Head and neck Flashcards
Where does the internal jugular vein drain?
Subclavian vein
What are the main sites of access for central venous lines?
Internal jugular vein or subclavian vein
What are central venous lines used for?
Monitoring central venous pressure in right atrium
Administration of irritant drugs
Intravenous feeding
What are the complications of insertion of central venous lines?
Arterial puncture leading to haematoma and potential airway obstruction Pneumothorax Nerve damage Air embolism Thrombosis Misplacement Infection
What defines posterior triangle of neck?
Anterior margin of trapezius
Posterior margin of sternocleidomastoid
Middle third of clavicle
What traverses the posterior triangle of neck?
Accessory nerve (CN XI)
Where the accessory nerve exit the skull?
The jugular foramen
What does the accessory nerve do and how would you test its function?
It innervates the trapezius and sternocleidomastoid and you would test its function by asking patient to shrug shoulders or turn head against pressure
What does the condyle of the mandible do during opening and closing of the mouth?
It articulates with mandibular fossa of temporal bone in a hinge action
What does the condyle of the mandible do during protrusion and retraction of mandible?
Glides forward to articulate on articular tubercle. Protraction mainly due to action of lateral pterygoids while retraction achieved using posterior temporalis
You can palpate temporalis and masseter during these movements
Why is the masseter easier to palpate than temporalis?
Masseter is superficial and large whereas temporalis is fan-shaped, thin and covered by temporal fascia
In each quadrant of the teeth what is there?
Incisors 2
Canines 1
Premolars 2
Molars 3
What is the full number of teeth in a typical permanent set?
32
What is the number of teeth in a complete deciduous set?
20
When do the first deciduous teeth usually erupt?
6-8 months
When is the deciduous set usually complete?
20-24 months
What are the approximate starting and completion ages for permanent set?
6 years to early twenties
What can be examined in mouth by using a torch and tongue depressor?
Submandibular salivary ducts Genioglossus muscle Sublingual salivary glands Papilla of parotid duct Tongue -> Filiform papilla, line of button like circumvallate papillae
Which nerves supply general sensation and taste to the anterior and posterior parts of the tongue?
Anterior 2/3: Sensation- Mandibular Taste- Facial VII
Posterior 1/3: Sensation and taste- IX
Why are tonsils clinically important?
May become inflamed and need surgical removal
What is the great sensory nerve of the face?
Trigeminal- it supplies general sensation through three divisions:
Ophthalmic
Maxillary
Mandibular
What does the opthalmic division supply?
Skin from the top of the head to the upper eyelids and a strip down the median line of the nose. It supplies sensation to very sensitive conjunctiva covering the anterior surface of the eye and much of the nasal mucosa and frontal sinus
What does the maxillary division supply?
Skin of anterior temple and middle part of face as far down as corners of mouth. In addition it supplies the upper teeth, lip, gums and roof of mouth
What does the mandibular division supply?
Strip of skin running from middle part of the temple then anterior to the ear and down to the chin. In addition, it supplies the lower teeth, gums and lip, lining of cheeks, floor of the mouth and buccal part of the tongue
How do you test the three different sections of the trigeminal nerve individually?
Pin-prick test to determine sensation in three divisions and ask patient to clench teeth to test motor component
What does the facial nerve supply?
Motor fibres to facial muscles
Taste sensation to the anterior 2/3 of the tongue and parasympathetic (secretomotor) nerves to lacrimal and salivary glands
How would you test a patients facial nerve function?
Ask patient to look at ceiling, screw up eyes or show their teeth
How do you test for the facial nerve innervation to the lacrimal and salivary glands?
Loss of tear or saliva production
What does the glossopharyngeal nerve innervate?
It is the main sensory nerve of the posterior 1/3 of the tongue and oropharynx.
What does stimulation of glossopharyngeal nerve cause?
Reflex of expulsive effort called gagging
What is the simplest test of the glossopharyngeal nerve?
Eliciting a gag reflex
What is the only motor nerve of the tongue?
The hypoglossal nerve
How do you test the function of the hypoglossal nerve?
Ask the patient to stick out their tongue
What will happen if the hypoglossal nerve is injured on one side only?
Tongue will deviate towards side of lesion
What else might you observe in long standing injury to a hypoglossal nerve?
Atrophy of the tongue on side of lesion
What structures should you be able to identify in the neck?
Thyroid cartilage
Cricoid cartilage
Thyroid gland
Hyoid bone
What happens to structures in the neck during swallowing?
Larynx is elevated during swallowing and with retroflexion of epiglottis over laryngeal inlet this helps to stop any food getting into the airway
Where would you perform a cricothyroidotomy?
Via the circothyroid membrane, which lies in the space between the thyroid cartilage (laryngeal prominence adam’s apple and the cricoid cartilage, on the anterior aspect of the neck
What is hypotropia?
When eye look down
What is hypertropia?
Eye looks up
What is exotropia?
Eye turns out
What is esotropia?
Eye turns in
