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SSN ANATOMY 5 ANSWER KEY January 30, 2003 Superficial Head & Neck: The beginnings… 1. What are the layers of the scalp? Skin Connective tissue: dense, superficial arteries and veins Aponeurosis: frontalis, occipitalis, anterior and superior auricularis Loose connective space: DANGER SPACE! Deep arteries & veins that communicate with diploic veins (and so to the dural sinuses), eyelids, superior nuchal line (posterior), temporal line (lateral) Periosteum 2. CRANIAL FOSSAE! Foramen Olfactory Foramina Location Ethmoid Bone Contents - Olfactory n Foramen Cecum Optic Canal btw ethmoid and frontal bones Sphenoid bone - Superior Orbital Fissure Sphenoid bone Foramen Rotundum Foramen Ovale Foramen Spinosum Foramen Lacerum Sphenoid bone Sphenoid bone Sphenoid bone btw Sphenoid and temporal b. Hiatus of Facial Canal Internal Auditory Meatus Temporal bone Temporal bone Jugular foramen btw Temporal and occipial b. Emissary vein - CN II – Optic Nerve - Opthalmic artery - Central vein of retina - CN III – Oculomotor Nerve - CN IV – Trochlear Nerve - CN VI – Abducens Nerve - CN V1 – Opthalmic Nerve - Superior Opthalmic Vein CN V2 – Maxillary Nerve - CN V3 – Mandibular Nerve - Middle meningeal artery - Carotid artery (runs across, not through foramen) - Greater superficial petrosal n - Greater superficial petrosal n - CN VII – Facial Nerve - CN VIII – Vestibulocochlear N - CN IX – Glossopharyngeal N CN X – Vagus N - CN XI – Spinal Accessory N (returns from C1-C5 via foramen magnum) - Internal jugular vein - CN XII – Hypoglossal N - Hypoglossal Canal Occipital bone 1 3. CSF! Please label the following, and trace the path of CSF through the ventricular system and then the path of fluid in the venous system. Straight Sinus Superior Sagittal Sinus Transverse Sinus Lateral Ventricle Third Ventricle Fourth Ventricle Cerebral Aqueduct Foramen of Monro Foramen of Magendie Subarachnoid Space Choroid plexus Superior sagittal sinus Arachnoid Villi Choroid Plexus Foramina of Luschka Arachnoid Villi Subarachnoid Space Straight sinus Lateral Ventricle Foramen of Monro Third Ventricle Transverse sinus Fourth ventricle Cerebral aqueduct Foramen of Magendie (Medial) Foramina of Luschka (Lateral) VENTRICULAR DRAINAGE: 2 Lateral Ventricles ---via Foramen of Monro 3rd Ventricle ---via cerebral aqueduct ventricle (1) central canal of spinal cord (2) via Foramen of Magendie/2 Foramina of Luschka Cisterna Magna subarachnoid space ---via arachnoid villi superior sagittal sinus 2 4th 4. CRANIAL NERVES: Start learning this NOW! Name Motor/Se nsory Function Foramen I Sensory Smell Cribriform Plate in Ethmoid II Sensory Sight Optic Canal/Foramen III Motor (& PS) Superior Orbital Fissure IV Motor All extraocular muscles except superior oblique (CN IV) & lateral rectus (CN VI) Superior oblique m V Both M & S V1 Sup. Orb. Fissure V2 Foramen Rotundum V3 Foramen Ovale VI Motor M: Muscles of mastication Tensor Tympani, Tensor Veli Palatini (via mandibular N.) S: Facial Sensation (including teeth, eye) Lateral rectus m VII Both M & S M: Muscles of facial expression Stapedius S: Ears, Taste (anterior 2/3 of tongue) Internal Acoustic Meatus VIII Sensory Hearing / Balance Internal Acoustic Meatus IX Both M & S (& PS) M: Stylopharyngeus S: Gag reflex, external acoustic meatus Taste (posterior 1/3 of tongue) Jugular Foramen X Both M & S (& PS) Jugular Foramen XI Motor M: Muscles of the palate/larynx/pharynx (except tensor veli palatine – CN VII, stylopharyngeus – CN IX) S: Throat sensation, cough reflex External acoustic meatus Taste (epiglottis) M: Trapezius, Sternocleidomastoid m XII Motor M:Tongue muscles (except palatoglossus – CN X) Hypoglossal Canal 3 Superior Orbital Fissure Superior Orbital Fissure Jugular Foramen 5. CRANIAL NERVES: A Developmental Approach Branchial Arch Derivatives (the cranial nerves that have both sensory and motor functions.) Branchiomeric nerves: have Pretrematic branches : Sensory Post-trematic branches: Both Branchia l Arch First Arch Bone Muscle - Mandible - Mm - Sphenomandibular lig. - Malleus - Incus Second Arch - Hyoid Third Arch Fourth Arch lesser horn - Stylohyoid ligament - Styloid process - Stapes - Hyoid body and greater horn - Laryngeal Cartilages of mastication tympani m. - Tensor palatini m. - Mylohyoid m. - Digastric (ant. belly) - Mm of facial expr. - Stylohyoid m. - Digastric (post. belly) - Stapedius m. - Stylopharyngeus m. - Tensor - Pharyngeal mm. m. - Cricothyroid Sixth Arch - Laryngeal Cartilages - Laryngeal mm. Innervation (Pre and Post) CN: Trigeminal Nerve (V) Pre: Maxillary N (S) Post: Mandibular N (M&S) CN: Facial N (VII) Pre: Chorda tympani (S) Post: Facial N proper (M&S) CN: Glossopharyngeal N (IX) Pre: Tympanic Branch (S) Post: Glossopharyngeal N (M&S) CN: Vagus N (X) Pre: Pharyngeal branches(S) Post: Superior laryngeal N (M&S) CN: Vagus N (X) Pre: ??? Post: Recurrent laryngeal N 6. HEMATOMAS! Subdural: Anatomy: Shearing of veins crossing through arachnoid layer → Extravasation of blood into subdural space, which is normally a “potential” space between the dura mater and arachnoid mater. Cause: Can occur with sudden jarring or blow to the head Symptoms: Low pressure venous bleed, can be asymptomatic or gradually symptomatic → Range from various levels of alertness to transient loss of consciousness Epidural: Anatomy: Tearing of middle meningeal artery → Extravasation of blood into the potential space between the two layers of the dura mater. Cause: Fracture of the temporal or parietal bone Symptoms: High pressure arterial bleed, rapidly causes symptoms associated with brain compression. Transient loss of consciousness, lucid interval (minutes to hours), death. 4 Subarachnoid: Anatomy: Rupture of cerebral artery passing in subarachnoid space on the surface of the brain. Cause: Rupture of berry aneurysm, usually found at bifurcations on the circle of Willis Symptoms: “Worst headache of my life,” nausea, vomiting. Blood in CSF on spinal tap. 7. EXTRAOCULAR MUSCLES! (What do they do to the eyeball? And what is the innervation?.) Muscle Primary Action Secondary Action (Normally Innervation canceled out) Superior Rectus Elevation Adduction / intorsion Inferior Oblique Elevation Abduction / extorsion Inferior Rectus Depression Adduction / extorsion Superior Oblique Depression Abduction / intorsion Medial Rectus Adduction - Lateral Rectus Abduction - Levator Palpebrae Superioris Raises upper eyelid - 5 Superior branch of CN III Inferior branch of CN III Inferior branch of CN III Trochlear N (CN IV) Superior branch of CN III Abducens N (CN VI) Superior branch of CN III 8. Cervical Plexus! Please label the following: CN XII Transverse Cervical N. Supraclavicular N. Mm of Tongue Lesser Occipital N. Sternothyroid m. Phrenic N. Omohyoid m. SENSORY MOTOR Hypoglossal N Muscles of Tongue C1 Greater auricular N Lesser occipital N Transverse Cervical N Supraclavicular N Sternohyoid m. Ansa Cervicalis Geniohyoid /Thyrohyoid Mm Greater Auricular N. Ansa Cervicalis C2 C3 Geniohyoid Thyrohyoid Sternohyoid Sternothyroid C4 Omohyoid C5 Phrenic N NOTE: Figure does not include innervation to SCM and Trapezius. These muscles receive two sources of innervation – 1) Spinal Accessory Nerve (C1-C5 coursing back up via foramen magnum, and then returning via jugular foramen) 2) Nerves directly to muscles via spinal nerves C2-C4 (see Netter 121) 6