H&N Flashcards
What is the retropharyngeal space? Why is it important?
Between alar fascia and buccopharyngeal fascia (part of pretracheal layer). Extends to posterior mediastinum, spread of infection. Has midline raphe so infections appear unilateral
What are the contents of the carotid sheath?
Vagus nerve Internal jugular vein Common carotid artery
What are the layers of the deep cervical fascia, superficial to deep?
Investing layer Prevertebral layer Alar fascia & carotid sheath Pretracheal layer (contains buccopharyngeal fascia)
How do the fibres from the superior cervical ganglion travel to their target?
Hitch-hikes along carotids Runs posterior carotid artery
How do the fibres from the middle cervical ganglion travel to their target?
Hitch-hikes along inferior thyroid artery Runs anterior to inferior thyroid artery
How do the fibres from the inferior cervical ganglion travel to their target?
Hitch-hikes along vertebral and subclavian arteries
What is the target of the fibres from the superior cervical ganglion?
- Dilator pupillae
- Superior tarsal muscle
- Salivary, lacrimal, nasal glands
- Carotid body
- Artery smooth muscle
- Cardiac plexus
What is the target of the fibres from the middle cervical ganglion?
- Larynx
- Trachea
- Pharynx
- Cardiac plexus
- Artery smooth muscle
What is the target of the fibres from the inferior cervical ganglion?
- Cardiac plexus
- Artery smooth muscle
How does Horner’s syndrome occur? How does it present?
Injury to sympathetic trunk/ganglia Causes: Pupillary constriction (unopposed parasympathetic) Partial ptosis (paralysis of superior tarsal muscle) Flushing Absence of sweating
What is the danger space? Why is it important?
Between prevertebral and alar fascia. Extends to diaphragm, spread of infection.
Which nerve is associated with the following pharyngeal arches?
- 1st
- 2nd
- 3rd
- 4th
- 6th
- 1st - CN V
- 2nd - CN VII
- 3rd - CN IX
- 4th - CN X (superior laryngeal nerve)
- 6th - CN X (recurrent laryngeal nerve)
Which muscles arise from the following pharyngeal arches?
- 1st
- 2nd
- 3rd
- 4th
- 6th
- 1st - Muscles of masstication
- 2nd - Muscles of facial expression
- 3rd - Stylopharyngeus
- 4th - Cricothyroid, levator palatini, constrictors of pharynx
- 6th - Intrinsic muscles of larynx
What are the cartilage derivatives of the following pharyngeal arches?
- 1st
- 2nd
- 3rd
- 4th
- 6th
- 1st - Merkel’s = Mandibular, Malleus, Incus
- 2nd - Reichert’s = Stapes, styloid process, lesser horn of hyoid bone
- 3rd = Remainder of hyoid bone
- 4th = Thyroid cartilage
- 6th = Cricoid cartilage
Which arteries are associated with the following aortic arches?
- 1st
- 2nd
- 3rd
- 4th
- 6th
- 1st - disappear
- 2nd - disappear
- 3rd - internal carotid artery
- 4th - L = arch of aorta, R = brachiocephalic artery
- 6th - pulmonary arch
What are the derivatives of the following pharyngeal pouches?
- 1st
- 2nd
- 3rd
- 4th
- 1st - Tympanic cavity and auditory tube
- 2nd - Palatine tonsil
- 3rd - Thymus and inferior parathyroid
- 4th - Superior parathyroid
What are the fates of the pharyngeal clefts?
- 1st cleft is all that remains - external auditory meatus
- 2nd cleft grows down to cover the others
- Can be remnants - brachial cysts and fistulae that occur along border of sternocleidomastoid
What is Di-George Syndrome? What are the defects expressed?
- Deletion of part of chromosome 22 causing abnormal development of neural crest
- Congenital thymic aplasia and absence of parathyroid glands
- Results in ‘CATCH-22’ defects
- C = Cardiac abnormalities (especially tetralogy of Fallot)
- A = Abnormal face
- T = Thymic aplasia
- C = Cleft palate
- H = hypocalcaemia
- D = Deletion of chromosome 22
What are thyroglossal cysts and fistulae?
- Persistance of thyroglossal duct - central
- Thyroid primordium moves down from floor of pharynx to place in the neck
From which nucleus do the parasympathetic fibres of CN III arise, which ganglia do they synapse in and what is their target?
- Edinger-Westphal nucleus
- Ciliary ganglion
- Sphincter pupillae, ciliary muscles
From which nucleus do the parasympathetic fibres of CN VII arise, which ganglia do they synapse in and what is their target?
- Superior salivatory nucleus
- Pterygopalatine ganglion which goes to lacrimal gland and mucous glands of nasopharynx, palate, nasal cavity
- Submandibular ganglion which goes to sublingual and submandibular gland
From which nucleus do the parasympathetic fibres of CN IX arise, which ganglia do they synapse in and what is their target?
- Inferior salivatory nucleus
- Otic ganglion
- Parotid gland
At what vertebral level do the superior, middle and inferior cervical ganglion lie?
- Superior = C1-C4
- Middle = C6
- Inferior = C7
What is the epithelium and innervation of the tympanic membrane?
Outside
- Non-keratinised stratified squamous epithelium
- Auriculotemporal branch of CN V3, and auricular branch of CN X
Inside
- Simple cuboidal epithelium
- Glossopharyngeal nerve (CN IX)
What are the borders of the carotid triangle?
- Superior - posterior belly of digastric
- Lateral - sternocleiomastoid
- Medial - superior belly of omohyoid
What passes in the posterior triangle in the neck?
External jugular artery
What are the borders of the anterior triangle in the neck?
- Anterior - midline
- Posterior - anterior border of SCM
- Superior - inferior border of mandible
What are the borders of the posterior triangle?
- Anterior - posterior border of SCM
- Posterior - anterior border of trapezius
- Inferior - middle third of clavicle
What are the suprahyoid muscles?
- Stylohyoid
- Digastric
- Mylohyoid
- Geniohyoid
What are the inferior hyoid muscles?
- Sternohyoid
- Sternothyroid
- Thyrohyoid
- Omohyoid
What runs through the cavernous sinus?
- Internal carotid artery
- CN III, IV, VI
- 2 branches of CN V - V1 & V2
What is the middle meningeal artery a branch of?
Maxillary artery
What are the branches of the external carotid artery?
- Superior thyroid
- Ascending pharyngeal
- Lingual
- Facial
- Occipital
- Posterior auricular
- Superficial temporal
- Maxillary
What are the two important lymphatic ducts, what do they drain and where do they drain to?
Right lymphatic duct
- Right upper quadrant of the body
- Drains into right venous angle (union between right internal jugular vein and right subclavian vein
Thoracic duct
- Rest of the body
- Drains into left venous angle (union between left internal jugular vein and left subclavian vein)
What muscles are responsible for protrusion and retraction of mandible?
Protrusion = lateral pterygoid
Retraction = Temporalis, masseter, geniohyoid, digastric
Which muscles are responsible for elevation and depression of the mandible?
Elevation = temporalis, massester, medial pterygoid
Depression = gravity, digastric, geniohyoid, mylohyoid
What is the danger triangle and why is it important?
- Area over the nose and top lip - venous drainage via facial vein
- Communication between facial vein and cavernous sinus - via ophthalmic veins
- Spread of infection
Which walls of the orbit are most likely to break?
Medial and inferior - weaker
What is otitis media with effusion?
- Infection of the middle ear caused by eustachian tube dysfunction
- Causes an imbalance in pressure
- Residual air is absorbed into veins of mucosa causing decrease in pressure and retraction of tyampanic membrane
What is otitis media?
- Infection of middle ear caused by Eushachian tube dysfunction
- Red, bulging tympanic membrane
What is cholesteatoma?
- Destructive and expanding growth of keratinising squamous epithelium in middle ear and/or mastoid process
- Can cause bone erosion due to pressure and oesteolytic enzymes
What is tympanosclerosis?
- Calcification of tympanic membrane
- Abnormal healing response
- Associated with acute otitis media, and middle ear effusion
Where is Kisselbach’s area found and which arteries contribute?
Nasal septum
- Greater palantine
- Anterior ethmoid
- Superior labial
- Posterior ethmoid
- Sphenopalatine
What is Waldeyer’s ring?
Tonsils in the nasopharynx and oropharynx
- Lingual tonsil
- Palatine tonsil
- Tubal tonsil
- Adenoid (nasopharyngeal tonsil)
What oropharynx and larynx structures sit at the following vertebral levels?
- C1
- C2
- C3
- C4
- C5
- C6
- C1 - Hard Palate
- C2 - Angle of mandible
- C3 - Hyoid bone
- C4 - Thyroid cartilage upper border
- C5 - Thyroid cartilage lower border
- C6 - Cricoid cartilage
What bony structure is the carotid pulse palpated against?
Carotid tubercle of C6
At what vertebral lelvel does the common carotid artery bifurcate?
C4
What are the branches of the facial nerve?
- Temporal
- Zygomatic
- Buccal
- Mandibular
- Cervical
‘To zanzibar by motor car’
