Gross 2 Exam 1 pt.1

Bell’s Palsy

• Facial nerve paralysis

• Paralysis of all pharyngeal arch muscles

What nerve is the motor innervation for the muscles of facial expression?

Facial nerve

What nerve is the sensory innervation to the face?

Trigeminal nerve

What are the three divisions of the trigeminal nerve?

1. Ophthalmic n. (V1) - face and scalp

2. Maxillary n. (V2) - cheek and area lateral to orbit

3. Mandibular n. (V3) - chin and temporal region

What are the 5 branches of Ophthalmic n.? (Hint - LIESS)

1. Lacrimal n.

2. Infratrochlear n.

3. External Nasal n.

4. Supraorbital n.

5. Supratrochlear n.

What are the 3 branches of Maxillary n.? (Hint - IZZ)

1. Infraorbital n.

2. Zygomaticotemporal n.

3. Zygomaticofacial n.

What is the most commonly injured nerve with a blow to the face?

Infraorbital n.

What are the branches of the Mandibular n.? (Hint - BAM)

1. Buccal n.

2. Auriculotemporal n.

3. Mental n.

Which division of the trigeminal nerve is the most commonly affected?

Maxillary division

What is the sensory innervation of the posterior aspect of the neck and scalp?

Posterior primary rami of cervical nerves 2-4

What nerve supplies sensory innervation to the occipital region?

Greater occipital n. (Posterior primary ramus of C2)

What nerve supplies sensory innervation to the upper part of the back of the neck?

Third occipital n. (Posterior primary ramus of C3)

What nerve supplies sensory innervation to the lower part of the back of the neck?

Posterior primary ramus of C4

T/F: C1 has no posterior root carrying sensory fibers (usually no sensory function)

True

What are the sensory branches of the Cervical plexus?

1. Lesser occipital n. (C2)

2. Great auricular n. (C2,C3)

3. Transverse cervical n. (C2,C3)

4. Supraclavicular n. (C3,C4)

What are the subdivisions of the supraclavicular n.?

1. Medial supraclavicular n.

2. Intermediate supraclavicular n.

3. Lateral supraclavicular n.

What part of the Ansa Cervicalis is NOT a branch of the Hypoglossal n.?

Inferior root (C2,C3)

What muscles does the Ansa Cervicalis supply?

1. Sternohyoid

2. Sternothyroid

3. Omohyoid

Which infrahyoid muscle is NOT innervated by the Ansa Cervicalis?

Thyrohyoid

What muscle does the Phrenic n. (C3,C4,C5) innervate?

Diaphragm

T/F: The Phrenic n. can be found on the anterior surface of the posterior scalene muscle

False - Anterior scalene

What is the nerve and function of Platysma?

Nerve: CN VII (Facial n.)

Function: Depresses the mandible and draws down the corner of the mouth

What is the nerve and action of the Sternocleidomastoid?

Nerve: CN XI (Accessory n.)

Function: Chief flexor of the head

How would torticollis affect the positioning of the head?

Tilt the head toward and face away from the affected side

What are the types of torticollis?

1. Congenital - fibrous tissue tumor

2. Muscular - birth injury

3. Spasmatic - abnormal tonicity

What is the function of the trapezius

Upper portion - elevates scapula

Middle portion - retracts scapula

Lower portion - depresses scapula

What is a primary cause for people having problems with upper trapezius?

Texting and computers

Which vein drains blood from the face, scalp, and contains a large amount of cerebral blood?

External Jugular v.

Which veins join to form the external jugular v.?

1. Retromandibular v.

2. Posterior auricular v.

3. Posterior external jugular v.

4. Anterior jugular v.

5. Transverse cervical v.

6. Suprascapular v.

Where is the external jugular v. located?

Lateral surface of the sternocleidomastoid

T/F: Variations of the arrangement for the tributaries of the external jugular v. never occur

False

What is a common pathological cause for a prominent external jugular v.?

Congestive heart failure or obstruction of the superior vena cava

What is a NON-pathological cause for a prominent external jugular v.?

Opera singer and bagpipe players, due to increase in intrathoracic pressure when singing/playing

Which lymph nodes are found along the external jugular v.?

Superficial cervical lymph nodes

What are the boundaries of the posterior triangle?

SCM, Trap, Clavicle

What are the boundaries of the anterior triangle?

Mandible, anterior midline, SCM

What structure does the apex of the anterior triangle lie inferior to?

Jugular notch

What are the subdivisions of the anterior triangle?

1. Submental triangle

2. Submandibular triangle

3. Carotid triangle

4. Muscular triangle

Which of the anterior triangle subdivisions is unpaired?

Submental

What are the boundaries of the submental triangle?

• Left & right anterior bellies of digastric

• Body of hyoid bone

What are the contents of the submental triangle?

Minor veins and lymph nodes

What are the contents of the submandibular triangle

• Submandibular gland

• Internal carotid a.

• Facial a.

• Internal jugular v.

• Glossopharyngeal n. (CN IX)

• Vagus n. (CN X)

Which triangle do you have to use caution while palpating and adjusting?

Submandibular

What are the contents of the carotid triangle?

• Common & internal carotid arteries

• External carotid a.

• Superior thyroid a.

• Lingual a.

• Facial a.

What is the contents of the muscular triangle?

• Sternohyoid & sternothyroid m.

• Thyroid gland

• Trachea

• Esophagus

What bone can be used for forensics when broken?

Hyoid

T/F: The hyoid bone articulates with other bones

False

What are the parts of the hyoid bone?

1. Body

2. Greater horn

3. Lesser horn

What muscles insert into the hyoid?

Superficial - Omohyoid & Sternohyoid

Deep - Sternothyroid & Thyrohyoid

What is the innervation of the omohyoid?

Ansa cervicalis (C1-C3)

What is the nerve innervation of Sternohyoid?

Ansa cervicalis )C1-C3)

What is the innervation of Sternothyroid?

Ansa cervicalis (C1-C3)

What is the innervation of Thyrohyoid?

Only C1 fibers through Hypoglossal n.

Why do all of the strap muscles depress the hyoid bone and larynx?

1. Swallowing

2. Speech

3. Respiration

4. Digastric depresses mandible if hyoid is fixed

What does the pretracheal fascia enclose?

• Thyroid gland

• Trachea

• Esophagus

Which deep cervical fascia is paired?

Carotid sheath

What structure is not found in the carotid sheath?

External carotid a.

What is the function of the cervical fascial layers?

Decreases friction during gross movements of the head/neck & swallowing

Adhesions in the cervical fascial layers leads to what clinical symptoms?

Neck pain

What is the clinical significance of the cervical fascial layers?

Cancer involving the deep cervical lymph nodes can compress internal jugular veins

What are the boundaries of the Superior thoracic aperture (thoracic inlet)?

1. T1

2. Rib 1

3. Manubrium of sternum

What shape is the superior thoracic aperture similar to?

Kidney

What are the arteries that pass through the thoracic inlet?

1. Brachiocephalic trunk

2. Left Common carotid

3. Left Subclavian

4. Internal thoracic

What nerves pass through the thoracic inlet? (Hint - RSVP)

1. Recurrent laryngeal

2. Sympathetic trunk

3. Vagus

4. Phrenic

What viscera passes through the superior thoracic aperture?

1. Cervical pleura

2. Apex of lung

3. Thymus

What increases the potential for lung collapse(atelectasis)?

A broken first rib or penetrating wound

What shrinks after puberty and leads to a decrease in immune function with age?

Thymus

What does the thymus produce?

T-lymphocytes

Where do T cells mature throughout a person’s lifetime?

Thymus

What does the thymus lie inferior to?

Thyroid gland

What do the sternohyoid and sternothyroid lie anterior to?

Thymus and thyroid gland

What produces thyroxine and calcitonin?

Thyroid gland

At what level does the thyroid gland lie?

C5-T1

What shape is the thyroid gland typically in?

H or U

What is the function of the isthmus of the thyroid gland?

Connects the left and right lobes

What percentage of thyroid glands have a pyramidal gland?

50%

What is another common variation associated with the thyroid gland that connects the isthmus of the thyroid gland to the hyoid bone?

Levator glandulae thyroideae muscle

What causes the thyroid gland to be highly vascular?

Endocrine function

10% of people have what artery that connects to the thyroid gland from the brachiocephalic trunk?

Thyroid Ima a.

Which vein from the Thyroid gthe land does NOT drain into the internal jugular v.?

Inferior thyroid v.

What causes endemic goiter?

Dietary deficiency of iodine

Which type of goiter mimics hypothyroidism due to the hormone being largely inactive?

Endemic goiter

What causes exophthalmic goiter?

Autoimmune disease

T/F: Someone suffering from hyperthyroidism (Grave’s disease) will have active thyroid hormones being released from their thyroid gland

True

Which nerve supplies all but one of the laryngeal muscles with motor innervation?

Recurrent laryngeal n.

What is the classification of the parathyroid glands?

Endocrine

How many parathyroid glands are found on the posterior surface of the thyroid gland?

4

What is the purpose for the opening on the back of the cartilaginous rings on the trachea?

Allows for expansion of esophagus during swallowing

What is the name of the muscular tube that connects the pharynx to stomach and is posterior to the trachea?

Esophagus

What are the main arteries of the head and neck?

Left and right common carotid arteries

What fascial sheath does the common carotid artery ascend within?

Carotid sheath

T/F: The external carotid artery branches to supply structures of the neck, face, and scalp

True

What are the branches of the external carotid artery?

1. Superior thyroid

2. Ascending pharyngeal

3. Lingual

4. Facial

5. Occipital

6. Posterior auricular

7. Superficial temporal

8. Maxillary

What are the terminal branches of the external carotid artery?

• Superficial temporal a.

• Maxillary a.

What is the function of the carotid body?

Chemoreceptor - detect chemical changes in the blood (O2/CO2)

What is the function of the carotid sinus?

Baroreceptor - detect changes in blood pressure

What nerve innervates the carotid sinus?

Glossopharyngeal n. (CN IX)

What does the internal jugular v. drain into?

Brachiocephalic v.

Which is NOT a tributary of the internal jugular v.?

Inferior thyroid v.

What are the tributaries of the internal jugular v.?

1. Inferior petrosal sinus

2. Pharyngeal veins

3. Facial v.

4. Lingual v.

5. Superior thyroid v.

6. Middle thyroid v.