CHA 101 Final Exam

What does the posterior triangle of the cervical region do?

it transmits nerves and vessels from the neck to the upper limb, and consists of 2 sub triangles:

1) occipital triangle

2) supraclavicular triangle

What does the anterior triangle of the cervical region do?

- it is associated the with following structures:

esophagus, pharynx, larynx, trachea, thyroid gland, and parathyroid gland

- And it consists of 4 sub triangles: musclar, carotid, digastric, submental

What are the borders of the posterior triangle?

1) sternocleidomastoid

2) Trapezius

3) Middle 1/3 of the clavicle

What are the contents of the Posterior Triangle?

1. CN XI

2. Cervical Plexus

3. Omohyoid Muscle

4. External Jugular Vein

5. Subclavian vessels

6. Brachial Plexus

7. Phrenic Nerve

What lies in between the infra hyoid muscles?

1. laryngeal prominence

2. cricoid cartilage

3. cricothyroid membrane

the thyroid gland is deep to which muscles

sternohyoid and sternothyroid

What does the parathyroid do?

regulates Calcium and increases calcium reabsorption to increase serum calcium

What does the carotid sinus do?

at base of internal carotid artery. it detects stretch in walls due to an increase in pressure

-CN IX

What does the carotid body do?

contains chemoreceptors that detect changes in O2, CO2 and arterial pH

-CN IX

Choanae

Adenoids

enlarged pharyngeal tonsils

If food gets caught in the piriform recess, what structures can get damaged?

superior and inferior laryngeal vessels, internal and recurrent laryngeal nerves!!!

The muscular layer of the pharyngeal walls is composed of 6 voluntary muscles involves in speaking and swallowing:

- 3 pharyngeal constrictors:

a) superior

b) middle

c) inferior

- 3 Pharyngeal elevators

a) palatopharyngeus

b) salpingopharyngeus

c) stylopharyngeus

Superior Pharyngeal Constrictor

originates from the pterygomandibular raphe, mandible and lateral pterygoid plate

Middle Pharyngeal Constrictor

originates from hyoid bone

the stylopharyngeus muscle separates the middle and superior pharyngeal constrictor

Inferior Pharyngeal Constrictor

originates from the thyroid and cricoid cartilages

Palatopharyngeus

originated from the hard palate and inserts into the side of the pharynx and the thyroid cartilage. Function = elevates the pharynx and larynx for swallowing and speaking

- innervated by VAGUS NERVE

Salpingopharyngeus

- originates from the pharyngotympanic tube and terminates by blending with the palatopharyngeus muscle

- Function = elevates the pharynx and larynx for swallowing and speaking

- innervated by VAGUS NERVE

Stylopharyngeus

- originates from the styloid process of the temporal bone and inserts onto the pharynx and thyroid cartilage. it shortens and widens the pharynx during swallowing and speaking

- innervated by CN IX

What enters the gap above the superior constrictor?

1. Pharyngotympanic tube

2. levator veli palatini muscle

What enters the gap above the middle constrictor?

1. stylopharyngeus muscle

2. glossopharyngeal nerve

What enters the gap above the inferior constrictor?

internal laryngeal nerve

What enters the gap below the inferior constrictor?

The recurrent laryngeal nerve

the retropharyngeal Space contains

loose connective tissue separates the buccopharyngeal fascia of the pharynx wall from the pre vertebral fascia that covers the vertebrae and associated muscles.

- this facilitates the mobility of the pharynx necessary for its function; predisposed to abscess formation following pharyngeal infections

Innervation of the pharynx

1. Motor - CN X except the stylopharyngeus which is innervated by CN IX

2. Sensory - nasopharynx by CN V2, oropharynx and hypopharynx by CN IX*

these intermingle to form the pharyngeal plexus

Voluntary Stage of Swallowing

food is chewed and formed into a bolus. contractions of the palatoglossus muscles then squeeze the bolus backwards through the oropharyngeal isthmus into the oropharynx

Involuntary Stage of Swallowing

- nasopharynx separated from the oropharynx by tensor veli palatini muscles

(tensing) or levator veli palatini muscle (raising) on the soft palate, and when the upper fibers of the superior constrictor pull the posterior wall forward.

- Palatopharyngeal arches are pulled into oppostion

- the larynx and laryngopharynx are elevated toward the epiglottis and the laryngeal opening is narrowed.

- the bolus moves around the epiglottis and the laryngeal opening to the lower part of the pharynx by gravity and successive contractions the superior, middle, and inferior pharyngeal constrictor muscles

- the cricopharyngeal sphincter relaxes and the bolus enters the esophagus.

- peristaltic contractions push the bolus into the stomach

Bell's Palsy

damage to CN VII within the facial canal of the temporal one; causes weakness or paralysis of the muscles of facial expression on the ipsilateral side

Parotid Gland

1. secretes serous fluid containing alpha-amylase, lysozyme, IgA

2. inflammation causes mumps

3. branches of facial nerve emerge from the gland

4. the duct crosses the master muscle, and pierces the buccinator muscle, and empties into the oral cavity

Masseter Muscle

Origin: zygomatic arch

Insertion: mandible, lateral surface of the angle and lower ramus

Innervation: CN V3

Action: elevates the mandible, and allows forceful closure of the mouth, muscle of mastication

Blood Supply of the face:

mainly from branches of the facial artery and superficial temporal branches of the external carotid artery

Primary Functions of the Larynx

1. as a sphincter at the air inlet passage

2. maintain the potency of the airway

3. In voice production

--> posteriorly to the bodies of the vertebrae C3-C6 and lateral to the carotid sheath

thyrohyoid membrane

suspends larynx from hyoid bone, pierced by superior laryngeal artery and vein, and the internal laryngeal nerve

What is the laryngeal inlet bounded by

in front by the epiglottis, laterally by the aryepiglottic folds, and posteriorly by the mucosa between the arytenoids (the oblique arytenoid muscle)

The laryngeal Cavity

1. vestibule - from inlet to vestibular folds

2. ventricles - between the vestibular and vocal folds

3. infraglottic cavity - from vocal ligaments to the lower border of the cricoid cartilage

The vocal folds

vibrate to produce sound. their free margins are anterior to posterior. the laryngeal muscles adjust the tension and degree of approx. of the focal folds.

the rima glottidis is

the opening between the vocal folds

the glottis is

the rims glottides and the vocal folds

the vestibular folds

provide protection to the glottis and the infraglottic cavity

Oblique Arytenoid

Origin: muscular process of arytenoid

Insertion: apex of opposite arytenoid, then continues into aryepiglottic folds as the aryepiglottic muscles

Innervation: Recurrent laryngeal nerve

Action: adducts arytenoid cartilages to close the posterior part of the rima glottidis

laryngeal sphincter

Transverse Arytenoid

Origin: back and medial surface of arytenoid

Insertion: back and medial side opposite of arytenoid

Innervation: Recurrent laryngeal nerve

Action: adducts arytenoid cartilages to close the posterior part of the rim glottidis

laryngeal sphincter

Lateral Cricoarytenoid

origin: lateral part of cricoid arch

insertion: back to muscular process of arytenoids

action: adducts vocal folds

innervation recurrent laryngeal

Posterior Cricoarytenoid

origin: back of cricoid lamina

insertion: laterally, to the muscular process of the arytenoid

action: ABDUCTS vocal fold and arytenoid cartilage

Cricothyroid

origin: side of cricoid arch

insertion: back to lamina and inferior horn of thyroid cartilage

action: pulls thyroid cartilage forward and tilts cricoid lamina posteriorly, stretching the vocal ligament to raise the pitch of the voice

INNERVATED by: external laryngeal nerve

Thyroarytenoid

origin: side of cricoid arch

insertion: anterior surface and vocal process of arytenoid

action: stiffens the vocal ligament via isometric contraction. Fibers parallel to the vocal ligament are known as vocals muscle, which makes minute adjustments in tension during speech

INNERVATION of the Larynx

1. Motor: all intrinsic muscles (oblique arytenoid, transverse arytenoid, lateral cricoarytenoid, posterior cricoarytenoid, and thyroarytenoid) except cricothyroid are innervated by the recurrent laryngeal nerve. The cricothyroid is innervated by the EXTERNAL LARYNGEAL NERVE

1. Sensory: the mucosa from the vocal folds upward is by the internal laryngeal nerve and the mucosa below the vocal folds is innervated by the recurrent laryngeal nerve.

Blood Supply of the Larynx

1. Superior laryngeal artery - from the superior thyroid artery

2. Inferior laryngeal artery - from the inferior thyroid artery

Functions of the Larynx

1. Swallowing

2. Coughing, sneezing

3. Micturition, defection, parturition

4. voice production

Swallowing

larynx is elevated by the supra hyoid muscles and the other elevators. The inlet is narrowed by the oblique arytenoid and aryepiglottic muscles. food passes laterally down the piriform recesses into the esophagus

Coughing and Sneezing

the rims glottides is closed by the sphincters after a deep breath. The expiratory muscles are contracted to increase intrathoracic pressure, then the rim glottides is opened rapidly.

Micturition, Defecation, parturition

the rims glottidis is closed after a deep breath. due to air trapped in lungs, the diaphragm cannot move upwards when the abdominal muscles are contracted, so pressure is transmitted to the pelvis and abdomen

Voice Production

vocal ligaments adducted. Expired air vibrates the vocal ligaments with a frequency depending on length and tension. the quality of the voice depends on resonation by the pharynx, mouth, and paranasal sinuses. for high tones, the entire larynx is elevated; for low tones, it is depressed.

External Fibrous Layer of Eye

a supporting layer, consisting of sclera posteriorly and cornea anteriorly. The cornea is avascular but innervated with sensory nerves from CN V1.

Middle Vascular Layer

from posterior to anterior, consists of choroid, ciliary body, and iris

Choroid

Ciliary Bodybetween sclera and retina; highly vascularized to supply retina

Ciliary Body

- divides the posterior and anterior compartments. Structure that encircles the eye opening posterior to the iris

- secretes aqueous humor into posterior chamber of the eye.

- connects the iris, suspensory ligaments, and ora serrata and includes muscles that draws it closer to the lens

- innervated by parasympathetic fibers of CN III

How does the ciliary body increase its focus on nearby objects?

since the lens is suspended from the ciliary body by suspensory ligaments, this action relaxes the suspensory ligaments, allowing the natural elasticity of the lens to become more convex, allowing an increase in focusing ability for near objects

Iris

pigmented diaphragm that regulates the size of the pupil to control the amount of light entering the eye

- the dilator pupillae dilates the pupil and is innervated by sympathetic nerve fibers from the superior cervical ganglion.

- the sphincter pupillae constricts the pupil and are unnerved by parasympathetic fibers of CN III

Optic Disc

a circular region medial to the posterior pole of the retina, where the optic nerve leaves the eyeball

Macula Lutea

just lateral to optic disc; the small yellowish area of the retina near the optic disk that provides central vision

Fovea Centralis

central depressed part of macula lute; the area of highest visual acuity

Ciliary and Iridial Retina

continuations of the the outer pigment cell layer of the retina over the inner surface of the ciliary body and iris; not light sensitive.

Retinal Detachment

separation between the pigment epithelium and the neural layers of the neural retina

Aqueous Humor

flows from the posterior chamber to the anterior chamber and is drained into the venous system at the scleral venous sinus (canal of Schlemm) at the iridocorneal angle

Vitreous Body

transparent jelly like filling the space between the lens and the retina, forms the posterior 4/5 of the eyeball

Conjunctiva

thin, vascular, transparent mucous membrane covering the sclera (bulbar) and the inner surfaces of the eyelids (palpebral)

blood supply of the eyeball

1. ophthalmic artery branches, from the internal carotid artery

2. ophthalmic veins which drain into facial vein or into the cavernous vein.

Levator Palpebrae Superioris

innervated by CN III, elevates upper eyelid

Lateral Rectus

abducts eye

Medial rectus

adducts eye

Superior Rectus

elevates/adducts eye

Inferior Retus

depress/adduct eye

Superior Oblique

- inserts posterior to the equator of the eye

- depresses

-abduction

Inferior Oblique

- inserts posterior to the equator of the eye

- elevates

-abduction

All the extra ocular muscles are innervated by CN III except

1. Lateral Rectus - CN VI

2. Superior Oblique - CN IV

What is the buttocks?

the gluteus maximus and the gluteus medius with superficial fascia

Gluteus Maximus

Origin: iliac crest, sacrum, sacrotuberous ligament

Insertion: iliotibial tract, gluteal tuberosity, femoral shaft

Main Action on Thigh: extension, lateral rotation

Innervation: inferior gluteal n.

Gluteus Medius

Origin: ilium external surface

Insertion: greater trochanter

Main Action on Thigh: abduction, medial rotation; and prevents pelvic tilt with gait

Innervation: superior gluteal n.

Deep to gluteus maximus

Gluteus Minimus

Origin: ilium external surface

Insertion: greater trochanter

Main Action on Thigh: abduction, medial rotation; and prevents pelvic tilt with gait

Innervation: superior gluteal n.

Deep to gluteus medius

Piriformis

Origin: sacrum, sacrotuberous ligament

Insertion: greater trochanter

Main Action on Thigh: laterally rotates the thigh and stabilizes the femoral head in the acetabulum

Innervation: inferior gluteal n.

More medial to gluteus minimus muscle

Gemellus Superior

Origin: ischial spine

Insertion: greater trochanter

Main Action: laterally rotate the thigh and stabilize the femoral head in the acetabulum

Obturator Internus

Origin: inner surface of obturator foramen

Insertion: greater trochanter

Main Action: laterally rotate the thigh and stabilize the femoral head in the acetabulum

Gemellus Inferior

Origin: ischial tuberosity

Insertion: greater trochanter

Main Action: laterally rotate the thigh and stabilize the femoral head in the acetabulum

Obturator Externus

Origin: outer margins of obturator foramen

Insertion: greater trochanter

Main Action: laterally rotate the thigh and stabilize the femoral head in the acetabulum

Deep to quadratus femoris

Quadratus Femoris

Origin: ischial tuberosity

Insertion: intertrochanteris crest of the femur

Main Action: laterally rotate the thigh and stabilize the femoral head in the acetabulum

Sciatic Nerve

it is the tibia nerve and the common fibular nerve wrapped in a common connective tissue sheath. Enters the gluteal region via the greater sciatic foramen and passes inferably deep to the gluteus maximus. DOES NOT SUPPLY MUSCLES IN THE GLUTEAL REGIONS. instead it innervates the muscles of the posterior thigh, leg and foot

Sciatica

Compression of sciatic nerve causing back pain with radiation to posterior leg

Trochanteric Bursitis

Inflammation at the site where the gluteus medius inserts or the IT-band passes over the trochanter

Iliotibial Band Syndrome

Over use injury. Cause by this band rubbing against bone, often in the area of the knee.

Piriformis Syndrome

→compression of the sciatic nerve

→caused when piriformis muscle is too big squishes the nerve: or due to overuse and random spasms.

The iliofemoral ligament

found on the anterior part of the joint and prevents overextension and helps maintain erect posture by resisting the hip extension caused by bearing weight

The ischiofemoral ligament

found posteriorly, and also limits extension

The pubofemoral ligament

found interiorly; prevents overabduction

Most of the blood supply of the head of the femur comes from the

medial and lateral femoral circumflex vessels, branches of the deep femoral artery or the femoral artery; these branches can be injured when the neck of the femur is fractured leading to aseptic necrosis of the head of the femur

The quadriceps femoris inserts onto the

tibial tuberosity

Deep Fascia

fascia lata in the thigh, and the crural fascia in the leg.

Along the lateral aspect of the knee and leg is called the

iliotibial tract

what do the fascia late and crural fascia do?

they help pump venous blood out of the lower limb; when the muscles of the lower limb contract, these fasciae prevent them from bulging outward and forces them to compress thin-walled veins. the fascia surrounding the lower limb also helps the various muscles to work more efficiently in unison as we walk and run

In the superficial fascia are the

superficial veins and cutaneous nerves.

what is the most important superficial vein?

the great saphenous vein; this vein drains blood from the medial aspect of the foot, leg, and thigh, and returns this blood to the femoral vein by passing through an opening in the fascia late of the proximal thigh called the saphenous opening

- the great saphenous vein can be found running just anterior to the medial malleolus at the ankle