Session 3: Neck and Face

Question 1

What are the three main functions of the neck?

Answer 1

Structural – support and move the head Visceral functions Conduit for blood vessels and nerves

Question 2

How are the components of these functions divided structurally in the neck?

Answer 2

Structural – inside prevertebral fascia Visceral – inside or associated with pretracheal fascia Blood vessels and nerves – carotid sheaths

Question 3

What are the two large muscles that are found on the anterior and posterior sides of the neck?

Answer 3

Anterior – sternocleidomastoid Posterior – trapezius

Question 4

What are the contents of the carotid sheath?

Answer 4

Internal jugular vein Common carotid artery Vagus nerve

Question 5

What are the contents of the visceral fascia?

Answer 5

Oesophagus Trachea Thyroid Gland

Question 6

What is the name given to the fascia between the posterior aspect of the oesophagus and the anterior part of the prevertebral fascia?

Answer 6

Buccopharyngeal fascia

Question 7

Which fascia splits in two around the sternocleidomastoid and trapezius?

Answer 7

Investing layer

Question 8

What important structures are at C2

Answer 8

Superior cervical ganglion

Question 9

What are the two triangles of the neck?

Answer 9

Anterior triangle Posterior triangle

Question 10

Which nerves innervate each of the four infrahyoid muscles?

Answer 10

Omohyoid – ansa cervicalis Sternohyoid – ansa cervicalis Sternothyroid – ansa cervicalis THYROHYOID – C1 fibres via the hypoglossal nerve

Question 11

The posterior triangle consists mainly of blood vessels and nerves. Which blood vessels and nerves are in the posterior triangle?

Answer 11

External jugular vein Subclavian artery Trunks of brachial plexus Phrenic nerve Spinal accessory nerve

Question 12

Where do the trunks of the brachial plexus emerge?

Answer 12

Posterior to scalenus anterior

Question 13

Where are the subclavian artery and vein relative to the scalene muscles?

Answer 13

Subclavian artery = posterior to scalenus anterior Subclavian vein = anterior to scalenus anterior

Question 14

Where is the phrenic nerve relative to the scalene muscles?

Answer 14

Phrenic nerve lies on the anterior surface of scalene anterior

Question 15

Which spinal nerves contribute to the phrenic nerve and what isits main function?

Answer 15

C3, C4 and C5 Motor supply of the diaphragm Sensory innervation to the diaphragmatic pleura and peritoneum

Question 16

What is platysma innervated by?

Answer 16

Facial nerve (cervical branch)

Question 17

What is mylohyoid innervated by?

Answer 17

Mandibular division of trigeminal nerve

Question 18

What are the anterior and posterior bellies of the digastric muscle innervated by?

Answer 18

Anterior – mandibular division of trigeminal nerve Posterior – facial nerve

Question 19

What are the clinical applications of a carotid pulse?

Answer 19

Measuring pulse rate

Question 20

List the main sites of access for central venous lines.

Answer 20

Internal jugular (most common) Subclavian vein Femoral vein

Question 21

What are the uses of central venous lines?

Answer 21

Long-term access e.g. for chemotherapy drugs Parenteral nutrition Monitoring blood pressure

Question 22

What are the complications of insertion of central venous lines?

Answer 22

Accidental arterial puncture Tracheal injury Arrhythmia Emboli Infection Pneumothorax or haemothorax

Question 23

Where does the accessory nerve exit the skull?

Answer 23

The accessory nerve begins in the upper spinal cord and ascends to enter the skull through the foramen magnum The accessory nerve then leaves via the jugular foramen

Question 24

What does the accessory nerve innervate?

Answer 24

Trapezius Sternocleidomastoid

Question 25

How would you test the function of the accessory nerve?

Answer 25

Ask the patient to shrug their shoulders and hold it there

Question 26

What important structures are at C3

Answer 26

Body of hyoid

Question 27

What important structures are at C4

Answer 27

Bifurcation of carotid artery Upper border of thyroid cartilage

Question 28

What important structures are at C6

Answer 28

Cricoid cartilage Middle cervical ganglion

Question 29

What important structures are at C7

Answer 29

Inferior cervical ganglion

Question 30

Borders of anterior triangle in neck

Answer 30

Inferior border of mandible Anterior border of sternocleidomastoid Midline

Question 31

What are main muscles in anterior triangle of neck

Answer 31

Platysma Mylohyoid Digastric muscles Infrahyoid muscles

Question 32

4 infrahyoid muscles

Answer 32

Sternohyoid Sternothyroid Thyrohyoid Omohyoid

Question 33

Attachments of omohyoid muscles

Answer 33

Superior border of scapular by scapular notch to hyoid bone

Question 34

Attachment of thyrohyoid muscle

Answer 34

Thyroid cartilage to hyoid

Question 35

Attachment of sternothyroid bone

Answer 35

Sternum to thyroid cartilage

Question 36

Attachment of sternohyoid bone

Answer 36

Sternum to hyoid bone

Question 37

What vessels are carried in anterior triangle of neck

Answer 37

Carotid arteries and internal jugular vein

Question 38

Posterior triangle of neck border

Answer 38

Posterior border of sternocleidomastoid muscle Anterior border of trapezius Clavicle

Question 39

Nervous supply of platysma

Answer 39

Facial nerve

Question 40

Nervous supply of mylohyoid

Answer 40

mandibular division of trigeminal

Question 41

Nerve supply of anterior belly of digastric

Answer 41

mandibular division of trigeminal nerve

Question 42

Nerve supply of posterior belly of digastric muscle

Answer 42

facial nerve

Question 43

Nerve supply of infrahyoid muscles

Answer 43

Omohyoid- ansa cervicalis Sternothyroid- ansa cervicalis Sternohyoid- ansa cervicalis Thyrohyoid- C1 fibres via hypoglossal nerve

Question 44

Lymph drainage in neck area

Answer 44

All nodes lead to superior and inferior deep cervical ganglions

Question 45

Where are superior and inferior deep cervical ganglions found

Answer 45

Along internal jugular vein