Podcast
Questions and Answers
Which bone is located at the front of the skull in the frontal view of an x-ray?
Which bone is located at the front of the skull in the frontal view of an x-ray?
What is the correct name for the area where the tooth meets the mandible?
What is the correct name for the area where the tooth meets the mandible?
Which of the following is true about the type of joint formed by sutures in the skull?
Which of the following is true about the type of joint formed by sutures in the skull?
In the lateral view of the skull, which structure is located just above the ramus of the mandible?
In the lateral view of the skull, which structure is located just above the ramus of the mandible?
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What is the name given to the angle formed by the mandible?
What is the name given to the angle formed by the mandible?
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What is the primary function of the sutures in the neurocranium before they fuse?
What is the primary function of the sutures in the neurocranium before they fuse?
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Which sinus is located laterally and not in the midline of the skull?
Which sinus is located laterally and not in the midline of the skull?
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What is NOT a function of the air-filled sinuses in the skull?
What is NOT a function of the air-filled sinuses in the skull?
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The mastoid process is primarily associated with which bone?
The mastoid process is primarily associated with which bone?
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Which suture is located between the parietal and occipital bones?
Which suture is located between the parietal and occipital bones?
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The coronal suture runs between which two bones?
The coronal suture runs between which two bones?
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Which bone serves as the division between the nostrils in the nasal septum?
Which bone serves as the division between the nostrils in the nasal septum?
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What type of imaging technique is primarily used for examining bony structures of the brain?
What type of imaging technique is primarily used for examining bony structures of the brain?
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The ethmoid bone is located in which part of the skull?
The ethmoid bone is located in which part of the skull?
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What is the purpose of the nasal conchae?
What is the purpose of the nasal conchae?
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Which structure is found at the anterior part of the neck and is not attached to other bones?
Which structure is found at the anterior part of the neck and is not attached to other bones?
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In MRI imaging, which technique shows brighter signals for fat?
In MRI imaging, which technique shows brighter signals for fat?
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Where does the sella turcica lie?
Where does the sella turcica lie?
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Which of the following bones form the lateral wall of the orbit?
Which of the following bones form the lateral wall of the orbit?
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What is the significance of the pterion in terms of cranial anatomy?
What is the significance of the pterion in terms of cranial anatomy?
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What region of the orbit is the thinnest and most susceptible to blowout fractures?
What region of the orbit is the thinnest and most susceptible to blowout fractures?
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Which bones articulate with the vomer?
Which bones articulate with the vomer?
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What is the main nerve responsible for the sensation of the face?
What is the main nerve responsible for the sensation of the face?
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Which layer of the scalp is considered the most dangerous in terms of potential infection and hemorrhage?
Which layer of the scalp is considered the most dangerous in terms of potential infection and hemorrhage?
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During a parotidectomy, which structure is at significant risk of injury?
During a parotidectomy, which structure is at significant risk of injury?
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What clinical manifestations may arise from a parotid gland abscess?
What clinical manifestations may arise from a parotid gland abscess?
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What causes facial hemiparesis, particularly affecting the ability to close the eye?
What causes facial hemiparesis, particularly affecting the ability to close the eye?
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Which cranial fossa must be accessed to reach the pterion?
Which cranial fossa must be accessed to reach the pterion?
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What is a common symptom of trigeminal neuralgia?
What is a common symptom of trigeminal neuralgia?
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The foramen rotundum, foramen ovale, and foramen spinosum are located in which part of the sphenoid bone?
The foramen rotundum, foramen ovale, and foramen spinosum are located in which part of the sphenoid bone?
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What is the primary function of the orbicularis oris muscle?
What is the primary function of the orbicularis oris muscle?
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What is the typical age range for the fusion of the metopic suture in infants?
What is the typical age range for the fusion of the metopic suture in infants?
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Which muscle impairment is primarily responsible for the inability to smile properly?
Which muscle impairment is primarily responsible for the inability to smile properly?
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What defines the route of the parotid duct?
What defines the route of the parotid duct?
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What causes the profuse bleeding in hair follicles during injury?
What causes the profuse bleeding in hair follicles during injury?
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Which artery is primarily responsible for supplying the bottom of the face?
Which artery is primarily responsible for supplying the bottom of the face?
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Where is the facial nerve particularly vulnerable to compression?
Where is the facial nerve particularly vulnerable to compression?
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Which of the following would cause taste loss due to impairment of the facial nerve?
Which of the following would cause taste loss due to impairment of the facial nerve?
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What is a common feature of Bell's palsy compared to a stroke?
What is a common feature of Bell's palsy compared to a stroke?
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Which layer of the meninges is the most vascularized?
Which layer of the meninges is the most vascularized?
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Which statement is TRUE regarding the branches of the facial nerve?
Which statement is TRUE regarding the branches of the facial nerve?
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Which condition can definitely cause facial paralysis?
Which condition can definitely cause facial paralysis?
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What is a characteristic of an epidural hemorrhage?
What is a characteristic of an epidural hemorrhage?
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What is the indication of inability to blow a trumpet?
What is the indication of inability to blow a trumpet?
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In the context of facial arteries, what do the labial arteries supply?
In the context of facial arteries, what do the labial arteries supply?
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Where does the facial nerve exit the skull?
Where does the facial nerve exit the skull?
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What branches from the facial nerve are responsible for raising the eyebrow?
What branches from the facial nerve are responsible for raising the eyebrow?
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Which facial nerve branch would mainly cause drooping of the mouth corner if injured?
Which facial nerve branch would mainly cause drooping of the mouth corner if injured?
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What is a common presentation of stroke compared to Bell's palsy?
What is a common presentation of stroke compared to Bell's palsy?
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Which muscle is affected by impairment to the orbicularis oculi?
Which muscle is affected by impairment to the orbicularis oculi?
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Which structure is at the risk of injury during a total hysterectomy?
Which structure is at the risk of injury during a total hysterectomy?
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Which type of hemorrhage is characterized by pressure buildup in the brain and potential cognitive issues?
Which type of hemorrhage is characterized by pressure buildup in the brain and potential cognitive issues?
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Which nerve is primarily responsible for facial sensation?
Which nerve is primarily responsible for facial sensation?
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What is a potential impact of Bell’s palsy on muscle function?
What is a potential impact of Bell’s palsy on muscle function?
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Which surface landmark identifies the site of electrode placement for the zygomatic branch?
Which surface landmark identifies the site of electrode placement for the zygomatic branch?
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What structure is involved in facial deformity due to certain nerve injuries?
What structure is involved in facial deformity due to certain nerve injuries?
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What are the boundaries of the area superficial to the cranium?
What are the boundaries of the area superficial to the cranium?
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Which nerve is responsible for providing sensory innervation to the parotid gland?
Which nerve is responsible for providing sensory innervation to the parotid gland?
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Which structure is the largest salivary gland in the human body?
Which structure is the largest salivary gland in the human body?
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What is the function of the emissary veins in relation to dural venous sinuses?
What is the function of the emissary veins in relation to dural venous sinuses?
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Which cranial nerve passes through the internal acoustic meatus?
Which cranial nerve passes through the internal acoustic meatus?
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What symptom is commonly associated with parotitis?
What symptom is commonly associated with parotitis?
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What causes non-infective parotitis?
What causes non-infective parotitis?
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Which artery is closely associated with the parotid region?
Which artery is closely associated with the parotid region?
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What is a reason why the scalp bleeds profusely when wounded?
What is a reason why the scalp bleeds profusely when wounded?
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Which foramen allows for the passage of the mandibular division of the trigeminal nerve?
Which foramen allows for the passage of the mandibular division of the trigeminal nerve?
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Study Notes
Frontal View of Skull X-ray
- The frontal bone is located at the front of the skull.
- The nasal bones are located in the nose.
- The maxilla is located below the orbit and forms the upper jaw.
- The mandible is the lower jaw, including the ramus.
Lateral View of Skull X-ray
- The frontal bone is located at the front of the skull.
- The maxilla forms the upper jaw.
- The angle of the mandible is significant for the jawline.
- The vertebral body of C2 can be observed.
- The occipital bone is at the very back of the head near the occipital lobe.
- The sella turcica of the sphenoid bone is located between the frontal and temporal bones, above the ramus of the mandible.
- The parietal bone is on the lateral, upper side of the cranium.
Sutures of the Skull
- Sutures are synarthroses (fibrous joints) with limited mobility.
- Sutures allow flexibility during birth and equal expansion of the skull during brain growth.
Types of Sutures
- The squamous suture separates the parietal and temporal bones.
- The lambdoid suture separates the parietal and occipital bones.
- The bregma is the junction of the sagittal and coronal sutures, located at the front top of the head.
- The lambda is the posterior top middle of the skull, where the lambdoid and sagittal sutures meet.
- The sagittal suture runs along the sagittal plane, between the two parietal bones on the superior side of the cranium.
- The coronal suture runs along the coronal plane, between the frontal and parietal bones.
Air-Filled Sinuses
- Sinuses are named after the bones they form in, lined with mucous membrane and connected to the nasal cavity.
Functions of Air-Filled Sinuses
- Increase speech resonance.
- Lighten the skull.
- Warm and humidify inhaled air.
- Produce mucus for the nasal cavity.
- Act as crumple zones in facial trauma.
Ethmoid Bone
- The ethmoid bone is long and narrow, located within the roof of the nasal cavity, between the orbital cavities and projecting anteriorly into the frontal zone.
- It is located anterior to the sphenoid bone.
Nasal Conchae
- Nasal conchae are projections within the nasal cavity.
- MRI scans are better for visualizing neural features compared to CT scans.
MRI Scan
- T1 weighted MRI shows fat as brighter.
- T2 weighted MRI shows fluid and CSF brighter.
- Bones appear darker on both T1 and T2 weighted MRI.
Sinuses on MRI
- All sinuses, except the maxillary, are in the midline.
- The maxillary sinus is lateral due to its location near the nose.
- The ethmoid sinuses are thin and long, while the sphenoid sinuses are sphenoid (wing) shaped.
CT Scan
- CT scans are most commonly used for visualizing brain bony structures, especially in the elderly.
The Styloid Process
- The styloid process is a sharp inferior projection of the temporal bone, anterior to the ear.
The Mastoid Process
- The mastoid process is an inferior, conical prominence of the temporal bone located behind the ear, connected to the middle ear.
Maxillary Sinus
- The maxillary sinus is located laterally and anteriorly, as seen on CT scans.
Inferior Nasal Concha
- The inferior nasal concha is located within the nose at the ethmoid level.
Hard Palate
- The hard palate is formed by the maxillary bone.
Alveolar Process
- The alveolar process is where the tooth joins the mandible.
Sella Turcica
- The sella turcica is located on the posterior side of the sphenoid bone and houses the pituitary gland.
Vomer
- The vomer forms the posteroinferior part of the nasal septum.
Palatine Bone
- The palatine bone forms the upper palate.
Hyoid Bone
- The hyoid bone is located in the anterior neck and is not attached to any other bone.
Zygomatic Bone
- The zygomatic bone forms the lateral side of the orbit, anterior to the sphenoid bone.
Condylar Process
- The condylar process of the mandible extends toward the ear, anterior to the styloid process.
External Auditory Meatus
- The external auditory meatus is a hole in the temporal bone through which sound enters.
Lambdoid Suture
- The lambdoid suture separates the parietal and occipital bones.
Internal Occipital Protuberance
- The internal occipital protuberance is located at the back of the head just posterior to the foramen magnum.
Occipital Clivus
- The occipital clivus is a bony structure that serves as a pathway for the medulla oblongata and the vertebral artery.
Jugular Foramen
- The jugular foramen is located laterally and posteriorly, and allows passage for the jugular vein, cranial nerves IX, X, and XI.
Carotid Canal
- The carotid canal is located anteromedially, and houses the carotid artery. It is medial to the jugular foramen.
Pterygoid Process
- The pterygoid process is located on the posterior and inferior portions of the sphenoid bone.
Ethmoid Bone
- The ethmoid bone contributes to the medial wall of the orbit, the roof and septum of the nasal cavity, and the anterior cranial fossa.
Sphenoid Bone
- The sphenoid bone contributes to the superior, medial, and lateral walls of the orbit, the lateral wall and roof of the nasal cavity, the anterior cranial fossa, and the middle cranial fossa.
Maxilla
- The maxilla contributes to the inferior wall of the orbit, the lateral wall of the nasal cavity, and the hard palate.
Frontal Bone
- The frontal bone contributes to the superior wall of the orbit, the anterior cranial fossa, and the calvarium.
Temporal Bone
- The temporal bone contributes to the middle and posterior cranial fossa.
Parietal Bone
- The parietal bone contributes only to the calvarium.
Zygomatic Bone
- The zygomatic bone contributes to the lateral wall of the orbit.
Occipital Bone
- The occipital bone contributes to the posterior cranial fossa.
### Pterion
- The pterion is an H-shaped suture where the frontal, temporal, sphenoid, and zygomatic bones meet.
- It is located superficially to the meningeal arteries and susceptible to intracranial hemorrhage.
- The pterion is accessed through the middle cranial fossa.
Orbit: Thinnest Wall Regions and Implications
- The thinnest portion of the orbit is its medial wall separating it from the ethmoid sinus.
- The floor of the orbit, separated by the maxillary sinus, is also thin.
- Blowout fractures can occur due to pressure increases in these regions.
- The lateral and superior walls are thicker.
Metopic Suture
- In the developing skull, the metopic suture separates the two frontal bones.
- It generally fuses between three and nine months of age.
- Metopic ridge formation, eventually fading, is usually caused by bone thickening.
The Vomer
- The vomer forms the inferomedial portion of the nasal septum.
- It articulates with the sphenoid bone superiorly, the ethmoid bone anterosuperiorly, the palatine bone posteroinferiorly, and the maxillary bone anteroinferiorly.
Foramina of the Greater Wing of Sphenoid
- The greater wing of the sphenoid bone houses the foramen rotundum, foramen ovale, and foramen spinosum.
- The foramen rotundum allows passage for the maxillary division of the trigeminal nerve.
- The foramen ovale allows passage for the mandibular division of the trigeminal nerve.
- The foramen spinosum allows passage for the middle meningeal artery.
Muscles Involved in Facial Drooping
- The risorius, zygomaticus major and minor, and levator labii superioris muscles help maintain the elevated position of the lateral corner of the mouth.
- Weakness or paralysis of the orbicularis oris muscle leads to a widened mouth.
Facial Hemiparesis and Eye Closure
- Individuals with facial hemiparesis often cannot close their eye on the affected side due to weakness of the orbicularis oculi muscle.
Trigeminal Neuralgia
- Abnormal twitching of facial muscles, often caused by uncontrolled sensory input from the face, can result in trigeminal neuralgia.
- The trigeminal nerve is the main sensory nerve of the face.
The Most Dangerous Layer of the Scalp
- The loose areolar connective tissue layer of the scalp is the most dangerous due to its large blood vessels and loose nature, allowing for easy spread of infection and hemorrhage.
Parotid Tumors and Parotidectomy
- Parotid gland tumors are the most common type of salivary gland tumors.
- Parotidectomy, surgical removal of the parotid gland, can endanger the facial nerve, retromandibular vein, and branches of the external carotid artery.
Clinical Manifestations of Parotitis or Parotid Gland Abscess
- Swelling of the parotid gland.
- Pain with jaw movement.
- Difficulty swallowing.
- Pus in the oral cavity.
- Pain around the ear.
- Referred pain along the auriculotemporal nerve.
Potential Complications of Parotidectomy
- Facial nerve damage, leading to inability to close the eye, smile properly, or experience taste loss.
- Salivary fistula.
- Facial deformity.
- Numbness around the ear.
- Sweating problems.
Parotid Duct (Stenon's Duct)
- The parotid duct originates from the anterior aspect of the parotid gland.
- It crosses the masseter muscle, pierces the buccinator muscle, and enters the oral cavity opposite the second upper molar.
- The facial vein and artery lie close to the parotid duct.
Course of the Facial Nerve
- The facial nerve enters the temporal bone through the internal auditory meatus.
- It exits the skull through the stylomastoid foramen.
- It travels through the posterior aspect of the parotid gland and its substance.
- It branches into the temporofacial (superior) and cervicofacial (inferior) branches.
- It further divides into the temporal, zygomatic, buccal, marginal mandibular, and cervical branches—remembered as "To Zanzibar by Motor Car."
Bell's Palsy
- Bell's palsy is idiopathic facial nerve palsy, characterized by unilateral facial paralysis.
- It is thought to be caused by viral infection or other inflammation leading to demyelination.
- The facial nerve is susceptible to compression within the narrow stylomastoid foramen or within the parotid gland due to its inelastic fascia.
Electrical Neurostimulation for Bell's Palsy
- Electrical neurostimulation helps prevent muscle atrophy and maintain tone in denervated facial expression muscles.
- Electrodes are placed strategically to target the main muscles supplied by each facial nerve branch.
- Temporal branch: Anterior to the ear, supralateral to the orbital ridge.
- Zygomatic branch: Lateral to the nose.
- Buccal branch: Over the cheek, anterior to the masseter.
- Marginal mandibular branch: Anterior half of the lateral mandible.
- Cervical branch: Inferior to the mandible body.
Causes of Facial Paralysis
- Parotid tumor surgery.
- Otitis media (middle ear infection).
- Injury at birth near the stylomastoid foramen.
- Shingles (Ramsay Hunt Syndrome), which can affect the geniculate ganglion of the facial nerve.
Signs and Symptoms of Terminal Facial Nerve Branch Damage
- Unable to blink: Orbicularis oculi muscle (temporal and zygomatic branches).
- Mouth drooping and drooling: Orbicularis oris and other lower facial muscles (buccal and marginal mandibular branches).
- Unable to blow a trumpet: Buccinator and orbicularis oris muscles (buccal branch).
- Unable to raise the eyebrow and wrinkle forehead: Frontalis muscle (temporal branch).
Boundaries of the Face
- Superior: Frontal bone.
- Inferior: Inferior border of the mandible.
- Lateral: Ears/zygomatic arch.
Pharyngeal Apparatus and Facial Structure Formation
- The first pharyngeal arch gives rise to muscles of mastication, innervated by the trigeminal nerve.
- The first pharyngeal cleft forms the ear.
- The second pharyngeal arch gives rise to muscles of facial expression, all innervated by the facial nerve.
The Scalp
- The scalp is the area superficial to the cranium, consisting of five layers: skin, dense connective tissue, epicranial aponeurosis, loose connective tissue, and pericranium.
- The scalp's boundaries are:
- Inferior: Supraorbital margin.
- Posterior: External occipital protuberance, superior nuchal lines.
- Lateral: Superior temporal lines.
Dural Venous Sinuses
- Dural venous sinuses are large channels within the dura mater.
- They connect to the scalp via emissary veins, passing through major foramina in the skull.
Major Bony Contributions to the Facial Region
- Frontal bone.
- Parietal bone.
- Temporal bone.
- Occipital bone.
- Sphenoid bone.
- Ethmoid bone.
- Maxilla.
- Mandible.
- Zygomatic bones.
- Nasal bones.
The Parotid Gland
- The parotid gland is the largest salivary gland.
- It is traversed by the facial nerve.
- Its duct (Stenon's duct) passes anteriorly, crossing the masseter and piercing the buccinator muscle.
- The retromandibular vein and external carotid artery are also closely related to the parotid gland.
Skull Base Fossae and Foramina: High-Yield Nerves
-
Anterior Cranial Fossa:
- Olfactory nerve (CN I): Through the cribriform plate of the ethmoid bone.
- Optic nerve (CN II): Through the optic canal in the lesser wing of the sphenoid bone.
-
Middle Cranial Fossa:
- Oculomotor nerve (CN III): Through the superior orbital fissure.
- Trochlear nerve (CN IV): Through the superior orbital fissure.
-
Trigeminal nerve (CN V):
- Ophthalmic division (V1): Through the superior orbital fissure.
- Maxillary division (V2): Through the foramen rotundum.
- Mandibular division (V3): Through the foramen ovale.
- Abducens nerve (CN VI): Through the superior orbital fissure.
-
Posterior Cranial Fossa:
- Facial nerve (CN VII): Through the internal auditory meatus and stylomastoid foramen.
- Vestibulocochlear nerve (CN VIII): Through the internal auditory meatus.
- Glossopharyngeal nerve (CN IX): Through the jugular foramen.
- Vagus nerve (CN X): Through the jugular foramen.
- Accessory nerve (CN XI): Through the jugular foramen.
- Hypoglossal nerve (CN XII): Through the hypoglossal canal.### Cranial Foramina and Nerve Passage
-
Cribriform plate - passage for olfactory nerve (CN I)
-
Optic canal - passage for optic nerve (CN II) and ophthalmic artery
-
Superior orbital fissure - passage for cranial nerves III, IV, VI, and V1
-
Foramen rotundum - passage for maxillary division of trigeminal nerve (V2)
-
Foramen ovale - passage for mandibular division of trigeminal nerve (V3)
-
Foramen spinosum - passage for middle meningeal artery
-
Internal acoustic meatus - passage for cranial nerves VII and VIII
-
Jugular foramen - passage for cranial nerves IX, X, and XI
-
Hypoglossal canal - passage for hypoglossal nerve (CN XII)
-
Foramen magnum - passage for spinal cord and vertebral arteries
Anatomy of Parotitis
- Parotid gland located anterior and inferior to the ear
- Facial nerve (CN VII) passes through the parotid gland, dividing it into superficial and deep lobes
- Auriculotemporal nerve (branch of mandibular nerve V3) provides sensory innervation to the parotid gland
- Great auricular nerve provides sensory innervation to the skin over the parotid gland
- Glossopharyngeal nerve provides parasympathetic innervation to the parotid gland
- Stensen's duct passes over the masseter, pierces the buccinator, and enters the mouth opposite the second upper molar
Causes of Parotitis
- Bacterial parotitis: often caused by Staphylococcus aureus, Haemophilus influenzae, or Streptococcus pneumoniae
- Viral parotitis: can be caused by Epstein-Barr virus (EBV) or Coxsackievirus
- Non-infective parotitis: may be related to salivary stones, dehydration, or other causes
Anatomy of the Scalp
- Supraoptic margin: inferior border of the scalp
- Zygomatic arch: lateral border of the scalp
- External occipital protruberance and nuchal line: posterior border of the scalp
-
Layers of the scalp:
- Skin
- Dense connective tissue
- Aponeurosis (epicranial aponeurosis, part of the occipitofrontalis muscle)
- Loose connective tissue
- Dense membrane
Arteries of the Face
- Facial artery: supplies the bottom of the face
- Labial arteries: supply the mouth and nose
- Angular artery: continuation of the facial artery
- Anterior superficial temporal artery: supplies the top of the face
- Maxillary artery: supplies the infratemporal fossa and includes the meningeal arteries
Facial Paralysis
- Facial nerve (CN VII): originates from the brainstem and passes through the internal acoustic meatus, facial canal, and stylomastoid foramen
- Bell's palsy: weakness on one side of the face, typically due to inflammation or autoimmune causes
- Stroke: blockage of a blood vessel in the brain, leading to paralysis on one side of the body
-
Difference between Bell's palsy and stroke:
- Bell's palsy typically affects one side of the face, stroke affects one quarter of the body
- Bell's palsy onset is gradual, stroke onset is rapid
- Bell's palsy is treated with corticosteroids and eye drops, stroke is treated with thrombectomy or surgery
Meninges and Haemorrhages
-
Meninges: three layers of membranes that surround the brain and spinal cord
- Dura mater: outer, tough layer
- Arachnoid mater: middle layer
- Pia mater: inner layer
- Epidural haemorrhage: bleeding between the dura mater and the skull, commonly caused by damage to the middle meningeal artery
- Subdural haemorrhage: bleeding between the dura mater and arachnoid mater, commonly caused by damage to cerebral veins
- Subarachnoid haemorrhage: bleeding between the arachnoid mater and pia mater, commonly caused by trauma
Other Anatomical Points
- Posterior sacroiliac ligament: attaches to the posterior superior iliac spine (PSIS)
- Ureter: at risk during a total hysterectomy
- Abberant obturator artery: can contribute to bleeding after inguinal hernia repair
- Superior gluteal nerve: most superior branch of the sacral plexus
- Testicular artery: arises most proximally from the aorta
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Description
Test your knowledge on the anatomy of the skull and mandible with this informative quiz. From bone identification to joint types, this quiz covers key aspects of cranial and jaw structure. Perfect for students of anatomy or those interested in human biology.
