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9 LO: Anatomy of the upper respiratory tract
Terms in this set (14)
Specify functional nerve modalities specific to each of the twelve cranial nerves.
Some = olfactory nerve, SS (smell)
Say = optic nerve, SS (vision)
Marry = oculomotor nerve, somatic efferent and visceral efferent
Money = trochlear nerve, somatic efferent, Superior oblique muscle
But = trigeminal nerve, both
- V1 = somatic afferent
- V2 = somatic afferent
- V3 = somatic afferent and efferent
My = abducens nerve, motor
Brother = facial nerve, both
Says = vestibulochochlear, sensory
Big = glossopharyngeal nerve, both
Brains = vagus nerve, both
Matter = spinal accessory nerve, motor
Most = hypoglossal nerve, motor
SS = special sense (main senses except for taste)
Smell, sight, hearing, and balance
S = sensory
M = motor
B = both
V1 = ophthalmic nerve
Sensory (somatic afferent)
Anterosuperior aspect of nose (bridge and tip of nose) and forehead
Anterior scalp, ethmoidal, frontal, and sphenoidal sinuses
And some parts of the dura mater
V2 = maxillary nerve
Sensory (somatic afferent)
Sides of nose (posteroinferior aspect)
Midface and temples
Palate, maxillary dentition (which is fancy for upper row of teeth)
Dura mater in the cranial cavity
V3 = mandibular nerve
Sensory and motor (somatic afferent and efferent, respectively)
Branchiomotor fibers, specifically
These are motor neurons that come from the pharyngeal arches, NOT SOMITES
Sensory division: looks like chin-strap beard
Tongue mucosa (front 2/3)
Proprioceptive info from chewing muscles (masticators)
Innervates 4 masticators (masseter, temporalis, medial pterygoid, lateral pterygoid
Ear muscles (tensor tympani)
Suprahyoid region of neck
Specify the functional nerve modalities specific to each of the following primary branches of CN VII: motor branch, chorda tympani and greater petrosal.
Facial expression muscles
Stapedius muscle of middle ear
Innervation for salivary glands
- Preganglionic parasympathetic fibers -> submandibular ganglia -> submandibular and sublingual salivary glands
- Front 2/3 of tongue
Greater (superficial) petrosal nerve:
Innervation for making tears and mucus
Preganglionic parasympathetic fibers -> pterygopalatine ganglion -> lacrimal and mucus-producing glands
Soft palate (not major
sinuses of the skull
Sinus's Location Relative to Lateral Nasal Wall:
Frontal Sinus - Superior Lateral
Ethmoid Sinus - Lateral
Sphenoid Sinus - Posterior Lateral and Deep
Maxillary Sinus - Inferior Lateral
Specify where the following structures open into the nasal cavity: anterior, middle and posterior ethmoidal air cells, frontal sinus, sphenoid sinus, maxillary sinus, nasolacrimal duct.
Anterior Ethmoidal Air Cells - Middle Meatus of the lateral nasal wall (semilunar hiatus)
Middle Ethmoidal Air Cells - Middle Meatus of the lateral nasal wall (ethmoidal bulla)
Posterior Ethmoidal Air Cells - Superior Meatus of the lateral nasal wall
Frontal Sinus - Middle Meatus of the lateral nasal wall (semilunar hiatus)
Sphenoid Sinus - Drains independently to the sphenoethmoidal recess of the lateral nasal wall
Maxillary Sinus - Middle Meatus of the lateral nasal wall (semilunar hiatus)
Nasolacrimal Duct - Inferior Meatus of the nasal cavity
Explain the anatomical basis of tooth pain secondary to maxillary sinus infections.
Due to the proximity of the maxillary sinuses to the roots of the maxillary dentition, infections of the maxillary sinus can be associated with tooth pain.
Distinguish the locations of arterial plexuses in the nasal cavities that result in epistaxis; explain the typical management of each
Kiesselbach's Plexus (Area) - The area where the Anterior Ethmoidal Artery (Ophthalmic Artery),
Lateral Nasal branch of Sphenopalatine Artery (Maxillary Artery), and Septal Branch of Superior Labial
Artery (Facial Artery) anastomose in in the nasal Cavity. Accounts for 90% of Nosebleeds.
Anterior (Kiesselbach's Plexus) bleed Management:
- Direct pressure for 10-15 minutes will often resolve mild case
- Sit patient forward so blood does not drain into nasopharynx
- Ingested blood can cause nausea and vomiting
- Ingestion of blood prevents accurate estimation of blood loss as it cannot be visualized
- Topical vasoconstriction- pledgets soaked with oxymetazoline may be used
- Cautery- silver nitrate sticks
- Nasal packing
- 3-5 days
▪Nasal tampons (eg. Rhino Rocket)
▪ Balloon catheters
- Some hospitalize if bilateral packing is used due to concern for airway obstruction
- Prophylactic antibiotics can be considered due to concern for development of toxic shock
Woodruff's Plexus - Made from contributions of the Sphenopalatine Artery (Maxillary Artery), Ascending
Pharyngeal Artery (from External Carotid Artery), and Internal Maxillary Veins. Accounts for 10% of all
Posterior Woodruff's Plexus Bleed Management:
- More difficult to manage
- Hospitalization is recommended for most posterior bleeds as they are more difficult to control
- Nasal packing
o Balloon catheter
o Cotton packingo Consider antibiotics
Specify the routes by which infections of the nasal cavities can spread to other locations.
Routes for Spread of Infections: o
o Infections of the nasal cavities may spread to the nasopharynx via the choanae and then on to the middle ear via the auditory tube.
o The nasolacrimal duct is a route for the spread of infections from the upper
respiratory tract to the conjunctiva of the eye/eyelids.
o Infections of the nasal cavities may spread to the anterior cranial fossa through the cribriform foramina.
Specify the function of the olfactory nerve and describe its anatomical relationship with the cribriform plate and nasal cavity walls.
The Olfactory Nerve is a sensory nerve that carries information concerned with the special sense of smell. Filaments of the Olfactory Nerve penetrate through the Cribriform Plate into the Nasal Cavity where they rest on the superior aspects of the Nasal Cavity Wall.
Describe how to elicit the gag reflex and specify its afferent and efferent limbs
Gag Reflex - Stimulation of the Glossopharyngeal nerve territory in the region of the oropharyngeal isthmus elicits the gag reflex, which is a reflex contraction of the palatoglossus and palatopharyngeus muscles that initiates swallowing. The gag reflex is triggered at the end of the oral preparatory stage when voluntary movements of the tongue position the food bolus against the forward bulge of the uvula and soft palate. Clinicians take advantage of the gag reflex to assess the status of the glossopharyngeal nerve. The afferent limb of this reflex is the Glossopharyngeal nerve; the efferent limb of this reflex is the Vagus nerve (which innervates the palatoglossus and palatopharyngeal
Describe how the glossopharyngeal nerve (CN IX) and the vagus nerve (CN X) are assessed clinically.
Glossopharyngeal nerve (CN IX) - Clinicians take advantage of the gag reflex to assess the status of the glossopharyngeal nerve.
Vagus nerve (CN X) - Function of the Vagus nerve is assessed clinically by observing the soft palate and uvula when having the patient say "ah" or "kah". If the right and left Vagus nerves are both intact and normal, the soft palate should elevate symmetrically. When one side is weak or paralyzed the uvula will deviate to the un-affected side (away from the affected side).
List the lymphatic tissues that form "Waldeyer's Ring" and specify their locations.
Waldeyer's Ring - The aggregation of lymphoid tissues "guarding" the openings of the digestive and respiratory tracts is known as Waldeyer's Ring. Most prominent among these lymphatic tissues are the Palatine, Lingual, and Pharyngeal Tonsils.
Lingual Tonsils - Are a collection of lymphatic tissue located in the lamina propria of the root of the tongue
Describe the palpatory location and clinical significance of the "tonsillar" node of the deep cervical chain.
Tonsillar (Jugulo- Digastric) node - Lymph from the palatine tonsil drains directly to the Jugulo- Digastric node, a large node of the superior group of the deep cervical chain. This "tonsillar" node is frequently enlarged and readily palpable when the palatine tonsil is inflamed (tonsillitis). This node is palpated anterior to the Sternocleidomastoid Muscle.
Specify the cranial nerves that transmit general sensory information and pain from the following regions of the upper respiratory tract: nasal cavity walls and paranasal sinuses, opening of the auditory tube, oropharynx and tonsillar fossae, laryngopharynx and larynx.
Nasal Cavity Walls - General sensory innervation from both the Ophthalmic Nerve (CN V1 - e.g., Ethmoidal Nerves) and the Maxillary Nerve (CN V2 - e.g., Lateral Nasal and Nasopalatine Nerves)
- Frontal sinus - Branches of Ophthalmic Nerve (CN V1)
- Ethmoid sinus - Branches of Ophthalmic Nerve (CN V1)
- Maxillary sinus - Branches of Maxillary Nerve (CN V2)
- Sphenoid sinus - Branches of Ophthalmic and Maxillary Nerves (CN V1 & CN V2)
Opening of the Auditory Tube - Sensory information provided by CN IX Glossopharyngeal Nerve
Oropharynx/Tonsillar Fossae - Sensory information provided by CN IX Glossopharyngeal Nerve
Laryngopharynx/Larynx - Sensory information provided by CN X Vagus Nerve
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