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Head and neck > 1 - Organisation > Flashcards

1 - Organisation Flashcards

1
Q

Why do lacerations to the scalp result in profuse bleeding?

A

Pull of occipitofrontalis muscle prevents closure of bvs
Bvs adhered to dense connective tissue so vasoconstriction prevented
Blood supply to scalp has many anastomoses

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2
Q

Why does loss of blood supply to scalp not result in bone necrosis?

A

Skull’s blood supply from middle meningeal artery

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3
Q

Which nerves innervate the scalp?

A

Trigeminal: Opthalmic: Supraorbital and supratrochlear
Maxillary: Zygomaticotemporal
Mandibular: Auriculotemporal
Cervical: Greater and lesser occipital

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4
Q

Describe the layers of the scalp

A

Skin
Dense connective tissue- contains neurovascular bundle, bleeds profusely
Aponeurotic - contains occipitofrontalis
Loose connective tissue - Infections can spread to meninges via emissary veins
Pericranium - Attached to bones, stuck on at sutures

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5
Q

What arteries supply the scalp?

A 
External carotid: Superficial temporal
Posterior auricular 
Occipital 
Internal carotid: 
Opthalmic: 
Supraorbital 
Supratrochlear
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6
Q

Where do facial muscles originate from?

A

2nd pharyngeal arch

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7
Q

What is the function of orbicularis oculi?

A

Palpebral part gently closes eyelid

Orbital part forcefully closes eyelid

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8
Q

What are the consequences of facial nerve palsy with respect to the eye?

A

Eye can’t shut, cornea dries out - Exposure keratitis

Lower eyelid droops- ectropion- lacrimal fluid pools instead of spreading across eye, so debris damages cornea

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9
Q

What is the action and attachments of orbicularis oris?

A

Purses the lips

Arises from maxilla, inserts into mucous membranes and skin of lips

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10
Q

What is the action and attachments of buccinator?

A

Pulls cheeks against teeth so food doesn’t accumulate

Originates from maxilla and mandible, blends with orbicularis oris into skin of lips

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11
Q

What are the muscles of facial expression?

A

Occipitofrontalis
Orbicularis oculi
Orbicularis oris
Buccinator

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12
Q

Where do the muscles of mastication develop from and what are they innervated by?

A

First pharyngeal arch

Innervated by mandibular branch of trigeminal nerve (V)

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13
Q

What are the attachments and actions of masseter?

A

Superficial: Maxillary process of zygomatic bone
Deep: Zygomatic arch of temporal bone
Inserts into mandible
Elevates mandible to close mouth

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14
Q

What are the attachments and actions of temporalis?

A

Originates from temporal fossa
Inserts as a tendon on mandible
Elevates mandible to close mouth and retracts mandible to pull jaw posteriorly

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15
Q

What are the attachments and actions of medial pterygoid?

A

Superficial head: Maxilla
Deep head: Lateral pterygoid plate of sphenoid bone
Inserts on mandible, near angle of mandible
Elevates mandible closing mouth

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16
Q

What are the attachments and actions of lateral pterygoid?

A

Superior head: Greater wing of sphenoid
Inferior head: Lateral pterygoid plate of sphenoid
Inserts as a tendon on neck of mandible
Bilaterally: Protract mandible, pushing jaw forwards
Unilaterally: Side to side movement of jaw

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17
Q

What is the action of the suprahyoid muscles?

A

Elevate the hyoid bone, for swallowing

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18
Q

What are the attachments, innervation and action of digastric?

A

Anterior belly: Mandible
Posterior: Mastoid process of temporal bone
Fibrous sling attaches to hyoid bone
Anterior innervation: Mandibular, trigeminal (V)
Posterior: Facial (VII)
Depresses mandible and elevates hyoid bone

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19
Q

What are the attachments and actions of omohyoid?

A

Originates at scapula, running under SCM to attach to hyoid bone
Depresses hyoid bone

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20
Q

What are the attachments, innervation and action of platysma?

A

Originates pectoral fascia, inserts into mandible
Innervated by cervical, facial nerve (VII)
Depresses the mandible

21
Q

What are the attachments, innervation and action of sternocleidomastoid?

A

Originates sternal head and medial clavicle, inserts on mastoid process of temporal bone
Innervated by the accessory nerve
Laterally flexes head and neck

22
Q

What are the attachments, innervation and action of trapezius?

A

Originates occipital lobe and spinous process of vertebrae. Inserts into lateral clavicle and scapula
Innervated by accessory nerve
Retraction, rotation, elevation and depression of scapula

23
Q

What are the borders of the posterior triangle?

A 
Anterior: Posterior SCM
Posterior: Anterior trapezius 
Inferior: Middle clavicle 
Roof: Investing fascia 
Floor: Prevertebral fascia
24
Q

What is the danger of a stab wound in posterior triangle?

A

EJV travels through superficially
If cut, its lumen is held open by investing fascia
Air drawn into vein, produces cyanosis and stops blood flowing through RA

25
Q

Which nerves run through the posterior triangle?

A

Accessory nerve
Cevical plexus - phrenic nerve
Brachial plexus

26
Q

What are the borders of the anterior triangle?

A 
Superior- Inferior mandible 
Lateral- Anterior SCM
Medial - Sagittal line down midline of neck 
Roof: Investing fascia
Floor: Visceral fascia
27
Q

What are the contents of the anterior triangle?

A 
Digastric
Omohyoid 
Common cartoid (bifurcates here)
IJV
Cranial nerves: Facial (VII), glossopharyngeal (IX), vagus (X), accessory (XI) and hypoglossal (XII) 
Carotid triangle
28
Q

What are the borders of the carotid triangle?

A

Superior: Posterior belly of digastric
Lateral: Medial SCM
Inferior: Superior belly of omohyoid (so hyoid bone)

29
Q

What are the contents of the carotid triangle?

A 
Common carotid artery, bifurcates here
IJV
Hypoglossal nerve
Vagus nerve 
Carotid sinus
30
Q

How does applying pressure to the carotid triangle lead to syncope?

A

Pressure on carotid sinus, baroreceptors sensitive to stretch
Glossopharyngeal nerve feeds back to brain
Brain becomes underperfused, causing syncope

31
Q

From out to in, what are the fascial layers of the neck?

A 
Superficial fascia 
Deep cervical fascia:
Investing layer
Pretracheal layer
Prevertebral layer 
Carotid sheaths
32
Q

What is contained within the superficial fascia layer?

A

Platysma
EJV
Fat - double chin
Lymph nodes and neurovascular supply to skin

33
Q

What is contained within the pretracheal layer and what does it fuse with?

A 
Infrahyoid muscles 
Thyroid gland
Trachea 
Oesophagus
Fuses with pericardium and posteriorly with buccopharyngeal fascia
34
Q

What is the danger of infection between investing and pretracheal fascia?

A

Infection can travel posteriorly to the anterior mediastinum

35
Q

What is contained within the prevertebral layer?

A

Vertebral column
Scalene muscles
Brachial plexus + subclavian artery to form axillary sheath

36
Q

What forms the carotid sheath?

A

Investing
Pretracheal
Prevertebral

37
Q

What is contained in the carotid sheath?

A

Common carotid artery
IJV
Vagus nerve
Cervical lymph nodes

38
Q

Why is the carotid sheath a pathway for infection?

A

Runs from base of skull to thoracic mediastinum

39
Q

Why is infection posterior to prevertebral fascia dangerous?

A

Infection can erode through prevertebral fascia and drain into retropharyngeal space, which extends to thorax so infection can reach mediastinum

40
Q

Where does the neck extend to and from?

A

Lower mandible to suprasternal notch of manubrium and upper clavicle

41
Q

Describe the typical presentation of a retropharyngeal abscess

A 
Child under 5
Bulge on oropharynx 
Difficulty swallowing 
Stridor
Reluctant to move neck 
Temperature
42
Q

How is a thyroid lump distinguishable?

A

Lump will move on swallowing as thyroid gland is enclosed in pre-tracheal fascia and attached to hyoid bone

43
Q

Describe retrosternal extension of the thyroid gland

A

As pre-tracheal fasica extends to thorax, thyroid can swell down
Compresses trachea and venous blood vessels causing breathlessness, stridor and facial oedema

44
Q

What complications occur due to facial injury damaging the parotid gland?

A

Facial nerve travels through parotid gland, can cause paralysis of facial muscles

45
Q

What are the consequences of a parotid cancer?

A

Ipsilateral partoid enlargement resulting in facial nerve palsy

46
Q

What is Bell’s palsy?

A

Inflammation of the facial nerve, half the face is paralysed and droops
Loss of taste in anterior 2/3 of tongue

47
Q

Describe the venous drainage of the face

A 
Facial vein (eye to mandible) drains into IJV
Superficial temporal and maxillary vein drain into EJV
EJV and IJV drain into subclavian vein
48
Q

Where is the facial artery pulse felt?

A

Inferior mandible

49
Q

Why do both sides of the face need to be compressed after a laceration?

A

Facial artery has many anastomoses with other arteries in face will bleed unless both sides compressed

Head and neck (14 decks)

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