Head And Neck Part 1 Flashcards
What is the Superior Thoracic Aperture Bounded by?
- Superior border of T1 Vertebra
- First ribs
- Suprasternal Notch of the sternum
What is the muscle of facial expression?
Platysma muscle
Where do the muscles of facial expression insert into?
Skin
-move skin at the joints
Which jugular vein may be absent in people?
External jugular vein
What is the origin, insertion and action of the sternocleidomastoid muscle?
O: sternum and clavicle
I: Mastoid process
A: turns face toward contralateral side
-Turns occipital toward ipsilateral side
What is the nerve supply of the sternocleidomastoid muscle?
Motor: Accessory Nerve
Proprioception: branches of anterior rami of C3 and C4 spinal nerves
What is congenital muscular torticollis?
Injury of the sternocleidomastoid muscle
-during intra-uterine or during delivery
How does a patient present with congenital muscular torticollis?
Chin rotated toward the contralateral side and head tilted lateral toward the ipsilateral side
*If right sternocleidomastoid muscle is injured then chin is rotated toward the left and head titled to the right
What is spasmodic torticollis?
Cervical dystopia of the sternocleidomastoid muscle
-painful
How does a patient present with spasmodic torticollis?
sustained rotation and lateral flexion of the neck
What does the investing fascia of the neck have within it?
Splits to invest the two muscles supplied by cranial nerve XI
What does the investing fascia of the neck inhibit?
Spread of infection from skin to deeper structures
What does the carotid sheath contain?
Carotid arteries
Internal jugular vein
Vagus Nerve (CN X)
What does the prevertebral fascia contain?
Prevertebral and paravertebral muscles
From anterior to posterior what are the different spaces of the neck?
- Suprasternal space
- Pretracheal space
- Retropharyngeal space
- Danger space
What are the boundaries of the posterior triangle?
- Sternocleidomastoid muscle
- Trapezius muscle
- Clavicle
What is within the posterior triangle?
Erb’s Nerve Point of the Neck
-Has cervical plexus nerves from Anterior Rami of C1-C5 Spinal nerves
-Emerge deep to the sternocleidomastoid muscle
Where is Erb’s Nerve Point of the Neck located?
Halfway up posterior border of sternocleidomastoid muscles
What are the different nerves that come off the Cervical Plexus?
- Great auricular nerves
- Lesser occipital nerves
- Transverse cervical nerve
- Supraclavicular nerves
What do the supraclavicular nerves supply?
Skin of the lower neck
-descend and pass superficial to clavicle
What dermatomes do the supraclavicular nerve supply?
C3
C4
What do the Transverse Cervical Nerves supply?
Skin of Anterior Triangle
-Cross sternocleidomastoid horizontally
What dermatomes does the Transverse Cervical Nerves supply?
C2
C3
What does the Great Auricular Nerve supply?
Supplies skin between the Mastoid Process of the Temporal Bone and Angle of the Mandible
-crosses Sternocleidomastoid vertically
What will the External jugular vein run with if its present?
Great Auricular Nerve
What dermatomes does the Great Auricular Nerve supply?
C2
What does the Lesser Occipital Nerve supply?
Supplies skin posterior to the ear
-runs vertically along posterior border of the sternocleidomastoid muscle
What dermatome does the Lesser Occipital Nerve Supply?
C2
Where does the Accessory Nerve run to from the brain?
- Passes deep to Sternocleidomastoid Muscle (supplies it)
- Passes along the floor of the Posterior Triangle-toward Trapezius muscle (supplies it)
Where is the Danger Area located?
Lower Half of Posterior Triangle
What separates the Posterior Triangle and Anterior Triangle?
Sternocleidomastoid Muscle
Are there any protections of the anterior neck?
No
-anterior neck is vulnerable to penetrating injuries to the neck
What are the palpable landmarks of the anterior neck?
Hyoid Bone
Thyroid cartilage
Cricoid cartilage
Tracheal Rings
What palpable landmarks make up the larynx?
Thyroid cartilage
Cricoid cartilage
From proximal to distal what are the bony and cartilaginous parts of the neck?
Hyoid Bone
Thyrohyoid membrane
Laryngeal Prominence
Thyroid Cartilage
Cricoid Cartilage
Thyroid glands
Trachea
What is the difference between the thyroid cartilage (laryngeal prominence) from women to men?
Women: wider and flatter
Men: Longer and pointy-er
What are the subdivision of the anterior triangle of the neck?
- Submandibular Triangle
- Carotid Triangle
- Muscular Triangle
- Submental Triangle
How are the infrahyoid muscle named?
For their inferior attachment + Superior attachment
What are the superficial infrahyoid muscles?
- Omohyoid muscle
- Sternohyoid
What are the deep infrahyoid muscles called?
- Thyrohyoid muscle
- Sternothyroid muscle
What are the Suprahyoid muscles?
- Digastric muscle
- Mylohyoid muscle
- Stylohyoid muscle
- Geniohyoid muscle
Where do the Submental lymph nodes receive lymph from?
- Tongue
- Floor of the mouth
- Lower incisors
- gingiva
- Central part of lower lip
- Skin of chin
What are enlarged lymph nodes indicative of?
Carcinoma
Or Infections from these areas
What are the structures of the submandibular triangle?
- Facial Vein
- Facial Artery
- Anterior belly of digastric muscle
- Submandibular glands
- Submandibular lymph nodes
Where do the facial vein and artery pass?
Vein: superficial
Artery: deep
*to the submandibular gland
What is the hypoglossal nerve?
CN XII
-motor to tongue muscles
-passes superficial to hyoglossus muscle, then deep to mylohyoid muscle
Where is the carotid fossa located?
Between the neck viscera and sternocleidomastoid muscles
-Carotid pulse point located here
What is in the carotid sheath? (Which is located in the carotid triangle)
- Carotid arteries
- Internal jugular vein
- Vagus nerve CN X
What comes off of CN XII (hypoglossal nerve)
Superior Root of Ana’s Cervicalis
What does the superior root of Ansa Cervicalis arises from?
Anterior Ramus of C1 Spinal Nerve
-jumps on CN XII, then falls off
What does the inferior root of Ansa Cervicalis arise from?
Anterior Rami of C2 and C3 spinal nerves
-makes a loop
What is the nerve supply of the infrahyoid muscles?
Ansa Cervicalis
What does the Ansa Cervicalis supply?
- Sternohyoid
- Omohyoid
- Sternothyroid
What is the nerve supply of the Thyrohyoid muscle?
Nerve to the Thyrohyoid muscle
Does the internal carotid artery have any branches?
No branches in the neck
Does the external carotid artery have branches?
yes
What are the branches of the external carotid artery?
- Occipital artery
- Facial Artery
- Lingual Artery
- Superior Laryngeal artery
- Superior Thyroid artery
Where does the occipital artery pass?
Up and Over the CN XII (hypoglossal nerve)
Where does the lingual artery pass?
Deep to Hyoglossus muscle
Where does the superior laryngeal artery arise from?
Superior thyroid artery
What does the superior laryngeal artery go through?
Thyrohyoid membrane
What dos Glossopharyngeal nerve supply? (CN IX)
- Carotid sinus
- Carotid body
What does the carotid body contain?
Chemoreceptors for blood gases
What does the carotid sinus contain?
Baroreceptors for blood pressure
What does the internal jugular vein branch off?
- Facial vein
- Superior thyroid vein
- Middle thyroid vein
Where are the deep cervical lymph nodes located?
Along internal jugular vein
-receive lymph from lymph nodes of the pericervical collar (basically all lymph)
What do vasculature and nerves need to pass through in order to reach the Axilla?
Root of the neck
What are the superior and inferior attachment of the Longus Capitis muscle? (Prevertebral)
Superior: Occipital bone
Inferior: Transverse processes of upper cervical vertebrae
What does the Longus Colli muscle do?
Interconnects cervical vertebrae
What are the actions of the Longus Capitis muscle and longus colli muscle
Bilateral: flexion of the neck
Unilateral: Lateral flexion of the neck
what are the attachments of the scalene muscles?
Superior: Transverse Processes of Cervical Vertebrae
Inferior: Rib 1 - anterior and middle scalene muscles
Rib 2: Posterior Scalene muscle
What are the actions of the scalene muscles?
Bilateral: Flexion of the neck
Unilateral: Lateral flexion of the neck (ipsilateral)
+Elevate ribs 1 and 2 during forced inspiration
What two scalene muscles are difficult to distinguish?
Middle and Posterior Scalene muscles
What are the boundaries of the Interscalene triangle?
- Anterior Scalene Muscle
- Middle Scalene muscle
- Rib 1
What passes out through the interscalene triangle?
- Brachial plexus
- Subclavian Artery
What could potentially compress the roots or trunks of the brachial plexus?
Scalenus Minimus muscle
-Can pass between anterior and middle scalenes
What is the thoracic outlet syndrome?
Compression of the Brachial Plexus and or subclavian artery
-by a cervical rib (C7) OR
-Extra scalene muscle
What can thoracic outlet syndrome cause?
Poor circulation
Pain
Numbness
Weakness in shoulder, upper limb, or fingers
What separates the subclavian vessels?
Anterior Scalene muscle
When does the subclavian vessels become axillary vessels?
At the lateral border of the 1st Rib
What vessels branch off the first part of the subclavian artery?
- Vertebral Artery
- Thyrocervical trunk
- Internal thoracic artery
What are the branches coming off of the thyrocervical trunk?
- Inferior thyroid artery
- Transverse cervical artery
- Suprascapular artery
What is the third part (branch) of the subclavian artery?
Dorsal Scapular Artery (optional)
-Passes through Brachial plexus
Where does the vertebral artery pass into?
Transverse Foramen of C6 vertebra
-ascends through transverse foramina of C5-C1
What is the blood supply of the breast?
- Internal thoracic Artery
- Lateral Thoracic Artery
What can be used during a CABG?
- Great saphenous vein
- Internal thoracic artery
Where does the transverse cervical artery descend to?
Drops down Superficial Branch to Trapezius muscle
Where does the Transverse cervical artery descend if the dorsal scapular artery is not there?
Descends to the Deep branch to levator scapular and rhomboid muscles
Where does the phrenic nerve come from?
C3-C5 anterior Rami
-Also from cervical plexus
Where does the phrenic nerve descend to?
Anterior to Anterior Scalene muscle
-pinned down by transverse cervical and Suprascapular arteries
Where does the right recurrent laryngeal nerve arise from?
Vagus nerve (CN X)
Where does the right recurrent laryngeal nerve ascend to?
From Vagus nerve
-Hooks around right subclavian artery
-Ascends between the trachea and esophagus
-heads to Larynx
Where does the root of the neck drain to?
Brachiocephalic vein
-Formed by the internal jugular and Subclavian veins
What does the right lymphatic duct do?
Drains all lymph from right side above diaphragm
What does the thoracic duct do?
Drains
-all lymph from both sides below diaphragm
-And left side above diaphragm
Where is the cervical extension of the sympathetic chain ganglia located?
Between the first rib AND
Carotid bifurcation
What is found between T1 and L2 Levels of Spinal cord?
- Preganglionic sympathetic neuronal cell bodies in the spinal cord
- White Rami communicates (axons of preganglionic sympathetic neurons to the sympathetic chain ganglia)
What causes Horner’s Syndrome?
Loss of sympathetic supply to the face
-Can be due to Pancoast Tumor (tumor of the apex of the lungs, will compress the sympathetic chain ganglia)
-Can be due to injury to T1 spinal nerve
What are the symptoms of Horner’s Syndrome?
- Flushed, warm skin (vasodilation)
- Anhihdrosis (attenuated sweating)
- Miosis (pupillary constriction)
- Mild ptosis
What does the superior cervical ganglion do?
It is postganglionic sympathetic nerve supply to ipsilateral half of head
What is the thyroid gland enclosed in?
Pretracheal fascia
-Attached to cricoid, thyroid cartilages, and upper tracheal rings
-will move with the larynx
What is the internal laryngeal nerve a branch of?
CN X (vagus nerve)
-will pierce the Thyrohyoid membrane
What is the external laryngeal nerve a branch of?
CN X (vagus)
-Supplies the cricothyroid muscle
What does the cricothyroid muscle do?
Tensor of the vocal cords
What is the nerve supply of the cricothyroid muscle?
External laryngeal nerve
What is the blood supply (arteries) of the thyroid gland?
- Superior thyroid artery
-From external carotid artery - Inferior thyroid artery
-from thyrocervical trunk - Thyroidea Ima Artery
What is the blood supply (veins) of the thyroid gland?
- Superior thyroid vein
- Middle thyroid vein
- Inferior thyroid vein
Where do the superior/middle thyroid veins drain to?
Internal jugular vein
Where does the inferior thyroid vein drain to/
Brachiocephalic vein
If the Thyroidea Ima is damaged during surgery what can happen?
Difficulty to control bleeding
Where are the parathyroid glands located (1-3)
Posterior side lobes of thyroid gland
What is the blood supply of parathyroid glands (1-3)?
Superior and inferior thyroid arteries
What is the bony ear hole called/
External Acoustic meatus
What are the muscles of facial expression?
- Platysma
- Orbicularis Oris muscle
- Orbicularis Oculi muscle
- Frontalis muscle
- Zygomaticus muscle
- Depressor Anguli Oris
- Levator Labii Superioris
- Depressor Labii Inferioris
- Buccinator muscle
Of the Orbicularis Oculi muscle what does the palpebral and orbital part do?
Palpebral part: Blinking
Orbital part: Tight closure
What is an important function of the Orbicularis Oculi muscle?
Distribute lacrimal fluid over cornea, protecting it from ulceration
Where is the origin and insertion of the zygomaticus major muscle?
O: body of zygomatic bone
I: Angle of the mouth
What is the insertion of the Depressor Anguli Oris muscle?
Angle of the mouth
What is the insertion of the Levator Labii superioris muscle?
Upper lip, closer to midline
What is the insertion of the Depressor Labii Inferioris muscle?
Lower lip, closer to midline
Where does CN VII (facial nerve) exits the skull?
Stylomastoid foramen
-passes through the parotid gland
What muscles does the facial nerve supply?
Muscles of facial expression
What is the mnemonic to remember where the branches of the facial nerve descend to?
To:Temperoal branch
Zanzibar: Zygomatic
By: Buccal
Motor: Mandibular
Car: Cervical
Where does the temporal branch ascend to?
Across zygomatic arch
Where does the zygomatic branch pass to?
Over Zygomatic bone toward Orbicularis oculi muscle
Who does the Buccal branch run with?
Parallel to Parotid duct
Where does the mandibular branch run to?
Toward the chin
Where does the cervical branch descend into?
Descends into the neck
What is CN V?
Trigeminal nerve
-sensory to the face
What are the major division of CN V (trigeminal nerve)
- Ophthalmic (V1)
- Maxillary (V2)
- Mandibular (V3)
What is the branch of CN V1? (Ophthalmic)
Supraorbital nerve
*Supraorbital foramen
What is the branch of CN V2? (Maxillary)
Infraorbital Nerve
*infraorbital foramen
What is the branch of CN V3? (Mandibular)
Mental nerve
*mental foramen
What is Trigeminal Neuralgia? (Tic Doloureux)
Intense unilateral cutting pain of the face
“Worse pain in the world”
*idiopathic
What branches end the external carotid artery?
Will form the
1. Superficial Temporal artery
2. Maxillary artery
What are the difference between the facial artery and vein?
Facial Artery
-Curly and 1cm anterior to facial vein
Facial Vein
- Straight and about 1 cm posterior to facial artery
What is in the Aponeurosis of the scalp?
Frontalis and Occipitalis muscles
-Galea Aponeruotica
What are the layers of the scalp? (Superficial to Deep)
- Skin
- Dense connective tissue
- Aponeurosis
- Loose connective tissue
- Pericardium (outer periosteum of the crania bones)
Where can subgaleal hematomas form?
Form in Loose connective tissue between pericardium and muscle layer
