Chapter 9 - H/N anatomy, Embryology, Rads Flashcards
Branchial arch vs pouch
Arch - msk
Pouch- endothelium, glands
Most common cancer to metastasize to retropharyngeal LN
NPCa
How far RPS, Danger Sp, and PVS extend
SB to Mediastinum
SB to Diaphragm
Clivus to Coccyx
Contents of PPF
Maxillary artery/nerve
PPG
1st Branchial arch
Mandible (body/ramus) Sphenomandobular lig Ant malleolar lig Malleus (except manubrium) Incus (except long process)
mm mastication, TT, TVP, AD, Mylo (V)
2nd Branchial Arch
Stylohyoid lig, Styloid pr
Mall manubrium, LP incus
Stapes
Body, less cornu hyoid
mm expression, PD, Stylohyoid, Stapedius (VII)
3rd Arch
Body, great cornu hyoid
Stylopharyngeus (IX)
4-6 Arch
mm pharynx (constrictors), upper 1/2 esophagus striated, larynx mm (X)
Thyroid, Cricoid, Arytenoid, Corniculate, Cuneiform Cart
1st pharyngeal pouch
Epithel middle ear, TM
2nd pouch
Epithel pal tonsil
3rd pouch
Sup: Inf parathyroid
Inf: thymus
4th pouch
Superior Parathyroid
5-6 pouches
Parafollicular (C) cells
First BC anomaly
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
Second BC anomaly
Most common (95%)
Below angle mand, ant border SCM
Sinus tract passes deep to ECA, stylohyoid, Dig
Superficial to ICA
Third BCA
Ant to SCM, lower in neck
Sinus tract deep to IX, ICA, Sup to X at thyrohyoid memb or piriform sinus
Fourth BCA
Left sided usually
Thyroid or paratracheal mass
Sinus tract deep to SLN, Sup to RLN
Oral Cavity Boundaries/Subsites
Vermillion Bord, H/S palate jxn, tonsillar pillars, circumvall pap
Lip, Oral tongue, buccal mucosa, FOM, HP, gingiva (alv ridge), RMT
Nasopharynx Bound
Post NC, Sphenoid (Sup), 1/2 Vert, SP, Eustachian Tube, Torus Tub, Fossa Rosen (Lat)
Oropharynx Bound, Subsites
OC, SP, Post Ph Wall, Hyoid
Sites: BOT (post 1/3), palatine tonsil, lat pharyngeal wall, SP, post pharyngeal wall
Most common location for HPV SCCa
OP (tonsil, BOT)
Bound/Site Hypopharynx
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
Boundaries of Retropharyngeal Space
SB –> Mediastinum (trach bif)
BPF (lines post ph/esoph) –> Alar fascia
Carotid sheath (lat)
Boundaries of Danger Space
SB –> Diaphragm
Alar –> PVF
TP vertebrae (lat)
Boundaries of PVS
Clivus –> Coccyx
PVF –> VB
TP vertebrae (lat)
Describe retropharyngeal lymphatics
Lateral (Rouviere): 1-3, 2-5mm, smaller in adults
Medial: Inferior, upp/low, absent in adults
Triangles of Neck
Anterior: Submandibular, Submental (div by AD); Carotid, Muscular (div by Omo)
Posterior: Occipital, Supraclavicular (div by Omo)
Level 1a LN
Mandible –> Hyoid
Mylohyoid superior
AD lateral
Level 1b LN
Mandible –> PD
AD is ant/inf border
Level II LN
SB –> Hyoid (Carotid Bif)
Post border SCM –> Lat border sternohyoid/stylohyoid mm
a= anterior to XI
b= post/sup to XI
Level III LN
Hyoid (Carotid Bif) –> Omo/IJ jxn
Level IV LN
Omo –> clavicle
Level V LN
Post SCM –> Ant Trap
Down to clavicle
a= sup to inf border cricoid
b= inf to inf border cricoid
Level VI
Hyoid –> suprasternal notch
Medial border carotid sheaths (lat)
Cranial Nerve VII enter/exit SB
Enter IAM
Motor root exits SMF
Chorda exists petrotympanic fissure
Grt Sup Petrosal n exits pterygoid canal
Structures passing through SOF
III, IV, V1, VI
superior ophthalmic vein
a branch of the inferior ophthalmic vein
Structures passing through optic canal
II, ophthalmic artery
Structures passing through foramen rotundum
V2
artery of for rot
emissary vv
Structures passing through foramen ovale
V3
accessory meningeal a
emissary vv (cav sinus, pterygoid plexus)
otic ganglion
nervus spinosus, lesser petrosal nerve (occasionally)
Structures passing through IAM
VII-VIII
vestibular ganglion, labyrinthine a (br of AICA or basilar)
Structures passing through jugular foramen
IX, X, XI inferior petrosal sinus (drains into IJ) jugular bulb (between sigmoid sinus and IJ)
Boundaries of PPF
Medial half IOF –> Upper end palatine canal
Maxilla –> pterygoid plates
SPF, perp plate palatine bone –> PMF
Communications of PPF
Maxillary sinus, Orbital cavity (OIF), MCF (for rotundum, pterygoid canal), oral cavity (palatine canal), infratemporal fossa (PMF), nasal cavity (SPF)
Pterygopalatine ganglion
PNS, innervate lacrimal gland, nasal mucosa
