Unit 2 Blue Box Summaries:

Chapter 7 Gradually the mental foramen gets closer to

superior border disappears, exposing mental
Cranium nerves.
Head Injuries Loss of all teeth decrease vertical dimension
Can cause: hemmorage, infection, injury to brain of face and mandibular prognathism (over-
or CNs closure)

Headaches & Facial Pain Fractures of Calvaria
Severe causes: Brain Tumor, subarachnoid Normally distribute forces well. Hard blows can
hemmorage, meningitis fracture thin areas.
Neuralgias (pain) stabbing pain over the course Linear calvarial fractures occur at point of
of a nerve caused by demyelination. impact and radiate away.
Otalgia = earache Communicated fractures = several pieces.
Odontalgia = tooth ache Contrecoup (counterblow) fracture = no
fracture at point of impact, but somewhere else
Injury to Superciliary Arches in a thinner portion.
A blow to them may lacerate skin (theyre sharp)
Surgical Access to Cranial Cavity
Malar Flush Craniotomy = removal of neurocranium section,
Zygomatic Bone = Malar Bone called a bone flap.
Redness over zygomatic prominence (malar Little regeneration occurs, so its wired back
eminence) is associated with fever in certain into place. Most successful when you retain the
diseases (Tuberculosis, Lupus) overlying muscle and skin keeps blood supply.
Craniectomy bone flap is not put back,
Features of Maxillae and Associated Bones replaced.
Le Fort I Fracture = horizontal, above teech,
crossing nasal septum Development of Cranium
Le Fort II Fracture = From posteriolateral Calvaria intramembranous ossification;
portion of maxillary sinuses through to orbital cranial base endochondral ossification
foramina and across bridge of nose (connecting Birth: calvaria bones = smooth + unilaminar
orbitals) central maxilla separated from Infants large calvaria from growth of brain &
cranium. eyes.
Le Fort III Fracture = Passes through through Facial nerves close to surface -- > injury during
superior orbitals and extending to the greater forcep delivery
wings of sphenoid. Also fracture along Calveria bones separated by membraneous
zygomatic arches. intervals (newborn) ant & post fontanelle
can judge growth, hydration (depressed if
Fractures of Mandible dehydrated, and intracranial pressure (bulge)
Usually involve two fractures on either side. Anterior Fontanelle (largest) site of bregma
Coronoid process fractures are uncommon. Frontal suture (separates frontal bone)
Fracture of neck are associated with dislocation obliterated by 8th yr (dont confuse with
of TMJ fracture) remnants = metopic suture
Fracture along angle are oblique Post fontenalle = lambda
Fracture on body pass through socket of tooth Cranial bone softness, loose connections, and
fontanelle calvaria mold to birth canal.
Resorption of Alveolar Bone
Extraction of teeth causes this.

 Unit 2 Blue Box Summaries:

Age Changes in Face Arteries of scalp supply little blood to calvaria,
The mandible undergoes the most change so scalp removal does not = necrosis of calvaria.
(newborns dont have alveolar processes)
Enlargement of face is concurrent with Scalp Wounds
paranasal sinus enlargement (small or abscent The epicranial aponeurosis prevents scalp
at birth) wounds from gaping.
If this lining is lacerated, however, the wound
Obliteration of Cranial Sutures will gape widely from the pull of the frontal and
Begins around 30-40 on inside. (10 yrs later occipital bellies of the occipitalfrontalis muscle
outside) in opposite directions.
Starts at bregma and continues towards sagittal,
coronal, and lamboid structures. Scalp Infections
Loose connective tissue (layer 4) of scalp is
Age Changes in Cranium danger area because blood/pus can pass freely
It becomes thinner and lighter with age. in it.
Bone marrow loses blood cells and fat Infections can spread to cranial cavity through
gelatinous appearance. emissary veins.
Cannot pass into neck or laterally beyond
Craniosynostosis and Cranial Malformations zygomatic arches due to the occiptiofrontalis
Primary craniocyntosis = premature closure of muscle and epicranial aponeirosis respectively.
cranial sutures doesnt affect brain dev. Infections can enter eyelids and root of nose.
Scaphocephaly = premature closure of the Blows to periorbital region can cause
saggital sutures small/abscent anterior periorbital ecchymosis (black eye). Ecchymosis
fontanelle long narrow wedge shapped head (purple patches) result from extravasation of
Plagiocephaly = premature closure of the blood into subq tissue.
coronal/lambdoid sutures twisted a
symmetrical head Sebaceous Cysts
Oxycephaly/turricephaly = premature closure When gland is obstructed retains secretion
of coronal suture high tower-like cranium sebaceous cyst.

Face and Scalp Cephalhematoma
Facial Lacerations and Incisions = blood trapped between pericranium and
They tend to gape because no deep fascia. Blood calvaria as a result of a difficult birth. (ruptured
tends to accumulate because of the loose arteries that provide blood to calvaria.)
connective tissue.
Inflammation large amounts of swelling. Flaring of Nostrils
Wrinkles occur in the direction of muscles. Nasal breathers do this very well
Importance of Langer Lines. They follow these Mouth breathing reduces/elimates this ability.
cleavages and wounds in the same direction Chronic child mount breathers develop dental
have minimal scarring. malocclusion (improper bite)

Scalp Injuries Paralysis of Facial Muscles
A partially detached scalp will probably heal as Bell Palsy = injury to facial nerve paralyzing
long as one of the vessels remains intact. Many some/all muscles on that side. Area sags/no
of the vessels anastomose freely. facial expression.
Attached Craniotomy they always leave one of Obicularis oculi loses tonus no lacrimal fluid
the arteries intact. spread over eye cornea vulnerable to
ulceration imparide vision.
 Unit 2 Blue Box Summaries:

Corner of mouth droops. Difficult to talk and Herpes Zoster Infection of Trigeminal Ganglion
eat. Drool a lot skin irritation. This may produce a lesion in the cranial ganglia
(involvement of trigeminal ganglia occurs 20%)
Infra-Orbital Nerve Block Can affect any division of CN V but generally
Done to treat injury of the upper lip or ophthalmic (1st) painful corneal ulceration
maxillary incisor. scaring of cornea.
Anesthetic given near/at the infra-orbital
foramen where the nerve emerges. Testing Sensory Function of CN V
Carelessness injection into the orbit Touch each region innervated by CN V.
paralysis of the extraocular muscles. Forehead (CN V1), cheek (CN V2), lower jaw (CN
V3)
Mental and Incisive Nerve Blocks
Done to treat injury to the lower lip/skin of chin Injury to Facial Nerve
(e.g. lip laceration) W/ or w/o loss of taste or secretion of
Given near the mental foreamen where nerve lacrimal/salivary ducts.
supplies skin + mucous membrane of lower lip. Lesion at origin = complete paralysis
Lesion distal to geniculate ganglion = same but
Buccal Nerve Block lacrimal not affected
Done to treat injury to cheek (knife wound) Lesion near stylomastoid foramen = only motor
Given at the mucosa covering of the retromolar loss.
fossa (posterior to third mandibular molar) Causes: inflammation (causing compression),
fracture of temporal bone, idiopathic (unknown
Trigeminal Neuroglia casue) surgery complication (parotidectomy),
AKA Tic Douloureux disorder of sensory CN V dental, vaccination, pregnancy, HIV, Lyme
most often in middle aged/eldery. attacks of diseas, otitis media.
paroxysm (sudden sharp pain) leads to Zygomatic branch lesion = loss of orbicularis
wincing or tics (hence the name) oculi
CN V(2) (maxillary) is most often involved and Buccal branch = buccinators, superior
CN V(1 least) (ophthalmic) orbicularis oris, and upper lip muscles
Initiated by touching of trigger zone Marginal Mandibular = lower orbicularis oris,
(sometimes at tip of nose or cheek) and lower lip muscles.
Causes demylenation of axons which is cause by
pressure from a small aberrant artery. When Compression of Facial Artery
artery is moved away the symptoms often stop. If bleeding you must compress both arteries
Selective ablation of parts of trigeminal ganglion because of numerous anastomoses.
to treat. To prevent nerve fiber regeneration,
perform a rhizotomy. Pulses of Arteries of Face and Scalp
Another treatment option =sectioning spinal Temporal and Facial arteries can be used.
tract of CN V (tractotomy) loss of sensation
generally provided by CN V Stenosis of Internal Carotid Artery
Occurs at medial angle of eye between facial
Lesions of Trigeminal Nerve (branch of external) and cutaneous branches of
Causes widespread anesthesia around the half internal carotid.
of scalp, face and paralysis of muscles involved Internal carotid becomes stenotic with age
in mastication. brain still receives blood due to anastomose of
facial with ophthalmic artery.


 Unit 2 Blue Box Summaries:

Scalp Lacerations Tentorial Herniation
Bleed a lot due to numerous anastomose. Tentorial Notch = larger than necessary for
Furthermore, they are held open by connective midbrain, thus space occupying lesions
tissue. (tumors) can develop increased cranial
Can be fatal if not sutured. pressure.
Causes temporal lobe to herniate through notch
Squamous Cell Carcinoma of Lip (lobe can be lacerated) and compress CN III
From too much sun or smoking (paralysis of extrinsic eye muscles)
Cancer cells in central part of lower lip/floor of
mouth/apex of tongue spread to submental Bulging of Diaphagma Sellae
lymph nodes. Pituitary Tumors can extend superiorly into the
Cancer cells from lateral parts of lower lip go to diaphragm sellae disturbances in endocrine
submandibular lymph nodes. and/or visual impairment (pressure on CN II)

Cranial Cavity and Meninges Occlusion of Cerebral Veins and Dural Venous
Fracture of Pterion Sinuses
Can be life-threatening because it overlies These can occur through thrombi (clots),
anterior branches of middle meningeal vessels. thrombophlebitis (venous inflammation), or
Can rupture these middle meningeal artery tumors (meningiomas). Mostly in transverse,
hemorrhage (epidural-hematoma pressure cavernous, and superior sagittal sinuses.
on cerebral cortex) Cavernous Sinus Thrombosis usually from
infections in the danger triangle (pimple
Thrombophlebitis of Facial Vein poppers)
Facial vein makes connection with: Infected thrombus extends into cavernous sinus
Cavernous sinus through superior thrombophlebitis of cavernous sinus.
ophthalmic vein. May affect CN VI or nerves in lateral wall of
Pterygoid Venous plexus through inf. sinus.
ophthalmic & deep facial veins. Can produce acute meningitis.
Infection can spread to these areas when blood
flows opposite direction. Metastasis of Tumor Cells to Dural Venous Sinuses
People with thrombophlebitis of facial vein Basilar & Occiptal sinuses communicate w/
(inflammation with secondary clot) can have vertebral venous plexus, thus compression of
pieces of clot spread upward thorax/abdomen/pelvis force venous blood
thrombophlebitis of cavernous sinus into vertebral venous system spread
Can spread to dural sinus through nose pus/tumor cells into vertebrae & brain.
lacerations or pimple popping.
Danger Triangle of the Face Fracture of Cranial Base
internal carotid may be torn arterial
Blunt Trauma to Head fistula arterial blood rushes into cavernous
Can detach dura from calvaria w/o fracturing sinus.
cranial bones leakage of CSF Exopthalmos & chemosis (conjunctiva becomes
Inner part of dura (dural border cell layer) engorged.
composed of flattened fibroblasts (large spacing Eyeballs pulsate with radial pulls.
between cells) weakness at dura-arachnoid CN III, CN IV, CN V1, CN V2, & CN VI can be
junction. damaged because in lateral wall of cavernous
sinus.


 Unit 2 Blue Box Summaries:

Dural Origin of Headache slowness of movements, hand tremors, slow
Dura = sensitive to pain. Pulling on sinuses or cerebration (use of ones brain)
arteries hurts. Distension of scalp or vessels Cerebral contusion = pia stripped blood
headache. enters subarachnoid space (from jerking
Headache after lumbar spinal puncture movement)
(interruption in dura) and less CSF brain Cerebral Lacerations from depressed cranial
sagging & pulling on dura. fractures or gunshots ruptured vessels
P keep head down after spinal puncture bleeding into brain increased cranial
minimize headache. pressure
Cranial Compression; produced by: intracranial
Leptomeningitis collection of blood, obstruction of CSF
= inflammation of leptomeninges (arachnoid & circulation, intracranial tumor/abcess, brain
pia) from pathogenic microorganism. edema from increase in water/Na content.
Bacteria can enter through blood or compound
cranial fracture. Cisternal Punctures
Acute purulent meningitis can result from Done to obtain CSF in infants/children. (lumbar
almost any pathogenic bacteria. puncture for adults)
Needle post. antlanto-occiptal membrane
Head Injuries and Intercranial Hemmorage ristern.
Extradural/Epidural Hemorrhage (arterial) Can use subarachnoid space/ventricular
blood from torn middle meningeal collects system: monitor pressure, injecting antibiotics
between dura and calvaria strips dura from or contrast media
cranium. forms extradural hematoma
Concussion drowsiness & coma Hydrocephalus
From hard blow. As blood mass increases, Overproduction in CSF/obstruction of outflow
brain compression increases excess fluid in ventricles enlargement of
Dural Border Hematoma/subdural hematoma head obstructive hydrocephalus
(venous) blood splits open the dural border Aqueductal stenosis caused by tumor in
cell layer, from tearing of superior cerebral surrounding area or fungal infection reduced
vein/superior sagittal sinus CSF outflow.
Blow that jerks the brain. Blockage dilation of ventricle superior to
Blood go into space b/w dura & arachnoid obstruction squeezes brain between
but rather creates space. ventricular fluid & calvarial bones.
Subarachnoid hemorrhage (arterial) from Infants expansion of calvaria because sutures
rupture of aneurysm (sac like arterial dialation) are still open
Cranial fractures/cerebral lacerations may Communicating Hypdrocephalus = CSF flow
cause this. blocked from subarachnoid space into venous
Meningeal irritation/headache/stiffness/ system (instead of from ventricles into
unconscious subarachnoid as is the case above)

Brain Leakage of Cerebrospinal Fluid
Cerebral Injuries CSF otorrhea = fracture in floor of middle
Cerebral concussion = brief loss of cranial fossa and meninges tear and tympanic
consciousness after a head injury (boxing membrane ruptures. CSF leaks through ears.
knockdown) if not longer than 6 hrs = good CSF rhinorrhea = fracture in cribiform plate of
Chronic encephalopathy (punchdrunk ethmoid (floor of ant. fossa) CSF leaks through
syndrome) weakness in lower limbs, nose. Has different [glucose] than mucus but =
to bloods.
 Unit 2 Blue Box Summaries:

These can result in meningitis. P w/ TIA have high risk for myocardial
infarction or ischemic stroke.
Anastomoses of Cerebral Arteries and Cerebral
Embolism Orbital Region, Orbit, and Eyeball
Cerebral embolism in branch (after big Fractures of the Orbit
anastomose (willis) microscoping Usually occur at the three-suture junction
anastomoses not enough to supply that branchs forming orbital margin.
area cerebral ischemia & infarction Blowout Fracture: displaces orbital walls.
necrosis neurological problems death. Medial Wall: ethmoidal + sphenoidal sinuses
Lat Wall: Inf + Maxillary Sinuses
Variations of Cerebral Arterial Circle Superior wall = stronger, but can be penetrated
Variations are common and significant if by knife damage to frontal lobe of brain.
emboli/arterial disease occur. Fractures usually intraorbital bleeding
pressure on eyeball (exophathmos).
Strokes Maxillary sinus bleed displace maxillary
Ischemic Stroke = impaired cerebral blood flow teeth
causing SUDDEN neurological deficits (cardinal Nasal bones hemorrhage, airway
feature) result of embolism in major cerebral obstruction, and infection that can spread to
artery. cavernous sinus through ophthalmic vein.
Cerebral Thrombosis/ hemorrhage/ embolism
or subarachnoid hemorrhage = common causes Orbital Tumors
Circle of Willis (ie. Collateral circulation) works Malignant Tumor in ethmoidal/sphenoidal
when obstruction is gradual, but not when sinuses compress optic nerve and produce
sudden. exophthalmos.
Hemorrhagic stroke follow the rupture of an Tumor from middle cranial fossa spread
artery (scalar aneurysm) Berry Aneurysm through superior orbital fissure
occurs near circle of willis Temporal fossa via inferior orbital fissure
Sudden Rupture severe headache and stiff Lateral side of eyeball is a good approach for
neck surgery more access.

Brain Infarction Injury to Nerve Supplying Eyelid
Atherosclerotic plaque (e.g. common coratid Lesion of CN III droopy eyelid
bifurcation) stenosis.
Lesion CN VII eye cant close all the way +
Plaque embolus seperates lodges in small drying of cornea unprotected eye
brain artery acute cortical infarciton (sudden excessive tear formation.
blood insufficiency in brain)
30 seconds: alter brain metabolism. Inflammation of Palpebral Glands
1-2 minutes: neural function loss. Glands in eyelid become infected/obstructed
5 min: anoxia (lack of oxygen) cerebral Ciliary glands sty (hordeolum) red pus
infarction. producing swelling cysts of sebaceous
Quickly give back O2 may reverse damage gland (chalazia) may also form
Tarsal glands inflammation, a tarsal
Transient Ischemia Attacks chalzion rubs against eyeball during blink
TIA = neurologic symptoms from ischemia
Generally last a few minutes up to an hour Hyperemia of Conjunctiva
Carotid/vertebrobasilar stenosis prolongs. = Conjuctivas blood vessels are dialated
Symptoms: Dizziness, staggering, light- blood shot eyes.
headedness, fainting, paresthesia. Caused by local irritation
 Unit 2 Blue Box Summaries:

Conjunctivitis (pinkeye) may develop Glaucoma
Aqueous Humor outflow into blood must =
Subconjunctival Hemorrhages production rate
Red batches deep in bulbar conjunctiva If outflow = blocked pressure builds in ant &
Results from blow to eye, hard sneeze post chambers of eye compression of retina +
ruptures small subconjunctival arteries retinal arteries blindness

Development of Retina Hemmohage into Anterior Chamber
Retina + Optic nerve are outgrowths of Caused from blunt trauma
forebrain (optic vesicle) Called hyphema
Carry meninges with it. (Basically extension of Stops in a few days + good recovery
brain)
Corneal Reflex
Retinal Detachment Touch cornea w/ wisp of cotton
From blow to eye. No blink = lesion to V1 or possibly VII
Seperation results from fluid seepage between (orbicularis oculi)
neural and pigment cells layers, can even be
long after trauma. Corneal Ulcers and Transplants
Flashes of light/floating specks = symptoms Damage to V1 cornea vulnearable to injury
scarring of cornea
Pupillary Light Reflex Can have corneal transplant
Involves CN II (afferent) and CN III (efferent)
Light enters 1 eye and both constrict. One fiber Horners Syndrome
sends signal down both tracts. Interruption of Cervical sympathetic trunk
Sphincter pupillae = parasympathetic redness + increased temp of skin + anhydrosis
innervation. (no sweating) + ptosis (droopy eyelid) + miosis
Slowness to pupillary light response = first sign (pupil constriction) (due to unopposed para
of CN III compression action)

Uveitis Paralysis of Extraocular Muscles/Palsies of Orbital
Inflammation of vascular layer of eye (uvea) Nerves
severe blindness if not treated Results in diplopia (double vision) due to
limited movement
Papilledema CN III Palsy: affects most extraocular muscles +
Increase CSF pressure (pressure in subarchnoid levator palbpebrae superioris + sphincter
space round CN II) slow venous return pupillae fully abducted depressed dilated
edema of retina swelling of optic disc eyeball (down and out)
(papilledema) CN VI Palsy: Cannot abduct pupil fully
adducted eyeball (pulled to medial side)
Presbyopia and Cataracts
Reduced focusing power = presbyopia Blockage of Central Artery of Retina
Opaque lens = cataracts Obstruction by embolus instant total
cataract extraction + intraocular lens implant blindness
Unilateral and in older people
Coloboma of Iris
= Abscense of a section of Iris Blockage of Central Vein of Retina
from: birth defect (choroid fissure doesnt close Thrombophlebitis of cavernous sinus may
properly), injury to eyeball, or iridectomy passage of thrombus into central vein of retina
 Unit 2 Blue Box Summaries:

blockage in a smaller vein slow painless
loss of vision. Inferior Alveolar Nerve Block
Inferior Alveolar Nerve is a branch of CN V3
Parotid and Temporal Regions, Injection around mandibular foramen.
Infratemporal Fossa, and All mandibular teeth are anesthetized. Also skin
Temporomandibular Joint of lower lip, labial alveolar mucosa and
Parotidectomy gingivae, and skin are anesthetized due to
Most salivary gland cancers begin in the parotid. mental nerve branching off of inferior alveolar.
Treatment = Excision of gland Problems: Injection into parotid gland or medial
pterygoid arch affect movement of mandible.
Must be careful with CN VII

The gland makes contribution to contour of face
Dislocation of TMJ

Yawning can lead to anterior dislocation of
Infection of Parotid Gland
mandibular heads cannot close mouth.
Can be infected by agents passing through blood
Sideways blow to chin dislocate on that side.
stream (e.g. mumps) inflammation
(parotiditis) May also accompany fractures.
Mumps inflammation of parotid duct + Posterior dislocation uncommon. Neck will
redness of parotid papilla (small projection at break before.
opening) Careful during surgery b/c facial (CN VII) and
Can be confused with toothache auriculotemporal (CN V3) nerves are in close
Parotid Gland Disease pain over temporal proximity.
fossa & auricle Injury to auriculotemporal laxity/instability
of TMJ
Abscess in Parotid Gland
Bacterial infection abcess Arthritis of TMJ
Caused by poor dental hygene. Can cause TMJ to become inflamed.
Can spread to gland through parotid duct. May cause dental occlusion or crepitus (from
delayed anterior disc movement)
Sialography of Parotid Duct
Parotid Sialogram done to demonstrate part of Oral Region
duct system displaced/dilated by disease. Cleft Lip
Radiopaque fluid injected into orifice of parotid Unilateral or Bilateral
duct @ mucous membrane of cheek. Mild: small notch in transitional zone between
lip & vermilion border.
Blockage of Parotid Duct Bad: Extend through lip into nose
Can be occluded by calcified deposit called Worst: Goes deeper and continuous with cleft
sialolith or calculus. palate.
Painful when eating
Cyanosis of Lips
Accessory Parotid Gland Have abundant superficial arterial bloodflow.
Accessory gland can lie on the masseter muscle Sympathetically innervated arteriovenous
between the parotid duct and the zygomatic anastomoses redirect considerable amount
arch. of blood to core helps reduce body heat loss
causes cyanosis.
Mandibular Nerve Block
Anesthetic injected near infratemporal fossa. Large Labial Frenulum
Will anesthetize the auriculotemporal, inferior Skip
alveolar, lingual, and buccal branches of CN V3.
 Unit 2 Blue Box Summaries:

Gingivitis CN IX (afferent) & X give off glossopharyngeal
Skip branches gag reflex (muscular contraction of
pharynx)
Dental Caries, Pulpitis, and Tooth Abscesses
Infection can spread from toothe alveolar Paralysis of Genioglossus
bone Causes tongue to fall posteriorly obstructing
Pus from an abcess can to maxillary sinus airway risk of suffocation
causing sinusitis, or sinusitis may stimulate Happens under general anesthesia this is
alveolar nerves simulating a toothache. why an airway tube is inserted during surgery

Supernumerary Teeth (Hyperdontia) Injury to Hypoglossal Nerve
Skip Fractured mandible
paralysis + atrophy of tongue deviates
Extraction of Teeth towards affected side during protrusion (due to
Lingual Nerve is closely related to 3 molars
rd unopposed genioglossus)
caution during their extraction
Unerupted 3rd molars removal care not to Sublingual Absorption of Drugs
damage alveolar nerve Drugs enter lingual veins in < 1 min

Dental Implants Lingual Carcinoma
Skip Lingual carcinoma on posterior aspect
metastizes superior deep cervical lymph
Nasopalatine Block nodes
Anesthetic injected into incisive fossa both Anterior submental
nerves affected Sides submandibular
Affects: palatal mucosa, lingual gingivae, Middle inferior deep cervical
alveolar bone of the six anterior maxillary teeth, So anterior and sides wont reach the cervical
and the hard palate nodes until later in the disease.

Greater Palatine Block Frenectomy
Inject anesthetic greater palatine foramen Frenulum is undertongue, and if too large
Nerve emerges between 2 and 3 molars
nd rd affects speech (tongue tied) surgically incise.
Affects: palatal mucosa, and lingual gingivae
posterior to maxillary canine, and underlying Excision of Submandibular Gland and Removal of
bone of palate Calculus
Incision made 2.5 cm inferior to angle of
Cleft Palate mandible
Failure of mesenchymal masses in the lateral Care not to damage mandibular branch of VII
palatine processes to meet and fuse with each Care not to damage lingual of V3 when removing
other, nasal septum, and/or the posterior submandibular duct (near each other @ 3rd
margin of the medial palatine process. molar).
Mild: May only involve Uvula
Bad: Extend through soft/hard regions of Sialography of Submandibular Ducts
palate. Cannot usually see sublingual glands ducts. (too
Worst: Continuous with cleft lip. small and too many)
Can see everything else
Gag Reflex

 Unit 2 Blue Box Summaries:

Pterygopalatine Fossa Know that the ostia are small and
Transantral Approach to Pterygopalatine Fossa supromedially located can only drain when
Surgical access is gained through maxillary full, or when laying down (one at a time)
sinus tossing and turning nights to drain sinuses.
Maxillary artery is ligated in cases of chronic
epistaxis. Relationship of Teeth to Maxillary Sinus
Three maxillary molars beneath maxillary sinus
The Nose Communication between sinus and oral cavity
Nasal Fractures can accidentally be created during a dental
Epistaxis (Nosebleed) procedure infection
Direct blow may fracture cribiform plate of Superior alveolar nerves (off of V2) supply teeth
ethmoid bone and maxillary sinus pain in sinus
accompanied by toothache.
Deviation of Nasal Septum
Generally in all people, a lot of times from Transillumination of Sinuses
trauma Maxillary sinus: Direct light under one side of
May obstruct breathing snoring hard palate illuminates sinus
Frontal: Direct light beneath the orbit
Rhinitis If mass/fluid glow will decrease
Nasal mucosa swollen and inflamed (large
amounts of vascularity) Ear
Can spread to: anterior crancial fossa (cribiform External Ear Injury
plate), nasopharynx/retropharyngeal tissues, Injury Hematoma untreated fibrosis
middle ear (pharyngotympanic tube deformation of auricle
connects tympanic cavity to nasopharynx),
paranasal sinus, lacrimal apparatus and Otoscopic Examination
conjunctiva (lacrimal duct) Pull ear up, back, and out on adult to straighten
Notice it can spread to all the structures in canal (down and back on children) and observe
which it has contact with the translucent tympanic membrane

Epistaxis Acute Otitis Externa
Rich in vascularity Infection of external auditory meatus, common
Occurs in anterior 1/3 in swimmers not drying, or bacterial.
Associated with infections and hypertension
Oitits Media
Sinusitis Infeciton in middle ear usually secondary to
Infection spreads to the paranasal sinuses respitory infection possible blockage of
through the continuous tubes swelling may pharyngotympanic tube
block one of the openings Tympanic membrane bulges ear popping
Can produce impaired hearing from scarring on
Infections of Ethmoid Cells auditory ossicles
Maybe the nasal drainage is blocked infection
through medial wall of orbit blindness from Perforation of Tympanic Membrane
posterior ethmoid air cells (close to optic canal) Can be from otitis media or foreign body
Infection can spread to the dural sheath optic Large need surgical repair
neuritis Myringotomy incision in tympanic
membrane people with chronic ear infections
Infection of Maxillary Sinus have tubes placed through the incision.
 Unit 2 Blue Box Summaries:

Mastoiditis (Flyers/Divers) When injury occurs due to
Infection of mastoid cells result of medial imbalance of pressure between middle ear and
otitis spreading ambient air.
Be aware of facial nerve running through canal

Blockage of the Pharyngotympanic Tube
When blocked, residual air in tympanic cavity
absorbed into vessels lower pressure in
cavity retraction of membrane affects
hearing

Paralysis of Stapedius
Facial nerve lesion no stapedius nerve no
stapedius muscle (protects ear from loud noises
dampens sound) uninhibited movement of
stapes hyperacusis (excessive hearing)

Motion Sickness
The membrane of labyrinth has small hairs that
have particles that bend with gravity
stimulate vestibular nerve proprioception
Motion sickness discordance between
vestibular and visual stimulation

Dizziness and Hearing loss
Injury to peripheral auditory system 3
symptoms 1. Hearing loss 2. Vertigo 3.
Tinnitus (buzzing)
Conductive Hearing Loss: something
obstructing external/middle ear people
speak softer than normal because they think
they are louder
Sensorineural Hearing Loss: defects in pathway
from cochlea to brain cochlear implants (if
hair cells on the spiral cochlea have been
damaged)

Mnire Syndrome
Results from a blockage of the cochlear
aquaduct recurrent attacks of hearing loss,
vertigo, and tinnitus

High Tone Deafness
Frequent exposure to loud noises
degenerative changes to cochlea high tone
deafness

Otic Barotrauma
 Unit 2 Blue Box Summaries:

Chapter 8 Infections can spread into the posterior
mediastinum or superior mediastinum.
Bones of the Neck Similarly air from ruptured trachea can pass
Cervical Pain superiorly to the neck.
Several Causes: inflamed lymph nodes, muscle
strain, IV disc herniation Superficial Structures of the Neck:
Enlarged Lymph Nodes may indicate malignant Cervical Regions
tumor in the head. These generally start in Congenital Torticollis (Wry Neck)
thorax or abdomen (because the neck connects Torticollis is a contraction of the cervical
head) muscles that produces a twisting of the neck.
Most chronic pain caused by abnormalities or Causes neck to twist away from affected side (or
trauma tilt towards)
Common cause = tumor in SCM before or after
Injuries to the Cervical Vertebral Column birth. (before birth = breached delivery)
Fractures may damage spinal cord and/or Another cause = excess pulling on head during
vertebral arteries passing through the birth hematoma. This develops into mass
transverse foramina. than entraps CN XI denervating SCM fibrosis
and shortening
Fracture Hyoid Bone Surgical release of SCM necessary so person can
Occurs from strangulation. depression of hold head normally.
body onto thyroid cartilage
Inability to elevate and move hyoid anteriorly Spasmodic Torticollis
beneath tongue makes swallowing and Cervical dystonia (abnormal tonicity of cervical
maintenance of alimentary and respiratory muscles know as Spasmodic Torticollis) usually
tracts difficult Aspiration Pneumonia occurs in adulthood.
Shifting occurs involuntarily.
Cervical Fascia
Paralysis of Platysma Subclavian Vein Puncture
Results from injury to cervical branch of facial AKA Central Line Placement. To deliver venous
nerve skin falls from neck into folds. Extra nutrition/medication and monitor venous
care should be taken during surgery to pressure.
preserve. Care must be taken to not puncture the
Ugly scar will develop if the surgeon does not subclavian artery, puncture the lung/pleure
carefully suture. pneumothorax.

Spread of Infections in the Neck Right Cardiac Catheterization
If infection occurs between investing layer of Puncture IJV to insert catheter into right
deep cervical fascia and the muscular part of brachiocephalic vein SVC Right side of
pretrachial fascia, then infection limited to heart.
superior edge of manubrium. IJV and subclavian vein are most ideal. EJV is
If goes into the visceral layer of pretrachial not due to angle.
fascia, then it can spread into the thoracic cavity IJV (in carotid triangle bound by SCM, &
Pus from the an abscess posterior to the digastrics)
prevertebral layer of deep cervical fascia can
perforate said fascia and enter the Prominence of External Jugular Vein
retropharyngeal space retropharyngeal Serve as internal barometer.
abcess. Can cause difficulty breathing Should only be visible for a short distance above
(dysphagia) and speaking (dysarthia). clavicle.
 Unit 2 Blue Box Summaries:

If visible for too far: sign of high pressure Not performed on people with pulmonary of
heart failure, SVC obstruction, enlarged cardiac disease since this usually paralyzes that
supraclavicular lymph nodes, or increased half of the diaphragm.
thoracic pressure. Upper limb anesthesia is injected around
supraclavicular portion of BP, superior to the
Severance of EJV midpoint of the clavicle.
If slashed along posterior border of SCM, its
lumen is held open by investing deep layer of Injury to Suprascapular Nerve
cervical fascia. Vulnerable when middle third of clavicle is
Negative thoracic pressure sucks air into it. fractured.
Venous air embolism produced will fill right Loss of lateral rotation (infraspinatus muscle)
side of heart with froth blood stops flowing resulting in waiters tip position.
through it. Abduction also affected. (supraspinatus)
Pressure onto vein until it can be sutured.
Ligation of External Carotid Artery
Lesions of CN XI Decreases blood flow through it and its
Uncommon. Caused by: branches but doesnt eliminate it.
Penetrating Trauma Blood flows across the midline to the other
Surgical Procedures (care must be taken in external carotid.
procedures in the lateral cervical regions, The occipital artery provides the main collateral
lymph node dissection for ex.) branch, anastomosing with the vertebral and
Tumors at cranial base/cancerous lymph deep cervical arteries.
nodes
Fracture of jugular foramen (where CN XI Surgical Disection of Carotid Triangle
exits cranium) Through this triangle, we have access to the IJV,
Does not affect SCM too much, though some the vagus and hypoglossal nerves, and cervical
weakness in turning head against resistance. sympathetic trunk.
Primarily affects trapezius impairing neck Damage to vagus/recurrent laryngeal may alter
movements. Drooping of shoulder occurs voice because these nerves supply the laryngeal
Most common iatrogenic nerve injury! muscles.

Severance of Phrenic Nerve, Phrenic Nerve Block, Carotid Occlusion and Endarterectomy
and Phrenic Nerve Crush Atherosclerotic thickening of internal carotid
Severance = diaphragm paralysis on that side may occlude causing a transient ischemia attack
Phrenic block may be used for lung procedures. (TIA), a sudden loss of neurological function
Anesthetic is injected an anterior surface of that disappears in 24 hours.
middle third of scalene muscle A minor stroke, symptoms like TIA or loss of
Nerve crush (with clamps) will produce longer function on one side of body, can occur but
anesthesia. Accessory phrenic nerves may be disappears within 3 weeks.
present and must be crushed to paralyze Sypmtoms depend on the degree of occlusion
hemidiaphragm. and the amount of collateral blood flow.
Doppler color study used to diagnose.
Nerve Blocks in Lateral Cervical Regions Carotid Endarterectomy is a procedure in which
Anesthetic injected along posterior border of the artery is opened and the plaque is stripped
SCM, mainly at junction of superior and middle off. Drugs to inhibit clot formation given until
thirds. This is the nerve point of the neck (Erbs the endothelium as regrown.
point). Risk of damage to CN IX, X (or its branch,
superior laryngeal nerve, XI, XII)
 Unit 2 Blue Box Summaries:

Carotid Pulse Deep Structures of the Neck
Neck Pulse found between trachea and Cervicothoracic Ganglion Block
infrahyoid muscles, anterior border of SCM. Blocks transmission of the cervical and superior
Absence = cardiac arrest thoracic ganglia. (Stellate)
Done to relieve vascular spasms in brain and
Carotid Sinus Hypersensitivity upper limb.
Excessive responsiveness of carotid sinus. Useful to a person with excess vasoconstriction
External pressure may slow heart rate, decrease in the ipsilateral limb.
BP, cause cardiac ischemia resulting in syncope
(fainting). Syncope results from a sudden Lesion of the Cervical Sympathetic Trunk
decrease in cerebral profusion. = Horners Syndrom
Checking pulse here is not recommended for Sypmotoms:
people with this. Contraction of pupils (miosis) from
paralyzed dilator pupillae.
Role of Carotid Bodies Drooping of superior eyelid (ptosis) from
Monitor blood O2 before it reaches the brain. paralysis of levator palpebrae superiorisis
Decrease (like high altitude) activates these Sinking of eye (enopthalamos) from
chemoreceptors increasing alveolar ventilation. paralysis of orbital muscle.
Also monitor CO2 levels. Vasodilation + absence of sweating on face
The glossopharyngeal nerve (CN IX) conducts and neck (anhydrosis) from lack of
this to brain and the response is increase depth sympathetic nerve supply to the blood
and rate of breathing. vessels and sweat glands of the face.
Pulse and BP also increase.
Viscera of the Neck
Internal Jugular Pulse Thyroid Ima Artery
Provide information about heart activity. 10% of people have this unpaired artery. Runs
Pulse is especially visible when the head is through midline.
inferior to lower limbs (Trendelenburg Consider it when performing procedures
Position) inferior to the isthmus because it is a potential
There are no valves in brachiocephalic vein or source for bleeding (eg. Tracheostomy)
superior cava.
A strong pulse can be a sign of Mitral Valve Thyroglossal Duct Cysts
disease which puts increased pressure on the Thyroid gland is attached to foramen cecum by
pulmonary circulation and the Right side of the thyroglossal duct during development. This
heart. duct normally disappears.
The R IJV should be used since straighter path It can, however, remain and develop a cyst at
to R. Atrium. any point in its descent. (Usually close to hyoid)

Internal Jugular Vein Puncture Aberrant Thyroid Gland
Palpate common carotid artery and insert Aberrant thyroid glandular tissue may be found
needle lateral to it at a 30 degree angle. Aim at anywhere along the embryological thyroglossal
the apex of the triangle between the sternal and duct. (failure to relocate)
clavicular heads of SCM. If on the roof of the tongue, its referred to as
Right one is preferred since its longer and lingual thyroid gland.
straighter. Occasionally thyroid glandular tissue is
associated with a cyst. Must be careful when
excising these cysts because possible total

 Unit 2 Blue Box Summaries:

thyroidectomy totally dependent on thyroid Generally try to preserve posterior lobe or at
medication. least isolate them to protect them during
surgery.
Accessory Thyroid Glandular Tissue
May appear anywhere on embryological course. Fracture of Laryngeal Skeleton
Most times in lateral neck on thyrohyoid Result from direct blows. (hockey/baseball
muscle. Insufficient by itself. catcher masks)
Pyramidal Lobe of Thyroid Gland Produces submucous hemorrhage and edema,
50% have these. respiratory obstruction, hoarseness, and
Small lobe in between the two main lobes that temporary inability to speak.
can connect to the hyoid.
Remnants of thyroglossal duct. Laryngoscopy
Procedure to examine interior larynx. 2
Enlargement of Thyroid Gland methods:
Called Goiter and generally from lack of iodine. Indirect Laryngoscopy: uses a mirror at the
May occur during menstruation and pregnancy. back of the mouth.
Compress surrounding structures. (trachea, Direct Laryngoscopy: endoscopic intstrument.
esophagus, recurrent laryngeal nerve) Vestibular folds = pink and vocal folds = pearly
Can enlarge anywhere except superiorly due to white.
muscular attachment. (sternothyroid/hyoid)
Valsalva Maneuvar
Thyroidectomy Strain like eight lifting raises thoracic
Due to malignant tumor on thyroid gland. pressure
Surgical treatment of hyperthyroidism Impairs venous return to the right atrium
preserve posterior lobes (near-total Study the effects of raised peripheral venous
thyroidectomy) to protect recurrent and pressure and decreased cardiac filling and
superior laryngeal nerves and parathyroids. cardiac output.
Postoperative hemorrhage can compress
trachea. Aspiration of Foreign Bodies and Heimlich
Maneuver
Injury to Recurrent Laryngeal Nerves Object can become trapped superior to
The right one is generally more vulnerable. The vestibular folds laryngeal muscles go into
left one has a very vertical path. The right is spasms rima glottis closes no air into
closely intertwined with branches of inferior trachea
thyroid artery. To help preserve the nerve, this Heimlich performed air from lungs forced
artery can be ligated. upwards and dislodges object.
Hoarseness is sign of unilateral recurrent nerve Sometimes need emergency needle
damage. Aphonia, disturbance of voice cricothyrotomy to permit entry of air into lungs
production may occur.
Tracheostomy
Inadvertent Removal of Parathyroid Glands Transverse incision through ant. wall of trachea
Removal done to treat parathyroid adenoma, a airway; infrahyoid muscles retracted and
benign tumor associated with isthmus of thyroid divided
hyperparathyroidism. Opening b/w 1st & 2nd or 2nd & 4th
Causes parathyroid tetanyneurological Tracheostomy tube inserted
syndrome characterized by twitches/cramps. Inferior thyroid veins arise from a venous
(decreased Ca Serum levels) plexus on thyroid gland and descend on ant.
Aberrant sites are of most concern. trachea
 Unit 2 Blue Box Summaries:

Thyroid ima artery could be present males (testosterone). Agonadal males voices
Left brachiocephalic vein, jugular venous arch, do not deepen without testosterone.
and pleurae possibly encountered in children. The thyroid, cricoid, and arytenoid cartilages
Thymes covers inferior part in chiledrn ossify with age (around 25)
Trachea = small and soft in children damage
to esophagus. Foreign Bodies in Laryngopharynx
Foreign bodies (chicken bone) entering pharynx
Injury to Laryngeal Nerves may lodge in piriform recess; if sharp can pierce
Unilateral of inferior laryngeal (continuation of injure internal laryngeal nerve
recurrent) -> weak voice (hoarse), becomes Generally large foreign bodies stop at inferior
better end of laryngopharynx (most narrow point)
Bilateral abscent voice, no vocal fold
abduction (phonation) or adduction (increased Sinus Tract from Piriform Fossa
respiration stridor (high pitched noisy Possible tract from piriform fossa to thyroid =
respiration asthmatic-like episode potential site for recurring thyroiditis.
Progessive Lesions of Recurrent: abduction lost From remnants of thyroglossal.
before adduction (recovery is opposite) Removal of this sinus tract = partial
carcinoma = common disorder hoarseness thyroidectomy because piriform fossa is deep to
Paralysis of superior laryngeal nerve, or superior pole
internal anesthesia of superior laryngeal
mucosa foreign bodies can easily enter Tonsillectomy
Injury to external (or superior) paralyzed Removal palatine tonsil from tonsillar bed.
cricothyroid unable to vary length and Bleeding generally from external palatine vein.
tension of vocal cords monotonous CN XI is vulnerable to injury (accompanies
During thyroidectomy: Superior thyroid artery tonsillar artery. Internal carotid can be
ligated more superior where not closely related vulnerable if it lies lateral to the tonsil.
to superior laryngeal nerve
Adenoiditis
Superior Laryngeal Nerve Block Inflammation of pharyngeal tonsils (adenoids) =
Administered with endotracheal intubation. For adenoiditis. Obstructs nasal passage = hard to
peroral endoscopy, transesophageal breath.
echocardiography, and laryngeal/esophageal Can spread to tubal tonsils closing
instrumentation. pharyngotympanic tubes impaired hearing.
Insert needle b/w thyroid cartilage and hyoid, Can cause otitis media (mid ear infection)
anterior to greater horn. Anesthesia bathes T&A = tonsillectomy + adenoidectomy
internal and superior laryngeal nerves.
Brachial Fistula
Cancer of Larynx Canal that opens internally on tonsillar fossa
In many smokers, present with hoarseness and and externally on side of neck passes over SCM
associated otalgia (earache) and dysphagia. and passes through carotid sheath.
Enlarged pretracheal or paratracheal lymph Results from persistence of 2nd pharyngeal
nodes may indicate. pouch and groove.
Laryngectomy for severe cases (people with Infection from saliva can result.
funny voice machines)
Branchial Sinuses and Cysts
Age Change in Larynx Occurs when the embryonic cervical sinus fails
Grows until 3 then starts again around 12. Walls to disappear in lateral neck. (ant. to SCM)
strengthen and laryngeal cavity enlarges in Can form a branchial cyst (lateral cervical cyst).
 Unit 2 Blue Box Summaries:

Generally present in infants. Lymphatics in the Neck
Careful removal because generally close to the Radical Neck Dissections
CN IX, XI, XII. When cancer invades cervical lymphatics
(involved in spread into abdomen and thorax).
Esophageal Injuries Referred to as cervical sentinel lymph nodes
Rare, and generally in conjunction with airway because they are first clue that cancer has
injury. spread to this area.
Difficult to detect. Many times leads to death. Deep cervical lymph nodes and surrounding
tissue removed in one piece.
Tracheo-Esophogeal Fistula (TEF) Major arteries, BP, CN X, and phrenic nerve
Abnormal connection between esophagus and preserved.
trachea, generally combined with esophageal Cutaneous branches of cervical plexus removed.
atresia.
Most common: superior ends in blind pouch.
Inferior communicates with trachea. The pouch
fills with mucus that the infant aspirates.
Results from abnormalities in partitioning of
the esophagus and trachea by the trachea-
esophageal septum.

Esophageal Cancer
Dysphagia (difficulty swallowing) is the most
common complaint for this.
Esophagoscopy = diagnostic tool
Enlargement of deep cervical lymph nodes also
sign.
Hoarseness also a symptom (compression of
recurrent laryngeal)

Zones of Penetrating Neck Trauma
Zone 1: Root of Neck, from clavicle/manubrium
to just below cricoid cartilage. Cervical pleura,
apices of lungs, thyroid/parathyroid, esophagus,
common carotid, jugulars, and cervical region of
vertebral column are at risk.
Zone 2: From below cricoid to angle of
mandible. Superior lobes of thyroid, cricoid
cartilage, larynx, laryngopharynx, carotids,
jugulars, esophagus, and cervical region of vert.
column are at risk.
Zone 3: Above 2. Salivary glands, oral and nasal
cavities, oropharynx, and nasopharynx are at
risk.
Zones 1 and 3 have greatest morbidity and
mortality rate due to airway obstruction. Zone 2
can control bleeding with pressure and treat
structures easier.

 Unit 2 Blue Box Summaries:

Chapter 9 Compression of Oculomotor Nerve
Extradural hematoma pressure compress
Cranial Nerves CN III against crest of petrous part of temporal
Cranial Nerve Injuries bone first thing to go = pupillary light reflex
Injury is usually due to fracture at the base of
the cranium Aneurysm of Posterior Cerebral or Superior
Excessive movement tear/bruise CN I Cerebral Artery
CN III, IV, V1, and ESPECIALLY VI are susceptible These may simply affect the nerve
to compression related to pathologies affecting
cavernous sinus. Trochlear Nerve
Longest Intracranial Course
Olfactory Nerve Causes diplopia
AnosmiaLoss of Smell Person has to tilt head because this is the
Fractured cribiform plate (ethmoid bone) primary muscle of intortion thus extortion is
tear olfactory nerve fibers unopposed
This loss of smell can be a sign of a fractured
cranial base and rhinorrhea Trigeminal Nerve
Injury to Trigeminal Nerve
Olfactory Hallucinations Loss of mastication muscles mandible
Lesion to temporal lobe false perception of deviates towards affected side
smells (olfactory hallucinations) Loss of corneal reflex (blinking in response to
having cornea touched) and sneezing reflex
Optic Nerve (irritants in respiratory tract)
Demyelinating Diseases and Optic Nerves Trigeminal Neuralgia (Tic Douloureux)
Actually part of CNS (not PNS) so its disease affecting sensory root of V episoding
myelination is by glial cells (not schwann) pain in response to stimulation
susceptible to these diseases (MS)
Dental Anesthesia
Optic Neuritis Superior alveolar nerve = unreachable thus
Inflammation (MS/alcohol) dentists inject anesthesia into roots of teeth
(this is for maxillary teeth)
Visual Field Defects Inferior Alveolar Nerve is commonly blocked for
Complete section blindness in temporal and procedures on mandibular teeth.
nasal fields of view of ipsilateral eye
Section @ chiasma no temporal vision in Abducent Nerve
either eye bitemporal hemianopsia Long Intradural Course
Section between chiasma & brain no nasal for Can be compressed due to brain tumor, berry
ipsilateral + no temporal for contralateral aneurism, atherosclerotic carotid artery in
patients with strokes cavernous sinus (close relation here), and
thrombosis in sinus (pimple popper)
Oculomotor Nerve
Injury to Oculomotor Nerve Facial Nerve
Lesion ipsilateral oculomotor palsy (down & Longest Intraosseous Course
out) (and parasympathetic affects on pupil) Central Lesion (CNS) contralateral
Lesion at origin/genticulate ganglion
ipsilateral


 Unit 2 Blue Box Summaries:

Depending on where lesion is, taste may/may 1 Recurrent hoarseness & dysphonia
not be affected 2 Reccurents aphonia + inspiratory stridor
Common with fractures of temporal bone usually due to cancer of larynx/thyroid
(hence stylomastoid foramen)
Spinal Accessory Nerve
Vestibulocochlear Nerve Subcutaneous passage in posterior cervical
Injuries to Vestibulocochlear Nerve region.
The vestibule and cochlear nerves are
essentially independent, however a lesion Hypoglossal Nerve
affects them bothhence the 3 symptoms Paralyzes ipsilateral half of tongue looks
(vertigo, hearing loss, tinnitus) shrunken and atrophied over time
When protruded; apex deviates towards
Deafness paralyzed side unopposed action of
The 2 kinds of deafness listed in the ear section genioglossus muscle
above.

Acoustic Neuroma
Slow grooving benign tumor of the neurolemma
(shwann cells) begins in vestibular nerve
the three ear symptoms

Trauma and Vertiga
Head Trauma fucks up your proprioception
(peripheral vestubular nerve lesion)
swaying, vertigo, dizziness, maybe vomitting

Glossopharyngeal Nerve
Lesions of Glossopharyngeal Nerve
Uncommon and not associated with perceptible
disability
Taste (post 1/3) + gag reflex absent on
ipsilateral side. Change in swallowing
Generally other nerves are affected. Ex. Tumor
in jugular foramen affects IX, X, XI Jugular
Foramen Syndrome

Glossopharyngeal Neuraglia (Tic)
Causes unknown
Similar to Tic Douloureux intense pain
Can be initiated by swallowing, protruding
tongue, talking, or touching palatine tonsils.

Vagus Nerve
Lesion of pharyngeal branch dysphagia
(diffuclty swallowing)
Supeior Laryngeal anesthesia of superior
larynx & paralyzed cricothyroid weak
monotonous voice that tires easy