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Modified: Wednesday, 16-Nov-2005 19:38:55 EST
The Structural Basis of Medical Practice (SBMP) - Human Gross Anatomy, Radiology, and Embryology
Essay Answer Guide for Head and Neck Examination Part IV (36 pts) - October 28, 2005
The College of Medicine at The Pennsylvania State University
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Review the anatomy of the vertebral triangle. Include bones, spaces, relationships, contents,
vascularization, innervation, and lymphatic drainage. (12 pts).
- General Comments
- The vertebral triangle shares a lateral border with the anterior border of the interscalene triangle.
This common border is provided by the interscalene muscle. The vertebral triangle and its contents
account for the predominant features of the root of the neck.
- Bones, Spaces, and Borders
- Superior - Transverse Process of C6 (carotid tubercle is key relationship)
- Inferior - First rib from verterbal body T1 to insertion of anterior scalene (first part subclavian artery) -
- Anterior - Prevertebral Fascia
- Posterior - Intrinsic posterior cervical muscles at posterior border of transverse process C6 - T1
- Medial - Vertebral bodies of C6 - T1 and longus colli
- Lateral - Anterior Scalene Muscle
- Contents and Relationships
- Intrinsic
- Vertebral artery (transverse process of C6)-
- Vertebral vein (transverse process of C7) -
- Subclavian artery -
- Thyrocervical trunk and branches (4) -
- Costocervical trunk and branches (2) -
- Dorsal scapular artery (inconsistent) -
- Internal thoracic artery (definitional) -
- Phrenic nerve -
- Stellate and vertebral sympathetic trunk ganglia -
- Ansa subclavia -
- Thoracic duct -
- Extrinsic
- Carotid sheath and contents -
- Cervical sympathetic trunk -
- Recurrent laryngeal nerve -
- Roots C6 - T1 brachial plexus (arguably intrinsic) -
- Innervation
- Cervical and brachial plexuses -
- Sympathetic trunk and derivatives -
- Lymphatic drainage
- Compression of the common carotid artery
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Review the anatomy of the cavernous sinus. Include bones, spaces, boundaries, relationships, contents,
vascularization, innervation, and lymphatic drainage. Specify the venous sinuses that directly communicate
with the cavernous sinus. Further, discuss routes of infection to the cavernous sinus from the face, scalp,
and ischiorectal fossa. What are the expected neural and vascular symptoms resulting from damage to each
structure within the cavernous sinus? Consider that the damage is isolated to the structure being discussed.
Explain why one eye is adducted at the onset of symptoms whereas, eventually, both eyes are adducted.
What is pulsatile exophthalmos? (12 pts.)
- General Comments
- The cavernous is a venous blood sinus (not an air sinus) created by divergent layers of periosteal and
meningeal dura. It is located in the middle cranial fossa adjacent to the sella turcica. Immediately
medial to the thin lateral border of the sella turcica is the sphenoid air sinus. This relationship
puts the cavernous sinus at risk during transphenoidal surgery of the hypophysis. Five of the 12
crainial nerves have components at risk during pathology of the cavernous sinus.
- Bones
- Sellae turcica -
- Greater wing of sphenoid -
- Boundaries and Spaces
- Superior -
- Inferior -
- Anterior -
- Posterior -
- Medial -
- Lateral -
- Contents, Relationships, and Clinical Symptoms
- Internal carotid artery -
- Internal carotid plexus -
- Sympathetic root of the ciliary ganglion -
- Deep petrosal nerve -
- Greater superficial petrosal nerve -
- Oculomotor nerve (and branches) -
- Trochlear nerve -
- Ophthalmic nerve (V1) and branches -
- Maxillary nerve (V2) -
- Abducens nerve -
- Vascularization
- Hypophyseal arteries -
- Ophthalmic vein -
- Sphenoparietal sinus -
- Superior petrosal sinus -
- Inferior petrosal sinus -
- Emissary vein to pterygoid venous plexus -
- Intercavernous sinus sinus -
- Innervation
- Meningeal branches of maxillary and mandibular nerves -
- Routes of Infection
- Face and Orbit -
- Scalp -
- Infratemporal fossa -
- Ischiorectal fossa and internel vertebral venous plexus -
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Review the relationships and function of the masseter muscle. Include bones, articulations,
ligaments, spaces, movements, and limitations of movement, vascularization, innervation, and
lymphatic drainage. (12 pts)
- General Comments
- Bones and Relationships
- Superior -
- Inferior -
- Anterior -
- Posterior -
- Medial -
- Lateral -
- Articulations
- Brief account of temporomandibular joint -
- Ligaments
- Sphenomandibular ligament -
- Pterygomandibular raphe -
- Spaces and Regions
- Buccal fatpad -
- Parotid region -
- Infratemporal fossa -
- Temporal fossa -
- Movements, and Limitations of Movement
- Elevation -
- Deviation -
- Grinding -
- Occlusion -
- Sphenomandibular ligament -
- Stylomandibular ligament (investing fascia) -
- Vascularization
- Inferior alveolar artery -
- Masseteric artery -
- Lingual artery -
- Transverse facial artery -
- Maxillary artery -
- Retromandibular vein -
- External jugular vein -
- Pterygoid venous plexus and maxillary vein -
- Facial vein and branches -
- Innervation
- Motor innervation by masseteric nerve branch of mandibular nerve -
- Relationships to facial nerve branches -
- Relationships to buccal nerve -
- Lymphatic drainage
- Submental nodes -
- Submandibular nodes -
- Deep cervical nodes -
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The Structural Basis of Medical Practice - Human Gross Anatomy
The College of Medicine
of the The Pennsylvania State University
Email: lae2@psu.edu
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