anatomy block 1d clinical correlates
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Disorder/Drug Problem/Target Cause/Mechanism
Trianglesof
theNeck Congenital Torticollis Sternocleidomastoid
TriangleContents
Anterior Triangle Submental Submental lymph nodes - Mylohyoid m
Submandibular
Carotid Carotid sheath (CCA, ICA, IJV, Vagus n.
Muscular Thyroid gland - Parathyroid gla
Posterior Triangle Occipital
Subclavian
Lymphatics
Lymphatics Spread of infection/cancer
Tongue Drainage
Fascia
Carotid Sheath
Face
Development Frontonasal Prominence Forehead - Upper eyelids -
Maxillary Prominence 1st Pharyngeal Arch (CN V) Cheeks - Upper jaw - Upper lip -
Mandibular Prominence Mandible - C
Muscles of the face Facial n. (CN VII): To-
Muscle&Nerve
Physical Exam Elevate eyebrows - Clinch eyes tightly - Smile - Sensa
Cleft Lip/Palate
Bell's Palsy
Trigeminal Neuralgia
otid
Parotid Gland
Parotidectomy Salivary gland cancer
Spinal Acc. N. (XI) (Test) Shrug shoulder, Turn head against resistance
Trauma at delivery-> scarring,shortenedmuscle; spasms of SCM
Submandibular gland - Submandibular lymph
- Hypoglossal n. (CN XIII) - Su
4 muscles (Splenius capitis, Levator scapulae,4 nerves (Lesser occipital, Great auriular,
Deep nerves (CN XI, Brachial plexus [
Anterior scalene m. - Phrenic n. - Suprascapuplexus (lo
Body -> Thoracic duct; R face, upper(Head/Neck) Superficial [EJV] ->
D
Bilateraldrainage Middle anterior 2/3 -> Inferior deep;Posterior 1/3 -> Superior deep
Allow sliding - Compartments contain infection - Spaces provide rSuperficial -> (Deep) Investing -> Visceral [Pret
Retropharyngeal Inferior open to Prevertebral& buccopharyngeal
Invasion by Resect depends on extent of
2nd Pharyngeal Arch (CND26 (OPM) - Early W4 (5 Prom) - Late W4 (Plac; Mand fz) - W5 (Pit/Prom; Aur; ONM) - W6
Failed fusion of prominences: medial nasal& maxillary- or -
Danger Triangle of Top ofnose to Upper lip Veins have no valves; route of infect
Compression/Lesion of Motor; Facial n.;paralysis of muscl
CN V, Artery compressing? Sensory; Trigeminal n. (V2
commo
Structures: G-E-R-A-F - Innervation: I Got Time, L
Remove parotid, must preserve
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Par
Frey's Syndrome Parotidectomy
DeepNeck
Internal Jugular Vein IV site, lateral to carotid a. I've got a lovely bunch of coconut
Thyroidectomy
TracheostomyTorticollis
Raynaud's Syndrome
Sympathectomy
Horner's Syndrome
Fac
ialn.
(CNVII Motor Damage
Autonom
ics
Lacrimal gland
Mucous glands
Facial n. (VII) Damage Laceration Following parotid surgery
Bell's Palsy Big ones, small ones, some as big as your head; give them a twist a flick of the wri
n
inges&
D
Scalp
Anastomoses Internal & External carotid aa. anteriorly (4 near orbit) - Left
Scalp Lacerations Profuse bleeding
Scalp Veins Spread of infection
s
Epidural Hematoma
Auriculotemporal n. synapses on sacetylcholine at both synapses -> S
Arterial supply= Superior transient hoarsenessParathyroid glands = closely as
Avoid inferior thyroid v.or thyroid ima a.to avoid excess ble
Thoracic OutletSyndrome
Compression ofneurovascular between
Spasm, contracture ofscalene mm.-> pull 1st rib up; also caused by
Excessive sympatheticdischarge
Artery constriction ->hypothermia, LOS, cyanosis,necrosis of digits
Cut sympathetic system Vessels dilate -> blood flow to
Cervical sympatheticchain interruption
Ptosis (drooping eyelid), Miosis ( sweating), Flushing (capillary dila
General SensoryDamage
Internal acoustic meatus, Geniculate ganglion,stylomastoid foramen; external auditory meatus, auricle of
Taste (Special)Sensory Damage
Geniculate ganglion,petrotympanic fissure , chordatympani-lingual n.; anterior 2/3 of tongue
Brainstem, stylomastoid foramen; TZBMC, PostAu, Stylohy,PostDi, Plat, Stapedius (facial canal)
Superior salivary nucleus, Greater petrosal/N. of pterygoidcanal, hiatus, Pterygopalatine gang, CN V2, CN V1; lacrimal
Superior salivary nucleus, Greater petrosal/N. of pterygoid
canal, hiatus, Pterygopalatine gang; mucous glands of nose,Sublingual/Submandibular
Superior salivary nucleus, Chorda tympani, Submandibulargan, CN V3; sublingual & submandibular glands
Galea aponeurosis & dense CT->
Emissary & diploic v. traverse scalp,
Arterialtear (middle
meningeal a. often)
Between dura & inner table of
skull; fairly confined d/t tight
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lp,
CranialCavity,
M
MeningeSubdural Hematoma
DuralSin
use
Pituitoma Pituitary tumor
Venous Drainage Communication of facial v. -> ophthalmic v. -> cavernous sinus
rossBrai
Frontal Lobe Reason - Organization/Planning - Personality - Writi
Parietal Lobe Understanding (sensory) - Sensory - Hearin
Occipital Lobe Vision - Processing (vision)
Temporal Lobe Mood - Virtual (memory) - Sm
Brain
stemD
evelopment
Brainstem
Neural Tube DefectsSpina bifida Spina bifida occulta
Occulta
Cystica
Tethered Spinal Cord
Dermal Sinus
Diastematomyelia
Lipoma w/ spine Ectopic fat
Filum terminale Fibrous bands
Chiari Malformation
Type I
Type II
W1 (Imp) - W2 (Lay) - W3-4 (Neu) [D:18,20,22,25,27] - W4-7 (NuTu) - W5-6 (VenInd)
W5-12 (Expansion) - W7-24 (Cortex) [M3-6 (NuMig)] - M7-Y1 (NuMat) [cone,guide]
Operculation
Platelet Activating Factor
Venous tear Between dura & arachnoid; morediffuse, can resolve d/t proteases
Sub-ArachnoidHematoma
Cerebrala. tear(intracranial)
Blood in sulci(grooves) of brain;bloody CSF; clot -> CSF
Cavernous Sinus
Thrombosis
Hemorrhagic stroke in
cavernous sinus
Internal carotid fills sinus -> clot ->
compress structuresGrow into cavernous sinus ->
ForTeD (Fore=Tele+Dien) - MiMes (Mid=Mes) - HiTMyBell
W4 (NuFo fz, Limb, CNS, NuMig) 3 ves, 2 flex - Intermediate (Alar/Basal) vs. Marginal (w
Defect closure of neural Nutritional factors - (70% reduced)Defect vertebral arch
Level L5 or S1 No neurological symptoms - Dimple
Meninges/tissue Meningocele (no cord) - Meningomy
Attachmentat distal end Stretches spinal cord, neurologic
Opening of skin in midlineAttachedto dura -> Tethering; Co
Spinal cord division Thoracic and down; Septated-> No
Connected to lower end of cord -> Te
Thickening & fixation of cord -> Tet
Caudal cerebellumherniates through
Compress caudal medulla & uppercervical spinal cord
Isolatedmalformation; No symptoms until adulthood
Associatedw/ lumbar meningomyelocele & hydrocephalus
Dandy-WalkerMalformation
Cerebellar vermisagenesis w/ cysticdilation of4th ventricle
Associated w/ other abnormalities:corpus callosum agenesis,malformed: heart, face, limbs, digits,
Insular cortex Insular grow slow -> infolding; Failur
Growth cone collapse PAF collapses neuron growth cones -
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Telence
phalon
Genetic/Chromosomal
Teratogen Exposure Environmental agent Born with physical defect - Developm
N
eurulationAnencephaly
Meroanencephaly
Encephalocele
Prosenc.
Holoprosencephaly
Ne
uralMigration
Lissencephaly
Schizencephaly
Heterotopia
Pachygyria
Callosal Agenesis
O
ther
Hydrocephalus
Microcephaly
Primary
Secondary
CranialSutures
Craniosynostosis
Acrocephaly ["Acro" ~ "High"] High, tower-like he
Brachycephaly
Oxycephaly ["Oxy" ~ "Boxy"] Pointed head
Plagiocephaly
Scaphocephaly
Congenital Birth Born with birth defect - Physical defe
AbN neural tube closure No brain & cranial vault
No brain & cranial vaultbut,
AbN neural tube closure;CNS herniation
Midline defect in cranium formation;Meningocele,
Meningoencephalocele,Failed forebraincleavage
1 cerebralstructure, 1 ventricle;No: longitudinal fissure, corpuscallosum, olfactory bulbs
No neuroblastmigration Smooth brain surface; Nooperculation, gyri, differentiation
Focalmigrationaldefect Clefting ofcerebral cortex(may b
Miller-DiekerLissencephaly
LIS1 (hemiz. deletion17p13.3)
LIS1 co-localizes microtubules,regulates PAF hydrolase -> AbN
AbN neural migration Neurons accumulate in whitematter; improper connections b/c
Incomplete gyri Large gryi, complete folds but too
Defect lamina terminalisgrowth
No corpus callosum; defective 2fold -> often no cingulate gyrus
CongenitalHydrocephalus
Accumulation ofCSF Communicating = Structures intact,communicating = Physical blocka
Obstructivehydrocephalus; Fail braindevelop; Vascular defect;
CSF replaces brain matter; nocortex, only brainstem; babylooks/behaves normally at first; no
'Infectious idiology Smallcranial vault & brain
Genetic factors In first 7 prenatal months
Environmentalfactors In 8th & 9th prenatal mo. or post-
Mesenchymal defects; Metabolic bone disorder; Intrauterine
["Brachy" -> "Broad"] Broad head; R
Coronalsuture
Coronal& Lamboid ["Plat" -> "Flat"] Flat on one side, u
Sagittalsuture ["Scapho" ~ "Scaffold"] Long, narro
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Trigonocephaly
Orbit
Bones of the Orbit Zeus Made Leda Erotic For Swan Pals (start inf
Blow-Out Fracture Blunt trauma to head/face
Eyelid
Sty
Chalazion
Pink Eye Pink coloration of sclera due to inflam
Conjunctivitis an infection of the conjunctiva
Eye
Diplopia Double vision
Actively displace the globe forward w
Central Retinal a. & v.
There's nothing herewellexcept this
Medial Strabismus
AutonomicsoftheEye
Lacrimal gl. & Muller's m.Parasympathetic Path
Sympathetic Path
Pupil & Ciliary m. Parasympathetic PathSympathetic Path
Ptosis (Droopy eyed)
Pupillary Light Reflex
Accommodation
Presbyopia
Cataract
Hyphema
Glaucoma
["Trigono" -> "Triangle"] Triangular
Orbittal walls are thin, can fractured -
Obstruction ofciliarygland obstruction
Obstruction ofMeibomian (sebaceous/tarsal) glands
Inflammedconjunctiva
InfectedconjunctivaDue toparalysis of 1
Double Whammy Voluntaryocular
Blockage -> Blindness Arterialblock -> Instant, totalblindness; Venous block -> Slow,
Danger Triangle of
Abducent n. (VI) damage Loss oflateral rectus m. function
Some Folks Go Nuts Pickling Peppe
I Wanna Sleep, Could Do
Ever wish Inhaling opiatesCIf We Succeed, Itll
Sympathetic n. damage Symp to lacrimal gl. & Muller's m.
Parasympathetic (III)damage
Each retina sends fibers to both sidsphincterpupillae -> ipsilateral slopposite side
Ciliary muscles relaxed Fibers taut-> pulls on lens -> foc
Ciliary muscles Fibers slack-> lens rounds -> foc
Hardening lens Occurs with age; harder, flatter lens -
Loss oftransparency Lens becomes opaque; occurs with a
Blunt trauma to eyeball Hemorrhage into anterior chamber
Humoral drainage Accumulation ofaqueous humor->
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Effect/Symptom
. - Submental vv. (to Anterior jugular v.)
. [CN X]) - Hypoglossal n. (CN XII) - ECA
d - Infrahyoid mm. (ST, SH, TH)
ose - Nasal cavity - Septum
Secondary palate - Lateral nose
in - Lower Lip
anzibar-By-Motor-Car
tion in each region of face
Weak trapezoid&
Headtilts towardinjured side Chinturned superiorly to opposite side
nodes - Mylohoid m. - N. to mylohyoid (CN V3)
mental a. - Facial a. - Facial v.
Posterior scalene, Middle scalene) -Transverse cervical, Supraclavicular) -Dorsal scapular, C5 & C6 root]) - Transverse
lar a. - Subclavian a. - Subclavian v. - Brachialwer roots)
limb, chest -> R Lymphatic duct;Superior deep;ep [IJV] (Superior & Inferior) ->
Spread ofcarcinoma
oute - Planes of surgical cleavagerach./Buccopharyn.] -Retropharyn.
Routeof infection to mediastinum
Ansa cervicalis embedded in sheath
(Cho) - W7-10 (Fz; 2Pal) - W10-14
djacent medial nasal
ion from face to dural sinus -> CNS
les of facial expressions on one side
); sharp, sudden attack ofpain; tic
t'sOrder Another Pint
Post-resection -> Frey's Syndrome
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ts, there they are standing in a row
Minor loss of sensation
Loss of taste to anterior 2/3 of tongue
ist, that's what the showman said
ide & Right side throughout scalp
eat glands of cheek ->alivation = Sweating on cheek
unk; [10%] Thyroid ima a.
upil constriction),Anhidrosis (no
tion), Enophthalmos (eye sinks in)
Loss of facial expresion -Hyperacusis (sounds seem louder
Slightly dry mouth - nasalsecretions - Dry eye
facial express'n - sensation -
Rigid; causes arteries to "gape open"
enetrate skull, drain to sinus (venous
Lens-shapedclot - May result in lossof consciousness -> lucid -> coma ->
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Transmission of infectious particles
ng - Movement - Speech
g - Associations
ell
- Spina bifida cystica
- W8-16 (Prolif) - M3-5 (NuMig)
- M7-B (Gy/Sul) - M3-Y2 (Myel)
Concave X-raypattern - Blood inone hemisphere - Shaken-babySyndrome
"Worst headache of my life" - Stiffneck - Loss of consciousness
CN III (oculomotor), IV(trochlear), VI(abducent), V
1
(ophthalmic), V2
(maxillary)
(Hind=Met[pons]+Myel[medulla]
hite) - W5 5 ves, 1 flex - M4 (Myel)
Folic acid - (Causes) Valproic acid,
nd/or tuft of hair- 10% of
locele (cord/root) - Myeloschisis
Pain - Sense - Weak - Incont'nce -
municate w/ spinal canal ->
rejoining;Aseptate -> 1-2
thering
ering
Headache - Pain - Weakness -
Sensory s - Hoarseness - Facialnumbness - Resp dysfxn -Uncoordina'd movmnt - Dysrhythmia-Slow motor development - Enlargedskull- 1:25-30,000
e to operculate = immat. brain,
repels neuronal
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ental delay in neonatal period
This clinical correlate load makes it feel like Block 1A again =)
d; Vertical forehead
ts often primary symptoms or 2 to
Dx: (12-16 weeks) Ultrasound-Polyhydramnios - AFP - 1:1000
Dx: (12-20 weeks) - Syndromic(often 2, not limited to CNS) - 1:2000
- Occipital meningoencephalocele = MEC,Craniofacial dysplasia - Midlinefacial abnormalities (Cyclopia)
Dx: (>32 weeks) - Developmentaldelay - Seizures - Mental retardation
thin or absent)
Hypertelorism - jaw - brow - Upnares - philtrum - Bitemporal
AbN operculation - Under-developed surface - Epilepsy - 2
Dx: (>20 weeks)
CSF productionNon-ge of CSF movement
Dx: (20-36 weeks) - Often seizures -Transilluminating skull
Dx: (18-36 weeks) -Small skull - 2facial abnormalities - Normal facesize - Head circumference > 2SD
Premature fusion of 1 cranial
cessed forehead
ilateral
w head
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rolateral & go CCW)
"a little more serious"?
mation of the conjunctiva
hile retracting the eyelids
Cross-eyed
Horner's Syndrome
ead; Vertical ridge in midforehead
> contents of orbit leak into adjacent
Diabetes -> Retinopathy-> Retinalvessel damage -> blindness
rs, Zucchinis, Cucumbers, Lemons &
ning Nine Zanax Let Me?
uld Somehow Cure Sickness?l Open Some Doors
es, damage -> compromisedwness of response, dilation of
l length ~ object distance =
l length ~ object distance = close
> reduced focusing power
e or certain steroids
of eyepressure in chambers of the eye
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Triangle Muscle Nerve Artery Vein Other
Submental Mylohyoid Small vv. form AJV Subme Nodes
Mylohyoid Submental Facial Subma Glands
Facial Subma Nodes
Muscular Sternothyroid Thyroid gland
Sternohyoid Parathyroid gland
ThyrohyoidCarotid Hypoglossal (CN XII) External carotid Carotid Sheath*
Vagus (CN X)* Internal jugular*
Occipital Splenius capitis Lesser occipital Transverse cervical
Great auricular
Transverse cervical
Middle scalene Supraclavicular
[Deep]
Spinal accessory (CN XI)
Subclavian Anterior scalene Phrenic Subclavian Subclavian
Brachial plexus (lower roots) Suprascapular
Submandibular
N. to mylohyoid (CN V3)Hypoglassal (CN XII)
Common carotid*Internal carotid*
Levator
Posterior
Brachial plexus (C5 & C6
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Phrenic nerve
Between anterior and middle scalene mm.
Ansa cervicalis Embedded in carotid sheath
Dorsal scapular n. Pierces middle scalene m.
Occulomotor (III) Leave brainstem between Posterior cerebral & Superior cerebellar aa.
Vagus (X) Medial & deep to phrenic n.
Spinal accessory (XI)
Hypoglossal (XII) Exits hypoglossal canal; Runs w/ C1 from cerival plexus loop 1
Anterior scalene Sublclavian a. is behind, Sublclavian v. is in front
Subclavian a. Deep to anterior scalene m.
Ansa subclavia Pre-Symp; Joins middle (C5-6) & inferior (C7-8) ganglia
Sympathetic chain
Anterior of anterior scalene m. w/ ascending cervical a.; Pinned by transverse cerv& suprasca aa.; Lateral & superficial to Vagus n. & Sympathetic chain
C6)
Exits jugular foramen; Runs over levator scapulae m.; Communicates w/ cervicalplexus loops 2 & 3
Vertebral, Thyrocervical trunk [Infer thy, Ascen & Transv cerv, Suprascap],Internal thoracic (second) Costocervical trunk [Deep cerv, Highest intercos]
(third) Suprascapular, Descending scapular
Medial to phrenic, Deep to carotid sheath, In prevertebral fascia; C1-4 (Post-Sym),C5-6, C7-8
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Vesicle Region Alar plate Basal plate Cavity CN
Medulla (Caudal) Pyramids
Cuneate nuclei [lateral] -Choroid plexus
(Rostral) Motor nuclei -3 foramen
Motor nuclei V, VI, VII
Midbrain Motor nuclei (tegmentum) Cerebral aqueduct IV
(Ventral) Cerebral peduncle
Diencephalon Forebrain NONE 3rd ventricle
Thalamus: Massa intermedia
Hypothalamus
Pituitary gland: Neurohypophysis
Myelencephalon
(Caudal) Gracile nuclei [medial] 4th ventricle, VIII, IX, X, XI,XII
(Rostral) Sensory & Inferior olivary
Metencephalon
Pons,Cerebellum
Rhombic Lip -> Cerebellar, Pontine,Cochlear, Vestibular nuclei
4th ventricle,cranial(Marginal) Cerebellar
pedunclesMesencephalon
2 inferior colliculi (auditory),2 superior colliculi (visual)
Epithalamus: Pineal gland,
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Disorder/Drug Problem/Target Cause/Mechanism
Prevertberal
Dens (Axis) Hangman's fractures, rheumatoid arthritis (lax ligaments), Dow
Whiplash Injuries
Stellate Ganglion
CN IX Problems
Vagus (CN X)
CN X Problems
Carotid Massage
Spinal Accessory (CN XI)
CN XI Problems
Hypoglossal (CN XII)
CN XII Problems
Horner's Syndrome
Tympanic Membrane
Otitis Media
Raynaud's Syndrome
ity&ParanasalSinus
es
Palate&Pharynx
Anterior Clefts
Posterior Clefts
Velopharyngeal Seal
CN X Lesion
salCavityNasal Mucosa
Rhinitis
Anterior longitudinal ligament & Longus collim. injury
Vertebral ArteryDissection
Arterial intima separates 2 to minor trauma: spinalmanipulation, "ceiling painting",
C7-T1 sympathetic fusion Located at C7; affected bypancoast
Glossopharyngeal (CN Jugular foramen; (Sense) Phary, Tons, Pal, Tong-post1/3, (Tas(Test) Gag Reflex- (Damage) Salivation, Minor difficulty s
Jugular foramen; (Sense) Ext. Ear, (PrePara) Almost all of body,
(Test) Gag Reflex, Uvula deviates away from damage -(Dama
Massaging the Carotid Baroreceptors in sinus, ICA, CN IX
Spinal (C1-5), Foramen magnum, Accessory [cranial] (brainstem
(Test) Shrug against, Lat. flex headagainst -(Damage) Trap
Glomus Jugulare Tumor in jugular Compression of transmitting
Hypoglossal canal; (Motor) Tongue-Int/Ext, "-glossus"
(Test) Stick out your tongue -(Damage) Tongue towards, Diffi
Sympathetic chaindisruption
Flushing (blood vessel dilation),Anhconstricts), Enophthalmos (eyesin
CN IX(outside) CN X Ear infection, TM inflamed -> volle
Middle earinfection (Children) angle of auditory tubeallows ingested fluids to travel to
Excessive sympathetic Arterial vasospasmin upper
Anteriorto incisiveforamen
No fzn ofmaxillaryw/ medialnasalLips, Upper jaw, Between1 & 2
Posteriorto incisiveforamen No fzn ofshelves(size/notonguedrop) 2 palate, Uvula
Swallowing -> soft palate elevates -> uvula contacts superio
VelopalatalInsufficiency
Incompetent sealbetween soft palate & wall
Foods & liquids pass intonasopharynxduring swallowing
Uvula deviates to leasion
Secretions trap articles -> swept posteriorly -> swallowed; Cilia
Inflammation d/t UpperRespiratory InfectionsorAllergies
Infections can spread to: Anterior craNasopharynx & Retropharyngeal soft(auditory tube) - Lacrimal apparatus
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P
alate,
NasalCa N
CSF Rhinorrhea Clear nasal discharge
Para
nasalSinuses
Water's Projection
Maxillary Sinus
Sinusitis
Optic Neuritis
Kiesselbach's Area
Epistaxis Nosebleeds
Pterion
Pha
rynx
Brachial Cyst
Brachial Fistula
First Arch Syndrome
First Arch Syndrome
First Arch Syndrome
DiGeorge Syndrome
mporal/Infratempo TMJ TMJ inflammation Meniscus lesions affect both moveme
Ischemia Maxillary a. supplies blood to anterior 1/3 of the face; diffuse pai
Mandibular n. (V3) Damage or impingement
Ear
Preauricular Pits
Hyperacusis
Otitis media
Head trauma -> fracture ofcribifor
Posteroanterior radiographic "open mouth" view to visuali
Highplacement->poordrainage; Maxillary molar removal-cavity -> infection; Maxillary teeth & sinus same innervation ->
Inflamed paranasal Swelling blocks opening -> poor
Posterior ethmoidcell
sinusitis
Fragile medial wall (orbit), near optic
canal -> infection to optic sheathAnt. nasal septum: Sphenopalatine - Septal br. of sup. labial -
Rupture of cavernous mucosa -> sev
"H": Frontal - Parietal - Temporal - Sphenoid; Thin wall; Middle
Persistent cervical sinus Cyst on anteriorofSCM m. =
Persistent 2nd cleft &pouch
Membrane rupture btwn cleft &pouch -> tract from pharynx to
Thyroglossal Duct Persistent thyroglossal Cyst along duct = midline of neck
Neural crest cells Insufficient NCC -> AbN
Treacher-CollinsUnder-developed
zygomatic b., sma
Pierre-RobinSyndrome
"Triad": insufficient NCC for bone -normally but space -> no descentcleft palate;posteriorplacement o
Undifferentiated pouch 3& 4
No thymus and/orparathyroid: Im (PTH/calcitonin), micrognathia & pe
TemporomandibularJoint Dysfunction
Hypomobility Muscles too tightin
Hypermobility Subluxation ligament/capsulestretched; articular surfaces still in
Dislocation, torn meniscus/articulardisc; condyle anterior to articular
Cannot clinch jaw, difficulty chewin
Auricles fail to form
Preauricular Accessoryauricles
Stapedius/Tensor Loss of function -> can't reduce mo
Middle earinfection Chronic, untreated -> can lead to CN
Secondary Otitis Nasopharynxinfection Usually Strep., infection travels to mi
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Mastoiditis
Tympanosotomy Tube in your ear
Ostoscelrosis
SpecialSenses
Eye
Corneal Endothelium
Cataracts
Glaucoma
Closed Angle Canal of SchlemmOpen Angle Canal of Schlemm
Congenital Unknown
Retinal Detachment
Macular Degeneration Retinal deterioration
Dry Type
Wet Type
Ear
Attentuation Reflex
Otosclerosis Oval window
Otitis Media Middle ear infection
Larynx
Laryngeal carcinoma Smoking, chewing tabacco
Nerve injury
External Laryngeal n. Nerve injury
Larynx & Puberty
Mastoidprocess infection From untreated, acute otitis media
Txfor chronic ear infections; slit T
Stapes & Oval window AbN bone growth -> limited
Damage to inner corneal Normal (ion in, fluid out); Damage -
Lens opacity Impaired vision with age, diabetes,
Intraoccularpressure Pathological pressure >20 mmHg ->
Defective canal; shallow anterior chCanal of Schlemm seems normal but
Separation atpigmentepi&photoreceptor
Retinal field deficits, retina relies onvascular supply from choroid
Loss ofcentral vision
Atrophic, Non-exudative d/t thickening Bruch's, atrophy ofpi
Neovascular, Exudadtive d/t neovascularization w/ fragile ve
Dampen ossicular Intense sound -> tensor tympani&
Conductive Hearing Mechanicalimpedment Externalor middle earSpongy bone growth that can impe
Sensorinerual Hearing Neural/Haircell injury Organ of Cortior hair cells
Laryngeal cancer
Recurrent Laryngealn.
Vocal cords paralyzed; disease inchest can affect by
Cricothyroid m. paralyzed; no vary
Testosterone changeslarynx
Larygneal cavity& all cartilagessize; AP diamtere ofrima glottis
doubles; vocal folds
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Effect/Symptom
's syndrome (lax ligaments), sports
Severe occipital headache, post.nuchal pain -> neuro symptoms of
tumors; Blocked for: arm pain,
te) Tong-pos1/3, (PrePara) Parotid,allowing
GI [to splenic flexure] (Motor) Lary,
e) Hoarseness, Minor difficulty
Tx: SVT - Associated risks
),Jugular foramen; (Motor) SCM, Trap
&SCM,Abduct armpast horizon,
Deficits: CN IX - CN X - CN XI
m. exceptpalatoglossus m.
ultyswallowing, Slurred speech
ydrosis (no sweat), Miosis (pupils), Ptosis (Drooping eyelid)
of sense to IX & X -> GI motility
Referred pain, cough/nausea d/tvagal br. to external ear - Check
Finger necrosis -Tx:
(Lip) 1/1000, 80% male(Palate) 1/2500, 67% female [fz 1
wk later]
r constrictor m. -> velopharyngeal
nhibitedby
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Infection
Blindness
Pharyngeal & Facial deformities
nts (sliding & hinge)
Diffuse neurovascular problems
from artery impingement
plate -> tearing ofmeninges ->
ize maxillary& frontalsinuses
> communication of sinus & oralsinus inflation -> "Toothache"
nt. ethmoid - Post. ethmoid - Greater
re bleeding, coag AbN, severe HTN
eningeal a. underneath ->
Fluid/Cell debris -> size - Tx:
Travels between ICC & ECC aa. -Infection - Discharge of saliva - Tx:
Swelling - Tx: Surgery
ll mandible, defects ofexternal ear
micrognathia; tongue develops-> palatine processes can't fz ->ftongue -> glossoptosis -> risk of
unologicproblems, hypocalcemiarsistent truncus arteriosus(NCC
May self-reduce
Manually reduce - Pain (manynerves)
, lateral pterygoids ->jaw
vement of ossicles - > can't
VII paralysis, meningitis, brain
iddle ear;posteriorspread ->
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Progressive conduction deafness
Trauma - Drugs - Infections - Aging
Brain complications - Child mortality
, insert tube, drains fluid
> fluid accumulates in stroma ->
UV exposure, smoking, infection
retinal & optic nerve damage
amber, narrow filtration anglefunctions inadequately
Trauma - Intraocular pressure -Vascular disease
ment epi, loss ofchoroid layer
ssels that leak/hemorrhage ->
stapedius contract -> ossicles rigid
Wax - TM perf - Otitis media -e sound conduction
Dysphagia - Dysphonia - Tx
Hoarseness - Stridor(high-pitch,noisy)
Monotonous voice - Laryngitis -
Vocal tone drops 1 octave
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Head & Neck
Anatomical Feature Origin Insertion Function Innervation
Su
perficialNeck
Sup
erficial
Platysma Cervical br. of VII
Spinal accessory (XI)
Suprahyoid
Digastric (anterior)
Hyoid bone
Mylohyoid Hyoid bone; Median raphe
Stylohyoid Styloid process
Hyoid bone
N. to stylohyoid (VII)
Geniohyoid
Infrahyoid
Thyrohyoid
Omohyoid (inferior)
Sternohyoid Depress hyoid & larynx
Sternothyroid Manubrium Depress thyroid cartilage
De
ep Anterior scaleneus 1st rib: scalene tubercle
Adjacent cervical nn.Middle scaleneus 1st rib: scalene tuberclePosterior scaleneus 2nd rib
ssion
Eye
Occipito(frontalis)
Close eyelids
Temporal br. of VII
Nose
Procerus Wrinkle bridge of nose
Buccal br. of VII
Nasalis Dilate nostrils
Depressor septi Draw (inferior) septum
Orbicularis oris Pucker-Up Close, Shape (speech) lips
Superficial fascia:upper pectoralis major
Mandible: inferior border;Skin & Facial mm. over
Depress mandible; Depresslower lip; Tense neck skin
Sternocleidomastoi
d
(Sternal head)
Manubrium (Clavicularhead) Clavicle: medial1/3
Mastoid process;
Superior nuchal line: upper1/2
(Unilateral) Flex, Rotate
neck; Turn (superiorly) chin(Bilateral) Flex,
Extend neck
Mandible: Digastricfossa Elevate hyoid (swallowing);
Depress mandible
N. to mylohyoid [br. ofInferior alveolar (V3)]
Digastric(posterior)
Temporal bone:Mastoid notch
N. to posterior belly ofthe digastric (VII)
Mandible: Mylohyoidline
Elevate hyoid, mouth floor,tongue (swallowing)
N. to mylohyoid [br. ofInferior alveolar (V3)]
Elevate hyoid (swallowing);
Depress mandibleMandible: inferiormental spine C1 spinal, ventral rami
[w/ Hypoglossal (XII)]Thyroid cartilage:oblique line
Depress hyoid;Elevate thyroid cartilage
Omohyoid(superior)
Suprascapular notch:medial edge
Depress, Retract hyoid &larynx
hypoglossus, ansacervicalis, superior, C1
Ansa cervicalis C1 - C3Manubrium; Clavicle:medial end
Thyroid cartilage: oblique
Cervical vertebrae:
transverse processes
Elevate rib 1 & 2;
(Unilateral) Flex , Rotateneck; (Bilateral) Stabilize
Raise eyebrow; WrinkleTemporal br. of VII
Orbicularis oculi
Orbicularis oculi Zygomatic br. of VII
Corrugator Draw (inferior; medial)
Levator labiisuperioris alaequenasi
Elevate angle of mouthElevate upper lip
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FacialExpre
Mouth
Smile
Zygomaticus minor Elevate angle of mouth
Zygomaticus major
Levator angulis oris
Risorius Retract angle of mouth
Buccinator Pucker-Up Compress cheeks
Frown
Depress angle of mouth
Mandibular br. of VIIDepress lower lipMentalis Protrude lower lip
Ear
Auricularis anterior Retract earTemporal br. of VII
Auricularis superior Elevate ear
NeckPlatysma Tense skin of neck Cervical br. of VII
Orbit
Eyelid
Orbicularis oculi Closes eye T & Z br. of VII
Superior eyelid
Opens eye
Oculomotor (III), superior
Muller's palpebral
Eye
Medial rectus
Sclera: anterior to equator
Medial Oculomotor (III), inferior
Lateral Abducent (VI)
Superior rectus Medial Superior Oculomotor (III), superior
Inferior rectus Oculomotor (III), inferior
Superior oblique Sclera: posterior to equator Trochlear (IV)
Inferior oblique Lateral Superior Oculomotor (III), inferior
Dilator pupillae Dilate pupils
Sphincter pupillae Constrict pupils
Ciliary Manipulate lens
Prevertebral
Longus colli Flex, Rotate neck Spinal C2 - C6Longus capitus Occiput Flex, Rotate neck Spinal C1 - C3/4
Atlas Occipital boneFlex atlanto-occipital joint Spinal C1
Occipital: jugular process
StyloglossusSkull, Styloid process
Tongue Elevate, Retract tongue Hypoglossal (XII)
Stylohyoid Hyoid bone Facial (VII)
Stylopharyngeus Pharnyx Elevate pharynx Glossopharyngeal (IX)
Tensor veli palatini
Levator labii
Despressor anguli
Depressor labii
Auricularis
Levator palpebraesuperioris
Sphenoid: superior tooptic canal
Levator palpebraesuperioris m.: inferior Tarsal plate: superiormargin Sympathetic[IWSCDNZLM]
Common tendinousring (Annulus of Zinn)
Lateral rectus (2
Medial
Sphenoid: superior to Lateral
Maxilla:nasolacrimal Globe: posterolateral
Sympathetic
Parasympathetic[EwIoCSCS]
C1-T3: slips to vertberal bodies & transverseC3-6: transverse
Rectus capitus
Rectus capitus Atlas: transverse
Medial pterygoid plate:scaphoid fossa;Sphenoid spine;
Pharyngotympanictube
Palatine aponeurosis;(Hook) Medial pterygoidplate: hamulus
Tense soft palate; Open(assist) auditory tube
Medial pterygoid br. of V3
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Palate
Levator veli palatini Palatine aponeurosis
Vagus (X)
Palatoglossus Palatine aponeurosis Tongue: lateral portion
Palatopharyngeus Palatine aponeurosis Pharynx: lateral wall
Musculus uvulae Uvula: mucosa
Constrictor mm.Median raphe
SwallowingPharyngeal plexus (X)
Superior constrictor Velopharyngeal seal
Mouth
Pharynx
Stylopharyngeus
Elevate pharynx
Glossopharyngeal (IX)
Auditory tube, posterior
Vagus (X)Palatopharyngeus
Submand.
Mylohyoid
Geniohyoid
Stylohyoid
Tongue
Intrinsic mm. Longitudinal, Vertical, Transverse Alter shape of tongue
Hypoglossal (XII)
Genioglossus
Hypoglossus
Tongue: sidesStyloglossus Styloid process Retract, Elevate tongue
mporal
Zygomatic process Mandible: ramus
Stylomandibular Styloid process Mandible: angle
Sphenomandibular Sphenoid bone Mandible: lingual
Masseter
Temporalis
Auditory tube:cartilage; Temporalbone: petrous
Elevate (superior, posterior)soft palate [swallow, yawn]
Elevate tongue (posterior);Draws soft palate to tongue
Tense soft palate; Pull(superior, anterior, medial)
pharynx [swallow]Palatine aponeurosis;Palatine bone:posterior nasal spine
Shorten, Elevate uvula;Closes nasopharynx[swallow, phonate]
Temporal bone: Styloidprocess
Thyroid cartilage (betweensuperior & middle
Salpingopharyngeus
Blends into fibers of middleconstrictor &
Hard palate, posterior;
Soft palate
Thyroid cartilage; blends
into pharynx
Digastric (ant &
Mandible: Genialtubercle (mentalspines)
Hyoid: body; Tongue:dorsum
Protrude, Retract, Depresstongue
Hyoid: body & greater
cornu
Depress, Draw (lateral)
tongue
Ligamen
t
Temporomandibula
Zygomatic arch:inferior border &medial surface
Mandible: ramus, lateral Elevate, Protrude mandible;Close, Abducts jaw
Masseteric br. of V3
Temporal fossa: floor;Deep temporal fascia
Mandible: ramus, anterior;Coronoid process
Elevate mandible;Close, Abduct, Retract jaw
Deep temporal br. of V3
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Temporal/Infrate
Mastication
Medial pterygoid
Lateral pterygoid
Ear
Tensor tympani Auditory tube Malleus: handle Tenses tympanic membrane
Stapedius Pyramidal prominence Stapes: neck Movement of stapes Facial (VII)
Larynx
Cricothyroid Cricoid cartilage: arch Tense vocal folds (chief)
Vocalis
Recurrent laryngeal (X)
Thyroarytenoid
Abduct vocal folds
Adduct vocal folds
Runs between Arytenoid cartilage, posterior
Oblique arytenoid
(Superficial) Maxilla:tuberosity;(Deep) Sphenoid:Lateral pterygoid plate,medial surface
Mandible: ramus, medialsurface
(Unilateral) Grinding motion(Bilateral) Elevate mandible;Close, Protrude jaw
Medial pterygoid br. of V3
(Superior) Sphenoid:greater wing,infratemporal surface &crest; (Inferior)Sphenoid: lateralpterygoid plate, lateralsurface
Mandible: neck;TMJ: articular disc &
capsule
(Unilateral) Side-to-sidemotion (Bilateral) Protrude,Adduct mandible; Open jaw
Lateral pterygoid br. ofV3
Medial pterygoid br. of V3
Thyroid cartilage: inferiorhorn & lower border
External laryngeal (X)
Thyroid cartilage:
anteromedial lamina
Arytenoid cartilage: vocal
process; Vocal ligament
Adjust tension of vocal
folds; (fine tune)Thyroid cartilage: innerlamina
Arytenoid cartilage:anterolateral surface
Relax vocal folds;Close rima glottis
Posteriorcricoarytenoid
Cricoid cartilage:posterior lamina Arytenoid cartilage:
muscular processLateralcricoarytenoid
Cricoid cartilage: upperborder
TransverseAdduct vocal folds;Close rima glottis
Arytenoid cartilage:muscular process
Arytenoid cartilage: apex;(Aryepiglottic m.)
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Vascularization
Facial(Submental,Inferior labial,Superior labial,
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Long ciliary
Angular),Transversefacial,Supraorbital,Supratrochlear
Ophthalmic(Central retinal,Posterior ciliary,
Meningeal,Lacrimal,Supraorbital,Supratrochlear,Post. ethmoidal,Anteriorethmoidal,Dorsal nasal)
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Lingual a.(Dorsal lingual,Deep lingual,Submandibular)
Masseteric(2nd maxillary)
Deep temporal(2nd maxillary)
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Pterygoid aa.(2nd maxillary)
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Bone(s) involved Opening Type(s) of Fibers
FrontalSupraorbital a.
Ethmoid Cribiform plate CN I: Olfactory n. Smell
In the orbit
Communicating a.
Inferior orbital fissure
Inferior ophthalmic v.
Infraorbital a/v
Infraorbital canal
Infraorbital a/v
Nasolacrimal canal --
Zygomatic
Palatine
General sensory
Descending palatine a.
Descending palatine v.
General sensory
Lesser palatine a.
Lesser palatine v.
Palatine, Sphenoid Sphenopalatine a.
Sphenopalatine v.
MaxillaGeneral sensory
Sphenopalatine a.
Sphenopalatine v.
Maxilla, Sphenoid Maxillary a.
Mandible
Inferior alveolar a.
Inferior alveolar v.
SphenoidPterygoid canal N. of the pterygoid canal Pre-Para
Post-Symp
Optic canal CN II: Optic n. Vision
Ophthalmic a.
Structures
Supraorbitalforamen/notch
Supraorbital n.(V1)
Lacrimalforamen
Maxillary n. (V2)
Infraorbital n.(V2)
Zygomaticoorbitalforamen
Zygomatic n.(V2)
Zygomaticofacialforamen
Zygomaticofacial n.(V2)
Zygomaticotemporal Zygomaticotemporal n.
Greater palatine
foramen
Greater palatine n.(V2)
Lesser palatine foramen Lesser palatine n.(V2)
Sphenopalatine foramen Nasopalatine n.(V2)
Infraorbitalforamen Infraorbital n.(V2)
Incisive foramen Nasopalatine n. (V2)
Pterygomaxillary
Mentalforamen Mental n.(V3)
Mandibularforamen Inferior alveolar n.(V3)
Sphenoid(lesser wing)
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Sphenoid Superior orbital fissure CN III: Oculomotor n. General sensory
*3 TYPES OF FIBERS* CN IV: Trochlear n. Motor
(no special sensory) Pre-Para
CN VI: Abducens n.
Cavernous plexus nn. Post-Symp
Superior ophthalmic v.
Inferior ophthalmic v.
Foramen rotundum General sensory*GEN.SENSORY ONLY*
Foramen ovale General sensory
*3 TYPES OF FIBERS* Lesser petrosal n. Motor
(no special sensory) Pre-Para
Middle meningeal a. --
Greater petrosal n.
Internal carotid a.
Temporal
CN VII: Facial n. General Sensory
Motor
Carotid canal Post-SympInternal carotid a.
Greater petrosal n. Pre-Para
-- --
Petrotympanic fissure Chorda tympani n. Taste
CN VII: Facial n. Taste, Hearing
*ALL 4 TYPES OF FIBERS* General sensory
Motor
Pre-Para
Occipital, Temporal
Jugular foramen Taste
*ALL 4 TYPES OF FIBERS* CN X: Vagus n. General sensory
Motor
Ascending pharyngeal a. Pre-Para
Inferior petrosal sinus
Sigmoid sinus
Occipital
--
Medulla oblongata
Vertebral aa.
Hypoglossal canal CN XII: Hypoglossal n. Motor
*MOTOR ONLY*
Anterior cranial fossa -- --
Sphenoid, Temporal Middle cranial fossa -- --Temporal, Occipital Posterior cranial fossa -- --
(between greater &lesser wings) CN V1: Ophthalmic n.
Sphenoid(greater wing)
CN V2: Maxillary n.
CN V3: Mandibular n.
Foramen spinosum
Sphenoid, Temporal,Occipital
Foramen lacerum Cross over horizontally(do not run through
Stylomastoidforamen
Internal carotid plexus
Hiatus of facial canal
External acoustic
Internal acoustic
CN VIII:
CN IX: Glossopharyngeal
CN XI: Spinal accessory
Foramen magnum Spinal roots ofCN XI
, ,
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,
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Additional notes
Do not confuse with the superior orbital fissure!
Supraorbital a. comes from the ophthalmic a.
Synapse in olfactory bulb
Between middle meningeal a. and lacrimal a.
Leads out to infraorbital foramen
Big, vertical, medial; path for tears
Tiny, lateral in orbit on zygomatic bone
--
Behind arch
Big, by back teeth
Smaller, by back teeth
Right behind front teeth
Big hole on inside of mandible
Find when disarticulated
The maxillary n. splits into zygomatic n. andinfraorbital n.; this branch of the inferior
ophthalmic v. drains to the pterygoid plexus
Do not have to identify this because we cantsee it
In vertical line with supraorbital and mental
Teardrop shape, mandible must be removed to
In vertical line with supra and infraorbitalforamina
Can be considered part of anterior or middlefossa
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Drain to cavernous sinus
Drain to cavernous sinus
Round, going forward
Football shape
Otic ganglion just outside
Small, round, going down
Medial to FO
Between mastoid and styloid processes
Runs sideways just behind FO
--
Crack in front of styloid
Behind petrosal ridge,
From cavernous sinus to Internal jugular v.
Drains to internal jugular v.
--
Sideways, lateral to FM
Directly above the orbit
----
Crack on top of CC; Geniculate ganglion just
CN VIII is larger
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