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HEAD AND NECK BLOCK 2 EXAM

HEAD AND NECK BLOCK 2 EXAM. 1 - WRITTEN EXAM 24 Questions 11.8% of lecture grade 2 - PRACTICAL EXAM 15 Questions Gross Anatomy 9.4% of lab grade 1) Prosections 2) New specimens 3) Skulls 4) X-rays, Angiograms.

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HEAD AND NECK BLOCK 2 EXAM

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  1. HEAD AND NECK BLOCK 2 EXAM 1 - WRITTEN EXAM 24 Questions 11.8% of lecture grade 2 - PRACTICAL EXAM 15 Questions Gross Anatomy 9.4% of lab grade 1) Prosections 2) New specimens 3) Skulls 4) X-rays, Angiograms

  2. ADVICE ON HOW TO TAKE THE HEAD AND NECK EXAM DRAW: 1. CRANIAL NERVE FUNCTIONAL COMPONENTS CHART 3. SVE MUSCLES - 'incantation' 4. BRANCHIAL ARCHES, POUCHES 5. GVE PARASYMPATHETICS - HITCHHIKING PATHWAYS - BRANCHES IX 6. BRANCHES OF MAXILLARY ARTERY

  3. ANATOMICAL/CLINICAL REVIEW 1. NASAL CAVITY, AIR SINUSES, V2 2. PALATE - MUSCLES, CLEFT PALATE 3. PHARYNX - TONSILS, POPCORN 4. ORAL CAVITY CRANIALNERVE IX 5. NECK 6. LARYNX

  4. NASAL CAVITY Projections that increase surface area called Nasal Conchae = Turbinates (one is separate bone; others projections from Ethmoid bone) AIR NASAL SEPTUM

  5. A. BOUNDARIES OF NASAL CAVITY Nasal Frontal Boundaries Floor 1) Maxillary Bone (Palatine Process) 2) Palatine Bone (Horizontal Plate) Roof 1) Nasal Bone 2) Frontal Bone 3) Ethmoid (Cribriform Plate) 4) Sphenoid (Body) Ethmoid Sphenoid Palatine Maxillary NOSE

  6. NASAL SEPTUM ANT. CRANIAL FOSSA Medial = Nasal Septum 1)Septal Cartilage 2)Ethmoid (Perpendicular Plate) 3)Vomer NOSE ETHMOID– Fracture of nose can break cribriform plate, floor of Ant. Cranial fossa - leak CSF from nose; Meningitis

  7. B. LATERAL WALL OF NASAL CAVITY Sphenoid Ethmoid Nasal Lateral Wall 1) Nasal Bone 2) Maxillary 3) Inferior Concha 4) Palatine 5) Ethmoid 6) Sphenoid Maxillary Palatine Inf. Concha NOSE

  8. II. PARANASAL AIR SINUSES 1) Air filled extensions of Nasal Cavity 2) All Paired - Develop After birth - Lined by mucous membrane - Serve to lighten bones 3) A mistake of evolution? - Fill bones with spongy (cancellous) bone & would not get infected

  9. PARANASAL AIR SINUSES Ethmoid Frontal Sphenoid Maxillary

  10. Nasal septum Maxillary sinus Lateral pterigoid plate Lateral pterigoid m Ramus of mandible Medial pterigoid plate Styloid process Mastoid air cells Spinal card

  11. Frontal sinus Crista galli Sphenoid sinus Temporalis m Temporal lobe Petrous bone Pons Mastoid air cells Sigmoid sinus Cerebellar hemisphere Internal occipital protuberance Trapezius m

  12. ? MAXILLARY SINUS

  13. 276

  14. PARANASAL AIR SINUSES All usually paired VIEW: FLOOR OF ANT. CRAN. FOSSA WITH BONE REMOVED A. Frontal - separate by septum, variable size C. Ethmoid- also called aircells (Ant., Mid., Post.) B. Sphenoid - in body of Sphenoid bone NOSE Ethmoid - Blocked Sinus Infection Can Spread to Orbit

  15. NASAL CAVITY: OPENINGS a.Sphenoethmoidal Recess 1) Olfactory Foramina 2) Sphenoid air sinus b. Superior Meatus – Post. Ethmoidal air cells c. Middle Meatus 1) Middle ethmoidal air cells - Bulla 2) Ant. Ethmoidal air cells - Hiatus Sem. 3) Max. Sinus - Hiatus Semilunaris 4) Frontal Sinus - Infundibulum. d. Inferior Meatus – opening of Nasolacrimal duct ETHMOID BULLA SPHENOID AIR SINUS HIATUS SEMI- LUNARIS

  16. see ETHMOID BULLA HIATUS SEMI- LUNARIS INFUNDIBULUM

  17. NERVES of NASAL CAVITY Nerves 1.Olfactory N. - SVA smell; Olfactory Area 2.General Sensation - GSA touch, pain, etc. - V1 Anterior Ethmoidal N. - V2 Nasal Branches - V2 Nasopalatine N. 3. Mucous Glands of nose - GVE - VII - Facial N. by Pterygopalatine Ganglion (hitchhike with branches of V) OLFACTORY N. PTERYGO- PALATINE GANGLION ANT. ETHMOIDAL N. NASAL BR. NASOPALATINE N. OLFACTORY AREA = area of Olfactory nerve endings RESPIRATORY AREA = rest of nasal cavity

  18. FORAMEN ROTUNDUM – CN V2

  19. V1 V2 V3 TRIGEMINAL (SEMILUNAR) GANGLION

  20. PTERYGO- MAXILLARY FISSURE – LEADS TO PTERYGO- PALATINE FOSSA

  21. V2 - MAXILLARY - GSA Inferior Orbital Fissure Pterygomaxillary Fissure Post. Sup Alveolar For.

  22. V2 - MAXILLARY - GSA Infraorbital Nose Zygomatic 3. Posterior Superior Alveolar Maxillary molar teeth 4. Infraorbital Lower eyelid, nose, upper lip a) Ant. & Mid Sup Alveolar Other Maxillary teeth 5. Zygomatic Skin of check Post Sup. Alveolar Clinical Correlate/Questions: 1) Damage/Fracture maxillary sinus in tooth extraction - Roots of teeth closely related to floor of sinus; 2) Maxillary sinus infection feels like tooth ache - Ant. and Post. Sup. Alveolar branches of CN V2 supplies mucous membrane of maxillary sinus and teeth

  23. V2 - MAXILLARY - GSA 1. Meningeal Branch Dura of Middle Cranial Fossa 2. Ganglionic branches a) Greater Palatine N. Hard Palate b) Lesser Palatine N. Soft Palate c) Nasopalatine Nasal Cavity Ant. part of hard Palate d) Nasal Branches Nasal Cavity Nasal Branches V2 Greater Palatine Lesser Palatine Naso- Palatine

  24. NASAL CAVITY SPHENO- PALATINE FORAMEN

  25. E. and F. ARTERIES/VEINS, LYMPHATICS SPHENO- PALATINE A. ANT. ETHMOIDAL A. 1. Arteries a. Sphenopalatine Artery - from Maxillary A. b. Ant. & Post Ethmoidal A. - from Ophthalmic A. c. Branches of Facial A. br. of FACIAL A. 2. Veins a. Ethmoidal vein drain to Ophthalmic v. b. Other branches Pterygoid Venous Plexus c. Facial Vein F. Lymphatics- Retro- pharyngeal Nodes Clinical Note/Questions: Epistaxis (nosebleed) can be extensive due to Anastomoses (Int. and Ext. Carotid Aa.) – Spurting if arterial.

  26. PALATE B. Anatomy 1. Hard Palate a. Maxillary Bones (palatine process) b. Palatine bones (horizontal plate) INCISIVE FORAMEN

  27. SAY AAHH! PALATOGLOSSAL ARCH PALATOGLOSSAL ARCH = SITE OF OROPHARYNGEAL MEMBRANE = BOUNDARY, BETWEEN ORAL CAVITY AND PHARYNX

  28. MUSCLES OF SOFT PALATE - SVE NASAL CAV. 1) Tensor Palati - O - Auditory tube; I - Palatine Aponeurosis (tendon under hamulus of medial pterygoid plate A - Tenses Soft Palate Inn - V3 2) Levator Palati - O - Temporal Bone, Auditory Tube; I - Palatine Aponeurosis; A - Elevates Soft Palate - Inn - X 3) Musculus uvuli - O - Palatine aponeurosis, I - Uvula; A - Raises Uvula Inn - X VIEW: POST. SIDE OF NASAL AND ORAL CAVITIES 3)

  29. MUSCLES OF SOFT PALATE Tensor 4) Palatoglossus O - Palatine aponeurosis, I - Side of tongue; A - Draws palate down, raises tongue Levator Musculus Uvuli Palatoglossus Innervation - All X except Tensor (V3) Clinical - 1) Swallowing - damage motor inn. of palate X, (V) 2) Ears pop in airplane - Aud. Tube opens when swallow

  30. 231 See Hard/Soft Palate Tensor and Levator

  31. DEVELOPMENT OF FACE 2. Medial & Lateral Nasal Processes–form at margins of nasal placodes 3. Medial nasal process& Maxillary Process–fuse to form upper lip fusion eye Lateral nasal process Medial nasal process Medial nasal process Maxillary process PHILTRUM OF UPPER LIP Terminology: process = prominence

  32. PALATE DEVELOPMENT a. Primary Palate – Anterior to incisive foramen formed by union Medial Nasal Processes PRIMARY PALATE MAX PROC. MAX PROC. SECONDARY PALATE b. Secondary Palate – posterior to incisive foramen- formed by fusion of Maxillary process

  33. CLINICAL: CLEFT PALATE 2) Posterior Cleft Palate - Not fuse Secondary palate (not fuse Maxillary Processes each side) 1:2500 births 1:1000 Births 1) Anterior Cleft Palate - Not fuse Medial Nasal Process and Maxillary Process Note: Ant. Cleft Palate is same as Cleft Lip Can be unilateral or bilateral

  34. PHARYNX - is continuous with esophagus, opens to larynx trachea PHARYNX HYOID BONE LARYNX ESOPHAGUS

  35. PHARYNX All Pharynx is GVA In 3 Cranial Nerves Nasal Cavity GSA NASOPHARYNX - VII soft palate Oral Cavity GSA OROPHARYNX - IX epiglottis LARYNGOPHARYNX - X

  36. PHARYNX Tell Constrictors Apart by level SUPERIOR CONSTRICTOR O - Pterygomandibular Raphe (Conn. Tiss. Lig. from Med. Pterygoid plate to Mandible - CONTINUOUS ANT. WITH BUCCINATOR) Sup. Const. Mid. Const. MIDDLE CONSTRICTOR O - HYOID Inf. Const. INFERIOR CONSTRICTOR O - THYROID & CRICOID Cartilage

  37. PHARYNX Structures Through Gaps In Constrictors 1) Between Sup. Constrictor and Skull Levator Veli Palatini M. Auditory Tube 2) Between Sup. and Mid. Constrictor Glossopharyngeal N. (IX) Stylopharyngeus M. 3) Between Mid. and Inf. Constrictor Superior Laryngeal A. Internal Laryngeal N. Sup. Const. Mid. Const. Inf. Const.

  38. 1037

  39. CONTENTS OF PHARYNX in Nasopharynx - Pharyngeal Tonsil (Adenoids) - opening of Auditory Tube in Oropharynx - Palatine Tonsils (Tonsillitis) posterior to Palatoglossal Arch Soft Palate

  40. PALATINE TONSILS - LOCATION PALATO- GLOSSAL ARCH PALATO- PHARYNGEAL ARCH PALATINE TONSIL AAH!

  41. PALATINE TONSILS - Tonsillectomy - incise mucosa TONSILLAR BR. OF FACIAL A. IX Tonsillar ‘Bed’ - Formed by 1) Superior Constrictor of pharynx and 2) Styloglossus Clinical - 1) Damage IX 2) Bleeding

  42. 231 PHARYNGEAL TONSIL CLINICAL - ADENOIDS - adolescent develops nasal voice

  43. PHARYNX - INTERNAL STRUCTURES CLINICAL VIGNETTE PIRIFORM RECESS: lateral to inlet of larynx Inlet of Larynx A child complains that he has popcorn stuck in his throat. Examination shows that it is lodged in the laryngopharynx, lateral to the inlet of the larynx. The popcorn is in the __________.

  44. PHARYNX - INTERNAL STRUCTURES VALLECULAE - in Oropharynx

  45. ORAL CAVITY - TONGUE FORAMEN CECUM A. SUPERFICIAL STRUCTURES 1. SULCUS TERMINALIS - V-SHAPE GROOVE DIVIDES TONGUE INTO: ANT. 2/3- ORAL PART - GSA; POST 1/3 -PHARYNGEAL PART - GVA 2. FORAMEN CAECUM - PIT IN MIDDLE OF SULCUS TERMINALIS- SITE OF INVAGINATION OF THYROID GLAND SULCUS TERMINALIS CLINICAL QUESTION: MASS IN POSTERIOR TONGUE; CHECK IF IT IS THYROID TISSUE BEFORE SURGICAL EXCISION

  46. FOLDS, LANDMARKS BENEATH TONGUE 4. FIMBRIATED FOLDS (PLICA FIMBRIATA) ( L. FRINGE) - LATERAL TO LINGUAL FRENULUM, LOCATION OF LINGUAL VEINS 3. LINGUAL FRENULUM (L. BRIDLE) MIDLINE FOLD FROM FLOOR OF MOUTH SUBLINGUAL PAPILLA- SWELLING AT BASE OF FRENULUM; OPENINGS SUBMANDIB. SALIV. GLANDS 5. SUBLINGUAL FOLDS (PLICA SUBLINGUALIS) OVERLIE & HAVE OPENINGS FOR SUBLINGUAL SALIV GLANDS

  47. MUSCLES OF TONGUE - all innervated by XII A) GENIOGLOSSUS O - GENIAL TUBERCLE OF MANDIBLE I - TONGUE TO ITS DORSAL SURFACE A - PROTRUDE 1. EXTRINSIC MUSCLES - ATTACH TONGUE TO BONES NOSE STYLOID PROCESS C) STYLOGLOSSUS - O-STYLOID PROCESS OF TEMP. BONE I - LAT. SIDE OF TONGUE A - DRAWS TONGUE SUPERIORLY & POSTERIORLY B) HYOGLOSSUS - O - GREATER & LESSER HORNS OF HYOID BONE I - LAT. SIDE OF TONGUE A - DEPRESS MANDIBLE HYOID

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