Interval 10: Head and Neck

Question 1

The skeletal muscles of the face and scalp include muscles of _________ and __________.

Answer 1

• facial expression

- mastication

Question 2

What nerves innervation the facial expression and mastication muscles? What are these muscles’ general functions?

Answer 2

• Facial expression: facial nerve (CN VII) and act as sphincters and dilators of openings on the face
• Mastication: mandibular nerve of CN V3 and act to move the mandible at the temporomandibular joint

Question 3

What does TMJ stand for?

Answer 3

-Temporomandibular joint

Question 4

The skin of the face and scalp is innervated by cutaneous branches of ____________.

Answer 4

-3 divisions of the trigeminal nerve and by cervical spinal nerves

Question 5

What are the 3 branches of the trigeminal nerve?

Answer 5

V1: ophthalmic division
V2: Maxillary division
V3: Mandibular division

Question 6

Branches of what 2 arteries supply the face and scalp?

Answer 6

• external carotid

- ophthalmic

Question 7

Tributaries of what 2 veins drain the face and scalp?

Answer 7

-retromandibular and facial veins

Question 8

The parotid gland is situated in the lateral part of the face on the surface of the ___________. A deep part of the gland extends between the ramus of the mandible and the mastoid process.

Answer 8

-masseter muscle

Question 9

Describe the route of the parotid duct

Answer 9

-cross the masseter, passes through the buccinator, and opens into the oral cavity near the second upper molar

Question 10

What traverses the parotid gland and what innervates it?

Answer 10

• traversed by muscular branches of the facial nerve, retromandibular vein, external carotid artery
• innervated by glossopharyngeal nerve
• *Note: the facial nerve DOES NOT innervate the gland, it just traverses it

Question 11

The preganglionic parasympathetic fibers from the glossopharyngeal nerve synapse in the __________. The postganglionic parasympathetic fibers then travel to the parotid gland with the ___________ branch of the trigeminal nerve.

Answer 11

• otic ganglion

- autriculotemporal nerve

Question 12

What symptoms may a parotid gland tumor cause?

Answer 12

-may compress the muscular branches of the facial nerve and cause weakness of muscles of facial expressions on the side of the tumor

Question 13

Define trigeminal neuralgia (tic douloureux). Which branch does it usually affect?

Answer 13

• syndrome characterized by excruciating pain of sudden onset in the areas of distribution of one or more branches of the trigeminal nerve
• usually the maxillary nerve, the ophthalmic division is rarely involved

Question 14

The most common neuralgia associated with CNV2 and CNV3 divisions of the trigeminal nerve is the type associated with ________.

Answer 14

-dental caries (cavities)

Question 15

Is the trigeminal nerve mixed, sensory, or motor?

Answer 15

-mixed; large sensory root and smaller motor root

Question 16

Where does the sensory root of the trigeminal nerve arise from?

Answer 16

• cell bodies in the trigeminal (gasserian) ganglion located in the lateral portion of the cavernous venous sinus
• it passes posteriorly under cover of the superior petrosal venous sinus and tentorium cerebelli to penetrate the pons

Question 17

The sensory fibers of which division of the trigeminal nerve are joined by the motor root?

Answer 17

-mandibular

Question 18

Describe the composition of the ophthalmic division of the trigeminal nerve

Answer 18

• only sensory
• supplies bulb of eye, conjunctiva, lacrimal gland; parts of nasal mucousa, paranasal sinuses, and the cutaneous areas of the forehead, eyelids, and nose

Question 19

Describe the composition of the maxillary division of the trigeminal nerve

Answer 19

• only sensory
• supplies skin on midface and lower eyelid, side of the nose, and upper lip; mucous membrane of the nasopharnyx, maxillary sinus, soft palate, tonsil, root of mouth; maxillary teeth and gingiva

Question 20

Describe the composition of the mandibular division of the trigeminal nerve

Answer 20

• largest of 3 divisions; mixed
• sensory:temporal area, ear, cheek, lower lip, and lowerface; mucous membrane of cheek and tongue; mastoid air cells, lower teeth and gums, mandible, TMJ, parts of cranial dura mater
• motor: muscles of mastication (masseter, temporalis, medial and lateral pterygoid), mylohyoid, anterior belly of digastric, tensor veli palatini and tensor tympani

Question 21

What are the 2 compartments of the neck and where do they arise and extend?

Answer 21

• visceral: anterior and extends from the base of the skull to the thoracic outlet
• vertebral: posterior and extends from the foramen magnum to the thoracic outlet

Question 22

What is found in the visceral compartment of the neck?

Answer 22

-hyoid bone, suprahyoid and infrahyoid muscles, pharynx, esophagus, larynx, and trachea

Question 23

What surrounds the visceral compartment of the neck?

Answer 23

• pretracheal layer of deep cervical fascia encloses structures
• buccopharyngeal fascia is a continuation of the pretracheal fascia which surrounds the posterior aspect of the pharynx and esophagus

Question 24

What is found within the vertebral compartment of the neck?

Answer 24

-cervical vertebrae, skeletal muscles that attach to cervical vertebrae, ventral rami of the cervical plexus and brachial plexus, and vertebral arteries and veins

Question 25

What encloses the vertebral compartment of the neck?

Answer 25

-prevertebral layer of deep cervical fascia

Question 26

The prevertebral layer is separated from the buccopharyngeal fascia by the ____________.

Answer 26

-retropharyngeal space: a potential space

Question 27

Structures in the visceral compartment of the neck covered by pretracheal fascia glide against the ________________ during swallowing.

Answer 27

-prevertebral fascia

Question 28

An infection in the retropharyngeal space may spread where?

Answer 28

-inferiorly into the superior mediastinum

Question 29

Both compartments of the neck are partially covered by what 2 superficial muscles?

Answer 29

- trapezius and sternocleidomastoid | - an investing layer of deep cervical fascia encloses both compartments and splits to enclose the trapezius and the SCM

Question 30

What does the superficial cervical fascia contains?

Answer 30

-platysma, a muscle of facial expression

Question 31

What are the bounds/borders of the posterior triangle of the neck?

Answer 31

- trapezius - posterior border of the SCM - clavicle

Question 32

What does the floor of the posterior triangle contain? What covers these muscles?

Answer 32

- anterior scalene, middle scalene, posterior scalene, levator scapulae, splenius capitis muscles - covered by prevertebral fascia

Question 33

What forms the root of the posterior triangle?

Answer 33

-investing layer of deep cervical fascia

Question 34

Describe how the external jugular vein is formed and its trajectory

Answer 34

- formed by union of posterior auricular and retromandibular veins - crosses SCM obliquely, pieces the investing fascia, and drains into the subclavian vein

Question 35

The subclavian vein passes anterior to the _________________ and joins what vein to form the ____________.

Answer 35

- phrenic nerve and anterior scalene | - joins internal jugular vein to form a brachiocephalic vein posterior to the medial end of clavicle

Question 36

What drains into the right and left brachiocephalic veins at their origins?

Answer 36

- right lymphatic duct into the right brachiocephalic vein | - thoracic duct into the left brachiocephalic vein

Question 37

Name 3 arteries to course through the posterior triangle

Answer 37

- suprascapular - transverse cervical - occipital arteries

Question 38

Where do the suprascapular and transverse cervical arteries arise from? Give their trajectory and what they supply.

Answer 38

- arise from the thyrocervical trunk of the subclavian - pass anterior to the anterior scalene and phrenic nerve and cross the posterior triangle - supply trapezius, rhomboids, levator scapulae, and muscles that attach to the posterior aspect of the scapula

Question 39

Where does the occipital artery arise and what is its trajectory?

Answer 39

-arises from the external carotid artery and passes through the apex of the posterior triangle

Question 40

Describe the composition of the accessory nerve (CN XI), where it arises, its trajectory, and what it innervates.

Answer 40

- skeletal motor axons arising from ventral roots of first 4-5 cervical nerves - enters subarachnoid space and pass through the foramen magnum into the cranial cavity; it exits the skills through the jugular foramen with other nerves - innervates SCM and trapezius

Question 41

Where does the accessory nerve exit the skull and what other nerves does it exit with?

Answer 41

- jugular foramen | - glossopharyngeal and vagus nerves

Question 42

Lesions of accessory nerve is posterior triangle and inferior to the jugular foramen

Answer 42

- PT: weakness in trapezius muscle; difficulty elevating scapula (shrugging shoulder) and laterally rotating scapula during abduction of arm - JF: weakness also in SCM; decreased ability to turn the chin to the side opposite of the lesioned nerve

Question 43

The phrenic nerve courses of the anterior surface of the ___________ deep to the ____________.

Answer 43

- anterior scalene | - deep to prevertebral fascia

Question 44

The ventral rami and trunks of the brachial plexus and the subclavian artery pass between _____________.

Answer 44

-anterior and middle scalene muscles

Question 45

Where do the cutaneous branches of the cervical plexus emerge and what is their trajectory?

Answer 45

- emerge posterior to the SCM approx. halfway between its sternal and mastoid attachments - arise from VR of C1-C4 spinal nerves and pierces the investing and superficial fascia

Question 46

List the 4 branches of the cutaneous branches of the cervical plexus and their segments

Answer 46

1. Great auricular nerve (C2,C3) 2. Lesser occipital nerve (C2) 3. transverse cervical nerve (C2,C3) 4. Supraclavicular nerves (C2, C3, C4)

Question 47

What does the cutaneous branches of the cervical plexus supply?

Answer 47

- skin of the anterior and lateral neck including skin over the angle of the mandible - skin of the scalp posterior to the vertex of the skull

Question 48

What is the vertex of the skull?

Answer 48

-coronal plane through the most superior aspect of the cranium

Question 49

Explain to someone how to find the tendinous insertion of the SCM

Answer 49

-it is palpable just lateral to the suprasternal notch

Question 50

Boundaries of the anterior triangle of the neck

Answer 50

- SCM - mandible - midline of the neck

Question 51

List the following structures from superior to inferior: Adam's apple, hyoid bone, cricoid cartilage of trachea

Answer 51

- hyoid bone - Adam's apple: beginning of trachea; thyroid cartilage** - Cricoid cartilage***

Question 52

What is the movement of the trachea when swallowing?

Answer 52

-upward

Question 53

What is a tracheotomy?

Answer 53

-commonly performed procedure in which an incision in made and a tube inserted through the front of the neck into the lumen of the trachea to provide an airway

Question 54

2 potential sites of tracheotomy

Answer 54

1. High trach: incision is made between cricoid cartilage and isthmus of thyroid gland 2. Low trach:between 2-3 tracheal rings whith thyroid gland first being retracted upwards

Question 55

TracheOSTOMY

Answer 55

-when a round or square opening is made in the neck rather than a slit and the tracheal mucosa brought into continuity with the skin

Question 56

What must physicians be cautious of during a high vs. low tracheotomy?

Answer 56

- High: care not to damage thyroid gland and its extensive blood supply and the anterior jugular veins which lie on either side of the midline - Low: more difficult due to presence of inferior thyroid venous plexus, and close proximity of pleural sacs, brachiocephalic veins, and jugular venous arch