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QUICK REFERENCE for OTOLARYNGOLOGY Guide for Aprns, Pas, and Other Health Care Practitioners IMAGE BANK QUICK REFERENCE for OTOLARYNGOLOGY Guide for APRNs, PAs, and Other Health Care Practitioners Kim Scott Consultants Richard F. Debo Alan S. Keyes David W. Leonard SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 1 33/17/2014/17/2014 33:58:02:58:02 PPMM Physical Examination Documentation of Normal and Abnormal Findings From the Ear, Nose, and Throat Examination FIGURE 1.1 Normal tympanic membrane. © Springer Publishing Company SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 2 33/17/2014/17/2014 33:58:03:58:03 PPMM Crura of Scaphoid antihelix Helix fossa Auricular Triangular tubercle fossa Cymba of Crus of helix concha Concha of auricle Tragus Cavum of concha External auditory meatus Antihelix Intertragic notch Helix Lobule Antitragus FIGURE 1.2 Pinna. © Springer Publishing Company SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 3 33/17/2014/17/2014 33:58:05:58:05 PPMM External ear Middle ear Inner ear Auricle (not to scale) Temporal Tympanic Semicircular Facial nerve (pinna) bone membrane canals External Vestibular nerve auditory Acoustic meatus Cochlear nerve (VIII) nerve Vestibule Oval window Round window Malleus Incus Stapes Eustachian tube Auditory ossicles FIGURE 1.3 External, middle, and inner ear. © Springer Publishing Company SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 4 33/17/2014/17/2014 33:58:05:58:05 PPMM Pars flaccida Short process of malleus Incus Handle of malleus Pars tensa Cone of light Umbo FIGURE 1.4 Tympanic membrane. © Springer Publishing Company SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 5 33/17/2014/17/2014 33:58:05:58:05 PPMM FIGURE 1.5 Central tympanic membrane perforation. © Springer Publishing Company SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 6 33/17/2014/17/2014 33:58:05:58:05 PPMM FIGURE 1.6 Tympanosclerosis. © Springer Publishing Company SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 7 33/17/2014/17/2014 33:58:07:58:07 PPMM Frontal bone Nasal bones Upper lateral nasal cartilages Septal cartilage and dorsum of the nose Tip Alar groove Greater alar cartilage Lower lateral Lateral crus Alla nasal cartilages Medial crus Columalla Septal cartilage FIGURE 1.7 External nose. © Springer Publishing Company SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 8 33/17/2014/17/2014 33:58:08:58:08 PPMM Cribriform plate Frontal of ethmoid sinus Orbital plate (frontal bone) Lamina papyracea Ethmoid air cells (ethmoid) Orbit Superior turbinate and meatus Uncinate process Maxillary sinus Middle turbinate and meatus Vomer Inferior turbinate and meatus FIGURE 1.8 Paranasal sinuses. © Springer Publishing Company SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 9 33/17/2014/17/2014 33:58:09:58:09 PPMM Stensen’s Parotid duct salivary gland Masseter muscle Sublingual ducts Wharton’s duct Sublingual salivary gland Submandibular salivary gland FIGURE 1.9 Salivary glands. © Springer Publishing Company SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 1100 33/17/2014/17/2014 33:58:09:58:09 PPMM Superior lip Gingivae (gums) Superior labial Hard palate frenulum Soft palate Palatoglossal arch Uvula Palatopharyngeal arch Palatine tonsil Posterior wall of oropharynx Duct of submandibular gland Tongue Lingual frenulum Vestibule Gingivae (gums) Inferior lip Inferior labial frenulum FIGURE 1.10 Oral cavity and oropharynx. © Springer Publishing Company SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 1111 33/17/2014/17/2014 33:58:09:58:09 PPMM 0 1 2 Surgically removed tonsils Tonsils hidden within Tonsils extending to tonsil pillars the pillars 3 4 Tonsils are beyond Tonsils extend to midline the pillars FIGURE 1.11 Tonsil size scoring. © Springer Publishing Company SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 1122 33/17/2014/17/2014 33:58:09:58:09 PPMM Sella turcica Frontal sinus Adenoid Pharyngeal opening of Sphenoid sinus auditory (eustachian) tube Soft palate Uvula Hard palate Nasopharynx Incisive canal Oral cavity Body of tongue Palatine tonsil Oropharynx Base of tongue Lingual tonsil Hypopharynx Hyoid bone Epiglottis Transverse arytenoid muscle Thyrohyoid membrane Cricoid cartilage Thyroid cartilage Esophagus Vocal fold (cord) Trachea FIGURE 1.12 Oropharynx, hypopharynx, trachea, and larynx. © Springer Publishing Company SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 1133 33/17/2014/17/2014 33:58:10:58:10 PPMM Median glosso-epiglottic fold Base of tongue (lingual tonsil) Vallecula Vocal folds Epiglottis (true cords) Ventricular folds (false cords) Glottic aperature Trachea Vestibule Piriform recess Aryepiglottic fold Interarytenoid notch Ventricle Esophagus Arytenoid FIGURE 1.13 Larynx landmarks. © Springer Publishing Company SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 1144 33/17/2014/17/2014 33:58:10:58:10 PPMM OMEGA-SHAPED EPIGLOTTIS VALLECULA FIGURE 1.14 Omega-shaped epiglottis and vallecula. © Springer Publishing Company SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 1155 33/17/2014/17/2014 33:58:10:58:10 PPMM Anterior View Epiglottis Hyoid bone Thyrohyoid membrane Superior horn of thyroid cartilage Arytenoid cartilage (behind thyroid cartilage) Larynx location Thyroid cartilage Cricothyroid ligament Inferior horn of thyroid cartilage Cricoid cartilage Trachea FIGURE 1.15 Cartilages of larynx. © Springer Publishing Company SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 1166 33/17/2014/17/2014 33:58:14:58:14 PPMM Occipital nodes Mastoid nodes Jugulodigastric node (Level II) node (Level Jugulodigastric nodes Deep lateral V) (spinal accessory nodes) (Level deep cervicalInferior IV) (scalene) node (Level cervical Transverse V) chain of nodes (Level © Springer Publishing Company © Springer Publishing Level I nodesLevel IV nodesLevel II nodes Level V nodes Level III nodes Level VI nodes Level FIGURE 1.16 Neck: Lymphatic system and node groups. Supraclavicular nodes (Level IV) nodes (Level Supraclavicular Suprahyoid node (Level I) node (Level Suprahyoid Internal jugular chain of nodes Facial nodes Facial (anterior jugular nodes) (Level VI) (anterior jugular nodes) (Level Submental nodes (Level I) Submental nodes (Level Anterior superficial cervical nodes submandibular (buccal nodes) (buccal nodes (Level I) nodes (Level Mandibular and Mandibular to parotid gland) Anterior deep cervical and (pretracheal Superficial parotid nodes (deep parotid nodes deep Subparotid node (Level II) Subparotid node (Level (deep lateral cervical nodes) (Levels II and III) cervical(deep lateral nodes) (Levels thyroid) nodes (deep to strap muscles) (Level VI) (Level muscles) nodes (deep to strap thyroid) SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 1177 33/17/2014/17/2014 33:58:14:58:14 PPMM Ear, Nose, and Throat Anatomy and Physiology Normal Findings Frontal bone Parietal bone Nasal bone Sphenoid bone Zygomatic arch Temporal bone Maxilla Occipital bone Mandible Mastoid process Styloid process FIGURE 2.1 Skull bone landmarks. © Springer Publishing Company SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 1188 33/17/2014/17/2014 33:58:14:58:14 PPMM Temporal branch Trigeminal nerve Ophthalmic branch (V1) Facial nerve Maxillary branch (V2) Buccal branch Zygomatic branch Mandibular branch Mandibular branch (V3) Cervical branch FIGURE 2.2 Trigeminal nerve and facial nerve branches. © Springer Publishing Company SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 1199 33/17/2014/17/2014 33:58:14:58:14 PPMM To parotid gland Superior and inferior ganglia To pharynx Glossopharyngeal nerve To palatine tonsil To carotid body and carotid sinus To tongue for taste and general sensation To stylopharyngeus muscle FIGURE 2.3 Glossopharyngeal nerve. © Springer Publishing Company SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 2200 33/17/2014/17/2014 33:58:15:58:15 PPMM Anterior (superior) semicircular canal and duct Ampullae Common crus and duct Dura mater Posterior semicircular canal and duct Endolymphatic sac Lateral semicircular canal and duct Endolymphatic duct in vestibular aqueduct Stapes in oval (vestibular) window Utricle Incus Saccule Malleus Vestibule Round (cochlear) window (closed by secondary Cochlear aqueduct tympanic membrane) Tympanic cavity External acoustic meatus Tympanic membrane Auditory (eustachian) tube FIGURE 2.4 Middle and inner ear. © Springer Publishing Company SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 2211 33/17/2014/17/2014 33:58:15:58:15 PPMM SSINUSINUS CTCT SCAN:SCAN: CORONALCORONAL VIEWVIEW NASALNASAL SSEPTUMEPTUM MMAXILLARYAXILLARY SINUSSINUS CCAVITIESAVITIES FIGURE 2.5 Maxillary sinuses. © Springer Publishing Company SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 2222 33/17/2014/17/2014 77:14:15:14:15 PPMM Septal branch of facial artery Nasal septum turned superiorly Branches of posterior ethmoidal artery Branches of anterior ethmoidal artery Septal branch of nasopalatine artery Nasopalatine artery Kiesselbach’s Plexus Sphenopalatine foramen Lateral nasal Lateral nasal branch branches of of nasopalatine artery facial artery Anastomosis between Maxillary artery septal branch of nasopalatine artery and greater palatine artery External carotid artery in incisive canal Greater palatine artery Lateral wall of Lesser palatine artery nasal cavity FIGURE 2.6 Arteries of nasal cavity. © Springer Publishing Company SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 2222 33/17/2014/17/2014 33:58:15:58:15 PPMM Olfactory bulb Olfactory nerves Olfactory
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