1
Q
What runs through the optic nerve?
A
- Central Artery of Retina 2. Central Vein of Retina
2
Q
Fibers of oculomotor nerve
A
- motor 2. proprioceptive 3. PSNS (pregang to ciliary ganglion)
3
Q
Sxs of oculomotor paralysis
A
- Ptosis of upper eyelid (levator palpebrae superioris) 2. Abduction of eye (unopposed LR and SO) 3. Dilation of Pupil (Sphincter pupillae muscle lost)
4
Q
What is unique about the trochlear nerve?
A
It is the only cranial or spinal motor nerve arising from the dorsal aspect of the CNS
5
Q
“Weakling of the Cranial Contents”
A
Abducens -Susceptible to injury because stretched across the petrous part of the temporal bone
6
Q
Parent of the ophthalmic artery
A
Cerebral part of the internal carotid artery
7
Q
Branches of ophthalmic artery
A
- Central artery of retina 2. Several arteries to the eye 3. Lacrimal artery 4. Conjunctival Arteries 5. Ethmoidal Arteries (anterior and posterior) 6. Branch that anastomoses with angular branch of facial artery
8
Q
Ophthalmic veins
A
- Superior ophthalmic vein 2. Inferior ophthalmic vein
9
Q
What forms the superior ophthalmic vein?
A
- Supraorbital Vein 2. Angular Vein
10
Q
Where do the opthalmic veins end?
A
the cavernous sinus
11
Q
Where does the inferior ophthalmic vein begin?
A
Plexus on floor of orbit
12
Q
Where does the central vein of the retina run?
A
To the cavernous sinus directly
13
Q
What forms the straight sinus?
A
- Inferior sagittal sinus 2. Great cerebral vein (of Galen)
14
Q
Where are GSEs and GSAs found?
A
The entire body
15
Q
What do GVEs and GVAs innervate?
A
Smooth muscle, cardiac muscle, and glands
16
Q
SVE
A
Innervates all pharyngeal-derived muscles
17
Q
SVA
A
Special sense of taste and smell
18
Q
SSA
A
Special sense of hearing and sight
19
Q
CNs with PSNS fibers
A
- # 3 Oculomotor 2. #7 Facial 3. #9 Glossopharyngeal 4. #10 Vagus (V3 also has PSNS fibers but they do not come from the brain)
20
Q
Inferior Alveolar Nerve Fiber Types (before and after giving off mylohyoid nerve)
A
Before: GSA, SVE -After: GSA (Mylohyoid takes SVE)
21
Q
Lingual Nerve fiber types (before and after receiving chorda tympani)
A
Before: GSA -After: GVE, GSA, SVA
22
Q
Pain pathway for spinal nerves
A
Dorsal root ganglion –> Chief nucleus of dorsal horn –> crossover –> ascend in Lateral spinothalamic tract –> ventral posterior thalamic nucleus –> somesthetic area/post-central gyrus
23
Q
Cell body locations (spinal nerve pain)
A
- Dorsal root ganglion 2. Chief nucleus of dorsal horn 3. ventral posterior thalamic nucleus
24
Q
Pain pathway for trigeminal nerve
A
Trigeminal ganglion –> pons –> descends in spinal tract of trigeminal nerve –> nucleus of spinal tract of trigeminal nerve in medulla –> crossover –> ascends in trigeminothalamic tract –> ventral posterior thalamic nucleus –> Somasthetic area/post-central gyrus
25
Cell body locations (trigeminal nerve pain)
1. Trigeminal ganglion 2. Nucleus of spinal tract of trigeminal nerve 3. Ventral posterior thalamic nucleus
26
Parts of Nucleus of Spinal tract of trigeminal nerve and respective functions
1. Nucleus rostralis (simple touch and pressure) 2. Nucleus interpolaris (simple touch and pressure) 3. Nucleus caudalis (pain)
27
Where does the nucleus of the spinal tract of the trigeminal nerve extend?
from the medulla to the upper cervical spinal cord
28
What carries all the pain fibers from all the spinal nerves?
Lateral spinothalamic tract
29
Simple touch and pressure pathway for spinal nerve
Dorsal root ganglion --> ascends 4-5 levels --> cheif nucleus of dorsal horn --> crossover --> ascends in ventral spinothalamic tract --> ventral posterior thalamic nucleus --> somesthetic area/post-central gyrus
30
Cell body locations (spinal nerve simple touch and pressure)
1. Dorsal root ganglion 2. chief nucleus of dorsal horn (4-5 levels higher than entry level) 3. ventral posterior thalamic nucleus
31
Simple touch and pressure pathway for trigeminal nerve (2 options)
From Trigeminal Ganglion: 1. descend to medulla in spinal tract of trigeminal nerve --> nucleus of spinal tract of trigeminal nerve --> crossover --> ascend in trigeminothalamic tract --> ventral posterior thalamic nucleus --> post-central gyrus 2. chief sensory nucleus of trigeminal nerve in pons --> crossover --> ascend in tigeminothalmic tract --> ventral posterior thalamic nucleus --> post-central gyrus
32
Location of cell bodies (simple touch and pressure trigeminal nerve)
1. Trigeminal ganglion 2. Chief sensory nucleus of trigeminal nerve or nucleus of spinal tract of trigeminal nerve 3. ventral posterior thalamic nucleus
33
Divisions of spinal nerves in proproception pathway
1. C1-T7or8 2. T8-CX1
34
Proprioceptive pathway for upper division of spinal nerves
Dorsal root ganglion --> Fasciculus cuneatus --> Nucleus cuneatus in medulla --> crossover --> Medial lemniscus --> ventral posterior thalamic nucleus --> post-central gyrus
35
Proprioceptive pathway for lower division of spinal nerves
Dorsal root ganglion --> Fasciculus gracilis --> nucleus gracilis in medulla --> cross over --> Medial lemniscus --> ventral posterior thalamic nucleus --> post-central gyrus
36
Location of Cell bodies (proprioceptive of spinal nerves)
1. Dorsal root ganglion 2. Nucleus cuneatus (upper) or Nucleus gracilis (lower) 3. Ventral posterior thalamic nucleus
37
Proprioceptive pathway for trigeminal nerve (normal pathway)
Trigeminal ganglion --> Chief sensory nucleus of trigeminal nerve in pons --> cross over --> trigeminothalamic tract --> ventral posterior thalamic nucleus --> post-central gyrus
38
Proprioceptive pathway for trigeminal nerve (TMJ)
Goes through trigeminal ganglion without synapsing --> Mesencephalic nucleus of trigeminal nerve in midbrain --> crosses over --> trigeminothalamic tract --> ventral posterior thalamic nucleus --> post-central gyrus
39
Location of cell bodies (proprioceptive for Trigeminal nerve)
1. Trigeminal nerve or mesencephalic nucleus of trigeminal nerve 2. Chief sensory nucleus of trigeminal nerve or mesencephalic nucleus of trigeminal nerve 3. Ventral posterior thalamic nucleus
40
Locations of main nuclei of trigeminal nerve pathways (superior to inferior)
1. Mesencephalic nucleus of trigeminal nerve (midbrain) 2. Chief sensory nucleus of trigeminal nerve (pons) 3. Nucleus of spinal tract of trigeminal nerve (medulla)
41
Divisions of the Pyramidal system
1. Corticospinal (all spinal nerves) 2. Corticobulbar (all cranial nerves)
42
Corticobulbar pathway
Pre-central gyrus --> internal capsule --> crossover --> synapse with respective nuclei --> send off lower motor neuron
43
Corticospinal pathway
Pre-central gyrus --> internal capsule --> Pyramid of medulla --> Fibers to ventral (15%) corticospinal tract then crossover at respective level or crossover and then to lateral spinothalamic tract (85%)
44
Nuclei for corticobulbar fibers (location and nerves)
1. Facial motor nucleus (pons): Facial Nerve 2. motor nucleus of trigeminal nerve (pons): Trigeminal nerve 3. Hypoglossal nucleus (medulla): Hypoglossal nerve 4. Nucleus ambiguus (medulla): CNs 9, 10, and 11
45
Cell body locations (corticobulbar)
1. Pre-central gyrus 2. Respective motor nuclei
46
Cell body locations (corticospinal)
1. Pre-central gyrus 2. respective ventral horns
47
Olfactory Nerve CNFT
Sense of smell
48
Optic nerve CNFT
sense of sight
49
Oculomotor CNFT
1. motor innervation to SR, IR, MR, IO and levator palpebrae superioris 2. PSNS to ciliary muscles (pregang. to ciliary ganglion)
50
Trochlear CNFT
innervates Superior oblique
51
Ophthalmic CNFT
1. Corneal reflex (afferent: nasociliary; efferent: facial) 2. Sensation in forehead, upper eyelid, superior part of external nose, and tip of nose (frontal and nasociliary nerves)
52
Maxillary Nerve CNFT
1. Cutaneous distribution (upper lip, lateral nose, lower eyelid, zygoma) 2. Teeth and gingiva (sup. alveolar, nasopalatine, and greater palatine nerves) 3. Some nasal cavity
53
Mandibular nerve CNFT
1. Cutaneous distribution over body of mandible and ramus (lower lip, cheek, area over parotid, lateral aspect of scalp) 2. Oral cavity: general sensation to teeth, gums, floor of mouth, ant. 2/3 tongue, and cheek 3. Motor root
54
Motor root tests for Mandibular nerve
1. Clench jaw (masseter and temporalis tone) 2. Open mouth (inferior head of lateral pterygoid paralysis moves to affected side) 3. Lateral excursion against resistance (inferior head of lateral pterygoid) 4. Protract and retract mandible 5. Bite tongue depressor and compare strength 6. Sensitivity to loud noises (tensor tympani) 7. Soft palate dysfunction (tensor veli palatini) 8. Flaccid floor of mouth (ant. belly digastric and mylohyoid)
55
Abducens CNFT
Motor innervation to LR
56
Vestibulocochlear CNFT
Equilibrium and and hearing
57
Glossopharyngeal CNFT
1. Gag reflex by touching anterior pillars or base of tongue 2. Parotid gland secretion with Vit. C/Spicy food
58
Vagus CNFT
1. Say "ah," uvula should rise, otherwise deviation towards opposite side of dysfunction 2. Swallowing and no hoarseness
59
Spinal Accessory CNFT
Traps and SCM
60
Hypoglossal CNFT
1. Lateral deviation to nonfunctional side during protrusion of tongue (genioglossus) 2. Lateral movements of tongue (move tongue depressor or cheek) 3. Paralysis leads to wrinkling and atrophy of tongue on affected side
61
What does the internal carotid artery supply?
1. Frontal lobe 2. Parietal lobe 3. Part of temporal lobe (anterior and superior part of cerebrum)
62
Parts of Internal carotid artery
1. Cervical: in neck 2. Petrous: through carotid canal 3. Cavernous: enters cavernous sinus along carotid sulcus 4. Cerebral: gives off middle and anterior cerebral arteries
63
Branches of Internal Carotid artery
1. branches to trigeminal ganglion, dura, and hypophysis 2. Ophthalmic artery 3. Posterior communicating artery (to posterior cerebral artery) 4. Anterior cerebral artery 5. Middle cerebral artery
64
Branch of anterior cerebral artery
Anterior communicating artery
65
Where does the anterior cerebral artery travel?
In the longitudinal fissure
66
Where does the middle cerebral artery travel?
in the lateral fissure
67
What does the middle cerebral artery supply?
A lot of the brain including the motor and sensory cortices
68
Deficits from occlusion of Anterior cerebral artery
Area of knee and below
69
Deficits from occlusion of middle cerebral artery
Contralateral paralysis (hemiplagia) excpet for knee and below
70
Branches of vertebral arteries
1. Spinal cord branches 2. Posterior inferior cerebellar arteries 3. Forms basilar artery
71
Branches of basilar artery
1. Anterior inferior cerebellar artery 2. Superior cerebellar arteries 3. splits into posterior cerebral arteries
72
What do the vertebral and basilar arteries supply?
1. Upper spinal cord 2. Brainstem 3. Cerebellum 4. Part of temporal lobe 5. Occipital lobe (Posterior and inferior part of cerebrum)
73
What vessels form the circle of Willis?
1. Posterior cerebral arteries 2. Posterior communicating artery 3. Internal carotid artery 4. Anterior cerebral artery 5. Anterior communicating artery
74
Layers of the Dura Mater
1. Endosteal layer: on insde of cranial bones 2. Meningeal Layer
75
Another name for meningeal layer of dura
Projecting layer of dura
76
Processes of Meningeal layer of dura
1. Falx Cerebri 2. Tentorium Cerebelli 3. Falx cerebelli 4. Diaphragma Sellae
77
Where is the endosteal layer of dura continuous with pericranium (external periosteum)?
Sutures and foramina
78
Where is the falx cerebri located?
in the longitudinal fissure
79
What is the anterior and posterior attachment point for the falx cerebri?
Anterior: Crista galli -Posterior: Fuses with tentorium cerebelli
80
What encloses the superior sagittal sinus
Falx Cerebri
81
What is contained in the inferior border of the flax cerebri
inferior sagittal sinus
82
Where is the tentorium cerebelli located?
between the occipital lobe and cerebellum
83
Interior border of tentorium cerebelli
Tentorial notch, which allows communicating between brain and spinal cord
84
External border of tentorium cerebelli
encloses transverse sinuses, superior petrosal sinus, and cavernous sinus
85
What forms the Cavum Trigeminali?
Tentorium cerebelli
86
Contents of Cavum trigeminali
Trigeminal ganglion and nerve
87
Buccal space
Space between masseter and buccinator
88
What encloses the straight sinus?
1. Tentorium cerebelli 2. Falx cerebri
89
Pterygopalatine space (main N, main A)
Main N: Maxillary Nerve S2 -Main A: Maxillay Artery
90
What encloses the occipital sinus?
Falx cerebelli
91
Retromandibular space (aka)
Parotid space -investing fascia around Parotid gland and contents (parotideomasseteric fascia)
92
Where is the falx cerebelli located?
between hemispheres of cerebellum
93
Submasseteric space
space between masseter and ramus of mandible
94
Where is the diaphragma sellae located?
on the four clinoid processes over the sella turcica
95
Spaces below mylohyoid
1. Sumandibular space 2. Submental space
96
What passes through the diaphragma sellae?
Infundibulum of hypophysis
97
Spaces above mylohyoid
Sublingual space
98
Lateral Pharyngeal Space (aka)
-Parapharyngeal space -space between posterior wall of pharynx (pretracheal/buccopharyngeal fascia) and Alar fascia
99
Space 4 (aka)
Prevertebral/Dange space -space between alar and Prevertebral fascia
100
Maxillary tooth spread of infection
1. Vertical: Maxillary sinus (canine to molars) or nasal cavity (ant teeth) 2. Lingual: Palate 3. Buccal (molars only): Buccal space/subQ (above buccinator) or Vestibule (below buccinator)
101
Mandibular tooth spread of infection
1. Inferior: Mandible, mandibular canal, and space of body of mandible 2. Buccal (molars only): Vestibule (above buccinator) or buccal space/subQ (below buccinator) 3. Lingual: Sublingual space (above mylohyoid) or submandibuar space (below mylohyoid)
102
Which spaces can communicate in spread of infection?
Submandibular space and sublingual space around the posterior border of the mylohyoid
103
Spread of infection mandibular tooth lingual distribution
1. 3rd molars: Always below mylohyoid (submandibular space) 2. 2nd molars: 50/50 split 3. 1st molars and anterior: Always above mylohyoid (sublingual space)
104
What bones form the bony orbit?
1. Maxillary 2. Zygomatic 3. Frontal 4. Palatine 5. Lacrimal 6. Sphenoid 7. Ethmoid
105
What bones make up the margin of the orbit?
1. Maxilla 2. Zygomatic 3. Frontal
106
What forms some of the medial wall of the orbit?
Lamina papyracea/lamina orbitalis/orbital plate
107
Openings in the orbit
1. Superior orbital fissure 2. Inferior orbital fissure 3. Optic canal 4. Anterior ethmoid foramen 5. Posterior ethmoid foramen 6. Supraorbital foramen 7. Infraorbital Canal 8. Nasolacrimal canal 9. Zygomaticoorbital foramen
108
What two compartments does the optic canal connect?
1. Middle cranial fossa 2. Orbit
109
What two compartments does the superior orbital fissure connect?
1. Middle cranial fossa 2. Orbit
110
What two compartments does the inferior orbital fissure connect?
1. Pterygopalatine fossa 2. Orbit
111
Ocular Muscles
1. Lateral rectus 2. Medial rectus 3. Superior rectus 4. Inferior rectus 5. Superior oblique 6. Inferior oblique
112
Origin of rectus muscles (ocular)
Common tendinous ring/annulus surrounding optic canal and part of superior orbital fissure
113
Structures passing through annulus/tendinous ring
1. Optic nerve 2. Ophthalmic artery 3. Nasociliary nerve
114
Insertion of rectus muscles (ocular)
anterior protion of sclera
115
Superior oblique origin (functional origin)
Posterior of orbit, superior and medial to optic canal -Functional origin: tendon through trochlea attached to frontal bone
116
Superior oblique insertion
Laterally, underneath superior rectus, to insert into posterior lateral sclera
117
Inferior oblique origin
Front of orbit; upper surface of maxilla lateral to nasolacrimal canal
118
Which muscle is an exception to the general origin of ocular muscles?
Inferior oblique
119
Inferior oblique insertion
Passes under lateral rectus and inserts into lateral aspect of sclera
120
Actions of ocular muscles
1. Abduction/Adduction around vertical axis 2. Elevation/depression around horizontal axis 3. Rotation around anteroposterior axis
121
Lateral and Medial rotational movement of eyeball
Lateral = Extorsion -medial = Intorsion
122
Respective actions of ocular muscles
1. Lateral and medial rectus move eyeball laterally or medially respectively 2. Rest of eyeball muscles (SO, IO, SR, IR) move eyeball in all 3 axes
123
Innervation of ocular muscles
1. LR6 (Abducens) 2. SO4 (Trochlear) 3. Rest are 3 (IO, MR, SR, IR)
124
Muscles of Eyelid
1. Palpebral part of orbicularis oculi 2. Levator palpebrae superioris
125
Sxs of paralysis of Palpebral part of orbicularis oculi
Ptosis of lower eyelid
126
Sxs of paralysis of Levator palpebrae superioris
Ptosis of upper eyelid
127
Inervation of Levator palpebrae superioris
Oculomotor nerve
128
Innervation of palpebral part of orbicularis oculi
Facial Nerve
129
Palpebral fissure
Distance between upper and lower eyelid (slit when eyelids closed)
130
Eyelashes (aka, location)
-Cilia -2-3 rows on free margin of eyelid
131
Glands of eyelashes
Ciliary glands with hair follicles of cilia
132
Infection of ciliary glands
Sty
133
Features of medial end of free margin of eyelid
1. Lacrimal punctum 2. Lacrimal papilla
134
Tarsal plate
Dense fibrous connective tissue providing strength to eyelid
135
Tarsal glands
Sebaceous glands that open on free margin of eyelid near posterior edge
136
Obstruction/inflammation of tarsal glands
Tarsal chalazion
137
Tarsal muscles (kind, innervation, action)
Smooth muscle -Innervated by CNS -Widens palpebral fissure
138
Ligaments of palpebrae
1. Medial palpebral ligament 2. Lateral palpebral ligament
139
Function of palpebral ligaments
Hold tarsal plates
140
Parts of Conjunctiva
1. Palpebral conjunctiva 2. Bulbar conjunctiva
141
Semilunar fold (aka)
Plica semilunaris -located at medial canthus deep to lacrimal caruncle
142
Lacrimal caruncle
Large, pink mass located at medial canthus of eye
143
Color of conjunctiva
palpebral conjunctiva = red (vascular) -Bulbar conjunctiva = transparent (red in infections)
144
How many ducts does the lacrimal gland have and where do they empty?
-12 ducts -empties into conjunctival sac
145
Where does the lacrimal gland secretion go?
1. 50% evaporates 2. 50% drains into lacrimal punctum
146
What prevents tears from overflowing?
Tarsal glands' oily secretion
147
Path of tears
1. Lacrimal gland 2. ducts of lacrimal gland 3. conjunctiva sac 4. Lacrimal punctum 5. lacrimal canaliculi (become common sinus) 6. lacrimal sac 7. nasolacrimal duct
148
How do tears move into lacrimal canaliculi?
1. Capillary action 2. Lacrimal part of orbicularis oculi
149
Pharyngeal Arch #1
Nerve: S3 -Muscles: Muscles of mastication, Anterior belly of digastric, Mylohyoid, Tensor tympani, Tensor veli palatini
150
Pharyngeal arch #2
Nerve: Facial -Muscles: Muscles of Facial expression, Posterior belly of digastric, stylohyoid, stapedius
151
Phayrngeal Arch #3
Nerve: Glossopharyngeal -Muscles: Stylopharyngeus
152
Pharyngeal Arch #4
Nerve: External branch of superior laryngeal Nerve -Muscles: Cricothyroid
153
Pharyngeal Arch #6
Nerve: recurrent laryngeal Nerve -Mucsles: Rest of laryngeal Muscles (Posterior cricoarytenoid, thyroarytenoid, vocalis, and aryepiglottidis)
154
#1 Olfactory Fiber Type
SVA
155
#2 Optic Fiber Type
SSA
156
#3 Oculomotor Fiber Type
1. GSE 2. GVE 3. GVA
157
#4 Trochlear Fiber Type
GSE
158
#5 Trigeminal Fiber Type
1. SVA 2. GSE
159
#6 Abducens Fiber Type
GSE
160
#7 Facial Fiber Type
1. SVE 2. GVE 3. GVA 4. SVA 5. GSA
161
#8 Vestibulocohlear Fiber Type
SSA
162
#9 Glossopharyngeal Fiber Type
1. SVE 2. GVE 3. GVA 4. SVA 5. GSA
163
#10 Vagus Fiber Type
1. SVE 2. GVE 3. GVA 4. SVA 5. GSA
164
#11 Spinal Accessory Fiber Type
GSE
165
#12 Hypoglossal Fiber Type
GSE
166
Path of tympanic nerve
General sensory and PSNS fibers --> jugular foramen via tympanic canaliculus --> tympanic cavity --> forms tympanic plexus (sensation to tympanic cavity) --> Lesser Petrosal nerve leaves through hiatus for lesser petrosal nerve --> groove for LPN --> Foramen ovale --> IT fossa --> Otic ganglion --> Auriculotemporal nerve --> Parotid
167
Path of SNS nerves to parotid
Middle meningeal artery --> Auriculotemporal nerve --> blood vessels to parotid gland
168
Frey's syndrome (aka)
Auriculotemporal syndrome -Lac to Parotid gland and Great auricular or Auriculotemporal Nerve get healing secretomotor/PSNS fibers causing sweating instead of salivating
169
Space of body of mandible
Investing fascia split around inferior border of mandible
170
Superficial and deep temporal spaces
Superficial: between temporalis fascia and temporalis -deep: deep to temporalis
171
Masticator space
Investing fascia encircling muscle of mastication
172
Infratemporal space (main nerve, procedures)
Main Nerve: S3 -Procedures: PSA block and mandibular block
173
What runs between the skull and the superior pharyngeal constrictor?
1. Ascending palatine artery 2. Pharyngotympanic tube 3. Levator veli palatini
174
What runs between the Inferior pharyngeal constrictor and the esophagus?
1. Recurrent laryngeal nerve 2. Inferior thyroid artery
175
Innervation of muscles of the pharynx
-Most innervated by Pharyngeal plexus (9,10,11; mostly vagus) -Exception: stylopharyngeus innervated by Glossopharyngeal Nerve
176
Phases of Deglutition (which one is the fastest, most likely to fail with age?)
1. Oral/Mouth 2. Pharyngeal (fastest) 3. Esophageal
177
Layers of the Pharyngeal Wall
1. Mucosal 2. Muscular (inner longitudinal and outer circular) 3. Fascial (buccopharyngeal above hyoid and pretracheal below hyoid)
178
Sensory innervation of nasopharynx, oropharynx, and laryngopharynx
Nasopharynx: S2 -Oropharynx: Mainly Glossopharyngeal with some S2 -Laryngopharynx: Vagus (e.g. superior laryngeal Nerve, etc.)
179
What does the larynx connect?
The laryngopharynx and the trachea
180
Relationships of the Larynx (anterior, posterior, and lateral)
Anterior: Superficial/palpable -Posterior: Laryngopharynx -Lateral: Carotid sheath, thyroid gland, and Muscles (SCM, infrahyoids)
181
Space between vocal folds
Rima glottidis
182
Where do the vestibular folds extend?
Thyroid cartilage to corniculate cartilage
183
Where do the vocal folds extend?
thyroid cartilage to Vocal processes of arytenoid
184
How do you tell the difference between false and true vocal cords?
False vocal cords are all red (vascular) and true vocal cords have a white (avascular) vocal ligament
185
Saccule
Sebaceous gland found as diverticulum in ventricle; "oil can of the larynx"
186
Muscles of the larynx
Intrinsic muscles 1. Cricothyroid 2. Posterior cricoarytenoid 3. Thyroarytenoid 4. Vocalis 5. Aryepiglottidis Extrinsic muscles 1. Suprahyoids 2. Infrahyoids 3. Pharyngeal muscles
187
General functions of the intrinsic muscles of the larynx
1. Open rima glottidis (abduction) 2. Close rima glottidis (adduction) 3. Regulate tension in the true vocal cords
188
Intrinsic muscles of the larynx and respective functions
1. Cricothyroid (adduction) 2. Posterior Cricoarytenoid (abduction) 3. Thyroarytenoid (Reg. tension of true vocal cords) 4. Vocalis (Reg. tension of true vocal cords) 5. Aryepiglottidis (close aditus by pulling epiglottis down and approximating aryepiglottic folds)
189
Where is the aryepiglottidis muscle located?
in the aryepiglottic fold
190
Innervation of the muscles of the larynx
Most Innervated by recurrent laryngeal Nerve (from Vagus N) -Exception: Cricothyroid Innervated by External branch of superior laryngeal Nerve (also from Vagus N)
191
Sensory innervation of the larynx
Internal branch of superior laryngeal nerve (from vagus N)
192
Otic Ganglion (CN, Nucleus, Preganglionic fibers, postganglionic fibers, structures innervated)
CN: Glossopharyngeal Nerve -Nucleus: Inferior Salivatory Nucleus (medulla) -Preganglionic: Tympanic Nerve, Tympanic plexus, Lesser Petrosal Nerve -Postganglionic: Auriculotemporal Nerve -Structures Innervated: Parotid gland
193
What is the Aditus the boundary for?
boundary between the laryngopharynx and the larynx
194
What nerve is in the depth of the piriform recess?
Internal branch of the superior laryngeal nerve
195
MPC (origin and insertion)
origin: hyoid -Insertion: tendinous/Pharyngeal raphe
196
Where are the motor nerve cell bodies located for CNs 9, 10, &11?
Nucleus Ambiguus
197
Nucleus Ambiguus (location and contents)
-Medulla -Motor nerve cell bodies of CNs 9, 10, 11
198
Where does the PSNS supply for the Glosopharyngeal nerve come from?
Inferior salivatory nucleus
199
Inferior salivatory nucleus (location, contents)
medulla -PSNS nerves to Glossopharyngeal
200
What does the glossopharyngeal supply (sensation)?
Sensation and taste for posterior 1/3 of tongue
201
Where are all the cell bodies of the sensory nerves of the Glossopharyngeal located?
Inferior Ganglion
202
Inferior Ganglion (location, contents)
Just inside the jugular foramen -cell bodies of sensory nerves of Glossopharyngeal
203
Branches of Glossopharyngeal
1. Tympanic Nerve 2. General sensory branches to carotid sinus 3. Nerve to stylopharyngeus 4. Sensation fibers to oropharynx, tonsils, and post 1/3 of the tongue 5. Taste fibers to post 1/3 of tongue
204
Why is otitis media so painful?
Because of the tympanic plexus
205
Boundaries of laryngopharynx (superior and inferior)
superior: line of demarcation posteriorly from epiglottis -Inferior: Inferior border of the cricoid cartilage
206
Anterior features of laryngopharynx
1. Aditus/laryngeal inlet/laryngeal opening 2. Aryepiglottic folds 3. Arytenoid, corniculate, and cuneiform cartilages 4. Lamina of cricoid cartilage
207
Anterolateral features of the laryngopharynx
Piriform recess
208
What muscles originate at the styloid process and what is their respective innervation?
1. Stylopharyngeus: Glossopharyngeal Nerve 2. Stylohyoid: Facial Nerve 3. Styloglossus: Hypoglossal Nerve
209
SPC (origin and insertion)
origin: pterygomandibular raphe -Insertion: tendinous/Pharyngeal raphe
210
IPC (origin and insertion)
origin: thyroid and cricoid cartilages -Insertion: tendinous/Pharyngeal raphe
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What is the only muscle innervated by the Glossopharyngeal nerve?
Stylopharyngeus
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What does the stylopharyngeus pass between?
the superior and middle pharyngeal constrictors
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Types of epithelia and locations (and exceptions)
1. Stratified Squamous - Where food is 2. Respiratory Epithelium - Air passages Exceptions 1. Superior border of soft palate is respiratory epithelium 2. Vestibule of larynx near epiglottis is respiratory epithelium
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Function of the arytenoid cartilage
Sound production
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Parts of the Laryngeal Cavity
1. Vestibule (Aditus to Vestibular folds) 2. Ventricle (Ventricular folds to Vocal folds) 3. Infraglottic Cavity (Vocal folds to inferior border of cricoid cartilage)
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What does speech require?
1. Exipratory air (from lungs) 2. "laryngeal tone makers" (true vocal cords) 3. Resonance and articulation (mouth, pharynx, nose, and related muscles)
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What is posterior to the inferior pharyngeal constrictor?
Prevertebral muscles
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Muscles of the Pharynx
Longitudinal (inner layer) 1. Stylopharyngeus 2. Palatopharyngeus 3. Salpingopharyngeus Circular (outer layer) 1. Superior pharyngeal constrictor 2. Middle pharyngeal constrictor 3. Inferior pharyngeal constrictor
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What runs between the superior and middle pharyngeal constrictors?
1. Stylopharyngeus 2. Glossopharyngeal Nerve 3. Stylohyoid Ligament
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What runs between the middle and inferior pharyngeal constrictor?
1. Superior laryngeal artery 2. Internal branch of superior laryngeal nerve
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What runs within the substance of the Inferior pharyngeal constrictor?
External branch of superior laryngeal nerve (to cricothyroid)
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Cartilages of the Larynx and type
1. Thyroid (Hyaline) 2. Cricoid (Hyaline) 3. Epiglottic (Elastic) 4. Arytenoid (Hyaline) 5. Corniculate (Elastic) 6. Cuneiform (Elastic)
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Shape and orientation of arytenoids
pyramidal with apex superiorly and base on cricoid lamina
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Glottis
1. Both vocal folds 2. Rima glottidis
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Alternate names for vestibular and vocal folds
-Vestibular folds = False vocal cords -Vocal folds = true vocal cords
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Function of the saccule
Lubrication of the true vocal cords
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Horns of thyroid cartilage and related structures
1. Superior horns (hyoid) 2. Inferior horns (cricoid)
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Where does the epiglottic cartilage attach?
Superior posterior surface of the thyroid cartilage
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Vocal processes
Processes of the base of the arytenoid that move back and forth on the lamina of the cricoid cartilage
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Space between vestibular folds
Rima vestibuli
