Session 1 - Anatomy of the neck

Question 1

What are the two triangles formed when the neck is viewed anteriorly?

Answer 1

Anterior triangle Posterior triangle

Question 2

Which of the two triangles which form the head and neck has more structures?

Answer 2

The anterior triangle

Question 3

What are the borders of the anterior triangle of the neck? Anterior Posterior SUperior Roof Floor

Answer 3

o Anterior – Mid line o Posterior – The anterior border of SCM o Superior – Inferior border of the mandible o Apex – Jugular notch in the manubrium o Roof – Superficial cervical fascia, containing the platysma o Floor – Pharynx, larynx, thyroid gland

Question 4

What are the four subdivisions of the anterior triangle?

Answer 4

Submandibular Submental Carotid Muscular

Question 5

What four things are contained within the submandibular triangle?

Answer 5

§ Submandibular gland § Submandibular lymph nodes § Hypoglossal and Mylohoid nerves § Parts of facial artery and vein

Question 6

What two things are contained within the submental triangle?

Answer 6

§ Submental lymph nodes § Small veins which unite to form anterior jugular vein

Question 7

What 7 structures are contained within the carotid triangle?

Answer 7

§ Carotid sheath § Thyroid gland § Larynx § Pharynx § External carotid artery and some of its branches § Hypoglossal and Spinal accessory nerves Branches of cervical plexus

Question 8

What four muscles are contained with the muscular (omotracheal) triangle?

Answer 8

§ Sternothyroid § Sternohyoid § Thryoid Parathyroid

Question 9

What is 4?

Answer 9

Submandibular triangle

Question 10

What is 5?

Answer 10

Submental triangle

Question 11

What is 6?

Answer 11

Carotid triangle

Question 12

What is 7?

Answer 12

Muscular triangle

Question 13

Give the borders of the posterior triangle of the neck Anterior Posterior Inferior Apex Roof Floor

Answer 13

o Anterior – Posterior border of SCM o Posterior – Anterior border of Trapezius o Inferiorly – Middle third of the clavicle, between Trapezius and SCM o Apex – Where SCM and Trapezius meet on the superior nuchal line of the occipital bone o Roof – Investing layer of deep cervical fascia o Floor – Muscles covered by the Prevertebral layer of deep cervical fascia

Question 14

What is 2?

Answer 14

Occipital triangle

Question 15

What is 3?

Answer 15

Omoclavicular triangle

Question 16

What is found in the occipital triangle?

Answer 16

§ Spinal Accessory Nerve (CN XI) § Trunks of Brachial Plexus § Part of external jugular vein § Posterior branches of cervical plexus § Cervicodorsal trunk § Cervical lymph node

Question 17

What is found in the omoclavicular triangle?

Answer 17

§ 3rd part Subclavian Artery § Part of Subclavian Vei § Suprascapular artery § Supraclavicular lymph nodes

Question 18

What are the three main parts of the neck in cross section?

Answer 18

o Superficial fascia o Platysma o Deep cervical fascia § Investing § Pretracheal § Prevertebral Carotid Sheath

Question 19

What is the platysma innervated by?

Answer 19

Facial nerve (CN VIII)

Question 20

What four structures make up the deep cervical fascia (4)

Answer 20

o Investing o Pretracheal Prevertebral Carotid sheath

Question 21

What are the three main functions of the deep cervical fascia

Answer 21

Support Limit the spread of abscesses that result from infection Fluidity

Question 22

What does the investing layer enclose?

Answer 22

o Sternocleidomastoid o Trapezius o Submandibular and Parotid Salivary Glands

Question 23

What does the pretracheal layer enclose?

Answer 23

o Muscular layer § Encloses infrahyoid muscles o Visceral layer § Thyroid gland § Trachea § Oesophagus

Question 24

What is the prevertebral layer?

Answer 24

The innermost layer of the deep fascia which forms a sheath for the vertebral column. Extends laterally as the axillary sheath that surrounds the brachial plexus.

Question 25

What four structures are found within the carotid sheath?

Answer 25

• Common carotid artery (ant-med) • IJV (ant-lat) • Vagus nerve (post) • Deep cervical LNs

Question 26

What are cleavage planes?

Answer 26

The layers of deep cervical fascia form natural cleavage planes allowing separation of tissues during surgery.

Question 27

What is the clinical significance of cleavage planes?

Answer 27

Deep fascial layer determine the direction in which abscesses in the neck may spread.

Question 28

What three main places can infection occur between deep fascial layers?

Answer 28

Between the investing layer and the muscular part of the pretracheal Between the investing and visceral pretracheal layers Behind the prevertebral layer

Question 29

Where will infection spread to if it derives from between the investing layer and the muscular part of the pretacheal?

Answer 29

Will not spread beyond manubrium

Question 30

Where will infection spread if between the investing and visceral pretracheal layers?

Answer 30

Spread it thoracic cavity anterior to the pericardium

Question 31

Where will infection spread if begind prevertebral layer?

Answer 31

May extend laterally into the neck § May perforate the fascial layer and enter the retropharyngeal space. § This will produce a bulge (retropharyngeal abscess) in the pharynx, resulting in dysphasia (difficulty swallowing) and dysphonia (difficulty speaking)

Question 32

What is the retropharyngeal space?

Answer 32

A potential space between the Prevertebral layer of fascia and the fascia surrounding the pharynx superficially. This is the largest, most important interfascial space in the neck because it is the major route of spread of infection from the neck to the thorax. The space runs to the diaphragm.

Question 33

WHat are the four main muscle groups of the head?

Answer 33

o Muscles of facial expression o Muscle of the cheek (buccinators) o Occipitofrontalis muscle Muscles of mastication

Question 34

What are the muscles of mastication innervated by?

Answer 34

Mandibular division of the trigeminal nerve (branch of CN V)

Question 35

What does the facial nerve supply? (CN VII)

Answer 35

Platysma, muscles of facial expression, buccinators, muscles of the ear and the occiptofrontalis muscle. Innervates parotid

Question 36

What is the most common cause of non-traumatic facial paralysis?

Answer 36

Inflammation of the facial nerve near its exit from the cranium at the stylomastoid foramen

Question 37

What does inflammation of facial nerve near its exit from the cranium at the stylomastoid foramen cause?

Answer 37

Oedema and compression of the nerve, causing the affected area to sag and distort the facial expression.

Question 38

Give three places where facial nerve vulnerable to injury?

Answer 38

Child birth Surgery on parotid Parotid inflammation

Question 39

Where does inflammation of the parotid gland cuase pain?

Answer 39

Auricle of the ear External acoustic meatus Temporal region TMJ

Question 40

What does the hoid bone provide attachments for?

Answer 40

Suprahyoid muscles superiorly Infrahyoid muscles inferiorly

Question 41

Name the four suprahyoid muscles

Answer 41

o Mylohyoid o Geniohyoid o Stylohyoid o Digastric Muscles

Question 42

What are the three main functions of the suprahyoid muscles

Answer 42

Constitute the floor of the mouth Elevate the hyoid and larynx in relation to swallowing and tone production

Question 43

Name four infrahyoid muscles (and divide into planes)

Answer 43

Superficial - Sternohyoid - Omohyoid Deep - Sternohyoid - Thyrohyoid

Question 44

What is the significance of the infrahyoid muscles?

Answer 44

Anchor the hyoid, sternum, clavicle and scapula. Depress hyoid and larynx during swallowing and speaking. Provide a firm base for the tounge.