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Head quiz


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Skull cap - vault of the skull without facial bones
What type of joint is suture
Coronal suture
Lies between frontal and two parietal bones
Saggital suture
Lies between two parietal bones
Squamous suture
Lies between parietal and squamous part of temporal bone
Lambdoidal suture
Between parietal and occipital bones
interection of lambdoid and saggital sutures
Intersection of saggital and coronal sutures
craniometric point at junction of frontal, parietal, and temporal bones and great wing of sphenoid bone
Craniometric point at junction of parietal, occipital and temporal (mastoid) bones
Sella turcica contains what
Pituitary gland or hypophysis so also called hypophyseal fossa
spongy bone between inner and outer cortical tables
Anterior cranial fossa
-Cribriform plat
-Foramen cecum
-Anterior and posterior ethmoidal foramen
Middle cranial fossa
-Optic canal
-Superior orbital fissure
-FOramen rotundum
-Foramen ovale
-Foramen spinosum
-Foramen lacerum
-Carotid canal
Posterior cranial fossa
-Internal auditory meatus
-Jugular foramen
-Hypoglossal canal
-Foramen magnum
-Condyloid foramen
-Mastoid foramen
2 layers of dura mater
Periosteal and meningeal
Arachnoid layer
Connected to pia mater by trabeculations. Subarachnoid space filled with CSF.
Dural venous sinuses are _
Spaces between periosteal and meningeal layers of dura mater
Falx cerebri
Lies between cerebral hemispheres
Falx cerebelli
Lies between cerebellar hemispheres
Tentorium cerebelli
Supports occipital lobes of cerebrum and covers cerebellum
Diaphragma sellae
Forms roof of sella turcica covering pituitary gland of hypophysis
Dural venous sinuses drain what
-Brain and meninges
-Vertebral column
-Face, orbit, nasal cavity
-Parietal, mastoid, occipital areas via emissary veins
What distinguishes dural venous sinuses from veins
No valves
Dural venous sinuses ultimately drain into _
Prostate cancer can metastasize through _ to dural venous sinuses
Vertebral plexus
Straight sinus is formed by _
Inferior saggital sinus + great cerebral vein
Cavernous sinus is located where
Each side of sella turcica and body of sphenoid bone and lie between meningeal and periosteal layers of dura mater
Sigmoid sinus runs where and enters what?
Continuation of transverse sinus - arches downward and medially in S shaped groove on mastoid part of temporal bone.
Enters - IJV
If you have infection of scalp, what would spread it intracranially
Emissary veins
Cavernous sinus has _ in outer wall and _ in inner wall
CN III, IV, V1, V2 in outer wall
Internal carotid artery and CN VI inside
Cavernous sinus drains to _
Inferior and superior petrosal sinuses
Cavernous sinus receives_
Superior ophtalmic vein
Sphenoparietal sinus
Cerebral veins
Emissary veins to pterygoid plexus
Describe danger zone of the face and how its related to cavernous sinus
Danger zone of the face is located in the area of nose and upper lip
Infections, thrombophlbitis from facial vein can travel intracranially via SUPERIOR OPHTALMIC VEIN to CAVERNOUS SINUS or inferior ophtalmic vein to cavernous plexus or pterygoid plexus, this would lead to thrombophlebitis of cavernous sinus which is mortal in 1/3 of cases
Innervation of dura
Anterior/middle cranial fossa - CN V - trigeminal
Posterior cranial fossa - CN X and C1, C2, C3
* C1, C2, C3 can come from hypoglossal canal with CN XII or enter jugular foramen with CN X
Blood supply of dura
Anterior cranial fossa - anterior meningeal artery (branch of anterior ethmoidal)
Middle cranial fossa - middle meningeal (branch of maxillary via foramen spinosum) and accessory meningeal (branch of maxillary via foramen ovale)
Posterior cranial fossa - posterior meningeal arteries
Venous drainage of dura
Directly to dural venous sinuses
Most of the dura blood supply comes from
Middle meningeal artery
Subdural hematoma
-Due to rupture of bridging cerebral veins as they pass from the brain surface to one of the venous sinuses
-Results from the blow on front or back of head, causing displacement of brain, elderly people can have shrinkage which puts pressure on those veins, shaken babies
-Blood is not contained so have a vast spread of blood
Extradural hematoma
-Due to rupture of middle meningeal artery or veins caused by PTERION TRAUMA, also can be fracture of greater wing of sphenoid or rupture of dural venous sinus
-Blood is contained between periosteum and cranium
Dural headache
-Loss of CSF following lumbar puncture can cause brain to sag which causes pull on the vessels attached to the dura and you get pain
-General tension on dural nerves can also produce headache
-Need to get in Trendelenburg position - put head below chest
Layers of scalp
Connective tissue - dense - vessels firmly bound and do not contract easily when they are cut so get profuse bleeding, also anastomoses cause both ends to bleed
Aponeurosis - galea aponeurotica connects frontalis and occipitalis
Loose connective tissue - allows scalp to move - "danger layer" - allows spread of infection via emissary veins
Scalp hemorrhage usually occurs in which layer
Dense connective tissue - vessels are unable to contract to stop bleeding
Scalp infections are usually in which layer
Loose connective tissue - spreads to intracranial dural venous sinuses through emissary veins
Innervation of scalp
– supratrochlear,
- zygomaticotemporal,
- auriculotemporal,
-lesser occipital,
-greater occipital and
- third occipital nerves
Blood supply of scalp
Internal carotid - supratrochlear and supraorbital branches
External carotid - superficial temporal, posterior auricular and occipital branches
V1 division of CN V
Ophtalmic division - innervates area above upper eyelid and dorsum of the nose
Branches - supratrochlear, infratrochlear, supraorbital, external nasal and lacrimal
V2 division of CN V
Maxillary division - innervates face below levels of eyes and above upper lip
Branches - zygomaticofacial, zygomaticotemporal, infraorbital
V3 division of CN V
Mandibular division - innervates face below level of lower lip
Branches - auriculotemporal, buccal, temporal
Auricular branch of CN X supplies _
Cutaneous innervation to external audotry meatus area and some posteromedial auricular surfaces
Trigeminal ganglion
-Sensory ganglion of CN V
- Also called Gasserian or Semilunar
-Cell bodies of pseudounipolar sensory neurons
Trigeminal neuralgia
-Sensory disorder of CNV
-Stabbing, bolt like pain that may be temporary or lengthy
-More likely in V2, V3 then V1
-Can be due to middle meningeal artery constricting sensory root of CN V
Treatment options - pain medication, gel pad between nerve and vessel, surgical removal of sensory root, anesthetic injection, radiofrequency treatment
If you want to block trigeminal nerve , which nerve would you inject with anesthetic
CNV1 - supraorbital
CNV2 - infraorbital
CNV3 - mental
Facial artery
arises from external carotid artery, passes deep to mandible, winds around lower border of the mandible and runs upward and forward on the face.
Branches in face are: - Superior and inferior labial arteries, lateral nasal branches in face.
Terminal branch – angular artery.
Cavernous sinus thrombosis
formation of thrombus in cavernous sinus, occurs when you pop pimples in the danger area of the face. This will produce edema of the optic disc resulting from increased intracranial pressure, exophtalmos, diplopia, loss of vision, chemosis (swelling of the conjunctiva). It is associated with high mortality but can be treated with high dose antibiotics.
4 muscles of mastication
-Medial pterygoid
-Lateral pterygoid
All 4 muscles of mastication attach to _
Functions of muscles mastication
Masseter, temporalis and medial pterygoid close jaw
-Lateral pterygoid opens jaw
Innervation of muscles of mastication
Mandibular division of trigeminal nerve
Boundaries of infratemporal fossa
SUperior - base of skull with temporal bone and greater wing of sphenoid
Inferior - submandibular region
Anterior - maxilla and buccinator
Posterior - styloid process
Lateral - ramus of mandible
Medial - lateral pharyngeal wall
Contents of infratemporal fossa
1. Lower portion of temporalis, pterygoid muscles
2. Buccal fat pad
3. Maxillary artery and branches
4. Pterygoid plexus of veins
5. Mandbular division of trigeminal nerve and branches
6. Chorda tympani (CN VII) and postganglionic parasympathetic fibers from otic ganglion via auriculotemporal nerve
Communications of pterygoid plexus
Superior - with cavernous sinus via sphenoid emissary veins
Medial - with nasal cavity via sphenopalatine vein
Anterior - with facial vein via inferior ophtalmic vein and infraorbital vein
Posterior - with pharyngeal plexus of veins
Inferior - with facial veins via deep facial veins
Mandibular division of trigeminal nerve
GSA - exteroseptive - skin of face, scalp, ear, auditory canal, tympanic membrane
GSA - proprioceptive - for ALL skeletal muscles innervated by V3
SVE - motor muscles of first pharyngeal arch
Carries autonomic parasympathetic fibers GVE- p of CN's VII (chorda tympani) and IX (lesser petrosal )and SVA fibers of CN VII
Innervation of parotid gland
1. CN IX exits jugular foramen
2. Tympanic branch re enters skull via tympanic canaliculus to enter tympanic cavity
3. Forms plexus on promontory of medial wall
4. Exits as Lesser petrosal nerve via lesser petrosal hiatus in middle cranial fossa
5. Exits via foramen ovale
6. Presynaptic fibers synapse in otic ganglion
7. Post ganglionics hitch hike a ride on auriculotemporal nerve to parotid gland
Innervation of submandibular gland
1. Chorda tympani branches from CN VII in facial canal to enter middle ear
2. Traverses medial surface of middle ear
3. Exits cranium via petrotympanic fissure
4. Joins Lingual nerve
5. Synapses in submandibular ganglion
6. Post ganglionics innervate submandibular gland directly and re enter lingual nerve to course to sublingual gland

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