The document summarizes various topics related to the head and cranium:
1) It describes fractures of the calvaria bones, which can be linear fractures at the impact point or contrecoup fractures in a thinner remote area.
2) Craniotomies and craniectomies are discussed as surgical techniques for accessing the cranial cavity by removing a bone flap that is later wired back or not replaced.
3) Development and aging changes of the cranium are outlined, such as intramembranous ossification of the calvaria and endochondral ossification of the cranial base. Sutures gradually obliterate with age.
The document summarizes various topics related to the head and cranium:
1) It describes fractures of the calvaria bones, which can be linear fractures at the impact point or contrecoup fractures in a thinner remote area.
2) Craniotomies and craniectomies are discussed as surgical techniques for accessing the cranial cavity by removing a bone flap that is later wired back or not replaced.
3) Development and aging changes of the cranium are outlined, such as intramembranous ossification of the calvaria and endochondral ossification of the cranial base. Sutures gradually obliterate with age.
The document summarizes various topics related to the head and cranium:
1) It describes fractures of the calvaria bones, which can be linear fractures at the impact point or contrecoup fractures in a thinner remote area.
2) Craniotomies and craniectomies are discussed as surgical techniques for accessing the cranial cavity by removing a bone flap that is later wired back or not replaced.
3) Development and aging changes of the cranium are outlined, such as intramembranous ossification of the calvaria and endochondral ossification of the cranial base. Sutures gradually obliterate with age.
Chapter
7
Gradually
the
mental
foramen
gets
closer
to
superior
border
disappears,
exposing
mental
Cranium
nerves.
Head
Injuries
Loss
of
all
teeth
decrease
vertical
dimension
Can
cause:
hemmorage,
infection,
injury
to
brain
of
face
and
mandibular
prognathism
(over- or
CNs
closure)
Headaches
&
Facial
Pain
Fractures
of
Calvaria
Severe
causes:
Brain
Tumor,
subarachnoid
Normally
distribute
forces
well.
Hard
blows
can
hemmorage,
meningitis
fracture
thin
areas.
Neuralgias
(pain)
stabbing
pain
over
the
course
Linear
calvarial
fractures
occur
at
point
of
of
a
nerve
caused
by
demyelination.
impact
and
radiate
away.
Otalgia
=
earache
Communicated
fractures
=
several
pieces.
Odontalgia
=
tooth
ache
Contrecoup
(counterblow)
fracture
=
no
fracture
at
point
of
impact,
but
somewhere
else
Injury
to
Superciliary
Arches
in
a
thinner
portion.
A
blow
to
them
may
lacerate
skin
(theyre
sharp)
Surgical
Access
to
Cranial
Cavity
Malar
Flush
Craniotomy
=
removal
of
neurocranium
section,
Zygomatic
Bone
=
Malar
Bone
called
a
bone
flap.
Redness
over
zygomatic
prominence
(malar
Little
regeneration
occurs,
so
its
wired
back
eminence)
is
associated
with
fever
in
certain
into
place.
Most
successful
when
you
retain
the
diseases
(Tuberculosis,
Lupus)
overlying
muscle
and
skin
keeps
blood
supply.
Craniectomy
bone
flap
is
not
put
back,
Features
of
Maxillae
and
Associated
Bones
replaced.
Le
Fort
I
Fracture
=
horizontal,
above
teech,
crossing
nasal
septum
Development
of
Cranium
Le
Fort
II
Fracture
=
From
posteriolateral
Calvaria
intramembranous
ossification;
portion
of
maxillary
sinuses
through
to
orbital
cranial
base
endochondral
ossification
foramina
and
across
bridge
of
nose
(connecting
Birth:
calvaria
bones
=
smooth
+
unilaminar
orbitals)
central
maxilla
separated
from
Infants
large
calvaria
from
growth
of
brain
&
cranium.
eyes.
Le
Fort
III
Fracture
=
Passes
through
through
Facial
nerves
close
to
surface
--
>
injury
during
superior
orbitals
and
extending
to
the
greater
forcep
delivery
wings
of
sphenoid.
Also
fracture
along
Calveria
bones
separated
by
membraneous
zygomatic
arches.
intervals
(newborn)
ant
&
post
fontanelle
can
judge
growth,
hydration
(depressed
if
Fractures
of
Mandible
dehydrated,
and
intracranial
pressure
(bulge)
Usually
involve
two
fractures
on
either
side.
Anterior
Fontanelle
(largest)
site
of
bregma
Coronoid
process
fractures
are
uncommon.
Frontal
suture
(separates
frontal
bone)
Fracture
of
neck
are
associated
with
dislocation
obliterated
by
8th
yr
(dont
confuse
with
of
TMJ
fracture)
remnants
=
metopic
suture
Fracture
along
angle
are
oblique
Post
fontenalle
=
lambda
Fracture
on
body
pass
through
socket
of
tooth
Cranial
bone
softness,
loose
connections,
and
fontanelle
calvaria
mold
to
birth
canal.
Resorption
of
Alveolar
Bone
Extraction
of
teeth
causes
this.
Unit 2 Blue Box Summaries:
Age
Changes
in
Face
Arteries
of
scalp
supply
little
blood
to
calvaria,
The
mandible
undergoes
the
most
change
so
scalp
removal
does
not
=
necrosis
of
calvaria.
(newborns
dont
have
alveolar
processes)
Enlargement
of
face
is
concurrent
with
Scalp
Wounds
paranasal
sinus
enlargement
(small
or
abscent
The
epicranial
aponeurosis
prevents
scalp
at
birth)
wounds
from
gaping.
If
this
lining
is
lacerated,
however,
the
wound
Obliteration
of
Cranial
Sutures
will
gape
widely
from
the
pull
of
the
frontal
and
Begins
around
30-40
on
inside.
(10
yrs
later
occipital
bellies
of
the
occipitalfrontalis
muscle
outside)
in
opposite
directions.
Starts
at
bregma
and
continues
towards
sagittal,
coronal,
and
lamboid
structures.
Scalp
Infections
Loose
connective
tissue
(layer
4)
of
scalp
is
Age
Changes
in
Cranium
danger
area
because
blood/pus
can
pass
freely
It
becomes
thinner
and
lighter
with
age.
in
it.
Bone
marrow
loses
blood
cells
and
fat
Infections
can
spread
to
cranial
cavity
through
gelatinous
appearance.
emissary
veins.
Cannot
pass
into
neck
or
laterally
beyond
Craniosynostosis
and
Cranial
Malformations
zygomatic
arches
due
to
the
occiptiofrontalis
Primary
craniocyntosis
=
premature
closure
of
muscle
and
epicranial
aponeirosis
respectively.
cranial
sutures
doesnt
affect
brain
dev.
Infections
can
enter
eyelids
and
root
of
nose.
Scaphocephaly
=
premature
closure
of
the
Blows
to
periorbital
region
can
cause
saggital
sutures
small/abscent
anterior
periorbital
ecchymosis
(black
eye).
Ecchymosis
fontanelle
long
narrow
wedge
shapped
head
(purple
patches)
result
from
extravasation
of
Plagiocephaly
=
premature
closure
of
the
blood
into
subq
tissue.
coronal/lambdoid
sutures
twisted
a
symmetrical
head
Sebaceous
Cysts
Oxycephaly/turricephaly
=
premature
closure
When
gland
is
obstructed
retains
secretion
of
coronal
suture
high
tower-like
cranium
sebaceous
cyst.
Face
and
Scalp
Cephalhematoma
Facial
Lacerations
and
Incisions
=
blood
trapped
between
pericranium
and
They
tend
to
gape
because
no
deep
fascia.
Blood
calvaria
as
a
result
of
a
difficult
birth.
(ruptured
tends
to
accumulate
because
of
the
loose
arteries
that
provide
blood
to
calvaria.)
connective
tissue.
Inflammation
large
amounts
of
swelling.
Flaring
of
Nostrils
Wrinkles
occur
in
the
direction
of
muscles.
Nasal
breathers
do
this
very
well
Importance
of
Langer
Lines.
They
follow
these
Mouth
breathing
reduces/elimates
this
ability.
cleavages
and
wounds
in
the
same
direction
Chronic
child
mount
breathers
develop
dental
have
minimal
scarring.
malocclusion
(improper
bite)
Scalp
Injuries
Paralysis
of
Facial
Muscles
A
partially
detached
scalp
will
probably
heal
as
Bell
Palsy
=
injury
to
facial
nerve
paralyzing
long
as
one
of
the
vessels
remains
intact.
Many
some/all
muscles
on
that
side.
Area
sags/no
of
the
vessels
anastomose
freely.
facial
expression.
Attached
Craniotomy
they
always
leave
one
of
Obicularis
oculi
loses
tonus
no
lacrimal
fluid
the
arteries
intact.
spread
over
eye
cornea
vulnerable
to
ulceration
imparide
vision.
Unit 2 Blue Box Summaries:
Corner
of
mouth
droops.
Difficult
to
talk
and
Herpes
Zoster
Infection
of
Trigeminal
Ganglion
eat.
Drool
a
lot
skin
irritation.
This
may
produce
a
lesion
in
the
cranial
ganglia
(involvement
of
trigeminal
ganglia
occurs
20%)
Infra-Orbital
Nerve
Block
Can
affect
any
division
of
CN
V
but
generally
Done
to
treat
injury
of
the
upper
lip
or
ophthalmic
(1st)
painful
corneal
ulceration
maxillary
incisor.
scaring
of
cornea.
Anesthetic
given
near/at
the
infra-orbital
foramen
where
the
nerve
emerges.
Testing
Sensory
Function
of
CN
V
Carelessness
injection
into
the
orbit
Touch
each
region
innervated
by
CN
V.
paralysis
of
the
extraocular
muscles.
Forehead
(CN
V1),
cheek
(CN
V2),
lower
jaw
(CN
V3)
Mental
and
Incisive
Nerve
Blocks
Done
to
treat
injury
to
the
lower
lip/skin
of
chin
Injury
to
Facial
Nerve
(e.g.
lip
laceration)
W/
or
w/o
loss
of
taste
or
secretion
of
Given
near
the
mental
foreamen
where
nerve
lacrimal/salivary
ducts.
supplies
skin
+
mucous
membrane
of
lower
lip.
Lesion
at
origin
=
complete
paralysis
Lesion
distal
to
geniculate
ganglion
=
same
but
Buccal
Nerve
Block
lacrimal
not
affected
Done
to
treat
injury
to
cheek
(knife
wound)
Lesion
near
stylomastoid
foramen
=
only
motor
Given
at
the
mucosa
covering
of
the
retromolar
loss.
fossa
(posterior
to
third
mandibular
molar)
Causes:
inflammation
(causing
compression),
fracture
of
temporal
bone,
idiopathic
(unknown
Trigeminal
Neuroglia
casue)
surgery
complication
(parotidectomy),
AKA
Tic
Douloureux
disorder
of
sensory
CN
V
dental,
vaccination,
pregnancy,
HIV,
Lyme
most
often
in
middle
aged/eldery.
attacks
of
diseas,
otitis
media.
paroxysm
(sudden
sharp
pain)
leads
to
Zygomatic
branch
lesion
=
loss
of
orbicularis
wincing
or
tics
(hence
the
name)
oculi
CN
V(2)
(maxillary)
is
most
often
involved
and
Buccal
branch
=
buccinators,
superior
CN
V(1
least)
(ophthalmic)
orbicularis
oris,
and
upper
lip
muscles
Initiated
by
touching
of
trigger
zone
Marginal
Mandibular
=
lower
orbicularis
oris,
(sometimes
at
tip
of
nose
or
cheek)
and
lower
lip
muscles.
Causes
demylenation
of
axons
which
is
cause
by
pressure
from
a
small
aberrant
artery.
When
Compression
of
Facial
Artery
artery
is
moved
away
the
symptoms
often
stop.
If
bleeding
you
must
compress
both
arteries
Selective
ablation
of
parts
of
trigeminal
ganglion
because
of
numerous
anastomoses.
to
treat.
To
prevent
nerve
fiber
regeneration,
perform
a
rhizotomy.
Pulses
of
Arteries
of
Face
and
Scalp
Another
treatment
option
=sectioning
spinal
Temporal
and
Facial
arteries
can
be
used.
tract
of
CN
V
(tractotomy)
loss
of
sensation
generally
provided
by
CN
V
Stenosis
of
Internal
Carotid
Artery
Occurs
at
medial
angle
of
eye
between
facial
Lesions
of
Trigeminal
Nerve
(branch
of
external)
and
cutaneous
branches
of
Causes
widespread
anesthesia
around
the
half
internal
carotid.
of
scalp,
face
and
paralysis
of
muscles
involved
Internal
carotid
becomes
stenotic
with
age
in
mastication.
brain
still
receives
blood
due
to
anastomose
of
facial
with
ophthalmic
artery.
Unit 2 Blue Box Summaries:
Scalp
Lacerations
Tentorial
Herniation
Bleed
a
lot
due
to
numerous
anastomose.
Tentorial
Notch
=
larger
than
necessary
for
Furthermore,
they
are
held
open
by
connective
midbrain,
thus
space
occupying
lesions
tissue.
(tumors)
can
develop
increased
cranial
Can
be
fatal
if
not
sutured.
pressure.
Causes
temporal
lobe
to
herniate
through
notch
Squamous
Cell
Carcinoma
of
Lip
(lobe
can
be
lacerated)
and
compress
CN
III
From
too
much
sun
or
smoking
(paralysis
of
extrinsic
eye
muscles)
Cancer
cells
in
central
part
of
lower
lip/floor
of
mouth/apex
of
tongue
spread
to
submental
Bulging
of
Diaphagma
Sellae
lymph
nodes.
Pituitary
Tumors
can
extend
superiorly
into
the
Cancer
cells
from
lateral
parts
of
lower
lip
go
to
diaphragm
sellae
disturbances
in
endocrine
submandibular
lymph
nodes.
and/or
visual
impairment
(pressure
on
CN
II)
Cranial
Cavity
and
Meninges
Occlusion
of
Cerebral
Veins
and
Dural
Venous
Fracture
of
Pterion
Sinuses
Can
be
life-threatening
because
it
overlies
These
can
occur
through
thrombi
(clots),
anterior
branches
of
middle
meningeal
vessels.
thrombophlebitis
(venous
inflammation),
or
Can
rupture
these
middle
meningeal
artery
tumors
(meningiomas).
Mostly
in
transverse,
hemorrhage
(epidural-hematoma
pressure
cavernous,
and
superior
sagittal
sinuses.
on
cerebral
cortex)
Cavernous
Sinus
Thrombosis
usually
from
infections
in
the
danger
triangle
(pimple
Thrombophlebitis
of
Facial
Vein
poppers)
Facial
vein
makes
connection
with:
Infected
thrombus
extends
into
cavernous
sinus
Cavernous
sinus
through
superior
thrombophlebitis
of
cavernous
sinus.
ophthalmic
vein.
May
affect
CN
VI
or
nerves
in
lateral
wall
of
Pterygoid
Venous
plexus
through
inf.
sinus.
ophthalmic
&
deep
facial
veins.
Can
produce
acute
meningitis.
Infection
can
spread
to
these
areas
when
blood
flows
opposite
direction.
Metastasis
of
Tumor
Cells
to
Dural
Venous
Sinuses
People
with
thrombophlebitis
of
facial
vein
Basilar
&
Occiptal
sinuses
communicate
w/
(inflammation
with
secondary
clot)
can
have
vertebral
venous
plexus,
thus
compression
of
pieces
of
clot
spread
upward
thorax/abdomen/pelvis
force
venous
blood
thrombophlebitis
of
cavernous
sinus
into
vertebral
venous
system
spread
Can
spread
to
dural
sinus
through
nose
pus/tumor
cells
into
vertebrae
&
brain.
lacerations
or
pimple
popping.
Danger
Triangle
of
the
Face
Fracture
of
Cranial
Base
internal
carotid
may
be
torn
arterial
Blunt
Trauma
to
Head
fistula
arterial
blood
rushes
into
cavernous
Can
detach
dura
from
calvaria
w/o
fracturing
sinus.
cranial
bones
leakage
of
CSF
Exopthalmos
&
chemosis
(conjunctiva
becomes
Inner
part
of
dura
(dural
border
cell
layer)
engorged.
composed
of
flattened
fibroblasts
(large
spacing
Eyeballs
pulsate
with
radial
pulls.
between
cells)
weakness
at
dura-arachnoid
CN
III,
CN
IV,
CN
V1,
CN
V2,
&
CN
VI
can
be
junction.
damaged
because
in
lateral
wall
of
cavernous
sinus.
Unit 2 Blue Box Summaries:
Dural
Origin
of
Headache
slowness
of
movements,
hand
tremors,
slow
Dura
=
sensitive
to
pain.
Pulling
on
sinuses
or
cerebration
(use
of
ones
brain)
arteries
hurts.
Distension
of
scalp
or
vessels
Cerebral
contusion
=
pia
stripped
blood
headache.
enters
subarachnoid
space
(from
jerking
Headache
after
lumbar
spinal
puncture
movement)
(interruption
in
dura)
and
less
CSF
brain
Cerebral
Lacerations
from
depressed
cranial
sagging
&
pulling
on
dura.
fractures
or
gunshots
ruptured
vessels
P
keep
head
down
after
spinal
puncture
bleeding
into
brain
increased
cranial
minimize
headache.
pressure
Cranial
Compression;
produced
by:
intracranial
Leptomeningitis
collection
of
blood,
obstruction
of
CSF
=
inflammation
of
leptomeninges
(arachnoid
&
circulation,
intracranial
tumor/abcess,
brain
pia)
from
pathogenic
microorganism.
edema
from
increase
in
water/Na
content.
Bacteria
can
enter
through
blood
or
compound
cranial
fracture.
Cisternal
Punctures
Acute
purulent
meningitis
can
result
from
Done
to
obtain
CSF
in
infants/children.
(lumbar
almost
any
pathogenic
bacteria.
puncture
for
adults)
Needle
post.
antlanto-occiptal
membrane
Head
Injuries
and
Intercranial
Hemmorage
ristern.
Extradural/Epidural
Hemorrhage
(arterial)
Can
use
subarachnoid
space/ventricular
blood
from
torn
middle
meningeal
collects
system:
monitor
pressure,
injecting
antibiotics
between
dura
and
calvaria
strips
dura
from
or
contrast
media
cranium.
forms
extradural
hematoma
Concussion
drowsiness
&
coma
Hydrocephalus
From
hard
blow.
As
blood
mass
increases,
Overproduction
in
CSF/obstruction
of
outflow
brain
compression
increases
excess
fluid
in
ventricles
enlargement
of
Dural
Border
Hematoma/subdural
hematoma
head
obstructive
hydrocephalus
(venous)
blood
splits
open
the
dural
border
Aqueductal
stenosis
caused
by
tumor
in
cell
layer,
from
tearing
of
superior
cerebral
surrounding
area
or
fungal
infection
reduced
vein/superior
sagittal
sinus
CSF
outflow.
Blow
that
jerks
the
brain.
Blockage
dilation
of
ventricle
superior
to
Blood
go
into
space
b/w
dura
&
arachnoid
obstruction
squeezes
brain
between
but
rather
creates
space.
ventricular
fluid
&
calvarial
bones.
Subarachnoid
hemorrhage
(arterial)
from
Infants
expansion
of
calvaria
because
sutures
rupture
of
aneurysm
(sac
like
arterial
dialation)
are
still
open
Cranial
fractures/cerebral
lacerations
may
Communicating
Hypdrocephalus
=
CSF
flow
cause
this.
blocked
from
subarachnoid
space
into
venous
Meningeal
irritation/headache/stiffness/
system
(instead
of
from
ventricles
into
unconscious
subarachnoid
as
is
the
case
above)
Brain
Leakage
of
Cerebrospinal
Fluid
Cerebral
Injuries
CSF
otorrhea
=
fracture
in
floor
of
middle
Cerebral
concussion
=
brief
loss
of
cranial
fossa
and
meninges
tear
and
tympanic
consciousness
after
a
head
injury
(boxing
membrane
ruptures.
CSF
leaks
through
ears.
knockdown)
if
not
longer
than
6
hrs
=
good
CSF
rhinorrhea
=
fracture
in
cribiform
plate
of
Chronic
encephalopathy
(punchdrunk
ethmoid
(floor
of
ant.
fossa)
CSF
leaks
through
syndrome)
weakness
in
lower
limbs,
nose.
Has
different
[glucose]
than
mucus
but
=
to
bloods.
Unit 2 Blue Box Summaries:
These
can
result
in
meningitis.
P
w/
TIA
have
high
risk
for
myocardial
infarction
or
ischemic
stroke.
Anastomoses
of
Cerebral
Arteries
and
Cerebral
Embolism
Orbital
Region,
Orbit,
and
Eyeball
Cerebral
embolism
in
branch
(after
big
Fractures
of
the
Orbit
anastomose
(willis)
microscoping
Usually
occur
at
the
three-suture
junction
anastomoses
not
enough
to
supply
that
branchs
forming
orbital
margin.
area
cerebral
ischemia
&
infarction
Blowout
Fracture:
displaces
orbital
walls.
necrosis
neurological
problems
death.
Medial
Wall:
ethmoidal
+
sphenoidal
sinuses
Lat
Wall:
Inf
+
Maxillary
Sinuses
Variations
of
Cerebral
Arterial
Circle
Superior
wall
=
stronger,
but
can
be
penetrated
Variations
are
common
and
significant
if
by
knife
damage
to
frontal
lobe
of
brain.
emboli/arterial
disease
occur.
Fractures
usually
intraorbital
bleeding
pressure
on
eyeball
(exophathmos).
Strokes
Maxillary
sinus
bleed
displace
maxillary
Ischemic
Stroke
=
impaired
cerebral
blood
flow
teeth
causing
SUDDEN
neurological
deficits
(cardinal
Nasal
bones
hemorrhage,
airway
feature)
result
of
embolism
in
major
cerebral
obstruction,
and
infection
that
can
spread
to
artery.
cavernous
sinus
through
ophthalmic
vein.
Cerebral
Thrombosis/
hemorrhage/
embolism
or
subarachnoid
hemorrhage
=
common
causes
Orbital
Tumors
Circle
of
Willis
(ie.
Collateral
circulation)
works
Malignant
Tumor
in
ethmoidal/sphenoidal
when
obstruction
is
gradual,
but
not
when
sinuses
compress
optic
nerve
and
produce
sudden.
exophthalmos.
Hemorrhagic
stroke
follow
the
rupture
of
an
Tumor
from
middle
cranial
fossa
spread
artery
(scalar
aneurysm)
Berry
Aneurysm
through
superior
orbital
fissure
occurs
near
circle
of
willis
Temporal
fossa
via
inferior
orbital
fissure
Sudden
Rupture
severe
headache
and
stiff
Lateral
side
of
eyeball
is
a
good
approach
for
neck
surgery
more
access.
Brain
Infarction
Injury
to
Nerve
Supplying
Eyelid
Atherosclerotic
plaque
(e.g.
common
coratid
Lesion
of
CN
III
droopy
eyelid
bifurcation)
stenosis.
Lesion
CN
VII
eye
cant
close
all
the
way
+
Plaque
embolus
seperates
lodges
in
small
drying
of
cornea
unprotected
eye
brain
artery
acute
cortical
infarciton
(sudden
excessive
tear
formation.
blood
insufficiency
in
brain)
30
seconds:
alter
brain
metabolism.
Inflammation
of
Palpebral
Glands
1-2
minutes:
neural
function
loss.
Glands
in
eyelid
become
infected/obstructed
5
min:
anoxia
(lack
of
oxygen)
cerebral
Ciliary
glands
sty
(hordeolum)
red
pus
infarction.
producing
swelling
cysts
of
sebaceous
Quickly
give
back
O2
may
reverse
damage
gland
(chalazia)
may
also
form
Tarsal
glands
inflammation,
a
tarsal
Transient
Ischemia
Attacks
chalzion
rubs
against
eyeball
during
blink
TIA
=
neurologic
symptoms
from
ischemia
Generally
last
a
few
minutes
up
to
an
hour
Hyperemia
of
Conjunctiva
Carotid/vertebrobasilar
stenosis
prolongs.
=
Conjuctivas
blood
vessels
are
dialated
Symptoms:
Dizziness,
staggering,
light- blood
shot
eyes.
headedness,
fainting,
paresthesia.
Caused
by
local
irritation
Unit 2 Blue Box Summaries:
Conjunctivitis
(pinkeye)
may
develop
Glaucoma
Aqueous
Humor
outflow
into
blood
must
=
Subconjunctival
Hemorrhages
production
rate
Red
batches
deep
in
bulbar
conjunctiva
If
outflow
=
blocked
pressure
builds
in
ant
&
Results
from
blow
to
eye,
hard
sneeze
post
chambers
of
eye
compression
of
retina
+
ruptures
small
subconjunctival
arteries
retinal
arteries
blindness
Development
of
Retina
Hemmohage
into
Anterior
Chamber
Retina
+
Optic
nerve
are
outgrowths
of
Caused
from
blunt
trauma
forebrain
(optic
vesicle)
Called
hyphema
Carry
meninges
with
it.
(Basically
extension
of
Stops
in
a
few
days
+
good
recovery
brain)
Corneal
Reflex
Retinal
Detachment
Touch
cornea
w/
wisp
of
cotton
From
blow
to
eye.
No
blink
=
lesion
to
V1
or
possibly
VII
Seperation
results
from
fluid
seepage
between
(orbicularis
oculi)
neural
and
pigment
cells
layers,
can
even
be
long
after
trauma.
Corneal
Ulcers
and
Transplants
Flashes
of
light/floating
specks
=
symptoms
Damage
to
V1
cornea
vulnearable
to
injury
scarring
of
cornea
Pupillary
Light
Reflex
Can
have
corneal
transplant
Involves
CN
II
(afferent)
and
CN
III
(efferent)
Light
enters
1
eye
and
both
constrict.
One
fiber
Horners
Syndrome
sends
signal
down
both
tracts.
Interruption
of
Cervical
sympathetic
trunk
Sphincter
pupillae
=
parasympathetic
redness
+
increased
temp
of
skin
+
anhydrosis
innervation.
(no
sweating)
+
ptosis
(droopy
eyelid)
+
miosis
Slowness
to
pupillary
light
response
=
first
sign
(pupil
constriction)
(due
to
unopposed
para
of
CN
III
compression
action)
Uveitis
Paralysis
of
Extraocular
Muscles/Palsies
of
Orbital
Inflammation
of
vascular
layer
of
eye
(uvea)
Nerves
severe
blindness
if
not
treated
Results
in
diplopia
(double
vision)
due
to
limited
movement
Papilledema
CN
III
Palsy:
affects
most
extraocular
muscles
+
Increase
CSF
pressure
(pressure
in
subarchnoid
levator
palbpebrae
superioris
+
sphincter
space
round
CN
II)
slow
venous
return
pupillae
fully
abducted
depressed
dilated
edema
of
retina
swelling
of
optic
disc
eyeball
(down
and
out)
(papilledema)
CN
VI
Palsy:
Cannot
abduct
pupil
fully
adducted
eyeball
(pulled
to
medial
side)
Presbyopia
and
Cataracts
Reduced
focusing
power
=
presbyopia
Blockage
of
Central
Artery
of
Retina
Opaque
lens
=
cataracts
Obstruction
by
embolus
instant
total
cataract
extraction
+
intraocular
lens
implant
blindness
Unilateral
and
in
older
people
Coloboma
of
Iris
=
Abscense
of
a
section
of
Iris
Blockage
of
Central
Vein
of
Retina
from:
birth
defect
(choroid
fissure
doesnt
close
Thrombophlebitis
of
cavernous
sinus
may
properly),
injury
to
eyeball,
or
iridectomy
passage
of
thrombus
into
central
vein
of
retina
Unit 2 Blue Box Summaries:
blockage
in
a
smaller
vein
slow
painless
loss
of
vision.
Inferior
Alveolar
Nerve
Block
Inferior
Alveolar
Nerve
is
a
branch
of
CN
V3
Parotid
and
Temporal
Regions,
Injection
around
mandibular
foramen.
Infratemporal
Fossa,
and
All
mandibular
teeth
are
anesthetized.
Also
skin
Temporomandibular
Joint
of
lower
lip,
labial
alveolar
mucosa
and
Parotidectomy
gingivae,
and
skin
are
anesthetized
due
to
Most
salivary
gland
cancers
begin
in
the
parotid.
mental
nerve
branching
off
of
inferior
alveolar.
Treatment
=
Excision
of
gland
Problems:
Injection
into
parotid
gland
or
medial
pterygoid
arch
affect
movement
of
mandible.
Must
be
careful
with
CN
VII
The
gland
makes
contribution
to
contour
of
face
Dislocation
of
TMJ
Yawning
can
lead
to
anterior
dislocation
of
Infection
of
Parotid
Gland
mandibular
heads
cannot
close
mouth.
Can
be
infected
by
agents
passing
through
blood
Sideways
blow
to
chin
dislocate
on
that
side.
stream
(e.g.
mumps)
inflammation
(parotiditis)
May
also
accompany
fractures.
Mumps
inflammation
of
parotid
duct
+
Posterior
dislocation
uncommon.
Neck
will
redness
of
parotid
papilla
(small
projection
at
break
before.
opening)
Careful
during
surgery
b/c
facial
(CN
VII)
and
Can
be
confused
with
toothache
auriculotemporal
(CN
V3)
nerves
are
in
close
Parotid
Gland
Disease
pain
over
temporal
proximity.
fossa
&
auricle
Injury
to
auriculotemporal
laxity/instability
of
TMJ
Abscess
in
Parotid
Gland
Bacterial
infection
abcess
Arthritis
of
TMJ
Caused
by
poor
dental
hygene.
Can
cause
TMJ
to
become
inflamed.
Can
spread
to
gland
through
parotid
duct.
May
cause
dental
occlusion
or
crepitus
(from
delayed
anterior
disc
movement)
Sialography
of
Parotid
Duct
Parotid
Sialogram
done
to
demonstrate
part
of
Oral
Region
duct
system
displaced/dilated
by
disease.
Cleft
Lip
Radiopaque
fluid
injected
into
orifice
of
parotid
Unilateral
or
Bilateral
duct
@
mucous
membrane
of
cheek.
Mild:
small
notch
in
transitional
zone
between
lip
&
vermilion
border.
Blockage
of
Parotid
Duct
Bad:
Extend
through
lip
into
nose
Can
be
occluded
by
calcified
deposit
called
Worst:
Goes
deeper
and
continuous
with
cleft
sialolith
or
calculus.
palate.
Painful
when
eating
Cyanosis
of
Lips
Accessory
Parotid
Gland
Have
abundant
superficial
arterial
bloodflow.
Accessory
gland
can
lie
on
the
masseter
muscle
Sympathetically
innervated
arteriovenous
between
the
parotid
duct
and
the
zygomatic
anastomoses
redirect
considerable
amount
arch.
of
blood
to
core
helps
reduce
body
heat
loss
causes
cyanosis.
Mandibular
Nerve
Block
Anesthetic
injected
near
infratemporal
fossa.
Large
Labial
Frenulum
Will
anesthetize
the
auriculotemporal,
inferior
Skip
alveolar,
lingual,
and
buccal
branches
of
CN
V3.
Unit 2 Blue Box Summaries:
Gingivitis
CN
IX
(afferent)
&
X
give
off
glossopharyngeal
Skip
branches
gag
reflex
(muscular
contraction
of
pharynx)
Dental
Caries,
Pulpitis,
and
Tooth
Abscesses
Infection
can
spread
from
toothe
alveolar
Paralysis
of
Genioglossus
bone
Causes
tongue
to
fall
posteriorly
obstructing
Pus
from
an
abcess
can
to
maxillary
sinus
airway
risk
of
suffocation
causing
sinusitis,
or
sinusitis
may
stimulate
Happens
under
general
anesthesia
this
is
alveolar
nerves
simulating
a
toothache.
why
an
airway
tube
is
inserted
during
surgery
Supernumerary
Teeth
(Hyperdontia)
Injury
to
Hypoglossal
Nerve
Skip
Fractured
mandible
paralysis
+
atrophy
of
tongue
deviates
Extraction
of
Teeth
towards
affected
side
during
protrusion
(due
to
Lingual
Nerve
is
closely
related
to
3
molars
rd unopposed
genioglossus)
caution
during
their
extraction
Unerupted
3rd
molars
removal
care
not
to
Sublingual
Absorption
of
Drugs
damage
alveolar
nerve
Drugs
enter
lingual
veins
in
<
1
min
Dental
Implants
Lingual
Carcinoma
Skip
Lingual
carcinoma
on
posterior
aspect
metastizes
superior
deep
cervical
lymph
Nasopalatine
Block
nodes
Anesthetic
injected
into
incisive
fossa
both
Anterior
submental
nerves
affected
Sides
submandibular
Affects:
palatal
mucosa,
lingual
gingivae,
Middle
inferior
deep
cervical
alveolar
bone
of
the
six
anterior
maxillary
teeth,
So
anterior
and
sides
wont
reach
the
cervical
and
the
hard
palate
nodes
until
later
in
the
disease.
Greater
Palatine
Block
Frenectomy
Inject
anesthetic
greater
palatine
foramen
Frenulum
is
undertongue,
and
if
too
large
Nerve
emerges
between
2
and
3
molars
nd rd affects
speech
(tongue
tied)
surgically
incise.
Affects:
palatal
mucosa,
and
lingual
gingivae
posterior
to
maxillary
canine,
and
underlying
Excision
of
Submandibular
Gland
and
Removal
of
bone
of
palate
Calculus
Incision
made
2.5
cm
inferior
to
angle
of
Cleft
Palate
mandible
Failure
of
mesenchymal
masses
in
the
lateral
Care
not
to
damage
mandibular
branch
of
VII
palatine
processes
to
meet
and
fuse
with
each
Care
not
to
damage
lingual
of
V3
when
removing
other,
nasal
septum,
and/or
the
posterior
submandibular
duct
(near
each
other
@
3rd
margin
of
the
medial
palatine
process.
molar).
Mild:
May
only
involve
Uvula
Bad:
Extend
through
soft/hard
regions
of
Sialography
of
Submandibular
Ducts
palate.
Cannot
usually
see
sublingual
glands
ducts.
(too
Worst:
Continuous
with
cleft
lip.
small
and
too
many)
Can
see
everything
else
Gag
Reflex
Unit 2 Blue Box Summaries:
Pterygopalatine
Fossa
Know
that
the
ostia
are
small
and
Transantral
Approach
to
Pterygopalatine
Fossa
supromedially
located
can
only
drain
when
Surgical
access
is
gained
through
maxillary
full,
or
when
laying
down
(one
at
a
time)
sinus
tossing
and
turning
nights
to
drain
sinuses.
Maxillary
artery
is
ligated
in
cases
of
chronic
epistaxis.
Relationship
of
Teeth
to
Maxillary
Sinus
Three
maxillary
molars
beneath
maxillary
sinus
The
Nose
Communication
between
sinus
and
oral
cavity
Nasal
Fractures
can
accidentally
be
created
during
a
dental
Epistaxis
(Nosebleed)
procedure
infection
Direct
blow
may
fracture
cribiform
plate
of
Superior
alveolar
nerves
(off
of
V2)
supply
teeth
ethmoid
bone
and
maxillary
sinus
pain
in
sinus
accompanied
by
toothache.
Deviation
of
Nasal
Septum
Generally
in
all
people,
a
lot
of
times
from
Transillumination
of
Sinuses
trauma
Maxillary
sinus:
Direct
light
under
one
side
of
May
obstruct
breathing
snoring
hard
palate
illuminates
sinus
Frontal:
Direct
light
beneath
the
orbit
Rhinitis
If
mass/fluid
glow
will
decrease
Nasal
mucosa
swollen
and
inflamed
(large
amounts
of
vascularity)
Ear
Can
spread
to:
anterior
crancial
fossa
(cribiform
External
Ear
Injury
plate),
nasopharynx/retropharyngeal
tissues,
Injury
Hematoma
untreated
fibrosis
middle
ear
(pharyngotympanic
tube
deformation
of
auricle
connects
tympanic
cavity
to
nasopharynx),
paranasal
sinus,
lacrimal
apparatus
and
Otoscopic
Examination
conjunctiva
(lacrimal
duct)
Pull
ear
up,
back,
and
out
on
adult
to
straighten
Notice
it
can
spread
to
all
the
structures
in
canal
(down
and
back
on
children)
and
observe
which
it
has
contact
with
the
translucent
tympanic
membrane
Epistaxis
Acute
Otitis
Externa
Rich
in
vascularity
Infection
of
external
auditory
meatus,
common
Occurs
in
anterior
1/3
in
swimmers
not
drying,
or
bacterial.
Associated
with
infections
and
hypertension
Oitits
Media
Sinusitis
Infeciton
in
middle
ear
usually
secondary
to
Infection
spreads
to
the
paranasal
sinuses
respitory
infection
possible
blockage
of
through
the
continuous
tubes
swelling
may
pharyngotympanic
tube
block
one
of
the
openings
Tympanic
membrane
bulges
ear
popping
Can
produce
impaired
hearing
from
scarring
on
Infections
of
Ethmoid
Cells
auditory
ossicles
Maybe
the
nasal
drainage
is
blocked
infection
through
medial
wall
of
orbit
blindness
from
Perforation
of
Tympanic
Membrane
posterior
ethmoid
air
cells
(close
to
optic
canal)
Can
be
from
otitis
media
or
foreign
body
Infection
can
spread
to
the
dural
sheath
optic
Large
need
surgical
repair
neuritis
Myringotomy
incision
in
tympanic
membrane
people
with
chronic
ear
infections
Infection
of
Maxillary
Sinus
have
tubes
placed
through
the
incision.
Unit 2 Blue Box Summaries:
Mastoiditis
(Flyers/Divers)
When
injury
occurs
due
to
Infection
of
mastoid
cells
result
of
medial
imbalance
of
pressure
between
middle
ear
and
otitis
spreading
ambient
air.
Be
aware
of
facial
nerve
running
through
canal
Blockage
of
the
Pharyngotympanic
Tube
When
blocked,
residual
air
in
tympanic
cavity
absorbed
into
vessels
lower
pressure
in
cavity
retraction
of
membrane
affects
hearing
Paralysis
of
Stapedius
Facial
nerve
lesion
no
stapedius
nerve
no
stapedius
muscle
(protects
ear
from
loud
noises
dampens
sound)
uninhibited
movement
of
stapes
hyperacusis
(excessive
hearing)
Motion
Sickness
The
membrane
of
labyrinth
has
small
hairs
that
have
particles
that
bend
with
gravity
stimulate
vestibular
nerve
proprioception
Motion
sickness
discordance
between
vestibular
and
visual
stimulation
Dizziness
and
Hearing
loss
Injury
to
peripheral
auditory
system
3
symptoms
1.
Hearing
loss
2.
Vertigo
3.
Tinnitus
(buzzing)
Conductive
Hearing
Loss:
something
obstructing
external/middle
ear
people
speak
softer
than
normal
because
they
think
they
are
louder
Sensorineural
Hearing
Loss:
defects
in
pathway
from
cochlea
to
brain
cochlear
implants
(if
hair
cells
on
the
spiral
cochlea
have
been
damaged)
Mnire
Syndrome
Results
from
a
blockage
of
the
cochlear
aquaduct
recurrent
attacks
of
hearing
loss,
vertigo,
and
tinnitus
High
Tone
Deafness
Frequent
exposure
to
loud
noises
degenerative
changes
to
cochlea
high
tone
deafness
Otic
Barotrauma
Unit 2 Blue Box Summaries:
Chapter
8
Infections
can
spread
into
the
posterior
mediastinum
or
superior
mediastinum.
Bones
of
the
Neck
Similarly
air
from
ruptured
trachea
can
pass
Cervical
Pain
superiorly
to
the
neck.
Several
Causes:
inflamed
lymph
nodes,
muscle
strain,
IV
disc
herniation
Superficial
Structures
of
the
Neck:
Enlarged
Lymph
Nodes
may
indicate
malignant
Cervical
Regions
tumor
in
the
head.
These
generally
start
in
Congenital
Torticollis
(Wry
Neck)
thorax
or
abdomen
(because
the
neck
connects
Torticollis
is
a
contraction
of
the
cervical
head)
muscles
that
produces
a
twisting
of
the
neck.
Most
chronic
pain
caused
by
abnormalities
or
Causes
neck
to
twist
away
from
affected
side
(or
trauma
tilt
towards)
Common
cause
=
tumor
in
SCM
before
or
after
Injuries
to
the
Cervical
Vertebral
Column
birth.
(before
birth
=
breached
delivery)
Fractures
may
damage
spinal
cord
and/or
Another
cause
=
excess
pulling
on
head
during
vertebral
arteries
passing
through
the
birth
hematoma.
This
develops
into
mass
transverse
foramina.
than
entraps
CN
XI
denervating
SCM
fibrosis
and
shortening
Fracture
Hyoid
Bone
Surgical
release
of
SCM
necessary
so
person
can
Occurs
from
strangulation.
depression
of
hold
head
normally.
body
onto
thyroid
cartilage
Inability
to
elevate
and
move
hyoid
anteriorly
Spasmodic
Torticollis
beneath
tongue
makes
swallowing
and
Cervical
dystonia
(abnormal
tonicity
of
cervical
maintenance
of
alimentary
and
respiratory
muscles
know
as
Spasmodic
Torticollis)
usually
tracts
difficult
Aspiration
Pneumonia
occurs
in
adulthood.
Shifting
occurs
involuntarily.
Cervical
Fascia
Paralysis
of
Platysma
Subclavian
Vein
Puncture
Results
from
injury
to
cervical
branch
of
facial
AKA
Central
Line
Placement.
To
deliver
venous
nerve
skin
falls
from
neck
into
folds.
Extra
nutrition/medication
and
monitor
venous
care
should
be
taken
during
surgery
to
pressure.
preserve.
Care
must
be
taken
to
not
puncture
the
Ugly
scar
will
develop
if
the
surgeon
does
not
subclavian
artery,
puncture
the
lung/pleure
carefully
suture.
pneumothorax.
Spread
of
Infections
in
the
Neck
Right
Cardiac
Catheterization
If
infection
occurs
between
investing
layer
of
Puncture
IJV
to
insert
catheter
into
right
deep
cervical
fascia
and
the
muscular
part
of
brachiocephalic
vein
SVC
Right
side
of
pretrachial
fascia,
then
infection
limited
to
heart.
superior
edge
of
manubrium.
IJV
and
subclavian
vein
are
most
ideal.
EJV
is
If
goes
into
the
visceral
layer
of
pretrachial
not
due
to
angle.
fascia,
then
it
can
spread
into
the
thoracic
cavity
IJV
(in
carotid
triangle
bound
by
SCM,
&
Pus
from
the
an
abscess
posterior
to
the
digastrics)
prevertebral
layer
of
deep
cervical
fascia
can
perforate
said
fascia
and
enter
the
Prominence
of
External
Jugular
Vein
retropharyngeal
space
retropharyngeal
Serve
as
internal
barometer.
abcess.
Can
cause
difficulty
breathing
Should
only
be
visible
for
a
short
distance
above
(dysphagia)
and
speaking
(dysarthia).
clavicle.
Unit 2 Blue Box Summaries:
If
visible
for
too
far:
sign
of
high
pressure
Not
performed
on
people
with
pulmonary
of
heart
failure,
SVC
obstruction,
enlarged
cardiac
disease
since
this
usually
paralyzes
that
supraclavicular
lymph
nodes,
or
increased
half
of
the
diaphragm.
thoracic
pressure.
Upper
limb
anesthesia
is
injected
around
supraclavicular
portion
of
BP,
superior
to
the
Severance
of
EJV
midpoint
of
the
clavicle.
If
slashed
along
posterior
border
of
SCM,
its
lumen
is
held
open
by
investing
deep
layer
of
Injury
to
Suprascapular
Nerve
cervical
fascia.
Vulnerable
when
middle
third
of
clavicle
is
Negative
thoracic
pressure
sucks
air
into
it.
fractured.
Venous
air
embolism
produced
will
fill
right
Loss
of
lateral
rotation
(infraspinatus
muscle)
side
of
heart
with
froth
blood
stops
flowing
resulting
in
waiters
tip
position.
through
it.
Abduction
also
affected.
(supraspinatus)
Pressure
onto
vein
until
it
can
be
sutured.
Ligation
of
External
Carotid
Artery
Lesions
of
CN
XI
Decreases
blood
flow
through
it
and
its
Uncommon.
Caused
by:
branches
but
doesnt
eliminate
it.
Penetrating
Trauma
Blood
flows
across
the
midline
to
the
other
Surgical
Procedures
(care
must
be
taken
in
external
carotid.
procedures
in
the
lateral
cervical
regions,
The
occipital
artery
provides
the
main
collateral
lymph
node
dissection
for
ex.)
branch,
anastomosing
with
the
vertebral
and
Tumors
at
cranial
base/cancerous
lymph
deep
cervical
arteries.
nodes
Fracture
of
jugular
foramen
(where
CN
XI
Surgical
Disection
of
Carotid
Triangle
exits
cranium)
Through
this
triangle,
we
have
access
to
the
IJV,
Does
not
affect
SCM
too
much,
though
some
the
vagus
and
hypoglossal
nerves,
and
cervical
weakness
in
turning
head
against
resistance.
sympathetic
trunk.
Primarily
affects
trapezius
impairing
neck
Damage
to
vagus/recurrent
laryngeal
may
alter
movements.
Drooping
of
shoulder
occurs
voice
because
these
nerves
supply
the
laryngeal
Most
common
iatrogenic
nerve
injury!
muscles.
Severance
of
Phrenic
Nerve,
Phrenic
Nerve
Block,
Carotid
Occlusion
and
Endarterectomy
and
Phrenic
Nerve
Crush
Atherosclerotic
thickening
of
internal
carotid
Severance
=
diaphragm
paralysis
on
that
side
may
occlude
causing
a
transient
ischemia
attack
Phrenic
block
may
be
used
for
lung
procedures.
(TIA),
a
sudden
loss
of
neurological
function
Anesthetic
is
injected
an
anterior
surface
of
that
disappears
in
24
hours.
middle
third
of
scalene
muscle
A
minor
stroke,
symptoms
like
TIA
or
loss
of
Nerve
crush
(with
clamps)
will
produce
longer
function
on
one
side
of
body,
can
occur
but
anesthesia.
Accessory
phrenic
nerves
may
be
disappears
within
3
weeks.
present
and
must
be
crushed
to
paralyze
Sypmtoms
depend
on
the
degree
of
occlusion
hemidiaphragm.
and
the
amount
of
collateral
blood
flow.
Doppler
color
study
used
to
diagnose.
Nerve
Blocks
in
Lateral
Cervical
Regions
Carotid
Endarterectomy
is
a
procedure
in
which
Anesthetic
injected
along
posterior
border
of
the
artery
is
opened
and
the
plaque
is
stripped
SCM,
mainly
at
junction
of
superior
and
middle
off.
Drugs
to
inhibit
clot
formation
given
until
thirds.
This
is
the
nerve
point
of
the
neck
(Erbs
the
endothelium
as
regrown.
point).
Risk
of
damage
to
CN
IX,
X
(or
its
branch,
superior
laryngeal
nerve,
XI,
XII)
Unit 2 Blue Box Summaries:
Carotid
Pulse
Deep
Structures
of
the
Neck
Neck
Pulse
found
between
trachea
and
Cervicothoracic
Ganglion
Block
infrahyoid
muscles,
anterior
border
of
SCM.
Blocks
transmission
of
the
cervical
and
superior
Absence
=
cardiac
arrest
thoracic
ganglia.
(Stellate)
Done
to
relieve
vascular
spasms
in
brain
and
Carotid
Sinus
Hypersensitivity
upper
limb.
Excessive
responsiveness
of
carotid
sinus.
Useful
to
a
person
with
excess
vasoconstriction
External
pressure
may
slow
heart
rate,
decrease
in
the
ipsilateral
limb.
BP,
cause
cardiac
ischemia
resulting
in
syncope
(fainting).
Syncope
results
from
a
sudden
Lesion
of
the
Cervical
Sympathetic
Trunk
decrease
in
cerebral
profusion.
=
Horners
Syndrom
Checking
pulse
here
is
not
recommended
for
Sypmotoms:
people
with
this.
Contraction
of
pupils
(miosis)
from
paralyzed
dilator
pupillae.
Role
of
Carotid
Bodies
Drooping
of
superior
eyelid
(ptosis)
from
Monitor
blood
O2
before
it
reaches
the
brain.
paralysis
of
levator
palpebrae
superiorisis
Decrease
(like
high
altitude)
activates
these
Sinking
of
eye
(enopthalamos)
from
chemoreceptors
increasing
alveolar
ventilation.
paralysis
of
orbital
muscle.
Also
monitor
CO2
levels.
Vasodilation
+
absence
of
sweating
on
face
The
glossopharyngeal
nerve
(CN
IX)
conducts
and
neck
(anhydrosis)
from
lack
of
this
to
brain
and
the
response
is
increase
depth
sympathetic
nerve
supply
to
the
blood
and
rate
of
breathing.
vessels
and
sweat
glands
of
the
face.
Pulse
and
BP
also
increase.
Viscera
of
the
Neck
Internal
Jugular
Pulse
Thyroid
Ima
Artery
Provide
information
about
heart
activity.
10%
of
people
have
this
unpaired
artery.
Runs
Pulse
is
especially
visible
when
the
head
is
through
midline.
inferior
to
lower
limbs
(Trendelenburg
Consider
it
when
performing
procedures
Position)
inferior
to
the
isthmus
because
it
is
a
potential
There
are
no
valves
in
brachiocephalic
vein
or
source
for
bleeding
(eg.
Tracheostomy)
superior
cava.
A
strong
pulse
can
be
a
sign
of
Mitral
Valve
Thyroglossal
Duct
Cysts
disease
which
puts
increased
pressure
on
the
Thyroid
gland
is
attached
to
foramen
cecum
by
pulmonary
circulation
and
the
Right
side
of
the
thyroglossal
duct
during
development.
This
heart.
duct
normally
disappears.
The
R
IJV
should
be
used
since
straighter
path
It
can,
however,
remain
and
develop
a
cyst
at
to
R.
Atrium.
any
point
in
its
descent.
(Usually
close
to
hyoid)
Internal
Jugular
Vein
Puncture
Aberrant
Thyroid
Gland
Palpate
common
carotid
artery
and
insert
Aberrant
thyroid
glandular
tissue
may
be
found
needle
lateral
to
it
at
a
30
degree
angle.
Aim
at
anywhere
along
the
embryological
thyroglossal
the
apex
of
the
triangle
between
the
sternal
and
duct.
(failure
to
relocate)
clavicular
heads
of
SCM.
If
on
the
roof
of
the
tongue,
its
referred
to
as
Right
one
is
preferred
since
its
longer
and
lingual
thyroid
gland.
straighter.
Occasionally
thyroid
glandular
tissue
is
associated
with
a
cyst.
Must
be
careful
when
excising
these
cysts
because
possible
total
Unit 2 Blue Box Summaries:
thyroidectomy
totally
dependent
on
thyroid
Generally
try
to
preserve
posterior
lobe
or
at
medication.
least
isolate
them
to
protect
them
during
surgery.
Accessory
Thyroid
Glandular
Tissue
May
appear
anywhere
on
embryological
course.
Fracture
of
Laryngeal
Skeleton
Most
times
in
lateral
neck
on
thyrohyoid
Result
from
direct
blows.
(hockey/baseball
muscle.
Insufficient
by
itself.
catcher
masks)
Pyramidal
Lobe
of
Thyroid
Gland
Produces
submucous
hemorrhage
and
edema,
50%
have
these.
respiratory
obstruction,
hoarseness,
and
Small
lobe
in
between
the
two
main
lobes
that
temporary
inability
to
speak.
can
connect
to
the
hyoid.
Remnants
of
thyroglossal
duct.
Laryngoscopy
Procedure
to
examine
interior
larynx.
2
Enlargement
of
Thyroid
Gland
methods:
Called
Goiter
and
generally
from
lack
of
iodine.
Indirect
Laryngoscopy:
uses
a
mirror
at
the
May
occur
during
menstruation
and
pregnancy.
back
of
the
mouth.
Compress
surrounding
structures.
(trachea,
Direct
Laryngoscopy:
endoscopic
intstrument.
esophagus,
recurrent
laryngeal
nerve)
Vestibular
folds
=
pink
and
vocal
folds
=
pearly
Can
enlarge
anywhere
except
superiorly
due
to
white.
muscular
attachment.
(sternothyroid/hyoid)
Valsalva
Maneuvar
Thyroidectomy
Strain
like
eight
lifting
raises
thoracic
Due
to
malignant
tumor
on
thyroid
gland.
pressure
Surgical
treatment
of
hyperthyroidism
Impairs
venous
return
to
the
right
atrium
preserve
posterior
lobes
(near-total
Study
the
effects
of
raised
peripheral
venous
thyroidectomy)
to
protect
recurrent
and
pressure
and
decreased
cardiac
filling
and
superior
laryngeal
nerves
and
parathyroids.
cardiac
output.
Postoperative
hemorrhage
can
compress
trachea.
Aspiration
of
Foreign
Bodies
and
Heimlich
Maneuver
Injury
to
Recurrent
Laryngeal
Nerves
Object
can
become
trapped
superior
to
The
right
one
is
generally
more
vulnerable.
The
vestibular
folds
laryngeal
muscles
go
into
left
one
has
a
very
vertical
path.
The
right
is
spasms
rima
glottis
closes
no
air
into
closely
intertwined
with
branches
of
inferior
trachea
thyroid
artery.
To
help
preserve
the
nerve,
this
Heimlich
performed
air
from
lungs
forced
artery
can
be
ligated.
upwards
and
dislodges
object.
Hoarseness
is
sign
of
unilateral
recurrent
nerve
Sometimes
need
emergency
needle
damage.
Aphonia,
disturbance
of
voice
cricothyrotomy
to
permit
entry
of
air
into
lungs
production
may
occur.
Tracheostomy
Inadvertent
Removal
of
Parathyroid
Glands
Transverse
incision
through
ant.
wall
of
trachea
Removal
done
to
treat
parathyroid
adenoma,
a
airway;
infrahyoid
muscles
retracted
and
benign
tumor
associated
with
isthmus
of
thyroid
divided
hyperparathyroidism.
Opening
b/w
1st
&
2nd
or
2nd
&
4th
Causes
parathyroid
tetanyneurological
Tracheostomy
tube
inserted
syndrome
characterized
by
twitches/cramps.
Inferior
thyroid
veins
arise
from
a
venous
(decreased
Ca
Serum
levels)
plexus
on
thyroid
gland
and
descend
on
ant.
Aberrant
sites
are
of
most
concern.
trachea
Unit 2 Blue Box Summaries:
Thyroid
ima
artery
could
be
present
males
(testosterone).
Agonadal
males
voices
Left
brachiocephalic
vein,
jugular
venous
arch,
do
not
deepen
without
testosterone.
and
pleurae
possibly
encountered
in
children.
The
thyroid,
cricoid,
and
arytenoid
cartilages
Thymes
covers
inferior
part
in
chiledrn
ossify
with
age
(around
25)
Trachea
=
small
and
soft
in
children
damage
to
esophagus.
Foreign
Bodies
in
Laryngopharynx
Foreign
bodies
(chicken
bone)
entering
pharynx
Injury
to
Laryngeal
Nerves
may
lodge
in
piriform
recess;
if
sharp
can
pierce
Unilateral
of
inferior
laryngeal
(continuation
of
injure
internal
laryngeal
nerve
recurrent)
->
weak
voice
(hoarse),
becomes
Generally
large
foreign
bodies
stop
at
inferior
better
end
of
laryngopharynx
(most
narrow
point)
Bilateral
abscent
voice,
no
vocal
fold
abduction
(phonation)
or
adduction
(increased
Sinus
Tract
from
Piriform
Fossa
respiration
stridor
(high
pitched
noisy
Possible
tract
from
piriform
fossa
to
thyroid
=
respiration
asthmatic-like
episode
potential
site
for
recurring
thyroiditis.
Progessive
Lesions
of
Recurrent:
abduction
lost
From
remnants
of
thyroglossal.
before
adduction
(recovery
is
opposite)
Removal
of
this
sinus
tract
=
partial
carcinoma
=
common
disorder
hoarseness
thyroidectomy
because
piriform
fossa
is
deep
to
Paralysis
of
superior
laryngeal
nerve,
or
superior
pole
internal
anesthesia
of
superior
laryngeal
mucosa
foreign
bodies
can
easily
enter
Tonsillectomy
Injury
to
external
(or
superior)
paralyzed
Removal
palatine
tonsil
from
tonsillar
bed.
cricothyroid
unable
to
vary
length
and
Bleeding
generally
from
external
palatine
vein.
tension
of
vocal
cords
monotonous
CN
XI
is
vulnerable
to
injury
(accompanies
During
thyroidectomy:
Superior
thyroid
artery
tonsillar
artery.
Internal
carotid
can
be
ligated
more
superior
where
not
closely
related
vulnerable
if
it
lies
lateral
to
the
tonsil.
to
superior
laryngeal
nerve
Adenoiditis
Superior
Laryngeal
Nerve
Block
Inflammation
of
pharyngeal
tonsils
(adenoids)
=
Administered
with
endotracheal
intubation.
For
adenoiditis.
Obstructs
nasal
passage
=
hard
to
peroral
endoscopy,
transesophageal
breath.
echocardiography,
and
laryngeal/esophageal
Can
spread
to
tubal
tonsils
closing
instrumentation.
pharyngotympanic
tubes
impaired
hearing.
Insert
needle
b/w
thyroid
cartilage
and
hyoid,
Can
cause
otitis
media
(mid
ear
infection)
anterior
to
greater
horn.
Anesthesia
bathes
T&A
=
tonsillectomy
+
adenoidectomy
internal
and
superior
laryngeal
nerves.
Brachial
Fistula
Cancer
of
Larynx
Canal
that
opens
internally
on
tonsillar
fossa
In
many
smokers,
present
with
hoarseness
and
and
externally
on
side
of
neck
passes
over
SCM
associated
otalgia
(earache)
and
dysphagia.
and
passes
through
carotid
sheath.
Enlarged
pretracheal
or
paratracheal
lymph
Results
from
persistence
of
2nd
pharyngeal
nodes
may
indicate.
pouch
and
groove.
Laryngectomy
for
severe
cases
(people
with
Infection
from
saliva
can
result.
funny
voice
machines)
Branchial
Sinuses
and
Cysts
Age
Change
in
Larynx
Occurs
when
the
embryonic
cervical
sinus
fails
Grows
until
3
then
starts
again
around
12.
Walls
to
disappear
in
lateral
neck.
(ant.
to
SCM)
strengthen
and
laryngeal
cavity
enlarges
in
Can
form
a
branchial
cyst
(lateral
cervical
cyst).
Unit 2 Blue Box Summaries:
Generally
present
in
infants.
Lymphatics
in
the
Neck
Careful
removal
because
generally
close
to
the
Radical
Neck
Dissections
CN
IX,
XI,
XII.
When
cancer
invades
cervical
lymphatics
(involved
in
spread
into
abdomen
and
thorax).
Esophageal
Injuries
Referred
to
as
cervical
sentinel
lymph
nodes
Rare,
and
generally
in
conjunction
with
airway
because
they
are
first
clue
that
cancer
has
injury.
spread
to
this
area.
Difficult
to
detect.
Many
times
leads
to
death.
Deep
cervical
lymph
nodes
and
surrounding
tissue
removed
in
one
piece.
Tracheo-Esophogeal
Fistula
(TEF)
Major
arteries,
BP,
CN
X,
and
phrenic
nerve
Abnormal
connection
between
esophagus
and
preserved.
trachea,
generally
combined
with
esophageal
Cutaneous
branches
of
cervical
plexus
removed.
atresia.
Most
common:
superior
ends
in
blind
pouch.
Inferior
communicates
with
trachea.
The
pouch
fills
with
mucus
that
the
infant
aspirates.
Results
from
abnormalities
in
partitioning
of
the
esophagus
and
trachea
by
the
trachea- esophageal
septum.
Esophageal
Cancer
Dysphagia
(difficulty
swallowing)
is
the
most
common
complaint
for
this.
Esophagoscopy
=
diagnostic
tool
Enlargement
of
deep
cervical
lymph
nodes
also
sign.
Hoarseness
also
a
symptom
(compression
of
recurrent
laryngeal)
Zones
of
Penetrating
Neck
Trauma
Zone
1:
Root
of
Neck,
from
clavicle/manubrium
to
just
below
cricoid
cartilage.
Cervical
pleura,
apices
of
lungs,
thyroid/parathyroid,
esophagus,
common
carotid,
jugulars,
and
cervical
region
of
vertebral
column
are
at
risk.
Zone
2:
From
below
cricoid
to
angle
of
mandible.
Superior
lobes
of
thyroid,
cricoid
cartilage,
larynx,
laryngopharynx,
carotids,
jugulars,
esophagus,
and
cervical
region
of
vert.
column
are
at
risk.
Zone
3:
Above
2.
Salivary
glands,
oral
and
nasal
cavities,
oropharynx,
and
nasopharynx
are
at
risk.
Zones
1
and
3
have
greatest
morbidity
and
mortality
rate
due
to
airway
obstruction.
Zone
2
can
control
bleeding
with
pressure
and
treat
structures
easier.
Unit 2 Blue Box Summaries:
Chapter
9
Compression
of
Oculomotor
Nerve
Extradural
hematoma
pressure
compress
Cranial
Nerves
CN
III
against
crest
of
petrous
part
of
temporal
Cranial
Nerve
Injuries
bone
first
thing
to
go
=
pupillary
light
reflex
Injury
is
usually
due
to
fracture
at
the
base
of
the
cranium
Aneurysm
of
Posterior
Cerebral
or
Superior
Excessive
movement
tear/bruise
CN
I
Cerebral
Artery
CN
III,
IV,
V1,
and
ESPECIALLY
VI
are
susceptible
These
may
simply
affect
the
nerve
to
compression
related
to
pathologies
affecting
cavernous
sinus.
Trochlear
Nerve
Longest
Intracranial
Course
Olfactory
Nerve
Causes
diplopia
AnosmiaLoss
of
Smell
Person
has
to
tilt
head
because
this
is
the
Fractured
cribiform
plate
(ethmoid
bone)
primary
muscle
of
intortion
thus
extortion
is
tear
olfactory
nerve
fibers
unopposed
This
loss
of
smell
can
be
a
sign
of
a
fractured
cranial
base
and
rhinorrhea
Trigeminal
Nerve
Injury
to
Trigeminal
Nerve
Olfactory
Hallucinations
Loss
of
mastication
muscles
mandible
Lesion
to
temporal
lobe
false
perception
of
deviates
towards
affected
side
smells
(olfactory
hallucinations)
Loss
of
corneal
reflex
(blinking
in
response
to
having
cornea
touched)
and
sneezing
reflex
Optic
Nerve
(irritants
in
respiratory
tract)
Demyelinating
Diseases
and
Optic
Nerves
Trigeminal
Neuralgia
(Tic
Douloureux)
Actually
part
of
CNS
(not
PNS)
so
its
disease
affecting
sensory
root
of
V
episoding
myelination
is
by
glial
cells
(not
schwann)
pain
in
response
to
stimulation
susceptible
to
these
diseases
(MS)
Dental
Anesthesia
Optic
Neuritis
Superior
alveolar
nerve
=
unreachable
thus
Inflammation
(MS/alcohol)
dentists
inject
anesthesia
into
roots
of
teeth
(this
is
for
maxillary
teeth)
Visual
Field
Defects
Inferior
Alveolar
Nerve
is
commonly
blocked
for
Complete
section
blindness
in
temporal
and
procedures
on
mandibular
teeth.
nasal
fields
of
view
of
ipsilateral
eye
Section
@
chiasma
no
temporal
vision
in
Abducent
Nerve
either
eye
bitemporal
hemianopsia
Long
Intradural
Course
Section
between
chiasma
&
brain
no
nasal
for
Can
be
compressed
due
to
brain
tumor,
berry
ipsilateral
+
no
temporal
for
contralateral
aneurism,
atherosclerotic
carotid
artery
in
patients
with
strokes
cavernous
sinus
(close
relation
here),
and
thrombosis
in
sinus
(pimple
popper)
Oculomotor
Nerve
Injury
to
Oculomotor
Nerve
Facial
Nerve
Lesion
ipsilateral
oculomotor
palsy
(down
&
Longest
Intraosseous Course
out)
(and
parasympathetic
affects
on
pupil)
Central
Lesion
(CNS)
contralateral
Lesion
at
origin/genticulate
ganglion
ipsilateral
Unit 2 Blue Box Summaries:
Depending
on
where
lesion
is,
taste
may/may
1
Recurrent
hoarseness
&
dysphonia
not
be
affected
2
Reccurents
aphonia
+
inspiratory
stridor
Common
with
fractures
of
temporal
bone
usually
due
to
cancer
of
larynx/thyroid
(hence
stylomastoid
foramen)
Spinal
Accessory
Nerve
Vestibulocochlear
Nerve
Subcutaneous
passage
in
posterior
cervical
Injuries
to
Vestibulocochlear
Nerve
region.
The
vestibule
and
cochlear
nerves
are
essentially
independent,
however
a
lesion
Hypoglossal
Nerve
affects
them
bothhence
the
3
symptoms
Paralyzes
ipsilateral
half
of
tongue
looks
(vertigo,
hearing
loss,
tinnitus)
shrunken
and
atrophied
over
time
When
protruded;
apex
deviates
towards
Deafness
paralyzed
side
unopposed
action
of
The
2
kinds
of
deafness
listed
in
the
ear
section
genioglossus
muscle
above.
Acoustic
Neuroma
Slow
grooving
benign
tumor
of
the
neurolemma
(shwann
cells)
begins
in
vestibular
nerve
the
three
ear
symptoms
Trauma
and
Vertiga
Head
Trauma
fucks
up
your
proprioception
(peripheral
vestubular
nerve
lesion)
swaying,
vertigo,
dizziness,
maybe
vomitting
Glossopharyngeal
Nerve
Lesions
of
Glossopharyngeal
Nerve
Uncommon
and
not
associated
with
perceptible
disability
Taste
(post
1/3)
+
gag
reflex
absent
on
ipsilateral
side.
Change
in
swallowing
Generally
other
nerves
are
affected.
Ex.
Tumor
in
jugular
foramen
affects
IX,
X,
XI
Jugular
Foramen
Syndrome
Glossopharyngeal
Neuraglia
(Tic)
Causes
unknown
Similar
to
Tic
Douloureux
intense
pain
Can
be
initiated
by
swallowing,
protruding
tongue,
talking,
or
touching
palatine
tonsils.
Vagus
Nerve
Lesion
of
pharyngeal
branch
dysphagia
(diffuclty
swallowing)
Supeior
Laryngeal
anesthesia
of
superior
larynx
&
paralyzed
cricothyroid
weak
monotonous
voice
that
tires
easy