Cervical region, face, temporal Flashcards
deep Cervical Fascia
Investing
Pretracheal
Prevertebral
Investing layer
- surrounds entire neck deep to skin and subq tissue
- encloses sternocleidomastoid and trapezius muscles
Carotid sheath contains…
- common and internal carotid arteries
- internal jugular vein
- vagus nerve
- carotid sinus nerve (from glossopharyngeal nerve)
- sympathetic fibers
What is in the prevertebral fascia layer?
- vertebral column
- longus colli, longus capitis
- scalenes
- deep cervical muscles
Where is the retropharyngeal space?
What does it do?
- 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
- major area for spread of infection
sternocleidomastoid
innervation
action
- Spinal accessory nerve
- Unilateral: laterally flexes neck, turning face toward opposite side
- Bilateral: extends neck at atlanto-occipital joint
Mylohyoid
innervation and action
- branch of CN V3
- elevates hyoid, floor of mouth and tongue with swallowing and speaking
Geniohyoid
innervation and action
- C1 via hypoglossal nerve
- pulls hyoid anterosuperior, shortens floor of mouth, widens pharynx
Stylohyoid
innervation and action
- stylohyoid branch of facial nerve
- elevates and retracts hyoid, thus elongating floor of mouth
Digastric
innervation and action
- anterior belly: nerve to mylohyoid, branch of CN V3
- Posterior belly: digastric branch of facial nerve
- depresses mandible, elevates and steadies hyoid with swallowing and speaking
Sternohyoid, Omohyoid, Sternothyroid
innervation and action
- C1-C3 by a branch of the ansa cervicalis
- C2-C3 for sternothyroid
- depresses hyoid
Thyrohyoid
innervation and action
- C1 via hypoglossal nerve
- depresses hyoid and elevates larynx
Anterior and middle scalenes
action
flexes neck laterally
elevates 1st rib during forced inspiration
What makes up the Ansa Cervicalis and what does it innervate?
- Superior root- C1 and hypoglossal nerve
- innervates superior belly of omohyoid
- Inferior root- C2 and C3
- innervates sternothyroid, sternohyoid, inferior belly of omohyoid
Lesser Occipital nerve (C2) inervates ______
skin of neck and scalp posterosuperior to auricle
Greater Auricular nerve (C2 and C3) innervates ______
skin of posterior aspect auricle, angle of mandible, and mastoid process
Transverse cervical nerve (C2 and C3) innervates ______
skin of anterior cervical region
Supraclavicular nerve (C3 and C4) innervates ________
skin of the neck, clavicle, and shoulder
What feeds into the phrenic nerve?
What path does it take?
C3-C5
mostly C4
Comes out between anterior and middle scalene
Goes posterior to subclavian vein and anterior to sublcavian artery
Goes anterior to heart
What does the phrenic nerve innervate?
Motor and sensory to diaphragm
sensation to mediastinum pleura and pericardium
Receives sympathetic communicating fibers from cervical sympathetic ganglia
Hypoglossal CN XII innervates ______
- Somatic motor of the tongue
- styloglossus
- hyoglossus
- genioglossus
- and intrinsic muscles of the tongue
- Hypoglossal nerve is the superior root of the Ansa Cervicalis to supply the infrahyoid muscles
Glossopharyngeal nerve innervates ________
- somatic motor
- stylopharyngeus muscle for swallowing and gag reflex
- visceral motor
- parasympathetic innervation to parotid gland via otic ganglion
- Special sensory
- taste from posterior 1/3 of tongue
Vagus nerve somatic innervation
and special sensory
- somatic motor
- constrictor muscles of pharynx, larynx palate and muscle in superior 2/3 of esophagus
- somatic sensation
- auricle
- external acoustic meatus
- dura mater of posterior cranial fossa
- special sensory
- taste from epiglottis and palate
Vagus nerve visceral innervation
- Visceral motor
- parasympathetic innervation to smooth muscle of trachea, bronchi, digestive tract, and cardiac muscle
- visceral sensory
- from base of tongue, pharynx, larynx, trachea, bronchi, heart, esophagus, stomach, and intestine
Pathway of the Vagus Nerve
- Both the Left and right vagus nerve have the superior laryngeal nerve split off
- This splits into the internal and external laryngeal divisions at the level of the greater nornu of the hyoid bone
- Right Vagus- passes anterior to the first part of subclavian artery posterior to the brachiocephalic vein and sternoclavicular joint
- Left vagus descends between the left common carotid and left subclavian arteries and posterior sternoclavicular joint
What does the Right recurrent laryngeal nerve come off of and what does it innervate?
comes off the Right Vagus
Loops underneath subclavian
innervates the laryngeal muscles except the Cricothyroid
What does the Left recurrent laryngeal nerve come off of and what does it innervate?
Comes off the Left Vagus nerve
loops below the aorta and innervates the muscles of the larynx except for Cricothyroid
What forms the stellate ganglion?
what is this site used for?
- Inferior cervical ganglia fused with first thoracic ganglion
- this is site for cervicothoracic ganglion block used for vascular spasms of brain and upper limb
What happens with a lesion of the cervical sympathetic trunk?
- Horner syndrome
- pupillary constriction
- Ptosis (drooping of eyelid)
- enopthalmos (sinking in of eyeball)
- Anhidrosis (loss of sweating) and vasodilation
What arteries do the Right cervical arteries come off of?
- Right
- Brachiocephalic trunk
- becomes right common carotid and R subclavian
- Right subclavian artery
- Brachiocephalic trunk
What are the 4 branches off the subclavians?
medial to latera
- vertebral arteries
- thyrocervical trunk
- costocervical trunk
Where does the common carotid divide?
at the superior border of thyroid cartilage
Internal carotid arteries
Does it have cervical branches?
where does it enter cranium?
- No cervical branches
- enter into cranium through carotid canals
- main arteries of the brain and structures in the orbits
External carotid arteries
what do they supply?
what are the terminal branches?
- Supply most structures external to cranium
- terminal branches: Maxiallary and superficial temporal arteries
- six other branches
Carotid body
Where is it?
What innervates it?
What does it do?
- Medial (deep) side of the bifurcation of the common carotid
- Innervated by the carotid branch (sinus nerve of Hering) of Glossopharyngeal nerve, vagus nerve, and superior cervical ganglion
- action:
- chemoreceptor monitors level of O2 in blood
- low O2 stimulates a reflex that increases rate/depth of respiration, HR and BP
Caronid sinus
Where is it?
innervation?
what does it do?
- at the bifurcation of common carotid- slight dilation
- innervated by carotic branch (sinus nerve of Hering) of glossopharyngeal nerve, Vagus nerve, and superior cervical ganglion
- action:
- baroreceptor
- stimulated by increases in arterial blood pressure results in decrease of HR and SVR
External jugular vein
- begins near the angle of the mandible, terminates in the sublcavian veins
- receives blood from the cervicodorsal, suprascapular and anterior jugular veins
Internal jugular vein
- drains blood from brain, anterior face, cervical viscera, and deep muscles of neck
- jugular foramen to sublcavian vein within the carotid sheath
- lateral to carotid artery and CN X
Subclavian vein
- Anterior to the anterior scalene and prenic nerve
- Joins IJV and EJV to form brachiocephalic vein –> superior vena cava
Thyroid gland
location
affiliated arteries and nerves
- deep to sternothyroid and sternohyoid
- level of C5-T1
- two main arteries
- superior thyroid (branch of external carotid)
- Inferior thyroid (branch of thyrocervical trunk
- nerves are from cervical sympathetic ganglia
- vasomotor
- endocrine secretion is regulated by pituitary gland
- ****Note: where in pic does a trach go and where do you crich?
Parathyroid gland
location
innervation
- four dots on the posterior aspect of thyroid
- nerves come from cervical sympathetic ganglia
- vasomotor
- endocrine secretion regulated by pituitary gland
Esophagus
- Voluntary, striated muscle in upper 1/3
- involuntary smooth muscle lower 1/3
- mix in the middle 1/3
- innervation:
- superior half: sensory and somatic via recurrent laryngeal nerve of vagus
- inferior half: parasympathetic innervation and sensory by vagus nerve, vasomotor fibers by cervical sympathetic trunks
what muscle creates the superior esophageal sphincter
inferior pharyngeal constrictor
Occipitofrontalis
innervation and action
- innervation: facial nerve
- action: elevates eyebrows, wrinkles skin of forehead
Orbicularis oculi
I and A
- I: Facial nerve
- A: closes eyelids; orbital sphincter
Orbicularis oris
I and A
- I: Facial nerve
- A: closes mouth, compresses and protrudes lips
Buccinator
I and A
- I: Facial nerve
- A: presses cheek against molar teeth; works with tong to keep food between occlusal surfaces
Platysma
I and A
- I: facial nerve
- A: depresses mandible, tenses skin of inferior face and neck
What nerves innervate all the muscles of facial expression?
- Facial nerve
- posterior auricular branch
- temporal branch (nerve stimulator)
- zygomatic branches
- buccal branch
- mandibular branch
- cervical branch
What is Bells palsy?
injury to the facial nerve that results in unilateral paralysis of some or all of the muscles on the affected side
Cutaneous division of the face
Anterior to the auricle
V1, V2, V3
Cutaneous innervation back of head
posterior to the auricle
spinal cutaneous nerves
Where do most superficial arteries of the face arise from?
external carotid artery
*except supratrochlear and supra orbital arteries which arise from the internal carotid artery
Where do the majority of facial veins drain?
Internal jugular vein
**Except auricular and post auricular region veins drain into the external jugular vein
Parotid gland
innervation
- parasympathetic innervation via glossopharyngeal nerve via otic ganglion
- **note the pathway of facial nerve
Muscles of mastication (4)
innervation
- innervated by motor root of V3
- temporalis
- masseter
- lateral pterygoid
- medial pterygoid
What is in the infratemporal fossa?
- maxillary artery
- V3
- Chorda tympani
