LESSON #26 (6 HOURS)
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.
A³m: Study the structural and topographical pecul³ar³t³es of maxillary, mandibular, facial, accessory and hypoglossal nerves and parasympathetic ganglia.
The profess³onal or³entat³on . 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.
I. Practical work – 9:00-12:00 am (4 hours)
1) Methodology of practical class.
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.
Individual Students Program – 9:00-11:15 am (3 hours)
2. Muscles of the neck and head.
3. Organs of the head.
1. Demonstration corpse.
2. Study corpse.
Demonstrate on preparations:
1. Medulla oblongata.
2. Trunk of the cerebrum.
3. Table-scheme of rhomboid fossa.
4. V pare (trigeminal nerve).
5. VII pare (facial nerve).
6. XI accessories nerve.
7. XII hypoglossus nerve.
I. II. Seminar discussion 12:30 am – 14:00 pm (2 hours)
Special attention should be paid to the following questions:
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?
²²². Independent students work – 14:15pm – 15:00 pm
1. During operation surgeon can see that the inferior alveolar nerve and vessels are contents of…
A. Mental foramen
B. Angle of mandible
C. Mandibular notch
D. Mandibular canal
E. None of these
2.During operation surgeon can see that the mandibular nerve passes through the next region and contains…
A. Oval foramen, sensory and motor fibres
B. Rotundum foramen, motor fibres
C. Oval foramen, sympathetic fibres
D. Mandibular foramen, sensory and motor fibres
E. None of these
3. The patient has a lesion of the trigeminal nerve, it would result in weakness of…
A. Moving the eyeball
B. Closure the eyes
C. Compression the teeth
D. Lifting the upper eyelid
E. Contraction of tongue
4. The patient has lesion of control facial expressions, which nerve is responsible for this function?
A. Accessory nerve
B. Trigeminal nerve
C. Facial nerve
D. Vestibulocochlear nerve
E. Trochlear nerve
5. The patient has lesion of the ansa cerviccalis nerve, it would result in weakness of:
A. Contraction of platisma
B. Contraction of sternocleidomastoid muscle
C. Contraction of orbicularis oris muscle
D. Contraction of infrahyoid muscle
E. Contraction of mylohyoid muscle
6. The patient has the lesion of the facial nerve, it would result in weakness of…
A. Contraction of masseter muscle
B. Contraction of orbicularis oculi muscle
C. Compression the teeth
D. Protrubing the mandible
E. None of these
Initial level of knowledges and skills are checked by solving situational tasks for each topic, answers in test evaluations and constructive questions (the instructor has tests & situational tasks).
Student should know: the structure of:
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.
Student should be able to:
1 Demonstrate on preparations Medulla oblongata.
2. Demonstrate on preparations Trunk of the cerebrum.
3. Demonstrate on preparations Table-scheme of rhomboid fossa.
4. Demonstrate on preparations V pare (trigeminal nerve).
5. Demonstrate on preparations VII pare (facial nerve).
6. Demonstrate on preparations XI accessories nerve.
7. Demonstrate on preparations XII hypoglossus nerve.
Correct answers for tests and situational tasks:
1- D; 2- A; 3- C; 4- C; 5-D; 6-B.
1. Atlas of Human Anatomy/ Frank H. Netter,- 5 edition, - 2011 by Saunders, an Imprint of Elsevior Inc.
3. Materials preparation for lectures
4. Materials preparation for practical classes
2. F.H. Netter. Atlas of Human Anatomy. – C³ba Pharmaceut³cals D³v³s³on, 1994. – 514 p.
3. Syneln³kov R.D. The atlas of anatomy of the man. ²n 4-th volumes. -: Med³c³na, 1991.
4. Reminetskyy B.Y., Fedonyuk Y.I. Human anatomy. Notes. 136 p.
Methodical instructions have been prepared by: Assistant Prof. Gavlich O. B.
The instruction was discussed and confirmed at the department meeting
12.06.2013. Protocol number 11