INTRO TO HEAD: Functions o houses/protects brain, mninges, sense organs o respiration

o
o SKULL

vocalization produced/modified in head&neck chewing (mastication) and swallowing (deglutition) 28 bones 29 with hyoid Cranium (skull without mandible)

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o

Neocranium surrounds brain Parietal Frontal Occipital Temporal Sphenoid (where your temples are)

MANDIBLE o attaches to skull at Temporomandibular joing (TMJ) synovial used in chewing HYOID o u-shaped b/w mandible and thyroid cartilage in neck swallowing EAR OSSICLES o Lateral Medial

Ethmoid (below frontal?) inb/w eyes, top of nose ridge Viscerocranium (facial skeleton) Nasal Lacrimal (superior, posterior to Maxilla) Maxilla Zygomatic (cheek bones) Vomer Palatine (roof of mouth ish) Inferior nasal conchae (inside nose)

Malleus Incus Stapes SUTURES o fibrous joints b/w adjacent skull bones o
Coronal perpendicular to saggital, b/w frontal/parietal Saggital midline b/w parietal bones Lambdoid b/w occipital and parietal

Squamosal b/w temporal and parietal CRANIAL CAVITIES (5 cavities) o Endocranial Cavity (inside skull) 3 Fossae Anterior superior to orbit house frontal lobes Middle houses temporal lobes Posterior houses cerebellum and brainstem

Orbits for eyes o Nasal, Oral, Middle Ear BASICRANIAL FORAMINA o Exit/Entry points for CN

o o o o o o

CN I Cribiform plate (b/w anterior fossa) CN II Optic canal CN V2 Foramen rotundum CN V3 Formane ovale CN VII/VIII Internal acoustic canal CN IX, X, XI Jugular foramen

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o

CN XII Hypoglossal Huge hole for spinal cord

BRAIN AND MENINGES

Prosencephalon forebrain before brain 3 wks o 6 wks:

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Telencephalon far off brain Diencephalon through brain

Mesencephalon midbrain middle brain 3 wks Rhombencephalon hindbrain spinning brain 3wks o 6 wks: Myelencephalon marrow brain FOREBRAIN (Prosencephalon) o Cerebrum (Telencephalon) largest part of brain four lobes: Frontal, Parietal, Occipital, Temporal Folds (gyri) separated by grooves (sulci) o Diencephalon control sensory impulse and autonomic response Thalamus, Hypothalamus, Epithalamuc (w/ pineal gland) MIDBRAIN (Mesencephalon) o subconscious motor response and maintains consciouness o Superior/Inferior Colliculi, Cerebral Aqueduct HINDBRAIN (Rhombencephalon) o Metencephalon Cerebellum: motor function Pons: b/w midbrain and medulla contains 4th ventricle sends sensory info to cerebellum and thalamus controls subconscious somatic and visceral motions Myelencephalon (medulla oblongata) Continues with spinal cord

o o

Metencephalon with brain

Visceral functions cardiovascular, respiratory, gastrointestinal relay sensory to thalamus 7 CN originate from it

BRAINSTEM o Midbrain, pons, medulla

OVERVIEW: Prosencephalon o Telencephalon cerebrum

o Diencephalon diencephalon Mesencephalon o Mesencephalon Rhombencephalon o Metencephalon Cerebellum and Pons o

Myelencephalon Medulla oblongata

SPINAL CORD Conduct sensory/motor impulses to/from CNS and to/from bodys periphery

Continuous w/ medulla at foramen magnum surrounded by same meninges Spinal cord is in vertebral canal ; NOT intervertebral foramen Ends at conus medullaris around L2

below L2 branches of spinal nerves Cauda Equina (horse tail)

Swelling in cervical and lumbar regions nerve origins for brachial and lumbrosacral plexuses

MENINGES Protective coverings of brain and spinal cord o Pia Mater (gentle mother) innermost layer intimate connection to brain and spinal cord highly vascularized o Arachnoid Mater (Cobweb Mother)

thin,transparent middle layer bridges sulci and grooves doesnt go down into sulci like pia mater

separated from pia mater by subarachnoid space meshwork of fibers Dura Mater (tough mother)
in the skull two layers (fused)

Periosteal outermost periosteum for bones of endocranial cavity Meningeal innermost adhere to arachnoid mater

two layers separate in some regions of skull venous sinuses 4 areas where cranial dura folds in to separate portions of brain and limit excessive movement

*Falx cerebri crescent shape b/w two cerebral hemispheres *Tentorium cerebelli horizontal b/w cerebrum and cerebellum Falx cerebelli separate two hemis of cerebellum Diaphragma sellae covers pituitary gland gland sits on sella turcica

Spinal Meninges similar to brain meninges

cranial dural layers spit meningeal spinal dura Extradural space b/w spinal dura and surrounding periosteum and ligaments of vertebral canal

periosteal layer periosteum

ATERIAL SUPPLY TO BRAIN AND SPINAL CORD Brain Vertebral Arteries enter through foramen magnum travels up neck in transverse foramina in cervical vertebrae o Cerebral Arterial Circle (Circle of Willis) anastomosis at base of brain b/w internal carotid and basilar artery (formed by junction of vertebral arteries) Spinal Cord o Longitudinal anterior/posterior spinal arteries from vertebral artery enter foramen magnum o Segmental spinal arteries enter vertebral canal through intervertebral foramina at each spinal level

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Internal Carotid Arteries enter at base of skull carotid canals

VEINS Brain

arise from vertebral (cervical region), intercostals (thorax), and lumbar aa(abdomen)

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Dural sinuses internal jugular vein Superior sagittal sinus (upper border of falx cerebri) drain to tranver sinus @ confluence of sinuses empties to sigmoid sinus internal jugular vein Inferior sagittal sinus (inferior falx cerebri) straight sinus confluence of sinuses

Cavernous sinuses either side of pituitary drain through petrosal sinuses internal jugular vein Spinal Cord

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Anterior/Posterior spinal veins run longitudinally in subarachnoid space Longitudinal veins segmental veins via internal vertebral plexus in extradural space

VENTRICULAR SYSTEM Cavities/passages in brain produce Cerebrospinal Fluid (CSF)

o o o

Lateral ventricles paired cavities in cerebral hemis comm.. w/ third ventricle @ interventricular foramen Third ventricle surrounded by diencephalon join Fourth vent @ cerebral aqueduct

Fourth ventricle inside pons/medulla comm. w/ subarachnoid space @ median/lateral apertures CSF circulation o made in Choroid plexus @ 3rd/lateral ventricles

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o

Flow down cerebral aqueduct 4th vent subarachnoid space via apertures Absorbed into venous system via arachnoid granulations(villi) in superior sagittal sinus

SCALP

Surface acts as one way valve allow CSF into venous sinu but not blood into subarachnoid space

5 layers: o Skin o Connective Tissue

o
o o FACE

Aponeurosis b/w frontalis and occipitalis Loose connective tissue Pericranium

CN V trigeminal nerve Muscles (superficial) CN VII facial nerve

o o o o o o o o o o

Orbicularis oculi surrounds eye orbicularis oris surrounds mouth zygomaticus muscles inferior to oris cheeks buccinators inferior to zygomaticus cheeks masseter cheek muscles along jaw pokes out when you chew temporalis temples lateral pterygoid medial to mandible jaw

Muscles (deep) CN V3 trigeminal nerve (mandibular)

medial pterygoid medial to mandible jaw Salivary glands (paired) o Parotid CN IX ventral to ear Submandibular CN VII near throat posterior to sublingual Sublingual CN VII ventral to tongue Vasculature o Arteries

Most from external carotid artery (branches) (from rostral to caudal) Superficial temporal Maxillary

o Veins

Facial goes toward face Occipital goes up Lingual caudal to facial Superior Thyroid down to thyroid

Internal carotid artery supply to branches in face via ophthalmic artery

generally mirror arteries w/ exceptions:

Maxillary joins Superficial Temporal retromandibular vein Facial and Anterior division of Retromandibular internal jugular vein Posterior division external jugular vein

CRANIAL NERVES FUNCTIONS o General sensory (Afferent) touch, pain, temp, stretch

o o

somatic from skin, mucous visceral cervical, thoracic, abdominal viscera

Special sensory (Afferent) vision, hearing, balance, taste, olfaction Motor (Efferent) striated muscles in head and neck Somatic motor eye/tongue

Branchiomotor face, larynx, pharynx Pharyngeal arches Parasympathetic (visceral motor, Efferent) smooth muscles of eye, viscera, secretomotor to glands (lacrimal, salivary, mucous) synapses occur one of 4 ganglion or in walls of target organs (CN V)

o o o o o o

CN III Ciliary ganglion CN VII pterygopalatine gangion CN VII submandibular gangion CN IX otic ganglion

CN I OLFACTORY Location of bodies Olfactory epithelium in nasal cavity Path to skull Cribriform plate of Ethmoid Function special sensory olfaction Location of bodies Retina Path to skull Optic canal Function special sensory vision medial half cross to other side via optic chiasm lateral half stay on same side

CN II OPTIC

CN III OCULOMOTOR o 5 muscles that move eyeball (SLIM) Superior rectus Levator palpebrae superioris Inferiors (rectus and oblique) Medial rectus o

Cell bodies CNS midbrain Parasympathetic motor to smooth eye muscle Sphincter pupillae Ciliary muscle Cell bodies Ciliary ganglion Exit: superior orbital fissure

CN IV TROCHLEAR o One eye muscle Superior oblique one w/ trochlear Location CNS midbrain Exit superior orbital fissure

CN V TRIGEMINAL o Nerve of first Pharyngeal arch

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o

Motor cell bodies Pons Sensory cell bodies Trigeminal ganglion 3 divisions:

V1 Opthalmic nerve

general sensory cornea, eyeball, forehead, upper eyelid, frontal/ethmoid sinus, lacrimal gland Cell bodies trigeminal ganglion suspends ciliary ganglion Entrance Superior orbital fissure Branches: o Frontal and Lacrimal (superficial) o Nasociliary (deeper) general sensory middle of face, upper jaw/teeth, palate, maxillary sinus, nasal cavity, part of dura mater Cell bodies trigeminal ganglion suspends pterygopalatine gangion Entrance foramen rotundum

V2 Maxillary nerve

V3 Mandibular nerve largest CN general sensory lower jaw, teeth, mouth floor, ant. 2/3 of tongue motor mastication muscles, Branches: o Lingual, Inferior Alveolar, Auriculotemporal Enter/Exit foramen ovale Suspends two parasympathetic ganglia o Submandibular ganglion CN VII

o
CN VI ABDUCENT NERVE

Otic ganglion CN IX

o o o

one eye muscle ABDUCTS EYE lateral rectus Cell bodes Pons Exit superior orbital fissure

CN VII FACIAL NERVE o Nerve of second pharyngeal arch o Functions: everything

sensory part of ear and external auditory meatus (EAM) motor muscles of fascial expression, stapedius, stylohyoid, posterior belly of digastric special sensory taste (anterior 2/3) parasympathetic

o Location:

pterygopalatine ganglion lacrimal, muscous of palate, nasal cavity, paranasal sinuses submandibular ganglion submandibular and sublingual salivary glands

sensory (general and special) genicular ganglion Path In/Out of skull

Motor pons

Enters Internal Acoustic meatus w/ CN VIII Exit Stylomastoid foramen (ant/inf to ear)

Two branches: Greater petrosal

b/w geniculate ganglion and back of face delivers preganglionic parasympathetic fibers pterygopalatine ganglion postganglionic go to lacrimal gland and nasal mucosal glands

relay taste fibers from palate geniculate ganglion Nerve of Pterygoid canal o greater petrosal picks up sympathetic fibers around internal carotid Chorda tympani runs through middle ear joins lingual branch of V3

delivers preganglionic parasympathetic fibers submandibular ganglion postganglionic fibers ride w/ branches of lingual nerve submandibular and sublingual salivary glands relay taste from anterior 2/3 of tongue

CN VIII VESTIBULOCOCHLEAR

o o o

Function special sensory hearing/balance Cell bodies vestibular ganglion and spiral ganglion (inner ear) Exit/entrance internal acoustic meatus (w/ CN VII)

CN IX GLOSSOPHARYNGEAL o Nerve of third pharyngeal arch o Funcions: does everything

Motor stylopharyngeaus muscle General sensory post. 1/3 of tongue, mucosa of upper pharynx, soft palate, middle ear cavity, auditory tube, carotid sinus (bld pressure receptor) and carotid body (bld CO2) Special taste from 1/3 of tongue Contribute sensory fibers to pharyngeal plexus mixture of fibers of IX and X on back of pharynx

Parasympathetic otic gangliong to parotid salivary gland Cell bodies:

Sensory superior/inferior glossopharyngeal ganglia Exit/Entrance: jugular foramen Branches:

Motor medulla oblongata

o o

Tympanic nerve reeneter skull via middle ear cavity gives rise to lesser petrosal nerve Lesser petrosal nerve exit middle ear along top of petrous portion of temporal exit in/near foramen ovale

carries parasympathetic preganglionic fibers otic ganglion\ postganglionic parotid gland Otic gland medial to mandibular trigeminal as the latter exits foramen ovale

CN X VAGUS NERVE o Nerve of 4th, 6th pharyngeal arch o Functions:

motor soft palate, pharynx, larynx, esophagus general ear and external auditory meatus special taste from epiglottis parasympathetic thoracic and abdominal viscera

Cell bodies

distally to left colic flexure ganglia in walls of targets

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o

motor medulla sensory (both) superior and inferior vagal ganglia

Entrance/Exit jugular foramen Branches (6)

contribute to pharyngeal plexus mainly motor fibers superior laryngeal nerve spit to inernal/external branches mainly sensory motor to cricothyroid muscle recurrent laryngeal travel up to larynx left curve under aortic arch

right curve under right subclavian artery motor to res of laryngeal muscle sensory below vocal folds

CN XI ACCESSORY o Spinal Accessory

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o

Function motor to sternocleidomastoid and trapezius muscles Cell bodes: upper cervical spinal cord cranial roots arise from medulla oblongata roots join briefly in skull before it leaves to innervate muscles cranial joins vagus Exit jugular foramen Function motor to glossus muscles (except palatoglossus part of pharynx so treated by vagus) Cell bodies medulla Exit hypoglossal canal Unusual relationship w/ cervical spinal nerves vis ansa cervicalis C1-3 ride briefly on hypoglossal to muscles in neck Useful marker pass inferior to occipital a. and close w/ hyoid bone and digastric

spinal roots travel up through foramen magnum

o o o o
o o ORBIT o

CN XII HYPOGLOSSAL

Walls: 6 bones o Frontal o Sphenoid o Zygomatic o Maxilla o Lacrimal o Ethmoid o Palatine Openings:

Lacrimal groove lacrimal sac and nasolacrimal duct Lacrimal Gland o superolateral corner of orbit o secretes tears

o o o o

Optic Cana CN II Superior orbital fissure CN III, IV, V1, VI Inferior orbital fissure CN V2, Branch of maxillary a.

o drain into lacrimal sac down nasolacrimal duct into nose Eyelids o Muscles: orbicularis oculi

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levator palpebrae superioris raise upper eyelid as it inserts Tarsal plate and glands Blockage = Chalazion Ciliary glands (base of eyelashes) Blockage = Sty Conjunctiva
vascular membrane lining inside eyelids and reflected onto eyeball Inflammation = conjunctivitis Clinical: PTOSIS = eyelid droop Drooping upper eyelid = tension lack in levator palpebrae superioris CN III problem Sagging both eyelids (esp lower) = tension lack in orbicularis oculi

CN VII problem orbicularis oculi = facial exp muscle

EYEBALL o 3 layers o Fibrous external Sclera and cornea o Middle vascular Ciliary body, Choroid, Iris Iris controls pupil size through:

Sphincter pupillae CN III parasympathetic closes pupil concentric fibers o parasympathetic motor nerves CN III (oculomotor) o synapse in ciliary ganglion suspended form CN V1 branch Dilator pupillae sympathetic opens pupil radial fibers

sympathetics come up from thorax synapse in superior cervical ganglion

Internal Neural layer

Retina continuous w/ optic nerve @ optic disc

branches of ophthalmic artery enter retina w/ optic nerve @ optic disc blind spot macula lutea spot lateral to optic disk

o center = fovea centralis most acute vision Neural vs Pigmented layers o pigmented attached to choroid o two layers not firmly connected
Detached Retina Trauma (Congenital Susceptibility separation of retina from choroid

o EYE REFRACTION

Fibrous Sclera and Cornea Vascular Iris, Ciliary bodies, Choroid Neural Retina

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o

Refraction: as light travels b/w objcs w/ diff. densities speed changes light bends eye bends light precisely to focus on retina Cornea clear, anterior most layer of eye

curved, denser than air 80% refraction occurs here Aqeous humor
produced by ciliary processes in posterior chamber behind iris normal: flow through pupil anterior chamber (behind cornea) drain to scleral venous sinus Clinical:

drainage impeded pressure build in ant. chamger pressure on all structures posterior including retina glaucoma

Lens

transparent, biconvex structure behind iris final adjustments in focus enclosed in fibrous capsule attached to ciliary body by radiating zonular fibers (suspensory ligament of lens) can change shape to alter light bending

zonular fibers keep tension keep its flat more focused on distant objects o sympathetics relax ciliary muscle pull zonular fibers and lens capsule tigher Accommodation (near sight) 3 step process

fairly elastic left alone spherical

First: Ciliary muscle (in ciliary body) contract parasympathetics running in CN III (oculomotor) synapse in ciliary ganglion suspended from CN V1 branch Second: Contraction loosen zonular fibers pull on choroid or slide anteriorly down anterior eyeball surface

Third: allow lens to become spherical bend light more sharply Age Change in Lens
Cataracts opacities in lens diffuse to localized Vitreous Body clear, gel-like fills posterior 80& of eyeball supports lens anteriorly, retina posteriorly Other Visual Impariments

Presbyopia lens become stiffer w/ age not as spherical reading glasses

Myopia near-sightedness eyeball too long image forms anterior to retina correction: diverge light rays slighty before they hit lens Hyperopia far-sightedness eye too short image posterior to retina converge light rays before they hit lens Astigmatism

imperfections in cornea multiple points of focus on/near retina

CNS blurred vision

EXTRAOCULAR MUSCLES (6 moves eye, 1 raise upper eyelid) o Levator palpebrae superioris raise upper eyelid CN III

Rectus muscles Superior, inferior, medial, lateral relative to eyeball

o o
o

Lateral CN VI Abducent abductor for eye Others CN III Oculomotor Functions:

o o o o

Superior raises eyeball look up Inferior lowers eyeball Medial Adducts turn medial Lateral Abduct turn laterally

Oblique muscles superior, inferior Superior pass through fibrocartilaginous trochlea (pully) in superiomedial corner of orbit CN IV Trochlear Inferior CN III Oculomotor look medially test medial rectus

H-Test

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medial down superior oblique

look up inferior oblique look laterally lateral rectus lateral up superior rectus look down inferior rectus

NERVES OF ORBIT o CN II Optic special sensory retina to CNS

o o o

CN III Oculomotor parasympathetic smooth muscle of eye CN III, IV, VI extraocular mm CN V Trigeminal general sensory to orbit, eyelids, eyeball o Mainly V1 but some from V2

VASCULATURE o Ophthalmic artery o branch of internal carotid o Important: Central artery of retina Enter optic nerve supply retina, branches of ophthalmic around orbit and into nose Superior/Inferior Ophthalmic veins o drain into cavernous sinus Central Vein of Retina o like artery, travel inside optic nerve o drain to cavernous sinus

o o

Impeded drainage increased CSF pressure around optic nerve optic disc swells Papilledema

NASAL CAVITY/PARANASAL SINUSES o Functions of Nose:

o o

proximal ends of respiratory system filters, warms, humidifies it location of sensory endings of olfactory nerve uppermost recesses

dont smell during inhale smell when you exhale conchae create turbulence drives air into olfactory region

smell better if you sniff more turbulence o receive secretion from paranasal sinuses and nasolacrimal duct o reonating chamber for sound waves froom vocal tract Innervation o
o Trigeminal V general sensory Nose lined w/ mucosal glands Parasympathetics preganglionic arrive via Greater petrosal of CN VII (facial)

Blood vessels sympathetic innervation Blood Supply

o o o

synapse in pterygopalatine ganglion suspended from V2

Olfaction CN I special sensory

Arteries behind, above, front

Sphenopalatine and Greater Palatine from external carotid terminal branches of maxillary artery

cover most of posterior portion of lateral wall and midline septum of nose

Anterior and Posterior Ethmoidal from internal carotid branches of ophthalmic artery cover anterior portion of lateral wall and septum

Branches of facial artery through anterior portion of nose arise from external carotid only reach anteriormost portion of lateral wall and septum Veins (follow arteries )

NOSE STRUCTURE

Sphenopalatine and Greater palatine posteriorly into pterygoid plexus behind face into retromandibular vein Anterior and Posterior Ethmoidal superiorly then posteriorly into cavernous sinus Facial veins anteriorly into retromandibular vein

Nasal Septum midline structure dividing nose to R/L chambers cartilage in anterior portion and bone bone: perpendicular plate of ethmoid and vomer o sits right in midline forms medial wall of BOTH nasal cavities Lateral Wall of Nasal Cavity o Nasal conchae turbinates covered w/ mucous membrane o Two bones: o

o o o o o

Inferior nasal concha separate bone Middle/Superior nasal conhae part of ethmoid

Spaces b/w conchae Meatus Superior, middle, inferior meatus paranasal sinuses comm.. w/ nose through these spaces

Paranasal sinuses air spaces w/in bones of skull Frontal empty to middle meatus hiatus semilunaris Maxillary empty upwards medially to middle meatus hiatus semilunaris Ethmoidal air cells

anterior/middle cells middle meatus posterior superior meatus

Sphenoid drain to superior meatus

PALATE ROOF OF MOUTH, FLOOR OF NASAL CAVITY Structure o Anterior bony palate hard anterior 2/3 Maxillae and Palatines o Posterior soft palate soft posterior 1/3

extend from posterior edge of palatine Uvula Palatine aponeurosis and temporal Veli Palatini M. Functions

Soft separate nasal cavity from oral cavity o swallowing: seals off nose from mouth Muscles that move Soft palate (all attach to Palatine Aponeurosis) o Tensor Veli Palatini tense and pull laterally from medial pterygoid plate and cartilage of auditory tube hooks around hamulus to tense plate helps open auditory tube to equalize air pressure in middle ear and pharynx Levator Veli Palatini lift cartilaginous part of auditory tube and petrous temporal Palatopharyngeus tense, lift pharynx in swallowing (up, forward, medial) forms palatopharyngeal arch from side of palate to pharynx

o o

Musculus Uvulae lift uvula in swallowing Innervation o Vagus nerve X from pharyngeal plexus

o o o

Palatoglossus pulls base of tongue closer to soft

Tensor veli palatine Trigeminal V3

TONGUE Structure/Function o Mastication, swalloing, speech

o
o Muscles

Terminal Sulcus (Sulcus Terminalis) v shaped Anterior (oral) Posterior (Pharyngeal) Root of tongue attached to hyoid bone and muscles of mouth floor Four Extrinsic (glossus)

Palatoglossus elevates posterior portion Four Intrinsic (change shape of tongue)

Genioglossus depress and protracts tongue Hypoglossus depresses and retracts tongue Styloglossus retracts tongue and curls it

Sup/Inf longitudinal curve side/tip sup/inf Transverse muscle narrows/thickens

Vertical broaden/flattens Innervation o Palatoglossus Vagus X via pharyngeal plexus

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o

Others Hypoglossal XII Sensory

general ex. pain Trigminal V or Glossopharyngeal IX special ex. taste Facial VII or Glossopharyngeal IX

MASTICATION/CHEWING Preapre food for deglutition (swallowing) and digestion Temporomandibular Joint (TMJ) o anterior gliding and hingelike motion o mandibular condyle articulate w/ mandibular fossa and articular tubercle

o o
o o o

joint capsule thickened laterally Lateral or Temporomandibular ligament usually described as simple hinge joint much more complicated Joint cavity divided to two parts by articular disc can rotate like hinge and slide elevation, depression, protrusion, retraction, mediolateral Working side vs. balancing side

Muscles

condyle on balancing side slides down articular tubercle separates teeth on that side forces those on working side together

Mediolateral Medial/Lateral Pterygoids Innervation o Depressors:

o o o o o

Elevators Temporalis, Masseter, Medial/Lateral Pterygoids (lies medial to mandible) Depressors Digastric, Infrahyoid mm (below hyoid bone), gravity Protrusion Massetor (superficial), Medial/Lateral Pterygoids Retraction Temporalis (posterior), Masseter (deep)

Posterior Belly of digastric Facial CN VII

Infrahyoid Cervical spinal nerves Others: Trigeminal CN V3

BASICRANIUM (BASE OF SKULL ) Bones: o Maxillae o Palatines o Vomer o Sphenoid o Temporals o Occipital o Some Parietals and zygomatics Functions: o Contributes to oral/nasal cavities o suspends pharynx o articulates w/ mandible o contains openings for spinal cord, cranial nerves and vessels

Principal Foramina Anterior to posterior (from below)

o o o o o o o o o o o o
o

Incisive foramen (fossa) nasopalatine nerves (V2 + an artery) Palatine foramina back of hard palate greater & lesser palatine nerves (V2) and vessels Foramen Ovale in sphenoid V3 Foramen Spinosum in sphenoid middle meningeal vessels to dura Foramen Lacerum b/w sphenoid, temporal, occipital filled by cartilage internal carotid pass superior to it Carotid Canal in temporal bone initial entry for internal carotid to skull and sympathetic plexus Jugular Foramen b/w temporal and occipital internal jugular vein & CN IX, X, XI Stylomastoid Foramen in temporal bone CN VII Foramen Magnum in occipital spinal cord, vertebral arteries, CN XI (spinal part)

Hypoglossal Canal in occipital CN XII Other structures: o Choanae posterior nasal openings junction b/w nasal cavity and nasopharynx Pterygoid Plates sphenoid attachment cite for chewing muscles Mandibular Fossa condyle of mandible Styloid process Opening for auditory tube joines nasopharynx and tympanic cavity (middle ear) External Audtitory meatus external ear canal opening Mastoid process Occipital Condyles articulate skull on vertebral column

o o
o

o
NECK o

Crucial path for: o Trachea o Esophagus o Muscles o Vessels o Nerves o Cervical skeletal elements o location of pharynx and larynx Superficial/Lateral Muscles

o o

Platysma facial expressions CN VII Sternocleidomastoid sternum & clavicle to mastoid

unilateral fire tilt head down chin face opp. side

bilateral fire tilt head down CN XI o Trapezius shrug shoulder, some head movement CN XI Deep/Lateral Muscles o Splenius Capitis o Levator Scapula

o
o

Scalene help tilt head to one side

Anterior/middle crucial landmarks for neck Carotid Sheath o Fascial tube: Internal jugular vein, common carotid artery, vagus nerve CN X
Triangles separated by sternocleidomastoid o Posterior Triangle Boundaries: sternocleidomastoid, trapezius, skull, clavicle

deeper lateral muscles form floor Contents:

CN XI passes en route to trapezius Cervical plexus of spinal nerves cutaneous Trunks of brachial plexus Subclavian artery en route to upper limb Lymph nodes

Suprascapular and transverse cervical arteries from thyrocervical trunk

External jugular vein pass superficial to sternocleidomastoid pierce fascia over inferior portion of posterior triange enter subclavian vein Anterior Triangle Boundaries: sternocleidomastoid, midline of neck, mandible, manubrium Contents:

Hyoid muscles suprahyoid (above hyoid bone) raise hyoid and stabilizes it during speech o infrahyoid (below hyoid) depress hyoid and stabilize Carotid Arteries/Branches o Common Crotid Internal Carotid no branches go to carotid canal to skull base o External Carotid many branches Internal Jugular Vein o receive branches similar to external carotid Vagus Nerve CN X pass through in carotid sheath Hypoglossal Nerve CN XII en route to tongue Submandibular gland salivary gland Thyroid gland

Root of Neck o Arteries: Common carotid Brachiocephalic trunk (right side) Subclavian artery and branches o Veins External jugular Internal jugular Subclavian Brachiocephalics (both sides) o Nerves

Vagus CN X

recurrent Laryngeal larynx


o Viscera

Phrenic diaphragm

Sympathetic trunk and ganglia deep to carotid sheath

o o o

Thyroid endocrine metabolism deep to infrahyoid muscles inferior/lateral to larynx anterior/lateral to trachea Parathyroid calcium/phosphorus metabolism 1-3 pairs on posterior surface of thyroid Larynx connect pharynx and trachea cartilaginous skeleton

PHARYNX o Fibromuscular tube suspended from skull

o
o

Common passageway for air/food extend from nasal/oral cavities above esophagus Division:

Laryngopharynx posterior to larynx and continuous with esophagus Muscles: o External: Superior, Middle, Inferior Pharyngeal Constrictors

o o o

Nasopharynx posterior to nasal cavities Oropharynx posterior to oral cavity

Nerves:

Constrictors have gaps b/w lateral margins allow important structures entry Internal: 3 paired longitudinal muscles: Stylopharyngeus Platatopharyngeus Salpingopharyngeus Pharyngeal plexus mix of CN IX, X most sensory/motor innervation Stylopharyngeus CN IX separate branch

All insert to pharyngeal raphe contract: squeeze pharynx Lower constrictor overlaps constrictor above it

o o

SWALLOWING o Intro: food oral cavity pharynx esophagus GI tract o Muscles: face, mastication, tongue, hyoid, pharynx, esophagus o CN V, VII, IX, X, XI, XII and sympathetics o Phases o Oral phase (voluntary) ingestion, mastication, mix saliva, coord of masticatory and tongue muscles, bolus pushed by tongue into oropharynx o Pharyngeal phase (involuntary and complex)

soft palate elevates to close nasopharynx hyoid and larynx also elevated

epiglottis fold down close larynx and trachea rapid, involuntary sequential contractions move bolus through pharynx to esophagus Esophageal phase (involuntary)

peristaltic contractions propel bolus through esophagus to stomach

LARYNX

Cartilage-skeleton o Cricoid Cartilage o Thyroid cartilage o Artenoid Cartilage Vocal chords come off vocal processes o Epiglottis Membranes/Ligaments o Thyrohyoid membrane/lig o Conus Elasticus, Cricothyroid or Cricovocal membrane/lig membranous structure: begin @ cricoid, end superior as vocal fold sound production Quadrangular (Vestibular) membrane

o o Muscles

sweep down from inside epiglottis end as vestibular/false vocal fold

o
o

Extrinsic: swallowing, stabilize hyoid so tongue can move Suprahyoid muscles Infrahyoid Intrinsics: ADDUCTORS of vocal folds: transverse & oblique arytenoids lateral cricoarytenoids ABDUCTORS of vocal folds: posterior cricoarytenoid ADJUSTORS of shape/tension of vocal folds:

SPEECH

cricothyroid tension thryoarytenoid and vocalis vocalis changes shape so certain parts dont vibrate vocalis can also ADD

o
o

Intro: English exhaled air o create sound waves @ vocal folds

o create sound waves up vocal tract tongue, lips, etc. Sounds in Larynx o breathing patterns change
Quick inspiration and controlled expiration in speech muscles of inspiration help control expiration Vocal Fold Vibration o changes in air pressure

o o
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Breathing AB Speech ADD

Fold adducted try to exhale pressure built up under vocal folds (subglottal pressure increase) gradually force folds apart When apart pressure drows (Bernoulli effect) sucked back together by lower pressure cycle starts again Net Effect:

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pressure wave travels through air alternating areas of high/low pressure

Larynx determine what fundamental frequency is produced normal sounds waves are NOT pure tones

SOUND WAVES

as sound passes up through vocal tract certain frequences amped or damped

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Vocal tract: stop/restrict airflow lips/teeth

Aperiodic sound wave w/ no discernible pitch S or T

Use Vocal folds: voice or unvoiced S vs. Z / P vs. B Never hear sounds as they are produced at vocal folds every sound produced at folds is changed by passage through vocal tract

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vocal tract resonator amp/damp Any change in vocal fold affects voice

3 parts: External, Middle, Inner EXTERNAL

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Auricle/Pinna collecting device for sound waves localize sound source External Acoustic Meatus external auditory canal channel sound to tympanic membrane (eardrum) Nerves:

MIDDLE o Function: transfer sound waves from air in external too inner ear liquid impedance matching/transformer protection of inner ear maintenance of similar pressure on either side of tympanic membrane o Ossicles: Malleus, Incus, Stapes o Muscles:

also protects middle ear act as resonator Spinal nerves from cervical plexus (greater auricular, lesser occipital) Facial CN VII Trigeminal CN V Vagus CN X

Eardrum pushed in stapes rocks on oval window of inner ear Tensor Tympani handle of malleus CN V3 Stapedius neck of stapes CN VII

When they both contract restrict movement of ossicles protect inner ear Other Stuff Tympanic membrane (ear drum) lateral wall of middle ear Auditory tube connect middle ear w/ back of nasal cavity when open: equalizes pressure inside middle ear w/ pressure inside nose

Levator and tensor veli palatine help it important for hearing w/ dramatic external pressure changes

o Nerves:

Promontory medial wall of middle ear smooth mound of bone pushed into middle ear by cochlea of inner ear Oval window (fenestra vestibule) on medial wall of inner ear connection b/w Stapes and Scala Vesibuli of inner ear Round window (fenestra cochleae) medial wall of middle ear membrane over it: pressure-release for pressure waves traveling through scala tympani of inner ear Facial CN VII inside bone of back wall of middle ear Chorda Tympani CN VII pass through middle ear Tympanic plexus CN IX medial wall (promontory) of middle ear

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Bony (osseous) Labyrinth (paths/channels inside temporal lobe) 3 semi-circle canals (curved channels set at right angles to each other in temporal bone) crucial for sense of balance Vestibule chamber inside temporal bone marks junction of two main parts of inner ear hearing and balance

Oval window fenestra vestibule: close by footplate of stapes Round window fenestra cochleae: closed by secondary tympanic membrane

Perilymph fluid that fills much of bony labyrinth: surrounds membranous labyrinth

Cochlea passageway within portion of inner ear associated w/ sense of hearing snail-shell Membranous Labyrinth (flexible ducts floating in perilymph inside bony labyrinth) 3 semi-circular ducts inside semicircular canals ampullae (expansions) 2 sacs withint vestibule: balance utricle saccule Cochlear duct within cochlea divides passageway to 2 parts (either side of cochlear duct)

Scala vestibule Scala tympani o Endolymph: fluid inside cochlear duct

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HEARING o Sound transmission:

Vestibular membrane: mark boundary b/w scala vestibuli and cochlear duct Basilar membrane: mark boundary b/w cochlear duct and scala tympani Cochlear portion of CN VIII enter duct via bone @ cochlea center Hair cells (w/ cilia) rest on basilar membrane Tectorial membrane draped over hair cells in duct

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Sound wave move tympanic membrane in external move ossicles rocking motion of stapes in oval window (middle ear ) pressure waves in perilymph undulations of vestibular + basilar membrane of cochlear duct (inner) displacement of ciliar on hair cells moves tectorial membrane above them stimulate CN VIII in inner ear sound intensity changes in rate of discharge of inner/outer hair cells sound frequency location along cochlear duct of strongest vibrations o high freq: base (proximal) o low freq: tip (distal)