Head and Neck

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Head and Neck
2010-10-25 20:02:17
Head Neck

Head and Neck
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  1. The neurocranium (cranial vault)
    is the bony covering (case) of the brain and its membranous coverings, the cranial meninges. It also contains the proximal parts of the cranial nerves and the vasculature of the brain. The neurocranium has a dome-like roof, the calvaria (skullcap), and a floor or cranial base (basicranium).
  2. The neurocranium is formed by eight bones:
    four singular bones centered on the midline (frontal, ethmoid, sphenoid, and occipital) and two sets of bones occurring as bilateral pairs (temporal and parietal). Most calvarial bones are united by fibrous interlocking sutures; however, during childhood, some bones (sphenoid and occipital) are united by hyaline cartilage (synchondroses).
  3. The viscerocranium (facial skeleton) is
    made up of the facial bones that mainly develop in the mesenchyme of the embryonic pharyngeal arches. The viscerocranium forms the anterior part of the cranium and consists of bones surrounding the mouth, nose, and most of the orbits
  4. The viscerocranium (facial skeleton) consists 15 irregular bones:
    three singular bones lying in the midline (mandible, ethmoid, and vomer) and six paired bones occurring bilaterally (maxilla; inferior nasal concha; and zygomatic, palatine, nasal, and lacrimal bones).
  5. Identify the bones that form the calvarium.
  6. Frontal, Parital, Occipital
  7. Locate the fontanels on a fetal skull. Reminder: fontanels allow the brain to grow.
  8. Anterior, Posterior, Mastoid and Sphenoid
  9. Identify the bones that form the orbit: Identify the only intrinsic bone of the orbit?
  10. a. Roof: Frontal bone
    • b. Floor: Maxilla (some: zygomatic, palatine)
    • c. Lateral wall: Zygomatic bone (frontal process) and the Greater Wing of the Sphenoid
    • d. Medial wall: Ethmoid (some: frontal, lacrimal, sphenoid)
  11. How does the hyoid bone make a connection to the skull and or cervical vertebrae?
    To the skull, Styloid Process: stylohyoid muscle
  12. Which one of the nasal conchae is a separate bone? The remaining conchae are processes of what bones?
  13. The inferior Nasal Conchae is a separate bone. The Superior and Middle Conchae belong to the Ethmoid bone.
  14. What opens beneath each concha?
    • the maxillary sinus is under the middle concha
    • inferior? superior?
  15. To what bone does the mandibular condyle articulate?
    Temporal (inferiorly)
  16. Give an example of lines or ridges on the skull that are produced by the pull (contraction) of muscles.
    Nuchal Lines
  17. Be able to identify each opening (foramen) of the skull and what passes through these openings.
    CN V2 Maxillary Nerve
  18. Be able to identify each opening (foramen) of the skull and what passes through these openings.
    CN V3 Mandibular Nerve, accessory meningeal artery
  19. Be able to identify each opening (foramen) of the skull and what passes through these openings. Spinosum:
    CN V3 meningial branch, Middle meningeal artery and vein
  20. Be able to identify each opening (foramen) of the skull and what passes through these openings.
  21. Be able to identify each opening (foramen) of the skull and what passes through these openings.
    Medulla, meninges, vertebral arteries, CN XI, dural veins, anterior/posterior spinal arteries
  22. Be able to identify each opening (foramen) of the skull and what passes through these openings.
    Jugular Foramen:
    CN IX, X, XI, IJV, inferior petrosal & sigmoid sinuses, meningeal branches of pharyngeal and occipital arteries
  23. Be able to identify each opening (foramen) of the skull and what passes through these openings.
    Stylomastoid Foramen:
    CN VII
  24. Be able to identify each opening (foramen) of the skull and what passes through these openings.
    Carotid Canal:
    Internal Carotid Artery
  25. Be able to identify each opening (foramen) of the skull and what passes through these openings.
    Hypoglossal Canal:
  26. CN XII
  27. Be able to identify each opening (foramen) of the skull and what passes through these openings.
    Optic Canal:
    CN II
  28. Be able to identify each opening (foramen) of the skull and what passes through these openings.
    Olfactory foramen
    CN I
  29. Be able to identify the components of the bony complexes of the skull and the single bones of the skull. EX. Sphenoid, ethmoid, A&M pg 493-498
  30. Be able to identify the points of articulation (joints) for the bones of the skull (reminder: some joints are immoveable). A&M pg. 493-498
  31. Be able to identify and locate the ventricles of the brain. How are the ventricles connected? What does the choroid plexus produce? Where is this plexus found?
    • Ventricles: Lateral, 3rd, 4th. The 3rd and 4th are connected via the Cerebral Aqueduct.
    • Choroid Plexus produces CSF. Choroid Plexus is found in the ventricles.
  32. Be able to identify the component parts of the lacrimal system.
    Lacrimal Apparatus
    The lacrimal apparatus consists of:
  33. -Lacrimal glands secrete lacrimal fluid (tears).
    • -Lacrimal ducts convey lacrimal fluid from the lacrimal glands to the conjunctival sac.
    • -Lacrimal canaliculi (L. small canals), each commencing at a lacrimal punctum (opening) on the lacrimal papilla near the medial angle of the eye, convey the lacrimal fluid from the lacrimal lake to the lacrimal sac, the dilated superior part of the nasolacrimal duct
    • -Nasolacrimal duct conveys the lacrimal fluid to the nasal cavity.
    • -The almond-shaped lacrimal gland lies in the fossa for the lacrimal gland in the superolateral part of each orbit.
  34. Be able to identify the paranasal sinuses, where they are located and where they empty. A&M pg. 566-568 See question: 43 of Head and Neck
  35. Be able to identify the primary action of the muscles of mastication.
  36. Temporalis: Elevates Mandible
    • Masseter: Elevates Mandible
    • Lateral Pterygoid: bilateral: Protracts mandible, depress chin, unilateral: swings jaw
    • Medial Pterygoid: contributes to protrusion, synergistic action, unilateral: grinding
  37. Be able to locate and give the primary function (motor, sensory, or autonomic) of the twelve pairs of cranial nerves. A&M p,g 633, entire chapter 9,
    See: pg. 637-639 Table 9.1
  38. What is the primary attachment (insertion) of the muscles of facial expression? What are these muscles’ actions? What is their innervation?
    Innervation by CN VII (7)
  39. What type of cut to the scalp would cause profuse bleeding (longitudinal or frontal)?
  40. Be able to identify the salivary glands and where they empty their products into the oral cavity.
    The salivary glands include the parotid, submandibular, and sublingual glands.
  41. The parotid glands are
    the largest of the major salivary glands. Each parotid gland has an irregular shape because it occupies the gap between the ramus of the mandible and the styloid and mastoid processes of the temporal bone. The purely serous secretion of the gland passes through the parotid duct and empties into the vestibule of the oral cavity opposite the second maxillary molar tooth.
  42. The submandibular glands
    lie along the body of the mandible, partly superior and partly inferior to the posterior half of the mandible and partly superficial and partly deep to the mylohyoid muscle. The orifices of the submandibular ducts are visible, and saliva often sprays from it when the tongue is elevated and retracted (as when yawning). The sublingual glands are the smallest and lie in the floor of the mouth between the mandible and the genioglossus muscle. The sublingual ducts open into the floor of the mouth alongside the lingual folds.
  43. Identify and locate the papillae and taste buds that are present on the tongue.
    Vallate papillae
    Vallate papillae are large and flat topped; they lie directly anterior to the terminal groove and are surrounded by deep moat-like trenches, the walls of which are studded by taste buds; the ducts of serous lingual glands (of von Ebner) open into these trenches.
  44. Identify and locate the papillae and taste buds that are present on the tongue. Foliate papillae
    are small lateral folds of lingual mucosa; they are poorly developed in humans.
  45. Identify and locate the papillae and taste buds that are present on the tongue. Filiform papillae
    are long, numerous, thread-like and scaly; they contain afferent nerve endings that are sensitive to touch.
  46. Identify and locate the papillae and taste buds that are present on the tongue. Fungiform papillae
    are mushroom-shaped and appear as pink or red spots; they are scattered among the filiform papillae but are most numerous at the apex and sides (margins) of the tongue.
  47. Identify and locate the papillae and taste buds that are present on the tongue.
    The vallate, foliate, and most of the fungiform papillae contain taste receptors in the taste buds. A few taste buds are also in the epithelium covering the oral surface of the soft palate, the posterior wall of the oropharynx, and the epiglottis.
  48. What is the pericranium?
  49. Pericranium: dense layer of connective tissue, forms the external periosteum of the neurocranium
  50. Be able to identify the primary vessels that form the arterial circle on the base of the brain (Circle of Willis).
    These come from the Vertebral Arteries then Basilar: Posterior Cerebral, Posterior Communicating, Internal Carotid, Anterior Cerebral and Anterior Communicating Arteries
  51. What are the boundaries and contents of the temporal fossa?
  52. The temporal fossa (Fig. 7.22A & C), in which most of the temporal muscle (L. temporalis) is located, is bounded:
    • Posteriorly and superiorly by the superior and inferior temporal lines. Anteriorly by the frontal and zygomatic bones.Laterally by the zygomatic arch. Inferiorly by the infratemporal crest.
    • The floor of the temporal fossa is formed by parts of the four bones (frontal, parietal, temporal, and greater wing of the sphenoid) that form the pterion. The fan-shaped temporal muscle arises from the bony floor and the overlying temporal fascia, which makes up the roof of the temporal fossa (Fig. 7.24; Table 7.8). The temporal fascia extends from the superior temporal line to the zygomatic arch. When the powerful masseter, attached to the inferior border of the arch, contracts and exerts a strong downward pull on the arch, the temporal fascia provides resistance
  53. Identify the area referred to as the pterion and what bones form this area?
    Pterion: H shaped formation of sutures that unites the frontal, parietal, sphenoid (Greater Wing) and temporal bones
  54. Identify the two areas of the nasal cavity?
  55. Olfactory (smell) and Respiratory (breathing)
  56. What is hydrocephalus?
  57. Overproduction, obstruction or interference with CSF absorption that causes the head to enlarge.
  58. Be able to identify and locate the venous sinuses of the skull. To what vessels do these sinuses drain?
    The dural venous sinuses
    are endothelial-lined spaces between the periosteal and meningeal layers of the dura
  59. The superior sagittal sinus
    lies in the convex attached (superior) border of the cerebral falx. It begins at the crista galli and ends near the internal occipital protuberance at the confluence of sinuses. The superior sagittal sinus receives the superior cerebral veins and communicates on each side through slit-like openings with the lateral venous lacunae, lateral expansions of the superior sagittal sinus.
  60. The inferior sagittal sinus,
    much smaller than the superior sagittal sinus, runs in the inferior, free concave border of the cerebral falx and ends in the straight sinus.
  61. The straight sinus is
    formed by the union of the inferior sagittal sinus with the great cerebral vein. It runs inferoposteriorly along the line of attachment of the cerebral falx to the cerebellar tentorium to join the confluence of sinuses.
  62. The transverse sinuses
    pass laterally from the confluence of sinuses in the posterior attached margin of the cerebellar tentorium, grooving the occipital bones and the posteroinferior angles of the parietal bones. The transverse sinuses leave the cerebellar tentorium at the posterior aspect of the petrous temporal bone and become the sigmoid sinuses.
  63. The sigmoid sinuses
    follow S-shaped courses in the posterior cranial fossa, forming deep grooves in the temporal and occipital bones. Each sigmoid sinus turns anteriorly and then continues inferiorly as the internal jugular vein (IJV) after transversing the jugular foramen.
  64. The occipital sinus
    lies in the attached border of the cerebellar falx and ends superiorly in the confluence of sinuses. The occipital sinus communicates inferiorly with the internal vertebral venous plexus.
  65. The cavernous sinus is
  66. is located bilaterally on each side of the sella turcica on the body of the sphenoid bone. The cavernous sinus consists of a venous plexus of extremely thin-walled veins that extend from the superior orbital fissure anteriorly to the apex of the petrous part of the temporal bone posteriorly. The cavernous sinus receives blood from the superior and inferior ophthalmic veins, superficial middle cerebral vein, and sphenoparietal sinus. The venous channels in the cavernous sinuses communicate with each other through intercavernous sinuses anterior and posterior to the stalk (infundibulum) of the pituitary gland. The cavernous sinuses drain posteroinferiorly through the superior and inferior petrosal sinuses and via emissary veins to the pterygoid plexuses
  67. What is a function of the arachnoid granulations?
  68. The arachnoid granulations protrude into the venous sinuses of the brain, and allow CSF to exit the brain and enter the blood stream.
  69. Be able to identify the layers of the meninges.
  70. Dura, Arachnoid and Pia
  71. What is the general function of the parasympathetic and sympathetic nervous system?
  72. Parasympathetic: Anabolic, promotes normal function and conserving energy (rest and digest)
    Sympathetic: Catabolic, fight (fight or flight)
  73. What are the boundaries of the anterior (anterolateral) and posterior (cervical) triangles (regions) of the neck?
    • Anterior boundary: formed by the median line of the neck.
    • Posterior boundary: formed by the anterior border of the SCM.
    • Superior boundary: formed by the inferior border of the mandible.
    • Apex: located at the jugular notch in the manubrium of the sternum.
    • Roof: formed by subcutaneous tissue containing the platysma.
    • Floor: formed by the pharynx, larynx, and thyroid gland.
  74. Be able to identify a structure that lies in each of the triangles.
    The anterior cervical region is subdivided into four smaller triangles (the unpaired submental triangle and three small paired triangles
  75. The skin of the neck is thin and pliable. The subcutaneous connective tissue contains the platysma, a thin sheet of striated muscle that ascends to the face.
    • The broad SCM is the key muscular landmark of the neck. It defines the sternocleidomastoid region and divides the neck into anterior and lateral cervical regions. It is easy to observe and palpate throughout its length as it passes superolaterally from the clavicle and manubrium to the mastoid process of the temporal bone. The SCM can be made to stand out by asking the person to rotate the face toward the contralateral side and elevate the chin.
    • The EJV runs vertically across the SCM toward the angle of the mandible. This vein may be prominent, especially if distended by asking the person to take a deep breath (Valsalva maneuver). The jugular notch in the manubrium is the fossa between the sternal heads of the SCM. The lesser supraclavicular fossa, between the sternal and the
    • clavicular heads of the SCM, overlies the inferior end of the IJV. Deep to the superior half of the SCM is the cervical plexus, and deep to the inferior half of the SCM are the IJV, common carotid artery, and vagus nerve in the carotid sheath. The trapezius, which defines the posterior cervical region, can be observed and palpated by asking the person to shrug the shoulders against resistance.
    • Just inferior to the belly of the omohyoid is the greater supraclavicular fossa, the depression overlying the omoclavicular triangle. The subclavian arterial pulsations can be palpated here in most people. The occipital triangle contains the spinal accessory nerve (CN XI). Because of its vulnerability and frequency of iatrogenic injury (damage resulting from medical treatment), it is important to be able to estimate the location of the nerve. Its course can be approximated by a line that intersects the junction of the superior and middle thirds of the posterior border of the SCM and the junction of the middle and lower thirds of the anterior border of the trapezius. The submandibular gland nearly fills the submandibular triangle. The submandibular lymph nodes lie superficial to the gland and, if enlarged, can be palpated by moving the fingers from the angle of the mandible along its inferior border. If continued until the fingers meet under the chin, enlarged submental lymph nodes can be palpated in the submental triangle. The carotid arterial system is located in the carotid triangle. The carotid sheath can be mapped out by a line joining the sternoclavicular joint to a point midway between the mastoid process and the angle of the mandible. The carotid pulse can be palpated by placing the index and 3rd fingers on the thyroid cartilage and pointing them posterolaterally between the trachea and SCM. The pulse is palpable just medial to the SCM muscle.
  76. What is the origin of the phrenic nerve and where does it lie in the neck?
  77. Origin: CN III, CN IV, CN V: Cervical Nerves 3,4,5 Keep the man alive. Descends with the Internal Jugular Veins
  78. What is the function of the carotid body and the carotid sinus and what nerves supply these structures?
    • Carotid Body: Innervated by CN IX and CN X, function: chemoreceptor, monitors the level of oxygen in the blood
    • Carotid Sinus: Innervated by CNIX and CN X, function: baroreceptor, reacts to changes in blood pressure
  79. Identify the three layers of deep cervical viscera.
    Endocrine, Respiratory and Alimentary
  80. Define an endocrine organ. Where are these organs located in the head and neck?
    Head: Pituitary, Pineal; Neck: Thyroid, Parathyroid. A system of glands, each of which secretes a type of hormone to regulate the body
  81. Identify the cartilages of the larynx? Which cartilage forms a complete ring?
    9 cartilages in the Laryngeal Skeleton: Thyroid, Cricoid, Epiglottic, Arytenoid (paired), Corniculate (paired) & Cuneiform (paired)
  82. The tracheal rings are incomplete posterior. What lies in this gap?
    Trachealis Muscle
  83. Where does the trachea terminate and what structure(s) does it form?
    The trachea terminates at the level of the sternal angle into a right and left Primary Bronchi.
  84. Identify the three sets of tonsils and where they are located? Which set of the three tonsils is called adenoids when infected?
  85. Pharyngeal Tonsils (called adenoids when enlarged): located in the mucous membrane of the roof and posterior wall of the nasopharynx.
  86. Palatine Tonsils: lie in the tonsilar sinus between the palatoglossal and palatopharyngeal arches.
  87. Tubal Tonsil: located in the submucosa pharynx near the pharyngeal oriface of the pharyngotympanic tube
  88. Identify each of the paranasal sinuses and where each drains. Which one does not drain by gravity?
  89. The paranasal sinuses are air-filled extensions of the respiratory part of the nasal cavity into the following cranial bones: frontal, ethmoid, sphenoid, and maxilla. They are named according to the bones in which they are located.
  90. The frontal sinuses are
  91. The frontal sinuses are between the outer and the inner tables of the frontal bone, posterior to the superciliary arches and the root of the nose. Each sinus drains through a frontonasal duct into the ethmoidal infundibulum, which opens into the semilunar hiatus of the middle meatus. The frontal sinuses are innervated by branches of the supraorbital nerves (CN V1).
  92. The ethmoidal cells (sinuses)
  93. include several cavities that are located in the lateral mass of the ethmoid between the nasal cavity and the orbit. The anterior ethmoidal cells drain directly or indirectly into the middle meatus through the infundibulum. The middle ethmoidal cells open directly into the middle meatus. The posterior ethmoidal cells, which form the ethmoidal bulla, open directly into the superior meatus. The ethmoidal sinuses are supplied by the anterior and posterior ethmoidal branches of the nasociliary nerves.
  94. The sphenoidal sinuses,
    unevenly divided and separated by a bony septum, occupy the body of the sphenoid bone; they may extend into the wings of this bone in the elderly. Because of these sinuses, the body of the sphenoid is fragile. Only thin plates of bone separate the sinuses from several important structures: the optic nerves and optic chiasm, the pituitary gland, the internal carotid arteries, and the cavernous sinuses. The posterior ethmoidal artery and nerve supply the sphenoidal sinuses.
  95. The maxillary sinuses
    are the largest of the paranasal sinuses. These large pyramidal cavities occupy the bodies of the maxillae. The apex of the maxillary sinus extends toward and often into the zygomatic bone. The base of the maxillary sinus forms the inferior part of the lateral wall of the nasal cavity. The roof of the maxillary sinus is formed by the floor of the orbit. The floor of the maxillary sinus is formed by the alveolar part of the maxilla. The roots of the maxillary teeth, particularly the first two molars, often produce conical elevations in the floor of the maxillary sinus. Each sinus drains by an opening, the maxillary ostium, into the middle meatus of the nasal cavity via the semilunar hiatus. Because of the superior location of this opening, it is impossible for the sinus to drain when the head is erect until the sinus is full. The arterial supply of the maxillary sinus is mainly from superior alveolar branches of the maxillary artery; however, branches of the greater palatine artery supply the floor. Innervation of the maxillary sinus is from the anterior, middle, and posterior superior alveolar nerves branches of CN V2.
  96. Where are the tarsal glands located? What is their function?
  97. The superior (upper) and inferior (lower) eyelids are strengthened by dense bands of connective tissue, the superior and inferior tarsi (singular tarsus). Fibers of the palpebral portion of the orbicularis oculi muscle are in the subcutaneous tissue superficial to these tarsi and deep to the skin of the eyelid. Embedded in the tarsal plates are tarsal glands, the lipid secretion of these glands lubricates the edges of the eyelids and prevents them from sticking together when they close. This secretion also forms a barrier that lacrimal fluid does not cross when produced in normal amounts. When production is excessive, it spills over the barrier onto the cheeks as tears.
  98. What does the term ptosis mean?
    Ptosis: to droop, in the case of an eye, the upper lid droops.
  99. What is the function and where is the common tendinous ring located?
    • Function: Origin of the rectus muscles of the eye.
    • Location: Surrounding the optic canal and part of the superior orbital fissure.
  100. Be able to identify and give the innervation of the seven extra-occular muscles of the eye.
  101. Levator Palpebrae Superioris innervated by CN III
    • Superior Oblique innervated by CN IV
    • Inferior Oblique innervated by CN III
    • Superior and Inferior Rectus innervated by CN III
    • Medial and Lateral Rectus innervated by CN VI
  102. What is the scleral venous sinus? Why is it important?
    The aqueous humor drains into the scleral venous sinus, canal of Schlemm at the iridocorneal angle. The aqueous humor is removed by the limbal plexus, a network of scleral veins close to the limbus, which drain, in turn, into both tributaries of the vorticose and anterior ciliary veins.
  103. Accessory structures of the eyeball.
    Extraocular muscles of the orbit, bulbar fascia
  104. Eyeball layers and their subdivisions.
    Fibrous layer (outer coat) consisting of the sclera and cornea.Vascular layer (middle coat), consisting of the choroid, the ciliary body, and the iris. Inner layer (inner coat), consisting of the retina, which has both optic and non-visual parts
  105. What is the nerve supply to the tympanic membrane?
    CN V, CN IX, CN X
  106. The mastoid air sinus communicates with which ear cavity?
    Middle ear cavity
  107. In which bone of the skull is the internal ear located? (cochlea)
    It is buried in the Petrous part of the Temporal bone
  108. What is the function of the auditory tube?
    • Also known as the Pharyngotympanic Tube or Eustachian Tube.
    • It serves as a connection between the tympanic cavity (middle
    • ear) and the nasopharynx.
  109. What structure of the ear is the receptor of auditory stimuli?
  110. Which cranial nerve passes through the middle ear cavity?
    Chordae Tympani branch of Cranial Nerve VII (7)
  111. What are the parts of the internal ear and what are their functions?
  112. a. Vestibulocochlear Organ: sound and balance. Contained within the Bony Labyrinth:
  113. b. Cochlea (sound)
  114. c. Semicircular Canal and Duct (balance).
  115. What are the names of the three middle ear bones? In what order are they found from external to internal?
    Found in the following order: Mallus, Incus and Stapes.
  116. Motion sickness results mainly from discordance between what two stimuli?
  117. Vestibular and Visual stimuli.
  118. Identify the five layers of the scalp, external to internal.
    • Remember:
    • S Skin
    • C Connective Tissue
    • A Aponeurosis
    • L Loose Connective Tissue
    • P Periosteum