Chapter 9 - H/N anatomy, Embryology, Rads

Question 1

Branchial arch vs pouch

Answer 1

Arch - msk

Pouch- endothelium, glands

Question 2

Most common cancer to metastasize to retropharyngeal LN

Answer 2

NPCa

Question 3

How far RPS, Danger Sp, and PVS extend

Answer 3

SB to Mediastinum

SB to Diaphragm

Clivus to Coccyx

Question 4

Contents of PPF

Answer 4

Maxillary artery/nerve

PPG

Question 5

1st Branchial arch

Answer 5

Mandible (body/ramus)
Sphenomandobular lig
Ant malleolar lig
Malleus (except manubrium)
Incus (except long process)

mm mastication, TT, TVP, AD, Mylo (V)

Question 6

2nd Branchial Arch

Answer 6

Stylohyoid lig, Styloid pr
Mall manubrium, LP incus
Stapes
Body, less cornu hyoid

mm expression, PD, Stylohyoid, Stapedius (VII)

Question 7

3rd Arch

Answer 7

Body, great cornu hyoid

Stylopharyngeus (IX)

Question 8

4-6 Arch

mm pharynx (constrictors), upper 1/2 esophagus striated, larynx mm (X)

Answer 8

Thyroid, Cricoid, Arytenoid, Corniculate, Cuneiform Cart

Question 9

1st pharyngeal pouch

Answer 9

Epithel middle ear, TM

Question 10

2nd pouch

Answer 10

Epithel pal tonsil

Question 11

3rd pouch

Answer 11

Sup: Inf parathyroid

Inf: thymus

Question 12

4th pouch

Answer 12

Superior Parathyroid

Question 13

5-6 pouches

Answer 13

Parafollicular (C) cells

Question 14

First BC anomaly

Answer 14

All anomalies have sinuses that pass deep to associated aortic arch derivative
Second most common after 2
I- ectoderm, duplicate EAC, cyst A/I To lobule
II- ecto and mesoderm, si duplicates cartilage too, sinus below angle mandible, through parotid, Inf to EAC or into EAC at b/c jxn

Question 15

Second BC anomaly

Answer 15

Most common (95%)

Below angle mand, ant border SCM
Sinus tract passes deep to ECA, stylohyoid, Dig
Superficial to ICA

Question 16

Third BCA

Answer 16

Ant to SCM, lower in neck

Sinus tract deep to IX, ICA, Sup to X at thyrohyoid memb or piriform sinus

Question 17

Fourth BCA

Answer 17

Left sided usually

Thyroid or paratracheal mass
Sinus tract deep to SLN, Sup to RLN

Question 18

Oral Cavity Boundaries/Subsites

Answer 18

Vermillion Bord, H/S palate jxn, tonsillar pillars, circumvall pap

Lip, Oral tongue, buccal mucosa, FOM, HP, gingiva (alv ridge), RMT

Question 19

Nasopharynx Bound

Answer 19

Post NC, Sphenoid (Sup), 1/2 Vert, SP, Eustachian Tube, Torus Tub, Fossa Rosen (Lat)

Question 20

Oropharynx Bound, Subsites

Answer 20

OC, SP, Post Ph Wall, Hyoid

Sites: BOT (post 1/3), palatine tonsil, lat pharyngeal wall, SP, post pharyngeal wall

Question 21

Most common location for HPV SCCa

Answer 21

OP (tonsil, BOT)

Question 22

Bound/Site Hypopharynx

Answer 22

Larynx (ant), hyoid/pharyngoepiglottic folds, Retropharyngeal space, esophageal introitus (CP mm)
Sites: Piriform sinuses (inv pyramid, apex below cricoid, base at pharyngoepiglottic fold), postcricoid (ant wall hypoph), post pharyngeal wall

Question 23

Boundaries of Retropharyngeal Space

Answer 23

SB –> Mediastinum (trach bif)
BPF (lines post ph/esoph) –> Alar fascia
Carotid sheath (lat)

Question 24

Boundaries of Danger Space

Answer 24

SB –> Diaphragm
Alar –> PVF
TP vertebrae (lat)

Question 25

Boundaries of PVS

Answer 25

Clivus --> Coccyx PVF --> VB TP vertebrae (lat)

Question 26

Describe retropharyngeal lymphatics

Answer 26

Lateral (Rouviere): 1-3, 2-5mm, smaller in adults | Medial: Inferior, upp/low, absent in adults

Question 27

Triangles of Neck

Answer 27

Anterior: Submandibular, Submental (div by AD); Carotid, Muscular (div by Omo) Posterior: Occipital, Supraclavicular (div by Omo)

Question 28

Level 1a LN

Answer 28

Mandible --> Hyoid Mylohyoid superior AD lateral

Question 29

Level 1b LN

Answer 29

Mandible --> PD | AD is ant/inf border

Question 30

Level II LN

Answer 30

SB --> Hyoid (Carotid Bif) Post border SCM --> Lat border sternohyoid/stylohyoid mm a= anterior to XI b= post/sup to XI

Question 31

Level III LN

Answer 31

Hyoid (Carotid Bif) --> Omo/IJ jxn

Question 32

Level IV LN

Answer 32

Omo --> clavicle

Question 33

Level V LN

Answer 33

Post SCM --> Ant Trap Down to clavicle a= sup to inf border cricoid b= inf to inf border cricoid

Question 34

Level VI

Answer 34

Hyoid --> suprasternal notch | Medial border carotid sheaths (lat)

Question 35

Cranial Nerve VII enter/exit SB

Answer 35

Enter IAM Motor root exits SMF Chorda exists petrotympanic fissure Grt Sup Petrosal n exits pterygoid canal

Question 36

Structures passing through SOF

Answer 36

III, IV, V1, VI superior ophthalmic vein a branch of the inferior ophthalmic vein

Question 37

Structures passing through optic canal

Answer 37

II, ophthalmic artery

Question 38

Structures passing through foramen rotundum

Answer 38

V2 artery of for rot emissary vv

Question 39

Structures passing through foramen ovale

Answer 39

V3 accessory meningeal a emissary vv (cav sinus, pterygoid plexus) otic ganglion nervus spinosus, lesser petrosal nerve (occasionally)

Question 40

Structures passing through IAM

Answer 40

VII-VIII | vestibular ganglion, labyrinthine a (br of AICA or basilar)

Question 41

Structures passing through jugular foramen

Answer 41

``` IX, X, XI inferior petrosal sinus (drains into IJ) jugular bulb (between sigmoid sinus and IJ) ```

Question 42

Boundaries of PPF

Answer 42

Medial half IOF --> Upper end palatine canal Maxilla --> pterygoid plates SPF, perp plate palatine bone --> PMF

Question 43

Communications of PPF

Answer 43

Maxillary sinus, Orbital cavity (OIF), MCF (for rotundum, pterygoid canal), oral cavity (palatine canal), infratemporal fossa (PMF), nasal cavity (SPF)

Question 44

Pterygopalatine ganglion

Answer 44

PNS, innervate lacrimal gland, nasal mucosa