Head and Neck 3 Flashcards
How many cervical vertebrae are there?
7
How many thoracic and lumbar vertebrae are there?
Thoracic = 12 Lumbar = 5
Describe a typical cervical vertebrae.
Body anteriorly placed, concave superiorly, convex inferiorly
Bifid spinal processes = short, attached to ligamentum nuchae
C7 = no bifid process, process is instead long
Vertebral canal: large and triangular
Transverse foramina (small or absent in C7), carry vertebral arteries (subclavian arteries)
What is the spinous process of C7 called?
Vertebra prominens
How is the atlas different?
No spinous processes
No body
Consists of two lateral masses connected by anterior and posterior arches
Anterior and posterior tubercle
What is the joint called joining C1 and the skull?
Atlanto-occipital joint
Superior articular facet receives occipital condyles of skull
Permit nodding of head
Describe the shape of the axis (C2)
Dens on anterior surface, projecting superiorly from body
What is the name of the joint between C1 and C2?
Atlanto-axial Joint
Permit side to side head movement
Dens acts as a pivot that allows skull and C1 as a unit to rotate on C2
What is the ligament called of the atlas?
Transverse ligament - strong band extending between medial surfaces of lateral masses
Holds the dens of C2 against the anterior arch of C1
Where does the cruciform ligament travel?
Vertically oriented superior and inferior bands from transverse ligament
Attach to occipital bone above and C2 below
Where does the alar ligaments travel?
Extend from sides of dens to lateral margins of foramen magnum
Check excessive rotation of the head and atlas relative to the axis
Name the primary and secondary curve and where they are found.
Primary curve: kyphosis (concave anteriorly) - thoracic region
Secondary curve: lordosis (convex anteriorly): cervical and lumbar regions
Where does the thyroid gland lie?
Deep to the strap muscles - sternohyoid and sternothyroid
Infront of C5-T1
What joins the two lobes of the thyroid gland?
Isthmus
What tracheal rings does the thyroid gland lie over?
2nd
3rd
4th
Where are the parathyroid glands found?
Posterior lobes of thyroid
Where do the parathyroid lobes develop from?
Superior develops from 4th pharyngeal pouch
Inferior develops from 3rd pharyngeal puch
Where does the external and recurrent laryngeal nerves lie?
In the gutter between the larynx/trachea and pharynx/oesophagus
What blood vessels supply the thyroid gland?
Superior thyroid artery from ECA (anterior branch)
Inferior thyroid artery from subclavian artery (branch of thyrocervical trunk)
Where does the external laryngeal nerve lie?
Just behind the superior thyroid artery at the upper pole of the lobe
What sometimes supplies the isthmus?
Thyroidea ima artery from brachiocephalic artery
What are the veins of the thyroid gland?
Superior thyroid gland drains superior part of gland and drains into IJV
Middle thyroid vein drains into IJV
Inferior thyroid vein drains into brachiocephalic vein
What are the levels of the phrenic nerve?
C3, C4, C5
Where does the phrenic nerve arise from?
Cervical plexus (C1-C4)
Where is the cervical plexus found?
Between the scalene medius and scalene anterior
What does the phrenic nerve mainly supply?
Sole motor to diaphragm and sensory to its central part
Where does the phrenic nerve travel?
Leaves on superior lateral border of scalenus anterior and runs obliquely in front of scalene anterior towards medial side
Descends across the muscle and passes between the subclavian vein and subclavian artery to enter the thorax
What else does the phrenic nerve supply?
Sensory to mediastinal and diaphragmatic pleura, pericardium and peritoneum under the diaphragm
Where does the inferior thyroid artery arise from?
Thyrocervical trunk of the subclavian artery
Inferior thyroid artery passes to inferior pole of thyroid gland
What are the 3 branches of the thyrocervical trunk of the subclavian artery?
1 - inferior thyroid artery
2 - transverse cervical
3 - suprascapular
Where does the thyrocervical trunk of the subclavian artery lie?
Medial to scalenus anterior muscle
Where does the lingual artery travel?
Arches superoanteriorly and deep to hypoglossal nerve
Disappears beneath hyoglossus muscle of tongue
Where does the facial artery travel?
Either travels in common with lingual artery or immediately superior to it from ECA
Tortuous course over face to medial canthus of eye
Makes indentation deep to submandibular gland
Pulse can be felt at angle of mandible
Where does the ascending pharyngeal artery arise from?
First/second branch from medial side of ECA
Ascends on pharynx
Where does the occipital artery arise and where does it travel?
Arises posteriorly from ECA
Hypoglossal nerve travels over it at its origin
Travels along posterior belly of digastric to posterior part of scalp
Where does the posterior auricular artery arise?
Small posterior branch from ECA
Travels posteriorly to external auditory meatus
What does the internal jugular vein drain?
Brain and superficial face and neck
Where does the IJV start?
Jugular foramen
Continuation of sigmoid sinus
Where does the IJV travel?
Inferiorly in neck in carotid sheath
What are the tributaries of the IJV?
Lingual
Pharyngeal
Facial
Superior and middle thyroid veins
What forms the brachiocephalic vein?
Union of subclavian and internal jugular vein
What do the brachiocephalic veins form?
SVC
Retropharyngeal space
Space behind pharynx, in front of vertebral bodies
May cause spread of infection
Name the contents of the nasopharynx.
Auditory tube
Nasopharyngeal tonsils
Name the contents of the oropharynx.
Oropharyngeal isthmus
Palatoglossal arch
Palatopharyngeal arch
Palatine tonsil
Name the contents of the laryngopharynx.
Laryngeal aditus
Piriform recess
What separates the naso and oropharynx?
Soft palate
Where is the soft palate found?
Mobile flap, hangs down back of hard palate
Consists of an aponeurosis to which several muscles are attached
Uvula hangs from lower margin
What is the main nerve supply of the pharynx?
Pharyngeal branch of vagus - motor to muscles of pharynx and soft palate (except stylopharyngeus = IX/glossopharyngeal)
What supplies sensation to nasopharynx mucosa?
Pharyngeal branch of maxillary (V2)
What supplies sensory innervation to the oropharynx?
Glossopharyngeal nerve (IX)
What supplies sensory innervation to the laryngopharynx?
Vagus
What forms the pharyngeal plexus?
Pharyngeal branch of Maxillary (V2)
Glossopharyngeal (IX)
Vagus (X)
What is the innervation of the tensor veli palatini muscle?
Mandibular division (V3)
What is the function of the tensor vali palatini muscle?
Tenses soft palate
Opens auditory tube
Where does the tensor veli palatini muscle run?
From medial pterygoid plate and cartilage of auditory tube
Muscle passes inferiorly, hooks around the hamulus of the medial pterygoid plate
Expands and joins opposite tendon to form palatine aponeurosis
What is the innervation of levator veli palatini muscle?
Pharyngeal plexus (pharyngeal branch of vagus)
What is the action of levator veli palati?
Elevates soft palate
Where does the levator veli palati run?
From auditory tube cartilage and petrous part of temporal bone to palatine aponeurosis
Below tensor veli palatini
Where does the palatoglossus muscle run?
Arise from palatine aponeurosis
Runs downwards, forming the palatoglossal arch and inserted into side of tongue
What is the function of the palatoglossus muscle?
Pulls tongue up and constricts the oropharyngeal isthmus
What is the function of the palatopharyngeus muscle?
Elevates the larynx or pharynx
Depresses soft palate
Which arch is more posterior?
Palatopharyngeal arch
Where does the palatine tonsil lie?
Between the palatoglossal and palatopharyngeal arches
Which side is the uvula pulled to in a high vagus lesion?
Uvula pulled towards unaffected side
What are the spinal nerves that make up the cervical plexus?
C1 - C4
What nerve is found over the angle of the mandible?
Greater auricular nerve, cutaneous branch from cervical plexus
Do all the veins draining the thyroid gland drain into the IJV?
No, superior and middle thyroid do
Inferior thyroid vein drains into brachiocephalic vein
Is the arterial supply to the thyroid gland derived entirely from the ECA?
No, superior thyroid artery is
Inferior thyroid artery comes from thyrocervical trunk arising from the subclavian artery
Main contribution to the origin of the phrenic nerve is which spinal nerve?
C4
What would be the effects of damage to the one phrenic nerve?
Paralysis of that half of the diaphragm
IJV commences via continuation of which venous sinus and where?
Sigmoid sinus at jugular foramen
Name the structure that separates the subclavian artery from the subclavian vein at the root of the neck.
Scalenus anterior muscle
Name the cervical vertebra that does not have a body.
Atlas
Movement occurs between which two parts of the first and second cervical vertebrae when rotating the head?
Dens and anterior arch of atlas
