Anatomy Head, neck and spine Book Flashcards
Layers of scalp
Skin
Connective tissue
Aponeurosis- tendinous of epicranial muscles
Loose areolar tissue- potential spaces for infection or blood
Pericranium- held firmly to skull
Branches of external carotid
Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Superficial temporal
Maxillary
some anatomist love fish other prefer sausage and mash
Where does the facial nerve leave the skull
Stylomastoid foramen
What leaves through foramen spinosum
Middle meningeal artery
Meningeal branch of mandibular
What passes through foramen Magnus
Medulla
Anterior and posterior spinal arteries
Dural veins
Spinal root of XI
Vertebral arteries
Subdivisions of triangles of neck
Anterior
Submental
Submandibular
Carotid
Muscular
posterior
Occipital
Supraclavicular
Borders of muscular triangle
Superiorly – hyoid bone.
Medially – imaginary midline of the neck.
Supero-laterally – superior belly of the omohyoid muscle.
Infero-laterally – inferior portion of the sternocleidomastoid muscle.
Contents of muscular triangle
Infrahyoid muscles -omohyoid, thyrohyoid, sternothyroid, sternohyoid
Thyroid
Parathyroid
Fascia levels in the neck
Superficial
Superficial Cervical Fascia- blends in with platysma
Deep
Investing -splits in 2 surrounding SCMand trapezius
Pretracheal - infrahyoid muscles then another layer with tracheal thyroid, para, oesophagus and vessels and nerves
Prevertebral - vertebrae and posterior neck muscles
Carotid- carotid arteries, internal jugular, and vagus
Suprahyoid muscles
Stylohyoid- superifical to diagastric
Digastric- superficial to mylo
Mylohyoid- forms floor
Geniohyoid-deep to the mylohyoid muscle
Carotid triangle boundaries
Superior – posterior belly of the digastric muscle.
Lateral – medial border of the sternocleidomastoid muscle.
Inferior – superior belly of the omohyoid muscle.
Contents of carotid triangle
Common carotid- which bifurcates within
Internal jugular vein
Hypoglossal
Vagus nerves
Boundaries of submental triangle
Inferiorly – hyoid bone.
Medially – midline of the neck.
Laterally – anterior belly of the digastric
Contents of submental triangle
Mylohyoid as floor
Submental lymph nodes
Boundaries of submandibular triangle
Superiorly – body of the mandible.
Anteriorly – anterior belly of the digastric muscle.
Posteriorly – posterior belly of the digastric muscle.
Contents of submandibular triangle
Submandibular gland
Lymph nodes
Facial artery and vein
Borders of occipital and subclavian triangle
Divided by omohyoid
Content of posterior triangle
Nerves
Accessory nerve
Phrenic nerve
Three trunks of the brachial plexus
Branches of the cervical plexus: Supraclavicular nerve, transverse cervical nerve, great auricular nerve, lesser occipital nerve
Vessels
External jugular vein
Subclavian artery
Muscles
Inferior belly of omohyoid
Scalene
Lymph nodes
Supraclavicular
Occipital
Bones forming pterion
Frontal
Sqaumous temporal bone
Sphenoid greater wing
Parietal
What structures to go through on an LP
L3/4 or L4/5
Suprapsinous
Interspinous
Ligamentum flavus
Dura and arachnoid mater
Contents of cavernous sinus
Medial to lateral
Internal carotid
Abducens
Oculomotor, trochlear superior lateral border V1, V2 infeiror lateral border
Sx of cavernous sinus thrombosis
Painful
Oedematous eye
Ipsilateral
Internal and external ophthalmoplegia with papilodema
Palsies
Can go from one sinus to next
Branches of subclavian artery
First - vertebral, internal thoracic, thyrocevical
Second - costocervical trunk
Third- dorsal scapular
Bones making up zygomatic arch
Temporal
Zygomatic
Maxilla
Fracture of zygomatic arch can damage
Zygomatic branch of facial nerve
Signs of longitudinal temporal bone fracture
Can affect vestibulocochelar and facial nerve
Parallel to long axis of petrous bone- most common
Tear of tympanic membrane
CSF otorrhoea
Facial nerve palsy
Conductive hearing loss
Signs of transverse temporal fracture
Usually cochlear or vestibular damage
Vertigo and SN hearing loss
Differentials of neck lumps
Cystic hygroma- left posterior
Cysts- fluctuant (sign it contains fluid)
Lymph nodes- non fluctuant
What forms external jugular
Retromandibular(formed by superfiical temporal and maxillary) and post auricular
Branches from posterior external and transverse cervical
External jugular in relation to scales anterior
Anterior
Most common site for cervical fracture
C7/T1
Types of cervical fractures
Clay Shoveler- spinous process of C6/7
Hangman - both peduncles of C2
Jefferson- burst C1-ant and post arch
Where caudal equine begins
L1
Middles meningeal artery forms from
Which branch is affected by pterion
Maxillary artery
Anterior
Relations of parotid gland
Superior - external acoustic meatus and temporalmandibular joint
Inferior - diagastric posterior belly
Medial - styloid
Anterior - masseter
Structures transversing parotid
Facial nerve
Retromandibular vein
External carotid
Fascia of parotid
Investing
Where duct of parotid comes out
Comes out anteriorly, running on lateral surface of master and pierces buccinator opposite second molar
Relations of sublingual gland and drainage
Bordered laterally by the mandible and medially by genioglossus
The submandibular duct and lingual nerve pass alongside the medial aspect of the sublingual gland.
Both glands (forms sublingual fold) unite around frenulum
Secretions drain into the oral cavity by minor sublingual ducts (of Rivinus)- then join submandibular to Sublingual papillae openiing
Blood supply of thyroid
Superior and inferior
Superior- branch of external
Inferior- thyrocevical trunk- from subclavian
Floor and roof of posterior triangle
Roof- investing facia, platysma
Floor- prevertebral fascia
Infratemporal boundaries
Lateral – condylar process and ramus of the mandible bone
Medial – lateral pterygoid plate; tensor veli palatine, levator veli palatine and superior constrictor muscles
Anterior – posterior border of the maxillary sinus
Posterior – carotid sheath
Roof – greater wing of the sphenoid bone
Floor – medial pterygoid muscle
Pretracheal fascia relation to strap muscles and level it runs to
Superficial and deep
From hyoid to arch of aorta
Deep investing fascia attachments
Mastoid
Superior nuchal line
Zygomatic process
Manidble
Manubrium
Clavicles
Scapulae spine
Acromion
Which structures does the deep investing fasciae envelop
SCM
Trapezius
Parotid
What does prevertebral fascia envelop and where does it run
Levator scapula
Scalenus
Subclavian artery
Skull to T3
Becomes axillary sheath inferior to clavicle
Which tracheal rings does thyroid overly
2-3rd by isthmus
Lateral from thyroid cartilage to 6th ring
What does isthmus lie deep to
Anterior jugular veins
Usually ligated with tracheostomy
Which nerves can be damaged in thyroid surgery
When ligating inferior thyroid artery- risk of damage to recurrent laryngeal
Hence why it is ligated far away from gland
Superior thyroid artery ligated more proximal
External branch of superior laryngeal
Supplies cricothyroid
Lies deep to upper pole of gland
Which nerve supplies internal carotid
IX- baroreceptors
Where does internal carotid enter skull
Carotid canal in petrous temporal bone
Branches of internal carotid
Terminal- anterior, middle cerebral and posterior communicating
Ophthalmic- which gives off central retinal which is sole course of retina
No branches before entering skull
What does the internal carotid pass deep to and which structure separates it from external at base of skull
Posterior digastric
Styloid process
Where does the pyramidal lobe of thyroid usually lie
Left of isthmus
Lymphatic drainage of tongue
Tip to submental
Anterior 2/3- submental and submanidibular - poor crossover
Posterior 1/3- deep cevical- rich midline anastomosis- increased likelihood of contralateral mets
Sensory supply of ear
Upper lateral half of pinna- auriculotemporal (branch of V3)
Upper medial - lesser occipital (C2)
Lower-greater auricular
EAM- aurculotemporal, facial, vagus
Lateral tympanic membrane- “”
Medial tympanic membrane- facial and glossopharyngeal
Where does larygopharynx run from and to
Extends from tip of epiglottis to termination of pharynx at C6
Innervation of larynx
Recurrent laryngeal nerve – provides sensory innervation to the infraglottis, and motor innervation to all the internal muscles of larynx (except the cricothyroid).
Superior laryngeal nerve – the internal branch provides sensory innervation to the supraglottis, and the external branch provides motor innervation to the cricothyroid muscle.
Blood supply of larynx
Superior laryngeal artery – a branch of the superior thyroid artery - follow superior laryngeal int branch
Inferior laryngeal artery – a branch of the inferior thyroid artery- follows recurrent
Sections of larynx
Supraglottis – From the inferior surface of the epiglottis to the vestibular folds (false vocal cords).
Glottis – Contains vocal cords and 1cm below them. The opening between the vocal cords is known as rima glottidis, the size of which is altered by the muscles of phonation.
Subglottis – From inferior border of the glottis to the inferior border of the cricoid cartilage.
Muscles of larynx
Cricothyroid
Thyroarytenoid
Posterior cricoarytenoid
Lateral cricoarytenoid
Transverse and Oblique Arytenoids
Superficial veins of head and neck
Superficial temporal and maxillary form retromandibular (anterior and posterior)
RMp+ posterior auricular- external jugular
RMa + facial- common facial into internal
External jugular level in fascia and to SCM
Within superficial fasciae
Superficial to SCM
Crosses roof of posterior triangle to enter deep cervical fascia just above clavicle to join subclavian
Where do the anterior jugular veins drain
Lie either side of midline
Pass from medial to lateral over internal jugular vein to join external
Drainage of paranasal sinuses
Sphenoid - sphenoethmoidal recess (above superior conchae)
Frontal - middle meatus anteriorly at semilunar hiatus
Maxillary - middle meatus posteriorly
Ethmoid - superior and middle meatus
Nasolacrimal - inferior meatus (below inferior turbinate)
Muscles causing movements of the jaw
Elevation - masseter, temporalis, medial pterygoid
Depression - mylohyoid, geniohyoid, lateral pterygoid
Protraction - pterygoids together
Side to side - pterygoids together but one per side
Retraction- temporalis
Number of vertebrae total
33
C1 characteristics
Atlas
No vertebral body and no spinous process.
Instead, the atlas has lateral masses which are connected by an anterior and posterior arch.
transverse ligament of the atlas – which attaches to the lateral masses.
C2 characteristics
Axis (C2) is easily identifiable due to its dens (odontoid process)
Cervical vertebrae characteristics
Triangular vertebral foramen.
Bifid spinous process – this is where the spinous process splits into two distally.
Transverse foramina – holes in the transverse processes. They give passage to the vertebral artery, vein and sympathetic nerves.
C7- vertebrae prominens
Transverse process is commonly absent
Embryological derivatives of parathyroid glands
Superior- 4th brachial arch
Inferior- 3rd develop with thymus
Location of parathyroid glands
Superior- located at the middle of the posterior border of each thyroid lobe, approximately 1cm superior to the entry of the inferior thyroid artery into the thyroid gland.
Inferior- inconsistent in location between individuals, the inferior parathyroid glands are usually found near the inferior poles of the thyroid gland.
What % of parathyroid glans are aberrant
10%
Structures that pass through superior orbital fissure from superior to inferior
Lacrimal artery
Lacrimal nerve- V1
Frontal - V1 (superior opthalmic vein)
Trochlear
Superior branch of oculomotor
Nasociliary - V1
Inferior branch of oculomotor
Abducens
Inferior opthalmic vein
Borders of orbit
Roof (superior wall) – Formed by the frontal bone and the lesser wing of the sphenoid. The frontal bone separates the orbit from the anterior cranial fossa.
Floor (inferior wall) – Formed by the maxilla, palatine and zygomatic bones. The maxilla separates the orbit from the underlying maxillary sinus.
Medial wall – Formed by the ethmoid, maxilla, lacrimal and sphenoid bones. The ethmoid bone separates the orbit from the ethmoid sinus.
Lateral wall – Formed by the zygomatic bone and greater wing of the sphenoid.
Contents of optic canal
Optic nerve
Ophthalmic artery
Contents of inferior orbital fissure
Transmits the zygomatic branch of the maxillary nerve
The inferior ophthalmic vein
Sympathetic nerves.
Ophthalmic artery in relation to optic nerve
First branch of internal carotid
Inferior lateral to it when entering orbit
Spiral around to lie lateral
Then over the top to medial- provide branches
Why does infection spread easily from orbit to cavernous sinus
No valves in orbital veins
Pathway of ethmoid arteries
Branches of ophthalmic artery
Accompany branches of nasocilliary
Exit by medial wall ethmoid foramen-anterior and posterior
Borders of tympanic cavity
Roof – formed by a thin bone from the petrous part of the temporal bone-tegmen tympani
Floor – known as the jugular wall, it consists of a thin layer of bone, which separates the middle ear from the internal jugular vein
Lateral wall – made up of the tympanic membrane and the lateral wall of the epitympanic recess.
Medial wall – formed by the lateral wall of the internal ear. It contains a prominent bulge, produced by the facial nerve as it travels nearby.
Anterior wall – a thin bony plate with two openings; for the auditory tube and the tensor tympani muscle. It separates the middle ear from the internal carotid artery.
Posterior wall (mastoid wall) – it consists of a bony partition between the tympanic cavity and the mastoid air cells.
What is contained in tympanic cavity and eptympanic recess
Tympanic- malleus, incus and stapes.
Medial to tympanic membrane
Etympanic- superior to the tympanic cavity, which lies next to the mastoid air cells. The malleus and incus partially extend upwards
Muscles of middle ear and innervation
The tensor tympani- originates from the auditory tube (anterior wall) and attaches to the handle of malleus, pulling it medially when contracting.
It is innervated by the tensor tympani nerve, a branch of the mandibular nerve.
The stapedius muscle attaches to the stapes, and is innervated by the facial nerve.
Nerve supply of Eustachian tube
Glossopharyngeal
Connection between mastoid air cells and middle ear
Aditus
Connections of ossicles
Connected to each other by synovial joints
Malleus connected to tympanic membrane
Stapes- adherent to oval window
Parts of malleus and positions
Head - within tympanic recess
Handle- attached to tympanic membrane in cavity
Infrahyoid strap muscles
Sternothyroid
Sternohyoid
Thyrohyoid
Omohyoid
Layers going through to do a tracheostomy
Skin
Superficial fascia
Platysma
Investing fascia
Strap
Pretracheal fascia
Thyroid isthmus
Trachea
Vertebral levels of cartilage in larynx, hyoid bone and epiglottis
Hyoid- C3
Thyroid- upper C4
Cricoid- C6
Epiglottis- C3
Arytenoid- C5
Content of posterior triangle
Occipital
Transverse cervical
Subclavian
Suprascauplar arteries
Accessory nerve
Brachial and cerivcal plexus
Suprascapular and external jugular veins
Branches of V1
Frontal
Nasociliary
Lacrimal
Frontal - supraorbital, supratrochlear
Upper eyelid, conjunctiva, forehead
Supraorbital- lateral
Lacrimal- Sensory innervation of lacrimal gland, upper eyelid and conjunctiva
Contains parasympathetic fibres to lacrimal gland from V2
Nasociliary
Ant ethmoid- frontal, ethmoid, sphenoid and nasal cavity
Post ethmoid- sphenoid sinus absent in 30%
Infratrochlear - bridge of nose and upper eyelid
Long ciliary - eye (contains symp)
Where does a pharyngeal pouch form
Between thyropharyngeus and cricopharyngeus
Killisin dehiscence
Level external carotid is formed
C4
Which veins communicate between face and cavernous sinus
Anterior facial
Ophthalmic
What forms from 1st brachial arch
Muscles
Muscles of mastication
Anterior belly of digastric
Mylohyoid
Tensor tympanic
Tensor veli palatini
Nerve
Mandibular
Artery
Maxillary
External carotid
Maxilla
Meckels cartilage
Incus
Malleus
What forms from 2nd brachial arch
Muscles
Buccinator
Platysma
Muscles of facial expression
Stylohyoid
Posterior belly of digastric
Stapedius
Nerve
Facial
Stapes
Styloid process
Lesser horn and upper body of hyoid
Arteries
Inferior branch of superior thyroid artery
Stapedial artery
What forms from 3rd brachial arch
Muscles
Stylopharyngeus
Nerves
Glossopharyngeal
Greater horn and lower part of hyoid Thymus
Inferior parathyroids
Arteries
Common and internal carotid
What forms from 4th brachial arch
Cricothyroid
All intrinsic muscles of the soft palate
Nerves
Vagus
Thyroid and epiglottic cartilages Superior parathyroids
Right- subclavian artery, Left-aortic arch
What forms from 6th brachial arch
All intrinsic muscles of the larynx (except cricothyroid)
Cricoid, arytenoid and corniculate cartilage
Nerve
Vagus and recurrent laryngeal nerve
Right -Pulmonary artery
Left- Pulmonary artery and ductus arteriosus
What forms posterior fossa of cranium
Anteriorly
Petrous bone laterally
Sphenoid bone medially
Occipital forms floor
Contents of posterior fossa
Foramen magnum
Jugular foreamen
Hypoglossal canal
Internal acoustic meatus
Condylar canal -the occipital emissary vein
Internal occipital protuberance in mid line
Contents of middle fossa
Optic canal
Superior orbital fissure
Foramen rotundum
Ovale
Spinous
Lacerum
Carotid canal
Hiatus of greater petrosal nerve
What forms posterior cerebral arteries
Basillar
After vertebral join together
Apex and floor of posterior triangle
Apex- occipital bone just posterior to mastoid
Base- middle 1/3 clavicle
Where does accessory enter posterior triangle
Junction of superior and middle 1/3 of SCM
Branches of axillary artery
1- superior thoracic
2nd part- thoracromical
Lateral thoracic
3rd part- Ant and post circum, subscapularis
Where does inferior thyroid artery originate from
Thyrocervical trunk
1st part of subclavian
Veins of thyroid
Superior and middle-to internal jugular
Inferior veins - brachiocephalic
Thyroid ima artery location and prevalence
Ascends on the anterior surface of the trachea and supplies both the trachea and thyroid
10%
Which tracheal rings does thyroid overly
2-4th
Facial vein pathway
Descends from lateral border of nose
To inferior border of mandible
Sensory supply of parotid
Auriculotemporal nerve (gland) and the great auricular nerve (fascia)
Parotid capsule is a continuation of
Deep investing fascia
Symptoms of middle meningeal damage
Oculomotor compressed against petrous part of temporal
Autonomic fibres are superficial and cause dilation
Which foramen does the internal carotid pass across
Lacerum
Risks if superior laryngeal nerve is damaged
Increased aspiration risk due to lack of sensation superior to vocal cords
Actions of muscles of larynx
Posterior cricoarytenoid- abducts
Lateral cricoarytenoid- adducts
Transverse arytenoid- adductor
Thyroaretenoid- relaxes
Cricothyroid- stretches and tenses
Pharynx extends from and to
Base of skull to inferior border of cricoid at C6
Which fasciae does the pharynx lay against posteriorly
Prevertebral
Which pharyngeal pouch are palatine tonsils derived from
2nd
Where do palatine and adenoids lie
Palatine- between palatoglossal and palatopharyngeal arch
Adenoid- mucous membrane of roof and posterior wall of nasopharynx
Blood supply of tonsils
Tonsillar branch of facial
Paratonsillar vein- risk of damage cause of bleeding
What passes through jugular foramen
CN IX, X, XI
Internal jugular
Meningeal branch of occipital and pharyngeal artery
Damage to what structure causes CSF to leak out the ear
Tegmen tympani
Patient hit in vertex what structure most likely damaged
Sup Sagittal vein
Vertex (highest point in head)
