Exam 3
Epiglottis
- Epiglottis forms posterior boundary of Vallecula (space between poserior tongue and epiglottis that has taste buds via CN10).
Tonsillectomy. Structures (blood vessels, nerves) at risk. p.1047 blue box
- dissect palatine tonsil - bleeding from ext palatine v or tonsillar a - tonsillar a followed by CN IX and ICA so easily damaged
Where are the deep cervical lymph nodes located?
- large and numerous nodes that form a chain along carotid sheath and extend from base of skull to root of neck.
Paralysis of stapedius. blue box
= hyperacusis (excessive acuteness of hearing) = lesion of CN7 (N to stapedius) by tumor in internal acoustic meatus. - tympanic muscles dampen large vibrations of tympanic membrane - stapedius paralysis-> uninhibited movement of stapes
Sympathetic Trunk - Chain & Ganglion.
Back of neck Sympathetic Chain (very thin - tag this) Sympathetic Ganglion (thicker - pin in this).
What is the location of the palatine tonsils? What is their elaborate blood supplies?
Btwn palatoglossal & palatopharyngeal folds. - will see this in cross section picture. Blood = facial artery; also dorsal lingual branch of lingual artery sends a branch; descending palatine artery branch of maxillary artery approaches from superior region. your "tonsils"
Olfactory Nerve
CN1
Jugular Foramen
CN9, 10, 11, IJV exits. = will probably see this at back of neck.
Epiglottic Cartilage
Epiglottal Cartilage - heart shaped, internal-anterior surface of larynx. Connects with thyroid cartilage. see picture!
How to decipher Vagus Nerve (X) vs. Sympathetic Chain?
In back of neck, CN10 straight with sympathetic chain, but CN10 has branch (Superior Laryngeal Nerve).
What drains to the Anterior Cervical Lymph nodes
Inferior deep cervical nodes
This creates an image by exciting hydrogen protons in water and fat?
MRI
Which sinus cannot drain into nasal cavity by gravity W/O tipping the head?
Maxillary sinus
What part of the ethmoid bone is comprised of turbinate (and which turbinate)?
Perpendicular Plate of Ethmoid Bone contains superior turbinate & middle turbinate (inferior is own "bone").
Where do all of the pharyngeal Constrictors Attach?
Pharyngeal Tubercle, part of occipital bone
What is the sulcus terminalis / terminal sulcus?
Separates the oral portion (anterior) and pharyngeal (posterior) of the tongue.
What are the contents of Foramen Rotundum?
from pterygopalatine fossa to middle cranial fossa in cranial cavity = opening for: CNV2, maxillary N branch of trigeminal.
Greater palatine block (& osteology). - blue box
inject greater palatine f. btw 2nd/3rd max molar→ all palatal mucosa, lingual gingivae post to max canine
Route to Cavernous Sinus (asoc w facial vein)
- angular to supraorbital. - angular to inferior opthalmic, IOV to SOV to CS - superior opthalmic vvein drains DIRECTLY to CS.
Olfactory Receptor Cells (of nasal)
- olfactory tract = - olfactory bulb = - relation of cribriform plate to these?
What provides sensory to the inner surface of the tympanic membrane? What other nerves provide sensory innervation to the inner middle ear? What provides sensory to the skin of the ear?
CN9 -> sensory to eardrum CN7 & 10 also provide some sensory to rest of middle ear. skin of the ear = - superior ear = auricolotemporal N, V3 - inferior ear including lobule = great auricular nerve, from cervical plexus C2,C3.
Tag on stylopharyngeus - What innervates this muscle, how do you confirm that its that nerve and not a dif one?
CN9 motor [exception to pharyngeal muscles (constrictors and S/P-pharyngeus by CN10)]. confirm its CN9 because goes IN this muscle (bottom) & above part goes into tonsil (tonsilar branch).
The parasympathetic preganglionic nerve fibers to the pterygopalatine ganglion are fibers of which cranial nerve? A. trigeminal B. oculomotor C. vagus D. facial E. glossopharyngeal
D. Facial (greater petrosal n)
Papilla that do not contain taste buds?
Filiform papilla do not have taste buds - fung, vallate, folate do.
Thyrohyoid Membrane - what would be the two things piercing this membrane in the neck?
Internal Laryngeal Nerve (superior laryngeal N, CN10) & Superior Laryngeal Artery (superior thyroid artery)
Palatoglossal Fold
Oral Pharynx - between soft palate & hyoid bone. - lateral wall = anterior pillar / palatoglossal fold & posterior pillar / palatopharyngeal fold of the fauces. - palatine tonsil is btwn two pillars in tonsillar crypt.
Palatopharyngeal Fold
Oral Pharynx - between soft palate & hyoid bone. - lateral wall = anterior pillar / palatoglossal fold & posterior pillar / palatopharyngeal fold of the fauces. - palatine tonsil is btwn two pillars in tonsillar crypt.
Accessory Nerve (XI) - how can you decipher?
SCM, Trap. From jugular foramen.
Fluid (CSF, Blood) appears WHITE on which type of MRI - T1 or T2?
T2
Sella Turcica
The sphenoidal sinus is located below it, in body of sphenoid (may extent to grater wing). [= pituitary gland, hypophyseal fossa]
Where would you find the posterior superior alveolar artery?
WILL BE TAGED (infratemporal fossa area) dives into maxilla.
Sensorineural hearing loss. blue box
a) inability to detect HIGH-frequency sound waves bc defect w hair cells at BASE of cochlea. b) cant detect LOW-freq sounds bc defect w hair cells at APEX (apical) of cochlea. - pathway defect from cochlea and brain = damage to: cochlea, cochlea nerve, brainstem, or cortical connections - cochlea implants -> restore sound perception of rhythm and sound intensity
Ventricle - located where? If a probe is inserted here, what would be the likely pathology?
area between true & false vocal cords. If probe in sacule of ventricle -> Larygocoele (looks like goiter at neck).
Paralysis of genioglossus - blue box
fall posteriorly-> obstruct airway, inc. suffocation
Vestibule of larynx
inlet above false vocal cords. bounded by epiglottis, aryepiglottic folds, and arytenoid cartilages.
Whispers muscle
lateral cricoarytenoid muscle adducts the vocal cords, but leaves a space between arytenoid cartilages for air to pass. - won't tag this muscle on exam, so know what it does.
Middle Superior Alveolar N
maxillary canines and premolars. = v2 orbit = pterygopalatine n branch of V2 (sensory, PNS); pass thru orbital canal in lateral walla of maxila to maxillary bicuspid teeth and gingiva, also maxillary sinus.
Foramen Cecum (structure, oral cavity)
middle of terminal sulcus = ectopic thyroid (blue box) originates here then goes down to the gland.
Pharyngotympanic Tube
opening is located in anterior wall (carotid wall, carotid canal) of ear. Helps with
Posterior Superior Alveolar N
posterior maxillary teeth. = pterygopalatine n branch of V2 (sensory, PNS); arise within pterygopalatine fossa, pass to posterior superior alveolar foramina; supply 3 molar teeth and gingiva, also maxillary sinus.
Rima Glottidis & Rima Vestibule
prob wont be given on cadaver, would see in image. Rima Glottidis = between false vocal cords. Rima Vestibule = between true vocal cords. Think: G before V; F before T.
Laryngoscopy, name the structures in image. P.1044 blue box
rima vestibuli >(bigger) rima glottidis @ normal breathing - can see vestibular folds & vocal cords.
Meningeal Nerve Branch of V2
sensory to Dura, is only branch off V2 BEFORE it exits through foramen rotundum.
Which muscles aBduct the vocal cord?
separate (increase space btwn) vocal ligaments only Posterior Cricoarytenoids [rotate arytenoid cartilages laterally opening the space between the ligaments]
What is the oral vestibule?
space / region between lips and teeth
What does amalgam do when you take a CT scan?
streak artifact from amalgam on head & neck CT. - minimize CT artifact by placing patient on CT table.
How is lymph drained from the lip?
upper lip & lateral margins of lower lip to submandibular nodes; lower lip (near midline) to submental nodes).
Which muscle is attached directly to the vocal ligaments?
vocalis muscle (recall: it relaxes vocal cords for lower pitch) - won't tag on the exam.
What provides sensory innervation to the pharynx?
1. Pharyngeal branch of V2 (maxillary nerve) - to roof nasopharynx above openings Eustachian tubes. 2. Pharyngeal branch of Glossopharyngeal N - to nasopharynx below Eustachian tube & oral pharynx. 3. Pharyngeal branch of Vagus N (CN10) - to laryngeal pharynx.
Cough Reflex
1. Sense object enter = internal laryngeal nerve = AFFERENT 2. Vagus nerve, phrenic nerve, intercostal nerves = EFFERENT = signals get sent back to brain, then to respiration muscles. 3. glottis closes by contraction of tranverse arytenoid and lateral cricoarytenoid muscle by recurrent laryngeal nerve; then contraction of abdominal muscles to expire air. 4. Vocal cords relax => explosive release air from larynx.
Sinuses & where each drain to?
1. Sphenoidal Sinus -> Supreme Meatus aka Sphenoethmoidal Recess. 2. Maxillary Sinus via maxillary ostium (high in medial wall of sinus) -> semilunar hiatus (middle neatus) 3. Frontal Sinus via nasofrontal duct -> semilunar hiatus (middle meatus) 4. Ethmoidal Air Cells Anterior -> semilunar hiatus (middle meatus) Middle -> Ethmoidal bulla (middle meatus) Posterior -> superior meatus
What are the contents of Sphenopalatine Foramen
= connection btwn pterygopalatine fossa to nasal cavity; hole (probe all way through to nasal cavity) at end of pterygomaxillary fissure. = Sphenopalatine Artery (branch of descending palatine A, branch of infraorbital artery) , Vein, & Posterior Superior Nasal Nerves.
Vestibular Folds
= false vocal cords. mucosa overlying vestibular ligaments. have little or no part in voice production; serve a protective function.
1) Bulla ethmoidalis
= in center of this is opening for middle ethmoidal air cells; is medial projection causes by middle ethomoidal air cells;
You examine a 68 year old man with a history of hypertension who has suffered a stroke. During an examination it is noted that his uvula deviates to the LEFT and the RIGHT side of the palate is sagging. Which nerve has most likely been affected?
Right CN10 -> motor to uvula muscle - damage causes CONTRALATERAL deviation; CN10 damage on R side causing uvula deviation to L side; Also, bifid uvula may lead to middle ear infections due to nasal regurgitation.
Solitary Nucleus - from quiz
Special Sense
What do the meatuses drain (each receives drainage from...)?
Supreme Meatus (1) (sphenoethmoidal recess): 1) Sphenoid Sinus Superior Meatus (1): 1) Posterior Ethmoidal Air cells Middle Meatus (4)= ethmoidal bulla + semilunar hiatus. [Is betwen middle and inferior turbinate. ]: - Semilunar Hiatus <= (FAM): Frontal Sinus (via nasofrontal duct), Anterior Ethmoidal Sinus, & Maxillary Sinus (via maxilary ostium). - Ethmoidal Bull = Middle Ethmoidal Sinus. Inferior Meatus (1) [below inferior turbinate]: 1) drains nasolacrimal duct (<- opening is in inferior turbinate) that's coming from medial side of orbit
Hypoglossal Nerve (XII) - where is it taggable? how can you decipher?
Taggable in 3 places - deep lateral tongue; - over occipital artery (branch of external carotid); - back of neck (retropharyngeal), know it's NOT CN10 (goes all way down) bc it'll take turn to go forward to go to mandible and innervate the tongue.
Which muscle widens the laryngeal inlet (helps control size of laryngeal inlet)?
Thyroepiglottic Muscle - won't tag on the exam but will be a question.
How is lymph drained from the tongue? Where can metastatic cancer of the tongue spread easily to?
Tip Anterior -> Submantal Nodes. Lateral / Sides of tongue -> Submandibular nodes [can bypass these nodes into deep cervical nodes]. - Posterior - end in deep cervical nodes. (Basal - posterior 1/3 of tongue to superior deep cervical nodes; Central - to superior deep cervical nodes). - Middle of tongue can drain to nodes on either side -> inferior deep cervical lymph nodes. - Back of tongue behind terminal sulcus -> superior deep cervical nodes. Metastatic spread from cancer of tongue/ lower lip -> submental, submandibular, & deep cervical nodes.
Gag reflex: what is it? afferent vs efferent limb? blue box
Touch posterior 1/3 of tongue -> person will gag bc pharyngeal muscles get activated (afferent), and then pharynx will constrict & elevate (efferent). - Sensory = afferent limb = CN9 - Motor = efferent limb = CN IX and CN X do muscular contraction of pharynx.
Retromandibular Vein
Tributaries of = SUPERFICIAL TEMPORAL vein, & MAXILLARY vein (is short). - maxillary vein drains to pterygoid plexus. - retromandibular runs in parotid, behind the mandible. Divides into ANTERIOR & POSTERIOR DIVISIONS: anterior retromandibular joins facial to form COMMON FACIAL -> IJV; posterior retro joins post. auricular to form EXTERNAL JUGULAR -> subclavian vein.
Frenulum of Tongue & Lips (structure, oral cavity)
Turn down your lower lip and lift your upper lip. Identify the frenulum in the midline of each lip.
Conus Elasticus - what is the upper free edge of it? What is its functions?
Upper free edge of it (vocal ligaments) that forms the true vocal cords. [is area below vocal cords in the "hole" of your larynx] functions: 1) Sound production - vibrate (like lips of trumpet player) 2) Closed rima glottidis stops outflow air; upward movement of diaphragm - when contracted abdominal muscle pressure increases in abdominal cavity; ocurs in childbirth. defecation.
What is the nerve supply to upper lip, & to lower lip? What is the blood supply to the lips?
V2 = upper lip; infra-orbital N branch. V1 = lower lip; mental N branch Superior Labial Artery = upper lip. Inferior Labial Artery = lower lip.
Epiglottic Vallecula (structure, oral cavity) versus Piriform Recess
Vallecula : fossa (pin) btwn posterior tongue & epiglottis. - Has taste buds = vagus nerve (CN X) - During swallowing, food passes over posterior portion of tongue through vallecula, and down into piriform recess. Piriform = recess (probe) internal laryngeal nerve is located in fold on its lateral wall; it leads into esophagus and is an area in lower part of laryngopharynx. Rima = space between vocal cords
X-ray colors
White = bones, attenuate xray beam. Gray = soft tissues, allow some xray penetration. Black = pharynx, trachea, filled with air
CNV1 in nasal cavity
Won't see nerves, will jstu tag "what innervates here" Anterior ethmoidal Nerve of V1 has three branches. Medial Internal Nasal Nerve Branch of Anterior Ethmoidal N (of V1) -> front of nasal septum. Lateral Internal Nasal Nerve Branch of Anterior Ethmoidal N (of V1) -> lateral wall inside front. External Branch of Anterior Ethmoidal N (of V1) -> outside of nose, on ridge nose.
What are the contents of the Zygomaticofacial foramen & Zygomaticotemporal Foramen?
Zygomaticofacial foramen is passage of zygomaticofacial N (V2, zyogmatic branch emerges after foramen rotundum) from orbit to front of zygomatic bone = sensory to upper cheek. Zygomaticotemporal foramen is passage of zygomaticotemporal N from orbit to back of zygomatic bone = sensory to anterior temporal region.
Hyoid Bone - what attaches here?
attachment of middle pharyngeal constrictor (superior will be above; inferior will be below it). e.g. During a mixed martial arts fight, one fighter punched his opponent in the anterior neck, resulting in a fracture of the hyoid bone. Which of the following muscles would be most directly affected by this injury? MPC.
Superior Thyroid Artery
branches into superior laryngeal artery, which enters larynx thru thyrohyoid membrane.
Nosebleed Most p.964 - blue box
epitaxis = nosebleed = Keisselbach plexus in anterior of nose = sphenopalatine, lateral nasal branches of descending palatine, ethmoid, and facial arteries. 1 & 2. Sphenopalatine Artery (maxillary A -> sphenopalatine foramen) & Greater Palatine (maxillary A -> greater palatine foramen, along hard palate, out incisive canal -> into nasal cav). f 3. Anterior & Posterior Ethmoidal Arteries (from orbit, branches of ophthalmic A). 4. Superior Labial Artery (from facial A)
Otoscopic examination - what does the Image look like? landmarks associated? p.977. blue box
ext acoustic meatus and tympanic membrane - adults- helix grasped and pulled posterosuperiorly -> dec. curvature ext acoustic meatus - infants- pulling auricle inferoposteriorly
Zygomatic Nerve Branch of V2
first branch after V2 comes out foramen rotundum; goes to orbit, then branches into: Zygomaticotemporal N (foramen back of zygomatic bone); and Zygomaticofacial N (foramen front of zygomatic bone).
What are the contents of the Pterygoid Canal?
from pterygopalatine fossa to foramen lacerum in base of skull; = see: - Deep Petrosal Post SNS (id bc branch off it is SNS Pharyngeal N). - Greater Petrosal (CN7) PNS Pre-G (pterygopalatine ganglion). - Sensory CN7 from soft palate lesser palatine nerve. - Artery of pterygoid canal.
What are the contents of Inferior Orbital Fissure?
from pterygopalatine fossa to orbit.; = opening for: Zygomatic N branch of CNV2, infraorbital vessels connecting inferior opthalmic vein to pterygoid venous plexus.
What are the contents of the pharyngeal canal?
from pterygopalatine fossa to roof of nasopharynx; located between alar of vomer and medial pterygoid canal, is more medial & near pterygoid canal. = Pharyngeal N (maxillary N) & Pharyngeal A (maxillary A).
What are the contents of the Pterygopalatine Canal?
from pterygopalatine fossa to roof of oral cavity; eventially into Greater and lesser palatine foramen. "if going from infratemporal fossa to pterygopalatine fosa via pterygomaxillary fissure, would fall down into THIS"
Quadrangular Membrane - gives rise to what structure? what is its' upper free edge called? lower free edge?
gives rise to the false vocal cords; has an upper free edge called aryepiglottic fold, and a lower free edge called vestibular ligament.
Excision of submandibular gland and removal of a calculus. Where to make incision, which structures to avoid, relationships between structures. - blue box
incision @ 2.5cm inferior to angle of mandible avoid marginal mandibular branch of CN VII caution to avoid lingual n @ duct incision submandibular duct passes over lingual nerve to 3rd molar [ Careful of lingual nerve while incising the duct directly under the floor of the mouth]. - Sialolith (stone) in a patient's right submandibular duct, the surgeon exposed the duct via an intraoral approach -> tissues or structures must be cut through? = Mucous membrane only - - submandibular duct lies deep to the mucosa and between the hyoglossus and mylohoid muscles
Orbital Branches (V2, pterygopalatine N's)
infraorbital fissure -> sensory to = periostieum of orbit, mucous posterior ethmoidal air cells and sphenoidal sinus.
Nasopalatine block (& osteology). p.949 blue box
inject incisive fossa→ palatal mucosa, lingual gingivae, alveolar bone of ant max teeth, hard palate
What nodes will enlarge as a result of tonsillitis?
jugulo-digastric nodes - located right behind angle of mandible.
Which muscles relax the vocal cords?
lower pitch (relaxed) = Thyroarytenoid (relax vocal cords, by pulling arytenoid cartilage anteriorly; lateral mucsle fiber of true vocal cord) & Vocalis - kinda (most medial part thyroarytenoid; relax vocal cords by pulling arytenoid cartilage anteriorly; medial muscle fiber of true vocal cord).
Anterior Superior Alveolar N
maxillary anterior teeth up till canine. = v2 orbit = pterygopalatine n branch of V2 (sensory, PNS); arise in orbital canal, pass to incisors and canine teeth and gingiva; also to maxillary sinus; & small branch to floor of nasal cavity and inferior meatus.
Infection of maxillary sinuses. (Radiographic appearance). - blue box
most commonly infected - mucous membrane obstructed -> max ostia obstructed - head erect-> impossible for sinus to drain - lying on side drains ostia - drained/cannulated by passing cannula from nares to max ostium to sinus
Median Sulcus (structure, oral cavity)
on tongue. division line down the middle of it.
What drains to inferior deep cervical nodes?
parts of scalp and neck, superficial pectoral region & part of arm, afferents are from superior deep cervical nodes (aka efferents of superior deep cervical nodes to inferior). & their efferents help to form jugular vein trunk.
Stylohyoid Ligament
styloid process to hyoid bone.
Glossopharyngeal Nerve (IX)
supplies most sensation from palatine tonsils and oral pharynx, and posterior 1/3 tongue.
Myringotomy
surgery to alleviate fluid build-up in middle ear [infection - otitis media]. Make curvilinear incision in inferior portion of tympanic membrane below malleus handle. Long incision so that you can get good drainage.
During swallowing, food passes over posterior portion of tongue through _______, and down into ______.
through vallecula, and down into piriform recess.
External Carotid Artery Branches (from behind now)
Posterior Auricular Artery Ascending Pharyngeal Artery (find sup. thyroid first, goes via jugular foramen); occipital artery (wraps around hypoglossal nerve).
Innervation to Turbinates
Posterior SUPerior Lateral Nasal Branch of Maxillary Nerve of V2 (sensory, PNS) = Middle & Superior Turbinates, & Posterior Ethmoidal Air cells. Posterior Inferior Lateral Nasal Branch of Greater Palatine Nerve of V2 = Inferior Turbinate
What is the common origin of Superior Pharyngeal Constrictor Muscle & Buccinator Muscle?
Pterygomandibular Raphe (thus, laceration of pterygomandibular raphe would cause paralysis of those muscles).
Maxillary Sinus Infection
"severe cold" Can cause referred pain from face & upper teeth (supplied by branches of trigeminal nerve) -> frontal headache, pain side of face, upper teach ache. 3 maxillary molar teeth close to floor of maxillary sinus. Maxillary molar teeth infection misinterpreted as sinus infection/happening in sinus (& vice versa). EXPLAINED - From TGG: a) -> V2 => superior alveolar nerves => posterior branches off first goes to maxilla teeth; anterior & middle go through maxillary sinus & then to teeth [RSN FOR TEETH PAIN from MAX SINUS INFECTION]. b) V1 => supraorbital, supratrochlear nerves => frontal sinus => dull frontal head ache.
Sublingual Gland - what provides ANS?
(the other salivary gland!) - below mucous membrane of mouth - Superior border w many ducts provide opening into vestibule. - PNS by post-ganglionic fibers from submandibular ganglion (chorda tympani)
What is the role of ANS in the functions of the salivary glands in the submandibular region?
- Parasympathetic - @ Submandibular Ganglion Chorda Tympani (CN7) synapses, which joins lingual nerve. - Chorda Tympani (CN7) joins Lingual Nerve - Post fibers to Submandibular Gland & Sublingual Gland.
Submandibular Gland (structure, oral cavity) - know where its located
- Superficial portion; then deep portion & submandibular duct (Wharton's duct) is deep to mylohyoid muscle. - PNS via chorda tympani (CN7) joins lingual Nerve -> synapse at submandibular ganglion -> post to gland. = a salivary gland.
CN7 Facial - geniculate ganglion - greater petrosal nerve - motor root of facial nerve - chorda tympani - stylomastoid foramen - hiatus of greater petrosal nerve - delete / write out
- The geniculate ganglion has cell bodies of sensory fibers associated with the Facial nerve,including taste. [Trigeminal ganglion has cell bodies of sensory fibers from CN V] - facial nerve enters posterior wall of tympanic cavity (ear) below the aditus and exist from the base of the temporal bone via the stylomastoid foramen. - chorda tympani arises from facial n within posterior wall of middle ear, courses over eardrum along lateral wall, and exits via petrotympanic ifssure into infratemporal fossa.
Ludwigs Angina
- bilateral swelling of submental, sublingual, and submaxillary spaces => hardness floor of mouth, swelling doesn't have any "give" bc of pus formation, cannot open mouth (trismus); infection can spread to lateral pharyngeal space and then can enter retropharyngeal space and even down to mediastinum => gotta clear airway. Cause? extraction of lower molar tooth & subsequent infection! [bc roots of second and third molar reach downward to level of attachment of mylohyoid muscle, while most of others are above this level]. Death? result of suffocation bc edema of mouth, tongue, glottis, and from mediastinitis bc spread.
Internal Jugular Vein
- drains dural venous sinuses & occipital vein (tho often drains to vertebral) , pharyngeal common facial, lingual vein, superior and middle thyroid veins. - in root of neck, it joins subclavian vein to form brachiocephalic (junction is also site for return of lymph).
Pyramidal lobe of thyroid gland. p.1042 blue box
- extends upwards & left of median plane (from isthmus of thyroid gland); from remnants of thyroglossal duct 's epithelium and connective tissue.
Frontal Sinus
- forehead; in between inner & outer tables of frontal bone. two of them are asymetrical. - drains = via NASOFRONTAL DUCT (infundibulum)to middle meatus.
Superior laryngeal nerve block. blue box
- injection btw thyroid cartilage and ant greater horn of hyoid. - passes thyrohyoid membrane => int laryngeal n - anesthesia of mucosa superior to vocal folds
Motion sickness. blue box
- maculae of membranous labyrinth=primary static organs w/ otoliths on hair cells - gravity -> otoliths cause hair cells bend→ stimulate VESTIBULAR NERVE -> aware of head position - hair cells also respond to tilting, linear accel/deceleration - discordance btw vestibular/visual stimulation -> motion sickness
Venous Drainage of TMJ from lateral aspect via? from medial aspect via?
- superficial temporal vein = lateral aspect. - maxillary vein and pterygoid plexus of veins = medial aspect.
Sublingual Veins
- superficial, thin walls. = route to administer medications. - suscetpible to injury when placing implants. - sublingual, dorsal lingual, and deep lingual drain to lingual vein.
Facial Vein (drainage pattern) - draw and fix
- tributaries = supraorbital, supratrochlear, infraorbital, angular (medial eye), DANGER TRIANGLE. - receives external nasal vein and inferior palpebral veins. - DEEP FACIAL VEIN drains: superior labial vein, inferior labial vein, & pterygoid plexus of veins. - facial vein lies posterior to facial artery. - In Neck = superficial to submandibular salivary gland; joins anterior division of retromandibular to form the common facial vein; common facial vein drains to internal jugular.
CNIX Glossopharyngeal - tympanic plexus (not in dissection) - lesser petrosal nerve - hiatus of lesser petrosal nervw
- tympanic plexus of fibers of = CN7, 9, 10 intermingle = passage of = 1) sensory fibers to external & middle ear; 2) preganglionic parasympathetic fibers from greater superficial petrosal nerve of CN7. 3) preganglionic PNS fibers of tympanic nerve of CN9, that'll become the LESSER petrosal nerve.
1) Venous drainage of tongue and floor of mouth 2) Of Hard & soft palate 3) of nasal cavity (anterior & post.)
1) - lingual vein to IJV - Hypoglossal vein to facial, common facial, or IJV. 2) Greater Palatine Vein & Lesser Palatine Vein => sphenopalatine vein to pterygoid plexus of veins. 3) anterior nasal cavity => facial vein; posterior => sphenopalatine vein to pterygoid plexus.
Where does the Lingual Artery supply blood to?
1) Blood supply to submandibular region - is crossed by CN12 - branch of external carotid - medial then once lateral goes "into" hypoglossal muscle 2) blood supply to the tongue - Lingual Artery, from external carotid, passes thru carotid triangle, passes forward DEEP to hyoglossus msucle; crossed by hypoglossal nerve, posterior belly of digastric and stylohyoid muscle. - branches: dorsal lingual, sublingual, anterior or deep lingual.
Greater Palatine Nerve, Lesser Palatine Nerve, Nasopalatine Nerve.
1) Greater = pterygopalatine n branch of V2 (sensory, PNS). = palatine canal * -> greater palatine foramen -> communicates with nasopalatine nerve -> sensory to mucoperiosteum. 2) Lesser = pterygopalatine n branch of V2 (sensory, PNS); passes through palatine canal, emerges at lesser palatine foramen, supplies sensory palatine tonsil & soft palate. 3) Nasopalatine = = pterygopalatine n branch of V2 (sensory, PNS); passes thru s phenopalatine foramen*, along septum, emerges thru Incisive Foramen, supplies hard palate. *so do posterior superior lateral nasal branches of V2.
1) Ear structure that is sensitive to rotational movement of the head? 2) Ear structure sensitive to gravity & linear movement of the head?
1) Semicircular Canals / Ducts. - 3 of them contained in vestibular apparatus (vestibular labyrinth - also contains utricle and saccule). - Because within them there are ampullae swellings that contain the crista sense organ. Crista have hair cells that respond when fluid crosses them and stimulate vestibular nerve to tell brain about the position of the head. 2) Utricle & Saccule - bc they have hair cells, utricle macula (horizontal plane) & saccule macula (vertical plane).
1) Lesion of the lingual nerve before chorda tympani joining it will lead to loss of? 2) Lesion of chorda tympani? 3) Lesion of lingual nerve after being joined by chorda tympani?
1) general sensation from anterior 2/3 tongue. 2) Lose taste and salivation. 3) Lose taste, salivation, and general sensation.
What muscles would you find in area from tongue to (under) chin? What are each innervated by?
1. Anterior Belly Digastric Muscle = N to mylohyoid (v3) 2. Mylohyoid Muscle = " " 3. Geniohyoid Muscle = C1 ("via hypoglossal"); fibers go posterior to insert on hyoid bone. 4. Genioglossus muscle = CN12
Greater Palatine Foramen & Lesser Palatine Foramen
1. Greater Palatine Foramen = nerves that innervate hard palate and can also innervate floor of nasal cavity. 2. Lesser Palatine Foramen = behind greater palatine foramen. Transmits = lesser palatine nerves & arteries that innervate and blood supply to soft palate.
What structures would you find on the lateral side of the tongue (deep-ish)?
1. Submandibular Duct (Wharton's Duct) - Empties saliva into (opens at) sublingual caruncle, at the base of the lingual frenulum of tongue. - crossed twice (superficial, then deep) by lingual nerve. 2. Lingual Nerve [PNS pre-gang cell bodies in Geniculate and Trigeminal Ganglion (V3); postganglionic PNS in submandibular ganglion) -> tongue general sensory to anterior 2/3 = heat, not taste] - CONFIRM not hypoglossal bc crossed by submandibular duct; horizontal across tongue, may spread fibers. 3. Hypoglosal Nerve (CN12) - from deep bottom, coming from deep below mylohyoid then into bottom mouth. 4. Lingual Artery - DEEP TO hyoglossus muscle (deeper dissection) & will be shown "coming from" hyoglossus muscle.
1. What is the tympanic cavity (middle ear) derived from? 2. What are the mallus and incus derived from? 3. Stapes derived from?
1. first pharyngeal pouch 2. first pharyngeal arch cartilages 3. second pharyngeal arch cartilages
Injury to laryngeal nerves: superior laryngeal n., inferior laryngeal n. p.1045 blue box
1. paralysis of sup laryngeal n => foreign body enters larynx easily 2. ext sup laryngeal n paralysis => paralysis of cricothyroid m => monotonous voice
Relationship of teeth to maxillary sinus. Ear - blue box
3 max molars superior alveolar n innervates max teeth and max sinus
4. Mastoid atrium 5. Malleus 6. Incus 7. Stapes 8. Chorda Tympani - located where, what type of procedure would you need to avoid it in? 10. Facial Nerve (portion of)
5. Malleus - has head, neck, manubrium, w lateral process and inferior tip. 6. Incus = body of it articulates w malleus at malleoincudal joint. 7. Stapes - has head, neck, posterior and anterior limbs and footplate attached to oval window by an annular ligament. 8. chorda tympani is located medial to "pars flaccida" (lateral part of malleus) so avoid it when puncturing eardrum to drain middle ear, by placing incision to anterior lower quadrant.
Hypoglossal Nerve (CN12) fix
= All glossus muscles of tongue(H,G,S) EXCEPT Palatoglossus. = Taggable in 3 places: 1) deep lateral tongue, relation to lingual nerve 2. Over Occipital Artery (ECA branch) 3. Back of Neck (retropharyngeal) -
Recurrent Laryngeal Nerve - 1) inferior laryngeal nerve
= Branch of CN10; passes deep to cricopharyngeus and inferior constrictor to enter larynx. NEED TO SPECIFY SIDES - Left Recurrent Laryngeal Nerve around aorta; Right Recurrent Laryngeal Nerve around subclavian A. - SENSORY (1) to BELOW vocal cords mucosa (larynx). - MOTOR to ALL laryngeal muscles [EXCEPT cricothyroid muscle] incl posterior cricoarytenoid, lateral cricoarytenoid, thyroarytenoid, thryoepiglottic => close laryngeal inlet during swallowing to prevent aspiration of food into trachea; & abduct, adduct, relax vocal cords to prevent high pitched sound when breathing.
Pharyngeal Constrictors - know origins and insertions
= CN10 => move food in esophagus. 1) Inferior Constrictor Muscle (inferior pharyngeal constrictor) = oblique line; from sides of cricoid cartilage & thyroid cartilage; posterior fibers attach to Pharyngeal Raphe {basically vertical line down middle of constrictors} 2) Middle Constrictor Muscle attach = hyoid bone. 3) Superior Constrictor Muscle: origin = pterygomandibular raphe [common origin for the superior pharyngeal constrictor and buccinator muscles].
Superior Laryngeal Nerve
= CN10 Branch = > Internal Laryngeal Nerve (Sensory) & External Laryngeal Nerve (motor)
Circumvallate Papillae (structure, oral cavity)
= CN9 (glossopharyngeal). = taste receptors located Directly anterior to the terminal sulcus; make up the "V" of terminal sulcus (separate between anterior and posterior tongue).
What are the muscles of the tongue and their functions? What innervates them?
= Hypoglosasl Nerve CN12 - EXCEPT: Palatoglossus by CN10. 1. Hyoglossus (C12 motor) - pulls lateral part of tongue down. 2. Genioglossus (C12 motor)- Einstein pic: sticks tongue out (protrusion) & Pulls anterior tip downward -> preventing suffocation while in supine position. [imp relations: CN12 superficial to it, Lingual A disapears to its lateral border; from hyoid bone to insert onto tongue]. 3. Styloglossus Muscle (C12 motor)- elevates sides of tongue (cannot see on cadaver / will originate near stylopharyngeus but goes farther to tongue). 4. Palatoglossus Muscle (CN10 motor) - elevates tongue, pulls down soft palate -> sealing oropharynx; makes "k" sound. 5. Intrinsic Muscles = majority of tongue tag!!!
Stylohyoid Muscle
= Immediate anterior relationship to posterior belly digastric. = Branch of CN7 also (^) = Passes from anterior apical part of styloid process to hyoid bone; Is in submandibular region
Arytenoid Cartilage (s, 2 of them) - is the attachment of what?
= attachment of vocal ligaments (true vocal cords) Arytenoid Cartilage (2 of them) - pyramid; located above cricoid cartilage & behind (posterior) thyroid cartilage.
Superior Laryngeal Artery
= blood supply (1 of 2) to upper half larynx. = branch of superior thyroid artery, = enters larynx thru THYROHYOID MEMBRANE W/ internal laryngeal nerve.
Inferior Laryngeal Artery
= blood to lower half larynx (2 of 2); branch of Inferior Thyroid Artery, enters larynx W/ recurrent laryngeal nerve.
Meniere syndrome, excessive endolymph / blockage of the endolymphatic duct. Larynx blue box
= increased endolymphatic pressure ( endolymphatic hydrops (excess fluid in inner ear)). = involves semi-circular canals 1) dizziness (vertigo, feeling of motion) when standing / loss of balance. 2) low pitched ringing (tinnitus) when no other sounds around. 3) Hearing loss (progressive, months). - blockage of cochlear aqueduct - recurrent attacks of tinnitus, hearing loss, vertigo - sense of pressure, distortion of sounds, sensitivity to noise - inc. endolymphatic volume -> ballooning of cochlear duct, utricle, saccule
Pharyngeal N
= pterygopalatine n branch of V2 (sensory, PNS); pass thru pharyngeal canal to sphenoid sinus and nasopharynx behind autidory tube.
Torus Tubarius
= the cartilage of the pharyngotympanic (eustachian) tube that is covered by mucosa, located slightly above the opening of the tube. - lower part is start of Salpingopharyngeal Fold (and muscle) that goes downward & blends in with palatopharyngeal fold. Fxn = auditory tube =communication of middle ear with nasopharynx.
Inferior Thyroid Vein
= tributary OF brachiocephalic vein = middle and superior thyroid veins are tributaries of internal jugular vein.
What drains to superior deep cervical lymph nodes?
= veins: occipital, posterior auricular, anterior auricular (pre-auricular), parotid: superficial, deep to, deep facial. = from parts of scalp, ears, back of neck, part of tongue, larynx, thyroid, trachea, nasopharynx, nasal cavities, palate and esophagus. - Efferents to inferior deep cervical nodes and to jugular trunks.
Nasal Septum (bony part) - consists of what structures? What structures are NOT part of the nasal septum (i.e. would NOT be damaged if the nasal septum is perforated)?
= vomer, perpendicular plate of ethmoid, septal cartilage NOT included = nasal bones, any turbinates, cribiform plate / frontal bone.
What are the contents of Pterygomaxillary Fissure?
== lateral approach to pterygopalatine fossa from the infratemporal fossa; maxillary artery (disappears here),vein; posterior superior alveolar nerve. = sphenopalatine foramen is hole at the end of it. IMP NOTE - The pterygopalatine fossa communicates with the infratemporal ossa via the pterygomaxillary fissure.
After a radiograph revealed a sialolith (stone) in a patient's right submandibular duct, the surgeon exposed the duct via an intraoral approach. In this approach, what tissues or structures must be cut through? A. Mucous membrane only B. Mucous membrane and C. genioglossus muscle D. Mucous membrane and mylohyoid muscle E. Mucous membrane and hyoglossus muscle
A.
Q: A 10-year-old boy underwent surgery, a bilateral palatine tonsillectomy. During a postoperative examination, the doctor noted the boy did not possess a gag reflex on the right side on the posterior tongue. He also complained of abnormal taste sensations in the back of his oral cavity. The soft palate elevated symmetrically when the gag reflex was tested. No other signs or symptoms were noted. What cranial nerve was damaged during the tonsillectomy?
A: Glossopharyngeal CN9 bc it supplies most of the sensation from the palatine tonsils as well as the oral pharynx and posterior 1/3 of the tongue
How is lymph drained from the larynx?
Above vocal cords -> deep cervical nodes Below vocal cords - > pretracheal nodes or paratracheal nodes, then to inferior deep nodes.
Which muscles adduct the vocal cord?
Adductors (3)= bring vocal ligaments (arytenoid cartilages) together. - Transverse Arytenoids, Oblique Arytenoid, & Lateral CricoArytenoids {<- these leaves space for whispering / air to pass}.
What is the major artery / blood supply to the middle ear?
Anterior Tympanic Artery (there are a bunch of other arteries).
Vocal Ligaments - where do these attach?
Arytenoid Cartilages (lateral of quadrangular membrane) = anterior aspect of thyroid cartilage.
Your 56-year-old patient has dysphagia (trouble swallowing) that you believe is neural in origin. Which of the following nerves is least likely to have an effect on deglutition? A. Hypoglossal B. Recurrent laryngeal C. Glossopharyngeal D. Mandibular division of Trigeminal E. Pharyngeal branches of vagus
B. The recurrent laryngeal nerve is nerve which supplies motor and sensory innervation from the larynx. The other nerves supply muscles of the tongue (CN XII) , mastication (CN V3) and pharynx (CNs IX,X)
Which of the following does NOT contribute blood supply to the nasal septum? A. anterior ethmoidal artery B. lesser palatine artery C. nasopalatine artery D. septal branch of the superior labial artery
B. lesser palatine artery
Mechanics of Swallowing
Bolus pushed back into oropharynx (mylohyoid muscle, V3) by elevating and retraacting tongue (styloglossus CN7 & palatoglossus CN10). Soft palate elevated & tensed (levator veli palatini CN10 & tensor veli palatini V3) Laryngeal Inlet closed PREVENTING CHOKING = aryepiglottic, oblique arytenoids - CN10. Glottis Closed (transverse, oblique arytenoids, lateral cricoarytenoid - CN10). Larynx and Pharynx Elevated (stylopharyngeus CN9, & salpingopharyngeus CN10).
Fracture of maxillae and associated bones, Le Fort classification - blue box p837
Fractures of maxillae (& associated structures). 1 = horizontal, superior to maxillary alveolar process, crossing septum (and pos. pterygoid plates). 2 = from cavities in the maxillae up through infraorbital foramen, lacrimals, or ethmoids to the bridge of the nose; central part of face separates from cranium. 3 = • horizontal through superior orbital fissures, ethmoids, and nasal bones through greater wings of sphenoid and frontzygomatic sutures; if zygomatic arches are fractured, maxillae and zygomatic bones separate from the cranium.
Nasopalatine Nerve
Branch of V2. Goes through sphenopalatine foramen, along nasal septum floor, to incisive canal/foramen.
Danger Space #4
Btwn alar fascia (anteriorly) and vertebral fascia (posteriorly) [it's lateral sides are where alar and vertebral fascia fuse @ transverse processes of vertebrae]. Up from base of skull, goes down into posterior mediastinum (of the thorax) - - INFECTION SPREAD TO HEART!
An abscess (pus) from the APEX of the mandibular canine pointing medially will enter the: A. space of the submandibular gland. B. space of the body of the mandible. C. sublingual space. D. submaxillary space. E. lateral pharyngeal space.
C. sublingual space - abscesses from anterior teeth drain here bc their roots lie above the mylohyoid line of inner mandible. Wrong answers because... Submaxillary space drains abcess from second and third molar teeth bc roots of them lie below mylohyoid line of inner mandible. Space of submandibular gland is formed by superficial investing fascia that splits to completely enclose the gland. Space of body of mandible is a closed space (anterior & posterior bound by superficial investing fascia; bounded above by inferior border of body of mandible). lateral pharyngeal space is bounded by pharyngeal fascia that covers lateral part of pharyngeal constrictors.
What provides parasympathetic innervation to the middle ear?
CN7 chorda tympani is located medial to "pars flaccida" (lateral part of malleus) so avoid it when puncturing eardrum to drain middle ear, by placing incision to anterior lower quadrant.
Vestibulocochlear Nerve
CN8 = internal acoustic meatus entry into temporal bone. supplies special sensory afferent fibers to hair cells of cochlea, ampuullae of semicircular ducts, utricle and saccule. - splits into cochlear portion (hearing) and vestibular portion (equilibrium).
Nerve that runs across deep surface of tympanic membrane (doc can see it when using otoscope to do ear examination)?
Chorda Tympani
Which muscles tense the vocal cords?
Cricothyroid Muscle supplied by External Laryngeal Nerve. Think: people wearing bowties seem tense.
Development & Functons of Paranasal Sinuses
Develop from nasal meatuses; supply mucous to nasal fosae and moisten and warm inspired air.
Inner longitudinal layer of Pharyngeal muscles - innervation to each? Function? 1) Salpingopharyngeus 2) Palatopharyngeus muscle 3) Stylopharyngeus muscle
During swallow, elevate & widen pharynx (recall: outer constrictors will contract to move food in esophagus). 1)Salpingo"" = CN10 - located below Torus Tubarius (opening of eustachian tube)!!! - pin at up by eustachian tube. - called Salpingopharyngeal Fold when w membrane. 2) Palato""= CN10 - palate to tongue. 3) Stylo"" = THE EXCEPTION = CN9 - CN9 goes in this muscle (bottom) and (above part) goes into tonsil (tonsilar branch). - from styloid process
What provides general sensation to the tongue? What provides special taste sensation? (not on objetives)
General Sensation to anterior 2/3 via Lingual Nerve (V3), to posterior 1/3 via Glossopharyngeal CN9., to epiglottic region via superior laryngeal nerve branch of Vagus CN10. Taste to anterior 2/3 via chorda tympani CN7, to post 1/3 via glossopharyngeal CN9, to epiglottic region via superior laryngeal nerve branch of vagus 10. [Note: motor supply is hypoglossal CN12, except to palatoglossues by CN10.]
A 5 year old child with a developmental defect (shown below) is scheduled to undergo surgery to correct this defect. Which nerve(s) must be anesthetized in order to carry out this procedure?
Greater palatine and nasopalatine [This is an example of cleft palate]
Pterygopalatine Ganglion
Greater superficial petrisal (CN7, PNS) joints Deep Petrosal (carotid plexus, SNS) to form vidian nerve (nerve of pterygoid canal). PNS fibers synapse, SNS fibers only pass through (superior cervical ganglion). Post-ganglionic fibers pass to glands of nose, soft & hard palates, lacrimal gland, upper pharynx. [lateral nasal]
Greater Palatine Nerve, Greater Palatine Artery; Lesser Palatine Nerve, Lesser Palatine Nerve
Hard Palate = greater palatine artery (& nasopalatine artery). , greater palatine nerve (&nasopalatine N) Soft Palate = lesser palatine artery; lesser palatine nerve post (pterygopalatine ganglion) PNS general sensation (V3)
Describe the hard and soft palates including muscles, blood supply, and nerve supply ?
Hard Palate Bones = palatine process of maxilla, horizontal portions of palatine bones. Blood Supply: Hard Palate = greater palatine artery & nasopalatine artery. Soft Palate = lesser palatine artery. Nerve Supply: Hard Palate = greater palatine nerve & nasopalatine nerve (CNV); autonomics to palatal glands from CN7 via pterygopalatine ganglions. Soft Palate = general sensation via lesser palatine nerve (V3); autonomics to glands of soft palate via lesser palatine nerves carrying postganglionic parasympathetic fibers from pterygopalatine ganglion.
A 32 year old male visits the dentist to have a maxillary 3rd-molar tooth removed. The extraction was very difficult. Several days later while eating, he experiences REGURGITATION of fluids FROM his ORAL PHARYNX to the NASAL CAVITY. Explain what might have happened during the DENTAL EXTRACTION?
In this case, the hamulus of the medial pterygoid plate was fractured, compromising the ability of the tensor veli palati (which pivots around the hamulus) to tense the soft palate; it was then possible for food to pass from the oral pharynx into the nasal cavity. EXPLAINED - When swallowing, in order to prevent regurgitation of fluid from mouth to nose, you need to elevate and tense the soft palate by action of tensor veli palatini.
Cricothyrotomy - where is the incision made? And then where is the breathing tube placed in the larynx?
Incision in cricothyroid membrane; tube in Infraglottic Cavity of the larynx.
Injury to hypoglossal nerve. p950 - blue box
Ipsilateral Atrophy -> tongue deviates to paralyzed side (side w damaged CN10 & a paralyzed genioglossus m) @ protrusion, due to unapposed action of the other genioglossus muscle. - caused by fracture of mandible. - note: taste (CN7) & sensation (V3) are NOT AFFECTED.
Cisterna Chyli
L2 Starts, crosses from R to L at T5. Drains all lower body below neck (L venous angle to L thoracic duct) XCEPT right upper quadrant (which drains to R venous angle via R lymphatic duct).
Maxillary Nerve
Maxillary division of the trigeminal nerve (V2) - courses from the foramen rotundum to the inferior orbital ssure. The maxillary divi- sion passes through the pterygopalatine fossa and gives off pterygopalatine branches that will form the greater and lesser palatine nerves.
What supplies innervation to your cheeks?
Motor = buccal branches of facial nerve (CN7); Sensory = buccal branches of V3 [long buccal nerve], which pass THRU cheek muscle (buccinator?) to provide sensory innervation to lining of cheek.
What nerve supplies Cricothyroid membrane (cricothyroid muscle)? Why is this membrane clinically important?
Muscle is innervated by external laryngeal N, motor branch of superior laryngeal N (CN10). [Located at C6 level] Membrane is pierced to create and emergency airway.
Infraorbital Nerve - anesthesia this will numb what?
Numb => upper canine & neighboring teeth, skin of right inferior eyelid, cheek, lateral nose, upper lip. 1) = v2 orbit = pterygopalatine n branch of V2 (sensory, PNS); emerges through infra-orbital foramen onto cheek: V2 face branches - 1) Inferior Palpebral N to lower eyelid and conjunctive; 2) External/ Lateral Nasal N branch to lateral side of nose; 3) Superior labial branches to upper lip. 2) = V2 labial mucosa (mucosa under your UPPER lip)
Where are the pharyngeal and lingual tonsils located? What are other names for the pharyngeal tonsils?
Pharyngeal Tonsils are located in pharyngeal recess, above torus tubarius (opening of eustachian tube / pharyngotympanic tube) - called tubal if near eustachian tube, adenoid if enlarged. Lingual Tonsils located posterior of tongue behind foramen cecum.
Which ear muscles attenuate loud sounds? What nerves innervate these muscles (must know!)?
Tensor Tympani M (V3), and Stapedius M (CN7). - Tensor Tympani tendon inserts handle of malleus; originates off cartilage portion of pharyngotympanic (eustachian) tube and part of greater wing of sphenoid. acts to tense the eardrum by pulling medially. - Stapedius Muscle = CN7 (nerve to stapedius); tendon inserts onto neck of stapes, originates off walls of pyramidal eimenence - Bell's palsy complaining of sensitivity to loud sounds (hyperacusis); normally dampens sound.
What muscle opens the eustachian tube (auditory tube) as we yawn?
Tensor Veli Palatini
Levator veli Palatini & Tensor Veli Palatini Muscles - innervation? how to differentiate it? relations to specific structures? functions?
Tensor Veli palatini = V3 [also suplies muscles of mastication e.g. masseter muscle] = shiny white = TENDON of tensor veli palatinin wraps around Hamulus of Medial pterygoid plate, belly of it sits in scaphoid fossa (between medial & lateral pterygoid plates) - fxn: prevents food/fluid from regurgitating from oral pharynx to nasal cavity; & flattens palate & opens eystachian tube (auditory tube) to pop ur ears (middle ear pressure equibration) Levator Veli Palatini = CN10 = elevates soft palate= above the tensor, is more meaty flesh appearance.
Ascending Pharyngeal Artery
The ascending pharyngeal artery is the sixth branch of the external carotid artery. It arises from the medial surface of the external carotid artery close to the bifurcation of the common carotid artery.
