Revision (Practical and OSPE) PDF

**[Revision (Practical and OSPE)]** - **[Face:]** - **[Muscles:]** 1. **Masseter muscle** *(on the outer surface of the ramus)* **Nerve supply:** anterior division of mandibular nerve. **Action:** Elevation and protrusion of mandible 2. **Temporalis muscle** *(on the temporal reg...

**[Revision (Practical and OSPE)]** - **[Face:]** - **[Muscles:]** 1. **Masseter muscle** *(on the outer surface of the ramus)* **Nerve supply:** anterior division of mandibular nerve. **Action:** Elevation and protrusion of mandible 2. **Temporalis muscle** *(on the temporal region)* **Nerve supply:** anterior division of mandibular nerve. **Action:** Elevation and retrusion of the protruded mandible 3. **Medial pterygoid muscle** *(deep to the ramus, attached to the angle)* **Nerve supply:** main trunk of mandibular nerve. **Action:** Elevation, protrusion and side to side movement of mandible. 4. **Lateral pterygoid muscle** *(deep to the ramus, with upper and lower heads)* **Nerve supply:** anterior division of mandibular nerve. **Action:** Depression, protrusion and side to side movement of mandible. 5. **Buccinator muscle** *(muscle of cheek)* **Nerve supply:** buccal branch of facial nerve. **Action: -**Prevent accumulation of food in the vestibule (by compressing cheeks against gums). - Prevent drippling of saliva (by forming a sphincter at the angle the mouth). - Movement of lips, whistling and blowing. 6. **Orbicularis occuli muscle** *(around the orbit)* **Nerve supply:** temporal and zygomatic branch of facial nerve. 7. **Occipitofrontalis muscle***)* **Nerve supply:** Frontal belly\-\-\-- temporal branch of facial nerve. Occipital belly\-\-\-- posterior auricular branch of facial nerve. - **[Glands:]** 8. **Parotid gland** *(infront and below the auricle)* **Nerve supply: Sensory:** Auriculotemporal nerve **Sympathetic:** Plexus around external carotid artery **Parasympathetic:** Glossopharyngeal nerve. **Structures embedded:** Facial nerve, Retromandibular vein, External carotid artery. 9. **Parotid duct** **Site of its opening:** Vestibule opposite upper 2^nd^ molar. **Structures pierced by it:** Buccal pad of fat- Buccopharyngeal fascia- Buccinator muscle- Buccal mucosa. - **[Nerves:]** 10. **Inferior alveolar nerve** *(deep to the ramus, enters mandibular canal)* **Branches: Sensory:** Mental nerve -Incisive nerve **Motor:** Nerve to mylohyoid (*supplies mylohyoid and anterior belly of digastric muscles*) 11. **Lingual nerve** *(deep to the ramus, behind the mandible)* **Structures supplied by:** anterior 2/3 of the tongue- sublingual and submandibular glands- lingual mucosa and floor of mouth. **Nerve joining it in the infratemporal fossa:** Chorda tympani *(special sensory from facial nerve)* **Ganglion attached to it:** Submandibular ganglion (*receives parasympathetic fibers from chorda tympani- supplies sublingual and submandibular glands*) 12. **Auriculotemporal nerve** **Structures supplied by:** Posterior half of temporal region- Upper half of outer surface of auricle- anterior half of external auditory meatus and ear drum- sensory to parotid gland (capsule)- TMJ. - **[Vessels:]** 13. **Maxillary artery** *(one of the 2 terminations of ECA- deep to the neck of condyle)* **Branches: 1^st^ part:** Middle meningeal- Inferior alveolar- Anterior tympanic- Deep auricular- Accessory meningeal 14. **Superficial temporal artery** *(one of the 2 terminations of ECA- deep to the neck of condyle)* **Branches:** Transverse facial- zygomatico orbital- Middle temporal. 15. **Facial artery** *(branch from ECA- has a wavy course in the face)* **Branches in the face:** Superior and inferior labial -- nasal -- angular **Branches in the neck:** ascending palatine- tonsillar- glandular- submental 16. **Anterior facial vein** *(behind facial artery)* **Tributaries:** Supraorbital- Supratrochlear- Superior and inferior labial -- nasal -- Deep facial vein. - **[Neck:]** - **[Muscles:]** 17. **Sternomastoid muscle** **Nerve supply:** spinal part of accessory nerve. **Action: 1 muscle:** tilt the head to the same side and turns the face to the opposite side. 2. **muscles:** flexion and extension of the head (nodding) 18. **Trapezius muscle** *(on the back of the neck)* **Nerve supply:** spinal part of accessory nerve. 19. **Digastric muscle** **Nerve supply:** **anterior belly** (nerve to mylohyoid from inferior alveolar n.) **Posterior belly** (facial nerve) **Action: anterior belly** (depress the mandible.) **Posterior belly** (tilt the head backwards) **2 bellies** (retract the hyoid bone) 20. **Mylohyoid muscle** **Nerve supply:** nerve to mylohyoid from inferior alveolar n. **Action:** forms the floor of the mouth- depress the mandible. 21. **Hyoglossus muscle** **Nerve supply:** Hypoglossal nerve **Action:** depress posterior half of the tongue (during sucking and swallowing) **Superficial relations:** Styloglossus muscle Lingual nerve and submandibular ganglion Deep dart of submandibular gland and duct Hypoglossal nerve **Deep relations:** Glossopharyngeal nerve Lingual artery 22. **Infrahyoid muscles** **Nerve supply:** ansa cervicalis (except thyrohyoid muscle from C1 through hypoglossal nerve) NB: ***Ansa cervicalis is formed of 2 roots (descendens hypoglossi from C1 and descendens cervicalis from C2,3)*** - **[Glands:]** 23. **Submandibular gland** *(below the mandible)* **Nerve supply: Sensory:** Lingual nerve **Sympathetic:** Plexus around facial artery **Parasympathetic:** Chorda tympani (from facial nerve). **Site of opening of its duct:** Floor of the mouth, close to lingual frenulum. 24. **Thyroid gland:** **Arterial supply:** Superior thyroid artery (from ECA) Inferior thyroid artery (from thyrocervical trunk of the 1^st^ part of subclavian artery) Thyroidae ima (from arch of aorta or brachiocephalic artery) **Venous drainage:** Superior thyroid vein (into IJV) Middle thyroid vein (into IJV) Inferior thyroid vein (into brachiocephalic vein) - **[Vessels:]** 25. **Common carotid artery (CCA)** **Branches:** External and internal carotid arteries **Level of bifurcation:** at the upper border of thyroid cartilage 26. **Internal carotid artery (ICA)** **Branches:** Anterior and middle cerebral Meningeal- Hypophyseal 27. **External carotid artery (ECA)** **Branches: Anteriorly:** Superior thyroid- Lingual- Facial **Posteriorly:** Occipital- Posterior auricular **Medially:** Ascending pharyngeal **Terminations:** Maxillary -- Superficial temporal 28. **Lingual artery *(forms a loop, 2^nd^ branch from the anterior aspect of the ECA)*** **Branches:** 1^st^ part (suprahyoid artery) 2^nd^ part (dorsal lingual arteries) 3^rd^ part (sublingual artery) Termination (deep lingual artery) 29. **Internal jugular vein (IJV) *(deep to sternomastoid muscle, lateral to CCA)*** **Tributaries:** Inferior petrosal sinus - Pharyngeal veins- Common facial v.- Lingual v. - Superior thyroid v.- Middle thyroid v.- Jugular lymph trunk (on the right side) 30. **External jugular vein (EJV) *(superficial to sternomastoid muscle, lateral to CCA)*** **Tributaries:** Posterior auricular v.- Posterior division of retromandibular v. **Drainage:** into subclavian vein - **[Nerves:]** 31. **Glossopharyngeal nerve** **Branches:** **Parasympathetic:** Tympanic **Motor:** Nerve to stylopharyngeus **Sensory:** Meningeal- carotid- pharyngeal- termination (supplies posterior 1/3 of the tongue, soft palate, tonsils) 32. **Vagus nerve** **Branches in the neck:** meningeal- auricular- pharyngeal- superior & inferior cardiac- Superior laryngeal- recurrent laryngeal 33. **Spinal part of accessory nerve** **Muscles supplied by it:** Sternomastoid- Trapezius 34. **Hypoglossal nerve** **Muscles supplied by it:** Hyoglossus- Genioglossus- Styloglossus- intrinsic muscles of the tongue. **Branches:** Fibers from C1 (meningeal- descendens hypoglossi- nerve to geniohyoid- nerve to thyrohyoid. 35. **Sympathetic chain (superior cervical sympathetic ganglion)** **Branches:** Communicating (to 9^th^, 10^th^, 12^th^ cranial nerves and first four cervical spinal nerves) Vascular (to ICA and ECA) Visceral (pharyngeal- cardiac) - **[Cranial cavity:]** 36. **Falx cerebri** **Dural venous sinuses:** superior sagittal- inferior sagittal- straight. 37. **Tentorium cerebelli** **Dural venous sinuses:** transverse- superior petrosal- straight. 38. **Falx cerebelli** **Dural venous sinuses:** occipital sinus 39. **Cavernous sinus** **Tributaries:** Ophthalmic veins- Sphenoparietal sinus- Superficial middle cerebral veins- Inferior cerebral veins **Drainage:** Superior petrosal sinus (into the transverse sinus) Inferior petrosal sinus (into IJV) **Structures embedded in the lateral wall:** Oculomotor n.- Trochlear n.- Ophthalmic n.- Maxillary n. **Structures traversing it (inside):** Internal carotid artery - Abducent nerve **Connections:** 1\. Communicated to the facial vein through the ophthalmic veins. 2\. Communicated to that of the opposite side by the intercavernous sinuses and the basilar venous plexus. 3\. Communicated to the pterygoid venous plexus by an emissary vein which passes through the foramen ovale. 4\. Communicated to the Pharyngeal venous plexus by an emissary vein which passes through the foramen lacerum. 5\. Communicated to the end of transverse sinus by the superior petrosal sinus. 6\. Communicated to the internal jugular vein by the inferior petrosal sinus. - **[Sagittal section:]** - **[Oral cavity:]** 40. **Tongue** **Muscles: extrinsic muscles (**Hyoglossus- Genioglossus- Styloglossus- Palatoglossus) **intrinsic muscles** (Superior and inferior longitudinal- transverse- vertical) **Motor nerve supply:** All muscles are supplied by Hypoglossal nerve except palatoglossus (supplied by cranial accessory through pharyngeal branch of vagus) **Sensory nerve supply:** Anterior 2/3: Lingual nerve (general sensation)- Chorda tympani (taste sensation) Posterior 1/3: Glossopharyngeal nerve (general &taste) **Blood supply:** Lingual artery and Lingual vein 41. **Soft palate** **Muscles:** Tensor palat i- Levator palati- Palatoglossus- Palatopharyngeus- Musculus uvelae **Motor nerve supply:** Cranial accessory through pharyngeal branch of vagus except tensor palati (from nerve to medial pterygoid from mandibular nerve) **Sensory nerve supply:** Glossopharyngeal nerve -- Lesser palatine nerve 42. **Hard palate** **Sensory nerve supply:** Greater palatine & Nasopalatine nerves *(from sphenopalatine ganglion)* - **[Pharynx:]** 43. **Opening of eustachian (pharyngeotympanic)tube** **Function:** equalizes the pressure on the ear drum. **Site:** Nasopharynx **Elevation surrounding it:** Tubal elevation **Fold behind:** Salpingopharyngeal fold *(containing salpingopharyngeus muscle)* 44. **Tonsillar fossa** **Site:** Oropharynx **Structure related to it:** Palatine tonsil **Anterior boundary(pillar):** palatoglossal fold *(containing palatoglossus muscle)* **Posterior boundary(pillar):** palatopharyngeal fold *(containing palatopharyngeus muscle)* - **[Nasal cavity:]** 45. **Inferior meatus** **Opening in this area:** Nasolacrimal duct 46. **Middle meatus** **Paranasal air sinuses opening in it:** Bulla ethmoidalis (Middle ethmoidal sinus) Hiatus semilunaris (Frontal- Maxillary- Anterior ethmoidal sinus) 47. **Superior meatus** **Paranasal air sinus opening in it:** Posterior ethmoidal airsinus 48. **Sphenoethmoidal recess** **Paranasal air sinus opening in it:** Sphenoid air sinus ***[Skull Foramena]*** 1. Incisive fossa \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-- Long nasopalatine nerve, Greater palatine nerve 2. Greater palatine foramen \-\-\-\-\-\-\-\-\-\-\-- Greater palatine nerve and vessels 3. Lesser palatine foramen \-\-\-\-\-\-\-\-\-\-\-\-- Lesser palatine nerve and vessels 4. Foramen ovale \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-- Mandibular nerve Lesser petrosal nerve Middle meningeal vein Emissary vein (connecting cavernous sinus with pterygoid venous plexus) Accessory meningeal artery 5. Foramen spinosum \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-- Middle meningeal artery Nervous spinosus (meningeal nerve) 6. Stylomastoid foramen \-\-\-\-\-\-\-\-\-\-\-\-\-\-- Facial nerve Stylomastoid artery 7. Carotid canal \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-- Internal carotid artery Sympathetic plexus 8. Jugular foramen \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-- Internal jugular vein, Inferior petrosal sinus Glossopharyngeal 9^th^ , vagus 10^th^, accessory 11^th^ cranial nerves 9. Anterior condylar foramen) \-\-\-\-\-\-\-- 12^th^ cranial nerve (Hypoglossal) 10. Foramen rotundum \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-- Maxillary nerve 11. Superior orbital fissure\-\-\-\-\-\-\-\-\-\-\-\-\-- Ophthalmic nerve Oculomotor 3^rd^, Trochlear 4^th^, Abducent 6^th^ cranial nerves Ophthalmic veins 12. Infraorbital foramen\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-- Infraorbital nerve & vessels 13. Internal auditory meatus\-\-\-\-\-\-\-\-\-\-\-\-\-\-- Facial nerve & Vestibulocochlear nerve. 14. Optic canal\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--Optic nerve & ophthalmic artery 15. Cribriform plate of ethmoid\-\-\-\-\-\-\-\-\-\--Olfactory nerve