CN I
OlfactoryFxn: sensory- noseLocation: foramina of cribriform plate to superior nasal concha
CN II
OpticFxn: sensory- eyeLocation: optic canal (with ophthalmic artery)
CN III
OculomotorFxn: motor- eye musclesLocation: Superior orbital fissure (with CN IV, CN V-1, CN VI, and superior ophthalmic vein)
CN IV
TrochlearFxn: motor- superior oblique muscleLocation: Superior orbital fissure (with CN III, CN V-1, CN VI, and superior ophthalmic vein)
CN V
TrigeminalFxn: sensory- face, sinuses, teeth etcmotor- muscles of masticationLocation: superior orbital fissure (V 1), foramen rotundum (V 2), Foramen ovale and spinosum (V 3)
CN VI
AbducensFxn: motor- external rectus muscleLocation: superior orbital fissure (with CN III, CN IV, CN V-1, and superior ophthalmic vein)
CN VII
FacialFxn: motor- muscles of the faceLocation: internal acoustic meatus (with CN VIII)
CN VIII
VestibulocochlearFxn: sensory- inner earLocation: internal acoustic meatus (with CN VII)
CN IX
GlossopharyngealFxn: motor- pharyngeal muscles sensory- posterior part of tongue, tonsil, pharynxLocation: jugular foramen (with CN X, CN XI, sigmoid sinus, posterior meningeal artery)
CN X
VagusFxn: motor- heart, lungs, bronchi, gastrointestinal tractsensory- heart, lungs, bronchi, trachea, larynx, pharynx, gastrointestinal tract, external earLocation: jugular foramen (with CN IX, CN XI, sigmoid sinus, posterior meningeal artery)
CN XI
Accessory Fxn: motor- sternocleidomastoid, trapezius musclesLocation: jugular foramen (with CN IX, CN X, sigmoid sinus, posterior meningeal artery)
CN XII
HypoglossalFxn: motor- muscles of the tongueLocation: Hypoglossal canal
Sagittal suture
between parietal bones
Coronal suture
the suture between the parietal and frontal bones of the skull
Lamboid suture
the suture between the occipital and parietal bones
Squamous suture
Between parietal and temporal bones
Frontonasal suture
Suture between the nasal and frontal bones
Pterion suture
Junction of frontal, parietal, sphenoid, and temporal bones
Bregma suture
anterior fontanelle; supposed to close around 1-2 years old
Lambda suture
posterior fontanelle; supposed to close at 1-2 months
What nerve travels through the mental foramen?
inferior alveolar nerve; the mental foramen also communicate with the mandibular foramen
Tongue deviates to the right. What muscle or nerve may be damaged?
Hypoglossal nerve (CNXII) damage or Right genioglossal muscle weaknesshappens to stroke or TBI patients; be careful tongue can drop back when in supine position and block airway
Jaw deviates to the right. What muscle or nerve may be damaged?
Right lateral pterygoid weakness or right CN V-3 Mandibular n damage
Uvula deviates to the right. What muscle or nerve may be damaged?
The left uvulus muscle is weak or left CN X damaged
Which cranial nerves carry special and general sensory for different parts of the tongue? What is their clinical significance?
Root: special and general- CN X/ vagusPosterior 1/3:special and general- CN IX/ Glosspharyngeal (bitter)Anterior 2/3: special sensory- CN VII/ Facial via chord tympani (taste sweet, sour salty)general sensory- CN V/ Trigeminal V-3 (touch, temp, pressure, proprioception)Clinical significance example: pt. can not feel hot water on tongue- problem with CN V-3
Sphenoid sinus
Location: cuboid spaces adjacent to midline in body of sphenoid boneDrain into: spenoethmoidal recessHow to position pt.: prone to drain opening in front
Ethmoid sinus
Location: thinned walled cells within lateral part of ethmoid bone; the middle and anterior ethmoid sinus open at the ethmoidal bulla Drain into: middle meatus
Frontal sinus
Location: either side of midline within frontal bone, rarely symmetricalDrain into: communicates with nasal cavity through frontonasal duct and empties into anterior part of middle meatusHow to position pt.: supine with head above feet (lean back)
Maxillary sinus
Location: largest; lateral to lateral nasal wall; extends superiorly up to orbital surface of maxilla Drain into: from superior medial wall to middle meatus, the opening is on the super-media-posterior wall of sinusHow to position pt.: sidelying on contralateral side with legs higher than head
Nasolacrimal duct
Location: inferior nasal meatus; connects eyes and noseTears drain into inferior nasal meatus then to this ductpostition pt.: sit straight
Tears. How do they travel?
1. Lacrimal glands produce2. Lacrimal sac collects them 3. Nasalacrimal duct is first site of drainage4. Inferior nasal meatus is where they ultimately drain
Macular degeneration
ophthalmic artery and vein (from internal caroitd) run together through optic canal. age can cause plaque buildup and clotting of blood causing the artery to become stagnant.
Dangerous triangle of the face. What structures are wrapped in the sinus?
The Cavernous Sinus is a meningeal structure that wraps around the bundle including the internal carotid artery, CN IV, CN V-1 and CNVI. This sinus is supposed to drain into facial/ ophthalmic vein. Facial vein/ ophthalmic vein do not have any valves, so can flow wrong way back into the cavernous sinus causing meningitis. Ex. when picking at a pimple in this area.
CN V- 1, 2 and 3 sensory innervation of the face
CN V-1: Ophthalmic nerveCN V-2: Maxillary nerveCN V-1: Mandibular nerve
Describe the action of swallowing.
1. tongue forces food into pharynx2. soft palate, hyoid bone and larynx are raised; tongue is pressed against palate; epiglottis closes and the inferior constrictor mm relax so that esophagus opens3. superior constrictor mm contract and force food into esophagus4. peristaltic waves move food through the esophagus to the stomach
Suprahyoid muscles
1. Digastric- anterior and posterior belly2. Stylohyoid3. Mylohyoid4. Geniohyoid
Infrahyoid muscles
1. Sternohyoid2. Omohyoid - superior belly, inferior belly3. Sternothyroid4. Thyrohyoid
How can you facilitate the action of hyoid bone elevation?
...
Scalp lump vs. raccoon eyes
Lump: local injury above aponeurosis, tight connective tissue prevents blood from spreadingRaccoon eyes: blood flows under occipitofrontalis and orbicularis oris muscles deeper to loose aponeurosis
Corneal reflex
Sensory- V1 (opthalmic- nasociliary branch, levator palpebrae)Motor- VII (Temporal Branch, Orbicularis Oculi)Test: touch eye with damp q-tip, supposed to close eye.
Pupillary reflex
both pupil should constrict when light is directed at one eyesensory- optic nerve (special sensory)motor: oculomotor nerve
Gag reflex
Glossopharyngeal (IX) sensory, Motor (X)
Sneeze reflex
Sensory- CN V-2 (Maxillary) innervates nasal cavity surfaceMotor- CN VII (Facial)
Pharyngeal muscles
Outer layer: contract to push food down1. superior pharyngeal constrictor 2. middle pharyngeal constrictor3. inferior pharyngeal constrictor Inner layer: lift and broaden1. stylopharyngeus *2. palatopharyngeus3. salpingopharyngeusN: CN X, except the stylopharyngeus which is CN IXA: expand the larynx
Carotid sheath
contains common carotid artery, internal jugular vein, and CN X vagus nerve
cervical sympathetic trunk
located medially to carotid sheath and vasomotor sympathetic innervation to esophagus
How does the internal carotid artery travel in the skull?
Foramen lace rum, cavernous sinuses
Carotid sinus and body
Carotid sinus: dilation of internal carotid a. innervated mainly by CN IX and partly X Baroreceptor (pressure)Carotid body: Chemoreceptor innervated mainly by CN IX and partly X. Stimulated by low levels of O2- initiates a reflex which increases rate and depth of respiration, cardiac rate and BP
What muscles are hurt during whiplash?
longus capitis and Colli
What muscle related to torticollis?
a spastic, tight SCM- most common in newborns
Scalene muscles
AnteriorO- trans processes C3-6I- 1st ribMiddleO- trans processes C2-7I- 1st ribPosteriorO- trans processes C4-6I- 2nd ribA: elevate 1st and 2nd ribs, anterior flexion of vertebral column; one side- ipsilateral flexion to the side
Contents of scalene triangle
Scalene Triangle Contents:1. carotid sheath- condensation of deep fascia around Common carotid artery- anterior and medialInternal carotid arteryExternal carotid arteryinternal jugular vein- anterior and lateral ○ vagus nerve- posterior2. Scalenus muscles (anterior, medius and posterior) 3. Phrenic nerve (C3-C5) sitting on the anterior scalene 4. Brachial plexus (behind scalenus anterior)5. Subclavian artery- Vein does not go through, it only passes in front 6. Thoracic duct7. Longus colli and longus capitis muscles (deep)A) flex head/neck and rotates head ipsilaterallyB) muscles that can cause whiplash from too much head/neck extension
Which nerves get contribution from C3-C4? Clinical application?
Phrenic and supraclavicularPhrenic nerve supplies the diaphragm- if an internal organ pushes against can get referred pain
Anterior cranial fossa, what cranial nerves/lobe could be compressed?
frontal lobe Olfactory nerves that come out of the cribriformplate foramen
Middle cranial fossa, what cranial nerves/lobe could be compressed?
temporal lobe Optic nerve and ophthalmic artery out of the optic canal Oculomotor Trochlear Ophthalmic N. Abducens Maxillary N Mandibular N
Posterior cranial fossa, what cranial nerves/lobe could be compressed?
occipital lobe Facial Vestibulocochlear Glossopharyngeal Vagus Spinal Accessory Hypoglossal
Sella turcica contains, what cranial nerves/structure could be compressed?
pituitary gland
What causes epidural and subdural hematomas?
Epidural: a hit to the pterion (weak spot where frontal, temporal, sphenoid and parietal bones meet- 1 finger posterior to lateral eye angle); The middle meningeal artery runs under surface and becomes damaged. Subdural:Injury to the loose connective tissueThe brain shrinks with age/alcohol abuse. When the brain shrinks certain veins are stretched, making them more susceptible to injury if the person falls/has a head injury; the veins are more likely to be torn and leak blood into the subdural space.
5 layers of the scalp
1. Skin2. Connective tissue-tight3. Aponeurosis4. Loose connective tissue5. Pericranium
Branches of external carotid artery
Anterior:1. Superior thyroid2. Ascending pharyngeal3. LingualPosterior:4. Facial5. Occipital6. Posterior auricularTerminal:7. Maxillary8. Superficial temporal
Branches of the subclavian artery
1. vertebral2. internal thoracic3. thyrocervical trunk -> branch into inferior thyroid and transverse cervical 4. costocervical trunk5. dorsal scapular
TMJ dysfunction
Temporomandibular joint; abnormality of joint where lower jaw hinges to upper jawtest: cannot put three fingers in mouth
Parotid gland infection
facial nerve passes through parotid glandsymptoms: inflammation, local pain and temperature increase in area
Temporal arteritis
giant cell arteritis, involves superficial temporal arterysymptoms: pain over temporal area that is worse at night, mostly unilateralcan palpate in front of tragus to see if one side weaker
Bell's palsy
paralysis of the facial nerve, causing muscular weakness in one side of the face.common with truck drivers who have wind blowing on face the nerve comes out of stylomastoid foramen
Wisdom tooth pain
Hurts on the inside of the mouthtest by pushing on tooth
Levator palpebral innervation and orbicularis occuli
dual- somatic and sympathetic, because you blinkLevator- oculomotor; occuli- facial
Why does a patient with Horner's syndrome show eyelid drooping?
Sympathetic shut down of the eye
Nasopharynx
Soft palate and above Contains:1. Opening of auditory tube2. Torus tubarius - cartilage end of auditory tube3. Pharyngeal recess - common spot for nasalpharyngeal tumor4. Ethmoidal bulla5. Nasopharyngeal Tonsil (adenoids)
Oropharynx
Soft palate to epiglottis 1. Uvula2. Palatine Tonsils
Larngopharynx
Epiglottis to cricoid cartilage (C6 level) Contains1. Vocal and vestibular folds
Reason for a NPO sign?
pt. can not differentiate between foodand air, Could be due to impairment of the internal laryngeal nerve that sensitizes the epiglottis to differentiate between air and food to know when to open and close. If this nerve is affected, the patient could have an unsafe swallow and be on an NPO order
TMJcharacteristic of the joint disc, how the condyle moves in the temporal/mandibular fossa during mouth opening and closing; nerve innervation to the joint. Disc's role in TMJ function?
temporomandibular joint is a synovial joint-articular surfaces covered with fibrocartilage (durable) articular disc:-divides joint capsule into two cavities-pars meniscus and posterior are innervated as a protective mechanism to keep from opening jaw too much or too much pressure (eat something hard)Condylar mvmt:-open mouth: condylar process moves forward and anterior tilit-closed mouth: condylar process moves backward in posterior tilt2 ligaments: stylomandibular and sphenomandibular
What innervates the vocal muscles? What accompanies these nerves? What are the clinical applications?
external laryngeal n and recurrent laryngeal n
How to make a high pitch voice?
narrowing of vocal cords, less air flows in and adduction
How to make a low pitch voice?
widening of vocal cords, more air flows in and abduction
Pt. has brain tumor that comprises on the right foramen oval. What are the symptoms?
Nerve CNV-3 (mandibular) the mouth will deviate to the right side.
Muscle chain from back of neck to back?
Tension all the way in the back muscles can cause headache due to this. Occipitalis, traps, splenius capitis, semitispinalis capitis, erector spinae,
Acoustic neuroma
fibers from hearing part of CN VIII can overgrown, next to the internal auditory meatus (VII- facial and VIII- vestibulocochlear pass through here) patients will complain of hearing, falls, then facial problems occur at later stages
What age do kids have permanent teeth?
6 years old
Where to palpate the facial artery?
Where the anterior edge of the masseter crosses the mandible- it supplies O2 to the faceCompare each side to indicate an external carotid artery problem (since it branches from)
What muscles close the nasal cavity by elevating soft palate?
1. tensor veli palatine2. levator veli palatineIf dysfunction- pt. may have food exit out nose
Where to stick a dry needle for the lateral pterygoid muscle?
Superior to the mandibular notch, under zygomatic bone
Cutaneous nerves of neck
From dorsal ramus1. (C2) Greater occipital n- scalp over back of head to vertexFrom cervical plexus:1. (C2, 3) Transverse cervical n- skin of anterior triangle2. (C2,3) Greater auricular n- skin over mastoid process lower part of auricle, skin over parotid gland and angle of mandible3. (C2) Lesser occipital n- skin over scalp and behind/ above ear4. (C3,4) Supraclavicular n- pierces platysma, skin over base of neck, upper sternum SC joint, pec major to 3rd rib level and shoulder to distal 1/3 of deltoid
Cutaneous nerves of the face
all trigeminal nerve CN VV1 Opthalmic nerve divisions:1. supraorbital- most of forehead and upper eyelid2. supratrochlear- medial forehead and upper eyelid3. lacrimal- larimal gland 4. nasocillary nerve-V2 Maxillary division5. infraorbital- skin over upper lip (1 finger below eye split and 1 finger from middle line)V3 Mandibular Division6. auriculotemporal- temporal region, anterior aspect of ear, tmj, external acoustic meatus and some of parotid gland 7. mental- lower lip and some of mandible8. buccal
Mosquito bite on tip of nose, which nerve feels it?
CN V1 Ophthalmic
Anterior cervical triangle
Borders:superior- inferior border of mandiblelateral- anterior border of SCMmedial- anterior midlineroof- skin and superficial fascia with platysma
What artery must be lit aged, be careful not to harm which nerve?
inferior thyroid artery and recurrent laryngeal nerve- controls the voice musclesgradual voice improvement can be achieved if cricoid muscle compensates
What nerve runs with the superior thyroid artery?
external laryngeal nerve (superior laryngeal nerve)
What nerve runs with the superior laryngeal artery?
internal laryngeal nerve (superior laryngeal nerve)
What nerve runs with the inferior thyroid artery?
recurrent laryngeal nerve also called inferior laryngeal nerve
If the external laryngeal nerve is cut what happens?
cricothryoid paralyzedvoice becomes low pitched due to decreased tension
Tumor in nasopharynx region
Common for the pharyngeal recess to have a tumor that pushes on auditory tubesymptoms: the ear feels stuffed up and can cause pain
Thoracic Outlet Syndrome
1. Between anterior and middle scalene muscles -Scalenus-Anticus Syndrome where Scalenus compress Subclavian Artery and nerves from Brachial Plexus (Subclavian Vein DOES NOT pass through)2. Between the clavicle and rib cage-Costoclavicular Syndrome (Eden's Syndrome) where Clavicle compresses vessels and nerves3. Between pec minor and rib cage-Hyperabduction Syndrome where Pectoralis Minor compresses vessels and nerves
procerus sign
a medical sign consisting of vertical forehead wrinkling around the bridge of the nose and the glabella. This can be seen in neurodegenerative diseases such as progressive supranuclear palsy and Parkinson's