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REVIEW OF HEAD AND NECK

REVIEW OF HEAD AND NECK. CRANIAL NERVES AND EVERYTHING ELSE. OLFACTORY NERVE CN I. ANTERIOR CRANIAL FOSSA. OLFACTORY FORAMINA IN CRIBIFORM PLATE OF ETHMOID BONE – CN I OLFACTORY NERVE. CRISTA GALLI OF ETHMOID. ETHMOID BONE (posterior view). I - OLFACTORY NERVE. OLFACTORY

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REVIEW OF HEAD AND NECK

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  1. REVIEW OF HEAD AND NECK CRANIAL NERVES AND EVERYTHING ELSE

  2. OLFACTORY NERVE CN I ANTERIOR CRANIAL FOSSA OLFACTORY FORAMINA IN CRIBIFORM PLATE OF ETHMOID BONE – CN I OLFACTORYNERVE CRISTAGALLIOFETHMOID

  3. ETHMOID BONE (posterior view)

  4. I - OLFACTORY NERVE OLFACTORY NERVE BRANCHES (fila olfactoria) OLFACTORY BULB DAMAGE - loss of sense of smell

  5. renumbered 283

  6. CT CORONAL PLANE OF HEAD CRISTA GALLI OF ETHMOID ANTERIOR CRANIAL FOSSA ETHMOID SINUS ORBIT INFERIOR CONCHA (TURBINATE) MAXILLARY SINUS NASAL CAVITY NASAL SEPTUM

  7. CLINICAL QUESTION: BLOW TO NOSE PRODUCES LEAKAGE OF FLUID FROM NOSE; FRACTURE CRIBRIFORM PLATE OF ETHMOID Crista galli of ethmoid bone ANT. CRANIAL FOSSA Nasal Bones Nasal Septum 1)Septal Cartilage 2)Ethmoid (Perpendicular Plate) 3)Vomer NOSE ETHMOID– Fracture of nose can break cribriform plate, floor of Ant. Cranial fossa - leak CSF from nose; spread of infection

  8. NERVES of NASAL CAVITY Nerves 1.Olfactory N. - SVA smell; Olfactory Area 2.General Sensation GSA - touch, pain, etc. - V1 Anterior Ethmoidal N. [- V2 Nasal Branches - V2 Nasopalatine N.] 3. Mucous Glands of nose - Parasympathetics - VII - Facial N. by Pterygopalatine Ganglion (hitchhike with branches of V2) OLFACTORY N. PTERYGO- PALATINE GANGLION NASAL BR. ANT. ETHMOIDAL N. NASOPALATINE N.

  9. OPTIC FORAMEN CN II OPTICNERVE, OPHTHALMIC ARTERY MIDDLE CRANIAL FOSSA

  10. OPHTHALMIC ARTERY

  11. II - OPTIC NERVE OPHTHALMIC ARTERY ENTERS ORBIT WITH OPTIC NERVE FORE- HEAD NASAL CAVITY Optic Nerve Optic Nerve CENTRAL ARTERY OF RETINA OPHTHALMIC ARTERY - from Int. Carotid

  12. CLINICAL QUESTION: SUDDEN ONSET BLINDNESS IN ONE EYE OPHTHALMOSCOPE VIEW BRANCHES OF CENTRAL ARTERY AND VEINS RETINA CENTRAL ARTERY OF RETINA - BRANCH OF OPTHALMIC ART. NO ANASTOMOSES; OCCLUSION RESULTS IN BLINDNESS

  13. OPTIC NERVE FUNCTION COMPROMISED BY INCREASED CSF PRESSURE PAPILLEDEMA - engorgement of retinal veins (correspond to branches of central artery) CSF IN SUBARACH SPACE DURA & SUBARACHNOID SPACE (CSF) EXTEND AROUND OPTIC NERVE; INCREASE IN CSF CAN EFFECT VISION Clinical - slow onset; headaches

  14. SUPERIOR ORBITAL FISSURE – CN III, IVV1, VI, OPHTHALMIC VEINS MIDDLE CRANIAL FOSSA

  15. EYE MOVEMENTS DIAGRAM ELEV ADD ABD DEP RESTING POSITION OF EYE: DETEMINED BY BALANCE OF ACTION OF OPPOSING MUSCLES

  16. 278 III III IV? IV V VII, VIII VI VI IX X XII XI C1

  17. III 1073 III IV V VII, VIII VI IX X IV? XII XI V C1

  18. ABDUCENS NERVE DAMAGE PATIENT WITH ABDUCENS (VI) NERVE DAMAGE X SYMPTOM: DIPLOPIA ABDUCENS (VI): AT REST MEDIAL STRABISMUS (CROSS-EYED) DUE TO DAMAGE/PARALYZE LATERAL RECTUS

  19. TROCHLEAR (IV) NERVE DAMAGE: INABILITY TO TURN EYE DOWN AND OUT; ALSO HEAD TILT NORMAL HEAD EYE EYE Rotation - occurs when tilt head; rotate ipsilateral eye medially when tilt head laterally HEAD PATIENT CANNOT LOOK DOWN AND OUT X Symptoms - Difficulty walking down stairs; HEAD TILTED AFTER IV DAMAGE - eye rotated laterally; PATIENT TILTS HEAD TO OPPOSITE SIDE so both eyes rotated (chin toward side of lesion)

  20. OCULOMOTOR (III) NERVE DAMAGE AT REST - LATERAL STRABISMUS (WALL-EYED) DUE TO PARALYZE MEDIAL RECTUS ALSO - PTOSIS - DROOPING EYELID- PARALYZE LEV. PALPEBRAE SUPERIORIS - DILATED PUPIL - PARALYZE PUPILLARY CONSTRICTOR

  21. ANATOMY: LEVATOR PALPEBRAE SUPERIORIS LEVATOR PALPEBRAE skeletal muscle III smooth muscle sympathetics TARSAL PLATE LEVATOR PALPEBRAE SUPERIORIS MUSCLE - ORIGIN FROM TENDINOUS RING - COMPOSED OF SKELETAL (CN III) & SMOOTH (SYMPATHETICS) MUSCLE PARTS DAMAGE INNERVATION PTOSIS = DROOPING EYELID

  22. PTOSIS = DROOPING EYELID; CAN BE SIGN OF DAMAGE TO OCULOMOTOR NERVE (III) OR SYMPATHETICS SKELETAL MUSCLE PART SMOOTH MUSCLE PART SYMPATHETICS - HORNER'S SYNDROME - - Miosis - constricted pupil - Anhydrosis - lack of sweating OCULOMOTOR NERVE PALSY other symptoms: - Pupil is dilated - denervate pupillary constrictor (mydriasis) - Also affect Eye movements - Accomodation (Sympathetic pathway: out spinal cord T1 and T2; ascend sympathetic chain; synapse Superior Cervical ganglion; distribute with arteries(Ophthalmic A.))

  23. EYE- STRUCTURE OF EYEBALL- VASCULAR LAYER IRIS - PIGMENTED, CONTRACTILE LAYER SURROUNDING PUPIL DILATOR PUPIL- RADIAL SMOOTH MUSCLE; SYMPATHETICS PUPIL CONSTRICTOR PUPIL- CIRCULAR SMOOTH MUSCLE; PARASYMPATHETICS III

  24. PARASYMPATHETIC MECHANISM OF ACCOMODATION SUSPENSORY LIGAMENTS OF LENS ACCOMODATION- THICKEN LENS FOR NEAR VISION; PARASYMPATHETIC CONTROL- III (CILIARY GANGLION) CILIARY BODY- ATTACHES SUSPENSORY LIGAMENTS OF LENS CONTAINS CILIARY MUSCLES CILIARY MUSCLES CILIARY MUSCLES- SMOOTH MUSCLES CONTRACT PRODUCE - RELAXATION OF LIGAMENTS - THICKENING LENS

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