Anatomy Block 1D Clinical Correlates

8/7/2019 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


9/33

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


10/33

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


11/33

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


12/33

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


13/33

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,


14/33

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


15/33

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


16/33

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


17/33

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


18/33

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


(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


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,


25/33

Long ciliary

Angular),Transversefacial,Supraorbital,Supratrochlear

Ophthalmic(Central retinal,Posterior ciliary,

Meningeal,Lacrimal,Supraorbital,Supratrochlear,Post. ethmoidal,Anteriorethmoidal,Dorsal nasal)


26/33

Lingual a.(Dorsal lingual,Deep lingual,Submandibular)

Masseteric(2nd maxillary)

Deep temporal(2nd maxillary)


27/33

Pterygoid aa.(2nd maxillary)


28/33

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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,


31/33

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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Documents

Anatomy Block 1D Clinical Correlates