1 - Head & Neck - General

Question 1

Name the 3 layers of deep cervical fascia, from superficial to deep:

Answer 1

1 - Investing layer
2 - Pretracheal layer
3 - Prevertebral layer

Question 2

In which cervical fascial layer is the Platysma and the external jugular vein found?

Answer 2

Superficial cervical fascia

Question 3

Which cervical fascial layers form the carotid sheath?

Answer 3

Deep cervical fascial layers:

• Investing layer
• Pretracheal layer
• Prevertebral layer

Question 4

What are the attachments of the investing layer of deep cervical fascia?

Answer 4

Superiorly:

• Inferior mandible
• Mastoid process
• Superior nuchal line
• External occipital protuberance

Inferiorly:

• Superior border of manubrium
• Superior border of clavicles
• Acromion
• Spine of scapula

Question 5

What are the attachments of the pretracheal layer of deep cervical fascia?

Answer 5

Superiorly = Hyoid bone
Inferiorly = Blends with fibrous pericardium

Question 6

What are the 2 layers of the pretracheal layer, and what do they enclose?

Answer 6

1 - Muscular layer = Enclose infrahyoid muscles

2 - Visceral layer = Enclose Thyroid gland, Trachea and Oesophagus

Question 7

The investing layer splits to invest which key muscles and glands?

Answer 7

• Trapezius
• Sternocleidomastoid
• Submandibular salivary glands
• Parotid salivary glands

Question 8

How can a thyroid goitre cause facial oedema and breathlessness?

Answer 8

Goitre can extend retrosternally as the pretracheal layer extends into thorax.
Therefore goitre can put pressure on trachea = breathlessness.
Goitre can compression the venous drainage from the head and neck = facial oedema.

Question 9

Name the important contents of the carotid sheath:

Answer 9

• Common carotid artery
• Internal jugular vein
• Vagus nerve
• Cervical lymph nodes

Question 10

The prevertebral layer of deep cervical fascia extends between which structures?

Answer 10

• Base of cranium

- 3rd thoracic vertebrae (T3)

Question 11

Which layer of deep cervical fascia forms the axillary sheath (surrounding the axillary vessels and brachial plexus)?

Answer 11

Prevertebral layer

Question 12

Where is the retropharyngeal space?

Answer 12

Space between the prevertebral and buccopharyngeal (fascia surrounding pharynx) fascial layers

Question 13

What is found in the retropharyngeal space?

Answer 13

Nothing (lymph nodes up to age 4)

Question 14

What is the main function of the retropharyngeal space?

Answer 14

Allows pharynx to move freely, and to expand when swallowing

Question 15

If an infection develops in the retropharyngeal space, how far down in the body can it spread?

Answer 15

To the posterior mediastinum

Question 16

What age group most commonly develops infections in the retropharyngeal space?

Answer 16

Under 5 yrs

Question 17

How can a retropharyngeal abscess present?

Answer 17

• Visible bulge on oropharynx
• Sore throat
• Dysphagia
• Stridor
• Neck stiffness
• High temperature

Question 18

What is the function of the buccinators?

Answer 18

• Keep cheeks taut

- Aid chewing

Question 19

What nerve innervates the muscles of mastication?

Answer 19

Trigeminal nerve - Mandibular division

CN V

Question 20

What nerve innervates the muscles of facial expression?

Answer 20

Facial nerve

CN VII

Question 21

What is Bell’s palsy?

Answer 21

Facial paralysis due to inflammation of facial nerve. Often due to viral infection.

Question 22

Through which gland does the fascial nerve pass?

Answer 22

Parotid gland

Question 23

What are the main muscles of mastication?

Answer 23

• Temporalis
• Masseter
• Medial and lateral Pterygoids

Question 24

Name the 5 branches of the facial nerve:

Answer 24

1 - Temporal
2 - Zygomatic
3 - Buccal
4 - Marginal mandibular
5 - Cervical

Question 25

Name the 3 branches of the trigeminal nerve:

Answer 25

1 - Opthalmic 2 - Maxillary 3 - Mandibular

Question 26

How can you test the facial nerve?

Answer 26

``` Motor: - Raise both eyebrows - Frown - Close both eyes tightly - Try to open eyes against resistance - Show both upper and lower teeth - Smile - Puff out both cheeks Sensory: - Test for taste ```

Question 27

How can you test the trigeminal nerve?

Answer 27

``` Motor: - Palpate temporalis and masseter as patient clenches jaw - Ask to keep mouth open and side-to-side against resistance - Jaw jerk Sensory = Light touch in 3 divisions: 1) Opthalmic = forehead 2) Maxillary = cheeks 3) Mandibular = chin ```

Question 28

Name the boundaries of the anterior triangle of the neck:

Answer 28

Superior = inferior margin of mandible Laterally = medial border of sternocleidomastoid Middle - Imaginary sagittal line down midline

Question 29

Name the boundaries of the posterior triangle of the neck:

Answer 29

``` Anterior = Posterior border of sternocleidomastoid Posterior = Anterior border of trapezius Inferior = Superior border of medial 1/3rd clavicle ```

Question 30

Which nerve innervates the sternocleidomastoid muscle?

Answer 30

Accessory nerve | CN XI