Anatomy Week 6 Outline (Exam 3)

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Questions and Answers

Which cranial nerve is responsible for innervating the muscles of facial expression?

  • Facial Nerve (CN VII) (correct)
  • Oculomotor Nerve (CN III)
  • Abducent Nerve (CN VI)
  • Trigeminal Nerve (CN V)

The pterion is a clinically significant area of the skull because it is the intersection of which bones?

  • Frontal, Parietal, Temporal, and Sphenoid (correct)
  • Parietal, Temporal, Occipital, and Zygomatic
  • Frontal, Parietal, Sphenoid, and Ethmoid
  • Frontal, Parietal, Occipital, and Temporal

Which of the following describes the action of the orbicularis oris muscle?

  • Closes the eyelids
  • Depresses the corners of the mouth
  • Elevates and retracts the upper lip
  • Oral sphincter, used in kissing and whistling (correct)

Which of the following is a key function of the trigeminal nerve (CN V)?

<p>Sensory innervation to the face and motor supply to the muscles of mastication. (B)</p> Signup and view all the answers

Which structure does the foramen magnum in the occipital bone transmit?

<p>Spinal cord and vertebral arteries (B)</p> Signup and view all the answers

The temporomandibular joint (TMJ) is formed by the articulation of the:

<p>Mandibular condyle with the mandibular fossa of the temporal bone. (C)</p> Signup and view all the answers

Which layer of the scalp contains dense connective tissue and blood vessels?

<p>Connective Tissue (dense) (C)</p> Signup and view all the answers

Which of the following facial bones contributes to the formation of the hard palate?

<p>Palatine (D)</p> Signup and view all the answers

Which cranial bone articulates with the mandible?

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

What is the primary function of the Sphenomandibular ligament related to the temporomandibular joint (TMJ)?

<p>Acts like a 'swing rope' to the mandible, preventing inferior dislocation (A)</p> Signup and view all the answers

Which of the following cranial bones articulates with all other cranial bones?

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

A patient presents with difficulty protruding and moving their jaw from side to side. Damage to which muscle is MOST likely the cause?

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

Which layer of the scalp is described as having dense connective tissue?

<p>Connective Tissue (C)</p> Signup and view all the answers

A patient has damage to a nerve that affects their ability to wrinkle their forehead and elevate their eyebrows. Which muscle is MOST likely affected?

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

Which of the following is ONLY a sensory branch of the Trigeminal Nerve(CN V)?

<p>Maxillary (V2) (B)</p> Signup and view all the answers

Which movement does the strong joint capsule NOT allow in the TMJ?

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

Which of the following structures is formed by the temporal process of the zygomatic bone and the zygomatic process of the temporal bone?

<p>Zygomatic arch (D)</p> Signup and view all the answers

If a patient has damage to the trochlear nerve (CN IV), which muscle's function will be MOST affected?

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

Which bony element is responsible for creating the forehead region?

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

Which of the following muscles associated with facial expression is responsible for compressing the cheeks?

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

Damage to the cribriform plate of the ethmoid bone would MOST directly affect which of the following?

<p>The sense of smell (A)</p> Signup and view all the answers

Which statement BEST explains the biomechanical function of the articular disc within the temporomandibular joint (TMJ)?

<p>It facilitates a modified hinge-type synovial movement by separating the joint into superior and inferior articular cavities. (C)</p> Signup and view all the answers

A patient is diagnosed with damage to the nerve that innervates the lateral rectus muscle. Which cranial nerve is MOST likely affected?

<p>Abducens nerve (CN VI) (D)</p> Signup and view all the answers

A surgeon needs to access the cranial cavity and plans to make an incision along a suture. If they cut along the intersection of the occipital bone and parietal bones, which suture are they incising?

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

Damage to the mandibular branch (V3) of the trigeminal nerve would MOST directly affect the function of which muscle?

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

A patient presents with paralysis of the muscles of facial expression. Which nerve is MOST likely affected?

<p>Facial nerve (CN VII) (A)</p> Signup and view all the answers

If a patient is experiencing impaired function related to the 'H'-shaped intersection of the frontal, parietal, temporal, and sphenoid bones, which cranial landmark is potentially involved?

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

An elderly patient displays a notable decrease in cheek prominence. Which of the following facial bones is MOST likely undergoing age-related resorption?

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

A patient is undergoing a procedure that requires ligating the chief artery of the face for hemostasis. Which vessel is MOST likely being targeted?

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

During a physical exam, a physician palpates the pulse of an artery against the mandible's inferior border. Which artery is MOST likely being assessed?

<p>Facial artery (C)</p> Signup and view all the answers

A patient has difficulty elevating the angle of their mouth, which is essential for smiling. Which muscle is MOST likely affected?

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

If a patient has a compromised ability to wrinkle their forehead, which muscle is MOST likely affected?

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

A lesion affecting the superior orbital fissure would MOST likely impact the function of which muscle of the orbit?

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

A patient has lost the ability to flare their nostrils. Which muscle is MOST likely affected?

<p>Levator labii superioris alaeque nasi (C)</p> Signup and view all the answers

Which of the following ligaments is thought to have a possible role in the prevention of inferior dislocation of the temporomandibular joint (TMJ)?

<p>Stylomandibular ligament (D)</p> Signup and view all the answers

Which action is PRIMARILY associated with the 'swing rope' mechanism of the sphenomandibular ligament?

<p>Preventing inferior dislocation of the mandible (A)</p> Signup and view all the answers

A patient has an injury that severs the ascending branch of the external carotid artery. Which artery is MOST at risk due to its origin from the external carotid's ascending branch?

<p>Facial artery (C)</p> Signup and view all the answers

A patient CANNOT move their eyeball laterally. Assuming nerve damage, which of the following cranial nerves has MOST likely been damaged?

<p>Abducens nerve (CN VI) (D)</p> Signup and view all the answers

When describing the anatomical relationship of the skin to the pericranium, which term is MOST accurate?

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

A patient is experiencing impaired elevation and retraction of the tongue. A deficit in muscles innervated by which cranial nerve could MOST likely cause this?

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

If the external acoustic meatus is located on the temporal bone, which bone landmark can also be found on the temporal bone?

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

Why might the zygomatic arch, created by the temporal process of the zygomatic bone, undergo reconstruction following a traumatic injury?

<p>To prevent restriction of mandibular movements (B)</p> Signup and view all the answers

A patient with trigeminal neuralgia affecting the ophthalmic nerve (V1) would MOST likely experience pain in which area?

<p>Forehead and around the eye (B)</p> Signup and view all the answers

A patient's difficulty with the motor control of mastication is attributed to damage along the mandibular branch (V3) of the trigeminal nerve. Which muscle action would be MOST compromised?

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

Following a traumatic injury, a patient undergoes a surgical procedure. Postoperatively, they exhibit impaired sensation of the upper lip and cheek. Which nerve was MOST likely affected during the procedure?

<p>Maxillary nerve (CN V2) (C)</p> Signup and view all the answers

Which intersection is characterized as the junction of the lambdoid and sagittal sutures?

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

The frontal bone contributes to several key anatomical landmarks. Which of the following is a structure formed by the frontal bone?

<p>Supra-orbital margin (A)</p> Signup and view all the answers

A stroke patient's MRI reveals localized damage primarily affecting the right frontal lobe. Which cranial bone is MOST directly associated with this impacted brain region?

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

If a pathologist is examining a skull and identifies the largest and strongest facial bone, which bone is the pathologist MOST likely examining?

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

Surgical access to the pituitary gland often involves traversing a bone located at the anteromedial base of the cranium. Which bone is this?

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

While studying cranial sutures, a student is trying to differentiate the sagittal and coronal sutures. Which statement BEST describes the orientation of the sagittal suture?

<p>It joins the right and left parietal bones (C)</p> Signup and view all the answers

A patient presents with diminished sense of smell due to damage of the cribriform plate requires the surgeon to discuss the risk associated with the bone. Where is this bone located on the scull?

<p>Forms part of bony nasal septum with the ethmoid (C)</p> Signup and view all the answers

A person exhibiting deep worry/concern has action in which of the following muscles?

<p>Corrugator supercilia (C)</p> Signup and view all the answers

When considering the bony structure of the cranium, the calvaria is synonymous with which anatomical region?

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

Which nerve innervates skin of posterior head.?

<p>Cervical Spinal Nerves C2 &amp; C3 (D)</p> Signup and view all the answers

What structures do the occipital condyles articulate with?

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

Why are the muscles of facial expression crucial?

<p>Surrounds facial orifices: mouth, eyes, nose and ears (B)</p> Signup and view all the answers

Which of the following does NOT occur in the inferior articular cavity?

<p>protrusion (protraction)/retrusion (retraction) (A)</p> Signup and view all the answers

If a patient required reconstruction of hard palate which paired bone MOST likely needs reconstruction?

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

A structure creates the Zygomatic arch with Temporal process of Zygomatic Bone, which structure is it?

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

Flashcards

Neurocranium

Bony casing of the brain, consisting of the calvaria (skullcap) and cranial base.

Coronal Suture

Sutures join the frontal bone with both parietal bones.

Sagittal Suture

Sutures join the right and left parietal bones together.

Lambdoid Suture

Joins occipital bone with both parietal bones.

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Squamous Suture

Joins parietal bone with temporal bone.

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Lambda

Intersection of lambdoid and sagittal sutures.

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Pterion

"H" shaped intersection of frontal, parietal, temporal and sphenoid bone.

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Superficial Face

Anterior aspect of the head between the forehead and chin.

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Orbicularis Oris

Oral sphincter; used for kissing, whistling. Innervated by CN VII

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Occipitofrontalis

Elevates eyebrows, wrinkles forehead; worry muscle. Innervated by CN VII

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Study Notes

  • Layers of the scalp include skin, connective tissue, aponeurotic tissue, loose connective tissue, and pericranium.
  • The cranium has two divisions.
  • Important landmarks of each cranial and facial bone should be identified.
  • Sutures of the cranium should be described.
  • The formation of the Lambda, Bregma, and Pterion intersections of the cranium should be described.
  • Muscles of the face and orbit including actions and Innervations, should be identified.
  • The articulations, joint type, ligaments, and movements of the TMJ should be identified.
  • Actions and Innervations of the muscles of mastication should be identified.
  • The innervation and vasculature of the face should be described.
  • Contains the Cranial Cavity, Ears (2), Orbits (2), Nasal Cavities (2), and Oral Cavity.
  • The cranial cavity contains the brain and coverings, including the cranium and meninges.
  • The oral cavity contains the Temporomandibular Joint (TMJ) and Muscles of Mastication.

Superficial Regions

  • The scalp covers the superior, posterior, and lateral regions and consists of 5 layers: skin, connective tissue, aponeurotic tissue, loose connective tissue, and pericranium.
  • The face covers the anterior aspect of head and contains the Muscles of Fascial Expression.

Cranium (Skull)

  • The skeleton of the head is also known as the Neurocranium; the bony casing of the brain.
  • Regions of the Neurocranium include:
    • Roof: calvaria (skullcap)
    • Floor: Cranial Base
  • Bones of the Neurocranium include:
    • Frontal Bone: Creates forehead with supra-orbital margin and glabella
    • Parietal (paired): Superior and lateral aspect of the skull with superior and inferior temporal lines.
    • Temporal (paired): Includes external acoustic meatus, mastoid process, and styloid process.
    • Sphenoid (wedge): Anteromedial base of skull with medial and lateral pterygoid processes.
    • Occipital: Base of posterior aspect of skull (occiput), containing foramen magnum that transmits spinal cord and vertebral arteries, occipital condyles, and external occipital protuberance.

Sutures

  • Flat and irregular bones of the skull are interlocked by sutures, which are fibrous joints.
    • Coronal Suture: Joins frontal bone with both parietal bones.
    • Sagittal Suture: Joins the right and left parietal bones together.
    • Lambdoid Suture: Joins occipital bone with both parietal bones.
    • Squamous (2) Sutures: Joins parietal bone with temporal bone.
  • Other Intersections include:
    • Lambda: Junction of lambdoid and sagittal sutures.
    • Bregma: Junction of sagittal and coronal sutures.
    • Pterion: "H" shaped intersection of frontal, parietal, temporal, and sphenoid bone.

Viscerocranium

  • The Viscerocranium (Facial Bones) consists of 15 bones in total.
    • Mandible: The skeleton of the lower jaw, largest and strongest facial bone, has 2 parts: horizontal part (body) and 2 vertical rami (superior part of ramus) with condyle (head and neck), coronoid process (anterior), angle, and mental protuberance (chin).
    • Ethmoid contributes to oral and nasal cavity formation.
    • Vomer: Forms part of bony nasal septum with the ethmoid.
    • Maxilla (paired): upper jaw between mouth and eyes.
    • Inferior nasal conchae (paired): Bony plate in the lateral wall of the nasal cavity.
    • Zygomatic (paired): Forms prominence of cheeks and anterolateral rims of infraorbital margins of orbits and creates zygomatic arch with temporal bone.
    • Palatine (paired): Creates the hard palate with maxillae.
    • Nasal (paired): Creates the bridge of the nose.
    • Lacrimal (paired): Creates medial wall of orbit, associated with passage of tears.

Superficial Face

  • The anterior aspect of the head between the forehead and chin.
  • Fascial shape is determined by underlying bones.

Nerves of the Face

  • Cervical Spinal Nerves C2 and C3 innervate the skin of the posterior head.
  • The Trigeminal Nerve (CN V) is sensory to the face, motor to muscles of mastication (chewing), and has 3 branches: Ophthalmic (CN V1): sensory, Maxillary (CN V2): sensory, and Mandibular (CN V3): motor supply to muscles of mastication.
  • The Facial Nerve (CN VII) supplies muscles of facial expression, auricular muscles (around the ear), and scalp muscles.

Arteries of the Face

  • Facial A: Branch of External Carotid A, Chief artery of the face, palpable at inferior border of mandible.
  • Superficial Temporal A: Small branch of external carotid artery, palpable anterior to external ear.

Veins of the Face

  • Facial V: Major venous drainage of face, drains into internal jugular vein.
  • Superficial Temporal V: Drains into external jugular vein.

Muscles of the Face (bolded)

  • Present in subcutaneous tissue and attached to skin and surround facial orifices.
  • Innervated by CN VII (facial).
  • Muscles of Forehead:
    • Occipitofrontalis: elevates eyebrows, wrinkles forehead.
  • Muscles around the mouth:
    • Orbicularis oris: oral sphincter, kissing, whistling.
    • Platysma: depresses mandible, tenses skin of inferior face and neck.
    • Buccinator: holds food between teeth and cheeks, resists distension (when blowing).
  • Muscles around the eye:
    • Orbicularis oculi: orbital sphincter, closes eyelids.
    • Corrugator supercilia: draws eyebrow medially and inferiorly (concern/worry).
  • Muscles around the nose:
    • Nasalis: opens nostrils.

Muscles of the Orbit

  • The muscles that move the eye: 4 Recti (Superior, Inferior, Medial, and Lateral) and 2 Oblique (Superior, Inferior).

Temporomandibular Joint (TMJ)

  • Articulation: head of the mandible with mandibular fossa of the temporal bone.
  • Joint type: Modified hinge-type synovial joint, separated by articular disc into superior and inferior articular cavities.
  • Ligamentous Supports: strong joint capsule, lateral, stylomandibular, and sphenomandibular ligaments.
  • Movements: Gliding and pivoting, protrusion, elevation/depression, and lateral movements.

Muscles of Mastication

  • These muscles are innervated by the Mandibular Division (CN V3) of CN V (Trigeminal).
  • The muscles include: Temporalis, Masseter, Lateral pterygoid, and Medial pterygoid.

Clinical Pearls

  • Plagio- and Brachycephaly.
  • Pterion and Skull Fractures.
  • Bell's Palsy.
  • TMJ Dysfunction.

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