nodes. It could be injured in surgery requiring the removal of biopsy of lymph nodes in the posterior triangle of the neck

pineal gland development

in the roof of the diencephalon the pineal gland is derived from the epiphysis

Anterior cervical region - Submandibular boundaries

inferior = mandible anterior & posterior = bellies digastric muscles floor = mylohyoid, hypoglossus and middle constrictor pharynx muscle

The _________________ is a branch of the internal maxillary artery that runs with the inferior alveolar nerve.

inferior alveolar artery

The __________ is usually fused with the first thoracic ganglion to form the stellate ganglion.

inferior cervical ganglion

Identify the branched of the facial artery:

inferior labial artery Superior labial artery lateral nasal branch angular artery

Where does the nasolacrimal duct empty?

inferior nasal meatus

otitis media

inflammation/infection of the middle ear occurs through auditory tube cause perforation in tympanic membrane complications of suppurative otitis media include meningitis, mastitis, internal jugular vein thrombosis • An earache and a bulging red tympanic membrane may indicate pus or fluid in the middle ear, a sign of otitis media. Infection of the middle ear is oftenInflammation and swelling of thesecondary to upper respiratory infections.mucousmembrane lining the tympanic cavity may cause partial or complete blockage of the pharyngotympanic tube. • The tympanic membrane becomes red and bulges,and the person may complain of "ear popping." •An amber-colored bloody fluid may be observed through the tympanic membrane. • If untreated, otitis media may produce• impaired hearing as the result of scarring of the auditoryossicles, limiting their ability to move in response to sound.

Anterior cervical region - muscular

infrahyoid muscles, supra hyoid muscles

The ___________________ is a cutaneous branch of the trigeminal nerve that emerges deep to the levator labii superioris.

infraorbital nerve

name structures that pass through inferior orbital fissure

infraorbital nerve & vesssls and zygomatic nerve

lingual nerve injury during extraction of last lower molar tooth

injured because lingual nerve is closely related to the mandible and is medial to the last molar toot

Causes of Horner's syndrome

injury to nerve, carotid artery, a stroke, lesion in brain stem, tumor in the lung

buccinator muscle

innervated by the buccal branches of the facial nerve and not a branch of V3 § important muscle for mastication §keeps the cheek taut so it is not folding over and becoming injured by chewing § it aids mastication by pulling the cheek against the molar teeth so that food does not keep collecting in the vestibule of the mouth § if this muscle was injured, the cheek could not press against the molar teeth, and food would fall between the teeth and cheek mucosa while chewing

zygomatic major

innervated by the zygomatic and buccal branches of the facial nerve § it elevates the corner of the mouth and draws it laterally, "smile" muscle! § Unilateral sneer (disdain)

transverse cervical nerve (C2-C3)

innervates the anterior triangle of the neck cutaneous to anterior triangle cross SCM and platysma

The _____________ is accompanied by the superior laryngeal artery.

internal laryngeal nerve

Deep Neck Fascia

investing, pre tracheal, and pre vertebral carotid sheath surrounds all neck deep to skin trapezius and SCM muscles parotid and submandibular glands

deep cervical fascia

invests of muscles of the neck, forms a capsules of the glands, and protective sheath around neurovascular structures arrange in 3 layers (outside - inside) -investing layer -prevertebral layer -pre tracheal layer -carotid sheath (around the neuromuscular bundle)

cranium basilar fracture

involve the bone forming the cranial base as a result of the fracture, cerebrospinal fluid may leak into the nose and ear, and cranial nerve and blood vessel injury may occur, depending on the site of the fracture

sinusitis

involves frontal and maxillary sinuses, caries teeth, infection of tongue, palate submandibular lymph nodes may become enlarged and tender Because the paranasal sinuses are continuous with the nasal cavities through apertures that open into them, infection may spread from the nasal cavities, producing inflammation and swelling of the mucosa of the sinuses (sinusitis) and local pain. • Sometimes, several sinuses are inflamed (pansinusitis), and the swelling of the mucosa may block one or more openings of the sinuses into the nasal cavities.

Intracapsular lens extraction

involves removing the lens and lens capsule, and implanting a synthetic intra-ocular lens in the anterior chamber

extracapsular cataract extraction

involves removing the lens but leaving the capsule of the lens intact to receive a synthetic intra-ocular lens

back strain

involves some degree of stretching or microscopic tearing of muscle fibers -the muscles usually involved are those producing movements of the lumbar IV joints, especially the erector spinal. -If the weight is not properly balanced on the vertebral column, strain is exerted on the muscles -common cause of low back pain -using the back as a lever when lifting puts an enormous strain on the vertebral column and its ligaments and muscles -these strains can be minimized if the lifter crouches, holds the back as straight as possible, and uses the muscles of the buttocks and lower limbs to assist with lifting

back sprain

is an injury in which only ligamentous tissue or the attachment of ligament to bone is involved without dislocation of fracture. -it results from excessively string contractions related to movements of the vertebral column, such as excessive extension or rotation

infratemporal fossa

is an irregular space at the lateral aspect of the skull located inferior to the temporal fossa and deep to the ramus of the mandible Function: serves as a passageway for numerous neurovascular structures and protect them from external factors Connections: temporal fossa, pterygopalatine fossa, orbit

parotid glands

is located in the parotid region (front and below ear lobule) fills gap between the ramus of mandible and the mastoid process Boundaries: superior = extends up to the external acoustic meatus inferior = reaches the upper part of carotid triangle posterior = overlaps sternocleidomastoid muscle anterior = overlaps masseter medial = reaches to the styloid process

lacrimal gland

is lodged in the lacrimal fossa on the anterolateral aspect of the roof of the bony orbit secretes tears consists of: larger orbital and smaller palpebral -continuous with each other around lateral margin of levator palpebral superiors

Torticollis (wryneck)

is painful twisted and tilted neck. can be congenital or acquired spasms of shortening sternocleidomastoid muscle of one side results in head on the same side and chin directly opposite

maxillary process

is replaced by the maxilla, pre maxilla, zygomaticbone, and part of the temporal bone

Molecular Development of The Eye - 3 Weeks PAX6

is the master gene for eye development and is expressed as a band in the center of the neural ridge

Dangerous area of face

is triangle bounded by lines join root of nose with angle of mouth venous drainage from this area enter angular veins which communicates with cavernous sinus flow of blood in all tributaries and communication are reversible as they possess no valve spread of infection can lead to thrombosis of cavernous sinus cavernous communicate with dangerous area of face through 2 routes: -superior ophthalmic vein -deep facial veins, pterygoid plexus of vein, emissary vein

Injury to the auriculotemporal nerve would present as?

it carries the postganglionic parasympathetic fibers to the parotid gland ▪ provides sensory innervation to the skin of the anterosuperior ear, part of the external auditory meatus, and the temporomandibular joint Frey's Syndrome: in response to the taste of food the patients face will flush and sweat instead of salivating.

The _________________ cartilage give shape to the bridge of the nose.

lateral nasal

name structures that pass through superior orbital fissure

lateral part -recurrent branch of ophthalmic artery - lacrimal nerve -frontal nerve -trochlear nerve -superior ophthalmic vein middle part -abducent nerve -superior division of oculomotor nerve -nasociliary nerve -inferior division of oculomotor medial part -inferior ophthalmic vein

What muscle of the eye movement functions to abduct the eyeball?

lateral rectus

relationship between Uvula deviation and Tongue protrusion.

left vagus nerve and right hypoglossal nerve

The ________________ nerve hooks around the submandibular duct but close to the side of the tongue.

lingual

Identify

lingual artery

The ___________ supplies general sensation for the anterior two-thirds of the tongue.

lingual nerve

submandibular triangle

located underneath the body of the mandible contains: submandibular gland and lymph nodes, facial artery and vein Boundaries: •Superiorly - body of the mandible. •Anteriorly - anterior belly of the digastric muscle. •Posteriorly - posterior belly of the digastric muscle.

submental triangle

located underneath the chin contains: submental lymph nodes boundaries: •Inferiorly - hyoid bone. •Medially - midline of the neck. •Laterally - anterior belly of the digastric floor: mylohyoid muscle

Pericranium layer of scalp

loosely connected to the underlying bones and be easily stripped except at sutures, where it is connected to the endocranium via sutural ligaments

lesion of glossopharyngeal nerve

loss of general and taste sensations from posterior 1/3 of the tongue loss of salivation from parotid gland ipsilateral loss of gag relax

lymphatic drainage of tongue

lymphatics vessels drain divided into -apical vessels: drain the tip of the tongue into submental lymph nodes --> drain into submandibular lymph nodes -marginal vessels: drain the lateral area of anterior 2/3 of tongue --> unilaterally into submandibular nodes then deep cervical lymph nodes -central vessels: drain central part of anterior 2/3 of tongue --> bilaterally into deep cervical lymph nodes -basal vessels: drain posterior 1/3 of tongue --> bilaterally into the juggle-diagastric and retropharyngeal nodes

vocalis muscle

main body of vocal folds and only modulated tension in vocal cords

Identify

mandible

identify #8

mandible

The auriculotemporal nerve is a cutaneous nerve derived from the _________________ division of the trigeminal nerve.

mandibular

The tensor veli palatini is innervated by the...

mandibular branch of the trigeminal nerve

7th week and 10th week of development of face

maxillary prominences have fused with the medial nasal prominences following detachment of the nasolacrimal cord (future nasolacrimal duct) the maxillary and lateral nasal prominences merge with each other

identify #5

maxillary sinus

pain from an infected tooth

may be referred to the ear because both are supplied by branches of mandibular nerve

thyroglossal cysts

may lie at any point along the migratory pathway of the thyroid gland but is always near or in the midline of the neck 50% these cysts are close or just inferior to the body of the hyoid bone and they may also be found at the base of the tongue or close to the thyroid cartilage

Robin Sequence

may occur independently or in association with other syndromes development of the mandible most severely affected (micrognathia), cleft palate, and glossoptosis (posteriorly placed tongue), airway obstruction Alters first- arch structures, with development of the mandible most severely affected.• Note very small mandible

Pus in the posterior triangle arising from tubercular cervical vertebra

may track downward in the axilla the muscular floor of posterior triangle is covered by prevertebral fascia, which extends around the brachial plexus and axillary artery (continuation of subclavian artery) as axillary sheath Pus in the posterior triangle deep to prevertebralfascia arising from tubercular cervical vertebra may track downwards and laterally along the axillary sheath to appear in the axilla or even in the arm

Identify

mentalis

1st pharyngeal pouch derivatives

middle ear eustachian tubes mastoid air cells -contributes to endoderm-line structures of ear

tympanic cavity

middle ear communicates: anterior = nasopharynx via pharyngotympanic tube/auditory tube posterior = mastoid atrium and mastoid air cells via adits to antrum

vestibule

middle part of bony labyrinth contains utricle and saccule anteriorly continuous with cochlea posteriorly has opening of semicircular canals lateral wall has oval window

Neural crest cells migrating into the facial region

migration pathways of neural cyst cells. from forebrain, midbrain, and hind brain regions into heir final locations in the pharyngeal arches and faces

posterolateral herniation

most common in the lumbar region; approximately 95% of protrusions occur at the L-L5 or L5-S1 levels -in patients of advanced years, the nerve roots are more likely being compressed by increased ossification of the IV foramen as they exit -Sciatica pain in the lower back and hip and radiating down the back of the thigh into the leg, is caused by a herniated lumbar IV disc or osteophytes that compress the L55 or S1 component of the sciatic nerve -The spinal nerve that exits a given IV foramen passes through the superior half of the foramen and lies above and is not affected by a herniating disc at that level -the nerve roots passing to the IV foramen immediately and farther below pass directly across the area of herniation

1st pharyngeal arch

muscles of mastication (temporals, masseter, lateral and medial pterygoids), mylohyoid, anterior belly of digastric, tensor tympani, anterior 2/3rds of tongue, tensor deli palatine trigeminal nerve = chewing

identify

mylohyoid muscle

middle pharyngeal constrictor

narrows pharynx and innervated by vagus nerve through pharyngeal plexus

Identify #4

nasal bone

identify #2

nasal bone

name structures that pass through nasolacrimal canal

nasolacrimal duct

identify

nasopalatine nerve

Identify

nasopharynx

Branches from the Upper Trunk of the Brachial Plexus

nerve to subclavius (C5&6) passes downwards in front of the brachial plexus and subclavian vessels to supply the subclavius muscle Suprascapular nerve (C5 &6) passes laterally deep to inferior belly of omrohyoid and trapezius to reach the supraspinous fossa via suprascapular notch supplies supraspinatus and infraspinatus muscles

The epithelium of the ciliary body is derived from...

neuroectoderm

4 week development of face

observe the frontonasal prominence mandibular and maxillary prominence (first branchial arch)

nerve supply superior rectus

oculomotor nerve - elevation, adduction, and intorsion

Identify

olfactory bulb

gag reflex

on touching the posterior part of tongue or soft palate or pharynx there is reflex contraction of pharyngeal muscles causing gagging and retching receptors are in oral muscosa on the side of uvula -test normal motor response of nerves -afferent fibers = pass in glossopharyngeal nerve (CN IX) -efferent fiber = pass in vagus nerve (CN X) effector function is the rise of the oral mucosa; absence of reflex often indicates damage to the brain stem

lateral cervical cyst

opening at the side of neck by way of a fistula directly anterior to the sternocleidomastoid muscle commonly lie under the angle of the mandible and do not enlarge until later in life

The supratrochlear artery is a branch of which artery?

ophthalmic artery

name structures that pass through optic canal

optic nerve with meninges and ophthalmic artery

An inability to close lips would be a presentation of paralysis of which muscle?

orbicularis oris muscles

splenius capitis

origin: lower part of ligament nuchal and upper four thoracic spines Insertion: mastoid process and outer part of superior nuchal line Nerve supply: segmental innervation from the dorsal rami of spinal nerves Action: Extension of neck

Sternocleidomastoid

origin: via two heads sternal and clavicular -sternal head: is a rounded tendon which arises from the anterior surface of supernatural part of manubrium sterni -clavicular head: is flat and musculoaponeurotic and arises from the superior of medial 1/3rd of clavicle insertion: on the lateral surface of the mastoid process and lateral half of superior nuchal line nerve supply: spinal accessory and proprioceptive fibers are carried by the ventral rami of C2 and C3 spinal nerve

Accessory thyroid tissue

originates from remnants of the thyroglossal duct— a transitory endodermal tube extending from the posterior tongue region of the embryo carrying the thyroid-forming tissue at its descending distal end.• Although the accessory tissue may be functional, it is usually too small to maintain normal function if the thyroid gland is removed. **most of the arytenoid cartilages often ossify as age advances, commencing at approximately 25 years of age in the thyroid cartilage.

stylohyoid muscle

originates from styloid process of temporal bone and attaches to hyoid bone lifts hyoid during swallowing innervated by facial nerve parallel to posterior belly of digastric

parts of the inner ear

outer bony labyrinth -filled with a fluid perilymph inner membranous labyrinth -filled with a fluid endolymph and houses receptors for hearing and equilibrium

Anterior cervical region - visceral parathyroid gland

ovarian glands (4) external to capsule inferior glands more variable - 1%-5% superior mediastinum

What muscles are near the tonsils?

palatoglossus and palatopharyngeus muscles

What nerve fibers are used to produce tears?

parasympathetic fibers

Maxillary pain would suggest associated pain with which duct?

parotid duct

salivary glands

parotid gland, submandibular gland, sublingual gland and ducts

postganglionic fibers

pass through zygomatic nerve (branch of maxillary nerve) its zygomaticotemporal branch which joins lacrimmal nerve (branch of opthalmis nerve) and reach supply the lacrimal gland

mocker's cartilage

pharyngeal arch 1 in the mandibular process its dorsal end persist and forms the incus and malleus replaced by the mandible and develop by membranous ossification

Reichert's cartilage

pharyngeal arch 2 gives rise to the stapes, styloid process stylohyoid ligamen ventrally the lesser horn and upper part of the body of the hyoid bone

The nasopharynx continues inferiorly with the oropharynx by way of a narrow passage posterior to the uvula called the ____________________

pharyngeal isthmus

___________ are structures consisting of ectoderm, intervening mesoderm and neural crest, and endoderm located between each pharyngeal arch.

pharyngeal membranes

____________ forms the inferior parathyroid gland and thymus.

pharyngeal pouch 3

The _________ nerve descends vertically on the anterior surface of the scalenus anterior muscle toward the thorax.

phrenic

branches of facial nerve below the stylomastoid foramen

posterior auricular nerve: supplies occiptal belly of occipitotempolaris and auricular muscles nerve to posterior belly of digastric and stylohyoid muscles

sphenoidal paranasal sinus

posterior to nasal cavity posteroethmoidal artery sphenopalatine artery retropharyngeal lymph nodes posterior ethmoidal nerve orbital branch of pterygopalatine ganglion

Accessory Nerve (XI)

posteroinferior direction superficial to levator scapulae muscle disappear at anterior border of trapezius SCM and trapezius muscles

infection of the eyelid

pre auricular nodes are inflamed

Anterior cervical region - visceral thyroid gland lymphatic

prelaryndeal, pre tracheal, paratracheal

3 semicircular ducts

present in 3 semicircular canals anterior, lateral, posterior) their dilated ends called ampullae have crest which contain receptors to detect rotational acceleration

utricle and saccule

present in the vestibule contains sense organs called maculae which detect linear acceleration of the head

cochlear duct

present within the cochlea contains organ of court

A lesion of the superior division of CN III

produce an even more marked ptosis due to paralysis of the voluntary muscle fibers of the elevator palpebrae superioris but would also paralyze the superior rectus, causing depression of the pupil and probably producing diplopia

Injury of the levator palprbrae superioris

produce drooping of superior eyelid

General Visceral Efferent (GVE)

produce tears, saliva, secretion

Anterior cervical region - visceral thyroid gland

produce thyroid and calcitonin hormones affects all tissues except itself, brain, spleen, testes, and uterus deep to sternohyoid and sternothyroid (C5-T1) two lobules and one isthmus: anterior to 2-3 tracheal ring external fibrous capsule attached to cricoid cartilage of larynx and tracheal rings

Cartilage of the Third Pharyngeal Arch

produces the lower part of the body and greater horn of the hyoid bone

Herniation of Nucleus Pulposus

protrusion of the gelatinous nucleus pulpous into or through the anulus fibrosis is a well-recognized cause of low back and lower limb pain -if degeneration of the posterior longitudinal ligament and wearing of the anulus fibrosis has occurred, the nucleus pulpous may herniate into vertebral canal and compress the spinal cord or nerve roots of spinal nerves in the caudal equine -occur posterolaterally, where the anulus is relatively thin and does not receive support from the posterior or anterior longitudinal ligaments -localized back pain of a herniated disc results from pressure on the longitudinal ligaments and periphery of the anulus fibrosis and from local inflammation resulting from chemical irritation by substances from ruptured nucleus pulpous

Special visceral efferent (SVE)

provide motor innervation to the muscles of the pharyngeal -voluntary striated muscles of the larynx and pharynx and the muscles of facial expression and mastication

The space between the mandible and the medial pterygoid muscle is called the ____________________ space

pterygomandibular

The ____________ ganglion distribute to the lacrimal gland.

pterygopalatine

Features of Horner's syndrome

reduced sweating looping eyelid constricted pupil sunken eyeball vasodilation unilateral (damaged side)

Placodes

region of ectodermal thickening found at location of developing special sense organs on the embryo will assist neural crest cells in formation of the fifth, seventh, ninth, and tenth cranial sensory ganglia

Molecular Development of The Eye - 3 Weeks PAX2

regulates the optic stalk differentiation, while PAX6 regulates differentiation of the eye.

Thyro-arytenoid

relaxes vocal ligament and is innervated by recurrent laryngeal nerve

perforation of the tympanic membrane

result from otitis media and is one of several causes of middle ear deafness. • Perforation may also result from foreign bodies in the external acoustic meatus, trauma, or excessive pressure (e.g., during scuba diving). • Minor ruptures of the tympanic membrane often heal spontaneously while large ruptures usually require surgical repair. • Because the superior half of the tympanic membrane is much more vascular than the inferior half, incisions to release pus from a middle ear abscess (myringotomy), for example, are made postero-inferiorly through the membrane • This incision also avoids injury to the chorda tympani nerve and auditory ossicles. • In persons with chronic middle ear infections, myringotomy may be followed by insertion of tympanostomy or pressure-equalization (PE) tubes in the incision to enable drainage of effusion and ventilation of pressure

vertebrae fractures

result from sudden forceful flexion, as in an automobile accident -injury is a crush or compression fracture of the body of one or more vertebrae -if violent anterior movement of the vertebra occurs in addition to compression, a vertebra may be displaced anteriorly on the vertebra inferior to it -this dislocates and fractures the articular facets between the two vertebrae and ruptures the interspinous ligaments -irreparable injuries to the spinal cord accompany most severe flexion injuries of the vertebral column

pupillary light reflex

retina of the eye is the receptor; many CNS centers involved -tests function of the sensory (afferent) optic nerve (CN I) and of efferent oculomotor nerve (CN III) effect muscles are smooth muscles of the iris; absence of reflex is late indication of severe trauma or deterioration of brain stem When light shone on one eye, the pupil of this eye should be constrict (direct pupillary reflex) and the pupil of the other eye also should be constrict (consensual pupillary reflex). • Thus, this test exam the oculomotor nerve III of both eyes and the optic nerve of one eye (which have the light shone on it).

When the maxillary and superficial temporal veins join what vein is formed?

retromandibular vein

Arteries of the scalp

rich blood supply from internal and external carotid arteries anastomosis between the branches of two sides and branches of internal and external carotid arteries of the same side 5 arteries on each side (3 in front of auricle and 2 behind auricle) Front: -supratrochlear and supraorbital (branches of internal carotid artery) -superficial temporal (branch of external carotid artery) Behind: -Posterior auricular and occipital (branches of external carotid artery)

Identify

rigorous muscle

name the bones forming walls of orbit

roof = orbital plate of front bone & lesser wing of sphenoid lateral wall = orbital surface of zygomatic bone & greater wing of sphenoid medial wall = body of sphenoid, orbital plate of ethmoid, lacrimal bone, and frontal process of maxilla floor = zygomatic bone, orbital plate of maxilla, & orbital process of palatine bone

EJVs prominence

routine observation for distention of the EJVs during physical examination may reveal diagnostic signs of heart failure, obstruction of the superior vena cava, enlarged supraclavicular lymph nodes, or increased intrathoracic pressure

The ___________ detects vertical orientation.

saccule

Molecular Development of The Eye - 3 Weeks SHH

secreted in the prechordal plate inhibits the expression of PAX6 in the midline.

How would an injury to the trigeminal ganglion present?

sensory loss on face, loss of mastication, jaw deviation towards the side of the lesion, loss of the corneal/sneeze reflexes

Organ of Corti

sensory organ of hearing

The _____________________ cartilage separates the right and left nasal cavities and forms the anterior part of the nasal septum.

septal

causes of cleft palate

single gene mutation part of chromosomal syndrome (Down's syndrome, Edward syndrome) Anticonvulsant drugs

neural ectoderm

smooth muscle of iris-optic vesicle & cup-iris epithelium-part of vitreous-retina-retinal pigment epithelium, fibers of optic nerve

scalp

soft tissue that covers the vault of the skull borders: anterior = supraorbital margin lateral = superior temporal lines posterior = external occipital protuberance and superior nuchal lines

prevertebral space

space between behind the prevertebral fascia and and in front of the vertebra

retropharyngeal space

space in front of the prevertebral fascia and behind the pharynx containing loose areolar tissue and retropharyngeal lymph nodes

Identify #7

sphenoid bone

Identify

sphenopalatine artery

What artery supplies the nasal mucosa?

sphenopalatine branch of the maxillary artery

The iris contains the ____________ and the ___________.

sphincter pupillae muscle; dilator pupillae muscle

The sternocleidomastoid muscle is innervated by the ___________ nerve.

spinal accessory

Occipital triangle: nerves & arteries

spinal accessory nerves C3, C4 cervical nerves supplying levator scapulae and trapezius muscle dorsal scapular nerve (C5) Beginning of 4 cutaneous branches of cervical plexus -lesser occipital -great auricular -transverse cervical -supraclavicular occipital artery superficial transverse cervical artery

strabismus

squinting unilateral paralysis medial/internal squint = paralysis of lateral rectus muscle external/lateral squint = medial rectus muscle

infrahyoid muscles

sternohyoid muscle omrohyoid (superior belly) sternothyroid thyrohyoid

identify

sternothyroid

lacrimal sac

structure that collects tears before emptying into the nasolacrimal duct located in the lacrimal groove on medial wall of orbit -continuous inferiorly with nasolacrimal duct covered by lacrimal fascia except medially

identify

styloid process temporal bone

Dangerous layer of the scalp

subaponeurotic layer loose areolar connective tissue named this because the blood and pus tend to collect in this layer and as I contains emissary veins (connects veins of scalp to intracranial dural venous sinuses) the infection from this layer may travel readily along the emissary veins into the intracranial venous sinuses

The _________ vein passes anterior to the scalenus anterior muscle.

subclavian

The ____________ ganglion distributes to the submandibular and sublingual glands.

submandibular

Anterior cervical region - Submandibular content

submandibular gland and duct -sublingual papilla, each side lingual frenulum Hypoglossal nerve (CN XIII) Nerve to mylohyoid/ anterior belly digastric (CN V3) Facial artery and vein Submental artery (brach facial artery

Anterior cervical region - submittal contents

submental lymph nodes anterior jugular vein

Anterior triangles of the neck

submental, submandibular, carotid, muscular triangles

What nerve fibers are derived from C1?

suboccipital nerve and hypoglossal nerve are derived from C1

lateral cervical region lymph nodes

superficial cervical (EJV) to deep cervical (IJV)

Identify

superficial temporal artery

Anterior cervical region - muscular boundaries

superior = belly of omohyoid anterior = border of SCM Median = plane of neck

Anterior cervical region - carotid boundaries

superior = belly of omrohyoid muscle posterior = belly of digastric anterior = border of SCM

Boundaries of retropharyngeal space

superior = skull base lateral = carotid sheath inferior superior mediastinum

Anterior cervical region - visceral thyroid gland veins

superior and middle drains into IJV inferior drains into brachiocephalic veins

The muscular floor of the tonsillar bed is formed by the ________________ muscle.

superior constrictor

What artery supplies the nasal and oral mucosa?

superior labial arteries

Intrinsic muscles of the tongue

superior longitudinal, inferior longitudinal, transverse, vertical

identify

superior oblique muscle

The facial vein communicates with the _______________.

superior ophthalmic vein

The frontal nerve is associated with what orbital fissure?

superior orbital fissure

Name the branches of the external carotid artery found in the anterior triangle of the neck:

superior thyroid artery > facial artery > lingual artery > ascending pharyngeal artery

Anterior cervical region - visceral thyroid gland nerves

superior, middle, and inferior cervical ganglia

What vein drains into the cavernous sinus?

superoir and inferior ophthalmic veins

second pharyngeal ach

supplied by facial nerve

third pharyngeal arch

supplied by the glossopharyngeal nerve

sixth pharyngeal arch

supplied by the recurrent branch of the vagus nerve

fourth pharyngeal arch

supplied by the superior laryngeal branch of the vagus nerve

first pharyngeal arch

supplied by the trigeminal nerve with three branches: the ophthalmic, maxillary and mandibular

supraclavicular nerve (C3-C4)

supplies skin of superior chest and shoulder cutaneous to neck and shoulders

Lesser occipital nerve (C2)

supplies the skin of the neck and scalp posterosuperior to the auricle cutaneous to neck and scalp (postern-superior to auricle) greater auricular nerve (C2-C3) -cross SCM and platysma

The _______________________ is a cutaneous branch of the trigeminal nerve that emerges deep to the frontalis muscle.

supraorbital

Identify

supratrochlear

lamininectomy

surgical excision of one or more spinous processes and their supporting laminae -remoal of most of the vertebral arch by transecting the pedicles -provide access to the vertebral canal to relieve pressure on the spinal cord or nerve roots caused by a tumor, herniated IV disc, or bony hypertrophy

Herniation of Nucleus Pulposus cervical region

symptom --producing IV disc protrusions occur in the cervical region -in the cervical region, the IV discs are centrally placed and extend to the anterior border of the IV foramen -A herniating cervical disc compresses the spinal nerve exiting at that level -cervical spinal nerves exit superior to the vertebra of the same number -cervical disc protrusions result in pain in the neck, shoulder, arm, and hand

Types of Craniofacial defects

teacher collins syndrome robin sequence digeorge's goldenhar syndrome

The temporalis muscle is covered by the

temporal fascia

branches of facial nerve on face

temporal nerve zygomatic nerve buccal nerves (upper and lower) marginal mandibular cervical

Cricothyroid muscle

tension vocal cords

Nerve supply of tympanic cavity

tensor tympani muscle (handle of malleus - makes the tympanic membrane taut) mandibular nerve Stapedius muscle (neck of stapes - pulls the stapes laterally dampening vibrations of the stapes to control amplitude of sound) facial nerve

Which nerve supplies tensor veli palatini, levator veli palatini muscles?

tensor veil palatine muscle = trigeminal nerve levator veli palatini = vagus nerve

severe hyperextension injuries

the anterior longitudinal ligament is severely stretched and may be torn -dislocation of vertebrae in the thoracic and lumbar region is uncommon because of the interlocking of the articular processes; owing to the abrupt transition from the relatively inflexible thoracic region to the much more mobile lumbar region, T11 &T12 are the most commonly fractured noncervical vertebrae -injure the posterior parts of the vertebrae (the vertebral arches and their processes) -may pinch the posterior arch of C1 vertebra between the occipital bone and the C2 vertebra. (the C1 vertebrae breaks at one or both grooves for the vertebral arteries) -Anterior longitudinal ligament and adjacent anulus fibrosis of the C2-C3 IV disc rupture (if this occurs, the cranium, C1, and C2 are separated from the rest of axial skeleton and the spinal cord is usually severed. Individuals with this injury seldom survive)

cervical vertebrae injury

the bodies of the cervical vertebrae can be dislocated in neck injuries with less force than is required to fracture them -because of the large vertebral canal in the cervical region, slight dislocation can occur without damaging the spinal cord (severe dislocations may injure the spinal cord) -if the dislocation does not result in "facet jumping" with locking of the displaced articular processes, the cervical vertebrae may self-reduce -severe hypertension of the neck

cranium comminuted fracture

the bone is broken into several places

cranium contrecoup (counterblow) fracture

the fracture occurs on the opposite side of the cranium rather than at the point of impact

5th and 6th week development of face

the lateral and medial nasal prominences are gradually separated from the maxillary prominence by deep furrows the nasolacrimal grooves

4.5 week development of face

the nasal places are visible on either side of the frontonasal prominence

24 day embryo

the oropharyngeal membrane temporarily close the stomodeum is surrounded by five mesenchymal prominences ruptured oropharyngeal membrane and formation of the nasal places on the frontonasal prominence

development of secondary palate 6.5 weeks

the palatine shelves from the maxillary prominences are in the vertical position on each side of the tongue

partial thyroidectomy

the posterior part of thyroid lobes are left behind to avoid removal of parathyroid glands

The location of the four parasympathetic ganglia

the pterygopalatine fossa: is located superior to the posterolateral aspect of the hard palate small pyramidal shaped space located posterior and inferior to the apex of the orbit everything in it is a branch of the maxillary nerve or artery pterygopalatine fossa contains: pterygopalatine ganglion, the terminal third of the maxillary artery (infraorbital artery) the maxillary nerve CN V2, , with which is the nerve of the pterygoid canal, a combination of the greater petrosal nerve (preganglionic parasympathetic) and the deep petrosal nerve (postganglionic sympathetic).

development of pharyngeal cleft

the second pharyngeal arch grows over the third and fourth arches burying the second, third, and fourth pharyngeal clefts remnants of the second, third, and fourth pharyngeal clefts form the cervical sinus, which is normally obliterated

lacrimal apparatus

the structures that produce, store, and remove tears

superficial relations face

the surface is covered from superficial to deep by: skin superficial fascia containing: -anterior branch of great auricular nerve pre auricular (superficial parotid) lymph odes platysma muscle fibers superficial lamella of parotid fascia

What is the role of cranial sutures in head and neck development?

the sutures of the skull allows for movement of the cranial bones during infancy and holds the bones of the skull together

development of secondary palate 7.5 weeks

the tongue has moved downward and the palatine shelves have reached a horizontal position above the tongue and fuse forming the secondary palate

development of secondary palate 10 weeks

the two palatine shelves have fused with each other and with the nasal septum. The incisive foramen forms the midline between the primary and secondary palate

aponeurosis layer of scalp

the wounds of the scalp gape if epicranial aponeurosis (occipitalfrontalis muscle) is cut transversely because the aponeurosis is pulled in the anteroposterior direction by the tone if occipimtofrontalis muscle

Neural crest cell migration

there are three streams of crest cells that provide guidance cues for cranial nerves growing back from their anglia to establish connections in the hindbrain endoderm is responsible for patterning the skeletal derivates of the arches mesenchymal expression patterns are established by neural crest cells

identify

thyroid gland

ankyloglossia

tongue-tie; frenulum extends to the tip of the tongueum

General somatic afferent (GSA)

touch, temperature, and noxious stimuli.

Identify

transverse cervical artery

Identify

transverse cervical nerve

Identify

transverse part of trapezius muscle

Review trigeminal ganglion/nerve (ophthalmic, maxillary, and mandibular branch) damage and each clinical manifestation.

trigeminal ganglion anesthesia: anterior half of scalp, cornea, mucose membrane of the nose and paralysis of the mastication muscles Infraorbital nerve: numbness and paresthesia within the upper canine and neighboring teeth, as well as the skin of the right inferior eyelid, cheek, lateral nose, and upper lip

The superior oblique muscle is innervated by the ____________ nerve.

trochlear

nerve supply superior oblique

trochlear nerve - depression, abduction, & intorsion

lacrimal ducts

tubes that carry tears to the lacrimal sac 10-12 ducts are all transverse the palpebral part of the lacrimal gland to open into the lateral part of superior conjunctional fornix

Deep Neck Fascia: Carotid sheath

tubular fascia from the base of skull to the root of the neck -Contents: common and internal carotid arteries, internal jugular vein, vagus nerve, deep cervical lymph nodes, carotid sinus nerves, and sympathetic fibers communicate with mediastinum inferiorly and cranial cavity superiorly

Preauricular lymph node (superficial parotid)

upper area of face comprising: lateral part of forehead lateral halves of eyelids conjuctiva lateral part of chek parotid region drain into this group of lymph nodes

brachial plexus supplies

upper limb

lymphatics of thyroid gland

upper part of thyroid glans drain into pre laryngeal and upper deep cervical lymph nodes lower part of thyroid drain into pre tracheal, paratracheal, and lower deep cervical lymph nodes

Within the carotid sheath, the _________ nerve lies between the internal jugular vein and the carotid artery.

vagus

The vagus nerve presents dilated pupils/ near vision problems

vagus nerve

identify

vagus nerve

Identify #2

vertebral artery

subclavian artery part 1

vertebral artery internal thoracic thyrocervical trunk -inferior thyroid artery -transverse cervical artery -suprascapular artery

Special Somatic Afferent (SSA)

vision, hearing, balance

The hyaloid canal is found in the...

vitreous body

identify

vomer

Actions of SCM

when muscle of only one side contracts, it tilts the head towards the shoulder on the same side and rotates the head so that the chin is turned to the opposite side taking place during upward sideways glimpse wen muscles of both side contract they pull the head forwards as in lifting the head from the pillow or bending the head during eating food, if the head is fixed by prevertebral muscles, it conserve as an accessory muscle of respiration during forced inspiration

inferior alveolar nerve block

when the mouth is open wide, a mucosal fold can be seen at the posterior aspect of inside of cheek, this fold overlies the pterygomandibular raphe, which can be felt as a firm band upwards from just behind the lower third molar tooth. The upper end of the raphe is an important landmark for inferior alveolar nerve block

identify

zygomaticus major

Parotidectomy

• About 80% of salivary gland tumors occur in the parotid glands. • Most tumors of the parotid glands are benign, but most salivary gland cancers begin in the parotid glands. • Surgical excision of the parotid gland (parotidectomy) is often performed as part of the treatment. • Because the parotid plexus of CN VII is embedded in the parotid gland, the plexus and its branches are in jeopardy during surgery.

otoscopic examination

• Examination of the external acoustic meatus and tympanic membrane begins by straightening the meatus. • In adults, the helix is grasped and pulle posterosuperiorly (up, out, and back). These movements reduce the curvature of the external acoustic meatus, facilitating insertion of the otoscope • The meatus is relatively short in infants; therefore, extra care must be exercised to prevent injury to the tympanic membrane. • The meatus is straightened in infants by pulling the auricle inferoposteriorly (down and back). • The examination also provides a clue to tenderness, which can indicate inflammation of the auricle and/or the meatus. • The tympanic membrane is normally translucent and pearly gray. • The handle of the malleus is usually visible near the center of the membrane (the umbo). From theinferior end of the handle, a bright cone of light is reflected from the otoscope's illuminator. This light reflex is visible radiating antero- inferiorly in the healthy ear.

Sublingual absorption of drugs

• For quick transmucosal absorption of a drug—for instance, when nitroglycerin is used as a vasodilator in angina pectoris (chest pain)—thepill (or tongue,spray) is put under the where the thin mucosaallows the absorbed drug to enter the deep lingual veins in less than a minute.

molar teeth relation to maxillary sinus

• The close proximity of the three maxillary molar teeth to the floor of the maxillary sinus poses potentially serious problems. During removal of a molar tooth, a fracture of a root may occur. • If proper retrieval methods are not used, a piece of the root may be driven superiorly into the maxillary sinus. • A communication may be created between the oral cavity and the maxillary sinus as a result, and an infection may occur.

Infection of Parotid Gland

• The parotid gland may become infected by infectious agents that pass through the bloodstream, as occurs in mumps, an acute communicable viral disease. • Infection of the gland causes inflammation (parotiditis) and swelling of the gland. • Severe pain occurs because the parotid sheath limits swelling. • Often the pain is worse during chewing because the enlarged gland is wrapped around the posterior border of the ramus of the mandible and is compressed against the mastoid process of the temporal bone when the mouth is opened. • The mumps virus may also cause inflammation of the parotid duct, producing redness of the parotid papilla, the small projection at the opening of the duct into the superior oral vestibule. • Because the pain produced by mumps may be confused with a toothache, redness of the papilla is often an early sign that the disease involves the parotid gland and not a tooth. • Parotid gland disease often causes pain in theauricle externaland external acoustic meatus of the ear, the temporal region, and TMJ because the auriculotemporal and great auricular nerves, from which the parotid gland and sheath receives sensory fibers, also supplies sensory fibers to the skin over the temporal fossa and auricle.

nasal septum deviation

• This could be the result of a birth injury,during adolescencebut more often, the deviation resultsand adulthood fromtrauma (e.g., during a fist fight). • Sometimes, the deviation is so severe that the nasal septum is in contact with the lateral wall of the nasal cavity and often obstructs breathing or exacerbates snoring. • The deviation can be corrected surgically.

hypoglossal nerve injury

• Trauma, such as a fractured mandible, may injure the hypoglossal nerve (CN XII), resulting in paralysis and eventual atrophy of one side of the tongue. • The tongue deviates to the paralyzed side during protrusion because of the action of the unaffected genioglossus on the other side

Paralysis of Genioglossus

• When the genioglossus is paralyzed, the tongue mass has a tendency toshift posteriorly, airway and presenting the riskobstructing theofsuffocation. • Total relaxation of the genioglossus muscles occurs during general anesthesia; therefore, the tongue of an anesthetized patient must be prevented from relapsing by inserting an airway.

Nasal Fracture

• fractures of the nasal bones are common facial fractures in automobile accidents and sports (unless face guards are worn). Epistaxis (nosebleed) usually occurs. • In severe fractures, disruption of the bones and cartilages results in displacement of the nose. • When the injury result from a direct blow, the cribriform plate of the ethmoid bone may also fracture, often accompanied by CSF rhinorrhea (leaking of CSF through the nose).

Innervation of the eye

•Parasympathetic fibers : preganglionic fibers from midbrain, Edinger Westphal nucleus. Postganglionic from ciliary ganglion.•Sympathetic fibers: postganglionic from carotid plexus.•General sensory: CN V1, cells in trigeminal (semilunar or Gasserian) ganglion

A 4-year-old girl's grandmother noticed that she was holding her head to one side. The child's mother took the girl to the pediatrician, who confirmed the grandmother's observation. On examination, he observed that the child's head was tilted to the right, her occiput was rotated toward her shoulder, and her chin was rotated to the left and elevated. The pediatrician also detected a palpable mass in the inferior part of the child's sternocleidomastoid (SCM). The remainder of the muscle was prominent throughout its course in the neck. He diagnosed the condition as congenital muscular torticollis. What is the common cause of this abnormality? When does it usually occur?

1. Lesions of the SCM may result from fixed positioning of the head and neck in the uterus that causes tearing of the muscle fibers and fibrosis (formation of fibrous tissue as a reparative or reactive process). Excessive stretching of the neck during a difficult delivery may also cause tearing of fibers and bleeding within the SCM. The resulting hematoma is contained within its own fascial compartment, which results in increased pressure on the muscle fibers. This damages the muscle and results in an area of ischemia. The damaged muscle fibers gradually undergo fibrosis. Congenital muscular torticollis usually occurs at birth.

A 62-year-old man consulted his physician about his difficulty in swallowing and breathing. He said that his wife was also concerned about the swelling in the anterior part of his neck, which she thought was a goiter. Physical examination, an ultrasound scan, and a needle biopsy revealed that the man had thyroid cancer. It was decided to perform a thyroidectomy and a neck dissection to search for and remove enlarged lymph nodes. Why is a total thyroidectomy usually not performed? How can one avoid damaging the nerves during a thyroidectomy?

1. Total thyroidectomy is usually not performed because of the danger of injuring the recurrent laryngeal nerves and inadvertently removing all the parathyroid glands. Medially, the recurrent laryngeal nerves are closely related to the posterior part of the capsule of the thyroid gland. The parathyroid glands, when in their usual position, lie in close relationship to the posterior aspect of the thyroid gland, outside its fibrous capsule but inside its fascial sheath. 1. Surgeons avoid injury to the recurrent laryngeal nerves during thyroidectomy by not cutting through the posterior aspect of the fibrous capsule of the thyroid, especially medially where these nerves lie in the tracheoesophageal grooves.

The mother of an 11-year-old child consulted her physician about a swelling in the anterior aspect of her daughter's neck. Although the swelling was painless, the mother was concerned because the lump was slowly getting larger. The physician explained that this type of neck swelling is common in children. He told the mother that these swellings often represent developmental anomalies that do not become apparent until childhood, adolescence, or early adulthood. He also stated that these midline masses tend to be benign (nonmalignant). Physical Examination: Physical examination revealed that none of the cervical lymph nodes was enlarged or tender. The physician noted that the swelling was located just inferior to the hyoid and that it was cystic and freely movable (see Figure 9.1<csfig9-1.jpg>). The physician held the swelling gently between his first and second fingers and asked the patient to swallow. The swelling moved superiorly during swallowing. He then asked the patient to stick her tongue out as far as possible and then retract it. The physician noted a definite superior tug on the mass as the patient's tongue protruded. The physician aspirated fluid from the swelling for laboratory investigation. Laboratory Report: The fluid consists of a thin, watery substance containing gelatinous material. Diagnosis: Thyroglossal duct cyst. Where are these cysts usually found?

1. duct may persist anywhere along the anterior midline of the neck between the foramen cecum of the tongue and the thyroid gland. These remnants may give rise to cysts in the tongue or neck, but they usually lie just inferior to the hyoid.

What would this condition be called if a midline cervical opening into the cyst had been present?

A thyroglossal duct cyst may develop an opening onto the surface of the neck (thyroglossal sinus). This results from erosion of cervical tissues following infection and rupture of the cyst.

A newborn infant was referred to a pediatrician because she was coughing and choking when attempts were made to feed her. The referring physician stated that the infant became cyanotic when she was coughing. Suctioning of excess secretions from the mouth and pharynx resulted in some improvement, but the symptoms quickly recurred. Attempts to insert a catheter into the stomach was unsuccessful. Radiographic studies revealed that the stomach was distended with air. Which of the following statements best describes the most likely cause of he infant's symptoms and signs? A. Esophageal atresia and trachea-esophageal fistula B. Brachial fistula C. Congenital pyloric stenosis D. Compression of vagus nerve E. Esophageal tumor

A. Esophageal atresia and trachea-esophageal fistula Most infants with excessive oral secretions and choking during the initial feeding attempts have esophageal atresia and tracheo-esophageal fistula. Because of the fistula between the trachea and esophagus, aspiration of fluids into lungs occurs and air enters into the stomach. It maybe so distended that it affects breathing

A 32-year-old woman consulted her family physician about a circumscribed, hyperpigmented swelling of the skin on the right side of her neck. The physician examined the lesion located in the lateral cervicalregion (posterior triangle) along the posterior border of the SCM. He was concerned when she said the nevus (mole) was gradually becoming larger. Concerned that the nevus might be a malignant melanoma, he referred her to a dermatologist. During removal, the dermatologist found that the nevus was adherent to the underlying fascia, so she performed an extensive tissue dissection. Pathological stud of the nevus revealed that it was a melanoma. The skin was closed, and the patient returned home. When the patient arose the next day, she had difficulty shrugging (elevating) her right shoulder and combing her hair due to diminished ability to perform movements requiring her right upper limb to be elevated to or above the horizontal level. She called the dermatologist who asked her to come to her office. On physical examination, the physician noted dropping of her right shoulder. Which of the following statements best describes the most likely cause of the weakness of the woman's right upper limb A. Injury of the spinal accessory. nerve B. Injury to the phrenic nerve C. Injury to the glossopharyngeal nerve D. Injury to the cervical branch of the facial nerve E. Injury to the vagus nerve

A. Injury of the spinal accessory. nerve Because the spinal accessory nerve emerges from the posterior border of the SCM and crosses the lateral cervical region in a nearly subcutaneous position to supply the trapezius and would produce the symptoms of the patient

A 55-year-old man consulted his family physician about a swelling anteroom-inferior to his left ear. At the exam, he also complained that the left side of his face felt weak and the corner of his mouth was drooping. On examination, the physician detected a hard mass deep within the substance of parotid Gand. He also observed that the man's facial muscles on the left side were weaker than one the right side. Which of the following statements best describes the most likely cause of the patient's complaints? A. the parotid plexus of the facial nerve (CN VIII) was being compressed by a carcinoma of left parotid gland B. compression of the trigeminal ganglion C. compression of the otic ganglion D. Compression of the auriculotemporal nerve E. compression of the external carotid artery

A. The parotid plexus of the facial nerve (CN VIII) was being compressed by a carcinoma of left parotid gland The damaged CN VIII caused the weakness of the facial muscles on the left side and the sagging of the left corner of his mouth

A pitcher was hit on the right side of his head by a baseball. He fell to the ground and was unconscious for about 4 minutes. When he awoke, he complained of a severe headache and considerable pain and was rushed to the hospital. He was initially conscious but suddenly became very drowsy. On examination, a large bruise was observed on his right temple and his right pupil was dilated. A radiograph of his cranium revealed a fracture of the squamous part of the temporal bone. Which of the following statements best describes the most likely cause of the pitcher's symptoms and signs? A. Compression of the brain by a dural border (subdural) hematoma B. Fracture of the calvaria and rupture of the middle meningeal artery producing an extradural hematoma C. Hemorrhage into the subarachnoid space D. A cerebral laceration resulting from a depressed cranial fracture E. Rapid acceleration of the head

B. Fracture of the calvaria and rupture of the middle meningeal artery producing an extradural hematoma The depressed fracture tore the artery traveling within the vascular grooves in the inner table of the cranial bone and blood collected between the dura and the calvaria in the region of the period. This produced an extradural hematoma that compressed the lateral aspect of the brain. This is most commonly associated with lateral blows to the head

A 20-year-old man was slammed in the right anterior cervical region (anterior triangle). An ambulance was called, and the paramedics stopped the bleeding from the external jugular vein. He was taken to an emergency room where a physician examined him. When the man was asked to protrude his tongue, its apex deviated to the right side. The physician concluded that there was a nerve lesion. Which of the following statements best describes the most likely cause of the deviation of the man's tongue? A. Injury of the glossopharyngeal nerve (CN IX) B. Paralysis of the right hypoglossal nerve (CNXII) C. Injury of the pharyngeal plexus of nerves D. Injury of the vagus nerve E. Injury of the transverse cervical nerve (C2 and C3)

B. Paralysis of the right hypoglossal nerve (CN XII) CN XII supplies all muscles of the tongue except the palatoglossus. When there is a lesion of CN XII, the apex of the tongue deviates towards the paralyzed side. This occurs because the geniolossus muscle is paralyzed due to severed right hypoglossal nerve

A middle-aged woman complains to her physician of vocal difficulties. On examination, she is unable to abduct her vocal cords during quiet breathing. Which of the following muscles is most likely paralyzed? A. Cricothyroid muscle B. Posterior circa-arytenoid muscle C. Oblique arytenoid muscle D. Vocalis muscle E. Lateral circa-arytenoids

B. Posterior circa-arytenoid muscle This is the only muscle that abducts the vocal cords during quiet breathing

A 42-year-old woman told her family physician that she recently observed a swelling in the anterior part of her neck. She also said that her breathing seemed to be abnormal. Physical examination revealed a firm swelling on the left side of her thyroid gland, which moved up and down during swallowing. An ultrasound scan revealed a solid nodule in the left lobe of her thyroid gland. A needle biopsy indicated that malignant changes had occurred in the cells. Based on your knowledge of the lymphatic vessels of the thyroid gland, to which lymph nodes do you think the cancerous cells would most likely metastasize?

Because malignant cells were in the thyroid nodule, the cells would likely metastasize to the prelaryngeal, pretracheal, and paratracheal lymph nodes. From these nodes, the malignant cells would likely pass to the inferior deep cervical lymph nodes.

A 68-year-old man who had a severe cold became acutely ill about 2 weeks later. His wife consulted their family physician, who said to bring him to his office as soon as possible. During her examination, the physician noted that he had a high fever, pain in his eyeballs, a severe headache, parasol sinusitis, no pupillary reflex, and dilation of the pupil. She also noted that his right eyeball was abducted and directed slightly inferiorly. Which of the following statements best describes the most likely cause of the man's symptoms and signs? A. Thrombophlebitis of the cavernous sinus involving the trochlear nerve (CN IV) B. Atherosclerotic blockage of the central artery of the retina C. Cavernous sinus thrombophlebitis invovling the oculomotor nerve (CN III) D. Injury to the abducent nerve (CN VI) in the cavernous sinus E. Obstruction of blood flow through the ophthalmic and central retinal veins

C. Cavernous sinus thrombophlebitis involving the oculomotor nerve (CN III) Cavernous sinus thrombophlebitis is an infectious inflammation of the cavernous sinus. The infection ost likely spread from the infections of the face to the superior and inferior ophthalmic veins of the orbital cavities. Thrombi (clots) formed in the cavernous sinus , which resulted in inflammation of its lateral wall containing CN III. This nerve is involved because if the characteristic signs of a CN III lesion

A 33-year-old singer visits his physician and complains of changes in his voice. A laryngoscopes examination demonstrates a lesion of the superior laryngeal nerve. Which of the following muscles would be affected by such a lesion? A. Middle pharyngeal constrictor B. Thyro-arytenoid C. Cricothyroid D. Superior pharyngeal constrictor E. Thyrohyoid

C. Cricothyroid The external laryngeal branch of the superior laryngeal nerve supplies the cricothyroid and inferior pharyngeal constrictor muscles

A 4-year-old girl was taken to her doctor because difficult nasal respiration and ear pain. The physician examination reveals a bulging tympanic membrane. She also complains that sounds are muffled. Which of the following statements best describes the most likely cause of the child's signs and symptoms? A. Meniere syndrome B. Mastoiditis C. Otitis media D. Sensorineural hearing loss E. Otitis externa

C. Otitis media Otitis media is an infection of the middle ear. severe or repeated infections may affect hearing, which may resolve when the infection is treated

Discuss the possible results of a meningeal infection.

Cavernous sinus thrombosis may result in meningitis, thrombophlebitis of cortical veins, and cerebral edema, an increase in brain volume resulting from an increase in water and sodium content. When severe, brain edema can cause various forms of herniation of the brain and pressure on the brainstem, which may result in failure of respiration and circulation.

A 3-year-old boy was playing with some coins that he found on the floor. He put a nickel into his mouth and accidentally swallowed it. He suddenly began to cough, drool, and choke. The boy was rushed to the hospital. A lateral radiograph of his neck revealed that the coin was lodged in his esophagus. What would make the child choke? How do you think the coin might be removed?

Choking of the infant would result from compression of the larynx or trachea by the localized enlargement of the esophagus. emoval of the coin would likely be performed under direct vision with an esophagoscope.

A 42-year-old man visited his primary care physician because of a swelling in his mouth and pain under his tongue. The physician examined his mouth and observed that there was inflammation and swelling around his right sublingual caruncle. When she asked the patient when he feels the pain, he said it occurs mostly when he eats. A CT exam revealed a large calculus (stone) in a structure under the tongue. Which of the following statements best describes the most likely cause of the sublingual swelling in the man's mouth? A. Obstruction of the right parotid duct B. Blockage of one or more of the sublingual ducts C. Blockage of the deep lingual vein D. Blockage of the right submandibular duct E. Inflammation of the right sublingual gland

D. Blockage of the right submandibular duct This duct was blocked by a calculus close to its opening on the sublingual caruncle. The terminal part of the duct lies beneath the oral mucosa on the sublingual fold. The calculus obstructs the flow of saliva, resulting in swelling of the submandibular caruncle and pain, especially at mealtimes

A 67- year-old is complaining to his physician of immediate lacrimation (tearing) during eating. He also told his physician that he had a severe and long-lasting episode of bell palsy. The physician recognized the syndrome as "crocodile tearsyndrome" that results because of misdirection of regenerating autonomic nerve fibers. Which of the following nerves has been injured? A. Auriculotemporal nerve B. Lacrimal nerve C. Facial nerve at the stylomastoid foramen D. Facial nerve proximal to the geniculate ganglion E. Chorda tympani in the infra temporal fossa

D. Facial nerve proximal to the geniculate ganglion "crocodile tears syndrome" (lacrimation during eating) is caused by a lesion of facial nerve proximal to the geniculate ganglion resulting from misdirection of regenerating parasympathetic fibers, which formerly innervated the submandibular and sublingual salivary glands to the lacrimal gland

A 3-year-old boy asked his mother why his head was tilted to the side. His mother took him to a pediatrician because she thought he might have injured his neck. The deformity developed after delivery. The pediatrician found that the cervical region of the boy's vertebral column was permanently held in a position of slight left lateral flexion (bending). She also observed that his head was tilted to the left side with his occipital rotated toward his shoulder. Furthermore, she detected a palpable pea-sized mass in the inferior aspect of a protruding muscle. AP and lateral radiographs of the boy's neck were normal as were the deep cervical lymph nodes. Which of the following statements best describes the most likely cause of the boy's twisted neck? A. Congenital malformation of the cervical region of the vertebral column B. Muscular torticollis resulting from injury to the longus colli muscle at birth C. Muscular torticollis resulting from injury to the scalenus anterior muscle at birth D. Muscular torticollis resulting from injury of the sternocleidomastoid muscle at birth E. A maligant tumor in the posterior cervical region (posterior triangle) of the neck

D. Muscular torticollis resulting from injury of the sternocleidomastoid muscle at birth This is the most common cause of torticollis during infancy and childhood. Excessive stretching of the neck during delivery likely resulted in tearing and bleeding within the SCM. This damaged the muscle resulting in an area of ischemia that was subsequently replaced by fibrous tissue. The fibrous tissue contracted the SCM producing torticollis

A 23-year-old man is suffering from numbness at the tip of his nose after being diagnosed with a brain tumor. Which of the following nerves is most likely being compressed by the tumor? A. Auriculotemporal nerve B. Mandibular division of the trigemini nerve C. Maxillary division of the trigeminal nerve D. Ophthalmic division of the trigeminal nerve E. Facial nerve

D. Ophthalmic division of the trigeminal nerve The skin overlying the tip of the nose is innervated by the external nasal branch of the nasociliary branch of the ophthalmic division of the trigeminal nerve

A 20-year-old man was concerned about a swelling in the anterior aspect of his neck because it was gradually becoming larger. He was urged by his mother to consult a physician. Doing the examination, it was noted that his voice was hoarse. The young man said that he has had a cold for about 2 weeks. On further examination, the physician observed a nonpulsatile, well defined swelling in the midline of the man's neck superior to the thyroid gland. He asked the man to stick out his tongue and then to swallow. The neck swelling moved superiorly when he stuck out his tongue but did not move when he swallowed. Which of the following statements best describes the most likely case of the swelling in the young man's neck? A. Tumor of the left laryngeal nerve B. Brachial cyst (remnant of embryonic cervical sinus) C. Infection of deep cervical lymph nodes D. Thyroglossal duct cyst E. Goiter (enlargement of the thyroid)

D. Thyroglossal duct cyst Remnants of the embryonic thyroglossal duct persisted along the course of descent of developing thyroid gland. Some remnant became cystic and formed a soft, nonpulsatile swelling superior to the thyroid gland. Thyroglossal duct cysts are usually attached to the tongue by fibrous tissue strands. Therefore, when the tongue is protruded, the cystic swelling moves superiorly.

A 38-year-old woman consulted her physician about a persistent cough, nasal congestion, and pain in her left cheek and superior molar teeth. After examination, the physician told her she had acute paranasal sinusitis. Which of the following statements best describes the most likely cause of the patient's synmptoms? A. Acute sphenoidal sinusitis B. Acute petrosal sinusitis C. Acute frontal sinusitis D. Acute ethmoidal sinusitis E. Acute maxillary sinusitis

E. Acute maxillary sinusitis Maxillary sinusitis commonly results in pain in the cheek and in one or more molar teeth. Because the paranasal sinuses communicate with the nasal cavities. The pain results from acute infection and inflammation of the mucous membrane of the maxillary sinus. The pain in the molar teeth occurs because their roots are in contact with the inflamed mucous membrane lining the floor of the maxillary sinus

While shaving, a 75-year-old man noticed that his left superior eyelid was drooping. His wife, who was concerned that he might have had a mild stroke, insisted that he see their family physician. On examination, ptosis (drooping of the superior eyelid), miosis (contraction of the pupil), and a lack of facial sweating was detected. Which of the following statements best describes the problems? A. A lesion of the superior division of CN III B. A lesion of the facial nerve C. A lesion invovling the parasympathetic component of CN III D. Injury of the levator palprbrae superioris E. Interruption of the cervical sympathetic trunk

E. Interruption of the cervical sympathetic trunk A lesion of a sympathetic trunk in the neck results in a sympathetic disturbance n the head (Horner syndrome) that resulted in the described signs and symptoms. Ptosis results from a loss of innervation of the superior tarsal muscle sand, and the mitosis results from a loss of innervation to the dilator papillae muscles

During a fight, a 14-year-old receives an injury to the phrenic nerve from a knife wound in the neck. Which of the following anatomical relationships is correct about this nerve? A. It passes posterior to the subclavian artery B. It passes deep to the brachial plexus C. Anterior to the subclavian vein D. It passes medial to the common carotid artery E. It passes anterior to the anterior scalene muscle

E. It passes anterior to the anterior scalene muscle The phrenic nerve descends on the superficial surface of the anterior scalene muscle and passes into the thorax

If the nasal fracture extends into the cranium, what may be the result?

If the fracture extends into the floor of the anterior cranial fossa, the cribriform plate may fracture and the meninges may tear, resulting in cerebral spinal fluid (CSF) rhinorrhea, discharge of CSF through the nose.

A 65-year-old woman consulted her physician about muscle weakness, anorexia, nausea, constipation, and polyuria (passage of large volumes of urine). After taking a thorough history and performing an extensive physical examination, the physician ordered laboratory studies of her blood and urine. The laboratory reports revealed an elevated serum calcium concentration, an elevated serum level of parathormone, and an elevated urinary calcium excretion. A diagnosis of parathyroid adenoma was made. It was decided that resection of the enlarged gland(s) should be performed. The surgeon located the superior parathyroid glands without difficulty and found them to be normal in size. She could locate only one inferior parathyroid gland. Because it was enlarged and a frozen section suggested parathyroid hyperplasia and parathyroid adenoma, the gland was removed. She systematically searched the anterior part of the neck for the fourth parathyroid gland but was unable to find it. Continued searching resulted in detection of the gland. If the ectopic parathyroid gland was not detected in the neck, where do you think the surgeon would search for it?

If the gland is not in the neck, the surgeon might explore the superior mediastinum.

Based on your knowledge of the relations of the trachea, what structures may be injured during this procedure?

In a tracheal incision that extends too far posteriorly, the posterior tracheal wall and esophagus may be damaged, especially in children. In some cases, injury to the recurrent laryngeal nerves may occur during a tracheostomy

A 16-year-old youth was referred to a dermatologist for treatment of a severe case of acne (acne vulgaris). The physician observed a small abscess (boil) on the ala of the youth's nose that had developed a yellow "head" at its apex. She treated the youth with antibiotics but warned him not to pick or squeeze the boil because it might cause the infection to spread to the meninges (meningitis) and brain (encephalitis). Explain anatomically how an infection could spread from the nose to the meninges and brain

Inflammation of the facial vein associated with thrombus formation may result in the spread of infection from the facial vein through the superior and inferior ophthalmic veins to the meninges and the cavernous sinus.

A 6-year-old child was taken to a family physician for treatment of a persistent sore throat. During physical examination, the physician observed infection and hypertrophy of the tonsils and adenoids. He also detected an enlarged tonsillar lymph node. Although the boy's tonsils were the site of chronic infection, he was reluctant to recommend a tonsillectomy and adenoidectomy (T & A). Which lymph node is commonly referred to as the tonsillar lymph node? Where is this node located?

Lymph from the palatine tonsil drains to the superior deep cervical lymph nodes, especially the jugulodigastric node, often referred to as the tonsillar node. The jugulodigastric lymph node lies on the IJV where the posterior belly of the digastric muscle crosses the IJV.

Following removal of a malignant tumor from the right posterosuperior region of the neck of a 52-year-old man, the surgeon decided to do a radical neck dissection of the region to remove the enlarged lymph nodes. One enlarged lymph node was in the submandibular triangle, deep to the superior end of the SCM. After the operation, the man informed the surgeon that he had difficulty shrugging his right shoulder and turning his face to the left side against resistance. What nerve was probably injured during the surgical removal of the enlarged lymph nodes? Which lymph nodes do you think the surgeon removed?

Most likely the spinal accessory nerve (CN XI) was injured. The enlarged lymph nodes the surgeon removed would be submandibular lymph nodes, located beneath the investing layer of deep cervical fascia.

The mother of an 11-year-old child consulted her physician about a swelling in the anterior aspect of her daughter's neck. Although the swelling was painless, the mother was concerned because the lump was slowly getting larger. The physician explained that this type of neck swelling is common in children. He told the mother that these swellings often represent developmental anomalies that do not become apparent until childhood, adolescence, or early adulthood. He also stated that these midline masses tend to be benign (nonmalignant). Physical Examination: Physical examination revealed that none of the cervical lymph nodes was enlarged or tender. The physician noted that the swelling was located just inferior to the hyoid and that it was cystic and freely movable (see Figure 9.1<csfig9-1.jpg>). The physician held the swelling gently between his first and second fingers and asked the patient to swallow. The swelling moved superiorly during swallowing. He then asked the patient to stick her tongue out as far as possible and then retract it. The physician noted a definite superior tug on the mass as the patient's tongue protruded. The physician aspirated fluid from the swelling for laboratory investigation. Laboratory Report: The fluid consists of a thin, watery substance containing gelatinous material. Diagnosis: Thyroglossal duct cyst. What is the anatomical basis for the cyst's superior movement when the child protruded her tongue and swallowed? What glandular tissue may be associated with this type of cyst?

Often the cyst is in intimate contact with the anterior part of the hyoid. It may be connected superiorly by a duct with the foramen cecum, inferiorly with a pyramidal lobe, or the isthmus of the thyroid gland, or both. Thus, thyroglossal cysts may move up and down during deglutition and when the tongue is protruded. Sometimes thyroid tissue is associated with a thyroglossal duct cyst and, in unusual cases, the entire thyroid gland is attached to the cyst because it failed to descend to its normal position during the embryonic period.

A shortstop fielding a ground ball was hit on the side of the nose when the ball bounced unexpectedly. Blood spurted from his, nose and his nasal airway was obstructed. His nose was deformed, and the nasal bones were displaced. Disruption of the nasal cartilages was also detected. What causes spurting of blood from the nose? What specific structures are involved?What causes obstruction to the nasal airway?

Spurting of blood from the nose results from ruptured arteries, particularly at the site of anastomosis of the sphenopalatine and greater palatine arteries on the nasal septum (Kiesselback area). The nasal airway is often obstructed when there is a nasal fracture because bone fragments may block the nose.

A young man was deeply slashed with a knife in the middle of the right lateral cervical region. The cut ended anterior to the middle of the SCM. The bleeding was arrested, and the wound was sutured. The patient, who was right-handed, later complained that he had difficulty combing his hair and tilting his head to the right. Which blood vessel was likely severed?

The EJV was most likely severed. This large vessel passes inferolaterally across the SCM and pierces the investing layer of deep cervical fascia just superior to the clavicle.

Injury to the cervical branch of the facial nerve

The cervical branch of CN VII emerges from the inferior border of the parotid gland and passes anteriorly in the neck inferior to the mandible to supply the platysma, a broad thin sheet of muscle in the subcutaneous tissue of the neck. The injury and muscle would cause the skin to fall away from the neck in slack folds

A 3-year-old boy was playing with some coins that he found on the floor. He put a nickel into his mouth and accidentally swallowed it. He suddenly began to cough, drool, and choke. The boy was rushed to the hospital. A lateral radiograph of his neck revealed that the coin was lodged in his esophagus. Where would the coin probably lodge in the cervical esophagus? 1. If the coin passed further down the esophagus into the thorax, where might it lodge?

The coin would most likely lodge where the laryngopharynx joins the superior end of the esophagus, which is located at the level of the inferior border of the cricoid cartilage. If the coin passed into the thoracic esophagus, it would likely lodge in the second constriction at the level of the arch of the aorta.

Describe the danger triangle of the face.

The danger triangle of the face has its base at the vermillion border of the upper lip and its apex at the bridge of the nose.

epistaxis

The diplopia suggests that the eyeball and orbit may have been injured. Diplopia indicates malalignment of the visual axes. Temporary blurred vision may be a complication of zygomatic fractures. relatively common because of the blood supply to the nasal mucosa.rich • In most cases, the cause is trauma, and the bleeding is from an area in the anterior third of the nose (Kiesselbach area). • Epistaxis is also associated with infections and hypertension. • Spurting of blood from the nose results from rupture of arteries. • Mild epistaxis may also result from nose picking, which tears veins in the vestibule of the nose.

A 58-year-old man complained to his physician about a swelling on his cheek anterior to his ear lobule. He said that it had been growing rapidly for approximately 2 months and that this part of his face felt weak. He also experienced difficulty when he tried to whistle. The physical examination and subsequent pathological studies revealed a carcinoma of the parotid gland. How could this tumor cause weakness of the face and make it difficult for the man to whistle?

The facial nerve leaves the cranium through the stylomastoid foramen and almost immediately enters the parotid gland. Its branches spread out like the abducted fingers of the hand. Consequently, a malignant parotid tumor invades the facial nerve and interferes with its supply to the facial muscles, including those used to whistle.

Is the facial paralysis likely to be permanent?

The facial paralysis is likely permanent because severely injured cranial nerves do not regenerate.

A 30-year-old man was eating a fish dinner when he suddenly started to choke. He told his wife that he believed a fishbone was stuck in his throat. She drove him to the emergency department of a hospital. The attending physician examined the man's larynx with a laryngeal mirror; however, he was unable to see a fishbone. He then inserted an endoscope into the patient's laryngopharynx and was able to locate and remove the bone. Where do you think the fishbone was lodged?

The fishbone was likely lodged in the piriform fossa between the aryepiglottic fold and the lateral wall of the laryngopharynx. Foreign bodies such as fishbones and chicken bones often pass into these pear-shaped recesses because when food passes through the laryngopharynx during swallowing, it is forced to flow through these recesses. Sharp objects may lodge in them and pierce the floors of the recesses.

A figure skater fell on the ice, hitting the back of her head hard on the ice. She did not lose consciousness but was slightly confused and complained of temporary dizziness. Her pupils appeared normal. The fist-sized swelling on the back of her head was tense on palpation. The physician who examined her said that she probably had a hematoma of the scalp but would monitor her condition for several hours. In what layer of the scalp would the hematoma likely be located? What limits the spread of a superficial hematoma of the scalp? What initial treatment would likely be given?

The hematoma was probably located in the thick, richly vascularized subcutaneous layer of connective tissue of the scalp (layer two). A superficial hematoma of the scalp is limited by the fibrous tissue that binds the skin to the epicranial aponeurosis. The initial treatment of the hematoma was probably the application of an ice pack to control the bleeding and swelling.

A 30-year-old man was eating a fish dinner when he suddenly started to choke. He told his wife that he believed a fishbone was stuck in his throat. She drove him to the emergency department of a hospital. The attending physician examined the man's larynx with a laryngeal mirror; however, he was unable to see a fishbone. He then inserted an endoscope into the patient's laryngopharynx and was able to locate and remove the bone. What structure might be injured if the bone pierced the mucous membrane? What would be the result of injury to this structure?

The internal laryngeal nerve may be injured because both nerves run immediately deep to the mucous membrane lining the recess. This nerve supplies sensory fibers to the laryngeal mucosa superior to the vocal folds, including the superior surface of these folds. The mucous membrane of the superior part of the larynx is sensitive, and contact by a foreign object causes immediate explosive coughing to expel it. Lack of sensation in this mucosa resulting from a nerve injury could allow food to enter the larynx and cause choking.

During an automobile accident, the neck of an 82-year-old man was injured by the safety belt as the vehicle stopped suddenly. He complained of difficult breathing and a sore "Adam's apple." The physician who examined him realized that it was necessary to perform an emergency cricothyroidotomy to secure an adequate airway. What structures in the anterior part of the neck were most likely injured by the safety belt during the automobile accident? How could this cause difficult breathing?

The laryngeal cartilages, particularly the protruding thyroid cartilage, were likely fractured. The displaced laminae of the thyroid cartilage probably blocked the airway. In addition, edema of the submucosa of the larynx may have obstructed the passage of air.

Why is the laryngeal skeleton more easily fractured in elderly people?

The laryngeal skeleton, particularly the thyroid cartilage, is more easily fractured in elderly people because of ossification of the cartilages.

A young man was playing in a pickup hockey game when he was knocked down. He was not wearing a helmet and hit his head hard on the ice. He was momentarily stunned and said that he "saw stars." His vision was blurred for approximately 20 seconds. He skated to the bench and showed no other signs of injury except that he complained of a lingering headache. What may the lingering headache indicate?

The lingering headache may indicate increasing intracranial pressure resulting from damage to the brain (e.g., contusion of the cerebral cortex).

A 62-year-old man consulted his physician about his difficulty in swallowing and breathing. He said that his wife was also concerned about the swelling in the anterior part of his neck, which she thought was a goiter. Physical examination, an ultrasound scan, and a needle biopsy revealed that the man had thyroid cancer. It was decided to perform a thyroidectomy and a neck dissection to search for and remove enlarged lymph nodes. Why was the man having difficulty breathing and swallowing?

The man had dyspnea and dysphagia because the enlarged thyroid gland was compressing the trachea and esophagus and partially occluding their lumina, causing difficulty in breathing and swallowing.

A young man was deeply slashed with a knife in the middle of the right lateral cervical region. The cut ended anterior to the middle of the SCM. The bleeding was arrested, and the wound was sutured. The patient, who was right-handed, later complained that he had difficulty combing his hair and tilting his head to the right. Explain why the patient had difficulty combing his hair and laterally flexing his head.

The patient had difficulty combing his hair because the knife had cut his CN XI, paralyzing his trapezius. To raise his hand to his head, the trapezius, assisted by the serratus anterior, must rotate the scapula so the glenoid cavity faces superolaterally. He experienced some difficulty tilting his head to the right side because of paralysis of the SCM, which is also supplied by the spinal accessory nerve.

A hockey player was struck viciously on the lower face by an elbow during a scuffle in the corner of the rink. Profuse bleeding from the mouth was obvious, and he was unable to close his jaws normally. What bone may have been fractured? What other structures may be fractured? Discuss these injuries.

The player's lower jaw was probably fractured, which resulted in his teeth not fitting together (occluding) as they normally do. Fracture of the mandible is common in sports such as hockey, football, and rugby. Often two mandibular fractures, or a fracture-dislocation of the TMJ, occur in the jaw. The most common fracture site is near the angle of the mandible. 1. Fractures of the teeth may also occur when the jaws are hit by a hard blow. The fracture may occur through the enamel, pulp, or root of the tooth. Fractures exposing the pulp of the tooth cause severe pain and sensitivity to heat and cold. Root fractures cause mobility of the teeth.

A young woman who was not wearing a seat belt hit her forehead on the dashboard of her 10-year-old car during a head-on collision. The frontal area of her scalp was lacerated and bleeding profusely. The wound was cleansed with a saline solution and covered with a sterile bandage. By the time the woman reached the hospital, she had two black eyes. Further examination revealed that there was no injury to her eyeballs. How could blood pass to both eyes when there was no injury to the orbital regions?

The skin of the scalp is continuous with that covering the forehead. Hence, bleeding in the loose connective layer can pass to the face, especially around the eyes, because this fourth layer of the scalp is somewhat like a sponge and may distend with blood from an injury. As the blood accumulates, it gravitates to the face and collects around the eyes.

Where do the ducts of the submandibular glands open?

The submandibular duct opens by one to three orifices on the small sublingual papilla beside the lingual frenulum.

From what areas do submandibular lymph nodes receive lymph?

The submandibular nodes receive lymph from a wide area, including lymph vessels from the submental, buccal, and lingual groups of lymph nodes.

A young woman who was not wearing a seat belt hit her forehead on the dashboard of her 10-year-old car during a head-on collision. The frontal area of her scalp was lacerated and bleeding profusely. The wound was cleansed with a saline solution and covered with a sterile bandage. By the time the woman reached the hospital, she had two black eyes. Further examination revealed that there was no injury to her eyeballs. Why does the scalp bleed so profusely? How could the scalp wound bleeding be controlled?

The superficial arteries of the scalp, unlike most superficial arteries in subcutaneous tissue, course within the dermis superficial to the epicranial aponeurosis, with their walls firmly attached to the dense connective tissue. The severed arteries are thus unable to contract in response to the cut as other superficial arteries do, allowing clotting to occur sooner. Bleeding from a deep scalp wound can be stopped by direct pressure with sterile gauze. Once the bleeding has stopped, a circular dressing can be applied for transportation to the hospital for further treatment (e.g., suturing the epicranial aponeurosis).

A 42-year-old woman told her family physician that she recently observed a swelling in the anterior part of her neck. She also said that her breathing seemed to be abnormal. Physical examination revealed a firm swelling on the left side of her thyroid gland, which moved up and down during swallowing. An ultrasound scan revealed a solid nodule in the left lobe of her thyroid gland. A needle biopsy indicated that malignant changes had occurred in the cells. Why did this nodular swelling move up and down when the woman swallowed? Why was her breathing affected?

The thyroid gland and the nodular swelling in it are invested by the visceral layer of pretracheal deep cervical fascia, which attaches the gland's capsule to the cricoid cartilage and tracheal rings. Consequently, when the woman swallows, her thyroid gland and the nodule within it move up and down as the larynx (and upper trachea) are elevated and then depressed by the suprahyoid and infrahyoid muscles, respectively. Her breathing was affected because each lobe of the thyroid gland is closely related to the trachea. Consequently, an enlarged lobe resulting from a large tumor is likely to compress the trachea and partially occlude its lumen, causing dyspnea.

A 4-year-old girl's grandmother noticed that she was holding her head to one side. The child's mother took the girl to the pediatrician, who confirmed the grandmother's observation. On examination, he observed that the child's head was tilted to the right, her occiput was rotated toward her shoulder, and her chin was rotated to the left and elevated. The pediatrician also detected a palpable mass in the inferior part of the child's sternocleidomastoid (SCM). The remainder of the muscle was prominent throughout its course in the neck. He diagnosed the condition as congenital muscular torticollis. Why does it take so long for the torticollis to develop? Can the injury be diagnosed during infancy and treated before torticollis develops?

The torticollis develops slowly as fibrosis, and contraction of the SCM occurs. It may not be noticed until the child is 4-6 years old. A thorough examination may reveal a hematoma in the inferior third of the SCM. If this swelling is massaged and daily passive neck stretching exercises are carried out, the hematoma may disappear and no fibrosis and shortening of the SCM may develop.

A young man was deeply slashed with a knife in the middle of the right lateral cervical region. The cut ended anterior to the middle of the SCM. The bleeding was arrested, and the wound was sutured. The patient, who was right-handed, later complained that he had difficulty combing his hair and tilting his head to the right. What large nerves would likely be injured? Describe the course of these nerves.

The transverse cervical nerve was likely cut because it turns around the middle of the posterior border of the SCM and crosses the muscle deep to the platysma. It then divides into branches that supply the skin on the side and anterior part of the neck. Superior to the middle of the posterior border of the SCM, the spinal accessory nerve (CN XI) crosses the lateral cervical region obliquely. It supplies the SCM and trapezius.

A young man was playing in a pickup hockey game when he was knocked down. He was not wearing a helmet and hit his head hard on the ice. He was momentarily stunned and said that he "saw stars." His vision was blurred for approximately 20 seconds. He skated to the bench and showed no other signs of injury except that he complained of a lingering headache. Do you think the person would have a fractured calvaria? Explain your answer.

The young man probably does not have a fractured calvaria because he did not lose consciousness. The fall on his head resulted in the slight alterations in neurological function: "seeing stars" and blurred vision.

A batter was struck in the superolateral part of the right cheek by a baseball. His cheek appeared flat and depressed. There was soon swelling and ecchymosis around the eye. The player complained of dizziness, double vision in the right eyeball, and numbness of the cheek. What bone was most likely fractured? What other bones may have been fractured? What symptom suggests that the eyeball and orbit may be injured?

The zygomatic bone was most likely fractured. The bones forming the orbit may also have fractured. 1. Fractures of the zygomatic bone are the most common fractures of the upper cheek, the most serious of which is the "tripod" fracture of the zygomatic bone involving three separate breaks of the cranial bones: a) Through the infra-orbital foramen and canal to the infra-orbital groove (a fracture of the maxilla). b) Through the zygomaticoparietal suture of the lateral margin of the orbit. c) Through the zygomatic arch, usually at its narrowest point, where the suture between the zygomatic process of the temporal bone and the temporal process of the zygomatic bone occurs. The diplopia suggests that the eyeball and orbit may have been injured. Diplopia indicates malalignment of the visual axes. Temporary blurred vision may be a complication of zygomatic fractures.

What is the relationship of this nerve to the superior end of the SCM? Describe the course and function of this nerve.

This nerve pierces the deep surface of the superior part of the SCM and supplies it. CN XI then crosses the lateral cervical region and supplies the trapezius. The SCM tilts the head laterally and rotates the neck, explaining why the patient had difficulty turning his head. The trapezius elevates, retracts, and rotates the scapula, explaining why he had difficulty shrugging his shoulder.

What structure is incised to enter the trachea during a cricothyroidotomy?

To facilitate breathing, the cricothyroid membrane was likely incised and a small tracheostomy tube was inserted into the trachea.

A 58-year-old man complained to his physician about a swelling on his cheek anterior to his ear lobule. He said that it had been growing rapidly for approximately 2 months and that this part of his face felt weak. He also experienced difficulty when he tried to whistle. The physical examination and subsequent pathological studies revealed a carcinoma of the parotid gland. Where do tumor cells from this gland usually metastasize?

Tumor cells from the carcinoma would metastasize to the deep cervical lymph nodes. These nodes form a chain along the course of the IJV from the cranium to the root of the neck.

oblique arytenoid muscle

adducts vocal cords

A lesion invovling the parasympathetic component of CN III

affects the pupil but would produce dilation due to unopposed action of the sympathetically stimulated dilator papillae.

Thyrohyoid

depresses hyoid, elevates larynx and is innervated by C1 via the hypoglossal

Goiter (Enlargement of the thyroid gland)

enlargement of the thyroid gland that produces a swelling in the anterior part of the neck. -Occurs in certain regions where there is a lack of iodine in the diet -Low iodine levels lead to low T3 and low T4 -Thyroid stimulating hormone will promote the thyroid gland to secrete T3 and T4 but because there is no iodine the thyroid increases in size

Congenital pyloric stenosis

hypertrophy pyloric muscle of the stomach; vomiting non-bile stained fluid in 2-4 weeks

mastoiditis

inflammation of the mastoid process