Anat of head and neck Flashcards
What are the layers of scalp?
SCALP
Skin
Cutaneous tissue - dense
Epicranial aponeurosis/galea aponeurotica
Loose areolar tissue
Pericranium
What is a risk in superficial scalp lacerations?
Severe bleeding because of arteries in 2nd layer cannot retract
What is the function of the epicranial aponeurosis?
Connect 2 frontalis bellies and 2 occipitalis bellies of occipitofrontalis muscle
What is a risk of a laceration through the aponeurosis?
Wide, gaping wound in scalp
What is the action of the frontalis muscle?
Elevation of eyebrows
What innervates the frontalis muscle?
Temporal branch of the facial nerve
What is the action of the occipitalis muscle?
Pulls scalp posteriorly and wrinkles skin on posterior neck
What is the innervation of the occipitalis muscle?
Posterior auricular branch of the facial nerve
What can occur in the loose areolar tissue layer?
Distension with fluid from injury or infection
What is the significance of the loose areolar tissue layer?
Emissary veins though parietal foramen do not have valves - can carry infection into the brain - dangerous area of scalp
What is the pericranium?
Periosteum covering outer surface of skull bones
What can occur at the pericranium level?
Cephalhematoma - between pericranium and calvaria
What causes a black eye/periorbital ecchymosis?
Extravasation of blood in 4th layer of scalp that gravitates down into eyelids because frontalis has no bony attachments
What arteries go to the scalp in front of the auricle?
Supratrochlear
Supraorbital
Superficial temporal
What arteries go to the scalp behind the auricle?
Posterior auricular
Occipital
What veins make up the dangerous area of the face?
Supratrochlear vein and Supraorbital vein into Angular vein into Facial vein
What does the retromandibular vein divide into?
Anterior and posterior divisions
What forms the common facial vein?
Anterior division of retromandibular and facial vein
What forms the subclavian vein from the head?
Posterior division of retromandibular and posterior auricular vein
What does the occipital vein go into?
Sub-occipital plexus
What does the common facial vein go to?
Internal jugular vein
What does the posterior auricular vein become?
External jugular vein
What nerves go in front of the auricle?
Supratrochlear
Supraorbital
Zygomaticotemporal
Temporal branch of facial
Auriculotemporal
What nerves branch off from ophthalmic trigeminal for the scalp?
Supratrochlear
Supraorbital
What nerve branches off from maxillary trigeminal for the scalp?
Zygomaticotemporal
What nerve branches off from mandibular temporal for the scalp?
Auriculotemporal
What nerves innervate the scalp behind the auricle and where do they branch from?
Great auricular
Posterior auricular
Lesser occipital
Greater occipital
Third occipital
Posterior rami of C2-C3
What nerves branch off of ophthalmic trigeminal for the face?
Infratrochlear
Lacrimal
External nasal
What nerves branch off of maxillary trigeminal for the face?
Infraorbital
Zygomaticofacial
What nerves branch off of mandibular trigeminal for the face?
Mental
Buccal
What lymph nodes does the upper facial area drain into?
Preauricular/superficial parotid
What lymph nodes does the intermediate area of the face (maxillary) drain into?
Submandibular
What lymph nodes does the lower area (mandibular) area of the face drain into?
Submental
How much of saliva production is done by the parotid glands?
25%
What is the path of the parotid duct?
From anterior parotid gland, along masseter, and opens opposite to second upper molar tooth
What nerve innervates the the parotid?
Glossopharyngeal to lesser petrosal to relay in otic ganglion then into auriculotemporal nerve to the parotid
What are the structures within the parotid gland?
FRE:
-Facial nerve
-Retromandibular vein
-ECA
What is another name for parotitis?
Mumps
What are clinical signs of parotitis/mumps?
Swelling of parotid gland
Pain with compression of gland
Paresis of five terminal branches of facial nerve
What are complications for parotitis/mumps?
Orchitis
Meningitis
What is Frey’s/Baillarger’s syndrome?
Sweating and flushing of skin along distributions of the auriculotemporal nerve
What causes Frey’s/Baillarger’s syndrome?
After trauma or surgery auriculotemporal nerve that is supposed to innervate parotid reattaches to sweat glands in same region
What is the main artery of the face?
Facial artery
What is the path of the facial artery?
From external carotid around inferior mandible into face
What is an area of compression for the facial artery?
Anterior to masseter muscle
What arteries branch off from facial artery?
Superior and inferior labial arteries
Angular artery
Superficial temporal
What arteries branch off from internal carotid and go to the face and scalp?
Supraorbital
Supratrochlear
What vein drains the face?
Facial vein
What part of the orbicularis oculi gently closes the eye?
Palpebral part
What part of the orbicularis oculi aids in draining tears?
Lacrimal part
What part of the orbicularis oculi tightly closes the eye?
Orbital part
What is the function of the buccinator?
Chewing, blowing, whistling
What nerve innervates the buccinator?
Facial nerve
What are the branches of the facial nerve?
Temporal
Zygomatic
Buccal
Marginal mandibular
Cervical
What are the branches of the trigeminal nerve?
Ophthalmic
Maxillary
Mandibular
What nerve innervates angle of the jaw?
Great auricular nerve from cervical plexus
What is the test for the temporal branch of the facial nerve?
Frown and wrinkle forehead
What is the test for zygomatic branch of the facial nerve?
Close eyes tightly
What is the test for the buccal branch of the facial nerve?
Puff up cheeks
Smile and show teeth
What is the test for the cervical branch of the facial nerve?
Neck stress - platysma
What is a test of the marginal mandibular branch of the facial nerve?
Muscles of lower lip and chin
What are clinical features of Bell’s palsy?
Transverse wrinkles of forehead disappear and eyebrows droop
Eyeball of effected side rolls up with trying to close eyes
Food gets accumulated in vestibule of mouth
Speech and pursing of lips may be affected
Angle of mouth remains motionless on effected side while smiling
What nerve is affected in Bell’s palsy?
Facial nerve
What are possible causes of Bell’s palsy?
Sudden exposure to cold
Middle ear infections
Fractures or tumors
What are ligaments of the TMJ?
Capsular ligament
Lateral/temporomandibular ligament
Sphenomandibular ligament
Stylomandibular ligament
What type of joint is the TMJ?
Synovial bi-condylar - modified hinge
What nerves supply the TMJ?
Auriculotemporal nerve from posterior mandibular
Masseteric nerve from anterior mandibular
What arteries run along the TMJ?
Superficial temporal artery
Maxillary artery
What are the muscles of mastication?
Temporalis
Masseter
Lateral pterygoid
Medial pterygoid
What innervates the muscles of mastication?
Mandibular division of trigeminal nerve
What are the three layers of deep cervical fascia?
Investing layer
Pre-tracheal layer
Prevertebral layer
What layer of deep cervical fascia surrounds the entire neck?
Investing layer
What layer of deep cervical fascia is limited to anterior neck from hyoid into thorax?
Pre-tracheal layer
What layer of deep cervical fascia continues with fibrous pericardium?
Pre-tracheal layer
What are the two parts of the pre-tracheal layer?
Muscular part
Visceral part
What is the function of the muscular part of the pre-tracheal layer?
Encloses infrahyoid muscles
What is the function of the visceral part of the pre-tracheal layer?
Encloses thyroid gland, trachea, esophagus
What continues with the buccopharyngeal fascia of the pharynx?
Visceral part of the pre-tracheal layer of the deep cervical fascia
What is the function of the prevertebral layer of deep cervical fascia?
Tubular sheath for vertebral column and associated muscles
What structures pierce the carotid sheath?
External carotid
Most tributaries of internal jugular vein
9th,11th, and 12th branches of the vagus nerve CNX
What makes up the retropharyngeal space?
Anterior - buccopharyngeal fascia
Posterior - prevertebral fascia
Carotid sheaths laterally
Superiorly - base of skull
Inferiorly - superior mediastinum of thorax
What is the function of retropharyngeal space?
For expansion of pharynx during deglutition
What is contained in the retropharyngeal space?
Loose areolar tissue
Pharyngeal plexus of nerves and vessels
What makes up the roof of the posterior triangle?
Skin, superficial fascia, platysma, investing layer of deep cervical fascia
What structure is related to the roof of the posterior triangle?
External jugular vein
What are the nerves associated with the posterior triangle?
Lesser occipital
Greater auricular
Transverse cervical
Supraclavicular
Spinal accessory
What are the two subdivisions of the posterior triangle?
Occipital
Supraclavicular
What makes up the floor of the occipital trangle?
Semispinalis, splenius capitus, levator scapulae, scalenus medius and posterior
What makes up the floor of the supraclavicular triangle?
Outer border of first rib, scalenus medius, first digitation of serratus anterior
What is Erb’s point?
Region in upper trunk of brachial plexus where 6 nerves meet
What nerves meet in Erb’s point?
C5, C6, suprascapular nerve, anterior and posterior nerve to subclavius
What is the first nerve to be damaged in posterior triangle neck surgeries?
Spinal accessory nerve
What are the actions of the sternocleidomastoid?
Flexion and rotation of neck
Accessory muscle of respiration
What is a wry neck?
Applied spasm of sternocleidomastoid
What is torticullis?
Applied spasm of sternocleidomastoid and trapezius
What are signs of wry neck or torticollis?
Elevation of shoulder on affected side
Stiffness and shortening of the neck muscles
Limited ROM of neck
When is common to see enlargement of the Virchow’s group of lymph nodes?
Malignant growth from stomach, testis, left thorax, other abdominal organs
What are the Virchow’s group of lymph nodes?
Deep group of cervical/supraclavicular lymph nodes
What are the contents of the anterior triangle?
Carotid artery and its branches
Internal jugular vein and its tributaries
Four cranial nerves (1-12) - ansa cervicalis
Submandibular and part of parotid
What are the anterior branches of the external carotid in the neck?
Superior thyroid
Lingual
Facial
What are the posterior branches of the external carotid in the neck?
Occipital
Posterior auricular
What is the medial branch of the external carotid in the neck?
Ascending pharyngeal
What are the terminal branches of the external carotid off of the facial branch?
Maxillary
Superficial temporal
