Head & Neck Flashcards
Level of C3
-Hyoid bone
Level of C6
- Cricoid cartilage
- Tracheotomy @ this LVL
- Junction between larynx & trachea
- Carotid artery can be compressed against transverse process
- inferior & middle thyroid arteries enter thyroid (common carotid)
- Site for blocks of the brachial plexus (subclavian vein ant.)
Cervical fascia
- Superficial: contains platysma (covers the sterno. muscle fascia)
- Deep:
1. investing SCM & Trapezius
2. Prevertebral: surrounds vertebrae & muscles
3. pretracheal: surrounds trachea, esophagus, & thyroid
4. carotid sheath: continuous w/ pretracheal fascia
Carotid Sheath
- Continuous w/ pretracheal fascia (3)
- Contains: 1. internal carotid, internal jugular, vagus nerve (CN10)
- 90% of strokes occur here
- 10% circle of willis @ base of brain
Posterior Triangle
- Floor: Clavicle, scalenes (anterior, medius, posterior - resp. accessory muscle) levator scapulae, splenius capitis (whiplash)
- Roof: investing fascia surrounding SCM & Trapezius (superficial, innv. by CN 11)
- Brachial plexus/subclavian artery.
- Phrenic nerve (C3,4,5)
Sternocleidomastoid (SCM)
- Enclosed by Fascia
- 2 origins & 2 Insertions
- O: Manubriumsterni & Medial 1/3 clavicle
- I: Mastoid process & lateral nucheal line (behind the ear)
- Accessory muscle for breathing (pump handle)
- Innv: Spinal accessory nerve CN 11
Anterior Triangle
- Roof: Superficial cervical fascia/Platysma
- Subdivided into: submandibular, carotid, muscular triangle
- Contains larynx, pharynx, trachea, thyroid, carotid sheath, & strap muscles
Anterior Triangle (muscular)
Boundaries: -Omohyoid (depresses hyoid bone) -SCM -Midline Contains: 4 infrahyoid (strap) muscles & thyroid/parathyroid 1. Mylohyoid 2. Sternohyoid 3. Thryrohyoid 4. Omohyoid
Anterior Triangle (submandibular)
- Boundaries: Ant. & post. bodies of digastric muscles (ant & post) - push bolus and move mandible
- Contains: submandibular gland & lymph nodes & hypoglossal nerve CN 12
Anterior Triangle (carotid)
- Boundaries: posterior belly of digastric, omohyoid, & trapezius
- Contrains: Carotid sheath & vagus nerve CN 10
Anatomy of Thyroid Gland
- Bi-lobed endocrine gland overlying cricoid cartilage
- Two lobe bridged by isthmus ant. to trachea
- Strap muscles & SCM ant.
- Carotid sheath lateral
- thyroid cartilage & trachea posterior
- Blood supply: Sup/inf thyroid artery
- Recurrent laryngeal nerve post.
Blood supply to Thyroid
- Right subclavian–>Thyrocervial–>inferior thyroid artery (ant & post)
- Right subclavian–>superior thyroid artery (ant & post)
- Brachiocephalic trunk–>Thyroid Ima artery (midline supply ant)
Venous drainage head/neck
-Right/left internal jugular vein–>Left/Right subclavian–>SVC
Contents of the Larynx
- Superior to Inferior:
- Tip of epiglottis
- Body of Hyoid bone (C3)
- Thyrohyoid membrane
- Laryngeal prominence (adam’s apple) & posterior is arytenoid cartilage
- Cricothyroid ligament/membrane
- Cricoid cartilage (C6) & lateral cricothyroid muscle
Laryngeal cartilage (Thyroid)
- 2 thin laminae joined @ midline
- Joining forms laryngeal prominence
- Attachment of infra hyoid (strap) muscle to hyoid bone (C3)
Laryngeal cartilage (Epiglottis)
- Post. aspect of thyroid cartilage inside Thyrohyoid membrane
- Attached by quadrangular membrane (false vocal cords) to arytenoid cartilage
Laryngeal cartilage (cricoid/artenoids)
- Cricoid: C6, articulates with thyroid cartilage through cricohyroid muscle
- Artenoids: Pyramid shape post aspect articulate with cricoid cartilage & attach to cricoartenoid muscles/vocal ligament
Laryngeal muscles (extrinsic)
- Suprahyoid (elevate)
- Infrahyoid (depress)
Laryngeal muscles (intrinsic)
- Open/close the airway & responsible for phonation
- Cricothyroid (external laryngeal nerve)
- Thyroarytenoid
- Posterior & lateral circoartenoid
- Transverse & oblique arytenoid
- ALL innv. by recurrent laryngeal nerve (CN 10)
Phonation
- Articulation at the synovial cricothryoid & cricoaryenoid joints alter LENGTH, TENSION & POSITION of vocal cords.
- Tilting forward of larynx lengthens the vocal cords producing a higher pitch
- Cricohyroid = forward
- Thyroartenoid = reverse back
Swallowing
- Involves RAISING of larynx to meet bolus coming from the pharynx & depression of the epiglottis towards the artenoid cartilage (pyramid shape/post)
- Mainly passive due to passage of bolus
Muscle actions of vocal cords
- Posterior cricoarytenoid = bring together to midline = opening
- Transverse arytenoid = midline = closing
- Thyroarytenoid = ant = closing
- Lateral cricoarytenoid = ant = closing
- Oblique arynoid = midline = closing
Piriform Fossa
-Space surrounds the epiglottis
Neck Trauma
- Zone 1 & 3 most prone to airway obstruction or bleeding
- Zone 2 are more common to injury BUT bleeding can be controlled & Cricothyroidotomy can overcome obstruction
- Zone 3 = above chin
- Zone 2 = Chin to clavicle
- Zone 1 = Manubrium
External carotid artery
- 8 main branches supplies whole head and neck
1. Superior thyroid
2. lingual
3. Facial
4. Superficial temporal
5. maxillary
6. posterior auricular
7. occipitan
8. ascending pharyngeal
7 Bones of the ocular cavity
- From posterior to anterior
1. Greater/Lesser wing of sphenoid
2. Frontal bone (roof)
3. Ethmoid bone
4. Lacrimal bone
5. Palantine bone (between ethmoid/maxilla)
6. Maxilla (most anterior/medial)
7. Zygomatic (anterior/lateral next to maxilla)
Borders of orbit
- Superior wall: Frontal bone
- Medial wall: Ethmoid bone
- Lateral wall: Zygomatic/greater wing of Sphenoid
- Inferior wall: Maxilla
- Apex: Optic canal (most medial)
3 layers of the eyeball
- Fibrous: sclera (wraps around entire circumference) & cornea (located in front)
- Vascular: Choroid (below the sclera wraps around entire circum), ciliary body (muscles that make adjustments) & iris (below the iris)
- Inner layer: Retina (cones, blind spot = optic nerve)
Anatomy of the Pupil
- opening through the Iris
- round shape is controlled by sympathetic/parasympathetic within iris = dilator & sphincter muscles (ciliary body)
- Pupil size can be affected by drugs like atropine dilates pupils.
Anatomy of Iris
- Most anterior extension of the uveal tract (Iris, ciliary body, choroid)
- Made up of blood vessels, connective tissue, melanocyctes (melanin producing) make different eye colors
- Dilator/Sphincter muscles
- Anterior/posterior layer of cells- collagen, fibrils, matrix of mucopolysaccharide (long chain sugar mol. make fluid)
Anatomy of ciliary muscles
- Middle portion of the uveal tract
- 3 muscles fibers
1. longitudinal muscles
2. radial
3. Circular