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Head - 4 > General organisation of H&N - fascial planes of neck > Flashcards

General organisation of H&N - fascial planes of neck Flashcards

1
Q

what does the head consist of?

A 
scalp, skull, brain & coverings (meninges)
special sense organs
muscles
cranial nerves & branches
glands
blood vessels
lymphatics
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2
Q

what do the structures of the head run through the neck in close relation to?

A 
thyroid gland
pharynx
larynx
trachea
oesophagus
cervical vertebrae
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3
Q

where does the next extend from to?

A

from lower margin of mandible
to suprasternal notch of manubrium & upper border of clavicle below
connects head to rest of body

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4
Q

how are structures in the neck compartmentalised?

A

by layers of cervical fascia

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5
Q

how many layers of cervical fascia are there?

A

superficial cervical fascia

3 deep cervical fascia layers

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6
Q

describe the superficial cervical layer

A

just below the skin

largely fatty tissue

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7
Q

what is within the superficial cervical layer?

A

superficial blood vessels within (external jugular vein, cutaneous nerves, superficial lymph nodes)
platysma muscle

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8
Q

what are the 3 layers of deep cervical fascia? (superficial to deep)

A

investing layer
pretracheal layer
prevertebral layer

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9
Q

what is formed by all 3 layers of deep cervical fascia?

A

carotid sheath

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10
Q

what does the carotid sheath create?

A

a compartment for a number of neurovascular structures running between the head and thorax

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11
Q

what does the investing layer (most superficial layer) of the deep cervical fascia surround?

A

the entire neck like a collar

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12
Q

where does the superior margin of the investing layer attach?

A

on each side to the entire lower border of the mandible (midline to angle)
the mastoid process, the superior nuchal line
external occipital protuberance in posterior midline

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13
Q

what does the investing layer attach to posteriorly?

A

spinous processes of the vertebrae

ligamentum nuchae

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14
Q

what does the investing layer attach to inferiorly?

A

upper border of the manubrium
upper surface of the clavicle
acromion
spine of scapula

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15
Q

what does the investing layer split to enclose?

A

sternocleidomastoid
trapezius muscle
submandibular + parotid salivary glands

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16
Q

describe the pretracheal layer (middle)? where it sits?

A

thin and limited to anterior part of the neck

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17
Q

what does the pretracheal layer attach to superiorly?

A

hyoid bone

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18
Q

what does the pretracheal layer attach to inferiorly?

A

extends into the thorax - blends with fibrous pericardium

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19
Q

what does the pretracheal layer consist of? what do they enclose?

A

muscular layer enclosing the infrahyoid muscles

visceral layer - encloses thyroid gland, trachea, oesophagus

20
Q

what happens to the visceral layer as it encloses the thyroid gland?

A

splits around the thyroid gland to form a false capsule

21
Q

what do diseases affected the thyroid gland cause?

A

enlargement of gland (goitre) / discrete lumps to appear

22
Q

how can you localise pathology to the thyroid gland?

A

asking patient with a swelling or lump in their neck to swallow and observing whether it moves

23
Q

why does the thyroid gland move when swallowing?

A

thyroid gland is enclosed by pre-tracheal fascia - which is attached to the hyoid bone (superiorly)

24
Q

which level is the hyoid bone at?

A

C3

25
Q

what moves up when swallowing?

A

hyoid bone and larynx (so will thyroid + any swelling / lump involved)

26
Q

where can enlarged thyroid gland sometimes be extended to?

A

retrosternally, through the root of the neck

27
Q

why can enlarged thyroid sometimes be extended retrosternally?

A

because lower limit of the pre-tracheal fascia (middle) extends into thorax

28
Q

what can retrosternal extension of a goitre lead to?

A

compression of other structures running through the root of the neck (thoracic inlet) e.g. trachea + venous blood vessels

29
Q

what symptoms can compression of other structures running through thoracic inlet via goitre lead to?

A

breathlessness + stridor - tracheal compression

facial oedema - compression impending venous drainage from head + neck

30
Q

what is the carotid sheath?

A

a tubular, fibrous structure that extends from base of cranium through the root of neck to arch of aorta

31
Q

what does the carotid sheath contain?

A 
a number of structures including:
common carotid artery
internal jugular vein
vagus nerve (CN X)
32
Q

what does the prevertebral layer (innermost) of deep cervical fascia form?

A

a sheath for the vertebral column and muscles associated with it

33
Q

where does the prevertebral layer extend?

A

from base of cranium to 3rd thoracic vertebra

34
Q

what does the prevertebral layer extend laterally as? surrounding what?

A

as the axillary sheath that surrounds the axillary vessels and the brachial plexus of nerves running into the upper limb

35
Q

what do the layers of deep cervical fascia form?

A

natural cleavage planes allowing structures to move pass one another with easy and easy separation of tissues during surgery

36
Q

what do the fascial layers determine?

A

the direction and extent to which any infection occurring within the neck may spread

37
Q

what do the fascial compartmentalisation of structures in the neck give rise to?

A

potential spaces between fascial planes

38
Q

what is an important deep neck space?

A

the retropharyngeal space

39
Q

where does the retropharyngeal space lie?

A

between prevertebral layer of fascia and fascia surrounding the pharynx

40
Q

what is the fascia surrounding the pharynx? what is it a component of?

A

buccopharyngeal fascia - component of pre-tracheal (middle) fascia

41
Q

what does the retropharyngeal space contain up until 3-4 years old?

A

lymph nodes

42
Q

what is the retropharyngeal space helpful in?

A

allowing the pharynx to move freely on the vertebral column and expand during swallowing
can be space for infection to collect

43
Q

where can an infection that develops in the retropharyngeal space potentially spread from? to? risking development of what?

A

neck into thorax as far down as the posterior mediastinum

risking development of mediastinitis (rare but life threatening)

44
Q

what can an infection in the retropharyngeal space be secondary to? common age group?

A

throat infection

commonly in children under 5 years

45
Q

what can infection in retropharyngeal space develop into?

A

an abscess (collection of pus)

Head - 4 (111 decks)

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