Disorder/Drug Problem/Target Cause/Mechanism
Spinal Acc. N. (XI) Injury (Test) Shrug shoulder, Turn head against resistance
Congenital Torticollis
Triangles of the Neck
Anterior Triangle
Triangle Contents
Posterior Triangle
Lymphatics
Lymphatics
Tongue Drainage
Fascia
Retropharyngeal Space
Carotid Sheath
Frontonasal Prominence
Development
Maxillary Prominence
Mandibular Prominence
Muscles of the face
D26 (OPM) - Early W4 (5 Prom) - Late W4 (Plac; Mand fz) - W5 (Pit/Prom; Aur; ONM) - W6 (Cho) - W7-10 (Fz; 2⁰Pal) - W10-14 (Eye/Ear; Myo)- W12
Physical Exam
Muscle & Nerve
Cleft Lip/Palate
Face
Danger Triangle of Face
Bell's Palsy
Trigeminal Neuralgia
Parotid Gland
Parotid
Parotidectomy
Frey's Syndrome
Internal Jugular Vein
Effect/Symptom
Weak trapezoid & sternocleidomastoid
Sternocleidomastoid Trauma at delivery -> scarring, shortened Head tilts toward injured side Chin
muscle; spasms of SCM turned superiorly to opposite side
Submental Submental lymph nodes - Mylohyoid m. - Submental vv. (to Anterior jugular v.)
Submandibular Submandibular gland - Submandibular lymph nodes - Mylohoid m. - N. to mylohyoid (CN V3) - Hypoglossal n. (CN
XIII) - Submental a. - Facial a. - Facial v.
Carotid Carotid sheath (CCA, ICA, IJV, Vagus n. [CN X]) - Hypoglossal n. (CN XII) - ECA
Muscular Thyroid gland - Parathyroid gland - Infrahyoid mm. (ST, SH, TH)
Occipital 4 muscles (Splenius capitis, Levator scapulae, Posterior scalene, Middle scalene) - 4 nerves (Lesser
occipital, Great auriular, Transverse cervical, Supraclavicular) - Deep nerves (CN XI, Brachial plexus
[Dorsal scapular, C5 & C6 root]) - Transverse cervical a.
Subclavian Anterior scalene m. - Phrenic n. - Suprascapular a. - Subclavian a. - Subclavian v. - Brachial plexus (lower roots)
Spread of infection/cancer Body -> Thoracic duct; R face, upper limb, chest -> R Lymphatic duct; (Head/Neck)
Superficial [EJV] -> Superior deep; Deep
[IJV] (Superior & Inferior) -> Jugular trunks -> Thoracic/R Lymphatic ducts
Bilateral drainage Middle anterior 2/3 -> Inferior deep; Spread of carcinoma
Posterior 1/3 -> Superior deep
Allow sliding - Compartments contain infection - Spaces provide route - Planes of surgical cleavage Superficial
-> (Deep) Investing -> Visceral [Pretrach./Buccopharyn.] -Retropharyn. Space -> Prevertebral -> Carotid
Inferior open to mediastinum Prevertebral & buccopharyngeal fascia Route of infection to mediastinum
Invasion by tumors/abcess Resect depends on extent of infiltration Ansa cervicalis embedded in sheath
Forehead - Upper eyelids - Nose - Nasal cavity - Septum
1st Pharyngeal Arch (CN V) Cheeks - Upper jaw - Upper lip - Secondary palate - Lateral nose
Mandible - Chin - Lower Lip
2nd Pharyngeal Arch (CN VII) Facial n. (CN VII): To-Zanzibar-By-Motor-Car
Elevate eyebrows - Clinch eyes tightly - Smile - Sensation in each region of face
Failed fusion of prominences: medial nasal & maxillary - or - adjacent medial nasal (intermaxillary segment)
Top of nose to Upper lip Veins have no valves; route of infection from face to dural sinus -> CNS infection
Compression/Lesion of CNVII Motor; Facial n.; paralysis of muscles of facial expressions on one side
CN V, Artery compressing? Sensory; Trigeminal n. (V2 common); sharp, sudden attack of pain; tic douloureux
Structures: G-E-R-A-F - Innervation: I Got Time, Let's Order Another Pint
Salivary gland cancer Remove parotid, must preserve facial n. Post-resection -> Frey's Syndrome
Parotidectomy Auriculotemporal n. synapses on sweat glands of cheek -> acetylcholine at both synapses ->
Salivation = Sweating on cheek
IV site, lateral to carotid a. I've got a lovely bunch of coconuts, there they are standing in a row
 Thyroidectomy Arterial supply = Superior <- ECA; Inferior <- Thyrocervical trunk; [10%] Thyroid ima a.<- Aortic arch
Recurrent laryngeal n. = close to Inferior thyroid a. -> ligate artery distal to gland; swelling -> transient hoarseness
Parathyroid glands = closely associated w/ thyroid, leave some of thyroid behind

Tracheostomy Avoid inferior thyroid v.or thyroid ima a.to avoid excess bleeding
Deep Neck

Torticollis
Thoracic Outlet Syndrome Compression of neurovascular Spasm, contracture of scalene mm. -> pull Diminished neural fxn/vascular supply
between clavicle & 1st rib 1st rib up; also caused by cervical rib
Raynaud's Syndrome Excessive sympathetic discharge Artery constriction -> hypothermia, LOS, Necrosis of digits - Tx: Sympathectomy
cyanosis, necrosis of digits
Sympathectomy Cut sympathetic system Vessels dilate -> ↑blood flow to digits Uncontrolled parasympathetic -> Horner
Horner's Syndrome Cervical sympathetic chain Ptosis (drooping eyelid), Miosis (pupil constriction), Anhidrosis (no sweating), Flushing
interruption (capillary dilation), Enophthalmos (eye sinks in)
General Sensory Damage Internal acoustic meatus, Geniculate ganglion, stylomastoid foramen; Minor loss of sensation
external auditory meatus, auricle of ear
Taste (Special) Sensory Geniculate ganglion, petrotympanic fissure, chorda tympani-lingual n.; Loss of taste to anterior 2/3 of tongue
Damage anterior 2/3 of tongue
Motor Damage Brainstem, stylomastoid foramen; TZBMC, PostAu, Stylohy, PostDi, Plat, Loss of facial expresion - Hyperacusis (sounds
Facial n. (CN VII

Stapedius (facial canal) seem louder than normal)

Lacrimal gland Superior salivary nucleus, Greater petrosal/N. of pterygoid canal, hiatus,
Pterygopalatine gang, CN V2, CN V1; lacrimal gland
Mucous glands Superior salivary nucleus, Greater petrosal/N. of pterygoid canal, hiatus, Slightly dry mouth - ↓ nasal secretions - Dry
Autonomics

Pterygopalatine gang; mucous glands of nose, palate, pharynx eye

Sublingual/Submandibular Superior salivary nucleus, Chorda tympani, Submandibular gan, CN V3;
sublingual & submandibular glands
Facial n. (VII) Damage Laceration Following parotid surgery ↓facial express'n - ↓sensation - Frey's
Bell's Palsy Big ones, small ones, some as big as your head; give them a twist a flick of the wrist, that's what the showman said

Anastomoses Internal & External carotid aa. anteriorly (4 near orbit) - Left side & Right side throughout scalp
Scalp, Cranial Cavity, Meninges & Dura
Scalp

Scalp Lacerations Profuse bleeding Galea aponeurosis & dense CT -> Rigid; causes arteries to "gape open"
Scalp Veins Spread of infection Emissary & diploic v. traverse scalp, penetrate skull, drain to sinus (venous channel)
Epidural Hematoma Arterial tear Between dura & inner table of skull; fairly Lens-shaped clot - May result in loss of
(middle meningeal a. often) confined d/t tight apposition consciousness -> lucid -> coma -> death
Meninges

Subdural Hematoma Venous tear Between dura & arachnoid; more diffuse, Concave X-ray pattern - Blood in one
can resolve d/t proteases hemisphere - Shaken-baby Syndrome
Sub-Arachnoid Hematoma Cerebral a. tear (intracranial) Blood in sulci (grooves) of brain; bloody CSF; "Worst headache of my life" - Stiff neck - Loss
clot -> ↓CSF movement -> ↑ICP of consciousness
Cavernous Sinus Thrombosis Hemorrhagic stroke in cavernous Internal carotid fills sinus -> clot -> compress CN III (oculomotor), IV (trochlear), VI
Dural Sinuses

sinus structures (abducent), V1 (ophthalmic), V2 (maxillary)

 (abducent), V1 (ophthalmic), V2 (maxillary)

Dural Sinus
Scalp, Cr Pituitoma Pituitary tumor Grow into cavernous sinus -> compress'n
Venous Drainage Communication of facial v. -> ophthalmic v. -> cavernous sinus Transmission of infectious particles
Frontal Lobe Reason - Organization/Planning - Personality - Writing - Movement - Speech
Gross Brain

Parietal Lobe Understanding (sensory) - Sensory - Hearing - Associations

Occipital Lobe Vision - Processing (vision)
Temporal Lobe Mood - Virtual (memory) - Smell
Brainstem ForTeD (Fore=Tele+Dien) - MiMes (Mid=Mes) - HiTMyBell (Hind=Met[pons]+Myel[medulla]+Cerebellum)
W4 (NuFo fz, Limb, CNS, NuMig) 3 ves, 2 flex - Intermediate (Alar/Basal) vs. Marginal (white) - W5 5 ves, 1 flex - M4 (Myel)
Neural Tube Defects Defect closure of neural tube Nutritional factors - (70% reduced) Folic acid - (Causes) Valproic acid, teratogens
Spina bifida Defect vertebral arch fusion Spina bifida occulta - Spina bifida cystica
Occulta Level L5 or S1 No neurological symptoms - Dimple and/or tuft of hair - 10% of population
Cystica Meninges/tissue invovled Meningocele (no cord) - Meningomyelocele (cord/root) - Myeloschisis (cord open)
Brainstem Development

Tethered Spinal Cord Attachment at distal end Stretches spinal cord, neurologic damage Pain - Sense - Weak - Incont'nce - Scoliosis
Dermal Sinus Opening of skin in midline Attached to dura -> Tethering; Communicate w/ spinal canal -> Meningitis
Diastematomyelia Spinal cord division Thoracic and down; Septated -> No rejoining; Aseptate -> 1-2 segments rejoin
Lipoma w/ spine Ectopic fat Connected to lower end of cord -> Tethering
Filum terminale Fibrous bands Thickening & fixation of cord -> Tethering
Chiari Malformation Caudal cerebellum herniates Compress caudal medulla & upper cervical Headache - Pain - Weakness - Sensory ∆s -
through foramen magnum spinal cord Hoarseness - Facial numbness - Resp dysfxn -
Uncoordina'd movmnt - Dysrhythmia -
Type I Isolated malformation; No symptoms until adulthood Dysphagia
Type II Associated w/ lumbar meningomyelocele & hydrocephalus
Dandy-Walker Malformation Cerebellar vermis agenesis w/ Associated w/ other abnormalities: corpus Slow motor development - Enlarged skull -
cystic dilation of 4th ventricle & callosum agenesis, malformed: heart, face, 1:25-30,000
hydrocephalus limbs, digits, toes

W1 (Imp) - W2 (Lay) - W3-4 (Neu) [D:18,20,22,25,27] - W4-7 (NuTu) - W5-6 (VenInd) - W8-16 (Prolif) - M3-5 (NuMig)
W5-12 (Expansion) - W7-24 (Cortex) [M3-6 (NuMig)] - M7-Y1 (NuMat) [cone,guide] - M7-B (Gy/Sul) - M3-Y2 (Myel)
Operculation Insular cortex development Insular grow slow -> infolding; Failure to operculate = immat. brain, premies, AbN
Platelet Activating Factor Growth cone collapse PAF collapses neuron growth cones -> repels neuronal maturation/migration
Congenital Birth Defects Genetic/Chromosomal Born with birth defect - Physical defects often primary symptoms or 2⁰ to syndrome
Teratogen Exposure Environmental agent Born with physical defect - Developmental delay in neonatal period
Anencephaly AbN neural tube closure No brain & cranial vault Dx: (12-16 weeks) Ultrasound -
Polyhydramnios - ↑AFP - 1:1000
Neurulation

Meroanencephaly No brain & cranial vault but, brainstem

Encephalocele AbN neural tube closure; Midline defect in cranium formation; Dx: (12-20 weeks) - Syndromic (often 2⁰, not
CNS herniation Meningocele, Meningoencephalocele, limited to CNS) - 1:2000 - Occipital
Meningohydroencephalocele meningoencephalocele = MEC, back of head
 Holoprosencephaly Failed forebrain cleavage 1 cerebral structure, 1 ventricle; No: Craniofacial dysplasia - Midline facial
Prosenc.
longitudinal fissure, corpus callosum, abnormalities (Cyclopia)
olfactory bulbs

Lissencephaly No neuroblast migration Smooth brain surface; No operculation, gyri, Dx: (>32 weeks) - Developmental delay -
differentiation of grey/white matter Seizures - Mental retardation
Neural Migration

Schizencephaly Focal migrational defect Clefting of cerebral cortex (may be thin or absent)
Miller-Dieker Lissencephaly LIS1 (hemiz. deletion 17p13.3) LIS1 co-localizes microtubules, regulates PAF Hypertelorism - ↓jaw - ↑brow - Up nares - ↑
Telencephalon

hydrolase -> AbN neural migration philtrum - Bitemporal hollowing

Heterotopia AbN neural migration Neurons accumulate in white matter; AbN operculation - Under-developed surface -
improper connections b/c not at surface Epilepsy - 2 bands of gray matter
Pachygyria Incomplete gyri formation Large gryi, complete folds but too big This clinical correlate load makes it feel like Block 1A again =)

Callosal Agenesis Defect lamina terminalis growth No corpus callosum; defective 2⁰ fold -> Dx: (>20 weeks)
often no cingulate gyrus
Congenital Hydrocephalus Accumulation of CSF Communicating = Structures intact, ↑CSF production Non-
communicating = Physical blockage of CSF movement
Hydrocephalus Obstructive hydrocephalus; Fail CSF replaces brain matter; no cortex, only Dx: (20-36 weeks) - Often seizures -
brain develop; Vascular defect; brainstem; baby looks/behaves normally at Transilluminating skull
Other

Intrauterine disease first; no thermoregulat'n

Microcephaly Infectious idiology Small cranial vault & brain Dx: (18-36 weeks) -Small skull - 2⁰ facial
Primary Genetic factors In first 7 prenatal months abnormalities - Normal face size - Head
circumference > 2SD below mean
Secondary Environmental factors In 8th & 9th prenatal mo. or post-natal
Craniosynostosis Mesenchymal defects; Metabolic bone disorder; Intrauterine constraint Premature fusion of ≥ 1 cranial sutures
Acrocephaly ["Acro" ~ "High"] High, tower-like head; Vertical forehead
Cranial Sutures

Brachycephaly ["Brachy" -> "Broad"] Broad head; Recessed forehead

Oxycephaly Coronal suture ["Oxy" ~ "Boxy"] Pointed head
Plagiocephaly Coronal & Lamboid suture ["Plat" -> "Flat"] Flat on one side, unilateral
Scaphocephaly Sagittal suture ["Scapho" ~ "Scaffold"] Long, narrow head
Trigonocephaly ["Trigono" -> "Triangle"] Triangular head; Vertical ridge in midforehead
Bones of the Orbit Zeus Made Leda Erotic For Swan Pals (start inferolateral & go CCW)
Blow-Out Fracture Blunt trauma to head/face Orbittal walls are thin, can fractured -> contents of orbit leak into adjacent cavities
Sty Obstruction of ciliary gland obstruction
Chalazion Obstruction of Meibomian (sebaceous/tarsal) glands …"a little more serious"…?
Eyelid

Pink Eye Inflammed conjunctiva Pink coloration of sclera due to inflammation of the conjunctiva
Conjunctivitis Infected conjunctiva …an infection of the conjunctiva
Orbit

Diplopia Double vision Due to paralysis of ≥ 1 extraocular m.

Double Whammy Sydrome Voluntary ocular dislocation Actively displace the globe forward while retracting the eyelids
Eye
 Central Retinal a. & v.
Eye
Danger Triangle of Face
Medial Strabismus
Lacrimal gl. & Muller's m.
Pupil & Ciliary m.
Autonomics of the Eye
Ptosis (Droopy eyed)
Pupillary Light Reflex
Accommodation
Presbyopia
Cataract
Hyphema
Glaucoma
Blockage -> Blindness
Abducent n. (VI) damage
Parasympathetic Path
Sympathetic Path
Parasympathetic Path
Sympathetic Path
Sympathetic n. damage
Parasympathetic (III) damage
Ciliary muscles relaxed
Ciliary muscles contracted
Hardening lens
Loss of transparency
Blunt trauma to eyeball
Humoral drainage blocked
Arterial block -> Instant, total blindness; Diabetes -> Retinopathy -> Retinal vessel
Venous block -> Slow, painless blindness damage -> blindness
There's nothing here…well…except this
Loss of lateral rectus m. function Cross-eyed
Some Folks Go Nuts Pickling Peppers, Zucchinis, Cucumbers, Lemons & Limes
I Wanna Sleep, Could Downing Nine Zanax Let Me?
Ever wish Inhaling opiates Could Somehow Cure Sickness?
If We Succeed, It’ll Open Some Doors
Symp to lacrimal gl. & Muller's m. same Horner's Syndrome
Each retina sends fibers to both sides, damage -> compromised sphincter pupillae ->
ipsilateral slowness of response, dilation of opposite side
Fibers taut -> pulls on lens -> ↑focal length ~ ↑object distance = distant vision
Fibers slack -> lens rounds -> ↓focal length ~ ↓object distance = close vision
Occurs with age; harder, flatter lens -> reduced focusing power
Lens becomes opaque; occurs with age or certain steroids
Hemorrhage into anterior chamber of eye
Accumulation of aqueous humor -> ↑pressure in chambers of the eye
Triangle Muscle Nerve Artery
Submental Mylohyoid
Submandibular Mylohyoid N. to mylohyoid (CN V3) Submental
Hypoglassal (CN XII) Facial
Muscular Sternothyroid
Sternohyoid
Thyrohyoid
Carotid Hypoglossal (CN XII) External carotid
Vagus (CN X)* Common carotid*
Internal carotid*
Occipital Splenius capitis Lesser occipital Transverse cervical
Levator scapulae Great auricular
Posterior scalene Transverse cervical
Middle scalene Supraclavicular
[Deep]
Spinal accessory (CN XI)
Brachial plexus (C5 & C6 root)
Subclavian Anterior scalene Phrenic Subclavian
Brachial plexus (lower roots) Suprascapular
Vein Other
Small vv. form AJV Subme Nodes
Facial Subma Glands
Subma Nodes
Thyroid gland
Parathyroid gland

Carotid Sheath*
Internal jugular*

Subclavian
Phrenic nerve
Brachial plexus (C5 & C6)
Ansa cervicalis
Dorsal scapular n.
Occulomotor (III)
Vagus (X)

Spinal accessory (XI)

Hypoglossal (XII)
Anterior scalene
Subclavian a.

Ansa subclavia

Sympathetic chain
Anterior of anterior scalene m. w/ ascending cervical a.; Pinned by transverse cerv & suprasca aa.;
Lateral & superficial to Vagus n. & Sympathetic chain
Between anterior and middle scalene mm.
Embedded in carotid sheath
Pierces middle scalene m.
Leave brainstem between Posterior cerebral & Superior cerebellar aa.
Medial & deep to phrenic n.

Exits jugular foramen; Runs over levator scapulae m.; Communicates w/ cervical plexus loops 2 & 3
Exits hypoglossal canal; Runs w/ C1 from cerival plexus loop 1
Sublclavian a. is behind, Sublclavian v. is in front
Deep
(first) to anterior
Ansa scalene
subclavia, m. n., R. recurrent laryngeal n., Phrenic n.;
R. Vagus

Vertebral, Thyrocervical trunk [Infer thy, Ascen & Transv cerv, Suprascap], Internal thoracic
(second) Costocervical trunk [Deep cerv, Highest intercos] (third)
Suprascapular, Descending scapular
Pre-Symp; Joins middle (C5-6) & inferior (C7-8) ganglia

Medial to phrenic, Deep to carotid sheath, In prevertebral fascia; C1-4 (Post-Sym), C5-6, C7-8
 Vesicle Region Alar plate Basal plate Cavity CN
Myelencephalon Medulla (Caudal) Gracile nuclei [medial] (Caudal) Pyramids 4th ventricle, caudal VIII, IX, X, XI, XII
Cuneate nuclei [lateral] -Choroid plexus
(Rostral) Sensory & Inferior olivary nuclei (Rostral) Motor nuclei -3 foramen
Metencephalon Pons, Cerebellum Rhombic Lip -> Cerebellar, Pontine, Cochlear, Motor nuclei 4th ventricle, cranial V, VI, VII
Vestibular nuclei (Marginal) Cerebellar peduncles

Mesencephalon Midbrain 2 inferior colliculi (auditory), 2 Motor nuclei (tegmentum) Cerebral aqueduct IV
superior colliculi (visual) (Ventral) Cerebral peduncle
Diencephalon Forebrain Epithalamus: Pineal gland, Habenulae NONE 3rd ventricle
Thalamus: Massa intermedia
Hypothalamus
Pituitary gland: Neurohypophysis
 Disorder/Drug
Dens (Axis)
Whiplash Injuries
Vertebral Artery Dissection
Stellate Ganglion
Glossopharyngeal (CN IX)
CN IX Problems
Vagus (CN X)
CN X Problems
Prevertberal
Carotid Massage
Spinal Accessory (CN XI)
CN XI Problems
Glomus Jugulare Tumor
Hypoglossal (CN XII)
CN XII Problems
Horner's Syndrome
Tympanic Membrane
Otitis Media
Raynaud's Syndrome
Anterior Clefts
Palate & Pharynx
Posterior Clefts
Velopharyngeal Seal
Palate, Nasal Cavity & Paranasal Sinuses
Velopalatal Insufficiency
CN X Lesion
Nasal Mucosa
Nasal Cavity
Rhinitis
CSF Rhinorrhea
Water's Projection
al Sinuses
Problem/Target Cause/Mechanism Effect/Symptom
Hangman's fractures, rheumatoid arthritis (lax ligaments), Down's syndrome (lax ligaments), sports
Anterior longitudinal ligament & Longus colli m. injury
Arterial intima separates 2⁰ to minor trauma: spinal manipulation, Severe occipital headache, post. nuchal pain
"ceiling painting", neck trauma, HTN -> neuro symptoms of post. fossa
C7-T1 sympathetic fusion Located at C7; affected by pancoast tumors; Blocked for: arm pain, Raynaud's
Jugular foramen; (Sense) Phary, Tons, Pal, Tong-post1/3, (Taste) Tong-pos1/3, (PrePara) Parotid, (Motor) Sty-Phary
(Test) Gag Reflex - (Damage) ↓ Salivation, Minor difficulty swallowing
Jugular foramen; (Sense) Ext. Ear, (PrePara) Almost all of body, GI [to splenic flexure] (Motor) Lary, Phary, Pal
(Test) Gag Reflex, Uvula deviates away from damage - (Damage) Hoarseness, Minor difficulty swallowing
Massaging the Carotid Sinus Baroreceptors in sinus, ICA, CN IX Tx: SVT - Associated risks
Spinal (C1-5), Foramen magnum, Accessory [cranial] (brainstem), Jugular foramen; (Motor) SCM, Trap
(Test) Shrug against, Lat. flex head against - (Damage) Trap & SCM, Abduct arm past horizon, Face to/Head away
Tumor in jugular foramen Compression of transmitting structures Deficits: CN IX - CN X - CN XI
Hypoglossal canal; (Motor) Tongue-Int/Ext, "-glossus" mm. except palatoglossus m.
(Test) Stick out your tongue - (Damage) Tongue towards, Difficulty swallowing, Slurred speech
Sympathetic chain disruption Flushing (blood vessel dilation), Anhydrosis (no sweat), Miosis (pupil constricts),
Enophthalmos (eye sinks), Ptosis (Drooping eyelid)
CN IX (outside) CN X (inside) Ear infection, TM inflamed -> volley of sense to IX & X -> ↑GI motility via X -> vomit
Middle ear infection (Children) angle of auditory tube allows Referred pain, cough/nausea d/t vagal br. to
ingested fluids to travel to middle ear external ear - Check ears
Excessive sympathetic firing Arterial vasospasm in upper exremity Finger necrosis - Tx: Sympathectomy
Anterior to incisive foramen No fzn of maxillary w/ medial nasal Lips,
Upper jaw, Between 1⁰ & 2⁰
(Lip) 1/1000, 80% male (Palate)
Posterior to incisive foramen No fzn of shelves(↓size/no tongue drop) 2⁰ 1/2500, 67% female [fz 1 wk later]
palate, Uvula
Swallowing -> soft palate elevates -> uvula contacts superior constrictor m. -> velopharyngeal sphincter
Incompetent seal between soft Foods & liquids pass into nasopharynx during
palate & wall of pharynx swallowing
Uvula deviates to leasion side
Secretions trap articles -> swept posteriorly -> swallowed; Cilia inhibited by <10⁰C; URT infection = "runny" nose
Inflammation d/t Upper Infections can spread to: Anterior cranial fossa (cribiform plate) - Nasopharynx &
Respiratory Infections or Retropharyngeal soft tissue - Paranasal sinus - Middle ear (auditory tube) - Lacrimal
Allergies apparatus & Conjunctiva
Clear nasal discharge Head trauma -> fracture of cribiform plate -> tearing of meninges -> CSF leakage
Posteroanterior radiographic "open mouth" view to visualize maxillary & frontal sinuses
Palate, Nasal Maxillary Sinus High placement -> poor drainage; Maxillary molar removal -> communication of sinus & oral cavity -> infection; Maxillary
Paranasal Sinuses
teeth & sinus same innervation -> sinus inflation -> "Toothache"
Sinusitis Inflamed paranasal sinus Swelling blocks opening -> poor drainage Infection
Optic Neuritis Posterior ethmoid cell sinusitis Fragile medial wall (orbit), near optic canal -> Blindness
infection to optic sheath
Kiesselbach's Area Ant. nasal septum: Sphenopalatine - Septal br. of sup. labial - Ant. ethmoid - Post. ethmoid - Greater palatine
Epistaxis Nosebleeds Rupture of cavernous mucosa -> severe bleeding, coag AbN, severe HTN
Pterion "H": Frontal - Parietal - Temporal - Sphenoid; Thin wall; Middle meningeal a. underneath -> Epidural hematoma
Brachial Cyst Persistent cervical sinus Cyst on anterior of SCM m. = lateral neck Fluid/Cell debris -> ↑size - Tx: Surgery
Brachial Fistula Persistent 2nd cleft & pouch Membrane rupture btwn cleft & pouch -> Travels between ICC & ECC aa. - Infection -
tract from pharynx to lateral neck surface Discharge of saliva - Tx: Surgery
Thyroglossal Duct Cyst Persistent thyroglossal duct Cyst along duct = midline of neck Swelling - Tx: Surgery
First Arch Syndrome Neural crest cells migration Insufficient NCC -> AbN development Pharyngeal & Facial deformities
Pharynx

Treacher-Collins Syndrome First Arch Syndrome Under-developed zygomatic b., small mandible, defects of external ear & eyelids
Pierre-Robin Syndrome First Arch Syndrome "Triad": insufficient NCC for bone -> micrognathia; tongue develops normally but ↓ space
-> no descent -> palatine processes can't fz -> cleft palate; posterior placement
of tongue -> glossoptosis -> risk of airway obstruction

DiGeorge Syndrome Undifferentiated pouch 3 & 4 No thymus and/or parathyroid: Immunologicproblems, hypocalcemia (PTH/calcitonin),
micrognathia & persistent truncus arteriosus(NCC migration)
TMJ TMJ inflammation Meniscus lesions affect both movements (sliding & hinge)
Temporal/Infratemporal

Temporomandibular Joint Hypomobility Muscles too tight in spasm/contraction Diffuse neurovascular problems
Dysfunction Hypermobility Subluxation ligament/capsule stretched; May self-reduce
articular surfaces still in contact
Dislocation, torn meniscus/articular disc; Manually reduce - Pain (many nerves)
condyle anterior to articular tubercle
Ischemia Maxillary a. supplies blood to anterior 1/3 of the face; diffuse pain from artery impingement
Mandibular n. (V3) Damage or impingement Cannot clinch jaw, difficulty chewing, lateral pterygoids -> jaw towards lesion
Preauricular Pits Auricles fail to form
Preauricular Appendages Accessory auricles
Hyperacusis Stapedius/Tensor tympani m. Loss of function -> can't reduce movement of ossicles - > can't dampen loud noises
Otitis media Middle ear infection Chronic, untreated -> can lead to CN VII paralysis, meningitis, brain abscesses
Ear

Secondary Otitis Media Nasopharynx infection Usually Strep., infection travels to middle ear; posterior spread -> mastoid air cells
Mastoiditis Mastoid process infection From untreated, acute otitis media Brain complications - Child mortality
Tympanosotomy Tube in your ear Tx for chronic ear infections; slit TM, insert tube, drains fluid
Ostoscelrosis Stapes & Oval window AbN bone growth -> limited movement Progressive conduction deafness
Corneal Endothelium Damage to inner corneal layer Normal (ion in, fluid out); Damage -> fluid accumulates in stroma -> opaque cornea
Cataracts Lens opacity Impaired vision with age, diabetes, UV exposure, smoking, infection
 Glaucoma ↑ Intraoccular pressure Pathological pressure >20 mmHg -> retinal & optic nerve damage
Closed Angle Canal of Schlemm Defective canal; shallow anterior chamber, narrow filtration angle
Open Angle Canal of Schlemm Canal of Schlemm seems normal but functions inadequately
Eye

Congenital Unknown
Special Senses

Retinal Detachment Separation at pigment epi &
photoreceptor layers
Macular Degeneration Loss of central vision
Dry Type Atrophic, Non-exudative
Wet Type Neovascular, Exudadtive
Attentuation Reflex Dampen ossicular movement
Conductive Hearing Loss Mechanical impedment
Ear
Retinal field deficits, retina relies on vascular Trauma - Intraocular pressure - Vascular
supply from choroid disease
Retinal deterioration
d/t thickening Bruch's, atrophy of pigment epi, loss of choroid layer capillaries
d/t neovascularization w/ fragile vessels that leak/hemorrhage -> scarring/fibrosis
Intense sound -> tensor tympani & stapedius contract -> ossicles rigid
External or middle ear compromised Wax - TM perf - Otitis media - Otosclerosis

Otosclerosis Oval window Spongy bone growth that can impede sound conduction
Sensorinerual Hearing Loss Neural/Hair cell injury Organ of Corti or hair cells Trauma - Drugs - Infections - Aging
Otitis Media Middle ear infection
Laryngeal carcinoma Laryngeal cancer Smoking, chewing tabacco Dysphagia - Dysphonia - Tx laryngectomy
Recurrent Laryngeal n. Nerve injury Vocal cords paralyzed; disease in chest can Hoarseness - Stridor (high-pitch, noisy)
affect by inflammation/compression
Larynx

External Laryngeal n. Nerve injury Cricothyroid m. paralyzed; no vary tone Monotonous voice - Laryngitis - Nodules
Larynx & Puberty Testosterone changes larynx Larygneal cavity & all cartilages ↑size; AP Vocal tone drops 1 octave
diamtere of rima glottis doubles; vocal
folds ↑ length/thickness
 Head & Neck
Anatomical Feature Origin Insertion Function Innervation
Platysma Superficial fascia: upper Mandible: inferior border; Skin Depress mandible; Depress lower Cervical br. of VII
pectoralis major & deltoid & Facial mm. over mandible lip; Tense neck skin
Superficial

Sternocleidomastoid (Sternal head) Manubrium Mastoid process; Superior (Unilateral) Flex, Rotate neck; Turn Spinal accessory (XI)
(Clavicular head) Clavicle: nuchal line: upper 1/2 (superiorly) chin (Bilateral)
medial 1/3 Flex, Extend neck

Digastric (anterior) Mandible: Digastric fossa N. to mylohyoid [br. of Inferior

alveolar (V3)]
Elevate hyoid (swallowing);
Hyoid bone Depress mandible
Digastric (posterior) Temporal bone: Mastoid N. to posterior belly of the
notch digastric (VII)
Suprahyoid
Superficial Neck

Mylohyoid Mandible: Mylohyoid line Hyoid bone; Median raphe Elevate hyoid, mouth floor, tongue N. to mylohyoid [br. of Inferior
(swallowing) alveolar (V3)]
Stylohyoid Styloid process N. to stylohyoid (VII)
Geniohyoid Mandible: inferior mental Elevate hyoid (swallowing);
spine Depress mandible
C1 spinal, ventral rami [w/
Thyrohyoid Thyroid cartilage: oblique Depress hyoid; Elevate Hypoglossal (XII)]
line thyroid cartilage
Hyoid bone
Omohyoid (superior) Decendens hypoglossus, ansa
Infrahyoid

Suprascapular notch: medial Depress, Retract hyoid & larynx

edge cervicalis, superior, C1
Omohyoid (inferior)
Sternohyoid Manubrium; Clavicle: medial Depress hyoid & larynx
end Ansa cervicalis C1 - C3
Sternothyroid Manubrium Thyroid cartilage: oblique line Depress thyroid cartilage
Anterior scaleneus 1st rib: scalene tubercle Elevate rib 1 & 2; (Unilateral)
Cervical vertebrae:
Deep

Middle scaleneus 1st rib: scalene tubercle Flex , Rotate neck; (Bilateral) Adjacent cervical nn.
transverse processes Stabilize neck
Posterior scaleneus 2nd rib
Occipito(frontalis) Raise eyebrow; Wrinkle forehead
Temporal br. of VII
Orbicularis oculi (sup)
Eye

Close eyelids
Orbicularis oculi (inf) Zygomatic br. of VII
Corrugator supercilii Draw (inferior; medial) eyebrow Temporal br. of VII
Procerus Wrinkle bridge of nose
Nose

Nasalis Dilate nostrils

Depressor septi Draw (inferior) septum
Orbicularis oris Pucker-Up Close, Shape (speech) lips
Levator labii superioris
alaeque nasi Elevate angle of mouth
Facial Expression

Elevate upper lip Buccal br. of VII

Levator labii superioris
Zygomaticus minor Smile Elevate angle of mouth
Zygomaticus major
Mouth

Levator angulis oris

 Mout
Facial
Risorius Retract angle of mouth
Buccinator Pucker-Up Compress cheeks
Despressor anguli oris Depress angle of mouth
Depressor labii inferioris Frown Depress lower lip Mandibular br. of VII
Mentalis Protrude lower lip
Auricularis anterior Retract ear
Auricularis posterior
Ear

Temporal br. of VII

Auricularis superior Elevate ear
Platysma Tense skin of neck Cervical br. of VII
Neck

Orbicularis oculi Closes eye T & Z br. of VII

Levator palpebrae Sphenoid: superior to optic Superior eyelid Oculomotor (III), superior
Eyelid

superioris canal
Opens eye
Muller's palpebral Levator palpebrae superioris Tarsal plate: superior margin Sympathetic [IWSCDNZLM]
m.: inferior
Medial rectus Medial Oculomotor (III), inferior
Lateral rectus (2 heads) Lateral Abducent (VI)
Orbit

Common tendinous ring

(Annulus of Zinn) Sclera: anterior to equator
Superior rectus Medial Superior Oculomotor (III), superior
Eye

Inferior rectus Medial Inferior Oculomotor (III), inferior

Superior oblique Sphenoid: superior to MR Sclera: posterior to equator Lateral Inferior Trochlear (IV)
Inferior oblique Maxilla:nasolacrimal canal Globe: posterolateral aspect Lateral Superior Oculomotor (III), inferior
Dilator pupillae Dilate pupils Sympathetic [IWSICOSD]
Sphincter pupillae Constrict pupils
Parasympathetic [EwIoCSCS]
Ciliary Manipulate lens
Longus colli C1-T3: slips to vertberal bodies & transverse processes Flex, Rotate neck Spinal C2 - C6
Longus capitus C3-6: transverse processes Occiput Flex, Rotate neck Spinal C1 - C3/4
Prevertebral

Rectus capitus anterior Atlas Occipital bone

Rectus capitus lateralis Atlas: transverse process
Styloglossus
Stylohyoid Skull, Styloid process
Stylopharyngeus
Tensor veli palatini Medial pterygoid plate:
scaphoid fossa; Sphenoid
spine; Pharyngotympanic
tube
Occipital: jugular process
Tongue
Hyoid bone
Pharnyx
Palatine aponeurosis; (Hook)
Medial pterygoid plate: hamulus
Flex atlanto-occipital joint Spinal C1
Elevate, Retract tongue Hypoglossal (XII)
Facial (VII)
Elevate pharynx Glossopharyngeal (IX)
Tense soft palate; Open (assist) Medial pterygoid br. of V3
auditory tube

Levator veli palatini Auditory tube: cartilage; Palatine aponeurosis Elevate (superior, posterior) soft
Temporal bone: petrous palate [swallow, yawn]
Palatoglossus Palatine aponeurosis Tongue: lateral portion Elevate tongue (posterior); Draws
soft palate to tongue
Palate

Palatopharyngeus Palatine aponeurosis Pharynx: lateral wall Tense soft palate; Pull (superior,
anterior, medial) pharynx Vagus (X)
[swallow]
 Musculus uvulae Palatine aponeurosis; Uvula: mucosa Shorten, Elevate uvula; Closes
Palatine bone: posterior nasopharynx [swallow, phonate]
nasal spine
Constrictor mm. Swallowing
Median raphe Pharyngeal plexus (X)
Superior constrictor Velopharyngeal seal
Stylopharyngeus Temporal bone: Styloid Thyroid cartilage (between Glossopharyngeal (IX)
process superior & middle constrictors)
Pharynx

Salpingopharyngeus Auditory tube, posterior Blends into fibers of middle

constrictor & palatopharyngeus Elevate pharynx
Vagus (X)
Palatopharyngeus Hard palate, posterior; Soft Thyroid cartilage; blends into
palate pharynx
Digastric (ant & post)
Submand.
Mouth

Mylohyoid
Geniohyoid
Stylohyoid
Intrinsic mm. Longitudinal, Vertical, Transverse Alter shape of tongue
Genioglossus Mandible: Genial tubercle Hyoid: body; Tongue: dorsum Protrude, Retract, Depress tongue
(mental spines)
Tongue

Hypoglossal (XII)
Hypoglossus Hyoid: body & greater cornu Depress, Draw (lateral) tongue
Tongue: sides
Styloglossus Styloid process Retract, Elevate tongue
Temporomandibular Zygomatic process Mandible: ramus
Ligament

Stylomandibular Styloid process Mandible: angle

Sphenomandibular Sphenoid bone Mandible: lingual
Masseter Zygomatic arch: inferior Mandible: ramus, lateral Elevate, Protrude mandible; Close, Masseteric br. of V3
border & medial surface Abducts jaw
Temporalis Temporal fossa: floor; Deep Mandible: ramus, anterior; Elevate mandible; Close, Deep temporal br. of V3
temporal fascia Coronoid process Abduct, Retract jaw
Temporal/Infratemporal

Medial pterygoid (Superficial) Maxilla:
tuberosity; (Deep)
Sphenoid: Lateral pterygoid
plate, medial surface
Mastication
Mandible: ramus, medial surface (Unilateral) Grinding motion Medial pterygoid br. of V3
(Bilateral) Elevate mandible; Close,
Protrude jaw

Lateral pterygoid (Superior) Sphenoid: greater Mandible: neck; TMJ: (Unilateral) Side-to-side motion Lateral pterygoid br. of V3
wing, infratemporal surface articular disc & capsule (Bilateral) Protrude, Adduct
& crest; mandible; Open jaw
(Inferior) Sphenoid: lateral
pterygoid plate, lateral
surface

Tensor tympani Auditory tube Malleus: handle Tenses tympanic membrane Medial pterygoid br. of V3
Ear

Stapedius Pyramidal prominence Stapes: neck Movement of stapes Facial (VII)

Cricothyroid Cricoid cartilage: arch Thyroid cartilage: inferior horn & Tense vocal folds (chief) External laryngeal (X)
lower border
 Vocalis Thyroid cartilage: Arytenoid cartilage: vocal process; Adjust tension of vocal folds; (fine
anteromedial lamina Vocal ligament tune)
Thyroarytenoid Thyroid cartilage: inner Arytenoid cartilage: anterolateral Relax vocal folds; Close
lamina surface rima glottis
Larynx

Posterior cricoarytenoid Cricoid cartilage: posterior Abduct vocal folds

lamina Arytenoid cartilage: muscular Recurrent laryngeal (X)
Lateral cricoarytenoid Cricoid cartilage: upper process Adduct vocal folds
border
Transverse arytenoid Runs between Arytenoid cartilage, posterior
Oblique arytenoid Arytenoid cartilage: Arytenoid cartilage: apex; Adduct vocal folds; Close
muscular process (Aryepiglottic m.) Epiglottis rima glottis
Vascularization

Facial (Submental,
Inferior
labial, Superior
labial, Angular),
Transverse facial,
Supraorbital,
Supratrochlear
Supraorbital,
Supratrochlear

Ophthalmic (Central
retinal, Posterior
ciliary, Meningeal,
Lacrimal,
Supraorbital,
Supratrochlear, Post.
ethmoidal, Anterior
ethmoidal, Dorsal
nasal)

Long ciliary
Lingual a. (Dorsal
lingual, Deep lingual,
Submandibular)

Masseteric (2nd
maxillary)
Deep temporal
(2nd maxillary)

Pterygoid aa. (2nd

maxillary)
 Bone(s) involved Opening Structures transmitted Type(s) of Fibers
Supraorbital foramen/notch Supraorbital n. (V1)
Frontal
Supraorbital a.
Ethmoid Cribiform plate CN I: Olfactory n. Smell
Lacrimal foramen Communicating a.
Inferior orbital fissure Maxillary n. (V2)
Inferior ophthalmic v.
In the orbit Infraorbital a/v
Infraorbital canal Infraorbital n. (V2)
Infraorbital a/v
Nasolacrimal canal --
Zygomaticoorbital foramen Zygomatic n. (V2)
Zygomatic Zygomaticofacial foramen Zygomaticofacial n. (V2)
Zygomaticotemporal foramen Zygomaticotemporal n. (V2)
Greater palatine foramen Greater palatine n. (V2) General sensory
Descending palatine a.
Descending palatine v.
Palatine
Lesser palatine foramen Lesser palatine n. (V2) General sensory
Lesser palatine a.
Lesser palatine v.
Sphenopalatine foramen Nasopalatine n. (V2)
Palatine, Sphenoid Sphenopalatine a.
Sphenopalatine v.
Infraorbital foramen Infraorbital n. (V2)
Incisive foramen Nasopalatine n. (V2) General sensory
Maxilla
Sphenopalatine a.
Sphenopalatine v.
Maxilla, Sphenoid Pterygomaxillary fissure Maxillary a.
Mental foramen Mental n. (V3)
Mandibular foramen Inferior alveolar n. (V3)
Mandible
Inferior alveolar a.
Inferior alveolar v.
Pterygoid canal N. of the pterygoid canal Pre-Para
Sphenoid
Post-Symp
Sphenoid Optic canal CN II: Optic n. Vision
(lesser wing) Ophthalmic a.
Sphenoid Superior orbital fissure CN III: Oculomotor n. General sensory
(between greater & lesser *3 TYPES OF FIBERS* CN IV: Trochlear n. Motor
wings) (no special sensory) CN V1: Ophthalmic n. Pre-Para
CN VI: Abducens n.
Cavernous plexus nn. Post-Symp

Foramen rotundum
*GEN.SENSORY ONLY*
Sphenoid (greater Foramen ovale
wing) *3 TYPES OF FIBERS*
(no special sensory)
Foramen spinosum
Foramen lacerum
Sphenoid, Temporal, Occipital
Stylomastoid foramen
Carotid canal
Hiatus of facial canal
Temporal External acoustic meatus
Petrotympanic fissure
Internal acoustic meatus
*ALL 4 TYPES OF FIBERS*
Jugular foramen
*ALL 4 TYPES OF FIBERS*
Occipital, Temporal
Foramen magnum
Occipital
Hypoglossal canal
*MOTOR ONLY*
Frontal, Ethmoid, Sphenoid Anterior cranial fossa
Sphenoid, Temporal Middle cranial fossa
Temporal, Occipital Posterior cranial fossa
Some of Sphenoid, Parietal
Superior ophthalmic v.
Inferior ophthalmic v.
CN V2: Maxillary n. General sensory
CN V3: Mandibular n. General sensory
Lesser petrosal n. Motor
Pre-Para
Middle meningeal a. --
Greater petrosal n. Cross over horizontally (do
not run through vertically)
Internal carotid a.
CN VII: Facial n. General Sensory
Motor
Internal carotid plexus nn. Post-Symp
Internal carotid a.
Greater petrosal n. Pre-Para
-- --
Chorda tympani n. Taste
CN VII: Facial n. Taste, Hearing
CN VIII: Vestibulocochlear General sensory
Motor
Pre-Para
CN IX: Glossopharyngeal n Taste
CN X: Vagus n. General sensory
CN XI: Spinal accessory n. Motor
Ascending pharyngeal a. Pre-Para
Inferior petrosal sinus
Sigmoid sinus
Spinal roots of CN XI --
Medulla oblongata
Vertebral aa.
CN XII: Hypoglossal n. Motor
-- --
-- --
-- --
Additional notes
Do not confuse with the superior orbital fissure!
Supraorbital a. comes from the ophthalmic a.
Synapse in olfactory bulb
Between middle meningeal a. and lacrimal a.
The maxillary n. splits into zygomatic n. and infraorbital n.;
this branch of the inferior ophthalmic v. drains to the
pterygoid plexus

Leads out to infraorbital foramen

Big, vertical, medial; path for tears

Tiny, lateral in orbit on zygomatic bone
--
Behind arch
Big, by back teeth

Smaller, by back teeth

Do not have to identify this because we can’t see it

In vertical line with supraorbital and mental foramina

Right behind front teeth

Teardrop shape, mandible must be removed to see it

In vertical line with supra and infraorbital foramina
Big hole on inside of mandible

Find when disarticulated

Can be considered part of anterior or middle fossa
Drain to cavernous sinus
Drain to cavernous sinus
Round, going forward

Football shape
Otic ganglion just outside

Small, round, going down

Medial to FO

Between mastoid and styloid processes

Runs sideways just behind FO

Crack on top of CC; Geniculate ganglion just outside

--
Crack in front of styloid
Behind petrosal ridge,
CN VIII is larger

From cavernous sinus to Internal jugular v.

Drains to internal jugular v.
--

Sideways, lateral to FM

Directly above the orbit

--
--