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CHAPTER 14: HEAD, FACE, NECK, AND REGIONAL LYMPHATICS

Key Anatomical Structures

  • Bones of the Head:
    • Coronal suture
    • Sagittal suture
    • Frontal bone
    • Parietal bone
    • Nasal bone
    • Lacrimal bone
    • Maxilla
    • Mandible
    • Lambdoid suture
    • Occipital bone
    • Temporal bone
    • Sphenoid bone
    • Zygomatic bone
    • External acoustic meatus
    • Mastoid process
  • Joints:
    • Temporomandibular joint
  • Vertebrae:
    • C1 (Atlas)
    • C2 (Axis)
    • C7 (vertebral prominens)

Major Blood Vessels and Glands

  • Blood Vessels:
    • Internal jugular vein
    • External jugular vein
    • Common carotid artery
    • Internal carotid artery
    • External carotid artery
  • Glands:
    • Parotid gland
    • Submandibular gland
    • Sublingual gland

Neck Muscles

  • Major Neck Muscles:
    • Sternomastoid Muscle:
    • Innervated by cranial nerve XI.
    • Functions: enables head rotation and flexion. It divides each side of the neck into two anatomical triangles: anterior and posterior triangles.
    • Trapezius Muscle:
    • Functions: moves shoulders and extends and turns head.

Triangular Structures of the Neck

  • Anterior Triangle:
    • Defined by the sternomastoid muscle and midline of the neck.
  • Posterior Triangle:
    • Bounded by the sternomastoid muscle and trapezius muscle.

Cartilages and Glands in the Neck

  • Cartilages:
    • Cricoid cartilage
    • Thyroid cartilage
  • Other Structures:
    • Hyoid bone
    • Thyroid gland
    • Trachea
    • Isthmus of thyroid
    • Manubrium

Regional Lymphatics

  • Lymph Nodes:
    • Posterior auricular
    • Occipital
    • Jugulodigastric
    • Superficial cervical
    • Posterior cervical
    • Supraclavicular
    • Preauricular
    • Submandibular
    • Submental
    • Deep cervical chain

Developmental Competence – Aging Adult

  • Changes in physical appearance:
    • Facial bones and orbits appear more prominent.
    • Facial skin sags due to decreased elasticity, reduced subcutaneous fat, and moisture in the skin.
    • Lower face may appear smaller if teeth are lost.

Culture and Genetics

  • Headaches:
    • Leading cause of acute pain and lost productivity; classified by etiology and often misdiagnosed.
    • Chronic Migraine: Occurs more than 15 days per month.
    • Gender Differences: More common in females, peaking in midlife.
    • Ethnic Differences: More prevalent among Caucasian and Hispanic populations.
    • Various etiological theories proposed for headaches.

Abnormal Findings: Primary Headaches

  • Diagnosis is based on patient history with no abnormal findings on exam/labs.
  • Types of headaches include:
    • Tension headaches
    • Migraines
    • Cluster headaches
  • Factors to Review:
    • Definition of headache type
    • Location, character, duration, quantity, and severity
    • Timing, aggravating symptoms or triggers
    • Associated symptoms and relieving factors
    • Efforts to treat headaches.

Thyroid Disorders

  • Graves' Disease:
    • Physical Presentation: Goiter, eyelid retraction, exophthalmos (bulging eyes).
  • Hypothyroidism:
    • Physical Presentation: Puffy, edematous face; periorbital edema; coarse facial features; coarse hair and eyebrows.

CHAPTER 15

Anatomy of the Eye

  • Components:
    • Upper and lower eyelids
    • Palpebral fissure
    • Medial canthus
    • Lateral canthus
    • Pupil
    • Iris
    • Sclera
    • Caruncle
    • Limbus (border between cornea and sclera)

Extraocular Muscles

  • Cranial Nerve Innervations:
    • Cranial Nerve VI (Abducens Nerve): Innervates lateral rectus muscle (abducts the eye).
    • Cranial Nerve IV (Trochlear Nerve): Innervates superior oblique muscle.
    • Cranial Nerve III (Oculomotor Nerve): Innervates all other muscles including:
    • Superior rectus
    • Inferior rectus
    • Medial rectus
    • Inferior oblique muscle.
    • Remember using the mnemonic: "LR6 SO4".

Internal Anatomy of the Eye

  • Composed of three concentric coats:
    • Outer Fibrous Coat: Sclera
    • Middle Vascular Coat: Choroid
    • Inner Nervous Layer: Retina
  • The only accessible parts during examination are the sclera (anteriorly) and the retina (via an ophthalmoscope).

Middle Layer Functionality

  • Choroid: Dark pigmentation to prevent internal light reflection, heavily vascularized to deliver blood to retina.
  • Iris: Functions as a diaphragm, varying pupil size by:
    • Muscle contraction in bright light for accommodation.
    • Dilation in dim light for far vision.

Visual Pathways

  • Light rays refracted through:
    • Cornea
    • Aqueous humor
    • Lens
    • Vitreous body
  • Form an image on the retina, transmitted to the brain via the optic nerve.
    • At the optic chiasm, visual fields' fibers crossover.

Aging Adult Considerations

  • Eye Changes:
    • Central acuity may decrease, especially after age 70.
    • Peripheral vision may also diminish.
  • Structural Changes:
    • Eyebrows show loss of hair, types' outer third.
    • Wrinkles around the eyes due to skin atrophy.
    • Upper eyelid may elongate due to tissue atrophy.

Abnormal Findings in Eye Exams

  • Notable conditions:
    • Battle Sign
    • Acute Otitis Media
  • Focus on identifying asymmetries or abnormalities in structure during exams.

CHAPTER 16: EARS

Anatomy of the Ear

  • Tympanic Membrane Structures:
    • Incus
    • Umbo
    • Pars flaccida
    • Pars tensa
    • Cone of light
    • Manubrium of malleus
    • Anterior and posterior folds

Inner Ear Function

  • Structure and Function:
    • Bony labyrinth contains sensory organs for equilibrium and hearing.
    • Includes vestibule and semicircular canals (vestibular apparatus) and cochlea (central hearing apparatus).

Pathways of Hearing

  • Sound pathways:
    • Bone Conduction Pathway and Air Conduction Pathway.
    • High frequency, medium frequency, low frequency sound processed accordingly.

Equilibrium

  • Labyrinth contributes to maintaining body position in space.
  • An inflamed labyrinth can lead to staggering gait and vertigo.

Developmental Competence in Adults

  • Otosclerosis: Common cause of conductive hearing loss for ages 20-40, leading to progressive deafness.

Developmental Competence in Aging Adults

  • Cilia in ear canal become coarse, leading to cerumen accumulation which can reduce hearing.
  • Cerumen Characteristics:
    • Drier in aging due to apocrine gland atrophy.
    • Impacted cerumen is a reversible cause of hearing loss.

CULTURE AND GENETICS

  • Impact on Hearing Loss:
    • Presbycusis affects men more than women; increased prevalence in Caucasians and Hispanics.
    • Cerumen types based on genetics:
    • Dry cerumen: gray and flaky (prevalent in East Asians & American Indians).
    • Wet cerumen: honey-brown and moist (more common in Caucasians and African Americans).

CHAPTER 17: NOSE, MOUTH, AND THROAT

Anatomy of the Nose

  • Sinuses:
    • Frontal sinus: in frontal bone above and medial to orbits.
    • Maxillary sinus: in maxilla alongside the nasal cavity.
    • Ethmoid and sphenoid sinuses (smaller and located deep within the skull).

Oral Cavity Anatomy

  • Components:
    • Hard and soft palate
    • Anterior and posterior pillars
    • Uvula
    • Tonsils
    • Dorsum of the tongue

Salivary Glands

  • Major glands include:
    • Parotid gland
    • Submandibular gland
    • Sublingual gland

Abnormalities to Focus On

  • Important conditions:
    • Candidiasis
    • Cleft lip/palate
    • Dental caries
    • Deviated septum
    • Dysphagia
    • Rhinorrhea
    • Sinusitis
    • Tonsillitis
    • Xerostomia