Head Neck and Spine Part 3 Flashcards
How to test for movements at atlanto-axial joints
Holds neck just below jaws Instructs patients to rotate head side to side Check that cervical spine doesn’t bend
How to test for movements at atlanto-occipital joints
Holds neck just below jaws Instructs patients to nod head up and down Check that cervical spine doesn’t bend
Diagram of oral cavity
Oral fissure between lips
Cheeks form lateral walls
Oral vestibule - space between teeth and lips/cheeks
Oral cavity proper - space internal to the teeth
Hard and soft palate making the roof
Floor mainly made from muscular diaphragm
Tongue
Intrinsic and extrinsic muscles
Extrinsic muscles attached to mandile and hyoid bone
Superior surface of tongue is covered with mucosa containing papillae and taste bonds
Where different ducts enter in the mouth
Submandibular ducts open at sublingual caruncle either side of frenulum
Sublingual glands are smallest of salivary glands
Have ducts that open into the oral cavity at the crest of sublingual folds
Parotid glands open into vestibule of mouth opposite upper 1st molar tooth
What is a pharnyx
Fibromuscular tube which extends from base of skull to oesphagus
Nasopharynx, oropharynx and larngopharnx
Opening of auditory tube can be seen on lateral wall of nasopharnyx on the same level as inferior concha
Posterior wall pharnyx lies against provertebral fascia anterior to vertebral bodies
Constrictor muscles superior middle and inferior constrictors
What are the two sets of dentition
Deciduous and permanent
Deciduos - 20 (6 months to 2.5 yrs)
Permanent -32 (6 to 18 yrs)
How are teeth arranged
Maxillary and mandibular arches
Two incisors, one canine, two premoolars and three molares in each half of the arches
Two incisors, one canine and two molars in deciduous
How do you identify teeth
All have a crown
One or more roots in the alveolar bone
Incisors have thin cutting energys
Canines have single pointed cusps
Premolars have two cusps
Molars have 3-5 cups
Glossopharyngeal Nerve (9th)
Motor: innervates stylopharyngeus muscle
Sensory: innervates oropharnyx
Special sensory: taste sensation
Parasympathetic: parasympathetic innervation to parotid gland
Arises from medulla and leaves via jugular foramen
Test via gag reflex
Efferent nerve is vagus nerve
Vagus Nerve (10)
Motor: Innervation to most of the muscles of the pharnyx and larnyx
Sensory: Innervation to skin of external acoustic meatus and surfaces of larnygopharnyx and superior larnyx
Visceral sensory information from trachae, lungs, heart, oesophagus and abdominal organs
Parasympathetic: lungs and gastrointestinal tract and control heart rate
From medulla and exits via jugular foramen
Pharnygeal branches - innervates pharnyx and soft palate
Reccurent larnygeal nerve: ride side only hooks around right suclavian artery
Superior laryngeal nerve - sensation to laryngopharnyx and superior larnyx
How to test for vagus nerve
Ahhhhh - provides motor innervation to levator veli palatini
If right vagus is damaged right palate will not raise so deviate to left
Testing of accessory nerve
Shrug your shoulders while you push them down
Posterior Triangle
Posterior border of sternocleidomastoid muscle
Middle third of the clavicle
Anterior border of trapezius muscle
Separated into larger occipital triangle and smaller subclavian triangle by the inferior belly of omophyoid muscle
Roof of triangle is made of investing layer of cervical fascia
Floor of triangle is made of prevertebral eayer of cervical fascia
What are the contents of the posterior triangle
External juglar vein
Subclavian artery as it crosses the 1st rib - press the artery against the 1st rib in the supraclavicular fossa at the junction of the middle and medial thirds of the clavicle. Important pressure point to occlude the artery when there is bleeding
Accessory nerve - from junction of superior and middle thrids of SCM and junction of middle and inferior thirds of trapezius muscle
Cervical plexus of nerves - located at junction of superior and middle thirds
Trunks of brachial plexus - anterior inferior angle of the posterior trianlge behind subclavian pulse
Apex of lung - percussed
Trunks of
How to examine the thyroid
Expose the neck fully
Check for thyroid scars
Thyroglossal gyst - move upwards and drink of water will move upwards
Thyroid cartilage - larnygeal prominence, anterior protrusion of thyroid cartilage
Hyoid bone - above laryngeal promence feel it when patient swallows
Cricoid cartilage - laryngeal prominence move down
Spinous process of C7 - patient bend head forward, bump at bottom of back of neck
Lateral mass of the atlas - fingers at base of skull and allow head to sink into hands
Thyroid gland - start from laryngeal prominence - move fingers lateral to midline 2-3cm. Ask patient to stick tongue out and take sip of water
Locating the carotid pulse
Upper border of thyroid cartilage it splits
Internal carotid is posterior to the external carotid and lies more laterally
Superior thyroid, ascending pharyngeal and lingual arteries arise from the external carotid artery below or around the level of the angle of mandible
Clincal Anatomy of Internal Jugular Vein
Jugular foramen
Descends to join subclavian vein
Lateral then anterolateral to the carotid artery
Level of thyroid cartilage veins lies deep to the sternocleidomastoid muscle
Emerges just above the clavicle
Right sided juglar cannulation is preferred due to the direct path to the superior vena cava
How to surface mark internal jugular vein
Common carotid arteries which run from sternoclavicular joint to ear lobe. Just lateral of it
