1. General organisation of H&N

Question 1

name the 5 fascial layers of the neck

Answer 1

1. superficial

Deep:

2. investing
3. pre-tracheal
4. carotid sheath
5. pre-vertebral

Question 2

what does the superficial fascial layer consist of

Answer 2

• loose CT

- contains: superficial blood vessels (eg EJV), superficial lymph nodes, cutaneous nerves and platysma

Question 3

what are the attachments of the investing fascial layer and which important structures does it enclose

Answer 3

• superiorly: mandible, mastoid process, superior nuchal line and external occipital protuberance
• posteriorly: ligamentum nuchae and vertebral spinous processes
• inferiorly: manubrium, clavicle, acromion and scapular spine

Contains:

• SCM and trapezius
• submandibular and parotid glands

Question 4

what are the attachments of the pre-tracheal layer and which important structures does it enclose

Answer 4

• anteriorly: hyoid bone to pericardium
• posteriorly (as buccopharyngeal fascia): skull base to diaphragm

Contains:

• muscular layer: infrahyoid muscles
• visceral layer: thryoid, tracheal and oesophagus

Question 5

what are the attachments of the carotid sheath and which important structures does it enclose

Answer 5

• skull base to aortic arch

Contains:

• common carotid a. (and then ICA) - medial
• IJV - lateral
• vagus n. - posterior

Question 6

what are the attachments of the pre-vertebral layer and which important structures does it enclose

Answer 6

• skull base to 3rd thoracic vertebra

Contains: vertebral column and associated muscles

Question 7

which space lies posterior to pre-tracheal fascia and what are its boundaries

Answer 7

retropharyngeal space

• anterior: buccopharyngeal fascia
• posterior: pre-vertebral fascia
• lateral: carotid sheaths

Question 8

which pathology can arise in the retropharyngeal space, what are the symptoms/signs

Answer 8

• RETROPHARYNGEAL ABSCESS secondary to upper resp. tract infection (esp. in young children)
• symptoms:
  1. throat pain
  2. dysphagia, dribbling
  3. difficulty moving neck
  4. dyspnoea
• signs:
  1. visible bulge of oropharynx
  2. stridor
  3. pyrexia

Question 9

why does a retropharyngeal abscess carry sig. morbidity and mortality

Answer 9

can potentially spread into thorax to posterior mediastinum… MEDIASTINITIS

Question 10

does a goitre move on swallowing and why

Answer 10

yes as is enclosed by pre-tracheal fascia which is attached to hyoid bone

Question 11

describe the borders of the anterior triangle

which cranial nn pass through here

Answer 11

• superior: lower margin of mandible
• medial: midline of neck
• lateral: anterior border of SCM

cranial nerves: facial, glossopharyngeal, vagus, accessory and hypoglossal

Question 12

describe the borders of the carotid triangle

Answer 12

• superior: posterior belly of digastric
• lateral: anterior border of SCM
• inferior: superior belly of omohyoid

Question 13

which important structures are found in the carotid triangle

Answer 13

1. vessels
   - CCA - bifurcates here into ICA and ECA
   - IJV
2. nerves
   - hypogloassal n.
   - vagus n.
3. carotid sinus: dilated portion of CCA qnd ICA contain baroRs detecting stretch as measure of BP (transmitted to brain via br of CN IX)

Question 14

describe the borders of the posterior triangle

Answer 14

• inferior: clavicle
• medial: posterior border of SCM
• lateral: anterior border of trapezius