Head and Neck Review 2024 PDF

Head and Neck Review - Cranial Nerves Anatomical Sciences – D102 Kornberg School of Dental Medicine Identify Brain Stem Features and Cranial Nerves Optic chiasm CN I CN II...

Head and Neck Review - Cranial Nerves Anatomical Sciences – D102 Kornberg School of Dental Medicine Identify Brain Stem Features and Cranial Nerves Optic chiasm CN I CN II Pituitary stalk & mammillary CN III bodies CN IV Cerebral crus CN V CN VI Pons CN VII Pyramid Cerebellum CN VIII Olive CN IX CN X Medulla oblongata CN XI (Ventral view) CN XII A drop of venous blood originating in the ophthalmic veins in the orbit could traverse which dural venous sinuses on its way to reach the internal jugular vein? (Select all that apply) A) Cavernous B) Transverse C) Superior Petrosal D) Straight E) Inferior Sagittal F) Inferior Petrosal G) Sigmoid H) Superior Sagittal A drop of venous blood originating in the ophthalmic veins in the orbit could traverse which dural venous sinuses on its way to reach the internal jugular vein? (Select all that apply) A) Cavernous B) Transverse C) Superior Petrosal D) Straight E) Inferior Sagittal F) Inferior Petrosal G) Sigmoid H) Superior Sagittal  Dural Septa and Dural Venous Sinuses Coronal Superior sagittal Section Inferior sagittal Falx cerebri Straight Sigmoid Tentorium Transverse cerebelli Pituitary gland Confluence – inferior to diaphragma sellae Cavernous sinus (circles Falx cerebelli pituitary gland)  Coronal Section Superior sagittal sinus Periosteal layer of dura Meningeal layer of dura Superficial vein Diploic vein Emissary vein Cerebral vein Falx cerebri Inferior sagittal sinus  Dural Septa and Dural Venous Sinuses Superior ophthalmic vein (emissary vein) To the internal jugular vein which begins at the jugular Cavernous foramen sinus Superior petrosal sinus Sigmoid sinus Inferior petrosal Transverse sinus sinus Confluence of sinuses Stenosis of which of the following cranial foramina could cause a patient to have loss of sensation to the palatal mucosa, the nasal cavity, the maxillary teeth, and the face in the region between the lower eyelid and the upper lip? A) Superior Orbital Fissure B) Foramen Ovale C) Foramen Spinosum D) Foramen Rotundum Stenosis of which of the following cranial foramina could cause a patient to have loss of sensation to the palatal mucosa, the nasal cavity, the maxillary teeth, and the face in the region between the lower eyelid and the upper lip? A) Superior Orbital Fissure B) Foramen Ovale C) Foramen Spinosum D) Foramen Rotundum  Bones of the Cranium (Floor of Cranial Cavity – Superior View) Frontal Crista galli Anterior Ethmoid cranial fossa Cribriform plate Lesser Wing Greater Wing Middle cranial fossa Sphenoid Sella Turcica Body Pituitary Fossa Temporal Posterior cranial fossa Petrous Ridge Petrous pyramid (of temporal bone) Occipital  (Superior view) Cribriform plate (CN I) Optic canal (CN II & ophthalmic artery) Superior orbital fissure (CN III, IV, V1, VI & ophthalmic veins) Foramen rotundum (CN V2) Internal acoustic meatus (CN VII & VIII) Foramen ovale (CN V3) Foramen spinosum (middle meningeal Hypoglossal canal artery) (CN XII) Carotid canal (internal carotid artery) Foramen magnum (spinal cord & Jugular foramen vertebral arteries) (CN IX, X, & XI)  (Inferior view) Incisive canal (branch of V2) Greater palatine foramen (branch of V2) Foramen ovale (CN V3) Foramen spinosum (middle meningeal artery) Carotid canal (lateral end) (Internal carotid artery) Stylomastoid foramen (Facial nerve to muscles of facial expression) III. OCULOMOTOR NERVE Motor Only to the levator palpebrae superioris and the superior rectus (superior division of the oculomotor), and the inferior and medial recti and the inferior oblique muscles (inferior division of the oculomotor) of the eye. parasympathetic fibers to the sphincter pupillae and ciliary muscles. IV. TROCHLEAR NERVE Motor Only to the superior oblique muscle of the eye VI. ABDUCENS NERVE Motor Only to the lateral rectus muscle of the eye  Elevation Abduction Intorsion Muscle Nerve Depression Adduction Extorsion Lateral VI -------- Abduct -------- Rectus Medial Rectus III -------- Adduct -------- Superior III Elevate Adduct Intort Rectus Inferior III Depress Adduct Extort Rectus Superior IV Depress Abduct Intort Oblique Inferior III Elevate Abduct Extort Oblique  Elevation Abduction Intorsion Muscle Nerve Depression Adduction Extorsion Lateral VI -------- Abduct -------- Rectus Medial Rectus III -------- Adduct -------- Superior III Elevate Adduct Intort Rectus Inferior III Depress Adduct Extort Rectus Superior IV Depress Abduct Intort Oblique Inferior III Elevate Abduct Extort Oblique  Veins of the Orbit Superior & inferior ophthalmic veins (emissary veins) Facial vein Cavernous sinus Pterygoid plexus of veins (infratemporal fossa) Retromandibular vein Arteries of the Orbit Supratrochlear & Supraorbital (to skin of forehead) Lacrimal gland Anterior & Posterior Ethmoidal Arteries Ophthalmic Artery Lacrimal Artery Central Retinal Nasal cavity Internal Carotid Artery Artery While testing the extraocular muscle functions, you note that your patient cannot look up when the left eye is fully abducted. You suspect a lesion affecting the function of the muscle? A) Superior Oblique B) Inferior Rectus C) Inferior Oblique D) Superior Rectus While testing the extraocular muscle functions, you note that your patient cannot look up when the left eye is fully abducted. You suspect a lesion affecting the function of the muscle? A) Superior Oblique B) Inferior Rectus C) Inferior Oblique D) Superior Rectus Parasympathetic (Secretomotor) Innervation of the Lacrimal Gland – CN VII Lacrimal nerve CN V2 CN V1 Preganglionic Nerve Fibers from CN VII Synapse of Postganglionic Nerve Cell Bodies in Pterygopalatine Ganglion Pterygopalatine Ganglion (parasympathetic) Which of the following deficits could result from a lesion affecting the sympathetic innervation of the head? (Select all that apply) A) Pupillary Constriction (Miosis) B) Pupillary Dilation (Mydriasis) C) Excessive Sweating (Hyperhidrosis) D) Drooping of the upper eyelid (Ptosis) E) Lack of Sweating (Anhidrosis) Which of the following deficits could result from a lesion affecting the sympathetic innervation of the head? (Select all that apply) A) Pupillary Constriction (Miosis) B) Pupillary Dilation (Mydriasis) C) Excessive Sweating (Hyperhidrosis) D) Drooping of the upper eyelid (Ptosis) E) Lack of Sweating (Anhidrosis)  4. X X 3. Which lesion(s) would produce an upper 1. Horner’s Syndrome X 2. X 4 only Abducens nerve (VI)  Cavernous Sinus Region Internal carotid artery Optic chiasm CN III CN IV Pituitary CN VI CN V1 CN V2 Sphenoid sinus Nasopharynx Coronal section through cavernous sinus Arteries of Brain and Circle of Willis Anterior cerebral Anterior communicating Internal carotid Middle cerebral Posterior communicatings Posterior cerebrals Basilar Circle of Willis Vertebrals True or False The ophthalmic and maxillary divisions of the trigeminal nerve are purely sensory; they do not have any motor components. The entire nasal cavity receives its sensory innervation from branches of the maxillary division of the trigeminal nerve. Blood supply to the nasal septum is derived from branches of both the external and internal carotid arteries. True or False The ophthalmic and maxillary divisions of the trigeminal nerve are purely sensory; they do not have any motor components. True The entire nasal cavity receives its sensory innervation from branches of the maxillary division of the trigeminal nerve. False Blood supply to the nasal septum is derived from branches of both the external and internal carotid arteries. True TRIGEMINAL NERVE Sensory (V1, V2, V3) and Motor (V3 only) general sensation from the skin of the face and the mucous membrane of oral and nasal cavities, teeth, anterior 2/3 of tongue, eye, and other structures in the anterior half of the head motor to the 4 muscles of mastication (masseter, temporalis, lateral and medial pterygoids), 2 tensors (tensor tympani, tensor veli palatini) and 1½ muscles (mylohyoid and anterior belly of digastric) V - Trigeminal V - Trigeminal V2 - Trigeminal V2 - Trigeminal Anterior Ethmoidal from Nasociliary Nerve V2 - Trigeminal  Muscles of Mastication Temporalis Masseter  Muscles of Mastication Lateral Pterygoid (superior & inferior heads) Medial Pterygoid V3 - Trigeminal V3 - Trigeminal  Inferior Alveolar Artery Maxillary Artery exits Infratemporal Fossa by passing medially thru Pterygomaxillary Fissure to supply the Superficial nasal & oral cavities Temporal Artery Middle Meningeal Artery Maxillary Artery Posterior External Carotid Artery Superior Alveolar Arteries  Blood Supply to Nasal Septum Kiesselbach’s Area Nasal Septal Branch 3. 2. Greater Palatine (via the of Superior Labial incisive canal) (Facial) (External Carotid) (Maxillary) (External Carotid) 1. Posterior Septal Anterior 4. Branch of Ethmoidal Sphenopalatine (Maxillary) (Ophthalmic) (External (Internal Carotid) Carotid) 3. 2. If a tumor originating in the middle ear cavity erodes through the bone forming the superior wall (roof), it could invade the … A) cerebellum in the posterior cranial fossa B) internal carotid in carotid canal C) inner ear (cochlea) D) temporal lobe in the middle cranial fossa If a tumor originating in the middle ear cavity erodes through the bone forming the superior wall (roof), it could invade the … A) cerebellum in the posterior cranial fossa B) internal carotid in carotid canal C) inner ear (cochlea) D) temporal lobe in the middle cranial fossa What cranial nerve innervates each of the following muscles? Stylohyoid? Stylopharyngeus? Styloglossus? What cranial nerve innervates each of the following muscles? Stylohyoid - Facial Stylopharyngeus - Glossopharyngeal Styloglossus - Hypoglossal Temporal Bone – Superior & Posterior Views Locate the following the Temporal Bone Model Genu of Facial Nerve Cochlea Location of Geniculate Ganglion (sensory ganglion) of the Facial Nerve Facial Nerve Anterior Semicircular (Enters Internal Canal Acoustic Meatus) Lateral Semicircular Vestibulocochlear Canal Nerve (Enters Internal Acoustic Meatus) Posterior Semicircular Canal Jugular Foramen (Internal Jugular Vein exits) Groove for Sigmoid Sinus  Middle Ear Cavity Roof - Tensor TympaniTympanic Stapedius MCF Genu – Facial Chorda Tympani Nerve Membrane Auditor y Tube Internal Carotid Mastoid Air Floor – Facial Cells Internal Nerve Lateral Wall of Middle Jugular Medial WallVein of Middle Ear Cavity Ear Cavity VII. FACIAL NERVE Motor and Sensory motor to muscles of facial expression, and to the stapedius, stylohyoid, and posterior digastric muscles parasympathetic fibers to submandibular and sublingual glands, lacrimal gland, and the glands of nasal cavity, paranasal sinuses and palate general sensation from skin of central part of auricle, mastoid region and posterior wall of external auditory meatus taste, from the anterior 2/3 of tongue What are the functions of the Facial Nerve (C.N. VII)? Skeletomoto Secretomoto Taste Cutaneous r r Sensation Pterygoi Greater d Canal Facial Petrosal Lacrima Canal Nerve l Gland Internal Pterygopalatin (+ Geniculate e Ganglion Nasal Auditory Ganglion Cavity Meatus & Stapediu s (Taste, Anterior 2/3 ofPalate) Tongue) Skin Over Chorda Mastoid Middle Ear Tongue Tympani Process Cavity Stylomastoid Foramen Submandibular Ganglion Sublingual Muscles of Facial Expression Submandibular Gland (+ Stylohyoid & Posterior Belly of Gland VII - Facial VII - Facial Path of Parasympathetic Nerve Fibers to Lacrimal Gland Lacrimal Nerve (Branch of V1) Ophthalmic Division of Trigeminal (V1) Maxillary Division of Trigeminal (V2) Infraorbital Nerve 6 Pterygopalatine (Branch of V2) Ganglion Zygomatic Nerve (Branch of V2) Which of the following functions are associated with the glossopharyngeal nerve? (Select all that apply) A) Sensory Innervation of the Middle Ear Cavity B) Motor Innervation of the Pharyngeal Constrictor Muscles C) Sensory Innervation of the Pharynx D) Parasympathetic (secretomotor) Innervation of the Parotid Gland E) Sensory Innervation of the Larynx F) Motor Innervation of the Cricothyroid Muscle G) Parasympathetic (secretomotor) Innervation of the Sublingual Gland H) Motor Innervation of the Styloglossus Which of the following functions are associated with the glossopharyngeal nerve? (Select all that apply) A) Sensory Innervation of the Middle Ear Cavity B) Motor Innervation of the Pharyngeal Constrictor Muscles C) Sensory Innervation of the Pharynx D) Parasympathetic (secretomotor) Innervation of the Parotid Gland E) Sensory Innervation of the Larynx F) Motor Innervation of the Cricothyroid Muscle G) Parasympathetic (secretomotor) Innervation of the Sublingual Gland H) Motor Innervation of the Styloglossus IX. GLOSSOPHARYNGEAL NERVE Sensory and Motor general sensation from skin of central part of the auricle, mastoid region and posterior wall of external auditory canal visceral sensation from middle ear, pharynx, posterior 1/3 of the tongue, carotid sinus and body taste from posterior 1/3 of the tongue parasympathetic fibers to the parotid gland motor to the stylopharyngeus muscle IX - Glossopharyngeal IX - Glossopharyngeal  Palate and Oral Cavity Medial Pterygoid Plate Torus Tubarius Opening of Auditory Tube Levator Veli Palatini (CN X) Tensor Veli Salpingopharyngeus (CN X) Palatini (CN V3) Soft Palate Palatoglossus (CN X) Hamulus Palatopharyngeus (CN X) Palatine Tonsilar Fossa Glossopharyngeal Nerve (CN IX) X. VAGUS NERVE Motor and Sensory general sensation from skin of central part of auricle, mastoid region and posterior wall of external auditory meatus visceral sensation from many organs (heart, esophagus, much of the G.I. tract, trachea, bronchi, lungs) parasympathetic fibers to heart, pulmonary system, esophagus, and the muscle and glands of the G.I. tract down to left portion of transverse colon (with bulbar XI) ‑to all skeletal muscles of the larynx, pharynx, palate and upper esophagus except the tensor veli palatini and the stylopharyngeus muscles X - Vagus  Larynx Arytenoids (transverse & oblique) Thyroarytenoid Posterior Cricoarytenoid Lateral Cricoarytenoid Cricothyroid Muscle X - Vagus X - Vagus Posterior View Lateral View Superior Laryngeal Nerve Superior Thyroid Artery Inferior Thyroid Artery Inferior Laryngeal (Recurrent) Nerve X - Vagus Where would you perform a laryngostomy? Inferior thyroid artery X - Vagus Where would you perform a laryngostomy? * Inferior thyroid artery X - Vagus Where would you perform a laryngostomy? A tracheostomy? * Inferior thyroid artery X - Vagus Where would you perform a laryngostomy? A tracheostomy? * Inferior thyroid artery * Summary of Arteries at Base of Anterior Neck Internal Carotid External Carotid Vertebral Common Carotid C6 Transverse Cervical Inferior Thyroid Suprascapular Thyrocervical Trunk Costocervical Trunk Subclavian Internal Thoracic  Anterior Neck – Arteries and Nerves Thyroid Gland Vagus Nerve Inferior Thyroid Sympathetic Trunk Artery Phrenic Nerve Vertebral Artery Transverse Cervical Artery Recurrent Laryngeal Nerve (branch of vagus Suprascapular nerve, loops under subclavian Artery artery & ascends to larynx) Costocervical Trunk Common Carotid Artery Thyrocervical Trunk Brachiocephalic Subclavian Artery Artery Anterior Neck – Branches of External Carotid Artery Ste rno Superficial Temporal Artery cle doi ma sto id St Mandible ylo External Carotid Artery hy oi Posterior Belly of Digastric (cut) d Internal Carotid Artery Facial Artery Occipital Artery Hyoid Bone Lingual Artery Ascending Pharyngeal Artery Superior Laryngeal Artery Carotid Bifurcation Superior Thyroid (C3/C4 vertebral level) Hypoglossal Nerve Artery XI. ACCESSORY NERVE Motor Only (Spinal portion) - motor to the sternocleidomastoid and trapezius muscles (Bulbar portion) ‑ see Vagus nerve XI - Accessory XII. HYPOGLOSSAL NERVE Motor Only motor to extrinsic and intrinsic muscles of the tongue (except the palatoglossus) Which of the following structures can be found between the mylohyoid and hyoglossus muscles? (Select all that apply) A) Lingual Nerve B) Inferior Alveolar Nerve C) Hypoglossal Nerve D) Duct of the Submandibular Gland E) Lingual Artery F) Facial Artery G) Sublingual Gland H) Palatine Tonsils Which of the following structures can be found between the mylohyoid and hyoglossus muscles? (Select all that apply) A) Lingual Nerve B) Inferior Alveolar Nerve C) Hypoglossal Nerve D) Duct of the Submandibular Gland E) Lingual Artery F) Facial Artery G) Sublingual Gland H) Palatine Tonsils XII - Hypoglossal XII - Hypoglossal XII - Hypoglossal  Nerve Lesion Test Summary RULE: With a unilateral lesion, deviation in the oral cavity or oropharynx points toward the normal side, whereas deviation outside of the oral cavity points toward the affected side. Test Major Muscle Motor Normal Response Paralysis on one Involved Innervation side Stimulation of Pharyngeal CN X Posterior pharyngeal Curtain-like deviation oropharynx (gag constrictors wall moves forward toward normal side reflex) First, what is sensory limb?? Asking Patient to say Levator veli CN X/CN V3 Uvula will remain Uvula will deviate “ahhh” palatini/Tensor veli centrally located toward the normal palatini side Tongue Retraction Styloglossus CN XII If one side is working Tongue will deviate independently, tongue toward normal side will deviate toward upon retraction ipsilateral side Tongue Protrusion Genioglossus CN XII If one side is working Tongue will deviate independently, tongue toward affected side will deviate toward upon protrusion contralateral side Open Jaw Lateral Pterygoid CN V3 If one side is working Chin will deviate independently, chin towards affected side will deviate toward contralateral side Last 2 tests involve muscles that have a medial origin & lateral insertion. Therefore, when one side contracts independently, deviation towards the opposite side occurs. H&N Parasympathetics… THE GANGLIA GAME CN carrying Ganglion Route of postganglionic Target preganglionic axons Structure(s) axons Oculomotor (3) ciliary short ciliary nerves ciliary muscles; sphincter pupillae Facial (7): greater pterygopalatin V2 (zygomatic n.) < V1 (lacrimal n.) lacrimal gland* petrosal n. e Facial (7): chorda submandibula not discussed (travel alongside submandibular & tympani n. r arteries to target) sublingual glands Glossopharyngeal otic V3 (auriculotemporal n.) parotid gland (9): tympanic n. then lesser petrosal n. The greater petrosal n. also carries preganglionic fibers to the glands of the nasal cavity, palate and some paranasal sinuses. Their postganglionic fibers follow V2 nerves exiting the pterygopalatine fossa. The End