Head, Neck, TMJ Anatomy & Conditions PDF (Dec 2024)

HEAD , NECK , TMJ ANATOMY & CONDITIONS SCALP ➔ Soft tissue that covers and protects the cranial vault 1. S- kin is the outermost layer of the scalp ; sebaceous gland and hair follicles 2. C- onnective tissue layer : Major arteries and veins located. 3. A-pone...

HEAD , NECK , TMJ ANATOMY & CONDITIONS SCALP ➔ Soft tissue that covers and protects the cranial vault 1. S- kin is the outermost layer of the scalp ; sebaceous gland and hair follicles 2. C- onnective tissue layer : Major arteries and veins located. 3. A-poneurosis : Sheath like structure that connects 2 muscles (Occipitalis and Frontalis) Aka Aponeurotica 4. L-oose Aveolar Tissue Area : numerous of blood vessel located ; emissary veins (valveless) Aka “Dangerous Layer” 5. P-erriosteum : innermost layer of the scalp ; it is the outermost layer of the skull ; it provides nutrition of the scalp SKULL BONES : 22 CRANIAL BONES : 8 “PTFOES” Parietal - 2 Temporal - 2 Frontal - 1 Occipital - 1 Ethmoid - 1 → 2nd most difficult to visualize in imaging Sphenoid - 1 → most difficult to visualize imaging CARMINA P. MANALO PTRP REVIEWER FOR BOARD EXAM DEC 2024 FACIAL BONES : 14 “ “NILaPaZVMaMa” Notes: “ Voman” = 1 1. Nasal -2 2. Inferior Nasal Conchae -2 3. Lacrimal -2 4. Palatid -2 5. Zygomaticus -2 6. Vomer - 1 7. Maxilla- 1 8. Mandible - 2 CARMINA P. MANALO PTRP REVIEWER FOR BOARD EXAM DEC 2024 Coronal Suture: connects the frontal and parietal bone Sagittal Suture: connects 2 parietal bones Lambdoid Suture: connects Parietal bone and Occipital bones Squamosal Suture : connects temporal bone to parietal bone FONTANELLES 1. Anterior Fontanelle Closes between 18-24 months BREGMA : it is the point where the coronal and sagittal suture intersect 2. Posterior Fontanelle Closes between 9- 12 months LAMBDA : the point where the sagittal and lambdoid suture intersect. “NaNaPPIG” 1. Nasion → depression at the root of the nose 2. Nasolabial folds → indentation at the lateral part of the mouth & nose 3. Philtrum → indentation between the mouth and the nose 4. Pterion → thinnest portion of the lateral skull The middle meningeal artery lies beneath this area. 5. Inion → small eminence at the post. Portion of the skull. CARMINA P. MANALO PTRP REVIEWER FOR BOARD EXAM DEC 2024  AKA external occipital protuberance ; Bump of knowledge Landmark for head circumference measurement 6. Glabella → skin between the eyebrows Glabellar tap reflex (+) Myerson’s Sign → persistent blinking MUSCLES ACTION 1. Occipitofrontalis - Elevates the eyebrows ; muscle for surprise 2. Corrugator - Pulls the eyebrows together ; muscle for frowning Supercilli 3. Procerus - Winkles the bridge of the nose ; muscle for distaste or disgust 4. Zygomaticus - Primary muscle for smiling Major 5. Zygomaticus - 2ndary muscle to zygomaticus major (smiling) ; Minor elevates / protrudes the upper lip. 6. Risorius - Grimace “ fake smile* 7. Orbicularis oris - Close the lips ; muscle for kissing 8. Buccinator - Blowing , sucking & whistling - Pouts the cheek 9. Levator Anguli - Elevates the angle of the mouth Oris - “sneering” 10. Mentalis - Doubting CARMINA P. MANALO PTRP REVIEWER FOR BOARD EXAM DEC 2024  11. Platysma - Depresses the angle of the mouth - “EGAD muscle” ★ MUSCLE FOR EYE OPENING 1. Levator Palpebrae Superioris → 80% of eye opening → Oculomotor n. (CN III) → “Ptosis” 2. Mueller’s Muscle → 20% of eye opening ; Sympathetic nerves MUSCLE FOR EYE CLOSING 1. Orbicularis Oculi → CN VII EXTRAOCULAR MUSCLES “IO MR. SO” MUSCLES Actions 1. Superior - Upward and outward Rectus 2. Inferior - Downward and outward Rectus CARMINA P. MANALO PTRP REVIEWER FOR BOARD EXAM DEC 2024  3. Lateral - Adducts with eyeball Rectus - CN 6 4. Medial - Abducts with eyeball Rectus 5. Superior - Downward and inward Oblique - SO4 - CN4 6. Inferior - Upward and inward Oblique Note: ★ If CN VI is weak (+) medial strabismus ★ If CN III is weak (+) lateral strabismus ★ SO4 LR6 ★ Vertical diplopia CN IV ★ Horizontal diplopia CN VI CN EXIT POINTS 1. Cribriform Plate - I 2. Optic Canal -II 3. Superior Orbital Fissure - III, IV, V and VI 4. Foramen Rotundum - V v2 5. Foramen Ovale - V v3 6. Internal Auditory Meatus - VII, VIII 7. Jugular Foramen - IX , X, XI 8. Hypoglossal canal - XII 9. Foramen Lacerum - ICA 10. Foramen Spinosum - MMA CARMINA P. MANALO PTRP REVIEWER FOR BOARD EXAM DEC 2024  CERVICAL VERTEBRAE Cervical - Small body - 1 triangular shaped foramen - Short and bifid SP C1 ➔ “Atlas” ➔ No body and No SP ➔ Jefferson Fx ➔ (+) Anterior arch ➔ Bony Ring C2 ➔ “Axis” ➔ dens/ odontoid process ➔ Small transverse process ➔ Hangman Fx (2) - hyperextension of the upper cervical spine ➔ Teardrop Fx (dens) - forced extension of the neck C7 ➔ “Vertebral Prominens” ➔ Long & non bifid spinous process ➔ Small foramen transversarium -> vertebral veins ➔ Clay shoveler fx. -> sheat forces, hyperflexed the spine or direct trauma Special Landmarks C3 ➔ hyoid C4-C5 ➔ Thyroid C6 ➔ Cricoid CARMINA P. MANALO PTRP REVIEWER FOR BOARD EXAM DEC 2024 Notes: Atlantooccipital joint - Yes joint Antlantoaxial joint - No joint Muscles: SCM- innervated by XI (Spinal Accessory) - Ipsilateral flexion (uni-action) - Contralateral rot (uni-action) - Cervical flexion (Bilat action) Scalene Ipsilateral flexion - uni- action Ipsilateral rotation- uni action Cervical flexion - bilat action Hyoid bone - no articulation - Stylohyoid ligament - Connects the hyoid - Bone to the base of the skull Suprahyoid muscles - muscles that are attached above the hyoid bone. SUPRAHYOID MUSCLES (“DMSG”) INFRAHYOID MUSCLES (“TOSS”) ➔ muscles that are attached above the ➔ Muscles attached below the hyoid hyoid bone. bone ➔ Digastric < ant.belly (CN V) & Post. ➔ Thyrohyoid - 1st cervical mm ➔ Omohyoid (Ansa cervicalis ) Belly (CNVI) ➔ Sternohyoid (Ansa cervicalis ) ➔ Mylohyoid (CN V) ➔ Stemothyroid (Ansa cervicalis ) ➔ Stylohyoid (CN VII) ➔ Geniohyoid (CN XII) CARMINA P. MANALO PTRP REVIEWER FOR BOARD EXAM DEC 2024 (“ALI SAP SAP SIP API SAI”) 1. ALI (Submental Triangle) Anterior Neck line L- anterior body of digastric Inferior- Hyoid bone 2. SAP (Submandibular Triangle) S Mandible Anterior belly of Digastric Posterior belly of digastric 3. SAP (Muscular Triangle) S- superior fibers omohyoid A-Ant. Neck Line Posterior Anterior Border of SCM 4. SIP (Carotid Triangle) S - Posterior Belly of digastric I - Superior Fibers of omohyoid P - ant. Border of SCM CARMINA P. MANALO PTRP REVIEWER FOR BOARD EXAM DEC 2024  5. API (Occipital Triangle) A- Posterior border of SCM P- Trapezius I- Inferior Fibers omohyoid 6. SAI (Supraclavicular Triangle) S- inferior fibers omohyoid A– post.border of SCM I- Clavicle NOTES: ➔ MAIN Anterior Triangle 1. Mandible 2. Anterior Neck Line 3. SCM ➔ MAIN Posterior Triangle 1. SCM 2. CLAVICLE 3. TRAPEZIUS ➔ Articulation between the mandibular condyle and mandibular fossa. ➔ Modified hinge joint ➔ Ginglymoarthroidal joint “STIR” SUPERIOR JT - translation INFERIOR JT -rotation OPP ❖ Mouth slightly open, lips together, teeth not in contact CPP ❖ Tightly clenched teeth Capsular Pattern ❖ Limitation in mouth opening CARMINA P. MANALO PTRP REVIEWER FOR BOARD EXAM DEC 2024  1. Mandibular depression ★ ➔ At the first 26 mm mouth opening, Bilateral ant. Rotation occurs, after the 26 mm of mouth opening, (B) ant. Translation occurs. ➔ N: 35-55 mm ➔ Fxnal mouth opening : 25 mm ➔ Minimum required mastication : 18 mm 2. Mandibular Elevation/ Mouth Closure ➔ (B) post. Translation followed by (B) post. rotation 3. Mandibular protrusion ➔ (B) ant. Translation ➔ N: 3-6 mm (old). >7 mm (new) 4. Mandibular Retrusion ➔ Bilateral post. Translation ➔ N: 3-4 mm *LATERAL DEVIATION/ MANDIBULAR EXCURSION Ipsilateral rotation (ipsirot) Contralateral translation (contran) N: 10-15 mm - TIME MUSCLE ACTION Temporalis - Mouth closing Muscle Fibers Posterior (responsible for retrusion) CARMINA P. MANALO PTRP REVIEWER FOR BOARD EXAM DEC 2024  Anterior (mouth closing Superior (closing) Internal pterygoid - Mouth closing - (protrusion) Masseter - Mouth closing - (protrusion) External pterygoid - Mouth opening (mandibular excursion) - (protrusion) - Ipsilateral external pterygoid - Contralateral internal , pterygoid Pt has LOM towards ® mandibular excursion. What muscle should be stretched? a. R temporalis b. R digastric c. R medial pterygoid d. R geniohyoid Answer : R medial pterygoid NOTE: - Ipsilateral. Temporalis - C/L pterygoids Innervated by CN XII (GHS) except Palatoglossus (CN X) Palatoglossus - elevation Genioglossus - tongue protrusion / protraction Hyoglossus - tongue depression Styloglossus - tongue retraction or retrusion CARMINA P. MANALO PTRP REVIEWER FOR BOARD EXAM DEC 2024  ❖ TMJ Disc Displacement (+) Click upon mouth opening ❖ TMJ Displacement (+) click upon mouth closing ❖ TMJ Capsulitis (+) pain upon mouth opening (+) Limitation in mouth opening (+) limitation in contralateral deviation (-) swelling ❖ TMJ Synovitis (+) pain on mouth opening (+) limitation in M.O (+) limitation in C/L deviation (+) swelling ❖ TMJ Hypomobility (+) limitation of M.O and C/L deviation ❖ TMJ Hypermobility (+) excessive M.O and C/L deviation Note: ★ Most common direction of dislocation of the TMJ - ANTERIOR CARMINA P. MANALO PTRP REVIEWER FOR BOARD EXAM DEC 2024