Anatomy (Head, Neck And Spine) Flashcards
location of periosteum of skull
• inner and outer surfaces are lined by periosteum inner periosteum is the endosteal layer of the dura mater
what is cephalohaematoma.
• collections of blood beneath this layer are therefore limited by suture lines
division and subdivision of trigeminal nerve
Division—
Ophthalmic
Maxillary
Mandibular
Subdivision—
Supraorbital (of V1)
Infraorbital (of V2)
Mental(of V3)
sensory supply over angle of mandible/parotid
.greater auricular nerve, a branch of the cervical plexus
what goes in mandibular foreman and comes out of mental foreman
•inferior alveolar branch of the mandibular division of the trigeminal nerve goes in from inner side and emerges as mental nerve through outer side—mandibular foramen is shielded by a projecting
process, the lingula.
what is (Arnold–Chiari malformation)
• differential growth between spinal cord and vertebral column PULLS the hindbrain into the foramen magnum (Arnold–Chiari malformation)
*Processes of face development
*Frontonasal—
• nose
• nasal septum
• nostril
• philtrum (midline depression on upper lip)
• premaxilla (bearing four incisor teeth).
*Maxillary—
• cheeks
• upper lip (except philtrum)
• upper jaw
• palate (except premaxilla).
*Mandibular—
• lower jaw.
*Derivatives of Pharyngeal pouches
•1st Eustachian tube, middle ear, mastoid antrum
•2nd Tonsillar fossa (palatine tonsil)
•3rd Thymus, INFERIOR parathyroid
•4th SUPERIOR parathyroid, part of thyroid
ligaments of pharyngeal arches
•1st pharyngeal arch
Sphenomandibular
Anterior ligament of malleus
•2nd pharyngeal arch
Stylohyoid
Muscles of pharyngeal arches
*Muscles of 1st pharyngeal arch
Mastication
Mylohyoid
Anterior belly of digastric
Tensor tympani
Tensor palati
*Muscles of 2nd pharyngeal arch
Facial expression
Posterior belly of digastric
Stylohyoid
Stapedius
*Muscle of 3 Rd pharyngeal arch
Stylopharyngeus
*Muscle of 4th-6th pharyngeal arch
Muscles of pharynx,
larynx, palate
what is scalping???
Muscle attachment to lateral pterygoid process
On medial surface—medial pterygoid
On lateral surface—lateral pterygoid
Muscle attachment of medial pterygoid process
Superior pharyngeal constructor
Which pterygoid plate is associated with infratemporal fossa
Lateral
Which pterygoid plate is associated with pharynx
Medial pterygoid plate
What does age have to do with midline of mandible
• The midline of the mandible is often referred to as the symphysis menti, which is a joint up to the second year of life, after which fusion takes place.
Parts of orbicularis oculi with function
• Orbicularis oculi surrounds the eye. The PALPEBRAL part is in the eyelid and closes the eye as in SLEEP; the ORBITAL part surrounds the orbit and forcibly closes the eye, e.g. when DUST blows in the face.
Site of pulsation of superficial temporal artery
• Pulsation can be felt just in front of tragus of ear.
Is there any anastomosis between superficial temporal artery with facial artery
• Wide anastomosis between superficial temporal artery
and facial artery.
Why Central area of the face is sometimes known as the ‘dangerous area’,
Facial vein
Communicates freely with deeper veins such as those of the pterygoid venous plexus.
• Communicates with veins of orbit and THEN with the cavernous sinus.
•So infection can spread via the veins to the cavernous sinus.
Sure which has richest cutaneous blood supply of body
Subcutaneous connective tissue of SCALP
What forms Aponeurotic layer of SCALP
It is part of occipitofrontalis,
which is fibrous over the vertex of the skull but muscular in the occipital and frontal areas
Reason of movement of SCALP
Loose connective tissue
Up to which layer do we have to take for scalping flap
Loose connective tissue
What is the bone between the 2 layers of compact skull bone called
trabecular bone
also known as cancellous bone or spongy bone, is a porous bone tissue made up of a network of rods and plates called trabeculae.
Trabeculae means rod-shaped structures
Attachment of Falx cerebri
It is attached along the lips of the sagittal groove
Course of middle meningeal vessels
Posterior to the CORONAL suture, the middle meningeal vein accompanied by the middle meningeal artery groove the VAULT of the skull.
What is lambda
The lambda is the junction between the lambdoid suture and the sagittal suture (it is the area of the posterior fontanelle in the infant).
What is Bregma
The bregma is the junction between the coronal and sagittal suture (it is the area of the anterior fontanelle in infants).
Location of pterion
• The pterion is the thin part of the skull at the junction of the parietal, frontal and temporal bones, and the greater wing of the sphenoid in the temporal region of the skull.
Located in the temporal fossa, about 4 cm above the zygomatic arch and 3.5 cm behind the frontozygomatic suture.
Vessel related to pterion
• The anterior branch of the middle meningeal artery traverses the pterion.
Vessel related to pterion
• The anterior branch of the middle meningeal artery traverses the pterion.
Clinical importance of pterion
It is considered the weakest part of the skull. It is STRUCTURALLY weak (NOT thin) because it’s the point where multiple bones meet.
Clinical importance of pterion
It is considered the weakest part of the skull. It is STRUCTURALLY weak (NOT thin) because it’s the point where multiple bones meet.
Location of crista galli
occupies the gap between the two orbital
plates.
Crista Galli provides an attachment point for the falx cerebri
Petrous meaning
- of or like rock; hard; stony.
- designating or of that part of the temporal bone which surrounds and protects the internal ear.
Importance of arcuate eminence of temporal bone
It is a rounded prominence upon the superior surface of the petrous part of the temporal bone.
It forms the lateral part of the posterior wall of the middle cranial fossa.
The arcuate eminence indicates the position of the underlying superior semicircular canal (anterior semicircular canal).
Clinoid meaning
The word clinoid likely comes from the Greek root klinein or the Latin clinare, both meaning “sloped” or “inclined”.
ACP is an important structure for surgery on the pituitary gland and the internal carotid artery.
What are clinoid processes
These are bony projections on the sphenoid bone that surround the sella turcica.
Boney roof of nasal cavitIES
The cribriform plate roofs the nasal cavitIES.
Which veins connect cerebral veins in nasal cavity and foreman of skull they pass through
Frontal emissary veins
Foramen ovale
What does subConjunctival haemorrhage indicate
Bleeding into the orbit
Optic canal is in which cranial fossa
Middle
Superior orbital fissure is in which cranial fossa
Middle
Which cranial fossa is more prone to fracture and why
Middle
as the
bone is weakened by the foramina and canals
What is tegmen tympani
The tegmen tympani, also known as the tegmental wall or roof of the tympanic cavity.
It is a thin plate of the petrous part of the temporal bone that separates the intracranial compartment and middle ear.
Importance of tegmen tympani
• fracture involving the tegmen tympani results in bleeding into the middle ear
• excessive bleeding into the middle ear can rupture the tympanic membrane, resulting in bleeding from the ear
• CSF otorrhoea may occur
• cranial nerves VII and VIII may also be involved, as they run in the petrous temporal bone.
What means CLIVUS with it’s location and
formation and function
The word “clivus” comes from Latin and means “slope”.
The clivus is located near the spine
Body of sphenoid and Basilar part of occipital form the clivus.
The clivus is a crucial point that connects and splits different anatomical compartments, and it’s also a pathway for the abducens—6 nerve.
what defines emissary vein and they’re risk
Emissary veins are small, valveless veins that connect the intracranial and extracranial venous systems of the head.
RISK
They can be a route for infection to spread from outside the cranium into the venous sinuses, and they can also rupture to cause a subgaleal hemorrhage—
Subgaleal hemorrhage, also known as subgaleal hematoma, is bleeding in the potential space between the skull periosteum and the scalp galea aponeurosis (dense fibrous tissue surrounding the skull)
Contents of Superior orbital fissure
*Nerves
III
IV
V1
VI
Sympathetic
*Vein
Ophthalmic
Structures of s passing through foramen ovale
Explanation:
O—Ottic ganglion
V—V3
A—Accessory meningeal branch of the maxillary artery
L—Lesser petrosal nerve
E—Emissary veins
O - Otic ganglion: A small ganglion located near the foramen ovale.
V - V3 (mandibular division) of the trigeminal nerve: The primary nerve that passes through the foramen ovale.
A - Accessory meningeal artery: A small artery accompanying the mandibular nerve.
L - Lesser petrosal nerve: A branch of the glossopharyngeal nerve.
E - Emissary veins: Ophthalmic emissary veins that connect the cavernous sinus to the pterygoid plexus.
Structures of s passing through foramen ovale
Explanation:
O—Ottic ganglion
V—V3
A—Accessory meningeal branch of the maxillary artery
L—Lesser petrosal nerve
E—Emissary veins
O - Otic ganglion: A small ganglion located near the foramen ovale.
V - V3 (mandibular division) of the trigeminal nerve: The primary nerve that passes through the foramen ovale.
A - Accessory meningeal artery: A small artery accompanying the mandibular nerve.
L - Lesser petrosal nerve: A branch of the glossopharyngeal nerve.
E - Emissary veins: Ophthalmic emissary veins that connect the cavernous sinus to the pterygoid plexus.
ganglion connected to ophthalmic nerve
ciliary
*located in the orbit, on the lateral side of the optic nerve.
*controls the muscles in the eye.
*It’s part of the parasympathetic nervous system, which controls involuntary functions like eye muscles—
Pupil constriction.
Lens shape
General sensations
Blood vessel supply
(The ciliary ganglion’s sympathetic root supplies blood vessels in the eyeball).
ganglion connected to maxillary nerve
pterygopalatine
*contains postganglionic parasympathetic and sympathetic fibers along with general sensory fibers of the maxillary nerve.
*These three types of fibers leave the ganglion as orbital, palatine, nasal and pharyngeal branches.
*is the largest of the parasympathetic ganglia
*ganglion supplies the lacrimal gland, paranasal sinuses, and other structures.
—by sending postganglionic sympathetic fibers through the short ciliary nerves, which then directly innervate the blood vessels within the eye, primarily affecting their constriction and dilation to regulate blood flow; essentially, these fibers travel through the ganglion and reach the eye’s blood vessels to control their diameter via neurotransmitter release.
ganglion connected to mandibular nerve
otic
*plays a role in conveying parasympathetic and sympathetic fibers to the parotid gland.
*otic ganglion receives some preganglionic inputs from the facial nerve via the chorda tympani.
internal jugular vein is the continuation of which sinus?
sigmoid sinus
Nerves exciting thorough Jugular foremen
IX
X
XI
Atypical course of nerve XI
Enters through foramen Magnum
Exits through Jugular foramen
Artery in hypoglossal canal
meninGEAL branch of ascending pharynGEAL artery
Structures passing through Internal auditory meatus
VII—facial nerve
VIII—vestibulocochlear nerve
labyrinthine artery
(Facial nerve exits the base of the skull via the stylomastoid foramen)
Relation between petrous and sigmoid
sigmoid sinus continues beneath the petrous temporal bone as a continuation of transverse sinus
Which fracture may cause bleeding into pharynx
Fractures of the posterior cranial fossa may involve the basilar part of the occipital bone, which separates the pharynx from the posterior cranial fossa.
More lateral fractures can bleed into the back of the neck.
Formation of the margins of the orbit
The margins of the orbit are—
#Roof:
• frontal bone anteriorly
• lesser wing of sphenoid posteriorly.
#Lateral wall:
• frontal process of zygomatic bone
• zygomatic process of frontal bone.
#Floor:
• maxillary process of zygomatic bone laterally
• maxilla medially.
#Medial wall:
• frontal process of maxilla
• frontal bone
• lacrimal bone
• orbital PLATE of ethmoid bone
• BODY of the sphenoid.
Draining point of ophthalmic veins
Cavernous sinus
Structures passing through the inferior orbital fissure
• the infraorbital nerve, the major branch of the maxillary division of the trigeminal nerve
• veins draining orbital structures into the veins of the pterygopalatine fissure and infratemporal fossa.
Type of coat of orbit and parts
Fibro—Vasculo—Neural
F—sclera, cornea
V—choroid, ciliary body, iris
N—retina.
Relation of sclera with Neuro-Muscular structures
•It receives insertion of the extra-ocular muscles.
• Sclera is continuous posteriorly with the dural sheath of the optic nerve.
• Posteriorly the sclera is pierced by the optic NERVE 3 mm to the MEDIAL side OF the optical AXIS (posterior pole)
BECAUSE THEY HAVE TO CONVERGE TO FORM THE OPTIC CHIASMA
Components of ciliary body
Ring
Processes
Muscles
Layers of iris
Consists of four layers:
• anterior MESOthelial layer
• connective tissue stroma containing PIGMENT cells
• smooth MUSCLE: radial (dilator pupillae), circular (sphincter pupillae)
• posterior layer of PIGMENTED cells.
Layers of ratina
head neck spine
REMEMBER YOUR 10 FINGERS
palm facing up & right anterior to left one
Rt thumb inner limit. membrane
Lt thumb middle limit. membrane
Lt ring external limit. membrane
Lt little (innermost layer)—rods and cones
Lower 4 of remaining 6 fingers are for
Plexiform—Nuclear—Plexiform—Nuclear
Remaining 2 fingers are for
Nerve—Ganglion
Each layer of cells has a specific purpose, and the layers work together.It contains ten distinct layers of neurons.
The layers from front to the back are—
Inner limiting membrane: The innermost layer, which forms a smooth boundary against the vitreous humor
Nerve fiber layer: Contains retinal ganglion cell axons, astrocytes, and Muller cell processes
Ganglion cell layer: Contains ganglion cell bodies, which project axons that form the optic nerve
Inner plexiform layer: Where bipolar cell axons synapse onto ganglion cells
Inner nuclear layer: Contains the cell bodies of bipolar cells, horizontal cells, and amacrine cells
Middle limiting membrane: A layer of the retina
Outer plexiform layer: A layer of the retina
Outer nuclear layer: Contains photoreceptors (rods and cones)
External limiting membrane: A layer of the retina
Layer of rods and cones: A layer of the retina
#Other notes
*What is sinus venosus sclera
Canal of Schlemm
*hyaloid membrane and hyaloid canal
• Soft gelatinous substance vitreous humor contained within the hyaloid membrane.
• Hyaloid membrane passes forwards in front where it is thickened, receiving the attachments from the ciliary processes and giving rise to the suspensory ligament of the lens.It is a layer of collagen that separates the vitreous humor from the rest of the eye.
• The hyaloid canal (containing lymph) passes forwards through the vitreous from the optic disc as far as the capsule of the lens.
Connection of lens
• ciliary processes: approximately 70 folds arranged radially between the ciliary ring and the iris, and connected posteriorly to the suspensory ligament of the lens
Ora serrata is a part of what structure
Retina
Secretion and reabsorbtion of aqueous humor
Secreted into the posterior chamber and reabsorbed in Anterior chamber
Through which vessel and into what does absorbtion of aqueous humor take place?
Through canal of Schlemm
(sinus venosus sclerae).
Into ciliary veins
Through which vessel and into what does absorbtion of aqueous humor take place?
Through canal of Schlemm
(sinus venosus sclerae).
Into ciliary veins
Insertion of superior and inferior oblique
S—superomedially
I— inferolaterally
Muscle layer of eyelid
Upper —O. Oculi, levator p. Superioris
Lowe—O. Oculi
What is fenestra vestibuli of middle ear
(oval window): occupied by the
base of the stapes
What is fenestra cochleae
(round window): lies at the bottom
of a funnel-shaped depression behind the promontory; closed by the secondary tympanic membrane
Layers of tympanic membrane
three layers:
• outer stratified squamous epithelium
• middle layer of fibrous tissue
• inner mucous layer facing the tympanic cavity and continuous with the mucoperiosteum of the cavity.
What part of loose on tympanic membrane
Upper part
What part of Malleus is attached to tympanic membrane
handle attached to tympanic membrane
Connection of incus to other than Malleus
to the posterior wall by a short process
How do we damp high-frequency
vibrations
two muscles which serve to dampen high-frequency vibrations are associated with the ossicles:
• stapedius: attached to the neck of the stapes and supplied by the facial nerve
• tensor tympani: inserted into the handle of the malleus and supplied by the mandibular division of the trigeminal nerve.
Location of tubal tonsil with importance
Around Eustachian tubes nasopharyngeal opening
may swell with infection, blocking the tube and predisposing to middle ear infection.
Location of vestibular nerve
utricle, saccule and semicircular ducts
Distribution of cochlear nerve
organ of Corti in the cochlear duct.
function of the semicircular ducts
they tell you where you are going
function of the utricle and saccule
they tell you where you are.
component of the membranous labyrinth
utricle and saccule
semicircular canals
cochlea.
receptor of utricle and saccule
maculae
Receptor of semicircular canals
ampullary crests
Receptor of cochlea.
spiral organ of Corti
Transmission of sound
• sound waves set up vibrations in the tympanic membrane
• transmission occurs through the ossicles and the stapes is pushed backwards and forwards in the OVALl window, setting up vibrations in the perilymph
• these travel up the SCALA vestibuli (filled with perilymph) in the cochlea, through the helicotrema and down through the scala tympani to the secondary tympanic membrane.
• This sets up vibrations in the basilar membrane, and these are transformed into nerve impulses.
Openings
• Sphenoethmoidal recess: sphenoidal sinus.
• Superior meatus: posterior ethmoidal air cells.
• Middle meatus:
• bulla of ethmoid (middle ethmoidal air cells open
onto it)
• hiatus semilunaris: receives infundibulum of frontal
sinus and anterior ethmoidal air cells in front and
maxillary ostium behind.
• Inferior meatus: nasolacrimal duct.
• Olfactory:
• superior concha
• upper part of middle concha
• corresponding part of septum
• roof of nose.
• Respiratory:
• lines remainder of nasal cavity.
follows:
• olfactory region: columnar epithelium
• respiratory region (and paranasal sinuses): columnar
ciliated epithelium with mucous cells
• vestibule: stratified squamous epithelium.
• Upper part of nasal cavity: ethmoidal branches of oph-
thalmic artery.
• Lower part of nasal cavity: sphenopalatine branch of
maxillary artery.
• Septal branch of facial artery anastomoses with sphe-
nopalatine branch of maxillary artery on the anteroin-
ferior part of septum (Little’s area); nosebleeds occur
from this area.
• Venous drainage:
• downwards into facial vein
• backwards to ethmoidal tributaries of ophthalmic
veins, and hence ultimately to cavernous sinus.
• Largest of the paranasal sinuses.As the ostium is
high on the wall, drainage depends on ciliary action and
not gravity.
the sinus via the inferior meatus of the nasal cavity.
itis the anterior bony wall of the maxillary sinus is
removed, the mucosa is stripped and a permanent
drainage hole is made into the nose through the infe-
rior meatus.
• The maxillary division of the trigeminal nerve via infra-
orbital and superior dental nerves. Pain due to sinusitis
may often manifest itself as toothache.
• Absent until end of first year.
Origin
• Anterior two-thirds of lower border of zygomatic arch,
posterior third of lower border and whole of deep sur-
face of arch.
Insertion
• Outer surface of ramus of mandible from mandibular
notch to angle.
tal, retract the jaw
muscles for molar teeth grinding.
hyaline), and there is also a fibrocartilaginous articu-
lar disc dividing the joint cavity into upper and lower
compartments
• elevation: masseter, temporalis, medial pterygoid
• depression: lateral pterygoid ?????? How together with digastric,
mylohyoid and geniohyoid; gravity also allows the jaw
to open during sleep
• retraction: posterior fibres of temporalis
• protraction (protrusion): lateral pterygoid???? How
• side-to-side: lateral and medial pterygoids together, act-
ing alternately on each side.
tion, where the condyloid process of the mandible slides
forwards onto the articular eminence and then into the
infratemporal fossa. This can be reduced by pressing
down the mandible on the molar teeth to stretch the
masseter and temporalis which are in spasm and then
pulling up the chin to lever the condyle back into the
mandibular fossa. BEWARE OF THUMBS
• Formed by the mylohyoid, which separates the oral cav-
ity from the neck.
• Mylohyoid muscles of both sides meet along a midline
raphe.
• Mylohyoids are reinforced SUPERIORLY by geniohyoids.
the hyoglossus muscle.
• A number of important structures in the floor of
the mouth lie on hyoglossus. These are, from above
downwards:
• lingual nerve
• deep part of submandibular gland and submandibu-
lar duct
• hypoglossal nerve.
nerve lies against the periosteum of the alveolar process
closely related to the third molar tooth. The nerve can
be damaged here during dental extraction
• Descends between internal jugular vein and internal carotid artery.
• Supplies the superior limb of the ansa cervicalis (C1) to
innervate the infrahyoid muscles.
• On hyoglossus, breaks up into branches to supply all
muscles of the tongue except palatoglossus.
• Buccal and pharyngeal parts separated by V-shaped
groove, sulcus terminalis, at the apex of which is the
foramen caecum.
• Larger vallate papillae lie immediately in front of sulcus
terminalis.
Papillae carry
taste buds.
Posterior third has no papillae but has numerous lym-
phoid nodules
verse; they alter the shape of the tongue.
• genioglossus: protrudes the tongue
• styloglossus: retracts the tongue
• hyoglossus: depresses the tongue.
relatively avascular plane.
Also little cross-communication of lymphatics between drainage of two
sides of tongue in ANTERIOR 2/3.
extensive cross-communication, therefore tumours may
spread to contralateral nodes.
• Anterior two-thirds: sensory supply from lingual
branch of cranial nerve V. Taste fibres pass in lingual
nerve (from chorda tympani of cranial nerve VII).
• Posterior third: sensation and taste (including vallate
papillae) from nerve IX.
• Motor supply from the hypoglossal nerve, except for
palatoglossus.
tongue on the same side. Deviation to the paralysed side
on protrusion.
• In the unconscious patient, when the tongue has dropped
back, causing laryngeal obstruction, pushing the mandi-
ble forwards by pressure on the angle of the jaw on each
side will pull the tongue forwards with the jaw, owing to
attachment of genioglossus to the lower jaw.
Type of parotid gland
(Serous
Relation of mandible/masseter to the largest salivary gland
They lie anteriorly
muscles of styloid process
Ppt
Exercises
Stretch
Pain
Mri
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The styloid process of the temporal bone gives rise to three muscles: the stylohyoid, stylopharyngeus, and styloglossus:
Stylohyoid: Attaches to the hyoid bone
Stylopharyngeus: Attaches to the pharyngeal wall
Styloglossus: Attaches to the APEX of the tongue, and helps draw up the sides of the tongue to help with swallowing
These muscles work together to lift the aerodigestive tract upward and backward. The styloid process also helps move the tongue, pharynx, larynx, hyoid bone, and mandible.
Structures Traversing the parotid gland from superficial to deep
• facial nerve
• retromandibular vein
• external carotid artery, dividing into the superficial temporal and maxillary branches.
Another name of parotid duct
Stensen’s Duct
Most vulnerable division of trigeminal nerve and the reason behind it
• The mandibular division is the longest, thinnest and therefore most vulnerable branch.
Type of Submandibular Gland
Mixed Serous and Mucous Gland
What separates parotid gland from Submandibular gland
stylomandibular ligament.
Another name of Submandibular duct with its opening
Wharton’s duct
It runs forwards and opens at the side of the frenulum of the tongue.
Relation of Wharton’s shifts with lingual nerve
It is crossed from superficial to deep by the lingual nerve, which passes from the lateral side of the duct, below and then medial to it; it ‘double-crosses’ it.
To avoid the mandibular branch of the facial nerve during incision for Submandibular gland
the incision to
approach the gland should be made more than 2.5 cm below the angle of the mandible.
Palpation of Submandibular gland
• The gland (and a stone in the duct) can be palpated bimanually in the floor of the mouth
Type of The Sublingual Gland
(Mucous
Unique opening of sublingual and
• Opens separately into the floor of mouth by a series of ducts.
• Part of it also opens into the submandibular duct.
Clinical importance of external jugular vein divided just above the midpoint of the clavicle
• External jugular vein pierces the investing fascia below omohyoid, just above the midpoint of the clavicle (if the vein is divided here, the DEEP fascia holds it open, air is drawn into the veins on inspiration and air embolism
occurs).
Division of deep fascia of neck
Deep fascia, which is divided into a further three layers:
• investing layer (enveloping)
• prevertebral fascia
• pretracheal fascia.
What fascia forms a base upon which the pharynx, oesophagus and carotid sheath
Prevertebral Fascia upon which the pharynx, oesophagus and carotid sheath slide in swallowing and neck movements.
Extension of Pretracheal Fascia with function
• Extends from hyoid bone above to fibrous pericardium below.
• Encloses larynx, trachea, pharynx, oesophagus and thyroid gland.
Why there is asymmetrical consistency of carotid fascia
Carotid Sheath
• Separate tube of fascia, strong over carotid arteries and weak over jugular vein (to allow for expansion of latter).
Contents of carotid seath
• carotid artery
• internal jugular vein
• vagus nerve.
In which triangle of neck deep cervical lymph nodes are
Anterior
The anterior triangle can be further divided into smaller triangles named as—
• submental
• submandibular
• carotid
• muscular.
Function of suprahyoid and infrahyoid
The suprahyoid muscles:
• elevate the hyoid and pull it forwards during swallowing.
The infrahyoids
•are active in opening the mouth against resistance.
The suprahyoids consist of:
• stylohyoid
• mylohyoid
• digastric
• geniohyoid.
Infrahyoids consist of:
• sternohyoid
• sternothyroid
• thyrohyoid
• omohyoid.
Boundary of supraclavicular triangle
Middle third of clavicle
Posterior belly of omohyoid
Posterior border of sternocleidomastoid
What are strap muscles and their nerve supply
• The infrahyoids
•supplied by the ansa cervicalis (C1, 2, 3)
Which vessel is related to Ansa cervicalis with its root value
It is a nerve loop on the internal jugular vein. C123
Importance of Ansa cervicalis to goitre surgery
• The branches enter the muscles in their lower half; therefore, during exposure of a large goitre, the strap muscles are cut in their upper half to preserve the nerve supply from the ansa cervicalis.
Level of bifurcation of common carotid artery
at the upper border of the thyroid cartilage (level of third cervical vertebra).
Which structures separate external and internal carotid arteries
• styloid process
• stylopharyngeus muscle
• glossopharyngeal nerve
• pharyngeal branch of vagus.
branches of the external carotid artery
• superior thyroid artery
• lingual artery
• facial artery
• occipital artery
• posterior auricular artery
• ascending pharyngeal artery
• maxillary artery
• superficial temporal artery.
Which vein is related to deep cervical chain
• The deep cervical chain of lymph nodes is found along the internal jugular vein.
So
• In block dissection of the neck, the internal jugular vein is removed to facilitate removal of the nodes.
What lies behind the gap between the sternal and clavicular heads of sternocleidomastoid
• At the root of the neck, the internal jugular vein lies behind the gap between the sternal and clavicular heads of sternocleidomastoid.
Termination of internal jugular vein
• The vein terminates by joining the subclavian vein to form the brachiocephalic vein.
Internal jugular vein cannulation
• Usually carried out on right side as the right vein is in a straight line with the right brachiocephalic vein and superior vena cava.
• High approach: vein is palpated lateral to common carotid artery pulsation deep to anterior border of sternocleidomastoid at the level of C6 vertebra.
• Low approach: the needle is inserted near the apex of the triangular gap between the sternal and clavicular heads of the sternocleidomastoid.
Level of thyroid isthmus
overlying second and third tracheal rings
Level of lateral thyroid lobes
extending from lateral aspect of thyroid
cartilage to level of sixth tracheal ring
Relation of vessels and nerves of thyroid
• Care must be taken in dividing the superior thyroid
artery (close to the gland, to avoid the external branch
of the superior laryngeal nerve) and the inferior thyroid
artery (far away from the gland, to avoid the recurrent
laryngeal nerve).
The intravertebral foramina transmit the segmental spi-
nal nerves as follows:
• C1–7 pass over the superior aspects of their corre-
sponding cervical vertebrae
• C8 passes through the foramen between C7 and T1
• all subsequent nerves pass between the vertebra of
their own number and the one below.
Vertebral artery
(artery does not pass
through the foramen of the seventh cervical vertebra)
Spines of cervical vertebra
Spines small and bifid, except C1 and C7, which are
single.
(odontoid process
(represents the detached centrum
of C1)
Agreement vs disagreement
• nodding (agreement) and lateral flexion occur at the
atlanto-occipital joint
• rotation of the skull (disagreement) occurs at the
atlantoaxial joint
commonest sites of vertebral injury.
the cervi-
codorsal and dorsolumbar junctions Movement of the spine occurs particularly at these junctions
‘slipped disc’. Mechanism
posterior part of the annulus fibrosus ruptures (owing to relatively thin) & then the nucleus pulposus protrudes posteriorly into the vertebral canal or intervertebral foramen mostly passes lateral to the posterior longitudinal ligament (paracentral disc) causing compression of the transiting nerve root
Commonest site for ‘slipped disc’
L4/5, L5/S1, or in
the neck C5/6 or C6/7.
What is sciatica
• Prolapsed L4/5 disc produces pressure on the root of L5 nerve and that of L5/S1 on S1 nerve. Pain is referred to the back of the leg and foot along the distribution of the sciatic nerves (sciatica).
• With L5 lesion there will be weakness of ankle dorsiflex-
ion and big toe extension. There will be numbness over
the lower and lateral part of the leg and medial side of
the foot.
• With S1 lesion ankle jerk may be diminished or
absent, there will be weakness of the evertors of the
foot and there will be numbness over the lateral side
of the foot.
What is cauda equina syndrome.
• Direct posterior prolapse of the disc (central disc pro-
lapse) may compress the cauda equina, giving rise to
cauda equina syndrome.
• Cauda equina syndrome causes compression of the
sacral outflow, saddle paraesthesia, reduced anal
sphincter tone, reduced bladder coordination, painless
retention and overflow, loss of anal reflex and bilateral
leg symptoms. It is a surgical emergency.
Termination of external carotid artery
• Upper part of artery enters parotid gland, where it
divides into its two terminal branches, the maxillary
artery and the superficial temporal artery.
The branches of the external carotid artery
• superior thyroid artery
• lingual artery
• facial artery
• occipital artery
• posterior auricular artery
• ascending pharyngeal artery
• maxillary artery
• superficial temporal artery.
Optic canal belongs to which cranial fossa
Middle
Internal auditory meatus belongs to which cranial fossa
Posterior
Blood supply of parathyroid glands
Posterior branches of superior and inferior thyroid arteries
How to avoid damaging recurrent laryngeal nerve
If ligation of interior thyroid artery is required then do it more laterally
Result of damage to the superior laryngeal nerve
Hoarse voice
results in a change of pitch of the voice owing to loss of innervation of cricothyroid muscle, which is a tensor of the vocal cord.
Visual identifier of false vocal cords
They are RED and wide apart
Color of true vocal cord
Pearly WHITE
Lymphatic Drainage of palatine tonsils and importance
• To the jugular digastric lymph node situated behind the angle of the mandible.
• This node is often palpable in chronic tonsillitis.
Relation of Sibson’s Fascia with Subclavian artery, subclavian vein and brachial plexus
They lie on suprapleural membrane.
Stellate Ganglion and its importance
• First thoracic ganglion frequently fuses with the inferior cervical ganglion to form the stellate ganglion.
• The stellate ganglion lies at the root of the NECK against the NECK of the first rib.
• Damage to the stellate ganglion or invasion of it in a Pancoast tumour will result in Horner’s syndrome:
• constriction of the pupil
• SLIGHT ptosis
• anhidrosis on the side of the lesion.
What is Troisier’s sign
Virchow’s node associated with intra-
abdominal malignancy
Mechanism of L5 root compression and manifestation
•Prolapsed L4/5 disc produces pressure on the root of L5 nerve
• With L5 lesion there will be weakness of ankle dorsiflexion and big toe extension. There will be numbness over the LOWER and LATERAL part of the LEG and MEDIAL side of the FOOT.
Mechanism of S1 root compression and manifestation
•Prolapsed L5/S1 disc
• With S1 lesion ankle jerk may be diminished or absent, there will be weakness of the evertors of the
foot and there will be numbness over the LATERAL side of the FOOT.
