Cervical region,face neck,temporal and infratemporal Flashcards
Hyoid bone components and function
- Mobile
- Level of C3
- Greater and lesser cornu/horns
- Serves as an attachment for anterior neck muscles and a prop to keep airway patent
Superficial cervical fascia components
Subcutaneous tissue of the neck between dermis and deep cervical fascia layer
contains the
Cutaneous nerves, blood and lymph vessels, fat
Platysma component,innervation, and function
Thin, superficial muscle of facial expression CN VII(Facial nerve)
Depresses mandible, tenses skin of inferior face and neck
Deep cervical Facia components and function
Three fascial layers
Investing
Pretracheal
Prevertebral
Allows for structures to smoothly slide past each other
Allows for separation of structures during surgery
Supports viscera, muscles, vessels and deep lymph nodes
Investing layer components and functions
Surrounds entire neck-deep to the skin and subcutaneous tissue
Encloses sternocleidomastoid muscles and trapezius muscles
Pretracheal layer components and function
*Muscular part
Infrahyoid muscles
*Visceral part
Encloses thyroid gland/parathyroid, trachea, esophagus
*Carotid sheath
Common and internal carotid arteries
Internal jugular vein
Vagus nerve
Carotid sinus nerve (from the glossopharyngeal nerve)
Sympathetic fibers (carotid periarterial plexuses)- but NO cervical ganglion/trunk
Role with infections and extravasated blood
Prevertebral layer components
Tubular sheath for the vertebral column and the muscles associated with it
Longus colli, longus capitis
Scalenes
Deep cervical muscles
Retropharyngeal space components
Potential space between the visceral part of the prevertebral layer and the buccopharyngeal fascia
Permits movement of pharynx, esophagus, larynx, trachea relative to the vertebral column during swallowing
A major pathway for the spread of infection
Sternocleidomastoid (SCM)(Clavicle head and sternal head)
Function and innervation
Spinal Accessory Nerve (CN IX) for motor; C2/C3 for pain/ proprioception.
Unilateral: laterally flexes neck turning face superiorly toward the opposite side; bilateral: extends neck at atlanto-occipital joints, flexes cervical vertebrae so chin approaches manubrium, or extends superior cervical vertebrae while flexing inferior vertebrae so chin is thrust forward with head keep level; assists in deep respiration
Occipitofrontalis innervation and function
Elevates eyebrows, wrinkles skin of the forehead, muscle of facial expression
Facial nerve(CN7)
Hyoid Muscles function
Steady or move the hyoid bone and larynx, as a whole, either more cephalad or caudal
Muscles of Anterior Cervical Region(Extrinsic Muscles of Larynx
Suprahyoid Muscles
Mylohyoid function and innervation
branch of CN V3
Elevates hyoid, floor of mouth, and tongue with swallowing and speaking
Muscles of Anterior Cervical Region(Extrinsic Muscles of Larynx
Suprahyoid Muscles
Geniohyoid function and innervation
C1 via hypoglossal nerve (CN XII)
Pulls hyoid anterosuperior; shortens floor of mouth; widens pharynx
Muscles of Anterior Cervical Region(Extrinsic Muscles of Larynx
SpraHyoid Muscles
Stylohyoid function and innervation
Stylohyoid branch of facial nerve (CN VII)
Elevates and retracts hyoid, thus elongating floor of mouth
Muscles of Anterior Cervical Region(Extrinsic Muscles of Larynx
Suprahyoid Muscles
Digastric function and innervation
Anterior belly: nerve to mylohyoid, branch of CN V3
Posterior belly: digastric branch of facial nerve (CN VII
Working with infrahyoid muscles, depresses mandible; elevates and steadies hyoid with swallowing and speaking
Muscles of Anterior Cervical Region(Extrinsic Muscles of Larynx)
Infrahyoid muscles
sternohyoid
Innervation and function
C1-C3 by a branch of the ansa cervicalis
Depresses hyoid after elevation during swallowing
Muscles of Anterior Cervical Region(Extrinsic Muscles of Larynx)
Infrahyoid muscles
omohyoid
Innervation and function
C1-C3 by a branch of the ansa cervicalis
Depresses, retracts and steadies hyoid
Muscles of Anterior Cervical Region(Extrinsic Muscles of Larynx)
Infrahyoid muscles
sternothyoid
Innervation and function
C2 and C3 by a branch of the ansa cervicalis
Depresses hyoid and larynx
Muscles of Anterior Cervical Region(Extrinsic Muscles of Larynx)
Infrahyoid muscles
Thyrohyoid
Innervation and function
C1 via hypoglossal nerve
Depresses hyoid and elevates larynx
Deep prevertebral muscles are?
ANterior scalene
Middle Scalene
Posterior Scalene
ANterior scalene Innervation and function
Cervical spinal nerves C4-C6/Flexes neck laterally; elevates 1st rib during forced inspiration
Middle scalene Inn and function
Anterior rami of cervical spinal nerves
Flexes neck laterally; elevates 1st rib during forced inspiration
Posterior scalene Innervation and function
Anterior rami of cervical spinal nerves C7 and C8
Flexes neck laterally; elevates 2nd rib with forced inspiration
Temporalis and Massetter
Inn and func
Motor root of cranial nerve V3
Muscle of Mastication
what are the nerves on the lateral cervical region
Accessory Nerve (CN XI) and Cervical Plexus
Location and supplies of the CN XI
Deep to SCM as it supplies the muscle
Deep to the investing layer of deep cervical fascia
Deep to the trapezius and pierces the muscle
Branches of the cervical plexus
Anterior rami of C1-C4
Cutaneous branches emerge posterior border of SCM
“Nerve point of the neck”
What is the importance of the “Nerve point of the neck”
Cervical plexus block
Anesthesia to anterolateral neck, superolateral thoracic wall, and the scalp between the auricle and external occipital protuberance
Temporary paralysis to trapezius and +/- SCM
Whats the Cervical plexus made up of?
Series of nerve loops from anterior rami of C1-C4
Anteromedial to the levator scapulae and middle scalene muscle; deep to SCM
Superficial branches are cutaneous
Deep branches are motor
Receives communicating branches from the superior cervical ganglion (sympathetic nerves)
Forms the ansa cervicalis
Ansa cervical branches are? and where do they innervate
Superior root C1 and Hypoglossal nerve Superior belly of omohyoid Inferior root C2 and C3 Sternothyroid Sternohyoid Inferior belly of omohyoid
What are the additional branches of the cervical plexus
Lesser Occipital nerve (C2)- skin of neck and scalp posterosuperior to auricle
Great Auricular nerve (C2 & C3)- skin of posterior aspect auricle, angle of mandible, and mastoid process
Transverse cervical nerve (C2 & C3)- skin of anterior cervical region
Supraclavicular nerve (C3 & C4)- skin of the neck, clavicle and shoulder.
Phrenic nerves (C3-C5; mainly C4)
Location of Phrenic nerve and where does it innervate
Forms on the anterior scalene muscle at the level of the superior border of the thyroid cartilage
Note pathway!
Motor and sensation to diaphragm
Sensation to mediastinum pleura and pericardium
Receives sympathetic communicating fibers from cervical sympathetic ganglia
Hypoglossal nerves innervation, what does it innervate and location
Somatic motor to the extrinsic muscles- styloglossus, hyoglossus, genioglossus (expect palatoglossus) and intrinsic muscles of the tongue via lingual branches
Provides superior root of the Ansa cervicalis to supply the infrahyoid muscles
Exits via a hypoglossal canal
Glossopharyngeal Nerve, location, what does it innervate and function
Exits via the jugular foramen
Somatic motor to the stylopharyngeus muscle to assist with swallowing, responsible for gag reflex (sensory)
Visceral motor-Parasympathetic innervation to parotid gland via otic ganglion
Special sensory taste from posterior 1/3 of tongue
Cell bodies contained within the superior and inferior ganglia
General somatic sensory to the external ear, pharynx, and middle ear
Cell bodies contained within the superior and inferior ganglia
Visceral sensory to the carotid body and sinus
Cell bodies contained within the superior and inferior ganglia
Note Brachial Plexus!
Note Phrenic nerve pathway!
Vagus nerve function, where does it innervate and location
Exits via jugular foramen
Somatic motor to constrictor muscles of pharynx, intrinsic muscles of larynx, muscles of palate (except tensor veli palatini), and striated muscle in superior 2/3 of esophagus
Visceral motor-Parasympathetic innervation to smooth muscle of trachea, bronchi, digestive tract and cardiac muscle of heart
Visceral sensory from base of tongue, pharynx, larynx, trachea, bronchi, heart, esophagus, stomach and intestine
Special sensory of taste from epiglottis and palate
General somatic sensation from auricle, external acoustic meatus and dura mater of posterior cranial fossa
2nd part:
Posterior part of the carotid sheath
Left and right Vagus nerves give rise to superior laryngeal nerves
Internal and external laryngeal divisions; level of the greater cornu
Right Vagus nerve passes anterior to the first part of the subclavian artery posterior to the brachiocephalic vein and sternoclavicular (SC) joint—-> thorax
Gives off right recurrent laryngeal nerve
Loops inferior to the right subclavian artery and ascends
Left Vagus nerve descends between the left common carotid and the left subclavian arteries and posterior to SC joint —–>thorax
Gives off left recurrent laryngeal nerve
Loops inferior to the arch of the aorta and ascends
Airways.
sympathetic nervous system components and Superior, Middle and Inferior Cervical Ganglion
No white communications in the neck
Receive presynaptic fibers conveyed to the sympathetic trunk by the superior thoracic spinal nerves and their white rami communicates
Synapse in the cervical ganglia
Postsynaptic ganglia send fibers to
Cervical spinal nerves via gray rami communicates
Thoracic viscera via cardiopulmonary splanchnic nerves
Head and viscera of the neck via cephalic arterial branches (vertebral and internal and external carotid arteries) as the sympathetic periarterial plexuses
Inferior cervical ganglia usually fuses with first thoracic ganglion to form stellate ganglion
Site for cervicothoracic ganglion block
Anesthesia for vascular spasms of brain and upper limb
Lesion of the cervical sympathetic trunk
Horner syndrome: Pupillary constriction Ptosis (drooping of eyelid) Enopthalmos (sinking in of the eyeball) Anhidrosis (loss of sweating) and vasodilation of face and neck
What are the Roost of the cervical arteries:Right side.
Brachiocephalic trunk..divided into 2:
its the First branch of the aorta
Divides into right 1.common carotid and 2.right subclavian
Right subclavian artery divisions,functions and location
Anterior scalene divides into three parts:
1st: medial to anterior scalene
Vertebral artery, internal thoracic artery,
thyrocervical trunk
2nd: posterior to anterior scalene
Costocervical trunk
3rd: lateral to anterior scalene
Dorsal scalpular artery
Roots Of the Cervical arteries left side
Left common carotid artery Second branch of aorta Left subclavian artery Third branch of aorta Anterior scalene divides into three parts 1st: medial to anterior scalene Vertebral artery, internal thoracic artery, thyrocervical trunk 2nd: posterior to anterior scalene Costocervical trunk 3rd: lateral to anterior scalene Dorsal scalpular artery
Vertebral arteries
Location and function
Foramina of the transverse processes of vertebrae C1-C6
Enters cranium through foramen magnum
Common Carotid Arteries location and function
Divides into External and Internal carotid arteries at superior border of thyroid cartilage
Internal carotid arteries location and function
No cervical branches
Enter into cranium through carotid canals
Main arteries of the brain and structures in the orbits
External carotid arteries location and function
Supply most structures external to cranium
Terminal branches: Maxillary and superficial temporal arteries
Six other branches
Components of carotid body and function
Medial (deep) side of the bifurcation of the common carotid
Carotid branch (sinus nerve of Hering) of Glossopharyngeal nerve (CN IX), Vagus nerve (CN X), and superior cervical ganglion
Chemoreceptor monitors level of oxygen in the blood (pO2)
Low levels of oxygen stimulate a reflex that increases rate/deep of respiration, cardiac rate and blood pressure
Carotid Sinus components and function
Bifurcation of common carotid- slight dilation
Carotid branch (sinus nerve of Hering) of Glossopharyngeal nerve (CN IX), Vagus nerve (CN X), and superior cervical ganglion
Baroreceptor
Stimulated by increases in arterial blood pressure results in decrease of heart rate and SVR
External jugular vein (EJV) location and function
Begins near the angle of the mandible, terminates in the subclavian veins
Receives blood from the cervicodorsal, suprascapular and anterior jugular veins
Internal jugular vein (IJV) location and function
Drains blood from brain, anterior face, cervical viscera, and deep muscles of neck
Jugular foramen to subclavian vein within the carotid sheath
Lateral to carotid artery and CN X
Subclavian Vein
location and function
Anterior to the anterior scalene and phrenic nerve
Joins IJV and EJV to form brachiocephalic vein——-> superior vena cava
Cervical Viscera- Endocrine Layer:Thyroid Gland Location and function
Deep to sternothyroid and sternohyoid
Level of C5-T1
Left and right lobes
Two main srteries of the Thyroid Gland
Two main arteries
Superior (branch of external carotid) and inferior thyroid (branch of thyrocervical trunk) arteries
Nerves are derived from cervical sympathetic ganglia
Vasomotor
Endocrine secretion is regulated by pituitary gland
Note vasculature and location for tracheostomy and cricothyrotomy
Cervical Viscera- Endocrine Layer:Parathyroid Gland
Location and function
Lie external to thyroid capsule on posterior aspect
Typically four parathyroid glands
Nerves are derived from cervical sympathetic ganglia
Vasomotor
Endocrine secretion is regulated by pituitary gland
Cervical Viscera- Alimentary Layer:Esophagus
location and function
Muscular tube from laryngopharynx to stomach
Voluntary, striated, muscle in upper 1/3
Involuntary, smooth, muscle in lower 1/3
Mix in middle 1/3
Inferior pharyngeal constrictor muscle creates the superior esophageal sphincter
Nerve supply of the esophagus is ?
Superior half: Sensory and Somatic motor via recurrent laryngeal nerve of vagus
Inferior half: Parasympathetic innervation and sensory by vagus nerve, vasomotor fibers by cervical sympathetic trunks
Occipitofrontalis
Inn and function
facial nerve(CN5) Elevates eyebrows, wrinkles skin of forehead
Orbicularis oculi
Facial nerve (CN VII) Closes eyelids; orbital sphincter
Orbicularis oris
Facial nerve (CN VII) Closes mouth, compresses and protrudes lips
Buccinator
Facial nerve (CN VII)
Presses cheek against molar teeth; works with tongue to keep food between occlusal surfaces; cheek muscle
Motor nerves of the face are
Facial nerve (CN VII) innervates all muscles of facial expression via its six branches once it exits via the stylomastoid foramen Posterior auricular branch Temporal branch (nerve stimulator!) Zygomatic branches Buccal branch Mandibular branch Cervical branch Bell Palsy- injury to the facial nerve results in unilateral paralysis of some or all of the muscles on the affected side
Cutaneous face and scalp innervation anterior to the auricle is by the the following nerves
three divisions of the trigeminal nerve (CN V)
Branches of the Ophthalmic division (CN V1)
Branches of the Maxillary division (CN V2)
Branches of the Mandibular division (CN V3)
Trigeminal neuralgia-excruciating facial pain, thought to be caused by vessel that compresses sensory root of CN V
Cutaneous face and scalp innervation posterior to the auricle is by what nerve?
spinal cutaneous nerves
Posterior rami of C2, C3 (greater and third occipital nerves)
Anterior rami of C2, C3 (great auricular nerve and lesser occipital)
Superficial vasculature face are and scalp are?
Great variability and anastomosis
Most superficial arteries of face arise from the external carotid artery
Except supratrochlear and supra orbital arteries which arise from the internal carotid artery
Majority of facial veins drain into the internal jugular vein
Auricular and post-auricular regional veins drain into the external jugular vein
Parotid Gland,Location ,function and innervation
Note the pathway of the facial nerve (CN VII), external carotid artery and retromandibular vein
Parasympathetic innervation via Glossopharyngeal nerve (CN IX) via otic ganglion!
What are the Muscles of Temporal and infratemporal regions,innervation and function
Temporalis
Masseter
Lateral pterygoid
Medial pterygoid
Motor root of trigeminal nerve (CN V3)
Muscle of mastication
Infratemporal fossa components and innervation
Maxillary artery- branch of the external carotid artery
CN V3
General somatic sensory from skin over mandible, lower lip, side of head, mandibular teeth, temporomandibular joint, mucosa of mouth, and anterior 2/3 of tongue
Somatic motor to muscles of mastication
Chorda tympani nerve Facial nerve (CN VII) Joins with lingual nerve of CN V3 Taste anterior 2/3 of tongue Presynaptic parasympathetic fibers for submandibular and sublingual glands via submandibular ganglion
