Spinal Exam 4- Head and Neck

When does the metopic suture close?

1st year

When does the coronal suture close?

24 years

When does the sagittal suture close?

21-30 years

When does the lambdoid suture close?

26 years

What is considered a weak point in the skull?

pterion

What does the anterior skull derive from?

neural crest cells and pharyngeal arches

What does the posterior skull derive from?

paraxial mesoderm

What type of ossification does the base of the skull go through?

endochondral

What type of ossification does most of the skull bones go through?

intramembranous

When do fontanelles close?

posterior- 2-3 mos.

sphenoidal-6 mo.

mastoid- 6-8 mos.

anterior- 1-3 yrs.

What is craniosynostosis?

premature fusion of sutures

affects bones associated with intramembranous cranial vault

What is achondroplasia?

early fusion of epiphyses in limb bones and synchondroses of skull bones

affects endochondral ossification

What does the anterior cranial fossa house?

frontal, ethmoid, and sphenoid bones

olfactory bulb, attachment for falx cerebri

What does the middle cranial fossa house?

temporal, sphenoid, parietal bones

pituitary gland, CN II-VI

What does the posterior cranial fossa house?

sphenoid, temporal, occipital bones

cerebellum, pons, and medulla

internal acoustic meatus, foramen magnum, jugular foramen, hypoglossal canal

What houses inner ear structures?

petrosal portion of temporal

What is the only movable joint in the adult skull?

TMJ

What does the trigeminal nerve and its divisions supply cutaneous innervation to ?

Ophthalmic division: nose (apex), orbit, eye, forehead

Maxillary division: upper lip, nose (ala), anterior temporal region

Mandibular division: lower lip, anterior auricle, temporal region

What does the great auricular supply cutaneous innervation to?

skin around parotid and auricle

What does the lesser occipital supply cutaneous innervation to?

skin behind auricle

What is trigeminal neuralgia?

aka tic douloureux

compression of CN V

sudden/severe sharp facial pain

COMMON IN MAXILLARY DIVISION

Where do the muscles of facial expression derive from? originate? insert?

Derive: second pharyngeal arch

Originate: fascia and bone

Insert: skin

Why are muscles of facial expression unique?

do not connect two bones together

Bony attachments may be completely missing in all of the following except for

A.) Procerus

B.) Risorius

C.) Orbicularis oculi

D.) Oribicularis oris

C.) orbicularis oculi

What is the motor and sensory innervation of the muscles of facial expression?

Motor: Facial nerve

Sensory: trigeminal nerve

Where does the facial nerve exit?

stylomastoid foramen

Where does the facial nerve enter?

parotid gland

What are the branches of facial nerve?

1. Temporal

2. Zygomatic

3. Buccal

4. Mandibular

5. Cervical

6. Posterior auricular branch

What is bell’s palsy?

facial muscle paralysis- entire ½ of face usually paralyzed ipsilateral to lesion

facial dropping or sagging, may be dribbling out on side of mouth

idiopathic- 80% affected make full recovery

What are the layers of the scalp?

1. Skin

2. Dense connective tissue

3. Epicranial aponeurosis

4. Loose connective tissue

5. Pericranium

What is the arterial supply to the face?

1. facial artery

2. superficial temporal artery

What is the venous drainage of the face?

1. Facial vein

2. Retromandibular vein

What is the lymphatic drainage of the face?

1. Submental

2. Submandibular

3. Parotid

4. Retromandibular

5. Occipital

What region has secretomotor innervation?

parotid

What is the parasympathetic innervation of the parotid region?

glossopharyngeal nerve

Where do preganglionic fibers from foramen ovale (lesser petrosal n.) synapse?

otic ganglion

What do postganglionic fibers from parotid region “hitch a ride” on?

auriculotemporal nerve

What is the passage of the parotid duct?

passes over masseter and buccinator

opens into oral vestibule

located by 2nd maxillary molar over posterior 1/3 of tongue

What is the sensory innervation of the parotid gland?

1. great auricular nerve

2. auriculotemporal nerve

What structures are found within the parotid gland?

1. lymph nodes

2. facial nerve and branches

3. external carotid artery

4. retromandibular vein

5. great auricular nerve

6. auriculotemporal nerve

What are the mumps?

swelling of the parotid gland

What forms the floor of the temporal fossa?

four skull bones (frontal, parietal, temporal, sphenoid)

What forms the roof of the temporal fossa?

temporal fascia, investing deep fascia of the temporalis muscle

What is the innervation of the temporalis m.?

mandibular nerve

What is the insertion of the temporalis m.?

coronoid process

What is the innervation of the masseter?

mandibular nerve

What are the contents of the infratemporal region?

1. inferior portion of temporalis mm.

2. lateral and medial pterygoid

3. maxillary vein and artery

4. pterygoid venous plexus

5. mandibular division of V3

6. chorda tympani

7. otic ganglion

What is the lateral boundary of the infratemporal region?

internal surface of ramus of mandible

What is the inferior boundary of the infratemporal region?

medial pterygoid attachment to mandible

What are the muscles of mastication innervated by?

mandibular division of V3

What are muscles of mastication derived from?

1st pharyngeal arch

What are the muscles of mastication?

1. Temporalis

2. Masseter

3. Medial pterygoid

4. Lateral pterygoid

What is the TMJ?

temporomandibular joint

modified hinge-type joint

What are the two cavities of the TMJ responsible for?

Upper: gliding movements, protrusion and retrusion

Lower: hinge movements, opening and closing

What is the nerve supply of the TMJ?

auriculotemporal and masseteric

What are the supporting TMJ ligaments?

1. Temporomandibular ligament- thickening of fibrous capsule

2. Stylomandibular ligament- thickening of deep cervical fascia

3. Sphenomandibular ligament- portion of meckel’s cartilage

What muscles are involved in elevation or closure of mouth?

1. temporalis

2. masseter

3. medial pterygoid

What muscles are involved in depression or opening of mouth?

lateral pterygoid

supra- and infrahyoid

gravity

What muscles are responsible for protrusion of chin?

lateral pterygoid

masseter

medial pterygoid

What muscles are involved in retrusion of chin?

temporalis

masseter

What muscles are responsible for lateral movements like grinding and chewing?

temporalis on same side

pterygoids on opposing side

masseter

What makes up the apex of the orbit?

optic canal

What makes up the superior wall of the orbit?

frontal, lesser wing sphenoid

What makes up the lateral wall of orbit?

zygomatic, greater wing sphenoid

What makes up the medial wall of orbit?

frontal, lesser wing sphenoid, ethmoid, lacrimal

What makes up the inferior wall of orbit?

maxilla, zygomatic, palatine

What are the four layers of the eyelid?

1. Skin

2. Palpebral part of orbicularis oculi

3. Superior and inferior tarsal plate

4. Palpebral conjunctiva

What attaches tarsus to maxillary or zygomatic bones?

medial and lateral palpebral ligaments

What are modified sebaceous glands within tarsus?

tarsal glands

What do tarsal glands secrete?

meibum; prevents evaporation of tear film

What is at the base of eyelashes?

ciliary gland- contains aqueous humour; nourishes cornea and lens

What causes a chalazion?

blocked meibomian gland

What causes a stye?

blocked oil gland on edge of eyelid

T/F Palpebra conjunctiva is continuous with bulbar conjunctiva

true

What is another name for superior tarsal muscle? function?

muscle of muller

elevates upper eyelid during sympathetic response

What is the function the lacrimal punctum?

excess tear film drained

the lacrimal gland is composed of what?

3-9 excretory ducts that open into superior fornix

What is the passageway of tears?

tears drained by lacrimal punctum into lacrimal canaliculi and then empty into nasolacrimal duct which drains into lacrimal sac and then into inferior nasal meatus

Where is the anterior and posterior chamber of the eye?

anterior chamber- front of iris

posterior chamber- behind iris

What are chambers continuous with?

aqueous humor

What does a buildup of aqueous humor in the scleral venous plexus cause?

Glaucoma

What orbital muscles are supplied by oculomotor nerve?

1. Inferior rectus

2. medial rectus

3. inferior oblique

4. superior rectus

What muscle is supplied by trochlear nerve?

superior oblique

What muscle is supplied by abducens nerve?

lateral rectus

What forms the auricle?

single piece of elastic cartilage covered with skin

What are the small extrinsic muscles of the auricle?

1. Superior auricular

2. Anterior auricular

3. Posterior auricular

4. Temporoparietalis

What is the posterior auricular m. innervated by?

posterior auricular branch of facial nerve

What are ¾ of the auricle m. innervated by?

temporal branches of facial nerve

What are external ear arteries derived from?

branches of external carotid artery

What is the sensory innervation of the external ear?

1. posterior auricular cutaneous branches

2. great auricular nerve

3. lesser occipital nerve

4. auriculotemporal nerve

5. auricular nerve

What does the nasal cavity open into?

nasopharynx

What does septal cartilage attach to?

1. Perpendicular plate

2. vomer

3. internasal suture

What does lateral cartilage attach to?

1. nasal bones

2. frontal process

What does major alar cartilage attach to?

unique, lacks attachment of bone, stabilized by adjacent cartilage

What are the veins of the external nose?

submucosal venous plexus drains into pterygoid venous plexus

What arteries supply the external nose?

infraorbital artery and dorsal nasal artery