Clinical Anatomy

Head and Neck Exam

Petrous ridge

separates the MCF from the PCF

Tentorium

dural reflection that separates the cerebrum from the cerebellum and brainstem

Where is the Pterygopalatine Fossa?

zygomatic arch, on the backside of the maxillary bone

What does the PPF hold?

Maxillary Nerve, Vidian nerve, Pterygopalatine ganglion, Maxillary artery

What is the infratemporal fossa?

space behind the masseter muscle and zygomatic arch

What fills most of the Infratemporal fossa?

temporalis muscle

What is found inside of the Infratemporal fossa?

Branches of the Maxillary artery, pterygoid venous plexus, nerves

What nerves are found in the infratemporal fossa?

Mandibular, inf. alveolar, lingual, buccal, chorda tympani, otic ganglion

CN V is AKA....?

Trigeminal nerve

Where does CN V leave the brainstem from?

pons

What leaves the pons and fuses to create the trigeminal ganglion?

large sensory branch and small motor branch

The trigeminal ganglion is AKA...?

Gasserian ganglion

What are the 3 divisions of the gasserian ganglion?

v1 - ophthalmic
v2 - maxillary
v3 - mandibular

Which divisions of CN V are purely sensory? Which are mixed?

v1 and v2 - purely sensory
v3 - mixed

Which part of CN V passes through the PPF?

v2

What does the v1 sensory field include?

cornea, superior palpebral conjunctiva, bulbar conjunctiva

What CN is the submandibular gland innervated by?

CN VII

What gland is located under the tongue?

Sublingual

What is the parotid gland?

makes saliva and brings it to the upper part of the mouth

Where does the parotid gland enter?

above and lateral to 2nd molar

What innervates the platysma?

CN VII

Where is the thyroid?

bridges the midling, covers the 2-3rd tracheal ring

What type of gland is the thyroid?

endocrine

What is the purpose of the thyroid gland?

it regulates calcium

What arteries serve the thyroid?

1. external carotid
2. thyrocervical trunk

What veins serve the thyroid?

1. internal jugular
2. inferior thyroid vein
3. brachiocephalic

How many parathyroid glands do we usually have?

4

What glands were recently discovered?

Tubarial glands

Which lymph node does the medial portion of the lid and conjunctiva drain too?

submandibular nodes

Which lymph node does the lateral portion of lids and conjunctiva drain into?

preauricular nodes AKA superficial parotic nodes

What are lymphatic basins?

How the lymph structures are divided in the neck

What are the lymphatic basins important?

drainage patterns exist, can tell where lesion/swollen lymph nodes are

Larynx principle functions

valve separating the air way for the system, voice production

What are surface features of the larynx?

Laryngeal prominence, thyroid notch

What structures of the larynx rise while swallowing?

laryngeal prominence, thyroid notch

What are the 3 paired and 3 unpaired Laryngeal cartilages?

Arytenoid, Corniculate, Cuneiform
Thyroid (u), Cricoid (u), Epiglottis (u)

relative depth of voice is related to ___.

length of vocal cord

What CN are the muscles of the larynx innervated by?

(recurrent laryngeal branch of) CN X

rima glottidis

aperture between vocal folds

glottis

collective term for vocal folds, rima and narrow part of larynx at level of folds

3 stages of deglutition

1. voluntary - bolus pushed from mouth -> oropharynx
2. involuntary - rapid, no chewing or breathing
3. voluntary - contraction of inferior constrictor of pharynx

vestibule

above false vocal folds

vestibular folds

false vocal folds

ventricle of larynx

between the true and false vocal folds

infraglottic cavity

below true vocal folds

thyroid cartilage has ___ and___ horn

superior and inferior

when the lids close, what happens to the eyes?

they elevate (look upwards)

if the lids are not closed fully during sleep, which part of the cornea will be damaged?

inferior cornea

where is the tear meniscus located?

both top and bottom lids

Landmarks of the lid

MGOs, Grey line, Lashes

Layers of skin on the lid

epidermis, dermis, NO hypodermis

what muscles are found in the lid?

orbicularis oculi muscle, levator palpebral muscle, Mueller's muscle

what does the orbicularis oculi muscle do?

closes the lids

What does the levator palpebral muscle do? What type of muscle is it?

raises the lid, skeletal muscle

What does the Mueller's muscle do? What type of muscle is it?

it holds the lid once its been lifted, smooth muscle

What is the levator aponeurosis?

Orbital septum

What is the function of the levator aponeurosis?

barrier, travels around the whole eye

What is the tarsal plate?

reinforcement for the lid, where the Meibomian (tarsal) glands

In the lid we can find palpebral conjunctival ___ and ___.

stroma and epithelium

Layers that can be found in the lid epidermis and dermis

basal cell, prickle cell, granular, keratinized, rete pegs, lid skin

What are the subparts of the orbicularis oculi muscle?

orbital, preseptal, pertarsal, muscle of riolan, horner's muscle

orbital part of the OOM

portion that is over/outside the bone, outermost section

Preseptal part of OOM

below the orbital rim

Pretarsal part of the OOM

overlies the tarsal plate, getting closer to the lid margin

Muscle of Riolan part of OOM

rims the lid margins, upper and lower

Horner's muscle part of OOM

where the superior and inferior muscle of riolan fuse at the medial canthus and attach to the bone

inputs to the portion of the motor nucleus of CN VII serving the temporal branch are ___

bilateral

If there is a lesion below the moto nucleus of CN VII, is bilateral cortical representation affected? How will the lid close?

Bilateral representation IS affected, lids WILL NOT close effectively

What type of tissue is the orbital septum? Where is it?

striated white tissue that runs all the way around the lids

What is Whitnall's Ligament?

large CT band that connects to upper medial portion behind the orbital rim, and then runs right along the levator all the way across to lacrimal gland

What type of tissue is the tarsal plate

dense connective tissue

What are the glands of the lids

Sebaceous, accessory, moll-modified sweat, eccrine (merocrine), meibomian, glands of zeiss, glands of moll, goblet cells

What do the lateral palpebral arteries arise from?

lacrimal artery

What do the medial palpebral arteries arise from?

ophthalmic artery

Why is this area considered a danger zone?

infections in this area can cause cavernous sinus thrombosis or brain abscess

where drainage of the face goes into the _____ _____.

cavernous sinus

what type of gland is the lacrimal gland?

exocrine

what is pathway of tears in the nasolacrimal system?

Lacrimal gland → Inferior puncta → Lacrimal sac → Nasolacrimal duct → Inferior concha/meatus

Blink cycle

1. lid is open
2. lacrimal sac is at atmospheric pressure and is filled with tears
3. initiate a blink
4. lacrimal sac is squeezed
5. tears are squirted out the bottom into inferior meatus
6. valve of Hasner closes after tears are deposited
7. lids come together
8. both puncta are immersed in lacrimal lake and draw in fluid to reinflate the sac (relieve negative pressure)

What animal does the human embryo represent?

fish

What is the branchial apparatus composed of?

branchial arches, branchial grooves, pharyngeal pouches

When do the branchial arches appear?

3rd week

How many branchial arches are there? Which are vestigial?

6 arches, 5th and 6th are vestigial

What are the first 2 branchial arches named?

1. Mandibular
2. Hyoid

What are the divisions of the 1st branchial arch?

(smaller) upper maxillary processes
(larger) lower mandibular processes

What process is above the mandibular arch?

frontonasal process

What does each arch contain

aortic arch artery, cartilaginous bar, somemuscle, cranial nerve

what CN innervates the 1st arch?

CN V

what CN innervates the frontonasal process?

CN V1

what CN innervates the maxillary process of arch 1?

CN V2

What CN innervates the mandibular process of Arch 1?

CN V3

What CN innervates the 2nd branchial arch?

CN VII - muscles of arch 2 are muscles of facial expression

What CN innervates the 3rd branchial arch?

CN IX - glossopharyngeal, pharynx, esophagus

What CN innervates the 4th-6th arch?

CN X (recurrent laryngeal branches of CN X)

What is each arch lined with on the inside and outside? What do the linings cover?

1. inside - endoderm
outside - surface ectoderm
2. mesoderm and neural crest

What are the pinches inside and outside of the branchial groove called?

inside - pharyngeal pouch
outside - branchial groove

What arches is branchial groove #1 between? Does it remain in adults?

Between Arch 1 and 2, remains in adults as external meatus

Do arches 3-6 remain in adults?

No, covered by fusion of arch 3 and 4-6 to produce a temporary cervical sinus

What does the temporary cervical sinus in embryos become in adults?

neck

What do all of the pharyngeal pouches become?

1st pouch - pharyngotympanic (eustachian) tube from middle ear cavity to back of oropharynx

2nd pouch - ducts of palatine tonsils

3rd pouch - lower parathyroids

4th pouch - upper parathyroids

5th-6th pouch - ultimobranchial bodies which give parafollicular cells of thyroid contributing to regulation of calcium