Head and Neck Flashcards
What structures pass through the cribriform plate?
Olfactory (I) nerve bundles
What structures pass through the optic canal?
Optic nerve (II) including central artery of retina
Ophthalmic artery
What structures pass through the superior orbital fissure?
Oculomotor nerve (III)
Trochlear nerve (IV)
Lacrimal, front and nasociliary branches of ophthalmic nerve (V1)
Abducens nerve (VI)
Superior ophthalmic vein
What structures pass through foramen rotundum?
Maxiliary nerve (v2)
What structures pass through Foramen ovale?
O tic ganglion
V3 (Mandibular nerve:3rd branch of trigeminal)
A ccessory meningeal artery
L esser petrosal nerve
E missary veins
What structures pass through foramen spinosum?
Middle meningeal artery and vein
What structures pass through foramen lacerum?
nothing
What structures pass through carotid canal?
internal carotid artery
internal carotid nerve plexus
What structures pass through internal acoustic meatus?
facial nerve (VII)
vestibulocochlear nerve (VIII)
labyrinthine artery
What structures pass through jugular foramen?
Inferior petrosal sinus
Glossopharyngeal nerve (IX)
Vagus nerve (X)
Accessory nerve (XI)
Sigmoid sinus -> internal jugular vein
Posterior meningeal artery
What structures pass through hypoglossal canal?
Hypoglossal nerve (XII)
What structures pass through the foramen magnum?
medulla oblongata
meninges
vertebral arteries
meningeal branches of vertebral arteries
spinal roots of accessory nerves
What passes through the mandibular foramen?
inferior alveolar neurovasscular bundle
what does the inferior alveolar neurovascular bundle innervate?
mandibular teeth and supplies them with blood
What are the first and 2nd most commonly fractured facial bones?
- nasal bone
- mandible (at cuspid area and 3rd molar)
What sort of joint is the TMJ?
synovial joint between the mandibular fossa and the articular tubercle of the temporal bone and head of mandible
How many synovial cavities in TMJ?
2 separated by an articular disc of fibrocartilage
What is a Jefferson fracture?
fracture of the atlas usually across the anterior and posterior arches (method blow to top of head)
What is a hangman fracture?
fracture of the axis involving the dens or across the neural arch between superior and inferior articular facets
What type of joint is the Atlanto- occipital joint?
biaxial condyloid synovial joint between atlas and occipital condyles (nodding)
What type of joint is the Atlanto-axial joint?
uniaxial synovial joints (head turning)
what is the purpose of the alar internal craniocervical ligaments?
limit rotation
What are the 3 ear ossicles?
malleus, incus, stapes
Which muscles attache to the auditory ossicles?
tensor tympani (to malleus)
stapedius (to stapes)
dampen large vibrations
what is the function of the ossicles?
they amplify sonic vibrations from the tympanic membrane and transmit them to the inner ear
Where are all muscles of facial expression derived from embryologically?
2nd pharyngeal (branchial) arch
what are all muscles of facial expression innervated by?
terminal branches of the facial nerve (CNVII)
What structures pass through the parotid gland?
Facial nerve (Mnemonic: The Zebra Buggered My Cat; Temporal Zygomatic, Buccal, Mandibular, Cervical)
External carotid artery
Retromandibular vein
Auriculotemporal nerve
Anterior relations of the parotid?
masseter, medial pterygoid, superficial temporal and maxillary artery, facial nerve, stylomandibular ligament
Posterior relations of the parotid?
posterior belly digastric muscle, sternocleidomastoid, stylohyoid, internal carotid artery, mastoid process, styloid process
Innervation of the parotid?
Parasympathetic-Secretomotor
Sympathetic-Superior cervical ganglion
Sensory- Greater auricular nerve
What supplies common sensation to the anterior 2/3 of the tongue?
The lingual branch of the mandibular division of the trigeminal nerve
What nerve supplies taste to the anterior 2/3 of the tongue?
chorda tympani branch of the facial nerve
What supplies common sensation + taste to the posterior 1/3 of the tongue?
lingual branch of the glossopharyngeal nerve
Which nerve supplies the intrinsic muscles of the tongue?
All intrinsic muscles of the tongue are supplied by the hypoglossal nerve
What are the branches (in order) of the external carotid artery?
She Always Likes Friends Over Papa, Sister and Mama
Superior thyroid artery
Ascending pharyngeal artery
Lingual artery
Facial artery
Occipital artery
Posterior auricular artery
Superficial Temporal artery
Maxillary artery
Where does the external carotid artery terminate?
It terminates by dividing into the superficial temporal and maxillary arteries in the parotid gland.
Which lymph nodes do the lateral surface of the upper half of the ear drain to?
superficial parotid lymph nodes
Which lymph nodes do the cranial surface of the superior half drain to?
mastoid nodes and deep cervical lymph nodes
Which lymph nodes do the lower half and lobule drain into?
superficial cervical lymph nodes
Paired cartilaginous aspects of the larynx?
arytenoid, corniculate and cuneiform
Single cartilaginous aspects of larynx?
thyroid, cricoid and epiglottic
Structures within the parotid gland- superficial to deep?
Facial nerve
Retromandibular vein
External Carotid
Motor functions of the trigeminal nerve (v3)?
Motor
Distributed via the mandibular nerve.
The following muscles of mastication are innervated:
Masseter
Temporalis
Medial pterygoid
Lateral pterygoid
Other muscles innervated include:
Tensor veli palatini
Mylohyoid
Anterior belly of digastric
Tensor tympani
Contents of cavernous sinus?
Mnemonic for contents of cavernous sinus:
O TOM CAT
Occulomotor nerve (III)
Trochlear nerve (IV)
Ophthalmic nerve (V1)
Maxillary nerve (V2)
Carotid artery
Abducent nerve (VI)
T
OTOM=lateral wall components
CA= components within sinus
What is the cavernous sinus?
cavernous sinuses are paired and are situated on the body of the sphenoid bone
lateral /medial relations of the cavernous sinus?
Lateral: Temporal lobe
Medial:Pituitary fossa
Sphenoid sinus
Cavernous sinus blood supply
Ophthalmic vein, superficial cortical veins, basilar plexus of veins posteriorly.
Drains into the internal jugular vein via: the superior and inferior petrosal sinuses
What does the vagus carry afferent fibres from?
pharynx, larynx, oesophagus, stomach, lungs, heart and great vessels
What are the two types of efferent vagus fibres?
- preganglionic parasympathetic fibres -> innervate smooth muscle of the innervated organs
- direct skeletal muscle innervation -> larynx and pharynx
Where does the vagus arise from in the brain?
medulla oblongata
cranial and caudal relations of the vagus?
cranial - glossopharyngeal
caudal - accessory
Muscular contributions of first pharyngeal arch?
Muscles of mastication:
-Anterior belly of digastric
-Mylohyoid
-Tensor tympanic
-Tensor veli palatini
Skeletal contributions of first pharyngeal arch?
Maxilla
Meckels cartilage
Incus
Malleus
Artery contributions of first pharyngeal arch?
Maxillary
External carotid
Muscular contributions of 2nd pharyngeal arch?
Buccinator
Platysma
Muscles of facial expression
Stylohyoid
Posterior belly of digastric
Stapedius
Cranial nerve for first pharyngeal arch?
CNV - trigeminal
Cranial nerve for 2nd pharyngeal arch?
CNVII - facial
Skeletal contributions for 2nd pharyngeal arch?
Stapes
Styloid process
Lesser horn and upper body of hyoid
Artery contributions of 2nd pharyngeal arch?
Inferior branch of superior thyroid artery
Stapedial artery
Muscular contributions 3rd pharyngeal arch?
Stylopharyngeus
Skeletal contributions 3rd pharyngeal arch?
Greater horn and lower part of hyoid
Endocrine contributions 3rd pharyngeal arch?
Thymus
Inferior parathyroids
Artery 3rd pharyngeal arch?
Common and internal carotid
Muscular contributions 4th pharyngeal arch?
Cricothyroid
All intrinsic muscles of the soft palate
Skeletal contributions 4th pharyngeal arch?
Thyroid and epiglottic cartilages
Endocrine contributions 4th pharyngeal arch?
Superior parathyroids
Artery contributions 4th pharyngeal arch?
Right- subclavian artery, Left-aortic arch
Muscular contributions 6th pharyngeal arch?
All intrinsic muscles of the larynx (except cricothyroid)
Skeletal contributions 6th pharyngeal arch?
Cricoid, arytenoid and corniculate cartilages
Artery contributions 6th pharyngeal arch?
Right -Pulmonary artery, Left- Pulmonary artery and ductus arteriosus
What is the action of scalenus anterior and scalenus medius?
Elevate 1st rib and laterally flex the neck to same side
What is the action of scalenus posterior?
Elevate 2nd rib and tilt the cervical spine
Innervation of scalene?
Spinal nerves C4-6
origin of scalenes?
Transverse processes C2 to C7
Relation of brachial plexus to scalenes?
The brachial plexus pass between the anterior and middle scalenes through a space called the scalene hiatus/fissure.
Relation of subclavian artery to scalenes?
The subclavian artery pass between the anterior and middle scalenes through a space called the scalene hiatus/fissure.
Relation of subclavian vein to scalenes?
The subclavian vein passes anteriorly to the anterior scalene as it crosses over the first rib.
Relation of phrenic nerve to scalenes?
The phrenic nerve passes anteriorly to the anterior scalene as it crosses over the first rib.
Which cranial nerves may be injured in submandibular gland excision?
Marginal mandibular branch of the facial nerve
Lingual nerve
Hypoglossal nerve
Superficial relations of the submandibular gland?
Platysma, deep fascia and mandible
Submandibular lymph nodes
Facial vein (facial artery near mandible)
Marginal mandibular nerve
Cervical branch of the facial nerve
Deep relations of the submandibular gland?
Facial artery (inferior to the mandible)
Mylohyoid muscle
Sub mandibular duct
Hyoglossus muscle
Lingual nerve
Submandibular ganglion
Hypoglossal nerve
Sympathetic innervation to the submandibular gland? (Whartons duct)
Derived from superior cervical ganglion
Parasympathetic innervation to submandibular gland?
Submandibular ganglion via lingual nerve
Borders of the posterior triangle of the neck?
Apex: Sternocleidomastoid and the Trapezius muscles at the Occipital bone
Anterior: posterior border of SCM
Posterior: anterior border of trapezius
Base: Middle third of the clavicle
Contents of the posterior neck triangle (nerves)?
Accessory nerve
Phrenic nerve
Three trunks of the brachial plexus
Branches of the cervical plexus: Supraclavicular nerve, transverse cervical nerve, great auricular nerve, lesser occipital nerve
Contents of the posterior triangle of the neck (vessels)?
External jugular vein
Subclavian artery
Contents of the posterior triangle of the neck? (muscles)
Inferior belly of omohyoid
Scalene
Contents of the posterior triangle fo the neck (lymph nodes)?
Supraclavicular
Occipital
branches of the subclavian artery?
Vertebral artery
Internal thoracic artery
Thyrocervical trunk
Costocervical trunk
Dorsal scapular artery
Arterial blood supply of the thyroid?
Superior thyroid artery (1st branch of external carotid)
Inferior thyroid artery (from thyrocervical trunk)
Thyroidea ima (in 10% of population -from brachiocephalic artery or aorta)
Venous supply of the thyroid?
Superior and middle thyroid veins - into the IJV
Inferior thyroid vein - into the brachiocephalic veins
Boundaries of the anterior triangle of the neck?
Anterior border of the Sternocleidomastoid
Lower border of mandible
Anterior midline
Boundaries of the anterior triangle of the neck?
Anterior border of the Sternocleidomastoid
Lower border of mandible
Anterior midline
Contents of the digastric triangle?
Submandibular gland
Submandibular nodes
Facial vessels
Hypoglossal nerve
Contents of the muscular triangle?
Strap muscles
Jugular vein
Contents of the carotid triangle?
Carotid sheath (Common carotid, vagus and internal jugular vein)
Ansa cervicalis
Nerve supply to digastric muscle?
Anterior: Mylohyoid nerve
Posterior: Facial nerve
Which skull foramina lie within the sphenoid bone?
Foramen ovale
Foramen spinosum
Foramen rotundum
Superior orbital fissure
Which skull foramina lie within the temporal bone?
Stylomastoid foramen
Jugular foramen
Which skull foramina lie within the occipital bone?
Foramen magnum
Which bone does the Foramen lacerum/ carotid canal lie in?
Located between the sphenoid, the apex of the petrous temporal and the basilar part of the occipital
Branches of the cerebral portion of the internal carotid?
Mnemonic for branches of the cerebral portion of the internal carotid artery ‘Only Press Carotid Arteries Momentarily’
Only = Opthalmic
Press = Posterior communicating
Carotid = Choroidal
Arteries = Anterior cerebral
Momentarily = Middle cerebral
Where does the common carotid branch into the internal carotid?
opposite the upper border of the thyroid cartilage
Path of the internal carotid?
superiorly to enter the skull via the carotid canal. From the carotid canal it then passes through the cavernous sinus, above which it divides into the anterior and middle cerebral arteries.
anterior relations of the internal carotid?
Sternocleidomastoid
Lingual and facial veins
Hypoglossal nerve
lateral relations of the internal carotid?
Internal jugular vein (moves posteriorly at entrance to skull)
Vagus nerve (most posterolaterally)
Medial relations of the internal carotid?
External carotid (near origin)
Wall of pharynx
Ascending pharyngeal artery
Posterior relations of the internal carotid?
Longus capitis
Pre-vertebral fascia
Sympathetic chain
Superior laryngeal nerve
which vessels is the circle of willis primarily formed from ?
two internal carotid arteries and two vertebral arteries
What is each half circle of willis formed by?
- Anterior communicating artery
- Anterior cerebral artery
- Internal carotid artery
- Posterior communicating artery
- Posterior cerebral arteries and the termination of the basilar artery
Branches of the vertebral arteries?
PAP
Posterior spinal artery
Anterior spinal artery
Posterior inferior cerebellar artery
Branches of the basilar arteries?
Anterior inferior cerebellar artery
Labyrinthine artery
Pontine arteries
Superior cerebellar artery
Posterior cerebral artery (at the point where it bifurcates)
Below which spinal level will lower motor neurone symptoms be present?
For lesions below L1 LMN signs will occur
what is the blood supply of the oesophagus?
cervical oesophagus - inferior thyroid artery
thoracic oesophagus- direct branches from thoracic aorta
lower oesophagus - left gastric artery
where do the inferior and superior parathyroid glands originate from embryologically?
inferior - third pharyngeal pouch
superior - fourth pharyngeal pouch
Which muscles of the larynx are supplied by the recurrent laryngeal nerve?
posterior cricoarytenoid
lateral cricoarytenoid
thyroarytenoid
transverse and oblique arytenoid
vocalis
Which muscle of the larynx is supplied by the external laryngeal nerve?
cricothyroid
which nodes do the supraglottic part of the larynx drain to?
Upper deep cervical nodes
which nodes do the subglottic part of the larynx drain to?
Prelaryngeal and pretracheal nodes and inferior deep cervical nodes
What is the lymphatic drainage of the vocal cords?
lymphatic watershed (no lymphatic drainage)
which sinus drains the superior meatus?
Posterior ethmoidal sinus
which sinus drains the middle meatus?
Frontal sinus, maxillary sinus ,anterior and middle ethmoidal sinus
which sinus drains the inferior meatus?
Nasolacrimal duct
which sinus drains the sphenoethmoidal recess?
sphenoidal sinus
which muscles are innervated by ansa cirvicalis?
GHost THought SOmeone Stupid Shot Irene
GenioHyoid
ThyroidHyoid
Superior Omohyoid
SternoThyroid
SternoHyoid
Inferior Omohyoid
What are the branches of external carotid artery?
External carotid artery branches mnemonic:
‘Some Angry Lady Figured Out PMS’
Superior thyroid (superior laryngeal artery branch)
Ascending pharyngeal
Lingual
Facial (tonsillar and labial artery)
Occipital
Posterior auricular
Maxillary (inferior alveolar artery, middle meningeal artery)
Superficial temporal
which blood vessel supplies the nasal cavity?
sphenopalatine artery
what signs may be seen in cavernous sinus syndrome?
Diagnosis is based on signs of pain, opthalmoplegia, proptosis, trigeminal nerve lesion (opthalmic branch) and Horner’s syndrome.
Blood supply of the lacrimal system?
Lacrimal branch of the opthalmic artery. Venous drainage is to the superior opthalmic vein.
Innervation of lacrimal gland?
The gland is innervated by the secretomotor parasympathetic fibres from the pterygopalatine ganglion which in turn may reach the gland via the zygomatic or lacrimal branches of the maxillary nerve or pass directly to the gland
What do the preganglionic lacrimal fibres travel to the pterygopalatine ganglion in?
in the greater petrosal nerve (a branch of the facial nerve at the geniculate ganglion).
Which nerve provides sensory innervation to the angle of the jaw?
The angle of the jaw is innervated by the greater auricular nerve. (C2-C3)
Muscles innervated by the trigeminal nerve?
Muscles of mastication
Mylohyoid
Anterior belly of digastric
Tensor tympani
Tensor palati
Path of nerves involved in resizing the pupils
pretectal nucleus in midbrain -> Edinger - Westphal nucleus -> motor axons from here pass along with the oculomotor nerve -> ciliary ganglion neurones ->the parasympathetic axons from this then innervate the iris
Branches of the internal carotid artery?
Anterior and middle cerebral artery
Ophthalmic artery
Posterior communicating artery
Anterior choroid artery
Meningeal arteries
Hypophyseal arteries
What is the function of the sub-occipital muscles?
connect atlas to axis
connect atlas to the base of the skull
Innervated by nerves from the c1 root
Suprahyoid muscles?
Mylohyoid, Stylohyoid, Geniohyoid and Digastric
My Gravy Spoon Darling
Infrahyoid muscles?
Sternohyoid, Omohyoid, Sternothyroid and Thyrohyoid
TOSS
Suprahyoid anterior muscle innervation?
Mylohyoid and Anterior belly of the Digastric
Mandibular Division of the Trigeminal Nerve (V3)
Suprahyoid posterior muscle innervation?
Stylohyoid and Posterior belly of the Digastric
Facial Nerve (VII)
Geniohyoid innervation?
C1 fibres via the Hypoglossal Nerve (XII)
Infrahyoidmuscle innervation?
Thyrohyoid:
C1 fibres via the Hypoglossal Nerve (XII)
Omohyoid, sternohyoid and sternothyroid:
Ansa cervicalis (anterior rami of C1 to C3)
Contents of posterior triangle?
3 vessels and 4 nerves
External jugular veins
Subclavian artery & vein
Trunks of brachial plexus
Spinal accessory
Phrenic nerve
Vagus nerve
Contents of the carotid sheath?
IJV
Carotids
Vagus
Structures anterior to posterior surrounding scalenes?
Contents of carotid sheath:
(IJV, Carotids, Vagus)
SC vein
Phrenic nerve
Scalenus Anterior
Brachial plexus roots and SC artery
Scalenus Medius
What does the vagus nerve innervate?
Larynx
Heart
Lungs
GI tract
Origins of phrenic nerve?
C3,C4,C5
What does the phrenic nerve innervate?
Motor to diaphragm and sensory to peritoneum and pleura around diaphragm
lies anterior to scalenus anterior
What does the subclavian artery enter the thorax between?
-between subclavian artery and vein
Which artery supplies the thyroid gland?
2 pairs of arteries:
-Superior thyroid artery: First branch of the external carotid
-Inferior thyroid artery: Arises from the first part of the subclavian artery
This artery does not only supply the thyroid, but also supplies the superior oesophagus and the trachea.*
which veins drain the thyroid gland?
pairs of superior, middle and inferior thyroid veins
Superior and middle thyroid veins: Drain into the internal jugular vein*
Inferior thyroid vein: Drains into brachiocephalic trunk*
uses of central lines?
Monitoring CVP and JVP
Monitoring central venous saturation
Delivery of toxic drugs
Antibiotics
Drugs that are prone to cause phlebitis in peripheral veins e.g. chemotherapy
Central feeding
Dialysis
Complications of central lines?
Puncturing common carotid
Nerve damage
Air embolism
Thrombosis
Infection
