Head and Neck Clinical
Cricothyrotomy - through what ligament?
Median Cricothyroid Ligment
Thyroid Gland Enlargement is called
Loss of SNS to one side of head 1. partial ptosis (tarsalis muscle) 2. miosis (papillary constriction) 3. anhydrosis (no sweating 4. vasodilation (flushing)
CN III Palsy, can't do what?
Can't adduct, elevate, depress during abduction. + pupilary dilation and ptosis
Stair Step Diplopia - what nerve?
CN IV - Trochlear Nerve, down and in.
Bell's Palsy, what nerve? What features?
CN VII. Muscles of facial expression are weak/paralyzed on one side of face. Decreased naso-labial fold, mouth 'down'.
"Stick out your tongue"
Action of the Genioglossus is to move the tongue toward the midline, tongue deviates toward the paralyzed side.
Affected over the cutaneous distribution, unilaterally
"Danger area of the scalp"
Loose Connective Tissue
Synovial, with meniscus strong lateral lig., has anterior tubercle to prevent dislocation, condyles over the articular eminence w pain
Fracture of Zygomatic Arch
Aff: V1 Eff: VII, orbicularis oculi
Aff: CN II Eff: CN III, parasympathetic
Aff: CN II Eff: CN VII
Facial Paralysis, not Bell's
Skull fracture, facial nerve laceration, post-surgical, parotid tumor, otitis media.
Asphyxia, Bacterial meningitis, Congenital perinatal infections, Defects of H&N, Elevated bilirubin, Family Hx, Gm birth wt
Earache. Referred pain from Tooth abscess, Cancer of tongue, Tonsilitis, Cancer of larynx, Otitis media, TMJ, Cervical spondylosis, Herpes Z
Middle Ear Infection
Tympanic membrane perforation, Taste alteration, Facial paralysis, Mastoiditis, Balance alteration, Meningitis, Temporal lobe abscess, Hearing alteration. (v3, 7, 9, 10)
Keyhole pupil. Failure of closure of retinal fissure. Defect in iris.
Between neural and pigment layers. Congenital or due to trauma to eye.
Distal hyaloid vessels degenerates after 6th month, but sometimes remain. Floaters
Absence of Iris. Bad optic cup development.
No Lens. Poor formation of lens placode.
White/opaque lens at birth. Rubella.
Small eye, arrested development. Rubella.
No eye, + eyelids. Other defects associated
Hidden eye - palpebral fissure development poor. Small/defective eye behind the skin.
External Meatal Plug
recanalization failure. External auditory meatus, 9th yr. full-size
Ear bones MIS, adult size at birth
Which part of the ear develops first?
Inner ear, from the otic pit/vesicle.
Deaf Mutism. Can be genetic. Can be part of first arch syndrome or nerve
During 7-8 weeks may cause maldevelopment of spiral organ of corti of inner ear, deafness.
Crocodile Tears/Gustolacrimal Reflex
Unilateral & spontaneous tearing along with normal eating/salivation. With facial paralysis or misdirected regenerating nerve
Idiopathic (no idea why). use nasal spray
Nasal stufiness during sex. Side effect of sildenafil (viagra) bc erectile tissue is similar. may be hormonal
Aff: CN IX Eff: CN X
Aff: CN X Eff: CN X
Danger Zone of Face
Triangle formed by upper lip and nose, drains to cavernous sinus. thrombosis danger to CN III, IV, V1, V2, VI and ICA.
Hay Fever Ganglion
Ptergopalatine Ganglion (PT)
Can be at foramen cecum which is embryonic site of attachment to thyroglossal duct.
Sublingual Drug Administration
Absorption through veins, close to surface
Tongue-tie. Short Frenulum. Speech, eating probs
Nasolacrimal groove development
Between maxillary & lateral nasal processes
Oblique Facial Cleft
Failure of maxillary process to fuse with lateral nasal process & medial nasal process on same side, open nasolacrimal duct.
Cleft Lower Lip
Failure of fusion of mandibular processes
Between primary and secondary palate
Anterior Cleft Anomalies
Cleft upper lip and gum, failure of fusion between primary & secondary palate.
Posterior Cleft Anomalies
Failure of fusion between lateral palatine processes, behind incisive fossa - soft palate
Sinuses present at birth
Maxillary & Ethmoidal, small at birth
Breast-feeding discomfort, tongue lacerations, can be aspirated
Pitted or fissured, nutritional deficiency
Blue/black in erythroblastosis fetalis, yellow if tetracyclines taken when formed.
Anterior to SCM. Failure of obliteration of cervical sinus.
Cervical sinus and 2nd cleft (ext.) or pouch (int.) not obliterated
Persistence of 2nd pouch & cleft. Opening into tonsillar sinus internally, between ICA and ECA externally.
Remnants of 1st groove or detached ectodermal folds, pit in front of ear/earlobe
Failure of neural crest migration to 1st arch. Micrognathia, 50% cleft palate, conductive hearing loss, malformed pinna, drooping of lateral eye, small zygoma.
Micrognathia/retrognathia (sm jaw w normal tongue)- glossoptosis (tongue in pharynx) leads to cleft palate. Feeding and respiratory problems. May outgrow.
Chromosome 22 (catch 22). Faulty migration of neural crest. Exposure to retinoids, EtOH, maternal diabetes mellitus. No Thymus. 3rd and 4th pouch derivates under-developed.
Laryngitis (inflammation). Squamous cell carcinoma. Nodules (fr singing). Papilloma.
Overproduction of CSF, Obstruction in CSF flow
Movement of CSF into venous system impaired (through loss of arachnoid granulations, subarachnoid hemorrhage)
Rupture of artery/aneurysm, mostly fatal. Hypertension related. Severe headache, stiff-neck.
Arterial (fast bleed, middle meningeal artery). Trauma, concussion leads to loss of consciousness followed by lucid interval then drowsiness, coma. "lens, lentil shaped"
Venous (slow bleed). Superior cerebral vein related. Reason may be trivial, forgotten, contusion. No lucid interval post loss of consciousness. "crescent shaped"
Arterial (fast bleed, aneurysm, laceration), meningeal irritation, worst headache, stiff neck, loss of consciousness. "tree shaped"
Bone in CT
Fat in CT
Fat & Bone in MRI
various shades of Grey
Folic Acid Supplements
Avoid Neural Tube defects
Failure of rostral neuropore to close, alpha-fetoprotein in maternal serum amniotic fl.
Defect in cranial vault, midline.
Protrusion of meninges + CSF
Protrusion of meninges + CSF + brain
Protrusion of meninges + CSF + brain + ventricle
1:15,000 births, facial defects. Severe, fatal. No cleavage of the forebrain. EtOH abuse during pregnancy. Cyclop (one eye).
Distance between eyes is reduced
Cerebellum herniates into the foramen mag. Posterior cranial fossa is small, CN IX, X and XII may be stretched - speech, swallowing may be affected.
Small brain resulting from genetics, maternal EtOH, maternal CMV or rubella, exposure to radiation.
Tumor of remnant of anterior pituitary