Anatomy Theory Block 2 Set B** Objectives

Lateral nasal wall.

Are the conchae found on the nasal septum or on the lateral nasal wall?

Yes.

Are there veins on the surface of the brain? Y/N

Trigeminal nerve. The trigeminal sensory ganglion rests on the sphenoid bonEach of the nerve's three divisions contacts the surface of the sphenoid bone in the cranial cavity, and each also passes through a hole in the bone.

As you work through the material in this theory event and the next one, you will be able to use the sphenoid and temporal bone objectives to anchor your knowledge of cranial nerves. What cranial nerve dominates the sphenoid bone? In what way does it do that?

Recurrent laryngeal nerve, vagus nerve.

All of these muscles are innervated by the ________________, which is a branch of the ________________ nerve.

Mandibular division of trigeminal nerve.

Innervation: trigeminal nerve. (Both of the tensor muscles that are located in the head are innervated by CN V.) Which one of the three divisions of the trigeminal nerve carries motor fibers?

No.

Is the auditory tube directly part of the sound conduction pathway? Y/N

Deoxygenated.

Is the blood in a dural venous sinus oxygenated or deoxygenated?

Maybe a little, but usually it is not medial.

Is the internal carotid artery medial to the external carotid artery, as its name might suggest it will be?

Yes.

Is the internal carotid artery posterior to the external carotid artery? Y/N

Inferior.

Is the isthmus of the thyroid gland inferior to the gap between the thyroid cartilage and the cricoid cartilage, or is it superior to the gap?

Inferior.

Is the laryngeal ventricle superior or inferior to the false vocal fold?

Vestibular folds are more lateral at rest.

Is the resting position of the vestibular folds medial to the resting position of the true vocal folds, or lateral to that?

Internal auditory meatus. Greater petrosal nerve and chorda tympani.

Oh, cranial nerve VII. It starts with a different question. How does the facial nerve enter the cranium? From there it breaks up into various branches. One branch can access the deep face and even the lacrimal gland; another can access the submandibular and sublingual salivary glands.

Ophthalmic division of trigeminal nerve. Maxillary division of trigeminal nerve. Mandibular division of trigeminal nerve.

On the hemi-head model - Along the way, identify anatomy study list items at numbers 34, 36 and 37.

Lingual nerve and glossopharyngeal nerve because nociception is general sensory.

Most of the perception of piquancy (spicy hotness) is nociception (not gustation). What nerve or nerves serve for that sense on the tongue?

Whole trigeminal nerve; supraorbital nerve; infraorbital nerve; mental nerve.

On the hemi-head model - Trace from number 32 distally to 35, 45 and 43, and name these four study list features.

Lingual nerve.

On the hemi-head model - Lift the tongue out by its metal knob to see another branch of the same cranial nerve.

Whole trigeminal nerve.

On the hemi-head model, identify tag number 32.

CN VI is out of order because it slips under the dura mater in the posterior cranial fossa but stays in the cranial cavity for a long course between dura mater and bone.

Name the nerve that is markedly out of numerical sequence, and describe the discrepancy anatomically.

Pharyngeal tonsil, palatine tonsil, lingual tonsil.

Name the three principal tonsils.

Hyoid bone, thyroid cartilage, cricoid cartilage, trachea (tracheal rings).

Name, in order from superior to inferior, the four structures on the anatomy study list that form the laryngeal skeleton.

Yes, buccinator. Holding the cheeks inward is useful for effective chewing and swallowing; it is not really an expression for communicating.

Consider the actions of each of the eight muscles in ASL 12 A. Do any of the muscles have principal actions that are not really facial expressions? Explain.

Superior. Glide inferiorly.

Consider the gap between the thyroid cartilage and the cricoid cartilage; the cricothyroid ligament is there. Is the glottis superior to that gap, or inferior to it? So in a cricothyrotomy, will you avoid the vocal apparatus by guiding the scalpel blade (and then the intubation tube) superiorly or by guiding it inferiorly?

No, they are the same distance from the midsagittal plane. Frontal bone, maxillary bone, mandible.

Consider the supraorbital foramen, infraorbital foramen and mental foramen. Is one much more medial or lateral than the others? While they are on your mind, state the names of their three bones. The names of the nerves and vessels that use them are perfect examples of "Simple anatomy is the best."

Glossopharyngeal nerve, vagus nerve, hypoglossal nerve. Add the trigeminal nerve, too.

Dysphagia is a medical term meaning difficulty with swallowing. Identify three cranial nerves that you will want to assess in a patient with dysphagia.

Ophthalmic division.

First, what division of the trigeminal nerve serves the anterosuperior parts of the nasal cavity for general sensory innervation?

At its anterior end, the dura mater of falx cerebri anchors to the crista galli of the ethmoid bone and to the frontal bone.

Fit the others together in a different lesson. Background: If the anterior cranial fossa had its own anatomy study list section, it would include cribriform foramina, crista galli, dura mater, falx cerebri and olfactory nerve. Previous Q: Fit some of those terms together in a little lesson.

Jugular foramen.

How does the glossopharyngeal nerve leave the cranial cavity? That exit prepares it to work deep in the neck, but not for its parasympathetic function. Instead, the preganglionic fibers use a tiny nerve to enter the temporal bone and eventually gain access to the foramen ovale of the sphenoid bone. From there, it is a short trip to the parotid salivary gland.

Superior orbital fissure.

How does the oculomotor nerve (CN III) leave the cranial cavity? That exit prepares it to work in the orbit, actually inside the eye.

Jugular foramen.

How does the vagus nerve leave the cranial cavity? From there, it is well positioned to serve the cervical viscera (including some parasympathetic function) and to run down the neck and enter the trunk for its parasympathetic and sensory service in the thorax and abdomen.

Not very far.

How far away from this incision point is the glottis in an adult?

Three.

How many meati are usually found on each side of the nasal cavity?

Four; two posterior to the left lobe of the thyroid gland and two posterior to the right lobe.

How many parathyroid glands are usually present? And where are they located?

Most of it.

How much of the maxillary sinus is inferior to this drainage point?

It ascends on the squamous part of the occipital bone.

How will you recognize the occipital artery on a lateral view angiogram?

The patient lies in the right lateral decubitus position; that puts the opening of the sinus that is to be drained in a relatively low position.

How would you position a patient's head to increase drainage of the left maxillary sinus?

Cribriform foramina.

The anterior cranial fossa has two names for foramina that you will find there. One of the names, "foramen cecum" is not on the study list. So please give the name for the anterior fossa foramina that is on the ASL. That word means "like a sieve;" please explain.

Cricoid cartilage.

The barking cough and whistling breath (a sound called stridor) that result are called croup. What rigid anatomical structure prevents that edema from pushing the tissues outward, away from the airway?

Middle meningeal artery.

The book has plenty of discussion about the arterial supply of the dura mater. You need to know only one of the various branches of arteries that are described. Unfortunately, that artery is not written as an uninterrupted term in the text on GBA page 432. But it is placed prominently in the top left corner of Figure 8.19. Are you ready to name it? (Do not be misled by the way Figure 8.19 makes the artery look like it comes out of the sella turcica. You should know that it is more lateral because it uses the foramen spinosum of the sphenoid bone.)

Superficial temporal artery.

The book really goes after the nerves and vessels of the scalp. I am not sure we need all that detail. However, the artery that is anterior to the ear is on your study list. (It is the reason why ASL 12 C is linked to this objective.) Please name it. In clinical life, you will need to be aware of this one; more than other arteries it is affected by a painful condition called giant cell arteritis.

Pocket.

The maxillary bones and the mandible have alveolar processes. Do you recall the translation of alveolus that we learned when we studied the thorax? Each tooth root sits in an alveolus of bone. The two superior alveolar processes or of the inferior alveolar process are U-shaped. Those large curved structures do not look like other processes, but hey, they do protrude from the body of the maxillary bone or mandible.

Lacrimal nerve.

The nerve that innervates the skin of the lateral aspect of the upper eyelid is named for the gland that it penetrates. What is it called? (See the text in Gray's Basic Anatomy p. 458.)

Sympathetic trunk.

The nerve that is pressed against the bodies of cervical vertebrae crosses anterior to the inferior thyroid artery. This crossing point is not very close to a normal thyroid gland, but the nerve could be at risk. Please name it.

The brain is posterior to the face.

Thinking of the largest organ the internal carotid artery supplies, why would you want the internal carotid artery to be posterior to the external carotid artery?

Let's go to the cervical viscera instead of to the nuchal region, to the tongue and face instead of the brain.

Thinking of the principal field into which it sends branches, why would you want the external carotid artery to be anterior to the internal carotid artery?

First rib. More posterior (more proximal).

To which rib is the middle scalene muscle attached? Relative to the anterior scalene, where on the rib is that attachment?

Second rib.

To which rib is the posterior scalene muscle attached? Scalene muscle fascicles that are attached to the rib you named in the previous question are middle scalene muscle by definition.

Vagus nerve.

Very soon we will unpack all (or almost all) of the functions of these nerves. There is one parasympathetic cranial nerve that got much attention in Set 1A, Set 1B and Set 2A. What is that nerve?

The vomer has a point anteriorly (with the cartilage of the nasal septum above it); it has a little bit of flare or broadening inferiorly; it is highest posteriorly.

Vomer means "plow." Explain how its name describes the shape of the vomer bone.

Sublingual salivary gland.

We already know that the floor of the oral cavity lateral to the tongue and medial to the mandible is the place to find the submandibular duct and the sublingual salivary gland. Which one of these two is entirely within the oral cavity?

Yes.

We're talking about sympathetics now. Should there be connections to body wall structures (e.g., the upper limb), or only to visceral structures (e.g., trachea)? Y/N

That allows regulation of the diameter of the airway.

What advantage comes from having smooth muscle and no cartilage on one wall of the trachea?

Anterior clinoid process.

What bilateral feature of the sphenoid bone forms the most anterior attachments of the tentorium cerebelli?

Temporal bone.

What bone is anterior and lateral to the jugular foramen?

Occipital bone.

What bone is posterior and medial to the jugular foramen?

Frontal bone and parietal bones.

What bones articulate at the coronal suture?

Parietal bones.

What bones articulate at the sagittal suture?

Throat.

What common English word means pharynx?

Vagus nerve.

What cranial nerve occupies the interval between the carotid axis and the vein you just named? (It is one of three cranial nerves exiting the skull by the jugular foramen.)

Facial nerve, vestibulocochlear nerve. [Facial nerve]

What cranial nerves are prominent in the temporal bone? When we take on the cranial nerves, we will be able to state that one of the two dominates the temporal bone by having branches within the bone that emerge in various places.

Hiatus semilunaris.

What curved groove or channel is inferior to that bump in the middle meatus?

The joint contains a fibrocartilaginous disc that separates it into two parts.

What does the temporomandibular joint have in common with the knee joint, the sternoclavicular joint and the distal end of the ulna?

Pharyngeal orifice of the auditory tube.

What does the torus tubarius surround?

Eustachian tube.

What eponym is commonly associated with the auditory tube? - Its most anatomical name is the pharyngotympanic tube.

Greater wing.

What feature is inferior and lateral to the superior orbital fissure?

Lesser wing.

What feature of the sphenoid bone is superior and medial to the superior orbital fissure?

Palate.

What horizontal surface of bone and soft tissue is inferior to the inferior meatus?

Diploë is a fancy name for the spongy bone of the cranial vault. I do not know why we have to give it a special name when it is not very different from the spongy bone inside a long bone like the femur or a flat bone like a rib.

What is diploë? We see it when the skull is cut to look at the cranial cavity.

It detects and monitors the pressure of the arterial blood that is delivered to the head.

What is the basic function of the carotid sinus (what does it detect and monitor?)?

Brachial plexus.

What is the collective name for the large nerves that are also in the interscalene triangle? The risk of injuring them is the reason why the subclavian artery will not be your first choice to access the arterial system with a needle or other probe.

Rima vestibule. Rima glottidis.

What is the name of the slit or airspace that can be sealed effectively in this way? What is the name of the slit or airspace that can only be sealed well enough to produce a squeak?

Stylopharyngeus muscle.

What is the one striated muscle that the glossopharyngeal nerve innervates?

Olfaction. (It conveys signals that will be processed as the sense of smell, and also some unconscious detection and processing of pheromones.)

What is the only function of the olfactory nerve?

Jugular foramen.

What major foramen of the posterior cranial fossa is in the suture between the temporal bone and the occipital bone?

Internal jugular vein.

What major vascular structure is parallel to the deep cervical lymph nodes?

Sagittal suture and lambdoid suture.

What meeting of sutures is featured on the posterior aspect of the skull? You can see why one of those sutures is named for a familiar Greek letter.

Pectoralis minor muscle.

What muscle divides the axillary artery into a proximal part, a middle part and a distal part? (Axillary artery, not subclavian artery.)

Transverse arytenoid muscle.

What muscle on the anatomy study list draws one arytenoid cartilage closer to the other in a way that adducts the vocal folds for speech?

Posterior cricoarytenoid muscle.

What muscle on the anatomy study list pulls on the muscular process of the arytenoid cartilage in a way that abducts the vocal folds?

Anterior scalene muscle.

What muscle separates the subclavian vein from the subclavian artery?

Pharyngeal constrictors may actually perform most of this function.

What muscles that are innervated by the vagus nerve can assume the function of the muscle you named in question c? C = Stylopharyngeus muscle.

Left and right recurrent laryngeal nerves.

What nerve ascends from the thorax or from the root of the neck in the tracheoesophageal interval to supply both structures?

Glossopharyngeal nerve.

What nerve innervates the stylopharyngeus muscle?

Mandibular division of trigeminal nerve.

What nerve is the source of the lingual nerve?

Internal laryngeal nerve.

What nerve penetrates the thyrohyoid membrane to pass between the greater horn of the hyoid bone and the top of the thyroid cartilage?

Vagus nerve.

What nerve will be at risk if an enlarged gland has distorted the shape of the carotid sheath or worked its way through the sheath?

Cranial nerve XII.

What numbered cranial nerve is the hypoglossal nerve?

Posterior third of tongue, general sensory and gustation.

What part of the tongue does the glossopharyngeal nerve supply? What functions does it serve there?

The lung.

What part of what major organ is on the other side of the pleura from here?

Moisturize inspired air, warm inspired air, cool expired air to conserve heat or warm it to shed heat.

What physiological advantages come from the increased surface area of the nasal cavity that the conchae and meati provide?

Mylohyoid muscle provides a stable base for the tongue.

What role will the mylohyoid muscle have in tongue function?

Cough.

What should someone do if acidic liquid such as gastric juice splashes into his or her larynx? (I'm thinking of physiology, not emergency medicine.)

Thyroid cartilage.

What structure has the laryngeal prominence as one of its features? Structures: Hyoid bone, thyroid cartilage, cricoid cartilage, trachea (tracheal rings).

Middle concha.

What structure must one reflect or remove to reveal these features of the middle meatus?

Brachial plexus, apex of lung.

What structures around the subclavian artery make it a poor choice for access in angiography or arterial blood gas measurement?

Nasal cavity, oral cavity, larynx.

What three functional spaces give the three parts of the pharynx their separate names nasopharynx, oropharynx, laryngopharynx?

Nasolacrimal duct.

What tubular structure opens into the inferior meatus?

Sphenoid bone anteriorly; parietal bone superiorly.

What two bones articulate with the squamous part of the temporal bone?

Nasal cavity, nasopharynx.

What two volumes does the choana separate?

Internal jugular vein and sigmoid sinus (or inferior petrosal sinus).

What vein and dural venous sinus are we linking up with here?

The eyelid closes by contraction of the orbicularis oculi muscle.

Returning to the facial nerve, what happens to the eyelid in all three of these blinks?

Internal laryngeal nerve from the vagus nerve.

Some people have "silent heartburn." Reflux of acid is injuring the esophagus, but the patient happens not to be sensitive to that burning. He or she only perceives burning when acid reaches the upper esophagus or the pharynx, maybe even splashing into the larynx. What specific nerve branch innervates the piriform recess of the laryngopharynx and the laryngeal vestibule?

Yes. No, no other fluid if you consider the cerebrospinal fluid that has drained into the sinuses has become part of the blood.

Start by comparing and contrasting dural venous sinuses and veins. Do both carry venous blood? Does either carry any other fluid?

32.

Starting superiorly, the trigeminal nerve rests atop the medial end of the temporal bone and it is covered with dura mater, so the trigeminal nerve looks like it goes into a hole in bone there. In the cranial nerves spreadsheet, that spot goes into Column D, Row 10. Currently, the note there reads "(The trunk of the trigeminal nerve is superior to the medial end of the petrous ridge)." I hope you do not find that to be confusing; it is not is a mistake. The whole trigeminal nerve sits on the temporal bone before it branches. Look at any of the photographs of the hemi-head model that are provided in the theory slideshow. What number indicates the whole trigeminal nerve?

Cricoid cartilage.

Yes, I know; this question has been asked already. Obstruction of the infraglottic space occurs with edema because the swelling cannot go outward. What ring of cartilage forces the swelling to go into the airway?

Superior sagittal sinus.

You could generate several questions for the relationships to skull bones. Here is one. Which dural venous sinus is deep to the sagittal suture?

Foramen ovale, foramen spinosum.

You might be thinking of the greater wing of the sphenoid bone only on the lateral aspect of the skull. The standard definition of it includes all of the thin part of the bone that is on the skull base, too. So what two important foramina pierce the greater wing?

The overall amount of metabolism and energy expenditure.

he thyroid gland secretes both thyroid hormone and calcitonin into the blood. In general, what aspect of metabolism does thyroid hormone regulate?

Glossopharyngeal nerve.

Stylopharyngeus is the only muscle innervated by a certain cranial nerve. What is that nerve?

For a seated patient, tilt the head into flexior. Or have the patient lie prone and tip the head into extension a littlI am told you have to work with this a bit because if the head is positioned to put the opening at the lowest point of the sinus, air cannot get in and little or no liquid will drain out.

So how might you position your patient to get mucous fluid to drain out of the sphenoid sinus?

Trigeminal nerve; facial nerve; glossopharyngeal nerve; vagus nerve.

So list the four nerves with general sensory service.

It emerges from the hypoglossal canal. Carotid triangle, submandibular triangle. Across the hyoglossus muscle and into the muscles that support or form the tongue.

12.33 - This objective is about halfway to being the right place for CN XII. In the objectives that are designated for Theory 12 the hypoglossal nerve should have only neck issues. We will soon address functional and clinical issues of the hypoglossal nerve. For now, just look for the nerve sweeping across the neck. How does the hypoglossal nerve relate to the skull? Which triangles of the anterior triangle does cranial nerve XII cross? And where does it go?

Inferior alveolar nerve

A single nerve block does most or all of the "numbing" necessary for a dentist to work on lower teeth. The teeth, gingiva and bone are all innervated by one nerve. What is it?

Cerebrospinal fluid, arteries, veins, nerves and nerve branches.

Add some cerebrospinal fluid and you will have stated the normal anatomical contents of the subarachnoid space. [Name] all of them.

They emerge from the skull near the midsagittal plane.

Facial nerve branches wrap around the face from the side. How do the trigeminal nerve branches get to the face?

Foramen ovale, foramen spinosum.

Again, what foramina are located in the greater wing of the sphenoid bone in the middle cranial fossa?

C6 transverse foramen.

And now let's discuss the branches of the subclavian artery. At what bone feature does the vertebral artery go out of sight?

Oculomotor nerve, trochlear nerve, ophthalmic division of trigeminal nerve, sometimes maxillary division of trigeminal nerve.

And please list the four nerves that are in the wall of the sinus. Relative to the nerve you named in "b" above, they are a little less vulnerable to infection if an infectious thrombus settles in the sinus. Background/Previous Q: And then name the small but important dural venous sinus that is in the middle cranial fossa. It is labeled in the relevant slides. Which two important structures are in the sinus, bathed in venous blood? A: Internal carotid artery, abducens nerve.

C7.

And so which is the vertebra with a transverse foramen that is relatively empty?

Internal carotid artery, abducens nerve.

And then name the small but important dural venous sinus that is in the middle cranial fossa. It is labeled in the relevant slides. Which two important structures are in the sinus, bathed in venous blood?

It detects the O2 concentration of the arterial blood that is delivered to the head.

And what is the basic function of the carotid body?

Each of the three pharynges is posterior to the space that gives its name.

And what is the relationship of the pharynx to these three functional spaces? [Nasal cavity, oral cavity, larynx.]

Tentorium cerebelli.

And which dural fold or folds are symmetrical from right to left?

Temporalis muscle. Yes, it can be good to forcibly scrape the lower incisors against the upper incisors.

And which is most capable of applying retraction force when it elevates the mandible? Is there value in retraction while elevating? Explain.

No.

Is any part of the thyroid gland normally inside the carotid sheath?

Rib 1.

Continuing distally, the subclavian artery lies on a groove on the superior surface of one of the bones that made the thoracic inlet. What bone?

Strong deviation (pushing with the tip of the tongue) requires bilateral muscular effort.

Contrast the paralytic protrusion you just described to a healthy individual's voluntary and fully functional tongue deviation to one side or the other.

Cricothyroid muscle. External laryngeal nerve.

Definition of the intrinsic laryngeal muscles: the muscles that connect only the epiglottis, arytenoid cartilage, thyroid cartilage and cricoid cartilage (without connecting to other structures). One muscle in that set of muscles is innervated by a different branch of the cranial nerve you named in the previous question. What muscle? What nerve?

Buccal branch of facial nerve: stylomastoid foramen, wrap around the side of the face, innervate buccinator muscle; buccal branch of trigeminal nerve: foramen ovale, emerge from deep to the mandible, provide general sensory service for the oral vestibule.

Did you notice that there are some duplicated nerve names, names that apply to the facial nerve and to other cranial nerves? Those are good. They let you discuss two different sources and two different functions. Give an example.

About halfway between the midline of the skull and the external surface of the neck.

Describe how deep in the head the inferior (external) opening of the carotid canal is.

Subdural potential space.

Do not infer from the text on page 430 of Gray's Basic Anatomy that the arachnoid mater is attached to the dura mater across its entire surface. The word "contact" is correct. The surfaces touch. Read ahead to the next objective and state the name of the potential space that can open up here because the two surfaces are not adherent to each other.

Yes.

Do the cranial nerves have to cross the subarachnoid space to access their skull foramina? Y/N

No.

Do the dural folds completely separate any of the cranial fossae from the other cranial fossae? Y/N

No, the corpus callosum and other structures pass inferior to the falx cerebri.

Do the dural folds completely separate the sides of the cranial cavity?

More vulnerable in a tracheotomy incision.

Do the location of the thyroid ima artery and the most common location of the inferior thyroid vein(s) make them more vulnerable to injury in a cricothyrotomy incision or a tracheotomy incision?

The superior poles of the gland often extend that far superiorly.

Does any part of the thyroid gland lie in the same transverse plane as the thyroid cartilage?

Increase, in various ways. Calcium is removed from bone under the influence of parathyroid hormone.

Does parathyroid hormone increase the concentration of its selected component in the blood, or decrease its concentration? What is the impact on bone?

The posterior side. The lingual nerve comes through the foramen ovale of the sphenoid bone; but the chorda tympani is a branch of the facial nerve, so it comes out of the temporal bone

Does the chorda tympani merge onto the anterior side or onto the posterior side of its larger partner? Explain using the osteology of both nerves.

Medial.

Does the inferior thyroid artery run medial from the thyrocervical trunk or lateral from the trunk?

Rather low in the neck.

Does the inferior thyroid artery run medial from the thyrocervical trunk or lateral from the trunk? -> Medial Is it straight or curved? -> Curved, convex upward. Question: Is it high in the neck or low in the neck?

Curved, convex upward.

Does the inferior thyroid artery run medial from the thyrocervical trunk or lateral from the trunk? -> Medial Question: Is it straight or curved?

The false vocal folds and the air space between them are superior to the glottis.

During a laryngeal examination, you have to look through the rima vestibuli to see the glottis. In spatial terms, what does that mean?

People who vomit very frequently may scar their esophagus, pharynx and laryngeal vestibule enough that they become insensitive, and thereby vulnerable to more burning from vomitus with low pH.

Exact same question/answer in the study guide - People who vomit very frequently may scar their esophagus, pharynx and laryngeal vestibule enough that they become insensitive, and thereby vulnerable to more burning from vomitus with low pH.

We get to see the white vocal folds even though they are inferior to the puffy reddish vestibular folds.

Explain the significance of that relationship for laryngoscopy.

Esophagus, trachea, brachiocephalic veins.

Follow the course of the subclavian artery out of the thorax. First you pass through the thoracic inlet: the ring of T1 vertebral body, first ribs, cartilages and manubrium. Name a few structures that might logically be thought of as entering the thorax via this "inlet."

The gland is external to and posterior to the mylohyoid muscle; the duct crosses superior to the posterior edge of the muscle to reach the oral cavity.

For the submandibular gland and its duct, you cannot claim sufficient mastery of location and anatomical relationships unless you include the mylohyoid muscle. Explain.

Facial artery.

Fourth, what cranial nerve is responsible for providing parasympathetic innervation to the lining of the nasal cavity?

Vocal process.

GBA Figure 8.190 (p. 555) gives us a thorough description of the arytenoid cartilage. I am content to work with only the vocal and muscular processes. Which one of those two is more anterior and medial?

Muscular process.

GBA Figure 8.190 (p. 555) gives us a thorough description of the arytenoid cartilage. I am content to work with only the vocal and muscular processes. Which one of those two is more posterior and lateral?

One must maintain tone in the genioglossus muscle when lying supine; otherwise the tongue will retract (or may retract) far enough to block the pharynx. Since deep sedation produces muscle relaxation, a sedated or anesthetized patient has to be intubated with a tube inserted from the mouth all the way to the trachea.

GBA Table 8.22 gives you the basic information you need. Only one muscle is an effective protruder of the tongue. What muscle is that? -> Genioglossus muscle. What part of that muscle performs this action? -> The parts that are inserted relatively far posterior act to protrude the tongue. Why is having proper innervation of that muscle necessary for lying supine?

Periosteal layer; meningeal layer. Periosteal layer. Meningeal layer.

Gray's Basic Anatomy starts with a description of the two layers of dura mater in the skull. Please name them. Which one is tightly applied to the bones of the cranial cavity? And which one is adjacent to the arachnoid mater?

Maxillary bone and lacrimal bone. (It does not touch the nasal bone or the ethmoid bone.) Maxillary bone. Inferior nasal meatus.

Gently circle the orbital opening of the nasolacrimal canal. What bones does it touch? What bones does it contact as it spirals downward into the canal? And into what space does it enter when it emerges from the nasal end?

A clinically valuable bit of physioanatomy. No, not as much as real veins.

Have you learned yet that blood vessels are lined with a single layer of cells called endothelium that prevents blood cell adhesion and clot formation? Do you expect dural venous sinuses to have endothelial lining?

Skin, superficial fascia (1), platysma (2), clavicle (3), subclavian vein (4), phrenic nerve (5), anterior scalene muscle (6), subclavian artery (7), brachial plexus (8), middle scalene muscle (9), posterior scalene muscle.

I count nine structures including the superficial fascia and the clavicle. Compare your list to mine, and then find as many as you can on the Anatomy study list.

Infraorbital branch of maxillary division. Touch your patient's cheek with a soft brush and with a pointed object to test the infraorbital nerve and all parts of its pathway. Contrast that with pain when you accidentally bite your cheek.

I do not like the way the service of the buccal branch of the trigeminal nerve is described in Gray's Basic Anatomy. What branch of which division of the trigeminal nerve is the principal innervator of the skin of the cheek? (Hint: it is not the buccal branch of the third division.) So the main role for the buccal branch of the mandibular division is to provide general sensory service to the oral vestibule. State the services of those two nerves in practical terms.

Temporal bone, because that is where the middle ear and mastoid air cells are located.

I do not think you will find the auditory tube on a plastic skull. It can be hard to find on real bone. On what bone must you look for it?

Accessory nerve.

If it is not already there, put the sternocleidomastoid muscle's innervation into your memory bank, too. What nerve?

The filaments of the olfactory nerve convey signals for the sense of smell (olfaction) upward from the nasal cavity through the cribriform foramina to reach the cranial cavity in the anterior cranial fossa.

If the anterior cranial fossa had its own anatomy study list section, it would include cribriform foramina, crista galli, dura mater, falx cerebri and olfactory nerve. Fit some of those terms together in a little lesson.

Inferior nasal meatus.

If you push a thin, straight probe into your patient's nares and directly posterior through his or her nasal cavity and into the nasopharynx, through which meatus will the probe pass?

Masseter muscle. The anterior parts of the masseter muscle compress the teeth directly without having to work across a joint. In fact, pressures in the temporomandibular joint are normally not very high, even though the muscles exert much force.

Imagine a series of coronal plane sections through the head. (Yes, I know we should do this with MRI along with the imagining.) Which of the two muscles is largely in the same plane as the molar teeth? What effect does this have on the teeth and temporomandibular joint?

Corneal blink reflex is blinking because the cornea has been touched; a nociceptive stimulus is the sensory limb.

In Cell S12 we read that a facial nerve lesion might be indicated if all blink reflexes are impaired. Did you already look up the difference between corneal blink reflex and optical blink reflex? The optical blink reflex might also be called the visual blink reflex. If you blink when you hear a sudden loud sound, you have had an auditory blink reflex.

The air there blocks fewer x-rays than the various tissues that are nearby.

In a PA chest or AP cervical radiograph, the normal appearance of the infraglottic space is a dark triangle or inverted "vee," sort of like the roof of a building. Why is it dark?

Frontal bone, parietal bone, temporal bone, sphenoid.

In a previous objective we identified pterion as a small region on the lateral aspect of the skull. What four bones are found there?

Bone, respiratory epithelium, nasal glands.

In addition to rich and expansively dilatable vascular beds, what tissues are found in the conchae?

Generally, the larynx, although sometimes the pharynx.

In general, do you cough when something stimulates your pharynx excessively, or when something stimulates your larynx excessively?

Removed.

In the middle cranial fossa, is the dural covering over the bones intact or removed?

Cranial nerve XII stems from the medulla oblongata of the brainstem and cranial nerve XI stems from the spinal cord, but cranial nerve XI exits the cranial cavity through the jugular foramen, which is superior to the hypoglossal canal.

In the undissected cranial cavity, the anatomical order is: I, II, III, IV, V, VI, VII, VIII, IX, X, XI, XII. This list is the only one where anatomical order and numerical order are identical. Now you are ready to use anatomical terms to explain the discrepancy in the previous question. Please do so.

Both generate lymphocytes; the most important difference is that the exposed surface of a tonsil has epithelium but no connective tissue capsule—the pathogens or antigens arrive from the exposed surface rather than through the lymph stream.

In what ways are tonsils similar to lymph nodes? How are they different?

Temporal bone.

In which skull bone is the carotid canal located?

Carotid triangle. (Simple anatomy is the best.)

In which triangle of the neck is the bifurcation of the common carotid artery located?

Maxillary artery.

Infratemporal fossa: pterygomaxillary fissure, which is very visible on the skull. (Lateral to the fossa you see its doorway between the posterior wall of the maxillary sinus and the anterior surface of the pterygoid process.) It maybe too soon to ask this, but what artery passes through here?

Temporal bone.

Into what bone does the auditory tube penetrate?

Subclavian vein.

Into which vein does the external jugular vein drain inferiorly?

Internal jugular vein.

Into which vessel does it flow on the inferior side of the jugular foramen? "It" = a drop of venous from blood from the anterior end of the superior sagittal sinus to the jugular foramen.

Orbicularis oris.

Keep your lips tightly together while you fill your cheeks with air. What muscle are you testing?

Lateral nasal wall, nasal septum, lips, anterior tongue.

Let's switch from air spaces to tissues. Perhaps you have already studied a little bit about anaphylaxis, the process whereby histamine secretion stimulates edema. List some structures of the upper airway that can produce minor problems if they become edematous in an allergic reaction. (Emphasis on minor.)

Posterior tongue, vocal folds, tissues of infraglottic larynx.

List some structures that can cause a serious problem (i.e., complete obstruction of the airway) if they become edematous. (Emphasis on major.)

Ethmoid bone, frontal bone, parietal bones, occipital bone, temporal bone.

List the bones it passes.

From the tonsils comes lymph that may contain infectious material or antibodies, from the tongue will come lymph that provides a route for metastasis if there is cancer of the tongue.

List two structures that are drained by the deep cervical chain of lymph nodes.

Right and left maxillary bones, right and left palatine bones.

Look at an inferior view of the hard palate to identify the "cruciate suture." What four bones (two pairs of bones) make this set of sutures?

Cranial nerve VI, the abducens nerve.

Lower and more lateral, the facial nerve and vestibulocochlear nerve enter the internal auditory meatus together; they are not much smaller than the trigeminal nerve. Do not mistake V for VII and VIII or vice versa. What nerve is between these two sets, positioned in a way to help you distinguish V from VII and VIII? (You are using nerve counting to your advantage.)

Vagus nerves.

Many people perceive reflux of stomach acid into the esophagus as "heartburn." Many people do not. What nerve is responsible for general sensory innervation of the distal part of the esophagus?

Foramen rotundum.

Middle cranial fossa: maxillary division of trigeminal nerve, and so ____________.

Common carotid artery, carotid bifurcation and carotid sinus, internal carotid artery, beginning of external carotid artery, vagus nerve, internal jugular vein, superior laryngeal nerve.

Name the major contents of the carotid sheath again, please.

Common carotid artery, carotid bifurcation and carotid sinus, internal carotid artery, beginning of external carotid artery, vagus nerve, internal jugular vein, superior laryngeal nerve

Name the major contents of the carotid sheath.

Nasal cavity → meati → choana → pharynx → laryngeal inlet → laryngeal vestibule → rima vestibuli → ventricle → rima glottidis → infraglottic space → tracheal lumen

Name all of the spaces and doorways that air travels through to get from the outside world to the trachea.

Superficial temporal artery.

Name another ascending branch at the superior end of the external carotid artery.

Ascending pharyngeal artery.

Name one ascending branch near the inferior end of the external carotid artery.

Ethmoid bulla.

Name the bump in the middle meatus.

Submental triangle, submandibular triangle, carotid triangle, muscular triangle.

Neck triangle - Name the four triangles in the anterior triangle.

Occipital triangle, subclavian triangle.

Neck triangle - Name the two triangles in the posterior triangle.

Glossopharyngeal nerve, some vagus nerve.

Now help me out with the innervation of the tongue by regions. > Posterior one third, gustation:

Hypoglossal nerve.

Now help me out with the innervation of the tongue by regions. > Somatic motor:

Buccinator.

Now use a muscle in the face to prevent your cheeks from inflating when you blow a thin stream of air between your lips. What additional muscle are you testing now?

Submandibular ganglion. Lingual nerve.

Notice that this objective does not include the parasympathetic innervations of these glands. Maybe it should. What ganglion of the parasympathetic innervation is included on your anatomy study list? With what nerve is that ganglion anatomically associated?

Trigeminal nerve (lingual nerve).

Now help me out with the innervation of the tongue by regions. > Anterior two thirds, general sensory:

Facial nerve (chorda tympani).

Now help me out with the innervation of the tongue by regions. > Anterior two thirds, gustation:

Glossopharyngeal nerve.

Now help me out with the innervation of the tongue by regions. > Posterior one third, general sensory:

Trigeminal nerve.

On the medial side of the hemi-head model we see the lateral nasal wall. This is because the nasal septum is not shown. Number tags 31, 12, 13, 30 and 33 are named nerves conveying general sensory information from the wall of the nasal cavity. From which one of the twelve cranial nerves do these branches arise? (Yes, there are two each of tags 30, 31, 33 and 35 and the numbering on the medial side does not match the numbering on the lateral side.)

CN XI comes after CN XII (or CN XII comes before CN XI).

On the surface of brain and spinal cord, the anatomical order is: I, II, III, IV, V, VI, VII, VIII, IX, X, XII, XI. You will learn the attachments of cranial nerves to the brain and spinal cord in Set 3A; for now, simply state where this anatomically ordered list strays from the numerical order.

Bone of the mandible, skin of chin.

Other than the lower teeth, what tissues or regions does that nerve serve? Nerve: Inferior alveolar nerve

Calcium ion concentration.

Parathyroid hormone replacement therapy can be very difficult to manage. What blood component does the hormone regulate? When that strays from normal levels, many biochemical and metabolic systems are affected, and some of them are affected abruptly.

Cribriform foramina; optic canal; superior orbital fissure; foramen rotundum; foramen ovale; Internal auditory meatus; jugular foramen; hypoglossal canal.

Passing through skull foramina, the anatomical order is: I, II, III- V1- VI- IV, V2, V3, VII, VIII, IX- X- XI, XII. Name the skull foramen through which each nerve passes.

Across the center of the right or left parietal bonA few centimeters lateral to the external occipital protuberance.

Plain radiographs remain viable as a way to look for skull fractures in trauma cases. Normal sutures can sometimes also be seen. Fractures are straight or smoothly curved and they appear in places where sutures are not located. So you have to know where the sutures might be seen. Give an example of a place where a suture is not located. A dark line on a radiograph there may indicate a fracture.

Epiglottic vallecula, laryngeal inlet and vestibule, rima glottidis.

Re: 1. laryngeal inlet and vestibule. 2. rima glottidis. 3. Pharyngoesophageal constriction. 4. Right principal bronchus. 5. Individual bronchi or bronchioles. For each of the locations above, state whether the airway is (or can be) obstructed completely so no respiration can occur.

Only the pharyngoesophageal junction (or elsewhere in the esophagus) does not directly obstruct the airway. Saliva fills the esophagus and pharynx proximal to the obstruction, and that must be expelled before it spills through the laryngeal inlet. A large bolus stuck in the esophagus can compress the trachea from posterior.

Re: 1. laryngeal inlet and vestibule. 2. rima glottidis. 3. Pharyngoesophageal constriction. 4. Right principal bronchus. 5. Individual bronchi or bronchioles. For each of the locations above, state whether the airway is (or can be) obstructed directly.

Middle ear cavity.

Re: Auditory tube penetrating the temporal bone What space does it find within that bone?

It approaches the tongue from posterior and inferior.

Re: Cranial nerve XII (hypoglossal nerve) And how does it therefore approach the tongue?

It is the last cranial nerve, so it exits the skull near the foramen magnum.

Re: Cranial nerve XII (hypoglossal nerve) And so, where is its foramen to exit the skull? Explain.

Torus tubarius.

Re: Eustachian tube What tissue surrounds its opening?

Superior thyroid artery, lingual artery, facial artery, maxillary artery.

Re: External Cartoid Artery Name four anterior branches.

Occipital artery, posterior auricular artery.

Re: External Cartoid Artery Name two posterior branches.

Opening the auditory tube by swallowing allows the air pressures in the middle ear and in the pharynx to equilibrate.

Re: Right and left tensor veli palatini muscles. The muscle's most posterior fibers originate from the cartilage of the auditory tube, and pull the tube open when one swallows. Why does one find this useful?

Rima glottidis.

Re: Rima glottides and glottis. And which one could get obstructed?

Glottis.

Re: Rima glottides and glottis. Which one is a place where inflammation, edema, scarring or irritation can occur?

It is relatively far from the larynx.

Re: Tracheotomy is preferred for creating a permanent opening (stoma) in the airway for a patient whose upper airway has a permanent complete or partial obstruction (e.g., after neck cancer surgery). Considering the location of the larynx, why is this approach preferred?

Pharyngoesophageal constriction.

Re: airway obstruction At the inferior end of the pharynx:

rima glottidis.

Re: airway obstruction Between the true vocal folds:

Right principal bronchus.

Re: airway obstruction Distal to the trachea (a classic for exam items in any clinical anatomy course):

Individual bronchi or bronchioles.

Re: airway obstruction Even more distal than that:

laryngeal inlet and vestibule.

Re: airway obstruction Going into the larynx:

Yes. The anterosuperior parts are supplied by branches of the ophthalmic artery, and the posteroinferior parts are supplied by the sphenopalatine artery.

Re: divisions of the trigeminal nerve Third, does the blood supply follow a similar principle? Explain.

Foramen ovale, from somewhat posterior and definitely superior.

Re: mandibular division of trigeminal nerve. So, how does it exit the skull, and how does it approach the tongue?

Lateral nasal wall.

Re: meati in the nasal cavity Are they located on the nasal septum or on the lateral nasal wall?

Inferior surface of body of sphenoid.

Re: nasal septum in the vomer With which bone does its posterior superior part articulate?

Tracheotomy.

Re: tracheotomy vs cricothyrotomy And which procedure is preferred for creating a permanent opening (stoma) in the airway for a patient whose upper airway has a permanent complete or partial obstruction (e.g., after neck cancer surgery)?

Cricothyrotomy.

Re: tracheotomy vs cricothyrotomy So which of these two airway access procedures is preferred in an emergency, when no breathing will occur until the flow of air in the airway is restored?

Approximately C4 vertebra, also approximately the upper border of the thyroid cartilage.

Relative to cervical vertebrae, where is the bifurcation of the common carotid artery located?

Close to the skin surface.

Relative to the anterior surface of the trachea superior to the sternum, is the cricothyroid ligament close to the skin surface or far from the skin surface?

Posterior, maybe a little inferior.

Relative to the groove you will name in Objective 13.14 question "l" below, where does the maxillary sinus drain into the nasal cavity? And you see why that point is on the anatomy study list.

At its anterior end.

Relative to the hiatus semilunaris, where does the frontal sinus drain into the nasal cavity?

Posterior.

Relative to the superior parts of the nasal cavity, where is the sphenoid sinus located?

Maxillary division.

Second, what division of the trigeminal nerve serves the posteroinferior parts of the nasal cavity for general sensory innervation?

Probably not.

Severe lesion of the hypoglossal nerve causes unilateral tongue atrophy. If you suspect this lesion (or if you are just trying to determine what normal functions your patient has retained), ask the patient to protrude his or her tongue. If one side is paralyzed, does it seem likely that the tongue will protrude very forcefully?

Hypoglossal nerve.

Suppose the patient tells you her swallowing problem seems to relate to control of her tongue at the beginning of swallowing. What nerve regulates the tongue muscles?

The right vein leads to the right side of the heart in a straight line. That is good for inserting a line temporarily. I think the left side is used for implanted pacemaker because the added length makes the placement more stable within the chest.

Suppose you want to put a line through veins and into the right side of the heart. Just by the positions and shapes of the veins, would you prefer to using the left subclavian vein or the right one?

Straight sinus.

That geometry determines the shape of the superior surface of the cerebellum, and it determines the angulation of one of the major dural venous sinuses as it projects toward the center of the cranial cavity. Name that dural venous sinus.

Straight sinus.

The great cerebral vein comes out of the brain to join this stream at the top of the tentorial notch; into which dural venous sinus does it drain?

Lack of valves allows blood to flow in two directions within these veins so infectious matter or malignant tumor cells can spread in either direction.

The intracranial venous connections that are described on page 462 are very important. It seems like the "danger area" that is described in plain text on that page should have had a green Clinical app box. What feature of all veins in the head (and most veins inside the thoracic cavity and abdominopelvic cavity) makes the venous connections in the head clinically relevant?

Yes.

The last part of this objective is a little out of place. Basically, it is asking you what structures are on the external surface of the brain, and we will study that thoroughly in Set 3A. Are there arteries on the surface of the brain? Y/N

Temporal branches, frontalis muscle or superior part of orbicularis oculi; zygomatic branches, zygomaticus major muscle or orbicularis oculi pars inferioris; buccal branches, buccinator muscle; marginal mandibular nerve, depressor anguli oris muscle; cervical branches, platysma muscle.

The facial nerve's branches in the deep part of the parotid gland are the reason why surgeons avoid parotid gland surgery for most benign tumors. Name the five nerve branches (or groups of branches), and state a destination muscle for each one.

As a doctor once told some of us during a lesson about inserting central lines, "There's poop down there." (The groin is relatively difficult to keep clean.)

The femoral artery (Block 3) near the inguinal ligament is usually better for short term access because it is large, it is subcutaneous, and it is not surrounded by major nerves. Thought question: why would the femoral artery or vein not be very good sites for long term vascular access?

cricoid cartilage

The inferior surface of the arytenoid cartilage articulates with the _____________ cartilage.

Hypoglossal nerve.

The palatoglossus muscle (inside the palatoglossal fold) is not on your study list. It is innervated by the vagus nerve. Its innervation is different from that all other muscles with "-glossus" in the name. What nerve innervates all of those other muscles (hyoglossus, genioglossus, etc.)?

Anterior digastric muscle, mylohyoid muscle, posterior digastric muscle.

The pharynx and larynx are also suspended from the skull by some of the muscles that attach to the hyoid bone. Name these structures from Anatomy study list 12 F (anterior triangle muscles).

Rapid fluctuation of the diaphragm and work with the tongue I guess.

The saccules of the ventricles can expand pathologically in trumpeters who play too many staccato notes with improper technique. That is painful, and there is risk of infection deep in the neck. They should be trained not to use the larynx to produce a series of rapid short expirations that will make "bap! bap! bap!" notes on the trumpet. How can the airflow be controlled in that way without opening and closing the vestibular folds?

Anterior scalene muscle.

The scalene tubercle is anterior to the groove of the subclavian artery. Which scalene muscle is anterior to the subclavian artery?

Submandibular ganglion.

The structure you named in "f" has a small parasympathetic ganglion dependent from its inferior surface. What is the name of that ganglion?

Isthmus of thyroid gland. Near the third tracheal ring, definitely below the cricoid and thyroid cartilages.

The study list could certainly have had the superior poles of the right and left lobes of the thyroid gland. But they are not there. What is the one part of the thyroid gland I am asking you to know? Please locate its normal position relative to the laryngeal skeleton.

1. Yes. 2. Yes. 3. Yes. 4. Yes. 5. Meningeal layer only, not the periosteal layer. 6. No, not necessarily.

The superficial cerebral veins and branches of cerebral arteries can have rather long courses on the surface of the brain, superficial to the pia mater. 1. On the path to the heart, do the veins have to go through the subarachnoid space? 2. Through the arachnoid mater? 3. Through the subdural potential space? 4. Through the dura mater? 5. If your answer to the last question was yes, which layer of dura mater must be pierced? (Or is it both?) 6. And must the veins pierce the epidural potential space?

Edema (as occurs when one has a cold or the flu) can cause the openings of the paranasal sinuses to swell closed, and that will favor infection within the sinus, and painful pressure build-up, too.

The various sinus openings can be difficult to find in an embalmed cadaver. I think this is because embalming inflates the tissue like edema. What clinical point do I hope you get from this observation?

Sheet of paper.

The wall of bone between the ethmoid air cells and the orbit is called the lamina papyracea. Translate.

I hope you said something like "No, the preganglionic fibers could not have left the spinal cord superior to the T1 segment."

There is some value in knowing that the sympathetic nerve supply of the heart includes some splanchnic nerves that branch from the superior cervical ganglion and descend in the neck to reach the mediastinum. Think about the preganglionic sympathetic pathway that leads up to those nerves. Does the location of the superior cervical ganglion mean that the preganglionic fibers pass through the cervical spinal nerves that are nearby (e.g., the C3 spinal nerve)?

In the adult skull, the most superior part of the tentorium cerebelli is several centimeters above the plane of the anterior clinoid processes and the confluence of sinuses.

Those two points and the confluence of sinuses define a plane. Approximately how far superior to that plane is the most superior point of the tentorial notch? You see that the "tent" really is like a tent.

Thoracoacromial trunk branching from the axillary artery.

Thyrocervical trunk is next. What nearby branch of the axillary artery has a name that is similar thyrocervical trunk?

Isotonic relative to nasal secretion, which is approximately isotonic to blood or contact lens cleaning fluid.

To decrease the sting the patient will feel, what is the tonicity of the liquid you might put on that probe?

The facial nerve emerges from the stylomastoid foramen.

To indicate the facial nerve on the face, spread the five fingers of one hand across your face or your friend's face, with your palm at the lobule of the auricle. Why is your palm there?

Inferior sagittal sinus, straight sinus, the confluence of sinuses, transverse sinus, sigmoid sinus, jugular foramen.

Trace a drop of venous blood from the anterior end of the inferior sagittal sinus to the jugular foramen.

Across the deep surface of the squamous part of the occipital bone and onto the deep side of the sagittal suture.

Trace along the midline of the cranial cavity from the crista galli to the superior surface of the sphenoid bone, then to the hypophyseal fossa, the dorsum sellae and the clivus to reach the basal part of the occipital bone. Go around the foramen magnum and onto the deep side of squamous part of the occipital bone, and then lead posteriorly and upward to the internal occipital protuberance. Where does your pointer go next, if it passes over the internal occipital protuberance but stays on the midline of the skull?

Superior sagittal sinus, confluence of sinuses, transverse sinus, sigmoid sinus, jugular foramen.

Trace the flow of a drop of venous blood from the anterior end of the superior sagittal sinus to the jugular foramen. What structures does it pass through?

Esophagus.

Trachea and esophagus - Which of these two structures is more posterior, and thereby closer to the vertebral column?

No; all are included in the model.

Try to count from I to XII. Are any of the cranial nerves not represented in the model's cranial cavity?

cavernous, transverse and sigmoid sinuses (also the inferior petrosal sinus).

Turn to the plastic hemi-head model that is featured at the end of the theory slideshow. Which dural venous sinuses are featured in the cranial cavity of the hemi-head model?

The mandibular foramen that allows passage of the inferior alveolar nerve and vessels.

Use GBA Figure 8.117 (p. 502) to see that protrusion and depression occur together to open the mouth. Thus, the axis of rotation for gape is not at the temporomandibular joint. Instead, it is more inferior, at a point within the ramus of the mandible. What foramen of the mandible is very near that axis of rotation?

Connective tissuIt has a mat of sturdy fibers that can prevent lacerated blood vessels from closing spontaneously, so the scalp often bleeds profusely when it is cut.

Use the SCALP mnemonic abbreviation to name the layers. C: ______________. Describe this layer in a clinical context.

Epicranial Aponeurosis.

Use the SCALP mnemonic abbreviation to name the layers. A: ______________.

Loose layer. This is an easy dissection plane, and place where blood can pool if there is trauma to the scalp. Ask Mr. Silverman about that.

Use the SCALP mnemonic abbreviation to name the layers. L: ______________.

Periosteum (external pericranium).

Use the SCALP mnemonic abbreviation to name the layers. P: ______________. In the anatomy laboratory, parts of this layer peel with the epicranial aponeurosis.

Skin.

Use the SCALP mnemonic abbreviation to name the layers. S: ______________. We could do a lot with anatomy of hair, but we are not going there.

Lingual nerve.

Which nerve is more anterior, the inferior alveolar nerve or the lingual nerve?

When you swallow.

When would you want your laryngeal inlet to be closed as snugly as you can make it?

Cricothyroid muscle. Posterior cricoarytenoid muscle. The transverse arytenoid/oblique arytenoid/aryepiglotticus muscle complex.

Where along the course of the vagus nerve does the superior laryngeal nerve arise? If a surgeon accidentally divides the vagus nerve between the superior laryngeal nerve and the recurrent laryngeal nerve, which muscle you named in the previous question will remain innervated? Which ones will lose their innervation?

Relatively far anterior.

Where along the length of the inferior meatus is this opening located?

In roof of the pharynx and in the superior part of the posterior wall of the pharynx; between the palatoglossal fold and the palatopharyngeal fold; on the surface of the posterior third of the tongue.

Where are the 3 principal tonsils located?

Thoracic duct.

Where do the deep cervical lymph nodes drain on the left side of the neck?

Right lymphatic trunk, which is seldom seen in dissection.

Where do the deep cervical lymph nodes drain on the right side of the neck?

Posterior and inferior.

Where in the nasal septum is the vomer located?

Lateral wall of the nasopharynx.

Where in the pharynx is the torus tubarius located?

The forehead.

Where is the most obvious place to expect a patient to report pain or a feeling of pressure if the frontal sinus is inflamed?

Deep in the cheek, ipsilateral to the inflamed sinus.

Where is the most obvious place to expect a patient to report pain or a feeling of pressure if the maxillary sinus is inflamed?

On the anterior aspect of the C2 and C3 vertebrae.

Where is the superior cervical ganglion located?

Internal carotid arteries.

Which of the carotid arteries goes through it to enter the skull?

Cricoid cartilage.

Which of the cartilages of the airway forms a complete ring to give stability to the relationships of the other cartilages in the larynx?

Glossopharyngeal nerve. Vagus nerve.

Which cranial nerve has the most significant role in delivering sensory information for the gag reflex? Which cranial nerve has the most significant role in stimulating the muscles that elevate the pharynx in the gag reflex?

Vagus nerve. Right levator veli palatini muscle, right vagus nerve.

Which cranial nerve innervates the levator palati muscle? If your patient's uvula deviates to the left when he elevates his soft palate by saying "ahhh," which levator veli palatini muscle appears to be paralyzed, and which nerve may be lesioned?

Falx cerebri and falx cerebelli.

Which dural folds are unpaired and are arranged in the midsagittal plane?

superior sagittal, inferior sagittal and straight sinuses.

Which major dural venous sinuses are not featured? Be sure you can identify those, too.

Trachea

Which of these structures continues into the thorax? Structures: Hyoid bone, thyroid cartilage, cricoid cartilage, trachea (tracheal rings).

Masseter muscle.

Which of these two muscles is more able to apply protrusion force when it elevates the mandible?

Foramen spinosum.

Which of those two foramina is at the posterolateral corner of the greater wing? By the way, that little hole is near a feature of the inferior surface called the spine of the sphenoid bone, and that is the source of the foramen's name.

Lingual nerve.

Which of those two is joined by the chorda tympani nerve?

Inferior alveolar nerve.

Which one enters the mandibular foramen to course through the mandibular canal and serve the lower teeth?

Lingual nerve.

Which one of the three structures enters the oral cavity from superior, having emerged from a foramen in the skull?

Hyoid bone.

Which one of these structures is made of bone? Structures: Hyoid bone, thyroid cartilage, cricoid cartilage, trachea (tracheal rings).

Thyroid cartilage, cricoid cartilage, trachea (tracheal rings).

Which ones of these structures are made of cartilage? Structures: Hyoid bone, thyroid cartilage, cricoid cartilage, trachea (tracheal rings).

Posterior cricoarytenoid muscle and the transverse arytenoid/oblique arytenoid/aryepiglotticus muscle complex. Cricothyroid muscle.

Which two of the three principal muscles of the larynx (cricothyroid muscle, the posterior cricoarytenoid muscle and the transverse arytenoid/oblique arytenoid/aryepiglotticus muscle complex) are innervated by the recurrent laryngeal nerve? And that leaves one to be served by a different vagus nerve branch. Name that muscle.

Submandibular duct, hypoglossal nerve. Submandibular duct. Mylohyoid muscle.

Which two of those structures enter the oral cavity from the neck? Which one of those two arrives near the posterior edge of the flat muscle that forms the floor of the oral cavity? What muscle is that?

That part of the skull is fragile, so one should not lift or carry the skull with fingers in the orbits.

Why should one think of this name whenever one picks up or handles a skull?

This is the straightest path of all.

Why would the internal jugular on that side be a slightly better access site than the subclavian vein?

Weakly toward the side of the injured nerve or nerve pathway.

With one side of the tongue working well and the other side paralyzed, will the tongue deviate toward the side of the injured nerve, or away from the side of the injured nerve when the patient protrudes the tongue?

Internal thoracic artery.

You should remember the next branch of the subclavian artery well from Block 1. What artery runs deep to the costal cartilages lateral to the sternum?

Trigeminal nerve (ophthalmic and maxillary divisions).

You will recall that a different one of the twelve cranial nerves serves the general sensory function for the nasal cavity. What nerve is that?

Protrusion and retraction, gliding; elevation and depression, rotation.

a. Each of those joints has two different prominent movements, one gliding and the other spinning or rotating. What are those two movements for the temporomandibular joint? Which is a gliding movement and which is a rotating movement?

Sinusitis.

a. What is the proper term for inflammation of a paranasal sinus?

Internal jugular vein.

a. What major vein is lateral to the carotid axis?

Phrenic nerve.

aSuppose the patient tells you it is hard to swallow when she has eaten, and she does better after she belches. (The clinical word for belch is "eructation." Why they can't just say belch, I do not know.) Maybe her problem relates to reflux of gas from her stomach into her esophagus. What nerve innervates the diaphragm and thereby helps to maintain closure of the gastroesophageal junction? If that nerve can be made to function better, her reflux issue might not be so bad.