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Head and Neck Written Examination 7 - October 24th, 2008: Part V - Essay

Note: This is an outline of topics to be covered. It is not the "answer key." It is an answer guide.

Anatomy of the Infratemporal Fossa

Review the anatomy of the infratemporal fossa. Include bones, boundaries, contents, bony communications, ligaments, muscles, movements and limitations of movement, vasculature and venous communications, innervation and functional components, relationships to surrounding structures, lymphatic drainage, and significance. (12 pts)
  • Bones and Boundaries
    • anterior - posterior aspect of maxilla
    • posterior - styloid process
    • superior - infratemporal crest
    • inferior - body of mandible
    • medial - pterygoid plate (pterygo maxillary fissure)
    • lateral - ramus of mandible
  • Bony communications
    • Foramen ovale - middle cranial fossa to infratemporal fossa, mandibular nerve (GSA, SVE) and lesser superficial nerve (Preganglionic GVE)
    • Foramen spinosum - middle cranial fossa to infratemporal fossa, middle meningeal artery
    • Petrotympanic fissure - middle ear to infratemporal fossa, chorda tympani nerve (SVA, preganglionic GVE)
    • Inferior orbital fissure - maxillary artery becomes infraorbital artery
    • Pterygomaxillary fissure - terminal branches of maxillary artery, posterior superior alveolar nerve (GSA and postganglionic GVE)
    • Mandibular foramen - inferior alveolar nerve (GSA) and artery
  • Contents - ligaments, muscles, movements and limitations of movement
    • Temporomandibular joint
    • Sphenomandibular ligament
    • Pterygomandibular raphe
    • Lateral and medial pterygoid muscles - protraction and elevation plus secondary actions
  • Vasculature and venous communications
    • Maxillary artery and branches
    • Pterygoid venous plexus - communicates with orbit and face, with retromandibular vein to neck and face, foramen ovale to cavernous sinus
  • Innervation and functional components
    • Mandibular branch of trigeminal nerve - GSA SVE
    • Chorda tympani - SVA GVE
    • Lesser superficial petrosal nerve - GVE
  • Lymphatic drainage and significance
    • Pathways to deep and superfical cervical nodes
    • Muscles of mastication
    • Spread of infection to intracranial locations
    • Gateway to the pterygopalatine fossa and route for injection to treat trigeminal neuralgia

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Anatomy of the Orbit

Discuss the anatomy of the orbit. Include contents, relationships, fascial specializations, vasculature, innervation, lymphatic drainage, muscles and movements, and nerve injury. What grave condition is indicated by pulsatile exophthalmos? (12 pts)
  • General Comments
  • Bones
    • Superior - orbital plate of frontal bone
    • Inferior - maxilla
    • lateral - zygoma
    • Medial - lacrimal bone, ethmoid bone, palatine bone
    • Posterior - greater wing of sphenoid bone, body of sphenoid bone,
  • Contents
    • Periorbita
    • Bulbar fat
    • CN2,3,4,5,6,7
    • Sympathetic root of ciliary ganglion
    • Extraocular muscles
    • Globe
    • Ophthalmic artery and branches
    • Opthalmic vein and branches
    • Ciliary ganglion
    • Annulus tendineus
    • Lacrimal gland
  • Relationships
    • Structures passing through annulus tendineus
    • Ciliary ganglion
    • Trochlea
  • Fascial specializations
    • Annulus tendineus
    • Periorbita
    • Bulbar fat
    • Trochlear
    • Orbital septum
    • Conjuctiva
  • Vascularization
    • Ophthalmic artery and branches
      • Lacrimal artery
      • Supraorbital artery
      • Supratrochlear artery
      • Infratrochlear artery
      • Anterior ethmoidal artery and clinical significance
      • Posterior ethmoidal artery
    • Ophthalmic vein and branches
      • Clinical significance of facial and orbital venous drainages
      • Clinical significance of inferior ophthalmic vein and pterygoid venous plexus
  • Innervation
    • Optic nerve
    • Superior division oculomotor nerve
    • Inferior division oculomotor nerve
    • Motor root of ciliary ganglion
    • Sympathetic root of ciliary ganglion
    • Nasociliary nerve
    • Sensory root of ciliary ganglion
    • Long and short ciliary nerves
    • Anterior and posterior ethmoidal nerves
    • Infratrochlear nerve
    • Lacrimal nerve and non-native fibers
    • Frontal nerve and branches
    • Trochlear nerve
    • Aducens nerve
  • Muscles and movements
    • Rectus muscles
    • Rotation by the obliques
    • Levator palprebrae superiorus and superior tarsal muscle
    • Obicularis oculi
  • Nerve injury
    • Inferior root CN3 and ciliary ganglion
    • Abducens and cavernous sinus infection
    • Sympathetic root of ciliary ganglion and ptosis
    • Horner's syndrome
  • Pulsating exophthalmos
    • Arteriovenous shunt within cavernous sinus

  • Bones and Boundaries
  • Bony communications
  • Contents - relationships, ligaments, muscles, movements and limitations of movement
  • Vasculature and venous communications
  • Innervation and functional components
  • Lymphatic drainage
  • Significance

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Anatomy of the Vertebral Triangle

Discuss the anatomy of the vertebral triangle. Include boundaries, contents, relationships, fascial specializations, vascularization, innervation, lymphatic drainage, and significance. (12 pts)
  • General Comments
    • The vertebral triangle shares a lateral border with the anterior border of the interscalene triangle. This common border is provided by the interscalene muscle. The vertebral triangle and its contents account for the predominant features of the root of the neck.
  • Bones, Spaces, and Borders
    • Superior - Transverse Process of C6 (carotid tubercle is key relationship)
    • Inferior - First rib from verterbal body T1 to insertion of anterior scalene (first part subclavian artery) -
    • Anterior - Prevertebral Fascia
    • Posterior - Intrinsic posterior cervical muscles at posterior border of transverse process C6 - T1
    • Medial - Vertebral bodies of C6 - T1 and longus colli
    • Lateral - Anterior Scalene Muscle
  • Contents and Relationships
    • Intrinsic
      • Vertebral artery (transverse process of C6)-
      • Vertebral vein (transverse process of C7) -
      • Subclavian artery -
      • Thyrocervical trunk and branches (4) -
      • Costocervical trunk and branches (2) -
      • Dorsal scapular artery (inconsistent) -
      • Internal thoracic artery (definitional) -
      • Phrenic nerve -
      • Stellate and vertebral sympathetic trunk ganglia -
      • Ansa subclavia -
      • Thoracic duct -
    • Extrinsic
      • Carotid sheath and contents -
      • Cervical sympathetic trunk -
      • Recurrent laryngeal nerve -
      • Roots C6 - T1 brachial plexus (arguably intrinsic) -
  • Innervation
    • Cervical and brachial plexuses -
    • Sympathetic trunk and derivatives -
  • Lymphatic drainage
    • Deep cervical nodes -
  • Compression of the common carotid artery
    • Carotid tubercle -
  • Bones and Boundaries
  • Bony communications
  • Contents - relationships, ligaments, muscles, movements and limitations of movement
  • Vasculature and venous communications
  • Innervation and functional components
  • Lymphatic drainage
  • Significance

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Comments

 

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-- LorenEvey - 09 Nov 2008

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Topic revision: r1 - 21 Oct 2010, UnknownUser
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