General Organisation of the Head and Neck

Question 1

Below the cranium, made up of the neuro and viscero cranium are 2 cartilages, a gland and a bone in the neck, order them.

Answer 1

Hyoid bone, thyroid cartilage (superior to Adam’s apple), cricoid cartilage the thyroid gland.

Question 2

What are the neck muscles supplied by (nerve wise)?

Answer 2

Platysma, sternocleidomastoid and trapezius are supplied by cranial nerves, as are supra-hyoid muscles (elevate and draw hyoid anteriorly), but infra-hyoids (which antagonise), are supplied by the cervical nerve (C1-3).

Question 3

Platysma sits in the __________ cervical fascia, running from the lower __________, down the neck and over the __________ to the chest wall. As a muscle of ________ __________, it’s innervated by the facial nerve (cranial nerve ___).

Answer 3

Superficial
Lower
Clavicle
Facial expression
VII

Question 4

What does the platysma do?

Answer 4

Contracting, it furrows the skin of the neck, depresses the corner of the mouth and assists in depression of the jaw.

Question 5

The is a sternocleidomastoid muscle on each side of the neck, where does it run and what is it innervated by?

Answer 5

Runs from both the medial clavicle and the sternum to the mastoid process. Innervated by the Accessory nerve.

Question 6

What does the sternocleidomastoid do?

How is it tested?

Answer 6

Together they flex the neck and singly produce lateral flexion, tilting the chin up contralaterally.
Have patient turn head to see and try to go back against resistance.

Question 7

What may happen to the sternocleidomastoid muscle in Torticollis?

Answer 7

Involuntary contraction.

Question 8

The trapezius muscles on either side are innervated by the Accessory nerve and can be tested by asking a patient to shrug against resistance, where do they run and what do they do in the head and neck?

Answer 8

The superior fibres elevate the shoulder and rotate the scapula for abduction.
They run from the external occipital protuberance, Michal ligament and spinous processes of C7-T1 to the spine of the scapula, acromion and lateral anterior 1/3 of clavicle.

Question 9

How may Accessory nerve damaged by noticed in the head and neck?

Answer 9

Wasting f the trapezius would result in asymmetry.

Question 10

What are the purposes of the anterior and posterior triangles in the neck?

Answer 10

Anterior is for structures running between the neck and the thorax and the posterior triangle is for structures from the thorax and neck to the upper limb.

Question 11

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

Answer 11

Inferior margin of mandible, imaginary midline and anterior border of SCM

Question 12

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

Answer 12

Clavicle, posterior border SCM and anterior trapezius.

Question 13

Hyoid muscles overlie the larynx and thyroid, which two, along with the SCM make the carotid triangle?

Answer 13

The infra hyoid muscle (aka strap muscle), is Omohyoid, which disappears behind the SCM.
The supra hyoid muscle is the Digastric - runs from mandible to hyoid to mastoid process.

Question 14

What is the purpose of fascial planes in the neck?

Answer 14

They help contain the spread of infection and promote ease of movement between structures.

Question 15

There is one superficial layer of neck fascia and 3 deep (not including the carotid sheath), what are they?

Answer 15

(Deep cervical…) Investing fascia
Pretracheal fascia
Prevertebral fascia

Question 16

The 4 deep cervical fascia are dense CT but the superficial is loose. What may the superficial cervical fascia contain? (5)

Answer 16

Fat, lymph nodes, platysma, cutaneous nerves and superficial blood vessels.

Question 17

What does the carotid sheath contain?

Answer 17

The common carotid artery (then ICA-bifurcates at C4), vagus nerve and internal jugular vein (plus maybe lymph nodes).

Question 18

The investing fascia is like a collar that encircles all deep fascia structures, including the trapezius and sternocleidomastoid muscles, what do the pretracheal and prevertebral fascia contain?

Answer 18

Pretracheal - trachea, oesophagus and thyroid gland.

Prevertebral - cervical vertebrae and surrounding vertebral muscles.

Question 19

What is the buccopharyngeal fascia?

Answer 19

A posterior thickening of the pretracheal fascia.

Question 20

Where is the retropharyngeal space and what is its significance in infection?

Answer 20

The retropharyngeal space lies posterior to the buccopharyngeal fascia, anterior to the prevertebral fascia and with the pretracheal space extends inferiorly into the mediastinum. Infections in these spaces may spread, leading to Mediastinitis. Inserting surgical airways could bring risk.

Question 21

Muscles of fascial ________ act as dilatory/__________ attaching to _____ and skin/fascia. They’re innervated by the ________ nerve (cranial nerve VII).

Answer 21

Expression
Sphincter
Bone
Facial

Question 22

Muscles of mastication are innervated by the trigeminal nerve, cranial nerve V, what is their function?

Answer 22

Open and close jaw, necessary for chewing.

Question 23

The trigeminal nerve is the main sensory nerve to the face and scalp, what are the 3 branches?

Answer 23

O Max Man:

Va Ophthalmic, Vb Maxillary and Vc Mandibular.

Question 24

The facial nerve had 5 key extracranial nerves, what are they?

Answer 24

To Zanzibar By Motor Car:
Temporal, Zygomatic, Buccal, Mandibular, Cervical.
Terminates by branching in the parotid gland.

Question 25

The common carotid artery (by its branches) is the main supplier of the head, what is the difference in the drainage of the internal and external jugular veins?

Answer 25

The IJV does the main head and neck drainage, but the EJV, which runs more superficially, also drains the scalp and face.

Question 26

Name the 4 muscles of mastication.

Answer 26

Masseter 
Temporalis
Lateral pterygoid - opens mouth
Medial pterygoid - closes
(Buccinator isn't one, but keeps food in oral cavity proper)

Question 27

What are the layers of the scalp?

Answer 27

Skin, dense Connective tissue, Aponeurosis, Loose CT, Periosteum.

Question 28

What are the functions of the different parts of Orbicularis oculi?

Answer 28

The palpebral part gently closes the eye (can do so unconsciously), where as the orbital part scrunches up the eyes.
Lacrimal part acts as tear pump.

Question 29

Lavator palpabrae superioris antagonises the obicularis oculi, how, where is it and what innervates it?

Answer 29

It is innervated by the occulomotor nerve to elevate and retract the upper eyelid. Proses can result if it doesn’t work. The muscles runs above and behind the eye into the socket.