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Anatomy For The MRCS Part A > Head and Neck anatomy(Matary surgical anatomy) > Flashcards

Head and Neck anatomy(Matary surgical anatomy) Flashcards

1
Q

What structures transmitted by( contained in) the Jugular foramen?

A

(1) Internal jugular vein
(2) Inferior petrosal sinus
(3) Glossopharyngeal nerve(IX)
(4) Vagus nerve(X)
(5) Spinal accessory nerve(XI)

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2
Q

What does a tumour invading the jugular foramen lead to?

A

Mnemonic:LIP

(1) Loss of taste sensation from the posterior 1/3rd of the tongue
(2) Increase ICP
(3) Paralysis of muscles of soft palate

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3
Q

Where is the location of the vagus nerve in the jugular foramen in relation to other structures?

A

The vagus nerve lies most medial in the jugular foramen

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4
Q

What are the contents of the anterior compartment of the jugular foramen?

A

Glossopharyngeal nerve and inferior petrosal sinus exit from the anterior compartment of the jugular foramen.

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5
Q

What are the contents of the middle compartment of the jugular foramen?

A

Vagus and spinal accessory nerves exit from the middle compartment of the jugular foramen

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6
Q

How does the internal jugular vein form in the jugular foramen?

A

The sigmoid sinus exits from the jugular foramen to become the internal jugular vein.

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7
Q

Define Jacobson nerve?

A

The tympanic branch of the glossopharyngeal nerve is called Jacobson nerve.

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8
Q

What are the compartments in the jugular foramen and what are their contents?

A

(1)Anterior compartment:
1-Glossopharyngeal nerve
2-Inferior petrosal sinus
(2)Middle compartment:
1-Vagus nerve
2-Spinal accessory nerve

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9
Q

Draw a diagram illustrating the contents of jugular foramen and its location and relation

A

Look at page 3 Matary surgical anatomy

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10
Q

Define the scalp?

A

It is the soft tissue covering the skull vault.

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11
Q

Enumerate layers of the scalp?

A

Mnemonic: SCALP
(1)Skin
rich in hair follicles and sebaceous glands
(2)Connective tissue
.Blood vessels are located primarily in this layer
.When injecting a local anasthaetic,the tip of the needle should inserted in this
layer.
(3)Apponeurosis
Flat membrane
(4)Loose areolar connective tissue
.The dangerous area of the scalp because it contains the emissary veins which
connects the scalp veins with dural venous sinuses.
.Allows free mobility of the 1st 3 layers on the underlying periosteum.
(5)Periosteum(pericranium)
.Loosely attached to the bones
.Firmly attached to the suture lines
.Continuous with the outer layer of dura at the foramen magnum

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12
Q

What does skin of the scalp contain?

A

(1) Hair follicles

(2) Sebaceous glands

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13
Q

What does connective tissue layer of the scalp contain?

A

Blood vessels are located primarily in this layer

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14
Q

What is the clinical importance of connective tissue layer of the scalp

A

When injecting a local anaesthetic,the tip of the needle should be inserted in this layer

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15
Q

What is the structure of aponeurosis layer of the scalp?

A

Flat membrane

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16
Q

What is the function of loose areolar connective tissue layer of the scalp?

A

Allows free mobility of the 1st 3 layers on the underlying periosteum.

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17
Q

What is the clinical importance of loose areolar connective tissue layer of the scalp?

A

The dangerous area of the scalp because it contains emissary veins which connect scalp veins with the dural venous sinuses.Furthermore,emissary veins do not have valves and open in the loose areolar connective tissue layer of the scalp.Therefore,infection can be transmitted from the scalp to the cranial cavity.

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18
Q

What are the connections of periosteum of the scalp?

A

(1) Loosely attached to the bones
(2) Firmly attached to the suture lines
(3) Continuous with the outer layer of dura at the foramen magnum

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19
Q

Enumerate muscles of the scalp with their attachments and mention their nerve supply?

A

(1)Occipitalis
Is attached to the skull(at superior nuchal line).
(2)Frontalis
Is not attached to the skull.
(3)The muscles of the scalp are innervated by the FACIAL NERVE

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20
Q

What innervates muscles of the scalp?

A

The muscles of the scalp are innervated by the FACIAL NERVE

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21
Q

What is the lymphatic drainage of the scalp?

A

To the superficial circle of LNs around the lower part of the skull which drain into the deep LNs around the carotid sheath.
The posterior part of the scalp is drained to the occipital and posterior auricular groups of LNs.

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22
Q

What is the sensory nerve supply of the scalp?

A

A)In front of the auricle-By trigeminal(5th) nerve
(1)Supratrochlear nerve
(2)Supraorbital nerve
(3)Zygomatico-temporal nerve
(4)Auriculo-temporal nerve
B)Behind the auricle-By cervical plexus
(1)Great auricular nerve
(2)Lesser occipital nerve
(3)Greater occipital nerve
(4)3 rd occipital nerve

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23
Q

What is the arterial blood supply of the scalp?

A

A)In front of the auricle
1)Branches of ophthalmic artery of the ICA
(1)Supratrochlear artery
(2)Supraorbital artery
2)Branches of ECA
Superficial temporal artery
B)Behind the auricle
Branches of ECA
(1)Posterior auricular artery
(2)Occipital artery

24
Q

What is the venous drainage of the scalp?

A

(1)Supratrochlear vein
(2)Supraorbital vein-Supratrochlear and Supraorbital veins unite to form facial
vein at the medial orbital margin.
(3)Superficial temporal vein
(4)Maxillary vein
(5)Occipital vein

25
Q

Enumerate points of surgical importance of scalp layers?

A

E The 1st three lavers of the scalp are intimatelv united & should be consjdered as one layer
. Comprise the superficial 3 layers.
o They are turned downwards & not upwards (nerves & vesse/s enter the scalp from periphery).
. Subcutaneous hematoma is small, tense & painful.
. Sub-aponeurotic collection of blood: may extend anteriorly to the eyelids forming black eye & posteriorly to superior nuchal line (attach ment of occipito-frontalis).
. Sub-periosteal collection of blood:
- ls limited by attachment of the periosteum to the suture lines.
- Feels like depressed fracture due to fibrin deposition at its periphery.
The scalp has very rich blood supplv. this explains:
. Wounds of scalp bleed profusely. Bleeding can be stopped by compressing the scalp over the underlying skull bone.
.
uncommon.
Wounds heal well; minimal debridement is required & wound infection is
tr There is no subcutaneous fat in scalp ) no lipoma.
tr Plentiful sebaceous qlands make the scalp one of the most common sites for sebaceous cysts.
tr Emissary veins do not have valves and open in the loose areolar tissue; therefore, infection can be transmitted from the scalp to the cranial cavity. The layer of loose areolar tissue is known as the dangerous area of the scalp.
tr Metastatic spread of maliqnant lesions in front of the auricle is to the parotid and cervical groups of lymph nodes. The posterior part of the scalp is drained to the occipital and posterior auricular groups of lymph nodes.
tr Anastomosis exists at the medial anqle of the eve. between the facial branch of the external carotid arterv and the cutaneous branch of the internal carotid arterv. During old age, if the internal carotid artery undergoes atherosclerotic changes, the intracranial structures can receive blood from the connection of the facial artery to the dorsal nasal branch of the ophthalmic artery.

26
Q

What is the surgical importance of the 1st 3 layers of scalp?

A

(1)The 1st 3 layers of the scalp are intimately united and should be considered
as one layer.
(2)Surgical flaps of scalp during craniotomy
.Comprise the superficial 3 layers
.They are turned downwards and not upwards(nerves and vessels enter
scalp from periphery)
(3)Scalp haematoma
.Subcutaneous haematoma
Is 1)small
2)tense
3)painful
.Subapneurotic haematoma
May extend 1)anteriorly-to the eyelids,forming black eye
2)posteriorly-to superior nuchal line(attachment of
occipital-frontalis)
.Sub-periosteal haematoma
1)is limited by attachment of the periosteum to suture lines
2)feels like depressed fracture due to fibrin deposition at its periphery

27
Q

What is the surgical importance of the rich blood supply of scalp?

A

.wounds of scalp bleed profusely.Bleeding can be stopped by compressing the
scalp over the underlying skull bone.
.wounds heal well;minimal debridement is required and wound infection is uncommon.

28
Q

Is there any subcutaneous fat in scalp?What is the surgical importance of that?

A

There is no subcutaneous fat in scalp which means NO LIPOMA

29
Q

What is the surgical importance of the sebaceous glands in scalp?

A

Plentiful sebaceous glands make the scalp one of the most common sites for sebaceous cysts

30
Q

What is the site of metastatic spread of tumours in the scalp?

A

Metastatic spread of malignant lesions in front of the auricle is to the parotid and cervical groups of lymph nodes.

31
Q

Where does the anastomosis in scalp occur?

A

Anastomosis exists at the medial anqle of the eve. between the facial branch of the external carotid arterv and the cutaneous branch of the internal carotid arterv. During old age, if the internal carotid artery undergoes atherosclerotic changes, the intracranial structures can receive blood from the connection of the facial artery to the dorsal nasal branch of the ophthalmic artery.

32
Q

What is the the extent of scalp?

A

1) Anteriorly-eye brows
2) Laterally-ears/zygomatic arch
3) Posteriorly-superior nuchal line

33
Q

What are the boundaries of posterior triangle of neck?

A

Anteriorly-posterior border of sternocleidmastoid muscle
Posteriorly-anterior border of trapezius muscle
Base-upper border of middle 1/3rd of the clavicle
Apex-confluence of upper parts of posterior border of sternocleidomastoid and
anterior border of trapezius behind the mastoid at the middle of superior nuchal
line
Roof-(1)Skin
(2)Superficial fascia-contains
1)Platysma
2)EJV
3)Cutaneous branches of cervical plexus
(3)Deep fascia-investing layer of deep cervical fascia
Floor-from above downwards
1)Semispinalis capitis
2)Splenuis capitis
3)Levator scapulae
4)Scalenus medius and posterior(called scalene mass)

34
Q

What are the contents of the posterior triangle of neck?

A

(1)Muscles
Inferior belly of omohyoid muscle which divides the triangle into 2
smaller triangles(the larger occipital and the smaller supraclavicular or
subclavian triangles)
(2)Arteries
1)3rd part of subclavian artery
2)Transverse cervical artery
3)Suprascapular artery-Both transverse cervical artery and suprascapular
artery are branches of the thyrocervical 1st part of
subclavian artery.
4)3rd part of occipital artery
(3)Veins
1)Subclavian vein
2)Transverse cervical vein
3)Suprascapular vein
(4)Lymph nodes-Supraclavicular LNs
(5)Nerves
1)Accessory nerve
2)Branches of cervical plexus
1.muscular branches
2.a loop from C1 to hypoglossal nerve
3.inferior root of ansa cervicalis and phrenic nerve
3)Brachial plexus(roots and trunks)

35
Q

What are the contents of the occipital triangle of neck?

A

Nerves-(1)Spinal accessory nerve
(2)Four cutaneous branches of cervical plexus
1.Lesser occipital nerve
2.Greater auricular nerve
3.Anterior cutaneous nerve of neck
4.Supraclavicular nerves
(3)Muscular branches
1.Two small branches to the levator scapulae(C3,C4)
2.Two small branches to the trapezius(C3,C4)
3.Nerve to rhomboids(C5 which is proprioceptive)
Vessels-(4)Transverse cervical artery and vein
L.Ns- (5)Along the posterior border of sternocleidomastoid,
more in the lower part-the supraclavicular nodes
and a few at the upper angle-the occipital nodes

36
Q

What are the contents of the supraclavicular(subclavian)triangle?

A

Nerves -(1)Roots and trunks of brachial plexus
(2)Nerve to serratus anterior(long thoracic nerve C5-C7)
(3)Nerve to subclavius(C5-C6)
(4)Suprascapular nerve(C5-C6)
Vessels-(5)3rd part of subclavian artery and vein
(6)Suprascapular artery and vein
(7)Commencement of transverse cervical artery and termination of
the corresponding vein
(8)Lower part of external jugular vein
L.Ns- (9)A few members of the supraclavicular chain

37
Q

What are the boundaries of anterior triangle of neck?

A

Anterior-midline of the neck
Posterior-anterior border of sternocleidomastoid muscle
Base-lower border of mandible

38
Q

What are the subdivisions of anterior triangle of neck and what subdivides them?

A

The digastric muscle and anterior belly of omohyoid divides the anterior triangle of neck into:

(1) 1/2 sub-mental triangle
(2) Diagastric triangle
(3) Muscular triangle

39
Q

What are the boundaries of sub-mental triangle of neck?

A

Above-symphysis menti
Below-body of hyoid bone
On either sides-anterior bellies of diagastric muscles

40
Q

What are the contents of sub-mental triangle?

A

Sub-mental LNs

41
Q

What are the boundaries of the diagastric triangle?

A 
Above-lower border of mandible
Below-two bellies(anterior and posterior)of diagastric 
Roof-skin and fascia 
Floor-(1)in front-mylohyoid muscle 
            (2)behind-hypoglossus muscle
42
Q

What are the contents of the diagastric triangle of neck?

A

(1) submandibular salivary gland
(2) submandibular L.Ns
(3) submandibular ganglion
(4) facial artery
(5) common facial vein
(6) hypoglossal nerve

43
Q

What are the boundaries of muscular triangle of neck?

A

Anteriorly-midline of the neck
Posterosuperiorly-superior belly of omohyoid muscle
Posteroinferiorly-anterior border of sternocleidomastoid muscle

44
Q

What are the contents of muscular triangle of neck?

A

(1) infra hyoid muscles(strap muscles)
1. sternohyoid muscle
2. sternothyroid muscle
3. thyrohyoid muscle
(2) lateral loop of thyroid gland

45
Q

What are the boundaries of the carotid triangle of neck?

A

Superiorly-posterior belly of diagastric
Inferiorly-superior belly of omohyoid
Posteriorly-anterior border of sternocleidomastoid muscle

46
Q

What are the contents of the carotid triangle of neck?

A

(1) Descending hypoglossi
(2) Descending cervicalis
(3) Carotid sheath
1. CCA
2. ICA
3. Vagus
4. IJV
(4) Sympathetic chain
(5) Most of ECA branches

47
Q

What is the relation of the investing layer of deep cervical fascia to anterior and posterior triangles of neck?

A

It forms a layer in the anterior and posterior triangles of neck

48
Q

What are the attachments of investing layer of deep cervical fascia?

A

1)It splits to surround the trapezius and sternocleidomastoid
2)Superiorly-(1)it is attached to:
1.mandible
2.mastoid process
3.superior nuchal line
(2)splits to form a capsule around the parotid gland which is incomplete
superiorly
3)Inferiorly-it splits to be attached to the manubrium sterni and clavicle

49
Q

What is the surgical importance of investing layer of deep cervical fascia?

A

(1) swellings of parotid gland elevate the ear

(2) parotid swellings are very painful due to tough parotid fascia

50
Q

Define stylomandibular ligament?

A

Is a thickened deep portion of parotid fascia(deep cervical fascia)

51
Q

Define pterygomandibular raphae?

A

Is a ligamentous band between:

    1. pterygoid hamulus
   2. mylohyoid line(posterior end)
52
Q

Define sphenomandibular fascia?

A

Is a thickening in the pterygoid fascia

53
Q

Define axillary sheath?

A

Axillary fascia is derived from prevertebral fascia

54
Q

Define the structures related to the investing layer of deep cervical fascia?

A

(1)stylomandibular ligament:is a thickened deep portion of parotid fascia(deep
cervical fascia).
(2)pterygomandibular raphae:is a ligamentous band between
1.pterygoid hamulus
2.mylohyoid line(posterior end)
(3)sphenomandibular ligament:is a thickening of pterygoid fascia
(4)axillary fascia:derived from pretrachial fascia

55
Q

What are the attachments of pretrachial fascia?

A

Above-to hyoid bone(so the thyroid gland moves up and down with deglutition)
Down-to fibrous pericardium
On either sides-(1)fuses with carotid
(2)it splits to form a capsule around the thyroid gland.This capsule is
thicker anteriorly(that is why the gland enlarges posterior at first)

56
Q

What are the contents of the pretrachial fascia?

A

i. e,structures are mobile with deglutition:
(1) Thyroid gland
(2) Parathyroid gland
(3) Pre-tracheal LNs(LNs of Delphi)
(4) Pre-laryngeal LNs(LNs of Poitier)
(5) Thyroglossal cyst and tract if found

Anatomy For The MRCS Part A (13 decks)

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