Module 7: Neck, Face, and Parotid Flashcards
What are the names of the deep cervical fascia?
- investing fascia
- pre-tracheal fascia
- pre-vertebral fascia
- carotid sheath
What are the boundaries of the investing fascia?
extends from mastoid process & mandible to clavicle & acromion, and from nuchal ligament & spinous processes to the midline/sternum
What are the contents of the investing fascia?
- encircles entire neck
- surrounds the trapezius, sternocleidomastoid, and inferior portion of parotid gland
- continuous with remainder of parotid fascia
What are the contents of the carotid sheath?
- common and internal carotid arteries
- internal jugular vein
- vagus nerve
What are the boundaries of the pre-vertebral fascia?
- encircles vertebrae
- extends lateral & anterior to levator scapulae, longus colli & capitis, and scalene muscles to form the floor of the posterior triangle
- from base of skull to mediastinum; continuous with axillary sheath and anterior longitudinal ligament
- defines boundary of retropharyngeal space
What are the contents of the pre-vertebral space?
- deep neck flexor and extensor muscles (scalene muscles, levator scapulae, splenius capitis, longus capitis & colli, etc)
What are the contents of the pre-tracheal fascia?
- infra hyoid muscles, thyroid gland, esophagus, trachea, thyroid cartilage
- continuous with buccopharyngeal fascia
What are the suprahyoid muscles?
- digastric (anterior and posterior belly)
- mylohyoid
- geniohyoid
- stylohyoid
What are the infrahyoid muscles?
- omohyoid (superior and inferior belly)
- sternohyoid
- sternothyroid
- thyrohyoid
What are the OIANs of the anterior belly of the digastric?
Origin: digastric fossa of mandible
Insert: intermediate tendon
Action: depression of mandible or elevation of hyoid
Nerve: mylohyoid branch of inferior alveolar nerve: CN V3 trigeminal
What are the OIANs of the posterior belly of the digastric?
Origin: temporal mastoid notch
Insert: intermediate tendon and body and cornu of hyoid
Action: depression of mandible or elevation of hyoid
Nerve: CN VII Facial Nerve
What are the OIANs of the geniohyoid?
Origin: inferior genial tubercle of mandible
Insert: anterior aspect of body of hyoid
Action: elevation of tongue and hyoid or depress mandible
Nerve: ventral ramus of C1 via CN XII
What are the OIANs of the mylohyoid?
Origin: mylohyoid line of mandible
Insert: midline raphe & anterior aspect of body of hyoid
Action: elevation of floor of oral cavity
Nerve: mylohoid branch of inferior alveolar branch of CN V3 trigeminal
What are the OIANs of the stylohyoid?
origin: styloid process of temporal bone
insert: body of hyoid bone
action: elevation and retraction of hyoid
nerve: CN VII facial nerve
What are the OIANs of the omohyoid?
origin: superior border of scapula and scapular notch
insert: lateral aspect of hyoid passing through an intermediate tendon sling loosely associated with the clavicle and 1st rib
action: depression of hyoid
nerve: ansa cervicalis (C1-C3)
What are the OIANs of the sternohyoid?
origin: posterior side of the proximal clavicle & adjacent manubrium
insert: inferior border of body of hyoid
action: depress hyoid
nerve: ansa cervicalis (C1-C3)
What are the OIANSs of the sternothryoid?
origin: posterior aspect of manubrium & costal cartilage of 1st rib
insert: thryroid lamina
action: depression of the elevated larynx
nerve: ansa cervicalis (C1-C3)
What are the OIANs of the thyrohyoid?
origin thyroid lamina
insert: greater horn of hyoid bone
action: depression of hyoid or elevation of thyroid cartilage
nerve: ventral ramus of C1 via CN XII
Which infrahyoid muscles are innervated by the ansa cervicalis?
- omohyoid
- sternohyoid
- sternothyroid
- thyrohyoid innervated by C1 via CN XII
What are the triangles of the neck?
Anterior and posterior triangles
What sub triangles are located in the anterior triangle of the neck?
- submental
- submandibular
- carotid
- muscular
What sub triangles are located in the posterior triangle of the neck?
- occipital
- supraclavicular
What are the borders of the submandiubular triangle?
- inferior mandible
- superior border of posterior digastric
- posterior border of anterior digastric
What are the contents of the submandibular triangle?
- submandibular lymph nodes
- submandibular gland
- facial artery
- hypoglossal nerve
- mylohyoid nerve
What are the borders of the carotid triangle?
- sup border SCM
- inf border of posterior digastric
- superior belly of omohyoid
What are the contents of the carotid triangle?
- common carotid artery split
- hypoglossal nerve CN XII
- carotid sheath
- ansa cervicalis
What are the borders of the submental triangle?
- hyoid bone
- anterior digastric muscle
- mandible
What are the contents of the submental triangle?
- submental lymph nodes
- small veins
What are the borders of the muscular triangle?
- superior belly of omohyoid
- SCM
- midline of neck
What are the borders of the occipital triangle?
- ant border of trapezius
- inferior belly of omohyoid
- SCM
What are the contents of the occipital triangle?
- CN XI accessory nerve
- trunks of brachial plexus
What are the borders of the supraclavicular triangle?
- inferior belly of omohyoid
- SCM
- clavicle
What are the contents of the supraclavicular triangle?
- thyrocervical trunk
- subclavian artery
What are the branches of the thyrocervical trunk?
- inferior thyroid artery
- ascending cervical artery
- suprascapular artery
- transverse cervical artery
What does it mean when we say C1 via CN XII
CN XII is large and sits on C1 branch of cervical plexus making it seem the nerves are coming from CN XII
What are the motor & sensory branches of the cervical plexus?
- suboccipital nerve
- C1 via CN XII to geniohyoid and thyrohyoid
- ansa cervicalis (C1-C3): sup omohyoid, inf omohyoid, sternothyroid, sternohyoid
- phrenic nerve (C3-C5)
What are the strictly sensory branches of the cervical plexus?
- greater occipital nerve (C2)
- lesser occipital nerve (C2)
- great auricular nerve (C2-C3)
- 3rd occipital nerve (C3)
- supraclavicular nerve (C3-4)
- transverse cervical nerve (C2-C3)
What infrahyoid muscle is innervated by the superior root of the ansa cervicalis?
superior belly of omohyoid
What infrahyoid muscles are innervated by the inferior root of the ansa cervicalis?
- inferior belly of omohyoid
- sternothyroid
- sternohyoid
What are the branchial (pharyngeal) arches the origin of?
- head and neck structures
What are the names of the branchial arches?
- mandibular
- hyoid
- third
- fourth
- sixth
fifth arch is reabsorbed
What are the muscles associated with the mandibular branchial arch?
- muscles of mastication
- mylohyoid
- ant belly of digastric
What nerve innervates the mandibular branchial arch muscles?
CN V3 trigeminal
What are the muscles associated with the hyoid branchial arch?
- facial expression muscles
- post belly of digastric
- stylohyoid
What nerve innervates the hyoid branchial arch muscles?
facial nerve CN VII
What is the muscle associated with the third branchial arch?
stylopharengeus
What nerve is innervates the muscle of the third branchial arch?
glossopharyngeal CN IX
What are the muscles associated with the fourth branchial arch?
- cricothyroid
- inf phayrngeal constrictor
What nerves innervate the muscles of the fourth branchial arch?
- vagus nerve CN X
- superior laryngeal
What is the muscle associated with the sixth branchial arch?
- intrinsic laryngeal
What nerves innervate the muscles of the sixth branchial arch?
- vagus nerve CN X
- recurrent laryngeal
What is branchial motor axon function and how is it related to the function of cranial nerves?
- innervate skeletal muscle from branchial (pharyngeal) arches
- specific CNs innervate these groups of muscles
What are the unique features of cervical vertebrae?
- bifid processes
- uncinate processes
- C1: atlas = ring of bone with no body or SP, articular facet of dens, superior articular surface articulates with condyles of skull)
- C2: axis = dens
- C7 = vertebra prominens
- transverse foramina
What are the muscles of facial expression?
- buccinator
- depressor anguli oris
- depressor labii inferioris
- frontalis
- levator labii superioris
- nasalis
- orbicularis oculi
- orbicularis oris
- platysma
- zygomaticus major
What are the OIANs of zygomaticus major?
origin: zygomatic bone
insert: angle of mouth
action: raises angles of mouth (smiling)
nerve: buccal & zygomatic branches of facial nerve CN VII
What are the OIANs of platysma?
origin: lower border of mandible
insert: superficial fascia of skin of the neck overlying clavicle
action: wrinkles the anterior nuchal skin (tension or stress)
nerve: cervical branch of facial nerve CN VII
What are the OIANs of orbicularis oris?
origin: angle of mouth
insert: superficial fascia of upper lip
action: oral sphincter (closes mouth, kissing/pucker lips)
Nerve: buccal and mandibular branches of facial nerve CN VII
What are the OIANs of obicularis oculi?
origin: oribital margin & medial palpebral ligament
insert: superficial fascia of eyelid
action: a palpebral sphincter (closes eye, wink)
nerve: temporal & zygomatic branches of facial n CN VII
What are the OIANs of nasalis?
origin: maxilla lateral and inferior to nasal notch
insert: bridge & ala of nose
action: transverse fibers compress & alar fiber widen the nasal aperture (nose flare during anger or exertion)
nerve: buccal branch of facial nerve CN VII
What are the OIANs of levator labii superioris?
origin: inferior orbital margin
insert: lateral aspect of upper lip
action: raise and evert upper lip
nerve: buccal & zygomatic branch of facial nerve CN VII
What are the OIANs of frontalis?
origin: superficial fascia of eyebrows
insert: epicranial aponeurosis
action: protracts scalp or elevates eyebrows (surprise or curiosity)
nerve: temporal branch of facial nerve CN VII
What are the OIANs of depressor labii inferioris?
origin: oblique line of mandible
insert: skin of lower lip
action: depress lower lip (pouting, sadness)
nerve: mandibular branch of facial nerve CN VII
What are the OIANs of depressor anguli oris?
origin: mandible
insert: angle of mouth
action: depresses angle of mouth lateral (frown, sadness)
nerve: buccal & mandibular branch of facial nerve CN VII
What are the OIANs of the buccinator?
origin: alveolar processes of maxilla and mandible, pterygoid hamulus, and pterygomandibular raphe
insert: angle of mouth
action: compresses cheek (blowing)
nerve: buccal branch of facial nerve CN VII
Which craniofacial muscles are innervated by the buccal branch of the facial nerve?
- buccinator
- depressor anguli oris
- levator labii superioris
- nasalis
- orbicularis oris
- zygomaticus major
Which craniofacial muscles are innervated by mandibular branch of the facial nerve?
- depressor anguli oris
- depressor labii inferioris
- orbicularis oris
Which craniofacial muscles are innervated by the zygomatic branch of the facial nerve?
- levator labii superioris
- orbicularis oculi
- zygomaticus major
What craniofacial muscles are innervated by the temporal branch of the facial nerve?
- frontalis
- orbicularis oculi
What muscle is innervated by the cervical branch of the facial nerve?
platysma
What muscle is involved in surprise (eyebrow raise)?
- frontalis
What muscle controls winking?
orbicularis oculi
What muscles control nose flare (anger)?
- nasalis
- levator labii superioris
What muscles control puffing the cheeks?
- orbicularis oris
- buccinator
What muscle control smiling?
- zygomatic major
What craniofacial muscles control sadness?
- levator labii superioris
- depressor labii inferioris
- depressor anguli oris
What craniofacial muscle controls lip puckering?
orbicularis oris
What craniofacial muscle controls frowning?
depressor anguli oris
What craniofacial muscle controls pouting?
depressor labii inferioris
What craniofacial muscle controls blowing?
buccinator
What craniofacial muscle controls conveying tension or stress?
platysma
What are the parasinuses of the skull and their location?
- maxillary sinus: maxillary bones
- ethmoid sinus: ethmoid bone
- frontal sinus: frontal bone
- sphenoidal sinus: sphenoid bone
What is another name for the orbit of the skull?
quadrilateral pyramid
What are the walls of the orbit?
- roof (superior)
- medial wall
- floor (inferior)
- lateral wall
What are the bones that form the roof of the orbit?
- frontal
- lesser wing of sphenoid bone
What are the bones that form the medial wall of the orbit?
- lacrimal bone
- ethmoid bone
What are the bones that form the floor of the orbit?
- maxilla
- zygomatic bone
What bones form the lateral wall of the orbit?
- greater wing of sphenoid bone
- zygomatic bone
What are the openings of the orbit?
- optic canal
- superior orbital + inferior orbital fissures
What are the contents of the orbit?
- eyeball (globe)
- vessels
- nerves
- muscles
- orbital fat
- connective tissue
What are the branches of the facial nerve?
- temporal
- zygomatic
- buccal
- mandibular
- cervical
What happens when there is a direct impact n the orbit?
- blow out fracture
- orbital fat has no where to go anteriorly or posteriorly
- goes through floor of orbit due to the bone being thin
- causes problems with the maxillary sinus
What is the terminal branch of the common carotid artery?
superficial temporal artery
What lymph nodes drain into the superior deep cervical lymph node?
- retropharyngeal
- occipital
- mastoid
- parotid
- facial
- submandibular
What lymph nodes drain into the inferior deep cervical lymph node?
- superior deep cervical
- submental
- lateral cervical
- anterior cervical
- infrahyoid
- pre laryngeal
- pre tracheal
- paratracheal
What lymph node drains into the submandibular lymph node?
submental
Where does the inferior deep cervical lymph node drain into and end up?
- drains into thoracic duct through left jugular trunk then goes to the left jugulosubclavian junction
What type of bleeding occurs in the epidural space?
- arterial: middle meningeal artery
What type of bleeding occurs in the subdural space?
venous: slower progression
What type of bleeding occurs in the subarachnoid space?
- arterial: most immediately harmful
Where is the dural sinus?
- between pariosteal and meningeal layer of dura mater
What are the OIANs of longus capitis?
origin: anterior tubercles of transverse processes of cervical vertebra
insert: basilar occipital bone
action: flexion of head and neck ipsilateral rotation
nerve: ventral rami C1-C3
What are the OIANs of longus Colli?
origin: body of cervical vertebrae
insert: body of cervical vertebrae and transverse processes
action: flexion, lateral flexion of neck, ipsilateral rotation
nerve: ventral rami C2-C7
What are the OIANs of the anterior scalene?
origin: anterior tubercles of middle cervical vertebrae
insert: scalene tubercle of 1st rib
action: elevation of 1st rib (forced inspiration) and flexion, lateral flexion, and contralateral rotation of neck
nerve: lower ventral rami of cervical spinal nerve
What are the OIANs of the middle scalene?
origin: transverse processes of cervical vertebrae
insert: 1st rib
action: elevation of rib (forced inspiration) and lateral flexion & contralateral flexion of neck
nerve: lower ventral rami of spinal nerve
What are the OIANs of the posterior scalene?
origin: lower cervical transverse processes
insert: 2nd rib
action: elevation of the rib (forced inspiration) and lateral flexion & contralateral rotation of neck
nerve: ventral rami of lower cervical spinal nerve
What are the OIANs of the sternocleidomastoid?
origin: lateral aspect of mastoid process & superior nuchal line
insert: manubrium and medial 1/3 of clavicle
action: flexion, ipsilateral rotation, and extension of head & neck, and contralateral rotation of head
nerve: accessory nerve and C1,2
What are the extraocular muscles?
- inferior oblique
- inferior rectus
- levator palpebrae superioris
- medial rectus
- superior rectus
- lateral rectus
- superior oblique
What are the OIANs of superior oblique muscle of the eye?
origin: superomedial, posterior aspect of orbit
insert: superolateral posterior aspect of sclera passing around the trochlea
action: depression, abduction, intorsion of eye
nerve: CN IV trochlear nerve
What are the OIANs of lateral rectus muscle of the eye?
origin: common tendinous ring
insert: lateral aspect of sclera
action: abduct eye
nerve: CN VI abducens nerve
What are the OIANs of superior rectus muscle of the eye?
origin: common tendinous ring
insert: superior aspect of sclera
action: elevation, adduction, and intorsion of eye
nerve: superior ramus of CN III oculomotor nerve
What are the OIANs of medial rectus muscle of the eye?
origin: common tendinous ring
insert: medial aspect of sclera
action: adduction of eye
nerve: inferior ramus of CN III oculomotor
What are the OIANs of levator palpebrae superioris muscle of the eye?
origin: inferior aspect of lesser wing of the sphenoid
insert: tarsus and skin of the upper
action: elevation of upper lid
nerve: superior ramus of CN III oculomotor nerve
What are the OIANs of inferior rectus muscle of the eye?
origin: common tendinous ring
insert: inferior aspect of the sclera
action: depression, adduction, and extrusion of eye
nerve: inferior ramus of CN III oculomotor nerve
What are the OIANs of inferior oblique muscle of the eye?
origin: maxilla lateral to nasolacrimal groove
insert: inferolateral, posterior aspect of sclera
action: elevation, abduction, and extorision of the eye
nerve: inferior ramus of CN III oculomotor nerve
