Head and Neck

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Somatic Portions

030 - The scalp layer of loose connective tissue between the epicranial aponeurosis and the periosteum forms the subaponeurotic or "danger" space. Emissary veins connect with the dural sinuses with potential for __________ Hematogenous spread of infection through the calvaria.

031 - Cranial fractures preferentially pass through cranial foramina injuring the contained __________ Nerves.

032 - Principal Foramina of the Anteiror Cranial Fossa:
Foramen Contents Results of Injury
Olfactory __________ Olfactory nerves Anosmia
Foramen cecum __________ An emissary vein  

033 - Principal Foramina of the Middle Cranial Fossa:
Foramen Contents Results of Injury
Optic canal __________ CN II Unilateral blindness
  __________ Ophthalmic artery Ischemic unilateral blindness
Superior orbital fissure __________ CN III Ophthalmoplegia
  __________ CN IV Inability to look down and out
  __________ CN V Unilateral loss of blink reflex
  __________ CN VI Inability to abduct eye
  __________ Superior ophthalmic vein Retinal engorgement
Foramen rotundum __________ CN V2 Loss of sneeze reflex
Foramen ovale __________ CN V3 Masticatory paralysis, loss of jawjerk reflex
Foramen spinosum __________ Middle meningeal artery  
Foramen lacerum __________ Nothing (except occasionally the greater superficial petrosal nerve)  
Hiatus of the facial canal __________ Gr. Superficial petrosal n. Dry eye, loss of submandibular and sublinguinal secretion

034 - Principal foramina of the posterior cranial fossa:
Foramen Contents Results of Injury
Internal auditory meatus CN VII __________ Facial paralysis
  CN VIII __________ Auditory and vestibular deficits
Jugular foramen CN IX __________ Loss of gag and carotid reflexes
  CN X __________ Loss of cough reflex. Paralysis of laryngeal muscles and some palatine muscles
  CN XI __________ Inability to shrug shoulders
  Internal jugular vein  
Anterior condylar canal CN XII __________ Paralysis of tongue muscles. Lingual deviation toward side of injury upon protusion

035 - CSF is produced by the choroids plexuses which project into the ventricles of the brain:
CSF Production Through Into
Lateral ventricles Foramina of Monro __________ Third ventricle
Third ventricle Iter (cerebral aqueduct) __________ Fourth ventricle
Fourth ventricle Foramina of Magendie & Luschka __________ Cisterna magna of subarachnoid space
From Through CSF Uptake
Subarachnoid space __________ Arachnoid villi Superior sagittal venous sinus

036 - The cerebral aqueduct is prone to occlusion, leading to __________ Hydrocephalus.

037 - Cranial and cerebral hematomas:
Hematoma Prognosis Location Cause
Epicranial __________ Resolves Subaponeurotic Space Superficial vessels
Epidural __________ Life-threatening Epidural space Torn middle meningeal artery
Subdural __________ Less serious Subdural Space Torn cerebral vein
Subarachnoid __________ Lethal Subaracnhnoid space Torn cerebral artery, cerebral aneurysm
Subpial __________ Usually resolves Cerebrum Cerebral contusion

038 - Regions of the orbit that are prone to fracture include the ethmoid lamina papyracea and the __________ Maxilla about the infraorbital groove.

039 - Contraction of the orbicularis oculi muscle, innervated by the facial nerve, produces the __________ Blink.

040 - Orbital muscle function and innervation:
Muscle Primary function Secondary functions (normally balance) Innervation
Pupil __________ Constriction Dilation   CN III parasympathetic sympathetic chain
Ciliary body __________ Accommodation   CN III parasympathetic
Superior tarsal muscle __________ Augment levator palpebrac superioris   Sympathetic chain
Levator palpebrae superioris __________ Elevate eyelid   CN III (oculomotor)
Medial rectus __________ Adduction   CN III (oculomotor)
Superior rectus __________ Elevation Adduction, intorsion CN III (oculomotor)
Inferior oblique __________ Elevation Abduction, extorsion CN III (oculomotor)
Inferior rectus __________ Depression Abduction, extorsion CN III (oculomotor)
Superior oblique __________ Depression Abduction, intorsion CN IV (Trochlear)
Lateral rectus __________ Abduction   CN VI (Abducens)

041 - Parasympathetic innervation to the __________ Pupil is by the oculomotor nerve. Temporal lobe herniation (from tumor, hematoma, or edema) __________ Compresses the oculomotor nerve within the tentorial notch, causing a dilated pupil that is unresponsive to light.

042 - Special sensory tests and dysfunction:
Nerve Foramen Dysfunction Test
CN I (Olfactory) Cribriform plate Anosmia __________ Whiff of clove
CN II (Optic) Optic canal Blindness __________ Optic field tests

Internal auditory meatus
Internal auditory meatus


__________ Hearing threshold
__________ Nystagmus

043 - Paralysis of the stapedius muscle, as a result of facial nerve palsy, produces __________ Hyperacusis.

Visceral portions

044 - The infrahyoid muscles, innervated by the ansa cervicalis (C1-C3), stabilize the hyoid bone and larynx during __________ Deglutition and phonation.

045 - The pretracheal space, deep to the pretracheal fascia, surrounds the trachea and thyroid gland, but is anterior to the esophagus. Infection I this space may track into the __________ Superior mediastinum.

046 - The retropharyngeal (retrovisceral) space lies posterior to the oroparynx and esophagus and is defined by septa from the pretracheal fascia. Infection within this space may track into the __________ Posterior mediastinum.

047 - The mandibular neurovascular bundle enters the mandibular foramen adjacent to the lingual, the point of __________ Minimal movement. It may be anesthetized by directing a needle posteriorly through the buccal wall just __________ Lateral to the pterygomandibular raphe.

048 - The deep cervical nodes receive lymph from the __________ Anteroinferior portion of the face, the nasal cavities, and the oral cavity.

049 - The nasal vestibule (the most common site for nose bleeds) receives vascular branches from internal and external __________ Carotid arteries.

050 - The __________ Palatine tonsil receives vascular branches from the maxillary, facial, and lingual arteries.

051 - Abduction of the vocal cords is a function of the posterior cricoarytenoid muscle only, innervated by the recurrent __________ Laryngeal nerve.

052 - Branchiomeric nerve functions and tests:
Nerve Course Sensory Motor Test
CN V (tigeminal)
VI Superior orbital fissure, supraorbital notch Forehead None __________ Blink relfex
V2 Foramen rotundum, maxillary foramen __________ Midface None Sneeze reflex
V3 Foramen ovale, mandibular foramen, mental foramen Anterior pinna, jaw Muscles of mastication, mylohyoid ant, belly of digastric, tensor palatine and tensor tympani __________ Jaw jerk
__________ CN VII (facial) Internal autitory meatus, facial canal, stylomastoid foramen Concha of ear, taste anterior 2/3 of tongue via chorda tympani Muscle of facial expression, stylohyoid, post belly of digastric, tensor tymani, parasympathetic to lacrimal nasal, palatine, lingual and submandibular glands via gr. Superficial petrosal nerve Blink reflex
CN IX (glossopharyngeal) Jugular foramen External auditory, meatus, oropharynx, carotid body and sinus, taste posterior 1/3 of tongue Stylopharyngeus muscle, parasympathetic to parotid gland via tympanic and lesser superficial petrosal nerves __________ Gag reflex, carotid reflex
CN X (vagus) Jugular foramen External auditory matus, larynx, taste from epiglottis, aortic body Palatine muscles, pharyngeal muscles, laryngeal muscles __________ Phonation

053 - Nerve functions and tests:
Nerve Course Sensory Motor Test
CN XI (spinal accessory) Foramen magnum, jugular foramen None Sternomastoid Upper trapezius __________ Turn head to opposite side
CN XII (hypoglossal) __________ Hypoglossal canal None Intrinsic and extrinsic tongue muscles Protrudes straight
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