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Head and Neck > Lec 1 - General Organisation of the Head and Neck > Flashcards

Lec 1 - General Organisation of the Head and Neck Flashcards

1
Q

What two groups can muscles of the face be divided into?

A

Muscles of Mastication and Muscles of Facial expression.

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2
Q

What do the muscles of mastication do?

A

They are for chewing.
They open or close the jaw.
They act on the temporomandibular joint.

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3
Q

What do the muscles of Facial expression do?

A

They are dilators or sphincters.
dilators - these are linearly arranged and they pull in a particular direction.
sphincters - these are round shaped and they constrict.
They attach to bone, the skin/fascia of the face and other muscles.

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4
Q

What is the innervation of the muscles of mastication?

A

Cranial nerve V (trigeminal)

This is the main sensory nerve of the face and scalp.

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5
Q

What is the innervation of the muscles of facial expression?

A

Cranial nerve VII (facial)

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6
Q

What is the temporomandibular joint?

A

This is where the jaw bone joins to the rest of the skull.

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7
Q

What are the branches of the facial nerve?

A

There are 5 extra-cranial branches.
To Zanzibar by Motor Car.
Two Zebras Bit My Cock.

Temporal
Zygomatic (close to zygome, cheek bone)
Buccal (branch goes to cheek)
Marginal Mandibular (along the jaw/ mandible)
Cervical (neck)

There is an important relationship between these branches and the parotid gland.

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8
Q

What are the branches of the Trigeminal Nerve?

A

Va ophthalmic division ( forehead and eye)
Vb Maxillary division (nose)
Vc Mandibular division (chin) - this division gives rise to motor fibres to the muscles of mastication.

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9
Q

What is the main arterial supply of the head and neck?

A

The common Carotid artery via its terminal branches.
These branches are the Internal carotid artery - this has no branches in the neck.
and the External Carotid artery (facial artery branch that supplies the face) - this has lots of branches that supply tissues of the neck and face.

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10
Q

What is the main vein that drains the head and neck structures?

A

The Internal jugular vein.

The IJV receives the venous drainage from the face (facial vein)

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11
Q

What is the vein that drains the scalp and face?

A

The External Jugular vein.

It runs more superficially than the IJV.

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12
Q

What are palpable structures of the neck?

A 
Hyoid bone - not palpable
Thyroid cartilage - Adams apple/
Cricoid cartilage
Thyroid gland
Trachea - not palpable
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13
Q

What are the muscles of the Neck?

A 
Platysma 
Trapezius 
Sternocleidomastoid
Scalene muscles 
Supra- and infra- hyoids
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14
Q

What is the location and innervation of the supra and infra hypoids?

A

They are located above and below the hyoid bone.
Supra- hyoids are supplied by the cranial nerves.
They are above the hyoid bone and attach the jaw or base of the skull to the hyoid bone.
They elevate the hyoid and depress the mandible.

Infra- hyoids are supplied by cervical nerves (C1-3)
These are strap muscles.
They overlie the larynx and thyroid gland.
They depress the hyoid and help to stabilise it.

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15
Q

What is the location and innervation of the platysma?

A

It lies beneath the superficial fascia.
It runs down the mandible.
Innervated by the facial nerve.

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16
Q

What is the location and innervation of the Trapezius?

A

It is in the superior part of the neck.

Innervated by the spinal accessory nerve.

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17
Q

What is the location and innervation of the SCM?

A

It is under the platysma.
It has two heads - the sternal and clavicular heads.
Origins - sternum and clavicle.
Inserts into the mastoid process, which is the bony part behind the ear.
Innervated by the spinal accessory nerve.

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18
Q

What is the action of the platysma?

A

Tenses the skin at the neck.

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19
Q

What is the action of the Trapezius?

A

elevates the shoulder and rotates the scapula.

To test function, place hands on someones shoulders and get them to push up against resistance.

20
Q

What is the action of the SCM?

A

when contract, it laterally flexes the head and chin to move superiorly.
Pulls the mastoid process down and rotates the head slightly.

21
Q

What are the anatomical borders of the Anterior triangle in the neck?

A

Inferior margin of the mandible.
Imaginary line down the midline of the neck.
Anterior margin of the SCM.

22
Q

What are the anatomical borders of the Posterior triangle in the neck?

A

Posterior margin of the SCM.
Clavicle.
Anterior margin of the trapezius.

23
Q

Which structures are associated with the anterior triangle?

A

those that course between the head and thorax.

24
Q

Which structures are associated with the posterior triangle?

A

those that course between the thorax/neck and upper limb.

25
Q

What is the significance of the scalene muscles in the posterior triangle?

A

They form the floor of the posterior triangles .

The brachial plexus and subclavian vessels pass through.

26
Q

What is the Carotid Triangle?

A

It is the bit of the neck where easy access to the carotid artery which may be used to in examination e.g the carotid pulse.

27
Q

What are the borders of the Carotid Triangle?

A

Top - Digastric (posterior belly)
Lateral - SCM
Medial - Omohyoid

28
Q

What is the benefits of Fascial Compartments?

A
  • Concentric fascial layers create compartments of structures that run through the neck.
  • this allows the following:
  • – form natural planes.
  • – Ease of movement between structures such as when swallowing.
  • – Can restrict but also permit the spread of infection.
29
Q

What is the problem with the communication between deep neck spaces and Mediastinum?

A

Infections within these deep neck spaces such as Retropharangeal abscess can potentially spread inferiorly into the mediastinum.
- Involvement of mediastinal structures can cause mediastinitus.

30
Q

How is the neck compartmentalised?

A

There is one superficial cervical fascial layer and three deep cervical fascial layers.

31
Q

Describe the superficial cervical fascial layer.

A
  • loose connective tissue.
  • contains adipose.
  • blood vessels are in here: anterior and external jugular veins. cutaneous nerves, superficial lymph nodes and the platysma muscle.
32
Q

What are the three deep cervical fascial layers?

A

from superficial to deep

  • investing layer
  • the pre tracheal layer
  • the pre vertebral layer.
33
Q

Describe the investing layer?

A
  • this surrounds the entire neck like a collar.
  • it is immediately visible.
  • This layer splits to enclose the SCM and trapezius muscles and the parotid salivary glands.
  • Superior margin - attached on each side to the entire lower border of the mandible, styloid process, the superior nuchal line and the external occipital protuberance in the posterior midline.
  • inferior - attached to the upper border of the manubrium, the upper surface of the clavicle, acromion and spine of the scapula.
  • posterior - attached to the spinous processes of the vertebrae and ligament nuchae.
34
Q

Describe the pre tracheal layer.

A
  • thin
  • limited to the anterior and lateral part of the neck.
  • consists of a muscular layer which encloses the infra hyoid muscles.
  • consists of a visceral layer which encloses the thyroid gland, trachea and oesophagus.
  • This layer blends with the buccopharyngeal fascia.
  • superiorly and anteriorly - attaches to the hyoid bone.
  • Inferiorly -extends to the thorax and blends with the fibrous pericardium.
35
Q

What is the Buccopharyngeal fascia?

A
  • this is fascia associated with the pharynx and oesophagus.

- it runs from the base of the skull superiorly to the diaphragm inferiorly.

36
Q

Describe the pre vertebral layer.

A
  • This layer forms a sheath for the vertebral column and the muscles associated with it.
  • It extends from the base of the cranium to the 3rd thorax vertebra.
  • It then extends laterally as the axillary sheath that surrounds the axillary vessels and the brachial plexus of nerves running into the upper limb.
37
Q

What is the Carotid Sheath?

A
  • This is a tubular, fibrous structure that extends from the base of the skull through the root of the neck to the arch of the aorta.
38
Q

What are the contents of the carotid sheath?

A 
common carotid artery 
internal jugular vein
Cranial nerve (CN)
Vagus nerve (CN X)
39
Q

What is the Retropharyngeal Space?

A
  • It is a deep space in the neck.
  • It lies between the prevertebral layer of fascia and the fascia surrounding the pharynx and oesophagus ( Buccopharyngeal fascia)
40
Q

what is in the retropharyngeal space up until the age of 3-4?

A

the superior part contains:

- lymph nodes, which drain areas of the nose, oral cavity and upper pharynx

41
Q

What does the retropharyngeal space do?

A

it allows the pharynx to move freely on the vertebral column and expand during swallowing.
- this space presents significant problems if infection spreads here.

42
Q

How might retropharyngeal infections spread?

A
  • The retropharyngeal space is between fascial layers that extend the length of the neck into the posterior mediastinum.
  • so retropharyngeal infections may spread inferiorly into the thorax, risking the development of mediastinitis.
43
Q

What are the signs and symptoms of a retropharyngeal abscess?

A
  1. visible budge on inspection of the oropharynx.
  2. sore throat
  3. difficulty swallowing
  4. reluctance to move their neck
  5. High temperature
  6. Stridor
44
Q

Why does the thyroid gland move during swallowing?

A
  • This is because the thyroid gland is enclosed by pre-tracheal fascia, which is attached to the hyoid bone.
  • –> The hyoid bone and the larynx move up with swallowing.
45
Q

Why can an enlarged thyroid gland move retrosternally through the root of the neck ?

A

This is because the lower limit the pre tracheal fascia extends into the thorax.

46
Q

What does the retrosternal extension of goitre result in?

A

Can lead to compression of other structures that run through the root of the neck such as the trachea and venous blood vessels.

47
Q

What are the symptoms of the retrosternal extension of the goitre?

A

Breathlessness and strider
- this is due to tracheal compression.

Facial oedema
- this is due to compression impeding venous drainage from the head and neck.

Head and Neck (8 decks)

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