3 - Head & Neck - Osteology + Clinical Relevance of Skull + Cervical Spine Flashcards
Between which cervical vertebrae is there no intervertebral disc?
C1 + C2
C1 does not have a vertebral body therefore no intervertebral disc
What structures pass through the foramina in the transverse processes of cervical vertebrae?
Vertebral Artery
Vertebral Vein
Sympathetic nerves
Which cervical vertebrae has an atypical spinous process? What makes it atypical?
C7
- Non-bifid
- Longest spinous process
Which cervical vertebrae are atypical?
- C1 = no vertebral body or spinous process
- C2 = dens
- C7 = non-bifid, long spinous process
Name the strongest cervical vertebrae:
Axis (C2)
Name the ligament which holds the dens in position, and prevents horizontal displacement:
Transverse ligament of the atlas
Where are the most common sites of cervical spine injuries?
- C1/2
- C6
- C7
List some injuries caused by hyperflexion of the cervical spine (ie blow to back of head):
- Dens fracture
- Dislocation/subluxation of cervical vertebrae
- Rupture of intervertebral discs (commonly C5/6 or C6/7)
- Rupture of supraspinous ligament
List some injuries caused by hyperextension of the cervical vertebrae (ie rear-end vehicle collision):
- Hangman’s fracture (of axis)
- Rupture of anterior longitudinal ligament
- Vertebral fracture
- Disc prolapse
What is another name for a ‘burst fracture of C1’, and how is it caused?
Jefferson’s fracture of Atlas
- Axial load = vertical fall onto extended neck
What is the mode of imaging of choice of a patient with a suspected cervical spine injury?
Adults = CT scan Children = MRI
List some general symptoms of c-spine injury:
- Loss of sensation
- Loss of function (ie difficulty breathing or moving limbs)
- Parasthesia
- Neck pain
List some c-spine changes which occur in cervical spondylosis:
- Osteophytes
- Facet joint hypertrophy
- Disc herniation
- Disc space narrowing
- Sclerosis of end plates of vertebrae
How does age affect the health of the cervical spine?
- Increased risk of osteoarthritis = intervertebral foramen can narrow
- Increased risk of intervertebral discs bulging = intervertebral foramen can narrow
= Compression of spinal nerve = pain and muscle weakness of that dermatome/myotome
Name the 2 main complications associated with cervical spondylosis:
1) Radiculopathy (nerve root impingement)
2) Myelopathy (spinal cord compression)
How many bones make up the neurocranium? Name as many as you can:
8 bones:
- Frontal
- Temporal x 2
- Parietal x 2
- Occipital
- Sphenoid
- Ethmoid
How many bones make up the viscerocranium? Name as many as you can:
14 bones:
- Nasal x 2
- Maxilla x 2
- Mandible
- Lacrimal x 2
- Zygomatic x 2
- Palatine x 2
- Vomer
- Inferior nasal conchae x 2
Which bones meet at the pterion?
- Frontal
- Parietal
- Temporal
- Sphenoid
What artery is at risk during a blow to the pterion?
Anterior branch of the middle meningeal artery
What type of haematoma may be caused by a blow to the pterion?
Extradural haematoma
Name the 3 sutures of the skull:
- Lambdoid
- Coronal
- Sagittal
What are the main signs which suggest a basilar skull fracture?
- Battle’s sign ( bruising over mastoid process)
- Periorbital eccymosis
- Haemotympanum
- CSF otorrhoea
- CSF rhinorrhoea
What is a fontanelle?
Membranous areas of unfused skull of an infant, to allow flexibility during passage through birth canal, and to allow for brain growth
How can the fontanelles be used to indicate the health of an infant?
If sunken = may indicate dehydration
If bulging = indicates increased intracranial pressure (ie Meningitis/hydrocephalus)
If enlarged = May be premature sign of brain damage, or due to Down’s syndrome or IUGR
Name the last parts of an infants skull to ossify:
- Anterior fontanelle
- Posterior fontanelle
When should the fontanelles close?
Anterior = between 18 - 24 months Posterior = within 2-3 months
What structure passes through foramen rotundum?
Maxillary branch of the Trigeminal nerve CN V2
What structure passes through foramen ovale?
Mandibular branch of the Trigeminal nerve CN V3
What structure passes through foramen spinosum to become intracranial?
Middle meningeal artery
What structures pass through foramen magnum?
- Medulla oblongata
- Spinal root of Accessory nerve CN XI
- Vertebral arteries
- Anterior and posterior spinal arteries
Through which foramen will the internal carotid artery take to become intracranial?
Carotid canal
