the head review

8/2/2019 The Head Review

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The Head

3rd Anatomy Exam Review

Matthew J. Crisp12/6/10


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Vasculature Overview

Some Attendings Like Freaking Out Potential Medical Students


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Ascending Pharyngeal


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Circle of Willis


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Cerebral Angiography

Anterior Cerebral Artery Middle Cerebral Artery

Posterior Cerebral Artery

Basilar ArteryVertebral Artery

CSF


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CSFTrace CSF flow from origin to termination

Lateral Ventricle (choroid plexus)

Third Ventricle

Fourth Ventricle

Subarachnoid space

Arachnoid granulations

(project into Superior

Sagittal Sinus)

Cerebral aqueduct (of Sylvius)

Foramina of Luschka (lateral)

Foramen of Magendie (medial)

Interventricular foramen (of Monro)

Hydrocephalus

Non-communicating

CommunicatingBlockage, malfunctioning,

absence, etc

Obstruction


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Brain Drain

Superior Sagittal Sinus

Confluence of sinuses

Transverse Sinus

Sigmoid Sinus

Straight Sinus

Great Vein of Galen

Note: Know path of venous drainage.

Confluence of sinuses receives blood

from the Superior sagittal sinus and

straight sinus (inferior sagittal sinus +

Great vein of Galen). Blood then

travels through the transverse sinus,

then sigmoid sinus, then internal

jugular vein.


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Brain Vascular Pathology

Epidural hematoma Subdural hematoma Subarachnoid hematoma

Location of Blood

B/w dural layers B/w dura and

arachnoid

B/w arachnoid and pia

Cause of Bleed

Tear of Middle

Meningeal a.

Tear of bridging/emissary

veins

Arterial (Circle of Willis) bleed

(e.g. )aneurysm rupture

Th E


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The Eye

Where is aqueous humor produced?

Where is aqueous humor drained?

Excess aqueous humor leading to

increased intraoptic pressure is called

what?

Responsible for 80% of focusing

power

Responsible for accommodation

Ciliary body

Canals of Schlemm

Glaucoma

Cornea

Lens (via ciliary body)


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Extraocular Muscles

ExtortionInferior

muscles (rectus,

oblique)

IntortionSuperior

muscles (rectus,oblique)


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Eye Movements

H-Test

Medial Rectus Lateral Rectus

Inferior Rectus

Superior Rectus

Superior Oblique

Inferior Oblique

Note: For illustrative purposes only. Cat eyes are not human eyes. They have funky horizontal eyelids and can see souls.

N P l i


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Nerve Palsies

Patient looking left

At restDown and Out

Trochlear Nerve Palsy

Abducens Nerve Palsy

Oculomotor Nerve Palsy

What other signs/sx would you expect to

see?

At rest upward drift

Head tilt towards opposite

side of palsy. Counteract

unopposed extortion of

affected eye by intortingunaffected eye

Ptosis loss of levator palpebrae superioris m.

Mydriasis unopposed dilator pupillae m.

Loss of accommodation


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Ocular Arterial Supply and Anastomoses

Internal carotid branches (from Ophthalmic a.)

Supratrochlear, Supraorbital, Dorsal Nasal

Ext. carotid branches

Infraorbital, Facial, Superficial Temporal

Central

Retinal a.

A central retinal artery occlusion would result in ischemia

to all of the retina except where (and why)?

Fovea supplied by ciliary branches (note: youd still go

blind)

V i T d Bl


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Veins, Tears, and Blowouts

Danger Area of the

Face!

Facial Trauma

The nasolacrimal duct drains where?

Inferior meatusBlowout fracture of orbit

floor fluid into what sinus?

Maxillary

Brain!

Lacrimal gland

Si


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Sinuses?

?

?

?

?

Si


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SinusesFrontal sinus

Maxillary

sinus

Ethmoid sinus

Sphenoid sinus

Eustachian Tube

N l C i


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Nasal Cavity

Inferior concha

Ethmoid bone

Which concha (turbinate) is its own bone?

The other concha are a part of which

bone?

Name the structures that drain into these

nasal cavity regions:

Inferior meatus

Middle meatus

Superior meatus

Sphenoethmoidal recess

Nasolacrimal duct

Maxillary sinus

Frontal sinus

Anterior and middle ethmoid aircells (sinuses)

Posterior ethmoid air cells

Sphenoid sinus

N l C it A t i l S l


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Nasal Cavity Arterial Supply

3 main sources:

Sphenopalatine a. (maxillary a.)

Anterior and posterior ethmoidal aa.

(ophthalmic a.)

Facial a.

Note: anastomosis in

Kiesselbachs area responsible for

majority of anterior epistaxis

(nosebleed)

Look, another example of ext.

and int. carotid anastomoses! (it

was a question on the 2008

exam)

The Jaw Salient Points


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The Jaw Salient Points

Name the embryological origins

1st arch

2nd arch

Inferior alveolar (branch of V3)

Muscles of mastication

Name them

Innervation

Which is/are responsible for jaw

protrusion/depression?

TemporalisMasseter

Medial and Lateral Pterygoids

Mandibular division of V (V3)

Lateral Pterygoids

Enters the mandibular foramen

Exits through the mental foramen as

Mental nerve

Note: Maxillary teeth via superioralveolar nerves (V2)

Name the nerve that travels through the

mandible and emerges on the chin

Name the foramina this nerve enters and

exits on its path through the mandible

This nerve innervates which set of teeth,

maxillary or mandibular?

Mandibular

The Tongue and Oral Cavity


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The Tongue and Oral Cavity

Used to protrude

the tongue

Note: Intrinsic

tongue muscles

change shape,

while external

muscles move

tongue

Pharynx


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Pharynx

?

?

?

?

?

?

Pharynx


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Pharynx

Tensor Veli Palatini m.

Palatoglossus m.

Levator Veli Palatini m.

Salpingopharyngeus m

Palatopharyngeus m.

CN IX

M l f F i l E i


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Muscles of Facial Expression

?

?

?

?

M l f F i l E i


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Muscles of Facial Expression

Frontalis

Obicularis Oculi

Zygomaticus Major

(dimples!)

Obicularis Oris

Note: although you may want to briefly glance at all

the facial muscles for insurance purposes, these

would be the ones I would focus on


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Good Luck!

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