Head & Neck S1

Question 0

Describe the buccinators

Answer 0

The keep the face taut and aid during chewing
Can be tested by asking patient to puff their cheeks full of air, then pushing on their cheeks to see if air leaks
Supplied by the facial nerve

Question 1

What are the major groups of muscles in the head?

Answer 1

Muscles of facial expression
Cheek muscles (buccinators)
Occipitofrontalis
The muscles of mastication

Question 2

Describe the muscles of mastication

Answer 2

For chewing

Supplied by the mandibular division of the trigeminal nerve

Question 3

Describe occipitofrontalis

Answer 3

Involved in the raising of eyebrows

Supplied by the facial nerve

Question 4

What does the facial nerve supply?

Answer 4

Platysma, muscles of facial expression and the ear and occipitofrontalis

Question 5

Describe Bell’s palsy

Answer 5

Inflammation of the facial nerve as it exits the cranium via the stylomastoid foramen
This causes oedema and inflammation of the facial nerve in the intracranial facial canal
This causes structural and functional disorders and is the most common non traumatic cause of facial paralysis

Question 6

What is the clinical relevance of the superficial location of the branches of the facial nerve?

Answer 6

They are easily damaged in childbirth, surgery, etc

Question 7

What is the clinical significance of the facial nerve passing through the parotid gland?

Answer 7

The nerve is vulnerable to damage during surgery on the gland or infection.

Question 8

What are the layers of fascia in the neck?

Answer 8

Superficial layer
Investing layer of deep cervical fascia
Pretracheal layer of the deep cervical fascia
Prevertebral layer of deep cervical fascia

Question 9

If an infection occurs between the investing fascia and the muscular component of the pretracheal fascia, where is it likely to spread?

Answer 9

It’s unlikely to spread further than the manubrium

Question 10

If an infection occurs between the investing fascia and the pretracheal layer, where can it spread?

Answer 10

It can spread into the thoracic cavity anterior to the pericardium

Question 11

If there is an infection posterior to the prevertebral fascia, where is it likely to spread?

Answer 11

It may extend laterally in the neck
If it perforates the fascia, it can enter the retro pharyngeal space, which can cause dysphagia and dysphonia by putting pressure on the pharynx. It’s also a route for the infection to spread to the thorax.

Question 12

What is the calvaria?

Answer 12

The vault of the skull and the base of the cranium

It consists of two layers of compact bone with a layer of marrow between them, known as the diploe

Question 13

What are the names of the sutures connecting the bones of the calvaria?

Answer 13

Lambdoid, coronal and saggital

Question 14

What is the pterion?

Answer 14

The thinnest part of the calvaria
Located on the lateral part of the skull
Vulnerable to fractures

Question 15

What does trauma to the vault of the skull usually result in?

Answer 15

Radiating linear fractures (where the fractures spread in two or more directions away from the point of impact)

Question 16

Describe a depressed fracture

Answer 16

Where the fragments of bone from the fracture have been pushed into the tissue beneath, causing pressure
May be the result of a severe, localised blow to the head

Question 17

If a patient has received a sharp blow to the side of the head, what would you be worried about?

Answer 17

Fracture of the pterion
If so, the middle meningial artery may have been damaged, so an epidural haematoma could form between the periosteal layer of the dura mater and exert pressure on the cerebral cortex beneath it

Question 18

What is a counter coup fracture?

Answer 18

When there has been trauma to one side of the head but the fracture is on opposite side of the skull

Question 19

Discuss fractures to the base of the skull

Answer 19

The bone here is strong but is fractured reasonably regularly because it is the point of contact between the head and the body, so a lot of force can travel to it up the spine.

Question 20

If a patient has an infection in their scalp, what would you be worried about and why?

Answer 20

Osteomyelitis of the bone beneath, because the superficial veins of the scalp are connected to the diploic veins and the intracranial venous sinuses by emissary veins, which are valveless so can be a route for infection to spread.

Question 21

Discuss common facial fractures

Answer 21

Facial fractures are usually caused by fist fights, falls and RTIs
Nasal bone involvement in fractures is common due to the prominence of the nose on the face
Maxillofacial fractures are associated with massive trauma
A hard blow to the jaw can cause fracture of the neck of the mandible along with dislocation of the TMJ

Question 22

Why might a fracture of the lower mandible cause numbness of the lower lip?

Answer 22

The inferior alveolar nerve runs through the mandible so is easily damaged in fractures and its branches supply the lower lip.

Question 23

What usually causes a black eye?

Answer 23

Bruising around the orbit causes accumulation of tissue fluid and blood in the surrounding connective tissue

Question 24

Describe malar flush

Answer 24

Red rash across the zygomatic processes, associated with mitral valve stenosis
Aka mitral facies

Question 25

Why are cervical vertebrae prone to dislocation?

Answer 25

They are stacked atop one another almost horizontally so require less force to be dislocated

Question 26

How is the dens most commonly fractured?

Answer 26

A fall on the head

Displacement can result in quadriplegia or damage to the medulla, causing death

Question 27

Why is neck pain more common as patients age?

Answer 27

The intervertebral foramina narrow with age, causing compression of nerves and so neck pain

Question 28

What injuries are associated with hyper flexion of the cervical spine (whiplash)?

Answer 28

Rupture of the lower cervical intervertebral disks, resulting in compression of C6 & C7 spinal nerve roots and so upper limb pain
Tearing of anterior and posterior longitudinal ligaments
Damage to neck muscles and blood vessels may also occur