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PRACTICE PRACTICAL EXAM HEAD AND NECK PART III Spring 2016 Key on slide 13; Review slides 1416 1 1. IDENTIFY SPECIFIC STRUCTURE AT TIP OF ARROW 2. WHAT TYPE(S) OF MOVEMENT OCCUR AT THIS JOINT? 2 AP View Xray of patient with open mouth 3 3. IDENTIFY STRUCTURE FOUND IN THIS LOCATION. 4. IDENTIFY NERVE 5. IDENTIFY NERVE 4 5 6 LARYNX AND LARYGO‐ PHARYNX IN POSTERIOR VIEW (Pharynx opened) 6. WHAT IS THE SPECIFIC STRUCTURE (SPACE) THE TIP OF THE PROBE IS IN? 7 7. A. IDENTIFY MUSCLE B. TYPES OF NEURONS THAT INNERVATE THIS MUSCLE VIEW OF SUBOCCIPITAL MUSCLES (Muscles removed on left) 8 9 C1 8. WHAT NERVE INNERVATES THIS MUSCLE? C2 9. IDENTIFY ARTERY. 10 10. IDENTIFY STRUCTURE AT TIP OF ARROW. 11 12 11. ACTION(S) OF THIS MUSCLE? 12. IDENTIFY MUSCLE. 13. IDENTIFY MUSCLE (BE SPECIFIC) 13 14 14. WHAT IS THE ANTERIOR ATTACHMENT OF THIS MUSCLE (BE SPECIFIC). 15. WHAT IS THE SPECIFIC TERM FOR THIS REGION? 14 KEY 1. Spinous process (bifid) of C2 vertebra (Axis) 2. Rotate C1-C2 (shake head 'no') 3. Pharyngeal tonsil (roof of nasopharynx) 4. Accessory nerve (CNXI) 5. Vagus nerve (CNX) 6. Piriform recess (popcorn 2, lateral to laryngeal inlet) 7. A. Stylopharyngeus, B. Branchiomotor 8. Suboccipital nerve (dorsal ramus C1) 9. Vertebral artery 10. Pedicle of vertebra 11. Extend C1-Occipital bone, Rotate C1-C2 12. Obliquus Capitis Inferior 13. Superior Pharyngeal Constrictor 14. Hyoid bone 15. Oropharynx Rectus Capitis Post. Minor REVIEW: SUBOCCIPITAL MUSCLES Rectus Capitis Post. Major Obliquus Capitis Superior Obliquus Capitis Inferior Semispinalis reflected 1. Rectus Capitis Post. Minor - C1 to Occipital bone; Extend 2. Rectus Capitis Post. Major - C2 to Occipital bone: Extend, Rotate 3. Obliquus Capitis Superior - C1 to Occipital bone; Extend 4. Obliquus Capitis Inferior C2 to C1; Rotate All innervated by Suboccipital N. (dorsal ramus C1) SUBOCCIPITAL MUSCLES ACTIONS DEDUCED FROM ORIGIN-INSERTION OCCIPITAL BONE flex‐extend C1 - ATLAS rotate C2 - AXIS Rectus Capitis Posterior Minor Rectus Capitis Posterior Major Obliquus Capitis Superior Obliquus Capitis Inferior 1. Rectus Capitis Posterior MinorExtend 2. Rectus Capitis Posterior MajorExtend/rotate 3. Obliquus Capitis SuperiorExtend 4. Obliquus Capitis InferiorRotate SUBOCCIPITAL TRIANGLE = Rectus Capitis Posterior Major, Obliquus Capitis Inferior, Obliquus Capitis Superior REVIEW: LIGAMENTS OF CRANIO-VERTEBRAL JOINTS SUPERIOR BAND 4. CRUCIATE (CROSS) LIGAMENTparts 1) Transverse Ligament of Atlas INFERIOR BAND 2) Superior Band to Occipital Bone 3) Inferior Band - Body of C2 REVIEW: PHARYNX CONSTRICTOR MUSCLES BUCCINATOR SUPERIOR CONSTRICTOR O - Pterygomandibular Raphe (Connective tissue 'ligament' from Medial Pterygoid plate to Mandible) CONTINUOUS ANT. WITH BUCCINATOR) Superior Constrictor Middle Constrictor Inferior Constrictor PTERYGOMANDIBULAR RAPHE MIDDLE CONSTRICTOR O - HYOID INFERIOR CONSTRICTOR O - THYROID & CRICOID Cartilage Tell Constrictors Apart by level