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Jess Head & Neck > Intro to head and neck > Flashcards

Intro to head and neck Flashcards

1
Q

Where does the neck begin and end?

*anteriorly and posteriorly

A

Anteriorly: Lower border of mandible -> upper surface of manubrium of sternum

Posteriorly: superior nuchal line on occipital bone -> IV disc between C7-T1

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2
Q

What are the four major compartments of the neck?

List them from anterior-posterior

A
  1. Visceral
  2. 2 vascular
  3. Vertebral
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3
Q

What structures would you penetrate through in the neck to go from skin-> deep cervical fascia?

A
  1. Skin
  2. Subcutaneous fat
  3. Superficial fascia (one layer)
  4. Deep cervical fascia
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4
Q

Name the sheath of muscle found only in the superficial layer of the anterior neck, where does it begin and what does it attach to? What movement does it contribute to?

A

Platysma: Begins in the superficial fascia of the thorax and runs upwards to attach to the mandible, blending with muscles of the face

Part of muscles contributing to facial expression

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5
Q

What innervates the platysma muscle?

A

CN VII: Facial n

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6
Q

What does the investing fascial layer of the neck attach to posteriorly?

A

Ligamentum nuchae and the spinous process of the cervical vertebrae

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7
Q

Describe the course of the investing layer of deep cervical fascia as it passes around the posterior-anterior neck

A
  1. Splits as it passes forwards to enclose bilateral trapezius muscles
  2. Reunites into single layer forming the roof of the posterior triangle
  3. Splits again to surround sternocleidomastoid and the 4 infrahyoid muscles
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8
Q

What are the borders of the posterior triangle of the neck? What forms the floor?

A

Anterior: sternocleidomastoid
Posterior: anterior border of trapezius
Inferior: middle 1/3 of clavicle

Floor formed by prevertebral fascia

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9
Q

What innervates the trapezius and sternocleidomastoid muscles?

A

Accessory nerve (CN XI)

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10
Q

Which muscle is responsible for dividing the anterior and posterior triangles of the neck?

A

Sternocleidomastoid

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11
Q

What are the pharyngeal arches?

A

Externally visible anterior tissue bands underneath the early brain that gives rise to structures of the head and neck

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12
Q

What overall structure is the hyoid bone a part of and what does it derive from?

A

Part of the axial skeleton, derived from the 2nd and 3rd pharyngeal arch

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13
Q

What level of vertebra does the hyoid bone correlate with?

A

C3

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14
Q

What suspends the hyoid bone?

A

The stylohyoid muscle which attaches to the styloid process

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15
Q

What suspends from and attaches to the hyoid bone?

A

Larynx is suspended from it

Attachment point for hyoid muscles (supra and infrahyoid muscles)

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16
Q

Name the four suprahyoid muscles, what is their function in general terms?

A

When they contract they raise the hyoid bone and thus the larynx during swallowing to avoid food, etc going down into the lungs

  1. Stylohoid (suspends the hyoid bone)
  2. Digastric (anterior and posterior belly)
  3. Mylohyoid
  4. Geniohyoid
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17
Q

Name the four infrahyoid muscles (aka ‘strap muscles’) from posterior-anterior, what is their function in general terms?
Which muscle lies overtop of them?

A 
Stabilize the hyoid bone and thus the larynx and lower it after swallowing 
Arranged in layers:
1. Thyrohyoid
2. Sternothyroid (just below thyrohoid) 
3. Sternohyoid 
4. Omohyoid

Sternocleidomastoid lies overtop

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18
Q

How does the prevertebral layer of deep cervical fascia attach to the vertebra? What ‘structure’ lies between its attachments?

A

Splits into two layers
-anteriorly attaches to transverse processes and vertebral bodies of vertebral column

  • between is longitudinal fascial space which contains loose CT extending from the base of the skull through the thorax
  • posteriorly attaches to nuchal ligament of vertebral column
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19
Q

What structures are enclosed by the prevertebral layer of deep cervical fascia both within and outside the neck?

A

Within neck: surrounds vertebral column and associated muscles (anterior, posterior, middle scalene and deep muscles of back)

As it exits the neck and travels into the upper limb it extends laterally as the axillary sheath which encloses the axillary artery and brachial plexus

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20
Q

Where does the pretracheal layer of deep cervical fascia extend from?

A

Begins at superior hyoid bone and ends inferiorly in the upper thoracic cavity where it blends with the fibrous pericardium

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21
Q

What does the pretracheal layer of deep cervical fascia pass and cover anteriorly, laterally and posteriorly? What does it cover overall?

A

Overall covers the neck’s viscera:
Muscular layer covers infrahyoid muscles
Visceral layer covers trachea, thyroid and esophagus

Anteriorly: posterior to infrahyoid muscles; covers trachea, thyroid gland and esophagus

Laterally: Continues covering lateral sides of thyroid glands and esophagus, blends with the carotid sheaths

Posterior: known as buccopharyngeal fascia which separates the esophagus from the preVERTEBRAL layer

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22
Q

Where does the carotid sheath extend from?

List the structures within the carotid sheath from lateral-medial
*bonus: which vessel is the carotid sheath thinner and thicker around?

A

From base of cranium -> root of neck

  1. Internal jugular (thinner here)
  2. Vagus N
  3. Common carotid artery inferiorly -> internal carotid artery superiorly (*external carotid isn’t in the sheath)
    (Thicker over the common carotid)
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23
Q

What contributes to the carotid sheath posteriorly, anteromedially and anterolateral Ly?

A

Posteriorly: prevertebral layer
Anteromedially: pretracheal layer
Anterolaterally: Investing layer of cervical fascia

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24
Q

What might the fascial spaces allow for?

A

Infection to spread from neck to mediastinum!

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25
Q

Name the three fascial spaces, where/how might an infection spread within them?

*Identify which space is the MAJOR pathway for infection to spread from the neck to the thorax

A
  1. Pretracheal fascia: infection might spread inferiorly into the superior mediastinum ANTERIOR to the pericardium
  2. Retropharyngeal space: major route for infection - may spread inferiorly into the superior mediastinum POSTERIOR to the pericardium
  3. Fascial space within the prevertebral layer
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26
Q

What forms the borders of the anterior triangle of the neck?

A

Anterior: midline of neck
Superior: inferior border of mandible
Posterior: sternocleidomastoid (its anterior border)

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27
Q

What are the four subdivisions of the anterior triangle of the neck?

A

Divided by the hyoid muscles

  1. Submandibular triangle
  2. Submental triangle (just below submandibular)
  3. Carotid triangle
  4. Muscular triangle (Just below submental)
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28
Q

What are the two subdivisions of the posterior triangle of the neck?

A
  1. Occipital triangle

2. Supraclavicular triangle

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29
Q

Describe the structure and function of the larynx

A

Structure: A hollow musculoligamentous structure with a cartilaginous framework

Function: a valve (sphincter) which closes entry into the lower resp tract (is continuous with the trachea) and produces sound

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30
Q

What does the larynx open into superiorly/posteriorly?

A

The pharynx

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31
Q

How mobile is the larynx and why?

A

Highly mobile as it can be moved up-down forwards-backwards by extrinsic muscles; comprised of suprahyoid and infrahyoid muscles, as well as stylopharyngeus (a muscle of the pharynx)

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32
Q

What happens to the larynx during swallowing?

A

It’s muscles pull upwards and forwards to help block the laryngeal inlet (epiglottis also moves to block this inlet)

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33
Q

What provides motor and sensory innervation to the larynx?

A

Vagus n

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34
Q

What structures do the R and L common carotid arteries pass laterally to as they ascend through the neck in the carotid sheath? Where do they divide into external and internal carotid branches?

A

Pass laterally to the trachea and esophagus

Divide into external and internal carotid branches nearer to the superior edge of thyroid cartilage

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35
Q

Which vessels provide superficial venous drainage to the head and neck?

A
  1. External jugular vein (the anterior branch)

2. Anterior jugular vein

36
Q

Which superficial vein crosses sternocleidomastoid as it descends down the neck?

A

External jugular vein

37
Q

Which vessel provides deep venous drainage to the head and neck? Which structure does it pass deep to and which structures does it drain?

A

Internal jugular vein, passes deep to sternocleidomastoid

Collects blood from skull, brain, superficial face and neck

38
Q

Which vessels does the internal jugular vein join with? Where does this occur and which vessel is inevitably formed by this fusion?

A

Posterior to the sternoclavicular joint the internal jugular vein joins with the subclavian veins to form the brachiocephalic vein

39
Q

What are the two parts of the cranium?

A
  1. Neurocranium/cranium: Calvaria (top part of skull) -> skull base (fossae)
  2. Viscerocranium: facial skeleton
40
Q

Name the layers of the scalp, which layer of the scalp would you find blood vessels that supply it?
Which layers are tightly bound together and which layer tends to be where infections localize and spread?

A

First 3 are tightly bound together
S: skin
C: CT (dense, main blood vessels and nerves)
A: Aponeurotic layer
L: Loose CT, where infections tend to localize and spread
P: Pericranium; dense irregular CT

41
Q

What does the pericranium adhere to?

A

Calvarial bone of the skull

42
Q

What does the aponeurotic layer consist of and what innervates it?

A

The occipitofrontalis muscle (a muscle of facial expression), therefore innervated by CN VII
Has two bellies
1. Occipital belly (near occipital bone)
2. Frontal belly (near frontal bone)

43
Q

What separates/connects the two muscle bellies of occipitofrontalis?

A

Galea aponeurotica AKA epicranial aponeurosis

44
Q

What is the role of the Loose CT layer of the scalp?

A

Facilitates movement of the scalp over the calvaria bone

45
Q

Name the two major sources of innervation to the scalp, which general areas of the head to they supply?

A
  1. Cranial nerves (mainly in front of ear)

2. Cervical nerves (mainly behind ear)

46
Q

Name the four major muscle groups in the face/head and the CN that innervates them. Where do they all lie?

A

All within the subcutaneous tissue

  1. Muscles of facial expression (VII)
  2. Muscles of the cheek (buccinators) VII
  3. Muscles of scalp (i.e occipitofrontalis, VII)
  4. Muscles of mastication (V3 branch)
47
Q

Name the four muscles of mastication, which muscle is not innervates by the V3 branch?

A
  1. Masseter
  2. Temporalis
  3. Buccinator: innervates by VII
  4. Medial and lateral Pterygoid
48
Q

Name the five divisions of CN VII on the face from superior-inferior

A

To Zanzibar By Motor Car

T: Temporal
Z: Zygomatic 
B: Buccal 
M: Mandibular  
C: Cervical
49
Q

Where does sternocleidomastoid extend from?

A

One head on the sternum, another on the clavicle - both extend to the mastoid process (behind the ear)

50
Q

Where do the two bellies of the digastric muscle (a suprahyoid muscle) extend from?

A

Posterior belly: mastoid process - hyoid bone

Anterior belly: hyoid bone - front

51
Q

Which muscle forms the floor of the mouth?

A

The mylohyoid muscle (a suprahyoid muscle)

52
Q

What might a lymph node in the supraclavicular triangle of the posterior triangle of the neck infer?

A

Metastasis or a pathology coming up from the stomach

53
Q

Which layer of fascia encloses the parotid and submandibular salivary glands?

A

The investing layer

54
Q

Which structures does the prevertebral layer of deep cervical fascia extend to and from?

A

From base of cranium -> 3rd thoracic vertebra

55
Q

What happens if pus behind the prevertebral layer extends laterally in the neck? How might this present?

A

Can perforate the prevertebral fascia and enter the retropharyngeal space - causing a bulge in the pharynx (retropharyngeal abscess).

This many present with dysphagia, difficult speech, fever and malaise

56
Q

Name three common causes of neck pain

A

Inflamed lymph nodes, muscle strain, displacement/protrusion of IV discs

57
Q

What commonly causes chronic neck pain?

A 
Bony abnormalities (i.e cervical osteoarthritis)
(Or local trauma)
58
Q

Major arteries supplying the face are branches of the ____?

A

External carotid artery

59
Q

What does the external carotid artery terminate as?

A

The temporal artery and the maxillary artery

60
Q

Which artery provides the major arterial supply to the face and what vessel does it branch off of? What should you do if one of the arteries (on one side of the face is lacerated)

A

Facial artery, branches off of external carotid

Since the facial artery has many anastomoses with other arteries of the face, if it is lacerated it is necessary to compress both arteries

61
Q

Which veins form the external jugular vein?

A

The retromandibular and posterior auricular veins

62
Q

Both internal and external jugular veins drain into the ____

A

Subclavian vein

63
Q

Which vein forms the major venous drainage of the face and which vessel does it drain into?

A

The facial vein, drains into the internal jugular vein

64
Q

After exiting the skull base, where does the facial branch divide into its terminal branches?

A

As it passes through the parotid gland

65
Q

What is the most common non-traumatic cause of facial paralysis? What is thought to cause it and what does it result in?

A

Bell’s palsy, a diagnosis of exclusion through to be due to facial nerve inflammation as it exits the facial canal (and cranium) via the stylomastoid foramen and results in edema and compression of the nerve in the facial canal

66
Q

How might the facial nerve be easily damaged and what would be the inevitable result?

A

Damage to the facial nerve results in weakness of the face

It’s branches are superficial and may be injured due to wounds, cuts or childbirth

Since the nerve and its branches pass through the parotid gland they are vulnerable during gland surgery or disease

67
Q

Name three areas that might become painful in parotid gland disease

A
  1. Auricle (external part) of the ear
  2. Temporal region
  3. Temporomandibular joint (TMJ)
  4. External acoustic meatus (ear canal running from outer-middle ear)
68
Q

Where does the auricle arise from?

A

Swellings forming around the entrance to the meatus (ear canal)

69
Q

How can you make the sternocleidomastoid muscle stand out?

A

Ipsilateral lateral flexion and rotate head to the opposite side

70
Q

Define the term “fascia” and describe its functions in the neck

A

It’s a CT - which is a mesenchymal organ that can be “loose” or “dense”

In the neck: separates organs so they can move against each other (i.e viscera in pre-tracheal layer glide against others to make swallowing possible), compartmentalizations infections

71
Q

Describe the 2 main divisions of fascia in the neck and their subdivisions from superficial-deep, which layer surrounds all neck structures?

A
  1. Superficial fascia (loose CT)
  2. Deep fascia (dense irregular CT), consisting of
    - investing fascia; surrounds all neck structures
    - pretracheal
    - prevertebral
    - carotid sheath
72
Q

Describe the term “potential space” as it applies to fascial planes of the neck?

A

Adjacent facial compartments are normally so close there is no space, BUT blood from perforated vessels or pus from infections can collect in between fascial planes and track to other areas, creating “potential spaces”

73
Q

What is the difference between the retropharyngeal space and the danger space?

Where are infections likely to spread?

A

The retropharyngeal space is posterior to the pretracheal fascia and anterior to the fascia surrounding the pharynx

The DANGER space is a potential space posterior to the retropharyngeal space. It connects inferiorly to the mediastinum (posterior to the pericardium) so infections of the pharynx may lead here

74
Q

Describe the relationship between the retropharyngeal space and the danger space in a healthy individual

A

In healthy patients the danger space is indistinguishable from the retropharyngeal space - and is only visible when distended by fluid or pus (below the level of T1-6) (since the retropharyngeal space variably ends at this level)

75
Q

How would a person with a dystonic (hypertonic) Sternocleidomastoid present? What is this condition called?

A

Head tilt (ipsilateral to lesion) and rotation of the chin (contralateral)

Called torticollis (or congenital torticollis in newborns)

76
Q

Name the two sphincter muscles of the face. Briefly describe their functions

A

Orbicularis oris and oculi
They contribute to facial expression AND anchor the majority of other small muscles

Orbicularis oculi also protects the cornea

77
Q

What might the loss of orbicularis oris lead to and which condition is this commonly seen in?

A

Drooling, commonly seen in facial nerve palsy/Belle’s palsy

78
Q

Which cranial nerve supplies the motor innervation to the muscles of the face?

A

Facial nerve CN VII

79
Q

What nerves provide sensory innervation to the face and neck?

A

Face: Cutaneous branches of the 3 divisions of Trigeminal (V1 - opthalmic, V2 - maxillary, V3 - mandibular)

Neck: cutaneous branches of the cervical nerves from the cervical plexus

80
Q

Name three conditions of the head and neck which commonly affect children

A
  1. Enlarged adenoids
  2. Cleft lip and palate
  3. Ear infections
81
Q

Name three conditions of the head and neck which commonly affect the elderly

A
  1. Presbyacusis - age related hearing loss
  2. Presbyopia - far sightedness (loss of elasticity in lens of eye)
  3. Macular degeneration (macula is central part of retina, therefore results in distorted/loss of central vision)
82
Q

Why are pregnant women at an increased risk of gingivitis and gum disease?

A

Increased volume of blood and hormonal changes effect the soft tissues around the body during pregnancy

83
Q

Why are pregnant women at an increased risk of acid reflux?

A

Pregnancy hormones relax the lower esophageal sphincter and the size of the baby increases the pressure on the stomach

84
Q

What is ostosclerosis and what can it be exacerbated by?

A

Hereditary disorder causing progressive deafness due to overgrowth of bone in the inner ear, can be exacerbated by pregnancy (likely due to estrogen)

85
Q

When does a wound to the scalp gape? How long would it take to remove sutures from the scalp/head (or face) region and why?

A

Gapes IF the wound is deep enough to involve the aponeurosis as the muscle bellies on either side of the aponeurosis (frontal and occipital) pull which creates tension and causes the wound to gape

Since the blood supply to the scalp is so rich (comes from internal and external carotids), sutures can often be removed much sooner than sutures elsewhere in the body

86
Q

Why is it that following a blow to the head, bleeding as a result of injury can pass forward into the orbital region (causing a black eye) but not into the subtemporal or occipital region?

A

This is because trauma to the head does not only cause bleeding in the dense vascular CT above the aponeurosis, but in the (smaller vessels of) loose CT UNDER the aponeurosis as well.

Fluid or blood can track freely within the loose CT underneath the aponeurotic layer, but can only go as far as the margins of the aponeurosis and its associated muscles; which relate to where it inserts into bone.

So, blood cannot track into the subtemporal region or occipital region because…
Laterally the aponeurosis is continuous with the temporalis fascia (which inserts into the zygomatic arch)

Posteriorly the occipital muscle attaches to the occipital bone and mastoid process

But, blood can track into the orbital region (including eyelids and root of nose) because…
The frontal is muscle inserts anteriorly by merging with the skin and subcutaneous tissue (NOT bone)

Jess Head & Neck (13 decks)

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