1 General Organisation of the Head and Neck Region Flashcards
Identify which muscle we could find in the superficial cervical fascial layer.
Platysma muscle
In which cervical fascial layer would you find the external jugular veins?
Superficial cervical fascial layer
Name the 4 deep cervical fascial layers.
- Investing cervical layer
- Prevertebral layer
- Pretracheal layer (w. Buccopharyngeal)
- Carotid sheath
Fill in the missing labels for the cervical fascial layers
What is the function of having layers of deep cervical fascia?
- Form natural cleavage planes
- Structures move and pass each other with ease
- Determines direction and extent which infection in neck may spread
Where is an infection in the retropharyngeal space likely to have spread from (ie what is it usually secondary to)?
Infection in Upper respiratory tract (nasal cavity, nasopharynx, oropharynx)
Who would usually present with a retropharyngeal space infection?
Children <5 yrs
What symptoms might we see with a retropharyngeal absess?
! Important to recognise early- significant morbitdity and mortality !
- Visible bulge on inspection of oropharynx
- Sore throat
- Difficulty swallowing
- Stridor (high-pitched, wheezing sound caused by disrupted airflow)
- Reluctance to move neck
- High temperature
You observe a lump in the thyroid gland area in a patients neck, and you ask them to swallow. The lump moves.
What will this indicate? Why?
What will this indicate?:
Indicates pathology is within/to do with the thyroid gland itself
Why?:
Thyroid gland enclosed in pre-tracheal fascia- attached to hyoid bone
Hyoid bone and larynx move up with swallowing
Can an enlarged thyroid gland (goitre) extend retrosternally (downwards behind the sternum through the root of the neck)?
Yes- lower limit of pre-tracheal fascia layer (contains thyroid gland) extends into thorax
Retrosternal extension of the goitre can cause symtoms including:
- Breathlessness and stridor
- Facial oedema
Why?
Goitre causes compression of structures running through throracic inlet (root of neck): Trachea and Venous blood vessels
- Tracheal compressions
- Impeding venous drainage from head and neck
A patient presents with:
- Weakness of facial muscles on one side
- Ipsilateral parotid enlargement
What is the likely diagnosis? Explain your findings.
Parotid cancer
Cancerous cells invade and damage facial nerve on its course through gland
(Rare for inflammatory conditions of parotid gland to cause damage to facial nerve- eg mumps)
The muscles of the face can be generally divided into two groups; name these 2 groups and the nerves that innervate them.
- Muscles of facial expression- Facial nerve (7th Cranial Nerve)
- Muscles of mastication- (Branch of) Trigeminal nerve (5th Cranial Nerve)
How many cranial nerves are there?
12
Identify the missing labels and where the temporomandibular joint is on the following diagram.
Name the 5 key extra-cranial branches of the Facial (cranial nerve VII) in order of superior to inferior.
(To Zanzibar By Motor Car)
- Temporal
- Zygomatic
- Buccal
- Marginal mandibular
- Cervical
The trigeminal (cranial nerve V) has an important motor fuction. What other important function does it have?
Main sensory nerve of face and scalp
Name the 3 key branches of the trigeminal nerve and state which division is the only division that carries the motor function.
- Va ophthalmic division
- Vb maxillary division
- Vc mandibular division–> Motor to muscles of mastication
Name the main vein draining the head and neck structures.
Internal jugular vein
The lines in the following diagram point to anatomy of the neck. Fill in the missing labels
In which cervical fascial layer are the platysma found and what nerve are they innervated by?
What can you ask a patient to do to test the function of the trapezius?
Ask patient to shrug shoulders
How would you test the function of the Platysma and Sternocleidomastoid muscles?
The facial artery supplies the face. From which artery does it branch off?
External carotid
Which jugular vein is used clinically (ie to take JVP)?
Internal jugular vein
(NOT external jugular vein)
Identify the borders of the carotid triangle.
- Digastric (posterior belly)
- Omohyoid (superior belly)
- Sternocleidomastoid
What can be found within the carotid triangle?
Carotid sheath contains:
- IJV
- Internal carotid
Easily accessible as not covered by sternocleidomastoid in this area
Fill in the missing labels in the following diagram:
Where can an infection in the retropharygeal space potentially spread to? What could this cause?
Mediastinum (space between 2 lungs and its contents)
Risk of medistinitus
In which fascial layer do regional lymph nodes sit in the neck?
Superficial cervical fascia
Name the borders of the anterior triangle of the neck
- Superior– inferior border of mandible (jawbone)
- Lateral – anterior border of sternocleidomastoid
- Medial – midline (saggital) of neck
What forms the floor and the roof of the anterior triangle?
Floor= visceral fascia
Roof= investing fascia
At what spinal level does the common carotid bifurcate?
C4
How do the common carotid, internal jugular and vagus nerve sit relative to each other in the carotid sheath
Carotid- medial and anterior
IJV- lateral and anterior
Between Carotid and IJV posteriorly
When looking at a prosection, how would you locate where the portal vein forms?
Find stomach
Locate pyloric plane (where pyloric sphincter is)
Underneath will be neck of pancreas
Under neck of pancreas portal vein forms
At what spinal level does the inferior mesenteric artery form? Does it arise on the left or the right?
at L3 on the left
(Remember IMA supplies hindgut for after first 2/3 of transverse colon so on left)
