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ESA 4 - Head and Neck > General Organisation of Head and Neck > Flashcards

General Organisation of Head and Neck Flashcards

1
Q

What does the head consist of?

A
  • Scalp
  • Skull
  • Brain and its coverings (meninges)
  • Special sense organs
  • Muscles
  • Cranial nerves and their branches
  • Glands
  • Blood vessels
  • Lymphatics
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2
Q

What is true of many of the structures of the head?

A

They also run through the neck

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3
Q

What are the structure of the head that run through the neck in close relationship with?

A
  • Thyroid gland
  • Pharynx
  • Larynx
  • Trachea
  • Oesophagus
  • Cervical vertebrae
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4
Q

Where does the neck extend?

A
  • Between the lower margin of the mandible superiorly
  • To suprasternal notch of manubrium and upper border of clavicle inferiorly
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5
Q

What is the necks overall function?

A

Connects head to rest of body

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6
Q

What happens to structures in the neck?

A

They are compartmentalised by concentric fascial layers creating compartments running through the neck

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7
Q

What are the functions of the fascial planes of the neck?

A
  • Form natural planes
  • Ease of movements between structures
  • Contains spread of infection
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8
Q

When is ease of movement between structures in the neck important?

A

During swallowing

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9
Q

Give an example of where fascial planes of the neck contain the spread of infection

A

Superficial skin infection in skin of neck cannot track deeper

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10
Q

What are the layers of fascial planes of neck?

A
  • Superficial fascial layer
  • Three deep cervical fascial layers
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11
Q

Where is the superficial fascial layer found?

A

Just below the skin

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12
Q

What is the superficial fascial layer made up of?

A

Largely fatty tissue, with;

  • External jugular vein
  • Cutaneous nerves
  • Superficial lymph nodes
  • Platysma muscle
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13
Q

What are the deep cervical fascial layers named according to?

A

What they do, or the structures they’re surrounding

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14
Q

What are the names of the three deep cervical fascial layers?

A
  • Investing layer
  • Pretracheal layer
  • Pre-vertebral layer
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15
Q

What does the investing cervical fascial layer do?

A

Surrounds the entire neck, like a collar

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16
Q

What is the superior margin of the investing cervical fascial layer attached to?

A
  • Entire lower border of mandible (midline to angle)
  • Mastoid process
  • Superior nuchal line
  • External occipital protuberance in the posteiror midline
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17
Q

What does the investing cervical fascial layer attach to posteriorly?

A
  • Spinous process of vertebrae
  • Ligamentum nuchae
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18
Q

What does the investing layer of cervical fascia attach to inferiorly?

A
  • Upper border of manubrium
  • Upper surface of clavicle
  • Acromion
  • Spine of scapula
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19
Q

What does the investing layer of cervical fascia split to enclose?

A
  • Sternocleidomastoid
  • Trapezius
  • Submandibular salivary gland
  • Parotid salivary glands
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20
Q

Is the pre-tracheal layer of cervical fascia thick or thin?

A

Thin

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21
Q

What is the pre-tracheal layer of cervical fascia limited to?

A

Anterior part of neck

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22
Q

What is the pretracheal layer of cervical fascia attached to in superiorly?

A

Hyoid bone

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23
Q

What happens to the pre-tracheal layer of fascia inferiorly?

A

It extends into the thorax, where it binds with the fibrous pericardium

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24
Q

What does the pre-tracheal layer of cervical fascia consist of?

A
  • Muscular layer
  • Visceral layer
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25
Q

What does the muscular layer of the pretracheal cervical fascia do?

A

Encloses the infrahyoid muscles

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26
Q

What does the visceral layer of the pre-tracheal cervical fascia do?

A

Encloses;

  • Oesophagus
  • Thyroid gland
  • Trachea
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27
Q

What does the visceral layer of pre-tracheal fascia do around the thyroid gland?

A

Splits around it to form a ‘false capsule’

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28
Q

What does the pre-vertebral layer of cervical fascia do?

A

Forms a sheath for the vertebral column and muscles associated with it

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29
Q

Where does the prevertebral layer of cervical fascia extend?

A

Base of cranium to 3rd thoracic vertebrae

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30
Q

How does the prevertebral layer of cervical fascia extend laterally?

A

As the axillary sheath

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31
Q

What does the axillary sheath surround?

A
  • The brachial plexus of nerves
  • Axillary vessels
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32
Q

What is the carotid sheath?

A

A tubular, fibrous structure

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33
Q

What is the carotid sheath formed from?

A

All three layers of deep cervical fascia

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34
Q

Where does the carotid sheath extend?

A

From base of cranium, through root of neck, to arch of aorta

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35
Q

What does the carotid sheath create?

A

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

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36
Q

What structures run through the carotid sheath?

A
  • Common carotid artery
  • Internal jugular vein
  • Vagus nerve (CN X)
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37
Q

What does the fascial compartmentilisation of structures in the neck give rise to?

A

Potential spaces between fascial planes

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38
Q

Where does the retropharyngeal space lie?

A

Between the prevertebral layer of fascia and the fascia surrounding the fascia (more specificially, the buccopharyngeal fascia)

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39
Q

What does the retropharyngeal space initially contain?

A

Lymph nodes

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40
Q

Up until when does the retropharyngeal space contain lymph nodes?

A

Up until age 3-4

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41
Q

What is the retropharyngeal space helpful in?

A
  • Allow pharynx to move freely on vertebral column
  • Expanding during swallowing
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42
Q

What is the problem with the retropharyngeal space?

A

Infection can collect

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43
Q

What areas in the neck are readily palpable (sometimes visible)?

A
  • Thyroid cartilage (Adam’s Apple)
  • Cricoid cartilage
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44
Q

What is the function of cartilage in the neck?

A

Supports underlying larynx

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45
Q

Where is the thyroid gland found?

A

At the base of the neck

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46
Q

Is the thyroid gland palpable?

A

Not unless enlarged

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47
Q

What is the purpose of the hyoid bone in the neck?

A

Attachment of lots of muscles, including strap like infrahyoid muscles

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48
Q

What course do the infrahyoid muscles take?

A

They descend from the hyoid bone

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49
Q

What is the neck divided into by anatomical borders?

A

Two triangles

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50
Q

What are the borders of the anterior triangle?

A
  • Superior - Inferior margin of mandible
  • Medial - Midline of neck
  • Lateral - Anterior margin of sternocleidomastoid
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51
Q

What structures are associated with the anterior triangle?

A

Structures coursing between the head and thorax

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52
Q

What are the border of the posterior triangle?

A
  • Inferior - Clavicle
  • Medial - Posterior margin of sternocleidomastoid
  • Lateral - Anterior margin of trapezius
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53
Q

What structures are associated with the posterior triangle?

A

Those coursing between thorax/neck and upper limb

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54
Q

Give an example of a structure associated with the posterior triangle?

A

Trunks of brachial plexus

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55
Q

Why are the anatomical triangles of the neck helpful?

A

Because different structures are found in them

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56
Q

What can diseases affecting the thyroid gland cause?

A
  • Enlargement of the gland
  • Discrete lumps
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57
Q

What can help localise a pathology to the thyroid gland?

A

Asking a patient with a swelling/lump in their neck to swallow, and observing wether it moves

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58
Q

Why will swelling/lumps associated with the thyroid gland move when swallowing?

A

The thyroid gland is enclosed by pre-tracheal fascia, which is attached to hyoid bone. The hyoid bone and larynx move up when swallowing, so hyoid bone will too, and any swelling or lump will involving this gland

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59
Q

What is an enlarged thyroid gland termed?

A

A goite

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60
Q

Where can a goite sometimes extend?

A

Retrosternally, through the root of the neck

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61
Q

Why can a goite sometimes extend through the root of the neck?

A

Because the lower limit of pre-tracheal fascia extends into the thorax

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62
Q

What can retrosternal extension of a goite lead to?

A

Compression of other structures running through the root of the neck

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63
Q

What structures can be compressed in a retrosternal extension of goite?

A
  • Trachea
  • Venous blood vessels
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64
Q

What symptoms can compression of the tracheal by a retrosternally extending goite lead to?

A
  • Breathlessness
  • Stridor
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65
Q

What symptoms can compression of venous blood vessels due to a retrosternally extending goite lead to?

A

Facial oedema, due to decreased venous drainage from head and neck

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66
Q

What do the layers of deep cervical fascia form?

A

Natural cleavage plates

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67
Q

What is the function of the natural cleavage plates formed by deep cervical fascia?

A
  • Allows structure to move and pass over one another with ease
  • Allows easy seperation of tissues during surgery
  • These layers determine the direction and extent to which any infection occuring within the neck may spread
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68
Q

Where can infection develop, regarding the fascial planes of the neck?

A
  • Retropharyngeal space
  • Pre-tracheal space
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69
Q

What is infection in the retropharyngeal and pre-tracheal space usually secondary to?

A

Throat infection

70
Q

What can potentially result from an infection in the retropharyngeal space and pre-tracheal space?

A

Can spread from neck into thorax, down as far as posterior mediastinum, which risks the development of mediastinitis

71
Q

What is the problem with mediastinitis?

A

Life threatening

72
Q

Is mediastinitis common?

A

No, it is rare

73
Q

What may infection in the retropharyngeal or pre-tracheal space develop into?

A

Abscess

74
Q

What is important when someone has an abscess caused by infection in retropharyngeal or pre-tracheal space?

A

Recognise and treat early

75
Q

Why must an abscess in the retropharyngeal or pre-tracheal space be recongised and treated early?

A

Carries significant morbiditity and mortality

76
Q

How may an abscess caused by infection in the retropharyngeal or pre-tracheal space present?

A
  • Visible bulge on inspection of oropharynx
  • Sore throat
  • Difficulty swallowing
  • Stridor
  • Neck stiffness
  • High temperature
77
Q

What risks the insertion of bacteria into the pre-tracheal space?

A

Inserting surgical airways

78
Q

What are most of the arteries supplying the face branches of?

A

The external carotid arteries

79
Q

How does the external carotid artery terminate?

A

As superficial temporal artery and maxillary artery

80
Q

What happens to the external carotid artery after termination?

A

It gives rise to a number of branches

81
Q

What important branche does the external carotid artery give rise to before termination?

A

Facial artery

82
Q

Why is the facial artery important?

A

It is the major arterial supply of the face

83
Q

Where can the pulse of the facial artery be palpated?

A

As the artery winds around the inferior border of the mandible

84
Q

Where does the facial artery have many anastomoses?

A

With other arteries of the face

85
Q

What is the result of the facial artery having many anastomoses with other arteries of the face?

A

In the event of laceration of artery on one side, it is necessary to compress both arteries to stop bleeding

86
Q

What runs with the facial artery?

A

The facial vein

87
Q

What course does the facial vein take?

A

From medial angle of eye, to inferior border of mandible

88
Q

What does the facial vein constitute?

A

The major venous drainage of the face

89
Q

What does the facial vein drain into?

A

The internal jugular vein

90
Q

What forms the external jugular vein?

A
  • Superficial temporal vein
  • Maxillary vein
  • Other veins
91
Q

What do the internal and external jugular veins drain into?

A

Subclavian vein

92
Q

What are the major muscles and groups of the head and neck?

A
  • Sternocleidomastoid
  • Trapezius
  • Muscles of facial expression
  • Muscles of the cheek (buccinators)
  • Occipitofrontalis muscle
  • Muscles of mastication
  • Superficial muscle of neck and chin (platysma)
  • Muscle of ear
93
Q

What is the sternocleidomastoid innervated by?

A

Accessory nerve (CN XI)

94
Q

What is the origin of the sternocleidomastoid?

A

Mastoid process

95
Q

What happens to the body of the sternocleidomastoid?

A

It splits into two heads, sternal and clavicular

96
Q

Where does the sternocleidomastoid insert?

A
  • Sternal head into sternum
  • Clavicular head into clavicle
97
Q

Where does the sternocleidomastoid lie relative to the platysma?

A

Deep

98
Q

Is the sternocleidomastoid palpable and visible?

A

Yes, especially when tensing the muscle

99
Q

What is the action of the sternocleidomastoid?

A
  • When acting unilaterally, lateral flexion of neck, moving ear towards shoulder, and rotates chin superiorly
  • When acting bilaterally, flexion at neck and extension at joint between base of skull and cervical vertebrae (atlanto-occipital joint)
100
Q

What does the trapezius arise from?

A
  • Back of skull
  • Nuchal ligament
  • Spinous process of vertebrae
101
Q

Where does the trapezius insert?

A
  • Lateral 1/3 of clavicle
  • Acromion
  • Spine of scapula
102
Q

Why does the trapezius have many actions?

A

Due to it being a very broad muscle

103
Q

What actions of the trapezius are important when considering the neck?

A

Elevates and rotates the shoulders, ‘shrugging’ them

104
Q

Is the trapezius muscle visible?

A

Superior border is visible when shoulders shrugged against resistance

105
Q

What is the trapezius supplied by?

A

The accessory nerve (CN XI)

106
Q

What to the sternocleidomastoid and trapezius form?

A

Important anatomical boundaries of the neck

107
Q

What are the muscles of facial expression supplied by?

A

The facial nerve (CN III)

108
Q

How do many of the muscles of facial expression act?

A

As dilators and sphincters

109
Q

Give 4 muscles of facial expression

A
  • Orbicularis oculi
  • Levator palpebrae superioris
  • Orbicularis oris
  • Dilator muscles of lips
110
Q

What are the parts of the orbicularis oculi?

A
  • Palpebral part
  • Orbital part
111
Q

What does the palpebral part of the orbicularis oculi do?

A

Performs gentle closure of eyelid

112
Q

What does the orbital part of the orbicularis oculi do?

A

Closes more forcefully

113
Q

What does the levitor palpabrae superioris do?

A

Elevates the upper eyelid

114
Q

What is the innervation of the levator palpebrae superioris?

A
  • Oculomotor nerve (CN III)
  • Superior tarsal muscle (located within the LPS) is innervated by sympathetic nervous system
115
Q

What does the orbicularis oris do?

A

Purses the lips

116
Q

What do the dilator muscles of the lips do?

A

Opens the mouth

117
Q

What do the muscles of the cheek do?

A
  • Keep cheek taut
  • Aid in chewing
118
Q

What are the muscles of the cheek supplied by?

A

Facial nerve (CN VII)

119
Q

Give a muscle of the cheek

A

Buccinator

120
Q

What does the buccinator do?

A

Pulls cheek inwards against teeth

121
Q

What is the function of the buccinator pulling cheeks inwards against the teeth?

A

Prevents accumulation of food in the area

122
Q

What is the occipitofrontalis muscle supplied by?

A

Facial nerve (CN VII)

123
Q

What are the muscles of mastication supplied by?

A

Mandibular division of trigeminal nerve (branch of CN IV)

124
Q

What do the musles of mastication act to do?

A

Open and close the jaw

125
Q

Are there more or less muscles of mastication than muscles of facial expression?

A

Less

126
Q

Give 4 muscles of mastication

A
  • Medial and lateral pterygoids
  • Masseter
  • Temporalis
127
Q

What does the lateral pterygoid do?

A
  • Acting bilaterally, protract the mandible, moving jaw forward
  • Acting unilaterally, produce side to side movement of jaw
128
Q

What does the medial pterygoid do?

A

Elevates the mandible, closing the mouth

129
Q

What does the temporalis muscle do?

A
  • Elevates the mandible, closing the mouth
  • Retracts the mandible, pulling the jaw posteriorly
130
Q

What is the platysma supplied by?

A

Facial nerve (CN VII)

131
Q

Describe the shape of platysma

A

Broad, sheet like

132
Q

Where does platysma lie?

A
  • Anteriorly in the neck
  • Very superficial
133
Q

What are the actions of platysma?

A
  • Draws corner of mouth inferiorly
  • Draws skin of neck superiorly if teeth are clenched
134
Q

What are the muscles of the ear supplied by?

A

Facial nerve (CN VII)

135
Q

Where do the muscles of the face lie?

A

In subcutaneous tissue

136
Q

What do most muscles of the face attach to?

A

Bone or fascia

137
Q

How do the muscles of the face produce their effects?

A

By pulling the skin

138
Q

What orifaces to the muscles of the face surround?

A
  • Mouth
  • Eyes
  • Nose
139
Q

What happens to the facial nerve once it has exited the cranium?

A

It enters the substance of the parotid gland

140
Q

What happens to the facial nerve in the parotid gland?

A

It divides into its five extracranial branches

141
Q

What will injury or pathology involving the facial nerve cause?

A

Muscle weakness of muscles of facial expression on ipsilateral side

142
Q

What is the most common non-traumatic cause of facial paralysis?

A

Bell’s palsy

143
Q

What is Bell’s palsy?

A

Inflammation of facial nerve near its exit from the cranium at the stylomastoid foramen

144
Q

What does inflammation of the facial nerve cause?

A

Oedema and compression of nerve in intracranial facial canal

145
Q

What is the clinical relevance of the facial nerve in the parotid gland?

A

As the facial nerve and its branches run through the parotid gland, and lie relatively superficial, they are vulnerable to damage in injuries to face, and in disease or surgery of the parotid gland

146
Q

Where do cranial nerves arise from?

A

Brainstem, or slightly above

147
Q

Where to the cranial nerves leave the skull?

A
  • Those supplying face leave through front of skull
  • Those supplying neck leave through base of skull
148
Q

What cranial nerve is the trigeminal nerve a branch of?

A

V

149
Q

What are the key branches of the trigeminal nerve?

A
  • Opthalmic
  • Maxillary
  • Mandibular
150
Q

What does the mandibular nerve do?

A

Supplies motor innervation to the muscles of mastication

151
Q

What is the importance of the trigeminal nerve?

A

Main sensory nerve of the face and scalp

152
Q

Draw a diagram illustrating the cutaneous distribution of the trigeminal nerve

A
153
Q

What aspects of the trigeminal nerve can be tested?

A
  • Sensory supply
  • Motor supply
154
Q

How is the sensory supply of the trigeminal nerve tested?

A
  • Ask patient to close their eyes
  • Introduce cottom wisp into areas of face supplied by three divisions of trigeminal nerve

This detects tactile sensory competence

155
Q

How is the motor supply of the trigeminal nerve tested?

A
  • Ask patient to clench their jaw, and palpate;
    • Superior to zygomatic arch
    • Inferiorly
  • Ask patient to open mouth and deviate mandible to left and right
156
Q

What is being felt for when palpating superior to zygomatic arch in trigeminal nerve testing?

A

Temporalis

157
Q

What is being felt for when palpating inferiorly in trigeminal nerve testing?

A

Masseter

158
Q

What is being tested for when asking patient to open mouth and deviate mandible to left and right in trigeminal nerve testing?

A

Competence of medial and lateral pterygoid muscles

159
Q

What cranial nerve is the facial nerve derived from?

A

VII

160
Q

What are the key branches of the facial nerve?

A
  • Temporal
  • Zygomatic
  • Buccal
  • Marginal mandibular branches
  • Cervical
161
Q

What does the temporal branch of the facial nerve innervate?

A
  • Frontalis
  • Orbicularis oculi
  • Corrugator supercilli
162
Q

What do the zygomatic branches of the facial nerve innervate?

A

Orbicularis oculi

163
Q

What do the buccal branches of the facial nerve innervate?

A
  • Orbicularis oris
  • Buccinator
  • Zygomaticus
164
Q

What do the marginal mandibular branches of the facial nerve innervate?

A

Mentalis

165
Q

What does the cervical branch of the facial nerve innervate?

A

Platysma

166
Q

What are the non-motor functions of the facial nerve?

A
  • Special sensory to the tongue, for taste
  • Provides parasympathetic innervation to lacrimal glands and salivary glands
167
Q

What can pathology of the parotid gland cause, regarding the facial nerve?

A

Can also affect the nerve, causing paralysis of facial expression

168
Q

How is the facial nerve tested?

A
  • Test corneal reflex
  • Ask patient to;
    • Raise eyebrows
    • Close eyes, and keep them closed against resistance
    • Puff their cheeks
    • Reveal their cheeks
169
Q

When is the corneal reflex absent?

A

In damage to trigeminal/opthalmic nerve, or facial nerve

170
Q

What is the corneal reflex?

A

Involuntary blinking of eyelids, stimulated by tactile, thermal, or physical stimulation of cornea

171
Q

Why must both side of the face be tested in facial nerve testing?

A

As they are paired nerves

172
Q

ADD PICTURES

A

ESA 4 - Head and Neck (30 decks)

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