HUMAN ANATOMY DEPARTMENT
Methodical instruction for 1st year students
Module 4. Vessels and nerves of head and neck
Ternopil 2009
Module 4. Vessels and nerves of head and neck
Lesson No 26
Theme. Common carotid artery. Vascular nervous bundle of the neck. External carotid artery (neck branches). Practical skills on senses organs preparations
Aіm: Study the structural and topographical peculіarіtіes of carotid arteries and branches.
The professіonal orіentatіon. Affection of aorta and its branches is a severe pathology, often dangerous to patient’s life and is not infrequent in medical practice (pathology of vessels in atherosclerosis, infectious diseases, congenital anomalies). The diagnostic and medical manipulations on vessels cannot be executed without knowing their normal anatomy. It is also impossible to determine a place of localization of pathological process, relying on clinical signs.
Base level of knowledge and skіlls
1. Skeleton of thoracis cage, neck and skull.
2. Muscles of the neck and head.
3. Organs of the neck and head.
I. Practical studies – 9:00-11:15 am (3 hours)
1. Studing external carotid artery, which supply with blood organs of a head and neck from the outside, to specify the place, where it is pressed at bleedings (carotic tubercle of Jasegnac). Pay attention to anastomoses.
2. Specify three groups of vessels, which origine from external carotid artery.
3. Pay attention to functional role of carotid, cardioaortal reflexogenic zones, and carotid glomus. Show a Pirogov’s triangle.
4. Studying thoracic aorta, describe its topography and branches, which spring from it.
Іllustratіve materіal
1. Demonstration corpse.
2. Study corpse.
3. Skeleton.
Methods of practical work.
Dissection the vessels of the neck. For better access to vessels and nerves bundle of neck teacher is suggests for students to cut manubrium in saggital plane and clavicle in middle plane. The sternoclaudomastoid muscle is carefully separated and turn away together with part of manubrium and clavicle. Then in anterior part of neck the students can find the neuro-vessel bundle which on either sides of trachea and pharynx. The dissection is done for common and external carotid arteries, also for anterior branches of external carotid artery (upper thyroid, lingual, facial and their branches)
· Practical skills and abilities of students, demonstrate on preparations:
Corpse with prepared vessels of a head and neck: anterior group of branches of external carotid artery (superior thyroid, lingual, facial arteries), their branches and sites of a branching; posterior group of branches of external carotid artery (sternocleidomastoid, occipital, auricularis posterior arteries), their branches and sites of a branching, medial group – ascending pharyngeal artery, its branches and sites of branching; final branches – superficial temporal artery, maxillary artery, their branches and sites of a branching.
II. Seminar discussion of practical work 11:45 am – 13:15 pm (3 hours)
Situational TASK.
1. The wound of a hairy part of a head is accompanied by profuse bleeding. What anatomic peculiarities of vessels of soft tissues of a brain part of a head determines significant bleeding in such wounds?
The answer: arterial vessels are in subcutaneous fat and their adventition grows strongly together with connective intersections, which connect skin with tendinous helmet. The vessels are iormal condition, their lumen gapes.
2. For uncovering the bones of a skull fornix the radial sections in the temporal area are made. What is this direction of sections determined by?
The answer: the direction of all arterial trunks in a brain part of the head is radial (as well as that of nervous trunks), therefore at such sections integrity of neurovascular fascicles is preserved as much as possible.
3 Patient with a trauma in temporal area and fracture of zygomatic bone has signs of intracranial hemorrage. What artery is injured most likely ?
The answer: a. meningea media.
4. Patient has profuse bleeding from branches of maxillary artery. Since this artery, owing to deep bedding on the face is inaccessible to bandaging, there was a necessity to tie up external carotid artery within carotid triangle. What topographical reference point should be used to distinguish external carotid artery from internal one in this site?
The answer: external carotid artery on a neck has artain amount of branches, unlike internal, that has no branches on a neck; external carotid artery goes forward and medially and lays more superficially, than internal carotid artery, that goes laterally and deep.
5. Patient has a wound in the area of the face that is accompanied by bleeding from branches of facial artery. Where is it possible to press a. facialis for temporary stop of bleeding?
The answer: artery can be pressed to a body of the lower jaw near anterior border of a chewer.
· Discussion of theoretical questions:
1. What parts of a head and neck are supplied by external carotid artery?
2. In which triangle is the common carotid artery divided into external and internal?
3. Show a place, where the common carotid artery can be palpated.
4. What is the practical role of Pirogov’s triangle?
5. Where is the carotic sinus and glomus located?
6. Into which groups are the branches of external carotid artery devided?
7. Which branches belong to anterior group?
8. Which branches belong to medial group of external carotid artery?
9. Composition and position of vascular nervous bundle of the neck.
10. Which branches belong to posterior group of external carotid artery?
11. Topography and region of supplying of lingual artery.
12. Topography and region of supplying of facial artery.
13. Topography and region of supplying of superior thyroid artery.
ІІІ. Тest control – 14:15 – 15:00 pm (1 hour)
References:
а) basic
1.Gray`s Anatomy. Lawrence H.Bannister, MartinM.Berry, Patricia Collins and others. Churchhill Livingstone, – 1999. 2092 p. 2. W. Kahle, H. Leonhardt, W. Platzer. Colour atlas and Textbook of Human Anatomy. –
b) additional
Lesson No 27
Theme. Lymphatic vessels and nodes of the neck. System of internal jugular vein. Superficial veins of the neck
Aіm: Study the structural and topographical peculіarіtіes of lymphatic and venous drainage of neck. To study the structure of lymphatic system, separate organs, tributaries to thoracic lymphatic trunk and to right lymphatic duct.
The professіonal orіentatіon. Superior vena cava and brachiocephalic trunk are in complex relations with organs of mediastinum surrounding them. Therefore disturbance of blood flow in this vessels may be indicate not only of disease of veins, but also of pathological process of organs of this area. In a brain part of the head there is an anatomic unity of four layers of veins: veins of soft covers of fornix, intraosteal veins, veins of dura mater (venous sinuses), and also intracerebral veins. Therefore any infection of soft covers of the head is dangerous in view of spread of infection to the cavity of skull. Veins of the face form plexus, that anastomose with veins of the cavity of skull and the orbits, and these anastomosis lack valves, therefore there is a real danger of spreading odontogenous inflammatory processes of jaws and paramaxillary soft tissues on these anastomosis.
Base level of knowledge and skіlls
1. Skeleton of thoracis cage, neck and skull.
2. Muscles of the neck and head.
3. Organs of the neck and head.
I. Practical studies – 9:00-11:15 am (3 hours)
Іllustratіve materіal
1. Demonstration corpse.
2. Study corpse.
3. Skeleton.
4. Tables “Venous system”.
Methods of practical work.
Work 1. Dissection of superficial veins of neck.
The students under the direction of teacher are making skin cuts on the left side of the neck and midial section from the chin to the jugular notch of the manubrium. Transverse section is made on the level of superior margin of neck. The cut along the clavicle to the acromion of scapula was made during the previous lesson. Then cautiously (not damaging platisma) dissection is made to the left from the midial cut. After that, the left platisma is exposed and cut near the base of mandible and is pulled to the side. Now the anterior external jugular vein and its branches can be viewed.
Work 2.Dissection of superficial vessels of face.
The students under the direction of teacher are making skin cuts on the left side of the face: midial-from the parietal bone to chin, circular-along the orbits, nostrils and oral cavity. Skin is carefully separated (not damaging mimetic muscle) dissected and pulled back to auricle of the ear. Then dissection of superficial vessels of face (facial artery and vein, retromandibular vein, superficial temporal artery and theirs branches) are made. take the cuts on left part of face. A skin cautiously exfoliate (to not to damage mimetic muscles), prepare and turn away to concha. Prepare the superficial facial vessels (facial artery and vein, retromandibular vein, superficial temporal artery and their tributaries).
· Practical skills and abilities of students, demonstrate on preparations:
1. Studying the internal jugular vein pay attention to its topography in the structure of vascular-nervous fascicle of the neck, its division into intracranial and extracranial tributaries, their connection.
2. Name intracranial tributaries to internal jugular vein.
3. Study extracranial tributaries to internal jugular vein and their anastomosis.
4. Studying external jugular vein, pay attention to its tributaries and places of confluence.
5. Study formation of anterior jugular vein and place of it confluence.
6. To know topography of subclavian vein and its tributaries.
7. Prepared corpse, lymphatic nodes in a site of head, neck, chest, abdominal cavity, shoulder girdle and upper limb, pelvis and lower limb. Thoracic lymphatic duct, left and right venous circulation.
8. Superior vena cava, left and right brachiocepalic veins, subclavian vein, anterior jugular veins, external jugular vein and its tributaries (their anastomosis), internal jugular vein with it extracranial tributaries (anastomosis), sinuses of dura mater.
II. Seminar discussion of practical work 11:45 am – 13:15 pm (3 hours)
The answer: cavernous sinus (superficial veins of the face – ophthalmic veins – cavernous sinus).
2. Patient has thymoma (the tumour of thymus) causing compression of a trunk of superior vena cava. Congestion in tributaries of vein is clinically manifested in cyanosis, edema and expansion of subcutaneous venous net. In what areas of a body will these symptoms be observed in this case?
The answer: in the face, neck, upper part of torso and upper limbs.
3. “Syndrome of superior vena cava ” is connected with compression of a vessel by neighbouring organs. In what organs the pathological process may be clinically manifested by signs of congestion in tributaries of superior vena cava?
The answer: pathological process in thymus, right lung, ascending aorta.
4. Surgical intervention on the parotid gland for purulent parotititis is complex as may become the cause of disturbance of integrity of vessels and nerves. Is there a danger of injuring large vein? If yes, then which?
The answer: yes; retromandibular vein, which passes through parotid gland.
The answer: а) vein of the nose – superior ophthalmic vein – cavernous sinus; б) external nasal veins – facial vein – pterygoid plexus – veins of dura mater – veins of a cavity of skull; в) external nasal veins – facial vein – pterygoid plexus – orbital veins – cavernous sinus.
6. Child in the age of 3 years has enlarged painful lymphatic node on mastoid process. Where first will you search for the focus of inflammation?
The answer: in site of auricle floor and the skin of parietal area.
· Discussion of theoretical questions:
1. Which vessels form superior vena cava?
2. With what organs does superior vena cava border?
4. Whence does internal jugular vein collect blood?
5. What does the internal jugular vein continue?
6. Where does the internal jugular vein begin?
7. Which expansions has the internal jugular vein?
8. Describe topography of internal jugular vein in the structure of vascular-nervous fascicle of neck.
9. What intracranial tributaries of internal jugular vein do you know ?
10. What are diploid and emissar veins? Where are they located? What do they drain?
11. Where do diploid veins fall in?
12. Whence do superior and inferior ophthalmic veins collect blood? What are their anastomosis?
13. How are veins of a labyrinth formed and where they run?
14. Name extracranial tributaries of internal jugular vein.
15. Whence does the facial vein collect blood?
16. Whence does the retromandibular vein collect blood? It’s anastomosis.
17. Describe topography of pharyngeal and lingual veins.
18. Whence does the superior thyroid vein collect blood?
20. Whence does the external jugular vein collect blood?
21. How are anterior jugular veins formed and where they run?
22. Describe topography of subclavian vein.
23. Where does thoracic duct fall? What lymphatic trunks fall into it?
24. From what partes of a body does thoracic duct collect lymph?
25. From what trunks is right lymphatic duct formed and where it pass?
26. From what parts of a body does right lymphatic duct collect lymph?
27. What lymphatic nodes are distinguished in an area of neck?
ІІІ. Тest control – 14:15 – 15:00 pm (1 hour)
Lesson No 28
Theme. Head abd neck division of vagus nerve and sympathetic trunk. Terminal branches of external carotid artery: maxillary and superficial temporal arteries, topography distribution of branches. Veins of the head.
Lymphatic vessels and nodes of the head
Aіm: Study the structural and topographical peculіarіtіes of autonomic nervous system, location of centres and peripheral parts and main functions.
The professіonal orіentatіon. Knowledge the organisation of the sympathetic part of the autonomic nervous system is the base for understanding of neurophysiology and neuropathology. Anatomical peculiarities of the location of centres and peripheral parts is necessary for neurological therapy and surgery in brain. If the vagus nerve is damaged there is impairment of function in the throat and the larynx: unilateral paralysis of the levator veli palatini muscle causes the soft palate and the uvula to the displaced to the intact side. The vocal cord on the affected side will remain immobile in the cadaver position (recurrent laryngeal nerve palsy) as a result of paralysis of the internal laryngeal muscles.
Base level of knowledge and skіlls
1. Skeleton of thoracis cage, neck and skull.
2. Muscles of the neck and head.
3. Organs of the neck and head.
4. Vessels of neck.
I. Practical studies – 9:00-11:15 am (3 hours)
Іllustratіve materіal
1. Demonstration corpse.
2. Study corpse.
3. Skeleton.
Methods of practical work.
Work 1. For preparatioerves near the base of skull necessary to cut and delete salivary gland. Delete the branch of mandible from joint.
Work 2. Preparation vagus nerve, its lower element. Track in to input in the breast cavity and preparation an upper laryngeal nerve, which leaves from the lower element.
Work 3. Dissection of maxillary artery. For better access to maxillary artery the students have to carefully (not damaging superficial vessels and nerves) cut the zygomatic arch near its root and connection with zygomatic bone. The zygomatic arch together with masseter muscle are turned away laterally and inferiorly. For this reason masseter muscle is partially separated near the place of its connection to the angle of mandible. Using a chisel, the caronoid process of mandible is separated, and together with zygomatic muscle is turn away superiorly. Now there is open access to maxilar artery.
· Practical skills and abilities of students, demonstrate on preparations:
1. vagus nerve
2. sympathetic trunk
3. maxillary artery
4. external carotid artery
5. superficial temporal artery
6. jugular veins
II. Seminar discussion of practical work 11:45 am – 13:15 pm (3 hours)
1. After a wound in the face, which was accompanied by profuse bleeding, patient’s external carotid artery was tied up. Which vessels (anastomoses between external and internal arteries) provide collateral blood supply?
The answer: dorsal artery of a nose (final branch of ophthalmic artery of the pool of internal carotid artery) anastomoses with angular artery (final branch of facial artery of pool of external carotid artery)
2. On the face it is possible to make primary and early plasty, transplants on the face graft much better, than in other sites. What anatomic peculiarity provides good grafting of transplant and, on the other hand, creates certain difficulties at surgical intervention?
The answer: rich vascular net of the face provides good conditions for the transplantation and causes significant bleeding during surgical intervention.
3. The wound of a hairy part of a head is accompanied by profuse bleeding. What anatomic peculiarities of vessels of soft tissues of a brain part of a head determines significant bleeding in such wounds?
The answer: arterial vessels are in subcutaneous fat and their adventition grows strongly together with connective intersections, which connect skin with tendinous helmet. The vessels are iormal condition, their lumen gapes.
4. For uncovering the bones of a skull fornix the radial sections in the temporal area are made. What is this direction of sections determined by?
The answer: the direction of all arterial trunks in a brain part of the head is radial (as well as that of nervous trunks), therefore at such sections integrity of neurovascular fascicles is preserved as much as possible.
· Discussion of theoretical questions:
1. Which nuclei does vagus nerve have? (name, function)
2. Describe the parts and topography of the vagus nerve.
3. Where are located sensory ganglia of vagus nerve?
4. Which branches does vagus nerve give off in head region? What do they supply?
5. Which branches does vagus nerve give off ieck? What do they supply?
6. Which parts do they distinguish in sympathetic part of the autonomic nervous system?
7. Which formations belong to central part of sympathetic system?
8. Where are located centres of sympathetic system?
9. Which formations belong to peripheral part of sympathetic system?
10. Where are located peripheral sympathetic ganglia?
11. Describe cervical sympathetic ganglia and their branches.
12. Which plexus do cervical sympathetic ganglia form? What do they supply?
13. Which parts has the maxillary artery?
14. Branches and supplying area of first part of maxillary artery.
15. Branches and supplying area of second part of maxillary artery.
16. Branches and supplying area of third part of maxillary artery.
17. Which arteries supply teeth of the upper jaw?
18. Which arteries supply the mucosa of maxillary sinus?
19. Branches and supplying area of superficial temporal artery.
20. What intracranial tributaries of internal jugular vein do you know ?
21. What are diploid and emissar veins? Where are they located? What do they drain?
22. Whence do superior and inferior ophthalmic veins collect blood? What are their anastomosis?
23. How are veins of a labyrinth formed and where they empty?
24. Name extracranial tributaries of internal jugular vein.
25. Whence does the facial vein collect blood?
26. Whence does the retromandibular vein collect blood?
27. What lymphatic nodes are distinguished in an area of head?
ІІІ. Тest control – 14:15 – 15:00 pm (1 hour)
References: basic
1.Gray`s Anatomy. Lawrence H.Bannister, MartinM.Berry, Patricia Collins and others. Churchhill Livingstone, – 1999. 2092 p. 2. W. Kahle, H. Leonhardt, W. Platzer. Colour atlas and Textbook of Human Anatomy. –
b) additional:
Lesson No 29
Theme. Internal carotid artery. Blood vessels of orbit. I, II, III, IV, VI cranial nerves, areas of distribution. I division of V cranial nerve, areas of distribution. Ciliary ganglion
Aіm: Study the structural and topographical peculіarіtіes of internal carotid and subclavian arteries. and their branches.
The professіonal orіentatіon. Vascular diseases of the brain, caused by the affliction of the branches of internal carotid artery, are leading among diseases of nervous system and are often the cause of death, invalidity, and severe conditions, which require urgent aid of a doctor of any speciality. The need of a brain of oxygen is 20 % of the need of oxygen of the whole organism (though the weight of a brain – on the average 1,4 kgs – is only 2 % of the weight of a body), and, consequently, if compared to the other organs the brain has increased sensitivity to hypoxia. Knowledge the topography and innervating regions of the 3rd, 4th, 6th cranial nerves is the base for understanding of neurophysiology and neuropathology. Anatomical peculiarities of the oculomotor, trochlear and abducens nerves are necessary for ophthalmology, neurological therapy and surgery in brain, also for traumatology and oncology.
Base level of knowledge and skіlls
1. Skeleton of thoracis cage, neck and skull.
2. Muscles of the neck and head.
3. Organs of the neck and head.
I. Practical studies – 9:00-11:15 am (3 hours)
Іllustratіve materіal
1. Demonstration corpse.
2. Study corpse.
3. Skeleton.
Methods of practical work.
Work 1. Dissection of internal carotid artery and its branches. Transverse section is made between two auricle by cutting the soft tissues of head. Then skin is detached and pulled down to superciliary arches and pulled up to superior nuchal line. The top of cranium is cut away, with the bone saw, at the level of base of the skull. Then dura matter is cut with parasaggital section, separated and pulled away laterally to the base of the skull. Now the superio-lateral surface of hemispheres can be seen together with superficial vessels. After dissection of sickle of cerebrum and setting apart the superior margins of cerebrum, the anterior cerebral arteries and their branches can be viewed on the medial surface of both hemispheres. In order to observe the branches of medial cerebral artery the web tissue and the lateral sulcus of hemispheres had been separated and set apart.
Work 2. Preparation of lacrimal nerve. Students under the teacher’s directions conduct skin cuts on the right part of face along the lateral wall of orbit.
Work 3. Develop graphic scheme of branching of orbital nerve.
· Practical skills and abilities of students, demonstrate on preparations:
1. Internal carotid artery, showing its course, topography in the area of neck and head.
2. Pay attention, that internal carotid artery, forming a S-shaped bend in the carotid channel, reaches a lacerated foramen of a skull and passes through cavernous sinus.
3. Studying branches of internal carotid artery it is necessary to specify vessels, which supply brain and take part in arterial anastomotic ring (Vilisian circle), final branch – ophthalmic artery, anastomosing with branches of facial artery.
4. Studying subclavian artery, pay attention to the difference of topography of vessels anastomosing on the left and on the right.
5. Specify, into what parts is subclavian artery divided and what branches anastomose in each section.
6. It is necessary to characterize course and topography of vertebral artery as its branches also participate in blood supply of a brain and supplement Vilisian circle.
Pay attention to a place of separation of internal carotid artery, its course on a neck, in the carotid channel. Draw the scheme of arterial Vilisian ring, to emphasize the importance of anastomosis between external and internal carotid arteries. To acquaint with parts of subclavian artery, its branches, places of its bandaging in bleedings.
Show on THE EDUCATIONAL PREPARATIONS:
1. Corpse with prepared vessels and heart: internal carotid artery to its entry into skull, subclavian artery (from the left, from the right), interscalene space, vessels, which go from subclavian artery in prescalene space – vertebral artery, thyroid trunk, internal thoracic artery; in interscalene space – costocervical trunk; in extrascalene space – transverse artery of a neck.
2. Damp preparation of a basis of a brain with preserved arachnoidal membrane: basic artery, posterior brain artery, internal carotid artery, anterior, middle arteries of a brain, posterior connecting artery, Vilisian circle.
3. Skull, cervical vertebrae: vertebral foramina on transverse processes, carotid channel, lacerated foramen, sulcus caroticus.
II. Seminar discussion of practical work 11:45 am – 13:15 pm (3 hours)
1. For bandaging the external carotid artery it is uncovered on a neck in a site of a carotid triangle. The erroneous bandaging of internal carotid artery may cause severe complication – softening of a substance of a brain. Name anatomic peculiarities, which allow to distinguish internal carotid artery from external one in the borders of this triangle.
The answer: а) internal carotid artery does not ramify on a neck of branches; б) internal carotid artery is placed laterally and behind, and then medially from the external carotid artery; в) if the sublingual nerve is uncovered in the area of the carotid triangle, it is seen to cross the internal carotid artery and locate ahead of it.
2. Patient has paresis of right hand and leg, impaired sensitivity in paretic limbs, motor aphasia – lost ability to utter words owing to impaired articulation of language. The cause of this condition is the disturbance of blood flow in one of branches of internal carotid artery. Name the afflicted vessel.
The answer: middle brain artery.
3. Patient has impaired functions of all oculomotor nerves owing to disturbed blood supply of their nuclei, paresis of both upper and lower limbs, disorder of vital functions (breath and circulation). Impaired blood flow in the pool of which artery is the cause of this condition?
The answer: basilar artery.
4. Eyelids possess high reparative ability even when smashed or stained. This is predetermined by rich arterial net of lids. Name sources of its formation.
The answer: medial (superior and inferior) arteries of lids (from ophthalmic artery) and lateral (superior and inferior) arteries of eyelids (from lacrimal artery).
5. Patient has a malignant tumour of the parotid gland. During surgical intervention the bandaging of external carotid artery is necessary. Name anastomosis between branches of external and internal carotid arteries, which provide blood supply in these conditions.
The answer: а) back artery of a nose (from ophthalmic artery) and angular artery (from facial artery); б) supratrochlear artery (from ophthalmic artery) and frontal branch (from superficial temporal artery); в) internal carotid artery and posterior artery of a brain (through posterior connective artery).
· Discussion of theoretical questions:
1. Where does the internal carotid artery begin?
2. What position does the internal carotid artery occupy in the structure of a neurovascular fascicle of a neck?
3. What shape has the bend of internal carotid artery at the passage through the cavernous sinus?
4. What arteries supply the brain?
5. What branches does the internal carotid artery give in the carotid channel?
6. Through what foramen does the ophthalmic artery penetrate into the cavity of the orbit?
7. Name branches of the ophthalmic artery.
8. Name terminal branches of the ophthalmic artery.
9. Which arteries supply the lids?
10. Which arteries represent anastomosis between the system of internal and external carotid arteries?
11. Name two terminal branches of internal carotis artery.
12. On what surface of the hemisphere does the anterior brain artery ramify?
13. What parts of the hemisphere of the brain are supplied by brain artery?
14. What artery connects both anterior brain arteries?
15. Which vessels form the Willi’s circle?
16. Where do olfactory nerves enter the cranial cavity?
17. What does belong to peripheral part of olfactory brain?
18. Where are located first neuron of the olfactory tract?
19. Optic nerve, its location and importance.
20. Where is there optic chiasma, why is it incomplete?
21. Where are located oculomotor nerve nuclei?
22. Which branches is oculomotor nerve divided in?
23. What do branches of oculomotor nerve supply?
24. Where are located trochlear nerve nuclei?
25. What does trochlear nerve supply?
26. What does abducens nerve supply?
27. Where are located abducens nerve nuclei?
28. How does trigeminus nerve form? Fibres from which nuclei compose it?
29. Where is located sensory ganglion of trigeminus nerve?
30. Describe the topography of the ophthalmic nerve. Which branches does it give off?
31. Describe the branches of frontal nerve. What do they supply?
32. Describe the branches of lacrimal nerve. What do they supply?
33. Describe the branches of nasociliaris nerve. What do they supply?
34. Where is positioned ciliary ganglion?
35. Which root does ciliary ganglion receive?
36. Which branches does ciliary ganglion give off?
37. What do short ciliary nerves supply?
38. What do long ciliary nerves supply?
ІІІ. Тest control – 14:15 – 15:00 pm (1 hour)
References:
а) basic
1.Gray`s Anatomy. Lawrence H.Bannister, MartinM.Berry, Patricia Collins and others. Churchhill Livingstone, – 1999. 2092 p. 2. W. Kahle, H. Leonhardt, W. Platzer. Colour atlas and Textbook of Human Anatomy. –
b) additional
Lesson No 30
Theme. II division of V cranial nerve, areas of distribution. Autonomic nerves of the head. III division of V cranial nerve, areas of distribution. Autonomic ganglia of the head. VII, XI and XII cranial nerves
Aіm: Study the structural and topographical peculіarіtіes of maxillary, mandibular, facial, accessory and hypoglossal nerves and parasympathetic ganglia.
The professіonal orіentatіon. Knowledge the topography and supplying regions of 2nd and 3d divisions of 5th cranial nerve is the base for understanding the physiology and neuropathology. Anatomical peculiarities of the branches of maxillary nerve and pterygopalatine ganglion are necessary for neurological therapy and surgery, also for traumatology and oncology. Damage to the accessory nerve results in a tilted position of the head and the arm cannot be lifted above the horizontal. Damage to the hypoglossal nerve produces hemiatrophy of the tongue. When the tongue is thrust out it deviates to the damaged side, since the action of the genioglossus muscle, which moves the tongue forward, predominates on the intact side.
Base level of knowledge and skіlls
1. Skull.
2. Muscles of the neck and head.
3. Organs of the head.
I. Practical studies – 9:00-11:15 am (3 hours)
Іllustratіve materіal
1. Demonstration corpse.
2. Study corpse.
3. Skeleton.
Methods of practical work.
Work 1. Preparation of maxillar and mandibular nerves. Separate a skin, cross a lateral and medial sphenoid muscles, where we can find mandible nerve and its branches.
Work 2. Preparation of inferior alveolar nerve. For the access to the inferior alveolar nerve carefully open mandible channel, parallel base of bone and open place in him of alveolar nerve.
Work 3. Develop graphic schemes of maxillar and mandibular nerves
Work 4. Preparation of the facial nerve. Skin cuts on the right part of face: middle – from parietal part to the chin, circular – on edges of eyelets, nostril and oral cavity. Skin carefully separate and turn to auricle. Then find and select a stem of the facial nerve.
Work 5. Preparation of parotid plexus. On the find this plexus, also marginal branch of lower and cervical branch.
Work 6. Middle cut of neck conduct from top to bottom via the larynx to breastbone. Lower to clavicle conduct a horizontal cut to scapula. Separate the skin. Then separate and take away subdermal muscle.
Work 7. For the broad access to deep structures needed recut in saggital planes part of breastbone and clavicles. After that sternocleidomastoid muscle carefully stands out upwards and outward.
Work
II. Seminar discussion of practical work 11:45 am – 13:15 pm (3 hours)
1. Describe the topography of the maxillary nerve.
2. Describe the topography and branches of zygomatic nerve. What do they supply?
3. Describe the topography and branches of infraorbital nerve. What do they supply?
4. Describe the topography and branches of ganglionic nerves. What do they supply?
5. Which ganglion is located near maxillary nerve?
6. Which root does pterygopalatine ganglion receive?
7. Which branches does pterygopalatine ganglion give off?
8. What do gsnglionic rami supply?
9. What are upper jaw teeth innervated by?
10. What is “pes anserinus minor”?
11. What is the skin of nose, lip and cheek innervated by?
12. What is mucous membrane of nose and palate innervated by?
13. What is lacrimal gland innervated by?
14. What fibres form mandibular nerve?
15. Which nerves are formed by motor fibres?
16. Which nerves are formed by sensory fibres?
17. Describe the topography and division of the mandibular nerve.
18. Describe the topography and division, supplying regions of the auriculotemporal nerve.
19. Which root does otic ganglion receive?
20. Which branches does otic ganglion give off? What do they supply?
21. Describe the topography and division, supplying regions of the lingualis nerve.
22. Describe the topography and division, supplying regions of the alveolaris inferior nerve.
23. Which root does submandibulare and sublinguale ganglia receive?
24. Which branches does submandibulare and sublinguale ganglia give off? What do they supply?
25. What are upper and lower jaws teeth innervated by?
26. How is innervated parotid gland?
27. How are innervated submandibulare and sublinguale glands?
28. How are innervated mastication muscles?
29. Which nerves compose the 7th cranial nerve?
30. Which nuclei (name, function) belong to facial nerve?
31. Which nuclei (name, function) belong to intermedius nerve?
32. Describe the topography of the facial nerve.
33. Which branches does facial nerve give off?
34. Which branches does intermedius nerve give off?
35. Where is located sensory ganglion of facialis nerve? What is its term?
36. Describe the topography of the petrosus major nerve. What does it supply?
37. Describe the topography of the chorda tympani. What does it supply?
38. Describe the topography and branches of the plexus parotideus. What do they supply?
39. Which nuclei (name, function) belong to accessory nerve?
40. Describe the topography, roots and branches of accessory nerve.
41. What does accessory nerve supply?
42. How are innervated sternocleidomastoideus and trapezius muscles?
43. Which nucleus (name, function) belong to hypoglossal nerve?
44. Describe the topography and branches of hypoglossal nerve.
45. What does hypoglossal nerve supply?
46. How is formed ansa cervicalis?
47. How are innervated muscles of tongue?
ІІІ. Тest control – 14:15 – 15:00 pm (1 hour)
References:
а) basic
1.Gray`s Anatomy. Lawrence H.Bannister, MartinM.Berry, Patricia Collins and others. Churchhill Livingstone, – 1999. 2092 p. 2. W. Kahle, H. Leonhardt, W. Platzer. Colour atlas and Textbook of Human Anatomy. –
b) additional
Lesson No 31
Theme. VIII, IX cranial nerves. Head and neck parts of vagus nerve
Practical skills on vessels and nerves of the head and neck
Aіm: Study the structural and topographical peculіarіtіes of vestibulo-cochlear, glossopharyngeal and vagus nerves.
The professіonal orіentatіon. Anatomical peculiarities of the 8th cranial nerve and auditory pathway are necessary for otology therapy and surgery, also for traumatology and oncology. Knowledge the topography and supplying regions of glossopharyngeal nerve is the base for understanding the physiology and neuropathology. Anatomical peculiarities of the branches of glossopharyngeal are necessary for neurological therapy and surgery, also for traumatology and oncology. If the vagus nerve is damaged there is impairment of function in the throat and the larynx: unilateral paralysis of the levator veli palatini muscle causes the soft palate and the uvula to the displaced to the intact side. The vocal cord on the affected side will remain immobile in the cadaver position (recurrent laryngeal nerve palsy) as a result of paralysis of the internal laryngeal muscles.
Base level of knowledge and skіlls
1. Skeleton of thoracis cage, neck and skull.
2. Muscles of the neck and head.
3. Organs of the neck and head.
I. Practical studies – 9:00-11:15 am (3 hours)
1.
Іllustratіve materіal
1. Demonstration corpse.
2. Study corpse.
3. Skeleton.
Methods of practical work.
Work 1. Finding and demonstrating 8ts pair of cranial nerves.
Work 2. Make auditory way scheme. At the demonstration to pay attention to topography of neurons, forming of lateral lemniscus and 4th neuron’s axon ends.
Work 3. Middle cut of neck conduct from top to bottom via the thyroid cartilage to the breastbone. Then lower make a horizontal cut to scapula. Preparation skin. Then separate subdermal muscles.
Work 4. For the broad access to deep structures you need to recut in saggital area part of the breastbone and clavicles. Then carefully stand out a sternocleidomatoid muscle, reject upwards and outwards.
Work 5. Find and recut back venter of stylohyoid muscle. Find glossopharyngeal nerve which passes on medial and then on lateral and frontal surfaces of this muscle.
Work 6. For preparatioerves near the base of skull necessary to cut and delete salivary gland. Delete the branch of mandible from joint.
· Practical skills and abilities of students, demonstrate on preparations:
1. vagus nerve
2. vestibulo-cochlear nerve in internal acoustic meatus
3. glossopharyngeal nerve
II. Seminar discussion of practical work 11:45 am – 13:15 pm (3 hours):
1. Where are located hearing receptors?
2. Location and parts of 8th cranial nerve.
3. Where are located nuclei of 8th cranial nerve?
4. Which formations form subcortical acoustic centres?
5. Name cortical acoustic centre.
6. Describe auditory pathway.
7. Which nuclei (name, function) belong to glossopharyngeal nerve?
8. Describe the topography of the glossopharyngeal nerve.
9. Which branches does glossopharyngeal nerve give off?
10. Where are located sensory ganglia of glossopharyngeal nerve? What is its term?
11. Describe the topography of the tympanicus and petrosus minor nerves. What do they supply?
12. Describe the topography of the r. sinus carotici and rr. tonsillares. What do they supply?
1. Describe the topography of the rr. Pharyngei and rr. lingules. What do they supply?
2. Which muscles are supplied by glossopharyngeal nerve?
3. How is innervated middle ear?
4. How is innervated larynx?
5. How is innervated pharynx?
6. How is innervated dura mater encephali?
7. How is innervated external ear?
8. How are innervated trachea, bronchi and lungs?
9. How are innervated oesophagus and stomach?
10. Which nuclei does vagus nerve have? (name, function)
11. Describe the parts and topography of the vagus nerve.
12. Where are located sensory ganglia of vagus nerve?
13. Which branches does vagus nerve give off in head region? What do they supply?
14. Which branches does vagus nerve give off ieck? What do they supply?
ІІІ. Тest control – 14:15 – 15:00 pm (1 hour)
References:
а) basic
1.Gray`s Anatomy. Lawrence H.Bannister, MartinM.Berry, Patricia Collins and others. Churchhill Livingstone, – 1999. 2092 p. 2. W. Kahle, H. Leonhardt, W. Platzer. Colour atlas and Textbook of Human Anatomy. –
b) additional
