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Head and Neck Review

Head and Neck Review

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Published by Lhora Arie Sandy
Review head and neck, eye, ear, tongue, pharynx, larinx, brain, anatomy, vascularisation, embryology
Review head and neck, eye, ear, tongue, pharynx, larinx, brain, anatomy, vascularisation, embryology

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Published by: Lhora Arie Sandy on Jul 24, 2014
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Review for head and neck

Intoduction to the Head:
Funct: houses and protects brain, meningies, special sense organs, respiration,
mastication, vocalization
SC!" la#ers: skin, connective tissue, aponeurosis epicranialis, loose connective
tissue, periostium
Skull$%% bones plus h#oid$ %& tightl# connected mandible freel# mobile
'parts:
(eurocranium: sphenoid )greater wing*, temporal, parietal, occipital,
frontal
+asicranium: sphenoid )lesser wing and pter#goid plate*, temporal,
ethmoid, occipital,
,iscerocranium: vomer, concha, ma-illa, mandible, palatine, z#gomatic,
lacrimal, h#oid, and ossicles
Coronal suture: between parietal and frontal )horiz*
!ambdoid suture: between parietal and occipital )horiz*
Sagital suture: separates the two parietal bones
. ma/or caivities of the skull: orbits, nasal cavities, oral, ear,
endocranial caivt#
endocranial cavit#: contains brain meningies, CSF, brain0s vascular s#st,
C($ enclosed b# neurocranium and basicranium
Floor is subdivided:
nterior fossa$ frontal lobes
1iddle fossa$ paired temporal lobes
"osterior fossa$ cerebellum and brainstem
+RI(: 2 main parts
3elencephalon: rt and lft verebral hemispheres )sep b# longitudinal
fissure* as well as basil ganglion )control various functions*$ folds$ g#ri
and grooves$ sulcus
4iencephalons: central core of brain between cerebral hemispheres$
surrounds '
rd
ventrical and is contiuous with the midbrain below$ onl#
visible from infundibulum ) where the pituitar# gland is located*$ optic
tracts eminate from here$ 5 parts: thalamus, h#pothalamus, epithalmus,
and subthalmus
1esencephalon: between the diencephalons and pons contains inferior and
superior colliculi )asso with vision and hearing* as well as cerebral
a6ueduct$ not vsible e-ternall#
"ons: trigeminal ( originates from here connects the % cerebellar
hemispheres
1edulla oblongata: ,I, ,II, ,III orginate between here and the pons
I7,7,7I,7II originate from lateral medulla oblongota
Cerebellum: % hemispheres
,entricular S#stem and 1eningies:
,entricles filled with CSF originating in Choroid ple-us
% lateral ventricles )in cerebral hemispheres* continuous with '
rd

ventical via interventricular foramen
'
rd
ventricle )in diencephalons* commun8 9ith 5
th
)in pons ans
medulla oblongata* via cerebral a6ueduct
CSF )bathes and cushions brain* enters subarachnoid space
through a median aperture and % lateral apertures in 5
th

ventricle$ in subarachnoid space CSF then drains into
venous blood stream thru arachnoid granulations )pressure
sensitive one wa# valve$ concentrated in lateral lacunae of
superior sagittal sinus
1eningies: la#ers of connective tissue
Funct: support, protection, nourishment of brain
"ia mater: adheres to surface of brain vessels suppl#ing brain
found here$ choroids ple-us is specialized pia mater lining
ventricles
rachnoid mater: above pia mater bridges sulci  subarachnoid
spaces at base of brain called cisterns
4ura 1ater: % la#ers outer )perosteal* and inner )neural* fused
together in most cases but sometimes separate to formvenous
sinuses or enclose meningeal vessels$
ma/or dural folds funt to limit e-cessive mobilit# of brain
which ma# cause concussion these are double folds of the
inner la#er and don0t include an# outer la#er
Fal- cerebri: sep % cerebral hemispheres and houses sup
and inferior sagittal sinus
3entorium cerebelli: separates cerebrum from cerebellum
below$ midline connects with fal- cerebi houses straight
and transverse sinus
Fal- cerebelli: separates cerebellum$ houses occipital sinus
4iaphragma sellae: small dural fold covering the pituitar#
gland
Cranial circulation:
,enous:
Superior sagittal sinus$attached to fal- cerebri gets blood from cerebra and
menigies viens via lateral lacuna drain into the confluence of sinuses
Inferior sagital sinus$drains fal- cerebri /oins with the great vien to form
the straight sinus
Striaght sinus receives some from small occipital sinus then drain into
confluence
Confluence transverse sinus sigmoid sinus /ugular foramen I;,
Cavernous sinus drain directl# to I,; via Inferior petrosal sinus or from
superior petrosal sinus
Can also drain into the pter#goid ple-us into the <;,
Superficial temporal and ma-illar# veins /oin to form retromandibular
vien
Retromandibular vien splits into anterior and posterior
"osterior /oins the post8 uricular vien to empt# in <;,
nterior /oins facial and empties into I;,
4eep face drained b# deep facial ) drains into cavernous sinus* and
sup= inf ophthalmic viens ) drain into pter#goid ple-us*
<;, terminates at subclavian vien when I;, /oins it
brachicephalic vien
rterial:
<-ternal Carotid: suoerior th#roid, ascending phar#ngeal, lingual,
facial, occipital, post auricular, ma-illar#, superficial temporal
Internal Carotid: gives off the ophthalmic arter# as well as anterior
and middle cerebral$ posterior communicating connects with it to
creat circle of willis

,ertebral: travel up via transverse foramena$ enter endocranial
cavit# via foramen magnum give off small cerebellar branches
then combine to form basilar arter# terminating in posterior
cerebral arteries
Circle of willis: anastomosis of IC and ,ertebral$ principal blood
suppl# of the brain
+SICR(I>1="HR?(7: fibromuscular tube, common route for air and food
'parts:
(asophar#n-: post to nasal cavities, sup to soft palate$ opens to choanae$
contains the phar#ngeal tonsils or adenoids and opening of auditor#
@rophar#n-: soft palateepiglottis contains palatoglossal and
palatophar#ngeal arches and uvulae
!ar#ngophar#n-: posterior to lar#n- from epiglottis to cricoid cartilage
where becomes continuous with esophagus$ contains aditus )inlet of
lar#n-* and piriform recesses on each side of aditus
<-ternal muscles:
Superior constrictor: pter#gomandibular raphe and hamulus to median
raphe and phar#ngeal tubercle
Inferior constrictor: h#oid bone to meidan raphe
middle constrictor: th#roid and cricoid cartilage to median raphe
Internal:
"alatophar#ngeus: palate to th#roid cartilage and side of phar#n-
St#lophar#ngeus: st#loith#roid cartilage
Salpingophar#ngeus: cartilaginous part of auditor# tube phar#n-
(erves: most from phar#ngeal ple-us I7 )sensor# mucosa e-cept nasopah#n- ,%*, 7
)motor actuall# from cranial branch of 7I carried b# 7* and s#mpathetics from
superior cervical ganglion all phar#ngeal muscles innervated b# this ple-us e-cept
st#lophar#ngeus )motor I7* Inferior constrictor also gets some e-ternal phar#ngeal
and recurrent phar#ngeal from 7
rrangement:
+uccinator and Superior Constrictor meet at pter#gomandibular raphe
St#lophar#ngeus, I7 and st#loh#oid ligament pass between sup8 nd mid
constrictor
Internal lar#ngeal and superior lar#ngeal vessels pass between the middle and
inferior constrictors
Recurrent and inferior lar#ngeal passes below inferior constrictor
(ose:
Function: to transmit, warm humidif# and filter inspired air, olfaction, and acts as
a resonating chamber
Secretions: recived from paranasal sinus and nasolacrimal duct
Innervation: mucosal lining ,&,%, ,II )paras#mpathetic*, I )spec sense*
(asal septum: midline struct8 Forms medial wall divides nasal cavities
!ateral wall: composed of superior, middle )part of ethmoid* and inferior conchae
spaces between called meatus through which paranasal sinuses communicate with
nasal cavit#
Sinuses$ ari spaces withint bones of skull that commun with nasal cavit#
Frontal, ma-illar#, ethmoidal, sphenoidal
"alate:
nt %=' bon# hard palate post &=' soft palate$ fibromuscular ) mostl# tensor veli
palatine*$ covered with mucosa w= small palatine glands A soft palate moves up when
swallowing to seal off nasophar#n-
1uscles of soft palate all atach to palatine aponeurosis all C(7 e-cept tensor ,':
!evator veli paltini: elevates palate )from auditor# tube*
3ensor veli palatine: tense palate and helps open auditor# tube
"alatophar#ngeal: forms arch tenses palate pulling up forwad and mediall#
on phar#n-
"alatoglossus$ pulls tongue and soft palate together forms arch
1usculus uvulae: pulls uvula up to help swallow
3ongue: Sulcus divides ant and post tongue with foramen cecum at ape- of triangle )was
opening to embr#onic th#roglossal duct*
<-trinsic muscles all C( 7II e-cept palatoglossus )7*:
Benioglossus$ attached to h#oid and mandible, depresses and protrudes
tongue
H#oglossus: attached to h#oid depresses and retracts the tongue
St#loglossus: retracts and curls the tongue
"alatoglossus: elevates post of tongue
Intrinsic
Sup= Inf longitudinal: curves sides and tips of tongue
3ransverse: narrows and thickens the tongue
,ertical$ broadens and flattens the tongue
(erves: ant %=' sensor# ,' spec Sense ,II, post &=' sensor# and spec sensor# I7
1astication:
3emporomandibular /oint allows for vertical, anteroposterior and mediolateral
movements$ hinget#pe s#novial /oint divided into sup=inf compartments b# an
srticular disc
1adibular cond#le articulates with mandibular fossa$ surrounded b# loose
fibrous articular capsule thickens on sides to form 3emporomandibular ligament
1uscles all but depressors innervated b# ,':
<levators: temporalis, massateur, med and lat pter#goids
4epressors: digastric, infrh#oids, gravit#
"rotrusion: massateur, pter#goids
Retraction: temporalis, massateur
1ediolateral motion: pter#goids
1astication: two movements at the 31; anterior gliding and hingelike
9hen the mandible is depressed the cond#le can slide forward and rotate
on the articular disc
I8 @lfactor#$
Special Sensor#$ smell
II8 @ptic e-its via$optic canal
Special Sensor#$ Sight
III8 @cculomotor e-its via$ superior orbital fissure
"aras#mpath$ Cilliar# Banglion
1otor A Inferior +ranch$ Inferior @bli6ue, 1ed, Inf8, rectus
Superior +ranch$ Superior Rectus, levataor palpebrae superioris
I,8 3rochlear e-its via superior orbital fissure
1otor$ Superior @bli6ue
,8 3rigeminal
,& @pthalmic Asuperior orbital fissure
Beneral Sensor#$ cornea, e#eball, forehead, frontal and ethmoid
sinuses, lachr#mal gland
+ranches:
!acrimal
Frontal )supraorbital, supratrochlear*
(asociliar#$ carries cilliar# ganglion
!ong Cillar# carr# s#mpathetics to cilliar# bod#, iris
<thmoidal and nasal nerve
Infratrochlear
,% 1a-illar#$ foramen rotundum
Beneral sensor#$middle of face upper /aw and teeth, palate,
ma-illar# sinus, nasal cavit# and part of dura
+ranches: Suspends pterigopalatin ganglion, C#gomatic, Superior
veoler, Infraorbital, (asal, "alatine )lesser, greater, nasopalatine*,
1an#ngeal, phar#ngeal
,' 1andibular$ foramen @vale
+ranches: mental, auricotemporal, buccal
Beneral sensor#$ lower /aw and teeth floor of mouth, (3<RI@R
%=' of tongue
1otor$ muscles of mastication)temporalis, massateur, lat=med8
pter#goid*, m#loh#oid, digastrics,D tensor veli palatineD, tensor
t#mpani ) via inferior alveolar*
+ranches: +uccal )internal and e-ternal*, auricotemporal )suspends
otic ganglion, does t#mpanic memb, <1*, !ingual )sensor# ant8
%=' and suspends submandibular ganglion*, Inferior lveoler
) dental and 1ental (erves*, 1eningeal (erve ) accompanies mid
menig a8*
,I8 bducent$ superior orbital fissure
1otor$!ateral Rectus
,II8 Facial$ internal auditor# meatus and st#lomastoid )(8 of %
nd
arch*
Beneral Sensor#: part of ear and e-ternal auditor# meatus
Special Sensor#: taste nterior %=' of tongue
1otor: facial e-pression strapedius ect8
Frontalis, @rbicularis oris, orbicularis occuli, levator labii
superioris, plat#sma, mentalis, buccinator
"aras#mpathetic$ pter#gopalatine )lacrimal and mucus glands of palate
nsasl cavit# and paranasal* and submandibular )subman and sublingual*
<-ternal cranial muscles of facial e-pression$ st#lomastoid foramen
3emporalis, z#gomatic, buccal, mandibular, cervical and post
auricular*$ muscles of facial e-pression, plat#sma, buccinator,
auricular, occipital, and frontal
+ranches: (ervus Intermedius ) sensor# with paras#mpath*, geniculate
ganglion, Chorda 3#mpani )/oins with lingual (8 , submandib gang does
tast ant %='*, greater petrosal )with s#path from deep petrosal becms nerve
of pter#goid canal to pter#gopalatine gang$ taste for mucous memb of
palate*
,III8 ,estibulocochlear$ internal auditor# meatus
Special sensor#$ balance and e6uilibrium
+ranches: Cochlear and vestibular
I78 Blossophar#ngeal$ /ugular foramen
Beneral Sensor#$ posterior &=' of tongue, upper phar#n- mucosa, soft
palate, middle ear cavit#, auditor# tube, carotid sinus and carotid bod#
1otor: st#lophar#ngeus muscle
Special Sensor#$ "osterior &=' of tongue
+ranches: 3#mpanic )carries paras#mp in lesser petrosal ( to otic
ganglion, visceral to t#mpanic cavit#, auditor# tube and mastoid cells*
Carotis Sinus (erve )innervate carotid sinus )blood press* and
carotid bod# )chemoreceptor*
"aras#mpathatic$ otic ganglion
78 ,agus$/ugular foramen )some taste on epiglotiss and back of mouth*
1otor$ soft palate, lar#n-, phar#n-, esophagus
Suprerior constrictor, Inferior Constrictor, middle constrictor,
palaophar#ngeus, salpingophar#ngeus, cricoth#roid )e-t lar#ngeal*, poat
cricoar#tenoid )recurrent lar#ngeal* lateral cricoar#tenoid )recurrent
lar#ngeal* th#roar#tenoid )recurrent*, transverse and obli6ue ar#tenoids
)recurrent* vocalis )recurrent*
!evator ,eli palatine, palatoglossus, palatophar#ngeus, musculus uvulae
Beneral Sensor#$
"aras#mpathetic$ viscera of abdomen and thora- up to left coli fle-ure
+ranches: uricular )general sensor# to <1*
"har#ngeal ple-us ) with I7, brachiomotor to phar#n- and soft
palate e-cept tensor veli palatine ),'**,
Superior !ar#ngeal )nerve of 5
th
arch*
Internal: sesor# for mucous member of lar#n- and lower
lar#n-
<-ternal: Inferior constrictor and cricoth#roid
Recurrent !ar#ngeal: )( of 2
th
phar#ngeal arch* to all lar#ngeal
muscles e-cept cricoth#roid
7I8 ccessor#$/ugular foramen
1otor$ trapezius and Sternocleidomastoid
+ranches:
Cranial branch goes with ,agus
Spinal Root
7II8 H#poglossal$ h#poglossal canal
1otor to tongue$ genioglossus, h#oglossus, st#loglossus )e-cept
palatoglossus*
In communication with ansa cervicalis )loop from C&,C%,C'* to suppl#
infrah#oids e-cept th#roh#oid with it supplies onl# in con/unct8 9ith C&
along with the genioh#oid
S9!!@9I(B
@ral phase$bolus to phar#n-$ tongue tip of hard palate
"erioral muscles
"lat#sma and lateral pter#goid muscles
+uccinator and tongue muscles ) genioglossus, h#oglossus, st#loglossus*
"har#ngeal phase$ bolus to esophagus protecting airwa#,
$seal nasophar#n- )tensor veli palatine,levator veli palatine, musculus
uvulae*,
$propel bolus )h#poglossus* and
$elevate h#oid )suprh#oids$ m#loh#oid ),'*, genioh#oid )C&*,
digastric)ant8 ,' post8 Facial*, st#loh#oid)facial**
$seal phar#ngeal inlet$ superior constricots, palatoglossus, st#loglossus,
pter#gophar#ngeus, st#lophar#ngeus, st#loh#oid, post digastrics
$Clear blous=restore h#oid*$ inf=middle constrictors and infrah#oids
)depress h#oid$ sternoh#oid )ansa cervicalis*, th#roh#oid )C&*,
sternoth#roid )ansa cervicalis*, omoh#oid) ansa cervicalis*, strap muscles*
<sophogeal phase$bolus to stomach
"rimar# peristalsis in reponse to presence of food
Secondar# peristalsis$ if residual food
3eriar# peristalsis$ non$prpulsive spasm
>pper &=' striated muscle
!ower %=' smooth muscle
$4o barium studies if don0t suspect a leak because not water souble and
remains forever good because can var# the thickness
$If suspect a leak use gastrograffin, omnipa6ue ect8 Can0t var# thickness
$Should do stud# sitting up and l#ing horizontal
<?<
9alls of orbit
Floor: ma-illa )z#gomatic and palatine*
1edial: ethmoid, lacrimal, frontal
Roof: frontal )sphenoid*
!ateral: z#gomatic, sphenoid
!acrimal gland and drainage of tears
Superolateral part of orbit  drainage of tears to lacrimal puncta and
canaliculae, then to nasolacrimal duct
<#elids:
1uscle levataor palpebrae )C( III* orbicularis occuli )C( ,II*
3arsus with tarsus gland keeps e#elids from sticking together
<#eball:
' coats: fibrous outer: scalera and cornea
,ascular middle: choroids, cilliar# bod#, iris
(eural Inner coat: Retina ) pigmented and neural la#er*
@ptic disc$ blind spot where optic nerve enters
1acula lutea$ fovea$ al cones
Fovea centralis$
,itreous humor with collagenous fibers, a6ueous humor in ant and post
chambers, and lends held b# suspensor# ligaments ) zonular fibers*
"roblems:
"apilledema: swelling of optic disc due to increased CFS pressure
Con/untiva: inflamm of con/untiva covering fibrous la#er
Blaucoma: increased pressure in a6ueous humor
Cataracts: opa6ue lens
Image production:
Results from Refraction of light onto retina
$ refractive inde- of media impt8
$ ngle of incidence of light ra#s$ effected b# curvature of
interface
$ ' refraction surfaces:
o Corena$ most refract occurs here
o !ens ant )with a6ueous* and post )with vitreous*$
uni6ue because can change shape
ccomidation: change in curvature aiding ra#s in focus on retina
$contraction$ paras#mp from cilliar# gang III loosening of
zonula fibers  more sphereical shape so can see closer up
$ dialation$s#mpathetic see things far awa#
"robs with refraction:
<mmetropia$ image focuses on retina
1#opia$ near sighted$ e#e too long corrected w= concave=divergent
H#peropia$far sighted$ image in back retina
stigmatism$ irreg curvature of lens or cornea
Strabismus$ non$parallel visual a-es
<#e 1vmnt:
2 muscles: superior, inferior, medial, lateral rectus and sup and inferior
obli6ue
;oint: fat pad and bon# orbit allows to spin
(erves: sup obli6ue$ I,, !at rectus$,I, all others$ III
If aline visual field with a-is of muscle can determine its funct more easil#
Clincal Correlation for Retinopath#:
Corea Capilaris is the vascular s#stem for below the pigmented retina$ one peric#te per
one endothelial cell in this s#stem
not man# capillaries directl# around arteries but if the# dead end in angio gram prob no
4"ase no 4"Se means endothelial cells dead$
+od# tries to compensate with vascular neogensis but usuall# bad vessels that
hemorage$$E Retinopath# and eventuall# blindess
3heor# that (eutrophils ma# be so large the# occule and then release @% radicals leading
to vascular death
<1+R?@!@B?
&*Sources of tissue:
(eural Crest: bone cartilage connective tissue of face and skull
1esoderm: occipital bone and lar#ngeal cartilage
Somitomeres )from para-ial mesoderm*: voluntar# muscles of head and neck
%* )wk'*Somitomeres$ F total from para-ial mesoderm
$ induce segmental development of brain
1esodermal orgins muscles Innervation
Somitomeres &,% Sup8, I(f8, 1ed Recti III
' Sup @bli6ue I,
5 ;aw closing ,
. !at Rectus ,I
2 ;aw opening and %
nd
arch ,II
F St#lophar#ngeus I7
&,% Intrinsic lar#ngeals 7
%$. 3ongue 7II
'*(CC0s )cells that migrate from ectoderm of rising neural fold to mesoderm*
migrate to arches bringing H@7 code)from neural fold* along to maint8 Segs8
$some apoptose to create gaps )clefts* avoiding the mi-ing of
segments
D5* )wk5*"har#ngeal rches$
$sweelings on side head in part from prolif8 of (CC and mesoderm
$made from mesoderm line b# endoderm)in* and ectoderm)out*$ clefts and
pouches separate them
arch arter# (erve muscles "ouch
)inside$endo*
Cleft )outside$
ecto*
& 1a-illar# , mastication & 3#mpanic
cavit# and
auditor# tube
<-t meatus and
eardrum
)t#mpanic memb*
% H#oid,
stapedial
,II Facial, post
digastric,
st#loh#oid
stapedius
% "alatin tonsil Cervical sinus
) degenerates*
' Carotid I7 St#lophar#ngeus ' 3h#mus and
inf parath#roid
)pulled inf b#
desc8 3h#mus*
Cervical sinus
5 Right
subclavian
and aortic
arch
7
)Sup*
Cricoth#roid,
lev8 "alatine,
phar#n-
constrictors
5 Sup8
"arath#roid
)attach to
dorsal side as
Cervical sinus
th#roid moves
caudall#*
. $ $ . >ltimobrachial
bod# )becms
embedded in
th#roid to reg
Ca*
Cervical sinus
2 pulmonar# 7
)recur*
Intrinsic !ar#n-
muscles
5* 3ongue
$ endoderm )mucosa* and mesoderm )occipital somites* of &,%,',5
th
arches
$nterior %=' arch I so C( , innervation for sensor# )sep b# terminal
sulcus*
$1ucosa of "osterior portion from '
rd
and 5
th
so Cn I7 and 7
$ special sensor# ant %=' ,II, post &=' I7, 7
$Frenulum onl# remaining connection of tongue to floor
.* 3h#roid Bland
$ arises from endoderm prolif between ant and post portions of tongue
)foramen cecum*
$descends along phar#ngeal gut remains attached to tongue b#
th#roglossal duct$ degenerates later in devel8$ stops /ust caudal to
lar#ngeal cartilages$ picks up parath#roid glands along the wa#
$begins funct8 <arl# during fetal period
2* Face
$4uring anterior neural tube close frontalnasal prominences seens as
rounded e-ternal contour$ nasal placodes are present on fronolateral
$mesench#mal sweeling encircle placodes med=lat nasal prominences
which become the future nose
$Stomadeum )primitive oral cavit#* below frontalnasal prominenc$
directl# below this is the first phar#ngeal arch
$First phar#ngeal arch % parts$ dorsal$ ma-illar# prominence and ventral$
mandibular prominence
$ ma-illar# prom8 Fuse with medical prominences froming the
midline of the nose and mouth and primar# palate
$ ma-illar# and lateral nasal prominence sep b# nasolacrimal
groove$ ectoderm from floor of this groove nasolacrimal duct
which detaches from ectoderm
$ after detach of chord lateral and ma-illar# fuse and
enlarge cheeks while lat8 nasal prom8 +ecm side of nose
F* 4evelopment of secondar# "alate )wk2*
$two shelf like outgrowths from the ma-illar# prominences, the palatine
shelves$ directed obli6uel# downward on each side of the tongue
$wkF the# ascend to horiz position above the tongue and fuse with each
other
$anteriorl# fuse with primar# palate with incisive foramen demarcating the
diff between primar# and secondar#
$nasal septum grows down and /oins with sephalic aspect of newl# formed
plate
G* <ar:
<-ternal:
$<1 from &
st
phar#ngeal cleft
$3#mpanic membrane from ectoderm lining of bottom of <1,
endodermal lining of t#mpanic cavit#, and intermed la#er of connective
tissue
$uricle from 2 mesench#mal proliferations on dorsal and of the &
st
and
%
nd
phar#ngeal arches called auricular hillock which fuse
$s mandible grows ear pushed up and back
1iddle:
$t#mpanic cavit# and auditor# tube from &
st
phar#ngeal pouch
$ossicles from cartilage of &
st
and %
nd
arches$ malleus and incus from &
)tensor t#mpani C(,* and stapes from % )stapedius m8 C( ,II*$ the# are
in mesench#me until week G when the#0re enveloped b# endoderm of
t#mpanic cavit#
Internal: )wk5*
$thickening on surface of ectoderm on either side of hindbrain, otic
placodes
$placodes invaginate becoming otic vesicles and divide such that
,entralsaccule and cochlear duct 4orsal semicircular canals and
endol#mphatic duct
Cochlear 4uct$
wk2 initiates as outgrowth of saccule and penetrates surrounding mesench#me in
a spiral fashion
$surrounding mesench#me diff into cartilage event bcms two compartments: scala
vestibule and scala t#mpani each filled with peril#mph$ C( ,III
Semicircular Canals:
$utricle forms ' flattened outpocketings$ each lose central core
$ sensor# cells arise in ampulla, utricle and saccule$ send impulses via C(,III
G*<#e: )wk5*
$% depressions on each of the forebrain hemispheres, optic vesicles
$ as neural folds close vesicles appro-imate surface ectoderm$ it0s induced
to bcm columnar, lens placodes
$optic vesicles and lens placode invaginate forming optic cup
$groove in optic stalk ) choroids fissure* allows h#aloid arter# to enter e#e
and feed lense arter# will degenerate
$wkF choroid fissure fuses and stalk gains mass becming optic nerve
$mesench#me around lens and retina becomes scalera)contin with dura
mater*
$ after sep8 of lens from surface ectoderm, cornea developes from
mesenhc#me
$mesench#me also makes cilliar# muscles and puppillar# muscles )C(III*
!R?(7
' basic functions:
$protect airwa# e-8 Swallowing
$controlling infra$thoracic pressure )e-8 in coughing*
$ production of sound
Cartilaginous framework$
r#tenoid cartilage )post of th#roid cartilage*, 3h#roid cartilage )below h#oid*,
cricoid cartilage )inf8*
1embranes and !igaments:
$th#roh#oid membrane between the h#oid bone and th#roid cartilage
$6uandrangular ligament )seen on sagital section inside th#roid cartilage
with epiglottis making up one edge*
$,estibular ligament$ bottom of 6uadrangular space no asso muscles
$,ocal ligaments$ top of cricoth#roid ligament with asso muscles
$cricoth#roid ligaments, Conus elasticus, cricovocal memb )all same*
<-trinsic 1uscles:
$Suprh#oid muscles ) m#loh#oid ,', digastrics ant,' post ,II,
genioh#oid C& via 7II, st#loh#oid ,II$ raise lar#n- and depress mandible
)high notes*
$Infrh#oids$ )omoh#oid, th#roh#oid )reall# /ust C&*, sternoh#oid,
steroth#roid* invervated b# ansa cervicalis dpress lar#n-$ low notes
Intrinsic 1uscles:
DD all innervated b# recurrent lar#ngeal e-cept cricoth#roid which is
innervated b# e-ternal lar#ngeal
$dductors of ,ocal Folds
$3ransverse ar#tenoids
$obli6ue ar#tenoids
$lateral cricoar#tenoids
$bductor of ,oal Folds
$"osterior cricoar#tenoids
$d/ustors$ ad/ust tension b# pulling down like helmet or sliding fwrd
$Cricoth#roid muscles
$th#roar#tenoids and vocalis muscles$ diff fiber directions allow
for fine voice control and fin tuning if #ou will
<pithelium vocal fold gets stiffer
,ocal folds r#tenoids and th#roid cartilages gets stiffer
!ar#ngeal vibrations are not the result of rh#thmic contraction of mar#ngeal
muscles but rather due to changes in air pressure )folds forced apart and sucked
back together* low pressure )rarefraction* and high pressure ) compression*
Changes in amplitude confer loudness
Changes in fre6uenc# confer diff pitches
1ore massive vocal folds lower pitches
Infant lar#n- higher in neck so can breath more easil# while suckling
"ubert# abrupt change in lar#n- size leads to pitch control problems
9hispering$ leave vocal folds partiall# open so lots of air comes out
9ith Cold mucous adds mass to chords H the# don0t close right so rasp#
<R:
<-ternal:
$auricle: function$ collecting device for sounds waves, localizes source
$<-ternal coustic 1eatus )concha to t#mpanic memb*
Funct$ channels sound to t#mpanic memb, protects middle ear and
acts as an acoustic resonator
$lat &=' cartilagenous, ant8 %=' osseus
$(erves: ,II, ,')auricotemporal*, 7, cervical ple-us )greater
auricular, lesser occipital*
1iddle )t#mpanic cavit#* transfers sounds from gas to li6uid
Function: transformer )boosts signal to inner ear*, protects from ver# loud
sounds, maintenance of pressure on both sides
$ designed to react to normal things heard in nature and to protect
from volume of own voice
@ssicles:
1alleus, Incus )both &
st
arch*, Stapes)%
nd
arch*
1uscles:
3ensor 3#mpan# )asso w= malleus so innervated b# ,*
Stapedius ) asso8 w= stapes %
nd
arch so innervated b# ,II*
(erves: ,, ,II )facial, and schorda 3#pmani*, I7 )3#mpanic ple-us*
@ther Structs: 3#mpanic 1emb )ear drum*, uditor# tube )surrounded b#
cartilage$ pulled on b# tensor t#mpan# to pop ears=open cartilage to
e6ualize pressure*, promontor#, @val 9indow )fenestra vestibule*, round
window )fenestra cochleae*
$@ssicles all connected and held in place b# ligaments
1alleus$ sup8=ant8 1allal !ig and tensor 3#mpani tendon
Incus$ sup=post Incudal !ig8
Stapes$ Stapedius tendon
Chorda 3#mpani runs thru the connection of all of these
3#mpanic memb pushes malleus down, the Incus kicks the stapes which
rocks back and forth such the the footplate hits the ovale window
increasing pressure in the li6uid of the inner ear
If ears feel plugged it0s pressure build up in inner ear so abnorm
sound transmission
Inner <ar:
Semicurcular canals : Superior, !ateral, "osterior ' semicircular ducts
with ampullae and % sacs within vestibule
,estibule: connects the vestibular s#stem to the cochlea
Cochlea: oval window cloased off b# the foot plate of the stapes into the
scala vestibuli, round window at the end of scala t#mpani
$helicotrema connects them
+on# labr#nth: Semicircular canals, vestibule
$filled with peril#mph
1embranous !ab#rinth: ' semicircular ducts with ampullae % sacs within
vestibule )utricle and saccule*, cochlear duct
$filled with endol#mph
Cochlea: tapered tube with bone# core )1odiolus* and osseus spiral
lamina )bona# shelf acts as entr# route for nerves to cochlear duct*$ spiral
ligament acts as support for cochlear duct on outside wall of cochlea$
cochlear duct flanked b# scala vestibule and scala t#mpani,
Sound 3ransmission: Stapes rocks and sends a pressure wave thru causing
fle-ible cochlear duct to vibrate this causes movement of the organ of corti
* consisting of the tectorial membrane connected to the vestib memb via
the limbus sitting on top of internal and e-ternal hairs8 9hen the C4
vibrates it causes the tectoral memb to chear these hais which sit on top of
the basilar memb8 9hich picks up this movement via the ,III nerve and
detects it as sound
,ariations in sound intensit# ma# partiall# be detectable through changes
in rate of discharge of nerve cells to inner vs8 outer hair cells
,ariations in fre6uenc# ma# be traced to patterns of vibration along all or
part of the basilar membrane
Components of foramen of Cranial +ase )from (etter p8&I*
Foramen Cecum: emissar# vien to sagittal sinus
nt8 <thmoidal foramen=nasal slit: ant8 <thmoidal vien, arter# and nerve
Foramina of cribiform plate: olfactor# nerve bundles
"ost8 <thmoidal foramen: post ethmoidal arter#, vein and nerve
@ptic canal: optic nerve II and ophthalmic ater#
Superior orbital fissure: occulomotor (erve III, 3rochlear )I,*, @pthalmic (erve ),&*,
bducent (erve ),I*, Superior @pthalmic ,ien
Formen rotundum: ma-illar# nerve ),%*
Foramen @vale: 1andibular (erve ,', ccessor# meningeal arter#, lesser petrosal nerve
Foramen Spinosum: middle menigeal arter# and vein, menigeal branch of mandibular
nerve
Carotid Canal: Internal carotid arter# and nerve ple-us
Internal ucoustic 1eatus: ,estibulocochlear (erve ),III*, Facial (erve ),II*,
!abr#nthine arter#
<-ternal opening of vestibular a6ueduct$ endol#mphatc duct
1astoid Foramen: emissar# vien
;ugular Foramen: Blossophar#ngeal )I7*, ,agus )7*, cessor# )7I* Inferior petrosal
sinus, Sigmoid Sinu, post8 1eningeal arter#
Cond#lar Canal: <missar# ,ien and meningeal branch of ascending phar#ngeal arter#
H#poglossal foramen: h#poglossal (erve )7II*
Foramen 1agnum: 1edulla oblongata, meningies, vertebral arteries, meningeal branches
of vertebral arteries, spinal roots of accessor# nerves
Bood neumonics
+ranches of e-ternal Carotid:
Susie lwa#s !ies Flat on pillows making se- terrific
Superior th#roid
scending "har#ngeal
!ingual
Facial
@ccipital
"ost8 uricular
1a-illar#
Superior temporal
2 +ones of the Skull:
Step @f
Sphenoid
3emporal
<thmoid
"arietal
@ccipital
Frontal
,ontents of voice bo-$ ' ,0s, vocal folds, ventricles, vestibular folds
Contents of Cavernous Sinus:
@ 3om Cat )@ 3om is superior to Inferior*
@cculomotor (erve
3rochlear
@pthalmic
1a-illar#
Carotid rter#
bducent
3trochlear )C are sinus componets that enter at level of 3*
+ones of the Face:
,o#tek cannot make m# pet zebra laugh
,omer
Concha
1a-illa
1andibular
"alatine z#gomatic lacrimal
Contents of carotid sheath:
I8C8 &I C8C0s I,
Intercal Carotir, ,agus )Cn7*, Common Carotid, Internal ;ugular ,ein
Cervical "le-us from upper right clockwise
Blast
Breater uricular,
!esser Suricular
ccessor# )goes between ! and S*
Supraclavicular
3ransverse Cervical
1edical 9all of orbit bones:
1# little e#e sits in the orbit
1a-illa
!acrimal
<thmoid
Sphenoid
BELL'S Palsy:
Blink refle- abnormal
Earache
Lacrimation Jdeficient, e-cessK
Loss of taste
Sudden onset
Palsy of ,II nerve muscles
L ll s#mptoms are unilateral8
3he !ingual nerve
3ook a curve
round the H#oglossus8
M9ell INll be fDOkedPM
Said 9hartonNs 4uct,
M3he bastardNs gone and crossed usPM
,' innervation )&
st
phar#ngeal arch*
MM.D. My TVM:
Mastication Jmasseter, temporalis, pter#goidsK
Digastric Janterior bell#K
Myloh#oid
tensor T#mpani
tensor Veli palatini
Superior 3h#roid +ranches
MMa# I Softl# S6ueeze CharlieNs GirlEM:
Muscular
Infrah#oid
Superior lar#ngeal
Sternomastoid
Cricoth#roid
Glandular
1a-illar# rter# +ranches:
MDAM I AM Piss Drunk But Stupid Drunk I Prefer, Must Phone Alcoholics
Anon#mousM:
Deep auricular
Anterior t#mpanic
Middle meningeal
Inferior alveolar
Accessor# meningeal
Masseteric
Pter#goid
Deep temporal
Buccal
Sphenopalatine
Descending palatine
Infraorbital
Posterior superior alveolar
Middle superior alveolar
Phar#ngeal
Anterior superior alveolar
Arter# of the pter#goid canal
1uscles attaching to H#oid
MChrist, He DidnNt Screw Girls Much8 ThatNs Obvious, StupidM:
L 3he first sentence is for 2 muscles attaching superiorl#, the second sentence is
for ' muscles attaching inferiorl#8
L +oth sentences are in order from lateral to medial:
Constricter )middle*
H#oglossus
Digastric
St#loh#oid
Genioh#oid
M#lo#oid
Th#roh#oid
Omoh#oid
Sternoh#oid
nsa Cervicalis (erves
B that sure sounds super Ian
Genioh#oid
Th#roh#oid
Superior Omoh#oid
Sternoth#roid
Sternoh#oid
Inferior omoh#oid
M!acrimalNs stor# of G !NsM:
Lacrimal nerve runs on Lateral wall of orbit above Lateral rectus, then Lets
communicating branch /oin in, then supplies Lacrimal gland, then Leaves it and
supplies Lateral upper e#e LidP
Saccule below >tricle$ #our Sacc is below >
Scalp nerve supply
GLASS:
Greater occipital= Greater auricular
Lesser occipital
Auriculotemporal
Supratrochlear
Supraorbital

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