Anatomy: Head and Neck Part 2
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Questions and Answers

What is the primary function of the hypoglossal nerve?

  • Sensory function
  • Regulation of heart rate
  • Taste sensation
  • Motor function (correct)

    • Where does the hypoglossal nerve emerge from?

  • Posterior surface of the medulla oblongata
  • Posterior surface of the spinal cord
  • Anterior surface of the medulla oblongata (correct)
  • Anterior surface of the spinal cord

    • What is the path of the cranial root of the accessory nerve?

  • It descends into the spinal cord and becomes part of the spinal nerve
  • It crosses the posterior cranial fossa and joins the hypoglossal nerve
  • It joins the vagus nerve and is distributed to the muscles of the soft palate and pharynx (correct)
  • It leaves the skull through the jugular foramen and joins the spinal root

    • What is the relationship between the cranial root of the accessory nerve and the vagus nerve?

    <p>The cranial root of the accessory nerve joins the vagus nerve and is distributed to its branches</p> Signup and view all the answers

    What is the point of exit of the hypoglossal nerve from the skull?

    <p>Jugular foramen</p> Signup and view all the answers

    What is the innervation of the genioglossus muscle?

    <p>Hypoglossal nerve</p> Signup and view all the answers

    What is the path of the spinal root of the accessory nerve?

    <p>It descends into the spinal cord and forms the spinal nerve</p> Signup and view all the answers

    What is the relationship between the hypoglossal nerve and the ansa cervicalis?

    <p>The hypoglossal nerve and the ansa cervicalis are separate nerves that run parallel to each other</p> Signup and view all the answers

    What is the name of the muscle attached to the stapes bone?

    <p>Stapedius muscle</p> Signup and view all the answers

    Which structure is located posterior to the head of the malleus?

    <p>Posterior ligament</p> Signup and view all the answers

    What is the name of the air-filled spaces in the mastoid process?

    <p>Mastoid air cells</p> Signup and view all the answers

    What is the name of the bony prominence that projects from the medial side of the head?

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

    Which structure separates the middle ear cavity from the inner ear?

    <p>Fenestra vestibuli</p> Signup and view all the answers

    What is the name of the air-filled cavity in the mastoid process that communicates with the middle ear?

    <p>Mastoid antrum</p> Signup and view all the answers

    What is the primary function of the oculomotor nerve?

    <p>To supply all the orbital muscles except the superior oblique and the lateral rectus</p> Signup and view all the answers

    Which structure is located anterior to the mastoid antrum?

    <p>Eustachian tube</p> Signup and view all the answers

    What is the name of the bone that articulates with the incus?

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

    What is the term for the loss of the lateral halves of the fields of vision of both eyes?

    <p>Bitemporal hemianopia</p> Signup and view all the answers

    What is the primary method of testing the olfactory nerve?

    <p>Applying substances with different odors to each nostril</p> Signup and view all the answers

    What is the name of the muscle supplied by the trochlear nerve?

    <p>Superior oblique</p> Signup and view all the answers

    What is the term for the loss of the sense of smell?

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

    What is the primary function of the abducens nerve?

    <p>To innervate the lateral rectus muscle</p> Signup and view all the answers

    Where is the lesion typically located in a patient with bitemporal hemianopia?

    <p>Pituitary gland</p> Signup and view all the answers

    During the examination of the ocular muscles, what is the position of the patient's head?

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

    What is the result of the compression wave in the perilymph passing down the scala tympani at the apex of the cochlea?

    <p>A lateral bulging of the secondary tympanic membrane in the fenestra cochleae</p> Signup and view all the answers

    What is the purpose of the auditory tube during palatal activity?

    <p>To equalize pressure and drain the middle ear</p> Signup and view all the answers

    What is the relationship between the mastoid antrum and the tympanic cavity?

    <p>The mastoid antrum is related to the tympanic cavity</p> Signup and view all the answers

    What is the function of the muscles of the soft palate during swallowing and yawning?

    <p>To open the auditory tube</p> Signup and view all the answers

    What is the position of the basilar fibers of the basilar membrane?

    <p>At the apex of the cochlea</p> Signup and view all the answers

    What is the significance of the continuity of the mucous membrane from the nasopharynx to the middle ear?

    <p>It facilitates the spread of infection from the nasopharynx to the middle ear</p> Signup and view all the answers

    What is the thickness of the lateral wall of the mastoid antrum?

    <p>1.5 cm</p> Signup and view all the answers

    What is the relationship between the medial wall of the mastoid antrum and the posterior semicircular canal?

    <p>The medial wall is related to the posterior semicircular canal</p> Signup and view all the answers

    What is the term for blindness in one half of each visual field?

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

    What is the primary function of the trigeminal nerve's motor root?

    <p>Motor control of the mandibular division</p> Signup and view all the answers

    What is the symptom of a lesion in the optic tract and optic radiation?

    <p>Blindness in one half of each visual field</p> Signup and view all the answers

    What is the term for the uncontrollable pendular movement of the eyes?

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

    What is the function of the glossopharyngeal nerve's secretomotor fibers?

    <p>Regulating parotid gland function</p> Signup and view all the answers

    What is the purpose of using a cotton wisp over each area of the face supplied by the divisions of the trigeminal nerve?

    <p>To evaluate sensory function of the trigeminal nerve</p> Signup and view all the answers

    What is the muscle that is supplied by the glossopharyngeal nerve?

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

    What is the primary function of the pharyngeal branch of the vagus nerve?

    <p>Supplying the muscles of the pharynx</p> Signup and view all the answers

    Where does the vagus nerve pass through the skull?

    <p>Through the jugular foramen</p> Signup and view all the answers

    What is the name of the branch that supplies the cricothyroid muscle?

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

    What is the name of the structure that the vagus nerve descends through in the neck?

    <p>Carotid sheath</p> Signup and view all the answers

    What is the name of the branch that supplies the mucous membrane of the piriform fossa?

    <p>Internal laryngeal nerve</p> Signup and view all the answers

    What is the location of the vagus nerve in the posterior cranial fossa?

    <p>Between the olive and the inferior cerebellar peduncle</p> Signup and view all the answers

    What is the name of the branch that joins the pharyngeal plexus?

    <p>Cranial root of the accessory nerve</p> Signup and view all the answers

    What is the relationship between the vagus nerve and the carotid arteries?

    <p>The vagus nerve descends alongside the carotid arteries</p> Signup and view all the answers

    What is the effect on the diaphragm if the phrenic nerve is injured in the neck?

    <p>The paralyzed half of the diaphragm relaxes and is pushed up into the thorax</p> Signup and view all the answers

    Which nerve supplies the skin over the angle of the mandible?

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

    What percentage of people have an accessory phrenic nerve?

    <p>About one third</p> Signup and view all the answers

    What is the origin of the muscular branches of the cervical plexus?

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

    Which nerve may be injured in penetrating wounds of the neck, leading to diaphragmatic paralysis?

    <p>Phrenic nerve</p> Signup and view all the answers

    Where do the cutaneous branches of the cervical plexus emerge?

    <p>Posterior margin of the sternocleidomastoid muscle</p> Signup and view all the answers

    What is the result of diaphragmatic paralysis on the affected side?

    <p>The lower lobe of the lung on that side may collapse</p> Signup and view all the answers

    What is the clinical significance of the cutaneous branches of the cervical plexus?

    <p>They are important for referring pain from the phrenic nerve</p> Signup and view all the answers

    What is the result of paralysis of the lateral rectus muscle?

    <p>The eyeball turns medially</p> Signup and view all the answers

    What is the term for blindness in one half of each visual field?

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

    Which nerve is responsible for supplying the stylopharyngeus muscle?

    <p>Glossopharyngeal nerve</p> Signup and view all the answers

    What is the term for the uncontrollable pendular movement of the eyes?

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

    What is the purpose of testing the patient's ability to hear a voice or a tuning fork?

    <p>To test cochlear function</p> Signup and view all the answers

    What is the function of the motor root of the trigeminal nerve?

    <p>To supply the muscles of mastication</p> Signup and view all the answers

    What is the term for the loss of the sense of smell?

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

    What is the purpose of using a cotton wisp over each area of the face supplied by the divisions of the trigeminal nerve?

    <p>To test the integrity of the trigeminal nerve</p> Signup and view all the answers

    What is the primary component of the craniocervical autonomic nervous system?

    <p>Both sympathetic and parasympathetic components</p> Signup and view all the answers

    Where do the preganglionic neurons of the sympathetic part originate?

    <p>Lateral horn of the first through fourth spinal cord segments</p> Signup and view all the answers

    What is the location of the cervical part of the sympathetic trunk?

    <p>Directly behind the internal and common carotid arteries</p> Signup and view all the answers

    What is the destination of the thyroid branches?

    <p>Thyroid gland</p> Signup and view all the answers

    Where does the middle cervical ganglion lie?

    <p>At the level of the cricoid cartilage</p> Signup and view all the answers

    What is the path of the superior cardiac nerve?

    <p>Descends in the neck and ends in the cardiac plexus</p> Signup and view all the answers

    What is the function of the gray rami communicantes?

    <p>Connects the sympathetic trunk to the anterior rami of the cervical nerves</p> Signup and view all the answers

    What is the organization of the sympathetic part of the autonomic nervous system?

    <p>Simple with a few components</p> Signup and view all the answers

    What is the main function of the wax and the hall in the ear?

    <p>To protect the ear from foreign bodies</p> Signup and view all the answers

    Which nerves are the main sensory nerves of the auricle?

    <p>Leuer occipital and great auricular nerves</p> Signup and view all the answers

    What is the shape of the tympanic membrane?

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

    What is the function of the antedor and postellor malleolar folds?

    <p>To pass to the lateral process of the malleus</p> Signup and view all the answers

    What is the size of the tympanic membrane?

    <p>1 cm in diameter</p> Signup and view all the answers

    What is the name of the groove in the bone where the tympanic membrane is slotted?

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

    What is the name of the small triangular area on the tympanic membrane?

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

    Which nerve also provides sensory innervation to the auricle?

    <p>All of the above</p> Signup and view all the answers

    What structure connects the inner surface of the lips to the gums?

    <p>Labial frenolae</p> Signup and view all the answers

    What is the term for the shallow vertical groove seen in the midline on the superficial surface of the upper lip?

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

    What muscles make up the substance of the lips?

    <p>Orbicularis oris muscle and buccinator muscle</p> Signup and view all the answers

    At what age do the 32 permanent teeth start erupting?

    <p>6 years</p> Signup and view all the answers

    What is included in the substance of the lips?

    <p>Salivary glands and labial blood vessels</p> Signup and view all the answers

    What is the origin of the epithelium of the hard palate?

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

    At what age do all 20 primary teeth erupt?

    <p>2 years</p> Signup and view all the answers

    What nerve divides into vestibular and cochlear portions at the bottom of the internal acoustic meatus?

    <p>Vestibulocochlear nerve (CN VIII)</p> Signup and view all the answers

    What is the shallow vertical groove seen in the midline on the superficial surface of the upper lip?

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

    What is the origin of the secretory epithelium of the parotid salivary gland?

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

    What is the location of the alveolar margins in the jaw?

    <p>Maxilla and mandible</p> Signup and view all the answers

    What is the last permanent tooth to erupt?

    <p>Third molar</p> Signup and view all the answers

    What is the origin of the epithelium of the tongue?

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

    What is the age range for the eruption of the third molar?

    <p>17-25 years</p> Signup and view all the answers

    What is the location of the utricle in relation to the saccule?

    <p>The utricle is larger than the saccule and is connected to it.</p> Signup and view all the answers

    What is the purpose of the ductus endolymphaticus?

    <p>It passes on to end in a small blind pouch, the saccus endolymphaticus.</p> Signup and view all the answers

    What is the function of the vestibular nerve?

    <p>It expands to form the vestibular ganglion and supplies the utricle, saccule, and ampullae of the semicircular ducts.</p> Signup and view all the answers

    What is the location of the semicircular ducts?

    <p>They are located within the bony semicircular canals.</p> Signup and view all the answers

    What is the purpose of the five orifices of the canals?

    <p>They open into the vestibule.</p> Signup and view all the answers

    What is the relationship between the membranous labyrinth and the bony labyrinth?

    <p>The membranous labyrinth is lodged within the bony labyrinth.</p> Signup and view all the answers

    What is the purpose of the ductus utriculosaccularis?

    <p>It joins the ductus endolymphaticus.</p> Signup and view all the answers

    What is the location of the vestibular ganglion?

    <p>It is located in the lateral end of the internal acoustic meatus.</p> Signup and view all the answers

    What is the characteristic of the mucous membrane covering the posterior third of the tongue?

    <p>It has an irregular surface</p> Signup and view all the answers

    What is the function of the lingual frenulum?

    <p>It connects the tongue to the floor of the mouth</p> Signup and view all the answers

    What is the name of the fold of mucous membrane located lateral to the lingual vein?

    <p>Plica fimbriata</p> Signup and view all the answers

    What is the composition of the tongue?

    <p>A mass of skeletal muscle covered with mucous membrane</p> Signup and view all the answers

    What is the division of the tongue into right and left halves?

    <p>A median fibrous septum</p> Signup and view all the answers

    What type of muscles attach the tongue to the styloloid process and the soft palate?

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

    What is the characteristic of the intrinsic muscles of the tongue?

    <p>They are confined to the tongue and are not attached to bone</p> Signup and view all the answers

    What is the location of the deep lingual vein?

    <p>Lateral to the lingual frenulum</p> Signup and view all the answers

    What artery supplies blood to the tongue?

    <p>Lingual artery</p> Signup and view all the answers

    Which nerve is responsible for general sensation in the anterior two-thirds of the tongue?

    <p>Lingual nerve</p> Signup and view all the answers

    What is the primary function of the hypoglossal nerve in relation to the tongue?

    <p>Motor function</p> Signup and view all the answers

    Which lymph nodes drain the posterior third of the tongue?

    <p>Deep cervical lymph nodes</p> Signup and view all the answers

    What is the term for the groove that separates the anterior two-thirds of the tongue from the posterior third?

    <p>Sulcus terminalis</p> Signup and view all the answers

    Which nerve is responsible for taste sensation in the posterior third of the tongue?

    <p>Glossopharyngeal nerve</p> Signup and view all the answers

    What is the name of the median swelling that appears in the entodermal ventral wall or floor of the pharynx during embryonic development?

    <p>Taberculum imper</p> Signup and view all the answers

    What is the name of the vein that drains blood from the tongue?

    <p>Internal jugular vein</p> Signup and view all the answers

    What is the location of the sublingual salivary gland?

    <p>Under the tongue</p> Signup and view all the answers

    What is the function of the pharyngeal tonsil?

    <p>To trap pathogens and other debris</p> Signup and view all the answers

    What is the name of the tube that connects the middle ear to the nasopharynx?

    <p>Eustachian tube</p> Signup and view all the answers

    What is the name of the part of the pharynx that lies above the soft palate?

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

    What is the name of the muscle that forms the floor of the mouth?

    <p>Mylohyoid muscle</p> Signup and view all the answers

    What is the name of the space that communicates with the middle ear?

    <p>Mastoid antrum</p> Signup and view all the answers

    What is the name of the opening in the floor of the nasopharynx?

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

    What is the shape of the pharynx?

    <p>Funnel-shaped</p> Signup and view all the answers

    What muscle is responsible for widening the laryngeal inlet?

    <p>Thyroeptglottis muscle</p> Signup and view all the answers

    Which muscle is responsible for adducting the vocal cords?

    <p>Lateral cricoarytenoid muscle</p> Signup and view all the answers

    What is the movement of the vocal folds dependent on?

    <p>The movement of the arytenoid cartilages</p> Signup and view all the answers

    What is the result of the contraction of the posterior cricoarytenoid muscle?

    <p>The vocal folds are abducted</p> Signup and view all the answers

    What is the function of the elastic tissue in the capsules of the cricoarytenoid joints?

    <p>To keep the arytenoid cartilages apart</p> Signup and view all the answers

    What is the name of the muscle that approximates the arytenoid cartilages?

    <p>Transverse arytenoid muscle</p> Signup and view all the answers

    Which muscle is responsible for relaxing the vocal cords?

    <p>Thyroarytenoid muscle</p> Signup and view all the answers

    What is the movement of the vocal process when the posterior cricoarytenoid muscle contracts?

    <p>The vocal process is abducted</p> Signup and view all the answers

    What is the purpose of raising the back of the head off the table with a pillow during intubation?

    <p>To align the axis of the mouth with the axis of the pharynx</p> Signup and view all the answers

    What can be seen within the larynx during laryngoscopy?

    <p>The vestibular folds and the vocal folds</p> Signup and view all the answers

    What is the shape of the rima glottidis during quiet breathing?

    <p>Triangular, with the apex in front</p> Signup and view all the answers

    What happens to the vocal folds during deep inspiration?

    <p>They become abducted</p> Signup and view all the answers

    Why must the three upper airway axes be aligned during laryngoscopy?

    <p>To facilitate endotracheal intubation</p> Signup and view all the answers

    What is the effect of extending the head at the atlanto-occipital joints?

    <p>The axis of the mouth is correctly placed</p> Signup and view all the answers

    What is the purpose of asking the patient to breathe deeply during laryngoscopy?

    <p>To abduct the vocal folds and visualize the inside of the trachea</p> Signup and view all the answers

    What is the consequence of unilateral complete section of the recurrent laryngeal nerve?

    <p>The affected vocal fold assumes a position midway between abduction and adduction</p> Signup and view all the answers

    What can be seen during laryngoscopy with the head in the neutral position?

    <p>The axes of the mouth, pharynx, and trachea are not aligned</p> Signup and view all the answers

    What is the result of bilateral complete section of the recurrent laryngeal nerve?

    <p>Both vocal folds assume a position midway between abduction and adduction, and speech is lost</p> Signup and view all the answers

    What is the effect of section of the external laryngeal nerve?

    <p>Weakness of the voice due to paralysis of the cricothyroid muscle</p> Signup and view all the answers

    What is the relationship between the recurrent laryngeal nerve and the arteries of the thyroid gland?

    <p>The recurrent laryngeal nerve is closely related to the arteries of the thyroid gland</p> Signup and view all the answers

    What can cause damage to the recurrent laryngeal nerve?

    <p>Operations on the thyroid gland</p> Signup and view all the answers

    What is the consequence of unilateral partial section of the recurrent laryngeal nerve?

    <p>The affected vocal fold assumes a position midway between abduction and adduction</p> Signup and view all the answers

    What is the location of the rima glottidis?

    <p>Between the vocal folds</p> Signup and view all the answers

    What is the effect of malignant involvement of the deep cervical lymph nodes on the recurrent laryngeal nerve?

    <p>The recurrent laryngeal nerve is damaged</p> Signup and view all the answers

    What is the result of unilateral partial damage to the recurrent laryngeal nerve?

    <p>Paralysis of the affected vocal fold in the midline position</p> Signup and view all the answers

    Why are the nerve fibers to the abductor muscles more prone to damage in the recurrent laryngeal nerve?

    <p>They are located in a more exposed position in the nerve</p> Signup and view all the answers

    What is the consequence of bilateral partial damage to the recurrent laryngeal nerves?

    <p>Bilateral paralysis of the abductor muscles and drawing together of the vocal folds</p> Signup and view all the answers

    What is the significance of the loose attachment of the laryngeal mucous membrane to the underlying structures?

    <p>It makes the mucous membrane more prone to edema</p> Signup and view all the answers

    What is the significance of the firm attachment of the laryngeal mucous membrane to the vocal ligaments?

    <p>It makes the mucous membrane less prone to edema</p> Signup and view all the answers

    What is the consequence of cricothyroidotomy or tracheostomy in cases of bilateral paralysis of the abductor muscles?

    <p>Relief of acute breathlessness and stridor</p> Signup and view all the answers

    What is the correct positioning of the patient's head and neck during intubation?

    <p>in the sniffing position</p> Signup and view all the answers

    What is the purpose of the BURP maneuver during intubation?

    <p>to align the box of the larynx relative to the laryngoscope blade</p> Signup and view all the answers

    What is the anatomical structure that the laryngoscope blade passes alongside during intubation?

    <p>the right mandibular molar teeth</p> Signup and view all the answers

    What is the consequence of stimulating the mucous membrane of the upper airway during intubation?

    <p>bradycardia and hypertension</p> Signup and view all the answers

    What is the anatomical structure that the laryngoscope blade follows during intubation?

    <p>the anatomic curvature on the posterior surface of the tongue</p> Signup and view all the answers

    What is the result of correct placement of the laryngoscope blade during intubation?

    <p>the cords and the glottis are visualized</p> Signup and view all the answers

    What is the anatomical structure that the trachea is described as being?

    <p>a mobile and membranous tube</p> Signup and view all the answers

    What is the relationship between the thyroid cartilage and the glottis during intubation?

    <p>the thyroid cartilage is at the level of the glottis</p> Signup and view all the answers

    What is the name of the structure that separates the middle ear cavity from the inner ear?

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

    What is the name of the bone that articulates with the incus?

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

    What is the primary function of the straight venous sinus?

    <p>Draining blood from the brain</p> Signup and view all the answers

    What is the name of the structure that separates the two hemispheres of the brain?

    <p>Falx cerebri</p> Signup and view all the answers

    What is the name of the air-filled spaces in the mastoid process?

    <p>Air cells</p> Signup and view all the answers

    What is the name of the structure that the vagus nerve descends through in the neck?

    <p>Jugular foramen</p> Signup and view all the answers

    What is the name of the structure that separates the anterior horn of the lateral ventricle from the frontal lobe?

    <p>Corpus callosum</p> Signup and view all the answers

    What is the significance of the upper border of the thyroid cartilage?

    <p>It lies opposite the fourth cervical vertebra.</p> Signup and view all the answers

    What is the relationship between the hyoid bone and the thyroid cartilage?

    <p>The Thyrohyoid membrane fills the interval between them.</p> Signup and view all the answers

    What is the primary function of the nasal conchae and nasal meati?

    <p>Drainage of the paranasal sinuses and nasolacrimal duct</p> Signup and view all the answers

    Which artery supplies the major vessels of the nasal cavity?

    <p>Sphenopalatine artery</p> Signup and view all the answers

    What is the boundary between the oral cavity and the pharynx?

    <p>Palatoglossal folds</p> Signup and view all the answers

    Which nerve carries general sensation from the body of the tongue?

    <p>Lingual nerve</p> Signup and view all the answers

    What is the function of CN X in the larynx?

    <p>Supplying the entire larynx</p> Signup and view all the answers

    What is the significance of the trachea?

    <p>It is a continuation of the larynx</p> Signup and view all the answers

    What is the function of the intrinsic muscles of the tongue?

    <p>Alter the shape of the tongue</p> Signup and view all the answers

    What is the purpose of the thyroid, cricoid, arytenoid, and epiglottic cartilages?

    <p>Forming the skeleton of the larynx</p> Signup and view all the answers

    Where can the po8terfor border of the ramus be felt?

    <p>Below the parotid gland</p> Signup and view all the answers

    What is the correct way to examine the mandible?

    <p>With one finger inside the mouth and another on the outside</p> Signup and view all the answers

    What is the location of the supraorbltal notch?

    <p>At the junction of the medial and intermediate thirds of the upper margin of the orbit</p> Signup and view all the answers

    What is the muscle that covers the outer surface of the ramus?

    <p>Masseter muscle</p> Signup and view all the answers

    Where can the pterygomandibular ligament be palpated?

    <p>On the medial side of the ramus</p> Signup and view all the answers

    What is the structure that forms the orbital margin?

    <p>Frontal, zygomatic, and maxillary bones</p> Signup and view all the answers

    What is the location of the mandible when it is examined?

    <p>When the muscle is relaxed</p> Signup and view all the answers

    What is the structure that turns medially and opens into the mouth opposite the upper second molar tooth?

    <p>The anterior border of the masseter</p> Signup and view all the answers

    What is the location of the external occipital protuberance?

    <p>At the junction of the head and neck</p> Signup and view all the answers

    Which structures are contained within the carotid sheath?

    <p>Carotid arteries, internal jugular vein, vagus nerve, and deep cervical lymph nodes</p> Signup and view all the answers

    What is the name of the process that can be felt in the midline of the neck?

    <p>Spinous process of the seventh cervical vertebra</p> Signup and view all the answers

    Which muscle can be palpated throughout its length as it passes upward from the sternum and clavicle to the mastoid process?

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

    Which nerve is relatively superficial as it emerges from the posterior border of the sternocleidomastoid and runs downward and backward to pass beneath the anterior border of the trapezius?

    <p>Accessory nerve</p> Signup and view all the answers

    At what level does the common carotid artery bifurcate into the internal and external carotid arteries?

    <p>At the level of the upper border of the thyroid cartilage</p> Signup and view all the answers

    What is the name of the ligament that covers the cervical spines one to six?

    <p>Ligamentum nuchae</p> Signup and view all the answers

    How can the sternocleidomastoid muscle be made to stand out?

    <p>By asking the patient to approximate the ear to the shoulder of the same side</p> Signup and view all the answers

    Study Notes

    Cranial Nerves

    • Hypoglossal nerve (CN XII) is a motor nerve that emerges on the anterior surface of the medulla oblongata between the pyramid and the olive.
    • It crosses the posterior cranial fossa and leaves the skull through the jugular foramen.
    • The cranial root of the accessory nerve joins the vagus nerve and is distributed in its branches to the muscles of the soft palate and pharynx.

    Systematic Examination of Cranial Nerves

    • Systematic examination of the 12 cranial nerves is an important part of the examination of every neurologic patient.
    • It may reveal a lesion of a cranial nerve nucleus or its central connections, or it may show an interruption of the lower motor neurons.

    Testing Olfactory Nerve Integrity

    • The olfactory nerve can be tested by applying substances with different odors to each nostril.
    • It should be remembered that food flavors depend on the sense of smell and not on the sense of taste.
    • Fractures of the anterior cranial fossa or cerebral tumors of the frontal lobes may produce lesions of the olfactory nerves, with consequent loss of the sense of smell (anosmia).

    Testing Optic Nerve Integrity

    • The optic nerve is evaluated by first asking the patient whether any changes in eyesight have been noted.
    • A small object is then moved in an arc around the periphery of the field of vision, and the patient is asked whether they can see the object.
    • Blindness in one half of each visual field is called hemianopia.
    • Lesions of the optic tract and optic radiation can cause hemianopia.

    Testing Trigeminal Nerve Integrity

    • The trigeminal nerve has sensory and motor roots.
    • The sensory root passes to the trigeminal ganglion, from which emerge the ophthalmic (V1), maxillary (V2), and mandibular (V3) divisions.
    • The motor root joins the mandibular division.
    • The sensory function can be tested by using a cotton wisp over each area of the face supplied by the divisions of the trigeminal nerve.

    Testing Glossopharyngeal Nerve Integrity

    • The glossopharyngeal nerve supplies the stylopharyngeus muscle and sends secretomotor fibers to the parotid gland.
    • Asking the patient to clench the teeth can test the motor function.

    Anatomy of the Middle Ear

    • The mastoid antrum is an important structure in the middle ear.
    • The relations of the mastoid antrum are important in understanding the spread of infection.
    • The anterior wall of the mastoid antrum is related to the tympanic cavity and contains the aditus to the mastoid antrum.
    • The posterior wall separates the antrum from the sigmoid venous sinus and the cerebellum.
    • The lateral wall forms the floor of the suprameatal triangle and is 1.5 cm thick.
    • The medial wall is related to the posterior semicircular canal.
    • The superior wall is a thin plate of bone, the tegmen tympani.

    Middle Ear Function

    • The auditory tube serves as a route for equalizing pressure and draining the middle ear.
    • Opening of the auditory tube occurs during palatal activity, such as during swallowing and yawning.
    • The continuity of the mucous membrane from nasopharynx to auditory tube to middle ear allows the spread of infection from the nasopharynx to the middle ear.

    Vagus Nerve (CN X)

    • Composed of motor and sensory fibers, with the most extensive distribution of all cranial nerves
    • Emerges from the medulla oblongata between the olive and the inferior cerebellar peduncle
    • Passes laterally through the posterior cranial fossa and leaves the skull through the jugular foramen
    • Has both superior and inferior ganglia (Fig. 12.65)
    • Pharyngeal branch contains nerve fibers from the cranial part of the accessory nerve and supplies all muscles of the pharynx (except the stylopharyngeus) and of the soft palate (except the tensor veli palatini)

    Branches of Vagus Nerve

    • Auricular branch supplies the pinna, external auditory meatus, and tympanic membrane
    • Pharyngeal branch joins the pharyngeal plexus and supplies all muscles of the pharynx (except the stylopharyngeus) and of the soft palate (except the tensor veli palatini)
    • Superior laryngeal nerve divides into the internal and external laryngeal nerves
    • Internal laryngeal nerve is sensory to the mucous membrane of the piriform fossa and the larynx down to the vocal cords
    • External laryngeal nerve is motor and supplies the cricothyroid muscle

    Testing Cranial Nerve Integrity

    • Testing vagus nerve integrity: assesses the nerve's motor and sensory functions
    • Testing trigeminal nerve integrity: assesses the nerve's sensory and motor functions
    • Testing glossopharyngeal nerve integrity: assesses the nerve's function in the stylopharyngeus muscle and the parotid gland

    Autonomic Nervous System

    • Consists of both sympathetic and parasympathetic components
    • Sympathetic part has a simpler organizational scheme, while the parasympathetic part has more components and more complex pathways

    Sympathetic Part

    • Preganglionic neurons originate in the lateral horn of the first through fourth spinal cord segments
    • Axons enter the sympathetic trunk at those levels (via white rami communicantes) and ascend through it
    • Cervical part of the sympathetic trunk extends from the base of the skull down to the neck of the first rib
    • Middle cervical ganglion lies at the level of the cricoid cartilage and has branches that include:
      • Gray rami communicantes to the anterior rami of the fifth and sixth cervical nerves
      • Thyroid branches, which pass along the inferior thyroid artery to the thyroid gland
      • Middle cardiac nerve, which descends in the neck and ends in the cardiac plexus in the thorax

    Cervical Plexus

    • Supplies skin and muscles of the head, neck, and shoulder, plus the diaphragm and other thoracic structures
    • Four cutaneous nerves (lesser occipital, great auricular, transverse cervical, and supraclavicular) branch off the cervical plexus and supply the skin over the lower head and the front and sides of the neck
    • The lesser occipital nerve (C2) supplies the back of the scalp and the auricle
    • The great auricular nerve (C2 and 3) supplies the skin over the angle of the mandible
    • The transverse cervical nerve (C2 and 3) supplies the skin over the front of the neck

    Ear

    • Tympanic membrane is circular and measures about 1 cm in diameter
    • The circumference is thickened and is slotted into a groove in the bone
    • The groove (tympanic sulcus) is deficient superiorly, which forms a notch
    • From the sides of the notch, two bands, termed the anterior and posterior malleolar folds, pass to the lateral process of the malleus
    • The small triangular area on the tympanic membrane that is bounded by the folds is slack and is called the pars flaccida

    Labyrinth

    • The labyrinth consists of the membranous labyrinth and the bony labyrinth.
    • The membranous labyrinth is filled with endolymph and surrounded by perilymph.
    • The bony labyrinth has three semicircular canals, which are connected to the vestibule.
    • The vestibule has five openings that connect to the semicircular canals.
    • The duct of the cochlea is located in the bony cochlea.

    Vestibular Apparatus

    • The utricle is the larger of the two vestibular sacs.
    • The utricle is connected to the saccule and the ductus endolymphaticus.
    • The vestibular nerve expands to form the vestibular ganglion.
    • The branches of the nerve supply the utricle, the saccule, and the ampullae of the semicircular ducts.

    Teeth

    • The teeth are placed in the alveolar margins of the maxillae (upper jaw) and mandible (lower jaw).
    • The teeth begin to erupt at 6 months after birth and are fully erupted by the end of 2 years.
    • The 32 permanent teeth consist of 4 incisors, 2 canines, 4 premolars, and 6 molars in each jaw.
    • The teeth of the lower jaw appear before those of the upper jaw.

    Oral Cavity Development

    • The oral cavity is formed from two sources: a depression from the ectoderm and a part from the cephalic end of the foregut lined with endoderm.
    • The buccopharyngeal membrane separates the two parts at first, but breaks down and disappears during the 3rd week of development.
    • The epithelium of the hard palate, sides of the mouth, and enamel of the teeth are ectodermal structures.

    Tongue

    • The tongue is a mass of striated muscle covered with mucous membrane.
    • The tongue is divided into right and left halves by a median fibrous septum.
    • Muscles attach the tongue to the styloid process and the soft palate above, and to the mandible and the hyoid bone below.
    • The tongue is supplied by the lingual artery and drained by the internal jugular vein.

    Lymph Drainage

    • The tip of the tongue drains into the submental lymph nodes.
    • The sides of the anterior two-thirds of the tongue drain into the submandibular and sublingual lymph nodes.
    • The posterior third of the tongue drains into the deep cervical lymph nodes.

    Sensory Innervation

    • The anterior two-thirds of the tongue is innervated by the lingual nerve branch of the mandibular division of the trigeminal nerve (general sensation) and the chorda tympani branch of the facial nerve (taste).
    • The posterior third of the tongue is innervated by the glossopharyngeal nerve (general sensation and taste).

    Hypoglossal Nerve Testing

    • Asking the patient to protrude their tongue is a basic test of the function of the hypoglossal nerve.
    • Deviation of the tip of the tongue indicates a lesion of the nerve on the side to which the deviation occurs.

    Head and Neck

    • The sublingual salivary gland lies beneath the sublingual fold of the floor of the mouth and opens into the mouth through numerous small ducts.

    Cyst Formation

    • Blockage of one or more of these ducts is believed to cause cysts under the tongue.

    Pharynx

    • The pharynx is situated behind the nasal cavities, mouth, and larynx, and consists of three parts: nasopharynx, oropharynx, and laryngopharynx.

    Structure of Pharynx

    • The pharynx is funnel-shaped, with its upper, wider end lying under the base of the skull, and its lower, narrower end continuous with the esophagus opposite the sixth cervical vertebra.

    Musculomembranous Wall

    • The pharynx has a musculomembranous wall, which is deficient anteriorly, where it is replaced by the posterior openings into the nose (choanae), the opening into the mouth, and the inlet of the larynx.

    Nasopharynx

    • The nasopharynx lies above the soft palate and behind the nasal cavities, with a collection of lymphoid tissue (pharyngeal tonsil) sitting in the submucosa of the roof.

    Auditory Tube

    • The opening of the auditory tube is on the lateral wall of the nasopharynx, with an elevated ridge (tubal elevation) capping the opening.

    Laryngeal Inlet

    • Two muscles modify the laryngeal inlet:
    • Oblique arytenoid muscle (narrowing the inlet)
    • Thyroepiglottis muscle (widening the inlet)

    Vocal Fold Movement

    • Five muscles move the vocal folds (cords):
    • Cricothyroid muscle (tensing the vocal cords)
    • Vocalis muscle (tensing the vocal cords)
    • Thyroarytenoid muscle (relaxing the vocal cords)
    • Lateral cricoarytenoid muscle (adducting the vocal cords)
    • Posterior cricoarytenoid muscle (abducting the vocal cords)

    Arytenoid Cartilages

    • Rotating and sliding up and down on the sloping shoulder of the superior border of the cricoid cartilage
    • The elastic tissue in the capsules of the cricoarytenoid joints keeps the arytenoid cartilages apart

    Nerve Damage

    • The left recurrent laryngeal nerve may be involved in bronchial or esophageal carcinoma or secondary metastatic deposits in the mediastinal lymph nodes
    • Section of the external laryngeal nerve produces weakness of the voice because the cricothyroid muscle is paralyzed and the vocal fold cannot be tensed
    • Unilateral complete section of the recurrent laryngeal nerve results in the vocal fold on the affected side assuming the position midway between abduction and adduction
    • Bilateral complete section of the recurrent laryngeal nerve results in both vocal folds assuming the position midway between abduction and adduction, impaired breathing, and loss of speech

    Laryngeal Mucous Membrane Edema

    • The mucous membrane of the larynx is loosely attached to the underlying structures by submucous connective tissue
    • The mucous membrane is firmly attached to the vocal ligaments in the region of the vocal folds

    Important Anatomic Axes for Endotracheal Intubation

    • Three upper airway axes must be brought into alignment for adequate visualization of the glottis through a laryngoscope:
    • Axis of the mouth
    • Axis of the pharynx
    • Axis of the trachea

    Reflex Activity Secondary to Endotracheal Intubation

    • Stimulation of the mucous membrane of the upper airway during intubation may produce cardiovascular changes such as bradycardia and hypertension
    • These changes are largely mediated through the branches of the vagus nerves

    Brain Structure

    • Axial image of the brain shows different parts of the lateral ventricle and the lateral sulcus of the cerebral hemisphere
    • Coronal image through the frontal lobe shows the anterior horn of the lateral ventricle with improved contrast between gray and white matter

    Ventricles and Sulci

    • Lateral ventricle has anterior, posterior, and inferior horns
    • Longitudinal fissure and falx cerebri are present
    • Gray matter and white matter of the cerebral hemisphere and cerebellum can be differentiated

    Skull and Head Structures

    • Frontal lobe, occipital lobe, and corpus callosum are visible in the brain
    • Nasal cavity, pituitary gland, and fourth ventricle are present
    • Medulla oblongata and cerebellum are located in the posterior cranial fossa

    Mandible and Neck Structures

    • Mandible has a body, ramus, and angle
    • Ramus has a posterior border overlapped by the parotid gland
    • Masseter muscle covers the outer surface of the ramus
    • Pterygomandibular ligament can be palpated as a tense band on the medial side of the ramus

    Neck Anatomy

    • Neck is subject to individual variation in body form and content
    • Anterior and posterior triangles of the neck can be examined
    • Thyrohyoid membrane fills the interval between the hyoid bone and the thyroid cartilage
    • Upper border of the thyroid cartilage lies opposite the fourth cervical vertebra

    Posterior Aspect of the Neck

    • External occipital protuberance lies in the midline at the junction of the head and neck
    • Nuchal groove and cervical spines can be palpated
    • Carotid sheath contains the carotid arteries, internal jugular vein, vagus nerve, and deep cervical lymph nodes

    Lateral Aspect of the Neck

    • Sternocleidomastoid muscle can be palpated throughout its length
    • Accessory nerve is relatively superficial as it emerges from the posterior border of the sternocleidomastoid

    Digestive System

    • Oral cavity, pharynx, and esophagus are the major components of the digestive system in the head and neck
    • Nasal cavity has nasal conchae, nasal meati, and the olfactory region
    • Paranasal sinuses (maxillary, frontal, sphenoid, and ethmoid) drain to specific spots on the lateral wall of the nasal cavity

    Larynx

    • Thyroid, cricoid, arytenoid, and epiglottic cartilages are the major skeletal elements
    • Extrinsic and intrinsic muscles act on the cartilages to produce abduction/adduction of the vocal folds or tension/relaxation of the vocal ligaments
    • CN X supplies the entire larynx via its superior laryngeal and recurrent laryngeal branches

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    Description

    The hypoglossal nerve is a motor nerve that emerges on the anterior surface of the medulla oblongata. It passes through the jugular foramen and is distributed to the muscles of the soft palate and pharynx.

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