3 - Neck and face Flashcards by Saira C

What are the branches of the trigeminal nerve (CN V)

the ophthalmic nerve (V1)
the maxillary nerve (V2)
the mandibular nerve (V3)

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What nerves exit the skull through the supraorbital fissure?

oculomotor (III)
trochlear (IV)
opthalmic (V1)
abducens (VI)
(and superior ophthalmic vein)

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What passes through the foramen rotunda?

maxillary division of the trigeminal (V2)

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What passes through the foramen ovale?

mandibular division of the trigeminal (V3)

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What passes through the foramen spinosum?

the middle meningeal artery and vein

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What passes though the internal acoustic meatus?

facial nerve (CN VII)
vestibulocochlear nerve (CN VIII)
labyrinthine artery

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What passes though the jugular foramen?

glossopharyngeal nerve (CN IX)
vagus nerve (CN X)
accessory nerve (CN XI)
sigmoid sinus (drains into the jugular vein)

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What passes through the foramen magnum?

medulla of brain
vertebral arteries
spinal roots of accessory nerve (CN XI)

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What are the anterior and posterior boundaries of the neck?

Anteriorly: from the lower border of the mandible to the manubrium of sternum
Posteriorly: from the superior nuchal line on the occipital bone to the intervertebral disc between CVII and T1

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What are the fist few layers of the neck the are encountered?

Skin
Subcutaneous Fat
Platysma

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What nerve is the platysma innervated by?

(by the cervical branch of the) facial nerve

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What are the deep compartments of the neck?

What do they contain?

visceral - trachea, oesophagus and thyroid.
vascular (carotid sheath) - vagus nerve, common carotid and internal jugular
vertebral/muscular - vertebra and musculature

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Name and describe the locations of the fascia of the neck

superficial fascia
investing fascia - surrounds all structures (more superficial of deep fascia)
pre-tracheal fascia surrounds the visceral compartment
carotid sheath surrounds vascular bundles
prevertebral fascia - surrounds vertebral compartment
(^note that these are all deep cervical fascia)

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Give the levels of the vertebra of the neck with the corresponding landmarks that are present at that level

C1 - open mouth
C2 - superior cervical ganglion
C3 - body of the hyoid
C4 - upper body of the thyroid cartilage
      - bifurcation of the common carotid artery
C6 - cricoid cartilage
      - middle cervical ganglion
C7 - inferior cervical ganglion

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What are the borders of the anterior triangle?

Anterior border of sternocleidomastoid
Midline
Inferior border of mandible

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What are the contents of the anterior triangle?

Mainly muscles
Hyoid bone
Carotids and Internal Jugular Vein

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What is the hyoid bone? Why is it important?

U shaped bone in the neck - important in swallowing and tongue movement
All anterior neck musculature relates to the hyoid
No bony articulations; suspended in space by an array of muscles and ligaments.

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Name the deep muscles of the anterior triangle

Platysma

Suprahyoid (x4)
Mylohyoid, (Stylohyoid, Geniohyoid) and Digastric

Infrahyoid (x4) AKA Strap Muscles
Sternohyoid, Omohyoid, Sternothyroid and Thyrohyoid

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Describe the innervation of the suprahyoid muscles

anterior innervation: Mylohyoid and Anterior belly of the Digastric
Mandibular Division (V3) of the Trigeminal Nerve
Posterior Innervation: Stylohyoid and Posterior belly of the Digastric
Facial Nerve (VII)

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What are the attachments of the mylohyoid muscles?
Describe its innervation
State the function

Body of mandible (mylohyoid line)
Body of hyoid

innervated by V3

Support floor of oral cavity
Elevates the hyoid

What are the attachments of the geniohyoid?

What is its innervation?

Internal aspect of mandible
Body of hyoid

innervated by C1 fibres, via hypoglossal

Anterior belly of digastric:
What are the attachments?
Describe its innervation

Attachments:
Internal aspect of mandible
Tendon (attached to hyoid)

Innervation?
V3

Posterior belly of digastric:
What are the attachments?
Describe its innervation

Attachments:
Mastoid process
Tendon (attached to body of hyoid)

Innervation?
VII (facial)

Describe the innervation of the infrahyoid muscles

Thyrohyoid :
C1 fibres via the Hypoglossal Nerve (XII)

Omohyoid, sternohyoid and sternothyroid:
Ansa cervicalis (anterior rami of C1 to C3)

Thyrohyoid muscle What are the attachments? Describe its innervation

Attachments: Thyroid cartilage (Greater horn of )hyoid Innervation? C1 via hypoglossal

Omohyoid muscle What are the attachments? Describe its innervation

Attachments: Sup. border of scapula Body of hyoid Innervation? Ansa cervicalis

Sternothyroid muscle What are the attachments? Describe its innervation

Attachments: Posterior surface of manubrium Thyroid cartilage Innervation? Ansa cervicalis

Sternohyoid muscle

Attachments: Posterior aspect of manubrium Body of hyoid Innervation? Ansa cervicalis

What are the borders of posterior triangle?

Posterior border of sternocleidomastoid Anterior border of trapezius Middle 1/3rd of clavicle

Give the contents of the posterior triangle

3 vessels and 4 nerves External jugular veins Subclavian artery & vein Trunks of brachial plexus Spinal accessory Phrenic nerve Vagus nerve

Through which foramen does the spinal accessory nerve exit the cranium?

Jugular foramen

What does the spinal accessory nerve innervate?

sternocleidomastoid and trapezius

How would you test for the function of the spinal accessory nerve?

shrug/raise shoulders

the vagus nerve exits the cranium through which foramen?

Jugular foramen

What does the vagus nerve innervate?

Larynx Heart Lungs GI tract

the vagus nerve travels in the ____

carotid sheath

How do you test for the function of the vagus nerve?

gag reflex

Describe the innervation of the phrenic nerve

Motor to diaphragm and sensory to peritoneum and pleura around diaphragm

Where does the phrenic nerve lie in relation to the scalenes?

Lies anteriorly to scalenus anterior

How is the brachial plexus formed? | What does it innervate?

Formed from anterior rami of C5-T1 | Innervates the upper limb

Give the origin and course of the carotids

- Right CC is a branch of the brachiocephalic trunk - Left CC comes directly from aortic arch. - Both enter neck posterior to the sternoclavicular joints - Ascend in carotid sheaths - Bifurcate at the level of C4: - ----> External - supplies many arteries in the face and neck - ----> Internal - ascends into cranium before dividing

Describe how you would find the carotid pulse

- Anterior border of the sternocleidomastoid - Above and lateral to the hyoid bone (Basically any point above C6) - Keep the head straight because the sternocleidomastoid muscle protects the carotid sheath when the head is turned.

Why would you use the carotid pulse?

- Easy to find - Assess rhythm - Time murmurs - If radial pulse cannot be felt e.g. low blood pressure - Used to locate jugular vein (USS)

Describe the branches of the subclavian artery

- Vertebral artery -----> Ascend through foramen transversarium of cervical spine -----> Form the basilar artery Internal thoracic artery -----> Runs inside thoracic cage -----> Gives off anterior intercostal branches & perforating vessels of breast - Additionally, the inferior thyroid artery arises from the first part of the subclavian artery

What is the foramen transversarium?

only found in the cervical vertebrae. | a gap on each of the transverse processes which contain the vertebral artery and vein and a sympathetic nerve plexus

In what three locations are central venous lines/catheters placed?

Catheters can be inserted through a peripheral vein or a proximal central vein, most commonly: - internal jugular - neck - subclavian - thorax - femoral vein - groin

Describe the general organisation of the lymph nodes in the neck

- Organised in a ring - Each group drains area above it Everything drains superficial to deep

Describe the lymph drainage of the neck

- All lymph nodes drain into the deep cervical nodes which lie along the internal jugular vein. - These converge to form the right and left jugular lymphatic trunks - Rt jugular lymphatic trunk empties into the rt lymphatic duct* - Lt jugular lymphatic trunk enters into the thoracic duct

State the order of the cartilage in the neck and the corresponding vertebral levels

``` hyoid = C3 thyroid = C4 cricoid = C6 ```