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Head and Neck Flashcards

1
Q

Compartments and Fascias of the Neck

A
  • somatic neck (perivertebral fascia)
  • visceral neck (peritracheal fascia)
  • vascular compartment (carotid sheath)
  • investing fascia
  • retropharyngeal space
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2
Q
A

Retropharyngeal Space

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3
Q

Cervical Vertebrae

A
  • C1-7
    • C1 = atlas
    • C2 = axis
    • C7 = vertebra prominens
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4
Q

Atlanto-occipital joint

A

“yes” joint between atlas and occipital bone

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5
Q

Atlantoaxial joint

A
  • “no” joint between atlas and axis
  • contributes to 50% of rotation of neck
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6
Q
A

Hyoid bone

  • greater horn
  • lesser horn
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7
Q

Superficial Neck Muscles w/ Innervation

A
  • sternocleidomastoid
  • trapezius
  • largest muscles moving the head
  • CN XI - spinal accessory
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8
Q

Sternocleidomastoid

A
  • O: manubrium of sternum, medial clavicle
  • I: mastoid process
  • A:
    • unilateral - rotation of head to opposite side, flexion to same side
    • bilateral - flexion of neck
  • I:
    • motor: spinal accessory (IX)
    • general sensory: cervical plexus (C2-3)
  • A: occipital artery, superior thryoid artery
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9
Q

Middle Neck Muscles w/Innervation

A
  • suprahyoid muscles
  • infrahyoid muscles
  • inside anterior triangle
  • innervated by ventral primary rami of cervical spinal nerves
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10
Q

Suprahyoid muscles

A
  • above hyoid bone
  • move hyoid and jaw
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11
Q

Infrahyoid Muscles

A
  • below hyoid bone
  • move hyoid and larynx
  • thyrohyoid, sternothyroid, omohyoid, sternohyoid
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12
Q

Deep Layer of Neck Muscles

A
  • muscles deep to the perivertebral fascia including scalenes
  • longus capitis
  • longus colli
  • scalenes (anterior, middle, posterior)
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13
Q

Visceral Structures of the Neck

A
  • endocrine - thyroid, parathyroid
  • respiratory - larynx, trachea
  • alimentary - pharynx, esophagus
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14
Q

Directions for Blood Vessels

A
  • arteries run up from thorax to head
  • veins run down from head to thorax
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15
Q

Major Arteries of the Neck

A
  • subclavian artery
    • vertebral artery
    • thyrocervical trunk
  • common carotid artery
    • internal carotid
    • external carotid
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16
Q

Branches of the Thyrocervical Trunk

A
  • comes off first part of subclavian medial to anterior scalene
  • TITS
    • inferior thyroid artery
    • transverse cervical artery
    • suprascapular artery
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17
Q

Major Veins of the Neck

A
  • subclavian vein
  • internal jugular vein - brain, neck
  • external jugular vein - scalp, side of face
  • venous angle
  • brachiocephalic vein
  • anterior jugular
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18
Q

Nerves of the Neck (Major Categories)

A
  • cranial nerves (down from head)
  • sympathetic nerves (up from thorax)
  • cervical spinal nerves (some intrinsic)
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19
Q

Cranial Nerves of the Neck

A
  • vagus (X)
    • jugular foramen
    • major parasympathetic of thorax and abdomen
    • motor and sensory to pharynx and larynx
  • accessory nerve (XI)
    • jugular foramen
    • motor SCM and trapezius
  • hypoglossal nerve (XII)
    • hypoglossal canal
    • motor to muscles of the tongue
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20
Q

Contents of Carotid Sheath

A
  • carotid arteries (common and internal)
  • internal jugular vein
  • vagus nerve
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21
Q

Sympathetic Nerves of the Neck

A
  • cervical sympathetic trunk
  • superior cervical ganglion
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22
Q

Cervical Spinal Nerves

A
  • cervical plexus (C1-4)
  • brachial plexus (C5-T1)
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23
Q

Root of the Neck Boundaries

A
  • first ribs
  • manubrium of sternum
  • T1 vertebrae
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24
Q

Structures in Root of the Neck (for head and neck)

A
  • bone: cervical vertebrae
  • muscle: prevertebral muscles, scalenes, infrahyoid muscles
  • visceral: trachea, esophagus
  • vessels: vertebral artery, common carotid, inferior thyroid artery, jugular veins (internal, external, anterior)
  • nerves: phrenic nerve, vagus nerve, recurrent laryngeal, sympathetic trunk
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25
Phrenic Nerve
* C3, 4, 5, keep the diaphragm alive * anterior aspect of anterior scalene
26
Boundaries of Posterior Triangle
* sternocleidomastoid * trapezius * clavicle
27
Posterior Triangle Roof
investing fascia
28
Posterior Triangle Floor
* from superior to inferior * splenius capitis major * levator scapulae * scalenes * perivertebral fascia
29
Subdivisions of Posterior Triangle
* inferior belly of omohyoid (occipital triangle above, omoclavicular triangle triangle) * spinal accessory nerve (carefree zone above, careful zone below)
30
1. SCM 2. levator scapulae 3. clavicle 4. trapezius 5. lesser occipital nerve 6. great auricular nerve 7. transverse cervical nerve 8. external jugular vein
31
Nerves in Posterior Triangle
* spinal accesory (XI) * cervical plexus (C1-4) * sensory branches: coming from nerve point * lesser occipital nerve - scalp * great auricular nerve - around ear * transverse cervical nerve - anterior triangle * supraclavicular nerves - posterior triangle * if nerve point is anesthetized, skin of neck is numb * contributes to ansa cervicalis * motor branches: phrenic nerve * brachial plexus * dorsal scapular nerve
32
Veins in Posterior Triangle
* external jugular
33
Arteries in Posterior Triangle
* transverse cervical artery - superficial back muscles * suprascapular artery - shoulder * dorsal scapular artery
34
Topographical Landmarks of Posterior Triangle
* SCM - separates anterior and posterior triangle * thyroid cartilage * mandible
35
Platysma
* O: subcutaneous tissue around clavicle * I: mandible, cheek, lip, mouth * A: expressions of sadness and fright * I: cervical branch of facial nerve (VII) * A: submental artery, suprascapular artery
36
Boundaries of Anterior Triangle
* SCM * inferior border of mandible * midline of the neck
37
Subdivisions of Anterior Triangle
A. submental triangle B. submandibular triangle C. carotid triangle D. muscular triangle
38
Submandibular Triangle Boundaries
* inferior border of mandible * anterior belly of digastric * posterior belly of digastric
39
Submandibular Triangle Contents
* submandibular salivary gland * hypoglossal nerve * mylohyoid nerve
40
Submental Triangle Boundaries
* midline of neck * anterior digastric * hyoid bone
41
Submental Triangle Contents
* mylohyoid muscles
42
Carotid Triangle Boundaries
* posterior belly of digastric * superior omohyoid * SCM
43
Carotid Triangle Contents
* common carotid artery and its bifurcation into internal and external carotid arteries * carotid body and sinus (IX and X) * glossopharyngeal (IX) * vagus (X)
44
Muscular Triangle Boundaries
* midline of neck * superior belly of omohyoid * SCM
45
Muscular Triangle Contents
* 4 infrahyoid/strap muscles - depress and stabilize the hyoid * sternohyoid * sternothyroid * thyrohyoid * omohyoid
46
Suprahyoid Muscles
* 5 muscles * anterior belly of digastric * posterior belly of digastric * stylohyoid * mylohyoid * geniohyoid * A: * if infrahyoids are active, then depress mandible (except stylohyoid) * if infrahyoids are inactive, then elevate hyoid/neck * I: * mylohyoid nerve (V3): anterior digastric, mylohyoid * facial (VII): posterior digastric, stylohyoid * C1: geniohyoid
47
Anterior Belly of Digastric
* O: digastric fossa of mandible * I: intermediate tendon * A: depress mandible, elevate hyoid * I: mylohyoid nerve (V3) * A: facial artery
48
Posterior Belly of Digastric
* O: mastoid process * I: intermediate tendon * A: depress mandible, elevate hyoid * I: facial (VII) * A: occipital artery
49
Stylohyoid
* O: styloid process * I: hyoid bone * A: elevate hyoid * I: facial (VII) * A: N/A
50
Mylohyoid
* O: mylohyoid line of mandible * I: hyoid * A: depress mandible, elevate hyoid * I: mylohyoid nerve (V3) * A: mylohyoid branch of inferior alveolar artery
51
Geniohyoid
* O: mental spine of mandible * I: hyoid * A: depress mandible, elevate hyoid * I: C1 via hypoglossal (XII) * A: N/A
52
Infrahyoid Muscles
* 4 strap muscles * omohyoid * sternohyoid * sternothyroid * thyrohyoid * action: stabilize hyoid bone when active, allow hyoid to move when relaxed * innervation: * ansa cervicalis (C1-3) for omohyoid, sternohyoid, and sternothyroid * C1 via hypoglossal (XII) for thyrohyoid
53
Omohyoid
* O: superior border of scapula * I: hyoid * A: stabilize hyoid, allow hyoid movement * I: ansa cervicalis
54
Sternohyoid
* O: sternum * I: hyoid * A: stabilize hyoid, allow for hyoid movement * I: ansa cervicalis * A: superior thyroid artery
55
Sternothyroid
* O: sternum * I: thyroid cartilage * A: stabilize hyoid, allow for hyoid movement * I: ansa cervicalis * A: superior thyroid artery
56
Thyrohyoid
* O: thyroid cartilage * I: hyoid * A: stabilize hyoid, allow for hyoid movement * I: C1 via hypoglossal (XII) * A: superior thyroid artery
57
Common Carotid Artery Asymmetry
* right - from brachiocephalic artery * left - from aortic arch
58
Carotid Body and Sinus w/Innervations
* located at bifurcation of common carotid artery * carotid body - chemoreceptors * carotid sinus - baroreceptors * afferent - glossopharyngeal (IX) * efferent - vagus (X) * parasympathetic - decreased heart rate and contractility * sympathetic - increased heart rate and contractility
59
External Carotid Branches
* "Some Angry Lady Figured Out PMS" * superior thyroid artery - thyroid, strap muscles * ascending pharyngeal artery - soft palate * lingual artery - tongue * facial artery - face * occipital artery - occiput area * posterior auricular artery - behind external ear * maxillary artery - infratemporal fossa, deep face * superior temporal artery - side of head
60
Internal Jugular Vein System
* drains sigmoid sinus in neurocranium * facial vein and retromandibular vein contributes
61
Vagus Nerve (X)
* jugular foramen --\> carotid sheath --\> thorax * branches: * pharyngeal plexus - palate and pharynx * superior laryngeal nerve * internal laryngeal nerve - sensory to area above glottis, pierces thyrohyoid membrane * external largyneal nerve - motor to cricothyroid and inferior pharyngeal constrictor * recurrent laryngeal nerve - larynx, posterior cricoarytenoid, lateral cricoarytenoid, arytenoideus, thyroarytenoid, aryepiglottis, esophagus
62
Head and Neck Sympathetics
* preganglionic * T1-4 * sympathetic chain * 3 ganglions - stellate, middle, superior cervical * postganglionic - hitch rides with cervical spinal nerves and arteries
63
Thyroid Gland
* highly vascularized * superior thyroid artery from above (branch of external carotid) * inferior thyroid artery from below (branch of subclavian artery)
64
Head and Neck Lymphatics
* many lymph nodes under SCM * deep cervical chain
65
1. common carotid artery 2. external carotid artery 3. internal carotid artery 4. lingual artery 5. facial artery 6. continuation of external carotid 7. ascending pharyngeal artery 8. occipital artery 9. superior thyroid 10. superior laryngeal artery 11. cervical sympathetic trunk 12. internal laryngeal nerve 13. hypoglossal nerve
66
Neurocranium
houses brain and special senses
67
Viscerocranium
"gut" cranium - feeding, eating, speaking, etc.
68
Viscerocranium Subdivisions
* orbital region * nasal region * upper jaw * lower jaw * infratemporal and temporal fossa
69
Cutaneous Nerve Supply
70
Arterial Blood Supply to Head
* neurocranium: vertebral artery (posterior cranial fossa), internal carotid (anterior and middle cranial fossa) * viscerocranium: external carotid
71
Venous Drainage from the Head
* neurocranium: sinuses * internal jugular vein * no valves!
72
Cranial Nerve Modalities
* sensory/afferent * general sensory - pain, temperature, touch, propioception, pressure, etc. * special sensory - smell, vision, hearing, balance, taste * visceral sensory - pain from viscera, blood pressure, oxygen content * motor/efferent * somatic/branchial motor - skeletal muscle * visceral motor - smooth muscle (cranial nerves only have parasympathetic)
73
Olfactory Nerve (I)
* modality: special sensory (olfaction) * foramen: cribiform plate * course: fila olfactoria --\> olfactory bulb --\> olfactory tract * innervated structure: olfactory organ
74
Optic Nerve (II)
* modality: special sensory (vision) * foramen: optic canal * course: within orbit --\> optic canal --\> optic chiasm * innervated structure: retina
75
Oculomotor Nerve (III)
* modality: somatic motor, visceral motor * foramen: superior orbital fissure * innervated structure: * somatic motor: 4 EOMs (superior, medial, and inferior recti, inferior oblique), levator palpebrae superioris * visceral motor: sphincter pupillae, ciliary muscles (ciliary ganglion) * course: within orbit, splits into superior and inferior divisions
76
Trochlear Nerve (IV)
* modality: somatic motor * foramen: superior orbital fissure * innervated structure: superior oblique * course: within orbit
77
Trigeminal Nerve (V)
* 1st pharyngeal arch * 3 branches: * opthalamic (V1) * maxillary (V2) * mandibular (V3) * modality: all general sensory, V3 also has branchial motor * V3 branch guides parasympathetics and taste fibers from facial nerve to anterior 2/3 of tongue
78
Opthalamic Nerve (V1)
* modality: general sensory * foramen: superior orbital fissure * course: branching within orbit (NFL) * nasociliary nerve (nasal cavity mucosa) * frontal - supratrochlear, supraorbital (forehead skin, mucosa of frontal sinus, upper eyelid skin * lacrimal nerve (lacrimal gland)
79
Maxillary Nerve (V2)
* modality: general sensory * foramen: foramen rotundum * innervated structures: skin of lateral nose, inferior eyelid, cheek, and upper lip, maxillary teeth, mucous membranes of nasal cavity, paranasal sinuses, palate, and oral vestible * course: to pterygopalatine fossa --\> branches * infraorbital nerve (infraorbital canal) * zygomatic nerve (inferior orbital fissure) * nasopalatine (sphenopalatine foramen) * superior alveolar nerves * palatine nerves * pharyngeal nerves
80
Mandibular Nerve (V3)
* modality: general sensory, somatic motor * foramen: foramen ovale * course: infratemporal fossa, branching * sensory branches (BAIL) - skin of lower lip, buccal, parotid, and temporal regions of face, mandibular teeth, TMJ, mucosa of oral cavity * long buccal * auriculotemporal * inferior alveolar * lingual * motor branches - muscles of mastication, mylohyoid, anterior digastric, tensor veli palatini, tensor tympani
81
Abducens (VI)
* modality: somatic motor * foramen: superior orbital fissure * innervated structure: lateral rectus * course: within orbit laterally
82
Facial Nerve (VII)
* 2nd pharyngeal arch * 4 modalities: general sensory, special sensory (taste), somatic/branchial motor, visceral motor * foramen: internal acoustic meatus * branches: * greater petrosal nerve (parasympathetics) * nerve to stapedius (somatic motor) * chorda tympani (special sensory, parasympathetics, visceral motor * auricular (general sensory) * other branches - facial expression, stylohyoid, posterior belly of digastric (somatic motor) * innervated structures: * branchial motor - muscles of facial expression, posterior belly of digastric, stylohyoid, stapedius * visceral motor - lacrimal gland via pterygopalatine ganglion, submandibular and sublingual glands via submanidbular ganglion * general sensory - area of skin on auricle * taste - anterior 2/3 of tongue
83
Vestibulocochlear Nerve (VIII)
* modality: special sensory (hearing, balance) * foramen: internal acoustic meatus (doesn't exit skull) * branches: * vestibular nerve (utricle, saccule of inner ear) * cochlear nerve (hair cells, semicircular ducts)
84
Glossopharyngeal Nerve (IX)
* 3rd pharyngeal arch * 5 modalities: general sensory, special sensory (taste), visceral sensory, branchial/somatic motor, visceral motor * foramen: jugular foramen * branches * tympanic nerve (general sensory, parasympathetics) * carotid sinus nerve * small branchial motor nerve (stylopharyngeus) * other branches (general sensory to mucous membrane of oropharynx, taste to posterior 1/3 of tongue) * innervated structures * branchial motor - stylopharyngeus * visceral motor - parotid via tympanic nerve and otic ganglion * general sensory - tympanic cavity, mucosa of oropharynx, posterior 1/3 of tongue * visceral sensory - carotid sinus and body * special sensory - posterior 1/3 of tongue
85
Vagus (X)
* 5 modalities: general sensory, special sensory (taste), visceral sensory, branchial motor, visceral motor * foramen: jugular foramen * innervated structures: * general sensory - inferior pharyx and larynx, root of tongue and epiglottis * special sensory - taste for root of tongue * somatic motor - muscles of soft palate and pharynx, muscles of larynx * visceral motor and sensory - thoracic and abdominal organs * branches in head and neck * pharyngeal branches - pharyngeal plexus * superior laryngeal nerve - general sensory to mucosa of larynx up to vocal folds, motor to cricothyroid muscle * recurrent laryngeal nerve - general sensory to mucosa of larynx inferior to vocal folds, motor to internal laryngeal muscles
86
Spinal Accessory (XI)
* modality: somatic motor * foramen: jugular foramen * course: with internal carotid * innervated structures: SCM, trapezius
87
Hypoglossal Nerve (XII)
* modality: somatic motor * foramen: hypoglossal canal * course: forms loop in carotid triangle, C1-2 run with hypoglossal for a while, approach tongue from inferior * innervated structures: most extrinsic and all intrinsic muscles of the tongue
88
Parasympathetics in the Head
* CNIII, VII, IX, X * 4 ganglion * ciliary ganglion (III) * pterygopalatine ganglion (VII) * submandibular ganlgion (VII) * otic ganglion (IX)
89
Ciliary Ganglion
* pre: CN III * post: short ciliary nerves * innervate: ciliary muscles, sphincter pupillae
90
Pterygopalatine Ganglion
* pre: CN VII --\> greater petrosal nerve * post: fibers travel with V2 * innervate lacrimal gland and other small glands
91
Submandibular Ganglion
* pre: CN VII --\> chorda tympani via lingual nerve * post: travel with lingual nerve * innervate: submandibular gland, sublingual gland
92
Otic Ganglion
* pre: CN IX --\> lesser petrosal nerve (with tympanic nerve) * post: travel with auriculotemporal nerve (V3) * innervate: parotid gland
93
Mnemonics for Cranial Nerves
* Oh, Oh, Oh, To Touch And Feel A Virgin Girls' Vaginas, Ah Heaven * Some Say Marry Money, But My Brother Says Big Boobs Matter More

Human Structure (5 decks)

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