CLINICAL REVIEW OF HEAD

FROM KLM
1) Neuralgia:
Algos → pain, severe throbbing/stabbing pain due to demyelinating lesion of nerve in its course.
2) BLACK EYE:-
Periorbital echyosis, Injury to super ciliary arches cause bruising of skin surrounding orbit cause
tissue fluid & blood to accumulate which gravitates in superior eyelids & around eye.
3) MALAR FLUSH :
Malar bone → zygomatic bone , raise in temperature in fever with T.B & systemic lupus erythmatosis
disease.
4) FRAUTURE OF MAXILA :
-le fort 1 :- wide variety of horizontal fracture involving maxillary alveolar process , nasal septum
pterygord plates.
-Le fort 2:- hard palate & alveolar process is separated from cranium .Passes from posterolateral part
of maxillary sinus & supromedial of infraorbital foramen passing from ethmoid /lacrimal bone
-Le fort 3 :- cause maxilla & zygomatic to separate from rest.involving orbital foramen + ethmoidal &
nasal bone + greater wing of sphenoid + frontozygomatic suture.
5) FRACTURE OF MANDIBLE :
-below to jaw cause fracture of neck of mandible & its body in 2nd canine teet + Dislocation of TMJ
-Fracture of coronoid process UNCOMON ,single.
-Fracture of mandible oblique , involve alveolus of 3rd molar.
-Fracture of body pass through socket of canine tooth.
6) FRACTURE OF CLAVARIA :
-Depresses fracture :- bone fragment is depressed inward ,compressing brain
-Linear calvaria fracture :- most frequent,occur at point of impact but fracture line appears in 2
directions.
-COMMINUTED FRACTURES:- fracture in many pieces.
-If area of impact is thick . bone depressed there but fracture occurs at nearby thin part.
-CONTERCUP:- no fracture on point of impact but on opposite side
7) DEVELOPMENT OF CRANIUM :-
No mastoid & styloid process present and birth, so facial nerve is near surface so it is danger.
There are ant & dost & paired Sphenoidal mastoid fontanels, palpation of them determines:
.Progress of frontal & parietal bone
 .degree of hydration
.level of intracranial pressure
During fetus passing through birth canal, halves of the frontal bone become flat, occipital is drawn
out & 1 paritel bone slightly override other, then after few days shape is retained. This resist fracture.
8) AGE CHANGES IN FACE :-
Mandible is most dynamic of our bones paranasal sinuses are important in altering shape of face &
adding resonance.
9) OBLITERATION OF CRAWAL SUTRES :-
It begins in 30-40 years after birth internally & 10 years later externaly.It begins at bregma & goes to
sagittal , coronal, lamboid sutures.
10) AGE CHANGES IN CRANIUM :-
It gets thinner ,lighter, gradulay diploe becomes gelatinous by losing its blood cells , blood supply &
fat
11) CRANIOSYNOSTOSIS & CRANIAL MALFORMATION :-
premature closure of sutures is craniosynotosis.it doesn’t affect brain growth, more common in
males.
-SCAPHLOCEPHALY :- premature closure of sagittal suture in which Ant fontanels is small , wedge ,
narrow shape cranium
-Oxycephaly/turicephaly in females, of coronal suture, high tower like
-Plagiocplaly of lamboid suture on 1 side, twisted asymmetrical shape.
12) SCALP INJURIES :-
in attached craniotomy, superficial temporal artery intact. Frist three layers of scalp are known as .
Scalp proper
Blood vessels & nerves of scalp enter inferiorly, so take care during surgery and little blood supply to
calvaria is by MMA artery of scalp
13) SCALP WOUND :-
Superficial wounds don’t of gape. deep wounds gape when laceration of epicranial aponeurosis is in
coronal plane bcz of pull of occipitofrontalis.
14) SCALP INFECTIONS :-
Pus / blood can spread by loose connective tissue layers 4. It can pass to cranial cavity by emissary
veins, which pass through parietal foramen. Can’t go in neck due to occipitiofrntalis , neither laterally
bcz of epicranial aponurosis is continuous.
15) SEBACEOUS CYST :-
Or wens. Bcz ducts of sebaceous gland associated with hair follicles it may obstruct and cause cyst
formation.
16) CEPHALHEMATOMA :-
blood trapped is cepholohematono, During difficult birth , many periosteal arteries rupture & cause
bleeding b/w baby’s pericranium & clavaria.
Usually over 1 parietal bone .
17) PARALYSIS OF FACIAL MUSCLES :-
injury to facial nerve paralysis of facial muscles of affected size (bell’s palsy ) sad appearance, lower eyelid
everted →cornea vulnerable → impaired vision ,food accumulation, dribbling saliva, can’t whistle ,
weakening to produce labial sounds (B,M,P,W) ,using handkerchief to wipe tears , saliva cause skin
irritation.
18) INFRA ORBITAL NERVE BLOCK :-
For treating wounds of upper lip , cheeks or maxillary incisor ,this nerve is blocked in infra orbital
foramen ,at junction of mucosa & gingiva , it may pass in orbital causing temporary block of extra
ocular muscle.
19) MENTAL & INCISIVE NERVE BLOCK :-
In lower lip problem
20) BUCCAL NERVE BLOCK :-
In cheeks , in retromolar fossa , located post to 3rd mandibular . molar B/w ant border of ramus &
temporal crest.
21) TRIGEMIMAL NEURALGIA / TIC DOULOREUX :-
Sensory problem of sensory root of CNV , its excruciating facial pain , set off by chewing ,
shaving , Drinking , touching face, brushing teeth , initiate by touching tip of nose, cheek
demyelination of sensory axon occurs
Aberrant artery compress is to block infraorbital nerve/selective ablation of parts of trigeminal
ganglion by foramen ovale/ rhizotomy → by cutting sensory root b/w brain stem / tracotmy ,
sectioning spinal trout of CNV
CNV2 is most common, then v3 and least v1
22) LESION OF TRIGENMIMAL PAIN :-
It cause Anesthesia of ant half of scalp, mucosal membrane of nose , mouth , ant part of
tongue.
Face except area around angle of mandible cornea, conjunctiva & paralyze muscle of
mastication !
23) HERPES ZOOSTER INFECTION OF TRINGEMINAL
GANGLION :-
Ophthalmic division is most common cornea mostly affected
24) INJURY TO FACIAL NERVE :-
 Maybe due to parotidectomy ,HIV ,pregnancy, vaccination, Lyme disease, otitis media,
- if it is near origin from pons/proximal to greater petrosal (region of geniculate ganglion )
result in loss of motor , gustatory & autonomic functions
-Lesion distal to geniculate. But proximal to chorda tympani same expect dysfunction ,
lacrimal secretion spare
-Near stylomastoid foramen result in loss of motor function only
25) COMPRESION OF FACIAL ARTERY:-
by pressure against mandible , facial wounds bleed freely & heal quickly
26) 2 PULSES OF ARTERIES OF FACE & SCALP :-
Superficial temporal & facial artery’s pulse is taken.
-Temporal pulse:- STA crosses zygometic arch ant to auricle
-FACIAL PULSE:- ant to master muscle inf border of mandible
27) STENOSIS OF INTERNAL CAROTID :-
Due to thickening of tunica intima, anastomosis present b/w facial artery (ECA) & cutaneous
branch of (ICA) .intracranial structures by connection of facial artery to dorsal nasal branch of
ophthalmic artery!
28) SCALP LACERATION :-
These wounds bleed profusely bcz arteries bleed from both ends occurring to abundant anastomosis
arteries don’t retract bcz held open by dense C.T of layer 2 bleeding can be fatal.
29) SQUAMOUS CELL CARCINOMA :-
Usually involve lower lip, exposure to sunshine, chronic irritation from pipe smoking, cancer from
central part spread to sub mental lymph nodes.& from lateral part to submandibular lymph nodes
(lower lips)
30) FRACTUER OF PTERION :-
It can be life threatening bcz it overlies ant branches of MMA & hematoma can exert pressure on
cerebral cortex.
31) THROMBOPHELEBITIS OF FACIAL VEIN :-
Inflammation of facial vein secondary to thrombus formation ,pieces of clots may pass in intracranial
venous system . (may spread to Dural venous sinuses) facial vein is connected to cavernous sinus
through superior ophthalmic vein & inf ophthalmic & deep facial vein of pterygoid venous plexus.
32) BLUNT TRAUMA TO HEAD :-
Blow to head can detach periosteal layer of Dura matter from matter from calvaria . At cranial base 2
Dura layers are attached firmly, so it fracture tear it & cause leakage of CSF.
Inner most part of Dura , Dural border cell layer , have fibroblast separated by layer extracellular
space.
 This cause weakness at dura-archnoid junction.
33) TENTORIAL HERNIATION :-
temporal lobe herniate & cause occulomotor lesion.
34) BLUGING OF DIAPHRAGMA SALLAE :-
Tumor of pituitary cause this , and pressurize optic chiasmic causing visual impairment.
35) OCCLUSION OF CERBRAL VENIS & DURAL VENOUS SINUS :-
The Dural venous sinuses , most frequently thrombosed are transverse , cavernous ,superior sagittal.
Thrombophlebitis of cavernous sinus may affected abducent nerve.
36) METASTASIS OF TUMORCELLS TO DURAL VENOUS SINUSES
:-
Basilar & occipital sinus communicate through Forman magnum via internal vertebral venous plexus.
Abscess / tumor in abdomen , thorax, pelvis goes in internal vertebral venous plexus & then to brain,
vertebrae
37) FRACTURE OF CARNIAL BASE :-
it may torn internal carotid artery & make AV fistula with cavernous sinus ,so enlarge it specially
ophthalmic vein , causing protruded eyeballs + pulse match with radial pulse (pulsating
exophthalmos ) CN 3,4,51 , 52 , 6 are in danger.(close to lateral wall of sinus )
38) DURAL ORIGN OF HEADACHE :-
Dura is sensitive to pain , after lumbar puncture usually.
39) LEPTOMENINGITIS :-
Inflammation of lepto menings (arachnoid+pia) ,usually infection is confined to subarachnoid space
& arachnoid-pia & bacteraia may enter in subarachnoid space via blood/heart/lungs
40) HEAD INJURIES & INTRACRANEAL PRESURE :
Extradural/ epidural hemorrhage is arterial in origin blood from MMA collects b/w periosteal layer of
Dura & calvaria , concusion(unconsciousness),drowsiness & comma, compression of brain,
A Dural border hematoma is subdural hematoma, blood creates a space at Dura arachnoid junction.
Typically venous in origin.
Subarachnoid hematoma is arterial, it is due to rupture of secular aneurysm such as ICA.
41) FRACTURES OF ORBIT:-
Medical & inferior walls are thin ,and weak, fracture of medical wall involve ethmoidal& sphenoidal
bone & fracture of inferior wall involve maxillary sinus superior wall is stronger but thin &
translucent.
42) ORBITAL TUMORS :-
 Optic nerve is close to sphenoidal & post. Ethmoidal sinus , malignant tumor may erode thin walls.
From middle cranial fossa it reaches to orbital cavity by sup orbital fissure , and from temporal &
inratemporal fossa goes in cavity by inf. Orbital fissure.
2.5cm of eyeball is exposed when turned medially so lateral side affords good site for operations.
43) INJURY TO NERVES SUPLYING EYELIDS:-
Injury to CN3 ,cause ptosis ,injury to cN7 prevent its closure, so eyelid Evert, drying
cornea,iiritation,ulceration,excessive but inefficient lacrimation.
44) DEVELOPMENT OF RETINA :-
Pigment layer develops from outer layer of optic cup and neural layer from inner layer of cup.
45) RETINAL DETACHMENT :-
In fetus there is intraretinal space , but in adults it fuse except space b/w pigment & neural layer so
patient with retinal detachment after days complains flashes of light in front of eyes.
46) UVEITIS :-
Inflammation of vascular layer of eyeball (uvea) .
47) OPHTHALMOSCOPY:-
To view fundus of eye, oval disc pale color appears on medial side.
48) PAPILLIDEMA:-
Swelling of optic disc due to increased intracranial pressure or increased interracial pressure or
increased CSF pressure by slowing down venous return.
49) PRESBYOPIA & CATRACTS :-
PRESBYOS → old, in old ages, lenses become harder & loss its focusing power → presbyopia
but if it also losses its transparency its cataract.
50) COLOBOMA OF IRIS :-
Birth defect , choroid fissure doesn’t close properly.
51) GLAUCOMA :-
Outflow of aqueous humor through scleral venous sinus in blood sinus is less than its production.
Pressure builds up in ant. Chamber
52) HYPHEMA/HYPHMIA :-
hemorrhage into ant. Chamber
53) ARTIFICIAL EYE :-
Suspensory ligament is saved in surgical removal of bony floor (during removing tumor)
54) CORNEAL ABRESION & LACERATIONS :-
Sudden stabbing pain in eyeball &tears.
55) HORNER SYNDROME :-
Absence of sympathetically stimulated functions on ipsilateral side of head
 Miosis: bcs parasympathetic sphincter is unopposed.
Ptosis: bcs bcs paralysis of smooth muscle which interdigitate with elevator palpebral superiors(
superior tarsal muscle)
And vasodilation,anhydrosis
56) PARALYSIS OF ORBITAL NERVES:
By disease in brainstem or head injury,extraocular muscles paralyze & cause diplopia.
57) OCCLOMOTOR NERVE PALSAY:
It causes:
Superior eyelids drops ( unopposed action of orbicularis oculi)
Pupil dilates (unopposed dilator pupilae)
Pupil is abducted (unopposed lateral rectus & sup oblique)
58) ABDUCENT NERVE PALSY:
Pupil fully adducted by unopposed action of medial rectus.
59) BLOCKAGE OF CENTRAL VEIN OF RETINA:
Results in slow, painless loss of vision, its connection is with cavernous sinus so thrombophlebitis.
60) BLOCKAGE OF CENTRAL ARTER OF RETINA
Usually unilateral & in old people,bcs branches are end arteries so total blindness
61) INFECTION OF PAROTID GLAND:
Pain gets worse in chewing bcs gland is wrapped around post border of ramus of mandible & is
compressed against mastoid
process of temporal bone when mouth is opened.
It maybe misdiagnosed as toothache so red papilla In oral vestibule is early sign.
It cause pain in auricle, external acoustic meatus, temporal region,TMJ bcs of auricotemporal &
greater auricular nerve.
62) ABSCESS IN PAROTID GLAND:
Can result from extremely poor dental hygiene
63) BLOCKAGE OF PAROTID DUCT:
Caused by sialolith or calculus (pebbles) sucking a lemon is painful bcs buildup of saliva in proximal
part of blocked duct.
64) ACCESORY PAROTID GLAND:
On masseter muscle,b\w parotid duct & zygomatic arch.
65) MANDIBULAR NERVE BLOCK:
Needle is passed through mandibular notch of ramus of mandible to infratemporal fossa, it blocks
auricotemporal,inferior alveolarmlingual,buccal branches of CN 5 3
66) INFERIOR ALVEOLAR NERVE BLOCK:
 Site of anesthesia agent is mandibular foramen, opening in mandibular canal on medial aspect of
ramus of mandible, this also blocks mental nerve.
67) DISLOCATION OF TMJ:
Sometimes head of mandible dislocates ant due to contraction of lateral pterygoids.
Post dislocation is uncommon,resisited by post glenoid tubercles & lateral ligaments. Care must be
taken in surgery due to facial & auricotemporal nerve.
68) CLEFT LIP\HARELIP:
Usually of upper lip & usually in males, cleft maybe small notch in transitional zone or maybe
vermilion border to notch that extends through the lip into the nose.
69) CYNOSIS OF LIPS:
Lips like the fingers have abundant, superficial arterial blood flow & sympathetic innervated V
anastomosis.& this happens due to cold ,less oxygenation.
70) GINGIVITIS:
Due to improper oral hygnie,it may produce periodontitis,dentoalveolar abscess.
71) DENTAL CARIES,PUPITIS,TOOTH ABSCESS:
Acid,enzyme produced by oral bacteria may decay hard tissue of teeth→ dental caries.
Invasion of pulp by deep carious lesion results in infection & irritation in tissue→ pulpitis.
Bcs pulp cavity is rigid space ,swollen tissue cause pain → toothache.
Pressure of swollen tissue & infected material may pass through apical canal → alveolar bone,
producing abscess,periapical abscess.
72) ERACTION OF TEETH:
Lingual nerve is related to medial aspect of 3rd molar teeth.
73) NASOPALATINE BLOCK:
Anesthesia into incisive fossa on hard plate,platal mucosa,ligual gingiva ,alveolar bone of 6 ant
maxillary teeth ,hard plate anesthetized
74) GREATER PALATINE NERVE BLOCK:
Anesthesia into greater palatine foramen.it emerges b\w 2nd & 3rd molar teeth. Palatal mucosa,ligual
gingiva, post to maxillary canine teeth & underlying bone.
75) CLEFT PALATE:
More common in females, it may be alone or with cleft lip.it may only involve uvula or may extend
through soft & hard palate region.
76) GAG REFLEX:
CN9,10 are involved in muscular contraction of each side of phyarnx.glossophargeal branches
provide afferent limb for this reflex.
77) PARALYSIS OF GENIOGLOSUS:
 It cause tongue to fall posteriorly and obstruct airway.
78) INJURY TO HYPOGLOSAL NERVE:
Fracture of mandible cause this, results in paralysis & atrophy of tongue. Tongue deviates to
paralyzed side due to unaffected genioglosus of other side.
79) LINGUAL CARCINOMA:
In post part it passes to superior deep cervical lymph nodes. But in ant part does not metastasis to
inf deep cervical lymph nodes until last stage. Bcs they are close to IJV. It may reach to sub mental &
submandibular regions.
80) EXCISION OF SUBMANDIBULAR GLAND:
During surgery, in incision take care of marginal mandibular nerve of facial.
& during incising take care of lingual nerve, inferior to 3rd molar.
81) TRANSANTRAL APPROACH TO PTERYGOPALATINE FOSSA:
Surgically it is accessed by maxillary sinus.in chronic epistaxis,3rd part of maxillary artery is ligated in
this fossa.
82) NASAL FRACTURES:
Common in facial fractures. Direct blow also injures cribriform plate of ethmoid bone.
83) RHINITIS:
Nasal mucosa become swollen\inflamed sue to its vascularity.
Cause id hay fever(allergic reaction),severe upper respiratory infection.
May spread to
Ant cranial fossa by cribriform plate.nasopharynx & retrophrgeal soft tissue, middle ears through
phargyotympanic tube,paranasal sinus,lacrimal apparatus.
84) EPISTAXIS:
Nosebleed, from ant 3rd of nose (kisselbach’s area) due to infection, hypertension.
85) SINUSITIS:
Inflammation & swelling of mucosa of sinus.
86) INFECTION OF ETHMOID CELLS:
Nasal drainage block→ infection of ethmoid cells through medial wall of orbit→ blindness bcs post
ethmoidal cell affect Dural sheath of optic nerve.

87) INFECTION OF MAXILARY SINUS:

Most commonly affected,bcs Ostia are small & high in supromedial walls. When mucous membrane
is congested, sinus blocks.becuase of high position of Ostia the drainage is impossible until they are
full when head is erect. So lying on right side drain left side.
88) RELATIONSHIP OF TEETH TO MAXILARY SINUS:
three maxillary molar teeth are related to maxillary floor.
89) OTOSCOPTIC EXAMINATION:
In adults helix is grasped posterosuperiorly ( up,back,out). In infants inferoposteriorly ( down,back).
To reduce curvature of external acoustic meatus.tumpanic membrane is pearly gray, handle is mealus
is visible on umbo.
90) ACUTE OTITIS EXTRENA:
Inflammation of external acoustic meatus due to bacterial infection, in swimmers, pain & itching
pulling auricle or applying pressure on tragus increase pain.
91) OTITIS MEDIA:
Secondary to upper respiratory tract infection,& infection of mucous membrane of tympanic cavity
may block phargyotympanic tube.
tympanic membrane becomes red color, ear poping,impaired hearing, scarring of auditory ossicles if
untreated.
92) PERFORATION OF TYMPANIC MEMBRANE:
Rupture of eardrum results from otitis media, cause middle ear defness.superior half of tympanic
membrane is more vascular, so incision to release pus is made posteroinferiorly.take care to chorda
tympani,auditory ossicles during surgery.
93) MASTOIDTIS:
Infection of mastoid antrum & mastoid cells due to middle ear infection.
May pass to middle cranial fossa in children due to pterosquamous fissure(osteomyelitis)→ bone
infection of tegmen tympani.
Take care of facial nerve in surgery.
94) BLOCKAGE OF PHARGYOTYMPANIC TUBE:
Phragytmpanic tube occluded→ residual air in tympanic cavity is absorbed in mucosal blood
vessels→ lower pressure in tympanic cavity→ retraction of tympanic membrane→ interfere with its
free movements→ impair hearing.
95) PARALYSIS OF STEPEDIUS:
Lesion of facial nerve→ stepedius paralyze→ hyperacusis (excessive acuteness of hearing)
96) MOTION SICKNESS:
Due to discordance b\w visual & vestibular stimulus, macula of membranous lybrnthine having
otolith in hair cells,primay static organs.otolith→ bending of hair cells→ stimulate vestibular nerve.
97) DIZZINES & HEARING LOSS:
Injury in peripheral auditory system cause
Hearing loss (conductive type)
 Vertigo when injury involve semicircular canals.
Tinnitus (buzzing) when injury is localized in cochlear duct.
2 TYPE OF HEARING LOSS:
-conductive type: problem with external or middle ear interfering with conduction & movement of
oval window.to them their own voice seems loud so they speak softly.
-sensorineural type: problem in cochlear nerve,chochlea,brain stem, cortical connections.
98) MENIERE SYNDROME:
Due to blockage of cochlear duct,chracters are hearing loss,buzzing,vertigo,ballooning of cochlear
duct,utricle,saculae by increasing endolymphatic volume.
99) OTIC BAROTRAUMA:
Usual in divers & fliers, injury in ear by imbalance air pressure in ambient & air in middle ear.

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