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H&N 1 Flashcards

1
Q

What is a suture?

A

Fibrous Synarthrosis join with no movement Attaches bones of skull together, apart from mandible which forms the lower jaw

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2
Q

How may cervical pain be caused? (3)

A

Inflamed LNs Muscle strain Displacement/protrusion of inter-vertebral discs

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3
Q

What do the buccinators do?

A

these are the muscles of the cheek, keep cheek taut and aid in chewing

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4
Q

Nerve supply to muscles of mastication?

A

Mandibular division of trigeminal nerve

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5
Q

What does the facial nerve (7th cranial) supply?

A

Muscles of facial expression Muscles of ear e.g. stapedius Stylohyoid P belly of digastric

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6
Q

Where does the facial nerve divide into extra-cranial branches?

A

parotid gland

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7
Q

What is the facial artery a branch of?

A

External carotid

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8
Q

Which artery provides main arterial supply to face?

A

Facial artery

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9
Q

What does the external carotid artery terminate as?

A

Superficial temporal and Maxillary arteries

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10
Q

How is blood drained from face?

A

Facial vein into internal jugular vein

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11
Q

What is bell’s palsy?

A

paralysis of facial muscles due to dysfunction of facial nerve due to compression caused by inflammation at the stylomastoid foramen

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12
Q

why might surgery on parotid gland cause facial paralysis?

A

Surgery may damage facial nerve innervating muscles of facial expression as nerve and its branches pass through gland

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13
Q

What is the 1st layer of the deep cervical fascia and what does it surround?

A

Investing later Sternocleidomastoid and trapezius muscles Parotid and submandibular salivary glands

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14
Q

What is the 2nd layer of deep cervical fascia and what does it surround?

A

Pretracheal layer Infrahyoid muscles, thyroid gland, trachea and oesophagus.

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15
Q

What do the carotid sheaths enclose?

A

Common carotid artery Internal jugular vein Vagus nerve Deep cervical LNs

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16
Q

What is the 3rd layer of deep cervical fascia and what does it surround?

A

Prevertebral layer VC and assoc. muscles

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17
Q

Where might an infection occur that can spread into thoracic cavity anterior to pericardium?

A

Between the investing layer and the pretracheal layer of the deep cervical fascia

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18
Q

Symptoms of patient with a retropharyngeal abscess?

A

Dysphagia and dysphonia

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19
Q

What is the retropharyngeal space?

A

Potential space between prevertebral and pretracheal layers of the deep cervical fascia

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20
Q

What is the pterion?

A

Junction between the frontal, parietal and temporal bones Thinnest part of the skull

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21
Q

Clinical relevance of pterion?

A

Skull is thinnest hear meaning it is easily fractured Can lacerate the middle meningeal artery running underneath causing an extradural haematoma

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22
Q

What is a countercoup fracture?

A

Fracture occurs on opp side of cranium rather than at site of impact

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23
Q

How may an infection of the scalp cause osteomyelitis?

A

Via emissary veins

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24
Q

which bone forms the upper jaw?

A

Maxillary bone

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25
How is the odontoid (dens) process of C2 held in place?
Transverse ligament of atlas
26
How can bleeding from common carotid arteries be controlled?
By compression against anterior tubercles of C6
27
What is a simple skull fracture?
Break in bone without damage to skin
28
What is a linear skull fracture?
Thin line, without splintering, depression or distortion of bone
29
What is a depressed skull fracture?
Bone pushed towards brain
30
What is a compound skull fracture?
break in or loss of skin, and splintering of bone accompanied by brain injury and bleeding
31
What is the calvaria and what is it composed of?
Roof of cranial cavity, protecting superior aspect of brain. Comprised of the frontal bone anteriorly, paired parietal bone in middle and occipital bone posteriorly.
32
What sutures are visible internally in calvaria and what are the junctions between these sutures called?
Coronal: between frontal and parietal bones Sagittal: between paired parietal bones Lambdoid: between parietal and occipital bones Junctions are: Bregma: where coronal and sagittal meet Lambda, where lambdoid and sagittal meet
33
which are the main bones contributing to the cranial base (floor of cranial cavity)?
sphenoid, temporal and occipital bones
34
at which joint do the muscles of mastication act?
temporomandibular joint
35
main muscle groups in head?
occipitofrontalis muscles of facial expression buccinators muscles of mastication
36
why can pulse of facial artery be palapated?
as passes around inferior border of mandible
37
what does the masseter muscle do?
elevates mandible, so closes mouth
38
what are the fascial spaces of the neck?
between fascial layers, provide conduit for spread of infection from neck to mediastinum 3 spaces: pretracheal retropharyngeal third space
39
what are the boundaries of the anterior triangle?
anterior border of sternocleidomastoid posteriorly inferior border of mandible superiorly midline of neck anteriorly
40
boundaries of posterior triangle?
posterior border of sternocleidomastoid anteriorly anterior border of trapezius posteriorly middle 1/3 of clavicle basally apically by occipital bone
41
why are movements of neck especially free?
IV discs thick relative to size of VB articular surfaces of ZP joints relatively large, and joint planes almost horizontal joint capsules of ZP joints loose less surrounding soft tissue bulk in neck compared with trunk
42
which nerve provides sensory innervation to the face?
trigeminal nerve- opthalmic, maxillary and mandibular divisions
43
which nerve innervates the facial muscles?
facial nerve
44
what structures can be found passing through the posterior triangle?
supraclavicular artery external jugular vein accessory nerve
45
what is the mastoid process?
an inferior projection of temporal bone of skull, just posterior to ear provides superior attachment site of sternocleidomastoid
46
where will infection spread if occurs between investing layer of deep cervical fascia and muscular part of pretracheal fascia enclosing infrahyoid muscles? what if between investing and visceral part of pretracheal?
usually not beyond superior edge of manubrium can spread into thoracic cavity anterior to pericardium
47
importance of retropharyngeal space?
major pathway for spread of infection from neck to thorax
48
proximal and distal attachments of trapezius muscle?
Proximal- medial 1/3 of superior nuchal line, external occipital protuberance, nuchal ligmanet, spinour processes of C7-T12 vertebrae Distal- lateral 1/3 of clavicle, acromion and spine of scapula descending part elevates, and ascending part depresses scapula, middle part retracts, D and A act to rotate GC superiorly
49
what is the only major opening of the box of the head?
foramen magnum
50
why can bones of skull forming sutures interlock firmly?
serrated edges of bones, so are also less likely to be easily unlocked by force applied in 1 direction
51
type of bones forming skull?
flat bones
52
function of middle layer of spongy bone- diploe, of the skull?
help reduce weight of cranium bone marrow for haematopoiesis
53
name of suture joining bones of mandible?
mental symphisis
54
2 separate bones of mandible?
L and R mandibles
55
main bones of cranial cap?
frontal, occipital, parietal, temporal
56
bone forming roof of orbit?
frontal bone
57
likely outcome of ethmoid fracture and why?
anosmia- ethmoid allows for passage of olfactory nerve (tract) fibres through cribiform plate CSF rhinorrhea
58
4 parts of occipital bone?
squamous right and left condylar basilar
59
why high probability of brain damage from trauma of normal birthing process if occurs prematurely?
cranial sutures are too wide open for pressures of birthing to result in interlocking of the cranial bones
60
type of CT forming superficial fascia?
LCT
61
type of CT forming deep fascia?
Dense irregular CT
62
only complete cartilage in larynx?\*
cricoid cartilage
63
branches of facial nerve when exits partoid gland?
temporal cervical bucal marginal mandibular zygomatic
64
muscles innervated by cranial nerve V?
masseter temporalis medial and lateral pterygoid mylohyoid A belly of digastric tensor tympani tensor veli palatini
65
bones of skeleton of neck?
cervical vertebrae hyoid manubrium of sternum clavicles
66
why large vertebral foramina in comparison to VB in cervical region?
SC at its largest within this region as all the nerves which are going to pass d.wards e.g. to supply UL must pass through here
67
why small, saddle shaped VB in cervical region?
less support needed for body axis in comparison to lower vertebrae
68
characterisitcs of C3-C6 vertebrae?
small VB, longer from side to side than AP, superior surface concave, infer convex large and triangular vertebral foramen foramina transversaria for vertebral vessels in transverse processes spinous processes short and bifid superior facets of articular processes directed superoposteriorly, inferior directed inferoposteriorly
69
describe the bone of the cranium?
2 plates of compact bone- outer and inner, giving resilience due to compact packing and 1 middle layer of spongy bone- lessens weight of cranium, and BM so site of haemopoiesis. middle layer= diploe
70
articulations of bones of cranial base\*?
atlas, facial bones and mandible
71
why is the cranial base (part of calvaria) susceptible to fracture?
large number of foramina for passage of anatomical structures between extra and intra cranial compartments make floor of cranium weak, so base liable to fracture in high energy impacts to head
72
where is the stylomastoid foramina?
between styloid and mastoid processes of temporal bone
73
symptoms of skull fractures?
Bleeding from the wound, ear, nose or around eyes, bruising, draining of CSF from ears or nose, swelling, confusion, convulsions, difficulties with balance, drowsiness, headache, loss of consciousness, nausea, vomiting, visual disturbance, stuff neck and slurred speech.
74
what is a linear calvarial fracture (most frequent type of calvarial fracture)?
fracture at site of impact, but fracture lines radiate away from it in 2 or more directions
75
What is a Basal Skull Fracture?
Fracture of skull base, presents with Battle’s Sign- subcutaneous purpura - extravasated blood, of mastoid process of temporal bone
76
how may superciliary arches be damaged?
during boxing- sharp blow to them can lacerate skin and cause bleeding, as relatively sharp bony ridges. Bruising surrounding orbit cause tissue fluid and blood to accumulate in surrounding CT, which gravitates into superior eyelid and around eye- black eye
77
What is a malar flush?
redness of skin covering zygomatic prominence, assoc with rise in temp in fevers assoc with for example TB and SLE- butterfly rash
78
When do facial fractures commonly occur?
In Car accidents, fistfights and falls which commonly involve the nasal bones due to the prominence of the nose. Maxillofacial fractures occur as a result of massive facial trauma. A hard blow to the lower jaw often results in a fracture of the neck of the mandible and may be associated with TMJ dislocation.
79
how do transverse processes end in typical cervical vertebrae and clinical significance of this for palpating carotid pulse?
Anterior and posterior tubercles common carotid artery can be compressed against anterior tubercle of transverse process of C6 vertebra- known as carotid tubercle, below bifurcation at C4 vertebra where it is more likely that a drop in BP and HR might occur can also control bleeding of artery by compression here
80
why might slight dislocations of C vertebrae not damage SC?
as large vertebral canal
81
what may cause a fractures of the dens?
horizontal blow to head, or complication of osteopenia can injure SC- quadriplegia may injure medulla of bstem, causing death
82
when might hyperflexion of cervical region occur?
head on car collisions rupture of lower intervertebral discs (C5/C6 and C6/C7) resulting in compression of spinal roots C6 and C7 Pain is felt in the neck, shoulder, arm and hand
83
When does whiplash injury occur?
rear-end car collisions may tear A and P longitudinal ligaments, disc dislocation, fracture spinous processes, neck muscle injury, blood vessel injury
84
what is a broken neck?
Compression of the cervical spine against the shoulder May involve spinal cord damage  Partial or complete paralysis  Death Most common at C2, C6 and C7 The most fatal injuries occur in the upper part of the spine (C1 or C2)
85
why does leakage of CSF tend to occur with cranial base fractures?
the 2 dural layers are firmly attached and difficult to separate from the bones, hence a fracture usually tears the dura. plane of structural weakness at dura-arachnoid junction
86
when might a patient present with a pulsating exophthalmos?
fracture of cranial base: internal carotid artery may be torn, producing an arteriovenous fistula within the sinus, arterial blood rushes into cavernous sinus, enlarging it and forcing retrograde blood flow into venous tributaries, especially opthalmic veins.
87
which bone surrounds the external auditory meatus?
temporal bone (tympanic part)
88
where does the middle meningeal artery pass through the cranial base?
foramen spinosum

ESA 4 (24 decks)

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