1. REVIEW OF HEAD AND NECK CRANIAL NERVES AND EVERYTHING ELSE

2. OLFACTORY FORAMINA IN CRIBIFORM PLATE OF ETHMOID BONE – CN I OLFACTORY NERVE CRISTA GALLI OF ETHMOID ANTERIOR CRANIAL FOSSA OLFACTORY NERVE CN I

3. ETHMOID BONE (posterior view)

4. I - OLFACTORY NERVE OLFACTORY BULB OLFACTORY NERVE BRANCHES (fila olfactoria) DAMAGE - loss of sense of smell

5. renumbered 283

6. CT CORONAL PLANE OF HEAD ANTERIOR CRANIAL FOSSA ORBIT MAXILLARY SINUS NASAL CAVITY INFERIOR CONCHA (TURBINATE) NASAL SEPTUM CRISTA GALLI OF ETHMOID ETHMOID SINUS

7. Nasal Septum 1)Septal Cartilage 2)Ethmoid (Perpendicular Plate) 3)Vomer ANT. CRANIAL FOSSA ETHMOID – Fracture of nose can break cribriform plate, floor of Ant. Cranial fossa - leak CSF from nose; spread of infection CLINICAL QUESTION: BLOW TO NOSE PRODUCES LEAKAGE OF FLUID FROM NOSE; FRACTURE CRIBRIFORM PLATE OF ETHMOID NOSE Crista galli of ethmoid bone Nasal Bones

8. Nerves 1.Olfactory N. - SVA smell; Olfactory Area 2.General Sensation GSA - touch, pain, etc. - V1 Anterior Ethmoidal N. [- V2 Nasal Branches - V2 Nasopalatine N.] 3. Mucous Glands of nose - Parasympathetics - VII - Facial N. by Pterygopalatine Ganglion (hitchhike with branches of V2) NERVES of NASAL CAVITY OLFACTORY N. PTERYGO- PALATINE GANGLION ANT. ETHMOIDAL N. NASOPALATINE N. NASAL BR.

9. OPTIC FORAMEN CN II OPTIC NERVE, OPHTHALMIC ARTERY MIDDLE CRANIAL FOSSA

11. OPHTHALMIC ARTERY

12. Optic Nerve II - OPTIC NERVE OPHTHALMIC ARTERY ENTERS ORBIT WITH OPTIC NERVE OPHTHALMIC ARTERY - from Int. Carotid Optic Nerve CENTRAL ARTERY OF RETINA FORE- HEAD NASAL CAVITY

13. CLINICAL QUESTION: SUDDEN ONSET BLINDNESS IN ONE EYE CENTRAL ARTERY OF RETINA - BRANCH OF OPTHALMIC ART. NO ANASTOMOSES; OCCLUSION RESULTS IN BLINDNESS RETINA OPHTHALMOSCOPE VIEW BRANCHES OF CENTRAL ARTERY AND VEINS

14. DURA & SUBARACHNOID SPACE (CSF) EXTEND AROUND OPTIC NERVE; INCREASE IN CSF CAN EFFECT VISION OPTIC NERVE FUNCTION COMPROMISED BY INCREASED CSF PRESSURE CSF IN SUBARACH SPACE PAPILLEDEMA - engorgement of retinal veins (correspond to branches of central artery) Clinical - slow onset; headaches

15. SUPERIOR ORBITAL FISSURE – CN III, IV V1, VI, OPHTHALMIC VEINS MIDDLE CRANIAL FOSSA

16. EYE MOVEMENTS DIAGRAM ADD DEP ELEV ABD RESTING POSITION OF EYE: DETEMINED BY BALANCE OF ACTION OF OPPOSING MUSCLES

17. III VI IV? 278 III IV VI V VII, VIII IX X XI XII C1

18. III V IV? 1073 III IV VI V VII, VIII IX X XI XII C1

19. ABDUCENS (VI): AT REST MEDIAL STRABISMUS (CROSS-EYED) DUE TO DAMAGE/PARALYZE LATERAL RECTUS PATIENT WITH ABDUCENS (VI) NERVE DAMAGE ABDUCENS NERVE DAMAGE SYMPTOM: DIPLOPIA X

20. PATIENT CANNOT LOOK DOWN AND OUT TROCHLEAR (IV) NERVE DAMAGE: INABILITY TO TURN EYE DOWN AND OUT; ALSO HEAD TILT Symptoms - Difficulty walking down stairs; HEAD TILTED NORMAL EYE HEAD Rotation - occurs when tilt head; rotate ipsilateral eye medially when tilt head laterally AFTER IV DAMAGE - eye rotated laterally; PATIENT TILTS HEAD TO OPPOSITE SIDE so both eyes rotated (chin toward side of lesion) EYE HEAD X

21. AT REST - LATERAL STRABISMUS (WALL- EYED) DUE TO PARALYZE MEDIAL RECTUS ALSO - PTOSIS - DROOPING EYELID- PARALYZE LEV. PALPEBRAE SUPERIORIS - DILATED PUPIL - PARALYZE PUPILLARY CONSTRICTOR OCULOMOTOR (III) NERVE DAMAGE

22. LEVATOR PALPEBRAE TARSAL PLATE LEVATOR PALPEBRAE SUPERIORIS MUSCLE - ORIGIN FROM TENDINOUS RING - COMPOSED OF SKELETAL (CN III) & SMOOTH (SYMPATHETICS) MUSCLE PARTS ANATOMY: LEVATOR PALPEBRAE SUPERIORIS DAMAGE INNERVATION PTOSIS = DROOPING EYELID skeletal muscle III smooth muscle sympathetics

23. OCULOMOTOR NERVE PALSY other symptoms: - Pupil is dilated - denervate pupillary constrictor (mydriasis) - Also affect Eye movements - Accomodation SYMPATHETICS - HORNER'S SYNDROME - - Miosis - constricted pupil - Anhydrosis - lack of sweating (Sympathetic pathway: out spinal cord T1 and T2; ascend sympathetic chain; synapse Superior Cervical ganglion; distribute with arteries(Ophthalmic A.)) SKELETAL MUSCLE PART PTOSIS = DROOPING EYELID; CAN BE SIGN OF DAMAGE TO OCULOMOTOR NERVE (III) OR SYMPATHETICS SMOOTH MUSCLE PART

24. IRIS - PIGMENTED, CONTRACTILE LAYER SURROUNDING PUPIL PUPIL DILATOR PUPIL- RADIAL SMOOTH MUSCLE; SYMPATHETICS CONSTRICTOR PUPIL- CIRCULAR SMOOTH MUSCLE; PARASYMPATHETICS III EYE- STRUCTURE OF EYEBALL- VASCULAR LAYER

25. CILIARY MUSCLES- SMOOTH MUSCLES CONTRACT PRODUCE - RELAXATION OF LIGAMENTS - THICKENING LENS ACCOMODATION- THICKEN LENS FOR NEAR VISION; PARASYMPATHETIC CONTROL- III (CILIARY GANGLION) CILIARY MUSCLES PARASYMPATHETIC MECHANISM OF ACCOMODATION SUSPENSORY LIGAMENTS OF LENS CILIARY BODY - ATTACHES SUSPENSORY LIGAMENTS OF LENS CONTAINS CILIARY MUSCLES