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Head & Neck Flashcards

1
Q

Level of C3

A

-Hyoid bone

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2
Q

Level of C6

A
  • 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.)
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3
Q

Cervical fascia

A
  • 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
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4
Q

Carotid Sheath

A
  • 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
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5
Q

Posterior Triangle

A
  • 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)
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6
Q

Sternocleidomastoid (SCM)

A
  • 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
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7
Q

Anterior Triangle

A
  • Roof: Superficial cervical fascia/Platysma
  • Subdivided into: submandibular, carotid, muscular triangle
  • Contains larynx, pharynx, trachea, thyroid, carotid sheath, & strap muscles
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8
Q

Anterior Triangle (muscular)

A 
Boundaries:
-Omohyoid (depresses hyoid bone)
-SCM
-Midline
Contains: 4 infrahyoid (strap) muscles & thyroid/parathyroid 
1. Mylohyoid
2. Sternohyoid
3. Thryrohyoid
4. Omohyoid
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9
Q

Anterior Triangle (submandibular)

A
  • Boundaries: Ant. & post. bodies of digastric muscles (ant & post) - push bolus and move mandible
  • Contains: submandibular gland & lymph nodes & hypoglossal nerve CN 12
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10
Q

Anterior Triangle (carotid)

A
  • Boundaries: posterior belly of digastric, omohyoid, & trapezius
  • Contrains: Carotid sheath & vagus nerve CN 10
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11
Q

Anatomy of Thyroid Gland

A
  • 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.
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12
Q

Blood supply to Thyroid

A
  • Right subclavian–>Thyrocervial–>inferior thyroid artery (ant & post)
  • Right subclavian–>superior thyroid artery (ant & post)
  • Brachiocephalic trunk–>Thyroid Ima artery (midline supply ant)
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13
Q

Venous drainage head/neck

A

-Right/left internal jugular vein–>Left/Right subclavian–>SVC

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14
Q

Contents of the Larynx

A
  • 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
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15
Q

Laryngeal cartilage (Thyroid)

A
  • 2 thin laminae joined @ midline
  • Joining forms laryngeal prominence
  • Attachment of infra hyoid (strap) muscle to hyoid bone (C3)
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16
Q

Laryngeal cartilage (Epiglottis)

A
  • Post. aspect of thyroid cartilage inside Thyrohyoid membrane
  • Attached by quadrangular membrane (false vocal cords) to arytenoid cartilage
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17
Q

Laryngeal cartilage (cricoid/artenoids)

A
  • Cricoid: C6, articulates with thyroid cartilage through cricohyroid muscle
  • Artenoids: Pyramid shape post aspect articulate with cricoid cartilage & attach to cricoartenoid muscles/vocal ligament
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18
Q

Laryngeal muscles (extrinsic)

A
  • Suprahyoid (elevate)

- Infrahyoid (depress)

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19
Q

Laryngeal muscles (intrinsic)

A
  • 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)
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20
Q

Phonation

A
  • 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
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21
Q

Swallowing

A
  • 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
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22
Q

Muscle actions of vocal cords

A
  • Posterior cricoarytenoid = bring together to midline = opening
  • Transverse arytenoid = midline = closing
  • Thyroarytenoid = ant = closing
  • Lateral cricoarytenoid = ant = closing
  • Oblique arynoid = midline = closing
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23
Q

Piriform Fossa

A

-Space surrounds the epiglottis

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24
Q

Neck Trauma

A
  • 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
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25
Q

External carotid artery

A
  • 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
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26
Q

7 Bones of the ocular cavity

A
  • 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)
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27
Q

Borders of orbit

A
  • Superior wall: Frontal bone
  • Medial wall: Ethmoid bone
  • Lateral wall: Zygomatic/greater wing of Sphenoid
  • Inferior wall: Maxilla
  • Apex: Optic canal (most medial)
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28
Q

3 layers of the eyeball

A
  1. Fibrous: sclera (wraps around entire circumference) & cornea (located in front)
  2. Vascular: Choroid (below the sclera wraps around entire circum), ciliary body (muscles that make adjustments) & iris (below the iris)
  3. Inner layer: Retina (cones, blind spot = optic nerve)
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29
Q

Anatomy of the Pupil

A
  • 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.
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30
Q

Anatomy of Iris

A
  • 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)
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31
Q

Anatomy of ciliary muscles

A
  • Middle portion of the uveal tract
  • 3 muscles fibers
    1. longitudinal muscles
    2. radial
    3. Circular
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32
Q

Anatomy of Choroid

A
  • posterior portion of the uveal tract & nourishes the retina (blood supply/O2)
  • Supplies rods which require ALOT of blood
  • Basement membrane = Bruch’s membrane (transports metabolic waste)
33
Q

Anterior chambers structures

A
  • Aqueous humor (secreted by ciliary epithelium)
  • Trabecular meshwork (drains the aqueous humor)
  • Canal of schlemm: meshwork allows for fluid to drain into canal and finally blood supply
34
Q

Role of eyelids & Lacrimal glands

A
  • Major role to protect cornea & eyeball from injury/irritation
  • Production of of lacrimal fluid from glands stimulated by parasympathetic from Facial nerve (CN7)
  • Convey fluid into conjunctival sacs (between eyeballs and lids)
  • When cornea becomes dry–>eyelid blinks pushing film fluid medially over the cornea
  • Debris is pushed medially in lacrimal lake (eye boogers) & drains by capillary action
  • Fluid passes inferior by nasolacrimal duct to inferior meatus of nose to be swallowed
35
Q

Extra ocular muscles NOT CN3

A
  • Superior oblique (CN4) = Abducts,depresses and rotates eyeball medially (intorsion)
  • Lateral rectus (CN6): ABducts eyeball
36
Q

Extra ocular nerves CN 3

A
  • Superior Rectus: elevates, ADducts, rotates eyeball medially (intorsion)
  • Medial rectus: Adducts
  • Inferior rectus: depresses, Adducts, rotates eyeball laterally (extorsion)
  • Inferior oblique: ABducts, elevates, rotates laterally (extorsion)
37
Q

Fracture to orbit

A
  • Most common to inferior & medial walls due their thinness
  • Medial wall fractures may involve ethmodial & sphenodial sinuses
  • Inferior wall involve maxillary
  • Fractures can have bleeding occur which causes pressure = exophathalmos (protrusion of eyeball)
38
Q

“Blow out” fracture of orbit

A

-indirect trauma that displaces orbital walls

39
Q

Normal landmarks of eye exam

A
  • Blood vessels of surface of retina
  • Optic disc (blind spot)-Blood vessels radiate from & optic nerve exits here
  • The macula (lutea): middle for each retina, yellowish in color & BV absent
  • Fovea: dark spot in the macula midline marker
40
Q

Clinical conditions of eye exam

A
  • Papilloedema: associated with intracranial pressure seen @ optic disc as widening.
  • Bacterial endocarditis: starts from bacterial infection of lining of heart chambers that travels through the blood. Appears as mini hemorrhages in eye
41
Q

Papilloedema

A
  • Optic nerve surrounded by dura, arachnoid, & pia mater
  • Increased ICP –> Obstruction to axoplasmic transport
  • Swelling @ the optic disc –>optic atrophy & Blindness
42
Q

CN 3 Palsy

A
  • Appearance: Ptosis (drooping superior eyelid), pupil fully dilated, down & out
  • Causes: Hypertension, Diabetes, Trauma
43
Q

CN 6 Palsy

A
  • Appearance: Eye deviated nasally/Eye can not be abducted from midline
  • Causes: Diabetes, MS, ICP, Trauma
44
Q

Horner’s syndrome

A

Appearance: Partial Ptosis, Miosis (excessive constriction of pupil), Anhydrosis (dry eye)
-Causes: Damage to sympathetic cervical trunk, Pancoast tumor (@ apex of lung) can spread

45
Q

Overview of External Ear

A
  1. Auricle & Pinna: Collect sound

2. External auditory meatus: responsible for transmitting sound to tympanic membrane

46
Q

Auricle (Pinna)

A
  • Framework of elastic cartilage adherent to perichondrium
  • Lobule has NO cartilage
  • Attached to skull with anterior/posterior ligaments & useless auricular muscles
  • Helix (superior part)
  • Antihelix (middle & inferior to helix)
  • Antitragus (midline ridge before meatus)
  • Concha (inner/outer ear sup. to meatus)
  • Targus (midline closest to nose)
47
Q

External Auditory Meatus

A
  • Curves anteriorly, inferiorly, medially
  • Lateral 1/3 cartilage & medial 2/3 bony (temporal)
  • Meatus guarded by Ceruminous glands = secrete ear wax (antibacterial)
48
Q

Tympanic membrane

A
  • outer ear
  • Cone of light (reflex back)-midline
  • Pars flaccida (most posterior)
  • Pars Tensa (anterior/superior to malleus)
  • Umbo (located superior to cone of light)-midline
  • Malleus (long bone forms line w/umbo)
49
Q

Middle ear boundaries

A
  • between tympanic membrane (lateral wall) & Cochlea (medial wall)
  • Roof & floor = Temporal bone
  • Anterior = Carotid sheath (internal jugular vein & artery) & mastoid process
  • Posterior = CN 7 (facial)
50
Q

Middle ear ossicles

A
  1. Malleus
  2. Incus
  3. Stapes
    - 1-3 = Ossicular chain (movement transmits sound to inner ear through oval window)
    - 2 muscles: Stapedius & tensor tympani (protect inner ear by reducing movement of tympanic membrane = reducing movement of stapes)
    - Innv. by chorda tympani of CN 7
    - Communicates with pharynx through eusacian tube = meningitis
51
Q

Pharyngotympanic tube

A
  • Equalizes pressure between middle ear and outside
  • Tube @ rest is closed=active process of 2 muscles tensor & levator palanti
  • EX. Yawning
52
Q

Otalgia (ear pain)

A
  • From Otitis media or Otitis externa

- referred pain from dental pain, esophageal pain due to different CN innervation.

53
Q

Inner ear

A
  • Main function to receive sound & maintain balance

- Bony Labyrinth surrounding a membrane which is suspended in perilymph FILLED with endolymph

54
Q

Inner ear (labyrinths)

A
  • Bony Labyrinths (3 parts)
    1. Cochlea: Hearing
    2. Vestibule: Communicates w/middle ear
    3. 3 semilunar canals: balance
  • Membranous Labyrinths w/in bony-
    1. Cochlea duct: hearing
    2. Saccule & Utricle: w/in vestibule
    3. (3) semilunar valve ducts: balance
55
Q

Cochlea

A
  • Bony tube of 2.5 turns that spiral around bony pillar MODIOLUS
  • Sep. into 2 perilymph chambers by thin plate of bone = spiral lamina
  • Endolymph filled cochlea duct (membranous labyrinth) = another chamber
  • Base opens to vestibule
  • Innv. Cochlear nerve (CN 8)
56
Q

Cochlea and sound

A
  1. Vibration of stapes (middle ear)
  2. Oval window
  3. Scala vestibuli
  4. Helicotrema
  5. Scala tympani
  6. Round window
57
Q

Hair cells & hearing

A
  • Vibration through perilymph causes movement membrane of spiral
  • Movement of tectorial membrane bends sterocilia on hair cells = sensory of cochlear nerve CN 8
  • Outer hair cells (connected to sterocilia) respond w/change in length alters basilar membrane = cochlear amplifier
58
Q

Conductive hearing loss

A
  • Defined as no transmission of sound into the inner ear
  • Wax (cerumen) build up
  • Tumor
  • Otosclerosis (stiffness)
59
Q

Sensorineural hearing loss

A
  • Damage to cochlea & CN 8
  • Old age
  • Medications
  • Immune disorders
  • Noise exposure
60
Q

Balance & Inner ear

A
  • Comprised of the vestibular system
    1. 3 semilunar canals
    2. Utricle (larger)
    3. Saccule
  • Each SCC: 1 ampulla - Crista sense kinetic/dynamic movement
  • Utricle/Saccule contain a Macula=static head positions
61
Q

Balance Problems

A
  • Vertigo: Spinning sensation NOT dizziness = inner ear or central (BS/cerebellum) - viral infection
  • Vestibular Nystagmus: Uncontrollable oscillations of eye = Peripheral lesion =horizontal/rotary form does NOT change direction & Central lesion= all directions and may change directions
62
Q

External features of Nose

A
  • Root (bridge)
  • Apex (tip of nose)
  • Ala (rim around the nostril)
  • Nasal bone = root
  • Lateral cartilage (inferior to root)
  • alar cartilage - ala
63
Q

Nasal cavity proper

A
  • Vestibule (entrance)
  • Inferior, middle, superior turbinate
  • Cribriform plate of erythnoid bone (roof) = CN 1
  • Choana (exit)
64
Q

Boundaries of Nasal cavity

A
  • Roof: ethmoid bone & sphenoid bone
  • Floor: Maxilla & palantine bone
  • Medial: Septal cartilage, Vomer bone (inferior) & ethmoid bone (superior)
  • Lateral: 3 nasal conche/turbinates = form meatuses
65
Q

Nasal passageways

A
  • Originate from turbinates split into 4 passageways
    1. Sphenoethmodial reces: Above superior conche = drains spehnoid sinus
    2. Superior meatus: drains post. ethmoid
    3. Middle meatus: Drains maxillary, middle ethmodial & frontal (major drainage)
    4. Inferior meatus: drains naso-lacrimal duct
66
Q

Paranasal Sinuses

A
  • Named after the bone associated with
  • Act to lighten skull & increase resonance in voice
  • Maybe sites of infection
  • Frontal sinus (sup to orbits)
  • Ethmodial sinus (Bridge of nose)
  • Maxillary sinus (sides of nose)
  • Sphneodial sinus (post. to ethmodial)
67
Q

Paranasal Sinuses (Frontal/Maxillary)

A
  • Frontal: opens into middle meatus & anterior to cranial cavity
  • Maxillary: Largest sinus, Root of molar teeth project into it, opens into middle meatus, Most prone to infection due to drainage against gravity. “muslim prayer position”
68
Q

Paranasal Sinuses (Ethmoid/Sphenoid)

A
  • Ethmoid: Thin wall between orbit & nasal, Opens to superior & middle meatus
  • Sphenoid: Most posterior, drains into Spheno-ethmodial recess above superior concha (transphenoidial procedure for pituitary tumor)
69
Q

Anterior view of Skull

A
  1. Frontal bone (Forehead)
  2. Nasal bone
  3. Lacrimal bone (lacrimal duct)
  4. Zygomatic bone (cheek bone)
  5. Maxilla (Maxillary sinus/teeth)
  6. Mandible (jaw bone)
  7. Temporal bone (temple)
70
Q

Lateral view of Skull

A
  1. Parietal bone (post. to frontal)
  2. Coronal suture (bond between frontal/parietal)
  3. Sphenoid bone (ant. to temporal)
  4. Lacrimal bone (lacrimal duct)
  5. Maxilla (frontal=sup. & alveolar=inf.)
  6. zygomatic (cheek bone)
  7. Occipital (post. base of skull) - external occipital protuberance
  8. Temporal (1.Ant.squamos,2. zygomatic,3.external acoustic 4. mastoid process)
71
Q

Posterior view of Skull

A
  1. Saggital suture (bonds both halves of parietal & superior to occipital)
  2. Lambdoid suture ( inferior to parietal & bonds both occipital to parietal)
72
Q

Superior view of Skull

A
  1. Bregma (fontanel found on coronal suture and Saggital)
  2. Saggital suture (bonds both parietal bone)
  3. Coronal suture (bonds frontal & both parietal)
73
Q

Anterior cranial Fossa

A

Boundaries-

  1. Anterior: Frontal bone
  2. Floor: Ethmoid bone
  3. Posterior: Lesser wings of sphenoid bone
  4. Contents: Frontal lobe
    - Fracture to floor of may involve cribriform plate = CSF leakage = CSF rhinorehea
74
Q

Middle cranial Fossa

A
  • Boundaries:
    1. Anterior: Greater wings of sphenoid bone
    2. Floor: Temporal bone
    3. Posterior: Occipital bone
    4. Contents: Temporal lobe
  • Fracture to floor = CSF otorrhea = possible meningitis
75
Q

Posterior cranial Fossa

A

Boundaries-

  1. Anterior: Temporal bone
  2. Floor: Occipital bone
  3. Contents: Cerebellum & Brainstem
76
Q

Foramina @ Base of skull

A
  1. Cribriform plate: CN1 olfactory
  2. Optic canal: CN2 Optic
  3. Superior orbital fissure: CN 3, 4, 5(1), 6
  4. Foramen rotundum: CN 5(2)
  5. Foramen Ovale: CN 5(3) Mandibular
  6. Internal auditory meatus: CN 7, 8
  7. Jugular Foramen: CN 9, 10, 11
  8. Hypoglossal Canal: CN 12
77
Q

Layers of the scalp

A
  1. Skin
  2. Connective tissue (avascular)
  3. Aponeurosis: Posterior =Occipitalis, Middle = epicranial, Anterior = Frontalis
  4. Loose areolar tissue
  5. Pericranium=periosteum loosely connected to bone
78
Q

Skull Fractures

A
  1. Linear fractures: most frequent type can split bone causing miscommunication of bone
  2. Depressed fracture: common to thin parts of the skull depressing bone inward causing ICP
  3. Comminuted fracture: bone is broken is several places
  4. Basilar Fracture @ base of skull (occipital = CSF leakage)
  5. Le Fort fracture - ant. drawer test with maxillary skull
  6. Pterion fracture: @ temple weakest part of skull Anterior branch of middle meningeal artery = epidural haematoma
79
Q

The meninges

A
  1. Skull
  2. Outer periosteal layer of dura mater
  3. Dura mater
  4. Inner meningeal layer of dura mater
  5. Arachnoid mater
  6. Subarachnoid space
  7. Pia mater (tight to brain)

Anatomy (10 decks)

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