Head & Neck 1 Flashcards by Paras Marlowe

What is the difference between the viscerocranium and the neuro cranium

Viscerocranium - bones of the face

Neurocranium - Bones surrounding the brain

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To remind you of all the MSK you’ve forgotten, how many cervical vertebrae are there? Specific features?

7 - foramina in transverse processes, relatively small bodies

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From top to bottom list the four notable structures in the neck that are in line with the trachea

Hyoid bone
Thyroid cartilage
Cricoid cartilage
Thyroid gland

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Name the three notable muscles in the neck

Platysma
Sternocleidomastoid
Trapezius

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Other than muscle function, what is worth remembering about the SCM and Trapezius muscles

Their borders form important anatomical boundaries of the neck

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Platysma: shape and position?

Broad, sheet-like, v. superficial (within superficial fascia), overlies SCM

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Platysma: action?

Draws corners of mouth inferiorly and skin of neck superiorly (if teeth clenched)

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Platysma: innervation?

Facial Nerve - CN VII

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SCM: attachments and position?

Mastoid process, Clavicle and Sternum

Deep to platysma but palpable and visible

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SCM: action? (unilateral AND bilateral please)

Unilateral - lateral flexion of the neck (i.e. ear to shoulder while rotating chin superiorly)
Bilateral - flexion at neck, extension at atlanto-occipital joint

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SCM: innervation?

Accessory nerve - CN XI

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As Trapezius is in MSK as well let’s do it all in one

Arises - back of skull, nuchal ligament, spinous processes of vertebrae
Attaches - lateral 1/3 of clavicle, acromion, spine of scapula
Actions - shrugs, rotates scapula
Nerve - Acessory CN XI

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What are the borders of the anterior triangle of the neck?

Midline of the neck
Anterior margin of SCM
Inferior margin of mandible

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What are the borders of the posterior triangle?

Anterior margin of trapezius
Clavicle
Posterior margin of SCM

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What is the function of the fascial planes in the neck?

Organises structures into compartments
Ease of movement while swallowing
Containing spread of infection

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How many layers of cervical fascia are there?

5 - 1 superficial and 4 deep

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What are the contents of the superficial layer of fascia?

Loose connective tissue
Fat 
Platysma
Cutaneous nerves 
Lymph nodes 
Superficial blood vessels

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Name each of the deep layers, superficial to deep if you please

Investing
Pretracheal
Prevertebral
Carotid Sheath(s)

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Investing layer: what does it surround?

All neck structures -

It splits into 2 in order to completely surround the SCMs and Traps

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Investing layer: attachments?

Hint: 7

External occipital protuberance, superior nuchal line, hyoid bone, clavicle, manubrium, scapular spine, ligamentum nuchae

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Pretracheal layer: position?

anteriorly in neck - spans between hyoid bone and thorax (fuses there with pericardium)

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Pretracheal layer: what structures are contained within it?
Hint: 4

Trachea, oesophagus, thyroid gland and infrahyoid muscles

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What are the infrahyoid muscles?

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4 muscles (obviously) located inferiorly to the hyoid bone that work to depress the hyoid bone or thyroid cartilage

What can the pretracheal layer be subdivided into?

Hint: 2 parts

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Muscular and visceral parts;
Muscular - encloses the infrahyoids
Visceral - encloses the rest

Prevertebral layer: what does it surround?

The vertebral column and its associated muscles

Prevertebral layer: attachments?

base of skull, transverse processes and vertebral bodies of vertebral column as well as ligamentum nuchae and endothoracic fascia of ribcage

Prevertebral fascia: other anatomical significance? | Hint: boundaries

Forms the floor of the posterior triangle of the neck AND the axillary sheath

Carotid sheaths: what are they?

Paired structures formed from contributions of the other deep layers

Carotid sheaths: what do they contain? | Hint: 4

Common carotid artery (bifurcates in it) Internal jugular vein Vagus nerve Cervical lymph nodes

Carotid sheaths: clinical relevance?

Their organisation into a column running from the skull base to the thoracic mediastinum creates a pathway for infection to spread (mediastinitus)

Retropharyngeal and pre-tracheal spaces: why?

Allow spread of infection within them - e.g. tracheostomy could introduce bacteria into pretracheal space

What are the two broad sets of muscles of the face and their respective innervation?

Muscles of facial expression - Facial nerve CN VII | Muscles of mastication - Trigeminal nerve CN V

What other function does the trigeminal nerve have? Which branches are involved?

``` Sensory to the face and scalp (Roughly top to bottom) Opthalmic Maxillary Mandibular ```

What is the cranial nerve number of the facial and trigeminal nerves?

Trigeminal - V | Facial - VII

Name the terminal branches of the facial nerve | Hint: 5

``` Temporal Zygomatic Buccal Marginal mandibular Cervical ```

Facial nerve: other functions?

SS (special sensory) tongue | Parasympathetic innervation to salivary and lacrimal glands

Clinical relevance: how can the fascial layers aid in diagnosing goitres?

The thyroid gland is enclosed in pretracheal fascia, in turn attached to the hyoid which moves up in swallowing, therefore so will a goitre

Clinical relevance: signs of a retrosternal goitre?

Compression = breathlessness, stridor, facial oedema

How is the facial nerve tested?

Forehead creasing, keeping eyes shut against resistance, revealing the teeth and puffing out the cheeks

How is the trigeminal nerve tested?

Sesory testing with cotton buds | Corneal reflex

Orbicularis oculi: action an innervation?

Closes the eyelid and scrunches the eye | Facial nerve

Levator palpebrae: action and innervation?

Opens the eyelids | Oculomotor nerve CN III

Orbicularis Oris: action?

Purses lips

Buccinator: action?

Compresses cheeks against teeth and is involved in blowing (not that kind)

Pterygoids, lateral and medial: actions?

Clenching jaw and moving it anteriorly

Temporalis: action?

Crushing food in molars

What is the scalp?

The 5 layers of skin and subcutaneous tissue that cover the bones of the cranial vault

Now name the layers of the scalp. Hint: SCALP is a pseudo-mnemonic

``` Skin (Dense) Connective tissue (Epicranial) Aponeurosis Loose areolar connective tissue Periosteum ```

Why does the scalp bleed so much?

The dense connective tissue layer has lots of blood vessels that are tightly attached preventing them from constricting if lacerated

Which muscles are connected by the epicranial aponeurosis?

Occipitalis and frontalis

Clinical relevance: scalp infections?

Can spread to cranial cavity via emissary veins, could cause meningitis

Scalp: arterial supply?

Opthalmic and external carotid

Scalp: which branches of external carotid are involved?

Roughly anterior to posterior; superficial temporal, occipital, posterior auricular

Scalp: superficial venous drainage?

Follows arterial supply via veins with the same names

Scalp: deep veous drainage?

Pterygoid venous plexus - draining into the maxiallry vein

Scalp: additional venous drainage? Hint: anastomoses

Scalp veins connect to diploic veins of the skull via valveless emissaary veins connecting scalp to dural venous sinuses

Scalp: innervation? Hint: 6 nerves from 2 sources

4 fromTrigeminal; supratrochlear, supraorbital, zygomaticotemporal and auriculotemporal 2 from cervical nerves; lesser and greater occipital nerves (C2 & 3)

Head & Neck 1 Flashcards

(57 cards)