Anatomy Muscle and Nerve Quiz
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Questions and Answers

Which muscle is primarily responsible for plantar flexion of the foot?

  • Tibialis anterior
  • Soleus (correct)
  • Gastrocnemius (correct)
  • Plantaris

    • Injury to the tibial nerve can result in an inability to stand on toes.

    True (A)

    What is the name of the nerve that is commonly injured in a fracture of the fibular neck?

    common peroneal nerve

    Injury to the common peroneal nerve can result in ______ of the foot.

    <p>foot drop</p> Signup and view all the answers

    Match the following muscles with their primary actions:

    <p>Gastrocnemius = Plantar flexion of the foot Tibialis anterior = Dorsiflexion of the foot Soleus = Plantar flexion of the foot Plantaris = Plantar flexion of the foot</p> Signup and view all the answers

    The plantaris muscle is always present in the human body.

    <p>False (B)</p> Signup and view all the answers

    What type of cancer is most common in the breast?

    <p>adenocarcinoma</p> Signup and view all the answers

    Which of the following statements is TRUE about breast carcinoma?

    <p>Breast carcinomas are malignant tumors. (D)</p> Signup and view all the answers

    The ______ suture lies between the two parietal bones and the occipital bone.

    <p>lambdoid</p> Signup and view all the answers

    Match the cranial suture with its location:

    <p>Sagittal suture = Between the two parietal bones Squamous suture = Between the parietal bone and the squamous part of the temporal bone Lambdoid suture = Between the two parietal bones and the occipital bone</p> Signup and view all the answers

    The anterior fontanelle is typically present at birth and closes between 9 and 18 months of age.

    <p>True (A)</p> Signup and view all the answers

    Which of the following conditions results from the premature closure of the sagittal suture?

    <p>Scaphocephaly (A)</p> Signup and view all the answers

    What is the term used to describe a twisted and asymmetrical cranium resulting from premature closure of the coronal or lambdoid suture on one side?

    <p>Plagiocephaly</p> Signup and view all the answers

    Oxycephaly is a condition where the coronal suture closes prematurely leading to a high, tower-like skull.

    <p>True (A)</p> Signup and view all the answers

    Which of the following conditions might be indicated by a diminished size or absence of the anterior fontanelle at birth?

    <p>Both A and B (D)</p> Signup and view all the answers

    The ______ is the largest fontanelle and is located at the intersection of the sagittal, coronal, and frontal sutures.

    <p>anterior fontanelle</p> Signup and view all the answers

    Which muscle is primarily affected if the inferior gluteal nerve is injured?

    <p>Gluteus maximus (C)</p> Signup and view all the answers

    An avulsion fracture of the ischial tuberosities can affect the hamstrings muscles.

    <p>True (A)</p> Signup and view all the answers

    What is the primary action of the hamstrings muscles?

    <p>Extension of the hip joint and flexion of the knee joint</p> Signup and view all the answers

    The ______ nerve supplies the hamstrings muscles, except for the short head of the biceps femoris, which is supplied by the ______ nerve.

    Signup and view all the answers

    Which of the following sinuses opens into the middle meatus?

    <p>Frontal sinus (C)</p> Signup and view all the answers

    Epistaxis most often occurs from the posterior nasal septum.

    <p>False (B)</p> Signup and view all the answers

    What is the area called where branches of several arteries converge, leading to a higher risk of nosebleeds?

    <p>Kiesselbach's area</p> Signup and view all the answers

    Which nerve supplies the cricothyroid muscle?

    <p>External laryngeal nerve (D)</p> Signup and view all the answers

    The recurrent laryngeal nerve supplies all muscles of the larynx including the cricothyroid muscle.

    <p>False (B)</p> Signup and view all the answers

    The _____ receives the opening of the nasolacrimal duct.

    <p>inferior meatus</p> Signup and view all the answers

    What is the procedure called that is performed to relieve an airway obstruction?

    <p>Cricothyrotomy</p> Signup and view all the answers

    Match the anatomical structure with its corresponding type of sinus or duct:

    <p>Sphenoethmoidal recess = Sphenoidal air sinus Superior meatus = Posterior ethmoidal air cells Inferior meatus = Nasolacrimal duct Middle meatus = Frontal and maxillary sinuses</p> Signup and view all the answers

    Which artery is NOT involved in the vascularization that leads to epistaxis?

    <p>Superficial temporal artery (B)</p> Signup and view all the answers

    The internal laryngeal nerve supplies sensory function to the __________ of the larynx above the vocal folds.

    <p>mucous membrane</p> Signup and view all the answers

    Sphenoiditis can lead to complications during pituitary surgery.

    <p>True (A)</p> Signup and view all the answers

    Match the following components of the vagus nerve to their functions:

    <p>Internal laryngeal nerve = Sensory supply to the larynx External laryngeal nerve = Motor supply to the cricothyroid muscle Recurrent laryngeal nerve = Supplies all muscles of the larynx except cricothyroid Cricothyrotomy = Emergency airway procedure</p> Signup and view all the answers

    What anatomical structure does the right recurrent laryngeal nerve hook around?

    <p>Subclavian artery (A)</p> Signup and view all the answers

    Name one potential complication associated with sphenoiditis.

    <p>Injury during pituitary surgery</p> Signup and view all the answers

    A __________ laryngeal nerve ascends in a groove between the trachea and esophagus.

    <p>recurrent</p> Signup and view all the answers

    The external laryngeal nerve is responsible for sensory innervation of the upper trachea.

    <p>False (B)</p> Signup and view all the answers

    Which cranial nerve is responsible for the motor supply to the muscles of facial expression?

    <p>Facial Nerve (CN VII) (B)</p> Signup and view all the answers

    The Facial Nerve (CN VII) provides sensory innervation to the taste buds of the entire tongue.

    <p>False (B)</p> Signup and view all the answers

    What is the name of the nerve that provides sensory innervation to a small area over the angle of the mandible?

    <p>Great auricular nerve</p> Signup and view all the answers

    The Facial Nerve carries ______ fibers to the submandibular and sublingual salivary glands.

    <p>parasympathetic</p> Signup and view all the answers

    Which of the following is NOT a function of the Facial Nerve (CN VII)?

    <p>Sensory innervation to the skin of the face (A)</p> Signup and view all the answers

    Match the following structures with their respective innervation by the Facial Nerve (CN VII):

    <p>Submandibular salivary gland = Parasympathetic secretomotor Lacrimal gland = Parasympathetic secretomotor Muscles of facial expression = Motor Taste buds in anterior 2/3 of tongue = Sensory</p> Signup and view all the answers

    The Facial Nerve is responsible for both motor and sensory innervation to the muscles of facial expression.

    <p>False (B)</p> Signup and view all the answers

    What is the name of the branch of the Facial Nerve that carries taste sensation from the anterior 2/3 of the tongue?

    <p>Chorda tympani</p> Signup and view all the answers

    What happens to the pelvis if the superior gluteal nerve on the left side is injured?

    <p>The right pelvis falls downward (C)</p> Signup and view all the answers

    Injury to the inferior gluteal nerve primarily affects hip flexion.

    <p>False (B)</p> Signup and view all the answers

    What muscles are involved in the action of hip extension and knee flexion?

    <p>Hamstrings muscles</p> Signup and view all the answers

    An avulsion fracture can occur at the ischial tuberosities where the ______ muscles are attached.

    <p>hamstrings</p> Signup and view all the answers

    Match the following muscles with their corresponding nerve supply:

    <p>Biceps femoris = Tibial nerve (short head by common fibular nerve) Semitendinosus = Tibial nerve Semimembranosus = Tibial nerve</p> Signup and view all the answers

    Study Notes

    100 Most Important Gross Anatomy Concepts

    • This presentation is a guide for final GA exam preparation
    • It does not cover all Gross Anatomy course material
    • Students must refer to all professor's presentations for complete GA material

    Lumbar Puncture (Tap) and Epidural Anesthesia

    • Lumbar puncture: needle enters subarachnoid space to extract cerebrospinal fluid (spinal tap) or inject anesthetic (spinal block) or contrast material.
    • Needle typically inserted between L3/L4 or L4/L5, level of horizontal line through upper points of iliac crests.
    • Spinal cord may end as low as L2 in adults and L3 in children; dural sac extends caudally to level of S2.
    • Before procedure, examine patient for signs of increased intracranial pressure (ICP) because cerebellar tonsils may herniate through foramen magnum.

    Herniated IV Disc

    • Herniated discs commonly occur in lumbar (L4/L5 or L5/S1) or cervical (C5/C6 or C6/C7) regions in individuals younger than 50.
    • Herniations often follow degenerative changes in the anulus fibrosus and are sometimes caused by sudden compression of the nucleus pulposus.
    • Herniated lumbar discs typically involve the nerve root one number below the level of the herniation (e.g., L4/L5 herniation compresses L5 root).

    Abnormal Curvatures of the Spine

    • Kyphosis: an exaggerated thoracic curvature, may result from osteoporosis (multiple vertebral compression fractures) or disk degeneration, commonly seen in elderly.
    • Lordosis: an exaggerated lumbar curvature that may be temporary and occurs as a result of pregnancy, spondylolisthesis, or potbelly.
    • Scoliosis: a complex lateral (sideways) and rotational curvature, caused by poliomyelitis, a leg-length discrepancy, or hip disease.

    Upper Limb Fractures: Humerus

    • Sites of potential nerve and artery injury in humerus fractures:
      • Axillary nerve and posterior humeral circumflex artery at surgical neck.
      • Radial nerve and profunda brachii artery at midshaft.
      • Brachial artery and median nerve at supracondylar region.
      • Ulnar nerve at medial epicondyle.

    Fracture of Distal Radius

    • Transverse fracture within the distal 2 cm of the radius, most common forearm fracture (after age 50).
    • Smith's fracture: fall/blow to the dorsal aspect of flexed wrist → ventral angulation, distal fragment anteriorly displaced.
    • Colles' fracture: forced extension of hand → dorsal angulation, distal fragment posteriorly displaced ("dinner fork deformity").
    • Ulnar styloid process may be avulsed (broken off).

    Scaphoid Fracture

    • Occurs from a fall onto the palm when the hand is abducted.
    • Pain in the lateral side of the wrist, especially during wrist extension and abduction.
    • Scaphoid fracture may not appear on X-rays for 2–3 weeks but deep tenderness in anatomical snuffbox is present.
    • Proximal fragment may undergo avascular necrosis due to interrupted blood supply.

    Boxer's Fracture

    • Metacarpal necks are frequently fractured during fistfights.
    • Typically involves the 2nd and 3rd metacarpals in professional boxers and the 5th (and sometimes 4th) metacarpals in unskilled fighters.

    Rotator Cuff Muscles (SITS)

    • Support the shoulder joint by forming a musculotendinous rotator cuff around it.
    • Reinforces the joint on all sides except inferiorly, where dislocation is most likely.
    • Muscles include: Supraspinatus, Infraspinatus, Teres minor, Subscapularis (SITS).

    Abduction of Upper Limb

    • Abduction of upper extremity is initiated by the supraspinatus muscle.
    • Further abduction to the horizontal position is a function of the deltoid muscle.
    • Raising the extremity above the horizontal position is through scapular rotation (trapezius) and serratus anterior.

    Subacromial Bursitis

    • Inflammation of the subacromial bursa, commonly due to calcific supraspinatus tendinitis.
    • Causes painful arc of abduction.

    Medial (Golfer's Elbow) and Lateral (Tennis Elbow) Epicondylitis

    • Medial epicondylitis: inflammation of the common flexor tendon.
    • Lateral epicondylitis: repeated forceful flexion and extension of the wrist → strain and inflammation of the common extensor tendon of the lateral epicondyle. Pain over lateral epicondyle, radiating down posterior forearm. Pain when opening a door or lifting a glass.

    Arterial Anastomoses Around the Scapula

    • Blockage of Subclavian or Axillary artery may be bypassed by anastomoses between branches of thyrocervical and subscapular arteries.
    • Includes: Transverse cervical, Suprascapular, Subscapular, and Circumflex scapular arteries.

    Cubital Fossa

    • Contents (lateral to medial): Biceps brachii tendon, brachial artery, median nerve.
    • Subcutaneous structures (lateral to medial): Cephalic vein, median cubital vein (joins cephalic and basilic veins), basilic vein.
    • Median cubital vein is a common venipuncture site because it lies over the bicipital aponeurosis and is not accompanied by nerves.

    Carpal Tunnel Syndrome

    • Results from a lesion reducing the size of the carpal tunnel (fluid retention, infection, dislocation of lunate bone).
    • Median nerve is most sensitive structure and is most affected.
    • Clinical manifestations: pins and needles / anesthesia of the lateral 3.5 digits; palm sensation not affected.
    • Apehand deformity absent / Opposition absent.

    Test of Proximal and Distal Interphalangeal Joints

    • PIP - tested by flexor digitorum superficialis (FDS).
    • DIP - tested by flexor digitorum profundus (FDP).

    Lesion of UL Nerves (Upper Brachial Palsy)

    • Injury of upper roots and trunk (C5 & C6)
    • Usually from excessive increase in angle between neck & shoulder.
    • May occur as birth injury.
    • "Waiter's tip" hand (adducted shoulder, medially rotated arm, extended elbow) loss of sensation in lateral aspect of upper limb.

    Lower Brachial Palsy (Klumpke Paralysis)

    • Injury of lower roots and trunk (C8 & T1)
    • Commonly caused by sudden superior pull of the upper limb (eg., grabbing a support during a fall).
    • Involvement typically in intrinsic muscles of the hand, and may include "claw hand" (ulnar nerve) and/or "ape hand" (median nerve); loss of sensation in medial aspect of upper limb and medial 1.5 fingers; possible Horner syndrome.

    Injury to Musculocutaneous Nerve

    • From lesions of lateral cord.
    • Resulting in weakness of elbow flexion (biceps & brachialis) and forearm supination (biceps).
    • Possible sensory loss over lateral forearm.

    Cutaneous Innervation of the Hand

    • Dorsal: C5-T1 from radial, median, and ulnar nerves.
    • Palmar: C5-T1 from median and ulnar nerves.

    Avascular Necrosis of Femoral Head

    • A common fracture in elderly women with osteoporosis, most often femoral neck fracture.
    • Disrupts blood supply to the head of the femur via retinacular arteries (from medial circumflex femoral artery).
    • Can lead to avascular necrosis of the femoral head if blood supply through the ligament to the head is inadequate.

    Knee Joint Injury: Unhappy Triad

    • Typically results from lateral impact (e.g., football tackle).
    • Tibial collateral ligament, medial meniscus, and anterior cruciate ligament are involved in "unhappy triad" injuries .

    Fibular Collateral Ligament (Lateral Collateral Ligament)

    • Rounded cord between the lateral epicondyle of the femur and head of fibula.
    • Does not blend with the joint capsule or attach to lateral meniscus.
    • Limits extension and adduction of the leg at the knee.

    Rupture of the Cruciate Ligaments

    • Anterior cruciate ligament: prevents posterior sliding of femur on tibia and hyperextension of knee.
    • Posterior cruciate ligament: prevents anterior sliding of femur on tibia, particularly when the knee is flexed.
    • Rupture of either ligament can result in a characteristic anterior or posterior drawer sign.

    Prepatellar and Suprapatellar Bursa

    • Prepatellar bursa: between patella and skin; prone to inflammation and swelling (prepatellar bursitis)
    • Suprapatellar bursa: superior extension of synovial cavity between distal end of femur and quadriceps muscle/tendon. Usual site for intra-articular injections.

    Knee Jerk Reflex

    • Tested by tapping the patellar ligament to elicit extension at the knee joint.
    • Afferent and efferent limbs of reflex arch are in femoral nerve (L2-L4).
    • Tests spinal nerves L2-L4.

    Ankle Joint Injury: Ankle Sprains

    • Inversion injuries are most common.
    • Anterior talofibular ligament is injured, often quite severely.
    • Lateral malleolus of fibula may be fractured in severe sprains.

    Pott's Fracture

    • Fracture-dislocations of the ankle (Pott's fracture):
    • Often caused by forced eversion or inversion of foot (abduction or adduction)
    • Medial ligament avulsion with medial malleolus or tears; fibula fractures at a higher level.

    Ankle Jerk Reflex

    • Tested by tapping the calcaneal tendon to generate plantar flexion.
    • Afferent and efferent reflex limbs are in the tibial nerve (S1 and S2).
    • Tests spinal nerves S1–S2.

    Injury of the Gluteal Region: Piriformis Syndrome

    • Inflammation or spasm of the piriformis muscle.
    • Can mimic sciatica.
    • Action of piriformis: supination of hip joint.

    Injury to Sciatic Nerve

    • Weakened hip extension and knee flexion.
    • Footdrop (lack of dorsiflexion)
    • Flail foot (lack of dorsiflexion and plantar flexion).
    • Improperly placed gluteal injections or posterior hip dislocation can injure sciatic nerve.

    Superior Gluteal Nerve Injury

    • Paralysis of gluteus medius and minimus causing inability to abduct hip or laterally rotate thigh are possible in superior gluteal nerve injury.
    • The contralateral pelvis will drop when elevating the affected thigh.
    • May be caused by injury during surgery, hip dislocation, or poliomyelitis.

    Injury to Inferior Gluteal Nerve

    • Causes weakened hip extension (gluteus maximus); often noticeable when climbing stairs or standing up from a seated position.
    • May result from posterior hip dislocation or surgery.

    Avulsion Fracture of the Hip Bone and Hamstring Muscles

    • Avulsion: where muscles are attached to the ischial tuberosities.
    • Hamstring muscles (biceps femoris, semitendinosus, semimembranosus) work together in hip extension & knee flexion.
    • Often results from severe contractions, sports activities

    Femoral Sheath & Femoral Hernia

    • Formed by extension of transversalis fascia.
    • Consists of 3 compartments that enclose the femoral artery, femoral vein, and some lymph nodes.
    • A femoral hernia occurs when abdominal content protrudes into the femoral canal, common in women.

    Femoral Hernia

    • Femoral hernia occurs when a portion of the abdominal contents pass through the femoral ring.
    • Often located on the upper thigh.
    • Can get strangulated (blood supply is disrupted).
    • An aberrant obturator artery is also vulnerable during surgical repair.

    Rupture of the Achilles Tendon and Triceps Surae Muscle

    • Avulsion or rupture of the Achilles tendon is a common injury, particularly with intense plantar flexion.
    • This compromises the actions of the gastrocnemius and soleus muscles within the triceps surae, making plantarflexion of the foot impossible.
    • Also includes the plantaris muscle – a small, thin muscle that may sometimes be absent but sometimes hypertrophy.

    Injury to Tibial Nerve

    • In the popliteal fossa, injury to the tibial nerve results in loss of plantar flexion via the gastrocnemius and soleus muscles, along with diminished inversion via the tibialis posterior muscle.
    • Can cause calvary.
    • Inability to stand on toes.

    Fracture of the Fibular Neck

    • Common injury to the common peroneal nerve from fractures of the fibular neck.
    • Results in paralysis of muscles in the anterior and lateral compartments of the leg (affecting dorsiflexors and evertors).
    • Causes foot drop.

    Breast: Carcinoma of the Breast

    • Carcinomas are malignant tumors, usually adenocarcinomas (arise from epithelial cells in lactiferous ducts of mammary gland)
    • Manifestations: skin dimpling, edema, and/or shadows indicating retraction of suspensory ligaments (Cooper's ligaments).

    Lymphatic Drainage of the Breast

    • Most (>75%) lymph from lateral breast quadrants drains to the axillary lymph nodes (particularly pectoral ones).
    • Medial breast quadrants drain to parasternal or opposite breast lymph nodes.

    Mastectomy

    • Radical mastectomy: removal of breast, pectoralis muscles, fat, fascia, and many axillary lymph nodes.
    • Possible long thoracic nerve damage during ligation of lateral thoracic artery; potential serratus anterior muscle paralysis, weakness in abduction above 90°, and winged scapula.
    • Intercostobrachial nerve also vulnerable, causing numbness in medial arm skin.

    Breast Infection (Mastitis)

    • Infection of breast tissue, most common during breastfeeding (1–3 months postpartum).
    • Causes pain, swelling, redness, and increased temperature.
    • Often due to bacteria from baby's mouth entering a milk duct via nipple crack.

    Foramina of the Base of Skull

    • Skull's base contains numerous foramina for nerves, blood vessels and other structures.
    • Critical anatomical landmarks for neurosurgery; commonly related to cranial nerve exits and vessels.

    Exit of Cranial Nerves

    • Visual diagram illustrating the exit points of various cranial nerves (I–XII) from the brain stem.

    Fracture of the Anterior Cranial Fossa

    • Fracture of the cribriform plate (ethmoid bone) indicated by anosmia (loss of smell), periorbital bruising (raccoon eyes), and CSF leakage from nose (rhinorrhea).

    Development of Skull Sutures (Neurocranium)

    • Coronal suture: between frontal and both parietal bones
    • Sagittal suture: between two parietal bones
    • Squamous suture: between parietal and temporal bones
    • Lambdoid suture: between two parietal and occipital bones.

    Cranial Malformations

    • Scaphocephaly: premature closure of sagittal suture → long, narrow skull.
    • Oxycephaly: premature closure of coronal suture → high, tower-like skull.
    • Plagiocephaly: premature closure of one coronal or lambdoid suture → twisted cranium.

    Fontanelles

    • Anterior fontanelle: present at birth, closes 9-18 months.
    • Posterior fontanelle: present at birth, closes ~2 months.
    • Abnormal size or absence at birth may suggest craniosynostosis or microcephaly.

    Epidural Hematoma

    • Skull fracture near pterion commonly causes an epidural hematoma.
    • Bleeding from torn middle meningeal artery dissects a wide space between dura mater and cranium.
    • Results in a characteristic biconvex pattern on computed tomography images.

    Infection of the Cavernous Sinus

    • Lateral to body of sphenoid bone and sella turcica, where cavernous sinus is located.
    • Contains: Internal carotid artery, internal carotid plexus, abducens nerve (CN VI), oculomotor nerve (CN III), and trochlear nerve (CN IV).

    Ophthalmic Veins

    • Superior ophthalamic vein communicates with the facial (angular) vein.
    • Inferior ophthalmic vein communicates with the pterygoid plexus of veins via the inferior orbital fissure.
    • Both drain into cavernous sinus.

    Layers of the Scalp

    • Skin: contains sweat and sebaceous glands.
    • Connective tissue (dense): superficial fascia containing nerves and blood vessels.
    • Epicranial aponeurosis: connects frontal and occipital parts of occipitofrontalis muscles.
    • Loose areolar tissue: allows movement of upper scalp layers and contains spaces for fluid.
    • Pericranium (periosteum): covers outer skull bone.

    Innervation of Face Skin

    • Skin supplied by branches of trigeminal nerve except at the angle of the mandible, which is innervated by the great auricular nerve (C2–C3–cervical plexus).
    • Trigeminal nerve (CN V) divisions (ophthalmic, maxillary, and mandibular).

    Facial Nerve (CN VII)

    • Sole motor supply to muscles of facial expression and other structures.
    • Sensory to anterior 2/3 of tongue via chorda tympani.
    • Secretomotor to salivary glands (submandibular, sublingual, palatine), lacrimal gland.
    • Originates from the embryonic 2nd pharyngeal arch.

    Bell's Palsy

    • Idiopathic unilateral facial paralysis.
    • 75% of facial nerve lesions.
    • Caused by parotid cancer/surgery.
    • Infant's facial nerve injury during forceps delivery.

    Lesions of CN VII

    • Symptoms determined by location within the facial nerve.
    • Manifestations: inability to close lips/eyelids, dry eye, abnormal whistling / chewing, facial distortion, taste disturbance, reduced/absent secretion from submandibular and sublingual glands.

    Communication of Paranasal Sinuses

    • Sphenoethmoidal recess: receives posterior ethmoidal air cells.
    • Superior meatus: receives frontal, maxillary sinuses and anterior ethmoidal air cells.
    • Inferior meatus: receives nasolacrimal duct.

    Epistaxis

    • Most common cause of nosebleeds (epistaxis).
    • Usually from anterior nasal septum (Kiesselbach's area).
    • Related arteries: anterior ethmoidal, sphenopalatine, and superior labial.

    Sphenoiditis

    • Infection of sphenoid sinuses.
    • Important due to close proximity to pituitary gland, cavernous sinuses, optic nerves, and the cranium.
    • Infections can extend/spread to nasopharynx and cause meningitis/temporal lobe abscess/sigmoid sinus thrombosis

    Cheeks

    • Walls of oral cavity formed by zygomatic prominences and buccinator muscle.
    • Parotid duct opens on buccinator surface.
    • Primarily a fat pad collection.

    Movements of TMJs (Temporomandibular Joints)

    • 4 muscles of mastication (temporalis, masseter, medial pterygoid, lateral pterygoid).
    • Innervated by mandibular division (V3).
    • Temporalis: elevation, retraction
    • Medial pterygoid: elevation
    • Lateral pterygoid: protrusion

    Lesion of CN XII (Hypoglossal Nerve)

    • Deviation of tongue toward paralyzed side in a lesion of CN XII due to unopposed action of contralateral genioglossus muscle.

    Gag Reflex

    • Testing of CN IX (glossopharyngeal) and CN X (vagus) nerves.
    • Stimulating posterior pharynx results in pharyngeal muscular contraction (gag reflex).

    Tonsillitis

    • Palantine tonsillectomy may injure glossopharyngeal nerve (CN IX); loss of taste and sensation from posterior 1/3 of tongue.
    • Hemorrhage from tonsillar branch of facial artery can occur.

    Palatine Tonsils

    • Receives blood supply from the facial artery's tonsillar branch.
    • Drained by lymph vessels (jugulodigastric node)
    • Supplied by nerves in the tonsillar plexus (CN IX & X)

    Lymph Drainage from Face Structures

    • Submandibular lymph nodes receive drainage from scalp front, nose, upper and lower cheeks, lip, frontal, maxillary and ethmoid air sinuses, anterior 2/3 of tongue (excluding tip) and floor of mouth/gums.
    • Important for tumor assessment, assessment of infections.

    Blow-Out Fracture

    • Fracture of orbital floor, typically from blunt trauma without involving orbital rim.
    • Nerve and vessel damage (e.g., infraorbital nerve/artery) is possible.

    Muscles of the Orbit

    • Skeletal muscles that move the eyes (superior rectus, inferior rectus, medial rectus, lateral rectus, superior oblique, inferior oblique, levator palpebrae superioris).
    • Each muscle has unique specific function depending of its placement in orbit and action on the eye.

    Clinical Testing Actions of Extraocular Muscles

    • Precise testing procedures for each extraocular muscle action.
    • Instructions to patient regarding how to position the eyes.

    Oculomotor Nerve Palsy (External Squint)

    • Affects most extraocular muscles.
    • Manifestations: ptosis, fully dilated pupil, eye is depressed and abducted ("down and out").
    • Due to unopposed actions of superior oblique and lateral rectus.

    Trochlear Nerve Palsy

    • Lesions impair ability to turn eyeball infero-medially (pupil looks superio-laterally).
    • Characteristic sign is diplopia (double vision).
    • Often evident during downward gaze (e.g., when going down stairs).
    • Patient can compensate with head tilt.

    Abducens Nerve Palsy (Internal Squint)

    • Injury results in paralysis of the lateral rectus muscle.
    • Affected eye is fully adducted to the nasal side due to actions of medial rectus (CN III).

    Corneal Reflex

    • Involves sensory afferent fibers (ophthalmic nerve, CN V1) and motor fibers (facial nerve, CN VII).
    • Response is blinking in response to corneal stimulation.

    Horner Syndrome

    • Caused by interrupting ascending preganglionic sympathetic fibers; affecting pupils, eyelid, and sweating.
    • Manifestations: miosis (constricted pupils), ptosis (drooping eyelids), reduced/absent sweating (anhydrosis), and possible redness in skin (vasodilation).
    • Caused by penetrating neck injury, Pancoast tumor, or thyroid carcinoma.

    Otitis Media

    • Hearing diminished (due to pressure and reduced ossicle movement).
    • Taste alterations (chorda tympani affected)
    • Potential for infection spreading posteriorly causing mastoiditis.
    • Potential for meningitis, temporal lobe abscess, or sigmoid sinus thrombosis.

    Perforation of the Tympanic Membrane

    • May result from otitis media(conduction deafness)
    • Causes: foreign bodies in the external acoustic meatus, excessive pressure, otitis media
    • Important because damage to the chorda tympani can cause loss of taste from the anterior 2/3 of the tongue and secretion from the sublingual/submandibular glands.

    Thyroid and Parathyroid Glands

    • Thyroid: Largest endocrine gland regulating metabolism; produces thyroid hormone (controls metabolic rate) and calcitonin (regulates calcium).
    • Parathyroid: regulates calcium and phosphorus metabolism through parathormone (PTH) actions.

    Anatomical Relations of the Thyroid Gland

    • A complex relationship of nerves, vessels, and other structures (larynx, trachea, esophagus) around the thyroid gland.
    • Critical considerations for surgical procedures (e.g., thyroid surgery, tracheostomy).

    Median Cervical Cyst

    • Usually a painless midline mass near hyoid bone that moves during swallowing.
    • Remnant of thyroglossal duct (embryological thyroid development pathway).

    Variation of Parathyroid Glands Position

    • Superior parathyroid glands are more consistently positioned than inferior ones.
    • Inferior parathyroid glands are usually near inferior thyroid poles; but sometimes deep in superior mediastinum, near thymus.
    • Variation in 1–5% of individuals due to embryonic origin.

    Larynx

    • Two folds (vestibular and vocal) with gaps (rima vestibuli and rima glottidis) divide the interior.
    • Contains muscles including abductors (posterior cricoarytenoids) which control vocal cord abduction.

    Vagus Nerve (CN X)

    • Has several branches relevant to the larynx, including the superior and recurrent laryngeal nerves.
    • Internal laryngeal nerve provides sensory input to larynx above vocal folds; external supplies cricothyroid muscle.
    • Recurrent laryngeal nerve supplies most other laryngeal muscles and mucous membrane below vocal folds.

    Cricothyrotomy

    • Emergency procedure for airway obstruction (e.g., airway foreign body).
    • Insertion of a tube through a small incision in the cricothyroid membrane to enable breathing.

    Retropharyngeal Space

    • Anatomical space behind the pharynx, bordered by buccopharyngeal fascia (anterior) and prevertebral fascia (posterior).
    • Contains prevertebral tissues/muscles.

    Carotid Sheath

    • Composed of all three layers.
    • Encloses the common and internal carotid arteries, internal jugular vein, and vagus nerve.
    • Contains deep cervical lymph nodes, carotid sinus nerve, and periarterial plexuses.

    Axillary Sheath

    • Formed by prevertebral fascia.
    • Encloses axillary vessels and the brachial plexus as they emerge in the interval between the scalene anterior and medius muscles.
    • Extends into the axilla (armpit).

    Posterior Triangle of the Neck

    • Borders: Inferior portion of sternocleidomastoid, superior portion of trapezius, and middle portion of clavicle.
    • Contains: scalene muscles, external jugular vein, subclavian vein, occipital arteries, accessory nerve, brachial plexus branches, cervical plexus branches, and phrenic nerve.
    • Important for surgical and anatomical considerations.

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