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H&N 2 Flashcards

1
Q

Why is the left common carotid artery longer than the right?

A

left derived from arch of aorta, and so courses for about 2cm in superior mediastinum before entering neck, whereas right from brachiocephalic artery where bifurcates behind r sternoclavicular joint

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2
Q

what is the course of the common carotid artery defined as?

A

carotid line: defined by a line beginning below sternoclavicular joint and terminating midway between angle of mandible and mastoid process of temporal bone.

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3
Q

where does the external carotid artery divide into maxillary and superficial temporal branches?

A

at a level behind neck of mandible, within substance of parotid gland
here it is accompanied by the facial nerve and the retromandibular vein

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4
Q

reliable anatomical landmark for birfurcation on common carotid artery?

A

superior border of thyroid cartilage

carotids terminate midway between angle of mandible and mastoid process of temporal bone

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5
Q

where does the inferior thyroid artery originate from?

A

thyrocervical trunk- comes off subclavian artery

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6
Q

branches of external carotid artery?

A 
superior thyroid
lingual
facial
ascending pharyngeal
occipital
posterior auricular

terminal: superficial temporal
maxillary

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7
Q

clinical relevance of carotid triangle?

A

carotid pulse
access vagus and hypoglossal (XII) nerves
carotid end arterectomy, surgical approach to carotid artery or IJV
carotid sinus massage e.g. in supraventricular tachycardia

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8
Q

why can a cut to the scalp lead to profuse bleeding?

A

arteries supplying scalp lie in dense CT which is closely attached to the walls of the arteries, limiting their constriction

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9
Q

why is scalp bleeding predominantly arterial?

A

venous pressure extremely low in erect position

arteries have limited ability to constrict when lacerated due to close attachment of their walls with dense CT

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10
Q

what is an extradural hamatoma?

A

bleeding into the extradural space- potential space between dura mater and bone, periosteal layer of dura normally firmly attached to bones surrounding outside of cranial cavity, but can become fluid-filled space with haemorrhage e.g. laceration of middle meningeal artery or a torn dural venous sinus

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11
Q

how might an infection of the scalp spread to involve the meninges?

A

blood can flow from the veins of the scalp into the diploic veins of the skull, and then into the dural venous sinuses, due to emissary veins connecting veins of scalp to diploic veins

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12
Q

what does the facial artery supply?

A

muscles of facial expression and face

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13
Q

what does the superior labial artery supply?

A

upper lip, and side and septum of nose

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14
Q

what does inferior labial artery supply?

A

lower lip

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15
Q

what does lateral nasal artery supply?

A

skin on ala and dorsum of nose

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16
Q

what does angular artery supply?

A

superior part of cheek and inferior eyelid

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17
Q

what does occipital artery supply?

A

scalp of back of head, as far as vertex

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18
Q

what does posterior auricular artery supply?

A

scalp post to auricle and auricle

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19
Q

what does superficial temporal artery supply?

A

facial muscles, and skin of temporal frontal and temporal regions

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20
Q

what does the transverse facial artery supply?

A

parotid gland and duct, muscles and skin of face

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21
Q

what does mental artery supply?

A

facial muscles and skin of chin

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22
Q

what does supra-orbital and supratrochlear arteries supply?

A

muscles and skin of forehead, and scalp and superior conjunctiva

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23
Q

which arteries supply blood to the brain?

A

internal carotid

vertebral

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24
Q

what is the carotid sheath made from?

A

areolar (LCT) tissue

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25
what is the carotid sheath derived from?
fusion of prevertebral layer of fascia posteriorlu, pretracheal anteromedially, and superficial layer of cervical fascia anterolaterally
26
where does the sympathetic trunk lie in relation to the carotid sheath?
outside sheath, medially and behind it
27
major source of blood to extra-cranial structures?
external carotid artery
28
where are the superficial cervical LNs situated?
along the course of the EJV
29
LNs in regional group of head and neck?
occipital, retroauricular, submandibular, submental, anterior, cervical, superficial cervical, retropharyngeal, laryngeal and tracheal
30
give examples of 2 deep (terminal) cervical LNs, and what they drain?
jugulo-digastric: located just below and behind angle of mandible, drains tongue and tonsil jugulo-omohyoid: drainage of tongue, oral cavity, trachea, oesophagus, and thyroid gland
31
what do the efferent lymph vessels from deep cervical nodes join to form?
the jugular lymph trunks
32
what do the jugular lymph trunks join with on the L side?
throacic duct, which enters the L brachiocephalic vein at junction of subclavian and internal jugular vein
33
what do the jugular lymph trunks join with on the R side?
enters venous system at junction between subclavian and IJV via a short right lymphatic duct
34
What does a surgeon do when cervical metastases occur?
performs a block dissection of cervical nodes, removing en bloc the IJV, fascia, LNs and submandibular salivary gland. Aim to remove all lymph tissues on affected side of enck
35
where is the carotid body located in relation to the division of the common carotid artery?
just posterior to it
36
how specifically can the common carotid artery pulse be felt?
by pressing against the anterior tubercle of transverse process of C6 vertebra. Also at point of division of artery- vertebral level C4- upper border of thyroid cartilage Can be felt just medial to SCM
37
why must carotid artery palpation be performed low in neck?
to avoid pressure on carotid sinus which could cause a reflex drop in heart rate and blood pressure
38
Why is the right IJV evaluated rather than the left?
the right is straighter
39
why are pulsations of IJV visible?
transmitted through surrounding tissue
40
worry if sudden occurrence of a stiff neck, with fever and headache?
meningtitis
41
what might neck pain be associated with because of referred pain?
MI or angina, as referred pain from chest
42
muscles derived from first pharyngeal arch?
``` muscles of mastication- temporalis, masseter, medial and lateral pterygoids mylohyoid anterior belly of digastrics tensor tympani tensor veli palatine ```
43
cranial nerve of first pharyngeal arch?
trigeminal (V)- maxillary and mandibular divisions mandibular branch supplies muscles of arch principal sensory nerve of head- skin of face, and lining of mouth and nose motor to muscles of mastication and those derived from mandibular process
44
cranial nerve of second pharyngeal arch?
facial nerve (VII)
45
what does facial nerve pass through?
stylomastoid foramen and parotid gland | supplies muscles of facial expression, and those derived from 2nd pharyngeal arch
46
small sensory component of facial nerve?
taste buds in anterior 2/3 of tongue
47
why might thyroid surgery result in vocal cord paralysis?
damage to recurrent laryngeal nerves
48
name of oblique plane where curvature of aorta starts and ends?
transverse thoracic plane
49
clinical importance of jugulo-omohyoid internal jugular LN which lies above the omohyoid muscle?
can be enlarged in oral cancer
50
why might a patient have difficulty turning their head and shrugging their shoulders if they have had their spinal accessory nodes (part of deep group) removed?
these nodes lie in the posterior triangle of the neck, along course of accessory nerve, and removal due to malignancy may damage the accessory nerve , causing weakness in SCM and trapezius
51
examples of deep cervical LNs?
internal jugular spinal accessory supraclavicular
52
where does the thoracic duct arise?
from cisterna chyli in the abdomen at L2, ascends through aortic hiatus at T12 in diaphragm, crosses midline at T5 to the left, post to oesophagus and ascends into superior medistinum
53
where does thoracic duct empty into venous system?
at left venous angle- where union of left internal jugular and subclavian veins may enter origin of left brachiocepahlic vein or may empty directly into left subclavian vein
54
how are the pharyngeal clefts and pouches separated?
branchial (pharyngeal) membrane- thin sheet of ectoderm on outside, and endoderm on inside
55
how may branchial cysts in the neck be formed?
A flap of tissue from the second pharyngeal arch grows down to cover the third to sixth arches and clefts, obliterating all other clefts except 1st, creating a space, the Cervical Sinus. This is normally obliterated, but remnants of clefts may persist as branchial cysts in the neck if it is not. can occur anywhere along A border of SCM- path taken by 2nd pharyngeal arch
56
cranial nerves innervating pharyngeal arches?
CN V, VII, IX and X
57
muscles of 2nd pharyngeal arch?
muscles of facial expression poster. belly of digastrics stylohyoid stapedius
58
nerve of 3rd pharyngeal arch?
glossopharyngeal
59
muscle of 3rd pharyngeal arch?
stylopharyngeus
60
nerve of 4th to 6th pharyngeal arches?
vagus: superior laryngeal to 4th, recurrent laryngeal to 6th
61
muscles of 4th pharyngeal arch?
cricothyroid, levator palatini, constrictors of pharynx
62
muscles of 6th pharyngeal arch?
intrinsic muscles of larynx
63
general and special sensory innervation of glossopharyngeal nerve?
posterior 1/3 of tongue
64
what cells are the skeletal elements of the head and neck derived from?
neural crest cells
65
name of 1st pharyngeal arch cartilage?
Meckel's cartilage
66
derivatives of 1st pharyngeal arch cartilage?
malleus and incus- middle ear bones sphenomandibular ligament template for mandible which forms by intramemebranous ossification, so cartilage not converted into bone
67
2nd pharyngeal arch cartilage?
Reichert's cartilage
68
skeletal element derivatives of 2nd pharyngeal arch?
stapes- bones of middle ear styloid process of temporal bone stylohyoid ligament lesser cornu and upper body of hyoid
69
skeletal element derivative of 3rd pharyngeal arch?
greater cornu and part of body of hyoid
70
skeletal element derivatives of 4th and 6th pharyngeal arch catilages?
thyroid, arytenoid and cricoid cartilages of larynx
71
what is the epiglottis derived from?
4th and 6th pharyngeal arch mesenchyme from the pharyngeal floor
72
what provides arterial supply to pharyngeal arches?
aortic arches
73
3rd aortic arch artery?
internal carotid
74
4th aortic arch arteries?
arch of aorta on left, brachiocephalic artery on right
75
6th aortic arch artery?
pulmonary arch On R, distal part of 6th aortic arch and 5th disappear, so R recurrent laryngeal nerve moves up and hooks around R subclavian vein L nerve does not move up as distal part of 6th aortic arch persists as ductus arteriosus
76
derivative of 2nd pharyngeal pouch?
palatine tonsils- 2nd pouch epithelial proliferation, followed by colonisation by lymphoid precursors
77
what are the parathyroid glands derived from?
the 3rd (forms inferior) and 4th (forms superior) dorsal pharyngeal pouches
78
what is the thymus gland derived from?
the 3rd ventral pharyngeal pouch
79
1st pharyngeal pouch derivatives?
tympanic cavity and eustachian tube remember, ossicles= 1st and 2nd arch cartilage bar derivatives
80
outcome of 1st pharyngeal cleft?
external acoustic meatus
81
how are the eyes shifted from sides of head to front?
growth of maxillary prominences towards midline
82
what are the tympanic cavity and eustacian tube of middle ear derived from?
1st pharyngeal pouch
83
how is the facial vein connected to the cavernous sinus?
via the superior opthalmic vein
84
importance of facial vein being valveless?
infection of face can spread to involve venous sinuses, as facial vein connected to cavernous sinus
85
veins which form the external jugular vein?
union of posterior auricular and retromandibular (posterior branch) veins
86
what are the layers of the scalp?
SCALP:skin, CT-vessels and nerve, aponerurosis-epicranial between occipital and frontalis muscles, LCT, periosteum (pericranium)

ESA 4 (24 decks)

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