head and neck anatomy ch 7-9 exam

duct

• passageway to carry secretion from the exocrine gland to set location

exocrine

• gland with associated duct serving as passageway

• all major and minor salivary glands or sweat glands

• only glands that have ducts

endocrine

• ductless gland with secretions being poured directly into vascular system

• what they make is secreted directly into bloodstream 

• adrenal glands

primary lymph nodes

• organs include the bone marrow and thymus

• create special immune system cells called lymphocytes

secondary lymph nodes 

• organs include the lymph nodes, the spleen, the tonsils and certain tissue in carious mucous membrane layers in the body

• lymph only comes from a primary node

do not

unlike blood vessels, lymph vessels __ __ have valves to prevent backflow from occurring

parotid gland

• the largest salivary gland 

• is encapsulated

• innervated by the 9th cranial nerve

• empties around the 2nd maxillary molar which is a site of calculus build-up

another name for parotid duct

• stenson duct

percentage of saliva excreted from parotid duct

• 25%

• serous secretion

mumps is a result of this enlarged saliva gland

parotid

submandibular gland

• is encapsulated 

• innervated by the 7th cranial nerve

• gland drains into the submandibular lymph nodes

• most common site for salivary stones

• seen externally as the sublingual caruncle

another name for submandibular gland

• Wharton’s duct

• “men go to war”

percentage of saliva secreted from submandibular gland

• 65%

• mixed secretions, mostly serous

sublingual gland

• located below the tongue

• is the only gland not encapsulated

• innervated by the 7th and 9th cranial nerve

• seen externally as sublingual caruncle

percentage of saliva excreted by sublingual gland

• 10%

• mixed secretions but mostly mucous

minor salivary glands

• they are most numerous but generally smaller

• located on soft palate, hard palate, and every type of mucosa

• all secrete mucous saliva EXCEPT Von Ebner

thyroid gland

• 2 lobes

• is the largest endocrine gland in the body

• located below the thyroid cartilage where the larynx meets the trachea

• not visible in healthy patients

• deals with metabolism and hormones

  • thyroxine (T4)!!

hormone secreted by thyroid

• thyroxine

what regulated the thyroid

• pituitary gland

where does the thyroid gland drain

• into superior deep cervical lymph node

arteries that supplies the thyroid

• inferior and superior thyroid arteries

parathyroid

• 4 small bean shaped glands on the back of the thyroid gland

• cannot be palpated

• produces and secretes the parathyroid hormone which regulates calcium and phosphorus levels

where do parathyroid veins drain

• into the thyroid vein plexus

where do parathyroid lymphatic vessels drain

• into the deep cervical lymph nodes

lacrimal glands

• located within the orbit above the lateral end of the eye

• sits in lacrimal fossa

• tears flow down to the medial canthus and drain into the inferior nasal meatus

  • (runny nose when crying)

• innervated by the 7th cranial nerve

• composed of epithelial and lymphatic tissue

cervical lymph nodes

• receive all the lymph from the head and neck 

  • either directly or indirectly via the superficial lymph nodes

• these lie along the internal jugular vein

thymus

• primarily to produce and mature T-cells

• superficial and lateral to the trachea and deep to sternum (cannot palpate)

• attached to lobes of thyroid gland

• innervated by the 10th cranial nerve

• supplied by inferior thyroid and internal thoracic arteries

• shrinks after puperty

T-cells

• a type of white blood cell that helps the body fight infection and disease

nerve

• bundle of neural processes outside the CNS

  • parts of peripheral nervous system

nervous system

• extensive, intricate network of structures that activates, coordinates, and controls all functions of body

neuron

• cellular component of nervous system

  • composed of a cell body and neural processes

afferent nerve

• SENSORY nerve carry info from body periphery TO brain or spinal cord

  • periphery → brain/spinal cord

efferent nerve 

• MOTOR nerve carrying info AWAY from brain or spinal cord to periphery 

  • brain/spinal cord→ periphery

dental plexus

• network of nerves within both maxillary and mandibular arches

synapse

• junction between 2 neurons or between neuron and effector organ that transmits through electrical or chemical means

the two components of nervous system

• central nervous system

• peripheral nervous system

central nervous system (CNS)

• brain and spinal cord 

peripheral nervous system (PNS)

• composed of afferent and efferent nerves

  • automatic nervous system

  • somatic nervous system

automatic nervous system

• involuntary

  • sympathetic nervous system

  • parasympathetic nervous system

somatic nervous system

• voluntary actions and movements

  • muscle innervation

sympathetic nervous system

• fight or flight

parasympathetic nervous system

• rest and digest

CN I- Olfactory

• afferent only

• responsible for sense of smell

• passes through cribriform plate of ethmoid bone

  • ( cribs smell)

CN II - Optic

• afferent only

• responsible for vision

• enters optic canal of sphenoid bone

• both R and L nerves join at the optic chiasma where the fibers cross to contralateral sides before entering the brain

CN III - oculomotor

• efferent only

• controls most eye muscles and pupil constriction

• passes through superior orbital fissure of sphenoid bone

CN IV - Trochlear

• efferent only

• controls superior oblique muscles of the eye

• exits skull through superior orbital fissure of sphenoid bone

CN V - Trigeminal

• both sensory and motor roots

• afferent- teeth, tongue, oral cavity, lacrimal gland, nasal cavities, and skin of face

• efferent - muscle of mastication

• three divisions

  • opthalmic (V1)

  • maxillary (V2)

  • mandibular (V3)

opthalmic division of trigeminal nerve

• sensory

• enters at superior orbital fissure

maxillary branch of trigeminal nerve

• sensory

• enters at foramen rotundum

mandibular branch of trigeminal nerve

• motor AND sensory

• enters at foramen ovale

CN VI - Abducens

• efferent only

• supplies muscles for eye movement and innervates lateral rectus muscle of eye

• exits through superior orbital fissure of sphenoid bone

• 1st nerve affected by serious sinus infections

CN VII - Facial

• both afferent and efferent

• efferent - facial expression muscles

• afferent - taste anterior 1/3 of the tongue

• passes through stylomastoid foramen

• gives motor innervation to stylomastoid muscles

bells palsy

• paralysis of facial nerve

chorda tympani

• branch of facial nerve

CN VIII -Vestibulocochlear

• afferent only

• helps with hearing and balance

• passes through internal acoustic meatus 

• damage causes vertigo, hearing loss, tinnitus

CN IX- Glossopharyngeal

• both motor and sensory

• efferent - stylopharyngeus muscle, parotid gland

• afferent - taste and sensation to posterior 1/3 of tongue

  • includes gag reflex

• passes through jugular foramen

CN X- Vagus

• both motor and sensory 

• efferent - soft palate, pharynx, larynx, thoracic organs

• afferent - taste sensation for epiglottis

• passes through jugular foramen

• helps with speech and swallowing

CN XI - Accessory

• motor only

• provides innervation for trapezius and sternocleidomastoid muscles, muscle of soft palate, and muscles of pharynx

• passes through jugular foramen

• damage may cause shoulder droop and difficulty turning head

CN XII- Hypoglossal

• motor only

• controls tongue movements

• aids in speech

• passes through hypoglossal canal of occipital bone

branches we block for trigeminal nerve

• V2 Maxillary

• V3 Mandibular 

maxillary arch local anethetic blocks

• PSA

• MSA

• ASA

• NP

• GP

Mandibular arch local anethetic blocks

• IA

• Long buccal nerve block

• mental/ incisive nerve block 

posterior superior alveolar nerve block (PSA)

• insertion: mucobuccal fold above the DB root of the 2nd molar

  • target is maxillary tuberosity

• can cause hematoma if injected into pterygoid plexus

• teeth anesthetized: maxillary molars except the MB root of the 1st molar

• soft tissue anethetized: buccal gingiva of the maxillary molars

middle superior alveolar nerve block (MSA)

• insertion: mucobuccal fold above 2nd premolar 

• teeth anesthetized: maxillary premolars and MB root of the 1sst molar

• soft tissue anethetized: buccal gingiva of maxillary premolars

anterior superior alveolar nerve block (ASA)

• insertion: height of the mucobuccal fold near mesial aspect of maxillary canine

• teeth anesthetized: maxillary incisors/cuspids and MSA teeth

• soft tissue anesthetized: maxillary incisors and cuspid gingiva

Nasopalatine nerve block (NP)

• insertion: palatal mucosa just lateral to the incisive papilla

• soft tissue anethetized: lingual gingiva of the maxillary incisor/cuspids

greater palatine nerve block (GP)

• Insertion: apply pressure to slightly bow needle at junction of alveolus and hard palate of the greater palatine foramen and inject anterior to the cotton tip applicator

• locate the foramen before injecting an utilize pressure anesthesia!

• soft tissue anesthetized: lingual gingiva of the maxillary molars/ premolars 

Inferior alveolar nerve block (IA)

• mandibular block

• most commonly used block in dentistry

• anesthetizes: mandibular teeth to midline, associated lingual periodontium, gingiva, and facial periodontium to the midline

• target: IA nerve exiting the mandibular foramen on medial surface of the mandibular ramus

• insertion: 2/4 distance from coronoid notch to deepest part of the pterygomandibular raphe, 6-10 mm above mandibular occlusal plane

• can cause hematoma if injected into pterygoid plexus

long buccal nerve block

• anesthetizes: long buccal nerve, associated buccal periodontium and gingiva of mandibular molars within

• insertion: mucous membrane distal and buccal to last molar and parallel to occlusal plane 

• long buccal block + IA = complete mandibular quadrant anesthesia 

mental / incisive nerve block

• anesthetizes: mental nerve, associated periodontium, and gingiva of mandibular anterior teeth and premolars to midline

  • includes lower lip and chin

• insertion: mucobuccal fold, just anterior to mental foramen, parallel to long axis of tooth

  • right between premolars

Vazirani-Akinosi nerve block

• anesthetizes: IA, lingual, mental, incisive, and mylohyoid nerves (within pterygomandibular space), and long buccal nerve 75% of the time

• mandibular teeth to midline and associate periodontium, and gingiva

• more similar to IA block in coverage

Gow Gates

• anesthetizes: IA nerve, lingual nerve, mental, incisive, mylohyoid, auriculotemporal, and long buccal nerve

• considered the true mandibular block because it anesthetizes entire mandibular nerve and its branches 

mneumontic for cranial nerve names

• Oh

• Once

• One

• Takes

• The

• Anatomy

• Final

• Very

• Good

• Vacations

• Are

• Heavenly

mneumonic for sensory motor or both

• some

• say

• marry

• money

• but

• my

• brother

• says

• big

• boobs

• matter

• more

SAME mneumonic

• Same/Afferent

• Motor/ Efferent

foramen location of the olfactory nerve

• cribriform plate of the ethmoid bone

foramen location of the optic nerve

• optic canal of sphenoid bone

• eventually crosses over in the optic chiasm 

foramen location of the oculomotor nerve

• superior orbital fissure of sphenoid bone

foramen location of the trochlear nerve

• superior orbital fissure of the sphenoid bone

foramen location of the trigeminal nerve

• different for each branch

  • opthalmic = superior orbital fissure

  • maxillary = rotundum

  • mandibular = ovale

foramen location of the abducens nerve

• superior orbital fissure of the sphenoid bone

foramen location of the facial nerve

• exits skull via stylomastoid foramen

• “need style”

foramen location of the vestibulocochlear nerve

• internal acoustic meatus

foramen location of the vagus nerve

• jugular foramen

foramen location of the glossopharyngeal nerve

• jugular foramen

foramen location of the accessory nerve

• jugular foramen

foramen location of the hypoglossal * nerve

• hypoglossal canal