It also comes loaded with informative examples and illustrations, endless practice questions reflecting the latest question types, and customizable testing modes to ensure you are fully prepared to tackle every aspect of Part I of the NBDE.
Toggle navigation. Easy-to-use outline format organizes essential data and key points in a clean, streamlined fashion.
Exam-based progression of topics presents sections and topics in the same order as they appear on the actual exam. Practice exams with approximately questions appear at the end of the book along with the correct answers and rationales. Approximately diagrams and photographs provide visual evidence to support key topics, including anatomic structures, physiology, and microbiology.
Tables and text boxes provide supplementary information and emphasize important data from the text. Practice and testing modes for NBDE I review allow you to test yourself via category or in a testing format that allows you to create an unlimited number of unique practice tests with instant feedback. Posterior auricular vein Superior and inferior labial Retromandibular veins vein Facial vein.
External jugular Common facial vein vein Internal jugular vein Anterior jugular vein Jugular venous arch. Communicate with the facial vein via b. Termination: drains into the retro- the supraorbital vein.
Termination: facial vein and cavernous c. Tributaries include middle meningeal, sinus. Retromandibular veins buccal, palatine, inferior alveolar, and a. Formed by the joining of the maxillary deep facial veins. Cavernous sinuses parotid gland. Located on both sides of the sella tur- b.
Termination: the retromandibular vein cica of the sphenoid bone. The right bifurcates into an anterior and poste- and left cavernous sinuses are joined rior division. The anterior division by the intercavernous sinuses. Tributaries include the ophthalmic and become the common facial vein, external cerebral veins, the sphenopari- which terminates into the internal etal sinuses, and the pterygoid plexuses.
The posterior division c. Pterygoid plexus 1—5. Note: these nerves and the struc- a. A network of veins located at the level tures they innervate can be affected by a of the pterygoid muscles that drains cavernous sinus infection. Termination: the superior and inferior tissues, including the intraoral cavity, petrosal sinuses.
The petrosal sinuses ulti- and the meninges. Pituitary gland Figure 1—5. Cavernous sinus thrombosis: since c. Superficial parotid nodes blood flow in the cavernous sinus is 1 Located on the surface of the slow-moving, dental or eye infections parotid gland.
This 3 Tissues drained include the scalp, eye- can result in an urgent, and possibly lids, external ear, and lacrimal gland. The infection d. Retroauricular nodes has the potential to spread as a result of 1 Located adjacent to the mastoid certain venous communications with process. The supe- and external ear. Occipital nodes a passageway for infection to 1 Located at the occipital region of the spread from the facial vein to the skull.
Deep lymph nodes pterygoid plexus of veins, which in 1. Retropharyngeal nodes turn drains into the cavernous a. Located within the retropharyngeal sinus.
The deep facial vein is a trib- space. Secondary node: superior deep cervi- cal nodes. Tissues drained include the hard and Lymphatic drainage soft palate, paranasal sinuses, nasophar- ynx, and the nasal cavity. Lymphatic drainage of the head and neck is 2. Deep parotid nodes accomplished through a series of lymphatic a. Located within the parotid gland. Lymph from a b. Secondary node: deep cervical nodes. Tissues drained include the parotid node, then a secondary lymph node, and ulti- gland and middle ear.
Deep cervical nodes 1. Superficial lymph nodes 1. The chain of deep cervical nodes extends a. Submandibular nodes vertically down the entire length of the 1 Located beneath the angle of the neck.
They receive lymph from both mandible. Termination nodes will drain into the deep cervi- a. The left deep cervical chains form the cal lymph nodes. The right deep cervical chains form the upper lip, palate, sublingual and sub- right jugular lymph trunk, which termi- mandibular glands, tongue body, all nates in the right lymphatic duct.
Submental nodes Basic principles and definitions 1 Located beneath the chin. Basic principles and definitions submental lymph nodes drains into 1.
There are 12 cranial nerves; they are the submandibular or deep cervical listed in Table 1—5. TABLE 1—3. Foramen: a hole in bone. Ganglion: group of nerve cell bodies Superior deep Inferior to the Maxillary third cervical lymph anterior border of the molars found outside the central nervous sys- nodes sternocleidomastoid Nasal cavity tem CNS.
Reflexes: cranial nerves also serve as affer- Tongue Deep parotid Middle ear Deep cervical ent and efferent nerves for certain reflexes nodes Parotid gland nodes associated with the head and neck. These Retropharyngeal Posterior pharynx, Nasal cavity nerve reflexes are summarized in Table 1—6. Cranial nerve pneumonics Pharynx 1.
TABLE 1—5. CN I: olfactory nerve 1. Foramen: cribriform plate of ethmoid bone. Sensory function: smell. CN II: optic nerve 1. Foramen: optic canal. Sensory distribution: vision. When the right optic nerve sensory and motor, and so forth.
The A. Cranial nerve nuclei right lateral process remains on the right 1. Nucleus: a group of nerve cell bodies in side, and together with the left medial the CNS. The 2. Brainstem organization optic tract continues to the lateral genicu- a. The brainstem plays a major role in late nucleus of the thalamus Figure 1—6.
Note: the central artery of the retina, a nial nerves to and from the brain. The branch of the ophthalmic artery, courses brainstem can be divided into three through the optic nerve. CN III: oculomotor nerve ulla. Foramen: superior orbital fissure. Cell bodies of cranial nerves that share 2. Motor distribution: superior, medial, and common functions are grouped into dif- inferior rectus muscles, inferior oblique ferent clusters or nuclei.
These motor muscle Figure 1—7 , and levator palpe- and sensory nuclei are scattered brae superioris, which raises the eyelid. Parasympathetic distribution: lacrimal spinal cord.
The cranial nerve nuclei are listed in muscles. The last two control the papil- Tables 1—7 and 1—8. TABLE 1—7. TABLE 1—8. Medial nasal retina Figure 1—6.
Optic pathway of CN II. Lateral temporal retina Louis, Mosby, Optic chiasma nasal fibers cross. Optic tract Lateral geniculate body.
Motor pathway: oculomotor nerve fibers run through the oculomotor nucleus in Medial rectus Lateral rectus the midbrain to the extrinsic eye muscles. Parasympathetic pathway: preganglionic nerve fibers originate at the Edinger- Superior oblique Westphal nucleus in the midbrain and are Inferior rectus muscle CN IV carried by the oculomotor nerve to the muscle CN III ciliary ganglion, where postganglionic Figure 1—7. Muscles and nerves involved in the coordi- neurons extend to the lacrimal gland and nation of eye movements.
Pneumonic: all eye muscles are innervated b. IV and lateral rectus is innervated by CN c. Sensory pathway: the maxillary nerve VI. CN IV: Trochlear nerve and exits the skull through the foramen 1. It then passes through the 2. Motor distribution: superior oblique mus- pterygopalatine fossa, where it commu- cle, which moves the eyeball laterally and nicates with the pterygopalatine gan- downward.
CN V: Trigeminal nerve and zygomatic nerves Figure 1—10, 1. Three divisions: Table 1—9. V1—ophthalmic nerve. Pterygopalatine ganglion: branches of b. V2—maxillary nerve. V3—mandibular nerve. V1—ophthalmic nerve thetic fibers and include nerves travel- a.
Sensory distribution: cornea, eyes, upper pharynx, and nasal cavity. Infraorbital nerve: the posterior supe- Figure 1—9. Sensory pathway: the ophthalmic infraorbital nerve in the pterygopala- nerve branches from the trigeminal tine fossa. The infraorbital nerve then ganglion and exits the skull via the passes through the inferior orbital fis- superior orbital fissure.
It then divides sure to enter the orbit floor, coursing into three major nerves: the frontal, along the infraorbital groove toward lacrimal, and nasociliary nerves. In the canal, the 3.
V2—maxillary nerve middle superior and anterior superior a. Foramen: foramen rotundum. The infraor- bital nerve then exits the maxilla via the infraorbital foramen. Zygomatic nerve: after branching from the maxillary nerve, the zygomatic I nerve passes through the orbit after entering from the superior orbital fis- sure.
The zygo- matic nerve continues into the zygomatic canal, where it divides into III the zygomaticofacial and zygomati- cotemporal nerves. It also travels to the lacrimal gland. Greater and lesser palatine nerves: the Figure 1—9. Sensory distribution for the three divisions palatine nerves branch from the ptery- of the trigeminal nerve.
Lacrimal n. Zygomatic n. Zygomaticotemporal n. Zygomaticofacial n. Ganglionic brs. Palpebral n. N of pterygoid canal Nasal n. Middle superior Pterygopalatine alveolar n. Lesser palatine n. Labial n. Posterior superior alveolar n. Figure 1— Branches of the maxillary nerve CN V2.
V3—mandibular nerve Posterior superior Sensory Maxillary second and alveolar nerve third molars a. Foramen: foramen ovale. Maxillary first molar: b. Sensory distribution: lower cheek, palatal and external auditory meatus, the temporo- distobuccal root Maxillary sinus mandibular joint TMJ , chin, lower lip, Middle superior Sensory Maxillary first and tongue, floor of the mouth, and alveolar nerve second premolars mandibular teeth see Figure 1—9.
Maxillary first molar: mesiobuccal root c. Motor distribution: muscles of mastica- Anterior superior Sensory Maxillary anterior tion temporalis, masseter, internal and alveolar nerve teeth external pterygoid muscles , anterior Greater palatine Sensory Posterior hard palate nerve Lingual gingiva of belly of the digastric, tensor tympani, maxillary posterior tensor veli palatine, and mylohyoid teeth muscle. Lesser palatine Sensory Soft palate nerve Tonsils d.
Note: the mandibular nerve V3 is the Nasopalatine Sensory Anterior hard palate largest division of the trigeminal nerve and nerve Lingual gingiva of is the only one with motor function. Anatomic pathway: both motor and sensory fibers of the mandibular nerve exit the skull through the foramen h. Nasal branches: lateral nasal branches ovale, where they form the mandibular divide from the pterygopalatine ganglion trunk.
The trunk then divides into an toward the posterior nasal cavity. One of anterior and posterior division in the these branches, the nasopalatine nerve, infratemporal fossa. Long buccal nerve Sensory Cheek f. Inferior alveolar nerve IAN : the IAN Buccal gingiva of descends lateral to the lingual nerve posterior mandibular and medial pterygoid muscle toward teeth Posterior buccal the mandibular foramen. It stays mucosa medial to the sphenomandibular liga- Lingual nerve Sensory Lingual gingiva of ment and lateral to the neck of the mandibular teeth Floor of mouth mandible within the pterygomandibu- Inferior alveolar Sensory Mandibular posterior lar space.
Before entering the foramen, nerve teeth the mylohyoid nerve branches off. The Mental nerve Sensory Chin Lower lip IAN then passes through the mandibu- Anterior labial lar foramen into the mandibular canal, mucosa where it travels with the inferior alveo- Incisive nerve Sensory Mandibular anterior teeth lar artery and vein and forms a dental Auriculotemporal Sensory TMJ plexus, providing innervation to the nerve External auditory mandibular posterior teeth.
The mental nerve nerves, anterior exits the mandible via the mental and posterior Masseteric nerve Motor Masseter muscle foramen, which is usually located Lateral pterygoid Motor Lateral pterygoid around the apex of the second nerve muscle mandibular premolar. The incisive. Branches to muscles Temporal branches of mastication. Parasympathetic branches Long buccal n.
Lingual n. Chorda tympani n. Submandibular ganglion N to mylohyoid. Mental n. Inferior alveolar n. Branches of the mandibular division of the trigeminal nerve CN V3. Greater petrosal nerve: the greater petrosal lar anterior teeth. Lingual nerve: the lingual nerve glion, carrying preganglionic parasympa- descends toward the base of the thetic fibers in it, and travels through the tongue, coursing between the medial foramen lacerum.
It is then joined by the pterygoid muscle and the mandible. It deep petrosal nerve which contains sym- remains medial to the IAN. The chorda pathetic fibers from the carotid plexus tympani a branch from CN VII, con- before it enters the pterygoid canal.
It taining parasympathetic fibers joins it emerges as the nerve of the pterygoid before it meets the submandibular gan- canal. The nerve of the pterygoid canal glion, where it continues toward the continues toward the pterygopalatine fossa submandibular and sublingual glands. Auriculotemporal nerve: the auricu- toward the lacrimal gland along the zygo- lotemporal nerve travels posteriorly and matic nerve, a branch of CN V2 , and encircles the middle meningeal artery smaller glands in the nasal cavity, upper remaining posterior and medial to the pharynx, and palate Figure 1— It continues up toward the TMJ, 6.
Chorda tympani: the chorda tympani external ear, and temporal region, pass- branches from the facial nerve, carrying ing through the parotid gland and travel- both sensory fibers for taste and pregan- ing with the superficial temporal artery glionic parasympathetic fibers. It exits and vein. Postganglionic parasympa- from of the temporal bone via the thetic nervous system fibers from the petrotympanic fissure and joins the lingual lesser petrosal branch, a branch from nerve a branch of CN V3 as it courses infe- CN IX, join the auriculotemporal nerve to riorly toward the submandibular ganglion the parotid gland.
Postganglionic parasym- F. CN VI: Abducens nerve pathetic fibers emerge from the ganglion 1. Motor distribution: lateral rectus muscle, submandibular glands see Figure 1— Sensory distribution: taste for the ante- rior two-thirds of the tongue.
Temporal branch 2. Motor distribution: muscles of facial expression. Parasympathetic distribution: sublingual, submandibular, and lacrimal glands. Anatomic pathway: the facial nerve enters the internal acoustic meatus, located in Zygomatic branch the temporal bone. In the bone, the facial nerve communicates with the geniculate CN VII ganglion and the chorda tympani nerve branches off. The facial nerve then contin- Buccal branch ues and descends to exit the skull via the stylomastoid foramen.
The auricular Mandibular branch nerve and nerves to the posterior belly of the digastric and stylohyoid muscles branch off before the facial nerve divides Cervical branch into five main branches: temporal, zygo- Figure 1— Facial nerve CN VII : motor branches to matic, buccal, mandibular, and cervical the muscles of facial expression.
Modified from branches Figure 1— Saunders, Nerve of the Lacrimal gland pterygoid canal. Deep petrosal n. Greater petrosal n. Pterygopalatine ganglion. Superior salivatory nucleus Pterygopalatine ganglion. Sublingual and Chorda tympani submandibular glands. Submandibular ganglion Figure 1— It descends to the supe- 1. Foramen: internal auditory meatus. Sensory distribution: equilibrium, bal- the tympanic nerve of Jacobson or tym- ance, and hearing. Both ganglia I.
CN IX: Glossopharyngeal nerve contain sensory and motor cell bodies. The 1. Foramen: jugular foramen. Sensory distribution: posterior one-third inferiorly to provide sensory and motor of the tongue taste , pharynx, tonsils, function to the posterior tongue, middle middle ear, carotid sinus.
Parasympathetic distribution: parotid carotid sinus. Parasympathetic pathway: the tympanic 4. It continues from there as ganglion. They divide into external and the lesser petrosal nerve toward the otic internal laryngeal branches. The external laryngeal nerve provides nerve CN V3. Postganglionic parasympa- motor innervation to the cricothyroid thetic fibers emerge from the ganglion muscle and inferior pharyngeal con- and travel along the auriculotemporal strictor muscles.
The internal laryngeal nerve travels with Figure 1— CN X: vagus nerve through the thyrohyoid membrane to 1. Motor distribution with fibers from CN XI : membranes from the base of the tongue the laryngeal muscles phonation, swallow- to the vocal folds.
The internal laryngeal ing , all muscles of the pharynx except the nerve also carries parasympathetic stylopharyngeus, and all muscles of the fibers. Recurrent laryngeal branches: the right 3. Sensory distribution: posterior one third of recurrent laryngeal nerve ascends back to the tongue taste , heart, lungs, and the neck around the subclavian artery. The left recurrent laryngeal nerve passes 4. Parasympathetic distribution: heart, around the arch of the aorta or ligamen- lungs, abdominal organs.
Anatomic pathway: the vagus nerve exits between the trachea and esophagus. As the skull via the jugular foramen at the they ascend, the nerves provide sensory medulla. It descends through the superior and parasympathetic innervation to and inferior ganglion of the vagus nerve, mucous membranes and structures up to giving off branches in the pharynx and the vocal cords.
The nerves then continue larynx. The vagus nerve descends and is as the inferior laryngeal nerves in the lar- accompanied by the carotid artery and ynx, providing motor innervation to all jugular vein within the carotid sheath as it the muscles of the larynx, except the enters the thoracic area.
In the thorax, the cricothyroid muscle. A motor branch also right and left vagus nerves then give off the provides innervation to the inferior pha- right and left recurrent laryngeal nerves, ryngeal constrictor muscle. CN XI: Accessory nerve into the neck. The two vagus nerves meet 1. Past the 2. Sensory distribution: sternocleidomas- diaphragm, the joined vagus nerves toid and trapezius muscles. Also joins esophageal plexus divide into the ante- with CN X in supplying motor function to rior and posterior vagal trunks.
Pharyngeal branches: the pharyngeal cles. Foramen: hypoglossal canal. Motor distribution: intrinsic muscles of 7.
Superior laryngeal branches: branch from the tongue, genioglossus, hyoglossus, and the vagus nerve just below the inferior styloglossus muscles.
Inferior salivatory Otic ganglion nucleus. Scheme of parasympathetic nerve fibers of CN IX. Masticator space—includes four spaces: Spaces and cavities of the a. Temporal space head and neck 1 Location: between the temporalis Potential spaces, or fascial spaces, of the head muscle and its fascia.
Odontogenic infections can b. Infratemporal space therefore spread to these areas. Spaces of the maxillary region the mandible and temporalis mus- 1. Vestibular space of the maxilla cle. Medially, it is bordered by the a. Location: between the buccinator mus- lateral pterygoid plate and phar- cle and oral mucosa. It is inferior to the ynx. It is inferior to the greater wing alveolar process. Potential odontogenic source of infec- 2 Contents: maxillary artery and its tion: maxillary molars.
Canine fossa branches, and the pterygoid plexus. Location: positioned just posteriorly 3 Infections of the infratemporal and superiorly to the roots of the maxil- space are considered dangerous lary canines.
It remains inferior to the due to the potential of spread of orbicularis oculi muscle, posterior to infection to the cavernous sinus via the levator muscles, and anterior to the the pterygoid plexus. Potential odontogenic source of infec- infection: maxillary third molars tion: maxillary canines and first premo- and infectious anesthetic needles.
Submasseteric space 3. Canine space 1 Location: between the masseter a. Location: situated within the superfi- muscle and mandibular ramus. It is 2 Potential odontogenic source of posterior to the orbicularis oris muscle infection: mandibular third molars and anterior to the levator anguli oris rare. Best Wishes to all. Furthermore, please bear in mind that we do not own copyrights to these books. And therefore, we highly encourage our visitors to purchase original books from the respected publishers.
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