14 - Head + Neck - Oral cavity, Tongue, TMJ + Infratemporal fossa

Question 1

Name the boundaries of the oral cavity:

Answer 1

Sup: Soft + hard palate (maxilla + palatine bones)
Inf: Muscular diaphragm + tongue
Lat: Buccinators

Question 2

Between which 2 muscles does the tonsillar fossa lie? Which tonsil is located here?

Answer 2

1) Palatoglossal muscle
2) Palatopharyngeal muscle

Palatine tonsil

Question 3

Which salivary gland is most commonly affected by stone formation?

Answer 3

Submandibular gland

Question 4

All muscles (except 1) of the tongue are innervated by which nerve?

Answer 4

CN XII

Exception = Palatoglossal = CN X

Question 5

If a patient has a lesion of the left CN XII, what will happen if they try to stick their tongue out?

Answer 5

Tongue will deviate towards the side of the lesion

Question 6

If a patient has a lesion of the left CN X, what will you see when they open their mouth?

Answer 6

Uvula deviation away from the side of the lesion

Question 7

Which extrinsic muscle of the tongue is responsible for closing the oral cavity during swallowing?

Answer 7

Palatoglossus

Question 8

What is ‘tonsillitis’ and name some common symptoms:

Answer 8

Inflammation of Palatine tonsil

• Sore throat
• Odyno/dysphagia
• Enlarged erythematous tonsils

Question 9

What are the 4 signs accompanying tonsillitis which indicates a bacterial cause:

Answer 9

1) Cervical lymphadenopathy
2) Fever
3) Pus
4) Absence of cough

Question 10

If a patient presents with sore throat, cough and enlarged tonsils, what is the most likely diagnosis and underlying cause?

Answer 10

Viral tonsillitis (viral as cough present)

• Rhinovirus
• Adenovirus

Question 11

How can you differentiate between tonsillitis and a peritonsillar abscess?

Answer 11

Tonsillitis = usually bilateral, intact arches
Quinsy = 
- usually unilateral
- loss of posterior arch
- severe throat pain
- difficulty opening mouth
- 'hot potato' voice
- FEVER

Question 12

Name the duct which drains from the parotid gland into the oral cavity:

Answer 12

Stenson’s duct

Question 13

Name the duct which drains from the submandibular gland into the oral cavity:

Answer 13

Wharton’s duct

Question 14

How does a salivary stone usually present?

Answer 14

Pain/swelling @ meal times

Question 15

Which nerve gives general sensation to the anterior 2/3rds of the tongue?

Answer 15

CN V3 - Lingual nerve

Question 16

Which nerve gives special sensory fibres to the anterior 2/3rds of the tongue?

Answer 16

PNS fibres of CN VII - on Chorda Tympani

Question 17

Which nerve gives general and special sensory fibres to the posterior 1/3rd of the tongue?

Answer 17

CN IX

Question 18

List the types of teeth from medial to lateral:

Answer 18

• Central incisor
• Lateral incisor
• Canine
• 1st + 2nd Premolars
• 1st + 2nd + 3rd Molars

Question 19

Which nerve supplies the lower jaw and its teeth?

Answer 19

CN V3 - Inf. alveolar nerve

Question 20

Name the articulating surfaces of the temporomandibular joint:

Answer 20

• Mandibular fossa (temporal bone)
• Articular tubercle (temporal bone)
• Mandibular condyle

Question 21

What type of connective tissue lines the articulating surfaces of the temporomandibular joint?

Answer 21

Fibrocartilage

Question 22

Which ligament associated with the temporomandibular joint prevents posterior dislocation?

Answer 22

Lateral ligament

Question 23

What is the most common type of dislocation affecting the temporomandibular joint?

Answer 23

Anterior

ie blow to side of mandible when mouth is open = ant. dislocation of same side

Question 24

What nerves are at risk during an anterior dislocation of the mandible (lock jaw)?

Answer 24

• CN V3 - Auriculotemporal

- CN VII

Question 25

Name some common causes of TMJ pain:

Answer 25

- Bruxism (grinding) - Osteoarthritis - Anxiety - Sleep disorders - Excess alcohol/smoking

Question 26

Where is the infratemporal fossa?

Answer 26

- Deep and inferior to zygomatic arch | - Deep to ramus of mandible

Question 27

Name the borders of the infratemporal fossa:

Answer 27

``` Sup: Inf. greater wing of sphenoid Inf: Med. pterygoid attachment of mandible Ant: Post. maxilla Post: Cervical sheath Med: Lat. pterygoid plate of sphenoid Lat: Ramus of mandible ```

Question 28

Which muscles lie within the infratemporal fossa?

Answer 28

- Masseter - Medial pterygoid - Lateral pterygoid

Question 29

Which blood vessels lie within the infratemporal fossa?

Answer 29

- Maxillary artery | - Pterygoid venous plexus

Question 30

Which nerves lie within the infratemporal fossa?

Answer 30

- Inf. alveolar (CN V3) - Lingual (CN V3) - Buccal (CN V3) - Chorda tympani (CN VII) - Otic ganglion

Question 31

Describe a mandibular nerve block:

Answer 31

``` - Inject anaesthesia into infratemporal fossa via mandibular notch of ramus of mandible Blocks branches of CN V3: - Auriculotemporal - Inferior alveolar - Lingual - Buccal ```

Question 32

Describe a inferior alveolar nerve block:

Answer 32

- Inject anaesthesia @ mandibular foramen | - Blocks sensation to 1/2 mandibular teeth