Head and Neck Blue Boxes

Contraction of cervical muscles -> twisting of neck and slanting of head
From fibrous tissue tumor in SCM before birth or breech delivery
If SCM tears -> hematoma -> fibrotic mass -> entraps XI and denervates SCM

By penetrating trauma, surgical procedures, tumors at cranial base, fractures of jugular foramen where XI leaves cranium
Weakness in turning head to opposite side against resistance
Uniparalysis of trapezoid
Drooping shoulder

Occurs in vascular disease
In these patients pressing on carotid pulse results in fall in BP and cardiac ischemia -> fainting

Occlusion -> TIA or minor stroke
Endarterectomy - opening of artery and stripping off plaque

Usually a swelling near hyoid
Thyroid development begins at foramen cecum and the descends from tongue to neck, but remains attached to f. cecum by thyroglossal duct
Normally disappers but can remain and cause a cyst along path of descent

Medial wall -> ethmoidal + sphenoidal sinuses
Inferior wall -> maxillary sinus
Superior wall -> puncture to frontal lobe
Can result in intraorbital bleeding and pressure on eye -> exophthalmos (protrusion)

Oculomotor lesion -> levator palpebrae superioris -> ptosis
Facial nerve lesion -> orbicularis oculi -> eyelids can't close -> drying of cornea

CN II afferent
CN III efferent
Light enters one eye -> II afferent -> optic tracts of both eyes -> III efferent parasympathetic sphincter pupillae
Slow pupillary light reflex -> 1st sign of CN III compression

Observed in fundoscopic exam
Increased intracranial CSF pressure in extension of subarachnoid space around CN II -> retinal edema -> papilla
DO NOT PERFORM LP (can cause herniation of brain into vertebral canal when pressure is high)

CN V (lacrimal) afferent
CN VII (orbicularis oculi) efferent
Touch cornea w/ wisp of cotton to induce blink
Absence sugests lesion of V or VII

From interruption of cervical sympathetic trunk:
Constriction of pupil (miosis) from unopposed parasymp
Ptosis from symp in sup tarsal muscle
Vasodilation
Anhydrosis (absence of sweating)

Poor drainage of aqueous humor into scleral venous sinus from ant/post chambers
-> Compression of retina and retinal arteries -> blindness

If person has excess vasoconstriction in ipsilateral limb, blocking ganglion relieves vascular spasms in brain and upper limb

Bell's palsy (injury to VII)
Ipsilateral
Loss of tone to orbicularis oculi causes inf eyelid to ever -> lacrimal fluid doesnt spread -> ulcerations

Paroxysms in face
Usually V2 or V3
Could be due to compression by anomalous artery
Treat by: block infraorbital nerve, ablate trigeminal ganglion, cut root of ganglion, or section spinal V

Origin - loss of motor, gustatory, ANS
Geniculate - loss of motor, gustatory
Stylomastoid - loss of motor
Most common cause is inflammation near stylomastoid

80% of salivary gland tumors
Most tumors are benign
Have to identify and isolate VII branches

Often infected by mumps
Pain due to swelling and worse during chewing
Inflammation of parotid duct -> redness of parotid pailla at opening into superior oral vestibule -> good sign of parotid injection and not toothache

Head of mandible passes posterior to articular tubercle
Postglenoid tubercle and intrinsic lateral ligament resist posterior dislocation

posterior tongue is touched
-> IX afferent
-> pharynx contracts due to IX and X

Paralysis and atrophy of one side of tongue
Tongue deviates to paralyzed side

Posterior tongue carcinoma ->
Superior deep cervical lymph node
Can be widely spread to submental and submandibular regions due to IJV

At root of tongue posterior to foramen cecum or in neck

Incision inferior to angle of mandible to avoid injury to marginal branch of facial nerve
During incision, lingual n. is is directly under submandibular duct inferior to 3rd molar

Paranasal sinuses are continuous w/ nasal cavity
Infections can spread from nasal to sinuses -> inflammation of sinus mucosa -> local pain -> if several are inflamed -> blockage of opening to nasal cavity

Most common
Mucous of sinus can become congested and block ostia
Lying on side can drain an upper sinus (eg right sinus if lying on left side) because ostia lie on medial sides

CN II is CNS w/ oligodendrocytes (not Schwann)
Susceptible to demylenating disease of CNS like MS

Lesions of optic nerve that cause diminution of visual acuity w/ or w/o changes in peripheral fields of vision
Caused by inflammatory, degen, demyl, toxic disorders
Optic disc is pale on exam

Complete section -> blindness in temporal and nasal field ipsilaterally
Complete section of optic chiasm -> bitemporal hemianopsia - loss of a different half visual field in both eyes
Complete section of (eg) right optic tract post chiasm - loss of right nasal and left temporal -> homonymous hemianopsia (same side of visual field is lost in both eyes)

Pressure on III
(pupil dilation?)

Diplopia when looking down

Paralysis of muscles of mastication w/ deviation toward side of lesion
Loss of vibratory, pain, temp on face
Loss of corneal reflex

Diplopia in all ranges of movement
Medial deviation of affected eye
Caused by: aneurysm of Willis, pressure from atherosclerotic IC, septic thrombosis of sinus subsequent to infection of nasal cavity/sinus

I - horizontal fractures of maxillae superior to maxillary alveolar process and crossing bondy nasal septum

From posterolateral maxillary sinuses through infraorbital foramina, lacrimals, and bridge of nose. Separates entire central part of face from rest of cranium

Horizontal fracture through superior orbital fissures and ethmoid and nasal bonds. Concurrent fracture of zygomatic arches causes maxillae and zygomatic bones to separate from rest of cranium

Usually involves two fractures on opposite sides of mandible
1. Coronoid process - uncommon and single
2. Neck of mandible - associated w/ TMJ dislocation on same side
3. Angle of mandible - can involve bony socket or alveolus of 3rd molar
4. Body of mandible - through socket of canine tooth

Depressed fractures - bone fragment goes inward injuring brain
Most common - linear calvarial fractures

Rupture middle meningeal

Indirect w/ mirror or direct w/ laryngoscope
Vestibular folds - pink
Vocal folds - pearly white

Poor, absent voice
Vocal cords cannot abduct or adduct
Abduction lost before adduction

Anesthesia of superior laryngeal mucosa -> absent cough reflex -> foreign bodies can enter larynx
External br injuries - monotonous voice due to paralysis of cricothyroid

High in smokers and tobacco chewers
Present w/: hoarseness, otalgia, dysphagia, enlarged pretracheal and paratracheal lymph nodes

Often secondary to respiratory infections
Signs: earache, bulging red tympanic membrane -> pus or fluid in middle ear
If untreated -> hearing loss due to scarring of auditory ossicles

Can result from otitis media
Minor ruptures heal spontaneously, larger ruptures require surgical repair

Middle ear infection -> inflammation of mastoid process -> infection of mastoid antrum and cells

When occluded residual air in tympanic cavity is absorbed by mucosal blood vessels -> lower air pressure in tympanic cavity -> retraction of tympanic membrane -> hearing affected

Blockage of cochlear aqueduct
Recurrent attacks of tinnitus, hearing loss, vertigo
Ballooning of cochlear duct caused by increase in endolymphatic volume