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Applied Head and Neck Anatomy > General Organisation > Flashcards

General Organisation Flashcards

(54 cards)

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1
Q

Where is the neck located?

A

Extends from the lower margin of the mandible to the suprasternal notch of manubrium and the upper border of the clavicle.

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2
Q

How are structures in the neck compartmentalised?

A

By layers of cervical fascia:

  • ONE layer of superficial cervical fascia
    • loose connective tissue containing adipose
  • THREE deep cervical fascial layers:
    • Investing layer (most superficial)
    • Pretracheal fascia
    • Prevertebral fascia (most deep)
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3
Q

What structures lie in the superficial fascia?

A
  • external jugular vein
  • anterior jugular vein
  • cutaneous nerves
  • superfical lymph nodes
  • platysma
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4
Q

Describe the investing layer

A
  • Most superficial of the deep fascia
  • Surrounds entire neck
  • Encloses the sternocleidomastoid muscle and trapezius
  • Encloses submandibular and parotid salivary glands
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5
Q

What are the superior, inferior, anterior and posterior attachments of the investing layer?

A
  • Superior:
    • lower border of mandible
    • mastoid process
    • external occipital protuberance
  • Inferior
    • upper border of manubrium
    • upper surface of the clavicle
    • acromion and spine of scapula
  • Anteriorly
    • hyoid bone
  • Posterior
    • spinous process of vertebrae
    • ligamentum nuchae
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6
Q

Describe the pretracheal fascia

A
  • anterior neck
  • attaches to the hyoid bone superiorly and anteriorly
  • inferiorly extends into the thorax to join fibrous pericardium

Has a muscular and visceral layer;

  • muscular encloses infrahyoid muscles
  • visceral encloses thyroid gland, trachea and oesophagus
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7
Q

Where is the buccopharyngeal fascia located?

A

Posterior to the oesophagus, blending with the pretracheal fascia. Runs from the base of the skull superiorly to the diaphragm inferiorly.

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8
Q

Where is the carotid sheath located?

A

Base of the skull through the root of the neck to the arch of the aorta.

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9
Q

What does the carotid sheath contain?

A
  • Common carotid artery
  • Internal jugular vein
  • Cranial nerve (CN)
  • Vagus nerve (CN X)
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10
Q

Where is the prevertebral fascia located?

A

Surrounding the vertebral column.

Attachments:

  • Superior - base of skull
  • Anterior - transverse processes and vertebral bodies of the vertebral column
  • Posterior - nuchal ligament of vertebral column
  • Inferior - 3rd thoracic vertebrae

Extends laterally as the axillary sheath surrounding the axillary vessels and the brachial plexus running into the upper limb

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11
Q

What is the clinical correlation between deep cervical fasciae and infection?

A

Layers of deep cervical fascia form natural cleavage planes allowing structures to move and pass over one another with ease. These are useful during surgery as they allow for easy separation of the layers but determine the direction and extent to which any infection occurring in the neck will spread.

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12
Q

Where do infections of deep neck spaces normally arise from?

A

Infections of:

  • teeth
  • tissues of the pharynx
  • sinus
  • middle ear

Infections of deep neck spaces are rare but lethal

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13
Q

Where is the retropharyngeal space located?

A

A deep neck space found between the prevertebral fascia and the buccopharyngeal fascia

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14
Q

What are the sources of a retropharyngeal infection?

A

Usually secondary to an upper respiratory tract infection (nasal cavity, nasopharynx and oropharynx).

  • commonly seen in children under the age of 5
  • can develop into an abscess
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15
Q

What are the signs and symptoms of a retropharyngeal abscess?

A
  • bulge when inspection oropharynx
  • sore throat
  • difficulty swallowing (dysphagia)
  • stridor
  • reluctance to move neck
  • fever

Important to recognise and treat early as high morbidity and mortality

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16
Q

What is dysphagia?

A

Difficultly swallowing

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17
Q

What is stridor?

A

High pitched wheezing sound caused by disrupted airflow. Also known as musical breathing or extrathoracic airway obstruction.

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18
Q

What is the difference between morbidity and mortality?

A

Morbitity = illness

Mortality = death

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19
Q

In what direction does a goitre normally grow?

A

Retrosternally (behind the sternum) as the pretracheal fascia extends into the thorax.

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20
Q

What are the symtoms of an enlarged retrosternal goitre?

A
  • Breathlessness and Stridor
    • due to compression of the trachea
  • Facial oedma
    • due to compression of venous drainage from the head and neck
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21
Q

What are the two broad groups of the muscles of the head and neck?

A
  • Muscles of facial expression
    • normally dilators and sphincters, apart from buccinator
    • attaches to bone or skin/fascia
  • Muscles of mastication
    • open or close the jaw
    • act on the temporomandibular joint
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22
Q

Which nerve supplies the muscles of fasical expression?

Study These Flashcards
A

Facial nerve (Cranial Nerve VII)

23
Q

Which nerve supplies the muscles of mastication?

Study These Flashcards
A

Trigeminal nerve (Cranial Nerve V)

24
Q

What are the branches of the Facial Nerve?

Study These Flashcards
A

FIVE extra-cranial branches (terminal)

  • Temporal
  • Zygomatic
  • Buccal
  • Mandibular
  • Cervical

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25
Which structure does the facial nerve pass through?
Parotid gland (secretes saliva)
26
What is the most common non-traumatic cause of facial paralysis?
Bell's palsy - inflammation of the facial nerve. Muscles the are affected are ipsilateral to the nerve.
27
What are the symptoms of Bell's palsy?
* weakness or total paralysis on one side of your face that develops within 2 days * drooping eyelid or corner of the mouth * drooling * dry mouth * loss of taste * eye irritation, such as dryness or more tears Important to treat within 72 hours of symptoms to have the best outcome.
28
What is the most likely diagnosis for ipsilateral parotid enlargement and weakness of facial muscles?
Parotid cancer. Cancerous cells invade and damage the facial nerve during its course.
29
What are the key branches of the trigeminal nerve (CN V) ?
* Opthalmic Division (Va) * Maxillary Division (Vb) * Mandibular _Division_ (Vc) CN V is the **main sensory nerve** of face and scalp and **motor to the muscles of mastication.** **O**ff **M**y **M**an
30
What are the muscles of mastication?
* Temporalis * Masseter * Medial Pterygoids * Lateral Pterygoids All are supplied by the **mandibular division** of the **trigeminal nerve**
31
Action, innervation and examination of lateral pterygoids
Action: * Protrudes mandible * Opens jaw * Contralateral excursion (jaw left to right) Innervation: * Mandibular branch of trigeminal nerve Examination: * Open mouth against resistance * Move jaw side to side
32
Action, innervation and examination of medial pterygoids
Action: * Elevation * Contralateral excursion Innervation: * Mandibular branch of trigeminal nerve Examination: * Open mouth against resistance * move jaw side to side
33
Action, innervation and examination of masster muscle
Action: * Elevates mandible (stronger action than medial pterygoid) Innervation: * Mandibular branch of trigeminal nerve Examination: * Palpation during jaw clench
34
Action, innervation and examination of temporalis
Action: * Elevates of retrudes manidble Innervation: * Mandibular branch of trigeminal Examination: * Palpation during jaw clench
35
Which muscles act to open the jaw (depressing the mandible) ?
* Suprahyoids * Lateral pterygoid (Say LaaaaAaaa)
36
Describe suprahyoid muscles
Act to **elevate the hyoid bone** and **depress the mandible**. Innervated by branches of the **trigeminal nerve** and **hypoglossal nerve**. Found **superior** to the hyoid bone.
37
Describe the infrahyoid muscles
Four muscles situated below the hyoid bone. Supplied by **cervical nerves (C1-3)** Superficial layer: * Omohyoid * Sternohyoid Deep layer: * Sternothyroid * Thyrohyoid Either **depress** _hyoid bone_ or _thyroid cartilage_
38
Why is it important to determine which triangle of the neck a lump is located in?
To determine the likely cause
39
Sternocleidomastoid: action, innervation and examination
Action: Head rotation to the opposite side, lateral neck flexion and neck flexion Innervation: Accessory nerve Examination: Turn head against resistance (turning _right_ examines _left_ SCM)
40
Trapezius: action, innervation and examination
Action: Upper and lower fibres rotate scapula. Middle fibres retract scapula. Innervation: Accessory nerve Examination: Elevate shoulder
41
Platysma: action, innervation and examination
Action: Depresses lower jaw, small function in drawing down lower lip, tenses skin Innervation: Cervical branch of facial Examination: none
42
Orbicularis Oculi: action, innervation and examination
Action: **orbital region** uses to **consciously close the eye**, _palpebral region_ (found in eyelid) used for _unconscious light closure in blinking and sleep._ Innervation: Temporal and zygomatic branches of facial nerve Examination: Close eyes and resist opening
43
Levator Palpebrae Superioris: action, innervation and examination
Action: elevates upper eyelid Innervation: oculomotor nerve Examination: inspection of eyes for ptosis
44
What is ptosis?
Drooping or falling of upper eyelid
45
Occipitofrontalis: action, innervation and examination
Action: elevates eyebrows Innervation: Frontal belly = temporal branch of facial nerve, Occipital belly = posterior auricular branch of facial nerve Examination: elevate eyebrows against resistance
46
What are the layers of the scalp?
S: skin C: (dense) connective tissue A: aponeurosis of occipitofrontalis L: loose connective tissue P: pericranium
47
Orbicularis Oris: action, innervation and examination
Action: closes mouth Innervation: buccal branch of facial nerve Examination: face inspection; drooping angle of mouth in CNVII palsy
48
Dilator muscles of the lips: action, innervation and examination
Action: separates the lips Innervation: Buccal and mandibular branches of facial nerve Examination: Not individually examined
49
Buccinator: action, innervation and examination
Action: flattens cheek, holds cheek close to teeth when chewing preventing food from pooling between cheek and gums. Innervation: Buccal branch of facial nerve Examination: Blow out cheeks and resist expulsion of air
50
What are the scalene muscles?
Accessory muscles of respiration. Found within the neck and form the floor of the posterior triangle.
51
What structures pass close to the scalene muscles?
* Brachial plexus * Subclavian vessels * Phrenic nerve
52
What are the borders of the anterior triangle of the neck?
Superiorly - inferior border of mandible Medially - sagittal line down the middle of the neck Lateral - anterior border of sternocleidomastoid
53
What are the contents of the anterior triangle?
Muscles: * Suprahyoid muscles * Infrahyoid muscles Vessels: * Common carotid * Internal carotid * External carotid Nerves: * Facial (VII) * Glossopharyngeal (IX) * Vagus (X) * Accessory (XI) * Hypoglossal (XII)
54
What are the subdivisions of the anterior triangle of the neck?
* Carotid triangle * Submental triangle * Submandibular triangle * Muscular triangle

Applied Head and Neck Anatomy (4 decks)

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