Organziation of head and neck

Question 1

Explain the connections of the neck making its attatchment from the head to the rest of the body

Answer 1

Extends from the the lower margin of madible to suprasternal notch of manubrium and upper border of clavicle below

Question 2

Structures of neck are compartmentalised by layer of what?

Answer 2

Cervical fascia

Question 3

What is a fascia? Explain divisions of the cervical fascia

Answer 3

Fascia is a layer of fibrous tissue that surrounds muscles, vessels & nerves.

Question 4

where is the retropharangeal space? what is its importance?

Answer 4

lies btw the prevertebral layer of fascia and fascia surrounding the pahrynx (buccopharyngeal fascia)

It allows pharynx to move freely on the vertebral column and during swallowing, infection can collect here too!

Question 5

Explain what happens if an infection develops in the retropharyngeal space?

Answer 5

spreads from the neck into the thorax down to the posterioir mediastinum>> casuing life threatening MEDIASTINITS

Question 6

explain how the retropharyngeal space is split?

Answer 6

by ALAR FASCIA

splits it into the true retropharyngeal space and the danger space

Question 7

Infection in the retropharangeal space can develop into an ABSCESS, explaint he symptoms u get

Answer 7

• visible bulge on oropharynx
• sore throat
• difficulty swallowing
• stridor
• fever
• reluctance to move their neck
• An abscess is a painful collection of pus, usually caused by a bacterial infection.*

Question 8

how dou drain a retropharyngeal abscess?

Answer 8

Question 9

we ask a patient with a lump in their neck to swallow? why

Answer 9

the thyroid gland is enclosed with the pretracheal fascia which is attached to the hyoid bone, & hyoid bone and larynx move up when swallowing

Question 10

what sign and symptoms do u get following a retrosternal goitre?

Answer 10

can lead to compression of the thoracic inlet!

(trahcea, venous Bv)

• breathless & stridor>> bc tracheal compression
• facial edema>> impedes venous drainage from heads & neck

Question 11

Major muscle group of face (4)

Answer 11

• muscles of facial expression
• muscles of cheeks (buccinators)
• occiptofrontalis muscle
• muscles of mastication

Question 12

Where do muscles of the face lie? How do they make their move?

Answer 12

In the subcutaneous tissue , by pulling the skin

Question 13

function of buccinators?

Answer 13

keeps cheek taunt, helps in chewing, ensures that food remains w/ in the oral cavity

(buckle up tight!)

Question 14

how many muscle of mastication r there?

innervation?

Answer 14

mandibular division of the trigemnal nerve

Question 15

Answer 15

Question 16

Answer 16

Question 17

Question 18

What. Structure Runs deep to platysma but runs superficial to SCM

Answer 18

Question 19

Why might the pulsation of the external jugular vein be mistaken for the jugular venous pulse when measuring the JVP in a patient?

Answer 19

.

Question 20

Answer 20

Question 21

Answer 21

Question 22

border of anterior portion of the neck? What structures r found here? (Muscle and vasculature)

Answer 22

• the suprahyoid muscles and infrahyoid muscles
• common carotid a. (Bifurcates into internal & external)

-internal jugular vein

-some cranial nerves

Question 23

borders of posterior triangle

Answer 23

Question 24

muscles forming posterior traingle

Question 25

Borders of carotid traingle and structures running through it it extends from where to where?

Answer 25

***I see 10 CC's in the IV*** ## Footnote I See = IC (internal carotid) ``` 10 = CN X (vagus nerve) in the IV = internal jugular vein ``` Extends from base of skull to aortic arch

Question 26

Draw the fascial layers and identify the retropharyngeal space

Answer 26

Question 27

In a patient with a retropharyngeal abscess, why is swallowing and movement of the neck typically difficult and painful?

Answer 27

While this چspaceڇ is helpful in allowing the pharynx to move freely on the vertebral column and expand during swallowing.

Question 28

branches of facial nerve

Answer 28

Question 29

trigeminal divisions

Answer 29

Question 30

what r most of the **arteries** supplying the structures of the face and neck ?

Answer 30

branches of the external carotid arteries, which terminates as the superficial temporal & maxillary A.

Question 31

what is torticollis?

Answer 31

Contraction of this SCM, either voluntarily, or involuntarily as a result of dystonia would cause the head to tilt and rotate.

Question 32

explain venous drainage of face? what do they drain into?

Answer 32

the **facial vein**, (which runs with the facial artery) from the **medial angle of the eye** to the inferior border of the mandible, forms the major venous drainage of the face, **draining into the *internal jugular vein. \>\>*** ***both internal and external vein drain into _subclavian vein_***

Question 33

if a laceration of the facial artery occurs, what approach must be taken? why?

Answer 33

compress both the arteries to stop bleeding. *bc the facial a. has many **anastomses** w/ other arteries of the face!*

Question 34

Major BV (common **carotid a**. and **jugular v.**) & nerves in the neck lack bony protection and can be injured in penetrating wounds !

Answer 34

shitttttt

Question 35

which jugular vein is more easier to see?

Answer 35

EJV

Question 36

Name layers of scalp and describe each

Answer 36

**Skin**: contains many sweat and sebaceous glands and hair follicles. **Connective tissue:** forms the thick, dense, richly *vascularized* subcutaneous layer that is well supplied with cutaneous nerves. **Aponeurosis** (epicranial aponeurosis): the broad, strong, tendinous sheet that covers the calvaria and serves as the attachment for muscle bellies converging from the forehead and occiput (occipitofrontalis muscle) **Loose areolar tissue**: a sponge-like layer including potential spaces that may distend with fluid as a result of injury or *infection*. *_This layer allows free movement of the scalp proper (the first three layers—skin, connective tissue, and epicranial aponeurosis) over the underlying calvaria._* **Pericranium:** a dense layer of connective tissue that forms the external periosteum of the neurocranium.

Question 37

black eye smthn

Answer 37

Question 38

scalp

Answer 38

cools

Question 39

label

Answer 39

**"SCALP"** ## Footnote the first **3** of which are **connected intimately** and move as a unit *(e.g., when wrinkling the forehead and moving the scalp)*

Question 40

innervation of scalp

Answer 40

**anterior** to the auricles of the ears is \>\> all divisions of *trigeminal nerve* **Posterior** to the auricles, \>\> *spinal cutaneous nerves* (C2 and C3). *(C2&3\>\>someones behind me...) turn around give a forehead and say TRY-ME"*

Question 41

1) why do superficial scalp wounds not gape (open widely) and the margins of the wound are held together? 2) why do deep scalp wounds gape widely?

Answer 41

1) bc of the strength of the ***epicranial aponeurosis*** 2) Deep scalp wounds gape widely when the epicranial aponeurosis is lacerated in the coronal plane because of the *pull of the frontal and occipital bellies of the occipitofrontalis muscle in opposite directions* (anteriorly and posteriorly).

Question 42

in which layer of the scalp do the arteries lie? why do scalp wound bleed heavily?

Answer 42

The a. course within layer **two** of the scalp, * *the **connective tissue** layer between the skin and the epicranial aponeurosis* (arteries r CONNection to life) **bc they r supplied by branches of BOTH the i & E carotid a. and form anastomoses in the midline,** *The arterial walls are firmly attached to the _dense connective tissue_ in which the arteries are embedded, limiting their ability to **constrict** when cut. Consequently, bleeding from scalp wounds is profuse.*

Question 43

which layer of the scalp is the ***danger area*** of the scalp? why?

Answer 43

The ***loose aerolar layer*** (layer four) bc pus or blood spreads easily in it. I

Question 44

why does “black eyes” ***(peri-orbital ecchymosis***) result from an injury to the scalp and/or the forehead?

Answer 44

An infection or fluid (e.g., pus or blood) can enter the eyelids bc the occipitofrontalis inserts into the **skin** & **subcutaneous tissue** & **_does not attach to the bone_**. Ecchymosis (purple patches), develop as a result of extravasation of blood into the subcutaneous tissue and skin of the eyelids and surrounding regions.

Question 45

How would a person with a dystonic sternocleidomastoid muscle present? What nerve supplies this muscle?

Answer 45

Question 46

cool pic

Answer 46

super cool

Question 47

what is cephalohaematoma?

Answer 47

This benign condition frequently results from birth trauma that ruptures multiple, minute periosteal arteries that nourish the bones of the calvaria.

Question 48

How might an infection deep within the scalp, beneath the aponeurotic layer ***spread intracranially*** *(i.e. to structures within the cranial cavity of the skull? )*

Answer 48

infection in this layer can also pass into the cranial cavity through ***_small emissary veins_***, which pass through *parietal foramina* in the calvaria, and reach intracranial structures such as the meninges.

Question 49

what structure the facial nerve pierce in? how is this clinically relevant?

Answer 49

if u get facial nerve pasly in the context of parotid gland enlargment, it is highly likely to be ***parotid cancer!*** (though this is rare) *(facial nerve exits cranium and enter the partoid gland where it branches into 5)*

Question 50

what do we use that to measure JVP?

Answer 50

**IJV,** ## Footnote cuz it goes horizontally down to the right side of heart and right atrium, whule the EJV has to drain the the subclavian vein

Question 51

Outline the major differences between the fetal/infant and adult skull.

Answer 51

* **large calvaria** relative to the face in fetal skull; * (in adult skull facial skeleton forms 1/3 of cranium whereas infant skull it forms 1/8)* * **Small, underdeveloped maxilla**, mandible and paranasal sinuses (some of which are actually absent at birth) in fetal skull * **Absence of erupted teeth** in fetal skull * **Small nasal cavitie**s in fetal skull * **Absence of mastoid and styloid process** in fetal skull