Lab Objectives Head Neck and Back

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Lab Objectives Head Neck and Back
2014-02-03 07:54:02

PAP-550 Lab Objectives
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  1. epidermis:
    stratified squamous epithelium
  2. dermis:
    lower, connective tissue layer with vasculature
  3. superficial fascia (subcutaneous tissue):
    loose connective tissue underneath dermis
  4. deep fascia:
    tougher connective tissue surrounding muscle (epimysium)
  5. anulus fibrosis:
    fibrocartilage ring holding in cushioning nucleus pulposus, can weaken with age to allow contents to herniate ("slipped disc")
  6. anterior longitudinal ligament:
    a long ligament on the anterior (ventral) surface of the vertebral bodies that helps to prevent hyperextension damage, e.g., in "whiplash" injury.
  7. articular process (facet), superior and inferior:
    superior and inferior processes that allow articulation (at the facet surface) of adjacent vertebrae. Osteophytes from the processes may lead to spinal nerve impingement.
  8. atlanto-occipial and atlantoaxial joints:
    nodding and no joints, respectively. Neither have intervertebral discs, and both contain membranes and ligaments to limit the extent of those movements.
  9. atlas:
     C1: with two articular surfaces for occipital condyles and "yes" motion.
  10. axis and dens (odontoid process):
    C2-with its projection to allow swivel "no" motion
  11. facet (zygapophyseal) joint:
    small synovial joints between vertebrae (Gr: together projection)
  12. inion (external occipital protuberance):
    projection of posterior occipital bone, landmark for posterior neck muscles
  13. interspinous ligament:
    smaller connective tissue bands running between the spinous processes of adjacent vertebrae
  14. intervertebral disc:
    tough cushioning between discs, thickest in the mobile cervical and lumbar regions, made of anulus fibrosis and nucleus pulposus
  15. intervertebral foramen:
    gap between vertebral notches of adjacent pedicles, where spinal nerves exit
  16. lamina:
    the "roof" over the vertebral canal; cut into for a laminectomy
  17. ligamentum(a) flavum(a) :
    ligamenta flava ("yellow ligaments") are connective tissue bands that connect adjacent laminae.
  18. nucleus pulposus:
    gooey internal contents of intervertebral disc, adult remnants of notochord
  19. occipital bone and occipital condyles:
    part of skull that contains foramen magnum; projections that allow "yes" motion
  20. pedicle:
    the "stalk" supporting the arch from the body
  21. posterior longitudinal ligament:
    a long ligament on the posterior (dorsal) surface of the vertebral bodies (i.e., within the "floor" of the vertebral canal) that helps to prevent hyperflexion damage, e.g., in "whiplash" injury.
  22. posterior tubercle:
    off of C1, instead of a spinous process
  23. spinous process:
    dorsal projection, those of C7 and T1particularly palpable
  24. superior nuchal line:
    the ridge on the occipital bone that includes the inion, superior limit of neck
  25. supraspinous ligament:
    tough connective tissue band running from the dorsal "peak" of one spinous process to another to help hold vertebrae together
  26. transverse foramen:
    hole in transverse process of a cervical vertebra, space for vertebral artery
  27. transverse process:
    sticks out sideways for muscle attachment; "divides" hypaxial and epaxial muscle groups
  28. vertebra: 
    cervical, thoracic, lumbar, sacral, coccyx: note overall differences; cervical (C1-7) with foramina transversaria (contain vertebral aa.) and bifid spinous process; thoracic (T1-12) have costal facets and inferior-pointing spinous processes; lumbar (L1-5) are large and weight-bearing; sacral (S1-5) are fused into the curved sacrum; and the coccyx (Co1-4) is the fused remnant of caudal vertebrae (as well as painful to land on, being one cause of coccygodynia/coccydynia)
  29. vertebral canal:
    the "tunnel" made by the vertebral foramina strewn together, for the spinal cord
  30. vertebral foramen:
    the hole made by the vertebral arch
  31. erector spinae m., consisting of iliocostalis m., longissimus m., spinalis m. :
    large block of epaxial muscle major spine extensor and a lateral flexor. Note that epaxial mm. names refer more to patterns of attachment than to individual muscles, e.g., longissimus thoracis, cervicis, capitis. Erector spinae mm. refers to the following three components; iliocostalis most lateral, attached to ribs, longissimus attached to transverse processes, spinalis thin and most medial, attached to spinous processes.
  32. interspinales (interspinal) and intertransversarii (intertransverse) m.*:
    deepest back muscles, dorsal rami of spinal nerves, either between spinous process to extend or transverse processes to flex, respectively.
  33. latissimus dorsi m.:
    inferior back, makes up posterior axillary wall, thoracodorsal n., antagonistic to pectoralis muscles, useful for butterfly swimmers
  34. levatores costarum m.*:
    O: transverse processes of C7-T11, I: posterior surface of ribs, N: dorsal rami of corresponding spinal nerves, A: elevate ribs
  35. serratus posterior inferior vs. superior m.:
    serratus posterior inferior: O: spinous processes of T11-L2, I: posterior ribs 9-12, N: intercostal nerves, A: depresses ribs and so assists expiration. Serratus posterior superior: O: spinous processes of C7-T2, I: posterior ribs 2-5, N: intercostal nerves, A: elevates ribs and so assists inspiration. The serratus posterior muscles are thin and are more layer landmarks to encourage careful dissection this first week than acting as active contributors to respiration.
  36. splenius capitis m.:
    O: spinous processes of T1-6, I: occipital bone, mastoid process, N: cervical nerves (dorsal rami), A: extend head/neck, or if singly, can rotate to one side. Palpable; also may be better seen as part of posterior triangle of neck.
  37. splenius cervicis m.:
    O: spinous processes of T3-6, I: transverse processes of C1-3, N: dorsal rami of C 5, 6, A: extend, rotate cervical spine.
  38. suboccipital triangle*:
    deep to semispinalis capitis, includes a number of muscles innervated by C1 (suboccipital n.); these include rectus capitis posterior major and minor m., and obliquus capitis superior and inferior m.; listed here as an objective as they may be involved in whiplash, or be trigger points to be addressed by massage therapy. Presumably, these small muscles are offering proprioceptive information regarding head and neck movements.
  39. thoracolumbar fascia:
    fascia surrounding deep muscle, especially in lumbar region, blends in with other fascia, e.g., that of quadratus lumborum m.
  40. transversospinalis m..:
    semispinalis, including semispinalis capitis, multifidus group (multifidi), rotatores m. small sets of postural muscles that connect from transverse process to spinous process, made of the following sets of semispinalis, including semispinalis capitis, multifidus group (multifidi), rotatores mm.: small, epaxial m. that contribute to an overall postural effect, even though small individually. These are in the order of superficial to deep and longer to shorter, e.g., rotatores run from the transverse process of one vertebra to the spinous process of the adjacent superior vertebra. Multifidus helps to stabilize the lumbar spine, so can be implicated in low back pain (LBP).
  41. trapezius m.:
    large multifunction scapular muscle, remnant of gill-raising m. to explain its CN XI motor innervation
  42. arachnoid mater:
    a thinner middle meningeal layer, so named because of the trabeculations extending through the subarachnoid space
  43. cauda equina:
    "horse's tail" of dorsal and ventral roots reaching out to intervertebral foramina of lumbar and sacral nerves�a result of the continued growth of the vertebral column compared to that of the CNS. Hence, L3-4 and L4-5 make a useful site for lumbar puncture (spinal tap).
  44. central canal:
    somewhat vestigial, contains CSF, contiguous with ventricles; cervical central canal may be enlarged with syringomyelia
  45. conus medullaris:
    terminal portion of spinal cord, at about L1-2 in adults.
  46. denticulate ligaments*:
    pegs of pia mater that help to hold the spinal cord into position in the vertebral canal.
  47. dorsal and ventral ramus (i) of spinal nerves:
    after the mixed spinal nerve is formed at the point of the intervertebral foramen, it splits into a small dorsal and larger ventral ramus to supply the deep back and the rest of the body wall and limbs, respectively.
  48. dorsal root (spinal) ganglion:
    home to the nerve cell bodies of sensory neurons
  49. dura mater:
    the outermost, tough connective tissue meningeal covering that will thin out as spinal nerves reach out peripherally
  50. dural sac:
    that part of dura mater inferior to the conus medullaris, so a target for lumbar puncture (spinal tap).
  51. epidural (extradural) space:
    space between the bony vertebral canal and the meninges covering the spinal cord; useful for epidural anesthesia, e.g., access through sacral hiatus (the "epidural" of labor and delivery)
  52. gray matter with ventral, lateral (intermediate), dorsal horns:
    gray from neuron cell bodies, ventral horn with lower motor neurons, ventral horn associated with sensory tracts, and lateral horn, present from T1-L2, the location of the cell bodies of the sympathetic preganglionic neurons
  53. pia mater:
    most internal meningeal layer, better seen on brain as a sheet
  54. spinal cord:
    major component of CNS
  55. subarachnoid space:
    between arachnoid and pia mater, site of CSF (cerebrospinal fluid).
  56. terminal filum*:
    connective tissue that connects conus medullaris; may be the basis of tethered cord syndrome
  57. ventral and dorsal roots of spinal nerves:
    refers to the motor and sensory, respectively, to the mixed spinal nerves
  58. white matter:
    white from myelinated axons that can be broken up into different regions: posterior funiculus, dominated by the dorsal columns (carries discriminatory senses); lateral funiculus, with corticospinal tract (major motor tract) and spinocerebellar tracts (unconscious proprioception), with anterolateral region dominated by spinothalamic tract (pain and temperature); anterior funiculus, dominated by extrapyramidal reticulospinal and vestibulospinal tracts that affect posture.
  59. anterior nasal aperture; maxillary paranasal air sinuses:
    (piriform aperatures); open up into nasal cavities, sinuses, found within many bones, frontal, maxillary, etc. may be better appreciated on x-ray (or on after-dinner commercials for various remedies!)
  60. bregma:
    junction of coronal/sagittal sutures; used in skull measurement; adult remnant of anterior sagittal suture
  61. calvaria:
    cranial vault or brain case vs. the facial skeleton vs. the skullcap (calotte)
  62. coronal suture:
    between frontal and parietal b.
  63. external acoustic meatus:
    external ear canal, often with cerumen (wax) buildup.
  64. frontal b.:
    in about 10% of population, there's a remnant of a frontal suture
  65. frontal sinus:
    behind superciliary arches within frontal bone; continue to enlarge through puberty and adolescence. If fractured, risk of CSF leakage.
  66. hyoid b., body, greater and lesser horns:
    U-shaped attachment for many neck muscles, can be fractured in (manual) strangulation. Body main part with horns projecting from it.
  67. lambda:
    junction of lamboid/sagittal sutures; used in skull measurement; adult remnant of posterior fontanel
  68. lambdoid suture:
    between occipital and parietal b.
  69. mandible (body, ramus, angle, posterior border, articular condyle, coronoid process):
    horizontal body, two rami, angle the posterior body/ramus meeting spot, posterior border of ramus, surface involved in TMJ (temporomandibular joint), coronoid process anterior to that, for mastication muscle attachment
  70. mandible b. :
    single bone; can be dislocated at TMJ.
  71. maxilla b. :
    Le Fort type I fracture horizontal through maxillae
  72. mental foramen:
    in mandible, site of mental n. (branch of CN V3)
  73. occipital b. :
    contains foramen magnum
  74. other facial bones:
    ethmoid b., lacrimal b., palatine b., sphenoid b. (greater and lesser wings), vomer b.: ethmoid notable for cribriform plate (see CN I and braincase dissection); lacrimal: medial side of orbit, superior to maxilla; has fossa for lacrimal sac; palatine contribute to posterior portion of hard palate sphenoid contributes to anterior cranial fossa (lesser wing) and middle cranial fossa (greater wing) as well as forming sella turcica; vomer: unpaired, midline, much of bony nasal septum
  75. parietal b.
    parietal (L. wall)
  76. sagittal suture:
    between parietal bones
  77. sphenoid sinus:
    in sphenoid bone, most posterior of sinuses. Drains down into pharynx.
  78. stylomastoid foramen:
    pathway for CN VII, vulnerable point for Bell's palsy within the facial canal that opens into this foramen
  79. superciliary arch:
    bony ridge deep to eyebrows, may lead to skin laceration if struck hard
  80. superior*, middle, inferior nasal conchae:
    the turbinates (covered by respiratory pseudostratified epithelia in situ); useful for humdification, especially large inferior conchae. Superior and middle conchae off of the ethmoid b., while the inferior conchae are separate bones. Superior conchae protect the olfactory bulb, middle conchae cover over the sinus openings.
  81. teeth, alveolar processes:
    (L. alveolus-little bowl, basin), sockets for teeth
  82. temporal b. (mastoid and styloid process):
    temporal bone made of several different bones that fuse; mastoid air sacs develop postnatally
  83. temporomandibular joint (TMJ):
    modified hinge synovial joint w/ squamous part of temporal bone; typically, anterior dislocation, e.g., in yawning position
  84. vertex:
    most superior part of skull, near center of sagittal suture
  85. zygomatic arch:
    consists of temporal bone/zygomatic bone
  86. zygomatic b.:
    makes up orbital wall, anterior part of zygomatic arch; cheek prominence
  87. anterior scalene (scalenus anterior) m.:
    O: similar to scalenus medius, except that origin is on the anterior aspect of the transverse processes as vs. the posterior of the cervical transverse processes seen in scalenus medius.
  88. buccinator m.:
    O: maxilla and mandible, I: orbicularis oris, N: facial n, A: compresses cheek, e.g., trumpet playing or chewing.
  89. cricothyroid m.:
    O: cricoids cartilage I: thyroid cartilage N: superior laryngeal n. (from CN X) A: pulls thyroid cart. forward, thereby lengthening vocal cords. Rest of laryngeal m. from recurrent laryngeal n.
  90. digastric m.:
    Two-bellied mm that connect off of hyoid bone. Anterior belly O: from posterior belly, I: mandible, N: CN V. Posterior belly O: mastoid process, I: anterior belly, N: CN VII, A: elevate hyoid, depress mandible.
  91. frontalis m., occipitalis m.:
    frontalis m.: O: galea aponeurotica, I: skin of eyebrow, N: facial n, A: elevates eyebrows and forehead. occiptalis m.: O: occipital bone (nuchal line), I: galea aponeurotica, N: facial n, A: pull skin posteriorly and wrinkle posterior neck, move scalp backward.
  92. intrinsic tongue muscles vs. extrinsic tongue muscles (genioglossus m. by name) :
    (CN XII for all of them). The intrinsic muscles: longitudinal, transverse, vertical, alter the tongue shape. The extrinsic muscles help to move the tongue around, e.g., genioglossus m. is the largest of the extrinsic muscles; O: internal, medial mandible (genial spine); I: other tongue muscles; A: protrudes tongue through mouth.
  93. lateral pterygoid m.:
    (note; two heads) O: sphenoid b. (including its pterygoid plate); I: mandibular neck n. I: CN V3: O: together, protrude mandible, separately, side-to-side movement of jaw.
  94. levator labii superioris m.:
    O: frontal process of maxilla, zygomatic bone, I: orbicularis oris and skin above lips, N: facial n, A: elevates upper lip
  95. levator scapulae m.*:
    O: transverse processes of C1-4, I: superior margin of scapula, N: cervical nn., I: elevate scapula
  96. longus colli m.:
    O: bodies of T1-3 and transverse processes of lower cervical vertebrae, I: atlas and bodies of upper cervical vertebrae, N: ventral rami of C2-6, A: flexes/rotates cervical spine. May be damaged during whiplash-type injuries.
  97. masseter m.:
    O: zygomatic arch, I: ramus of mandible, N: CN V (trigeminal), A: elevates mandible
  98. medial pterygoid m.:
    (note; two heads) O: maxilla and pterygoid plate of sphenoid b.; I: mandibular ramus and angle. I: CN V3: O: together, elevate mandible, separately, protrude side of jaw, can work to create grinding motion.
  99. middle scalene (scalenus medius) m.:
    O: transverse processes of C2-C7, I: first rib, N: ventral rami of cervical n., A: flexes neck lateally, elevates 1st rib in forced inspiration.
  100. mylohyoid m.:
    O: body of mandible, I: midline, N: CN V, A: elevates floor of mouth
  101. omohyoid m.*:
    Two bellied m. O: superior border of scapula, I: hyoid bone, N: ansa cervicalis (off of cervical plexus), A: depresses hyoid
  102. orbicularis oculi m.:
    O: bones of medial orbit, I: tissue of eyelid, N: facial n, A: closes eyelids. Important in preventing dry eye with blinking, and so concern of corneal ulcer with Bell('s) palsy.
  103. orbicularis oris m.:
    O: fascia surrounding lips, I: mucous membranes of lips, N: facial n, A: compresses and protrudes (purses) lips. If Bell's palsy, then lots of drooling.
  104. platysma m.:
    O: fascia over superior thoracic muscles, I: inferior mandibular border, N: CN VII (facial), A: depresses lower lip, tightens neck skin (human remnant of subcutaneous muscle that "quivers" flies away in cows).
  105. posterior scalene (scalenus posterior) m.*:
    O: transverse processes of C4-C6, I: rib #2, N: ventral rami of cervical n., A: flexes neck laterally, elevates second rib if necessary as acessory respiratory mm (other scalenes assist with forced inspiration as well).
  106. risorius m. :
    O: facial deep fascia, I: angle of mouth, N: facial n., A: retracts angle (think of risor sardonicus in tetanus).
  107. splenius capitis m.*:
    O: spinous processes of T1-6, I: occipital bone, mastoid process, N: cervical nerves (dorsal rami), A: extend head/neck, or if singly, can rotate to one side. Palpable; also may be better seen as part of posterior triangle of neck.
  108. sternocleidomastoid m.:
    SCM: O: sternum, clavicle, I: mastoid process, N: CN XI, A: turns head to opposite side, flexes neck. Torticollis (wryneck): congenital thickening.
  109. sternohyoid m.:
    O: sternum, I: hyoid, N: cervical n (C1), A: lowers hyoid
  110. sternothyroid m.:
    O: sternum, I: thyroid cartilage, N: cervical n (C2, 3), A: lowers larynx
  111. stylohyoid m.:
    O: styloid process, I: lesser horn of hyoid bone, N: CN VII, A: elevates and retracts hyoid
  112. subclavius m.:
    small m. deep to clavicle, helps to anchor it and to protect subclavian vessels
  113. temporalis m.
    O: temporal fossa, I: mandible, coronoid process, N: CN V (trigeminal); elevates mandible
  114. thyrohyoid m.:
    O: hyoid bone I: thyroid cartilage, N: cervical n (C1), A: raises larynx
  115. trapezius m.:
    the other big CN XI muscle, don't shrug it off.
  116. zygomaticus major m.:
    O: zygomatic bone, I: superior corner of orbicularis oris, N: facial n, A: elevates corner of mouth (smile!)
  117. anterior jugular v.:
    highly variable drainage of the anterior neck, ending (~50:50) into subclavian or external jugular veins; may be a site for accidental placement of a central venous catheter.
  118. axillary a.:
    continuation of subclavian artery, with boundaries from lateral edge of 1st rib to distal margin of teres major muscle.
  119. carotid sinus and carotid body*:
    the carotid sinus is a dilation near the proximal internal carotid a. that acts as a major baroreceptor, while the body is a small brownish/pinkish chemoreceptor in the same area. Both innvervated by CN IX (CN X covers aortic arch bodies, stemming from branchial arch development).
  120. common carotid a.:
    off of aortic arch on L, brachiocephalic a. on R
  121. external carotid a.:
    blood supply to face and visceral neck
  122. external jugular v.:
    drains most of the face and scalp on that side; crosses SCM in superficial fascia before joining subclavian v.
  123. facial a., v.:
    chief artery of face, arising from external carotid. Facial wounds bleed freely, heal quickly. Facial v. major drainage of face, drains into internal jugular. Has no valves, so concern if infection or thrombi of facial v get into cavernous sinus off of the dura mater (don't squeeze those boils!).
  124. internal carotid a.:
    major blood supply to brain via circle of Willis
  125. internal jugular v.:
    main drainage from dural sinuses
  126. maxillary a.:
    large terminal branch of external carotid a.; middle meningeal a. branches off of it.
  127. subclavian a., v.:
    artery coming out of interscalene triangle, vein anterior to scalenus anterior
  128. superficial temporal a., v.:
    superior branch of external carotid a., begins within parotid gland, supplies scalp, the site of temporal arteritis (giant cell arteritis), the vein accompanies.
  129. superior thyroid a.:
    large branch off of external carotid artery
  130. anterior pillar (palatoglossal arch) and posterior pillar (palatopharyngeal arch):
    derived from the second and third pharyngeal arches, respectively
  131. anterior triangle (of neck):
    SCM, mandible, neck midline are boundaries. Carotid sheath of carotid artery, jugular vein, and vagus nerve in here, as well as hyoid muscles and thryoid/parathyroid glands.
  132. arytenoid cartilages:
    paired, attachment for vocal cords
  133. auricle:
    the external ear, contains elastic cartilage for its springiness.
  134. carotid sheath:
    connective tissue that covers carotid a., internal jugular v., and CN X in neck
  135. clavicle:
    collarbone, most frequently broken in the body
  136. cricoid cartilage:
    inferior to thyroid cartilage (most inferior of all the laryngeal cartilages)
  137. cricothyroid membrane:
    between thyroid and cricoid cartilages; possible site for emergency airway access
  138. epiglottis:
    guards the opening into the larynx, marks its upper surface; epiglottitis a medical emergency
  139. esophagus:
    continues from lower laryngopharynx
  140. first tracheal ring:
    inferior to cricoid cartilage
  141. helix:
    prominent rim of auricle
  142. interscalene triangle:
    between anterior and medial scalene: brachial plexus and subclavian artery pass through here.
  143. laryngeal prominence:
    in males, prominent, so called Adam's apple
  144. laryngopharynx:
    from epiglottis to level of lower cricoid cartilage, where it joins up with esophagus
  145. larynx:
    voice box for phonation
  146. nasopharynx:
    respiratory function; superior to soft palate
  147. orifice of auditory (pharyngotympanic, Eustachian) tube:
    laterally positioned in nasopharynx
  148. oropharynx, hard palate, soft palate, uvula:
    oropharynx: digestive function; from soft palate to epiglottis; hard palate: roof of mouth, separating oral and nasal cavities, posterior soft portion is soft palate, and uvula is a midline muscular structure (check its position with CN X testing); cleft palate developmental concerns
  149. palatine tonsil:
    the tonsils we're all familiar with, on either side of oropharynx in between palatoglossal/palatopharyngeal arches; the largest component of Waldeyer's ring of lymphatic tissue.
  150. parathyroid glands*:
    supply parathyroid hormone (PTH) to raise blood calcium levels, small and pinkish brown, hard to find
  151. parotid duct:
    (Stensen's duct), turns anterior and in front of masseter, penetrates buccinator to 2nd maxillary molar
  152. parotid gland:
    Large salivary gland anterior/inferior to auricle. CN VII passes through it (but CN IX innervates it!). The gland swells up in mumps.
  153. pharyngeal tonsil:
    also known as adenoids when enlarged. If swollen, they obstruct the nasopharynx, which leads to mouth breathing ("adenoid facies").
  154. pharynx:
    both digestive/respiratory functions; boundaries from oral and nasal cavities to past the cranial base to about C6, with portions of naso-, oro-, and laryngopharynx
  155. philtrum:
    (infranasal depression), groove in upper lip extending to the nose. May be flattened in FAS (fetal alcohol syndrome).
  156. posterior triangle (of neck) :
    SCM/trapezius/clavicle: CN XI in there.
  157. rima glottidis:
    the space between the true vocal cords, a common spot for that overly large piece of steak to lodge
  158. skin of scalp:
    "S"; superficial fascia: "C"; galea aponeurotica: "A"; loose areolar tissue: "L"; pericranium (periosteum): "P": "S"(SCALP) typically (?) with hair; "C" (SCALP, connective tissue) subcutaneous tissue, tough and dense, with vessels, nerves running through it; "A" (SCALP) (epicranial aponeurosis), the aponeurosis between frontalis and occipitalis. When split, deep wounds gape open; "L" (SCALP) what separates the pericranium from the "SCA" layers of the scalp. A danger area for infections to spread, as it is loosely filled to allow frontalis/occipital movement; "P" (SCALP) what covers the bones of the cranial vault. During birth, may have cephalohematomas. Poor osteogenic properties, so need to have "fill ins" for adult defects.
  159. submandibular gland:
    around the posterior edge of mylohyoid muscle (lateral inferior mandible)
  160. thyroid cartilage:
    when prominent, "Adam's apple"
  161. thyroid gland and isthmus:
    two lobes connected by an isthmus, around the trachea, with isthmus as midline connection between two thyroid lobes
  162. trachea:
    in superior mediastinum, supported by cartilaginous C rings
  163. tragus:
    fleshy, triangular structure anterior to ear canal (may have hair on it)
  164. vallecula:
    depressions between median and lateral glossoepiglottic folds. Targets for laryngoscope blade during intubation.
  165. vestibular folds:
    false vocal cords superior to true vocal cords; help to close larynx during swallowing to prevent food entry
  166. vocal folds:
    true vocal cords
  167. CN II-optic n.:
    outgrowth from forebrain (hence surrounded by meninges, leading to papilledema in the optic disc with swelling), responsible for sight
  168. CN V-three divisions of trigeminal n.:
    ophthalmic, maxillary, mandibular divisions: V1 ophthalmic, V2, maxillary, V3, mandibular. Maxillary (and mandibular) susceptible to trigeminal neuralgia (tic douloureux).
  169. CN VII-facial n.:
    emerges from pons/medulla junction. Moves the face, tastes, salivates (sublingual, submandibular glands), cries. One-sided defect in Bell's palsy, since comes out in "tight fit" of stylomastoid foramen and facial canal.
  170. CN IX-glossopharyngeal nerve:
    carotid sinus n. component should be visible going to carotid bifurcation, also sensory to posterior tongue and triggers salivation from the parotid gland.
  171. CN X-vagus n.:
    runs in carotid sheath
  172. CN XI-spinal accessory n.:
    the spinal component is the part responsible for SCM and trapezius m.
  173. CN XII-hypoglossal n.:
    motor to tongue; see it near mandibular angle and mylohyoid m.
  174. ansa cervicalis*:
    nerve loop of C1-3 on the internal jugular v. that supplies the infrahyoid mm.
  175. brachial plexus:
    coming out of interscalene triangle
  176. inferior alveolar n.:
    this and lingual n. are sensory branches of CN V3 ; sensory to the lower teeth.
  177. lingual n.:
    branch of CN V3; sensory to the anterior tongue.
  178. phrenic n.:
    "C 3,4,5, gotta breathe to stay alive"; see it here closely on top of scalenus anterior.
  179. recurrent laryngeal n.* (l, r):
    are branches of vagus n. to larynx supplying almost all of the intrinsic laryngeal muscles
  180. anterior chamber:
    region between cornea and iris, can be blood-filled in hyphema
  181. aqueous humor:
    transparent, protein-containing fluid of anterior and posterior chambers
  182. bulbar vs. palpebral conjunctiva and conjunctival fornix:
    bulbar conjunctiva covers sclera, with vessels (bloodshot eyes), palpebral (continuous) covers eyelid (anemia); conjunctivitis if inflamed. Fornix (L. vault): deep recess of the palpebral conjunctiva
  183. choroid:
    vascular layer in posterior eye
  184. ciliary body:
    deep to the sclera-corneal junction, contains ciliary m. for lens tension, and for aqueous humor production
  185. cornea:
    clear epithelium, nonvascularized, focusing element, target for LASIK (laser-assisted in situ keratomileusis) or other corrective surgeries.
  186. iris:
    circular, pigmented diaphragm
  187. lacrimal gland:
    makes tears via CN VII stimulation, in superiorlateral part of orbit
  188. lacrimal papilla and punctum: papilla:
    small elevation, both superior and inferior: tears stem from suprerolateral glands and wash to there; punctum: small black pit on nasal end of eyelids, on top of papilla; to drain tears
  189. lacrimal sac and nasolacrimal duct*:
    drainage point for tears, in medial portion of orbit. From here, tears drain to nose.
  190. lens:
    biconvex, focuses light onto retina. Cataracts, presbyopia seen with age.
  191. levator palpebrae superioris m. and superior tarsal m.:
    O: lesser wing of sphenoid; I: superior tarsal plate and upper eyelid skin, N: CN III, A: elevate lid. Superior tarsal m. is smooth m. attached underneath lev. palp. sup. and is innervated by sympathetic fibers to elevate the eyelid. Hence, either CN III lesion or sympathetic disruption (Horner syndrome) can lead to ptosis.
  192. macula with fovea (centralis):
    retinal region for central vision, with fovea containing all cones. Macular degeneration in older individuals.
  193. optic disc:
    "blind spot" entrance of CN II to eyeball. Papilledema (swelling) from increased intracranial pressure
  194. posterior chamber:
    aqueous-filled region between iris and lens
  195. pupil:
    dark since seeing into pigmented posterior eye
  196. retina:
    inner layer of posterior eye, contains rod and cone photoreceptors
  197. sclera:
    white, continuous with cornea; tough, protective
  198. scleral venous sinus (canal of Schlemm)*:
    drainage of aqueous at angle of iris and cornea compromise of drainage may lead to glaucoma
  199. six extrinsic muscles of eye:
    inferior and superior oblique, inferior, superior, lateral, and medial rectus: CN III: medial rectus (adduct), superior rectus (elevate), inferior rectus (depress), inferior oblique (depends how hard it's contracting: up and out all the way, otherwise elevate while the eye is adducted). CN IV: superior oblique (depends on how hard it's contracting: down and out, otherwise depress while the eye is adducted). CN VI: lateral rectus (abduct).
  200. superior and inferior tarsal plates:
    dense connective tissue that make up internal support of the eyelids.
  201. tarsal (meibomian) glands:
    sebaceous glands that open at eyelid rim, may encyst as a chalazion.
  202. vitreous humor
    transparent, more gel-like substance in main ocular cavity posterior to lens