Cervical region,face neck,temporal and infratemporal

Question 1

Hyoid bone components and function

Answer 1

• Mobile
• Level of C3
• Greater and lesser cornu/horns
• Serves as an attachment for anterior neck muscles and a prop to keep airway patent

Question 2

Superficial cervical fascia components

Answer 2

Subcutaneous tissue of the neck between dermis and deep cervical fascia layer

contains the
Cutaneous nerves, blood and lymph vessels, fat

Question 3

Platysma component,innervation, and function

Answer 3

Thin, superficial muscle of facial expression
CN VII(Facial nerve)

Depresses mandible, tenses skin of inferior face and neck

Question 4

Deep cervical Facia components and function

Answer 4

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

Question 5

Investing layer components and functions

Answer 5

Surrounds entire neck-deep to the skin and subcutaneous tissue
Encloses sternocleidomastoid muscles and trapezius muscles

Question 6

Pretracheal layer components and function

Answer 6

*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

Question 7

Prevertebral layer components

Answer 7

Tubular sheath for the vertebral column and the muscles associated with it
Longus colli, longus capitis
Scalenes
Deep cervical muscles

Question 8

Retropharyngeal space components

Answer 8

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

Question 9

Sternocleidomastoid (SCM)(Clavicle head and sternal head)

Function and innervation

Answer 9

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

Question 10

Occipitofrontalis innervation and function

Answer 10

Elevates eyebrows, wrinkles skin of the forehead, muscle of facial expression

Facial nerve(CN7)

Question 11

Hyoid Muscles function

Answer 11

Steady or move the hyoid bone and larynx, as a whole, either more cephalad or caudal

Question 12

Muscles of Anterior Cervical Region(Extrinsic Muscles of Larynx

Suprahyoid Muscles

Mylohyoid function and innervation

Answer 12

branch of CN V3

Elevates hyoid, floor of mouth, and tongue with swallowing and speaking

Question 13

Muscles of Anterior Cervical Region(Extrinsic Muscles of Larynx

Suprahyoid Muscles
Geniohyoid function and innervation

Answer 13

C1 via hypoglossal nerve (CN XII)

Pulls hyoid anterosuperior; shortens floor of mouth; widens pharynx

Question 14

Muscles of Anterior Cervical Region(Extrinsic Muscles of Larynx

SpraHyoid Muscles
Stylohyoid function and innervation

Answer 14

Stylohyoid branch of facial nerve (CN VII)

Elevates and retracts hyoid, thus elongating floor of mouth

Question 15

Muscles of Anterior Cervical Region(Extrinsic Muscles of Larynx

Suprahyoid Muscles
Digastric function and innervation

Answer 15

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

Question 16

Muscles of Anterior Cervical Region(Extrinsic Muscles of Larynx)
Infrahyoid muscles
sternohyoid
Innervation and function

Answer 16

C1-C3 by a branch of the ansa cervicalis

Depresses hyoid after elevation during swallowing

Question 17

Muscles of Anterior Cervical Region(Extrinsic Muscles of Larynx)
Infrahyoid muscles
omohyoid
Innervation and function

Answer 17

C1-C3 by a branch of the ansa cervicalis

Depresses, retracts and steadies hyoid

Question 18

Muscles of Anterior Cervical Region(Extrinsic Muscles of Larynx)
Infrahyoid muscles
sternothyoid
Innervation and function

Answer 18

C2 and C3 by a branch of the ansa cervicalis

Depresses hyoid and larynx

Question 19

Muscles of Anterior Cervical Region(Extrinsic Muscles of Larynx)
Infrahyoid muscles
Thyrohyoid
Innervation and function

Answer 19

C1 via hypoglossal nerve

Depresses hyoid and elevates larynx

Question 20

Deep prevertebral muscles are?

Answer 20

ANterior scalene
Middle Scalene
Posterior Scalene

Question 21

ANterior scalene Innervation and function

Answer 21

Cervical spinal nerves C4-C6/Flexes neck laterally; elevates 1st rib during forced inspiration

Question 22

Middle scalene Inn and function

Answer 22

Anterior rami of cervical spinal nerves

Flexes neck laterally; elevates 1st rib during forced inspiration

Question 23

Posterior scalene Innervation and function

Answer 23

Anterior rami of cervical spinal nerves C7 and C8

Flexes neck laterally; elevates 2nd rib with forced inspiration

Question 24

Temporalis and Massetter

Inn and func

Answer 24

Motor root of cranial nerve V3

Muscle of Mastication

Question 25

what are the nerves on the lateral cervical region

Answer 25

Accessory Nerve (CN XI) and Cervical Plexus

Question 26

Location and supplies of the CN XI

Answer 26

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

Question 27

Branches of the cervical plexus

Answer 27

Anterior rami of C1-C4 Cutaneous branches emerge posterior border of SCM “Nerve point of the neck”

Question 28

What is the importance of the “Nerve point of the neck”

Answer 28

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

Question 29

Whats the Cervical plexus made up of?

Answer 29

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

Question 30

Ansa cervical branches are? and where do they innervate

Answer 30

``` Superior root C1 and Hypoglossal nerve Superior belly of omohyoid Inferior root C2 and C3 Sternothyroid Sternohyoid Inferior belly of omohyoid ```

Question 31

What are the additional branches of the cervical plexus

Answer 31

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)

Question 32

Location of Phrenic nerve and where does it innervate

Answer 32

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

Question 33

Hypoglossal nerves innervation, what does it innervate and location

Answer 33

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

Question 34

Glossopharyngeal Nerve, location, what does it innervate and function

Answer 34

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!

Question 35

Vagus nerve function, where does it innervate and location

Answer 35

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.

Question 36

sympathetic nervous system components and Superior, Middle and Inferior Cervical Ganglion

Answer 36

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 ```

Question 37

What are the Roost of the cervical arteries:Right side.

Answer 37

Brachiocephalic trunk..divided into 2: its the First branch of the aorta Divides into right 1.common carotid and 2.right subclavian

Question 38

Right subclavian artery divisions,functions and location

Answer 38

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

Question 39

Roots Of the Cervical arteries left side

Answer 39

``` 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 ```

Question 40

Vertebral arteries | Location and function

Answer 40

Foramina of the transverse processes of vertebrae C1-C6 | Enters cranium through foramen magnum

Question 41

Common Carotid Arteries location and function

Answer 41

Divides into External and Internal carotid arteries at superior border of thyroid cartilage

Question 42

Internal carotid arteries location and function

Answer 42

No cervical branches Enter into cranium through carotid canals Main arteries of the brain and structures in the orbits

Question 43

External carotid arteries location and function

Answer 43

Supply most structures external to cranium Terminal branches: Maxillary and superficial temporal arteries Six other branches

Question 44

Components of carotid body and function

Answer 44

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

Question 45

Carotid Sinus components and function

Answer 45

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

Question 46

External jugular vein (EJV) location and function

Answer 46

Begins near the angle of the mandible, terminates in the subclavian veins Receives blood from the cervicodorsal, suprascapular and anterior jugular veins

Question 47

Internal jugular vein (IJV) location and function

Answer 47

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

Question 48

Subclavian Vein | location and function

Answer 48

Anterior to the anterior scalene and phrenic nerve Joins IJV and EJV to form brachiocephalic vein-------> superior vena cava

Question 49

Cervical Viscera- Endocrine Layer:Thyroid Gland Location and function

Answer 49

Deep to sternothyroid and sternohyoid Level of C5-T1 Left and right lobes

Question 50

Two main srteries of the Thyroid Gland

Answer 50

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

Question 51

Cervical Viscera- Endocrine Layer:Parathyroid Gland Location and function

Answer 51

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

Question 52

Cervical Viscera- Alimentary Layer:Esophagus | location and function

Answer 52

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

Question 53

Nerve supply of the esophagus is ?

Answer 53

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

Question 54

Occipitofrontalis | Inn and function

Answer 54

``` facial nerve(CN5) Elevates eyebrows, wrinkles skin of forehead ```

Question 55

Orbicularis oculi

Answer 55

``` Facial nerve (CN VII) Closes eyelids; orbital sphincter ```

Question 56

Orbicularis oris

Answer 56

``` Facial nerve (CN VII) Closes mouth, compresses and protrudes lips ```

Question 57

Buccinator

Answer 57

Facial nerve (CN VII) Presses cheek against molar teeth; works with tongue to keep food between occlusal surfaces; cheek muscle

Question 58

Motor nerves of the face are

Answer 58

``` 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 ```

Question 59

Cutaneous face and scalp innervation anterior to the auricle is by the the following nerves

Answer 59

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

Question 60

Cutaneous face and scalp innervation posterior to the auricle is by what nerve?

Answer 60

spinal cutaneous nerves Posterior rami of C2, C3 (greater and third occipital nerves) Anterior rami of C2, C3 (great auricular nerve and lesser occipital)

Question 61

Superficial vasculature face are and scalp are?

Answer 61

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

Question 62

Parotid Gland,Location ,function and innervation

Answer 62

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!

Question 63

What are the Muscles of Temporal and infratemporal regions,innervation and function

Answer 63

Temporalis Masseter Lateral pterygoid Medial pterygoid Motor root of trigeminal nerve (CN V3) Muscle of mastication

Question 64

Infratemporal fossa components and innervation

Answer 64

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 ```