There are four unpaired bones of the cranium: ethmoid, sphenoid, frontal,
occipital.
Petrous temporal bone forms the floor of the middle cranial fossa and
separates middle and posterior cranial fossae.
Middle meningeal artery is located in the middle cranial fossae (exits foramen
spinosum)
The ophthalmic artery (a branch of the internal carotid artery, ICA) is the
major blood
supply to the orbit and eye. It enters the orbit with the optic nerve via the
optic canal.
The middle meatus contains openings for the frontal sinus, anterior and
middle ethmoidal sinuses, and maxillary sinuses
The mandibular canal traverses the mandibular body and opens anteriorly at
the mental foramen.
The superior petrosal sinus connects the cavernous and sigmoid sinuses.
The abducens nerve is most likely affected from laterally expanding pituitary
tumor because it is medially located within the cavernous sinus.
Deep facial vein connects anterior facial vein and the pterygoid plexus.
The ophthalmic artery is a branch of the ICA (follows the optic nerve through
the optic foramen into orbit); it gives off the anterior ethmoidal branch that
supplies the nasal cavity
See embryology. The tongue is derived from the first four pharyngeal arches
and is
innervated by associated nerves of the those arches: arch 1(CN V), arch 2
(CN VIII), arch 3 (CN IX), arch 4 (CN X)
All tongue muscles except palatoglossus (CN X), are innervated by CN XII.
The muscles attaching to genial tubercles are the genioglossus and the
geniohyoid.
The tongues blood supply is via lingual artery; veins drain into IJV.
The palatal salivary glands are mostly mucous, are located beneath the
mucous membrane of hard and soft palates, and contribute to oral fluid.
The soft palate attaches to the tongue by the palatoglossal arches and to the
pharynx by the palatopharyngeal arches.
The tensor and levator veli palatini muscles prevent food from entering the
nasopharynx.
Postganglionic nerves from the pterygopalatine ganglion exit via the inferior
orbital fissure and join the lacrimal nerve (of V-1) to supply the lacrimal
gland
The lingual artery and facial artery are both branches of the external carotid
artery (ECA)
Going from the largest to smallest, the major salivary glands go from serous
to mixed to mostly mucous (parotid, submandibular, and sublingual
respectively)
Parotid and von Ebner glands are the only glands to secrete serous-only
saliva.
Left lateral pterygoid muscle moves mandible to the right; the right condyle
is pivot point. Injury to left lateral pterygoid cause the madible to
deviate toward the left, injured side. Subcondylar fracture: Mandible
deviates to affected side for same reason. Only the contralateral lateral
pterygoid is functional, pulling the mandible on the fractured side.
Masseter and medial pterygoid muscles form a sling and the angle of the
mandible; both elevate/close the mandible and stabilize laterally.
The prevertebral layer of deep cervical fascia is why the thyroid moves w/
laryngeal movements
Submandibular triangle contains two glands (or nodes), two nerves, two
arteries, and two veins.
The sub occipital triangle (of the posterior triangle) is where the vertebral
artery is found.
The mylohyoid is the muscle that makes it difficult to place anterior periapical
films in the mouth when it is not relaxed.
The terminal branches of the ECA are the maxillary and superficial temporal
arteries
In addition to the lingual artery, the tongue receives some blood supply from
the tonsillar branch of the facial artery and the ascending pharyngeal artery.
The mnemonic to remember the branches of the facial artery of the facial
artery is TAGS ISLA.
The greater palatine artery (out greater palatine foramen) supplies the hard
palate (posterior to the maxillary canine)
The lesser palatine artery (out of the lesser palatine foramen) supplies the
soft palate and the tonsils.
The scalp can drain superficially (via superficial temporal and posterior
auricular veins) or deeply (via emissary veins)
The deep cervical nodes from the jugular lymph trunk (along IJV)
The vocal cords attach anteriorly at the lamina of thyroid cartilage and
posteriorly at the vocal process of arytenoid cartilages.
All intrinsic laryngeal muscles are supplied by the recurrent laryngeal nerve
except the cricothyroid muscle, which is innervated by the external laryngeal
nerve (a branch of the superior laryngeal nerve)
The thenar (thumb) region of the hand and nailbeds of thumb, index, and
middle fingers (and half of ring finger) are supplied by palmar digital nerves
of the median nerve.
The hypothenar (pinky) region of the palm is supplied by the ulnar nerve
The posterior cord gives rise to the radial and axillary nerves
The radial nerve is a great extensor nerve It is motor to all muscles of the
posterior arm. It is the most often injured nerve in a mid-humeral shaft
fracture because it runs in the radial (spiral) groove of the humerus. Radial
nerve deficit includes wrist drop, inability to make a tight fist, and sensory
deficit to the radial hand and lower part of thumb and digits of 2 and 3 and
(half of 4).
The posterior cord gives rise to the radial and axillary nerves
Axillary nerves are often injured by falling on an outstretched arm when the
glenohumeral joint is dislocated because the nerve runs immediately inferior
to the glenohumeral joint.
One can damage the lower part of the brachial plexus if the arm is abruptly
extended above the head (e.g. when grabbing a fixed object to slow a fall, as
with a skier grabbing tree)
The long thoracic nerve (nerve of Bell) supplies the serratus anterior SALT
(C5, C6, C7 or wings of heavan.
In one stabs the fourth intercostal space near sternal border, the right
ventricle is injured. If one fractures the tenth and eleventh ribs, the spleen is
injured.
The phrenic nerve travels through the thorax between pericardium and
pleura.
Aspiration occurs more often in the lung (apical aspect of right lower lobe)
because the right mainstem bronchus is straighter, shorter, and larger than
the left. The left mainstem takes a more acute angle.
Chordae tendinae and papillary muscles prevent the AV valves from everting
back into the atria.
All lymphoid organs are derived exclusively from mesenchyme except for the
thymus:
Remember the thymus has double embryological orgin
o Mesenchyme
Lymphocytes (hematopoietic stem cells)
o Endoderm
Hassalls corpuscle
Derived from 3rd pharyngeal pouch
Remember there is once brachiocephalic artery, and two brachiocephalic
veins.
If the celiac trunk is blocked blood can still reach the foregut by way of
anastomoses between the superior pancreaticoduodenal artery (a branch of
the gastroduodenal) and the inferior pancreaticoduodenal (a branch of the
SMA)
The right superior intercostal vein drains into the azygous vein
The left superior intercostal vein drains into the brachiocephalic vein.
The left gonadal vein drains into the left renal vein. The right gonadal vein
empties directly into the IVC.
The left renal vein is longer than the right renal artery is longer than the left.
This is due to the positions of the vena cava and aorta, respectively.
Portal blood can also get to the IVC by the azygous and hemiazygous vein.
Portocaval shunt can be created by anastomosing the splenic vein and renal
vein (a portal component and a systemous venous component)
The gallbladder does not contain a submucosa (the stomach and small and
large bowel do)
Bil is composed of bile salts, pigments, cholesterol, and lecithin. Bile serves
to emulsify fats, and fat soluble vitamin (A,D,E, and K)
Descending and sigmoid colon, rectum, and anus are part of the hindgut, so
they are supplied by the pelvic splanchnic nerves rather than the vagus
Bile and pancreatic enzymes are released at ampulla of Vater into the second
part of duodenum
As ureter enters pelvic cavity it crosses over the top of the common iliac
artery (at its point of bifurcation) and dives deep into the pelvis
Females are more prone to urinary tract infections because of the shorter
urethra.
All cranial nerves except (I and II) originate from the brainstem.
Tracts: Olfactory, Optic, no nuclei for CN I and II.
Preganglionics come from the T1-2 (ciliospinal center of Budge) where they
have descended from the brainstem
The lingual nerve is found in the pterygomandibular space with the inferior
alveolar nerve, artery, and vein. The lingual artery does not run with the
lingual nerve. The lingual artery is medial to the hyoglossus muscle whereas
the lingual vein and nerve are lateral to the hyoglossus (as is the
submandibular duct and the hypoglossal nerve [XII])
If the lingual nerve is cut after the chorda tympani joins you lose both taste
and tactile sensation.
The lingual nerve can be damaged with third molar extraction because it lies
close to the mandibular ramus in the vicinity of the third molar.
Orbicularis oculi (CN VII) closes eyelid; lesion results in inability to close, no
corneal reflex.
Middle ear communicates posteriorly with the mastoid cells and the mastoid
antrum via the aditus ad antrum.
Otis media: Middle ear infections, can extend to both mastoid and
nasopharynx via the Eustachian tube.
Otis externa: Infection of ear canal (past external auditory meatus)
Central hearing connections are bilateral so a central lesion will not cause
deafness in either ear.
Vagus nerve lose their identity in the esophageal plexus. The anterior gastric
nerve can be cut (vagotomy) to reduce gastric secretion.
The cardiac branches of the vagus (form the cardiac plexus) are
preganglionic parasympathetic nerves that synapse with postganglionic
parasympathetic nerves in the heart.
The abdominal viscera below the left colic flexure (and genitalia and pelvic
viscera) are supplied by pelvic splanchnic nerves (parasympathetic
preganglionics)
Also with CN XII paralysis, the tongue tends to fall back and obstruct the
airway (genioglossus).
CSF is located in the subarachnoid space. This space is entered during the
lumbar tap or puncture
In the spinal cord, white matter is peripheral and gray matter is central, the
reverse of the cerebral cortex.
The spinal cord is protected by the bony and ligamentous walls of the
vertebral canal and CSF.
The cell bodies for afferent/sensory nerves are located in the dorsal root
ganglion.
Splanchnic nerves are sympathetic nerves to the viscera. They pass through
the sympathetic chain ganglia without synapse (exceptions to short
preganglionic and long-postganglionic) and synapse in the effector.
Acrosome is delivered from the Golgi; the middle piece contains numerous
mitochondria; the tail is flagellum (9x2+2)
Primitive blood formation occurs in the allantois, yolk sac, liver, spleen, and
bone.
Foramen Ovale
In fetal heart allows blood to flow from RA to LA
Bypass pulmonary circuit
o Because oxygenated blood comes from the mother/placenta
Closes with fibrous connective tissue to become fossa ovalis in the
adult.
Organogenesis occurs from week 3 to 8.
The neural plate invaginates to form neural groove with neural
folds on each side on day 18 of embryonic life (two neural folds
fuseforming the neural tube)
Neuroectoderm (ectoderm of neural plate) gives rise to CNS (brain
and spinal)
Week 4 of Embyologic development
Neural Tube is closed
Four pairs of branchial arches are visible externally
Characterisitc C-Shaped curvature of embryois appreciated due to
folding
Upper and lower limb buds appear
Brainstem=midbrain+hindbrain
Brainstem=midbrain+pons+medulla
1st Arch:
Meckels cartilage
o Model for the mandible
Dissolutes with only minor contribution to ossification
Mandibular process (forms mandible)
Maxillary process (forms maxilla, zygoma, squamous temporal)
Tongue Formation (anterior 2/3s)
o Tuberculum impar (median tongue bud)
o Lateral lingual swellings (2) (distal tongue buds)
2nd Arch:
Hyoid , muscles of facial expression, stapedius, stylohyoid (CN VII)
3rd Arch:
Stylopharyngeous (glossopharyngeal nerve)
th
4 Arch:
Pharyngeal and Laryngeal musculuature (CN X)
The mandible and maxilla except the mandibular condyles, are formed by
intramembranous ossification. Most of the upper lip is formed by the
maxillary processes. The corner of the mouth is formed by the fusion of the
maxillary and mandibular processes
The vestibular lamina seperates the lips and cheeks externally and jaw
structures internally in the developing embryo.
The plane passing through the right and left anterior pillars marks the
seperation between the oral cavity and the oropharynx in the adult
Lateral cleft lip occurs because the maxillary and medial nasal processes fail
to fuse. Cleft lip can be unilateral or bilateral.
Embryologically, the tongue is derived from the first four pharyngeal arches,
and innervation comes from associated nerves of those arches (arch 1, V;
arch 2 VII; arch 3 IX; arch 4 X)
Bifid tongue occurs because of lack of fusion of distal tongue buds (lateral
swellings)