Clinical Head Abd Neck 1-3

Question 1

What are the orbital complications of sinusitis?

Answer 1

1. Periorbital (Pre-septal) cellulitis
2. Orbital (post-septal) cellulitis
3. Sub periosteal Abcess
4. Orbital abscess
5. Cavernous Sinus thrombophlebitis

Question 2

What are the fascia of the neck?

Answer 2

Fascia of the neck
➢Cervical subcutaneous tissue and platysma
➢Deep cervical fascia: Consists of three fascial layers (sheaths):

Investing, pretracheal, and prevertebral

Question 3

What is the danger (third ) space?

Answer 3

Infections can spread to the diaphragm

Anteriorly: Alar fascia
Posteriorly: prevertebral fascia.
Superiorly: Base of the skull
Inferiorly: Diaphragm

Question 4

What’s the significance of retropharyngeal space?

Answer 4

Retropharyngeal space – infections can spread to the upper part of the superior mediastinum
Superior: Base of the skull
 Inferior: Superior mediastinum 
Lateral: Carotid sheath
Anterior: Buccopharyngeal fascia 
Posterior: Alar fascia

Question 5

How are infections spread in the neck?

Answer 5

• The investing layer of deep cervical fascia helps prevent the spread of abscesses (purulent infections) caused by tissue destruction.
• If an infection occurs between the investing layer of deep cervical fascia and the muscular part of the pretracheal fascia surrounding the infrahyoid muscles, the infection will usually not spread beyond the superior edge of the manubrium of the sternum.
• If the infection occurs between the investing fascia and the visceral part of pretracheal fascia, it can spread into the thoracic cavity anterior to the pericardium

Question 6

How can infections spread through the retropharyngeal space?

Answer 6

• Infections in the head may also spread inferiorly posterior to the esophagus and enter the posterior mediastinum, or it may spread anterior to the trachea and enter the anterior mediastinum.
• Infections in the retropharyngeal space may also extend inferiorly into the superior mediastinum.
• Similarly, air from a ruptured trachea, bronchus, or esophagus (pneumomediastinum) can pass superiorly in the neck.

Question 7

What is the action and innervation and action of the cricothyroid?

Answer 7

Nerve: external laryngeal nerve

Action: stretches and tenses vocal ligament

Question 8

What is the action and innervation and action of the thyro-artenoid?

Answer 8

Inferior laryngeal nerve (recurrent laryngeal nerve)

Relaxes vocal ligament

Question 9

What is the action and innervation and action of the posterior crico-arteyoid?

Answer 9

Inferior laryngeal nerve (recurrent laryngeal nerve)

Abducts vocal folds

Question 10

What is the action and innervation and action of the lateral cruciate-arytenoid?

Answer 10

Inferior laryngeal nerve (recurrent laryngeal nerve)

Adduct vocal folds (inter-ligament outs portion)

Question 11

What is the action and innervation and action of the transverse and oblique arytenoids

Answer 11

Inferior laryngeal nerve (recurrent laryngeal nerve)

Adduct Artenoid cartilages (adducting) intercartilaginous portion of vocal folds, closing posterior rims glottidus)

Question 12

What is the action and innervation and action of the vocalis?

Answer 12

Inferior laryngeal nerve (recurrent laryngeal nerve)

Relaxes posterior vocal ligament while maintaining (or increasing) tension of anterior part

Question 13

What are the major classes of herniation ?

Answer 13

Supratentorial herniation:
A. Uncal (transtentorial)
B. Central
C. Cingulate (subfalcine/transfalcine)
D. Transcalvarial
E. Tectal (posterior)

Infratentorial herniation:

1. Upward (upward cerebellar or upward transtentorial)
2. Tonsillar (downward cerebellar)

Question 14

What can cause a sub dural hematoma?

Answer 14

• Subdural hematomas can also occur after a minor head injury.
• The amount of bleeding is smaller and occurs more slowly.
• This type of subdural hematoma is often seen in older adults.

Question 15

What are the symptoms of subarachnoid hemorrhage?

Answer 15

• Bleeding into the area between the arachnoid
membrane and the pia mater surrounding the brain.

• Usually from a ruptured cerebral aneurysm.

• Symptoms:
• Severe headache of rapid onset
• Vomiting
• Decreased level of consciousness • Fever
• Seizures
• Neck stiffness or neck pain

Question 16

Describe the anatomy of an headache

Answer 16

The brain itself is not sensitive to pain, because it lacks pain receptors.

• Several areas of the head and neck do have pain receptors:

• Extracranial arteries
• Middle meningeal artery
• Large veins & venous sinuses
• Cranial and spinal nerves
• Head and neck muscles
• Head and neck muscles
• The meninges
• Falx cerebri & parts
of the brainstem
• Eyes, ears, teeth and lining of the mouth.