--

Review of Head/Neck
Olfactory
Can't smell Cribiform plate
• Smell
(Sensory)
No reaction to light (both
Optic
Optic canal .... • Vision
pupils same size) (Sensory)
• Eye movement
Contralateral reaction (one
• Levator palpebrae
Superior orbital fissue Occulomotor
pupil is big, one is small) superioris

or drooping lid v
• Sphincter pupillae
• Ciliary MM
Trochlear
Double vision when
V
Superior orbital fissue
• Superior Oblique (S04)
looking down

• M of mastication
• Mylohyoid
VI =no corneal reflex -' VI = superior orbital fissure
Trigeminal (Vi, V2, V3) • Ant. digastric belly
V2=no sneeze reflex V
2
=rotundum
(Both) • Tensor veli palatini
' V
3
=ovale V3=no jaw jerk reflex "
• Tensor tympani t( Q \ \I v
• (face sensation)
Abducens Media1 deviation of eye '
Superior orbital fissure , • Lateral rectus (LR6)
(unable to aBduct) ./ (Motor)
• M of facial expression
Bells Palsy ­
• Post. digastric belly
Facial Dry mouth
Internal acoustic meatus • Stylohyoid, stapedius
(Both) Dry eye
• Lacrimal! salivary glands
No taste on ant 2/3­
• Taste at ant 2/3
Vertigo
Vestibulocochlear
Internal acoustic meatus Deafness • Equilibrium + hearing
(Sensory)
Tinnitus
• Stylopharyngeus
Glossopharyngeal • Parotid gland
Jugular foramen No gag reflex '.....--'
(Both)
• Pharynx + middle ear
• Taste at post 1/ 3
• M of pharynx, larynx +
Dysphagia (difficulty
palate
Vagus swallowing) 1/
Jugular foramen • s. of pharynx, larynx
(Both) Uvula deviates away from
• taste of epiglottis, uvula
lesion
''/
• palatoglossus m
Accessory
. .. SCM + trapezius Jugular foramen Can't shrug or turn head'\......-/
(Moto!)
Hypoglossal • Tongue MM
Hypoglossal canal Deviate toward lesion \
(Moto!)
• Except palatoglossus
,
C '
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.-
8
p
1n 05Urv-- Middle geM,.L"jeaJ =Artery . 0 <1­
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cU- U W\ -,- n. cJ.. carohd-
:r ..... *

(--1 I ,1. •
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$lncJ rook: 0{2 -=-XI
~ t !2!3
P o ~ 1/3.
CS LnjvA-l
tj
(horde..
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q
l M f ~
Reflexes
For every reflex there is a sensory (in) and motor lout)
Out In

Reflex
f1""-.

\In)
Corneal light un
Corneal blink J
1
VII - closes eye V (Vl) - helps eye stay open
Sneeze V (V2) X
\....-­
L",,\: Gag X '..../'
X X Cough
V V Jaw Jerk
« m
Arches
Clefts/ Grooves
Pouches (Mesoderm + Neural Crest)
Pouch (Ectoderm)
(endoderm)
Neural Crest =Bone + CT
Mesoderm =MM + AA
• MM of mastication
f"/ A-l-'
• Myelohyoid
• Mandible malleus
N
Miclclle ear caviry
External auditory meatus • Maxilla I
}\uditorv tube
INN by CN V (V2 + V3) • Tensor velli palitini (/I
M
Mastoid air cells
• Tensor tympani
• Incus
\(3
• Ant. digastric maxilla
• MM of facial expression
• Post. digastric
• Stylohyoid
Mesenchyme overgrows 3 + 4 • Stapedius
2.
Epithelial lining of palatine tonsils
INN by CN VII • Stapks
-
• Lesser
--
hom of hyoid
• Styloid process
'
LL ,
• Styln)wnicl ligament

(!lo.l!haryngeUsIt
10:"- e
h
f"1V\
",cJ
3. CNIX • mmon carotid )
Inferior parathyroid '
-
• Greater hom of hyoid
• Soft .Qll !ll te mm except
palatine ' "It; 1
• Pharynx mm except
4. CN X (Superior Laryngeal)
Superior £arathyroid

• Cncott yrOld muscle
---

• Cricopharyngeus
• lArch ot aorta) Ll' gJ-
g
fA '-1/ I}Ak
M
\
• Intrinsic larynx except
cricothyroid muscle
ct.,,\ .
UlJ..\ 6<-(\.0-
J
6. CN X (Recurrent Laryngeal) • Esophageal mm
• vPulmonary aa
• ...-Ductus arteriosus
C

(-c"J C:.l.-r. """"" '-­
Really good summary of embryo ill FIRST AID
,2"d.- ad__ .
o..rck... SC)n.dr-OMe QnofT\Cllld .
CLINICALS FOR EMBRYO
DiGeorge Syndrome
• failure of pouches 3 & 4 to differentiate
• no thymus & no parathyroids
• mnemonic: CATCH 22 (22=x-some, C=cardiac problems, A = abnormal facies, T=thymic hypoplasia, C=cleft
palate, H == hypocalcemia)
Thyroid Embryo
• thryroid starts .in the pharynx floor migrates to to hypoglossal duct to
become foramen cecum
Face + palate
• formed from 3 swellings
o frontal nasal prom.inence
o maxillary prom.inence
o mandibular
• all are a part of pharyngeal arch #1
CLINICAL
Cleft lip
• failure of fusion of maxillary & medial nasal processes
Cleft palate
• failure of fusion of lateral palatine processes, nasal septum and/ or median palatine processes
Pituitary
Ant - foregut @.athke's ouch) ascends to sella turcica to jo.in posterior
Post - diencep alon outgrowth descends to sella turcica to jo.in anterior
CLINICAL
Pituitary tumor
• may .increase GH which leads to gigantism
• imp.inge on optic chi.;?m (optic nerves cross .in bra.in) causing a visual field defect called bzjempora! hemianopsia
DL .
MecL:-CVVL C--Lett

4
Op ,

pi !;'is. -')
t"r\..U.'ls,s ....,
no SLO
.... o\,- (
/j. of the Neck
Submandibular /j.
• hypoglossyl N
• mylohyoid N
• facial A + N
Submental /j.
• submental lymph
Carotid /j.
• common carotid
• jugular vein
• vagus
• external carotid
• hypoglossyl N
• superior root of ansa cervicalis
• CNXI
• Thyroid gland
• Larynx + pharynx
Muscular /j.
• Sternothyroid
• Sternohyoid
• Thyroid
• Parathyroids
Occipital /j.
• Part of external jugular vein
• CNXI
• Brachial plexus trunks
• Transverse cervical a
Subclavian /j.
3
rd
• part of subclavian artery
• Part of sublcavian vein
• Suprascapular artery
:r:"" ;.,terSic>n
f.., &.'torSiO'f'l.
LR

occ.u1 o""C-+O""
f"\ls.'1
.u.
LR, s
b\ood
-- J.,

Carn E.CL
7-. no blood.. Sl...l-Pp
l
l1
..
¥ -+ro.(. ..., hoI'''' C '1"""
• 00.()- nQ.l..?ron.e.
hev-'1,..(.C>Y'lCp :4
• e.6t
c;; '" L b •.
'"
n-u:.dle
. y cu,c.uJ cJl
dQrk:...
Gi,'c..r '1
e Cuv<L.J:..... is .

Near objc:d-s -4 m .
TRIGEMINAL NERVE (eN V)
Opthalmic
• through cavernOus sinus _____
• sensorfto eye to
• goes to lacrimal gland
• has a frontal division: goes to scalp, forehead, frontal sinus & upper eyelid
• nasociliary: short ciliary muscles (parasympathetic & sympathetic); long ciliary muscles (sympathetic to dilator
papillae & afferents from iris & cornea)
• meningeal: goes to dura mater
Maxillary
• through cavernous sinus
• general sensory to face below eye & above upper lip
• zygomatic division: zygomaticofacial N. & zygomaticotemporal N. Goins lacrimal)
• meningeal division: gives to dura mater in middle cranial fossa
Mandibular
• general sensory to face below lower lip
• muscular division: mm of mastlcatlon
• buccal division: b;;gal ­
• lingual: sensatiqfto ant 2/ 3 of
TONGUE

• anterior 2/3
o CN VII - chorda tympani for taste
o eN v - lingual for sensation
• posterior 1/3 l tl. ... cl.. (
o eN IX - for taste & sensation

Venous Drainage . U
1. facial vein
a. major venous drainage of face
b. facial vein -7 sup/inf ophthalmic veins -7 cavernous sinus
facial vein -7 pterygoid plexus -7 cavernous sinus
{ d. clinical
ol i. danger zone of face (from between eyes to nose end)
eEf . 1. infection travesl via 1 of 2 routes and infects cavernous sinus
2. diploic veins
a. have no valves
b. run in flat bones of skull
3. enussary vellS
a. anastomose superficial veins & dural venous sinuses
Dural Venous Sinuses
1. superior sagittal sinus
• located along the superior fabc cerebri
• arachnoid granulations transmit CSF into this sinus
2. inferior sagittal sinus
• along the inferior fabc cerebri
3. straight sinus
IV"tu" 1"1 oJ
Co. r o\-i cJ.
Q("tcr,-\­
~ - = - - Lf- g s...p.
patrO!l<.\ S;t'\...I..U
SLlhd o.vi Ov'--'
..1Gt- PeAct"

formed where the interior sagittal & Great vein of Galen meet
L1 deep drainage areas of the brain
4. occipital sinus
- attached at the border of the tentorium cerebelli
5. confluence of sinuses
supetior sagittal & occipital & straight sinuses all meet
-
6. transverse SillUS
- drains blood from the confluence
- takes blood to the sigmoid sinus
7. sinus
- drains into IJV
8. cavernous SillUS
- located on either side of the sphenoid bone
-,I receives venous blood from:

" L1 facial vein
L1 ophthalmic vein
0 \1 .
L1 pterygoid plexus of veins
L1 central vein of retina l
50
-
receive blood from each other via the intercavernous isnus
drain into the superior or inferior petrosal sinus
-

L1 superior petrosal sinus transverse sigmoid IJV
...
L1 inferiorpetro"ffl sinus IJV
located in :l:fl.Us:
-
L1 internal carotid artery & abducens nerve (CN VI)
located in of cavernous sinus:
-
L1 CN III, CN IV, CN V2, CN V3
CSF Flow
Lateral ventricles Foramen of Monroe (interventriculat foramen) 3
rd
ventricle cerebral aquaduct 4th
ventricle .­

Now it can go 2 ways:
4th ventricle foramen of Magand (1 & it's medial) '/
4th ventricle foramen of (2 & they are lateral) v
• comes back in the atach oid anulations & into the superior sagittal sinus
• any block in CSF flow is h 'droce halus
1. communicating (non-obstructive
- no block in normal flow
- p roblem is in £WlCIinoid granulation;)
- CSF does not get back into venous flow
2. non-communicating (obstructive)
- there will be a along th.!",normal CSF flow
-1CSF stasis tbluild-up will occur everywhere in front of the block
Hematomas
1. epidural
Ce.rebMJ
Ant -4 let.-VeK' eoc.t . Cdp; ncJ CO ret
pes .

." C9'-,;,Yj <
----l-­
lr r [ eM

th0./ a. t-M...


up
• skull fracture near pterion (ex. someone is hit in the head, knocked unconscious, wakes up & is fine
but is found dead 4 hours later)
• damage to meningeal artery
• SIgnS:
no blood in CSF _
arterial blood betweeJ skull & dura J
able to talk before death
2. subdural "shaking baby syndrome"
• ' Vlolent shaking of a baby's head
• veins: su!!!ior cerebell ar veins (aka bridging or emissary veins)
• sIgns: ­
no blood in CSF
venous blood between


3.



• SIgnS:
blood in CSF!!!
arterial blood ' . hin subarachnoid s
e of their life"
Superior Cervical Ganglion
• contains cell bodies of post-ganglionic sympathetic fibers that pass to visceral structures of head & neck
• CLINICAL: Homer's Syndrome
o ptosis (drooping eyelid)
o miosis (pupil constriction)
o anhydrosis (dry skin)
• cP C) S t-C-r l Cl ' oR -I€ -.e
[Vle,Wi1 s.., J{o'" mahcrvc ::(;
s-teP\OSt:S ­
c.epha.l..uJ. ­
Lul'Y) Ioa..- pt-VV\. c.tu.., ­
, ..
Parasympathetic. Sympathetic, Both
Ciliary ganglion
• sits behind eyeball between optic nerve & lateral rectus muscle
.. ,\
occulomotor .Y
Edinger-Westphal ...
...
Nucleus
Superior Cervical
internal carotid artery
..
~
Ganglion plexus (I eA)
Ill.
r \ lion
short ciliary
long ciliary
.. sphincrer pupillae
T
ciliary mu de
..
dilator pupillae
..
muscle
Pterygopalatine ganglion
• lies in pterygopalatine fossa (anterior to pterygoid canal)
greater petrosal
nerve to
Facial Nerve
nerve pterygoid canal
lacrimal gland
Superior Cervical
lCA
Ganglion
nasal gland
Pl n ,­
p.lt.H1n
r. ll1!h )II
Submandibular
• suspended from the lingual nerve
CNV
3
lingual
I
corda tympani
CNVII
I
facial a.
plexu
..
..
..

_ut m.m Ilul r
1 hit
submandibular
..
~
gland
...
ublingual
...
gland
Otic Ganglion
• infratemporal fos sa
tympamc lesser petrosal
auriculotemporal
parotid gland
nerve
ICAplexus
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Nose & Nasal Cavity:
• Conchae
t1 superior concha: posterior ethymoid sinus, sphenoid sinus
t1 inferior concha: nasal lacrimal duct
t1 middle conchae: all other sinuses (i.e. maxillary sinus)
• CLINICAL: Nosebleed
t1 sphenopalatine artery
Pharynx
1. Nasopharynx
t1 communicates with nasal cavity
t1 has pharyngeal tonsils
t1 connected with tympanic cavity via Eustachian tubes
t1 CLINICAL: Adenoid
• Hypertrophy of pharyngeal tonsils that obstruct airflow can become cancerous
2. Oropharynx
t1 runs from soft palate to epiglottis
t1 contains palatine tonsils
t1 CLINICAL: tonsillectomy
• can result in glossopharyngeal nerve damage
• can lead to loss of taste on posterior 1/ 3 of tongue as well as sensation
3. laryngopharynx
t1 from epiglottis to lower end of cricoid cartilage
t1 piriform recess is on each side of larynx opening (where foreign bodies can get lodged)
Larynx
• lower pharynx to trachea
• organ of voice production
• note: posterior cricoarytenoid is the only muscle that ABDUCTS rima glottidis
• CLINCAL: choking
t1 aspirated food gets lodged in rima glottidis (laryngeal space between vocal folds in arytenoid cartilages
- most narrow portion of larynx)
• innervated by CN X
• lesion of recurrent laryngeal
t1 hoarseness/inability to speak
t1 loss of sensation BELOW vocal cords
t1 can happen during thyroidectomy, cricythyromy, aortic aneurysm
• lesion of internal laryngeal
.
t1 loss of sensation ABOVE vocal cords
" ..
Inn
~ \ 1'"'\ .
t1 no epiglottis taste
• lesion of external laryngeal
t1 paralysis of cricothyroid mm. 4­
t1 fatigued/weakness of voice
t1 thyroidectomy can damage this nerve because it accompanies superior thyroid artery
• CLINICAL: thyroidectomy
t1 surgical removal of thyroid
t1 inferior thyroid vein & anterior jugular vein are vulnerable to injury
t1 CN X can be injured as well
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