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Head & Neck > General Organisation > Flashcards

General Organisation Flashcards

1
Q

What is the definition of fascia? What purpose does it serve? Why is it important to know about? Give some examples of fascia.

A

FASCIA = connective tissue (therefore mesenchymal origin) forming layers of variable thickness in all regions of the body. Superficial fascia is found immediately beneath the skin. Deep fascia envelops organs and tissues

  • eases movement of muscles by reducing friction
  • lines all organs, separating tissues of the body into compartments
  • binds tissues together (therefore spaces do not exist normally; potential spaces exist)

Determines spread of infection

Loose connective tissue (superficial fascia) = adipose tissue
Dense regular connective tissue (muscle) = tendons/aponeurosis
Dense irregular connective tissue (dermis) = deep fascia

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2
Q

What are the anatomical boundaries of the anterior triangle of the neck?

A

Anterior: median vertical line of the neck

Superior: inferior margin of the mandible

Posterior: anterior margin of sternocleidomastoid

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3
Q

What are the anatomical boundaries of the posterior triangle of the neck?

A

Anterior: posterior margin of the sternocleidomastoid

Posterior: anterior margin of trapezius

Inferior: middle 1/3 of the clavicle

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4
Q

What are the major contents of the anterior triangle of the neck?

A

Major structures that pass between the head and thorax:

  • major arteries (e.g. common carotid) and veins (e.g. internal jugular vein)
  • oesophagus
  • larynx
  • pharynx
  • thyroid gland
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5
Q

What are the major contents of the posterior triangle of the neck?

A

Structures passing into and out of the upper limb (axillary inlet - brachial plexus under facial floor):

  • fat
  • lymph nodes
  • spinal accessory nerve
  • external jugular vein
  • suprascapular artery
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6
Q

Outline the attachments and innervation of the trapezius and sternocleidomastoid.

A

TRAPEZIUS attaches to:

  • vertebrae C1-C7 by ligamentum nuchae
  • external occipital protruberance

STERNOCLEIDOMASTOID attaches to:

  • mastoid process (bilateral)
  • sternum (one head)
  • clavicle (one head)

Both innervated by spinal accessory nerve (CNXI)

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7
Q

What are the subdivisions of the anterior triangle of the neck?

A

Submandibular/digastric triangle

Submental triangle

Carotid triangle

Muscular/visceral triangle

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8
Q

What are the muscles of the anterior triangle of the neck?

A

SUPRAHYOID: elevate hyoid and larynx during swallowing

Superficial:

  • digastric (2 heads, change angle under fibrous band)
  • stylohyoid

Intermediate: mylohyoid

Deep: geniohyoid

INFRAHYOID: depress hyoid and larynx during speech or swallowing

Superficial:

  • sternohyoid
  • omohyoid (2 heads, change angle under fibrous band)

Deep:

  • sternothyroid
  • thyrothyroid
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9
Q

What are the different layers of the neck?

A

Skin

Subcutaneous fat/superficial fascia

Platysma muscle: thin band-like muscle extending from mandible to clavicle on both sides of ANTERIOR neck (but deficient in the middle)

Investing/deep cervical fascia: tight “collar” of fascia separating compartments (increases tension —> allows continuity of movement)

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10
Q

What are the different types of fascia present in the neck beneath the deep cervical fascia?

A

Pretracheal fascia: encloses trachea, oesophagus, and thyroid

Carotid sheath: contains common carotid artery (ant. -> med.), internal jugular vein (ant. -> lat.), vagus nerve (post.), deep cervical lymph nodes

note: pretracheal fascia and carotid sheath are fused

Prevertebral fascia: contains muscles surrounding the vertebrae (base of skull -> T2/T3

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11
Q

Describe how infection would spread in each space within the fascia of the neck, and what the consequences of this might be.

A

Superficial infections (outside the deep cervical fascia): e.g. cellulitis, abscesses —> fluctuant spread

Within retropharyngeal space: skull base —> diaphragm (mediastinitis)
note: rare; 2-4yrs, keeps head still, lymph node involvement

e.g. retropharyngeal abscess: pus accumulates in retropharyngeal space, between prevertebral fascia and the buccopharyngeal membrane —> compresses pharynx —> dysphagia and dysarthria (unclear pronunciation)

Within parapharyngeal space: skull base —> mediastinum (T2/T3)
note: rare; due to dental abscesses/tonsillitis spread, & can affect carotid sheath structures e.g. jugular vein thrombosis

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12
Q

Name the branches of the internal carotid artery present in the neck.

A

NONE

1st branch of internal carotid artery is the occipital, which does not enter the neck

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13
Q

How might the sternocleidomastoid muscle be damaged in newborns? How does this damage manifest?

A

Torticollis

Causes:

  • congenital: fibrous tissue tumour in sternocleidomastoid
  • acquired: torn during difficult birth/damaged by compression or pulling by forceps in delivery/damaged due to spending too long lying on back (why babies’ heads need to repositioned regularly)

Contraction/shortening of cervical muscles (dystonia) makes neck twist and head tilt (on affected side)

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14
Q

Contrast the neurocranium and the viscerocranium.

A

NEUROCRANIUM = cranial skeleton (calvaria + cranial base)
- supplied by internal carotid artery

note: calvaria = “skullcap”; dome-like superior portion of cranium (superior portions of frontal, parietal, and occipital bones)

VISCEROCRANIUM = facial skeleton (ethmoid, mandible, maxilla, zygomatic, nasal, lacrimal, palatine)
- supplied by external carotid artery

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15
Q

How does the neonatal skull differ to an adult skull?

A
  • facial skeleton small at birth
  • alveolar processes & paranasal sinuses rudimentary at birth
  • fontanelles present (large membranous, unossified gaps between skull bones) which allow the head to deform during passage through birth canal, + open sutures
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16
Q

What occurs when the frontal bones fail to fuse? What occurs when the frontal bones fuse prematurely?

A

Persistent metopic suture (median frontal suture)
note: no clinical significance, but can be mistaken for cranial fractures

Premature fusion = metopic synostosis —> trigonocephaly

17
Q

What complications can occur during childbirth resulting from the relative small size of the foetal mastoid processes?

A

Facial nerve emerges directly from the stylomastoid foramen onto the lateral surface of the skull

+ mastoid air cells do not develop until aged 2-3yrs

= facial nerve exposed —> increased risk of damage —> increased risk of facial nerve palsy/paralysis

note: after birth there is an increased risk of otitis media with effusion when the mastoid air cells are particularly small

18
Q

What is the antrum of the facial skeleton?

A

Maxillary sinus

19
Q

What is Paget’s disease of the bone? How does it affect the skull?

A

Osteitis deformans

Grossly disordered bone remodelling (irregular, woven trabecular bone with large osteoclasts) where formation exceeds resorption —> skull enlargement —> bone of middle cranial fossa remodelled —> progressive loss of hearing

Inflammation of periosteum of cranial bones —> headaches

Unknown aetiology

note: teeth can be displaced/fused with bone —> risk of severe haemorrhage during oral surgery

20
Q

Why might a fracture of the lower mandible cause numbness of the lower lip?

A

Mandibular nerve (CNV3) splits into inferior alveolar nerve as it moves over the mandible

Inferior alveolar nerve exits via mental foramen to supply the mucous membranes of lower lip and chin

Blocked during dental surgery

21
Q

What is the function of ligamentum nuchae? Where does it attach?

A

Continuation of interspinous and supraspinous ligaments of thoracic and lumbar vertebrae

Thickened fibroelastic tissue

Attaches to:

  • external occipital protruberance
  • posterior border of foramen magnum
  • spinous processes of cervical vertebrae

Preserves the normal curvature of the cervical spine

22
Q

Why are cervical vertebrae prone to dislocation in whiplash injuries?

A

Articular facets of the cervical vertebrae are more horizontally orientated, so the vertebrae are less tightly interlocked

Less energy required to dislocate than fracture

note: due to large vertebral foramina, slight dislocations can occur without damaging the spinal cord
note: whiplash injuries can be caused by both hyperextension of the neck (can tear ant. longitudinal ligament) and hyperflexion of the neck (can dislocate vertebral arches)

23
Q

How can severe whiplash injuries cause death?

A

Fracture of the vertebral arch of the axis (C2) - hangman’s fracture:

If the body of C2 is displaced anteriorly with respect to the body of C3, this compresses the spinal cord, which can cause quadriplegia or death (if spinal cord compressed above phrenic nerve outflow —> respiration ceases)

Ruptured ant. longitudinal ligament & annulus fibrosus of C2-C3 intervertebral disc —> cranium, C1, & dens and body of C3 separated from rest of axial skeleton —> severs spinal cord

24
Q

By which route might you aspirate a subdural haematoma in a baby?

A

Through open suture and anterior fontanelle of cranium (percutaneously) —> through dura mater and into subdural layer

Direct needle laterally, i.e. between the membranous portions of the frontal and parietal bones

25
Q

What are the most important orbital muscles of facial expression? (More needed?)

A

Orbicularis oculi: protects cornea by closing eyes

  • orbital: forceful closure of eyelids
  • palpebral: gentle closure of the eyelids

Corrugator supercili: draws eyebrows medially and downwards (vertical wrinkles on bridge of nose)

26
Q

What are the most important nasal muscles of facial expression? (More needed?)

A

Nasalis:

  • alar: opens nares
  • transverse: compresses nares

Procerus: pulls medial angle of eyebrows downward to produce transverse wrinkles in nose

Depressor septi nasi: pulls nose inferiorly (opens nares)

27
Q

What are the most important oral muscles of facial expression? (More needed?)

A

Orbicularis oris: purses the lips (closes and protrudes lips)
- loss of —> mouth droops & drools

Buccinator: pulls cheek inwards against the teeth (preventing accumulation of food in that area) & compresses distended cheeks

Motor innervation = mandibular branch of motor root of facial nerve

28
Q

List some of the minor facial muscles. (More needed?)

A

Upper:

  • risorius
  • zygomaticus major & minor
  • levator labii superioris
  • levator labii superioris alaeque nasi
  • levator anguli oris

Lower:

  • depressor anguli oris
  • depressor labii inferioris
  • mentalis

+ ant., sup., & pos. auricular (ear upwards & backwards)
+ occipitofrontalis
- frontal belly: wrinkles forehead, raises eyebrows
- occipital belly: draws scalp backwards

29
Q

Which nerves provide the sensory innervation of the face and neck?

A

Face = cutaneous branches of trigeminal nerve (CNV):

  • ophthalmic (CNV1)
  • maxillary (CNV2)
  • mandibular (CNV3)

Neck = cutaneous branches of cervical plexus (neck, parotid region, angle of mandible) - transverse cervical nerve (C1 & C2)

30
Q

What nerve branches run through the parotid gland?

A

Facial nerve extracranial branches: To Zanzibar By Motor Car

  • temporal
  • zygomatic
  • buccal
  • mandibular
  • cervical

(+ posterior auricular?)

31
Q

Why does parotidectomy/parotid gland carcinoma cause facial weakness and impaired sensation? (More needed?)

A

Facial nerve compression

Muscles of facial expression affected

32
Q

What are the muscles of the posterior triangle of the neck?

A
  • sternocleidomastoid
  • trapezius
  • omohyoid
  • levator scapulae
  • anterior, middle, and posterior scalene muscles
  • splenius capitis
33
Q

What are the contents of the carotid sheath?

A
  • common carotid artery —> internal carotid artery (superior part of sheath only)
  • internal jugular vein
  • vagus nerve
  • deep cervical lymph nodes

note: carotid sheath closely related to pretracheal, prevertebral, and investing layers of deep fascia

34
Q

What are the boundaries and contents of the carotid triangle?

A

Superior boundary: posterior belly of digastric

Medial boundary: superior belly of omohyoid

Lateral boundary: anterior border of sternocleidomastoid

  • internal jugular vein
  • bifurcation of common carotid (therefore can palpate carotid pulse)
  • vagus nerve
  • hypoglossal nerve
35
Q

What anatomical structures in the head and neck are derived from somites?

A

Platysma
Orbicularis oris
Other lower lip muscles

36
Q

What is the key difference between muscles of facial expression and other skeletal muscles?

A

Face is lacking in deep fascia, so the muscles insert deep into the skin —> contraction results in changes in facial expression

37
Q

Reminder: what is the definition of a motor unit?

A

Combination of a motor nerve and the muscle fibres it supplies

38
Q

How can C1-C6 be discerned?

A

C1 = hard palate

C2 = angle of mandible

C3 = hyoid bone

C4 = upper border of thyroid cartilage

C5 = lower border of thyroid cartilage

C6 = cricoid cartilage

39
Q

What are some important landmarks present at C6 in the neck?

A
  • junction of larynx with trachea & junction of pharynx with oesophagus
  • vertebral arteries enter transverse foramina of C6 vertebrae
  • carotid pulse (felt by pressing common carotid artery against carotid tubercle of transverse process of C6 vertebra)
  • inferior border of cricoid cartilage
  • superior belly of omohyoid crosses carotid sheath
  • inferior thyroid artery enters thyroid gland & middle thyroid vein emerges from thyroid gland
  • middle cervical sympathetic ganglion

Head & Neck (12 decks)

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