v. cranial cavity- divided into depressions (fossae) · v. cranial cavity- divided into depressions...
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ANTERIOR CRANIAL FOSSA (ROOF OF NASAL CAVITY, ORBIT)
MIDDLE CRANIAL FOSSA (ORBIT, NASAL CAVITY, FACE)
POSTERIOR CRANIAL FOSSA (FACE, ORAL CAVITY, NECK)
V. CRANIAL CAVITY- DIVIDED INTO DEPRESSIONS (FOSSAE)
ANTERIOR CRAN. FOSSA -BONES: FRONTAL, ETHMOID, SPHENOID;
LOOK FOR: suture on floor of fossa: between frontal and Lesser wing of sphenoid
MIDDLE CRAN. FOSSA - BONES: SPHENOID, TEMPORAL, PARIETAL
LOOK FOR: sharp edge of Petrous part of Temporal bone: attachment of Tentorium Cerebelli
POSTERIOR CRAN FOSSA -BONES: SPHENOID, TEMPORAL, OCCIPITAL, PARIETAL
LOOK FOR: Foramen Magnum: on cadavers level indicated by Vertebral Artery
LESSER WINGOF SPHENOID
GREATER WINGOF SPHENOID
PETROUS PART OF TEMPORAL BONE
PETROUS PART OF TEMPORAL BONE
TENTORIUMCEREBELLI
SKULL SESSION 1: FORAMINA OF INTERIOR OF SKULL AND CRANIAL NERVES
Basic facts:
1) Cranial nerves are numbered 1-12
2) Learn foramina of interior of skull in anterior-posterior sequence; this reflects numbering of cranial nerves
I. Olfactory II. OpticIII. OculomotorIV. TrochlearV. TrigeminalVI. AbducensVII. FacialVIII. Vestibulo-cochlear IX. GlossopharyngealX. VagusXI. Accessory XII. Hypoglossal
CRANIAL NERVES
A. Contain inflow/outflow of brain; spinal nerves contain inflow/outflow of spinal cord.B. Contain types of similar to those found in spinal nerves; ex. sensory axons to skin.C. Contain types of neurons not found in spinal nerves; ex. taste fibers.D. Many cranial nerves contain more than one type of neuron.E. To analyze types of neurons in different cranial nerves, system of classification of types of neurons.
CRANIAL NERVES
CRANIALNERVES
SPINALNERVES
Seven types of neurons - some are the same types of neurons as are found in spinal nerves; others are only found in cranial nerves
A. Same types as spinal nerves
1. Somatic motor - Voluntary skeletal muscles (derived from somites)
2. Somatic sensory - Precise sensation to skin joints, muscle, tendon receptors (in head, also nasal and oral cavities)
3. Visceral motor (efferents) = AUTONOMICS - smooth muscles (including arrector pilae muscles of skin), blood vessels; secretomotor to glands.
4. Visceral sensory - Imprecise sensation from gut, blood vessels, glands, internal organs (in head, pharynx which is rostral end of gut)
2) CLASSIFICATION OF INNERVATION
WHERE/WHAT IS THE PHARYNX?
NASALCAVITY
ORALCAVITY
PHARYNX -region behindOral and Nasal Cavities
PHARYNX IS CONNECTED TO TRACHEA (RESPIRATORY SYSTEM) AND ESOPHAGUS (GI) SYSTEMtrachea
esophagus
VII
IX
IX
2) CLASSIFICATION OF INNERVATION
B. Only in cranial nerves
5. Special senses - vision, hearing (auditory), balance (vestibular apparatus)
6. Chemical senses - taste and smell
7. Branchiomotor - Voluntary skeletal muscles from branchial arches
MOST CRANIAL NERVES ARE RELATIVELY SIMPLE
CONTAIN ONLY ONE TYPE OF NEURONSENSORYI - Olfactory nerve - Chemical sense - smellII - Optic nerve - Special sense- visionVIII - Vestibulo-cochlear nerve - Special senses -hearing, balance
MOTORXII - Hypoglossal - muscles of tongue - Somatic motorXI - Accessory - motor to Sternocleidomastoid, Trapezius - BranchiomotorIV - Trochlear - eye muscle - Superior Oblique -Somatic motorVI - Abducens - eye muscle - Lateral Rectus - Somatic motor
MOST CRANIAL NERVES ARE RELATIVELY SIMPLE
CONTAIN ONLY TWO TYPES OF NEURONS
MOTOR AND AUTONOMICIII - Oculomotor - Somatic motor - many eye muscles and Lev. Palp. Sup.+ Visceral motor - Parasympathetics (Constrictor pupil, Ciliary muscle)
MOTOR AND SENSORYV - Trigeminal - Branchiomotor - Incantation Arch I(Muscles of mastication, Tensor tympani, Tensor palati, Mylohyoid, Anterior belly of Digastric)+ Somatic Sensory - Skin, joints, properioception: Oral cavity, Nasal cavity.
VII, IX and X are complex and have a number of types of neurons
CRANIAL NERVE CHART: TYPES OF NEURONS
X
Branchio-motor
VisceralMotor(Parasymp.)
SomaticSensory
VisceralSensory
Taste,Smell
IX, X: Remember- Facial - Muscles facial expression + incantation- name: Glossopharyngeal - Glosso - post. 1/3 tonguetaste, touch; Pharyngeal - oropharynx sensory; also visceral sensory = CAROTID SINUS (blood pressure), CAROTID BODY (blood chemo)- Vagus - incantation - Larynx (sensory/motor), Pharynx motor (except Stylopharygeus, Soft palate (except Tensor Palati)
PARASYMPATHETICS - IN CRANIAL NERVES
+palate
III
VII
IXX
PRE-GANGLIONICNEURONSLEAVEWITHCRANIALNERVES
GANGLIA CLOSE TO TARGET ORGAN
(Constrictor) =
CHEMICAL SENSES - TASTE - in three cranial nerves
X - VAGUS -ant. to epiglottis
IX - GLOSSO-PHARYNGEALpost. 1/3 of tongue
VII - FACIAL -ant. 2/3 of tongue
TONGUE
FIRSTARCH
SECONDARCH
THIRDARCH
FOURTHARCH
CAUDAL SIXTHARCH
note: Innervation pattern of Cranial Nerves applies to muscles of branch ARCHES: DOES NOT APPLY TO POUCHES OR CLEFTS
IICRANIAL NERVESARE NUMBEREDACCORDINGTO THEIR POSITION ON THE BRAINSTEM
IIIIVVVI
VII, VIIIIX, XXI
XII
ANTERIOR
POSTERIOR
CRANIAL NERVES
I
II
III, IV, V1, VIV2V3Middle Meningeal A.VII, VIIIIX, X, XIXII
NOSE
OLFACTORYFORAMEN –CN IOLFACTORYNERVE
CRISTAGALLIOFETHMOID
CHEMICAL SENSES - TASTE AND SMELL
I - OLFACTORY NERVE -SMELL
TEST: SMELL ODORS(note: not ammonia; painin nasal cavity CN5)
DAMAGE:LOSS OF SENSE OFSMELL (ANOSMIA)
also: can be damagedby fractures (blows) tonose
OPTICFORAMEN CN IIOPTICNERVE,OPHTHALMICARTERY
SPECIAL SENSES
Detect light - Test visual acuity
II -OPTICNERVE
fiberscross atopticchiasm
Retina
DAMAGE OPTIC NERVE: loss ofvision in one eye
DAMAGE VISUAL PATHWAY:more complex visual fielddeficits
Note: Branches of Ophthalmic Artery supply eye: Posterior Ciliary Arteries and Central Artery of Retina enter posterior side of Eyeball
BLOOD SUPPLY TO ORBIT: OPHTHALMIC ARTERYOPHTHALMICARTERY
OPHTHALMICARTERY
SUPRAORBITALARTERY
SUPRATROCHLEARARTERY
MAJOR BRANCHESTO EYE:
2) CENTRALARTERY OFRETINA1) POSTERIOR CILIARY ARTERIES (Long and Short)
(ANT. CILIARY ARTERIES - small, derived from branches to muscles) OPTIC
NERVE
INTERNALCAROTIDARTERY
CONTAINS RODS AND CONES (PHOTOSENSITIVE)CENTRAL ARTERY OF RETINA- BRANCH OF OPHTHALMIC ART.NO ANASTOMOSES; OCCLUSIONRESULTS IN BLINDNESS
CENTRAL ARTERY OF RETINA
RETINA
EYE- STRUCTURE OF EYEBALL- RETINA
OPHTHALMOSCOPE VIEW
BRANCHES OFCENTRAL ARTERYAND VEIN OFRETINA
OPTIC NERVE(DISC)
MACULA =visual acuity
DURA AND SUBARACHNOID SPACE (CSF) EXTEND AROUND OPTIC NERVE; INCREASE IN CSF (PRESSURE) CANAFFECT VISION
SUBARACHNOID SPACE EXTENDS TO BACK OF EYEBALL
CSF INSUBARACHNOIDSPACE
PAPILLEDEMA - engorgementof retinal veins (correspond to branches of central artery)
Clinical - slow onset;headaches
DURA
PAPILLEDEMA = swelling of optic disc
SUPERIORORBITALFISSURE –CN III, IVV1, VIOPHTHALMICVEINS
Boundary-Lateral edgeof eye
Boundary Lateral edgeof mouth
IV. SENSORY INNERVATION - TRIGEMINAL NERVE -TO SKIN OF HEAD – 3 DIVISIONS
V1 – OPHTHALMICDIVISION -SOMATIC SENSORY
V2 – MAXILLARYDIVISON -SOMATIC SENSORY
V3 – MANDIBULARDIVISION - SOMATIC SENSORY + BRANCHIOMOTOR
V1
V2
V3
CAVERNOUSSINUS
SELLA TURCICA
VENOUS SINUSES
7. Cavernous sinuses - in middle cranial fossa; on side of the body of the sphenoid bone; connected by Intercavernous sinus; receive blood from Sup. and Inf. Ophthalmic veins, Cerebral veins; drain to Sup. and Inf. Petrosal sinuses
8. Sup. and Inf. Petrosal sinuses - on petrous part of temporal boneSup. drains to TransverseInf. Drains to Internal Jugular
PITUITARY
CAV.SINUS
INTERNALCAROTID
IIIIV
V1,V2
VI
STRUCTURES PASSING THROUGH WALL OF CAVERNOUSSINUS - Int. Carotid A., Cranial N.'s III, IV, V1, V2, VI;Clinical sign of Infection in Sinus – ‘BLURRED’ VISION
III IV
VI
FORAMENROTUNDUM –CN V2
Boundary-Lateral edgeof eye
Boundary Lateral edgeof mouth
IV. SENSORY INNERVATION - TRIGEMINAL NERVE -TO SKIN OF HEAD – 3 DIVISIONS
V1 – OPHTHALMICDIVISION -SOMATIC SENSORY
V2 – MAXILLARYDIVISON -SOMATIC SENSORY
V3 – MANDIBULARDIVISION - SOMATIC SENSORY + BRANCHIOMOTOR
V1
V2
V3
FORAMENOVALE –CN V3
FORAMENSPINOSUM
F. BLOOD SUPPLY TO CALVARIUM
1) OUTER SURFACE –ARTERIES TO SCALP
2) INNER SURFACE-MENINGEAL ARTERIES
COURSE NEXT TO BONE; MISNAMED - SOUND LIKE SUPPLY MENINGES- MOST BLOOD TO BONES
Clinical - bleeding is arterial; can be profuse and rapid (ex, car accident); patient lucid at first; can be fatal within hours if herniation occurs
Skull Fracture Near Pterion
EPIDURAL HEMATOMA
TearMiddleMeningealArtery
1) Skull fracture near Pterion2) Tear Middle Meningeal Artery3) Blood 'peels' durafrom bone4) Lens shaped (biconvex)mass on CT
5) mass candisplace brain
6) Herniation -i. Uncal herniation -push Temporal lobe (uncus) through Tentorial Notchii. Tonsillar herniation -push Cerebellum (tonsil) through Foramen Magnum
Uncalherniation
Tonsillar herniation
OPENINGOFCAROTIDCANAL(FORAMENLACERUM)
CAROTIDCANAL –OPENS TOFORAMENLACERUMINSIDEMIDDLECRANIALFOSSA
OPENINGOFCAROTIDCANAL(FORAMENLACERUM)
INTERNAL CAROTID ARTERY: ENTERS SKULL
PASSESTHROUGHCAVERNOUSSINUS
INTERNALCAROTIDARTERY
PITUITARY
CAV.SINUS
INTERNALCAROTID
IIIIV
V1,V2
VI
STRUCTURES PASSING THROUGH WALL OF CAVERNOUSSINUS - Int. Carotid A., Cranial N.'s III, IV, V1, V2, VI;Clinical sign of Infection in Sinus – ‘BLURRED’ VISION
INTERNALCAROTID
INTERNALAUDITORYMEATUS –VII, VIII
VII BRANCHIOMOTOR MUSCLES OF FACIAL EXPRESSION
FACIALPARALYSIS
STYLOHYOID,POST. BELLY DIGASTRIC
STAPEDIUS - dampens sound -DAMAGE HYPERCOUSIA - sounds seem too loud
sagging faceloss of naso-labial foldinability to close eye
view insideMiddle ear
view of Neck
Mandible = jaw bone
Stapes - bone of middle ear
CHEMICAL SENSES - TASTE - in three cranial nerves
X - VAGUS -ant. to epiglottis
IX - GLOSSO-PHARYNGEALpost. 1/3 of tongue
VII - FACIAL -ant. 2/3 of tongue
TONGUE
SPECIAL SENSES
VIII -VESTIBULO-COCHLEAR
to 1) cochlea - hearing2) semicircular canals -(vestibular apparatus) -balance
in petrous part oftemporal bone
VIII
DAMAGE - LOSS OF HEARINGON ON SIDE
JUGULARFORAMEN –CN IX, X, XI
CN X -most muscles of soft palate
CN X -mot muscles of pharynx
CN X -muscles of larynx
CN IX -stylo-pharyngeus
BRANCHIOMOTOR - IX GLOSSOPHARYNGEALAND X VAGUS
soft palate TEST BY HAVING PATIENTSAY AAHH! (also GAG REFLEX)
STERNOCLEIDO-MASTOID
TRAPEZIUS
XI - ACCESSORY NERVE
Branchiomotor to twomuscles
CLINICAL: TORTICOLLIS –Contracture of Sternocleidomastoid;Face turned to opposite side
Shrugshoulders
Turn head
HYPOGLOSSALCANAL –CN XII
FORAMENMAGNUM
PROTRUDED TONGUE DEVIATES TOWARD SIDE OF LESION - due to unopposed action of the Genioglossus muscle which protrudes tongue.
HYPOGLOSSAL NERVE (XII) - ALL MUSCLES OF TONGUE - SOMATIC MOTOR
DAMAGEHYPOGLOSSALNERVE ON ONESIDE
GENIO-GLOSSUSINTACT
GENIO-GLOSSUSPARALYZED
VENOUS SINUSES OF BRAINSUPERIOR SAGITTAL SINUS
INFERIORSAGITTALSINUS
STRAIGHTSINUS
TRANSVERSESINUS
CAVERNOUSSINUS
SIGMOID SINUS
INTERNAL JUGULARVEIN
falx cerebri
tentorium cerebelli
TransverseTransverse
Sigmoid
VENOUS SINUSES4. Transverse sinuses - in lateral fixed part of tentorium; receive blood from Sup. Sagittal or Confluens5. Sigmoid sinuses - S-shaped continuation of Transverse; endin Jugular Foramen; form Internal Jugular Vein6. Occipital Sinuses - in falx cerebelli; drain to Confluens
Sigmoid
NOSE
VENOUS SINUSES MAKE GROOVES IN CRANIAL CAVITY
TRANSVERSESINUS
SIGMOIDSINUS
VENOUS SINUSES
7. Cavernous sinuses - in middle cranial fossa; on side of the body of the sphenoid bone; connected by Intercavernous sinus; receive blood from Sup. and Inf. Ophthalmic veins, Cerebral veins; drain to Sup. and Inf. Petrosal sinuses
8. Sup. and Inf. Petrosal sinuses - on petrous part of temporal boneSup. drains to TransverseInf. Drains to Internal Jugular
VENOUS SINUSES MAKE GROOVES IN CRANIAL CAVITY
INFERIORPETROSALSINUS
SUPERIORPETROSALSINUS
CAVERNOUSSINUS
RIGIDLY LINKED FOR EYE MOVEMENTS
A. BOUNDARIES
1. ROOFFRONTAL
4. LATERAL WALLZYGOMATIC SPHENOID
2. FLOORMAXILLARY
SPHENOID
ZYGOMATIC
I. BONES OF ORBIT
MAXILLARY
3. MEDIAL WALL - INCLUDES MAXILLARY, LACRIMAL, ETHMOID, FRONTAL AND SPHENOID BONES (NASAL CAVITY IS MEDIAL TO MEDIAL WALL OF ORBIT)
MAXILLARY
LACRIMAL
ETHMOIDSPHENOID
BONES OF ORBIT
FRONTAL
NOSE
FORAMINA- MOST THINGS ENTER ORBIT FROM MIDDLE CRANIAL FOSSA
1) OPTIC CANAL- IN BASE OF LESSER WING OF SPHENOID BONE, CONTAINS OPTIC NERVE (II) and OPHTHALMIC ARTERY
2) SUPERIOR ORBITAL FISSURE - BETWEEN GREATER AND LESSER WINGS OF SPHENOID, CONTAINS III, IV, V1, VI, OPHTHALMIC VEINS
B. FORAMINA OF ORBIT
OPTICFORAMEN CN IIOPTICNERVEOPHTHALMICARTERY
SUPERIORORBITALFISSURE –CN III, IVV1, VI,OPHTHALMICVEINS
1) OPTIC CANAL- IN BASE OF LESSER WING OF SPHENOID BONE,CONTAINS OPTIC NERVE AND OPHTHALMIC ARTERY
2) SUPERIOR ORBITAL FISSUREBETWEEN GREATER AND LESSER WINGS OF SPHENOID, CONTAINS III, IV, V1, VI, OPTHALMIC VEINS
NOSE
INFERIOR ORBITAL FISSURE
1) INFERIOR ORBITAL FISSURE- SLIT BELOW SUP. ORBITAL FISSURE: BETWEEN SPHENOID AND MAXILLARY - CONNECT PTERYGOPALATINE FOSSA AND INFRATEMPORAL FOSSA WITH ORBIT - CONTAINS INFRAORBITAL AND ZYGOMATIC N., A. AND V. (V2, MAXILLARY A.)
3. MEDIAL WALL- INCLUDES MAXILLARY, LACRIMAL, ETHMOID, FRONTAL AND SPHENOID (NASAL CAVITY IS MEDIAL TO MEDIAL WALL OF ORBIT)
MAXILLARY
LACRIMAL
ETHMOIDSPHENOID
BONES OF ORBIT
FRONTAL
NOSE
2) ANT. AND POST. ETHMOIDAL FORAMINA-BETWEEN ETHMOID AND FRONTAL BONES -CONNECT ORBIT AND NASAL CAVITIES -CONTAIN ANT AND POST ETHMOIDAL N., A. AND V. (V1 AND OPHTHALMIC A.)
ANTERIOR AND POSTERIOR ETHMOIDAL FORAMINA
OPENING OF 3) NASOLACRIMAL DUCT- IN MAXILLARY, LACRIMAL BONES AND INF. NASAL CONCHA -CONTAINS MEMBRANEOUS NASOLACRIMAL DUCT AND TEARS
NASOLACRIMAL DUCT
NASOLACRIMAL DUCT
ORBIT- SERVES AS PASSAGEWAY FOR NERVES, VESSELS TO FACE, SCALP AND NASAL CAVITY
1) SUPRAORBITAL NOTCH OR FORAMEN-IN FRONTAL BONE CONTAINS SUPRAORBITAL N., A. and V. FROM V1, OPTHALMIC A. and V.
2) INFRAORBITAL FORAMEN- IN MAXILLARY BONE CONTAINS INFRAORBITAL N., A. and V. FROM V2 AND MAXILLARY
OTHER FORAMINA OF ORBIT
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