01 Head and Neck Flashcards
Embryological structure which consists of pharyngeal grooves, pharyngeal arches, and pharyngeal pouches?
Branchial apparatus
Branchial apparatus?
Cartilage: Meckel cartilage, incus, malleus, sphenomandibular ligament, lingula of mandible
Artery: maxillary artery
Nerve: trigeminal nerve
Muscle: muscles of mastication, anterior belly of digastric, mylohyoid, tensor tympani, tensor palatini
Pouch: pharyngotympanic tube
I
Branchial apparatus?
Cartilage: Reichert cartilage, stapes, styloid process, stylohyoid ligament, lesser cornu, part of body of hyoid bone
Artery: stapedial artery
Nerve: facial nerve
Muscle: muscles of facial expression, stapedius muscle, stylohyoid muscle, posterior belly of digastric
Pouch: tonsils
II
Branchial apparatus?
Cartilage: greater cornu, part of body of hyoid bone
Artery: internal carotid artery
Nerve: glossopharyngeal nerve
Muscle: stylopharyngeus muscle
Pouch: thymus, inferior parathyroid gland
III
Branchial apparatus?
Cartilage: laryngeal cartilages
Artery: aortic arch, subclavian artery
Nerve: vagus nerve (superior laryngeal branch)
Muscle: cricothyroid, levator palatini, constrictors of the pharynx
Pouch: superior parathyroid gland
IV
Branchial apparatus?
Pouch: ultimobranchial body
V
Branchial apparatus?
Cartilage: cricoid cartilage, arytenoid, corniculate, cuneiform
Artery: right and left pulmonary artery
Nerve: vagus nerve (recurrent laryngeal branch)
Muscle: intrinsic muscles of the larynx
VI
Superior: hard palate
Inferior: portion of the tongue anterior to sulcus terminalis
Anterior: vermillion border of the lips
Posterior: anterior tonsillar pillars, junction of the hard and soft palate, circumvallate papillae
Oral cavity
Superior: skull base
Inferior: plane of the hard and soft palate
Lateral: torus tobarius, Eustachian tube, Rosenmuller fossa
Anterior: posterior nasal septum, choanae
Posterior: adenoids
Nasopharynx
Superior: hard palate – soft palate junction
Inferior: hyoid bone – vallecula
Oropharynx
Superior: hyoid bone – vallecula
Inferior: lower border of cricoid cartilage
Hypopharynx
Subsite of larynx?
Epiglottis, false cords, ventricles, aryepiglottic folds, arytenoids
Supraglottis
Subsite of larynx?
True vocal cords, anterior and posterior commisures
Glottis
Subsite of larynx?
Begins 10mm below the level of the free margin of the vocal cords, inferior edge of cricoid cartilage
Subglottis
Deep neck space?
Superior: base of the skull
Inferior: greater cornu of the hyoid bone
Medial: fascia of the tensor veli palatini and medial pterygoid muscles, pharyngobasilar fascia, superior constrictor muscle
Lateral: medial pterygoid muscle, mandible, deep lobe of the parotid gland, small portion of the digastric muscle posteriorly
Anterior: pterygomandibular raphe
Posterior: prevertebral fascia
Parapharyngeal space
Parapharyngeal space compartment?
Minor salivary glands, parotid gland (deep lobe), lymphatic tissue, internal maxillary artery, ascending pharyngeal artery, venous plexus, branches of the mandibular division of the trigeminal nerve
Prestyloid compartment
Parapharyngeal space compartment?
Carotid artery, internal jugular vein, cranial nerves IX, X, XI, XII, cervical symphatetic chain
Poststyloid compartment
Deep neck space? Superior: base of the skull Inferior: superior mediastinum (T4) Lateral: carotid sheath Anterior: buccopharyngeal fascia Posterior: alar fascia Contents: retropharyngeal nodes
Retropharyngeal space
Potential space behind the retropharyngeal space where infections can easily spread down to the thorax?
Danger (alar) space
Deep neck space? Superior: base of the skull Inferior: diaphragm Anterior: alar fascia Posterior: prevertebral fascia
Danger space
Triangle of the neck?
Superior: body of mandible
Posterior: sternocleidomastoid muscle
Anterior: midline
Anterior cervical triangle
Triangle of the neck?
Superior: inferior border of mandible
Posteroinferior: posterior belly of digastric
Anteroinferior: anterior belly of digastric
Contents: submandibular gland, submandibular duct, submandibular lymph nodes, CN XII, cervical mandibular branch of CN VII, submental branch of facial vessels
Submandibular or digastric triangle
Triangle of the neck? Superior: mentum of mandible Medial: midline of neck Lateral: anterior bellies of digastric Roof: skin and superficial fascia Floor: mylohyoid Contents: submental nodes
Submental triangle
Triangle of the neck?
Superior: posterior belly of digastric
Anterior: superior belly of omohyoid
Posterior: sternocleidomastoid muscle
Roof: investing layer of deep cervical fascia
Floor: hyoglossus muscle, inferior constrictor of pharynx, thyrohyoid muscle, middle constrictor of the pharynx, longus capitus muscle
Contents: carotid sheath (common carotid, internal jugular vein, vagus nerve), lymph nodes (II, III, IV), branches of the external carotid artery, internal carotid artery, spinal accessory nerve hypoglossal nerve, ansa hypoglossi, cervical symphatetic trunks
Carotid triangle
Triangle of the neck?
Superolateral: superior belly of omohyoid muscle
Inferolateral: sternocleidomastoid muscle
Medial: midline
Roof: investing layer of the deep fascia, strap muscles, cricothyroid
Floor: prevertebral fascia, prevertebral muscles, sternohyoid, sternothyroid
Contents: thyroid and parathyroid glands, trachea, esophagus, sympathetic nerve trunk
Muscular triangle
Triangle of the neck?
Posterior: trapezius muscle
Anterior: sternocleidomastoid muscle
Inferior: clavicle
Roof: superficial investing layer of deep cervical fascia
Floor: prevertebral fascia and muscles, splenius capitus muscle, levator scapulae muscle, scalene anterior, medius, posterior
Contents: 3 trunks of brachial plexus, subclavian artery, subclavian vein, spinal accessory nerve (CN XI), phrenic nerve, cutaneous branches of the cervical plexus, cervical lymph nodes (V)
Posterior cervical triangle
Residual thyroid tissue left behind during its descent that presents as a midline neck mass in children, moves up and down with swallowing or with protrusion of the tongue?
Thyroglossal duct cysts
Management for thyroglossal duct cyst, en-bloc resection of the thyroglossal duct cyst, its tract up to its origin in the tongue, and central portion of hyoid bone?
Sistrunk procedure
Persistence of a portion of branchial apparatus presenting as painless swelling in the region of the parotid gland, ear, or high in the sternocleidomastoid?
1st branchial cleft anomalies
Persistence of a portion of branchial apparatus coursing from the skin to the tonsillar fossa?
2nd branchial cleft anomalies
Persistence of a portion of branchial apparatus connecting the pyriform sinus to the skin?
3rd branchial cleft anomalies
Sequestration of lymphatic tissue developing which do not communicate with the lymphatic system, resulting from maldevelopment and obstruction of lymphatic system, appearing soft, compressible and nontender masses usually located in the lateral or posterior triangle of the neck?
Cystic hygroma
Sclerosing agents that may be used as intralesional injection for cystic hygroma?
OK-432, Bleomycin
Life-threatening infection of the floor of the mouth, submental, sublingual, and submandibular spaces usually following an odontogenic infection, presenting with bilateral facial edema around the mandible and neck with dysphagia, odynophagia, dyspnea, pain?
Ludwig angina
Most common facial fracture?
Nasal fracture
Second most common facial fracture?
Mandibular fracture
Most common sites of mandibular fracture?
Condylar process (36%), body (21%), angle (20%)
Clear nasal drainage in patient with facial trauma with skull base fracture?
Cerebrospinal fluid rhinorrhea
Differential capillary action of CSF and blood on a white cloth or tissue?
Halo sign
Confirmatory test for CSF rhinorrhea?
Beta-2 transferrin test
Midline fracture: floating palate
Palate separated from maxilla, horizontal fracture through maxilla superior to maxillary dentition?
Le Fort I
Midline fracture: floating maxilla
Maxilla separated from the face, pyramidal fracture through maxilla and orbit, outlining the nose?
Le Fort II
Midline fracture: floating face
Complete craniofacial dysfunction, fracture of the facial bones from skull?
Le Fort III
Most prevalent type of head and neck carcinoma?
Squamous cell carcinoma
Cervical lymph node level?
Superior: lower border of body of mandible
Posterior: posterior belly of digastric muscle
Inferior: hyoid bone
I – submental (Ia) and submandibular (Ib) triangles
Cervical lymph node level?
Superior: base of skull
Anterior: posterior belly of digastric muscle
Posterior: posterior border of sternocleidomastoid
Inferior: hyoid bone
II – upper jugular lymph nodes
Cervical lymph node level?
Superior: hyoid bone
Anterior: posterior belly of digastric muscle
Posterior: posterior border of sternocleidomastoid
Inferior: cricothyroid membrane
III – middle jugular lymph nodes
Cervical lymph node level?
Superior: cricothyroid membrane
Anterior: lateral limit of sternohyoid muscle
Posterior: posterior border of sternocleidomastoid
Inferior: clavicle
IV – lower jugular lymph nodes
Cervical lymph node level?
Anterior: posterior border of sternocleidomastoid muscle
Posterior: anterior border of trapezius
Inferior: clavicle
V – posterior triangle lymph nodes
Cervical lymph node level?
Superior: hyoid bone
Inferior: suprasternal notch
Lateral: medial border of carotid sheath on either side of neck
VI – anterior compartment of neck
Cervical lymph node level?
Superior: suprasternal notch
VII – superior mediastinal lymph nodes
Type of neck dissection?
Removes levels I to V cervical lymphatics, spinal accessory nerve, internal jugular vein, sternocleidomastoid muscle
Radical neck dissection or Crile procedure
Type of neck dissection?
Removes levels I to V cervical lymphatics, preserves spinal accessory nerve, internal jugular vein, and sternocleidomastoid muscle
Modified radical neck dissection
Type of neck dissection?
Preserves lymphatics
Selective neck dissection
