Review of Head/Neck

Olfactory
(Sensory)
Optic
• Smell

• Vision
Cribiform plate

Optic canal
Can't smell
--
No reaction to light (both
pupils same size)
....
(Sensory)
• E ye movement
• Levator palpebrae Contralateral reaction (one
Occulomotor Superior orbital fissue
superioris pupil is big, one is small)
(Moto~
• Sphincter pupillae or drooping lid v

• Ciliary MM
Trochlear Double vision when V
• Superior Oblique (S04) Superior orbital fissue
(Moto~ looking down
• M of mastication
• Mylohyoid -'
VI = superior orbital fissure VI =no corneal reflex
Trigeminal (Vi, V2, V3) • Ant. digastric belly
V 2=rotundum V2=no sneeze reflex
(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 '
• Lateral rectus (LR6) Superior orbital fissure ,
(Motor) (unable to aBduct) ./
• M of facial expression
Bells Palsy ­
• Post. digastric belly
Facial Dry mouth
• Stylohyoid, stapedius Internal acoustic meatus
(Both) Dry eye
• Lacrimal! salivary glands No taste on ant 2/3­
• Taste at ant 2/3
Vertigo
Vestibulocochlear
• Equilibrium + hearing Internal acoustic meatus Deafness
(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 /
• s. of pharynx, larynx Jugular foramen
(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
,
8 p 1n 05Urv-- ~ Middle geM,.L"jeaJ =Artery . C '
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Reflexes

For every reflex there is a sensory (in) and motor lout)

Reflex Q~~8:J ~ In Out

•
f1""-.

Corneal light ~'~"' ~t

Corneal blink J
1
~ un
V (Vl) - helps eye stay open
\In)
VII - closes eye
Sneeze V (V2) X \....-­
Gag L",,\: X '..../'
Cough X X ~
Jaw Jerk V V ~
~Pillih-~~ « m
Arches
Clefts/ Grooves
(Mesoderm + Neural Crest) Pouches
Pouch (Ectoderm)
Mesoderm MM + AA = (endoderm)
=
Neural Crest Bone + CT
• 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
\(3 • Incus
• 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 -
LL , • Styloid process '

• Styln)wnicl ligament

3.
-
CNIX
10:"- eh f"1V\ ",cJ
• ( !lo.l!haryngeUs It
• mmon carotid )
• Greater hom of hyoid
Inferior parathyroid ~3 '
• Soft .Qll!ll te mm except te1i1 s ~r ,velli
palatine ' "It; 1
• Pharynx mm except
4. CN X (Superior Laryngeal) s ~~h..a~7~eus Superior £arathyroid
--- v~~
• Cncott yrOld muscle
• Cricopharyngeus
• lArch ot aorta) Ll ' gJ-
• Intrinsic larynx muscl~ ex cept
g ~..?J
\
~j(V,J fA '-1/ I}Ak M
cricothyroid muscle ~ ct.,,\ .
6. CN X (Recurrent Laryngeal) • Esophageal mm U lJ..\ ~o 6<-(\.0- J
• vPulmonary aa
• ...-Ductus arteriosus C ,~u. ~) (-c"J C:.l.-r. """"" '-­
Really good summary of embryo ill FIRST AID
P~7 i1.~tQ ~ ,2"d.- ad__ .

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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 neck~connects to tongue~via 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

~ko\oOlO~~~ DL .

MecL:-CVVL C--Lett
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4
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pct~" l pi !;'is. -')

t"r\..U.'ls,s ...., (.c'I~,ct-.,, ·

A.nh.:Jdr"S~5 . '" no SLO ~

E~Y1.Op\t;alr;'\o!>,~ . ~ ~r~'~.c.' .... o\,- ~U~ (
/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.
rd
• 3 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.,
,..c:.:t~

Carn E.CL Sl...l-Pp l l1

7-.

•
no
00.()-
blood..
rn::1~fc..hat,"-d nQ.l..?ron.e.
.. ¥ -+ro.(. ..., hoI'''' C '1""" 1..I~
hev-'1,..(.C>Y'lCp :4
• ~h e.6t ~~e ;~cJ.e...oL
c;; '" L cj.~~r(\ ~ b •.~~O,..,J
h~u'\C'~1 '"

CJ,orD;~ ~~ n-u:.dle (~e;l,. -

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~ dQrk:...

Gi,'c..r '1

·~rf"l\.b ~ e JI12rI~~ b,,~ Cuv<L.J:..... is . SL~) S~f>~so.nj

Lijo.",,~

Near objc:d-s -4 m .
TRIGEMINAL NERVE (eN V)

Opthalmic
• through cavernOus sinus _____
• sensorfto eye to ~ 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 m~?? ? ­
• lingual: sensatiqfto ant 2/ 3 o f tongu~

~OJ ~)
C
TONGUE
• anterior 2/3
o CN VII - chorda tympani for taste
o eN v - lingual for sensation
• posterior 1/3 l tl. ... cl.. ( ~ral. ~)
o eN IX - for taste & sensation
L\~ o. rc.lA-~ ~\oJJ1S .
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
 ~-=-- Lf- g s...p.
patrO!l<.\ S;t'\...I..U

IV"tu" 1"1 oJ
Co. r o\-i cJ.
Q("tcr,-\­

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..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

6.
- supetior sagittal & occipital & straight sinuses all meet

transverse SillUS

- drains blood from the confluence

- takes blood to the sigmoid sinus

7. sigm~id sinus

- drains into IJV

8. cavernous SillUS

- located on either side of the sphenoid bone

-,I receives venous blood from: •

" L1 facial vein

~d\("ecr ~ ~~
L1 ophthalmic vein

L1 pterygoid plexus of veins 0 \1 .

L1 central vein of retina ~ l ' ~~4.5
p+~"-.j 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
~
~... ~£U"':J
~ L1 inferiorpetro"ffl sinus ~ IJV

- located in th~ :l:fl.Us:

L1 internal carotid artery & abducens nerve (CN VI)

located in th~ of cavernous sinus:

- L1 CN III, CN IV, CN V2, CN V3

CSF Flow

Lateral ventricles ~ Foramen of Monroe (interventriculat foramen) ~ 3rd 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)

-1
- there will be a ?~omewhete along th.!",normal CSF flow

t
CSF stasis bluild-up will occur everywhere in front of the block

Hematomas
1. epidural
Ce.rebMJ art~

Ant ~ . -4 let.-VeK' eoc.t . Cdp; ncJ CO ret \~I~)

pes .

."

----l-­
v-'~
C9'-,;, Yj

.trebr~
<
lr r [ eM c e.f>"' ''''o~) th 0./ a. t-M...
--+-~ . ~

up

~ rY\ e cLu.l l ~
o6 Ia~C{k. .
 • 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 mi~dle 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 o f a baby's head
• veins: su!!!ior cerebellar veins (aka bridging or emissary veins)
• sIgns: ­
~ no blood in CSF
~ venous blood between
~
~
3.
• ~
• SIgnS:
c~~~
~ 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)
• ~ O \Jt.....cJ.""" o~e.. c P C) S t- C-r l Cl ' sh.,.:~ oR -I€-.e ~G6oLl...J

[Vle,Wi1cr~ s.., ~fLJ{o '" m ahcrvc ::(; =~n,.;.cJ­

.Ar~ s-teP\OSt:S ­

~j&ro c.epha.l..uJ. ­
Lul'Y) Ioa..- p t-VV\. c.tu.., r~ ­
 , .

Parasympathetic. Sympathetic, Both

Ciliary ganglion
• sits behind eyeball between optic nerve & lateral rectus muscle

Edinger-Westphal
Nucleus
occulomotor
.. ,\
.Y ...... short ciliary .
T
sphincrer pupillae
ciliary m u de
Ill.
r \ lion

Superior Cervical internal carotid artery .. long ciliary

... dilator pupillae
Ganglion plexus (I e A) ~
muscle

Pterygopalatine ganglion
• lies in pterygopalatine fossa (anterior to pterygoid canal)

greater petrosal nerve to

Facial Nerve nerve

pterygoid canal

Pl n ,­
lacrimal gland
p.lt.H1n
r. ll1!h )II
Superior Cervical lCA

Ganglion

nasal gland

Submandibular
• suspended from the lingual nerve
..
CNV3
lingual I .. submandibular
~

gland
_ut m.m Ilul r
CNVII
I
corda tympani
. 1 hit
ublingual
facial a. ...... gland
plexu •

Otic Ganglion
• infratemporal fos sa

tympamc lesser petrosal

auriculotemporal
nerve parotid gland

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
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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