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Head and neck > 2 - Skull and Cervical vertebra > Flashcards

2 - Skull and Cervical vertebra Flashcards

1
Q

What distinguishes cervical vertebrae from thoracic?

A

Large, triangular vertebral foramen to allow for larger spinal cord
Bifid spinous process
Transverse foramina (allowing vertebral artery, vein and sympathetics through)
Horizontally orientated vertebrae, dislocate with much less force then needed to fracture
Nuchal ligament attaching to tip of spinous processes C1-C7

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2
Q

What distinguishes atlas/C1 from other vertebrae?

A

No vertebral body
No spinous process
Articular facet anteriorly to articulate with dens of axis
Lateral masses either side of vertebral arch for transverse ligament to attach
Posterior arch has groove for C1 spinal nerve and vertebral artery

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3
Q

What distinguishes axis/C2 from other vertebrae?

A

Dens (odontoid process) extends from anterior portion to articulate with articular facet of atlas

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4
Q

What is the name and function of the joints between C1/C2?

A

Medial atlanto-axial joints, formed by articulation between inferior facets and lateral masses of c1 and superior facets of c2
Allows for rotation of head

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5
Q

What is the name and function of the joint between occipital bone/C1?

A

Atlanto-occipital joint
Occur between superior facets of lateral masses of atlas and occipital condyles at base of cranium
Allows for flexion at head

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6
Q

Where are the most common and dangerous spinal injuries?

A

Most common: C2, C6 and C7

Most dangerous: C1-C4 can lead to quadriplegia and cessation of respiratory movements

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7
Q

Describe hyperflexion injuries

A

Head on traffic collision, lower cervical spine affected
Crush fractures of vertebral body
/Rupture of supraspinous ligament
/Rupture of lower vertebral discs compressing C6-C7 nerve roots (Musculocutaneous, axillary, median, radial nerves affected)

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8
Q

How is the atlanto-axial joint stabilised?

A

Dens is held in place by transverse ligament of atlas, preventing horizontal displacement

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9
Q

Describe hyperextension injuries

A 
Rear-end traffic collision/rugby tackle - whiplash
Affects upper cervical spine
Anterior longitudinal ligament damaged
Vertebral fracture and disc prolapse
odontoid process can fracture
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10
Q

Describe Hangman’s fracture

A

Hyper-extension injury caused by contact with steering wheel in collision or hanging
Fracture through both lamina of C2, disrupting the posterior arch
Anterior displacement of c2 onto c3

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11
Q

Describe Jefferson’s fractures

A

Fall onto head from a height

Burst fracture of C1, involving posterior and anterior arches

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12
Q

What are facet joints and how does osteoarthitis affect them?

A

Between articular processes of adjacent vertebrae
Close to intervertebral foramina, where spinal nerves emerge
Osteoarthritis can affect the facet joints, narrowing intervertebral foramina and compressing spinal nerve

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13
Q

Where do the sutures fuse?

A

Coronal - frontal to parietal
Sagittal - parietal to parietal
Lamboid - occipital to parietal

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14
Q

What are fontanelles and what is their purpose?

A

Incompletely fused suture joints form membranous gaps between bones in neonates
Allows rapid expansion of neurocranium as brain expands faster than bone can grow

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15
Q

Where are fontanelles found?

A

Frontal fontanelle - junction of coronal and sagittal sutures
Occipital - Junction of sagittal and lamboid sutures

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16
Q

When do the fontanelles close?

A

Occipital - 2-3 months

Frontal - 18-24 months

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17
Q

What are the divisions of the cranium?

A

Neurocranium - calvaria and cranial floor

Viscerocranium - forms facial skeleton

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18
Q

What bones make up the calvaria?

A

Frontal
Parietal
Occipital

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19
Q

What bones make up the cranial floor?

A 
Frontal 
Etmoid
Sphenoid
Parietal
Temporal 
Occipital
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20
Q

What is the pterion?

A

H shaped junction between frontal, sphenoid, parietal and temporal bones

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21
Q

Why is damage to the pterion dangerous?

A

Thinnest part of skull

Middle meningeal artery lies here, causing extradural haematoma which puts pressure on the brain

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22
Q

Describe the layers of the calvaria and their function

A

Tri-lamina arrangement gives protection without adding weight
2 layers of compact bone separated by spongy bone- diploe

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23
Q

How is the cranial floor divided?

A 
Anterior cranial fossa: Depression formed by frontal, ethmoid and sphenoid bones 
Middle cranial fossa:
Sphenoid, temporal and parietal bones 
Posterior cranial fossa:
Temporal and occipital bones
24
Q

Why are the cranial fossa vulnerable to fracture?

A

Contain lots of foramina, weakening structure

25
Q

What is a basilar skull fracture and what are the signs?

A

Fracture through the cranial floor as force is transmitted to skull base through vertebral column
Battle’s sign - bruising over mastoid process
Raccoon eyes - bruising around both eyes
Haemotympanum - blood behind ear drum
CSF leak from nose (CSF rhinorrhea) or ear (CSF otorrheoa)

26
Q

What is a depression fracture?

A

Depression of bone inwards, causing skull indentation and brain injury. Result of direct blow

27
Q

What is a linear fracture?

A

Break in bone traversing its full thickness, radiating fracture lines from point of impact

28
Q

Why is skin easily split above eye?

A

Skin lies on sharp bony supraciliary ridge

29
Q

Why is the mandible moveable?

A

It articulates with cranial base at temporomandibular joint, which is the only moveable joint in skull

30
Q

What are the bones of the viscerocranium?

A 
Zygomatic 
Lacrimal 
Nasal 
Inferior nasal conchae 
Palatine 
Maxilla 
Vomer
Mandible
31
Q

What occurs in a hard blow to the mandible?

A

Fracture of neck of the mandible

Dislocation of temporomandibular joint

32
Q

What is the cribiform plate and what does it contain?

A

Sheet of bone either side of the crista gali, containing many small formania to transmit olfactory nerve into nasal cavity - thinnest part of anterior cranial fossa, most likely to fracture

33
Q

What are the consequences of a cribiform plate fracture?

A

Anosmia - olfactory nerve fibres sheared, loss of sense of smell
CSF rhinorrhoea - Fragments of bone tear meningeal covering, CSF leaks into nasal cavity

34
Q

How is the middle cranial fossa divided?

A

Central part - contains pituitary gland

Lateral parts - contain temporal lobes of brain

35
Q

Describe the structure of the central part of the middle cranial fossa

A

Sella turcica (bony, saddle shaped prominence) :
-Tuberculum sellae: vertical elevation of bone, forms chiasmatic sulcus
-Hypophysial fossa: depression of body of sphenoid, holds pituitary gland
-Dorsum sellae: posterior wall of sella turcica, posterior clinoid processes extend from here
Anterior clinoid processes extend from sphenoidal lesser wings - site of attachment for tentorium cerebelli

36
Q

What is the chiasmatic sulcus and where is it found?

A

Groove running between the optic canals, found on body of sphenoid bone

37
Q

Describe the structure of the lateral part of the middle cranial fossa

A

Greater wings of sphenoid

Squamous and petrous parts of temporal bone, support temporal lobes of brain

38
Q

What foramina lie in the sphenoid bone and which cranial nerve travels through them?

A

Optic canal: Optic nerve (II)
Superior orbital fissure: Oculomotor (III), trochlear (IV), opthalmic of trigeminal (V1) and abducens (VI)
Foramen rotundum: Maxillary of trigeminal (V2)
Foramen ovale: Mandibular of trigeminal (V3)
Foramen spinosum: Mandibular of trigeminal and middle meningeal artery

39
Q

What foramina lie in the temporal bone and what passes through them?

A

Carotid canal: Internal carotid artery
Hiatus of petrosal nerve: Greater petrosal nerve (facial VII) and lesser petrosal (glossopharygneal IX)
Internal acoustic meatus: Facial nerve (VII) and vestibulocochlear (VIII)

40
Q

What is contained in the posterior cranial fossa?

A

Cerebellum

Brainstem: Medulla oblogata, pons and midbrain

41
Q

What formina lie in the occipital bone and what do they contain?

A

Foramen magnum: Medulla, meninges , spinal accessory (XI) and dural veins
Jugular foramina: IJV, Glossopharyngeal (IX), vagus (X) and spinal accessory (XI)
Hypoglossal canal: Hypoglossal (XII)

42
Q

Describe cerebellar tonsillar herniations

A

Cerebellar tonsils displaced downwards through foramen magnum due to raised intracranial pressure
Results in compression of pons and medulla

43
Q

What are dural venous sinuses?

A

Venous blood filled spaces created by separation of meningeal from periosteal layer of dura mater

44
Q

Describe the path of the dural venous sinuses

A

Superior sagittal drains to confluence of sinuses
Inferior sagittal sinus combines with great cerebal vein to form straight sinus, which flows to confluence of sinuses
Confluence goes to transverse sinus, curves down to form sigmoid sinus to drain into IJV

45
Q

What is a cerebral venous sinus thrombosis?

A

Thrombus in venous sinus, causes accumulation of deoxygenated blood in brain, leading to venous infarction.

46
Q

Describe extra-dural haemorrhages

A

Arterial bleed
Just in periosteum, not beyond suture lines
Usually middle meningeal artery
CT shows light area bulging through skull

47
Q

Describe subdural haemorrhages

A

Venous bleed
Damaged bridging veins as they empty into dural venous sinuses, increasingly likely with age as veins held under more tension
Falx cerebra prevent blood from spreading to other half of brain
Ct shows cresent shaped light area on one side, within skull

48
Q

Describe subarachnoid haemorrhages

A

Arterial bleed
Due to trauma/aneurysm, blood leaks into subarachnoid space and mixes with CSF. Usually fatal
CT shows light area in centre, over cerebral arteries

49
Q

What are the meninges?

A

Membranous layers protecting the brain:
Dura - tough
Arachnoid - soft
Pia - microscopic, closely adheres to brain

50
Q

Describe the layers of the dura

A

Periosteal - endosteum lining inner bones of skull
Meningeal - adjacent to arachnoid layer
Separation between layers creates dural sinuses

51
Q

What is a herniation?

A

Rise in pressure inside skull leading to compression of brain against rigid fold of the dura

52
Q

Describe the dural folds

A

Falx cerebri - attaches anteriorly at crista galli and ethmoid sinuses
Tentorium cerebelli - separates cerebellum from occipital lobe

53
Q

What is the temporal fossa?

A

Depression on lateral skull, site of temporalis origin

Temporal, sphenoid, parietal and frontal bone contributes to wall

54
Q

What is the infra-temporal fossa?

A

Space below zygomatic arch, inferior orbital fissure and pterygopalatine fossa communicate with it
Site of medial and lateral pterygoid muscles

55
Q

What is the pterygopalatine fossa?

A

Tiny space on inferior surface of skull
Between pterygoid plate of sphenoid and maxilla
Contains maxillary (V2) nerve via foramen rotundum passing through and sphenopalatine foramen containing sphenopalatine artery - cause of epistaxis (nose)

Head and neck (14 decks)

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