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ESA 4 > Head and Neck > Flashcards

Head and Neck Flashcards

1
Q

What structures does cranial nerve VII innervate?

A

Cranial nerve VII is the facial nerve, it innervates the facial muscles, buccinators, superficial muscles of the neck and chin, muscles of the ear and occipitofrontalis muscle

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2
Q

State the anatomical location of the neck

A

Between the lower margin of the mandible, suprasternal notch of the manubrium and the upper border of the clavicle

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3
Q

What are the layers of the neck?

A

Skin, subcutaneous fat, platysma muscle, deep cervical fascia, pre tracheal fascia, carotid sheaths and the pre-vertebral fascia

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4
Q

What is the significance of the retropharyngeal space?

A

Located behind the pharynx and it runs to the diaphragm. If infected it could spread and cause mediastinitis

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5
Q

What is the significance of the parapharyngeal space?

A

Contains the carotid sheaths and lies parallel to the pharynx. Infections can spread to about T2/3 and can cause tonsillitis or dental problems

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6
Q

State the suprahyoid and infrahyoid muscles

A

Suprahyoid - digastric, mylohyoid, stylohyoid and geniohyoid

Infrahyoid - thyrohyoid, sternohyoid, sternothyroid, omohyoid

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7
Q

What are the main contents of the anterior triangle?

A

IJV, facial vein, retromandibular vein and EJV. Submandibular gland. Nerve to mylohyoid. Anterior JV, hyoid bone, oesophagus, thyroid and parathyroidg glands. Larynx. Carotid sheath and branches of the external carotid artery. Lymph nodes. Ansa cervicalis.

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8
Q

What forms the internal jugular vein?

A

Anastomosis of the sigmoid sinus of the dura mater and the common facial vein - provides venous drainage of the skull

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9
Q

Which vessels form the external jugular vein?

A

Posterior division of the retromandibular vein and the posterior auricular vein

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10
Q

State the borders of the anterior triangle of the neck

A

Superiorly - inferior border of the mandible
Laterally - medial border of SCM
Medially - imaginary sagittal line down the midline of the body

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11
Q

State the borders of the posterior triangle of the neck

A

Anteriorly - posterior border of the SCM
Posteriorly - anterior border of the trapezius
Inferiorly - middle third of the clavicle

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12
Q

What does the superficial cervical fascia encompass?

A

Investing layer (trapezius, SCM, parotid and submandibular glands), pre-tracheal layer (infrahyoid muscles, thyroid gland, trachea and oesophagus), prevertebral layer (vertebral column and associated muscles) and the carotid sheath (common carotid artery, internal jugular vein, vagus nerve and lymph nodes).

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13
Q

What is the most common cause of non-traumatic facial paralysis?

A

Inflammation of the facial nerve near its exit from the cranium at the sylomastoid foramen. This leads to oedema and compression of the nerve in the intracranial facial canal (Bell’s palsy)

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14
Q

What are the structural features present at 4 weeks in regards to the head and neck in an embryo?

A

An association with the brain, sensory placodes and the involvement of other systems e.g. brain and CVS

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15
Q

Describe pharyngeal arches

A

A system of mesenchymal proliferations in the neck region of an embryo. There are 5 in total (1-4 and 6). Each arch has an associated artery, nerve and cartilage bar and is lined by endodermal tissue.

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16
Q

What are the three vesicles in the three vesicle stage called?

A

Prosencephalon, mesencephalon and rhomboencephalon

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17
Q

Explain why the distribution of the cranial nerves is the way it is

A

Initially they start off segmental (like the other nerves) however their segmental arrangement is lost as the foetus grows.

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18
Q

What are the muscle derivatives of the first pharyngeal arch?

A

Muscles of mastication, mylohyoid, anterior belly of digastric muscle, tensor palati and tensor tympani

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19
Q

What are the muscle derivatives of the second pharyngeal arch?

A

Muscles of facial expression, occipitofrontalis, platysma, stylohyoid, posterior belly of the digastric muscle, stapedius and auricular muscles

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20
Q

What are the muscle derivatives of the third pharyngeal arch?

A

Stylopharyngeus

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21
Q

What are the muscle derivatives of the fourth pharyngeal arch?

A

Cricothyroid, levator palatini and constrictors of the pharynx

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22
Q

What are the muscle derivatives of the sixth pharyngeal arch?

A

Intrinsic muscles of the larynx

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23
Q

Describe cranial nerve V

A

CN V (aka trigeminal nerve) is the nerve of the first arch. Principle sensory nerve of the head - skin of face and lining of mouth/nose. Motor - muscles of mastication and muscles derived from the mandibular process

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24
Q

Describe cranial nerve VII

A

CN VII (aka facial nerve) is the nerve of the second pharyngeal arch. Passes through the stylomastoid foramen and the oarotid gland. Mostly supplies motor innervation - muscles of mastication and other muscles derived from the second arch. Small sensory component - anterior 2/3 of taste buds in the tongue

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25
Describe cranial nerve IX
CN IX (aka glossopharyngeal nerve) is the nerve of the third arch. Innervates the stylopharyngeus and provides sensory innervation to posterior 1/3 of the tongue
26
Describe cranial nerve X
CN X (aka vagus nerve) is the nerve of the fourth and sixth arches. Fourth arch branch is the superior laryngeal nerve which supplies the cricothyroid and constrictors of the pharynx. Sixth arch branch is the recurrent laryngeal nerve which supplies the intrinsic muscles of the larynx
27
State the neural crest derived cartilage bar for each of the pharyngeal arches
First - Meckel's, second - reichert's, fourth and sixth - cartilages of the larynx
28
What are the arterial contributions of the pharyngeal arches?
First - maxillary artery and external carotid, second - stapedial artery and hyoid artery, third - common carotid and internal carotid arteries, fourth - right gives subclavian artery and left gives aortic arch and sixth - right gives pulmonary artery and left gives pulmonary artery and ductus arteriosus.
29
How are the parathyroid glands formed?
The third and fourth pharyngeal pouches divide into dorsal and ventral components and go on to form the parathyroid glands.
30
How is the thymus formed?
The ventral part of the third arch forms the thymus (starts off as two separate lobes that then migrate and form a single gland)
31
What is the fate of the second pharyngeal pouch?
The epithelia proliferates and is then colonised by lymph precurors
32
Describe the development of the middle ear
Ossicles are formed from first and second pharyngeal arch cartilages (Meckel's = malleus and incus, Reichert's = stapes). First pharyngeal pouch endoderm forms the auditory tube that enlarges to incorporate the tympanic cavity surrounding the ossicles. Mesoderm comes from the first and second arch.
33
What are the muscles of the face?
Orbital, nasal and oral muscles
34
Explain why the left common carotid artery is longer than the right common carotid artery
The RCC branches off the subclavian artery whereas the LCC branches directly off the arch of the aorta and thus has a longer way to travel to get to the head
35
Where do the carotids terminate?
Midway between the angle of the mandible and the mastoid process of the temporal bone
36
Where is the 'common carotid line'?
A line beginning below the sternoclavicular joint and terminating midway between the angle of the mandible and the mastoid process
37
At what level do the common carotid arteries bifurcate?
Level of the superior border of the thyroid cartilage
38
What are the branches of the external carotid artery in the neck?
Superior thyroid artery, ascending pharyngeal artery, lingual artery, facial artery, occipital artery, posterior auricular artery, maxillary artery and the superficial temporal artery
39
Which arteries does the subclavian artery give rise to?
Vertebral arteries, internal thoracic artery and the thyrocervical arteries
40
Where does the external carotid artery split into the maxillary and the superficial and temporal arteries?
In the substance of the parotid gland, accompanied by the facial nerve and the retromandibular vein
41
State the boundaries of the carotid triangle
Superior - posterior belly of the digastric muscle Lateral - SCM Medial - superior belly of omohyoid
42
What does the carotid triangle contain?
Carotid arteries, internal jugular vein, vagus nerve and hypoglossal nerve
43
What are the arteries that supply the scalp?
Supra-orbital, supratrochlear, superficial temporal, posterior auricular and occipital arteries
44
State the layers of the scalp
Skin, connective tissue, aponeurosis, loose connective tissue and the periosteum
45
Why does the scalp bleed profusely?
Walls of the arteries are closely attached to connective tissue which limits constriction and keeps the wound open. There are also numerous anastomoses. Deep lacerations can involve the epicranial aponeurosis which compounds the bleeding due to opposing forces of occipitofrontalis
46
What is the venous drainage of the scalp?
Superficial veins generally accompany arteries (e.g. superficial temporal arteries, occipital arteries and posterior auricular arteries). Supraorbital and supratrochlear veins unite at the medial angle of the eye to form angular vein which drains to the facial vein. Some deep parts have veins which drain into the pterygoid venous plexus.
47
Explain the significance of the dural venous sinuses
They connect to the venous drainage of the scalp. Veins of the scalp connect to diploic veins of skull through emissary veins. Infection can therefore spread to the cranial cavity and the meninges
48
State the blood supply to the dura and skull
Anterior, middle and posterior meningeal arteries.
49
What is the significance of the pterion?
Weak point over which the anterior meningeal artery passes - can be injured. This can cause blood to pool in the periosteal layer of the skull (extra/epidural haemorrhage)
50
What is the cavernous sinus?
Plexus of extremely thin walled veins on the upper surface of the sphenoid.
51
What structures are in the cavernous sinus?
Internal carotid artery, CN III, CN IV, CN VI and two branches of the trigeminal nerve (ophthalmic and maxillary)
52
What are the three main functions of lymph?
Removal of excess tissue fluid from extracellular spaces, removal of of macromolecules and putting fluid into the venous circulation
53
State the order of lymph flow
Tissue fluid, lymphatic capillary, afferent lymphatic vessels, lymphatic nodes, efferent lymphatic vessels, lymphatic trunks and lymphatic ducts
54
How is unidirectional flow maintained in lymph vessels?
Valves, passive constriction due to surrounding structures like skeletal muscle and intrinsic constriction by endothelial cells and skeletal muscle around the vessels which constrict in reaction to expansion
55
State some reasons for lymphoedema
Removal or enlargement of lymph nodes, infection, damage to lymphatic system, lack of limb movement, congenital, radiotherapy which can scar vessels
56
Describe a typical lymph node
Connective tissue structures with a tough fibrous capsule and a reticular connective tissue inside. About 2.5 cm in a healthy individual. Contain lymphocytes and macrophages. Physical and phagocytic filter
57
What are the palpable lymph nodes?
Cervical (posterior, pre-auricular, upper, median or lower, supraclavicular), axillary, epitrochlear, inguinal, femoral and popliteal
58
What are the non-palpable lymph nodes?
Mediastinal (paratracheal, hilar, retrocrural), para aortic, common iliac, external iliac, mesenteric (celiac, splenic hilar, portal)
59
What is Waldeyer's ring?
Annular collection of lymphatic tissue surrounding the superior pharynx. Consists of pharyngeal tonsils, palatine tonsils and lingual tonsils
60
State the superficial lymph nodes in the head and neck region
Submental, submandibular, preauricular, postauricular, occipital, superficial external jugular vein, posterior and anterior
61
State the deep lymph nodes in the head and neck region
Jugulo-digastric, jugulo-omohyoid and supraclavicular nodes (left - virchow's node, right - mid-section chest, oesophagus and lungs)
62
Describe the calvaria
Can be divided into cap and base. Cap - frontal, parietal, occipital and frontal bones. Base - ethmoid, sphenoid, occipital, paired frontal and paired temporal bones
63
Describe the main features of the ethmoid bone
Found in the midline of the anterior cranial fossa. Cribiform plate, crista galli, ethmoid bulla and the ethmoid air cells.
64
Describe the main features of the sphenoid bone
Has a central body and two wings (lesser and greater) and the pterygoid process which projects downwards. Body forms the median part of the cranial fossa. Optic groove, tuberculum sellae, sella turcica, dorsum sellae, posterior clinoid process and clivus
65
Describe the main features of the parietal bone
Forms a large part of the side and roof of the cranial cavity. Internal surface - groove for meningeal artery, sagittal sulcus, granular pits and grooves for sigmoid sinus.
66
Describe the main features of the temporal bone
Six parts: squamous, petrosal, mastoid, tympanic, styloid process and zygomatic process.
67
Describe the main features of the occipital bone
Three parts arranged around the foramen magnum - squamous, condylar, basilar segments
68
What are the main bones of the cranial floor?
Frontal, ethmoid, sphenoid, temporal and occipital bones
69
Which structures enter the cranial fossa?
Sensory nerves, arterial blood supply to the brain and meninges, sympathetic nerve and some venous blood
70
What leaves through the cranial fossa?
Cranial motor nerves, parasympathetic outflow, venous drainage and lymphatics
71
What are the functions of the skull?
Protect the brain and other special sensory organs, site of attachment for muscles and meninges.
72
Define the anatomical term 'skull'
Cranium + mandible; bones involved are frontal, parietal, temporal, sphenoid, occipital, facial and mandible.
73
Define the anatomical term 'cranium'
Bone encasing the brain. It's a tri-lamina structure with two plates of compact bone (outer and inner) and one plate of spongy bone (diploe) which is in the middle
74
State the major types of skull fractures
Simple, linear, depressed and compound
75
State some signs and symptoms of skull fractures
Bleeding, bruising, draining of CSF from eyes or nose, swelling, confusion, convulsions, difficulties with balance, drowsiness, headaches, loss of consciousness, nausea, vomiting, visual disturbance, stiff neck and slurred speech
76
What type of fracture can cause an epidural haematoma?
Lateral fracture of the pterion can lacerate the medial meningeal artery.
77
What are countrecoup fractures?
Fractures that occur on the opposite side of the cranium than the site of impact
78
What kind of fracture does trauma to the vault commonly cause?
Radiating linear fracture
79
Which part of the cranial fossa is most prone to fracture and why?
Middle cranial fossa because it is the weakest due to the thin bones and multiple foramina
80
State some common causes of facial fractures
Road traffic collisions, fist fights and falls
81
What causes a 'black eye'?
Trauma or blow to the superciliary arches which can cause laceration of skin and result in profuse bleeds. Skin bruising around the orbit causes tissue fluid and blood to accumulate in the surrounding connective tissue
82
Why might elderly patients have neck pain?
As people age the intervertebral foramina become narrower which can cause compression of spinal nerve roots, resulting in neck pain
83
What are common sites of cervical spine injury?
C2, C6 and C7
84
What are the consequences of a hyperflexion injury of the cervical region?
Can result in rupturing of the lower cervical intervertebral discs, causing compression of the associated spinal nerve roots. Pain is felt in the neck, shoulder, arm and hand
85
What are the consequences of a hyperextension injury of the neck?
Can result in tearing of the cervical spinous processes, disc rupture, neck muscles and blood vessel injuries
86
What are the skeletal contributions of the first pharyngeal arch?
Premaxilla, maxilla, zygomatic bone, part of the temporal bone, Meckel's cartilage, mandible, malleus, incus, anterior ligament of malleus and the sphenomandibular ligament
87
What are the skeletal contributions of the second pharyngeal arch?
Stapes, styloid process, stylohyoid ligament, lesser horn and upper portion of the body of the hyoid bone
88
What are the skeletal contributions of the third pharyngeal arch?
Greater horn and lower portion of the hyoid bone
89
What are the skeletal contributions of the fourth and sixth arches?
Laryngeal cartilages (thyroid, cricoid, arytenoid, corniculate and cuneiform)
90
What is the development of the face driven by?
Expansion of the cranial neural tube, appearance of a complex tissue system associated with the cranial gut tube and the outflow of the developing heart and development of the sensory organs and the need to separate the respiratory tract from the GI tract
91
What are the major features of the face embryologically speaking?
Palpebral fissures, oral fissures, nares and the philtrum. Facial skeleton, muscles of mastication and muscles of facial expression.
92
What does the frontonasal prominence contribute to?
Forehead, bridge of the nose, medial and lateral nasal prominences
93
What does the medial nasal prominence contribute to?
Philtrum, primary palate and the mid upper jaw
94
What does the lateral nasal prominence contribute to?
Sides of the nose
95
What does the maxillary prominence contribute to?
Cheeks, lateral upper lip, secondary palate and lateral upper jaw
96
What does the mandibular prominence contribute to?
Lower jaw and lip
97
What is a cleft lip?
Failure of fusion of the medial nasal prominences and the maxillary prominence
98
Describe development of the nose briefly
Nasal placodes sink and create nasal pits. Medial and lateral nasal prominences form. Maxillary prominences grow medially, pushing the medial nasal prominences together. They fuse in the midline. Maxillary prominence gives rise to two palatal shelves which grow vertically down. These then grow towards each other and fuse in the midline. Nasal septum grows and fuses with this.
99
Briefly describe the development of the eyes
Optic vesicles grow towards the surface and contact the lens placode which then invaginates and pinches off. Eye primordia are positioned on the side of the head. As the facial prominences grow the eyes move to the front of the face, allowing binocular vision
100
Briefly describe how the ears are formed
External auditory meatus is formed from the first pharyngeal arch. External ears develop in the neck. As the mandible grows the ears ascend to the side of the head. Inner ear is formed from otic placodes which invaginate to form auditory vesicles and the membranous labyrinth.
101
What is the membranous labyrinth formed of?
Saccule, cochlear duct, utricle, semicircular canals and endolymphatic ducts
102
Describe cranial nerve I
Olfactory nerve - sensory function. Starts at olfactory mucosa, ascends through cribriform plate and goes into the olfactory canal, forming the olfactory bulb. Responsible for sense of smell. Brain tract rather than a nerve
103
Describe cranial nerve II
Optic nerve - sensory function. From the retina to the optic tract and then the occipital lobe. Responsible for sight. Brain tract, not a true nerve. Passes through the optic canal
104
Describe cranial nerve III
Oculomotor nerve - motor. Originates in oculomotor nucleus in midbrain. Supplies four extraocular muscles and levator palpebrae superioris. Passes through superior orbital fissure and then splits into superior and inferior branches. Travels with parasympathetic fibres (Edinger-Westphal nucleus)
105
Describe cranial nerve IV
Trochlear nerve - motor. Originates from trochlear nucleus, dorsal midbrain and goes to the superior oblique muscle. Travels through superior orbital fissure and then the cavernous sinus.
106
Describe cranial nerve VI
Abducens - motor. Originates from abducens nucleus in pons and travels to lateral rectus muscle. Passes through superior orbital fissure.
107
Describe cranial nerve V
Trigeminal nerve - sensory and motor. Originates from trigeminal sensory nuclei and splits into three (ophthalmic, maxillary and mandibular branches). Provides general sensation to the face and muscles of mastication. Ophthalmic passes through superior orbital fissure, maxillary passes through foramen rotundum and mandibular passes through the foramen ovale.
108
Describe cranial nerve VII
Facial nerve - sensory and motor. Originates in the pons and passes through the facial canal. Responsible for taste, facial movements, salivation and lacrimation.
109
Describe cranial nerve VIII
Vestibulocochlear - sensory. Originates from the cerbellopontine angle and goes to the cochlea and semicircular canals. Responsible for hearing (cochlear) and balance (vestibular). Passes through the internal acoustic meatus
110
Describe cranial nerve IX
Glossopharyngeal nerve - sensory and motor. Originates from medulla oblongata. Passes through jugular foramen. Responsible for sensation of the oropharynx, posterior 1/3 of tongue, and carotid body and sinus. Motor - stylopharyngeus. Parasympathetic - parotid gland. Part of the gag reflex.
111
Describe cranial nerve X
Vagus - sensory and motor. Originates from medulla oblongata. Passes through jugular foramen. Sensation to laryngopharynx and ear. Motor to muscles of pharynx and larynx. Parasympathetic to heart, lungs, GI etc. Also contributes to gag reflex.

ESA 4 (3 decks)

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