MSK Review 2

What is the **lateral border** of the Infratemporal fossa?

Mandibular ramus

What is the **anterior border** of the Infratemporal fossa?

Posterior aspect of maxilla

What is the **superior border** of the Infratemporal fossa?

Inferior surface of the greater wing of the Sphenoid bine

What is the **posterior border** of the Infratemporal fossa?

Tympanic plate, mastoid process, & styloid process of temporal bone

What is the **inferior border** of the Infratemporal fossa?

Medial pterygoid muscle attachment at the angle of the mandible

What is the **medial border** of the Infratemporal fossa?

Lateral pterygoid plate

What are the contents of the Infratemporal fossa?

* Temporalis muscle
* Lateral & medial pterygoid muscles
* Mandibular nerve & its inferior alveolar, lingual, & buccal branches
* Otic ganglion
* Chorda tympani (CN VII branch)
* Maxillary artery & majority of its branches
* Pterygoid venous plexus

What are the muscles of mastication?

* Temporalis
* Masseter
* Medial pterygoid
* Lateral pterygoid

What innervates the muscles of mastication?

Motor root of the mandibular nerve (CN V3)

What muscles of mastication are outside the Infratemporal fossa?

Temporalis (majority) & masseter

What muscle of mastication elevates (closes) & retracts mandible?

Temporalis

What muscle of mastication elevates (closes) & protracts mandible?

Masseter

What muscle of mastication protracts & depresses (open) mandible & contributes to the chewing motion?

Lateral pterygoid

What muscle of mastication elevates (closes) & protracts mandible & contributes to the chewing motion?

Medial pterygoid

What is the classification of the TMJ?

Ginglymoarthrodial synovial joint (hinge & plane joints) + diarthrosis

What are articulating sturctures of the TMJ?

* Mandibular fossa of temporal bone
* Articular tubercle of temporal bone
* Head of mandibular condyle
* Articular disc

What is the arterial supply to the TMJ?

* Superficial temporal artery
* Deep auricular artery
* WhatAnterior tympanic artery

What is the innervation of the TMJ?

* Auriculotemporal nerve (posterior division of CN V3)
* Posterior deep temporal nerve (anterior division of CN V3)
* Masseteric nerve (anterior division of CN V3)

What **depresses** the TMJ?

* Lateral pterygoid (prime mover)
* Suprahyoid & infrahyoid

What **elevates** the TMJ?

* Temporalis (prime mover)
* Masseter (prime mover)
* Medial pterygoid (prime mover)

What **protrudes** the TMJ?

* Lateral pterygoid (prime mover)
* Medial pterygoid (prime mover)
* Masseter

What **retrudes** the TMJ?

* Posterior fibers of Temporalis muscle (prime mover)
* Masseter

What **laterally deviates** the TMJ ipsilaterally?

* Posterior fibers of Temporalis muscle
* Digastric
* Mylohyoid
* Geniohyoid

What **laterally deviates** the TMJ contralaterally?

* Lateral pterygoid (prime mover)
* Medial pterygoid (prime mover)
* Middle fibers of Temporalis muscle

What is structure 1?

Anterior tympanic artery

What is structure 2?

Deep auricular artery

What is structure 3?

Lateral pterygoid muscle

What is structure 4?

Superficial temporal artery

What provides motor innervation to the tongue?

Hypoglossal nerve (CN XII) **except** palatoglossus which is the Vagus nerve (X)

What provides sensory innervation to the tongue?

Lingual nerve & chorda tympani

Where does the **Frontal** sinus drain?

Middle meatus of the nasal cavity

Where does the **Sphenoid** sinus drain?

Sphenoid-ethmoidal recess

Where does the **Ethmoidal** sinus drain?

* Anterior & middle - middle meatus
* Posterior - superior meatus

Where does the **Maxillary** sinus drain?

Inferior meatus of the nasal cavity

What cranial nerves mediate **gestation** within the tongue?

Facial nerve & glossopharyngeal nerve (CN VII & CN IX)

What cranial nerves mediate **speech & sound production** + **mastication & swallowing** within the tongue?

Vagus nerve & hypoglossal nerve (CN X & CN XII)

What cranial nerves mediate **touch** within the tongue?

Lingual nerve & glossopharyngeal nerve (branch of CN V3 & CN IX)

What is the **superiorly** attached to the Hyoid bone?

Oral cavity

What is the **inferiorly** attached to the Hyoid bone?

Larynx

What is the **posteriorly** attached to the Hyoid bone?

Pharynx

What is the Superficial cervical fascia & what does it contain?

Layer between the dermis & deep cervical fascia:

* Neurovascular supplies
* Superficial veins
* Superficial lymph nodes
* Fat
* Platysma muscle

What is the Deep cervical fascia & what are its layers?

Layer deep to the superficial fascia & patysma muscle:

* Investing
* Pretracheal
* Prevertebral
* Carotid sheath

What fascia surrounds the Cervical vertebral column & the scalene muscles, prevertebral muscles, & the deep muscles of the back?

Prevertebral layer of the Deep cervical fascia

What neurovascular bundles of the neck does the Carotid sheath enclose?

* Common carotid artery
* Internal jugular vein
* Vagus nerve
* Accompanying cervical lymph node

What are the Superficial muscles of the neck?

* Sternocleidomastoid (sternal & clavicular heads)
* Platysma
* Trapezius

What Superficial muscles of the neck are innervated by the Spinal accesseory nerve (CN XI) & ventral rami of C2-C4?

* Sternocleidomastoid (sternal & clavicular heads)
* Trapezius

What is the Platysma innervated by?q

Cervical branch of facial nerve (CN VII)

What is the unilateral function of the Sternocleidomastoid?

Lateral flexion of neck toward the ipsilateral shoulder & simutaneously rotates head so the face is turned superiorly toward contralateral side

What is the bilateral function of the Sternocleidomastoid?

Flexes head & cervical vertebrae of neck

What is different between the Sternocleidomastoid sternal head & clavicular head?

Origin - upper part of anterior surface of manubrium & upper part & anterior surface of medial 1/3 of clavicle

What is the function of the Platysma?

Depress angle of mouth & draw skin of the neck superiorly to prod. expressions of sadness, anxiety, or fright

What is the function of the Trapezius?

* Unilateral does lateral flexion to ipsilateral shoulder & bilateral extends neck
* Retracts & depresses scapula, descending & ascending fibers superiorly rotate scapula

What are the Suprahyoid muscles of the neck?

* Stylohyoid - CN VII & pulls hyoid up
* Digastric (ant.) - CN V3 & opens mouth/lowers mandible + raises hyoid bone
* Digastric (post.) - CN VII & pulls hyoid up & back
* Mylohyoid - CN V3 & elevate floor of mouth & hyoid
* Geniohyoid - CN XII & pulls hyoid forward & mandible down/inward

What are the Infrahyoid muscles of the neck?

* Omohyoid & sterno__hyoid__ (superficial)
* Sterno__thyroid__ & thyrohyoid

Where does the Brachial plexus & subclavian artery pass between & what is this important for?

Anterior & middle scalene muscles for interscalene blocks

What is located posterior to the Anterior scalene muscle?

Subclavian artery

What elevates the 1st & 2nd ribs to increase intrathoracic volume?

Scalene muscles

This muscle **originates** on posterior tubercles of CIV to CVI, **inserts** on surface rib II, is **innervated** by ant. rami of C5 to C7, & **elevates** rib II:

Posterior scalene

This muscle **originates** on posterior tubercles of CII to CVII, **inserts** on upper surface of rib I post. to groove for subclavian, is **innervated** by ant. rami of C3 to C7, & **elevates** rib I:

Middle scalene

This muscle **originates** on anterior tubercles of CIII to CVI, **inserts** on scalene tubercle & upper surface of rib I, is **innervated** by ant. rami of C4 to C7, & **elevates** rib I:

Anterior scalene

What is the **superior** border of the Anterior triangle?

Inferior border of mandible

What is the **lateral** border of the Anterior triangle?

Anterior border of sternocleidomastoid

What is the **medial** border of the Anterior triangle?

Sagittal line down the midline of the neck

What muscles are in the Anterior triangle?

Suprahyoid & infrahyoid muscles

What vessels are in the Anterior triangle?

* Common carotid artery → ECA & ICA
* Internal jugular vein

What nerves are in the Anterior triangle?

• CN VII (facial nerve)

• CN IX (glossopharyngeal nerve)

• CN X (vagus nerve)

• CN XI (accessory nerve)

• CN XII (hypoglossal nerves)

What are the contents of the Carotid triangle?

* Common carotid artery
* Internal jugular nerve
* CN XII (hypoglossal nerve)

What is the **superior** border of the Carotid triangle?

Posterior belly of the digastric muscle

What is the **lateral** border of the Carotid triangle?

Medial border of the Sternocleidomastoid muscle

What is the **inferior** border of the Carotid triangle?

Superior belly of the Omohyoid muscle

What is the **anterior** border of the Posterior triangle?

Posterior border of the Sternocleidomastoid

What is the **posterior** border of the Posterior triangle?

Anterior border of the Trapezius

What is the **inferior** border of the Posterior triangle?

Middle 1/3 of the Clavicle

What is the **roof** border of the Posterior triangle?

Investing layer of fascia

What is the **floor** border of the Posterior triangle?

Prevertebral fascia

What are the muscles of the Posterior triangle?

* Omohyoid muscle
* Splenius capitis
* Levator scapulae
* Scalenes

What are the veins of the Posterior triangle?

* External jugular vein
* Subclavian vein
* Transverse cervical vein
* Suprascapular vein

What is the blood supply of the Posterior triangle?

* Subclavian vein
* Transverse cervical
* Suprascapular veins

What are the nerves of the Posterior triangle?

* Accessory nerve (CN XI)
* Cervical plexus
* Brachial plexus

The _ enters into the Subclavian vein once it pierces the deep fascia of the clavicular head of the Sternocleidomastoid muscle:

External jugular vein

What forms the Brachiocephalic vein?

Internal jugular vein + subclavian vein

What is the Retromandibular vein formed by?

Superficial temporal vein + maxillary vein with the parotid gland

What does the **anterior** division of the Retromandibular vein divide into?

Facial vein & common facial vein

What does the **posterior** division of the Retromandibular vein divide into?

External jugular vein

What are the direct branches of the ECA?

* Superior thyroid artery
* Ascending pharyngeal artery
* Lingual artery
* Facial nerve
* Occipital artery
* Posterior auricular artery

What are the terminal branches of the ECA?

* Maxillary artery
* Superficial temporal artery

What is the structure 1 & its function?

Superficial temporal artery, terminating branch of ECA, & supplies the Temporal region

What is the structure 2 & its function?

Transverse facial artery, branch of the Superficial temporal artery, & supplies the cheek & parotid gland

What is the structure 3 & its function?

Facial artery, branch of ECA, & supplies the face

What is the structure 4 & its function?

Lingual artery, branch of ECA, & supplies the tongue

What is the structure 5 & its function?

Superior thyroid artery, branch of ECA, & supplies the larynx & thyroid gland

What is the structure 6 & its function?

External carotid artery

What is the structure 7 & 10 its function?

Maxillary artery, terminating branch of ECA, & supplies deep structures of the face like the infratemporal fossa

What is the structure 8 & its function?

Occipital artery, branch of ECA, & supplies occipital region of the scalp

What is the structure 9 & its function?

Ascending pharyngeal artery, branch of ECA, & supplies pharynx & palatine tonsils

What is the function of the Posterior auricular artery?

Supplies scalp posterior to the ear

What are the branches of the 1st (mandibular) part of Maxillary artery

* Deep auricular artery
* Anterior tympanic artery
* Middle meningeal artery
* Accessory meningeal artery
* Inferior alveolar artery

What are the branches of the 2nd (pterygoid) part of Maxillary artery?

* Masseteric artery
* Pterygoid artery
* Deep temporal artery
* Buccal artery

What are the branches of the 3rd (pterygopalatine) part of Maxillary artery?

* Descending palatine
* Posterior superior alveolar
* Infraorbital artery
* Pharyngeal artery of Pterygoid canal
* Sphenopalatine artery

What provides most of the blood supply to the head & neck?

Subclavian & common carotid arteries