Y2S2 P2 Head and Neck (Innervation + Blood supply + extra notes)
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What is the primary function of the vestibulocochlear nerve [VIII]?

  • Controlling the movement of the tympanic membrane
  • Facilitating taste transmission to the anterior ⅔ of the tongue
  • Transmitting special afferent fibers for hearing and balance (correct)
  • Regulating blood supply to the inner ear

    • Which artery supplies blood to the membranous labyrinth?

  • Anterior tympanic branch of the maxillary artery
  • Labyrinthine artery from the anteroinferior cerebellar artery (correct)
  • Middle meningeal artery - petrosal branch
  • Posterior auricular artery - stylomastoid branch

    • What anatomical feature separates the anterior wall from the internal carotid artery?

  • Pharyngotympanic tube (correct)
  • Tensor tympani muscle attachment
  • Round and oval windows
  • Exit of chorda tympani

    • Which structure is located on the labyrinthine wall of the inner ear?

    <p>Facial canal containing facial nerve [VII]</p> Signup and view all the answers

    What branch of the vestibulocochlear nerve divides into superior and inferior parts?

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

    Which of the following nerves is responsible for innervating the diaphragm?

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

    The anterior triangle of the neck is bounded by which of the following structures?

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

    Which branch of the cervical plexus is primarily responsible for cutaneous sensation in the region near the external ear?

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

    What is the main function of the ansa cervicalis?

    <p>Supplies the strap muscles of the neck</p> Signup and view all the answers

    Which structures are associated with the posterior triangle of the neck?

    <p>Subclavian artery and accessory nerve</p> Signup and view all the answers

    What is the consequence of damage to the accessory nerve during its course?

    <p>Difficulty in rotating the neck and shrugging the shoulders</p> Signup and view all the answers

    Which of the following pairs of muscles are primarily innervated by the phrenic nerve?

    <p>Diaphragm and pericardium</p> Signup and view all the answers

    Which structure is NOT found within the carotid sheath?

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

    What is the consequence of an issue with the vagus nerve?

    <p>Uvula deviates towards the normal side</p> Signup and view all the answers

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

    <p>Trigeminal nerve [V]</p> Signup and view all the answers

    Which statement regarding tongue innervation is true?

    <p>The vagus nerve innervates the palatoglossus muscle.</p> Signup and view all the answers

    Which nerve provides taste sensation to the anterior two-thirds of the tongue?

    <p>Facial nerve [VII] via chorda tympani</p> Signup and view all the answers

    Which of the following correctly matches the area with its innervating nerve?

    <p>Epiglottis - Vagus nerve [X]</p> Signup and view all the answers

    Which arteries contribute to Kiesselbach’s Area, a common site for nasal bleeding?

    <p>Anterior/posterior ethmoidal a. and greater palatine a.</p> Signup and view all the answers

    What is the primary innervation for the frontal sinus?

    <p>Ophthalmic n. (V1)</p> Signup and view all the answers

    Which structure has the potential to allow infection to spread to the central nervous system?

    <p>Pterygoid plexus</p> Signup and view all the answers

    Which nerves provide the anterior ethmoidal branches to the nasal cavity?

    <p>Ophthalmic n. (V1)</p> Signup and view all the answers

    Where do the lymphatics of the nasal cavity primarily drain posteriorly?

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

    What anatomical feature separates the anteroposterior drainage of the nasal cavity?

    <p>Nasal septum</p> Signup and view all the answers

    Which of the following veins drains the anterior aspect of the nasal cavity?

    <p>Facial vein</p> Signup and view all the answers

    Which structures drain into the superior meatus of the nasal cavity?

    <p>Posterior ethmoidal sinuses</p> Signup and view all the answers

    Which muscle is primarily responsible for opening the pharyngotympanic tube during yawning or swallowing?

    <p>Tensor veli palatini</p> Signup and view all the answers

    What is the main mode of innervation for the soft palate muscles?

    <p>Vagus nerve via pharyngeal plexus</p> Signup and view all the answers

    Which artery gives off the greater palatine branch, contributing to the blood supply of the hard palate?

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

    Which structure is formed by the fusion of the medial nasal processes?

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

    What is the role of the palatoglossus muscle during swallowing?

    <p>Pulls the pharynx up and medially</p> Signup and view all the answers

    Which nerve provides sensory innervation to the hard palate?

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

    Which of the following structures does NOT have a direct relationship with the median labial frenulum?

    <p>Lower lip</p> Signup and view all the answers

    Which of the following best describes the relationship between the palatoglossus and palatopharyngeus muscles?

    <p>Palatoglossus is anterior to palatopharyngeus</p> Signup and view all the answers

    What type of nodes are responsible for draining lymphatics from the palate?

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

    Which of the following muscles primarily helps to depress the soft palate?

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

    Study Notes

    Fascia

    • Fascia is a connective tissue layer that surrounds muscles, organs, and other structures in the body.
    • When trying to reach the vertebra, you will encounter fascia first.

    Cervical Plexus

    • Located in the Posterior Triangle of the neck.
    • Contains cutaneous and muscular branches.

    Cutaneous Branches

    • Anterior rami (curls around SCM):
      • Lesser occipital (C2)
      • Great auricular (C2-3)
      • Transverse cervical (C2-3)
      • Supraclavicular (C3-4)
    • Posterior rami:
      • Greater occipital (C2)
      • Dorsal rami of C3, 4, 5

    Muscular Branches

    • C1 (travels with hypoglossal nerve):
      • Suprahyoids
    • Ansa Cervicalis (C1-3):
      • Straps (sternohyoid, sternothyroid), omohyoid
    • Phrenic (C3-5):
      • Diaphragm and pericardium
    • Segmental branches (C1-4):
      • Anterior/middle scalenes
    • Other branches :
      • Other cervical muscles

    Triangles of the Neck

    • Anterior Triangle:

      • Bounded by the mandible, SCM, and midline.
      • Associated with structures between the head and thorax.

    • Structures:

      • Midline structures: hyoid bone, larynx, thyroid/parathyroid, oesophagus
      • Carotid sheath: carotid artery bifurcation, internal/external jugular vein, CNX
      • Glossopharyngeal and hypoglossal nerves.
      • Spinal accessory nerve (lateral to medial)

    • Posterior Triangle:

      • Bounded by the clavicle, SCM, and trapezius.
      • Associated with the axillary inlet (upper limb structures).

    • Structures:

      • Accessory nerve [XI] - innervates SCM and trapezius muscles.
      • Omohyoid muscle splits the triangle into supraclavicular and occipital regions.
      • Subclavian artery [VII] - later supplies taste to the anterior ⅔ of the tongue.

    Middle Ear

    • Anterior wall :
      • Separates from the internal carotid artery.
      • Exit of chorda tympani.
      • Pharyngotympanic tube.
      • Tensor tympani muscle attachment (to malleus).
    • Labyrinthine wall (medial) :
      • Also the lateral wall of the inner ear.
      • Round and oval window (attachment of stapes).
      • Promontories for:
        • Cochlea - on which lies tympanic plexus.
        • Facial canal (containing facial nerve [VII]).
        • Lateral semicircular canal.
      • Lesser petrosal nerve from tympanic plexus enters otic ganglion via foramen ovale.

    Internal Ear - Vessels and Nerves

    Associated Nerves

    • Vestibulocochlear nerve [VIII]:
      • Special afferent fibers for hearing and balance.
      • Enters via internal acoustic meatus.
      • Branches into:
        • Cochlear nerve (forming spiral ganglion in modiolus).
        • Vestibular nerve (forming vestibular ganglion which divides into superior and inferior parts).

    Blood Supply

    • Bony labyrinth :

      • Same as surrounding temporal bone.
      • Supplied by external carotid artery.
      • Branches:
        • Anterior tympanic branch from maxillary artery.
        • Stylomastoid branch from posterior auricular artery.
        • Petrosal branch from middle meningeal artery.

    • Membranous labyrinth :

      • Flows with brain circulation.
      • Labyrinthine artery (from anteroinferior cerebellar artery) enters the inner ear.

    Nasal Cavity

    Structures

    • Foramen Cecum :
      • Nasal vein to superior sagittal sinus.
    • Cribriform plate :
      • Olfactory nerve (CNI).
      • Anterior ethmoidal nerve (Ophthalmic V1 branch).
      • Anterior/posterior ethmoidal artery (from internal carotid).
    • Around naris :
      • Internal nasal branches of infraorbital nerve (from V2).
      • Alar branches of nasal artery from facial artery.
    • Small foramina :
      • Inferior nasal branches from greater palatine branch of V2.
    • Nasopalatine nerve :
      • Exits to oral cavity.

    Kiesselbach’s Area/ Little’s Area

    • Huge vascular supply and anastomosis between internal and external carotid arteries located on both medial and lateral walls of the nasal cavity.
    • Found on the nasal septum.
    • Site of epistaxis due to anastomosis between:
      • Internal carotid → ophthalmic artery → anterior/posterior ethmoidal arteries.
      • External carotid → maxillary artery → greater palatine artery, sphenopalatine artery.

    Nose - Venous and Lymphatic Drainage

    Veins

    • Anteriorly: facial vein.
    • Posteriorly: pterygoid plexus.
    • Superiorly: ethmoidal vein → superior ophthalmic vein → cavernous sinus.
    • Nasal vein (1% of people) passes through foramen cecum into superior sagittal sinus.

    Lymphatics

    • Anteriorly: forward onto face → submandibular nodes.
    • Posteriorly: upper deep cervical nodes.

    Nasal Sinuses

    • Air-filled spaces in the skull formed in childhood.
    • All open into the nasal cavity.

    Sinus Drainage Innervation Arterial Supply

    • Frontal Middle meatus: Supra-orbital nerve (from Anterior Semilunar hiatus [V1]) ethmoidal

    • Ethmoidal Middle meatus: Anterior/ posterior Anterior/ - anterior - ethmoidal ethmoidal branches posterior infundibulum/ semilunar of nasociliary nerve ethmoidal

    Tongue

    • Sublingual and submandibular glands and ducts.
    • Important relation: lingual nerve underneath submandibular duct.

    Cheeks

    • Mainly buccinator.

    Lips

    • Anterior : Oral fissure, lips, philtrum, median labial frenulum.
    • Posterior : Oropharyngeal isthmus (formed by palatoglossal arches, opened/closed by soft palate and tongue).

    Soft Palate Muscles

    • All innervated by the vagus nerve [X] via pharyngeal branch to pharyngeal plexus EXCEPT tensor veli palatini - mandibular nerve [V3] via branch to medial pterygoid.
    • Palatoglossus is anterior to palatopharyngeus:
      • Forms the palatoglossal/palatopharyngeal arches with the palatine tonsil resting in between.
      • Depresses the soft palate or pulls the pharynx up, forward, medially during swallowing.
      • Attached to palatine aponeurosis and draws tongue and palate together.
    • Tensor veli palatini (TVP) is anterior to levator veli palatini:
      • Both elevate the soft palate, but only LVP above neutral.
      • TVP comes from above, wraps around the pterygoid hamulus before attaching to the palatine aponeurosis.
      • Opens the pharyngotympanic tube during yawning/swallowing.
    • Musculus uvulae pulls the uvula superiorly.

    Palate - Neurovasculature

    Arteries

    • Greater and lesser palatine arteries.
    • Maxillary artery gives off the greater palatine branch, which gives off the lesser palatine branch in the palatine canal.
    • Travel through the greater and lesser palatine foramen (in palatine bone) respectively.
    • Greater branch → hard palate → incisive canal.
    • Lesser branch → soft palate → uvula.

    Veins

    • Follow arteries and drain into the pterygoid or pharyngeal plexus.

    Lymphatics

    • Deep cervical nodes.

    Innervation

    • Branches of pterygopalatine ganglion
      • Greater/lesser palatine nerve (hard and soft palate respectively).
      • Nasopalatine nerve (through incisive canal).
      • Ganglion receives branches from:
        • Maxillary nerve.

    Tongue - Innervation (HIGH YIELD)

    Reasoning

    • Hypoglossal [XII] = muscles of the tongue as hypo = under, and the nerve runs underneath the tongue to access all the muscles.
    • Vagus [X] is all of the palate (except TVP) therefore:
      • Motor to palatoglossus.
      • Sensory to epiglottis and soft palate.
    • General sensory is the same as surroundings:
      • Closest to face (ant ⅔) = trigeminal [V].
      • Closest to pharynx (post ⅓) = glossopharyngeal [IX].
    • Taste is provided by the same sensory nerve except the anterior ⅔ of the tongue via facial nerve [VII] chorda tympani.

    Tongue Innervation Summary

    • Motor :
      • Muscles of the tongue - Hypoglossal nerve [XII].
      • Palatoglossus - Vagus nerve [X].
    • Sensory :
      • Anterior ⅔ - Trigeminal [V] (general sensation), Facial [VII] via chorda tympani (special sensation (taste))
      • Posterior ⅓ - Glossopharyngeal [IX] (general and special sensory).
      • Epiglottis and soft palate - Vagus nerve [X] (general and special sensory).

    Salivary Glands

    • Mostly small glands in the submucosa or mucosa of the oral epithelium.

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